Goals: We compare bowel cleanliness in patients taking same-day versus split-dose 4-L polyethylene glycol laxative for afternoon colonoscopy. Secondary objectives included patient satisfaction, adverse effects and patient tolerability. Background: Afternoon colonoscopies have been associated with inadequate bowel preparation and lower adenoma detection rates. Same-day (morning) or split-dosing of the laxative have improved preparation quality but differences between these options are unclear. Materials and methods: Single-center prospective randomized endoscopist blinded trial. Patients aged 18 years and above prescribed 4-L polyethylene glycol for colonoscopy were randomized into same-day or split-dose preparation. Preparation quality was assessed using the Ottawa Bowel Preparation Scale. Patient satisfaction and side effects was collected using a questionnaire. Intention-to-treat and per-protocol analysis were performed. Results: A total of 300 patients (158 split-dose, 142 same-day) were evaluated. No statistically significant difference was seen on total Ottawa score among the groups (P=0.47) or by individual colonic segments in intent-to-treat and per-protocol analysis. Patients in split-dose group were more likely to complete the entire preparation (P=0.01) but reported more sleep loss (P=0.001). The same-day preparation group reported higher incidence of vomiting (P=0.036). Patients ingesting bowel preparation ≥7 hours before colonoscopy had higher total Ottawa scores (P=0.001). Conclusions: There were no differences in quality of preparation in patients taking same-day versus split-dose preparation for afternoon colonoscopy. Those receiving same-day preparation were less likely to lose sleep but more likely to have emesis. These differences should be considered when selecting a bowel preparation regimen.
Teduglutide (TG) is approved for the treatment of parenteral nutrition (PN)-dependent adult patients with short bowel syndrome (SBS). Its well-known adverse effect is expedited growth of colon polyps and potential formation of new polyps. Apart from animal studies, de novo development of duodenal polyps in a patient during TG therapy has not been reported in the literature. We report a case of a 71-year-old man with SBS on TG who developed multiple new duodenal polyps that were found incidentally during a diagnostic endoscopy. Furthermore, an accelerated growth of duodenal polyps was noted while on TG therapy, suggesting a potential trophic effect of TG on these polyps. There are no current recommendations for the surveillance of intestinal polyps in patients on TG therapy, but we recommend exercising caution and possible need for surveillance based on this case report.
We report a case of a 63-year-old man with a history of monoarthritis, thought to have Rheumatoid Arthritis (RA) and treated with disease-modifying antirheumatic drugs (DMARDs). No clinical or serological improvement was observed. After five months synovectomy was performed. A foreign body was recovered, and synovial fluid analysis revealed a rare fungal infection, Phaeoacremonium sp. This is an educational case that reveals potential pitfalls of the specificity of using the current classification criteria for Rheumatoid Arthritis (RA) as a diagnostic tool in patients presenting with monoarthritis and highlights the need to continually reassess the diagnosis when there's inadequate response to treatment.
Background:Social media is widely used these days and has the capacity to distribute information widely and rapidly to a large audience. Twitter is a popular social network site with hundreds of millions of users and over 500 million Tweets being sent each day. Patients commonly receive information about their condition from social media sites including Twitter. Patient education plays an important role in the management of systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). The role of Twitter and its present application in SLE and RA patients’ education was analyzed.Methods:Twitter advanced search function was used to retrieve all tweets (English language only) containing the words systemic lupus erythematosus, lupus and/or SLE, as well as rheumatoid arthritis over one week (October 23, 2017 to October 29, 2017). Contents of collected tweets were analyzed, and tweets were categorized into 2 groups: general public (editorial/blogging, social/conversational, and advertisement tweets) and professional sources (tweets from physicians, rheumatologists, including hyperlinks to academic publications and websites of professional organizations, and educational tweets by awareness groups).Results:Over the one-week timeframe, a total of 618 tweets mentioned lupus, systemic lupus erythematosus and/or SLE, and a total of 178 tweets mentioned rheumatoid arthritis. In the respective disease groups, tweets assigned to the professional sources category were 32% of the total tweets for SLE (200/618) and 51% for RA (92/178). Tweets sent by physicians constituted 2.6% (21/796) and by rheumatologists 1 % (8/796) of the total tweets. Tweets with links to reliable sources (defined as hyperlinks to academic publications, professional organizations and awareness groups) were 23% of the total tweets. Finally, educational tweets by patient advocate groups were 10% of the total tweets.Conclusions:Twitter has the capability of engaging a wide audience in a topic-specific conversation. Thus, it can be used as cost-effective platform for public health campaigns and to distribute evidence-based knowledge to educate patients. At this time, disease-specific search revealed a smaller percentage of content is employed for public health education and awareness. Links to reliable sources were 23% of the total tweets, indicating shortage of contribution from healthcare organizations and professionals. Majority of tweets were in the general public category (including tweets by patients) indicating an audience waiting for professional input. Health advocates should use Twitter to construct public health campaigns. Further research should be conducted to examine approaches to target specific Twitter users that engage in SLE and RA conversations.Disclosure of Interest:None declared
INTRODUCTION: Hyponatremia (hypoNa) in cirrhosis represents another consequence of splanchnic vasodilation. Splanchnic vasoconstrictors are currently used in hepatorenal syndrome (HRS) which has similar pathogenesis, however their role in hypoNa has not been fully investigated. Aim of the study is to evaluate the effect of octreotide ± midodrine on hypoNa in cirrhotics. METHODS: We retrospectively included adult cirrhotics admitted to the Cleveland Clinic hospitals between 10/1/2011 and 10/1/2015, who had Na < 133 at or during admission. We excluded subjects with less than 5 days of follow up, those who received potent vasoconstrictors as norepinephrine or received hypertonic saline, tolvaptan or renal replacement therapy during admission. Population was divided into those who received octreotide versus those who did not. Outcomes were Na level at days 5, 7 and 10 after starting octreotide. Secondary outcome was determination of predictors of change of Na at day 5 using a multivariate model that included variables with P < 0.1 on univariate analysis. We then performed a subgroup analysis for only those with baseline Na < 125 (as this is the correction threshold for many transplant centers). RESULTS: Patients in the octreotide group were younger, had higher Model for End-Stage Liver Disease score, more patients had ascites and varices compared to controls [Table 1]. The octreotide group had lower baseline Na, but the Na levels at 5,7 and 10 days after octreotide were significantly higher [Figure 1]. The two predictors of higher Na at 5 days were having a lower baseline Na and receiving both octreotide and midodrine Table 2]. When analysis was restricted to the subgroup with baseline Na < 125, 97% of those who received octreotide had Na ≥125 by day 5 (compared to 77% of controls, P = 0.03). In this subgroup, the only predictor of reaching Na ≥125 by day 5 (multivariate logistic regression model) was receiving octreotide; OR 11.2 (1.16- 109), P = 0.04. CONCLUSION: Cirrhotics with hypoNa that received octreotide had a significantly higher rise in Na. On a multivariate analysis accounting for the potential confounders, octreotide remained a significant predictor only when combined with midodrine, suggesting a synergistic effect (similar to HRS). To our knowledge, this is the largest study evaluating the effect of splanchnic vasoconstrictors on sodium level in cirrhotics with hypoNa compared to controls. Prospective studies are needed with matched controls and longer follow up.
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