Pantoprazole-induced Thrombocytopenia: Unresponsive to Corticosteroid and Thrombocyte Concentrate Transfusion

Introduction Pantoprazole is a proton pump inhibitor (PPI) class drug that is widely used in the treatment of SRMD (stress-related mucosal disease in critical ill patients. PPI are one class of drugs used commonly both for treatment and prophylactic therapy for stress ulcers in intensive care unit (ICU). Case We report a case of a 51-year old male who was referred to PKU Hospital. He was admitted to ICU with diagnosis of Hyperosmolar Hyperglymic State and bronchopneumonia. Thrombocytopenia was noted in admission. There was more than 70% decrease in platelet count after initiation of pantoprazole. Patient received Thrombocyte Concentrate (TC) transfusion and corticosteroid iv for several days, but only had minor increase in platelet count. The platelets recovered after stopping pantoprazole. Discussion In the present case report, another exposures to parenteral pantoprazole in a dose of 40 mg once daily reproduced the same adverse drug reaction. In comparison to lansoprazole, thrombocytopenia from pantoprazole is more severe that necessitate TC transfusion and corticosteroid trial. However, in the present case, TC transfusion and corticosteroid fail to escalate platelet count. This finding suggests probability of non-immune mechanism of pantoprazole-induced thrombocytopenia. Conclusion Pantoprazole may induce thrombocytopenia with new features that were immediately developed, resulting a decrease in platelet count >70%. The mechanism found in this case may be non-immune. Drug-induced thrombocytopenia is one of the rare complications that has to be kept in mind with the use of pantoprazole.

A Fungal Transcription Regulator of Vacuolar Function Modulates Candida albicans Interactions with Host Epithelial Cells

Candida albicans is a fungus that resides on various human mucosal surfaces. Individuals with debilitated immune systems are prone to develop C. albicans infections, which can range in severity from mucosal disease (e.g., oral thrush in AIDS patients) to life-threatening conditions (e.g., deep-seated, disseminated infections in patients undergoing organ transplants).

Pathophysiological role of ion channels and transporters in gastrointestinal mucosal diseases

The incidence of gastrointestinal (GI) mucosal diseases, including various types of gastritis, ulcers, inflammatory bowel disease and GI cancer, is increasing. Therefore, it is necessary to identify new therapeutic targets. Ion channels/transporters are located on cell membranes, and tight junctions (TJs) affect acid–base balance, the mucus layer, permeability, the microbiota and mucosal blood flow, which are essential for maintaining GI mucosal integrity. As ion channel/transporter dysfunction results in various GI mucosal diseases, this review focuses on understanding the contribution of ion channels/transporters to protecting the GI mucosal barrier and the relationship between GI mucosal disease and ion channels/transporters, including Cl−/HCO3− exchangers, Cl− channels, aquaporins, Na+/H+ exchangers, and K+ channels. Here, we provide novel prospects for the treatment of GI mucosal diseases.

Role of Osteitis in Chronic Rhinosinusitis: A Predictive Marker of Disease Severity?

Introduction Chronic rhinosinusitis (CRS) not only affects the overlying mucosa but also involve the underlying sinus bone termed as osteitis. The role of osteitic bone in severity and persistence of disease has received little attention. Thus understanding of this can help in formulating better treatment plan for CRS. We conceived this study with an aim to assess correlation of osteitis with severity of disease and short term disease outcome by examining the various parameters concerned with CRS. Material and Methods This prospective cohort study included 40 participants as clinically diagnosed CRS cases and 20 participants as controls. Various pre and post-operative parameters concerning CRS were assessed like pre and post-operative Sino-Nasal Outcome Test (SNOT) 20 symptom score, Lund-Kennedy endoscopy and Lund Mackay CT scores, bone density / Hounsfield unit (HU), radiological bone thickness and histopathological mucosal and bone grading. Correlation between osteitis and all these parameters were analyzed. Results Osteitis / bone grade was found to have statistically significant, moderate and positive correlation with the preoperative Lund and Mackay CT score and mucosal grade. The osteitis / bone grade was found to be weakly and positively correlated to the Lund and Kennedy score and weakly but negatively correlated to change in SNOT- 20 values (both statistically insignificant). Conclusion There are high chances of harbouring severe osteitis underneath high grade mucosal disease in CRS. Preoperative Lund and Mackay CT score can serve as a surrogate marker for osteitis. Symptomatic severity of disease does not correlate with osteitis. Osteitis affects disease outcome negatively.

P052 Comprehensive proteomic profiling of stool from UC and CD patients reveals expected and novel mucosal pathobiology, enabling identification of candidate non-invasive biomarkers to monitor mucosal disease activity

Background Inflammatory bowel disease (IBD) is a multifactorial disorder characterized by chronic gastrointestinal (GI) inflammation. In clinical practice, physicians urgently need biomarkers to monitor changes in mucosal disease to manage treatment. Non-invasive tools such as fecal biomarkers could allow for frequent monitoring of mucosal disease activity and may reflect inflammation of the entire GI tract. Towards identification of novel non-invasive fecal biomarkers, we performed a comprehensive, unbiased, analysis of the human fecal proteome from ulcerative colitis (UC), Crohn’s disease (CD) patients, and healthy controls (HC), focusing on human secreted proteins using proteomic approaches. Methods Fecal extraction processes optimized for recovery of secreted proteins were applied to stool samples of mild to severe UC and CD patients and HCs, 20 samples per group. An unbiased survey of the human fecal proteome of the IBD and HC stool extracts was performed using both data-dependent acquisition and data-independent acquisition methods on QExactive HF and Fusion Lumos mass spectrometers. Data were analyzed in Spectronaut for peptide identification, followed by analysis in MS Stats for protein quantification. Fecal calprotectin (fCAL) levels were measured in these stool samples using the Buhlmann EK-CAL immunoassay kit to correlate fCAL levels to proteomic calprotectin (S100A8/S100A9 heterodimer). Results We identified and quantified 594 differentially expressed proteins in stool using proteomics, including known proteins perturbed in IBD pathobiology. Elevated levels of neutrophilic proteins, e.g. fCal, neutrophil elastase, lactoferrin and leucine-rich Α-2 glycoprotein 1 were detected as well as proteins linked to rectal bleeding and ulceration e.g. hemoglobin subunit alpha 1 and beta. Pancreatic enzymes, suggested to be associated with active disease, were also detected. Overall, UC and CD contained many proteins not detected in HC. Differential abundances were observed between UC and CD patients, possibly reflecting differences in mucosal pathophysiology. The abundance of proteomic calprotectin correlated highly with the fCAL levels as determined by immunoassay (Spearman rank order > 0.9 for S100A8 and S100A9 to fCAL), validating the fecal proteomic approach to uncover known and novel proteins of IBD biology. Conclusion We developed and qualified methods to perform fecal proteomics on IBD stool samples, enabling identification of known and novel proteins of mucosal UC and CD disease biology. In depth analysis of these proteomic datasets may reveal novel fecal biomarker candidates, targeted to reflect mucosal disease activity and potentially serve as non-invasive surrogates for endoscopy and help guide treatment in IBD patients.

Audiological profile of pre-operative and post-operative results in mucosal diseases of the ear: a comparative study

<p class="abstract"><strong>Background:</strong> The Objectives of the study were to study pre-operative audiological results in mucosal diseases of ear; to study post-operative audiological results in mucosal diseases of ear and to compare pre-operative and post-operative audiological results in mucosal diseases of ear.</p><p class="abstract"><strong>Methods:</strong> A prospective study was done on 60 patients presenting to out-patient department of Otorhinolaryngology and Head and Neck Surgery, S.Nijalingappa Medical College and H.S.K Hospital and Research Centre, Bagalkot from May 2018 to April 2020 with CSOM-mucosal disease. Audiological evaluation was done and compared using pure tone audiometry (Amplaid311TypeIEC645) before and after tympanoplasty with cortical mastoidectomy and mean air conduction (AC) threshold improvement and mean air-bone gap (AB gap) closure was analyzed. </p><p><strong>Results:</strong> Out of 60 patients, 27(45%) patients had medium sized central perforation. Mean pre-operative AC threshold was 44.5958±10.64639 dB HL which improved to 30.100±10.41056 dB HL at 1month and 21.8125±8.6928 dB HL at 3months post-operatively which was statistically significant with p&lt;0.001*. Mean AB gap closure at 1-month was 10.175±6.01098 dB HL and at 3-months was 11.0416±6.3458 dB HL.</p><p><strong>Conclusions:</strong> AC threshold gain and AB gap closure at 1month and 3 months post-tympanoplasty with cortical mastoidectomy for CSOM-mucosal disease are significant. Hence surgery is main basic tool which results in improvement of audiological results in mucosal diseases of ear.</p>