New-onset or flare-up of bullous pemphigoid associated with COVID-19 vaccines: a systematic review of case report and case series studies

Background

Numerous cutaneous manifestations have been associated with the Coronavirus Disease 2019 (COVID-19) outbreak and vaccination, but new-onset bullous pemphigoid (BP) or flaring up of pre-existing BP is a rare side effect of COVID-19 vaccines that has been mentioned to a lesser extent in the literature. Therefore, we aimed to conduct a systematic review focused on the association between the new- onset or flare-up of BP and the COVID-19 vaccination.

Method

A comprehensive literature search was conducted using PubMed (MEDLINE), Scopus, and the Web of Science databases up to 11 March 2023. The search aimed to identify English-language studies reporting new-onset or flare-ups of BP as a potential side effect of the COVID-19 vaccination. The search terms included bullous pemphigoid and COVID-19 vaccination-related MeSH terms.

Results

The systematic review of 40 articles investigating the incidence of BP in individuals who received various COVID-19 vaccines revealed pertinent findings. Among the 54 patients with new-onset BP, the median age was 72.42 years, and most were men (64%). Conversely, the median age of the 17 patients experiencing a flare-up of BP was 73.35 years, with a higher proportion of women (53%). Regarding vaccination types, a significant number of patients (56%) developed new-onset BP after receiving the BNT162b2 vaccine (Pfizer-BioNTech).

Conclusion

This study indicates a potential association between COVID-19 vaccinations, particularly mRNA vaccines, and the occurrence of BP. It suggests that this rare autoimmune disorder may be triggered as an adverse event following the COVID-19 vaccination. However, it is important to note that the majority of BP patients in our study were unaffected by the COVID-19 vaccine, and even those who experienced worsening of their conditions were managed without significant consequences. These findings provide additional evidence supporting the safety of COVID-19 vaccines. Physicians should be mindful of this uncommon adverse event and encourage patients to complete their planned vaccination schedules.

Primary abdominal cocoon syndrome manifesting with Chilaiditi syndrome and intestinal obstruction: A case report

Key Clinical Message

Abdominal cocoon syndrome and Chilaiditi syndrome are rare etiologies of bowel obstruction which have to be considered in patients with obstructive symptoms. Patients can profit from surgical management rather than non-surgical approach.

Abstract

Encapsulating peritoneal sclerosis or abdominal cocoon syndrome (ACS) is an uncommon cause of intestinal obstructions associated with encapsulation of the small bowel by a fibro collagenous sac. Clinical presentations of ACS are unspecific and most patients are diagnosed intraoperatively. Moreover, Chilaiditi syndrome is another rare cause of bowel obstruction defined by interposition of colon and liver. There is no reported relation between these two conditions and surgical intervention is the suggested approach for severe bowel obstruction following them individually. We present a case with both conditions and describe our approach. A 47-year-old male presented with complaints of colic abdominal pain and distention, nausea and several attacks of bilious and nonbilious vomiting, anorexia, and constipation in the last 10 days before his admission. Laboratory data were normal and abdominal X-ray showed large dilation at the distal part of the bowel without air fluid level. The patient underwent explorative laparotomy and a mass-like lesion containing necrotic bowel and a whitish spleen accompanied by a complete anterior-rotated liver was found. The encapsulated bowel and the spleen were resected followed by the complete resolution of symptoms in the patient. The intestinal obstruction caused by ACS is mostly approached by surgery to prevent the fatal sequela of this condition.

The effect of leaf hydroalcoholic extract of Ephedra pachyclada infertility in male rats treated with cyclophosphamide: An experimental study

Background

Cyclophosphamide (CP) has clinical applications in treating diverse malignancies and autoimmune disorders; at the same time, it also has harmful effects on the body tissues, particularly the genitals. The most significant side effects of CP are changing the reproductive system's function and infertility.

Objective

This study determines the Ephedra hydroalcoholic extract (EP) role on testicular tissue and the pituitary-gonadal axis in CP-treated male rats.

Materials and Methods

In this experimental study, 48 adult Wistar rats were separated into 6 groups (n = 8/each): control, sham, CP recipients, and CP recipients with gavage-fed EP (250, 500, and 1000 mg/kg). On the 29th day, the blood of the weighed animals' was drawn from their heart, and serum concentrations of follicle-stimulating hormone, luteinizing hormone, and testosterone were measured. After preparing testicular tissue segments, cells were counted.

Results

While CP decreased follicle-stimulating hormone, luteinizing hormone, and testosterone levels (p < 0.05), the use of EP changed them and even reached the control. Serum gonadotropin-releasing hormone increased significantly in all EP groups compared to the control and CP groups. Compared to the control, a significant decrease in total antioxidant capacity and plasma glutathione peroxidase was observed in the CP groups. EP (all doses) significantly increased their concentration compared to the CP group (p < 0.05); significant reduction in serum total oxidant status and malondialdehyde in CP groups changed by EP (p < 0.05). Although CP's role on spermatogonia counts (57.5 ± 5.2 in CP, 67.1 ± 6.0 in control), higher doses of EP had no significant effect on this but did affect spermatocyte and spermatid cells count.

Conclusion

Due to its antioxidant characteristics, EP mitigated the effects of CP on the investigated parameters in rats.

Scattering and absorption control in biocompatible fibers towards equalized photobiomodulation

Transparent tissue scaffolds enable illumination of growing tissue to accelerate cell proliferation and improve other cell functions through photobiomodulation. The biphasic dose response of cells exposed to photobiomodulating light dictates that the illumination be evenly distributed across the scaffold such that the cells are neither under nor over exposed to light. However, equalized illumination has not been sufficiently addressed. Here we analyze and experimentally demonstrate spatially equalizing illumination by three methods, namely: engineered surface scattering, reflection by a gold mirror, and traveling-waves in a ring mesh. Our results show that nearly equalized illumination is achievable by controlling the light scattering-to-loss ratio. This demonstration furthers opportunities for dose-optimized photobiomodulation in tissue regeneration.

Evaluation of the antimicrobial effect of conventional and nanosilver-containing varnishes on oral streptococci

STATEMENT OF THE PROBLEM

Nanosilver particles have the potential to serve as a bactericidal agent because of the inherent antimicrobial influences of silver ion. The literature confirmed that specific micro-organisms, especially streptococci, have an important role as an etiological factor for caries.

PURPOSE

The aim of this study was to evaluate the antimicrobial effect of conventional and nanosilver-containing varnishes on oral streptococci.

MATERIALS AND METHOD

Pure cultivations of Streptococcus mutans and Streptococcus salivarius were prepared on blood agar media. Thereafter, 0.5 McFarland standard of recently grown bacteria in normal saline was prepared and the bacteria were cultivated monotonously on the culture medium surface by applying a swab. Different concentrations of nanosilver varnishes were prepared in the Mueller- Hinton broth medium in the test tubes and equal amounts of 0.5 McFarland suspension of all the tested bacteria were added separately to all test tubes. A tube without varnish was included as the control sample. The tubes were kept at 37°C for 24 hours, then cultured to determine the numbers of bacteria in each tube by counting colonies. The numbers of bacteria in tubes with varnish were compared to the numbers of bacteria in the tube without varnish. In the instance of observing any reduction in the growth, the minimum inhibitory concentration for growth in the tube with varnish was determined.

RESULTS

Nanosilver varnish had an antimicrobial effect on S. mutans and S. salivarius.  S. salivarius was more susceptible than S. mutans to the nanosilver varnish.

CONCLUSION

Based on the results of this study, nanosilver varnishes can be used under amalgam restorations to reduce microbial population and subsequently preventing the recurrent caries.