Racial differences in the outcomes of IBD hospitalizations: a national population-based study.

PURPOSE: There are  scarce data describing the outcomes of hospitalized patients admitted with inflammatory bowel disease (IBD) stratified by race. In this retrospective cohort study, we evaluated the difference in outcomes between adult white and black patients hospitalized with a principal diagnosis of inflammatory bowel disease. METHODS: Data were obtained from the 2016 and 2017 National Inpatient Sample (NIS) database. Our primary outcome was inpatient mortality while the secondary outcomes were hospital length of stay (LOS), total hospital charges (THC), red blood cell (RBC) transfusion, diagnosis of bowel perforation, and severe sepsis with septic shock. We conducted the analysis using STATA software. We used propensity-matched multivariate regression analysis to adjust for potential confounders. RESULTS: Among 71 million hospital hospitalizations, we found 177,574 hospitalizations with a principal diagnosis of IBD, with 24,635 (13.9%) for black patients, 124,899 (70.3%) for white patients, and 28,040 (15.8%) were for others. There was no significant difference in inpatient mortality for black vs white patients. Among secondary outcomes, white compared to black patients had increased odds of having a diagnosis of bowel perforation when admitted with a diagnosis of IBD while there was no difference in the odds of developing septic shock. White patients admitted with a diagnosis of UC were also found to have increased total LOS and THC. CONCLUSION: White patients hospitalized with a principal diagnosis of IBD had no difference in inpatient mortality or septic shock but had worse outcomes such as increased odds of bowel perforation compared to black patients.

Primary Liver Diffuse Large B-Cell Lymphoma following Complete Response for Hepatitis C Infection after Direct Antiviral Therapy.

INTRODUCTION: Hepatitis C infection is highly prevalent worldwide and has a well-known association with B-cell lymphoid malignancies. Antiviral therapy has successfully decreased the rate of liver cirrhosis and improved the outcome in patients with hepatitis C-associated lymphomas. However, although there are a few case reports of aggressive lymphomas after successful hepatitis C therapy, the mechanism behind this association remains unclear. CASE PRESENTATION: We present the case of a 55-year-old man with chronic hepatitis C infection and liver cirrhosis who received antiviral therapy with sofosbuvir and ribavirin and achieved a sustained complete virological response. One year after successful therapy, there was an unexplained decline of his liver function and atypical liver nodularity, which led to the diagnosis of a primary liver diffuse large B-cell lymphoma. DISCUSSION: We review the evidence supporting possible mechanisms of lymphomagenesis after successful hepatitis C therapy, particularly involving late "second-hit" mutations after viral-induced DNA damage and antiviral therapy facilitating the emergence of latent malignant B-cell clones by decreasing local inflammation and immune surveillance. More reports may help elucidate any association between hepatitis C antiviral therapy and late lymphoid malignancies.

Tubercular Hepatic Abscess: An Incidental Finding.

Tuberculosis (TB) is an infectious disease caused by a bacterium, Mycobacterium tuberculosis. It is known to generally affects the lungs, but it can also affect multiple other parts of the body. Liver involvement with hepatic abscess is an infrequent manifestation of TB which is missed because of the rarity and non-specific symptoms, especially in the west. A thorough literature review shows very few case reports published in the western world. We present a rare case of isoniazid-resistant pulmonary TB associated with a hepatic abscess in the United States. It was diagnosed by aspiration of the abscess that later grew M. tuberculosis and treated with antitubercular drugs.

Differential Expression of Non-Coding RNAs in Stem Cell Development and Therapeutics of Bone Disorders.

Stem cells' self-renewal and multi-lineage differentiation are regulated by a complex network consisting of signaling factors, chromatin regulators, transcription factors, and non-coding RNAs (ncRNAs). Diverse role of ncRNAs in stem cell development and maintenance of bone homeostasis have been discovered recently. The ncRNAs, such as long non-coding RNAs, micro RNAs, circular RNAs, small interfering RNA, Piwi-interacting RNAs, etc., are not translated into proteins but act as essential epigenetic regulators in stem cells' self-renewal and differentiation. Different signaling pathways are monitored efficiently by the differential expression of ncRNAs, which function as regulatory elements in determining the fate of stem cells. In addition, several species of ncRNAs could serve as potential molecular biomarkers in early diagnosis of bone diseases, including osteoporosis, osteoarthritis, and bone cancers, ultimately leading to the development of new therapeutic strategies. This review aims to explore the specific roles of ncRNAs and their effective molecular mechanisms in the growth and development of stem cells, and in the regulation of osteoblast and osteoclast activities. Furthermore, we focus on and explore the association of altered ncRNA expression with stem cells and bone turnover.

Generation of a Bessel beam of variable spot size.

We report the generation of a zero-order Bessel beam of continuously variable spot size using a simple optical setup. We have used a pair of metal axicon mirrors to generate a hollow beam of variable dark diameter. This beam was subsequently focused by a convex lens to get a Bessel beam of variable spot size. We also studied the effect of a hollow-beam ring width on nondiffracting propagation range of the generated beam.

Drug-Induced Liver Injury Caused by "Khat," an Herbal Stimulant.

We describe a case of Catha edulis (Khat) drug-induced liver injury in a 28-year-old man from Yemen. The patient presented with jaundice, fatigue, and anorexia. Extensive workup, including liver biopsy, was performed. This is the first reported case in the United States without definite autoimmune hepatitis. Diagnosis requires high clinical suspicion and extensive workup. Increasing migration and differences in cultural practices lead to the need for an increased awareness of this type of cases, which is underreported.

Antimycotic potential of Crataeva religiosa Hook and Forst against some selected fungal pathogens.

Crataeva religiosa Hook and Forst belonging to family Capparidaceae (Cappaceae) was selected based on its ethnopharmacological uses like diuretic, laxative, lithonotriptic, antirheumatic, antiperiodic, bitter tonic, rubifacient and counterirritant and was investigated to evaluate in vitro antimycotic potential of petroleum ether, chloroform, ethanolic and aqueous extracts against Candida albicans, Candida tropicalis, Candida krusei, Cryptococcus marinus and Aspergillus niger by disc diffusion method. The minimum inhibitory concentrations of C. religiosa extracts were found in the range of 0.062 - 0.5 mg/disc. The ethanolic extract significantly inhibits the growth of selected fungal pathogens, whereas aqueous extract do not show zone of inhibition against the tested Candida species. The results indicate the possible therapeutic uses of the plant as a potent antifungal agent.

Optimization of some physical and nutritional parameters for the production of hyaluronidase by Streptococcus equi SED 9.

The effects of some physical and nutritional parameters were studied for the optimum production of an extracellular enzyme hyaluronidase employing Streptococcus equi SED 9 by submerged fermentation. The effects of initial pH, incubation temperature and time, inoculum level and age of inoculum were studied. The maximum enzymatic activity was obtained with an initial pH 5.5, incubation temperature 37 degrees C, incubation time for 48 h and inoculum level 10% with inoculum age 48 h. The effects of various carbon and inorganic nitrogen sources, vitamins, amino acids and growth hormones were studied. The results indicated that dextrose, ammonium sulfate, nicotinic acid, L-cysteine and kinetin showed the highest enzymatic activity among them.

Synthesis and antimicrobial activity of some 1-(2,4-dinitrophenyl)-3-(3-nitrophenyl)-5-(4-substituted phenyl)-4-bromo-2-pyrazolines and 1-(2,4-dinitrophenyl)-3-(3-nitrophenyl)-5-(4-substituted phenyl)-2-pyrazolin-4-ones.

A series of 1-(2,4-dinitrophenyl)-3-(3-nitrophenyl)-5-(4-substituted phenyl)-2-pyrazolin-4-ones (4a-e) have been synthesized by the oxidation of 1-(2,4-dinitrophenyl)-3-(3-nitrophenyl)-5-(4-substituted phenyl)-4-bromo-2-pyrazolines (3a-e) with dimethylsulfoxide. The structure has been established on the basis of spectral data (IR,1H NMR). The synthesized compounds have been screened in vitro for their possible antimicrobial activity.

Juvenile nasopharyngeal angiofibroma presenting as a palatal swelling.

Juvenile nasopharyngeal angiofibroma (JNA) is a rare, benign, highly vascular and locally aggressive tumor that predominantly occurs in adolescent males. Usually the presenting symptom is a painless nasal obstruction or epistaxis; however, other symptoms may depend on the size and extent of the tumor mass. Owing to the vascularity of the tumor, incisional biopsy is not attempted and the diagnosis is, therefore, dependent on multiplanar imaging modalities such as computed tomography, magnetic resonance imaging and angiography. These also help to assess the tumor mass, pre-operative embolization of the feeder vessel, and treatment planning. Usually, JNA patients are diagnosed by otorhinolaryngologists. The purpose of this paper is to present a rare case of JNA with a tender palatal swelling that was first seen by a dentist.

Determinants of variation in analgesic and opioid prescribing practice in an emergency department.

OBJECTIVE: Adequate treatment of patients' pain is a top priority for the World Health Organization (WHO), American Medical Association (AMA), and American College of Emergency Physicians (ACEP), but "adequate" is not clearly defined. Most previous studies of emergency department (ED) pain treatments have centered on musculoskeletal pain in terms of rates of analgesia and disparities in treatment based on race and age. This study will examine complaints of pain other than musculoskeletal and will focus on treatment disparities that may result from differences inpatient and physician characteristics. METHODS: This retrospective study is of ED patients 18 years and older with nonmusculoskeletal pain who were seen by ED faculty over a period of eight weeks. Logistic regression and CHI2 tests were performed to quantify effects of doctor, patient, and clinical characteristics on rates of ED analgesia, ED opioids, and analgesic prescriptions at discharge. RESULTS: A total of 1360 patients were included. There was wide variation in the type and frequency of ED analgesia depending on the attending doctor. For example, patients seen by one specific ED doctor were less than half as likely to receive any analgesia and seven times less likely to receive an opioid than those seen by another doctor. Age, race, doctor's training and experience, and whether the patient had chronic pain were important predictors of ED analgesia. There were similar findings for ED opioids and discharge analgesics. CONCLUSION: Pain practices in EDs are highly variable and seem inadequate when measured against the goals of WHO, AMA, and ACEP. Patient age, race, and type of pain and the physician's identity, training, and experience all contribute to practice variation. Further research is needed to identify the causes of these variations, and there is a need to develop interventions to standardize and improve pain assessment and treatment.

Disparities in analgesia and opioid prescribing practices for patients with musculoskeletal pain in the emergency department.

INTRODUCTION: Healthy People 2010 seeks to eliminate racial and ethnic disparities in health care; however, disparities due to age and race have been described in emergency department pain treatment. Although pain is a common patient complaint in emergency departments, many people receive no analgesia. This study examined the influence of patient and provider characteristics on ED and discharge analgesia and opioid prescribing practices. METHODS: This descriptive study used chart review of selected variables from ED patients 18 years and older who presented with musculoskeletal pain and were treated by core ED faculty. Logistic regression analyses were performed to determine whether analgesia- and opioid-prescribing disparities existed and were influenced by patient and provider characteristics. RESULTS: A total of 868 patient records were examined. Physician characteristics and wide variation in practice were the only sources of disparities in the prescription of analgesics in the emergency department, but patient characteristics including race, age, chronic pain, and trauma influenced prescription of ED opioids and discharge analgesics. No gender or financial status disparities were found. Fewer opioids and discharge analgesics were prescribed for black patients than for white patients. Younger patients, those with trauma, and those with chronic pain received more opioids and discharge analgesics compared with older patients and those without trauma or chronic pain. Providers who completed emergency medicine residencies and had fewer than 3 years' experience prescribed more analgesics in the emergency department. DISCUSSION: Pain management in our emergency department is widely variable, with some disparities based on patient and physician characteristics. Multicenter prospective studies are needed to validate these findings and examine knowledge and attitude development about pain and its management. Protocols for nurse-initiated analgesia may help improve and standardize ED pain care.