Background and Aims. Gastric cancer is the 5th leading cause of cancer mortality worldwide and the leading infection-associated cancer. Helicobacter pylori is the most common chronic bacterial infection in humans and the major predisposing factor for the development of gastric intestinal metaplasia (GIM), the principal preneoplastic lesion in the gastric carcinogenesis pathway. GIM surveillance is now recommended for individuals among high-risk subgroups by three major gastroenterology societies in Europe, England, and U.S. Our objective was to provide the initial epidemiologic data for GIM among Hispanics in Puerto Rico. Methods. Using a cross-sectional study design, we analyzed an extensive pathology database ( n = 43,993 ) that captured approximately 50% of all endoscopy biopsies taken during 2012-2014 at academic, public, and private sectors in Puerto Rico. Prevalence estimates of GIM, GIM subgroups, and H. pylori status were estimated using logistic regression models. Results. A total of 4,707 GIM cases were identified during the study period for a prevalence rate of 10.7%. H. pylori was detected in 26.9% (95% CI: 25.7-28.2) of the GIM cases. The majority of the pathology reports lacked information regarding the high-risk subtypes (99.6%) and extension (71.2%). Conclusions. The prevalence of GIM among Hispanics living in Puerto Rico may be higher than in U.S. mainland non-Hispanic populations. The prevalence of H. pylori detected in our study population was comparable to the rates reported in the mainland U.S. Standardization of the endoscopy biopsy protocol and pathology reporting is needed to characterize and risk stratify GIM surveillance programs in Puerto Rico.

RATIONALE: Fast dissolving tablets for sublingual allergen immunotherapy (SLIT) are now globally available and cover the three major allergies grass, house dust mite and ragweed. This allows for comparative evaluation of immunological responses to treatment on a global scale across SLIT-tablet development programs. METHODS: Data collected during 8 placebo-controlled phase III studies covering 2509 patients was used for analysis. In all trials, allergen-specific IgE and IgG4 (sIgE and sIgG4) were measured using ImmunoCAP. Active treatment comprised fast-dissolving Zydis-formulation (SLIT-tablets) for allergic rhinitis and/or allergic asthma due to the following allergens: house dust mite (4 trials), grass (2 trials), and ragweed (2 trials). RESULTS: Across trials and allergens, active treatment groups show comparable levels of changes in immunological responses of sIgE and sIgG4. For all trials, the largest average increase in sIgE was observed within the first three months whereas sIgG4 continuously increased during the first year of treatment. For placebo-treated patients, a minor increase in antibody titers in relevant pollen seasons was observed. Looking at individual measurements, consistency was further demonstrated by similar distribution profiles of changes in sIgE and sIgG4 during the early and late phase of treatment, respectively. CONCLUSIONS: During the first year and across trials, changes in sIgE and sIgG4 demonstrate a high level of similarity despite underlying heterogeneity in enrolled patients, tablet treatments and geographical location including Europe, North America and Japan. This indicates a common immunological mechanism for the entire class of fast-dissolving SLIT-tablets.

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Anti-N-methyl-D-aspartate receptor (Anti-NMDAR) encephalitis is an under-recognized progressive neurological disorder caused by antibodies against the GluN1 (NR1) subunit of NMDA receptors in the brain. It is characterized by the subacute development of neuropsychiatric symptoms, movement disorders and seizures, often evolving into a severe and disabling encephalopathy with detrimental consequences over the functionality of affected individuals. The variable clinical presentation and infrequency with which it is clinically encountered presents a formidable diagnostic challenge in primary care. Initial misdiagnosis as psychiatric disease or infectious encephalitis significantly delays diagnosis and treatment of this medical condition. We present the case of a 34-year-old male who was evaluated after being transferred from a psychiatric institution due to worsening neuropsychiatric symptoms and seizures. Symptoms were preceded by new onset headaches, followed by behavioral changes, movement disorders, and a myriad of symptoms that pointed towards a psychiatric disorder. The non-specific nature of the presenting signs and symptoms of this patient led to initial misdiagnosis and delay of treatment. Thus, recognizing key elements of the patient’s clinical presentation and progression are of paramount importance. Our aim is to highlight key clinical and diagnostic findings that could help clinicians consider anti-NMDAR encephalitis in the differential diagnosis of patients presenting similarly as our patient did, as well as to present a review of literature of this unique neurological condition.

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