Non-adherence to treatment in inflammatory bowel disease in Czech Republic

Objective:To assess overall non-adherence to the treatment among patients with Crohn's disease (CD) and ulcerative colitis (UC).Patients and methods:396 inflammatory bowel disease (IBD) patients were enrolled in the study (200 males, 196 females, 210 CD, 186 UC) and fulfilled the questionnaire to assess their non-adherent behaviour during the treatment. The data was analysed using factor analysis.Results:Overall intentional non-adherence was reported by 32% of patients. A 12% of patients reported they at least once discontinued the treatment. Voluntary dose reducing was reported by 19% of patients. An 11% of patients occasionally non-refill the medication in time. There were no differences in intentional adherence between males and females, disease type, previous bowel surgery, marital, smoking and non-smoking statuses. A 42% of patients reported unintentional non-adherence. Factor analysis proved non-adherent patients are more likely to have a higher activity of the disease ( τ = 0.109, p = 0.008).Conclusions:The overall intentional non-adherence is relatively high among IBD patients and a gastroenterologist's attention should be focused on it. Our results stimulate discussion how to improve education of the patients with inflammatory bowel disease and accent importance of the maintenance therapy to them.     

Prevalence and determinants of delayed gastric emptying in hospitalised Type 2 diabetic patients

AIM： To determine the prevalence of delayed gastric emptying （GE） in older patients with Type 2 diabetes mellitus. METHODS： One hundred and forty seven patients with Type 2 diabetes, of whom 140 had been hospitalised, mean age 62.3 ± 8.0 years, HbA1c 9.1% ± 1.9%, treated with either oral hypoglycemic drugs or insulin were studied. GE of a solid meal （scintigraphy）, autonomic nerve function, upper gastrointestinal symptoms, acute and chronic glycemic control were evaluated. Gastric emptying results were compared to a control range of hospitalised patients who did not have diabetes. RESULTS： Gastric emptying was delayed （T50 〉 85 min） in 17.7% patients. Mean gastric emptying was slower in females （T50 72.1 ± 72.1 min vs 56.9 ± 68.1 min, P = 0.02） and in those reporting nausea （112.3 ± 67.3 vs 62.7 ± 70.0 min, P 〈 0.01） and early satiety （114.0 ± 135.2 vs 61.1 ± 62.6 min, P = 0.02）. There was no correlation between GE with age, body weight, duration of diabetes, neuropathy, current glycemia or the total score for upper gastrointestinal symptoms. CONCLUSION： Prolonged GE occurs in about 20% of hospitalised elderly patients with Type 2 diabetes when compared to hospitalised patients who do not have diabetes. Female gender, nausea and early satiety areassociated with higher probability of delayed GE.     

Post-natal growth of 157 children born as extremely premature neonates

Aim: With increasing survival rate of extremely premature neonates, their long‐term outcomes including growth and risk factors for later disorders need to be considered. We prospectively evaluated anthropometric parameters in children born as extremely premature neonates. Methods: Anthropometric parameters were measured at the ages of 2 and 5 years in 72 extremely premature children born between the 22nd and 25 + 6th weeks of gestation (group I) and 85 children born between the 26th and 27 + 6th weeks of gestation (group II). Results: Although catch‐up in the postnatal growth was observed in both groups of children, resulting in growth improvement, the height of the extremely premature children at the ages of 2 and 5 years remains lower (P < 0.01) compared with the control population. A decline in head growth was observed in both groups between the ages of 2 and 5 years, resulting in decrease of standard deviation score (SDS) for head circumference (HC) in comparison with that of the control population, accompanied by an increased number of children with microcephaly, defined as HC < ?2 SD. At the age of five, microcephaly was found in 18% of children from group I and 11.7% of children from group II. At the age of 5 years, the waist and hip circumferences and ten skinfolds were not different between both groups of children. Conclusion: Long‐term follow‐up of extremely premature neonates is important not only to establish their growth patterns but also for risk factors assessment including adiposity for later development of adult‐onset diseases.     

Identification of deleterious germline CHEK2 mutations and their association with breast and ovarian cancer

Germline mutations in checkpoint kinase 2 (CHEK2), a multiple cancer-predisposing gene, increase breast cancer (BC) risk; however, risk estimates differ substantially in published studies. We analyzed germline CHEK2 variants in 1,928 high-risk Czech breast/ovarian cancer (BC/OC) patients and 3,360 population-matched controls (PMCs). For a functional classification of VUS, we developed a complementation assay in human nontransformed RPE1-CHEK2-knockout cells quantifying CHK2-specific phosphorylation of endogenous protein KAP1. We identified 10 truncations in 46 (2.39%) patients and in 11 (0.33%) PMC (p = 1.1 × 10⁻¹⁴). Two types of large intragenic rearrangements (LGR) were found in 20/46 mutation carriers. Truncations significantly increased unilateral BC risk (OR = 7.94; 95%CI 3.90–17.47; p = 1.1 × 10⁻¹⁴) and were more frequent in patients with bilateral BC (4/149; 2.68%; p = 0.003), double primary BC/OC (3/79; 3.80%; p = 0.004), male BC (3/48; 6.25%; p = 8.6 × 10⁻⁴), but not with OC (3/354; 0.85%; p = 0.14). Additionally, we found 26 missense VUS in 88 (4.56%) patients and 131 (3.90%) PMC (p = 0.22). Using our functional assay, 11 variants identified in 15 (0.78%) patients and 6 (0.18%) PMC were scored deleterious (p = 0.002). Frequencies of functionally intermediate and neutral variants did not differ between patients and PMC. Functionally deleterious CHEK2 missense variants significantly increased BC risk (OR = 3.90; 95%CI 1.24–13.35; p = 0.009) and marginally OC risk (OR = 4.77; 95%CI 0.77–22.47; p = 0.047); however, carriers low frequency will require evaluation in larger studies. Our study highlights importance of LGR detection for CHEK2 analysis, careful consideration of ethnicity in both cases and controls for risk estimates, and demonstrates promising potential of newly developed human nontransformed cell line assay for functional CHEK2 VUS classification.     

The evaluation of an automated mariPOC SARS‐CoV‐2 antigen test compared to RT‐qPCR SARS‐CoV‐2 assay and comparison of its sensitivity in Delta‐ and Omicron‐variant samples

BackgroundThe rapid diagnostics tests for SARS‐CoV‐2 antigen vary in their sensitivities, and moreover, genomic mutations may further affect the performance of the assays. We aimed to evaluate the analytical performance of an automated antigen assay and compare its sensitivity in Delta‐ and Omicron‐variant positive clinical samples.Material and methodsThe analytical performance of an automated mariPOC SARS‐CoV‐2 antigen test was evaluated on a population of community‐dwelling subjects with mild respiratory symptoms or being asymptomatic investigated by the RT‐qPCR Allplex™ SARS‐CoV‐2 assay. The sensitivity and specificity of the antigen test were evaluated on prospective 621 nasopharyngeal swabs along with oropharyngeal swabs. The sensitivity regarding variants determined by the Allplex™ SARS‐CoV‐2 Variant assays was analysed in additional, retrospective 158 Delta and 59 Omicron samples.ResultsThe overall sensitivity of the antigen test in prospective samples was 77.9% (113/145; 95% confidence interval [CI] 70.3–84.4) with the specificity of 99.8% (95% CI 98.8–100). Regarding the variant, the sensitivity was higher in Omicron‐variant samples, 93.2% (55/59; 95% CI 83.5–98.1), compared to Delta‐variant samples, 71.5% (113/158; 95% CI 63.8–78.4; p = .001).ConclusionIn community‐dwelling subjects with mild respiratory symptoms or being asymptomatic, the automated mariPOC SARS‐CoV‐2 antigen test showed high sensitivity over 98.0% in subgroup samples with cycle threshold (Ct) values < 25. Regarding the variant, the antigen test sensitivity was higher in the Omicron‐variant samples compared to the Delta‐variant samples. The analytical performance of the antigen test can differ between the SARS‐CoV‐2 variants, and a re‐evaluation should be performed for new circulating lineages.     

Dependent Personality and Interpersonal Dependency: At the Intersection of Developmental,Identity and Interpersonal Aspects

The author examines dependency as a pathological personality feature—one that originates in failures of developmental need fulfilment—and shows how the subsequent identity impairment may influence adult relationships. The author argues that, developmentally, the caregiver's unresolved pathological dependency causes a disruption in the child's need gratification as the child's focus is turned towards the caregiver's pathological needs. Internal object relations become characterized by a dependent internal object and need-fulfilling self-representation, which are supported developmentally by the disavowal of authentic dependency needs. In adult life, the individual's identity and self-esteem, through projections, become dependent on interpersonal relationships, which are used to control internal cohesion at the expense of authentic attachment and intimacy. Pathological dependency is thus intrapsychic rather than merely interpersonal. The author also explores the concept of excessive independence, that is, through identification with independence as an ego ideal, considered a defensive attempt to disidentify from an underlying pathological dependency.