Pellagra is a disease largely associated with alcohol abuse, poverty, and malnutrition and is very common in developing countries. However, in the wake of "slimmer is better" fads and the ever-growing population of patients infected with human immunodeficiency virus, it may be on the surge in the United States. This vitamin deficiency disorder, though easy to diagnose and treat, can be easily missed and requires a high index of suspicion. We describe a case involving a patient who presented with the classic triad of "diarrhea, dermatitis, and dementia" and was promptly diagnosed and appropriately treated.

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simvastatin-induced (5 mM, 16 hours) Rac activation was markedly attenuated in ECs transfected with siRNA specific for integrin b4 (38% decrease), with no change in total Rac noted. Additionally, LPSinduced (5 mg/mL, 10 minutes) Erk phosphorylation was inhibited in ECs treated with simvastatin (5 mM, 16 hours), an effect that may contribute to the antiangiogenic properties of statins, whereas Erk phosphorylation was significantly enhanced in ECs transfected with integrin b4 siRNA (100% increase). Finally, RT-PCR confirmed that IL-8 RNA was markedly increased in integrin b4-silenced ECs compared with control cells (

IntroductionIntestinal helminth infestations are usually asymptomatic, but serious infestations may cause symptoms ranging from abdominal discomfort to severe pain. Anorexia, nausea, diarrhea, pruritus, rectal prolapse, bowel obstruction, and death may occur. Hives and eosinophilia may develop, and the worms may sometimes spontaneously exit the body through the anus. This is a case report of intestinal helminth infestation harboring the human intestine with four different parasites at the same time.Case ReportA 53-year-old male patient, a recent immigrant from Bangladesh, was admitted with progressively worsening generalized weakness and exertional dyspnea. Physical examination was unremarkable except for severe pallor. Rectal examination revealed brown stool, guaiac positive. Laboratory values were indicative of severe anemia, with hemoglobin 5.6 g/dL and hematocrit of 18.5%. Mean corpuscular volume was 56 fl. The patient also had significant eosinophilia (42%) on differential diagnosis, with an absolute eosinophil count of 42%. Iron studies revealed anemia consistent of iron deficiency. On further interview, the patient admitted abdominal discomfort associated with diarrhea and passage of worm through the anus in the past. Stool for ova and parasite revealed four different helminthes: Ascaris lumbricoides, Trichuris trichura, Strongyloides stercoralis, and Anchylostoma duodenale. The patient was treated with a 1-week course of albendazole. He received blood transfusion and was started on iron supplements. A follow-up examination of stool for ova and parasite was performed and was negative for ova and parasite. The patient also underwent a colonoscopy and upper endoscopy during the course and was negative for any lesions. The patient significantly improved during the hospital course, and hemoglobin reached to 10.4 mg/dL and hematocrit 31.1 with a mean corpuscular volume of 82.7.DiscussionIntestinal helminth infestations most commonly affect travelers, migrant laborers, refugees, children of foreign adoptions, and the homeless. Parasitic infections may be associated with daycare centers and overseas travel. Clinicians should have a high index of suspicion for parasite infestation as a cause of anemia in the immigrant population. A very simple test of stool for ova and parasite helps in the diagnostic workup of anemia.