The Ad26.COV2.S vaccine, developed by Janssen (Beerse, Belgium), the pharmaceutical wing of Johnson & Johnson (JNJ), is one of the three vaccines approved for use against coronavirus disease 2019 (COVID-19) infection in the United States. We present a case of a 66-year-old female who presented to the emergency department with a one-day history of nausea, vomiting, room-spinning vertigo, and complete right facial weakness immediately after getting vaccinated with Ad26.COV2.S. Initial workup focused on uncovering a possible association between the vaccine and Bell's palsy. However, her prior history of stroke, presence of predisposing risk factors, and additional symptoms of nausea, vomiting, and vertigo prompted further neurological testing, which revealed an isolated right pontine lacunar infarct involving the right facial colliculus, mimicking Bell's palsy. Isolated dorsal pontine lesion presenting as hemifacial palsy is very rare and can be easily missed by clinicians. Relevant history and thorough neurological examination can help guide appropriate diagnostic testing and prevent potential biases. It is crucial for clinicians to know the distinguishing features between true Bell's palsy and acute brainstem infarction masquerading as Bell's.
We report the determination of the absolute configuration of a diterpenoid, namely, ballonigrin lactone A (BLA), by comparison of the computed optical rotations, [α]D, of its two diastereomers using density functional theory (DFT) calculations to the experimental [α]D value of +22.4. One of the diastereomers having configurations 4S, 5R, 6S, 10S, 15S was named “α-BLA,” and the other one with configuration 4S, 5R, 6S, 10S, 15R was called “β-BLA”. Six conformers for each diastereomer (α-BLA and β-BLA) of BLA were identified through their conformational analysis. [α]D values of these six conformations for each diastereomer were calculated using DFT at the mPW1PW91/6-311G(d,p)/SMDChloroform level of theory, leading to the conformationally averaged [α]D values of −96.8 for α-BLA and +65.1 for β-BLA. Thus, it was found that the experimental [α]D value of +22.4 was of 4S, 5R, 6S, 10S, 15R, i.e., β-BLA. Experimental and computed nuclear magnetic resonance (NMR) data were also compared, and this comparison was in accordance with the conclusion drawn from the comparison of [α]D values. Finally, the results were augmented with the calculation of the DP4 analysis, and the probability obtained also endorsed our earlier calculations.
Introduction: Infective endocarditis (IE) is a life-threatening condition with an annual mortality of up to 40%. Vegetations are the hallmark of IE, however, factors that affect the initial size and changes in size remain unclear. Our study aims to investigate the natural history of cardiac vegetation, including changes in size and/or resolution with adequate treatment, and to analyze factors that influence size and potential for persistence.Material and methods: We conducted a retrospective review of 102 patients admitted with native-valve endocarditis at Henry Ford Health System from September 1, 2017, to June 30, 2019. We included patients treated with six weeks of intravenous antibiotics who had both a diagnostic and a follow-up echocardiogram after antibiotic completion.The primary outcome was the change in vegetation size. Secondary measures included pathogen identification, valve involvement, number of complications, associated IV drug use, and co-infection with hepatitis B/C. Results: Of the 102 patients reviewed, 30 patients matched the inclusion criteria. There was a significant decrease in vegetation size after adequate antibiotic treatment. However, complete resolution was not often seen. A statistically significant relationship was seen between vegetation size, IV drug use, and Staphylococcal species (including both methicillin-susceptible Staphylococcus aureus [MSSA] and methicillin-resistant S. aureus [MRSA]), whereas a history of hepatitis B or C was not significantly related to vegetation size. Conclusion: Large vegetation may predict a higher risk of embolic complications and can be reduced with IV antibiotics, although complete resolution is not likely. IV drug use and Staphylococcal endocarditis influence vegetation size and embolic complications. We argue that these subgroups should be prioritized for early surgical intervention.
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