Pulmonary miliary tuberculosis complicated with tuberculous spondylitis; an extraordinary rare association: a case report

In the last decade a significant rise in the prevalence of tuberculosis as well as in its extrapulmonary manifestations is detected worldwide. The central nervous system, the genitourinary tract, the organs of the abdomen and the skeletal system, are common sites of infection. Misdiagnosis and delay in treatment are common events. Herein, we present a case of a 78-year-old man non-smoker, with miliary tuberculosis complicated with tuberculous spondylitis. The patient presented with anemia and a left shoulder pain, accompanied by rigor and fever 37.5°C-38°C of one month duration. This entity is extremely rare, since only two similar cases have been reported in the English literature according to PubMed search

Primary localized laryngeal amyloidosis presenting with hoarseness and dysphagia: a case report

<p>Abstract</p> <p>Introduction</p> <p>Primary localized laryngeal amyloidosis is an extremely rare condition. It usually presents with hoarseness, pain and/or difficulty in breathing.</p> <p>Case presentation</p> <p>We present the case of a 23-year-old woman with primary localized laryngeal amyloidosis who presented with hoarseness and dysphagia.</p> <p>Conclusion</p> <p>A search of PubMed shows that dysphagia in patients with laryngeal amyloidosis has been reported only once, although this symptom is relatively common in other conditions presenting with laryngeal mass. There were no signs of any systemic disease in our patient and diagnosis was established histopathologically. She was treated surgically by microlaryngoscopy under general anesthesia and the mass was excised using a CO₂ laser technology method.</p

Ο ρόλος διαλυτών μορίων προσκόλλησης σε φλεγμονώδεις καταστάσεις της καρδιάς

The property of cell adhesion and its mediation by cell adhesion molecules (CAMs) is crucial for the cells. In the present study the role of soluble adhesion molecules that are expressed during the inflammatory process is studied. The soluble forms of ICAM-1, ICAM-2, ICAM-3, VCAM-1, L-selectin, P-selectin, E-selectin, PECAM and MadCAM were measured by ELISA in 15 patients with infectious endocarditis (category I), 30 patients with acute myocarditis (category II) and 30 patients with acute pericarditis (category III) and these values were compared to a control group 20 healthy volunteers.In group I the mean value of ICAM-1 was 600(202-1067) ng/ml, VCAM-1 was 1702(824-2646) ng/ml, L-selectin was 908(605-1235) ng/ml, E- selectin was 158(64.6-195) ng/ml, P- selectin was 283.5(188-366) ng/ml while MadCAM was 422.8(268-599) ng/ml in comparison to the values 277.1(197-337) ng/ml, 661.55(421.3-1007.9) ng/ml, 555(355-823) ng/ml, 49.7(21-93) ng/ml, 116(97-132.6) ng/ml and 253.22(143.8-312) ng/ml of the control group respectively (p0.05). In group II the mean value of the soluble forms of ICAM-1 was 440.7(287-609) ng/ml, VCAM-1 was 1153(676-1602) ng/ml, E-selectin was 116.2(58.4-168) ng/ml and P-selectin was 181.5(82.1-181.5) ng/ml while in group III the mean value of ICAM-1 was 532(308-659) ng/ml, VCAM-1 was 1325(981-1722) ng/ml, E-selectin was 118.9(54.1-174) ng/ml and P-selectin was 120.9(88.4-165) ng/ml in comparison to the values 277.1(197-337) ng/ml, 661.5(421.3-1007.9) ng/ml, 49.7(21-93) ng/ml, 116(97-132.6) ng/ml respectively of the control group (p0.05). The soluble adhesion molecules ICAM-1, VCAM-1, L-selectin, E- selectin, P- selectin and MadCAM consist potential strong diagnostic and prognostic markers for the endocarditis patients, while the role of ICAM-2, ICAM-3 and PECAM needs further investigation with future studies so as to establish a possible role in the inflammatory prossess of infectious endocarditis group of patients. The combination of elevated levels of the soluble adhesion molecules ICAM-1, VCAM-1, E-selectin, characterizes all three inflammatory heart diseases (endocarditis, acute myocarditis, and acute pericarditis). These molecules may be used in the future as useful diagnostic and prognostic biomarkers, which will guide a more successive therapeutic strategy.Η έννοια της προσκόλλησης και οι διαμεσολαβητές αυτής τα μόρια προσκόλλησης (cell adhesion molecules, CAMs) θεωρούνται ζωτικής σημασίας για τα κύτταρα. Στην παρούσα μελέτη μελετήθηκε ο ρόλος διαλυτών μορίων προσκόλλησης που εκφράζονται στις φλεγμονώδεις καταστάσεις της καρδιάς. Οι διαλυτές μορφές των CAMs, ICAM-1, ICAM-2, ICAM-3, VCAM-1, L-selectin, E- selectin, P- selectin και MadCAM, PECAM προσδιορίστηκαν με την χρήση ELISA σε 15 ασθενείς με λοιμώδη ενδοκαρδίτιδα (κατηγορία Ι), 30 ασθενείς με οξεία μυοκαρδίτιδα (κατηγορία ΙΙ) και 30 ασθενείς με οξεία περικαρδίτιδα (κατηγορία ΙΙΙ) και συγκρίθηκαν με 20 ασθενείς που αποτελούσαν την ομάδα ελέγχου. Στην κατηγορία Ι η μέση τιμή του ICAM-1 ήταν 600(202-1067) ng/ml, του VCAM-1 ήταν 1702(824-2646) ng/ml, της L-selectin ήταν 908(605-1235) ng/ml, της E- selectin ήταν 158(64.6-195) ng/ml, της P- selectin ήταν 283.5(188-366) ng/ml ενώ του MadCAM ήταν 422.8(268-599) ng/ml συγκρινόμενη με τις τιμές 277.1(197-337) ng/ml, 661.55(421.3-1007.9) ng/ml, 555(355-823) ng/ml, 49.7(21-93) ng/ml, 116(97-132.6) ng/ml και 253.22(143.8-312) ng/ml αντίστοιχα, της ομάδας ελέγχου (p0.05). Στην κατηγορία ΙΙ η μέση τιμή του ICAM-1 ήταν 440.7(287-609) ng/ml, του VCAM-1 ήταν 1153(676-1602) ng/ml, της E-selectin ήταν 116.2(58.4-168) ng/ml και της P-selectin ήταν 181.5(82.1-181.5) ng/ml. Στην κατηγορία ΙΙΙ η μέση τιμή του ICAM-1 ήταν 532(308-659) ng/ml, του VCAM-1 ήταν 1325(981-1722) ng/ml, της E-selectin ήταν 118.9(54.1-174) ng/ml και της P-selectin ήταν 120.9(88.4-165) ng/ml συγκρινόμενη με τις τιμές 277.1(197-337) ng/ml, 661.5(421.3-1007.9) ng/ml, 49.7(21-93) ng/ml, 116(97-132.6) ng/ml αντίστοιχα, της ομάδας ελέγχου (p0.05). Τα ICAM-1, VCAM-1, L-selectin, E- selectin, P- selectin και MadCAM αποτελούν δυνητικά σημαντικούς διαγνωστικούς και προγνωστικούς δείκτες για τους ασθενείς με ενδοκαρδίτιδα ενώ ο ρόλος των μορίων ICAM-2, ICAM-3 και PECAM χρειάζεται περεταίρω διερεύνηση με μελλοντικές μελέτες ώστε να καταδειχτεί ο πιθανός η μη ρόλος τους στην διαδικασία της φλεγμονής σε πάσχοντες από λοιμώδη ενδοκαρδίτιδα. Ο συνδυασμός αυξημένων επιπέδων των διαλυτών μορίων προσκόλλησης ICAM-1, VCAM-1, E- selectin, χαρακτηρίζει και τις τρεις φλεγμονώδεις καταστάσεις της καρδιάς. Αυτά τα μόρια δύναται στο μέλλον να καταστούν χρήσιμοι διαγνωστικοί και προγνωστικοί βιοδείκτε

Challenges, Risks and Opportunities for Connected Vehicle Services in Smart Cities and Communities

A multi-level multi-objective framework is proposed for identification and management of risk for connected vehicle services in smart cities and communities. The framework will better model uncertainty, interdependencies, priorities between objectives and players as single-level multi-objective optimization is insufficient to tackle the complexities of a smart city ecosystem. An approach for determining an index for city readiness for connected and autonomous vehicles across the domains of smart connected cities is also proposed. A risk management process for smart port cities is introduced, focusing on coordinating complex subsystems of port and near-port areas. The process is based on analyzing risk of potential hazards to better comprehend their nature and need for prevention strategies

Bilateral pulmonary nodules in an adult patient with bronchiolitis obliterans-organising pneumonia

A 58-year-old male ex-smoker was admitted to hospital because of nodular infiltrates on chest x rays. He was complaining of fatigue, dyspnoea with exertion, low grade fever and weight loss. Physical examination was unremarkable. Bronchoscopy was inconclusive but revealed endobronchial lesions of chronic active inflammation. The diagnosis of cryptogenic organising pneumonitis bronchiolitis obliterans-organising pneumonia (COP-BOOP) was established by open lung biopsy. Proliferative bronchiolitis with regions of organising pneumonia is the characteristic feature of COP. The radiological picture of bilateral pulmonary nodules is an infrequent manifestation of COP. Lung biopsy, open or with video assistance thoracic surgery, is recommended to confirm the diagnosis