Do Non-steroidal Anti-inflammatory Drugs Cause Exacerbations of Inflammatory Bowel Disease?

The safety of non-steroidal anti-inflammatory drugs (NSAIDs) in patients with inflammatory bowel disease (IBD) remains unclear. This report discusses potential mechanisms whereby NSAIDs might exacerbate IBD and reviews the available clinical data on the role of NSAIDs in causing exacerbations of ulcerative colitis (UC) and Crohn’s disease (CD).     

Is the Gag Reflex Useful in the Management of Swallowing Problems in Acute Stroke?

The goal of this study was to compare the diagnostic value of an absent gag reflex in acute stroke patients with the bedside swallowing assessment (BSA) and assess its relationship to outcomes. Two hundred forty-two acute stroke patients had their gag reflex tested and a BSA performed. Numbers needing nasogastric or gastrostomy tube insertion were noted, also their discharge destination, discharge Barthel Index, and mortality. The mean age of the subjects was 76.5 ± 10.2 years; 37.6% were male; 41.7% of the patients were dysphagic on BSA; 18.2% had an absent gag. Dysphagia was present in 88.6% of the patients with an absent gag and in 31.3% of those with an intact gag. The gag reflex was absent in 38.6% of dysphagic and 3.5% of nondysphagic patients. Comparing an absent gag against the criterion of the BSA, its specificity was 0.96, sensitivity 0.39, positive predictive value 0.89, and negative predictive value 0.69. Regression analyses found that an intact gag gave an Odds Ratio [CI] of 0.23 [0.06–0.91] for gastrostomy feeding but did not predict other outcomes. We conclude that the gag reflex is as specific as but less sensitive than the BSA in detecting dysphagia in acute stroke patients. An intact gag may be protective against longer-term swallowing problems and the need for enteral feeding.Deborah Ramsey’s post has been funded by Action Research.     

Is There an Effect of Cannabis Consumption on Acute Pancreatitis?

Digestive Diseases and Sciences - Twenty-percentage of acute pancreatitis (AP) cases is labeled as idiopathic. Cannabis remains the most frequently used illicit drug in the world. The aim of this...     

COPD: an inflammatory disease of the airways?

COPD is characterized by a not fully reversible airflow limitation which is progressive and associated with an abnormal inflammatory reaction of the lungs. Airflow limitation is most often assessed by FEV (1.0). However, FEV (1.0) does not always reflect the course of the disease and does not appropriately describe the functional effect of a pharmacological or non-pharmacological intervention. Measurement of inspiratory parameters, e.g. IC or FIV (1.0), as well as assessment of exercise capacity should therefore be part of functional tests. The abnormal inflammatory reaction of the lungs can be assessed by a variety of methods. However, the characteristic increase of the number of neutrophils does not indicate a new therapeutic target. The term abnormal inflammation of the airways in bronchial asthma as well as in COPD presumably prompted a number of studies investigating the effects of inhalative corticosteroids in COPD. ICS do not alter the course of the disease, however they may reduce the number and severity of exacerbations. Combination of long-acting beta -agonists and ICS exert a better effect than either compound alone. This beneficial effect is difficult to explain by an anti-inflammatory action, as the long acting anticholinergic tiotropium has a comparable symptomatic and functional effect and reduces exacerbations without any known anti-inflammatory component. Future pharmacological therapies should therefore be based on a better understanding of the functional consequences of the disease and its pathogenesis.     

Is the Volume of the Parathyroid Gland a Predictor of Maxacalcitol Response in Advanced Secondary Hyperparathyroidism?

We evaluated the relationship between the volume of parathyroid glands estimated by ultrasonography (US) and response of 22-oxa calcitriol (Maxacalcitol, OCT) in patients with secondary hyperparathyroidism (2HPT) to evaluate whether the volume can be a predictor of the OCT response. Eleven institutes participated in this study. Ninety-four patients with advanced 2HPT were enrolled. The volume of the parathyroid glands were estimated by US before and 6 months after OCT treatment. The response of OCT treatment was classified into three groups (Group A: i-PTH < 300 pg/mL; Group B: 300 pg/mL < or = i-PTH < 500 pg/mL; Group C: i-PTH > or = 500 pg/mL). Forty-eight patients were in Group A, 28 patients in Group B, and 18 patients in Group C. The PTH levels at the beginning and 6 months were 458.3-199.1 pg/mL (P < 0.0001) in Group A, 524.6-403.2 pg/mL (P = 0.007) in Group B and 736.7-613.6 pg/mL (ns) in Group C, respectively. The volume of the largest gland in Group B was significantly larger than that in Group A (96.2 vs. 343.2 mm3: P < 0.001). Clinical factors affecting response of OCT was evaluated by logistic regression analysis and only the volume of the largest gland was a significant factor. In the patients whose volume was less than 300 mm3, the OCT response was significantly effective. We conclude that the glandular volume of the largest parathyroid gland estimated by US can be a useful factor to predict the OCT response in patients with moderate or severe renal HPT.     

Is prophylaxis the best use of the ICD? Response to the letter to the editor (Sharma et al.).

We thank Dr. Sharma and his colleagues for their interest inour article and wish to respond to the issues they have raised.¹ Regarding ß-blocker use in the MADIT study,² Mosshas shown that the ICD benefit "...remained significant after adjustment for ß-blocker use".³The Multicenter UnSustained Tachycardia Trial (MUSTT)—withpatients nearly identical in profile to     

Is it possible to predict the success of non-invasive positive pressure ventilation in acute respiratory failure due to COPD?

There is now sufficient evidence that non-invasive positive pressure ventilation (NIPPV) in selected patients with severe hypercapnic acute respiratory failure due to chronic obstructive pulmonary disease (COPD) is more effective than pharmacological therapy alone. The aim of this study was to identify prognostic factors to predict the success of this technique. Fifty-nine consecutive patients with COPD admitted to a respiratory ward for 75 episodes of acute respiratory failure treated with NIPPV were analysed: success (77%) or failure (23%) were evaluated by survival and the need for endotracheal intubation. There were no significant differences in age, sex, cause of relapse and lung function tests between the two groups. Patients in whom NIPPV was unsuccessful were significantly underweight, had an higher Acute Physiology and Chronic Health Evaluation (APACHE) II score, and a lower serum level of albumin in comparison with those in whom NIPPV was successful. They demonstrated significantly greater abnormalities in pH and PaCO2 at baseline and after 2h of NIPPV. The logistic regression analysis demonstrated that, when all the variables were tested together, a high APACHE II score and a low albumin level continued to have a significant predictive effect. This analysis could predict the outcome in 82% of patients. In conclusion, our study suggests that low albumin serum levels and a high APACHE II score may be important indices in predicting the success of NIPPV.     

Is the beneficial effect of preinfarction angina related to an immune response?

Immune-mediated mechanisms are thought to play a key role in the development of coronary artery disease and its thrombotic complications. Preinfarction angina has been suggested to improve left ventricular function and short-term outcomes. The purpose of the present study was to investigate the relation between the immune response and in-hospital clinical course in preinfarction angina. We prospectively evaluated 93 patients. Forty-three patients exhibited preinfarction angina within 24 hours before the onset of acute myocardial infarction (AMI) (preinfarction angina group) and 50 patients were free from preinfarction angina (sudden onset group). The incidence of complications (heart failure, recurrent angina, arrhythmia and coronary interventions) and in-hospital mortality were assessed in the two study groups. We detected some immune markers, including white blood cells, C-reactive protein, immunoglobulins, and complement. White blood cells and CRP were significantly lower in the preinfarction angina group than in the sudden onset group (P < 0.001, P < 0.005, respectively). Conversely, IgE and C(4) were significantly higher in the preinfarction angina group than in the sudden onset group (P < 0.001, P < 0.001, respectively). The incidences of heart failure and severe arrhythmias were lower in the preinfarction group than in the sudden onset group (P < 0.005, P < 0.05 respectively). The beneficial effect of preinfarction angina may be associated with an immune-inflammatory response modified by a brief ischemic episode.