Proctitis in men having sex with men: anything else you can think of?

We report two cases of proctitis in men having sex with men.

Strongyloides stercoralis with Gastroduodenal Involvement and Complicated with SIADH: An Unusual Diagnosis to Consider in Immunosuppressed Patients with Hyperemesis and Eosinophilia.

Strongyloides stercoralis is an intestinal nematode that colonizes and reproduces in the upper small intestinal mucosa. Infection in immunocompetent hosts is self-limited but in immunocompromised patients it can be complicated and cause hyperinfection. We present a 60-year-old female who was admitted due to an exacerbation of acquired thrombotic thrombocytopenic purpura requiring high doses of corticosteroids. The patient began to experience persistent pyrosis, nausea, vomiting, and oral intolerance. She was di-agnosed with syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Upper endoscopy was performed and showed esophageal, gastric, and duodenal mucosa with edema and erythema. Moreover, there were superficial erosions and thickened folds in duodenum. Gastric and duodenal biopsies were taken. Abdominal computed tomography and magnetic enteroresonance displayed duodenal dilation and inflammatory changes. The histological study of biopsies showed colonization by S. stercolaris in the antrum and duodenum. S. stercolaris is a human parasite that is endemic in tropical, subtropical, and temperate regions. Its lifecycle is complex because it completes its entire cycle within the human host; it penetrates the skin, migrates to the lungs, and reach the gastrointestinal tract. The most affected site is the duodenum and upper jejunum. The lifecycle includes autoinfection through the intestinal mucosa or perianal skin, especially in immunocompromised hosts. Immunossuppression can lead to hyperinfection syndrome and disseminated disease. However, involvement of the stomach has relatively rarely been reported. SIADH has been related to systemic hyperinfection, although the mechanism is not clear. The relatively nonspecific clinical and imaging features and the low sensitivity of routine parasite tests make the diagnosis challenging and delayed.

Strongyloides stercoralis é um nematódo intestinal que coloniza e se reproduz na mucosa do intestino delgado proximal. A infeção em hospedeiros imunocompetentes é auto-limitada mas em doentes imunocomprometidos pode ter um curso complicado e causar hiperinfeção. Apresentamos um caso de uma mulher de 60 anos que é admitida devido a uma exacerbação de uma púrpura trombocitopénica trombótica adquirida com necessidade de altas doses de corticoides. A doente inicia quadro de pirose persistente, náuseas, vómitos e intolerância alimentar. Faz-se o diagnóstico de síndrome de secreção inapropriada de hormona antidiurética (SIADH). A endoscopia digestiva alta evidencia mucosa gástrica e duodenal com edema e eritema, para além de erosões e pregas espessadas duodenais. O TC e a enteroRMN mostram dilatação duodenal e alterações inflamatórias. A histologia mostra S. stercoralis a colonizar a mucosa do antro e duodeno. O S. stercolaris é um parasita humano, endémico em regiões tropicais e subtropicais. Tem um ciclo de vida complexo já que completa o seu ciclo todo dentro do organismo humano: penetra pela pele, migra para os pulmões e atinge o trato gastrointestinal. Os sítios mais afetados são o duodeno e o jejuno proximal. O ciclo de vida envolve autoinfeção na mucosa intestinal ou pele perianal, especialmente em doentes imunocomprometidos, com a imunodepressão podendo levar a síndrome de hiperinfeção e doença disseminada. Contudo, o envolvimento gástrico é raramente descrito. O SIADH tem sido relacionado com o síndrome de hiperinfeção, contudo, o seu mecanismo não é claro. O relativo inespecífico quadro clínico e alterações imagiológicas, assim como a baixa sensibilidade dos testes de parasitas de rotina atrasam e fazem o diagnóstico desafiante.

Endothelin-1 as a Mediator of Heme Oxygenase-1-Induced Stemness in Colorectal Cancer: Influence of p53.

Heme oxygenase-1 (HO-1) is an antioxidant protein implicated in tumor progression, metastasis, and resistance to therapy. Elevated HO-1 expression is associated with stemness in several types of cancer, although this aspect has not yet been studied in colorectal cancer (CRC). Using an in vitro model, we demonstrated that HO-1 overexpression regulates stemness and resistance to 5-FU treatment, regardless of p53. In samples from CRC patients, HO-1 and endothelin converting enzyme-1 (ECE-1) expression correlated significantly, and p53 had no influence on this result. Carbon monoxide (CO) activated the ECE-1/endothelin-1 (ET-1) pathway, which could account for the protumoral effects of HO-1 in p53 wild-type cells, as demonstrated after treatment with bosentan (an antagonist of both ETRA and ETRB endothelin-1 receptors). Surprisingly, in cells with a non-active p53 or a mutated p53 with gain-of-function, ECE-1-produced ET-1 acted as a protective molecule, since treatment with bosentan led to increased efficiency for spheres formation and percentage of cancer stem cells (CSCs) markers. In these cells, HO-1 could activate or inactivate certain unknown routes that could induce these contrary responses after treatment with bosentan in our cell model. However more research is warranted to confirm these results. Patients carrying tumors with a high expression of both HO-1 and ECE-1 and a non-wild-type p53 should be considered for HO-1 based-therapies instead of ET-1 antagonists-based ones.

Green Tea and Its Relation to Human Gut Microbiome.

Green tea can influence the gut microbiota by either stimulating the growth of specific species or by hindering the development of detrimental ones. At the same time, gut bacteria can metabolize green tea compounds and produce smaller bioactive molecules. Accordingly, green tea benefits could be due to beneficial bacteria or to microbial bioactive metabolites. Therefore, the gut microbiota is likely to act as middle man for, at least, some of the green tea benefits on health. Many health promoting effects of green tea seems to be related to the inter-relation between green tea and gut microbiota. Green tea has proven to be able to correct the microbial dysbiosis that appears during several conditions such as obesity or cancer. On the other hand, tea compounds influence the growth of bacterial species involved in inflammatory processes such as the release of LPS or the modulation of IL production; thus, influencing the development of different chronic diseases. There are many studies trying to link either green tea or green tea phenolic compounds to health benefits via gut microbiota. In this review, we tried to summarize the most recent research in the area.

Assessing the antioxidant and metabolic effect of an alpha-lipoic acid and acetyl-L-carnitine nutraceutical.

Personalized nutrition (PN) is seen as a potentially effective and affordable strategy for the prevention of non-communicable diseases (NCDs). In this study we aimed to evaluate the antioxidant and metabolic effect of a dietary supplement based on alpha-lipoic acid (ALA) and acetyl-L-carnitine (ALC) in order to include this product in a novel PN service. The antioxidant properties of the commercial nutraceutical were investigated at physiological conditions (through in vitro digestion) and at mitochondrial conditions. The metabolic activity was assessed in a human pilot study using a Gas Chromatography-Mass Spectrometry (GC-MS) methodology in dried urine samples. The nutraceutical exerted an elevated antiradical activity and reducing capacity, especially at mitochondrial conditions, after in vitro digestion. This increase in mitochondrial activity was also evidenced in vivo by a significant increase in the urinary phosphate concentration (p â€‹= â€‹0.004). As pro-oxidant effect was reached with the concentration of 4 capsules, 2 capsules at the same time could be a reasonable dose. No adverse effects were recorded in vivo with this dose. Thus, although its metabolic effect was not so conclusive, ALA â€‹+ â€‹ALC combination might be beneficial as a dietary supplement for the prevention of the oxidative stress and an interesting dietary supplement to consider in large scale studies.

An in vitro batch fermentation protocol for studying the contribution of food to gut microbiota composition and functionality.

Knowledge of the effect of foods on gut microbiota composition and functionality is expanding. To isolate the effect of single foods and/or single nutrients (i.e., fiber, polyphenols), this protocol describes an in vitro batch fermentation procedure to be carried out after an in vitro gastrointestinal digestion. Therefore, this is an extension of the previous protocol described by Brodkorb et al. (2019) for studying in vitro digestion. The current protocol uses an oligotrophic fermentation medium with peptone and a high concentration of fecal inoculum from human fecal samples both to provide the microbiota and as the main source of nutrients for the bacteria. This protocol is recommended for screening work to be performed when many food samples are to be studied. It has been used successfully to study gut microbiota fermentation of different foodstuffs, giving insights into their functionality, community structure or ability to degrade particular substances, which can contribute to the development of personalized nutrition strategies. The procedure does not require a specific level of expertise. The protocol takes 4-6 h for preparation of fermentation tubes and 20 h for incubation.

Subcapsular hepatic hematoma as a complication of ERCP: what do we know about its etiology?

We present the case of a 79-year-old male who underwent endoscopic retrograde cholangiopancreatography (ERCP) after cholangitis. The papilla was rigid and the biliary tract was dilated with sharpening of the distal bile duct, with no obvious cause. There was no bile flow after sphincterotomy, no stone after sweeping the duct with a balloon and the brush did not expand properly when trying to obtain cytologic material. Finally, a plastic stent was placed and purulent bile flowed. Biopsies of the papilla were taken due to the suspicion of tumor infiltration. The next day, the patient had pain in the right upper quadrant and blood tests highlighted mild anemization.

It seems like cholangiocarcinoma but it is not: discovering the choledochal cyst.

A 52-year-old female was referred for a study of a left intrahepatic bile duct dilation with an initial suspicion of Klatskin. Analytically, there was no cholestasis and tumor markers were negative. On echoendoscopy, there was dilation of the intrahepatic bile duct to the confluence at the level of the left hepatic lobe, with no evidence of a lesion that could be biopsied by fine needle aspiration (FNA).

Lemmel syndrome: an uncommon complication of periampular duodenal diverticulum.

Lemmel's syndrome consists of obstructive jaundice due to compression of a periampular duodenal diverticulum (DDP), in the absence of choledocholithiasis or tumor. DDP are pseudodiverticula without a muscle layer within a radius of 2-3 centimeters from the ampulla of Vater. They rarely cause obstructive jaundice, although the prevalence is estimated at up to 22 % according to the sensitivity of the diagnostic test. They are usually incidental findings, but up to 1-5 % can be complicated with diverticulitis, bleeding, perforation, obstructive jaundice (Lemmel syndrome), choledocholithiasis, pancreatitis or cholangitis.

Intestinal spirochetosis: normal intestinal flora or etiology of diarrhea?

A 22-year-old male began with up to 12 loose stools per day, with mucus and no blood. They were present for two months, even during the night. Moreover, he complained of abdominal pain and weight loss. There were no findings on the blood tests. Fecal calprotectin was 225 µg/g. Stool microbiology tests were negative. Ileocolonoscopy displayed normal mucosa but the histological study of the biopsies showed Treponemas genus Brachispira. The patient had a sexual risk behavior. Treatment with metronidazole was initiated with clinical improvement.

Gastroparesis secondary to pulmonary vein cryoablation: a factor to consider.

We present a patient who underwent cryoballoon ablation for symptomatic atrial fibrillation, with gastroparesis five days later. The case was resolved with conservative measures such as prokinetics. The case was a 72-year-old female with a history of symptomatic paroxysmal atrial fibrillation treated with edoxaban. Pulmonary vein isolation using a cryoballoon catheter was performed. Five days later, she presented with upper abdominal pain, bloating and vomiting.

Splenic rupture as an endoscopic complication: as rare as it appears?

The case was an 86-year-old male with multiple cardiovascular comorbidites, including anticoagulated atrial fibrillation, who underwent a colonoscopy due to acute lower gastrointestinal bleeding and anemia. Colonoscopy only showed some small angiodysplasias in the cecum. A few hours later, the patient presented with abdominal pain and hemodynamic instability. An abdominal computed tomography was performed, which showed a splenic laceration and hemoperitoneum. An expectant attitude was decided, with a good evolution from the abdominal point of view. There was no sign of active splenic bleeding in a control computed tomography. However, he developed decompensated heart failure and finally died.

Gastrointestinal tuberculosis, the great simulator. From inflammatory disease to a tumor.

A 52-year-old Senegalese male presented due to abdominal pain and fever, with findings suggestive of a stenosing tumor of the right colon. Biopsies during colonoscopy were compatible with adenocarcinoma and infiltration into neighboring organs was observed during the surgery. New biopsies were taken that did not show dysplasia but granulomatous foci that were suggestive of a non-filiated infection. Thus, tuberculosis was ruled out.

Apropos of a case of pancreatic lymphoepithelial cyst: importance of the preoperative diagnosis by ecoendoscopy.

The case was a 75-year-old female with dyspeptic symptoms of a 2 month duration. There was a polycystic lesion at the level of the uncinate pancreatic process of 44 x 42 x 34 mm on abdominal ultrasound and MRI, which caused a slight dilation of the main pancreatic duct. EUS was performed that identified a multicystic formation of 25x36 mm in the pancreatic body and FNA was performed of the lesion. The cytological analysis identified squamous epithelial cells with lymphoid tissue, which was compatible with a lymphoepithelial cyst, with no evidence of cell atypia or other signs of malignancy. Radiological control and monitoring of the lesion was performed and it has remained stable for 2 years.

Digestive involvement in a patient with Lambert-Eaton syndrome.

We present the case of a 50-year-old male diagnosed with myasthenia gravis, secondary to thymoma or Lambert-Eaton syndrome during the study of repeated vomiting. Gastrointestinal symptoms persisted despite the treatment of the thymoma. He suffered from sigma volvulus that required sigmoidectomy 9 years after diagnosis. Neuromuscular junction disorders are not characterized by gastrointestinal involvement, as in our case. They have previously sporadically been related to intestinal motility dysfunction.