Varying presentations in patients with symptomatic type IV vascular Ehlers-Danlos syndrome

Ehlers-Danlos syndrome (EDS) represents a group of inheritable connective tissue disorders. Patients with type IV or vascular EDS, autosomal dominant pattern of inheritance, may present with aneurysm formation or arterial dissection. Due to vessel fragility, operative therapy for such disorders has been reserved for compelling indications in which benefit clearly warrants risk, yet assessment of risk is largely clinical with operative decisions guided by factors such as response to previous operations and age at onset of index vascular complications. We present 2 patients with differences in their clinical presentations and outcomes and review the literature with emphasis on operative decision making.     

Clinical performance of a polymerase chain reaction testing algorithm for diagnosis of HIV-1 infection in peripheral blood mononuclear cells

The clinical performance of a modified polymerase chain reaction (PCR) testing algorithm was evaluated for confirming the presence of HIV-1 proviral DNA in peripheral blood mononuclear cells. A whole cell lysate, rather than phenol-purified DNA, was used for PCR amplification, under systematically optimized conditions designed and verified within each PCR run to detect as few as 10 copies of proviral DNA. A sequential testing algorithm was designed requiring reactivity in duplicate (with corresponding non-reactivity in negative controls) with at least two sets of primers, before reporting a specimen as HIV-1-positive. In 196 specimens from patients staged according to the Walter Reed staging system, the PCR test sensitivity and the coculture isolation rate (in parentheses) were found to be: 97% (71%), 100% (85%), and 100% (76%) in stage 1, stage 2, and stage 3 specimens, respectively; and 100% (100%) in stage 4, 5, and 6 specimens. Results were uniformly negative for PCR and coculture isolation from 21 blind negative specimens and 105 (negative) donor leukopacks. These data indicate that this PCR testing algorithm is more accurate than tissue culture isolation methods, especially with early stage patients, and results in detection of HIV-1 in virtually 100% of seropositive individuals, with no false positives.     

A systematic review of vaccine-induced thrombotic thrombocytopenia in individuals who received COVID-19 adenoviral-vector-based vaccines

Journal of Thrombosis and Thrombolysis - Reports of thrombotic response after receiving COVID-19 Adenoviral-Vector Based Vaccines raise concerns about vaccine-induced thrombotic thrombocytopenia...     

Antiplatelets Versus Anticoagulation in Cervical Artery Dissection: A Systematic Review and Meta-analysis of 2064 Patients

Background and ObjectivesIn young people aged < 50 years, cervical artery dissection (CeAD) is among the most common causes of stroke. Currently, there is no consensus regarding the safest and most effective antithrombotic treatment for CeAD. We aimed to synthesize concrete evidence from studies that compared the efficacy and safety of antiplatelet (AP) versus anticoagulant (AC) therapies for CeAD.MethodsWe searched major electronic databases/search engines from inception till September 2021. Cohort studies and randomized controlled trials (RCTs) comparing anticoagulants with antiplatelets for CeAD were included. A meta-analysis was conducted using articles that were obtained and found to be relevant. Mean difference (MD) with 95% confidence interval (CI) was used for continuous data and odds ratio (OR) with 95% CI for dichotomous data.ResultsOur analysis included 15 studies involving 2064 patients, 909 (44%) of whom received antiplatelets and 1155 (56%) received anticoagulants. Our analysis showed a non-significant difference in terms of the 3-month mortality (OR 0.47, 95% CI 0.03–7.58), > 3-month mortality (OR 1.63, 95% CI 0.40–6.56), recurrent stroke (OR 0.97, 95% CI 0.46–2.02), recurrent transient ischaemic attack (TIA) (OR 0.93, 95% CI 0.44–1.98), symptomatic intracranial haemorrhage (sICH) (OR 0.38, 95% CI 0.12–1.19), and complete recanalization (OR 0.70, 95% CI 0.46–1.06). Regarding primary ischaemic stroke, the results favoured AC over AP among RCTs (OR 6.97, 95% CI 1.25–38.83).ConclusionOur study did not show a considerable difference between the two groups, as all outcomes showed non-significant differences between them, except for primary ischaemic stroke (RCTs) and complete recanalization (observational studies), which showed a significant favour of AC over AP. Even though primary ischaemic stroke is an important outcome, several crucial points that could affect these results should be paid attention to. These include the incomplete adjustment for the confounding effect of AP–AC doses, frequencies, administration compliance, and others. We recommend more well-designed studies to assess if unnecessary anticoagulation can be avoided in CeAD.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40268-022-00398-z.     

Central positional vertigo as first initial multiple sclerosis symptom: A case report with systematic review

Multiple sclerosis is a disease that affects the central nervous system, resulting in various symptoms such as vision, physical activity, and stability. Central positional vertigo as initial multiple sclerosis symptoms are a rare case. It increases the attention of doctors to follow accurate measurements to diagnose multi sclerosis regarding the initial symptoms.     

Homo‐ and Copolymerization of Strained Cyclic Olefins with New Palladium(II) Complexes Bearing Ethylene‐Bridged Heterodonor Ligands

Amorphous and high molar mass polymers of norbornene and phenylnorbornene (endo/exo ratio of 80/20) were prepared by the use of new dicationic palladium(II) single‐component catalysts of the general type [Pd(L∩L)(NCCH₃)₂](BF₄)₂. [(L∩L) = 2‐(diphenylarsino)‐1‐(methylthio)ethane (S∩As, 1 ) ( 4 ), 2‐(diphenylphosphino)‐1‐methylthio)ethane (S∩P, 2 ) ( 5 ), 1, 2‐bis(diphenylphosphino)ethane (P∩P, 3 ) ( 6 ). With increasing the trans influence of the donor atom in the ligands (P > As > S) the polymerization activity of the catalysts towards polymerization of norbornene increases instantly. Both the molecular weight and the thermal behavior of the polymer can be tailored using ethene as chain transfer agent. Catalyst 4 is also active towards the alternating copolymerization of carbon monoxide and norbornene. The isolated copolymer is highly soluble in toluene, THF and chlorinated solvents. The DSC measurement of the norbornene‐carbon monoxide copolymer showed a melting temperature (T_m) of 241°C (ΔH_f = 47.3 J/g) and a glass transition temperature (T_g) of 161°C which is about 170°C lower compared to the homopolynorbornene (T_g ≅ 330°C).     

Greater than expected prevalence of pseudotumor cerebri: a prospective study

BackgroundThe overall incidence of pseudotumor cerebri (PTC) has been estimated at 1 per 100,000 in the general population, with an increase to 19 per 100,000 among overweight patients. About 25% of affected patients are asymptomatic until they present with vision loss. We hypothesized that PTC would be highly prevalent among obese patients seeking bariatric surgery. The setting of our study was a university hospital.MethodsDuring a 2-year period, clinical data were collected from candidates for bariatric surgery. A group of the study population was concurrently screened for papilledema using fundus imaging. All images were reviewed by a single neuro-ophthalmologist. All patients with abnormal images were referred for neuro-ophthalmic evaluation.ResultsThe imaging group (78% women) had a mean age of 45.4 ± 10.7 years, and the mean body mass index of 47.8 ± 8.7 kg/m². High definition nonmydriatic fundus imaging was normal in 489 patients (91.9%) and abnormal in 43 patients (8.9%). The subsequent evaluation by the neuro-ophthalmologist revealed ocular abnormalities other than optic disc edema in 27 patients (5.1%) and normal findings in 7 patients (1.3%). Five patients (.9%) declined additional evaluation. Four patients (.8%) had confirmed optic disc edema and normal brain magnetic resonance imaging findings. Of these patients, 3 underwent lumbar puncture, which confirmed the diagnosis of PTC.ConclusionWe identified a greater prevalence of PTC overall (.65%) and in the imaging group (.9%) than previously reported or would have been predicted from the current data. Although routine funduscopic examination is of limited utility, these findings warrant additional investigation into the utility of, and optimal method for, screening morbidly obese patients for this co-morbidity.