Strongyloides stercoralis Infection in Immunocompromised Host

Strongyloides stercoralis is a soil-dwelling roundworm that causes an intestinal infection, Strongyloidiasis. In the United States, this helminth generally causes chronic asymptomatic infection, and severe symptomatic infections are reported in immunocompromised hosts like patients undergoing chemotherapy, receiving long-term corticosteroids, transplant patients, or patients with HIV. The clinicians should have a high index of suspicion to diagnose this infection, as the exposure is usually remote and symptoms are non-specific. The treatment is simple, with oral anti-helminthic drugs like ivermectin and albendazole.

Impact of COVID-19 on gastroenterology fellowship training: a multicenter analysis of endoscopy volumes

Background and study aims  The COVID-19 pandemic has had a profound impact on gastroenterology training programs. We aimed to objectively evaluate procedural training volume and impact of COVID-19 on gastroenterology fellowship programs in the United States. Methods  This was a retrospective, multicenter study. Procedure volume data on upper and lower endoscopies performed by gastroenterology fellows was abstracted directly from the electronic medical record. The study period was stratified into 2 time periods: Study Period 1, SP1 (03/15/2020 to 06/30/2020) and Study Period 2, SP2 (07/01/2020 to 12/15/2020). Procedure volumes during SP1 and SP2 were compared to Historic Period 1 (HP1) (03/15/2019 to 06/30/2019) and Historic Period 2 (HP2) (07/01/2019 to 12/15/2019) as historical reference. Results  Data from 23 gastroenterology fellowship programs (total procedures = 127,958) with a median of 284 fellows (range 273-289; representing 17.8 % of all trainees in the United States) were collected. Compared to HP1, fellows performed 53.6 % less procedures in SP1 (total volume: 28,808 vs 13,378; mean 105.52 ± 71.94 vs 47.61 ± 41.43 per fellow; P  < 0.0001). This reduction was significant across all three training years and for both lower and upper endoscopies ( P  < 0.0001). However, the reduction in volume was more pronounced for lower endoscopy compared to upper endoscopy [59.03 % (95 % CI: 58.2-59.86) vs 48.75 % (95 % CI: 47.96-49.54); P  < 0.0001]. The procedure volume in SP2 returned to near baseline of HP2 (total volume: 42,497 vs 43,275; mean 147.05 ± 96.36 vs 150.78 ± 99.67; P  = 0.65). Conclusions  Although there was a significant reduction in fellows' endoscopy volume in the initial stages of the pandemic, adaptive mechanisms have resulted in a return of procedure volume to near baseline without ongoing impact on endoscopy training.

Radiotherapy May Offer a Recurrence and Survival Benefit in Rectal Cancers Treated Surgically with Transanal Endoscopic Microsurgery: A Systematic Review and Meta-analysis

BACKGROUND/AIM

Several studies report outcomes of Transanal Endoscopic Microsurgery (TEMS) surgery in combination with radiotherapy, however the combination of those treatments is provided mostly on an adhoc individual basis and the role of radiotherapy remains unclear. The aim of this study was to identify the effect of neo-adjuvant or adjuvant radiotherapy in the oncological outcomes of rectal cancer treated surgically with TEMS.

MATERIALS AND METHODS

We performed a systematic review of the literature on MEDLINE and Pubmed databases. Data were extracted by two independent reviewers and meta-analyzed using an inverse variance heterogeneity model to calculate overall (pooled) effect sizes for survival or recurrence of disease against neo+/-adjuvant treatment.

RESULTS

A total of 48 studies were included in the qualitative meta-analysis which included 3,285 patients with rectal cancer. The overall survival odds ratio (OR), was 9.39 (95% CI=6.1-14.4) with a Cochran's Q variable of 151.7 on 47 degrees of freedom (d.f.) (p=0.000). Recurrence-free OR was 8.7 (95%CI=6.58-11.44) with a Cochran's Q variable of Q=145.2 on 44 d.f. (p=0.000). Studies which contained more than 10% of pT3 tumours, and provided neo+/-adjuvant treatment in more than 35% of cases, were associated with survival benefit, as demonstrated by an overall odds of survival of 32.2 (95%CI=16.3-63.5, p=0.001, Q=8.4, p=0.21). Studies that contained more than 10% of pT3 tumours and provided neo+/-adjuvant treatment in more than 20% of the cases had an overall effect size of recurrence-free odds of 20.23 (95%CI=13.84-29.57, p=0.000, Q=2.18, p=0.54).

CONCLUSION

There seems to be a benefit from radiotherapy on overall survival and recurrence-free odds, which is more apparent in cohorts with more than 10% of pT3 tumours. Our results suggest that neo-adjuvant or adjuvant radiotherapy should be considered for inclusion in formal treatment protocols for rectal cancers treated with TEMS as they offer a recurrence and survival benefit.

Serial insertion of bilateral uncovered metal stents for malignant hilar obstruction using an 8 Fr biliary system: a case series of 17 consecutive patients

Controversy exists over the need for unilateral versus bilateral stent placement in patients with malignant obstruction at the biliary hilum. Placement of bilateral uncovered self-expanding metal stent (UCSEMS) at this location is technically challenging, and generally associated with lower rates of procedural success. Serial insertion of side-by-side UCSEMS may be especially difficult when simultaneous deployment is not possible using larger stent delivery catheters. In this single-center, retrospective case series of all patients who underwent bilateral placement of uncovered Wallflex(TM) biliary stents between July 2008 and July 2014, we evaluate the feasibility, technical success, and safety of patients undergoing serial insertion of bilateral UCSEMS using the 8 Fr Wallflex(TM) biliary system for malignant hilar obstruction. A total of 17 patients were included. Primary cholangiocarcinoma, Bismuth IV, was the most common diagnosis. Mean procedure time was 54.4 minutes. Overall procedural technical success was achieved in 17/17 patients. Stricture dilation was necessary prior to Wallflex(TM) insertion in 8/17 patients (47.1%). Transpapillary extension of two stents was performed in all patients. There were no cases of stent deployment malfunction, or inability to insert or deploy the 2(nd) stent. Nine of 17 patients (52.9%) required inpatient hospitalization following ERCP; the most common indications were abdominal pain and need for IV antibiotics. There was one case of ERCP-related cholangitis otherwise; there were no other major complications. Bilateral, serial insertion of UCSEMS using the 8 Fr Wallflex(TM) biliary system in malignant hilar obstruction is feasible with an excellent technical success profile. Using this device for side-by-side deployment of UCSEMS appears to be safe in the majority of patients.

Toxic Epidermal Necrolysis Associated with Gemcitabine Therapy in a Patient with Metastatic Transitional Cell Carcinoma of the Bladder

The authors report on a case of treatment-related toxic epidermal necrolysis in an elderly man receiving chemotherapy (gemcitabine) for transitional cell carcinoma of bladder and discuss the implications of the case.

Haptic perception in anorexia nervosa before and after weight gain

Haptic perception of patients with anorexia nervosa (n = 10) was analyzed in a longitudinal study (T0-T1). The haptic explorations consisted of palpating the structure of 12 sunken reliefs in sequence with both hands, eyes closed. After each exploration the structure was reproduced on a piece of paper. In the anorexia group, mean exploration time was significantly shorter than in healthy control subjects. However, the reproductions of complex stimuli submitted by the anorexia group were of notably poorer quality than those of the healthy controls. This was also observed after weight gain (T1). The results of the haptic explorations can be interpreted as a cortical dysfunction and deficits in somatosensorical integration processing in patients with anorexia nervosa. This may be due to a disorder of tactual-spatial processing in the right parieto-occipital regions.

Deficits in haptic perception and right parietal theta power changes in patients with anorexia nervosa before and after weight gain

OBJECTIVE

Our goal was to investigate whether patients with anorexia nervosa (AN) show deficits in haptic exploration tasks before and after weight gain.

METHOD

The haptic exploration tasks consisted of palpating the structure of six sunken reliefs in sequence with both hands, eyes closed. After each exploration, the structure was reproduced on a piece of paper. A 19-channel digital electroencephalogram (EEG; linked ears) was continuously recorded during rest and haptic tasks for 10 AN patients (females, mean age: 15.90) and 10 healthy controls (CO; females, mean age: 16.14). Mean spectral power density was calculated as the mean amplitude of the spectral lines of the theta band (4-8 Hz). The AN patients were examined again after weight gain (T(0) and T(1)).

RESULTS

The reproductions submitted by the AN patients were of notably poorer quality than those of the CO. Reproduction quality was unchanged after weight gain and independent of body mass index and intelligence. Mean exploration time was similiar in AN patients and CO. The analysis of spectral EEG power of both groups showed significant decrease in power data in the theta frequency band during haptic exploration compared with the rest intervals. The comparison of the theta power between CO and AN patients during haptic exploration showed major differences between the groups in both T(0) and T(1). Theta power was lower in AN patients than in the CO over the right hemisphere and right parietal regions.

DISCUSSION

The quality of reproduction of the haptic stimuli and the theta-power changes indicate a cortical dysfunction and deficits in somatosensory integration processing of the right parietal cortex in AN patients even after weight gain.

Theta power in the EEG of humans during ongoing processing in a haptic object recognition task

Dynamic changes in spectral theta power (TP) in the EEG over frontal regions were reported previously during the processing of visually presented spatial and verbal tasks [Cereb. Cortex, 7 (1997) 374-385]. Lower TP was found at the beginning compared to the end of processing. In order to test another modality, we examined theta power during the exploration of haptic stimuli with different complexity. A linear correlation between theta power and mean exploration time (as a measure of stimulus complexity) was found at the end of exploration but not at its beginning. These data are in line with our hypothesis since one could expect minimal load of working memory independent of stimulus complexity at the beginning of exploration whereas working memory would have integrated the stimuli of differing complexity into a perceptual model at the end of exploration.

Hippocampal volume discriminates between normal cognition; questionable and mild dementia in the elderly

The sensitivity of MRI volumetric measures to detect cognitive dysfunction is examined in 39 participants of an epidemiological field study (age 75-85, MMSE 19-30). According to Clinical dementia rating (CDR), 17 subjects had normal cognition (CDR 0), 12 had questionable (CDR 0.5) and 10 mild dementia (CDR 1). Discriminant analysis based on four hippocampal measures resulted in a correct classification of 76.9% of all subjects. Left-sided and posterior hippocampal measures were more responsible for group discrimination than right-sided and anterior measures. In CDR 0.5, a significant hippocampal volume reduction of 14.3% vs.11.3% (left vs. right) relative to normal was found. The right hippocampus was significantly greater than the left in CDR 0 and CDR 0.5, but not in CDR 1. The magnitude of non-directional hippocampal asymmetry increased with decreasing cognitive state. We conclude that hippocampal atrophy is sensitive to detect cognitive dysfunction and subjects at risk for Alzheimer's disease in the elderly population.

Correlation between cortical theta activity and hippocampal volumes in health, mild cognitive impairment, and mild dementia

Cognitive decline is known to be associated with both increased theta power over frontal regions and hippocampal atrophy. The aim of this study was to reveal the relation between these parameters in groups with mild dementia, mild cognitive impairment, and healthy control subjects. The authors examined a preliminary randomly selected sample of 39 right-handed subjects joining the Leipzig Longitudinal Study of the Aged, consisting of 17 normal elderly subjects, 12 patients with mild cognitive impairment, and 10 patients with mild dementia assessed by Clinical Dementia Rating. All subjects were between 75 and 85 years old (mean age, 78 years; standard deviation, 2.78 years) and underwent EEG and brain MRI. Mean spectral power densities were calculated, and hippocampal body volume was measured. Significant negative linear correlations between theta power over frontal regions and hippocampal volumes were found. The results support the assumption about a relationship between hippocampal atrophy and theta power, and may be helpful for a better understanding of the course of Alzheimer's disease.

[Haptic perception and EEG changes in anorexia nervosa]

OBJECTIVES

We predicted that due to diminished somatosensory integrative ability, the anorectic patients would have problems reproducing haptic stimuli. In addition we sought to determine whether EEGs from anorectic patients (AN) and the healthy controls (CO) would show discrepancies between the two groups during haptic explorations in theta-power over the right parietal region.

METHOD

EEG power (theta-power) data of AN (n = 13) and CO (n = 13) were analyzed during haptic exploration tasks and rest intervals. The haptic explorations consisted of palpating the structure of six sunken reliefs in sequence with both hands, eyes closed. After each exploration the structure was drawn on a piece of paper.

RESULTS

The reproductions of haptic stimuli submitted by the anorectic patients were of notably poorer quality than those of the healthy controls. During rest intervals and haptic explorations, spectral power was generally lower in the AN group in comparison to the healthy controls. Significant theta-power differences between groups showed over the right parietal cortex during haptic explorations. The decrease in EEG power in the anorectic patients in the theta bands across the right parietal region during haptic exploration tasks could be interpreted as a minor activation of visuo-spatial regions. The results of the haptic explorations as well as the EEG-power changes indicate a cortical dysfunction and deficits in somatosensory integration processing in anorexia nervosa patients.

[Haptic perception and EEG changes in anorexia nervosa]

OBJECTIVES

We predicted that due to diminished somatosensory integrative ability, the anorectic patients would have problems reproducing haptic stimuli. In addition we sought to determine whether EEGs from anorectic patients (AN) and the healthy controls (CO) would show discrepancies between the two groups during haptic explorations in theta-power over the right parietal region.

METHOD

EEG power (theta-power) data of AN (n = 13) and CO (n = 13) were analyzed during haptic exploration tasks and rest intervals. The haptic explorations consisted of palpating the structure of six sunken reliefs in sequence with both hands, eyes closed. After each exploration the structure was drawn on a piece of paper.

RESULTS

The reproductions of haptic stimuli submitted by the anorectic patients were of notably poorer quality than those of the healthy controls. During rest intervals and haptic explorations, spectral power was generally lower in the AN group in comparison to the healthy controls. Significant theta-power differences between groups showed over the right parietal cortex during haptic explorations. The decrease in EEG power in the anorectic patients in the theta bands across the right parietal region during haptic exploration tasks could be interpreted as a minor activation of visuo-spatial regions. The results of the haptic explorations as well as the EEG-power changes indicate a cortical dysfunction and deficits in somatosensory integration processing in anorexia nervosa patients.

Power of theta waves in the EEG of human subjects increases during recall of haptic information

Several studies have reported a functional relationship between spectral power within the theta-band of the EEG (theta-power) and memory load while processing visual or semantic information. We investigated theta power during the processing of different complex haptic stimuli using a delayed recall design. The haptic explorations consisted of palpating the structure of twelve sunken reliefs with closed eyes. Subjects had to reproduce each relief by drawing it 10 s after the end of the exploration. The relationship between mean theta power and mean exploration time was analysed using a regression model. A linear relationship was found between the exploration time and theta power over fronto-central regions (Fp1, Fp2, F3, F7, F8, Fz, C3) directly before the recall of the relief. This result is interpreted in favour of the hypothesis that fronto-central theta power of the EEG correlates with the load of working memory independent of stimulus modality.

The prognosis of mild cognitive impairment in the elderly

PURPOSE

To determine whether or not subtypes of intellectual functioning are suitable to predict further cognitive decline in individuals with mild cognitive impairment.

DESIGN

Naturalistic longitudinal study (mean interval 2.7 years).

PATIENTS

41 subjects with mild cognitive impairment who attended a memory clinic.

METHODS

SIDAM, CT, SPECT, and ApoE genotype.

RESULTS

At follow-up, 8 out of 41 patients (19.5%) with MCI had progressed to dementia, 8 patients (19.5%) had improved to normal levels of cognitive functioning, 25 patients (61%) had remained stable within the MCI group. At baseline the two prognostic groups differed significantly with regard to age, memory functions, orientation, and the degree of atrophy of the left medial temporal lobe on CT scan.

CONCLUSION

The majority of MCI patients in this study remained cognitively stable within the observation period. Patients with older age, poorer test performance on memory tasks and orientation deficits are at higher risk of progressive decline to dementia. CT measures of medial temporal lobe atrophy may be a sensitive parameter of group discrimination.

Recurrent t(11;22) breakpoint mapping by chromosome flow sorting and spot-blot hybridization

The breakpoint of the recurrent t(11;22) translocation, one of the most frequent chromosome anomalies encountered in human population, always involves bands 11q23.2 and 22q11.2. The involvement of the C lambda locus of the immunoglobulin lambda gene cluster on chromosome 22 has been suggested: however, in situ hybridization experiments have yielded conflicting results. In order to solve these discrepancies by another approach, we have used bivariate flow sorting to separate the chromosomes of interest and to map the specific breakpoints by direct spot-blot hybridization with the gene-specific radiolabelled DNA probes, Alu, V lambda, ets. The results showed unambiguously that in the t(11;22) patient analysed, a set of C lambda and V lambda genes was translocated to the der(11) chromosome. Since V lambda genes are situated proximally to C lambda genes, we demonstrate that, in the case studied here, the chromosome 22 breakpoint is not located within or even immediately close to the C lambda region.

Tinea capitis due to Microsporum canis in infants

Three cases of scalp involvement by M. canis in infants are briefly reported. The first was a 2-month-old female with a few erythematous spots on the scalp, the second an 8-month-old male with lesions resembling seborrhoeic dermatitis and the third an 11-month-old male having areas of folliculitis of a kerion type. The father of the second case was found to have a tinea barbae infection due to the same fungus. Stray kittens were the most probable source of infection in all these cases.

Appearance of lupus erythematosus in a patient with lichen planus treated by isoniazide

We hereby present a case report of a patient suffering from lichen planus and who, while under treatment with isoniazide, developed skin lesions and serologic abnormality which were typical of lupus erythematosus. Laboratory data and course of the disease indicate that drugs play a role in the pathogenesis of the disease. The nature of relationship between lichen planus and lupus erythematosus is discussed.

Characterization of the glucose 6-phosphate dehydrogenase activity in rat liver mitochondria

Glucose 6-phosphate dehydrogenase activity in rat liver mitochondria can be released by detergent. The released activity is separated by chromatography into two peaks. One peak has the kinetic behaviour and mobility similar to the soluble sex-linked enzyme, whereas the other peak is similar to the microsomal hexose 6-phosphate dehydrogenase. There is no evidence for the existence of a new glucose 6-phosphate dehydrogenase activity in rat liver mitochondria.

A simple statistical analysis of Indian muntjac Giemsa band patterns

Indian Muntiacus muntjac G-banded chromosomes were used for computerized analysis for standardized karyotype generation. Individual chromosomes on high-contrast photographic negatives were scanned densitometrically. Alignment of each chromosome for analysis was achieved by locating predominant peaks as well as the centromere. This provided better alignment that the use of the chromosome-end locations. The standardized set was obtained by determing the root-mean-square average density along 10-20 homologous chromosomes. The resulting standard karyotype differs from those published earlier. Prophase chromosomes exhibited greater detail than more condensed metaphase chromosomes. Although Indian muntjac chromosomes were used as a model, the method of analysis should be readily adaptable for examining chromosomes of any origin. The analytic technique should be within the capabilities of the smallest cytogenetic laboratories.