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Background: Common variable immunodeficiency (CVID) is a rare disease characterized by humoral immunodeficiency, often causing sinopulmonary and gastrointestinal infections, and may cause enteropathy in some patients, which leads to severe malnutrition and electrolyte deficiencies. Although many autoimmune diseases are seen with increased frequency in CVID patients, primary hypoparathyroidism is extremely rare.

Case presentation: A 50-year-old man with CVID presented with diarrhea. The patient had complaints for 2 years and was cachectic. He had severe electrolyte and vitamin deficiencies that did not respond to oral treatment. The diarrhea causes such as celiac, inflammatory bowel diseases, and gastrointestinal infections were excluded and the endoscopy showed enteropathic changes in the duodenum and colon. Concomitant hypoparathyroidism was also detected in the patient with hypocalcemia despite adequate replacement.

Conclusion: Parenteral therapy should be considered in the management of CVID enteropathy cases that do not respond to oral replacement. Although very rare, hypoparathyroidism should be considered in the differential diagnosis of CVID patients with treatment-resistant hypocalcemia.


The COVID-19 pandemic continues to overwhelm global healthcare systems. While the disease primarily causes pulmonary complications, reports of central nervous system (CNS) involvement have recently emerged ranging from encephalopathy to stroke. This raises a practical dilemma for clinicians as to when to pursue neuroimaging and lumbar tap with cerebrospinal fluid (CSF) analysis in COVID-19 patients with neurological symptoms. We present a case of an encephalopathic patient infected with SARS-CoV-2 with no pulmonary symptoms. We propose a three-tier risk stratification for CNS COVID-19 aiming to help clinicians to decide which patients should undergo CSF analysis. The neurological examination remains an integral component of screening and evaluating patients for COVID-19 considering the range of emerging CNS complications.


Introduction: Non-alcoholic fatty liver disease (NAFLD) is one of the most common liver diseases worldwide. Lipid accumulation in the liver triggers inflammation and leads to NAFLD. Prolonged inflammation will worsen the disease progression. Pro-inflammatory cytokines, including interleukin (IL)-12, plays a role in the inflammatory process. This study aimed to determine the association between IL-12 and NAFLD severity.

Methods: A cross-sectional study was conducted between January and July 2019 in Haji Adam Malik Hospital Medan, Indonesia. Subjects were patients aged 18 years or older diagnosed with NAFLD based on ultrasound. Exclusion criteria were excessive alcohol consumption, other primary liver diseases, malignancies, and cardio-metabolic disturbances. Serum IL-12 level was determined using an enzyme-linked immunosorbent assay method. The severity of NAFLD was assessed using the BARD score and NAFLD fibrosis score.

Results: A total of 100 subjects were enrolled with male predominant. The mean age of subjects was 54.97 ± 8.85 years, and the most frequent comorbidity was obesity. Most subjects had mild to moderate disease progression. Serum IL-12 level was higher in more severe NAFLD based on ultrasound grading (P < 0.001), BARD score (P = 0.003), and NAFLD fibrosis score (P = 0.005). A positive correlation was observed between serum IL-12 level and BARD score (P < 0.001) with sufficient accuracy (AUC = 0.691, P = 0.014).

Conclusion: Serum IL-12 level was associated with the severity of NAFLD. Higher serum IL-12 level was observed in more severe NAFLD progression.


Gastroesophageal reflux disease (GERD) is considered one of the most frequent chronic gastrointestinal diseases globally with high costs due to treatment and investigations.

First line therapy is with proton pump inhibitors, those who do not respond to initial treatment usually require further investigations such as upper gastrointestinal endoscopy or ambulatory 24-hours esophageal pH monitoring. The total time of exposure to acid and the DeMeester score represent the most useful parameters associated with conventional pH-metry, because they can identify gastroesophageal reflux disease.

Although pH-metry is considered the gold standard for the evaluation of gastroesophageal reflux disease, new impedance-based parameters have been introduced in recent years with the role of increasing the accuracy of diagnosing gastroesophageal reflux disease and characterizing the type of reflux. The development of multichannel intraluminal pH-impedance has improved the ability to detect and quantify gastroesophageal reflux. New parameters such as post-reflux swallowing peristaltic wave (PSPW) index and the mean nocturnal basal impedance (MNBI) have recently been introduced to assess GERD phenotypes more accurately. This review evaluates current GERD diagnotic tools while also taking a brief look at newer diagnostic parameters like PSPW and MNBI.


Background: The objective of our present study is to assess the relation between persistent fatigue and rheumatoid arthritis (RA) disease activity and its functional impact and to determine if the positive effect of biologics on fatigue is due to good disease response or to a different pathway.

Methods: A study cohort of patients with established RA was conducted. We included patients who were initiation a biologic after at least failure of one conventional synthetic Disease Modifying Anti-Rheumatic Drug synthetic (csDMARDs). At baseline, patients had a moderately to highly active disease. Demographic characteristics, disease activity and functional impact were assessed by disease activity score (DAS28CRP) and health assessment questionnaire (HAQ) scores. Fatigue was evaluated by the Functional Assessment of Chronic Illness Therapy–Fatigue scale questionnaire (FACIT-F). Patients were examined before initiating biotherapy, then after three months and six months.

Results: Thirty women with RA, with a mean age of 52.5 years, were included. At baseline, 57% received anti-TNFα: Etanercept (n=9), Adalimumab (n=6), Infliximab (n=2) and 43% received Rituximab. Good Eular response was obtained in 80% of patients at the third month and 97% of patients at the sixth month. In the analytic study, a significant amelioration after 3 months of biotherapy was found in both disease response (DAS28CRP) and fatigue (FACITF), respectively (p=0.01,p<0.001 and p<0.001). The disease activity decreased significantly also after sixth month (p=0.01, p<0.001 and p=0.012). In the linear multivariate analysis, the regression of visual analogic pain (VAS pain) was the only predictors of the improvement of fatigue.

Conclusion: Biologics contribute to improve fatigue in patients with established RA and this effect seems to be independent from the clinical efficacy of this treatment.


Endoscopic submucosal dissection (ESD) has become the main treatment for early esophageal cancer. While treating the disease, ESD may also cause postoperative esophageal stricture, which is a global issue that needs resolution. Various methods have been applied to resolve the problem, such as mechanical dilatation, glucocorticoids, anti-scarring drugs, and regenerative medicine; however, no standard treatment regimen exists. This article describes and evaluates the strengths and limitations of new and promising potential strategies for the treatment and prevention of esophageal strictures.


Background and objectives

Running has gone from a vital necessity for the man to a playful sport. Different rheumatic and orthopedic pathologies have appeared, in front of which the shoe industry has reacted by creating reinforced shoes that are supposed to overcome the induced lesions. Several years later, the trend toward reinforcement has gone toward minimalism, which is the absence of reinforcement, that is, a more natural race.


We observed variations of kinetics and kinematics in young, unprofessional, healthy runners during a shoe race and a shoeless race, which is the form of maximum minimalism. We then correlated minimalism variations with the variables of the race and the joint angles.


We observed significant difference (P < 0.01) in the cycle rate, the cycle length, the step rate, and the angle of attack between running with and without shoes. A small variation of the minimalism index is associated with an increase in knee angle (r 2> 0.5). Conversely, a large variation in the minimalism index is related to a decrease in the knee angle (r 2> 0.5). The minimalism index has no impact on the angulation of the ankle and hip (r 2< 0.3).


Slow transition will bring gains in terms of decreasing the length of the stride, which limits the load on the shin. Greater flexibility can be achieved by decreasing the flexion angle of the knee, which decreases the demand for quadriceps muscles and the risk of knee injury with a greater risk of injury at the tibial level.


Primary Sjögren's syndrome (pSS) is a systemic autoimmune disease with exocrine gland dysfunction and multi-organ involvement. Currently, there is an increasing trend toward non-steroid therapy for the treatment of autoimmune diseases. Some biological agents or immunosuppressive drugs may be the ideal choices. In real-world practice, as patients have severe systemic complications or organ damage, they will have a bad prognosis even if they are treated with high-dose steroids and strong immunosuppressive drugs. However, if we can start early intervention and prevent progressive development in advance, the patient may have a good prognosis. Mycophenolate is an immunosuppressive drug with minor side effects. Here, we conduct a systemic review and find supporting evidence that patients with pSS benefit from early mycophenolate therapy. Mycophenolate may be the first-line treatment for pSS patients in the future.