Relapsing Polychondritis with Chronic lymphocytic Leukemia: Case Report

Background: Relapsing polychondritis is an autoimmune rheumatic disease which is associated with malignant diseases, rarely CLL. Case Report: We report a case of a patient who presented with a new diagnosis of both relapsing polychondritis RP and chronic lymphocytic leukaemia (CLL). The patient is a 59-year-old woman who presented with : joint pain, skin discoloration, Swollen joints, and nose. Conclusion: Patients with RP should go further investigations to exclude malignant diseases. Objective: Rare disease

Pilot Assessment of a Rapid Test for the Detection of COVID-19 Disease by Using Latex Agglutination

The rapid spread of the SARS-CoV-2 virus, which was declared a pandemic by the WHO in March 2020, has forced the scientific community to develop rapid detection tests in order to detect positive cases and implement the containment measures established in each country. In this regard, the techniques used (RTPCR, antibody test, etc.) have a number of drawbacks: require specialized personnel, in addition to, in some cases, obtaining results after 24 hours. Agglutination tests, widely used in the detection of viral particles, represent a simple, inexpensive and scalable method that would allow screening studies to be carried out in large populations. In this paper, we present a SARS-CoV-2 detection test based on this methodology, which could be considered as a complementary method to the techniques used for the detection of SARSCoV-2.

Impact of Second Wave of COVID-19 Pandemic: A Systematic Report of Tri-City Region of Chandigarh

The second wave of COVID-19 pandemic has blown the tri-city of Chandigarh with terrible shock waves among the residents. Being one of the top-notch per capita income cities in India, Chandigarh was found to be more vulnerable in this second wave of COVID-19 pandemic. This second wave of pandemic has caused high inflow of patients from nearby states and produced supplementary burden on the health care facilities in the city beautiful. The central aim of this work is to highlight the impact of this second wave of pandemic on the health of residents. The study represents the impact of second wave of COVID-19 on tri-city of Chandigarh by focusing on the main points of, (1) reported active cases from February to May, 2021, (2) number of deaths during this phase, (3) challenges faced during this time and (4) management and governance measures during this time. This kind of study helps to comprehend the impacts of second wave on Chandigarh and emphasized on the major lessons that can be learned during this phase. In one hand the study discussed the vulnerable impact of pandemic on clinical and economical situation of city, whereas on other hand it explains the timely measures taken by the administration to curb the surge of this second wave. Overall, this second wave of pandemic lead to an outstanding opening for tri-city planners and policy architectures to take necessary and timely actions towards making the city more susceptibility to pandemics.

The Current Role of Immunotherapy in mCRPC: A Systematic Review

Background: The development of immunotherapy has shown promising results in several malignant diseases, including prostate cancer, calling for a systematic review of the current literature. This review aims to evaluate the present data and prospects of immune checkpoint inhibitors in metastatic Castration Resistant Prostate Cancer (mCRPC). Methods: Articles were identified via a systematic search of the electronic database Pubmed, in accordance with the PICO process and following the PRISMA guidelines. Articles in English studying immune checkpoint inhibitors in patients with mCRPC published between March 2010 and March 2020 were eligible for inclusion. Endpoints of interest were Overall Survival (OS), Progression-Free Survival (PFS), clinical Overall Response Rate (ORR), and Prostate-Specific Antigen (PSA) response rate. Results: Ten articles were identified as eligible for inclusion. The studies primarily explored the use of Ipilimumab, a CTLA-4 inhibitor, and Pembrolizumab, a PD-1 inhibitor. These drugs were both used either as monotherapy or in combination with other treatment modalities. The largest trial included in the review demonstrated no significant difference in overall survival between the intervention and placebo. However, two studies presented promising data combing immunotherapy and immune vaccines. Grade 3 and 4 adverse events ranging from 10.1% to 82.3%, whit diarrhea, rash, and fatigue were the most frequently reported. Forty relevant ongoing trials were identified exploring immunotherapy with or without a parallel treatment modality. Conclusion: Overall, the current data shows that the effect of immune checkpoint inhibitors as monotherapy may have limited impact on mCRPC, and the results from ongoing combinational trials are eagerly awaited.

Screening for HNF1B Gene Mutations, in Four People with Typical Diabetes MODY5 Clinical Characteristics

Introduction: people with clinical characteristics of MODY benefit with a correct genetic diagnosis and are often only studied if having family history. In this work there were studied four people selected per their clinical characteristics of genitourinary abnormalities and MODY Diabetes, using the worldwide inclusion criteria for MODY5 except for a family history of diabetes or kidney disease. Methods: gene mutation screening in four people with clinical characteristics of MODY5 in search for alterations in the HNF1B gene with Sanger or NGS sequencing, and bioinformatic tools to analyze the results of the sequences. Results: from four people studied we found three mutations in the HNF1B gene, including a missense mutation previously described and two de novo whole gene deletions. The other person did not present any alteration in that gene even having clinical characteristics. Conclusions: people with clinical characteristics of MODY and having pancreatic, renal, kidney or genital located abnormalities are candidates for genetic screening of HNF1B. Yet, genetic screening of HNF1B should not only be restricted to such people but should also be considered in people without diabetes but having those other characteristics. We suggest also, the study of people even in the absence of family history, given that the possibility of occurrence of de novo mutations is underestimated.

Intra-Vitreous Injections of Bevacizumab in Choroidal Neovascularization Complicating Best Vitelliform Macular Dystrophy: Case Report of a Child

A 15-year-old child followed for Best vitelliform macular dystrophy presented to the clinic with an abrupt visual impairment of his left eye. Fundus examination showed bilateral vitelliform lesions, with serous retinal detachment and adjacent retinal hemorrhage in the left eye. Fluorescein angiography and optical coherence tomography confirmed the diagnosis of type-2 choroidal neovascularization complicating the Best disease. The juxtafoveal location of the choroidal neovascularization prompted us to realize monthly intra-vitreous injections of bevacizumab. After the fourth injection, we observed visual and anatomical improvement that remained stable after a 12-month follow-up. It’s important to look for complications in front of a sudden decrease in visual acuity in Best disease.

Intraoperative Spinal Cord Remote Monitoring with a Modified US A-Scope

Materials and Methods: The motivation for this feasibility study were: (i) to modify the ultrasonic A-scope in order to monitor remotely, intraoperatively and in real-time tumor’s depth and size, before cutting its dura and to control tumor’s residual thickness while its resection and (ii) to demonstrate these abilities during several spinal-cord surgeries. Results: The ultrasonic A-scope was modified for these purposes, to a noncontact, intraoperative and real-time device. It was successfully applied during several human spinal cord clinical trials. Its data were compared with those of a pre-operative MRI (of the same person), where a good similarity was obtained between them, with a difference less than 1mm, in most cases. Conclusions: The modified A-Scope advantages: (i) remote, intraoperative and real-time monitoring; (ii) accurate and objective data was obtained; (iii) there is no direct contact between the US transducer and the monitored tissue, as the ultrasound propagates through a free stream of normal saline; (iv) the length of the free stream is few mm, at least; (v) the handpiece enables to monitor in a confined area, as it has a small foot-print; (vi) it is simple to operate the device; (vii) it enables to define intraoperatively tumor edges, before cutting and opening the dura. Consequently, this modified device seems to be a valuable and useful tool to define intraoperatively tumor’s location and its complete removal and reducing potential damages to healthy tissues surrounding it.

Refractory Thrombocytopenia Associated to Disseminated Histoplasmosis in a Living-Related Renal Transplant Recipient: A Case Report and Review of the Literature

Opportunistic infections are frequent complications after renal transplantation because of the use of immunosuppressants. Disseminated Histoplasmosis (DH) is one such opportunistic infection, and its clinical presentation varies, which makes its diagnosis a challenge. There is no information regarding DH as a cause of refractory thrombocytopenia in renal transplant recipient (RTR); therefore, we consider this an atypical case, and, because of its clinical characteristics, we have classified it as an Immune Thrombocytopenic Purpura (ITP) induced by histoplasmosis. This is the first case reported in our milieu, and it opens up the possibility for use of intravenous immunoglobulin as a strategic therapy for thrombocytopenia induced by HP in immunosuppressed RTRs.

BCG Vaccine Induced Tuberculous Osteomyelitis of Left Distal Femur in a Young Child: Case Report and Literature Review

Tuberculosis (TB) is an essential problem for healthcare systems especially in developing countries. TB continues to pose a significant global health burden [1]. Bacillus Calmette-Guérin (BCG) is an important vaccine used to prevent Tuberculosis (TB), especially meningeal TB and disseminated TB disease in children [2]. BCG is prepared from live bovine tuberculosis bacillus, and is given to protect against TB. Although vaccination against TB by means of BCG is widespread all over the world and is generally considered to be safe, but serious adverse reactions can occur. These may be minor such as abscess formation or skin ulceration at the site of vaccination to major adverse reaction such as fatal disseminated infection especially in patients with immune deficiency [3]. These adverse reactions after BCG vaccination depend on the BCG dose, vaccine strain, vaccine administration method, injection technique, and recipient’s underlying immune status [4]. The aim of this case report is to point out that clinical suspicion of BCG-induced osteomyelitis is warranted in pediatric patients with chronic symptoms of pain, limping, swelling and a limited ROM in the extremity. We also aimed to remind that imaging and culture studies may guide the clinician although tissue biopsies and genetic tests can confirm the histopathology and to review related articles.

Optimal Time Period of Wearing Protective Collar after Anterior Cervical Discectomy and Fusion

Objective: There is still no consensus on the time period of wearing protective collar after Anterior Cervical Discectomy and Fusion (ACDF). We aim to investigate the optimal time period of wearing collar after ACDF. Methods: We retrospectively reviewed patients with cervical spondylosis who underwent one or two segment ACDF during January 2016 and December 2017, and included 97 patients who met inclusion and exclusion criteria. Patients were divided into three groups, 1-4 week group, 5-8 week group and 9-12 week group, according to the actual time period of wearing collar after ACDF. We analyzed Japanese Orthopedic Association (JOA) score, Axial Symptom (AS) score and Neck Disability Index (NDI) before surgery and at post-operative 3 months to investigate the optimal time period of wearing collar after ACDF procedure. Results: 1) JOA score: All three groups have a better post-operative JOA score compared with that before surgery (paired t test, p<0.05). There is no significant difference among the three groups with respect to post-operative JOA (ANOVA, p>0.05). 2) AS score: The post-operative AS scores of 1-4 week group and 5-8 week group were significantly better than that before surgery (paired t test, p>0.05). While the post-operative AS score of 9-12 week group was significantly worse than preoperative AS score (paired t test, p<0.05). 3) NDI: All three groups have a better post-operative NDI compared with that before surgery (McNemar test, p<0.05). Of note, in 5-8 weeks group, the percentage of no deficit increased by 45%, and the percentage of mild deficit decreased by 45% accordingly. That percentage is 26% and 31% in 1-4 week group and 9-12 week group, respectively. There was significant difference among these three groups (Fisher’s exact probability test, p<0.05). Conclusion: For cervical spondylosis patients who underwent 1 or 2 segment ACDF, the optimal time period of wearing protective is 5-8 weeks. This time period results in comparable neurological outcome, least risk of axial symptoms, and highest chance of no deficit with neck function.