Obesity in IBD is not associated with increased health care utilization and IBD-related surgeries. Optimal regimens for drug dosing in obese patients with IBD have yet to be defined.

Short exposure to a low concentration of ouabain protects the heart against ischemia/reperfusion injury. This effect of ouabain on the heart is most likely due to the activation of the Na+,K+-ATPase/c-Src receptor complex and subsequent stimulation of key mediators of preconditioning, namely PLC-gamma1 and PKCepsilon.

No abstract

Long-term follow-up of patients with Crohn's disease who were treated with infliximab initially between 1998 and 2002 showed persistence of therapy (due to clinical benefit) and an acceptable safety profile, despite the fact that less than one-third initially received three-dose induction followed by scheduled maintenance therapy. Infections and malignancy occurred at rates similar to those previously reported.

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Patients with severe acute pancreatitis complicated by organ failure and/or pancreatic necrosis or fluid collections should have placement of a double-lumen nasogastric-jejunal tube to be used for both gastric decompression and jejunal feeding. These patients are at risk for gastric outlet obstruction, which may be treated so that complications such as aspiration and reflux are avoided. Furthermore, early enteral feeding can prevent ileus, suppress further organ failure, and ultimately restore gut function if continued in an uninterrupted manner. Ultimately, this patient population will benefit from pancreatic rest and jejunal feeding specifically when compared with patients using nasogastric feeding tubes.

A 26-year-old male college student presented with 1 week of constant, right lower quadrant, throbbing abdominal pain that was worse after eating and accompanied by bilious emesis. He had experienced similar, albeit less severe and self-limited, episodes of abdominal pain during the preceding 6 months. He denied fevers or chills but had lost 4.5 kg (10 lbs) in the past 6 months. During the same time period, he was treated twice with antibiotics for urinary tract infections (UTIs) after reporting symptoms of dysuria and noting "bubbles" in his urine. A urine culture was never obtained. Urinary tract infections are uncommon in men because of the longer length of the male urethra, antibacterial properties of prostatic fluid, and less frequent periurethral colonization in men. The incidence in men younger than 50 years is approximately 5 to 8 per 10,000 per year. The incidence of UTIs in men increases with age, and the lifetime prevalence is estimated at 13,000 to 14,000 per 100,000 adult men.1 Although most community-acquired UTIs in women can be treated empirically with antibiotics without the need for a urine culture, a urine culture should always be obtained when a male patient presents with a suspected UTI. Simple UTIs (eg, cystitis in women) can be treated with 3 days of antibiotics 2 ; however, UTIs in men are considered "complicated" by definition and warrant at least 7 days of antibiotic therapy. Dysuria is the most frequent presenting symptom of UTIs in both men and women. 1,3,4 Most UTIs are caused by gram-negative organisms from the colon that colonize the periurethral skin. E coli is the most common cause of UTIs in both sexes.On examination, the patient appeared pale and cachectic. Cervical, axillary, and inguinal lymph nodes were not palpable. His abdomen was scaphoid with marked right lower quadrant tenderness without rigidity, guarding, or rebound tenderness. An ill-defined mass was palpable in the right lower quadrant. There was no tenderness in the costovertebral angle. On auscultation, bowel sounds were normoactive. Laboratory studies yielded the following results (reference ranges provided parenthetically): hemoglobin concentration, 11.9 g/dL (13.5-17.5 g/dL); mean corpuscular volume, 78.3 fL (81.2-95.1 fL); white blood cell count, 15.9 × 10 9 /L (3.5-10.5 × 10 9 /L) with 85% neutrophils; and creatinine level, 1.1 mg/dL (0.9-1.4 mg/dL). Urinalysis revealed 21 to 30 white blood cells per high-powered field, 3 to 10 red blood cells per high-powered field, no casts, and numerous bacteria. A clean-catch, midstream urine specimen showed no bacterial growth. Urinary tract infections in men, especially if recurrent, warrant a search for an underlying structural abnormality, such as an enlarged prostate, colovesical fistulas associated with colonic malignancy or inflammatory bowel disease, and congenital malformations of the urogenital tract. Instrumentation of the urinary tract (eg, during a cystoscopy or catheterization) can result in UTIs in both men and women. Conditions that suppress immune function...

Background Tofacitinib is an oral, small-molecule JAK inhibitor for the treatment of ulcerative colitis (UC). Using a novel electronic reporting tool, we aimed to prospectively describe the onset of tofacitinib efficacy during induction therapy in a real-world study. Methods Patient-reported outcome data (PROs) including the simple clinical colitis activity index (SCCAI), PRO Measurement Identification Systems (PROMIS) measures, and adverse events were collected daily for the first 14 days and at day 28 and 56. Paired t tests and P for trend were utilized to compare changes in SCCAI over time. Bivariate analyses and logistic regression models were performed to describe response (SCCAI <5) and remission (SCCAI ≤2) by clinical factors. Results Of all included patients (n = 96), 67% had failed ≥2 biologics, and 61.5% were on concomitant steroids. Starting at day 3, PROs showed significant and persistent decline of the mean SCCAI (−1.1, P < 000.1) including significantly lower SCCAI subscores for stool frequency (−0.3; P < .003), bleeding (−0.3; P < .0002) and urgency (−0.2; P < .001). Steroid-free remission at day 14, 28, and 56 was achieved in 25%, 30.2%, and 29.2% of patients, respectively. Neither prior biologics nor endoscopic severity were independently predictive of response or remission in multivariate models. Numeric improvements in all PROMIS measures (anxiety, depression, social satisfaction) were seen through day 56. Rates of discontinuation due to adverse events were low. Conclusions In this prospective real-world study, tofacitinib resulted in a rapid and persistent improvement in UC disease activity PROs. The safety findings were consistent with the established safety profile of tofacitinib.