Deliberate foreign body ingestion in patients with underlying mental illness: A retrospective multicentre study.

OBJECTIVE: Deliberate foreign body ingestion (DFBI) is characterised by recurrent presentations among patients with mental health conditions, intellectual disabilities and in prisoners. We aimed to profile the characteristics and evaluate the care of such patients in this study. METHODS: Adult patients with an endoscopic record of attempted foreign body retrieval between January 2013 and September 2020 were identified at three Australian hospitals. Those with a documented mental health diagnosis were included and their standard medical records reviewed. Presentation history, demographics, comorbidities and endoscopic findings were recorded and described. RESULTS: A total of 166 admissions were accounted for by 35 patients, 2/3 of which had borderline personality disorder (BPD). Repetitive presentations occurred in more than half of the cohort. There was an increased trend of hospital admissions throughout the years. At least half of the cohort had a documented mental health review during their admission. An average of 3.3 (2.9) foreign bodies were ingested per single episode. Endoscopic intervention was performed in 76.5% of incidents. The combined Length of stay for all patients was 680 days. CONCLUSION: Deliberate foreign body ingestion in mental health patients is a common, recurring and challenging problem that is increasing in frequency and requires collaborative research to further guide holistic management.

Weight and BMI Patterns in a Biologicals-Treated IBD Cohort.

BACKGROUND: Biologic therapies are effective at inducing and maintaining remission in people with inflammatory bowel disease (IBD). Previous studies have associated TNF-a inhibitors with weight gain, however, it is unclear if this is a class-specific effect or a manifestation of good disease control. To clarify this issue, a retrospective study was undertaken to examine weight changes over time during therapy with different biologic agents. METHODS: Adult patients with IBD who received any biological therapy for at least 12 months, between 2008 and 2020, were identified at two specialised IBD services. Demographic, disease, and therapy-related data were examined. Weight change and patterns thereof were examined for each specific therapy and relationships amongst weight outcomes and various predictive factors explored. RESULTS: Of 294 patients (156 females), 165 received Infliximab (IFX), 68 Adalimumab (ADA), 36 Vedolizumab (VDZ) and 25 Ustekinumab (UST). There was a statistically significant weight gain over time in the IFX and VDZ groups and more weight gain in the IFX vs ADA and VDZ vs ADA at most time points. Three weight trajectories were identified: around 95% of patients had small weight loss or a modest weight gain but 5% of patients, most of whom were on IFX had marked weight gain (24.3 kg). Having a baseline high BMI, being female, having an initiation CRP ≤ 5 or albumin > 35 reduced the odds of major weight gain. CONCLUSION: Weight gain in biologic treated IBD patients appears to be associated with clinical factors (male gender, high CRP, low albumin) and therapy-specific factors.

Distinctive gut microbiomes of ankylosing spondylitis and inflammatory bowel disease patients suggest differing roles in pathogenesis and correlate with disease activity.

BACKGROUND: Multiple studies have confirmed dysbiosis in ankylosing spondylitis (AS) and inflammatory bowel disease (IBD); however, due to methodological differences across studies, it has not been possible to determine if these diseases have similar or different gut microbiomes. RESULTS: In this study, faecal and intestinal biopsies were obtained from 33 Australian AS patients (including 5 with concomitant IBD, 'AS-IBD'), 59 IBD patients and 105 healthy controls. Stool samples were also obtained from 16 Italian AS patients and 136 Swedish AS patients. Focusing on the Australian cohort, AS, AS-IBD and IBD patients differed from one another and from healthy controls in both alpha and beta diversity. AS patients with and without clinical IBD could be distinguished from one another with moderate accuracy using stool microbiome (AUC=0.754). Stool microbiome also accurately distinguished IBD patients from healthy controls (AUC=0.757). Microbiome composition was correlated with disease activity measured by BASDAI and faecal calprotectin (FCP) levels. Enrichment of potentially pathogenic Streptococcus was noted in AS, AS-IBD and IBD patients. Furthermore, enrichment of another potentially pathogenic genus, Haemophilus, was observed in AS, AS-IBD, IBD, AS patients with increased BASDAI, and IBD patients with faecal calprotectin >100 µg/mg. Apart from these genera, no other taxa were shared between AS and IBD patients. CONCLUSIONS: In conclusion, the distinct gut microbiome of AS and AS-IBD patients compared to IBD patients and healthy controls is consistent with immunological and genetic evidence suggesting that the gut plays a different role in driving AS compared with IBD. However, enrichment of two potentially pathogenic genera in both diseases suggests that the presence of a shared/common microbial trigger of disease cannot be discounted.

Fibrosing cholestatic hepatitis and HBV after bone marrow transplantation.

Liver failure caused by reactivation of hepatitis B virus (HBV) is an uncommon complication of bone marrow transplantation. Fibrosing cholestatic hepatitis is a recently described liver lesion that develops in some patients undergoing liver transplantation for chronic HBV infection. The lesion is characterised by peri portal fibrosis, ballooning degeneration of hepatocytes, prominent cholestasis and paucity of inflammation. Recent data suggests it is a cytopathic effect of the pre-core mutant form of HBV with over-expression of viral antigens. Although only one case has so far been described associated with bone marrow transplantation (BMT) it is likely that increasing use of BMT in people with chronic HBV infection will lead to further patients being recognised.

DNA probes for two Microsporidia, Nosema bombycis and Nosema costelytrae.

Two DNA fragments which hybridize specifically with DNA of Nosema bombycis and Nosema costelytrae, respectively, were obtained from genomic DNA of each microsporidian species and sequenced. Neither fragment hybridized with genomic DNA from four other microsporidian isolates tested: Nosema apis, Vairimorpha sp. from cabbage white butterfly (Pieris rapae), and two isolates of Vavraia oncoperae, one from New Zealand grass grubs, Costelytrae zealandica, and another from porina caterpillars, Wiseana spp. The probe for N. bombycis did not hybridize with genomic DNA from N. costelytrae or with DNA from silkworms (Bombyx mori), the primary insect host of this microsporidium. Likewise, the probe for N. costelytrae did not hybridize with genomic DNA from N. bombycis or with DNA from grass grubs (C. zealandica). Both fragments were AT-rich (59 and 79% of total bases, respectively), had G+C/A+T ratios of 0.70 and 0.25, respectively, and represented repeated sequences dispersed throughout the genome.

Use of nucleotide sequence data to identify a microsporidian pathogen of Pieris rapae (Lepidoptera, Pieridae).

Nucleotide sequence was determined for a portion of genomic DNA which spans the V4 variable region of the small subunit ribosomal RNA gene of an unidentified microsporidium from the cabbage white butterfly, Pieris rapae (174 base pairs). Comparison with equivalent sequence data obtained here for two other microsporidian species, Nosema bombycis (240 base pairs) and Nosema bombi (200 base pairs), and from the GenBank database for 11 other microsporidian species suggests that the unidentified species from P. rapae is most closely related to some Vairimorpha species. Light and electron microscopic observations of the developmental stages of this parasite were in accord with this. Infection experiments conducted at 20 and 26 degrees C demonstrated temperature-dependent dimorphism, with the production of both binucleate free spores (mean dimensions: 3.8 x 1.8 microns; 10-13 polar filament coils) and membrane-bound uninucleate octospores (mean dimensions: 3.1 x 1.9 microns). Macrospores (mean dimensions 8.0 x 2.1 microns) were also observed. Sites of infection were the gut epithelium, the Malpighian tubules, the salivary glands, and the fat body. Infections were found in all insect life stages, including the egg. This microsporidium was found to be indistinguishable from both Nosema mesnili (Paillot) and Microsporidium (Thelohania) mesnili (Paillot) and we propose that these species be combined and transferred to the genus Vairimorpha Pilley.

Chemoattractants in fibrotic disorders.

Fibrosis represents an excessive deposition of connective tissue which impedes the normal functions of an organ or tissue. The mechanisms leading to this increased deposition of connective tissue may be similar to those occurring in normal wound repair. We have previously shown that the repair process involves the migration of connective tissue cells to the site of injury and their subsequent proliferation. One of the principal factors controlling these events appears to be the platelet-derived growth factor (PDGF). PDGF acts as a potent chemoattractant and mitogen for connective tissue cells but not other cell types. In addition to PDGF, factors produced by monocytes and tissue macrophages also act as chemoattractants for connective tissue cells. These observations suggest that such activities may be abundant in areas of inflammation. In normal repair these factors would be present for a relatively short period of time, whereas in fibrosis the chronic inflammatory response could maintain a constant or repeated release of such factors. This would recruit additional connective tissue cells to the area of inflammation, changing the cellular composition of the affected organ or tissue, resulting in an expansive and permanent nodule of connective tissue.

The effect of smoking on caffeine elimination: implications for its use as a semiquantitative test of liver function.

1. The effects of caffeine ingestion and cigarette smoking on caffeine and antipyrine pharmacokinetics were studied using normal subjects as their own controls before and after cessation of smoking in an attempt to minimize genetic and other environmental influences. 2. Moderate caffeine ingestion had no inducing effect on caffeine or antipyrine clearance. 3. Cessation of cigarette smoking significantly reduced clearance of caffeine and antipyrine. 4. These results demonstrate that cigarette smoking significantly affects caffeine pharmacokinetics and this may contribute to the variable results for caffeine kinetics found in patients with liver disease.