Graves’ disease associated with cholestatic jaundice and persistent diarrhoea

Liver involvement in Graves’ disease can be seen as a part of autoimmune process or rarely, due to the direct effects of thyrotoxicosis on liver. Hyperthyroidism can also have gastrointestinal manifestations like frequent bowel movements, diarrhoea, even malabsorption with steatorrhoea. We report a 36-year-old man with hyperthyroidism, presenting with cholestatic jaundice and persistent small bowel diarrhoea. He was diagnosed to have Graves’ disease and after ruling out more common causes, the cause of cholestatic jaundice was supposed to be Graves’ disease. Considering this possibility, the patient was started on treatment with carbimazole. As patient’s thyroid function tests started improving, he showed significant clinical and biochemical improvement from liver point of view as well.

SP7.1.16 Endoscopy and biopsy for chronic diarrhoea: an audit and cost analysis

Aims The aim of the study is to analyse the costs of performing diagnostic endoscopy with histopathological sampling for patients suffering with chronic or persistent diarrhoea. Methods 300 patients were identified who required an endoscopy in 2019 according to the British Society of Gastroenterology guidelines. Patient’s presenting complaint, endoscopic and histological diagnosis and follow up plans were noted. 147 patients were included into our study whose presenting complaint was solely chronic or persistent diarrhoea. Those who presented with acute diarrhoea, PR bleeding or other concomitant indication for lower gastrointestinal endoscopy were excluded. Data from the national schedule of NHS costs was used to calculate expenditure. Results The total expenditure calculated for the 147 patients was £55,973. There was a total of 126 colonoscopies and 21 flexible sigmoidoscopies performed by the department. The number of patients who received medical treatment following endoscopy was 13/147 (9%) 8 of whom had nonspecific colitis on histology. There were 29 patients (20%) who required symptomatic treatment and there were 98 patients (66%) who received no intervention or were discharged immediately and 7 patients (5%) that required surgical intervention. The total cost of procedures not leading to surgical or medical management with steroids or immunomodulators was £47733 which is 85.3% of the total expenditure. Conclusion A significantly large proportion of investigations lead to no intervention or symptomatic treatment of the patient. Given this lack of diagnostic yield and financial burden, there could be room for advancement in the current guidelines for managing persistent diarrhoea.

Shigella dysentery and shigella infections

In the Eastern Mediterranean Region, dysentery is recognized as one of the major causes of persistent diarrhoea and malnutrition. The latest estimates amount to about a million total shigella cases annually with approximately 40 000 deaths [an average of 4% case fatality rate]. This paper discusses the role of food and water in this major health problem as well as antimicrobial treatment of shigella dysentery;preparedness;and control of epidemics due to shigella

SARS-CoV-2-triggered lymphocytic colitis

The ability of SARS-CoV-2 to infect the gastrointestinal tract is well described. Inflammatory bowel diseases (IBD) are believed to represent a disorganised immune response in genetically predisposed individuals, which are triggered by various environmental factors, notably infections. Here we report a case of chronic watery diarrhoea that was triggered by a SARS-CoV-2 infection. The work-up confirmed a new diagnosis of lymphocytic colitis, and the patient responded favourably to a course of oral budesonide. Clinicians should become vigilant to the possibility of triggered IBD in patients with persistent diarrhoea following a SARS-CoV-2 infection.

Serum Zinc Levels of Under Five Children with Diarrheal Disease

Background: Diarrhoea is a major cause of morbidity and mortality in children below five years of age especially in developing countries. One of the consequences of diarrhoea in children is zinc deficiency, which may worsen the diarrhoea itself, and thus increase morbidity and mortality. Aim and Objectives: The study aimed to determine the serum zinc status of under five children with diarrhoea attending Federal Medical Centre Owerri. Also, to compare the serum zinc level between children with diarrhoea and their age and sex-matched controls, as well as determine the relationship, if any between types of diarrhoea, and frequency of diarrhoea episodes. Methodology: The study was a comparative cross-sectional study carried out at the Emergency Paediatric Unit, The Children’s Outpatient Clinic and The Children’s Ward of the Federal Medical Centre, Owerri. A total of 402 study participants were analyzed. Structured questionnaires were used to collect data including participants’ socio demographic characteristics, the clinical presentation of the present diarrhoeal episode, as well as the frequency and duration of diarrhoeal episodes in the preceding year. Serum zinc was assessed using Varian AA240 Atomic Absorption Spectrophotometer. Results: The prevalence of zinc deficiency in children with diarrhoea was 84.1% while that of children without diarrhoea was 56.2%. Mean serum zinc level was significantly lower in children with diarrhoea when compared to their age and sex matched controls (p=0.000). All children with persistent diarrhoea and dysentery had zinc deficiency. Children with persistent diarrhoea had significantly lower serum levels when compared to children with acute watery diarrhoea. There was a negative correlation between serum zinc level and frequency of stool, duration of the present episode of diarrhoea, frequency of diarrhoea episodes, and the duration of each episode of diarrhoea in the preceding year and the severity of dehydration. Conclusion: The findings of this study support the present recommendation of the World Health Organization for zinc supplementation in children with diarrhoea, and recommends that children with persistent diarrhoea should have longer treatment with zinc tablets.

Comparative proteomics of three Giardia lamblia strains: investigation of antigenic variation in the post-genomic era

Giardia lamblia is a causative agent of persistent diarrhoea widespread in regions with low hygienic standards. Laboratory research is based on cloned lines issuing from various patient isolates typed in the late 1980s and 90s using restriction analysis and serology. In the present study, we compared the well-characterized strain WBC6 with another clone of the parent WB isolate termed WBA1 and with a clone from another isolate, GS/M-83-H7, using shotgun mass spectrometry proteomics. We identified 398 proteins differentially expressed between the GS and both WB isolates and 97 proteins differentially expressed between the two WB isolates. We investigated the expression levels of the predominant variant-specific surface proteins (VSPs) in each clone and matched the previously described major VSPs of each strain to the corresponding open reading frame sequences identified by whole-genome sequencing efforts. Furthermore, since the original WB isolate comes from a patient treated with metronidazole, we compared the susceptibilities of the strains to nitro compounds, as well the expression levels of enzymes involved in nitro reduction and on the corresponding enzyme activities and found distinct differences between the three strains.

"A Double-Edged Sword": A Case Report on Liver Injury Side-Effect of Anti-Tuberculosis Drug on Liver Tuberculosis Patient

Hepatic involvement in extra-pulmonary tuberculosis (TB) is rare, even in the endemic area. It has a high mortality rate as it can easily be misdiagnosed due to its rarity and non-specific presentations, and the treatment can be challenging for its hepatotoxic side-effect. A 55-year old man who was newly diagnosed with AIDS and pulmonary TB which complicated with anti-TB-induced transaminitis, presented with a few weeks history of fever and persistent diarrhoea. It was initially treated as microsporidia infection but the symptoms persisted despite given antiparasitic agent for more than a week. He was subjected to computed tomography (CT) scan of the abdomen and noted multiple hypoechoic lesion at multiple segments of the liver, which later confirmed to be liver TB by liver biopsy. As he could not tolerate Akurit-4 (Rifampicin 150 mg, Isoniazid 75 mg, Pyrazinamide 400 mg and Ethambutol 275 mg), the second-line treatment was given instead. He is currently well on regular clinic appointment. The objective of this case report is to share the rare occurrence of hepatic TB and the difficulty to treat it as the hepatotoxic effect of anti-TB medications complicate the liver damage due to the infection.