Guillain-Barre syndrome following COVID-19 vaccination: a study of 70 case reports.

Background and objective: Guillain-Barre syndrome (GBS) has been found to have some interesting association with vaccinations. This paper mainly focuses on exploring different associations between COVID-19 vaccination and GBS. Methods: Electronic databases such as PubMed, Google Scholar, Cochrane, and Embase were searched using MESH terms for case reports published till 1 August 2023 from which 70 case reports were documented involving 103 individuals from 23 different countries. Result and discussion: The case reports were from a wide range of individuals aged from 13 to 87 years with an average age of 53±20 interquartile range years along with male predominance. The average time between receiving the vaccine and the onset of symptoms was 13.08±2.14 days. Prominent clinical features included back pain, facial diplegia, weakness, and paraesthesia whereas the main diagnostic studies were cerebrospinal fluid (CSF) analysis and electromagnetic studies. The principal diagnostic clue was albumin-cytological dissociation in CSF while being negative for anti-ganglioside antibodies or SARS-CoV-2. Available treatment options consisted of intravenous immunoglobulin and Plasmapheresis. Patients with comorbidities such as diabetes mellitus, hypertension, dyslipidemia, permanent atrial fibrillation, hypothyroidism, Hashimoto's thyroiditis, Chronic Obstructive Pulmonary Disease, asthma, osteoporosis, migraine, rheumatoid arthritis, osteoarthritis, ulcerative colitis, coeliac disease, seizures, bipolar disorder, endometriosis, multiple sclerosis, bell's palsy, squamous cell carcinoma, prostate cancer were included in our study. Conclusion: Overall, this review evaluated innovative and clinically relevant associations between COVID-19 vaccination and GBS. Understanding of this uncommon potential side effect of COVID-19 vaccination is crucial for prompt diagnosis and appropriate treatment. Importantly, GBS should not be considered a contraindication to vaccination. This underscores the importance of ongoing research to enhance the safety and efficacy of COVID-19 vaccination efforts.

The diagnostic performance in clinically significant prostate cancer with PI-RADS version 2.1: simplified bpMRI versus standard mpMRI.

OBJECTIVES: To compare the diagnostic performance for the detection of clinically significant prostate cancer (csPCa) between bpMRI with only axial T2WI (simplified bpMRI) and standard-multiparametric MRI (mpMRI). METHODS: A total of 569 patients who underwent mpMRI followed by biopsy or prostatectomy were enrolled in this retrospective study. According to PI-RADS v2.1, three radiologists (A, B, C) from three centers blinded to clinical variables were assigned scores on lesions with simplified bpMRI and then with mpMRI 2 weeks later. Diagnostic performance of simplified bpMRI was compared with mpMRI using histopathology as reference standard. RESULTS: For all the three radiologists, the diagnostic sensitivity was significantly higher with mpMRI than with simplified bpMRI (P < 0.001 to P = 0.035); and although specificity was also higher with mpMRI than with simplified bpMRI for radiologist B and radiologist C, it was statistically significant only for radiologist B (P = 0.011, P = 0.359, respectively). On the contrary, for radiologist A, specificity was higher with simplified bpMRI than with mpMRI (P = 0.001). The area under the receiver operating characteristic curve (AUC) was significantly higher for mpMRI than for simplified bpMRI except for radiologist A (radiologist A: 0.903 vs 0.913, P = 0.1542; radiologist B: 0.861 vs 0.834 P = 0.0013; and radiologist C: 0.884 vs 0.848, P = 0.0003). Interobserver reliability of PI-RADS v2.1 showed good agreement for both simplified bpMRI (kappa = 0.665) and mpMRI (kappa = 0.739). CONCLUSION: Although the detection of csPCa with simplified bpMRI was comparatively lower than that with mpMRI, the diagnostic performance was still high in simplified bpMRI. Our data justify using mpMRI outperforms simplified bpMRI for prostate cancer screening and imply simplified bpMRI as a potential screening tool.

Dysentery and leg ulcer as an atypical presentation of systemic lupus erythematosus: A case report.

INTRODUCTION: Due to heterogeneity in the organs involved and a variety of influencing factors, a wide range of clinical manifestations are possible in systemic lupus erythematosus (SLE). In our knowledge, a combination of leg ulcer and dysentery as presenting symptoms of SLE has never been reported previously. PATIENT CONCERNS: A 13-year-old female child presented with a chronic wound over right medial malleolus for 6 months, and passing of watery stool, later mixed with blood, for 4 days. On examination, she had a fever of 38.5°C. Lab reports revealed anemia, thrombocytopenia, proteinuria, and features of urinary tract infection. Renal biopsy showed membranous glomerulonephropathy. She was positive for antinuclear antibodies (ANA) and antidouble stranded DNA (anti-dsDNA). Immunofluorescence revealed reduced C4 and C3 levels. Abdominal ultrasound showed symmetrical circumscribed thickening, and edematous cecum and ascending colon. DIAGNOSIS: The patient was diagnosed with SLE based on the Systemic Lupus International Collaborating Clinics classification criteria. INTERVENTIONS: The patient was treated with prednisolone, hydroxychloroquine, metronidazole, ciprofloxacin, trypsin-chymotrypsin, zinc, calcium, and calcitriol tablets. OUTCOMES: Fever subsided within 3 days of treatment. Gastrointestinal symptoms subsided within 1 week of treatment. On 31 day of treatment, the wound had been reduced and showed features of healing. CONCLUSION: Dysentery and leg ulcers can be the manifestations of SLE. Therefore, SLE should also be considered when a patient presents with such symptoms. Any suspicion of infection in SLE should be treated aggressively with antibiotics.

A giant isolated primary splenic hydatidosis: A case report.

Introduction: and importance: Hydatid cyst disease is caused by Echinococcus tapeworm and is one of the major health problems in endemic regions like Nepal. The cases of splenic hydatidosis are quite rare and giant isolated primary splenic hydatidosis is even rarer. The patients present with vague symptoms or no symptoms at all. Here we report a case of isolated splenic hydatid cyst. So, we should think the differential diagnosis of splenic hydatidosis in any abdominal case of endemic regions. Case presentation: A 27-year-old female presented with left-side abdominal pain for the past 7 months without any particular attraction. Abdominal ultrasound showed a well-defined cystic mass on the upper pole with low-level internal floating debris. Contrast Enhanced CT scan showed well defined cystic lesion measuring about 10.8 × 9.6 × 8.5 cm in the upper pole of the spleen with an exophytic component and minimal homogenous wall enhancement. Laparoscopic Splenectomy was done and albendazole for 3 weeks was prescribed after all the patient was completely normal. Clinical discussion: In this case, the optimal treatment of giant isolated splenic hydatidosis was splenectomy and prescription of albendazole. Conclusion: We believe in any abdominal case of the endemic region, the hydatid cyst of the spleen should be taken as one of the differential diagnoses and should be managed appropriately before the complication arises.

Evaluation of different mathematical models and different b-value ranges of diffusion-weighted imaging in peripheral zone prostate cancer detection using b-value up to 4500 s/mm2.

OBJECTIVES: To evaluate the diagnostic performance of different mathematical models and different b-value ranges of diffusion-weighted imaging (DWI) in peripheral zone prostate cancer (PZ PCa) detection. METHODS: Fifty-six patients with histologically proven PZ PCa who underwent DWI-magnetic resonance imaging (MRI) using 21 b-values (0-4500 s/mm2) were included. The mean signal intensities of the regions of interest (ROIs) placed in benign PZs and cancerous tissues on DWI images were fitted using mono-exponential, bi-exponential, stretched-exponential, and kurtosis models. The b-values were divided into four ranges: 0-1000, 0-2000, 0-3200, and 0-4500 s/mm2, grouped as A, B, C, and D, respectively. ADC, , D*, f, DDC, α, Dapp, and Kapp were estimated for each group. The adjusted coefficient of determination (R2) was calculated to measure goodness-of-fit. Receiver operating characteristic curve analysis was performed to evaluate the diagnostic performance of the parameters. RESULTS: All parameters except D* showed significant differences between cancerous tissues and benign PZs in each group. The area under the curve values (AUCs) of ADC were comparable in groups C and D (p = 0.980) and were significantly higher than those in groups A and B (p< 0.05 for all). The AUCs of ADC and Kapp in groups B and C were similar (p = 0.07 and p = 0.954), and were significantly higher than the other parameters (p< 0.001 for all). The AUCs of ADC in group D was slightly higher than Kapp (p = 0.002), and both were significantly higher than the other parameters (p< 0.001 for all). CONCLUSIONS: ADC derived from conventional mono-exponential high b-value (3200 s/mm2) models is an optimal parameter for PZ PCa detection.

Feasibility Study of 3-T DWI of the Prostate: Readout-Segmented Versus Single-Shot Echo-Planar Imaging.

OBJECTIVE: The purpose of this prospective study was to assess the clinical utility of generalized autocalibrating partial parallel acquisition (GRAPPA)-accelerated readout-segmented echo-planar imaging (rs-EPI) DWI and compare it with standard single-shot EPI ( ss-EPI) DWI in visualization of the prostate during 3-T MRI. SUBJECTS AND METHODS: One hundred sixteen consecutively registered patients (mean age, 63.5 years; range 24-93 years) underwent 3-T MRI that included rs-EPI DWI and standard ss-EPI DWI with identical FOVs, slices, acceleration factors, b values, and image postprocessing procedure. The datasets were independently evaluated by two blinded radiologists. Images were evaluated for sharpness, anatomic distortion, imaging contrast, lesion conspicuity, detailed anatomic visualization, and overall image quality on a 5-point Likert scale (1, nondiagnostic; 5, excellent). RESULTS: The kappa values were 0.73 for image sharpness, 0.71 for anatomic distortion, 0.54 for imaging contrast, 0.56 for lesion conspicuity, 0.61 for detailed anatomic visualization, and 0.63 for overall image quality (all p < 0.05), indicating moderate to substantial agreement between the two observers. The mean Likert scores for standard ss-EPI and rs-EPI were as follows: image sharpness, 2.9 and 4.6; distortion level, 2.8 and 4.4; contrast, 3.1 and 3.8; lesion conspicuity, 3.0 and 4.0; structure, 3.1 and 4.2; and overall image quality, 3.1 and 4.2. The rs-EPI DWI sequence was associated with significantly better image quality and fewer susceptibility artifacts than was ss-EPI (all p < 0.05). The rs-EPI sequence was considered better overall in 90% of cases. CONCLUSION: The technique of rs-EPI DWI combined with GRAPPA enables robust prostate imaging with high image quality and may provide great benefit in routine clinical practice.

Comparison of field-of-view (FOV) optimized and constrained undistorted single shot (FOCUS) with conventional DWI for the evaluation of prostate cancer.

OBJECTIVES: Qualitative and quantitative comparison of the application value of diffusion-weighted imaging (DWI) magnetic resonance imaging based on field-of-view (FOV) optimized and constrained undistorted single shot (FOCUS) with the standard single-shot echo-planar imaging (ss-EPI) in patients with prostate cancer. METHODS: A total of 28 patients with 33 prostate cancers underwent ss-EPI and FOCUS DWI. Two independent readers assessed image studies. RESULTS: Image qualities of FOCUS were rated superior to ss-EPI (P<.001). The mean apparent diffusion coefficient value of 33 cancers was 974.030×10(-6)mm(2)/s and 941.727×10(-6)mm(2)/s, respectively, and the difference was statistically significant (t=2.579, P=.015). CONCLUSIONS: FOCUS as a high-resolution DWI technique has potential clinical utility.