Microscopic colitis related to food supplement containing turmeric: a review of 3 cases.

Microscopic colitis is a chronic inflammatory disorder of the colon characterized by microscopic changes in the intestinal lining. Turmeric, a commonly used spice, is generally regarded as beneficial for digestive and articular health thanks to its anti-inflammatory properties. No cases of microscopic colitis under a food supplement containing turmeric has been previously described in the literature. This article highlights 3 cases where the consumption of a specific turmeric-based supplement caused microscopic colitis. Each of them complained about profuse watery diarrhea shortly after initiating the food supplement containing turmeric. Ileo-colonoscopies with biopsies confirmed the diagnosis of microscopic colitis, with two cases classified as lymphocytic colitis and the third as collagenous colitis. Following the discontinuation of the supplement, all patients experienced a resolution of their symptoms within a few days. Subsequent control biopsies for the three patients confirmed the resolution of microscopic colitis.

Daño vascular y rendimiento cognitivo-funcional en una población con deterioro cognitivo leve / Vascular damage and cognitive-functional performance in a population with mild cognitive impairment

Introducción: Existe evidencia de etapas predemenciales en la demencia vascular. La enfermedad de Alzheimer y el trastorno cognitivo vascular comparten mecanismos de riesgo comunes, y la comorbilidad vascular puede estar presente en el 30-60% de los pacientes con enfermedad de Alzheimer. Este trabajo evalúa el impacto de la gravedad del daño vascular estructural según la clasificación de Fazekas en el desempeño cognitivo funcional en pacientes con deterioro cognitivo leve (DCL). Pacientes y métodos: Estudio de corte transversal de pacientes con DCL de 65 años o más con resonancia magnética cerebral. Se administró una batería neurocognitiva y la escala estudio funcional extendido (EFE) para evaluar la funcionalidad compleja. Los pacientes se clasificaron según Fazekas: 0-1, 2 y 3. Se realizó un análisis bivariado y un análisis multivariable. Resultados: Se incluyó a 346 pacientes, con una edad de 77,9 (desviación estándar: 6,1). El 66,2% presentó Fazekas 0-1; el 22,8%, Fazekas 2; y el 11%, Fazekas 3. La edad y el valor del Minimental State Examination se asociaron con un Fazekas más avanzado. El análisis multivariado mostró una asociación independiente entre el daño vascular y la alteración funcional compleja medida por el EFE. Conclusiones: La progresión del daño estructural a predominio de sustancia blanca afectaría al desempeño cognitivo global y a las tareas de función ejecutiva. El hallazgo más significativo fue la correlación del grado del daño vascular con el déficit de la funcionalidad compleja medida con herramientas clínicas que incluyeron recursos tecnológicos. Se resalta el valor clínico de identificar los individuos con demencia vascular prodrómica, ya que podría optimizar las medidas de prevención.(AU)

Introduction: There is evidence of predemential stages in Vascular Dementia (VD). Alzheimer Disease (AD) and VD share common risk factors and mechanisms. Vascular comorbility may present in 30-60% of patients with AD (mixed dementia). This work seeks to evaluate the impact of the severity of structural vascular damage according to the Fazekas classification (F) on functional cognitive performance in patients with Mild Cognitive Impairment (MCI). Patients and methods: A cross-sectional study of patients with MCI aged 65 years or older who had brain MRI was carried out. A neurocognitive battery and the EFE (Extended Functional Study) scale were administered to assess complex functionality. The patients were divided according to Fazekas classification: 0-1, 2 and 3. Bivariate analysis and multivariate analysis were performed. Results: 346 patients were included, age: 77.9 (SD 6.1). 66.2% presented F01, 22.8% F2 and 11% F3. Age and MMSE value were statistically significant. Multivariate analysis showed an independent association between vascular damage and complex functional alteration measured by EFE. Conclusions: In conclusion, the progression of structural damage to a predominance of white matter would affect global cognitive performance and tasks related to executive function. The most significant finding was the correlation of the degree of vascular damage with the deficit of complex functionality measured with clinical tools that include technological resources. The clinical value of identifying individuals with prodromal DV is highlighted as it could optimize prevention measures.(AU)

[Vascular damage and cognitive-functional performance in a population with mild cognitive impairment]. / Daño vascular y rendimiento cognitivo-funcional en una población con deterioro cognitivo leve.

INTRODUCTION: There is evidence of predemential stages in Vascular Dementia (VD). Alzheimer Disease (AD) and VD share common risk factors and mechanisms. Vascular comorbility may present in 30-60% of patients with AD (mixed dementia). This work seeks to evaluate the impact of the severity of structural vascular damage according to the Fazekas classification (F) on functional cognitive performance in patients with Mild Cognitive Impairment (MCI). PATIENTS AND METHODS: A cross-sectional study of patients with MCI aged 65 years or older who had brain MRI was carried out. A neurocognitive battery and the EFE (Extended Functional Study) scale were administered to assess complex functionality. The patients were divided according to Fazekas classification: 0-1, 2 and 3. Bivariate analysis and multivariate analysis were performed. RESULTS: 346 patients were included, age: 77.9 (SD 6.1). 66.2% presented F01, 22.8% F2 and 11% F3. Age and MMSE value were statistically significant. Multivariate analysis showed an independent association between vascular damage and complex functional alteration measured by EFE. CONCLUSIONS: In conclusion, the progression of structural damage to a predominance of white matter would affect global cognitive performance and tasks related to executive function. The most significant finding was the correlation of the degree of vascular damage with the deficit of complex functionality measured with clinical tools that include technological resources. The clinical value of identifying individuals with prodromal DV is highlighted as it could optimize prevention measures.

TITLE: Daño vascular y rendimiento cognitivo-funcional en una población con deterioro cognitivo leve.Introducción. Existe evidencia de etapas predemenciales en la demencia vascular. La enfermedad de Alzheimer y el trastorno cognitivo vascular comparten mecanismos de riesgo comunes, y la comorbilidad vascular puede estar presente en el 30-60% de los pacientes con enfermedad de Alzheimer. Este trabajo evalúa el impacto de la gravedad del daño vascular estructural según la clasificación de Fazekas en el desempeño cognitivo funcional en pacientes con deterioro cognitivo leve (DCL). Pacientes y métodos. Estudio de corte transversal de pacientes con DCL de 65 años o más con resonancia magnética cerebral. Se administró una batería neurocognitiva y la escala estudio funcional extendido (EFE) para evaluar la funcionalidad compleja. Los pacientes se clasificaron según Fazekas: 0-1, 2 y 3. Se realizó un análisis bivariado y un análisis multivariable. Resultados. Se incluyó a 346 pacientes, con una edad de 77,9 (desviación estándar: 6,1). El 66,2% presentó Fazekas 0-1; el 22,8%, Fazekas 2; y el 11%, Fazekas 3. La edad y el valor del Minimental State Examination se asociaron con un Fazekas más avanzado. El análisis multivariado mostró una asociación independiente entre el daño vascular y la alteración funcional compleja medida por el EFE. Conclusiones. La progresión del daño estructural a predominio de sustancia blanca afectaría al desempeño cognitivo global y a las tareas de función ejecutiva. El hallazgo más significativo fue la correlación del grado del daño vascular con el déficit de la funcionalidad compleja medida con herramientas clínicas que incluyeron recursos tecnológicos. Se resalta el valor clínico de identificar los individuos con demencia vascular prodrómica, ya que podría optimizar las medidas de prevención.

Survival and functionality in the elderly over 85 years of age with hip fracture. / Supervivencia y funcionalidad en ancianos mayores de 85 años con fractura de cadera.

BACKGROUND: There is a tendency for the aging population to fracture their hips. Our aim was to compare survival and functionality at one year, among elderly and very elderly patients with hip fracture. MATERIAL AND METHODS: A prospective cohort of patients included in the Institutional Registry of Elderly Patients with Hip Fracture between 2014 and 2017. We classified patients as elderly patients (EP) <65 and <85 years and very elderly patients (VEP) ≥85 years. RESULTS: We included 952 patients, 43% were EP and 57% were VEP. The proportion of women was 84% and 86% (P=.33) and with 2 or more points in the Charlson comorbidities index (28 and 31%, P= .36), respectively. The VEP were more dependent according to the Barthel score (34% and 62%, P<.01) and frailer according to the Edmonton score (30% and 61%, P<.01). One-year survival was 91% (95% CI 86-93) in the EP and 76% (95% CI 70-89) in the VEP. In-hospital complications were more frequent in the VEP 12% (7% in the EP, P<.01). Age is an independent risk factor for one-year survival (HR 2.11; 95% CI 1.36-3.29, P<.001). CONCLUSIONS: Age is a risk factor for the VEP group survival despite fragility and comorbidities. Because of their vulnerability, an appropriate care plan should be considered for VEP.

Systematic analysis of the interactions driving small molecule-RNA recognition.

RNA molecules are becoming an important target class in drug discovery. However, the principles for designing RNA-binding small molecules are yet to be fully uncovered. In this study, we examined the Protein Data Bank (PDB) to highlight privileged interactions underlying small molecule-RNA recognition. By comparing this analysis with previously determined small molecule-protein interactions, we find that RNA recognition is driven mostly by stacking and hydrogen bonding interactions, while protein recognition is instead driven by hydrophobic effects. Furthermore, we analyze patterns of interactions to highlight potential strategies to tune RNA recognition, such as stacking and cation-π interactions that favor purine and guanine recognition, and note an unexpected paucity of backbone interactions, even for cationic ligands. Collectively, this work provides further understanding of RNA-small molecule interactions that may inform the design of small molecules targeting RNA.

A pilot randomized controlled trial of a decision aid with tailored fracture risk tool delivered via a patient portal.

We tested the feasibility of a fracture prevention decision aid in an online patient portal. The decision aid was acceptable for patients and successfully decreased decisional conflict. This study suggests the possible utility of leveraging the patient portal to enhance patient education and decision making in osteoporosis care. INTRODUCTION: Although interventions have improved osteoporosis screening and/or treatment for certain populations of high-risk patients, recent national studies suggest that large-scale uptake of these interventions has been limited. We aimed to determine the feasibility and potential efficacy of a patient portal-based osteoporosis decision aid (DA). METHODS: We conducted a pilot randomized controlled trial of primary care patients aged ≥55 who were enrolled in a patient portal and had a T-score of <-1. Intervention subjects were provided a link to a patient DA. The DA contained a 10-year fracture risk calculator, summary of medication risks and benefits (prescription and nonprescription), and an elicitation of values. Subjects completed questionnaires assessing the primary outcomes of decisional conflict and preparation for decision making and secondary outcomes related to feasibility and planning for a larger trial. Charts were reviewed for physician-subject interactions and medication uptake. RESULTS: The DA was acceptable to subjects, but 17 % of the patients in the decision aid arm incorrectly entered their T-scores into FRAX-based risk calculator. Decisional conflict was lower post-intervention for those who were randomized to the decision aid arm compared to controls (17.8 vs. 47.1, p < .001), and there was a significant difference in the percentage of patients who made a treatment decision at 3 months. No significant differences were observed in medication uptake. CONCLUSIONS: A portal-based osteoporosis DA was acceptable and improved several measures of decision quality. Given its effect on improving the quality of patients' decisions, future studies should examine whether it improves physician guideline adherence or medication adherence uptake among treated patients.

Druggability of methyl-lysine binding sites.

Structural modules that specifically recognize--or read--methylated or acetylated lysine residues on histone peptides are important components of chromatin-mediated signaling and epigenetic regulation of gene expression. Deregulation of epigenetic mechanisms is associated with disease conditions, and antagonists of acetyl-lysine binding bromodomains are efficacious in animal models of cancer and inflammation, but little is known regarding the druggability of methyl-lysine binding modules. We conducted a systematic structural analysis of readers of methyl marks and derived a predictive druggability landscape of methyl-lysine binding modules. We show that these target classes are generally less druggable than bromodomains, but that some proteins stand as notable exceptions.

Macroscopic endoscopic lesions in microscopic collagenous colitis: double case report and review of the literature.

Collagenous colitis is a cause of chronic diarrhea of incompletely elucidated origin, defined by normal laboratory tests, a normal endoscopic appearance of colonic mucosa and specific microscopic inflammatory features on colonic biopsies. We report two cases of macroscopic endoscopic lesions observed in patients suffering from chronic diarrhea, whose biopsies confirmed a diagnosis of collagenous colitis and who were successfully treated in that setting, achieving clinical and endoscopic remissions. By means of a literature review, we summarize what is known about collagenous colitis. We particularly discuss macroscopic findings in that context, drawing attention on the so called "microscopic colitis" in the differential diagnosis of that type of lesions.

A novel potent Fas agonist for selective depletion of tumor cells in hematopoietic transplants.

There remains a clear need for effective tumor cell purging in autologous stem cell transplantation (ASCT) where residual malignant cells within the autograft contribute to disease relapse. Here we propose the use of a novel Fas agonist with potent pro-apoptotic activity, termed MegaFasL, as an effective ex-vivo purging agent. MegaFasL selectively kills hematological cancer cells from lymphomas and leukemias and prevents tumor development at concentrations that do not reduce the functional capacity of human hematopoietic stem/progenitor cells both in in vitro and in in vivo transplantation models. These findings highlight the potential use of MegaFasL as an ex-vivo purging agent in ASCT.

Pregnancy and inflammatory bowel diseases from conception to delivery.

BACKGROUND: Chronic inflammatory bowel diseases frequently affect young people and are of major concern to them when envisaging parenthood. MATERIALS AND METHODS: Using a literature review, we attempt to provide up-to-date solutions concerning conception, pregnancy, delivery and breastfeeding; we also underline potential risks associated with such diseases, their treatment and management. RESULTS AND CONCLUSION: Inflammatory bowel diseases are not incompatible with maternity or paternity, but foresight is recommended and future parenthood should be discussed with gastroenterologists so as to adapt treatment and follow-up to ensure successful pregnancy outcome.

Upper gastrointestinal bleeding: what has changed during the last 20 years?

AIM OF THE STUDY: The purpose of this study was to assess the clinical, epidemiological, therapeutic and prognostic changes observed in patients with upper gastrointestinal bleeding (UGIB) during the last two decades. METHODS: Two cohorts of 200 patients with UGIB consecutively recruited during the period 1984-1987 (cohort A) then during the period 2004-2006 (cohort B) were compared. RESULTS: Median age was 61.5 years in the cohort A and 67 years in the cohort B. The main etiologies remained variceal bleeding and peptic ulcer, but esophagitis and Mallory-Weiss syndrome were more frequently observed recently. The intake of gastrotoxic drugs did not decreased despite the widely acknowledged harmful effects of these drugs. Regarding management practices, a therapeutic intervention during the first endoscopy was performed in 36% of the cases in the cohort B but only in 2% of the cases 20 years ago. The frequency and the volume of blood transfusion dramatically decreased during the last two decades. Regarding the outcome, the requirement for surgery and the rate of recurrent bleeding decreased by half, but mortality remained unchanged. CONCLUSION: The main changes observed in patients admitted for UGIB 20 years apart concerned epidemiological features, treatment and prognosis.

Report on the Belgian consensus meeting on colorectal cancer screening.

Screening and prevention of colorectal cancer must be a public health priority. It is the most frequent malignancy in Europe, the second leading cause of cancer death, including Belgium where more than 6000 new cases occur per year. Various screening modalities, from non invasive to invasive are available and currently in use and they are all cost-effective in comparison with no screening. The decision as to which screening test to use should be made by the patient and clinician. Consensus documents prepared by the Belgian scientific community appear in this issue of Acta Gastroenterologica Belgica, summarizing the scientific evidence in favour as well as the limitations of fecal occult blood tests, flexible sigmoidoscopy, videocolonoscopy and virtual colonoscopy.

Colonoscopy as a screening test for colorectal cancer.

Colonoscopy is the current gold standard for the diagnosis and treatment of colorectal neoplasms. Several gastroenterological and/or endoscopical societies recommend screening by colonoscopy in high risk patients for colorectal cancer whilst for average risk patients colonoscopy remains a valid option. In some countries screening colonoscopy is now covered by medical insurance. It is also the final common pathway of all colorectal cancer screening methods. This paper addresses the advantages and also limitations of colonoscopy as the first procedure for colorectal screening and emphasizes the importance of organized training and continuous assessment of competence of gastroenterologists and the necessity to have quality control audits of the endoscopy units.

[Oral anticoagulants in cardiac patients undergoing elective surgical procedures: what attitude to adopt?]. / Anticoagulation orale chez les patients cardiaques qui nécessitent une intervention chirurgicale élective: quelle attitude adopter?

Clinicians are often required to decide how to manage patients receiving long-term anticoagulant therapy, and who need a surgical procedure. The decisions are based on the perceived risk of continuing or stopping the treatment. Generally, warfarin must be stopped before all interventions at high risk of bleeding, but can be maintained unchanged before oral and skin surgery. For patients with a high risk of thromboembolism, heparin should be administered preoperatively, when the INR is <2. The estimation of this risk depends largely on the undelying heart disease. In the postoperative phase, the restarting of anticoagulant therapy must be weighed against both thromboembolic and hemorragic risks.

Gait velocity in senior people. An easy test for detecting mobility impairment in community elderly.

BACKGROUND: Functional assessment is an important part of the evaluation of elderly patients. Mobility problems detected by functional tests predict the development of more severe disability and injurious events such as falls and hip fractures. Several tests to evaluate mobility have been described, but most of them are difficult to perform by a primary care physicians or take much time in the ambulatory setting. PURPOSE: To evaluate different mobility test to detect mobility impairment in community senior people. Select an easier test to perform on the ambulatory ward by a GP with the hypothesis that gait velocity could be an easier test to detect early mobility impairment. METHODS: A cohort of 100 elderly subjects of 75 year and older were selected from our database and contacted by phone. The subjects were appointed and assessed by three geriatricians from January to May 2000. The measures including MMSE, Yesavage Test, ADL (Barhtel) and IADL (Lawton), the Get Up and Go test, the POMA, one leg balance test and the Gait Velocity (GV). A gait velocity of 0.8 m/s or lower was defined as a pathological gait velocity (PGV). RESULTS: 95 subjects, mean age 79.63 (+/- 4) ranged form 75 to 95. Women in 71.3%. The ADLs were normal on 85% of the patients and the MMSE was normal on 78%. There was a significant association between pathological gait velocity (<0.8m/sec) and impairment on Get up and Go (OR 2.20; 95% CI 1.44-3.34), incapacity to perform the one leg balance test (OR 2.20; 95%CI: 1.43 - 4.71) and abnormal POMA test (OR 4.60; 95 %CI 1.5-14.7). Only 15% of the subjects with normal gait velocity reported recurrent falls in the previous 6 months while 35% of subjects with pathological gait velocity did. (OR 0.32 CI95% 010-099 p < 0.044). CONCLUSION: The pathological gait velocity (<0.8m/sec) correlates with a pathologic performance of Get Up and Go test and POMA and with the incapacity to perform the One Leg Balance test. Also correlate with previous repeated falls in the last 6 (p <0.04). The gait velocity could be a test easy to perform, no time consuming, and an operative tool to apply in the ambulatory care to detect elderly patients with mobility impairment.

Epidemiology of coeliac disease.

In this article we review recent worldwide epidemiological data of coeliac disease (CD). An emphasis is made on adult figures as there is reduction of infants cases that is counterbalanced by the increase of CD in older children or adults. We review data from Europe, USA, South America, Australia, Asia and Africa. Studies in mixed population and in patients undergoing endoscopy are also mentioned. The prevalence of the disease varies between 1/100-500 in different continents. It is possible that the low incidence of CD in some regions is due to the decrease of the prevalence of classic form of the disease.

Impact of hepatitis C virus infection on the aetiology of cirrhosis and hepatocarcinoma in three affiliated hospitals in southern Belgium.

In a consecutive series of 411 patients with cirrhosis attending the outpatient liver clinics of 3 general hospitals located in the southern part of Belgium, hepatitis C virus infection accounted for 20% of the cases, far behind alcohol (63%). However, in a consecutive series of 57 hepatocarcinoma superimposed on cirrhosis, hepatitis C virus infection was the main aetiological factor accounting for 44% of the cases.

Human peripheral blood leukocyte engraftment into SCID mice: critical role of CD4(+) T cells.

We examined the influence of donor T lymphocytes on human peripheral blood leukocytes (PBL) engraftment into severe combined immune deficient (SCID) mice. Mice were injected with unfractionated or subset-depleted human PBL, and treated at various times with OKT3, a cytotoxic monoclonal antibody against human CD3(+) T lymphocytes. PBL engraftment, high levels of human Ig, and high incidence of lymphoproliferative disease (lpd) were found in mice transplanted with unfractionated PBL and CD8- or CD14-depleted PBL, and in mice treated with OKT3 at distance from PBL transfer. Animals xenografted with CD3- or CD4-depleted PBL, or treated at transplantation time with OKT3, had very low levels of human Ig and did not develop lpd. PBL engraftment was minimal or absent in these animals, as determined by immunohistochemistry, dot-blot, and RT-PCR analyses. These results demonstrate that the presence of donor CD4(+) T lymphocytes at transplantation time is necessary for observing human PBL engraftment into SCID mice, an essential condition for human Ig production and lpd development.

Haemolytic onset of Wilson disease in a patient with homozygous truncation of ATP7B at Arg1319.

We describe a 19-year-old woman with haemolytic anaemia and thrombocytopenia as the initial manifestation of Wilson disease (WD). There are two reasons for reporting such an improbable case. First, it emphasizes the importance of recognizing atypical clinical presentations of potentially lethal recessive traits for which therapy is available. Second, it shows that, even in a monogenic disorder like WD, the phenotype cannot be extrapolated from the mutated genotype in a simple fashion; this patient had a relatively late-onset form of WD despite homozygosity for a genetic lesion leading to an apparent complete loss of function of the WD copper transporter.

In silico discovery of novel retinoic acid receptor agonist structures.

BACKGROUND: Several Retinoic Acid Receptors (RAR) agonists have therapeutic activity against a variety of cancer types; however, unacceptable toxicity profiles have hindered the development of drugs. RAR agonists presenting novel structural and chemical features could therefore open new avenues for the discovery of leads against breast, lung and prostate cancer or leukemia. RESULTS: We have analysed the induced fit of the active site residues upon binding of a known ligand. The derived binding site models were used to dock over 150,000 molecules in silico (or virtually) to the structure of the receptor with the Internal Coordinates Mechanics (ICM) program. Thirty ligand candidates were tested in vitro. CONCLUSIONS: Two novel agonists resulting from the predicted receptor model were active at 50 nM. One of them displays novel structural features which may translate into the development of new ligands for cancer therapy.