BACKGROUND Functional gastrointestinal disorders(FGIDs)in children present with chronic symptoms like abdominal pain,diarrhea,and constipation without identifiable structural abnormalities.These disorders are closely ...BACKGROUND Functional gastrointestinal disorders(FGIDs)in children present with chronic symptoms like abdominal pain,diarrhea,and constipation without identifiable structural abnormalities.These disorders are closely linked to gut-brain axis dysfunction,altered gut microbiota,and psychosocial stress,leading to psychia-tric comorbidities such as anxiety,depression,and behavioral issues.Under-standing this bidirectional relationship is crucial for developing effective,holistic management strategies that address physical and mental health.AIM To examine the psychiatric impacts of FGIDs in children,focusing on anxiety and depression and their association with other neurodevelopmental disorders of childhood,such as attention-deficit/hyperactivity disorder,emphasizing the role of the gut-brain axis,emotional dysregulation,and psychosocial stress.Key mechanisms explored include neurotransmitter dysregulation,microbiota imbalance,central sensitization,heightening stress reactivity,emotional dysregulation,and symptom perception.The review also evaluates the role of family dynamics and coping strategies in exacerbating FGID symptoms and contributing to psychiatric conditions.METHODS A narrative review was conducted using 328 studies sourced from PubMed,Scopus,and Google Scholar,covering research published over the past 20 years.Inclusion criteria focused on studies examining FGID diagnosis,gut-brain mechanisms,psychiatric comorbidities,and psychosocial factors in pediatric populations.FGIDs commonly affecting children,including functional constipation,abdominal pain,irritable bowel syndrome,gastroesophageal reflux,and cyclic vomiting syndrome,were analyzed concerning their psychological impacts.RESULTS The review highlights a strong connection between FGIDs and psychiatric symptoms,mediated by gut-brain axis dysfunction,dysregulated microbiota,and central sensitization.These physiological disruptions increase children’s vulnerability to anxiety and depression,while psychosocial factors-such as chronic stress,early-life trauma,maladaptive family dynamics,and ineffective coping strategies-intensify the cycle of gastrointestinal and emotional distress.CONCLUSION Effective management of FGIDs requires a biopsychosocial approach integrating medical,psychological,and dietary interventions.Parental education,early intervention,and multidisciplinary care coordination are critical in mitigating long-term psychological impacts and improving both gastrointestinal and mental health outcomes in children with FGIDs.展开更多
BACKGROUND Managing critical care emergencies in children with autism spectrum disorder(ASD)presents unique challenges due to their distinct sensory sensitivities,communication difficulties,and behavioral issues.Effec...BACKGROUND Managing critical care emergencies in children with autism spectrum disorder(ASD)presents unique challenges due to their distinct sensory sensitivities,communication difficulties,and behavioral issues.Effective strategies and protocols are essential for optimal care in these high-stress situations.AIM To systematically evaluate and synthesize current evidence on best practices for managing critical care emergencies in children with ASD.The review focuses on key areas,including sensory-friendly environments,communication strategies,behavioral management,and the role of multidisciplinary approaches.METHODS A comprehensive search was conducted across major medical databases,including PubMed,Embase,and Cochrane Library,for studies published between 2000 and 2023.Studies were selected based on their relevance to critical care management in children with ASD,encompassing randomized controlled trials,observational studies,qualitative research,and case studies.Data were extracted and analyzed to identify common themes,successful strategies,and areas for improvement.RESULTS The review identified 50 studies that met the inclusion criteria.Findings highlighted the importance of creating sensory-friendly environments,utilizing effective communication strategies,and implementing individualized behavioral management plans.These findings,derived from a comprehensive review of current evidence,provide valuable insights into the best practices for managing critical care emergencies in children with ASD.Sensory modifications,such as reduced lighting and noise,visual aids,and augmentative and alternative communication tools,enhanced patient comfort and cooperation.The involvement of multidisciplinary teams was crucial in delivering holistic care.Case studies provided practical insights and underscored the need for continuous refi-nement of protocols.CONCLUSION The review emphasizes the need for a tailored approach to managing critical care emergencies for children with ASD.Sensory-friendly adjustments,effective communication,and behavioral strategies supported by a mul-tidisciplinary team are integral to improving outcomes.Despite progress,ongoing refinement of care practices and protocols is necessary.This ongoing process addresses remaining challenges and engages healthcare professionals in continuous improvement of care for children with ASD in critical settings.展开更多
BACKGROUND Antibiotic resistance is a growing global health threat,and understanding local trends in bacterial isolates and their susceptibility patterns is crucial for effective infection control and antimicrobial st...BACKGROUND Antibiotic resistance is a growing global health threat,and understanding local trends in bacterial isolates and their susceptibility patterns is crucial for effective infection control and antimicrobial stewardship.The coronavirus disease 2019(COVID-19)pandemic has introduced additional complexities,potentially influencing these patterns.AIM To analyze trends in bacterial isolates and their antibiotic susceptibility patterns at Salmaniya Medical Complex from 2018 to 2023,with a specific focus on the impact of the COVID-19 pandemic on these trends.METHODS A retrospective analysis of microbiological data was conducted,covering the period from 2018 to 2023.The study included key bacterial pathogens such as Escherichia coli(E.coli),Klebsiella pneumoniae,Acinetobacter baumannii,Pseudomonas aeruginosa,and Staphylococcus aureus,among others.The antibiotic susceptibility profiles of these isolates were assessed using standard laboratory methods.To contextualize the findings,the findings were compared with similar studies from other regions,including China,India,Romania,Saudi Arabia,the United Arab Emirates,Malaysia,and United States.RESULTS The study revealed fluctuating trends in the prevalence of bacterial isolates,with notable changes during the COVID-19 pandemic.For example,a significant increase in the prevalence of Staphylococcus aureus was observed during the pandemic years,while the prevalence of E.coli showed a more variable pattern.Antibiotic resistance rates varied among the different pathogens,with a concerning rise in resistance to commonly used antibiotics,particularly among Klebsiella pneumoniae and E.coli.Additionally,the study identified an alarming increase in the prevalence of multidrug-resistant(MDR)strains,especially within Klebsiella pneumoniae and E.coli isolates.The impact of the COVID-19 pandemic on these trends was evident,with shifts in the frequency,resistance patterns,and the emergence of MDR bacteria among several key pathogens.CONCLUSION This study highlights the dynamic nature of bacterial isolates and their antibiotic susceptibility patterns at Salmaniya Medical Complex,particularly in the context of the COVID-19 pandemic.The findings underscore the need for continuous monitoring and effective anti-microbial stewardship programs to combat the evolving threat of antibiotic resistance.Further research and policy initiatives are required to address the identified challenges and improve patient outcomes in the face of these ongoing challenges.展开更多
BACKGROUND The relationship between exercise and gastrointestinal(GI)health is complex and bidirectional.While moderate exercise generally promotes gut health by enhancing motility,reducing inflammation,and supporting...BACKGROUND The relationship between exercise and gastrointestinal(GI)health is complex and bidirectional.While moderate exercise generally promotes gut health by enhancing motility,reducing inflammation,and supporting microbial balance,intense or prolonged physical activity may exacerbate GI symptoms,particularly in individuals with preexisting digestive disorders.A deeper understanding of this interplay is essential for optimizing both exercise performance and GI well-being.AIM To synthesize current evidence on exercise-related GI disorders,exploring the prevalence,mechanisms,risk factors,and management strategies associated with exercise-induced GI symptoms.METHODS Following PRISMA guidelines,comprehensive searches of databases,including PubMed,Scopus,Web of Science,and EMBASE were conducted.Studies were included if they focused on exercise-induced GI disorders,encompassed randomized controlled trials,cohort studies,case-control studies,and cross-sectional designs,and addressed symptoms across various exercise modalities.Data were extracted and analyzed to identify patterns and implications for clinical and athletic practice.RESULTS A total of 231 studies met the inclusion criteria,highlighting both the benefits and risks of exercise on GI health.Regular moderate-intensity exercise,including activities such as walking,cycling,and yoga has been associated with improved GI function in conditions like gastroesophageal reflux disease,irritable bowel syndrome,inflammatory bowel disease,and constipation.These benefits are attributed to enhanced intestinal motility,reduced systemic inflammation,and improved gut barrier integrity.Additionally,exercise plays a role in regulating the gut-brain axis,with practices like yoga and Tai Chi demonstrating particular effectiveness in alleviating functional GI disorders.Conversely,high-intensity or prolonged exercise may contribute to symptoms such as nausea,diarrhea,and abdominal pain due to mechanisms like splanchnic hypoperfusion and increased intestinal permeability.Individual factors,including fitness level,dietary habits,hydration status,and underlying GI conditions,significantly influence the body’s response to exercise.CONCLUSION Moderate-intensity exercise is a beneficial and well-tolerated intervention for promoting GI health,whereas highintensity activities require careful monitoring,particularly in individuals with pre-existing GI disorders.Personalized exercise and dietary strategies are essential for balancing the benefits of physical activity with the risk of GI distress.Further research is needed to explore the long-term effects of exercise on gut microbiota composition and overall digestive health.展开更多
BACKGROUND The relationship between diabetes mellitus(DM)and asthma is complex and can impact disease trajectories.AIM To explore the bidirectional influences between the two conditions on clinical outcomes and diseas...BACKGROUND The relationship between diabetes mellitus(DM)and asthma is complex and can impact disease trajectories.AIM To explore the bidirectional influences between the two conditions on clinical outcomes and disease control.METHODS We systematically reviewed the literature on the relationship between DM and asthma,focusing on their impacts,mechanisms,and therapeutic implications.Various studies were assessed,which investigated the effect of glycemic control on asthma outcomes,lung function,and exacerbations.The study highlighted the role of specific diabetes medications in managing asthma.RESULTS The results showed that poor glycemic control in diabetes can exacerbate asthma,increase hospitalizations,and reduce lung function.Conversely,severe asthma,especially in obese individuals,can complicate diabetes management and make glycemic control more difficult.The diabetes-associated mechanisms,such as inflammation,microangiopathy,and oxidative stress,can exacerbate asthma and decrease lung function.Some diabetes medications exhibit anti-inflammatory effects that show promise in mitigating asthma exacerbations.CONCLUSION The complex interrelationship between diabetes and asthma suggests bidirectional influences that affect disease course and outcomes.Inflammation and microvascular complications associated with diabetes may worsen asthma outcomes,while asthma severity,especially in obese individuals,complicates diabetes control.However,the current research has limitations,and more diverse longitudinal studies are required to establish causal relationships and identify effective treatment strategies for individuals with both conditions.展开更多
BACKGROUND Far lateral lumbar disc herniation(FLLDH)is a special type of lumbar disc herniation with high rate of missed diagnosis.Selective nerve root block(SNRB)has special advantages in identifying the responsible ...BACKGROUND Far lateral lumbar disc herniation(FLLDH)is a special type of lumbar disc herniation with high rate of missed diagnosis.Selective nerve root block(SNRB)has special advantages in identifying the responsible nerve root.Percutaneous transforaminal endoscopic discectomy(PTED)is a minimally invasive and effective method to treat FLLDH.However,no report has investigated PTED combined with SNRB to treat FLLDH.AIM To explore the diagnosis and treatment process,surgical technique and clinical efficacy of PTED combined with SNRB to treat FLLDH.METHODS This is a multicenter center,retrospective,observational study.Between January 2020 and January 2022,32 patients were initially diagnosed with FLLDH.All the patients were identified using SNRB to determine the responsible segment and involved nerve roots.Because of poor symptomatic control following SNRB,2 patients were excluded.30 patients diagnosed with FFLDH underwent PTED.The clinical characteristics,operative and postoperative outcomes,complication and subsequent follow-up were collected.RESULTS 30 patients who underwent SNRB combined with PTED were followed up.The average visual analogue scale(VAS)-leg score,VAS-back score,Oswestry disability index(ODI)score at the Follow-up(1 day,1 month,3 months and last follow-up)were significantly different compared per-operation.According to the modified Macnab efficacy evaluation standard,the satisfaction degree at the last follow-up was excellent(28,93.33%),good(1,3.33%),medium(1,3.33%)and poor(0,0%).CONCLUSION SNRB provides an effective method for the definite diagnosis of FLDH and responsible nerve roots.Combination therapy offers several advantages including minimal invasiveness,precision,effectiveness,safety and low recurrence rates.展开更多
BACKGROUND Malnutrition and epilepsy share a complex bidirectional relationship,with malnutrition serving as a potential risk factor for epilepsy development,while epilepsy,in turn,often exerts profound effects on nut...BACKGROUND Malnutrition and epilepsy share a complex bidirectional relationship,with malnutrition serving as a potential risk factor for epilepsy development,while epilepsy,in turn,often exerts profound effects on nutritional status.Nutritional interventions have emerged as a critical adjunctive approach in epilepsy management.AIM To explore the multifaceted associations between malnutrition and epilepsy,structured into three primary sections:(1)Elucidating the impact of malnutrition as a risk factor for epilepsy onset;(2)Examining the reciprocal influence of epilepsy on nutritional status,and(3)Evaluating diverse nutritional interventions in the management of epilepsy.METHODS A systematic search was conducted across PubMed,Scopus,and Web of Science databases utilizing defined keywords related to malnutrition,epilepsy,and nutritional interventions.Inclusion criteria encompassed various study types,including clinical trials,animal models,cohort studies,case reports,meta-analyses,systematic reviews,guidelines,editorials,and review articles.Four hundred sixteen pertinent references were identified,with 198 review articles,153 research studies,21 case reports,24 meta-analyses,14 systematic reviews,4 guidelines,and 2 editorials meeting the predefined criteria.RESULTS The review revealed the intricate interplay between malnutrition and epilepsy,highlighting malnutrition as a potential risk factor in epilepsy development and elucidating how epilepsy often leads to nutritional deficiencies.Findings underscored the importance of nutritional interventions in managing epilepsy,showing their impact on seizure frequency,neuronal function,and overall brain health.CONCLUSION This systematic review emphasizes the bidirectional relationship between malnutrition and epilepsy while emphasizing the critical role of nutritional management in epilepsy treatment.The multifaceted insights underscore the need for a holistic approach to addressing nutritional aspects alongside conventional epilepsy management strategies.展开更多
BACKGROUND Gastrointestinal(GI)manifestations are prevalent in genetic myopathies,posing significant diagnostic and management challenges.AIM To synthesize evidence on the diagnostic approaches,management strategies,p...BACKGROUND Gastrointestinal(GI)manifestations are prevalent in genetic myopathies,posing significant diagnostic and management challenges.AIM To synthesize evidence on the diagnostic approaches,management strategies,patient perspectives,and future research directions regarding GI symptoms in genetic myopathies.METHODS A systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines.We searched PubMed,Scopus,EMBASE,and Web of Science from inception to December 2024.Eligible studies reported GI manifestations in genetic myopathies,including clinical evaluations,imaging,physiological tests,histopathology,and genetic analyses.Inclusion criteria encompassed original research studies,review articles,case reports,and clinical guidelines published in peer-reviewed journals.Exclusion criteria included conference abstracts without full-text availability and non-peer-reviewed sources.Two independent reviewers screened studies and extracted data.They assessed methodological quality using the Newcastle-Ottawa Scale for observational studies,A MeaSurement Tool to Assess Systematic Reviews for systematic reviews,and the Joanna Briggs Institute checklist for case reports.A systematic narrative synthesis was employed to summarize the findings.RESULTS A total of 234 studies met the inclusion criteria.GI manifestations varied widely,with dysphagia,gastroesophageal reflux,abdominal pain,constipation,diarrhea,and fecal incontinence being the most frequently reported symptoms.The included studies highlighted a multidisciplinary diagnostic approach incorporating clinical assessment,imaging,physiological testing,histopathology,and genetic testing.Management strategies ranged from dietary interventions and rehabilitative therapies to pharmacological treatments and surgical procedures.Patient perspectives underscored the significant impact of GI symptoms on quality of life,social interactions,and emotional well-being.The main limitations of the included studies were high heterogeneity in study design,small sample sizes,and the potential risk of bias due to limited methodological rigor in some reports.CONCLUSION This review underscores the complexity of GI manifestations in genetic myopathies and the need for a comprehensive,multidisciplinary management approach.Future research should focus on elucidating molecular mechanisms,identifying biomarkers,and developing targeted therapies to improve patient outcomes.The findings have implications for both clinical practice and public health,emphasizing the necessity of early diagnosis and personalized management strategies.展开更多
BACKGROUND Functional neurological disorder(FND)in children is a complex and multifaceted condition characterized by neurological symptoms that cannot be explained by organic pathology.Despite its prevalence,FND in pe...BACKGROUND Functional neurological disorder(FND)in children is a complex and multifaceted condition characterized by neurological symptoms that cannot be explained by organic pathology.Despite its prevalence,FND in pediatric populations remains under-researched,with challenges in diagnosis and management AIM To synthesize the current literature on FND in children,focusing on clinical presentation,diagnostic approaches,treatment strategies,and outcomes.METHODS A comprehensive literature search was conducted across multiple databases,including PubMed,Scopus,and Web of Science,for articles published up to August 2024.Studies were included if they addressed FND in pediatric populations,specifically focusing on review articles,research articles,systematic reviews,meta-analyses,case reports,guidelines,expert opinions,and editorials.Data extraction and quality assessment were performed according to PRISMA guidelines.A total of 308 articles were included in the final analysis.RESULTS The analysis included 189 review articles,57 research articles,3 systematic reviews and meta-analyses,5 case reports,2 guidelines,5 expert opinions,and 2 editorials.Key findings revealed a broad spectrum of symptoms,including motor and sensory disturbances and psychological factors contributing to the onset and persistence of FND.Diagnostic challenges were frequently highlighted,emphasizing the need for interdisciplinary approaches.Treatment strategies varied,with cognitive-behavioral therapy(CBT)and multidisciplinary care emerging as the most effective approaches.The outcomes varied,with early intervention being critical for a better prognosis.CONCLUSION Early diagnosis and multidisciplinary care,including CBT,are critical for improving outcomes in pediatric FND.Standardized diagnostic criteria and treatment protocols are needed to enhance clinical management.展开更多
Cow milk protein allergy(CMPA)is a prevalent food allergy in infancy.It often presents with symptoms that overlap with other conditions,such as gastroeso-phageal reflux disease,lactose intolerance,food protein-induced...Cow milk protein allergy(CMPA)is a prevalent food allergy in infancy.It often presents with symptoms that overlap with other conditions,such as gastroeso-phageal reflux disease,lactose intolerance,food protein-induced enterocolitis syndrome,and eosinophilic esophagitis.This diagnostic overlap makes distin-guishing CMPA from its mimics difficult,resulting in potential misdiagnoses and unnecessary dietary restrictions.This review aims to comprehensively analyze CMPA and its mimicking conditions,highlighting their clinical presentations,diagnostic approaches,and management strategies to enhance diagnostic accu-racy and optimize patient care.A systematic literature search was conducted using PubMed,Scopus,Web of Science,and Google Scholar,focusing on studies published within the last 20 years.Articles addressing CMPA and its mimicking conditions were selected,with data synthesized into comparative analyses of diagnostic methods and management strategies.Accurate differentiation between CMPA and its mimics requires a thorough clinical evaluation supported by diagnostic tests such as skin prick tests,serum-specific IgE,and oral food challenges.Misdiagnosis can lead to nutritional deficiencies,psychological stress,and increased healthcare costs.Emerging diagnostic technologies,including component-resolved diagnostics and cytokine profiling,offer promising avenues for improving accuracy.A multidisciplinary approach involving pediatricians,allergists,and dietitians is essential for precise diagnosis and effective management.Ongoing research and education are crucial to enhancing clinical outcomes and reducing the burden on families.展开更多
Pediatric inflammatory bowel disease(IBD),encompassing Crohn’s disease,ulcerative colitis,and IBD-unclassified,has become increasingly prevalent worldwide,including in previously low-incidence regions.Children often ...Pediatric inflammatory bowel disease(IBD),encompassing Crohn’s disease,ulcerative colitis,and IBD-unclassified,has become increasingly prevalent worldwide,including in previously low-incidence regions.Children often present with more extensive and aggressive disease,creating unique diagnostic and management challenges that differ significantly from adult-onset IBD.This review aims to synthesize current knowledge on pediatric IBD,highlighting historical challenges while exploring emerging frontiers in diagnosis,treatment,and long-term care strategies.A narrative synthesis of global and regional epidemiological data,clinical classifications,diagnostic advancements,management approaches,and psychosocial considerations was conducted,with a particular emphasis on innovations in precision medicine,microbiome-targeted therapy,and multidisciplinary care models.Pediatric IBD continues to rise globally,driven by environmental and genetic interactions,especially in rapidly industrializing regions.Novel diagnostic tools,age-specific treatment protocols,biologics,nutritional strategies,and psychosocial support are reshaping care.Emphasis on very early-onset IBD,transition care,and regional policy adaptations underscores the evolving complexity of managing pediatric IBD.The landscape of pediatric IBD care is rapidly evolving.Addressing the distinct pathophysiology,developmental impact,and healthcare challenges of pediatric patients requires an integrated,child-centered approach.Ongoing research into genetics,immune pathways,and the microbiome will be essential in tailoring precision therapies and improving outcomes globally.展开更多
BACKGROUND Children with autism spectrum disorder(ASD)face unique challenges in maintaining oral health due to sensory sensitivities,communication difficulties,and behavioral barriers.These factors,along with limited ...BACKGROUND Children with autism spectrum disorder(ASD)face unique challenges in maintaining oral health due to sensory sensitivities,communication difficulties,and behavioral barriers.These factors,along with limited access to ASD-trained dental professionals,increase their risk of dental caries,periodontal disease,bruxism,and other oral health issues.Despite growing awareness of these challenges,a comprehensive synthesis of evidence-based solutions remains lacking.AIM To review synthesizes existing research on dental problems in ASD,barriers to care,management strategies,and future directions for improved oral health outcomes.METHODS A systematic search of PubMed,Cochrane Library,and Scopus was conducted using predefined search terms.Related to ASD,dental health,and management strategies.Inclusion criteria encompassed studies focusing on children with ASD,dental health issues,and interventions.Data extraction included study design,participant characteristics,key findings,and intervention outcomes.The quality of studies was assessed using appropriate tools such as the Cochrane Risk of Bias Tool and the Newcastle-Ottawa Scale.A narrative synthesis approach,incorporating thematic analysis,was utilized to evaluate the findings.RESULTS A total of 165 studies met the inclusion criteria.Children with ASD exhibited a higher prevalence of dental caries,gingivitis,bruxism,and malocclusion compared to neurotypical peers.Barriers to dental care included sensory sensitivities,communication difficulties,financial constraints,and a shortage of ASD-trained dental professionals.Effective interventions included desensitization programs,behavioral therapy,digital applications,and interdiscip-linary collaboration.Parental education and professional training were crucial for improving oral health outcomes.CONCLUSION Tailored dental care strategies,including sensory adaptations,behavioral interventions,and interdisciplinary collaboration,are essential for children with ASD.Standardized guidelines and long-term studies are needed to refine evidence-based protocols.Future research should explore digital interventions and probiotic applications in ASD dental care.展开更多
BACKGROUND Epiploic appendagitis is a rare,often underrecognized cause of acute abdominal pain.Misdiagnosis can lead to unnecessary hospitalization,antibiotic use,or surgical intervention.Advances in imaging have impr...BACKGROUND Epiploic appendagitis is a rare,often underrecognized cause of acute abdominal pain.Misdiagnosis can lead to unnecessary hospitalization,antibiotic use,or surgical intervention.Advances in imaging have improved the recognition of this self-limiting condition,but clinical awareness remains critical.AIM To provide a comprehensive update on the epidemiology,anatomy,pathogenesis,clinical presentation,diagnostic strategies,differential diagnosis,and management of epiploic appendagitis,emphasizing its distinguishing features from other causes of acute abdomen.METHODS A review of the literature was conducted,focusing on the clinical characteristics,imaging findings,differential diagnoses,and evidence-based management strategies for epiploic appendagitis.RESULTS Epiploic appendagitis typically presents with acute,localized,non-radiating abdominal pain without significant systemic symptoms.Diagnosis is heavily reliant on imaging,with computed tomography(CT)being the gold standard.Hallmark CT findings include a small,fat-density ovoid lesion adjacent to the colon,with the usual characteristic ring and dot signs.Differential diagnoses include mainly diverticulitis,appendicitis,omental infarction,and many other causes.Management is predominantly conservative with nonsteroidal anti-inflammatory drugs and observation,reserving surgical intervention for rare,complicated cases.CONCLUSION Recognizing the clinical and imaging features of epiploic appendagitis is essential to avoid unnecessary interventions.Increased clinician awareness,coupled with judicious use of imaging,facilitates timely diagnosis and appropriate management,ensuring optimal patient outcomes.展开更多
AIM:To use microarray-based miRNA profiling of colonic mucosal biopsies from patients with ulcerative colitis (UC), Crohn's disease (CD), and controls in order to identify new potential miRNA biomarkers in inflamm...AIM:To use microarray-based miRNA profiling of colonic mucosal biopsies from patients with ulcerative colitis (UC), Crohn's disease (CD), and controls in order to identify new potential miRNA biomarkers in inflammatory bowel disease. METHODS:Colonic mucosal pinch biopsies from the descending part were obtained endoscopically from patients with active UC or CD, quiescent UC or CD, as well as healthy controls. Total RNA was isolated and miRNA expression assessed using the miRNA microarray Geniom Biochip miRNA Homo sapiens (Febit GmbH, Heidelberg, Germany). Data analysis was carried out by principal component analysis and projection to latent structure-discriminant analysis using the SIMCA-P+12 software package (Umetrics, Umea, Sweden). The microarray data were subsequently validated by quantitative real-time polymerase chain reaction (qPCR) performed on colonic tissue samples from active UC patients (n = 20), patients with quiescent UC (n = 19), and healthy controls (n = 20). The qPCR results were analyzed with Mann-WhitneyU test.In silico prediction analysis were performed to identify potential miRNA target genes and the predicted miRNA targets were then compared with all UC associated susceptibility genes reported in the literature. RESULTS:The colonic mucosal miRNA transcriptome differs significantly between UC and controls, UC and CD, as well as between UC patients with mucosal inflammation and those without. However, no clear differences in the transcriptome of patients with CD and controls were found. The miRNAs with the strongest differential power were identified (miR-20b, miR-99a, miR-203, miR-26b, and miR-98) and found to be upregulated more than a 10-fold in active UC as compared to quiescent UC, CD, and controls. Two miRNAs, miR-125b-1* and let-7e*, were up-regulated more than 5-fold in quiescent UC compared to active UC, CD, and controls. Four of the seven miRNAs (miR-20b, miR-98, miR-125b-1*, and let-7e*) were validated by qPCR and found to be specifically upregulated in patients with UC. Usingin silico analysis we found several predicted pro-inflammatory target genes involved in various pathways, such as mitogen-activated protein kinase and cytokine signaling, which are both key signaling pathways in UC.CONCLUSION:The present study provides the first evidence that miR-20b, miR-98, miR-125b-1*, and let7e* are deregulated in patients with UC. The level of these miRNAs may serve as new potential biomarkers for this chronic disease.展开更多
The pathogenesis of inflammatory bowel disease (IBD) is complex and largely unknown. Until recently, research has focused on the study of protein regulators in inflammation to reveal the cellular and molecular network...The pathogenesis of inflammatory bowel disease (IBD) is complex and largely unknown. Until recently, research has focused on the study of protein regulators in inflammation to reveal the cellular and molecular networks in the pathogenesis of IBD. However, in the last few years, new and promising insights have been generated from studies describing an association between an altered expression of a specific class of non-coding RNAs, called microRNAs (miRs or miRNAs) and IBD. The short (approximately 22 nucleotides), endogenous, single-stranded RNAs are evolutionary conserved inanimals and plants, and regulate specific target mRNAs at the post-transcriptional level. MiRNAs are involved in several biological processes, including development, cell differentiation, proliferation and apoptosis. Furthermore, it is estimated that miRNAs may be responsible for regulating the expression of nearly one-third of the genes in the human genome. Thus, miRNA deregulation often results in an impaired cellular function, and a disturbance of downstream gene regulation and signaling cascades, suggesting their implication in disease etiology. Despite the identification of more than 1900 mature human miRNAs, very little is known about their biological functions and functional targets. Recent studies have identified dysregulated miRNAs in tissue samples of IBD patients and have demonstrated similar differences in circulating miRNAs in the serum of IBD patients. Thus, there is great promise that miRNAs will aid in the early diagnosis of IBD, and in the development of personalized therapies. Here, we provide a short review of the current state-of-the-art of miRNAs in IBD pathogenesis, diagnostics and therapeutics.展开更多
Inflammatory bowel disease (IBD) is a group of chronic disorders of the gastrointestinal tract comprising Crohn’s disease (CD) and ulcerative colitis (UC). Their etiologies are unknown, but they are charac...Inflammatory bowel disease (IBD) is a group of chronic disorders of the gastrointestinal tract comprising Crohn’s disease (CD) and ulcerative colitis (UC). Their etiologies are unknown, but they are characterised by an imbalanced production of pro-inflammatory mediators, e.g., tumor necrosis factor (TNF)-α, as well as increased recruitment of leukocytes to the site of inflammation. Advantages in understanding the role of the inflammatory pathways in IBD and an inadequate response to conventional therapy in a large portion of patients, has over the last two decades lead to new therapies which includes the TNF inhibitors (TNFi), designed to target and neutralise the effect of TNF-α. TNFi have shown to be efficient in treating moderate to severe CD and UC. However, convenient alternative therapeutics targeting other immune pathways are needed for patients with IBD refractory to conventional therapy including TNFi. Indeed, several therapeutics are currently under development, and have shown success in clinical trials. These include antibodies targeting and neutralising interleukin-12/23, small pharmacologic Janus kinase inhibitors designed to block intracellular signaling of several pro-inflammatory cytokines, antibodies targeting integrins, and small anti-adhesion molecules that block adhesion between leukocytes and the intestinal vascular endothelium, reducing their infiltration into the inflamed mucosa. In this review we have elucidated the major signaling pathways of clinical importance for IBD therapy and highlighted the new promising therapies available. As stated in this paper several new treatment options are under development for the treatment of CD and UC, however, no drug fits all patients. Hence, optimisations of treatment regimens are warranted for the benefit of the patients either through biomarker establishment or other rationales to maximise the effect of the broad range of mode-of-actions of the present and future drugs in IBD.展开更多
AIM: To investigate the effects of a low fermentable, oligosaccharides, disaccharides, monosaccharides and polyols diet (LFD) and the probiotic Lactobacillus rhamnosus GG (LGG) in irritable bowel syndrome (IBS).
AIM To develop a scale of domains associated with the health-related quality-of-life(HRQOL) in patients with cirrhosis-related ascites.METHODS We initially undertook literature searches and a qualitative study in orde...AIM To develop a scale of domains associated with the health-related quality-of-life(HRQOL) in patients with cirrhosis-related ascites.METHODS We initially undertook literature searches and a qualitative study in order to design a cirrhosis-associated ascites symptom(CAS) scale describing symptoms with a potential detrimental impact on health related quality of life(HRQL)(the higher the score, the worse the symptoms). Discriminatory validity was assessed in a validation cohort including cirrhotic patients with(1) tense/severe;(2) moderate/mild; or(3) no ascites(controls). Patients also completed chronic liver disease questionnaire(CLDQ) and the Euro QoL 5-Dimensions 5-Level(EQ-5D-5L) questionnaire evaluating HRQL. The relation between scale scores was analysed using Spearman correlations. RESULTS The final CAS scale included 14 items. The equivalent reliability was high(Chronbach's alpha 0.88). The validation cohort included 103 patients(72% men, mean age 62.4 years). The mean scores for each question in the CAS scale were higher for patients with severe/tense ascites than for mild/moderate ascites and controls. Compared with controls(mean = 9.9 points), the total CAS scale score was higher for severe/tense ascites(mean = 23.8 points) as well as moderate/mild ascites(mean = 18.6 points)(P < 0.001 both groups). We found a strong correlation between the total CAS and CLDQ score(rho = 0.82, P < 0.001) and a moderate correlation between the CAS and the EQ-5D-5L score(0.67, P < 0.001). CONCLUSION The CAS is a valid tool, which reflects HRQOL in patients with ascites.展开更多
In the present study we report on changes in irritable bowel syndrome-severity scoring system (IBS-SSS) and irritable bowel syndrome-quality of life (IBS-QoL) in 19 IBS patients, aged 18 to 74 years (F/M: 14/5), durin...In the present study we report on changes in irritable bowel syndrome-severity scoring system (IBS-SSS) and irritable bowel syndrome-quality of life (IBS-QoL) in 19 IBS patients, aged 18 to 74 years (F/M: 14/5), during 12 wk registering their symptoms on the web-application (www.ibs.constant-care.dk). During a control period of the first 6-wk patients were asked to register their IBS-SSS and IBS-QoL on the web-application weekly without receiving any intervention. Thereafter, low fermentable oligo-, di-, mono-saccharides and polyols (FODMAP) diet (LFD) was introduced for the next 6 wk while continuing the registration. Though a small sample size a significant improvement in disease activity (IBS-SSS) was observed during both the control period, median: 278 (range: 122-377), P = 0.02, and subsequently during the LFD period, median: 151 (range: 29-334), P < 0.01. The IBS-QoL solely changed significantly during the LFD period, median: 67 (37-120), P < 0.01. The significant reduction in disease activity during the control period shows a positive effect of the web-application on IBS symptoms when presented as a “traffic light”. However adding the diet reduced IBS-SSS to < 150, inactive to mild symptoms. In the future results from larger scale trials are awaited.展开更多
The use of thiopurines as immunosuppression for the treatment of refractory or chronic active inflammatory bowel disease is established for both Crohn's disease and ulcerative colitis.Nevertheless,many questions r...The use of thiopurines as immunosuppression for the treatment of refractory or chronic active inflammatory bowel disease is established for both Crohn's disease and ulcerative colitis.Nevertheless,many questions remain concerning the optimal treatment regimens of azathioprine,6-mercaptopurine and thioguanine.We will briefly summarize dose recommendations,indications for thiopurine therapy and side effects which are relevant in clinical practice.We discuss some currently debated topics,including the combination of azathioprine and allopurinol,switching of thiopurine therapy in case of side effects,the use of azathioprine in pregnancy,the infection risk using thiopurines and the evidence when to stop thiopurines.Excellent reviews have been published on the thiopurine metabolic pathway which will not be discussed here in detail.展开更多
文摘BACKGROUND Functional gastrointestinal disorders(FGIDs)in children present with chronic symptoms like abdominal pain,diarrhea,and constipation without identifiable structural abnormalities.These disorders are closely linked to gut-brain axis dysfunction,altered gut microbiota,and psychosocial stress,leading to psychia-tric comorbidities such as anxiety,depression,and behavioral issues.Under-standing this bidirectional relationship is crucial for developing effective,holistic management strategies that address physical and mental health.AIM To examine the psychiatric impacts of FGIDs in children,focusing on anxiety and depression and their association with other neurodevelopmental disorders of childhood,such as attention-deficit/hyperactivity disorder,emphasizing the role of the gut-brain axis,emotional dysregulation,and psychosocial stress.Key mechanisms explored include neurotransmitter dysregulation,microbiota imbalance,central sensitization,heightening stress reactivity,emotional dysregulation,and symptom perception.The review also evaluates the role of family dynamics and coping strategies in exacerbating FGID symptoms and contributing to psychiatric conditions.METHODS A narrative review was conducted using 328 studies sourced from PubMed,Scopus,and Google Scholar,covering research published over the past 20 years.Inclusion criteria focused on studies examining FGID diagnosis,gut-brain mechanisms,psychiatric comorbidities,and psychosocial factors in pediatric populations.FGIDs commonly affecting children,including functional constipation,abdominal pain,irritable bowel syndrome,gastroesophageal reflux,and cyclic vomiting syndrome,were analyzed concerning their psychological impacts.RESULTS The review highlights a strong connection between FGIDs and psychiatric symptoms,mediated by gut-brain axis dysfunction,dysregulated microbiota,and central sensitization.These physiological disruptions increase children’s vulnerability to anxiety and depression,while psychosocial factors-such as chronic stress,early-life trauma,maladaptive family dynamics,and ineffective coping strategies-intensify the cycle of gastrointestinal and emotional distress.CONCLUSION Effective management of FGIDs requires a biopsychosocial approach integrating medical,psychological,and dietary interventions.Parental education,early intervention,and multidisciplinary care coordination are critical in mitigating long-term psychological impacts and improving both gastrointestinal and mental health outcomes in children with FGIDs.
文摘BACKGROUND Managing critical care emergencies in children with autism spectrum disorder(ASD)presents unique challenges due to their distinct sensory sensitivities,communication difficulties,and behavioral issues.Effective strategies and protocols are essential for optimal care in these high-stress situations.AIM To systematically evaluate and synthesize current evidence on best practices for managing critical care emergencies in children with ASD.The review focuses on key areas,including sensory-friendly environments,communication strategies,behavioral management,and the role of multidisciplinary approaches.METHODS A comprehensive search was conducted across major medical databases,including PubMed,Embase,and Cochrane Library,for studies published between 2000 and 2023.Studies were selected based on their relevance to critical care management in children with ASD,encompassing randomized controlled trials,observational studies,qualitative research,and case studies.Data were extracted and analyzed to identify common themes,successful strategies,and areas for improvement.RESULTS The review identified 50 studies that met the inclusion criteria.Findings highlighted the importance of creating sensory-friendly environments,utilizing effective communication strategies,and implementing individualized behavioral management plans.These findings,derived from a comprehensive review of current evidence,provide valuable insights into the best practices for managing critical care emergencies in children with ASD.Sensory modifications,such as reduced lighting and noise,visual aids,and augmentative and alternative communication tools,enhanced patient comfort and cooperation.The involvement of multidisciplinary teams was crucial in delivering holistic care.Case studies provided practical insights and underscored the need for continuous refi-nement of protocols.CONCLUSION The review emphasizes the need for a tailored approach to managing critical care emergencies for children with ASD.Sensory-friendly adjustments,effective communication,and behavioral strategies supported by a mul-tidisciplinary team are integral to improving outcomes.Despite progress,ongoing refinement of care practices and protocols is necessary.This ongoing process addresses remaining challenges and engages healthcare professionals in continuous improvement of care for children with ASD in critical settings.
文摘BACKGROUND Antibiotic resistance is a growing global health threat,and understanding local trends in bacterial isolates and their susceptibility patterns is crucial for effective infection control and antimicrobial stewardship.The coronavirus disease 2019(COVID-19)pandemic has introduced additional complexities,potentially influencing these patterns.AIM To analyze trends in bacterial isolates and their antibiotic susceptibility patterns at Salmaniya Medical Complex from 2018 to 2023,with a specific focus on the impact of the COVID-19 pandemic on these trends.METHODS A retrospective analysis of microbiological data was conducted,covering the period from 2018 to 2023.The study included key bacterial pathogens such as Escherichia coli(E.coli),Klebsiella pneumoniae,Acinetobacter baumannii,Pseudomonas aeruginosa,and Staphylococcus aureus,among others.The antibiotic susceptibility profiles of these isolates were assessed using standard laboratory methods.To contextualize the findings,the findings were compared with similar studies from other regions,including China,India,Romania,Saudi Arabia,the United Arab Emirates,Malaysia,and United States.RESULTS The study revealed fluctuating trends in the prevalence of bacterial isolates,with notable changes during the COVID-19 pandemic.For example,a significant increase in the prevalence of Staphylococcus aureus was observed during the pandemic years,while the prevalence of E.coli showed a more variable pattern.Antibiotic resistance rates varied among the different pathogens,with a concerning rise in resistance to commonly used antibiotics,particularly among Klebsiella pneumoniae and E.coli.Additionally,the study identified an alarming increase in the prevalence of multidrug-resistant(MDR)strains,especially within Klebsiella pneumoniae and E.coli isolates.The impact of the COVID-19 pandemic on these trends was evident,with shifts in the frequency,resistance patterns,and the emergence of MDR bacteria among several key pathogens.CONCLUSION This study highlights the dynamic nature of bacterial isolates and their antibiotic susceptibility patterns at Salmaniya Medical Complex,particularly in the context of the COVID-19 pandemic.The findings underscore the need for continuous monitoring and effective anti-microbial stewardship programs to combat the evolving threat of antibiotic resistance.Further research and policy initiatives are required to address the identified challenges and improve patient outcomes in the face of these ongoing challenges.
文摘BACKGROUND The relationship between exercise and gastrointestinal(GI)health is complex and bidirectional.While moderate exercise generally promotes gut health by enhancing motility,reducing inflammation,and supporting microbial balance,intense or prolonged physical activity may exacerbate GI symptoms,particularly in individuals with preexisting digestive disorders.A deeper understanding of this interplay is essential for optimizing both exercise performance and GI well-being.AIM To synthesize current evidence on exercise-related GI disorders,exploring the prevalence,mechanisms,risk factors,and management strategies associated with exercise-induced GI symptoms.METHODS Following PRISMA guidelines,comprehensive searches of databases,including PubMed,Scopus,Web of Science,and EMBASE were conducted.Studies were included if they focused on exercise-induced GI disorders,encompassed randomized controlled trials,cohort studies,case-control studies,and cross-sectional designs,and addressed symptoms across various exercise modalities.Data were extracted and analyzed to identify patterns and implications for clinical and athletic practice.RESULTS A total of 231 studies met the inclusion criteria,highlighting both the benefits and risks of exercise on GI health.Regular moderate-intensity exercise,including activities such as walking,cycling,and yoga has been associated with improved GI function in conditions like gastroesophageal reflux disease,irritable bowel syndrome,inflammatory bowel disease,and constipation.These benefits are attributed to enhanced intestinal motility,reduced systemic inflammation,and improved gut barrier integrity.Additionally,exercise plays a role in regulating the gut-brain axis,with practices like yoga and Tai Chi demonstrating particular effectiveness in alleviating functional GI disorders.Conversely,high-intensity or prolonged exercise may contribute to symptoms such as nausea,diarrhea,and abdominal pain due to mechanisms like splanchnic hypoperfusion and increased intestinal permeability.Individual factors,including fitness level,dietary habits,hydration status,and underlying GI conditions,significantly influence the body’s response to exercise.CONCLUSION Moderate-intensity exercise is a beneficial and well-tolerated intervention for promoting GI health,whereas highintensity activities require careful monitoring,particularly in individuals with pre-existing GI disorders.Personalized exercise and dietary strategies are essential for balancing the benefits of physical activity with the risk of GI distress.Further research is needed to explore the long-term effects of exercise on gut microbiota composition and overall digestive health.
文摘BACKGROUND The relationship between diabetes mellitus(DM)and asthma is complex and can impact disease trajectories.AIM To explore the bidirectional influences between the two conditions on clinical outcomes and disease control.METHODS We systematically reviewed the literature on the relationship between DM and asthma,focusing on their impacts,mechanisms,and therapeutic implications.Various studies were assessed,which investigated the effect of glycemic control on asthma outcomes,lung function,and exacerbations.The study highlighted the role of specific diabetes medications in managing asthma.RESULTS The results showed that poor glycemic control in diabetes can exacerbate asthma,increase hospitalizations,and reduce lung function.Conversely,severe asthma,especially in obese individuals,can complicate diabetes management and make glycemic control more difficult.The diabetes-associated mechanisms,such as inflammation,microangiopathy,and oxidative stress,can exacerbate asthma and decrease lung function.Some diabetes medications exhibit anti-inflammatory effects that show promise in mitigating asthma exacerbations.CONCLUSION The complex interrelationship between diabetes and asthma suggests bidirectional influences that affect disease course and outcomes.Inflammation and microvascular complications associated with diabetes may worsen asthma outcomes,while asthma severity,especially in obese individuals,complicates diabetes control.However,the current research has limitations,and more diverse longitudinal studies are required to establish causal relationships and identify effective treatment strategies for individuals with both conditions.
基金Supported by the National Key R&D Program of China,No.Key Special Project for Marine Environmental Security and Sustainable Development of Coral Reefs 2022-3.5the National Natural Science Foundation of China,No.82102605,82472458,and 82272533.
文摘BACKGROUND Far lateral lumbar disc herniation(FLLDH)is a special type of lumbar disc herniation with high rate of missed diagnosis.Selective nerve root block(SNRB)has special advantages in identifying the responsible nerve root.Percutaneous transforaminal endoscopic discectomy(PTED)is a minimally invasive and effective method to treat FLLDH.However,no report has investigated PTED combined with SNRB to treat FLLDH.AIM To explore the diagnosis and treatment process,surgical technique and clinical efficacy of PTED combined with SNRB to treat FLLDH.METHODS This is a multicenter center,retrospective,observational study.Between January 2020 and January 2022,32 patients were initially diagnosed with FLLDH.All the patients were identified using SNRB to determine the responsible segment and involved nerve roots.Because of poor symptomatic control following SNRB,2 patients were excluded.30 patients diagnosed with FFLDH underwent PTED.The clinical characteristics,operative and postoperative outcomes,complication and subsequent follow-up were collected.RESULTS 30 patients who underwent SNRB combined with PTED were followed up.The average visual analogue scale(VAS)-leg score,VAS-back score,Oswestry disability index(ODI)score at the Follow-up(1 day,1 month,3 months and last follow-up)were significantly different compared per-operation.According to the modified Macnab efficacy evaluation standard,the satisfaction degree at the last follow-up was excellent(28,93.33%),good(1,3.33%),medium(1,3.33%)and poor(0,0%).CONCLUSION SNRB provides an effective method for the definite diagnosis of FLDH and responsible nerve roots.Combination therapy offers several advantages including minimal invasiveness,precision,effectiveness,safety and low recurrence rates.
文摘BACKGROUND Malnutrition and epilepsy share a complex bidirectional relationship,with malnutrition serving as a potential risk factor for epilepsy development,while epilepsy,in turn,often exerts profound effects on nutritional status.Nutritional interventions have emerged as a critical adjunctive approach in epilepsy management.AIM To explore the multifaceted associations between malnutrition and epilepsy,structured into three primary sections:(1)Elucidating the impact of malnutrition as a risk factor for epilepsy onset;(2)Examining the reciprocal influence of epilepsy on nutritional status,and(3)Evaluating diverse nutritional interventions in the management of epilepsy.METHODS A systematic search was conducted across PubMed,Scopus,and Web of Science databases utilizing defined keywords related to malnutrition,epilepsy,and nutritional interventions.Inclusion criteria encompassed various study types,including clinical trials,animal models,cohort studies,case reports,meta-analyses,systematic reviews,guidelines,editorials,and review articles.Four hundred sixteen pertinent references were identified,with 198 review articles,153 research studies,21 case reports,24 meta-analyses,14 systematic reviews,4 guidelines,and 2 editorials meeting the predefined criteria.RESULTS The review revealed the intricate interplay between malnutrition and epilepsy,highlighting malnutrition as a potential risk factor in epilepsy development and elucidating how epilepsy often leads to nutritional deficiencies.Findings underscored the importance of nutritional interventions in managing epilepsy,showing their impact on seizure frequency,neuronal function,and overall brain health.CONCLUSION This systematic review emphasizes the bidirectional relationship between malnutrition and epilepsy while emphasizing the critical role of nutritional management in epilepsy treatment.The multifaceted insights underscore the need for a holistic approach to addressing nutritional aspects alongside conventional epilepsy management strategies.
文摘BACKGROUND Gastrointestinal(GI)manifestations are prevalent in genetic myopathies,posing significant diagnostic and management challenges.AIM To synthesize evidence on the diagnostic approaches,management strategies,patient perspectives,and future research directions regarding GI symptoms in genetic myopathies.METHODS A systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines.We searched PubMed,Scopus,EMBASE,and Web of Science from inception to December 2024.Eligible studies reported GI manifestations in genetic myopathies,including clinical evaluations,imaging,physiological tests,histopathology,and genetic analyses.Inclusion criteria encompassed original research studies,review articles,case reports,and clinical guidelines published in peer-reviewed journals.Exclusion criteria included conference abstracts without full-text availability and non-peer-reviewed sources.Two independent reviewers screened studies and extracted data.They assessed methodological quality using the Newcastle-Ottawa Scale for observational studies,A MeaSurement Tool to Assess Systematic Reviews for systematic reviews,and the Joanna Briggs Institute checklist for case reports.A systematic narrative synthesis was employed to summarize the findings.RESULTS A total of 234 studies met the inclusion criteria.GI manifestations varied widely,with dysphagia,gastroesophageal reflux,abdominal pain,constipation,diarrhea,and fecal incontinence being the most frequently reported symptoms.The included studies highlighted a multidisciplinary diagnostic approach incorporating clinical assessment,imaging,physiological testing,histopathology,and genetic testing.Management strategies ranged from dietary interventions and rehabilitative therapies to pharmacological treatments and surgical procedures.Patient perspectives underscored the significant impact of GI symptoms on quality of life,social interactions,and emotional well-being.The main limitations of the included studies were high heterogeneity in study design,small sample sizes,and the potential risk of bias due to limited methodological rigor in some reports.CONCLUSION This review underscores the complexity of GI manifestations in genetic myopathies and the need for a comprehensive,multidisciplinary management approach.Future research should focus on elucidating molecular mechanisms,identifying biomarkers,and developing targeted therapies to improve patient outcomes.The findings have implications for both clinical practice and public health,emphasizing the necessity of early diagnosis and personalized management strategies.
文摘BACKGROUND Functional neurological disorder(FND)in children is a complex and multifaceted condition characterized by neurological symptoms that cannot be explained by organic pathology.Despite its prevalence,FND in pediatric populations remains under-researched,with challenges in diagnosis and management AIM To synthesize the current literature on FND in children,focusing on clinical presentation,diagnostic approaches,treatment strategies,and outcomes.METHODS A comprehensive literature search was conducted across multiple databases,including PubMed,Scopus,and Web of Science,for articles published up to August 2024.Studies were included if they addressed FND in pediatric populations,specifically focusing on review articles,research articles,systematic reviews,meta-analyses,case reports,guidelines,expert opinions,and editorials.Data extraction and quality assessment were performed according to PRISMA guidelines.A total of 308 articles were included in the final analysis.RESULTS The analysis included 189 review articles,57 research articles,3 systematic reviews and meta-analyses,5 case reports,2 guidelines,5 expert opinions,and 2 editorials.Key findings revealed a broad spectrum of symptoms,including motor and sensory disturbances and psychological factors contributing to the onset and persistence of FND.Diagnostic challenges were frequently highlighted,emphasizing the need for interdisciplinary approaches.Treatment strategies varied,with cognitive-behavioral therapy(CBT)and multidisciplinary care emerging as the most effective approaches.The outcomes varied,with early intervention being critical for a better prognosis.CONCLUSION Early diagnosis and multidisciplinary care,including CBT,are critical for improving outcomes in pediatric FND.Standardized diagnostic criteria and treatment protocols are needed to enhance clinical management.
文摘Cow milk protein allergy(CMPA)is a prevalent food allergy in infancy.It often presents with symptoms that overlap with other conditions,such as gastroeso-phageal reflux disease,lactose intolerance,food protein-induced enterocolitis syndrome,and eosinophilic esophagitis.This diagnostic overlap makes distin-guishing CMPA from its mimics difficult,resulting in potential misdiagnoses and unnecessary dietary restrictions.This review aims to comprehensively analyze CMPA and its mimicking conditions,highlighting their clinical presentations,diagnostic approaches,and management strategies to enhance diagnostic accu-racy and optimize patient care.A systematic literature search was conducted using PubMed,Scopus,Web of Science,and Google Scholar,focusing on studies published within the last 20 years.Articles addressing CMPA and its mimicking conditions were selected,with data synthesized into comparative analyses of diagnostic methods and management strategies.Accurate differentiation between CMPA and its mimics requires a thorough clinical evaluation supported by diagnostic tests such as skin prick tests,serum-specific IgE,and oral food challenges.Misdiagnosis can lead to nutritional deficiencies,psychological stress,and increased healthcare costs.Emerging diagnostic technologies,including component-resolved diagnostics and cytokine profiling,offer promising avenues for improving accuracy.A multidisciplinary approach involving pediatricians,allergists,and dietitians is essential for precise diagnosis and effective management.Ongoing research and education are crucial to enhancing clinical outcomes and reducing the burden on families.
文摘Pediatric inflammatory bowel disease(IBD),encompassing Crohn’s disease,ulcerative colitis,and IBD-unclassified,has become increasingly prevalent worldwide,including in previously low-incidence regions.Children often present with more extensive and aggressive disease,creating unique diagnostic and management challenges that differ significantly from adult-onset IBD.This review aims to synthesize current knowledge on pediatric IBD,highlighting historical challenges while exploring emerging frontiers in diagnosis,treatment,and long-term care strategies.A narrative synthesis of global and regional epidemiological data,clinical classifications,diagnostic advancements,management approaches,and psychosocial considerations was conducted,with a particular emphasis on innovations in precision medicine,microbiome-targeted therapy,and multidisciplinary care models.Pediatric IBD continues to rise globally,driven by environmental and genetic interactions,especially in rapidly industrializing regions.Novel diagnostic tools,age-specific treatment protocols,biologics,nutritional strategies,and psychosocial support are reshaping care.Emphasis on very early-onset IBD,transition care,and regional policy adaptations underscores the evolving complexity of managing pediatric IBD.The landscape of pediatric IBD care is rapidly evolving.Addressing the distinct pathophysiology,developmental impact,and healthcare challenges of pediatric patients requires an integrated,child-centered approach.Ongoing research into genetics,immune pathways,and the microbiome will be essential in tailoring precision therapies and improving outcomes globally.
文摘BACKGROUND Children with autism spectrum disorder(ASD)face unique challenges in maintaining oral health due to sensory sensitivities,communication difficulties,and behavioral barriers.These factors,along with limited access to ASD-trained dental professionals,increase their risk of dental caries,periodontal disease,bruxism,and other oral health issues.Despite growing awareness of these challenges,a comprehensive synthesis of evidence-based solutions remains lacking.AIM To review synthesizes existing research on dental problems in ASD,barriers to care,management strategies,and future directions for improved oral health outcomes.METHODS A systematic search of PubMed,Cochrane Library,and Scopus was conducted using predefined search terms.Related to ASD,dental health,and management strategies.Inclusion criteria encompassed studies focusing on children with ASD,dental health issues,and interventions.Data extraction included study design,participant characteristics,key findings,and intervention outcomes.The quality of studies was assessed using appropriate tools such as the Cochrane Risk of Bias Tool and the Newcastle-Ottawa Scale.A narrative synthesis approach,incorporating thematic analysis,was utilized to evaluate the findings.RESULTS A total of 165 studies met the inclusion criteria.Children with ASD exhibited a higher prevalence of dental caries,gingivitis,bruxism,and malocclusion compared to neurotypical peers.Barriers to dental care included sensory sensitivities,communication difficulties,financial constraints,and a shortage of ASD-trained dental professionals.Effective interventions included desensitization programs,behavioral therapy,digital applications,and interdiscip-linary collaboration.Parental education and professional training were crucial for improving oral health outcomes.CONCLUSION Tailored dental care strategies,including sensory adaptations,behavioral interventions,and interdisciplinary collaboration,are essential for children with ASD.Standardized guidelines and long-term studies are needed to refine evidence-based protocols.Future research should explore digital interventions and probiotic applications in ASD dental care.
文摘BACKGROUND Epiploic appendagitis is a rare,often underrecognized cause of acute abdominal pain.Misdiagnosis can lead to unnecessary hospitalization,antibiotic use,or surgical intervention.Advances in imaging have improved the recognition of this self-limiting condition,but clinical awareness remains critical.AIM To provide a comprehensive update on the epidemiology,anatomy,pathogenesis,clinical presentation,diagnostic strategies,differential diagnosis,and management of epiploic appendagitis,emphasizing its distinguishing features from other causes of acute abdomen.METHODS A review of the literature was conducted,focusing on the clinical characteristics,imaging findings,differential diagnoses,and evidence-based management strategies for epiploic appendagitis.RESULTS Epiploic appendagitis typically presents with acute,localized,non-radiating abdominal pain without significant systemic symptoms.Diagnosis is heavily reliant on imaging,with computed tomography(CT)being the gold standard.Hallmark CT findings include a small,fat-density ovoid lesion adjacent to the colon,with the usual characteristic ring and dot signs.Differential diagnoses include mainly diverticulitis,appendicitis,omental infarction,and many other causes.Management is predominantly conservative with nonsteroidal anti-inflammatory drugs and observation,reserving surgical intervention for rare,complicated cases.CONCLUSION Recognizing the clinical and imaging features of epiploic appendagitis is essential to avoid unnecessary interventions.Increased clinician awareness,coupled with judicious use of imaging,facilitates timely diagnosis and appropriate management,ensuring optimal patient outcomes.
基金Supported by Fonden til Lgevidenskabens Fremme (the AP MΦller Foundation)the Family Erichsen Memorial Foundationthe Foundation of Aase and Ejnar Danielsen
文摘AIM:To use microarray-based miRNA profiling of colonic mucosal biopsies from patients with ulcerative colitis (UC), Crohn's disease (CD), and controls in order to identify new potential miRNA biomarkers in inflammatory bowel disease. METHODS:Colonic mucosal pinch biopsies from the descending part were obtained endoscopically from patients with active UC or CD, quiescent UC or CD, as well as healthy controls. Total RNA was isolated and miRNA expression assessed using the miRNA microarray Geniom Biochip miRNA Homo sapiens (Febit GmbH, Heidelberg, Germany). Data analysis was carried out by principal component analysis and projection to latent structure-discriminant analysis using the SIMCA-P+12 software package (Umetrics, Umea, Sweden). The microarray data were subsequently validated by quantitative real-time polymerase chain reaction (qPCR) performed on colonic tissue samples from active UC patients (n = 20), patients with quiescent UC (n = 19), and healthy controls (n = 20). The qPCR results were analyzed with Mann-WhitneyU test.In silico prediction analysis were performed to identify potential miRNA target genes and the predicted miRNA targets were then compared with all UC associated susceptibility genes reported in the literature. RESULTS:The colonic mucosal miRNA transcriptome differs significantly between UC and controls, UC and CD, as well as between UC patients with mucosal inflammation and those without. However, no clear differences in the transcriptome of patients with CD and controls were found. The miRNAs with the strongest differential power were identified (miR-20b, miR-99a, miR-203, miR-26b, and miR-98) and found to be upregulated more than a 10-fold in active UC as compared to quiescent UC, CD, and controls. Two miRNAs, miR-125b-1* and let-7e*, were up-regulated more than 5-fold in quiescent UC compared to active UC, CD, and controls. Four of the seven miRNAs (miR-20b, miR-98, miR-125b-1*, and let-7e*) were validated by qPCR and found to be specifically upregulated in patients with UC. Usingin silico analysis we found several predicted pro-inflammatory target genes involved in various pathways, such as mitogen-activated protein kinase and cytokine signaling, which are both key signaling pathways in UC.CONCLUSION:The present study provides the first evidence that miR-20b, miR-98, miR-125b-1*, and let7e* are deregulated in patients with UC. The level of these miRNAs may serve as new potential biomarkers for this chronic disease.
基金Supported by Grants from Fonden til Lgevidenskabens Fremme(the AP Mller Foundation)the Family Erichsen Memorial Foundation+2 种基金the Lundbeck Foundationthe Axel Muusfeldts Foundationthe Foundation of Aase and Ejnar Danielsen
文摘The pathogenesis of inflammatory bowel disease (IBD) is complex and largely unknown. Until recently, research has focused on the study of protein regulators in inflammation to reveal the cellular and molecular networks in the pathogenesis of IBD. However, in the last few years, new and promising insights have been generated from studies describing an association between an altered expression of a specific class of non-coding RNAs, called microRNAs (miRs or miRNAs) and IBD. The short (approximately 22 nucleotides), endogenous, single-stranded RNAs are evolutionary conserved inanimals and plants, and regulate specific target mRNAs at the post-transcriptional level. MiRNAs are involved in several biological processes, including development, cell differentiation, proliferation and apoptosis. Furthermore, it is estimated that miRNAs may be responsible for regulating the expression of nearly one-third of the genes in the human genome. Thus, miRNA deregulation often results in an impaired cellular function, and a disturbance of downstream gene regulation and signaling cascades, suggesting their implication in disease etiology. Despite the identification of more than 1900 mature human miRNAs, very little is known about their biological functions and functional targets. Recent studies have identified dysregulated miRNAs in tissue samples of IBD patients and have demonstrated similar differences in circulating miRNAs in the serum of IBD patients. Thus, there is great promise that miRNAs will aid in the early diagnosis of IBD, and in the development of personalized therapies. Here, we provide a short review of the current state-of-the-art of miRNAs in IBD pathogenesis, diagnostics and therapeutics.
基金Supported by Grants from the Foundation of Aase and Ejnar Danielsenthe Foundation of Axel Muusfeldtthe A P Mφller Foundation("Fonden til Lgevidenskabens Fremme")
文摘Inflammatory bowel disease (IBD) is a group of chronic disorders of the gastrointestinal tract comprising Crohn’s disease (CD) and ulcerative colitis (UC). Their etiologies are unknown, but they are characterised by an imbalanced production of pro-inflammatory mediators, e.g., tumor necrosis factor (TNF)-α, as well as increased recruitment of leukocytes to the site of inflammation. Advantages in understanding the role of the inflammatory pathways in IBD and an inadequate response to conventional therapy in a large portion of patients, has over the last two decades lead to new therapies which includes the TNF inhibitors (TNFi), designed to target and neutralise the effect of TNF-α. TNFi have shown to be efficient in treating moderate to severe CD and UC. However, convenient alternative therapeutics targeting other immune pathways are needed for patients with IBD refractory to conventional therapy including TNFi. Indeed, several therapeutics are currently under development, and have shown success in clinical trials. These include antibodies targeting and neutralising interleukin-12/23, small pharmacologic Janus kinase inhibitors designed to block intracellular signaling of several pro-inflammatory cytokines, antibodies targeting integrins, and small anti-adhesion molecules that block adhesion between leukocytes and the intestinal vascular endothelium, reducing their infiltration into the inflamed mucosa. In this review we have elucidated the major signaling pathways of clinical importance for IBD therapy and highlighted the new promising therapies available. As stated in this paper several new treatment options are under development for the treatment of CD and UC, however, no drug fits all patients. Hence, optimisations of treatment regimens are warranted for the benefit of the patients either through biomarker establishment or other rationales to maximise the effect of the broad range of mode-of-actions of the present and future drugs in IBD.
文摘AIM: To investigate the effects of a low fermentable, oligosaccharides, disaccharides, monosaccharides and polyols diet (LFD) and the probiotic Lactobacillus rhamnosus GG (LGG) in irritable bowel syndrome (IBS).
文摘AIM To develop a scale of domains associated with the health-related quality-of-life(HRQOL) in patients with cirrhosis-related ascites.METHODS We initially undertook literature searches and a qualitative study in order to design a cirrhosis-associated ascites symptom(CAS) scale describing symptoms with a potential detrimental impact on health related quality of life(HRQL)(the higher the score, the worse the symptoms). Discriminatory validity was assessed in a validation cohort including cirrhotic patients with(1) tense/severe;(2) moderate/mild; or(3) no ascites(controls). Patients also completed chronic liver disease questionnaire(CLDQ) and the Euro QoL 5-Dimensions 5-Level(EQ-5D-5L) questionnaire evaluating HRQL. The relation between scale scores was analysed using Spearman correlations. RESULTS The final CAS scale included 14 items. The equivalent reliability was high(Chronbach's alpha 0.88). The validation cohort included 103 patients(72% men, mean age 62.4 years). The mean scores for each question in the CAS scale were higher for patients with severe/tense ascites than for mild/moderate ascites and controls. Compared with controls(mean = 9.9 points), the total CAS scale score was higher for severe/tense ascites(mean = 23.8 points) as well as moderate/mild ascites(mean = 18.6 points)(P < 0.001 both groups). We found a strong correlation between the total CAS and CLDQ score(rho = 0.82, P < 0.001) and a moderate correlation between the CAS and the EQ-5D-5L score(0.67, P < 0.001). CONCLUSION The CAS is a valid tool, which reflects HRQOL in patients with ascites.
文摘In the present study we report on changes in irritable bowel syndrome-severity scoring system (IBS-SSS) and irritable bowel syndrome-quality of life (IBS-QoL) in 19 IBS patients, aged 18 to 74 years (F/M: 14/5), during 12 wk registering their symptoms on the web-application (www.ibs.constant-care.dk). During a control period of the first 6-wk patients were asked to register their IBS-SSS and IBS-QoL on the web-application weekly without receiving any intervention. Thereafter, low fermentable oligo-, di-, mono-saccharides and polyols (FODMAP) diet (LFD) was introduced for the next 6 wk while continuing the registration. Though a small sample size a significant improvement in disease activity (IBS-SSS) was observed during both the control period, median: 278 (range: 122-377), P = 0.02, and subsequently during the LFD period, median: 151 (range: 29-334), P < 0.01. The IBS-QoL solely changed significantly during the LFD period, median: 67 (37-120), P < 0.01. The significant reduction in disease activity during the control period shows a positive effect of the web-application on IBS symptoms when presented as a “traffic light”. However adding the diet reduced IBS-SSS to < 150, inactive to mild symptoms. In the future results from larger scale trials are awaited.
文摘The use of thiopurines as immunosuppression for the treatment of refractory or chronic active inflammatory bowel disease is established for both Crohn's disease and ulcerative colitis.Nevertheless,many questions remain concerning the optimal treatment regimens of azathioprine,6-mercaptopurine and thioguanine.We will briefly summarize dose recommendations,indications for thiopurine therapy and side effects which are relevant in clinical practice.We discuss some currently debated topics,including the combination of azathioprine and allopurinol,switching of thiopurine therapy in case of side effects,the use of azathioprine in pregnancy,the infection risk using thiopurines and the evidence when to stop thiopurines.Excellent reviews have been published on the thiopurine metabolic pathway which will not be discussed here in detail.
