A Rare Case of Signet Ring Cell Colon Cancer Presenting as Adult Colorectal Intussusception.

Signet ring cell carcinoma of the rectum is rare and typically presents with advanced disease. We report a case of a 68-year-old man who presented with left lower quadrant pain and was found to have signet ring cell carcinoma with intussusception. This case is unusual because of its polypoid growth pattern and apparent early pathological stage. We discuss the differential diagnoses and prognosis.

Predictors of Unmet Dental Health Needs in US Adults in 2018: A Cross-Sectional Analysis.

OBJECTIVE: To identify predictors of unmet dental needs for adults 18 y of age or older in the United States. METHOD: Using the Aday and Andersen framework and data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS), we ran logistic regression to estimate predictors for adults of not having a dental visit within 5 y and having lost any teeth using a national sample of 155,060 survey respondents. RESULTS: Results showed that predisposing factors (age, race/ethnicity, gender, and educational attainment) and enabling factors (income and health insurance status) are important predictors for losing teeth due to decay or gum disease. Men, the elderly, and less educated and low-income residents were less likely to have seen a dentist within the past 5 y and more likely to have lost their permanent teeth. Compared to non-Hispanic White adults, Hispanics adults were more likely to have had a dental visit within the past 5 y. Unmet dental needs varied across states. People living in states with extensive Medicaid dental care benefit coverage were less likely to lose their teeth and more likely to have had a dental visit within the past 5 y. CONCLUSION: Efforts to improve oral health should address unmet dental needs of men and adults with low socioeconomic status. Studying the variation between state oral health care programs could further our understanding of how public policy can improve population oral health. KNOWLEDGE TRANSFER STATEMENT: Men, non-Hispanic Blacks, mixed and other race minorities, and low socioeconomic status adults are most at risk of unmet dental needs. States can address these needs by expanding Medicaid coverage for adults.

Spindle Cell Melanoma Presenting as an Ulcer in a Black Diabetic.

Background. Melanoma in blacks is uncommon and exceedingly rare in association with a diabetic ulcer. We present a case of a spindle cell melanoma masquerading as a diabetic ulcer. Case Report. A 57-year-old overweight woman presented to The Maria Holder Diabetes Centre for the Caribbean with a nonhealing ulcer of the right heel after being treated by various primary care physicians over the preceding year. Her general and systematic examinations were unremarkable. There was a 1 × 1.5 cm ulcer with a necrotic base which bled easily on contact with no evidence of peripheral neuropathy nor arterial insufficiency. Microscopic examination of a biopsy of the lesion showed fascicles of spindle cells with plump nuclei and intracytoplasmic yellow-brown pigment. Immunohistochemistry confirmed a diagnosis of melanoma. Discussion. There should be a high index of suspicion of malignancy with nonhealing diabetic ulcer especially when coupled with short disease duration. This case highlights the importance of a biopsy and histological evaluation in ulcers presenting in recently diagnosed diabetics with no evidence of peripheral neuropathy or vascular disease. Melanoma should be considered in spindle cell lesions especially with pigment and residual nevus cells.

Race, Medical Mistrust, and Segregation in Primary Care as Usual Source of Care: Findings from the Exploring Health Disparities in Integrated Communities Study.

Compared to White Americans, African-Americans are less likely to use primary care (PC) as their usual source of care. This is generally attributed to race differences in socioeconomic status and in access to primary care services. Little is known about the relationship between race differences in medical mistrust and the usual source of care disparity. Using data from the Exploring Health Disparities in Integrated Communities (EHDIC) study, we examined the role of medical mistrust in choosing usual source of care in 1408 black and white adults who were exposed to the same healthcare facilities and low-income racially integrated community. Multinomial logistic regression models were estimated to examine the relationship between race, medical mistrust, and usual source of care. After adjusting for demographic and health-related factors, African-Americans were more likely than whites to use the emergency department (ED) (relative risk ratio [RRR] = 1.43 (95 % confidence interval (CI) [1.06-1.94])) and hospital outpatient department (RRR1.50 (95 %CI [1.10-2.05])) versus primary care as a usual source of care. When medical mistrust was added to the model, the gap between African-Americans' and whites' risk of using the ED versus primary care as a usual source of care closed (RRR = 1.29; 95 % CI [0.91-1.83]). However, race differences in the use of the hospital outpatient department remained even after accounting for medical mistrust (RRR = 1.67; 95 % CI [1.16-2.40]). Accounting for medical mistrust eliminated the ED-as-usual-source of care disparity. This study highlights the importance of medical mistrust as an intervention point for decreasing ED use as a usual source of care by low-income, urban African-Americans.

Health insurance and chronic conditions in low-income urban whites.

Little is known about how health insurance contributes to the prevalence of chronic disease in the overlooked population of low-income urban whites. This study uses cross-sectional data on 491 low-income urban non-elderly non-Hispanic whites from the Exploring Health Disparities in Integrated Communities-Southwest Baltimore (EHDIC-SWB) study to examine the relationship between insurance status and chronic conditions (defined as participant report of ever being told by a doctor they had hypertension, diabetes, stroke, heart attack, anxiety or depression, asthma or emphysema, or cancer). In this sample, 45.8 % were uninsured, 28.3 % were publicly insured, and 25.9 % had private insurance. Insured participants had similar odds of having any chronic condition (odds ratios (OR) 1.06; 95 % confidence intervals (CI) 0.70-1.62) compared to uninsured participants. However, those who had public insurance had a higher odds of reporting any chronic condition compared to the privately insured (OR 2.29; 95 % CI 1.21-4.35). In low-income urban areas, the health of whites is not often considered. However, this is a significant population whose reported prevalence of chronic conditions has implications for the Medicaid expansion and the implementation of health insurance exchanges.

High-risk variants of cutaneous squamous cell carcinoma in patients with discoid lupus erythematosus: a case series.

Cutaneous squamous cell carcinoma, the second most common form of non-melanotic skin cancer, may develop in long-standing discoid lesions, especially those that are depigmented and located in sun-exposed areas. The clinical course of this complication may be aggressive, with early metastases and a risk of mortality. We report three cases demonstrating this emerging trend of secondary squamous cell carcinoma in discoid lesions as the incidence of this secondary malignancy in other diseased skin lesions is on the decline.

Acid-shock of Campylobacter jejuni induces flagellar gene expression and host cell invasion.

The bacterial pathogen Campylobacter jejuni is the leading cause of foodborne gastroenteritis in the developed world, with the organism being transmitted by ingestion of contaminated and undercooked poultry. Exposure to acid is an inevitable stressor for C. jejuni during gastric passage, yet the effect of low pH on C. jejuni virulence is still poorly understood. Here, we investigate the effect of acid-shock on C. jejuni viability, gene expression and host-cell invasion. C. jejuni strain NCTC 11168 survived acid exposure at pH 3.5 and above for up to 30 min without a drop in viability, and this exposure induced the expression of flagellar genes transcribed from σ(54)-dependent promoters. Furthermore, acid-shock resulted in increased C. jejuni invasion of m-ICcl2 mouse small intestine crypt cells grown on transwells, but not when the cells were grown on flat-bottomed wells. This suggests that C. jejuni might be invading intestinal epithelial cells at the basolateral side, possibly after paracellular passage. We hypothesize that acid-shock prior to intestinal entry may serve as a signal that primes C. jejuni to express its virulence gene repertoire including flagellar motility genes, but this requires further study in the context of an appropriate colonization or disease model.

Genomics of thermophilic campylobacter species.

The thermophilic Campylobacter species C. jejuni and C. coli are important human pathogens, which are major causes of bacterial gastroenteritis. The recent progress in genomics techniques has allowed for a rapid increase in our knowledge of the molecular biology of Campylobacter species, but needs to be matched by concurrent increases in our understanding of the unique biology of these organisms. Campylobacter species display significant levels of genomic variation via natural transformation, phase variation, plasmid transfer and infection with bacteriophages, and this poses a continuous challenge for studies on pathogenesis, physiology, epidemiology and evolution of Campylobacter. In this chapter we will review the current state of the art of the genomics of thermophilic Campylobacter species, and opportunities where genomics can further contribute to our understanding of the biology of these successful human pathogens.

Leiomyosarcoma of the kidney / El Leiomiosarcoma del riñón

The case of a 42- year old woman with leiomyosarcoma of the kidney, a very rare renal lesion, is presented. Leiomyosarcomas are the most common of the primary renal sarcomas which account for less than 1% of renal tumours in adults.

Se presenta el caso de una mujer de 43 años de edad con un leiomiosarcoma del riñón - una lesión renal muy rara. Los leiomiosarcomas son los más comunes de los sarcomas renales primarios, y representan menos del 1% de los tumores renales en adultos.

Leiomyosarcoma of the kidney.

The case of a 42-year-old woman with leiomyosarcoma of the kidney, a very rare renal lesion, is presented. Leiomyosarcomas are the most common of the primary renal sarcomas which account for less than 1% of renal tumours in adults.

How accurate and reliable are doctors in estimating fracture angulation?

This study assessed the accuracy of doctors in estimating fracture angulation. Radiographs of fractured wrist and forearm of varying angulations were shown to all grades of doctors in the speciality of trauma and orthopaedics. They were asked to estimate the angulation at the fracture site without using a goniometer. The estimates were analysed for accuracy and variability. This study showed that doctors have a mean error of 8-9 degrees and had poor agreement with themselves and others. We recommend the use of a goniometer to assess fracture angulation.

Bilateral epididymal metastases from primary adenocarcinoma of the prostate.

A 65-year-old man diagnosed with adenocarcinoma of the prostate gland opted for hormonal manipulation and had bilateral orchiectomy. Histological evaluation showed tumour deposits in both epididymides. Despite the relatively common occurrence of adenocarcinoma of the prostate, epididymal metastasis is a rare occurrence. This case highlights the need for proper evaluation of the testes and para-testicular structures so that accurate staging of these tumours can be made.

Bilateral epididymal metastases from primary adenocarcinoma of the prostate

A 65-year-old man diagnosed with adenocarcinoma of the prostate gland opted for hormonal manipulation and had bilateral orchiectomy. Histological evaluation showed tumour deposits in both epididymides. Despite the relatively common occurrence of adenocarcinoma of the prostate, epididymal metastasis is a rare occurrence. This case highlights the need for proper evaluation of the testes and para-testicular structures so that accurate staging of these tumours can be made

Hepatic abscesses at the University Hospital of the West Indies. A 24-year autopsy review.

A retrospective review of all hepatic abscesses identified at autopsy over the 24-year period 1977-2000 at the University Hospital of the West Indies (UHWI), Kingston, Jamaica, was conducted. Post mortem and microbiology records were reviewed. Data collected included age, gender, predisposing factors, organisms isolated, number of abscesses and associated conditions, such as diabetes mellitus. Data for the adults was analyzed separately. Thirty-nine cases of pyogenic abscesses were identified from 7480 post-mortems. Thirty-three occurred in adults of mean age 59.5 years. Sixty per cent of the abscesses were solitary. Biliary tract disease was the predisposing factor in 33% of cases. Six per cent were cryptogenic: 11/33 patients were diabetic and these were significantly older than non-diabetics (p < 0.014) Klebsiella pneumoniae was the most common organism isolated from diabetics (6.9). Only 2/33 abscesses were diagnosed ante-mortem. The abscesses in children were more frequently multiple and associated with extra-abdominal infection. Gram positive cocci were the commonly isolated organisms in children. There were no cases of amoebic abscess. The prevalence of hepatic abscess was low. Diabetes mellitus was a significant contributing factor. A high index of clinical suspicion is therefore warranted particularly in elderly diabetics.

Hepatic abscesses at the University Hospital of the West Indies. A 24-year autopsy review

A retrospective review of all hepatic abscesses identified at autopsy over the 24-year period 1977-2000 at the University Hospital of the West Indies (UHWI), Kingston, Jamaica, was conducted. Post mortem and microbiology records were reviewed. Data collected included age, gender, predisposing factors, organisms isolated, number of abscesses and associated conditions, such as diabetes mellitus. Data for the adults was analyzed separately. Thirty-nine cases of pyogenic abscesses were identified from 7480 post-mortems. Thirty-three occurred in adults of mean age 59.5 years. Sixty per cent of the abscesses were solitary. Biliary tract disease was the predisposing factor in 33 of cases. Six per cent were cryptogenic: 11/33 patients were diabetic and these were significantly older than non-diabetics (p < 0.014) Klebsiella pneumoniae was the most common organism isolated from diabetics (6.9). Only 2/33 abscesses were diagnosed ante-mortem. The abscesses in children were more frequently multiple and associated with extra-abdominal infection. Gram positive cocci were the commonly isolated organisms in children. There were no cases of amoebic abscess. The prevalence of hepatic abscess was low. Diabetes mellitus was a significant contributing factor. A high index of clinical suspicion is therefore warranted particularly in elderly diabetics

Exercise-induced muscle "burning," fatigue, and hyper-CKemia: mtDNA T10010C mutation in tRNA(Gly).

A 42-year-old woman presented with myopathy and without a family history of neuromuscular disorder. Muscle biopsy showed ragged red fibers and reduced activities of mitochondrial respiratory chain enzyme complexes I, III, and IV. Analysis of mitochondrial DNA revealed a heteroplasmic T10010C mutation in the transfer RNA glycine gene.

Phage display combinatorial libraries of short peptides: ligand selection for protein purification.

A library of heptapeptides displayed on the surface of filamentous phage M13 was evaluated as a potential source of affinity ligands for the purification of Rhizomucor miehei lipase. Two independent selection (biopanning) protocols were employed: the enzyme was either physically adsorbed on polystyrene or chemically immobilized on small magnetic beads. From screening with the polystyrene-adsorbed lipase it was found that there was a rapid enrichment of the library with "doublet" clones i.e. the phage species which carried two consecutive sequences of heptapeptides, whilst no such clones were observed from the screening using lipase attached to magnetic beads. The binding of the best clones to the enzyme was unambiguously confirmed by ELISA. However the synthetic heptapeptide of identical sequence to the best "monomeric" clone did not act as a satisfactory affinity ligand after immobilization on Sepharose. This indicated that the interaction with lipase was due to both the heptapeptide and the presence of a part of the phage coat protein. This conclusion was further verified by immobilizing the whole phage on the surface of magnetic beads and using the resulting conjugate as an affinity adsorbent. The scope of application of this methodology and the possibility of preparing phage-based affinity materials are briefly discussed.

Enantioselectivity of recombinant Rhizomucor miehei lipase in the ring opening of oxazolin-5(4H)-ones.

Enantioselectivity of enzyme catalysis is often rationalized via active site models. These models are constructed on the basis of comparing the enantiomeric excess of product observed in a series of reactions which are conducted with a range of homologous substrates, typically carrying various side chain substitutions. Surprisingly the practical application of these simple but informative 'pocket size' models has been rarely tested in genetic engineering experiments. In this paper we report the construction, purification and enantioselectivity of two recombinant Rhizomucor miehei lipases which were designed to check the validity of such a model in reactions of ring opening of oxazolin-5(4H)-ones.