There is increasing evidence for the role of microscopic inflammation in patients with IBS.
We aimed to examine the prevalence of microscopic colitis and inflammation in Malaysian
IBS patients with diarrhoea (IBS-D).
Abdominal Tuberculosis Revisited–A single institutional experience of 72 case...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Abdominal Tuberculosis Revisited–A single institutional experience of 72 case...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Management strategies in inflammatory bowel disease. https://youtu.be/ZVtMSTH...Yasser Abdel-Halim
https://youtu.be/ZVtMSTHb-JM
Modern strategies used in IBD (inflammatory bowel disease), (Crohn's disease & ulcerative colitis) with the most recent data from Network Meta-Analysis & AGA guidelines. We have one goal. Which is to block the structural bowel damage progression before it becomes irreversible, with the least possible side effects. & We have three clinical objectives, Early Remission, Maintaining Remission, De-escalation when Longstanding Remission. & To achieve objectives, we have four strategies. Early effective therapy for high-risk patient strategy, Treat to Target strategy, Tight Control strategy & Exit Strategy.
Abstract—Hydatid cyst disease is a zoonotic disease caused by the larval stage of Echinococcus granulosus and Echinococcus Multilocularis. In human beings, apart from involving the liver and lungs commonly, it also affects other organs like brain, kidney and spleen. Rupture of Hydatid cyst into abdominal cavity causes disseminated abdominal hydatidosis which is a rare complication. Here this rare case was presenting as a 48 years old female patient of disseminated intra-abdominal hydatidosis. Disseminated abdominal hydatidosis occurs secondary to traumatic or surgical rupture of a hepatic cyst. Ultrasonography or Computed Tomography findings are helpful in making a definitive diagnosis. For localized hydatid cysts in liver or lungs, the management of choice is preferably surgical while the treatment for disseminated intra-abdominal hydatidosis remains medical. Albendazole is the treatment of choice for disseminated abdominal hydatidosis.
PERFORATIVE PERITONITIS: CONTINUING SURGICAL CHALLENGE.(PROSPECTIVE STUDY OF ...KETAN VAGHOLKAR
Background: Perforative peritonitis poses a significant diagnostic and therapeutic challenge to the attending
surgeon. Delay in diagnosis followed by sub-optimal treatment may lead to many complications, thereby increasing both
morbidity and mortality. This is by virtue of various factors which affect the prognosis. Hence the need arises to identify
these prognostic factors. Aims and Objectives: To study the various etiological factors of perforative peritonitis and to
identify prognostic factors and comorbid conditions which influence the outcome in perforative peritonitis. Materials
and Methods: 50 patients with an established diagnosis of perforative peritonitis due to various aetiologies confirmed
by clinical and radiological investigations were included in the study and studied prospectively. On admission to the
hospital, various haematological and radiological investigations were conducted to confirm the diagnosis. Patients
subsequently underwent surgical intervention. Postoperative recovery and outcomes assessed. Results were tabulated
and statistically analysed. Results: The mean age of patients in the study was 36.5 ±5 years. Patients who presented
in an advanced stage developed complications. The majority of patients were males. The interval between the onset
of symptoms and operative intervention was directly related to postoperative complications. Pneumoperitoneum was
the most common x-ray finding, followed by dilated bowel loops with free fluid in the peritoneal cavity as the most
common ultrasonography finding. Tachycardia and oliguria, which were markers of the severity of the disease process,
were associated with an increased rate of complications. Peptic ulcer perforation was the most common, followed by
perforations caused by infective aetiology. Perforations caused by infective aetiology had a higher rate of complication.
Primary closure of the perforation was the most commonly performed procedure. Significant abdominal contamination
found intraoperatively contributed to a negative outcome, as were comorbid conditions, which also increased the
complication rate significantly. Conclusion: Delayed intervention after the onset of symptoms, tachycardia, oliguria
and comorbidities are associated with a higher complication rate. Radiological investigations help in confirming the
diagnosis. Infective aetiology of the perforation and extensive peritoneal contamination was associated with higher
complication rates. Prompt and aggressive resuscitation on admission, optimum antibiotic administration, and early
meticulous surgical intervention can reduce morbidity and mortality to a bare minimum.
Background: The incidence of abdominal tuberculosis is increasing. Preoperative diagnosis continues to
be the biggest challenge. Diagnosis is established only after histopathological examination. The modes of presentation
and therapeutic options need to be assessed. Objectives: To study the patterns of presentations, the extent of organ
involvement and therapeutic options. Materials and methods: Fifty histopathologically proven cases of abdominal
tuberculosis were studied. In addition, epidemiologic data, clinical patterns of presentation, diagnostic and various
surgical options, including outcomes, were studied. Results: The mortality in the study was 8%. The disease was
commonly seen in 21 to 40 years old and commonly seen in females. HIV positivity, anaemia and hypoproteinaemia
were associated with poor outcomes. Four types of presentations were observed. Diagnostic laparoscopy enabled early
histopathological diagnosis of biopsy specimens. Chemotherapy is the mainstay of treatment Surgery is a significant
adjunct in diagnosing and managing complications. Patients presenting with perforative peritonitis had a poor prognosis
Conclusion: Critical evaluation of chronic abdominal pain is essential. Supportive evidence such as the history of TB or
contact with a patient suffering from TB is highly suggestive of abdominal tuberculosis. Radiological tests are highly
suggestive but not diagnostic. Diagnostic laparoscopy enables tissue diagnosis. Chemotherapy accompanied by surgical
intervention for complications is the mainstay of treatment.
Chronic diarrhea as a result of colonic fistulas -two case reports with different origin. When it comes to chronic diarrhea symptom, the first thing
one thinks of is never a surgical cause, but an infectious disease. The aim of this paper is to show 2 different cases of chronic diarrhea, resulting from
benign surgical causes - colonic fistula. The first case is a result of cholecystocolic fistula, while the second is the result of gastrojejunocolic fistula.
Colonic fistulas originate from different causes: malignancy, NSAID, diverticulosis of the colon, cholecystitis, pancreatitis, lymphoma, or after radiation
therapy. They can also result from a trauma, which can be post-surgical.
Introduction:
Cholecystocolic fistula occurs as a result of the inflammation of the gallbladder. It arises from existing adhesions. The incidence rate
is not high, but the complication is not a rarity per se. It is less frequent complication than cholecystoduodenal fistula. The main symptoms are secretory
diarrhea, vitamin K malabsorption and weight loss, and thus suspicion of malignancy is usual. The treatment is surgical removal of the gallbladder,
fistula and part of the colon en bloc.
Case report:
A 73-year old male patient was admitted to the department after 5 months of medical treatment. Laboratory tests, coproculture,
colonoscopy, abdominal ultrasonography, and gastroduodenoscopy were performed - the diagnosis was not established. The diagnosis was made by
means of irrigography and short and narrow cholecystocolic fistula was confirmed. The possibility of malignant disease was not completely excluded.
The patient underwent surgery after parental nutrition-adhesions, gallbladder, and the prepared fistula were removed as well as the longitudinal part
of the transverse colon, which was simultaneously repaired. Ex-tempore diagnosis-the surgical specimen originated from inflammation, not from
malignancy. The post-operative course was uneventful. The first post-operative stool was normal. The patient gained some weight after a few months.
Conclusion:
Along with the contemporary diagnostics methods, contrast examination plays an important diagnostic role. When infection is
excluded as the cause of chronic diarrhea, cholecystocolic fistula should be considered. Malignant disease should be excluded before the surgery, or it
may be diagnosed during the surgery, which would determine the course of the treatment. The treatment of benign cholecystocolic fistula is surgical
en bloc procedure.
RECENT ADVANCES IN THE MANAGEMENT OF INFLAMMATORY BOWEL DISEASEPARUL UNIVERSITY
Medical treatment for inflammatory bowel disease (IBD) has progressed significantly over the past decade to achieve and maintain clinical remission in patients & to overcome the side effects of existing drugs for IBD. Conventional therapy for IBD include the use of Amino salicylates, corticosteroids & Anti-microbials. Patients who fail to respond to the conventional therapy are treated with agents such as Calcineurin inhibitor (Cyclosporine), and Biologics like TNF-α inhibitors (Infliximab or Adalimumab) or Anti-cell adhesion molecules (Vedolizumab, natalizumab). These agents are targeted against pro-inflammatory cytokines such as Tumor Necrosis Factor-α (TNF-α), Interleukin-2 (IL-2) and Cell Surface Adhesion Molecules Integrin α4β7. In this review, we provide an overview on the recent advances in the treatment for IBD such as newer Biologics, Small Molecule drugs and Biosimilars effective for IBD and the role of other therapies like Probiotics, Prebiotics, Stem cell transplant and Faecal microbiota transplant and Microbiome targeting diet in the management of IBD
Inflammatory Bowel Disease ( Pathogensis & Steps of Diagnosis and Management) For Resident at Gastroenterology and Hepatology department at Kafrelsheikh by Dr/ Mohammed Hussien ( Assistant Lecturer).
Linitis plastica is a diffuse form of gastric cancer and accounts for about 10% of all cases of gastric malignancy and its exact general population distribution is unknown. There are no characteristic or specific symptoms, the symptoms are similar to those of other forms of stomach cancer and can manifest as a feeling of fullness after eating, nausea and vomiting, epigastric pain, weight loss, and progressive dysphagia [1]. Plastic linitisis characterized by malignant glandular proliferation of cricoid cells in the fibrous stroma, which ultimately leads to thickening and rigidity of the stomach wall.
Management strategies in inflammatory bowel disease. https://youtu.be/ZVtMSTH...Yasser Abdel-Halim
https://youtu.be/ZVtMSTHb-JM
Modern strategies used in IBD (inflammatory bowel disease), (Crohn's disease & ulcerative colitis) with the most recent data from Network Meta-Analysis & AGA guidelines. We have one goal. Which is to block the structural bowel damage progression before it becomes irreversible, with the least possible side effects. & We have three clinical objectives, Early Remission, Maintaining Remission, De-escalation when Longstanding Remission. & To achieve objectives, we have four strategies. Early effective therapy for high-risk patient strategy, Treat to Target strategy, Tight Control strategy & Exit Strategy.
Abstract—Hydatid cyst disease is a zoonotic disease caused by the larval stage of Echinococcus granulosus and Echinococcus Multilocularis. In human beings, apart from involving the liver and lungs commonly, it also affects other organs like brain, kidney and spleen. Rupture of Hydatid cyst into abdominal cavity causes disseminated abdominal hydatidosis which is a rare complication. Here this rare case was presenting as a 48 years old female patient of disseminated intra-abdominal hydatidosis. Disseminated abdominal hydatidosis occurs secondary to traumatic or surgical rupture of a hepatic cyst. Ultrasonography or Computed Tomography findings are helpful in making a definitive diagnosis. For localized hydatid cysts in liver or lungs, the management of choice is preferably surgical while the treatment for disseminated intra-abdominal hydatidosis remains medical. Albendazole is the treatment of choice for disseminated abdominal hydatidosis.
PERFORATIVE PERITONITIS: CONTINUING SURGICAL CHALLENGE.(PROSPECTIVE STUDY OF ...KETAN VAGHOLKAR
Background: Perforative peritonitis poses a significant diagnostic and therapeutic challenge to the attending
surgeon. Delay in diagnosis followed by sub-optimal treatment may lead to many complications, thereby increasing both
morbidity and mortality. This is by virtue of various factors which affect the prognosis. Hence the need arises to identify
these prognostic factors. Aims and Objectives: To study the various etiological factors of perforative peritonitis and to
identify prognostic factors and comorbid conditions which influence the outcome in perforative peritonitis. Materials
and Methods: 50 patients with an established diagnosis of perforative peritonitis due to various aetiologies confirmed
by clinical and radiological investigations were included in the study and studied prospectively. On admission to the
hospital, various haematological and radiological investigations were conducted to confirm the diagnosis. Patients
subsequently underwent surgical intervention. Postoperative recovery and outcomes assessed. Results were tabulated
and statistically analysed. Results: The mean age of patients in the study was 36.5 ±5 years. Patients who presented
in an advanced stage developed complications. The majority of patients were males. The interval between the onset
of symptoms and operative intervention was directly related to postoperative complications. Pneumoperitoneum was
the most common x-ray finding, followed by dilated bowel loops with free fluid in the peritoneal cavity as the most
common ultrasonography finding. Tachycardia and oliguria, which were markers of the severity of the disease process,
were associated with an increased rate of complications. Peptic ulcer perforation was the most common, followed by
perforations caused by infective aetiology. Perforations caused by infective aetiology had a higher rate of complication.
Primary closure of the perforation was the most commonly performed procedure. Significant abdominal contamination
found intraoperatively contributed to a negative outcome, as were comorbid conditions, which also increased the
complication rate significantly. Conclusion: Delayed intervention after the onset of symptoms, tachycardia, oliguria
and comorbidities are associated with a higher complication rate. Radiological investigations help in confirming the
diagnosis. Infective aetiology of the perforation and extensive peritoneal contamination was associated with higher
complication rates. Prompt and aggressive resuscitation on admission, optimum antibiotic administration, and early
meticulous surgical intervention can reduce morbidity and mortality to a bare minimum.
Background: The incidence of abdominal tuberculosis is increasing. Preoperative diagnosis continues to
be the biggest challenge. Diagnosis is established only after histopathological examination. The modes of presentation
and therapeutic options need to be assessed. Objectives: To study the patterns of presentations, the extent of organ
involvement and therapeutic options. Materials and methods: Fifty histopathologically proven cases of abdominal
tuberculosis were studied. In addition, epidemiologic data, clinical patterns of presentation, diagnostic and various
surgical options, including outcomes, were studied. Results: The mortality in the study was 8%. The disease was
commonly seen in 21 to 40 years old and commonly seen in females. HIV positivity, anaemia and hypoproteinaemia
were associated with poor outcomes. Four types of presentations were observed. Diagnostic laparoscopy enabled early
histopathological diagnosis of biopsy specimens. Chemotherapy is the mainstay of treatment Surgery is a significant
adjunct in diagnosing and managing complications. Patients presenting with perforative peritonitis had a poor prognosis
Conclusion: Critical evaluation of chronic abdominal pain is essential. Supportive evidence such as the history of TB or
contact with a patient suffering from TB is highly suggestive of abdominal tuberculosis. Radiological tests are highly
suggestive but not diagnostic. Diagnostic laparoscopy enables tissue diagnosis. Chemotherapy accompanied by surgical
intervention for complications is the mainstay of treatment.
Chronic diarrhea as a result of colonic fistulas -two case reports with different origin. When it comes to chronic diarrhea symptom, the first thing
one thinks of is never a surgical cause, but an infectious disease. The aim of this paper is to show 2 different cases of chronic diarrhea, resulting from
benign surgical causes - colonic fistula. The first case is a result of cholecystocolic fistula, while the second is the result of gastrojejunocolic fistula.
Colonic fistulas originate from different causes: malignancy, NSAID, diverticulosis of the colon, cholecystitis, pancreatitis, lymphoma, or after radiation
therapy. They can also result from a trauma, which can be post-surgical.
Introduction:
Cholecystocolic fistula occurs as a result of the inflammation of the gallbladder. It arises from existing adhesions. The incidence rate
is not high, but the complication is not a rarity per se. It is less frequent complication than cholecystoduodenal fistula. The main symptoms are secretory
diarrhea, vitamin K malabsorption and weight loss, and thus suspicion of malignancy is usual. The treatment is surgical removal of the gallbladder,
fistula and part of the colon en bloc.
Case report:
A 73-year old male patient was admitted to the department after 5 months of medical treatment. Laboratory tests, coproculture,
colonoscopy, abdominal ultrasonography, and gastroduodenoscopy were performed - the diagnosis was not established. The diagnosis was made by
means of irrigography and short and narrow cholecystocolic fistula was confirmed. The possibility of malignant disease was not completely excluded.
The patient underwent surgery after parental nutrition-adhesions, gallbladder, and the prepared fistula were removed as well as the longitudinal part
of the transverse colon, which was simultaneously repaired. Ex-tempore diagnosis-the surgical specimen originated from inflammation, not from
malignancy. The post-operative course was uneventful. The first post-operative stool was normal. The patient gained some weight after a few months.
Conclusion:
Along with the contemporary diagnostics methods, contrast examination plays an important diagnostic role. When infection is
excluded as the cause of chronic diarrhea, cholecystocolic fistula should be considered. Malignant disease should be excluded before the surgery, or it
may be diagnosed during the surgery, which would determine the course of the treatment. The treatment of benign cholecystocolic fistula is surgical
en bloc procedure.
RECENT ADVANCES IN THE MANAGEMENT OF INFLAMMATORY BOWEL DISEASEPARUL UNIVERSITY
Medical treatment for inflammatory bowel disease (IBD) has progressed significantly over the past decade to achieve and maintain clinical remission in patients & to overcome the side effects of existing drugs for IBD. Conventional therapy for IBD include the use of Amino salicylates, corticosteroids & Anti-microbials. Patients who fail to respond to the conventional therapy are treated with agents such as Calcineurin inhibitor (Cyclosporine), and Biologics like TNF-α inhibitors (Infliximab or Adalimumab) or Anti-cell adhesion molecules (Vedolizumab, natalizumab). These agents are targeted against pro-inflammatory cytokines such as Tumor Necrosis Factor-α (TNF-α), Interleukin-2 (IL-2) and Cell Surface Adhesion Molecules Integrin α4β7. In this review, we provide an overview on the recent advances in the treatment for IBD such as newer Biologics, Small Molecule drugs and Biosimilars effective for IBD and the role of other therapies like Probiotics, Prebiotics, Stem cell transplant and Faecal microbiota transplant and Microbiome targeting diet in the management of IBD
Follow up model for patients with atrophic chronic gastritis and metaplasia
Similar to Low prevalence of ‘classical’ microscopic colitis but evidence of microscopic inflammation in Asian Irritable Bowel Syndrome patients with diarrhoea
Inflammatory Bowel Disease ( Pathogensis & Steps of Diagnosis and Management) For Resident at Gastroenterology and Hepatology department at Kafrelsheikh by Dr/ Mohammed Hussien ( Assistant Lecturer).
Linitis plastica is a diffuse form of gastric cancer and accounts for about 10% of all cases of gastric malignancy and its exact general population distribution is unknown. There are no characteristic or specific symptoms, the symptoms are similar to those of other forms of stomach cancer and can manifest as a feeling of fullness after eating, nausea and vomiting, epigastric pain, weight loss, and progressive dysphagia [1]. Plastic linitisis characterized by malignant glandular proliferation of cricoid cells in the fibrous stroma, which ultimately leads to thickening and rigidity of the stomach wall.
Linitis plastica is a diffuse form of gastric cancer and accounts for about 10% of all cases of gastric malignancy and its exact general population distribution is unknown. There are no characteristic or specific symptoms, the symptoms are similar to those of other forms of stomach cancer and can manifest as a feeling of fullness after eating, nausea and vomiting, epigastric pain, weight loss, and progressive dysphagia [1]. Plastic linitisis characterized by malignant glandular proliferation of cricoid cells in the fibrous stroma, which ultimately leads to thickening and rigidity of the stomach wall.
Linitis plastica is a diffuse form of gastric cancer and accounts for about 10% of all cases of gastric malignancy and its exact general population distribution is unknown. There are no characteristic or specific symptoms, the symptoms are similar to those of other forms of stomach cancer and can manifest as a feeling of fullness after eating, nausea and vomiting, epigastric pain, weight loss, and progressive dysphagia [1]. Plastic linitisis characterized by malignant glandular proliferation of cricoid cells in the fibrous stroma, which ultimately leads to thickening and rigidity of the stomach wall.
Linitis plastica is a diffuse form of gastric cancer and accounts for about 10% of all cases of gastric malignancy and its exact general population distribution is unknown. There are no characteristic or specific symptoms, the symptoms are similar to those of other forms of stomach cancer and can manifest as a feeling of fullness after eating, nausea and vomiting, epigastric pain, weight loss, and progressive dysphagia [1]. Plastic linitisis characterized by malignant glandular proliferation of cricoid cells in the fibrous stroma, which ultimately leads to thickening and rigidity of the stomach wall.
Linitis plastica is a diffuse form of gastric cancer and accounts for about 10% of all cases of gastric malignancy and its exact general population distribution is unknown. There are no characteristic or specific symptoms, the symptoms are similar to those of other forms of stomach cancer and can manifest as a feeling of fullness after eating, nausea and vomiting, epigastric pain, weight loss, and progressive dysphagia [1]. Plastic linitisis characterized by malignant glandular proliferation of cricoid cells in the fibrous stroma, which ultimately leads to thickening and rigidity of the stomach wall.
Linitis plastica is a diffuse form of gastric cancer and accounts for about 10% of all cases of gastric malignancy and its exact general population distribution is unknown. There are no characteristic or specific symptoms, the symptoms are similar to those of other forms of stomach cancer and can manifest as a feeling of fullness after eating, nausea and vomiting, epigastric pain, weight loss, and progressive dysphagia [1]. Plastic linitisis characterized by malignant glandular proliferation of cricoid cells in the fibrous stroma, which ultimately leads to thickening and rigidity of the stomach wall.
Linitis plastica is a diffuse form of gastric cancer and accounts for about 10% of all cases of gastric malignancy and its exact general population distribution is unknown. There are no characteristic or specific symptoms, the symptoms are similar to those of other forms of stomach cancer and can manifest as a feeling of fullness after eating, nausea and vomiting, epigastric pain, weight loss, and progressive dysphagia [1]. Plastic linitisis characterized by malignant glandular proliferation of cricoid cells in the fibrous stroma, which ultimately leads to thickening and rigidity of the stomach wall.
Introduction: Diffuse Large B Cell Lymphoma (DLBCL), as a set of heterogeneous aggressive lymphoma, most commonly originated in the germinal center B lymphocytes. Rare cases were from peripheral blood B cell (outside germinal center) or from the inert lymphoma development and transformation. And such tumor with originality outside germinal center was seldom seen in the literature. Even the tumor in combination with chronic gastritis has not been reported before.
Similar to Low prevalence of ‘classical’ microscopic colitis but evidence of microscopic inflammation in Asian Irritable Bowel Syndrome patients with diarrhoea (20)
Incidence of pneumonia and risk factors among patients with head and neck can...Enrique Moreno Gonzalez
This study investigated the incidence and patient- and treatment-related risk factors related to pneumonia acquired during radiotherapy (PNRT) in head and neck cancer (HNC) patients.
Gene expression analysis of a Helicobacter pyloriinfected and high-salt diet-...Enrique Moreno Gonzalez
Helicobacter pylori (H. pylori) infection and excessive salt intake are known as important risk factors for stomach cancer in humans. However, interactions of these two factors with gene expression profiles during gastric carcinogenesis remain unclear. In the present study, we investigated the global gene expression associated with stomach carcinogenesis and prognosis of human gastric cancer using a mouse model.
Acute myeloid leukemia (AML) is a hematopoietic malignancy with a dismal outcome in the majority of cases. A detailed understanding of the genetic alterations and gene expression changes that contribute to its pathogenesis is important to improve prognostication, disease monitoring, and therapy. In this context, leukemia-associated misexpression of microRNAs (miRNAs) has been studied, but no coherent picture has emerged yet, thus warranting further investigations.
Recently, a phase II clinical trial in hepatocellular carcinoma (HCC) has suggested that the combination of sorafenib and 5-fluorouracil (5-FU) is feasible and side effects are manageable. However, preclinical experimental data explaining the interaction mechanism(s) are lacking. Our objective is to investigate the anticancer efficacy and mechanism of combined sorafenib and 5-FU therapy in vitro in HCC cell lines MHCC97H and SMMC-7721.
Differences in microRNA expression during tumor development in the transition...Enrique Moreno Gonzalez
The prostate is divided into three glandular zones, the peripheral zone (PZ), the transition zone (TZ), and the central zone. Most prostate tumors arise in the peripheral zone (70-75%) and in the transition zone (20-25%) while only 10% arise in the central zone. The aim of this study was to investigate if differences in miRNA expression could be a possible explanation for the difference in propensity of tumors in the zones of the prostate.
Multicentric and multifocal versus unifocal breast cancer: differences in the...Enrique Moreno Gonzalez
The aim of this study was to evaluate the expression of the cell adhesion-related glycoproteins MUC-1, β-catenin and E-cadherin in multicentric/multifocal breast cancer in comparison to unifocal disease in order to identify potential differences in the biology of these tumor types.
The life in sight application study (LISA): design of a randomized controlled...Enrique Moreno Gonzalez
It is widely recognized that spiritual care plays an important role in physical and psychosocial well-being of cancer patients, but there is little evidence based research on the effects of spiritual care. We will conduct a randomized controlled trial on spiritual care using a brief structured interview scheme supported by an e-application. The aim is to examine whether an assisted reflection on life events and ultimate life goals can improve quality of life of cancer patients.
Clinical and experimental studies regarding the expression and diagnostic val...Enrique Moreno Gonzalez
Carcinoembryonic antigen-related cell adhesion molecule 1 (CEACAM1) is a multifunctional Ig-like cell adhesion molecule that has a wide range of biological functions. According to previous reports, serum CEACAM1 is dysregulated in different malignant tumours and associated with tumour progression. However, the serum CEACAM1 expression in nonsmall-cell lung carcinomas (NSCLC) is unclear. The different expression ratio of CEACAM1-S and CEACAM1-L isoform has seldom been investigated in NSCLC. This research is intended to study the serum CEACAM1 and the ratio of CEACAM1-S/L isoforms in NSCLC.
Assessment of preoperative exercise capacity in hepatocellular carcinoma pati...Enrique Moreno Gonzalez
Cardiopulmonary exercise testing measures oxygen uptake at increasing levels of work and predicts cardiopulmonary performance under conditions of stress, such as after abdominal surgery. Dynamic assessment of preoperative exercise capacity may be a useful predictor of postoperative prognosis. This study examined the relationship between preoperative exercise capacity and event-free survival in hepatocellular carcinoma (HCC) patients with chronic liver injury who underwent hepatectomy.
Overexpression of YAP 1 contributes to progressive features and poor prognosi...Enrique Moreno Gonzalez
Yes-associated protein 1 (YAP 1), the nuclear effector of the Hippo pathway, is a key regulator of organ size and a candidate human oncogene in multiple tumors. However, the expression dynamics of YAP 1 in urothelial carcinoma of the bladder (UCB) and its clinical/prognostic significance are unclear.
CXCR7 is induced by hypoxia and mediates glioma cell migration towards SDF-1a...Enrique Moreno Gonzalez
Glioblastomas, the most common and malignant brain tumors of the central nervous system, exhibit high invasive capacity, which hinders effective therapy. Therefore, intense efforts aimed at improved therapeutics are ongoing to delineate the molecular mechanisms governing glioma cell migration and invasion.
Abnormal expression of Pygopus 2 correlates with a malignant phenotype in hum...Enrique Moreno Gonzalez
Pygopus 2 (Pygo2) is a Pygo family member and an important component of the Wnt signaling transcriptional complex. Despite this data, no clinical studies investigating Pygo2 expression in lung cancer have yet been reported.
Differentiation of irradiation and cetuximab induced skin reactions in patien...Enrique Moreno Gonzalez
In order to improve the clinical outcome of patients with locally advanced squamous cell carcinoma of the head and neck (LASCCHN) not being capable to receive platinum-based chemoradiation, radiotherapy can be intensified by addition of cetuximab, a monoclonal antibody that blocks the epidermal growth factor receptor (EGFR). The radioimmunotherapy with cetuximab is a feasible treatment option showing a favourable toxicity profile. The most frequent side effect of radiotherapy is radiation dermatitis, the most common side effect of treatment with cetuximab is acneiform rash. Incidence and severity of these frequent, often overlapping and sometimes limiting skin reactions, however, are not well explored. A clinical and molecular differentiation between radiogenic skin reactions and skin reactions caused by cetuximab which may correlate with outcome, have never been described before.
Cholestasis induces reversible accumulation of periplakin in mouse liverEnrique Moreno Gonzalez
Periplakin (PPL) is a rod-shaped cytolinker protein thought to connect cellular adhesion junctional complexes to cytoskeletal filaments. PPL serves as a structural component of the cornified envelope in the skin and interacts with various types of proteins in cultured cells; its level decreases dramatically during tumorigenic progression in human epithelial tissues. Despite these intriguing observations, the physiological roles of PPL, especially in noncutaneous tissues, are still largely unknown. Because we observed a marked fluctuation of PPL expression in mouse liver in association with the bile acid receptor farnesoid X receptor (FXR) and cholestasis, we sought to characterize the role of PPL in the liver and determine its contributions to the etiology and pathogenesis of cholestasis.
Functional p53 is required for rapid restoration of daunorubicin-induced lesi...Enrique Moreno Gonzalez
The tumour suppressor and transcription factor p53 is a major determinant of the therapeutic response to anthracyclines. In healthy tissue, p53 is also considered pivotal for side effects of anthracycline treatment such as lesions in haematopoietic tissues like the spleen. We used a Trp53null mouse to explore the significance of p53 in anthracycline (daunorubicin) induced lesions in the spleen.
Post-diagnosis hemoglobin change associates with overall survival of multiple...Enrique Moreno Gonzalez
Anemia refers to low hemoglobin (Hb) level and is a risk factor of cancer patient survival. The National Comprehensive Cancer Network recently suggested that post-diagnosis Hb change, regardless of baseline Hb level, indicates the potential presence of anemia. However, there is no epidemiological study evaluating whether Hb change has direct prognostic values for cancer patients at the population level.
Cost-effectiveness of MRI for breast cancer screening in BRCA1/2 mutation car...Enrique Moreno Gonzalez
Women with mutations in BRCA1 or BRCA2 are at high risk of developing breast cancer and, in British Columbia, Canada, are offered screening with both magnetic resonance imaging (MRI) and mammography to facilitate early detection. MRI is more sensitive than mammography but is more costly and produces more false positive results. The purpose of this study was to calculate the cost-effectiveness of MRI screening for breast cancer in BRCA1/2 mutation carriers in a Canadian setting.
Impaired mitochondrial beta-oxidation in patients with chronic hepatitis C: r...Enrique Moreno Gonzalez
Hepatic steatosis is often seen in patients with chronic hepatitis C (CH-C). It is still unclear whether these patients have an impaired mitochondrial β-oxidation. In this study we assessed mitochondrial β-oxidation in CH-C patients by investigating ketogenesis during fasting.
Intraepithelial lymphocyte distribution differs between the bulb and the seco...Enrique Moreno Gonzalez
Evaluation of intraepithelial duodenal lymphocytosis (IDL) is important in celiac disease (CD). There is no established cut-off value for increased number of IELs in the bulb. We therefore investigated the relation between IEL counts in the bulb and duodenal specimens in non-celiac subjects.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
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2. Low prevalence of ‘classical’ microscopic colitis but
evidence of microscopic inflammation in Asian
Irritable Bowel Syndrome patients with diarrhoea
Ida Hilmi1*
*
Corresponding author
Email: ida.hilmi@gmail.com
Juanda Leo Hartono1
Email: juanda_leohartono@yahoo.com
Jayalakshmi Pailoor2
Email: jpailoor@yahoo.com
Sanjiv Mahadeva1
Email: sanjiv@ummc.edu.my
Goh Khean Lee1
Email: klgoh56@gmail.com
1
Gastroenterology Unit, Department of Medicine, Faculty of Medicine,
University of Malaya, Kuala Lumpur, Malaysia
2
Department of Pathology, Faculty of Medicine, University of Malaya, Kuala
Lumpur, Malaysia
Abstract
Background
There is increasing evidence for the role of microscopic inflammation in patients with IBS.
We aimed to examine the prevalence of microscopic colitis and inflammation in Malaysian
IBS patients with diarrhoea (IBS-D).
Methods
Consecutive patients who met the Rome III criteria for IBS-D and asymptomatic controls
were prospectively recruited. Colonoscopy was performed in all study subjects and
systematic biopsies taken from all segments of the colon. The diagnosis of lymphocytic
colitis and collagenous colitis was made using previously defined criteria. Patients with post
infectious IBS were excluded.
Results
120 subjects (74 IBS-D, 46 controls) were recruited during the study period. In the IBS-D
group, the colonoscopic (macroscopic) findings were as follows; normal findings n = 58
(78.4%), diverticula disease n = 5 (6.8%), diminutive polyps n = 9 (12.2%) and haemorrhoids
3. n = 2(2.7%). No subject under the age of 40 had any significant findings. Microscopically,
there was only one case (1.3%) with histology consistent with collagenous colitis. However,
the IBS-D patients had a higher prevalence of moderate microscopic inflammation (n = 11,
14.9%) compared to controls (n = 1, 2.2%) (p = 0.005).
Conclusions
‘Classical’ microscopic colitis is uncommon in Malaysian patients with IBS-D but a
significant number of adults showed evidence of microscopic inflammation.
Background
Irritable Bowel Syndrome (IBS) is defined as a chronic abdominal discomfort associated with
altered bowel habit. It is a common gastrointestinal disorder worldwide, with prevalence rates
ranging from 2-22% in the West (depending on criteria used) [1] and a rate of 15% in the
Malaysian population, based on the Rome II criteria [2,3]. The Rome criteria, the most recent
modification being the Rome III criteria [4], allows a positive diagnosis of IBS based on
symptoms alone and additionally allows for subtype classification depending on the
predominant symptom. The exact pathogenesis of IBS is generally unknown but postulated
mechanisms include alterations in gut motility, visceral hypersensitivity, bacterial flora,
together with psychological association [5-7]. Recently, there has been an increased interest
in the role of microscopic inflammation in patients with IBS [7-14].
‘Classical’ microscopic colitis is a histopathological diagnosis which is currently accepted as
an umbrella term for either lymphocytic colitis or collagenous colitis. Both subtypes share
similar histological features, apart from the fact that collagenous colitis has a significantly
thickened sub-epithelial collagen layer. The annual incidence in western countries ranges
from 1 to 12 per 100,000 and is a common finding (10-15%) in patients investigated for
chronic diarrhoea [15]. It is a disease of the elderly with a strong female preponderance. The
pathogenesis is not fully elucidated but autoimmunity, luminal antigens, drugs such as
NSAIDs and bile salt malabsorption have been implicated [15]. The clinical symptoms
include chronic diarrhoea, urgency, incontinence, anorexia, nausea, abdominal cramping, and
mild weight loss. Not surprisingly, a significant number of patients who have microscopic
colitis also fulfill the Rome criteria for IBS [16-18]. Therefore, a subset of IBS patients, in
particular those with diarrhoea (IBS-D) who do not undergo colonoscopy and biopsies would
have missed a diagnosis of microscopic colitis. This is clinically relevant as there is effective
treatment, in particular budesonide, which has been specifically licensed for this condition
[15,19-22]. In addition, a diagnosis of microscopic colitis should prompt a search for
associated autoimmune conditions such as coeliac disease.
As IBS represents a significant health problem in Malaysia, the aim of this study was to
examine the prevalence of microscopic colitis in Malaysian patients with IBS-D. In view of
the increasing evidence for the role of inflammation in patients with IBS, our secondary
objective was to examine the histopathological features in these patients compared to
controls.
4. Methods
This study was approved by the University of Malaya Medical Centre (UMMC) Ethics
Committee. Consecutive patients who presented to the UMMC Endoscopy Unit, who met the
Rome III criteria for IBS-D from May 2010 to May 2011, were prospectively recruited
following informed consent. These patients were primarily referred from primary care
physicians for further investigation, and none had undergone prior colonoscopy. In our
clinical practice, a colonoscopy is usually requested after a negative screen for organic causes
of diarrhoea such as parasitic infestation, thyroid disease, etc. However, screening for Coeliac
Disease and Tropical Sprue are not routinely performed as they are rare in our population.
The controls chosen during the same time period were asymptomatic subjects who had
undergone colonoscopy for colorectal cancer screening or polyp surveillance. Subjects with
the following features were excluded: prior gastrointestinal surgery, significant loss of
weight, bloody stool, metabolic disorders such as thyrotoxicosis, corticosteroid usage in the
past 4 weeks and those with a recent GI infection (i.e. indicative of post-infectious IBS).
Baseline demographic characteristics, detailed GI symptoms, smoking history, alcohol intake,
drug history and concomitant medical illness were documented. A single stool sample from
each patient was sent for microscopy and culture.
Colonoscopy and biopsy
For all subjects, the bowel preparation used was polyethylene glycol (Fortrans®). During
colonoscopy, the macroscopic findings were recorded. Two well-oriented biopsies were taken
from each part of the colon (i.e. caecum, ascending colon, transverse colon, descending
colon, sigmoid, and rectum) which appeared macroscopically normal. The biopsies were
fixed in 10% buffered formalin and sent for processing. The tissues were routinely processed
for light microscopic examination. The paraffin embedded biopsy materials were sectioned
and stained with the Hematoxylin and eosin stain. Additional stains such as Masson
trichrome stains for collagen fibres were done when collagenous colitis was suspected on
H&E stains.
Histopathological assessment
Biopsy specimens were assessed by an experienced pathologist who was blinded to the
clinical indication for colonoscopy. Quantitative assessment of intraepithelial lymphocytes,
intraepithelial neutrophils, subepithelial collagen thickness, and lamina propria infiltration
(by lymphocytes, plasma cells, and mononuclear cells) were documented as well as the
presence of crypt distortion and surface epithelial damage. The histological criteria for the
diagnosis of lymphocytic colitis was as follows; increased intraepithelial lymphocytes (IEL)
of 20 or more per 100 epithelial cell in conjunction with surface epithelial damage, normal
collagen layer and normal crypt architecture. The histological criteria for collagenous colitis
was abnormally thickened subepithelial collagen band of 10 µm or more, chronic
inflammation including increased IEL and normal crypt architecture [23].
5. Results
Demography
One hundred and twenty subjects, 74 who fulfilled the Rome III criteria and 46 controls were
recruited. The demography of both cases (IBS-D patients) and controls are highlighted in
Table 1. Among IBS-D patients, the male:female ratio was 1:1.4, and the median age was 51
years. The median stool frequency was 4 times per day (range 2–10), the median duration of
symptoms was 12 months and nocturnal diarrhoea was seen in 3 (4%) subjects. In the control
group, the male:female ratio was 1:0.9, and the median age was 62 years.
Table 1 Summary of baseline characteristics, endoscopic and histological findings in
patients with IBS-D and controls
IBS-D n(%) Controls n(%)
Total 74 Total 46
Gender Gender
Male 31(41.9%) Male 24(52.2%)
Female 43(58.1%) Female 22(47.8%)
Median age(years) 51(16–78) Median(range) 61 (26–79)
Race Race
Malay 15(20.3%) Malay 8(17.4%)
Chinese 36(48.6%) Chinese 31(66%)
Indian 23(31.1%) Indian 7(14.9%)
Colonoscopic findings Colonoscopic findings
Normal 58 (78.4%) Normal 27(58.7%)
Polyps 9 (12.2%) Polyps 15(32.6%)
Diverticular disease 5 (6.8%) Diverticular disease 3(6.5%)
Haemorrhoids 2(2.7%) Haemorrhoids 1(2.2%)
Histological findings Histological findings
Normal 62(83.8%) Normal 0(97.8%)
Collagenous 1(1.4%) Collagenous colitis 0(0)
Lymphocytic colitis 0(0%) Lymphocytic colitis 0(0)
Non specific colitis 11(14.9%) Non specific colitis 1(2.2%)
Colonoscopy findings
The colonoscopy (macroscopic) findings in the IBS-D group were as follows; normal
findings n = 58 (78.4%), diverticula disease n = 5 (6.8%), diminutive polyps n = 9 (12.2%)
and haemorrhoids n = 2(2.7%). No subject under the age of 40 had any significant findings.
Colonoscopy findings in the control group were as follows: normal findings n = 27(58.7%),
adenomas n = 15(32.6%) (one large rectal polyp 1 cm, the others <1 cm), diverticula disease
n = 3(6.5%) and haemorrhoids n = 1(2.2%).
Histological findings
Collagenous colitis was diagnosed in a single, 63-year old female IBS-D patient, of Indian
ethnicity. The histological features of thickened collagen fibres were observed in the
6. transverse, descending, sigmoid colon and rectum (Figure 1). There were no subjects who
fulfilled the criteria for lymphocytic colitis.
Figure 1 IBS-D patient with collagenous colitis. Note the thickened collagen band (arrow).
A further 11/74 (14.9%) IBS-D cases showed evidence of microscopic inflammation, with
moderate lymphocytic and plasmacytic infiltration in the lamina propria. Eight cases had
distal involvement but in four cases, inflammation was seen only proximal to the splenic
flexure only. Infiltration of an occasional crypt by neutrophils was seen in five of the cases
and scattered crypt abscesses in the transverse colon, sigmoid colon and rectum were present
in one case. Moderate infiltration of the lamina propria only without crypt involvement was
noted in the remaining five cases. An example of one of the cases is seen in Figure 2. The
remaining 62 (83.7%) subjects with IBS-D did not show any evidence of significant
inflammation throughout the colon (Figure 3).
Figure 2 IBS -D patient with evidence of moderate to severe inflammation on histology.
Figure 3 IBS-D patient with normal histology.
Amongst those in the control group, moderate infiltration of lymphocytes in the ascending
and transverse colon, with no evidence of cryptitis, was found in 1/46 (2.2%) adult. This
patient was an asymptomatic, 60-year-old Chinese male, who had undergone a colonoscopy
for colorectal cancer screening. None of the other subjects in the control group showed any
evidence of significant microscopic inflammation. Univariate analysis demonstrated that IBS-
D subjects, compared to controls, had a greater prevalence of moderate to severe microscopic
inflammation (14.9% vs 2.2%, OR 11.44, 95% CI = 1.49-240.69, p = 0.005).
Discussion
There are several relevant observations in our study. The primary objective was to look at the
prevalence of microscopic colitis in patients who were diagnosed with IBS-D as defined by
the Rome III criteria. From the study, it appears that classic microscopic colitis is very
uncommon in our cohort of patients with IBS-D. However, a significant percentage of
subjects with IBS-D had evidence of microscopic inflammation that did not fit the criteria for
classical microscopic colitis. The most common abnormalities seen were mixed chronic and
acute inflammatory cells, lymphocytes, plasma cells and neutrophils; with or without cryptitis
and crypt abscesses.
The categories of microscopic colitis were recently expanded by Falodia et al. into five
subtypes: collagenous colitis, lymphocytic colitis, minimal change colitis (crypt architectural
abnormality in the form of cryptitis and crypt dilatation in the absence of increase in
intraepithelial lymphocytes and subepithelial collagenous band), microscopic colitis not
otherwise specified (increased inflammatory cell infiltrates in the lamina propria in the
absence of other abnormalities) and microscopic colitis with giant cells [24]. If we were to
reclassify our patients according to the above categories, one patient had collagenous colitis,
six patients had minimal change colitis and five patients had microsopic colitis not otherwise
specified. However, the classification proposed by Falodia et al. has yet to be widely
accepted and the therapeutic studies carried out in the past only looked specifically at
collagenous and lymphocytic colitis. Inflammation was patchy throughout the colon and from
7. the study, four cases showed inflammation beyond the splenic flexure. This is similar to
classical microscopic colitis, where the diagnosis can be missed unless a complete
colonoscopy with biopsies throughout the colon is conducted [15].
The role of inflammation in IBS has been of interest in recent times and evidence of low level
inflammation has been demonstrated in both post infectious and non-post infectious IBS.
Gwee et al. found increased expression of pro-inflammatory cytokine interleukin Iβ (IL-1β)
mRNA in subjects with post-infectious IBS, which was not observed in adults without IBS
[12]. Chadwick et al. [25,26] had divided the histological findings of IBS patients into three
groups; those with normal histology, those with evidence of microscopic inflammation and
those who met criteria for lymphocytic colitis. With immunostaining, it was found that all
three groups had increased numbers of activated immunocompetent cells in the intestinal
mucosa. Barbara et al. [27] reported that increased numbers of activated mast cells in close
proximity to intestinal innervation correlated with abdominal pain in IBS. In addition to this,
there is evidence that patients with IBS-D have an increased expression of TNFα and IL-1β in
the peripheral blood monocytes, not dissimilar to that found in patients with inflammatory
bowel disease [8]. A study from Sri Lanka also showed low grade inflammation in IBS
patients, similar to Western studies but with an increase in eosinophils as well as the other
chronic inflammatory cells [28].
An attractive concept is that IBS-D forms the mildest part of a disease spectrum, with
idiopathic inflammatory bowel disease (in particular, ulcerative colitis) at the other end, with
classical microscopic colitis in between [29,30]. There is a clear overlap in terms of their
proposed pathogenesis including alterations in intestinal microbiota and bile salt
malabsorption. However, the common pathways between the conditions remain poorly
understood and the majority of IBS-D patients fail to demonstrate significant inflammation
on histology.
In the light of Western studies demonstrating a significant overlap between classical
microscopic colitis and IBS-D, as well as the increasing role of inflammation in IBS patients,
‘to do or not to do’ colonoscopy in patients with IBS-D remains as unclear as ever. Although
the single case of collagenous colitis in our study was found in the ‘typical’ subject (elderly,
female), non specific inflammation was seen in both age groups, both genders and across all
three races. As the prevalence of collagenous and lymphocytic colitis appears to be low in our
population, routine colonoscopy is not justified in young patients who have been identified as
IBS on symptom based criteria. This may change however, in light of promising data on the
use of anti-inflammatory drugs such as mesalazine in IBS [31-34]. It is uncertain, however, if
only those with evidence of microscopic inflammation will respond to anti-inflammatory
therapy, thereby necessitating the use of routine colonoscopy in order to provide a more
individualised approach to the management of these patients.
The low colonoscopic yield among IBS patients in this study is noteworthy. No macroscopic
abnormalities were seen in subjects under the age of forty and it is also reassuring to note that
no significant pathology was identified in the older adults. In fact, our findings were very
similar to a large study carried out in USA where findings of polyps, diverticular disease and
haemorrhoids in subjects with IBS were no different to that of asymptomatic controls [35].
While it is certainly reasonable to still offer colonoscopy in older patients with IBS for
colorectal cancer screening, the study emphasizes the importance of careful history taking in
stratifying patients who do or do not require colonoscopy and those who require it urgently or
otherwise. This is especially relevant in Malaysia, which is still considered a developing
8. country, with limited endoscopic facilities and only 106 registered gastroenterologists in a
population of 25 million [36].
There are several limitations of the study. The study sample was small and patients were
derived from secondary care, which may not be representative of IBS patients in the
community. As IBS, like other functional GI diseases, is rarely life-threatening, medical
consultation rates amongst sufferers are known to be low. CD3 staining for lymphocytes was
not carried out which may have resulted in an under-diagnosis of lymphocytic colitis [37].
Screening for Coeliac Disease, rare among our population but known to be associated with
collagenous colitis, was not performed. However, the merits of this study lay in our strict
adherence to the Rome III criteria and systematic sampling of colonic mucosal tissue,
providing an accurate estimation of inflammation in an Asian population with IBS-D.
Conclusions
In this prospectively conducted study, we have found a significant proportion of patients with
IBS-D who have evidence of colonic inflammation on biopsies which may be part of a
microscopic colitis spectrum. This further adds to the growing evidence for the role of
inflammation which will hopefully result in increasing the therapeutic options for the
management of this common but difficult to treat condition.
Competing interests
All authors declare no competing interests in the conduct of this study and preparation of the
manuscript.
Authors’ contributions
IH - research design, drafting of manuscript; JLH - research design, acquisition of data; JP -
analysis and interpretation of results; SM - research design, acquisition of data, critical
review of manuscript; GKL - critical review of manuscript. All authors read and approved the
final manuscript.
Acknowledgements
This study was funded by a University of Malaya Research Grant (UMRG), No:
RG027/09HTM
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