Upregulation of CD40, CD80, CD83 or CD86 on alveolar macrophages after lung transplantation.

BACKGROUND: Alveolar macrophages (AMs) are known to be poor antigen-presenting cells, and lack the accessory molecules such as CD40, CD80 or CD86 to activate T cells. The question raised is about the potential changes in phenotypes after lung transplantation, particularly during acute rejection episodes. METHODS: The present study analyzed the phenotype of AMs longitudinally in 45 lung transplant patients, between August 1997 and April 2002, with a follow-up period of 27.2 +/- 2.5 (mean +/- SEM) months. There were 7.7 +/- 0.6 bronchoalveolar lavage (BAL) assessments performed per patient (i.e., 345 BALs), simultaneously with transbronchial biopsies. Transplantation was soon followed by a progressive upregulation of CD40 on 49.7 +/- 8% of AMs during the first month, and this marker remained elevated at 60 +/- 8% after 5 years. RESULTS: Both CD86 and CD80, as well as CD83, a marker of dendritic cells, were enhanced for most AMs during Grade A2 and A3 rejection episodes. A correlation was found between expression of CD83 and CD86, but not between CD1a and CD86. Immunohistology confirmed that CD40-positive cells in the alveoli corresponded to AMs and to some dendritic cells in the basal layers of the airways. In vitro studies showed that harvested AMs with these enhanced accessory molecules remained poor stimulators of allogeneic cells, a phenomenon that may be related to the ongoing immunosuppressive treatments. CONCLUSIONS: AM phenotypes showed marked changes during early or late acute rejection episodes, acquiring CD80, CD83 and CD86, while CD40 expression was further enhanced. This finding may provide clues on how to monitor the tolerance of transplanted lungs and may also provide new insights into the pathophysiology of lung transplantation.     

Epidemiology of hypertensive crisis in the Buea Regional Hospital,Cameroon

Hypertensive crisis (HC) includes hypertensive urgency (HU) and hypertensive emergency (HE). There is scarcity of data on the epidemiology of patients presenting with HC in Cameroon. The aim of this study was to determine the prevalence, clinical characteristics, and outcome of HU and HE. We conducted a cross‐sectional study from June 2018 until June 2019. The criteria to define a hypertensive crisis were systolic and/or diastolic blood pressure ≥180/110 mm Hg. We compared HU vs HE. Out of the 1536 patients admitted, 95(6.2%) had a HC. There were 49(51.6%) men and 56 (58.9%) had a HE. The mean age was 51.1 ± 14.9 years. A history of hypertension was found in 75.3% of the patients but only 24.2% were on treatment. 33.7% consumed alcohol and 24.2% had chronic kidney disease. Headache (34.7%), dyspnea (34.7%), and neurological deficit (23.2%) were the most common symptoms. Patients with HE had higher systolic and diastolic blood pressures though the difference was not significant. The most frequent forms of HE were acute left ventricular failure with pulmonary edema (44.6%), intracerebral hemorrhage (21.4%), and cerebral infarction (16.1%). The most commonly prescribed medication was labetalol (44.2%). Mean length of hospital stay was 8.4 days. Patients with HE had a longer hospital stay (9.8 vs 6.3 days, P < .001). In‐hospital case fatality was 6.3%. Hypertensive crisis accounted for 6.2% of admissions in the medical unit with HE being more common than HU. Acute left ventricular failure with pulmonary edema and stroke were the most frequent target organ lesions in HE.     

Monoamine oxidase activity and enzyme kinetics in three subpopulations of density-fractionated platelets in chronic paranoid schizophrenics

Platelet monoamine oxidase (MAO) activity was studied in three subpopulations of density-fractionated platelets in 15 unmedicated chronic paranoid schizophrenic patients and contrasted with normal controls. No significant difference in MAO activity was found in any of the three platelet fractions in schizophrenics compared to controls. Enzyme kinetic studies performed on the intermediate-density platelet fraction demonstrated no significant differences in V _max or Michaelis' constant (K _m) between schizophrenics and controls, but showed that the higher platelet MAO activity reported in females compared to male is due to a significantly greater V _max rather than altered K _m. It is suggested that conflicting results reported in the literature regarding platelet MAO in schizophrenia are not related to the platelet subpopulations studied but are largely due to the selected patient population.     

Primary Hyperparathyroidism: Can Parathyroid Carcinoma Be Anticipated on Clinical and Biochemical Grounds? Report of Nine Cases and Review of the Literature

Background Parathyroid carcinoma (PC) mimics benign primary hyperparathyroidism (PHP), but the diagnosis of PC is seldom available at the time of the first operation. Because PC is plagued by recurrences usually beyond cure, one may wonder whether some of these could be prevented by more extensive resections initially, i.e., if the diagnosis of PC were available at that time.Methods Over a 25-year period, 311 consecutive patients with PHP underwent operation in our department: 302 had benign disease (adenomas or hyperplasias), and 9 had PC. Several clinical parameters, serum calcium and parathyroid hormone (PTH) levels, and the weight of the parathyroid tumor removed were compared in both groups. Receiver operating characteristic curves and logistical regression analyses were used to distinguish PC from benign PHP.Results Eight of 9 patients with PC had symptoms, versus 238 (79%) of 302 with benign PHP (not significant). In the PC subgroup, serum calcium and PTH levels and the tumor weights of the parathyroid glands removed were significantly higher than in the benign PHP cohort, even if these three parameters were regularly flawed by low positive predictive values (14%, 20%, and 15%, respectively).Conclusions Serum calcium, PTH levels, and tumor weights were significantly greater in the PC subgroup, even if not invariably in a discriminatory way. However, when PTH is <4 times the upper limit of normal and tumor weight is <1.9 g, the probability of PC is nil.     

Four-year follow-up of body compostion in lung transplant patients

BACKGROUND: Both undernutrition and overnutrition can affect the quality of life and survival of patients with pulmonary disease and lead to quantitative and functional alterations of fat-free mass (FFM). This longitudinal study determines the changes in weight, FFM, and body fat before and up to 4 years after lung transplant (LTR). METHODS: Height, weight, and body composition measurements (bioelectrical impedance) were obtained in 37 LTR patients. FFM and body fat were measured before and at 1, 3, 6, 9, 12, 18, 24, 36, and 48 months after LTR. RESULTS: Weight changed by +16.6%, +3.2%, -0.2%, and -3.2% and FFM by +14.0%, +2.5%, -0.3%, and -1.0% during years 1, 2, 3, and 4, respectively. A diagnosis of obliterative bronchiolitis after LTR was associated with loss of body weight, FFM, and body fat, compared with stable weight or gain in weight, FFM, and body fat in obliterative bronchiolitis-negative subjects; 76.2% and 85.7%, and 28% and 38% of men and women, respectively, demonstrated low FFM at 1 month and at 2 years after LTR, respectively. The FFM change was higher (39% of weight) during year 1 than during year 2 (25%) or year 3 (21%). CONCLUSIONS: After LTR, patients gained weight, FFM, and body fat, and two-thirds reached normal levels of FFM by year 2. A weight increase resulted in an FFM increase. Contrary to studies after heart or liver transplantation, our results suggest that despite posttransplant infections and grafts rejection, LTR permits FFM recovery.     

Arterial stiffness and wave reflections in patients with sickle cell disease

We tested the hypothesis that lower blood pressure and increased vasodilatation reported in sickle cell disease (SCD) patients with hemoglobin SS genotype (SS) are translated by lower arterial stiffness determined by pulse wave velocity (PWV) and wave reflections assessed by augmentation index (AI). We enrolled 20 SS (8 females; 12 male) patients closely matched for age, gender, height, and body mass index to 20 subjects with hemoglobin AA genotype (AA). Carotid-femoral PWV (PWV(CF)) and carotid-radial PWV (PWV(CR)) were recorded with the Complior device. Aortic AI was derived from pressure wave analysis (SphygmocoR). PWV(CF) and PWV(CR) were lower in SS than in AA (4.5+/-0.7 m/s versus 6.9+/-0.9 m/s, P<0.0001 and 6.6+/-1.2 m/s versus 9.5+/-1.4 m/s, P<0.0001, respectively). AI was lower in SS than in AA (2+/-14% versus 11+/-8%, P=0.02). Multivariate analysis revealed that both PWV(CF) and PWV(CR) were negatively associated with hemoglobin SS type and positively related to mean arterial pressure (MAP), whereas AI was positively associated with MAP and total cholesterol (all P<0.0001). Multivariate analysis restricted to SS indicated a positive association between PWV(CF) and PWV(CR) with age but a negative association with MAP (R2=0.57 and 0.51, respectively, both P<0.001), whereas MAP and heart rate were independently associated with AI (R2=0.65, P<0.001). This study provides the first evidence that SCD is associated with both lower arterial stiffness and wave reflections. SS patients have a paradoxical negative association between PWV and MAP, suggesting that low MAP does not protect them against arterial stiffness impairment.     

Prevalence and determinants of undiagnosed diabetes in an urban sub-Saharan African population

AimsTo report the prevalence of undiagnosed diabetes and its determinants among adults Cameroonian urban dwellers.MethodsOn May 17th 2011, a community-based combined screening for diabetes and hypertension was conducted simultaneously in four major Cameroonian cities. Adult participants were invited through mass media. Fasting blood glucose was measured in capillary blood.ResultsOf the 2120 respondents, 1591 (52% being men) received a fasting glucose test. The median age was 43.7 years, and 64.2% were overweight or obese. The sex-specific age adjusted prevalence (for men and women) were 10.1% (95% confidence interval [CI]: 8.1–12.1%) and 11.2% (95%CI: 9.1–13.3%) for any diabetes, and 4.6% (95%CI: 2.6–6.6%) and 5.1% (95%CI: 3.0–7.2%) for screened-detected diabetes, respectively. The prevalence of diabetes increased with increasing age in men and women (all p ≤ 0.001 for linear trend). Older age (p < 0.001), region of residence (p < 0.001), excessive alcohol intake (p = 0.02) were significantly associated with screened-detected diabetes, while physical inactivity, body mass index, and high waist girth were not significantly associated with the same outcome.ConclusionsPrevalence of undiagnosed diabetes is very high among Cameroonian urban dwellers, indicating a potentially huge impact of screening for diabetes, thus the need for more proactive policies of early detection of the disease.