ABSTRACT
Background: A dramatic rise in the rate of clostridium difficile infection [CDI] in patients with inflammatory bowel disease [IBD] has been reported in recent years
Methods: In this observational case control study, 65 patients were included and were divided into two groups of IBD+CDI as case group and IBD without CDI as control group
Results: 35 patients who had positive test for clostridium difficile were assigned to the case group. The control group consisted of 30 patients with negative test for clostridium difficile. Pancolitis was seen in the cases more statistically significant than the controls and proctitis was seen more among the controls than the cases [p =0.001]. The cases were on immunosuppressive [p=0.001] and antibiotic [p =0.02] therapy more than the controls. Colonoscopic findings revealed more severe and extensive inflammation among the cases versus milder inflammation among the controls, but these differences were not statistically significant [p =0.2]. Colectomy was seen in 10% of controls and none of the cases and this difference was statistically significant [p value=0.05]. More fecal calprotectin were seen among the cases than the controls and this difference was statistically significant [p <0.05]
Conclusion: This study showed more clostridium difficile infection among the patients on antibiotic or immunosuppressive therapy. Pathological investigation revealed more severe and extensive inflammation among the cases than the controls. Cases had clinically more severe signs and symptoms with higher mayo scores than the controls. ESR[erythrocyte sedimentation rate] and fecal calprotectin were higher in patients with positive clostridium difficile infection and serum albumin was lower in such patients
ABSTRACT
A 40-year-old woman was referred to our health center with a bulky rectorrhagia. The patient was treated with meropenem and vancomycin for an enterococcal meningitis one week earlier. A colonoscopy was performed at a different center, which was unsuccessful due to high blood volume in the colon and poor vision. The patient underwent angiography of the superior and inferior mesenteric arteries and the rectum artery, but the origin of the bleeding was not known. A polypoid mass with ulcer and bleeding from the site was seen in repeated colonoscopy of the left colon reagion. Due to the severity of the bleeding, the patient was transferred to the operating room and a large uterine mass that had transmitted to the lobes of the sigmoid colon was observed. Due to the diagnosis of uterine tumor, hysterectomy and oophorectomy were performed, and the descending colon was removed as a colostomy from the abdominal wall. In the pathological examination, diffuse endometriosis was found, which had involved the left ovary, the left fallopian tube, and both parametrium and sigmoid to the submucosal layer. On the 26th day, the patient was discharged with a good general condition and full vigilance
Subject(s)
Humans , Adult , Female , Lower Gastrointestinal Tract/pathology , Rectum , Uterine Neoplasms/diagnosis , Endoscopy , ColonoscopyABSTRACT
Clostridium difficile infection in patients with inflammatory bowel disease [IBD] is associated with more severe disease, longer hospital admission, higher treatment costs, and higher risk of colectomy and mortality rate. The classic endoscopic view of the disease is adherent whitish-yellowish multifocal membrane, defined as "psudo-membrane". Using stool polymerase chain reaction [PCR] is the best way for identifying this organism. Patients with mild to moderate infection are treated with oral metronidazole, while severe infections are treated with oral vancomycin for 10 days. The first recurrence of clostridium difficile infection is treated with the same regimen as the initial episode; however the second recurrence is treated with vancomycin pulse therapy. In the third recurrence, fecal microbiota transplantation [FMT] is one of the treatment choices. This study is a report of three successful FMT in our patients
ABSTRACT
Gastrointestinal tract candidiasis is a common infection seen in immunocompromised hosts but occurs most frequently in esophagus. Candidiasis of the stomach and the small intestine is unusual. Herein we describe a 60-year-old woman with a history of diabetes mellitus and hypertension who presented to our hospital with melena, hematemesis, and confusion. She had taken ibuprofen since 2 weeks before the admission. In endoscopic evaluation multiple black and necrotic gastric ulcers in incisura and antrum with active bleeding and one clean base ulcer in the bulb of duodenum was seen. Amphotericin B was started because of highly suspicion to candida or mucormycosis infection. She was discharged from the hospital with well condition. Results of pathological evaluation confirmed candida associated gastric ulcer
ABSTRACT
Background and aims: interferon monotherapy is currently the only approved treatment for chronic hepatitis C [CHC] infection in transfusion dependent thalassemic patients, in whom ribavirin has limited use because of its hematologic complications. Our aim was to evaluate the efficacy and safety of pegylated Interferon monotherapy for the treatment of HCV infection in transfusion dependent thalassemic patients
Methods: the trial was a multicenteric, open label, single treatment prospective study of Peginterferon alfa-2 a [PEGASYS, 180 micg per week] for a period of 48 weeks. 32 subjects, 18 to 42 years old [mean +/- SD: 24.1 9.44 years], whose serum HCV RNA was positive and mean ALT remained greater than 1.5 times upper limit of normal were enrolled. A percutaneous liver biopsy was performed before treatment and all patients underwent monthly assessment of any adverse events and were monitored for serum ALT. Efficacy was assessed by measuring serum HCV RNA following 24 week treatment-free period . One patient missed follow up and another died due to a drug unrelated cause and 30 patients were evaluated
Results: liver biopsy showed mild fibrosis in 3 1.2%, moderate fibrosis in 53.1 % and cirrhosis in 15.6% of patients. Siderosis was severe in 16 patients [50%]. In 26 out of 30 patients [86.6%] HCV RNA was negative at the end of treatment [ETR response]. Data about 24 weeks post treatment was available in 23 patients, which showed a sustained virological response [SVR] of about 14/23 [60.8%]. Two patients had an elevated end of treatment serum ALT instead of negative HCV RNA but their ALT returned to normal assoon as the treatment stopped. These 2 patients were considered to have INF toxicity
Conclusion: our experience indicates that the cure of HCV-related liver disease in thalassemic patients is not an unrealistic aim and may be reached with Peginterferon alfa-2a monotherapy in a sizable portion of cases