Alpha-fetoprotein-producing gastric carcinoma (AFP-GC) is a rare malignant tumor, and has been regarded as a distinct category because of its particularly aggressive biological behavior and poor patient prognosis. In the literature, AFP-GC was never reported in neuroendocrine carcinoma of the stomach. In this article, we described a 60-year old man who sought medical attention because of epigastric pain and poor appetite. His laboratory data were within normal limits except for elevated serum level of alpha-fetoprotein. He was found to have an ulcer on gastroscopic examination which led to the final diagnosis of AFP producing neuroendocrine carcinoma of the stomach. He underwent a radical gastrectomy followed by chemotherapy using leucovorin and 5-fluorouracil.His disease was brought under remission for only six months before radiological recurrence occurred. His recurrent disease was treated with irinotican plus cisplatin without a significant response. His prognosis looked grave. We reported the first case of AFP producing gastric neuroendocrine carcinoma to share our experience.
Treatment with immune checkpoint inhibitors is a landmark in the treatment of melanoma and other cancers. These treatments have been very effective and have increased the survival of cancer patients. The promise of immunotherapy also comes with a variety of adverse events. One of the common sites of immune related adverse events (irAEs) is skin. The cutaneous irAEs present a unique challenge to the success of immunotherapy. It is important to diagnose and understand the mechanism related to these cutaneous irAEs to increase the effectiveness of immune checkpoint inhibitor therapy. In this review, we have characterized the various cutaneous irAEs associated with immune checkpoint inhibitor therapies and their possible mechanisms.
Diabetes is considered a multifactorial disease that afflicts populations of the most diverse classes worldwide, being among the main health problems today. Among the types of diabetes, type 2 diabetes mellitus (DM-2) is considered the most prevalent pathology. This is due to the direct relationship between the cause of this disease and people’s eating behavior. These factors justify the growing search for the development of drugs for DM-2, given that current drugs act on targets that are not very efficient for the treatment. Therefore, the objective of this review is to evaluate the progress of research related to the search for new synthetic drugs for a more selective treatment for DM-2. The researches were searched in the main academic databases (National Center for Biotechnology Information (NCBI), Science Direct and Google Scholar), and research tools such as Drug Bank and Clinical Trials. Seventy articles were selected that were causally related to the descriptors used. According to the survey, about 60 compounds of synthetic origin were found and present in the various phases of the study and some molecules already approved for use. A variety of strategies and new therapies related to DM-2 grows each year, as new targets involved are elucidated. Therefore, it is possible to envision a promising future for the treatment of DM-2. because studies like this show the evolution of biochemical research methods and the advances in medicinal chemistry, it will be possible in the future that a multifactorial disease of this type can be treated in a specific way for each patient.
The therapeutic approach established for diabetes control varies according to its classification. Understanding the differences between each type is possible a complete and distinct treatment for the individual. This chapter will address the classification of diabetes types as well as their main differences.
Importance: As the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic spreads, increasing cases of dermatologic manifestations of the disease continue to be reported. Observations: In this general review of the case reports, case series, and other systematic reviews on this subject, several patterns of cutaneous lesions have been compiled. These include viral exanthems, papulovesicular, pernio-like, vasculopathy-related, and other miscellaneous rashes. Conclusions and Relevance: While clinical observations and subjective cases of rashes associated with SARS-CoV-2 are important to furthering our research and study of this viral disease, we as clinicians must be cautious in attributing causation with correlation. Continued research and study are needed before we can attribute a source for these dermatologic manifestations. Funding: This research was partially support by IMPACT funds to NY from the School of Medicine, University of Alabama at Birmingham.
Non-alcoholic Fatty Liver Disease among patients with Inflammatory Bowel Disease in Qatar: Prevalence and Risk Factors
Background: Non-alcoholic fatty liver disease (NAFLD) has been increasingly identified in patients with inflammatory bowel disease (IBD), though metabolic risk factors for NAFLD are less frequent in IBD patients. Qatar is among countries characterized by the high prevalence of fatty liver. We aimed to characterize NAFLD in IBD patients and to determine factors associated with its severity. Methods: A retrospective observational study was conducted to estimate the prevalence of NAFLD in all IBD patients followed at Hamad hospital, Doha, Qatar between January 2008 to December 2017. The associations between two or more qualitative variables were assessed using χ2-test and quantitative data between two independent groups were analyzed using the unpaired t-test. Multivariate logistic regression analysis was applied to determine the predictive values of each predictor for NAFLD among IBD patients. Results: Among 913 IBD patients with a mean age of 36.9±13.2 years and BMI 26.9±6.1; 550 were males (60.2%), 383(41.9%) with Crohn’s disease and 530 (58.1%) with Ulcerative colitis. 24 (22.2%) patients had severe steatosis. The overall prevalence of NAFLD was 11.8% (95% CI 9.9, 14.1) and does not differ significantly between CD and UC patients (11.7% vs 11.9%; P=0.949).Patients who developed NAFLD were older at baseline (42.6±12.5 vs 36.2±13.1 years; P 30 kg/m2 (adjusted OR 2.24; 95% CI 1.28, 3.91; P=0.01) and diabetes mellitus (adjusted OR 1.98; 95% CI 1.15, 3.4; P=0.02) significantly associated with an increased risk of NAFLD. Females were less likely having the risk of NAFLD (adjusted OR 0.58; 95% CI 0.36, 0.93; P = 0.02) in comparison to males. The treatment with biologic does not increase the risk of steatosis. The predicted cutoff NAFLD score ≥ -1.67 had good predictive ability for significant steatosis in IBD cases. Conclusion: The prevalence of NAFLD is not uncommon among IBD patients in Qatar. Older age, high BMI and…
Universal acquired melanosis or “Carbon Baby Syndrome” is a progressive condition without any definitive evidence of etiology, long-term prognosis and treatment1. We describe case of a four year old female child presented with blackish discolouration of skin all over body giving a picture similar to “Carbon Baby”.
Cultural competence is more than speaking the language or recognizing the cultural icons of a given group of individuals. Treating the individual is treating their culture. A culturally competent treatment professional must acknowledge an individual’s cultural strengths, values, and experiences while encouraging behavioral and attitudinal change. A significant variable in the change process is the relationship between racial or ethnic matching of clients and counselors. Successful treatment reveals a group of cultural dynamics on how this therapeutic alliance might affect treatment outcomes. To meet these complex cultural challenges, the movement towards a pluralistic cultural framework of helping with its bilingual and bicultural sensitivity appears to be a significant variable to engage the community and the individual in the healing process. Environmental exposures, such as pollution, high-crime areas, and lack of parks or playgrounds, social services, such as transportation, housing, and childcare, mental health care, significantly impact on lifestyle choices. Building strong, grassroots recovery community organizations (RCOs) and linking RCOs into a national movement to develop recovery leaders, offer many opportunities for the recovery community. It helps people in recovery, family members, friends, and allies to express their collective individual and neighborhood voices on issues of common concern by providing a forum for recovery-focused community services that support individual growth.
With the COVID pandemic sweeping across the globe , over 1240,000 people have been infected in India (as of July 23,2020 ) in India. With approximately 30,000 deaths, the nation has been reeling under the ravages of COVID 19, and the economic fallout that followed in its wake. Tamil Nadu has over 1,80,000 cases with approximately 3144 deaths (23/07/2020). In this unfavourable milieu, surgical postgraduates joined the course through the process of NEET selection and counselling. Given that social distancing was essential, meet and greet, introduction and case based discussions are held on online platforms such as Google Meet and ZOOM.
Higher rates of anger and aggression have been observed in problem gamblers. In this cross-sectional study the relationship between anger, aggression and a community sample of problem gamblers was examined within two subtypes of gambling: Perceived Skill Gambling (sports, cards, track) and Chance Gambling (bingo, lotteries, slot machines) gambling. Aggression and anger were assessed by the Aggression Questionnaire (AQ) and the Trait Anger Scale (TAS), respectively. Results indicated that Perceived Skill Gamblers (i.e., sports, card, track) scored higher on expressing anger on the AQ as well as on the hostility, physical and verbal and aggression subscales of the TAS. There were no sex differences on any AQ subscale except for the Physical Aggression Subscale. We did not find gender differences on the TAS. The study shows evidence that Perceived Skill Gamblers experience more anger, hostility, physical and verbal aggression as measured by the AQ. The current findings contribute to an improved understanding of the complexity of the factors that are implicated in gambling disorder, and suggests that anger and aggression should be routinely assessed among disordered gamblers seeking treatment.