Endoscopic Ultrasound Assessment of the Duodenal Wall Lesions

Subepithelial tumors (SETs) in the upper digestive tract are rare and only 10% of are located in the duodenum. Assessment of lesions protruding from the duodenal wall is difficult. Upper gastrointestinal (GI) endoscopy and computed tomography (CT) are not able to completely distinguish between different tumors and guide their subsequent management. Endoscopic ultrasonography (EUS) has a significant diagnostic yield in this context. EUS is able to accurately diagnose duodenal lesions, perform a biopsy if considered useful, guide the approach for resection and provide appropriate follow-up. SETs reported during upper GI endoscopy are more commonly cysts, polyps, lipomas, Brunner’s gland adenoma, ectopic pancreas, gastrointestinal stromal tumors (GISTs) or neuroendocrine tumors (NETs). In addition, although more rarely, adenocarcinomas and lymphomas can be identified. EUS should be performed for any duodenal lesion larger than 1 cm that lacks the endoscopic characteristics of a cyst or a lipoma

Carbamazepine-induced DRESS syndrome: a case report

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a potentially life-threatening, idiosyncratic, acute adverse drug reaction. Fever, morbilliform cutaneous eruption, and eosinophilia are essential features for the diagnosis of this syndrome, along with significant multisystem involvement, hepatitis being the most common, followed by nephritis. The pathogenesis of DRESS syndrome is not yet fully understood. Several hypotheses have been proposed which support the involvement of an intricate interplay of multiple factors. We report a clinical case of DRESS syndrome with renal injury, induced by carbamazepine, in a patient with alcohol abstinence syndrome. In order to define the case, the RegiSCAR score and the Japanese Group score, used in the diagnosis of drug-induced hypersensitivity, were applied. DRESS syndrome is a potentially fatal disease, with a mortality that can reach up to 40% of cases. This condition endangers the patient\u27s life by affecting the internal organs, mainly the liver, kidneys, heart, and lungs. Our case attempts to increase awareness among physicians about this serious disease and the importance of early diagnosis, especially since carbamazepine is a commonly used anticonvulsant drug

Novel Concepts in Systemic Sclerosis Pathogenesis: Role for miRNAs

Systemic sclerosis (SSc) is a rare connective tissue disease with heterogeneous clinical phenotypes. It is characterized by the pathogenic triad: microangiopathy, immune dysfunction, and fibrosis. Epigenetic mechanisms modulate gene expression without interfering with the DNA sequence. Epigenetic marks may be reversible and their differential response to external stimuli could explain the protean clinical manifestations of SSc while offering the opportunity of targeted drug development. Small, non-coding RNA sequences (miRNAs) have demonstrated complex interactions between vasculature, immune activation, and extracellular matrices. Distinct miRNA profiles were identified in SSc skin specimens and blood samples containing a wide variety of dysregulated miRNAs. Their target genes are mainly involved in profibrotic pathways, but new lines of evidence also confirm their participation in impaired angiogenesis and aberrant immune responses. Research approaches focusing on earlier stages of the disease and on differential miRNA expression in various tissues could bring novel insights into SSc pathogenesis and validate the clinical utility of miRNAs as biomarkers and therapeutic targets