Posterior Reversible Encephalopathy Syndrome Associated with Oxaliplatin Use for Pancreatic Adenocarcinoma

The posterior reversible encephalopathy syndrome (PRES) was first described by Hinchey’s group in 1996 as a reversible vasogenic brain edema on magnetic resonance imaging (MRI). Hypertension represents the most frequent manifestation associated with PRES. In the present report, we present a patient diagnosed with locally advanced pancreatic adenocarcinoma who received 3 cycles of a 5-fluoruracil plus oxaliplatin-based chemotherapy regimen and developed PRES after the third cycle. Several days after receiving the second cycle of FOLFOX chemotherapy, the patient started having episodes of hypertensive crisis (systolic pressure = 180, diastolic pressure = 100), that was controlled with amlodipine, irbesartan, and hydrochlorothiazide. After the administration of the third cycle, this time with the FOLFIRINOX regimen, he appeared lethargic and disoriented in place and time. MRI revealed bilateral areas of signal hyperintensity in the thalamus, hypothalamus, fibers of reticular formation, anterior section of cerebral vermis and a mild edema of left parahippocampal gyrus, with no signs of brain metastases. Ultimately, the patient was diagnosed with PRES syndrome, and he was treated with glucose, 5% saline, thiamine supplementation, levetiracetam (Keppra®), and i.v. dexamethasone. Three weeks later, he gradually became conscious, with cognitive function recovery, and capable of executing movements

Association between Helicobacter pylori Infection and Nasal Polyps: A Systematic Review and Meta-Analysis.

BACKGROUND Helicobacter pylori (H. pylori) has definite or possible associations with multiple local and distant manifestations. H. pylori has been isolated from multiple sites throughout the body, including the nose. Clinical non-randomized studies with H. pylori report discrepant data regarding the association between H. pylori infection and nasal polyps. The aim of this first systematic review and meta-analysis was the assessment of the strength of the association between H. pylori infection and incidence of nasal polyps. METHODS We performed an electronic search in the three major medical databases, namely PubMed, EMBASE and Cochrane, to extract and analyze data as per PRISMA guidelines. RESULTS Out of 57 articles, 12 studies were graded as good quality for analysis. Male-to-female ratio was 2:1, and age ranged between 17-78 years. The cumulative pooled rate of H. pylori infection in the nasal polyp group was 32.3% (controls 17.8%). The comparison between the two groups revealed a more significant incidence of H. pylori infection among the nasal polyp group (OR 4.12), though with high heterogeneity I$^{2}$ = 66%. Subgroup analysis demonstrated that in European studies, the prevalence of H. pylori infection among the nasal polyp group was significantly higher than in controls, yielding null heterogeneity. Subgroup analysis based on immunohistochemistry resulted in null heterogeneity with preserving a statistically significant difference in H. pylori infection prevalence between the groups. CONCLUSION The present study revealed a positive association between H. pylori infection and nasal polyps

Does COVID-19 Vaccination Warrant the Classical Principle " ofelein i mi vlaptin"?

The current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic warrants an imperative necessity for effective and safe vaccination, to restrain Coronavirus disease 2019 (COVID-19) including transmissibility, morbidity, and mortality. In this regard, intensive medical and biological research leading to the development of an arsenal of vaccines, albeit incomplete preconditioned evaluation, due to emergency. The subsequent scientific gap raises some concerns in the medical community and the general public. More specifically, the accelerated vaccine development downgraded the value of necessary pre-clinical studies to elicit medium- and long-term beneficial or harmful consequences. Previous experience and pathophysiological background of coronaviruses' infections and vaccine technologies, combined with the global vaccines' application, underlined the obligation of a cautious and qualitative approach, to illuminate potential vaccination-related adverse events. Moreover, the high SARS-CoV-2 mutation potential and the already aggregated genetical alterations provoke a rational vagueness and uncertainty concerning vaccines' efficacy against dominant strains and the respective clinical immunity. This review critically summarizes existing evidence and queries regarding SARS-CoV-2 vaccines, to motivate scientists' and clinicians' interest for an optimal, individualized, and holistic management of this unprecedented pandemic

Development of a woven, molded finger stock for a pressurized glove

M.S.L. Howard Olso

Recurrent acute pancreatitis secondary to a duodenal duplication cyst in an adult. A case report and literature review

Duodenal duplication cysts are rare congenital abnormalities that are most commonly diagnosed in infancy and childhood. However, in rare cases, the lesion can remain asymptomatic until adulthood. An extremely rare case of a previously healthy adult patient with recurrent acute pancreatitis, who was diagnosed with a duodenal duplication cyst is presented. At laparotomy, a duplication cyst measuring 4.8 cm × 4 cm × 4 cm was found adjacent to the ampulla of Vater. A partial cyst excision and marsupialization into the duodenal lumen was performed. The patient is healthy and asymptomatic four years after surgery. The present case illustrates the necessity of considering a duodenal duplication cyst in the differential diagnosis of recurrent acute pancreatitis in previously healthy adults

Biliary stenting alone versus biliary stenting plus sphincterotomy for the treatment of post-laparoscopic cholecystectomy biliary leaks: a prospective randomized study

Objective Although various endoscopic techniques have been proved effective in treating post-cholecystectomy biliary leaks, the choice of the best method remains controversial. The aim of this prospective study was to compare the efficacy and safety of biliary stenting alone with biliary stenting plus sphincterotomy for the treatment of post-cholecystectomy biliary leaks. Methods Patients with post-laparoscopic cholecystectomy leaks were randomized into two groups. The first group included 24 patients who were treated with a 7 Fr biliary stent alone, and the second group included 28 patients who underwent an endoscopic sphincterotomy followed by insertion of a 10 Fir biliary stent. Results Endoscopic therapy was successful in all patients (100%). Clinical improvement was observed after 2-6 days. Patients remained hospitalized for 4-12 days. Stents were removed after 6.7 (6-8) weeks. The overall complication rate was 4.16% for the first group and 10.71% for the second (P=0.615). No complications were recorded during the follow-up period. Conclusions Endoscopic therapy of biliary leaks with a small-diameter biliary stent alone is as effective and safe as endoscopic sphincterotomy followed by insertion of a large-diameter stent

Abnormal Pattern Detection in Wireless Capsule Endoscopy Images Using Nonlinear Analysis in RGB Color Space

In recent years, an innovative method has been developed for the non-invasive observation of the gastrointestinal tract (GT), namely Wireless Capsule Endoscopy (WCE). WCE especially enables a detailed inspection of the entire small bowel and identification of its clinical lesions. However, the foremost disadvantage of this technological breakthrough is the time consuming task of reviewing the vast amount of images produced. To address this, a novel technique for distinguishing pathogenic endoscopic images related to ulcer, the most common disease of GT, is presented here. Towards this direction, the Bidimensional Ensemble Empirical Mode Decomposition was applied to RGB color images of the small bowel acquired by a WCE system in order to extract their Intrinsic Mode Functions (IMFs). The IMFs reveal differences in structure from their finest to their coarsest scale, providing a new analysis domain. Additionally, lacunarity analysis was employed as a method to quantify and extract the texture patterns of the ulcer regions and the normal mucosa, respectively, in order to discriminate the abnormal from the normal images. Experimental results demonstrated promising classification accuracy (> 95%), exhibiting a high potential towards WCE-based analysis