Personalized clinical managements through exploring circulating neural cells and electroencephalography

BACKGROUND

Since an initial diagnosis of Alzheimer disease (AD) in 1907, early detection, was unavailable through 116 years. Up-regulation of V-Ets erythroblastosis virus E26 oncogene homolog 2 (Ets2) is capable to enhance neuronal susceptibility and degeneration. Protein expression (PE) of Ets2 has functional impact on AD and Down's syndrome, with diverse intensity. PE of Ets2 has an influential pathogenic impact on AD. Clinical aspects of neurological disorders directly interact with psychological maladies. However, deterioration requires an early management including programmed based protection.

AIM

To include cell biology in neuro-genetics; personalized, prognostics, predictive, preventive, predisposing (5xP) platform, accompanied by stratifying brain channels behavior pre- and post-intervention by light music in the AD-patients.

METHODS

Include exploration of PE assay and electroencephalography of brain channels. The processes are applied according to: (1) Triangle style, by application of cellular network; and (2) PE assay of Ets2 in the peripheral blood of the patients with AD, by Manual single cell based analysis, and Flow-cytometry. (1) Applying the Genetic counselling and pedigree analysis; (2) considering the psychological status of the referral cases; (3) considering the macro-and/or micro-environmental factors; (4) performing the required Genetics' analysis; and (5) applying the required complementary test(s).

RESULTS

PE of Ets2 has pathogenic role in AD. PE unmasked the nature of heterogeneity/diversity/course of evolution by exploring Ets2, D1853N polymorphism in Ataxia Telangiectasia mutated gene (ATM), vascular endothelial growth factor (VEGF), epidermal growth factor (EGF) and course of evolution at the single cell level of the brain. Ets2 revealed different cellular behavior in the blood and suggested the strategy as 'Gene Product-Based Therapy' and the personalized managements for the patients. PE reflected weak expression of ATM, mosaic pattern of Ets2; remarkable expression of VEGF and EGF by highlighting an early detective platform, considering circulating neural cells (CNCs) and the required molecular investigation, for the target individual(s) predisposed to AD or other neural disease including brain neoplasia. Brain channels-cooperation with diverse/interactive-ratios lead to strategic balancing for improving the life-quality in AD.

CONCLUSION

We highlighted application of the single CNCs and correlated Ratio based between Brain channels by providing the 5xP personalized clinical management model for an early detection and therapy of the patients with AD and their targeted/predisposed relatives. Novel-evolutionary/hypothetic/heterogenic-results in brain-channels offer personalizd/constructive markers with unlimited cooperation in health and disease.

Ophthalmologic implications to consider when using hydroxychloroquine to treat COVID-19 and induced arthritis

As the world continues to grapple with the novel coronavirus [coronavirus disease 2019 (COVID-19)], many treatments have been proposed to help alleviate the symptoms and reduce the mortality rate. Hydroxychloroquine (HCQ) is an antimalarial drug that is typically used for several autoimmune, rheumatic, and dermatological conditions. It has also been considered to treat and prevent COVID-19 and subsequent arthritis associated with the infection. This drug is known to cause retinal toxicity, which can lead to vision impairment or loss. While the exact mechanism is not yet fully understood, it is thought to be due to the accumulation of the drug in the retinal pigment epithelium. The risk of toxicity increases with long-term use or with high doses of the drug and is more likely to occur in patients with pre-existing retinal diseases or those who are predisposed to retinal diseases. In this context, several steps can be taken to monitor and minimize the risk of ophthalmological adverse events when using HCQ to treat patients with COVID-19.

Neurologic orphan diseases: Emerging innovations and role for genetic treatments

Orphan diseases are rare diseases that affect less than 200000 individuals within the United States. Most orphan diseases are of neurologic and genetic origin. With the current advances in technology, more funding has been devoted to developing therapeutic agents for patients with these conditions. In our review, we highlight emerging options for patients with neurologic orphan diseases, specifically including diseases resulting in muscular deterioration, epilepsy, seizures, neurodegenerative movement disorders, inhibited cognitive development, neuron deterioration, and tumors. After extensive literature review, gene therapy offers a promising route for the treatment of neurologic orphan diseases. The use of clustered regularly interspaced palindromic repeats/Cas9 has demonstrated positive results in experiments investigating its role in several diseases. Additionally, the use of adeno-associated viral vectors has shown improvement in survival, motor function, and developmental milestones, while also demonstrating reversal of sensory ataxia and cardiomyopathy in Friedreich ataxia patients. Antisense oligonucleotides have also been used in some neurologic orphan diseases with positive outcomes. Mammalian target of rapamycin inhibitors are currently being investigated and have reduced abnormal cell growth, proliferation, and angiogenesis. Emerging innovations and the role of genetic treatments open a new window of opportunity for the treatment of neurologic orphan diseases.

Update on hydroxychloroquine use in pregnancy

It is well-known that hydroxychloroquine (HCQ) treats malaria, systemic lupus erythematosus, and rheumatoid arthritis in women for its immunomodulatory and anti-inflammatory action. Additionally, HCQ was used in cases with refractory antiphospholipid syndrome. HCQ safety was reinforced in pregnant women owing to insignificant reports of adverse pregnancy outcomes and major congenital malformation. Recently, HCQ was tested in cases with chronic placental inflammation with a promising result of increased life birth; however, its benefit needs further validation. We aimed to highlight the recent updates for HCQ use in various conditions in pregnancy.

Writing strategies for improving the access of medical literature

When conducting a literature review, medical authors typically search for relevant keywords in bibliographic databases or on search engines like Google. After selecting the most pertinent article based on the title’s relevance and the abstract’s content, they download or purchase the article and cite it in their manuscript. Three major elements influence whether an article will be cited in future manuscripts: the keywords, the title, and the abstract. This indicates that these elements are the “key dissemination tools” for research papers. If these three elements are not determined judiciously by authors, it may adversely affect the manuscript’s retrievability, readability, and citation index, which can negatively impact both the author and the journal. In this article, we share our informed perspective on writing strategies to enhance the searchability and citation of medical articles. These strategies are adopted from the principles of search engine optimization, but they do not aim to cheat or manipulate the search engine. Instead, they adopt a reader-centric content writing methodology that targets well-researched keywords to the readers who are searching for them. Reputable journals, such as Nature and the British Medical Journal, emphasize “online searchability” in their author guidelines. We hope that this article will encourage medical authors to approach manuscript drafting from the perspective of “looking inside-out.” In other words, they should not only draft manuscripts around what they want to convey to fellow researchers but also integrate what the readers want to discover. It is a call-to-action to better understand and engage search engine algorithms, so they yield information in a desired and self-learning manner because the “Cloud” is the new stakeholder.

Physiopathological mechanisms related to inflammation in obesity and type 2 diabetes mellitus

Overweight, obesity, and type 2 diabetes mellitus pose global health problems that are ever-increasing. A chronic low-grade inflammatory status and the presence of various pro-inflammatory markers either in circulation or within dysfunctional metabolic tissues are well established. The presence of these factors can, to some extent, predict disease development and progression. A central role is played by the presence of dysfunctional adipose tissue, liver dysfunction, and skeletal muscle dysfunction, which collectively contribute to the increased circulatory levels of proinflammatory factors. Weight loss and classical metabolic interventions achieve a decrease in many of these factors’ circulating levels, implying that a better understanding of the processes or even the modulation of inflammation may alleviate these diseases. This review suggests that inflammation plays a significant role in the development and progression of these conditions and that measuring inflammatory markers may be useful for assessing disease risk and development of future treatment methods.

Role of children in the Bulgarian COVID-19 epidemic: A mathematical model study

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic affects all aspects of our lives, including children. With the advancement of the pandemic, children under five years old are at increased risk of hospitalization relative to other age groups. This makes it paramount that we develop tools to address the two critical aspects of preserving children's health – new treatment protocols and new predictive models. For those purposes, we need to understand better the effects of COVID-19 on children, and we need to be able to predict the number of affected children as a proportion of the number of infected children. This is why our research focuses on clinical and epidemiological pictures of children with heart damage post-COVID, as a part of the general picture of post-COVID among this age group.

AIM

To demonstrate the role of children in the COVID-19 spread in Bulgaria and to test the hypothesis that there are no secondary transmissions in schools and from children to adults.

METHODS

Our modeling and data show with high probability that in Bulgaria, with our current measures, vaccination strategy and contact structure, the pandemic is driven by the children and their contacts in school.

RESULTS

This makes it paramount that we develop tools to address the two critical aspects of preserving children's health – new treatment protocols and new predictive models. For those purposes, we need to understand better the effects of COVID-19 on children, and we need to be able to predict the number of affected children as a proportion of the number of infected children. This is why our research focuses on clinical and epidemiological pictures of children with heart damage post-COVID, as a part of the general picture of post-Covid among this age group.

CONCLUSION

Our modeling rejects that hypothesis, and the epidemiological data supports that. We used epidemiological data to support the validity of our modeling. The first summer wave in 2020 from the listed here school proms endorse the idea of transmissions from students to teachers.

Correction to “Performance of a serological IgM and IgG qualitative test for COVID-19 diagnosis: An experimental study in Brazil”

Correction to “Freire de Melo F, Martins Oliveira Diniz L, Nélio Januário J, Fernando Gonçalves Ferreira J, Dórea RSDM, de Brito BB, Marques HS, Lemos FFB, Silva Luz M, Rocha Pinheiro SL, de Magalhães Queiroz DM. Performance of a serological IgM and IgG qualitative test for COVID-19 diagnosis: An experimental study in Brazil. World J Exp Med 2022; 12(5): 100-103 [PMID: 36196438 DOI: 10.5493/wjem.v12.i5.100]”. In this article, we identified an issue with the “Acknowledgments” section. Here, we then provide a recognition section for our supporting institutions.

Proportion of thyroid cancer and other cancers in the democratic republic of Congo

BACKGROUND

Cancer diagnosis is increasing around the world and in the Democratic Republic of the Congo (DRC). The proportion of thyroid cancer has increased over the past three decades. There are very few studies on cancer epidemiology, and in particular on thyroid cancer in the DRC.

AIM

To establish the most recent proportion of thyroid cancer in the DRC compared to other cancers.

METHODS

This is a retrospective and descriptive study of 6106 consecutive cancer cases listed in the pathological registers of 4 Laboratories in the city of Kinshasa. This study included all cancer cases recorded in the registers between 2005 and 2019.

RESULTS

From a sample of 6106 patients, including all cancer types, 68.3% cases were female and 31.7% were male. Breast and cervical cancer were the most common types of cancer in women and, prostate and skin cancer were the most common types in men. Thyroid cancer was sixth in proportion in women and eleventh in men compared to all cancers. Papillary carcinoma was the most common of thyroid cancers. Rare cancers such as anaplastic and medullary thyroid carcinomas had a proportion of 7% and 2%, respectively.

CONCLUSION

Newer diagnostic tools led to a surge in cancer diagnoses in the DRC. Thyroid cancer has more than doubled its proportion over the last several decades in the country.

Melatonin’s actions are not limited to sleep

Melatonin is widely available as a supplement, usually for sleep disorders. The consumption of melatonin supplements has increased considerably in recent years. An overlooked aspect of melatonin’s administration is the resulting increase in prolactin secretion, via its action on hypothalamic dopaminergic neurons. We believe that since the effect of melatonin on prolactin is tangible, the laboratory finding of hyperprolactinemia could be encountered more often, given the increase in melatonin’s use. This is an issue that merits further study.

Fertility outcomes following bariatric surgery

Obesity impacts human health in more than one way. The influence of obesity on human reproduction and fertility has been extensively examined. Bariatric surgery (BS) has been used as an effective tool to achieve long-term weight loss in both sexes. BS improves hormonal profiling, increasing the odds of spontaneous pregnancy and success rates following assisted reproductive techniques in infertile females. For obese males, BS does improve sexual function and hormonal profile; however, conflicting reports discuss reduced sperm parameters following BS. Although the benefits of BS in the fertility field are acknowledged, many areas call for further research, like choosing the safest surgical techniques, determining the optimal timing to get pregnant, and resolving the uncertainty of sperm parameters.

Can hydroxychloroquine be used for COVID-19-induced arthritis? A debatable hypothesis

Hydroxychloroquine (HCQ) is a known disease-modifying antirheumatic drug for rheumatoid arthritis. It is also being used in viral arthritis on many occasions. HCQ is also being used to treat coronavirus disease 2019, but the results are not satisfactory. HCQ has been shown to have antiviral effects. In this context, we have a hypothesis that HCQ may be used as a treatment option in post-coronavirus disease 2019 arthritis.

Diet and nutrition against inflammatory bowel disease: Trick or treat(ment)?

Even if the relationships between nutrition and inflammatory bowel disease (IBD) remain underexplored, the current literature is providing, day by day, much more evidence on the effects of various diets in both prevention and treatment of such illnesses. Wrong dietary habits, together with other environmental factors such as pollution, breastfeeding, smoke, and/or antibiotics, are among the theoretical pathogenetic causes of IBD, whose multifactorial aetiology has been already confirmed. While some of these risk factors are potentially reversible, some others cannot be avoided, and efficient treatments become necessary to prevent IBD spread or recurrence. Furthermore, the drugs currently available for treatment of such disease provide low-to-no effect against the symptoms, making the illnesses still strongly disabling. Whether nutrition and specific diets will prove to effectively interrupt the course of IBD has still to be clarified and, in this sense, further research concerning the applications of such dietary interventions is still needed.

Performance of a serological IgM and IgG qualitative test for COVID-19 diagnosis: An experimental study in Brazil

Qualitative antibody tests are an easy, point-of-care diagnostic method that is useful in diagnosing coronavirus disease 2019, especially in situations where reverse transcription-polymerase chain reaction is negative. However, some factors are able to affect its sensitivity and accuracy, which may contribute to these tests not being used as a first-line diagnostic tool.

Bariatric surgery outcomes following organ transplantation: A review study

Weight gain is a frequent postoperative complication following a solid organ transplant which can be solved by bariatric surgery. The outcomes of bariatric surgery among patients with an organ transplant history are always a challengeable subject for surgeons and surgery candidates. In this review article, we aim to investigate the existence literature about the rates of morbidity and mortality, frequent complications in terms of graft function, remission in diabetes, hypertension, pulmonary and cardiovascular disorders, hepatic and renal functions, and immunosuppressive stability, as well as the safety of bariatric surgery among patients.

Complement-mediated microvascular injury and thrombosis in the pathogenesis of severe COVID-19: A review

Coronavirus disease 2019 (COVID-19) causes acute microvascular thrombosis in both venous and arterial structures which is highly associated with increased mortality. The mechanisms leading to thromboembolism are still under investigation. Current evidence suggests that excessive complement activation with severe amplification of the inflammatory response (cytokine storm) hastens disease progression and initiates complement-dependent cytotoxic tissue damage with resultant prothrombotic complications. The concept of thromboinflammation, involving overt inflammation and activation of the coagulation cascade causing thrombotic microangiopathy and end-organ damage, has emerged as one of the core components of COVID-19 pathogenesis. The complement system is a major mediator of the innate immune response and inflammation and thus an appealing treatment target. In this review, we discuss the role of complement in the development of thrombotic microangiopathy and summarize the current data on complement inhibitors as COVID-19 therapeutics.

Comparative evaluation of effect of injectable platelet-rich fibrin with collagen membrane compared with collagen membrane alone for gingival recession coverage

BACKGROUND

Collagen membrane and platelet-rich fibrin (PRF) have emerged as vital biomaterials in the field of periodontal regeneration. Minimally invasive techniques are being preferred by most periodontists, as it is patient compliant with fewer post-surgical complications as compared to conventional surgical techniques. Thus, in this study we have evaluated the effect of injectable PRF (i-PRF) with collagen membrane compared with collagen membrane alone using vestibular incision subperiosteal tunnel access (VISTA) technique for gingival recession coverage.

AIM

To compare the efficacy of VISTA using collagen membrane with collagen membrane soaked in injectable PRF for gingival recession coverage.

METHODS

A split mouth randomized controlled clinical trial was designed;13 subjects having at least 2 teeth indicated for recession coverage were enrolled in this study. The sites were randomly assigned to control group (VISTA using collagen membrane alone) and the test group (VISTA using collagen membrane with i-PRF). The clinical parameters assessed were pocket depth, recession depth (RD), recession width (RW), relative attachment level, keratinised tissue width (KTW), keratinised tissue thickness (KTT), and percentage root coverage.

RESULTS

RD showed a statistically significant difference between the test group at 3 mo (0.5 ± 0.513) and 6 mo (0.9 ± 0.641) and the control group at 3 mo (0.95 ± 0.51) and 6 mo (1.5 ± 0.571), with P values of 0.008 and 0.04, respectively. RW also showed a statistically significant difference between the test group at 3 mo (1 ± 1.026) and 6 mo (1.65 ± 1.04) and the control group at 3 mo (1.85 ± 0.875) and 6 mo (2.25 ± 0.759), with P values of 0.008 and 0.001, respectively. Results for KTW showed statistically significant results between the test group at 1 mo (2.85 ± 0.489), 3 mo (3.5 ± 0.513), and 6 mo (3.4 ± 0.598) and the control group at 1 mo (2.45 ± 0.605), 3 mo (2.9 ± 0.447), and 6 mo (2.75 ± 0.444), with P values of 0.04, 0.004, and 0.003, respectively. Results for KTT also showed statistically significant results between test group at 1 mo (2.69 ± 0.233), 3 mo (2.53 ± 0.212), and 6 mo (2.46 ± 0.252) and the control group at 1 mo (2.12 ± 0.193), 3 mo (2.02 ± 0.18), and 6 mo (1.91 ± 0.166), with P values of 0.001, 0.001, and 0.001, respectively. The test group showed 91.6%, 81.6%, and 67% root coverage at 1 mo, 3 mo, and 6 mo, while the control group showed 82.3%, 66.4%, and 53.95% of root coverage at 1 mo, 3 mo, and 6 mo, respectively.

CONCLUSION

The use of minimally invasive VISTA technique along with collagen membrane and injectable form of platelet-rich fibrin can be successfully used as a treatment method for multiple or isolated gingival recessions of Miller’s class-I and class-II defects.

Use of hydroxychloroquine and azithromycin combination to treat the COVID-19 infection

Coronavirus disease 2019 (COVID-19) infection is unequivocally the worst crisis in recent decades, which is caused by a severe acute respiratory virus 2. Currently, there is no effective therapy for the COVID-19 infection. Different countries have different guidelines for treating COVID-19 in the absence of an approved therapy for COVID-19. Therefore, there is an imminent need to identify effective treatments, and several clinical trials have been conducted worldwide. Both hydroxychloroquine [HCQS], chloroquine, and azithromycin (AZ) have been widely used for management based on in vitro studies favoring antiviral effects against the COVID-19 virus. However, there is evidence both in favor and against the use of hydroxychloroquine and azithromycin (HCQS+AZ) combination therapy to manage the COVID-19 infection. The combination of hydroxychloroquine and azithromycin was significantly associated with increased adverse events. However, the inference of these findings was from observational studies. Therefore, large randomized trials are imperative to show the future path for the use of HCQS+AZ combination therapy. However, owing to the ban on HCQS use in COVID-19, this may no longer be essential. This review is on the pharmacology, trials, regimens, and side effects of hydroxychloroquine and azithromycin combination therapy.

Concise review of radiosurgery for contemporary management of pilocytic astrocytomas in children and adults

Pilocytic astrocytoma (PA) may be seen in both adults and children as a distinct histologic and biologic subset of low-grade glioma. Surgery is the principal treatment for the management of PAs; however, selected patients may benefit from irradiation particularly in the setting of inoperability, incomplete resection, or recurrent disease. While conventionally fractionated radiation therapy has been traditionally utilized for radiotherapeutic management, stereotactic irradiation strategies have been introduced more recently to improve the toxicity profile of radiation delivery without compromising tumor control. PAs may be suitable for radiosurgical management due to their typical appearance as well circumscribed lesions. Focused and precise targeting of these well-defined lesions under stereotactic immobilization and image guidance may offer great potential for achieving an improved therapeutic ratio by virtue of radiosurgical techniques. Given the high conformality along with steep dose gradients around the target volume allowing for reduced normal tissue exposure, radiosurgery may be considered a viable modality of radiotherapeutic management. Another advantage of radiosurgery may be the completion of therapy in a usually shorter overall treatment time, which may be particularly well suited for children with requirement of anesthesia during irradiation. Several studies have addressed the utility of radiosurgery particularly as an adjuvant or salvage treatment modality for PA. Nevertheless, despite the growing body of evidence supporting the use of radiosurgery, there is need for a high level of evidence to dictate treatment decisions and establish its optimal role in the management of PA. Herein, we provide a concise review of radiosurgery for PA in light of the literature.

Machine learning algorithm using publicly available echo database for simplified “visual estimation” of left ventricular ejection fraction

BACKGROUND

Left ventricular ejection fraction calculation automation typically requires complex algorithms and is dependent of optimal visualization and tracing of endocardial borders. This significantly limits usability in bedside clinical applications, where ultrasound automation is needed most.

AIM

To create a simple deep learning (DL) regression-type algorithm to visually estimate left ventricular (LV) ejection fraction (EF) from a public database of actual patient echo examinations and compare results to echocardiography laboratory EF calculations.

METHODS

A simple DL architecture previously proven to perform well on ultrasound image analysis, VGG16, was utilized as a base architecture running within a long short term memory algorithm for sequential image (video) analysis. After obtaining permission to use the Stanford EchoNet-Dynamic database, researchers randomly removed approximately 15% of the approximately 10036 echo apical 4-chamber videos for later performance testing. All database echo examinations were read as part of comprehensive echocardiography study performance and were coupled with EF, end systolic and diastolic volumes, key frames and coordinates for LV endocardial tracing in csv file. To better reflect point-of-care ultrasound (POCUS) clinical settings and time pressure, the algorithm was trained on echo video correlated with calculated ejection fraction without incorporating additional volume, measurement and coordinate data. Seventy percent of the original data was used for algorithm training and 15% for validation during training. The previously randomly separated 15% (1263 echo videos) was used for algorithm performance testing after training completion. Given the inherent variability of echo EF measurement and field standards for evaluating algorithm accuracy, mean absolute error (MAE) and root mean square error (RMSE) calculations were made on algorithm EF results compared to Echo Lab calculated EF. Bland-Atlman calculation was also performed. MAE for skilled echocardiographers has been established to range from 4% to 5%.

RESULTS

The DL algorithm visually estimated EF had a MAE of 8.08% (95%CI 7.60 to 8.55) suggesting good performance compared to highly skill humans. The RMSE was 11.98 and correlation of 0.348.

CONCLUSION

This experimental simplified DL algorithm showed promise and proved reasonably accurate at visually estimating LV EF from short real time echo video clips. Less burdensome than complex DL approaches used for EF calculation, such an approach may be more optimal for POCUS settings once improved upon by future research and development.

Comparison between SARS-CoV-2 positive and negative pneumonia in children: A retrospective analysis at the beginning of the pandemic

BACKGROUND

Even though coronavirus 2019 disease (COVID-19) clinical course in children is much milder than in adults, pneumonia can occur in the pediatric population as well. Here, we reported a single-center pediatric case series of COVID-19 from Kazakhstan during the first wave of pandemic.

AIM

To analyze the main clinical and laboratory aspects in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) positive and negative children diagnosed with pneumonia.

METHODS

This is a retrospective analysis of 54 children, who were medically assessed as close contacts of COVID-19 adults in their family setting, between June and September 2020. These children were all hospitalized: We compared the clinical and laboratory characteristics of children affected with pneumonia in the presence (group 1) or absence (group 2) of SARS-CoV-2 infection.

RESULTS

Overall, the main clinical manifestations at the admission were fever, cough, loss of appetite, fatigue/weakness, nasal congestion and/or rhinorrhea, and dyspnea. Based on the SARS-CoV-2 polymerase chain reaction (PCR) test, 24 positive children with pneumonia (group 1) and 20 negative children with pneumonia (group 2) were identified; 10 positive children did not show any radiological findings of pneumonia. No significant differences were found between the two pneumonia study groups for any clinical and laboratory parameters, except for C-reactive protein (CRP). Of course, both pneumonia groups showed increased CRP values; however, the COVID-19 pneumonia group 1 showed a significantly higher increase of CRP compared to group 2.

CONCLUSION

In our case series of children assessed for SARS-CoV-2 infection based on contact tracing, the acute inflammatory response and, in detail, CRP increase resulted to be more pronounced in COVID-19 children with pneumonia than in children with SARS-CoV-2-unrelated pneumonia. However, because of multiple limitations of this study, larger, controlled and more complete clinical studies are needed to verify this finding.

New translational and experimental insights into the role of pro-resolving lipid mediators in inflammatory bowel disease

The resolution of inflammation is an active process, guided by specialized pro-resolution lipid mediators (SPMs). These mediators originate from polyunsaturated fatty acids, such as omega-3. Sufficient evidence suggests that the beneficial effects attributed to omega-3 are, at least in part, the result of the immunomodulatory action of the SPMs, which act systemically by overcoming inflammation and repairing tissue damage, without suppressing the immune response. Recent studies suggest that an imbalance in the synthesis and/or activity of these compounds may be associated with the pathogenesis of several inflammatory conditions, such as inflammatory bowel disease (IBD). Thus, this review highlights the advances made in recent years with regard to the endo-genous synthesis and the biological role of lipoxins, resolvins, protectins, and maresins, as well as their precursors, in the regulation of inflammation; and provides an update on the participation of these mediators in the development and evolution of IBD and the therapeutic approaches that these immunomodulating substances are involved in this context.

Differential diagnosis and management of immune checkpoint inhibitor-induced colitis: A comprehensive review

Immune checkpoint inhibitors (ICIs) are a new class of cancer pharmacotherapy consisting of antibodies that block inhibitory immune regulators such as cytotoxic T lymphocyte antigen 4, programmed cell death 1 and programmed death-ligand 1. Checkpoint blockade by ICIs reactivates a tumor-specific T cell response. Immune-related adverse events can occur in various organs including skin, liver, and gastrointestinal tract. Mild to severe colitis is the most common side effect with some experiencing rapid progression to more serious complications including bowel perforation and even death. Prompt diagnosis and management of ICI-induced colitis is crucial for optimal outcome. Unfortunately, its clinical, endoscopic and histopathologic presentations are non-specific and overlap with those of colitis caused by other etiologies, such as infection, medication, graft-versus-host disease and inflammatory bowel disease. Thus, a definitive diagnosis can only be rendered after these other possible etiologies are excluded. Sometimes an extensive clinical, laboratory and radiologic workup is required, making it challenging to arrive at a prompt diagnosis. Most patients experience full resolution of symptoms with corticosteroids and/or infliximab. For ICI-induced colitis that is treatment-refractory, small scale studies offer alternative strategies, such as vedolizumab and fecal microbiota transplantation. In this review, we focus on the clinical features, differential diagnosis, and management of ICI-induced colitis with special attention to emerging treatment options for treatment-refractory ICI-induced colitis.

Emerging role of cell-free DNA in kidney transplantation

Monitoring kidney transplants for rejection conventionally includes serum creatinine, immunosuppressive drug levels, proteinuria, and donor-specific antibody (DSA). Serum creatinine is a late marker of allograft injury, and the predictive ability of DSA regarding risk of rejection is variable. Histological analysis of an allograft biopsy is the standard method for diagnosing rejection but is invasive, inconvenient, and carries risk of complications. There has been a long quest to find a perfect biomarker that noninvasively predicts tissue injury caused by rejection at an early stage, so that diagnosis and treatment could be pursued without delay in order to minimize irreversible damage to the allograft. In this review, we discuss relatively novel research on identifying biomarkers of tissue injury, specifically elaborating on donor-derived cell-free DNA, and its clinical utility.

Potential role of intermittent fasting on decreasing cardiovascular disease in human immunodeficiency virus patients receiving antiretroviral therapy

Cardiovascular disease (CVD) has become one of the commonest causes of comorbidity and mortality among People living with human immunodeficiency virus (HIV) (PLWH) on antiretroviral therapy (ART). Nearly 50% of PLWH are likely to have an increased risk of developing CVD, including coronary heart disease, cerebrovascular disease, peripheral artery disease and aortic atherosclerosis. Aside from the common risk factors, HIV infection itself and side effects of antiretroviral therapy contribute to the pathophysiology of this entity. Potential non-pharmacological therapies are currently being tested worldwide for this purpose, including eating patterns such as Intermittent fasting (IF). IF is a widespread practice gaining high level of interest in the scientific community due to its potential benefits such as improvement in serum lipids and lipoproteins, blood pressure (BP), platelet-derived growth factor AB, systemic inflammation, and carotid artery intima-media thickness among others cardiovascular benefits. This review will focus on exploring the potential role of intermittent fasting as a non-pharmacological and cost-effective strategy in decreasing the burden of cardiovascular diseases among HIV patients on ART due to its intrinsic properties improving the main cardiovascular risk factors and modulating inflammatory pathways related to endothelial dysfunction, lipid peroxidation and aging. Intermittent fasting regimens need to be tested in clinical trials as an important, cost-effective, and revolutionary coadjutant of ART in the fight against the increased prevalence of cardiovascular disease in PLWH.

Antenatal corticosteroids in COVID-19 perspective

The aim of this manuscript is to discuss the practice of antenatal corticosteroids administration for fetal maturation in severe acute respiratory syndrome coronavirus 2 positive pregnant women. Recent high-quality evidence supports the use of dexamethasone in the treatment of hospitalized patients with coronavirus disease 2019 (COVID-19). Randomized disease outcome data have identified an association between disease stage and treatment outcome. In contrast to patients with more severe forms who benefit from dexamethasone, patients with mild disease do not appear to improve and may even be harmed by this treatment. Therefore, indiscriminate usage of fluorinated corticosteroids for fetal maturation, regardless of disease trajectory, is unadvisable. Obstetrical care needs to be adjusted during the COVID-19 pandemic with careful attention paid to candidate selection and risk stratification.

Role of serological rapid antibody test in the management of possible COVID-19 cases

BACKGROUND

Although the detection of viral particles by reverse transcription polymerase chain reaction (RT-PCR) is the gold standard diagnostic test for coronavirus disease 2019 (COVID-19), the false-negative results constitute a big challenge.

AIM

To examine a group of patients diagnosed and treated as possible COVID-19 pneumonia whose multiple nasopharyngeal swab samples were negative for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by RT-PCR but then serological immunoglobulin M/immunoglobulin G (IgM/IgG) antibody against SARS-CoV-2 were detected by rapid antibody test.

METHODS

Eighty possible COVID-19 patients who had at least two negative consecutive COVID-19 RT-PCR test and were subjected to serological rapid antibody test were evaluated in this study.

RESULTS

The specific serological total IgM/IgG antibody against SARS-CoV-2 was detected in twenty-two patients. The mean age of this patient group was 63.2± 13.1-years-old with a male/female ratio of 11/11. Cough was the most common symptom (90.9%). The most common presenting chest computed tomography findings were bilateral ground glass opacities (77.2%) and alveolar consolidations (50.1%). The mean duration of time from appearance of first symptoms to hospital admission, to hospital admission, to treatment duration and to serological positivity were 8.6 d, 11.2 d, 7.9 d, and 24 d, respectively. Compared with reference laboratory values, serologically positive patients have shown increased levels of acute phase reactants, such as C-reactive protein, ferritin, and procalcitonin and higher inflammatory markers, such as erythrocyte sedimentation rate, lactate dehydrogenase enzyme, and fibrin end-products, such as D-dimer. A left shift on white blood cell differential was observed with increased neutrophil counts and decreased lymphocytes.

CONCLUSION

Our study demonstrated the feasibility of a COVID-19 diagnosis based on rapid antibody test in the cases of patients whose RT-PCR samples were negative. Detection of antibodies against SARS-CoV-2 with rapid antibody test should be included in the diagnostic algorithm in patients with possible COVID-19 pneumonia.

Spontaneous posterior vitreous detachment: A glance at the current literature

Spontaneous posterior vitreous detachment (PVD) is a common age-related condition in which prevalence tends to increase with age. Acute PVD can cause the onset of symptoms that include visual disturbances, myodesopsia and photopsia. The goal of this short review was to provide a quick glance at the important factors related to PVD based on current literature in this field, which includes incidence, symptoms, diagnosis, risk factors, and education for patients with acute symptoms, and treatments. The take home message is that an ophthalmic examination at the onset of symptoms is of utmost importance, considering that irreversible sight-threatening complications can be prevented if diagnosed and treated promptly.

Phase I study on the safety and preliminary efficacy of allogeneic mesenchymal stem cells in hypoxic-ischemic encephalopathy

BACKGROUND

Hypoxic-ischemic encephalopathy (HIE) is a leading cause of morbidity and mortality in the adult as well as in the neonate, with limited options for treatment and significant dysfunctionality.

AIM

To investigate the safety and preliminary efficacy of allogeneic mesenchymal stem cells (MSCs) in HIE patients.

METHODS

Patients who had HIE for at least 6 mo along with significant dysfunction and disability were included. All patients were given Wharton’s jelly-derived MSCs at 1 × 10⁶/kg intrathecally, intravenously, and intramuscularly twice a month for two months. The therapeutic effects and prognostic implications of MSCs were evaluated by multiple follow-ups. Functional independence measure (FIM), modified Ashworth, and Karnofsky scales were used to assess any side effects, neurological and cognitive functions, and overall outcomes.

RESULTS

The 8 subjects included in the study had a mean age of 33.25 ± 10.18 years. Mean HIE exposure and mean post-HIE durations were 45.63 ± 10.18 and 19.67 ± 29.04 mo, respectively. Mean FIM score was 18.38 ± 1.06, mean modified Ashworth score was 43.5 ± 4.63, and mean Karnofsky score was 20. For the first 24 h, 5 of the patients experienced a subfebrile state, accompanied by mild headaches due to intrathecally administration and muscle pain because of intramuscularly administration. Neurological and functional examinations, laboratory tests, electroencephalography, and magnetic resonance imaging were performed to assess safety of treatment. Mean FIM score increased by 20.88 ± 3.31 in the first month (P = 0.027) and by 31.38 ± 14.69 in 12 mo (P = 0.012). The rate of patients with an FIM score of 126 increased from 14.58% to 16.57% in the first month and 24.90% in 12 mo.

CONCLUSION

Multiple triple-route Wharton’s jelly-derived MSC administrations were found to be safe for HIE patients, indicating neurological and functional improvement. Based on the findings obtained here, further randomized and placebo research could be performed.