No abstract

Oscillospira is an under-studied anaerobic bacterial genus from Clostridial cluster IV that has resisted cultivation for over a century since the first time it was observed. In recent years its 16S rRNA gene was identified in several human gut microbiota studies where it was often associated with interesting traits, especially leanness. However, very little is known about its metabolism or physiology. Here we used nearly complete genomes derived from shot-gun metagenomic data from the human gut to analyze Oscillospira and related bacteria. We used sequence similarity, gene neighbourhood information and manual metabolic pathway curation to decipher key metabolic features of this intriguing bacterial genus. We infer that Oscillospira species are butyrate producers, and at least some of them have the ability to utilize glucuronate, a common animal-derived sugar that is both produced by the human host and consumed by that host in diets rich in animal products. These findings could help explain diet-related inter-individual variation in faecal Oscillospira levels as well as the observation that the presence of this genus is reduced in diseases that involve inflammation.

No abstract

BackgroundHyperemesis gravidarum (HG) is characterized by severe intractable nausea and vomiting in pregnancy leading to electrolyte imbalance, ketonuria, and weight loss. The cause is unknown. This study sought to investigate the prevalence and characteristics of HG in the Western Galilee in two ethnic populations and to estimate its economic burden.MethodsData on ethnicity, age, gestational age, number of pregnancies, and length of hospitalization were collected from the medical files of all women with HG admitted to the Galilee Medical Center in 2010–2013. Findings were compared between Arabs and Jews. Prevalence was assessed relative to total number of births. Economic burden was assessed by cost of hospitalization and work days lost.ResultsThe cohort included 184 women, 124 Arabic (67.4 %) and 60 Jewish (32.6 %). There were 13,630 births at the medical center during the study period, for a calculated prevalence of HG of 1.2 %. There was no difference in the relative proportions of Arabs and Jews between the cohort and the total women giving birth at our center. Mean patient age was 27.2 years, gestational age 9.3 weeks, parity 2.35. Mean age was significantly higher in the Jewish group. There were no significant between-group differences in the other clinical parameters. Mean number of hospitalization days was 2.24 days, and of additional rest days prescribed, 4.62. The calculated annual cost of HG was 452,943.42 NIS (120,144.14 USD), crudely extrapolated to a nationwide cost of 15–20 million NIS (5,300,000 USD).ConclusionThe prevalence and characteristics of HG are similar in the Arabic and Jewish populations of northern Israel. Mean gestational age at admission for HG was lower in our study than earlier ones, probably owing to the universal health care provided by law in Israel. HG prevalence was twice that reported previously in southern Israel but still within the range observed in other world regions. The socioeconomic differences between Arabs and Jews in the Galilee are smaller than elsewhere in Israel, suggesting a multifactorial etiology of HG. HG poses a major economic burden which should be considered when planning health policies. Further studies of this issue are warranted.

A 72-year-old man presented to the emergency department with epigastric pain and melena. On physical examination, he had mild epigastric tenderness and tarry black stool per rectum. On gastroscopy, a solid, ulcerated, lobulated protruding antral mass of 3.5 cm was observed ( Figure A) and biopsies were taken ( Figure B). A positron emission tomography/computed tomography scan showed diffuse uptake corresponding with the antral finding ( Figure C) with no pathologic uptake indicative of disease elsewhere. Histology found ulcerated fragments of gastric mucosa showing amelanotic melanocytic malignant proliferation compatible with melanoma. Melanoma cocktail and s100 staining were positive ( Figure D). A thorough ophthalmologic and dermatologic examination excluded any primary lesion. The patient underwent surgical resection of the lesion and adjuvant therapy with pembrolizumab.Follow-up positron emission tomography/computed tomography 6 months after the surgery was normal. Although there is controversy whether solitary malignant melanoma of the gastrointestinal tract represents a primary melanoma or a metastasis from an undetected primary lesion, we suggest keeping in mind that melanoma is a rare, yet well recognized cause of gastrointestinal bleeding.

Goal:The aim was to assess proactive specialized inflammatory bowel diseases (IBD) emergency department (ED) consultation and multidisciplinary IBD team (IBD-MDT) intervention on IBD-related patient outcomes after discharge.Background: Despite advances in patient care, IBD-related ED visits have increased and substantially contribute to the IBD burden.Methods: Consecutive patients with IBD (below 50 y) who visited the ED during November 2017 to April 2018 (intervention group) were compared with patients with IBD that visited the same ED during 2014 to 2017 (standard-care group). The primary outcomes were hospitalization and ED revisits at 30, 90, and 180 days. Results:The intervention group (45 patients, mean age 32.43 ± 8.6 y, 57.8% male) and the standard-care group (237 patients) had comparable baseline characteristics, including age, sex, and IBD type, and similar rates of hospital admissions from the ED (46.7% vs. 38.8%, P = 0.32). The intervention group more frequently underwent computed tomography (40% vs. 8%, P < 0.001) and surgical interventions (13.3% vs. 0.8%, P < 0.001) within the same hospital admission, compared with the standard-care group. In the intervention group, 24 patients were discharged from the ED, of whom 17 patients visited the IBD clinic (median 5 d postdischarge) and the majority were referred to ambulatory IBD-MDT services (dietitian: 46.7%, psychologist: 6.7%, advanced endoscopist: 8.9%, and proctology services: 6.7%). The intervention group had significantly fewer ED revisits than the standard-care group (30 d: 4.4% vs. 19.8%, P = 0.013; 90 d: 4.4% vs. 35.9%, P < 0.001; 180 d: 6.7% vs. 43%, P < 0.001). Conclusion:Proactive specialized ED assessments and IBD-MDT interventions after a hospital discharge were preferable; they significantly reduced the ED revisit rate for at least 6 months.

No abstract

Background More than 2.5 million people in Europe suffer from inflammatory bowel diseases (IBD). IBD affects the quality of life, but also has important consequences for health systems. As IBD care and education might differ and might be linked to Gross Domestic Product (GDP), we conducted this European Variation In ibd PracticE suRvey (VIPER) to study potential differences. Methods This trainee-initiated survey, run through SurveyMonkey®, consisted of 47 questions inquiring basic demographics, IBD training and clinical care. The survey was distributed through social media and national GI societies from December 2020 - January 2021. Results were compared according to GDP per capita, for which countries were divided into 2 groups (low/high income, according to the World Bank). Differences between groups were calculated using the chi2 statistic. Results The online survey was completed by 1268 participants from 39 European countries (Figure 1). Most of the participants are specialists (65.3 %), followed by fellows in training (&gt;/&lt; 3 years, 19.1%, 15.6 %). Majority of the responders are working in academic institutions (50.4 %), others in public/district hospitals (33.3 %) or private practices (16.3 %). Despite significant differences in access to IBD-specific training between high (56.4%) and low (38.5%) GDP countries (p&lt;0.001), majority of clinicians feels comfortable in treating IBD (77.2% vs 72.0%, p=0.04). Interestingly, a difference in availability of dedicated IBD units could be observed (58.5% vs 39.7%, p&lt;0.001), as well as an inequality in multidisciplinary meetings (72.6% vs 40.2%, p&lt;0.001), which often take place on a weekly basis (53.0%) (Figure 2). In high GDP countries, IBD nurses are more common (86.2%) than in low GDP countries (36.0%, p&lt;0.001), which is mirrored by differences in nurse-led IBD clinics (40.6% vs 13.8%, p&lt;0.001). IBD dieticians (32.4% vs 16.6%) and psychologists (16.7% vs 7.5%) are mainly present in high GDP countries (p&lt;0.001). In the current COVID era, telemedicine is available in 58.4% vs 21.4% of the high/low GDP countries respectively (p&lt;0.001), as well as urgent flare clinics (58.6% vs 38.7%, p&lt;0.001) and endoscopy within 24 hours if needed (83.0% vs 86.7% p=0.1). Treat-to-target approaches are implemented everywhere (85.0%), though access to biologicals and small molecules differs significantly (Figure 3). Almost all (94.7%) use faecal calprotectin for routine monitoring, whereas half also use intestinal ultrasound (47.9%). Conclusion A lot of variability in IBD practice exists across Europe, with marked differences between high vs low GDP countries. Further work is required to help address some of these inequalities, aiming to improve and standardise IBD care across Europe.