Coexistent Disease Research Articles

Incidence and prevalence of coexistent retinal diseases and cognitive impairment or dementia: A systematic review

AbstractBackgroundAs chronic and progressive age‐related diseases, there are commonalities between age‐related macular degeneration (AMD), glaucoma, and diabetic retinopathy (DR), and cognitive impairment (CI) and dementia. We undertook a systematic review to quantify such associations.MethodMEDLINE, EMBASE, PsycINFO and CINAHL were searched (from inception to June 2020) for observational studies reporting incidence or prevalence of AMD, glaucoma or DR in people with CI or dementia, and CI or dementia among people with AMD, glaucoma or DR. A 9‐item quality assessment tool was used to categorize studies as having low, moderate or high risk of bias. Rates of comorbid disease were extracted and presented in forest plots. Prospero registration [CRD42020189484].ResultOf 6,803 abstracts reviewed, 76 were considered for full‐text analysis, of which 47 were included for syntheses. There were 27 and 20 assessed as having low and moderate risk of bias, respectively.Incidence of dementia in people with age‐related retinal diseases ranged from 9.5 to 20 (AMD), from 1.1 to 11.6 (glaucoma) and was 32.9 (DR) per 1000 person‐years, respectively (Figure 1). There were no reports on the incidence of CI in AMD, glaucoma or DR, nor of retinal diseases in CI or dementia.There were two studies reporting prevalence of AMD or glaucoma in people with CI (Figure 2). Prevalence of DR in those with CI ranged from 11.4% to 70.1%. Prevalence of AMD, glaucoma and DR among people with dementia ranged from 1.4% to 52.6%, from 0.2% to 25.9% and from 11 to 20%, respectively.Prevalence of CI in people with AMD, glaucoma and DR ranged from 8.4% to 52.4%, from 2.8% to 90.2% and from 3.9% to 45.2%, respectively (Figure 3). Prevalence of dementia in people with AMD, glaucoma and DR ranged from 9.9% to 62.6%, 2.5% to 3% and 0.8% to 12.5%, respectively.ConclusionThere are wide ranging estimates of incidence and prevalence of retinal diseases in relation to CI/dementia. Further research is required to better understand the reasons for such variations.

Coexistent coronary artery disease in Indian patients undergoing permanent pacemaker implantation (PPI) for symptomatic bradyarrythmias of above 50 years of age

Coexistent coronary artery disease in Indian patients undergoing permanent pacemaker implantation (PPI) for symptomatic bradyarrythmias of above 50 years of age

Real-World Outcomes of Axicabtagene Ciloleucel (Axi-cel) for the Treatment of Large B-Cell Lymphoma (LBCL): Impact of Age and Specific Organ Dysfunction

Real-World Outcomes of Axicabtagene Ciloleucel (Axi-cel) for the Treatment of Large B-Cell Lymphoma (LBCL): Impact of Age and Specific Organ Dysfunction

Factors influencing the quality of life in children after biliary atresia treatment.

BackgroundDespite surgical treatment, children with biliary atresia (BA) may face many problems which seriously affect their quality of life. However, there is a paucity of studies in China examining the quality of life of these children after BA treatment. This study investigated the current status of the quality of life of children after BA treatment and analyzed the influencing factors so as to provide a scientific basis for the development of targeted interventional measures.MethodsFrom May 1 to May 31, 2021, the STAR questionnaire method was used to conduct cross-sectional surveys in children following BA surgery in the West China Hospital of Sichuan University, China. The basic information questionnaire was used to investigate the general characteristics of the children. The children were also given quality of life questionnaires during follow-up sessions after surgical treatment for BA. In addition, a 12-point health survey was used to assess the physical and mental health of the children’s caregivers. Age- and gender-matched healthy children were recruited as controls. Correlation analysis and multiple linear regression equations were established to explore the influencing factors of the quality of life of children after surgery for BA.ResultsAfter surgery, children with BA experienced significantly lower physical health, emotional function, social function, cognitive function, and quality of life compared to healthy children (P<0.050). Co-existing diseases had a statistically significant impact on the quality of life of children with BA (b=−12.566; t=−2.343; P=0.021), and the caregiver’s understanding level of liver transplantation also had a statistically significant impact on the quality of life of these children (b=6.481; t=2.376; P=0.021).ConclusionsThe quality of life of children after BA surgery was significantly lower than that of age-matched healthy children. Co-existing diseases and the caregiver’s understanding level of liver transplantation were the main factors affecting the quality of life of these children.

Co-existing inflammatory bowel disease and Barrett's esophagus is associated with esophageal dysplasia: a propensity score-matched cohort.

Background and study aims Barrettʼs esophagus (BE) and inflammatory bowel disease (IBD) predispose to the development of dysplasia and cancer. It is unclear if the inflammatory cascade seen in IBD affects disease progression in BE. We aimed to determine if patients with BE who have co-existing IBD had a higher risk of dysplasia, nodular disease, or longer segments than BE patients without IBD. Patients and methods This was a multicenter, retrospective propensity score-matched cohort study. We compared rates of dysplasia, nodular disease, and segment length in patients with BE and IBD (cases) to patients with BE who did not have IBD (controls). Controls were 1:1 propensity score matched with controls for age, sex, body mass index (BMI), smoking, and hiatal hernia. Results A total of 132 patients were included in the IBD + BE group and 132 patients in the BE group. Patients with IBD + BE had higher rates of esophageal dysplasia compared to controls (15.9 % vs. 6.1 % [adjusted odds ratio [OR]: 2.9, 95 % CI: 1.2–6.9]) and more nodules (9.8 % vs. 3.0 % [adjusted OR: 3.5, 95 % CI: 1.1–11.0]). IBD + BE group was also associated with longer BE segments (43.9 % vs. 12.1 % [OR: 5.7, 95 % CI: 3.0–10.6]). Conclusions Co-existing IBD may increase the risk of dysplasia and esophageal nodules in patients with BE. Our findings may have implications for BE surveillance intervals in IBD patients. Prospective studies are needed to confirm our findings.

Exertional ventilation/carbon dioxide output relationship in COPD: from physiological mechanisms to clinical applications.

There is well established evidence that the minute ventilation (V'E)/carbon dioxide output (V'CO2 ) relationship is relevant to a number of patient-related outcomes in COPD. In most circumstances, an increased V'E/V'CO2 reflects an enlarged physiological dead space ("wasted" ventilation), although alveolar hyperventilation (largely due to increased chemosensitivity) may play an adjunct role, particularly in patients with coexistent cardiovascular disease. The V'E/V'CO2 nadir, in particular, has been found to be an important predictor of dyspnoea and poor exercise tolerance, even in patients with largely preserved forced expiratory volume in 1 s. As the disease progresses, a high nadir might help to unravel the cause of disproportionate breathlessness. When analysed in association with measurements of dynamic inspiratory constraints, a high V'E/V'CO2 is valuable to ascertain a role for the "lungs" in limiting dyspnoeic patients. Regardless of disease severity, cardiocirculatory (heart failure and pulmonary hypertension) and respiratory (lung fibrosis) comorbidities can further increase V'E/V'CO2 A high V'E/V'CO2 is a predictor of poor outcome in lung resection surgery, adding value to resting lung hyperinflation in predicting all-cause and respiratory mortality across the spectrum of disease severity. Considering its potential usefulness, the V'E/V'CO2 should be valued in the clinical management of patients with COPD.

A Cross Sectional On Leukocytes, Blood Glucose, Cholesterol, Triglyceride, Temperature, Onset, Comorbidities, Sex, And Benson's Relaxation Response

Abstract. The increase in physiological response may lengthen ischemic duration, cause recurrent stroke risk and worsen the complication of AIS (Acute Ischemic Stroke) attack which results in impairment and death. The identification of AIS patients with the risk of increasing physiological response is essential during treatments in hospitals. Some of the factors related to the increase of physiological response had been identified, yet the factors that include the intervention remain unknown. The factors are leukocyte, blood glucose, total cholesterol, triglyceride, temperature, onset, coexisting disease, gender, and Benson’s relaxation response. This observational analysis research uses cross-sectional design. The total number of subjects are 42 AIS patients that include 21 respondents in control group and 21 respondents in intervention group. The results of the study show that the level of Leukocyte p= 0.790; Blood Glucose p= 0.565; Total Cholesterol p= 0.982; Triglyceride p= 0.782; Temperature p= 0.50; Onset p= 0.028; Coexisting Disease p= 0.345; Sex p= 0.707; Benson’s Relaxation Response p= 0.019. Based on the results of the study, it is concluded that Onset and Benson’s Relaxation Response are significant factors in physiological response of AIS patients.

Therapy of Type 2 Diabetes in Patients with SARS-CoV-2 Infection.

COVID-19 infection poses an important clinical therapeutic problem, especially in patients with coexistent diseases such as type 2 diabetes. Potential pathogenetic links between COVID-19 and diabetes include inflammation, effects on glucose homeostasis, haemoglobin deoxygenation, altered immune status and activation of the renin-angiotensin-aldosterone system (RAAS). Moreover, drugs often used in the clinical care of diabetes (dipeptidyl peptidase 4 inhibitors, glucagon-like peptide 1 receptor agonists, sodium-glucose cotransporter 2 inhibitors, metformin and insulin) may influence the course of SARS-CoV-2 infection, so it is very important to verify their effectiveness and safety. This review summarises the new advances in diabetes therapy and COVID-19 and provides clinical recommendations that are essential for medical doctors and for patients suffering from type 2 diabetes.

Non Healing Venous Ulcer

Chronic leg ulceration affects 1–2% of the population and is associated with poor healing, frequent ulcer recurrence, and significant morbidity. Venous reflux can be identified in more than 70% of ulcerated legs. Coexistent arterial disease may be a factor in up to 20% of patients, but the clinical significance is poorly understood. We describe a patient who presented with a lower-limb ulcer, which was treated as a misdiagnosed case of venous ulcer for 12 years, following femoral pseudoaneurysm ligation.

Contemporary Medical Management of Peripheral Artery Disease.

Peripheral artery disease (PAD) is a manifestation of systemic atherosclerosis. Modifiable risk factors including cigarette smoking, dyslipidemia, diabetes, poor diet quality, obesity, and physical inactivity, along with underlying genetic factors contribute to lower extremity atherosclerosis. Patients with PAD often have coexistent coronary or cerebrovascular disease, and increased likelihood of major adverse cardiovascular events, including myocardial infarction, stroke and cardiovascular death. Patients with PAD often have reduced walking capacity and are at risk of acute and chronic critical limb ischemia leading to major adverse limb events, such as peripheral revascularization or amputation. The presence of polyvascular disease identifies the highest risk patient group for major adverse cardiovascular events, and patients with prior critical limb ischemia, prior lower extremity revascularization, or amputation have a heightened risk of major adverse limb events. Medical therapies have demonstrated efficacy in reducing the risk of major adverse cardiovascular events and major adverse limb events, and improving function in patients with PAD by modulating key disease determining pathways including inflammation, vascular dysfunction, and metabolic disturbances. Treatment with guideline-recommended therapies, including smoking cessation, lipid lowering drugs, optimal glucose control, and antithrombotic medications lowers the incidence of major adverse cardiovascular events and major adverse limb events. Exercise training and cilostazol improve walking capacity. The heterogeneity of risk profile in patients with PAD supports a personalized approach, with consideration of treatment intensification in those at high risk of adverse events. This review highlights the medical therapies currently available to improve outcomes in patients with PAD.

MO158CLINICOPATHOLOGICAL FEATURES OF COEXISTENT LIGHT CHAIN CASE NEPHROPATHY AND LIGHT CHAIN DEPOSITION DISEASE IN PATIENTS WITH NEWLY DIAGNOSED MULTIPLE MYELOMA

Abstract Background and Aims Several patients with multiple myeloma suffered from more than one type of kidney disease simultaneously, of which the most common pattern is coexistent light chain cast nephropathy and light chain deposition disease (LCCN+LCDD). We investigated clinicopathological characteristics of LCCN+LCDD in comparison with pure LCCN and pure LCDD. Method Forty-seven percent of the renal biopsies revealed a monoclonal κ light chain restriction, ranging from 31% in the pure LCCN group to 90% in the pure LCDD group. Of note, more than half of the patients with LCCN+LCDD showed λ light chain isotype, which was significantly different from patients with pure LCDD (56% vs. 10%, p = 0.033). Compared with patients with pure LCDD, patients with LCCN+LCDD usually presented atypical features of LCDD with less nodular glomerulosclerosis (p = 0.003) and less diffuse deposit distribution (p = 0.027). Compared to patients with pure LCDD, patients with LCCN+LCDD had lower hemoglobin (126.5 g/L vs. 82.0 g/L, p = 0.008), higher incidence of AKI (20% vs. 89%, p = 0.003), lower percentage of urinary albumin excretion (%UAE) (68.9% vs. 5.1%, p = 0.003). There was no significant clinical difference between patients with LCCN+LCDD and patients with pure LCCN. Compared to patients with pure LCDD, patients with pure LCCN had lower hemoglobin (126.5 g/L vs. 87.0 g/L, p = 0.001), higher incidence of AKI (20% vs. 85%, p &amp;lt; 0.001), higher incidence of hemodialysis at diagnosis (10% vs. 65%, p = 0.003), higher serum creatinine (165.8 μmol/L vs. 627.0 μmol/L, p = 0.02) and lower incidence of hematuria (6/10 vs. 4/26, p = 0.035). Results Forty-seven percent of the renal biopsies revealed a monoclonal κ light chain restriction, ranging from 31% in the pure LCCN group to 90% in the pure LCDD group. Of note, more than half of the patients with LCCN+LCDD showed λ light chain isotype, which was significantly different from patients with pure LCDD (56% vs. 10%, p = 0.033). Compared with patients with pure LCDD, patients with LCCN+LCDD usually presented atypical features of LCDD with less nodular glomerulosclerosis (p = 0.003) and less diffuse deposit distribution (p = 0.027). Compared to patients with pure LCDD, patients with LCCN+LCDD had lower hemoglobin (126.5 g/L vs. 82.0 g/L, p = 0.008), higher incidence of AKI (20% vs. 89%, p = 0.003), lower percentage of urinary albumin excretion (%UAE) (68.9% vs. 5.1%, p = 0.003). There was no significant clinical difference between patients with LCCN+LCDD and patients with pure LCCN. Compared to patients with pure LCDD, patients with pure LCCN had lower hemoglobin (126.5 g/L vs. 87.0 g/L, p = 0.001), higher incidence of AKI (20% vs. 85%, p &amp;lt; 0.001), higher incidence of hemodialysis at diagnosis (10% vs. 65%, p = 0.003), higher serum creatinine (165.8 μmol/L vs. 627.0 μmol/L, p = 0.02) and lower incidence of hematuria (6/10 vs. 4/26, p = 0.035). Conclusion Pathologically, patients with LCCN+LCDD were more likely to have λ light chain isotype and presented atypical features of LCDD including less nodular glomerulosclerosis and less deposit distribution than patients with pure LCDD. In clinical characteristics, patients with LCCN+LCDD and patients with pure LCCN shared similar features. For patients with LCCD, especially those with λ restriction, nephrologists should carefully evaluate the kidney specimens to exclude the possibility of combined LCCN.

Suture reduction of the borderline ascending aortic dilatation during aortic valve replacement.

This study was conducted to evaluate the efficacy of simple suture reduction of the ascending aorta (SRA) performed with aortic valve replacement (AVR) in patients with borderline ascending aortic dilatation (45-50 mm). Ninety-eight patients (ascending aortic diameter 47.7±3.4 mm) who underwent concomitant SRA with AVR were enrolled. Median follow-up duration was 83 (IQR 27-173) months. Computed tomographic angiography (CTA) follow-up was performed at 71 (47-149) months after surgery (N.=69). At least two CTA scans were performed in 34 patients (interval = 63 [46, 156] months). Early and long-term outcomes were evaluated, and dilatation rate (mm/year) of the repaired aorta was analyzed. Major adverse aortic events (MAEs) were defined as death related to aortic events, including sudden death, aortic rupture or dissection, aortic reoperation and recurrent aortic aneurysm (>45 mm). Early mortality rate was 2.0%. No patients had postoperative complications associated with SRA. A recurrent aortic aneurysm (>45 mm) was found in nine patients, but none of the patients had an ascending aorta diameter >50 mm. A multivariable analysis demonstrated that neither preoperative diameter of the ascending aorta nor bicuspid valve was associated with dilatation of the repaired aorta. Co-existing coronary artery disease was associated with both recurrent aneurysm and increased dilatation rate after SRA. There were two cases of sudden death and no one suffered from aortic dissection, rupture or aortic reoperation. Ten- and 20-year freedom rates from MAE were 90.3% and 79.3%, respectively. Concomitant SRA might be a safe and effective surgical alternative to ascending aorta replacement in AVR patients with borderline ascending aortic dilatation regardless of aortic valve pathology.

Coexistent Alcohol-Related Liver Disease and Alcohol-Related Pancreatitis: Analysis of a Large Health Care System Cohort.

Although coexistence of alcohol-related liver disease (ALD) and pancreatitis (ALP) is seen in clinical practice, a clear understanding of the overlap between these diseases is lacking. Moreover, the relative risks for certain population groups have not been studied. We determined the prevalence and coexistence of ALD and ALP in patients with an alcohol use disorder using retrospective analysis of a large patient cohort from Western Pennsylvania. We specifically emphasized the analysis of underrepresented populations, including women and blacks. We identified all unique patients who received care in UPMC health system during 2006-2017 with at least one International Classification of Diseases versions 9 and/or 10 codes for alcohol misuse, ALD and pancreatitis. We noted their sex, race and age of first diagnosis and duration of contact. Among 89,774 patients that fit our criteria, the prevalence of ALD, ALP and coexistent ALD and ALP in patients with alcohol misuse was 11.7%, 7.4% and 2.5%, respectively. Prevalence of ALP in ALD was 16.4%, and ALD in ALP was 33.1%. Prevalence of ALP in ALD was slightly more prevalent in women (18.6% vs. 15.6%, p < 0.001). Prevalence of ALP in ALD was 2-4 folds greater in blacks than other races. A sizeable fraction of patients with ALD or ALP has coexistent disease. This is the first study to identify that blacks are at a higher risk for ALP in the presence of ALD. Future studies should define the clinical impact of coexistent disease on clinical presentation and short- and long-term outcomes.

Unilateral Common Iliac Artery Ostial Lesion Stenting versus Kissing Stenting

Background: Iliac arteries are common sites of occlusive atherosclerotic disease that is responsible for symptomatic arterial insufficiency of lower extremities and as atherosclerosis is a systemic disease, iliac diseases frequently have coexistent disease below the inguinal ligament. Objective: This study aimed to assess using unilateral Common iliac artery stent versus kissing stent as regard clinical and technical success in unilateral ostial common iliac artery lesions. Patients and Methods: From December 2018 to December 2020 in Al-Azhar University Hospital and Military Hospitals in Cairo, we assigned 20 patients with unilateral common iliac artery ostial lesion to undergo either unilateral stent or kissing stent; in two equal groups. Patients were followed up on clinical, technical success, and complications. Results: Regarding co-morbidities, 80% were smokers, 40% were diabetic, 40% had hypertension (HTN), and 40% had ischemic heart disease (IHD). Regarding complication, 15% had small groin hematoma, 1% had distal emboli, 5% had arterial dissection and 5% had contrast-induced nephropathy. Conclusion: No significant difference between unilateral and kissing technique regarding clinical, technical success, and complications. The unilateral stent is as safe and effective as kissing stents in the treatment of unilateral common iliac artery ostial lesions as regarding high technical, clinical success, and patient clinical improvement.

Diagnosis of silent coronary ischemia with selective coronary revascularization might improve 2-year survival of patients with critical limb-threatening ischemia

BackgroundPatients with critical limb-threatening ischemia (CLTI) have had poor long-term survival after lower extremity revascularization owing to coexistent coronary artery disease. A new cardiac diagnostic test, coronary computed tomography-derived fractional flow reserve (FFRCT), can identify patients with ischemia-producing coronary stenosis who might benefit from coronary revascularization. We sought to determine whether the diagnosis of silent coronary ischemia before limb salvage surgery with selective postoperative coronary revascularization can reduce the incidence of adverse cardiac events and improve the survival of patients with CLTI compared with standard care. MethodsPatients with CLTI and no cardiac history or symptoms who had undergone preoperative testing to detect silent coronary ischemia with selective postoperative coronary revascularization (group I) were compared with patients with standard preoperative cardiac clearance and no elective postoperative coronary revascularization (group II). Both groups received guideline-directed medical care. Lesion-specific coronary ischemia in group I was defined as FFRCT of ≤0.80 distal to a stenosis, with severe ischemia defined as FFRCT of ≤0.75. The endpoints included all-cause death, cardiovascular (CV) death, myocardial infarction (MI), major adverse CV events (i.MACE; CV death, MI, unplanned coronary revascularization, stroke) through 2 years of follow-up. ResultsGroups I (n = 111) and II (n = 120) were similar in age (66 ± 9 vs 66 ± 7 years), gender (78% vs 83% men), comorbidities, and surgery performed. In group I, unsuspected, silent coronary ischemia was found in 71 of 103 patients (69%), with severe ischemia in 58% and left main coronary ischemia in 8%. Elective postoperative coronary revascularization was performed in 47 of 71 patients with silent ischemia (66%). In group II, the status of silent coronary ischemia was unknown. The median follow-up was >2 years for both groups. The 2-year outcomes for groups I and II were as follows: all-cause death, 8.1% and 20.0% (hazard ratio [HR], 0.38; 95% confidence interval [CI], 0.18-0.84; P = .016); CV death, 4.5% and 13.3% (HR, 0.32; 95% CI, 0.11-0.88; P = .028); MI, 6.3% and 17.5% (HR, 0.33; 95% CI, 0.14-0.79; P = .012); and major adverse CV events, 10.8% and 23.3% (HR, 0.44; 95% CI, 0.22-0.88; P = .021), respectively. ConclusionsThe preoperative evaluation of patients with CLTI and no known coronary artery disease using coronary FFRCT revealed silent coronary ischemia in two of every three patients. Selective coronary revascularization of patients with silent coronary ischemia after recovery from limb salvage surgery resulted in fewer CV deaths and MIs and improved 2-year survival compared with patients with CLTI who had received standard cardiac evaluation and care. Prospective controlled studies are required to further define the role of FFRCT in the evaluation and treatment of patients with CLTI.

Coexistent coronary artery disease in Indian patients undergoing permanent pacemaker implantation (PPI) for symptomatic bradyarrhythmia

BackgroundThe cause-effect of conduction disturbance in chronic lesion of coronary arteries is complicated. This study was designed to evaluate coexistent CAD in patients with symptomatic bradyarrhythmia to find common anatomic basis for conduction disturbances and its relationship to conventional coronary risk factors. MethodsIn this prospective observational study, 929 patients who admitted for symptomatic bradyarrhythmia requiring permanent pacemaker implantation were included. All included patients underwent coronary angiography and were divided into groups based on angiographic findings. Association between conduction disturbances and these groups were analyzed. ResultsA total of 929 patients with mean age of 63.1 years were included in our study. We found age ≥50 years, male sex, presence of diabetes and hypertension as statistically significant predictors of abnormal coronary angiography. Obstructive CAD (≥50% stenosis) was found in 34.4% patients. Prevalence of single vessel disease, double vessel disease and triple vessel disease was 15.3%, 10.2% and 8.9% respectively. Severe coronary obstruction (≥90% obstruction) was found in 16.25% patients. Revascularization was advised in three fourth of cases of obstructive CAD. Approximately two third of patients didn’t have significant obstruction in coronaries supplying the conduction system. Type 4 was the commonest anatomy in obstructive CAD. SA Nodal artery was found more diseased in patients of SSS with p value of 0.01. ConclusionObstructive CAD was found in one third of patients undergoing PPI. Age ≥50 years, male sex, diabetes and hypertension were found significantly correlated with presence of CAD and may act as important markers for the judgment of further coronary evaluation.

POS-338 GASTRO-INTESTINAL ANGIODYSPLASIA IN PATIENTS WITH CHRONIC KIDNEY DISEASE

Angiodysplasia is an abnormal, dilated small blood vessel in the mucosal and submucosal layers of the gastrointestinal (GI) tract. It’s responsible for approximately 6% of lower GI bleeding cases and up to 8% of upper GI bleeds. Besides, it has been reported to be associated more with some pathologies, among others, end-stage chronic kidney disease (CKD). Yet under diagnosed because of current anemia and GI bleeding in patients with CKD, which present the main symptoms of angiodysplasia. We looked into our department’s database from 2007 till 2020. We registered 7 confirmed cases among our patients with angiodysplasia at end-stage renal disease. One of them was excluded because of partial damage of his record. We conducted a retrospective study on the rest of the cases. The clinical features, risk factors and prognosis were evaluated. The prevalence of angiodysplasia across all the periods studied was higher in males than in female (5 cases vs 1) with a mean age of 60.7 years. The majority of patients were tobacco smokers (4 patients), had hypertension (5 patients), and other cardiovascular diseases (4 patients), but only one among those six presented a coexistent aortic valve disease. In all cases angiodysplasia was diagnosed at end-stage CKD on the occasion of a low GI bleed either simultaneously with the diagnosis of end-stage CKD (half cases) or during the first six months of hemodialysis (the other half) . No specific association was established between this pathology and the nephropathy leading to renal failure. However, the association with other causes of GI bleeding found in 3 cases (anticoagulant overdose, ischemic colitis, Stomach ulcers) detained early treatment. Gastric localization (1 case) had the best prognosis while the rest of patients with intestinal and ileocolic angiodysplasia presented recurrence of bleeding and required further treatment: argon plasma coagulation and total colectomy (1 case); embolization (2 cases). Yet the mortality is estimated at 3 per 6 in the 6th month of evolution and reached 5 of them at the 12th month. Gastrointestinal bleeding in end-stage renal disease patients require further awareness because of frequent association with angiodysplasia usually underdiagnosed. Advanced age, overall high comorbidity and hypertension; commonly present at the end-stage CKD; are significant factors for angiodysplasia-associated gastrointestinal bleeding. Besides, dialysis seems increasing the prevalence of abnormal vessel bleeding and leads to a high risk of mortality.

Cardiovascular magnetic resonance-determined left ventricular myocardium impairment is associated with C-reactive protein and ST2 in patients with paroxysmal atrial fibrillation

BackgroundMyocardial strain assessed with cardiovascular magnetic resonance (CMR) feature tracking can detect early left ventricular (LV) myocardial deformation quantitatively in patients with a variety of cardiovascular diseases, but this method has not yet been applied to quantify myocardial strain in patients with atrial fibrillation (AF) and no coexistent cardiovascular disease, i.e., the early stage of AF. This study sought to compare LV myocardial strain and T1 mapping indices in AF patients and healthy subjects, and to investigate the associations of a portfolio of inflammation, cardiac remodeling and fibrosis biomarkers with LV myocardial strain and T1 mapping indices in AF patients with no coexistent cardiovascular disease.MethodsThe study consisted of 80 patients with paroxysmal AF patients and no coexistent cardiovascular disease and 20 age- and sex-matched healthy controls. Left atrial volume (LAV), LV myocardial strain and native T1 were assessed with CMR, and compared between the AF patients and healthy subjects. Biomarkers of C-reactive protein (CRP), transforming growth factor beta-1 (TGF-β1), collagen III N-terminal propeptide (PIIINP), and soluble suppression of tumorigenicity 2 (sST2) were obtained with blood tests, and compared between the AF patients and healthy controls. Associations of these biomarkers with those CMR-measured parameters were analyzed for the AF patients.ResultsFor the CMR-measured parameters, the AF patients showed significantly larger LAV and LV end-systolic volume, and higher native T1 than the healthy controls (max P = 0.027). The absolute values of the LV peak systolic circumferential strain and its rate as well as the LV diastolic circumferential strain rate were all significantly reduced in the AF patients (all P < 0.001). For the biomarkers, the AF patients showed significantly larger CRP (an inflammation biomarker) and sST2 (a myocardium stiffness biomarker) than the controls (max P = 0.007). In the AF patients, the five CMR-measured parameters of LAV, three LV strain indices and native T1 were all significantly associated with these two biomarkers of CRP and sST2 (max P = 0.020).ConclusionsIn patients with paroxysmal AF and no coexistent cardiovascular disease, LAV enlargement and LV myocardium abnormalities were detected by CMR, and these abnormalities were associated with biomarkers that reflect inflammation and myocardial stiffness.

Polymicrobial Keratitis: Risk Factors, Clinical Characteristics, Bacterial Profile, and Antimicrobial Resistance.

To describe clinical characteristics, complications, and the most prevalent microorganisms causing polymicrobial keratitis and their antibiotic sensitivities. A cross-sectional study including a consecutive analysis of patient's records with a diagnosis of bacterial keratitis with a positive culture and antibiogram report were included. Patients were grouped into those having monomicrobial and polymicrobial infection. Features studied included demographic and clinical characteristics, risk factors, Gram stain, cultures, and antibiotic sensitivity. We included 656 patients; in 31.5% more than one microorganism was found. Seven hundred and twenty-three gram-positive bacteria were isolated, and 336 (46.5%) had polymicrobial keratitis. One hundred sixty-one gram-negative bacteria were isolated, and 99 (61.5%) from polymicrobial keratitis. Fourteen (0.60%) patients presented ring infiltrate, and 10 (71.42%) of those patients had polymicrobial keratitis (X2 10.654, P=0.001). Multivariate analysis showed that patients with history of contact lens use (odds ratio [OR] of 1.78, P=0.042), coexistent autoimmune disease (OR 4.64, P=0.03), irregular edges of the infiltrate (OR 2.06, P=0.005), and ring infiltrate (OR 6.034, P=0.005) have a higher risk for developing polymicrobial infection. In the polymicrobial group, gram-positive and gram-negative organisms showed a high sensitivity to Netilmicin. We found a high incidence of polymicrobial keratitis. Our results suggest that it should be suspected in patients with a history of contact lens use, coexistent autoimmune disease, infiltrates with indistinct edges, and ring infiltrates. Sensitivities to moxifloxacin are lower than those reported in previous studies, but sensitivity to Netilmicin is higher.

The Abstruse Side of Type I Interferon Immunotherapy for COVID-19 Cases with Comorbidities

The Coronavirus Disease-2019 (COVID-19) pandemic, caused by the novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has claimed 1.2 million people globally since December 2019. Although the host factors underpinning COVID-19 pathology are not fully understood, type I interferon (IFN-I) response is considered crucial for SARS-CoV-2 pathogenesis. Perturbations in IFN-I signaling and associated interferon-inducible genes (ISG) are among the primary disease severity indicators in COVID-19. Consequently, IFN-I therapy, either alone or in- combination with existing antiviral or anti-inflammatory drugs, is tested in many ongoing clinical trials to reduce COVID-19 mortality. Since signaling by the IFN-I family of molecules regulates host immune response to other infectious and non-infectious diseases, any imbalance in this family of cytokines would impact the clinical outcome of COVID-19, as well as other co-existing diseases. Therefore, it is imperative to evaluate the beneficial-versus-detrimental effects of IFN-I immunotherapy for COVID-19 patients with divergent disease severity and other co-existing conditions. This review article summarizes the role of IFN-I signaling in infectious and non-infectious diseases of humans. It highlights the precautionary measures to be considered before administering IFN-I to COVID-19 patients having other co-existing disorders. Finally, suggestions are proposed to improve IFN-I immunotherapy to COVID-19.