Acute Disseminated Encephalomyelitis and Acute Encephalitis Following Vaccination Against SARS-CoV-2: Two Case Reports and Review of Literature

The spectrum of severe neurological complications following COVID-19 vaccination includes cerebrovascular events, inflammatory diseases of the CNS, cranial and peripheral nerve involvement and muscle affections. Post-vaccinal acute disseminated encephalomyelitis (ADEM) and acute encephalitis are rare. We report on a patient suffering from acute encephalitis and another with post-vaccinal monophasic ADEM. Beside imaging features typical for acute autoimmune associated inflammation, cranial MRI disclosed also transient haemorrhagic signal alterations in some cerebral lesions. To our best knowledge, this has not been mentioned before in literature. Competing causes were excluded by extensive laboratory investigations including serial CSF analysis. In line with the literature, repeated iv high-dosage corticosteroid therapy resulted in impressive improvement of neurological symptoms in both patients.

Helicobacter pylori Type IV Secretion System and Its Adhesin Subunit, CagL, Mediate Potent Inflammatory Responses in Primary Human Endothelial Cells

The Gram-negative bacterium, Helicobacter pylori, causes chronic gastritis, peptic ulcers, and gastric cancer in humans. Although the gastric epithelium is the primary site of H. pylori colonization, H. pylori can gain access to deeper tissues. Concurring with this notion, H. pylori has been found in the vicinity of endothelial cells in gastric submucosa. Endothelial cells play crucial roles in innate immune response, wound healing and tumorigenesis. This study examines the molecular mechanisms by which H. pylori interacts with and triggers inflammatory responses in endothelial cells. We observed that H. pylori infection of primary human endothelial cells stimulated secretion of the key inflammatory cytokines, interleukin-6 (IL-6) and interleukin-8 (IL-8). In particular, IL-8, a potent chemokine and angiogenic factor, was secreted by H. pylori-infected endothelial cells to levels ~10- to 20-fold higher than that typically observed in H. pylori-infected gastric epithelial cells. These inflammatory responses were triggered by the H. pylori type IV secretion system (T4SS) and the T4SS-associated adhesin CagL, but not the translocation substrate CagA. Moreover, in contrast to integrin α5β1 playing an essential role in IL-8 induction by H. pylori upon infection of gastric epithelial cells, both integrin α5β1 and integrin αvβ3 were dispensable for IL-8 induction in H. pylori-infected endothelial cells. However, epidermal growth factor receptor (EGFR) is crucial for mediating the potent H. pylori-induced IL-8 response in endothelial cells. This study reveals a novel mechanism by which the H. pylori T4SS and its adhesin subunit, CagL, may contribute to H. pylori pathogenesis by stimulating the endothelial innate immune responses, while highlighting EGFR as a potential therapeutic target for controlling H. pylori-induced inflammation.

The Helicobacter pylori cytotoxin CagA is essential for suppressing host heat shock protein expression

Bacterial infections typically elicit a strong Heat Shock Response (HSR) in host cells. However, the gastric pathogen Helicobacter pylori has the unique ability to repress this response, the mechanism of which has yet to be elucidated. This study sought to characterize the underlying mechanisms by which H. pylori down-modulates host HSP expression upon infection. Examination of isogenic mutant strains of H. pylori defective in components of the type IV secretion system (T4SS), identified the secretion substrate, CagA, to be essential for down-modulation of the HSPs HSPH1 (HSP105), HSPA1A (HSP72), and HSPD1 (HSP60) upon infection of the AGS gastric adenocarcinoma cell line. Ectopic expression of CagA by transient transfection was insufficient to repress HSP expression in AGS or HEK293T cells, suggesting that additional H. pylori factors are required for HSP repression. RT-qPCR analysis of HSP gene expression in AGS cells infected with wild-type H. pylori or isogenic cagA-deletion mutant found no significant change to account for reduced HSP levels. In summary, this study identified CagA to be an essential bacterial factor for H. pylori-mediated suppression of host HSP expression. The novel finding that HSPH1 is down-modulated by H. pylori further highlights the unique ability of H. pylori to repress the HSR within host cells. Elucidation of the mechanism by which H. pylori achieves HSP repression may prove to be beneficial in the identification of novel mechanisms to inhibit the HSR pathway and provide further insight into the interactions between H. pylori and the host gastric epithelium.

Tessier number 30 clefts with congenital heart defects

Introduction:

Midline cleft of mandible, classified as Tessier 30 clefts is extremely rare, with less than 100 reported cases in the latest studies. Variations in severity and associated malformations have been reported before.

Case Presentation:

In this report, we present the first documented Iranian case of Tessier 30 with median cleft of lower lip and bifid tongue concomitant with congenital heart defects.

Conclusions:

We explain embryologic origin, differential diagnosis, other associated anomalies and its treatment by reviewing literature.

The correlation of serum estrogens and androgens with bone density in the late postmenopause

A pilot group of 16 women in the late postmenopause were evaluated for bone density by computerized axial tomography (CT) scanning and for hormonal milieu. A highly statistically significant positive correlation between lumbar-3 spongiosum density and both dehydroepiandrosterone-sulfate (DHEA-S), r = 0.67; P less than 0.005 and androstenedione (A), r = 0.56; P less than 0.03 was found. No such correlations were observed with estradiol (E2), estrone (E1) or an array of other hormones. The results of this preliminary report indicate a clear association of weak androgens with bone density in the late postmenopause.

Neurogenic pulmonary edema

Neurogenic pulmonary edema, although not frequently seen, is extremely important in the differential diagnosis of pulmonary edema. Often the diagnosis is suggested by roentgenogram and clinical history and effective therapy can therefore be instituted.

Tracheoesophageal fistula secondary to esophageal carcinoma presenting with aspiration pneumonia

Tracheoesophageal fistulas should be suspected in patients with recurring chronic aspiration pneumonitis. They are most often secondary to intrathoracic malignancies. A case report of a patient with this disorder is presented, along with a review of pertinent literature.

An unusual angiographic appearance of aorto-iliac disease presenting as the Leriche syndrome

An unusual angiographic presentation of Leriche syndrome is described that demonstrates short segment occlusions of iliac arteries with bilaterally symmetrical post-stenotic dilatations.

Pulmonary sequestration

Pulmonary sequestration is a disturbance in embryonic development that results in a cystic mass of nonfunctioning lung tissue. The authors present a case of this disorder and review the pertinent literature.

Addison's disease due to metastatic carcinoma: the value of CT scan

A case of Addison's disease secondary to bilateral adrenal metastasis is reported. The adrenal metastasis were secondary to bronchogenic carcinoma and the diagnosis was made on the basis of the CT scan. The role of CT in the diagnosis of adrenal disease as well as the importance of including the adrenals in the chest CT scan for preoperative staging of bronchogenic carcinoma is discussed.

Anencephaly: agent orange implications?

A case of anencephaly is presented and the question of its association with Dioxin ("agent orange") is raised.

Accidental overdose intoxication: a hazard of drug smuggling

Three patients involved in illicit drug smuggling via the swallowing of high dose, high purity drugs packed in multiple condoms are reported. Two of these patients experienced drug overdose symptoms due to leakage or rupture of the condoms in the GI tract. They were treated successfully.

Demonstration of pericardial effusion by real-time ultrasonography

Pericardial effusion has a variety of causes. Among these, inflammatory processes are the most common. Traditionally x-rays, isotopic scanning, carbon dioxide injection, and M-mode echocardiography have been used for evaluation of pericardial effusion. The most recent advance in real time scanning enables the examiner to more completely and more accurately evaluate and serially investigate pericardial effusions through a noninvasive technique.

Congenital cleidodysostosis

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Ultrasonic diagnosis and aspiration of loculated pleural effusion

A method of localizing and evacuating pleural effusions under visual control is described which in the author's opinion is an improvement and enhancement over current procedures. This method is easy, rapid, safe and causes no distress to the patient. On many occasions, failures at puncture of loculated fluid by conventional methods can successfully be accomplished under ultrasonic guidance.

Notching of ribs: a new roentgenographic finding in Down's syndrome

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A dramatic response of laryngeal tumor to radiation therapy

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