A controlled clinical trial on the effects of exercise on cognition and mobility in adults with multiple sclerosis

Objective To investigate the effects of a 6-month exercise program on cognition and mobility in participants with multiple sclerosis. Design Prospective, single blind, controlled clinical trial. Setting A community rehabilitation program within a large metropolitan health service. Participants Twenty-eight patients with multiple sclerosis, referred for outpatient rehabilitation. Interventions Participants were allocated to one of two groups and undertook a cognitive-motor exercise program or monitoring (control group). Main outcome measures Cognition and mobility. Cognition was evaluated using the Mini-Mental State Examination and the Frontal Assessment Battery. Mobility was assessed with the Timed Get-Up-and-Go-Test, applied with and without dual task distractors. Results The findings showed benefits provided by exercise on cognition and mobility. Differently, participants of the control group did not have significant changes in cognition scores after 6 months of follow-up, and had a worse performance in mobility tests. Conclusion Six months of exercise provided benefits to cognition and mobility in adults with multiple sclerosis. This trial was registered prospectively with the Brazilian Clinical Trials Register, ID: RBR-9gh4km, (https://ift.tt/2tsqhM3). All correspondence and requests for reprints should be addressed to: Gustavo Christofoletti, PhD, Institute of health, Universidade Federal de Mato Grosso do Sul, Av. Universitária, s/n, Caixa Postal 549, Campo Grande, MS, Brazil. Email: g.christofoletti@ufms.br Clinical Trial Identifier: RBR-9gh4km (https://ift.tt/2tsqhM3) Conflicts of interest: none. Financial disclosures: none. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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SHORT-TERM EFFECTS OF NORMOCAPNIC HYPERPNEA AND EXERCISE TRAINING IN COPD PATIENTS: A PILOT STUDY

Objective To evaluate the short-term physiologic effects of respiratory muscle training with normocapnic hyperpnea (NH) added to standard exercise training on respiratory muscle endurance/strength and exercise tolerance in COPD patients. Design Randomized controlled trial. Patients referred for rehabilitation were randomly assigned to 20 sessions (twice daily 5 days/week) of either NH (Group 1, n = 12) or sham maneuvers (Group 2, n = 10) in addition to individualized cycle training and abdominal, upper and lower limb muscle exercise. At baseline and end of study, patients underwent evaluation of respiratory muscle endurance, maximum voluntary ventilation (MVV), maximal inspiratory (MIP) and expiratory pressures (MEP), and 6-min walking distance (6MWD). Results Following training, a significant improvement was found only for Group 1 in respiratory muscle endurance time [by 654 (481) vs. 149 (216) sec for Group 2, P = 0.0108] and MIP [Group 1: from 81.2 (21.9) to 107.6 (23.0) cmH2O, P = 0.018 vs. Group 2: from 75.4 (13.8) to 81.3 (18.9) cmH2O, P = 0.139]. The difference between groups for 6MWD, MVV and MEP was not significant. Conclusions Short-term NH training added to standard exercise, compared to exercise training alone, improves respiratory muscle endurance and strength but not exercise tolerance in COPD patients. Correspondence to: Mara Paneroni, PT MSc, Department of Respiratory Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS via Giuseppe Mazzini 129, 25065 Lumezzane (BS), Italy; email: mara.paneroni@icsmaugeri.it Authorship MP: Data collection, data analysis, statistics, writing, editing CS: Data collection, data analysis, writing, editing MS: Data collection, data analysis, writing DT, GFA, IS, GP: data collection NA: Review, editing MV: Protocol, editing All the Authors approved and critically revised the manuscript FUNDING The Research was supported by Institutional funding. CONFLICT OF INTEREST The Authors have no conflicts of interest to declare. ACKNOWLEDGMENTS The Authors thank Rosemary Allpress for the English revision of the paper and Laura Comini for editorial assistance. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Genetic variants of major genes contributing to phosphate and calcium homeostasis and their association with serum parameters in pigs

Abstract

Calcium and phosphorus are irreplaceable components of life. Tracking the fate of calcium and phosphorus in organisms deserves high attention due to their relevance in bone metabolism and subsequently animal health. Indeed, bone serves as reservoir for calcium and phosphorus, whose formation and resorption follow specific molecular routes including hormones, receptors, and transcription factors. The objective of the study was to analyze the genetic variation of major components driving mineral utilization such as calcitonin receptor, calcium sensing receptor, fibroblast growth factor 23 (FGF23), parathyroid hormone receptor, osteopontin, stanniocalcin 1, RAF-type zinc finger domain containing 1 (TRAFD1), and vitamin D receptor. A German Landrace pig population (n = 360) was used to perform an association analysis between selected single nucleotide polymorphisms (SNP) and relevant serum parameters (calcium, phosphorus, calcium/phosphorus ratio, alkaline phosphatase). Analyzed SNPs in FGF23 (rs710498025) and TRAFD1 (rs345195312) were significantly (p ≤ 0.05) associated with the serum calcium/phosphorus ratio and serum phosphorus levels, respectively. This might represent a modulation of the homeostatic balance between calcium and phosphorus. Furthermore, TRAFD1 is known to be involved in skeletal disorders which emphasize its link to phosphorus utilization and immune system. However, none of the analyzed genetic variants of these major regulators of phosphate and calcium homeostasis showed significant associations after correction for multiple testing (q value > 0.05). Thus, minor contributors as well as unknown and yet to be elucidated regulators of mineral homeostasis need to be characterized towards the implementation of improved phosphorus efficiency in pig breeding programs.

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Idiopathic Scoliosis Families Highlight Actin-Based and Microtubule-Based Cellular Projections and Extracellular Matrix in Disease Etiology

Idiopathic scoliosis (IS) is a structural lateral spinal curvature of ≥10 that affects up to 3% of otherwise healthy children and can lead to life-long problems in severe cases. It is well-established that IS is a genetic disorder. Previous studies have identified genes that may contribute to the IS phenotype, but the overall genetic etiology of IS is not well understood. We used exome sequencing to study five multigenerational families with IS. Bioinformatic analyses identified unique and low frequency variants (minor allele frequency ≤5%) that were present in all sequenced members of the family. Across the five families, we identified a total of 270 variants with predicted functional consequences in 246 genes, and found that eight genes were shared by two families. We performed GO term enrichment analyses, with the hypothesis that certain functional annotations or pathways would be enriched in the 246 genes identified in our IS families. Using three complementary programs to complete these analyses, we identified enriched categories that include stereocilia and other actin-based cellular projections, cilia and other microtubule-based cellular projections, and the extracellular matrix (ECM). Our results suggest that there are multiple paths to IS and provide a foundation for future studies of IS pathogenesis.

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Adaptations of Vancomycin-Intermediate Sequence Type 72 Methicillin-Resistant Staphylococcus aureus for Daptomycin Nonsusceptibility

Microbial Drug Resistance, Ahead of Print.


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First Report of SHV-148-Type ESBL and CMY-42-Type AmpC β-Lactamase in Klebsiella pneumoniae Clinical Isolates in Tunisia

Microbial Drug Resistance, Ahead of Print.


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Prevalence and Characterization of β-Lactamases Genes and Class 1 Integrons in Multidrug-Resistant Escherichia coli Isolates from Chicken Meat in Korea

Microbial Drug Resistance, Ahead of Print.


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Both glypican-3/Wnt/β-catenin signaling pathway and autophagy contributed to the inhibitory effect of curcumin on hepatocellular carcinoma

The aim of this study is to investigate the role of Glypican-3(GPC3)/wnt/β-catenin signaling pathway and autophagy in the regulation of hepatocellular carcinoma (HCC) growth mediated by curcumin.

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A real life comparison of the effectiveness of adalimumab and golimumab in moderate-to-severe ulcerative colitis, supported by Propensity Score analysis.

Adalimumab and golimumab are effective in the treatment of moderate to severe ulcerative colitis.

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Frontal EEG asymmetry in extremely low birth weight adult survivors: Links to antenatal corticosteroid exposure and psychopathology

The brain is particularly vulnerable to adverse environmental exposures during sensitive periods of development (Gluckman et al., 2008; Schlotz and Phillips, 2009). Infants born at extremely low birth weight (ELBW, <1000g) are exposed to significant perinatal adversity and provide a model that allows researchers to examine the impact of early life stress on neurodevelopment across the lifespan. While advances in neonatal care have significantly increased the number of ELBW infants surviving into adulthood (Stoll et al., 2015), relatively little is known about the long-term effects of preterm birth on the brain.

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Osteoconductive Lattice Microarchitecture for Optimized Bone Regeneration

3D Printing and Additive Manufacturing, Ahead of Print.


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Quantitative EEG and functional outcome following acute ischemic stroke

Publication date: August 2018
Source:Clinical Neurophysiology, Volume 129, Issue 8
Author(s): Carla Bentes, Ana Rita Peralta, Pedro Viana, Hugo Martins, Carlos Morgado, Carlos Casimiro, Ana Catarina Franco, Ana Catarina Fonseca, Ruth Geraldes, Patrícia Canhão, Teresa Pinho e Melo, Teresa Paiva, José M. Ferro
ObjectiveTo identify the most accurate quantitative electroencephalographic (qEEG) predictor(s) of unfavorable post-ischemic stroke outcome, and its discriminative capacity compared to already known demographic, clinical and imaging prognostic markers.MethodsProspective cohort of 151 consecutive anterior circulation ischemic stroke patients followed for 12 months. EEG was recorded within 72 h and at discharge or 7 days post-stroke. QEEG (global band power, symmetry, affected/unaffected hemisphere and time changes) indices were calculated from mean Fast Fourier Transform and analyzed as predictors of unfavorable outcome (mRS ≥ 3), at discharge and 12 months poststroke, before and after adjustment for age, admission NIHSS and ASPECTS.ResultsHigher delta, lower alpha and beta relative powers (RP) predicted outcome. Indices with higher discriminative capacity were delta-theta to alpha-beta ratio (DTABR) and alpha RP. Outcome models including either of these and other clinical/imaging stroke outcome predictors were superior to models without qEEG data. In models with qEEG indices, infarct size was not a significant outcome predictor.ConclusionsDTAABR and alpha RP are the best qEEG indices and superior to ASPECTS in post-stroke outcome prediction. They improve the discriminative capacity of already known clinical and imaging stroke outcome predictors, both at discharge and 12 months after stroke.SignificanceqEEG indices are independent predictors of stroke outcome.



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Do fetuses need vasopressors just before their birth?

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The effectiveness of bench press training with or without throws on strength and shot put distance of competitive university athletes

Abstract

Purpose

Maximum force exertion against various resistance levels (heavy–light) is commonly implemented to improve both strength- and speed-oriented components of power. Medium–light resistances allow rapid accelerations, yet incur significant decelerations in the later concentric phase to bring the bar to a halt, which may limit the concentric effort and, therefore, the effectiveness of training. Accordingly, ballistic actions have been recommended. This study evaluated the effectiveness of power bench press training, with the bar thrown on a Smith machine (BP_throw) or without throwing (BP_non-throw), for developing strength and shot put distance.

Methods

Nine university shot-putters performed BP_throw and BP_non-throw at 50, 40 and 30% 1RM, as well as seated and standing shot put trials. Peak angular velocities at the elbow were measured in these tasks using a wireless electro-goniometer. Participants underwent 24 sessions of training (12 weeks) with either BP_throw (n = 5) or BP_non-throw (n = 4) at the three intensities (20 s × 2 sets at 50, 40 and 30% 1RM).

Results

The peak elbow velocity during BP_throw was 1.7 times greater than BP_non-throw for all intensities. The velocity of BP_throw at 30% 1RM (854.7°/s), however, was still slower than seated (1121.3°/s) and standing (1539.1°/s) shot puts. BP_throw training significantly improved 1RM (+ 10.0%) and the distances of seated (+ 11.7%) and standing (+ 3.8%) shot puts, while no performance changes occurred after BP_non-throw training.

Conclusion

When undergoing power bench press against medium–light resistances, maximum ballistic actions are important strategies for improving 1RM and shot put performance of university shot-putters.

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Comprehensive non-surgical treatment versus self-directed care to improve walking ability in lumbar spinal stenosis: A randomized trial

Publication date: Available online 20 June 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Carlo Ammendolia, Pierre Côté, Danielle Southerst, Michael Schneider, Brian Budgell, Claire Bombardier, Gillian Hawker, Y. Raja Rampersaud
ObjectivesTo compare the effectiveness of a comprehensive non-surgical training program to a self-directed approach in improving walking ability in lumbar spinal stenosis.DesignRandomized controlled trial.SettingAcademic hospital outpatient clinic.ParticipantsA total of 104 participants with neurogenic claudication and imaging confirmed LSS were randomized. The mean age was 70.6 years, 57% were female, 84% had leg symptoms for more than 12-months and the mean maximum walking capacity was 328.7m.InterventionsA six-week structured comprehensive training program or a six-week self-directed program.Main Outcome MeasuresContinuous walking distance in meters (m) measured by the Self-Paced Walk Test (SPWT) and proportion of participants achieving at least 30% improvement (MCID) in the SPWT at 6-months. Secondary outcomes included the Zurich Claudication Questionnaire (ZCQ), Oswestry Disability Index (ODI), ODI walk score and the Short-Form General Health Survey (SF-36) subscales.ResultsForty-eight verses 51 participants who were randomized to comprehensive (n=51) or self-directed (n=53) treatment respectively, received the intervention and 89% of the total study sample completed the study. At 6-months the adjusted mean difference in walking distance from baseline was 421.0m (95% confidence interval (CI), 181.4 to 660.6;) favoring the comprehensive program and 82% of participants in the comprehensive group and 63% in the self-directed group achieved the MCID, (adjusted relative risk (RR), 1.3; 95% CI, 1.0 to1.7; P= 0.03). Both primary treatment effects persisted at 12-months favoring the comprehensive program. At 6-months the ODI walk score and at 12-months the ZCQ, SF-36 physical function and bodily pain scores showed greater improvements favoring the comprehensive program.ConclusionsA comprehensive conservative program demonstrated superior, large and sustained improvements in walking ability and can be a safe non-surgical treatment option for patients with neurogenic claudication due to LSS.



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Myoelectric Prosthesis Users Improve Performance Time and Accuracy using Vibrotactile feedback when Visual Feedback is disturbed

Publication date: Available online 20 June 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Eitan Raveh, Sigal Portnoy, Jason Friedman
ObjectiveTo evaluate the effects of adding Vibrotactile feedback (VTF) in myoelectric prosthesis users during performance of a functional task when visual feedback is disturbed.DesignA repeated-measures design with a counter-balanced order of three conditions.SettingLaboratory setting.ParticipantsTransradial amputees using a myoelectric prosthesis with normal or corrected eyesight (N=12, median age 65±13 years). Exclusion criteria were orthopaedic or neurologic problems.InterventionsAll subjects performed the Modified Box & Blocks test, grasping and manipulating 16 blocks over a partition using their myoelectric prosthesis. This was performed three times: In full light, in a dark room without VTF, and in a dark room with VTF.Main outcome measuresPerformance time, i.e. the time needed to transfer one block, and accuracy during performance, measured by number of empty grips, empty transitions with no block and block drops from the hand.ResultsSignificant differences were found in all outcome measures when VTF was added, with improved performance time (4.2 versus 5.3 seconds) and a reduced number of grasping errors (3.0 versus 6.5 empty grips; 1.5 versus 4 empty transitions; 2.0 versus 4.5 block drops).ConclusionsAdding VTF to myoelectric prosthesis users has positive effects on performance time and accuracy when visual feedback is disturbed.



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Transition from post‐capillary pulmonary hypertension to combined pre‐ and post‐capillary pulmonary hypertension in swine: a key role for endothelin

The Journal of Physiology, EarlyView.


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The heart of the matter: a vascular hypothesis for bronchopulmonary dysplasia

The Journal of Physiology, EarlyView.


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Reducing branched‐chain amino acid intake to reverse metabolic complications in obesity and type 2 diabetes

The Journal of Physiology, EarlyView.


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Initiating life‐long aerobic exercise 4–5 days per week before or near age 50 years: is this the ‘holy‐grail’ of preventing age‐related central artery stiffness?

The Journal of Physiology, EarlyView.


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Cholinergic excitation complements glutamate in coding visual information in retinal ganglion cells

The Journal of Physiology, EarlyView.


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The fetus at the tipping point: modifying the outcome of fetal asphyxia

The Journal of Physiology, EarlyView.


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Monitoring of tritium concentration in Hanoi's precipitation from 2011 to 2016

Publication date: December 2018
Source:Journal of Environmental Radioactivity, Volume 192
Author(s): Ha Lan Anh, Vo Thi Anh, Trinh Van Giap, Nguyen Thi Hong Thinh, Tran Khanh Minh, Vu Hoai
Tritium is a radioisotope of hydrogen and a component of the water molecule. It is a marker for reservoirs such as the stratosphere, troposphere, and oceans involved in the hydrological cycle. Tritium monitoring is an essential research tool in hydro-climate, dating for water and recharge groundwater. The Isotope Hydrology Laboratory has collected monthly precipitation samples in Hanoi for tritium concentration analysis. This paper reports the tritium concentrations in precipitation in the city from 2011 to 2016. The results show that monthly tritium concentration reached a maximum of 7.07 Tritium Units (TU) in August 2011. The mean annual tritium concentration stabilized from 2.03 to 3.36 TU. It suggests that tritium in monitoring station precipitation is predominantly natural. The seasonal variation trend of ³H in precipitation at the Hanoi station is similar to those monitored at the Hong Kong station. The correlation of tritium and rainfall was also estimated.

Graphical abstract

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Anxious gambling: Anxiety is associated with higher frontal midline theta predicting less risky decisions

Psychophysiology, EarlyView.


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Acceptability of Postpartum Contraception Counseling at the Well Baby Visit

Abstract

Objectives The postpartum period is a high-risk time for unintended pregnancy, and additional opportunities to provide contraception are needed. Our objective was to evaluate the acceptability of providing postpartum contraceptive counseling at a pediatric well baby visit, and compare it to counseling at the routine postpartum visit. Methods Postpartum women (100 per group) were recruited for this cohort study at pediatric well baby visits and obstetric postpartum visits at an academic medical center. Well baby participants completed a baseline survey followed by contraceptive counseling by an obstetrician or midwife and a post-counseling survey. Postpartum participants were surveyed after their visit only. Results All well baby visit participants completed the intervention and were enrolled earlier in the postpartum period than postpartum visit participants (mean = 4.1 vs. 6.6 weeks, respectively, p < 0.01). Following counseling, 95% of well baby participants reported being very comfortable discussing contraception, compared to 83% before counseling (RR 1.14, 95% CI 1.06, 1.25) and a higher proportion reported being very likely to use a contraception prescription obtained at the well baby visit (79% after counseling vs. 65% before; RR 1.23, 95% CI 1.08, 1.39). Similar proportions of postpartum and well baby participants were very comfortable discussing contraception at their visits (91 vs. 95%, respectively). Conclusions for practice Contraceptive counseling paired with well baby visits is acceptable among postpartum women. Acceptability increased further after the counseling intervention at the well baby visit. Obstetricians and Pediatricians can partner to offer contraceptive counseling at the well baby visit to increase opportunities for contraception education at an earlier time postpartum.

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Oldest evidence for grooming claws in euprimates

Publication date: Available online 20 June 2018
Source:Journal of Human Evolution
Author(s): Doug M. Boyer, Stephanie A. Maiolino, Patricia A. Holroyd, Paul E. Morse, Jonathan I. Bloch
Euprimates are unusual among mammals in having fingers and toes with flat nails. While it seems clear that the ancestral stock from which euprimates evolved had claw-bearing digits, the available fossil record has not yet contributed a detailed understanding of the transition from claws to nails. This study helps clarify the evolutionary history of the second pedal digit with fossils representing the distal phalanx of digit two (dpII), and has broader implications for other digits. Among extant primates, the keratinized structure on the pedal dpII widely varies in form. Extant strepsirrhines and tarsiers have narrow, distally tapering, dorsally inclined nails (termed a 'grooming claws' for their use in autogrooming), while extant anthropoids have more typical nails that are wider and lack distal tapering or dorsal inclination. At least two fossil primate species thought to be stem members of the Strepsirrhini appear to have had grooming claws, yet reconstructions of the ancestral euprimate condition based on direct evidence from the fossil record are ambiguous due to inadequate fossil evidence for the earliest haplorhines. Seven recently discovered, isolated distal phalanges from four early Eocene localities in Wyoming (USA) closely resemble those of the pedal dpII in extant prosimians. On the basis of faunal associations, size, and morphology, these specimens are recognized as the grooming phalanges of five genera of haplorhine primates, including one of the oldest known euprimates (∼56 Ma), Teilhardina brandti. Both the phylogenetic distribution and antiquity of primate grooming phalanges now strongly suggest that ancestral euprimates had grooming claws, that these structures were modified from a primitive claw rather than a flat nail, and that the evolutionary loss of 'grooming claws' represents an apomorphy for crown anthropoids.



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Interaction between anesthetic conditioning and ischemic preconditioning on metabolic function after hepatic ischemia–reperfusion in rabbits

Abstract

Background

Both anesthetic-induced and ischemic preconditioning are protective against hepatic ischemia–reperfusion injury. However, the effects of these preventive methods on the metabolic function remain to be elucidated. We investigated the anesthetic conditioning and ischemic preconditioning on the metabolic function of the rabbit model of hepatic ischemia–reperfusion.

Methods

After approval by the institutional animal care and use committee, 36 Japanese White rabbits underwent partial hepatic ischemia for 90 min either under sevoflurane or propofol anesthesia. All the rabbits underwent 90 min of hepatic ischemia, and half of the rabbits in each group underwent additional 10-min ischemia and 10-min reperfusion before index ischemia. Hepatic microvascular blood flow was intermittently measured during reperfusion period, and galactose clearance, serum aminotransferase activities, and lactate concentrations were determined 180 min after reperfusion.

Results

Neither anesthetic conditioning with sevoflurane nor ischemic preconditioning altered hepatic microvascular blood flow during reperfusion and serum transaminase activities after reperfusion. However, galactose clearance of reperfused liver was significantly higher under sevoflurane anesthesia than propofol (0.016 ± 0.005/min vs. 0.011 ± 0.004/min). Statistically significant interaction between anesthetic choice and application of ischemic preconditioning suggests that the ischemic preconditioning is selectively protective under propofol anesthesia. Increase of blood lactate concentration was significantly suppressed under sevoflurane anesthesia compared to propofol (1.5 ± 0.8 vs. 3.9 ± 1.4 mmol/l) without any statistically significant interaction with the application of ischemic preconditioning.

Conclusion

Sevoflurane attenuated the decrease of galactose clearance and increase of the blood lactate after reperfusion compared to propofol. Application of ischemic preconditioning was significantly protective under propofol anesthesia.

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International consensus on the assessment of bruxism: Report of a work in progress

Journal of Oral Rehabilitation, EarlyView.


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Psychiatric and functional neuroimaging abnormalities in chronic hepatitis C virus patients: Is vasculitis a contributing factor?

Publication date: Available online 20 June 2018
Source:Arab Journal of Gastroenterology
Author(s): Hania S. Zayed, Amr Amin, Samy Alsirafy, Nahla D. Elsayed, Soheir Abo Elfadl, Mohamed Nasreldin, Dalia Enaba, Zeinab Nawito
Background and study aimsCentral nervous system (CNS) involvement in hepatitis C virus (HCV) infection has different facets such as anxiety, depression, cognitive impairment and vasculitis. We were interested in detecting subclinical CNS involvement in chronic HCV infected subjects with and without systemic vasculitis.Patients and methodsNineteen patients (15 females and 4 males) with chronic HCV infection (mean age 46.5 ± 7 and mean duration since diagnosis of HCV infection 4.7 ± 4 years, including 6 (32%) Child-Pugh class A cirrhotic patients) and 30 age, sex and education matched healthy control subjects were studied. Thirteen patients had associated vasculitis. Patients and control subjects were assessed using the block design and comprehension subtests of Wechsler Bellevue Adult Intelligence Scale, Wechsler Memory scale (WMS), Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI). Brain HMPAO Single Photon Emission Computed Tomography (SPECT) was performed for HCV patients.ResultsPatients with HCV had lower scores on the block design test compared to control subjects (8.37 ± 1.89 versus 10.37 ± 1.47, p < 0.001), lower total WMS scores (43.15 ± 10.49 versus 60.27 ± 8.08, p < 0.001) and higher anxiety and depression scores (16.94 ± 10.46 and 37.17 ± 10.38 versus 10.3 ± 4.67 and 28.9 ± 5.99, p = 0.004 and 0.001, respectively). Total WMS were lower in HCV patients with vasculitis compared to those without vasculitis (39.14 ± 9.3 versus 51.17 ± 8.3, p = 0.019) while the block design and comprehension tests, BAI and BDI were not significantly different between both groups. The block design and comprehension tests, WMS, BAI and BDI were not significantly different between cirrhotic and non-cirrhotic patients. Seven patients had different patterns of cerebral hypoperfusion on SPECT, and all of them had associated vasculitis. Abnormal SPECT was associated with lower total WMS scores (35.87 ± 10.8 versus 46.79 ± 8.6 in those with normal SPECT, p = 0.049).ConclusionsVasculitis may contribute to the development of neuropsychiatric involvement in HCV patients.



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The gut microbiome and irritable bowel syndrome: State of art review

Publication date: Available online 20 June 2018
Source:Arab Journal of Gastroenterology
Author(s): Ahmed E. Salem, Rajdeep Singh, Younan K. Ayoub, Ahmed M. Khairy, Gerard E. Mullin
Irritable bowel syndrome (IBS) is a functional disorder of the gastrointestinal tract, the physiology of which is not very well understood. There are multiple factors and pathways involved in pathogenesis of this entity. Among all, dysmotility, dysregulation of the brain-gut axis, altered intestinal microbiota and visceral hypersensitivity play a major role. Over the last years, research has shown that the type of gut microbiome present in an individual plays a significant role in the pathophysiology of IBS. Multiple studies have consistently shown that subjects diagnosed with IBS have disruption in gut microbiota balance. It has been established that host immune system and its interaction with metabolic products of gut microbiota play an important role in the gastrointestinal tract. Therefore, probiotics, prebiotics and antibiotics have shown some promising results in managing IBS symptoms via modulating the interaction between the above. This paper discusses the various factors involved in pathophysiology of IBS, especially gut microbiota.



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Rifaximin versus metronidazole in management of acute episode of hepatic encephalopathy: An open labeled randomized clinical trial

Publication date: Available online 20 June 2018
Source:Arab Journal of Gastroenterology
Author(s): Mohamed A. Mekky, Ahmad R. Riad, Marwa A. Gaber, Mohamed O. Abdel-Malek, Yosef M. Swifee
Background and study aimsMany regimens are tried in managing overt hepatic encephalopathy (HE). We investigated the efficacy of rifaximin versus metronidazole in management of an acute episode of HE on top of cirrhosis.Patients and methodsAn open label prospective controlled trial was conducted on patients with an acute episode of HE on top of cirrhosis who were randomly divided into metronidazole-group (M-group) and rifaximin-group (R-group) with 60 patients in each.The main outcome measure was the clinical improvement of HE, duration of hospital stay and the changes in the level of serum ammonia after 3 days of starting therapy.ResultsBoth M-group and R-group were comparable as regards age and sex (mean age 51 ± 11 years and 49 ± 12; male/female ratio 45:15 and 50:10, respectively). Forty-six patients (76.7%) in M-group compared with forty-five (75%) in R-group showed clinical improvement (p = 0.412). Hospital stays were comparable between both group; 4.2 ± 2.1 and 3.9 ± 1.7 for M-group and R-group; respectively (p = 0.435). There was no significant difference of venous ammonia levels (Mean of delta 160.77 ± 185.34 µg/dL and 207.95 ± 218.43 µg/dL with p 0.664 and 0.974 in M-group and R-group, respectively). No adverse events were reported throughout the whole study.ConclusionRifaximin and metronidazole are equally effective in management of acute episode of overt HE, therefore, re-auditing of treatment protocols of HE are warranted especially in limited resource settings.



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Treatment of PPI-resistant gastro-oesophageal reflux: A systematic review

Publication date: Available online 20 June 2018
Source:Arab Journal of Gastroenterology
Author(s): Giulia Gallusi, Stefano Pontone
Background and study aimsSeveral studies have demonstrated the superiority of proton-pump inhibitors (PPIs) in resolving erosive gastro-oesophageal reflux disease (GORD). However, this first line of treatment can fail to control symptoms in around 30% of cases, especially in the presence of non-erosive GORD. In situations where the first line of treatment fails, there is a lack of concordance regarding the best strategy to apply. This study presents a systematic review of the trials which have tested second-line treatments after PPI failure.MethodsThe study was conducted according to the PRISMA statement. The systematic review included medical trials written in English which were published between 2000 and 2016 and were retrieved from PubMed and Scopus using the keywords 'PPI-resistant gastro-oesophageal reflux', 'alginate AND gastro-oesophageal reflux', 'hyaluronic acid AND gastro-oesophageal reflux', 'prokinetics AND gastro-oesophageal reflux', 'sucralfate AND gastro-oesophageal reflux' and 'baclofen AND gastro-oesophageal reflux'.ResultsTen randomised and non-randomised studies were included, which included 1515 patients of both sexes (mean age = 49.19 years, age range = 18–85, males = 700; 46.2%).ConclusionsA personalised choice of the best treatment for PPI-resistant GORD should be based on the results of an upper endoscopy and pH/MII monitoring. For patients in situations where the first line of treatment fails, we encourage the execution of trials for testing double doses of PPIs against alternative medicaments.



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