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ARP Rheumatology 2024Patients being on immunosuppressive treatment of any reason, along with other risk factors such as smoking and obesity, are vulnerable to be infected from SARS-CoV2. Aim... (Review)
Review
INTRODUCTION
Patients being on immunosuppressive treatment of any reason, along with other risk factors such as smoking and obesity, are vulnerable to be infected from SARS-CoV2. Aim of this report is to describe a case of a female patient under Rituximab therapy who experienced episodes of lung infection due to Severe Acute Coronavirus 2 (SARS-CoV-2 ) invasion although fully vaccinated.
CASE REPORT
A 50-year-old woman, with a past medical history of lupus nephritis on rituximab was diagnosed with lung infection due to SARS-CoV-2. Eight months later, following her last infusion of Rituximab (RTX), she developed moderate Coronavirus Disease 2019 (COVID-19). After a partial recovery, she exhibited exacerbation of respiratory symptoms leading to readmission and invasive oxygenation. She was eventually discharged home after 31 days. Her monthly neurological evaluation did not reveal evidence of disease activity. She later received intravenous immunoglobulin and a decision was made to restart rituximab.
CONCLUSIONS
This case raises the possibility of persistent virus shedding and reactivation of severe acute respiratory syndrome coronavirus in a patient with SLE and Rituximab therapy. We emphasize a precise consideration of management of patients with autoimmune disorders during the COVID-19 pandemic.
Topics: Humans; Rituximab; Female; COVID-19; Middle Aged; Lupus Erythematosus, Systemic; SARS-CoV-2; COVID-19 Vaccines; Immunosuppressive Agents
PubMed: 38956996
DOI: No ID Found -
Insect Science Jul 2024Entomopathogenic fungi may interact with insects' symbiotic bacteria during infection. We hypothesized that topical infection with Beauveria bassiana may alter the...
Entomopathogenic fungi may interact with insects' symbiotic bacteria during infection. We hypothesized that topical infection with Beauveria bassiana may alter the microbiota of the Colorado potato beetle (CPB) and that these modifications may alter the course of mycoses. We used a model with two concentrations of conidia: (1) high concentration that causes rapid (acute) pathogenesis with fast mortality followed by bacterial decomposition of insects; (2) lower concentration that leads to prolonged pathogenesis ending in conidiation on cadavers. The fungal infections increased loads of enterobacteria and bacilli on the cuticle surface and in hemolymph and midgut, and the greatest increase was detected during the acute mycosis. By contrast, stronger activation of IMD and JAK-STAT signaling pathways in integuments and fat body was observed during the prolonged mycosis. Relatively stable (nonpathogenic) conditions remained in the midgut during both scenarios of mycosis with slight changes in bacterial communities, the absence of mesh and stat expression, a decrease in reactive oxygen species production, and slight induction of Toll and IMD pathways. Oral administration of antibiotic and predominant CPB bacteria (Enterobacteriaceae, Lactococcus, Pseudomonas) led to minor and mainly antagonistic effects in survival of larvae infected with B. bassiana. We believe that prolonged mycosis is necessary for successful development of the fungus because such pathogenesis allows the host to activate antibacterial reactions. Conversely, after infection with high concentrations of the fungus, the host's resources are insufficient to fully activate antibacterial defenses, and this situation makes successful development of the fungus impossible.
PubMed: 38956988
DOI: 10.1111/1744-7917.13414 -
Korean Circulation Journal Jun 2024The outstanding development in contemporary medicine, highlighted by percutaneous coronary intervention (PCI), was achieved through the adoption of drug-eluting stents... (Review)
Review
The outstanding development in contemporary medicine, highlighted by percutaneous coronary intervention (PCI), was achieved through the adoption of drug-eluting stents (DESs). Although DES is the established therapy for patients undergoing PCI for de novo coronary artery disease (CAD), their drawbacks include restenosis, stent thrombosis, and the requirement for dual antiplatelet therapy (DAPT) with an uncertain duration regarding its optimality. Drug-coated balloon (DCB) treatment leaves nothing behind on the vessel wall, providing the benefit of avoiding stent thrombosis and not necessitating obligatory extended DAPT. After optimizing coronary blood flow, DCB treatment delivers an anti-proliferative drug directly coated on a balloon. Although more evidence is needed for the application of DCB treatment in de novo coronary lesions, recent studies suggest the safety and effectiveness of DCB treatment for diverse conditions including small and large vessel diseases, complex lesions like bifurcation lesions or diffuse or multivessel diseases, chronic total occlusion lesions, acute myocardial infarctions, patients at high risk of bleeding, and beyond. Consequently, we will review the current therapeutic choices for managing de novo CAD using DCB and assess the evidence supporting their concurrent application. Additionally, it aims to discuss future important perspectives.
PubMed: 38956941
DOI: 10.4070/kcj.2024.0148 -
Korean Circulation Journal Jun 2024The clinical benefits of complete revascularization (CR) in acute myocardial infarction (AMI) patients are unclear. Moreover, the benefit of CR is unknown in AMI with...
BACKGROUND AND OBJECTIVES
The clinical benefits of complete revascularization (CR) in acute myocardial infarction (AMI) patients are unclear. Moreover, the benefit of CR is unknown in AMI with diabetes mellitus (DM) patients. We sought to compare the prognosis of CR and incomplete revascularization (IR) in patients with AMI and multivessel disease, according to the presence of DM.
METHODS
A total of 2,150 AMI patients with multivessel coronary artery disease were analyzed. CR was defined based on the angiographic image. The primary endpoint of this study was the patient-oriented composite outcome (POCO) defined as a composite of all-cause death, any myocardial infarction, and any revascularization within 3 years.
RESULTS
Overall, 3-year POCO was significantly lower in patients receiving angiographic CR (985 patients, 45.8%) compared with IR (1,165 patients, 54.2%). When divided into subgroups according to the presence of DM, CR reduced 3-year clinical outcomes in the non-DM group but not in the DM group (POCO: 11.7% vs. 23.2%, p<0.001, any revascularization: 7.2% vs. 10.8%, p=0.024 in the non-DM group, POCO: 24.3% vs. 27.8%, p=0.295, any revascularization: 13.3% vs. 11.3%, p=0.448 in the DM group, for CR vs. IR). Multivariate analysis showed that CR significantly reduced 3-year POCO (hazard ratio, 0.52; 95% confidence interval, 0.36-0.75) only in the non-DM group.
CONCLUSIONS
In AMI patients with multivessel disease, CR may have less clinical benefit in DM patients than in non-DM patients.
PubMed: 38956939
DOI: 10.4070/kcj.2024.0017 -
Endocrine, Metabolic & Immune Disorders... Jul 2024Malabsorption syndromes are known chronic complications of bariatric surgery. Therefore, it is recommended to take oral supplementation with multivitamins. Wernicke's...
BACKGROUND
Malabsorption syndromes are known chronic complications of bariatric surgery. Therefore, it is recommended to take oral supplementation with multivitamins. Wernicke's encephalopathy represents an acute neuropsychiatric syndrome associated with alcoholism or severe malnutrition; sporadic cases of this potential complication related to bariatric surgery are described in the literature. We present a case of Wernicke's encephalopathy due to severe vitamin B1 deficiency after bariatric surgery.
CASE REPORT
A 31-year-old woman with deaf-mutism from the age of 3 years old, operated 3 months before with a mini-gastric bypass for severe obesity, was transferred to our unit after accessing the emergency room. In the immediate medical history, there was the sudden and rapid decline in vision, leading to complete loss of vision, marked asthenia, and paresthesia in the four limbs. Considering the previous bariatric surgery, the diagnosis of non-alcoholic Wernicke's syndrome was suspected, for which IV therapy with Vitamin B1 was started at a dosage of 5 vials of 200 mg in 100 cc of saline solution (three times a day for the first 72 hours, subsequently 1 once/day). After 12 hours, there was an improvement in visual acuity, and the symptoms completely resolved within 48 hours. She was discharged with complete resolution of all symptoms after 1 month.
CONCLUSION
Initial vision loss without confusion or encephalopathy is one atypical presentation of Wernicke syndrome. Clinical suspicion must be high in case of alcoholism or post-bariatric surgery. Early recognition of atypical symptoms, including vision loss, and timely administration of therapy improves the prognosis of this potentially reversible but time-dependent neurological emergency.
PubMed: 38956916
DOI: 10.2174/0118715303318400240624104538 -
British Journal of Pharmacology Jul 2024Remote ischaemic preconditioning (rIPC) for cardioprotection is severely impaired in diabetes, and therapeutic options to restore it are lacking. The vascular...
BACKGROUND AND PURPOSE
Remote ischaemic preconditioning (rIPC) for cardioprotection is severely impaired in diabetes, and therapeutic options to restore it are lacking. The vascular endothelium plays a key role in rIPC. Given that the activity of endothelial nitric oxide synthase (eNOS) is inhibited by proline-rich tyrosine kinase 2 (Pyk2), we hypothesized that pharmacological Pyk2 inhibition could restore eNOS activity and thus restore remote cardioprotection in diabetes.
EXPERIMENTAL APPROACH
New Zealand obese (NZO) mice that demonstrated key features of diabetes were studied. The consequence of Pyk2 inhibition on endothelial function, rIPC and infarct size after myocardial infarction were evaluated. The impact of plasma from mice and humans with or without diabetes was assessed in isolated buffer perfused murine hearts and aortic rings.
KEY RESULTS
Plasma from nondiabetic mice and humans, both subjected to rIPC, caused remote tissue protection. Similar to diabetic humans, NZO mice demonstrated endothelial dysfunction. NZO mice had reduced circulating nitrite levels, elevated arterial blood pressure and a larger infarct size after ischaemia and reperfusion than BL6 mice. Pyk2 increased the phosphorylation of eNOS at its inhibitory site (Tyr656), limiting its activity in diabetes. The cardioprotective effects of rIPC were abolished in diabetic NZO mice. Pharmacological Pyk2 inhibition restored endothelial function and rescued cardioprotective effects of rIPC.
CONCLUSION AND IMPLICATIONS
Endothelial function and remote tissue protection are impaired in diabetes. Pyk2 is a novel target for treating endothelial dysfunction and restoring cardioprotection through rIPC in diabetes.
PubMed: 38956895
DOI: 10.1111/bph.16483 -
Ophthalmic Genetics Jul 2024Fleck corneal dystrophy (FCD) is a rare autosomal dominant disease that affects exclusively the corneal stroma. The disease is caused by heterozygous variants in...
BACKGROUND
Fleck corneal dystrophy (FCD) is a rare autosomal dominant disease that affects exclusively the corneal stroma. The disease is caused by heterozygous variants in PIKFYVE, a gene encoding a lipid kinase involved in multiple cellular pathways, primarily participating in membrane dynamics and signaling. This report describes a familial case of FCD caused by a complete deletion of the PIKFYVE gene.
MATERIAL AND METHODS
A clinical ophthalmic examination was performed on the proband and family members. Genetic testing included next-generation sequencing (multigene panel), and chromosomal microarray analysis. A quantitative PCR assay was designed in order to segregate the deletion.
RESULTS
A 19-year-old male, with no family or personal history of ocular disease, presented for evaluation due to an acute illness consisting of burning, foreign body sensation, and red eye. Slit lamp biomicroscopy revealed bilateral small pterygia and scattered bilateral white opacities in the corneal stroma, a very similar corneal phenotype was found in the 47-year-old father, who was asymptomatic. NGS detected a heterozygous deletion of the entire PIKFYVE coding sequence. CMA in DNA from the propositus indicated a 543 kb deletion in 2q33.3q34 spanning the entire PIKFYVE gene. The deletion was confirmed in the father.
CONCLUSIONS
We add to the molecular spectrum of FCD by describing a familial case of a whole PIKFYVE gene deletion in affected subjects. Our findings support that normal expression of PIKFYVE is necessary for corneal keratocytes homeostasis and normal corneal appearance. We conclude that PIKFYVE haploinsufficiency is the molecular mechanism underlying this familial case of FCD.
PubMed: 38956867
DOI: 10.1080/13816810.2024.2365737 -
European Journal of Sport Science Jul 2024Knee osteoarthritis is associated with deficits in muscle strength, muscle mass, and physical functioning. These muscle-related deficits are acutely exacerbated... (Review)
Review
Knee osteoarthritis is associated with deficits in muscle strength, muscle mass, and physical functioning. These muscle-related deficits are acutely exacerbated following total knee arthroplasty (TKA) and persist long after surgery, despite the application of standardized rehabilitation programs that include physical/functional training. Resistance exercise training (RET) has been shown to be a highly effective strategy to improve muscle-related outcomes in healthy as well as clinical populations. However, the use of RET in traditional rehabilitation programs after TKA is limited. In this narrative review, we provide an updated view on whether adding RET to the standard rehabilitation (SR) in the recovery period (up to 1 year) after TKA leads to greater improvements in muscle-related outcomes when compared to SR alone. Overall, research findings clearly indicate that both muscle strength and muscle mass can be improved to a greater extent with RET-based rehabilitation compared to SR. Additionally, measures of physical functioning that rely on quadriceps strength and balance (e.g., stair climbing, chair standing, etc.) also appear to benefit more from a RET-based program compared to SR, especially in patients with low levels of physical functioning. Importantly though, for RET to be optimally effective, it should be performed at 70%-80% of the one-repetition maximum, with 3-4 sets per exercise, with a minimum of 3 times per week for 8 weeks. Based upon this narrative review, we recommend that such high-intensity progressive RET should be incorporated into standard programs during rehabilitation after TKA.
Topics: Humans; Arthroplasty, Replacement, Knee; Resistance Training; Muscle Strength; Osteoarthritis, Knee; Quadriceps Muscle; Postural Balance
PubMed: 38956794
DOI: 10.1002/ejsc.12114 -
Otology & Neurotology : Official... Jul 2024Acute mastoiditis (AM) is a relatively rare complication arising from acute otitis media, a common condition among children. The COVID-19 pandemic has significantly...
INTRODUCTION
Acute mastoiditis (AM) is a relatively rare complication arising from acute otitis media, a common condition among children. The COVID-19 pandemic has significantly impacted AM cases. We noted a surge in pediatric AM cases in Germany after COVID-19 restrictions were lifted in 2022. This study assesses AM incidence and the clinical course in children before, during, and after the pandemic. The study also explores complication rates and microbial changes.
METHODS
Participants: We included children (0-18 yr) diagnosed with AM who underwent mastoidectomy at a tertiary-care university hospital from January 2012 to June 2023.Objectives: We aimed to evaluate AM incidence during pre-COVID, COVID, and post-COVID periods; assess complications; and analyze the microbial spectrum.Data Analysis: Incidence and complication rates were compared between periods, along with the microbial spectrum.
RESULTS
Population: 75 children were included (median age, 3.3 yr).Incidence: Significant increases in AM cases occurred in the post-COVID period compared to pre-COVID and COVID periods. No significant difference was observed between pre-COVID and COVID periods.Complications: Complication rates increased notably in the post-COVID period compared to pre-COVID and COVID periods with respect to more sensitive imaging methods being used in the post-COVID period. No significant difference was observed between pre-COVID and COVID periods.Spectrum of Pathogens: No significant differences were found in pathogen distribution between periods. Streptococcus pyogenes and Streptococcus pneumoniae were common throughout.
DISCUSSION
The study highlights a substantial rise in AM cases and complications after COVID-19 restrictions were lifted in Germany. This underscores the importance of monitoring infectious diseases and their complications during health crises. Additionally, the study highlights the importance of contrast-enhanced imaging. Further research is needed to explore the mechanisms behind this trend.
CONCLUSION
The study reveals a significant increase in pediatric AM cases and complications following the COVID-19 pandemic in Germany. Adequate computed tomographic or magnetic resonance imaging, including contrast enhancement, is shown to be a very important parameter beside clinical symptoms in deciding for the right therapy. Thus, surgical treatment became more important. Continuous monitoring and adaptive healthcare strategies during health crises are vital for optimal patient care. Further research is warranted to understand the reasons behind these trends and to inform future pandemic preparedness efforts.
PubMed: 38956778
DOI: 10.1097/MAO.0000000000004238 -
International Neurourology Journal Jun 2024Previous studies have simply confirmed recurrence of acute cystitis negatively affects a patient's psychological state. This study was performed to assess the impact of...
PURPOSE
Previous studies have simply confirmed recurrence of acute cystitis negatively affects a patient's psychological state. This study was performed to assess the impact of the recurrence of urinary tract infections on anxiety and depression and further assess whether there is a correlation between the number of recurrences and the degree of anxiety and depression.
METHODS
This cross-sectional study enrolled patients with recurrent cystitis who visited a tertiary care center between April 2018 and June 2022. For eligible patients, depression and anxiety were assessed by the Patient Health Questionnaire-9 and State-Trait Anxiety Inventory. Among the clinical characteristics, factors that independently affected the degree of depression and anxiety were analyzed. Additionally, the relationship between the level of anxiety, depression, and the number of recurrent cystitis was assessed.
RESULTS
A total of 112 female patients with recurrent cystitis were enrolled in this study. The proportion of patients with depression (moderate, 8%; severe, 0%) was relatively low compared with that of patients with anxiety (moderate, 22.3%; severe, 68.8%). Multivariate regression analysis showed that more recurrent episodes were significantly associated with higher anxiety scores (P<0.001). It was confirmed that longer disease duration is associated with higher depression scores (P=0.031). Additionally, there was a positive correlation between the number of recurrences and State-Trait Anxiety Inventory and Patient Health Questionnaire-9 scores (r=0.362, P<0.001 and r=0.248, P=0.009, respectively).
CONCLUSION
Our study reveals that recurrent cystitis notably increases patients' anxiety, correlating with the frequency of recurrences. Disease duration is also linked to depression. These findings emphasize the importance of preventing urinary tract infection recurrences to reduce psychological complications. To reinforce these results, larger cohort studies are necessary.
PubMed: 38956775
DOI: 10.5213/inj.2448096.048