Background: Even though patients with inflammatory bowel disease (IBD) are not at increased risk of COVID-19 infection, patients with post-acute COVID-19 have been reported to have de novo IBD or a ...new diagnosis of IBD.
Objective: This article reviews the presentation, diagnosis, and clinical course of patients described in the literature to have new-onset IBD after the diagnosis of COVID-19 infection as well as discusses the possible pathophysiological mechanism.
Methodology: Extensive literature review by compiling information from case reports and original studies identified by a Pubmed and EMBASE search from inception to May 2021.
Results: We identified 4 cases of de novo IBD that were reported in the literature, 2 weeks – 5 months after acute COVID-19 infection. Patients presented with persistent bloody diarrhea, abdominal pain, and anemia. Three patients were diagnosed with ulcerative colitis and one patient was diagnosed with Crohn's disease. Available evidence indicates that COVID-19 infection can instigate an intestinal inflammation and trigger de novo IBD, potentially through intestinal barrier leakage, alterations in gene expression, gut microbiota dysbiosis, and exaggerated immune response.
Conclusion: The presence of the SARS-CoV-2 virus in the gut can cause de novo IBD through complex multiple factors. Further studies need to be done to confirm a causal link and the underlying mechanism. Clinicians should be vigilant about the possibility of IBD in patients present with anemia, abdominal pain, or chronic bloody diarrhea after a short interval of COVID-19 infection that warrant a referral to a gastroenterologist.
Background and Aims: Current guidelines recommend multiple biopsies from the first (D1) and second (D2) part of duodenum to establish a diagnosis of celiac disease. In this meta-analysis we aimed to ...find whether D1 biopsy can increase the diagnostic yield of adult celiac disease. Methods: Literature databases were searched until January 2023 for studies reporting diagnosis of celiac disease in the adult population using D1 biopsy. Meta-analysis was done using a random-effects model. Heterogeneity was assessed by I 2 % and 95% prediction interval statistics. Measured outcomes were diagnostic yield with D1 and D2 biopsies and from 4 versus 2 biopsy samples. Results: A total of 16 studies were included in the final analysis. The pooled diagnostic rate of celiac disease from D1 biopsy was 77.4% 95% CI (64.7-86.5, I 2 94%) and from D2 biopsy was 75.3% 60.8-85.7, I 2 96%. The pooled rate of increase in diagnostic yield with D1 biopsy was 6.9% I 4.6-10.2, I 2 66%. The pooled diagnosis rate with 2 biopsy samples were 77.3% 50-92, I 2 93% and 86.4% I 58.4-96.7, I 2 87% from D1 and D2 respectively, whereas that with 4 biopsy samples were 83.3% 49.8-96.2, I 2 76% and 70.5% I 51-84.6, I 2 96% from D1 and D2, respectively, the difference being non-significant. Conclusion: Our study demonstrates that taking 4 biopsy samples does not incur any additional diagnostic value over taking 2 biopsy samples from each duodenum segment. Although biopsy from the D1 and D2 has similar diagnostic yield in the adult population, there was an overall increase in diagnostic yield with D1 biopsy, especially in those with a patchy disease distribution.
Despite the growing disease burden of non-alcoholic fatty liver disease (NAFLD), approved medical treatments to improve or prevent liver fibrosis are effective only in a small number of patients. ...Recent studies have found the new use of antiplatelet agents for antifibrotic benefits in NAFLD, but human studies are still limited. The goal of this meta-analysis was to combine the findings of existing relevant studies to investigate the effects of antiplatelet therapy in reducing or preventing advanced liver fibrosis in patients with NAFLD. We conducted a systematic literature search in PubMed, EMBASE, and Web of Science databases from inception to January 2021 to identify all original studies that investigated the use of antiplatelet agents in patients with NAFLD. We used the National Institutes of Health’s quality assessment tool for observational cohort and cross-sectional studies to assess study quality and risk of bias. The primary outcome was the prevalence of advanced liver fibrosis stage 3–4. Data from each study was combined using the random-effects, generic inverse variance method of DerSimonian and Laird to calculate pooled odds ratio (OR) and 95% confidence intervals (CIs). Of the 2,498 studies identified, 4 studies involving 2,593 patients with NAFLD were included in this study (949 antiplatelet agent users and 1,644 non-antiplatelet agent users). The use of aspirin and/or P2Y12 receptor inhibitors was associated with a lower pooled OR of advanced liver fibrosis in patients with NAFLD (pooled OR = 0.66; 95% CI: 0.53–0.81,
I
2
= 0.0%;
p
< 0.001). This study focuses on the outcome of advanced liver fibrosis in patients with NAFLD. Our study is limited by the small number of studies that were included. Preliminary evidence from this meta-analysis suggests a protective association between antiplatelet therapy and the prevalence of advanced liver fibrosis in patients with NAFLD. Our findings support future research into repositioning an antiplatelet agent as a novel NAFLD treatment.
Collagenous gastritis is a rare cause of heartburn in adults. Histopathological examination of gastric mucosal biopsy from the stomach shows submucosal collagen deposition. The pathophysiologic ...mechanism is unknown, and collagenous gastritis cases have been associated with certain drugs, such as olmesartan and non-steroidal anti-inflammatory drugs, and certain medical conditions, such as common variable immunodeficiency, primary IgM deficiency, autoimmune disorders, and psoriatic arthropathy. Here we report a case of collagenous gastritis in a 29-year-old woman with psoriatic arthropathy who presented with persistent heartburn. She was successfully treated with oral pantoprazole.
Key words: heartburn, collagenous gastritis,
Tegument protein pUL83 is the most abundant component of human cytomegalovirus (hCMV) particles. The viral protein is predicted to be composed of three domains: a pyrin association domain (PAD), a ...carboxy-terminal domain (CTD), and an intrinsically disordered linker domain (amino acids 388–479) located between the PAD and CTD. Although pUL83 has been shown to antagonize interferon (IFN) responses, it has not been fully elucidated how the viral protein may contribute to hCMV replication. In this study we demonstrate that pUL83 associates broadly with viral and host chromatin including condensed chromosomes during mitosis. We further show that the linker domain in pUL83 is both required and sufficient for host chromatin targeting, and that this interaction depends on two evolutionary conserved arginine residues (R453 and R455) in the viral protein. Our data indicate that the pUL83 linker domain specifically associates with human core histones (but not linker histones). Furthermore, pUL83 inhibits IFN-beta and IFN-lambda gene induction, but not expression of other cytokine genes, via a mechanism that largely depends on the linker domain including R453/455. Although earlier studies suggested that pUL83 is dispensable for productive hCMV infection in fibroblasts, we find that the viral protein is necessary for efficient plaque formation in these cells, specifically in the presence of IFN. Finally, the pUL83 linker domain including R453/455 contributes significantly to the plaque size in hCMV-infected fibroblasts. Overall, we propose that pUL83 promotes spread of hCMV by selectively inhibiting induction of IFN gene expression via a novel chromatin-based molecular mechanism involving core histones.
Thyrotoxicosis can exhibit overlapping symptoms of psychosis in the general population. Each of these pathologies has well-established workups and management. Rare presentations of thyroiditis and ...psychosis in the postpartum state have been seen in case studies mostly, but data on the prevalence of postpartum psychosis in association with postpartum thyroiditis are not available. Here, we present a unique case of a patient with a history of bipolar disorder who originally presented with postpartum thyroiditis that was worked up and managed appropriately. However, on follow-up, the patient was found to have progressed into prominent psychosis. Both thyroiditis and psychosis were managed individually with full remission upon discharge and is doing well today. The co-occurrence of postpartum psychosis and thyroiditis presents a unique challenge for timely diagnosis and management. We present a case of a young woman initially diagnosed with postpartum thyroiditis needing further management of postpartum psychosis due to persistent symptoms. Clinical presentation supported with a prior history of mood disorder increases the likelihood of these diagnoses together.
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