bluuebunny/crossref_metadata_2025_split huggingface dataset:
P853 Amoebic colitis mimicking inflammatory bowel disease: a report of four cases
Authors: Tufail Q , O’Meara D , Thi A , Lim F , Richards C 
Published: January 2020

Abstract

Background
Amoebic colitis, caused by Entamoeba histolytica is an emerging diagnostic challenge for gastroenterologists in developed countries. Due to the similarity of symptoms and endoscopic findings, it can be easily misdiagnosed as inflammatory bowel disease (IBD) with a potentially devastating outcome especially if patient receives immunosuppression. The aim of this study is to look into the misdiagnosed cases to identify the challenges in differentiating amoebic colitis from IBD and to outline strategies to avoid this

Methods
Clinical and electronic case notes for the 4 patients, who were misdiagnosed as IBD between September 2015 to February 2019 at University Hospitals of Leicester U.K. were reviewed. The histology of resected colon specimens and endoscopic colonic biopsies were re-reviewed specifically for amoebic trophozoites.

Results
Three were male and 1 female. 1 patient was Caucasian while 3 patients were British Asian. Their mean age was 47.75 years (range 28–71). 3 cases were new IBD presentations while 1 patient was misdiagnosed as IBD since 2015. Two patients had a travel history to India and travelled to South East Asia 12 months prior to presentation. The travel history for 1 patient was not available. All 4 cases presented with bloody diarrhoea and had an endoscopic examination around the time of diagnosis which suggested acute inflammation likely IBD. Three were treated as ulcerative colitis while 1 patient was treated as Crohn’s disease. One patient required rescue therapy with cyclosporin while on intravenous steroids. As clinical symptoms worsened with rescue therapy, the patient required a subtotal colectomy. Similarly the patient who was treated for Crohn’s disease with Azathioprine and intravenous steroids, required subtotal colectomy due to recurrent flare ups. The other two cases were successfully treated with antimicrobial after the diagnosis of amoebic colitis although one of them received adalimumab prior to the correct diagnosis. The diagnosis of amoebic colitis was made through histological examination of the resected colon in 2 patients, colonic biopsy in 1 patient and stool E. histolytica DNA polymerase chain reaction (PCR) in 1 patient.

Conclusion
All 4 cases who were misdiagnosed as IBD had the diagnostic challenge of differentiating IBD from amoebic colitis due to similarity of symptoms and the endoscopic findings. Travel history is an important clue and should be considered for any patient presenting with colitis. New local guidelines were introduced to screen all patient with colitis for E. histolytica with serology and stool PCR. Patients requiring immunosuppression for suspected IBD are commenced on antimicrobial cover until E. histolytica results are available.
N01 Factors related to self-medication with corticosteroids, aminosalicylates or analgesics and reasons given by patients with ulcerative colitis from Spain
Authors: Cañas M , Mesonero F , Rodriguez-Lago I , Savini C , Saldaña R , Feo-Luca L , FERNANDEZ S , Cea-Calvo L , Juliá B 
Published: January 2020

Abstract

Background
Self-medication, when agreed with the treating physician, is an essential component of self-care. We describe the associated factors and the reasons related to the practice of self-medication with steroids, aminosalcylates (AS) or analgesics in patients with ulcerative colitis (UC) in Spain.

Methods
Information was anonymoulsy provided by patients through a web-based cross-sectional survey developed by 3 inflammatory bowel disease (IBD) experts from the Spanish working group on IBD (GETECCU), one nurse from the Spanish nursing working group on IBD (GETEII) and two patients from the Spanish confederation of associations of patients with IBD (ACCU). Participants voluntarily answered to the survey based on their own experiences from February to April 2019. Reasons for self-medication are described as frequencies and associated factors through logistic regression models.

Results
A total of 546 patients (61% women, mean age 40 years old) responded. Of these, 36 (7%) patients self-medicated with corticosteroids, and was associated with higher number of UC self-reported flares during the past year [OR 7 (95% CI: 1–32), p &lt; 0.001] and follow-up by a general gastroenterologist instead of in an IBD unit [OR 0.08 (0.01–0.5), p = 0.007]. Self-medication with AS was reported by 90 patients (16%) [oral 20 (22%) and topic 70 (78%)], and was associated with treatment with topical AS [OR 3 (95% CI: 2–4), p &lt; 0.001]. Finally, 320 patients (59%) self-medicated with analgesics and this was associated with female gender [OR 2 (95% CI: 1–3), p &lt; 0.001], need of intravenous (IV) biological therapy [OR 3 (95% CI: 2–5) p &lt; 0.001] and emergency room visits within the past year [OR 3 (95% CI: 2–4), p &lt; 0.001]. The main reasons for self-medication were ‘need for quick relief of symptoms’, ‘fear of worsening’ and, for AS, ‘agreed with the doctor’ (Table 1).

Conclusion
Self-medication in UC is not a common practice, but most of the times it is not agreed with the treating physician. Self-medication with analgesics was more frequent, probably reflecting a need of self-care. Female sex, number of flares, IV treatment, and need of emergency room care were factors associated to self-medication.
This project was endorsed by GETECCU, GETEII, ACCU and funded by MSD Spain.
N03 Disease burden of patients with inflammatory bowel disease from the viewpoint of QOL and depression
Authors: Takahashi M , Aoyama N , Nunotani M 
Published: January 2020

Abstract

Background
Inflammatory bowel disease (IBD) can lead to a decreased quality of life (QOL), and mental care is necessary for patients with IBD. Disease burden (patient burden caused by a disease) attracts attention from the viewpoint of QOL and mental care. However, the relationship between QOL and depression in patients with IBD has not yet been adequately researched. Therefore, we aimed to examine disease burden and the relationship between QOL and depression in Japanese patients with IBD.

Methods
The present study enrolled 200 patients with ulcerative colitis (UC) and 31 patients with Crohn’s disease (CD) who were treated in Aoyama Clinic between July 2018 and September 2018. We evaluated QOL using a 24-item questionnaire which we made originally based on previous studies. Next, we evaluated depression according to the Patient Health Questionnaire-9 (PHQ-9). Partial Mayo score of less than 2 points indicated UC remission, whereas the CDAI score of less than 150 points denoted CD remission. We analysed the difference in QOL and depression scores between UC and CD, the age or sex, the disease activity, and the time since diagnosis using chi-square test. The association between QOL and depression scores was analysed using Spearman’s rank correlation coefficient. This study was approved by the Aoyama Clinic Ethical Review Board (2018-1).

Results
Decrease in QOL (scale ≥ 7) and depression (PHQ-9 score ≥ 10) in active phase were higher than those in remission phase (decrease in QOL among UC in active phase: 6.3 ± 4.8, among UC remission phase: 2.2 ± 3.4; p &lt; 0.05, among CD in active phase: 3.8 ± 3.3, among CD remission phase: 2.3 ± 2.7, depression score among UC in active phase: 4.9 ± 4.8, among UC remission phase: 3.1 ± 3.8; p &lt; 0.05, among CD in active phase: 3.8 ± 3.3, among CD remission phase: 2.3 ± 2.7), but no difference was noted in the age or sex and disease duration. Meanwhile, the QOL decrease and depression score in UC as a whole (r = 0.397, p = 0.000) positively correlated. In remission, the correlation in women (r = 0.385, p = 0.000) was considerably higher than that in men (r = 0.290, p = 0.007). Factors regarding QOL decrease in remission were carcinogenesis, defecation frequency, surgery, economic matters, relapse, lavatory, and heredity.

Conclusion
Even in UC remission and when QOL decrease is mild, women strongly feel a mental burden; thus, they should be given the appropriate care. Disease burden including QOL and mental care is an important point that medical staff and physicians should deal with together.
N07 Patient reported outcome measures collected from patients using a digital tablet: early benefits
Authors: Avery P , Blackmore K , Angel C 
Published: January 2020

Abstract

Background
At a district general hospital (DGH) on the south coast of England the inflammatory bowel disease (IBD) nurse led service introduced an eHealth system in 2015 linked to the IBD registry but limited to access via a desktop limiting flexibility. In liaison with the IBD registry and the software developer the lead nurse instigated an upgrade to the system. This allows patients access both remotely and via a digital tablet in outpatients. Discussion is being had about the best way to collect patient reported outcome measures (PROMS) both for large data analyse and local patient benefit. This presentation of the first 3 months collection of the PROMS seeks to show the benefit of these data locally

Methods
PROMS were gathered from both Consultant and Nurse led clinics from July 2019 to the 22 October 2019. Patients were asked to fill in the IBD control PROM (this PROM forms part of the IBD registry Data set) on a tablet before entering the consultation room. Additionally a disease activity score either the Harvey Bradshaw Score (HBI) or the Simple Clinical Colitis activity index (SCCAI) is collected at the same time. These scores were then extracted from the system and evaluated using a descriptive data analysis approach.

Results
After Data cleansing 200 records are shown in Table 1 covering all disease sub-types.
Fatigue was the most commonly reported complication of IBD in addition,126 patients who attended outpatients reported a wellness score of above 75 out of 100 isolating the wellness score from the PROM score allowed a comparison with the corresponding disease activity score in these patients and correlated in 95% of UC Patients and CD 84% (see Table 2).

Conclusion
Fatigue is a widely reported symptom of IBD as well as pain and anxiety or depression. These data confirm this trend but also present the first local population information for the IBD service at this DGH. When looking at the impact of these scores there is an opportunity to identify patients that may need medically optimising. The patients that remain could then be targeted with support services and a business case for counselling is now planned. In addition to this together with self-testing with IBDoc ® the PROMs and disease activity scores provide opportunity for remote management of some patients. These PROMs collected from patients using a tablet in outpatients at a DGH show promising value for service development.
N08 IBD Home at GHP Stockholm Gastro Center in Sweden
Authors: Jäghult S 
Published: January 2020

Abstract

Background
Patients with IBD and with biological treatment often need close monitoring. In this study, a digital tool was used to meet the patients′ need and increase their participation. IBD Home is a cell phone application that is connected to the national quality registry, SWIBREG. It offers the patients to register their symptoms and to perform a home-test of faecal kalprotectin, the result transmitted directly to the registry. At the Stockholm Gastro Center we decided to offer inclusion in IBD Home to all patients on biological treatment. The aim of this study was to investigate the functionality of IBD Home from the patients and the health care professionals point of view, and to investigate if the patients experienced an increased participation by monitoring with IBD Home.

Methods
In March 2018, a letter with information about IBD Home and an offer to use the tool was sent to all patients with biological treatment. A letter of reminder was sent after two months. Those who accepted were included and got information about how to download the application. In December, both patients and health care professionals got a questionnaire concerning IBD Home.

Results
A total of 166 patients on biological treatment were offered monitoring by IBD Home and 89 (53%) accepted. When answering the evaluation, 79 patients were active in using IBD Home. Causes for inactivity were stated as: too old phone model (n = 1), technical differences (n = 2), worries concerning the security of the system (n = 1), and others e.g. ‘forgotten about it’ and ‘did not find the time to do it’. Only 27 patients (34%) left home-test faecal kalprotectin on a regular basis. The questionnaire was answered by 27 patients (34%). The majority (n = 24) stated that it was easy to install IBD Home. A total of nine patients noted that their participation in their own health care had increased, while the majority (n = 16) stated that there was no difference. A total of five nurses and three gastroenterologists answered the questionnaire. Those using the manual for including patients in IBD Home and the manual to interpret values expressed them to be very clear or fairly clear (n = 4). Four health care professionals had never used the manuals. The majority (n = 6), had used IBD Home in the clinical work and regarded it as useful.

Conclusion
Patients using IBD Home experiences the tool to be very easy to use but most of them did not experience any improvements concerning participation in their own care. The response rate was however low. It may be some difficulties to get started with the home-test faecal kalprotectin since only 34% are using it on a regular basis. The health care professionals using IBD Home in their clinical work found it useful.
N15 A ‘real-world’ observational multi-centre study comparing the side effects and patient acceptability of budesonide MMX with prednisolone in patients with mild to moderate ulcerative colitis
Authors: Kearns J , Scullion L , Masterson C , Kennedy N , Butcher C 
Published: January 2020

Abstract

Background
Budesonide MMX is indicated for the induction of remission in mild to moderate Ulcerative Colitis (UC) patients when 5-ASA treatment is not sufficient. Unlike traditional first-generation glucocorticoid steroids such as prednisolone, budesonide MMX has demonstrated a robust safety profile, comparable to placebo in several randomised controlled trials1,2,3. There is however limited real-world evidence to substantiate this safety claim in clinical practice. The aim of this observational analysis is to evaluate the tolerability and ease of administration of budesonide MMX in the real-world setting using prednisolone as a benchmark.

Methods
Patients receiving treatment for mild to moderate UC were identified in 3 treatment centres between April and October 2019. After providing privacy and data consent, patients completed a detailed nurse-led questionnaire regarding their experiences with prednisolone treatment. Following 6 weeks of therapy with budesonide MMX, patients were sent a follow-up questionnaire. Data from both the initial and subsequent questionnaires were entered by the nurse into a database for assimilation and analysis.

Results
Twenty-eight patients completed initial and follow-up questionnaires. Of these, 78.6% (n = 22) had experienced ≥1 prednisolone-related side effects. In comparison, following treatment with budesonide MMX, 21.4% (n = 6) reported ≥1 side effects. Instances of these side effects are shown in Figure 1.
46.4% of patients (n = 13) reported the impact of prednisolone-related side effects on daily life as moderate or severe vs. 7.1% (n = 2) following treatment with budesonide MMX. By week 2 of treatment with budesonide MMX, rectal bleeding was resolved in 32.1% of patients (n = 9) and stool frequency in 35.7% (n = 10). 93.1% (n = 27) found the instructions to take budesonide MMX given by the health care professional very easy to understand and of those expressing a preference, 71.1% of patients (n = 19) would take budesonide MMX again if prescribed. Additional data will be presented.

Conclusion
Data from this ‘real-world’ observational study appear to support the safely profile of budesonide MMX reported in clinical trials. The incidence of patients who experienced &gt; 1 side-effect was nearly 4 times lower for budesonide vs. prednisolone. In addition, budesonide MMX therapy was acceptable to the majority of patients and accompanying instructions easy to understand. Additional data will be presented.

References
41 Geometric change in valvular apparatus during tricuspid repair for severe tricuspid regurgitation
Authors: Obase K , Matsumaru I , Nakaji S , Miura T , Eishi K 
Published: January 2020

Abstract

Background
For repairing severe tricuspid regurgitation (TR) with leaflet tethering, our team employs spiral suspension procedure, in which papillary muscles (PMs) are approximated and suspended towards annulus by suture in addition to annuloplasty.

Purpose
To visualize subtricuspid apparatus and investigate its geometric change by the procedure, comparing with annuloplasty alone.

Methods
11 patients who underwent spiral suspension and 10 patients who underwent annuloplasty alone were studied. Using 3D dataset derived from transesophgeal echocardiography with transgastric approach, the distances between the mid septal annulus (point C) and the anterior PM tip (point A) and posterior PM (point P) were calculated. Also, annular perimeter, leaflet surface area and tenting height were measured

Results
In all cases, PM tips could be visualized and identified for the measurements. By spiral suspension, the distance CA and tenting height were significantly reduced. On the other hand, by annuloplasty alone, CA and tenting height were likely to be increased but statistically not significant.

Conclusions
Spiral suspension ameliorated leaflet tethering with relocating PMs. Annuloplasty alone reduced leaflet surface area, which indicates increase of coaptation surface. Interestingly, PM tip- annulus distance and tenting height were possibly increased by annuloplasty. Further investigation is need in large number.
Result of measurements Annuloplasty alone Spiral suspension Pre-op Post-op Pre-op Post-op Annular perimeter, mm 120.9 ± 11.2 78.8 ± 5.1* 142.4 ± 18.2* 81.1 ± 6.4** Leaflet surface area, cm2 13.1 ± 3.1 5.6 ± 0.9* 19.3 ± 4.8* 5.8 ± 0.8** Tenting height, mm 2.8 ± 2.3 3.1 ± 1.2 7.0 ± 4.8* 2.9 ± 2.6** CA, mm 27.3 ± 3.9 29.1 ± 6.2 35.7 ± 6.9* 29.6 ± 5.2** CP, mm 33.1 ± 6.0 33.8 ± 9.4 38.5 ± 8.2 33.9 ± 6.1 *p &lt; 0.05, vs Annuloplasty alone pre-op **p &lt; 0.05, vs Spiral suspension pre-op
Abstract 41 Figure. Pre- and post-operative valve apparatus
87 A gynaecological cause of right heart failure
Authors: Wong C Y 
Published: January 2020

Abstract

Introduction
A 68-year-old lady complained of pelvic pain associated with progressive abdominal distension over few months. Physical examination revealed ascites, smooth hepatomegaly and lower limb edema. CT scan of abdomen and pelvis showed a 4 cm x 5 cm right ovarian mass without other intraabdominal lesion. Surgical excision of the ovarian mass was performed with clear resection margin. The ascitic fluid was negative for malignant cells. However, the patient had persistent ascites and lower limb edema after surgery. The gynaecologist suspected that she might have cardiac problems.

Procedure
Transthoracic echocardiogram was performed. The right atrium and ventricle were markedly enlarged. The tricuspid valve leaflets appeared retracted and sclerotic, with failed coaptation during systole (Figure A), severe tricuspid regurgitation (Figure B) and marked dilatation of inferior vena cava without respiratory variation. The pulmomary valve was not well visualized on 2D images. Continuous wave Doppler across pulmonary valve demonstrated short pressure half time 66 msec and premature termination of diastolic flow (Figure C), suggestive of severe pulmonary regurgitation. There was no intracardiac shunt. Left sided valves were unremarkable. Additional tranesophageal echocardiogram allowed better assessment of pulmonary valve, which revealed one of the cusps to be thickened, retracted and immobile on real time 3D images (Figure D, arrow).

Discussion
The ovarian mass was confirmed to be a carcinoid tumour. Due to its direct drainage into systemic venous circulation the vasoactive substances (serotonin, prostaglandin etc) reach the right heart directly without being metabolized by liver, resulting in plaque like deposit of fibrous tissue on the endocardium and valve surfaces, leading to classical appearance of thickened, retracted and immobile leaflet and subsequent valvular regurgitation or, less commonly, stenosis. Left-sided valve disease is less common, and may occur in cases of bronchial carcinoid or in presence of atrial right to left shunt (e.g. PFO). Urinary 5-hydroxyindoleacetic acid (5-HIAA) is a useful non-invasive diagnostic test. Carcinoid heart disease usually does not regress even the tumour is treated, and valve replacement is the only definitive curative treatment. This lady received tricuspid and pulmonary valve replacement with subsequent symptom resolution and chest X-ray showed marked reduction of cardiomegaly (Figure E).

Conclusion
A baseline echocardiogram is recommended for assessment valvular involvement in patient with carcinoid tumour, as the cardiac symptoms may be mistaken to be related to regional spread of tumour. Pulmonary valve is very often the "forgotten" valve in many Echo studies. However, it is crucial to have detailed assessment (with aids by 3D images or TEE) due to its implication to the surgical treatment planning.
Abstract 87 Figure.
91 Mitral fracking: an unusual complication of infective endocarditis
Authors: Cespon Fernandez M , Basalo Carbajales M , Munoz Pousa I , Blanco Gonzalez E , Bilbao Quesada R , Castineira Busto M , Gonzalez Rios C , Matajira Chia T M , Pazos Lopez P , Calvo Iglesias F 
Published: January 2020

Abstract
The conglomerate of microorganisms, inflammatory cells, fibrin and platelets that constitutes the characteristic lesion of infectious endocarditis, that is, vegetation, was considered as a major criterion of infectious endocarditis in the 90s thanks to the development of ultrasound. Ecocardiography allows the diagnosis of complications derived from the infection, such as valvular perforation, prosthetic dehiscence, fistula or abscesses. One of the most infrequent complications is the mitral pseudoaneurysm. It has its origin in the impact of a jet of aortic regurgitation on the anterior leaflet of the mitral valve, which is why we have called it mitral fracking.
A 60-year-old man who had a recent history of pneumonia and for whom he was still receiving antibiotic treatment, debuted suddenly with dyspnea of minimal effort. He went to a cardiology clinic where he was found to have severe mitral regurgitation. He was directly derived to cardiac surgery of our hospital. Prior to the intervention, a transesophageal ultrasound study was performed in our department, which showed the following findings: a bicuspid aortic valve with a small vegetation on its aortic surface (Figure A, surgical piece), a protuberance on the anterior mitral leaflet (Figure B) with internal flow that caused systolic expansion towards the atrium (Figure C) and diastolic collapse towards the ventricle (figure D): the mitral pseudoaneurysm.
The therapeutic action was based on the replacement of both valves with mechanical prostheses. The blood cultures were negative, but the surgical piece revealed unequivocal histological findings of infectious endocarditis. Currently, the patient is stable and the valves are normofunctional in the regular follow-up controls.
Abstract 91 Figure.