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Introduction: Oral folic acid supplementation is essential for patients treated with pemetrexed, to prevent the risk of severe hematologic toxicity. In case of intestinal absorption disorder, no recommendations exist for intravenous folic acid supplementation. Case report: We describe a 74-year-old patient with multimetastatic non-small-cell lung adenocarcinoma, receiving first-line chemotherapy with carboplatin AUC5, pemetrexed 500 mg/m2 and pembrolizumab 200 mg intravenously every 3 weeks. The patient presented neglected celiac disease, resulting in malabsorption syndrome with iron and folic acid deficiency. The question was how to administer folic acid supplementation during the pemetrexed-based chemotherapy. Management and outcomes: Intravenous injection of 200 mg levoleucovorin on day 1 of cycle 1 of pemetrexed-based chemotherapy was administered and well tolerated. During the second cycle, the levoleucovorin perfusion was not renewed by omission. The patient was hospitalized for 7 days because of febrile aplasia. Piperacillin–tazobactam was started, and then switched to amoxicillin–clavulanate plus ciprofloxacin. After this episode of post-chemotherapy febrile aplasia, it was decided to systematically supplement the patient with intravenous levoleucovorin, with blood folate concentration monitoring at each cycle. At 16 months after start of treatment, the patient was in complete remission, indicating that the immune-chemotherapy was effective, with no further febrile neutropenia. Discussion/conclusion: This case report highlights intravenous levoleucovorin supplementation as an alternative to oral folic acid if needed during pemetrexed – antifolate-based chemotherapy. [ABSTRACT FROM AUTHOR]

The epithelial cell adhesion molecule gene (EPCAM, previously known as TACSTD1 or TROP1) encodes a membrane-bound protein that is localized to the basolateral membrane of epithelial cells and is overexpressed in some tumors. Biallelic mutations in EPCAM cause congenital tufting enteropathy (CTE), which is a rare chronic diarrheal disorder presenting in infancy. Monoallelic deletions of the 3' end of EPCAM that silence the downstream gene, MSH2, cause a form of Lynch syndrome, which is a cancer predisposition syndrome associated with loss of DNA mismatch repair. Here, we report 13 novel EPCAM mutations from 17 CTE patients from two separate centers, review EPCAM mutations associated with CTE and Lynch syndrome, and structurally model pathogenic missense mutations. Statistical analyses indicate that the c.499dupC (previously reported as c.498insC) frameshift mutation was associated with more severe treatment regimens and greater mortality in CTE, whereas the c.556-14A>G and c.491+1G>A splice site mutations were not correlated with treatments or outcomes significantly different than random simulation. These findings suggest that genotype-phenotype correlations may be useful in contributing to management decisions of CTE patients. Depending on the type and nature of EPCAM mutation, one of two unrelated diseases may occur, CTE or Lynch syndrome.

Common variable immunodeficiency (CVID), the most common symptomatic primary antibody deficiency, is accompanied in some patients by a duodenal inflammation and malabsorption syndrome known as CVID enteropathy (E-CVID).The goal of this study was to investigate the immunological abnormalities in CVID patients that lead to enteropathy as well as the contribution of intestinal microbiota to this process.We found that, in contrast to noE-CVID patients (without enteropathy), E-CVID patients have exceedingly low levels of IgA in duodenal tissues. In addition, using transkingdom network analysis of the duodenal microbiome, we identified Acinetobacter baumannii as a candidate pathobiont in E-CVID. Finally, we found that E-CVID patients exhibit a pronounced activation of immune genes and down-regulation of epithelial lipid metabolism genes. We conclude that in the virtual absence of mucosal IgA, pathobionts such as A. baumannii, may induce inflammation that re-directs intestinal molecular pathways from lipid metabolism to immune processes responsible for enteropathy.

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Breath testing is the most widely utilized modality to diagnose small intestinal bacterial overgrowth (SIBO) and/or intestinal methanogen overgrowth (IMO). Although SIBO can be diagnosed with small bowel aspiration and breath testing, IMO can only be diagnosed with breath testing in clinical practice. Breath testing can tailor antibiotic therapy and predict response to treatment; however, the test is limited by its indirect method of measurement and concerns about the variability of orocecal transit time. Like any clinical test, breath testing has inherent strengths and limitations, and results must be interpreted with consideration of the clinical context and influencing factors. Recent studies have demonstrated the expanding clinical utility of breath testing in the diagnosis, management, and prediction of treatment response in SIBO and particularly in IMO along with the identification of distinct breath test patterns such as flat-line and high baseline hydrogen. This article reviews the strengths and limitations of breath testing in diagnosing SIBO and IMO as well as its expanding utility in clinical practice. [ABSTRACT FROM AUTHOR]

Collagenous sprue is a rare and unrecognized cause of diarrhea and weight loss, mainly affecting the duodenum and small bowel. The clinical picture often resembles that of coeliac sprue, the main differential diagnosis, albeit, being refractory to a gluten-free diet. The histological features are fundamentally characterized by the deposition of collagen beneath the basement membrane of gut mucosa. Treatment should be initiated as soon as the diagnosis is established, so as to prevent the progression of fibrosis. We will describe the case of a 76-year-old woman with collagenous sprue, her diagnostic workup, histopathological examination, and response to treatment. [ABSTRACT FROM AUTHOR]

Background: Congenital syphilis (CS) depends on the placental transmission of Treponema pallidum (TP) spirochetes from an infected mother to fetus during pregnancy. It shows a wide clinical variability with cutaneous and visceral manifestations, including stillbirths, neonatal death, and asymptomatic cases. Preterm infants with CS may have more severe features of disease than the term ones, due to the combined pathogenic effect of both CS and prematurity. Case presentation: We report on a female preterm (32+6 weeks of gestation) newborn showing most of the typical CS manifestations, in addition to gastrointestinal disorders including feeding difficulties, colon stenosis and malabsorption leading to postnatal growth restriction. The mother resulted positive at the syphilis screening test of the first trimester of pregnancy, but she did not undergo any treatment. At birth, our newborn was VDRL positive (antibody titer four times higher compared to the mother), and she was treated with intravenous benzathine benzylpenicillin G for 10 days (50,000 IU/Kg three times per day). Poor tolerance to enteral nutrition (abdominal distension, increased biliary type gastric secretions) was observed. A barium enema X-Ray identified a colon stenosis within the descending tract. However, the poor general conditions due to a concurrent fungal sepsis did not allow to perform any surgical procedure, and a conservative approach with total parenteral nutrition was started. The following evolution was marked by difficulties in enteral feeding including refusal of food and vomiting, to which also contributed the neurological abnormalities related to a perinatal asphyxia, and the affective deprivation for the physical absence of the mother during hospitalization. At 5 months of age, after the introduction of an amino acid-based formula (Neocate LCP Nutricia ®), an improvement of enteral feeding was observed, with no further and significantly decreased episodes of abdominal distension and vomiting respectively, and regular stool emission. A psychological support offered to the family allowed a more stable bond between the mother and her baby, thus providing a significant additional benefit to food tolerance and growth. She was discharged at 5 months of age, and included in a multidisciplinary follow-up. She at present shows global growth delay, and normal development apart from mildly increased tone of lower limbs. Conclusions: Our report highlights less common clinical CS manifestations like gastrointestinal disorders including feeding difficulties, colon stenosis and malabsorption leading to postnatal growth delay. Moreover, it underlines how prematurity may worsen the clinical evolution of such congenital infection, due to the additional pathogenic effect of possible associated diseases and/or conditions like sepsis, hypoxic/ischemic injury, or use of drugs. CS may be observed also in high-income countries, with high rates of antenatal screening and availability of prenatal treatment. A multidisciplinary network must be guaranteed to the affected subjects, to ensure adequate care and improve the quality of life for patients and their families. [ABSTRACT FROM AUTHOR]

Simple Summary: Infection with goose reovirus (GRV) can cause serious economic losses in the goose breeding industry. In this study, we determined infectious agents associated with arthritis and the generalized infection of a flock of young geese in Poland, using molecular biology, histopathology, and virus isolation methods. The disease caused by GRV has no cure or effective vaccine. The early detection of its pathogen is basic to prevent of secondary bacterial and fungal infections. Avian reovirus (ARV) is a cause of infections of broiler and turkey flocks, as well as waterfowl birds. This case report describes a reovirus detection in a fattening goose flock. GRV-infected geese suffer from severe arthritis, tenosynovitis, pericarditis, depressed growth, or runting-stunting syndrome (RSS), malabsorption syndrome, and respiratory and enteric diseases. GRV (goose reovirus) caused pathological lesions in various organs and joints, especially in the liver and spleen. GRV infection causes splenic necrosis, which induces immunosuppression, predisposing geese to infection with other pathogens, which could worsen the disease and lead to death. Our results showed that GRV was detected via RT-PCR and isolated in SPF (Specific Pathogen Free) embryos. This is the first report of the involvement of reovirus in arthritis, and the generalized infection of young geese in Poland, resulting in pathological changes in internal organs and sudden death. This study also provides new information about the GRV, a disease that is little known and underestimated. [ABSTRACT FROM AUTHOR]

Background: Bile acid diarrhoea (BAD) causes chronic diarrhoea and is primarily treated pharmacologically. This systematic review aimed to evaluate the effectiveness of non‐pharmacological therapies for evidence‐based management of BAD in adults. Methods: A systematic review of the medical literature was performed from 1975 to 13 July 2021 to identify studies on diet, psychological, and exercise therapies that met diagnostic criteria for BAD in adults with diarrhoea. Effectiveness was judged by responder or improvement in diarrhoea at study endpoint according to each study's definition of diarrhoea. Therapeutic effect on abdominal pain and flatulence was also measured. Risk of bias was assessed using the Risk Of Bias In Non‐Randomised Studies of Interventions tool. A narrative review was conducted using 'Synthesis Without Meta‐analysis' guidance. Certainty of the evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation. Results: Eight prospective cohort studies were identified on diet therapies from 2 weeks to over 2 years involving 192 patients. No psychological or exercise therapies were found. Carbohydrate modification (one study, n = 2) in primary BAD, and dietary fat intake reductions (five studies, n = 181) and an exclusive elemental diet therapy (two studies, n = 9) in secondary BAD, showed beneficial directions of effect on diarrhoea, abdominal pain, and flatulence. Risks of bias for each study and across studies for each therapy type were serious. Certainty of the evidence was very low for all outcomes. Conclusions: No conclusions could be drawn on the effectiveness of diet, psychological, or exercise therapies on diarrhoea, abdominal pain, and flatulence for the management of BAD in adults. High‐quality randomised controlled trials are needed. Key points: We do not know whether non‐pharmacological therapies can improve diarrhoeal symptoms in adults with bile acid diarrhoea.Available data from cohort studies outlined in this systematic review found that: (i) in primary bile acid diarrhoea, lactose and/or sorbitol and fructose intake reductions provided very low‐certainty evidence of a beneficial effect after optimisation with colestyramine; (ii) in secondary bile acid diarrhoea, dietary fat intake reduction and exclusive oral nutritional supplementation with elemental formula provided very low‐certainty evidence of beneficial effects as sole treatment or after optimisation with bile acid sequestrants; and (iii) there was no evidence on psychological or exercise therapies.We need high‐quality studies to evaluate the acceptability, feasibility, and effectiveness of diet, psychological, and exercise therapies adjunctive or separate to medication for the management of BAD in adults. [ABSTRACT FROM AUTHOR]

Avian reovirus (ARV) is highly disseminated in commercial Brazilian poultry farms, causing arthritis/tenosynovitis, runting-stunting syndrome, and malabsorption syndrome in different meat- and egg-type birds (breeders, broilers, grillers, and layers). In Brazil, ARV infection was first described in broilers in the 1970s but was not considered an important poultry health problem for decades. A more concerning outcome of field infections has been observed in recent years, including condemnations at slaughterhouses because of the unsightly appearance of chicken body parts, mainly the legs. Analyses of the performance of poultry flocks have further evidenced economic losses to farms. Genetic and antigenic characterization of ARV field strains from Brazil demonstrated a high diversity of lineages circulating in the entire country, including four of the five main phylogenetic groups previously described (I, II, III, and V). It is still unclear if all of them are associated with different diseases affecting flocks' performance in Brazilian poultry. ARV infections have been controlled in Brazilian poultry farms by immunization of breeders and young chicks with classical commercial live vaccine strains (S1133, 1733, 2408, and 2177) used elsewhere in the Western Hemisphere. However, genetic and antigenic variations of the field isolates have prevented adequate protection against associated diseases, so killed autogenous vaccines are being produced from isolates obtained on specific farms. In conclusion, ARV field variants are continuously challenging poultry farming in Brazil. Epidemiological surveillance combined with molecular biological analyses from the field samples, as well as the development of vaccine strains directed toward the ARV circulating variants, are necessary to control this economically important poultry pathogen. Reovirus aviares en granjas avícolas de Brasil. El reovirus aviar (ARV) está muy diseminado en las granjas avícolas comerciales brasileñas y causa artritis/tenosinovitis viral, síndrome de retraso de enanismo infeccioso y síndrome de malabsorción en diferentes tipos de aves de carne y huevos (reproductoras, pollos de engorde, parrillas y ponedoras). En Brasil, la infección por reovirus aviares se describió por primera vez en pollos de engorde en la década de 1970, pero no se consideró un problema importante de salud avícola durante décadas. En los últimos años se ha observado un resultado más preocupante de las infecciones de campo, incluidos los decomisos en las plantas de procesamiento debido a la apariencia antiestética de las partes del cuerpo de los pollos, principalmente las patas. Los análisis del desempeño de las parvadas avícolas han evidenciado pérdidas económicas adicionales para las granjas. La caracterización genética y antigénica de las cepas de campo de reovirus aviares de Brasil demostró una gran diversidad de linajes que circulan en todo el país, incluidos cuatro de los cinco grupos filogenéticos principales descritos anteriormente (I, II, III y V). Todavía no está claro si todos ellos están asociados con diferentes enfermedades que afectan el rendimiento de las parvadas en las aves de corral brasileñas. Las infecciones por reovirus aviares se han controlado en granjas avícolas brasileñas mediante la inmunización de reproductores y pollitos jóvenes con cepas vacunales vivas comerciales clásicas (S1133, 1733, 2408 y 2177) utilizadas en otras partes del hemisferio occidental. Sin embargo, las variaciones genéticas y antigénicas de los aislamientos de campo han impedido una protección adecuada contra enfermedades asociadas, por lo que se están produciendo vacunas autógenas inactivadas a partir de aislamientos obtenidos en granjas específicas. En conclusión, las variantes de campo de ARV son un desafío continuo para la avicultura en Brasil. La vigilancia epidemiológica combinada con análisis de biología molecular de las muestras de campo, así como el desarrollo de cepas de vacunas dirigidas a las variantes circulantes de los reovirus aviares, son necesarias para controlar este patógeno avícola económicamente importante. [ABSTRACT FROM AUTHOR]

A case study a 20‑month‑old boy born to third‑degree consanguineous parents presented to the pediatric neurology outpatient clinic with a history of multiple daily episodes of generalized tonic– clonic seizures, and myoclonic jerks of one‑month duration. Topics include antiseizure medications with poor seizure control despite treatment with neurological problem; and Electroencephalogram (EEG) revealed epileptiform activity arising from the bilateral posterior head region.

Hodgkin’s Lymphoma is a cancer affecting the lymphatic system. There are two subtypes of Hodgkin’s Lymphoma: Nodular lymphocyte predominant (NLPHL) and classical Hodgkin’s Lymphoma which has further four types. It has a bimodal distribution and is more common among males. The most common presentation is painless swelling in the neck, armpit or groin region. Associated Symptoms include night sweats, unintentional weight loss, fever, persistent cough or dyspnea. Involvement of the gastrointestinal tract is a rare occurrence. Diagnosis is based on hematological, radiological and histochemical studies. Here we report a rare presentation of a 47-year-old male who presented with symptoms of loose stools, weight loss and fever. CT scan and abdominal lymph node biopsy findings were consistent with a lymphoproliferative disorder Patient was being managed in the line of malabsorption syndrome with possible underlying malignancy but his condition deterioted before the histological diagnosis was confirmed. Thus, this report highlights the importance having a consideration for Hodgkin’s lymphoma in the management of chronic diarrhea. [ABSTRACT FROM AUTHOR]

The article reports that there are two differentiated concepts, which present a common symptomatology but which correspond to different pathophysiological mechanisms, giving rise to two syndromes known as maldigestion and malabsorption. Topics include examines maldigestion is an alteration that decreases the digestive processes necessary to transform ingested food into nutrients, producing a defective hydrolysis of the same.

Obesity is a major public health issue with significant health and financial costs. Almost one in three Australian adults are living with obesity. Bariatric surgery can have a role in the management of obesity. There is evidence for its effectiveness in preventing or reversing chronic health conditions. The type of bariatric surgery can significantly impact the absorption, distribution, metabolism or elimination of orally administered drugs. Some changes can be predicted from pharmacokinetic and physiological effects, but management should be individualised. The effect of weight loss itself after bariatric surgery may require drug doses to be altered. A review of the patient's medicines and ongoing follow-up are important before and after surgery to ensure optimal outcomes. [ABSTRACT FROM AUTHOR]

Copper deficiency often manifests with anemia and ataxia. The risk factors associated with the deficiency include gastrointestinal surgery, excessive zinc supplementation, and malabsorptive conditions. Little is known about the relationship between copper deficiency and alcohol consumption. Here we report a case of copper deficiency in a patient with alcohol use disorder who also had zinc deficiency, thereby posing a therapeutic dilemma because copper and zinc are competitively absorbed into the small intestine. Early recognition of copper deficiency is essential when treating zinc deficiency in such patients. [ABSTRACT FROM AUTHOR]