INTRODUCTION:Interstitial lung disease (ILD) is a leading cause of morbidity and mortality in systemic sclerosis (SSc). High-resolution computed tomography (HRCT) is the gold standard for assessing ILD extent but is limited by cost, availability, and radiation exposure. Practical functional tools are thus needed to identify extensive ILD in routine practice. METHODS:This cross-sectional study enrolled adult patients with SSc-associated ILD at a tertiary referral hospital in Jakarta, Indonesia. All participants underwent spirometry and the six-minute walk test (6MWT). Forced vital capacity (FVC), 6MWT distance, and exertional oxygen desaturation were evaluated. ILD extent on HRCT was classified as non-extensive (<20%) or extensive (≥20%). Associations were analyzed using bivariate analysis, receiver operating characteristic (ROC) curves, and multivariable Poisson regression with robust standard errors. RESULTS:A total of 83 patients were included; 21 (25%) had extensive ILD. Six-minute walk test distance did not differ significantly between groups (p = 0.492; AUC 0.550). Exertional oxygen desaturation ≥4% and FVC <70% predicted were each significantly associated with extensive ILD. FVC alone achieved an AUC of 0.795, whereas adding 6MWT distance resulted in only a marginal improvement in discrimination (AUC 0.799; ΔAUC 0.005), with adequate calibration and stable internal validation. CONCLUSION:FVC alone may serve as a practical functional indicator of ILD extent, particularly where HRCT access is limited. Routine addition of 6MWT distance is not justified solely for estimating ILD extent, although the 6MWT remains valuable for assessing functional capacity and exertional desaturation.
Primary angiitis of the central nervous system is an extremely rare diagnosis, with an incidence of 2.4 cases per 1,000,000 person-years. The exact cause of PACNS remains unknown, and typically cases present with a long prodrome. It is a diagnosis of exclusion, and various infectious, autoimmune, and malignant processes must be excluded prior to final diagnosis. Given the rarity of this condition, there is often a delay in diagnosis that can range from 6 to 23 months. It is imperative that all clinical providers be aware of this diagnosis when managing patients who present with insidious and non-specific neurological symptoms. We present a case of PACNS that responded well to a therapeutic regimen of high-dose steroids and cyclophosphamide.
INTRODUCTION:This study aimed to review and describe isolated cotton wool spots (CWS) on retinal examination in patients with systemic or occult presentation of giant cell arteritis (GCA). MATERIAL AND METHODS:In this scoping review, following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Extension for Scoping Reviews, PubMed, Scopus, and Web of Science were searched for peer-reviewed articles reporting an association between GCA and CWS from 1960 to 13th of June 2026. Case reports and case series of confirmed GCA with CWS as the sole fundoscopic finding were included. Data were charted independently by two reviewers using a standardized Excel extraction form. RESULTS:Sixteen articles, including fifteen case reports and one case series, were included in the study. 76.19% of patients had concurrent systemic symptoms, while the remaining 23.81% had an occult presentation. Patients with occult GCA tended to be younger at presentation compared with those with systemic disease. No difference in inflammatory markers was observed between the occult and the systemic presentation of the disease. CONCLUSION:This review summarizes the current evidence and characteristics of CWS as an isolated retinal manifestation of GCA. The included evidence suggests that this atypical presentation may occur even in the absence of systemic symptoms, highlighting the importance of early clinical recognition, as delayed diagnosis may lead to irreversible visual loss.
BACKGROUND:Hypereosinophilia of undetermined significance (HE-US) represents a rare subtype of hypereosinophilia (HE) defined by a persistent absolute eosinophil count (AEC) ≥ 1500/uL without an identifiable reactive or clonal cause, and importantly, without evidence of eosinophil-mediated end-organ damage. Long-term structured follow-up is essential due to its unpredictable outcome and the risk of transition into overt hypereosinophilic syndrome (HES) or occult malignancies. CASE PRESENTATION:We report the case of a 47-year-old woman with severe, persistent blood hypereosinophilia (up to 13600/uL) accompanied by chronic inconstant fixed erythematous-violaceous skin lesions. Extensive diagnostic evaluation for secondary, autoimmune, and clonal etiologies was negative, including fluorescence in situ hybridization (FISH) for FIP1L1-PDGFRA mutation. Bone marrow biopsy showed granulocytic hyperplasia with eosinophils <10% and mild reticulin fibrosis (MF-1). Whole-body computed tomography (CT) revealed small generalized lymphadenopathy (≤ 11mm) without parenchymal infiltration. The patient declined lymph-node biopsy. Although skin biopsy revealed eosinophilic infiltration, it was characterized as a non-specific reactive pattern without objective evidence of eosinophil-mediated cytotoxicity. The case was provisionally diagnosed as HE-US, acknowledging that lymphoproliferative disease could not be definitively excluded in the absence of the lymph-node biopsy. Intermittent systemic corticosteroids provide rapid hematologic response, but prompted immediate recurrence when tapered. CONCLUSION:The reported case underscores the diagnostic complexity and difficulties in managing hypereosinophilia of undetermined significance in clinical practice. While current evidence suggests a generally benign course, rare progression to hypereosinophilic syndrome or other malignancies requires structured long-term monitoring and individualized therapeutic decision-making.
BACKGROUND:Immune checkpoint inhibitors (ICIs) improve outcomes across malignancies but can cause immune-related adverse events (irAEs), notably myocarditis, with case-fatality up to 50. METHODS:We retrospectively reviewed five patients with potential ICI-associated myocarditis treated at Mayo Clinic Florida (2019-2024) and summarize the existing literature. Cases were retrospectively categorized as definite, probable, or possible myocarditis according to cardiac magnetic resonance (CMR) findings and histopathology when available. RESULTS:The median age was 74 years, and four of the five patients were male. Myocarditis developed between 5 and 30 days after initiation of anti-PD-1 therapy. Presentations included dyspnea (three patients), chest pain (one patient), and asymptomatic troponin elevation detected on routine monitoring (one patient). Troponin T elevation above the 99th percentile was seen in all five cases (normal <= 15 ng/L). Electrocardiograms (ECG) demonstrated conduction abnormalities or ventricular ectopy in each patient. Left ventricular ejection fraction was preserved in four patients and severely reduced in one. CMR provided findings supportive of myocarditis in two of the five cases, while one endomyocardial biopsy (EMB) was performed and did not demonstrate active inflammation. Based on predefined criteria, one case was classified as definite myocarditis, one as probable, and three as possible ICI-associated myocarditis. All five patients received corticosteroid therapy. Two required escalation of immunosuppression. One patient developed concurrent myasthenia gravis, consistent with myocarditis-myositis-myasthenia (MMM) overlap, and underwent plasmapheresis for the neuromuscular component. Three patients recovered. Two patients died during follow-up; in both cases, myocarditis was considered a contributing factor, although direct causality could not be definitively established.
INTRODUCTION:The Romanian Boston Carpal Tunnel Questionnaire (BCTQ) has been linguistically and internally validated, but data on clinical construct validity and subgroup stability in routine practice are limited. This study evaluated its performance in a consecutive outpatient sample of patients with idiopathic, electrophysiology-confirmed carpal tunnel syndrome (CTS) after exclusion of major secondary causes. METHODS:In this cross-sectional study, consecutive patients with idiopathic CTS diagnosed according to AAOS guidelines and confirmed by nerve conduction studies (NCS) were included. Clinical examination, grip strength testing, BCTQ, EQ-5D-5L (analyzed as an exploratory unweighted severity index), and electrophysiological assessment were performed within 7 days. Hand-level analyses were conducted using linear mixed-effects models to account for within-patient correlation and to assess associations with demographic and clinical variables. RESULTS:A total of 193 hands met electrodiagnostic criteria for CTS. Overall BCTQ scores did not differ significantly across age, sex, or education groups. SSS and FSS correlated with grip strength (ρ = -0.16/-0.39; p < 0.03), sensory and motor conduction velocities (SCV ρ = -0.33/-0.31; MCV ρ = -0.19/-0.27; p ≤ 0.012), unweighted EQ-5D-5L severity index (ρ = 0.38/0.59; p < 0.001), and the presence of Tinel's and Phalen's signs. Higher BCTQ scores were associated with worse NCS grades. In multivariable models, grip strength, nerve velocities, EQ-5D-5L, and clinical signs remained significant predictors (all p < 0.001). CONCLUSIONS:The Romanian BCTQ demonstrates expected associations with clinical, electrophysiological, and patient-reported measures, supporting its use as a complementary PRO in CTS assessment.
BACKGROUND:Chemotherapy-induced gastrointestinal toxicity remains a major clinical problem that limits treatment adherence and quality of life in cancer patients. Microbiota-modulating interventions such as probiotics, prebiotics, and synbiotics have been proposed as supportive therapies, yet their comparative effectiveness remains unclear. OBJECTIVE:This systematic review and meta-analysis evaluated the effectiveness of probiotics, prebiotics, and synbiotics in reducing chemotherapy-induced gastrointestinal toxicity in cancer patients. METHODS:A systematic search of PubMed, Scopus, Cochrane Library, and ClinicalTrials.gov was performed between March and August 2025 to identify randomized controlled trials (RCTs) involving chemotherapy-treated cancer patients with gastrointestinal toxicities. Studies comparing probiotics, prebiotics, or synbiotics with placebo or standard care were included. Two reviewers independently screened studies, extracted data, and assessed risk of bias using standardized criteria. Meta-analysis was conducted using RevMan 5.4. RESULTS:Twenty-nine RCTs were included, comprising probiotics (n = 17), prebiotics (n = 6), and synbiotics (n = 6). Probiotic supplementation, predominantly containing Lactobacillus and Bifidobacterium species, significantly reduced the incidence of chemotherapy-induced diarrhea (RR = 0.67; 95% CI 0.47-0.95; p = 0.03). Synbiotics demonstrated an even greater protective effect (RR = 0.51; 95% CI 0.29-0.89; p = 0.02). Evidence supporting prebiotics alone was limited and inconsistent. CONCLUSION:Probiotics and synbiotics may be effective in reducing chemotherapy-induced gastrointestinal toxicity, with the most consistent evidence for diarrhea.
BACKGROUND:The association between accelerated biological aging and sleep apnea remains unclear. This study aimed to investigate the association of phenotypic aging (PhenoAge) with sleep apnea, identify nonlinear patterns and high-risk subgroups, and explore metabolic-oxidative stress (as measured by uric acid-to-HDL ratio, UHR) as a potential mediator. METHODS:In a cross-sectional analysis of 4,901 adults from NHANES 2005-2008, sleep apnea was self-reported. PhenoAge was calculated from clinical biomarkers. Associations were assessed using multivariable logistic regression and restricted cubic splines; potential mediation by UHR was evaluated. RESULTS:Each 1-year increase in PhenoAge was associated with a 3% higher odds of sleep apnea (OR=1.03, 95% CI: 1.01-1.04). A statistically derived nonlinear inflection point at a PhenoAge of 44.09 years was observed. The association was significant only in adults ≥40 years (P-interaction=0.001) and was strongest in males and individuals with obesity. UHR accounted for 6.27% of the association, primarily in adults ≥40 years and individuals with obesity. CONCLUSION:In this cross-sectional study, accelerated biological aging, measured by PhenoAge, was associated with sleep apnea in a dose-dependent and age-delimited manner, with a statistical inflection point at 44.09 years. The modest association via UHR suggests oxidative-metabolic dysregulation as one potential explanatory factor. These exploratory findings provide a framework for hypothesis generation regarding the role of biological aging in sleep apnea.
INTRODUCTION:Gastrointestinal graft-versus-host disease (GI GVHD) is a major complication of allogeneic haematopoietic stem-cell transplantation (allo-HSCT). Endoscopic biopsy with histopathological grading according to the Lerner system remains the diagnostic standard, although invasive sampling is frequently constrained in this fragile population. We assessed the relationship between a four-parameter contrast-enhanced ultrasound (CEUS) score and the Lerner histopathological grade. METHODS:Prospective, single-centre study (October 2018 - December 2025). Adult allo-HSCT recipients with new-onset gastrointestinal symptoms underwent multimodal abdominal ultrasound, including CEUS with sulphur hexafluoride microbubbles, followed by endoscopic biopsy. A composite CEUS-GVHD score (range 0-12) integrated bowel-wall thickness, bowel-loop dilatation, contrast wash-out, and transmural microbubble migration. The cohort comprised 51 episodes (in 41 unique patients) with histopathologically confirmed GI GVHD and Lerner grade I-IV. A within-patient sensitivity analysis was performed on the first chronologically documented episode per patient (n=41), and additional sensitivity analyses were performed by stratification according to concurrent gastrointestinal infection and according to GVHD form (acute vs chronic). RESULTS:The total CEUS-GVHD score showed a positive correlation with the Lerner grade (p < 0.001). Median CEUS scores across grades were 5.5 (Lerner I), 7 (II), 8.5 (III), and 10 (IV) (p < 0.001). Among individual parameters, transmural microbubble migration showed the highest correlation, followed by bowel-wall thickness and contrast wash-out; these three correlations remained significant after Bonferroni correction. The bowel-loop dilatation correlation did not retain significance after correction. In an exploratory analysis, the area under the ROC curve of the total CEUS-GVHD score for discriminating severe (Lerner III-IV) from mild (Lerner I-II) histopathological GI GVHD was 0.853, with the same point estimate retained in the within-patient sensitivity analysis (AUC 0.853). CONCLUSION:In this single-centre cohort of biopsy-confirmed GI GVHD, the CEUS-GVHD score showed a moderate-to-strong association with Lerner histopathological grade. Because the study included only confirmed GI GVHD episodes, these findings support CEUS as a potential adjunct for severity assessment, not as a replacement for diagnostic biopsy. External multicentre validation with multiple operators is required.
INTRODUCTION:High-sensitivity troponin T (hs-TnT) is commonly elevated in heart failure (HF) and may have different prognostic meaning in women and men. We assessed sex-related differences in hs-TnT and whether sex-aware interpretation improves long-term risk stratification after HF hospitalization. MATERIALS AND METHODS:We conducted a retrospective single-center cohort study derived from the HI-HF registry (2011-2014). The analysis included adults hospitalized for HF with admission hs-TnT, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and in-hospital echocardiography. We derived outcome-optimized sex-specific hs-TnT cut-offs by ROC analysis. The endpoint was long-term all-cause mortality (ascertained through August 2024). Kaplan-Meier and multivariable Cox models (including sex stratification, interaction testing, and landmark/time-dependent analyses) were performed. RESULTS:Our cohort included 404 patients. Over a median follow-up of 5.72 years (IQR 3.38-6.87), 149 deaths (36.9%) occurred. Women had lower hs-TnT concentrations than men (median 14.18 vs 22.44 pg/mL). ROC-derived sex-specific mortality prognostic cut-offs were >15.83 pg/mL for women (AUC 0.773; sensitivity 70.7%; specificity 78.3%) and >19.02 pg/mL for men (AUC 0.725; sensitivity 75.0%; specificity 65.0%). Compared to the conventional cut-off of 14 pg/mL, the gender-adjusted values improved risk stratification by 22% for women and 23% for men. For each gender-defined subgroup, increased hs-TnT levels were independently associated with all-cause long-term mortality in Cox analysis alongside NT-proBNP and hemoglobin levels in men (HR 1.91 (1.07 - 3.41), p=0.029), and NT-proBNP and age in women (HR 3.54 (2.07 - 6.07), p<0.001). Prognostic effects were time-dependent, with stronger sex-related divergence beyond 1 year. CONCLUSIONS:Sex-specific hs-TnT cut-off recalibration improved long-term mortality risk stratification in hospitalized heart failure patients. Increased levels of hs-TnT defined by the gender-specific analysis were independent predictors of the outcome in both men and women.
BACKGROUND:The relationship of chronic hyperglycemia (CH) reflected by glycated hemoglobin A1c (HbA1c) with functional recovery in patients having acute ischemic stroke (AIS) remains controversial. This study evaluated how HbA1c values at admission could influence functional recovery following AIS of various etiologies. METHODS:In total, 518 patients with AIS were included. Stroke etiology was determined by TOAST criteria. The modified Rankin Scale (mRS) was applied to evaluate the functional recovery. Independent-samples Mann-Whitney U test was applied to assess the distribution of HbA1c across different subtypes. The relationship between HbA1c levels and functional recovery was analyzed applying multivariate logistic regression for adjustment of variables. Models predicting poor functional recovery, without and with HbA1c were developed utilizing binary logistic regression. RESULTS:HbA1c levels were significantly elevated among patients with poor functional recovery (p <0.001). The highest HbA1c values, median (IQR) [8.15(6.5-10.9)] were observed in patients with large artery atherosclerosis (LAA) subtype. Subgroup analyses by stroke subtype revealed significant associations of elevated HbA1c levels with poor functional recovery in the SVO (p = 0.021), LAA (p = 0.027), and cardio-embolic (CE), p = 0.046 groups. Elevated HbA1c remained independently associated with poor functional recovery (p = <0.001; OR = 1.27; 95% CI = 1.12-1.45) after full adjustment for clinical variables. CONCLUSIONS:Elevated admission HbA1c levels showed a fair to modest association with poorer functional recovery among patients with SVO, LAA, and CE stroke subtypes, which requires further external validation to establish its clinical implications and to consider HbA1c as an independent prognostic biomarker.
OBJECTIVE:This study aimed to characterize pulmonary function patterns in rheumatoid arthritis (RA), explore their clinical and serologic correlates, and evaluate the ability of spirometry and DLCO together with routine clinical factors to identify patients with high-resolution computed tomography (hrCT)-confirmed interstitial lung disease (ILD). METHODS:In this cross-sectional observational study, consecutive adults with RA underwent pulmonary function testing (PFT) and chest radiography irrespective of respiratory symptoms. Patients with unexplained dyspnea, abnormal PFT, or abnormal chest X-ray were referred for hrCT. RESULTS:Among the 106 included patients (81.1% women; mean age 65.3±9.7 years), DLCO correlated negatively with age and inflammatory markers, while FVC and FEV1 showed associations with serologic status, treatment exposure, and radiographic abnormalities. Forty-seven patients (44.3%) underwent hrCT, of whom 24 (51.1%) had ILD, corresponding to an overall prevalence of 22.6%. In the hrCT subgroup, swollen joint count at RA diagnosis was higher in ILD cases, whereas radiographic emphysema occurred only in non-ILD patients. In multivariable analysis, age, smoking history, and DAS28-CRP were not independently associated with ILD (AUC=0.634; 95%CI=0.451-0.807). ROC analyses demonstrated poor discrimination of ILD by PFT z-scores: DLCO AUC=0.431, FVC AUC=0.562, and FEV1 AUC=0.444, with high sensitivity but low specificity at optimal thresholds. CONCLUSIONS:In this real-world RA cohort, spirometry/DLCO showed limited ability to discriminate hrCT-confirmed ILD once patients were clinically selected for imaging. These findings support an integrated screening strategy in which PFT results are interpreted alongside clinical and radiographic risk factors to guide hrCT referral rather than used as standalone screening tools.
INTRODUCTION:Chronic Myeloid Leukemia is a hematologic malignancy characterized by the BCR-ABL fusion gene. Tyrosine Kinase Inhibitors such as imatinib and nilotinib have significantly improved the prognosis for CML patients. However, prolonged TKI therapy is associated with cardiovascular side effects, particularly hypertension. This study aims to compare the effects of imatinib and nilotinib on blood pressure in CML patients over a 12-month period. METHODS:A retrospective cohort study was conducted at Wahidin Sudirohusodo Hospital, including 148 adult CML patients who received imatinib or nilotinib for at least 12 months. BP measurements were taken at baseline, and at 3, 6, 9, and 12 months. Statistical analyses included paired t-tests and multivariate regression to evaluate BP changes and their associations with demographic and treatment variables. RESULTS:Both systolic and diastolic BP significantly increased in both groups over 12 months. In the imatinib group, systolic BP rose from 112 mmHg to 125 mmHg, and diastolic BP increased from 72 mmHg to 81 mmHg. In the nilotinib group, systolic BP increased from 111 mmHg to 130 mmHg, and diastolic BP rose from 70 mmHg to 83 mmHg. These increases were more pronounced in the nilotinib group (p < 0.001 for systolic and p = 0.006 for diastolic). CONCLUSION:Both imatinib and nilotinib therapies lead to significant increases in BP, with nilotinib showing a greater hypertensive effect. Monitoring BP is crucial, especially for patients on second-generation TKIs, to manage cardiovascular risks associated with long-term treatment.
Anti-melanoma differentiation-associated gene 5 (anti-MDA5) dermatomyositis is a distinct subtype of dermatomyositis frequently associated with clinically amyopathic disease and rapidly progressive interstitial lung disease (RP-ILD), a complication characterized by high mortality despite aggressive treatment. Early recognition and prompt immunomodulatory therapy are therefore critical. We report a fatal case of anti-MDA5 dermatomyositis complicated by RP-ILD with concomitant cytomegalovirus (CMV) reactivation. A 40-year-old woman with known dermatomyositis presented with progressive dyspnea, fever, and hypoxemia. Physical examination revealed typical cutaneous findings, including Gottron's sign and papules. Laboratory evaluation demonstrated elevated inflammatory markers and marked lymphopenia. Anti-MDA5 antibody testing was positive. Chest computed tomography showed rapidly progressive bilateral fibrotic interstitial lung disease compared with imaging obtained 10 days earlier. Despite empirical antimicrobial therapy, mycophenolate discontinuation, and initiation of intravenous immunoglobulin, respiratory failure progressed rapidly, requiring mechanical ventilation. Infectious investigations were negative except for low-level CMV viremia. Due to the absence of lung-specific diagnostic evidence, CMV was interpreted as reactivation related to immunosuppression rather than a primary cause of pulmonary injury. The patient subsequently developed multiorgan failure and died on the fifth day of intensive care. This case highlights the fulminant course and poor prognosis of anti-MDA5-associated RP-ILD. Severe lymphopenia and CMV reactivation may represent markers of immune dysregulation rather than direct etiologic drivers. Anti-MDA5 positivity should be recognized as a high-risk biomarker warranting early risk stratification, rapid initiation of immunomodulatory therapy, and close monitoring for opportunistic infections.
INTRODUCTION:Risk stratification in heart failure with preserved ejection fraction (HFpEF) remains inconsistent in routine care despite multiple prognostic scores. Key controversies persist. One concerns broad, clinically derived scores versus pathophysiology-grounded tools, including diagnostic frameworks used pragmatically for prognostication. Another concern is the distinction between static baseline risk and dynamic risk states that change across hospitalization and follow-up. METHODS:We performed a narrative, comparative synthesis of clinician-usable prognostic instruments in HFpEF across conceptual domains and care settings. We extracted study context, endpoints, follow-up, and performance metrics. We emphasized feasibility and clinical interpretability. RESULTS:Across studies, discrimination of baseline-only clinical instruments is generally moderate. Performance is often higher for tools that reflect congestion and physiological changes, particularly when reassessed at clinically meaningful time points. Discharge lung ultrasound B-lines, reflecting residual pulmonary congestion, frequently predict early post-discharge events. Immuno-nutritional indices derived from routine laboratory tests provide a complementary prognostic signal, especially in older or recently hospitalized patients. Serial trajectories appear more informative than single measurements. Patient-reported health adds independent prognostic information and supports risk communication. Diagnostic frameworks can stratify risk when constituent data are available, and phenotype distributions are compatible, but transportability and calibration remain recurrent limitations. CONCLUSION:HFpEF prognostication is best supported by a layered, phenotype-aware strategy. This approach integrates global clinical risk, selected biomarkers, discharge congestion assessment, and serial reassessment, rather than relying on a single score.
COPD is a complex disease with pulmonary and extrapulmonary manifestations intensively studied due to the numerous pathologic processes involved. Its prevalence is increasing, representing the fourth leading cause of mortality worldwide. Sarcopenia can occur in COPD patients with common risk factors. Sarcopenia is characterized by a decrease in muscle mass and function with consequences on muscle performance. Muscle changes can be measured by different methods: MRI, DXA, BIA, CT or biopsy. The prevalence of sarcopenia has been studied in numerous studies with varying results. This review identifies the main risk factors that contribute to the variable outcomes with a focus on the characteristics of the studied population, the criteria for defining sarcopenia and the methods used to measure muscle mass, strength and physical performance.
Background This study was designed to evaluate the relationship between serum interleukin-33 (IL-33) levels and clinical features of the disease in patients with Familial Mediterranean Fever (FMF).Methods Fifty-four patients diagnosed with FMF (28 colchicine responsive and 26 colchicine resistant) and 29 healthy controls constituted the study population. Demographic, clinical, biochemical and inflammatory parameters, as well as serum IL-33 levels of the participants, were compared.Results The mean age of FMF patients was 34.3 +/- 9.8 years, and 54% were female. Colchicine-resistant patients exhibited significantly higher median CRP levels than both colchicine-responsive patients and healthy controls (median [IQR]: 16 [30.4] mg/L, 2.9 [3.4] mg/L, and 3.4 [2.8] mg/L, respectively; p < 0.001). Median serum IL-33 levels were higher in FMF patients than in controls (273 [387] ng/L vs. 221 [179] ng/L, p = 0.06). The colchicine-responsive group had significantly higher IL-33 levels compared to the control group (287 [495] ng/L vs. 221 [179] ng/L, p = 0.006), while no significant difference was observed between the colchicine-resistant group and controls (257 [219] ng/L vs. 221 [179] ng/L, p = 0.74). No significant correlations were identified between IL-33 levels and inflammatory markers or clinical characteristics.Conclusions Serum IL-33 levels do not seem to be associated with FMF disease activity; however, the observed increase in colchicine-responsive patients may indicate an immunomodulatory or compensatory function. Further comprehensive studies are needed to elucidate the role of IL-33 in FMF pathogenesis.
INTRODUCTION:Urinary tract infections (UTIs) are associated with increased morbidity and mortality, yet data on the importance of secondary bacteremia remain scarce. METHODS:This retrospective, single-center study was conducted at a tertiary university hospital and included patients, hospitalized for UTIs, in order to assess the impact of secondary bacteremia on clinical outcomes (need for surgery, antibiotic change or death) and identify predictors for its presence. RESULTS:A total of 232 patients were included, with 56 (24.1%) developing secondary bacteremia. The bacteremia group exhibited higher CRP levels (18 mg/dL vs. 8 mg/dL, p < 0.01), lower hemoglobin (11.1 vs. 12 g/dL, p < 0.01), and higher disease severity scores. Hospital-acquired infections were an independent predictor of bacteremia (aOR: 4.440, p = 0.045). Patients with bacteremia exhibited longer hospital stays (8.5 vs. 4 days, p < 0.01) while its presence was independently associated with mortality (OR 11.01, 95% CI 1.19-101.50, p = 0.034). Multidrug-resistant (MDR) pathogens were the main prognostic factor for poor outcomes (aOR: 7.792, p < 0.001). CONCLUSIONS:Our study underscores the need for antimicrobial resistance surveillance, early detection and prompt intervention to improve patient outcomes.
BACKGROUND:Hypereosinophilic syndrome (HES) is a heterogeneous group of disorders characterized by sustained eosinophilia and multi-organ involvement resulting from eosinophil-mediated tissue injury. The condition may arise from diverse etiologies, including clonal myeloproliferative disorders, autoimmune diseases, infections, and idiopathic causes, posing significant diagnostic challenges. OBJECTIVE:To describe and analyze the varied clinical manifestations, etiologies, and outcomes of patients presenting with hypereosinophilia in a tertiary-care setting. METHODS:This case series includes five patients with persistent eosinophilia (absolute eosinophil count >1500 cells/μL) who presented with distinct systemic manifestations. All patients underwent detailed clinical, laboratory, and imaging evaluations to determine the underlying cause and extent of organ involvement. RESULTS:The clinical presentations were highly variable, including cerebral infarcts due to HES-related vasculopathy, disseminated fungal infection with lymph node and bone marrow eosinophilia, ANCA-associated vasculitis with neuropathy, bronchial asthma with marked eosinophilia, and eosinophilic gastrointestinal and hepatic disease. Corticosteroid therapy was the mainstay of treatment, supplemented with antifungal and immunosuppressive agents when indicated. Most patients showed significant improvement, though one had residual neurological deficits. CONCLUSION:Hypereosinophilia can manifest through diverse pathophysiological mechanisms affecting nearly any organ system. Early recognition, exclusion of secondary causes, and timely initiation of corticosteroids or targeted therapies are essential to prevent irreversible organ damage and improve clinical outcomes.
BACKGROUND:Numerous studies have demonstrated a connection between heightened arterial stiffness (AS) and cardiovascular disease. Over time, several techniques have been devised to gauge arterial stiffness. OBJECTIVE:This study aims to investigate the correlation between AS, measured using the PWV method on the arm, and the SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) score derived from coronary angiography (CAG). MATERIALS AND METHODS:The cohort comprised 53 patients (51.0%) diagnosed with non-ST elevation myocardial infarction (NSTEMI) and 51 patients (49.0%) diagnosed with ST elevation myocardial infarction (STEMI), all aged between 18 and 80 years. Using the 'Mobil-O-Graph® ARCsolver algorithm' device, we measured parameters such as PWV, augmentation index (AIx), and arterial blood pressure for all participants. The SYNTAX score was employed to gauge the severity and extent of coronary artery disease. RESULTS:The patients' average age stood at 61.36 years, with 61 (60.6%) being male and 43 (39.4%) female. The mean BMI was recorded at 28.43 kg/m2. Upon comparing the patient groups based on PWV measurements, intriguing insights emerged. Specifically, within the NSTEMI group, a noteworthy positive correlation emerged between PWV and key factors such as age, RDW (Red Cell Distribution Width), blood urea nitrogen (BUN) levels, and SYNTAX score (p<0.05). CONCLUSION:The elevation of PWV levels proved to be notably valuable in anticipating the severity of coronary artery disease in NSTEMI patients. Conversely, in STEMI patients, heightened PWV emerged as a predictor of an unfavorable prognosis, aligned with higher clinical risk scores.
