A Case of Myopericarditis and the HPV vaccine

Introduction: Human Papillomavirus (HPV) is the underlying etiology of numerous cancers and genital warts in both males and females. Vaccines were developed against HPV to prevent transmission and arrest development of cancers caused by the virus. Gardasil 9â is the newest vaccine, covering 9 serotypes of HPV and is recommended by the CDC for both males and females over 9 years of age in a series of vaccinations. Myopericarditis (including myocarditis and pericarditis) is not reported as an adverse reaction in the Gardasil 9â package insert. Case Report A healthy 18-year-old male with no significant past medical or social history received dose number 3 of HPV vaccine at his physician’s office. Within 24 hours, he developed chills and a fever (normal HPV reactions) and then recovered without sequelae within 48 hours. Three days later, he developed crushing chest pain, with arm tingling and jaw pain. He was triaged directly to the emergency room where he had troponins of greater than 11000 and T wave inversions on his EKG. Other diagnostic tests and labs showed normal heart anatomy and no early coronary artery disease. He was diagnosed with myopericarditis by cardiology. He was treated and recovered fully within 3 months. Discussion Using the WHO tool for adverse vaccine reactions, this case has a consistent causal relationship with vaccination. This is the eleventh case of myopericarditis reported to the Vaccine Adverse Effects Reporting system for the HPV vaccine. Conclusion Although rare, myopericarditis should be considered as a possible adverse effect from the human papillomavirus vaccine.

Mesenchymal stem cells versus their extracellular vesicles in treatment of liver fibrosis: Is it possible to compare?

Liver fibrosis (LF) is a worldwide health problem that is associated with a range of complications and high mortality. Due to the scarcity of liver donors, mesenchymal stem cell (MSC) therapy emerged as an alternative therapeutic strategy. However, it is widely accepted that most of the transplanted MSCs exhibit their therapeutic impact mainly via a bystander paracrine (medicinal) capacity. In addition to their secretory proteins, MSCs also produce various types of extracellular vesicles (EVs) that are classified into three main subtypes: microvesicles, exosomes and apoptotic bodies. Thanks to their peculiar cargo composition (e.g., proteins, lipids, and nucleic acids), EVs serve as an advantageous candidate for cell-free therapy. Recently, MSC-derived EVs (MSC-EVs) have gained the podium due to their regenerative and immunomodulatory effect. In mitigation/treatment of LF, a plethora of recent studies have shown the anti-inflammatory, anti-fibrotic and cytoprotective effects of both MSCs and MSC-EVs in various in vitro and in vivo models of LF. However, despite the limited evidence, we sought in this mini review to sort out the established data and formulate several challenging questions that must be answered to pave the way for further clinical applications. One of the major questions to ask is “Which is the best therapeutic approach, MSCs or MSC-EVs?” We tried to highlight how difficult it might be to compare the two approaches while our understanding of both candidates is still deficient. Among the major obstacles against such comparison is the inaccurate equivalent dose determination, the unknown in vivo behavior, and the undetermined lifespan/fate of each. Currently, the fields of MSCs and MSC-EVs seem to be rich in ideas but lacking in appropriate technologies to test these ideas. Nevertheless, continuous efforts are likely to help resolve some of the challenges listed here.

Human Milk: Benefits, Composition and Evolution

Breastfeeding provides all the energy that the child needs in the form of nutrients in the first months of life. The components cover the nutritional needs in all stages, including colostrum and final or mature milk. It must also be taken into account that the composition of milk varies from one woman to another, between both breasts, between feedings and in the different stages in the same mother. It can be said that variation is an active mechanism to perfectly adjust to the nutritional and immunological needs of each child. Components of breast milk can exert beneficial non-nutritional functions. Breast milk also has bioactive factors, which affect biological processes and, therefore, have an impact on health. In the nutrition of premature babies, parenteral nutrition is carried out first, which later becomes enteral through different strategies, such as early minimal enteral nutrition. Despite this, they still present postnatal growth restrictions, which is associated with adverse neurocognitive outcomes. Breast milk achieves multiple benefits in both preterm and term births. Digestion and absorption in the stomach and intestines follow circadian rhythms in mammals, and these rhythms are regulated by rhythmically expressed clock genes in the intestine, as well as by daily food intake.

Black Bile, Manic Depression and Melancholy: Two Pillars of Our Understanding

I aim to demonstrate the movement of the argument of the Aristotelian Problem XXX.1 as it illuminates the phenomena of melancholy, which it is argued is more rightly understood as manic depression, and black bile. The discussion will aid contemporary researchers in psychiatry as well as those in ancient philosophy and medicine. An appeal to both Emil Kraeplin and the Aristotelian author will demonstrate surprising resonances. An appeal to Aristotle’s discussion of anger in the De Anima will make clearer what is at stake in Problem XXX.1.

Retroactive assessment for DNA mismatch repair deficiency in women with a history of endometrial cancer

Objectives. Beginning in 2014, the Society of Gynecologic Oncology and the American College of Obstetricians and Gynecologists have recommended universal tumor testing for mismatch repair deficiency in endometrial cancer. Mismatch repair testing can triage patients who may benefit from genetic testing for Lynch syndrome. Many women previously diagnosed with endometrial cancer have not undergone mismatch repair tumor testing. We sought to determine the feasibility of retroactive assessment for mismatch repair deficiency among women with diagnosed with endometrial cancer prior to 2014. Methods. Between 2016 and 2018, we identified 36 patients presenting for gynecologic oncology follow-up visits who were previously diagnosed with endometrial cancer. The endometrial pathology underwent tumor assessment for loss of expression of mismatch repair proteins by immunohistochemistry. Patients with abnormal mismatch repair testing were referred to genetic counseling and, if indicated, for germline genetic testing. Results. Thirty-six patients underwent retroactive tumor immunohistochemistry, yielding 10 (28%) abnormal results, including nine (25%) with loss of one or more mismatch repair proteins and one with inconclusive staining (2.8%). All ten patients with abnormal immunohistochemistry were referred to genetic counseling; 9 (90%) accepted the referral and proceeded with genetic testing. One pathogenic mutation was identified in CHEK2 (11%). Five patients (56%) were found to have a variant of unknown significance. Conclusions. Implementation of universal retroactive tumor testing for mismatch repair deficiency in patients previously diagnosed with endometrial cancer is feasible. With the growing use of new molecular classification protocols for endometrial tumors, identification of mismatch repair deficiency may have significant clinicopathologic implications.

AN UPDATE ON TOXICITY OF THERAPEUTIC RADIONUCLIDES

Targeted radiotherapy is an evolving and promising modality of cancer treatment. Among the many advantages of this approach are its selectiveness in delivering the radiation to the target, relatively less severe and infrequent side effects, and the possibility of assessing the uptake by the tumor prior to the therapy. A number of radionuclides, such as iodine-131 (131I), phosphorus-32 (32P), strontium-90 (90Sr), and yttrium-90 (90Y), have been used successfully for the treatment of many benign and malignant disorders. The toxicity to radionuclides has come into vogue with its increasing utilization for multiple indications. Short term hematological toxicities include cytopenias and long term hematological toxicities include myeloid neoplasms. Non hematological toxicities commonly include renal and hepatotoxicity and long term toxicities like gonadal toxicity. This review focuses on the toxicities which need to be monitored during use of therapeutic radionuclides.

Blood Transfusions and Palliative Care: Systematic Literature Review

Anemia is an important condition related with symptoms in the later stages of disease; according to World Health Organization its prevalence is between 68-77% in patients with advanced cancer. There is no specific clinical guideline and we do not have clear evidence of the effect of blood transfusions in palliative care. Objective: Understand indicators and complications of the transfusions on advanced cancer patients. Methodology: In 2019 a systematic review on PubMed and Cochrane took place, using the key words: Palliative care AND Blood transfusion; analyzing: Type of study; sample size; Pathologies; transfusion criterion; Transfusions benefits; side effects; Survival; and amount of transfused concentrates. Results: 81 articles selected, adding 6 after a full text reading. For the most part, patients with solid tumors are described and some with no oncology pathology. The symptoms indicated by the transfusion are: Fatigue, dyspnea, asthenia, headache and/or brisk bleeding. Transfused unit’s average was 2 units. Only two studies present a post-transfusion recovery and less than half display information as to associated mortality. Conclusions: There is no consensus regarding the transfusion indication. The asthenia recovery, well-being, and quality of life based on subjective criteria, are the main effects described. More studies are required.

Prevalence of syphilis reactivity in patients with stroke, cognitive impairment and extrapyramidal syndromes: a retrospective study.

In the last two decades, there has been a resurgence of syphilis worldwide. However, epidemiological data on neurosyphilis are inconsistent for the lack of reporting data and diagnostic gold standard tests. The aim of the present study was to estimate the prevalence of syphilis reactivity in a cohort of patients with neurological diseases of our hospital. We retrospectively analyzed the medical records of the patients hospitalized at the Stroke Unit of the Neurology Clinic and those suffering from cognitive impairment hospitalized at the acute ward of the Geriatrics Clinic between January 2017 and December 2019. Also the patients who attended the Movement disorder outpatient clinic during the same study period were examined. To detect syphilis reactivity a qualitative specific treponemal test on patient’s serum was performed: the Treponema pallidum haemagglutination assay (TPHA). A total of 652 patients were admitted and 315 of them (52%) were submitted to a routine screening for syphilis: 307 (97%) were negative while 8 (3%) had a positive syphilis serology. The TPHA-positive patients (4 males, 4 females) were 2 patients with stroke, 5 with cognitive impairment and 1 with Parkinsonism with a mean age of 83 years, suffering from multiple comorbidities. Although the patients we have retrospectively studied have not undergone lumbar puncture to confirm the diagnosis of neurosyphilis, the not negligible syphilis reactivity rate found in our series suggests that serological screening for syphilis should be reviewed as a routine screening test in neurology and geriatrics departments, especially if the clinical presentation of the neurological diseases is atypical.

Biobased Hyperbranched Poly(ester)s of Precise Structure for the Release of Therapeutics

Hyperbrached poly(ester)s derived from naturally-occurring biomonomers may serve as excellent platforms for the sustained-release of therapeutics. Those generated from glycerol are particularly attractive. Traditionally, the difference in reactivity of the hydroxyl groups of glycerol has precluded the formation of well-defined polymers at high monomer conversion without gelation. Using the Martin-Smith model to select appropriate monomer ratios (ratios of functional groups), polymerization may be carried out to high conversion while avoiding gelation and with the assurance of a single type of endgroup. Various agents may be attached via esterification, amide formation or other process. Sustained release of the active agent may be readily achieved by enzyme-catalyzed hydrolysis.

Systemic soluble Programmed Death-Ligand 1 levels in sarcoidosis subjects does not vary with disease progression

Interaction of programmed cell death 1 (PD-1) receptor and its ligand 1 (PD-L1) is well studied in the field of fibrotic lung diseases, supporting its use as a biomarker of progression of interstitial lung disease. Anti PD-L1 therapy has shown effectiveness in improvement of many malignancies and murine models of autoimmune fibrotic lung diseases. Higher PD-1 expression on T cells and PD-L1 expression on human lung fibroblasts are known to contribute towards severity in sarcoidosis and idiopathic pulmonary fibrosis (IPF), respectively. The focus of this investigation was to determine if soluble form of PD-L1 (sPD-L1) serves as predictive biomarker of disease severity in interstitial lung disease (ILD), such as scleroderma, sarcoidosis and IPF. Comparison of local environments, such as bronchoalveolar lavage, revealed significantly higher sPD-L1 levels compared to systemic environments, such as peripheral blood (p=0.001, paired two-tailed Student’s t test). Investigation of serum samples of healthy control, IPF, scleroderma and sarcoidosis patients reveal significantly higher levels in sarcoidosis and IPF patients, compared to patients with scleroderma (p=0.001; p=0.02, one-way ANOVA with Tukey’s respectively). Comparison of serum levels between sarcoidosis patients and healthy controls revealed no significant differences (p=0.09, unpaired two-tailed t test). In addition, comparison of physiologic parameters, such as percent predicated Forced Vital Capacity (FVC) and sPD-L1 levels in sarcoidosis and IPF patients revealed no correlation. These observations suggest that sPD-L1 will not serve as a biomarker of sarcoidosis disease severity. Additional investigation of sPD-L1 in local environments is warranted.