The Young Adult Male's Perception of Life with Inflammatory Bowel Disease and a Stoma: A Qualitative Examination.

While the experiences of young adults with inflammatory bowel disease (IBD) and a resultant stoma have been investigated in the USA, there is a paucity of such qualitative research in Europe. In Ireland, the voices of this patient cohort have remained remarkably silent. The purpose of this study was to achieve an understanding of the lived experience as depicted by young adults with IBD and a stoma. Purposive sampling was employed. Those with a histological diagnosis of IBD and a consequential stoma within the last 12 months were approached via a letter of invitation. Of those approached, 5 male patients aged 20-30 years agreed to participate. A qualitative approach was adopted comprising a single, detailed semi-structured interview with each of the participants. Verbatim transcripts of these interviews and associated field notes were analysed using interpretative phenomenological analysis methodology. Five superordinate themes emerged from the analysis: (1) Control, (2) Secrecy, (3) Patient education and support services, (4) Difficult emotions, (5) Acceptance and growth. A universal struggle to preserve autonomy of bodily function, emotions and healthcare decisions existed among participants. Participants embraced the predictability of their stoma relative to the restraints imposed on them by their erratic pre-operative bowel habit. Moreover, participants also reinforced the importance of timely patient education in the peri-operative period to limit uncertainty and distress. This study provides a unique insight into the lived experience of young adult males with IBD and a stoma and in particular provides a greater understanding of the peri-operative education requirements of this patient cohort.

Tracheobronchitis in ulcerative colitis: a case report of therapeutic response with infliximab and review of the literature.

BACKGROUND: The extra-intestinal manifestation of tracheobronchitis is a rare complication of ulcerative colitis (UC). Here, we present a case of UC-related tracheobronchitis wherein the positive clinical effects of infliximab are demonstrated. CASE PRESENTATION: We report the case of a 39-year old woman who presented with a chronic productive cough on a distant background of surgically managed ulcerative colitis (UC). Our patient failed to achieve a satisfactory clinical improvement despite treatment with high dose inhaled corticosteroids, oral corticosteroids and azathioprine. Infliximab therapy was commenced and was demonstrated to achieve macroscopic and symptomatic remission of disease. CONCLUSIONS: We present the first case report documenting the benefits of infliximab in UC-related tracheobronchitis.

Pre-exposure prophylaxis for HIV prevention during pregnancy and lactation: forget not the women and children.

Pregnancy is known to be a time of increased susceptibility to acquiring to human immunodeficiency virus (HIV) infection and this increased maternal risk places the unborn child at risk of vertical transmission. Pre-exposure prophylaxis (PrEP) involves the provision of antiretroviral therapy to an HIV-negative individual with ongoing risk of HIV exposure to limit the likelihood of HIV transmission. The inclusion of PrEP as part of a comprehensive strategy is recognised as an effective and safe means of reducing HIV infection in serodiscordant couples, thereby reducing the risk of vertical transmission of HIV. Current data suggest that PrEP is safe to continue during pregnancy and breastfeeding in HIV-negative women who remain vulnerable to acquiring HIV. The recent Pharmaceutical Benefits Scheme subsidisation of PrEP has reduced the financial and practical obstacles of PrEP provision, and a subsequent increase in patient awareness and acceptance of PrEP is expected. The framework for appropriately identifying and managing at-risk pregnant and lactating women requiring PrEP is poorly defined and warrants further clarification to better support clinicians and this patient group. This review discusses the current recommendations highlighting the gaps in the guidelines and makes some recommendations for future guideline development.