bluuebunny/crossref_metadata_2025 huggingface dataset:
Association of autoimmune diseases with celiac disease and its risk factors
Authors: Kayar Yusuf , Dertli Ramazan
Published: October 2019

Objectives: Autoimmune Diseases (AIDs) are detected in celiac patients. Our purpose was to determine the AIDs that are associated with celiac disease and related risk factors in the Turkish population.

Methods: The study included 230 celiac patients who were diagnosed and followed-up in our clinics between 2015-2019. All AIDs that accompanied the celiac disease were recorded, and their association with risk factors was analyzed.

Results: The mean age of the patients was 35.6±10.6 years (age range:18-72). A total of 58(25.2%) patients were male and the mean age at onset of disease was 29.1±6.5 years. The duration of disease follow-up was 6.5±4.6 years. One hundred and twenty two (53%) patients were on a strict diet, and 72(31.3%) patients had accompanying AID. Hashimoto thyroiditis was found in 39(17%) patients, asthma in 16(7%) patients as the most common comorbidities. There was a significant relation between AID and female gender, age of diagnosis being <40 years, duration of disease, non-GIS symptoms at the time of admission, and non-employment status.

Conclusion: Screening other AIDs in celiac patients are important, especially in individuals who have risk factors. Considering that many AIDs may develop in the future despite dietary compliance, patients should be followed with a multidisciplinary approach.

doi: https://doi.org/10.12669/pjms.35.6.821

How to cite this:Kayar Y, Dertli R. Association of autoimmune diseases with celiac disease and its risk factors. Pak J Med Sci. 2019;35(6):1548-1553.   doi: https://doi.org/10.12669/pjms.35.6.821

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Γλωσσικά στερεότυπα σε κείμενα μαζικής κουλτούρας για παιδιά: Μια διαχρονική ανάλυση των γλωσσικών κωδίκων σε ταινίες κινουμένων σχεδίων της Disney
Authors: Στάμου Αναστασία , Τσώτσου Βικτωρία
Published: October 2019

Oι ταινίες κινουμένων σχεδίων της Disney έχουν μεγάλη απήχηση στα παιδιά. Ωστόσο, παρά τον ‘ελαφρό’ και ψυχαγωγικό τους χαρακτήρα, επιτελούν σημαίνοντα ιδεολογικό ρόλο, καθώς μεταφέρουν κοινωνικά και γλωσσικά μηνύματα στα παιδιά, μέσω των οποίων εκείνα αποκτούν συγκεκριμένες εικόνες για τη γλώσσα και τον κόσμο. Στην παρούσα έρευνα, εξετάζουμε τις γλωσσικές επιλογές που υιοθετούνται για την αναπαράσταση μυθοπλαστικών χαρακτήρων σε μεταγλωττισμένες στα ελληνικά ταινίες κινουμένων σχεδίων της Disney, από μια διαχρονική προοπτική. H ανάλυση του γλωσσικού ρεπερτορίου έξι ταινιών κινουμένων σχεδίων της Disney έδειξε πως, σε όλες ανεξαιρέτως τις ταινίες, η ομιλία των χαρακτήρων κατασκευάζεται μέσα από την άντληση συγκεκριμένων γλωσσικών κωδίκων. Έτσι, για παράδειγμα, η χρήση της καθομιλουμένης εξασφαλίζει την αμεσότητα, την απλότητα και την ‘αυθεντικότητα’ των χαρακτήρων για τα μικρά παιδιά. Ωστόσο, παρατηρούμε ότι κάποιοι γλωσσικοί κώδικες συνδέονται με συγκεκριμένους χαρακτήρες, αναπαράγοντας γλωσσικά και κοινωνικά στερεότυπα. Για παράδειγμα, η γλώσσα της πιάτσας συνδέεται με λαϊκούς (στις παλαιότερες ταινίες) ή αστείους χαρακτήρες (στις νεότερες ταινίες). Τέλος, στις νεότερες ταινίες απεικονίζεται μεγαλύτερη ποικιλία γλωσσικών κωδίκων, οι οποίοι ανήκουν ως επί το πλείστον σε μη πρότυπα γλωσσικά ύφη, κάτι που χαρακτηρίζει τα ΜΜΕ της μετανεωτερικότητας.
The Idea of the University: History and Fate
Authors: Mittelstrass Jürgen
Published: October 2019

The Idea of the University
University Landscape Architecture: Göttingen in the Age of Enlightenment
Authors: Freigang Christian
Published: October 2019

University Landscape Architecture: Göttingen in the Age of Enlightenment
On the Mechanism of Implementation of Strategy of Scientific and Technological Development
Authors: Тодосийчук А. , Todosiychuk A.
Published: October 2019

The analysis of scientific and technical potential is carried out, the assessment of its ability to provide transition of economy of the country from energy and raw materials to an innovative way of development is given. It is proved that in order to achieve the goals of strategic scientific and technological development of the country it is necessary to develop an effective organizational and economic mechanism for its implementation. Proposals are made to improve budget financing and human resources for the development of science through the implementation of national projects and programs.
Canine flea control: too much choice?
Authors: Paterson Sue
Published: October 2019

Ectoparasite control forms an important part of any routine canine health programme but is also an integral part of the management of pruritic skin disease in the dog. As such it is important that veterinary surgeons are aware of the life cycle of the flea and the mode of action of the numerous flea control products that are currently available. The suitability of a product may be different depending on the health status of the dog and concurrent therapy. This article considers the most important groups of flea control products.
Understanding bariatric surgery to support patients in primary care
Authors: Abraham Jenny , Shah Neha , Levine Fridi , Graham Yitka
Published: October 2019

The relatively new field of bariatric surgery is increasingly used as an option to address issues linked to obesity. Practice nurses must understand how they can manage patients who have undergone these procedures

Obesity is steadily rising, with 64% of adults in England in 2017 being classified as overweight or obese. Obesity is strongly linked to metabolic diseases such as cardiovascular disease, type 2 diabetes mellitus (T2DM), non-alcoholic fatty liver disease (NAFLD), polycystic ovary syndrome (PCOS), musculoskeletal and respiratory disorders, cancer as well as psychological illness ( World Health Organization (WHO), 2018 ). Therefore every opportunity should be taken to support patients to lose weight and maintain weight loss. Practice nurses are in a unique and pivotal position to guide patients in a variety of options to assist in their weight loss. Bariatric surgery in England is relatively new, with its usage having increased dramatically in the last 10 years. Practice nurses require knowledge of bariatric surgery to undertake their role effectively. This article provides information to assist practice nurses in providing care and support to patients who have had a surgical intervention. This paper also highlights signs and symptoms of physical and psychological complications including pregnancy and excess skin and recommended action and advice including nutritional monitoring and supplementation.
PENGARUH SUGARCANE STREAK MOSAIC VIRUS TERHADAP ANATOMI DAN KADAR KLOROFIL DAUN BEBERAPA AKSESI TEBU (Sacharrum officinarum)
Authors: Hamida Ruly , Suhara Cece
Published: October 2019

As one of the most important crops in Indonesia, sugarcane productivity is currently still hampered by Sugarcane Streak Mosaic Virus (SCSMV), with the intensity of leaf damage reach 60% . The symptoms of this disease are the occurrence of irregular pattern between light green to pale in sugarcane leaves.  The information about SCSMV in plant anatomy and physiology was still lacking. Therefore the objective of this studies was to determine the effect of SCSMV infection to morphological, anatomical and physiological characters of sugarcane leaves. The research was performed on 30 sugarcane clones by using a randomized block design with three replications. The results showed that there was change in the morphology of leaves, but leaf color did change. The decrease in the ratio of chlorophyll a / b leaves 65% higher in the resistant clones, i.e. clones PS 06 103 and PS 06 199. The number of stomata also decreased in clones by SCSMV.
PARAMETER POPULASI IKAN BETOK (Anabas testudineus (BLOCH, 1792)) DI EKOSISTEM PAPARAN BANJIR SUNGAI MUSI, Lubuk Lampam
Authors: Nurdawati Syarifah , Fahmi Zulkarnaen , Supriyadi Freddy
Published: October 2019

Anabas testudineus Bloch, 1792 is economically important fish species found in Lubuk Lampam floodplains of Musi River. Fishing activities that take place throughout the year can affect reproduction patterns and recruitment (new additions) of fish. This study aims to evaluate several parameters of betok fish populations that can be used as input for fish resource management policies in floodplains of Musi river. A total of 3271 samples of betok fish caught by fishermen from March to November 2011 were collected to obtain data on fish length and weight. Growth parameters (L∞, K, Z dan M) were calculated using FiSAT II based on the length frequency distribution of fish. The values of L∞ and K were obtained at 204.75 mm and 0.24 / year respectively while the maximum age of fish was estimated to be 4.36 years. The total mortality (Z) and natural mortality (M) of betok fish is 0.99 / year and 0.42 / year, Fishing mortality (0.56/year). The exploitation rate (0.57) was slightly lower than the predicted value (Emax= 0.69) indicating that Anabas  testudineus was near fully exploited in the Lubuk Lampam floodplain ecosystem.
THE MACROFUNGI DIVERSITY AND THEIR POTENTIAL UTILIZATION IN TANGALE NATURE RESERVE GORONTALO PROVINCE
Authors: Arini Diah Irawati Dwi , Christita Margaretta , Kinho Julianus
Published: October 2019

Tangale Nature reserve is a conservation area located in Gorontalo that have the biodiversity typical of Wallacea bioregion including macroscopic fungi. The purpose of this study was to identify the fungal species diversity found in the Tangale Nature reserve as well as its potential use, considering that the information on species diversity of fungi in the Wallacea region is very limited. This research was conducted using the cruise method by identifying macroscopic fungi along the hiking trail of Tangale Nature Reserve. The macroscopic fungi were observed for its morphological characteristic include the colour, diameter, surface of the veil, the shape of the stem, the length and diameter of the stem, the lamella, including ring and pore, type of lamella and the type of volva. The research recorded the substrates and the location where the fungus was found. Data were analyzed descriptively qualitative. The results of the research identified 28 species of macroscopic fungi that included to the division Ascomycota and Basidiomycota. It belongs to 16 families and 8 orders  are Pezizales, Agaricales, Auriculariales, Boletales, Cantharellales, Gomphales, Polyporales, dan Russulales. Based on place to grow as much as 57,14% were found growing on decaying wood and 42,86% found growing in the soil/litter. Based on the potential of use, it has identified four species of mushrooms potentially as edible mushroom are Pleurotus ostreatus,  Auricularia auricula, Ramaria formosa, and Polyporus arcularius. 11 species of mushrooms potentially as medicinal mushroom are Calvatia craniiformis, Scleroderma citrinum, Lenzites betulina, Microporus flabelliformis, Coriolus versicolor, Microporus xanthopus, and Albatrellus confluens.
KERAGAMAN KERAPATAN KAYU BATANG DAN CABANG KOMUNITAS POHON DI HUTAN GUNUNG PAPANDAYAN, JAWA BARAT
Authors: Tihurua Eka Fatmawati , Sulistyawati Endah
Published: October 2019

Wood density is the functional character which has important role in the function of ecosystem. Stem and branch wood density have different trait and effect on its ecosystem processes. The objectives of this research are to know the diversity of stem and branch wood density and to analyze whether branch wood density could be used to estimate stem wood density in the Mount Papandayan. Six plots of 0.1 ha at different sites (three plots each in interior and edge forest) were established. Branches were collected from trees with diameter at breast height larger than 10 cm, while stem wood density data were obtained from some wood density sources. Research results showed that stem wood density ranges were 0.35–0.82 g/cm3, while branch wood density ranges were 0.33–0.61 g/cm3. Average of branch wood density was lower (0.48 ± 0.09 g/cm3) than stem wood density (0.61 ± 0.1 g/cm3). Linear regression analysis indicated that branch wood density could be used to estimate stem wood density of trees in Mount Papandayan which is showed by R2 value and correlation coefficient of 0.28 and 0.55 (p value < 0.001) respectively.
NISHAH KELAMIN, HUBUNGAN PANJANG-BERAT DAN UKURAN REPRODUKSI HIU Hexanchus spp. DI PERAIRAN SELATAN NUSA TENGGARA
Authors: Sentosa Agus Arifin
Published: October 2019

Hexanchus spp. are shark species that are often caught in the Indian Ocean southern Nusa Tenggara and its status is Near Threatened, but the information is still relatively limited. This study aimed to sex ratio, length-weight relationship and reproductive size of sixgill shark, Hexanchus spp. caught from southern Nusa Tenggara waters. This study had been carried out during 2016 at the Fishing Port of Tanjung Luar, East Lombok, West Nusa Tenggara. Shark data collection was done by measuring the length, weight, maturity and fishing data. Data were analyzed  by formula of sex ratio, length-weight relationship, length at first maturity (Lm) and length at first catch (Lc). The results showed that Hexanchus spp. caught in the southern Nusa Tenggara waters consisted of H. nakamurai (81.82%) and H. griseus (18.18%). The sex ratio of both sharks was dominated by the female. The average of the total length of H. griseus (218.3 ± 96.08 cm). It was longer than H. nakamurai (127.6 ± 30.35 cm). The length-weight relationship of H. griseus was formulated as W = 0.0195 LT 2,6344 (R² = 0,9265) and H. nakamurai with the formula W = 0.002 LT 3,1098 (R² = 0.902). Both species  have the size of Lm was bigger than the size of Lc which indicated  to their population vulnerability.
Vegetative anatomy and mycorrhizal morphology of Schoenorchis nivea (Lindl.) Schltr., (Orchidaceae) and their adaptive significance
Authors: Balachandar Mayakrishnan , Ravi Ravichandran Koshila , Nagaraj Kandhasamy , Muthukumar Thangavelu
Published: October 2019

The anatomical description of the vegetative parts (leaf, leaf sheath, stem and root) and mycorrhizal morphology of Schoenorchis nivea (Lindl.) Schltr., belonging to the subfamily Epidendroideae of Orchidaceae was investigated. Leaves were amphistomatic covered by 10-12 μm thick cuticle, stomata paracytic with small and irregular substomatal chambers. Mesophyll homogenous, composed of thin-walled chlorenchymatous cells. Banded water-storage cells abundant in the mesophyll and the largest vascular bundle occurred at the centre of the leaf. The leaf sheath has both adaxial and abaxial epidermis covered with cuticle, homogenous mesophyll, water-storage cells, raphides and vascular bundles. The stem is surrounded by a uniseriate epidermis, cortex consisting of thick-walled fibers and collateral vascular bundles scattered in the ground tissue. Cortical proliferation was evident in S. nivea stem. Root hairs present in root regions were in contact with the substratum. Root hairs frequently branched at their tips. Root possess 2-3 layered velamen, ∩-thickened exodermal cells, O-thickened uniseriate endodermis, and cortex of thin-walled parenchymatous cells containing raphides and water-storage cells. Cover cells present. Xylem arches are 9-11, with vascular tissues embedded in sclerenchymatous cells. Pith composed of thick-walled sclerenchymatous cells with intercellular space. The stomatal characteristics in leaf, the size of water-storage cells and vascular bundles exhibited significant variation in different plant parts. Intact and degenerating pelotons of orchid mycorrhizal fungi were observed in the root cortical cells. The observations of the present study clearly indicate that S. nivea possesses several anatomical adaptations to thrive in epiphytic habitats.
Genetic diversity within local and introduced cultivars of wheat (Triticum aestivum L.) grown under Mediterranean environment as revealed by AFLP markers
Authors: Arabi Mohammed Imad Eddin , Shoaib Amina , Al-Shehadah Eyad , Jawhar Mohammed
Published: October 2019

Information on genetic diversity among cultivars is critical in wheat improvement. In this work, heterogeneity within local and introduced cultivars of bread wheat grown in Syria was investigated using amplified fragment length polymorphism (AFLP) markers. The eight primer pairs were used to detect 177 polymorphic bands among the 21 cultivars resulting in an average of 22.13 (57.3%) polymorphic loci per primer pair. Major allelic frequency ranged from 0.50 to 0.75 with a mean 0.64, and estimated gene diversity was 0.45. Values of average polymorphic information content (PIC) for these markers were estimated to be 0.34. This low value might be attributed to the rigorous selection pressure aimed at cultivar purity and associated breeding practices. Dissimilarity values ranged from 0.32 to 0.66 with an average of 0.54, indicating that such techniques sample distinct genome regions. Three major subgroups of wheat cultivars were identified using the unweighted pair-group method with arithmetic means analysis (UPGMA), with all local cultivars falling into one cluster, which was confirmed by a principal component analysis (PCA). The narrow genetic diversity observed among Syrian wheat cultivars suggests the need of broadening the genetic base of wheat breeding materials, including local landraces.
Isometric beak morphology in Phoenicopterus ruber roseus, Phoenicopteriformes
Authors: Parés-Casanova Pere M. , Arcas Sandra
Published: October 2019

It is well documented that size of various body parts tends to correlate within the same individual. In the current study, we explore the relationship between body weight and some area and lineal beak measurements in a sample of 17 corpses of Greater flamingo Phoenicopterus ruber roseus (10 immatures and 7 adults), collected and after obtaining beak radiographic latero-lateral projections. On images, the following traits were obtained: area of rhinotheca -the sheath covering the maxilla- and gnathotheca -the sheath covering the mandibular-, rhamphotheca height, ocular area, ocular height, ocular width, height, width and area of nares. Our results suggest that some beak measurements are positively correlated with body weight, while nostril area is not. Specifically, rhinotheca and gnathotheca areas and rhamphotheca height were strongly coupled and largely correlated to body weight. The observed differences in beak dimensions are merely a consequence of body weight difference. It is suggested, that the cranial skeleton and musculature are closely linked at least developmentally, allowing for efficient functional integration, but genetic and functional tests must have been performed to reveal the exact nature of the flamingo beak change.
Insecticidal activity of isolated essential oils from three medicinal plants on the biological control agent, Habrobracon hebetor Say (Hymenoptera: Braconidae)
Authors: Asadi Mohammad , Rafiee-Dastjerdi Hooshang , Nouri-Ganbalani Gadir , Naseri Bahram , Hassanpour Mahdi
Published: October 2019

The effects of Allium sativum L. (Alliaceae), Piper nigrum L. (Piperaceae) and Glycyrrhiza glabra L. (Fabaceae) essential oils were investigated on the biological control agent, Habrobracon hebetor Say. The female wasps of H. hebetor were treated by LC30 concentrations of the tested essential oils for 24 h and their demography was investigated. Results indicated that the adult longevity, survival, fecundity, fertility, hatch rate, offspring sex ratio and the other demographic parameters negatively were affected by these essential oils. At the same time, our findings indicated that G. glabra essential oil has the less severe effect on H. hebetor. Accordingly, G. glabra essential oil seems to be a compatible botanical compound with H. hebetor for applying in integrated pest management programs.
Profil Pasien Sakit Kritis yang Dirawat di Pediatric Intensive Care Unit Rumah Sakit Cipto Mangunkusumo berdasar Sistem Skoring Pediatric Logistic Organ Dysfunction-2
Authors: Dewi Rismala , Fatimatuzzuhroh Fatimatuzzuhroh
Published: October 2019

Latar belakang. Skor PELOD-2 digunakan untuk mengetahui disfungsi organ pada anak dengan sakit kritis. Hasil skor PELOD-2 tidak selalu berbanding lurus dengan luaran perawatan anak sakit kritis sehingga tidak selalu dapat digunakan sebagai prediktor luaran dan mortalitas anak yang dirawat di PICU.Tujuan. Mengetahui profil dan luaran pasien sakit kritis yang dirawat berdasar skor PELOD-2.Metode. Penelitian dilakukan secara retrospektif dengan mengambil data rekam medis pasien rawat di ruang intensif anak RSUPN Cipto Mangukusumo, sejak Januari sampai Desember 2018. Pengambilan subjek secara total sampling, penilaian dilakukan pada 24 jam pertama perawatan. Hasil. Diperoleh 477 subjek yang memenuhi kriteria. Subjek sebagian besar berjenis kelamin laki-laki (56,4%), berusia <1 tahun (27,9%), dengan bedah sebagai diagnosis awal terbanyak (65%). Sebagian besar pasien memiliki penyakit kronik (70,4%). Angka mortalitas penelitian ini adalah 10,7%. Mayoritas subjek memiliki lama rawat <7 hari (75,5%). Subjek dengan lama rawat >14 hari memiliki median skor PELOD-2 tiga kali lipat dari subjek dengan lama rawat <7 hari. Titik potong luaran mortalitas skor PELOD-2 pada penelitian ini adalah >5, memiliki spesifisitas 84,5% dan sensitifitas 84,3% dengan nilai AUC skor PELOD-2 dari kurva ROC sebesar 93,4% (IK 95% 90,6–96,2).Kesimpulan. Skor PELOD-2 dapat digunakan untuk memprediksi disfungsi organ yang mengancam kehidupan pada anak tanpa imunosupresi dan semakin tinggi skor PELOD-2 akan diikuti dengan peningkatan lama rawat dan mortalitas.
Analisis Faktor Risiko Sindrom Syok Dengue pada Anak di RSIA Bunda Aliyah Jakarta
Authors: Edwin Johanus , Budiarta Michelle , Edward Klemens
Published: October 2019

Latar belakang. Demam berdarah dengue (DBD) merupakan salah satu masalah kesehatan di Indonesia dengan presentasi klinis yang dipengaruhi oleh tingkat kebocoran plasma. Presentasi klinis terburuk adalah sindrom syok dengue (SSD). Tujuan. Mengidentifikasi faktor risiko SSD pada anak.Metode. Penelitian ini berupa kasus kontrol dengan menggunakan data rekam medik pasien SSD dan DBD berusia 0-17 tahun. Faktor risiko SSD dianalisis dengan uji chi square, Odds ratio, dan regresi logistik.Hasil. Dari penelitian ini didapatkan sampel 129 subjek, terdiri dari 43 kasus SSD dan 86 kasus DBD. Uji chi square menunjukkan bahwa jenis kelamin laki-laki, muntah, nyeri perut, kadar hematokrit ≥46%, dan kadar trombosit ≤50.000/mm3 berhubungan dengan kejadian SSD. Dari hasil analisis regresi logistik didapatkan bahwa jenis kelamin laki-laki, muntah, nyeri perut, kadar hematokrit ≥46%, dan kadar trombosit ≤50.000/mm3 adalah faktor risiko SSD yang bermakna.Kesimpulan. Jenis kelamin laki-laki, muntah, nyeri perut, kadar hematokrit ≥46%, dan kadar trombosit ≤50.000/mm3 adalah faktor risiko SSD yang bermakna.
Osteoporosis dan Osteodistrofi pada Anak
Authors: Soesanti Frida
Published: October 2019

Osteoporosis anak saat ini merupakan salah satu kelainan penting yang melibatkan hampir semua subspesialisasi. Berbeda dengan definisi osteoporosis pada orang dewasa, diagnosis osteoporosis pada anak tidak hanya ditentukan oleh densitas mineral tulang yang diukur dengan DXA (dual energy X-ray absorptiometry). Osteoporosis primer terjadi akibat kelainan genetik, misalnya osteogenesis imperfecta dan osteoporosis juvenil idiopatik. Osteoporosis disebut sekunder jika timbul akibat penyakit kronik yang mendasari atau terapi penyakit tersebut. Kemajuan teknologi kedokteran meningkatkan survival anak-anak dengan penyakit kronik atau penyakit yang mengancam nyawa. Banyak terapi medikamentosa ini memiliki efek jangka panjang pada tubuh, termasuk osteoporosis. Disfungsi endokrin, imobilitas, faktor nutrisi, penyakit kronik dan kondisi inflamasi kronik memengaruhi terjadinya osteoporosis sekunder pada anak. Pada anak dengan penyakit ginjak kronik, terjadi gangguan metabolism tulang, remodeling and modelling tulang yang menyebabkan suatu kondisi yang disebut dengan chronic kidney disease-mineral bone disorders (CKD-MBD), termasuk di dalamnya adalah osteodistrofi renal. Terapi osteoporosis pada anak masih merupakan suatu tantangan tersendiri. Tata laksana terbaik pada osteoporosis sekunder dan CKD-MBD adalah pencegahan. Deteksi dini kemungkinan terjadinya gangguan metabolisme tulang dan osteoporosis penting untuk mengoptimalkan kesehatan tulang anak, mencegah osteoporosis dan kemungkinan fraktur, yang pada akhirnya mengoptimalkan pertumbuhan dan perkembangan anak.
35 Is Weekend Admission Associated With Increased Risk of Post-ERCP Pancreatitis?
Authors: Goyal Abhinav , Chatterjee Kshitij , Rangaswami Janani , Singh Shailender
Published: October 2019

INTRODUCTION:

Pancreatitis is one of the most common complications of Endoscopic Retrograde Cholangiopancreatography (ERCP). There are endoscopist related factors and patient related factors that increase the risk of post-ERCP pancreatitis. However, epidemiologic factors that increase the risk of same are not well known. We aim to study the association between various epidemiologic factors especially weekend admission and post- ERCP pancreatitis.

METHODS:

National Inpatient Sample for years 2009–2013 was used for this study. It is the largest ICD-9 code based inpatient database in the US. ICD-9-CM procedure code 51.10 was used to identify all adults who underwent ERCP. Post-ERCP pancreatitis was identified with ICD-9-CM code 577.0 listed as secondary diagnosis. All hospitalizations with missing age & gender information, or primary diagnosis of pancreatitis were excluded. Mean and percentages were used to summarize continuous and categorical variables respectively. Multivariate logistic regression was used to identify the predictors of post-ERCP pancreatitis. Demographic & hospital characteristics, clinically relevant Elixhauser co-morbidites, pancreatic stent placement, and sphincterotomy were used as covariates for regression model.

RESULTS:

Total of 140859 ERCP(s) were performed during five years. Of these 18870 (13.4%) patients developed post-ERCP pancreatitis and 430 (2.3%) of these died during the hospitalization. Pancreatic duct stent was placed in 4356 patients and 943 (21.6%) of these patients developed post-ERCP pancreatitis. Demographic, hospital characteristics, and outcomes of patients who developed post-ERCP pancreatitis compared to those who didn't are shown in Table 1. On multivariate regression weekend admission (OR = 1.12, P = 0.01), sphincterotomy (OR = 1.48, P < 0.001), pancreatic stent placement (OR = 1.47, P = 0.01), obesity (OR = 1.45, P < 0.001) were some of the factors associated with increased risk of post-ERCP pancreatitis. Teaching hospitals (OR = 0.81, P < 0.001) were associated with lower risk of pancreatitis.

CONCLUSION:

Pancreatic stent placement has been shown to be protective for post-ERCP pancreatitis, however, in our study there were higher odds of pancreatitis in patients receiving pancreatic. This was likely because of pancreatic stents being placed in patients felt to be at higher risk of post ERCP pancreatitis. In conclusion, weekend admission was associated with higher risk, and teaching hospitals with lower risk of developing post-ERCP pancreatitis.
37 Depot Medroxyprogesterone Acetate in the Management of Recurrent Acute Pancreatitis in Patients With Cystic Fibrosis Gene Mutations
Authors: Haydek Christopher , Robbins Gordon , Ahmed Awais , Freedman Steven , Willingham Field
Published: October 2019

INTRODUCTION:

In patients presenting with recurrent acute pancreatitis, cystic fibrosis (CF) gene variants are found at an increased frequency. Pancreatitis also occurs in patients being followed with CF mutations, generally occurring in patients with less severe mutations or in the setting of CF-related sorder (CFRD). There are no established treatment options for CF mutation-related pancreatitis. Some evidence has suggested that lung function fluctuates during the menstrual cycle, and in CF, that estradiol may inhibit chloride secretion. It has been hypothesized that hormonal contraceptives could play a role in modulating the disease process in women with CF. This study examined the impact of depot medroxyprogesterone acetate on the course of recurrent pancreatitis in female patients with established CF gene mutations.

METHODS:

In this single center retrospective study, medical records of all adult female patients with CF and acute recurrent pancreatitis between 2008–2018 were reviewed. Patients were included if they had experienced at least two episodes of acute pancreatitis, had been started on depot medroxyprogesterone, and had at least one CF gene mutation. Patients were excluded if they had developed pancreatitis from gallstones or heavy alcohol use. Total hospitalizations, episodes of pancreatitis, and average lipase values were examined and compared before and after the initiation of the depot medroxyprogesterone.

RESULTS:

A total of 13 patients met the study screening criteria and were recommended to start depot medroxyprogesterone. All patients were Caucasian females with a mean age of 45 years. The average time of treatment from which the endpoints were collected was 5.6 months. After the initiation of the depot medroxyprogesterone, there were no episodes of acute pancreatitis and one hospitalization unrelated to pancreatitis. The average lipase values were significantly decreased (261 units/L vs 41 units/L, P = 0.039) after the patients had been started on depot medroxyprogesterone.

CONCLUSION:

In this cohort, there were no further episodes of recurrent acute pancreatitis following the initiation of depot medroxyprogesterone in female patients with CF mutations. This data will be combined with other institutions shortly to examine the outcomes in a larger retrospective sample. A multicenter prospective study is being developed to study the outcomes being seen clinically and reported here in this sample.
77 Post-ERCP Pancreatitis Rates and NSAID Use in a Community Hospital
Authors: Hyder Jeffrey , Srinivasan Sachin , Agha Yasmine Hussein , Wuthnow Chelsea , Salyers William , Tofteland Nathan
Published: October 2019

INTRODUCTION:

Endoscopic retrograde cholangiopancreatography (ERCP) has been consistently used for more than 50 years as a diagnostic and therapeutic procedure in pancreaticobiliary diseases. However, its use is associated with several adverse effects including bleeding, cholangitis, pancreatitis, intestinal perforation, and death. Of these, post-ERCP pancreatitis (PEP) is the leading cause of morbidity and mortality with an estimated incidence of 1.6–15%. Endoscopic techniques, patient characteristics, and the hospital setting have been noted to put patients at higher risk of developing PEP. Williams et al. reported a significantly increased risk of PEP in community hospitals compared to university hospitals. Rectal NSAIDs, including diclofenac and indomethacin, have shown promising results in several high-quality clinical trials and meta-analysis, especially in high-risk patients. More recent trials failed to show a significant reduction of PEP after NSAID use. There is scant data on the efficacy of rectal NSAIDs in higher risk patients in community hospitals. The aim of this study is to determine if there is an increased risk of PEP in a community hospital and if the use of rectal NSAIDs for high-risk patients is beneficial within a community hospital.

METHODS:

After obtaining IRB approval, the charts of every adult patient admitted to a Wichita, KS community hospital for ERCP in a 2-year time period were reviewed. Primary endpoint was percentage of patients developing PEP. Secondary endpoints included NSAID use in high-risk individuals (Table 1) and the change in incidence of PEP in this group with the use of rectal NSAID.

RESULTS:

422 patients underwent ERCP during the study period. Of these, about 212 (50.2%) were noted to have at least 1 high risk factor to develop PEP. 24 (5.6%) of the patients received rectal NSAIDs, of which 10 patients were noted to be high-risk for PEP. 9 patients (2.1%) developed PEP during the study time period. Of the nine patients, 3 patients were high risk and did not receive any NSAIDs. The use of NSAIDs did not cause a significant reduction in PEP in the high-risk group (p-value 0.7) or overall (P-value 0.66).

CONCLUSION:

PEP rates in a community hospital setting have not been well established. Our study reports an incidence of 2.1%, comparable to the PEP incidence described in academic trials. Despite the unstandardized use of rectal NSAIDs noted in the study population, there appears to be no significant benefit in their use overall or in the high-risk population.
128 Prevalence and Predictors of Adenomas in Young Adults Undergoing Diagnostic Colonoscopy in a Multicenter Midwest U.S. Cohort
Authors: Dave Devashree , Lu Ray , Klair Jagpal S. , Kassim Thamer , Ashfaq Muhammad , Chandra Subhash , Murali Arvind
Published: October 2019

INTRODUCTION:

Colorectal cancer incidence in population younger than 50 years of age is increasing in the United States. Data on prevalence of colon neoplastic polyps in young adults remains spars, especially in population <40 years of age. We aimed to identify the prevalence of adenoma, sessile serrated polyp and advanced adenoma in young adults undergoing diagnostic colonoscopy stratified by age 20–30, 31–40 and 41–49 years.

METHODS:

We reviewed diagnostic colonoscopies performed for lower gastrointestinal symptoms in young adult ≤49 years by 18 gastroenterologists at two institutions in the Midwest from October 2016 to April 2019. Patients with strong family history of colorectal carcinoma were excluded.

RESULTS:

We included 575 patients, mean age 34 (8) years, 220 (38%) were males, and mean BMI 30 (8), Table 1. Colon neoplastic polyps (adenoma and/or sessile serrated polyps) were noted in 116 (20%) patients, adenomas in 110 (19%), SSP/A in 30 (5%) patients and advanced adenoma was in 29 (5%). The prevalence of neoplastic polyps was 5% in patients <30 years of age, 24% in age 30–40, and 37% in age 40–49 years. Similar trend was noted for each of adenomas, SSP/A, and advanced adenomas (Table 2). Mix of adenoma and SSP/A were seen in 25 (4%) patients; with prevalence of 0.5% for age <30, 5.8% for age 30–40, and 7.4% for age 41–49 (Table 2). Males had a significantly higher adenoma prevalence (P < 0.001); no significant gender differences were noted in the prevalence of SSP/A (P = 0.17) (Table 3).

CONCLUSION:

Patients between 30 to 49 years of age undergoing diagnostic colonoscopy in US Midwest population is significantly higher than previously reported prevalence of neoplastic colon polyps. This is consistent with the reported increase in the incidence of colorectal neoplasia in this population. Therefore, a careful inspection for colon polyps is recommended during diagnostic colonoscopies in this population.
197 Annual Hospitalization and Mortality Trends Among Patients With Sickle Cell Disease and Clostridioides difficile Infection
Authors: Sharma Prabin , Hundt Melanie , Aguilar Rodrigo , Nader Mark , Yadav Siddhartha , Rawlings Ruth , Feuerstadt Paul
Published: October 2019

INTRODUCTION:

Frequent hospitalizations, antibiotic exposure, dysbiosis and impaired immune function associated with Sickle Cell Disease (SCD) predisposes pts to Clostridioides difficile infection (CDI). As a result, we hypothesize that the incidence of CDI in those with SCD has been increasing in the United States and that those with SCD and CDI have worse outcomes.

METHODS:

Using ICD-9 codes within the National Inpatient Sample Database, we identified pts between 2005–2012 with SCD. For each pt, we obtained various factors (e.g., demographics, medical co-morbidities and outcomes), grouped them as SCD and CDI (SCD + CDI) or those with SCD without CDI (SCD − CDI) and statistically compared. Using propensity score matching, SCD + CDI pts were matched with SCD − CDI in 1:1 ratio. All categorical variables were compared with Pearson's χ2 test and continuous variables were analyzed with paired t-test (SAS 9.4, Cary, NC).

RESULTS:

Among 747,127 hospitalized pts with SCD, 804 (0.1%) had SCD + CDI. SCD + CDI were more likely to be African Americans (88.0% v 32.7%, P < 0.0001), smokers (10.5% v 7.1%, P < 0.0001), and had a higher association with HIV (2.2% v 0.9%, P = 0.0001), Hepatitis C (1.6% v 0.8%, P = 0.007), chronic liver disease (6.0% v 2.8%, P < 0.0001), cholelithiasis (4.0% v 2.2%, P < 0.001), acute pancreatitis (2.5% v 1.4%, P < 0.0001) and chronic pancreatitis (2.0% v 0.6%, P < 0.0001). SCD + CDI were less likely to be associated with atrial fibrillation (4.9% v 15.1%, P < 0.0001), CHF (13.9% v 18.5%, P = 0.001) and hypothyroidism (3.7% v 9.4%, P < 0.0001). SCD + CDI had significantly higher complication rates including acute chest syndrome (4.4% v 1.8%, P < 0.0001), splenic sequestration (1.6% v 0.3%, P < 0.0001), and vaso-occlusive crises (2.7% v 1.4%, P < 0.0001). Though prematch inpatient mortality was not different between the two groups (5.9% v 6.5%, P = 0.43), SCD + CDI pts had significantly higher inpatient mortality than SCD − CDI pts after match (5.6% v 3.3%, P = 0.04). Over time, we noted increases in hospitalization-requirement and inpatient mortality for SCD + CDI pts (Tables 1 and 2).

CONCLUSION:

Ours is the largest study exploring the association of CDI in SCD patients. Hospitalization rates and mortality rates for hospitalized SCD pts with CDI has been rising in the United States and it seems that hospitalized SCD pts with CDI are more likely to develop SCD related complications and have a higher mortality. In SCD+CDI pts, clinicians should consider more aggressive initial treatment to minimize these poor outcomes.
201 Efficacy of Fecal Microbiota Transplantation for Acute Graft Versus Host Disease in the Gut: A Systematic Review and Meta-Analysis
Authors: Tariq Raseen , Furqan Fateeha , Pardi Darrell , Khanna Sahil
Published: October 2019

INTRODUCTION:

Graft versus Host disease (GVHD) is a major cause of mortality and morbidity in allogenic hematopoietic stem cell transplant recipients (HSCT). Gut microbiome dysbiosis secondary to conditioning regimens (which include antibiotics) in HSCT, appears to play a significant role in gut GVHD development through its interaction with the immune system. Fecal Microbiota Transplantation (FMT) has been explored for the treatment of gut GVHD owing to its ability to restore the gut microbiome. We performed a systemic review and meta-analysis to review the efficacy and safety of FMT for gut GVHD.

METHODS:

A systematic search of Medline, Embase, and Web of Science was performed from January 2000 through May 2019. Articles included for meta-analysis were observational studies which included patients with steroid-dependent or resistant gut GVHD after HSCT who underwent one or more FMTs. The main outcomes were pooled proportions of patients achieving response defined as a decrease in gastrointestinal symptoms including stool volume and frequency or reduction of steroid or immunosuppressant dose. Partial response was defined as a decrease of gastrointestinal symptoms followed by recurrence of symptoms.

RESULTS:

Five studies (4 prospective single arm pilot studies and 1 retrospective case series) including 37 patients were included with follow up ranging from 1–13 months. Three studies used naso-duodenal route, one used oral capsules and one used colonoscopy for FMT. Median number of FMTs per study was 2 (range, 1–6). Unrelated donors were used in 4 studies. A total of 23/37 patients achieved complete response with a pooled proportion of 61.0% (95% confidence interval [CI] 46–76.0), with no heterogeneity (I2 = 0%). Partial response was seen in 3 patients. Hence, the overall response rate was 74.0% (95% CI 49–93, I2 53%). FMT was generally well tolerated. No treatment-related mortality was reported by any study. Serious adverse events were reported in 3 patients (hypoxia in one patient and bacteremia in two patients) but were not directly attributed to FMT.

CONCLUSION:

FMT is a promising modality for management of gut GVHD and appears to be safe as a salvage therapy based on the current limited data. Ongoing placebo-controlled prospective clinical trials will help to further establish its safety and efficacy.
233  Managing Fecal Immunochemical Test (FIT) at Population Health Level in an Urban Safety Net Hospital
Authors: Elangovan Abbinaya , Greco Peter J. , Davis Katherine R. , Kaelber David C. , Sandhu Dalbir S.
Published: October 2019

INTRODUCTION:

Annual fecal immunochemical test (FIT) is a non-invasive screening method recommended for individuals at average risk of colorectal cancer (CRC). Lack of FIT orders is perceived as a barrier to complete CRC screening. We aimed to evaluate bulk ordering FIT as a population health level methodology in improving CRC screening rates.

METHODS:

Individuals 50–75 years old, who visited a primary care provider (PCP) in the MetroHealth System within the preceding 2 years were reviewed between 10/2018 and 04/2019. Individuals at average-risk of CRC who neither completed FIT in the preceding 11 months nor were assigned to the colonoscopy screening track were identified via querying of the electronic health record (EHR). Bulk orders were placed on eligible individuals once a month, using PCP as the authorizing provider or residency program director for residents. Individuals were informed of the order via the most appropriate channel: personal health record message (MyChart), email, or secure text message mediated by third-party texting services (Clintell). An automated daily process canceled any obsolete bulk FIT orders when patients turned 76 years old, switched to colonoscopy track, or had another FIT order resulted. FIT orders were released when the patient visited the clinic or requested the kit to be mailed. Individuals with a positive FIT were contacted by designated staff to schedule a follow-up colonoscopy. FIT numbers at each step of the bulk order method were compared to regular orders in usual care (FIT orders placed by a provider during an outpatient visit) to analyze differences in outcome.

RESULTS:

From 10/2018 to 04/2019, 27,212 bulk orders and 13,756 regular orders were placed. Only 8.5% of bulk orders were released compared to regular orders (91.6%) but the released orders were completed at similar rates in either group. Among those with a positive FIT, a significantly higher number had a follow-up colonoscopy within 120 days in the bulk order (67.8%) compared to usual care (53.2%), P = 0.04. 33.9% of positive bulk FIT detected an adenoma compared to 29.5% of positive routine care FIT, P = 0.50.

CONCLUSION:

Managing FIT at population health level provides a time-efficient way to identify patients due for CRC screening in an urban safety-net hospital. Bulk ordering bypasses the need for a PCP encounter for order placement. Bulk ordering FIT has shown better follow up rates compared to the traditional method and may ultimately improve CRC detection.
305 Clinical Significance of Pseudopolyps for Patients With Inflammatory Bowel Disease
Authors: Lewis Ayanna E. , Kirchgesner Julien , Dray Xavier , Svrcek Magali , Beaugerie Laurent
Published: October 2019

INTRODUCTION:

Postinflammatory polyps (PIPs), often referred to as “pseudopolyps,” have previously been associated with an increased risk for colorectal neoplasia (CRN) in inflammatory bowel disease (IBD) patients. This has resulted in some IBD patients with PIPs receiving a more aggressive colorectal cancer (CRC) surveillance strategy. However, newer studies have questioned whether the presence of PIPs increases overall risk for CRN. Recently, a multi-centered retrospective study did not find any association between the presence of PIPs in patients with IBD undergoing CRC surveillance and the development of CRN. We also suspected that PIPs did not confer any increased risk of CRN and speculated that this may in fact be explained by the degree of inflammation in the associated colonic segments. Our study sought to better understand the relationship between the presence of PIPs, colonic inflammation and subsequent risk for development of CRN.

METHODS:

We performed a retrospective analysis of patients entered from 1/1/1996 to 9/1/2018 in the MICISTA IBD registry at Saint Antoine Hospital in France. Patients were included if they had PIPs on at least one colonoscopy. Those with a questionable IBD diagnosis or without a colon were excluded. Endoscopy reports were divided into 4 segments for analysis. Each segment was then graded according to the number of PIPs identified per segment and the degree of endoscopic inflammation. The corresponding pathology reports were then also reviewed by segment for histological IBD activity using the Nancy histological index. Patients were also compared to a historical cohort of IBD patients without PIPs. Logistical regression was used to identify factors associated with detection of neoplasia in segments with and without PIPs.

RESULTS:

471 IBD patients were identified with a total of 607 endoscopies containing PIPs. 40 patients were found to have CRN. Preliminary analysis did not show any clear association between the presence of PIPs and the subsequent development of colorectal neoplasia.

CONCLUSION:

PIPs continue to pose a clinical dilemma for risk stratifying patients with IBD. Newer studies appear to upend the old knowledge that PIPs mandate a more aggressive approach to CRC surveillance. We suspect, with carefully performed endoscopy, these IBD patients may not require colonoscopies any more frequently than those without PIPs. This less intensive management strategy may lead to significant health cost-savings as well as improved quality of life for patients.