Predictors of Early Readmissions in Hospitalized Patients With Gastroparesis: A Nationwide Analysis

Background/Aims@#Gastroparesis is a chronic gastrointestinal disorder that frequently presents with symptoms that are difficult to manage, necessitating frequent hospitalizations. We sought to determine the predictors of early readmission due to gastroparesis based on etiology. @*Methods@#We identified all adults discharged with a principal diagnosis of gastroparesis after hospitalization from the 2014 Nationwide Readmission Database. We compared etiology wise (diabetes, post-surgical, and idiopathic) early readmission. Multivariate regression analyses were performed to identify significant predictors of 30-day readmission. @*Results@#A total of 12 689 patients were identified, 30.7% diabetic, 2.6% post-surgical, and 66.7% were idiopathic. Patients with diabetic gastroparesis were more likely to be readmitted within 30 days than idiopathic (adjusted odds ratio [aOR], 0.81; 95% confidence interval [CI], 0.69-0.94) and post-surgical gastroparesis (aOR, 0.58; 95% CI, 0.34-0.98). Pyloroplasty was associated with less likelihood of 30-day readmission (aOR, 0.45; 95% CI, 0.20-0.97). In addition, male gender (aOR, 1.18; 95% CI, 1.02-1.37), modifiedElixhauser comorbidity score ≥ 3 (aOR, 1.38; 95% CI, 1.18-1.61), chronic pain syndrome (aOR, 1.41; 95% CI, 1.11-1.78), younger(18-64 years) age (aOR, 1.64; 95% CI, 1.34-2.00), need for percutaneous endoscopic gastrostomy/jejunostomy tube (aOR, 2.06; 95% CI, 1.21-3.52), and need for total parenteral nutrition (aOR, 1.70; 95% CI, 1.24-2.35) were associated with increased risk of 30-day readmission. @*Conclusions@#One in 5 patients was readmitted with gastroparesis within 30 days. In the diabetic group, diabetes-related complications contributed to readmissions than gastroparesis. Pyloroplasty is associated with reduced early hospital readmission. Prospective studies are needed for validation of these results.

Predictors of Early Readmissions in Hospitalized Patients With Gastroparesis: A Nationwide Analysis

Background/Aims@#Gastroparesis is a chronic gastrointestinal disorder that frequently presents with symptoms that are difficult to manage, necessitating frequent hospitalizations. We sought to determine the predictors of early readmission due to gastroparesis based on etiology. @*Methods@#We identified all adults discharged with a principal diagnosis of gastroparesis after hospitalization from the 2014 Nationwide Readmission Database. We compared etiology wise (diabetes, post-surgical, and idiopathic) early readmission. Multivariate regression analyses were performed to identify significant predictors of 30-day readmission. @*Results@#A total of 12 689 patients were identified, 30.7% diabetic, 2.6% post-surgical, and 66.7% were idiopathic. Patients with diabetic gastroparesis were more likely to be readmitted within 30 days than idiopathic (adjusted odds ratio [aOR], 0.81; 95% confidence interval [CI], 0.69-0.94) and post-surgical gastroparesis (aOR, 0.58; 95% CI, 0.34-0.98). Pyloroplasty was associated with less likelihood of 30-day readmission (aOR, 0.45; 95% CI, 0.20-0.97). In addition, male gender (aOR, 1.18; 95% CI, 1.02-1.37), modifiedElixhauser comorbidity score ≥ 3 (aOR, 1.38; 95% CI, 1.18-1.61), chronic pain syndrome (aOR, 1.41; 95% CI, 1.11-1.78), younger(18-64 years) age (aOR, 1.64; 95% CI, 1.34-2.00), need for percutaneous endoscopic gastrostomy/jejunostomy tube (aOR, 2.06; 95% CI, 1.21-3.52), and need for total parenteral nutrition (aOR, 1.70; 95% CI, 1.24-2.35) were associated with increased risk of 30-day readmission. @*Conclusions@#One in 5 patients was readmitted with gastroparesis within 30 days. In the diabetic group, diabetes-related complications contributed to readmissions than gastroparesis. Pyloroplasty is associated with reduced early hospital readmission. Prospective studies are needed for validation of these results.

Concentración de aluminio en carne cocida almacenada en bandejas de aluminio descartables / Aluminum concentration in cooked beef stored in disposable aluminum trays

El aluminio puede ser consumido por personas a través de la contaminación de alimentos y el agua. Los metales pesa­dos en alimentos de origen animal son un riesgo potencial para la salud de los consumidores. En algunos países, es una práctica habitual que las comidas cocinadas listas para el consumo se presenten y mantengan calientes en bandejas de aluminio en tiendas minoristas, como locales de comida rápida y supermercados. No hay información disponible sobre el desprendimiento de metal en este tipo de recipiente de conservación de alimentos. El objetivo de este estudio fue determinar la concentración de aluminio en la carne y en los líquidos de cocción almacenados en bandejas de aluminio descartables. El diseño del estudio incluyó carne bovina cocida almacenada sola, en una salsa acuosa de hierbas a pH 7, y en una salsa acuosa cítrica (a base de limón) a pH 4, para simular condiciones encontradas en la práctica minorista. El Comité Mixto FAO / OMS de Expertos en Aditivos Alimentarios estableció una ingesta semanal tolerable provisional de 2 mg Al kg-1 de peso corporal. Una sola porción de 250 g de carne en salsa ácida almace­nada en una bandeja de aluminio calentada durante 1, 2, 4 u 8 horas contribuiría con 0,9%, 3,4%, 6,9% y 19,8% respectivamente de acuerdo al límite tolerable. Aunque la carne se mantiene caliente durante largos períodos en bandejas de aluminio descartable, el contenido de aluminio no se acerca a los límites actualmente recomendados. Este estudio proporciona datos que sugieren que puede ser prudente limitar el consumo de este tipo de comidas a base de carne con salsas ácidas almacenadas calientes por tiem­pos extendidos en contenedores de aluminio.

Aluminium can be consumed by people through contamination of foods and in water. Heavy metals in foods of animal origin are a potential risk to the health of consumers. It is common practice in some countries that ready-to-eat cooked meals are often presented and maintained hot in aluminium trays in retail outlets such as fast food take-out stores and supermarkets. There are not available information about the detachment of metal in this kind of container food preservation. The objective of this study was to determine the concentration of aluminium in meat and cooking liquids stored in disposable aluminium trays. The design of the study included cooked beef meat stored either alone, or in an aqueous sauce of herbs at pH 7, or in a citric (base of lemon) aqueous sauce at pH 4, to simulate a range of conditions found in retail practice. The Joint FAO/WHO Expert Committee on Food Additives established a provisional tolerable weekly intake of 2 mg Al kg body weight-1. A single 250 g portion of meat in acid sauce stored in a heated aluminium tray for 1, 2, 4, or 8 hours would contribute 0.9%, 3.4%, 6.9% or 19.8% towards this tolerable limit, respectively. Although the aluminium content in meat held warm for long periods in aluminium foil trays does not approach the consumption limits currently recommended, this study provides data that suggest that is may be prudent to limit consumption of ready-to eat meat-based meals with acid sauces stored warm in aluminium containers for extended times.

Obesity and Hypertension among Christian Religious Subgroups: Pentecostal vs. Orthodox.

Aims: The aim of this study was to determine the impact of religious practices and diet doctrines on obesity and hypertension among Pentecostal and orthodox Christians in the Tamale metropolis. Study Design: This study was a cross sectional study. Place and Duration of Study: This study was conducted between January and June 2014, at the Tamale metropolis, Ghana. Methodology: Three hundred (300) Ghanaian subjects (50.3% Pentecostal participants from the Perez Chapel International and the Church of Pentecost and 49.7% Orthodox participants from the Presbyterian Church and Bethel Methodist Church), 18-72 years of age were recruited for this study. Anthropometric measurements including height, weight, waist and hip circumference as well as blood pressure were measured for each of the study participants. Results: The male participants were taller, heavier with higher mean WHR as well as higher mean SBP as compared to the female participants. The females however, had broader hips as compared to the male participants. The males were more likely to fully comply with the religious prescription on fasting (52.6% vs. 40.7%; p = 0.0397) and diet (30.8% vs. 20.4%; p = 0.0375) as compared to the female. The prevalence of obesity among the population in this study ranged from 17% to 28% depending on the criteria used in the weight classification (i.e. BMI, WHR and WC) and the prevalence of hypertension was 15.0% with no significant difference between both genders. Conclusion: This study highlights the significant increase in the prevalence of obesity and hypertension among both males and female populations, with obesity being more prevalent among females. Compliance to religious doctrines on fasting and or diet does not have an impact on the prevalence of obesity and hypertension from this study.

Clinical practice guidelines on the diagnosis and treatment of gastroesophageal reflux disease (GERD)

In the last two decades gastroesophageal reflux disease (GERD), initially thought to be a disease only common  in the West, is described  increasingly in Asia, including the Philippines. A recent local report indicated that the prevalence of erosive esophagitis (EE), a common complication of GERD, has more than doubled, i.e., 2.9% to  6.3%,  between the two time periods of 1994-1997 and 2000-2003, respectively. GERD causes recurrent annoying symptoms which are common  reasons  for  clinic  visits  and consultations thus, it is the objective of these guidelines to provide both primary care physicians  (PCPs) and specialists a current, evidence-based, country-specific recommendations for the optimal management  of  GERD.  These  guidelines  are  intended   to   empower   PCPs   to   make   a   clinic-based diagnosis of GERD, to start an empiric acid-suppressive therapy in the appropriate patient,and direct them to select which GERD patient may need to undergo investigations to ascertain further the diagnosis of GERD or to assess outcomes of therapy. We acknowledge that studies published in the future may influence the impact on our confidence on the recommendations enumerated in  these guidelines thus, we commit to update this document when it is deemed appropriate.

Singapore Chapter of Rheumatologists Consensus Statement on the Eligibility for Government Subsidy of Biologic Disease Modifying Antirheumatic Agents for Treatment of Rheumatoid Arthritis (RA)

<p><b>INTRODUCTION</b>Up to 30% of patients with rheumatoid arthritis (RA) respond inadequately to conventional non-biologic disease modifying antirheumatic drugs (nbDMARDs), and may benefit from therapy with biologic DMARDs (bDMARDs). However, the high cost of bDMARDs limits their widespread use. The Chapter of Rheumatologists, College of Physicians, Academy of Medicine, Singapore aims to define clinical eligibility for government-assisted funding of bDMARDs for local RA patients.</p><p><b>MATERIALS AND METHODS</b>Evidence synthesis was performed by reviewing 7 published guidelines on use of biologics for RA. Using the modified RAND/UCLA Appropriateness Method (RAM), rheumatologists rated indications for therapies for different clinical scenarios. Points reflecting the output from the formal group consensus were used to formulate the practice recommendations.</p><p><b>RESULTS</b>Ten recommendations including diagnosis of RA, choice of disease activity measure, initiation and continuation of bDMARD and option of first and second-line therapies were formulated. The panellists agreed that a bDMARD is indicated if a patient has (1) active RA with a Disease Activity Score in 28 joints (DAS28) score of ≥3.2, (2) a minimum of 6 swollen and tender joints, and (3) has failed a minimum of 2 nbDMARD combinations of adequate dose regimen for at least 3 months each. To qualify for continued biologic therapy, a patient must have (1) documentation of DAS28 every 3 months and (2) at least a European League Against Rheumatism (EULAR) moderate response by 6 months after commencement of therapy.</p><p><b>CONCLUSION</b>The recommendations developed by a formal group consensus method may be useful for clinical practice and guiding funding decisions by relevant authorities in making bDMARDs usage accessible and equitable to eligible patients in Singapore.</p>

Recurrent Spontaneous Pneumothorax Following Helicopter Travel In High Altitude Areas.

A young healthy soldier, non smoker with no previous lung disease, presented with two separate episodes of primary spontaneous pneumothorax within six months, both preceded by low level helicopter travel during high altitude postings. This diagnosis must be considered in patients with acute onset chest pain and dyspnoea even when other risk factors are seemingly absent. Recurrence is common and so this differential must be kept in mind even after complete treatment of a previous episode.

Zinc, vitamin A, and glutamine supplementation in Brazilian shantytown children at risk for diarrhea results in sex-specific improvements in verbal learning

OBJECTIVE: To identify the impact of supplemental zinc, vitamin A, and glutamine, alone or in combination, on long-term cognitive outcomes among Brazilian shantytown children with low median height-for-age z-scores. METHODS: A randomized, double-blind, placebo-controlled trial was conducted in children aged three months to nine years old from the urban shanty compound community of Fortaleza, Brazil. Demographic and anthropometric information was assessed. The random treatment groups available for cognitive testing (total of 167 children) were: (1) placebo, n = 25; (2) glutamine, n = 23; (3) zinc, n = 18; (4) vitamin A, n = 19; (5) glutamine+zinc, n = 20; (6) glutamine+vitamin A, n = 21; (7) zinc+vitamin A, n = 23; and (8) glutamine+zinc+vitamin A, n = 18. Neuropsychological tests were administered for the cognitive domains of non-verbal intelligence and abstraction, psychomotor speed, verbal memory and recall ability, and semantic and phonetic verbal fluency. Statistical analyses were performed using SPSS, version 16.0. ClinicalTrials.gov: NCT00133406. RESULTS: Girls receiving a combination of glutamine, zinc, and vitamin A had higher mean age-adjusted verbal learning scores than girls receiving only placebo (9.5 versus 6.4, p = 0.007) and girls receiving zinc+vitamin A (9.5 versus 6.5, p = 0.006). Similar group differences were not found between male study children. CONCLUSIONS: The findings suggest that combination therapy offers a sex-specific advantage on tests of verbal learning, similar to that seen among female patients following traumatic brain injury.

Community-acquired respiratory infections: Spectrum of organisms and treatment

The respiratory infections addressed in this paper include otitis media, sinusitis, and community acquired pneumonia. The morbidity and mortality of respiratory infections are assessed from the American standpoint; their worldwide significance is even greater. The emphasis is on specific diagnosis. Treatment options vary from country to country. Therapeutic decisions are usually easy once a specific etiologic organism is isolated. Since in many of these common respiratory infections a specific microorganism is not documented and empiric therapy is designed based on past clinical studies, resistance patterns need to be known for each country