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Patients with amoebic liver abscess (ALA) may require percutaneous catheter drainage (PCD). Once the PCD output is substantially reduced or has ceased along with clinical recovery, residual collections on radiological evaluation may concern the treating physicians. The prevalence and significance of such collections is unknown, and the subsequent approach how to tackle them is unclear. Consecutive patients with one or more uncomplicated ALAs requiring drainage were prospectively enrolled from 3 hospitals and managed based on a standard approach. Catheter removal was attempted after the patients fulfilled all 4 of the following criteria: disappearance of abdominal pain, absence of fever for at least 48 h, an improving trend of TLC (documented on 2 consecutive reports), and catheter drain output of

Nonalcoholic fatty liver disease (NAFLD) is a chronic liver disease of immense public health relevance. Understanding illness perceptions in the NAFLD population will provide sound scientific evidence for planning high-quality patient-centered care and implementing effective interventions. The Brief Illness Perception Questionnaire (BIPQ) is a robust psychometric tool to systematically assess the dimensions of illness perceptions in various chronic ailments. In a cross-sectional study enrolling patients with newly diagnosed NAFLD, the sociodemographic, anthropometric, biochemical, and radiological determinants of enhanced illness perceptions (measured by the BIPQ score) were investigated using univariate and multivariable binary logistic regression analyses. Finally, the association between individual domains of the BIPQ and willingness to participate in comprehensive medical management was explored. In total, 264 patients (mean age 53 ± 11.9 years, 59.8% males) were enrolled in the final analysis. The mean and median BIPQ scores in the study population were 30.3 ± 12.8 and 31.0 (IQR, 22.0–40.0), respectively. The variables having a significant independent association with heightened perceptions (BIPQ > 31) were family history of liver disease (aOR, 5.93; 95% CI, 1.42–24.74), obesity (aOR, 3.33; 95% CI, 1.57–7.05), diabetes mellitus (aOR, 2.35; 95% CI, 1.01–5.49), and transaminitis (aOR, 2.85; 95% CI, 1.42–5.69). Patients with a higher level of illness perceptions (31.6 ± 12.9 vs 27.8 ± 12.3, p = 0.022) were more likely to express a willingness to participate in the comprehensive management plan, with 3 of the 8 domains (consequence, identity, and treatment control) mainly affecting willingness. A family history of liver disease, obesity, diabetes, and transaminitis were independently associated with increased illness perceptions. A belief in serious consequences, a strong illness identity, and higher perceived treatment control were significantly associated with the willingness to undergo comprehensive care for NAFLD.

Hydroxychloroquine, initially used as an antimalarial, is used as an immunomodulatory and anti-inflammatory agent for the management of autoimmune and rheumatic diseases such as systemic lupus erythematosus. Lately, there has been interest in its potential efficacy against severe acute respiratory syndrome coronavirus 2, with several speculated mechanisms. The purpose of this review is to elaborate on the mechanisms surrounding hydroxychloroquine. The review is an in-depth analysis of the antimalarial, immunomodulatory, and antiviral mechanisms of hydroxychloroquine, with detailed and novel pictorial explanations. The mechanisms of hydroxychloroquine are related to potential cardiotoxic manifestations and demonstrate potential adverse effects when used for coronavirus disease 2019 (COVID-19). Finally, current literature associated with hydroxychloroquine and COVID-19 has been analyzed to interrelate the mechanisms, adverse effects, and use of hydroxychloroquine in the current pandemic. Currently, there is insufficient evidence about the efficacy and safety of hydroxychloroquine in COVID-19.KEY MESSAGESHCQ, initially an antimalarial agent, is used as an immunomodulatory agent for managing several autoimmune diseases, for which its efficacy is linked to inhibiting lysosomal antigen processing, MHC-II antigen presentation, and TLR functions.HCQ is generally well-tolerated although severe life-threatening adverse effects including cardiomyopathy and conduction defects have been reported.HCQ use in COVID-19 should be discouraged outside clinical trials under strict medical supervision.

Tight near-total corrosive strictures of the proximal esophagus with concomitant involvement of the hypopharynx: Flexible endoscopic management using a novel technique

Zenker’s diverticulum (ZD) is a posterior hypopharyngeal mucosal and submucosal outpouching through an area of relative muscular weakness, known as Killian’s triangle. It is an uncommon but highly treatable cause of mechanical dysphagia in elderly patients. Diagnosis is established by esophagography and upper endoscopy. The treatment has evolved with the advancement in the understanding of underlying pathophysiology. Traditionally, the management had been open surgical exposure and cricopharyngeal myotomy, combined with diverticular excision, suspension or inversion. Peroral endoscopic techniques (rigid and flexible) have gained popularity as minimally invasive and effective therapeutic options, with lesser mortality and morbidity. Flexible endoscopic myotomy offers additional benefits over rigid endoscopic techniques, as it does not require general anesthesia and neck hyperextension. The initial results of flexible endoscopy are quite encouraging, but long-term data are not yet available. For the optimal outcome, flexible endotherapy requires a formidable endoscopic skill, sound knowledge of the neck anatomy and meticulous understanding of the electrosurgical principles. In this article, we have comprehensively reviewed the current understanding of the pathophysiology involved and various techniques used in the management of ZD, with a focus on flexible endoscopic techniques.

In February, 2014, a 14-year-old girl with no medical history presented to the emergency department with a 2 day history of severe abdominal pain associated with non-bilious vomiting. On examination she had pallor and diff use abdominal tenderness with guarding and sluggish bowel sounds but no rigidity. She had haemoglobin 88 g/L, total leucocyte count 3·6 × 109/L, platelets 96 × 109/L, and erythrocyte sedimentation rate (ESR) 54 mm/h. Urinalysis was normal and blood and urine cultures were sterile. Other blood tests, chest and abdominal radiographs, abdominal ultrasound, stool culture and microscopy, and endoscopies were unremarkable. We started empirical intravenous ciprofl oxacin, cefepime, and metronidazole and analgesia without improvement. On further questioning she reported a recent history of two episodes of multiple oral ulcers that had resolved spontaneously but had no other symptoms of connective tissue disease. Antinuclear antibody (ANA) by indirect immunofl uorescence (IIF) with HEp-2 cell substrate was negative. Contrastenhanced CT showed features of infl ammatory enteritis and bilateral hydroureteronephr osis and thick-walled bladder (fi gure, appendix). Despite the negative ANA the urological abnormalities in the presence of infl ammatory enteritis were suggestive of systemic lupus erythematosus. We repeated ANA at a diff erent laboratory with HEp-2 cell substrate and it remained negative, but dsDNA and anti-Ro antibodies were strongly positive and she had low concentrations of C3 and C4, and a mild pericardial eff usion on echocardiography. We made a diagnosis of ANA-negative systemic lupus erythematosus with lupus enteritis and lupus cystitis in view of the revised American College of Rheumatology (ACR) criteria, on the basis of recurrent oral ulcers, cytopenia, serositis, and autoimmune markers. We gave methylprednisolone and cyclophosphamide with marked improvement. At 3 month follow-up ultrasound showed the urological abnormalities had resolved (appendix). 1–2% of patients with active systemic lupus erythematosus can present with negative ANA. Gastrointestinal and genitourinary symptoms often present concurrently in systemic lupus erythematosus, and can be the fi rst signs of the condition. Urinary bladder wall thickening caused by chronic interstitial cystitis in systemic lupus erythematosus can lead to distal ureteral stenosis and hydroureteronephrosis, and in a patient with infl ammatory enteritis should alert the physician to the possibility of lupus enteritis.