Lymphocytic and collagenous colitis: the emerging entity of microscopic colitis. An update on pathophysiology, diagnosis and management.

Microscopic colitis (MC) encompasses the two morphologically distinct entities of collagenous colitis (CC) and lymphocytic colitis (LC). MC was first described less than 30 years ago but is presently recognized as a relatively common cause of chronic diarrhea in the adult population. Remarkably, up to 10% of adults who have a colonoscopy for the investigation of chronic diarrhea, and have endoscopically normal appearing mucosa, may have MC. Patients with MC generally present with chronic diarrhea, which can be associated with cramping and bloating. Endoscopic and radiological examinations are usually normal. Histological assessment reveals inflammation consisting predominantly of lymphocytic infiltration, and a thickened subepithelial collagen band is diagnostic of CC. Both LC and CC can be associated with autoimmune diseases such as celiac disease, diabetes, arthritis and thyroiditis, yet the mechanisms involved in the pathogenesis remain unclear. Emerging studies suggest that a stepwise approach be taken in the medical management of MC. This approach includes antidiarrheal agents and stopping of any offending agents; budesonide or bismuth subsalicylate; and cholestyramine or 5-acetylsalicylic acid agents. In resistant cases, oral corticosteroids and other immune modulatory therapy have been used.     

“Recumbent” gait: Relationship to the phenotype of “astasia‐abasia”?

Psychogenic gait disorders can present in many different ways. Among patients with a pure psychogenic gait disorder, buckling of the knee is the most common feature, followed by astasia-abasia. Here, we describe one such patient with a very unusual gait disturbance that might be regarded as a variant of astasia-abasia. The patient characteristics are described and discussed in a historical context.     

Long-Term Effect of Gluten-Free Diets on Nutritional Status,Body Composition,and Associated Factors in Adult Saudi Females with Celiac Disease

This cross-sectional study examines the influence of long-term gluten-free diet (GFD) consumption on nutritional status, body composition, and associated factors in adult Saudi females with celiac diseases (CD). Fifty-one patients who have been diagnosed with CD and have been on GFD for more than 1 year were included in this study where data regarding their dietary pattern, as well as a complete analysis of their anthropometric parameters, vitamins B12 and D levels, and complete blood count (CBC), were collected. Data have shown that all included patients showed a reduced intake in all micro and macro-nutrients, as well as vitamin D, folate, calcium, and iron. However, the vast majority of all measured hematological parameters and blood indices were within the expected reference range. In addition, 51%, 43.1%, and 60.8% of the patients showed low waist/hip ratio (WHR), decreased level of total body fat (BF), and decreased level of visceral fat (VF), respectively, whereas 33.3% were slim. The poor educational level and some psychosocial factors were associated with the poor nutritional status of the patients. In conclusion, the GFD-dependent intake by female patients with CD adversely affects their nutritional intake and anthropometric indices and leads to a deficiency in major nutrients, vitamins, and ions.     

成人不同垂直及矢状骨面型髁突特征的研究

目的 通过测量分析具有不同垂直和矢状骨面型的成人髁突特征的差异,研究成人骨面型与髁突特征的相关性。方法 选取颞下颌关节正常的成人患者180例,根据∠ANB、∠MP-FH和∠MP-SN将患者分为不同的垂直及矢状骨面型,共9组,每组20例。使用Invivo6软件测量所有样本的髁突长轴径、髁突短轴径、髁突最大横截面积、髁突颈部宽度、髁突上部高度、髁突高度、下颌升支高度,关节前、后、上、内侧间隙,关节结节后斜面角度和关节窝深度、宽度。使用SPSS 23.0软件进行统计学分析,比较各组测量指标的差异。结果 低角患者髁突粗大,关节间隙大,关节窝深而窄,关节结节后斜面角度大,升支长;高角患者则相反。骨性Ⅲ类患者髁突粗大,关节间隙小,关节窝浅而宽,关节结节后斜面角度小;而骨性Ⅱ类患者则相反。结论 骨性Ⅱ类高角、骨性Ⅲ类低角患者髁突特征明显,与下颌发育有关;髁突特征与垂直骨面型、矢状骨面型之间存在关联;垂直骨面型与髁突特征的关联程度比矢状骨面型更强。在临床治疗过程中要加强对髁突及其周围结构的关注。