Navigating the complexity of osmotic demyelination syndrome in the elderly: insight from three cases

Osmotic demyelination syndrome (ODS) results from rapid shifts in serum osmolality and can be triggered by various factors such as hyponatremia, hyperglycaemia, malnutrition, alcohol abuse, and liver disease. Although hyponatremia prevalence increases with age, ODS typically manifests between ages 30 to 50, indicating a complex age-susceptibility relationship. Its pathophysiology involves brain volume restoration adaptation, with rapid correction of osmolality leading to dehydration and subsequent demyelination. Hyperglycaemia-induced ODS results from rapid correction of hyperosmolar states, overwhelming neuronal compensatory mechanisms. Neuroimaging, usually MRI, is crucial for diagnosis, revealing hyperintense lesions. Clinical manifestations vary widely, from dysarthria and dysphagia to spastic quadriparesis, with poor outcomes, especially in older patients. Below, three cases of ODS in elderly patients are presented, each with distinct clinical presentations and outcomes. Case1 highlights the association between rapid correction of hyperglycaemia and ODS while Case 2 and 3 illustrates the consequences of overly rapid correction of hyponatremia. Diagnosing Osmotic Demyelination Syndrome (ODS) in the elderly poses challenges due to overlapping clinical features with conditions like encephalopathy, delirium, and postictal confusional states, which closely mimic ODS. Further research is needed to better understand the pathophysiology and optimize management approaches, especially in vulnerable populations like the elderly.

Writing case report and case series for family and community medicine practice

@#<p style="text-align: justify;" data-mce-style="text-align: justify;">Case reports remain to be an essential part of knowledge generation in health care. It is a research design that involves writing about a patient’s illness with either an unusual, new, unexpected, or unique characteristic. It can be about new findings, a novel diagnostic test, unfamiliar adverse events or innovative medical and surgical interventions. It is a detailed description of a patient’s course of illness including symptoms, physical examination findings, laboratory results, treatment modalities and outcomes. The essential element of writing a case report or series is to contribute to the generation of new knowledge. Wellwritten manuscripts have a valuable purpose in medicine as they present new illness, unexpected effects of treatment, novel diagnostic exams or unforeseen patients’ outcomes. The sections of a case report include an Abstract, Introduction or Background, Case Presentation [history, physical examinations, investigations or laboratories, differential diagnosis (if relevant), treatment (if relevant), outcome/follow-up, Discussion, Learning points/Take home messages, Patients perspectives and References. Manuscripts written as case reports or case series by nature of their design are not required to get approval from an Ethics Review Board (ERB). However, there should be an institutional process to clear and register papers. Case reports or a case series has its own distinctive writing components and features as not all single or series of clinical cases are reportable. This article aimed to define case reports/series, describe the different parts, how to write and evaluate a case report manuscript using the CARE guidelines.</p>

Rapid Manual Drainage of Ascites in a Home Visit Setting

Abdominal paracentesis is a standard intervention for symptom relief in patients with ascites; however, there is no established agreement regarding the optimal speed of ascites drainage. This paper presents three cases of rapid manual drainage of ascites (RMDA) conducted during home visits: a 72 year-old male with intractable cirrhosis, a 73 year-old male with malignant ascites secondary to cancer of the pancreatic tail, and a 54 year-old male suffering from malignant ascites due to pancreatic tail cancer with hepatic metastases. Drainage volumes ranged from 1.4 to 3 liters, with procedures taking between 12 to 14 minutes. Post-procedure systolic blood pressures were maintained above 90 mmHg at immediate, 2 (±1) hours, and 24 (±12) hours following the procedure in all cases. No severe adverse events were reported. RMDA may offer a reduced procedural time in the home visit context, lessening patient discomfort and healthcare provider costs. Further studies are needed to evaluate the safety of RMDA in home care settings.

Interstitial ectopic pregnancy: a case series

Interstitial ectopic pregnancy is very rare with incidence of 2-5%. Their presentation is not uniform and hence may go unrecognized till complications develop. We present three cases of interstitial ectopic pregnancies presenting in our hospital in a span of 1 year. Only one of them had pain in the abdomen at the time of presentation. All cases presented at around five to six weeks of gestation. Ultrasonography confirmed the diagnosis. One case was managed medically while in other two cases, there was a need of surgical management. There were no complications in all the cases. Thus, early presentation of cornual ectopic pregnancy results in satisfactory outcome.� Hence, all pregnant women should undergo regular antenatal checkups with early scans once the urine pregnancy test come positive to confirm whether it is an intra uterine pregnancy or not.

Manifestaciones gingivales de sífilis secundaria: serie de casos / Gingival manifestations of secondary syphilis: case series

Objetivo: La sífilis es una enfermedad de transmisión sexual con una incidencia creciente a nivel mundial. En la sí- filis secundaria, las lesiones orales son frecuentes, siendo a veces la única manifestación. El objetivo de este artículo es presentar una serie de casos clínicos de sífilis con localización predominante o exclusivamente gingival, destacando las ca- racterísticas clínicas más relevantes para su diagnóstico. Casos clínicos: Esta serie de casos clínicos incluyó nueve casos de sífilis secundaria con manifestaciones gingi- vales. El diagnóstico se realizó mediante pruebas serológicas (VDRL, TPPA, FTA-ABS y MHA-TP), y se describieron le- siones tanto gingivales como extragingivales. En la encía se observó sífilis secundaria afectando principalmente la región anterior ­tanto superior como inferior­, presentándose pla- cas rojas o blancas. Algunos casos también presentaban le- siones en otros sitios intraorales, tenían síntomas como dolor o sensación de ardor, o presentaban enfermedad periodontal dependiente de placa. El diagnóstico diferencial de sífilis se- cundaria gingival con condiciones periodontales inespecíficas es fundamental para un diagnóstico adecuado. Por lo tanto, se debe considerar el diagnóstico de sífilis secundaria cuando se enfrentan casos gíngivo-periodontales atípicos en la práctica diaria (AU)

Aim: Syphilis is a sexually transmitted disease with growing incidence worldwide. In secondary syphilis, oral le- sions are common, sometimes being the only manifestation. Gingival features of syphilis are rare and usually present mul- tiple oral lesions. The aim of this article is to present a series of clinical cases of syphilis with predominantly or exclusively gingival localization, highlighting the most relevant clinical characteristics for its diagnosis. Clinical cases: This clinical case series included nine cases of secondary syphilis with gingival manifestations. The diagnosis was made using serological tests (VDRL, TPPA, FTA-ABS, and MHA-TP), and both gingival and extragingi- val lesions were described. Secondary syphilis was observed in the gum, mainly affecting the anterior region ­both up- per and lower­, depicting red or white plaques. Some cases also presented lesions in other intraoral sites, had symptoms such as pain or burning sensation, or showed plaque induced periodontal disease. The differential diagnosis of second- ary syphilis considering non-specific periodontal conditions with gingival involvement is essential for a proper diagnosis. Thus, the diagnosis of secondary syphilis should be consid- ered when dealing with atypical gingivo-periodontal cases in everyday practice (AU)

A case series of invasive pneumococcal disease in children

Invasive pneumococcal disease (IPD) has a high clinical burden, particularly among children in developing countries. We presented 4 cases of IPD in children who were admitted to Pushpagiri institute of medical science and research centre, Kerala between 2021 and 2022. While our first 3 patients had milder course of disease, our fourth patient who presented with severe pneumonia with pleural effusion had poor outcome. The fact that three out of four of our patients have not received pneumococcal vaccination marks the necessity of this vaccine to prevent IPD in children.

Metodología: cómo realizar un informe de caso o informe de serie de caso / Methodology: How to develop a case report or case series report

RESUMEN El informe de caso o los informes de series de casos son estudios descriptivos. Pese a que su resultado no se emplea para realizar inferencias, son la primera línea de evidencia de las terapias nuevas y un preámbulo de investigaciones con diseño metodológico idóneo. Este tipo de estudio es fundamental para describir enfermedades nuevas o inusitadas, eventos adversos o complicaciones de las patologías conocidas. Se han convertido en un medio de comunicación elemental y accesible para los profesionales de la salud. De igual forma, son un material pedagógico adecuado para fomentar habilidades de escritura e intervención, principalmente para los investigadores novicios. Además de fortalecer la academia, estimulan la difusión del conocimiento y ayudan a resolver los dilemas de la práctica clínica. También son una herramienta básica para el inicio y el mantenimiento de la investigación, por lo que seguirán vigentes como medio de comunicación y de enlace del conocimiento médico. En consecuencia, es importante conocer su definición, su estructura y su papel en la literatura médica y en la investigación. En esta revisión se proporcionan los elementos necesarios para tener en cuenta cuando se va a publicar una metodología de este tipo de estudio.

A B S T R A C T Case reports or case series reports are descriptive studies, although their results are not used to make inferences, they are the first line of evidence for new therapies and a preamble to research with a stronger methodological design. This type of study is essential to describe new or unusual diseases, adverse events, or complications of known pathologies. They have become an elementary and accessible means of communication for health professionals. They are also pedagogical material to promote writing and intervention skills, mainly for novice researchers. This type of study strengthens academia, stimulates the spread of know ledge, and helps to resolve the dilemmas of clinical practice. In addition, they are a basic tool for the initiation and maintenance of research, so they will remain updated as a means of communication and linkage to medical knowledge. Therefore, it is important to know their definition, structure and role in the medical literature and research. This review provides the elements to consider when publishing a methodology for this type of study.

Figaro crowns- brings a smile or a frown?

Initially, the treatment option for grossly decayed teeth was extraction, but due to advancements in paediatric dentistry, it has now shifted to restoration. Earlier, only full-coverage stainless steel crowns were in use, but they have a disadvantage for aesthetic restorations. Following this many crowns have been introduced into paediatric dentistry to preserve the tooth for function and aesthetics. Investigators have argued that certain restorations are superior to others, yet the hunt for the ideal aesthetic restoration goes on. This case series aims to check the efficacy, aesthetics and ease of placement of the newly introduced Figaro crowns. This case series reports 4 cases in which Figaro Crowns were used for aesthetic full coronal restorations in children aged between 3- 6 years. Figaro crowns are time efficient, advantageous in uncooperative placement and can be done with minimal tooth structure reduction. Figaro crowns appear to be the alternative to zirconia crowns and strip crowns as they have superior aesthetics and minimal reduction of tooth structure, making them more time-saving compared to zirconia crowns.

A surgical management of articular disc injury in temporomandibular Joint: A compiled case series of two cases with articular disc tear managed with surgical intervention

Articular disc injury in the temporomandibular joint (TMJ) can lead to significant pain and limited jaw movement. We present two cases in this case series of articular disc injuries in the TMJ and elaborate on their etiology, clinical presentation, diagnostic modalities, and treatment provided with follow-up reviews. Case 1 involved a 50-year-old female with a history of pain and clicking in the left TMJ for 10 years, wherein imaging studies revealed a discal tear. Case 2 involved a patient who presented with trauma and was diagnosed with a displaced disc with a disc tear when the patient was screened for mandibular fractures. The patients underwent surgical intervention, and the disc tear was repaired, following which both showed marked improvement. Our cases highlight the importance of early diagnosis and necessary surgical management of articular disc injury in the TMJ for better clinical outcomes.

?he effect of task oriented approach on gait of hemiplegic patients: a case series study

The last few years, the main purpose of the treatment of the hemiplegic patient, is to regain his ability to execute functional activities of daily living independently. According to the latest studies, the effectiveness as well as the importance of task-oriented approach (TOA), is apparent and determining to reacquire the patient’s lost independency, through the practice of the specified functional activities. The aim of this study is to investigate a program of TOA on gait of hemiplegic patients. A sample of 5 post stroke patients was selected from according to the inclusion criteria. A TOA intervention was executed through the practice of 10 functional activities, related to gait, from Monday to Friday for 4 weeks. At the end of each week, gait and balance assessments were performed through the 10-meter walk test (10 MWT), the Berg balance scale (BBS), and the timed up and go test (TUG). The analysis indicates that TOA is extremely effective for stroke patients with mediocre and minor gait and balance deficits, as the difference was statistically significant (p<0.05). The statistically significant difference was from the first assessment T1 to the final assessment T5 and was proven through BBS, TUG and 10 MWT. In conclusion, TOA is a quite beneficial and a cost-effective intervention for the rehabilitation of gait and balance for stroke patients, while consequently improving the quality of their everyday life, independently from their original functional status.

A Series of Ocular Tuberculosis Cases from A Rural Tertiary Care Center in West Bengal

Tuberculosis in Eye can have diverse presentations leads to diagnostic difficulty. If no extra-ocular tubercular lesions are found then it becomes a challenge to diagnose & treat. Here authors present 6 cases of Ocular Tuberculosis without any associated extra-ocular tubercular lesions. One case of tubercular anterior uveitis, eales disease, solitary Choroidal Tuberculoma, bilateral multiple Choroidal Tuberculoma, multifocal & serpiginous like Choroiditis are presented here. All of them were resolved with first line anti-tubercular regimen and corticosteroids. Authors recommend initial visual assessment for all Tuberculosis cases to diagnose & treat hidden cases of Ocular Tuberculosis which may be sight threatening.

Feasibility of a Home-based Exercise Program after Abdominally Based Autologous Breast Surgery Reconstruction：An Observational Study / The Japanese Journal of Rehabilitation Medicine

Objective：We aimed to evaluate the feasibility of our rehabilitation program for abdominally based rehabilitation following autologous breast reconstruction, and investigate the changes in physical function and health-related quality of life in the early postoperative period.Methods：Fifteen patients who underwent breast reconstruction between September 2020 and October 2021 were included in this prospective, observational case series.The program composed of prehabilitation and postoperative home-based exercise until 12 weeks post-surgery. Adherence to home exercise program was surveyed using a self-reported workout check list. At postoperative 4th, 8th, 12th, and 24th weeks, a physio-/occupational therapist assessed the following objectives：i) Range of motion, muscle strength, and disability of upper extremity and trunk, ii) Quality of life using EQ-5D questionnaire, and iii) Patients' daily activities.Results：No adverse events were observed, and all patients completed the program. Overall adherence to daily exercise was 71.1％．Physical function of the upper extremities recovered in 8th postoperative week；however, truncal function, quality of life, and daily activities in 12th postoperative week remained lower than those observed preoperatively. Nevertheless, the program appeared useful for many patients, although some reported difficulty in continuing the exercise after returning to work.Conclusion：Rehabilitation programs directed by physio/occupational therapists may play a potentially advantageous role in facilitating a return to baseline function and quality of life during the early postoperative period.

Feasibility of a Home-based Exercise Program after Abdominally Based Autologous Breast Surgery Reconstruction：An Observational Study / The Japanese Journal of Rehabilitation Medicine

Objective：We aimed to evaluate the feasibility of our rehabilitation program for abdominally based rehabilitation following autologous breast reconstruction, and investigate the changes in physical function and health-related quality of life in the early postoperative period.Methods：Fifteen patients who underwent breast reconstruction between September 2020 and October 2021 were included in this prospective, observational case series.The program composed of prehabilitation and postoperative home-based exercise until 12 weeks post-surgery. Adherence to home exercise program was surveyed using a self-reported workout check list. At postoperative 4th, 8th, 12th, and 24th weeks, a physio-/occupational therapist assessed the following objectives：i) Range of motion, muscle strength, and disability of upper extremity and trunk, ii) Quality of life using EQ-5D questionnaire, and iii) Patients' daily activities.Results：No adverse events were observed, and all patients completed the program. Overall adherence to daily exercise was 71.1％．Physical function of the upper extremities recovered in 8th postoperative week；however, truncal function, quality of life, and daily activities in 12th postoperative week remained lower than those observed preoperatively. Nevertheless, the program appeared useful for many patients, although some reported difficulty in continuing the exercise after returning to work.Conclusion：Rehabilitation programs directed by physio/occupational therapists may play a potentially advantageous role in facilitating a return to baseline function and quality of life during the early postoperative period.

A Clinical Study on the Intervention of a Comprehensive Program of Traditional Chinese Medicine on Degenerative Lumbar Spinal Stenosis / 世界科学技术-中医药现代化

Objective To preliminarily verify the effectiveness and safety of bloodletting combined with drug bamboo cups in intervention of degenerative lumbar spinal stenosis,and to explore the prognostic factors that affect the efficacy of TCM regimens in the treatment of DLSS.Methods 64 consecutive patients with degenerative lumbar spinal stenosis were enrolled.Bloodletting combined with drug bamboo cup intervention was used.Acupoints were selected and treated with the same length of the governor channel of the lumbar spine,the first and second side lines of the bladder meridian and Ashi point,weekly 2 times,8 times per course,2 consecutive courses of treatment.Before treatment,after treatment,and 1 month follow-up,the changes of the patient's lumbar spinal stenosis specific scale(SSM),modified Oswestry dysfunction index(ODI),and 12 health survey summary scores(SF-12)were observed.Using SSM symptom or function score≥0.5,the criteria for grouping were first single-factor analysis,and then logistic regression was used to analyze the prognostic factors of the treatment.Results After 2 courses of treatment,the patient's SSM symptom score(2.25±0.56),SSM function score(2.06±0.67),ODI index(15.49±8.72),and SF-12 physiological score(36.31±7.35)were more significant than before treatment Improved,the difference was statistically significant(P<0.05),the SF-12 psychological score(49.70±9.47),the difference was not statistically significant compared with before treatment(P>0.05);the patient's SSM symptom score(2.22±0.54)was followed up for one month,SSM function score(2.09±0.66),ODI index(15.53±8.23),SF-12 physiological score(36.55±7.25),SF-12 psychological score(50.62±9.17),which are significantly better than before treatment,and the difference is statistically significant(P<0.05),the difference was not statistically significant(P>0.05)after 2 courses of treatment.The univariate logistic regression analysis of each influencing factor showed that:BMI,baseline symptom dimension,baseline functional dimension,foraminal stenosis,lateral recess stenosis,and two-stage stenosis had statistically significant differences between the effective and ineffective groups(P<0.05).Conclusion Bloodletting combined with drug bamboo cups has a certain clinical effect on degenerative lumbar spinal stenosis.

Optimization of homoeopathy in the management of post-traumatic stress disorder, the aftermath of COVID-19 pandemic: a retrospective case series

Psychological fragility caused to human life has been the largest aftermath of the pandemic posing a raised public health concern globally. This psychological impact is identified as Post-Traumatic Stress Disorder (PTSD) which was the most commonly diagnosed psychological disorder during this pandemic. These cases, if left untreated and unidentified may take a devastating transformation into psychotic disorders and cause gross damage to the individual and the community by disrupting human relations. Keeping in view the beneficial role of Homoeopathy in dealing with psychological disorders based on its philosophy and previous studies, a clinical case series of 10 PTSD cases successfully treated with Homoeopathy during this pandemic are presented here. 10 cases of PTSD consulted during the first wave of pandemic diagnosed based on the clinical picture analogous to PTSD cluster symptomatology from Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) and objectively through Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) were treated with Homoeopathic intervention. Homeopathic medicine was prescribed based on the totality of each case through repertorization and in consultation with the sourcebooks of Homoeopathic Materia Medica (HMM). The cases were followed monthly for clinical improvement and every three months using the CAPS-5 score. The outcome was assessed after six months clinically and objectively through the CAPS-5 score. At the end of one year, further to assess the casual attribution of clinical outcome to homoeopathic intervention, validated MONARCH (Modified Naranjo Criteria for Homoeopathy) tool was utilized. The 10 diagnosed PTSD cases showed marked improvement assessed after one year of Homoeopathic treatment. Significant improvement was found in the clinical picture affirmed through CAPS-5 score and MONARCH tool. Homoeopathic medicines showed a significantly beneficial role in the management of PTSD during the pandemic in the presented 10 cases. Further validation through well-designed clinical trials is warranted.

Sharing a Novel Experience of Treating Addiction to Opium and Derivatives with only Ayurvedic Approach- A Case Series

Introduction: Opium and its derivative addiction are one of the most prevalent addictions in western Rajasthan, because it is easily available and is being used openly in social programs as the culture of the same. In western Rajasthan, mainly Doda poppy, opium milk, smack, tramadol, etc. are major forms of opium-derived addictions. Withdrawal symptoms such as nausea, vomiting, diarrhea, chills, body ache, sleeplessness and flu-like symptoms begin, these symptoms can grow severe enough to necessitate emergency medical attention, and in extreme situations, they might have life-threatening consequences for the user as a result of respiration depression, and pupil dilation in the later stages. The assessment was based on Clinical Opiate Withdrawal Scale (cows) before and after the treatment. Intervention: Efforts have been applied to depict 8 cases of opium addiction in form of series who have been treated with Ahiphenmochanadi vati in the dose of 250 mg twice a day and Sameergaja kerari rasa in the tapering method (Padanshika Krama) starting with the dose of 375 mg along with panchakarma procedures, Shirodhara with til tail, Abhayanga, and Swedana with Mahanarayan Tail and Dashmool kwath respectively for a period of 1 month. Reduction in cows scale was observed, about 75-80% of symptoms subsided in all cases and the results have been reported very encouraging within a period of twenty to thirty days. Conclusion: Altogether, multimodal Ayurveda treatment can be an effective and safe solution for smack addictions.

Clinical characteristics of healthcare workers with prolonged COVID-19 symptoms: A case series

@#This study was a case series of nine healthcare workers who were documented to have had prolonged symptoms of COVID-19 between April 1, 2020, and November 30, 2020. The majority were females and middle-aged (40–59 years old) with the following comorbid conditions: hypertension, bronchial asthma, and allergic rhinitis. Four healthcare workers directly handled COVID-19 patients. Seven healthcare workers were admitted during the acute phase of the illness, three of whom were diagnosed with COVID-19 Pneumonia, and one was readmitted due to persistent palpitations. Their presenting symptoms varied among the 9 cases, such as chills, fever, headache, cough, colds, sore throat, throat itchiness, loss of taste and smell, and myalgia. Prolonged symptoms were the following: cough, myalgia, easy fatigability, exertional dyspnea, shortness of breath, hair loss, and diarrhea. The duration of symptoms from onset to resolution ranges from 4.5 weeks to 30 weeks. All individuals with COVID-19, including healthcare workers, are susceptible to long-term COVID, which involves heterogenous symptoms that may last for varying durations.

Clinical features and prognosis of newborns with congenital fissure of larynx presented with choking / 中国小儿急救医学

Objective:To summarize the clinical features and prognosis of neonates with congenital fissure of larynx due to choking, and improve the diagnosis and treatment of congenital fissure of larynx by neonatal medical professionals.Methods:This study was a single-center retrospective case series report.With "choking" as the key word, combined with the information from the first page of the medical record, we searched in the electronic medical record system, and summarized the clinical characteristics and prognosis of neonates diagnosed as congenital fissure of larynx.The study period was from January 2017 to February 2021.Results:A total of seven cases were diagnosed as congenital fissure of larynx, accounting for 2.2% of the total number of hospitalized children due to choking during the same period.Among them, six cases were male, gestational age was 38 (36, 39) weeks, birth weight was 2 820 (2 255, 3 420) g, admission age was 18(5, 20) days and hospitalization duration was 26 (6, 45) days.The common clinical symptoms were choking (7/7) and cyanosis (5/7). Six of the seven children with fissure of larynx were clearly classified as type Ⅰ(two cases), type Ⅲ(three cases), and type Ⅳ(one case). All the seven cases were accompanied by other site/tracheal malformations or congenital abnormalities, among which four (4/7) cases had VACTERL syndrome.A total of three children (two cases of type Ⅲ and one case of type Ⅳ) underwent laryngeal cleft repair operation, and all died shortly after surgery.Four cases didn′t receive laryngeal cleft repair operation (two cases of type Ⅰ, one case of type Ⅲ, one case of parting was unknown), one case with type Ⅰ fissure of larynx accepted the tracheoesophageal fistula repair operation only, who was followed up until the age of two years and six months, and he could have normal diet, one case of typeⅠfissure of larynx with gastric tube discharge, who was followed up to one year and eight months old, could be normal diet too, the two cases of children with no difference between the growth with their peers; one case with type Ⅲ fissure of larynx was lost to follow-up; One case, whose classification was unknown, was followed up until he was 40 days old, and still could be fed orally.The physical development of the child was significantly behind that of the same age.Conclusion:Congenital fissure of larynx is rare, with choking as its main symptom and other malformations.Diagnosis and classification require fiberlaryngoscope and bolting laryngoscope under general anesthesia combined with bronchoscopy, which is difficult to treat.Type Ⅰ has a good prognosis, while type Ⅲ and Ⅳ have poor prognosis.

Relación entre mielitis transversa y vacunas: actualización y revisión de la literatura

La mielitis transversa (MT) es un síndrome clínico caracterizado por una inflamación y desmielinización aguda de la médula espinal. Esta entidad tomó relevancia pública en septiembre de 2020 cuando fueron suspendidos los ensayos clínicos de la vacuna ChAdOx1 para SARS-CoV-2, desarrollada por AstraZeneca y la Universidad de Oxford, por casos de MT en tres participantes. Al respecto, esta investigación se plantea recopilar la información disponible que relacione casos de MT con vacunas a nivel mundial. En este sentido, se llevó a cabo una investigación descriptiva, con diseño documental, donde se efectuó la revisión sistemática de publicaciones disponibles en las bases de datos: "PubMed", "Redalyc" y "SciELO", desde el 01/2000 al 04/2021, que presentan casos clínicos de MT post vacunación. Se estudiaron 49 casos de MT posterior a la vacunación contra diferentes virus y bacterias, 81,8 % de los mismos sucedieron en el primer mes. Se argumenta que los antígenos de las vacunas o sus adyuvantes pueden propiciar complicaciones autoinmunes que explican este fenómeno. Sin embargo, los análisis estadísticos no encuentran relación causal clara, mientras que existe evidencia que sugiere que las vacunas pueden contribuir a que se manifieste un trastorno autoinmune subyacente. El riesgo de MT pos-vacunación parece ser muy pequeño o depender del azar, mientras que el beneficio derivado de la vacunación está demostrado, incluso para disminuir los trastornos autoinmunitarios. No obstante, es importante notificar y estudiar estos casos para la realización de estimaciones certeras en el futuro, contribuyendo al desarrollo de la medicina de precisión y personalizada

Transverse myelitis (TM) is a clinical syndrome characterized by acute inflammation and demyelination of the spinal cord. This entity gained public relevance in September 2020 when clinical trials of the ChAdOx1 vaccine for SARS-CoV-2, developed by AstraZeneca and the University of Oxford, were suspended due to possible cases of MT in three participants. For this reason, this research aims to compile the available information that relates MT cases to vaccinations worldwide. In this sense, a descriptive research with documentary design was carried out through a systematic review of the publications available in the databases "PubMed", "Redalyc" y "SciELO" that presented clinical cases of post-vaccination TM from 01/2000 to 04/2021. We studied 49 cases of post-vaccination MT for different viruses and bacteria, 81.8 % of which occurred in the first month. In this sense, It's argued that vaccine antigens or their adjuvants may promote autoimmune complications that explain this phenomenon. However, statistical analyses find no certain causal relationship, while there is evidence to suggest that vaccines may contribute to the development of an underlying autoimmune disorder. The risk of postvaccination MT appears to be very small or dependent on chance, whereas the benefit derived from vaccination is certain, including in decreasing autoimmune disorders. However, it is important to report and study these cases for accurate estimates in the future, contributing to the development of precise and personalized medicine

Chemotherapy-induced leukoencephalopathy: A case series

@#<p style="text-align: justify;"><strong>Rationale:</strong> Leukoencephalopathy, a complication associated with chemotherapy has been reported after giving high doses of methotrexate and cytarabine with no specific risk factors to date.</p><p style="text-align: justify;"><strong>Objectives:</strong><br />1. To review the prevalence of chemotherapy-induced leukoencephalopathy in children with acute lymphoblastic leukemia (ALL).<br />2. To present the clinical course, pathogenesis and neuro-imaging findings of chemotherapy-induced leukoencephalopathy in children with ALL.</p><p style="text-align: justify;"><strong>Case:</strong> We reported three cases of adolescent ALL precursor B-cell patients who received high doses of methotrexate and presented with neurologic and MRI findings consistent with leukoencephalopathy. Our patients were only placed on supportive measures with adequate hydration, without providing any special intervention. Yet, all of them had complete neurological recovery.</p><p style="text-align: justify;"><strong>Discussion and Summary:</strong> Methotrexate is a cell cycle-specific agent that inhibits the enzyme dihydrofolate reductase, preventing the conversion of folic acid to tetrahydrofolic acid and inhibiting cell replication. It is one of the most commonly implicated drug causing leukoencephalopathy. [3] On MRI T2-weighted images, all of them had hyperintensities on the posterior frontal/parietal corona radiata and centrum semiovale consistent with leukoencephalopathy. Complete recovery happened spontaneously in all of the cases. There is no standard treatment for acute and subacute toxicities from methotrexate.</p>