Persistent Gastrointestinal Symptoms in Human Mpox.

Mpox is a zoonotic disease caused by the double-stranded DNA Mpox virus (MPXV). Little information has been published regarding the gastrointestinal system and MPXV. This case presents a patient with active ileitis and 60 days of functionally limiting diarrhea after confirmation of MPXV. A diagnosis of postinfectious irritable bowel syndrome was made; however, despite a lack of apparent viral shedding on stool polymerase chain reaction, it remains possible that prolonged diarrhea represented direct sequelae from the MPXV disease. This is important from a public health perspective, suggesting that our ability to recommend removal from isolation may need to be reconsidered.

Pearls & Oy-sters: Salt and Pepper Sign, PLNTY for Drug-Resistant Epilepsy.

Drug-resistant epilepsy, defined as the failure of 2 or more antiseizure medications to achieve seizure freedom, is responsible for 2/3 of epilepsy cases. Tumors are responsible for up to 15% of all adult onset and up to 6% of childhood onset epilepsies. Among these tumors, commonly known subtypes DNET, ganglioglioma, and low-grade astrocytoma are often suspected. New advances in tumor classification have been made, with genetics playing a key role in tumor classification. Polymorphic low-grade neuroepithelial tumor of the young (PLNTY) is a highly epileptogenic subtype of tumors that may mimic low-grade gliomas but offer pathologic and genetic clues: oligodendroglioma-like cellular components and infiltration patterns and strong CD34-immunopositive stain. In addition, a key finding is radiologic: a unifocal abnormality best seen on MRI brain in FLAIR sequence as the "salt and pepper sign" and calcifications appreciated on CT head.

Molecular testing for adolescent and young adult central nervous system tumors: A Canadian guideline.

The 2021 World Health Organization (WHO) classification of CNS tumors incorporates molecular signatures with histology and has highlighted differences across pediatric vs adult-type CNS tumors. However, adolescent and young adults (AYA; aged 15-39), can suffer from tumors across this spectrum and is a recognized orphan population that requires multidisciplinary, specialized care, and often through a transition phase. To advocate for a uniform testing strategy in AYAs, pediatric and adult specialists from neuro-oncology, radiation oncology, neuropathology, and neurosurgery helped develop this review and testing framework through the Canadian AYA Neuro-Oncology Consortium. We propose a comprehensive approach to molecular testing in this unique population, based on the recent tumor classification and within the clinical framework of the provincial health care systems in Canada. Contributions to the field: While there are guidelines for testing in adult and pediatric CNS tumor populations, there is no consensus testing for AYA patients whose care occur in both pediatric and adult hospitals. Our review of the literature and guideline adopts a resource-effective and clinically-oriented approach to improve diagnosis and prognostication of brain tumors in the AYA population, as part of a nation-wide initiative to improve care for AYA patients.

Optimizing cecal views during colonoscopy using patient position change.

BACKGROUND: Patient positioning has been found to be a simple technique to improve luminal distention and visualization during colonoscopy. This study examined which position provided the cleanest image of the cecum using the Boston Bowel Prep Scale (BBPS) and the best view of the cecum overall as ranked by blinded assessors. METHODS: A sample of 90 sets of cecal images were obtained from patients undergoing a non-urgent colonoscopy. Each set included cecal images of patients while lying in three positions-right lateral decubitus, left lateral decubitus, and supine. Two authors reviewed these sets of images and excluded those that were unclear. A third author, blinded to the position, selected the final 33 sets of images. Two experienced endoscopists completed a blinded survey of each image set. They used the BBPS to assess and score each image as the primary outcome measure. The endoscopists also ranked each image set in terms of the best overall view of the cecum. Data were collected using Qualtrics software. Nonparametric tests were used to analyze the data using SPSS software (v.25). A p-value of ≤ 0.05 was considered significant. RESULTS: The BBPS showed a significant difference between patient positions when tested by Kruskal-Wallis. Subsequent Mann Whitney U tests indicated that the right lateral decubitus position was ranked higher than left lateral decubitus or supine positions. There was no significant difference in the left and supine positions. Cohen's Kappa suggested moderate agreement between raters. The raters also favored the right lateral position over the other positions when assessing overall image preference displaying the cecum. CONCLUSION: These results indicate that positioning patients in the right lateral decubitus position provides the best view of the cecum during colonoscopy.

Apparent transverse relaxation (R2∗) on MRI as a method to differentiate treatment effect (pseudoprogression) versus progressive disease in chemoradiation for malignant glioma.

INTRODUCTION: Pseudoprogression (psPD) is a transient post-treatment imaging change that is commonly seen when treating glioma with chemotherapy and radiation. The use of apparent transverse relaxation rate (R2∗), which is calculated from a contrast-free multi-echo gradient echo Magnetic Resonance Imaging (MRI) sequence, may allow for quantitative identification of patients with suspected psPD. METHODS: We acquired a multi-echo gradient echo sequence using a 3T-Siemens Prisma MRI. The signal decay through the echoes was fitted to provide the R2∗ coefficient. We segmented the T1 -gadolinium enhancing the image to provide a contrast enhancing lesion (CEL) and the FLAIR hyperintensity to provide a non-enhancing lesion (NEL). These regions of interest were applied to the multi-echo gradient echo to acquire a mean R2∗ within the CEL and NEL. We additionally acquired ADC data to attempt to corroborate our findings. RESULTS: We found that patients who later exhibited PD exhibited a higher R2∗ within the CEL as well as a higher ratio of CEL to NEL. Our data correctly distinguished pseudoprogression from treatment effect in 9/9 patients, while ADC corrected identified 7/9 patients using an absolute ADC of 1200 × 10-6  mm2 /s. CONCLUSIONS: Our method seems promising for the accurate identification of psPD, and the technique is amenable to evaluation in larger, multi-centre patient cohorts.

Development of Myasthenia Gravis in a Patient with Chronic Myeloid Leukemia during Treatment with Nilotinib.

We report on a patient diagnosed with chronic myeloid leukemia (CML) who developed myasthenia gravis while on treatment with nilotinib. Autoimmune disease, including the development of myasthenia gravis, has been described in association with CML as well as the use of tyrosine kinase inhibitors. Second generation tyrosine kinase inhibitors are highly effective in the treatment of CML, although can result in adverse effects related to off-target kinase inhibition, and longer term reporting of adverse effects is required.