Incidence of Guillain-Barré Syndrome post COVID-19: a systematic review of case reports and case series.

OBJECTIVE: The purpose of this systematic review was to study the incidence, risk factors and patients subjected to Guillain-Barré syndrome (GBS) after COVID-19. MATERIALS AND METHODS: For qualitative assessment and assessing the methodological quality, the Cochrane Handbook for Systematic Reviews of Interventions and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) checklist were utilized. Data from PubMed, Cochrane, Embase, CINAHIL, Medline, ResearchGate, and Scopus were searched. The relevant studies involved patients with confirmed COVID-19 diagnosis by RT-PCR, and GBS diagnosis based on typical clinical symptoms and/or confirmatory diagnostic results. A total of 12 English relevant articles (6 papers were case reports and 8 were case series with a total of 32 patients) published in a peer-reviewed journal from 2019 to 2021 were included. Following the review methodology, two independent raters were responsible for retrieving, extracting and checking for data eligibility. Demographic characteristics are presented as frequencies and percentages. Based on distribution of values, continuous data were expressed as median and interquartile range (IQR). RESULTS: Out of 32 patients, 26 patients reported neurological symptoms, 6 cases went unnoticed, 7 cases showed involvement of the cranial nerves, 12 cases did not, and 13 cases went unreported. CONCLUSIONS: It is too early to draw any conclusions concerning a potential relationship between SARS-CoV-2 infection and GBS. More large-scale observational studies are required to understand the pathogenesis of SARS-CoV-2-associated GBS and to demonstrate a definite causal relationship between GBS and SARS-CoV-2 infection.

Successful treatment of bullous pemphigoid with omalizumab as corticosteroid-sparing agent: report of two cases and review of literature.

BACKGROUND: Bullous pemphigoid (BP) is an autoimmune blistering disease that is characterized by formation of subepidermal bullae due to functional disturbance of the hemidesmosomal proteins on the keratinocytes at the basal membrane zone. In recent years, several studies have emphasized the important role of IgE autoantibodies in the pathogenesis of BP. Consequently, a therapeutic approach using IgE depleting antibodies, such as a humanized monoclonal anti-IgE antibody (e.g. omalizumab) may represent a new option for treatment of this autoimmune disease. METHODS: In this paper, we report about the successful treatment of BP with omalizumab in two patients and provide a review of the current literature on the relationship between IgE antibodies and this autoimmune blistering disease. RESULTS: Two patients with therapy-resistant BP were treated with humanized monoclonal anti-IgE antibody omalizumab 300 mg subcutaneously every 3 weeks as corticosteroid-sparing agent. Under this therapy, both patients experienced a significant improvement of skin condition and almost complete resolution of pruritus. The treatment was well tolerated. CONCLUSION: Until recently IgG autoantibodies against the basal membrane proteins BP180 und BP230 were considered to be causative in the pathogenesis of BP. However, new in vitro studies as well as data from experimental mouse models have indicated that in addition to specific IgG, also IgE antibodies against BP180 and BP230 play a role in the development of this disease. Based on these new findings, new treatment modalities of BP became possible.

Neural network and wavelet average framing percentage energy for atrial fibrillation classification.

ECG signals are an important source of information in the diagnosis of atrial conduction pathology. Nevertheless, diagnosis by visual inspection is a difficult task. This work introduces a novel wavelet feature extraction method for atrial fibrillation derived from the average framing percentage energy (AFE) of terminal wavelet packet transform (WPT) sub signals. Probabilistic neural network (PNN) is used for classification. The presented method is shown to be a potentially effective discriminator in an automated diagnostic process. The ECG signals taken from the MIT-BIH database are used to classify different arrhythmias together with normal ECG. Several published methods were investigated for comparison. The best recognition rate selection was obtained for AFE. The classification performance achieved accuracy 97.92%. It was also suggested to analyze the presented system in an additive white Gaussian noise (AWGN) environment; 55.14% for 0dB and 92.53% for 5dB. It was concluded that the proposed approach of automating classification is worth pursuing with larger samples to validate and extend the present study.

Elevation in multiple serum inflammatory biomarkers predicts survival of pancreatic cancer patients with inoperable disease.

PURPOSE: Cancer-associated inflammation plays a driver role in pancreatic tumor development and progression. Moreover, recent studies have implicated the inflammatory tumor microenvironment in modulating therapy response and inducing resistance. The aim of this study is to investigate the prognostic and predictive value of the inflammatory biomarkers serum ferritin and C-reactive protein (CRP) in advanced pancreatic cancer patients. METHODS: We measured pretreatment serum ferritin and CRP levels in 159 patients with inoperable pancreatic cancer participating in a phase III trial. RESULTS: Serum ferritin and CRP levels were examined for correlations with overall survival using Kaplan-Meier analysis. When analyzed on a categorical basis, patients with higher ferritin (>median) or CRP (>25th percentile) had shorter overall survival. Moreover, the two biomarkers were not correlated suggesting independent mechanisms of production and release. However, when patients were evaluated by their ferritin and CRP levels, only patients with elevation in both inflammatory biomarkers showed a significant decrease in overall survival. CONCLUSIONS: Serum ferritin and CRP are independent prognostic factors for shorter survival in patients with inoperable pancreatic tumors. Moreover, the evaluation of patients based on both biomarkers suggested that their prognostic value, although independent, reflected the broader state of cancer-associated inflammation. Thus, serum ferritin and CRP should be further explored as clinical biomarkers.

Association of MMP but not TIMP-1 gene polymorphisms with recurrent aphthous stomatitis.

OBJECTIVES: Recurrent aphthous stomatitis (RAS) is a common oral inflammatory disease induced by genetic and environmental factors. Gelatinases (MMP-2 and MMP-9) and their natural inhibitor TIMP-1 are active players in the inflammatory process. We aimed to determine whether inheritance of specific MMP-2, MMP-9, or TIMP-1 gene polymorphisms is associated with RAS susceptibility. SUBJECTS AND METHODS: Ninety-six RAS patients and 153 healthy controls were studied. Five polymorphisms were genotyped: rs17576, rs3918242, and rs11697325 in MMP-9, MMP-2 rs2285053, and TIMP-1 rs6609533. Association was assessed by logistic regression analysis after adjustment for confounding factors. Linkage disequilibrium (LD) was assessed using the Haploview program. RESULTS: MMP-9 rs11697325 was significantly associated with RAS, with an increase in the AA genotype in patients, determined using χ(2) analysis (OR = 2.3, P = 0.006) and adjusted regression analysis (OR = 3.1, P = 0.009). MMP-9 rs11697325 and rs17576 showed strong LD (D' = 0.95), with an increase in the AA haplotype (P = 0.023) and a decrease in the GA haplotype (P = 0.015) in patients. CONCLUSIONS: This is the first study to investigate the association of MMPs or TIMP-1 with RAS. We found a significant association between MMP-9 rs11697325 polymorphisms and RAS. Confirmatory studies in other populations and functional investigations are needed to determine the role of these genes in RAS.

[Pemphigus vulgaris. Therapy with cyclophosphamide]. / Pemphigus vulgaris. Therapie mit cyclophosphamid.

Pemphigus vulgaris is an autoimmune blistering disorder. The diagnosis is based on clinical presentation, histology, and direct and indirect immunofluorescence. Optimal treatment remains the greatest challenge. Treatment options include combinations of systemic steroids with azathioprine, mycophenolate, and cyclophosphamide. However, there is little solid data regarding the drug of choice. In our patient, the best tolerated and effective treatment was found after several therapeutic attempts.

The role of type II deiodinase polymorphisms in clinical management of hypothyroid patients treated with levothyroxine.

STUDY OBJECTIVE: Several factors can affect achieving the goals with levothyroxine (L-T4) therapy. This study investigates the clinical and biochemical response to L-T4 replacement therapy in hypothyroid patients in correlation with genetic variation in Deiodinase type || (DIO2) gene. DESIGN AND SETTING: This is a cross-sectional correlation study. The setting was the diabetes and endocrinology clinics at 2 Jordanian Hospitals. METHODOLOGY: Patients with primary hypothyroidism who are controlled on stable L-T4 replacement therapy were recruited and thyroid function test was performed. Genetic analysis to detect 4 single nucleotide polymorphisms (SNPs) rs225011, rs7140952, rs225012 and rs2839858 in DIO2 gene was carried out using the polymerase chain reaction-based restriction fragment length polymorphism assay (PCR-RFLP). RESULTS: There was no correlation between the 4 SNPs in DIO2 gene and replacement doses of L-T4, whereas a statistical significance was found between rs7140952 and central obesity (P<0.05), and systolic and diastolic blood pressure (P<0.05). The dose of L-T4 was associated with lower levels of TSH, fT4, central obesity, body mass index and waist circumference. CONCLUSION: While L-T4 dose is associated with several positive effects on hypothyroid patients, none of the examined SNPs in DIO2 is correlated with replacement doses of the drug. However, rs7140952 polymorphism is associated with components of metabolic syndrome including blood pressure and central obesity.

Human bocavirus in Jordan: prevalence and clinical symptoms in hospitalised paediatric patients and molecular virus characterisation.

INTRODUCTION: This study was aimed at investigating the prevalence of human bocavirus (HBoV) among Jordanian children hospitalised with lower respiratory tract infection (LRTI) as well as the clinical feature associated with HBoV infection, the seasonal distribution of HBoV and the DNA sequencing of HBoV positive samples. METHODS: A total of 220 nasopharyngeal aspirates were collected from children below 13 years of age who were hospitalised with LRTI in order to detect the presence of HBoV using real-time polymerase chain reaction assay and direct HBoV sequencing. RESULTS: HBoV was detected in 20 (9.1 percent) patients, whose median age was four (range 0.8-12) months. Children under the age of 12 months were more susceptible to HBoV infection (p-value is 0.016). The main clinical diagnoses of patients infected with HBoV were bronchopneumonia (35 percent) and bronchiolitis (30 percent). Coughing (100 percent), wheezing (82.7 percent) and fever (68.2 percent) were the most prominent symptoms in infected patients. HBoV infections were seasonal; increasing in cooler months, diminishing in the summer and peaking in March (45 percent). Direct DNA sequencing revealed that three out of 20 (15 percent) specimens were identical to Stockholm 1 and 2 isolates, and single base pair substitution (A to T) at codon 92 was found in 17 out of the 20 (85 percent) specimens that were positive for HBoV, resulting in a threonine-to-serine substitution. CONCLUSION: More attention should be given to diagnosing HBoV in patients with LRTI using molecular techniques.

An end-to-end secure patient information access card system.

The rapid development of the Internet and the increasing interest in Internet-based solutions has promoted the idea of creating Internet-based health information applications. This will force a change in the role of IC cards in healthcare card systems from a data carrier to an access key medium. At the Medical Informatics Department of Kyoto University Hospital we are developing a smart card patient information project where patient databases are accessed via the Internet. Strong end-to-end data encryption is performed via Secure Socket Layers, transparent to transmit patient information. The smart card is playing the crucial role of access key to the database: user authentication is performed internally without ever revealing the actual key. For easy acceptance by healthcare professionals, the user interface is integrated as a plug-in for two familiar Web browsers, Netscape Navigator and MS Internet Explorer.

The changing role of health care IC card systems.

Health care researchers and professionals have had increasing interest in the development of Internet-based solutions in health care, casting doubt on the future of IC card systems. However, IC cards used in conjunction with Internet-based health information systems may be more viable than either system alone. We conducted a worldwide survey to explore the possibilities of such a combined system. Our analysis shows that there is considerable awareness of the concept of Internet-based health care services among the professionals of IC card projects. In addition, our results indicate that IC cards could play a major role in health care systems as authorization keys that permit access to health information.

Fine mapping of progressive pseudorheumatoid dysplasia: a tool for heterozygote identification.

Progressive pseudorheumatoid dysplasia is a skeletal genetic disorder affecting primarily the articular cartilage, causing joint stiffness and leading to a crippling status. More than two-thirds of the reported patients belong to Arab and Mediterranean populations. The disease locus has been mapped to chromosome 6q22 in a region of 12.9 cM using a Jordanian family. We examined two additional families, one Jordanian and one Palestinian, to test for homogeneity of the disorder and the presence of a common haplotype, to fine map the disorder, and to use all the information to derive a tool for heterozygote identification. The two families showed linkage to the same previously reported locus, thus suggesting homogeneity, but they did not share a common haplotype. They also provided information that refined the genetic region for the disease locus to 2.1 cM with three microsatellite markers. The absence of a common haplotype indicates that no common ancestor mutations were inherited by our patients. Genotyping for the three-marker haplotype showed that it can be used as a heterozygote identification tool.

Towards a national patient card system in Japan.

Patient Card Systems (PCS) have been applied on a regional level to improve access to patient information. However, current projects lack a vision of future integration on a national level. In addition, Integrated Circuit cards and optical cards were introduced without considering that their cost and capacity limits impose significant constraints for future integration. The major arguments against PCS are the huge costs incurred by such a system and the limitations of the card capacities. In addition, standards and legislation have not been sufficiently developed. In this study, we propose a new model of PCS that employs recent communication and card technologies as a key to access a national medical information center. We demonstrate that PCS are feasible if implemented in several distinct phases and if the acceptance and cooperation of physicians and patients are achieved. However, political consensus about the necessity of reform in the health care sector must be established so that the necessary legislation can be enacted.