A Nutritional Approach for the Management of Chemotherapy-Induced Diarrhea in Patients with Colorectal Cancer

This study aimed to determine if dietary modifications using a nutritional regimen could prevent or reduce the incidence of cancer therapy-induced diarrhea in patients with metastatic colorectal cancer and to evaluate the relationship of Vitamin D blood levels with diarrhea severity. Patients with metastatic colorectal cancer were enrolled. A Mediterranean diet, containing some special limitations aiming to reduce the risk of diarrhea, was administered before and during the entire chemotherapy program. Enrolled patients numbering 60/137 (44%) had diarrhea during chemotherapy. Adherence to the diet was high in 36 (26.3%) patients, medium in 94 (68.6%), and low in 7 (5.1%). Mean adherence to the diet was significantly lower in patients who experienced diarrhea with maximum grade 2–3 compared to those who had no diarrhea or grade 1 diarrhea (score = 5.4 ± 1.9 vs. 7.1 ± 1.5, p < 0.001). Patients with higher adherence to the diet had a lower risk of grade 2–3 diarrhea (odds ratio: 0.5 (95% CI: 0.3–0.7, p < 0.001)). In addition, patients who completed a higher number of chemotherapy cycles had an increased risk of grade 2–3 diarrhea (odds ratio: 1.2 (95% CI: 1.0–1.5, p = 0.02)). Of note, a lower level of Vitamin D correlated with an increased risk of G2-G3 diarrhea (p = 0.03). A diet based on vegetables with a controlled fiber content, Mediterranean Modified Healthy Diet (MMHD), is useful to control the incidence of cancer therapy-induced diarrhea.     

Significance of mitochondrial activity in neurogenesis and neurodegenerative diseases

Mitochondria play a multidimensional role in the function and the vitality of the neurological system. From the generation of neural stem cells to the maintenance of neurons and their ultimate demise, mitochondria play a critical role in regulating our neural pathways’ homeostasis, a task that is critical to our cognitive health and neurological well-being. Mitochondria provide energy via oxidative phosphorylation for the neurotransmission and generation of an action potential along the neuron’s...     

Clinical and pathologic features of primary membranous nephropathy in Turkey: a multicenter study by the Turkish Society of Nephrology Glomerular Diseases Working Group

BackgroundWe aimed to evaluate the features of primary membranous nephropathy (MNP) in Turkish people.MethodsThis is a retrospective analysis of patients with biopsy-proven primary MNP. We obtained the data collected between 2009 and 2019 in the primary glomerulonephritis registry of the Turkish Society of Nephrology Glomerular Diseases Study Group (TSN-GOLD). Patients with a secondary cause for MNP were excluded. Clinical, demographic, laboratory, and histopathological findings were analyzed.ResultsA total of 995 patients with primary MNP were included in the analyses. Males constituted the majority (58.8%). The mean age was 48.4 ± 13.9 years. The most common presentation was the presence of nephrotic syndrome (81.7%) and sub nephrotic proteinuria (10.3%). Microscopic hematuria was detected in one-third of patients. The median estimated glomerular filtration rate (eGFR) was 100.6 mL/min/1.73 m² (IQR, 75.4–116.3), and median proteinuria was 6000 mg/d (IQR, 3656–9457). Serum C3 and C4 complement levels were decreased in 3.7 and 1.7% of patients, respectively. Twenty-four (2.4%) patients had glomerular crescents in their kidney biopsy samples. Basal membrane thickening was detected in 93.8% of cases under light microscopy. Mesangial proliferation and interstitial inflammation were evident in 32.8 and 55.9% of the patients, respectively. The most commonly detected depositions were IgG (93%), C3 complement (68.8%), and kappa and lambda immunoglobulin light chains (70%). Although renal functions were normal at presentation, vascular, interstitial, and glomerular findings were more prominent on biopsy in hypertensive patients. No significant effect of BMI on biopsy findings was observed.ConclusionsDespite some atypical findings, the main features of primary MNP in Turkey were similar to the published literature. This is the largest MNP study to date conducted in Turkish people.     

Retinal Nerve Fibre Layer Thickness in Migraine Patients with or without Aura

The objective of this study was to evaluate the retinal nerve fibre layer (RNFL) thickness using spectral-domain optical coherence tomography (Optos SD-OCT, UK) in migraine patients with or without aura and to search for possible structural effects of migraine on the retina. Eighty eyes of 40 migraine patients and 80 eyes of 40 healthy subjects were included in this study. All four quadrants (temporal, superior, nasal, and inferior) and average peripapillary RNFL measurements were taken with SD-OCT in both groups. The average age of the patients and the control group were 35.7 ± 9.5 and 40.9 ± 12.7 years, respectively. In the migraine group, 45% of patients were with aura, and 55% were without aura. The average frequency of attacks per month and the migraine diagnosis time was 4.6 ± 4.4 and 6.2 ± 5.6, respectively.Parameters related to RNFL thickness of right and left eyes’ average, superior, inferior, nasal, and temporal quadrant values were found to be similar in migraine and control subjects (p > 0.05). Focusing on the RNFL thickness of right and left eyes and the migraine parameters, there were no statistically significant differences between migraineurs with aura and without aura (p > 0.05). The correlations between the RNFL thickness parameters and the migraine patient’s MIDAS (Migraine Disability Assessment Score) score, frequency of attacks, and diagnosis time of migraine were studied and no correlation was noted (p > 0.05). These findings demonstrated that migraine disease with or without aura does not have any effect on the thickness of the RNFL.     

Evaluation of discomfort of Goldmann tonometry without anaesthetic

Goldmann applanation tonometry (GAT) is considered the gold standard technique for tonometry. It is a procedure involving administration of topical anaesthetic (a drug which could have several side effects). This prevents a large number of vision care practitioners from using GAT, due to legal restrictions regarding the use of these ophthalmic drugs. The purpose of this study was to establish whether the discomfort experienced during non‐anaesthetic Goldmann Applanation Tonometry (NAGAT) would be acceptable to subjects. The intensity of pain inflicted by GAT, NAGAT, Non‐Contact Tonometry (NCT) and Schirmer test was assessed on thirty‐one subjects enrolled in the study using the Numerical Rating Scale (NRS) to assess pain. The GAT was performed on one eye and the other three procedures were carried out in random order on the fellow eye. Initially, each subject was asked to score their Maximum Pain Without Complaint (MPWC). The MPWC and the Schirmer test were used as references to grade the pain levels. The scores for the five procedures were registered using the NRS (0–10) and compared using a non‐parametric statistical analysis (Friedman test and a post‐hoc analysis). In addition, IOP results for GAT and NAGAT were also compared using the t‐test. The scores obtained on the NRS ranged from 0–4, 0–5, 0–8, 0–7 and 3–8 with a median of 1, 1, 2, 2, and 5, respectively for NCT, GAT, NAGAT, Schirmer and MPWC. A statistically significant difference (p = 0.01) was found between the MPWC and the four clinical tests but no difference was found between the clinical tests. There was no statistically significant difference (p = 0.71) between the IOP results for GAT and NAGAT, 14.0 ± 2.0 mmHg and 13.8 ± 2.0 mmHg (mean ± 1S.D.) respectively. The Goldmann Applanation Tonometry without anaesthetic (NAGAT) can be performed with an acceptable level of discomfort for the majority of subjects and should be performed identically to a traditional GAT, informing the subjects about the possibility of feeling a small discomfort.     

Public Sector Workers’ Mental Health in Argentina: Comparative Psychometrics of the Perceived Stress Scale

ObjectivesGiven that Argentinian public-sector workers are highly exposed to stressful conditions, and that the psychometric properties of the widely used Perceived Stress Scale (PSS) should be evaluated in different settings, this work aimed to compare the psychometric properties of the Latin American Spanish PSS-10 and PSS-4 and to identify the optimal scale for stress assessment.MethodsA sample of 535 participants was randomly divided into 2 groups to evaluate dimensionality by exploratory and confirmatory factor analyses. The reliability of both scales was also evaluated. Convergent validity was estimated using the Executive Complaints Questionnaire, the average variance extracted, and the composite reliability. Discriminant validity was based on the correlation with the Utrecht Work Engagement Scale and the phi-square correlation between the components.ResultsThe factor analyses supported bidimensionality of the PSS-10 (stress and coping), which showed a better fit than the PSS-4. Moreover, the reliability of the PSS-10 was higher, whereas the PSS-4 did not achieve adequate values of internal consistency. The PSS-10 was also correlated significantly with all validation scales, and presented proper internal convergent and divergent validity.ConclusionsThe PSS-10 is a reliable and structurally valid instrument to measure perceived stress and coping in a Latin American Spanish-speaking population with high work demands, and the findings of this study expand our knowledge on the geographical and sociocultural applicability of the PSS.     

Combined medical,surgical and endovascular treatment of a giant cell arteritis case manifesting as upper limbs acute ischemia

We report a case of giant cell arteritis manifesting as upper limbs ischemia due to a complete occlusion of the left subclavian artery and a high grade stenosis of the right subclavian artery. We decided to use a combined medical, surgical and endovascular treatment followed by long term treatment with methotrexate. After 4 years the patient had no signs or symptoms of relapse. In our personal experience long term treatment with Methotrexate demonstrated a certain efficacy in avoiding relapse of the inflammatory phase and in maintaining stability of results in this kind of disease.     

Alcohol consumption in a sample of Italian healthcare workers: A cross-sectional study

ABSTRACT

Since previous evidence suggested a risky alcohol consumption among healthcare workers (HCW), this study aimed to investigate the patterns of alcohol use in a sample of HCWs in Italy, through the Alcohol Use Disorders Identification Test Consumption (AUDIT-C). Overall, 639 HCWs participated in the study. 43.8% of them reported a score of 0 at AUDIT-C test. Drinkers were divided into “low-risk” and “at-/high-risk,” being respectively the 47.1% and 9.1% of the whole sample. There were significant differences between abstainers and drinkers, and between low-risk and at-/high-risk drinkers. In the multivariate logistic regression model, being younger, male, and physicians was associated with the profile of regular alcohol drinkers. A high risk AUDIT-C score was more likely in older and female HCWs. Briefly, this study confirmed the hypothesis of a risky level of drinking in HCWs. Educational preventive measures should be implemented to reduce alcohol consumption in this population.