Background Proton pump inhibitors (PPIs) are widely used for the long-term management of gastroesophageal reflux disease (GERD). However, concerns about the cost and/or inconvenience of continuous maintenance PPI treatment have led to the evaluation of various alternative approaches. Aim To assess the effectiveness of on-demand PPI therapy in the maintenance treatment of nonerosive reflux disease (NERD) or mild erosive esophagitis (EE). Methods We searched MEDLINE, EMBASE, Web of Science, and Cochrane Library from inception until October 2, 2017, for randomized controlled trials (RCTs) comparing on-demand PPI versus placebo or daily PPI in the management of NERD or mild EE (Savary-Miller grade 1). Discontinuation of therapy during the trial was used as a surrogate for patient dissatisfaction and failure of symptomatic control. We calculated pooled odds ratios (OR) to evaluate the efficacy of on-demand PPI treatment. Separate analyses were conducted for studies comparing on-demand PPI with daily PPI and with placebo. Subgroup analysis was done based on NERD studies alone and on studies of both NERD and mild EE. These were analyzed using a random effects model. Results We included 10 RCTs with 4574 patients. On-demand PPI was superior to daily PPI (pooled OR = 0.50; 95% confidence interval (CI) = 0.35, 0.72). On subgroup analysis in NERD patients only, pooled OR was 0.44 (0.29, 0.66). In studies including patients with NERD and mild EE, pooled OR was 0.76 (0.36, 1.60). For studies comparing on-demand PPI with placebo, pooled OR was 0.21 (0.15, 0.29); subgroup analyses of studies evaluating NERD only and studies conducted in NERD and mild EE showed similar results (pooled OR was 0.22 (0.13, 0.36) and 0.18 (0.11, 0.31), resp.). Conclusions On-demand PPI treatment is effective for many patients with NERD or mild EE. Although not FDA-approved, it may be adequate for those patients whose symptoms are controlled to their satisfaction.
INTRODUCTION: Bowel movement (BM) frequency is used to titrate lactulose for hepatic encephalopathy (HE). However, stool consistency using the Bristol stool scale (BSS, 0-7) is often ignored.
specimen was more commonly obtained with EUS-TTNB (88.2%) compared to EUS-FNA (51.9%) (p<0.001). For cysts with insufficient amount of fluid for CEA (nZ19) or CEA<192 ng/mL (nZ22), the cumulative incremental diagnostic yield of a mucinous cyst was significantly higher with EUS-TTNB (51.2%) compared to EUS-FNA (17%) (pZ0.002). Nine (17%) patients underwent surgical resection. Surgical pathology was positive for a mucinous cyst (intrapapillary mucinous neoplasm or mucinous cystic neoplasm) in 7 cases, of which EUS-TTNB and EUS-FNA were diagnostic in 6 (85.7%) and 3 (42.9%) respectively. In all, there were two cases of self-limited intracystic bleeding (3.8%) that did not require additional interventions. There was one case (1.9%) of mild acute pancreatitis reported 48 hours after the procedure. Conclusion: EUS-TTNB is a safe and effective technique for the evaluation of PCLs. EUS-TTNB is a viable adjunctive tissue acquisition method that may help increase the diagnostic yield of pancreatic mucinous cysts during EUS.
Background
Untreated alcohol use disorder (AUD) is associated with poor cirrhosis outcomes. We evaluated factors associated with AUD treatment discussions and initiation in the Veterans Health Administration.
Methods
Chart reviews were conducted for veterans with International Classification of Diseases codes for both cirrhosis and AUD who were receiving care at one of three large medical centers in 2020. Factors associated with a 1‐year offer of AUD treatment and its acceptance were assessed using regression models, which included as covariates demographic characteristics, comorbidities, and depression, as measured by the patient health questionnaire (PHQ‐2) from the electronic health record.
Results
The cohort included 654 veterans, 68 of whom were engaged in AUD treatment at baseline and 174 who were documented as being in AUD remission. Treatment was offered to 264 (64%) of the 412 veterans with opportunities to initiate it. AUD treatment discussions were most often documented by practitioners in primary care (n = 162), hepatology (n = 45), or both (n = 41). Multivariable logistic regression modeling revealed that treatment was significantly more likely to be offered to patients with co‐occurring bipolar disorder (OR 2.94, p = 0.03) or depression (1.50, p = 0.05) or who were younger (0.97, p = 0.01). Of the 264 patients offered AUD treatment, 107 (40%) agreed to initiate it. Acceptance of an offer of treatment was significantly associated with hospitalization in the prior year (OR 1.74, p = 0.05), prior AUD treatment (9.92, p < 0.0001), and a higher PHQ‐2 depression score (2.85, p = 0.004).
Conclusions
We identified factors associated with an offer of AUD treatment and its initiation among veterans with cirrhosis. Application of these findings could increase the likelihood that veterans with alcoholic cirrhosis initiate AUD treatment.
Introduction: Body mass index is an important parameter associated with a variety of disease processes. The risk of hypertension and cardiovascular diseases increases with an increase in body mass index. The study was conducted to compare the relationship between body mass index and blood pressure.
Objective: To evaluate the prevalence and correlate the Obesity and Hypertension in medical students
Methodology: The study was conducted in 200 students (113 males and 87 females). Height, weight and blood pressure were recorded from all participants and body mass index was calculated. The recorded body mass index was utilized to divide the student into underweight, normal, over weight and obese category according to the World Health organization body mass index classification. Hypertension was determined from the measure of blood pressure. Then comparison of blood pressure with body mass index was made.
Results: Among 200 students 6% were obese, 22% were overweight, 65% were normal and 7% underweight. The mean height was 163cm and mean weight 60.48kg. The mean value of systolic blood pressure (105.85, 115.45, 134.95, 137.16 mmHg) and diastolic blood pressure (70.14, 76.15, 90.72, 93.33 mmHg) increased with increasing body mass index.
Conclusion: Overweight and obesity increases the risk of hypertension among students.
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