13 research outputs found
Hepatitis E—An important cause of imported non‐A, non‐B hepatitis among migrant workers in Qatar
No full textCan GastroPanel be used as a triage tool to select patients with advanced atrophic gastritis for gastroscopy? A prospective clinical validation study
No full textObjective Gastric adenocarcinoma (GAC) is the 17th most common cancer in the UK with a 5-year survival rate of 22%. GastroPanel (Biohit Oyj; Helsinki, Finland) is an ELISA kit that measures pepsinogen I (PGI); pepsinogen II (PGII); gastrin-17 (G-17); and Helicobacter pylori IgG antibodies (Hp IgG). PGI and the PGI/PGII ratio correlate inversely with the severity of chronic atrophic gastritis (AG). The aim of this study was to assess GastroPanel performance in the identification of moderate to severe AG in dyspepsia.Methods In this UK, single-centre, prospective diagnostic accuracy study, 324 patients [56.8% (n=184) female; median age 57 years (range 39–92 years)] were recruited for gastroscopy with biopsy and histology according to the updated Sydney System (USS). Blood (plasma) samples were collected for GastroPanel analysis. Paired samples were obtained from 268 patients [56.3% (n=151) female; median age=57 (range 39–92 years)]. GastroPanel results were interpreted using the GastroSoft app (Biohit).Results Overall agreement between GastroPanel and the USS classification was 90% (95% CI=86.7 to 93.8%), with a weighted kappa (κw) of 0.828 (95% CI=0.781 to 0.865). In receiver operating characteristics (ROC) curve analysis, using moderate/severe atrophic gastritis of the corpus (AGC2+) as the endpoint, AUC=0.840 (95% CI 0.630 to 1.000) and 0.960 (95% CI 0.907 to 1.000) for PGI and the PGI/PGII ratio, respectively.Conclusion GastroPanel is a reliable dyspepsia triage test distinguishing patients who can be safely treated conservatively from those with moderate to severe corpus atrophic gastritis at high risk of developing GAC
Therapeutic action of ketogenic enteral nutrition in obese and overweight patients: a retrospective interventional study.
No full textKetogenic enteral nutrition (KEN™) is a modification of Blackburn’s protein-sparing modified fast, using a hypocaloric, ketogenic liquid diet. The study is about ketogenic enteral nutrition (KEN) in overweight and obese patients receiving a short treatment of the nutritional solution as a 24-h infusion. It is a retrospective analysis that examines safety, weight loss and body composition changes after three sequential 10-day cycles of KEN therapy. Anthropometric and bio-impedance data from 629 patients who underwent KEN were collected before and after completing a 10-day cycle. The study focuses on the change in outcomes from the first cycle to the second cycle and from the first cycle to the third cycle. The following outcomes were explored: weight, waist circumference, BMI, fat mass, lean mass, dry lean mass, phase angle, wellness marker, water mass as a percentage of total body weight. Statistical tests were used to test for significant differences between paired cycle 1 and cycle 2 outcomes and also between paired cycle 1 and cycle 3 outcomes. Where changes in outcomes between timepoints were found to be normally distributed, the paired t test was used, whereas where the changes in outcomes had skewed distributions, the Wilcoxon signed-rank test was used. Linear regression was used to examine associations between changes in both phase angle and BMR/weight with percentage weight change. Initially the simple relationship between variables was examined, and subsequently multiple linear regression was used to re-examine the relationships after adjusting for two pre-specified confounding variables. The results suggested significant changes for all analyzed parameters. There were significant decreases in weight, waist circumference, BMI, fat mass, lean mass, dry lean mass and phase angle. Quantitative changes in lean mass and dry lean mass were minor changes with respect to changes in fat mass. When considering the change from cycle 1 to cycle 3, there was a significant association between change in BMR/weight and change in weight, which remained significant after adjusting for changes in phase angle, fat mass and waist circumference. A one-unit increase in BMR/weight was associated with a 2.4% reduction in weight. There was no significant association between change in phase angle from cycle 1 to cycle 3 in the simple analysis. However, after adjustments greater change in phase angle was associated with a greater weight loss. KEN treatment was overall well tolerated. Results might be restricted to a British cohort only and should not be universally applied. Long-term results need to be explored in controlled studies. KEN treatment is safe, well tolerated and results in rapid fat loss without detriment to dry lean mass
PTH-49 Successful endoscopy recovery strategy after the first wave of the Covid-19 pandemic
No full textCorrigendum to ‘An international genome-wide meta-analysis of primary biliary cholangitis: Novel risk loci and candidate drugs’ [J Hepatol 2021;75(3):572–581]
No full text\ua9 2021It has come to our attention that the name of one of the authors in our manuscript was incorrectly spelled ‘Jinyoung Byan’; the correct spelling is ‘Jinyoung Byun’ as in the author list above. In addition, the excel files of the supplementary tables were not included during the online publication of our article. These have now been made available online. We apologize for any inconvenience caused
European Guideline on Chronic Nausea and Vomiting—A UEG and ESNM Consensus for Clinical Management
No full textIntroduction: Chronic nausea and vomiting are symptoms of a wide range of gastrointestinal and non-gastrointestinal conditions. Diagnosis can be challenging and requires a systematic and well-structured approach. If the initial investigation for structural, toxic and metabolic disorders is negative, digestive motility and gut-brain interaction disorders should be assessed. United European Gastroenterology (UEG) and the European Society for Neurogastroenterology and Motility (ESNM) identified the need for an updated, evidence-based clinical guideline for the management of chronic nausea and vomiting. Methods: A multidisciplinary team of experts in the field, including European specialists and national societies, participated in the development of the guideline. Relevant questions were addressed through a literature review and statements were developed and voted on according to a Delphi process. Results: Ninety-eight statements were identified and voted following the Delphi process. Overall agreement was high, although the grade of scientific evidence was low in many areas. Disagreement was more evident for some pharmacological treatment options. A diagnostic algorithm was developed, focussing on the differentiating features between gastrointestinal motility and gut-brain interaction disorders with predominant nausea and vomiting. Conclusion: These guidelines provide an evidence-based framework for the evaluation and treatment of patients with chronic nausea and vomiting
Hepatitis C virus infection in the Middle East and North Africa “MENA” region: injecting drug users (IDUs) is an under-investigated population
No full textPurpose: Investigation of the injecting drug users (IDUs) population is becoming extremely critical and timely in light of the recent evidence that IDUs now act as the core of hepatitis C virus (HCV) epidemics in developed countries. The purpose of this article, therefore, is not only to review the epidemiology of HCV in the Middle East and North Africa (MENA) region, but also to see whether IDUs were adequately studied and whether harm reduction strategies to be applied for their protection have been set. Methods: A literature review was carried out of articles published within the last decade on HCV infection. Results: The gathered data showed that the population of IDUs is severely under-investigated throughout the whole region, possibly due to religious and cultural impediments. Conclusion: In order to reduce the risk of HCV infection in IDUs, a set of recommendations are advanced emphasizing the urgent need for bio-behavioral studies in this population in order to help identify the source and mode of transmission and the genotypes of HCV involved. These results may allow the development of effective and, yet, socially acceptable intervention strategies. We believe that the role which IDUs play in sustaining HCV infection is also an under-investigated topic in many developing countries. Similar reviews and, hence, interventions should be initiated in these regions. © 2011 Springer-Verlag.Abdel-Hamid M, 2007, J GEN VIROL, V88, P1526, DOI 10.1099-vir.0.82626-0; Abou MAA, 2009, VIROL J, V6, DOI 10.1186-1743-422X-6-146; Alashek WA, 2008, LIBYAN J MED, V3, P162, DOI 10.4176-080425; Alavian S. 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Contribution to the genetics of the mosquito aedes aegypti
No full textThe literature relevant to mosquito genetics is first reviewed.
In the present work, 51 different strains of Aedes aegypti have been examined for colour variation in particular. Methods of rearing, handling and routine are briefly described.
Colour of the dorsal abdomen was so variable, that a scheme was devised to classify it, according to paleness, in 37
grades
and
sub-
rades.
These
could
be
assiened
to
15
numerical
colour
values
to
enable
the
paleness
of
a
population
to
be
quantitatively
defined.
Photography
of
variants
was
adopted
as
a
routine.
In
Linkage
Group
I,
two
partially
sex-linked
factors
controlling
eye
colour
and
one
controlling
abdominal
colour
were
isolated,
and
4
linkage
distanoes
determined.
This
is
the
first
example
of
partial
sex-linkage
in
A.
aegypti
and
the
first
three-point,
linkage
estimation
in
any
mosquito.
In
Linkage
Group
II
one
new
mutant
control
ing
thoracic
colour
was
isolated
and
its
recombination
with
the
previously described
s
locus
measured.
At
least
4
mutant
alleles
are
shown
to
occur
at
the
s
locus
sld
one
is
identical
with
a
gene
previously
ascribed
to
another
locus.
Two
new
mutants
were
isolated
in
Lirucage
Group
III
and
the
crossover
distance
of
one
measured
from
the
previously
described
blt
locus
at
which
a
second
mutant
allele
was
isolated.
A
further
three
potentially
useful
mutants
were
obtained
and
other
variation
mentioned.
The
variation
in
abdominal
colour
in
39
strains
is
described
and
discussed.
The
frequency
of
genotypes
in
populations
polyworphic
for
an
s
allele
suggests,though
not
significantly,
some
degree
of
heterosis.
Hybrids
were
successfully
obtained
between
three
pairs
of
Stego
yia
species.
The
relationship
between
A.
aegypti
and
A. mascarensis,
one
of
the
two
crosses
giving
fertile
hybrids,
is
discussed
more
fully.
A
number
of
gynandromorphs
and
intersexes
is
also
recorded
Pretreatment prediction of response to ursodeoxycholic acid in primary biliary cholangitis: development and validation of the UDCA response score
No full textBACKGROUND:
Treatment guidelines recommend a stepwise approach to primary biliary cholangitis: all patients begin treatment with ursodeoxycholic acid (UDCA) monotherapy and those with an inadequate biochemical response after 12 months are subsequently considered for second-line therapies. However, as a result, patients at the highest risk can wait the longest for effective treatment. We determined whether UDCA response can be accurately predicted using pretreatment clinical parameters.
METHODS:
We did logistic regression analysis of pretreatment variables in a discovery cohort of patients in the UK with primary biliary cholangitis to derive the best-fitting model of UDCA response, defined as alkaline phosphatase less than 1·67 times the upper limit of normal (ULN), measured after 12 months of treatment with UDCA. We validated the model in an external cohort of patients with primary biliary cholangitis and treated with UDCA in Italy. Additionally, we assessed correlations between model predictions and key histological features, such as biliary injury and fibrosis, on liver biopsy samples.
FINDINGS:
2703 participants diagnosed with primary biliary cholangitis between Jan 1, 1998, and May 31, 2015, were included in the UK-PBC cohort for derivation of the model. The following pretreatment parameters were associated with lower probability of UDCA response: higher alkaline phosphatase concentration (p<0·0001), higher total bilirubin concentration (p=0·0003), lower aminotransferase concentration (p=0·0012), younger age (p<0·0001), longer interval from diagnosis to the start of UDCA treatment (treatment time lag, p<0·0001), and worsening of alkaline phosphatase concentration from diagnosis (p<0·0001). Based on these variables, we derived a predictive score of UDCA response. In the external validation cohort, 460 patients diagnosed with primary biliary cholangitis were treated with UDCA, with follow-up data until May 31, 2016. In this validation cohort, the area under the receiver operating characteristic curve for the score was 0·83 (95% CI 0·79-0·87). In 20 liver biopsy samples from patients with primary biliary cholangitis, the UDCA response score was associated with ductular reaction (r=-0·556, p=0·0130) and intermediate hepatocytes (probability of response was 0·90 if intermediate hepatocytes were absent vs 0·51 if present).
INTERPRETATION:
We have derived and externally validated a model based on pretreatment variables that accurately predicts UDCA response. Association with histological features provides face validity. This model provides a basis to explore alternative approaches to treatment stratification in patients with primary biliary cholangitis.
FUNDING:
UK Medical Research Council and University of Milan-Bicocca
Pretreatment prediction of response to ursodeoxycholic acid in primary biliary cholangitis: development and validation of the UDCA Response Score
No full textBackground: Treatment guidelines recommend a stepwise approach to primary biliary cholangitis: all patients begin treatment with ursodeoxycholic acid (UDCA) monotherapy and those with an inadequate biochemical response after 12 months are subsequently considered for second-line therapies. However, as a result, patients at the highest risk can wait the longest for effective treatment. We determined whether UDCA response can be accurately predicted using pretreatment clinical parameters. Methods: We did logistic regression analysis of pretreatment variables in a discovery cohort of patients in the UK with primary biliary cholangitis to derive the best-fitting model of UDCA response, defined as alkaline phosphatase less than 1·67 times the upper limit of normal (ULN), measured after 12 months of treatment with UDCA. We validated the model in an external cohort of patients with primary biliary cholangitis and treated with UDCA in Italy. Additionally, we assessed correlations between model predictions and key histological features, such as biliary injury and fibrosis, on liver biopsy samples. Findings: 2703 participants diagnosed with primary biliary cholangitis between Jan 1, 1998, and May 31, 2015, were included in the UK-PBC cohort for derivation of the model. The following pretreatment parameters were associated with lower probability of UDCA response: higher alkaline phosphatase concentration (p<0·0001), higher total bilirubin concentration (p=0·0003), lower aminotransferase concentration (p=0·0012), younger age (p<0·0001), longer interval from diagnosis to the start of UDCA treatment (treatment time lag, p<0·0001), and worsening of alkaline phosphatase concentration from diagnosis (p<0·0001). Based on these variables, we derived a predictive score of UDCA response. In the external validation cohort, 460 patients diagnosed with primary biliary cholangitis were treated with UDCA, with follow-up data until May 31, 2016. In this validation cohort, the area under the receiver operating characteristic curve for the score was 0·83 (95% CI 0·79–0·87). In 20 liver biopsy samples from patients with primary biliary cholangitis, the UDCA response score was associated with ductular reaction (r=–0·556, p=0·0130) and intermediate hepatocytes (probability of response was 0·90 if intermediate hepatocytes were absent vs 0·51 if present). Interpretation: We have derived and externally validated a model based on pretreatment variables that accurately predicts UDCA response. Association with histological features provides face validity. This model provides a basis to explore alternative approaches to treatment stratification in patients with primary biliary cholangitis. Funding: UK Medical Research Council and University of Milan-Bicocca
