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Patel A, Krishnapura Lakshminarayana S, Kumble D, Kariyappa M, Ramkumar G, Anilkumar H, Bhattad S. Enteritis: a window to the diagnosis of systemic lupus erythematosus in an adolescent girl: case report. Paediatr Int Child Health 2024; 44:42-47. [PMID: 38184810 DOI: 10.1080/20469047.2023.2299581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 12/20/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Enteritis is one of the rare systemic manifestations in childhood-onset systemic lupus erythematosus and its diagnosis is very challenging. This is a rare case of an adolescent girl with recurrent non-specific gastro-intestinal symptoms which were later diagnosed to be owing to lupus enteritis, the only presenting manifestation of an active flare. CASE REPORT A 15-year-old girl was admitted with recurrent episodes of abdominal pain, vomiting and loose stools. She had diffuse abdominal tenderness. Abdominal ultrasonography demonstrated moderate ascites. A contrast-enhanced abdominal computerised tomography scan revealed thickening of the small bowel wall. On colonoscopy, there were rectal erosions, and microscopic examination of the biopsy specimens demonstrated mild inflammation. Non-specific enteritis was diagnosed and she was given antibiotics and supportive care. She was re-admitted 6months later with abdominal pain. An abdominal contrast-enhanced computerised tomography scan revealed thickening of the bowel wall and the target sign and comb sign in the small intestine. The anti-nuclear antibody was positive. Renal biopsy demonstrated grade 2 lupus nephritis. Lupus enteritis was diagnosed and the case satisfied the 2019 EULAR-ACR criteria and SLICC criteria. She was treated with methylprednisolone, cyclophosphamide and hydroxychloroquine. She improved with treatment and has remained asymptomatic during follow-up. CONCLUSION This case emphasises the need for healthcare providers to be alert to the possibility of lupus enteritis. It also highlights the importance of close follow-up of cases who have non-specific gastro-intestinal symptoms. Lupus enteritis should be considered in the differential diagnosis of recurrent non-specific gastro-intestinal symptoms in children, especially adolescents, to ensure timely diagnosis and treatment.Abbreviations: ACR American College of Rheumatology; ANA anti-nuclear antibody; CRP: C-reactive protein; CT: computerised tomography; CECT: contrast-enhanced computerised tomography; EULAR: European League Against Rheumatism; GI: gastro-intestinal; LE: lupus enteritis; SLE systemic lupus erythematosis; SLICC: Systemic Lupus International Collaborating Clinics; SLEDAI: SLE disease activity index.
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Affiliation(s)
- Ashray Patel
- Department of Paediatrics, Vani Vilas Hospital, Bangalore Medical College and Research Institute, Bengaluru, India
| | | | - Dhanalakshmi Kumble
- Department of Paediatrics, Vani Vilas Hospital, Bangalore Medical College and Research Institute, Bengaluru, India
| | - Mallesh Kariyappa
- Department of Paediatrics, Vani Vilas Hospital, Bangalore Medical College and Research Institute, Bengaluru, India
| | - Gautham Ramkumar
- Department of Paediatrics, Vani Vilas Hospital, Bangalore Medical College and Research Institute, Bengaluru, India
| | - H Anilkumar
- Department of Paediatrics, Vani Vilas Hospital, Bangalore Medical College and Research Institute, Bengaluru, India
| | - Sagar Bhattad
- Division of Paediatric Immunology and Rheumatology, Department of Paediatrics, Aster CMI Hospital, Bengaluru, India
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Humphries C, Gillings M. RCEM best practice guideline: suspected cannabinoid hyperemesis syndrome in emergency departments. Emerg Med J 2024; 41:328-331. [PMID: 38448215 DOI: 10.1136/emermed-2024-213886] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 02/26/2024] [Indexed: 03/08/2024]
Abstract
Cannabinoid hyperemesis syndrome (CHS) is an episodic syndrome of cyclic vomiting in the context of the prolonged use of cannabis. The Royal College of Emergency Medicine Toxicology Special Interest Group has produced guidance to support emergency medicine clinicians with the recognition and treatment of people experiencing CHS.Considerations regarding recognition, investigation and communication are discussed, and recommendations regarding treatment options (which include haloperidol and capsaicin) are made. There is a focus on making recommendations on the best available evidence.
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van Aken GA. Computer modeling of digestive processes in the alimentary tract and their physiological regulation mechanisms: closing the gap between digestion models and in vivo behavior. Front Nutr 2024; 11:1339711. [PMID: 38606020 PMCID: PMC11007706 DOI: 10.3389/fnut.2024.1339711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/15/2024] [Indexed: 04/13/2024] Open
Abstract
Introduction A model has been developed for in silico simulation of digestion and its physiological feedback mechanisms. Methods The model is based on known physiology described in the literature and is able to describe the complexity of many simultaneous processes related to food digestion. Results Despite the early stage of development of the model, it already encompasses a large number of processes that occur simultaneously, enabling the prediction of a large number of post-prandial physiological markers, which can be highly functional in combination with in vitro, organ-on-a-chip and digital twin models purposed to measure the physiological properties of organs and to predict the effect of adjusted food composition in normal and diseased states. Discussion Input from and collaboration between science fileds is needed to further develop and refine the model and to connect with in vitro, in vivo, and ex vivo (organ-on-a-chip) models.
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Matsuura H, Kageyama H. An elderly man with chronic poor appetite. Emerg Med J 2024; 41:241-274. [PMID: 38514202 DOI: 10.1136/emermed-2023-213697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2023] [Indexed: 03/23/2024]
Affiliation(s)
- Hiroki Matsuura
- Emergency Medicine, Okayama City Hospital, Okayama, Japan
- General Internal Medicine, Okayama City Hospital, Okayama, Japan
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Matsuura H, Imajo K. Pale man with recurrent epistaxis. Emerg Med J 2023; 40:725-738. [PMID: 37758294 DOI: 10.1136/emermed-2022-212680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2023] [Indexed: 10/03/2023]
Affiliation(s)
- Hiroki Matsuura
- General Internal Medicine, Okayama City Hospital, Okayama, Japan
| | - Kenji Imajo
- Hematology, Okayama City Hospital, Okayama, Japan
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Al Taei T, Yusuf Z, Al Mail S, Bunajem F, Abdulrahim B, Meshkhas M, Sulail K. Abdominal Imaging Findings in Laboratory-Confirmed COVID-19 Patients: A Retrospective Observational Study. Cureus 2023; 15:e42677. [PMID: 37649952 PMCID: PMC10463944 DOI: 10.7759/cureus.42677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND AND AIM Coronavirus disease 2019 (CO-VID-19) is known to predominantly present with respiratory symptoms; however, a significant proportion of patients present with digestive symptoms. These symptoms are often non-specific and as such prompt the treating physician to request further imaging evaluation. Understanding the abdominal imaging findings in COVID-19 and their possible associations is thus crucial to direct patient care and prevent misdiagnosis. The aim of this study was to describe abdominal imaging findings on both computed tomography (CT) and ultrasound scans in cases with positive COVID-19 polymerase chain reaction (PCR) tests performed at our institution, and also, to evaluate the reason for requesting these imaging studies, and to correlate these findings with patients' demographics. METHODS A retrospective observational study was conducted at Salmaniya Medical Complex, Bahrain, between February 2021 and March 2022. We examined the abdominal CT and ultrasound data for PCR-confirmed COVID-19 patients. The demographic data, reason for requesting imaging and imaging findings were gathered by reviewing the hospital's electronic health records and picture archiving and communicating system (PACS). RESULTS The study included 97 patients, with the majority being male (57.7%). The most common reason for imaging was abdominal pain, as seen in over half of the patients (60.8%), followed by deranged liver enzymes (18.6%). More than 75% of imaging studies showed positive abdominal findings with the majority (19.6%) showing non-specific inflammatory findings, followed by gallbladder disease (13.4%). The CT studies were more likely to yield positive findings as compared to ultrasound, with only 7 (11.3%) CT scans yielding normal findings (χ2 = 14.65; P < 0.01). CONCLUSION To our knowledge, the research conducted on the abdominal manifestations of COVID-19 is still limited, especially in our region. Our study showed that there are variable presentations of abdominal organ involvement in COVID-19 cases, and as such more data is required to direct choice of imaging study, protocol, and interpretation of findings to better guide patient management.
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Affiliation(s)
| | - Zainab Yusuf
- Radiology, Salmaniya Medical Complex, Manama, BHR
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Elmansi Abdalla HE, Nour HM, Qasim M, Magsi AM, Sajid MS. Appendiceal Foreign Bodies in Adults: A Systematic Review of Case Reports. Cureus 2023; 15:e40133. [PMID: 37425596 PMCID: PMC10329456 DOI: 10.7759/cureus.40133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2023] [Indexed: 07/11/2023] Open
Abstract
Adults can accidentally swallow foreign bodies (FBs) with food. In rare occasions, these can lodge in the appendix lumen causing inflammation. This is known as foreign body appendicitis. We conducted this study to review different types and management of appendiceal FBs. A comprehensive search on PubMed, MEDLINE, Embase, Cochrane Library and Google Scholar was performed to detect appropriate case reports for this review. Case reports eligible for this review included patients above 18 years of age with all types of FB ingestion causing appendicitis. A total of 64 case reports were deemed to be eligible for inclusion in this systematic review. The patient mean age was 44.3 ± 16.7 years (range, 18-77). Twenty-four foreign bodies were identified in the adult appendix. They were mainly lead shot pellet, fishbone, dental crown or filling, toothpick, and others. Forty-two percent of the included patients presented with classic appendicitis pain, while 17% were asymptomatic. Moreover, the appendix was perforated in 11 patients. Regarding modalities used for diagnosis, computed tomography (CT) scans confirmed the presence of FBs in 59% of cases while X-ray only managed to detect 30%. Almost all of the cases (91%) were treated surgically with appendicectomy and only six were managed conservatively. Overall, lead shot pellets were the most common foreign body found. Fishbone and toothpick accounted for most of the perforated appendix cases. This study concludes that prophylactic appendicectomy is recommended for the management of foreign bodies detected in the appendix, even if the patient is asymptomatic.
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Affiliation(s)
| | - Hussameldin M Nour
- Department of Digestive Disease and General Surgery, Royal Sussex County Hospital, Brighton, GBR
| | - Muhammad Qasim
- Department of Digestive Disease and General Surgery, Royal Sussex County Hospital, Brighton, GBR
| | - Abdul Malik Magsi
- Department of Digestive Disease and General Surgery, Royal Sussex County Hospital, Brighton, GBR
| | - Muhammad S Sajid
- Department of Digestive Disease and General Surgery, Royal Sussex County Hospital, Brighton, GBR
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Balasubramanian B, Liu WC, Kim IH. Editorial: Application of natural bioactive compounds in animal nutrition. Front Vet Sci 2023; 10:1204490. [PMID: 37261114 PMCID: PMC10227608 DOI: 10.3389/fvets.2023.1204490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 05/02/2023] [Indexed: 06/02/2023] Open
Affiliation(s)
| | - Wen-Chao Liu
- Department of Animal Science, College of Coastal Agricultural Sciences, Guangdong Ocean University, Zhanjiang, China
| | - In Ho Kim
- Department of Animal Resource and Science, Dankook University, Cheonan-si, Chungnam, Republic of Korea
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Pognonec C, Dirhoussi Z, Cury N, Moreau M, Billard C, Yordanov Y, Thiebaud PC. External validation of Glasgow-Blatchford, modified Glasgow-Blatchford and CANUKA scores to identify low-risk patients with upper gastrointestinal bleeding in emergency departments: a retrospective cohort study. Emerg Med J 2023; 40:451-457. [PMID: 37185303 DOI: 10.1136/emermed-2022-213052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 04/09/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Upper gastrointestinal bleeding (UGIB) is a medical emergency with an approximate mortality of 10%, which results in a high hospitalisation rate. The Glasgow-Blatchford score (GBS) is recommended to identify low-risk patients who can be discharged from the emergency department (ED). A modified GBS (mGBS) and CANUKA score have recently been proposed but have not been well studied. The aim of this study was to assess whether the use of GBS, mGBS or CANUKA score could identify patients at low risk of death or need for intervention. METHODS A single-centre retrospective study was performed including patients with suspected UGIB visiting the ED of Saint-Antoine hospital (Paris, France) from January 2016 to December 2018. Demographic and medical data needed to calculate GBS and CANUKA were collected, as well as outcomes data. Need for intervention was defined as the need for blood transfusion, endoscopic haemostasis or rebleeding within 7 days. In-hospital mortality was also collected. Sensitivity, specificity and predictive values were measured for the score thresholds of interest. RESULTS A total of 386 patients were included. Median age was 60 years (38-78), 65.3% (n=252) were male and 60% (n=233) were hospitalised. A GBS≤1, mGBS=0 and CANUKA≤2 categorised 24.9%, 18.2% and 18.9% of patients as low risk, respectively. There was a need for intervention in 2.2%, 4.6% and 0% of those patients categorised as low risk by GBS, mGBS and CANUKA, respectively. No deaths occurred in the patients identified as low risk, regardless of the score used. All scores had a high sensitivity and negative predictive value. CONCLUSIONS In patients with UGIB, the use of a GBS≤1 or CANUKA score ≤2 appears to be safe for identifying patients at low risk of death or need for intervention.
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Affiliation(s)
- Célina Pognonec
- Hôpital Cochin, Service d'Accueil des Urgences, Assistance Publique - Hôpitaux de Paris, AP-HP.Université Paris Cité, Paris, France
| | - Zidane Dirhoussi
- Hôpital Saint-Antoine, Service d'Accueil des Urgences, Assistance Publique - Hôpitaux de Paris, AP-HP.Sorbonne Université, Paris, France
| | - Nicolas Cury
- Hôpital Saint-Antoine, Service d'Accueil des Urgences, Assistance Publique - Hôpitaux de Paris, AP-HP.Sorbonne Université, Paris, France
| | - Marie Moreau
- Hôpital Saint-Antoine, Service d'Accueil des Urgences, Assistance Publique - Hôpitaux de Paris, AP-HP.Sorbonne Université, Paris, France
| | - Charlotte Billard
- Hôpital Saint-Antoine, Service d'Accueil des Urgences, Assistance Publique - Hôpitaux de Paris, AP-HP.Sorbonne Université, Paris, France
| | - Youri Yordanov
- Hôpital Saint-Antoine, Service d'Accueil des Urgences, Assistance Publique - Hôpitaux de Paris, AP-HP.Sorbonne Université, Paris, France
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR-S 1136, Sorbonne Universite, Paris, France
| | - Pierre-Clément Thiebaud
- Hôpital Saint-Antoine, Service d'Accueil des Urgences, Assistance Publique - Hôpitaux de Paris, AP-HP.Sorbonne Université, Paris, France
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Athanasiou SA, Sergaki ES, Polydorou AA, Polydorou AA, Stavrakakis GS, Afentakis NM, Vardiambasis IO, Zervakis ME. Revealing the Boundaries of Selected Gastro-Intestinal (GI) Organs by Implementing CNNs in Endoscopic Capsule Images. Diagnostics (Basel) 2023; 13. [PMID: 36900009 DOI: 10.3390/diagnostics13050865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 02/03/2023] [Accepted: 02/22/2023] [Indexed: 03/06/2023] Open
Abstract
PURPOSE The detection of where an organ starts and where it ends is achievable and, since this information can be delivered in real time, it could be quite important for several reasons. For one, by having the practical knowledge of the Wireless Endoscopic Capsule (WEC) transition through an organ's domain, we are able to align and control the endoscopic operation with any other possible protocol, i.e., delivering some form of treatment on the spot. Another is having greater anatomical topography information per session, therefore treating the individual in detail (not "in general"). Even the fact that by gathering more accurate information for a patient by merely implementing clever software procedures is a task worth exploiting, since the problems we have to overcome in real-time processing of the capsule findings (i.e., wireless transfer of images to another unit that will apply the necessary real time computations) are still challenging. This study proposes a computer-aided detection (CAD) tool, a CNN algorithm deployed to run on field programmable gate array (FPGA), able to automatically track the capsule transitions through the entrance (gate) of esophagus, stomach, small intestine and colon, in real time. The input data are the wireless transmitted image shots of the capsule's camera (while the endoscopy capsule is operating). METHODS We developed and evaluated three distinct multiclass classification CNNs, trained on the same dataset of total 5520 images extracted by 99 capsule videos (total 1380 frames from each organ of interest). The proposed CNNs differ in size and number of convolution filters. The confusion matrix is obtained by training each classifier and evaluating the trained model on an independent test dataset comprising 496 images extracted by 39 capsule videos, 124 from each GI organ. The test dataset was further evaluated by one endoscopist, and his findings were compared with CNN-based results. The statistically significant of predictions between the four classes of each model and the comparison between the three distinct models is evaluated by calculating the p-values and chi-square test for multi class. The comparison between the three models is carried out by calculating the macro average F1 score and Mattheus correlation coefficient (MCC). The quality of the best CNN model is estimated by calculations of sensitivity and specificity. RESULTS Our experimental results of independent validation demonstrate that the best of our developed models addressed this topological problem by exhibiting an overall sensitivity (96.55%) and specificity of (94.73%) in the esophagus, (81.08% sensitivity and 96.55% specificity) in the stomach, (89.65% sensitivity and 97.89% specificity) in the small intestine and (100% sensitivity and 98.94% specificity) in the colon. The average macro accuracy is 95.56%, the average macro sensitivity is 91.82%.
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Dash KR, Panda C, Das HS, Mishra D, Behera SK, Parida PK, Mohapatra D. Association of Vitamin D Level With Disease Severity and Quality of Life in Newly Diagnosed Patients of Ulcerative Colitis: A Cross-Sectional Analysis. Cureus 2021; 13:e16481. [PMID: 34430097 PMCID: PMC8375454 DOI: 10.7759/cureus.16481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2021] [Indexed: 12/31/2022] Open
Abstract
Introduction Ulcerative colitis is an immunologically mediated disorder affecting the gastrointestinal tract. Vitamin D3 has been shown to modulate many immunological diseases, but its role in ulcerative colitis is not well documented. This study was done to find out if levels of vitamin D are associated with the severity of disease and quality of life in ulcerative colitis patients. Methods This cross-sectional study consists of two parts. The first part consists of having a comparative assessment of baseline parameters of newly diagnosed ulcerative colitis patients and healthy controls. The 2nd part consists of an evaluation of the association of levels of vitamin D3 with disease severity and quality of life in ulcerative colitis. Independent predictors of disease severity and quality of life were assessed using multiple linear regression. Results Vitamin D levels were significantly lower in healthy controls compared to newly diagnosed ulcerative colitis patients. Median ulcerative colitis disease activity index score was significantly higher in the vitamin D deficient group compared with those who had normal vitamin D levels (p-0.001). Quality of life was also poor in the vitamin D deficient group compared to those with normal vitamin D levels (p-0.000). Vitamin D levels were found to be independent predictors of ulcerative colitis disease activity scores and health-related quality of life scores. Conclusion Vitamin D may have some immunomodulating properties, which might be associated with decreased ulcerative colitis disease activity index and better quality of life.
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Affiliation(s)
- Kaibalya R Dash
- Gastroenterology, Srirama Chandra Bhanja Medical College and Hospital, Cuttack, IND
| | - Chittaranjan Panda
- Gastroenterology, Srirama Chandra Bhanja Medical College and Hospital, Cuttack, IND
| | - Haribhakti S Das
- Gastroenterology, Srirama Chandra Bhanja Medical College and Hospital, Cuttack, IND
| | - Debakanta Mishra
- Gastroenterology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, IND
| | - Sambit Kumar Behera
- Gastroenterology, Srirama Chandra Bhanja Medical College and Hospital, Cuttack, IND
| | - Prashant K Parida
- Gastroenterology, Srirama Chandra Bhanja Medical College and Hospital, Cuttack, IND
| | - Debjyoti Mohapatra
- Community Medicine, Srirama Chandra Bhanja Medical College and Hospital, Cuttack, IND
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Knefati M, Ganim I, Schmidt J, Makkar A, Igtiben S, Landa E, Tarawneh A, Hicks C, Zimmerman S, Sukpraprut-Braaten S. COVID-19 With an Initial Presentation of Intraperitoneal Hemorrhage Secondary to Spontaneous Splenic Rupture. Cureus 2021; 13:e15310. [PMID: 34211811 PMCID: PMC8236337 DOI: 10.7759/cureus.15310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2021] [Indexed: 01/08/2023] Open
Abstract
The WHO declared coronavirus disease 2019 (COVID-19) a global pandemic in early 2020. As the pandemic has continued to evolve over a period of several months, many cases of unusual presentations are now emerging, which pose a greater challenge for physicians in terms of quickly identifying COVID-19 patients based on initial signs and symptoms. In this report, we present one such unusual presentation in a patient with sudden intraperitoneal hemorrhage and spontaneous splenic rupture with COVID-19 as the likely etiology and contributing factor. The patient was a 75-year-old Caucasian woman who presented to the emergency department (ED) with complaints of severe left-sided abdominal pain for several days without any preceding trauma. A CT of the abdomen/pelvis revealed a large amount of fluid in the abdomen, which raised suspicion of bleeding. An exploratory laparotomy revealed splenic rupture with hemoperitoneum, and the patient subsequently underwent an emergent splenectomy. The patient's COVID-19 antigen test returned positive during the surgery and was subsequently confirmed with a polymerase chain reaction (PCR) test. COVID-19 has been found to result primarily in respiratory symptoms through its ability to invade endothelial cells via angiotensin-converting enzyme 2 affinity. It is speculated that this mechanism may cause a predisposition to micro-thromboses, which can eventually lead to manifestations such as large lymphoid organ thrombosis. Based on this case presentation and the evolving literature on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), spontaneous splenic rupture is an emergent differential diagnosis that should be considered in COVID-19 patients presenting with gastrointestinal complaints such as abdominal pain and nausea.
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Affiliation(s)
| | | | | | | | | | - Eric Landa
- Internal Medicine, Unity Health, Searcy, USA
| | - Ahmad Tarawneh
- Pulmonary and Critical Care Medicine, Unity Health, Searcy, USA
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Ye J, Wang W, Zhang Z. An unusual cause of abdominal pain. Emerg Med J 2020; 37:369-378. [PMID: 32487707 DOI: 10.1136/emermed-2019-208809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2019] [Indexed: 11/03/2022]
Affiliation(s)
- Jiarong Ye
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, Guangdong, China
| | - Weiliang Wang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, Guangdong, China
| | - Zhongde Zhang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, Guangdong, China
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Gehlen H, Wulke N, Ertelt A, Nielsen MK, Morelli S, Traversa D, Merle R, Wilson D, von Samson-Himmelstjerna G. Comparative Analysis of Intestinal Helminth Infections in Colic and Non-Colic Control Equine Patients. Animals (Basel) 2020; 10:ani10101916. [PMID: 33086590 PMCID: PMC7603170 DOI: 10.3390/ani10101916] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 09/29/2020] [Accepted: 10/06/2020] [Indexed: 11/16/2022] Open
Abstract
All around the world, intestinal helminths constitute one of the most prevalent life-long occurring infections and re-infections affecting all horse age groups. A range of parasite species among strongyles, ascarids, and tapeworms is known to have the potential to cause colic in horses. However, there is a lack of current scientific evidence on the actual relevance of helminth infection levels in the context of colic in horses kept during prevailing epidemiological conditions. Thus, a prospective case-control study on the occurrence of intestinal helminths in a total of 620 mainly adult equine clinic patients was conducted to investigate the association between colic and helminth infection. For each horse, a range of copromicroscopic, serological, and clinical data was obtained, in addition to a questionnaire on relevant anamnestic data, including previous anthelmintic treatment and husbandry. Using a FLOTAC-based copromicroscopic diagnosis, the highest infection rates were seen for strongyles (41.8%), followed by Anoplocephala perfoliata and Parascaris spp. (both 0.8%), with no significant difference between the two study groups. Employing a real-time PCR a 1.1% S. vulgaris DNA prevalence was found. Considerably higher seroprevalences were observed using S. vulgaris and A. perfoliata ELISAs, with 32.3% and 10.7%, respectively. It was noteworthy that no association concerning either serologic status was encountered with colic status. The shedding of strongyle eggs was associated with a 1.8-times increased risk of S. vulgaris seropositivity. Recent anthelmintic treatment was associated with the onset of colic, as animals who had received an anthelmintic during the previous week had a 2.4-times higher risk of signs of colic compared to those who had been treated at least eight weeks prior. Another noteworthy observation was that ponies were significantly less often affected by colic than warmbloods. The high S. vulgaris and considerable A. perfoliata seroprevalences encountered in this investigation should prompt veterinarians, farm managers, and horse owners to maintain consequent and effective worm control measures.
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Affiliation(s)
- Heidrun Gehlen
- Klinik für Pferde, Allgemeine Chirurgie und Radiologie, Fachbereich Veterinärmedizin, Freie Universität Berlin, 14163 Berlin, Germany; (H.G.); (N.W.); (A.E.)
| | - Nadine Wulke
- Klinik für Pferde, Allgemeine Chirurgie und Radiologie, Fachbereich Veterinärmedizin, Freie Universität Berlin, 14163 Berlin, Germany; (H.G.); (N.W.); (A.E.)
| | - Antonia Ertelt
- Klinik für Pferde, Allgemeine Chirurgie und Radiologie, Fachbereich Veterinärmedizin, Freie Universität Berlin, 14163 Berlin, Germany; (H.G.); (N.W.); (A.E.)
| | - Martin K. Nielsen
- M.H. Gluck Equine Research Center, Department of Veterinary Science, University of Kentucky, Lexington, KY 40546, USA;
| | - Simone Morelli
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy; (S.M.); (D.T.)
| | - Donato Traversa
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy; (S.M.); (D.T.)
| | - Roswitha Merle
- Institut für Veterinär-Epidemiologie und Biometrie, Fachbereich Veterinärmedizin, Freie Universität Berlin, 14163 Berlin, Germany;
| | - Douglas Wilson
- Faculty of Health Sciences, Langford Campus, Bristol Veterinary School, University of Bristol, Bristol BS40 5DU, UK;
| | - Georg von Samson-Himmelstjerna
- Institut für Parasitologie und Tropenveterinärmedizin, Fachbereich Veterinärmedizin, Freie Universität Berlin, 14163 Berlin, Germany
- Correspondence: ; Fax: +49 40 838 62311
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15
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Bijman R, Rossi L, Sharfo AW, Heemsbergen W, Incrocci L, Breedveld S, Heijmen B. Automated Radiotherapy Planning for Patient-Specific Exploration of the Trade-Off Between Tumor Dose Coverage and Predicted Radiation-Induced Toxicity-A Proof of Principle Study for Prostate Cancer. Front Oncol 2020; 10:943. [PMID: 32695670 PMCID: PMC7339044 DOI: 10.3389/fonc.2020.00943] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 05/13/2020] [Indexed: 12/14/2022] Open
Abstract
Background: Currently, radiation-oncologists generally evaluate a single treatment plan for each patient that is possibly adapted by the planner prior to final approval. There is no systematic exploration of patient-specific trade-offs between planning aims, using a set of treatment plans with a-priori defined (slightly) different balances. To this purpose, we developed an automated workflow and explored its use for prostate cancer. Materials and Methods: For each of the 50 study patients, seven plans were generated, including the so-called clinical plan, with currently clinically desired ≥99% dose coverage for the low-dose planning target volume (PTVLow). The six other plans were generated with different, reduced levels of PTVLow coverage, aiming at reductions in rectum dose and consequently in predicted grade≥2 late gastro-intestinal (GI) normal tissue complication probabilities (NTCPs), while keeping other dosimetric differences small. The applied NTCP model included diabetes as a non-dosimetric predictor. All plans were generated with a clinically applied, in-house developed algorithm for automated multi-criterial plan generation. Results: With diabetes, the average NTCP reduced from 24.9 ± 4.5% for ≥99% PTVLow coverage to 17.3 ± 2.6% for 90%, approaching the NTCP (15.4 ± 3.0%) without diabetes and full PTVLow coverage. Apart from intended differences in PTVLow coverage and rectum dose, other differences between the clinical plan and the six alternatives were indeed minor. Obtained NTCP reductions were highly patient-specific (ranging from 14.4 to 0.1%), depending on patient anatomy. Even for patients with equal NTCPs in the clinical plan, large differences were found in NTCP reductions. Conclusions: A clinically feasible workflow has been proposed for systematic exploration of patient-specific trade-offs between various treatment aims. For each patient, automated planning is used to generate a limited set of treatment plans with well-defined variations in the balances between the aims. For prostate cancer, trade-offs between PTVLow coverage and predicted GI NTCP were explored. With relatively small coverage reductions, significant NTCP reductions could be obtained, strongly depending on patient anatomy. Coverage reductions could also make up for enhanced NTCPs related to diabetes as co-morbidity, again dependent on the patient. The proposed system can play an important role in further personalization of patient care.
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Affiliation(s)
- Rik Bijman
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
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16
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Willenbring BA, Schnitker CK, Stellpflug SJ. Oral nitroglycerin solution for oesophageal food impaction: a prospective single-arm pilot study. Emerg Med J 2020; 37:434-436. [PMID: 32366615 DOI: 10.1136/emermed-2019-209320] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 03/26/2020] [Accepted: 04/02/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Thirteen episodes of oesophageal food impaction (EFI) per 100 000 people present to a medical setting each year. Several pharmacological interventions meant to relieve such impactions have been explored; none have proven superior. OBJECTIVES Perform a single-arm feasibility study of oral nitroglycerin solution for EFI. METHODS Twenty adult patients presenting to a single urban tertiary medical centre thought to have EFI were given up to three doses of 0.4 mg nitroglycerin solution orally and evaluated for resolution of symptoms, new symptoms and vital signs. Patients with intractable vomiting, haemodynamic instability, airway compromise, oesophageal perforation, coronary ischaemia or presentation delayed greater than 12 hours were excluded. RESULTS 17 of 20 enrolled subjects received the intervention. The average duration of symptoms prior to intervention was 285 min (SD=187). Four subjects did not tolerate the intervention (inability to swallow or headache). Two of 17 (11.8%) subjects obtained temporally proximal symptom resolution: 11 min after the second dose, and 7 min after the third dose. Seven also received glucagon during their visit, with 0% temporally proximal symptom resolution. Fifteen underwent endoscopy, with food bolus identified in 12. One subject had brief and mild hypotension with spontaneous resolution. Two subjects developed a headache after nitroglycerin administration. The median length of stay for those who found relief without endoscopy was 195 min (range 129-261) vs 374 min (range 122-525) among those with endoscopy. CONCLUSION The observed rate of relief after oral nitroglycerin solution for EFI is disappointing but comparable to previous glucagon, benzodiazepines and effervescent beverage studies, and that of placebo. Oral nitroglycerin solution appears to be well tolerated among those able to swallow, although in our sample several subjects were unable to tolerate swallowing entirely.
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Affiliation(s)
| | | | - Samuel J Stellpflug
- Department of Emergency Medicine, Regions Hospital, Saint Paul, Minnesota, USA
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17
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Olesen JA, Posselt CM, Poulsen CH, Nordentoft M, Hjorthøj C. Cannabis use disorders may protect against certain disorders of the digestive organs in people with schizophrenia but not in healthy controls. Psychol Med 2020; 50:499-506. [PMID: 30880659 DOI: 10.1017/s0033291719000370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Previous studies have shown a potential for cannabis in disorders of the digestive organs. We aimed to investigate whether cannabis use disorders (CUD) would decrease the risk of incident disorders of the digestive organs, in people with schizophrenia and population controls. METHODS We combined nationwide Danish registers to identify 21 066 cases with schizophrenia and 176 935 sex-and-age-matched controls. Two models were analyzed for the associations between CUD and digestive disorders in time-varying Cox regressions: one adjusted for sex, year of birth, and calendar year; and one further adjusted for alcohol and other substance use disorders and parental education. RESULTS CUD was associated with a decreased risk of developing disorders of gut-brain interaction (e.g. irritable bowel syndrome, dyspepsia, etc.) among cases with schizophrenia (HR = 0.84, 95% CI 0.74-0.94, p = 0.003). CUD was associated with decreased risk of inflammatory bowel disease (HR = 0.70, 95% CI 0.49-0.99, p = 0.045) in the basically adjusted model, dropping just below statistical significance in the fully adjusted model (HR = 0.71, 95% CI 0.48-1.03, p = 0.07). CUD displayed a tendency toward a decreased risk of serious disorders of the digestive organs among cases with schizophrenia (HR = 0.89, 95% CI 0.77-1.02, p = 0.09) in the fully adjusted model. No associations were observed among controls. CONCLUSIONS In people with schizophrenia, but not in controls, CUD is associated with decreased risk of disorders of gut-brain interaction and inflammatory bowel disease, and possibly other serious disorders of the digestive organs. Our findings could lead to new targets for treatment and prevention of disorders of the digestive organs.
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Affiliation(s)
- Julie Aamand Olesen
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPsych, Aarhus and Copenhagen, Denmark
- University of Copenhagen, The Research Unit for General Practice, Copenhagen, Denmark
| | - Christine Merrild Posselt
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPsych, Aarhus and Copenhagen, Denmark
| | - Chalotte Heinsvig Poulsen
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPsych, Aarhus and Copenhagen, Denmark
| | - Merete Nordentoft
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPsych, Aarhus and Copenhagen, Denmark
| | - Carsten Hjorthøj
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPsych, Aarhus and Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Section of Epidemiology, Copenhagen, Denmark
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18
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Mears SA, Worley J, Mason GS, Hulston CJ, James LJ. Addition of sodium alginate and pectin to a carbohydrate-electrolyte solution does not influence substrate oxidation, gastrointestinal comfort, or cycling performance. Appl Physiol Nutr Metab 2020; 45:675-678. [PMID: 31967853 DOI: 10.1139/apnm-2019-0802] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Eight well-trained cyclists ingested 68 g·h-1 of a carbohydrate-electrolyte solution with sodium alginate and pectin (CHO-ALG) or a taste and carbohydrate type-matched carbohydrate-electrolyte solution (CHO) during 120 min of cycling at 55% maximal power followed by an ∼20 min time trial. Oxygen uptake, carbon dioxide production, blood glucose concentration, substrate oxidation, gastrointestinal symptoms, and time trial performance (CHO-ALG: 1219 ± 84 s, CHO: 1267 ± 102 s; P = 0.185) were not different between trials. Novelty Inclusion of sodium alginate and pectin in a carbohydrate drink does not influence blood glucose, substrate oxidation, gastrointestinal comfort, or performance in cyclists.
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Affiliation(s)
- Stephen A Mears
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK.,School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK
| | - James Worley
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK.,School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK
| | - George S Mason
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK.,School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK
| | - Carl J Hulston
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK.,School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK
| | - Lewis J James
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK.,School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK
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19
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Liang YC, Tsai TY. A man with intolerant vomiting. Emerg Med J 2019; 37:41-49. [PMID: 31848264 DOI: 10.1136/emermed-2019-208863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2019] [Indexed: 11/04/2022]
Abstract
Case presentationA 57-year-old man was in a healthy state until 6 hours before presenting to the emergency department, when he suffered from more than 10 episodes of vomiting after a large meal at lunchtime. On physical examination, vital signs were unremarkable. Tenderness was noted over the epigastrium on palpation. Point-of-care ultrasound (POCUS) of the abdomen is shown in figure 1 and online supplementary video 1.DC1SP110.1136/emermed-2019-208863.supp1Supplementary video emermed;37/1/41/F1F1F1Figure 1Transverse (A) and longitudinal (B) ultrasonography of the epigastrium. QUESTION: What is the most likely diagnosis?Hypertrophic pylorus stenosisAortic dissectionSuperior mesentery artery (SMA) syndromeVolvulus For answer see page 2.
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Affiliation(s)
- Ya-Chin Liang
- Emergency Department, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Tou-Yuan Tsai
- Emergency Department, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
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20
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Sheahen BL, Fell JW, Zadow EK, Hartley TF, Kitic CM. Intestinal damage following short-duration exercise at the same relative intensity is similar in temperate and hot environments. Appl Physiol Nutr Metab 2018; 43:1314-1320. [PMID: 29874478 DOI: 10.1139/apnm-2018-0057] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Increasing temperature and exercise disrupt tight junctions of the gastrointestinal tract although the contribution of environmental temperature to intestinal damage when exercising is unknown. This study investigated the effect of 2 different environmental temperatures on intestinal damage when exercising at the same relative intensity. Twelve men (mean ± SD; body mass, 81.98 ± 7.95 kg; height, 182.6 ± 7.4 cm) completed randomised cycling trials (45 min, 70% maximal oxygen uptake) in 30 °C/40% relative humidity (RH) and 20 °C/40%RH. A subset of participants (n = 5) also completed a seated passive trial (30 °C/40%RH). Rectal temperature and thermal sensation (TSS) were recorded during each trial and venous blood samples collected at pre- and post-trial for the analysis of intestinal fatty acid-binding protein (I-FABP) level as a marker of intestinal damage. Oxygen uptake was similar between 30 °C and 20 °C exercise trials, as intended (p = 0.94). I-FABP increased after exercise at 30 °C (pre-exercise: 585 ± 188 pg·mL-1; postexercise: 954 ± 411 pg·mL-1) and 20 °C (pre-exercise: 571 ± 175 pg·mL-1; postexercise: 852 ± 317 pg·mL-1) (p < 0.0001) but the magnitude of damage was similar between temperatures (p = 0.58). There was no significant increase in I-FABP concentration following passive heat exposure (p = 0.59). Rectal temperature increased during exercise trials (p < 0.001), but not the passive trial (p = 0.084). TSS increased more when exercising in 30 °C compared with 20 °C (p < 0.001). There was an increase in TSS during the passive heat trial (p = 0.03). Intestinal damage, as measured by I-FABP, following exercise in the heat was similar to when exercising in a cooler environment at the same relative intensity. Passive heat exposure did not increase I-FABP. It is suggested that when exercising in conditions of compensable heat stress, the increase in intestinal damage is predominantly attributable to the exercise component, rather than environmental conditions.
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Affiliation(s)
- Brodie L Sheahen
- Sports Performance Optimisation Research Team, School of Health Sciences, College of Health and Medicine, University of Tasmania, Locked Bag 1322, Newnham, Launceston 7250, Tasmania.,Sports Performance Optimisation Research Team, School of Health Sciences, College of Health and Medicine, University of Tasmania, Locked Bag 1322, Newnham, Launceston 7250, Tasmania
| | - James W Fell
- Sports Performance Optimisation Research Team, School of Health Sciences, College of Health and Medicine, University of Tasmania, Locked Bag 1322, Newnham, Launceston 7250, Tasmania.,Sports Performance Optimisation Research Team, School of Health Sciences, College of Health and Medicine, University of Tasmania, Locked Bag 1322, Newnham, Launceston 7250, Tasmania
| | - Emma K Zadow
- Sports Performance Optimisation Research Team, School of Health Sciences, College of Health and Medicine, University of Tasmania, Locked Bag 1322, Newnham, Launceston 7250, Tasmania.,Sports Performance Optimisation Research Team, School of Health Sciences, College of Health and Medicine, University of Tasmania, Locked Bag 1322, Newnham, Launceston 7250, Tasmania
| | - Thomas F Hartley
- Sports Performance Optimisation Research Team, School of Health Sciences, College of Health and Medicine, University of Tasmania, Locked Bag 1322, Newnham, Launceston 7250, Tasmania.,Sports Performance Optimisation Research Team, School of Health Sciences, College of Health and Medicine, University of Tasmania, Locked Bag 1322, Newnham, Launceston 7250, Tasmania
| | - Cecilia M Kitic
- Sports Performance Optimisation Research Team, School of Health Sciences, College of Health and Medicine, University of Tasmania, Locked Bag 1322, Newnham, Launceston 7250, Tasmania.,Sports Performance Optimisation Research Team, School of Health Sciences, College of Health and Medicine, University of Tasmania, Locked Bag 1322, Newnham, Launceston 7250, Tasmania
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21
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Affiliation(s)
| | - Sinda Zarrouk-Mahjoub
- University of Tunis El Manar and Genomics Platform, Pasteur Institute of Tunis, Tunisia
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22
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Fuke N, Aizawa K, Suganuma H, Takagi T, Naito Y. Effect of combined consumption of Lactobacillus brevis KB290 and β-carotene on minor diarrhoea-predominant irritable bowel syndrome-like symptoms in healthy subjects: a randomised, double-blind, placebo-controlled, parallel-group trial. Int J Food Sci Nutr 2017; 68:973-986. [PMID: 28391736 DOI: 10.1080/09637486.2017.1311843] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
People with non-pathological diarrhoea-predominant irritable bowel syndrome (IBS-D)-like symptoms are present at a significant level even in healthy populations, but established prophylaxis is lacking. Previously, we have found that co-administration of Lactobacillus brevis KB290 (KB290) and β-carotene (βC) attenuated murine colitis (potential cause of IBS-D-like symptoms) significantly. Here, we investigated the effect of KB290 and βC on minor IBS-D-like symptoms in healthy volunteers. After a 4-week run-in period, subjects received a KB290 + βC or placebo capsule for 12 weeks, followed by a 4-week washout period. The KB290 + βC group showed a significant improvement in intensity of abdominal pain and stool frequency compared with the placebo group. The KB290 + βC group showed a significantly higher serum concentration of anti-inflammatory cytokine, interleukin-10, compared with the placebo group. In conclusion, we demonstrated that consumption of KB290 + βC improves minor IBS-D-like symptoms and inflammatory status in healthy volunteers. (UMIN000018002).
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Affiliation(s)
- Nobuo Fuke
- a Nature & Wellness Research Department , Innovation Division, KAGOME CO., LTD , Nasushiobara , Tochigi , Japan
| | - Koichi Aizawa
- a Nature & Wellness Research Department , Innovation Division, KAGOME CO., LTD , Nasushiobara , Tochigi , Japan
| | - Hiroyuki Suganuma
- a Nature & Wellness Research Department , Innovation Division, KAGOME CO., LTD , Nasushiobara , Tochigi , Japan
| | - Tomohisa Takagi
- b Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science , Kyoto Prefectural University of Medicine , Kamigyo-ku , Kyoto , Japan
| | - Yuji Naito
- b Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science , Kyoto Prefectural University of Medicine , Kamigyo-ku , Kyoto , Japan
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23
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Kentley J, Ooi JL, Potter J, Tiberi S, O'Shaughnessy T, Langmead L, Chin Aleong J, Thaha MA, Kunst H. Intestinal tuberculosis: a diagnostic challenge. Trop Med Int Health 2017; 22:994-999. [PMID: 28609809 DOI: 10.1111/tmi.12908] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To describe characteristics, presentation, time to diagnosis and diagnostic findings of patients with intestinal tuberculosis (ITB) in a low-burden country. METHOD Retrospective study of 61 consecutive ITB patients diagnosed between 2008 and 2014 at a large East London hospital. RESULTS Forty of sixty-one patients were male. Mean age was 34.6 years. 93% of patients were born abroad, mostly from TB-endemic areas (Indian subcontinent: 88%, Africa: 9%). 25% had concomitant pulmonary TB. Median time from symptom onset to ITB diagnosis was 13 weeks (IQR 3-26 weeks). Ten patients were initially treated for IBD, although patients had ITB. The main sites of ITB involvement were the ileocaecum (44%) or small bowel (34%). Five patients had isolated perianal disease. Colonoscopy confirmed a diagnosis of ITB in 77% of those performed. 42 of 61 patients had a diagnosis of ITB confirmed on positive histology and/or microbiology. CONCLUSION Diagnosis of ITB is often delayed, which may result in significant morbidity. ITB should be excluded in patients with abdominal complaints who come from TB-endemic areas to establish prompt diagnosis and treatment. Diagnosis is challenging but aided by axial imaging, colonoscopy and tissue biopsy for TB culture and histology.
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Affiliation(s)
- J Kentley
- Department of Respiratory Medicine, Barts Health NHS Trust, London, UK
| | - J L Ooi
- Department of Gastroenterology, Royal London Hospital, Barts Health NHS Trust, London, UK.,Blizard Institute, National Center for Bowel Research, Queen Mary University of London, London, UK
| | - J Potter
- Department of Respiratory Medicine, Barts Health NHS Trust, London, UK.,Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - S Tiberi
- Department of Infectious Diseases, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - T O'Shaughnessy
- Department of Respiratory Medicine, Barts Health NHS Trust, London, UK
| | - L Langmead
- Department of Gastroenterology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - J Chin Aleong
- Department of Pathology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - M A Thaha
- Blizard Institute, National Center for Bowel Research, Queen Mary University of London, London, UK
| | - H Kunst
- Department of Respiratory Medicine, Barts Health NHS Trust, London, UK.,Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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24
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Chawla A, Singh D. Chest pain: a diagnostic challenge. Emerg Med J 2016; 33:674. [PMID: 27539981 DOI: 10.1136/emermed-2015-205391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2015] [Indexed: 11/04/2022]
Affiliation(s)
- Ashish Chawla
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Dinesh Singh
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore, Singapore
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Abstract
We surveyed 910 athletes to assess behaviours towards self-selected food/ingredient avoidance to minimize gastrointestinal distress. Fifty-five percent eliminated at least 1 high fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) food/category, with up to 82.6% reporting symptom improvement. In athletes indicating that high FODMAP foods trigger gastrointestinal symptoms, lactose (86.5%) was most frequently eliminated, followed by galactooligosaccharides (23.9%), fructose (23.0%), fructans (6.2%), and polyols (5.4%). Athletes avoid predominantly lactose and to a lesser extent other high FODMAP foods to reduce gastrointestinal distress.
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Affiliation(s)
- Dana Lis
- a Sport Performance Optimisation Research Team, School of Health Sciences, University of Tasmania, Locked Bag 1322, Launceston, Tasmania 7250, Australia
| | - Kiran D K Ahuja
- a Sport Performance Optimisation Research Team, School of Health Sciences, University of Tasmania, Locked Bag 1322, Launceston, Tasmania 7250, Australia
| | - Trent Stellingwerff
- a Sport Performance Optimisation Research Team, School of Health Sciences, University of Tasmania, Locked Bag 1322, Launceston, Tasmania 7250, Australia.,b Canadian Sports Institute - Pacific, Victoria, BC V9E 2C5, Canada
| | - Cecilia M Kitic
- a Sport Performance Optimisation Research Team, School of Health Sciences, University of Tasmania, Locked Bag 1322, Launceston, Tasmania 7250, Australia
| | - James Fell
- a Sport Performance Optimisation Research Team, School of Health Sciences, University of Tasmania, Locked Bag 1322, Launceston, Tasmania 7250, Australia
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26
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Angus K, Asgharifar S, Gleberzon B. What effect does chiropractic treatment have on gastrointestinal (GI) disorders: a narrative review of the literature. J Can Chiropr Assoc 2015; 59:122-133. [PMID: 26136604 PMCID: PMC4486990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The purpose of this study was to provide a narrative review of the literature of studies describing the management of disorders of the gastro-intestinal (GI) tract using 'chiropractic therapy' broadly defined here as spinal manipulation therapy, mobilizations, soft tissue therapy, modalities and stretches. Search limiters include access to full text studies published between 1980 and November 2012 in peer-reviewed journals, English language only involving human subjects. Twenty-one articles were found that met our inclusion criteria. Retrievable articles varied from case reports to clinical trials to review articles of management options. The majority of articles chronicling patient experiences under chiropractic care reported they demonstrated mild to moderate improvements in presenting symptoms. No adverse side effects were reported. This suggests chiropractic care can be considered as an adjunctive therapy for patients with various GI conditions providing there are no co-morbidities.
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Affiliation(s)
- Katherine Angus
- Chiropractic and Health Associates Clinic, 1 St. Clair Ave West, Suite 404, Toronto, Ontario
| | | | - Brian Gleberzon
- Corresponding author: Professor, Chair of Department of Chiropractic Therapeutics, CMCC, 6100 Leslie St. Toronto, Ontario, M2H 3J1. E-mail:
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Abstract
Recent studies have shown that both Rho kinase signaling and oxidative stress are involved in the pathogenesis of a number of human diseases, such as diabetes mellitus, hypertension, and atherosclerosis. However, very little is known about the effect of oxidative stress on the gastrointestinal (GI) smooth muscle Rho kinase pathway. The aim of the current study was to investigate the effect of oxidative stress on Rho kinase II and muscle contraction in rat stomach. The peroxynitrite donor 3-morpholinosydnonimine (SIN-1), hydrogen peroxide (H2O2), and peroxynitrite were used to induce oxidative stress. Rho kinase II expression and ACh-induced activity were measured in control and oxidant-treated cells via specifically designed enzyme-linked immunosorbent assay (ELISA) and activity assay kits, respectively. Single smooth muscle cell contraction was measured via scanning micrometry in the presence or absence of the Rho kinase blocker, Y-27632 dihydrochloride. All oxidant agents significantly increased ACh-induced Rho kinase II activity without affecting its expression level. Most important, oxidative stress induced by all three agents augmented ACh-stimulated muscle cell contraction, which was significantly inhibited by Y-27632. In conclusion, oxidative stress activates Rho kinase II and enhances contraction in rat gastric muscle, suggesting an important role in GI motility disorders associated with oxidative stress.
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Affiliation(s)
- Othman Al-Shboul
- Department of physiology and biochemistry, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
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McGuire ND, Ewen RJ, de Lacy Costello B, Garner CE, Probert CSJ, Vaughan K, Ratcliffe NM. Towards point of care testing for C. difficile infection by volatile profiling, using the combination of a short multi-capillary gas chromatography column with metal oxide sensor detection. Meas Sci Technol 2014; 25:065108. [PMID: 27212803 PMCID: PMC4874467 DOI: 10.1088/0957-0233/25/6/065108] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Rapid volatile profiling of stool sample headspace was achieved using a combination of short multi-capillary chromatography column (SMCC), highly sensitive heated metal oxide semiconductor (MOS) sensor and artificial neural network (ANN) software. For direct analysis of biological samples this prototype offers alternatives to conventional GC detectors and electronic nose technology. The performance was compared to an identical instrument incorporating a long single capillary column (LSCC). The ability of the prototypes to separate complex mixtures was assessed using gas standards and homogenised in house 'standard' stool samples, with both capable of detecting more than 24 peaks per sample. The elution time was considerably faster with the SMCC resulting in a run time of 10 minutes compared to 30 minutes for the LSCC. The diagnostic potential of the prototypes was assessed using 50 C. difficile positive and 50 negative samples. The prototypes demonstrated similar capability of discriminating between positive and negative samples with sensitivity and specificity of 85% and 80% respectively. C. difficile is an important cause of hospital acquired diarrhoea, with significant morbidity and mortality around the world. A device capable of rapidly diagnosing the disease at the point of care would reduce cases, deaths and financial burden.
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Affiliation(s)
- N D McGuire
- Institute of Biosensing Technology, University of the West of England, Bristol, United Kingdom
| | - R J Ewen
- Institute of Biosensing Technology, University of the West of England, Bristol, United Kingdom
| | - B de Lacy Costello
- Institute of Biosensing Technology, University of the West of England, Bristol, United Kingdom
| | - C E Garner
- Institute of Biosensing Technology, University of the West of England, Bristol, United Kingdom
| | - C S J Probert
- Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | | | - N M Ratcliffe
- Institute of Biosensing Technology, University of the West of England, Bristol, United Kingdom
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Li YC, Chu SJ, Hou TY. Intractable abdominal pain in a healthy young man. Emerg Med J 2014; 32:43. [PMID: 24652934 DOI: 10.1136/emermed-2014-203680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Ya-Chi Li
- Division of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shi-Jye Chu
- Division of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Tsung-Yun Hou
- Division of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Tsai M, Wu J, Su C. Coffee ground vomitus in 84-year-old male. Emerg Med J 2014; 32:668. [PMID: 24569535 DOI: 10.1136/emermed-2013-203508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2014] [Indexed: 11/04/2022]
Affiliation(s)
- Mingtse Tsai
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Jiannming Wu
- Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chanping Su
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
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Affiliation(s)
- Avinoam Nevler
- Department of General Surgery and Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Israel (Affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel) The Dr. Pinchas Borenstein Talpiot Medical Leadership Program 2012, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Moshe Zilberman
- Department of General Surgery, The Baruch Padeh Medical Center, Poria, Lower Galilee, Israel
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Bonnet MS, Ouelaa W, Tillement V, Trouslard J, Jean A, Gonzalez BJ, Gourcerol G, Dallaporta M, Troadec JD, Mounien L. Gastric distension activates NUCB2/nesfatin-1-expressing neurons in the nucleus of the solitary tract. ACTA ACUST UNITED AC 2013; 187:17-23. [PMID: 24120633 DOI: 10.1016/j.regpep.2013.10.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Revised: 09/09/2013] [Accepted: 10/02/2013] [Indexed: 12/30/2022]
Abstract
Brainstem structures such as the nucleus of the solitary tract (NTS) and the dorsal motor nucleus of the vagus nerve (DMNX) are essential for the digestive function of the stomach. A large number of neurotransmitters including glutamate and gamma-aminobutyric acid (GABA) are involved in the central control of gastric functions. However, the neuropeptidergic systems implicated in this process remain undetermined. Nesfatin-1 was recently identified as a neuropeptide cleaved from the N-terminal part of NEFA/nucleobindin 2 precursor (NUCB2). Central administration of this neuropeptide inhibits food consumption and gastroduodenal motility in rodents. Interestingly, the NTS and the DMNX contain a dense population of NUCB2/nesfatin-1 cell bodies. These observations led us to investigate the possible involvement of NUCB2/nesfatin-1 neurons in the brainstem neuronal pathways that modulate gastric functions. We observed an activation of NTS NUCB2/nesfatinergic neurons after gastric distention in rats. In addition, we found that several NTS NUCB2/nesfatinergic neurons were GABAergic. Finally, when fluorogold was injected at the stomach level, many retrogradely labeled neurons were observed in the DMNX which were also positive for NUCB2/nesfatin-1. Taken together, these observations suggest for the first time that NUCB2/nesfatin-1 neurons of the NTS are sensitive to gastric distension and then may contribute to the satiety signal.
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Affiliation(s)
- Marion S Bonnet
- Physiology and Physiopathology of Motor and Autonomic Nervous Systems (PPSN, EA4667), University of Aix-Marseille, Marseille, France
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Affiliation(s)
| | - Joanna Collins
- Department of Acute Medicine, Frenchay Hospital, Bristol, UK
| | - Sam Patel
- Department of Acute Medicine, Frenchay Hospital, Bristol, UK
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Affiliation(s)
- Jian-Han Lai
- Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, No.92, Sec. 2, Chung-Shan North Road, Taipei 104, Taiwan
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