Proton pump inhibitors, antibiotics, and atopy increase the risk of eosinophilic esophagitis in children with esophageal atresia

OBJECTIVE

To determine whether proton pump inhibitor (PPI) exposure is associated with an increased risk of developing eosinophilic esophagitis (EoE) in children with esophageal atresia (EA).

STUDY DESIGN

A retrospective chart review of children with EA from January 1, 2005 to December 31, 2020 was undertaken at Sydney Children's Hospital Randwick. Children with EA and EoE (cases) were matched (1:2) to children with only EA (controls) to compare PPI exposure. Other early-life factors such as infantile antibiotic exposure and personal or family history of atopy were also analyzed using simple and multivariable logistic regression.

RESULTS

Of 184 children with EA, 46 (25%) developed EoE during this period. Thirty-eight EoE participants were matched to 76 controls. Children with EoE and EA received PPI for significantly higher durations (p = .018) and at significantly higher cumulative doses (p = .017) than controls. Food allergy (adjusted odds ratio [aOR], 7.317; 95% confidence interval [CI], 2.244-23.742), family history of atopy (aOR, 3.504; 95% CI, 1.268-9.682), and infantile antibiotic exposure (aOR, 1.040; 95% CI, 1.006-1.075) were also significantly associated with an increased risk of developing EoE in the EA cohort.

CONCLUSIONS

Prolonged duration and high cumulative dose of PPI exposure were significantly associated with subsequent EoE development in children with EA. Food allergy, family history of atopy, and infantile antibiotic exposure in EA were also significantly associated with an increased risk of EoE development.

Retrospective characterisation and outcome of surgical treatment for cervical lymph node abscessation in 15 dogs

CASE HISTORIES

Medical records of a private referral hospital (Veterinary Emergency Clinic, Toronto, Canada) and a university teaching hospital (Louisiana State University, Baton Rouge, LA, USA) were reviewed, using the search terms lymphadenectomy, lymph node extirpation, cervical lymphadenitis, and lymph node abscessation. Dogs (n = 15) with a diagnosis of cervical lymph node abscessations confirmed through histopathology that underwent surgery for treatment from January 2015-May 2022 were included in the study. Long-term follow-up data was obtained by an in-person visit or telephone interview with each owner. Dogs that met the inclusion criteria were of various breeds with a median age of 6 (min 0.5, max 12) years. All cases presented with cervical swelling and lethargy, with inappetence and fever in 5/15 dogs. The range of duration of clinical signs prior to treatment was 1-3 weeks. Seven dogs were treated with a short course of antibiotics, with or without prednisone, without successful resolution, before referral.

CLINICAL FINDINGS

Diagnostic imaging using CT or cervical ultrasound revealed enlargement of unilateral mandibular and retropharyngeal lymph nodes with regional cellulitis and oedema in four dogs, enlargement of unilateral retropharyngeal lymph nodes with regional cellulitis in eight dogs, and a right ventral cervical abscess infiltrating the right medial retropharyngeal lymph nodes with oedema in one dog. Unilateral or bilateral cervical lymph node abscessation was diagnosed by lymphadenectomy and histopathology of affected lymph nodes. Bacterial cultures from samples of excised lymph nodes were positive in six cases.

TREATMENT AND OUTCOME

Cervical exploration and lymphadenectomy were performed in all cases. Thirteen dogs received antibiotics along with surgical treatment. Resolution was defined as absence of cervical swelling or enlarged lymph node(s) at the time of long-term follow-up (median 300 (min 240, max 1,072) days). Most patients had resolution of clinical signs following surgical excision of affected lymph nodes. Two dogs had complications including recurrence of clinical signs and development of open wounds following surgery. Their clinical signs resolved following additional administration of antibiotics.

CONCLUSIONS AND CLINICAL RELEVANCE

All dogs in this series had lymphadenectomy of abscessed lymph nodes and showed resolution of clinical signs with a favourable outcome. As 13/15 dogs also received antibiotics in conjunction with surgical treatment, appropriate use of antimicrobials may also play a role in treatment of this disease process.

Collision in the colon: concurrent adenocarcinoma and diffuse large B-cell lymphoma in the same tumour

Double malignancies in the gastrointestinal tract are unusual. Concurrent lymphoma and adenocarcinoma is a rare clinical condition. We herein report a collision tumour which first presented with a diffuse large B-cell lymphoma in the skull base and ileocecal junction area. After rituximab and chemotherapy the skull base tumour disappeared, but the ileocecal lesion remained. A biopsy revealed the presence of adenocarcinoma in the same lesion. The tumour was surgically removed. Further microscopic examination of the tumour showed it was an adenocarcinoma but residual lymphoma cell infiltration could still be observed. Serum Epstein-Barr virus (EBV) was detected at diagnosis of lymphoma and the concentration further elevated at diagnosis of adenocarcinoma. Therefore, both lymphoma and carcinoma may be EBV related. Our experience illustrated that such collision tumours are rare and difficult in diagnosis. Clinicians and pathologists should be aware of such an association in order to make a correct diagnosis and initiate proper treatment.

Isolation of a novel candidate oncogene within a frequently amplified region at 3q26 in ovarian cancer

Amplification of 3q25-q26 was one of the most frequent chromosomal alterations in human ovarian carcinoma. A chromosome microdissection-hybrid selection method was applied to isolate transcribed sequences from a primary ovarian cancer containing high-copy-number amplification of 3q26 using 3q26 band-specific DNAs generated by chromosome microdissection. Using this method, we have isolated a novel candidate oncogene eIF-5A2 (eukaryotic initiation factor 5A2). eIF-5A2 shares 82% identity of amino acid sequence with eIF-5A including the minimum domain needed for eIF-5A maturation by hypusine modification at lysine-50 residue. Amplification and overexpression of eIF-5A2 was frequently detected in primary ovarian cancers and ovarian cancer cell lines. The proliferation-related function of eIF-5A supports that eIF-5A2 is a candidate oncogene related to the development of ovarian cancer.

Community study of depression in old age in Taiwan: prevalence, life events and socio-demographic correlates

BACKGROUND

Published studies of prevalence of depression in old age in Taiwan have yielded equivocal results.

AIMS

To study the prevalence of depressive disorders among community-dwelling elderly; further, to assess socio-demographic correlates and life events in relation to depression.

METHOD

A randomised sample of 1500 subjects aged 65 and over was selected from three communities. Research psychiatrists conducted all assessments using the Geriatric Mental State Schedule. The diagnosis of depression was made with the GMS-AGECAT (Automated Geriatric Examination for Computerised Assisted Taxonomy); data on life events were collected with the Taiwanese version of the Life Events and Difficulties Schedule.

RESULTS

One-month prevalence of psychiatric disorders was 37.7%, with 15.3% depressive neurosis and 5.9% major depression. A high risk of depressive disorders was found among widows with a low educational level living in the urban community, and among those with physical illnesses.

CONCLUSIONS

Contrary to most previous reports, we found that the prevalence of depressive disorders among the elderly in the community in Taiwan is high and comparable to rates reported in some studies of UK samples.

Validation of the Chinese Health Questionnaire (CHQ-12) in community elders

There has been no validated screening instrument for use in non-psychotic illness of the elderly in Taiwan. This study aims to test the validity of the 12-item Chinese Health Questionnaire (CHQ-12) among the elderly in a community study. The CHQ-12 was administrated via reading-out to 222 subjects aged 65 and over from three communities. Psychiatrists using the Geriatric Mental Status Schedule (GMS) assessed psychiatric condition while the diagnosis was made according to the computerized program, AGECAT. Validity indices of the CHQ-12 were calculated, using the Relative Operating Characteristic (ROC) analysis for its optimal cut-off point. Variables hypothesized to affect its performance were assessed. Validity of the CHQ-12 at optimal cut-off point 2/3 were estimated with a sensitivity of 79.7%, a specificity of 83.6%, a positive predictive value of 68.9%, a negative predictive value of 90.0% and an overall misclassification rate of 17.6%, and an estimate of the area under the ROC curve of 0.81. The performance of the CHQ-12 was better in males, in those who were literate, and in those without any physical illness. This study demonstrated that the use of CHQ-12 in the elderly community is as valid as in the general population survey. However, it should be read out by the investigator rather than self-administered due to the high proportion of illiteracy among the Taiwanese elderly.