Description: Symptomatic gastrointestinal (GI) amyloidosis is a rare manifestation of systemic amyloid light chain (AL) amyloidosis. Further, the presentation of primary GI amyloidosis without previously diagnosed systemic amyloidosis is exceptionally rare. We describe a case of a patient presenting with abdominal pain, nausea, vomiting, and weight loss later to be diagnosed with localized GI amyloidosis from underlying multiple myeloma. Unfortunately, the GI disease was insurmountable leading to her death. Amyloidosis exerts its pathology at the level of the mucosa, soft tissue, nerves, and vascular supply of the GI tract. No specific treatments for the GI complications of amyloidosis are available and supportive measures are universally employed. GI amyloidosis is not only infrequently amenable to systemic and symptomatic treatment, but has a negative impact on both quality of life and survival.

Description: DRESS syndrome (Drug Reaction with Eosinophilia and Systemic Symptoms) is a hypersensitivity reaction with rash, fever and multiorgan dysfunction potentially lethal in up to 10% of cases. It often affects liver function, but it can also affect kidney, lungs, and heart. Severe gastrointestinal involvement is rare. We present a case of a 31-year-old hispanic woman with pseudomembranous colitis associated with lamotrigine-induced DRESS syndrome. To the best of our knowledge, this is the fourth reported case of severe involvement of the gastrointestinal tract and the first to report pseudomembranous colitis in the setting of DRESS syndrome.

Description: A 76-year-old gentleman presented with anemia. He had a history of perforated duodenal ulcer six years ago, with Billroth II repair performed. A large gastric bezoar (8X6cm 2 ) with a clean base ulcer at the anastomotic junction was found during the initial Oesophago-gastro-duodenoscopy (OGDS). Rapid urease test was negative. He presented with melena during the subsequent follow up (OGDS showed a Forrest Ib prepylori ulcer). We have successful removed the gastric bezoar with dissolution therapy initially (injection of coke-cola into the bezoar, followed by drinking 325ml coca-cola twice daily), followed by four attempts of OGDS with endoscopic fragmentation. Histopathology reported as degenerated vegetable matter, acellular debris mixed with scattered fungal and bacterial colonies, which was compatible with bezoar. Follow up OGDS showed complete clearance of the bezoar. Coca-cola ingestion should be considered as initial treatment as it is non-invasive, and it enables further successful endoscopic fragmentation.

Description: Background: Insulin is a debatable risk factor for colon adenoma (Ad) among type II Diabetes Mellitus (DM II) patients. Obesity is an important confounding variable.  Methods: The study involved chart review of DM II patients undergoing screening colonoscopy. Study population was divided into obese (BMI=〉30) and non-obese (BMI〈30) groups which were further divided into insulin and non-insulin subgroup. Colonoscopy and pathology reports were used to calculate Ad detection rate (ADR) and AAd detection rate (AADR). Results: 538 subjects satisfied the inclusion and exclusion criteria. The study population composed of 52.8% obese and 47.2% non-obese subjects. Obese group had 28.9% insulin and 71.1% non-insulin subjects. Non-obese group composed of 29.9% insulin and 70.1% non-insulin subjects. ADR for non-obese insulin and non-insulin subgroup was 31.6% and 37.1% respectively. AADR for non-obese insulin and non-insulin subgroup was 13.2% and 11.2% respectively. ADR for obese insulin and non-insulin subgroup was 41.5% and 34.2% respectively. AADR for obese insulin and non-insulin subgroup was 15.9% and 16.3% respectively. Summary: Insulin exposure lacked statistically significant association with ADR or AADR among obese and non-obese DM II subjects.

Description: Gallbladder cancer prevalence is ever increasing with Salmonella Typhi chronic infection being one of the predisposing factors. Altered ratios or expression of TGF-β receptors and changes in its function are associated with loss in anti-proliferative effects of TGF-β and cancer progression.  Using Reverse-Transcriptase PCR we monitor any changes in TGF-β receptor gene expression. We simultaneously screen for S .Typhi within the samples.  From 73 patients undergoing cholecystectomy 39/50 (%) had significant expression (P〈0.05) of TβR-I and TβR-II during chronic cholelithiasis as compared to the remaining 19/23(%) with acute chronic cholelithiasis. There was no significant increase in TβR-III receptor expression. Patient’s positive for S .Typhi (7/73) did not show any significant changes in expression of these receptors, thus indicating no direct relation in regulating the host TGFβ-signalling pathway.  Further analysis on expression of downstream Smad components revealed that patients with up-regulated TGFβ receptor expression show 〉 2-fold increase in the R-Smads and Co-Smads with a 〉 2-fold decrease in I-Smads. Thus gain of TβR-I and II expression in epithelial cells of the gallbladder was associated with chronic inflammatory stages of the gallbladder disease.

Description: The purpose of the research was to estimate the clinical-diagnostic and predictive value of non-invasive ultrasonic elastography in dynamic monitoring in patients with diffuse liver disease. A number of 114 patients with diffuse liver disease were examined, specifically 68 (59.6%) men and 46 (40.4%) women. The patients were divided into three groups: 40 patients with steatosis; 38 with hepatitis; 36 with cirrhosis. The research included clinical and bio-chemical analysis, ultrasound examination of liver and spleen with doppler v. portae and v. lienalis, elastography of liver and spleen. The study found a high correlation of elastography data as regards the liver and spleen in patients with alcoholic cirrhosis (r=0.96), average correlation (r=0.69) in patients with steatosis and hepatitis of alcoholic etiology. On the basis of the statistical program receiver operating characteristic (ROC)-analysis it was ascertained that the spleen is in perfect condition (AUC 0.9-1.0), and the liver is in a very good condition (0.8-0.9). The research revealed therapeutically significant factor ΔF/ΔL for dynamic monitoring: the ΔF/ΔL 1 can predict a more favorable course of the disease. Noninvasive ultrasound elastography helps to forecast the process of the disease and correct the therapeutic approach. The research contributes to the search for additional and reliable techniques of identifying the stage of disease of patients with hepatic fibrosis, the dynamics of the disease as well as forecasting further complications.

Description: MicroRNAs (miRNAs) are impressive regulators of gene expression that have a critical role in the pathogenesis of Colorectal Cancer (CRC). With respect to the aberrant expression of microRNA-383 (miR-383) in some types of human malignancy, this prospective study characterized its contribution to CRC tumorigenesis. The real-time reverse transcription–polymerase chain reaction was used to examine miR-383 expression levels prospectively in 40 sample pairs of CRC tissues and adjacent noncancerous tissues (〉2 cm from cancer tissue). No significant relationship was found between miR-383 expression levels and clinicopathological features. The ability of miR-383 to function as a tumor marker was also examined. Showing significant changes overall, miR-383 expression levels were significantly down regulated in the group of CRC samples compared with matched noncancerous tissue samples. A receiver operating characteristic (ROC) curve also showed ROC area (AROC) of 70% for miR-383 with 68% and 75% sensitivity and specificity, respectively. Therefore, miR-383 can be considered as a tumor marker in CRC and help as a potential predictive biomarker in the diagnosis of colorectal cancer.

Description: Intestinal intussusception is an uncommon acute condition in adults and is most commonly caused by an intestinal tumour mass. Helminthic parassitosis is a widespread infection inAfrica, and the load of worms is often high in individuals living in areas with inadequate sanitation. We report a case of intestinal obstruction caused by Ascaris lumbricoides infection, which was complicated by ileo-caecal intussusception and required surgical treatment in a 40-year-old Ugandan lady. This case reinforces the importance of antihelminthic prophylaxis in African rural areas

Description: Gastroesophageal reflux disease (GERD) is common in the general population. Pregnancy is known to be associated with high incidence of GERD symptoms. Although, there are previously conducted studies involving both genders to determine the prevalence of GERD in different population groups in Nigeria, our preliminary literature search showed that there is a dearth of data on the prevalence of GERD among Nigerian pregnant women. The aim of this study is to determine the prevalence of GERD using the GerdQ questionnaire and to test the association between pregnancy and GERD among women of south-western Nigeria. The study was a descriptive hospital based cross-sectional survey involving three medical facilities in two states of south-western Nigeria. A total of 796 women consisting of 413 (51.9%) healthy pregnant women at various gestational ages and 383 (48.1%) nonpregnant women were interviewed. A predesigned questionnaire consisting of sociodemographic data, obstetrics information, the GerdQ questionnaire and previous history of GERD symptoms was administered to each of the participants. Of the 796 women interviewed, 413 (51.9%) were pregnant women with a mean of 27.42 (±5.00) years and 383 (48.1%) non-pregnant women of child bearing age with a mean of 26.72 (±6.46) years. The prevalence of GERD among the pregnant women was 14.5% while that among the nonpregnant group was 9.7%. This difference was statistically significant (P=0.036). Following adjustment for potential confounders, pregnancy maintained a positive statistically significant relationship with GERD [OR=1.67 (95% CI=1.07, -2.61), P=0.023]. GERD has a moderate prevalence in pregnancy in southwestern Nigeria. Pregnancy has a significant association with GERD, independent of the other risk factors.

Description: Although about 50% of lung cancers have distant metastasis at the time of initial diagnosis, colonic metastases are extremely rare. This report presents a rare clinical case of colonic metastasis from primary adenocarcinoma of the lung.