Donepezil and α-synuclein Constipation: A 48 Month Follow-Up

In a case study, four patients diagnosed at different stages of disease progression with the α‐synuclein or Lewy body disorders Parkinson’s disease (PD) and Neurocognitive Disorder with Lewy Bodies (NCDLB) were treated with the acetylcholinesterase inhibitor (AChEI) Donepezil to address the symptoms of constipation, obstipation and impaction. The use of Donepezil was associated with significant symptom reduction for each of the four patients. In follow-up studies conducted at intervals of six, twelve, eighteen, thirty-six and forty-eight months, symptom improvement was maintained with no apparent reduction in bowel motility, nor the emergence of any new symptoms. The results suggest that the AChEI Donepezil can have long-term benefit in reducing the symptoms of constipation, obstipation and impaction in patients with α-synuclein disorders. Keywords: Neurocognitive Disorder with Lewy Bodies, Parkinson’s disease, constipation, Donepezil, acetylcholinesterase inhibitor

Donepezil and α-synuclein Constipation: A 36 Month Follow-Up

A case study is described in which four patients diagnosed at different stages of disease progression with the α‐synuclein or Lewy body disorders Parkinson’s disease (PD) and Neurocognitive Disorder with Lewy Bodies (NCDLB) were treated with the acetylcholinesterase inhibitor (AChEI) Donepezil to address the symptoms of constipation, obstipation and impaction. In all four patients, the use of Donepezil was associated with significant symptom reduction, which was maintained at intervals of six, twelve, eighteen and thirty-six months, with no apparent reduction in bowel motility, nor the emergence of any new symptoms. The results suggest that the AChEI Donepezil can have long-term benefit in reducing the symptoms of constipation, obstipation and impaction in patients with α‐synuclein disorders. Keywords: Neurocognitive Disorder with Lewy Bodies, Parkinson’s disease, constipation, Donepezil, acetylcholinesterase inhibitor

A Rare Case of Gastric Crohn’s Disease Complicated by Gastric Carcinoma

Background: Inflammatory bowel diseases are strongly associated with colorectal cancer. In addition, a few cases reported with gastric and small bowel adenocarcinoma in gastroduodenal Crohn’s disease. Case report: We reported a case of a 47-Year-old female, who was referred to our surgical department and after a routine gastroscopy which revealed a lesion. Biopsy confirmed gastric well-differentiated adenocarcinoma of limited gastric Crohn’s disease, for a patient on regular anti Crohn’s medication. The patient underwent varying laparoscopic distal gastrectomy. She received adjuvant chemotherapy treatment and thereafter, she was cancer free within the period of 3- years of regular follow up. Conclusion: The only way to diagnose such lesions of a rare case of gastric cancer in a patient with Crohn’s disease is to regularly carry out upper gastrointestinal examinations. Keywords: Inflammatory bowel diseases, Crohn’s disease, Upper gastrointestinal tract Crohn’s disease, Gastric cancer

Atypical Early Onset Juvenile Sarcoidosis Presenting with Osteolytic Lesions

Sarcoidosis is a potentially fatal systemic inflammatory granulomatous disease, can occur in adult and pediatric patients, but it is relatively rare in children. Juvenile sarcoidosis has a diverse clinical course depending on the age of onset. Bone involvement is rarely noted in children with sarcoidosis and usually seen late in the course of the disease and is rarely the initial manifestation. Here we report a case of early onset juvenile sarcoidosis revealed by cutaneous and osseous lytic lesions of the phalanges. Keywords: Atypical, Early onset, Juvenile, Sarcoidosis, Osteolytic lesions, Osseous sarcoidosis, Phalanges.

Homeostasis Model Assessment (HOMA) and M Value in Daily Profile of Glucose

Background: Low Carbohydrate Diet (LCD) and Calorie Restriction (CR) have been on discussion for years. Authors have continued diabetic research about LCD, CR, Morbus (M) value and insulin secretion. In this study, homeostasis model assessment (HOMA) was investigated. Subjects and Methods: Subjects enrolled were 52 patients with type 2 diabetes mellitus (T2DM) (average 62.3 years). Methods included the measurement of fasting glucose and immunoreactive insulin (IRI), daily profile of blood glucose and M value. Results: The obtained data were as follows: average HbA1c 8.0%, average glucose of daily profile 222 mg/dL. Median data were M value 151, HOMA-R 1.07, HOMA-β 11.1. Divided into 4 groups due to M value, the levels of HOMA-R and HOMA-β in each group were 0.68, 1.08, 1.64, 1.38 and 16.9, 16.3, 10.2, 5.3, respectively. Significant correlation were observed between M value and HOMA-R (p<0.01), and between M value and HOMA-β (p<0.01). Discussion and Conclusion: As M value increases, HOMA-R increases and HOMA-β decreases. These findings suggested that diabetic patients would have insulin resistance and decreased β cell function correlated to the severity of diabetes, and that obtained results would become the basal data in this field, expecting the further development in the future research. Keywords: Type 2 diabetes mellitus (T2DM), Morbus value (M value), Homeostasis model assessment of insulin resistance (HOMA-R), Homeostasis model assessment of β cell function (HOMA-β), Daily profile of blood glucose, Immunoreactive insulin (IRI)

Donepezil for α‐synuclein Constipation: An 18 Month Follow-Up

In a series of case studies, four patients diagnosed with the α‐synuclein or “Lewy body” disorders Parkinson’s disease (PD) and Neurocognitive Disorder with Lewy Bodies (NCDLB) at different stages of disease progression were treated for the symptoms of constipation, obstipation, and impaction with the acetylcholinesterase inhibitor (AChEI) Donepezil. Initial findings indicated that the use of Donepezil was associated with significant symptom reduction. The symptom status of each of the four patients was reviewed at six and twelve month intervals, with no apparent reduction in bowel motility, nor the emergence of any new symptoms. After eighteen months, the symptom status of each of the four patients was again assessed. Evaluation of the results suggests that the AChEI Donepezil may have long-term benefit for relieving the symptoms of constipation, obstipation and impaction in patients with α‐synuclein disorders. Keywords: Neurocognitive Disorder with Lewy Bodies, Parkinson’s disease, constipation, Donepezil, acetylcholinesterase inhibitor

Case Report: Linear IgA Bullous Dermatosis Triggered by Amoxicillin-clavulanic acid

Linear IgA bullous dermatosis (LABD) is rare autoimmune disease that can be caused with or without drugs. We present a 32 year old male with LABD secondary to Amoxicillin-clavulanic acid with complete recovery after the antibiotic was discontinued. Keywords: Linear IgA Bullous disease, Vancomycin, Amoxicillin-clavulanic acid

Atrial Septal Defect Presenting as Platypnea Orthodeoxia Syndrome

Platypnea orthodeoxia syndrome (POS) is an uncommon phenomenon characterized by dyspnea and arterial desaturation in an upright position improved with recumbency. It is due to an anatomical factor that allows for interatrial communication and a functional factor that promotes right to left shunting. Once identified, early intervention allows for rapid symptomatic improvement. This case highlights that among patients who present with positional hypoxia, POS should be considered as a possible etiology. Thorough evaluation is warranted to identify potentially reversible etiologies and guide management. Keywords: Platypnea orthodeoxia syndrome, Atrial septal defect, Amplatzer closure device