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In Poland, drotaverine is the most frequently purchased antispasmodic, yet there is a paucity of real-world data on its use. We evaluated the profiles of patients who used drotaverine, and we investigated prescription patterns among general practitioners (GPs). In this cross-sectional, questionnaire-based study, we asked patients who purchased drotaverine about their reasons for using it, its perceived efficacy, satisfaction with treatment, and physician consultation. We also asked GPs about the status of drotaverine in their practice. Among 650 recruited patients, 74% used drotaverine for pain, 67% for cramps, and 19% for abdominal discomfort. Approximately 83% of patients purchased drotaverine without a physician\'s advice. Patients who used it after a physician\'s advice were more frequently female, older, and less educated. For all symptoms, mean severity scores decreased by ~5 points (0-10 scale) after the first dose. Ninety-eight percent of patients were satisfied with drotaverine. Among 210 GPs, the percentages prescribing drotaverine were: 42% for irritable bowel syndrome, 89% for cholelithiasis, 60% as supportive therapy for urinary infections, 89% for nephrolithiasis, and 75% for menstruation pain. The GPs perceived drotaverine as more useful, effective, and tolerable than other drugs for abdominal pain or cramps. Drotaverine significantly reduced the severity of all symptoms for which it was taken, and it was perceived as effective and tolerable.

BACKGROUND: Distinguishing between inflammatory bowel disease (IBD) and functional gastrointestinal disorders is a diagnostic challenge. The need for non-invasive biomarker as a diagnostic tool in the assessment of gastrointestinal symptoms is required. The objectives of current study were to determine the spectrum of clinical features in patients tested for fecal calprotectin presenting with high levels and to compare calprotectin levels among already diagnosed patients known to have IBD as per biopsy findings and documented on patients\' file with newly presenting patients who were being investigated and did not have a diagnosis.
METHODS: This retrospective cross-sectional study was conducted in the Department of Pathology and Laboratory Medicine and Department of Medicine, Aga Khan University, Karachi, Pakistan from January 2017 to December 2019. Subjects tested for fecal calprotectin who had elevated fecal calprotectin levels (n = 150) were included in the current study. Each patient deposited a random stool sample in an airtight container for calprotectin analysis. Biochemical analysis of calprotectin was performed by enzyme-linked immunosorbent assay using epitope calprotectin test kit (Epitope Diagnostics, Italy) on ETI-Max 3000 immunoassay analyzer (DiaSorin, Italy). A structured history form was used for data collection.  Results: One hundred and fifty patients were available for inclusion in the final analysis. Majority of the patients (n = 117, 78%) were adults (>18 years of age), and 52.7% (n = 79) were females. Median fecal calprotectin (IQR) was 317.3 μg/g (549.10 - 239.2 μg/g) in children (n = 33) and 305 μg/g (609.9 - 201.6 μg/g) in adults; the difference was statistically non-significant (p value > 0.05). On categorization according to disease, fecal calprotectin levels were significantly elevated (p value = 0.033) in IBD patients compared to normal subjects, 644 μg/g (644 - 587.8 μg/g) vs 308.5 μg/g (505.4 - 233.8 μg/g), respectively. Diarrhea (n = 13, 38.4%), abdominal cramps (n = 12, 36.4%), and weight loss (n = 11, 33.3%) were the most common complaints noted in children with high fecal calprotectin levels, whereas in adults, abdominal cramps (n = 60, 51.3%), diarrhea (n = 59, 50.4%), and weight loss (n = 46, 39.3%) were the common complaints. The median fecal calprotectin levels in children already known to have IBD (n = 3) were higher than the levels noted in children with no diagnosis (n = 30); p value > 0.05. Similarly, median fecal calprotectin levels in adults with IBD (n = 28) were higher than the levels noted in patients with no specific diagnosis (n = 91), 400.7 μg/g (656.6 - 244.3 μg/g) vs 302.7 μg/g (564.6 - 206 μg/g); p value > 0.05.
CONCLUSIONS: Current study affirms that the fecal calprotectin test can be used in identifying IBD patients in all age groups.

OBJECTIVE: To ascertain any predictors of potential food poisoning pathogens and development of post-infective irritable bowel syndrome (IBS) in UK travellers. An analysis was undertaken on prospectively collected data on 527 patients reporting symptoms of suspected food poisoning between June 2012 and June 2015.
METHODS: Positive stool sample indicative of food poisoning pathogens and diagnosis of post-infective IBS.
RESULTS: Data on 527 patients were examined. The large majority of patients did not provide a stool sample on return from holiday (n = 430, 81.6%) as few visited a Doctor locally or in the UK. Only 18 patients (18.6%, 95% confidence interval [CI] 11.4-27.7) who provided a stool sample were positive for microbiological food poisoning pathogens. Univariate analysis indicated a significant relationship between a positive stool sample and whether the individual sought any medical assistance at the resort (odds ratio [OR] 0.24, 95% CI 0.08-0.70) and whether they took any treatment (including self-medicated), (OR 0.21, 95% CI 0.06-0.67). Of the 527 patients only 30 (5.7%, 95% CI 3.9-8.1) experienced post-infective IBS. Univariate regression indicated a significant relationship between experiencing Per Rectal (PR) bleeding and a diagnosis of post-infective IBS (OR 3.64, 95% CI 1.00-10.49). Univariate regression also indicated an increase in the risk of developing post-infective IBS with increasing duration of symptoms (OR 1.04, 95% CI 1.02-1.05). No significant relationship was found between a positive stool sample and developing post-infective IBS (P = 0.307).
CONCLUSIONS: Very few patients provide a stool sample after experiencing holiday sickness abroad. Of those that do, only a small proportion have a positive stool sample indicative of a food poisoning microorganism. Around 6% of individuals were diagnosed with post-infective IBS. Those individuals with PR bleeding and symptoms persisting for longer durations were significantly more at risk of developing post-infective IBS, whilst medical aid and treatment abroad was found to reduce the odds of a positive stool sample.

Hyoscine butylbromide (Buscopan ®) is clinically used as an anticholinergic antispasmodic for the treatment of abdominal cramping or visceral pain associated with cramps. However, the spasmolytic efficacy on contractile activity of human gastrointestinal smooth muscle from various sections remains unclear. We aimed to investigate the potentially selective actions of Buscopan on different bowel segments, as well as muscular layers and contractile states. Human smooth muscle tissues of the esophagus, gastric corpus and antrum, jejunum, ileum and colon were obtained. Isometric measurements of circular and longitudinal muscle strips were performed to determine effects of Buscopan on spontaneous activity and induced-contractions by 30mM KCl, 10μM bethanechol and electrical field stimulation (EFS). Buscopan concentration-dependently (10(-9)-10(-5)M) inhibited smooth muscle activity, particularly in spasticity evoked by bethanechol and EFS but not high K(+). The inhibiting effects were mainly responsible for the antagonism on muscarinic M2 and M3 receptors (IC50 values: 3.1×10(-5)M vs. 0.9×10(-5)M). The sensitivity toward Buscopan revealed a tendency of increasing from the esophagus, gastric corpus and antrum to the colon, jejunum and ileum. There was a reversed gradient of mRNA and protein expression of muscarinic M2 and M3 receptors from the blocking effects of Buscopan, which could be ascribed to the fact that a higher concentration of Buscopan was needed to antagonize the spastic contraction to reach the equipotent inhibitory rate in the region with higher muscarinic receptor activity. The findings of different inhibitory effectiveness on various parts of the gastrointestinal tract provide a potential guideline for the clinical application.

This article provides a state-of-the-art report on oral contraceptives (OCs). Users are continuously informed about the risks of pill ingestion but there are benefits as well. Benign breast disease, benign ovarian cysts, ectopic pregnancy, ovarian cancer, and pelvic inflammatory disease (PID) were some of the conditions which were prevented by OCs. Iron deficiency anemia, rheumatoid arthritis, and initial PID were also prevented. The protective effect of OCs against PID is the most important protective effect of OCs. Decreased menstrual cramping may be another important pill benefit. A new triphasic OC, Trinordiol, may be highly effective in reducing side effects associated with low-dose pills. It provides doses of estrogen and progestin which vary in each 1/3 of the menstrual cycle. Some other advantages are improvement in acne, dysmenorrhea, breast tension, gastrointestinal upset, and rash. While scientists do not know the exact action of the pill on the cardiovascular system, it may have an effect on clotting mechanism activators. OCs increase fibronolytic activity; the pill provides a protective mechanism against blood clotting disorders. A table is presented which illustrates the effects of age, smoking, and the pill on thrombogenic and atherogenic factors. There is discussion about the woman over age 35 as a candidate for OC usage. It may be that the minipill may be ideal. The over-35 woman may need additional counseling about the other types of contraceptive methods available. The diaphragm and the IUD are good options; sterilization is an excellent option providing the patient has obtained counseling. Recent data indicate that the minipill may be a popular form of contraception. While they do have certain side effects, there are remarkably similar patterns of use between minipill and combined pill users. According to 1 doctor, withholding OCs from 10% of current users could reduce the incidence of excess myocardial infarction by 75%. These cases are among women over 30 who also smoke.

A study was made in Bombay, India of oral contraception using 2 combinations of ethynodiol diacetate and mestranol in 521 women over a period of 3 years with a total of 5196 menstrual cycles. The women were divided into 2 groups: 1 using 1 mg of ethynodiol diacetate plus .1 mg of mestranol and the other using .5 mg of ethynodiol diacetate and .1 mg of mestranol. 70% of the women studied were aged 21-30 years. Women over 35 and those with more than 3 children were urged to undergo operative procedures. Most had used no contraceptive method previously, 56.6% desired planned families, and 43.4% wanted no more children. There was a monthly interview when a new supply of tablets was distributed. No pregnancies followed in either group when tablets were taken regularly, but 2 did occur otherwise. Side effects were most severe during the first cycle. 55 women (10.5%) discontinued medication at the end of 3 years because of side effects. 267 discontinued the program because pills were not available near their homes. Of these, 71 became pregnant over the 3-year period, only 10 of whom desired pregnancy. None showed evidence of thromboembolic phenomena. Liver function tests showed no change. The cycle length of most women taking the preparations became more regular at 27-28 days. There was little difference in side effects of the 2 preparations.

Clinically evident lead poisoning is rare in Indian children but is more common than in adults. In children, lead poisoning may appear as fever, seizures, anemia, or abdominal pain, while in adults it is more likely to manifest as chronic minor peripheral neuropathy or gum pigmentation. Children with acute lead poisoning can be treated with chelators such as EDTA and BAL, but many are left with permanent brain damage. The most common sources of acute lead poisoning in Indian children are inhalation of fumes from burned car batteries, ingestion of flaking paint, consuming food cooked in cheap aluminum or brass utensils, and eating contaminated soil. The sources of chronic lead poisoning are water from lead pipes and fumes from industrial or automotive exhaust. Another common source in India is application of \"kajjal\" to children\'s eyes. Sources of lead in Western countries, such as drinking water, canned food, residential paint, automotive fuel, and ambient air quality, are regulated by law. None of these are regulated in India.

Endometrial biopsies from 20 patients using intrauterine devices (IUD) having different modes of action were taken in order to study the ultrastructural changes related to the different types of devices. 11 patients presented with spotting and/or pelvic discomfort; the others were asymptomatic. The tissue biopsies were observed with electron microscopy. The epithelium appears to be constituted by cells with abnormal nuclei, cilia and microvilli and infiltrated by numerous white cells. The vascular structures of the stroma show changes that explain the frequent bleeding; edema and stromal cell necrosis are also noted. The presence of white cells actually appears to be partially responsible for the efficacy of the devices; the vessel abnormalities are more marked among those using copper-based devices and devices made of inert material. The secretory function of the endometrium appears more significantly diminished in copper-based devices than in the inert devices. Progesterone-based devices cause longer menses and more frequent intermenstrual spotting, but an altogether smaller periodic blood loss. These results confirm the findings of previous studies and the advisability of using medicated IUDs.

The authors examined the cytological endometrial smears obtained from copper IUDs removed from a group of 232 patients, multiparas and nulliparas, among whom there were sufficiently represented groups of women who either tolerated the device quite well or who complained of pelvic cramping and bleeding. A remarkable correlation exists between the appearance of the endometrial cell population and clinical tolerance, with increased amounts of polimorphonucleates in patients with pelvic cramping and of endometrial epithelial cells in those with more or less marked bleeding. On the contrary, however, all the cell population in users who tolerated the device well were poorly represented and well-balanced among the various components, probably an expression of a favorable adaptation to the device. These data are interesting in that they justify the attitude of those who, seeing that the continuation of contraception is necessary, carry out the immediate substitution of the device as soon as the suggested period of use has passed without any interval after removal. (author\'s)