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  1. Article ; Online: What's New in the Postoperative Management of Crohn's Disease?

    Dasharathy, Sonya S / Limketkai, Berkeley N / Sauk, Jenny S

    Digestive diseases and sciences

    2021  Volume 67, Issue 8, Page(s) 3508–3517

    Abstract: Patients with Crohn's disease (CD) often require surgical resection due to complications, such as strictures and abscesses, or disease refractory to medical therapy. To understand the evolving management of patients with CD after surgery, we outline the ... ...

    Abstract Patients with Crohn's disease (CD) often require surgical resection due to complications, such as strictures and abscesses, or disease refractory to medical therapy. To understand the evolving management of patients with CD after surgery, we outline the risk factors for postoperative recurrence, advances in postoperative endoscopic evaluation and characterization of recurrence, noninvasive methods of assessing postoperative recurrence, use of postoperative prophylactic medical therapy including newer biologics, and novel surgical methods to reduce postoperative recurrence. The Rutgeerts score (RS) was developed to predict progression of disease based on endoscopic appearance postoperatively and to guide medical therapy. However, this scoring system groups ileal and anastomotic lesions into the same category. A modified RS was developed to separate lesions isolated to the anastomosis and those in the neo-terminal ileum to further understand the role of anastomotic lesions in CD progression. Additional scoring systems have also been evaluated to better understand these differences. In addition, noninvasive diagnostic methods, such as small bowel ultrasound, have high sensitivity and specificity for the detection of postoperative recurrence and are being evaluated as independent methods of assessment. Studies have also shown a reduction in endoscopic recurrence with postoperative anti-TNFα therapy. However, preoperative exposure to anti-TNFα therapy may impact postoperative response to these medications, and therefore, determining optimal postoperative prophylaxis strategy for biologic-experienced patients requires further exploration. Lastly, new surgical modalities to reduce postoperative recurrence are currently being investigated with preliminary data suggesting that an antimesenteric functional end-to-end anastomosis (Kono-S) may decrease postoperative recurrence.
    MeSH term(s) Anastomosis, Surgical/adverse effects ; Anastomosis, Surgical/methods ; Colon/surgery ; Crohn Disease/diagnosis ; Crohn Disease/drug therapy ; Crohn Disease/surgery ; Humans ; Ileum/surgery ; Postoperative Complications/etiology ; Postoperative Complications/prevention & control ; Recurrence ; Retrospective Studies
    Language English
    Publishing date 2021-08-18
    Publishing country United States
    Document type Journal Article ; Review ; Research Support, Non-U.S. Gov't
    ZDB-ID 304250-9
    ISSN 1573-2568 ; 0163-2116
    ISSN (online) 1573-2568
    ISSN 0163-2116
    DOI 10.1007/s10620-021-07205-w
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Psychological Factors Associated With Adherence to Oral Treatment in Ulcerative Colitis.

    Dasharathy, Sonya S / Long, Millie D / Lackner, Jeffrey M / Ben-Ami Shor, Dana / Yang, Liu / Bar, Nir / Ha, Christina / Weiss, Guy A

    Inflammatory bowel diseases

    2022  Volume 29, Issue 1, Page(s) 97–102

    Abstract: Introduction: Medication nonadherence in patients with ulcerative colitis (UC) can result in frequent relapses, severe disease, and higher risk of colorectal cancer. Behavioral models relying on motivation and perceived competence, like the self- ... ...

    Abstract Introduction: Medication nonadherence in patients with ulcerative colitis (UC) can result in frequent relapses, severe disease, and higher risk of colorectal cancer. Behavioral models relying on motivation and perceived competence, like the self-determination theory (SDT), have been implicated in nonadherence; however, the SDT has not been evaluated in the adult UC population. We sought to examine the association between adherence to oral medications in patients with UC and psychological distress, relationship with health care providers, motivation, and competence.
    Methods: We performed a cross-sectional study within the Inflammatory Bowel Disease (IBD) Partners online registry in which participants completed a baseline survey including demographic information, IBD history, symptoms, medication adherence, and psychosocial factors. Members of the registry with a diagnosis of UC received an online follow-up survey that included baseline questionnaires and assessment of competence, motivation, and patient-physician relationship. Logistic regression models were performed to determine the relationship between psychosocial factors, adherence modifiers, and medication adherence.
    Results: Of the 410 UC patients included, 29% had low adherence to their medications, 36% had medium adherence, and 34% had high adherence. In the multivariable analysis, younger patients, those with a lower perceived competence, and those with worse relationship with their providers were more likely to have lower adherence to their medications.
    Conclusions: Poor adherence to oral medications in UC was associated with lower perceived competence and worse relationship with providers. Further interventions based on the SDT can potentially improve adherence and optimize patient care.
    MeSH term(s) Adult ; Humans ; Colitis, Ulcerative/complications ; Cross-Sectional Studies ; Inflammatory Bowel Diseases/drug therapy ; Medication Adherence ; Surveys and Questionnaires
    Language English
    Publishing date 2022-03-22
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1340971-2
    ISSN 1536-4844 ; 1078-0998
    ISSN (online) 1536-4844
    ISSN 1078-0998
    DOI 10.1093/ibd/izac051
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Pneumococcal Vaccination Recommendation and Completion Rates Among Patients With Inflammatory Bowel Disease and Barriers to Vaccination.

    Dasharathy, Sonya S / May, Folasade P / Myint, Anthony / Yang, Liu / Rahal, Harman K / Cusumano, Vivy / Kozan, Philip A / Lowe, Sarina C / Beah, Peter Y / Limketkai, Berkeley N / Sauk, Jenny S

    Journal of clinical gastroenterology

    2023  Volume 57, Issue 10, Page(s) 1031–1037

    Abstract: Background: Guidelines for inflammatory bowel disease (IBD) patients receiving immunosuppression encouraged both the pneumococcal polysaccharide vaccine (PPSV23) and the pneumococcal conjugate vaccine (PCV13). We aimed to evaluate which pneumococcal ... ...

    Abstract Background: Guidelines for inflammatory bowel disease (IBD) patients receiving immunosuppression encouraged both the pneumococcal polysaccharide vaccine (PPSV23) and the pneumococcal conjugate vaccine (PCV13). We aimed to evaluate which pneumococcal vaccines are recommended and administered, and to understand provider and IBD patient knowledge regarding pneumococcal vaccinations.
    Methods: We performed a retrospective, cross-sectional analysis of 357 adult IBD patients on immunosuppression in our health care system. Patient demographics and clinical characteristics were collected. The primary outcome was rate of documented vaccinations recommended by providers; the secondary outcome was rate of receipt of the vaccines. We identified factors associated with receipt of any pneumococcal vaccine through multivariable logistic regression. We also performed provider and IBD patient surveys to understand provider and patient knowledge regarding pneumococcal vaccines. We used χ 2 and Fisher exact tests to assess survey responses.
    Results: Fifty seven percent of IBD patients had any pneumococcal vaccination recommended and 35% had recommendations for both PPSV23 and PCV13. Forty percent received any pneumococcal vaccine and 18% received both vaccines. In multivariable analyses, increasing age (adjusted odds ratio: 1.03, 95% CI: 1.01-1.05) was associated with receipt of any pneumococcal vaccine, after adjusting for gender, race, insurance, disease activity, and time seen in our gastroenterology clinics. In the survey study, on average, 59% of providers correctly answered questions regarding pneumococcal vaccination indications.
    Conclusion: In our health care system, while recommendation for any pneumococcal vaccination was >50%, receipt of both PPSV23 and PCV13 was low. Simplified vaccine regimens (ie, PCV20) will likely improve vaccination rates.
    MeSH term(s) Adult ; Humans ; Retrospective Studies ; Cross-Sectional Studies ; Vaccination ; Pneumococcal Vaccines ; Inflammatory Bowel Diseases
    Chemical Substances Pneumococcal Vaccines
    Language English
    Publishing date 2023-01-19
    Publishing country United States
    Document type Journal Article
    ZDB-ID 448460-5
    ISSN 1539-2031 ; 0192-0790
    ISSN (online) 1539-2031
    ISSN 0192-0790
    DOI 10.1097/MCG.0000000000001783
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    Zs.A 1523: Show issues Location:
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    Jg. 1995 - 2021: Lesesall (1.OG)
    ab Jg. 2022: Lesesaal (EG)

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  4. Article ; Online: Generalized Cytokine Increase in the Setting of a Multisystem Clinical Disorder and Carcinoid Syndrome Associated with a Novel NLRP12 Variant.

    Jacob, Noam / Dasharathy, Sonya S / Bui, Viet / Benhammou, Jihane N / Grody, Wayne W / Singh, Ram Raj / Pisegna, Joseph R

    Digestive diseases and sciences

    2019  Volume 64, Issue 8, Page(s) 2140–2146

    Abstract: Background: Nucleotide-binding oligomerization domain (NOD)-like receptors (NLRs) are a group of cytoplasmic sensors that survey danger signals released by invading pathogens or damaged tissue. Mutations in the NLRP subfamily affect pro-inflammatory ... ...

    Abstract Background: Nucleotide-binding oligomerization domain (NOD)-like receptors (NLRs) are a group of cytoplasmic sensors that survey danger signals released by invading pathogens or damaged tissue. Mutations in the NLRP subfamily affect pro-inflammatory mediators and cause nonspecific systemic symptoms.
    Aims: We sought to identify a potential genetic etiology of an inflammatory syndrome in a patient that presented with an atypical multisystem illness with carcinoid syndrome as well as atopic and autoimmune features.
    Methods: Exome sequencing was performed using the Agilent SureSelect Clinical Research Exome XT kit on an Illumina HiSeq 2500. Longitudinal monitoring of pro-inflammatory cytokines was performed.
    Results: We identified a novel variant (heterozygous c.536C > T [p.Thr179Ile]) in the NLRP12 gene in a 63-year-old woman and her daughter, who presented with an unusual clinical syndrome that differs from autoinflammatory disorders previously reported in association with the NLRP subfamily gene mutations. This NLRP12 variant was predicted to be pathogenic by functional analysis through Hidden Markov Models (FATHMM). Both the mother and the daughter had episodes of abdominal pain, fever, diarrhea, skin rash, hypothyroidism, and elevated urine 5-hydroxyindoleacetic acid (5-HIAA) levels. The proband also had elevated serum levels of pro-inflammatory (IL-1β, IL-6, IL-12, and TNF-α), Th1 (IL-2, IFN-γ), and Th2 (IL-4, IL-5, IL-13) cytokines, but not of Th17 (IL-17) and IL-10.
    Conclusion: This report adds to the expanding spectrum of clinical manifestations attributed to the NLRP subfamily gene variants and suggests a role of NLRP12 in the regulation of multiple cytokines.
    MeSH term(s) Autoimmune Diseases/blood ; Autoimmune Diseases/diagnosis ; Autoimmune Diseases/genetics ; Cytokines/blood ; Female ; Genetic Predisposition to Disease ; Heredity ; Humans ; Inflammation Mediators/blood ; Intracellular Signaling Peptides and Proteins/genetics ; Malignant Carcinoid Syndrome/blood ; Malignant Carcinoid Syndrome/diagnosis ; Malignant Carcinoid Syndrome/genetics ; Middle Aged ; Mutation ; Phenotype ; Up-Regulation
    Chemical Substances Cytokines ; Inflammation Mediators ; Intracellular Signaling Peptides and Proteins ; NLRP12 protein, human
    Language English
    Publishing date 2019-02-20
    Publishing country United States
    Document type Case Reports ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S.
    ZDB-ID 304250-9
    ISSN 1573-2568 ; 0163-2116
    ISSN (online) 1573-2568
    ISSN 0163-2116
    DOI 10.1007/s10620-019-05525-6
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  5. Article ; Online: Menstrual bleeding patterns among regularly menstruating women.

    Dasharathy, Sonya S / Mumford, Sunni L / Pollack, Anna Z / Perkins, Neil J / Mattison, Donald R / Wactawski-Wende, Jean / Schisterman, Enrique F

    American journal of epidemiology

    2012  Volume 175, Issue 6, Page(s) 536–545

    Abstract: Menstrual bleeding patterns are considered relevant indicators of reproductive health, though few studies have evaluated patterns among regularly menstruating premenopausal women. The authors evaluated self-reported bleeding patterns, incidence of ... ...

    Abstract Menstrual bleeding patterns are considered relevant indicators of reproductive health, though few studies have evaluated patterns among regularly menstruating premenopausal women. The authors evaluated self-reported bleeding patterns, incidence of spotting, and associations with reproductive hormones among 201 women in the BioCycle Study (2005-2007) with 2 consecutive cycles. Bleeding patterns were assessed by using daily questionnaires and pictograms. Marginal structural models were used to evaluate associations between endogenous hormone concentrations and subsequent total reported blood loss and bleeding length by weighted linear mixed-effects models and weighted parametric survival analysis models. Women bled for a median of 5 days (standard deviation: 1.5) during menstruation, with heavier bleeding during the first 3 days. Only 4.8% of women experienced midcycle bleeding. Increased levels of follicle-stimulating hormone (β = 0.20, 95% confidence interval: 0.13, 0.27) and progesterone (β = 0.06, 95% confidence interval: 0.03, 0.09) throughout the cycle were associated with heavier menstrual bleeding, and higher follicle-stimulating hormone levels were associated with longer menses. Bleeding duration and volume were reduced after anovulatory compared with ovulatory cycles (geometric mean blood loss: 29.6 vs. 47.2 mL; P = 0.07). Study findings suggest that detailed characterizations of bleeding patterns may provide more insight than previously thought as noninvasive markers for endocrine status in a given cycle.
    MeSH term(s) Adolescent ; Adult ; Estradiol/blood ; Female ; Follicle Stimulating Hormone/blood ; Health Surveys ; Humans ; Linear Models ; Luteinizing Hormone/blood ; Menstrual Cycle/blood ; Menstrual Cycle/physiology ; Menstruation/physiology ; Metrorrhagia ; Models, Statistical ; Ovulation/blood ; Ovulation/physiology ; Ovulation Detection ; Progesterone/blood ; Prospective Studies ; Self Report ; Young Adult
    Chemical Substances Progesterone (4G7DS2Q64Y) ; Estradiol (4TI98Z838E) ; Luteinizing Hormone (9002-67-9) ; Follicle Stimulating Hormone (9002-68-0)
    Language English
    Publishing date 2012-02-20
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Intramural
    ZDB-ID 2937-3
    ISSN 1476-6256 ; 0002-9262
    ISSN (online) 1476-6256
    ISSN 0002-9262
    DOI 10.1093/aje/kwr356
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  6. Article ; Online: Serum uric acid in relation to endogenous reproductive hormones during the menstrual cycle: findings from the BioCycle study.

    Mumford, Sunni L / Dasharathy, Sonya S / Pollack, Anna Z / Perkins, Neil J / Mattison, Donald R / Cole, Stephen R / Wactawski-Wende, Jean / Schisterman, Enrique F

    Human reproduction (Oxford, England)

    2013  Volume 28, Issue 7, Page(s) 1853–1862

    Abstract: Study question: Do uric acid levels across the menstrual cycle show associations with endogenous estradiol (E2) and reproductive hormone concentrations in regularly menstruating women?: Summary answer: Mean uric acid concentrations were highest ... ...

    Abstract Study question: Do uric acid levels across the menstrual cycle show associations with endogenous estradiol (E2) and reproductive hormone concentrations in regularly menstruating women?
    Summary answer: Mean uric acid concentrations were highest during the follicular phase, and were inversely associated with E2 and progesterone, and positively associated with FSH.
    What is known already: E2 may decrease serum levels of uric acid in post-menopausal women; however, the interplay between endogenous reproductive hormones and uric acid levels among regularly menstruating women has not been elucidated.
    Study design, size, duration: The BioCycle study was a prospective cohort study conducted at the University at Buffalo research centre from 2005 to 2007, which followed healthy women for one (n = 9) or 2 (n = 250) menstrual cycle(s).
    Participants/materials, setting, methods: Participants were healthy women aged 18-44 years. Hormones and uric acid were measured in serum eight times each cycle for up to two cycles. Marginal structural models with inverse probability of exposure weights were used to evaluate the associations between endogenous hormones and uric acid concentrations.
    Main results and the role of chance: Uric acid levels were observed to vary across the menstrual cycle, with the lowest levels observed during the luteal phase. Every log-unit increase in E2 was associated with a decrease in uric acid of 1.1% (β = -0.011; 95% confidence interval (CI): -0.019, -0.004; persistent-effects model), and for every log-unit increase in progesterone, uric acid decreased by ≈ 0.8% (β = -0.008; 95% CI: -0.012, -0.004; persistent-effects model). FSH was positively associated with uric acid concentrations, such that each log-unit increase was associated with a 1.6% increase in uric acid (β = 0.016; 95% CI: 0.005, 0.026; persistent-effects model). Progesterone and FSH were also associated with uric acid levels in acute-effects models. Of 509 cycles, 42 were anovulatory (8.3%). Higher uric acid levels were associated with increased odds of anovulation (odds ratio 2.39, 95% CI: 1.25, 4.56).
    Limitations, reasons for caution: The change in uric acid levels among this cohort of healthy women was modest, and analysis was limited to two menstrual cycles. The women in this study were healthy and regularly menstruating, and as such there were few women with high uric acid levels and anovulatory cycles.
    Wider implications of the findings: These findings demonstrate the importance of taking menstrual cycle phase into account when measuring uric acid in premenopausal women, and confirm the hypothesized beneficial lowering effects of endogenous E2 on uric acid levels. These findings suggest that there could be an underlying association affecting both sporadic anovulation and high uric acid levels among young, regularly menstruating women. Further studies are needed to confirm these findings and elucidate the connection between uric acid and reproductive and later cardiovascular health.
    MeSH term(s) Adolescent ; Adult ; Anovulation/blood ; Cohort Studies ; Estradiol/blood ; Female ; Follicle Stimulating Hormone/blood ; Humans ; Menstrual Cycle/blood ; Progesterone/blood ; Uric Acid/blood
    Chemical Substances Uric Acid (268B43MJ25) ; Progesterone (4G7DS2Q64Y) ; Estradiol (4TI98Z838E) ; Follicle Stimulating Hormone (9002-68-0)
    Language English
    Publishing date 2013-04-05
    Publishing country England
    Document type Journal Article ; Research Support, N.I.H., Intramural
    ZDB-ID 632776-x
    ISSN 1460-2350 ; 0268-1161 ; 1477-741X
    ISSN (online) 1460-2350
    ISSN 0268-1161 ; 1477-741X
    DOI 10.1093/humrep/det085
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.B 2892: Show issues Location:
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