Diseases Commons^™

Double Atrial Septum With Interatrial Space In Patients Experiencing Ischemic Attack, Blerim Berisha, Fadhel Hamidani, Mathias Humm

The Texas Heart Institute Journal

No abstract provided.

Utilizing Probiotics To Reduce Diet Induced Dysbiosis And Inflammation In Myelodysplastic Syndromes Susceptible Mice, Tejaswee Bolloju

Theses, Dissertations and Capstones

Human gut microbiota is helpful in digestion by helping in breaking complex carbohydrates, proteins, fats and fibers and many other physiological functions. The Western diet which is high in fat and carbo hydrate percentage alters gut microbiota and leads to growth of pathogenic bacteria and altered gut flora referred to as dysbiosis, which in turn cause gut inflammation and increased permeability of gut and it causes translocation of Lipopolysaccharides (LPS) which causes low grade systemic inflammation. Disturbance in gut microbiota correlated with metabolic conditions like obesity and leads to progression of hematologic diseases like Myelodysplastic Syndromes (MDS). Myelodysplastic syndromes are …

Investigating The Impact Of Phthalate Exposures From Personal Care Products On Uterine Fibroid Incidence And Prevalence In Us-Born Black Women, Ella Brissett

CMC Senior Theses

Uterine fibroids are benign tumors composed of smooth muscle cells and connective tissue that develop within or on the walls of the uterus. Despite being non-cancerous, they can severely affect quality of life by causing heavy bleeding, chronic pain, and reproductive complications. Fibroids are typically found in women of reproductive age, but they disproportionately affect Black women, who experience higher incidence and severity. The underlying causes of this disparity is poorly understood; however, an emerging body of research is highlighting the role of phthalates, endocrine-disrupting chemicals found in many personal care products, in exacerbating fibroid development. Through a critical analysis …

Comparative Analysis Of Lipid Accumulation And Antioxidant Responses In Masld And Control Ipsc-Heps, Anna Werts

CMC Senior Theses

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a prevalent liver condition characterized by lipid accumulation and associated inflammation, driven by genetic, environmental, and metabolic factors. Much is still unknown about the mechanisms of the disease, and research on this is important for advancing effective treatments. This study investigated lipid accumulation and oxidative stress responses to varying concentrations of oleic acid (OA) and palmitic acid (PA) in induced pluripotent stem cell-derived hepatocytes (iPSC-Heps) from MASLD and healthy donors. BODIPY staining revealed that MASLD iPSC-Heps exhibit significantly higher lipid accumulation than controls, especially under prolonged OA and PA exposure. Additionally, PLIN2 expression …

Regulation Of Neuronal Autophagy By Amyotrophic Lateral Sclerosis (Als) - Associated Kinase Tbk1: Evaluating The Role Of Ncoa7, Vikram Chatterjee

CMC Senior Theses

Amyotrophic lateral sclerosis (ALS) is a fatal, neurodegenerative disease characterized by motor neuron loss and the pathological accumulation of misfolded proteins. Autophagy, a lysosome-mediated clearance mechanism, plays a vital role in maintaining cellular homeostasis by removing damaged organelles and protein aggregates. Impairments in autophagy have been increasingly linked to ALS, underscoring its importance in neuronal health. TANK-binding kinase 1 (TBK1) is a key regulator of selective autophagy, facilitating the recognition and sequestration of specific cargo through phosphorylation of autophagy receptors. Notably, mutations in the TBK1 gene have been identified in ALS patients, directly implicating TBK1 dysfunction in disease pathogenesis. Through …

Diversity Within Species: Mechanisms, Evolution And Implications In Bacterial Disease, Kathryn R. Piper

Electronic Theses & Dissertations (2024 - present)

The Gram-positive bacterium Staphylococcus aureus and the Gram-negative bacterium Escherichia coli are ubiquitous commensal and opportunistic pathogens. In humans, S. aureus is commonly found on the skin and mucus membranes, and is known to cause infections in the skin, bloodstream and brain. E. coli is a normal part of the gut microbiota in humans and can cause intestinal and extraintestinal infections alike. S. aureus and E. coli pose global threats to public health, due to the high morbidity and mortality of invasive strains. The wide range of infections they cause in humans and other animals are exacerbated by the presence …

Enhancing The Accuracy Of Image Classification For Degenerative Brain Diseases With Cnn Ensemble Models Using Mel-Spectrograms, Sang-Ha Sung, Michael Pokojovy, Do-Young Kang, Woo-Yong Bae, Yeon-Jae Hong, Sangjin Kim

Mathematics & Statistics Faculty Publications

Alzheimer’s disease (AD) and Parkinson’s disease (PD) are prevalent neurodegenerative disorders among the elderly, leading to cognitive decline and motor impairments. As the population ages, the prevalence of these neurodegenerative disorders is increasing, providing motivation for active research in this area. However, most studies are conducted using brain imaging, with relatively few studies utilizing voice data. Using voice data offers advantages in accessibility compared to brain imaging analysis. This study introduces a novel ensemble-based classification model that utilizes Mel spectrograms and Convolutional Neural Networks (CNNs) to distinguish between healthy individuals (NM), AD, and PD patients. A total of 700 voice …

An Electrochemical Sensor For Tenofovir Monitoring, Abdellatif Ait Lahcen, Gymama Slaughter

Center for Bioelectronics Publications

Effective monitoring of tenofovir (TFV) adherence is critical for ensuring the success of antiretroviral therapies in preventing and managing HIV, as nonadherence can lead to treatment failure and the development of drug-resistant strains. In this study, a highly sensitive and selective novel biomimetic sensor for TFV determination is developed utilizing laser-scribed graphene (LSG) modified with gold spiky nanostructures (AuNSp) and molecularly imprinted polymer (MIP). The MIP layer is engineered with precise control to maximize molecular specificity for TFV. Electrochemical characterization demonstrates excellent performance, including the broadest linear detection range (10 nM to 200 μM) reported to date with a sensitivity …

Hiv Protein Tat Dysregulates Multiple Pathways In Human Ipscs- Derived Microglia, Liam Liyang Guo, Robert Jiang, Yan Cheng, Brooke Russell, Yan Y. Sanders, Ming-Lei Guo

Department of Biomedical and Translational Sciences Faculty Publications

In the era of combined antiretroviral therapy, around 50% of chronic HIV (+) individuals show varying degrees of memory and cognitive deficiency (NeuroHIV), a phenomenon of accelerated brain aging. HIV protein transactivator of transcription (TAT) has been well-accepted as a risk factor contributing to NeuroHIV through dysregulating microglia (Mg) functions. Previous studies have demonstrated that HIV-TAT can affect lipid metabolism, immune responses, autophagy, and senescence in rodent Mg. However, due to the significant species differences between rodent and human Mg (hMg), it is essential to take caution when interpreting the results obtained from rodent models into human conditions. For the …

Cellular And Molecular Mechanisms Of Lung Regeneration, Repair, And Fibrosis, Volume Ii, Yong Qiu, Xiao Xiao Tang, Shigeyuki Shichino, Prem Prakash Kushwaha, Yan Y. Sanders, Remo Castro Russo, Chunheng Mo

Department of Biomedical and Translational Sciences Faculty Publications

[Introduction] Organ fibrosis represents a substantial a major contributor to global disease burden, implicated in over 30% of cases leading to disability-associated and fatal conditions. Among these conditions, idiopathic pulmonary fibrosis (IPF) stands as a progressive and frequently fatal interstitial lung disease characterized by aberrant extracellular matrix deposition and parenchymal scarring. The prognosis for IPF patients is poor, with a median survival time of just 3–5 years (Bhattacharya and Ramachandran, 2023; Lederer and Martinez, 2018, Ma et al., 2024, Wei et al., 2024). Current FDA-approved therapeutics, Pirfenidone and Nintedanib, demonstrate capacity to attenuate functional decline in pulmonary fibrosis but remain …

Post-Traumatic Stress Disorder Among Critical Care Nurses Caring For Covid-19 Patients, Marwa Abdo

Nursing

Coronavirus disease 2019 (COVID-19) pandemic has significantly impacted global health, with a substantial number of severe cases requiring admission to isolated intensive care units (ICUs). This unprecedented situation exposed critical care nurses (CCNs) to a highly stressful traumatic environment, placing them at increased risk for developing post-traumatic stress disorder (PTSD). Early identification and intervention for PTSD are crucial to mitigate the negative consequences for nurses' well-being, job performance, and overall quality of life. Aim: This study aimed to assess post-traumatic stress disorder among CCNs caring for COVID-19 patients. Method: A descriptive cross-sectional design with a convenience sample of 109 CCNs …

Anemia In Pregnant Women: Findings From Kuwait Birth Cohort Study, Abdullah Al-Taiar, Ali H. Ziyab, Majeda S. Hammoud, Reem Al-Sabah, Saeed Akhtar

Epidemiology, Biostatistics, & Environmental Health Faculty Publications

Background Anemia is the most common hematologic disorder in pregnancy, affecting over one-third of pregnant women globally. This study aimed to assess the prevalence of anemia in pregnant women and its associated factors in the Kuwait Birth Cohort study.

Methods The Kuwait birth cohort (n = 1,108) was a prospective study in which pregnant women were recruited during their second or third trimester. Data were collected through personal interviews during antenatal care visits, including data on sociodemographic and lifestyle factors. Blood samples were analyzed under strict quality control to measure various laboratory indicators. Anemia was defined as hemoglobin (Hb) < 110 g/L. Predictors of anemia were categorized as underlying or direct factors, and logistic regression models were used to investigate their association with anemia.

Results …

Ciliary Arl14b In Vision, Alexis Breann Crockett

Graduate Theses, Dissertations, and Problem Reports (ETD)

Primary cilia are highly specialized organelles that regulate signaling, trafficking, and sensory perception across multiple tissues, including the retina. The small GTPase ADP Ribosylation Factor-Like Protein 13B (ARL13B) is an atypical ARF-family protein enriched in cilia. ARL13B acts as a guanine exchange factor (GEF) for another small GTPase ARF-like Protein 3 (ARL3). Mutations in ARL13B cause Joubert syndrome, a ciliopathy characterized by brain malformation, developmental delays, and retinal degeneration. Despite ARL13B’s known ciliary localization and clinical relevance, ARL13B’s precise functions in cilia remain poorly defined. This dissertation investigates the cilia-specific roles and GEF-specific roles of ARL13B in photoreceptors using two …

Investigating The Production Challenges Of The P100.1 Phage Endolysin, Jonah O. Frago

EWU Masters Thesis Collection

Acne vulgaris is one of the most common skin diseases globally. One key aspect of acne pathogenesis is the disturbance of healthy strain diversity of the skin bacterium Cutibacterium acnes. Many acne treatments are antimicrobial; however, these treatments are generally nonspecific and carry a variety of side effects in addition to contributing to rising antibiotic resistance. Lytic bacteriophages (or phages) are viruses that infect and kill bacteria. Their lytic lifestyle is facilitated by enzymes called endolysins. Phages have been studied as an alternative to traditional antimicrobials in acne treatment and have shown reduced C. acnes load in acne lesions and …

Assessing Sun Protection Policies In Texas School Districts Located In Counties With The Lowest And Highest Melanoma Risk: Content Analysis And Cross-Sectional Study, Nabeel Ahmad, Brooke Bartley, Stephanie Zhang, Madison M Taylor, Karl Schrader, Kehe Zhang, Hung Quoc Doan, Cici Bauer, Kelly C Nelson, Jennifer Cofer

Faculty, Staff and Student Publications

Introduction

School policy can encourage sun safe habits, such as wearing hats and applying sunscreen. However, sun safety policies (SSP) have not been formally assessed for Texas independent school districts (ISDs), particularly in counties with the highest melanoma incidence relative risk (RR). This study aims to assess the presence, strength, and intent of SSPs across Texas ISDs located in counties with the highest and lowest melanoma incidence. We also identify factors correlated with stronger SSP.

Methods

Eleven components of SSPs from 102 ISDs were evaluated in this cross-sectional study by examining school district websites, official documents, social media, media appearances, …

Chronic Administration Of A Cannabis-Derived Mixture At An Antihyperalgesic Dose Does Not Significantly Enhance Hepatotoxicity Or The Development Of Metabolic Dysfunction-Associated Steatohepatitis In Male Mice, Kim B. Pedersen, Tomislav Jelesijevic, Tamara M. Morris, Sarah M. Melton, Ashley S. Henderson, John F. Glenn, Gregory J. Davenport, Martin J.J. Ronis, Peter J. Winsauer

School of Medicine Faculty Publications

Cannabis and cannabinoid mixtures have been linked to a variety of health benefits including pain mitigation, suppression of nausea produced by chemotherapeutic agents, anti-inflammatory effects, and effects on energy homeostasis, glucose, and lipid metabolism. The latter properties have led to the suggestion that these products could have therapeutic effects on the development of metabolic dysfunction-associated steatohepatitis (MASH) - a severe type of liver pathology in obese and diabetic patients. However, varying agonist and antagonistic properties of different cannabinoids on the endogenous cannabinoid system make prediction regarding hepatic effects and diet interactions difficult. The current study was designed to examine hepatic …

Hydroxychloroquine-Induced Cardiomyopathy: A Case Report, Ahmed Hussein, Aya Salih, Tebyan Mohammedali, Yousif Mohamed, L Maximilian Buja

Faculty, Staff and Student Publications

Hydroxychloroquine (HCQ) is an immunomodulatory medication used for decades. HCQ is a weak base accumulating in acidic cytoplasmic vesicles, such as lysosomes. This accumulation raises the pH and interferes with the functions of the lysosomal enzymes, including α-galactosidase A, resulting in a unique clinical and pathologic feature. We present a case with severe HCQ-induced cardiomyopathy to show the pattern of cardiac involvement and available imaging and pathologic modalities. The case involves a 76-year-old woman with a history of Sjögren's disease who had been treated with HCQ for 13 years and presented with symptoms of heart failure. An echocardiogram showed thick …

In Danger: Hiv Vaccine Research And Development In Europe, Roger Tatoud, Yves Lévy, Roger Le Grand, Jose Alcami, Giorgio Barbareschi, Christian Brander, Andrea Cara, Behazine Combadière, François Dabis, Sarah Fidler, Tomáš Hanke, Carolina Herrera, Gunilla B. Karlsson Hedestam, Hester Kuipers, Sheena Mccormack, Christiane Moog, Giuseppe Pantaleo, Laura Richert, Rogier W. Sanders, Robin Shattock, Hendrik Streeck, Rodolphe Thiebaut, Alexandra Trkola, Klaus Üeberla, Marit J. Van Gills, Ralf Wagner, Winfried Weissenhorn, Yazdan Yazdanpanah, Gabriella Scarlatti, Jean Daniel Lelièvre

Department of Obstetrics & Gynecology Faculty Publications

Highly effective antiretroviral-based HIV prevention plays an important role in ending the global HIV/AIDS epidemic. However, the sustainable control of the epidemic is hampered by unequal access to prevention options, including HIV testing, alongside with drug resistance and ongoing barriers to accessing sustainable HIV treatment. Therefore, an HIV vaccine, combined with effective prevention and treatment, remains an absolute necessity to control the epidemic. Yet, the recent discontinuation of four major vaccine efficacy studies is raising concerns about the future of HIV vaccine research and development globally, and particularly in the European region where funding for vaccine research and development has …

Disparities In Cardiovascular Disease Outcomes And Economic Burdens Among Minorities In Southeastern Virginia, Ismail El Moudden, Asra Amidi, Reem Sharaf Alddin, Michael Bittner, Qi Zhang

Department of Obstetrics & Gynecology Faculty Publications

Background

Cardiovascular diseases are the leading cause of mortality in the United States, presenting significant public health challenges and financial burdens, particularly in Southeastern Virginia, where African American and Hispanic (AA&H) populations are disproportionately affected.

Methods

This retrospective observational study analyzed data from 30,855 hospital discharges of AA&H patients across Southeastern Virginia from 2016 to 2020, focusing on individuals aged 18 to 85 with cardiovascular diseases. Utilizing the Virginia Health Information database, we examined demographic information, clinical data, and healthcare utilization patterns through hypothesis tests and regression models to explore associations between these variables and the economic impacts of cardiovascular …

Prevalence Of Depression And Its Coping Strategies Among Rural And Urban Geriatric Population, Mohit Negi, Smitha M C

Digital Journal of Clinical Medicine

Background: Aging is a natural process, and older age is a period in which most aspects of life require support from others. Globally, Depression is a serious public health concern among elderly populations. The aim of this study was to estimate the prevalence of depression and its coping strategies among geriatric population and to evaluate the association between socio-demographic factors and level of depression.

Methods: A cross-sectional study was conducted among 410 study participants in both rural and urban areas. Geriatric Depression Scale (GDS-15) was used to measure the depression and brief-COPE (28-items) scale was used to measure the coping …

Myocardial Infarction Trends Following Covid-19 Vaccination: A Retrospective Investigation From India, Hema S. Pinnam, Hrithika Madhavan, Jagarlamudi Harshitha, Vikram Patil, Harshita Tiwari, Isha A. Kumthekar, Jampala Sri Mounya

Digital Journal of Clinical Medicine

Background: The relationship between COVID-19 vaccination and the incidence of myocardial infarction remains a topic of debate. The study aimed to analyze the demographic, clinical, and outcome characteristics of MI patients post-vaccination in India, focusing on differences between Covishield and Covaxin recipients.

Methods: The retrospective observational study included 303 MI patients admitted to a tertiary care center. Data were collected on demographics, comorbidities, vaccination status, ICU admissions, and outcomes. The Charlson Comorbidity Index (CCI) was used to assess disease severity. Statistical analyses evaluated the associations between vaccination status, clinical parameters, and mortality.

Results: Among the study population, 74.3% were males, …

Establishing Psychiatry Clubs: Novel Approach To Enhance Psychiatry Teaching Learning In India, Akuti Khanna, Kishor M

Digital Journal of Clinical Medicine

Despite the fact that over 150 million Indians suffer from psychiatric disorders, the country faces a severe shortage of mental health professionals, with less than 1,300 psychiatrists graduating annually. One such solution is the establishment of Psychiatry Clubs in medical colleges, which can significantly enhance awareness, education, and community engagement in mental health. The Psychiatry Club at JSS Medical College, Mysuru, established on October 10, 2023, aims to promote mental well-being, provide peer support, as well as foster professional development through workshops, seminars, and collaborations with other mental health professionals and other student led organisations. These clubs offer a sustainable …

Assessment Of Effectiveness And Evaluation Of Perception Among Students Towards Flipped Classroom Learning: A Prospective Study., Nagaraja Prasad Sai, Vedavathi Hanumaiah, Shreenivas Prabhakar Revankar, Shruthi S. Lingesh, Avanthi Eshwar

Digital Journal of Clinical Medicine

BACKGROUND: Flipped learning (FL) is a teaching learning approach in andragogy. In FL students are involved in self-directed learning with the teacher acting as a facilitator and a moderator. Introduction of Competency Based Medical Education led many educators to shift from traditional teaching to blended teaching learning methods. This study was conducted to assess effectiveness and evaluate students’ perception towards FL.

AIM AND OBJECTIVES: To assess effectiveness of FL teaching in improvement of student scores and to evaluate student’s perception towards FL teaching.

MATERIALS AND METHODS: Pre-class activities included study materials in the form of PowerPoint slides …

Changing Climate, Changing Health: Perspectives From General Population In Mysuru, Lekhashree A, Manirsha P V, Paranthaman Chinnasamy, Srishti Arya, Sunil Kumar D

Digital Journal of Clinical Medicine

Background: Climate change has emerged as a major public health concern, contributing to rising morbidity and mortality worldwide. In India, increasing heat waves, unpredictable rainfall, and deteriorating air quality have intensified climate-sensitive health conditions. This study aims to assess the health impacts of climate change among the general population of Mysuru.

Methodology: A community-based cross-sectional study was conducted among 400 residents of Mysuru (April–June 2024). Participants were recruited through simple random sampling. Data were collected using a pre-tested semi-structured questionnaire via Google Forms. Analysis was performed using SPSS v26, with descriptive and inferential statistics.

Results: Among 400 participants, …

Use Of Augmented Reality For Mosquito Breeding Sites Identification, Venant Niyonkuru, Sylla Sekou, Jimmy J. Sinzinkayo

Digital Journal of Clinical Medicine

An augmented reality app is used for detecting the possible breeding locations of mosquitoes in different settings precisely. With the aid of the advanced augmented vision technology, the AR system recognizes water-containing containers that are frequent breeding places for mosquitoes according to the visual information obtained through a head-mounted display. It then overlays visual highlights and labels directly onto these containers within the user's field of view, allowing one to instantly identify and spot breeding sites in real time. By combining state-of-the-art AR functionality with powerful computer vision algorithms, the method provides real-time visual feedback for identifying and tagging mosquito …

A Cross-Sectional Study Of The Correlation Between Working Models, Work-Life Balance And Psychological Distress In It Professionals In An Urban Setting., Neeharika Krishna Kumar, Ponnammal Sundar Lakshmi, Vathsalya S. Gowda, Kshamaa Haradanahalli Giriprakash, Manju Aswath

Digital Journal of Clinical Medicine

Background: India makes up more than 19% of the global Information Technology (IT) Market. The health and well-being of the population employed in this sector will affect their productivity at work and, in turn, the economic outcome. Changes in working models and altered work-life balance can lead to increased distress in IT Professionals, hence the current study.

Methodology: The current cross-sectional descriptive study assessed 247 IT professionals. A semi-structured questionnaire was used for socio-demographic details, working models and work-life balance. Kessler Psychological Distress Scale (K10) Plus was used to assess psychological distress. Statistics and correlations were done using SPSS 20. …

A Study Of Electrocardiogram And Echocardiography Parameters Of Post Covid – 19 Patients, Venkateswararao K, Durga Prasad Sadhupati

Digital Journal of Clinical Medicine

Background: Coronavirus Disease – 2019 [COVID-19] infection is multisystem disease not restricted to the lungs it has negative impact on Cardiovascular system by activation of ACE-2 receptors causing plaque stability, vascular inflammation and MI. ECG and 2D ECHO is a simple bed side diagnostic test can be used to assess cardiovascular disease involvement in such patients. We aimed to find out ECG and 2D ECHO abnormalities of Covid – 19 patients. To Study relation of SARS-COV-2 infection and Prevalence of Cardiovascular disease.

Methods: We perform Cross Sectional study among 500 Post Covid – 19 patients [>20 and

Results: Out …

Subclinical Myocardial Disease: The Next Frontier In Cardiovascular Prevention., Param Darpan Sheth, Chandana S., Nimrah Rehman

Digital Journal of Clinical Medicine

Subclinical myocardial disease refers to pathological cardiac changes that precede overt symptoms. It represents an emerging frontier in cardiovascular disease prevention; wherein early detection of myocardial dysfunction could allow timely intervention to avert heart failure (HF) and other outcomes. This narrative review summarizes the current and emerging tools for detecting subclinical myocardial disease, including advanced cardiac imaging and circulating biomarkers, and discusses their potential to improve risk stratification and preventive care in asymptomatic high-risk individuals. Novel echocardiographic measures such as global longitudinal strain (GLS) can unmask subtle systolic dysfunction despite preserved ejection fraction, while cardiac magnetic resonance (CMR) tissue mapping …

Major Adverse Cardiovascular Events Are Less Frequent In Psoriasis Patients Starting Glp-1ra Compared To Controls: An Observable Retrospective Cohort Study, Ana Ormaza Vera, Marla F. Osorlo, Madison Olexson, June Choi, Chunghwan Ro, Clinton Enos

Department Dermatology Faculty Publications

Background: Psoriasis is an independent risk factor for major adverse cardiovascular events (MACE). We have previously shown that psoriasis patients with dyslipidemia have an increased incidence of MACE despite treatment with a biologic and a statin. Glucagon-like peptide-1 receptor agonists (GLP-1RA) have shown to reduce MACE in patients with type 2 diabetes and obesity, comorbidities that commonly co-occur with psoriasis. However, the association between GLP-1RA and the incidence of MACE among patients with psoriasis remains unknown.

Methods: We conducted a retrospective cohort study from 2014-2024 using a large, multi-center, electronic health record network (TriNetX). Patients aged 18-90 who started GLP-1RA …

Opioid Tolerance And Withdrawal In The Mouse Colon, James Fune

Theses and Dissertations

Constipation is a major clinical obstacle associated with opioids, prompting patients to discontinue treatment due to pain, discomfort, and psychosocial stressors. Moreover, chronic users become tolerant to the analgesic effects of opioids, but not to their constipating effects. Upon cessation of long-term treatment, serious diarrhea–among other somatic signs of withdrawal–may ensue. These symptoms become a driving factor for relapse, causing patients to restart opioid treatment. In this study, we aim to understand mechanisms that contribute to opioid tolerance and withdrawal in the colon. Previous findings suggest that constipation occurs partly due to the colon’s lack of tolerance to opioids’ inhibitory …