•Leishmaniasis may present with manifestations suggestive of autoimmune disease.•Immune response, resistance and susceptibility to Leishmania have to be clarified.•We suggest to screen Leishmania in ...patients with diagnosis of autoimmune diseases.•In children the risk of life-threatening complications of Leishmaniasis is high.
Leishmaniasis is a group of diseases caused by the protozoa Leishmania, endemic in the Mediterranean countries.
Clinical manifestations can be divided into three different forms: cutaneous leishmaniasis, mucosal leishmaniasis and the visceral leishmaniasis, the most severe form which is potentially lethal if untreated.
Immunology and pathogenesis are complex: many different aspects of immune response, resistance and susceptibility to Leishmania have been studied but many others remain to be clarified.
The gold standard in diagnosis of visceral Leishmaniasis is the presence of amastigotes in bone marrow or tissue sections.
Patients can be initially misdiagnosed as having an autoimmune disease because it may mimic diseases like systemic lupus erythematosus, autoimmune hepatitis, dermatomyositis or others disorders.
As in pediatric age the risk of life-threatening complications is very high, leishmaniasis, must be kept in mind to the clinician, in order to avoid wrong diagnosis and an inappropriate immunosuppressive therapy.
Even though muscle injuries are very common, few scientific data on their effective treatment exist. Growth Factors (GFs) may have a role in accelerating muscle repair processes and a currently ...available strategy for their delivery into the lesion site is the use of autologous platelet-rich plasma (PRP). The present study is focused on the use of Platelet Rich Fibrin Matrix (PRFM), as a source of GFs. Bilateral muscular lesions were created on the longissimus dorsi muscle of Wistar rats. One side of the lesion was filled with a PRFM while the contralateral was left untreated (controls). Animals were sacrificed at 5, 10, 40 and 60 days from surgery. Histological, immunohistochemical and histomorphometric analyses were performed to evaluate muscle regeneration, neovascularization, fibrosis and inflammation. The presence of metaplasia zones, calcifications and heterotopic ossification were also assessed. PRFM treated muscles exhibited an improved muscular regeneration, an increase in neovascularization, and a slight reduction of fibrosis compared with controls. No differences were detected for inflammation. Metaplasia, ossification and heterotopic calcification were not detected. This preliminary morphological experimental study shows that PRFM use can improve muscle regeneration and long-term vascularization. Since autologous blood products are safe, PRFM may be a useful and handy product in clinical treatment of muscle injuries.
Abstract
A 68 year–old male presented to the Emergency Department of our Institute with palpitations for the last 20 minutes. The patient suffered from Becker’s muscular dystrophy (BMD) with ...hypotonic tetraparesis and dilated cardiomyopathy with moderate left ventricular dysfunction. The patient had also arterial hypertension and a previous ischemic stroke treated with thrombolysis and subsequently with warfarin. On the admission, the patient was alert, blood pressure was 90/60 mmHg and heart rate 180 bpm. An ECG (Fig. 1) showed regular, wide–complex tachycardia (QRS duration of 240 msec) with right branch block morphology with left axial deviation. A bolus of amiodarone 200 mg ev was administered without efficacy followed by a bolus of lidocaine 50 mg. The patient developed symptomatic hypotension, so external electrical cardioversion was performed with a single DC shock at 200J, effective in restoring sinus rhythm. Amiodarone and beta blocker therapy was started. On laboratory tests, the main values were normal, including the ultrasensitive troponin hs–cTnI. Echocardiography showed a mildly dilated left ventricle with diffuse hypokinesia conditioning severe reduction of systolic function (FE 35%) (Fig. 2). On subsequent telemetric ECG monitoring, no recurrences of sustained ventricular tachycardia (VT) were recorded, but it was observed an episode of complete atrioventricular (AV) block conditioning a symptomatic 9.5–second asystole, treated with atropine. Then the patient underwent CRT–D implantation in secondary prevention. The day after the procedure, an arrhythmic storm occurred and was effectively treated with multiple attempts of antitachycardia pacing and device shock. In the following days, the patient continued to present with episodes of VT despite antiarrhythmic drugs. Hence, an endo–epicardial ablation of the arrhythmic substrate was evaluated in Heart team. In view of an intubation and the high anesthesiological risk, it was indicated to continue the optimized medical therapy. Mexiletine 200 mg tid was added to metoprolol 100 mg bid and amiodarone 200 mg od. In the following days, no arrhythmic recurrences were recorded on continuous ECG monitoring. The patient was discharged from the hospital asymptomatic and with no sign of heart failure. At 2 years of follow–up, the patient remained asymptomatic, with no arrhythmic events recorded by the device and in the absence of any adverse effects caused by mexiletine.
Abstract Background Cardiac amyloidosis (CA) is an increasingly diagnosed disease sharing several phenotypical features with aortic stenosis (AS). Purpose As diagnosing the two diseases has crucial ...prognostic and therapeutic implications, this study aims to identify a set Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation of stable and discriminative radiomic features derived from cardiac computed tomography (CT) to differentiate them. Methods 21 patients with cardiac amyloidosis (CA) and 44 with aortic stenosis (AS) were randomly extracted from our database. All patients underwent CT scan. After image preprocessing, 107 radiomics features pertaining to shape and size, first-order statistics and textural classes, were extracted on the LV wall 3D-volume. Radiomic feature selection was based on stability, non-redundancy and relevance based on the Wilcoxon test followed by LASSO algorithm. All these steps were performed on the training set and then applied on the validation and test set. A nested cross-validation, composed of a 7-fold outer cross-validation and a 7-fold inner cross-validation, was performed, using five classifiers (k-nearest neighbors, support vector classifier, decision tree, logistic regression and gradient boosting). Four additional ML models were implemented including: I) age and sex; II) age, sex, BMI, LVEDVi and LVESVi, LV EF and IVS thickness; III) radiomic features, age, and sex; IV) radiomic features and variables included in II). Results Feature selection steps reduced the number of features to 10. As logistic regression showed the best performances in the validation set, it was selected for test set prediction obtaining an AUC of 0.92, sensitivity and specificity of 0.857 and 0.864 respectively. ROC curves for the test set, were computed using radiomic features (Figure 1a) and/or clinical variables (Figure 1b). The greatest performances were observed in model IV (AUC=0.96). Conclusions The application of radiomics shows promising results in distinguishing left ventricle hypertrophy caused by CA from AS and might be used as a noninvasive tool able to support clinical decision making.
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