Position change during colonoscopy improves caecal intubation rate, mucosal visibility, and adenoma detection in patients with suboptimal caecal preparation.

INTRODUCTION: Most colonoscopies are completed in the left lateral (LL) position but in cases of suboptimal caecal preparation, changing the patient's position to supine (S) and, if needed, to right lateral (RL) improves caecal intubation rate, mucosal visibility, and adenoma detection. AIM: To determine if position change during colonoscopy facilitates optimal visualisation of the caecum. MATERIAL AND METHODS: A total of 359 patients were grouped into three categories based on the initial caecal intubation position. After caecal intubation, caecal visibility was scored on a four-point scale depending on the number of imaginary quadrants of the caecum completely visualized - Arya Caecal Prep Score. A score of 1 or 2 was unsatisfactory, while 3 or 4 was considered satisfactory. In patients with unsatisfactory score, position was changed from LL to S and then RL and visibility was scored again. RESULTS: The initial caecal intubation in the LL position was achieved in 66.8% of patients, S in 28.5%, and RL in 4.8% of patients. 84.5% (300/355) of patients had an acceptable visualisation score at the initial caecal intubation position. Of the 55 patients with unsatisfactory caecum visualisation scores in the initial intubation position, 30 (8.5%) had satisfactory scores after the first position change (95% CI: 5.77-11.84). Twenty-five (7.04%) subjects required two position changes (95% CI: 4.61-10.22%). An additional 9.3% (11/118) of adenomas were detected in caecum and ascending colon following position change. CONCLUSIONS: Changing patient position improves caecal intubation rate, mucosal visibility, and adenoma detection.

Rapid colonoscopy preparation using bolus lukewarm saline combined with sequential posture changes: a randomized controlled trial.

OBJECTIVE: In this randomized clinical trial, we have compared the Shudh™ colon cleanse (SCC) with HalfLytely(®) colon prep (HCP) to evaluate the efficacy, bowel preparation time (BPT), adverse events, electrolyte abnormalities and patient acceptability. METHODS: Patients were randomized to receive either SCC (n = 65) or HCP (n = 68). All colonoscopies were performed by a single, blinded endoscopist. Colon prep was evaluated on a 5 point grading scale. Statistical non-inferiority was pre-defined as a difference of <15 % in the lower limit of the 95.5 % confidence interval for the treatment difference. Data that were collected include bowel prep score, BPT, adverse events, electrolyte abnormalities and patient acceptability. RESULTS: Bowel preparation efficacy was rated as "successful" for 59/65 (90.7 %) in SCC versus 66/68 (97.1 %) in HCP. This gave a success difference of -6.4 % with a 1-sided 95 % lower confidence limit (LCI) for the difference = -13.3 % (non-inferiority p = 0.25). This difference fell within the predefined limit for non-inferiority. The average BPT for SCC was 1.9 h versus 10.9 in HCP (p < 0.001). No serious adverse events were reported in either group. None of the patients in either group had any clinically significant electrolyte imbalance. Patient ratings for palatability and willingness to repeat were significantly better for SCC (p < 0.05). CONCLUSION: SCC was found to not be inferior to PEG with regards to the quality of bowel preparation. It is worth highlighting that a major advantage of SCC is shorter BPT.

Vitamin D deficiency as a risk factor for allergic disorders and immune mechanisms.

Vitamin D deficiency (VDD) has been reported in very high rates in the U.S. population. Deficiency has been implicated in various diseases such as diabetes, high blood pressure, cardiovascular disease, and many cancers. It has also been implicated in several allergic disorders and immune system dysregulation. The National Health and Nutrition examination survey (NHANES) in 2005-2006 was a cross-sectional survey performed in the noninstitutionalized population of the United States by the Center for Disease Control and Prevention and National Center for Health Statistics. It consists of an extensive interview performed at home and an examination performed at a mobile center. An allergy questionnaire was provided as interview data on self-reported allergic diseases including allergic rhinitis, allergies, and atopic dermatitis. Data were collected using the question, "Has the doctor or other health professional ever told you that you have allergies?" The laboratory parameter of vitamin D < 10 ng/mL was used to define severe VDD. The data were analyzed by logistic regression with SAS Version 9.1 (SAS Institute, Inc., Cary, NC) using the Procedure survey methods. Of 10,348 people who participated in the 2005-2006 NHANES survey, our final sample consisted of 4979 people in whom serum 25-hydroxyvitamin D levels were completed after excluding subjects <20 years of age and those with missing vitamin D values. The VDD was positively correlated with prevalence of allergies. After adjusting the model for age, gender, race, smoking, alcohol, and educational status, the odds ratio still remained significant. There was also a positive correlation with allergy subtypes such as prevalence of rashes, sneezing, and sinus infections with low vitamin D. VDD related to the immune system dysregulation has been extensively reviewed.

Bilirubin as a Protective Factor for Rheumatoid Arthritis: An NHANES Study of 2003 - 2006 Data.

BACKGROUND: Rheumatoid arthritis(RA) is a chronic inflammatory, autoimmune polyarthritis, with a prevalence estimated at one percent of the United States(US) population. Serum bilirubin, because of its antioxidant nature, has been conjectured to exert an anti-inflammatory biologic effect. The objective of this study is to discern whether higher serum Total Bilirubin(TBili) levels are protective against RA. METHODS: This is a secondary analysis of National Health and Nutrition Examination Survey (NHANES) data collected between 2003-2006. Study participants completed a comprehensive questionnaire regarding their health history, underwent a physical examination, and had body fluids collected for laboratory studies. In NHANES, to assess for the presence of RA, the following questions were asked: Doctor ever said you had arthritis?" If so, Which type of arthritis. Statistical analysis was performed, using SAS version 9.1, proc survey methods. Participant data were adjusted for demographic characteristics as well as risk factors for RA. RESULTS: NHANES 2003-2006 included 20,470 individuals, chosen as a representative sampling of the entire US population. Exclusion criteria included age less than twenty years or liver dysfunction, defined as history of abnormal liver function tests or liver disease. 8,147 subjects did not have any exclusion criteria and were included in the data analysis. RA is inversely related to the serum level of TBili with an odds ratio of 0.679 (95% CI 0.533-0.865) and remained significant even after adjusting for age, gender, race, education, and tobacco history, with an odds ratio 0.749 (95% CI 0.575 - 0.976). CONCLUSIONS: Our study supports the hypothesis that higher TBili levels are protective against RA. A plausible mechanism for this association would be that the anti-oxidant effects of TBili exert a physiologic anti-inflammatory effect, which provides protection against RA. This explanation is supported by prior studies which show that higher TBili levels are protective against stroke, atherosclerosis, and vasculitis. Further studies are needed to delineate the exact nature of the protective properties of TBili. KEYWORDS: Bilirubin; Rheumatoid arthritis; Antioxidant; Protective.