Massive hemorrhage after percutaneous liver biopsy in a pediatric patient with graft-versus-host disease; a successful angiographic embolization

Most cases of bleeding that develop after percutaneous liver biopsies can be managed with follow-up and supportive treatment. In life-threatening situations, however, open surgery or minimally invasive methods are required. This case report describes the clinical course of an 11-year-old patient with a diagnosis of Wiskott-Aldrich syndrome who experienced a major hemorrhage following a percutaneous liver biopsy. Clinical findings, imaging, interventions, and results were evaluated. Allogeneic hematopoietic stem cell transplantation was performed without any problem. The patient's bilirubin level started to increase on the 20th day after transplantation. Profuse watery diarrhea started on the 24th day. Graft-versus-host disease of the gastrointestinal tract and liver was considered as his diarrhea continued to the 29th day. An ultrasound-guided Tru-cut® liver biopsy (Merit medical, South Jordan, UT, USA) was performed with an 18-gauge needle on the 52nd day after transplantation. In the fourth hour after the procedure, the general condition of the patient started to deteriorate. Active bleeding was detected in the patient with computed tomography, and he was hypotensive and tachycardic. The patient was urgently transferred to the angiography unit and a successful angiographic embolization was performed. Angiographic embolization is an intervention with high success rates in cases of bleeding where the patient is hemodynamically stable. However, it can also be successfully applied in selected patients who are hemodynamically unstable.

Prenatal and Postnatal Manifestations of Congenital Chloride Diarrhea Due to a Heterozygote Variant of the SLC26A3 Gene: A Case Report

Congenital chloride diarrhea (CCD) is caused by a recessive mutation in the SLC26A3 gene and characterized mainly by watery diarrhea, hypochloremia and metabolic alkalosis. Various different mutations in SLC26A3 are responsible for the disease. In the prenatal period, the symptoms of CCD may include polyhydramnios, preterm labor and abdominal distension. The main feature of CCD is chloride-rich diarrhea, which leads to excessive loss of fluid and salt immediately after birth and is followed by weight loss and dehydration. Hyponatremia and hypochloremia are soon accompanied by hypokalemia and metabolic alkalosis. Untreated CCD is fatal even in the first weeks of life. Diagnosis is made by high fecal chloride concentrations in patients with serum electrolytes corrected by salt substitution and confirmed using genetic testing of peripheral blood samples. Here, we detail prenatal and postnatal manifestations of a preterm infant, born via Caesarian section, who was suspected to suffer intrauterine bowel obstruction. Upper median laparotomy was performed and no intestinal abnormalities found. The course of the neonatal period was complicated by severe diarrhea with hypochloremia, hyponatremia and metabolic alkalosis. Based on the patient's clinical picture and stool examination, a diagnosis of CCD was established. Mutation of the SLC26A3 gene was confirmed using genetic testing.

Effect of Zinc Supplement on Severity Of Acute Diarrhea Among Childern Under Five Years Of Age

According to World Health Organization (WHO) approximately four million children less than 5 years of age in Asia, Africa, and Latin America die annually from diarrhea; and 80% of these deaths occur in the first year of life. Objective: To see how a zinc supplement influences the severity of acute diarrhea in children under the age of five. Methods: In current study, we analyze the effect of zinc on diarrheal patients. Zinc was randomly assigned to diarrheal patients in different concentration 5 mg, 10 mg, 15 mg and 20 mg. There were two groups in our study, treatment and control group. Results: The results are presented in the form of descriptive and inferential statistics. In T1 (Treatment Group) number of Diarrhea patients < 1 Year of age were 16, 2-4 years of age were 45, 4-5 years of age and maximum no of patients in T1 < 2 year of age were 57. Number of male patients were 84 while female patients were 67 in T1.In T2 (Control Group) number of male patients were 92 while female patients were In T1 number of patients residing in urban area were 51 while rural were 100. In T2 number of urban were 69 while rural were 82.Number of patients stay in the hospital for one day were 67 ,15 for Four days and only 1 for seven days in T1. In T2 number of patients stay in the hospital for one day were 29, 17 for four days and only 6 for seven days. In T1 number of Patients with watery diarrhea were 87, Mucoid consistency of stool were 31,soft consistency of stool were 23 and formed consistency of stool were 9.In T2 watery diarrhea were 92,Mucoid consistency of stool were 25,soft consistency of stool were 31 and formed consistency of stool were 4. Frequency of stool significantly reduced (P<0.005) at 7th day of zinc treatment while consistency of stool was significantly improved (P<0.005) at day 3 and day 5 of zinc treatment. Children who received zinc supplements showed a marked improvement in all outcome measures, suggesting that this deficiency is amenable to correction by replacement.

Etiology, Assessment and Management of WDHA (Watery Diarrhea, Hypokalemia, and Achlorhydria) and VIPoma

The syndrome of watery diarrhoea, hypokalemia, and achlorhydria (WDHA syndrome) is an uncommon disorder marked by severe, watery diarrhoea caused by non–beta pancreatic islet cell oversecretion of vasoactive intestinal peptide (VIP). The onset of the disease is gradual, and diagnosis is often months or years later. Long-term dehydration, electrolyte and acid-base abnormalities, and chronic renal failure are all linked to morbidity. Pancreatic endocrine tumours are extremely rare, with less than 10 incidences per million people. VIPomas are uncommon tumours that affect between 0.05 and 2.0 percent of people. The most prevalent symptom is diarrhoea, which affects at least 89 percent of patients. VIPoma is treated with a combination of medicine and surgery The goal of first medical treatment is to reduce symptoms and restore fluids and electrolytes as quickly as possible

Clinical characteristics and cellular immunity in children with rotavirus infection

Objective. To determine clinical course and state of cellular immunity in young children with rotavirus infection.Children characteristics and research methods. The scientists examined children without infectious pathology and with rotavirus infection (20 patients in each group) using general clinical methods. Rotavirus infection was diagnosed by polymerase chain reaction and immunochromatography. Cellular immunity parameters were determined by flow cytometry.Results. All the children under observation had a moderate form of the disease with symptoms of exsicosis of the II degree. Changes in the immune status were mainly of a regulatory, adaptive nature, which contributed to the favorable course of rotavirus infection in children, however, the dynamics of the number of cells expressing Toll-like receptors indicates the immunosuppressive properties of rotavirus.Conclusion. Currently, rotavirus infection in young children is typical with watery diarrhea as the most pronounced and long-lasting clinical symptom. Shifts in immunogram indices in general indicate a deficiency of the cellular link of immunity and a violation of its regulation with simultaneous activation of the immune system in an effort to achieve the eradication of the rotavirus with immunosuppressive properties.

A Comprehensive View on the Host Factors and Viral Proteins Associated With Porcine Epidemic Diarrhea Virus Infection

Porcine epidemic diarrhea virus (PEDV), a coronavirus pathogen of the pig intestinal tract, can cause fatal watery diarrhea in piglets, thereby causing huge economic losses to swine industries around the world. The pathogenesis of PEDV has intensively been studied; however, the viral proteins of PEDV and the host factors in target cells, as well as their interactions, which are the foundation of the molecular mechanisms of viral infection, remain to be summarized and updated. PEDV has multiple important structural and functional proteins, which play various roles in the process of virus infection. Among them, the S and N proteins play vital roles in biological processes related to PEDV survival via interacting with the host cell proteins. Meanwhile, a number of host factors including receptors are required for the infection of PEDV via interacting with the viral proteins, thereby affecting the reproduction of PEDV and contributing to its life cycle. In this review, we provide an updated understanding of viral proteins and host factors, as well as their interactions in terms of PEDV infection. Additionally, the effects of cellular factors, events, and signaling pathways on PEDV infection are also discussed. Thus, these comprehensive and profound insights should facilitate for the further investigations, control, and prevention of PEDV infection.

A novel method of mechanical thrombectomy utilizing a stent retriever device with continuous aspiration prior to intracranial vascular embolectomy technique for acute superior mesenteric artery occlusion: A case report

Acute superior mesenteric artery (SMA) occlusion resulting from a thrombus formation carries a high mortality risk and therefore immediate diagnosis and treatment are warranted. In recent years, mechanical thrombectomy by interventional radiology has become a viable treatment option if the occlusion has not advanced to intestinal necrosis. We present a rare and interesting case involving a patient with acute SMA occlusion which was completely recanalized by mechanical thrombectomy utilizing a stent retriever device and the continuous aspiration prior to intracranial vascular embolectomy (CAPTIVE) technique. The CAPTIVE technique has become widely adopted in recent years to treat large vessel occlusions in the cerebrovascular region due to thrombi. First, a microcatheter with a microguidewire is advanced through the occlusive thrombus coaxially with an aspiration catheter. Next, a stent retriever is deployed in the thrombotic body and the aspiration catheter is advanced adjacently to the proximal part of the thrombus with strong aspiration until no backflow is present. After checking for backflow from the aspiration catheter, the microcatheter delivering the stent is removed to increase the aspiration force. Finally, the stent retriever and the aspiration catheter are retrieved as a single unit. An 87-year-old female patient with a history of atrial fibrillation (AF), chronic heart failure, aortic valve stenosis, hypertension, type2 diabetes mellitus, and hyperlipidemia was admitted to our hospital complaining of sudden onset upper abdominal pain, vomiting, and watery diarrhea. On arrival, her body temperature was 36.0°C (96.8°F), blood pressure was 131/75 mmHg, heart rate was 115 beats/min with AF rhythm, and her white blood cell count was 18,100 cells/μL. A contrast-enhanced computed tomography revealed a contrast defect in the SMA which we later diagnosed as an acute occluding thrombus of the SMA. Initially, we attempted aspiration of the thrombus but were unsuccessful, so we transitioned to mechanical thrombectomy utilizing a stent retriever device with CAPTIVE technique which rapidly and completely recanalized the occluded SMA. After the procedure, the patient’s abdominal pain immediately subsided. Normal stool was observed 2 days after the procedure and oral feeding was subsequently initiated. Twelve days after the procedure, the patient was discharged from the hospital in good health.

Pheno- and genotypic characterization and identification of novel subtypes of Peste des Petits Ruminants virus in domestic and captive wild goats in Northern Iraq

Background Peste des Petits Ruminants (PPR) is an acute or peracute contagious transboundary viral disease that mainly affects caprine and ovine and causes significant economic impact in developing countries. After two PPR virus outbreaks in 2011 and 2014, an investigation, from August 2015 to September 2016, was carried out in Northern Iraq when an increased morbidity and mortality rates were reported in the domestic and captive wild goats. In the present study, ten domestic goat farms and seven captive wild goat herds located in seven geographical areas of Northern Iraq were clinically, pathologically, serologically and genotypically characterized to determine the prevalence and potential cause of PPR virus outbreak. Results The outbreak occurred with rate of morbidity (26.1%) and mortality (11.1%) in domestic goat farms as compared to captive wild goat herds where relatively high mortality (42.9%) and low morbidity (10.9%) rates were recorded. Based on the clinical symptoms (mucopurulent nasal discharges, ulceration and erosion of oral mucosa, profuse watery diarrhea) and necropsy (hemorrhage and congestion on mucous membranes of the colon and rectum with zebra stripes lesions) results, overall, the serological test findings revealed a high frequency (47.9%) of positive samples for anti-PPRV nucleoprotein antibodies. Furthermore, the nucleoprotein (N) gene was detected in 63.2 and 89.1% of samples using conventional and reverse transcription real-time quantitative PCR assays. A phylogenetic analysis of N gene amino acid sequences clustered with the reference strain revealed lineage IV similar to the strains isolated in 2011 and 2014, respectively. However, two sub-types of lineage IV (I and II), significantly distinct from the previous strains, were also observed. Conclusion The phylogenetic analysis suggests that movements of goats are possible cause and one of the important factors responsible for the spread of virus across the region. The study results would help in improving farm management practices by establishing a PPR virus eradication program using regular monitoring and vaccination program to control and mitigate the risk of re-emergence of PPR virus infection in domestic and captive wild goats in Iraq.

Case Report: Molecular Diagnosis of Cystoisospora belli in a Severely Immunocompromised Patient with HIV and Kaposi Sarcoma

Diarrhea in an immunocompromised patient has a broad infectious differential. Diagnosis is difficult despite advances in diagnostic modalities. We report a case of a 45-year-old Nigerian woman who immigrated to the United States 2 years ago. She presented to the hospital with gastrointestinal bleeding, newly diagnosed HIV, and disseminated Kaposi sarcoma. During hospitalization, the patient had an onset of watery diarrhea and high eosinophilia. Subsequent stool analysis using multi-parallel real-time quantitative polymerase chain reaction for 13 parasites was positive for Cystoisospora belli. The patient was treated with trimethoprim–sulfamethoxazole, but had relapsed disease when her antibiotics were stopped prematurely. After restarting trimethoprim–sulfamethoxazole, her diarrhea and eosinophilia improved, and she had undetectable Cystoisospora belli DNA on repeat stool quantitative polymerase chain reaction. This case highlights the importance of a thorough workup for diarrhea, including parasites, especially for immunocompromised patients. Antibiotic prophylaxis is recommended in patients with Cystoisospora belli and HIV/AIDS.

Novel MYO5B Mutation in Microvillous Inclusion Disease of Syrian Ancestry

Microvillus inclusion disease (MVID, MIM♯ 251850), also known as congenital microvil-lus atrophy, was first described by Davidson et al. in 1978. It is a rare au-tosomal recessive disease that presents with an intractable life-threatening watery diarrhea either within the first days of life (early-onset form) or at several months of life (late-onset form) . The hallmarks of MVID are a lack of microvilli on the surface of villous enterocytes, occurrence of microvillous inclusions and the cytoplasmic accumulation of periodic acid-schiff-positive vesicles. In 2008, Muller et al showed that mutations in MYO5B (MIM ♯ 606540), en-coding the unconventional type Vb myosin motor protein, were associated with MVID in an ex-tended Turkish kindred. Since then, more mutations were described in different populations . In this report we describe a novel mutation in two unrelated Syrian patients with MVID.