MBL,P2X7, and SLC11A1 gene polymorphisms in patients with oropharyngeal tularemia

Conclusion: A significant association was found of oropharyngeal tularemia with SLC11A1 allele polymorphism (INT4?G/C) and MBL2 C?+?4T (P/Q). These results indicate C allele and Q allele might be a risk factor for the development of oropharyngeal tularemia.

Aim: This study aimed to investigate the relationship of SLC11A1, MBL, and P2X₇ gene polymorphism with oropharyngeal tularemia.

Methods: The study included totally 120 patients who were diagnosed with oropharyngeal tularemia. Frequencies of polymorphisms in the following genes were analyzed both in the patient and control groups in the study: SLC11A1 (5’(GT)_n Allele 2/3, Int4?G/C, 3’ UTR, D543N G/A), MBL (MBL2 C?+?4T (P/Q), and P2X₇ (?762 C/T and 1513 A/C).

Results: Among all polymorphisms that were investigated in this study, SLC11A1 gene showed a significance in the distriburtion of polymorphism allelle frequency at the INT4 region. Frequency of C allele was 54 (28%) in patients with oropharyngeal tularemia, and 31 (13%) in the control group (p?=?0.006 and OR = 1.96 (1.21–3.20)). An association was detected between MBL2 C?+?4T (P/Q) gene polymorphism and oropharyngeal tularemia (p?7 (?762 C/T and 1513 A/C) gene polymorphism and oropharyngeal tularemia in this study (p?>?0.05).     

Left atrial size may predict exercise capacity and cardiovascular events in patients with heart failure

Our aim was to investigate, in patients with heart failure, the relationship between left atrial size and exercise capacity and cardiovascular events. Seventy-five patients (67 men and 8 women; mean age, 53.4 +/- 8.8 yr) with left ventricular ejection fractions of < or =0.45 (New York Heart Association functional classes I-III) were matched by age and sex with 20 healthy control subjects. Echocardiographic examinations were performed, as was exercise testing by the modified Bruce protocol. Patients were monitored for a period of 330 to 480 days for cardiac death or for heart failure that required hospitalization. The indexed left atrial diastolic size (beta level = -0.534, P <0.001) and left ventricular late diastolic filling velocity (beta level = 0.247, P <0.017) were the most important values in predicting low exercise capacity. The only independent predictor of low exercise capacity (<5 METS) was the indexed left atrial diastolic size (odds ratio, 1.428; 95% confidence interval, 1.09-1.702; P <0.001). Every 1 mm/m2 increase in indexed left atrial diastolic dimension caused a 42.8% increase in the risk of severe heart failure (exercise capacity, <5 METS). Independent predictors for cardiovascular events were indexed as left atrial systolic size (odds ratio, 1.383; 95% confidence interval, 1.145-1.671; P <0.001) and left ventricular early diastolic/late diastolic filling velocity (odds ratio, 1.096; 95% confidence interval, 1.010-1.189; P <0.027). Indexed left atrial diastolic and left atrial systolic size predict exercise capacity and cardiovascular events, respectively, in New York Heart Association functional class I through III heart failure patients.     

Avaliação de Padrões Pressóricos Dipper e Não-Dipper e Qualidade de Vida entre Pacientes com Doença Pulmonar Obstrutiva Crônica

BackgroundNon-dipper blood pressure is defined by less than a 10% reduction in nighttime blood pressure, and it is associated with cardiovascular disease. Inflammation is thought to play a role in the pathogenesis of both chronic obstructive pulmonary disease (COPD) and non-dipper blood pressure pattern, and both diseases are associated with lower quality of life.ObjectiveThe aim of this study was to investigate the effects of non-dipper blood pressure pattern in patients with COPD.MethodsA cross-sectional study was carried out with 142 patients with COPD. The Saint George Respiratory Questionnaire and the Euro Quality of Life Scale were used to collect data. To understand arterial stiffness, the augmentation index and pulse wave velocity were measured, and 24-hour ambulatory blood pressure monitoring was subsequently performed. A multivariable logistic regression model was used to understand the relationship between different independent variables and blood pressure pattern. P values lower than 0.05 were considered statistically significant.ResultsAs a result, 76.1% (n = 108) of the patients had non-dipper blood pressure pattern. Non-dipper patients had higher C-reactive protein (OR:1.123; 95% CI:1.016;1.242), augmentation index (OR: 1.057; 95% CI: 1.011;1.105) and Saint George Respiratory Questionnaire total score (OR: 1.021; 95% CI: 1.001;1.042) than dipper patients. Also, as the number of people living at home increased, non-dipper blood pressure pattern was found to be more frequent (OR: 1.339; 95% CI: 1.009;1.777).ConclusionNon-dipper blood pressure pattern may increase cardiovascular risk by triggering inflammation and may adversely affect the prognosis of COPD by lowering the disease-related quality of life. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)     

A case of nodular posterior scleritis mimicking choroidal mass

The aim of this study is to report clinical and imaging findings, and treatment outcomes of a patient with nodular posterior scleritis. A 41-year-old woman was diagnosed as nodular posterior scleritis in the light of clinical and imaging findings. At first admission best corrected visual acuity was 20/50 in her right eye. Fundus examination revealed an amelanotic subretinal mass under the superior temporal arcade associated with subretinal fluid surrounding it. B-scan ultrasonography, optical coherence tomography, fluorescein angiography, and indocyanine green angiography findings confirmed the diagnosis. As treatment, nepafenac eye drops 3 times a day, and flurbiprofen tablet 100 mg twice a day were prescribed. After 4 weeks of treatment, the ocular pain was relieved, BCVA improved to 20/20, and subretinal mass totally regressed. Although the diagnosis of nodular posterior scleritis may be confusing, it has to be kept in mind in patients with a subretinal/choroidal mass. Multimodal fundus imaging may be helpful in differential diagnosis. The condition is usually curable with non-steroidal anti-inflammatory drugs and/or systemic steroids.     

Is multiple sclerosis a risk factor for atherosclerosis?

BackgroundMultiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system. We aimed to discuss possible predisposing factors to atherosclerosis such as carotid intima-media thickness (CIMT) and high-sensitivity C-reactive protein (Hs-CRP) levels in MS.MethodsThirty-five ambulatory patients with relapsing-remitting MS (RRMS) (22 females and 13 males) and 34 healthy controls (21 females and 13 males) with similar demographic variables were included. Blood cell counts, cholesterol levels, vitamin D and B12, Hs-CRP levels, body mass index (BMI), history of smoking, and CIMT of both groups, Expanded Disability Status Scale (EDSS) scores, and disease duration of patients were recorded. Patients with a history of other vascular diseases such as hypertension, diabetes mellitus, peripheral artery disease, and acute relapses were excluded.ResultsSixty-nine participants were included. The mean age of the study population was 35.8 ± 7.1 years. Right CIMT was significantly greater in the patient population (P < 0.001). Spearman's correlation coefficient between age and right CIMT was r = 0.41, P = 0.01. When we compared the Hs-CRP with a cut-off value of ≤ 3, the right, left, and mean CIMT levels were not statistically significant (P = 0.17; P = 0.22; P = 0.15). The mean serum vitamin D levels were higher in the patient group and this was statistically significant (P < 0.001). The statistically significant factors identified with univariate analysis with P < 0.2 were further entered into multivariate modelling.ConclusionCIMT seems to be affected in patients with MS by means of the disease itself and age. Thus, CIMT might reflect the predisposition to subclinical atherosclerosis more than Hs-CRP. Further investigation in a large MS population is still needed.     

High-dose thiotepa,melphalan and carboplatin (TMCb) followed by autologous stem cell transplantation in patients with advanced breast cancer: a retrospective evaluation

This study was conducted to evaluate the efficacy of high-dose thiotepa, melphalan and carboplatin (TMCb) regimen in 27 patients undergoing autologous stem cell transplantation (ASCT) for metastatic breast cancer. A total of 27 patients with stage IV breast cancer underwent ASCT following thiotepa (500 mg/m(2)), melphalan (100 mg/m(2)) and carboplatin (1200-1350 mg/m(2)). Of 27 patients, 17 had refractory relapse, eight had responding relapse, and two had no evidence of disease (NED) at the time of transplant. In all, 11 patients had only bone disease, nine had bone plus visceral disease, three had only visceral disease, and two had locoregional recurrent disease. The median time from diagnosis to transplant was 1081 days (range 180-2341). Staging for evaluation of response was performed 4-6 months after transplantation. Five patients were not evaluable (NE) for response because of NED at transplant (n=2) or early death due to transplant-related complications (n=3) (two of viral pneumonia and one of regimen-related toxicity) occurring at a median of 4 days (range 11-46) post-transplant. One of the two patients who was NED at the time of transplant is still NED on day 760 post-transplant. Seven of 15 refractory (47%) and 5/7 (71%) responsive patients with evaluable disease achieved a complete response of all measurable disease or all soft-tissue disease with at least improvement in bone lesions. Of 27 patients (37%),(10) are alive and progression-free, a median of 582 days (range 410-1380) after treatment, 6/17 (35%) with refractory disease and 4/10 (40%) with responsive disease. The probability of progression-free survival (PFS) for all patients was 0.50. The probabilities of PFS at 2 years for patients with refractory (n=17) and responsive (n=10) disease were 0.42 and 0.60, respectively. PFS at 2 years for the 14 patients who were NED or achieved CR/PR(*) following-HDC was 0.67. PFS at 2 years for patients who did not achieve CR/PR(*) following-DHC was 0.33. These preliminary data suggest that high-dose TMCb followed by autologous stem cell transplantation is an effective regimen for patients with advanced breast cancer and may be comparable to some previously used regimens.     

Clinical outcomes and mortality in elderly peritoneal dialysis patients

OBJECTIVES:

To evaluate the clinical outcomes and identify the predictors of mortality in elderly patients undergoing peritoneal dialysis.

METHODS:

We conducted a retrospective study including all incident peritoneal dialysis cases in patients ≥65 years of age treated from 2001 to 2014. Demographic and clinical data on the initiation of peritoneal dialysis and the clinical events during the study period were collected. Infectious complications were recorded. Overall and technique survival rates were analyzed.

RESULTS:

Fifty-eight patients who began peritoneal dialysis during the study period were considered for analysis, and 50 of these patients were included in the final analysis. Peritoneal dialysis exchanges were performed by another person for 65% of the patients, whereas 79.9% of patients preferred to perform the peritoneal dialysis themselves. Peritonitis and catheter exit site/tunnel infection incidences were 20.4±16.3 and 24.6±17.4 patient-months, respectively. During the follow-up period, 40 patients were withdrawn from peritoneal dialysis. Causes of death included peritonitis and/or sepsis (50%) and cardiovascular events (30%). The mean patient survival time was 38.9±4.3 months, and the survival rates were 78.8%, 66.8%, 50.9% and 19.5% at 1, 2, 3 and 4 years after peritoneal dialysis initiation, respectively. Advanced age, the presence of additional diseases, increased episodes of peritonitis, the use of continuous ambulatory peritoneal dialysis, and low albumin levels and daily urine volumes (<100 ml) at the initiation of peritoneal dialysis were predictors of mortality. The mean technique survival duration was 61.7±5.2 months. The technique survival rates were 97.9%, 90.6%, 81.5% and 71% at 1, 2, 3 and 4 years, respectively. None of the factors analyzed were predictors of technique survival.

CONCLUSIONS:

Mortality was higher in elderly patients. Factors affecting mortality in elderly patients included advanced age, the presence of comorbid diseases, increased episodes of peritonitis, use of continuous ambulatory peritoneal dialysis, and low albumin levels and daily urine volumes (<100 ml) at the initiation of peritoneal dialysis.