313 results on '"Barkin JS"'
Search Results
2. World Literature Review
- Author
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Barkin Js and Perry Hookman
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medicine.medical_specialty ,Hepatology ,medicine.diagnostic_test ,business.industry ,Gastroenterology ,Medicine ,Computed tomography ,Right lower quadrant pain ,Radiology ,business ,medicine.disease ,Appendicitis - Published
- 2000
3. Curved biopsy forceps
- Author
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Barkin Js and Jeffrey A. Goldstein
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medicine.medical_specialty ,business.industry ,Duodenum ,Biopsy ,Gastroenterology ,Equipment Design ,Surgery ,Gastric Mucosa ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Intestinal Mucosa ,business ,Biopsy forceps - Published
- 1998
4. Induction of Mania by Risperidone Resistant to Mood Stabilizers
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Barkin Js, Pais Vm, and Gaffney Mf
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Psychiatry and Mental health ,medicine.medical_specialty ,Mood ,Risperidone ,business.industry ,medicine ,Pharmacology (medical) ,medicine.symptom ,Psychiatry ,business ,Mania ,medicine.drug - Published
- 1997
5. Excessive lithium reabsorption by the proximal tubules
- Author
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Barkin Js
- Subjects
Psychiatry and Mental health ,medicine.medical_specialty ,Lithium (medication) ,business.industry ,Reabsorption ,Urology ,medicine ,Medical emergency ,business ,medicine.disease ,medicine.drug - Published
- 1994
6. Superiority of the DNA amplification assay for the diagnosis of C. difficile infection: a clinical comparison of fecal tests.
- Author
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Barkin JA, Nandi N, Miller N, Grace A, Barkin JS, Sussman DA, Barkin, Jodie A, Nandi, Neilanjan, Miller, Nancimae, Grace, Alexandra, Barkin, Jamie S, and Sussman, Daniel A
- Abstract
Background: Clostridium difficile infection (CDI) is a major infectious concern, accounting for substantial morbidity and resource utilization. Advances in microbiological and molecular techniques have resulted in an increasing number of testing options for CDI. A glutamate dehydrogenase (GDH) enzyme immunoassay (EIA) and a DNA amplification (DNA-A) test for the diagnosis of CDI have recently become commercially available.Aims: The aim of this prospective study was to compare the test performance characteristics of the traditional diagnostic modality for CDI diagnosis, the toxin A/B (TOX) EIA, with those of the GDH EIA and DNA-A test, utilizing enriched toxigenic culture (TGC) as the gold standard. Clinical variables predictive of CDI were also studied.Methods: Participants fulfilled one or more criteria placing them at increased risk for CDI. Each stool sample was tested by each of the methods mentioned above. Clinical data parameters were collected via a 12-month review of the electronic medical record prior to the index date of the first stool test.Results: A total of 272 stool samples from 144 admissions of 139 patients were evaluated for CDI. The sensitivity and positive predictive value (PPV) of the TOX EIA were 86.1 and 58.4 %, respectively, whereas the sensitivity and PPV of the GDH EIA and DNA-A test were 100 %. 1.8 % of the GDH tests yielded inconclusive results. Using TGC as the gold standard, nosocomial exposure with emphasis on nursing home residence, history of previous CDI, and female gender were predictive of CDI.Conclusions: Test performance characteristics of the DNA-A test and GDH EIA were superior to those of the traditional TOX EIA. The GDH test is limited by inconclusive test results and requires a multi-step diagnostic algorithm. Therefore, the DNA-A test should be implemented as the diagnostic method of choice for CDI. CDI clinical predictors are important for diagnostic decision-making. [ABSTRACT FROM AUTHOR]- Published
- 2012
7. Book reviews.
- Author
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Harlow MC, Kaempf A, Pinals DA, Nussbaum A, Rakfeldt J, Zdanowicz MT, Barkin JS, Khantzian EJ, Seward G, Hill KP, and Geller JL
- Published
- 2008
8. A practical workup for the patient with anemia.
- Author
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Barkin JS, Green R, Johnson B, and Krantz S
- Abstract
Whether you suspect anemia because of symptoms or discover it on the CBC, a detailed history, thorough physical exam, basic blood analyses, and, in selected patients, fecal occult blood testing are next. The findings lead directly to treatment or further diagnostic investigation. [ABSTRACT FROM AUTHOR]
- Published
- 1998
9. Significance of a dilated pancreatic duct on CT examination
- Author
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Fishman, A, primary, Isikoff, MB, additional, Barkin, JS, additional, and Friedland, JT, additional
- Published
- 1979
- Full Text
- View/download PDF
10. Fluoroscopically guided thin needle aspiration biopsy of the abdomen and retroperitoneum
- Author
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Pereiras, RV, primary, Meiers, W, additional, Kunhardt, B, additional, Troner, M, additional, Hutson, D, additional, Barkin, JS, additional, and Viamonte, M, additional
- Published
- 1978
- Full Text
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11. A sign of symptomatic chronic cholecystitis on biliary scintigraphy
- Author
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Al-Sheikh, W, primary, Hourani, M, additional, Barkin, JS, additional, Clarke, LP, additional, Ashkar, FS, additional, and Serafini, AN, additional
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- 1983
- Full Text
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12. Book reviews. Psychiatry in the scientific image.
- Author
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Barkin JS and Geller JL
- Published
- 2008
13. Meals ready to eat: a brief history and clinical vignette with discussion on civilian applications.
- Author
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Feagans JM, Jahann DA, Barkin JS, Feagans, Jacob M, Jahann, Darius A, and Barkin, Jamie S
- Abstract
Meals ready to eat (MRE) have undergone many revisions of their origins in the trench ration from World War I. The MRE was implemented in 1980. Its design allows extended storage and easy, safe meal preparation. MRE sodium content varies by meal and may range from 1.6 g/meal to 2.3 g/meal. The average MRE contains 1,200 kcal. When consumed as intended, MREs are adequate for maintaining a soldier's physical parameters without undesirable consequences. The average soldier has a healthy cardiovascular system, has the ability to excrete high sodium loads, and has high insensible losses. The American Heart Association recommends limiting sodium to 2.3 g/day for the general population. Additionally, those with heart failure should limit sodium to 2 g/day. Excess intake of calories and electrolytes may lead to adverse outcomes in certain populations. We describe a case of heart failure exacerbated by regular MRE consumption and the "perfect storm" of risk factors encountered with postdisaster distribution of MREs to a civilian population. [ABSTRACT FROM AUTHOR]
- Published
- 2010
- Full Text
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14. Real-World Patient Experience With Pancreatic Enzyme Replacement Therapy in the Treatment of Exocrine Pancreatic Insufficiency.
- Author
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Barkin JA, Harb D, Kort J, and Barkin JS
- Subjects
- Humans, Female, Male, Enzyme Replacement Therapy, Acute Disease, Patient Outcome Assessment, Pancreatitis drug therapy, Exocrine Pancreatic Insufficiency drug therapy, Pancreatic Neoplasms drug therapy
- Abstract
Objectives: This study aimed to provide patients insights on the management of exocrine pancreatic insufficiency (EPI) with pancreatic enzyme replacement therapy (PERT)., Materials and Methods: A survey of 75 members of Inspire's Pancreatitis or Pancreatic Cancer Support communities was conducted. Eligibility included having EPI secondary to chronic pancreatitis, pancreatic cancer, pancreatic surgery, or acute pancreatitis, and current/past PERT experience., Results: Patients were 73% female, 57% aged 50 to 69 years, and 85% White, with PERT prescribed by a gastroenterologist/pancreatologist for 64%. Only approximately half of respondents agreed that their healthcare provider provided detailed information about EPI (54%) or how PERT works to treat EPI (56%). Most respondents (83%) reported searching for information about EPI, 56% were taking PERT solely before or after eating, 36% reported taking suboptimal PERT doses, and 39% reported no follow-up. In addition, 24% decreased their PERT dosage without consulting their physician, and 21% reported purposely skipping PERT., Conclusions: This study reveals potential barriers to effective treatment of EPI with PERT, including lack of patient education, mainly how and when to take PERT, gaps in appropriate dosing, and lack of patient follow-up. Continued focus on patient and provider education is essential to address these gaps and optimize the treatment of EPI., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)
- Published
- 2024
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15. Exocrine Pancreatic Insufficiency Is Common in Celiac Disease: A Systematic Review and Meta-Analysis.
- Author
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Jiang C, Barkin JA, and Barkin JS
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- Male, Humans, Adult, Female, Intestine, Small, Diet, Gluten-Free, Intestinal Mucosa, Celiac Disease complications, Celiac Disease diagnosis, Celiac Disease epidemiology, Exocrine Pancreatic Insufficiency epidemiology, Exocrine Pancreatic Insufficiency etiology, Exocrine Pancreatic Insufficiency diagnosis
- Abstract
The prevalence of celiac disease (CD) is approximately 1% in the US. Studies have shown possible association between exocrine pancreatic insufficiency (EPI) and CD, with numerous hypothesized biological mechanisms including small bowel mucosal damage causing disruption of enteric-mediated hormonal secretion such as cholecystokinin and loss of enterokinase. The overall prevalence of EPI in CD remains unknown. We performed systematic review and metanalysis and examined the prevalence of EPI in patients who were first diagnosed with CD versus those who had been on treatment with gluten-free diet (GFD). Results Six studies were included in the analysis totaling 446 CD patients (Avg age 44.1 years; 34% Males). One hundred and forty-four patients had newly diagnosed CD, and 302 patients had known CD with at least 9 months treatment with GFD. Four studies examined newly diagnosed CD patients. The individual rates of EPI in new CD patients ranged from 10.5 to 46.5%. The pooled prevalence of EPI in newly diagnosed CD patients was 26.2% (95% CI 8.43-43.92%, Q = 2.24, I
2 = 0%). Five studies examined CD patients on GFD. The rate of EPI ranged from 1.9% to 18.2%. The prevalence of EPI in patients treated with GFD is 8% (95% CI 1.52-14.8%, Q = 4.42, I2 = 9.59%). Patients with newly diagnosed CD are significantly more likely to have EPI compared to those patients treated with GFD (p = 0.031). CD patients on GFD with persistent symptoms have a significantly higher rate of EPI (28.4%) compared to CD patients on GFD who are asymptomatic (3%) (p < 0.001)., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)- Published
- 2023
- Full Text
- View/download PDF
16. Association Between Immunosuppressive Therapy and Outcome of Clostridioides difficile Infection: Systematic Review and Meta-Analysis.
- Author
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Li Y, Cai H, Sussman DA, Donet J, Dholaria K, Yang J, Panara A, Croteau R, and Barkin JS
- Subjects
- Adult, Hospitalization, Humans, Immunosuppression Therapy, Risk Factors, Clostridioides difficile, Clostridium Infections complications, Clostridium Infections drug therapy, Clostridium Infections epidemiology
- Abstract
Background: Patients with Clostridioides difficile infection (CDI) often have coexisting medical problems requiring immunosuppressive therapy. However, limited data are available on the association between immunosuppressive therapy and CDI outcomes., Aim: To determine the association between immunosuppressive therapy and CDI outcomes., Methods: PubMed, Embase, and Cochrane Library were searched through February 2021. Two reviewers independently reviewed and included studies that compared adult CDI patients who received immunosuppressive therapy to those who did not. The primary outcome was complicated CDl, including death, surgery, shock, or ICU admission. Raw data or unadjusted odds ratios (ORs) were used to calculate pooled ORs with 95% confidence intervals (CIs)., Results: Twenty-two studies with a total of 5759 CDI patients were selected. Immunosuppressive therapy was significantly associated with both primary outcome and death, with pooled ORs of 1.61 (95% CI 1.33-1.96) and 1.73 (95% CI 1.39-2.15) separately. The association between corticosteroids and primary outcome was also significant with OR of 1.73 (95% CI 1.41, 2.12). In subgroup analysis, the factors explaining differences in study results included study quality, patient age, and whether individual studies had adjusted for potential confounders. In a systematic review, most studies suggested a positive association between immunosuppressive therapy and complicated outcomes of CDI in patients comorbid for IBD., Conclusions: Our systematic review and meta-analysis demonstrate that immunosuppressive therapy is a risk factor for complicated outcomes of CDI., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
- Published
- 2022
- Full Text
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17. Long-Term Consequences of Undiagnosed Celiac Seropositivity.
- Author
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Roldan GA, Vankawala P, and Barkin JS
- Subjects
- Humans, Celiac Disease complications, Celiac Disease diagnosis, Transglutaminases
- Published
- 2021
- Full Text
- View/download PDF
18. Effect of Pancrelipase Therapy on Exocrine Pancreatic Insufficiency Symptoms and Coefficient of Fat Absorption Associated With Chronic Pancreatitis.
- Author
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Barkin JA and Barkin JS
- Subjects
- Abdominal Pain drug therapy, Abdominal Pain physiopathology, Adolescent, Adult, Aged, Defecation drug effects, Exocrine Pancreatic Insufficiency diagnosis, Exocrine Pancreatic Insufficiency metabolism, Exocrine Pancreatic Insufficiency physiopathology, Feces, Female, Flatulence drug therapy, Flatulence physiopathology, Gastrointestinal Agents adverse effects, Humans, Male, Middle Aged, Pancreatitis, Chronic diagnosis, Pancreatitis, Chronic metabolism, Pancreatitis, Chronic physiopathology, Pancrelipase adverse effects, Randomized Controlled Trials as Topic, Time Factors, Treatment Outcome, Young Adult, Exocrine Pancreatic Insufficiency drug therapy, Gastrointestinal Agents therapeutic use, Intestinal Absorption drug effects, Lipid Metabolism drug effects, Pancreatitis, Chronic drug therapy, Pancrelipase therapeutic use
- Abstract
Objective: The aim of this study was to evaluate whether improvement in coefficient of fat absorption (CFA) with pancreatic enzyme replacement therapy correlates with clinical symptoms in patients with chronic pancreatitis with moderate to severe exocrine pancreatic insufficiency., Methods: Data were pooled from 2 randomized double-blind trials of the effects of 1 week of pancrelipase (n = 59) versus placebo (n = 57) on CFA and stool frequency, stool consistency, abdominal pain, and flatulence; 1 trial included a 51-week open-label pancrelipase treatment period (n = 34)., Results: Compared with placebo, significantly more patients receiving pancrelipase reported decreased stool frequency at week 1 (72% vs 38%; P < 0.001). Although 30% of patients receiving pancrelipase and 20% receiving placebo reported improved stool consistency, changes in stool consistency, abdominal pain, and flatulence were not different between groups. Mean CFA absolute change from baseline was significantly greater with pancrelipase versus placebo (24.7% vs 6.4%; P < 0.001). Improvements in stool consistency and frequency correlated with CFA improvement. Symptom improvements persisted or further improved through 52 weeks of treatment., Conclusions: Pancrelipase significantly improved exocrine pancreatic insufficiency maldigestive symptoms. Improvements in objective stool symptoms with pancreatic enzyme replacement therapy correlated with CFA improvement at 1 week., (Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc.)
- Published
- 2021
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19. Eosinophilic Pancreatitis Is a Benign Mimicker of Pancreatic Neoplasm: A Systematic Review.
- Author
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Kuftinec G, Barkin JA, Nemeth Z, and Barkin JS
- Subjects
- Adolescent, Adult, Aged, Diagnosis, Differential, Eosinophilia pathology, Eosinophilia therapy, Female, Humans, Male, Middle Aged, Pancreatic Neoplasms pathology, Pancreatitis pathology, Pancreatitis therapy, Predictive Value of Tests, Prognosis, Young Adult, Eosinophilia diagnosis, Pancreatic Neoplasms diagnosis, Pancreatitis diagnosis
- Published
- 2020
- Full Text
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20. Chronic Pancreatitis and Bone Disease.
- Author
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Barkin JA and Barkin JS
- Subjects
- Bone Density, Bone Density Conservation Agents therapeutic use, Calcium administration & dosage, Calcium metabolism, Dietary Supplements, Enzyme Replacement Therapy, Humans, Osteoporosis drug therapy, Osteoporosis epidemiology, Osteoporosis physiopathology, Osteoporotic Fractures etiology, Pancreatitis, Chronic drug therapy, Pancreatitis, Chronic physiopathology, Prevalence, Risk Factors, Vitamin D administration & dosage, Vitamin D metabolism, Vitamin D Deficiency complications, Vitamin D Deficiency epidemiology, Osteoporosis etiology, Pancreatitis, Chronic complications
- Abstract
Patients with chronic pancreatitis (CP) may have a higher prevalence of osteoporosis than the general population thereby increasing the risk of bone fracture. The pathophysiology of bone disease in CP is multifactorial. Their risk factors for secondary osteoporosis include increasing age, low body mass index from sitophobia, maldigestion due to exocrine pancreatic insufficiency (EPI) with resulting low vitamin D, as well as smoking and alcohol abuse. An obvious association of bone disease with CP is from EPI with maldigestion of fat-soluble vitamins including vitamin-D, which has a significant role in the process of bone formation. Vitamin-D deficiency may be higher in CP patients vs controls, and it is especially so in CP patients with EPI. Screening for CP-associated osteopathy, including osteopenia and osteoporosis, should be initiated early in the course of CP, as the overall prevalence of bone disease is approximately two-thirds of CP patients. Our initial approach in the treatment of osteoporosis should include correction of maldigestion resulting from EPI with use of pancreatic enzyme replacement therapy (PERT). PERT, which is the treatment for EPI is associated with improvement in Dual energy X-ray absorptiometry (DXA) values and vitamin-D levels compared to those who are not treated. This should improve, in addition to body mass index, vitamin-D deficiency and calcium absorption as well as improve overall nutritional status. Osteopathy is common in CP patients, has significant associated morbidity, should be screened for regularly, and corrected with fat soluble vitamin supplementation and PERT to prevent clinical sequelae. In this article, we review the epidemiology, pathophysiology, and treatment of bone disease in patients with CP., (Copyright © 2019 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.)
- Published
- 2020
- Full Text
- View/download PDF
21. Postcholecystectomy Biliary Clip Migration Causing Acute Pancreatitis.
- Author
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Panara A, Barkin JA, and Barkin JS
- Abstract
Postcholecystectomy biliary clip migration is a rare but important cause of acute pancreatitis (AP). We report the case of a patient with laparoscopic cholecystectomy for cholelithiasis with cholecystitis and recurrent AP 15 and 19 months after. Imaging findings were suggestive of biliary clip migration. Suspected mechanisms for endoclip migration-induced AP include migration of the clip at a site of dehiscence and migration. When considering this diagnosis, a plain radiograph may be helpful as a comparison to previous imaging to assess for changes in the number of endoclips present, and proper diagnosis can help lead to appropriate management., (© 2019 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology.)
- Published
- 2019
- Full Text
- View/download PDF
22. An update on IgG4-related lung disease.
- Author
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Morales AT, Cignarella AG, Jabeen IS, Barkin JS, and Mirsaeidi M
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- Adrenal Cortex Hormones therapeutic use, Biomarkers, Biopsy, Diagnosis, Differential, Humans, Immunoglobulin G4-Related Disease drug therapy, Lung Diseases drug therapy, Tomography, X-Ray Computed, Immunoglobulin G immunology, Immunoglobulin G4-Related Disease diagnosis, Lung pathology, Lung Diseases diagnosis
- Abstract
IgG4-related disease (IgG4-RD) is an autoimmune disorder characterized by substantial infiltration of plasma cells with IgG4 in target organs. Lung manifestations predominantly present as inflammatory pseudotumor, interstitial pneumonitis, organizing pneumonia, and lymphomatoid granulomatosis. There is no specific diagnostic test for IgG4-related lung disease (IgG4-RLD), and excluding diseases that mimic IgG4-RLD is important. Corticosteroids with or without disease-modifying anti-rheumatic drugs are recommended for treatment. The long-term prognosis of IgG4-RLD remains unknown. In this review, we summarized the current diagnostic algorithms and discussed potential biomarkers for future investigation., (Published by Elsevier B.V.)
- Published
- 2019
- Full Text
- View/download PDF
23. Frequency of Appropriate Use of Pancreatic Enzyme Replacement Therapy and Symptomatic Response in Pancreatic Cancer Patients.
- Author
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Barkin JA, Westermann A, Hoos W, Moravek C, Matrisian L, Wang H, Shemanski L, Barkin JS, and Rahib L
- Subjects
- Adult, Aged, Aged, 80 and over, Exocrine Pancreatic Insufficiency complications, Exocrine Pancreatic Insufficiency diagnosis, Female, Humans, Male, Middle Aged, Pancreas enzymology, Pancreas pathology, Pancreatic Neoplasms complications, Pancreatic Neoplasms diagnosis, Pancrelipase administration & dosage, Retrospective Studies, Surveys and Questionnaires, Treatment Outcome, Young Adult, Enzyme Replacement Therapy methods, Exocrine Pancreatic Insufficiency drug therapy, Pancreas drug effects, Pancreatic Neoplasms drug therapy, Pancrelipase therapeutic use
- Abstract
Objectives: Pancreatic cancer (PC) and its treatments can result in pancreatic exocrine insufficiency that requires pancreatic enzyme replacement therapy (PERT). Appropriate PERT usage is during meals and snacks. The aim was to determine the frequency of appropriate use of PERT and its impact on symptom alleviation in PC through a patient-reported outcomes online platform., Methods: Users in the Pancreatic Cancer Action Network's Patient Registry were prompted to answer a standalone questionnaire about their experience with PERT., Results: Two hundred sixty-two users completed the PERT questionnaire (January 2016-January 2018). Patients who reported taking PERT with meals had higher alleviation of symptoms compared with those taking PERT prior to or after meals. Specifically, "feeling of indigestion," "light-colored or orange stools," and "visible food particles in stool" were significantly decreased. Patients taking PERT with meals reported weight gain and less weight loss., Conclusions: Of the 89% of PC patients prescribed PERT, 65% were prescribed PERT appropriately with all meals and snacks. Overall compliance with PERT administration guidelines was low (50% [105/208]). Improvement in symptoms significantly correlated with appropriate use of PERT. Increase in PC patient and provider education about appropriate PERT usage and administration is warranted.
- Published
- 2019
- Full Text
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24. Are Triglycerides the Cause or Simply the Effect of Worsening Acute Pancreatitis Severity?
- Author
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Leone PJ, Barkin JA, and Barkin JS
- Subjects
- Acute Disease, Humans, Prognosis, Severity of Illness Index, Triglycerides, Hypertriglyceridemia
- Published
- 2019
- Full Text
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25. The Impact of Cannabis Consumption on Mortality, Morbidity, and Cost in Acute Pancreatitis Patients in the United States: A 10-Year Analysis of the National Inpatient Sample.
- Author
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Simons-Linares CR, Barkin JA, Jang S, Bhatt A, Lopez R, Stevens T, Vargo J, Barkin JS, and Chahal P
- Subjects
- Acute Disease, Adult, Comorbidity, Female, Hospitalization statistics & numerical data, Humans, Length of Stay statistics & numerical data, Male, Middle Aged, Pancreatitis mortality, Prevalence, United States epidemiology, Cannabis, Hospital Costs statistics & numerical data, Hospital Mortality, Inpatients statistics & numerical data, Marijuana Smoking epidemiology, Pancreatitis epidemiology
- Abstract
Objectives: The aim of this study was to identify the prevalence of cannabis use among all patients admitted with acute pancreatitis (AP) in the United States and to investigate the impact of cannabis use on AP mortality, morbidity, and cost of care., Methods: The National Inpatient Sample database from 2003 to 2013 was queried for all patients with AP and active exposure to cannabis. Outcomes included in-hospital mortality, length of stay, inflation adjusted charges, acute kidney injury, acute respiratory distress syndrome, and shock. Results were adjusted for age, sex, race, Charlson comorbidity index, median income quartile, and hospital characteristics., Results: More than 2.8 million patients with AP patients were analyzed. Cannabis-exposed (CE) patients' prevalence was 0.3%. Patients exposed to cannabis were younger and mostly males compared with non-cannabis-exposed patients. After adjusting for these factors, the CE group had significantly lower inpatient mortality compared with the noncannabis group (odds ratio, 0.17; 95% confidence interval, 0.06-0.53). Cannabis-exposed patients also had decreased length of stay, inflation-adjusted charges, acute kidney injury, ileus, shock, acute respiratory distress syndrome, and parenteral nutrition requirement., Conclusions: Cannabis-exposed hospitalized patients with AP had lower age-adjusted, mortality, morbidity, and hospitalization-cost than non-cannabis-exposed patients.
- Published
- 2019
- Full Text
- View/download PDF
26. Natural History of Spontaneous Rupture of a Pancreatic Pseudocyst Into the Peritoneal Cavity and Its Minimal Noninvasive Management.
- Author
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Diaz LI, Li Y, and Barkin JS
- Subjects
- Adenocarcinoma diagnostic imaging, Aged, 80 and over, Humans, Male, Pancreatic Cyst diagnostic imaging, Pancreatic Neoplasms diagnostic imaging, Pancreatic Pseudocyst diagnostic imaging, Rupture, Spontaneous, Tomography, X-Ray Computed methods, Drainage methods, Pancreatic Cyst surgery, Pancreatic Pseudocyst surgery, Peritoneal Cavity pathology
- Published
- 2019
- Full Text
- View/download PDF
27. Preferential usage of rifaximin for the treatment of hydrogen-positive smallintestinal bacterial overgrowth.
- Author
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Barkin JA, Keihanian T, Barkin JS, Antequera CM, and Moshiree B
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Bacterial Infections diagnosis, Bacterial Infections metabolism, Breath Tests, Female, Humans, Hydrogen analysis, Hydrogen metabolism, Male, Methane analysis, Methane metabolism, Middle Aged, Retrospective Studies, Treatment Outcome, Young Adult, Anti-Bacterial Agents therapeutic use, Bacterial Infections drug therapy, Intestine, Small microbiology, Rifaximin therapeutic use
- Abstract
Objectives: Small intestinal bacterial overgrowth (SIBO) is challenging to treat and diagnose and is associated with diagnosis of irritable bowel syndrome (IBS). Although no FDA-approved medications exist for treatment of SIBO, rifaximin has recently received approval to treat diarrhea-predominant IBS and patients with methane-positive SIBO breath tests. The aim of this study is to evaluate patient response to rifaximin for SIBO based on breath test results., Materials and Methods: All patients underwent breath testing to evaluate for SIBO during a 42-month period. Patients were defined as having a positive glucose breath test for SIBO based on an increase of ≥ 20 ppm of hydrogen and/or ≥ 10 ppm of methane 90 minutes after ingesting glucose. Patient demographic and symptom data, antibiotic treatment regimens, symptomatic response to therapy, and repeat treatments were recorded. Institutional review board approval was obtained., Results: A total of 53 of 443 patients had positive breath testing for SIBO. Response rates to rifaximin (550 mg three times daily for 14 days) were 47.4% for hydrogen positivity alone and 80% for both hydrogen and methane positivity., Conclusions: Rifaximin was the most commonly prescribed antibiotic regimen for SIBO therapy. Patients with hydrogen or hydrogen and methane positive breath tests responded well to rifaximin therapy. For patients with hydrogen-positive SIBO, rifaximin may prove a highly effective therapy in providing symptom relief from the effects of SIBO.
- Published
- 2019
28. Statin Use Shows Increased Overall Survival in Patients Diagnosed With Pancreatic Cancer: A Meta-Analysis.
- Author
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Wang D, Rodriguez EA, Barkin JS, Donath EM, and Pakravan AS
- Subjects
- Adenocarcinoma diagnosis, Aged, Female, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors administration & dosage, Male, Middle Aged, Outcome Assessment, Health Care methods, Outcome Assessment, Health Care statistics & numerical data, Pancreatic Neoplasms diagnosis, Retrospective Studies, Survival Analysis, Adenocarcinoma drug therapy, Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use, Pancreatic Neoplasms drug therapy
- Published
- 2019
- Full Text
- View/download PDF
29. Is It Acute Pancreatitis or Recurrent Acute Pancreatitis Leading to Chronic Pancreatitis that Increases Pancreatic Cancer Risk?
- Author
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Barkin JA, Freeman ML, and Barkin JS
- Subjects
- Acute Disease, Humans, Pancreas, Pancreatic Neoplasms, Pancreatitis, Recurrence, Neoplasm Recurrence, Local, Pancreatitis, Chronic
- Published
- 2018
- Full Text
- View/download PDF
30. Is There an Effect of Cannabis Consumption on Acute Pancreatitis?
- Author
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Simons-Linares CR, Barkin JA, Wang Y, Jaiswal P, Trick W, Bartel MJ, and Barkin JS
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Chicago epidemiology, Female, Humans, Male, Middle Aged, Pancreatitis mortality, Retrospective Studies, Young Adult, Cannabis, Pancreatitis etiology
- Abstract
Background and Aim: Twenty-percentage of acute pancreatitis (AP) cases is labeled as idiopathic. Cannabis remains the most frequently used illicit drug in the world. The aim of this study was to identify the prevalence of cannabis use among all patients with a first episode of AP, particularly in those labeled as idiopathic etiology, and determine any effect on AP severity., Methods: Retrospective cohort of all consecutive patients admitted with a first episode of AP at a large tertiary referral hospital from 01/2013 through 12/2014. AP was identified by ICD9 code, or lipase ≥ 3 times the upper limit of normal and abdominal pain consistent with AP. Cannabis users (CU) were identified via history or urine toxicology., Results: Four hundred and sixty patients were included. 54% were men, with a mean age of 48 years (range 17-89 years). Forty-eight patients (10%) were identified as CU. After adjusting for admission SIRS, age, and gender, cannabis use was not found to be an independent risk factor for persistent SIRS, AKI, ARDS, pancreatic necrosis, mortality, ICU admission, length of stay, in-hospital infections, nor recurrent AP. Of note, AKI was least common among non-CU compared to CU (OR 0.4; p = 0.02; CI 0.2-0.9) and non-CU had a higher admission BISAP score (≥ 2) compared to CU (OR 2.5; p = 0.009; CI 1.2-4.9)., Conclusion: This is the largest study to date examining cannabis use in AP. Cannabis use was found across almost all etiologies of AP with a prevalence of 10% (48 cases), and in 9% (9 cases) of so-called idiopathic AP cases in this cohort, which could account as an association for approximately 2% of all AP cases. Cannabis use did not independently impact AP severity or mortality.
- Published
- 2018
- Full Text
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31. Pancreatic Pseudocysts and Parenchymal Necrosis in Patients With Autoimmune Pancreatitis: A Systematic Review.
- Author
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Donet JA, Barkin JA, Keihanian T, Nemeth Z, and Barkin JS
- Subjects
- Autoimmune Diseases complications, Humans, Necrosis, Pancreatic Pseudocyst complications, Pancreatic Pseudocyst drug therapy, Pancreatitis complications, Risk Assessment methods, Risk Assessment statistics & numerical data, Risk Factors, Steroids therapeutic use, Autoimmune Diseases pathology, Pancreas pathology, Pancreatic Pseudocyst pathology, Pancreatitis pathology
- Abstract
Objective: To investigate the prevalence and natural history of pancreatic pseudocysts (PCs) and parenchymal necrosis in autoimmune pancreatitis (AIP)., Method: A search using PubMed, Embase, Scopus, and Cochrane was performed. Search terms were AIP, PC, acute fluid collection, and pancreatic necrosis., Results: Fifteen studies with 17 patients were included. In 8 of 17 patients, PC was noted concurrently with the AIP diagnosis, whereas in the other half, PC appeared months or years after. In 10 of 17 cases, PC appeared as solitary. The location was variable. Pseudocysts were small (<3 cm) in 4 cases and large (>3 cm) in 13 cases. A normal pancreatic duct was observed in 6 of 17 cases, whereas 9 of 17 had pancreatic duct stenosis. Steroids were given to 4 of 4 small and 10 of 13 large PC. All small PC resolved with steroids, whereas only 4 of 10 large PC treated had some response. Most (9/13) of large PC underwent endoscopic or surgical procedures. None of the 17 cases developed necrosis., Conclusions: Pseudocysts in AIP are rare. Pancreatic pseudocyst can present in variable number, size, and location. Small PC resolved with steroids. Large PC had poor response to steroids requiring invasive interventions. Necrosis in AIP has not been reported.
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- 2018
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32. Reply.
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Barkin JA and Barkin JS
- Published
- 2018
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33. Randomised controlled trial of long-term maintenance corticosteroid therapy in patients with autoimmune pancreatitis.
- Author
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Goyal J, Barkin JA, and Barkin JS
- Subjects
- Autoimmune Diseases, Glucocorticoids, Humans, Adrenal Cortex Hormones, Pancreatitis
- Abstract
Competing Interests: Competing interests: None declared.
- Published
- 2018
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34. Increasing Incidence of Multiply Recurrent Clostridium difficile Infection.
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Barkin JA, Stollman N, and Barkin JS
- Subjects
- Cohort Studies, Humans, Incidence, United States, Clostridioides difficile, Clostridium Infections
- Published
- 2018
- Full Text
- View/download PDF
35. Pancreatocolonic fistulization secondary to pancreatic adenocarcinoma presenting as unexplained halitosis.
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Manov J, Langston M, Roth P, Barkin J, Kuker R, and Barkin JS
- Abstract
Pancreatic cancer is often detected in late stages, which contributes to its grim prognosis. Although the manifestations of pancreatic cancer most often include nonspecific gastrointestinal complaints, we report a case with the sole initial complaint of halitosis and subsequent diagnostic workup demonstrating a pancreatic mass with secondary pancreatocolonic fistulization. The etiologies of and the radiological findings pertaining to halitosis, the presenting symptoms and imaging studies relevant to the diagnosis of pancreatic cancer, and the imaging and clinical findings of pancreatic fistulization are discussed.
- Published
- 2017
- Full Text
- View/download PDF
36. Safety of Eluxadoline in Patients With Irritable Bowel Syndrome.
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Croteau R and Barkin JS
- Subjects
- Diarrhea, Humans, Imidazoles, Phenylalanine analogs & derivatives, Irritable Bowel Syndrome
- Published
- 2017
- Full Text
- View/download PDF
37. Cannabis-Induced Acute Pancreatitis: A Systematic Review.
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Barkin JA, Nemeth Z, Saluja AK, and Barkin JS
- Subjects
- Acute Disease, Adolescent, Adult, Cannabis, Female, Humans, Male, Pancreatitis chemically induced, Risk Factors, Young Adult, Pancreatitis diagnosis, Pancreatitis prevention & control
- Abstract
Objectives: Cannabis is the most frequently consumed illicit drug in the world, with higher prevalence under the age of 35 years. Cannabis was first reported as a possible cause of acute pancreatitis (AP) in 2004. The aim of this systematic review is to examine cannabis use as an etiology of AP., Methods: A search using PubMed/Medline, Embase, Scopus, and Cochrane was performed without language or year limitations to May 1, 2016. Search terms were "Cannabis" and "Acute Pancreatitis" with all permutations. The search yielded 239 results. Acute pancreatitis was defined by meeting 2 of 3 Revised Atlanta Classification criteria. Cannabis-induced AP was defined by preceding use of cannabis and exclusion of common causes of AP when reported. Sixteen papers met inclusion criteria dating from 2004 to 2016., Results: There were 26 cases of cannabis-induced AP (23/26 men; 24/26 under the age of 35 y). Acute pancreatitis correlated with increased cannabis use in 18 patients. Recurrent AP related temporally to cannabis use was reported in 15 of 26. There are 13 reports of no further AP episodes after cannabis cessation., Conclusions: Cannabis is a possible risk factor for AP and recurrent AP, occurring primarily in young patients under the age of 35 years. Toxicology screens should be considered in all patients with idiopathic AP.
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- 2017
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38. Periprocedural Intravenous Fluid Administration for the Prevention of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis.
- Author
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Barkin JA and Barkin JS
- Subjects
- Administration, Intravenous, Fluid Therapy, Humans, Infusions, Intravenous, Cholangiopancreatography, Endoscopic Retrograde, Pancreatitis prevention & control
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- 2017
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39. Pancreatic Cysts: Controversies, Advances, Diagnoses, and Therapies.
- Author
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Barkin JA and Barkin JS
- Subjects
- Biomarkers, Tumor analysis, Biomarkers, Tumor genetics, Clinical Decision-Making, Diagnosis, Differential, Humans, Molecular Diagnostic Techniques, Neoplasms, Cystic, Mucinous, and Serous pathology, Neoplasms, Cystic, Mucinous, and Serous surgery, Pancreatic Cyst pathology, Pancreatic Cyst surgery, Pancreatic Ducts pathology, Pancreatic Neoplasms pathology, Pancreatic Neoplasms surgery, Practice Guidelines as Topic, Predictive Value of Tests, Reproducibility of Results, Risk Factors, Surgical Clearance, Endoscopic Ultrasound-Guided Fine Needle Aspiration standards, Incidental Findings, Neoplasms, Cystic, Mucinous, and Serous diagnosis, Pancreatic Cyst diagnosis, Pancreatic Neoplasms diagnosis
- Abstract
Pancreatic cysts are commonly found on cross-sectional imaging. The question arises in determining which lesions are premalignant or malignant and may require further testing, intervention, or follow-up. In pancreatic cysts without obvious malignancy on imaging, we approach them using the Four "S" Criteria. These are (1) symptoms that may be originating from the pancreatic cyst; (2) size of the cyst 2 cm or larger and/or main pancreatic duct greater than 5 mm; (3) survival of the patient, based on comorbidity index to determine surgical fitness; and then endoscopic ultrasound with fine needle aspiration (FNA) recommended to determine (4) solid component presence in the cyst, namely, nodule or thick walls, as well as to perform FNA to obtain cyst content. Current cyst fluid analysis options include use of cytology to determine presence of malignancy and carcinoembryonic antigen and fluid genetics to identify potentially premalignant lesions. The aims of this article are to explore current management guidelines for pancreatic cysts, present a comprehensive approach to pancreatic cysts, and explain the advantages and disadvantages of each option for evaluation of pancreatic cysts including endoscopic ultrasound with FNA with cyst fluid analysis using an evidence-based approach.
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- 2017
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- View/download PDF
40. Indomethacin and Short-Duration Intravenous Hydration as a More Feasible Regimen for Risk Reduction of Post-endoscopic Retrograde Cholangiopancreatography Pancreatitis.
- Author
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Barkin JA and Barkin JS
- Subjects
- Anti-Inflammatory Agents, Non-Steroidal, Humans, Indomethacin, Ringer's Lactate, Risk Reduction Behavior, Cholangiopancreatography, Endoscopic Retrograde, Pancreatitis
- Published
- 2017
- Full Text
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41. Assessment of Pancreas Safety in the Development Program of Once-Weekly GLP-1 Receptor Agonist Dulaglutide.
- Author
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Nauck MA, Frossard JL, Barkin JS, Anglin G, Hensley IE, Harper KD, and Milicevic Z
- Subjects
- Acute Disease, Diabetes Mellitus, Type 2 drug therapy, Exenatide, Female, Glucagon-Like Peptides adverse effects, Glucagon-Like Peptides therapeutic use, Humans, Insulin Glargine adverse effects, Insulin Glargine therapeutic use, Male, Metformin adverse effects, Metformin therapeutic use, Middle Aged, Peptides adverse effects, Peptides therapeutic use, Sitagliptin Phosphate adverse effects, Sitagliptin Phosphate therapeutic use, Venoms adverse effects, Venoms therapeutic use, Glucagon-Like Peptide-1 Receptor agonists, Glucagon-Like Peptides analogs & derivatives, Hypoglycemic Agents adverse effects, Hypoglycemic Agents therapeutic use, Immunoglobulin Fc Fragments adverse effects, Immunoglobulin Fc Fragments therapeutic use, Pancreatitis chemically induced, Recombinant Fusion Proteins adverse effects, Recombinant Fusion Proteins therapeutic use
- Abstract
Objective: To assess the risk of acute pancreatitis during treatment with glucagon-like peptide 1 receptor agonist dulaglutide, placebo, and active comparators across phase 2/3 dulaglutide trials., Research Design and Methods: A total of 6,005 patients with type 2 diabetes participated (dulaglutide group N = 4,006 [dose range 0.1-3.0 mg]; active comparator group [metformin, sitagliptin, exenatide twice daily, insulin glargine] N = 1,541; placebo group N = 703; 245 placebo-treated patients subsequently received dulaglutide or sitagliptin and were also included in these groups) for up to 104 weeks. The following events were adjudicated: investigator-reported pancreatitis, adverse events (AEs) of severe or serious abdominal pain of unknown etiology, and confirmed asymptomatic increases in pancreatic enzymes ≥3× the upper limit of normal range., Results: Overall, 203 events from 151 patients underwent adjudication (dulaglutide group n = 108; comparator group including placebo n = 43). Acute pancreatitis was confirmed by adjudication in seven patients (dulaglutide n = 3, placebo n = 1, sitagliptin n = 3). Exposure-adjusted incidence rates were as follows: dulaglutide group 0.85 patients/1,000 patient-years, placebo group 3.52 patients/1,000 patient-years, sitagliptin group 4.71 patients/1,000 patient-years. No events of pancreatitis were confirmed by adjudication in patients treated with exenatide twice daily, metformin, or glargine. Increases in median values of lipase and pancreatic amylase within the normal range were observed with all treatments except glargine. These changes were not associated with AEs., Conclusions: The exposure-adjusted incidence rate of acute pancreatitis in dulaglutide-treated patients was similar to the rates with placebo, with few reported cases during the entire program., (© 2017 by the American Diabetes Association.)
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- 2017
- Full Text
- View/download PDF
42. Clostridium difficile Infection and Patient-Specific Antimicrobial Resistance Testing Reveals a High Metronidazole Resistance Rate.
- Author
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Barkin JA, Sussman DA, Fifadara N, and Barkin JS
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Anti-Infective Agents pharmacology, Child, Child, Preschool, Clostridioides difficile isolation & purification, Clostridium Infections diagnosis, Drug Resistance, Microbial physiology, Feces microbiology, Female, Humans, Infant, Male, Metronidazole pharmacology, Middle Aged, United States epidemiology, Young Adult, Anti-Infective Agents therapeutic use, Clostridioides difficile drug effects, Clostridium Infections drug therapy, Clostridium Infections epidemiology, Drug Resistance, Microbial drug effects, Metronidazole therapeutic use
- Abstract
Background: Clostridium difficile (CD) infection (CDI) causes marked morbidity and mortality, accounting for large healthcare expenditures annually. Current CDI treatment guidelines focus on clinical markers of patient severity to determine the preferred antibiotic regimen of metronidazole versus vancomycin. The antimicrobial resistance patterns for patients with CD are currently unknown., Aim: The aim of this study was to define the antimicrobial resistance patterns for CD., Methods: This study included all patients with stools sent for CD testing to a private laboratory (DRG Laboratory, Alpharetta, Georgia) in a 6-month period from across the USA. Patient data was de-identified, with only age, gender, and zip-code available per laboratory protocol. All samples underwent PCR testing followed by hybridization for CD toxin regions A and B. Only patients with CD-positive PCR were analyzed. Antimicrobial resistance testing using stool genomic DNA evaluated presence of imidazole- and vancomycin-resistant genes using multiplex PCR gene detection., Results: Of 2743, 288 (10.5%) stool samples were positive for CD. Six were excluded per protocol. Of 282, 193 (69.4%) were women, and average age was 49.4 ± 18.7 years. Of 282, 62 were PCR positive for toxins A and B, 160 for toxin A positive alone, and 60 for toxin B positive alone. Antimicrobial resistance testing revealed 134/282 (47.5%) patients resistant to imidazole, 17 (6.1%) resistant to vancomycin, and 9 (3.2%) resistant to imidazole and vancomycin., Conclusions: CD-positive patients with presence of imidazole-resistant genes from stool DNA extract was a common phenomenon, while vancomycin resistance was uncommon. Similar to treatment of other infections, antimicrobial resistance testing should play a role in CDI clinical decision-making algorithms to enable more expedited and cost-effective delivery of patient care.
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- 2017
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43. Rectal indomethacin should be used routinely in all patients for prevention of post-ERCP pancreatitis.
- Author
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Barkin JA, Souto EO, and Barkin JS
- Subjects
- Administration, Rectal, Anti-Inflammatory Agents, Non-Steroidal, Cholangiopancreatography, Endoscopic Retrograde, Humans, Indomethacin, Pancreatitis
- Published
- 2017
- Full Text
- View/download PDF
44. Presence of small pancreatic cystic lesions should not preclude liver transplantation.
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Barkin JA and Barkin JS
- Subjects
- Humans, Pancreatic Neoplasms, Liver Transplantation, Pancreatic Cyst
- Published
- 2017
- Full Text
- View/download PDF
45. Total Pancreatectomy With Islet Autotransplantation Improves Quality of Life in Patients With Refractory Recurrent Acute Pancreatitis.
- Author
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Panara AJ, Barkin JA, and Barkin JS
- Subjects
- Humans, Pancreatitis, Chronic surgery, Quality of Life, Surveys and Questionnaires, Pancreatectomy, Transplantation, Autologous
- Published
- 2017
- Full Text
- View/download PDF
46. Serum Amyloid A as a Surrogate Marker for Mucosal and Histologic Inflammation in Patients with Crohn's Disease.
- Author
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Yarur AJ, Quintero MA, Jain A, Czul F, Barkin JS, and Abreu MT
- Subjects
- Adult, Biomarkers blood, C-Reactive Protein analysis, Colonoscopy, Crohn Disease pathology, Cross-Sectional Studies, Female, Humans, Inflammation blood, Inflammation pathology, Male, Middle Aged, Phenotype, Predictive Value of Tests, Prospective Studies, ROC Curve, Sensitivity and Specificity, Young Adult, Crohn Disease blood, Intestinal Mucosa pathology, Serum Amyloid A Protein analysis, Severity of Illness Index
- Abstract
Background: Serum amyloid A (SAA) is an acute-phase protein, but its role as a biomarker of disease activity in Crohn's disease is unclear. The aim of the study was to assess the correlation between SAA, inflammatory cytokines, and mucosal inflammation in patients with Crohn's disease and to investigate whether this marker might be useful in patients who do not have elevated C-reactive protein (CRP) levels despite having active disease., Methods: Cross-sectional study including patients with Crohn's disease who underwent colonoscopies for assessment of disease activity. Predictive variables were recorded at the time of the procedure and included demographics, phenotype of disease, medications, and collection of serum for cytokine analysis (SAA, CRP, intercellular adhesion molecule-1, vascular cell adhesion molecule-1, and interleukins 8, 1β, and 6). The primary outcome was the presence of mucosal healing (MH) (absence of macroscopic and microscopic inflammation)., Results: Ninety-four patients were included. Sixty-eight (72.3%) had not achieved MH. SAA, CRP, intercellular adhesion molecule, and interleukin-6 levels were significantly lower in those patients with MH. SAA was the only test that performed well in the sensitivity/specificity analysis (receiver operating characteristic: 0.81, P = 0.046). A high SAA was able to identify 70% of the patients with a normal CRP but active inflammation., Conclusions: High circulating SAA levels can correlate with lack of MH and may be used as a surrogate marker for disease activity, even in those patients in whom CRP levels do not correlate with disease activity.
- Published
- 2017
- Full Text
- View/download PDF
47. Indomethacin to Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis: When and How?
- Author
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George J, Saluja AK, and Barkin JS
- Subjects
- Anti-Inflammatory Agents, Non-Steroidal, Humans, Pancreatitis, Cholangiopancreatography, Endoscopic Retrograde, Indomethacin
- Published
- 2017
- Full Text
- View/download PDF
48. Video Capsule Endoscopy: Technology, Reading, and Troubleshooting.
- Author
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Barkin JA and Barkin JS
- Subjects
- Humans, Intestine, Small diagnostic imaging, Capsule Endoscopes, Capsule Endoscopy, Gastrointestinal Tract
- Abstract
Video capsule endoscopy (VCE) has completed the endoscopic visualization of the entire luminal gastrointestinal tract. VCE can be performed in inpatients and outpatients, requires appropriate bowel preparation before the study, and can be administered via oral swallowing or endoscopic device placement into the small bowel based on outlined patient-dependent factors. Current commercially available VCE systems were reviewed and compared for individual features and attributes. This article focuses on preparation for VCE, currently available VCE technology, how to read a VCE study, and risks and contraindications to VCE., (Copyright © 2016 Elsevier Inc. All rights reserved.)
- Published
- 2017
- Full Text
- View/download PDF
49. Gastric Enterovirus Infection: A Possible Causative Etiology of Gastroparesis.
- Author
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Barkin JA, Czul F, Barkin JS, Klimas NG, Rey IR, and Moshiree B
- Subjects
- 2-Aminopurine analogs & derivatives, 2-Aminopurine therapeutic use, Adult, Aged, Antiviral Agents therapeutic use, Biopsy, Enterovirus Infections pathology, Enterovirus Infections therapy, Famciclovir, Female, Gastritis pathology, Gastritis therapy, Gastroesophageal Reflux epidemiology, Gastroparesis therapy, Gastroparesis virology, Humans, Immunoglobulins, Intravenous therapeutic use, Immunologic Factors therapeutic use, Inosine Pranobex therapeutic use, Male, Middle Aged, Postural Orthostatic Tachycardia Syndrome epidemiology, Ribavirin therapeutic use, Stomach pathology, Young Adult, Enterovirus Infections epidemiology, Gastritis epidemiology, Gastroparesis epidemiology
- Abstract
Background: Gastroparesis (GP) is a disabling chronic gastroenterologic disorder with high morbidity that severely impacts patients' quality of life. GP can present acutely after a viral-like gastrointestinal illness resulting in speculation that in some patients, neurologic damage caused by the infection might underlie the pathogenesis of idiopathic gastroparesis (IGP)., Aims: The aim of this study is to document case reports of Enterovirus (EV) infection as a possible cause of IGP., Methods: Eleven patients referred with a diagnosis of GP underwent workup to exclude known causes of GP. Those with a history of flu-like symptoms or gastroenteritis prior to onset of GP symptoms had gastric biopsies taken during upper endoscopy to assess for the presence of gastric mucosal EV infection. Data on presenting symptoms, extra-intestinal symptoms and conditions, prior nutritional support requirements, upper endoscopy findings, and response to therapy were cataloged., Results: Eleven patients were diagnosed as IGP. Nine had active EV infection on gastric biopsies and were included (7/9 female, mean age 43 years). Eight out of nine received EV treatment with antivirals and/or immune therapies, with a wide degree of variability in treatment regimens. Four out of eight who received EV treatment had symptomatic improvement. One patient had stable symptoms. Three patients are currently undergoing therapy., Conclusions: Gastric EV infection was frequently detected (82 %) in patients undergoing investigation for IGP. Antiviral and/or immune therapies against EV seem to be favorable, as most of our patients had resolution of their GP symptoms after treatment. This is the first study to identify EV as a possible infectious etiology of IGP.
- Published
- 2016
- Full Text
- View/download PDF
50. Comparison of Performance Characteristics of Oval Cup Forceps Versus Serrated Jaw Forceps in Gastric Biopsy.
- Author
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Sussman DA, Deshpande AR, Shankar U, Barkin JA, Medina AM, Poppiti RJ, Cubeddu LX, and Barkin JS
- Subjects
- Biopsy methods, Endoscopy, Digestive System, Humans, Single-Blind Method, Biopsy instrumentation, Equipment Design, Gastric Mucosa pathology, Stomach pathology, Stomach Diseases pathology, Surgical Instruments
- Abstract
Background: Obtaining quality endoscopic biopsy specimens is vital in making successful histological diagnoses. The influence of forceps cup shape and size on quality of biopsy specimens is unclear., Aim: To identify whether oval cup or two different serrated jaw biopsy forceps could obtain specimens of superior size. Secondary endpoints were tissue adequacy, depth of tissue acquisition, and crush artifact., Methods: A single-center, prospective, pathologist-masked, randomized controlled trial was performed. In total 136 patients with a clinical indication for esophagogastroduodenoscopy with biopsy were randomized to receive serial biopsies with a large-capacity serrated forceps with jaw diameter 2.2 mm (SER1) and either a large-capacity oval forceps with jaw diameter 2.4 mm (OVL) or large-capacity serrated biopsy forceps with jaw diameter 2.4 mm (SER2) in two parallel groups., Results: SER2 provided significantly larger specimens than did the other forceps (SER2 3.26 ± 1.09 vs. SER1 2.92 ± 0.88 vs. OVL 2.92 ± 0.76; p = 0.026), with an average size difference of 0.34 mm greater with SER2 compared to SER1 and OVL. OVL provided significantly deeper biopsies compared to SER1 and SER2 (p = 0.02), with 31 % of OVL biopsies reaching the submucosa. SER2 had significantly less crush artifact than SER1 and OVL (p < 0.0001)., Conclusion: Serrated forceps provided larger samples compared to oval jaw forceps of the same size, with SER2 providing the largest specimen size. Oval cup forceps had deeper penetration of epithelium, while the larger jaw diameter serrated jaw forceps had less crush artifact. All three forceps provided specimens adequate for diagnostic purposes.
- Published
- 2016
- Full Text
- View/download PDF
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