Current Issue : July - September Volume : 2020 Issue Number : 3 Articles : 6 Articles
Background. Measurement of the degree of adherence is a key element for the evaluation of treatment efficacy and safety; thus,\nadherence plays an important role in clinical research and practice. The aim of this study was to investigate medication adherence in\nchildren with inflammatory bowel disease (IBD) utilizing a multimethod assessment approach. A further aim was to examine factors\nthat can influence adherence within this population. Methods. Medication adherence in 47 children (age range 3 to 17 years) with IBD\nin three centers in Northern Ireland and Jordan was assessed via subjective (parent and child versions of the Medication Adherence\nReport Scale (MARS) specific questionnaire) and objective methods, that is, high-performance liquid chromatography (HPLC)\ndetermination of the 6-mercaptopurine (6-MP) and azathioprine (AZA) metabolites in packed red blood cell samples taken during a\nclinic visit. Beliefs about prescribed medicines were also assessed in parents/guardians using the Beliefs about Medicines Questionnaire\n(BMQ). Results. An overall nonadherence to AZA/6-MP therapy in children with IBD was found to be 36.17% (17 out of 47 patients\nwere classified as nonadherent using at least one of the assessment methods). A total of 41 patients (91.1%) were classified as adherent to\nAZA or 6-MP using the blood sampling, while adherence rates using the MARS questionnaire completed by children and parents/\nguardians were 60.6% and 72.7%, respectively. The latter provides a more longitudinal measure of adherence. Child self-reported\nnonadherence rates were significantly higher than parent/guardian reported rates........................
Background and Aim. Upper gastrointestinal bleeding is a threat to patients with gastric varices (GVs). Previous studies have\nconcluded that both transjugular intrahepatic portosystemic shunt (TIPS) and balloon-occluded retrograde transvenous\nobliteration (BRTO) are effective treatments for patients with GV. We aimed to compare the efficiency and outcomes of these two\nprocedures in GV patients through meta-analysis. Methods. The PubMed, Cochrane Library, EMBASE, and Web of Science\ndatabases were searched using the keywords: GV, bleeding, TIPS, and BRTO to identify relevant randomized controlled trials and\ncohort studies. The overall survival (OS) rate, imminent haemostasis rate, rebleeding rate, technical success rate, procedure\ncomplication rate (hepatic encephalopathy and aggravated ascites), and Child-Pugh score were evaluated. Randomized clinical\ntrials and cohort studies comparing TIPS and BRTO for GV due to portal hypertension were included in our meta-analysis. Two\nindependent reviewers performed data extraction and assessed the study quality. A meta-analysis was performed to calculate risk\nratios (RRs), mean differences (MDs), and 95% CIs using random effects models. Results. A total of nine studies fulfilled the\ninclusion criteria. There was a significant difference between TIPS and BRTO in the OS rate (RR, 0.81 (95% CI, 0.66 to 0.98);......................
Background: Owing to the development of double-balloon enteroscopy (DBE) and video capsule endoscopy (VCE)\nin recent years, direct visualization of the entire small intestinal mucosa has become possible. Because of the\nnonspecific symptoms and the anatomic location of the small bowel, diagnosis of isolated small bowel Crohnâ??s\ndisease (CD) remains a challenge. The aim of this research was to explore the value of DBE for isolated small bowel\nCD in situations where routine tests cannot confirm the diagnosis.\nMethods: This study included patients with suspected isolated small bowel CD who were hospitalized in Shengjing\nHospital from April 2014 to June 2018. We included patients presenting with chronic diarrhea, abdominal pain,\nabdominal mass, perianal lesions, and systemic symptoms including weight loss, fever, and anemia after excluding\ninfection factors. Patients with purely colonic CD were excluded from this cohort. Patients with suspected isolated\nsmall bowel CD underwent DBE.\nResults: In 16/18 patients, pathological findings were detected by DBE. In 12 of the cases, small bowel CD was\nconfirmed. The remaining four patients were diagnosed with small bowel inflammation, duodenal carcinoma, ileum\ninflammation and small bowel ulcers. However, the diagnosis of CD was confirmed in 14/18 (78%) patients by\ntaking into account the clinical presentation, endoscopic and histological results as well as the experimental\ntreatment. DBE assisted in the diagnosis in 86% (12/14) of the patients.\nConclusions: In the diagnosis of small bowel CD, DBE is a helpful tool. Before assessment with DBE, clinical\nfeatures, colonoscopy, and CT were used to initially assess the intestine. According to the lesions indicated by CT,\nwe chose the most appropriate endoscope insertion route, and combined the endoscopic characteristics and\npathological results of DBE to confirm the diagnosis....
Gastric xanthelasma (GX) is a rare tumor-like lesion customarily found as an incidental finding due to its asymptomatic appearance.\nGrossly, it is a well-marked yellow-white plaque created in the lamina propria by microscopic clusters of foamy\nmacrophages. Xanthelasma is rarely correlated with gastric hyperplastic polyps; gastric xanthomas are rare benign lesions that\nappear to be associated with inflammation of the gastric mucosa. Etiopathogenesis is also unclear, but it has been suggested to be\ninvolved in chronic gastritis, infection with Helicobacter pylori (H. pylori), diabetes mellitus, and hyperlipidemia. The gastric\nxanthoma prevalence ranges from 0.23% to 7%. Orth first described the condition in 1887. It has been found that xanthelasmas are\nassociated with chronic gastritis, gastrointestinal anastomosis, intestinal metaplasia, and H. pylori infection. These lesions\npredispose patients to gastric cancer conditions. Xanthoma (GX) was reported to be a predictive marker for early gastric cancer.\nHowever, the effectiveness of these scores and xanthoma (GX) as predictive markers for early gastric cancer detected after H. pylori\neradication remains unknown....
Background. Approximately 0.7% of the Canadian population is infected with hepatitis C virus (HCV), and many individuals are\nunaware of their infection. Our objectives were to utilize an emergency department (ED) based point-of-care (POC) HCV\nscreening test to describe our local population and estimate the proportion of high-risk patients in our population with undiagnosed\nHCV. Methods. A convenience sample of medically stable patients (less than or equals to 18 years) presenting to a community ED in\nCalgary, AB, between April and July 2018 underwent rapid clinical screening for HCV risk factors, including history of injection\ndrug use, healthcare in endemic countries, and other recognized criteria. High-risk patients were offered POC HCV testing.\nAntibody-positive patients underwent HCV-RNA testing and were linked to hepatology care. The primary outcome was the\nproportion of new HCV diagnoses in the high-risk population. Results. Of the 999 patients screened by survey, 247 patients\n(24.7%) were high-risk and eligible for testing. Of these, 123 (49.8%) were from HCV-endemic countries, while 63 (25.5%) and 31\n(12.6%) patients endorsed a history of incarceration and intravenous drug use (IVDU), respectively. A total of 144 (58.3%) eligible\npatients agreed to testing. Of these, 6 patients were POC-positive (4.2%, CI 0.9-7.4%); all 6 had antibodies detected on confirmatory\nlab testing and 4 had detectable HCV-RNA viral loads in follow-up. Notably, 103 (41.7%) patients declined POC testing.\nInterpretation. Among 144 high-risk patients who agreed to testing, the rate of undiagnosed HCV infection was 4.2%, and the rate\nof undiagnosed HCV infection with detectable viral load was 2.8%. Many patients with high-risk clinical criteria refused POC\ntesting. It is unknown if tested and untested groups have the same disease prevalence. This study shows that ED HCV screening is\nfeasible and that a small number of previously undiagnosed patients can be identified and linked to potentially life-changing care....
Background: Nonalcoholic fatty liver disease (NAFLD) is one of the most common chronic liver diseases. Studies\nhave shown that sleep apnea is associated with NAFLD. However, studies on the association between sleep\ndisorders in general and NAFLD are limited. We conducted a nationwide population-based longitudinal study to\nevaluate this potential association.\nMethods: We identified patients diagnosed with sleep disorders in the years 2000 through 2005 in Taiwan using\nthe National Health Insurance Research Database and selected an equal number of patients without sleep disorders\nfrom the same database as the comparison cohort. The patients were followed from the index date to the\ndiagnosis of NAFLD or the end of 2013. We used Cox proportional hazards models to estimate the risk of NAFLD\nassociated with sleep disorders.\nResults: A total of 33,045 patients with sleep disorders were identified. The incidence of NAFLD was 14.0 per 10,000\nperson-year in patients with sleep disorders and 6.2 per 10,000 person-year in the comparison cohort. The adjusted\nhazard ratio (AHR) of NAFLD associated with sleep disorders was 1.78 (95% confidence interval [95%CI]: 1.46â??2.16),\nand other independent risk factors included male sex (AHR = 1.31, 95%CI: 1.12â??1.54), age 40â??59 years (AHR = 1.49,\n95%CI: 1.21â??1.82), and dyslipidemia (AHR = 2.51, 95%CI: 2.08â??3.04). In the subgroup analyses, both patients with\n(AHR = 2.24, 95%CI: 1.05â??4.77) and without (AHR = 1.77, 95%CI: 1.46â??2.15) sleep apnea had an increased risk of NAFLD.\nConclusions: Sleep disorders are associated with NAFLD, even in patients without sleep apnea. Further studies are\nwarranted to explore the mechanisms of the association....
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