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Background: Celiac disease, a gluten-triggered autoimmune disorder, is known for its systemic inflammatory effects. Its genetic associations with type 2 inflammatory diseases like asthma, allergic rhinitis, and atopic dermatitis remain unclear, prompting this study to explore their potential genetic interplay. Methods: Utilizing two-sample Mendelian randomization (TSMR), we examined the genetic associations using 15 genetic instruments from GWAS datasets. Our analysis focused on celiac disease and its relation to asthma, allergic rhinitis, atopic dermatitis, and IgE-mediated food allergies. A power analysis was conducted to determine the study's detection capabilities, and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using various MR methods. Results: Our Mendelian randomization analysis identified statistically significant genetic associations between celiac disease and several type 2 inflammatory diseases, although these were practically insignificant. Specifically, celiac disease was associated with a slight increase in the risk of atopic dermatitis (OR = 1.037) and a minor protective effect against asthma (OR = 0.97). The link with allergic rhinitis was statistically detectable (OR = 1.002) but practically negligible. Despite robust statistical confirmation through various sensitivity analyses, all observed effects remained within the range of practical equivalence (ROPE). Conclusions: Our study identifies potential genetic associations between celiac disease and certain type 2 inflammatory diseases. However, these associations, predominantly within the ROPE range, suggest only limited clinical implications. These findings highlight the need for cautious interpretation and indicate that further exploration for clinical applications may not be warranted at this stage.
RESUMO
PURPOSE: To compare the efficacy of fixed-time-interval oral analgesia and spinal-morphine for management of post-Cesarean pain. METHODS: In this open-label, parallel-group, randomized, controlled trial, 200 women due to undergo elective Caesarean section with spinal anaesthesia were enrolled between July 2015 and April 2016. Patients were randomly assigned to receive either spinal fentanyl followed by oral doses of tramadol, paracetamol, and diclofenac at predetermined regular intervals of 6 h for the first 48 h, and rescue treatment with percocet (oxycodone and paracetamol; oral analgesia group), or spinal morphine and rescue treatment with oral tramadol, paracetamol, and diclofenac (spinal-morphine group). The primary outcomes were pain intensity during the postoperative 48 h, measured on a 10-point numeric rating scale (NRS) and expressed as area under the curve (AUC), and the number of breakthrough events of moderate to severe pain (defined as NRS score ≥ 4). RESULTS: The oral analgesia group compared to the spinal-morphine group had similar mean pain intensity (AUC (120 ± 35 versus 121 ± 31, respectively; p = 0.8) but more events of moderate-to-severe breakthrough pain (4.8 ± 2 versus 3.8 ± 1.7, respectively; p = 0.0002). Higher rates and longer durations of pruritus, nausea, and vomiting were reported among patients receiving spinal morphine, as compared with oral analgesia. Satisfaction scores were high in both groups (8.2 ± 2.4 versus 8.7 ± 1.8 in the oral analgesia and spinal morphine, respectively; p = 0.23). CONCLUSIONS: Both oral analgesia at fixed time intervals and spinal morphine are satisfactory methods for treating post-Caesarean pain. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02440399, date of registration: 07/05/ 2015. URL: https://clinicaltrials.gov/ct2/show/NCT02440399?term=enav+yefet&rank=7 .