Relationship between Stress Perceived and Gastrointestinal Symptoms in Intensive Care Nurses During COVID-19 Pandemic: A Cross-Sectional Study

The purpose of this study is to determine the relationship between perceived stress and gastrointestinal (GI) symptoms during the COVID-19 outbreak in the intensive care unit (ICU) nurses. This cross-sectional study was conducted with 170 nurses working in the ICUs of a hospital in eastern Turkey. Descriptive, chi-square and multiple linear regression analyses were used to analyze data. In the last three months, 48.2% of the nurses had complaints such as heartburn, 44.1% abdominal distension, 41.7% diarrhea/ constipation. The mean perceived stress level experienced by the nurses was found to be 29.30±5.73. Results from regression analysis included perceived stress score, gender, perceived health status, diet, having been infected with COVID-19 before and risk degree of the ICU in question in terms of COVID-19 revealed a statistically significant associated with scores obtained from GI symptoms. Perceived stress level, health perception status, having been infected with COVID-19 before and the high-risk status of the intensive care unit in question for COVID-19 were predictive factors for the occurrence of gastrointestinal symptoms. These findings may provide a basis for creating a healthy work environment where factors contributing to work-related stress are reduced and coping strategies are developed. Keywords: gastrointestinal symptoms, intensive care, nurses, stress

Mobiluncus curtisii Bacteremia: Case Study and Literature Review

Background: There are few reports of bacteremia caused by Mobiluncus curtisii in the literature. We present a review of the literature in addition to a case study. Method: We describe the case of an 82-year-old patient who underwent gastrointestinal surgery and subsequently presented with dehydration, nausea, and hyperkalemia secondary to diarrhea. Further clinical work included blood cultures, and the patient was started empirically on piperacillin/tazobactam. Results: After five days, the blood culture bottle showed growth of a gram-variable, curved rod-shaped organism. After culture under anaerobic conditions on sheep blood agar, the organism was identified as Mobiluncus curtisii by MALDI-TOF mass spectrometry and enzymatic technology. A review of the literature reveals five additional cases of Mobiluncus curtisii bacteremia. Conclusions: This is the sixth case in the literature describing Mobiluncus species bacteremia. This organism is rarely identified in blood culture and is most often thought of in the context of bacterial vaginosis. However, the reported cases of bacteremia show gastrointestinal symptoms and presumed gastrointestinal source of infection. The pathogenesis of infection of this organism requires further investigation.

What Is Safe and How Much Does It Matter? Food Vendors’ and Consumers’ Views on Food Safety in Urban Nigeria

This study examines the food safety beliefs of vendors and consumers in a mid-sized Nigerian city using data from in-depth interviews and cognitive mapping techniques drawn from ethnography. We examine vendors’ and consumers’ perspectives on which foods are safe, which are not, and why; the place of foodborne illness among other health concerns and motivators of food choice; and how salient food safety is as a concern for vendors. The main perceived causes of unsafe food were found to be chemicals and insects; while bacterial illnesses were widely mentioned as a cause of gastrointestinal symptoms, these were not necessarily linked to food in consumers’ minds. Respondents agreed strongly that certain foods (e.g., cowpea, beef, green leafy vegetables, and local rice) were less safe than others. The importance of food safety as a choice motivator among consumers varies depending on framing: when asked directly, it was prominent and closely related to visible cleanliness, but concerns about food safety competed in consumers’ minds against other salient motivators of food and vendor choice, such as price. Most vendors did not see food safety, cleanliness, or hygiene as a key trait of a successful vendor, and just over half of vendors had any concern about the safety of their food. In conclusion, we note the implications for intervention designs, particularly the need to build upon consumers’ and vendors’ current beliefs and practices related to food safety in order to make foodborne disease prevention a more salient concern in food choice.

Foodborne Outbreak investigation: Al-Ahsa, Saudi Arabia, 2021. A retrospective cohort study (Preprint)

BACKGROUND On 10 September 2021, Al-Ahsa General Health Directorate reported unexpected number of patients had presented with gastrointestinal symptoms. All the patients gave a history of sharing a common meal as they ate from dinner was served at the mother's house the day before. OBJECTIVE We investigated to verify the outbreak, determine its magnitude, identify the source and implement control measures. METHODS A retrospective cohort design was conducted. Cases were defined as any person who ate dinner at the family gathering on the 9th of September 2021 and developed any or a combination of the following symptoms: diarrhea, vomiting, fever, or abdominal pain within 26 hours of food consumption. We collected information on demographics, symptoms, and food history using a semi-structured questionnaire. We reviewed hospital records for symptoms and Vital sings. We reviewed available laboratory results for cases, we conducted active case search to identify more cases. statistical analyses were performed using SPSS 21.0. RESULTS Twenty subjects were defined as cases (74%) and seven as non-cases (26%). among cases, 16 were females (80%), and 4 were males (20%). The ages ranged between 2–70 years. Among cases (59.3%) had vomiting, (59.3%) had a fever, (48.1%) developed diarrhea, (25%) abdominal pain. The incubation period ranged from 10-26 hours (mean 17.8). The relative risks and p- value were calculated for food items to assess the association between consumption of individual food items and subsequent illness. Among 8 food items consumed, red pasta with chicken (Relative Risk RR= 3.14, 95% CI = 3.2-424.6) and pizza (RR= 1.73, 95% CI = 1.74-42.2) were significantly associated with illness. CONCLUSIONS According to the epidemiological investigation, symptoms, incubation period, and laboratory results there might be some differential diagnosis, but we were unable to more definitively identify the source of the outbreak. We recommend more education to the households about food safety

The Effects of One Anastomosis Gastric Bypass Surgery on the Gastrointestinal Tract

One anastomosis gastric bypass (OAGB) is an emerging bariatric procedure, yet data on its effect on the gastrointestinal tract are lacking. This study sought to evaluate the incidence of small-intestinal bacterial overgrowth (SIBO) following OAGB; explore its effect on nutritional, gastrointestinal, and weight outcomes; and assess post-OABG occurrence of pancreatic exocrine insufficiency (PEI) and altered gut microbiota composition. A prospective pilot cohort study of patients who underwent primary-OAGB surgery is here reported. The pre-surgical and 6-months-post-surgery measurements included anthropometrics, glucose breath-tests, biochemical tests, gastrointestinal symptoms, quality-of-life, dietary intake, and fecal sample collection. Thirty-two patients (50% females, 44.5 ± 12.3 years) participated in this study, and 29 attended the 6-month follow-up visit. The mean excess weight loss at 6 months post-OAGB was 67.8 ± 21.2%. The glucose breath-test was negative in all pre-surgery and positive in 37.0% at 6 months (p = 0.004). Positive glucose breath-test was associated with lower reported dietary intake and folate levels and higher vitamin A deficiency rates (p ≤ 0.036). Fecal elastase-1 test (FE1) was negative for all pre-surgery and positive in 26.1% at 6 months (p = 0.500). Both alpha and beta diversity decreased at 6 months post-surgery compared to pre-surgery (p ≤ 0.026). Relatively high incidences of SIBO and PEI were observed at 6 months post-OAGB, which may explain some gastrointestinal symptoms and nutritional deficiencies.

Efficacy and Safety of the Combination of Nano-Liposomal Irinotecan and 5-Fluorouracil/L-Leucovorin in Unresectable Advanced Pancreatic Cancer: A Real-World Study

Aim: This retrospective study investigated the efficacy and safety of nano-liposomal irinotecan (nal-IRI) plus 5-fluorouracil/l-leucovorin (5-FU/l-LV) treatment in the second-line or later setting for advanced pancreatic cancer under real-world conditions.Methods: Between June 2020 and September 2021, a total of 44 patients with unresectable advanced pancreatic cancer treated with nal-IRI + 5-FU/l-LV in our affiliated hospitals were included. The prognosis, predictive factors (including systemic inflammation-based prognostic indicators), and adverse events were investigated.Results: The median age was 68 (interquartile range [IQR] 62-73) years old, and 22 patients (50.0%) were male. Concerning tumor factors, 9 patients (20.5%) had local advanced disease, and 35 patients (79.5%) had metastases. Twenty-five of the 44 patients were receiving second-line treatment, and 19 were receiving third-line or later treatment. The median overall survival (OS) and progression free survival (PFS) were 9.0 (range, 0.7-15.4) months and 4.4 (range, 0.6-15.4) months, respectively. The overall response rate (ORR) was 5.3%. The disease control rate (DCR) was 44.7%. Patients with a neutrophil-to-lymphocyte ratio (NLR) of >2.7 had a significant risk of a poor OS (HR=0.275, P=0.017). Adverse events were manageable, although gastrointestinal symptoms and neutropenia were observed. The most common grade ≥3 adverse event was neutropenia, which was reported in 20% of patients.Conclusions: Nal-IRI + 5-FU/l-LV therapy was considered to be a useful regimen as second-line or later treatment for unresectable advanced pancreatic cancer, even in clinical practice.

Fat-rich versus carbohydrate-rich nutrition in ALS: a randomised controlled study

ObjectiveThere is growing evidence that the course of amyotrophic lateral sclerosis (ALS) may be influenced beneficially by applying high-caloric food supplements (HCSs). However, it is unknown which composition of nutrients offers optimal tolerability and weight gain.MethodsWe conducted a randomised controlled study (Safety and Tolerability of Ultra-high-caloric Food Supplements in Amyotrophic Lateral Sclerosis (ALS); TOLCAL-ALS study) in 64 patients with possible, probable or definite ALS according to El Escorial criteria. Patients were randomised into four groups: a high-caloric fatty supplement (HCFS; 405 kcal/day, 100% fat), an ultra-high-caloric fatty supplement (UHCFS; 810 kcal/day, 100% fat), an ultra-high-caloric, carbohydrate-rich supplement (UHCCS; 900 kcal/day, 49% carbohydrates) and an open control (OC) group without any supplement. The primary endpoint was tolerability. Patients were followed up over 4 weeks.ResultsGastrointestinal side effects were most frequent in the UHCFS group (75.0%), while loss of appetite was most frequent in the UHCCS group (35.3%). During intervention, patients gained +0.9 kg/month of body weight (IQR −0.9 to 1.5; p=0.03) in the HCFS group and +0.9 kg/month (IQR −0.8 to 2.0; p=0.05) in the UHCFS group. A non-significant trend for weight gain (+0.6 kg/month (IQR −0.3 to 1.9; p=0.08)) was observed in the UHCCS group. Patients in OC group continued to lose body weight (−0.5 kg/month, IQR −1.4 to 1.3; p=0.42).InterpretationThe findings suggest that HCSs frequently cause mild to moderate tolerability issues in patients with ALS, most notably gastrointestinal symptoms in high-fat supplements, and loss of appetite in high-carbohydrate supplements. All three HCSs tested are suited to increase body weight.

Association of Allergic Symptoms in the First 2 Years of Life With Sleep Outcomes Among Chinese Toddlers

Background: Previous studies have linked allergic symptoms to sleep in children, but the associations might be different when considering different types of allergic symptoms or sleep outcomes. Moreover, the combined effects of multiple allergic symptoms remain unclear in early life. This study aimed to investigate the associations between multiple allergic symptoms and sleep outcomes in early life.Methods: We included 673 toddlers aged 2 years from a birth cohort in Guangzhou, China. We identified allergic symptoms (skin, eyes and nose, gastrointestinal tract, mouth and lips, and wheeze) within 2 years via standard questionnaires. Sleep outcomes including sleep duration and quality over the past month were assessed based on the Chinese version of the Brief Infant Sleep Questionnaire. Associations between allergic symptoms and sleep outcomes were examined using multivariable linear regression and logistic regression.Results: Compared to children without allergic symptoms, children with allergic nasal and ocular symptoms had higher odds of frequent nighttime awakenings (OR = 1.41; 95% CI: 1.03, 1.93) and irregular sleep (OR = 1.45, 95% CI: 1.05, 2.00); children with allergic gastrointestinal symptoms slept 0.28 h less during nighttime (95% CI: −0.48, −0.07) and 0.25 h less per day (95% CI: −0.43, −0.08), and had 59% higher odds of irregular sleep (95% CI: 1.24, 2.04). We also found significant association of multiple allergic symptoms with shortened nighttime sleep duration and increased irregular sleep. Whereas, allergic skin, mouth and lips, and wheeze symptoms were not significantly associated with sleep outcomes.Conclusion: Allergic symptoms within 2 years of age were adversely associated with sleep outcomes, which highlight the importance of early screening of allergic symptoms in toddlers in order to improve their sleep outcomes.

The effect of group-based education on gastrointestinal symptoms and quality of life in patients with celiac disease: randomized controlled clinical trial

Background In this trial, we investigated the effect of a group-based education program on gastrointestinal (GI) symptoms and quality of life (QOL) in patients with celiac disease (CD). Method In the present study, 130 patients with CD who were on a GFD for at least 3 months, randomly assigned to receive group-based education (n = 66) or routine education in the celiac clinic (n = 64) for 3 months. We assessed gastrointestinal symptoms and quality of life using the gastrointestinal symptom rating scale (GSRS) questionnaire and SF-36 questionnaire at baseline and 3 months after interventions. Results The mean age of the participants was 37.57 ± 9.59 years. There were no significant differences between the two groups regarding the baseline values. Results showed that the mean score of total GSRS score in the intervention group was significantly lower compared with the control group 3 months post-intervention (p = 0.04). Also, there was a significant difference in the mean score of SF-36 between the two groups 3 months post-intervention (p = 0.02). Conclusion Results showed that group-based education was an effective intervention in patients with celiac disease to improve gastrointestinal symptoms and quality of life. Trial registration IRCT code: IRCT20080904001197N21; registration date: 5/23/2019.