Health-related quality of life in patients with neuroendocrine neoplasms: a two-wave longitudinal study.

PURPOSE: Scientific knowledge on health-related quality of life (HRQoL) in patients with neuroendocrine neoplasm (NEN) is still limited and longitudinal assessment of HRQoL over the time in NEN patients are scarce. The current study aimed to assess the role of clinical severity and heterogeneity of NEN, as well as resilience, in the HRQoL of NEN patients over the course of a year. METHODS: 39 consecutive NEN patients (25 men and 14 women) aged from 29 to 73 years participated in a longitudinal Italian multicentric study. The main outcome measure concerned the severity and heterogeneity of NEN, HRQoL, and resilience. RESULTS: Over the course of a year, higher levels of the global health (GH) were associated to the absence of distant metastases, while the presence of metastases with higher levels of fatigue, diarrhea, and financial difficulties. Higher levels of resilience are still associated with better GH and lower levels of fatigue, diarrhea, and financial difficulties, but no longer with constipation. Furthermore, patients with gastroenteropancreatic NEN still have higher scores on constipation, but not on GH, fatigue, diarrhea, and financial difficulties. Patients with hereditary NEN continue to have greater GH than those with a sporadic NEN and lower fatigue, diarrhea, and financial difficulties. CONCLUSION: These findings showed that the effects of severity and clinical heterogeneity of the NEN on HRQoL may change over time. This evidence should lead clinicians to monitor the HRQoL of NEN patients throughout the course of the disease and psychologists to implement evidence-based resilience interventions.

Improvement of body composition and bone mineral density after enteral nutrition in pediatric Crohn disease.

BACKGROUND: The relationship between exclusive enteral nutrition (EEN) and bone status is poorly defined in pediatric Crohn disease (CD). AIMS: The aim of this study was to investigate the impact of EEN on body composition, nutritional status, and bone mineral density (BMD) in an incident CD cohort. METHODS: 18 newly diagnosed CD children starting EEN for 8 weeks were prospectively enrolled and evaluated at baseline and after 8 (T8), 26 (T26) and 52 weeks (T52) from diagnosis. The Fat Free Mass (FFM) and the Resting Energy Expenditure (REE) were measured through Bioelectrical Impedance (BIA) and the BMD was assessed by dual-energy X-ray (DXA). We compared DXA data of IBD patients to the data obtained in 15 healthy controls. RESULTS: CD children had a significant lower BMD compared to healthy control both at baseline (p<0.0001), and after EEN therapy at T52 (p=0.0004); although at this latest time point CD children had a significant increase of BMD compared to baseline (p=0.0015). The BIA analysis showed a significant increase at T26 and T52 of FFM and REE. T52. FFM measured by BIA and BMD measured by DXA were significantly correlated. CONCLUSION: EEN improves nutritional status and bone mineral composition.

Pooled data analysis of primary ventral (PVH) and incisional hernia (IH) repair is no more acceptable: results of a systematic review and metanalysis of current literature.

PURPOSE: Primary (PVHs) and incisional (IHs) ventral hernias represent a common indication for surgery. Nevertheless, most of the papers presented in literature analyze both types of defect together, thus potentially introducing a bias in the results of interpretation. The purpose of this systematic review and meta-analysis is to highlight the differences between these two entities. METHODS: Methods MEDLINE, Scopus, and Web of Science databases were reviewed to identify studies evaluating the outcomes of both open and laparoscopic repair with mesh of PVHs vs IHs. Search was restricted to English language literature. Risk of bias was assessed with MINORS score. Primary outcome was recurrence, and secondary outcomes were baseline characteristics and intraoperative and postoperative data. Fixed effects model was used unless significant heterogeneity, assessed with the Higgins I square (I2), was encountered. RESULTS: The search resulted in 783 hits, after screening; 11 retrospective trials were selected including 38,727 patients. Mean MINORS of included trials was 15.2 (range 5-21). The estimated pooled proportion difference for recurrence was - 0.09 (- 0.11; - 0.07) between the two groups in favor of the PVH group. On metanalysis, PVHs were smaller in area and diameters, affected younger and less comorbid patients, and were more frequently singular; the operative time and length of stay was quicker. Other complications did not differ significantly. CONCLUSION: Our paper supports the hypothesis that PVH and IH are different conditions with the latter being more challenging to treat. Accordingly, EHS classifications should be adopted systematically as well as pooling data analysis should be no longer performed in clinical trials.

Systematic review with meta-analysis: impact of one-handed vs. two-handed technique on quality outcomes of colonoscopy.

OBJECTIVE: Colonoscopy is usually performed with the one-handed technique (1HT), although several countries and operators still adopt the two-handed technique (2HT). It is still uncertain whether the 1HT can improve the quality outcomes of colonoscopy. We performed a systematic review with meta-analysis to explore the quality outcomes in patients undergoing 1HT or 2HT colonoscopy. MATERIALS AND METHODS: We performed a systematic review with meta-analysis to compare the pooled rates of adenoma detection rate (ADR), cecal intubation rate (CIR), cecal intubation time (CIT), and withdrawal time (WT), in patients undergoing 1HT or 2HT colonoscopy via PubMed/EMBASE, SCOPUS, and Cochrane databases. The primary outcome was the pooled rate of ADR and CIR. CIT and WT were also assessed. Pooled odds ratio (OR), standard mean differences (SMD), and 95% confidence intervals (CI) were calculated using fixed or random-effect models. RESULTS: Five studies (15,763 patients) met the inclusion criteria. The pooled ADR was not significantly different between the two techniques (OR 1.10; 95% CI 0.88-1.39; p=0.16), and CIR was not significantly different in 1HT from 2HT (OR 0.757; 95% CI 0.55-1.02; p=0.07), with no significant heterogeneity. Furthermore, no significant differences were seen for CIT (SMD 0.95; p=0.62) and WT (SMD 0.58; p=0.74). CONCLUSIONS: The 1HT colonoscopy does not add relevant improvement in the quality and efficacy of colonoscopy.

Susceptibility of group A beta-hemolytic streptococci in the lower St Lawrence region, Quebec.

OBJECTIVE: To determine the susceptibility of group A beta-hemolytic streptococci (GABHS) in the lower St Lawrence region, Quebec to different antibiotics, particularly macrolides, and to compare different antibiogram methods (disk diffusion, E-test and microdilution) and incubation atmospheres (ambient air and 5% carbon dioxide). METHODS: A total of 384 strains of GABHS isolated from 377 patients (throat 335; other sites 49) from three hospitals in the lower St Lawrence region were analyzed for their susceptibility to erythromycin, clarithromycin, azithromycin, penicillin, clindamycin, cephalothin, rifampin and vancomycin by disk diffusion on Mueller-Hinton (MH) agar supplemented with 5% defibrinated sheep blood (MHB) at 35ºC in 5% carbon dioxide. Strains that were found to be intermediately resistant or resistant to one of the antibiotics by disc diffusion, strains from sites other than throat, and a sample of 97 pharyngeal strains were evaluated by E-test on MHB (35ºC, 5% carbon dioxide) for their susceptibility to the antibiotics erythromycin, clarithromycin, azithromycin, penicillin, clindamycin and ceftriaxone. In addition, minimum inhibitory concentrations (MICs) were determined for erythromycin and azithromycin by broth microdilution using MH broth supplemented with 2.5 % of lysed horse blood (35ºC, ambient air) on strains that were resistant or intermediately resistant to the macrolides (erythromycin, clarithromycin, azithromycin). An evaluation was also carried out on these strains to determine the influence of the incubating atmosphere (ambient air versus 5% carbon dioxide) on susceptibility results obtained by disk diffusion (erythromycin, clarithromycin and azithromycin) and E-test (erythromycin and azithromycin) methods. RESULTS: Nine strains (2%) from nine patients (throat eight, pus one) were resistant to all macrolides as tested by three different techniques (disk diffusion, E-test and microdilution). All strains were susceptible to all the other antibiotics tested. For the strains intermediately resistant or resistant to macrolides, incubation in a 5% carbon dioxide atmosphere was associated with a reduction in the diameter of inhibition determined by disk diffusion (P<0.001) with frequent minor variations in interpretation, and with an increase in the MIC by E-test (P<0.001), which had no impact on interpretation. CONCLUSIONS: Resistance of GABHS to macrolides was not common (2%) in the lower St Lawrence Region. GABHS susceptibility to erythromycin seemed to predict the susceptibility to the other macrolides. Significant variation in antibiogram results (disk diffusion and E-test) of GABHS susceptibility to macrolides was related to the incubation atmosphere and may have an impact on the interpretation of disk diffusion results.

[Nutritional supplementation in patients with cystic fibrosis]. / Suplementação dietética em pacientes com fibrose cística.

OBJECTIVE: To evaluated the effect of short-term oral supplementation in the nutritional status of 14 patients with cystic fibrosis in 19 hospital admissions. METHODS: All patients received standard pulmonary therapy, and to 13 patients (Group I = GI) a high-fat oral supplement was offered besides the standard diet. The control group (GII) received the same diet except for the supplement. Anthropometric measurements, quantitative assessment of energy intake and serum biochemical parameters were determined on admission and prior to discharge from hospital. RESULTS: There was no difference in the weight gain between groups (median: GI=+1000 g; GII=+550 g), nor in the variations of height, skinfolds and body fat. Z scores were calculated (mean-/+SD: weight/age, GI=-2.19-/+1.0, GII=-2.57-/+1.1; height/age, GI=-1.73-/+1.4, GII=-2.06-/+1.4 ), showing that those patients had chronic severe malnutrition, with no changes in Z Score in this period. The diet offered to the patients provided the RDA for calories only in the supplemented group, and this value was significantly higher compared to the non-supplemented group (mean -/+ SD : GI= 146-/+20% RDA; GII=105-/+13%RDA). The energy intake was significantly higher in group I (mean-/+SD: GI=126-/+22%RDA; GII= 81-/+27%RDA), and it increased significantly by the end of admission in this group. The biochemical assessment revealed low levels of prealbumin in both groups on admission (mean-/+SD: GI=11-/+10mg/dl; GII=8-/+8 mg/dl), with significant increase only in group I (mean-/+SD: GI=23-/+15 mg/dl; GII=8-/+11 mg/dl). No variations in the levels of triglycerides were observed, but the cholesterol levels increased significantly in both groups. CONCLUSIONS: Although the weight gain was similar in both groups, prealbumin increased only in the supplemented group. This group had a higher energy intake than the non-supplemented one, and it reached the RDA for calories.

Outbreak of glutaraldehyde-induced proctocolitis.

BACKGROUND: An outbreak of hemorrhagic proctocolitis occurred after the introduction of 2% glutaraldehyde as a disinfectant for colonoscopes. An inadequate rinsing procedure was detected. Recent studies have pointed to glutaraldehyde as an irritant potentially capable of inducing colitis. This study aimed to measure retrospectively the occurrence of proctocolitis after colonoscopy in persons exposed to glutaraldehyde used as a disinfectant for colonoscopes, and to compare this rate with that in patients exposed to the previous cleaning procedure. METHODS: Colonoscopic procedures were randomly selected during the period when glutaraldehyde was used, as well as during the previous period, when a detergent was used. Patients were asked to respond to a questionnaire during a telephone interview, in search of symptoms compatible with proctocolitis after colonoscopy. RESULTS: Of the 400 colonoscopic procedures selected during each of the glutaraldehyde and the detergent periods, respectively 299 and 242 were evaluable. According to different nonexclusive definitions, we observed in the glutaraldehyde period higher frequencies of proctocolitis (at least five stools/day; 14/299 vs 3/242, p = 0.02), severe proctocolitis (> 10 stools/day; 10/299 vs 1/242, p = 0.04), and severe hemorrhagic proctocolitis (6/299 vs 0/242, p = 0.04). Younger age was associated with proctocolitis only during the glutaraldehyde period (p = 0.0008). No pathogen was demonstrated in the only two patients who had stool cultures. The median incubation after colonoscopy was 4 hours (range 0 to 24 hours) and the symptoms lasted 30 hours (range 6 to 216 hours). No patient had fever, and the illness resolved spontaneously in all cases. CONCLUSION: Inadequate rinsing of colonoscopes after immersion in glutaraldehyde may result in proctocolitis, presumably caused by direct action on the mucosa.

C-reactive protein as biochemical indicator of bacterial infection in neonates.

Serial quantitative measurements of C-reactive protein (CRP) were performed, using an automated enzyme immunoassay method, in 127 neonates (114 premature and 13 full-term) classified in three groups: neonates with a normal postnatal course (group 1, n = 69), neonates with clinical suspicion of bacterial infection but with negative cultures (group 2, n = 49), and neonates with proven bacterial infection (group 3, n = 9). A total of 545 serial serum CRP concentrations were determined. In group 1, CRP concentrations were below the detection limit of the method (10 mg/L) except in one neonate who suffered from neonatal anoxia but whose clinical course was uncomplicated (CRP: 31 mg/L within 24 h of life). Thirty-three neonates of group 2 had CRP values consistently below 10 mg/L while 16 had elevated CRP concentrations at least on one occasion ranging from 10 to 70 mg/L. Diagnoses other than bacterial infection could explain the raised CRP concentrations in neonates of group 2. CRP concentrations were found to be elevated (greater than 80 mg/L) during the course of infectious diseases in all neonates with proven bacterial infection (septicemia (4), pneumonia (1), multiple micro-abscesses (1), urinary tract infection (3]. Serial measurement of CRP concentrations are shown to be valuable in detecting bacterial infection in neonates as well as in following the efficacy of antimicrobial therapy.