Ultrasonographic scores for ileal Crohn's disease assessment: Better, worse or the same as contrast-enhanced ultrasound?

BACKGROUND: Intestinal ultrasound (IUS) is an increasingly used non-invasive tool to evaluate Crohn's disease (CD) activity. Recently, two IUS scores that evaluate inflammatory activity have emerged: the Simple Ultrasound Activity Score for CD (SUS-CD) and the International Bowel Ultrasound Segmental Activity Score (IBUS-SAS). We aimed to compare the accuracy of SUS-CD, IBUS-SAS and contrast-enhanced ultrasound (CEUS) in predicting inflammatory activity in the terminal ileum in ileocolonoscopy in CD patients. METHODS: Retrospective study including all consecutive CD patients submitted to IUS with CEUS directed to the terminal ileum performed by a single operator between April 2016 and March 2020. Segmental SUS-CD and IBUS-SAS were calculated. A time-intensity curve of the contrast bowel wall enhancement was created with measurement of peak intensity using CEUS. The CD endoscopic activity in ileocolonoscopy was graded by Simple Endoscopic Score for CD (SES-CD) as inactive (SES-CD < 7) or active (SES-CD ≥ 7). RESULTS: Fifty patients were included, 54.0% were female, with mean age of 34 ± 12 years, and most had isolated ileal disease (60.0%), and a nonstricturing, nonpenetrating behaviour (44.0%). Most of the patients (60.0%) had active endoscopic disease (SES-CD ≥ 7). SUS-CD and IBUS-SAS were not different between patients with active or inactive endoscopic disease (p = 0.15; 0.57, respectively), having a poor accuracy to correlate endoscopic activity (area under de curve (AUC) 0.62; 0.55, respectively). Peak intensity in CEUS was significantly different in patients with active or inactive endoscopic disease (p = 0.004), having a good accuracy to correlate endoscopic activity (AUC 0.80). CONCLUSION: Unlike CEUS, SUS-CD and IBUS-SAS were not able to accurately correlate endoscopic activity in terminal ileum in CD. Therefore, CEUS is a non-invasive emerging method that should be increasingly integrated in the ultrasonographic evaluation of CD patients.

Bowel preparation for small bowel capsule endoscopy - The later, the better!

BACKGROUND: In small bowel capsule endoscopy (SBCE), the presence of residue may compromise diagnostic accuracy. AIMS: To assess differences in quality of visualisation and diagnostic yield of SBCE using 3 different preparation protocols. METHODS: Prospective, randomized, blind, pilot study. Protocol A:Clear liquids diet the day before the examination with fasting from 8p.m.; Protocol B:Protocol A + 2 pouches of Moviprep®(polyethylene glycol electrolyte solution + sodium ascorbate) in 1 L of water from 8p.m. of the day before the examination; Protocol C: Protocol A + 2 pouches of Moviprep® in 1 L of water consumed after real-time confirmation of capsule arrival at small bowel. Small bowel preparation was classified by two experienced physicians, considering the percentage of the examination during which mucosal observation was adequate: Excellent(>90%); Good(90-75%); Fair(75-50%); Poor(<50%). RESULTS: 101 patients randomized to the 3 protocols (A 37, B 31, C 33 patients). Protocol C had an excellent/good small bowel preparation in a higher percentage of examinations for both readers(Reader 1-A:37.8% vs B:45.2% vs C:78.8%, p = 0.002 and Reader 2 -A:37.8% vs B:41.9% vs C:75.8%, p = 0.003). Also, protocol C had a higher detection of angioectasia (A:5.4% vs B:9.7% vs C:27.3%, p = 0.022). CONCLUSIONS: The administration of Moviprep® after the capsule had reached the small bowel was associated with a better small bowel preparation and a higher detection of angioectasia.

First Report of Sclerotium rolfsii in Greater Plantain in Paraná, Brazil.

Greater plantain or common plantain (Plantago major L.) is an herbaceous plant native to most of Europe, northern and central Asia, and it has adapted well to tropical regions where it is used as a medicinal plant. Between November 2011 and April 2012, greater plantains cultivated in the Medicinal Plant Garden at the Umuarama Advanced Campus of the State University of Maringa (UEM-CAU) suddenly died off. A visual examination revealed the presence of white mycelium and sclerotia on the lower third of the plant. These sclerotia were collected and deinfested by immersion in 70% alcohol and 0.5% sodium hypochlorite for 45 s, and in sterilized water for 1 min. Next, the sclerotia were placed on 10 petri dishes containing potato dextrose agar (PDA) culture medium and incubated at 29°C. After 7 days, the culture medium was entirely coated with a cottony white mycelial growth and, 15 days after isolation, sclerotia began to form. Healthy seedlings were transplanted individually into pots containing autoclaved soil (120°C/2 h). After 10 days, eight seedlings were inoculated with 8-mm mycelia disks deposited on the base of the plant, and eight seedlings inoculated with fungus-free PDA disks (control). The plants were irrigated and the pots placed in with plastic bags and kept at an average temperature of 28°C. Three days after inoculation, we observed a cottony white mycelial growth and symptoms of rot on the plants. The plastic bags were then removed and the plants kept under the same temperature, relative humidity of 80% and 12 h of light. Seven days after inoculation, the plants treated with the fungus died, whereas the plants treated with PDA developed normally. The fungus was re-isolated from the symptomatic plants and slides evaluated under a light microscope, revealing that the mycelium was thick, septate, and hyaline. The sclerotia formed were spherical, initially white or light brown, becoming dark brown or black, with diameters ranging from 0.5 to 1.5 mm. The fungus was subjected to DNA analysis using ribosomal region oligonucleotides ITS4 (5'-TCCTCCGCTTATTGATAT-3') and ITS5 (5'-GGAAGTAAAAGTCGTAACAAGG-3') (1) to amplify the target region. The segment including the 5.8S gene and rDNa regions ITS1 and ITS2 was 630 bp long. DNA analysis revealed that it was 99% identical to Athelia rolfsii (Curzi) Tu and Kimbr (anamorph: S. rolfsii) (GenBank Accession No. HM222638.1). The isolate was deposited in the fungus collection at the UEM-CAU Phytopathology Laboratory under code F-Sr-01-UMU. Reference: (1) T. J. White et al. Page 315 in: PCR Protocols: A Guide to Methods and Applications, M. A. Innis et al., eds. Academic Press, San Diego, CA, 1990.