Acute Gastrointestinal Symptoms Research Articles

Outbreak investigation of food poisoning attributed to Omphalotus japonicus using polymerase chain reaction‐based sequencing

AbstractObjectiveThis study aims to report and analyse an outbreak of Omphalotus japonicus poisoning following mushroom ingestion in Taiwan, and to employ PCR methods for accurate identification of the toxic mushrooms involved.MethodsA descriptive observational study was conducted involving a family of four who ingested the mushrooms in the mountainous rural area of Yilan County, Taiwan. Data were collected through interviews with the affected individuals and a review of their medical records. Due to the destruction of the mushroom samples, Polymerase Chain Reaction (PCR) methods were utilized for identification. Genomic DNA was extracted from the raw fruiting bodies, and specific primers targeting the internal transcribed spacer region of the nuclear ribosomal DNA were designed for PCR detection.ResultsThree family members (mother, daughter, and son) experienced gastrointestinal symptoms, including nausea, vomiting, abdominal cramps, and diarrhea, approximately 30 min after consuming the mushrooms. Upon admission to the emergency room, they were hydrated and monitored, with laboratory results showing slightly elevated alanine transaminase levels. The affected individuals recovered within 12 h and were discharged in good condition on day 2. PCR analysis of the mushroom sample confirmed the identification of Omphalotus japonicus, known to produce Illudin S and Illudin M, which cause acute gastrointestinal symptoms. This case represents the first documentation of using PCR‐based sequencing to diagnose Omphalotus japonicus poisoning in the English literature.

Acute gastrointestinal symptoms associated with oil spill exposures among U.S. coast guard responders to the Deepwater Horizon oil spill

PurposeResearch investigating gastrointestinal (GI) symptoms from oil spill-related exposures is sparse. We evaluated prevalent GI symptoms among U.S. Coast Guard responders deployed to the Deepwater Horizon oil spill cleanup. MethodsCrude oil (via skin contact, inhalation, or ingestion routes), combined crude oil/oil dispersant exposures, other deployment exposures, deployment characteristics, demographics, and acute GI symptoms during deployment (i.e., nausea/vomiting, diarrhea, stomach pain, and constipation) were ascertained cross-sectionally via a post-deployment survey (median time between deployment end and survey completion 185 days) (N = 4885). Log-binomial regression analyses were employed to calculate prevalence ratios (PRs) and 95 % confidence intervals (CI). Effect modification was evaluated. ResultsIn adjusted models, responders in the highest (versus lowest) tertile of self-reported degree of skin contact to crude oil were more than twice as likely to report nausea/vomiting (PR=2.45; 95 %CI, 1.85–3.23), diarrhea (PR=2.40; 95 %CI, 2.00–2.88), stomach pain (PR=2.51; 95 %CI, 2.01–3.12), and constipation (PR=2.21; 95 %CI, 1.70–2.89). Tests for trend were statistically significant (p < 0.05). Results were similar for crude oil exposure via inhalation and ingestion. Higher PRs for all symptoms were found with combined crude oil/dispersant exposure than with crude oil exposure alone. ConclusionsThese results indicate positive associations between self-reported crude oil and combined crude oil/oil dispersant exposures and acute GI symptoms.

Analysis of 5 patients with acute glyphosate poisoning clinical characteristics and metabolic concentration

Objective: To analyze the correlation between changes in the concentration of glyphosate (GLY) and its metabolites (AMPA) in patients with acute glyphosate poisoning and clinical symptoms, and to provide reference for the study of glyphosate toxicity. Methods: Urine samples from 5 patients with oral glyphosate poisoning admitted to the Emergency Department of Yangzhou Third Class A General Hospital from February to July 2021 were collected. Urine concentrations of GLY and AMPA were measured using derivatization gas chromatography-mass spectrometry, and analyzed based on the patient's clinical manifestations and treatment process. Results: The main symptoms of the patient after poisoning were acute gastrointestinal symptoms, such as nausea, vomiting, abdominal pain, etc. The concentration of GLY in the patient's urine reached its maximum on the first day and gradually decreased over time. On the day of discharge, the final concentration of GLY was 10% lower than the initial concentration. At discharge, the clearance rates of GLY in cases 1, 2, 3, and 4 were 96.97%, 95.91%, 96.87% and 92.87%, respectively. Conclusion: The glyphosate has a shorter maintenance time after entering the human body; There is no correlation between the concentration of glyphosate and its metabolites admitted to the hospital, the dose of poisoning, and clinical symptoms in poisoned patients.

Acute toxicity patterns and their management after moderate and ultra- hypofractionated radiotherapy for prostate cancer: A prospective cohort study

ObjectiveHypofractionation has become the new clinical standard for prostate cancer. We investigated the management of acute toxicity in patients treated with moderate hypofractionation (MHF) or Ultrahypofractionation (UHF). MethodsIn a prospective cohort setting, patients (N=316) received either MHF (20 fractions of 3/3.1 Gy, 5 fractions per week, N=156) or UHF (7 fractions of 6.1 Gy, 3 fractions per week, N=160) to the prostate +/- (base of the) seminal vesicles between 2019 and 2023. UHF was not indicated in case of significant lower urinary tract symptoms (LUTS) or T3b disease. Patient-reported outcomes (PRO) were online distributed at baseline, end of treatment (aiming at last fraction +/- 3 days), 3 months. Acute toxicity rates, management, and associations with baseline factors were analysed using Chi-square test and logistic regression. CTCAE scores (version 5) were calculated. ResultsTreatment for acute urinary complaints was prescribed in 46 % (MHF) and 29 % (UHF). Taking into consideration baseline LUTS, MHF and UHF showed similar rates of PROs and management. Medication for acute gastrointestinal (GI) symptoms was prescribed for 21.1 % (MHF) and 14.1 % (UHF) with more loperamide for diarrhea in MHF (9.0 %) vs UHF (1.9 %, p = 0.005). Grade ≥ 2 (MHF / UHF) was scored in 40 % / 28 % for GI (p = 0.03) and 50 % / 31 % for GU (p < 0.01). PROs for GI reported after last fraction of UHF were significantly worse compared to before last fraction. ConclusionUHF was safe with respect to acute toxicity risks in the selected population. MHF is associated with risks of significant diarrhea which needs further investigation. Furthermore, optimal registration of acute toxicity for UHF requires measurements up to 1–2 weeks after the last fraction.

A case of late-presenting congenital diaphragmatic hernia diagnosed at 5 years with acute abdomen

BackgroundSome congenital diaphragmatic hernias are diagnosed beyond 1 month. A late-presenting congenital diaphragmatic hernia shows a variety of clinical manifestations, and the preoperative clinical course is variable. We herein report a pediatric case of late-presenting congenital diaphragmatic hernia diagnosed as acute abdomen.Case presentationA 5-year-old boy was brought to our hospital because of herniation of the intestine into the left thoracic cavity, which was observed on radiography performed for abdominal pain. Enhanced computed tomography showed herniation of the small intestine and colon into the left thoracic cavity. Emergency laparoscopic surgery was performed based on the diagnosis of left diaphragmatic hernia. The entire small intestine and part of the colon herniated from the posterolateral defect of the diaphragm. We were able to retract the herniated intestine back into the abdomen but confirmed that the diaphragmatic defect and closure of the defect seemed to be technically challenging via laparoscopy; therefore, we converted the procedure to open laparotomy. The diaphragmatic defect was directly closed with interrupted sutures, and the thoracic cavity was degassed. Postoperatively, the left lung was found to be poorly expanded, but pulmonary hypoplasia was not evident in this case.ConclusionsWe herein report a pediatric case of late-presenting congenital diaphragmatic hernia diagnosed as abdominal pain. Late-presenting congenital diaphragmatic hernias present with a wide variety of symptoms; therefore, it is important to be reminded of these conditions and check chest radiographs in children presenting with acute or chronic respiratory or gastrointestinal symptoms of unknown etiology.

Characterisation of an outbreak of acute liver injury after ingestion of plant-based food supplement.

In April 2022, French Lentil and Leek Crumble (FLLC), a new frozen food preparation manufactured by Daily Harvest™ (containing Tara flour) was offered as a natural high-protein meal product. Soon thereafter, widespread anecdotal reports of acute gastrointestinal symptoms with liver injury were reported, leading to its voluntary withdrawal in June 2022, after shipment of 28,000 preparations. To summarise the clinical and laboratory features of 17 patients with FLLC associated liver injury from the Drug Induced Liver Injury Network (DILIN). Patients with FLLC-associated liver injury were enrolled into a prospective protocol and followed for 6 months. Cases were adjudicated by expert opinion causality assessment with summary statistics for data analysis. Enrolled subjects had a mean age of 41 years, 82% were female with mean BMI of 24 kg/m2. All were Caucasian without underlying liver disease. In most cases, abdominal pain and nausea arose within hours of FLLC ingestion. Mean days from ingestion to identification of liver injury was 3.1 days (±2.8). On enrolment, 53% had jaundice, 47% nausea, 24% fever, 59% abdominal pain, 41% itching and 12% rash. The mean initial serum ALT was 475 U/L (±302), AST 315 U/L (±315), alkaline phosphatase 190 U/L (±76), with a total bilirubin of 2.6 mg/dL (±2). In this study, 63% presented with a hepatocellular pattern of liver injury, 6% cholestatic and 31% mixed as determined by the R value. In addition, 24% of patients were hospitalised, and there were no fatalities or liver transplants. Liver biopsy in one subject revealed acute hepatitis with mild ductular reaction, mild lymphocytic and eosinophilic portal inflammation, mild lobular inflammation, preserved bile ducts and absence of interface hepatitis, steatosis, granulomatous reaction or cholestasis. Phylogenetic analysis confirmed the presence of Tara spinosa, the source of Tara flour. Natural food products are increasingly ubiquitous and may unexpectedly cause significant illness. All clinicians should inquire whether patients are consuming natural food products or herbal supplements and consider them as a potential cause of liver injury.

A multi-omics approach to elucidate okadaic acid-induced changes in human HepaRG hepatocarcinoma cells

Okadaic acid (OA), a prevalent marine biotoxin found in shellfish, is known for causing acute gastrointestinal symptoms. Despite its potential to reach the bloodstream and the liver, the hepatic effects of OA are not well understood, highlighting a significant research gap. This study aims to comprehensively elucidate the impact of OA on the liver by examining the transcriptome, proteome, and phosphoproteome alterations in human HepaRG liver cells exposed to non-cytotoxic OA concentrations. We employed an integrative multi-omics approach, encompassing RNA sequencing, shotgun proteomics, phosphoproteomics, and targeted DigiWest analysis. This enabled a detailed exploration of gene and protein expression changes, alongside phosphorylation patterns under OA treatment. The study reveals concentration- and time-dependent deregulation in gene and protein expression, with a significant down-regulation of xenobiotic and lipid metabolism pathways. Up-regulated pathways include actin crosslink formation and a deregulation of apoptotic pathways. Notably, our results revealed that OA, as a potent phosphatase inhibitor, induces alterations in actin filament organization. Phosphoproteomics data highlighted the importance of phosphorylation in enzyme activity regulation, particularly affecting proteins involved in the regulation of the cytoskeleton. OA's inhibition of PP2A further leads to various downstream effects, including alterations in protein translation and energy metabolism. This research expands the understanding of OA's systemic impact, emphasizing its role in modulating the phosphorylation landscape, which influences crucial cellular processes. The results underscore OA's multifaceted effects on the liver, particularly through PP2A inhibition, impacting xenobiotic metabolism, cytoskeletal dynamics, and energy homeostasis. These insights enhance our comprehension of OA's biological significance and potential health risks.

Serum ACTH and Cortisol Level is Associated with the Acute Gastrointestinal Injury Grade in ICU Patients.

The relationship between acute gastrointestinal symptoms and cortisol or adrenocorticotropic hormone (ACTH) levels has rarely been reported. We hypothesized that the elevation of serum cortisol or ACTH levels may be correlated with the severity of the acute gastrointestinal injury grade (AGI). This study was an observational study. All patients were admitted to the ICU between 2019.1.1 and 2020.1.1.. Serum ACTH and cortisol levels and clinical data were collected from the electronic medication records. The highest AGI grade during the ICU stay was the major endpoint to observe. The patient was treated in a standard procedure in the ICU. A total of 235 patients were included in our study, 132 of whom developed AGI. In univariate regression, cortisol level was found to be a risk factor for 28-day mortality. Serum cortisol and ACTH levels correlated with APACHE II, AGI grade, PCT, and CRP levels. Spearman analysis and partial correlation analysis indicated that cortisol and ACTH levels were correlated with AGI grade. The ACTH and cortisol levels were positively correlated with the higher severity of AGI grade. The cortisol level may be a useful way to access the GI injury.

Eosinophilic enteritis: the great mimic

Eosinophilic enteritis (EoN), a subtype of eosinophilic gastrointestinal disease, is a rare and complicated inflammatory condition affecting the small intestine. This case report discusses a 42-year-old patient who presented with acute gastrointestinal symptoms including diarrhea, nausea, and vomiting. Initial laboratory investigations revealed leukocytosis, peripheral eosinophilia, and distinctive imaging findings, prompting further evaluation. Endoscopic evaluation revealed extensive mucosal lesions in the small intestine, with subsequent biopsies confirming eosinophilic infiltration, ultimately leading to the diagnosis of chronic enteritis, probably of an eosinophilic nature. The case highlights the complex differential diagnostic process involved in identifying EoN, which requires a comprehensive understanding of all the clinical and histopathological features of the disease. The efficacy of budesonide therapy is also discussed in the management of EoN and it was evidenced by our patient's positive response to treatment. This case report contributes significant insights into the understanding and management of EoN, providing essential information for the medical community to facilitate accurate diagnosis and tailored therapeutic interventions for individuals experiencing this complex disorder.

Emergency Endoscopic Interventions in Acute Upper Gastrointestinal Bleeding: A Cohort Study

Introduction: Acute upper gastrointestinal bleeding is a common cause of emergency department admissions. The standard approach for the diagnosis and treatment of acute upper gastrointestinal bleeding (AUGIB) involves an endoscopy of the upper gastrointestinal tract. While daytime emergency endoscopy has been well studied, there is limited evidence regarding its effectiveness during the nighttime. Patients and Methods: We conducted a retrospective cohort study at a single center, analyzing adult patients with AUGIB referred for emergency endoscopy outside of regular hospital hours. Patients treated with endoscopic hemostatic methods were categorized into day-hours and night-hours groups based on the timing of the gastroscopy. The primary clinical endpoint was 120-day all-cause mortality, with secondary endpoints including hemostasis and recurrence. Results: In the population of 752 enrolled patients with acute upper gastrointestinal bleeding symptoms, 592 had a gastroscopy during the day hours between 8.00 a.m. and 10.00 p.m., while 160 had procedures performed at night between 10:00 p.m. and 8:00 a.m. In the day-hours group, the median time from symptom onset to endoscopy was 10 h (IQR 6–15), compared to 6 h (IQR 4–16) in the night-hours group. The gastroscopy duration (time to reach hemostasis during endoscopy) was significantly shorter during the night hours (p &lt; 0.001). In both groups, endoscopic intervention after the sixth hour from symptom onset yielded improved outcomes, while treatment before the fifth hour resulted in poorer outcomes. Although the night-hours group had higher 120-day all-cause mortality, the difference was not statistically significant. Conclusions: Our findings indicate that emergency therapeutic gastroscopy for acute upper gastrointestinal bleeding is similarly effective during both day and night hours, particularly when performed after the sixth hour from symptom onset.

Abstract 13309: Severe Cardiomyopathy as Harbinger of Multisystem Inflammatory Syndrome From Epstein Barr Infection

Introduction: Multisystem inflammatory syndrome in adults (MIS-A) is a rare condition characterized by multiple organ injury after a viral infection. Features include fever, elevated inflammatory markers, evidence of acute viral infection, and at least three of the following clinical criteria: peri/myocarditis or acute ventricular dysfunction, rash, encephalopathy, shock, and gastrointestinal symptoms. This is a case of nonischemic cardiomyopathy (NICMP) as a MIS-A manifestation after an Epstein-Barr viral (EBV) infection. Description of Case: A 38 year-old female, with a recent pneumonia, presented with two weeks of fever, dyspnea, hemoptysis, fatigue, and right leg swelling. Initial ECG showed sinus tachycardia. Laboratory testing showed leukocytosis 15.5k/uL, NT pro BNP 6470 pg/mL, C-reactive protein 234 mg/L, lactic acid 3.7 mmol/L, creatinine 1.5 mg/dL (baseline 0.7 mg/dL), AST 372 U/L, ALT 658 U/L. RSV, influenza, COVID-19, HIV, hepatitis B/C, and urine antigens were undetected. Imaging showed deep vein thrombosis in right leg veins and bilateral pulmonary emboli with infarcts. Heparin infusion was started. A transthoracic echocardiogram showed biventricular systolic failure with an ejection fraction of 20%. Coronary angiography showed no coronary artery disease. Cardiac MRI showed dilated NICMP with minimal late gadolinium enhancement. The nadir of her cardiac index was 1.2 L/min/m 2. She was started on nitroprusside infusion for early-stage cardiogenic shock. Extensive workup for thrombophilia, autoimmune, amyloidosis, infectious causes were all normal except for an elevated EBV early antigen IgG which indicated past infection within a few months, aligning with patient’s reported pneumonia symptoms before presentation. She clinically improved and was bridged to heart failure guideline directed medical therapy and apixaban on discharge. Discussion: Though MIS-A has been reportedly associated with COVID-19, EBV can cause MIS, with severe cardiomyopathy, nephropathy, hepatopathy, and pulmonary infarcts requiring intensive cardiac care, in a normal young adult.

Clinical Case: Intestinal Perforation in Patient with SARS-COV-2 Infection

As the SARS-COV-2 virus pandemic spreads around the world, new clinical manifestations are being reported. In addition to respiratory manifestations, acute kidney injury, hypercoagulability, pulmonary thromboembolism, and gastrointestinal symptoms have been reported. The Infectology Hospital of the La Raza National Medical Center, in the Intensive Care Unit, has treated 148 patients from November 2020 to November 2021 for severe to critical COVID-19. We present the case of a patient with SARS-COV-2, with intestinal perforation due to vascular congestion at the level of the cecum in a critical COVID-19 patient.

Prevalence, Risk Factors, and Sequelae of Asymptomatic Clostridioides difficile Colonization in Children with Cystic Fibrosis

Patients with CF (pwCF) have high antibiotic use and an altered intestinal microbiome, known risk factors for infection with Clostridioides difficile. However, in adults with CF, C. difficile infection (CDI) is uncommon and asymptomatic colonization with C. difficile occurs frequently, for reasons that remain unclear. We investigated the rate, risk factors, and sequelae of asymptomatic C. difficile colonization in children with CF (cwCF). We identified that 32% of cwCF were colonized with C. difficile without acute gastrointestinal symptoms. Higher BMI and exposure to specific antibiotic classes (cephalosporins, fluoroquinolones, and vancomycin) were significantly associated with C. difficile colonization. No children developed symptomatic CDI in 90-days following enrollment.

A Prospective Analysis of Toxicity Associated with Intraoperative, Real-Time Planned Low Dose Rate Brachytherapy or Intensity-Modulated Radiotherapy Boost for High/Intermediate Risk Prostate Cancer

<h3>Purpose/Objective(s)</h3> The ASCENDE-RT trial which used pre-planned brachytherapy boost (BT) reported worse treatment-related morbidity with BT vs dose-escalated intensity-modulated radiotherapy boost (DE-IMRT) for prostate radiation therapy (RT). However, toxicity is technique dependent and the outcomes of real-time intraoperative BT have not been well studied. We evaluate the toxicity profile of intraoperative, real-time planned BT vs DE-IMRT. <h3>Materials/Methods</h3> 402 patients treated from 2010-18 at our institution were included. Median dose for DE-IMRT was 79Gy. BT included IMRT to a median of 45Gy plus BT boost of 110 Gy. Patient-reported outcomes using the validated Prostate Cancer Symptom Indices and physician-graded CTCAE toxicity were prospectively collected from baseline to 2yrs post-RT. Clinically meaningful symptoms were defined as ≥Grade 2. Per institutional practice, an α-1 blocker is started prior to BT but not DE-IMRT boost. We report acute (0-6 months) & late (1 & 2yr) toxicity. Multivariable logistic regression calculated odds ratios (OR) for symptoms & controlled for hormone therapy, image guidance modality, risk category & age. <h3>Results</h3> At acute, 1-, & 2-yr time points 148, 108, 54 & 254, 214, 162 patients were available for BT & DE-IMRT analysis, respectively. Baseline and acute genitourinary (GU) or gastrointestinal (GI) symptoms did not differ between cohorts. For both modalities, PRO GI and GU symptom prevalence peaked acutely, declined over 1yr and returned near baseline by 2yrs (Table). At 2yrs, a difference in ≥Grade 2 CTCAE GU toxicity persisted (19% vs 2%, p = <0.001); urinary frequency (6% vs 0%, p = 0.02), & incontinence (9% vs 2%, p = 0.02) differed most. On MVA, BT had higher 2-yr GU symptoms for PRO (OR 32.0, 95%CI: 6.2-165, p < 0.0001) & CTCAE (2.2, 1.4-3.6, p = 0.0006). Cumulative incidence of CTCAE ≥Grade 3 events at 2yr were GU 3.4% vs 0%, p = 0.007 & GI 2.0% vs 2.0%, p = 1.0 for BT & DE-IMRT. <h3>Conclusion</h3> This large single institution series with prospectively collected PRO & CTCAE toxicity is one of the first to report outcomes for intraoperatively, real-time planned BT. Odds of GU symptoms ≥Grade 2 are elevated with BT but cumulative incidence of GU/GI CTCAE ≥Grade 3 toxicity at 2yr was <4% for BT & DE-IMRT. Our results may assist in counseling and suggest that among appropriately selected patients a BT boost with intraoperative planning is reasonably well tolerated.

Short-Term Effect of Additional Daily Dietary Fibre Intake on Appetite, Satiety, Gastrointestinal Comfort, Acceptability, and Feasibility.

Background: There is evidence that high-fibre diets have significant health benefits, although the effect of increasing fibre on individuals’ appetite, satiety, and gastrointestinal comfort is not well established, nor is its acceptability and feasibility. Methods: This mixed-methods feasibility randomised control trial included 38 participants allocated to one of three conditions: FibreMAX (two daily servings of 25 g of BARLEYmax®), FibreGRAD (two daily servings with the amount of fibre gradually increased), and Control (two daily servings totalling 25 g of placebo product). Participants completed a food diary at baseline. The Hunger and Fullness Questionnaire and questions regarding gastrointestinal response were completed at baseline and at the end of each week. Participants completed the acceptability of intervention measure and engaged in a semi-structured interview, following trial completion. Results: The qualitative data suggested that increased fibre influenced appetite and fullness perceptions. Baseline fibre consumption and the method of increased fibre increase did not influence our findings. The qualitative results also indicated that the fibre intake was perceived as beneficial to well-being; it influenced feelings of hunger and caused some minor acute gastrointestinal symptoms that dissipated after a short adaption period. Conclusion: This study suggests that increasing fibre intake through BARLEYmax® is a safe intervention that is acceptable to participants.

Ileal Perforation by Ingested Fishbone

Hollow viscus perforation is one of the most frequent causes of acute gastrointestinal symptoms, but these are rare due to foreign body (FB) ingestion. The majority of ingested FBs that reach the stomach pass uneventfully through the gastrointestinal tract. Hollow viscus perforation following a FB ingestion frequently occurs at the ileum. Fishbones are often ingested by older population, and only a small number of patients can recall an event of swallowing an FB. Here, we present a case of ileal perforation caused by ingesting a fishbone in a 60-year-old man who recovered successfully after receiving emergency surgical treatment.

S2716 CMV in IBD: An Innocent Bystander, or Active Pathogen?

Introduction: Ulcerative Colitis (UC) is a gastrointestinal inflammatory disease that affects over 6 million people worldwide. Clinical manifestations of UC such as bloody diarrhea and abdominal pain can often mimic an infectious colitis, such as cytomegalovirus (CMV) colitis. Often a silent infection, CMV has a worldwide seroprevalence of 83%. We present an interesting case of a UC patient with biopsy positive CMV colitis, who symptomatically improved on steroids and mesalamine alone. Case Description/Methods: A 66 year old African American female with a history of well-controlled UC was evaluated for acute onset bloody diarrhea and abdominal pain. Following negative stool studies for infection, the patient underwent colonoscopic evaluation. Preliminary imaging and results demonstrated a left-sided UC flare extending from the rectum to the splenic flexure. The patient was started on pulse dose steroids with instructions to taper as an outpatient and experienced resolution of symptoms. Biopsy revealed CMV with subsequent serologic testing showing a CMV viral load of < 390 cpy/mL, IgM level of 45.4 AU/mL and negative IgG levels. Interestingly, the patient's acute gastrointestinal symptoms resolved with glucocorticoid treatment. Discussion: CMV reactivation is common in patients with moderate to severe UC. Symptoms of diarrhea, bloody stool, abdominal pain and complications such as megacolon, fulminant colitis and perforation often overlap in both CMV and UC. Endoscopic evaluation can provide a more definitive means of differentiating CMV colitis from an acute exacerbation of UC, however, may not be able to be quickly performed before complications arise. There has been much debate on the role of CMV in UC and whether it is an active pathogen contributing to the inflammatory state or simply a surrogate marker for disease severity. Multiple studies have demonstrated an association of CMV antigenemia with endoscopically significant severe UC. In such patients, after detection of CMV in the colon with biopsy, treatment with antiviral therapy and withdrawal of immunosuppressive agents would be expected to induce clinical response. Continuation of immunosuppressive therapies was associated with adverse events such as fulminant colitis and colectomy. (Figure) Differentiating an active CMV infection versus a UC flare can be challenging given the wide overlap of symptoms. Colonoscopic evaluation is important in supplementing a diagnosis with histopathological confirmation of CMV and can help guide treatment.Figure 1.: Inflammation characterized by friability, loss of vascularity, mucous, pseudopolyps and deep ulcerations was found in a continuous and circumferential pattern in the terminal ileum (1,2), hepatic flexure (3), transverse colon (4,5,6), descending colon (7,8), sigmoid colon (9,10,11), and rectum (12,13,14). This was graded as Mayo Score 3 (severe, with spontaneous bleeding, ulcerations).

Neurological Manifestations of Acute Porphyrias.

Porphyrias constitute a group of rare metabolic disorders that result in a deficiency of the heme biosynthetic pathway and lead to the accumulation of metabolic intermediaries. Patients with porphyria can experience recurrent neurovisceral attacks which are characterized by neuropathic abdominal pain and acute gastrointestinal symptoms, including nausea, vomiting, and constipation. Depending on the type of porphyria, patients can present with cutaneous manifestations, such as severe skin photosensitivity, chronic hemolysis, or evidence of neurologic dysfunction, including alterations in consciousness, neurovascular involvement, seizures, transient sensor-motor symptoms, polyneuropathy, and behavioral abnormalities. More recently, cases of posterior reversible encephalopathy syndrome, cerebral vasoconstriction, and acute flaccid paralysis have also been described. While the exact pathogenic mechanisms linking the accumulation of abnormal heme biosynthetic intermediaries to neurologic manifestations have not been completely elucidated, it has been proposed that these manifestations are more common than previously thought and can result in permanent neurologic injury. This article reviews the basic principles of heme synthesis as well as the pathogenic mechanism of disease, presentation, and treatment of acute hepatic porphyrias with emphasis on those with neurologic manifestations.

MULTIPLE LIVER AND SPLENIC ABSCESSES AS AN EARLY COMPLICATION AFTER COVID-19 INFECTION: CASE REPORT AND REVIEW OF LITERATURE

COVID-19 is a major health problem affects millions of people worldwide. The effect of COVID-19 infection is not only related to the cardiopulmonary insult, but rather affecting every system in the body. Many publications have reported common hepatosplenic insult during COVID-19 infection. Here we describe a case ofmultiple liver and splenic abscesses post corona virus infection in a healthy 13-years old girl, highlighting the possible explanations of her condition in the context of literature review. Background:Coronavirus disease 2019 (COVID-19) has been considered overwhelming heath crisis with reported death over 6 million people till now and over half billion confirmed cases according to WHO dashboard (1). This raises a concern that this virus might have the capability of attacking not only the respiratory system but also almost every single organ system. Patients with the virus have presented with features of acute liver injury, gastrointestinal symptoms, endocrine problems, neurological damage, and cardiovascular disease, most of them recover completely with no sequalae, and others develop short- and long-termSide effects(2,3). Recent research on COVID-19 have shown a high incidence of liver injury ranging from 14.8 to 53%, mainly indicated by elevated liver enzymes levels accompanied by slightly elevated bilirubin levels. The proportion of patients who develop liver injury in severe COVID-19 seems to be higher than in mild cases(4). SARS-CoV-2 uses angiotensin-converting enzyme 2 (ACE2) as its entry receptor, which is expressed in liver and bile duct cells (5,6), suggesting direct liver injury in patients with COVID-19.In contrary, isolated splenic affection usually passed unnoticed unless splenicthrombosis or infarction with superadded abscess formation occurred (7). Here we describe apostcovid multiple hepatic and splenic abscesses without previous abnormalities shortly after COVID-19 infection in otherwise healthy 13 -years girl.

Large outbreak of Jimsonweed (Datura stramonium) poisoning due to consumption of contaminated humanitarian relief food: Uganda, March\u2013April 2019

BackgroundJimsonweed (Datura stramonium) contains toxic alkaloids that cause gastrointestinal and central nervous system symptoms when ingested. This can be lethal at high doses. The plant may grow together with leguminous crops, mixing with them during harvesting. On 13 March 2019, more than 200 case-patients were admitted to multiple health centres for acute gastrointestinal and neurologic symptoms. We investigated to determine the cause and magnitude of the outbreak and recommended evidence-based control and prevention measures.MethodsWe defined a suspected case as sudden onset of confusion, dizziness, convulsions, hallucinations, diarrhoea, or vomiting with no other medically plausible explanations in a resident of Napak or Amudat District from 1 March—30 April 2019. We reviewed medical records and canvassed all villages of the eight affected subcounties to identify cases. In a retrospective cohort study conducted in 17 villages that reported the earliest cases, we interviewed 211 residents about dietary history during 11–15 March. We used modified Poisson regression to assess suspected food exposures. Food samples underwent chemical (heavy metals, chemical contaminants, and toxins), proteomic, DNA, and microbiological testing in one national and three international laboratories.ResultsWe identified 293 suspected cases; five (1.7%) died. Symptoms included confusion (62%), dizziness (38%), diarrhoea (22%), nausea/vomiting (18%), convulsions (12%), and hallucinations (8%). The outbreak started on 12 March, 2–12 h after Batch X of fortified corn-soy blend (CSB +) was distributed. In the retrospective cohort study, 66% of 134 persons who ate CSB + , compared with 2.2% of 75 who did not developed illness (RRadj = 22, 95% CI = 6.0–81). Samples of Batch X distributed 11–15 March contained 14 tropane alkaloids, including atropine (25-50 ppm) and scopolamine (1-10 ppm). Proteins of Solanaceae seeds and Jimsonweed DNA were identified. No other significant laboratory findings were observed.ConclusionThis was the largest documented outbreak caused by food contamination with tropane alkaloids. Implicated food was immediately withdrawn. Routine food safety and quality checks could prevent future outbreaks.