Multifaceted pathogenesis of liver steatosis in inflammatory bowel disease: a systematic review.

OBJECTIVE: Non-Alcoholic Fatty Liver Disease (NAFLD), as a hepatic manifestation of metabolic syndrome (MET)-related obesity, insulin resistance, dyslipidemia, and hypertension, is the main cause of chronic liver disease. Inflammatory Bowel Diseases (IBD), (Crohn's Disease (CD) and Ulcerative Colitis (UC)), are often associated with extraintestinal manifestations. Of these, NAFLD is one of the most frequently reported. To highlight the etiopathogenesis of NAFLD in IBD, we performed a systematic review emphasizing the relationship between NAFLD genetic alterations, metabolic syndrome, and drugs. MATERIALS AND METHODS: According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement (PRISMA) criteria, we performed a systematic literature search on PubMed, Google Scholar, and Web of Science for literature updated from 2010 to 1 March 2021. Inclusion criteria for studies were observational design and Randomized Controlled Trials (RCTs); written in English; primary research only; based on adult patients, and human research only. RESULTS: We identified nine studies on the link between NAFLD and IBD. Among these, two described the genetic predisposition to NAFLD of patients with IBD. Four reported an association between MetS and NAFLD in IBD patients. Regarding medications, none of four studies included, detected a relationship between NAFLD onset and IBD treatment (corticosteroids, immunomodulators, methotrexate, or biologics).  However, a retrospective study showed a protective effect of anti-TNF alpha therapies against altered liver enzymes. CONCLUSIONS: In this interplay between genetic, metabolic, drug, and inflammatory factors, the underlying pathogenic mechanisms behind NAFLD in IBD are still far from clear. Further studies are needed to better clarify the role of individual components influencing the development of NAFLD in IBD.

Trends and characteristics associated with dietary triggers and psychological distress in patients with irritable bowel syndrome: a cross-sectional study.

OBJECTIVE: Diet, visceral sensitivity, and psychological distress play an important role in Irritable Bowel Syndrome (IBS). This study focused on the relation between IBS severity, foods, visceral sensitivity, and anxiety/depression. PATIENTS AND METHODS: Patients with IBS were investigated through (1) IBS-symptoms severity score (SSS), (2) self-reported food intolerance, (3) visceral sensitivity index (VSI), and (4) Hospital Anxiety and Depression Scale (HADS). Seventy-seven patients agreed to participate in the survey. Of them, 64 (83%) showed IBS according to Rome IV criteria and were included in the final analysis. Patients with IBS-D were 30 (47%), with IBS-C 27 (42%), and with IBS-M 7 (11%). RESULTS: Fifty-eight patients (90%) considered at least one foodstuff as IBS trigger. Amine-rich foods represented a symptom trigger for 77% of patients, those with lectin for 70%, IACs by 48%, and capsaicin by 37%. Overweight was significantly associated with amine-rich foods (p=0.015), age >45 years (p=0.001) and non-smoking condition (p=0.033) with lectin-rich foods, male gender (p=0.005) and overweight (p=0.027) with capsaicin-containing foods. A positive VSI score was found in 59% of patients, and non-smoking condition was significantly associated (OR 10.03; p=0.009). No factors were associated with a positive HADS score, shown by 80% of patients. Severe IBS was shown by 63% of patients, being amine-rich foods (p=0.024), overweight (p=0.020), and female gender (p=0.029) independent risk factors while marriage/cohabiting a protective one (p=0.038). Amine-rich foods are an independent risk factor for severe IBS, along with overweight and female gender. CONCLUSIONS: Clinicians should pay more attention to self-reported food intolerance in IBS patients. A personalized therapy including dietary advice as part of treatment could be of great benefit.

Biomass allocation and gas exchange are affected by light conditions in endangered Cedrela salvadorensis (Meliaceae) seedlings / Asignación de biomasa e intercambio de gases son afectados por las condiciones de luz en plántulas de Cedrela salvadorensis (Meliaceae) en peligro de extinción

Abstract:The determination of favorable light habitat conditions per species and life stage is transcendental, for both ex situ and in situ conservation strategies of endangered forest tree species, and for their utilization as plantation trees. This becomes especially important when planting material is scarce. We studied the multivariate responses in biomass allocation and in gas exchange to light and to CO2 in Cedrela salvadorensis seedlings, grown under similar light conditions as those this species faces in nature. During a period of 135 days, groups of ten seedlings were put under 75, 45, 15 and 3.5 % of full sun exposure obtained with neutral shade cloth, under nursery conditions. A series of biomass allocation variables and detailed gas exchange parameters (photosynthesis response curves to light and to internal carbon concentration) were measured at the end of the growth period in plants of the four treatments. According to the principal component analyses, highest values of gas exchange response were associated with the lower values of biomass allocation traits. These changes can be associated with resource-conservative and resource-acquisitive strategies, where the C. salvadorensis seedlings acclimatize their traits for the exploration and exploitation of light, to high or to dim light environment, respectively. The multivariate analyses also showed that the plants had a high performance at 45 % of light environments. These results suggest that 45 % of light environment was the optimal light habitat of this species at the tested developing stage. Our results have important implications to choose the best natural habitat for a successful establishment of C. salvadorensis. We propose practical considerations for programs of reforestation or reintroduction where this species be involved. Rev. Biol. Trop. 64 (3): 1143-1154. Epub 2016 September 01.

ResumenLa determinación de las condiciones lumínicas favorables por especie y estado de vida es trascendental para las estrategias de conservación ex situ y in situ de especies de árboles en peligro de extinción, y su utilización como plantaciones forestales. Esto se vuelve especialmente importante cuando el material de siembra es escaso. Aquí, nosotros estudiamos las respuestas en asignación de biomasa y en intercambio de gases a luz y CO2 en plántulas de Cedrela salvadorensis crecidas bajo condiciones lumínicas similares a las que esta especie enfrenta en la naturaleza. Durante 135 días, grupos de diez plántulas fueron colocadas bajo condiciones de 75, 45, 15 y 3.5 % de exposición total al sol obtenidas por medio de sarán bajo condiciones de vivero. Una serie de variables de asignación de biomasa y parámetros de intercambio de gases (fotosíntesis según curvas de respuesta a la luz y a la concentración de carbono interno) fueron medidas al final del periodo de crecimiento en las plantas de los cuatro tratamientos. De acuerdo con los análisis de componentes principales, valores altos de respuesta de intercambio de gases están asociados con valores bajos de rasgos de asignación de biomasa. Los cambios observados se encuentran asociados con las estrategias recurso-conservativas y recurso-adquisitivas donde C. salvadorensis aclimata sus rasgos para la exploración y explotación de luz en ambientes con escasa o excesiva radiación lumínica, respectivamente. Los análisis multivariados muestran también que las plantas tienen un alto rendimiento a 45 % de luz ambiental. Estos resultados sugieren que el 45 % de ambiente lumínico es el hábitat lumínico óptimo de esta especie en el estado de desarrollo estudiado. Nuestros resultados tienen importantes implicaciones para escoger el mejor hábitat natural para un exitoso establecimiento de C. salvadorensis. Por esto, proponemos consideraciones prácticas para programas de reforestación y reintroducción donde esta especie estaría involucrada.

Biomass allocation and gas exchange are affected by light conditions in endangered Cedrela salvadorensis (Meliaceae) seedlings.

The determination of favorable light habitat conditions per species and life stage is transcendental, for both ex situ and in situ conservation strategies of endangered forest tree species, and for their utilization as plantation trees. This becomes especially important when planting material is scarce. We studied the multivariate responses in biomass allocation and in gas exchange to light and to CO2 in Cedrela salvadorensis seedlings, grown under similar light conditions as those this species faces in nature. During a period of 135 days, groups of ten seedlings were put under 75, 45, 15 and 3.5 % of full sun exposure obtained with neutral shade cloth, under nursery conditions. A series of biomass allocation variables and detailed gas exchange parameters (photosynthesis response curves to light and to internal carbon concentration) were measured at the end of the growth period in plants of the four treatments. According to the principal component analyses, highest values of gas exchange response were associated with the lower values of biomass allocation traits. These changes can be associated with resource-conservative and resource-acquisitive strategies, where the C. salvadorensis seedlings acclimatize their traits for the exploration and exploitation of light, to high or to dim light environment, respectively. The multivariate analyses also showed that the plants had a high performance at 45 % of light environment. These results suggest that 45 % of light environment was the optimal light habitat of this species at the tested developing stage. Our results have important implications to choose the best natural habitat for a successful establishment of C. salvadorensis. We propose practical considerations for programs of reforestation or reintroduction where this species be involved.

Perceptions and patterns of reproductive tract infections in a young rural population in North-West Namibia.

Syndromic management of sexually transmitted diseases (STDs) is strongly promoted in Namibia. However, no data are available on rates of asymptomatic reproductive tract infections (RTIs) which would remain undetected and thus untreated in the general population. This study was aimed at assessing the prevalence of RTIs in a young rural population and to gain an insight into their health-care seeking behaviour for RTIs. A total of 97 patients (44 male, 53 female) <30 years of age attending the outpatient clinic of a rural hospital in Northern Namibia for problems unrelated to RTIs were interviewed and examined. Specimens were taken for investigation of RTIs according to a non-invasive diagnostic schedule. Laboratory examinations revealed 58 infections of the reproductive tract in 42 of the 97 patients (43%). In addition, HIV infection was detected in 13 cases (13%). RTI rates were highest in female teenagers (68%), but no infections were detected in their male counterparts. Of those 42 patients with a laboratory-diagnosed infection, 7 had both symptoms and signs (symptomatic), 16 had neither symptoms nor signs (asymptomatic), and 19 had signs on examination but no symptoms (inapparent). Awareness and perception of symptoms and signs of RTIs were low in the studied population. Provision of adequate treatment for RTIs alone is unlikely to have a major impact on the overall burden of disease since the largest burden of disease was found among those patients (predominantly females) with inapparent infections. Health education on RTIs including STDs and the symptoms they cause together with the importance of early attendance at health facilities and improved access to treatment need to be addressed urgently.

PIP: Findings are reported from a study conducted to assess the prevalence of reproductive tract infections (RTIs) in a young rural population in northern Namibia. 44 men and 53 women aged 16-29 years attending the outpatient clinic of Engela District Hospital during March-May 1997 for problems unrelated to RTIs were interviewed and examined. Specimens were taken to determine the presence of RTIs using a non-invasive diagnostic schedule. Laboratory examinations identified 58 infections of the reproductive tract in 42 of the 97 patients (43%). HIV infection was detected in 13 cases (13%). 68% of female teenagers had at least 1 RTI, while no infections were detected among male teens. Of the 42 patients with a laboratory-diagnosed infection, 7 had both symptoms and signs of infection, 16 had neither signs nor symptoms, and 19 had signs on examination but no symptoms (inapparent). The study subjects were poorly aware and poorly perceived the signs and symptoms of RTIs. Providing adequate treatment for RTIs alone will probably have no major effect upon the overall burden of disease since the largest such burden was found among those patients with inapparent infections.

Childhood acute promyelocytic leukemia in Nicaragua.

BACKGROUND: The pediatric hematology-oncology service of the Managua 'La Mascota' Children's Hospital in Nicaragua began its activities in 1988. We report on unusual high incidence of acute promyelocytic leukemia (APL) observed in Nicaragua in the last three years. PATIENTS AND METHODS: From 1990 to 1992, 17 of 110 children with acute leukemia were diagnosed as having acute non-lymphoblastic leukemia (AnLL). The diagnosis was performed according to the FAB criteria. In two cases DNA was recovered for molecular analysis of the t(15; 17). RESULTS: Ten of 17 cases of AnLL were classified as APL. PML and RAR alpha gene rearrangements were observed in the two cases where molecular analysis was performed. Nine children received chemotherapy; one was treated with all-trans-retinoic acid (ATRA), achieving complete remission. Eight children who received chemotherapy died early of hemorrhage and/or sepsis. DISCUSSION: In Nicaragua, APL may be much more common than is generally observed elsewhere. In recent years initial treatment of APL with ATRA has proved to reduce the incidence of early hemorrhagic deaths, and complete remissions can be achieved without marrow aplasia and thus prevent infectious complications. From that perspective APL might become a curable disease, also in developing countries where the treatment of AnLL is not usually affordable.

Case management of the anemic patient: epoetin alfa--focus on cognitive function.

Impaired cognitive function associated with end-stage renal disease (ESRD) can adversely affect a patient's quality of life and is only partially reversed by dialysis. Correction of anemia with Epoetin alfa improves cognitive function and other factors that affect quality of life. Thus, nephrology nurses can improve their patients' quality of life by ensuring adequate dosing of Epoetin alfa so that anemia is corrected and cognitive function benefits are achieved. In addition, a knowledge of how cognitive function is evaluated helps nurses analyze research studies related to this area.

Current trends in diet and drug therapy for the dialysis patient.

It is virtually impossible to discuss diet and drug therapy separately in the treatment of the hemodialysis patient. Drugs and dialysis techniques often necessitate changes in dietary care, just as dietary indiscretions call for changes in drug therapy and dialysis. In order to coordinate the various facets when ordering diets, several factors must be considered. The physician plans the drug therapy with input from the dialysis nurses, especially for dialysis effects on salt, water, K+, and protein balance, and the dietitian coordinates the diet with drug and dialysis therapy. It is therefore essential that all personnel must interact as a team if the patient is to receive the maximum benefit of hemodialysis. To maintain this delicate, constantly changing approach, a balance of teamwork is essential.