The Disease Severity Index for Inflammatory Bowel Disease Is a Valid Instrument that Predicts Complicated Disease

BACKGROUND

The disease severity index (DSI) for inflammatory bowel disease (IBD) combines measures of disease phenotype, inflammatory activity, and patient-reported outcomes. We aimed to validate the DSI and assess its utility in predicting a complicated IBD course.

METHODS

A multicenter cohort of adults with IBD was recruited. Intraclass correlation coefficients (ICCs) and weighted Kappa assessed inter-rater reliability. Cronbach's alpha measured internal consistency of DSI items. Spearman's rank correlations compared the DSI with endoscopic indices, symptom indices, quality of life, and disability. A subgroup was followed for 24 months to assess for a complicated IBD course. Area under the receiver operating characteristics curve (AUROC) and multivariable logistic regression assessed the utility of the DSI in predicting disease progression.

RESULTS

Three hundred and sixty-nine participants were included (Crohn's disease [CD], n = 230; female, n = 194; mean age, 46 years [SD, 15]; median disease duration, 11 years [interquartile range, 5-21]), of which 171 (CD, n = 99; ulcerative colitis [UC], n = 72) were followed prospectively. The DSI showed inter-rater reliability for CD (ICC 0.93, n = 65) and UC (ICC 0.97, n = 33). The DSI items demonstrated inter-rater agreement (Kappa > 0.4) and internal consistency (CD, α > 0.59; UC, α > 0.75). The DSI was significantly associated with endoscopic activity (CDn=141, r = 0.65, P < .001; UCn=105, r = 0.80, P < .001), symptoms (CDn=159, r = 0.69, P < .001; UCn=132, r = 0.58, P < .001), quality of life (CDn=198, r = -0.59, P < .001; UCn=128, r = -0.68, P < .001), and disability (CDn=83, r = -0.67, P < .001; UCn=52, r = -0.74, P < .001). A DSI of 23 best predicted a complicated IBD course (AUROC = 0.82, P < .001) and was associated with this end point on multivariable analyses (aOR, 9.20; 95% confidence interval, 3.32-25.49).

CONCLUSIONS

The DSI reliably encapsulates factors contributing to disease severity and accurately prognosticates the longitudinal IBD course.

Bilateral ankle syndesmosis injury: a rare case report

This report describes a case of bilateral acute ankle syndesmosis injuries in a 15-year-old male basketball player. The patient had a background of previous inversion injuries but no symptoms of chronic pain or instability. The case report illustrates the importance of clinical suspicion when evaluating acute syndesmosis injuries in conjunction with radiographic assessments in primary care. This is the first reported case of such injury in bilateral limbs.

Bilateral ankle syndesmosis injury: a rare case report

This report describes a case of bilateral acute ankle syndesmosis injuries in a 15-year-old male basketball player. The patient had a background of previous inversion injuries but no symptoms of chronic pain or instability. The case report illustrates the importance of clinical suspicion when evaluating acute syndesmosis injuries in conjunction with radiographic assessments in primary care. This is the first reported case of such injury in bilateral limbs.

Bilateral ankle syndesmosis injury: a rare case report

This report describes a case of bilateral acute ankle syndesmosis injuries in a 15-year-old male basketball player. The patient had a background of previous inversion injuries but no symptoms of chronic pain or instability. The case report illustrates the importance of clinical suspicion when evaluating acute syndesmosis injuries in conjunction with radiographic assessments in primary care. This is the first reported case of such injury in bilateral limbs.

Nutritional strategies of British professional and amateur natural bodybuilders during competition preparation

BACKGROUND

To prepare for competition, bodybuilders employ strategies based around: energy restriction, resistance training, cardiovascular exercise, isometric "posing", and supplementation. Cohorts of professional (PRO) natural bodybuilders offer insights into how these strategies are implemented by elite competitors, and are undocumented in the scientific literature.

METHODS

Forty-seven competitors (33 male (8 PRO, 25 amateur (AMA), 14 female (5 PRO, 9 AMA) participated in the study. All PROs were eligible to compete with the Drug Free Athletes Coalition (DFAC), and all AMAs were recruited from the British Natural Bodybuilding Federation (BNBF). Competitors in these organisations are subject to a polygraph and are drug tested in accordance with the World Anti-Doping Agency. We report the results of a cross-sectional study of drug free bodybuilders competing at BNBF qualifying events, and the DFAC and World Natural Bodybuilding Federation finals. Participants completed a 34-item questionnaire assessing dietary intake at three time points (start, middle and end) of competition preparation. Participants recorded their food intake over a 24-h period in grams and/or portions. Dietary intakes of PRO and AMA competitors were then compared. Repeated measures ANOVA was used to test if nutrient intake changed over time, and for associations with division.

RESULTS

Male PROs reported significantly (p < 0.05) more bodybuilding experience than AMAs (PRO: 12.3 +/- 9.2, AMA: 2.4 +/- 1.4 yrs). Male PROs lost less body mass per week (PRO: 0.5 +/- 0.1, AMA: 0.7 +/- 0.2%, p < 0.05), and reported more weeks dieting (PRO: 28.1 +/- 8.1, AMA: 21.0 +/- 9.4 wks, P = 0.06). Significant differences (p < 0.05) of carbohydrate and energy were also recorded, as well as a difference (p = 0.03) in the estimated energy deficit (EED), between male PRO (2.0 +/- 5.5 kcal) and AMA (- 3.4 +/- 5.5 kcal) competitors.

CONCLUSIONS

Longer diets and slower weight loss utilized by PROs likely contributed towards a lower EED compared to the AMAs. Slower weight loss may constitute an effective strategy for maintaining energy availability and muscle mass during an energy deficit. These findings require corroboration, but will interest bodybuilders and coaches.

Can the Platelet Function Analyzer (PFA)-100 test substitute for the template bleeding time in routine clinical practice?

The bleeding time (BT) is widely used in clinical medicine as a screening test of platelet function, although its deficiencies in such a role are well recognized. The Platelet Function Analyzer (PFA)-100 measures the ability of platelets activated in a high-shear environment to occlude an aperture in a membrane treated with collagen and epinephrine (CEPI) or collagen and ADP (CADP). The time taken for flow across the membrane to stop (closure time) is recorded. This study compared the PFA-100 with the BT as a screening test of platelet dysfunction in 113 hospital inpatients. The PFA-100 test was performed initially using the CEPI cartridge; CADP tests were performed on those with abnormal (> 163 s) CEPI closure times. Whole blood platelet aggregation studies and chart review were performed on patients in whom the BT and PFA-100 results did not agree.Abnormal bleeding times and PFA-100 results were obtained in 20.4% and 35.4% of patients, respectively. The results of BT and PFA-100 agreed in 74.3% of patients. Of the 29 patients in whom the BT and PFA-100 results were discordant, whole blood platelet aggregation studies supported the PFA-100 result in 25 (86.2%). The PFA-100 was more sensitive to aspirin-induced platelet dysfunction and was more rapidly and cheaply performed than the BT. Since the PFA-100 test reflects platelet function better than the BT, we conclude that this test could replace the BT as a first-line screening test for platelet dysfunction in clinical practice.

Determinants of family care giver reaction. New and recurrent cancer

PURPOSE

The authors examined the interaction of patient and care giver variables and identified whether changes in new and recurrent patients' levels of symptoms, functioning, and depression were related to changes in care givers' reactions to providing care.

DESCRIPTION OF STUDY

During a 6-month observation period, the psychosocial status and burden of a matched sample of patients with either new or recurrent cancer and their family care givers were assessed and compared.

RESULTS

Care givers of patients with recurrent disease experienced a marginally significantly different impact on depression over time. The type of disease (new or recurrent) did not impact care givers reactions to the care they were providing for patients. Instead, patients' symptoms and symptom experience incurred a greater impact on care giver depression.

CLINICAL IMPLICATIONS

The impact of cancer on patients and family care givers must be evaluated carefully and thoroughly, regardless of whether the diagnosis is new or recurrent. Patients' symptoms and symptom experience, mobility, and dependencies in instrumental activities of daily living are primary influences in creating emotional burden and depression in the family care giver of the patient diagnosed with new and with recurrent cancer.

Are postoperative activity restrictions necessary after posterior lumbar discectomy? A prospective study of outcomes in 50 consecutive cases

STUDY DESIGN

A prospective clinical trial was conducted.

OBJECTIVES

To determine if removing activity restrictions after surgery and encouraging early return to work would affect clinical outcomes after lumbar discectomy.

SUMMARY OF BACKGROUND INFORMATION

Current practice usually recommends several weeks to months of restricted activities after lumbar discectomy. No formal studies have been done to determine the optimal period of restriction, if any, after surgery.

METHODS

Fifty consecutive patients undergoing limited open discectomy for herniated lumbar intervertebral disc were prospectively treated with no restrictions at all after surgery and were urged to return to full activities as soon as possible. The patients were followed for a minimum of 2 years. At follow-up evaluation, an independent examiner evaluated each patient.

RESULTS

The mean time from surgery to return to work was 1,7 weeks. Eleven of 44 (25%) patients returned to work on the next work day. Ninety-seven percent of patients who were working before surgery returned to their previous work. Forty-three of 44 (97%) patients had returned to full duty by 8 weeks after surgery. At follow-up evaluation (3.8 years), five patients had changed work; three patients increased their work level, and two decreased their work level. No patient changed employment because of back or leg pain. There were three reherniations at the operative level (6%), all occurring more than 1 year after surgery. One patient required reoperation. Back and leg pain scores at follow-up evaluation were very low.

CONCLUSION

Lifting of postoperative restrictions after limited discectomy allowed shortened sick leave without increased complications. Postoperative precautions in these patients may not be necessary.

[Aortic dissection and pregnancy. Apropos of a case]

Aortic dissection is a serious disease which rarely affects young women. In this context, it occurs in nearly one out of two cases during pregnancy, usually during the third term. The authors report acute dissection of the ascending aorta (de Bakey type 2) during pregnancy for which rapid cardiothoracic surgical management as a semi-emergency resulted in a favourable outcome for mother and child.