Background: Whipple's disease (WD) is rarely the cause of a malabsorption syndrome. The disease is a chronic infection of the intestinal mucosa with the bacterium Tropheryma whipplei, which leads to a lymphostasis with an impaired absorption of the nutrition. Due to its low incidence (1:1,000,000) and the non-specific early symptoms, the disease is often diagnosed only after many years. Methods: Based on a selective literature review and the clinical experience of the authors, the current knowledge of WD regarding pathogenesis, clinical presentation, diagnosis, and therapy are presented in this paper. Results: Recent studies suggest that a host-specific dysfunction of the intestinal macrophages is responsible for the chronic infection with T. whipplei. Prior to patients reporting symptoms of a malabsorption syndrome (chronic diarrhea/steatorhea, weight loss), they often suffer from non-specific symptoms (polyarthralgia, fever, fatigue) for many years. Misdiagnoses such as seronegative polyarthritis are frequent. Furthermore, neurological, cardiac, ocular, or dermatological symptoms may occur. The standard method concerning diagnosis is the detection of PAS(periodic acid-Schiff)-positive macrophages in the affected tissues. Immunohistochemical staining and PCR(polymerase chain reaction)-based genetic analysis increase the sensitivity and specificity of conventional detection methods. Endoscopically, the intestinal mucosa appears edematous with lymphangiectasias, enlarged villi, and white-yellowish ring-like structures. The German treatment recommendations include a two-week intravenous induction therapy with ceftriaxone, which is followed by a three-month oral maintenance therapy with trimethoprim/sulfamethoxazole. Conclusion: WD is rarely responsible for a malabsorption syndrome. However, if WD is not recognized, the disease can be lethal. New diagnostic methods and prospectively approved therapeutic concepts allow an adequate treatment of the patient. Due to the host-specific susceptibility to T. whipplei, a lifelong follow-up is necessary.

Background Dolutegravir (DTG) and boosted darunavir (bDRV) are potent antiretrovirals with a high resistance barrier and might be valuable switch options for people with HIV (PWH). Methods DUALIS, a randomized, open-label, phase-3b, non-inferiority clinical trial, compared the switch to DTG+bDRV (2DR) versus continuation 2 nucleoside reverse transcriptase inhibitors (2NRTI)+bDRV (3DR). PWH with HIV RNA <50 copies/mL taking 2NRTI+bDRV (3DR) for ≥24 weeks (one accepted blip <200 copies/mL) were randomized to either switch to DTG 50 mg + DRV 800 mg (boosted with 100 mg ritonavir) or continue taking 3DR. Primary endpoint (PE) was the proportion of HIV RNA <50 copies/mL at week (W)48. Change in NRTI backbone was not classified as failure. Estimated sample size for PE analysis was 292; the non-inferiority margin was ≤ –10.0%. Results In total, 263 subjects were randomized and treated (2DR n=131, 3DR n=132; 90.1% male, 89.7% Caucasian, median age 48 years, interquartile range 39–54 years). At W48, 86.3% (n=113/131) of 2DR and 87.9% (n=116/132) of 3DR subjects had HIV RNA <50 copies/mL; difference between arms was –1.6% (95.48% confidence interval, based on the adjusted alpha-level accounting for the interim analysis at W24, –9.9 – +6.7%). Discontinuations due to adverse event: 2DR, 4.6% (n=6); 3DR, 0.8% (n=1). Kaplan–Meier estimates of confirmed HIV RNA ≥50 copies/mL at W48 were 1.6% (n=2) in the 2DR and 3.1% (n=4) in the 3DR group. Development of treatment-emergent resistance was not observed. Conclusions Switching to DTG+ bDRV was non-inferior to continuing 3DR in subjects already treated with bDRV

Background: Artificial intelligence systems recently demonstrated an increase in polyp- and adenoma detection rate. Over the daytime the adenoma detection rate decreases as tiredness leads to a lack of attention. It is not clear if a polyp detection system with artificial intelligence leads to a constant adenoma detection over the day. Methods: We performed a database analysis of screening and surveillance colonoscopies with and without the use of AI. In both groups, patients were investigated with the same endoscopy equipment and by the same endoscopists. Only patients with good bowel preparation (BBPS > 6) were included. We correlated the daytime, the investigational time, day of the week and the adenoma and polyp detection. Results: A total of 303 colonoscopies were analyzed. In the AI+ group 163 endoscopies and in the AI- group 140 procedures were included. In both groups the total adenoma detection rate was equal (AI+ 0.39 vs AI- 0.43). The adenoma detection rate throughout the day had a significant decreasing trend in the group without the use of AI (p=0.015) whereas this trend was not present in the investigations that have been performed with AI (p=0.65). The duration of investigation did not show a significant difference between the groups (8.9 minutes in both groups). No relevant effect was noticed in adenoma detection between single days of the working week with or without the use of AI. Conclusion: AI helps to overcome the decay in adenoma detection over the daytime. This may be attributed to a constant awareness caused by the use of the AI system.

<b><i>Introduction:</i></b> Artificial Intelligence (AI) is one of the most evolving fields in endoscopy. We aimed to test if a system for polyp detection and polyp characterization can be used to predict complete endoscopic resection of colon adenomas. <b><i>Methods:</i></b> We used the CAD-Eye AI system (Fujifilm Europe) in consecutive patients who received polypectomy using a cold snare. After resection, the submucosal space was flushed with water using an irrigation pump. Images were obtained using the CAD Eye system, and the characterization of the system was noted and afterward compared to histology of the removed specimen. <b><i>Results:</i></b> In total, 17 polypectomies were observed, and in no case the AI was able to give information about resection status. First, the resection plane itself was classified as being adenomatous in all cases, while, second, all adenomas were resected completely, thus harboring no potential for overlying misinterpretations in the images. <b><i>Conclusion:</i></b> An AI system trained to characterize polyps in healthy surrounding colorectal mucosa cannot predict the state of resection after removal of the adenoma. This is explained by the training and programming. Endoscopists using AI from now on should learn about the basics of AI and the pitfalls in interpreting results from AI.

<b><i>Background:</i></b> Post-operative infection is a common complication following abdominal surgery. The two most common infections are secondary peritonitis and surgical site infections, which lead to increased perioperative morbidity, prolonged hospitalization, higher mortality rates, and increased treatment costs. In addition to surgical procedures, treatment is based on effective antibiotic therapy. Due to increasing antimicrobial resistance, the correct use of antimicrobials is becoming more complex. Many initiatives call for the implementation of an antimicrobial stewardship (AMS) programme to optimize anti-infective therapy. The review article summarizes current recommendations in anti-infective therapy of post-operative peritonitis and surgical site infections and highlights the importance of an AMS programme in abdominal surgery. <b><i>Summary:</i></b> Larger studies evaluating the benefit of AMS in abdominal surgery are lacking. However, national and international guidelines have formulated appropriate recommendations for the rational use of antibiotics in post-operative peritonitis and surgical site infections. The rate of post-operative infections can be significantly reduced by perioperative antibiotic prophylaxis. The increase in multidrug-resistant bacteria complicates anti-infective therapy for post-operative infections. Analysis of local susceptibility patterns helps choose an adequate empiric therapy. A high rate of extended-spectrum beta-lactamase-producing bacteria may necessitate the use of other reserve antibiotics in addition to carbapenems, which are approved for the treatment of complicated intra-abdominal infections. A key role for the AMS team is the subsequent de-escalation of antibiotic therapy which limits the use of unnecessary broad-spectrum antibiotics. <b><i>Key Messages:</i></b> The increase in multidrug-resistant bacteria poses challenges for abdominal surgery. Post-operative infections should be treated by an interdisciplinary team of surgeons and specialists for AMS.