Colonic neoplasia in young patients with inflammatory bowel disease and primary sclerosing cholangitis.

AIM: Current guidelines recommend annual surveillance for colorectal cancer (CRC) in all patients with inflammatory bowel disease (IBD) and primary sclerosing cholangitis (PSC). The aim of our study was to validate the need for annual surveillance for colon neoplasia in patients ≤45 of age with a combined diagnosis of PSC and IBD. METHOD: We identified patients, ≤45 years of age with a combined diagnosis of PSC and IBD, who were seen at the Mayo Clinic between 1995 and 2010. We then reviewed the medical records of the patients who developed colonic neoplasia defined as cancer, high-grade dysplasia (HGD) or dysplasia-associated lesion or mass (DALM). RESULTS: In the population of 784 patients ≤45 years of age with a combined diagnosis of PSC and IBD, 10 (1.3%) of 784 developed colonic neoplasia during the follow-up period. Seven patients had colon cancer, one had HGD and two had a DALM. CONCLUSION: Colonic neoplasia is uncommon in young patients (≤45 years of age) with a combined diagnosis of PSC and IBD. We suggest delaying surveillance in young patients and propose that studies should be carried out to clarify the cost-effectiveness of annual or biannual surveillance colonoscopies according to patient age.

An update on primary sclerosing cholangitis:from pathogenesis to treatment.

Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease of unknown etiology despite advances in medical research that have focused on uncovering its pathogenesis. Recent developments in the diagnosis of PSC including technological advances in magnetic resonanace cholangiography and the recognition of distinct clinical subtypes have led to more frequent early detection and appropriate therapy when indicated. Continued work in the areas of identifying genetic predisposing factors and novel molecular therapeutic targets are expected to create new opportunities for treating patients suffering from this chronic illness. In this review we highlight recent advances in PSC pathogenesis, diagnosis and management.

Health related Quality of Life with HIV/AIDS in different stages of HIV infection.

Disease stages of HIV infection is one of the important predictor of Health related Quality of Life (HQoL) of the people living with HIV/AIDS. This cross sectional study was an attempt to compare the HQoL of HIV-infected patients across the three CDC stages of HIV-infection namely, asymptomatic, symptomatic, and AIDS-related conditions. A total of 82 patients, 28 in asymptomatic, 26 in symptomatic, and 28 in AIDS-related conditions, from three NGOs and one Infectious Disease Hospital (IDH) were interviewed using interviewer administered semi structured questionnaire developed by adopting "World Health Organization Quality of Life HIV BREF (WHOQOL-HIV BREF) instrument". Analysis revealed that AIDS-related conditions and symptomatic patients were experiencing significantly poorer quality of life than asymptomatic patients in the domain of physical (F=7.006, p <0.005), level of independence) F=6.552, p<0.005(, overall perception of health related quality of life (F=3.634, p<0.05) and overall general health perception (F=7.842, p<0.001).

Health related quality of life among the people living with HIV.

Identifying the level of health related quality of life (HQoL) and their influencing factors in human immunodeficiency virus (HIV) positive people is of extreme importance in implementing an interventional program to support this group. This cross sectional study was an attempt to determine the level and factors associated with HQoL among the people living with HIV. A convenient sample of 82 HIV-infected people from three NGOs and one Infectious Disease Hospital (IDH), were interviewed using an interviewer administered, semi structured questionnaire developed by adopting the "WHOQOL-HIV BREF instrument". A majority of the respondents were with low Quality of Life (QoL) in all the domains of HQoL. The proportion of respondents with low QoL was highest in the domain of social relationship (64.6%) followed by psychological domain (59.8%), physical domain (58.5%), level of independence domain (56.1%), environmental domain (52.4%) and spirituality domain (52.4%) of HQoL. Bivariate analysis revealed that the overall perception of QoL was better in the respondents living in urban area, who were employed and asymptomatic of the centre for disease control (CDC) stage of HIV. The perception of overall health was higher in females, all respondents less than 35 years of age, asymptomatic of the CDC stage of disease and with a current CD4 count greater than 200 cell/mm3. These findings highlight the need for enhanced socio-psychosocial support and a better environment for improving the health related quality of life among people living with HIV.

Effect of ECG-derived respiration (EDR) on modeling ventricular repolarization dynamics in different physiological and psychological conditions.

Ventricular repolarization dynamics is an important predictor of the outcome in cardiovascular diseases. Mathematical modeling of the heart rate variability (RR interval variability) and ventricular repolarization variability (QT interval variability) is one of the popular methods to understand the dynamics of ventricular repolarization. Although ECG derived respiration (EDR) was previously suggested as a surrogate of respiration, but the effect of respiratory movement on ventricular repolarization dynamics was not studied. In this study, the importance of considering the effect of respiration and the validity of using EDR as a surrogate of respiration for linear parametric modeling of ventricular repolarization variability is studied in two cases with different physiological and psychological conditions. In the first case study, we used 20 young and 20 old healthy subjects' ECG and respiration data from Fantasia database at Physionet to analyze a bivariate QT-RR and a trivariate [Formula: see text] model structure to study the aging effect on cardiac repolarization variability. In the second study, we used 16 healthy subjects' data from drivedb (stress detection for automobile drivers) database at Physionet to do the same analysis for different psychological condition (i.e., in stressed and no stress condition). The results of our study showed that model having respiratory information (QT-RR-RESP and QT-RR-EDR) gave significantly better fit value (p < 0.05) than that of found from the QT-RR model. EDR showed statistically similar (p > 0.05) performance as that of respiration as an exogenous model input in describing repolarization variability irrespective of age and different mental conditions. Another finding of our study is that both respiration and EDR-based models can significantly (p < 0.05) differentiate the ventricular repolarization dynamics between healthy subjects of different age groups and with different psychological conditions, whereas models without respiration or EDR cannot distinguish between the groups. These results established the importance of using respiration and the validity of using EDR as a surrogate of respiration in the absence of respiration signal recording in linear parametric modeling of ventricular repolarization variability in healthy subjects.

High-dose ursodeoxycholic acid increases risk of adverse outcomes in patients with early stage primary sclerosing cholangitis.

BACKGROUND: Ursodeoxycholic acid (UDCA) in a dose of 28-30 mg/kg/day increases the likelihood of clinical deterioration of primary sclerosing cholangitis (PSC) patients. AIM: To compare the risk of adverse clinical endpoints in patients with varying disease status. METHODS: We reviewed records from patients previously enrolled in a study evaluating the effects of high dose (28-30 mg/kg/day) UDCA in PSC. Patients were grouped according to treatment (UDCA vs. placebo) and baseline disease status (histological stage of PSC, total serum bilirubin). Development of clinical endpoints including death, liver transplantation, cirrhosis, oesophageal varices and cholangiocarcinoma was sought. RESULTS: A total of 150 patients were included of whom 49 patients developed endpoints. There was an increased development of endpoints among patients using UDCA vs. placebo (14 vs. 4, P=0.0151) with early histological disease (stage 1-2, n=88) but not with late stage (stage 3-4, n=62) disease (17 vs. 14, P=0.2031). Occurrence of clinical endpoints was also higher in patients receiving UDCA vs. placebo (16 vs. 2, P=0.0008) with normal bilirubin levels (total bilirubin ≤1.0 mg/dL) but not in patients with elevated bilirubin levels (15 vs. 16, P=0.6018). Among patients not reaching endpoints 31.7% had normalisation of their alkaline phosphatase levels when compared to 14.3% in patients who reached endpoints (P=0.073). CONCLUSION: The increased risk of adverse events with UDCA treatment when compared with placebo is only apparent in patients with early histological stage disease or normal total bilirubin.

The immunogenic effect of purified antigens of B. alexandrina against Schistosoma mansoni in experimental animals (I) as measured by worm load and viability of ova.

Current stratigies for the control of schistosomiasis are based primarily on chemotherapy but successful vaccination against infection has been also demonstrated in several host parasite models. In this study, the immunogenic effect of two purified antigens (Fiv 20-29 000 daltons & Fv 20-24 000 daltons) extracted from non infected hepatopancreas of B. alexandrina as measured by worm load, state of copulation and viability of ova in tissues. The antigens were prepared using gel filtration chromatography and their molecular weights were estimated through sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE). Four dilutions from each antigen were prepared and injected in two groups (33 each) of Swiss albino mice at weekly intervals. A control group was injected with phosphate buffer saline (PBS) in the same manner. All mice were injected with 100 cercariae using immersion method. Sacrification was done regularly after 7 weeks of injection. On the basis of worm load, Fiv gave protection of 44% while Fv gave only 36%. The number of worms in copula was significantly reduced and they became delicate, fragile, stunted and malformed. Both antigens gave a significant reduction in total viable eggs in tissues.

The immunogenic effect of purified antigens of B. alexandrina against S. mansoni in experimental animals (II) as measured by the histopathological changes in the liver.

It can be safely said that up till now, no method of vaccination (including recent genes encoding vaccines) has yet proved to be totally effective since they gave partial and low levels of protection against S. mansoni infection. The objective of this work is to try testing the immunogenic effect of two purified non infected B. alexandrina hepatopancreas through histopathological changes in liver of Swiss albino mice (15-20 gm). Gel filtration chromatography was used to fractionate the crude antigen into five fractions followed by re-fractionation and determination of their molecular weights by sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE). Four dilutions of Fiv (20000-29000 daltons) and Fv (20000-24000 daltons) were injected in two groups of mice (33 each) at weekly intervals and another control group was injected with phosphate buffer saline (PBS) in the same manner. Sacrification was done seven weeks from infection with 100 S. mansoni cercariae through immersion method. The results revealed that there is marked histopathological changes in liver of the control group in comparison to the two vaccinated groups which appear more or less normal with slight inflammatory infiltrate.