The role of the intestinal ultrasound in Crohn's disease diagnosis and monitoring.

Crohn's disease is characterized by persistent or recurrent chronic inflammation that may affect any segment of the gastrointestinal tract. It has an oscillating evolution, with periods of activity alternating with periods of remission. Crohn's disease has a significant impact on the economic status due to its increasing prevalence, often affecting young people. Suitable management for these patients involves frequent evaluations. Even though colonoscopy is the gold standard for the assessment of severity and mucosal healing, it is an invasive maneuver, not easily accepted by patients, and it does not have good repeatability. Intestinal ultrasound has the advantage of being non-irradiating, non-invasive, well-tolerated, cheap, and easy to repeat. Ultrasound parameters such as bowel wall thickness, intestinal wall architecture, intramural vascularisation, proliferation of mesenteric fatty conjunctive tissue, and intraperitoneal fluid can provide good information regarding the severity of the disease, the differentiation between remission and relapse, and its complications. Some of the latest studies show good correlations between ultrasound parameters and inflammation markers (C-reactive protein, fecal calprotectin) and clinical severity scores of Crohn's disease. Consequently, the importance of intestinal ultrasound has increased lately, and recent studies support its use to evaluate the severity of inflammation, differentiate between active disease and relapse, monitor therapy response and guide treatment, evaluate prognosis, and diagnose complications.

Acute esophageal necrosis following kidney transplantation.

We are reporting a case of spontaneous acute esophageal necrosis "black esophagus" of unclear etiology in a kidney transplant recipient. A patient with end-stage renal disease due to IgA nephropathy received a deceased-donor kidney transplant. The surgical procedure was uneventful, without hemodynamic instability. He was started on alemtuzumab for immunosuppression induction followed by maintenance immunosuppression with intravenous methylprednisolone for 3 days, then oral prednisone, mycophenolate mofetil and tacrolimus (a target level between 8 and 10ng/ml) daily. On postoperative day (POD) 3, the patient started to develop significant gastro-intestinal symptoms: epigastric pain, dysphagia, odynophagia, eructation, pyrosis, nausea, and regurgitation of food contents. He was diagnosed with esophageal necrosis by upper endoscopy on postoperative day 4. We describe a successful treatment with supportive therapy and complete recovery despite receiving immunosuppressive therapy. To our knowledge, this case is one of the few reported cases of esophageal necrosis in kidney transplant recipients and the first case that was not associated with clinical risk factors.

Not just eosinophilic fasciitis.

This case report describes a rare case of progressive muscle weakness in a patient treated for eosinophilic fasciitis (EF) for many years before being diagnosed with a second autoimmune disease: dermatomyositis. Our case is a report of a 65-year-old male diagnosed with eosinophilic fasciitis 7 years before being evaluated in our service at Mayo Clinic in Jacksonville, Florida, due to progressive muscle weakness despite the chronic treatment with methotrexate. Contrast-enhanced magnetic resonance imaging of the lower extremity showed enhancement throughout the thigh musculature, which led us to pursue biopsies of the fascia and muscle in order to confirm the diagnosis of EF associated with myopathy. This case illustrates the need to consider the possibility of myopathy in patients diagnosed with EF whenever muscle weakness is more prominent than expected.

Climate Change and Social Campaigns.

The impact of climate change on humanity and nature is increasingly evident. The atmosphere and oceans have warmed, leading to rising sea levels, a sharp drop in Arctic sea ice, floods, heatwaves, and fires. Calls to action are getting stronger. Concerns about climate change have become a full social movement, stimulating climate activism from the bottom up to the world, especially among young people. Campaigns are initiated by governments and international organizations, scientists and scientific institutions, organizations, groups, and people in civil society, public intellectuals and political, religious leaders, people of culture and entertainment. These campaigns generally aim to inform, raise awareness and shape public understanding about the science, problems, and policy of climate change, with the hope that, first of all, people will change their attitudes and behavior, and secondly, will mobilize to put pressure on policymakers for effective climate policies.

Nonalcoholic fatty liver disease: epidemiology, pathogenesis and therapeutic implications.

The increase of the prevalence of nonalcoholic fatty liver disease in the context of the explosive epidemy of obesity worldwide over the last decades and the emergence of new effective therapies for viral hepatitis has brought this entity to the forefront of hepatologist concerns. Today is a certainty that fatty liver can complicate with cirrhosis and hepatocellular carcinoma; moreover, nonalcoholic fatty liver disease is the main cause of cryptogenic cirrhosis and the second cause of liver transplantation. This review revises the epidemiology of the disease, brings forward some progress in pathogenesis and outlines the directions to be followed in nonalcoholic fatty liver disease prevention and therapy. Today, nonalcoholic fatty liver disease is considered to be the liver manifestation of metabolic syndome, with its same prevalence (20-30%). If the patients do not die through cardiovascular disease, it can lead to serious liver complications.