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Sexually Transmitted Infections Nov 2020We explored the association between nucleic acid amplification testing (NAAT) and rectal microscopy/proctoscopy findings and correlates of rectal STIs among 150 gay and...
OBJECTIVES
We explored the association between nucleic acid amplification testing (NAAT) and rectal microscopy/proctoscopy findings and correlates of rectal STIs among 150 gay and bisexual men (GBM) diagnosed with proctitis at the Sydney Sexual Health Centre from March 2016 to October 2017.
METHODS
From case files, we analysed risk behaviours, microscopy, proctoscopy and NAAT results for rectal STIs (, , , herpes simplex virus type 1/2, lymphogranuloma venereum and syphilis). χ test assessed the association between microscopy/proctoscopy findings and NAAT results. Linear regression assessed the association between NAAT positivity and correlates of rectal STIs.
RESULTS
The mean age was 32.5 (9.8) years, 43% (65/150) were taking pre-exposure prophylaxis, 17% (26/150) were HIV positive and 24% (36/147) had multiple rectal STIs.Among GBM with documented proctoscopy findings (n=113), 58% (65/113) had discharge, 36% (41/113) had anorectal erythema and 25% (28/113) had bleeding. A quarter of GBM (28/113) had negative proctoscopy findings.Discharge found on proctoscopy (p=0.001), positive HIV status (p=0.030) and time since last receptive anal intercourse (p=0.028) were independently associated with NAAT positivity for any rectal STI. Discharge had a positive likelihood ratio of 1.6 (95% CI 1.0 to 2.4).Among those with documented microscopy findings (n=69), 59% (41/69) and 41% (28/69) were NAAT positive and negative, respectively. Among NAAT-positive GBM, 27 (66%) had polymorphonuclear cells (PMNs) (mean number of PMNs, 10 (SD 9) cells per oil immersion field), 1 (2%) had Gram-negative intracellular diplococci and 11 (27%) had negative findings. There was no significant association between microscopy findings and NAAT results (p=0.651) or the number of rectal STI (p=0.279).
CONCLUSION
Microscopy does not reliably provide information necessary to tailor the management of GBM diagnosed with proctitis. Discharge found during proctoscopy may identify GBM with rectal STI. Services should consider recommendations to perform these investigations.
Topics: Adult; Australia; Health Risk Behaviors; Humans; Male; Microscopy; Nucleic Acid Amplification Techniques; Proctitis; Proctoscopy; Rectum; Sexual and Gender Minorities; Sexuality; Sexually Transmitted Diseases; Young Adult
PubMed: 32001659
DOI: 10.1136/sextrans-2019-054197 -
The Journal of Allergy and Clinical... May 2020
Topics: Food Hypersensitivity; Humans; Occult Blood; Pediatricians; Proctocolitis; Prospective Studies
PubMed: 32389280
DOI: 10.1016/j.jaip.2019.12.031 -
BMJ Case Reports Jan 2023Monkeypox is a viral zoonotic infection which has rapidly increased in incidence and spread globally since May 2022. There have been reports of rectal complications of...
Monkeypox is a viral zoonotic infection which has rapidly increased in incidence and spread globally since May 2022. There have been reports of rectal complications of monkeypox but so far these are not well not understood. Here, we describe a case of rectal pain in HIV-positive man with confirmed monkeypox. MRI on day 5 of hospital admission revealed proctitis with localised perforation. The patient was treated with tecovirimat, antibiotics, analgesia and laxatives and improved without requiring surgical intervention. All patients presenting with new rectal symptoms and deemed high-risk for monkeypox should be isolated and screened for the disease, and appropriate personal protective equipment should be worn by healthcare professionals caring for them. Clinicians should have a low threshold for cross-sectional imaging in patients with confirmed or suspected monkeypox who experience persistent and severe rectal symptoms or who become systemically unwell to investigate for complications such as perforation and abscess formation. The vast majority of monkeypox cases do not require antibiotics and their use should be reserved for patients who show signs of secondary bacterial infection or sepsis.
Topics: Male; Humans; Mpox (monkeypox); Proctitis; Rectum; Pain; Anti-Bacterial Agents; Coinfection
PubMed: 36653042
DOI: 10.1136/bcr-2022-252168 -
Clinical Infectious Diseases : An... Feb 2023We describe 2 cases of infectious proctitis secondary to human monkeypox in patients presenting with rectal pain. These cases highlight the importance of...
We describe 2 cases of infectious proctitis secondary to human monkeypox in patients presenting with rectal pain. These cases highlight the importance of multidisciplinary management of monkeypox and in expanding case definitions and enabling clinical recognition in patients presenting without skin rash.
Topics: Humans; Mpox (monkeypox); Proctitis; Exanthema; Intraabdominal Infections; Pain
PubMed: 36052417
DOI: 10.1093/cid/ciac713 -
Journal of Crohn's & Colitis Nov 2022Proctitis is the least extensive type of ulcerative colitis, for which rectal therapy is rarely studied and is underused. This study evaluated the efficacy, safety, and... (Randomized Controlled Trial)
Randomized Controlled Trial
Novel Budesonide Suppository and Standard Budesonide Rectal Foam Induce High Rates of Clinical Remission and Mucosal Healing in Active Ulcerative Proctitis: a Randomised, Controlled, Non-inferiority Trial.
BACKGROUND AND AIMS
Proctitis is the least extensive type of ulcerative colitis, for which rectal therapy is rarely studied and is underused. This study evaluated the efficacy, safety, and patient's preference of a novel formulation of budesonide suppository 4 mg, compared with a commercially available budesonide rectal foam 2 mg, for the treatment of mild to moderate ulcerative proctitis.
METHODS
This was a randomised, double-blind, double-dummy, active-controlled trial. Patients were randomly assigned in a 1:1 ratio to receive either budesonide 4 mg suppository or budesonide 2 mg foam once daily for 8 weeks. The co-primary endpoints were changes from baseline to Week 8 in clinical symptoms, for which clinical remission was defined as having a modified Ulcerative Colitis-Disease Activity Index [UC-DAI] subscore for stool frequency of 0 or 1 and a subscore for rectal bleeding of 0, and mucosal healing, defined as having a modified UC-DAI subscore for mucosal appearance of 0 or 1. Using a more stringent criterion, we additionally analysed deepened mucosal healing, which was defined as a mucosal appearance subscore of 0. Patient's preference, physician's global assessment, and quality of life were also assessed and analysed.
RESULTS
Overall, 286 and 291 patients were included in the 4 mg suppository and 2 mg foam groups, respectively. Budesonide 4 mg suppository met the prespecified criterion for non-inferiority to the 2 mg foam in both co-primary endpoints of clinical remission and mucosal healing. Secondary endpoints consistently supported the non-inferiority of the suppository. Trends in favour of the suppository were observed in the subgroup of mesalazine non-responders. More patients reported a preference for the suppository over rectal foam.
CONCLUSIONS
In patients with ulcerative proctitis, budesonide 4 mg suppository was non-inferior to budesonide 2 mg foam in efficacy, and both were safe and well tolerated.
Topics: Humans; Budesonide; Colitis, Ulcerative; Quality of Life; Treatment Outcome; Mesalamine; Proctitis; Double-Blind Method; Remission Induction
PubMed: 35709376
DOI: 10.1093/ecco-jcc/jjac081 -
Gut Jul 2021
Review
Topics: Administration, Oral; Administration, Rectal; Adrenal Cortex Hormones; Anti-Inflammatory Agents; Anti-Inflammatory Agents, Non-Steroidal; Colitis, Ulcerative; Drug Development; Endpoint Determination; Gastrointestinal Agents; Humans; Immunosuppressive Agents; Mesalamine; Proctitis; Randomized Controlled Trials as Topic; Sigmoidoscopy; Tacrolimus; Treatment Outcome
PubMed: 33789968
DOI: 10.1136/gutjnl-2021-324108 -
American Family Physician May 2016This summary of the American Cancer Society Prostate Cancer Survivorship Care Guidelines targets primary care physicians who coordinate care of prostate cancer survivors... (Review)
Review
This summary of the American Cancer Society Prostate Cancer Survivorship Care Guidelines targets primary care physicians who coordinate care of prostate cancer survivors with subspecialists. Prostate cancer survivors should undergo prostate-specific antigen screening every six to 12 months and digital rectal examination annually. Surveillance of patients who choose watchful waiting for their prostate cancer should be conducted by a subspecialist. Any hematuria or rectal bleeding must be thoroughly evaluated. Prostate cancer survivors should be screened regularly for urinary incontinence and sexual dysfunction. Patients with predominant urge incontinence symptoms, which can occur after surgical and radiation treatments, may benefit from an anticholinergic agent. If there is difficulty with bladder emptying, a trial of an alpha blocker may be considered. A phosphodiesterase type 5 inhibitor can effectively treat sexual dysfunction following treatment for prostate cancer. Osteoporosis screening should occur before initiation of androgen deprivation therapy, and patients treated with androgen deprivation therapy should be monitored for anemia, metabolic syndrome, and vasomotor symptoms. Healthy lifestyle choices should be encouraged, including weight management, regular physical activity, proper nutrition, and smoking cessation. Primary care physicians should be vigilant for psychosocial distress, including depression, among prostate cancer survivors, as well as the potential impact of this distress on patients' family members and partners.
Topics: Adrenergic alpha-Antagonists; Aftercare; Androgen Antagonists; Cholinergic Antagonists; Cystitis; Depression; Digital Rectal Examination; Gastrointestinal Hemorrhage; Healthy Lifestyle; Hematuria; Humans; Kallikreins; Male; Mass Screening; Neoplasm Recurrence, Local; Osteoporosis; Practice Guidelines as Topic; Primary Health Care; Proctitis; Prostate-Specific Antigen; Prostatic Neoplasms; Radiation Injuries; Rectum; Survivors; Urinary Incontinence
PubMed: 27175954
DOI: No ID Found -
Clinical Gastroenterology and... Aug 2017
Topics: Abdominal Pain; Adult; Gastrointestinal Hemorrhage; Homosexuality, Male; Humans; Lymphogranuloma Venereum; Male; Proctitis; Rectum
PubMed: 28365488
DOI: 10.1016/j.cgh.2017.03.033 -
Casopis Lekaru Ceskych 2017Lymphogranuloma venereum belongs to the sexually transmitted diseases. The disease is caused by Chlamydia trachomatis serotypes L1, L2 and L3. In the beginning of the...
Lymphogranuloma venereum belongs to the sexually transmitted diseases. The disease is caused by Chlamydia trachomatis serotypes L1, L2 and L3. In the beginning of the 21st century there has been observed a large increase in the incidence of this disease in the world. There is a frequent co-occurrence with other sexually transmitted diseases (HIV, syphilis, gonorrhea, hepatitis C). Predominantly this disease affects homosexuals, in which case the first manifestation of the disease may be proctitis or proctocolitis.
Topics: Humans; Incidence; Lymphogranuloma Venereum; Male; Proctitis
PubMed: 28722452
DOI: No ID Found -
Biomedical Physics & Engineering Express Dec 2023This study aims to predict radiotherapy-induced rectal and bladder toxicity using computed tomography (CT) and magnetic resonance imaging (MRI) radiomics features in...
This study aims to predict radiotherapy-induced rectal and bladder toxicity using computed tomography (CT) and magnetic resonance imaging (MRI) radiomics features in combination with clinical and dosimetric features in rectal cancer patients.A total of sixty-three patients with locally advanced rectal cancer who underwent three-dimensional conformal radiation therapy (3D-CRT) were included in this study. Radiomics features were extracted from the rectum and bladder walls in pretreatment CT and MR-T2W-weighted images. Feature selection was performed using various methods, including Least Absolute Shrinkage and Selection Operator (Lasso), Minimum Redundancy Maximum Relevance (MRMR), Chi-square (Chi2), Analysis of Variance (ANOVA), Recursive Feature Elimination (RFE), and SelectPercentile. Predictive modeling was carried out using machine learning algorithms, such as K-nearest neighbor (KNN), Support Vector Machine (SVM), Logistic Regression (LR), Decision Tree (DT), Random Forest (RF), Naive Bayes (NB), Gradient Boosting (XGB), and Linear Discriminant Analysis (LDA). The impact of the Laplacian of Gaussian (LoG) filter was investigated with sigma values ranging from 0.5 to 2. Model performance was evaluated in terms of the area under the receiver operating characteristic curve (AUC), accuracy, precision, sensitivity, and specificity.A total of 479 radiomics features were extracted, and 59 features were selected. The pre-MRI T2W model exhibited the highest predictive performance with an AUC: 91.0/96.57%, accuracy: 90.38/96.92%, precision: 90.0/97.14%, sensitivity: 93.33/96.50%, and specificity: 88.09/97.14%. These results were achieved with both original image and LoG filter (sigma = 0.5-1.5) based on LDA/DT-RF classifiers for proctitis and cystitis, respectively. Furthermore, for the CT data, AUC: 90.71/96.0%, accuracy: 90.0/96.92%, precision: 88.14/97.14%, sensitivity: 93.0/96.0%, and specificity: 88.09/97.14% were acquired. The highest values were achieved using XGB/DT-XGB classifiers for proctitis and cystitis with LoG filter (sigma = 2)/LoG filter (sigma = 0.5-2), respectively. MRMR/RFE-Chi2 feature selection methods demonstrated the best performance for proctitis and cystitis in the pre-MRI T2W model. MRMR/MRMR-Lasso yielded the highest model performance for CT.Radiomics features extracted from pretreatment CT and MR images can effectively predict radiation-induced proctitis and cystitis. The study found that LDA, DT, RF, and XGB classifiers, combined with MRMR, RFE, Chi2, and Lasso feature selection algorithms, along with the LoG filter, offer strong predictive performance. With the inclusion of a larger training dataset, these models can be valuable tools for personalized radiotherapy decision-making.
Topics: Humans; Bayes Theorem; Radiomics; Proctitis; Cystitis; Rectal Neoplasms; Machine Learning
PubMed: 37995359
DOI: 10.1088/2057-1976/ad0f3e