Prevalence and clinical features of colonic diverticulosis in a Middle Eastern population

AIM: To determine the prevalence, location, associations and clinical features of colonic-diverticulosis and its role as a cause of lower-gastroenterology-bleeding. METHODS: We retrospectively reviewed the medical records of 3649 consecutive patients who under-went a colonoscopy for all indications between 2007 and 2011 at King Khalid University Hospital, Riyadh, Saudi Arabia. The demographic data were collected retrospectively through the hospital’s information system, electronic file system, endoscopic e-reports, and manual review of the files by two research assistants. The demographic information included the age, sex, comorbidities and indication for the colonoscopy. The association among colonic polyps, comorbidities and diverticular disease was also measured.RESULTS: A total of 270 patients out of 3649 were diagnosed with colonic diverticulosis, with a prevalence of 7.4%. The mean age was 60.82 years ± 0.833, (range 12-110). Females comprised 38.89% (95%CI: 33-44.7) of the study population. The major symp-toms were rectal bleeding in 33.6%, abdominal pain in 19.3%, constipation in 12.8% and anemia in 6%. Diverticula were predominantly left-sided (sigmoid and descending colon) in 62%, right-sided in 13% and in multiple locations in 25%. There was an association between the presence of diverticulosis and adenomatous polyps (Pvalue < 0.001), hypertension (P-value < 0.0001) and diabetes mellitus (P-value < 0.0016). Diverticular disease was the second most common cause of lower gastrointestinal bleeding, in 33.6% (95%CI: 27.7-39.4), after internal hemor-rhoids, in 44.6% (95%CI: 40.3-48.9). On multivariable logistic regression, hypertension (OR = 2.30; 95%CI: 1.29-4.10), rectal bleeding (OR = 2.57; 95%CI: 1.50-4.38), and per year increment in age (OR = 1.05; 95%CI: 1.03-1.07) were associated with diverticulosis but not with bleeding diverticular disease. Limitations: A small proportion of the patients included had colo-noscopies performed as a screening test.CONCLUSION: Colonic-diverticulosis was found to have a low prevalence, be predominantly left-sided and associated with adenomatous-polyps. Age, hypertension and rectal bleeding predict the presence of diverticular disease.     

Effect of settlement on nutritional status of Bedouin children aged 6–10 years in the Lebanese Beqaa valley†

The paper examines the nutritional status of Bedouin children as affected by settlement and by production systems. Anthropometric data (height and weight) were collected on 215 children aged 6–10 years from the Bedouin population of the Bega's valley. The sample included settled and semi‐settled Bedouins having two production activities: livestock ownership, or agricultural work. Semi‐settled Bedouins when compared to settled ones tended to have improved weight and height in all age groups. The difference in height was statistically significant for those aged 10 years (P < 0.05). Production type also seemed to affect growth of Bedouin children whereby those from families involved in agriculture production tended to have better growth with a significant difference in height amongst those aged 7 and 10 years (P < 0.05). The Bedouin Children surveyed whether compared by their own position within centile distribution of reference population (NCHS) or as a standard deviation (Z‐Score) manifested mild to moderate stunting ht/age. Forty‐nine percent and 37% of settled and semi‐settled livestock groups respectively were below ‐ 1SD for ht/age, whereas, 38.5% and 31.6% of settled and semi‐settled agriculture groups fell in this lower range. All Bedouin children in the studied age groups were shorter than the American NCHS standard for height.

It could be concluded that settlement of nomads did not seem to demonstrate a positive effect on the physical growth of Bedouin children.     

Emerging from the screening of 57 million citizens and treating 4 million patients: future strategies to eliminate hepatitis C from Egypt

ABSTRACT

Introduction

Egypt succeeded in establishing a successful model of care for hepatitis C virus (HCV) management in the country with the highest worldwide disease prevalence. The Egyptian ministry of health announced an optimistic goal of near disease elimination. More steps are still required to achieve such a goal.     

Kidney injury molecule-1 (Kim-1): an early biomarker for nephropathy in type II diabetic patients

Renal damage is a serious major microvascular diabetic complication implicated in the death of diabetic patients, which would necessitate the need for new biomarkers to detect early stage of diabetic nephropathy (DN). Kidney injury molecule-1 (Kim-1), a type I transmembrane protein, is undetectable in normal kidneys but markedly induced in proximal tubules after ischemic and toxic injury. So, the present study was conducted to estimate and evaluate Kim-1 as a biomarker for DN. This cross-sectional study was carried out on 60 male and female type II diabetic patients (whose serum creatinine level was less than 2 mg/dL). Diabetic patients were classified as microalbuminuric with nephropathy (urinary albumin was 30–300 mg/dL) and normoalbuminuric without nephropathy (urinary albumin was <30 mg/dL). Twenty matched apparently healthy subjects were included as control group. Patients and controls were assessed for fasting blood glucose, glycosylated hemoglobin (HbA1c), serum creatinine, blood urea nitrogen (BUN), microalbuminuria, and urinary Kim-1. Urinary Kim-1 levels were elevated significantly tenfold in type II diabetic microalbuminuric patients as compared to the control group and normoalbuminuric diabetic patient. Urinary Kim-1 levels were positively correlated with microalbuminuria, serum creatinine, BUN, duration of diabetes, and BMI. Higher urinary Kim-1 level in T2D particularly in those with nephropathy and its correlation with urinary microalbumin, serum creatinine, blood urea, and BUN may reflect the role of Kim-1 as a biomarker for diagnosis and prognosis of diabetic nephropathy among T2D patients taking into account other risk factors.

     

Safety of enzalutamide in patients with metastatic castration‐resistant prostate cancer previously treated with docetaxel: Expanded access in North America

BACKGROUND

The open‐label, single‐arm enzalutamide expanded access program (EAP) in the United States and Canada evaluated the safety of enzalutamide in patients with metastatic castration‐resistant prostate cancer (mCRPC) who had previously received docetaxel.

METHODS

Patients (n = 507) received enzalutamide 160 mg/day until disease progression, intolerable adverse events (AEs), or commercial availability occurred. AEs and other safety variables were assessed on day 1, weeks 4 and 12, and every 12 weeks thereafter. Data following transition to commercial drug were not collected.

RESULTS

Median age was 71 years (range 43–97); 426 patients (83.9%) had a baseline ECOG score of ≤1. In addition to docetaxel, the majority of patients had received prior prostate cancer treatments such as abiraterone (76.1%) or cabazitaxel (28.6%). Median study treatment duration was 2.6 months (range 0.03–9.07). The most frequently reported reasons for discontinuation were commercial availability of enzalutamide (46.7%) and progressive disease (33.7%). A total of 88.2% of patients experienced AEs; 45.4% experienced AEs with a maximum grade of 1 or 2. Fatigue (39.1%), nausea (22.7%), and anorexia (14.8%) were the most commonly reported AEs. Seizure was reported in four patients (0.8%). The most commonly reported event leading to death was progression of metastatic prostate cancer (7.7%).

CONCLUSION

In this heavily pretreated EAP population with progressive mCRPC, enzalutamide was well tolerated and the safety profile was consistent with that of the AFFIRM trial. Prostate 75: 836–844, 2015. © 2015 The Authors. The Prostate, published by Wiley Periodicals, Inc.     

Value of nail fold video capillaroscopy and carotid intima media thickness in assessment of micro and macro-vascular disease in systemic sclerosis patients

Aim of the work: To assess micro and macro-vascular involvement in systemic sclerosis (SSc) patients and their possible association with variable disease parameters using non invasive imaging techniques. Patients and Methods: Thirty (SSc) patients and twenty four controls were enrolled. Skin thickness was assessed using modified Rodnan skin score (mRss). Nailfold videocapillarscopy (NVC) was employed to detect microangiopathy and carotid intima media thickness (IMT) was assessed by power Doppler ultrasound. Results: Patients were 96.7% females and 3.3% males, mean age was 41.6 ± 11.5 years, with mean disease duration 4.7 ± 3 years. 73.3% had limited form while 26.7% had diffuse form. The mean mRss was 18.6 ± 8.5. Microangiopathic patterns detected by NVC were: early, active and late (36.65%), (26.7%) and (36.65%) respectively, and structural alterations included: scar (70%), large capillaries (60%), hemorrhage (41.4%), scanty (36.7%), branched (20%), mega capillaries (16.7%), and tall (10%), but neither crossed nor ramified capillaries were detected. The mean IMT was higher in patients (1 ± 0.2 mm) compared to controls (0.7 ± 0.09 mm) (p < 0.001). A significant inverse correlation was found between high density lipoprotein (HDL) with capillary length (r = ?0.27, p = 0.05), arterial and venous loop diameters (r = ?0.29,p = 0.03)(r = ?0.41, p = 0.003) respectively. On linear regression for prediction of HDL, only the relation to venous loop was significant (p = 0.03). Atherosclerosis on carotid doppler showed significant association with arterial loop diameter (p = 0.04), venous loop diameter (p = 0.02) and capillary length (p = 0.001). Conclusion: Micro- and macro-vascular disease in SSc are different entities that do not simultaneously exist in every patient, although endothelial dysfunction can eventually lead to both, and should be meticulously evaluated.     

Development of an Arabic version of the Behçet’s Disease Current Activity Form (Ar-BDCAF): cross-cultural adaptation and validation initiative in Egypt

Clinical Rheumatology - Behçet’s disease (BD), commonly seen in the Silk road countries, is a variable vessel vasculitis with no specific investigation that reflects disease activity....     

Antifibrotic effect of AT‐1 blocker and statin in rats with hepatic fibrosis

Hepatic fibrosis is an outcome of chronic liver injury. Angiotensin II (ANG II) may play a role in the pathogenesis of hepatic fibrosis. Certain drugs such as ACE inhibitors, ANG II antagonists, and even statins could interfere with the renin angiotensin system and modulate its deleterious effects. This study was carried out to investigate the possible role of losartan and atorvastatin in liver fibrosis. Liver fibrosis was induced in rats by i.p. injection of 50% CCl₄ twice per week for 8 weeks. The rats intoxicated with CCl₄ were divided into four groups: fibrosis control; losartan group; atorvastatin group; and co‐treated group. A fifth group of normal healthy rats served as a control group. The results showed that losartan and atorvastatin, either alone or in combination, significantly decreased ALT, AST, hyaluronic acid and hydroxyproline levels in their groups compared to those of the fibrosis control group. A significant decrease in TGF‐β was found in the losartan and co‐treated groups but not in the atorvastatin group. These biochemical data were supported by liver histopathology and α‐SMA. The results indicate that the combined treatment with both losartan and atorvastatin produced a greater effect than either drug alone and proved a beneficial role in inhibiting or reversing liver fibrosis.     

Spectral Analysis of Ultrasound Radiofrequency Backscatter for the Detection of Intercostal Blood Vessels

Spectral analysis of ultrasound radiofrequency backscatter has the potential to identify intercostal blood vessels during ultrasound-guided placement of paravertebral nerve blocks and intercostal nerve blocks. Autoregressive models were used for spectral estimation, and bandwidth, autoregressive order and region-of-interest size were evaluated. Eight spectral parameters were calculated and used to create random forests. An autoregressive order of 10, bandwidth of 6?dB and region-of-interest size of 1.0?mm resulted in the minimum out-of-bag error. An additional random forest, using these chosen values, was created from 70% of the data and evaluated independently from the remaining 30% of data. The random forest achieved a predictive accuracy of 92% and Youden's index of 0.85. These results suggest that spectral analysis of ultrasound radiofrequency backscatter has the potential to identify intercostal blood vessels. (jokling@siue.edu) © 2018 World Federation for Ultrasound in Medicine and Biology