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Lupus enteritis as the only active manifestation of systemic lupus erythematosus: A case report

World Journal of Clinical Cases 2019年第11期7卷 1315-1322页

作者： adalberto gonzalez Vaibhav Wadhwa Fayssa Salomon Jeevna Kaur Fernando J Castro Department of Internal Medicine Cleveland Clinic Florida Weston FL 33331 United States Department of Gastroenterology and Hepatology Cleveland Clinic Florida Weston FL 33331 United States

BACKGROUND Lupus enteritis is a rare manifestation of systemic lupus erythematosus (SLE). Diagnosis of this condition is difficult, especially in the absence of other symptoms related to active SLE. We present the case of a 25-year-old female with lupus enteritis as the sole initial manifestation of active SLE. CASE SUMMARY A 25-year-old African American female presented to the Emergency Department complaining of diffuse abdominal pain, diarrhea, nausea, and vomiting for 2 days. Her past medical history was significant for seasonal allergies and family history was pertinent for discoid lupus in her father and SLE in a cousin. The patient’s vital signs on presentation were normal. Her physical exam was remarkable for significant lower abdominal tenderness without guarding or rigidity. A computed tomography of the abdomen and pelvis revealed marked circumferential wall thickening and edema of the proximal and mid small bowel predominantly involving the submucosa. Our main differential diagnoses were intestinal angioedema and mesenteric vein thrombosis. However, mesenteric vessels were patent, and laboratory testing for hereditary angioedema showed a normal C1 Esterase Inhibitor level and low C3 and C4 levels. Infectious work-up was negative. Autoimmune tests showed elevated anti-nuclear antibodies (ANA)(13.6), anti-Smith antibody, and anti-ribonucleoprotein (anti-RNP) antibody. The patient was diagnosed with SLE enteritis. She was maintained on bowel rest, given intravenous hydration, and started on methylprednisolone 60 mg IV daily. She had significant improvement in her abdominal pain, diarrhea, and emesis after 2 days of treatment. Steroids were tapered and maintained on Hydroxychloroquine with no relapses one year after *** This case of lupus enteritis represents a rare manifestation of SLE. Diagnosis requires clinical suspicion, characteristic imaging and laboratory tests. Endoscopic appearance and biopsies usually yield non-specific findings.

关键词： Lupus enteritis Systemic lupus erythematous Abdominal pain Hereditary angioedema Case report

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From hepatitis A to E:A critical review of viral hepatitis

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World Journal of Gastroenterology 2021年第16期27卷 1691-1715页

作者： Daniel Castaneda adalberto Jose gonzalez Mohammad Alomari Kanwarpreet Tandon Xaralambos Bobby Zervos Digestive Disease Institute Cleveland Clinic FloridaWestonFL 33331United States Transplant Department Cleveland Clinic FloridaWestonFL 33331United States

Viral infections affecting the liver have had an important impact on humanity,as they have led to significant morbidity and mortality in patients with acute and chronic *** an unknown etiology,the discovery of the viral agents triggered interest of the scientific community to establish the pathogenesis and diagnostic modalities to identify the affected *** the rapid scientific and technological advances in the last centuries,controlling and even curing the infections became a possibility,with a large focus on preventive medicine through ***,a comprehensive understanding of hepatitis A,B,C,D and E is required by primary care physicians and gastroenterologists to provide care to these *** review article describes the epidemiology,pathogenesis,clinical presentation,diagnostic tools and current medication regimens,with a focus on upcoming treatment options and the role of liver transplantation.

关键词： Hepatitis A Hepatitis B Hepatitis C Hepatitis D Hepatitis E Treatment

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COVID-19 in liver transplant patients: Impact and considerations

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World Journal of Transplantation 2023年第1期13卷 1-9页

作者： Shrouq Khazaaleh Mohammad Alomari Sanskriti Sharma Nikhil Kapila Xaralambos Bobby Zervos adalberto Jose gonzalez Department of Internal Medicine Cleveland Clinic Fairview HospitalClevelandOH 44126United States Department of Gastroenterology and Hepatology Cleveland Clinic FloridaWestonFL 33331United States Department of Internal Medicine WellStar Atlanta Medical CenterAtlantaGA 30312United States

The coronavirus disease 2019 pandemic has significantly impacted liver transplantation worldwide,leading to major effects on the transplant process,including the pretransplant,perioperative,and post-transplant *** is believed that patients with chronic liver disease,especially those with cirrhosis,have a higher risk of complications from coronavirus disease 2019 infection compared to the general ***,evaluation of coronavirus disease 2019 effects on liver transplant patients has not uniformly demonstrated worse ***,the pandemic created significant challenges and restrictions on transplant policies and organ allocation.

关键词： COVID-19 Liver transplantation Immunosuppression Living donor Mortality

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Managing liver transplantation during the COVID-19 pandemic:A survey among transplant centers in the Southeast United States

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World Journal of Hepatology 2021年第12期13卷 2161-2167页

作者： adalberto Jose gonzalez Nikhil Kapila Emmanuel Thomas Antonio Pinna Andreas Tzakis Xaralambos Bobby Zervos Department of Gastroenterology Cleveland Clinic FloridaWestonFL 33324United States Department of Transplant Cleveland Clinic FloridaWestonFL 33331United States Schiff Center for Liver Diseases University of Miami Miller School of MedicineMiamiFL 33136United States

BACKGROUND The coronavirus disease-2019(COVID-19)pandemic has had a profound worldwide ***,it has led to a vast decrease in organ transplantation,including liver transplants(LT).There is little data regarding adjustments made by LT centers as a response to the COVID-19 *** To assess the experience of LT centers in the United States during the *** We performed an observational survey study from May 11,2020 to June 5,*** sent out a 13 question survey to 15 LT centers across the southeastern United *** Eleven LT centers responded to the *** found that(11/11)100%of transplant centers made adjustments because of the COVID-19 *** least 50%of transplant centers had at least one transplant recipient infected with *** adjust,greater than 50%of centers performed fewer LT,100%of patients were tested for COVID-19,and most centers implemented a virtual *** The COVID-19 pandemic greatly affected liver transplantation in the southeastern United *** was evident that a concerted effort was made by LT centers to protect their patients and employees from COVID-19 but also to continue the lifesaving procedure of LT in this sick patient *** studies are needed to assess how LT centers around the world managed the pandemic in order to learn strategies to continue life-saving procedures in this patient population.

关键词： COVID-19 Liver transplantation Survey Telemedicine Immunosuppression Solid organ transplantation

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Liver transplantation amidst the COVID-19 era:Our center's experience

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World Journal of Clinical Cases 2023年第2期11卷 316-321页

作者： Shrouq Khazaaleh Zoilo Karim Suarez Mohammad Alomari Mamoon Ur Rashid Armaan Handa adalberto Jose gonzalez Xaralambos Bobby Zervos Nikhil Kapila Department of Internal Medicine Cleveland Clinic Fairview HospitalClevelandOH 44126United States Department of Internal Medicine Florida Atlantic University Charles E.Schmidt College of MedicineBoca RatonFL 33431United States Department of Gastroenterology and Hepatology Cleveland Clinic FloridaWestonFL 33331United States Royal College of Surgeons Dublin 11111United Kingdom

Coronavirus disease 2019 significantly impacted the liver transplant process ***,it brought significant challenges and limitations to transplant policies and organ allocation forcing liver transplant centers to adjust their protocols to ensure maximum benefit and avoid harm to their *** center,like many others,was obliged to adapt to the *** paper provided an overview of the effects of coronavirus disease 2019 on liver transplantations and detailed our center’s experience and efforts during this unprecedented pandemic to serve as a guide for future public health crises.

关键词： COVID-19 Liver transplantation Immunosuppression Experience Mortality

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Outcomes of total pancreatectomy with islet autotransplantation:A systematic review and meta-analysis

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World Journal of Transplantation 2023年第1期13卷 10-24页

作者： Shrouq Khazaaleh Sumbal Babar Mohammad Alomari Zaid Imam Pravallika Chadalavada adalberto Jose gonzalez Bara El Kurdi Department of Internal Medicine Cleveland Clinic Fairview HospitalClevelandOH 44126United States Department of Internal Medicine-Infectious Diseases Division University of Texas Health Science Center at San AntonioSan AntonioTX 78249United States Department of Gastroenterology and Hepatology Cleveland Clinic FloridaWestonFI 33324United States Department of Gastroenterology and Hepatology William Beaumont HospitalRoyal OakMI 48073United States Department of Gastroenterology and Hepatology Cleveland Clinic FloridaWestonFI 33331United States Department of Gastroenterology and Hepatology University of Texas Health Science Center at San AntonioSan AntonioTX 78249United States

BACKGROUND Despite the increased use of total pancreatectomy with islet autotransplantation(TPIAT),systematic evidence of its outcomes remains *** To evaluate the outcomes of *** We searched PubMed,EMBASE,and Cochrane databases from inception through March 2019 for studies on TPIAT *** were extracted and analyzed using comprehensive meta-analysis *** random-effects model was used for all *** was assessed using the I2 measure and Cochrane *** bias was assessed using Egger’s *** Twenty-one studies published between 1980 and 2017 examining 1011 patients were *** studies were of adults,while three studied pediatric *** independence was achieved in 53.5%[95% Confidence Interval(CI):45-62,P<0.05,I2=81%]of adults compared to 51.9%(95%CI:17-85,P<0.05,I2=84%)of *** post-procedure was achieved in 31.8%(95%CI:26-38,P<0.05,I2=64%)of adults with considerable heterogeneity compared to 47.7%(95%CI:20-77,P<0.05,I2=82%)in *** hemoglobin(HbA1C)12 mo post-surgery was reported in four studies with a pooled value of 6.76%(P=0.27).Neither stratification by age of the studied population nor metaregression analysis considering both the study publication date and the islet-cell-equivalent/kg weight explained the marked heterogeneity between *** These results indicate acceptable success for *** studies should evaluate the discussed measures before and after surgery for comparison.

关键词： Islet autotransplantation Pancreatectomy Pancreatitis Narcotics

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Comparison between metabolic-associated fatty liver disease and nonalcoholic fatty liver disease:From nomenclature to clinical outcomes

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World Journal of Hepatology 2023年第4期15卷 477-496页

作者： Mohammad Alomari Mamoon Ur Rashid Pravallika Chadalavada Jonathan Ragheb Hammad Zafar Zoilo Karim Suarez Shrouq Khazaaleh adalberto Jose gonzalez Fernando J Castro Department of Gastroenterology and Hepatology Cleveland Clinic FloridaWestonFL 33331United States Department of Internal Medicine Florida Atlantic University Charles E Schmidt College of MedicineBoca RatonFL 33431United States Department of Internal Medicine Cleveland Clinic Fairview HospitalClevelandOH 44126United States

As a result of the obesity epidemic,Nonalcoholic fatty liver disease(NAFLD)and its complications have increased among millions of ***,a group of experts recommended changing the term NAFLD to an inclusive terminology more reflective of the underlying pathogenesis;metabolic-associated fatty liver disease(MAFLD).This new term of MAFLD has its own disease epidemiology and clinical outcomes prompting efforts in studying its differences from *** article discusses the rationale behind the nomenclature change,the main differences,and its clinical implications.

关键词： Metabolic associated fatty liver disease Non alcoholic fatty liver disease Fatty liver disease Obesity Diabetes mellitus

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Novel device for monitoring respiratory rate during endoscopy-A thermodynamic sensor

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2019年第3期10卷 57-66页

作者： Vaibhav Wadhwa adalberto J gonzalez Kristen Selema Ronen Feldman Rocio Lopez John J Vargo Department of Gastroenterology and Hepatology Cleveland Clinic FloridaWestonFL 33324United States Department of Internal Medicine Cleveland Clinic FloridaWestonFL 33331United States Department of Technology Artep IncorporatedElliot CityMD 21042United States Department of Quantitative Health Sciences Cleveland ClinicClevelandOH 44195United States Department of Gastroenterology and Hepatology Digestive Disease and Surgery InstituteCleveland ClinicClevelandOH 44195United States

BACKGROUND Monitoring ventilation accurately is an indispensable aspect of patient care in procedural *** current gold standard method of monitoring ventilation is by measuring exhaled carbon dioxide concentration,known as capnography.A new device utilizing thermodynamic measurement,the Linshom Respiratory Monitoring Device(LRMD),has been designed to measure respiratory rate(RR)by using the temperature of exhaled *** hypothesized that the temperature sensor is at least equivalent in accuracy to capnography in monitoring *** To determine if the temperature sensor is equivalent to capnography in monitoring procedural *** In this prospective study,participants were individually fitted with a face mask monitored by both LRMD and *** following data were collected:gender,age,body mass index,type of procedure,and doses of *** each patient,we report the mean RR for each device as well as the mean *** analyses were performed using SAS,and a P<0.05 was considered statistically *** Twelve consecutive patients undergoing endoscopic procedures at our institution were *** patients were excluded due to incomplete data,inadequate data,patient cooperation,and capnography ***,we found that LRMD RR highly correlated to capnography RR(P<0.001);the average capnography RR increases by 0.66 breaths for every one additional breath measured by the *** addition,apnea rates were 7.4%for the capnography and 6.4%for the LRMD(95%confidence interval:0.92-1.10).CONCLUSION The LRMD correlated with the gold standard capnography with respect to respiratory rate detection and apnea *** LRMD could be used as an alternative to capnography for measuring respiration in endoscopy.

关键词： Sedation Capnography Linshom Thermodynamic sensor Endoscopy

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Feasibility of smart intraocular lens

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International Journal of Ophthalmology(English edition) 2024年第7期17卷 1379-1380页

作者： Francisco gonzalez CIMUS University of Santiago de CompostelaSantiago de Compostela 15782Spain Service of Ophthalmology and IDIS Complejo Hospitalario Universitario de Santiago de CompostelaSantiago de Compostela 15706Spain

Dear Editor,Wearable biosensors are monitoring implantable devices that provide real-time detection of biomarkers by means of non-invasive measurements[1].There is a high demand for novel sensors that can be comfortably used by the patients for clinical monitoring of ocular *** implanted into eyes have been improved and they have the capacity to monitor parameters such as intraocular pressure(IOP),and also have the possibility of recording lactic acid,glucose or cortisol levels[2-3].

关键词： intraocular clinical ocular

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Utilizing Instilling Negative Pressure Wound Therapy with Vashe Wound Solution for an Infected Sternal Dehiscence: A Case Report

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Surgical Science 2023年第3期14卷 231-239页

作者： Linnea T. Mauro Courtney M. Janowski Mariah J. Janowski adalberto C. gonzalez Eugene J. Sidoti Luis G. Fernandez Paul J. Kim Marc R. Matthews Valleywise Medical Center Department of Surgery Phoenix Arizona Department of Surgery Division of Trauma Surgery/Surgical Critical Care University of Texas Health Science Center Tyler Texas The University of Texas Tyler School of Medicine Endowed Chair in Trauma Surgery Tyler Texas Trauma Wound Care UT Health East Tyler Texas Department of Surgery University of Texas Medical Branch Galveston Texas Medicine and Nursing University of Texas Arlington Texas Department of Medical Education Health Science Center Tyler Texas Department of Physician Assistant Studies School of Health Professions University of North Texas Fort Worth Texas ACS National Committee on Trauma Chicago USA Plastic Surgery Department of Surgery University of Texas Southwestern Dallas Texas University of Arizona & Creighton University Schools of Medicine The Arizona Burn Center Phoenix Arizona

Utilization of negative pressure wound therapy with instillation (NPWTi) for sternal dehiscence wounds secondary to sternal wound infection after surgery has become an accepted therapy. NPWTi accelerates wound healing through macrostrain, microstrain, and cyclic fluid instillation. Wounds benefit from additional superficial infection control with the removal of microorganisms, the release of proinflammatory mediators, stimulation of angiogenesis, as well as mechanical debridement. However, very few cases of utilizing NPWTi in the treatment of sternal wound infections have been reported in the literature. This case study describes the use of NPWTi with hypochlorous acid for the treatment of a sternal wound infection.

关键词： Negative Pressure Wound Therapy with Instillation NPWT NPWTi NPWT with Dwell Hypochlorous Acid Vashe Wound Solution Sternal Dehiscence

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