Current Issue : July - September Volume : 2019 Issue Number : 3 Articles : 6 Articles
Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors of the gastrointestinal tract. The major cause of GIST is the\npresence of an abnormal form of tyrosine protein kinase (KIT) protein also known as CD117, which causes uncontrollable\ngrowth of the gastrointestinal cells. Most studies report incidences between 10 and 15 cases of GISTs per million. Metastases to\nthe liver and peritoneum are the most frequent. We report a case of advanced GIST with a liver metastasis infiltrating the\ninferior vena cava (IVC) and extending to the right atrium in the form of a large, floating, isolated intracardiac liver metastasis\nwith diastolic prolapsing through the tricuspid valve. This is a very rare manifestation. One week after heart surgery and\nremoval of a 5* 6cm tumor mass from the right atrium and the IVC, echocardiography depicted an early recurrence....
Background: Sustainable Development Goals set a challenge for the elimination of hepatitis B virus (HBV) infection\nas a public health concern by the year 2030. Deployment of a robust prophylactic vaccine and enhanced interventions\nfor prevention of mother to child transmission (PMTCT) are cornerstones of elimination strategy. However, in light of\nthe estimated global burden of 290 million cases, enhanced efforts are required to underpin optimisation of public\nhealth strategy. Robust analysis of population epidemiology is particularly crucial for populations in Africa made\nvulnerable by HIV co-infection, poverty, stigma and poor access to prevention, diagnosis and treatment.\nMethods: We here set out to evaluate the current and future role of HBV vaccination and PMTCT as tools for\nelimination. We first investigated the current impact of paediatric vaccination in a cohort of children with and\nwithout HIV infection in Kimberley, South Africa. Second, we used these data to inform a new parsimonious model\nto simulate the ongoing impact of preventive interventions. By applying these two approaches in parallel, we are able\nto determine both the current impact of interventions, and the future projected outcome of ongoing preventive\nstrategies over time.\nResults: Existing efforts have been successful in reducing paediatric prevalence of HBV infection in this setting to\n< 1%, demonstrating the success of the existing vaccine campaign. Our model predicts that, if consistently deployed,\ncombination efforts of vaccination and PMTCT can significantly reduce population prevalence (HBsAg) by 2030, such\nthat a major public health impact is possible even without achieving elimination. However, the prevalence of HBV\ne-antigen (HBeAg)-positive carriers will decline more slowly, representing a persistent population reservoir. We show\nthat HIV co-infection significantly reduces titres of vaccine-mediated antibody, but has a relatively minor role in\ninfluencing the projected time to elimination. Our model can also be applied to other settings in order to predict\nimpact and time to elimination based on specific interventions.\nConclusions: Through extensive deployment of preventive strategies for HBV, significant positive public health impact\nis possible, although time to HBV elimination as a public health concern is likely to be substantially longer than that\nproposed by current goals....
Background and Aims. We aimed to assess whether chronic statins used (> 6 months) were protective of the development of\nesophagitis in patients with gastroesophageal reflux disease. In the presence of esophagitis, complications such as strictures,\nBarrett's esophagus, and adenocarcinoma were themost common. Statins, lipid lowering drugs with a pleiotropic effect, are recently\nimplicated in various pathologies. Nevertheless, the possible impact of statins in esophagitis development has never been assessed.\nMethods. We performed a retrospective, cross-sectional, single center study that included 4148 gastroesophageal reflux disease\npatients from2014 and 2018 at EMMS Nazareth Hospital.We divided the patients into 5 groups. The groups were split into positive\ncontrol group, which was the nonesophagitis group, and the other 4 groups were A-D (as per Los Angeles classification). Results.\nOverall, out of the 4148 patients included, 48% were males and 2840 patients were in the control group. In groups A, B, C, and D\nthere were 818, 402, 72, and 16 patients, respectively. Logistic regression analysis revealed that chronic statins usage is protective\nby preventing development esophagitis (OR 0.463 [95%CI 0.370â??0.579], p < 0.0001). NSAIDS use, Hiatus hernia, and H. pylori\nwere promoting factors (OR, 1.362, 1.779, and 1.811; 95% CI, 1.183-1.569, 1.551-2.040, and 1.428-2.298; P<0.0001, P<0.0001, and\nP<0.0001, respectively). Conclusion. Using chronic statins was protective to the development of esophagitis among GERD patients.\nOur findings of potential clinical application mandate further randomized controlled trials to better assess the impact of statins on\nesophagitis....
Non-cirrhotic portal hypertension (NCPH) comprises a heterogeneous group of liver disorders causing portal hypertensionwithout\ncirrhosis and carries a high risk of variceal bleeding. Recent guidelines, based largely on patients with viral cirrhosis, suggest low\nlikelihood of high risk varices (HRV) in patients with a liver stiffness measurement (LSM) <20 kPa and platelet count >150 Ã? 10^9/L.\nIn NCPH, LSMis often higher than healthy controls but lower than matched cirrhotic patients. The aim of this study was to assess\nwhether LSMor other noninvasive assessments of portal hypertension could predict HRV in NCPH patients. Methods. Records of\npatients with NCPH seen at a single centre between 2007 and 2018 were reviewed retrospectively. Primary outcome measure was\npresence or absence of HRV at gastroscopy within 12 months of clinical assessment. Association of LSM or other clinical features\nof portal hypertension (spleen size, platelet count, platelet count/spleen length ratio (PSL), LSM-spleen length/platelet count ratio\nscore (LSP)) with HRV and ability of these variables to predict HRV was analysed. Results. Of 44 patients with NCPH who met\ninclusion criteria, 34% (15/44) had HRV. In amultivariate model, spleen size and PSL correlated with HRV but platelet count, LSM,\nand LSP did not (spleen size................................
Background: Acute intestinal ischemia is an abdominal suffering occasioned\nby a sudden reduction of mesenteric blood circulation. It is a rare and potentially\nserious medical-surgical emergency, deadly in 50% to 100% of cases. Diagnosis\nis known to be difficult at the early stage during which a well-conducted treatment\nmay help reduce mortality. Multi-detector scanners were assessed to be\nfar more sensitive and appropriate for the diagnosis of mesenteric ischemia\nthan angiography. Objective: Study the tomodensitometric aspects of acute\nintestinal ischemia, and the traps of late diagnosis, in order to optimize the\ncare and improve the prognosis of this disease. Patients and Methods: This\nis a prospective, longitudinal and descriptive study covering a period of nine\n(9) months. We have included all cases of acute intestinal ischemia. Results:\nTwenty (20) cases of acute intestinal ischemia were registered i.e. a frequency\nof 2.2 cases per month. The average age of the patients was 67.8 years with 0.7\nas sex ratio. Abdominal pain was noted in all cases. History of cardiovascular\ndisease was found in seven (7) cases. Abdominal angioscan was performed in\nfifteen (15) cases. There was a suspected diagnosis upon request in ten (10)\ncases. The main intestinal lesions were the lack of parietal enhancement (13\ncases) and parietal thickening (12 cases). There were sixteen (16) cases of\nacute mesenteric ischemia and four (4) cases of ischemic colitis. The acute\nmesenteric ischemia was arterial in eleven (11) cases, venous in two (2) cases\nand mixed in two (2) cases. Diagnosis was made at the stage of intestinal infarction\nin eleven (11) cases. Ten (10) patients were operated and 10 others\nwere treated medically. Thirteen (13) cases of death were registered. Conclusion:\nAcute intestinal ischemia is a rare but serious disease. Abdominal pain\nis the main ground for consultation. Diagnosis is often late and focuses on abdominal\nCT angiography. An early diagnosis could help improve its prognosis....
Background and Aim: Most studies focused on the benefits of weight loss on hepatic\nsteatosis and no studies have been specifically designed to assess the role of weight gain on the\ndevelopment of liver steatosis in patients affected by inflammatory bowel diseases. The aim of this\nstudy was to analyse the relation between weight change over time and liver steatosis in patients with\ninflammatory bowel diseases. Methods: We retrospectively evaluated a population of 89 ambulatory\npatients in clinical remission or affected by mild disease, as determined from disease activity indices,\nwith at least one follow-up visit. Transient elastography was used to quantify liver steatosis. Results:\nA total of 49 individuals (55%) were overweight/obese at baseline. A significant difference in weight\nchange was found between participants that improved, were stable and worsened, over a mean\nfollow-up of four years..........................
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