Chronic Digestive Diseases Research Articles

Age-related differences in the number of chronic diseases in association with trajectories of depressive symptoms: a population-based cohort study

BackgroundThe number of chronic diseases has been associated with changes in depressive symptoms over time among middle-aged and older adults. This study aimed to explore the association between the number of chronic diseases and trajectories of depressive symptoms and the role of age in this association.MethodsA total of 12,974 middle-aged and older Chinese adults (≥ 45 years) participated in the China Health and Retirement Longitudinal Study (CHARLS) in waves 2011, 2013, 2015, 2018, and 2020. The number of chronic diseases was determined by self-reported hospital diagnosis of hypertension, dyslipidemia, diabetes, cancer, chronic lung diseases, liver disease, heart diseases, stroke, kidney diseases, digestive diseases, emotional, nervous, or psychiatric problems, memory-related disease, arthritis or rheumatism, asthma, and then obtaining the total number of chronic diseases. Depressive symptoms were measured by the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10). Group-based trajectory modeling (GBTM) was adopted to capture the trajectories of depressive symptoms over time. Multinomial logistic regressions were conducted to examine the association between the number of chronic diseases and trajectories of depressive symptoms and the role of age in this association.ResultsFour distinct trajectories of depressive symptoms were observed in 34.68% individuals in mild, 40.76% in moderate, 19.41% in increasing, and 5.15% in severe group. Compared to participants without chronic diseases, those with one, two, three or more chronic diseases had a 1.81, 3, and 7.49-fold higher risk of developing severe depressive symptom trajectory, respectively. Moreover, the association between the number of chronic diseases and severe depressive symptoms trajectory differed by age (45–59 and ≥ 60 years) (P for interaction < 0.05).ConclusionParticipants with middle age may play a promoting role in the association between the number of chronic disease and severe depressive symptoms. The severe depressive symptoms intervention may be more beneficial for middle-aged adults.

Somatic and psychiatric comorbidity in people with diagnosed gambling disorder: A Finnish nation-wide register study.

This is the first nation-wide register study based on a total population sample measuring the gender-specific incidences of chronic diseases and conditions among adults diagnosed with gambling disorder (GD). The study used aggregated data for 2011-22 retrieved from the Register of Primary Health Care visits, Care Register for Health Care and Care Register for Social Welfare, including specialized outpatient and inpatient health care, inpatient social care and institutional care and housing services with 24-hour or part-time assistance, set in mainland Finland. Participants comprised people aged 18-90+ years with GD diagnosis [corresponding to pathological gambling, International Classification of Diseases 10th revision (ICD-10) code F63.0, n = 3605; men n = 2574, women n = 1031]and the general population (n = 4 374 192). Incidences of somatic diseases and psychiatric disorders were calculated for the people with diagnosed GD and for the general population, separately for women and men. After standardizing for age, the incidence of each diagnostic group was systematically higher for people with GD compared with the general population, except for cancer. The highest standardized incidence ratio (SIR) values were for psychiatric disorders [SIR = 234.2; 95% confidence interval (CI) = 226.1-242.4], memory disorders (SIR = 172.1; 95% CI = 119.1-234.8), nervous system diseases (SIR = 162.8; 95% CI = 152.8-173.1), chronic respiratory diseases (SIR = 150.6; 95% CI = 137.6-164.2), diabetes (SIR = 141.4; 95% CI = 127.9-155.5) and digestive diseases (SIR = 134.5; 95% CI = 127.1-142.2). In Finland, the incidence of chronic diseases and conditions among people with gambling disorder is higher compared with the general population, apart from cancer.

In vitro Biological Activities and Fatty Acid Composition Analysis of Musa paradisiaca L. Inflorescence

Musa paradisiaca L. is native to tropical climate. Inflorescences of this herb are used as a treatment of digestive distresses. This study involved analysis of the fatty acid contents and some in-vitro pharmacological activities of the inflorescence. Modified Kupchan method was used for extraction in solvents of varying polarity. Fatty acid content analysis was conducted on n-hexane extract; Palmitoleic acid was found to be the highest in proportion in both bound (34.40%) and free (37.80%) forms. n-hexane and dichloromethane extracts exhibited cytotoxicity against carcinoma cell (HeLa cell line). Ethyl acetate extract possessed significant amount of free radical (DPPH) scavenging capability (IC50 = 66.92±0.3065 μg/ml). The n-Hexane extract was found to be rich in phenolics (26.40 ± 0.033 mg GE/g) and flavonoids (83.40± 0.099 mg QE/g). Dichloromethane fraction exhibited the highest zone of inhibition (15 mm) against the bacterium Shigella dysenteriae. Ethyl acetate fraction showed blood clot lysis activity of 29.35% (standard streptokinase 63.05%). Presence of potent bioactivities imply the prospects of this sample as a source of lead compounds for effective formulations against chronic digestive diseases. Dhaka Univ. J. Pharm. Sci. 23(1): 69-76, 2024 (June)

Post-discharge surveillance of urinary tract infections in patients following hip and knee arthroplasty: Identifying targets for infection prevention and control

This population-based study aimed to evaluate the incidence of urinary tract infections following hip and knee arthroplasty (HPRO and KPRO) and identify urinary tract infection risk factors among Polish patients. The analysis included data from 83,525 patients, with incidence rates of 0.7% and 0.49% after HPRO and KPRO, respectively. We identified women, individuals over 65 years old, residents of long-term care facilities, patients with chronic circulatory, endocrine, or digestive diseases, and those operated on due to trauma as targets for infection prevention and control.

Causes of digestive symptoms in patients with COVID-19

This literature review discusses the problem of the causes of digestive symptoms in COVID-19 patients, examining papers in which SARS-CoV-2 gastrointestinal infection was the underlying cause of symptoms and papers in which the occurrence of such symptoms was associated with exacerbation of pre-existing, including previously undiagnosed GI diseases.&#x0D; Objective: to identify the most likely underlying cause of digestive symptoms in COVID-19 patients. Materials and Methods. We searched 59 literature sources from eLibrary, PubMed, Scopus, and Google scholar databases. All papers were published in the last 4 years.&#x0D; Results. The resulting digestive symptoms in coronavirus lesions are caused by direct disruption of the intestinal barrier; also, these symptoms may be a manifestation of exacerbation or debut of chronic digestive diseases on the background of COVID-19, and exacerbate the course of infection; or a result of COVID-19 therapy. A differential diagnosis of COVID-19 with inflammatory bowel diseases, chronic liver diseases, chronic and acute biliary pancreatitis is required in patients with diarrhea, abdominal pain, elevated blood liver and pancreatic enzymes. The correlation of gastroenterological symptoms with the direct COVID-19 lesion can be established by comparing the clinical picture with the detection of RNA virus in stool, histologic specimens, but sometimes there may be no unambiguous answer. Specific changes on computed tomography with angiography of the abdominal cavity organs (peri-intestinal fatty tissue strands against the background of intestinal wall thickening) are described only in the initial stage of COVID-19, at later stages the changes are nonspecific. Data from endoscopic studies in patients with COVID-19 are limited to single clinical cases or case series describing nonspecific findings and suggesting that the virus directly damages GI mucosal surfaces. This calls into question the results of the studies that have been conducted, most of which were retrospective and did not evaluate the baseline presence of gastrointestinal symptoms prior to COVID-19. Due to the peculiarities of the virus interaction with body cells and the diversity of clinical manifestations of the disease, a combined approach in the diagnosis of GI diseases in COVID-19 is necessary.

Prevalence of Coagulopathy in Patients with Celiac Disease: A Single-Center Retrospective Case-Control Study

Introduction: Despite being one of the most frequent chronic digestive diseases worldwide, with a prevalence of 1%, celiac disease (CD) remains severely underdiagnosed. Among the instruments used to improve its diagnostic rate, hematologic parameters have been proposed as screening tests to select patients with an increased probability of having CD. Assessment of coagulation is included in routine check-ups, and CD has been reported to be associated with coagulopathy. We aimed to assess if subtle changes in coagulation tests could be used in clinical practice to prompt testing for CD. Methods: We retrospectively recruited all patients with clinical suspicion for CD during a study period of 7 years (between 2015 and 2022), who were tested using IgA tissue transglutaminase (tTG) serology and serum total IgA (IgG tTG in case of IgA deficiency) and who underwent upper gastrointestinal endoscopy with multiple biopsy sampling of the duodenal bulb and distal duodenum. We stratified patients into three groups: newly diagnosed CD, gluten-free diet-treated CD, and non-CD controls. Results: Altogether, there were 133 CD patients (71 newly diagnosed, 62 GFD-treated) and 57 non-CD controls. Mean age and gender distribution were similar among the three groups: 43.3 years for newly diagnosed CD, 41.6 years for non-CD controls, and 44 years for GFD-treated CD patients, with a male gender distribution of 21.1%, 28%, and 24.1%, respectively. Among the included newly diagnosed CD patients, 14% had a prolonged INR. The mean INR was slightly higher in newly diagnosed CD patients, compared to GFD-treated CD patients and non-CD controls: 1.12 ± 0.30, 1.02 ± 0.83, and 1.00 ± 0.08, respectively (p = 0.009). Consequently, prothrombin activity was slightly lower in newly diagnosed CD patients, compared to GFD-treated CD and non-CD controls: 94.9 ± 19.3%, 102.3 ± 12.8%, and 101.9 ± 15.15, respectively. Interestingly, after GFD, the mean INR and prothrombin activity of CD individuals reached a value similar to that of non-CD controls. Conclusions: Subtle changes in INR, defined as a value within the normal range, but closer to the upper limit, could be an indicator of probability for CD.

The prevalence and risk factors of functional dyspepsia among adults in low- and middle-income countries: An international cross-sectional study.

Dyspepsia is one of the most common chronic digestive diseases, which is due to underlying organic causes that can be detected, or causes that cannot be detected called functional dyspepsia (FD). There is no epidemiological study to date that measures the prevalence and risk factors of the FD in low- and middle-income countries, so this international cross-sectional study was conducted in 15 low- and middle-income countries from data previously published its protocol NCT05340400. Participants were recruited in the period from 22/April/2022 to 14/June/2022. The diagnosis of the FD was according to clinical manifestations. We determined the physical activity, daily stress, and fatigue of the participants. A large number of collaborators were chosen from different regions and institutions within each country to achieve diversity within the sample and reduce the probability of bias. Our study concluded that the prevalence of FD is much higher in low- and middle-income countries 37.9% [6.2%-44.2%], compared to high-income countries 10% [8%-12%], with a higher rate among the Afro-Caribbean race 47.9%. Sudan obtained the highest prevalence 44.3%, then Egypt 41.4%, while the lowest prevalence was in Algeria 25.7%. Moreover, there are many risk factors, including modifiable ones, such as severe stress, chronic fatigue, smoking, abnormal BMI, insufficient or too many hours of sleep, and previous infection with Covid-19, and non-modifiable ones such as advanced age, chronic diseases, and female sex. Highlighting the prevalence and increasing risk factors of FD in low- and middle-income countries should draw the attention of those responsible for health care in these countries and reduce the risk factors.

Comorbidities are associated with self-reported sleep-disordered breathing and insomnia: a cross-sectional study from China.

We aimed to examine the associations of comorbidities with self-reported sleep-disordered breathing (SDB) and insomnia among Chinese adults. The study used data from a community-based cross-sectional survey performed in China in 2018-2020. Multivariable logistic regression models were used to analyze the associations of 12 comorbidities with SDB and insomnia. A total of 4329 Han Chinese adults aged ≥ 18years were enrolled. Of these, 1970 (45.5%) were male, with a median age of 48years (interquartile range: 34-59). Compared with the participants without any conditions, adjusted ORs for SDB and insomnia for those with ≥ 4 comorbidities were 2.33 (95% CI: 1.58, 3.43, P-trend < 0.001) and 3.89 (95% CI: 2.69, 5.64, P-trend < 0.001), respectively. Seven comorbidities (hypertension, hyperlipidemia, coronary heart disease (CHD), bone and joint disease, neck or lumbar disease, chronic digestive diseases, and chronic urological disease) were positively associated with both SDB and insomnia. Cancer and chronic obstructive pulmonary disease (COPD) were also independently associated with insomnia. Of all comorbidities, cancer was most strongly associated with insomnia (OR = 3.16; 95% CI: 1.78, 5.63; P < 0.001), and CHD was most strongly associated with SDB (OR = 1.77; 95% CI: 1.19, 2.64; P < 0.001). The findings showed that adults with an increasing number of comorbidities had higher odds for SDB and insomnia, which were independent of sociodemographic and lifestyle factors.

РАСПРОСТРАНЕННОСТЬ ХРОНИЧЕСКОГО ГАСТРОДУОДЕНИТА СРЕДИ ДЕТЕЙ, ПРОЖИВАЮЩИХ В ГОРОДЕ ЯРОСЛАВЛЕ

Chronic gastroduodenitis (CGD) is one of the most common diseases in children. Current data on the prevalence and incidence of CGD in children vary greatly from different sources, and therefore it is difficult to form strategies aimed at preventing CGD at an early age, which leads to an increase in the number of patients with late diagnoses, as well as a decrease in the quality of life of patients and their families, and has significant socio-economic consequences. The aim of the study was to assess the prevalence of CGD among children living in the large administrative center of the Central Federal District, the city of Yaroslavl. A retrospective analysis of the clinical, endoscopic and morphological status of the upper digestive tract in children with chronic digestive diseases examined in the conditions of the consultative and diagnostic center (CDC) of the Regional Children's Clinical Hospital (RCCH) for the period 2017-2021 was carried out. Based on the data obtained, the following statistical indicators were calculated: gender-age composition of patients with CGD, morbidity, prevalence for specific annual indicators and age groups. At the time of the retrospective analysis, 2,416 children were diagnosed with CGD. In 2021, the incidence was 4.92 per 1,000 children, and the prevalence was 20.61 per 1,000 children, these indicators change every year in waves. Our data on the prevalence of CGD in the city of Yaroslavl are underestimated and have a wide spread in different age categories. The problem raised in our study requires in-depth study on additional samples of children in this region.

Family adversity and health characteristics associated with intimate partner violence in children and parents presenting to health care: a population-based birth cohort study in England

Little is known about the clinical characteristics of children and parents affected by intimate partner violence (IPV) presenting in health-care settings. We examined the associations between family adversities, health characteristics, and IPV in children and parents using linked electronic health records (EHRs) from primary and secondary care between 1 year before and 2 years after birth (the first 1000 days). We compared parental health problems in in children and parents with and without recorded IPV. We developed a population-based birth cohort of children and parents (aged 14-60 years) in England, comprising linked EHRs from mother-child pairs (with no identified father) and mother-father-child triads. We followed the cohort across general practices (Clinical Practice Research Datalink GOLD), emergency departments, outpatient visits, hospital admissions, and mortality records. Family adversities included 33 clinical indicators of parental mental health problems, parental substance misuse, adverse family environments, and high-risk child maltreatment-related presentations. Parental health problems included 12 common comorbidities, ranging from diabetes and cardiovascular diseases to chronic pain or digestive diseases. We used adjusted and weighted logistic-regression models to estimate the probability of IPV (per 100 children and parents) associated with each adversity, and period prevalences of parental health problems associated with IPV. We included 129 948 children and parents, comprising 95 290 (73·3%) mother-father-child triads and 34 658 (26·7%) mother-child pairs only between April 1, 2007, and Jan 29, 2020. An estimated 2689 (2·1%) of 129 948 children and parents (95% CI 2·0-2·3) had recorded IPV and 54 758 (41·2%; 41·5-42·2) had any family adversity between 1 year before and 2 years after birth. All family adversities were significantly associated with IPV. Most parents and children with IPV had recorded adversities (1612 [60·0%] of 2689) before their first IPV recording. The probability of IPV was 0·6 per 100 children and parents (95% CI 0·5-0·6) with no adversity, increasing to 4·4 per 100 children per parents (4·2-4·7) with one adversity, and up to 15·1 per 100 parents and children (13·6-16·5) with three of more adversities. Mothers with IPV had a significantly higher prevalence of both physical (73·4% vs 63·1%, odds ratio [OR] 1·6, 95% CI 1·4-1·8) and mental health problems (58·4% vs 22·2%, OR 4·9, 4·4-5·5) than mothers without IPV. Fathers with IPV had a higher prevalence of mental health problems (17·8% vs 7·1%, OR 2·8, 2·4-3·2) and similar prevalences of physical health problems than those without IPV (29·6% vs 32·4%, OR 0·9, 0·8-1·0). Two in five of the children and parents presenting to health care had recorded parental mental health problems, parental substance misuse, adverse family environments, or high-risk presentations of maltreatment in the first 1000 days. One in 22 children and parents with family adversity also had recorded IPV before age 2 years. Primary and secondary care staff should safely ask about IPV when parents or children present with family adversity or health problems associated with IPV, and respond appropriately. NIHR Policy Research Programme.

Уровень апоптоза гранулезных клеток у женщин, имеющих экстрагенитальную патологию, с нарушением репродуктивной функции

Granulosa cells feed the oocyte during its maturation and protect it. Aberrant apoptosis in these cells is known to ultimately impair oogenesis. The current knowledge of how extragenital inflammation affects apoptosis in granulosa cells is incomprehensive, which is the root of an urgent problem connected to the spread of inflammatory diseases and the growing level of female infertility. This study aimed to assess the intensity of granulosa cell apoptosis in women with impaired reproductive function that suffer from chronic respiratory and/or digestive system diseases of inflammatory origin, and to identify the link, if any, between the studied factor and dysfunction of the reproductive system in the test group. The group included 60 women with a history of respiratory and/or digestive system inflammatory pathology that underwent IVF in 2021–2022. The women were donors of the granulosa cells from the follicular fluid collected through transvaginal puncture of preovulatory follicles. We studied the apoptosis process with the help of flow cytometry. For statistical analysis, we used the Fisher's F-test and the Kruskal–Wallis test. Twenty participants without extragenital pathology in their medical histories, the first subgroup, had the level of apoptosis in granulosa cells at 0.0088 ± 0.0062%, which is significantly lower than in twenty donors with a history of chronic inflammatory digestive system diseases, the second subgroup (granulosa cell apoptosis at 0.0140 ± 0.0099%, p = 0.015), and the subgroup of women suffering from inflammatory diseases of the respiratory system (granulosa cell apoptosis at 0.0650 ± 0.0391%, p = 0.033); the efficacy of IVF was higher in the first subgroup.

Bidirectional associations and a causal mediation analysis between depressive symptoms and chronic digestive diseases: A longitudinal investigation

Chronic digestive diseases (CDDs) and depression shared major pathogeneses. We aimed to prospectively examine the bidirectional incidence associations between depressive symptoms and CDDs and explore biologically and behaviorally relevant mediators in the bidirectional associations. Multivariable-adjusted Cox proportional hazard models were used to examine baseline depressive symptoms in relation to incident CDDs among 10,974 adults and the relation of baseline CDDs with new-onset elevated depressive symptoms among 7489 participants in the China Health and Retirement Longitudinal Study of nationally representative middle-aged and older adults. Elevated depressive symptoms were defined as the 10-item Center for Epidemiologic Studies Depression scale (CES-D-10) score at or higher than 10 and CDDs (except for tumor and cancer) were determined by self-reported physician diagnoses. Causal mediation analysis was performed to assess the mediated effects of a priori selected blood biomarkers and lifestyle factors in the bidirectional associations. Prevalence of elevated depressive symptoms and nonmalignant CDDs at baseline was 33.05% and 17.8% respectively. During a mean of 5.47years of follow-up, elevated depressive symptoms significantly increased hazard of CDDs by 1.66 folds (95%CI=1.49-1.84). Having CDDs at baseline was associated with a 27% (95%CI=16%-39%) increased hazard of developing elevated depressive symptoms. Shorter sleeping duration at night nominally significantly mediated 8.76% of the association between depressive symptoms and incident CDDs while no significant mediators were identified in the converse association. Limited mediator information and inadequately long follow-up may reduce chance of identifying significant mediators. Depressive symptoms and CDDs were mutual independent risk factors. Early screening and management of depressive symptoms and sleep disturbance are suggested in the prevention of CDDs and related comorbidities.

Self-Reported Primary Cooking Fuels Use and Risk of Chronic Digestive Diseases: A Prospective Cohort Study of 0.5 Million Chinese Adults.

Household air pollution (HAP) from inefficient combustion of solid fuels is a major health concern worldwide. However, prospective evidence on the health impacts of solid cooking fuels and risks of chronic digestive diseases remains scarce. We explored the effects of self-reported primary cooking fuels on the incidence of chronic digestive diseases. The China Kadoorie Biobank recruited 512,726 participants 30-79 years of age from 10 regions across China. Information on primary cooking fuels at the current and previous two residences was collected via self-reporting at baseline. Incidence of chronic digestive diseases was identified through electronic linkage and active follow-up. Cox proportional hazards regression models were used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations of self-reported long-term cooking fuel patterns and weighted duration of self-reported solid cooking fuel use with chronic digestive diseases incidence. Linear trend was tested by assigning the medians of weighted duration in each group and then taking those as continuous variables in the models. Subgroup analyses were undertaken across the baseline characteristics of participants. During y of follow-up, 16,810 new cases of chronic digestive diseases were documented, among which 6,460 were diagnosed as cancers. Compared with long-term cleaner fuel use, self-reported long-term use of solid cooking fuels (i.e., coal, wood) was associated with elevated risks of chronic digestive diseases (; 95% CI: 1.02, 1.13), including nonalcoholic fatty liver disease (NAFLD) (; 95% CI: 1.10, 1.87), hepatic fibrosis/cirrhosis (; 95% CI: 1.05, 1.73), cholecystitis (; 95% CI: 1.07, 1.32), and peptic ulcers (; 95% CI: 1.00, 1.33). The longer the weighted duration of self-reported solid cooking fuel use, the higher the risks of chronic digestive diseases, hepatic fibrosis/cirrhosis, peptic ulcers, and esophageal cancer (). The aforementioned associations were modified by sex and body mass index (BMI). Positive associations of always solid cooking fuel use with chronic digestive disease, hepatic fibrosis/cirrhosis, NAFLD, and cholecystitis were observed among women but not men. The longer the weighted duration of self-reported solid cooking fuel use, the higher the risk of NAFLD among those with a BMI . Long-term self-reported solid cooking fuels use was associated with higher risks of chronic digestive diseases. The positive association of HAP from solid cooking fuels with chronic digestive diseases indicates for an imminent promotion of cleaner fuels as public health interventions. https://doi.org/10.1289/EHP10486.

Factors responsible for the modulation of microbiota and their impact on course of inflammation in inflammatory bowel disease – selected aspects

Inflammatory bowel diseases (IBD) is a group of chronic digestive tract diseases of characterized by periods of exacerbation and remission. The pathophysiology of IBD is multifactorial and includes microbiological, immunological, genetic and environmental factors. In recent years, the significant role of the intestinal microbiome in the development of these entities has been emphasized. In the article we discussed the impact of selected factors: antimicrobial peptides, vitamin D and iron on the composition of the intestinal microbiota and their role in the immune response and pathogenesis of IBD.

The Pervasive Impact of the Stigmatization of Gastrointestinal Diseases-A Patient's Perspective.

Stigma is a centuries-old phenomenon that pervades chronic digestive diseases, regardless of classification. Patients with gastrointestinal (GI) illness perceive others hold stigmatizing beliefs about them and their illness, including from medical professionals, and may go on to internalize or believe these negative stereotypes as true. These perceptions seem to be based on the thought that the public views GI diseases negatively. The effects of GI stigma are substantial and influence quality of life, psychological distress, treatment adherence, disease severity, and health-care utilization. These realities underscore the need for stigma to be addressed by the GI community and measures taken to mitigate its impacts.

Analysis of Wumei Pills in treating chronic digestive system diseases with concept of "treating different diseases with same method" based on network pharmacology and molecular docking

The present study explored the material basis and underlying mechanism of Wumei Pills in the treatment of ulcerative colitis(UC), diabetic enteropathy(DE), and irritable bowel syndrome(IBS) based on network pharmacology and molecular docking.The active components and targets of Wumei Pills were obtained and screened out from TCMSP, and the target names were standardized by UniProt.The related targets of UC, DE, and IBS were searched from GeneCards, DisGeNET, DrugBank, and OMIM.The Venn dia-gram was constructed using the Venny 2.1 online analysis tool to obtain the common targets of the drug and diseases.The &quot;drug-active ingredient-target&quot; network was constructed by Cytoscape 3.7.2.Gene Ontology(GO) function enrichment and Kyoto Encyclopedia of Genes and Genomes(KEGG) pathway enrichment analyses of common targets were carried out by DAVID.The main active components and targets were docked by AutoDock.The therapeutic mechanism of Wumei Pills was presumedly related to the regulation of the cancer pathway, TNF signaling pathway, HIF-1 signaling pathway, PI3 K-Akt signaling pathway, NF-κB signaling pathway, Toll-like receptor signaling pathway, JAK-STAT signaling pathway, etc.The results of molecular docking showed that the main active components could bind to the core targets, possessing stable conformation.The therapeutic effects of Wumei Pills against three diseases involved a variety of compounds such as flavonoids, sterols, and alkaloids in the prescriptions, which acted on key targets through multiple organs and participated in multiple signaling pathways such as apoptosis and immune inflammation, thereby exerting the therapeutic action on different diseases with the same method.This study explained the underlying mechanism of Wumei Pills in &quot;treating different diseases with same method&quot;, and is expected to provide a theoretical basis for further understanding the mechanism of Wumei Pills and exploring the new clinical application.

The economic burden of overweight and obesity in Brazil: perspectives for the Brazilian Unified Health System

ObjectivesParallel to rising obesity prevalence in Brazil, there is expected to be increased direct health care costs related to non-communicable diseases (NCDs). In this study, we estimated the economic burden of NCDs attributable to overweight and obesity in the Brazilian Unified Health System (SUS). MethodsWe used self-reported body mass index of 85,715 adults from the 2019 Brazilian National Health Survey. Annual costs (1 US$ = 2.281 Reais) with inpatient and outpatient procedures were obtained from the Hospital and Ambulatory Information Systems of the Brazilian SUS. Relative risks for cardiovascular disease, chronic respiratory disease, neoplasm, digestive disease, musculoskeletal disorders, diabetes and kidney diseases, sense organ diseases, and neurological disorders were retrieved from the Global Burden of Disease study. ResultsAnnually, US$ 654 million (95% uncertainty interval: US$ 418.4 to US$ 893.2) direct health care costs related to NCDs were attributable to overweight and obesity. Attributable costs were higher in women than men. Cardiovascular diseases had the highest attributable costs (US$ 289 million), followed by chronic respiratory diseases (US$ 110 million), neoplasms (US$ 96 million), digestive diseases (US$ 60 million), musculoskeletal disorders (US$ 44 million), diabetes and kidney disease (US$ 31 million), sense organ diseases (US$ 22 million) and neurological disorders (US$ 11 million). ConclusionsOverweight and obesity account for US$ 654 million direct costs of NCDs annually. Effective policies to promote healthy body weight may have economic benefits.

Stigma experiences of patients living with gastroparesis.

Stigmatization toward chronic digestive diseases is well documented. Patients perceive others hold negative stereotypes toward their disease and may internalize these beliefs as true. Because of this, stigmatization is associated with poor outcomes across disease-related and psychosocial domains. No study to date evaluates stigmatization toward patients living with gastroparesis (GP), a poorly understood disease affecting gastric motility. We aimed to gain deep understanding of stigma in patients living with gastroparesis. Patients with GP were recruited from two university-based gastroenterology practices as well as patient advocacy support groups. Participants underwent a semi-structured qualitative interview about their experiences with stigma related to their GP diagnosis, which were audio-recorded and transcribed to text for analysis using a grounded theory approach. Major themes with representative quotations were documented. Twenty-three patients participated. The majority were White, female, with idiopathic GP under the care of a gastroenterologist. All patients reported stigma related to GP. Seven major themes were found: stigma from healthcare providers, stigma within interpersonal relationships, GP as an invisible disease, blame, unsolicited suggestions on how to manage disease, disclosure, and stigma resistance. This is the first study to describe stigma experiences in patients with GP. The results suggest patients experience considerable stigmatization toward their condition from multiple sources. Patients also demonstrated resistance to negative beliefs, which can serve as a protective factor for the negative effects of disease stigma. Clinicians should be aware of stigma in GP patients, including their own potential internal biases and behaviors.

Working With Patients With Chronic Digestive Diseases

Working With Patients With Chronic Digestive Diseases

Parenteral Antibiotic Use Among Ambulatory Children in United States Children's Hospital Emergency Departments.

BackgroundDespite increasing recognition of the importance of optimal antibiotic selection and expansion of antimicrobial stewardship activities to ambulatory settings, few studies have examined the frequency of parenteral antibiotic use among ambulatory children. We assessed the prevalence and patterns of parenteral antibiotic administration among ambulatory children in pediatric emergency departments (EDs).MethodsWe conducted a cross-sectional assessment of parenteral antibiotic use among ambulatory children aged 0–18 years in 49 US children’s hospital EDs in 2018. We assessed the prevalence rates of parenteral antibiotic use and stratified these by patient-, clinic-, and hospital-level characteristics. We also assessed the prevalence of use of specific antibiotics by age and diagnosis category. Among encounters associated with an infection diagnosis, we identified factors associated with parenteral antibiotic use using multivariable logistic regression.ResultsAmong 3 452 011 ambulatory ED encounters in 2018, parenteral antibiotics were administered in 62 648 (1.8%). The highest proportion of parenteral antibiotic use occurred in the 15–18-year age group (3.3%) and among encounters in children with complex chronic conditions (8.9%) and with primary diagnoses of neoplasms (36%). Ceftriaxone was the most commonly administered parenteral antibiotic (61%). In multivariable analysis, several factors including age ≤2 months, White race, private insurance, complex chronic conditions, digestive and genitourinary system diseases, and encounters attributed to emergency medicine providers were significantly associated with higher odds of parenteral antibiotic use.ConclusionsThis study demonstrates substantial variability in the frequency of parenteral antibiotic administration by age and diagnosis in the ambulatory ED setting and highlights potential opportunities to target stewardship activities.