Janice Cheong

The novel coronavirus 2 (SARS-CoV-2) has spread worldwide. While patients typically present with fever and symptoms of a respiratory illness, patients have also presented with gastrointestinal symptoms such as diarrhea, vomiting and abdominal pain. In addition, some patients were reported to have liver injury. In this article, we review gastrointestinal and liver aspects of COVID-19. In addition, we provide general gastroenterologists with guidance on the management of patients with gastrointestinal and liver disorders from COVID-19.

The National Physical Laboratory (NPL) is contracted to manage the UK Heavy Metals (HM) air quality Network. This network measures and reports concentrations of a selection of heavy metals in PM10 (particulate matter with an aerodynamic diameter < 10 µm) in ambient air and deposition (rain) across the UK. This is the Annual Report for 2023 and contains, in particular: Annual mass concentrations of all metals measured at all HM Network sites and performance against relevant data quality objectives (DQOs) and the requirements of the UK Air Quality Standards Regulations (AQSR) 2010. Highlighting of AQSR 2010 exceedances (for lead, nickel, arsenic, and cadmium), interpretation of data and discussion of trends across the HM Network. A description of HM Network operation, analytical and quality assurance / quality control procedures, and notable events and changes to the HM Network during 2023. In summary, during 2023: Lead: There were no annual average mass concentrations above the AQSR Lower Assessment Threshold (LAT) at any HM Network site. Recorded concentrations were well below the objective value set by the AQSR. Nickel: No sites had an annual average concentration recorded as above the AQSR target value. For two sites, Sheffield Tinsley and Pontardawe Tawe Terrace, the annual average concentrations were recorded as above the LAT, with Sheffield Tinsley [RB2] also exceeding the Upper Assessment Threshold (UAT). Arsenic and Cadmium: There were no annual average concentrations above the AQSR LAT. Recorded concentrations were well below the target values set by the AQSR. All DQOs specified in the AQSR were met, including time coverage, data capture, and measurement uncertainty requirements. In addition to the AQSR metals (lead, nickel, arsenic, and cadmium), concentrations in ambient air were also recorded for cobalt, chromium, copper, iron, manganese, selenium, vanadium, and zinc. Concentrations for a larger range of metals were recorded for the sites monitoring metals in deposition. Average data capture for metals in PM during 2023 was 97 %. For metals in deposition it was 100 %.

BACKGROUND: Histoplasma capsulatum is the most common endemic mycosis in the United States and frequently presents as an opportunistic infection in immunocompromised hosts. Though liver involvement is common in disseminated histoplasmosis, primary gastrointestinal histoplasmosis of the liver in absence of lung involvement is rare. Similarly, cholestatic granulomatous hepatitis in liver histoplasmosis is rarely seen. CASE PRESENTATION: We present a rare case of primary gastrointestinal histoplasmosis manifesting with acute granulomatous hepatitis and cholestasis in a 48-year-old female with psoriatic arthritis, receiving methotrexate and infliximab. The epidemiology, risk factors, clinical presentation, diagnosis, and treatment of histoplasmosis is discussed. Furthermore, we review the published cases of biopsy-proven disseminated histoplasmosis with cholestatic jaundice to highlight histoplasmosis involvement in the liver. CONCLUSION: Histoplasmosis should be considered in immunosuppressed patients with fever, chills, abdominal pain and cholestasis with progressive jaundice, particularly in subjects without evidence of biliary obstruction. Future studies are needed to accurately assess the risk of this fungal infection, specifically in patients on immunomodulatory therapy for autoimmune disease.