Changes In Bowel Movements Research Articles

Congenital Appendiceal Atresia: An Extremely Rare Disorder Presenting with Acute Abdomen

Abstract Introduction/Objective Congenital malformations of the appendix are extremely rare and difficult to diagnose preoperatively. One of those anomalies include congenital appendiceal atresia (CAA) which mimics acute appendicitis and is usually ignored in the differentials of acute abdomen. Herein, we present a case study of congenital appendiceal atresia associated with periappendicitis. Methods/Case Report A 62-year-old female with past history of diverticulitis presented with complaints of crampy, diffuse and progressive lower abdominal pain and nausea for two days. She denied fevers, chills or change in bowel movements. Physical examination revealed vitally stable patient with soft, non-distended and tender abdomen in bilateral lower quadrants, worse on the right side and showing positive rebound test. Her complete blood count and chemistry were within normal limits. A computerized tomography arterial portography (CTAP) scan with contrast demonstrated inflammatory stranding around the appendix without abscess, concerning for acute appendicitis. She then underwent laparoscopic appendectomy. Grossly, the appendix consisted of a cylindrical portion of yellow-pink fatty tissue covered by peritoneum measuring 6.2 x 3.3 x 0.5 cm. The peritoneal surface displayed patchy fibrinous exudates. Sectioning revealed yellow adipose tissue with no identifiable appendix. Microscopically, the entire specimen demonstrated a poorly formed, mainly fatty appendix without a discernible lumen or submucosal lymphoid tissue. There were scattered sparsely distributed non-continuous bundles of smooth muscle (muscularis propria) at the periphery, which were highlighted by desmin and trichrome stains. This atretic appendix, mesoappendix and peritoneal covering were acutely inflamed. The final diagnosis was poorly formed, acutely inflamed fatty appendix consistent with congenital appendiceal atresia with accompanying acute periappendicitis. Results (if a Case Study enter NA) NA Conclusion This case would add to the very limited existing literature for congenital appendiceal anomalies and highlight the importance of thorough surgical intraoperative abdominal exploration and submission of the entire specimen for microscopic examination in order to render a definitive diagnosis.

Anorectal melanoma: systematic review of the current literature of an aggressive type of melanoma.

Anorectal melanoma (ARM) is a rare malignancy often associated with a poor prognosis due to its late diagnosis and aggressive biological behavior. This review aims to comprehensively investigate ARM's diagnosis, management, and treatment, emphasizing its clinical characteristics, laboratory findings, and implications for patient prognosis. A systematic literature search was conducted in PubMed, Embase, and Cochrane CENTRAL databases from inception to 1 July 2024. This review synthesizes existing literature to provide a comprehensive understanding of this rare primary malignancy. A total of 110 articles reporting on 166 patients were included. Gender data were available for 131 cases, comprising 67 females (51.1%) and 64 males (48.9%). The median age was 66 years. The overall median time to diagnosis was 4 months for anal melanoma, 3 months for rectal melanoma, and 4 months for anorectal junction melanoma. The clinical presentation was nodular in 98.2% of cases. Pre-diagnosis symptoms included bleeding in 84.9% of cases, mucous elimination (6%), pain (68.7%), tenesmus (16.9%), and changes in bowel movements (28.5%). Overall survival (OS) was reported in 82 cases, with a median OS of 11 months: 11 months for anal melanoma, 7 months for rectal melanoma, and 12 months for anorectal junction melanoma. ARM is a rare and aggressive melanoma subtype often diagnosed at an advanced stage, leading to a poor prognosis. A female predominance was observed, consistent with other mucosal melanomas. Anal melanoma exhibited better progression-free survival, and OS compared to rectal and anorectal junction melanoma.

Effects of neoagarooligosaccharides on body fat and bowel movement indicators in overweight or obese adults: A randomized, double-blind, placebo-controlled trial

The prevalence of obesity is increasing globally, and dietary fiber supplementation can aid in its treatment. This 12-week randomized, double-blind, placebo-controlled trial examined the effect of Dyne-neoagarooligosaccharides (Dyne-NAOs), hydrolyzed from agar via β-agarase DagA, in overweight or obese adults. Eighty participants were randomly assigned using block randomization (1:1, block size 4) to receive either 15 g of Dyne-NAOs daily or a placebo (maltodextrin). After the intervention, body fat mass (−1.07 kg vs. −0.05 kg; p = 0.015) and body fat percentage (−1.04 % vs. −0.08 %; p = 0.018) were significantly lower in the NAO group than in the placebo group. The Constipation Scoring System (−1.42 vs. −0.06; p = 0.010) and Patient Assessment of Constipation-Symptoms (−3.28 vs. −0.42; p = 0.021), used to assess changes in bowel movements, also showed significant between-group differences. These findings suggest that Dyne-NAOs could be a promising anti-obesity dietary fiber supplement.

Irritable Bowel Syndrome in the Elderly Population: A Comprehensive Review.

Irritable bowel syndrome (IBS) is a fairly common functional digestive disorder; it occurs at any age but it is more common in adults and older adults. Patients experience a series of symptoms in which abdominal pain and changes in bowel movements stand out; some studies have revealed a possible association between IBS and psychological problems, such as anxiety and depression. Recent findings point to disorders of gut-brain interaction, disruption and alteration of gut microbiota and dysbiosis as key factors in the etiopathogenesis of IBS; aging is also one the factors involved. Most patients diagnosed with IBS required pharmacotherapy, greater caution needs to be considered when treating older patients because of the risk-benefit profile in the elderly.In this scenario, probiotics and non-pharmacological treatments appear as safe and accessible options. Clinicians must take into consideration the unique biopsychosocial factors in older adults when treating IBS.We aim to review criticallyrecent literature on the topic of IBS as there is a need for consolidated guidelines.

Retrospective Analysis Of Lung Cancer In A Tertiary Care Hospital: Unravelling Treatment Modalities, Adverse Drug Reactions, And Secondary Cancer

Cancer involves abnormal cell growth that can invade or spread to other body parts, unlike benign tumors which don't spread. Symptoms may include lumps, abnormal bleeding, cough, weight loss, and changes in bowel movements. There are over 100 cancer types. This 6-month retrospective study at an oncology hospital analyzed 400 patients' records to explore cancer types, treatment methods, adverse drug reactions, and secondary cancers, particularly focusing on lung cancer. The study aims to enhance understanding of cancer prevalence, treatment strategies, and the effects of therapies to improve patient care in tertiary settings.

Abdominal pain syndrome in patients with irritable bowel syndrome: features of selection of therapy

Irritable bowel syndrome (IBS) is an important social problem, since it is often diagnosed in people of young working age, significantly affects the quality of life of patients and causes economic damage to society. IBS is a chronic functional bowel disease, the main manifestation of which is pain combined with changes in bowel movements, frequency and character of stool. The mechanism of formation of abdominal pain syndrome is due to a disruption in the interaction along the brain-gut axis, which leads to changes in the regulation of intestinal motor function and the development of visceral hypersensitivity (VH). Abdominal pain as a manifestation of IBS is primarily associated with spasm of intestinal smooth muscles. The first-line drugs for pain relief are antispasmodics, which reduce the tone and contractility of intestinal smooth muscles, effectively coping with abdominal pain. The domestic pharmaceutical market is represented by different groups of muscle relaxants, among which calcium channel blockers are of particular relevance for patients with IBS. Representative of the latter is the drug Otilonium bromide, which is widely used throughout the world, is effective and safe, well tolerated and superior to placebo in reducing symptoms and preventing relapse of pain in patients with IBS. The effectiveness of otilonium bromide is due to a triple mechanism of action: blockade of calcium channels (relief of spasm), antagonism of tachykinone NK2 receptors (effect on HHV) and inhibition of acetylcholine muscarinic receptors (M3-ChR) (reduction of intestinal secretion). This article presents a short review of the literature on the causes and mechanism of development of pain in IBS, as well as the possibilities of its relief, primarily with the use of smooth muscle relaxants, namely otilonium bromide.

FRI042 Worsening Shortness Of Breath After A Mild Case Of Covid-19

Abstract Disclosure: K. Qureshi: None. T.S. Krause: None. K. Vidlock: None. This case demonstrates a complication of COVID 19 that may be more common than we know and overlooked. A 34-year-old female presents to the Emergency Department with worsening shortness of breath and tachycardia for 3 days. Her symptoms are worse with ambulation. She feels dizzy and lightheaded. The patient had COVID-19 about two weeks ago and received monoclonal antibodies. The patient has a history of “drenching” night sweats and unintentional weight loss. She denies fever and cough. The patient is eating and drinking normally with no abdominal pain, nausea, or rash. No changes in bowel movements. The patient’s past medical history consists of ADHD, Anxiety, Neuropathy, and Insomnia. The patient takes Adderall, amitriptyline (ELAVIL), fluocinonide (LIDEX). The patient’s family history consists of an aunt who has autoimmune disease and a maternal grandfather who has Non-Hodgkin's Lymphoma. She works as a medical assistant in a family medicine clinic. Patient underwent a CTA which displayed a new anterior mediastinal mass measuring 4.6 x 2.6 x 3.2 cm which was not shown on a previous CT scan 11 months prior. She was referred to a thoracic surgeon for mediastinoscopy, which couldn’t be performed due to location not adjacent to trachea. A PET scan showed mildly FDG-avid soft tissue density in the anterior mediastinum. Four months later, the patient had a CT scan which showed a modest decrease in size measuring 2.1 x 2.5 cm. The thymus is important in maturation of T cells and is replaced with fat through aging. The thymus plays an important immunological role in defending against pathogens and cancer by maturing and releasing T cells. Thymic hyperplasia is a response that has been displayed in autoimmune diseases such as Myasthenia Gravis. Thymic rebound hyperplasia is seen more often in children, typically after chemotherapy treatment but not seen in adults. Rebound hyperplasia occurs less often with viral illness. There have been a limited number of cases seen with COVID-19. An observational study of 87 participants suggested that rebound thymic hyperplasia may be a positive predictive factor due to the benefit of T-cell lymphocyte production. The presence of thymic hyperplasia on CT scan in COVID patients correlated with a better prognosis in a retrospective study of 325 COVID patients that had a CT scan. This patient will require repeated imaging and follow up. The long-term consequences of this finding are unknown and this patient has a history of night sweats which preceded the COVID course. Presentation: Friday, June 16, 2023

THU653 Subacute Thyroiditis Following Covid19 Infection

Abstract Disclosure: E. Fanous: None. J.G. Karam: None. Background: Subacute thyroiditis is a self-limiting inflammatory condition of the thyroid gland which usually occurs as a post-viral reaction, leading to the destruction of thyroid follicular cells due to infiltration of lymphocytes. During the first outbreak of COVID-19 virus, subacute thyroiditis had been reported as a complication that may occur in patients without any previous thyroid disorder [1]. Clinical Case: A 62-year-old female patient presented with few weeks history of generalized weakness, fatigue, chills, malaise, low appetite, and unintentional weight loss of around 10lbs. She stated that she feels "internal tremors" and palpitations with heart rate increasing from baseline 60 bpm to 90bpm. She had one episode of near syncope at work prompting her presentation. She reports no change in bowel movements, no heat intolerance, no fever or night sweat, no shortness of breath, no visual changes or eyes problems. Five weeks prior to presentation, the patient was diagnosed with COVID-19 infection by PCR, with a mild disease pattern that consisted of upper respiratory symptoms lasting for few days, however she continued to feel fatigue and low appetite since then, attributing her symptoms to long-term sequelae of Coivd-19. Her past medical history is remarkable for obesity, hypercholesterolemia, and two prior Covid 19 infections: in 2020, treated with monoclonal antibodies, and early 2022. The physical exam was significant for slightly tender thyroid and heart rate of 94 bpm. Thyroid function tests were consistent with hyperthyroidism; TSH<0.01mIU/ml, FT4=2.55ng/dl (0.58-1.64), T4=19.6 mcg/dl (4.4-9.5), T3=1.45ng/ml (0.72-1.35), with negative TSI, TPO AB, and TG AB. ESR was 44mm/hr, RAI uptake and scan showed very low uptake which is indicative for subacute thyroiditis. The patient was given supportive therapy. She developed mild and transient hypothyroidism at 6 weeks follow-up with TSH of 8.59 IU/ml and FT4=0.62 ng/dl (0.89-1.76) before her thyroid tests return to normal at 9 weeks with complete resolution of her symptoms. Conclusion: Prolonged diverse symptoms following Covid19 infection are often attributed to long term Covid symptoms. Health Care providers should be aware of the possibility of subacute thyroiditis following Covid 19 infection and should obtain thyroid function tests in patients who present with malaise, decreased appetite, weight loss and palpitations in the weeks following Covid 19 infection. Reference:1. Mattar SAM, Koh SJQ, Rama Chandran S, Cherng BPZ. Subacute thyroiditis associated with COVID-19. BMJ Case Rep. doi: 10.1136/bcr-2020-237336 Presentation: Thursday, June 15, 2023

Symptomatic Uncomplicated Diverticular Disease (SUDD): Practical Guidance and Challenges for Clinical Management.

Symptomatic Uncomplicated Diverticular Disease (SUDD) is a syndrome within the diverticular disease spectrum, characterized by local abdominal pain with bowel movement changes but without systemic inflammation. This narrative review reports current knowledge, delivers practical guidance, and reveals challenges for the clinical management of SUDD. A broad and common consensus on the definition of SUDD is still needed. However, it is mainly considered a chronic condition that impairs quality of life (QoL) and is characterized by persistent left lower quadrant abdominal pain with bowel movement changes (eg, diarrhea) and low-grade inflammation (eg, elevated calprotectin) but without systemic inflammation. Age, genetic predisposition, obesity, physical inactivity, low-fiber diet, and smoking are considered risk factors. The pathogenesis of SUDD is not entirely clarified. It seems to result from an interaction between fecal microbiota alterations, neuro-immune enteric interactions, and muscular system dysfunction associated with a low-grade and local inflammatory state. At diagnosis, it is essential to assess baseline clinical and Quality of Life (QoL) scores to evaluate treatment efficacy and, ideally, to enroll patients in cohort studies, clinical trials, or registries. SUDD treatments aim to improve symptoms and QoL, prevent recurrence, and avoid disease progression and complications. An overall healthy lifestyle - physical activity and a high-fiber diet, with a focus on whole grains, fruits, and vegetables - is encouraged. Probiotics could effectively reduce symptoms in patients with SUDD, but their utility is missing adequate evidence. Using Rifaximin plus fiber and Mesalazine offers potential in controlling symptoms in patients with SUDD and might prevent acute diverticulitis. Surgery could be considered in patients with medical treatment failure and persistently impaired QoL. Still, studies with well-defined diagnostic criteria for SUDD that evaluate the safety, QoL, effectiveness, and cost-effectiveness of these interventions using standard scores and comparable outcomes are needed.

Intestinal tuberculosis mimicking Crohn‘s disease: clinical case

Ieva Stainytė1, Martyna Vyčaitė1, Irma Kuliavienė2 1Lithuanian University of Health Sciences, Faculty of Medicine, Kaunas, Lithuania 2Hospital of the Lithuanian University of Health Sciences Kauno klinikos, Department of Gastroenterology, Kaunas, Lithuania Abstract Background. Gastrointestinal (GI) tuberculosis (TB) is a relatively rare form of tuberculosis that can affect the peritoneum, abdominal organs or the abdominal lymphatic system. As an extrapulmonary form, intestinal tuberculosis accounts for 2% of cases of this disease worldwide. Intestinal damage caused by Mycobacterium tuberculosis (M. tuberculosis) presents with nonspecific complaints such as constitutional symptoms, abdominal pain and changes in bowel movements. The most common site of damage is the ileocecal valve. People with immunosuppressive conditions are at greater risk of developing this disease. Clinical case. This article presents a clinical case of a patient in whom the initial diagnosis of Crohn’s disease (CD) and treatment with glucocorticoids were incorrect. Persistent symptoms led to consideration of ineffective treatment and alternative diagnoses, therefore, it was decided to perform a repeated fibrocolonoscopy (FCS). Ultimately, only a positive culture for M. tuberculosis confirmed the diagnosis of intestinal tuberculosis. Conclusions. This clinical case reflects the complicated diagnosis of intestinal tuberculosis and its differentiation from Crohn’s disease, which is determined by non-specific symptoms and insufficiently sensitive standard tests. A detailed examination, including fibrocolonoscopy with multiple biopsies for histological examination and microbiological identification of M. tuberculosis, is important for establishing the diagnosis. Multiplex polymerase chain reaction (PCR) testing is recommended when possible. Keywords: gastrointestinal tuberculosis, intestinal tuberculosis, M. tuberculosis. Full article https://doi.org/10.53453/ms.2023.2.16

Rectal perforation due to malignancy as a rare cause of acute abdomen in a third trimester pregnant patient: a case report

Anatomical and physiological changes during pregnancy may complicate diagnosis and treatment. While the cause of non-obstetric acute abdomen is encountered in one in 500 pregnancies, the most common one may be acute appendicitis. The incidence of colorectal cancer (CRC) during pregnancy is 0.002%. Common symptoms, such as abdominal pain, nausea, vomiting, and changes in bowel movements, are often observed in a regular pregnancy. Thus, most colorectal cases are overlooked and diagnosed in advanced stages associated with a poor prognosis. This case report presents a 31-year-old female patient at 37 weeks of gestation who applied with an acute abdomen, underwent emergency explorative laparotomy, had a 2 cm perforation detected in the rectum, and was referred to neoadjuvant chemo-radiotherapy due to perforation due to malignancy detected in the examinations performed in the postoperative follow-up. The relevant literature notes that colorectal cancer is rarely seen among expectant mothers. It should be suspected in the diagnosis among patients with gastrointestinal complaints for whom conservative treatment has failed. It should also be noted that bowel perforation, a rare complication of colorectal cancer, may also be present in emergency department applications with an acute abdomen.

Bowel movement changes after laparoscopic cholecystectomy

Background & objectives: Laparoscopic Cholecystectomy is the first choice of therapy in patients with symptomatic gallstone disease. This technique has been dramatically effective in decreasing the need for open cholecystectomy and its complications. However, not all patients are free from complications following cholecystectomy. This study was aimed at evaluating the prevalence of changes in bowel movement in patients undergoing laparoscopic cholecystectomy in a sample population in Erbil city. Methods: In this prospective clinical trial, 221 patients diagnosed with gallstone disease attended Rizgary Teaching hospital. The patients were screened clinically and by investigations for the eligibility criteria between November 1st, 2018, and October 31st, 2019. Out of these; 172 were included underwent laparoscopic cholecystectomy under general anesthesia. The patients were given appointment for follow up postoperatively at two weeks and three months for the bowel movement changes, such as diarrhea, constipation, and other complications. Results: The mean and range of age and body mass index of the patients were 40.77 (15-92 years) and 27.07 (17.92-45.20), respectively. Majority of the patients were females (82.6%), and the remaining were males (17.4%). The study revealed that 93.0% and 93.6% of the patients had no changes in their bowel movement upon follow-up for two weeks and three months postoperatively, respectively. The study found no significant differences in the diarrhea rate in patients with different body mass indices at three weeks and three months. The rate at which diarrhea occurred was significantly higher in younger aged patients at three-month follow-up (32.00 vs. 40.83 years). Conclusions: The current study showed a low rate of bowel movement changes in patients who underwent LC at two weeks and three months postoperatively.

Everyday challenges following hospital discharge. A multi-method study identifying and describing areas of concern for patients during the first month after colorectal cancer surgery.

Identify and describe areas of concern focusing on day-to-day variations during the first month after surgery for patients recovering from colorectal cancer surgery. A multi-method design was applied using diaries and interviews. Data was collected using semi-structured diaries kept 1 month after surgery by seven patients recovering from colorectal cancer surgery. Also, face-to-face interviews were conducted 1 month after surgery. Data from the diaries constituted a framework for the following directed content analysis of interviews. Low levels of pain were experienced but caused reduced mobility and tiredness. Practical matters in daily living were restricted, while social life could be hampered by a frequent need to defecate. Appetite and consequently the ability to eat and drink was the most prominent concern, due to changes in taste and ability to tolerate food. Worries were mainly related to changes in bowel movements. No Patient or Public Contribution.

PSAT352 A Case Report: Unilateral Graves’ Ophthalmopathy in Euthyroid Patient

Abstract Introduction Graves’ Ophthalmopathy is an immune mediated inflammation in orbital and retroorbital tissues, occurs mainly with hyperthyroidism,10% with euthyroid and rarely with hypothyroidism, more frequently in females(1). Thyroid-stimulating hormone (TSH) receptor (TSHR) is the main auto-antigen, expressed in the thyroid gland, adipocytes and fibroblasts. It is aligned with insulin-like growth factor 1 (IGF-1) receptor. T cells activate TSHR and IGF-1 receptors and initiating a retro-orbital inflammation and accumulation of hydrophilic glycosaminoglycans (GAG)(2). Case 46 yo, Hispanic obese male with history of type 2 DM and HLD, non-smoker, non- alcoholic, no illicit drugs. Family History of DM, no allergy,Home medications: Alogliptin benzoate 25mg/day, Metformin 1000mg twice/day and atorvastatin 10mg/day. Ophthalmology checkup 2 months before; visual acuity of 20/30, B/L nasal pterygium, no Diabetic retinopathy. Normal TSH (0.56ulU/ml) 6 months before. He presented to the Emergency department with 3 days of progressive redness, puffiness, photophobia and pressure like sensations in left eye, denied palpitations, change in bowel movements, weight loss/gain, heat/cold intolerance, fever, vomiting, headache, motor weakness, sensory loss. General examination alert, orientated x3,ABP 130/60, HR 75BPM, afebrile(98.4 F), BMI 37.56kg/m2, no tremors, no thyromegaly, normal heart, lung, abdomen examinations, no edema. Left eye conjunctival injection, proptosis, decrease visual acuity 20/60 and color vision, restricted eye movements, relative afferent pupillary defect, optic Neuropathy. Right eye nasal Pterygium and normal fundus examination. Laboratory findings; normal TSH 1.4ulU/ml, FT4 1.2ng/dl, FT3121ng/dl, High TSHR antibody4.69IU/L (normal less than 1.75IU/L), Thyroid peroxidase antibody 363IU/ml (normal less than 34.9IU/ml) and Thyroid stimulating immunoglobulin 3.55 IU/L (normal less than 0.55IU/L). Normal CBC, GFR, negative C-ANCA, P-ANCA antibodies. CT orbit showed marked exophthalmoses, prominence of infraorbital fat, thickening of inferior and medial rectus muscles of left eye. He was kept on IV Solumedrol 250mg Q 6hrs for 3 days, artificial tears. Symptoms improved, was discharged on tapering oral steroid starting with prednisone 80mg daily. Follow up after 5 days reported marked improvement of symptoms with slight proptosis, no optic neuropathy. Conclusion Graves’ Ophthalmopathy can occur in euthyroid patients. Presents mainly with bilateral eye affection, few cases have unilateral eye affection. IV or oral Steroid is the Main treatment of Graves’ ophthalmopathy with local eye measures and management of thyroid disease. Other options are teprotumumab (IGF-1 receptor Inhibitor), and rituximab or orbital decompression surgery/external orbital radiation. Close follow up is recommended as orbitopathy precedes hyperthyroidism in 20%of cases(3,4). References 1-Kersten R. American Academy of Ophthalmology Section 7, Orbit, Eyelids and Lacrimal System 2004-2005: 48-56. 2-Bahn RS. Graves’ ophthalmopathy. N Engl J Med 2010; 362: 726. 3-Douglas RS, Kahaly GJ, Patel A, et al. Teprotumumab for the Treatment of Active Thyroid Eye Disease. N Engl J Med 2020; 382: 341. 4-Zang S, Ponto KA, Kahaly GJ. Clinical review: Intravenous glucocorticoids for Graves’ orbitopathy: efficacy and morbidity. J Clin Endocrinol Metab 2011; 96: 320. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

ODP342 Panhypopituitarism Induced by CTLA-4 and PD-1/PD-L1 Inhibitor Immunotherapy

Abstract Background Breakthroughs in oncology have led to the incorporation of immunotherapy to improve the prognosis in patients with advanced malignancies. Checkpoint inhibitors are immunomodulatory antibodies that enhance the immune system using PD-1/PD-L1 and CTLA-4 as primary targets. Pharmacologic disruption in checkpoints can trigger autoimmune-like manifestations in various organs systems, known as immune-related adverse effects. Endocrinopathies of the pituitary, thyroid, or adrenal glands have been described; with the most common being hypothyroidism, hyperthyroidism and hypophysitis. We report a case of hypophysitis induced by immunotherapy in a patient treated with ipilimumab and nivolumab for renal cell carcinoma with bone metastases. Clinical case Case of a 63-year-old male patient with left renal cell carcinoma treated with nivolumab and ipilimumab, who presented with general weakness, malaise, disorientation, slow mentation and severe hyponatremianine weeks after immunotherapy initiation. Denied headache, loss of consciousness, dizziness, involuntary movements, nausea, vomiting, abdominal pain, changes in bowel movements, swelling of skin or changes in skin color, decreased libido or erectile dysfunction, hair loss, polyuria, polydipsia, mood changes or hypoglycemia. Laboratory results showed serum sodium levels of 117mEq/L, inappropriately normal ACTH (18.8 pg/mL), low serum cortisol in early morning (1.97µg/dL), low TSH (0.17 mIU/mL) and low total T4 (4.39µg/dL). Serum sodium levels improved to 136 mEq/L after administration of 3% NaCl and glucocorticoids, that were given due to concerns for adrenal insufficiency. Patient was discharged home on oral hydrocortisone and immunotherapy was discontinued. Repeated hormonal workup revealed previously identified central hypothyroidism and secondary adrenal insufficiency. Additionally, had an inappropriate lynormal FSH (11.10 mIU/L) and LH (2.62 IU/L), in view of a low total testosterone (< 2.5 pg/mL), suggestive of hypogonadotropic hypogonadism. Since the patient was asymptomatic for sexual dysfunction, hormonal work up was repeated later on, and found with normal gonadotropins and normal total testosterone levels (444 ng/dL; 93-740 ng/dL), with no evidence of hypogonadism. There was no indication for growth hormone therapy in view of anormal IGF-1 for age (236 ng/mL). He is currently clinically stable on replacement therapy with hydrocortisone and levothyroxine. Conclusion Immunotherapy-induced endocrinopathies are important adverse effects that clinicians should be aware of and monitored routinely in patients treated with checkpoint inhibitors. Hypophysitis typically manifests with fatigue and headache in the presence of adrenal insufficiency, hypothyroidism and hypogonadism with preservation of growth hormone. It This condition has been described with different immune checkpoint inhibitors, although incidence is higher with ipilimumab, as reported in this case. Recovery of some pituitary function is common, but persistent deficiences can occur, particularly adrenal insufficiency that rarely resolves. Complications associated with hormonal deficiencies can be life-threatening and prompt recognition is warranted. Presentation: No date and time listed

Genetic and phenotypic diversity of fecal Candida albicans strains in irritable bowel syndrome

Irritable bowel syndrome (IBS) is a common disorder characterized by chronic abdominal pain and changes in bowel movements. Visceral hypersensitivity is thought to be responsible for pain complaints in a subset of patients. In an IBS-like animal model, visceral hypersensitivity was triggered by intestinal fungi, and lower mycobiota α-diversity in IBS patients was accompanied by a shift toward increased presence of Candida albicans and Saccharomyces cerevisiae. Yet, this shift was observed in hypersensitive as well as normosensitive patients and diversity did not differ between IBS subgroups. The latter suggests that, when a patient changes from hyper- to normosensitivity, the relevance of intestinal fungi is not necessarily reflected in compositional mycobiota changes. We now confirmed this notion by performing ITS1 sequencing on an existing longitudinal set of fecal samples. Since ITS1 methodology does not recognize variations within species, we next focused on heterogeneity within cultured healthy volunteer and IBS-derived C. albicans strains. We observed inter- and intra-individual genomic variation and partial clustering of strains from hypersensitive patients. Phenotyping showed differences related to growth, yeast-to-hyphae morphogenesis and gene expression, specifically of the gene encoding fungal toxin candidalysin. Our investigations emphasize the need for strain-specific cause-and-effect studies within the realm of IBS research.

Clinical evaluation of the effect of Zataria multiflora Boiss and Trachyspermum copticum (L.) on the patients with irritable bowel syndrome

Background and AimIrritable Bowel Syndrome (IBS) is the most common gastrointestinal dysfunction characterized by abdominal pain or discomfort, as well as changes in bowel movements and stool shape. Given the global trend towards the increased use of complementary and alternative medicine (CAM), the high prevalence of IBS, the lack of a standard treatment for all IBS subtypes, and patients' willingness to use CAM treatments, investigations into CAM treatments are needed. Accordingly, the present study aimed to investigate the effect of a mix of two herbal medicines (Zataria-Trachyspermum, ZT) on the clinical symptoms of patients with IBS. Experimental procedureThe present study was performed on 3 groups including the positive control, experimental, and placebo groups. The sample size was calculated as 150 participants. Fifty patients were assigned to one of three parallel groups (ZT capsule, placebo, and mebeverine capsule) by block randomization. All three groups were treated for 4 weeks. The patients were monitored in the follow-up stage for 2 additional weeks. ResultsAfter the fourth week of intervention, symptoms of pain, bloating, and reflux showed a significant decrease in the ZT group compared to the placebo and mebeverine groups (P <0.05). Moreover, the participants in the ZT group reported a significant decrease in fatigue compared to the other two groups (P <0.05). ConclusionThis study confirmed the positive effect of ZT on IBS symptoms, especially pain, bloating, constipation, and bowel movements.

PREVENTION OF OVARIAN CANCER

Ovarian cancer is a gynecological malignancy that in Indonesia still ranks third after cervical cancer and uterine corpus cancer 1. In the United States, ovarian cancer is the second most common gynecologic cancer and the leading cause of death from gynecological cancer. Clinically, its development is different from cervical cancer. Namely, ovarian cancer does not have apparent initial clinical symptoms, so that it is difficult to detect early. As a result, 65-75% of ovarian cancer are diagnosed at an advanced stage. Symptoms of ovarian cancer are non-specific, easy to miss in the early stages; symptoms are often seen in advanced stages (stage III or stage IV) a combination of a full stomach, bloating, nausea, abdominal distension, early satiety, fatigue, changes in bowel movements, urinary symptoms, back pain, dyspareunia, and weight loss. Preventive and promotive efforts in reducing the incidence of ovarian cancer are identified risk factors for ovarian cancer.

The new guideline on irritable bowel syndrome: what is new?

WHAT IS NEW?: The following refers only to irritable bowel syndrome (IBS) in adults. The new guideline includes a separate section on IBS for paediatric patients. Irritable bowel syndrome (IBS) presents as a heterogeneous picture with chronic abdominal complaints related to the bowel. These are usually accompanied by changes in bowel movements and lead to impaired quality of life. The genesis is multifactorial and there are complex underlying pathophysiological mechanisms associated with IBS. Thus, disturbances in various components of the gut-brain axis and the increasing importance of the microbiome can be identified. Various psychological comorbidities also play a role. The diagnosis is made by a thorough anamnesis and symptom-oriented exclusion of important differential diagnoses. A subdivision into different subtypes depending on the main symptoms is beneficial for the further management of IBS patients. The diagnosis of IBS should be made as early as possible after reliable exclusion of the important differential diagnoses. If diarrhoea dominates as a symptom, a detailed differential diagnosis and functional diagnosis should be carried out. There is no proven causal and no established standard therapy. Due to the variable genesis and symptom manifestation of IBS, a broad spectrum of therapy options results, whereby there is no individual prediction regarding effectiveness and therefore every therapy is initially probationary. Symptom-independent general therapies that can be used for all subtypes include dietary methods (e. g. the low-FODMAP diet), probiotics, psychotherapy methods and complementary medicine. The choice of symptom-dependent drug treatments is made according to the subtype/main symptom. In the case of diarrhoea, bile acid binders, the non-absorbable antibiotic rifaximin or, in individual cases, 5-HT3-antagonists can be used in addition to loperamide. In constipation, prucalopride and linaclotide have value in addition to the use of soluble fibre and macrogol/other laxatives. For abdominal pain/cramps, studies show good results for spasmolytics, especially peppermint oil, and for tricyclic-type antidepressants. For the main symptom of flatulence, probiotics, rifaximin and especially the low-FODMAP diet can show positive results in studies.

Survey of defecation habits in apparently healthy and chronic kidney disease cats.

Changes in bowel movements (BMs) are an important clinical sign in many diseases, including chronic kidney disease (CKD), and the purpose of this study was to collect information on BMs and fecal scores in both apparently healthy and CKD cats. A secondary aim was to assess owner awareness of BM frequency. Owners were asked to complete an initial online questionnaire about their cat's health and litter box habits (including predicted BM frequency and fecal scores) and were then asked to clean the box daily for 7 days and report results (observed frequency of BMs and fecal scores) daily. Differences in BM frequency and fecal scores between apparently normal and CKD cats were compared using the Mann-Whitney test, and predicted vs observed data were compared using the Wilcoxon signed rank test. Difference in percentage of cats defecating more or less than once daily were assessed with Fisher's exact test. Survey data from 124 owners of apparently healthy cats and 43 owners of CKD cats who submitted two or more days of daily observations (in addition to the initial questionnaire) were analyzed. Eighty-five percent of apparently healthy cats were observed to defecate one or more times per day and 15% defecated less than once per day. Fifty-eight percent of CKD cats defecated one or more times per day and 42% defecated less than once per day. A significantly higher percentage of CKD cats defecated less than once per day in comparison with apparently healthy cats (P <0.0001). Observed BM frequency was significantly less in CKD cats compared with healthy cats (P = 0.02). Observed fecal scores were not significantly different between healthy and CKD cats. The observed BM frequency of cats with CKD was less than apparently healthy cats and represents a clinically important variation from normal.