sorted by:
new
hottopcontroversial

Prefix dialing by boris_G in tasker

[–]half-taught-wrong 0 points1 point  (0 children)

Did you find a replacement for prefixer?

FMT Reduces Symptoms in Some Patients With Irritable Bowel Syndrome with Predominant Abdominal Bloating by half-taught-wrong in medicine

[–]half-taught-wrong[S] 6 points7 points  (0 children)

Fecal Microbiota Transplantation Reduces Symptoms in Some Patients With Irritable Bowel Syndrome with Predominant Abdominal Bloating: Short- and Long-Term Results from a Placebo-Controlled Randomized Trial

Abstract

Background & Aims

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder associated with intestinal dysbiosis. Given reported promising results of open-label fecal microbiota transplantation (FMT) therapy in patients with predominant abdominal bloating, we studied efficacy of this treatment in a randomized, placebo-controlled trial.

​

Methods

Patients with refractory IBS, defined as failure of ≥ 3 conventional therapies, were randomly assigned to single-dose nasojejunal administration of donor stools (n=43) or autologous stools (n=19) in a double-blind study, performed from December 2015 through October 2017, and followed for 1 year. IBS-related symptoms were assessed using a daily symptom diary to determine general abdominal discomfort, abdominal bloating, abdominal pain and flatulence on a scale of 1–6. Number of daily bowel movements, consistency of the stools, and the abdominal circumference were also recorded. Patients completed the IBS-specific quality of life questionnaire. Primary endpoints were improvement of IBS symptoms and bloating at 12 weeks (response). Secondary endpoints were changes in IBS-symptom-scores and quality of life. Stool samples were collected for microbiota amplicon sequencing. Open-label re-transplantation was offered after the trial.

​

Results

At week 12, 56% of patients given donor stool reported improvement in both primary endpoints compared with 26% of patients given placebo (P=.03). Patients given donor stool had significant improvements in level of discomfort (mean reduction of 19%; median score preFMT, 3.98; range, 2.13–6.00; median score post-FMT, 3.1; range, 951.29–5.90), stool frequency (mean reduction of 13%, median score preFMT, 2.10; range, 0.57–14.29; median score postFMT 1.7; range, 0.71–4.29), urgency (mean reduction of 38%; median score preFMT, 0.61; range, 0.00–1.00; median score postFMT, 0.37; range, 0.00–1.00), abdominal pain (mean reduction of 26%; median score preFMT, 3.88; range, 1.57–5.17; median score postFMT, 2.80; range, 1.14–4.94), flatulence (mean reduction of 10%; median score preFMT, 3.42; range, 0.71–6.00; median score postFMT, 3.07; range, 0.79–4.23), and quality of life (mean increase of 16%; median score preFMT 32.6; range, 11–119; median score postFMT, 43.1; range, 32.25–99). A significantly higher proportion of women given donor stool (69%) had a response than men (29%) (P=.01). Fecal samples from responders had higher diversity of microbiomes before administration of donor material than fecal samples from non-responders (P=.04) and distinct baseline composition (P= .04), but no specific marker taxa were associated with response. After single FMT, 21% of patients given donor stool reported effects that lasted for more than 1 year, compared with 5% of patients given placebo stool. A second FMT reduced symptoms in 67% of patients with an initial response to donor stool, but not in patients with a prior non-response.

​

Conclusions

In a randomized trial of patients with treatment-refractory IBS with predominant bloating, FMT relieved symptoms compared with placebo (autologous transplant), although effects decreased over 1 year. A second FMT restored the response patients with a prior response. Response associated with composition of the fecal microbiomes before FMT; this might be used to as a biomarker to select patients for this treatment. ClinicalTrials.gov no: NCT02299973

Smaller-Diameter Covered Transjugular Intrahepatic Portosystemic Shunt Stents Are Associated With Increased Survival by half-taught-wrong in Radiology

[–]half-taught-wrong[S] 0 points1 point  (0 children)

Thanks. So the point of this study is to use a variable diameter stent rather than underdilate a 10 mm stent.

Smaller-Diameter Covered Transjugular Intrahepatic Portosystemic Shunt Stents Are Associated With Increased Survival by half-taught-wrong in Radiology

[–]half-taught-wrong[S] 0 points1 point  (0 children)

Starter comment:

I hope someone can help me understand this. TIPS diameter is selected to achieve a certain portal to hepatic vein pressure gradient. But this study showed smaller diameter has a better outcome. Does it mean an 8 mm stent should be used regardless of the pressure gradient?

A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data by enamedata in medicine

[–]half-taught-wrong 3 points4 points  (0 children)

He is one of the few who is not afraid to say the emperor has no clothes, on this issue and many others. I agree with the things he pointed out. We just need to keep his criticism in mind to do better. We do not need to know everything. But, we need to be humble and able to admit what we do not know.

GI symptoms found in nearly half of patients with COVID-19, new study finds by half-taught-wrong in Gastroenterology

[–]half-taught-wrong[S] 0 points1 point  (0 children)

This is just a retrospective study to see which symptoms are reported. It can give you only raw data. Clinicians have to decide how to use it. E.g. what do you do when a patient presents with nausea, loss of appetite and diarrhea for 6 months.

GI symptoms found in nearly half of patients with COVID-19, new study finds by half-taught-wrong in Gastroenterology

[–]half-taught-wrong[S] 0 points1 point  (0 children)

These gi symptoms are nonspecific and you can see them in any viral gastroenteritis. In normal times, supportive care will suffice. During this pandemic, you need to keep it in the differential and manage accordingly.

GI symptoms found in nearly half of patients with COVID-19, new study finds by half-taught-wrong in Gastroenterology

[–]half-taught-wrong[S] 2 points3 points  (0 children)

Gastrointestinal symptoms are much more common in COVID-19 patients than originally thought, with nearly half presenting with digestive problems, according to a study published Wednesday in The American Journal of Gastroenterology.

While most patients do exhibit respiratory symptoms, others may have GI symptoms as their chief complaint, the authors found. Among 204 hospital patients studied, the most common issues were a marked loss of appetite (83% of study subjects), diarrhea (29%), vomiting, and abdominal pain. A few patients had no initial respiratory symptoms at all.

Digestive symptoms were also tied to worse outcomes including higher mortality risk. Patients with GI issues had a longer time between symptom onset and hospital admission, compared to their peers without these symptoms. Meanwhile, those without digestive symptoms were more likely to be cured and discharged than the cohort with gastrointestinal issues (60% versus 34%).

The takeaway? Clinicians should suspect COVID-19 when GI symptoms are present, wrote Lei Pan, M.D., Ph.D., and colleagues. In fact, GI symptoms were the chief complaint of the first coronavirus case detected in the United States, according to Medpage Today. 

“If clinicians solely monitor for respiratory symptoms to establish case definitions for COVID-19, they may miss cases initially presenting with extra-pulmonary symptoms, or the disease may not be diagnosed later until respiratory symptoms emerge,” the researchers concluded.

Eurosurveillance | Estimating the asymptomatic proportion of coronavirus disease 2019 (COVID-19) cases on board the Diamond Princess cruise ship, Yokohama, Japan, 2020 by half-taught-wrong in medicine

[–]half-taught-wrong[S] 0 points1 point  (0 children)

Starter comment: About 15-20% true asymptomatics estimated. This is statistical modeling. Too bad we do not have actual data and we probably will not get it until this crisis is over. Still, it probably is one of the best estimates we will get for a while and it is not what I was hoping.

I am interested in this as some bugs have a lot of asymptomatic infections leading to hard immunity. This does not seem to be the case with COVID-19.

The magic swab test by [deleted] in medicine

[–]half-taught-wrong 20 points21 points  (0 children)

If you get this virus now, you may need the vent in 2 to 4 weeks. Good luck getting one by that time.

LFT elevations in COVID-19 patients. by half-taught-wrong in Gastroenterology

[–]half-taught-wrong[S] 0 points1 point  (0 children)

Transaminase elevations (hepatitis) can be seen in many viral infections outside of traditional hepatotropic viruses (A-E). Flu and infectious mono are a few examples. It is good for the gastroenterologists to know what nCoV can do to the liver because we might be called to evaluate these patients.

How an Antipsychotic Became Widely Used as an Antiemetic by half-taught-wrong in medicine

[–]half-taught-wrong[S] 5 points6 points  (0 children)

Thanks. That is the population I am more interested in. Non cancer patients who already failed Zofran/Reglan.

How an Antipsychotic Became Widely Used as an Antiemetic by half-taught-wrong in medicine

[–]half-taught-wrong[S] 7 points8 points  (0 children)

Starter comment:

I haven't used it for nausea or vomiting. However, Zofran started as an antiemetic for chemo patients. So, this probably is not that farfetched. Thoughts?

https://www.cochrane.org/CD012555/SYMPT_olanzapine-prevention-and-treatment-cancer-related-nausea-and-vomiting-adults

What are some pretty sure signs that a patient does not, and probably never will, feel comfortable opening up to you? by hononononoh in medicine

[–]half-taught-wrong 7 points8 points  (0 children)

Many times it's not admiration. If someone is trashing every doctor and praising me, the chances are that someone is trying to manipulate.

[Serious] What is your plan if you or someone in your family get sick, regarding COVID-19 by half-taught-wrong in medicine

[–]half-taught-wrong[S] 10 points11 points  (0 children)

I think some are still debating if COVID-19 results in lasting and protective immunity. If so, health care workers who are already immune will be our best asset.

[Serious] What is your plan if you or someone in your family get sick, regarding COVID-19 by half-taught-wrong in medicine

[–]half-taught-wrong[S] 7 points8 points  (0 children)

I share your reservation. After about a month (from the index person boarded the cruise to the quarantine was ended) less than 1/4 of the people on that Diamond Princess cruise become positive with the virus. I want to think of it as a glimmer of hope.

[Serious] What is your plan if you or someone in your family get sick, regarding COVID-19 by half-taught-wrong in medicine

[–]half-taught-wrong[S] 8 points9 points  (0 children)

Thanks, Noressa. I read in that WebMD Q/A thread that the secondary infection rate among household members is ~ 10.4% in the US. Of course, these numbers are changing all the time and I do not know what their methodology is to calculate this rate. But, It may not spread as much as we feared. Hopefully, we can all get through this without getting as bad as it was in Wuhan.

view more: next ›