Post-infectious gastrointestinal symptoms after acute Giardiasis. A 1-year follow-up in general practice

Abstract ObjectivesIn 2010-2011, a waterborne outbreak of the parasite, Cryptosporidium hominis, affected approximately 27,000 inhabitants in the city of Östersund, Sweden. Previous research suggested that post-infectious symptoms, such as gastrointestinal symptoms and joint pain, could persist for up to two years after the initial infection. In this study, we investigated whether the parasite caused post-infectious sequelae for up to five years after the outbreak. This prospective cohort study examined whether individuals infected during the outbreak were more likely than uninfected individuals to report post-infectious symptoms five years later. The participants completed a questionnaire on whether they experienced a list of symptoms. We analysed data using logistic regression and calculated odds ratios with 95% confidence intervals.Results The analysis included 626 individuals. Among the 262 individuals infected during the outbreak, 56.5% reported symptoms at follow-up. Compared to uninfected individuals, infected individuals were significantly more likely to report watery diarrhoea, diarrhoea, swollen joints, abdominal pain, bloating, joint discomfort, acid indigestion, alternating bowel habits, joint pain, ocular pain, nausea, and fatigue at the follow-up, after adjusting for age and sex. Our findings suggested that cryptosporidiosis was mainly associated with gastrointestinal- and joint-related post-infectious symptoms for up to 5 years after the infection.

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Composite phaeochromocytomas—a systematic review of published literature

Langenbeck s Archives of Surgery ◽

10.1007/s00423-021-02129-5 ◽

2021 ◽

Author(s):

K. Dhanasekar ◽

V. Visakan ◽

F. Tahir ◽

S. P. Balasubramanian

Keyword(s):

Case Reports ◽

Descriptive Analysis ◽

Management Strategies ◽

Gastrointestinal Symptoms ◽

Rare Condition ◽

Epidemiological Data ◽

Human Case ◽

Rare Tumour ◽

Palpable Mass

Abstract Introduction Composite phaeochromocytoma is a tumour containing a separate tumour of neuronal origin in addition to a chromaffin cell tumour. This study reports on two cases from a single centre’s records and presents a systematic literature review of composite phaeochromocytomas. Methods In addition to describing 2 case reports, a systematic search of the Medline database from inception up to April 2020 was done for human case reports on composite phaeochromocytomas. Relevant titles and/or abstracts were screened, and full texts were reviewed to identify appropriate studies. Data was extracted and a descriptive analysis of presentation, clinical features, management strategies and outcomes was performed. The quality of included studies was assessed using a critical appraisal checklist. Results There were 62 studies included, with a total of 94 patients. Of 91 patients where data was available, the median (range) age of patients was 48 (4–86) years. Of 90 patients where information was provided, 57% were female. In at least 28% of patients, a genetic cause was identified. Common presenting features include abdominal pain, palpable mass, cardiovascular and gastrointestinal symptoms. The most common tumour component with phaeochromocytoma is ganglioneuroma; other components include ganglioneuroblastoma, neuroblastoma and malignant peripheral nerve sheath tumours. In patients with follow-up data (n=48), 85% of patients were alive and well at a median (range) follow-up time of 18 (0.5–168) months. Conclusion Composite phaeochromocytoma is a rare tumour, with a significant genetic predisposition. This review summarises available epidemiological data, which will be useful for clinicians managing this rare condition.

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Effect of faecal calprotectin testing on referrals for children with chronic gastrointestinal symptoms in primary care: study protocol for a cluster randomised controlled trial

BMJ Open ◽

10.1136/bmjopen-2020-045444 ◽

2021 ◽

Vol 11 (7) ◽

pp. e045444

Author(s):

Sophie Ansems ◽

Marjolein Berger ◽

Patrick van Rheenen ◽

Karin Vermeulen ◽

Gina Beugel ◽

...

Keyword(s):

Primary Care ◽

Randomised Controlled Trial ◽

Controlled Trial ◽

Gastrointestinal Symptoms ◽

Cluster Randomised Controlled Trial ◽

Referral Rate ◽

Faecal Calprotectin ◽

Cluster Randomised ◽

Randomised Controlled

IntroductionChildren with chronic gastrointestinal symptoms are frequently seen in primary care, yet general practitioners (GPs) often experience challenges distinguishing functional gastrointestinal disorders (FGID) from organic disorders. We, therefore, aim to evaluate whether a test strategy that includes point-of-care testing (POCT) for faecal calprotectin (FCal) can reduce the referral rate to paediatric specialist care among children with chronic gastrointestinal symptoms. The study findings will contribute to improving the recommendations on FCal use among children in primary care.Methods and analysisIn this pragmatic cluster randomised controlled trial, we will randomise general practices into intervention and control groups. The intervention group will use FCal-POCT when indicated, after completing online training about its indication, interpretation and follow-up as well as communicating an FGID diagnosis. The control group will test and treat according to Dutch GP guidelines, which advise against FCal testing in children. GPs will include children aged 4–18 years presenting to primary care with chronic diarrhoea and/or recurrent abdominal pain. The primary outcome will be the referral rate for children with chronic gastrointestinal symptoms within 6 months after the initial assessment. Secondary outcomes will be evaluated by questionnaires completed at baseline and at 3- and 6-month follow-up. These outcomes will include parental satisfaction and concerns, gastrointestinal symptoms, impact of symptoms on daily function, quality of life, proportion of children with paediatrician-diagnosed FGID referred to secondary care, health service use and healthcare costs. A sample size calculation indicates that we need to recruit 158 GP practices to recruit 406 children.Ethics and disseminationThe Medical Research Ethics Committee (MREC) of the University Medical Center Groningen (The Netherlands) approved this study (MREC number: 201900309). The study results will be made available to patients, GPs, paediatricians and laboratories via peer-reviewed publications and in presentations at (inter)national conferences.Trial registration numberThe Netherlands Trial Register: NL7690 (Pre-results)

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Changes in Age at Diagnosis and Nutritional Course of Celiac Disease in the Last Two Decades

Nutrients ◽

10.3390/nu12010156 ◽

2020 ◽

Vol 12 (1) ◽

pp. 156 ◽

Cited By ~ 2

Author(s):

Mónica Villanueva ◽

Amaya Oyarzún ◽

Bárbara Leyton ◽

Mónica González ◽

Elizabeth Navarro ◽

...

Keyword(s):

Celiac Disease ◽

Nutritional Status ◽

Gastrointestinal Symptoms ◽

Failure To Thrive ◽

Age At Diagnosis ◽

Pediatric Hospitals ◽

Geographical Variations ◽

Number Of Patients ◽

Antiendomysial Antibodies

The frequency of celiac disease (CD) has increased along time, with relevant changes reported in geographical variations, clinical presentation and nutritional repercussions. In recent years, some celiac patients are presenting overweight/obesity, but it is unclear how frequent this is and to what extent undernutrition remains a concern. This is relevant because CD tends to be overlooked in overweight patients. With this in mind, we assessed age at diagnosis, clinical characteristics and nutritional status of 155 celiac patients diagnosed between 1994–2017 in four pediatric hospitals in Santiago, Chile. Since 2003, the number of patients diagnosed has increased (p < 0.0033), coinciding with antitransglutaminase and antiendomysial antibodies becoming available to public health systems. In 2000, 4.5% of patients were asymptomatic at diagnosis, suggesting that active search is not routinely applied. Gastrointestinal symptoms plus failure to thrive were significantly more frequent under 2 years (p = 0.0001). Nutritional status has improved at diagnosis and during follow up, but undernutrition remains more frequent in children <2 and <5 years (p < 0.002 and p < 0.0036, respectively). Overweight at diagnosis was reported in 2002 and obesity in 2010. After initiating treatment, since 2010, patients changing from undernourishment to overweight has sometimes been observed after only 6 months on a gluten-free diet.

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Is Acupuncture for Pain Relief in General Practice Cost-Effective?

Acupuncture in Medicine ◽

10.1136/aim.17.2.97 ◽

1999 ◽

Vol 17 (2) ◽

pp. 97-100 ◽

Cited By ~ 19

Author(s):

Steven Lindall

Keyword(s):

General Practice ◽

Pain Relief ◽

Acupuncture Treatment ◽

Cost Effective ◽

Total Saving ◽

Hospital Outpatient ◽

The Cost ◽

Lost To Follow Up ◽

Practice Cost

Sixty-five selected patients with pain, mainly of musculo-skeletal origin, were offered treatment by a qualified medical acupuncturist in his general practice surgery as an alternative to hospital outpatient referral. The patients assessed their own outcomes on a digital scale: there were 46 successful treatments and 14 failures, with 5 being lost to follow up. The cost of acupuncture treatment was compared to that of the referral that would have been made if acupuncture had not been offered. The acupuncture was found to have cost £10,943 against a minimum likely cost for hospital referrals of £26,783. A minimum total saving for all 60 patients of £13,916 was determined, giving an average saving per patient of £232. Additional hidden savings through avoiding further hospital procedures and expenditure on medication were not taken into account. It is concluded that acupuncture in selected patients and when used by an appropriately qualified practitioner appears to be a cost-effective therapy for use in general practice, reducing the need for more expensive hospital referrals.

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A 5-year follow-up of general practice patients experiencing depression

Family Practice ◽

10.1093/fampra/cmg611 ◽

2003 ◽

Vol 20 (6) ◽

pp. 685-689 ◽

Cited By ~ 21

Author(s):

I. Wilson

Keyword(s):

General Practice

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An acute eye condition masquerading as a flu-like syndrome: A potential pitfall in general practice

Journal of Clinical Images and Medical Case Reports ◽

10.52768/2766-7820/1084 ◽

2021 ◽

Vol 2 (2) ◽

Author(s):

Evita Evangelia Christou ◽

◽

Xenophon Bazoukis ◽

Alexandra Papoudou-Bai ◽

Maria Stefaniotou ◽

...

Keyword(s):

General Practice ◽

Differential Diagnosis ◽

General Practitioner ◽

Gastrointestinal Symptoms ◽

Angle Closure Glaucoma ◽

Angle Closure ◽

Potential Pitfall ◽

Primary Angle Closure ◽

Primary Angle Closure Glaucoma ◽

Systemic Condition

Acute primary angle closure glaucoma may masquerade a systemic condition. Proper differential diagnosis is requisite. A 52-year-old female visited the general practitioner due to her progressively worsening headache accompanied by gastrointestinal symptoms. This condition presented acutely while reading a book at semiprone position in a not well illuminated room.

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MO302ACUTE POST-INFECTIOUS GLOMERULONEPHRITIS IN ADULTS: A TUNISIAN SINGLE CENTER EXPERIENCE

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab104.0060 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Imen El Meknassi ◽

Mrabet Sanda ◽

Guedri Yosra ◽

Zellema Dorsaf ◽

Azzabi Awatef ◽

...

Keyword(s):

Acute Kidney Injury ◽

Kidney Injury ◽

Acute Glomerulonephritis ◽

Industrialized Countries ◽

Single Center Experience ◽

Nephritic Syndrome ◽

Stage Renal Disease ◽

End Stage ◽

Post Infectious

Abstract Background and Aims Acute post-infectious glomerulonephritis (APIGN) is a reactive immunological disease. Its prevalence in industrialized countries is declining contrasting with developed ones. It is uncommon in adults but the prognosis may be reserved. The aim of our study was to evaluate the epidemiological, clinical and histological features of APIGN as well as its prognosis. Method A retrospective and descriptive study was conducted in our department. Were included all cases of histologically proven APIGN between December 2006 and December 2017. Results We had collected 38 cases. The mean age was 37.7 ± 17.8 years. The sex ratio was 1.92. Twelve (31.6%) patients were diabetic and four of them had already a chronic kidney disease (CKD). APIGN was preceded by an infection in 27 cases with an average interval of 10 ± 5 days. The most common site of infection was the respiratory tract (15 cases). At presentation, 27 patients had nephritic syndrome and 13 had nephrotic-range proteinuria. Hematuria was observed in 97.4%, peripheral edema in 84.2% and hypertension in 73.7% of cases. Most patients (78.9%) had acute kidney injury and 10 (26.3%) patients required dialysis. Renal biopsy had shown benign acute glomerulonephritis in 31 cases and malignant form in 7 cases. An underlying nephropathy was found in 12 cases with mostly a diabetic nephropathy. Corticosteroids were used in 3 cases of benign APIGN and 5 cases of malignant form. During the follow-up, CKD was noted in 14(36.8%) patients including 7(18.4%) patients who progressed to end-stage renal disease. Poor prognostic factors were diabetes, the presence of an underlying nephropathy in the biopsy, acute kidney injury and the need for dialysis. Conclusion The APIGN is uncommon in adults, yet its prognosis may be reserved with progression to CKD.

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