Chronic Weight Loss Research Articles

Homeopathic and biotherapeutic therapies improve chronic arthritis and production rates in dairy goats displaying small ruminant lentiviruses

Small ruminant lentiviruses (SRLV) are chronic and progressive diseases that compromise production, health and animal welfare. Due to the lack of cure, vaccines or any effective treatments against SRLV, homeopathy emerges as a low-cost and residue-free approach. This study sought to evaluate the effect of two homeopathic interventions following a triple-blind, placebo-controlled protocol to treat goats displaying SRLV. A total of 42 adult Saanen goats (4.6 ± 1.3 years old; 2.6 ± 0.2 body condition score [BCS]; 59.5 ± 8.7 kg) with chronic arthritis and weight loss were included in this study after infection confirmation by PCR and seropositivity by Western Blot to SRLV. The following experimental groups were organized: SRLV living nosode (Gnosode; n=14), Homeopathic (Ghomeopathic; n=14) and Placebo (Gplacebo; n=14). Treatments were administered daily, orally, for 90 days. Every month, all goats underwent a clinical examination, joint ultrasound and collection of production indices. There was a treatment effect (p≤0.05) for productive (BCS and live weight) and clinical indices (clinical articular index, crepitation and width indices). Gnosode and Ghomeopathic showed a greater BCS when compared to Gplacebo (2.7±0.3 = 2.8±0.4 ≠ 2.5±0.3). Ghomeopathic had a greater live weight compared to Gplacebo, even though equal to Gnosode (62.4±11.2 ≠ 57.2±9.5 = 60.4±9.8 kg). In clinical evaluations, Gnosode obtained lower carpal joint indices when compared to Gplacebo, even though equal to Ghomeopathic (8.2±1.7 ≠ 8.7±1.0 = 8.5±1.4 cm). There was also an improvement (p≤0.05) for joint ultrasound indices (sagittal and transverse section of the carpus, distance from the joint capsule to the subchondral space, area and lesion perimeter). Such indices obtained lower values in both treated groups (Gnosode and Ghomeopathic) when compared to Gplacebo as highlighted for the distance from the joint capsule to the subchondral space (6.9±3.3 = 7.6±3.4 ≠ 10.8±4.4 mm), area (137.5±84.4 = 157.9±89.1 ≠ 235.0±90.1 mm) and joint lesion perimeter (81.8±18.8 = 85.7±17.6 ≠ 101.5±15.9 mm). Comparing the joint lesion area from D0 to D90, there was a reduction by more than 50% in both treated groups with an increase of 37.2% in Gplacebo. In conclusion, Gnosode and Ghomeopathic demonstrated promising outcomes improving arthritic lesions and production rates. Therefore, both medicines, can be safely used in goats infected with SRLV displaying chronic arthritis and weight loss.

BN SO39 - Laparoscopic Release of Median Arcuate Ligament Syndrome: A Case Series

Abstract Background Median arcuate ligament syndrome (MALS) is a recognized, but rare condition, which is characterized by compression of the celiac artery and ganglion by median arcuate ligament. The entity often presented with chronic post-prandial abdominal pain, vomiting, and weight loss. These patients often undergo comprehensive investigation prior to diagnosis of MALS. This report presents our experience and short-term outcomes of patients with laparoscopic release of MALS at our center. Method Between 2022-2024, five patients with MALS underwent laparoscopic release at a tertiary HPB center under a single surgeon (TS). Data on patient demographics, presenting symptoms and duration, preoperative diagnostic tests, intraoperative findings and complications, postoperative complications, symptom recurrence and follow-up were prospectively maintained. All patients were discussed at a tertiary Vascular and HPB MDT; MALS was confirmed on US doppler (USD) and CT angiogram (CTA) (fish-hook type configuration of Celiac Truck with post-stenotic dilatation). Results Two male and three female patients, with a median (range) age of 41 (25-70) years, underwent laparoscopic MALS release. The median (range) preoperative symptom duration was 54 (24-67) months, with most common presentation of post-prandial abdominal pain and weight loss. The median (range) BMI was 19.61 (18.30-17.82). The median (range) operative time was 313 (166-330) minutes. One patient required conversion to open due to bleeding from celiac trunk. The median (range) LOS was 7 (4-7) days. No postoperative complications occurred. The median follow-up was 10 months. One patient re-experienced abdominal pain, with no evidence of recurrence on USD and CTA. Conclusion Median Arcuate Ligament Syndrome should be considered as a differential in patients presenting with chronic post-prandial abdominal pain and weight loss. Thorough investigation (USD and CTA) along with discussion at Vascular MDT should be undertaken. Laparoscopic release of MALS is a safe and effective treatment option in this cohort.

Exploring the Diagnostic Challenges of Pseudotumoral Peritoneal Tuberculosis That Mimics Advanced Ovarian Cancer in Women: The Role of Laparoscopy in a Case Study

This case involves a 63-year-old multiparous woman with no significant medical history and no known exposure to tuberculosis. She presented with chronic abdominal pain and weight loss, anorexia, and subjective fevers. During the clinical examination, the patient was found to have ascites, bilateral pleural effusion, fever, and a general deterioration in her condition. Blood tests revealed normochromic normocytic anemia. The C-reactive protein was elevated, and the erythrocyte sedimentation rate was accelerated. Ferritin levels were raised. Her blood sugar, hepatic and renal functions were normals. The electrolyte panel showed no abnormalities. Serologies for hepatitis B, C, and HIV were negative, and the immunological profile was normal. The ascitic tap yielded a citrine-yellow fluid, and the cytochemical analysis indicated that the ascites were exudative. Analysis of the ascitic fluid revealed that the DNA test for Mycobacterium tuberculosis was negative, but the adenosine deaminase (ADA) level was elevated. Additionally, the CA125 level was significantly elevated, exceeding 600 UI/ml. A pelvic ultrasound identified a cystic pelvic mass with thick septations but without any solid tissue component, measuring 92x69 mm. The complementary CT (Computed Tomography) scan revealed enlarged ovaries, heterogeneous on the left, associated with a moderately abundant peritoneal effusion. The laparoscopic exploration revealed inflammatory peritoneal nodules, parietal adhesions, and serous ascites. Anatomopathology confirmed peritoneal tuberculosis. The peritoneal form, particularly in its pseudotumoral manifestation, can mimic ovarian cancer. Definitive diagnosis often requires invasive procedures.

Successful management of megaoesophagus associated with hypothyroidism in a dog: A case report

A seven-year-old male Dachshund was presented with a history of chronic regurgitation and weight loss for two months. On clinical examination, dry and rough hair coat with alopecia on nose bridge and rat tail appearance were observed. Elevated rectal temperature and increased respiratory rate were noticed. Auscultation of lung field revealed mild crackles. Leucocytosis and mild anaemia were evident on complete blood count. Hypercholesterolaemia, hypertriglyceridaemia and elevation of Lactate dehydrogenase (LDH) and Alkaline phosphatase (ALP) were observed in serum biochemistry. The total T4 (TT4) value was low and canine-specific thyroid stimulating hormone (cTSH) was elevated. Megaoesophagus was confirmed by plain radiography. Barium contrast radiograph revealed generalised dilatation with pooling of barium in the oesophagus. The animal was treated with levothyroxine sodium at 0.02 mg/kg BW PO BID and bethanechol at 10 mg PO TID. Supportive therapy included antibiotics, antacids and antiemetics. Elevated feeding was advised. The animal had no episodes of regurgitation even after one month Keywords: Megaoesophagus, hypothyroidism, bethanechol, elevated feeding

Eurytrematosis: An emerging parasitosis in cattle from Northeast Argentina

This study was carried out in the northwest region of Misiones Province, Argentina, focusing on the clinical, pathological, epidemiological, and parasitological aspects of Eurytrema spp. in cattle. Clinical monitoring of five cattle cases exhibiting chronic weight loss revealed that affected animals had enlarged pancreases, with severe fibrosis and presence of Eurytrema coelomaticum in the pancreatic ducts. Histopathological analysis confirmed severe fibrosing periductal lymphoplasmacytic interstitial pancreatitis with intralesional trematodes. A cross-sectional epidemiological study was conducted from June 2018 to May 2021, involving 44 farms and 718 fecal samples. Coproparasitological analysis revealed a within-farm prevalence of 70.7 %, with an animal-level prevalence of 37.5 %. A multivariable generalized linear model identified the abundance of snails, the limited availability of monthly veterinary assistance, and loss of body condition as significant risk factors for Eurytrema sp. prevalence. Spatial analysis detected three significant clusters with varying prevalence levels, highlighting areas of high and low parasite occurrence. This study represents the first detailed investigation of Eurytrema sp. in Argentina, confirming its endemic presence in the central-northern region of Misiones Province. The findings underscore the need for further research to evaluate the parasite's spread across the province and its potential impact on livestock production.

Very Rare Case of Pulmonary Lepidic Adenocarcinoma at a Young Age Man

Introduction: Lung cancer remains one of the higher prevalence of cancer and leading cause of death in the world. Smoking and genetic factors are two important etiologies in lung cancer. Adenocarcinoma is the most common type of non-small cell lung carcinoma. Lepidic predominant adenocarcinoma is one type of adenocarcinoma that has a good prognosis. Case Illustration: A 24-year-old male came with chronic cough and chest pain. He had a history of smoking and no prior family history of cancer. Plain chest Xray and Thorax computed tomography (CT) showed pleural effusion and presence of lung mass with suggestion of bone and liver involvement, respectively. The cytology from pleural effusion and bronchial lavage initially found no malignancy cell. Later thoracostomy biopsy and pathology study suggested lepidic adenocarcinoma. Discussion: Lung cancer is still one of the leading causes of death in men. Even though rarely found in young male, patients with a history of smoking or genetic factor with clinical manifestation suggestive chronic respiratory condition with weight loss should be suspected of the diagnosis. Adenocarcinoma, as the most common non-small cell lung carcinoma, could be later divided into several subtypes. Lepidic adenocarcinoma is distinguished by the pathology finding of a large invasion focus of stromal, lymphatic, vascular, or pleural space. Considered one of the most favorable, lepidic predominant adenocarcinoma has a very high rate of 5 year survival when diagnosed early and responds well to lobe resection. Advanced state however has poor outcome due to limited choice of therapy. Promising trial of targeted chemotherapy have been reported and could improve outcome in the future. Conclusion: Lung cancer in young male is a rare disease but should be suspected in those with chronic cough, chest pain and weight loss. The history of smoking and family history are crucial for this suspicion. Lepidic predominant adenocarcinoma has a good prognosis when diagnosed early. Studies in the future could enhance overall survival in these patients.

Yoyo Dieting, Post-Obesity Weight Loss, and Their Relationship with Gut Health.

Excessive body weight is associated with many chronic metabolic diseases and weight loss, so far, remains the gold standard treatment. However, despite tremendous efforts exploring optimal treatments for obesity, many individuals find losing weight and maintaining a healthy body weight difficult. Weight loss is often not sustainable resulting in weight regain and subsequent efforts to lose weight. This cyclic pattern of weight loss and regain is termed "yoyo dieting" and predisposes individuals to obesity and metabolic comorbidities. How yoyo dieting might worsen obesity complications during the weight recurrence phase remains unclear. In particular, there is limited data on the role of the gut microbiome in yoyo dieting. Gut health distress, especially gut inflammation and microbiome perturbation, is strongly associated with metabolic dysfunction and disturbance of energy homeostasis in obesity. In this review, we summarise current evidence of the crosstalk between the gastrointestinal system and energy balance, and the effects of yoyo dieting on gut inflammation and gut microbiota reshaping. Finally, we focus on the potential effects of post-dieting weight loss in improving gut health and identify current knowledge gaps within the field, including gut-derived peptide hormones and their potential suitability as targets to combat weight regain, and how yoyo dieting and associated changes in the microbiome affect the gut barrier and the enteric nervous system, which largely remain to be determined.

Acute and Chronic Weight-Making Practice in Professional Mixed Martial Arts Athletes: An Analysis of 33 Athletes Across 80 Fights.

Mixed martial arts' popularity has increased in recent years, alongside descriptive research and evidence-based performance recommendations. Guidelines for (both chronic and acute) weight making exist; however, how these translate in real-life scenarios and detailed investigations on practices in larger groups deserve attention. The present study examined the body mass (BM) and composition of 33 professional mixed martial arts athletes preparing for 80 fights. Athletes were supported by on-site dietitians, who encouraged evidence-based practices. Fasted BM was measured throughout the last ∼10days before all bouts (acute weight management phase). A subset of athletes had body composition assessed before and after the chronic weight loss phase for 40 fights. Most athletes engaged in chronic BM loss, and all engaged in acute weight loss. Many lost fat-free mass (FFM) during the chronic phase, with rates of BM loss <0.5% best preserving FFM. Regardless of losses, the present athletes possessed greater FFM than other combat sport athletes and engaged in greater acute weight loss. Dehydration in the 24-48hr before the weigh-in was not reflective of weight regain after the weigh-in, rather BM 7-10days before the weigh-in was most reflective. These findings suggest that many mixed martial arts athletes could increase FFM at the time of competition by maintaining leaner physiques outside of competition and/or allowing increased time to reduce BM chronically. Acutely, athletes can utilize evidence-based protocols, eliminating carbohydrates, fiber, sodium, and finally fluid in a staged approach, before the weigh-in, reducing the amount of sweating required, thus theoretically better protecting health and preserving performance.

Strongyloides Hyperinfection Syndrome and Severe Malnutrition in an Immunocompetent Patient

Aims: Strongyloides Hyperinfection Syndrome (SHS) and disseminated Strongyloidiasis have been extensively reported in immunocompromised patients. In SHS, large parasitic loads of larvae cause symptoms mainly limited to the gastrointestinal tract and lung, whereas in the disseminated form multiple organs can be affected with high mortality if inappropriately treated. Case Presentation: Here we present an unusual case of a 28-year-old (HIV negative) patient with confirmed untreated Helicobacter pylori, symptoms of gastric and pulmonary hyperinfection complicated with severe weight loss, respiratory symptoms with hemoptysis and refeeding syndrome. Discussion: The diagnosis was based on histological confirmation of the parasite in the gastric mucosal biopsy and stool analysis. The patient was successfully treated with ivermectin and discharged in reasonable medical conditions. Conclusion: This case illustrates the importance of considering Strongyloides Hyperinfection in immunocompetent patients presenting with chronic vomiting, weight loss and anemia, especially in developmental countries.

Evaluation of Acute Terminal Ileitis in Hospitalized Patients: Development of a Predictive Model to Distinguish Crohn's Disease from Other Etiologies.

Background/Objectives: Terminal ileitis (TI) is often identified on CT scans in emergency settings. Diagnosing Crohn's disease (CD) as a cause of TI is crucial due to its significant long-term implications. This study aimed to differentiate CD from other causes of acute TI and develop a predictive model for CD diagnosis. Methods: A retrospective case-control study was conducted at Shamir Medical Center including adults diagnosed with acute TI from January 2012 to December 2020. Patients with a history of inflammatory bowel disease or prior intestinal surgery were excluded. Patients were categorized into CD and non-CD groups based on their subsequent clinical course. A logistic regression model was developed and subsequently validated with additional patients hospitalized between 2021 and 2023. Results: Among 135 patients, 37 (27.4%) were diagnosed with CD. CD patients were younger (median age 27 vs. 39 years, p = 0.003), predominantly male (83.8% vs. 51%, p = 0.001), and had higher rates of chronic abdominal pain, diarrhea, anemia, and weight loss prior to hospitalization. Significant laboratory differences included higher platelet counts (p = 0.006) and lower mean corpuscular volume (MCV) (p = 0.001) in CD patients. Radiologic signs of complicated disease were more common in CD (35.1% vs. 4.1%, p < 0.001). The predictive model incorporating gender, abdominal pain history, and MCV showed an area under the curve (AUC) of 0.87, with a sensitivity of 100% and specificity of 63.6% in the validation group of 18 patients. Conclusions: This study identified key predictors of CD in patients presenting with acute TI and developed a predictive model with a substantial diagnostic capability. Use of this model for early identification and treatment of CD may potentially improve patient outcomes. Further prospective validation of this model is warranted.

Chronic regurgitation, weight loss, and lethargy in a 3-month-old intact female German Shepherd Dog.

Chronic regurgitation, weight loss, and lethargy in a 3-month-old intact female German Shepherd Dog.

Total magnesium intake and risk of frailty in older women.

An adequate magnesium intake might lower the risk of frailty through its role in muscle function. We analysed data from 81524 women aged ≥60years participating in the Nurses' Health Study. Total magnesium intake was obtained from repeated food frequency questionnaires administered between 1984 and 2010 and self-reported information on supplementation. Frailty was defined as having at least three of the following five FRAIL scale criteria: fatigue, low strength, reduced aerobic capacity, having ≥5 chronic illnesses and weight loss≥5%. The occurrence of frailty was assessed every 4years from 1992 to 2018. Cox proportional hazards models adjusted for lifestyle factors, medication use and dietary factors were used to assess the association between magnesium intake and frailty. During a median follow-up of 16years, we identified 15477 incident cases of frailty. Women with a higher intake of total energy-adjusted magnesium had a decreased risk of frailty after adjustment for lifestyle factors, medication use and dietary factors. The relative risk (95% confidence interval) for Quintile 5 (Q5) versus Quintile 1 (Q1) was 0.88 (0.82, 0.94) (P-trend<0.001). When only energy-adjusted magnesium from the diet was considered, the inverse association was stronger (Q5 vs. Q1: 0.68 [0.56, 0.82]; P-trend<0.001). Those reaching the recommended daily allowance (RDA) of magnesium through diet had a 14% (9%, 19%) lower risk of frailty compared with those not meeting the RDA. Increased intake of foods rich in magnesium was associated with a decreased risk of frailty.

Oesophageal adenocarcinoma presenting as a foreign body induced intrathoracic abscess in a dog

AbstractA 9‐year‐old, male, entire Irish setter was referred for further investigation of a chronic cough, anorexia, weight loss and lethargy. Computed tomography revealed a large ovoid encapsulated lesion, with a gas and fluid attenuating centre, and an intralesional mineral opacity. The lesion ran close to the caudal oesophagus, and extended cranially within the pulmonary parenchyma. Endoscopy revealed a communication between the lumen of the distal oesophagus and the lesion, which contained a purulent discharge and plant material. Based on the computed tomography and endoscopic findings, the diagnosis was expected to be a thoracic abscess, secondary to foreign body migration or penetration; however, surgical resection and histopathological analysis of the lesion revealed an oesophageal adenocarcinoma. This case details the unusual presentation of an oesophageal adenocarcinoma, with endoscopic and computed tomography findings that mimicked a thoracic abscess with an intralesional foreign body.

Lymphocytic Colitis With Enterocolic Lymphocytic Phlebitis

ABSTRACT Enterocolic lymphocytic phlebitis is a rare lymphocytic vasculitis afflicting the gastrointestinal veins without involving the arterial system. Lymphocytic colitis is a more common pathology described as lymphocytic inflammation of the colonic epithelium. Concurrence of both these pathologies is extremely rare. We describe a 53-year-old man presenting with chronic watery diarrhea, abdominal pain, and weight loss. Colonoscopic examination revealed normal-appearing mucosa, but biopsy findings revealed lymphocytic colitis with coexisting enterocolic lymphocytic phlebitis. The patient was started on oral budesonide and responded to the treatment with symptomatic and histopathological resolution.

Exploring the Triad of Thyroid Dysfunction, Chronic Diarrhea and Anemia

Hyperthyroidism, a disorder characterized by excessive thyroid hormone production, typically presents with many symptoms including weight loss, tremors, and heat intolerance. However, in rare instances, it can manifest solely as chronic diarrhea, posing a diagnostic challenge. This case study aims to highlight an unusual presentation of hyperthyroidism and underscore the importance of considering thyroid disease in the differential diagnosis of chronic gastrointestinal symptoms. We present the case of a fifty-year-old woman who, six months prior to her ER visit, had been experiencing severe weight loss and diarrhea along with anemia. Despite her lack of typical hyperthyroidism symptoms, a thorough investigation revealed that hyperthyroidism was the underlying cause of her gastrointestinal issues. This case illustrates that hyperthyroidism can present atypically, solely as chronic diarrhea. The patient&amp;apos;s anemia was linked to iron deficiency, worsened by chronic gastrointestinal loss and the hyper metabolic state induced by hyperthyroidism. Treatment of the hyperthyroidism led to significant improvement in her gastrointestinal symptoms and correction of the anemia. This case underscores the critical need to include thyroid disease in the differential diagnosis for patients with chronic diarrhea and weight loss, even in the absence of typical hyperthyroid symptoms. Early recognition and appropriate management of hyperthyroidism can significantly improve patient outcomes by alleviating gastrointestinal manifestations and correcting associated anemia. Clinicians should maintain a high index of suspicion for thyroid dysfunction in patients presenting with unexplained chronic diarrhea and weight loss to ensure timely and accurate diagnosis and treatment.

Association between inflammatory bowel disease and primary sclerosing cholangitis: Insights from bibliometric analysis.

Crohn's disease and ulcerative colitis are forms of inflammatory bowel disease affecting approximately 1% of the population. Their typical features include chronic diarrhea, abdominal pain, and weight loss. Extraintestinal manifestations may coincide with or precede the diagnosis of these diseases. Primary sclerosing cholangitis is one such extraintestinal manifestation. Although many papers on this field have been published, bibliometric analysis still needs to be conducted. This article summarizes the current research progress through a bibliometric study, provides an overview of the research status in this field, and analyzes recent research trends. Publications on inflammatory bowel disease and primary sclerosing cholangitis from January 1, 2008, to August 31, 2023, were extracted from the Web of Science Core Collection. VOSviewer and CiteSpace were used to perform a bibliometric and visual study. There are 1499 relevant articles, and the number of articles in this field has been relatively stable in recent years. The results indicate that Karlson TH from the University of Oslo has the highest cumulative number of publications. The institution with the highest publication output is the Mayo Clinic, and the United States leads in article production, occupying a dominant position. Keyword analysis reveals 4079 keywords, with primary sclerosing cholangitis, inflammatory bowel disease, and ulcerative colitis being the most frequently occurring keywords. Research on the association between inflammatory bowel disease and primary sclerosing cholangitis is steadily advancing, with the United States leading in publication output globally. China needs to invest more in research in this area, and collaboration among institutions should be strengthened. The research hotspots revolve around the association between inflammatory bowel disease and primary sclerosing cholangitis, gut microbiota, and other fields.

Linfoma alimentar de pequenas células em felinos

Alimentary lymphoma (AL) is the most prevalent hematopoietic tumor in geriatric felines, with three different histological grades: low, intermediate and high, with low grade being predominant. Environmental and infectious factors, such as feline immunodeficiency virus (FIV), feline leukemia virus (FeLV), tobacco smoke, and inadequate diets, increase the risk of this neoplasia. Common clinical manifestations include chronic vomiting, anorexia, diarrhea, and progressive weight loss. Diagnosis is primarily through intestinal biopsy and should be conducted early to allow for treatment with prednisolone and chlorambucil, providing good quality of life and longevity for affected felines. The prognosis for small-cell AL is reserved, with an average survival of 18 months and a high remission rate when treated effectively.

“Horrible—But Worth It”: Exploring Weight Cutting Practices, Eating Behaviors, and Experiences of Competitive Female Taekwon-Do Athletes. A Mixed Methods Study

This mixed methods study aimed to investigate weight cutting practices of female taekwon-do athletes internationally and explore their experiences of “making weight.” A survey of weight loss practices and eating behaviors was completed by 103 taekwon-do athletes from 12 countries, which illustrated that 72.5% of athletes engage in both acute and chronic weight loss practices prior to competition and that there were higher levels of disordered eating within this athletic population than nonweight cutting athletes. Semistructured interviews were conducted with five international-level competitors; thematic analysis of the interviews identified that the women in general felt weight cutting was “horrible—but worth it” and the women believed that (a) weight cutting is unpleasant, difficult, and challenging; and (b) weight cutting provides a competitive advantage. The implications of this study are that weight cutting is widespread among high-level competitive female taekwon-do athletes and this is unlikely to change given the perceived advantages. Efforts are needed to make sure that the women are knowledgeable of the risks and are provided with safe and effective means of making weight.

A74 A RARE CASE OF ANTIDEPRESSANT-INDUCED LYMPHOCYTIC COLITIS IN A TEENAGER

Abstract Background The etiopathogenesis of microscopic colitis may reflect an immunological reaction in genetically predisposed individuals exposed to an external stimulus causing gut microbiota disruption. Numerous factors such as smoking, autoimmune diseases, and medications have been linked to this condition in adults. Steroids may be required as therapy. Pediatric cases of microscopic colitis have only rarely been reported. Aims Case report. Methods Retrospective single chart review and literature review of microscopic colitis in children. Results A 17-year-old female newly diagnosed with major depression disorder following intentional acetaminophen intoxication was started on sertraline, a selective serotonin reuptake inhibitor (SSRI). Within 2 months from initiation, she began to have non bloody watery diarrhea and had a 5 kg weight loss over a 1-month period . Her laboratory workup only revealed a hypochromic, microcytic anemia. Due to severity of symptoms and reluctance of treating team to discontinue sertraline, she underwent an esophagogastroduodenoscopy and ileo-colonoscopy, both showing grossly normal mucosa. Histological assessment of the colon demonstrated increased intraepithelial lymphocytes, up to 50-60 lymphocytes/100 enterocytes (normal ≤ 20 lymphocytes/100 enterocytes), with associated reactive superficial epithelial changes including goblet cell and mucin depletion, compatible with lymphocytic colitis (Figure1). Sertraline was weaned off, and gastrointestinal symptoms resolved completely. A repeat sigmoidoscopy 5 months later confirmed complete normalization of the histology. Conclusions Microscopic Colitis encompasses two disorders, lymphocytic colitis and collagenous colitis, in which the endoscopic appearance is unremarkable, but histological changes are diagnostic. The clinical manifestations of both are similar and typically include chronic non bloody watery diarrhea, weight loss and abdominal pain. Certain medications have been implicated in causing lymphocytic colitis, including SSRIs. SSRIs historically have not been frequently prescribed in pediatrics, but their use has increased in recent years. The complete resolution of symptoms and histology, without the need for any medical therapy, strongly supports that this lymphocytic colitis was caused by sertraline. The association of lymphocytic colitis with sertraline is not well-known among pediatric practitioners: neither the pediatrician nor psychiatrist in our case were aware of such a possibility. This case highlights that medication adverse events, even if rare, should always be considered when chronology is supportive, and at times, simple discontinuation of the drug is sufficient to completely resolve the issue. Funding Agencies None

Immunohistochemical Examination of TNF-α and SAA Expressions in Goats Infected with Mycobacterium avium subspecies paratuberculosis

Paratuberculosis (Johne Disease), caused by Mycobacterium avium subspecies paratuberculosis (MAP) and commonly seen in ruminants, is a contagious disease that causes chronic diarrhea and serious economic losses. In this study, the presence of pro-inflammatory cytokine and acute phase protein expressions in lesional tissues of naturally infected goats with MAP was investigated. For this purpose, paratuberculosis suspected goats complaining of chronic diarrhea and excessive weight loss were examined by ELISA method for Mycobacterium avium subspecies paratuberculosis infection. After sacrificing 20 animals found to be infected with MAP, tissue samples taken from the intestines and lymph nodes were stained with Hematoxylin-Eosin (HE) for histopathological examination and Ziehl-Nelsen (ZN) to show acid-fast mycobacterium. Immunohistochemical staining was performed to examine the expressions of TNF-α as a pro-inflammatory cytokine and SAA as an acute phase protein. Macroscopic examination revealed in serous fat atrophy, mesenteric lymphadenitis, and granulomatous enteritis in the intestines. Histopathological examination revealed atrophy in villi, degeneration of enterocytes, inflammatory cell infiltration consisting mostly of mononuclear leukocytes in the mucosa, and epithelioid macrophage aggregation. Lymphoid hyperplasia and epithelioid histocyst aggregates were found in the mesenterial lymph nodes. In staining with ZN revealed the presence of bright red acid-fast agents in the intestine and mesenteric lymph nodes. In immunohistochemical examination, TNF-α and SAA expressions were observed in all samples. With this study, for the first time, the expressions of TNF-α, a proinflammatory cytokine, and SAA, an acute phase protein, were shown in the lesional tissues of MAP-infected animals, contributing to the immunopathogenesis of the disease.