Multiple cystic echinococcosis mimicking metastatic malignancy

AbstractCystic echinococcosis is seen worldwide. Considerable public health problems are encountered in endemic areas, such as South and Central America, the Middle East, sub-Saharan Africa, Russia, China, Australia and New Zealand. We have presented a case of innumerable cystic echinococcosis of lung and liver. The multiple lesions of cystic echinococcosis in chest X-ray graphy can imitate the metastatic malignancy of lung

New Horizons in the Genetic Etiology of Systemic Lupus Erythematosus and Lupus-Like Disease: Monogenic Lupus and Beyond

Systemic lupus erythematosus (SLE) is a clinically and genetically heterogeneous autoimmune disease. The etiology of lupus and the contribution of genetic, environmental, infectious and hormonal factors to this phenotype have yet to be elucidated. The most straightforward approach to unravel the molecular pathogenesis of lupus may rely on studies of patients who present with early-onset severe phenotypes. Typically, they have at least one of the following clinical features: childhood onset of severe disease (\u3c5 \u3eyears), parental consanguinity, and presence of family history for autoimmune diseases in a first-degree relative. These patients account for a small proportion of patients with lupus but they inform considerable knowledge about cellular pathways contributing to this inflammatory phenotype. In recent years with the aid of new sequencing technologies, novel or rare pathogenic variants have been reported in over 30 genes predisposing to SLE and SLE-like diseases. Future studies will likely discover many more genes with private variants associated to lupus-like phenotypes. In addition, genome-wide association studies (GWAS) have identified a number of common alleles (SNPs), which increase the risk of developing lupus in adult age. Discovery of a possible shared immune pathway in SLE patients, either with rare or common variants, can provide important clues to better understand this complex disorder, it\u27s prognosis and can help guide new therapeutic approaches. The aim of this review is to summarize the current knowledge of the clinical presentation, genetic diagnosis and mechanisms of disease in patents with lupus and lupus-related phenotypes

Inter-Observer Agreement on Diffusion-Weighted Magnetic Resonance Imaging Interpretation for Diagnosis of Acute Ischemic Stroke Among Emergency Physicians

SUMMARYObjectivesDiffusion-weighted magnetic resonance imaging (DW-MRI) is a highly sensitive tool for the detection of early ischemic stroke and is excellent at detecting small and early infarcts. Nevertheless, conflict may arise and judgments may differ among different interpreters. Inter-observer variability shows the systematic difference among different observers and is expressed as the kappa (Κ) coefficient. In this study, we aimed to determinate the inter-observer variability among emergency physicians in the use of DW-MRI for the diagnosis of acute ischemic stroke.MethodsCranial DW-MRI images of 50 patients were interpreted in this retrospective observational cross-sectional study. Patients who were submitted to DW-MRI imaging for a suspected acute ischemic stroke were included in the study, unless the scans were ordered by any of the reviewers or they were absent in the system. The scans were blindly and randomly interpreted by four emergency physicians. Inter-observer agreement between reviewers was evaluated using Fleiss’ Κ statistics.ResultsThe mean kappa value for high signal on diffusion-weighted images (DWI) and for reduction on apparent diffusion coefficient (ADC) were substantial (k=0.67) and moderate (k=0.60) respectively. The correlation for detection of the presence of ischemia and location was substantial (k: 0.67). There were 18 false-positive and 4 false-negative evaluations of DWI, 15 false positive and 8 false-negative evaluations of ADC.ConclusionsOur data suggest that DW-MRI is reliable in screening for ischemic stroke when interpreted by emergency physicians in the emergency department. The levels of stroke identification and variability show that emergency physicians may have an acceptable level of agreement

Psychiatric co-morbidity and attachment styles in obese adults: A comparative study with healthy volunteers

INTRODUCTION: Psychiatric co-morbidity and attachment issues are prevalent in obese patients. A possible relationship between insecure attachment styles and eating disorder risk has been proposed. The aim of this study is to determine the psychiatric co-morbidity, attachment styles and related risk factors in obese patients. METHODS: Obese patients with body mass index of 30 kg/m2 or higher and non-obese controls matched for age, sex and education were included with a total sample of 173 participants. Diagnostic assessment using Structured Clinical Interview for DSM-IV Axis I Disorders and the Adult Attachment Scale, Hamilton Depression, and Hamilton Anxiety scales were carried out. Attachment styles were classified as anxious/ambivalent, avoidant and secure. The anxious/ambivalant and avoidant groups were combined and compared with the secure group. RESULTS: Fifty three (40.8%) obese patients had psychiatric disorders including major depression (n=44; 33.8%). Anxiety was found to be a risk factor with obesity and BMI in both patients with or without any psychiatric co-morbidity. Psychiatric co-morbidity was significantly higher in obese patients (40.8%) than controls (18.6%). 55.4% of the participants had insecure attachment styles, it was significantly higher in obese patients. Insecure attachment styles were higher with psychiatric co-morbidity. DISCUSSION AND CONCLUSION: Psychiatric co-morbidity and insecure attachment styles were prevalent in obese patients, and the symptom of anxiety was found to be a predictor of obesity and body mass index. Psychiatric examinations including attachment styles and anxiety will help to advance better treatment strategies for obese patients

Bile reflux index after therapeutic biliary procedures

Research articl

Evaluation of e148q and concomitant aa amyloidosis in patients with familial mediterranean fever

The aim of the study was to compare the clinical phenotype of patients with familial Mediterranean fever (FMF)-related AA amyloidosis, according to the age of FMF diagnosis and E148Q genotype. Patients with biopsy-confirmed FMF-related AA amyloidosis were included in the study. Tel-Hashomer criteria were applied in the diagnosis of FMF. All patients had detailed baseline assessment of clinical features, renal functions, genetic testing, histopathological diagnosis of amyloidosis, and treatment received. Multiple comparisons were performed according to the age of diagnosis, disease phenotype, mutation, and mortality. Our study included 169 patients with a diagnosis of AA amyloidosis. There were 101 patients diagnosed with FMF \u3c 18 years of age and 68 patients diagnosed who were ≥18 years of age. The three most common clinical manifestations were fever (84.6%), abdominal pain (71.6%), and arthritis (66.9%). The most common allele among FMF patients was M694V (60.6%), followed by E148Q (21.4%), and M680I (10.3%). The most frequent genotypes were M694V/M694V (45.0%), M694V/E148Q (14.8%), and E148Q/E148Q (11.2%) among 169 patients in our cohort. During the follow-up period, 15 patients (10 male, 5 female) died, of whom 14 had M694V homozygous genotype and one was homozygous for E148Q. Clinicians should be aware of patients with homozygous E148Q genotype for close monitoring and further evaluation. The possible relationship between E148Q and AA amyloidosis needs to be confirmed in other ethnicities