scholarly journals Different clinical symptom patterns in patients with reflux micro-micro-aspiration

2021 ◽  
pp. 00508-2021
Author(s):  
Oleksandr Khoma ◽  
Jin-soo Park ◽  
Felix Michael Lee ◽  
Hans Van der Wall ◽  
Gregory L Falk
Keyword(s):  
The Other ◽  
Inclusion Criteria ◽  
Voice Change ◽  
Main Symptom ◽  
Presenting Symptoms ◽  
Throat Clearing ◽  
Specialist Centre ◽  
Inflammatory Bowel ◽  
Symptom Patterns ◽  
Reported Data

BackgroundPulmonary manifestation of gastro-oesophageal reflux disease (GORD) is a well-recognised entity, however little primary reported data exists on presenting symptoms of patients in whom reflux micro-aspiration is confirmed. The aim of this study is to report symptoms and presenting patterns of a large group of patients with confirmed reflux micro-aspiration.Patients and methodsData was extracted from a prospectively populated database of patients referred to a tertiary specialist centre with severe, refractory, or atypical reflux. Patients with reflux micro-aspiration on scintigraphy were included in this study. Separate group included patients with evidence of proximal reflux to the level of pharynx when supine and/or upright.ResultsInclusion criteria were met by 243 patients with confirmed reflux micro-aspiration (33% males; mean age 59). Most common symptoms amongst patients with micro-aspiration were regurgitation (72%), cough (67%), heartburn (66%), throat clearing (65%), and dysphonia (53%). The most common two-symptom combinations were heartburn/regurgitation, cough/throat clearing, regurgitation/throat clearing, cough/regurgitation and dysphonia/throat clearing. The most common three-symptom combinations were cough/heartburn/regurgitation, cough/regurgitation/throat clearing and dysphonia/regurgitation/throat clearing. Cluster analysis demonstrated two main symptom groupings, one suggestive of proximal volume reflux symptoms and the other with motility/inflammatory bowel syndrome (IBS)-like symptoms (bloat, constipation).ConclusionCombination of typical symptoms of GORD such as heartburn or regurgitation and a respiratory or upper aero-digestive complaint such as cough, throat clearing, or voice change should prompt consideration of reflux micro-aspiration.

641 CLINICAL SYMPTOM PATTERNS IN PATIENTS WITH REFLUX ASPIRATION

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Oleksandr Khoma ◽  
Jinsoo Park ◽  
Felix Lee ◽  
Hans Van der Wall ◽  
Gregory L Falk
Keyword(s):  
Large Volume ◽  
Symptom Clusters ◽  
Inclusion Criteria ◽  
Oesophageal Motility ◽  
Main Symptom ◽  
Presenting Symptoms ◽  
Throat Clearing ◽  
Specialist Centre ◽  
Symptom Patterns ◽  
Reported Data

Abstract   Multiple papers have discussed pulmonary manifestation of gastro-oesophageal reflux disease (GORD), however little primary reported data exists on presenting symptoms of patients in whom reflux aspiration is confirmed. The aim of this study is to report symptoms and presenting patterns of a large group of patients with confirmed reflux aspiration. Methods Data was extracted from a prospectively populated database of patients referred to a tertiary specialist centre with severe, refractory, or atypical reflux. Patients with reflux aspiration on scintigraphy were included in this study. Separate group included patients with evidence of proximal reflux to the level of pharynx when supine and/or upright. Results Inclusion criteria were met by 243 patients (33% males; mean age 59). Most common symptoms amongst patients with aspiration were regurgitation (72%), cough (67%), heartburn (66%), throat clearing (65%), and dysphonia (53%). The most common two-symptom combinations were heartburn/regurgitation, cough/throat clearing, regurgitation/throat clearing, cough/regurgitation and dysphonia/throat clearing. The most common three-symptom combinations were cough/heartburn/regurgitation, cough/regurgitation/throat clearing and dysphonia/regurgitation/throat clearing. Clusters analysis demonstrated two main symptom clusters one suggestive of proximal large volume reflux symptoms (regurgitation, heartburn) and the other with IBS type symptoms (bloat, dysphagia, constipation). Conclusion Combination of typical symptoms of GORD and a respiratory or upper aero-digestive complaint should prompt consideration of reflux aspiration. Cluster analysis of symptoms in this group supports previously postulated hypothesis of reflux aspiration pathogenesis by either large volume proximal reflux or by ineffective oesophageal motility.

scholarly journals P411 Faecal calprotectin is more tightly associated with endoscopic disease activity compared with other biomarkers in patients with inflammatory bowel disease under maintenance treatment with adalimumab

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S377-S377
Author(s):  
E Orfanoudaki ◽  
E Theodoraki ◽  
K Foteinogianopoulou ◽  
A Mantaka ◽  
I Koutroubakis
Keyword(s):  
Inflammatory Bowel Disease ◽  
Disease Activity ◽  
Maintenance Treatment ◽  
The Other ◽  
Inclusion Criteria ◽  
Faecal Calprotectin ◽  
Home Testing ◽  
Significant Difference ◽  
Inflammatory Bowel ◽  
Active Disease

Abstract Background Fecal calprotectin (FC) has been suggested as an important biomarker for the management of patients with inflammatory bowel disease (IBD). It is an indirect index of disease activity and plays a crucial role in the treat-to-target strategy. Consecutive measurements of FC in patients in clinical remission can predict a disease relapse and lead to early treatment optimisation. We aimed to compare FC with other biomarkers as for their association with endoscopic activity in IBD patients under maintenance treatment with adalimumab. Methods Consecutive IBD patients under maintenance treatment with adalimumab were studied retrospectively based on prospectively recorded data in an IBD registry. Inclusion criteria were at least one available endoscopic evaluation with accompanied biomarkers measurement within the last ± 3 months in the study period (10/2016–9/2019). Biomarkers assessed were FC (home testing Βühlmann fCAL ELISA), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), haemoglobin (Hb), white blood cells (WBC) and platelets (PLT). The disease was considered as active if endoscopic Mayo score was ≥2 in ulcerative colitis (UC) and SES-CD score >6 for Crohn’s disease (CD). Results From a total of 72 IBD patients under maintenance treatment with adalimumab, 53 met inclusion criteria [49 CD, 32 men, mean age 42.3 ± 14.9 years, mean disease duration 13.4 ± 9.5, median adalimumab use 34 (23–65) months, combination with immunosuppressants 11 (22%)]. In the logistic regression analysis with dependent variable, the endoscopic active disease FC (mean value 470.8 ± 382.3μg/g) and ESR were independently significantly correlated with the endoscopic disease activity (OR:1.002 95% CI 1.001–1006, p = 0.003 and OR:1.05 95% CI 0.01–1010, p = 0.01 respectively). FC identified patients with endoscopic active disease with an area under the receiver operating characteristic curve (AUC) value of 0.78 (95% CI 0.64–0.88) higher than the other biomarkers [CRP, AUC 0.70 95% CI 0.56–0.82; Hb, AUC 0.55 95% CI 0.41–0.69; ESR, AUC 0.57 95% CI 0.43–0.71; PLT, AUC 0.56 95% CI 0.42–0.69 and WBC, AUC 0.43 95% CI 0.35–0.63). In the pairwise comparison of the ROC curves, there was a significant difference of the AUC of FC and the AUC of Hb, ESR, PLT and WBC (all with p < 0.05). There was no significant difference between the AUC of FC and that of CRP (p = 0.35). FC levels >413 μg/g had a sensitivity of 75% and a specificity of 76% in predicting endoscopic active disease. Conclusion These real-life results indicate that in IBD patients under maintenance treatment with adalimumab faecal calprotectin home testing performs better than the other biomarkers in predicting the disease endoscopic activity.

Role of Vajraka Taila in the management of Vrana

2017 ◽  
Vol 2 (4) ◽  
Author(s):  
Ranjit Singh ◽  
Upasana Priya ◽  
Mahesh Chand Purvya
Keyword(s):  
The Other ◽  
Inclusion Criteria ◽  
Extrinsic Factors ◽  
External Application ◽  
Major Aspect

In today’s busy and fast life more people are living with conditions that increase their susceptibility to traumatic wounds, due to one or the other cause; thereby taking a heavy toll of life. As per Ayurveda, these type of wounds, which are caused by extrinsic factors are known as Sadyovrana. The major aspect of the management of the traumatic wounds is prevention of the infection, speedy healing, reducing pain, discharge and less discoloration after healing. In Ayurveda, various formulations for debridement are mentioned such as Kwaatha, Kalka, Churna, Rasakriya, Varti, Taila and Ghrita depending on the Avastha of Vrana. In the present study use of Vajraka Taila for external application, has been chosen. Total 30 patients fulfilling the inclusion criteria were selected and the treatment was given for 15 days. The study showed that Vajraka Taila is very effective in Vrana.

scholarly journals Fecal calprotectin is an early predictor of endoscopic response and histologic remission after the start of vedolizumab in inflammatory bowel disease

2020 ◽  
Vol 13 ◽  
pp. 175628482097976
Author(s):  
Renske W. M. Pauwels ◽  
Christien J. van der Woude ◽  
Nicole S. Erler ◽  
Annemarie C. de Vries
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Predictive Value ◽  
Fecal Calprotectin ◽  
Clinical Decisions ◽  
Inclusion Criteria ◽  
Inflammatory Bowel ◽  
A Prospective Study ◽  
Colonic Biopsies ◽  
Study Inclusion

Background and aims: Early prediction of the effect of vedolizumab (VDZ) in inflammatory bowel disease (IBD) is of paramount importance to guide clinical decisions. This study assessed whether early fecal calprotectin (FC) can predict endoscopic response and histologic remission after VDZ initiation. Methods: This was a prospective study. Inclusion criteria were endoscopic inflammation and FC >100 µg/g. FC was determined at baseline and weeks 2, 4, 8 and 16. At week 16, endoscopies with ileal and colonic biopsies were performed. FC changes were assessed with Wilcoxon Rank Sum tests. ROC statistics were used to assess the diagnostic accuracy of FC. Results: In total, 45 patients [27 Crohn’s disease (CD), 16/2 ulcerative colitis (UC)/IBD-unclassified] [40% males, median age 39 (28–51) years] were included. Week 16 endoscopic response and histologic remission rates were 58% and 33%. A median 37% decline in FC at week 2 was observed only in endoscopic responders, p = 0.025. FC <250 µg/g at week 8 predicted endoscopic response in both UC and CD (positive predictive value 100%), whereas absence of FC decline at week 8 corresponded with absence of endoscopic response in CD [negative predictive value (NPV) 82%] and absence of histologic remission in both UC and CD (NPV 90%). Conclusion: The onset of a decline in FC as early as week 2 is associated with endoscopic response to VDZ induction. FC <250 µg/g at week 8 is associated with endoscopic response, whereas absence of FC decline at week 8 is associated with absence of both endoscopic response and histologic remission. FC levels 8 weeks after the start of VDZ could be used to guide clinical decisions and might substitute for endoscopic response evaluation.

Neurogastroenterology

2015 ◽  
Author(s):  
Ronald F. Pfeiffer
Keyword(s):  
Wilson Disease ◽  
The Other ◽  
Neurologic Disease ◽  
Rare Disorders ◽  
Neurologic Diseases ◽  
Neurologic Dysfunction ◽  
Acquired Hepatocerebral Degeneration ◽  
Whipple Disease ◽  
Hepatocerebral Degeneration ◽  
Inflammatory Bowel

Contrary to what one may assume, neurology and gastroenterology are similar to each other in many ways. A process found in one system can also affect the other, whether it be gastrointestinal (GI) dysfunction present in neurologic diseases or neurologic dysfunction present in GI diseases. Several disorders from both fields of medicines are highlighted in this review, ranging from stroke, Parkinson disease, and multiple sclerosis (MS) as examples of GI dysfunction in neurologic disease, to celiac disease and inflammatory bowel disease as examples of neurologic dysfunction in GI disease. Rare disorders such as Whipple disease (WhD), chronic acquired hepatocerebral degeneration (CAHD), and Wilson disease (WD) should also be considered for their neurologic dysfunctions as manifested extraintestinally. Tables give an overview of clinical features of the various disorders presented in this review.   This module contains ­4 highly rendered figures, 9 tables, 349 references, and 5 MCQs. 

Reconstructive Techniques of Primary Distal Penile Hypospadias: A Meta-Analysis Study of Last 10 Years

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Omar Goda Hassan Mohammad ◽  
Khaled Ahmed Mahmoud Reyad ◽  
Ahmed Ali Hassan ◽  
Osama Fouad Mohamed Abdelgawad
Keyword(s):  
Meta Analysis ◽  
Surgical Techniques ◽  
Case Series ◽  
Hypospadias Repair ◽  
Inclusion Criteria ◽  
Meatal Stenosis ◽  
Postoperative Fistula ◽  
Distal Hypospadias ◽  
Reported Data ◽  
Reconstructive Techniques

Abstract Background Hypospadias is one of the most common congenital anomalies affecting males worldwide, with distal variants representing up to 70% of all cases. Several surgical techniques are adopted for distal hypospadias repair. However, there is still much controversy about the ideal technique. Objectives The aim of this study is to compare between the most popular reconstructive techniques for distal penile hypospadias repair. Highlighting their effectiveness, in term of success rate as well as the risk of postoperative complications. Methods For this systematic review, PubMed/Medline and ScinceDirect online databases were searched using the keywords ‘distal hypospadias, complications and outcome’. Inclusion criteria were primary repairs; distal hypospadias; pediatric case series and standard techniques. Abstracts of articles identified were reviewed, and then relevant articles were retrieved in full. Papers were only included if data on at least one of the main outcome measures was obtainable, which are postoperative fistula, meatal stenosis and glanular dehiscence. Data were pooled using CMA software, effect sizes were reported as event rates with 95% confidence intervals (CI) been calculated for each outcome. Results A total of 25 studies, which included 4572 patients, met the inclusion criteria. The tubularised incised plate (TIP) was the most commonly adopted procedure followed by the peri-meatal flap (Mathieu). Few studies reported data for other techniques like onlay flap, Thiersch-Duplay, meatal advancement and MAGPI procedures, in addition to urethral mobilization technique. The overall incidence of main complications was 10.5% with comparable results among different techniques. The results are in favor of urethral mobilization and TIP procedures over Mathieu regarding the incidence of both meatal stenosis and post-operative fistula. Overall, the quality of the included studies was determined to be satisfactory. Conclusion Compared with Mathieu technique, urethral mobilization and the TIP procedure for distal penile hypospadias (DPH) reconstruction were associated with a lower risk of overall complications specifically postoperative fistula and meatal stenosis.

scholarly journals Dynamics and Protein–Solvent Interactions of Hemoglobin in T and R Quaternary Conformation

2002 ◽  
Vol 16 (3-4) ◽  
pp. 227-233 ◽  
Author(s):  
Chiara Caronna ◽  
Antonio Cupane
Keyword(s):  
Quaternary Structure ◽  
Dynamic Properties ◽  
Low Frequency ◽  
Helical Structure ◽  
Blue Shift ◽  
Peak Frequency ◽  
The Other ◽  
Solvent Interactions ◽  
Reported Data ◽  
Increasing Temperature

In this work we report the thermal behaviour of the amide I′ band of carbonmonoxy and deoxy hemoglobin in 65% v/v glycerolD8/D2O solutions and in the temperature interval 10–295 K. Following recent suggestions in the literature, we analyze the amide I′ band in terms of two components, one at about 1630 cm−1and the other at about 1650 cm−1, that are assigned to solvent‒exposed and buried α‒helical regions, respectively.For deoxy hemoglobin (in T quaternary structure) both components are narrower with respect to carbonmonoxy hemoglobin (in R quaternary structure), while the peak frequency blue shift observed, upon increasing temperature, for the component at about 1630 cm−1is smaller. The reported data provide evidence of the dependence of hemoglobin dynamic properties upon the protein quaternary structure and suggest a more compact α‒helical structure of hemoglobin in T conformation, with reduced population of low‒frequency modes involving the solvent and protein.

scholarly journals The use, quality and effectiveness of pelvic examination in primary care for the detection of gynaecological cancer: a systematic review

2018 ◽  
Vol 36 (4) ◽  
pp. 378-386 ◽  
Author(s):  
Pauline Williams ◽  
Peter Murchie ◽  
Maggie E Cruickshank ◽  
Christine M Bond ◽  
Christopher D Burton
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Data Extraction ◽  
Diagnostic Delay ◽  
Gynaecological Cancer ◽  
Pelvic Examination ◽  
Inclusion Criteria ◽  
Cancer Symptoms ◽  
Presenting Symptoms ◽  
Critical Appraisal Skills

Abstract Background Urgent suspected cancer referral guidelines recommend that women with gynaecological cancer symptoms should have a pelvic examination (PE) prior to referral. We do not know to what extent GPs comply, their competency at PE, or if PE shortens the diagnostic interval. Objectives We conducted a systematic review of the use, quality and effectiveness of PE in primary care for women with suspected gynaecological cancer. Method PRISMA guidelines were followed. Three databases were searched using four terms: PE, primary care, competency and gynaecological cancer. Citation lists of all identified papers were screened independently for eligibility by two reviewers. Data extraction was performed in duplicate and independently. Paper quality was assessed using the relevant Critical Appraisal Skills Programme checklist. Emergent themes and contrasting issues were explored in a narrative ecological synthesis. Main Findings Twenty papers met the inclusion criteria. 52% or less of women with suspicious symptoms had a PE. No papers directly explored GPs’ competence at performing PE. Pre-referral PE was associated with reduced diagnostic delay and earlier stage diagnosis. Ecological synthesis demonstrated a complex interplay between patient and practitioner factors and the environment in which examination is performed. Presenting symptoms are commonly misattributed by patients and practitioners resulting in misdiagnosis and lack of PE. Conclusion We do not know if pre-referral PE leads to better outcomes for patients. PE is often not performed for women with gynaecological cancer symptoms, and evidence that it may result in earlier stage of diagnosis is weak. More research is needed.

scholarly journals A Meta-analysis of Major Complications between Traditional Pacemakers and Leadless Pacemakers

2020 ◽  
Author(s):  
Yun-Qing Chen
Keyword(s):  
Pericardial Effusion ◽  
Risk Ratio ◽  
Clinical Effect ◽  
Meta Analysis ◽  
Cochrane Central Register ◽  
Inclusion Criteria ◽  
Cardiac Perforation ◽  
Major Complications ◽  
Central Register ◽  
Reported Data

Objectives: We aim to compare the major complications between leadless pacemakers and traditional pacemakers.Background: Leadless pacemakers, which are increasingly used in clinical practice, have several advantages compared with traditional pacemakers in avoiding pocket- and lead-related complications. However, the clinical effect of leadless pacemakers remains controversial.Methods: PubMed, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), the CNKI database, and the Wanfang database were searched from July 2013 to December 2019. Studies comparing leadless pacemakers and traditional pacemakers were included. The primary end point was major complications. The secondary end points were cardiac perforation/pericardial effusion, device revision or extraction, loss of device function, and death.Results: Six studies fulfilled the inclusion criteria. Only four of the six studies reported data on major complications.Leadless pacemakers were associated with a lower incidence of major complications (risk ratio 0.33, 95% confidenceinterval 0.25–0.44, P < 0.00001, I² = 49%). We extracted data on cardiac perforation/pericardial effusion, device revisionor extraction, loss of device function, and death from six studies. Our meta-analysis showed that leadless pacemakershave a higher risk of cardiac perforation or pericardial effusion (risk ratio 4.28, 95% confidence interval 1.66–11.08,P = 0.003, I² = 0%). No statistically significant differences were found for mortality, device revision or extraction, andloss of device function.Conclusion: Compared with traditional pacemakers, leadless pacemakers have a significantly decreased risk of majorcomplications, but have a higher risk of cardiac perforation or pericardial effusion.

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