Incidence trends in upper GI cancer in young adults: a nationwide time-trend analysis using 2001-2019 United States Cancer Statistics databases.

BACKGROUND AND AIMS: Upper gastrointestinal (UGI) cancers, comprised of malignancies of the esophagus, stomach, duodenum, pancreas, liver, biliary tract, and gallbladder, are the second leading cause of cancer-related mortality in the US and is associated with significant comorbidities. Recent studies show a disproportionate rise in pancreatic and stomach cancer among young adults. This study aims to use a nationwide, population-based cohort to (1) evaluate the trend of al UGI cancer as an aggregate and (2) examine the role of demographics, histology, and tumor stage in UGI cancer incidence among young adults. METHODS: Individuals diagnosed with UGI cancer in the US from 2001-2019 were identified and obtained from the SEER-NPCR database. The primary outcomes were incidence rates of UGI cancer (calculated per 100,000, age-adjusted to the year 2000 US population), stratified by sex and age (< 55 years for young adults, and ≥55 years for older adults). Trends, annual percentage change (APC) and average APC (AAPC) were calculated using the parametric method. Sensitivity analysis was performed according to primary site and histology; further analysis examining race and cancer stage was performed in the young adult subgroup. RESULTS: A total of 2,333,161 patients with UGI cancer were identified. The majority of cases were male and 14.3% were <55 years of age. Incidence of UGI cancer increased most in women < 55 years of age, driven primarily by pancreatic and stomach cancers, as well as neuroendocrine tumor and gastrointestinal stromal tumor histology. African American race and localized tumors, and malignancy with distant spread are also contributing to the disparate increase among young women. UGI mortality rates have not changed significantly in young adults. CONCLUSION: The overall incidence rate of upper GI cancer is increasing significantly in young women compared to men. Increased endoscopic procedures and disparate exposure to risk factors are likely contributing to these trends.

Management of Tacrolimus-Induced Toxicity With Normal Serum Levels After Liver Transplant.

Drug-induced liver injury after liver transplant occurs in 1.7% of patients. Tacrolimus is an effective immunosuppressant that is used to treat acute rejection. Although rare, it can cause toxicity, which is demonstrated by cholestatic liver injury. Here, we present a case of a young male patient who was diagnosed with Wilson disease, had penicillaminechelating therapy, and underwent living related liver transplant. Within 1 month posttransplant, he developed deranged, predominantly cholestatic pattern liver function tests. Laboratory parameters showed total bilirubin of 1.12 mg/ dL, alanine aminotransferase of 553 IU/L, gammaglutamyltransferase of 624 IU/L, and tacrolimus level of 10.2 ng/mL. After thorough evaluation, a liver biopsy was performed. Liver biopsy showed hepatocellular necrosis with centrilobular cholestasis without any evidence of graft rejection. However, with normal level of tacrolimus, the biopsy was suggestive of drug-induced liver injury. Thus, tacrolimus dose was reduced, resulting in improved liver function tests and patient discharge from the hospital. Tacrolimus is an effective immunosuppressant after liver transplant and has the ability to treat early acute rejection. The patient's liver biopsy showed hepatocellular necrosis with centrilobular cholestasis without any evidence of graft rejection. Cholestatic liver injury after tacrolimus usually resolves after dose reduction or by switching to another agent. With demonstrated tacrolimus-induced toxicity in liver transplant recipients, despite normal serum levels, transplant physicians should keep high index of suspicion regarding toxicity in the posttransplant setting.

Differential to Terminal Ileitis: Terminal Ileum Neuroendocrine Tumor Identified on Screening Colonoscopy.

Background: Asymptomatic patients at average risk of developing colorectal cancer are encouraged to undergo screening colonoscopy beginning at age 45 years. While ileal intubation is often considered the gold standard for a complete colonoscopy, the relatively low diagnostic yield has prevented widespread adoption. Small bowel cancers, including neuroendocrine tumors, may present incidentally as terminal ileitis on routine colonoscopy with terminal ileum intubation. Neuroendocrine tumors, the most common primary neoplasm of the small intestine, are often asymptomatic or present as nonspecific abdominal pain in the sixth or seventh decade of life. Case Report: A 51-year-old asymptomatic male with unremarkable physical examination underwent screening colonoscopy that revealed scattered ulcerations of the terminal ileum. Immunohistochemistry of the lesion was consistent with well-differentiated neuroendocrine tumor, World Health Organization Grade I. DOTATATE positron emission tomography/computed tomography demonstrated avid adjacent right mesenteric lymph node and avid focal pancreatic body lesion. Fine-needle biopsy and immunohistochemistry of the pancreatic lesion confirmed neuroendocrine tumor, while the mesenteric lymph node was found to be benign. The patient underwent robotic-assisted ileocolic resection and has ongoing surveillance of the pancreatic lesion. Conclusion: Terminal ileitis encompasses a host of pathologic processes, including inflammatory states, infectious disease, malignancy, and vasculitis. Importantly, small bowel cancer is an increasing cause of terminal ileitis. Screening colonoscopy with ileal intubation can be a valuable tool for early detection of these lesions.

Rosai Dorfman Disease With Extensive Bony Involvement- A Diagnostic Dilemma.

Previously classified as Non Langerhan cell histiocytosis by the Working Group of Histiocytic Society in 1987 Rosai Dorfman Destombes disease was first described by Destombes in 1965 and later in 1969 by Rosai and Dorfman as a rare histiocytic disorder with sinus histiocytosis and massive lymphadenopathy. They exist in both nodal and extranodal forms. Immunohistochemistry is an essential part of diagnosis to differentiate between Langerhans cell histiocytosis and another malignant histiocytosis. Some overlap has also been reported with IgG4-related diseases. We hereby reflect upon a patient who presented to our facility with pyrexia of unknown origin, the challenges faced to reach a diagnosis and the management offered.

Pancreatic Tuberculosis mimicking as a Pancreatic Mass Lesion.

Tuberculosis is a global health problem and commonly affects the respiratory system. The involvement of the pancreas in this disease is a rare event. We hereby report a case of a young male who presented with right hypochondrial pain along with significant weight loss. Further workup revealed a raised erythrocyte sedimentation rate along with a pancreatic mass lesion on the CT scan. Endoscopic ultrasound-guided biopsy of the pancreatic lesion revealed evidence of caseation necrosis along with epithelioid granuloma, findings suggestive of tuberculosis. He was started on anti-tuberculous therapy for 6 months and a repeat CT scan showed complete disappearance of the mass lesion and resolution of symptoms. Key Words: Tuberculosis, Pancreatic mass, Endoscopic ultrasound, Biopsy.

Age-Dependent Effects of Copper Toxicity on Connective Tissue Structural Stability in Wistar Rats Skin.

Over the last three decades, there has been increasing global concern over the public health impacts attributed to direct and indirect environmental pollution, in particular, the global burden of disease. The World Health Organization estimates that, about a quarter of the diseases facing mankind today occur due to prolonged exposure to environmental pollution; the health of 200 million people in lower-income countries is at risk from toxins such as lead and copper or mercury, more than from AIDS, tuberculosis and malaria combined and that, nearly a quarter of deaths in developing countries including Nigeria and Ghana, are linked to pollution. The purpose of the study was to investigate the effects of the ingestion of large dose of copper on the structural stability of collagen molecules, as well as reveal age-dependent differences in the phenomena.  The content of de novo synthesized collagen was determined by hydroxyproline concentration using Stegmann-Staeder's method as modified by Utevskaya and Persky; the nature of intra- and inter-molecular covalent cross-links in collagen matrix was estimated by electrophoretic separation of products of partial thermal denaturation of collagen in polyacrylamide gel. There was intensification of synthesis over degradation in young rats, and that administration of copper led to a decrease in collagen solubility. Effects of copper on the structural stability of collagen appeared mostly in young rats.

Kratom (Mitragyna speciosa)-Induced Hepatitis.

Kratom is a plant with opioid-like properties known to produce stimulant and analgesic effects. Although there are numerous studies on the psychoactive components of kratom, less is known about the toxicity. Specifically, few reports describe kratom-induced hepatotoxicity and demonstrate histological features. We provide a case report detailing the clinicopathologic findings of drug-induced liver injury caused by kratom. The laboratory workup included significant elevation of total bilirubin and alkaline phosphatase. Liver biopsy demonstrated a prominent canalicular cholestatic pattern, mixed portal inflammation, and newly described perivenular necrosis. This report provides additional information on kratom toxicity because its use continues to rise.

Knowledge, attitudes and practices towards deceased organ donation among parents of children with End Stage Kidney Disease.

OBJECTIVE: To assess the knowledge, attitudes, and practices (KAP) towards deceased organ donation (DOD) of the parents/ guardians of children with end stage kidney disease (ESKD). METHODS: This cross sectional survey was conducted between April and December 2020. A structured questionnaire was filled to assess the sociodemographic information, knowledge, attitude, and practice about DOD. RESULTS: A total of 130 participants with a mean age of 37±7 years were included in the study. Among all, 66 (50.8%) claimed that they had prior knowledge about DOD. However, on further questioning, no one knew who can be the deceased organ donor. Their responses about registration place and permission from religion were positive in 24(36.4%) and 31(47.0%) cases respectively. Regarding attitude, positive responses to willingness to get registered and discussing DOD in social circle were given by 37(56.1%) and 21 (31.8%) participants respectively. Only one participant was registered as donor. The remaining 64(49.2%) participants who had no prior knowledge were given relevant information and were interviewed after one week. Only 24(37.5%) showed willingness to get registered as donors and 06 (9.4%) participants discussed the topic of DOD in their social circle. CONCLUSIONS: The results showed that the knowledge, attitudes, and practices of people who are most desperate for transplantation of their children were poor and did not change significantly even after providing them relevant information.

Mineral biofortification of vegetables through soil-applied poultry mortality compost.

Intensive agricultural practices lower soil fertility, particularly micronutrients which are rarely applied to soils as chemical fertilizers. Micronutrient deficiency in soils results in inferior product quality and micronutrient malnutrition in humans. Application of compost to soil may improve crop yields and quality by enhancing macro- and micronutrients availability, enhancing soil microbial population, and improving soil physicochemical properties. Poultry mortality compost (PMC) was prepared by decomposing dead poultry birds with poultry litter in an aerated bin through indigenous microbial populations. The prepared PMC was used as an amendment in three field experiments during 2017-18 and 2018-19 to investigate the effect on yield and nutritional quality of potato, carrot, and radish. In these field trials, two compost levels, i.e., 1250 kg ha-1 (PMC1) and 1850 kg ha-1 (PMC2) were compared with the control (no compost application). The results revealed a 10-25% increase in root or tuber yield at PMC2 compared to that in the control. A substantial increase in Zn, Fe, and Mn concentrations in vegetable root/tubers was also observed. Organic matter content and microbial biomass were improved in the soil with PMC application leading to better soil health and better nutrient availability. These studies led us to conclude that the application of PMC not only enhances the vegetable yield but also biofortifies vegetables with micronutrients such as Zn, Fe, and Mn extending agricultural sustainability and eliminating micronutrient malnutrition in humans.