Value of first-trimester serum lipid profile in early prediction of preeclampsia and its severity: A prospective cohort study

Study objective: The purpose of this study was to evaluate the association of first-trimester serum lipid profile with preeclampsia (PE) and if so, its association with the severity of the disease. Study: Prospective cohort study. Patient and methods: A total of 251 pregnant women participated in this study in their first trimester. Maternal blood samples were collected between 4 and 12 weeks of gestation. Fasting serum triglycerides (TGs), total cholesterol (TC), HDL-cholesterol, and low-density lipoprotein cholesterol (LDL-C) were drawn and measured by ELISA. From the cohort, 26 women developed PE (16 mild and 10 severe) and 174 remained normotensive and used as control subjects. Results: There was a significant rise in fasting serum TGs, TC, and LDL-C and a significant decrease in HDL-C in women who developed PE than in those who remained normotensive and more significantly evident in severe preeclamptic cases compared to mild cases of PE (p < 0.05). Conclusion: Early pregnancy dyslipidemia, particularly hypertriglyceridemia and hypercholesterolemia, may help in predicting women who later develop PE and may help in prediction of its severity.     

Positive pregnancy tests in a nongravid, premenopausal woman due to hCG beta-chain production by multiple myeloma

Positive pregnancy test results occurred in a nongravid, premenopausal woman while she was receiving chemotherapy for multiple myeloma. We tested 2 hypotheses to account for this finding: (1) Heterophil antibodies caused positive interference in the immunoassays. (2) Genuine human chorionic gonadotropin (hCG) originated from a nonsyncytiotrophoblastic source. Paraprotein was eliminated as a source of positive interference because 3 different instruments with unique capture and signal antibodies gave similar results (83, 90, and 97 mIU/mL [83, 90, and 97 IU/L]). Human antimouse antibodies (HAMAs) were unlikely to cause positive interference because immunoreactivity was maintained after serum was treated to neutralize heterophil antibodies. Immunoassays performed after gel filtration of serum indicated that immunoreactivity was due to genuine hCG. The high-molecular-weight fraction (heterophil antibody) had 6 mIU/mL (6 IU/L) of hCG. The low-molecular-weight fraction (hCG) had 86 mIU/mL (86 IU/L) of hCG. Immunohistochemical stains revealed that myeloma cells expressed immunoreactive hCG. Hence, multiple myeloma caused positive pregnancy test results in a nongravid woman.     

Mycobacterium bovis BCG urease attenuates major histocompatibility complex class II trafficking to the macrophage cell surface

We have previously shown that Mycobacterium tuberculosis attenuates cell surface expression of major histocompatibility complex class II molecules in response to gamma interferon (IFN-gamma) by a mechanism dependent on intracellular sequestration of alpha,beta dimers. In this study we examined whether intracellular alkalinization due to mycobacterial urease could account for the defect in intracellular trafficking of class II molecules. Phagocytosis of wild-type Mycobacterium bovis BCG was associated with secretion of ammonia intracellularly, which increased substantially upon addition of exogenous urea to the culture medium. Increased intracellular ammonia, due to urea degradation by the bacterium, correlated with inhibition of class II surface expression. Conversely, no ammonia was detected in cells infected with a urease-negative mutant strain of M. bovis BCG, which also displayed a reduced effect on surface expression of class II molecules. A direct cause-effect relationship between urease and class II molecule trafficking was established with experiments where cells ingesting beads coated with purified urease showed an increased ammonia level and decreased surface expression of class II in response to IFN-gamma. In contrast to BCG, infection of macrophages with Mycobacterium smegmatis, which expresses relatively greater urease activity in cell-free culture, had a marginal effect on both the intracellular level of ammonia and class II expression. The limited effect of M. smegmatis was consistent with a failure to resist intracellular killing, suggesting that urease alone is not sufficient to resist macrophage microbicidal mechanisms and that this is required for a more distal effect on cell regulation. Our results demonstrate that alkalinization of critical intracellular organelles by pathogenic mycobacteria expressing urease contributes significantly to the intracellular retention of class II dimers.     

Abnormal protein bands in patients with multiple myeloma after haematopoietic stem cell transplantation: does it have a prognostic significance?

Abnormal protein bands (APB) unrelated to the original monoclonal protein occasionally appear in serum immunofixation samples from patients with multiple myeloma (MM) following haematopoietic stem cell transplantation (HCT). To investigate the significance of APB, medical records and serum immunofixation patterns of 53 MM patients, who had undergone HCT (49 autologous and 4 allogeneic) at the stem cell transplantation unit of Gazi University Faculty of Medicine, were reviewed. Patients were staged according to Durie–Salmon and International staging systems (ISS) and disease response was determined according to European Bone Marrow Transplantation (EBMT) criteria. Fourteen (26.4%) of the 53 patients developed APBs after HCT. The median time for the appearance and duration of APB was 3 (range 1–24) and 5.5 (range 1.5–14) months, respectively. Probability of overall survival (OS) at the end of the follow‐up was 77 and 61.4% in patients with and without APB, respectively (p = 0.334). The median duration of follow‐up (767 days (range, 220–2905) vs. 726 days (range, 120–1780) p = 0.545) was not different in patients with and without APB. Probability of progression free survival (PFS) at the end of follow‐up was 28.8% in patients with and 27.7% in patients without APB (p = 0.835). PFS (910 days (range 180–2905) vs. 730 days (range 90–1765) p = 0.835) was longer in patients with APB, though without statistical significance. Thus, the occurrence of APB post‐transplantation is not associated with any adverse long‐term consequences and does not require treatment modification. Copyright © 2010 John Wiley & Sons, Ltd.     

Painless long-segmental aortic dissection diagnosed by echocardiography: a case report of a diagnostic conundrum with potentially poor outcome

Aortic dissection is a life-threatening condition with a higher mortality rate. Early diagnosis enhances the prognosis of this disease; however, while chest pain is the most common symptom, we can occasionally find asymptomatic patients, making diagnosis more difficult and even missed, it is an uncommon entity with few data in the literature based exclusively on reported cases. Here, we report a case of completely asymptomatic long segmental aortic dissection in a 66-year-old male, with a recent history of controlled hypertension. The diagnosis was made by noninvasive methods, and the patient was referred for surgical treatment. Aortic dissections that are painless provide a significant challenge to physicians in terms of improving prognosis for this frequently misdiagnosed yet lethal illness. The main goal of this report is to bring attention to the misdiagnosed signs and symptoms of aortic dissection.     

Carotid web stent for the prevention of recurrent stroke: Case report and literature review

Carotid web has been identified as one of the missed causes of recurrent stroke. The diagnosis and management of such cases impose a challenge to medical practitioners. This etiology should be kept in mind, especially in case of recurrence of stroke in a similar cerebral territory.     

Granulomatosis with polyangiitis presenting with unilateral exophthalmos: A case report

We report a case of a patient with no medical history, admitted for right exophthalmos. For whom imaging showed orbital masses without inflammatory signs pointing to a granulomatous origin. However, the histological and immunological workup revealed the diagnosis of Granulomatosis with polyangiitis.     

Concomitant renal and splenic infarctions in a COVID-19-patient with a catastrophic thrombotic syndrome

Since the outbreak of the COVID-19 pandemic, thrombotic events have been accurately described in patients infected by the SARS-CoV-2, especially venous thromboembolism. However, the mystery of arterial thrombosis is still unclear. Here, we report the case of a 59-year-old man with diabetes mellitus, admitted for COVID-19-pneumonia complicated by pulmonary embolism, a thrombus in the aortic isthmus, the descending thoracic aorta associated with splenic and left renal infarctions, and an acute right limb ischemia. The etiological assessment of this catastrophic thrombotic syndrome showed no evidence for preexisting inherited or acquired thrombophilia. Our case emphasizes the hypercoagulability state in COVID-19-patient leading to both arterial and venous thromboembolisms and the need to establish adequate strategies for the diagnosis and management of thrombo-embolisms to prevent these potentially fatal complications.     

Xeroderma pigmentosum and rhabdoid tumor of the kidney: A very rare case report association

The aim of this observation was to report an exceptional association of xeroderma pigmentosum and rhabdoid renal tumor in a 7-year-old girl, diagnosed with imaging and treated by adjuvant chemotherapy.     

Heavy head lice infestation in an adolescent girl following benzodiazepine poisoning

Loss of consciousness (LOC) is one of the most common causes of emergency department (ED) visits. It may be due to intoxication or hypoglycemia. We present a 15‐year‐old girl who was referred with heavy head lice and LOC to the ED in the north of Iran.