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High-grade pancreatic intraepithelial neoplasia (HG PanIN)/carcinoma in situ (CIS) in the pancreatic body and tail can induce parenchymal atrophy through chronic inflammatory changes presenting as a Hypoechoic area on EUS (Hypocho) or focal pancreatic parenchymal atrophy (FPPA) on computed tomography (CT) and magnetic resonance imaging (MRI). We herein discussed two patients with a hypoechoic area in the pancreatic head and neck on EUS resembling pancreatic ductal adenocarcinoma (PDAC). The lesions consisted of dense fibrosis and fat infiltration with pancreatic parenchymal atrophy around the HG PanIN/CIS in the main pancreatic duct (MPD), which penetrated the lesion and showed mild stenosis and upstream dilation. CT and MRI were unable to visualize the lesions. A specimen was obtained from one lesion by fine-needle aspiration under EUS (EUS-FNA) guidance for histopathological and cytological analysis, but the tests returned negative for adenocarcinoma. However, serial pancreatic-juice aspiration cytologic examination (SPACE) revealed adenocarcinoma in both lesions, prompting surgical resection. Histopathological examination revealed non-invasive HG PanIN/CIS in the MPD surrounded by dense fibrosis and fat deposition in the area of parenchymal atrophy. The CIS was restricted to the area of parenchymal atrophy.These two cases are noteworthy in illustrating a hypoechoic area appearing on EUS as a tumor-like lesion resembling PDAC. EUS-FNA has recently been used histopathologically to diagnose a pancreatic lesion. However, in the present and similar cases, EUS-FNA can only reveal secondary changes due to CIS unless the pancreatic duct covered by the CIS is accidentally punctured. We should bear in mind that CIS can appear as a hypoechoic area resembling PDAC on EUS, and that SPACE is the best method for diagnosing CIS in such cases.

Objective: To evaluate the metabolic changes in patients with acquired immunodeficiency syndrome. Methods: This is an observational analytical cross-sectional study that was carried out with 120 patients on regular use of antiretroviral therapy, from May to July 2018. The metabolic changes were determined through the collection of biochemical parameters: CD4, CD4 absolute, CD8, absolute CD8, hemoglobin, High-Density Lipoprotein, Low-Density Lipoprotein, triglycerides, and fasting blood glucose. Results: The lipid profile, in most individuals, showed serum values ​​of total cholesterol, triglycerides, and Low-Density Lipoprotein, within the normal range, while the serum levels of High-Density Lipoprotein were decreased by 53.6%, being related to the mean time disease of 8.7 years (± 6.1). As for hematological indices, 62 and 60 (80.5% and 77.9%) of the patients had adequate serum hemoglobin and hematocrit values, however, it was observed that those who had anemia lived with the virus for a longer time (9.27 years ± 6.89). When observing the parameters related to the immune system, it was seen that CD4 levels were low in 38% of patients, adequate absolute CD4 in 56.5%, increased CD8 in 90.7%, and absolute CD8 in 63%. Conclusion: It is known that metabolic changes, such as the decrease in serum levels of High-Density Lipoprotein are common in patients with the virus, as well as, it is known that the survival of these individuals is being prolonged by antiretroviral therapy, which can result in exposure important risk factors for cardiovascular disease. Emphasizing the importance of nutritional monitoring in this population.

Objective: Describe the socioeconomic profile of patients living with the human immunodeficiency virus in a Teaching Hospital in Recife-PE. Methodology: A cross-sectional study, carried out between April and November 2019. Identification, demographic and socioeconomic data were collected. The study was approved by the Research Ethics Committee of the Instituto de Medicina Integral Professor Fernando Figueira, under CAAE: 10262919.7.0000.5201. Statistical analysis was performed using SPSS version 13.0. Results: The sample consisted of 81 patients, with an average age of 37 years ± 11.3 years and 56.8% of females. The family income was 1714.9 ± 1533.5 reais and 46.8% of the individuals had some type of income. It was also possible to verify that, most of the patients had electric light (98.8%), water source by the public network (79.0%), mineral water (71.6%), television (95.1%), and internet (82.4%). Almost half of the individuals (46.9%) used the pit as a sanitary sewer. Conclusion: It can be concluded that the human immunodeficiency virus affects both individuals with low purchasing power and those who have better socioeconomic conditions.

Aim: The reported case involved a complicated diagnostic path, not only because of the usual difficulties specific to chronic urticaria but, also because the trigger was a T-cell large granular lymphocytic leukemia (T-LGLL), a rare type of leukemia with an indolent course whose etiology is still not well known. This leukemia is also known for its propensity to cause autoimmune diseases. The aim of this study was to identify whether the muscle damage was caused by dermatomyositis or by T-LGLL. Methods: After elevated muscle enzyme levels had been discovered magnetic resonance imaging (MRI) revealed muscle damage. Consequently, a muscle biopsy was performed in a targeted manner. In addition to muscle biopsy, transmission electron microscopy and anti-CN1A antibody testing were performed. Results: MRI of the lower limbs and pelvic girdle indicated moderate fibroadipose substitution in many muscles, moderate edema in others. No involvement of the shoulder girdle and upper limbs. Histological examination of the muscle fibers showed an “inflammatory myopathy with isolated phagocytotic fibers.” Inclusion-body myositis, which is known to be associated with chronic T-LGLL was excluded. On the same biopsy transmission electron microscopy confirmed inflammatory myopathy and anti-CN1A antibodies were positive. DNA extracted from the muscle of the micro-rearrangement for the y-chain of the TCR identified on the DNA extracted from peripheral blood was positive. Conclusions: Conclusions: Chronic urticaria was an indication of immunoproliferative disease. Myositis was the pathology due to T-LGLL, and dermatomyositis was excluded.

This retrospective clinical study evaluates an FDA-cleared high-volume colon irrigation bowel prep (BP) for colonoscopy, performed under standard operating procedures with Austin Gastroenterology (AG, Austin, TX). Patient related outcomes in 8,364 procedures, prescribed by 33 physicians in 4.5 years, demonstrated no serious adverse events and excellent satisfaction rates. The high level of adequacy using this BP far exceeds national benchmarking thresholds for adequate colon preparations. Adequacy rates remain high even when considering poor BP risk factors and patient noncompliance with ancillary pre-preparation regimens. Our analysis demonstrates that this colon irrigation BP has excellent Boston bowel preparation scores (BBPS), associated with high-level adenoma detection rates (ADR) and sessile serrated polyp (SSP) detection rates. ADR and SSP are inversely related to the patient’s post-colonoscopy interval colorectal cancer (CRC) risk, and are similarly related to an inadequate BP. Both modeling data and performance characteristics strongly suggest that this colon irrigation BP is highly safe, effective, and will reduce the costs and risks related to inadequate BP. This, accordingly, leads to significantly improved quality outcomes, savings to the healthcare systems, and a reduction of the patient’s burden.

A feasibility study was performed to test a bowel preparation (BP) method that would improve patients’ experience of colon capsule endoscope (CCE) while retaining clinical adequacy. Specifically, the use of high-volume colon irrigation with the Hygieacare® System, HygiPrep™, was tested in conjunction with Medtronic’s PillCam COLON 2 Capsule. This prospective, single-center, and IRB-approved study evaluated HygiPrep use prior to the PillCam COLON 2 procedure instead of the standard split-polyethylene glycol-electrolyte (PEG) oral prep. The study was performed at Austin Gastroenterology (Austin, TX), and all capsule video files were forwarded to a Central Reader to evaluate and compile a study report. Six of the seven (86%) subjects completed both the HygiPrep and PillCam COLON 2 exams and were graded as excellent, good, or adequate by the Central Reader. Patients’ feedback reported positive satisfaction scores for both the HygiPrep and the PillCam COLON 2 procedures. These results support our hypothesis that HygiPrep was as effective as Split-PEG BP. We suggest that the HygiPrep, is a suitable BP for CCE, providing adequate BP and high patient satisfaction.

Background: Acne vulgaris (AV) is a chronic inflammatory disease of the pilosebaceous follicular unit that often occurs. Acne is a skin disorder that is not life-threatening but is mostly complained of because it is aesthetically disruptive, which can cause significant psychological problems for sufferers. The management of acne vulgaris in female patients has its challenges. There are many histories of failed therapy using conventional therapy, such as with antibiotics or isotretinoin, and female patients have a predisposition to the condition of androgen excess. Also, the increasing awareness about limiting the use of antibiotics to prevent resistance in dermatological cases, including acne vulgaris, encourages other treatment options in the female patient population, one of which is hormone-based therapy. A systematic review and meta-analysis were performed of randomized clinical trials assessing the effects of Hormone Based Therapies (Spironolactone and Combined Oral Contraceptives) in the management of Acne Vulgaris in Women. Methods: Medline Pubmed, Scopus, Cochrane Library, the reference list, conference proceedings, researchers in the field of eligible studies were searched. Ten studies (n=1906 sub-jects) were included in qualitative analysis, of which two studies (n=1842 subjects) were included in the meta-analysis. The age of the participant was greater than 14 years old. Intervention using combined oral contraceptives (n=8) or oral spironolactone (n=2). Duration of intervention (minimum six months for COC and three months for SL) and out-comes of mean difference number of acne vulgaris lesions before and after treatment. Results: Pooling of data using random-effects model found a significant difference in the mean difference in the number of lesions after treatment in the group receiving hormone-based therapy (spironolactone and combined oral contraceptives) and those receiving control therapy (p = 0.005). The overall mean difference was -0.890 ± 0.316. A negative value indicating the number of lesions after hormone-based therapy (spironolactone and combined oral…

Background: Acne vulgaris is one of the most prevalent skin diseases, affecting up to 85% of teenagers and young adults. Multiple treatment options including topical, systemic or physical therapies. However, the effects of conventional therapies are limited due to antibi-otic resistance and adverse effects such as irritation and teratogenicity of isotretinoin. Light-based therapy is an alternative and/or adjuvant therapy in patients who cannot tolerate or unresponsive to conventional therapies that may provide fewer side effects, patient com-fort, fast onset of action, and with equal or greater effectiveness. We aimed to assess the effectiveness of using Pulsed Dye Laser as a treatment option for acne vulgaris. A systemat-ic Review and Meta-analysis was peformed of randomized clinical trials assessing the ef-fectiveness of Pulsed Dye Laser in management of acne vulgaris. Methods: Medline Pubmed, Scopus, Cochrane library, the reference list, conference pro-ceedings, researchers in field of eligible studies were searched. Eight studies (n=275 sub-jects) were included in qualitative analysis of which six studies (n=190 subjects) were in-cluded in meta-analysis. The mean age of the participant was 21,94 years old. Intervention using application of Pulsed dye laser as monotherapy or combination in acne vulgaris pa-tients with follow-up at least 12 weeks. and the outcomes is a decrease mean of acne vul-garis lesions counts after received pulsed dye laser therapy. Results: Pooling of data using random effects model showed that the group that received PDL therapy alone or in combination had a lower number of acne lesions than the control group with the mean difference was -0.593 (95% CI = -1.290 to 0.104), the z value was -1.668 with p = 0.095. This shows that the number of lesions in the group that received sin-gle or combined PDL therapy was lower than the control group. However the difference is insignificant. Conclusion. From the results of…

Reverse part model based on motion trajectory is a common method in mechanism design. Compared with the traditional calculation method, it is simple and practical, and can simulate the reconstruction of the trajectory. In this paper, S-type carbon-free car was taken as an example. Firstly, the motion trajectory of the ideal car path was given. UG software was used to obtain the curve characteristics, established a mathematical model, and took the curve into the model to obtain the data of cam coordinate points. Then the MATLAB software was used to draw the cam contour and analyzed the feasibility of cam operation. The vehicle trajectory simulation was realized in MATLAB environment. Finally, the reasonable cam contour coordinate point data was imported into UG software to establish a 3D model of the cam, and the car track was repeatedly optimized to get the optimal cam shape. The rationality and the accuracy of the model were verified by the carbon-free car made by the scheme, and the corresponding guidance was provided for the research of others.

Background: Human Immunodeficiency Virus (HIV) infection is a major public health problem in Africa, which alone recorded 71% of HIV / AIDS-related deaths in 2018. There is a link between the infection to HIV and the occurrence of certain cancers, in particular digestive cancers. Very little data in Africa, especially Cameroon, exists on the association between HIV and digestive cancers. Our goal was to determine the prevalence of HIV in patients with cancer of the digestive tract as well as the factors related to the prognosis of these patients in Cameroon. Methods: We conducted a cross-sectional and analytical study over a 10-year period from January 2010 to December 2019. It was carried out in the general hospitals of the cities of Douala and Yaoundé. We included records of patients with histologically confirmed gastrointestinal cancer. We excluded records of patients with lymphoma or Kaposi’s sarcoma. The data collected were socio-demographic, clinical and paraclinical data. Chi-square test was used to determine statistically significant associations for p