Negative effect of lockdown on juvenile idiopathic arthritis patients

Clinical Rheumatology - The aim of this study is to evaluate a possible negative action of lockdown, during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, in the...     

Liver Involvement in Obese Children (Ultrasonography and Liver Enzyme Levels at Diagnosis and During Follow-up in an Italian Population)

Our aim was to evaluate incidence and riskfactors of liver involvement in obese Italian childrenas assessed by both ultrasonographic and biochemicalparameters. In seventy-five consecutive obese children (age 9.5 ± 2.9 years, males/females41/34), serum levels of enzymes and ultrasonography ofthe liver were evaluated. Tests were repeated one,three, and six months after starting a moderatehypocaloric diet and an exercise program. Three obese childrenwho were found to have chronic viral hepatitis wereexcluded from the study. Thirty-eight of 72 (53%) obesechildren had an ultrasonographic image of bright liver consistent with liver steatosis. Thelatter was severe in nine children, moderate in 16, andmild in 13. Eighteen obese children (25%) had elevatedtransaminase levels. Bright liver andhypertransaminasemia were not due to any of the most common causesof liver disease. Both were rapidly responsive to lossof weight, confirming that liver involvement wassecondary to obesity and that steatosis orsteatohepatitis rather than fibrosis were involved. Obesityduration not more than three years (odds ratio = 4.77),a higher degree of obesity (odds ratio = 2.09), andhypertransaminasemia (odds ratio = 2.15) appeared asimportant predictive factors of liver involvement atultrasonography. Incidence of liver involvement assessedby means of ultrasonography is significantly higher thanthat revealed by measurement of serum liver enzymes. A short duration of obesity emerged as apotentially new risk factor of liver involvement in thepediatric obese population and needs to be confirmed infuture studies.     

New perspectives on the long-term outcome of segmental colectomy for Crohn’s colitis: an observational study on 200 patients

Background and aims

Surgical management of Crohn’s colitis represents one of the most complex situations in colorectal surgery. Segmental colectomy (SC) and total abdominal colectomy with ileorectal anastomosis (TAC-IRA) are the most common procedures, but there are few available data on their long-term outcome. The aim of the present study was to analyze the long-term outcome of patients who underwent segmental colectomy for Crohn’s colitis, with regard to the risk for total abdominal colectomy.

Methods

In this observational, monocentric, retrospective analysis, we analyzed patients who received a segmental colectomy for Crohn’s colitis at our institution. The database was updated by asking patients to complete a questionnaire by telephone or at the outpatient clinic. Only patients followed up at our Hospital were included. Patients were followed up by a specialized multidisciplinary team (IBD Unit). The primary endpoint was the interval between segmental colectomy and, when performed, total abdominal colectomy.

Results

Between 1973 and 2014, 200 patients underwent segmental colectomy for Crohn’s colitis. The median follow-up was 13.5 years (interquartile range [IQR] 7.8–21.5). Overall, 62 patients (31%) had a surgical recurrence, of these, 42 (21%) received total abdominal colectomy. At multivariate analysis, the presence of ≥?3 sites (HR =?2.47; 95% CI 1.22–5.00; p?=?0.018) and perianal disease (HR =?3.23; 95% CI 1.29–8.07; p?=?0.006) proved to be risk factors for total abdominal colectomy.

Conclusions

The risk for surgical recurrence after SC for Crohn’s colitis is acceptable. We recommend a bowel-sparing policy for the treatment of Crohn’s colitis in any case in which the extent of the disease at the moment of surgery makes the conservative approach achievable.

     

Observer variability in the pulmonary examination

Observer variability in the pulmonary examination was assessed by having four blindfolded observers (two medical students and two pulmonary physicians) twice examine 31 patients with abnormal pulmonary findings. Examiners were consistent in the repetitive detection of pulmonary abnormalities in 74–89% of the examinations; conversely, 11–26% of the time they disagreed with themselves. Although pulmonary specialists recorded fewer (55% of observations) abnormal findings than did medical students (74%), they were significantly (p=0.008) less self-consistent than were the students. There was no clear trend in agreement between examiners (kappa=0.20−0.49). Each examiner’s findings were compared with those of physicians specially trained in pulmonary examination. Dichotomous variables (wheezes, crackles, rubs) were more reliably detected (kappa=0.30−0.70) than graded variables (tympany, dullness, breath sound intensity), where kappa=0.16−0.43. The authors suggest that dichotomous variables deserve greatest clinical reliance; that time in training, alone, does not improve clinical performance; and that there is a disconcertingly large amount of inter- and intraobserver disagreement in this fundamental clinical task. Received from the Division of General Internal Medicine, Department of Medicine; the Division of Biometry, Department of Community and Family Medicine, Duke University Medical Center, Durham, North Carolina; and the Ambulatory Care Service and Health Services Research Field Program, Durham V.A. Medical Center, Durham, North Carolina.