LIRER score - a valuable tool to predict medium-long-term outcomes in hepatic cirrhosis decompensation.

Background: The liver-renal-risk (LIRER) score was developed to predict adverse outcomes in cirrhotic patients with Model for End-stage Liver Disease (MELD)<18, helping the allocation to liver transplantation in this population. We aimed to assess its prognostic performance compared to other prognostic scores in first admission for hepatic cirrhosis decompensation.

Methods: Retrospective study that included patients admitted for initial decompensation of cirrhosis between January 2010 and February 2017.

Combination therapy in inflammatory bowel disease patients: do we need to maximize the dose of azathioprine?

Background: The use of combination therapy of anti-TNFα and thiopurines in inflammatory bowel disease (IBD) is associated with greater efficacy and lower immunogenicity. However, the dose of thiopurine in this setting remains to be elucidated.

Aim: To compare the trough levels, anti-TNFα antibodies and the inflammatory biomarkers between three groups in combotherapy: group 1 (dose of azathioprine <1 mg/kg); group 2 (dose of azathioprine ≥1 and <2 mg/kg), and group 3 (dose of azathioprine ≥2 mg/kg).

A Rare Cause of Dyspnoea: Right-sided Bochdalek Hernia in an Adult.

Unlabelled: Right-sided Bochdalek hernia (BH) is very rarely diagnosed in adults. It commonly presents with gastrointestinal symptoms (pain, abdominal distension and vomiting). Breathlessness, recurrent chest infections and other pulmonary sequelae can also be present.

Adult-Onset Still's Disease: Typical Presentation, Delayed Diagnosis.

Adult-onset Still's disease (AOSD) is an uncommon auto-inflammatory disease of unknown etiology, with a classical triad of fever, arthritis, and evanescent rash. Its low prevalence and lack of specific guidelines contribute to frequent delays in diagnosis and treatment. Clinical manifestations vary greatly between mainly systemic or articular symptoms and the clinical pattern between monocyclic, polycyclic, or chronic illness.

Should patients with symptomatic cholelithiasis before 30 years of age be tested for gene mutations?

Background And Aims: Low phospholipid-associated cholelithiasis syndrome (LPAC) is characterized by recurrent symptomatic cholelithiasis in young adults associated with gene mutations. Current diagnosing criteria are complex and heterogeneous, making this a largely underdiagnosed entity. Also, although recommended, genetic testing is not necessary for the diagnosis and its real advantages are not clear.

Cardiopulmonary exercise testing in severe osteoarthritis: a crossover comparison of four exercise modalities.

Cardiopulmonary exercise testing is performed increasingly for cardiorespiratory fitness assessment and pre-operative risk stratification. Lower limb osteoarthritis is a common comorbidity in surgical patients, meaning traditional cycle ergometry-based cardiopulmonary exercise testing is difficult. The purpose of this study was to compare cardiopulmonary exercise testing variables and subjective responses in four different exercise modalities.

Inpatient Treatment of Acute Otitis Media at a Pediatric Hospital: A Missed Teaching Opportunity for Antimicrobial Stewardship.

Background: Acute otitis media (AOM) is a common pediatric condition known to contribute to excessive antibiotic use in the outpatient setting. Treatment of AOM in the inpatient setting has not been described. The objective was to describe the clinical features and inpatient management of AOM to harness this entity to teach learners about judicious antibiotic prescribing in all settings.

Theileria orientalis Ikeda genotype infection associated with anaemia, abortion and death in beef cattle in Western Australia.

Background: Theileria orientalis infection causes a clinical syndrome in cattle characterised by weakness, reluctance to walk, anaemia, jaundice and death in peri-parturient cows and young calves, referred to as bovine anaemia caused by Theileria orientalis group (BATOG). Abortions in pregnant cows are also reported. Pallor, pyrexia and elevated heart and respiratory rates are typical findings on physical examination.

Colon Capsule CLEansing Assessment and Report (CC-CLEAR): a new approach for evaluation of the quality of bowel preparation in capsule colonoscopy.

Background And Aims: Current colon capsule (CC) cleansing grading scales rely on subjective parameters and lack proper interobserver agreement. We should strive for higher intra- and interobserver agreement for the evaluation of the cleansing quality of CCs. Here we sought to validate a new grading scale for the evaluation of CC cleansing.

Pheochromocytoma and Paraganglioma: A Review of Diagnosis, Management and Treatment of Rare Causes of Hypertension.

Pheochromocytomas (PHEO) and paragangliomas (PGL) are rare tumors originated in cells derived from the neural crest. The first ones are located in the adrenal medulla, and the second ones in the sympathetic and parasympathetic nervous system. These kind of tumors may secrete excess catecholamines, including epinephrine, norepinephrine, dopamine and/or their metabolite metanephrine, normetanephrine and 3-methoxytyramine, respectively.

Acute Ultraviolet Light Exposure and Post-Resistance Exercise Serum Testosterone: A Pilot Study in Older Men.

Testosterone deficiency is linked to a multitude of conditions including depression, sexual dysfunction, and cognitive impairment. Although synthetic testosterone-boosting pharmaceuticals have gained wide use, recent data suggests that vitamin D, ingested orally, may positively impact serum testosterone. Furthermore, evidence tying ultraviolet (UV) light exposure to endogenous vitamin D synthesis presents an intriguing possibility for naturally enhancing serum testosterone.

A Comparison of Muscle Activation Among the Front Squat, Overhead Squat, Back Extension and Plank.

The purpose of this study was to compare the muscle activation of the scapula, leg, and trunk among the front squat (FS), overhead squat (OHS), back extension (BE) and plank (PL). Seven recreationally trained men (age: 28 ± 3.6 years, body mass: 92 ± 26.

Acute exercise-related cognitive effects are not attributable to changes in end-tidal CO or cerebral blood velocity.

Purpose: Cognition, cerebral blood flow (CBF) and its major regulator (i.e., arterial CO), increase with submaximal exercise and decline with severe exercise.

Acute Kidney Failure: When Multiple Myeloma Doesn´t Give Additional Clues.

Multiple myeloma (MM) is characterized by a proliferation of malignant plasma cells and a subsequent overabundance of monoclonal paraprotein. This disease commonly presents with hypercalcemia, kidney failure, anemia, and bone lesions. Acute kidney failure (AKF) as an initial presentation of MM has rarely been reported.

Looking beyond appearances: when liver biopsy is the key for hepatic tuberculosis diagnosis.

Primary hepatic tuberculosis is a rare clinical entity with non-specific clinical and imaging features that can mimic other liver diseases, representing a diagnostic challenge. We report a case of a 35-year-old man with metabolic syndrome, type 2 diabetes and high alcohol consumption presenting asymptomatic with abnormal liver tests, hepatosplenomegaly and diffuse hepatic steatosis in ultrasound imaging initially suspected to be alcoholic steatohepatitis but later diagnosed as hepatic tuberculosis in the histological specimen. Anti-tuberculosis therapy was started.

HIITing the brain with exercise: mechanisms, consequences and practical recommendations.

The increasing number of older adults has seen a corresponding growth in those affected by neurovascular diseases, including stroke and dementia. Since cures are currently unavailable, major efforts in improving brain health need to focus on prevention, with emphasis on modifiable risk factors such as promoting physical activity. Moderate-intensity continuous training (MICT) paradigms have been shown to confer vascular benefits translating into improved musculoskeletal, cardiopulmonary and cerebrovascular function.

Isoniazid-induced Lupus: When the Cure Can Be Lethal.

A 50-year-old female with a past medical history of bone tuberculosis diagnosed nine months ago was admitted in our infirmary for persistent fever with no evident cause. The patient was treated with isoniazid, rifampicin, pyrazinamide, and ethambutol for seven months and for the past two months, she was taking isoniazid and rifampicin. She went to our emergency room (ER) for back pain and fever that she had been experiencing for the last month.

Simplify to improve in capsule endoscopy - TOP 100 is a swift and reliable evaluation tool for the small bowel inflammatory activity in Crohn's disease.

Capsule endoscopy is a widely recognized method to study the small bowel, including in patients with Crohn's disease (CD). The Lewis score (LS) is a valuable tool in this setting, able to assess inflammatory activity. TOP100, a new software tool of the RAPID Reader, emerged to assist in the time-consuming capsule reading process, by automatically selecting 100 images that will most likely contain abnormalities.

Percutaneous endoscopic gastrostomy: dealing with the issue of dislodgement.

Percutaneous Endoscopic Gastrostomy (PEG) is accepted as an efficient method to provide long-term enteral nutrition. PEG accidental dislodgement (device exteriorization confirmed by expert evaluation) rate is high and can lead to major morbidity. To identify independent risk factors for PEG accidental dislodgement.

Variation in Proportion of Blood Cultures Obtained for Children With Skin and Soft Tissue Infections.

Objectives: To identify variation in the proportion of blood cultures obtained for pediatric skin and soft tissue infections (SSTIs) among children's hospitals.

Methods: We conducted a retrospective cohort study using the Pediatric Health Information System database, which we queried for emergency department (ED)-only and hospital encounters between 2012 and 2017 for children aged 2 months to 18 years with diagnosis codes for SSTI. The primary outcome was proportion of SSTI encounters during which blood cultures were obtained.

Intrathecal drug delivery in the era of nanomedicine.

Administration of substances directly into the cerebrospinal fluid (CSF) that surrounds the brain and spinal cord is one approach that can circumvent the blood-brain barrier to enable drug delivery to the central nervous system (CNS). However, molecules that have been administered by intrathecal injection, which includes intraventricular, intracisternal, or lumbar locations, encounter new barriers within the subarachnoid space. These barriers include relatively high rates of turnover as CSF clears and potentially inadequate delivery to tissue or cellular targets.

An Overlapping Case of Miller Fisher Syndrome and the Pharyngeal-Cervical-Brachial Variant of Guillain-Barré Syndrome.

Unlabelled: A 55-year-old Caucasian male presented initially to the emergency room (ER) reporting myalgia, chills and fever. Physical examination and laboratory tests were unremarkable and he was discharged with symptomatic care. He returned to our ER 2 weeks later reporting dizziness, loss of balance, blurred vision, mild dysarthria and bilateral hand paraesthesia.

High-Cost, High-Need Users of Acute Unscheduled HIV Care: A Cross-Sectional Study.

Background: High-cost, high-need users are defined as patients who accumulate large numbers of emergency department visits and hospital admissions that might have been prevented by relatively inexpensive early interventions and primary care. This phenomenon has not been previously described in HIV-infected individuals.

Methods: We analyzed the health records of HIV-infected individuals using scheduled or unscheduled inpatient or outpatient health care in St James's Hospital, Dublin, Ireland, from October 2014 to October 2015.

Impact of Multiplex Testing on the Identification of Pediatric Clostridiodes Difficile.

Objectives: To evaluate whether the implementation of a multiplex gastrointestinal pathogen panel (GIP) was associated with changes in Clostridioides difficile (C difficile) testing and detection rates.

Study Design: We conducted an observational study using interrupted time series analysis and included pediatric patients with testing capable of detecting C difficile. From 2013 to 2015 ("conventional diagnostic era"), stool testing included C difficile-selective polymerase chain reaction and other pathogen-specific tests.

Small Bowel Angioectasias Rebleeding and the Identification of Higher Risk Patients.

Background: Small bowel capsule endoscopy (SBCE) is the gold standard for suspected small bowel bleeding (SBB). Angioectasias are the most common vascular anomalies in the gastrointestinal tract and have been reported as the source of SBB in up to 80% of patients. Considering their frequency, their usual intermittent bleeding nature, and their risk of rebleeding, the aim of this study was to identify some features and possible predictors of rebleeding in the presence of these lesions.