Luminescent Supramolecular Metallogels: Drug Loading and Eu(III) as Structural Probe.

Supramolecular metallogels combine the rheological properties of gels with the color, magnetism, and other properties of metal ions. Lanthanide ions such as Eu(III) can be valuable components of metallogels due to their fascinating luminescence. In this work, we combine Eu(III) and iminodiacetic acid (IDA) into luminescent hydrogels. We investigate the tailoring of the rheological properties of these gels by changes in their metal:ligand ratio. Further, we use the highly sensitive Eu(III) luminescence to obtain information about the chemical structure of the materials. In special, we take advantage of computational calculations to employ an indirect method for structural elucidation, in which the simulated luminescent properties of candidate structures are matched to the experimental data. With this strategy, we can propose molecular structures for different EuIDA gels. We also explore the usage of these gels for the loading of bioactive molecules such as OXA, observing that its aldose reductase activity remains present in the gel. We envision that the findings from this work could inspire the development of luminescent hydrogels with tunable rheology for applications such as 3D printing and imaging-guided drug delivery platforms. Finally, Eu(III) emission-based structural elucidation could be a powerful tool in the characterization of advanced materials.

Inflammatory myofibroblastic tumor presenting as a subepithelial lesion of the colon.

We present the case of a 42-year-old male admitted to the emergency department for a 15-day history of diarrhea, with bloody stools in the past 7 days. The patient denied abdominal pain or distension as well as any constitutional symptoms. On physical examination he presented good general health condition, with abdomen slightly tender in the lower quadrants; digital rectal examination was remarkable for the presence of dark blood. Laboratory evaluation revealed new onset normocytic anemia (Hb 10.8 g/dL, MCV 89 fL) and RCP of 3.3 mg/dL. Colonoscopy was performed, which showed a large cecal subepithelial lesion, with surface ulcerations. Histology reported mixed inflammatory infiltrate but no malignancy. Further investigation was carried out with an abdominal and pelvic computerized tomography that, other than the cecal mass, showed multiple infracentimetric mesenteric lymph nodes. A right laparoscopic hemicolectomy was performed. Pathological analysis led to the unusual diagnosis of inflammatory myofibroblastic tumor (IMT) of the colon. There was no sign of recurrence after 6 months of follow-up.

Colonic Kaposi's sarcoma as the first clinical manifestation of undiagnosed HIV.

A 52-year-old male, without significant past medical history, is referred for new onset constipation, hematochezia and significant weight loss. Blood tests were unremarkable. A colonoscopy was performed, showing reddish, hematocystic and friable mucosa in a circumferential pattern in the rectum, with similar patches throughout the whole colon, one of them infiltrating the ileocecal valve. Biopsies were obtained and revealed spindle cell proliferation immunoreactive for CD34 and herpesvirus 8 (HHV-8), compatible with Kaposi's sarcoma (KS). HIV serologies were subsequently done, with a positive result, the patient then reporting previous heterosexual unprotected sexual activities. He was started on highly active antiretroviral therapy (HAART) and chemotherapy with liposomal doxorubicin, with a favorable outcome to this date. KS is a low-grade tumor of the vascular endothelium that requires infection with HHV-8. HIV-related KS is more commonly diagnosed in homosexual males with uncontrolled HIV infection and is associated with a variable clinical course. The gastrointestinal tract is involved in up to 51% of patients, but since the majority is clinically silent (70%), visceral involvement is probably underestimated. The treatment goal is symptomatic relief, and may range from HAART alone to a combination with systemic chemotherapy, depending on disease extent. We present this case given its endoscopic exuberance, with biopsies showing an HIV-defining condition, in a patient unaware of his diagnosis.

Consequences of thimerosal on human erythrocyte hemoglobin: Assessing functional and structural protein changes induced by an organic mercury compound.

BACKGROUND: Thimerosal (TM) is an organic mercury compound used as a preservative in many pharmacological inputs. Mercury toxicity is related to structural and functional changes in macromolecules such as hemoglobin (Hb) in erythrocytes (Ery). METHOD: Human Hb and Ery were used to evaluate O2 uptake based on the TM concentration, incubation time, and temperature. The influence of TM on the sulfhydryl content, production of reactive oxygen species (ROS), and membrane fragility was also evaluated. Raman spectra and atomic force microscopy (AFM) profiles for Ery in the presence and absence of TM were calculated, and docking studies were performed. RESULTS: At 37 °C, with 2.50 µM TM (higher concentration) and after 5 min of incubation in Hb and Ery, we observed a reduction in O2 uptake of up to 50 %, while HgCl2, which was used as a positive control, showed a reduction of at least 62 %. Total thiol assays in the presence of NEM (thiol blocker) quantified the preservation of almost 60 % of free SH in Ery. Based on the Raman spectrum profile from Ery-TM, structural differences in the porphyrinic ring and the membrane lipid content were confirmed. Finally, studies using AFM showed changes in the morphology and biomechanical properties of Ery. Theoretical studies confirmed these experimental results and showed that the cysteine (Cys) residues present in Hb are involved in the binding of TM. CONCLUSION: Our results show that TM binds to human Hb via free Cys residues, causing conformation changes and leading to harmful effects associated with O2 transport.

Tuning the luminescence efficiency by perfluorination of side chains in Eu3+ complexes with ß-diketones of the thiophene series.

A series of europium and gadolinium complexes comprising a ß-diketone moiety modified with a fluorinated side-group and thiophene ring have been designed and synthesized and a comparative study of their luminescence properties has been carried out. In this study, when the methyl side group was modified by sequential addition of fluorine substituents and then the perfluorinated carbon chain was extended up to n-C8F17 by adding CF2 fragments, it transpired that the non-radiative energy processes are significantly suppressed in structurally more rigid polyfluorinated ß-diketonate compounds of the series as C-H oscillators are replaced with low-energy C-F oscillators. The impact of other electron-withdrawing and electron-donating substituents on the spectroscopic and photophysical properties of the complexes in the present study has also been observed. Despite the presence of low-lying ligand-to-metal charge transfer states, the fluorinated Eu3+ complexes proved to be bright luminophores capable of delivering ca. 50% quantum yield under UV radiation. The role of fluorination and carbon chain length was examined by using experimental spectroscopic methods and the results obtained were largely in good agreement with theoretical calculations (Judd-Ofelt theory analysis, and semiempirical quantum chemistry calculations) supporting our key experimental findings.

Lower Gastrointestinal Bleeding Associated With Sodium Polystyrene Sulfonate Use.

Sodium polystyrene sulfonate (kayexalate) is a cation-exchange resin widely used in the management of hyperkalemia. Gastrointestinal adverse events are uncommon; symptoms are nonspecific, and mucosal injury can range from mild ulceration to bowel perforation. An 81-year-old man was admitted because of decompensation of cirrhosis with acute kidney injury and hyperkalemia, treated with sodium polystyrene sulfonate. During admission, he presented multiple episodes of hematochezia, accompanied by tachycardia and hemoglobin drop. Colonoscopy revealed colonic ulceration, and histopathological findings were compatible with ulceration due to kayexalate injury. Despite rare, the widespread use of sodium polystyrene sulfonate puts a large population at risk of serious complications related to its use.

Covid-19 Response From Global Makers: The Careables Cases of Global Design and Local Production.

Makerspaces-informal shared spaces that offer access to technologies, resources and a community of peer learners for making-across the globe initiated a rapid response to the lack of medical hardware supplies during the global pandemic outbreak in early 2020 caused by the Corona virus (COVID-19). As our health systems faced unexperienced pressure, being close to collapsing in some countries, and global supply chains failing to react immediately, makers started to prototype, locally produce and globally share designs of Open Source healthcare products, such as face shields and other medical supplies. Local collaboration with hospitals and healthcare professionals were established. These bottom-up initiatives from maker networks across the globe are showing us how responsible innovation is happening outside the constraints of profit-driven large industries. In this qualitative study we present five cases from a global network of makers that contributed to the production of personal protective equipment (PPE) and healthcare-related products. We draw our cases from the experiences made in Careables, a mixed community of people and organizations committed to the co-design and making of open, personalized healthcare for everyone. With the presented cases we reflect on the potential implications for post-pandemic local production of healthcare products and analyze them from a social innovation perspective. These global experiences are valuable indications of transformative innovations that can reduce dependencies from international supply chains and mainstream mass production.

Experimental and Theoretical Studies of Glyphosate Detection in Water by an Europium Luminescent Complex and Effective Adsorption by HKUST-1 and IRMOF-3.

Designing an effective and simple detection method to quantify glyphosate (GLY) herbicide is desirable. Current chromatography-mass spectrometry and electrochemical methods can be used for this purpose, but these methods are difficult to be made portable and need high-cost equipment. Here, we evaluate a luminescent ß-diketonate-Eu-ethylenediaminetetraacetic acid complex for GLY quantification in aqueous media on the basis of the luminescent quenching process. This complex successfully measured GLY at concentrations ranging from 5 × 10-7 to 10-5 mol L-1. Theoretical methods (LUMPAC) are also performed to identify the complex most probable structure in solution. We also demonstrate that the metal-organic frameworks HKUST-1 and IRMOF-3, easily synthesized, effectively adsorb GLY in water in about 30 min of contact.

Mononuclear lanthanide(III)-oxamate complexes as new photoluminescent field-induced single-molecule magnets: solid-state photophysical and magnetic properties.

Implementing additional optical (luminescent) properties into the well-known class of single-molecule magnets (SMMs) is considered as a promising route toward obtaining the next generation of optomagnetic materials for quantum information storage and computing. Herein, we report a joint optical and magneto-structural study for the two novel series of lanthanide(iii) complexes of general formula Bu4N[LnIII(HL)4(dmso)]·nH2O where H2L = N-(4-Xphenyl)oxamic acid with X = Cl and n = 2 [Ln = Eu (1_Cl), Gd (2_Cl), Dy (3_Cl), and Tb (4_Cl)] and X = F and n = 3 [Ln = Eu (1_F), Gd (2_F), Dy (3_F), and Tb (4_F)]. All these compounds are mononuclear species with each lanthanide(iii) cation in a low-symmetry nine-coordinate environment (LnO9) which is constituted by four didentate monoprotonated oxamate groups and one dmso molecule. Magnetic measurements show the occurrence of field-induced SMM behavior for the Gd3+ (2_Cl and 2_F), Dy3+ (3_Cl and 3_F), and Tb3+ complexes (4_Cl and 4_F). Solid-state photophysical measurements for the Eu3+ (1_Cl and 1_F) and Tb3+ complexes (4_Cl and 4_F) reveal that both monoprotonated chloro- and fluoro-substituted phenyl(oxamate) ligands are able to sensitize the lanthanide(iii)-based luminescence in the visible region, through an energy transfer process ("antenna effect"), as supported by theoretical calculations for Eu3+ compounds. In particular, 1_Cl and 1_F present a quantum efficiency of approximately 50%, being potentially suitable as efficient light conversion molecular devices (LCMDs).

Lanthanide Contraction in Lanthanide Organic Frameworks: A Theoretical and Experimental Study.

In this work, the lanthanide (Ln) contraction phenomenon has been analyzed for three-dimensional structures in the solid state. We chose to study an isostructural series of lanthanide organic frameworks (LOFs) of formula [Ln2(C4H4O4)3(H2O)2]n·H2O and 14 crystallographic structures (except promethium complex). The analysis of Ln contraction was made by analyzing the sum of all Ln-O bond lengths and the sum of all O-O distances, for the oxygen atoms of the coordination polyhedra, calculated with different semiempirical quantum mechanical models. The ∑Ln-O and ∑O-O for this LOF can be fit to a second-order polynomial. Based on the crystallographic structures, it is concluded that the phenomenon of Ln contraction is observed. Our results also suggest that the semiempirical Sparkle/PM3 and Sparkle/RM1 models reproduce the Ln contraction phenomenon well, and similar fits were obtained for ∑Ln-O and ∑O-O bond lengths.

Are the Absorption Spectra of Doxorubicin Properly Described by Considering Different Tautomers?

The elucidation of the action of doxorubicin (DOX) has been considered a challenge for cancer therapy. Using theoretical approaches, we investigated the structure and electronic properties of DOX as a function of pH, which we thought likely to be related to the influence of its tautomers. Regarding the relative stabilities among the tautomers, the results obtained from PM6 were the most similar to those obtained from DFT. The theoretical absorption spectrum for each tautomeric species simply showed a single absorption peak located around 400 nm, in contrast to the experimental absorption spectra in the literature that showed four absorption bands. The experimental evidence was properly explained by considering four tautomeric conformers of DOX. The spectroscopic study of the deprotonated tautomers also suggested the presence of four deprotonated tautomers at more basic pH values. The spectrum at pH 10.08 can be explained by the presence of protonated and deprotonated doxorubicin species.

Clinical score predicting a successful endoscopic approach of esophageal anastomotic leaks: external validation.

BACKGROUND: Recently, a clinical prediction rule has been proposed to predict the chance of successful endoscopic stenting in benign esophageal anastomotic leakage, perforation and fistula. We aimed to validate this score in a cohort of patients with anastomotic leaks managed with self-expanding metal esophageal stents, by assessing technical and clinical success rates and comparing the agreement between the predicted and the actual clinical success. METHODS: A multicenter retrospective cohort study including patients submitted to endoscopic stenting due to anastomotic leak was conducted. Variables of the score (leak size, location and C-reactive protein) were collected and the chance of success (≤50, 50-70 and ≥70%) and its accuracy was assessed. RESULTS: Fifty-three patients, submitted to esophageal stenting after cancer (n = 47) and bariatric surgery were included. Clinical success was achieved in 62% of patients. The area under the ROC curve to differentiate between successful and failed therapies showed a good discriminative power of the score (AUC 0.705; P < 0.01). For a predicted chance of success >50%, the positive predictive value was 72.5%; for a chance of success ≤50%, the negative predictive value was 69.2%. CONCLUSIONS: The application of this predictive model in patients with anastomotic leaks proved to be valid in a different cohort from that in which it was derived. Its usefulness in clinical practice may be anticipated, favoring stenting in patients with a chance of success >50%. However, we must be cautious in patients with a lower probability of success and a case-by-case decision should be made.

Reconstrução de couro cabeludo após ampla ressecção de angiossarcoma / Scalp reconstruction after wide resection of an angiosarcoma

Introdução: O couro cabeludo é uma área de difícil reconstrução devido à sua pouca elasticidade e por sobrepor-se a uma estrutura rígida e convexa. Existem diferentes técnicas cirúrgicas para reparação dos defeitos, que podem ser produto de diversas etiologias, como: traumas, deformidades e consequência de doenças, principalmente oncológicas, como é o caso do paciente apresentada neste trabalho. O angiossarcoma cutâneo é um tumor vascular maligno raro e extremamente agressivo, que afeta principalmente idosos. É caracterizado clinicamente pelo aparecimento de placas eritêmato-violáceas e de rápida evolução. O tratamento depende da extensão da doença. A maioria dos casos são tratados com ampla ressecção cirúrgica e reconstrução. O objetivo é relatar um caso de reconstrução de grande defeito do couro cabeludo depois de uma dissecção oncológica, realizado no Hospital Central do Exército (HCE) - RJ. Métodos: O caso foi tratado com enxerto autólogo e uso de matriz dérmica, em 2 tempos cirúrgicos, até a total cobertura da área lesionada. Resultados: Obteve-se resultado satisfatório após as cirurgias de enxertia de pele na área ressecada. Conclusão: O enxerto autólogo, juntamente a matriz dérmica mostrou-se uma opção viável na reconstrução do couro cabeludo.

Introduction: It is difficult to reconstruct the scalp due to its poor elasticity and presence of layers over a rigid convex structure. Different surgical techniques are used to repair defects that may develop due to several etiologies, such as trauma, deformities, and disease sequelae, especially cancer, as noted in the present case. Cutaneous angiosarcoma, a rare and extremely aggressive malignant vascular tumor that mainly develops in elderly individuals, is clinically characterized by the onset of rapidly evolving erythematous purple plaques. The treatment depends on disease extent. Most patients are treated with wide surgical resection and reconstruction. The objective is to report a case of reconstruction of a major scalp defect after an oncologic dissection performed at the Hospital Central do Exército in Rio de Janeiro. Methods: An autologous graft and dermal matrices were applied during two surgical periods till the damaged area was fully covered. Results: Satisfactory results were obtained after performing skin grafting surgery in the resected area. Conclusion: The autologous graft and dermal matrix proved to be a viable option for scalp reconstruction.

Violência contra o idoso: uma epidemia invisível / Violence against the elderly: an invisible epidemic / Violencia contra los ancianos: una epidemia invisible

A população idosa tem crescido nos últimos anos, sendo considerado um fenômeno mundial, e vem ocorrendo tributariamente à queda da taxa de mortalidade, e à diminuição da taxa de natalidade (IBGE, 2015). Em nosso país, no passado, os idosos eram vistos como fonte de sabedoria e respeito; hoje estes têm sido cada vez mais vítimas de violência das mais diversas formas: na forma de falta de acessibilidade, na falta de adaptação dos espaços e objetos a estes, no desprestígio social, quando até mesmo formas mais graves de violência como a física, a psicológica, para não dizer do abandono; muitas vezes, o abandono se dá por parte daqueles que deveriam cuidar e amar de seus velhos, como filhos e parentes. O objetivo deste trabalho é analisar as principais formas de violência cometidas contra o idoso, algumas nem sempre perceptíveis, além de refletir sobre o papel do profissional das redes protetoras, suas qualidades e limitações, além de oferecer meios ao profissional para prevenir a violência e ajudar o idoso que tenha sido vítima da violência. Órgãos e documentos, como o Estatuto ao Idoso (Lei n.º 10471 de 01 de outubro de 2003), buscam levar dignidade à população idosa, sendo ainda importante ressaltar, o papel das redes protetoras e os profissionais que acolhem e cuidam dessas pessoas. No entanto, estes mesmos profissionais ainda precisam melhorar sua eficiência, aprender a serem mais próximos e solidários aos que têm sofrido, no sentido de estarem aptos a identificar mais rapidamente o diagnóstico de violência.

The elderly population has grown in recent years, while not past, these are seen as a source of wisdom and respect, today are always more victims of violence in various forms. Be it in the form of lack of accessibility, lack of adaptation to these, be it no social discredit, even forms more graves of violence such as physical, psychological and abandonment, often on the part of those who should care and love, as children and relatives . Organs and documents, such as the Statute for the Elderly, seek to bring dignity to the elderly population. It is also important to emphasize protective and professional networks that welcome and care for people. However, these same professionals are better able to learn and be closer and more solidary in has been able to identify the diagnosis of violence more quickly. The objective of this study is to analyze the main forms of violence committed to the elderly, where some are not always perceptible, as well as to deal clearly with the role of the protective networks professional, their qualities and limitations, as well as to offer the means to prevent violence and helps elderly people who have been victims of violence. To do so, this article is done on the basis of bibliographic research, that is, it is carried out based on books, scientific articles and other serious and reliable source materials that will bring credibility yet still work.

La población de ancianos ha crecido en los últimos años, siendo considerada un fenómeno mundial, y ha estado ocurriendo debido a la caída en la tasa de mortalidad y la disminución en la tasa de natalidad (IBGE, 2015). En nuestro país, en el pasado, los ancianos eran vistos como una fuente de sabiduría y respeto; hoy en día han sido víctimas cada vez más violentas de las formas más diversas: en forma de falta de accesibilidad, en la falta de adaptación de espacios y objetos a ellos, en desprestigio social, cuando formas de violencia aún más graves como la física, psicológica, sin mencionar el abandono; a menudo, el abandono se produce por parte de quienes deben cuidar y amar a sus mayores, como los niños y los familiares. El objetivo de este trabajo es analizar las principales formas de violencia cometidas contra las personas mayores, algunas de las cuales no siempre son notables, además de reflexionar sobre el papel del profesional en las redes de protección, sus cualidades y limitaciones, además de ofrecer formas para que el profesional prevenga la violencia y ayude los ancianos que han sido víctimas de violencia. Los organismos y documentos, como el Estatuto de las personas de edad avanzada (2003), buscan dar dignidad a la población de personas mayores, y también es importante destacar el papel de las redes de protección y los profesionales que acogen y cuidan a estas personas. Sin embargo, estos mismos profesionales aún necesitan mejorar su eficiencia, aprender a estar más cerca y simpatizar con aquellos que han sufrido, en el sentido de poder identificar el diagnóstico de violencia más rápidamente.

Estimating the Individual Spectroscopic Properties of Three Unique EuIII Sites in a Coordination Polymer.

We isolated a coordination polymer with the formula [Eu3(3,5-dcba)9(H2O)(dmf)3]·2dmf, with three unique EuIII coordination sites in the asymmetric unit, with the EuIII ions bridged by 3,5-dichlorobenzoato (3,5-dcba) ligands. The coordination polymer crystallized in the triclinic space group P1̅ with unit cell dimensions a = 12.4899(15), b = 16.326(2), and c = 25.059(3) Å, α = 84.271(3)°, ß = 84.832(3)°, and γ = 68.585(3)° and V = 4725.2(10) Å3. The characteristic 5D0 → 7F J ( J = 0-4) EuIII transitions were observed upon ligand-centered excitation. Emission lifetimes of 0.825 ± 0.085 and 1.586 ± 0.057 ms were observed and were attributed to the sites with coordination of water or dimethylformamide (dmf) molecules to each ion, respectively. Through a combination of spectroscopy and calculations, we determined the photophysical properties of each unique EuIII site. Energy-transfer rates ligand → EuIII were determined for each unique site using the overlapped polyhedra method. The rates depend on the coordinated water molecules and the different donor-acceptor distances. The two sites without coordinated water molecules and shortest donor-acceptor distance display the fastest energy-transfer rate ligand → EuIII, whereas the site with coordinated water molecules and longest donor-acceptor distance displays the slowest energy-transfer rate. Donor-acceptor distances were estimated computationally and were confirmed by calculating the frontier orbitals in the asymmetric units of the polymer using density functional theory.

Colorectal Cancer Screening: What Is the Population's Opinion.

BACKGROUND: Colorectal cancer (CRC) is the first cause of death by cancer in Portugal and mortality has been increasing in the last 30 years. MATERIALS AND METHODS: During a raising awareness campaign performed by our Gastroenterology Department, in Setúbal, Portugal, an anonymous written questionnaire was developed and presented in order to evaluate the population's knowledge and attitude regarding CRC screening. RESULTS: The following results were reported: 140 persons; mean age 54.6 years; 61.4% women; 22.1% had a family history of colorectal cancer. The main risk factors mentioned by the respondents were family history of CRC, previous history of intestinal polyps, and intestinal infection. Screening was considered useful by all respondents. About 60% of the respondents had been counselled, at least, on one screening technique, mainly by their general practitioner: colonoscopy in 31, fecal occult blood test in 44, and flexible sigmoidoscopy in 9. Most of the respondents had had the appropriate screening test, according to their age and family history. Fourteen of the respondents had not undergone the recommended screening. Their answers showed that this was due to fear of pain/discovering a disease as well as embarrassment. CONCLUSION: Although the majority of the respondents were aware of the importance of CRC screening, results show that there are still several misconceptions about risk factors, fear, and reluctance concerning the screening techniques. Awareness actions are useful to clarify possible questions and inform the population in order to increase compliance with screening.

INTRODUÇÃO: O cancro colorretal (CCR) é a primeira causa de morte por cancro em Portugal, com uma mortalidade que tem aumentado nos últimos 30 anos. MATERIAIS E MÉTODOS: Durante uma acção de sensibilização levada a cabo por profissionais de saúde do Serviço de Gastrenterologia, em Setúbal, Portugal, foi realizado um inquérito escrito, anónimo, no sentido de avaliar os conhecimentos e atitudes da população face ao CCR. RESULTADOS: 140 indivíduos; idade média 54.6 anos; 61.4% mulheres; 22.1% tinham pelo menos 1 familiar com CCR. Os factores de risco para CCR mais referidos foram a presença de pólipos e a história familiar. A infecção intestinal foi considerada como um factor de risco para CCR por 74% dos inquiridos, sendo que o rastreio foi considerado útil por todos. Tinha sido recomendado pelo menos um exame de rastreio a cerca de 60% dos participantes, a maioria por indicação do médico assistente de medicina geral e familiar: colonoscopia total em 31, pesquisa de sangue oculto nas fezes em 44 e rectossigmoidoscopia em 9. Atendendo à idade e história familiar, a maioria efectuou um rastreio apropriado. Catorze pessoas não efectuaram o rastreio aconselhado; os motivos mais apontados foram o medo da dor/descobrir uma doença e vergonha. CONCLUSÃO: Embora a maioria dos inquiridos estivesse alerta para a importância do rastreio do CCR, persistem muitas ideias erradas em relação a factores de risco, receios e reticências quanto à realização dos exames de rastreio. Acções de sensibilização são úteis para clarificar dúvidas e informar a população no sentido de aumentar a adesão ao rastreio.

Seronegative Intestinal Villous Atrophy: A Diagnostic Challenge.

Celiac disease is the most important cause of intestinal villous atrophy. Seronegative intestinal villous atrophy, including those that are nonresponsive to a gluten-free diet, is a diagnostic challenge. In these cases, before establishing the diagnosis of seronegative celiac disease, alternative etiologies of atrophic enteropathy should be considered. Recently, a new clinical entity responsible for seronegative villous atrophy was described-olmesartan-induced sprue-like enteropathy. Herein, we report two uncommon cases of atrophic enteropathy in patients with arterial hypertension under olmesartan, who presented with severe chronic diarrhea and significant involuntary weight loss. Further investigation revealed intestinal villous atrophy and intraepithelial lymphocytosis. Celiac disease and other causes of villous atrophy were ruled out. Drug-induced enteropathy was suspected and clinical improvement and histologic recovery were verified after olmesartan withdrawal. These cases highlight the importance for clinicians to maintain a high index of suspicion for olmesartan as a precipitant of sprue-like enteropathy.