Immunological outcomes of autologous hematopoietic stem cell transplantation for multiple sclerosis: a systematic review.

Background: Autologous hematopoietic stem cell transplantation (AHSCT) is an extensive procedure that allows for the depletion of the immune system and its restoration from hemopoietic stem cells. The approach has been modified for the treatment of severe immune-mediated illnesses, including multiple sclerosis (MS), after being initially devised for the treatment of hematological malignancies. Objective: This systematic review aims to determine and consolidate the information on the short-term and long-term immunological effects of AHSCT on the cellular level in MS patients. Methods: The PubMed, Scopus, and Web of Science servers were used to conduct a systematic search in compliance with the PRISMA guidelines. The results were tabulated and analyzed. Results: A total of 17 studies (10 clinical trials, 6 cohort studies, and 1 case-control study) were included in the final analysis, and 383 MS patients were analyzed. A significant decline in the cell count of CD4 T cells was reported when compared to the CD8 T cells, B cells, and NK cells. B cell count returned to baseline in 71.4% of the studies at the end of 6 months. The NK cell count was found to be above the baseline in 62.5% of studies. Conclusion: AHSCT has been proven to be one of the most effective treatment modalities for MS in recent studies. However, debilitating complications due to immunological outcomes of the procedure have led to increased morbidity. Further research into this domain will help boost the success rate and efficacy of AHSCT.

Primary pleural hydatidosis presenting as an isolated cough: A rare case report.

INTRODUCTION AND IMPORTANCE: Echinococcus granulosus causes hydatid disease. The most affected organ is the liver which is followed by the lungs. The pleural cavity being the primary location of hydatid cysts is rare and should be discussed further. This paper documents a rare case of primary pleural hydatidosis which can present with a merely isolated cough followed by dyspnea. The diagnosis and surgical treatment along with post-operative medications are vital in this case. CASE PRESENTATION: We present a case of a 45-year-old who suffered from a cough for more than one week which did not subside after taking medications. This symptom was followed by dyspnoea for which an X-ray was done which showed left-sided pleural effusion, a complication of pleural hydatidosis. Computed tomography showed multiple cysts in the pleural cavity which confirmed the diagnosis of primary pleural hydatidosis as the cysts were not present in any other sites. Blood work revealed eosinophilia which is significant in parasitic diseases. A left posterolateral thoracotomy was performed, and the cysts were surgically removed. Additionally, empyemectomy and pleurectomy were done. The patient was then treated with anti-parasitic therapy and was advised to get X-rays during the follow-up visits. The X-rays were normal and indicated that there was no disease recurrence. CLINICAL DISCUSSION: Echinococcus granulosus is a parasitic worm that causes hydatid disease. The primary location is the liver. A diagnosis of intrathoracic but extrapulmonary disease, which involves the presence of hydatid cysts in the pleura, heart, pericardium, mediastinum, chest wall, and diaphragm, is difficult in individuals lacking a primary cyst in a common location (Isitmangil et al., 2003; Saeedan et al., 2020). CONCLUSION: This case implies the significance of a cough of more than a week that is not relieved by medications. This should be carefully evaluated and followed in cases that have a rare diagnosis requiring surgery. A diagnosis of primary pleural hydatidosis with left-sided pleural effusion and atelectasis with mediastinal shift to the right side was made which was treated with a surgical procedure.

Neuromyelitis optica spectrum disorder with AQP4-IgG presenting as area postrema syndrome and progressing to myelitis: A rare case report.

Key Clinical Message: Neuromyelitis optica spectrum disorders can less commonly present with area postrema syndrome progressing to myelitis. Management involves intravenous glucocorticoids, plasma exchange, and preventive immunotherapy. Abstract: Neuromyelitis optica spectrum disorders can less commonly present with area postrema syndrome progressing to myelitis. The majority of patients have positive AQP4-Ab. Diagnosis is based on clinical and imaging findings. These patients can be treated with intravenous glucocorticoids, plasma exchange, and preventive immunotherapy.

Atypical Presentations of Foix-Chavany-Marie Syndrome (FCMS) in Stroke.

Foix-Chavany-Marie syndrome (FCMS) presents with anarthria and bilateral (B/L) central facio-linguo-velo-pharyngo-masticatory paralysis with "autonomic voluntary dissociation." The most common cause of FCMS is cerebrovascular disease, while rarer causes include central nervous system infection, developmental disorders, epilepsy, and neurodegenerative disorders. Even though this syndrome is also referred to as (B/L) anterior operculum syndrome, patients with lesion in sites other than (B/L) opercular regions also can develop the syndrome. In this article we describe two such atypical cases. Case 1: A 66-year-old man with diabetes and hypertension who is a smoker had right-sided hemiplegia one year back developed the syndrome acutely two days before admission. CT brain showed left perisylvian infarct and right internal capsule anterior limb infarct. Case 2: A 48-year-old gentleman, who is a diabetic and hypertensive had right-sided hemiplegia one year back and developed the syndrome acutely two days before admission. CT brain showed (B/L) infarcts in the posterior limb of the internal capsule. Both patients had bifacial, lingual, and pharyngolaryngeal palsy thereby confirming the diagnosis of FCMS. None of them had the classical (B/L) opercular lesions on imaging and one patient did not even have a unilateral opercular lesion. Contrary to the common teaching, (B/L) opercular lesions are not always necessary to produce FCMS and can occur even without opercular lesions at all.