Nutrient Drink Test to Assess Gastric Accommodation in Cyclic Vomiting Syndrome: Single-blinded Parallel Grouped Prospective Study

Background/Aims@#Cyclic vomiting syndrome (CVS) is characterized by episodes of nausea and vomiting, separated by symptom-free intervals. The pathogenesis of CVS is poorly understood. Limited data exist on evaluating impaired gastric accommodation as a mechanistic means for symptoms. We aim to determine if CVS patients demonstrate impaired gastric accommodation applying a nutrient drink test (NDT) protocol. @*Methods@#Through this single-blinded pilot clinical trial, patients with CVS per Rome IV critera and healthy controls were assessed for presence of impaired gastric accommodation by administering an established NDT protocol. Statistical analysis was performed, with data presented as medians and interquartile range. @*Results@#Eleven CVS patients and 15 healthy controls participated in the study between January 2018 and October 2018. Median age was 42.0 years and 37.0 years; majority of subjects were female, 72.7% and 73.3%, respectively. Demographics were similar between CVS and healthy controls. Almost all healthy controls (93.3%) ingested the complete 500 mL protocol, whereas a smaller proportion (72.7%) were able to complete all 4 doses in the CVS group (P = 0.188). Post-prandial visual analogue scale scores of nausea and abdominal pain were found to be significantly higher in CVS patients compared to healthy controls. @*Conclusions@#To our knowledge, this is the first NDT protocol in CVS evaluating the role of impaired gastric accommodation and hypersensitivity as a possible pathophysiologic mechanism. Findings from this study suggest the presence of gastric hypersensitivity in a subset of CVS patients. These results provide the foundational data necessary for future larger testing of NDT and diagnostic accuracy in CVS.

High Prevalence of Slow Transit Constipation in Patients With Gastroparesis

BACKGROUND/AIMS: Current evidence suggests the presence of motility or functional abnormalities in one area of the gastrointestinal tract increases the likelihood of abnormalities in others. However, the relationship of gastroparesis to chronic constipation (slow transit constipation and dyssynergic defecation) has been incompletely evaluated. METHODS: We retrospectively reviewed the records of all patients with chronic dyspeptic symptoms and constipation who underwent both a solid gastric emptying scintigraphy and a high-resolution anorectal manometry at our institution since January 2012. When available, X-ray defecography and radiopaque marker colonic transit studies were also reviewed. Based on the gastric emptying results, patients were classified as gastroparesis or dyspepsia with normal gastric emptying (control group). Differences in anorectal and colonic findings were then compared between groups. RESULTS: Two hundred and six patients met the inclusion criteria. Patients with gastroparesis had higher prevalence of slow transit constipation by radiopaque marker study compared to those with normal emptying (64.7% vs 28.1%, P = 0.013). Additionally, patients with gastroparesis had higher rates of rectocele (88.9% vs 60.0%, P = 0.008) and intussusception (44.4% vs 12.0%, P = 0.001) compared to patients with normal emptying. There was no difference in the rate of dyssynergic defecation between those with gastroparesis vs normal emptying (41.1% vs 42.1%, P = 0.880), and no differences in anorectal manometry findings. CONCLUSIONS: Patients with gastroparesis had a higher rate of slow transit constipation, but equal rates of dyssynergic defecation compared to patients with normal gastric emptying. These findings argue for investigation of possible delayed colonic transit in patients with gastroparesis and vice versa.

Quality of life among postmenopausal women in rural Minia, Egypt

This study aimed to determine the prevalence and severity of menopausal symptoms and their effect on the quality of life of postmenopausal women in rural Minia. A cross-sectional study was conducted among 1 100 postmenopausal women aged 45-60 years selected by multistage random sampling. The menopause rating scale [MRS] was used to assess the menopausal symptoms. The mean age at menopause was 48.9 [SD 4] years. The most frequent symptoms were joint and muscle pain [82.1%], physical and mental exhaustion [69.6%] and hot flushes and sweating [49.2%]. The mean MRS somatic score was 4.12 [SD 2.22], the psychological score was 2.86 [SD 2.50] and urogenital score was 2.13 [SD 1.04]. The total MRS score indicated that the symptoms were of moderate severity [9.11 [SD 5.76]]. Education, marital status, occupation, parity and postmenopausal duration were significantly associated with MRS score. Rural primary health care workers should be aware of this critical stage of life in women to help women deal with symptoms that may affect their quality of life

Prevalence of type 2 diabetes and pre-diabetes in a rural area of Giza-Egypt; a community based study

Diabetes has a priority position on the Egyptian health policy agenda, since it became an emerging public health problem. this study responded to the need for [early detection] of diabetes, among rural individuals >/= 20 years. an epidemiological cross - sectional, community-based survey was conducted in nazlet el ashtar village, giza, upper egypt. a simple random sample of 1,000 male and female individuals >/= 20 years was taken. all participants were subjected to interview questionnaire [to assess sociodemographic characteristics, and diabetes risk factors], anthropometric measurements, blood pressure measurements, screening test to detect a random capillary blood glucose level and diagnostic tests; the fasting and 2 hours post prandial venous blood sample. history of diagnosed type 2 diabetes was stated by 4.3% of the individuals. findings of the screening test revealed prevalence of diabetes and pre-diabetes at 7.7% and 4.9% respectively. the diagnostic test conducted to positive cases for diabetes provided a prevalence rate for diabetes at 6.3%. the peak prevalence of diabetes and pre-diabetes was found to occur in the age interval 40-49 and the prevalence of pre-diabetes was significantly higher among males than females [p < 0.05]. stepwise logistic regression analysis revealed that positive history of hypertension, positive family history of diabetes and waist circumference >/= 88 in females and >/= 102 in males as risk factors for prediabetes and diabetes. the prevalence of type 2 diabetes is increasing in the rural area in greater cairo among >/= 20 years of age population. consider introduction of blood glucose testing, starting before the age of 40 years, for early detection of diabetes at the PHC level especially in the family medicine practice

Postmenopausal stress urinary incontinence: clinical and urodynamic evaluation of combined hormonal replacement therapy

Thirty postmenopausal women suffering from genuine stress urinary incontinence [SUI] were given 0.625 mg of conjugated estrogen and 2.5 mg of medroxyprogesterone acetate for 3 months. They were evaluated clinically and urodynamically before and after combined hormonal replacement, therapy [H R T], Clinically, 10 patients out of 15 [66.7%] with grade I stress urinary incontinence [SUI] had been improved, while 3 patients out of 15 [20%] with grade II SUI had been improved. There was no significant difference in the cystometrogram [CMG] before and after treatment. In those patients who reported clinical improvement, the maximum urethral pressure increased significantly after treatment [40.2 +/- 9.5 cmH2O Vs 65.7 +/- 6.6 cmH2O P < 0.05]. In addition, both the urethral closure pressure and the functional urethral length increased significantly after treatment [38.2 +/- 7.4 cmH2O Vs 59.6 +/- 10.3 cm H2O and 22 +/- . 0.5cm Vs 3.4 +/- 0.2cm respectively P<0.05]. These clinical and urodynarnic data add to the evidence that HRT has a role in conservative treatment in mild to moderate degrees of postmenopausal stress urinary incontinence

Antenatal magnesium sulfate therapy: is there a possible neuroprotective role in preterm neonates? a prospective controlled study

This controlled randomized comparative study was conducted to analyze the association between antenatal MgSO4 administration and the risk of intraventricullar haemorrhage [IVH] as well as periventricular leucomalacia [PVL] In preterm neonates. Study design: The study comprised a total of 97 parturients with preterm labour and gestations varied between 28 to 35 weeks. They were therapeutically categorized according to the tocolytic used into group I [who received MgSO4, n= 53] and group II [who received ritodrine, n = 44]. Inclusion and exclusion criteria have been described. After birth, the neonates of both groups have been subjected to trans-anterior fontanelle neurosonographic examination. The two groups have been compared for the incidence and grade of severity of abnormal neunosonographic findings with respect to neonatal IVH and PVL. Abnormal neurosonograms were demonstrated in eleven of neonates of group I [20.8%] versus sixteen of the neonates of group II [36.4%]. Out of these, two of the neonates of group I [3.8%] and seven of group II [15.9%] have shown severe abnormality according to papile's criteria. The difference in these neurosonographic abnormalities between the 2 groups has been found to be statistically significant [p < 0.05]. There has been no statistically significant difference between serum Mg level as well as the duration of use of MgSO4 and the occurrence of neurosonographic abnormalities. When logistic regression analysis was utilized and after adjustment for the potential variables, the adjusted odds ratio [OR] was 0.9 and the corresponding confidence interval [CI] = 0.6 - 1.1 when group I was compared to group II. This difference has not been found to be statistically significant [p > 0.05]. After adjustment for the potential confounders, the incidence as well as the severity of IVH and PVL in MgSO4 group has not been found to be statistically different from the ritodrine group. These findings provide a strong support for the hypothesis that MgSO4 therapy could not play an independent cerbroventrscular protective role in preterm neonates

Auditory dysfunction in Behcet's disease: a fact or a fiction?

Six neuro-behcet's patients were studied. Three of them had symptoms of auditory disturbances. CT scans and auditory examination including auditory brainstem responses [ABR] were done for each patient. Auditory dysfunction, as an unusual feature of this disease was proved to be a fact. The site of the lesion was shown to be multiple. Each case is discussed separately

Methyl alcohol retinotoxicity in rats: a biochemical and ultrastructural study

The effects of methyl alcohol poisoning on blood gases and serum electrolytes, in addition to its effect on the ultrastructure of the retina were estimated in male albino rats. A significant increase in potassium level and pCO2 was accompanied by depletion in pO2. Sodium and chloride levels were unchanged. A calculated increase in anion gap was due mainly to the increase of potassium level. Methyl alcohol also affected edema of all layers of the retina, fragmentation and ultrastructural changes of the photoreceptor outer segments, agglomeration of chromatin, dissolution of Nissl granules, swelling and degeneration of mitochondria. These necrotic changes were attributable mainly to the hypoxic state caused by the toxin and possibly aggravated by the resultant acidosis

effect of dopamine and its interaction with some drugs on the intraocular pressure of rabbits

The effect of dopamine on the intraocular pressure [IOP] of rabbit eye has been evaluated by electromanometric technique. Both intraocular pressure [IOP] and blood pressure [BP] were measured by manometry in anaethetised rabbits through cannulation of the anterior chamber and femoral artery respectively. This work was done as a trial to detect the type of receptors activated by dopamine in the eye. Injection of dopamine by intravenous infusion at a rate of 250 micro per minute for 20 minutes caused a significant reduction in the lOP which reached its maximum after two hours and the effect remained for four hours after stopping infusion. This ocular hypotensive effect of dopamine was blocked by the alpha-blocker phentolamine and possibly by chlorpromazjne which has an alpha-blocking and a dopaminergic blocking effects. On the other hand, the effect of dopamine was not affected by the dopaminergic blocker metoclopramide or by the beta blocker beta befunolol. From this study it could be concluded that the ocular hypotensive effect of dopamine on the rabbit eye may occur mainly through activation of alpha-receptors