Neuropsychiatric involvement in patients with Systemic Lupus Erythematosus (SLE), first mentioned by Kaposi more than 100 years ago, still remains one of the main challenge facing rheumatologist and ...other physicians. The diagnosis of neuropsychiatric SLE (NPSLE) is complex not only because of the considerable prevalence variation (14-80%) but also because of the wide spectrum of NP manifestations. They vary from overt neurologic alterations (seizure, psychosis), to subtle abnormalities (neurocognitive dysfunctions). Different NP manifestations result from a variety of mechanisms including antibodies, vasculitis, thrombosis, hemorrhages and cytokine-mediated damages. Of note, despite the dramatic clinical manifestations, too often changes at the morphological neuroimaging techniques are minimal and non specific. There is no one diagnostic tool specific for NPSLE and diagnosis must be based on the combinated use of immunoserological tests, functional and anatomical neuroimaging and standardized specific criteria. Symptomatic, immunosuppressive and anticoagulant therapies are the main strategies available in the management of these patients. Therapy for CNS lupus should be adjusted according to the needs of the individual patients. The coming years promise to be an important time for the development of new neuroimaging techniques and for the study of disease mechanism. An early and objective identification of brain involvement will allow for appropriate treatment to avoid severe complications.
ABSTRACT Introduction: Over the past years there has been a significant increase in hospitalizations and treatments due to kidney complications that eventually resulted in the increased number of ...patients on dialysis. The adenosine deaminase (ADA) enzyme mediates the formation of some defense cells of the organism and is therefore a marker of inflammation. Objective: The objective of this study was to evaluate biomarkers of renal function and serum ADA of hemodialysis patients. Materials and methods: Blood samples were collected from 80 patients – 40 women and 40 men – between 19 and 60 years old, before and after the completion of hemodialysis. Results: There was a significant difference in levels of creatinine, urea and ADA in pre- and post-hemodialysis periods (p < 0.0001). There was a significant increase in post-dialysis ADA regardless of sex; however there was a significantly greater increase in men. Conclusion: The results showed a reduction in urea and creatinine parameters, evidencing the main purpose of hemodialysis. This study suggests that the determination of ADA activity could be used to monitor inflammation in hemodialysis patients, however wider and more specific studies are needed to show the effectiveness of serum ADA activity as an inflammatory marker in patients with chronic kidney disease.
Aim of this study was to evaluate the prevalence of alexithymia in patients affected by SLE or RA and to investigate the correlation between alexithymia and immunoendocrine parameters (PRL, hGH, IL-6 ...and TNF-alfa).
Twenty-five patients (12 and 13 affected by SLE and RA, respectively) were enrolled into the study. The Toronto Alexithymia Scale-20 (TAS-20) was administered. PRL, hGH, IL-6 and TNF-alfa levels were measured by commercially available ELISA kits.
Alexithymia prevalence (TAS-20 > or = 51) was 54% in RA and 42% in SLE patients. hGH serum levels were 3.1+/-4.2 and 1.1+/-0.9 IU/ml in SLE and RA, respectively. PRL concentration was 18.4+/-6.5 ng/ml and 14.2+/-4.0 ng/ml in SLE and RA patients, respectively (p=0.03). In RA group, TNF-alpha was 20+/-36.2 whereas in SLE it was 4.9+/-12.8 pg/ml (p=0.03); IL-6 serum concentrations were 24.4+/-25.1 and 2.9+/-5.4 pg/ml, in RA and SLE respectively (p=0.004). The serum level of hGH showed slight increase in alexithymic group (A) compared to non alexithymic group (NA) in both SLE and RA patients. PRL serum levels in SLE-A patients was 26.7+/-17.3 ng/ml while in SLE-NA patients was 12.4+/-3.3 ng/ml (p=0.04). In RA patients increased values of IL-6 and TNF-alpha were present in the A group compared to NA group (IL-6: 35.3+/-28 pg/mL vs 3.5+/-3.9 pg/mL, p=0.01; TNF-alpha: 34.7+/-39 pg/mL vs 3.1+/-3.4 pg/mL, p=0.01).
In this preliminary results we found an high prevalence of alexithymia and a correlation between immunoendocrine parameters and alexhytimic features in SLE and RA, suggesting that an immunomodulatory pathway could influence this cognitive style in patients with autoimmune disorders. Other studies should contribute to find a common biological pathway linking alexithymia and autoimmunity.
The antiphospholipid syndrome (APS) is an autoimmune disorder, characterized by a wide spectrum of clinical manifestations. Thromboembolic events, with a greater involvement of extremities veins, are ...the most common features, and obstruction of abdominal vessels are sporadically reported. We present a singular case of a patient with primary APS (PAPS) that developed a spontaneous splenorenal shunt, secondary to a total portal, mesenteric and splenic vein thrombosis. Spontaneous splenorenal shunt, an uncommon circumstance reported in cirrhotic disease, to the best of our knowledge, has not been previously described in PAPS.
Antinuclear antibodies (ANA) represent the main diagnostic markers for systemic autoimmune disease (AD), although their presence can be detected in blood donors. The aim of this study was to study ...ANA prevalence in healthy subjects of different racial groups, exposed to the same environmental factors, in order to understand the relevance of genetics or environment in determining autoimmunity. We enrolled in this study 80 healthy Filipinos (Polynesian), migrated to Italy from an average of 15 years, and 60 healthy native Italians (Caucasian) and ANA were detected in their sera (at 1:80 screening dilution) through indirect immunofluorescence assay. We found a higher prevalence of ANA positivity in Filipinos compared to Italians (23.7% vs 8.3%--P = 0.02; OR 3.43; 95% CI 1.2-9.8), above all in females and elderly, although demographic characteristics, clinical history and habits were not significantly different between the two groups. These data confirm that ANA positivity is not a rare condition and healthy non-Caucasians present a higher prevalence of autoantibodies. This could be determined by their autoimmunity-prone immune system or by the exposition to infective agents, pollution, drugs or nutrition of a western country. Future studies to evaluate the ANA prevalence in Filipinos in their own country and the follow-up of positive patients could clarify the real predisposition to AD of this population.
The aim of this study is to evaluate the presence of antibodies to carbonic anhydrase I and/or II (ACAI and ACAII) in patients affected by connective tissue diseases (CTD) and to investigate their ...association with lung involvement evaluated by High resolution CT scan (HRCT). Ninety-six patients affected by CTD were studied, i.e. 33 rheumatoid arthritis (RA), 8 psoriatic arthritis (PA), 8 ankylosing spondilitis (AS), 23 Systemic Lupus Erythematosus (SLE), 10 Sjogren Syndrome (SS), and 14 Systemic Sclerosis (SSc). ACA were detected by ELISA. The lung involvement was evaluated by means of a previously described HRCT score. According to a receiver operator characteristic curve, patients were divided into those with HRCT score ≥ 10 and those with HRCT score < 10, where HRCT score ≥ 10 was predictive of interstitial lung disease. ACAI and/or ACAII were detected in 30/96 patients (31.2%) (P<0.0001 in comparison with controls). In particular, the prevalence of ACAI and/or ACAII was significantly higher in patients with RA (P = 0.002), PA (P < 0.0001), SLE (P = 0.0003) and SSc (P<0.0001). A positive correlation was found between HRCT scores and CRP or ACAI levels (P=<0.0001 and P=0.004, respectively). Thirty-nine of 96 patients (40.6%) showed a HRCT score ≥ 10 and both their CRP and ACAI levels were significantly higher when compared with patients showing a HRCT score < 10 (P<0.0006 and P = 0.0009, respectively). Moreover, C3 and C4 complement fractions inversely correlated with HRCT scores (P = 0.0004 and P<0.0001, respectively) and lower values of C3 and C4 complement fractions were found in patients with HRCT score ≥ 10 than in those with HRCT score < 10 (P = 0.014 and P = 0.007, respectively). Due to the lower levels of complement fractions detected in patients with HRCT score ≥ 10, a possible immune-complex-mediated pathogenic mechanism of lung involvement could be suggested.
In this paper, we report our experience in the development of a system for automatic acquisition of immuno-fluorescence assay (IFA) images. We focus on two basic issues. Firstly, we determine an ...autofocus function that can deal with photobleaching, a physical phenomenon affecting automatic acquisition of IFA images, and present a set of experiments on real images that confirm its effectiveness. Secondly, we discuss if the physicians may reliably use digital IFA images in place of direct microscope observations to carry out the diagnosis. In this respect, we present the results of a preliminary experiment where physicians perform the diagnosis on a set of images both by looking directly to them at the fluorescence microscope and by looking at digital images on the screen of a workstation
PDF
