scholarly journals Assessment of Gastrointestinal Autonomic Dysfunction: Present and Future Perspectives

2021 ◽  
Vol 10 (7) ◽  
pp. 1392
Author(s):  
Ditte S. Kornum ◽  
Astrid J. Terkelsen ◽  
Davide Bertoli ◽  
Mette W. Klinge ◽  
Katrine L. Høyer ◽  
...  
Keyword(s):  
Gastrointestinal Tract ◽  
Autonomic Dysfunction ◽  
Physiological Function ◽  
Clinical Performance ◽  
Data Interpretation ◽  
Assessment Methods ◽  
Common Finding ◽  
Colonic Manometry ◽  
Target Organs ◽  
Common Causes

The autonomic nervous system delicately regulates the function of several target organs, including the gastrointestinal tract. Thus, nerve lesions or other nerve pathologies may cause autonomic dysfunction (AD). Some of the most common causes of AD are diabetes mellitus and α-synucleinopathies such as Parkinson’s disease. Widespread dysmotility throughout the gastrointestinal tract is a common finding in AD, but no commercially available method exists for direct verification of enteric dysfunction. Thus, assessing segmental enteric physiological function is recommended to aid diagnostics and guide treatment. Several established assessment methods exist, but disadvantages such as lack of standardization, exposure to radiation, advanced data interpretation, or high cost, limit their utility. Emerging methods, including high-resolution colonic manometry, 3D-transit, advanced imaging methods, analysis of gut biopsies, and microbiota, may all assist in the evaluation of gastroenteropathy related to AD. This review provides an overview of established and emerging assessment methods of physiological function within the gut and assessment methods of autonomic neuropathy outside the gut, especially in regards to clinical performance, strengths, and limitations for each method.

scholarly journals Long-Term Longitudinal Evaluation of Six Commercial Immunoassays for the Detection of IgM and IgG Antibodies against SARS CoV-2

Viruses ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 1244
Author(s):  
Iulia Nedelcu ◽  
Raluca Jipa ◽  
Roxana Vasilescu ◽  
Cristian Băicuș ◽  
Costin-Ioan Popescu ◽  
...  
Keyword(s):  
Clinical Performance ◽  
Sample Selection ◽  
Early Time ◽  
Humoral Response ◽  
High Specificity ◽  
Data Interpretation ◽  
Serum Samples ◽  
Chemiluminescent Immunoassay ◽  
Chemiluminescent Microparticle Immunoassay ◽  
Antibody Levels

The number of serological assays for SARS-CoV-2 has skyrocketed in the past year. Concerns have been raised regarding their performance characteristics, depending on the disease severity and the time of the analysis post-symptom onset (PSO). Thus, independent validations using an unbiased sample selection are required for meaningful serology data interpretation. We aimed to assess the clinical performance of six commercially available assays, the seroconversion, and the dynamics of the humoral response to SARS-CoV-2 infection. The study included 528 serum samples from 156 patients with follow-up visits up to six months PSO and 161 serum samples from healthy people. The IgG/total antibodies positive percentage increased and remained above 95% after six months when chemiluminescent immunoassay (CLIA) IgG antiS1/S2 and electro-chemiluminescent assay (ECLIA) total antiNP were used. At early time points PSO, chemiluminescent microparticle immunoassay (CMIA) IgM antiS achieved the best sensitivity. IgM and IgG appear simultaneously in most circumstances, and when performed in parallel the sensitivity increases. The severe and the moderate clinical forms were significantly associated with higher seropositivity percentage and antibody levels. High specificity was found in all evaluated assays, but the sensitivity was variable depending on the time PSO, severity of disease, detection method and targeted antigen.

scholarly journals A35 ASSOCIATIONS BETWEEN AUTONOMIC DYSFUNCTION, COLONIC DYSMOTILITY AND ABSENT DEFECATION REFLEXES IN PATIENTS WITH CHRONIC REFRACTORY CONSTIPATION

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 276-278
Author(s):  
L Liu ◽  
N Milkova ◽  
M Ali ◽  
K Sharma ◽  
J D Huizinga ◽  
...  
Keyword(s):  
Nervous System ◽  
Autonomic Nervous System ◽  
High Resolution ◽  
Autonomic Dysfunction ◽  
Sympathetic Tone ◽  
Stress Index ◽  
Autonomic Reactivity ◽  
Autonomic Tone ◽  
Autonomic Nervous ◽  
Colonic Manometry

Abstract Background A defecation reflex involves sensory information from the colon sent to the central nervous system which results in propulsive motor patterns in the colon through programmed neural activity from the autonomic nervous system. Neurological causes of constipation are recognized but specific neurological pathways that contribute to pathophysiology of the disease is underexplored. Diagnosis and treatment usually do not involve the autonomic nervous system. Aims Our objective was to assess autonomic dysfunction and abnormal defecation reflexes as a possible cause of chronic constipation. Methods Defecation reflexes were assessed by high-resolution colonic manometry through balloon distention, meal intake, and rectal bisacodyl. Specific heart rate variability (HRV) parameters were used to assess general orthostatic autonomic reactivity, and autonomic functioning during high resolution colonic manometry, in 14 patients with chronic refractory constipation considered for surgery. Results All patients had a unique combination of motility, reflex ability and HRV profiles. Patients overall did not generate HAPWs or had lower HAPW amplitude and lower propulsive activity compared to healthy individuals. Half of the 14 patients were tested to have high sympathetic tone based on Baevsky’s stress index prior to HRCM, and 11 of the patients had sympathetic hyper-reactivity and/or low parasympathetic reactivity to at least one type of colonic stimulation during HRCM. Abnormal autonomic tone or autonomic reactivity to colonic stimulation was present in all four patients with absence of the vagosacral defecation reflex. Five of the seven patients with absence of the sacral defecation reflex showed high sympathetic tone or high sympathetic reactivity to stimulation. Only two patients had abnormality in coloanal coordination and this was associated with low parasympathetic reactivity to stimulation in both patients. Conclusions The assumption that colonic resection was needed to remove an inert colon was wrong in most patients, but most patients had some form of reflex abnormality. Sympathetic dominance far outweighed parasympathetic dysfunction. Incorporation of assessments of defecation reflexes and autonomic nervous system activity into diagnosis of chronic refractory constipation provides a comprehensive pathophysiological understanding of specific defective neurological pathways contributing to dysmotility. This forms the basis for our individualized treatment efforts through sacral neuromodulation. Funding Agencies CIHR

EXUDATIVE ENTEROPATHY

PEDIATRICS ◽  
1959 ◽  
Vol 24 (4) ◽  
pp. 521-522
Author(s):  
ROBERT A. ULSTROM
Keyword(s):  
Molecular Weight ◽  
Gastrointestinal Tract ◽  
Serum Albumin ◽  
Plasma Protein ◽  
Average Molecular Weight ◽  
Direct Methods ◽  
Common Finding ◽  
Gastrointestinal Digestion ◽  
Plasma Substitute ◽  
Patient Reported

Loss of plasma protein into the gastrointestinal tract in the absence of actual bleeding has recently been demonstrated as a cause of "idiopathic hypoproteinemia." The euphonious name, "exudative enteropathy," has been used by Gordon to describe a group of nine patients, including a 2-year-old boy, whose common finding was hypoproteinemia due to loss of plasma protein into the gastrointestinal tract. A concomitant report by Schwartz and Jarnum confirms the association of these events in four additional patients. Although the first such patient reported had quantities of plasma protein present in the gastric juice sufficient to allow their demonstration by electrophoresis, the rapid digestion of the proteins by the enzymes normally present in the gastrointestinal tract has required the use of less direct methods in most of the subsequent cases. Using a preparation of I131-labelled polyvinyl pyrrolidone (a plasma substitute with average molecular weight the same as serum albumin) Gordon has devised a test that avoids the problems created by the gastrointestinal digestion of protein.

Diagnostic Evaluation of Patients Presenting with Rectal Bleeding by Colonoscopy

2020 ◽  
Vol 42 (1) ◽  
pp. 36-39
Author(s):  
Bala R Malla ◽  
Suyog Simkhada
Keyword(s):  
Rectal Bleeding ◽  
Diagnostic Yield ◽  
Adult Population ◽  
Common Finding ◽  
Common Causes ◽  
Optic Colonoscopy ◽  
The Common ◽  
Gastro Intestinal Tract ◽  
Histopathologic Findings ◽  
Malignant Mass

Introduction Rectal bleeding indicates the bleeding from lower gastro-intestinal tract occurring distal to ligaments of Treitz. Annual incidence of per rectal bleeding has been estimated to be 20% . Colonoscopy is the examination of choice for investigation. The objective of this study is to know the diagnostic yield of colonoscopy in cases with per rectal bleeding and to know the common causes of per rectal bleeding in adults MethodsOne hundred and twenty-nine adult patients, age more than 18years, who presented to Surgical OPD and ward of Dhulikhel Hospital during the year 2018 and 2019 were taken for the study irrespective of their sex. All the patients were subjected to fibre-optic colonoscopy after necessary preparation and the findings were recorded. Diagnosis was based on colonoscopic and histopathologic findings. ResultsA total of 129 (77 male and 52 female )patients with per rectal bleeding were evaluated with colonoscopy. The age ranged from 18 years to 79 years with the mean age 42.25 (SD+/- 15.29). Colonoscopy showed abnormalities in 102 patients (79.06%). The most common finding was hemorrhoids in 36 patients (27.90%) followed by colorectal malignant mass in 20 patients (15.50%). Polyps were diagnosed as the cause of rectal bleeding in 14 patients (10.84%). ConclusionColonoscopy has good diagnostic yield at evaluating cases with per rectal bleeding. Hemorrhoids, colorectal malignant mass and polyps are the common causes producing PR bleeding in Nepalese adult population.

scholarly journals Conflict in a paediatric hospital: a prospective mixed-method study

2015 ◽  
Vol 101 (1) ◽  
pp. 23-27 ◽  
Author(s):  
Liz Forbat ◽  
Charlotte Sayer ◽  
Phillip McNamee ◽  
Esse Menson ◽  
Sarah Barclay
Keyword(s):  
Mixed Method ◽  
Qualitative Interviews ◽  
Data Interpretation ◽  
Staff Nurses ◽  
Semistructured Interview ◽  
Hospital Data ◽  
Paediatric Hospital ◽  
Communication Breakdown ◽  
Severity Rating ◽  
Common Causes

BackgroundConflict in healthcare is a well-recognised but under-examined phenomenon. Little is known about the prevalence and causes of conflict across paediatric specialties.ObjectiveTo report the frequency and characteristics of conflict in a paediatric hospital.Design and settingAn explanatory sequential mixed-method approach was adopted. A bespoke questionnaire recorded frequency, severity, cause and staff involved in conflict prospectively. Data were recorded for the same two 12-week periods in 2013 and 2014, in one UK children's teaching hospital. Data were analysed using descriptive statistics and correlation, the findings of which informed the construction of a semistructured interview schedule. Qualitative interviews were conducted with six key informant healthcare professionals to aid data interpretation; interviews were analysed thematically.Results136 individual episodes of conflict were reported. The three most common causes were ‘communication breakdown’, ‘disagreements about treatment’ and ‘unrealistic expectations’. Over 448 h of healthcare professional time was taken up by these conflicts; most often staff nurses, consultants, doctors in training and matrons. The mean severity rating was 4.9 out of 10. Qualitative interviews revealed consensus regarding whether conflicts were ranked as low, medium or high severity, and explanations regarding why neurology recorded the highest number of conflicts in the observed period.ConclusionsConflict is prevalent across paediatric specialties, and particularly in neurology, general paediatrics and neonatology. Considerable staff time is taken in managing conflict, indicating a need to focus resources on supporting staff to resolve conflict, notably managing communication breakdown.

Thrombocytopenia in the critically ill

2016 ◽  
Author(s):  
Jaimal Kothari ◽  
Marie Scully
Keyword(s):  
Intensive Care ◽  
Evidence Base ◽  
Intensive Care Unit Setting ◽  
Common Finding ◽  
Patient Specific ◽  
Blood Products ◽  
Platelet Destruction ◽  
Heparin Induced Thrombocytopenia ◽  
Common Causes ◽  
Underlying Pathology

Thrombocytopenia is an extremely common finding in patients in intensive care. This can lead to serious morbidity and mortality from bleeding, and also uncertainty with regards to how to assess this risk in the wider context of the underlying pathology, which may be multifactorial, when specific blood products should be transfused, and the associated risks of carrying out interventional procedures. Haemodilution, platelet consumption, increased platelet destruction, reduced production, and increased sequestration are the main mechanisms that account for thrombocytopenia, and in the ICU setting there is typically an interplay of more than one of these that accounts for the counts seen. Sepsis and disseminated intravascular coagulation are the most common causes of thrombocytopenia in the ICU, with significant overlap between the pathologies. Less common causes in an intensive care unit setting include heparin-induced thrombocytopenia (HIT) and thrombotic thromobocytopenic purpura (TTP). The evidence base surrounding platelet thresholds remains poor and is an active area of research. Anticoagulation in the context of thrombocytopenia is problematic and requires a patient-specific approach.

scholarly journals 0787 Autonomic Dysfunction and Phenoconversion in Idiopathic/Isolated REM Sleep Behavior Disorder

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A300-A300
Author(s):  
S McCarter ◽  
T Gehrking ◽  
E St. Louis ◽  
M Suarez ◽  
B Boeve ◽  
...  
Keyword(s):  
Autonomic Dysfunction ◽  
Rem Sleep ◽  
Rem Sleep Behavior Disorder ◽  
Behavior Disorder ◽  
Common Finding ◽  
Chi Square ◽  
Sleep Behavior ◽  
Autonomic Testing ◽  
Function Testing

Abstract Introduction REM-sleep behavior disorder (RBD) is a common finding among patients with synucleinopathies. We aimed to determine the degree of autonomic dysfunction in patients presenting with idiopathic RBD (iRBD), and the predictive value of autonomic dysfunction for phenoconversion to a defined neurodegenerative disease. Methods We searched our electronic medical record for patients diagnosed with iRBD who also underwent standardized autonomic function testing within 6 months of iRBD diagnosis, and who had clinical follow-up of at least 3 years following iRBD diagnosis. Patients who received a diagnosis of phenoconversion within 3 months of autonomic testing were excluded. The composite autonomic severity score (CASS) was derived and compared between phenoconverters and non-converters using chi-square and Wilcoxon rank-sum tests. Results We identified 18 patients who fulfilled in- and exclusion criteria. Average age at autonomic testing was 67 ± 6.6 years. Twelve (67%) patients phenoconverted during the follow-up period; 6 developed PD, the other 6 DLB. Fifteen (83%) patients had at least mild autonomic dysfunction. There were no significant differences between overall converters and non-converters in total CASS or CASS subscores. However, iRBD patients who developed DLB had significantly higher total and cardiovagal CASS scores compared with those who developed PD (p <0.05), and a trend for higher adrenergic CASS scores compared to those who developed PD and those who did not phenoconvert (p=0.08 for each). Conclusion Autonomic dysfunction was seen in 83% of iRBD patients, and more severe baseline cardiovagal and adrenergic autonomic dysfunction in iRBD was associated with phenoconversion to DLB but not PD. Prospective studies are needed to confirm the value of autonomic testing for predicting phenoconversion and disease phenotype in iRBD. Support  

scholarly journals Mild Hypertransaminasemia in Primary Care

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Said A. Al-Busafi ◽  
Nir Hilzenrat
Keyword(s):  
Primary Care ◽  
Liver Disease ◽  
Common Finding ◽  
Underlying Liver Disease ◽  
Nonalcoholic Fatty Liver ◽  
Muscle Disorders ◽  
Common Causes ◽  
Antitrypsin Deficiency ◽  
Unclear Etiology ◽  
The Cost

The liver enzymes, alanine transaminase (ALT) or aspartate transaminase (AST), are commonly used in clinical practice as screening as well as diagnostic tests for liver diseases. ALT is more specific for liver injury than AST and has been shown to be a good predictor of liver related and all-cause mortality. Asymptomatic mild hypertransaminasemia (i.e., less than five times normal) is a common finding in primary care and this could be attributed to serious underlying condition or has transient and benign cause. Unfortunately, there are no good literatures available on the cost-effectiveness of evaluating patients with asymptomatic mild hypertransaminasemia. However, if the history and physical examination do not suggest a clear cause, a stepwise approach should be initiated based on pretest probability of the underlying liver disease. Nonalcoholic fatty liver disease is becoming the most common cause of mild hypertransaminasemia worldwide. Other causes include alcohol abuse, medications, and hepatitis B and C. Less common causes include hemochromatosis, α1-antitrypsin deficiency, autoimmune hepatitis, and Wilson's disease. Nonhepatic causes such as celiac disease, thyroid, and muscle disorders should be considered in the differential diagnosis. Referral to a specialist and a possible liver biopsy should be considered if persistent hypertransaminasemia for six months or more of unclear etiology.

Autonomic dysfunction and the gastrointestinal tract

1999 ◽  
Vol 9 (2) ◽  
pp. 75-81 ◽  
Author(s):  
Maximilian Bittinger ◽  
Jürgen Barnert ◽  
Martin Wienbeck
Keyword(s):  
Gastrointestinal Tract ◽  
Autonomic Dysfunction
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