Predicting Liver Fibrosis in the Hepatitis C Population: Concordance Analysis Between Noninvasive Scoring Systems and Percutaneous Liver Biopsy.

Background Due to the slow progression of many chronic liver diseases, including hepatitis C, it is not practical or safe to monitor disease progression by serial liver biopsies. Noninvasive laboratory scoring systems based on routine laboratory tests are appealing surrogate markers of liver fibrosis for the staging and monitoring of chronic liver diseases such as hepatitis C. Methods We explored the accuracy of three scoring systems: the fibrosis-4 score (FIB-4), the aspartate aminotransferase to platelet ratio index (APRI score), and the aspartate aminotransferase to alanine aminotransferase ratio (AAR) in 496 patients with chronic hepatitis C virus (HCV) infection who had undergone percutaneous liver biopsy at a viral hepatitis clinic in Shreveport, Louisiana. Results For FIB-4, the area under the receiver operating characteristic curve (AUROC) for hepatic fibrosis stages ≥ 1, ≥ 2, ≥ 3, and 4 (cirrhosis) ranged from 0.74 (95% CI, 0.678 - 0.802) to 0.802 (95% CI, 0.751 - 0.854). At a cutoff value of 1.45, FIB-4 was 82% sensitive for advanced fibrosis or cirrhosis (stage 3 or 4) but was only 58% specific for these findings. Increasing the FIB-4 cutoff value to 3.25 reduced the sensitivity for detecting advanced fibrosis or cirrhosis to 39%, but this higher cutoff was 92% specific for these findings. Corresponding AUROCs for the APRI and AAR scores were inferior to FIB-4. Conclusion The FIB-4 index outperformed APRI and AAR in our HCV infected population in predicting severe fibrosis or cirrhosis.

Primary cutaneous Aspergillus fumigatus infection in immunocompetent host.

Primary cutaneous aspergillosis (PCA) occurs through inoculation of fungal spores directly into the skin from the environment through disrupted skin such as in burns, surgery or penetrating trauma patients. Most cases reported in literature were in the immunocompromised, rarely in immunocompetent patients. The characteristic lesion of cutaneous aspergillosis is a black eschar on a red plaque, or nodule at the site of skin injury. The diagnosis of PCA can be made by identifying hyphal forms on routine H&E staining or special stains such as periodic acid-Schiff or Gomori methenamine-silver stains on skin biopsy and by fungal cultures. We report a case of an 80-year-old farmer who developed cutaneous aspergillosis after a surgical procedure without any systemic spread. The diagnosis was made by histopathology and tissue fungal cultures. He was treated with incision and drainage followed by oral voriconazole for 4 weeks; which led to clinical recovery.

Neurofibromatosis type 1 and pregnancy: The transformation of a nodular to cystic neurofibroma in the cervical region.

BACKGROUND: The peripheral hallmarks of neurofibromatosis type 1 (NF1) are Café au lait and solid nodular neurofibromas. The morphological behavior of these lesions could be susceptible to modification during pregnancy. The present case report describes a case of cystic transformation of a nodular neurofibroma, with progressive growth and mass effect in the anterior cervical region, which was surgically resolved without any complications. CASE DESCRIPTION: A 33-year-old female patient with a known personal history of NF1, with annual control of the peripheral neurofibromas and cerebral and spinal magnetic resonance imaging follow-ups. Under genetic counseling, she decides to get pregnant following all the medical advises. Once the pregnancy is confirmed, she starts to notice the growth of one of them adjacent to the left cervical region. Such neurofibroma presented with the progressive gradual increase and in the last month, she presented dysphagia, dysphonia, and postural pain localized by the mass effect. Once the pregnancy concluded, the microsurgical approach was scheduled for resection of the lesion, where a cystic mass was found within the walls of the neurofibroma. The resection was uneventful. CONCLUSION: The transformation of a nodular to cystic neurofibroma during pregnancy is a very rare presentation, which may exacerbate the clinical symptomatology depending on the topography of the lesion due to the mass effect it may create. This condition may alert to the recommendations and vigilance in patients with NF1, who are pregnant or are planning on a future pregnancy. The neurosurgical resolution in this region is safe and beneficial.

Chitosan and Its Potential Use as a Scaffold for Tissue Engineering in Regenerative Medicine.

Tissue engineering is an important therapeutic strategy to be used in regenerative medicine in the present and in the future. Functional biomaterials research is focused on the development and improvement of scaffolding, which can be used to repair or regenerate an organ or tissue. Scaffolds are one of the crucial factors for tissue engineering. Scaffolds consisting of natural polymers have recently been developed more quickly and have gained more popularity. These include chitosan, a copolymer derived from the alkaline deacetylation of chitin. Expectations for use of these scaffolds are increasing as the knowledge regarding their chemical and biological properties expands, and new biomedical applications are investigated. Due to their different biological properties such as being biocompatible, biodegradable, and bioactive, they have given the pattern for use in tissue engineering for repair and/or regeneration of different tissues including skin, bone, cartilage, nerves, liver, and muscle. In this review, we focus on the intrinsic properties offered by chitosan and its use in tissue engineering, considering it as a promising alternative for regenerative medicine as a bioactive polymer.