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Journal of Pediatric Gastroenterology... Jan 2023Coffee and caffeinated products have been widely consumed for many centuries. Previous adult studies have suggested that both coffee and decaffeinated beverages induce...
OBJECTIVES
Coffee and caffeinated products have been widely consumed for many centuries. Previous adult studies have suggested that both coffee and decaffeinated beverages induce colonic motility. However, no study has been conducted in pediatrics, and the role of caffeine alone in pediatric colonic motility needs to be explored.
METHODS
A prospective study of pediatric patients undergoing standard colonic motility testing that were able to consume caffeinated coffee, decaffeinated coffee, and caffeine tablet during colonic manometry. Patients who had a gastrocolonic reflex and high amplitude propagated contractions (HAPCs) in response to intraluminal administration of bisacodyl in the colon were included in the final analyses.
RESULTS
Thirty-eight patients were recruited, 22 of which were excluded, 11 due to abnormal studies (no HAPC seen in response to intraluminal response to bisacodyl), and 11 due to inability to consume all study agents or complete the study. Sixteen patients met criteria for final analyses. Intracolonic bisacodyl produced a larger area under the curve (AUC) compared to all other agents. Caffeinated coffee resulted in a higher AUC, motility index (MI), and time to HAPC compared with decaffeinated coffee ( P < 0.05). There was no significant difference between caffeinated coffee and caffeine tablet, or caffeine tablet and decaffeinated coffee.
CONCLUSIONS
Caffeine is indeed a colonic stimulant; however, other components of caffeinated and non-caffeinated beverages likely induce colonic response and require further evaluation for possible use as a colonic stimulant.
Topics: Adult; Humans; Child; Caffeine; Coffee; Bisacodyl; Prospective Studies; Colon; Manometry
PubMed: 36574000
DOI: 10.1097/MPG.0000000000003627 -
Annals of Indian Academy of Neurology 2022Stapes reflex test is a method of evaluating the involuntary muscle contraction of the stapedius muscle in response to a high-intensity sound stimulus. The formation of...
BACKGROUND
Stapes reflex test is a method of evaluating the involuntary muscle contraction of the stapedius muscle in response to a high-intensity sound stimulus. The formation of this reflex involves the intact function of the 7 nerve, brain stem, 8 nerve, and middle ear. Due to ease of administration and information yielded, the stapedial reflex is considered one of the most powerful differential diagnostic audiological procedures. Numerous studies have remarked on the fluid communication between the intracochlear and intracranial spaces through the cochlear aqueduct. Currently, the potential significance of a noninvasive audiological technique in the discrimination of raised intracranial pressure constitutes a crucial topic of interest.
METHODS
We have performed the pre-LP and post-LP detailed otorhinolaryngological investigations, including the detailed inspection, audiometric testing, tympanometry, and stapedial reflex in a total of four consecutive patients with IIH.
RESULTS
We found that the stapedial reflex was bilateral absent initially in two of the patients. However, the second stapedial reflex investigations after LP showed reversal of the reflex responses in both of the patients.
CONCLUSIONS
We suggest some hypotheses and propose some clinical applications. Future studies focusing on the potential utility of this reflex in the monitorization of IIH may provide crucial perspectives.
PubMed: 35693648
DOI: 10.4103/aian.aian_379_21 -
Frontiers in Cardiovascular Medicine 2022Long COVID refers to a multitude of symptoms that persist long after SARS-CoV-2 infection. Fatigue and breathlessness are the most common symptoms of long COVID across a... (Review)
Review
Long COVID refers to a multitude of symptoms that persist long after SARS-CoV-2 infection. Fatigue and breathlessness are the most common symptoms of long COVID across a range of studies. They are also cardinal symptoms of chronic heart failure (CHF). In this review, we propose that fatigue and breathlessness in patients with long COVID may be explained by skeletal muscle abnormalities, in a manner similar to patients with CHF. The ergoreflex is a cardiorespiratory reflex activated by exercise, which couples ventilation and cardiovascular function to exercise intensity. At least part of the symptomatology of CHF is related to abnormal skeletal muscle and an enhanced ergoreflex, resulting in heightened sympathetic, vasoconstrictor and ventilator drives. Similarly, SARS-CoV-2 infection results in a hyperinflammatory and hypercatabolic state. This leads to reduction in skeletal muscle mass and altered function. We postulate that the ergoreflex is chronically overstimulated, resulting in fatigue and breathlessness. Exercise training preserves muscle mass and function as well as reduces ergoreflex activation; therefore may have a role in improving symptoms associated with long COVID. Should the ergoreflex be proven to be an important pathophysiological mechanism of long COVID, tailored exercise interventions should be trialed with the aim of improving both symptoms and perhaps outcomes in patients with long COVID.
PubMed: 35911550
DOI: 10.3389/fcvm.2022.940832 -
Journal of Neurosciences in Rural... 2022We have very little information about sexual activity and concerns of patients with myelopathy from India. The objectives of this study were to assess the sexual...
OBJECTIVES
We have very little information about sexual activity and concerns of patients with myelopathy from India. The objectives of this study were to assess the sexual dysfunction and sexual concerns among patients with myelopathy due to spinal cord lesion (SCL).
MATERIALS AND METHODS
This study was a single-center, cross-sectional, and hospital-based study among male and female patients in the age-group 18-50 years, with disability due to myelopathy due to SCL. The data were collected using a self-designed, pretested, and semi-structured questionnaire by face-to-face interview.
RESULTS
Eighty participants were recruited in the study, of which 62 (77.5%) were men. The mean standard deviation (SD) age of the participants was 33.7 (8.6) years, and mean (SD) age at time of illness was 31.4 (8.6) years with median duration of 17 months. Among 62 males, psychogenic erection was impaired in 77.2%, reflex erection was impaired in 78.9%, and ejaculation was affected in 70.7%. Orgasm was absent or reduced in 66.1% males. Among 18 female participants, psychogenic genital arousal was reduced in 66.5%, reflex genital arousal was impaired in 55.5%, and orgasm was absent in 38.8% subjects. Sexual desire in these patients was unchanged in 41 (51.2%) and decreased or absent in 39 (48.8%). Sexual activity involvement was there in 46 (57.5%) and 34 (42.5%) had not involved in any kind of sexual activity after injury/illness. The main reasons of non-involvement in sexual activity were bladder and bowel accidents, spasticity, and difficulty in positioning.
CONCLUSION
Comprehensive neurological rehabilitation should address sexual function of affected individual to allow them highest level of function and quality of life.
PubMed: 36743770
DOI: 10.25259/JNRP-2022-2-36 -
Indian Journal of Anaesthesia Nov 2023
PubMed: 38187976
DOI: 10.4103/ija.ija_713_23 -
Hereditary Cancer in Clinical Practice Apr 2022Lynch syndrome (LS) is associated with an increased risk of colorectal (CRC) and endometrial (EC) cancers. Universal tumor screening (UTS) of all individuals diagnosed...
INTRODUCTION
Lynch syndrome (LS) is associated with an increased risk of colorectal (CRC) and endometrial (EC) cancers. Universal tumor screening (UTS) of all individuals diagnosed with CRC and EC is recommended to increase identification of LS. Kaiser Permanente Northwest (KPNW) implemented a UTS program for LS among individuals newly diagnosed with CRC in January 2016 and EC in November 2016. UTS at KPNW begins with immunohistochemistry (IHC) of tumor tissue to determine loss of mismatch repair proteins associated with LS (MLH1, MSH2, MSH6, and PMS2)., IHC showing loss of MLH1 is followed by reflex testing (automatic testing) to detect the presence of the BRAF V600E variant (in cases of CRC) and MLH1 promoter hypermethylation to rule out likely sporadic cases.
MATERIALS AND METHODS
Individuals newly diagnosed with CRC and EC were identified between the initiation of the respective UTS programs and July 2018. Electronic medical records were reviewed to extract patient data related to UTS, including IHC and reflex testing results, date of referrals to the genetics department, and results of germline genetic testing for LS.
RESULTS
313 out of 362 individuals diagnosed with CRC and 61 out of 64 individuals diagnosed with EC who were eligible were screened by IHC for LS. Most (47/52 or 90%, including 46/49 CRC and 1/3 EC) individuals that were not screened by IHC only had a biopsy sample available. Fourteen individuals (3.7% overall, including 13/313 CRC and 1/61 EC) received an abnormal result after reflex testing and were referred for genetic counseling. Of these, 10 individuals (71% overall, including 9/13 CRC and 1/1 EC) underwent germline genetic testing for LS. Five individuals diagnosed with CRC were found to have pathogenic variants. in PMS2 (n = 3), MLH1 (n = 1), and MSH6 (n = 1). No pathogenic variants were identified in individuals diagnosed with EC.
CONCLUSIONS
UTS identified individuals at risk for LS. Most individuals who screened positive for LS had follow-up germline genetic testing for LS. The consistent use of biopsy samples is an opportunity to improve UTS.
PubMed: 35436948
DOI: 10.1186/s13053-022-00217-1 -
Otology & Neurotology : Official... Mar 2021To describe the site of lesion responsible for the severe, bilateral, symmetrical, selective loss of vestibular function in Cerebellar Ataxia with Neuronopathy and...
OBJECTIVE
To describe the site of lesion responsible for the severe, bilateral, symmetrical, selective loss of vestibular function in Cerebellar Ataxia with Neuronopathy and Vestibular Areflexia Syndrome (CANVAS), an adult-onset recessively-inherited ataxia, characterized by progressive imbalance due to a combination of cerebellar, somatosensory, and selective vestibular impairment with normal hearing.
METHODS
Histologic examination of five temporal bones and the brainstems from four CANVAS patients and the brainstem only from one more, each diagnosed and followed from diagnosis to death by one of the clinician authors.
RESULTS
All five temporal bones showed severe loss of vestibular ganglion cells (cell counts 3-16% of normal), and atrophy of the vestibular nerves, whereas vestibular receptor hair cells and the vestibular nuclei were preserved. In contrast, auditory receptor hair cells, the auditory ganglia (cell counts 51-100% of normal), and the auditory nerves were relatively preserved. In addition, the cranial sensory ganglia (geniculate and trigeminal), present in two temporal bones, also showed severe degeneration.
CONCLUSIONS
In CANVAS there is a severe cranial sensory ganglionopathy neuronopathy (ganglionopathy) involving the vestibular, facial, and trigeminal ganglia but sparing the auditory ganglia. These observations, when coupled with the known spinal dorsal root ganglionopathy in CANVAS, indicate a shared pathogenesis of its somatosensory and cranial nerve manifestations. This is the first published account of both the otopathology and neuropathology of CANVAS, a disease that involves the central as well as the peripheral nervous system.
Topics: Adult; Bilateral Vestibulopathy; Cerebellar Ataxia; Humans; Reflex, Abnormal; Reflex, Vestibulo-Ocular; Vestibular Diseases
PubMed: 33492056
DOI: 10.1097/MAO.0000000000002985 -
Poultry Science Mar 2021On-farm euthanasia of poultry, including turkeys, may not be possible for most people as birds gain weight; thus alternative mechanical methods have been developed. Our...
On-farm euthanasia of poultry, including turkeys, may not be possible for most people as birds gain weight; thus alternative mechanical methods have been developed. Our objective was to compare mechanical cervical dislocation with the Koechner Euthanizing Device (KED), captive bolt euthanasia with the Turkey Euthanasia Device (TED), head-only CO euthanasia (CO), and electric euthanasia as potential humane methods for euthanizing individual, heavy turkeys. We assessed their impact on loss of brain stem reflexes, acute distress (corticosterone, CORT), kill success, torn skin, and blood loss. Turkeys (n = 174) were euthanized on 3 sampling days, while birds were restrained using a mobile bird euthanasia apparatus. Brain stem reflexes recorded were the cessation and return of induced nictitating membrane reflex (loss of consciousness and brain stem dysfunction), mouth gaping reflex (brain stem dysfunction), and musculoskeletal movements (spinal cord dysfunction). Overall, KED resulted in more frequent (at 4 min: KED 7 of 14; electric 0 of 13; TED 0 of 11; CO 2 of 14 birds on day 1) and longer durations of the induced nictitating reflex compared to the other methods (means of day 2 and 3: KED 233; electric 15; TED 15; CO 15 s). The mouth gaping reflex endured the longest after KED euthanasia (means of day 2 and 3: KED 197; electric 15; TED 51; CO 15 s). Musculoskeletal movements endured longest after KED euthanasia (means of day 2 and 3: KED 235; electric 15; TED 219; CO 15 s). Returning reflexes were more frequent after KED and TED compared to CO and electric euthanasia, where it was absent. CO, electric, and TED euthanasia showed comparable kill success (success: CO 42 out of 43; electric 44 of 45; TED 42 of 44), with KED resulting in most unsuccessful kills (unsuccessful: 8 out of 42). CORT responses were inconsistent. Torn skin and blood loss occurred more frequently after KED and TED compared to CO and electric applications. Therefore, we conclude that, based on a comparison of these 4 methods, the most discernibly humane was electric euthanasia, which consistently resulted in quick loss of consciousness within 15 s, no returning reflexes, and no torn skin or blood loss.
Topics: Animal Welfare; Animals; Euthanasia, Animal; Farms; Female; Turkeys
PubMed: 33518334
DOI: 10.1016/j.psj.2020.11.001 -
Frontiers in Neurology 2022Peripheral neuropathies with autonomic nervous system involvement are a recognized cause of gastrointestinal dysmotility for a wide spectrum of diseases. Recent advances...
PURPOSE
Peripheral neuropathies with autonomic nervous system involvement are a recognized cause of gastrointestinal dysmotility for a wide spectrum of diseases. Recent advances in wireless motility capsule testing allow improved sampling of regional and whole gut motility to aid in the diagnosis of gastrointestinal motility disorders and may provide additional insight into segment-specific enteric involvement of peripheral neuropathies affecting autonomic nervous system function.
METHODS
We utilized standardized autonomic nervous system (ANS) reflex assessment and wireless motility capsule testing to evaluate 20 individuals with idiopathic autonomic neuropathy and unexplained gastrointestinal symptoms. Additionally, we examined the relationship between quantifiable autonomic neuropathy and gastrointestinal dysmotility at specific neuroanatomical levels. Symptom profiles were evaluated using the 31-item Composite Autonomic Symptom Score questionnaire (COMPASS-31) and compared to wireless motility capsule data.
RESULTS
We found that transit times were predominately abnormal (delayed) in the foregut (10 of 20; 50%), while contractility abnormalities were far more prominent in the hindgut (17 of 20; 85%), and that motility and symptom patterns, as assessed by the COMPASS-31 GI domain items, generally corresponded. Finally, we also found that there was neuroanatomical overlap in the presence of autonomic reflex abnormalities and WMC-based transit and/or contractility abnormalities.
CONCLUSIONS
We found that transit times were predominately abnormal in the foregut and midgut, while contractility abnormalities were far more prominent in the hindgut in individuals with idiopathic autonomic neuropathy. There was a high rate of agreement in segmental wireless motility capsule data with neuroanatomically corresponding standardized ANS function measures (e.g., cardiovagal, sudomotor, adrenergic). Expanded sudomotor testing, including additional neuroanatomical segments, could provide additional indirect assessment of visceral involvement in ANS dysfunction.
PubMed: 36588909
DOI: 10.3389/fneur.2022.1027348 -
Transplantation Proceedings Jun 2022The process of capturing and classifying the viability of corneal tissue for corneal transplantation is complex. The biomicroscopic examination is one of the techniques...
BACKGROUND
The process of capturing and classifying the viability of corneal tissue for corneal transplantation is complex. The biomicroscopic examination is one of the techniques used to evaluate the quality of corneal tissues. The aim of this study was to analyze the relationship between the evaluation criteria used in biomicroscopic examination using a slit lamp and the classification of the quality of corneal tissue.
METHODS
This is a longitudinal, retrospective cohort study, performed at the Human Ocular Tissue Bank in the state of Rio Grande do Norte, Brazil. The sample consisted of 419 corneas donated between 2005 to 2016.
RESULTS
After the evaluation, the 419 corneas were classified as excellent (8 -1.91%), good (217 - 51.79%), regular (85 - 20.29%), and bad (109 - 26.01%). The classification of corneal quality attributed by ophthalmologists considered 13 criteria: senile arch, scars, epithelial defect, epithelial exposure, stromal infiltrate, subepithelial opacity, pterygium, Descemet's folds, stromal edema, stromal streak, cornea guttata, specular reflex, and cell loss endothelial. The quality of the cornea classified as excellent and good showed a statistically significant association (P value < .05) with senile arch, scar, epithelial defect, epithelial exposure, Descemet's folds, stromal edema, stromal streak, cornea guttata, specular reflex, and losses of endothelial cells; they had evaluated criteria that were absent or slightly present.
CONCLUSIONS
The evaluation of the corneal quality for corneal transplantation should involve the implementation of reliable techniques and trained, qualified professionals. There is a need to create evaluation instruments that consider the criteria according to their degree of interference in the quality of corneal tissue.
Topics: Cicatrix; Cornea; Edema; Endothelial Cells; Humans; Retrospective Studies; Slit Lamp
PubMed: 35811151
DOI: 10.1016/j.transproceed.2022.03.030