Multisystemic inflammatory syndrome related to COVID-19, with latent tuberculosis in bone marrow, and satisfactory response to tocilizumab, in a 7-year-old boy

Paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS) or multisystem inflammatory syndrome in children (MIS-C) is a new acute-onset systemic inflammatory disease, which mainly affects children. Latent tuberculosis infection (LTBI) is characterized by the presence of immune sensitization to Mycobacterium tuberculosis (MTB) in the absence of any clinical or radiological evidence of active disease. We present a child with MIS-C related to COVID-19, with latent TB in the bone marrow, and satisfactory response to tocilizumab. It is important to pay attention in the investigation of TB cases in countries with a high prevalence of tuberculosis, especially when opting for immunusuppression.

Phenotypic and genotypic diversity in a multinational sample of drug-resistant Mycobacterium tuberculosis isolates

OBJECTIVE

To develop and evaluate rapid, molecular-based drug susceptibility testing (DST) for extensively drug-resistant tuberculosis (XDR-TB), we assembled a phenotypically and genotypically diverse collection of Mycobacterium tuberculosis isolates from patients evaluated for drug resistance in four high-burden countries.

METHODS

M. tuberculosis isolates from India (n = 111), Moldova (n = 90), the Philippines (n = 96), and South Africa (n = 103) were selected from existing regional and national repositories to maximize phenotypic diversity for resistance to isoniazid, rifampin (RMP), moxifloxacin, ofloxacin, amikacin, kanamycin, and capreomycin. MGIT™ 960 was performed on viable isolates in one laboratory using standardized procedures and drug concentrations. Genetic diversity within drug resistance phenotypes was assessed.

RESULTS

Nineteen distinct phenotypes were observed among 400 isolates with complete DST results. Diversity was greatest in the Philippines (14 phenotypes), and least in South Africa (9 phenotypes). Nearly all phenotypes included multiple genotypes. All sites provided isolates resistant to injectables but susceptible to fluoroquinolones. Many patients were taking drugs to which their disease was resistant.

DISCUSSION

Diverse phenotypes for XDR-TB-defining drugs, including resistance to fluoroquinolones and/or injectable drugs in RMP-susceptible isolates, indicate that RMP susceptibility does not ensure effectiveness of a standard four-drug regimen. Rapid, low-cost DST assays for first- and second-line drugs are thus needed.

A retrospective review of factors associated with vasovasostomies in United States military members

BACKGROUND

Men seeking a vasectomy should receive counseling prior to the procedure that includes discussion of later seeking a reversal. We sought to determine demographic factors that may predispose patients to possibly later seek a vasectomy reversal.

METHODS

All U.S. Military electronic health records were searched between 2000 and 2009 for either a vasectomy or vasovasostomy procedure code. Aggregate demographic information was collected and statistical analysis performed.

RESULT

A total of 82,945 patients had a vasectomy of which 4,485 had a vasovasostomy resulting in a vasovasostomy-to-vasectomy rate of 5.04%. The average age at vasovasostomy was 34.9±5.0, with an average interval of 4.1±2.2 years. Men undergoing a vasectomy at a younger age were more likely to have a vasovasostomy. Various religions did have statistically significant differences. Within ethnic groups, only Native Americans [OR=1.39 (95% CI 1.198-1.614)] and Asians [OR=0.501 (95% CI 0.364-0.690)] had statistically significant differences when compared to Caucasians. Men with more children at the time of vasectomy were more likely to have a vasovasostomy.

CONCLUSION

Younger men, Native Americans, and men with more children at vasectomy were more likely to undergo a vasovasostomy. The reason for these differences is unknown, but this information may assist during pre-vasectomy counseling.

Zero-refractoriness spirals in phase-coupled excitable media

Effects of excitability and coupling strength on plane and spiral waves in two-dimensional excitable lattices modeled by phase-coupled elements are investigated. The corresponding phase diagrams for stable plane waves and spiral waves are obtained by simulations. The parameters capable of supporting stable spiral waves are sorted out together with the spiral rotation frequencies. This discrete model corresponds to an excitable medium with zero refractoriness and in the continuum limit supports zero-core spiral waves. The associated wave propagating behaviors are also discussed analytically and verified.

Differential expression of nitric oxide by dermal microvascular endothelial cells from patients with scleroderma

Vascular abnormalities in scleroderma are fundamental to the pathogenesis of this disease. The objective of this study was to characterize dermal microvascular endothelial cells (DMEC) isolated from scleroderma patients with respect to growth and expression of the constitutive form of endothelial nitric oxide synthase (eNOS). DMEC from patients with both systemic sclerosis (SSc) and localized scleroderma (Loc Scl) contained small intact microvascular structures in contrast to single cell isolations obtained from control skin. Immunoaffinity selection on anti-PECAM-1 beads yielded pure populations of DMEC expressing normal markers. While the morphology and initial growth of SSc DMEC closely paralleled control cells, the growth of SSc DMEC decreased with time in culture (doubling time of 3 days vs. 5 days). Expression of ecNOS mRNA was reduced in both Loc Scl and SSc as shown by semi-quantitative RT-PCR (p < 0.001). Western blots showed variable but generally lower ecNOS protein levels and decreased levels of nitrogen oxides in media were found from both SSc and Loc Scl relative to control cells. The results indicate an intrinsic defect in the mechanism of nitric oxide production in DMEC isolated from scleroderma patients and suggest its possible involvement in the pathophysiology of scleroderma.

[Prediction factors for lymph node involvement in carcinoma of the larynx]

A series of 60 patients with squamous cell carcinoma of the larynx who underwent surgery of the primary tumor and elective bilateral neck dissection were reviewed to determine the importance of certain clinical and pathological features as risk factors for lymph node metastasis. Tumor location, extension to the vallecula and to the pyriform sinus, T stage, histological grade, palpable lymph nodes, laryngeal motility, and macroscopic aspects were studied. Logistic regression analysis demonstrated that T stage, tumor location, and palpable lymph nodes were the most important predictors of lymph node metastases.

[Biological markers of alcohol abuse in patients with carcinoma of the larynx]

In a total of 85 patients with laryngeal carcinoma, four markers of alcohol abuse were analyzed. The Ggt and VCM were disturbed. We found no correlation between tumor location, lymph node metastases, T stage, and histological grade.

[Correlation of lymph node status with survival in cancer of the larynx]

A histopathological study of regional lymph nodes was made in 50 patients with squamous cell carcinoma of the larynx in order to evaluate their prognostic significance for survival. Factors related with poor prognosis were presence and number of lymph node metastases and capsule rupture. The presence and grade of sinus histiocytosis was related with survival. In multivariate analysis, the presence of five or more metastatic nodes had an independent influence on survival.

[Paranasal sinus chondrosarcoma. A case report]

We report a case of chondrosarcoma of the nasal cavity and paranasal sinuses. These cartilaginous tumors are rare in the head and neck. The treatment of choice is surgery.

Placental abnormalities in systemic lupus erythematosus: in situ deposition of antinuclear antibodies

We studied 5 placentae from patients with systemic lupus erythematosus (SLE) for the presence of immunopathologic changes. We found antinuclear antibodies (ANA) deposited along the villi, trophoblast and amnion producing a lupus band-like pattern. The ANA were IgG class and had C3 fixing activity. Of the T cell subsets found in the placenta, OKT8 was the predominant type in patients with SLE and controls. All the patients were ANA positive, and 1 was also positive for anti-Ro(SSA). One newborn, positive for ANA and anti-Ro(SSA), developed neonatal lupus, 1 infant with a cardiac septal defect was ANA negative, and the other infants were normal. Our study demonstrates that in pregnant women with SLE, ANA deposition occurs in the placenta in situ.

Diagnostic value of free triiodothyronine in serum

Serum free T3 concentration has been assessed in various thyroid conditions by a T3 analog method and the results compared with those obtained by equilibrium dialysis in the same individuals. The methodology is easy to perform and reproducible. FT3 determination appears to be especially valuable in detecting borderline thyrotoxicosis as in cases previously cured from thyrotoxicosis but suspected of relapse, or in nontoxic goitrous patients overtreated with T4.