A Rare Case Presentation: Diagnosing Primary Biliary Cholangitis in a Male Patient With Concomitant Type 1 Diabetes.

Primary biliary cholangitis (PBC) is characterized as an autoimmune disease that involves the destruction of intrahepatic bile ducts, characteristically leading to a cholestatic liver. The presence of disease-specific antimitochondrial antibodies (AMA) is the gold standard to diagnose PBC. Typically, PBC is known to affect female populations exceedingly over their male counterparts. Associated autoimmune diseases include Sjogren's and Raynaud's syndrome, which are also more prevalent in women. The low incidence rates of men affected with PBC, especially with a concomitant type 1 diabetes diagnosis, have resulted in little being known about the clinical course of the disease in this particular population group. Current research suggests no significant histological, serological, or biochemical differences between PBC in males and females. However, some symptoms and clinical associations may be different. This case report presents the rare case of a male patient with type 1 diabetes recently diagnosed with PBC.

Hepatitis B Screening and Awareness in the Milwaukee Hmong Community.

INTRODUCTION: Hepatitis B virus (HBV) infection disproportionately affects the Hmong ethnic group, with reported US prevalence rates up to 20%, but data for Wisconsin's large Hmong community is lacking. We assessed the prevalence of HBV at Hmong screening events and whether small-group counseling affects HBV knowledge. METHODS: Free HBV screening events were held in Milwaukee, Wisconsin at a Hmong market, a local church, and annual Hmong New Year festival. Eligible Hmong subjects age 18 years and older also were invited to complete a 15-point survey on HBV knowledge at baseline and after education sessions. Hmong interpreters were available, and free HBV screening was offered. RESULTS: A total of 187 participants were tested for HBV, and 161 completed surveys. After education sessions, the mean knowledge score rose to 10.6 (71%) vs the pre-education score of 6.7 (45%) (P <0.0001). Active HBV [HBsAg(+) HBsAb(-)] was diagnosed in 18 participants (9.6%), 53 (28.3%) were susceptible [HBsAg(-) and HBsAb(-)], 5 (3.4%) were in the gray zone [HBsAg(-) with low/inadequate HBsAb(+) titer], and the remaining 110 (58.8%) were immune [HBsAg(-)/HBsAb(+)]. Of the 18 individuals with active HBV, 13 were male and 5 were female [age range 24-66]. CONCLUSION: Despite evidence that small-group education with visual aids is effective in enhancing HBV knowledge in the Hmong population, a significant knowledge gap remained on post-education scores, suggesting that better tools or repeated interventions may be warranted. While we acknowledge that this convenience sampling may have introduced biases, the rate of active HBV infection in Wisconsin is much higher than general US population reports, and a quarter of those tested were found to be susceptible to HBV.

Aortic Valve Stenosis, a Precipitating Factor of Recurrent Bleed in Colonic Angiodysplasia: A Literature Review.

Angiodysplasia (also known as angioectasia) is a lesion characterized by abnormal, dilated small blood vessels in the mucosa and submucosal layers of the GI tract. With the estimated low incidence of active GI bleeding from these lesions, angiodysplasia can be challenging to diagnose. The presence of aortic stenosis has increased the recognition rate of angiodysplasia, especially in the elderly. Despite the associations between aortic stenosis and angiodysplasia (Heyde's syndrome) revealed in several studies, the etiology of Heyde syndrome is still debatable, which has led to the proposition of several hypotheses that are reviewed in this article. This activity will help review the meaning of Heyde's syndrome, epidemiology, proposed pathophysiology, diagnosis, and management by surveying articles published between 1955 and 2021 on PubMed. We used search terms such as "colonic angiodysplasia," "arteriovenous malformation," "Heyde syndrome," "refractory gastrointestinal bleed," "aortic valve stenosis," and "acquired von Willebrand disease." Findings revealed an association between aortic stenosis and lower gastrointestinal (GI) bleed.

Extracolonic gastrointestinal tract morphologic findings in a case of pseudomembranous collagenous colitis.

"Pseudomembranous collagenous colitis" is a morphologic variant of collagenous colitis in which active inflammation with pseudomembrane formation is prominent and which has been associated with infectious, toxic, and ischemic etiologies. However, extracolonic morphologic findings in patients with pseudomembranous collagenous colitis have not been previously described. Here, we present a case of a patient with pseudomembranous collagenous colitis with abnormal extracolonic findings. These include gastric antral mucosa with histologic features reminiscent of ischemic injury and reactive gastropathy with intraepithelial lymphocytosis and partial villous atrophy in the duodenal and ileal biopsies. The findings in the small intestinal biopsies resemble those seen in enteric mucosa in patients with conventional collagenous colitis. Our pathologic findings as well as the clinical course of the patient further emphasize the clinical and histologic similarities shared by pseudomembranous collagenous colitis and conventional collagenous colitis.

Reproducibility of swallow-induced cortical BOLD positive and negative fMRI activity.

Functional MRI (fMRI) studies have demonstrated that a number of brain regions (cingulate, insula, prefrontal, and sensory/motor cortices) display blood oxygen level-dependent (BOLD) positive activity during swallow. Negative BOLD activations and reproducibility of these activations have not been systematically studied. The aim of our study was to investigate the reproducibility of swallow-related cortical positive and negative BOLD activity across different fMRI sessions. We studied 16 healthy volunteers utilizing an fMRI event-related analysis. Individual analysis using a general linear model was used to remove undesirable signal changes correlated with motion, white matter, and cerebrospinal fluid. The group analysis used a mixed-effects multilevel model to identify active cortical regions. The volume and magnitude of a BOLD signal within each cluster was compared between the two study sessions. All subjects showed significant clustered BOLD activity within the known areas of cortical swallowing network across both sessions. The cross-correlation coefficient of percent fMRI signal change and the number of activated voxels across both positive and negative BOLD networks were similar between the two studies (r ≥ 0.87, P < 0.0001). Swallow-associated negative BOLD activity was comparable to the well-defined "default-mode" network, and positive BOLD activity had noticeable overlap with the previously described "task-positive" network. Swallow activates two parallel cortical networks. These include a positive and a negative BOLD network, respectively, correlated and anticorrelated with swallow stimulus. Group cortical activity maps, as well as extent and amplitude of activity induced by volitional swallowing in the cortical swallowing network, are reproducible between study sessions.