Necrotizing gastritis as a rare complication in a pediatric patient with acute lymphoid leukemia. / Gastritis necrotizante como complicación infrecuente en un paciente pediátrico con leucemia linfoide aguda.

Necrotizing gastritis is an infrequent entity with unknown prevalence, the diagnosis is often incidental during exploratory laparotomy or autopsies of patients with acute abdomen. OBJECTIVE: To present a clinical case of necrotizing gastritis, a rare entity that should be taken into account in the context of immunocompromised patients with associated risk factors. CLINICAL CASE: 7-year-old male schoolboy diagnosed with T-precursor acute lymphoid leukemia, finishing induction chemotherapy cycle with PETHEMA 2013 protocol. He presented 12 days of symptoms characterized by epigastric abdominal pain and vomiting, initially acute pancreatitis was suspected, ruled out by normal pancreatic enzymes and abdominal computed tomography. Due to suspicion of acid peptic disease associated with steroids, treatment with proton pump inhibitors and prokinetics was started. Considering dyspepsia with alarm signs, such as progression of neutropenia, increased C-reactive protein and clinical deterioration, esophagogastroduodenoscopy (EGD) was performed, compatible with necrotizing gastritis, confirmed by histopathology. He received pharmacological management, zero regimen and parenteral support, and progressive improvement was evidenced in imaging controls. After fasting for 30 days, enteral nutrition was started, well tolerated, with ambulatory follow-up. After improvement, chemotherapy plan was completed, highlighting complete remission, without complications after 2 years. CONCLUSION: Necrotizing gastritis is a rare entity, in the case described the risk factors were immunocompromise, previous management with corticosteroids and cytotoxic therapy, and possibly, exposure to stressful situations during hospitalization. Early diagnosis and treatment determined a favourable prognosis.

Gene expression and functional deficits underlie TREM2-knockout microglia responses in human models of Alzheimer's disease.

The discovery of TREM2 as a myeloid-specific Alzheimer's disease (AD) risk gene has accelerated research into the role of microglia in AD. While TREM2 mouse models have provided critical insight, the normal and disease-associated functions of TREM2 in human microglia remain unclear. To examine this question, we profile microglia differentiated from isogenic, CRISPR-modified TREM2-knockout induced pluripotent stem cell (iPSC) lines. By combining transcriptomic and functional analyses with a chimeric AD mouse model, we find that TREM2 deletion reduces microglial survival, impairs phagocytosis of key substrates including APOE, and inhibits SDF-1α/CXCR4-mediated chemotaxis, culminating in an impaired response to beta-amyloid plaques in vivo. Single-cell sequencing of xenotransplanted human microglia further highlights a loss of disease-associated microglial (DAM) responses in human TREM2 knockout microglia that we validate by flow cytometry and immunohistochemistry. Taken together, these studies reveal both conserved and novel aspects of human TREM2 biology that likely play critical roles in the development and progression of AD.

The relationship between group size, intoxication and continuing to drink after bar attendance.

OBJECTIVE: The present study was undertaken to explore multilevel determinants of planning to continue to drink alcohol after leaving public drinking events. We assessed whether individual-level factors, group-related factors, or event-level bar characteristics were associated with post-bar drinking. METHOD: We recruited a total of 642 participants from 30 participating bars in urban Southern California. Groups who arrived to patron a bar were interviewed upon their entrance and exit. Given data nesting, we employed a multilevel modeling approach to data analysis. RESULTS: More than one-third (40%) of our sample reported the intention to continue drinking as they exited the bar. Results of our multilevel model indicated eight individual-level variables significantly associated with intending to continue to drink. Time of night moderated the relationship between BrAC change and intentions to continue to drink. Although none of the group factors were significant in our model, a significant cross-level interaction between BrAC change and number of group members indicated the effect of intoxication on planning to continue to drink increases as group members increase. At the bar level, the presence of temporary bars and server offers of non-alcoholic drinks significantly decreased intentions to continue to drink. CONCLUSIONS: Given the large percentage of participants who reported the intention to continue drinking after exiting a bar, this study draws attention to the fact that field studies of drinking behavior may assess drinking mid-event rather than at the end of a drinking event.

Hemangioma capilar intramedular / Intramedullary capillary hemangioma

Los hemangiomas capilares son lesiones tumorales benignas comunes en diferentes localizaciones. Sin embargo la afección del sistema central es extremadamente inusual. En la literatura tan solo han sido reportados 7 casos de hemangiomas capilares de localización exclusiva intramedular y poco más de 20 casos con compromiso extramedular adicional. Reportamos un paciente adolescente alteración motora y sensitiva progresivo del miembro superior izquierdo asociado a cervicalgia y espasmos musculares cervicales. La resonancia magnética reveló la presencia de una lesión medular cervical sugestiva de neoplasia con un importante componente vascular. Durante la resección no se observó compromiso extra-medular. Los exámenes histopatológico e inmunohistoquímico confirmaron el diagnostico de hemangioma capilar. Si bien, se han publicado muy pocos casos de hemangiomas capilares intramedulares, se cree que puede existir un importante subregistro. En general constituyen una patología benigna de buen pronóstico y que no requiere de manejos adyuvantes como quimio o radioterapia, pero si de un seguimiento neurológico.