Antibiotic-associated colitis in patients with COVID-19 – from imaging to diagnosis

The purpose of the study. To identify the main CT signs of colon inflammatory in patients with COVID-19, to correlate the detected signs with clinical manifestations and therapy, as well as to assess the validity of prescribing antibacterial therapy in accordance with Temporary guidelines for the treatment of coronavirus infection.Materials and methods. The data of CT scans of the chest and medical records were analyzed in 30 patients with confirmed coronavirus infection, in whom changes in the colon wall appeared in dynamics at the scanning level during CT. Laboratory data indicators, prescribed therapy, the presence of combined diseases were evaluated.Results. According to CT data, in dynamics in all patients – circular thickening of the colon wall with loss of gaustration, thickening of the submucosal layer in 63,3%, in 93,3% – edema of paracolic fiber. Shifts in the laboratory parameters were noted at admission: leukocytosis in 16.6%, an increase in procalcitonin in 13,3%; leukocyturia, bacteriuria – in 20%. None of the patients had indications of abdominal symptoms at admission, in dynamics at least one abdominal/dyspeptic symptom appeared in 76,6%. Fecal analysis for C.difficile toxins was taken in 50% patients, in 60% the result is positive. All patients were prescribed antibiotics and other therapy in the first 1–3 days of hospitalization. In 53,3%, levofloxacin (per os) was prescribed in combination with protected generation III cephalosporin (intravenously).Conclusions. Shifts in colon with C.difficile colitis in patients with COVID-19 according to CT data are highly likely to reflect the appearance of a pathological process and necessarily require a conclusion. There was a fact of irrational prescription of antibacterial therapy. Clear criteria for prescribing antibiotics against the background of immunosuppressive therapy are needed.

Frequency of Helicobacter Pylori Infection in the Local Population Presenting with Dyspeptic Symptom

Objectives: To determine the frequency of Helicobacter pylori infection in the local population presenting with dyspeptic symptom report to a tertiary care hospital of Nawabshah. Methodology: This cross-sectional study took place at department of medicine, Peoples Medical College and Hospital Nawabshah; during six months, form August 2015 to February 2016. A total of 115 patients with dyspeptic symptoms with upper abdominal disorders such as discomfort and pain, nausea, fullness, bloating, heartburn, anorexia, belching and regurgitation were included. After conducting detailed clinical examination and history, patients were subjected to relevant examinations, i.e. Blood antibody test (IgA antibody test), for H. pylori and venous blood was drawn. All the information was collected in the proforma. Results: The patients’ average age was 30.92±6.10 years. There were 66(57.4%) male cases and 49(42.6%) female cases. Helicobacter pylori (H. pylori) infection was observed to be frequent (60% cases) among both genders. Conclusion: In conclusion, the present results confirm that the frequency of patients suffering from helicobacter pylori infection was quite high in local population at tertiary care hospital, Nawabshah. Strategies could be developed at an earlier stage and prompt treatment may reduce the morbidity. Key Words: Dyspepsia, Helicobacter pylori, IgA antibody test

Evaluation of the Effectiveness of Cinnamon Oil Soft Capsule in Patients with Functional Dyspepsia: A Randomized Double-Blind Placebo-Controlled Clinical Trial

Background. Different effects of cinnamon and its oil in traditional medicine in the treatment of diseases, including gastrointestinal diseases, were reported. The aim of this study is to evaluate the efficacy and safety of cinnamon oil (Cinnamomum zeylanicum) in patients with functional dyspepsia in a double-blind, randomized placebo-controlled trial. Methods. Soft gelatin capsule was made using the rotary die process, and the final capsule was standardized based on its cinnamaldehyde amount and analyzed by high-performance liquid chromatography (HPLC) method. Sixty-four patients with symptomatic functional dyspepsia were randomized to receive cinnamon oil soft capsule (n = 29) or sesame oil soft capsule as placebo (n = 35) for 6 weeks. The primary efficacy variable was the sum score of the patient’s gastrointestinal symptom (five‐point scale). Secondary variables were the scores of each dyspeptic symptom including severity of vomiting, sickness, nausea, bloating, abdominal cramps, early satiety, acidic eructation/heartburn, loss of appetite, retrosternal discomfort, and epigastric pain/upper abdominal pain, as well as any reported adverse events. Results. The results showed that, after 6 weeks of treatment, the cinnamon oil and placebo groups significantly decreased the total dyspepsia score compared to the baseline at the endpoint ( P < 0.001 ). However, there was no significant difference between the cinnamon oil and placebo groups in terms of the baseline and endpoint values of the outcome variables ( P = 0.317 and P = 0.174 , respectively). Two patients in the cinnamon oil group complained of rashes, and three patients in the placebo group complained of nausea. Conclusion. This study showed significant improvements in gastrointestinal symptom score in both treatment and placebo groups. However, there was no significant difference between the cinnamon oil and sesame oil groups in terms of the baseline and endpoint values of the outcome variables. This study was registered as https://clinicaltrials.gov/ct2/show/IRCT20170802035460N2, 29 December 2017, in the Iranian Registry of Clinical Trials with https://www.IRCT.ir.

Transcutaneous auricular vagal nerve stimulation improves functional dyspepsia by enhancing vagal efferent activity

Objectives: This study was designed to investigate whether transcutaneous auricular vagal nerve stimulation (taVNS) would be able to improve major pathophysiologies of functional dyspepsia (FD) in patients with FD. Methods: Acute: Thirty-six FD patients (21F) were studied in two sessions (taVNS and sham-ES). Physiological measurements, including gastric slow waves, gastric accommodation and autonomic functions, were assessed by the electrogastrogram (EGG), a nutrient drink test and the spectral analysis of heart rate variability derived from the electrocardiogram (ECG), respectively. Chronic: Thirty-six FD patients (25F) were randomized to receive 2-week taVNS or sham-ES. The dyspeptic symptom scales, anxiety and depression scores and the same physiological measurements were assessed at the beginning and the end of the 2-week treatment. Results: Acute: In comparison with sham-ES, acute taVNS improved gastric accommodation (p=0.008), increased the percentage of normal gastric slow waves (%NSW, fasting: p=0.010; fed: p=0.007) and vagal activity (fasting: p=0.056; fed: p=0.026). Chronic：In comparison with baseline, 2-week taVNS but not sham-ES reduced symptoms of dyspepsia (p=0.010), decreased the scores of anxiety (p=0.002) and depression (p<0.001), improved gastric accommodation (p<0.001) and the %NSW (fasting: p<0.05; fed: p<0.05) by enhancing vagal efferent activity (fasting: p=0.015; fed: p=0.048). Compared with the HC, the patients showed increased anxiety (p<0.001) and depression (p<0.001), and decreased gastric accommodation (p<0.001) and %NSW (p<0.001) as well as decreased vagal activity (fasting: p=0.047). Conclusions: The noninvasive taVNS has a therapeutic potential for treating non-severe FD by improving gastric accommodation and gastric pace-making activity via enhancing vagal activity.

Frequency of helicobacter pylori stool antigen in individuals with dyspeptic symptom

Objectives: To evaluate the frequency of H. pylori stool antigen in individuals with dyspepsia. Study Design: Cross sectional study. Setting: Liaquat National Hospital, Karachi. Period: July-2017 to 31st December-2017). Patients and Methods: The individuals with dyspeptic symptoms for ≥3 months durations were included and explored for H. Pylori infection by H. Pylori stool antigen while the result were analyzed and frequencies and percentages were calculated. Results: The mean ± SD for overall population was 36.29±8.57 years while the frequency of H. pylori was recorded as 38.57% (54/140) patients respectively. Conclusion: H. pylori infection usually observed in dyspeptic individuals and should be screened for eradication therapy.