The contribution of diffusion-weighted MR imaging in multiple sclerosis during acute attack

PURPOSE: The aims of the study are firstly, to determine the difference in diffusion-weighted imaging (DWI) in normal appearing white matter (NAWM) between patients with acute multiple sclerosis (MS) and controls; secondly, to determine whether there is a correlation between EDSS scores and DWI in acute plaques and also NAWM. MATERIALS AND METHOD: Out of 50 patients with acute MS attack, 35 patients had active plaques with diffuse or ring enhancement on postcontrast images. Eighteen healthy volunteers constituted the control group. While 26 of 35 had relapsing-remitting, 9 had secondary progressive MS. Apparent diffusion coefficients (ADC) of the active plaques, NAWM at the level of centrum semiovale and occipital horn of lateral ventricle in the patients and NAWM in control group were measured. ADC values of active plaques were compared with WM of the patients and the control group. The relationship of ADC value of active plaques and WM in MS with expanded disability status scale (EDSS) was investigated by using Mann-Whitney U-test. RESULTS: Of 63 plaques totally, 26 and 37 of the active plaques had diffuse and ring enhancement, respectively. There was no statistically significant difference between ADC value of active plaques and EDSS (p>0.05). However, there was a statistically significant difference between ADC value of WM occipital horn and EDSS (p<0.05). ADC value of active plaques were higher than WM in both groups (p<0.001). The difference between ADC value of WM at the centrum semiovale (p<0.05) and occipital horns (p<0.001) in patients and controls was statistically significant. There was no statistically significant difference between EDSS scores, ADC value at centrum semiovale and WM around occipital horn and active plaques in subgroups (p>0.05). CONCLUSION: Apparently normal tissue in MS patients may show early abnormalities when investigated carefully enough, and there is an even though moderate correlation between EDSS and ADC values and early alterations of ADC value are starting in the occipital white matter along the ventricles. This has to be verified in larger series.     

Pemphigus vulgaris in childhood. A case report

An 11-year-old girl with vesicles and eroded lesions on her oral mucosa and tongue was diagnosed as having pemphigus vulgaris. The diagnosis was confirmed by histopathologic and immunofluorescence studies. The patient was successfully treated with methylprednisolone and azathioprine. After two months maintenance therapy was started. She is still taking methylprednisolone and azathioprine as maintenance therapy and no recurrence has been observed.     

Usefulness of oxidative stress marker evaluation at admission to the intensive care unit in patients with COVID-19

ObjectiveTwo critical processes in the coronavirus disease 2019 (COVID-19) pandemic involve assessing patients’ intensive care needs and predicting disease progression during patients’ intensive care unit (ICU) stay. We aimed to evaluate oxidative stress marker status at ICU admission and ICU discharge status in patients with COVID-19.MethodsWe included patients in a tertiary referral center ICU during June–December 2020. Scores of Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA), and clinical severity, radiologic scores, and healthy discharge status were noted. We collected peripheral blood samples at ICU admission to evaluate total antioxidants, total oxidants, catalase, and myeloperoxidase levels.ResultsThirty-one (24 male, 7 female) patients were included. At ICU admission, patients’ mean APACHE II score at ICU admission was 17.61 ± 8.9; the mean SOFA score was 6.29 ± 3.16. There was no significant relationship between clinical severity and oxidative stress (OS) markers nor between radiological imaging and COVID-19 data classification and OS levels. Differences in OS levels between patients with healthy and exitus discharge status were not significant.ConclusionsWe found no significant relationship between oxidative stress marker status in patients with COVID-19 at ICU admission and patients’ ICU discharge status.     

Lichen nitidus after hepatitis B vaccine

A 27‐year‐old man presented to our clinic with an asymptomatic papular eruption all over his body. The eruption first began after hepatitis B vaccination (Engerix B) and increased with the second vaccination which was given 1 month after the first. His medical history and systemic examination were normal. Physical examination revealed numerous, flesh‐colored or pink, 1–2 mm papules, with a flat, shiny surface, predominantly on the trunk and arms, and grouped in some areas. The face, nails, and oral mucosa were spared. Laboratory investigation revealed normal values of the routine hematologic and biochemical tests. Antistreptolysin O (ASO), C‐reactive protein (CRP), venereal disease research laboratory (VDRL) test, anti‐human immunodeficiency virus (anti‐HIV), chest X‐ray, and ultrasonography were normal. Anti‐hepatitis A virus immunoglobulin M (anti‐HAV IgM), anti‐hepatitis B core total (anti‐HBc total), and anti‐hepatitis C virus (anti‐HCV) were negative. Anti‐hepatitis A virus immunoglobulin G (anti‐HAV IgG) was positive; 10 mm erythema and induration were detected in the purified protein derivative (PPD) test. During the following period, spontaneous resolution of the lesions was observed. When the hepatitis B vaccine was given to the patient again after several months, however, the same types of lesion re‐occurred and spread rapidly all over his body. Again, physical examination revealed numerous, flesh‐colored or pink, 1–2 mm papules, with a flat, shiny surface, on the trunk, arms, and penis ( Fig. 1 ). Laboratory investigations revealed normal hematologic and biochemical values. Anti‐hepatitis B surface antigen (anti‐HBsAg) was > 150 IU/mL. Histopathologic examination of skin biopsy material taken from the regio antebrachii revealed, in the dermis, a granuloma formation of lymphocytes, histiocytes, and plasma cells which was surrounded by rete ridges and covered with focal parakeratotic epidermis ( Fig. 2 ).

Figure 1 Open in figure viewer PowerPoint Numerous, flesh‐colored to pink papules with a flat, shiny surface     

Kyphosis one level above the cervical disc disease: is the kyphosis cause or effect?

If present, kyphotic angulation is generally at the level of the cervical disc disease (CDD) in the neck, but sometimes occurs at one level above the CDD. We name this situation as kyphosis one level above (KOLA). KOLA CDD has not been studied previously. In this study, we present 18 patients who had KOLA among 147 patients operated for CDD over a 5-year period. Seven of these 18 patients also received surgery for their KOLA. As new, surgical treatment of kyphotic level was performed with plating and without bony fusion in 5 patients. Clinical outcomes (according to Odom's criteria) and kyphotic corrections of KOLA patients receiving and not receiving surgery for their kyphosis during were compared. The 7 KOLA patients having surgery to correct the kyphosis had a mean 20.14+/-3.13 degrees correction in their kyphosis (from mean 12.85 to -7.28 degrees), whereas the 11 patients undergoing surgery only for CDD showed only a mean 3.00+/-2.52 degrees correction (from mean 7.45 to 4.45 degrees). When kyphotic corrections were compared, statistically significant difference was found between 2 groups (P<0.01). Clinical outcome scores showed a trend towards improvement in the patients operated upon for kyphosis correction. KOLA may be a factor in the development of cervical disc herniation and spondylosis, and should be treated if more than 11 degrees. In cervical region, upper adjacent level disease may be an extension of KOLA. Larger studies can further define the relationship between KOLA and CDD, and indications for surgical correction of KOLA.     

Discovery of an Exceptionally Strong Luminescence of Polyethyleneimine‐Superparamagnetic Iron Oxide Nanoparticles

Polyethyleneimine (PEI) is rarely recognized as a luminescent polymer but is frequently used for the production of cationic nanoparticles and tagged with an organic fluorophore to be tracked optically. Herein, a strongly luminescent, branched PEI‐superparamagnetic iron oxide nanoparticle (bPEI‐SPION) without a traditional fluorophore is reported. A tremendous enhancement (1200 times) in the weak blue luminescence of bPEI is achieved only if it is adsorbed on a SPION during the synthesis of nanoparticles, which is improved further upon protonation, irreversibly. This is quite unexpected since SPIONs are strong absorbers in the visible region. All reaction parameters, different synthetic methods, as well as protonation are studied as independent factors to understand the origin of such enhancement. Detailed spectroscopic analysis and density functional theory calculations indicate that partial amine oxidation and Fe³⁺ reduction takes place during the synthesis, which significantly contributes to the luminescence enhancement. In addition, PEI‐SPION exhibits excitation wavelength dependent emission and maintains its magnetic properties.