Backgrounds and presents the results of an open-label, prospective, uncontrolled study created to investigate clincal response, serological changes, and side effects in Greek patients with rheumatoid ...arthritis (RA), after B-cell depletion with rituximab. Source: National Library of New Zealand Te Puna Matauranga o Aotearoa, licensed by the Department of Internal Affairs for re-use under the Creative Commons Attribution 3.0 New Zealand Licence.
Background: Cirrhosis is associated with elevated levels of acute‐phase proteins (APP), irrespective of the presence of infection. This condition limits the clinical application of APP determination ...in cirrhotic patients with bacterial infections.
Aims: To weigh the diagnostic value of several APP in cirrhotics with or without bacterial infection, and to correlate them with the clinical outcome.
Methods: We investigated 88 consecutive cirrhotic patients (67 males, 21 females; range 28–85 years) with mean age (SD) 58.9 (13.8) on admission, according to a standard protocol for infection. We measured the following APP: C‐reactive protein (CRP), fibrinogen (FIB), haptoglobin (Hpt), ferritin (Fer), β2‐microglobulin (β2‐mg), C3, C4 and C1 inhibitor.
Results: From the 88 patients, 19 (21.6%) had documented infection at the entry based on clinical, radiological and microbiological data. This group of patients did not differ in basic demographics from those without infection. CRP 17.5 (20.7) vs 77.1 (43.9), P<0.001, β2‐mg 4.4 (4.1) vs 5.6 (2.2), P<0.001 and ferritin 461.2 (776.4) vs 825.8 (870), P=0.03 were significantly higher in infection, whereas C3 was significantly lower. No significant differences were noted in the remaining APP levels between the two groups. After receiver operating characteristic curves were fitted, CRP was the best diagnostic test for infection (area under the curve 0.91), followed by β2‐mg, ferritin, FIB, C1 inhibitor, C4, Hpt and C3.
Conclusions: Serum CRP is the best test, among the examined APP, to discriminate bacterial infection in cirrhotics. A cut‐off value of >55.8 mg/L has high sensitivity (79%) and specificity (96%), with the best diagnostic accuracy (92%).
Pyomyositis is an acute bacterial infection of the skeletal muscles that arises from hematogenous spread and is caused predominantly by Gram-positive cocci.
We report a case of iliopsoas pyomyositis ...in a 25-year-old Greek Caucasian woman with a history of intravenous drug use. Her condition was complicated by bilateral dilation of the ureters and renal calyces as a result of mechanical pressure from inflammation and edema of the involved muscle. The patient did not present aggravation of renal function and was treated successfully solely with intravenous antibiotics, without surgical intervention. This is the first case report describing iliopsoas pyomyositis with reversible bilateral dilation of the urinary tract that was treated successfully with intravenous antibiotics, without surgical intervention.
We present the first described case of iliopsoas pyomyositis with reversible bilateral hydroureteronephrosis that was treated successfully with intravenous antibiotics, without the necessity of surgical intervention. To our knowledge, this is the first report of its kind in the literature regarding an unexpected event in the course of treating a patient with iliopsoas pyomyositis, and it should be of particular interest to different clinical medical specialties such as internal medicine, infectious disease and urology.
We report a case of a 39 year old male who presented with nausea and right upper quadrant pain. Marked eosinophilia and a hypoechoic liver lesion on ultrasound were identified. The differential ...diagnosis included neoplasms, infectious diseases and hepatic abscess. Indirect hemagglutination test using purified adult Fasciola hepatica f1Ag confirmed serologic diagnosis of fascioliasis. Radiologists should keep in mind the importance of correlating imaging, clinical and laboratory findings in order to reach the correct diagnosis.
Background. Circulating autoantibodies to endogenous erythropoietin (anti-Epo) are detected in human immunodeficiency virus type 1 (HlV-1)-infected patients and represent a risk factor for anemia. ...The aim of this study was to map the B-cell epitopes on the Epo molecule. Methods. Serum samples from HIV-1-positive patients and healthy individuals were tested against overlapping peptides covering the entire sequence of Epo. Results. Serum samples from anti-Epo-positive patients exhibited significant binding to Epo epitopes spanning the following sequences: amino acids 1-20 (Epl), amino acids 54-72 (Ep5), and amino acids 147-166 (Ep12). Structural analysis of erythropoietin revealed that the immunodominant epitopes, Epl and Ep12, comprise the interaction interface with Epo receptor (EpoR). Autoantibodies binding to this specific region are anticipated to inhibit the Epo-EpoR interaction, resulting in blunted erythropoiesis; this phenomenon is indicated by the significantly higher Epo levels and lower hemoglobin levels of anti-Ep 1-positive patients compared with anti-Epl— negative individuals. The region corresponding to the Epl epitope exhibited a 63% sequence homology with the ³⁴LVCASRELERFAVNPGLLE²² fragment of the HIV-1 p17 matrix protein. Conclusions. These results suggest that the main body of anti-Epo is directed against a functional domain of Epo, and that the presence of anti-Epo can be considered to be a result of a molecular mimicry mechanism, which is caused by the similarity between the Ep1 region and the p17 protein.
Context: Data from previous retrospective studies and case reports have suggested that infectious diseases of the central nervous system could cause pituitary deficiency.
Objective: The aim of this ...prospective study was to investigate pituitary function in patients admitted with infectious meningitis during the acute phase and after 12 months.
Design: Sixteen patients were studied. Basal pituitary function was assessed within 24 h of admission. Twelve of these patients underwent both basal and stimulated (insulin tolerance test) pituitary testing after 12 months.
Results: During the acute phase, five patients (31.25%) showed apparent pituitary hormone deficiencies: two patients with gonadotropic and three patients with somatotropic deficiency. The exact status of corticosteroid sufficiency could not be defined in four patients, because no dynamic test was performed in the acute phase. In addition, seven patients (44%) had probable low T3 syndrome. At 12 months, five patients (31.25%), two with viral and three with bacterial meningitis, had at least one anterior pituitary hormone deficiency. Two patients had isolated corticotropic and one isolated somatotropic deficiency. Combined corticotropic and somatotropic deficiencies were detected in two patients. New-onset deficiencies accounted for four of those five patients, whereas one patient demonstrated persisting somatotropic deficiency. All cases of low T3 syndrome resolved at 12 months.
Conclusions: Isolated or combined pituitary deficiencies, which could present at the acute phase and/or occur at a later stage, can develop in a considerable proportion of patients after acute infectious meningitis.
Isolated or combined pituitary deficiencies can develop in a considerable proportion of patients following acute infectious meningitis.
Antithyroid drug-induced aplastic anemia Thomas, Dimitrios; Moisidis, Anestis; Tsiakalos, Aristotelis ...
Thyroid (New York, N.Y.)
18, Številka:
10
Journal Article
Recenzirano
Antithyroid drugs have been used for more than 50 years for the management of hyperthyroidism. Most patients tolerate treatment well but some may develop life threatening side effects such as ...agranulocytosis and aplastic anemia (AA). We review all cases of antithyroid drug induced AA and describe, as illustrative cases, two women with Graves' disease who developed AA after 8 and 24 weeks of carbimazole (CBM) and methimazole (MMI) treatment respectively.
To date, at least 34 cases of aplastic anemia (AA) due to antithyroid drugs (1 with CMZ, 31 with MMI, and 2 with propylthiouracil (PTU) have been published, not including the two patients described here. In addition, at least another 14 patients in whom AA developed after treatment with antithyroid drugs (11 with CMZ, and 3 with MMI) have been reported in Yellow Card Scheme data analysis. Patients with AA usually exhibit sudden onset of symptoms after a relative short time of exposure to the drugs, and all have concomitant agranulocytosis. Most have a rapid recovery following discontinuation of the drug and supportive treatment. Although only two antithyroid drug induced AA deaths have been published, the mortality rate was higher in the Yellow Card Scheme data analysis.
Aplastic anemia associated with antithyroid drug treatment is rarer than antithyroid drug associated agranulocytosis. The prognosis of patients with antithyroid drug induced AA is good overall, but may not be as favorable as that of antithyroid drug induced isolated agranulocytosis.
Abstract We present 2 cases of HIV-related cryptococcal meningitis, persisting after 3 and 9 months, respectively, of standard treatment. Both patients were treated successfully with a salvage ...regimen consisting of the combination of liposomal amphotericin B (3 mg/kg), intravenous voriconazole, and subcutaneous recombinant interferon γ-1b (200 μg thrice weekly). Voriconazole was administered at an increased dose (5 mg/kg, twice daily) to overcome interactions with co-administered ritonavir. In both patients, resolution of clinical signs and symptoms, as well as sterilization of cerebrospinal fluid cultures occurred after 10 weeks of salvage therapy. No major side effects were encountered. At the end of treatment, both patients were placed on maintenance therapy with oral fluconazole; no recurrence has been observed after 4 years of follow-up.
Summary Objectives In a previous retrospective study we have shown that circulating antibodies to endogenous erythropoietin (anti-EPO) are associated with HIV-1-related anemia. The present ...longitudinal cohort study was conducted to examine the effect of anti-EPO on the risk of developing anemia over time. Methods The study population consisted of 113 HIV-1 seropositive patients, who were screened for the presence of anti-EPO, with a mean ± SD follow up of 105 ± 40 months, for a total of 2190 visits. Anti-EPO were detected with an ELISA assay. Results Anti-EPO were detected in 41% (46/113) at enrollment and 29% (320/1094) for all visits, and were associated with higher EPO levels for all visits (45.7 ± 60.4 vs. 31.8 ± 31.7 IU/ml, p < 0.001). After adjusting for other significant confounders, anti-EPO has been associated with increased risk of anemia both at enrollment (odds ratio OR, 5.07; 95% confidence interval CI, 1.25–20.49) as well as for all visits (OR, 2.15; 95% CI: 1.29–3.56). During follow up, a decline in prevalence of both anti-EPO and anemia was observed as the percentage of patients receiving HAART was increasing. Conclusions Anti-EPO are an independent risk factor for anemia in HIV-1-infected patients. HAART seems to reduce both anti-EPO and anemia prevalence.
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