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Background/Aims: Patients with diverticular disease (DD) frequently have abnormal bowel movements. However, it is unknown whether the entity of these alterations is associated with the severity of DD. We aimed to assess bowel habits and their relationship with the severity of DD according to Diverticular Inflammation and Complication Assessment (DICA) classification, Combined Overview on Diverticular Assessment (CODA) score, and fecal calprotectin (FC). Methods: An international, multicenter, prospective cohort study was conducted in 43 centers. A 10-point visual analog scale (VAS) was used to assess the severity of constipation and diarrhea. The association of constipation and diarrhea with DICA classification, CODA score, and basal FC was tested using non-parametric tests. Survival methods for censored observations were applied to test the association of constipation and diarrhea with the incidence of acute diverticulitis over a 3-year follow-up. Results: Of 871 patients with DD were included in the study. Of these, 208 (23.9%) and 199 (22.9%) reported a VAS score for constipation and diarrhea at least 3 at baseline, respectively. Higher constipation and diarrhea scores were associated with increasing DICA classification, CODA score and basal FC (P< 0.001). Constipation and diarrhea scores were independently associated with an increased hazard of developing acute diverticulitis (hazard ratio [HR]constipation = 1.15 per 1-VAS point increase, 95% confidence interval [CI], 1.04-1.27; P=0.004; and HRdiarrhea =1.14; 95% CI, 1.03-1.26; P=0.014, respectively). Conclusions: In newly diagnosed patients with DD, higher endoscopic and combined scores of DD severity were associated with higher scores of constipation and diarrhea at baseline. Both constipation and diarrhea were independent prognostic factors of acute diverticulitis.
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<b>Introduction:</b> Hemorrhoidal disease is the most common disease treated in proctology ambulatories. Conservative treatment is the basic form of treatment for this disease. One of the elements of treatment may be preparations with myoand phlebotropic effects.<b>Aim:</b> To assess the effect of a multi-ingredient myophlebotropic dietary supplement used as an adjunct on the rate and effectiveness of symptom relief in patients with stage II and III hemorrhoidal disease.<b>Material and method:</b> Patients with stage II and III hemorrhoidal disease with clinical symptoms such as pain, burning, itching and bleeding were qualified for the study. The patients were divided into two groups. The control group (Group I) of 29 patients receiving standard local treatment plus placebo and the study group (Group II) of 32 patients receiving the same local treatment and a six-component myophlebotropic product. Symptoms were analyzed at the time of inclusion in the study (day 0), after 4 and 10 days of therapy. The severity of hemorrhoidal disease and the feeling of relief were assessed on the day of inclusion (W0) and after 30 days of therapy.<b>Results:</b> There were no statistical differences between the groups in terms of disease advancement, age, gender, and duration of symptoms. Compared to the moment of inclusion in the study (W0), after 4 days (W1), after 10 days (W2) of taking the multi- -component product, there was a statistically significant improvement in the VAS scale: spontaneous pain and pain during defecation. In the qualitative assessment (yes/no), there were statistically significantly fewer cases of burning in the anus and itching. The treatment did not affect the rate of spontaneous bleeding, which was low at the beginning of the study, but significantly reduced the rate of bleeding during defecation. After 30 days of observation, it was found that the improvement in the severity of hemorrhoidal disease symptoms was significantly higher in the group using the tested preparation. Relief after a month of the study (one-question method) was noted in the group of patients receiving the tested product.<b>Conclusions:</b> The tested six-component myophlebotropic product proved to be effective in reducing the severity of symptoms such as spontaneous pain, pain during defecation, burning/burning in the anus and bleeding during defecation. Statistical significance was demonstrated in the symptom's relief and reduction in the severity of hemorrhoidal disease.
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Hemorroidas , Humanos , Hemorroidas/terapia , Feminino , Masculino , Pessoa de Meia-Idade , Adulto , Resultado do Tratamento , Suplementos Nutricionais , IdosoRESUMO
In recent years, much has been written about the possibilities of using exogenous sodium butyrate in the prevention and treatment of gastrointestinal diseases, in prehabilitation, in peri- and postoperative treatment, as well as its local application. It became possible thanks to the development of a special formulation (microencapsulation technique) enabling the delivery of unstable butyrate compounds to the large intestine, where it is used primarily as a source of energy. It also plays a key role in maintaining body homeostasis by maintaining the integrity of the intestinal epithelium and stimulating the intestinal immune system. There is growing evidence of the effectiveness of sodium butyrate in various areas of health. The following article discusses the possibilities of using microencapsulated sodium butyrate in the prevention and treatment of gastrointestinal diseases from the perspective of a gastroenterologist and gastrointestinal surgeon.
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Gastroenterologistas , Gastroenteropatias , Humanos , Ácido Butírico/uso terapêutico , Intestinos , Gastroenteropatias/tratamento farmacológico , Gastroenteropatias/cirurgiaRESUMO
Clathrate hydrates are among the most intensively studied H-bond inclusion compounds. Despite the broad definition for this class of compounds, their meaning commonly refers to closed polyhedral nanocages that encapsulate small guest molecules. On the other hand, larger solutes enforce another type of encapsulation because of the solute size effect. Herein, we report a series of structures containing various molecules encapsulated by intercalated water layers constructed of polycyclic moieties of L4(4)8(8) topology. We parametrized the corrugation of individual layers and characterized interactions governing their formation. We suggested that these could be categorized as two-dimensional clathrates based on the character of intra-layer interactions and the effects observed between entrapped molecules and water-based intercalators.
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Helicobacter pylori remains a major health problem worldwide, causing considerable morbidity and mortality due to peptic ulcer disease and gastric cancer. These guidelines constitute an update of the previous "Recommendations on the diagnosis and management of Helicobacter pylori infection" issued in 2014. They have been developed by a Task Force organized by the Governing Board of the Polish Society of Gastroenterology. They discuss, with particular emphasis on new scientific data covering papers published since 2014: the epidemiology, clinical presentation, diagnostic principles and criteria for the diagnosis, and recommendations for the treatment of H. pylori infection. The guidelines in particular determine which patients need to be tested and treated for infection. The Task Force also discussed recommended treatment algorithms. Accordingly, a combination of available evidence and consensus-based expert opinion were used to develop these best practice advice statements. It is worth noting that guidelines are not mandatory to implement but they offer advice for pragmatic, relevant and achievable diagnostic and treatment pathways based on established key treatment principles and using local knowledge and available resources to guide regional practice.
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Preparation of the elusive N-peri-annulated planar Blatter radicals was attempted using aza-Pschorr and photocyclization methods. In both methods, substrates containing N-Me and N-Ac groups yielded a zwitterionic heterocycle lacking the N-substituent as the main product, while in one of them a carbazole derivative representing a new heterocyclic system was also obtained. The formation of the zwitterion and the carbazole suggests the formation of the desired planar Blatter radical, which undergoes facile fragmentation through homolysis of the N-R bond. This mechanism is supported by DFT computational results, which also suggest that N-Ar derivatives should be sufficiently stable for isolation. Electronic structures of three planar Blatter radicals annulated with the O, S, and N-Ph groups are compared.
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Two derivatives of a "super stable" Blatter radical (1,3-diphenyl-7-trifluoromethyl-1,4-dihydrobenzo[e][1,2,4]triazin-4-yl) with N(1)-Ar = 2-CF3C6H4 and 2-MeOC6H4 were obtained and investigated using XRD and SQUID magnetometry methods. The investigation revealed strong antiferromagnetic interactions in both radicals, which are described using the Hatfield model. For the latter radical, an abrupt and reversible change in the χ(T) plot was observed at 29 K. It was ascribed to a structural transition, consistent with a two-dimensional to one-dimensional thermally activated crossover, as supported by specific heat measurements (CvHvs. T). It is suggested that the transition is related to an order-disorder transition of the CF3 group, which is corroborated using XRD structural analysis.
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BACKGROUND AND AIMS: The Diverticular Inflammation and Complication Assessment (DICA) classification and the Combined Overview on Diverticular Assessment (CODA) were found to be effective in predicting the outcomes of Diverticular Disease (DD). We ascertain whether fecal calprotectin (FC) can further aid in improving risk stratification. METHODS: A three-year international, multicentre, prospective cohort study was conducted involving 43 Gastroenterology and Endoscopy centres. Survival methods for censored observations were used to estimate the risk of acute diverticulitis (AD) in newly diagnosed DD patients according to basal FC, DICA, and CODA. The net benefit of management strategies based on DICA, CODA and FC in addition to CODA was assessed with decision curve analysis, which incorporates the harms and benefits of using a prognostic model for clinical decisions. RESULTS: At the first diagnosis of diverticulosis/DD, 871 participants underwent FC measurement. FC was associated with the risk of AD at 3 years (HR per each base 10 logarithm increase: 3.29; 95% confidence interval, 2.13-5.10) and showed moderate discrimination (c-statistic: 0.685; 0.614-0.756). DICA and CODA were more accurate predictors of AD than FC. However, FC showed high discrimination capacity to predict AD at 3 months, which was not maintained at longer follow-up times. The decision curve analysis comparing the combination of FC and CODA with CODA alone did not clearly indicate a larger net benefit of one strategy over the other. CONCLUSIONS: FC measurement could be used as a complementary tool to assess the immediate risk of AD. In all other cases, treatment strategies based on the CODA score alone should be recommended.
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Doenças Diverticulares , Diverticulose Cólica , Divertículo , Humanos , Diverticulose Cólica/diagnóstico , Diverticulose Cólica/terapia , Diverticulose Cólica/complicações , Colonoscopia , Complexo Antígeno L1 Leucocitário , Estudos Prospectivos , Doenças Diverticulares/complicações , Doenças Diverticulares/diagnóstico , Doenças Diverticulares/terapia , Divertículo/complicações , Inflamação/diagnóstico , Inflamação/complicaçõesRESUMO
Inflammatory bowel diseases (IBD), including Crohn's disease and ulcerative colitis, are chronic immune-mediated diseases with a high incidence and prevalence in Europe. Since these are diseases with associated disability, they require complex management and the availability of high-quality healthcare resources. We focused on the analysis of IBD care in selected countries of Central and Eastern Europe (Croatia, the Czech Republic, Hungary, Moldova, Poland, Romania and Slovakia) targeting the availability and reimbursement of diagnostic and therapeutic modalities, the role of IBD centers and also education and research in IBD. As part of the analysis, we created a questionnaire of 73 statements organized in three topics: (1) diagnostics, follow-up and screening, (2) medications and (3) IBD centers. The questionnaire was filled out by co-authoring IBD experts from individual countries, and then the answers and comments on the questionnaire were analyzed. We identified that despite the financial burden, which still partially persists in the region, the availability of some of the cost-saving tools (calprotectin test, therapeutic drug monitoring) differs among countries, mainly due to variable reimbursement from country to country. In most participating countries, there also remains a lack of dedicated dietary and psychological counseling, which is often replaced by recommendations offered by gastroenterologists. However, there is adequate availability of most of the currently recommended diagnostic methods and therapies in each participating country, as well as the implementation of established IBD centers in the region.
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Three new 2,6-disubstituted thiosemicarbazone derivatives of pyridine, namely, 2-{amino[6-(pyrrolidin-1-yl)pyridin-2-yl]methylidene}-N,N-dimethylhydrazine-1-carbothioamide, C13H20N6S, 2-{amino[6-(piperidin-1-yl)pyridin-2-yl]methylidene}-N,N-dimethylhydrazine-1-carbothioamide, C14H22N6S, and 2-[amino(6-phenoxypyridin-2-yl)methylidene]-N,N-dimethylhydrazine-1-carbothioamide monohydrate, C15H17N5OS·H2O, have been synthesized and characterized by NMR spectroscopy and low-temperature single-crystal X-ray diffraction. In addition, their antibacterial and anti-yeast activities have been determined. The ability of the tested compounds to inhibit bacterial growth was comparable to vancomycin as a reference drug. Compared to isoniazid (MIC 0.125 and 8â µgâ ml-1), the compounds showed the ability to inhibit the growth of Mycobacterium tuberculosis to a moderate degree for the standard strain and at the same level or higher (MIC 4-8â µgâ ml-1) for the resistant strain. All three compounds adopt the zwitterionic form in the crystal structure regardless of the presence or absence of solvent molecules.
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Tiossemicarbazonas , Estrutura Molecular , Tiossemicarbazonas/farmacologia , Tiossemicarbazonas/química , Cristalografia por Raios X , Ligação de Hidrogênio , Antibacterianos/químicaRESUMO
INTRODUCTION: We assessed the prevalence and clinical outcomes of segmental colitis associated with diverticulosis (SCAD) in patients with newly diagnosed diverticulosis. METHODS: A 3-year international, multicenter, prospective cohort study was conducted involving 2,215 patients. RESULTS: SCAD diagnosis was posed in 44 patients (30 male patients; median age: 64.5 years; prevalence of 1.99%, 95% confidence interval, 1.45%-2.66%). Patients with SCAD types D and B showed worse symptoms, higher fecal calprotectin values, needed more steroids, and reached less likely complete remission. DISCUSSION: Although SCAD generally had a benign outcome, types B and D were associated with more severe symptoms and worse clinical course.
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Colite , Divertículo , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Resultado do Tratamento , Colite/complicações , Colite/epidemiologia , Colite/diagnóstico , Divertículo/complicaçõesRESUMO
Various environmental factors affecting the human microbiota may lead to gut microbial imbalance and to the development of pathologies. Alterations of gut microbiota have been firmly implicated in digestive diseases such as hepatic encephalopathy, irritable bowel syndrome and diverticular disease. However, while these three conditions may all be related to dysfunction of the gut-liver-brain axis, the precise pathophysiology appears to differ somewhat for each. Herein, current knowledge on the pathophysiology of hepatic encephalopathy, irritable bowel syndrome, and diverticular disease are reviewed, with a special focus on the gut microbiota modulation associated with these disorders during therapy with rifaximin. In general, the evidence for the efficacy of rifaximin in hepatic encephalopathy appears to be well consolidated, although it is less supported for irritable bowel syndrome and diverticular disease. We reviewed current clinical practice for the management of these clinical conditions and underlined the desirability of more real-world studies to fully understand the potential of rifaximin in these clinical situations and obtain even more precise indications for the use of the drug.
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Doenças Diverticulares , Encefalopatia Hepática , Síndrome do Intestino Irritável , Rifamicinas , Humanos , Rifaximina/uso terapêutico , Síndrome do Intestino Irritável/complicações , Rifamicinas/efeitos adversos , Encefalopatia Hepática/tratamento farmacológico , Encefalopatia Hepática/complicações , Doenças Diverticulares/complicaçõesRESUMO
Addition of PhLi to 7-(CF3)benzo[e][1,2,4]triazine at -78 °C gives the "super stable" Blatter radical in high yields, while above -5 °C two additional products are formed. XRD analysis revealed the formation of a "trimer" and a benzo[f][1,2,4]triazepine via a novel mechanism. The latter is formed from the anion generated from the isolated radical, which suggests its instability in organic batteries.
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Four series of isostructural derivatives of 3-ring liquid crystalline derivatives containing p-carboranes (12-vertex A, and 10-vertex B), bicyclo[2.2.2]octane (C), or benzene (D) as the variable structural element were investigated for their mesogenic behavior and electronic interactions. Comparative studies demonstrated that the effectiveness of elements A-D in stabilization of the mesophase typically increases in the order: B
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Recently, special attention has been paid to the relationship between diet and inflammation in the body. A factor that influences both diet and inflammation is physical activity. The aim of this study was to assess the inflammatory potential of the diets of young people engaging in regular physical activity. The participants were physical education students (n = 141 men and n = 151 women). The measurements included basic anthropometric parameters and a 4-day nutritional history from which the dietary inflammatory index (DII) was calculated. The average DII for female students was 2.09 ± 1.52, and that for male students was 0.21 ± 1.69. Consumption of all macro- and micronutrients was significantly higher among women and men with the lowest DII value (corresponding to an anti-inflammatory diet). The female and male students consuming anti-inflammatory diets were characterized by greater lean body mass (LBM), and, for the male students, a lower body fat content, compared to those whose diets were pro-inflammatory. Young and regularly physically active people are also exposed to the pro-inflammatory nature of their diets, whose long-term effects may lead to health problems.
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Tecido Adiposo , Dieta , Feminino , Humanos , Masculino , Adolescente , Antropometria , Inflamação , Anti-InflamatóriosRESUMO
BACKGROUND: Butyric acid's effectiveness has not yet been assessed in the pediatric inflammatory bowel disease (IBD) population. This study aimed to evaluate the effectiveness of oral sodium butyrate as an add-on to standard therapy in children and adolescents with newly diagnosed IBD. METHODS: This was a prospective, randomized, placebo-controlled multicenter study. Patients aged 6-18 years with colonic Crohn's disease or ulcerative colitis, who received standard therapy depending on the disease's severity, were randomized to receive 150 mg sodium butyrate twice a day (group A) or placebo (group B). The primary outcome was the difference in disease activity and fecal calprotectin concentration between the two study groups measured at 12 weeks of the study. RESULTS: In total, 72 patients with initially active disease completed the study, 29 patients in group A and 43 in group B. At week 12 of the study, the majority of patients achieved remission. No difference in remission rate or median disease activity was found between the two groups (p = 0.37 and 0.31, respectively). None of the patients reported adverse events. CONCLUSIONS: A 12-week supplementation with sodium butyrate, as adjunctive therapy, did not show efficacy in newly diagnosed children and adolescents with IBD.
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Colite Ulcerativa , Doença de Crohn , Doenças Inflamatórias Intestinais , Adolescente , Ácido Butírico , Criança , Colite Ulcerativa/diagnóstico , Colite Ulcerativa/tratamento farmacológico , Doença de Crohn/diagnóstico , Doença de Crohn/tratamento farmacológico , Humanos , Doenças Inflamatórias Intestinais/tratamento farmacológico , Estudos ProspectivosRESUMO
BACKGROUND: Chronic inflammation can lead to the development of obesity, diabetes and other chronic diseases. One of the factors causing inflammation is diet. The aim of this study was to assess the inflammatory potential of the diet, expressed by the DII index, in young physically active men. METHODS: A total of 94 physically active students aged 19-23 participated in the study. The subjects' diets were assessed on the basis of 4-day dietary records, which were then analyzed using the computer program "Diet 5.0". The DII was calculated for each participant based on the individual consumption of the selected dietary components. The concentration of CRP protein was also determined. RESULTS: Participants was divided into groups according to values of DII. Diets with different DIIs provided similar amounts of calories, but differed significantly in the content of many nutrients. Participants whose diets showed the most anti-inflammatory effects consumed significantly more protein, magnesium, iron, zinc, antioxidant vitamins, and B vitamins compared to others. The highest concentration of CRP protein was observed in men whose diet was described as the most pro-inflammatory (Q4 group). A significant relationship was found between DII and body fat (%) in men in the most anti-inflammatory (Q1 group) and neutral diet (Q2-Q3 group). CONCLUSIONS: The Dietary Inflammatory Index is a promising method of describing the effect of dietary intake on the risk of inflammation in young, healthy individuals engaging in regular physical activity.
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Dieta , Inflamação , Doença Crônica , Registros de Dieta , Humanos , Inflamação/etiologia , Masculino , Obesidade/complicaçõesRESUMO
Photocyclization of 8-aryloxybenzo[e][1,2,4]triazines leads to the formation of π-expanded flat Blatter radicals for three phenanthryloxy and pyren-1-yloxy derivatives, whereas no photoreaction is observed for the perylen-3-yloxy precursor. Two of the new radicals are nonplanar, out of which one is unstable to isolation. The radical with the fused pyrene ring constitutes the largest thus far paramagnetic polycyclic π-system containing seven fused rings with 27 sp2-hybridized atoms and 29 π-delocalized electrons. The investigation of the reaction conditions demonstrated the higher efficiency of photoformation of the parent radical in polar solvents, which suggests a polar transition state and the S1 photoreactive state. The effect of π expansion on the electronic structure was investigated with spectroscopic (UV-vis, electron paramagnetic resonance) and electrochemical methods augmented with density functional theory computational studies. The molecular structure of one of the radicals was determined with a single-crystal X-ray diffraction method.
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Anemia is a common finding among patients with liver diseases. Patients who suffer from anemia are at a higher risk of liver function decompensation and hospitalization. It affects significantly their quality of life and contributes to mortality. Anemia is present in 70% of patients with liver cirrhosis and with varying incidence accompanies other liver disorders. As the etiology of anemia in liver diseases is multifactorial, various cases represent different clinical entities. Anemia accompanying hepatic disorders can be broadly divided into several types, such as anemia associated with blood loss, as well as aplastic, hemolytic and micronutrient deficiency anemia. However, it is sometimes difficult to delineate between those types in the clinical practice, as several pathophysiological causes can be present in one patient. It is reported that the most common cause of anemia in liver disease is blood loss and iron deficiency. Still, the incidence of unclear cases reaching over 50% suggests that other types of anemia can be underdiagnosed. This review comprehensively describes less frequent types of anemia associated with liver disease, namely hemolytic and aplastic anemia (AA). Hemolytic anemia can complicate autoimmune liver diseases or be a manifestation of membranopathy of red blood cells, dependent on severe hepatic function impairment or alcoholic liver disease. Aplastic anemia is best known as a sequela of viral hepatitis, but some degree of bone marrow inhibition can complicate virtually all advanced liver diseases.