Defecation symptoms in primary health care patients with irritable bowel syndrome

BACKGROUND

The objectives of the present study were to (a) measure the prevalence of defecation symptoms in IBS, (b) investigate the relationship between stool consistency and defecation symptoms in IBS, and (c) investigate the association of defecation symptoms with health-related quality of life (HRQL) and self-reported stress in patients with IBS cared for in a primary health care setting.

METHODS

Ten primary health care centres joined the study. 282 patients with IBS as well as 372 non-IBS controls filled in gastrointestinal symptom diaries prospectively for two weeks as well as the Perceived Stress Scale-14 (PSS14) and the EuroQol barometer to measure perceived stress and HRQL, respectively.

RESULTS

Incomplete evacuation was present in 51% vs. 21% of the stools among the IBS patients and the non-IBS controls, respectively. The need to strain during defecation was existing in 41% vs. 33% of the stools for the IBS patients and the non-IBS controls, respectively. Urgency was experienced in 37% of the stools in the IBS patients compared with 18% of the stools in the non-IBS controls. Patients with IBS experienced in a significant higher degree of overlapping symptoms per stool (p < 0.001 to p = 0.007). The occurrence of all defecation symptoms in the same patient was related to decreased HRQL, and increased stress (p = 0.001 to p < 0.001).

CONCLUSIONS

An overlap between IBS and symptoms from the anorectal region related to defecation was found in a primary health care population. Defecation symptoms are very common in primary care IBS-patients, it co-occurs with increased self-perceived stress, and decreased HRQL.

The Effect of the Flint Water Crisis Secondary to Increased Lead Levels in Drinking Water on Constipation in Children in the City of Flint, Michigan, USA

Introduction  Constipation is a common condition in children, affecting almost one-third of the population at some point in childhood across the world. Functional constipation is the most common cause, with no clear etiology. From April 25, 2014, through October 16, 2015, the water source for the city of Flint residents was untreated Flint River water, which resulted in lead-contaminated drinking water. Lead poisoning has been associated with constipation and has multisystem sequelae, including neurological, muscular, and hematological impacts. Children may be especially vulnerable to this with their higher water intake-to-body weight ratio. There has been no previous study examining the possible relationship between the Flint water crisis and constipation in children. In our study, we aimed to see if the increased lead level in the water had any effect on constipation in children in Flint. Methods We included all children seen and diagnosed with constipation at Hurley Medical Center's Pediatric Gastrointestinal (GI) Clinic. We included only children seen in 2013 (pre-water crisis) and 2017 (post-water crisis). Children with chronic neurologic disorders, celiac disease, hypothyroidism, diabetes, Hirschsprung's disease, short bowel syndrome, and gastrointestinal surgeries were excluded. We looked at the age of presentation, associated symptoms, medications used, need for hospital admission or emergency department (ED) visits, and improvements at follow-up. Results  A total of 79 patients were included in the study. There were 29 patients from 2013 and 50 patients from 2017 (post-lead exposure period). The rate of constipation referrals to the GI clinic for the Flint population of children was significantly higher in 2017 (p=0.001). The most common associated symptom was abdominal pain in both groups. Straining was more prominent in the 2017 group (60%) compared to the 2013 group (34.5%, p=0.029). There was no clinical or statistically significant difference between the groups noted in abdominal pain, blood in the stool, fecal incontinence, vomiting, history of urinary tract infection (UTI), abdominal distention, or stool impaction. Conclusions The number of patients referred to Hurley's Pediatric GI Clinic for constipation increased after the lead water crisis in Flint. Moreover, straining has significantly increased in post-lead exposure compared to pre-lead exposure. There was no clinical or statistically significant difference noted in abdominal pain, blood in the stool, fecal incontinence, vomiting, history of UTI, abdominal distention, or stool impaction between both groups. A larger study would need to be done to confirm these findings, rule out other cofactors, and look into minerals in water and their effect on intestine innervations.

Two Gold Kiwifruit Daily for Effective Treatment of Constipation in Adults-A Randomized Clinical Trial

Chronic constipation is highly prevalent worldwide and may be managed with two green or three gold kiwifruit daily. It is unknown whether a smaller standard serve of gold kiwifruit (two daily) is as effective in constipation management. The study aimed to improve chronic constipation with two gold kiwifruit and psyllium in lieu of a placebo daily over four weeks. Adult participants (18-65 years) with functional constipation (FC, n = 11), constipation-predominant irritable bowel syndrome (IBS-C, n = 13), and healthy controls (n = 32) were block-randomized to the treatment order: gold kiwifruit (2/day) or psyllium (fiber-matched, 7.5 g/day) for four weeks, followed by four weeks washout before crossover. Outcomes included alterations of Gastrointestinal Symptom Rating Scale (GSRS) domains and weekly complete spontaneous bowel movements (CSBM) as part of a larger study. Both interventions reduced GSRS constipation domain scores in all subjects compared to baseline values (p = 0.004). All participants reported significantly more weekly CSBM (p = 0.014). Two gold kiwifruit decreased straining (p = 0.021). Two gold kiwifruit daily are as effective as fiber-matched psyllium in treating constipation in adults and should be considered as a treatment option.

An assessment of techniques and practices used to elevate intra-abdominal pressure when assessing pelvic floor dysfunction

AIMS

To determine terminology and methods for raising intra-abdominal pressure (IAP) currently used by clinicians to assess pelvic floor dysfunction (PFD) and to measure the effect of these maneuvers on IAP.

METHODS

Three-hundred questionnaires were distributed at two scientific meetings in the United Kingdom to determine methods clinicians used to raise IAP and their perceptions of these methods. Twenty healthy volunteers were also recruited to measure the effect of two methods of raising IAP: Valsalva maneuver (VM) and bear down maneuver (BDM). IAP pressure was measured with rectal catheters connected to pressure sensors. The IAP was measured during each maneuver in both standing and supine positions.

RESULTS

Maneuvers used in practice were cough (79%), BDM (60%), and VM (38%). 44% of clinicians felt patients found it difficult to raise their IAP. There was uncertainty among clinicians as to which method was the most effective in raising IAP and whether the different methods produced the same rise in IAP. On testing IAP in 20 healthy volunteers, median (interquartile range) IAP generated during BDM; 101 (59.1) cmH₂ O was significantly higher than that generated during VM; 80.3 (43.6) cmH₂ O (p < .0001).

CONCLUSION

Clinicians varied widely in the maneuvers they used to raise patients' IAP to test for PFD and there was uncertainty about the maneuvers' effect on IAP. In healthy volunteers, BDM produced significantly higher IAP than VM. We recommend standardization of terminology and techniques used to raise IAP when assessing PFD, to ensure consistency of diagnosis and assessment of treatment outcomes.

Straining at Work and Its Relationship with Personality Profiles and Individual Consequences in Healthcare Workers (HCWs)

Straining is an attenuated form of mobbing, in which the continuity of vexatious actions is not driven by a discriminatory intent. With the objective of testing the possible moderating role of personality in the relationship between perceptions about straining at work and individual consequences, a correlational design research involved 374 healthcare workers (HCWs) from two Italian hospitals. The following questionnaires were administered: (1) Short Negative Acts Questionnaire (S-NAQ), to assess discriminative actions at work); (2) the Italian version of the Big Five Inventory (BFI-10 scale), to assess personality factors; (3) Occupational Stress Indicator (OSI), to measure psychological and physical health. Regression analysis and Structural Equation Models (SEM) were computed in order to test the relationships between variables. Perceived straining showed significant correlations with both psychological and physical health. Conscientiousness was inversely proportional to work-related bullying (WB), as agreeableness was to personal bullying (PB). Emotional stability was negatively correlated with all the three component scales of S-NAQ: WB, PB, and social bullying. The results seem to confirm that straining perceptions especially elicit, through emotional stability, psychological consequences. As regards the role of emotional stability in risk perceptions, it seems management has to pay thorough attention to personal factors in organizational perceptions and to straining actions.

Rectal duplication in an adult cat: a novel transanal surgical approach

CASE SUMMARY

A 3-year and 8-month-old male entire European domestic shorthair cat was presented with a history of recurrent rectal prolapse, straining and pain when defaecating. Previous non-surgical and surgical treatments had not provided a satisfactory result. Rectal prolapse had recurred within 2 weeks of treatment. Upon clinical examination, an intraluminal mass could be palpated rectally. A CT scan examination revealed the mass was of a cystic nature and the cyst was surgically excised via a transanal approach. On histological evaluation, the cyst walls consisted of three of the layers of normal rectum: mucosa, muscularis of the mucosa and submucosa. These findings led to the definite diagnosis of rectal duplication.

RELEVANCE AND NOVEL INFORMATION

Enteric duplication is among the differential diagnoses for straining and rectal prolapse in cats. This condition has previously been discussed in the veterinary literature, with a single case report describing a rectal duplication in a cat. In that particular case, the authors described a perineal surgical approach. Here we present a novel approach whereby the duplicated material was excised transanally in order to limit intra- and postoperative morbidity. The clinical outcome was excellent in our case, with complete resolution of clinical signs and no recurrence 18 months after surgery.

Rapid tests reduce the burden of tuberculosis in Azerbaijan prisons: special emphasis on rifampicin-resistance

AIMS

To evaluate the impact of addition of rapid tests for tuberculosis (TB) to mass screening and passive case finding on the burden of TB in high-incidence prisons of Azerbaijan.

MATERIALS AND METHODS

All new and relapse TB cases notified in 01.01.2009-31.12.2015 were retrospectively included.

RESULTS

2,315 TB patients were identified in 19 prisons. Implementation of the rapid tests to the case finding algorithms lead to 3-, 10- and 5-fold decrease in the annual rates of the notified, smear-positive and RIF-resistant TB cases, respectively. After introduction of rapid tests into the screening algorithms, there were significant linear trends towards decrease in the notified (p=0.009), smear-positive (p=0.011) and RIF-resistant TB cases (p=0.02) with the annual rates of decrease (95% confidence interval (CI)) being -435 (-614; -255), -356 (-517; -195), and -99 (-160; -38), respectively. Utilization of rapid tests also significantly increased treatment success with first-line drugs among all cases, cases detected by mass screening and those, detected by passive case finding [adjusted odds ratio (aOR)=2.38, 95% CI:1.86-3.05, aOR=4.56, 95% CI:2.64-7.89 and aOR=2.60, 95% CI:1.81-3.75, respectively].

CONCLUSIONS

Introduction of rapid tests into the screening lead to decline in the burden of TB and RIF-resistance, and improved outcomes of treatment with first-line drugs in prisons.

Prevalence of reactivity to the tuberculin test and associated factors in the population attended at a drug addiction center in the period 2013-2016

OBJECTIVE

Epidemiological study of prevalence, carried out at Center for Drug Addiction of the center of addictions of Nou Barris (Barcelona, Spain) during 2013-2016 in order to know the prevalence of tuberculin test reactivity (TTR) and its predictive factors in drug-dependent population.

MATERIAL AND METHODS

Epidemiological and clinical variables, associated with the consumption of drugs and the practice of the tuberculin test, were collected. The reading rate and the prevalence of TTR for annual periods, as well as the predictive factors through a bivariate and multivariate logistic regression analysis.

RESULTS

389 patients were studied (109 in 2013, 84 in 2014, 111 in 2015 and 85 in 2016) and they went to the reading of the TT 337 (86.6%). The prevalence of TTR was 33.2% in the readings. At the bivariate level, TTR was associated with sex, origin and prior history. In the multivariate analysis, the predictive value of age was confirmed (more reactivity in ≥40 years; p <0.001, odds ratio [OR]: 4.85, confidence interval [IC]: 2.68-8.78), being male (p = 0.003, OR: 2.81, IC: 1.43-5.53), and being an immigrant (p <0.001; OR: 7.32, IC: 3.56-15.03).

DISCUSSION

It is concluded that the prevalence of TTR is high, especially in men, in those of more age, and in immigrants and that the drug addiction devices continue to be basic in the detection and monitoring of the latent tuberculosis infection.

Prevalence of organic disease at colonoscopy in patients with symptoms compatible with irritable bowel syndrome: cross-sectional survey

OBJECTIVE

Guidelines for the management of irritable bowel syndrome (IBS) encourage a positive diagnosis, but some evidence suggests organic disease may be missed unless investigations are performed. We examined yield of colonoscopy in a cohort of secondary care patients meeting criteria for IBS.

MATERIALS AND METHODS

Demographic data, symptoms and findings at colonoscopy were recorded prospectively in consecutive, unselected adults with gastrointestinal (GI) symptoms compatible with IBS according to the Rome III criteria. Prevalence of organic GI disease was compared between those meeting criteria for IBS, according to the presence or absence of co-existent alarm features, and by IBS subtype.

RESULTS

A total of 559 patients met Rome III criteria for IBS, of whom 423 reported ≥1 alarm feature and 136 none. There was a significantly higher prevalence of organic GI disease among those reporting alarm features (117 [27.7%]), compared with those without (21 [15.4%]) (p = 0.002). In the latter group of 136 patients, Crohn's disease was the commonest finding (10 [7.4%] subjects), followed by coeliac disease (4 [2.9%] subjects), and microscopic colitis (3 [2.2%] subjects). Regardless of presence or absence of alarm features, patients with constipation-predominant IBS were less likely to exhibit organic GI disease than those with diarrhea-predominant or mixed IBS (12.7% vs. 32.1% and 23.8%, p = 0.006).

CONCLUSIONS

One in six patients with symptoms compatible with IBS without alarm features in this selected group exhibited organic GI disease following investigation. Assessment of alarm features in a comprehensive history is vital to reduce diagnostic uncertainty that can surround IBS.

Fate and Transport of Molybdenum Disulfide Nanomaterials in Sand Columns

Research and development of two-dimensional transition metal dichalcogenides (TMDC) (e.g., molybdenum disulfide [MoS₂]) in electronic, optical, and catalytic applications has been growing rapidly. However, there is little known regarding the behavior of these particles once released into aquatic environments. Therefore, an in-depth study regarding the fate and transport of two popular types of MoS₂ nanomaterials, lithiated (MoS₂-Li) and Pluronic PF-87 dispersed (MoS₂-PL), was conducted in saturated porous media (quartz sand) to identify which form would be least mobile in aquatic environments. The electrokinetic properties and hydrodynamic diameters of MoS₂ as a function of ionic strength and pH were determined using a zeta potential analyzer and dynamic light scattering techniques. Results suggest that the stability is significantly decreased beginning at 10 and 31.6 mM KCl, for MoS₂-PL and MoS₂-Li, respectively. Transport study results from breakthrough curves, column dissections, and release experiments suggest that MoS₂-PL exhibits a greater affinity to be irreversibly bound to quartz surfaces as compared with the MoS₂-Li at a similar ionic strength. Derjaguin-Landau-Verwey-Overbeek theory was used to help explain the unique interactions between the MoS₂-PL and MoS₂-Li surfaces between particles and with the quartz collectors. Overall, the results suggest that the fate and transport of MoS₂ is dependent on the type of MoS₂ that enters the environment, where MoS₂-PL will be least mobile and more likely be deposited in porous media from pluronic-quartz interactions, whereas MoS₂-Li will travel greater distances and have a greater tendency to be remobilized in sand columns.

Assessment of treatment response in chronic constipation clinical trials

Background

While chronic constipation (CC) clinical trials have focused primarily on bowel symptoms (symptoms directly related to bowel movements), abdominal symptoms are also prevalent among patients. The United States Food and Drug Administration’s (FDA’s) guidance on the use of patient-reported outcome measures to support product approvals or labeling claims recommends that endpoints be developed with direct patient input and include all symptoms important to patients.

Aim

To identify a comprehensive set of CC symptoms that are important to patients for measurement in clinical trials.

Methods

Following a targeted literature review to identify CC symptoms previously reported by patients, 28 patient interviews were conducted consistent with the FDA’s guidance on patient-reported outcomes. Subsequent to open-ended questions eliciting descriptions of all symptoms, rating and ranking methods were used to identify those of greatest importance to patients.

Results

All 67 studies reviewed included bowel symptoms; more than half also addressed at least one abdominal symptom. Interview participants reported 62 potentially distinct concepts: 12 bowel symptoms; 21 abdominal symptoms; and 29 additional symptoms/impacts. Patients’ descriptions revealed that many symptom terms were highly related and/or could be considered secondary to CC. The rating and ranking task results suggest that both bowel (for example, stool frequency and consistency) and abdominal symptoms (for example, bloating, abdominal pain) comprise patients’ most important symptoms. Further, improvements in both bowel and abdominal symptoms would constitute an improvement in patients’ CC overall.

Conclusion

Abdominal symptoms in CC patients are equal in relevance to bowel symptoms and should also be addressed in clinical trials to fully evaluate treatment benefit.

Extruded blend films of poly(vinyl alcohol) and polyolefins: common and hard-elastic nanostructure evolution in the polyolefin during straining as monitored by SAXS

Straining of PVA/PE and PVA/PP blends (70:30) is monitored by small-angle x-ray scattering (SAXS). Sheet-extruded films with different predraw ratio are investigated. The discrete SAXS of predrawn samples originates from polyolefin nanofibrils inside of polyolefin microfibrils immersed in a PVA matrix. PE nanofibrils deform less than the macroscopic strain without volume change. PP nanofibrils experience macroscopic strain. They lengthen but their diameter does not decrease. This is explained by strain-induced crystallization of PP from an amorphous depletion shell around the core of the nanofibril. The undrawn PVA/PE film exhibits isotropic semicrystalline nanostructure. Undrawn PVA/PP holds PP droplets containing oriented stacks of semicrystalline PP like neat precursors of hard-elastic thermoplasts. Respective predrawn films are softer than the undrawn material, indicating conversion into the hard-elastic state. Embedding of the polyolefin significantly retards neck formation. The polyolefin microfibrils can easily be extracted from the water-soluble matrix.

Transport behavior of functionalized multi-wall carbon nanotubes in water-saturated quartz sand as a function of tube length

A series of one-dimensional column experiments was conducted to examine the effects of tube length on the transport and deposition of 4-ethoxybenzoic acid functionalized multi-wall carbon nanotubes (MWCNTs) in water-saturated porous media. Aqueous MWCNTs suspensions were prepared to yield three distributions of tube lengths; 0.02-1.3 μm (short), 0.2-7.5 μm (medium), and 0.2-21.4 μm (long). Results of the column studies showed that MWCNT retention increased with increasing tube length. Nevertheless, more than 76% of the MWCNT mass delivered to the columns was detected in effluent samples under all experimental conditions, indicating that the functionalized MWCNTs were readily transported through 40-50 mesh Ottawa sand. Examination of MWCNT length distributions in the effluent samples revealed that nanotubes with lengths greater than 8 μm were preferentially deposited. In addition, measured retention profiles exhibited the greatest MWCNT deposition near the column inlet, which was most pronounced for the long MWCNTs, and decreased sharply with travel distance. Scanning electron microscope (SEM) images showed that MWCNTs were deposited on sand surfaces over the entire column length, while larger MWCNT bundles were retained at grain intersections and near the column inlet. A mathematical model based on clean bed filtration theory (CBFT) was unable to accurately simulate the measured retention profile data, even after varying the weighting function and incorporating a nonuniform attachment rate coefficient expression. Modification of the mathematical model to account for physical straining greatly improved predictions of MWCNT retention, yielding straining rate coefficients that were four orders-of-magnitude greater than corresponding attachment rate coefficients. Taken in concert, these experimental and modeling results demonstrate the potential importance of, and need to consider, particle straining and tube length distribution when describing MWCNT transport in water-saturated porous media.

Flow-dependent entrapment of large bioparticles in porous process media

The need for purification of biomolecules extends to larger bioparticles as well. For example, virus purification is required for production of many vaccines and gene delivery vectors, and understanding virus removal in porous media is also important in downstream processing of therapeutic proteins and in purification of water in soils. A convective entrapment mechanism for retention of large bioparticles is discussed here based on retention of such bioparticles in pore constrictions at high enough flow rates, even under non-binding conditions. A simple equation to predict whether such entrapment is expected to occur in a given system is derived based on a Péclet number that is proportional to the flow rate and to the cube of the bioparticle diameter. To test the theory, adenovirus was spiked onto chromatographic beds. As expected from the theory, under non-interacting conditions a progressively larger amount of virus becomes trapped with increasing flow rate. The entrapment is reversible upon flow rate reduction, which, within the proposed model, is based on the possibility of diffusive escape from pore constrictions. This mechanism can be exploited for virus purification or removal, and the theory is also consistent with the anecdotal evidence that monoliths and membranes are more difficult to clean than conventional chromatographic beds, especially at high flow rates.

How do older persons define constipation? Implications for therapeutic management

This study examined the relation between bowel-related symptoms and self-report of constipation in 10,875 subjects aged 60 years and over, who participated in the 1989 National Health Interview Survey. Subjects reporting constipation "always" or "mostly" over the past 12 months (n = 594) were compared with those who reported never having the symptom (n = 4,192). Straining (adjusted odds ratio 66.7; 95% confidence interval 31.5, 142.4) and hard bowel movements (25.6; 16.7, 38.7) were most strongly associated with self-report of constipation. These findings suggest that treatment for constipation in the older population should be directed as much or more at facilitating comfortable rectal evacuation, as increasing bowel movement frequency.