Do You Bleed? A 1-Year FOBT Case-Series Study.

GOALS: The goal of this study is to investigate fecal occult blood test's (FOBT) usage in cases of suspected gastrointestinal bleeding and how it may affect hospitalization length and inpatient endoscopy procedures. BACKGROUND: FOBT is an approved modality used in colorectal cancer screening but is often used inappropriately for the investigation of suspected gastrointestinal bleeding (GIB) in the hospital setting. The efficiency of FOBT when used for this purpose is questionable. STUDY: This study was performed at a 766-bed tertiary academic medical center. All FOBT performed during a 12-month period were identified and 678 cases were analyzed. The results of FOBT were collected along with information regarding patients' hemoglobin levels, rectal examination frequency, performance of endoscopy, length of hospital stay, and presence/absence of gastrointestinal lesions. RESULTS: There were no findings on endoscopy in 13.5% of cases with positive FOBT, demonstrating weak test sensitivity. Low percentage (14.6%) of patients having negative FOBT results underwent endoscopy, even with negative FOBT results, whereas less than 50% of positive FOBT patients were offered procedural evaluation, demonstrating the inefficiency of FOBT in guiding management. Patients with positive FOBT had longer hospitalization periods. Even in the absence of GIB symptoms, critically anemic patients would still undergo endoscopy for GIB investigation even without FOBT being performed. CONCLUSIONS: FOBT is inappropriately used in the hospital setting for GIB investigation. This study shows the inefficiency of FOBT to guide management and the high frequency of positive inpatient FOBT tests leading to unnecessary endoscopic investigation, longer hospitalizations, and delays in care. FOBT should be limited to the outpatient setting and be avoided while investigating GIB, anemia, etc. in the hospital.

Clostridium difficile Infection Rates During the Pandemic in New York Capital Area: A Single-Center Study.

Introduction Clostridioides difficile (C. difficile) colonizes the large intestine, rendering healthy individuals asymptomatic carriers of the disease. In certain instances, C. difficile infection (CDI) occurs. Antibiotic use remains the leading risk factor for CDI. During the coronavirus disease 2019 (COVID-19) pandemic, multiple risk and protective factors for and against CDI were identified, and as such multiple studies tried to analyze the pandemic's overall effect on CDI incidence rates, with contradictory results. Our study's aim is to further characterize the CDI incidence rates trends, but for a longer period of 22 months in the pandemic. Methods We included only adult (>18 years) patients, diagnosed with CDI during their hospitalization for the following period: January 1, 2018, to December 31, 2021. Incidence was calculated as cases per 10,000 patient days. The period identified as the COVID-19 pandemic period was the following: March 1, 2020, to December 31, 2021. All analyses were performed by an expert statistician using Minitab software (Minitab Inc., State College, Pennsylvania, United States). Results The mean CDI incidence rate per 10,000 patient-days was 6.86 +/-2.1. The 95% confidence interval for the CDI incidence rate prior to the pandemic was found at 5.67 +/-0.35 while the interval during the pandemic was calculated at 8.06 +/- 0.41 per 10,000 patient days. Those results reveal a statistically significant increase in CDI incidence rates during the COVID-19 era. Conclusion Multiple risk and protective factors for and against hospital-acquired infections (including CDI) have been identified during the unprecedented COVID-19 healthcare crisis. In the literature, there is high controversy regarding the trends of CDI incidence during the pandemic. The current study analyzed an almost two-year period into the pandemic, identifying an increase in CDI rates when compared to the pre-pandemic era.

Use of Simethicone After Capsule Ingestion and Its Impact on the Quality of Small Bowel Video Capsule Endoscopy: A Pilot Study.

Background Small bowel capsule endoscopy is a tool to visualize the small bowel (SB) for conditions such as obscure bleeding. Various studies have been performed to compare various bowel preparation regimens in terms of small bowel transit time (SBTT), small bowel visualization quality (SBVQ), and diagnostic yield (DY). Literature suggests that using polyethylene glycol (PEG) prep is significantly better compared to clear liquid and overnight fast in terms of SBVQ and DY. Other investigators have tried to assess the efficacy of adding simethicone to the bowel preparation regimen which seems to improve SBVQ. However, no studies have been done to assess the results of simethicone ingestion after capsule swallowing. We intend to give patients simethicone one hour after capsule ingestion for two consecutive hours and compare results for SBVQ pre-and post-ingestion groups. The objective of this study is to compare the effect of simethicone on SBVQ in pre- and post-capsule ingestion groups. Methodology This prospective, randomized controlled trial included patients who were scheduled for outpatient capsule endoscopy at Albany Medical Center (AMC) Endoscopy Suite. Patients were divided into the control group, group 1, and the treatment group (group 2). The control group followed the standard AMC pre-capsule protocol that included PEG 238 g the evening prior. Group 1 included patients who received 3 mL of simethicone (20 mg/0.3 mL) 20 minutes prior to ingesting the capsule. The treatment group (group 2) included patients who ingested simethicone 3 mL 20 minutes prior to capsule swallowing, 3 mL after one hour, and 1.5 mL after another hour, totaling 7.5 mL of simethicone. Data regarding SBVQ for every patient were evaluated as an individual zone score from 1-3 points, each in proximal, middle, and distal SB based on the SBTT. A cumulative score of 3-9 was given after adding the three zones. These scores were derived using the Boston Bowel Preparation Scale. Data analysis was done using Microsoft Excel software. Results There were six patients in the control group, eight in group 1, and eight in the treatment group (group 2). Proximal, middle, and distal SB did not show any significant difference between their SBVQ scores. Moreover, the total combined score also showed no statistical difference in the SBVQ score. Conclusions There were no statistically significant differences in the SBVQ neither while looking at the cumulative score nor individual segmental score of the entire SB. However, this is only a pilot project with a small number of subjects and results may differ in future studies with increased power.

A Comparison of the Effects of COVID-19 on Irritable Bowel Syndrome and Inflammatory Bowel Disease Patients While Working at Home and in the Office: A Retrospective Study.

Background Irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) have a strong relationship with psychological stress. Studies have shown increased stress levels in patients with IBS and IBD during the SARS-CoV-2 (COVID-19) pandemic. The current literature on the impact of work environment on IBD and IBS symptoms is limited, particularly during the current pandemic. Objective This study aims to analyze how the pandemic impacted patients with IBS and IBD in the setting of staying home versus working outside the home. Methods After Institutional Review Board (IRB) approval, a retrospective review of 245 patients with IBS and IBD who followed with our gastroenterology clinic in the past year was performed. Patients were asked about symptoms including, but not limited to, worsening diarrhea, constipation, and abdominal pain. Pearson's chi-squared test was used for analysis. Results Of the 245 patients in our study, 67 had IBS, 166 had IBD, and 12 had both. The male-to-female ratio was 1:1.4. A total of 136 (55.5%) patients worked from home during the pandemic, while 109 (44.5%) patients worked outside. Eighty-three patients working from home reported no change in symptoms, 35 reported worsening symptoms, and 18 reported an improvement in symptoms. Sixty-eight patients working outside the home reported no change in symptoms, 26 reported worsening symptoms, and 15 reported improvements. Working outside the home had a statistically significant relationship with COVID-19 infection. Thirty patients were infected, of which 22 (73.3%) worked outside the home (p=0.01). Overall, 203 (82.8%) patients received the vaccine, and only 14 of these patients reported worsening gastrointestinal (GI) symptoms one week after receiving the vaccine. Comparable results were seen after dividing the data into cohorts of IBS and IBD patients. Of the patients with IBD staying at home, 15.9% had depression (p=0.01). Conclusion Most patients had symptoms at baseline. There was no statistically significant correlation between change in symptoms and work settings. Patients were less likely to be infected with COVID-19 while staying home. Our patient population showed a high vaccination rate of 82.9% as compared to the national average of 59.2% (source: Centers for Disease Control and Prevention (CDC)). Only 5.7% of the patients reported new or worsening gastrointestinal symptoms in the week following vaccination. The limitations of the study included its retrospective design and poor correlation in general between symptoms and disease activity in IBD patients.

Pneumothorax in critically ill patients with COVID-19 infection: Incidence, clinical characteristics and outcomes in a case control multicenter study.

BACKGROUND: The clinical features and outcomes of mechanically ventilated patients with COVID-19 infection who develop a pneumothorax has not been rigorously described or compared to those who do not develop a pneumothorax. PURPOSE: To determine the incidence, clinical characteristics, and outcomes of critically ill patients with COVID-19 infection who developed pneumothorax. In addition, we compared the clinical characteristics and outcomes of mechanically ventilated patients who developed a pneumothorax with those who did not develop a pneumothorax. METHODS: This study was a multicenter retrospective analysis of all adult critically ill patients with COVID-19 infection who were admitted to intensive care units in 4 tertiary care centers in the United States. RESULTS: A total of 842 critically ill patients with COVID-19 infection were analyzed, out of which 594 (71%) were mechanically ventilated. The overall incidence of pneumothorax was 85/842 (10%), and 80/594 (13%) in those who were mechanically ventilated. As compared to mechanically ventilated patients in the non-pneumothorax group, mechanically ventilated patients in the pneumothorax group had worse respiratory parameters at the time of intubation (mean PaO2:FiO2 ratio 105 vs 150, P<0.001 and static respiratory system compliance: 30ml/cmH2O vs 39ml/cmH2O, P = 0.01) and significantly higher in-hospital mortality (63% vs 49%, P = 0.04). CONCLUSION: The overall incidence of pneumothorax in mechanically ventilated patients with COVID-19 infection was 13%. Mechanically ventilated patients with COVID-19 infection who developed pneumothorax had worse gas exchange and respiratory mechanics at the time of intubation and had a higher mortality compared to those who did not develop pneumothorax.

Serum vitamin D levels in patients with obstructive sleep apnea syndrome and level changes after continuous positive airway pressure therapy.

PURPOSE: Patients with obstructive sleep apnea syndrome (OSAS) have been found to exhibit lower serum vitamin D levels, even when the control groups are matched for confounding conditions. However, contradictory studies are also present. This study aimed to compare serum 25-hydroxyvitamin D (25(OH)D) levels between adult patients with OSAS and non-apneic controls and to evaluate the changes in 25(OH)D levels after 3 and 12 months of continuous positive airway pressure (CPAP) therapy. METHODS: The study was comprised of 30 patients with OSAS and 30 controls. Serum 25(OH)D levels were determined at baseline and after 3 and 12 months of CPAP therapy in all patients with OSAS. For analysis, patients with OSAS were divided into subgroups by adherence, with adherence defined as CPAP usage for > 4 h per night on at least 70% of nights. RESULTS: The 25(OH)D levels were not significantly different between OSAS and control groups at baseline. 25(OH)D levels did not change after 3 and 12 months of CPAP therapy. Patients who were CPAP-adherent showed less reduction in 25(OH)D levels compared with non-adherent ones (21.18 ± 9.3 vs. 12.13 ± 3.8 ng/mL, p = 0.022) after 1 year. The 25(OH)D levels were significantly correlated with higher daily CPAP usage at 3 and 12 months. Mean daily CPAP usage was a significant predictor of serum 25(OH)D levels at 12 months. CONCLUSIONS: Patients with OSAS who demonstrated good CPAP adherence showed significantly higher 25(OH)D levels after 1 year compared with those not adequately using CPAP. Long-term good CPAP adherence and highly daily CPAP usage positively affected 25(OH)D levels in patients with OSAS.

25-hydroxyvitamin D levels in patients with obstructive sleep apnea and continuous positive airway pressure treatment: a brief review.

The aim of the present study is to summarize the information available, to time, regarding the relationship between obstructive sleep apnea (OSA) and vitamin-D (vD) levels. Moreover, the association between vD deficiency and OSA severity will also be examined. At the end of the present study the possible advantageous effect of CPAP on vD-levels will be summarized. Extensive literature search was conducted in PubMed, Scopus, The Cochrane Library and Embase database. 13 articles were found concerning OSA and vD, of which 2 articles included treatment with a CPAP. Patients with OSA exhibit low levels of vD in the blood serum, and women present an even lower mean value than men. Lack of VD in blood serum seems to be related to the severity of the OSA syndrome, and to the short duration of sleep. OSA patients with concurrent metabolic syndrome exhibit lower serum vD-levels, as compared with those without metabolic syndrome. Long-term continuous positive airway pressure treatment (CPAP) treatment can increase vD-levels in male OSA patients while no change is observed in women. OSA patients demonstrate lower levels of vD in multiple studies. The severity of the OSA may be associated with vD-levels and deficiency, however more studies are needed to assess that relationship due to contradictions in current bibliography. CPAP can increase vD-levels in male patients. The relation between vD and OSA and/or CPAP is important but recent; therefore further research is needed about the exact relationship to be clarified. Also, the effect of gender hormones on vD regulation in OSA patients should be further investigated.

The effect of sleep quality in Sherpani Col High Camp Everest.

Recently, an increasingly higher volume of travelers deciding to get the experience of hiking to the highest summit worldwide has been noted. However, high altitude environments have adverse effects on the normal bodily function of individuals accustomed to living at low altitudes. The purpose of this study was to record sleep quality and physiological responses of 8 climbers during a 7 days stay at Sherpani Col High Camp Everest in an altitude of 5700-m. Eight experienced climbers (Age: 48 ±â€¯9.2 yrs, Height: 176.3 ±â€¯7.1 cm, Body mass: 76.9 ±â€¯11.7 kg, weekly exercise >80% HRmax > 270 min-1) participated in the study. The climbers recorded their sleep quality daily and one hour after waking up via a questionnaire (Groningen Sleep Quality Scale, GSQS), levels of perceived exertion (Borg CR10 Scale), heart rate (HR, bpm-1) and oxygen saturation in blood (SpO2, %) using the pulse oximeter Nonin Onyx Vantage 9590 (USA). Climbers also filled out questionnaires regarding how sleepy they felt (Epworth Sleepiness Score, ESS) 12 h post waking-up. Repeated measures ANOVA were used in order to examine possible variations between variables. Results showed statistical significant differences in the HR and SpO2 parameters, (HR: 86.5 ±â€¯5.2 bpm-1, p < 0.05; SpO2: 85.3 ±â€¯2.4%, p < 0.05). The subjective evaluation of GSQS, ESS and perceived exertion using a Borg CR10 Scale may be affected by the extreme hypoxic environment and the daily hike-climb which results in low blood oxygen saturation.

Impact of the financial crisis on COPD burden: Greece as a case study.

Poverty and low socioeconomic status have been associated with chronic obstructive pulmonary disease (COPD). The current financial crisis has forced millions back into poverty. Greece is one of the countries hit the hardest, and is in the middle of a deep ongoing collapse. There have been early reports stating the apparent effects of the Greek downturn on respiratory health. This review summarises the overall impact of the financial crisis on COPD burden throughout the period of economic downturn by analysing the case study of Greece. In all levels of the healthcare system, current economic restrictions have reduced the capacity to prevent, diagnose and treat COPD in parallel with current higher detection rates of COPD. Remarkably, expenditure on healthcare has been reduced by >25%, resulting in major healthcare equipment shortages. Lower wages (by up to 20%) and higher co-payments of up to 25% of a drug's purchase price have led to patients struggling to afford inhaled medications. Treatment nonadherence has been reported, resulting in 11.5% more exacerbations and 14.1% more hospitalisations annually, while the mean cost per severe COPD exacerbation has been approximated as €2600. Greece is a noteworthy example illustrating how COPD burden, quality of care and patients' outcome can be affected by economic crisis.