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Bowel disorders
Published in Henry J. Woodford, Essential Geriatrics, 2022
There is an increased risk of small bowel bacterial overgrowth in people with diabetes, prior intestinal surgery or diverticulosis. Gastric atrophy or proton pump inhibitor (PPI) use may also be factors. Resulting symptoms include diarrhoea, weight loss and abdominal pain, or symptoms secondary to nutrient deficiencies. Bacteria can metabolise bile salts, leading to a reduction in the absorption of fat-soluble vitamins, and also metabolise vitamin B12 which could result in deficiency. The bacteria can produce folate and levels of this vitamin may become elevated (seeTable 12.3). Diagnosis can be achieved by culture of small bowel aspirates, or more commonly, by a hydrogen breath test. In this latter test the patient is administered glucose or lactulose and breath hydrogen and methane are measured. These gases can only originate from abnormal metabolism by bacteria in the small bowel. However, these investigations can be unreliable and, when suspicion is high, guidelines recommend a trial of antibiotics.24
Pre-Hospital Care
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
Should a pre-hospital clinician attend an incident that has multiple casualties then a METHANE report may be given instead. (The M at the start standing for major incident declared or standby). Should a METHANE report be passed to the ambulance control room then a cascade of events will occur resulting in activation of the ambulance services major incident plan and prespecified clinical response. The plan will also involve a coordinated response with the other emergency services and local receiving hospitals.
Asphyxia
Published in Kevin L. Erskine, Erica J. Armstrong, Water-Related Death Investigation, 2021
Methane, a component of natural gas and a product of the decay of organic matter, may be encountered in coal mines, marshes, and sewers. With very low ambient O2 levels caused by displacement by CH4, consciousness will be lost in seconds and death will rapidly ensue.1 In cases involving multiple deaths in larger confined spaces, there will often be no specific external or autopsy findings that give any clue as to what may have caused the deaths, and the real danger may still exist, putting unsuspecting rescuers and investigators at risk.
Bioaugmentation of the green alga to enhance biogas production in an anaerobic hollow-fiber membrane bioreactor
Published in Biofouling, 2023
Sevcan Aydin, Hadi Fakhri, Nalan Tavsanli
Another contrast was seen in the Proteobacteria, which declined in the biofilm layer in the existence of H. pluvialis while mostly remaining unaffected in the sludge. A higher degree of dissociation was also seen in the HP reactor’s sludge and biofilm layer, with Firmicutes and Proteobacteria accounting for more than half of the total community in the sludge but less than 25% in the biofilm layer. Acetothermia and Cloacimonetes, neither of which were present in the biofilm layers of the C1 and C2 reactors, predominated in the biofilm layer of the HP reactor. The phyla Acetothermia, Acidobacteria, Armatimonadetes, and Chloroflexi were barely detectable in the sludge samples from the C1 and C2 reactors, whereas their presence in the HP reactor was much higher. Acetothermia spp. produce acetate, which is utilized in the formation of methane, thus enhancing biogas production. Phylum Thermotogae, previously reported to be correlated with hydrogenotrophic methane formation, did not change in the sludge samples, however decreased within the biofilm layer with the addition of antibiotics; and was completely diminished in the HP reactor in both sludge and biofilm layers. Citrobacter, Fervidobacterium, Klebsiella, Clostridium sensu stricto 5 and 8, Raoultella and Coprothermobacter were the most abundant genera in biofilm layers of the C1 and C2 reactors. Further, Acholeplasma was the most abundant genus in the biofilm layer of the HP reactor.
Breathing new life into clinical testing and diagnostics: perspectives on volatile biomarkers from breath
Published in Critical Reviews in Clinical Laboratory Sciences, 2022
Jordan J. Haworth, Charlotte K. Pitcher, Giuseppe Ferrandino, Anthony R. Hobson, Kirk L. Pappan, Jonathan L. D. Lawson
More importantly, genetic tests do not detect secondary lactase deficiency or assess symptoms. As a provocation test, tracking patient symptoms concurrently with hydrogen breath tests provides a measure of true intolerance (i.e. symptomatic response to lactose ingestion). However, a rise in hydrogen may also be consequent to SIBO, which means that it is important to establish whether a patient has SIBO before testing for malabsorption. When lactose is administered to a patient with SIBO, the substrate could be fermented by microbes in the small intestine leading to a false positive result for lactose malabsorption [13,43]. Alternatively, a false-negative result for lactose malabsorption can be obtained in people with a non-hydrogen producing-microbiota capable of metabolizing lactose. Methanogens, such as Methanobrevibacter smithii, can convert hydrogen into methane. The extent of breath methane production is also associated with the severity of constipation as a symptom [44]. HMBT is, therefore, favorable to traditional hydrogen breath testing to identify a cohort of patients with excessive methane production.
Recent advances in the pharmacological management of constipation predominant irritable bowel syndrome
Published in Expert Opinion on Pharmacotherapy, 2020
Karolina Niewinna, Anna Zielińska, Jakub Fichna
In two completed phase 2 studies (NCT02495623, NCT02493036) patients between the ages of 18 and 65 were enrolled for 28 days [60,61]. In the first study, 63 patients received a placebo, or either 21 or 42 mg of SYN-010, orally, once daily. Primary outcome was a change from baseline in breath methane production after 7-day therapy. Preliminary analysis of secondary efficacy assessment data indicates that an improvement in the stool frequency response for the 21 mg dose group (p = 0.02) was apparent, while the 42 mg dose group (p = 0.54) was numerically better demonstrating a positive trend. Additionally, an improvement has been observed in weekly abdominal pain intensity for the 42 mg dose group (p = 0.08), while the 21 mg dose group (p = 0.26) has been numerically better demonstrating a positive trend [59]. The second study was based on a group of 54 patients from a previous study and concerned a change of the drug for all groups to a dose of 42 mg for the next 56 days. In these patients, no differences were observed compared to the blind group.