Primary signet-ring cell carcinoma of the cecum: A rare case report.

INTRODUCTION AND IMPORTANCE: Primary SRCC is a rare histological colorectal cancer subtype. It is characterized by distinct clinical presentation. CASE PRESENTATION: This case report describes a rare case of a Primary Signet-ring cell carcinoma of the cecum. A 37-year-old man came to the emergency department with bowel obstruction and altered general condition. The abdominal CT scan showed an intestinal occlusion upstream a thickening of the cecum. An exploratory laparotomy found a distention of the bowl with a suspect thickening of the cecum. The patient underwent a right ileo-colectomy and ileocolostomy. Histologic analysis of the operatory specimen confirmed the diagnosis of a primary Signet-ring cell carcinoma of the cecum. The recovery was uneventful, and the patient is in good health after six -months of follow-up. After completing the chemotherapy, the patient is scheduled for a colonoscopy and reversal of colostomy. CLINICAL DISCUSSION: Colorectal primary signet ring cell carcinoma (SRCC) is a rare entity, and it is associated with poor prognosis compared with common colorectal adenocarcinomas. characterized by distinct clinical presentation, with very poor response rates. CONCLUSION: Primary SRCC is an aggressive histological type of colon cancer and it is associated with a poor prognosis. There are no conclusive guidelines for the treatment of this type of tumor.

Massive post-traumatic neglicted diaphragmatic hernia revealed by necrotizing pancreatitis, A case report according scare guidelines.

•Atypical chest presentation of acute pancreatitis consisting of a post-traumatic of less than 10 cases reported in the literature.•We describe a very exceptional complication of diaphragmatic rupture.•We propose to take into consideration diaphragmatic involvement in any patient suffering from abdominal trauma.

Adrenal adenoma as a cause of atypical psychosis: Presentation, diagnosis, surgical technique and outcome (case report with a brief literature review).

INTRODUCTION AND IMPORTANCE: Psychiatric symptoms may be a mode of the revelation of several endocrinopathies, but rarely in primary hyperaldosteronism, which can increase psychiatric comorbidity, as well as cardiovascular risk. CASE PRESENTATION: We report a case of a 26-year-old engineer, who suffered from atypical psychosis before being hospitalized for a state of agitation, he presented with high blood pressure and severe hypokalemia. An etiological assessment revealed a right adrenal adenoma, which was afterward resected, with a very good evolution. CLINICAL DISCUSSION: In this association, a high-level of aldosterone and hypokalemia can be behind these manifestations that present in an atypical form. Treatment is medical by anti-aldosterone or surgical by resection of the adenoma, but the challenge now is to know if we can or not stop psychotropic treatment after the treatment of the adenoma. In our case, the treatment was stopped six months after the resection of the adenoma, with very good outcomes until now. CONCLUSION: Despite the high prevalence of psychiatric illnesses, it is always necessary to look for the organic causes that may be behind these pathologies, especially if they are in atypical forms. LEARNING POINTS.

Genome-Wide Asymptomatic B-Cell, CD4+ and CD8+ T-Cell Epitopes, that are Highly Conserved Between Human and Animal Coronaviruses, Identified from SARS-CoV-2 as Immune Targets for Pre-Emptive Pan-Coronavirus Vaccines

Over the last two decades, there have been three deadly human outbreaks of Coronaviruses (CoVs) caused by emerging zoonotic CoVs: SARS-CoV, MERS-CoV, and the latest highly transmissible and deadly SARS-CoV-2, which has caused the current COVID-19 global pandemic. All three deadly CoVs originated from bats, the natural hosts, and transmitted to humans via various intermediate animal reservoirs. Because there is currently no universal pan-Coronavirus vaccine available, two worst-case scenarios remain highly possible: (1) SARS-CoV-2 mutates and transforms into a seasonal "flu-like" global pandemic; and/or (2) Other global COVID-like pandemics will emerge in the coming years, caused by yet another spillover of an unknown zoonotic bat-derived SARS-like Coronavirus (SL-CoV) into an unvaccinated human population. Determining the antigen and epitope landscapes that are conserved among human and animal Coronaviruses as well as the repertoire, phenotype and function of B cells and CD4+ and CD8+ T cells that correlate with resistance seen in asymptomatic COVID-19 patients should inform in the development of pan-Coronavirus vaccines 1. In the present study, using several immuno-informatics and sequence alignment approaches, we identified several human B-cell, CD4+ and CD8+ T cell epitopes that are highly conserved in: (i) greater than 81,000 SARS-CoV-2 human strains identified to date in 190 countries on six continents; (ii) six circulating CoVs that caused previous human outbreaks of the "Common Cold"; (iii) five SL-CoVs isolated from bats; (iv) five SL-CoV isolated from pangolins; (v) three SL-CoVs isolated from Civet Cats; and (vi) four MERS strains isolated from camels. Furthermore, we identified cross-reactive asymptomatic epitopes that: (i) recalled B cell, CD4+ and CD8+ T cell responses from both asymptomatic COVID-19 patients and healthy individuals who were never exposed to SARS-CoV-2; and (ii) induced strong B cell and T cell responses in "humanized" Human Leukocyte Antigen (HLA)-DR/HLA-A*02:01 double transgenic mice. The findings herein pave the way to develop a pre-emptive multi-epitope pan-Coronavirus vaccine to protect against past, current, and potential future outbreaks.