Letter to the editor regarding the paper ”Rare tapeworm segments case report and review of literature”Michele CalatriUniversity of Cagliari – Faculty of Medicine firstname.lastname@example.orgDear Editor,My initial enthusiasm was born from the premise of reading about an uncommon species of human parasite in the article “Rare tapeworm segments case report and review of literature” by Ahmed Ali Gaffer11Gaffer A. Rare tapeworm segments case report and review of literature. Clinical Case Reports . 2023;11(4). doi:https://doi.org/10.1002/ccr3.7167, which has given way first to confusion and then to a sincere disappointment, due to the many mistakes, inaccuracies, and misspellings which unfortunately result in a chaotic and inconclusive report.First, it should be noted that in most of his manuscript, the author makes incorrect use of the terms ”cestode” and ”trematode” as if they were interchangeable. As it is known, cestodes and trematodes belong to two different classes, Cestoda and Trematoda, within the phylum Platyhelminthes. These two groups of parasitic flatworms, while sharing some similarities (e.g. bilateral symmetry and the lack of a body cavity) by having a common ancestor, count many different morphological characteristics such that the two cannot be easily confused. In particular, the head or more properly ”scolex”, neck, and the ribbon-like segmented body (strobila) composed of segments called proglottids, in addition to the lack of a mouth and digestive tract, are all external peculiarities of adult cestodes, while adult trematodes typically have an anterior mouth, organs of attachment or ”suckers” and an unsegmented leaf-shaped body22Bogitsh BJ, Carter CE, Oeltmann TN. Human Parasitology . Academic Press, An Imprint Of Elsevier; 2019.. Having said that, it seems that the observed parasite would belong to Cestoda rather than Trematoda, assuming it is a parasite.The second major problem in the report is the total lack of the minimum morphological features that are usually required for the identification of a cestode. The image attached has a very poor resolution quality, the micrometer bar is absent and the author admits that eggs have not been detected in the observed specimen. The presumed scolex, an organ whose dimensions and morphologies often represent critical keys in classifying Cestoda genera and species33Khalil LF, Jones A, Rodney Alan Bray, C.A.B. International. Keys to the Cestode Parasites of Vertebrates . Cab International; 1994., lacks any useful detail. Inside each “triangular-shaped” segment it is honestly difficult to understand how it was possible to identify a uterus just from an amorphous central mass and consequently to count the individual ”uterine branches” of the hypothetical tapeworm. It should be remarked that this is an act that would usually require the injection of India ink through a lateral genital pore, another useful point of reference, not observed in the image provided44CDC. CDC - DPDx - Taeniasis. www.cdc.gov. Published January 22, 2019.https://www.cdc.gov/dpdx/taeniasis/index.html. Here the doubt is that the author has confused the uterine branches with the segments of the elements he observed, which - if it were a cestode - should instead be its proglottids (!).The scenario described so far becomes even more entangled in the final reflections when the author hypothesizes that we are dealing with an infective larval stage, expressing concern about the risk that the parasite “is ready to become adult worm”. In Cestoda, the larval forms, known as metacestodes, are quite different from the adult tapeworms, even because they lack of reproductive organs contained in the proglottids.To provide a minimum of clarity, perhaps it is necessary to briefly recall the biological cycle of a human cestode. In most cases, it involves two hosts: embryos develop into metacestodes in an intermediate host; metacestodes mature into adult worms in a definitive host. Humans can serve as both intermediate and definitive hosts.The intermediate host usually becomes infected after ingesting food or water contaminated with the parasite’s eggs. Once in the intestine, the eggs hatch releasing oncospheres that penetrate the intestinal walls, pass to the mesenteric capillaries, and from there to the bloodstream, through which they can reach various tissues (muscle, liver, lung, brain, bone), encyst and develop in metacestodes.The clinical spectrum of metacestode infections varies from asymptomatic to life-threatening conditions, essentially depending on the site of encystment. Given the parasitized sites, the approach to these infections is usually represented by imaging techniques, serology, and molecular diagnostics, the optical microscopy is useful only when the parasite is observed in biopsy specimens for histological examination55Lynne Shore Garcia. Diagnostic Medical Parasitology . Washington Asm Press; 2016..Examples of human metacestodiasis are cysticercosis, echinococcosis, and sparganosis, caused – respectively - by metacestodes of Taenia solium, Echinococcus spp., and Spirometra spp.The definitive host becomes infected if it consumes raw (or undercooked) meat containing the larval forms. Inside the intestine of the new host the metacestodes evert their scoleces through which they tenaciously attach themselves to the intestinal wall and, in a few months, they develop in adult worms, with the production of proglottids, a process known as strobilation.Those caused by adult cestodes are among the most common intestinal infections worldwide, afflicting millions of people, especially in developing countries. The symptoms are usually mild and non-specific and they can be diagnosed by the identification of eggs or proglottids in stool, a few months after the infection.Examples of human cestodiases are taeniasis, dibothriocephaliasis, and hymenolepiasis, caused by the adult tapeworm of Taenia spp., Dibotriocephalus spp., and Hymenolepis spp.However, this whole premise would seem to have been ignored by the author who, all along the manuscript, describes what he considers to be a parasite as it would be an adult tapeworm but - inexplicably - he comes to the conclusion that it is a larval form(!).For all the reasons described above, any comparative work with already described cestode species is also particularly difficult, if not impossible.Cases of rare or uncommon cestodiasis in humans have sometimes been described, such as in the case of infections by adults anoplocephalids of the genera Mathevotaenia66Lamom C, Greer GJ. Human Infection with an Anoplocephalid Tapeworm of the Genus Mathevotaenia. The American Journal of Tropical Medicine and Hygiene . 1986;35(4):824-826. doi:https://doi.org/10.4269/ajtmh.1986.35.824, Bertiella, Inermicapsifer, and Moniezia, by davaineids of the genus Raillitiella and Metacestoides77Sapp SGH, Bradbury RS. The forgotten exotic tapeworms: a review of uncommon zoonotic Cyclophyllidea. Parasitology. 2020;147(5):533-558. doi:https://doi.org/10.1017/S003118202000013X, but none of the above have similar features to those reported by the author. Not even among non-cyclophyllid cestodes, such as diphyllobothrids, can morphological similarities be found with the proposed case. Some of the infections with juvenile aberrant cestodes have been described in the literature, but no similarities can be found with these either88Garin F, Maria Teresa Galán-Puchades, Moulignier A, et al. Human brain abscess due to a tetra-acetabulate plerocercoid metacestode (Cyclophyllidea). American Journal of Tropical Medicine and Hygiene. Published online May 1, 2005. doi:https://doi.org/10.4269/ajtmh.2005.72.513.So, ultimately, are the elements in the picture cestodes and did they cause this patient’s clinical manifestations?As I have tried to stress, while it is certainly possible to rule out the grounds that we are dealing with a ”rare tapeworm”, without more data or better images, it is not possible to comment further on the true nature of the elements found by the author, although similarities with the material of plant or fungal origin are certainly evident (spines? Trichomes? Spores?). Given the eating habits of the young patient, it is also possible that there is another type of parasite, not observed by the author, behind the reported symptoms or that another type of pathogen is responsible, maybe a virus or a bacteria.To finish, although new technologies, such as the genetic tests called upon to help by the author, can certainly make an important contribution to today’s parasitological diagnostics, it should be remembered that their role must be to accompany and integrate the morphological identification of parasites by optical microscopy and not to replace it. The risk, is that basic skills in morphological identification under the light microscope are lost, which would paradoxically lead, among other things, to failure to detect precisely those species that are rare or entirely new in human pathology99Bradbury RS, Sapp SGH, Potters I, et al. Where Have All the Diagnostic Morphological Parasitologists Gone? Humphries RM, ed. Journal of Clinical Microbiology. 2022;60(11). doi:https://doi.org/10.1128/jcm.00986-22.
Introduction: Coronavirus disease-2019 (COVID-19) is a novel infection, that first appeared in Wuhan, China. It has been well established that different organs including the heart, kidney, pulmonary and gastrointestinal systems might be involved during or post COVID-19 infection. A possible reason is that the virus enters host cells through the angiotensin-converting enzyme 2 (ACE 2) receptor and this receptor is expressed by different human organs . ACE 2 receptor is also expressed in different parts of the eyes including the conjunctiva, cornea, limbus, aqueous humor, and retina .In addition, COVID-19-associated multisystem inflammatory syndrome in children (MIS-C) can affect different organ systems including skin, renal, cardiac, hematological, and gastrointestinal systems. But ocular involvement is not still a part of the world health organization (WHO) criteria or the Center for Disease Control and Prevention criteria for MIS-C .Whether uveitis or optic disk edema would be manifestations of acute COVID-19 infection or they can occur as a part of COVID-19-associated MIS-C is still unknown.
1. INTRODUCTIONIntramuscular myxoma (IMM) are benign soft tissue that account for 0.1 to 0.13 per 100,000 populations (1). Various theories have been described regarding the mechanism of IMM occurrence. Some researchers suggest that the reason is fibroblasts (unable to synthesize collagen fibers) that are not well differentiated from mesenchymal stem cells, which cause the synthesis of myxoid stroma without reticular fibers. Others consider the etiology of IMM to be caused by traumatic mechanisms or the growth of polysaccharide-producing cells in the neoplastic process (2). IMM is rare and can occur in the buttocks, thigh, upper extremities and shoulder muscles. Epidemiologically, its occurrence rate is higher in women (70%), increases with age (6th and 7th decade of life) and the most common sites of IMM is upper extremities muscles (50%-60%) (3). According to the location of the masses, soft-tissue myxomas are classified into superficial angiomyxoma, intramuscular myxoma, nerve sheath myxoma and aggressive angiomyxoma. From the clinical point of view, IMM is a palpable mass, painless, without inflammatory secretions and symptoms, which has no contractile properties and no stretch-contraction changes during flexion-extension of the adjacent muscles (4).From a diagnostic point of view, IMM is observed as a non-calcified mass in plain radiograph, which is seen in the supplementary findings with the help of ultrasonography as echogenic cystic lesions among the muscle tissue. The most important diagnostic method of IMM from other soft tissue lesions is magnetic resonance imaging (MRI), which can be seen as hypointense homogeneous mass in T1-weighted sections and hyperintense in T2-weighted sections (5). In case of edema with IMM in MRI sections (T1-weighted sections), it should be differentiated from other fluid-containing lesions (such as cystic teratoma, hematoma, myxoid sarcoma, cystic hygroma and even normal lymph nodes). Also, IMM should be differentiated from proliferative lesions, other myxoid neoplasms, myxochondroma, myxochondroma and myxoid liposarcoma (6). Cytology-histopathology findings with the help of intraoperative frozen section and needle biopsy help the information of MRI sections in the diagnosis of IMM. Density and ratio of cells/ collagen fibers, mucoid material secretion, nodular-vesicular pattern and fat density in histopathological sections contribute to IMM (7). In the present case, forearm intramuscular myxoma was observed inter-supinator muscle.
Rare Presentation of Papillary Thyroid CancerMahfujul Z. Haque, BS1Michael Burcescu, MD2Zirak Sajjad, BS11Michigan State University College of Human Medicine, Grand Rapids, MI, USA2Detroit Medical Center, Detroit, MI, USAWord Count: 444Table/Figure Count: 4Reference Count: 4Acknowledgements: N/AFunding Sources: NoneConflicts of Interest: NoneConsent Statement: N/ACorresponding author:Mahfujul Haque15 Michigan St NE,Grand Rapids, MI 49503Email: email@example.comWritten informed consent was obtained from the patient to publish this report in accordance with the journal’s patient consent policy.Key Words: papillary thyroid cancer, thyroid nodule, neoplasm, endocrine cancerArticle Type: Case ImageThe patient is a 51-year-old African American female with incidental thyroid nodules identified on MRI of the cervical spine. Patient describes a tender palpable right thyroid nodule but is otherwise asymptomatic. There is no history of tobacco use or toxic occupational exposure. There is no palpable neck mass. Thyroid panel was within normal limits. The majority of parathyroid adenomas are located adjacent and posterior or just inferior to the thyroid gland. Rarely, an intrathyroidal ectopic parathyroid gland may become adenomatous and mimic thyroid nodule. When it does, it is usually homogenously hypoechoic to thyroid tissue and may demonstrate a peripheral rim of hyper-vascularity. Here we describe the case of an incidental nodule with irregular margins and punctate echogenic foci consistent with a TI-RADS 5 nodule and suggestive of malignancy.Fine needle aspiration biopsy of right upper thyroid nodule showed moderately cellular with cohesive groups as sheets and singly scattered cells exhibiting nuclear grooves, powdery chromatin, irregular nuclear outlines. A few intranuclear pseudo-inclusions are seen with some colloids in the background. True papillae, psammoma bodies, and necrosis were not detectable despite sampling with 3 adequate passes.Figure 1A is an axial T1 that demonstrates an unexpected nodule of the right thyroid lobe after gadolinium administration.Figure 1B demonstrates the same nodule with a traditional T1 view. Figure 1C demonstrates a T2 hyper intensive nodularity of the right thyroid lobe. Figure 2A demonstrates a long-axis ultrasound image of the right thyroid lobe revealed a 1.5 x 1.0 x 1.3 cm hypoechoic solid nodule with irregular margins, punctate echogenic foci, and mildly increased vascularity on color Doppler investigation.Figure 2B demonstrates a transverse ultrasound image of the right thyroid lobe showed a 1.5 x 1.0 x 1.3 cm hypoechoic solid nodule with irregular margins and punctate echogenic foci. Figure 3Ademonstrates a longitudinal-axis ultrasound image of the right thyroid lobe with a slight enlargement of the nodule, measuring 1.5 x 1.2 x 1.3 cm, with hypoechoic wider than tall features, irregular margins, and punctate echogenic foci, which are consistent with the previous sonographic evaluation. Figure 3B demonstrates a longitudinal-axis color Doppler image of the right thyroid lobe reveals increased vascularity within the thyroid nodule, indicating heightened blood flow to the nodule. Figure 4A demonstrates a Longitudinal-axis ultrasound image of the right thyroid lobe with further nodule enlargement to 1.9 x 1.3 x 0.9 cm.Studies report that 5-15% of all detected thyroid nodules and up to 11% of incidental thyroid nodules, represent malignancy . The SEER database reports the USA incidence of thyroid carcinoma to be 14.9 per 100,000 with a 1:2.8 male to female predilection . Papillary thyroid cancer (PTC), a common endocrine tumor originating from thyroid follicular cells, represents 85% of thyroid malignancy . PTC is invasive and known to metastasize to adjacent structures including: lungs, mediastinal lymph nodes, and bone. Well-established risk factors for thyroid cancer include radiation exposure, family history of thyroid cancer, occupational exposure, and obesity .PTC is associated with favorable mortality of 11-17% and a low recurrence rate of 5-15% . Extra-thyroidal growth, larger tumor size, and older age at diagnosis detrimentally impact outcome . The primary treatment for PTC is surgical. Preprocedural considerations include tumor size, metastases, extra-thyroidal extension, and airway compromise. Patients with unifocal PTC, measuring > 4 cm, are candidates for thyroid lobectomy . For larger lesions, total or near-total thyroidectomy is often required . Ablation with radioactive iodine (RAI) is recommended for patients with residual tumor or metastasis. Additional considerations include patient age, microvascular invasion, and histologic subtyping . RAI is performed 4 - 6 weeks following excision and repeated until residual radiotracer uptake is eliminated . Successful intervention results in decreased serum thyroglobulin within 4 - 6 weeks. Thyroid hormone supplementation reduces tumor stimulation by suppressing TSH production . Sonographic and biochemical recurrence monitoring are typically performed at 6-12 month intervals for at least 5 years.
Leukemic retinopathy is a severe complication of severe leukocytosis that results from untreated chronic myelogenous leukemia (CML). Immediate cytoreduction via leukapheresis may reverse ocular manifestations and prevent permanent vision damage. We present a case of a patient with acute unilateral vision loss found to have leukemic retinopathy in the setting of
INTRODUCTIONSchizencephaly is an uncommon anomaly of the brain characterized by abnormal gray matter lined clefts extending from the ependymal surface of the ventricle to the subarachnoid space. There are two distinct subtypes. Cleft with fused lips is a type 1 or closed type whereas unopposed lips allowing communication of the cleft to the ipsilateral ventricle is an open type. Although the exact cause of this disorder is uncertain, diverse theories have been put forward to establish a definite underlying etiology. A defect in neuronal migration or some form of molecular genetic abnormalities such as mutation in EMX2 , SHH and SIX 3 gene  , intrauterine infections are few of the probable causes advocated in literature. MRI is the best suited imaging modality for diagnostic evaluations owing to its superiority in gray and white matter distinction, and hence distinguishing the entity from porencephaly or any other post infectious, postoperative or post necrotic lesions.
Heterotaxy pattern associated with Sinus Node Dysfunction in an adult: A case report.Authors : Naman Shah MBBS1, Sankalp Acharya2, Apoorva Tripathi MBBS2, Himanshi Bisht MBBS2,Maitri Shah MBBS1, Aayushi Pareek MBBS3, Asmit Gera MBBS4, Abhigan Babu Shrestha, MBBS5, Vikash Jaiswal MD61. GMERS Medical college Sola, Ahmedabad, India2. B. J. Medical College, Ahmedabad, India3. RHUS College of Medical Science, Jaipur, Rajasthan4. JCCR Cardiology Research, Varanasi, India5. M Abdur Rahim Medical College, Dinajpur, Bangladesh6. AMA School of Medicine, Makati, Philippines
A Case Report: The First Show Phenomenon In The Treatment Of Spinal Cord Injury With Regentime Procedure Using Autologous Bone Marrow-Derived Stem CellsRita T. Boulos a†, Lea I. Nemerb†, Vanessa J. Mansour c†, Cynthia F. Najjoumd††,Elsa A. Asmar e†† and Nassim H. Abi Chahinef*† Authors’ equal contribution†† Authors’ equal contributionStem Cell Transplantation/Neurology, ACE Cells Lab Limited, Beirut, LBStem Cell Transplantation/Molecular Biology, ACE Cells Lab Limited, Beirut, LBStem Cell Transplantation/Infectious Diseases/Immunology, ACE Cells Lab Limited, Beirut, LBStem Cell Transplantation/Infectious Diseases/Immunology, ACE Cells Lab Limited, Beirut, LBStem Cell Transplantation/Functional Genomics/Proteomics, ACE Cells Lab Limited, Beirut, LBStem Cell Transplantation/Neurological Surgery, ACE Cells Lab Limited, Beirut, LB* Correspondence to:Dr. Nassim H. Abi ChahineTel: +9613082498E-mail: firstname.lastname@example.org