bluuebunny/crossref_metadata_2025_split huggingface dataset:
Strongyloidiasis Of Duodenum Clinically Mimicking As Celiac Disease: A Case Report
Authors: Shah J 
Published: October 2020

Abstract

Casestudy
Strongyloides stercoralis is classified as a roundworm or nematode. S. stercoralis is unique and different from other intestinal nematodes because of its ability to complete its life cycle within the host through an asexual auto infective cycle, allowing the infection to persist in the host indefinitely. It is usually asymptomatic can be symptomatic in immunocompromised individual leading to disseminated disease. Serology and stool microscopy are the investigations of choice. Though histopathology is the gold standard it is invasive procedure and has its own complication. strongyloidiasis is easily treatable with oral anthelminthic drugs. To date, only a limited number of cases has been published in our part of the world.
Strongyloidiasis is often asymptomatic in immunocompetent individuals. We present the case of a 34-year old man from hilly region of Nepal with complaints of on and off abdominal pain since one and half year. Over the last week his symptoms worsened with bilious vomiting, nausea, abdominal pain, loss of appetite and weight loss. Patient was short statured with multiple pruritic lesions over skin. A clinical diagnosis of celiac disease was suspected clinically. Blood examination was performed shows Microcytic Hypochromic Anemia with mild increase in eosinophils. Stool examination and serology was performed it was negative. An endoscopic biopsy from duodenum was performed and histopathologic examination revealed gastrointestinal strongyloidiasis.

Conclusion
Helminthic infections can clinically mimic large number of non-neoplastic and neoplastic diseases like celiac sprue, IBD, GI malignancy etc. The present case highlights the importance of basic investigation like multiple stool examination in patient with GI symptoms before subjecting the patient to invasive procedures.
Isolation Of Anticancer Drug Taxol Producing Endophytic Fungus Alternaria Alternata By Using HPLC And LC- MS
Authors: Ghaly M , Talat I E , Abeer A , Mohamed M , Elmetwalli A W 
Published: October 2020

Abstract

Introduction/Objective
In the exploration of an alternative source, optimum and numerous solvents with different percentage were exploited to extract Taxol from plant palm branche. The fungal endophytes producing secondary metabolites that are effective against the human infections have fascinated many researchers across the world.
Among these, the exploration for novel cancer therapeutic agents is of countless reputation due to upsurge in the number of cancer deaths, high worth of the drugs and the side effects concomitant with cancer treatments.
Accordingly, in the current study, an endophytic fungal strain was isolated from its host plant palm branche and identified as Alternaria Alternata based on its morphological features and internal transcribed spacer sequence analysis.

Methods
Firstly, palm branche were collected for the isolation of endophytic fungi. The samples were placed on PDA plates and after 72 h, the mycelium produced were isolated and sub-cultured. Secondly, further analysis for the presence of Taxol by using chromatographic and spectrometric techniques. Illustratively, ethanol or acetone and 50% and 20% of ethanol. Then, the residues were dissolved in 5 ml of methanol and filtered. By using the internal standard, the resulting solution was subjected to the HPLC to determine the extraction efficiencies of tested solvents. Finally, filtrate was also subjected to the LC-MS – ESI using water/acetonitrile (10/90) as mobile phase to identify the authenticity of Taxol

Results
HPLC analysis revealed that Taxol could be quantified by UV detection using standard curve. Furthermore, the standard curve covering the concentration was linear (r2= 0.9992) and CV% ranged from 0.52 to 15.36. The peaks of fraction 5 obtained by HPLC analysis were quite similar to that of standard taxol confirming the presence of taxol. A parent ion peak of m/z 851.85 was observed in the LC–ESI–MS spectrum which was similar to paclitaxel with reported m/z of 854 [M+H] + ion. A. Alternata produced about 113.193 mg/L taxol as quantified through HPLC

Conclusion
we are recording for the first time the production of taxol by an endophytic fungus Alternaria Alternata. In a final word, present study results advocate that the endophytic fungus A.Alternata aids as a potential source for the production of taxol isolated from Palm branche plant
Ethnic Differences in Infection with SARS-CoV-2; a Veteran Affairs Medical Center (VAMC) Experience
Authors: Petersen J M , Dalal S , Jhala D 
Published: October 2020

Abstract

Introduction/Objective
An Institute of Medicine (IOM) report from 2002 has documented that racial and ethnic minorities have tended to receive worse health outcomes compared to non-minorities. This pattern has been demonstrated for many chronic and acute injuries and illnesses, but to the author’s knowledge, there is sparse literature on this study on outcomes related to the novel coronavirus (SARS-CoV-2). SARS-CoV-2 has become a pandemic of global importance with significant impact on all elements of society. As part of quality assurance, as becoming confirmed positive for SARS-CoV-2 would be adverse clinical news, a review was undertaken to see if there were ethnic differences in the veteran population being tested at the Veteran Affairs Medical Center (VAMC) on the risk of testing positive for SARS-CoV-2.

Methods
As part of a quality assurance/quality improvement project, a manual retrospective review of all SARS-CoV- 2 RT-PCR tests performed at the VAMC from March 11th, 2020 to April 13th, 2020. These tests were reviewed within
the computerized medical record system to determine the age, gender, ethnicity of the patients, and test result of the patient.

Results
There were 571 patients who had tested for SARS-CoV-2. Out of these patients, 99 of these patients had a positive test result. The ethnic breakdown of the unique patients with a positive test result was 67 were African- American (68% of positive results), 2 Asian-American (2%), 1 Native Hawaiian or other Pacific Islander/Hispanic mixed (1%), 17 Caucasian (17%), and 12 declined to answer or left ethnic field unanswered. Among the 471 who had negative results, only 197 or 42% were African American and 118 were Caucasian (25%).

Conclusion
African Americans had more infections with SARS-CoV-2 compared to the other ethnic groups. Caucasians had many of the negative results, and positive results were otherwise not common in the other ethnic groups in the VAMC cohort. Given this first report in the literature of the disproportionate impact SARS-CoV-2 is having on those of African American ethnicity, appropriate clinical access and low threshold to test is essential.
Establishing Adrenocortical Carcinoma Specific Prognostic Genes Signature
Authors: Patil A R , Dabrowski D S , Cotelingam J , Veillon D , Ong M , Dela Cruz N , Wei E , Tirupathi R , Ganti N , Vanga P , Otohinoyi D 
Published: October 2020

Abstract

Introduction/Objective
Adrenal Cortical Carcinoma (ACC) is a rare malignant neoplasms originating from adrenal cortical tissue with an annual incidence rate of 1 to 2 cases per million individuals. These tumors have poor prognosis with 5-year disease free survival being 30% after complete resection in Stage I to Stage III patients. Hence, there is a need for identifying prognostic markers for effective management of disease in these patients.

Methods
We analyzed the data in The Cancer Genome Atlas of 1141 ACC individuals, using cbioportal.org, a web- based platform for analysis of large-scale cancer genomics data sets, and derived correlation between prognosis and genetic alterations in approximately 51,309 genes.

Results
We identified 15 signature genes (NOTCH1, TP53, ZNRF3, LRP1, KIF5A, MDM2, LETMD1, MTOR, NOTCH3, RERE, SMARCC2, LDLR, HRNR, AVPR1A and PCDH15), alterations in which indicated a poor prognosis for ACC individuals. Analysis of 15 signature genes demonstrated that disease specific median survival for the patients with ACC, was reduced to 39.5 months (p value &lt; 8 x 10 -9 and sensitivity of 93%) when any one or more of these genes was altered. Whereas, disease specific median survival was greater than 180 months (90% survival being 180 months) with no alteration in our signature genes. In addition, our analysis of our signature genes demonstrates reduced overall survival, disease free survival and progression free survival in individuals having alterations in our signature genes. Moreover, our set of 15 genes belonged mainly to MDM2-TP53, NOTCH and mTOR pathways, and small molecule modulators of these pathways are in process of development.

Conclusion
Our 15 gene signature was not only able to predict poor prognosis in ACC, but also has the potential to serve as a molecular marker set for initiation of NOTCH and mTOR specific targeted therapies in these patients.
Family History of Crohn’s Disease (CD) May Be a Risk Factor for Developing de novo CD following Ileal Pouch Anal Anastomosis (IPAA) for Ulcerative Colitis (UC)
Authors: Li H , Arslan M , Fu Z , Lee H , Mikula M 
Published: October 2020

Abstract

Introduction/Objective
A subset of patients with an established diagnosis of UC develops signs of CD (de novo CD) following IPAA. While the etiology and risk factors of de novo CD remain largely unknown, preliminary studies have shown controversial results regarding family history of inflammatory bowel disease (IBD) and smoking history.

Methods
Patients that underwent IPAA for UC, with at least 1 year of follow-up, were identified (n=161; 1996 to 2018). We retrospectively reviewed the electronic medical records. Patients that were diagnosed with de novo CD during the follow-up period were further identified. Smoking history and family history of IBD were evaluated. Chi square test was performed to compare the frequencies. Odds ratio (OR) and 95% confidence intervals (CIs) were estimated by logistic regression model. P&lt;0.05 was considered statistically significant.

Results
29 de novo CD were identified. At the time of proctocolectomy, the family history of IBD and smoking history was documented in 152 UC patients including 27 that subsequently developed de novo CD. 23 of 152 had a family history of IBD (12 UC, 9 CD and 2 IBD, NOS). 19/129 (14.7%) UC patients without a family history of any type of IBD, 4/9 (44.4%) with a family history of CD, and 4/12 (33.3%) with a family history of UC developed de novo CD. Patients with a family history of CD were more likely to develop de novo CD post IPAA than those without a family history of any type of IBD (OR 4.63, 95% CI 1.14-18.82, p=0.03). Family history of UC did not correlate with development of de novo CD (OR 2.90; 95% CI 0.79-10.57, p=0.108). At the time of proctocoletomy, 11 were current smokers, 25 were former smokers, and 116 never smoked. In de novo CD group, there were 4/27 (14.8 %) former smokers and 23/27 (85.2 %) never smokers. No de novo CD patient was current smoker. In the UC group that remained as UC following IPAA, 11/125 (8.8%) were current smokers, 21/125 (16.8 %) former smokers, and 93/125 (74.4 %) were never smokers. Current smoking status was not associated with development of de novo CD (p = 0.214).

Conclusion
Family history of CD may be a risk factor for developing de novo CD following IPAA for UC. Current smoking status was not associated with development of de novo CD following IPAA for UC.
Histologic Correlation of Breast Biopsies Presenting as Non-Mass Enhancing Lesions on Magnetic Resonance Imaging: A Contemporary Single Institutional Series
Authors: Gruenberg J , Ravindran A , Visscher D , Valencia E , Wickre M 
Published: October 2020

Abstract

Introduction/Objective
Non-mass enhancement (NME) in breast tissue is an area of enhancement on MRI that appears distinct from background breast parenchyma, but lacks definitive features of a mass. NME is characterized by its internal enhancement pattern and distribution, and can represent benign, high risk, or malignant pathology. Given this considerable overlap, a core biopsy is often necessary for diagnosis and management. We aimed to elucidate the most frequent histologic findings found on breast biopsies for MRI NME.

Methods
Using our institutional database we identified 70 female patients with high risk status for breast cancer with MRI screen detected NME (BIRADS-4-suspicious for malignancy) that underwent subsequent biopsy procedure during the period of 01/2016-12/2017. Primary pathologic diagnoses were subcategorized as follows: malignant, atypical, benign mass-like lesions, fibrocystic changes (proliferative, nonproliferative), or “other” primary diagnoses.

Results
The median age of patients was 48 years (range: 22-76 years). Of the 70 patients, 66 underwent MRI-guided core biopsy, 3 underwent ultrasound-guided core biopsy and 1 underwent excisional biopsy. The primary diagnosis was analyzed. Of these 70 cases, 8 (11.4%) were malignant (7 with ductal carcinoma in situ and 1 with invasive ductal carcinoma), 1 (1.4%) had atypical lobular hyperplasia, and the remaining 61 (87.1%) showed benign findings (36 with fibrocystic changes (FCC), 22 benign mass-like lesions, 3 with other non-specific findings). The FCC were subcategorized as proliferative (usual ductal hyperplasia, columnar cell change, incidental radial scar, incidental intraductal papilloma, sclerosing adenosis, focal pseudoangiomatous stromal hyperplasia (PASH)) or nonprolifeative (stromal fibrosis, duct ectasia, apocrine metaplasia). Majority (61.1%) of FCC were both proliferative and nonproliferative, 22.2% proliferative only and 16.7% nonproliferative only. Benign mass-like lesions included PASH (45.4%), fibroadenomatoid nodule (22.7%), fat necrosis (18.2 %) and remaining had the diagnosis of clustered apocrine cysts, papillomatosis, and radial sclerosing lesion.

Conclusion
Less than a third of cases showed malignant findings and more than two-third of cases showed benign findings with a high rate of detection of proliferative lesions and PASH.
Overall Survival Of Extraosseous Plasmacytoma: An Updated Analysis Of National Cancer Institute Database
Authors: Deb P Q , Heller D S , Jiang J 
Published: October 2020

Abstract

Introduction/Objective
Plasma cell neoplasms arising outside of bone are known as extraosseous/extramedullary plasmacytoma. Although they constitute about 1% of all plasma cell neoplasms, updated epidemiological data are lacking in the current literature. Here, we have analyzed the incidence provided by the national cancer institute (SEER database) from 1975 – 2016 to shed light on the incidence, demographics, and survival of extraosseous plasma cell neoplasms.

Methods
We selected all cases of plasma cell neoplasms from the data provided by the national cancer institute (SEER database) from 1975 – 2016. We excluded all cases designated with the primary site as bone or bone marrow. We analyzed the data using SPSS statistics 20. We compared overall survival among different demographic groups and performed the log-rank test to see differences in overall survival.

Results
A total of 731 cases were found with extraosseous plasmacytoma in the United States with a male: female ratio of 1.85:1. The age range was from 9 to 92 years with a median age of 61. Younger age of diagnosis was associated with better overall survival. Overall survival was not significantly different between males and females (p = 0.4). The majority of the patients were Caucasian and overall survival was significantly better in this group (p = 0.028). Consistent with the current literature, the primary sites of the majority of cases were head and neck (44.5%) and soft tissue (15.7%). Overall survival was significantly different between different primary sites (p &lt; 0.05) with primary sites of soft tissue, thorax (including lung, mediastinum, and pleura), and CNS showing particularly poor survival.

Conclusion
Our results suggest that the prognosis of extraosseous plasma cell neoplasm is site-specific and a better understanding of tumor microenvironment in plasmacytoma arising in different primary sites is warranted.
Adequacy And Rate Of Atypical Cytology On Fine Needle Aspiration Technique Using Suction (FNA-S) – A Quality Assurance Study At CMCVAMC
Authors: Dalal S , Jhala D 
Published: October 2020

Abstract

Introduction/Objective
Thyroid cancer is one of the most common prevailing conditions. Both genetic and environmental risk factors play a role in causation of thyroid cancers, with agent orange being the most documented risk factor in Veteran patient population. Based on the ultrasonographic appearance, thyroid nodules can be further investigated by minimally invasive fine needle cytology. This can be done by either of two available techniques, Fine needle aspiration with suction (FNA-S) and Fine needle capillary cytology without using suction (FNC), depending upon the preference of practicing endocrinologist. We aim to compare both cytology techniques for comparing the diagnostic yield and rate of atypia of undetermined significance (AUS) or Follicular lesion of undetermined significance (FLUS), requiring repeat FNA in approximately three months.

Methods
Retrospective study was conducted by searching the cases performed by an endocrinologist at Corporal Michael J Crescenz VA Medical Center between the period of January 1, 2015 and July 2, 2015. 30 nodules from 11 patients were tested by Fine needle capillary cytology technique (FNC). Yield for the diagnosis with rates of atypical (AUS) cytology were compared. On second set of the 29 patients with 38 nodules, both techniques - FNA-S versus FNC were carried out. Adequacy and rate of AUS/FLUS were calculated.

Results
Out of 30 total nodules performed by fine needle aspiration (FNA-S), all cases yielded diagnostic material. Of them, 14 (46.6%) were diagnosed as AUS and 16 (53.33%) were benign. On the follow-up/re-aspiration by FNC technique, all these 14 nodules were diagnosed benign. On second set of patients on whom both techniques (FNA-S and FNC) were used alternatively, 13 of 38 nodules (34.21%) were diagnosed as AUS/FLUS, 23 (60.52%) were benign/nodular goiter and 2 were non-diagnostic/inadequate (5.2%).

Conclusion
FNA-S (with suction) yields adequate diagnostic material, however, also has greater number of atypical cytology results requiring repeat patient visit which may increase morbidity with a burden on total health care cost.
FNC (without suction) has low rates of AUS/FLUS, is diagnostically superior with excellent smear quality, less blood clots, time savings, and less inconvenience of patients/physician. FNC (without suction) is a modality of choice for an effective screening of thyroid nodules in veterans.
Unusually Severe Course of Autoimmune Hemolytic Anemia / Cold Agglutinin Disease: A Case Report
Authors: Yilmaz M M , Tanhehco Y 
Published: October 2020

Abstract

Introduction/Objective
Autoimmune hemolytic anemia (AIHA) is a group of disorders with limited epidemiological and clinical data, characterized by hemolysis due to autoantibodies against red blood cell surface antigens. Cold agglutinins account for about 25% of all AIHA, which can agglutinate erythrocytes at 0-4 °C. Cold agglutinin disease (CAD) is a self limited disease and usually does not cause significant hemolysis. Here, we report a case with an unusually severe course for secondary CAD and role of plasma exchange in the management.

Methods
A 53-year-old male patient with no known past medical history presented to the emergency department with shortness of breath and syncope after a week of upper respiratory tract infection symptoms. The patient became profoundly anemic (presented with 8.1 g/dL hemoglobin level and progressively decline to 4.2 g/dL) in a short period of time. Upon initial evaluation, his peripheral blood smear demonstrated clumps of RBCs. Direct anti-globulin testing was negative for IgG but positive for C3 which is consistent with CAD. A respiratory PCR panel detected Rhinovirus. Mycoplasma and EBV IgM were negative. Additionally, chest X-ray showed right middle lobe pneumonia that was treated with antibiotics. Patient received multiple transfusions of pre-warmed pRBCS and showed initial improvement but eventually went into respiratory failure and cardiac arrest with return of spontaneous circulation after 8 minutes of CPR. Subsequently, plasma exchange was started. Only after intiation of plasma exchange, the patient’s ongoing hemolysis was stabilized.

Conclusion
This case report presents a patient with unexpectedly rapid and severe hemolysis from secondary cold agglutinin disease. Interestingly, the case appeared not to be caused by EBV or Mycoplasma pneumonia infection but Rhinovirus. Further studies confirmed patient had no autoimmune disorder or lymphoid malignancy that may had initiated secondary CAD. On the management aspect, pre-warmed RBC transfusions were not sufficient to stabilize the patient’s condition. Plasma exchange was able to control ongoing hemolysis within 2 sessions successfully.
Frugivory and seed dispersal in a hyperdiverse plant clade and its role as a keystone resource for the Neotropical fauna
Authors: Messeder João Vitor S , Silveira Fernando A O , Cornelissen Tatiana G , Fuzessy Lisieux F , Guerra Tadeu J 
Published: October 2020

AbstractBackground and AimsMuch of our understanding of the ecology and evolution of seed dispersal in the Neotropics is founded on studies involving the animal-dispersed, hyperdiverse plant clade Miconia (Melastomataceae). Nonetheless, no formal attempt has been made to establish its relevance as a model system or indeed provide evidence of the role of frugivores as Miconia seed dispersers.MethodsWe built three Miconia databases (fruit phenology/diaspore traits, fruit–frugivore interactions and effects on seed germination after gut passage) to determine how Miconia fruiting phenology and fruit traits for &gt;350 species interact with and shape patterns of frugivore selection. In addition, we conducted a meta-analysis evaluating the effects of animal gut passage/seed handling on Miconia germination.Key ResultsMiconia produce numerous small berries that enclose numerous tiny seeds within water- and sugar-rich pulps. In addition, coexisting species provide sequential, year long availability of fruits within communities, with many species producing fruits in periods of resource scarcity. From 2396 pairwise interactions, we identified 646 animal frugivore species in five classes, 22 orders and 60 families, including birds, mammals, reptiles, fish and ants that consume Miconia fruits. Endozoochory is the main dispersal mechanism, but gut passage effects on germination were specific to animal clades; birds, monkeys and ants reduced seed germination percentages, while opossums increased it.ConclusionsThe sequential fruiting phenologies and wide taxonomic and functional diversity of animal vectors associated with Miconia fruits underscore the likely keystone role that this plant clade plays in the Neotropics. By producing fruits morphologically and chemically accessible to a variety of animals, Miconia species ensure short- and long-distance seed dispersal and constitute reliable resources that sustain entire frugivore assemblages.