Publications by authors named "Awais Ahmed"

22 Publications

  • Page 1 of 1

Inpatient Alcohol Cessation Counseling Is Associated With a Lower 30-Day Hospital Readmission in Acute Alcoholic Pancreatitis.

J Clin Gastroenterol 2022 Jan 10. Epub 2022 Jan 10.

Department of Internal Medicine Division of Gastroenterology & Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA Division of Gastroenterology, Duke University Medical Center Division of Gastroenterology, Durham VA Medical Center, Durham, NC.

Background: Alcohol use is a common cause of recurrent acute pancreatitis. Thus, guidelines recommend providing alcohol prevention resources during hospitalization. There is limited data on the real-world implementation of this recommendation. We aimed to assess how often inpatients admitted with alcohol-induced acute pancreatitis (AAP) receive counseling and to determine the impact of counseling on readmissions for AAP.

Methods: We retrospectively studied patients admitted with AAP at a tertiary care center from 2008 to 2018. We compared demographics, clinical features, and outcomes in patients who did and did not receive counseling. Outcomes studied were the proportion of patients with AAP receiving counseling, and readmission rates for AAP at 30 days and 1 year.

Results: A total of 243 patients with AAP were identified, of which 115 had inpatient alcohol counseling (47%). Demographic data were comparable between the 2 groups. Fewer patients receiving alcohol counseling were readmitted at 30 days compared with patients not receiving counseling (19.3% vs. 31.2%, P=0.048). At 1 year, the 2 groups had similar readmission rates. On multivariate analysis, patients who received counseling were half as likely to be readmitted in 30 days compared with those who did not receive counseling [odds ratio=0.52 (0.27, 0.98), P=0.046].

Conclusions: We note that <50% of patients receive alcohol counseling. Patients receiving alcohol counseling were less likely to be readmitted at 30 days, inferring possible value in the intervention provided. Similar readmission rates at 1 year suggest that the single intervention may not have a durable effect on alcohol prevention.
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http://dx.doi.org/10.1097/MCG.0000000000001666DOI Listing
January 2022

Prospective evaluation of sleep disturbances in chronic pancreatitis and its impact on quality of life: a pilot study.

Sleep Breath 2022 Jan 4. Epub 2022 Jan 4.

Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Rabb 423, Boston, MA, USA.

Background: Patients with chronic pancreatitis (CP) have poor quality of life (QOL). Sleep disorders affect QOL when associated with chronic pain and opioid use. Hence patients with CP may have unrecognized sleep disturbances.

Aims: The aim of the study was to evaluate sleep disturbances in CP and its impact on QOL.

Methods: Established CP patients were prospectively enrolled after exclusion of patients with co-morbidities known to negatively affect sleep and QOL. Three questionnaires were used to identify sleep disturbances, PROMISv1SF8, Insomnia Severity Index, and Epworth Sleepiness Scale, and one for restless leg syndrome (RLS). PANQOLI and SF12 questionnaires were used to evaluate QOL. Two blinded sleep pulmonologists evaluated the responses. QOL assessments were then analyzed in patients with and without sleep disturbances.

Results: Of 89 patients, 48 met exclusion criteria, 41 were eligible, and 28 completed the study. Twenty patients (71%) had sleep disturbances with significantly worse scores across all 3 sleep questionnaires and also had lower scores on both PANQOLI (50 vs 76, p = 0.002) and SF-12 (physical component 29.3 vs 53.9, p < 0.001; mental component 36.4 vs 46.1, p = 0.03). Eleven patients (39%) had RLS and sleep disturbances.

Conclusion: In patients with established CP there was a high prevalence of sleep disturbances and RLS with worse QOL representing a potential therapeutic target to improve QOL.
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http://dx.doi.org/10.1007/s11325-021-02541-7DOI Listing
January 2022

The Impact of an Inpatient Pancreatitis Service and Educational Intervention Program on the Outcome of Acute Pancreatitis.

Am J Med 2021 Oct 27. Epub 2021 Oct 27.

Division of Gastroenterology & Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass. Electronic address:

Background: We introduced an inpatient pancreatitis consultative service aimed to 1) provide guideline-based recommendations to acute pancreatitis inpatients and 2) educate inpatient teams on best practices for acute pancreatitis management. We assessed the impact of pancreatitis service on acute pancreatitis outcomes.

Methods: Inpatients with acute pancreatitis (2008-2018) were included in this cohort study. Primary outcomes included length of stay and refeeding time. The educational intervention was a guideline-based decision support tool, reinforced at hospital-wide educational forums. In Part A (n = 965), we compared outcomes pre-service (2008-2010) to post-service (2012-2018), excluding 2011, when the pancreatitis service was introduced. In Part B (n = 720, 2012-2018), we divided patients into 2 groups based on if co-managed with the pancreatitis service, and compared outcomes, including subgroup analysis based on severity, focusing on mild acute pancreatitis.

Results: In Part A, for mild acute pancreatitis, length of stay (111 vs 88.4 h, P = .001), refeeding time (61.8 vs 47.4 h, P = .002), and infections (10.0% vs 1.87%, P < .001) were significantly improved after the pancreatitis service was introduced, with multivariable analysis showing reduced length of stay (odds ratio 0.83; 95% confidence interval, 0.82-0.84; P < .001) and refeeding time (odds ratio 0.75; 95% confidence interval, 0.74-0.77; P < .001). In Part B, for mild acute pancreatitis, refeeding time (44.2 vs 50.3 h, P = .123) and infections (5.58% vs 4.70%, P = .80) were similar in patients cared for without and with the service. Length of stay was higher in the pancreatitis service group (93.3 vs 81.2 h, P = .05), as they saw more gallstone acute pancreatitis patients who had greater length of stay and magnetic resonance cholangiopancreatography. In the post-service period, a majority of patients with moderate/severe acute pancreatitis and nearly all intensive care unit admits received care from the pancreatitis service.

Conclusions: Implementation of an inpatient pancreatitis service was associated with improved outcomes in mild acute pancreatitis. Guideline-based educational interventions have a beneficial impact on management of mild acute pancreatitis by admitting teams even without pancreatitis consultation.
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http://dx.doi.org/10.1016/j.amjmed.2021.09.021DOI Listing
October 2021

Hyperlipasemia in absence of acute pancreatitis is associated with elevated D-dimer and adverse outcomes in COVID 19 disease.

Pancreatology 2021 Jun 4;21(4):698-703. Epub 2021 Mar 4.

Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.

Background: Coronavirus SARS-CoV-2 affects multiple organs. Studies have reported mild elevations of lipase levels of unclear significance. Our study aims to determine the outcomes in patients with COVID-19 and hyperlipasemia, and whether correlation with D-dimer levels explains the effect on outcomes.

Methods: Case-control study from two large tertiary care health systems, of patients with COVID-19 disease admitted between March 1 and May 1, 2020 who had lipase levels recorded. Data analyzed to study primary outcomes of mortality, length of stay (LOS) and intensive care utilization in hyperlipasemia patients, and correlation with D-dimer and outcomes.

Results: 992 out of 5597 COVID-19 patients had lipase levels, of which 429 (43%) had hyperlipasemia. 152 (15%) patients had a lipase > 3x ULN, with clinical pancreatitis in 2 patients. Hyperlipasemia had a higher mortality than normal lipase patients (32% vs. 23%, OR = 1.6,95%CI = 1.2-2.1, P = 0.002). In subgroup analysis, hyperlipasemia patients had significantly worse LOS (11vs.15 days, P = 0.01), ICU admission rates (44% vs. 66%,OR = 2.5,95%CI = 1.3-5.0,P = 0.008), ICU LOS (12vs.19 days,P = 0.01), mechanical ventilation rates (34% vs. 55%,OR = 2.4,95%CI = 1.3-4.8,P = 0.01), and durations of mechanical ventilation (14 vs. 21 days, P = 0.008). Hyperlipasemia patients were more likely to have a D-dimer value in the highest two quartiles, and had increased mortality (59% vs. 15%,OR = 7.2,95%CI = 4.5-11,P < 0.001) and LOS (10vs.7 days,P < 0.001) compared to those with normal lipase and lower D-dimer levels.

Conclusion: There is high prevalence of hyperlipasemia without clinical pancreatitis in COVID-19 disease. Hyperlipasemia was associated with higher mortality and ICU utilization, possibly explained by elevated D-dimer.
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http://dx.doi.org/10.1016/j.pan.2021.02.021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7929790PMC
June 2021

Bone disease in chronic pancreatitis.

World J Clin Cases 2020 May;8(9):1574-1579

Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States.

Bone disease (osteopenia or osteoporosis) is a highly prevalent condition in society and presents a tremendous, preventable public health burden. Screening procedures, such as, dual-energy X-ray absorptiometry scans, have allowed early identification and intervention to improve bone health, and reduce the risk of osteoporotic fractures, which carry significant morbidity and mortality. The association of bone disease has been recognized in several diseases of the gastrointestinal tract, resulting in established guidelines for screening in patients with malabsorptive disorders such as inflammatory bowel disease and celiac disease. Increasingly, the risk of bone disease has been recognized in patients with chronic pancreatitis (CP), who share similar risk factors as patients with other high gastrointestinal disorders. As a result, there have been a number of studies examining the prevalence and risks of bone disease and fractures in patients with CP. This review aims to summarize the recent literature and current recommendations related to bone disease in CP.
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http://dx.doi.org/10.12998/wjcc.v8.i9.1574DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7211537PMC
May 2020

Survival and behavior of free and encapsulated probiotic bacteria under simulated human gastrointestinal and technological conditions.

Food Sci Nutr 2020 May 17;8(5):2419-2426. Epub 2020 Apr 17.

The University of Gambia Gambia Gambia.

The present study was designed with the objective to compare the viability and stability of free and encapsulated probiotics under simulated technological and human gastrointestinal conditions. was encapsulated using two wall materials (sodium alginate, soy protein isolate, and SA-SPI) by extrusion method for enhanced viability under stressed conditions. Free and encapsulated probiotics were subjected to some simulated technological and gastrointestinal conditions. Furthermore, free and encapsulated probiotics were also incorporated in dairy dessert to evaluate the viability and stability during storage. Encapsulation using sodium alginate and SPI as a coating materials significantly ( < .05) improved the survival of probiotics under simulated gastrointestinal and thermal conditions. The buffering effect of microbeads prolonged their survival and stability of under simulated conditions. The number of surviving probiotic cells encapsulated with sodium alginate, SPI, and SA-SPI over 120 days of product storage was 7.85 ± 0.39, 7.45 ± 0.37, and 8.50 ± 0.43 cfu/ml, respectively. In case of free cells, the surviving cells were just 3.5 ± 0.18 cfu/ml over the period of storage. In short, the study depicted that encapsulation provides protection during exposure to various hostile conditions.
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http://dx.doi.org/10.1002/fsn3.1531DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7215207PMC
May 2020

Reducing Hospitalization in Mild Acute Pancreatitis: Results of Long-term Follow-up.

J Clin Gastroenterol 2021 02;55(2):180-186

Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.

Goals And Background: Acute pancreatitis (AP) is a common emergency department (ED) diagnosis, amounting to enormous costs. Our previous pilot study demonstrated the feasibility of reducing hospitalization using an ED-based observation pathway. In this follow-up study, we hypothesize that the pathway is durable in clinical practice, outside of research supervision, and patients can safely be managed without hospitalization.

Study: We reviewed patients prospectively enrolled in the observation pathway after the end of the pilot study. We compared outcomes to patients enrolled in our pilot study and with a historic cohort of patients admitted with mild AP. Our primary outcome was hospitalization rate during the enrollment period and secondary outcomes included length of stay, 30-day readmissions, mortality, and health care utilization.

Results: Over a 2-year period 165 patients met criteria for AP with 118 (71.5%) having mild AP. Fifty-four of 118 patients (45.8%) were enrolled in the observation pathway and of these, 45 patients were discharged from the ED, reducing hospitalization by 31.2%, compared with pilot study (22.2%) and historic cohort (0%) (P<0.05). Median length of stay was shorter [19.9 (observation) vs. 72.0 h (historic cohort), P<0.01]. There were fewer radiographic examinations in the observation cohorts (pilot and current study) than in the historic cohort (P<0.05), with similar 30-day readmissions, and no reported deaths.

Conclusions: This follow-up study demonstrates the durability of an observation-based pathway to manage mild AP outside of a research protocol and maintain its ability to reduce hospitalizations without affecting readmission rates or mortality.
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http://dx.doi.org/10.1097/MCG.0000000000001354DOI Listing
February 2021

Evaluation of Opioid Use in Acute Pancreatitis in Absence of Chronic Pancreatitis: Absence of Opioid Dependence an Important Feature.

Am J Med 2020 10 7;133(10):1209-1218. Epub 2020 Apr 7.

Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.

Background: Chronic opioid use and dependence is common in patients with chronic pancreatitis. Patients with acute pancreatitis are frequently treated with opioids, but their risk for ongoing use is not well known. The aim of our study is to characterize opioid use in patients after an episode of acute pancreatitis and to assess persistent, chronic, and daily opioid use in such patients in the absence of chronic pancreatitis.

Methods: This is a single-center review of prospectively enrolled patients with acute pancreatitis. Using the Massachusetts Prescription Awareness Tool, we recorded all opioid prescriptions (ie, frequency, duration, and amount) for patients from December 2016 to September 2019, after index hospitalization for acute pancreatitis. Patients with chronic pancreatitis were excluded. We used univariate and multivariate analysis to determine predictors of opioid use at discharge and subsequent follow-up over 18 months.

Results: Of 235 enrolled patients who were opioid-naïve, 123 patients (52.3%) received opioids at discharge after index hospitalization. In follow-up over 18 months, 40 patients (17.0%) received additional opioid prescriptions. These patients had more severe disease, longer length of stay, and higher pain score at discharge. Patients with prior history of acute pancreatitis, local complications, and higher pain scores were twice as likely to subsequently be prescribed opioids. Persistent opioid use was seen only in recurrent acute pancreatitis. There was no daily or chronic opioid use.

Conclusions: In the absence of chronic pancreatitis, there was no daily or chronic use of opioids in patients with acute pancreatitis. Persistent use was only seen in patients with recurrent acute pancreatitis. These patients are at increased risk of chronic opioid use and dependence.
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http://dx.doi.org/10.1016/j.amjmed.2020.03.010DOI Listing
October 2020

Identification and inoculation of fungal strains from rhizosphere involve in growth and alleviation of high nitrogen stress.

Saudi J Biol Sci 2020 Jan 26;27(1):524-534. Epub 2019 Nov 26.

Department of Biotechnology, COMSATS University Islamabad, Abbottabad Campus, Abbottabad 22060, Pakistan.

is economically and ethnobotanically an important forest tree and is shown to be at decline in Northern areas of Pakistan in recent years mainly due to high concentration of Nitrogen in forests. Ectomycorrhizal (ECM) association forming fungi enables the forest trees to develop optimally by absorbing water from the rhizosphere through their absorptive hyphae and by making available the nutrients by mobilization of N and P from the organic substrates. This study was conducted to identify the ECM strains from rhizosphere and to analyse the impact of high N load on the seedlings to establish N critical load value for coniferous forests of Pakistan. Six new fungal strains were identified from the rhizosphere of and were registered at GenBank (NCBI) as strain ACE1, strain ACE2, strain ACE3, strain ACE4, strain ACE5 and strain ACE6 with accession numbers MH145426, MH145427, MH145428, MH145429, MH145430 and MH547115. Four out of six isolated strains were inoculated with seedlings of singly and in consortium (CN) in combination with nitrogen load of 0 (C), 25 (T1), 50 (T2), 100 kg N ha yr (T3). Agronomic, physiological and gene expression studies for () and () were made to analyse the impact of fungal strains in relation to high N stress. This study suggests a positive impact of T1 (25 kg N ha yr) Nitrogen load and a negative impact of T3 (100 kg N ha yr) on growth parameters and expression patterns of and genes. Peroxidase (POX) activity decreased in the order ACE5 > ACE2 > C > ACE3 > ACE1 > CN. However, the results of Superoxide dismutase (SOD) showed decreasing trend in the order ACE5 > C > CN > ACE1 > ACE2 > ACE3. Strain ACE3 was shown to have a positive impact on the seedlings in terms of growth, physiology and expression of genes. Present study suggests that newly identified fungal strains showing positive impact on the growth and physiology of could be used for the propagation of this economically important plant in Pakistan after pathogenicity test.
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http://dx.doi.org/10.1016/j.sjbs.2019.11.016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6933180PMC
January 2020

Segment IV hepatic artery in potential donors for living related liver transplantation: Evaluation with multi-detector CT.

J Pak Med Assoc 2019 Jun;69(6):799-805

Shifa International Hospital, Islamabad.

Objective: To assess segment IV hepatic arterial anatomy and its variation on multi-detector computed tomography in potential liver donors.

Methods: The retrospective study was conducted at Shifa International Hospital, Islamabad and comprised data of potential liver transplant donors related to the period between January 2012 and June 2017. Computed tomography scans were performed using multi-detector scanners. Images were transferred to work station for postprocessing and were analysed regarding the origination and variation of the arteries by two independent experienced radiologists.

Results: Of the 455 patients whose records were evaluated, 299(65.7%) were males and 156(34.3%) were females. Six types of segment IV artery were defined based on their points of origin: left hepatic artery 285(62.6%), right hepatic artery 111(24.4 %), proper hepatic artery 9(1.8 %), common hepatic artery 29(6.4%), gastro duodenal artery 3(0.7 %), and dual 18(4.1 %).313 of total cases (68.8%) had normal anatomy with no variation. Those with aberrant/variant anatomy constituted 142(31.2%) of the total.

Conclusions: Multi-detector computed tomography angiography was found to be a fast, reliable and non-invasive technique that could evaluate normal as well as anatomical variants of segment IV arteries.
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June 2019

Spatially and temporally variable urinary N loads deposited by lactating cows on a grazing system dairy farm.

J Environ Manage 2018 Jun 20;215:166-176. Epub 2018 Mar 20.

Agriculture Victoria Research, Department of Economic Development, Jobs, Transport and Resources, 1301 Hazeldean Road, Ellinbank, Victoria 3821, Australia. Electronic address:

Feed nitrogen (N) intakes in Australian grazing systems average 545 g cow day, indicating that urinary N is likely to be the dominant form excreted. Grazing animals spend disproportionate amounts of time in places on dairy farms where N accumulation is likely to occur. We attached to grazing cows sensors that measure urine volume and N concentration, as well as global positioning systems sensors used to monitor the times the cows spent in different places on a farm and the location of urination events. The cows were monitored for up to 72 h in each of two seasons. More urination events and greater urine volumes per event were recorded in spring 2014 (3.1 L) compared with winter 2015 (1.4 L), most likely influenced by environmental conditions and the greater spring rainfall observed. Mean (range) N concentration (0.71%; 0.02 to 1.52%) and N load (12.8 g cow event; 0.3 to 64.5 g cow event) did not differ over the two monitoring periods. However, mean (range) daily N load was greater in spring (277 g cow day; 200 to 346 g cow day) than in winter (90 g cow day; 44 to 116 g cow day) due to the influence of urine volume. Relatively greater time was spent in paddocks overnight (13.3 h) than in paddocks between morning and evening milking (6.4 h), compared with the mean numbers of urinations in these places (6.4 and 3.8 respectively). The mean N load deposited overnight in paddocks (89.6 g cow) was more than twice that deposited in paddocks during the day (43.8 g cow), due to the greater N load per event overnight, and was more closely linked to the relative difference in time spent in paddocks than in the number of urination events. These data suggest that routinely holding cows in the same paddocks overnight will lead to high urinary N depositions, increasing the potential for N losses from these places. Further research using this technology is required to acquire farm and environment specific urinary data to improve N management.
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http://dx.doi.org/10.1016/j.jenvman.2018.03.046DOI Listing
June 2018

Impact of Methylprednisolone on Postoperative Quality of Recovery and Delirium in the Steroids in Cardiac Surgery Trial: A Randomized, Double-blind, Placebo-controlled Substudy.

Anesthesiology 2017 02;126(2):223-233

From the Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia (C.F.R., J.O.-Y., A.R.); Department of Anaesthesia and Pain Management (C.F.R.) and Department of Cardiothoracic Surgery (A.R.), The Royal Melbourne Hospital, Melbourne, Victoria, Australia; Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio (L.S., A.K., A.A., K.P.D.I.S.); Department of Surgery (R.W., P.J.D.), Population Health Research Institute (R.W., J.V., P.J.D.), Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada; and Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Thailand (K.P.).

Background: Inflammation after cardiopulmonary bypass may contribute to postoperative delirium and cognitive dysfunction. The authors evaluated the effect of high-dose methylprednisolone to suppress inflammation on the incidence of delirium and postoperative quality of recovery after cardiac surgery.

Methods: Five hundred fifty-five adults from three hospitals enrolled in the randomized, double-blind Steroids in Cardiac Surgery trial were randomly allocated to placebo or 250 mg methylprednisolone at induction and 250 mg methylprednisolone before cardiopulmonary bypass. Each completed the Postoperative Quality of Recovery Scale before surgery and on days 1, 2, and 3 and 1 and 6 months after surgery and the Confusion Assessment Method scale for delirium on days 1, 2, and 3. Recovery was defined as returning to preoperative values or improvement at each time point.

Results: Four hundred eighty-two participants for recovery and 498 participants for delirium were available for analysis. The quality of recovery improved over time but without differences between groups in the primary endpoint of overall recovery (odds ratio range over individual time points for methylprednisolone, 0.39 to 1.45; 95% CI, 0.08-2.04 to 0.40-5.27; P = 0.943) or individual recovery domains (all P > 0.05). The incidence of delirium was 10% (control) versus 8% (methylprednisolone; P = 0.357), with no differences in delirium subdomains (all P > 0.05). In participants with normal (51%) and low baseline cognition (49%), there were no significant differences favoring methylprednisolone in any domain (all P > 0.05). Recovery was worse in patients with postoperative delirium in the cognitive (P = 0.004) and physiologic (P < 0.001) domains.

Conclusions: High-dose intraoperative methylprednisolone neither reduces delirium nor improves the quality of recovery in high-risk cardiac surgical patients.
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http://dx.doi.org/10.1097/ALN.0000000000001433DOI Listing
February 2017

Barriers to mesalamine adherence in patients with inflammatory bowel disease: a qualitative analysis.

J Manag Care Spec Pharm 2014 Mar;20(3):309-14

Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 022156, USA.

Background: The causes for nonadherence to mesalamine in patients with inflammatory bowel disease (IBD) have been characterized using mostly indirect methods. Patient-reported barriers are lacking in this population.

Objective: To identify patient-reported barriers to mesalamine adherence through direct interviews.

Methods: Focus groups and one-on-one interviews were undertaken in adult patients with IBD. Transcripts from the focus groups and interviews were analyzed to identify themes and links between these themes, assisted by qualitative data software MaxQDA.

Results: Of 27 patients participating, 21 (78%) had ulcerative colitis, and 6 (22%) had Crohn's disease. Their self-reported adherence ranged from complete adherence (n = 3) to intermittent nonadherence (n = 24). Patients frequently indicated that they were resistant to taking medications for their condition. The barriers to adherence that emerged from interviews could be categorized under a number of themes: competing priorities, social stigma, refill inconvenience, costs, efficacy values, side effects, and pill characteristics. Efficacy values reported to influence adherence included doubts about efficacy, consequences of missed doses, and doubts about need for maintenance medication. Pill characteristics reported as barriers included pill size and pill frequency. Despite use of electronic prescribing, obtaining refills was reported as an obstacle to adherence in this cohort. Decanting of pills to multiple containers to increase accessibility was also reported.

Conclusions: Patients with both ulcerative colitis and Crohn's disease report a number of common barriers to mesalamine adherence. Factors in medication-taking behavior and beliefs were reported in this study that may have implications for strategies to improve adherence by health care providers.
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http://dx.doi.org/10.18553/jmcp.2014.20.3.309DOI Listing
March 2014

Characteristics of inflammatory bowel disease serology in patients with indeterminate colitis.

J Clin Gastroenterol 2014 Apr;48(4):351-5

*Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA †Division of Gastroenterology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA.

Goals And Background: Inflammatory bowel disease (IBD) serology testing is often used in patients with indeterminate colitis (IC) to help distinguish between ulcerative colitis (UC) and Crohn's disease (CD). We investigated the performance of serology testing in predicting future diagnosis in this setting.

Study: This was an observational study of individuals with IC at a single center who underwent IBD serology testing [anti-Saccharomyces cerevisiae antibody (ASCA), perinuclear anti-neutrophil cytoplasmic antibody (pANCA), and anti-outer membrane porin C antibody (anti-OmpC)] and had at least 12 months follow-up from the time of serology test results.

Results: A total of 117 individuals with IC and with 1-year follow-up data were enrolled. All IC patients had endoscopic and histologic evidence of colitis at enrollment. One year after serology testing, 58 (50%) individuals with IC were diagnosed with UC, 49 (42%) with CD, and 10 (9%) remained labeled with IC. The sensitivity/specificity of an initial positive pANCA for a subsequent diagnosis of UC was 78%/44%. For ASCA and anti-OmpC, the results were 18%/84% and 27%/75%, respectively, for a subsequent diagnosis of CD. A positive pANCA test was associated with a likelihood ratio (LR) of 1.4 [95% confidence interval (CI), 1.1-1.8] for a subsequent diagnosis of UC at 1 year. Neither positive ASCA (LR 1.1; 95% CI, 0.5-2.5) nor anti-OmpC (LR 1.1; 95% CI, 0.6-2.0) was associated with a subsequent diagnosis of CD in patients with IC.

Conclusions: The disease phenotype in the majority of individuals initially labeled with IC evolved to be more consistent with either UC or CD on follow-up. pANCA, ASCA, and anti-OmpC, individually, were of limited utility in predicting a patient's subsequent disease phenotype.
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http://dx.doi.org/10.1097/MCG.0000000000000083DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3956001PMC
April 2014

The burden of inflammatory bowel disease: a patient-reported qualitative analysis and development of a conceptual model.

Inflamm Bowel Dis 2014 Mar;20(3):545-52

*Oxford Outcomes, ICON Plc Company, Bethesda, Maryland; †Outcomes Research Strategies in Health LLC, Washington, District of Columbia; ‡Shire Development LLC, Wayne, Pennsylvania; and §Center for Inflammatory Bowel Disease, Beth Israel Deaconess Medical Center, Boston, Massachusetts.

Background: The aim of this study was to describe the impacts of inflammatory bowel disease (IBD) from the patients' perspective and to inform the development of a conceptual model.

Methods: Focus groups and one-on-one interviews were undertaken in adult patients with IBD. Transcripts from the focus groups and interviews were analyzed to identify themes and links between themes, assisted by qualitative data software MaxQDA. Themes from the qualitative research were supplemented with those reported in the literature and concepts included in IBD-specific patient-reported outcome measures.

Results: Twenty-seven patients participated. Key physical symptoms included pain, bowel-related symptoms such as frequency, urgency, incontinence, diarrhea, passing blood, and systemic symptoms such as weight loss and fatigue. Participants described continuing and variable symptom experiences. IBD symptoms caused immediate disruption of activities but also had ongoing impacts on daily activities, including dietary restrictions, lifestyle changes, and maintaining close proximity to a toilet. More distal impacts included interference with work, school, parenting, social and leisure activities, relationships, and psychological well-being. The inconvenience of rectal medications, refrigerated biologics, and medication refills emerged as novel burdens not identified in existing patient-reported outcome measures.

Conclusions: IBD symptoms cause immediate disruption in activities, but patients may continue to experience some symptoms on a chronic basis. The conceptual model presented here may be useful for identifying target concepts for measurement in future studies in IBD.
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http://dx.doi.org/10.1097/01.MIB.0000440983.86659.81DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3932523PMC
March 2014

Local excision of rectal tumours by minimally invasive transanal surgery.

Br J Hosp Med (Lond) 2013 Jul;74(7):387-90

Department of Colorectal Surgery, Mid Staffordshire NHS Foundation Trust, Stafford ST16 3SA.

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http://dx.doi.org/10.12968/hmed.2013.74.7.387DOI Listing
July 2013

A mild Lewis acid mediated epoxy-ester to bicyclic ortho ester rearrangement.

Chem Commun (Camb) 2013 Sep;49(68):7489-91

Department of Chemistry, University of Loughborough, Loughborough, Leicestershire LE11 3TU, UK.

A high yielding rearrangement of epoxy-esters, under Lewis acid conditions, to give bicyclic ortho esters is reported.
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http://dx.doi.org/10.1039/c3cc44364gDOI Listing
September 2013

Focal physiologic fluorodeoxyglucose activity in the gastrointestinal tract is located within the colonic lumen.

Nucl Med Commun 2012 Jun;33(6):641-7

Department of Radiology, Division of Nuclear Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02115, USA.

Aim: Physiologic activity of 18F-fluorodeoxyglucose (FDG) in the intestinal tract occurs frequently in patients undergoing PET/computed tomography (CT) imaging, appearing most often in the colon. The purpose of this study is to determine the localization of the FDG within the colon. We hypothesize that intestinal FDG activity is intraluminal.

Methods: In a prospective Institutional Review Board-approved and Health Insurance Portability and Accountability Act-compliant study, patients with physiologic colonic FDG activity on PET/CT scans were enrolled to undergo repeat imaging 2 h after stimulation of colonic motility with a high-fat meal.

Results: We identified 13 patients who had focal FDG activity in their colon during a routine clinical PET/CT scan. After administration of a high-fat meal, 10 patients (77%) demonstrated antegrade movement of FDG along the colon, consistent with luminal clearance.

Conclusion: Our results suggest that normal physiologic FDG activity within the large intestine, seen on PET/CT scans, is intraluminal.
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http://dx.doi.org/10.1097/MNM.0b013e328350859bDOI Listing
June 2012

Abdominal phlegmons in Crohn's disease: outcomes following antitumor necrosis factor therapy.

Inflamm Bowel Dis 2012 Apr 6;18(4):691-6. Epub 2011 Jun 6.

Center for Inflammatory Bowel Disease, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts 02215, USA.

Background: An abdominal phlegmon is an inflammatory mass that can develop in the setting of penetrating Crohn's disease (CD). Anti-tumor necrosis factor (TNF) antibody therapy is typically avoided in CD complicated by phlegmon because of concern for peritoneal infection but may offer an effective alternative to surgical resection after infection has been controlled with antibiotics. The aim of this study was to examine outcomes for patients with CD who developed an abdominal phlegmon that was subsequently treated with an anti-TNF antibody.

Methods: We retrospectively reviewed the records of all CD patients attending Beth Israel Deaconess Medical Center between 2004 and 2010 with an abdominal phlegmon who were treated with an anti-TNF antibody in order to evaluate the safety and efficacy of this treatment regimen.

Results: There were 13 patients with CD complicated by a phlegmon treated with antibiotics and an anti-TNF antibody at our center between 2004 and 2010. Ten were male. Median time (interquartile range) from diagnosis to development of the phlegmon was 5.9 (1.9-22.7) years. The phlegmon was associated with an abscess in 12 patients. In addition to anti-TNF therapy, all patients were treated with broad-spectrum antibiotics. Anti-TNF therapy was effective without complications in all subjects. Two patients eventually had surgery more than a year after initiating anti-TNF treatment.

Conclusions: Penetrating CD complicated by phlegmon formation may be safely and effectively managed with a combination of antibiotics and anti-TNF therapy. Larger, prospective trials are required to confirm these initial findings.
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http://dx.doi.org/10.1002/ibd.21783DOI Listing
April 2012

Once-daily mesalamine granules for ulcerative colitis.

Expert Rev Clin Immunol 2010 Jul;6(4):521-6

Harvard Medical School, Center for Inflammatory Bowel Disease, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA.

Mesalamine extended-release capsules (Apriso [Salix Pharmaceuticals, Raleigh, NC, USA]) are the first once-daily mesalamine preparation approved by the US FDA for the maintenance of remission of ulcerative colitis (UC). Each mesalamine extended-release capsule contains granules of a mesalamine-polymer matrix that are coated with a pH-sensitive resin. This design begins releasing mesalamine (0.375 g) once the pH is more than 6 in the ileum and colon. Two clinical trials have reported that mesalamine extended-release capsules (1.5 g/day) maintained remission in 79% of patients with UC who were in clinical remission. Reported adherence with mesalamine extended-release capsules once daily was high (>90%) in these studies. This article examines the efficacy and safety of mesalamine extended-release capsules in the maintenance of remission in patients with UC.
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http://dx.doi.org/10.1586/eci.10.22DOI Listing
July 2010

Dynamics and management of cytopenias associated with dasatinib therapy in patients with chronic myeloid leukemia in chronic phase after imatinib failure.

Cancer 2009 Sep;115(17):3935-43

Department of Leukemia, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.

Background: The incidence, dynamics, and management of cytopenias were investigated in patients with chronic myeloid leukemia in chronic phase (CP CML) who received dasatinib therapy after imatinib failure.

Methods: Data were analyzed from 130 patients with CP CML who were treated with dasatinib from November 2003 to March 2006 in phase 1 (n = 22) or phase 2 or 3 (n = 108) studies for the development of grade 2 to 4 cytopenia (according to the National Cancer Institute Common Terminology Criteria [version 3.0]).

Results: Grade 2 to 4 neutropenia and/or thrombocytopenia occurred in 94 (72%) patients during dasatinib therapy and grade 3 to 4 occurred in 67 (52%) patients. Of the 94 patients who developed grade 2 to 4 neutropenia and/or thrombocytopenia, 64 (68%) also developed at least grade 2 anemia, and 16 (17%) developed grade 3 to 4 anemia. Management of cytopenias included transient dasatinib interruption in 35 (37%) patients, filgrastim in 12 (14%) patients, recombinant erythropoietin in 29 (45%) patients, and interleukin-11 in 3 (5%) patients. Factors associated with an increased risk for developing grade 2 to 4 cytopenias were longer time from diagnosis to treatment, prior interferon or imatinib therapy, and a lower white blood cell count at the initiation of dasatinib therapy.

Conclusions: Hematologic toxicity was frequent during dasatinib therapy in patients with CP CML, particularly at doses >100 mg daily. Treatment interruption and/or dose reduction as well as growth factor support were found to be safe and efficacious strategies to facilitate the continuous administration of dasatinib.
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http://dx.doi.org/10.1002/cncr.24432DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4386888PMC
September 2009

Rapid resolution of Mycobacterium marinum chronic skin infection during lenalidomide therapy for chronic lymphocytic leukemia.

Clin Infect Dis 2008 Apr;46(7):e69-71

Department of Leukemia, University of Texas M. D. Anderson Cancer Center, Houston, USA.

The immunomodulatory drug lenalidomide is currently being evaluated for its antineoplastic properties in treating hematologic malignancies. However, its potential role in augmenting immune reactions against opportunistic infections has not been explored. We report the rapid resolution of chronic Mycobacterium marinum infection in a patient following initiation of lenalidomide therapy for chronic lymphocytic leukemia.
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http://dx.doi.org/10.1086/529388DOI Listing
April 2008
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