General practitioners' management of symptomatic uncomplicated diverticular disease of the colon by using rifaximin, a non-adsorbable antibiotic

OBJECTIVE

Symptomatic uncomplicated diverticular disease of the colon (SUDD) is generally managed by gastroenterologists rather than General Practitioners (GPs). The aim of this study was to assess the efficacy of the treatment of SUDD with rifaximin, a non-absorbable antibiotic, in a primary care setting by GPs.

PATIENTS AND METHODS

This retrospective, observational study investigated the use of rifaximin at a dose of 400 mg b.i.d. for 5, 7 or 10 days monthly, up to 3 months. The symptoms were reported by the patients using a visual analogic scale (VAS) of 0-10.

RESULTS

286 SUDD patients were enrolled (44.4% of men, average age 70.92±10.98). Respectively, 15 (5.2%) patients received the treatment for 5 days, 205 (71.7%) for 7 days and 66 (23.1%) for 10 days. After three months, a significant reduction of VAS score was observed in almost all symptoms assessed: 135 (47.2%) patients reported no abdominal pain (p<0.001) and 23 (8.1%) reported no symptom. Adverse events related to the treatment were recorded in 3 (1.04%) patients, all of them mild and not requiring interruption of the treatment. Acute diverticulitis occurred in 9 (3.1%) patients, but only 2 of them [0.7% (n=2)] underwent surgery due to complicated diverticulitis. Analysis within the different treatment groups (5, 7 and 10 days) shows that rifaximin treatment is effective in reducing the severity of symptoms in almost all groups except for the constipation in the 5-day group.

CONCLUSIONS

Rifaximin can be effectively used by GPs in real-life for the management of SUDD.

Real-world use and accuracy of stress echocardiography: preliminary insights from the EVAREST study

Background

Stress echocardiography is a widely used, non-invasive imaging modality used to identify prognostically significant coronary artery disease. High levels of accuracy have been reported, however this is highly dependent on operator training and image quality. There are currently limited data available on the accuracy of stress echo in every day clinical practice.

Purpose

The EVAREST study links stress echo clinics in 30 NHS Hospital Trusts in England and therefore provides data to evaluate the performance and diagnostic accuracy of stress echo in “real-world” clinical practice.

Methods

Analysis was performed on the first 7415 patients recruited prospectively between 2015 and January 2020. Participants are included if they have undergone stress echo to investigate for ischaemic heart disease. Data is collected on medical history and stress echo performance. Participants are followed up for 12 months through health records and patient phone call, with all outcomes undergoing expert adjudication. A positive cardiac outcome is defined as initiation of anti-anginal medications, ≥70% stenosis on coronary angiography, revascularisation, confirmed acute coronary syndrome or cardiac-related death.

Results

Mean age of patients undergoing stress echo is 65±12.3 years and 56% are male. Average BMI is 28.9±5.6 kg/m2. 71.4% undergo dobutamine stress (DSE) and 28.4% exercise with &lt;1% having a pacemaker-mediated stress. Contrast was used in 71.4% of studies. Stress echos were interpreted at time of clinic visit as positive for inducible ischaemia in 18.2% of patients. One-year outcome data is currently available for 1892 participants. Sensitivity and specificity for clinician prediction of a positive cardiac outcome was 88.7% and 94.4%, respectively. Positive and negative predictive value of stress echo was 76.4% and 97.6%, respectively.

Conclusion

EVAREST provides unprecedented, large-scale information on the “real world” use and accuracy of stress echo across different healthcare settings in the UK, demonstrating performance consistent with best practice. Ongoing data collection will be used to evaluate sources of heterogeneity in the predictive accuracy of stress echo and identify optimal approaches to further improve performance.

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): Ultromics Ltd., Lantheus Ltd.

Spreading of COVID-19 in Italy as the spreading of a wave packet

We find that the spreading of the COVID-19 pandemic in Italy can be described as the propagation of a wave packet in a dispersive medium where the effect of lockdown is simulated by the dispersion relation of the medium. We start expanding a previous statistical analysis based on the official data provided by the Italian Civil Protection during 100 days, from March 2nd to June 9th. As the total number of people infected with the virus is uncertain, we have considered the trend of ICU patients and the sum of hospitalized patients and the deceased. Both the corresponding curves are well approximated by the same function depending on four free parameters. The model allows to predict the short-term behavior of the pandemic and to estimate the benefits due to lockdown measures.

Dependence of the electron-cloud instability on the beam energy

The electron cloud (EC) can be formed in the beam pipe of a circular accelerator if the secondary emission yield (SEY) of the inner surface is larger than 1, and it can detrimentally affect the circulating beam. Understanding the underlying physics and defining the scaling laws of this effect is indispensable to steer the upgrade plans of the existing machines and the design of new ones. The single bunch EC instability (ECI) is shown to be strongly affected by the transverse beam size. Transversely, smaller beams going through an electron cloud generate higher electron peak densities and lower the intensity threshold to make the beam unstable. In particular, since higher energy beams have smaller transverse sizes (for equal normalized transverse emittances), the scaling of the ECI threshold with the beam energy turns out to be surprisingly unfavorable.

Incoherent effects of electron clouds in proton storage rings

Electron clouds in the beam pipe of high-energy proton or positron storage rings can give rise to significant incoherent emittance growth, at densities far below the coherent-instability threshold. We identify two responsible mechanisms: namely, (1) a beam particle periodically crosses a resonance and (2) a beam particle periodically crosses a region of the bunch where its motion is linearly unstable. Formation of halo or beam-core blow up, respectively, are the result. Key ingredients for both processes are synchrotron motion and electron-induced tune shift. The mechanisms considered provide a possible explanation for reduced beam lifetime and emittance growth observed at several operating accelerators. Similar phenomena are likely to occur in other two-stream systems.

Subungual myxoid pleomorphic fibroma

The authors report an example of pleomorphic fibroma in a unique site: the subungual space of the thumb. A 54-year-old man presented with paronychia and markedly thickened hyperkeratotic nail. The nail plate was removed, and an exophytic, red, friable, granulation tissue-like lesion was revealed subungually. The lesion was diagnosed clinically as pyogenic granuloma. Excisional biopsy was performed. Histologically, the lesion showed a hypocellular fibroma with myxoid areas and dilated blood vessels. Interspersed with ordinary appearing fibroblasts, there were bizarre, atypical fibroblasts with hyperchromatic and large, pleomorphic nuclei and multinucleated floret-like giant cells. These atypical cells showed strong immunoreactivity with antibodies against CD34 and vimentin. Occasional positivity was noted with factor XIIIa and alpha-1-antichymotrypsin, whereas no reactivity occurred with alpha-1-antitrypsin, actin, or S-100 protein. The entity of pleomorphic fibroma has been reported in many body sites; however, this is the first case to be reported in the subungual space.

Theory of mind and rule use in individuals with Down's syndrome: a test of the uniqueness and specificity claims

The relationship between Theory of Mind (ToM) and rule use was explored in adults with Down's Syndrome (DS) and in non-handicapped pre-schoolers. Twelve low-functioning individuals with DS (mean mental age = 5.1 years, mean chronological age = 22.7) performed worse than 12 MA-matched non-handicapped children (mean MA = 5.1 years) on several standard ToM tasks and on a color-shape card-sorting task in which subjects were required to switch between two incompatible sets of rules. On the ToM tasks, people with DS tended to focus on a single state of affairs (e.g. the present situation). Likewise, on the card sort, these subjects tended to use a single set of rules on all trials. Performance in the two types of task was positively correlated when MA was partialed out. The results are inconsistent with the slaim that ToM reflects a domain-specific psychological function and the notion that deficits in ToM are unique to individuals with autism.

[Use of the glycosylated hemoglobin test in outpatient practice]

Haemoglobin glycosilate was evaluated using the bio-rad method in 129 diabetics during their periodic visits to outpatient departments. A significant correlation between this test and metabolic compensation was revealed in confirmation of results reported in most research so far carried out. The advantages of using this test in outpatients departments is also emphasised.

[Anomalous immunoelectrophoretic behavior of ceruloplasmin in severely burned patients]

Laurell's two-dimensional technique was employed in a study of the immunoelectrophoretic behaviour of caeruloplasmin in 10 major burn cases. A double peak was noted throughout the entire course. The second peak disappeared on recovery whereas it persisted and was well marked in the case of those who died. It is suggested that this pattern reflects the severe liver damage sustained by burn patients.