The low-FODMAP diet as an effective tool for managing irritable bowel syndrome – an assessment of adult patients’ knowledge of dietary guidelines

Background. Irritable bowel syndrome (IBS) is the most common gastrointestinal disorder that is driven by the gutbrain axis and affects 1-20% of the population. Most patients note that various foods elicit abdominal symptoms, and they eliminate these products from their diets. A diet that is low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) is currently one of the mainstays in IBS treatment. Objective. The aim of this study was to assess the knowledge of IBS patients about the disease, treatment and the principles of the low-FODMAP diet that can alleviate gastrointestinal symptoms. Material and methods. The participants were adults diagnosed with IBS, the inclusion criteria were: absence of comorbidities requiring an elimination diet, age over 18 years, and consent to participate in the study. The respondents filled out an anonymous questionnaire containing questions about the IBS diagnosis, disease history and treatment, as well as 45 questions assessing the participants’ knowledge about the low-FODMAP diet. Results. In 28% of the cases, IBS was diagnosed by a general practitioner; in nearly 40% of the cases – by a gastroenterology specialist; in 10% of the cases – by a dietitian, whereas the remaining respondents had arrived at the diagnosis independently or with the help of support groups for IBS patients. After diagnosis, only every fourth respondent sought treatment in a gastroenterology clinic. In the studied population, 237 of the respondents had followed to the low-FODMAP diet, and the differentiating factors were sex (p=0.002), place of residence (city with a population higher than 100,000 vs. rural area; p=0.0001) and education (university vs. vocational school p=0.0043). Respondents who had been recently diagnosed with IBS (less than 12 months vs. more than 12 months before the study) were more likely to follow the FODMAP diet. Conclusions. The surveyed population was characterized by high levels of knowledge about the low-FODMAP diet, but many respondents did not strictly comply with dietary guidelines, in particular the duration of each dietary phase. Age was significantly correlated with the respondents’ knowledge, and the participants’ familiarity with low-FODMAP guidelines decreased with age. Nutritional consultations did not significantly improve the respondents’ knowledge about the low-FODMAP diet.

Site-Specific Cerebrospinal Fluid Tau Hyperphosphorylation in Response to Alzheimer’s Disease Brain Pathology: Not All Tau Phospho-Sites are Hyperphosphorylated

Background: Understanding patterns of association between CSF phosphorylated tau (p-tau) species and clinical disease severity will aid Alzheimer’s disease (AD) diagnosis and treatment. Objective: To evaluate changes in tau phosphorylation ratios to brain imaging (amyloid PET, [18F]GTP1 PET, and MRI) and cognition across clinical stages of AD in two different cohorts. Methods: A mass spectrometry (MS)-based method was used to evaluate the relationship between p-tau/tau phosphorylation ratios on 11 sites in CSF and AD pathology measured by tau PET ([18F]GTP1) and amyloid PET ([18F]florbetapir or [18F]florbetaben). Cohort A included cognitively normal-amyloid negative (n = 6) and positive (n = 5) individuals, and amyloid positive prodromal (n = 13), mild (n = 12), and moderate AD patients (n = 10); and Cohort B included amyloid positive prodromal (n = 24) and mild (n = 40) AD patients. Results: In this cross-sectional analysis, we identified clusters of phosphosites with different profiles of phosphorylation ratios across stages of disease. Eight of 11 investigated sites were hyperphosphorylated and associated with the SUVR measures from [18F]GTP1 and amyloid PET. Novel sites 111, 153, and 208 may be relevant biomarkers for AD diagnosis to complement tau hyperphosphorylation measures on previously established sites 181, 205, 217, and 231. Hypophosphorylation was detected on residues 175, 199, and 202, and was inversely associated with [18F]GTP1 and amyloid PET. Conclusion: Hyperphosphorylated and hypophosphorylated forms of tau are associated with AD pathologies, and due to their different site-specific profiles, they may be used in combination to assist with staging of disease.

Treatment for Viral Hepatitis as Secondary Prevention for Hepatocellular Carcinoma

Chronic infections with either hepatitis B or C virus (HBV or HCV) are among the most common risk factors for developing hepatocellular carcinoma (HCC). The hepatocarcinogenic potential of these viruses is mediated through a wide range of mechanisms, including the induction of chronic inflammation and oxidative stress and the deregulation of cellular pathways by viral proteins. Over the last decade, effective anti-viral agents have made sustained viral suppression or cure a feasible treatment objective for most chronic HBV/HCV patients. Given the tumorigenic potential of HBV/HCV, it is no surprise that obtaining sustained viral suppression or eradication proves to be effective in preventing HCC. This review summarizes the mechanisms by which HCV and HBV exert their hepatocarcinogenic activity and describes in detail the efficacy of anti-HBV and anti-HCV therapies in terms of HCC prevention. Although these treatments significantly reduce the risk for HCC in patients with chronic viral hepatitis, this risk is not eliminated. Therefore, we evaluate potential strategies to improve these outcomes further and address some of the remaining controversies.

Efficacy of Itraconazole vs Itraconazole Plus Isotretinoin in Treatment of Chronic Tinea

Background: About 20 to 25% of the global population is affected by the fungal skin infections. Different antifungal drugs used in traditional doses have developed widespread resistance, necessitating the development of an efficient antifungal treatment. Objective: To assess efficacy of itraconazole vs itraconazole plus isotretinoin in treatment of chronic tinea. Methodology: This was comparative study conducted at the Department of Dermatology Qazi Hussain Ahmad Complex Nowshera and alshifa clinic and skin aesthetic, Nowshera for duration of one year from November 2020 to November 2021. In both group A and B, 40 individuals were taken randomly. Treatment of group A patients was done with oral itraconazole and isotretinoin while patients of group B treatment was done with oral itraconazole alone. All patients were monitored for four weeks to assess their responsiveness to therapy and side effects. Results: Complete cure response was recorded in all the patients of group A, while in group B, complete cure response was recorded in 20 (50%) patients. A statistically significant treatment response was observed between both the groups (p<0.05). There were 22 (55%) individuals in group A and 7 (17.5%) patients in group B who had cheilitis and dryness of the lips as major adverse effects. Conclusion: Our study concludes that combination therapy with oral itraconazole and isotretinoin is efficient and safe for the treatment of chronic tinea. Our study recommends conducting study based on large sample size for better results.

Comparison of Open Sub-Inguinal and Microscopic Sub-Inguinal Varicocelectomy for Improvement of Sperm Parameters

Background: Varicoceles along with oligospermia as well as with asthenozoospermia lead to the male infertility. It can weaken the spermatogenesis via many different pathophysiological mechanisms. Many surgical and non-surgical methods are available for its treatment. Objective: To compare microscopic versus open sub-inguinal varicocelectomy in males with varicocele with oligospermia and asthenozoospermia. Study Design: Randomized controlled trail Place and Duration of Study: Department of Urology, Lahore General Hospital, Lahore from 1st May to 30th November 2017. Methodology: One hundred and fifty males with varicocele were recruited and divided in two equal groups. Group A patients underwent microsurgical sub-inguinal varicocelectomy and Group B patients underwent conventional/open sub-inguinal varicocelectomy. Semen analysis was done before surgery and after four months of surgery and 50% improvement in semen parameters were noted. Results: The mean age was 31.69±5.49 years. In group A and group-B ≥50% improvement was observed in 36 (48%) and 21 (28%) respectively. The improvement was significantly higher in group A than group B (p>0.012). Conclusion: The improvement in sperm count and motility was significantly higher in patients treated with microsurgical sub-inguinal varicocelectomy when treated with conventional/open sub-inguinal varicocelectomy. Keywords: Male infertility, Varicocele, Varicocelectomy, Seminal parameters, Microsurgical sub-inguinal, Conventional/open sub-inguinal

Drug Candidates for Covid-19 Treatment in Brazil

Background: COVID-19 has emerged worldwide in less than 6 months, leaving millions of deaths behind. While scientist search for new drugs, an old arsenal has been proposed as a form of treatment. Objective: This article was designed as a literature review, scrutinizing antiparasitic chloroquine, ivermectin, nitazoxanide; and also glucocorticoids, as candidates to be applied in patients with COVID-19 in some Brazilian hospitals. Methodology: clinical evidence of COVID-infected patients and literature consultation have been accomplished for the construction of this article. On line searches and gray literature have also been consulted, whose database include PUBMED Central, BVS/BIREME, Web of Science, Science Direct, Higher Level Personnel Improvement Coordinator (CAPES), Periodic Door (Portal de Periódicos da CAPES, The Cochrane Library and PROSPERO). Results: chloroquine, ivermectin and nitazoxanide do present antiviral characteristics to support their usage in phase 1 of COVID-19 symptoms. Glucocorticoids, especially methylprednisolone and dexamethasone, seem to be efficient in patients with pulmonary symptoms, such as those present in phase 2B and 3 of the disease. Conclusion: After analyzing the literature, antiparasitic agents constitute a promising approach for patients with COVID-19. However, their usage seems to be efficient in the very beginning of the symptoms. Methylprednisolone and dexamethasone are best indicated for hospitalized patients with pulmonary commitment.

Regenerative Endodontic Treatment of Maxillary Incisors with a History of Severe Traumatic Injury

The treatment objective for children with avulsed anterior teeth should concentrate on preserving the alveolar bone volume and contour. Posttraumatic external inflammatory root resorption (EIRR) is also a high-risk complication often observed in children. Regenerative endodontic procedure (REP) has been considered a successful treatment to arrest EIRR, especially in posttraumatic cases. This case report presents clinical outcomes of REP in two teeth of an 8-year-old systemically healthy patient with a history of severe dentoalveolar traumatic injury, one with a history of avulsion, and the other with an EIRR. The treatment consisted of REP on both teeth #8 and #9. The results showed some evidence of maturation in the apical third of tooth #9 and resolution of signs and symptoms on tooth #8.

Mechanical thrombectomy in ischemic stroke: Parameters affecting the TICI outcome

BACKGROUND: Mechanical thrombectomy (MT) is a standard stroke treatment for patients with large vessel occlusions (LVOs). A decisive factor for a successful outcome is, among other things, timely treatment. OBJECTIVE: The objective was to analyze several time points in relation to outcomes and/or surrogate parameters. Furthermore, our data was placed in the context of other clinical trial data. METHODS: We retrospectively evaluated 133 data sets from patients who underwent MT. The correlation of various time periods with parameters, such as the ASPECTS, NIHSS, mRS, and, particularly, the TICI score, was investigated. RESULTS: A correlation was found for both the NIHSS score at discharge and the TICI score with the time periods of arrival and/or start to groin puncture as well as with arrival to the end of the intervention and the duration of the intervention. CONCLUSIONS: This retrospective study is consistent with large randomized clinical trials investigating stroke management and provides data from daily clinical practice.

Indian Board of Orthodontics Case Report: Management of Class II Skeletal Malocclusion Using 2-Phase Treatment

KL, a 12-year-old boy, presented with a class II Div I malocclusion on a class II skeletal base (retrognathic mandible) with a 7-mm overjet and a horizontal growth pattern. He had a convex profile, incompetent lips, lip trap, deep mentolabial sulcus, everted lower lip, and positive visual treatment objective (VTO). KL had a CS2 cervical maturation stage, which indicates 65% to 85% adolescent growth remaining. Treatment involved growth modification using a removable Twin Block with midpalatal expansion screw. This was followed by upper and lower fixed appliance using 0.022” × 0.028” slot Mclaughlin Bennet and Trevisi (MBT) prescription. The retention protocol involved upper wrap around and lower lingual bonded retainer.

Association between prenatal care and peripartum and postpartum maternal obstetric complications. endes 2017 to 2019

Introduction: Obstetric complications are an important cause of maternal morbidity and mortality, with prenatal control (PNC) being a strategy for their adequate prevention and treatment. Objective: To determine the association between adequate CPN and peripartum and postpartum maternal obstetric complications. Methodology: Quantitative, observational, retrospective, cross-sectional and analytical study, based on information from the ENDES 2017-2019. Results: A sample of 41,803 mothers was analyzed, 21,0% and 28,7% had peripartum and postpartum complications respectively, furthermore, it was found that not having a quality NPC (PR = 1.20; 95% CI = 1.14-1.27), residing in metropolitan Lima (PR = 1,38; 95% CI = 1,27-1,49) or in the mountains (PR = 1,25; 95% CI = 1,18-1,33), belong to wealth quintile two (PR = 1,13; 95% CI = 1,04-1,22) or three (PR = 1,11; 95% CI = 1,03-1,20), having been attended only by qualified personnel (PR = 1,81; 95% CI = 1,33-2,48) and only in the public sector (PR = 1,48; 95% CI = 1,31-1,68) were associated with a greater possibility of peripartum complications. Not having a quality NPC (PR = 1,28; 95% CI = 1,22-1,33), residing in metropolitan Lima (PR = 1,12; 95% CI = 1,05-1,20) or in the mountains (PR = 1,06; 95% CI = 1,01-1,12), belong to wealth quintile two (PR = 1,13; 95% CI = 1,05-1,20) or three (PR = 1,12; 95% CI = 1,05-1,19) and having received NPC only in the public sector (PR = 1,28; 95% CI = 1,17-1,41) were associated with a greater possibility of postpartum complications. Conclusions: Within the adequate NPC, an association was found between the quality NPC and the peripartum and postpartum maternal obstetric complications.