Granulomatous Hepatitis Secondary to Histoplasmosis in an Immunocompetent Patient

Histoplasma capsulatum is the most common endemic mycosis in the United States and usually occurs in certain geographic areas, such as the Mississippi or Ohio River valleys. Histoplasmosis usually causes a mild disease in the immunocompetent but can progress to disseminated disease in patients with impaired immunity. Granulomatous hepatitis as a manifestation of disseminated histoplasmosis in immunocompetent patients is extremely rare. We report the case of a 62-year-old immunocompetent gentleman with a history of histoplasmosis who presented with abdominal pain, elevated liver enzymes, who was diagnosed with granulomatous hepatitis secondary to histoplasmosis

Small Bowel Metastasis as a Presentation of Testicular Seminoma

Testicular germ cell tumors account for 95% of testicular cancers in men with approximately 71,000 patients being diagnosed with testicular cancer every year. The overall survival of testicular germ cell tumors is approximately 95%. However, the prognosis becomes less favorable when distant metastasis is present. Gastrointestinal (GI) tract metastasis occurs in less than 5% of patients with non-seminomatous tumors, and in less than 1% in patients with pure seminomas. GI metastasis usually involves the colon, esophagus, and stomach with the most common symptoms of GI metastasis being diarrhea, nausea, vomiting, and obstruction. We discuss the case of a 42-year-old male patient with GI manifestations as the first presentation of testicular seminoma with metastasis to the small bowel. Computed tomography of the abdomen and pelvis revealed a small bowel mass, and the diagnosis was confirmed with histopathologic examination of endoscopic biopsy samples. The patient subsequently underwent chemotherapy treatment with close surveillance. Clinicians should maintain a high index of suspicion in the differential diagnosis of abdominal pain in young male patients, especially when associated with symptoms like unexplained weight loss, constitutional symptoms, and testicular pain or swelling. Metastasis to the GI tract from the testis should be promptly diagnosed and managed, as the overall survival rates can significantly decrease with the delay of diagnosis

The association between microscopic colitis and celiac disease: a systematic review and meta-analysis

BACKGROUND: Multiple studies suggested that celiac disease (CD) may be associated with microscopic colitis (MC); however, most were limited by a small sample size or the main scope of interest. We aimed to analyze previously published literature on this association to determine its extent and significance. METHODS: A systematic review was conducted in PubMed, Embase, PubMed Central, Cochrane, and ScienceDirect databases from inception through January 2022. The PRISMA guideline was followed for data extraction. Effect estimates were extracted and combined using random effect, the generic inverse variance method of DerSimonian and Laird and pooled odds ratio (OR), and event rates (ER) were calculated. The Newcastle-Ottawa scale was used to evaluate the risk of bias. Forest plots were generated and publication bias assessed via conventional techniques. RESULTS: Twenty-six studies with a total of 22,802 patients with MC were included in this analysis. CD was significantly associated with MC (odds ratio [OR] 8.276, 95% confidence interval [CI] 5.888-11.632; P\u3c0.001). The ER for MC in CD patients was 6.2% (95%CI 4.1-9.2%; P\u3c0.001), while the ER for CD in MC patients was 6.1% (95%CI 3.9-9.5%; P\u3c0.001). CD was prevalent in both types of MC: 5.2% (95%CI 2.2-12.1%; P\u3c0.001) in collagenous colitis and 6.3% (95%CI 3.4-11.5%; P\u3c0.001) in lymphocytic colitis. We found no publication bias, according to funnel plots and Egger\u27s regression asymmetry testing. CONCLUSIONS: Our meta-analysis confirms a statistically significant association between CD and MC, with a high prevalence of CD in both types of MC. Gastroenterologists should be wary of this association when evaluating patients with either disease, particularly patients with a suboptimal response to first-line therapy

Private sector opportunities and threats to achieving malaria elimination in the Greater Mekong Subregion: results from malaria outlet surveys in Cambodia, the Lao PDR, Myanmar, and Thailand.

BACKGROUND: The aim of this paper is to review multi-country evidence of private sector adherence to national regulations, guidelines, and quality-assurance standards for malaria case management and to document current coverage of private sector engagement and support through ACTwatch outlet surveys implemented in 2015 and 2016. RESULTS: Over 76,168 outlets were screened, and approximately 6500 interviews were conducted (Cambodia, N = 1303; the Lao People\u27s Democratic Republic (PDR), N = 724; Myanmar, N = 4395; and Thailand, N = 74). There was diversity in the types of private sector outlets providing malaria treatment across countries, and the extent to which they were authorized to test and treat for malaria differed. Among outlets stocking at least one anti-malarial, public sector availability of the first-line treatment for uncomplicated Plasmodium falciparum or Plasmodium vivax malaria was \u3e75%. In the anti-malarial stocking private sector, first-line treatment availability was variable (Cambodia, 70.9%; the Lao PDR, 40.8%; Myanmar P. falciparum = 42.7%, P. vivax = 19.6%; Thailand P. falciparum = 19.6%, P. vivax = 73.3%), as was availability of second-line treatment (the Lao PDR, 74.9%; Thailand, 39.1%; Myanmar, 19.8%; and Cambodia, 0.7%). Treatment not in the National Treatment Guidelines (NTGs) was most common in Myanmar (35.8%) and Cambodia (34.0%), and was typically stocked by the informal sector. The majority of anti-malarials distributed in Cambodia and Myanmar were first-line P. falciparum or P. vivax treatments (90.3% and 77.1%, respectively), however, 8.8% of the market share in Cambodia was treatment not in the NTGs (namely chloroquine) and 17.6% in Myanmar (namely oral artemisinin monotherapy). In the Lao PDR, approximately 9 in 10 anti-malarials distributed in the private sector were second-line treatments-typically locally manufactured chloroquine. In Cambodia, 90% of anti-malarials were distributed through outlets that had confirmatory testing available. Over half of all anti-malarial distribution was by outlets that did not have confirmatory testing available in the Lao PDR (54%) and Myanmar (59%). Availability of quality-assured rapid diagnostic tests (RDT) amongst the RDT-stocking public sector ranged from 99.3% in the Lao PDR to 80.1% in Cambodia. In Cambodia, the Lao PDR, and Myanmar, less than 50% of the private sector reportedly received engagement (access to subsidized commodities, supervision, training or caseload reporting), which was most common among private health facilities and pharmacies. CONCLUSIONS: Findings from this multi-country study suggest that Cambodia, the Lao PDR, Myanmar, and Thailand are generally in alignment with national regulations, treatment guidelines, and quality-assurance standards. However, important gaps persist in the private sector which pose a threat to national malaria control and elimination goals. Several options are discussed to help align the private sector anti-malarial market with national elimination strategies

Multiple Primary Malignancies in Gynecologic Cancer Patients in Thai Tertiary Care Center: a 10-Year Retrospective Study

Objective: To investigate the incidence, pathologic features, clinical characteristics, oncologic outcomes, and prognostic factors in gynecologic cancer patients with multiple primary malignant tumors (MPMT). Methods: This single-center retrospective study included the medical records of gynecologic cancer patients diagnosed with MPMT according to Warren and Gates’s criteria who were treated at the Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Siriraj Hospital during January 2006 and December 2016. Relevant demographic, clinical, and pathologic data were collected and analyzed. Results: Of 8,076 cases of gynecologic cancer during the study period, 146 women with MPMT were included. Ninety-four women had multiple primary gynecologic cancers (MPGC), and 52 had gynecologic cancer coexisting with non-gynecologic cancer (GNC). The prevalence of MPGC was 1.2%. Synchronous cancer, nulliparous, premenopause, and early stage of endometrial and ovarian cancer were significantly more common among MPGC than GNC. Five-year recurrence-free survival (RFS) was significantly longer in the MPGC group (87.3% vs. 79.6%). Coexisting endometrial and ovarian cancer was the most frequently observed MPGC, with a 5-year overall survival (OS) and RFS of 98.1% and 86.0%, respectively. Specific to this cancer combination, residual tumor and depth of myometrial invasion were found to be independently associated with shorter RFS. Conclusion: The prevalence of MPGC in this study was 1.2%. Five-year RFS was significantly longer among MPGC than among GNC. Three-quarters of MPGC patients had synchronous endometrial-ovarian cancer. Residual tumor and the depth of myometrial invasion were identified as prognostic factors that were independently associated with RFS in the patients with synchronous endometrial-ovarian cancer

Supramolecular architecture from nucleoside derivatives

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

C=C Excel spreadsheets to calculate binding constants and associated p-values for 2:1 binding alkynyl cytosine receptor

<p>Supplementary Information to:</p> <p>"Apparent non-statistical binding in a ditopic receptor for guanosine". Org. Biomol. Chem.  2009, 7, 2093-2103. doi: 10.1039/b812969j</p> <p> </p> <p>Excel spreadsheets allowing the calculation of binding constanst and p-values for guanosine (G) binding to cytosine (C) and ditopic cytosine receptors.  Determination of cooperativity.</p> <p> </p> <p> </p