Access to Social Protection by People Living with,at Risk of,or Affected by HIV in Eswatini,Malawi, Tanzania,and Zambia: Results from Population-Based HIV Impact Assessments

AIDS and Behavior - We aimed to measure social protection coverage among the general population, women and men living with HIV (WLHIV, MLHV), female and male sex workers (FSW, MSW), men who have...     

Serum amylase, pancreatic stents, and pancreatitis after sphincter of Oddi manometry

BACKGROUND: Serum amylase levels 2 hours after ERCP predict postprocedure pancreatitis. The value of serum amylase measurements after sphincter of Oddi manometry (SOM) and the effect of pancreatic-duct stent placement on serum amylase are unknown. METHODS: Records were reviewed for 88 SOM patients who had serum amylase measured 2 hours after the procedure. Post-SOM pancreatitis was defined as pain with a >3-fold elevation of serum amylase on the morning after SOM. "Possible pancreatitis" was defined as pain with a <3-fold elevation of serum amylase on the morning after SOM. RESULTS: Post-SOM pancreatitis and possible pancreatitis each occurred in 13% of the study cohort. Post-SOM pancreatitis was associated with the absence of a pancreatic stent and occurred in 0% of patients without a stent who had normal 2-hour serum amylase vs. 67% with elevated 2-hour serum amylase (p < 0.01). Among patients who received a stent, pancreatitis occurred in 6%, regardless of whether the 2-hour serum amylase was elevated. Possible pancreatitis occurred mainly in patients who received stents, and it also was associated with elevation of the 2-hour serum amylase. CONCLUSIONS: Elevation of the serum amylase level 2 hours after SOM predicts post-SOM pancreatitis but only in patients who do not receive a pancreatic stent. Among patients who received a stent, elevated 2-hour serum amylase levels predict subsequent findings that may be caused by attenuated pancreatitis.     

Isospora cholangiopathy: case study with histologic characterization and molecular confirmation

Isospora belli is an intracellular protozoan parasite that causes diarrhea worldwide and is endemic in the tropics. In the United States, it is an uncommon cause of traveler's diarrhea and a relatively rare opportunistic pathogen among the immunocompromised, particularly AIDS patients. Isospora infects the small intestine, where both sexual and asexual replication occur, and oocysts are shed in the stool. Isosporiasis of the gallbladder has also been described in AIDS patients. We report a case of diffuse biliary isosporiasis in a West African man who presented with acute illness and was found to have dilated bile ducts. He had no history of hepatobiliary disease; his HIV status was unknown. Endoscopic retrograde cholangiopancreatography demonstrated markedly abnormal intrahepatic and extrahepatic bile ducts, with radiologic findings reminiscent of primary sclerosing cholangitis. However, common bile duct biopsies revealed Isospora belli, which was confirmed by both electron microscopy and polymerase chain reaction–based molecular analysis.     

Facial growth subsequent to Le Fort I osteotomies in adolescent monkeys

The study goal was to assess qualitatively and quantitatively the craniofacial adaptations following total maxillary osteotomy with and without mandibular autorotation. Six adolescent female Macaca fascicularis monkeys were randomly divided into two surgical groups, and eight others served control. Prior to surgery, metallic implants were inserted in the anterior part of the cranial base, on opposite sides of craniofacial sutures, and in multiple sites of the maxilla and mandible. Group I animals underwent a Le Fort I advancement of 4 mm, while Group II animals had a 5-mm advancement and a 2.5-mm impaction. Lateral cephalometric head-films were taken at monthly intervals for a total follow-up of 12 months after surgery. At least two cephalograms were taken on each occasion, one with the teeth in occlusion and the other with the mouth wide open. The latter was used to ascertain accurately the outline of the mandibular condyle. Cephalometric superimposition methods were used to quantify the growth changes. The findings indicated that the growth changes in the maxilla and mandible were related to the extent of injury caused by maxillary surgery. The largest increments and rates of growth were observed respectively in the control animals, Group I animals (anterior maxillary repositioning), and Group II animals (anterior and superior maxillary repositioning). The most interesting finding was that mandibular growth pattern followed maxillary growth pattern in both experimental groups, and the immediate postsurgical occlusion in Class II molar relationship was maintained with increased overjet in both experimental groups throughout the postsurgical observation period.     

Endoscopic retrograde cholangiopancreatography and endoscopic ultrasound for diagnosis of chronic pancreatitis

The diagnosis of chronic pancreatitis is based on altered pancreatic morphology and function. A spectrum of disease exists, and milder forms of disease may be missed by CT but demonstrated by endoscopic retrograde cholangiopancreatography (ERCP) or endoscopic ultrasound (EUS). The accuracy of ERCP and EUS for diagnosis of “minimal change” or “early” chronic pancreatitis is controversial, particularly when the results from these imaging procedures are discordant with each other or with tests of pancreatic function; in some cases ERCP and EUS should be considered indeterminate for diagnosis. This review discusses recent data concerning the accuracy of ERCP and EUS for diagnosis of chronic pancreatitis, the use of EUS fine-needle aspiration for differential diagnosis of pancreatic masses, and the use of EUS and EUS-guided TruCut biopsy for diagnosis of autoimmune pancreatitis.     

Do consensus indications for resection in branch duct intraductal papillary mucinous neoplasm predict malignancy? A study of 147 patients

BACKGROUND AND AIMS: Recent consensus guidelines suggest that presence of > or =1 of the following is an indication for resection (IR) of branch duct intraductal papillary mucinous neoplasm (IPMN-Br): cyst-related symptoms, main pancreatic duct diameter > or =10 mm, cyst size > or =30 mm, intramural nodules, or cyst fluid cytology suspicious/positive for malignancy. Among a cohort of patients with IPMN-Br we determined if the consensus IR (CIR), presence of multifocal IPMN-Br, or growth of cyst size on follow-up predict malignancy. METHODS: We identified 147 patients with IPMN-Br of whom 66 underwent surgical resection at diagnosis and 81 were followed conservatively, of whom 11 were resected during follow-up. Clinical, imaging, histological, and cyst fluid characteristics from all 147 patients with IPMN-Br were obtained from clinical records and/or by contacting the patients. In all cases, presence of CIR at baseline and during follow-up (N = 66), presence of multifocal cysts (N = 57), and increase in cyst size (N = 38) were noted. RESULTS: Among the 77 resected IPMN-Brs, at initial evaluation 61 had at least one CIR and 16 had none. Malignancy was present in 9/61 (15%) with CIR and 0/16 without IR (P= 0.1). When presence of any one of the CIR was taken as an indicator of malignancy, the CIR had a sensitivity, specificity, positive predictive value, and negative predictive value of 100%, 23%, 14%, and 100%, respectively. Prevalence of malignancy in those with single versus multifocal IPMN-Br was similar (13%vs 11%). No patient has developed malignancy after a median follow-up of 15 months. So far, none of the 38 patients with increase in cyst size on follow-up has developed malignancy related symptoms. CONCLUSIONS: Suggested consensus indications for resection identify all patients with malignancy; however, their specificity is low. In the short term it would be safe to follow patients without these features.