Risk Factors Affecting 90-day Readmission of Patients with Inflammatory Bowel Disease

BACKGROUND: The rate of hospital readmission is seen as a measure of quality and accountability. Knowing the risk factors that can be changed could reduce the cost burden on patients with inflammatory bowel disease (IBD) and the health system. METHODS: Retrospective analysis was performed on the data extracted from hospital records during a 4-year period. The study setting encompassed three referral hospitals in Tehran and the south of Iran. The primary outcome was hospital readmission of patients with IBD. The factors associated with binary and categorical dependent variables were analyzed using robust logistic regression and multinomial logistic regression, respectively. The significance level was set at P=0.05. RESULTS: 187 patients were admitted during the 4-year study period for an IBD-related reason, among whom 131 patients (70.1%) had ulcerative colitis (UC), and 56 patients (29.9%) had Crohn's disease (CD). Moreover, 29% (55) of the participants had been readmitted at least once during the study period, and seven patients with IBD had been readmitted five or more times during the study period. Corticosteroids (OR=4.55, 95% confidence interval CI: 1.65- 12.55) and chronic pain (OR=6.65, 95% CI: 1.73-25.62) were two factors associated with their readmission within 90 days. For the patients with five or more times of readmissions, Corticosteroids (RRR=5.68), chronic pain (RRR=5.05), length of hospital stay (RRR=0.69), and age (RRR=0.9) could significantly explain the hospital readmissions. CONCLUSION: About one in seven hospitalizations of patients with IBD leads to 30-day readmission. Moreover, younger patients with IBD and shorter length of hospital stay were more likely to be readmitted five or more times during the study period. The use of corticosteroids and the presence of chronic pain were predictors of 90-day readmission. More studies are needed to detect the best management plan for chronic pains.

The effect of date versus sugar on sensory, physicochemical, and antioxidant properties of ice cream

BACKGROUND

Despite the popularity of ice cream, its high content of sugar and fat is worrisome. Substituting sugar with natural and useful resources is one possible solution. Dates (Phoenix dactylifera) are rich in carbohydrates and are a good source of energy; they also have a large amount of phenolic compounds and anthocyanin.

AIMS

The aim of this study is to evaluate the effect of ice cream sugar replacement with date products.

METHODS

Accordingly, four ice cream samples with different sweeteners including 1) sucrose (as a control), 2) date pulp + sucrose, 3) date liquid sugar, and 4) sucrose + date liquid sugar, were produced. Total phenolics, anthocyanins, and antioxidant activities of dates and their effects on physicochemical and sensory properties of ice cream were investigated.

RESULTS

A large amount of phenolic compounds and anthocyanin was found in the ice cream contained date pulp and liquid sugar, which enhanced the reducing power and antioxidant effect of it. The overrun and density of an ice cream did not change with sugar replacement. Total substitution of sucrose by date liquid sugar, increased the titratable acidity, viscosity, and antioxidant properties of ice cream, but it was found to have some negative effects on the organoleptically score of color. However, the partial replacement of granular sugar with date pulp/liquid sugar, improved the antioxidant value of this dairy dessert without any change in its color.

CONCLUSION

It seems that the addition of date pulp to an ice cream, not only maintain the quality and sensory properties of an ice cream, but also provides an antioxidant property.

Assessment of the Effects of IL9, IL9R, IL17A, and IL17F Gene Polymorphisms on Women with Allergic Rhinitis in Shahrekord, Iran

Background:

The genes encoding IL9, IL9R, IL17A, and IL17F have recently been implicated in the genetic basis of rhinitis and allergy.

Aim:

The purpose of this study was to assess the association of the single nucleotide polymorphisms (SNPs) of IL9, IL9R, IL17A, and IL17F and potential interaction of these genes with the determination of IgE levels in women with allergic rhinitis (AR) in Shahrekord, Iran.

Subjects and Methods:

In a case–control study, SNPs from the IL9, IL9R, IL17A, and IL17F were genotyped in 394 random samples including 195 AR patients and 199 normal controls. Enzyme-linked immunosorbent assay was performed for the determination of serum total IgE levels. The Student's t-test was used to compare the differences. The Chi-square test was performed to compare proportions of cases with different clinical features among cases with different genotypes. The genotype and allele frequencies were obtained by direct counting. Hardy–Weinberg equilibrium was tested between cases and controls separately. The relative risk associated with rare alleles was estimated as an odds ratio with 95% confidence interval. P ≤ 0.05 was considered statistically significant.

Results:

The rs731476 SNP in the IL9R was significantly associated with the AR phenotype in women. No association was found between any of the other SNPs in IL9, IL17A, and IL17F genes and AR. In the gene–gene interaction analysis, we found that IL9R/IL9 genotype rs731476 T-/rs2069885 G conferred a higher risk for AR phenotype development. We also did not find a significant association in terms of IgE levels between cases and controls.

Conclusion:

Our result suggests that the rs731476 SNP located in the IL9R is associated with an increased susceptibility to AR in females. In a subsequent gene–gene interaction analysis, the rs731476 T-/rs2069885 G-genotype combination (IL9R/IL9) has significantly been associated with the development of the AR phenotype.

Detection of IgM and IgG anti-Toxoplasma antibodies in renal transplant recipients using ELFA, ELISA and ISAGA methods: comparison of pre- and post-transplantation status

In the transplant recipient patients receive immunosuppressive therapy, the possibility of reactivation of the old infection or acquisition of infection from a donor's tissue increases. In this study, IgM and IgG anti-Toxoplasma immunoglobulins seroconversion in renal transplant recipients (RTRs) have been evaluated before and after transplantation. This is a prospective cohort study on a total of 102 RTRs. Two serum samples were obtained from each patient. The first was taken before administration of any immunosuppressive drugs such as corticosteroids and the second was taken 3 months after transplantation. The IgM and IgG anti-Toxoplasma antibodies were assayed by enzyme-linked flourescence assay (ELFA) and enzyme-linked immunosorbent assay (ELISA) techniques. IgM/immunosorbent agglutination assay (ISAGA) method has also been used. All RTRs were tested for toxoplasmosis before and after transplantation. ELFA identified 65 (63·7%) pre-transplantation samples as IgG+ and did not detect any positive IgM samples. However, IgM was detected in three (2·9%) post-transplantation samples by this method. Forty-nine (48%) pre-transplantation samples were reported IgG+ by ELISA and no IgM positive sample was identified by this method. ELISA has detected two (1·9%) IgM-positive reactions in post-transplantation samples. By IgM/ISAGA method, we have detected no IgM positive reactions in pre-transplantation samples, whereas 3 months later (second sampling) IgM antibody was detected in 3 (2·9%) cases. Secondary toxoplasmosis infection was observed in 30 cases per 1000 RTRs, which indicates that screening for toxoplasmosis infection should be performed in developed countries for these patients. On the other hand, as the risk of re-active toxoplasmosis infection exists in developing nations, they should consider the necessary preventive measures to control this condition.

Regional differences in intramyocellular lipids in humans observed by in vivo 1H-MR spectroscopic imaging

Regional differences in the content of intramyocellular lipids (IMCL), extramyocellular lipids, and total creatine (TCr) were quantified in soleus (S), tibialis posterior (TP), and tibialis anterior (TA) muscles in humans using in vivo 1H proton spectroscopic imaging at 4 T. Improved spatial resolution (0.25-ml nominal voxel resolution) made it feasible to measure IMCL in S, TP, and TA simultaneously in vivo. The most significant regional difference was found in the content of IMCL compared with extramyocellular lipids or TCr. The concentrations of TCr were found to be 29-32 mmol/kg, with little regional variation. IMCL content was measured to be 4.8 +/- 1.6 mmol/kg tissue wt in S, 2.8 +/- 1.3 mmol/kg tissue wt in TP, and 1.6 +/- 0.9 mmol/kg tissue wt in TA in the order of S > TP > TA (P < 0.05). It is likely that these IMCL values are consistent with the known fiber types of these muscles, with S having the greatest fraction of type I (slow-twitch, oxidative) fibers and TA having a large fraction of type IIb (fast-twitch, glycolytic) fibers.