ADIPONECTIN LEVELS IN GRAVES' DISEASE - SYSTEMATIC REVIEW AND META-ANALYSIS.

Context: Graves' disease is the most prevalent cause of hyperthyroidism worldwide. Adiponectin, the most abundant adipokine, plays a significant role in a cluster of prevalent diseases connected to metabolic disorders. Objective: Although the association between adiponectin and Graves' disease has been studied, the existing data is inconsistent. Therefore, we conducted this systematic review and meta-analysis to evaluate the relationship between adiponectin levels and Graves' disease. Methods: We performed a systematic electronic search on PubMed, EMBASE, Scopus and Cochrane Library using predefined keywords. We used the NHLBI quality assessment tools to assess the included studies. Results: There were 11 studies involving 781 subjects included in our qualitative synthesis, while 6 studies were included in our quantitative synthesis. We observed significantly increased adiponectin levels in Graves' disease patients compared to controls (MD 2.983 [95% CI 0.138-5.828]) and hypothyroidism patients (MD 3.389 [95% CI 1.332-5.446]). Nevertheless, no significant MD was observed when comparing Graves' disease patients with and without Graves' ophthalmopathy (MD -27.124 [95% CI -88.893 - 34.645]). Conclusions: Adiponectin levels were significantly higher in patients with Graves' disease compared to controls and hypothyroidism patients. However, patients with and without Graves' ophthalmopathy did not present a significant mean difference in adiponectin levels.

Assessing the conceptual model of the Oral Health Impact Profile-49 (OHIP-49): A path analysis.

OBJECTIVE: To assess the fit between of the Romanian version of the Oral Health Impact Profile (OHIP-49) and Locker's conceptual model of oral health. BASIC RESEARCH DESIGN: Cross-sectional interview study. CLINICAL SETTING: Convenience sample of hospitalized internal medicine patients, in Cluj-Napoca, Romania. PARTICIPANTS: 340 participants (40% male), divided in two samples, sample N1 = 165 to analyse the theoretical model, and a cross-validation sample, N2 = 175. MAIN OUTCOME MEASURES: Path-analysis was used to assess the fit between the conceptual model proposed by Locker, and the data. RESULTS: Initial results showed an unsatisfactory fit to the data: χ² = 43.8 (df = 5, p = 0.001), χ² was found to be significant; GFI = 0.932, CFI = 0.948, TLI = 0.782, these indices presented values lower than 0.95, while SRMR = 0.053 and RMSEA = 0.22 (90% CI 0.16 - 0.28) were situated above the accepted threshold. Evaluation of the residual matrix and the modification indices lead to the respecification of the first model, obtaining an better fit of the second model: χ² = 17.63 (df = 9, p = 0.04), while GFI = 0.972, CFI = 0.988, TLI = 0.973, were above the threshold and SRMR = 0.036 and RMSEA = 0.07 (90% CI 0.02 - 0.12). CONCLUSIONS: The current study indicates that OHIP-49 represents an acceptable operationalization of the Oral Health related Quality of Life, as it was conceptualized by Locker's theoretical model.

GASTROINTESTINAL MOTILITY DISORDERS IN OBESITY.

The gastrointestinal (GI) motility, which is important for the digestion and absorption, may be altered in obesity. The aim of this review is to present the GI motility changes occurring in obesity, as well as their underlying mechanisms. We have conducted a systematic review of the published literature concerning GI motility and obesity and have described recent published data on the changes throughout the entire GI tract. Most recent discoveries include evidence supporting the increase of gastroesophageal reflux disease in obesity and inhibition of gastric motility. Intestinal transit of the distal small bowel generally slows down, ensuring enough time for digestion and absorption. Constipation is more frequent in obese patients than in those with a normal weight. The gut-brain axis plays an important role in the pathophysiology of GI motility disorders in obesity. This bidirectional communication is achieved by way of neurons, hormones, metabolites derived from intestinal microbiota and cytokines. The molecular mechanisms of GI motility changes in obesity are complex. Current data offer a starting point for further research needed to clarify the association of obesity with GI motility disorders.

Therapy of the postinfectious irritable bowel syndrome: an update.

After acute infectious gastroenteritis, up to thirty percent of patients present prolonged gastrointestinal symptoms and a part of those affected patients can have the diagnostic criteria for postinfectious irritable bowel syndrome. Treatment is symptom directed rather than curative and includes agents prescribed for the treatment of irritable bowel syndrome in general. Prophylaxis or early treatment of acute bacterial diarrhea may reduce the risk of postinfectious irritable bowel syndrome development by reducing the occurrence, duration, and severity of the chronic inflammation and mucosal alterations (all these believed to play an important role in disease persistence). Probiotic treatment is effective in restoring the intestinal microbiota in patients with irritable bowel syndrome and in animal models there are improvements of postinfectious irritable bowel syndrome. Fecal microbiota transplantation seems to be one of the most effective methods of treating the postinfectious irritable bowel syndrome (with recurrent episodes) caused by Clostridium difficile.

Helicobacter pylori Infection, Gastric Cancer and Gastropanel.

Gastric cancer (GC) is one of the most widespread types of cancer worldwide. Helicobacter pylori infection has been clearly correlated with gastric carcinogenesis. At present and in the near future, the most important challenge is and will be the significant reduction of mortality due to GC. That goal can be achieved through the identification of higher-risk patients, such as those with atrophic gastritis, intestinal metaplasia and dysplasia. In this review we intend to discuss the importance of diagnosing H. pylori infection and chronic atrophic gastritis in preventing gastric cancer, using a new non-invasive test called GastroPanel. This test is a classification algorithm including four biochemical parameters pepsinogen I and II (PGI and PGII), gastrin-17 (G17), and anti-Helicobacter pylori antibodies (Ig G anti-Hp) measured in fasting sera, which allows to classify patients as having atrophic or non-atrophic gastritis and to find whether gastritis is associated or not with H. pylori infection. GastroPanel is not a "cancer test", but it can and should be used in the screening and diagnosis of subjects with a high cancer risk; still, a careful diagnostic made by superior digestive endoscopy is compulsory to find possible precancerous or cancerous lesions at an early and curable stage.

Psychological factors associated with NAFLD/NASH: a systematic review.

OBJECTIVE: Nonalcoholic fatty liver disease (NAFLD) represents one of the most common chronic liver diseases worldwide. So far, the pathogenesis of NAFLD and its more severe variant nonalcoholic steatohepatitis (NASH) is yet unclear, with many mechanisms being proposed as possible causes. This article aims to review the psychological factors associated with NAFLD/NASH. MATERIALS AND METHODS: Three main categories of factors have been investigated: emotional, cognitive and behavioral. Five electronic databases were searched, limited to studies published in the English language, during the period 2005-2015: PubMed, Thomson ISI - Web of Science, Scopus, ProQuest, and ScienceDirect. RESULTS: Results indicated the most relevant emotional factors to be depression and anxiety. The areas of investigation for cognitive functioning concern those contents and processes related to the ability to initiate and maintain lifestyle changes. The most important behavioral factors identified are physical activity, nutrition/food intake and substance consumption: coffee, alcohol, cigarettes. CONCLUSIONS: Some of the factors identified act as protective factors, other as vulnerability factors. NAFLD/NASH may be considered a cognitive-behavioral disease, the most effective management being lifestyle changes, with emphasis on diet and exercise.

Pathogenic Factors in Postinfectious Irritable Bowel Syndrome - An Update.

After acute infectious gastroenteritis, up to thirty percent of patients present prolonged gastrointestinal symptoms and a part of those affected patients can have the diagnostic criteria for postinfectious irritable bowel syndrome. The main diagnosis of a patient with postinfectious irritable bowel syndrome was till this summer, clinically based on Roma III criteria. The Rome IV criteria brought some changes that involve also the post infectious irritable bowel syndrome, recognizing further the postinfectious IBS as a specific entity according to the multidimensional clinical chronic mucosal inflammation triggered by enteric infection, may underlie persistent bowel symptoms in patients who develop postinfectious irritable bowel syndrome.

IMPLICATION OF GUT MICROBIOTA IN DIABETES MELLITUS AND OBESITY.

BACKGROUND AND AIMS: Differences in the composition of the species of microorganisms in the gut may predict the evolution toward obesity and diabetes mellitus. We carried out a systematic review of the studies dedicated to the role of gut microbiota in diabetes mellitus and obesity. METHODS: A systematic literature search of electronic databases was performed, using the search syntax: "Gut microbiota and diabetes and obesity"; abstracts in English, with data about mechanisms of pathogenesis and treatment options by changing the gut composition were included (259 articles). Studies were excluded if they did not have an abstract, or they contained no data about the exact implication mechanism of microbiota. RESULTS: There are differences regarding the composition of the gut microbiota in healthy people and type 2 diabetes mellitus patients; the later proved to have significantly decreased Clostridium components, and increased Lactobacillus and Bifidobacterium populations.The intestines of obese subjects are less rich in microbial genes, have a reduced amount of Bacteroidetes and an increased amount of Firmicutes. Fecal microbiota transplantation from obese subjects resulted in adoption of the donor somatotype. Early differences in gut microbiota composition (higher number of Bifidobacteria) function as diagnostic markers for the development of type 2 diabetes mellitus in high-risk patients.The gut endotoxins contribute to metabolic syndrome manifestation. Experimental studies with prebiotic showed lower levels of cytokines and antiobesity potential. CONCLUSION: Microbiota composition and its changes since childhood have an important role in the metabolic syndrome. Any intervention in order to prevent or treat obesity and diabetes mellitus should have as target the gut immune system.

An investigation of the concomitant use of angiotensin-converting enzyme inhibitors, non-steroidal anti-inflammatory drugs and diuretics.

OBJECTIVE: To determine in retrospective data the prevalence at hospital discharge of co-prescribing angiotensin-converting enzyme inhibitors (ACE-I) and non-steroidal anti-inflammatory drugs (NSAIDs) and ACE-I/NSAIDs and diuretics and to identify factors associated with the co-prescription. Secondary, we evaluated the extent of serum creatinine and potassium monitoring in patients treated with ACE-I and these associations and determined the prevalence of values above the upper normal limit (UNL) in monitored patients. PATIENTS AND METHODS: Hospitalized patients with ACE-I in their therapy at discharge were included in 3 groups as follows: ACE-I, DT (double therapy with ACE-I and NSAIDs) and TT (triple therapy with ACE-I, NSAIDs and diuretics) groups. We evaluated differences on demographic characteristics, co-morbidities, medications, laboratory monitoring and quantified the patients with serum creatinine and potassium levels above the UNL using descriptive statistics. Logistic regression analysis with backward elimination was performed to identify significant predictors of combination therapy. RESULTS: Of 9960 admitted patients, 1214 were prescribed ACE-I, 40 were prescribed ACE-I/NSAIDs and 22 were prescribed ACE-I/NSAIDs/diuretics (3.13% and 1.72%, respectively, of the patients prescribed with ACE-I). Serum creatinine and potassium were monitored for the great majority of patients from all groups. The highest percentage of hyperkalemia was found in the DT group (10% of the patients) and of serum creatinine above UNL in the TT group (45.45%). The logistic regression final model showed that younger patients and monitoring for potassium were significantly associated with combination therapy. CONCLUSIONS: The prevalence of patients receiving DT/TT was relatively low and their monitoring during hospitalization was high. Factors associated with the combinations were younger patients and patients not tested for serum potassium.

Evolution of Psychosomatic Diagnosis in DSM. Historical Perspectives and New Development for Internists.

The so-called "Psychosomatic symptoms" represent a real challenge for internists. These have often been described as non-specific, non-organic, functional, dysfunctional or idiopathic. These "diagnostic puzzles" are obviously difficult to treat. Psychosomatic symptoms have been categorized as hysteria, psychogenic, psychosomatic, conversion, somatization and somatoform disorder. It is only when modern classificatory systems such as the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD) were developed that research was stimulated and new clinical developments became much stronger than any other time. The current paper is aimed at briefly presenting the evolution of psychosomatic symptoms in DSM while pointing out the major milestones as well as the benefits and challenges along the way. We discuss the perspectives open with the advent of the 5th edition the DSM-V.

Four years Follow-up of Patients with Irritable Bowel Syndrome.

UNLABELLED: There is little data on the long term evolution of patients with irritable bowel syndrome (IBS) and of associated conditions. We therefore studied the evolution of IBS patients in a single tertiary center during a long interval of time. METHODS: We carried out a retrospective study based on the survey of patients records. We analyzed the records of symptoms, therapy, associated diseases, as consigned at follow-up visits for an interval of 4 years in average (2008-2011). RESULTS: A cohort of 114 patients with IBS diagnosed based on Rome III criteria were included (29 men and 85 women), age 19-85 years (mean age: 43.45 years). Urban patients were predominant. The main three symptoms were: abdominal pain, bowel disorders (constipation, diarrhea) and bloating. IBS--constipation (IBS--C) is associated with a favorable course of symptoms (increasing the number of stools, decrease intensity of abdominal pain and bloating) after treatment and IBS--diarrhea (IBS--D) is associated with variable symptoms after treatment (p = 0.031). Using trimebutin or mebeverin in association with other drugs for one month correlates with a favorable evolution of symptoms after treatment and monotherapy is associated with fluctuating symptoms ( p< 0.001). Favorable symptoms are associated with the use of probiotics in combination, but not in monotherapy (p< 0.001). Favorable evolution of symptoms is also associated with the use of anxiolytics in combination. Persistence of symptoms after treatment was correlated with the presence or absence of depression. The absence of depression was correlated with a favorable evolution of symptoms (p = 0.005). IBS-C is associated at limit (marginal significance) with hemorrhoidal disease (p = 0.56). 33 patients (29%)--received monotherapy (trimebutin or mebeverin or probiotics); 81 patients (71%)--received combined therapy: (trimebutin or mebeverin or probiotics) + anxiolytics or proton pump inhibitors (PPI) or nonsteroidal anti-inflammatory (NSAI) or spasmolytics. The most common associated diseases observed in patients with IBS were: depression (27.19%), dyslipidemia (25.43%), hemorrhoidal disease (22.80%) and fibromyalgia (21%). CONCLUSIONS: The highest response rate was obtained with trimebutin or mebeverin + anxiolitics + probiotics. The most frequent disease associated with IBS was depression. Other diseases with a high incidence: dyslipidemia, hemorrhoidal disease and fibromyalgia. Further studies are needed to analyze the link between IBS and some associated diseases.

Irritable Bowel Syndrome and the Small Intestinal Microflora. What Do We Know?

Irritable bowel syndrome, one of the most common functional gastro intestinal disorders all over the world is considered to have a multi factorial pathogenesis. Recently more and more studies are focusing on the changes that take place in the microbiota of patients with irritable bowel syndrome, underlining the bacterial role in this pathogenesis. As a consequence, bacterial overgrowth, along with intestinal dysmotility, altered brain-gut axis and genetic factors are considered part of this pathophysiology. This report intends to summarize the actual knowledge on irritable bowel syndrome and small intestinal bacterial overgrowth syndrome, from details on the epidemiology, clinical manifestation, pathophysiology, diagnosis, treatment to details on the relationship between these two syndromes.

Drug-drug Interactions of Statins Potentially Leading to Muscle-Related Side Effects in Hospitalized Patients.

INTRODUCTION: The associations of drugs that may interact with the statins resulting in elevated serum concentration of the statins are an important risk factor for statin induced muscle disorders. We aimed to determine the prevalence of these associations in all hospitalized patients that had been prescribed statins before/during hospitalization and to find out how often they are associated with muscle-related side effects. METHODS: This prospective, non-interventional study performed in two internal medicine departments included patients with statin therapy before/during hospitalization. Data on each patient demographic characteristics, co-morbidities and treatment was collected from medical charts and interviews. We evaluated patients' therapy for the targeted associations using Thomson Micromedex Drug Interactions checker and we ranked the identified drug-drug interactions (DDIs) accordingly. Each patient with statin treatment before admission was additionally interviewed in order to identify muscular symptoms. RESULTS: In 109 patients on statin treatment we found 35 potential (p) DDIs of statins in 30 (27.5%) patients, most of which were in the therapy before admission (27 pDDIs). The pDDIs were moderate (20 pDDIs) and major (15 pDDIs). Of the total number of pDDIs, 24 were targeting the muscular system. The drugs most frequently involved in the statins' pDDIs were amiodarone and fenofibrate. Two of the patients with pDDIs reported muscle pain, both having additional risk factors for statin induced muscular effects. CONCLUSION: The prevalence of statins' pDDIs was high in our study, mostly in the therapy before admission, with only a small number of pDDIs resulting in clinical outcome.

Small intestinal bacterial overgrowth is associated to symptoms in irritable bowel syndrome. Evidence from a multicentre study in Romania.

BACKGROUND AND AIMS: Small intestinal bacterial overgrowth (SIBO) is involved in the pathogenesis of irritable bowel syndrome (IBS). It has been suggested that by treating SIBO in IBS, symptoms may be improved. The aim of this study was to evaluate the prevalence of SIBO in patients with IBS compared with healthy volunteers (HV), to assess the effect of an intestinal antibiotic in eradicating SIBO and on the symptoms, in patients with IBS. METHODS: Design: a cross-sectional multicentre study with cohort comparison performed in 6 medical centers from Romania. 331 consecutive patients diagnosed with IBS according to Rome III criteria and 105 HV were screened for SIBO using glucose hydrogen breath test (GHBT). Positive patients received 7 days therapy with the antibiotic rifaximin 1200 mg/day and were retested 1 week after completing the treatment. The IBS symptoms were assessed before and after treatment. The group was controlled with 20 age and sex matched IBS patients who did not receive any antibiotic therapy for their condition (control patients). RESULTS: SIBO was found in 105 patients with IBS (31.7%) and in 7 HV (6.6%) (OR= 6.5, p < 0.0001). Patients with IBS have been classified according to Rome III criteria into 4 groups: IBS-constipation, IBS-diarrhea, IBS-mixed (alternation of constipation/and diarrhea) and IBS-unclassified. Diarrhea and mixed symptoms were found to be predictive for SIBO (OR= 2.5 for IBS-diarrhea and OR = 2.23 for mixed). Among patients with SIBO, 85.5% were found negative after treatment (p = 0.0026). SIBO patients showed an important relief of their symptoms, with complete improvement in 46.6% and partial in 31.4%. CONCLUSIONS: This study is the first to estimate the prevalence of SIBO in ibs patients from Romania (31.7%). SIBO was present in nearly half of the IBS-D patients (45.7%). Rifaximin is effective in treating SIBO in IBS patients and controlled trials are warranted.

Histopathological features of canine spontaneous non-neoplastic gastric polyps - a retrospective study of 15 cases.

Fifteen cases of canine gastric polyps, collected over a 4-year period, were investigated using gross inspection, histological procedures and immunohistochemical techniques for Helicobacter infection. No breed or sex predisposition was found for gastric polyps, although they occurred mainly in elderly animals. There were 9 pedunculated and 6 sessile polypoid growths, between 5 to 30 mm in diameter developed mainly in the pyloric region of the stomach. The most common type of gastric polyps was the hyperplastic one. The inflammatory type was identified in three cases. Foci of AB/PAS Goblet positive cells resembling intestinal metaplasia, mild dysplasia of gastric epithelium, well delimited calcified areas, islands of osteoid matrix and nematodes were present in some of these lesions. Histological examination of the adjacent gastric polyp (surrounding gastric mucosa) revealed a severe chronic inflammation in 13 cases and a high grade of Helicobacter species colonization in all cases, but Kendall test analysis showed no correlation between Helicobacter spp. colonization degree and gastritis scores (τ = 0289; p = 0.204). A significant correlation was found between Helicobacter spp. location and gastritis scores (τ = 0.497; p = 0.035). Immunohistochemistry performed with a polyclonal antibody confirmed Helicobacter spp. infection in all cases. Based on their morphology, Helicobacter pylori - like organisms were described in 3 of 15 cases. No high degree of dysplasia nor neoplasia were identified in these lesions. The etiology and pathogenesis of gastric polyps in dogs are still unknown, although a severe chronic antral gastritis may be a predisposing condition for development of gastric polyps in dogs.

Small intestinal bacterial overgrowth produces symptoms in irritable bowel syndrome which are improved by rifaximin. A pilot study.

AIM: Searching for the role of small intestinal bacterial overgrowth (SIBO) in the pathogenesis of mechanisms and symptoms in patients with irritable bowel syndrome (IBS). METHOD: 72 patients with IBS according to Rome III criteria were screened for proximal small intestinal bacterial overgrowth by glucose hydrogen breath test (GHBT). Positive patients received a 14 day therapy with the antibiotic rifaximin 1200 mg/day and were retested 1 week after completing the treatment. RESULTS: SIBO was found in 8 patients out of 72 (11.1%) All patients receiving rifaximin according to an open label protocol and retested 1 week after the end of treatment were found negative for SIBO 85.7% . Simultaneously the symptoms of IBS improved, according to the measurement by a Likert scale. Patients with IBS-D had a 5.6 RR of presenting SIBO than non IBS-D. CONCLUSIONS: Rifaximin effectively normalized the GHBT and reduced the IBS symptoms by possibly counteracting the SIBO. Whether such therapeutic approach is ultimately associated with symptom improvement in the long term, however, requires additional studies.

The use of complementary and alternative therapies and of psychotherapy by Romanian patients with irritable bowel syndrome.

UNLABELLED: Irritable bowel syndrome (IBS) is an invalidating condition, lacking a perfect therapy. Therefore, many patients use also complementary and alternative therapies (CAT) or psychotherapy (PT). There are no data on the use of CAT and PT in IBS in our area. We looked for this until uncovered aspect of IBS management in Romania. MATERIAL AND METHODS: 250 consecutive patients with IBS (142 F/108M, aged 49 +/- 12 years) referred to a tertiary gastroenterological center were questioned about the use of CAT and PT using a structured specially developed questionnaire. All of the patients accepted to answer the questionnaire after careful instruction. RESULTS: 162 out of 250 pts (64%) admitted to have used one or more CAT, usually together with pharmacological prescriptions. Among CAT users, 32 patients (20%) used only CAT and not allopathic drugs. CAT used were: homeopathy 13%, herbal therapy 72%, acupuncture 3%, bioenergetic resonance 11%, others 13%. Probiotics were used by 30%. Users were mainly females of lower educational levels. Psychotherapy was used by 30 pts (12%). 25 (10%) used CBT, 15 (6%) used relaxation therapy. CONCLUSION: The majority of IBS pts. in our area use CAT usually in association with allopathic therapy. The most frequently used are herbal prescriptions followed by probiotics. PT less frequently used in our IBS patients.

Do antioxidants prevent colorectal cancer? A meta-analysis.

BACKGROUND: Oxidative stress is the first step involved in mutagenesis, carcinogenesis and aging. There has been great interest in recent years in potentially health benefits of dietary and antioxidant supplements in cancer prevention. OBJECTIVES: Our primary objectives were to estimate the global effect of antioxidants on colorectal cancer incidence, adenomatous polyp recurrence, overall mortality and cancer related mortality. A secondary aim was to evaluate these effects across specific antioxidant compounds, dose and duration of antioxidant supplementation. METHODS: Using Cochrane Collaboration methodology we searched for all randomized controlled trials (RCTs) from 1966 till May 2009 (MEDLINE, Cochrane Controlled Clinical Trials Registry), comparing antioxidant supplements with placebo or no intervention on the occurrence of colorectal cancer or adenoma. The results expressed as relative risk (RR) and 95% confidence intervals (95% CI) were obtained using random and fixed effect meta-analysis. RESULTS: Twenty RCTs, including 26 8590 participants, were eligible: 12 analyzing the colorectal cancer incidence included 25 0676 participants and 8 analyzing colorectal adenoma recurrence included 17914 participants. Antioxidant supplements had no significant effect on colorectal cancer incidence or colorectal adenoma recurrence (RR = 0. 94, 95% CI, 0.84-1.06, p = 0.32) in a random-effect meta-analysis. The antioxidant supplements had no significant effect on overall mortality (RR = 1.03, 95% CI, 0.99-1.07, p = 0.12) or cancer related mortality (RR = 1.05, 95% CI, 0.94-1.16, p = 0.38) in a random effect meta-analysis. Selenium supplementation was associated with a trend in reducing colorectal cancer incidence, (RR = 0.88, 95% CI, 0.55-1.40, p = 0.59), colorectal adenoma recurrence (RR = 0.70, 95% CI, 0.43-1.14, p = 0.16) and overall mortality (RR = 0.91, 95% CI, 0.82-1.02, p = 0.09). Beta carotene alone was associated with a slight increase in colorectal cancer incidence (RR = 1.09, 95% CI, 0.92-1.29, p = 0.34) and in combination with other antioxidants it was associated with an increase in mortality (RR = 1.05, 95% CI, 0.99-1.11, p = 0.10). For both selenium and beta carotene, the effect was not statistically significant. Vitamin C and Vitamin E combination slightly reduced colorectal cancer incidence with no effect on overall mortality. CONCLUSIONS: This meta-analysis found no evidence in favor of a protective effect of the studied antioxidant supplements in the prevention of colorectal cancer or cancer related mortality. Only selenium supplementation might have anticarcinogenic effects and requires further research.

Diagnostic value of calprotectin in irritable bowel syndrome and in inflammatory bowel disease.

The inflammation is an important component of the bowel wall structure. The amount of inflammation is gradually increased from normal state, to functional bowel disorders and to inflammatory bowel disease. Calprotectin is a recently established marker for intestinal inflammation. This paper surveys the present knowledge on fecal calprotectin testing as predictor of intestinal inflammation. We also show on a sample of patients that inflammation as tested with fecal calprotectin test may also be found, in lower degree, in irritable bowel syndrome. In inflammatory bowel disease, the calprotectin fecal test shows higher intensity values.

Assessing health related quality of life in diabetic patients.

INTRODUCTION: The number of people with diabetes mellitus (DM) is increasing. For chronic illnesses such as DM, where there is no cure, it is important to establish that therapy really makes people feel better. The purpose of the study was to analyze the quality of life in a group of diabetic patients without major complications. SUBJECTS AND METHODS: The study group consisted of 50 patients, males and females, aged 60 (+/- 6), diagnosed with type 2 DM and followed up at an outpatient clinic. The Romanian version of the SF-36 questionnaire was used as a health survey tool to measure the quality of life (QOL) of patients in the study. RESULTS: Validity (coefficient alpha Cronbach) was > 0.7 for all scales except social functioning. QOL scores for study group were significantly lower compared with general population. Examining the effects of insulin use and QOL, there are no significant differences between patients following insulin therapy and patients with other therapeutic protocols. Role limitations due to emotional problems correlate with disease duration. Statistical analysis demonstrates a significant correlation between energy/fatigue scores and HbA1c. There are no other statistically significant correlations between SF-36 scores and other variables analyzed. DISCUSSIONS AND CONCLUSIONS: Patients with DM have statistically significant impairment of all aspects of QOL, not simply physical functioning. DM put a substantial burden on affected individuals by influencing physical, psychological and social aspects of QOL. The progressive nature of type 2 DM and the real risk for developing chronic complications certifies that insulin use will be a reality for most diabetic patients, but its use did not seem to have a negative impact upon QOL. Glycemic control becomes an important measurement for preventing long-terms complications and provides a better QOL to diabetic patient. This end-point should be a much more important target for healthcare interventions.