Increased Intrathecal B and Plasma Cells in Patients With Anti-IgLON5 Disease

Background and ObjectivesDespite detection of autoantibodies, anti-IgLON5 disease was historically considered a tau-associated neurodegenerative disease, with limited treatment options and detrimental consequences for the patients. Observations in increasing case numbers hint toward underlying inflammatory mechanisms that, early detection provided, open a valuable window of opportunity for therapeutic intervention. We aimed to further substantiate this view by studying the CSF of patients with anti-IgLON5.MethodsWe identified 11 patients with anti-IgLON5 from our database and compared clinical, MRI, and CSF findings with a cohort of 20 patients with progressive supranuclear palsy (PSP) (as a noninflammatory tauopathy) and 22 patients with functional neurologic disorder.ResultsPatients with anti-IgLON5 show inflammatory changes in routine CSF analysis, an increase in B-lymphocyte frequency, and the presence of plasma cells in comparison to the PSP-control group and functional neurologic disease controls. Patients with intrathecal plasma cells showed a clinical response to rituximab.DiscussionOur findings indicate the importance of inflammatory mechanisms, in particular in early and acute anti-IgLON5 cases, which may support the use of immune-suppressive treatments in these cases. The main limitation of the study is the small number of cases due to the rarity of the disease.

Chronic Laryngotracheal Granulomatous Disease Secondary to Sporothrix schenckii in an Immunocompromised Patient

Objective: To describe a rare presentation of laryngotracheal granulomatous disease secondary to sporotrichosis. Methods: The authors report a case of laryngeal sporotrichosis in an immunocompromised patient, with accompanying endoscopic images and pathology. Results/case: A 72-year-old immunocompromised female with a history of rose-handling presented with a year of hoarseness and breathy voice. Flexible nasolaryngoscopy showed diffuse nodularity; biopsy of the lesions demonstrated granulomatous inflammatory changes, and fungal culture grew Sporothrix schenkii. Long-term itraconazole treatment was initiated, with improvement in dysphonia and few residual granulomas on follow-up examination. Conclusion: When evaluating granulomatous disease of the airway, a broad differential including infectious or inflammatory etiologies should be considered, especially in immunocompromised patients. Adequate tissue samples should be collected to facilitate special staining. The current recommendations for laryngeal sporotrichosis include treatment with a prolonged course of itraconazole.

Liver abscess in the caudate lobe caused by a fishbone and treated by laparoscopy: a case report

Background Ingestion of fish bones leading to gastric perforation and inducing abscess formation in the caudate lobe of the liver is very rare. Case presentation A 67-year-old man presented to our hospital with a 2-day history of subxiphoid pain. There were no specific symptoms other than pain. Laboratory tests showed only an increase in the number and percentage of neutrophils. Contrast-enhanced Computerized tomography (CT) of the abdomen showed two linear dense opacities in the gastric cardia, one of which penetrated the stomach and was adjacent to the caudate lobe of the liver, with inflammatory changes in the caudate lobe. We finally diagnosed his condition as a caudate lobe abscess secondary to intestinal perforation caused by a fishbone based on the history and imaging findings. The patient underwent 3D laparoscopic partial caudate lobectomy, incision and drainage of the liver abscess, and fishbone removal. The procedure was successful and we removed the fishbone from the liver. The patient was discharged on the 9th postoperative day without other complications. Conclusions Liver abscess caused by foreign bodies requires multidisciplinary treatment. Especially when located in the caudate lobe, we must detect and remove the cause of the abscess as early as possible. Foreign bodies that perforate the gastrointestinal tract can penetrate to the liver and cause abscess formation, as in this case. When exploring the etiology of liver abscesses, we should investigate the general condition, including the whole gastrointestinal tract.

Is it necessary to correct the intestinal microbiota disorders in chronic pancreatitis?

The frequency of intestinal microbiota disorders in patients with chronic pancreatitis (CP) is extremely high and can reach 97%. The bacterial overgrowth syndrome (SIBO) and the syndrome of increased epithelial permeability (SPEP), developing against the background of excretory insufficiency of the pancreas, affect the severity of the clinical picture of the disease, reduce the effectiveness of enzyme replacement therapy and generally contribute to the further progression of CP.The article presents a modern view on the mechanisms of the formation of SIBO and SPEP in CP. There is their aggravating effect on the course of the disease and the aggravation of disorders of the digestive and absorption processes that accompany them is shown and analyzed in the article.For decontamination of conditionally pathogenic and pathogenic flora, increasing the number and metabolic activity of indigenous microflora in patients with CP, the use of a non-absorbable broad-spectrum antibiotic rifaximin is effective. In order to restore the barrier function of the gastrointestinal mucosa, the drug of choice is rebamipid, a universal cytoprotector that affects all three levels of epithelial tissue protection (preepithelial, epithelial and subepithelial).Conclusion. CP is characterized by the complexity of its etiology and pathogenesis. Bacterial factors, in particular, SIBO and SPEP, play an essential role in the development of inflammatory changes in the pancreas. In the complex therapy of CP, it is advisable to take measures aimed at correcting disorders of the intestinal microbiota.

Anti- inflammatory effect of boric acid on cytokines in ovariectomy-induced rats

The increase in the rate of inflammation in the post-menopause period also leads to a significant increase in the use of anti-inflammatory agents. This study aimed to investigate the effect of BA supplementation on pro-and anti-inflammatory cytokines in ovariectomy (OVX) induced rats. A total of 48 nonpregnant female Wistar albino rats (80-100 g) were used in the experiment. Forty-eight rats were divided into six equal groups (n=8): Control, OVX, OVX+5 mg/kg BA (OVX+BA5), OVX+10 mg/kg BA (OVX+BA10), 5 mg/kg BA (BA5), 10 mg/kg BA (BA10). Serum TNF-α cytokine levels of rats in the OVX group were higher than in control rats (P<0.05). TNF-α levels were significantly reduced in the OVX-induced rats with 5 mg/kg BA and 10 mg/kg BA supplementation (P<0.05). While serum IL-1α and IL-6 levels were not different between OVX and control rats, serum IL-3 levels were low (P<0.05) and not affected by 5 mg/kg and 10 mg/kg BA supplementation. Serum IL-11 levels increased significantly in the OVX rats with 5 mg/kg and 10 mg/kg BA supplementation (P<0.05). As far as we know, certain doses (5 and 10 mg/kg) of BA are the first study on the prevention of increased inflammation in rats induced by OVX. Results suggest that the supplementation of BA regulates the inflammatory changes associated with OVX and thus has beneficial for menopause management.

Bacteriological and pathological investigations on the preputial glands of one-year-old C57BL/6NCrl mice maintained in individually ventilated cages

Spontaneous infections of the preputial glands represent overlooked health problems in mice that could raise welfare concerns and potentially confound scientific experiments. Agents involved in preputial gland infections have rarely been investigated, with opportunistic pathogens of laboratory animals usually detected in inflamed preputial glands. The aim of this study was to investigate the prevalence of bacterial infection in the preputial glands and the relationship between haematological and pathological changes and infection status. We analysed 40 preputial glands from 20 one-year-old C57BL/6NCrl male mice by using bacteriology, haematology and pathology. Bacteria were isolated from 16/20 (80%) mice, for a total of 32/40 (80%) examined preputial glands. Enterobacter cloacae, Pasteurella spp., Klebsiella spp. and Staphylococcus aureus were identified in 35%, 17.5%, 15% and 12.5% of the examined glands, respectively. Preputial gland inflammation was identified in 29/40 (72.5%) glands and was classified as chronic interstitial adenitis in 27 cases and suppurative adenitis in the remaining two glands. No haematological changes were found in mice with infected glands. Histologically, the presence of intralesional bacteria, intraluminal necrotic material, intraluminal keratin accumulation, interstitial inflammatory cell infiltrate and granulocytes (intraluminal and/or interstitial), along with total inflammatory score and total histopathological score, were significantly increased in infected glands and correlated with the bacterial load. Most severe inflammatory changes were identified after S. aureus infection, while ductal hyperkeratosis was significantly increased in glands infected with Klebsiella spp. In conclusion, preputial gland infection was a common event in one-year-old C57BL/6NCrl mice, and bacterial load correlated with pathological findings, while systemic effects were not highlighted by haematology.

An Imbalance Between RAGE/MR/HMGB1 and ATP1α3 is Associated with Inflammatory Changes in Rat Brain Harboring Cerebral Aneurysms Prone to Rupture

Background and Purpose: An aneurysmal subarachnoid hemorrhage is a devastating event. To establish an effective therapeutic strategy, its pathogenesis must be clarified, particularly the pathophysiology of brain harboring intracranial aneurysms (IAs). To elucidate the pathology in brain harboring IAs, we examined the significance of the receptor for advanced glycation end-products (RAGE)/mineralocorticoid receptor (MR) pathway and Na+/K+-ATPase (ATP1α3).Methods: Ten-week-old female rats were subjected to oophorectomy as well as hypertension and hemodynamic changes to induce IAs, and were fed a high-salt diet. Brain damage in these rats was assessed by inflammatory changes in comparison to sham-operated rats fed a standard diet.Results: Six weeks after IA induction (n = 30), irregular morphological changes, i.e., an enlarged vessel diameter and vascular wall, were observed in all of the left posterior cerebral arteries (Lt PCAs) prone to rupture. Approximately 20% of rats had ruptured IAs within 6 weeks. In brain harboring unruptured IAs at the PCA, the mRNA levels of RAGE and MR were higher, and that of ATP1α3 was lower than those in the sham-operated rats (p < 0.05, each). Immunohistochemically, elevated expression of RAGE and MR, and decreased expression of ATP1α3 were observed in the brain parenchyma adjacent to the Lt PCA, resulting in increased Iba-1 and S100B expression that reflected the inflammatory changes. There was no difference between the unruptured and ruptured aneurysm rat groups. Treatment with the MR antagonist esaxerenone abrogated these changes, and led to cerebral and vascular normalization and prolonged subarachnoid hemorrhage-free survival (p < 0.05).Conclusion: Regulation of the imbalance between the RAGE/MR pathway and ATP1α3 may help attenuate the damage in brain harboring IAs, and further studies are warranted to clarify the significance of the down-regulation of the MR/RAGE pathway and the up-regulation of ATP1α3 for attenuating the pathological changes in brain harboring IAs.

Potamogeton perfoliatus L. Extract Attenuates Neuroinflammation and Neuropathic Pain in Sciatic Nerve Chronic Constriction Injury-Induced Peripheral Neuropathy in Rats

Sciatic nerve injury is often associated with neuropathic pain and neuroinflammation in the central and peripheral nervous systems. In our previous work, Potamogeton perfoliatus L. displayed anti-inflammatory, antipyretic and analgesic properties, predominantly via the inhibition of COX-2 enzyme and attenuation of oxidative stress. Herein, we extended our investigations to study the effects of the plant’s extract on pain-related behaviors, oxidative stress, apoptosis markers, GFAP, CD68 and neuro-inflammation in sciatic nerve chronic constriction injury (CCI) rat model. The levels of the pro-inflammatory marker proteins in sciatic nerve and brainstem were measured with ELISA 14 days after CCI induction. Pretreatment with the extract significantly attenuated mechanical and cold allodynia and heat hyperalgesia with better potential than the reference drug, pregabalin. In addition, CCI lead to the overexpression of prostaglandin E2 (PGE2), inducible nitric oxide synthase (iNOS), tumor necrosis alpha (TNFα), nuclear factor κB (NF-κB), cyclooxygenase-2 (COX-2), 5-lipoxygenase (5-LOX), and NADPH oxidase-1 (NOX-1) and decreased the catalase level in sciatic nerve and brainstem. The observed neuro-inflammatory changes were accompanied with glial cells activation (increased GFAP and CD68 positive cells), apoptosis (increased Bax) and structural changes in both brainstem and sciatic nerve. The studied extract attenuated the CCI-induced neuro-inflammatory changes, oxidative stress, and apoptosis while it induced the expression of Bcl-2 and catalase in a dose dependent manner. It also decreased the brainstem expression of CD68 and GFAP indicating a possible neuroprotection effect. Taking together, P. perfoliatus may be considered as a novel therapy for neuropathic pain patients after performing the required clinical trials.

POSSIBILITIES OF COMPUTED TOMOGRAPHY IN THE DIAGNOSIS OF PNEUMONIA ASSOCIATED WITH COVID-19

Актуальность проблемы быстрой и точной диагностики пневмонии, ассоциированной с covid-19, в период присвоения коронавирусной инфекции (covid-19) статуса пандемии, безусловно бесспорна. Своевременная диагностика влияет на прогноз заболевания. Цель оценить возможности КТ при выявлении пневмонии, ассоциированной с covid-19 и уточнения стадии развития пневмонии. Материал и методы. Исследования проводились на мультиспиральном компьютерном томографе SOMATOM Difinition AS (Siemens). В исследования включены пациенты, прошедшие КТ грудной полости с 01.06.2020. по 31.08.2020. из базы Центральной Городской Клинической Больницы (ЦГКБ) г.Алматы. Результаты КТ оценивали визуальным методом. Визуальную оценку осуществляли с использованием трехплоскостной реформации изображений, что позволяло определить локализацию, контуры, протяженность измененных участков легочной ткани. Результаты. По данным проведенных обследований у большинства пациентов были выявлены признаки воспалительных изменений в легких, которые оценивались рентгенологами нашей клиники с учетом уже известных на тот момент специфических паттернов, характерных для пневмонии, ассоциированной с covid-19. По результатам КТ органов грудной клетки при дифференциальной диагностике пневмонии, ассоциированной с covid-19 от другой легочной патологии. Специфичность составила 88%. Заключение. КТ органов грудной полости является высокоспецифичным методом исследования при диагностике пневмонии, ассоциированной с covid-19. The urgency of the problem of rapid and accurate diagnosis of pneumonia associated with covid-19 during the assignment of coronavirus infection (covid-19) pandemic status is certainly indisputable. Timely diagnosis affects the prognosis of the disease. The aim is to evaluate the possibilities of CT in detecting pneumonia associated with covid-19 and to clarify the stage of development of pneumonia. Material and methods. The studies were carried out on a multispiral computed tomograph SOMATOM Difinition AS (Siemens). The study included patients who underwent CT of the thoracic cavity from 01.06.2020. to 31.08.2020. from the base of the Central City Clinical Hospital (CGKB) in Almaty. CT results were evaluated by visual method. Visual assessment was carried out using a three-plane image reformation, which made it possible to determine the localization, contours, and extent of the altered areas of lung tissue. Results. According to the conducted examinations, most patients showed signs of inflammatory changes in the lungs, which were evaluated by radiologists of our clinic taking into account the specific patterns already known at that time, characteristic of pneumonia associated with covid-19. According to the results of CT of the chest organs in the differential diagnosis of pneumonia associated with covid-19 from other pulmonary pathology. The specificity was 88%. Conclusion. CT of the thoracic cavity is a highly specific method of investigation in the diagnosis of pneumonia associated with covid-19.