Clinical Spectrum of Amebiasis in Adults
Roberto R. Kretschmer in Amebiasis: Infection and Disease by Entamoeba histolytica, 2020
Three syndromes result from infection with E. histolytica: asymptomatic infection, symptomatic infection without evidence of tissue invasion (controversial), and invasive forms. Most individuals infected by this protozoarian, in fact 90% of them, fall into the asymptomatic category.3 Symptomatic gastrointestinal disease ranges from low abdominal, colic-like pain with mild diarrhea, all the way to the more serious forms with higher fever, dysentery with mucus- and blood-containing stools, tenesmus, and intense generalized abdominal pain, all unmistakenly indicating tissue invasion by the parasite. Three additional distinct clinical forms of serious intestinal amebiasis, occurring mostly in adults, are fulminant colitis (toxic megacolon), ameboma, and amebic appendicitis.
Malignant Neoplasms of the Colon
Philip H. Gordon, Santhat Nivatvongs, Lee E. Smith, Scott Thorn Barrows, Carla Gunn, Gregory Blew, David Ehlert, Craig Kiefer, Kim Martens in Neoplasms of the Colon, Rectum, and Anus, 2007
Primary plasmacytoma involving the colon is an exceedingly rare lesion (1079,1080). Presenting symptoms are nonspecific for gastrointestinal disease and may include abdominal pain, rectal bleeding, weight loss, nausea, vomiting, and anorexia. The lesion may be single or multiple and consists of polypoid or nodular protrusions. In the presence of intestinal involvement, appropriate scans and bone marrow biopsy should be obtained to rule out bone and marrow involvement. Microscopically, the plasmacytoma lesion is composed of many plasma cells. In most cases treatment has consisted of resection of the involved colon. An 80% 10-year survival can be expected (1037). However, if the diagnosis can be made by colonoscopic biopsy, treatment options include chemotherapy and radiotherapy (1081).
Clinical management
Alistair Burns, Michael A Horan, John E Clague, Gillian McLean in Geriatric Medicine for Old-Age Psychiatrists, 2005
Clinical symptoms are used to guide investigations. However, the fol- lowing blood tests are routinely performed: full blood count (FBC) to look for anaemia; urea and electrolytes are checked to ind�cate chronic renal disease; blood glucose should be measured to diagnose diabetes mellitus. Liver function tests might indicate liver metastases or alcoholic liver disease. Thyroid function testing is performed to diagnose hyperthyroidism. A bone profile may reveal a raised calcium or raised alkaline phosphatase level, which might indicate metastatic bone disease. A chest X-ray should be performed for all patients to look for primary or secondary lung neoplasms. Uri�e should be tested for haematuria. When baseline investigations do not indicate a likely cause of weight loss and weight loss contin�es, further tests are required. Gastrointestinal disease is the most likely cause. Gastroscopy, flexible sigmoidoscopy and barium enema examination are performed to identify the more common gastrointestinal causes of weight loss. The order of investigation is determined by symptoms, but sometimes no clinical indi- cators are present and all tests are required. An abdominal ultrasound sean to identify disease in the liver, kidneys and pancreas is also useful in unex- plained weight loss. This test can be performed earlier in the order of investigation if there is hepatomegaly or abnormal liver function. Further investigations might include CT scans of the chest and abdomen.
Unmet needs in cystic fibrosis
Published in Expert Opinion on Biological Therapy, 2018
The major goal in treating CF is to clear the abnormal and excess secretions that lead to infection and inflammation in the lungs. For patients with advanced stages of disease, a lung transplant may be necessary. Treatment of gastrointestinal disease is also important. A diet rich in fat and protein supplemented with digestive pancreatic enzymes for the 85% of patients who have pancreatic malabsorption will lead to weight gain and better health outcomes. Because of fat malabsorption, the fat-soluble vitamins A, D, E, and K are supplemented using water soluble forms of these vitamins. Patients with significant hepatic dysfunction will benefit from therapy with medications such as ursodiol and those with CF related diabetes mellitus may require insulin supplementation to maintain health. Together, treatment of GI and pulmonary disease is the mainstay of the medical management of CF.
Incidence of allergic reactions to Crotalidae polyvalent immune Fab
Published in Clinical Toxicology, 2019
Moteb Khobrani, Yvonne Huckleberry, Keith J. Boesen, Ahmed Aljabri, Mobarak Alharthi, Asad E. Patanwala
Reactions occurred during the loading dose (n = 10), followed by the maintenance doses (n = 4), and or were delayed allergic reactions (n = 6). All delayed reactions occurred 1–2 weeks after FabAV administration. There was one patient who had a reaction with both loading dose (nausea/vomiting) and maintenance dose (hives). In the remaining patients, the presence of the reaction was only in one of the three phases (i.e., loading, maintenance, or delayed). The types of reactions during each phase are in Table 1. Symptoms recorded included pruritus (n = 8), hives (n = 8), rash (n = 7), vomiting (n = 7), nausea (n = 6), dyspnea or wheezing (n = 4), diaphoresis (n = 3), throat irritation (n = 2), and mild hypotension (n = 2). Most patients (16/19) had more than one of the above symptoms noted. Allergic reactions were managed by decreasing the infusion rate or by the administration of diphenhydramine, methylprednisolone, or ondansetron. One patient was given an epinephrine infusion until completion of the antivenom course. This patient had nausea and vomiting, with acute onset each time FabAV was initiated or restarted. The gastrointestinal distress was refractory to treatment with antiemetics, histamine antagonists, and corticosteroids. The decision was made to initiate an epinephrine infusion, which was effective in preventing any subsequent reactions.
Impact of Diets Rich in Whole Grains and Fruits and Vegetables on Cardiovascular Risk Factors in Overweight and Obese Women: A Randomized Clinical Feeding Trial
Published in Journal of the American College of Nutrition, 2018
Somaye Fatahi, Elnaz Daneshzad, Hamed Kord-Varkaneh, Nick Bellissimo, Neil R. Brett, Leila Azadbakht
To the best of our knowledge, this was the first controlled feeding trial to test the separate and combined effects of various sources of dietary fiber on CVD risk factors. However, this trial did have some limitations. First, a modest sample size and the specificity of our population may limit the applicability of results to other populations. Second, although adherence to the high-fiber diets appeared to be high, there is always the possibility of gastrointestinal distress from high-fiber diets. Third, in this paper, we did not report other CVD risk factors, such as inflammatory markers, coagulating factors, and liver enzymes. These outcomes are important to investigate in the future to be able to establish a stronger link between consumption of various fiber sources and effects on CVD risk factors. Fourth, our weight loss and WC results would have been further strengthened with the measurement of body fat changes, as previously done (43). Finally, a biomarker was not used to assess adherence because participants consumed the fruits, vegetables, and whole grains under supervision.