Complete Blood Analysis Research Articles

Implementation of the International Myeloma Working Group reccomendations on renal impairment in multiple myeloma patients in routine clinical practice

Background: Renal impairment (RI), is one of the most common complications of multiple myeloma (MM), and it is associated with an increased risk of early death. The incidence of RI at MM diagnosis ranges from 20% to 50%, while its comparison occurred in 60% MM patients (pts). In this scenario tempestive diagnosis of RI in MM pts and exclusion of possible alternative causes of RI are essential.We applied the diagnostic algorithmproposed by the International Myeloma Working Group in pts admittedto our Hospital for RI (with known and unknown MM, or suspected cast nephropathy, CN), in order to verify the possible positive impact of this diagnostic workflow on MM-related RI management. Patients and methods: We collected data of adult pts, with known or unknown MM, with or withouth monoclonal component (MC). We performed complete blood analysis, with eGFR (CKD-EPI and MDRD methods), serum and urine electrolites, bicarbonatemia, serum and urine immunofixation, fraction 3 and 4 of complement, crioglobulinemia, HbA1c, arterial gas analysis, evaluation of urine rate every 6 hours, daily urine collection. We investigated eventual nephrotoxic concomitant therapies, clinical parameters and objectives signs of RI (edema, symptomatic disionia). In the second day of hospitalization we tested protein electrophoresis on serum and urine, chest X-ray, ultrasonography of abdomen, ecocardiography and electrocardiography. In the third day we evaluated results of previous exams and we decided, if necessary, eventual biopsies (bone marrow in unknown MM pts, renalin suspected CNpts, umbilical fat for amyloidosis). Results: From March to December 2016 we admitted 89 pts with RI and MC (51 F, 38 M, 41-83 yrs range), 25 are knownMM pts with newly diagnosed RI. Among RI cases, we diagnosed 22 de novo MM, 26 diabetes related RI, 5 amyloidosis, 11 other causes. We obtained diagnosis of RI within 4 days, both in known and in de novo MM pts. Conclusions: The implementation of the International Myeloma Working Group Reccomendations on RIin a routine clinical practice confirmed its feasibility and utility in the optimal workout of MM pts, with a positive impact on reduced hospitalization, uncessary dyalisis and steroids overtreatment.

Protocolo de práctica asistencial de las poliadenopatías crónicas

IntroductionUncertain origin of chronic adenopathies is a challenge for the clinician due to multiple causes and heterogeneous causes are involved. EtiologyInfection signs are usually found. However, in hematological or oncological diseases, adenopathies can be the first sign in appear. Thus, diagnosis should be faster. Empirical treatment should be avoided before diagnosis was established. DiagnosisPersonal history (infections and constitutional symptoms) and physical examination (number, location, size, tenderness, time of evolution, splenomegaly) are essential to suspect the disorders. Laboratory assays that includes complete peripheral blood analysis, blood smear and serology must be performed. In addition, other tests should be included in accordance with clinical suspicion (autoimmunity, oncological biomarkers). Biopsy is necessary to confirm the hematological disorder diagnoses. Treatment and prognosticIt́s depend on causative diseases.

Seminal Vesiculitis in Three Pet Rabbits ( Oryctolagus cuniculus ).

To date, descriptions of pathologic conditions of the seminal vesicle in rabbits are scarce and limited to the laboratory animals in experimental conditions. The present article describes three cases of strangury, abdominal pain, and anorexia associated with seminal vesiculitis in pet rabbits. Three non-neutered male pet rabbits aged 3.6, 1.5, and 2.1 yrs were presented with strangury, abdominal pain, and anorexia. Seminal vesiculitis was diagnosed based on clinical signs and ultrasonography findings. Vesiculectomy was performed in two cases that presented strangury refractory to medical treatment, and diagnosis was confirmed by histopathology. In the third case, the patient received medical treatment, and a sequela in the form of lithiasis of the seminal vesicle was detected 3 yrs later. Plain radiographs were nearly unremarkable, and results from complete blood analysis and urinalysis were not specific in all three cases. Contrast radiography was performed in one case, showing a dilated seminal vesicle. Ultrasound and surgical biopsy seem to be the most sensitive techniques in the diagnosis of this pathology. Seminal vesiculitis must be included in the differential diagnosis of acute or chronic strangury in male pet rabbits.

A comprehensive study of chronic diabetes complications in streptozotocin-induced diabetic rat

Background: The purpose of this study was to provide a reference of chronic diabetes complications by investigating the prolonged hyperglycemia effects on hematological, biochemical and histopathological changes (liver, kidney, spleen, cardiac muscle, adrenal gland, and endocrine pancreas) in diabetic rats induced by streptozotocin. Methods: Ten adult female Sprague-Dawley of uniform age were divided into two Groups. Group 1 was made diabetic by single intraperitoneal injection of streptozotocin (60 mg/kg/bw) whereas Group 2 served as control. After six months, the rats were anaesthetized using pentobarbital. Cardiac puncture was performed to get 3 ml of the blood sample; following 12 hours of an overnight fast. Serum chemistry test and complete blood analysis for lipid profile and blood glucose test; liver and renal functions were performed. Tissue specimens of liver, kidney, spleen, cardiac muscle, adrenal gland, and endocrine pancreas were fixed in 10% formal saline and processed for histological study. Results: There were severe histopathological changes in the affected organs; and the presence of a significant abnormality of lipid profile, liver, and renal functions. Conclusions: The presence of histopathological changes with abnormal biochemical changes is related to the chronic absence of insulin production in the destroyed β-cells which reflect the diabetic complications in a human being.

Association of BCL11A genetic variant (rs11886868) with severity in β-thalassaemia major & sickle cell anaemia.

Background & objectives:The amount of foetal haemoglobin that persists in adulthood affects the clinical severity of haemoglobinopathies including β-thalassaemia major and sickle cell anaemia (SCA). The present study was undertaken to analyse β-thalassaemia as well as SCA patients for the single nucleotide polymorphism (SNP), rs11886868 (T/C) in BCL11A gene and to evaluate the association between this polymorphism and severity of β-thalassaemia major and SCA.Methods:A total of 620 samples (420 β-thalassaemia major and 200 SCA cases) were analysed before blood transfusion using basic screening tests like complete blood analysis and osmotic fragility and further confirmed by high performance liquid chromatography (HPLC), amplification refractory mutation system-polymerase chain reaction (ARMS-PCR) and reverse dot blot techniques. All patients were transfusion dependent. Patients with β-thalassaemia and SCA were classified into mild, moderate, severe according to the severity score based on Hb levels, age of onset, age at which patients received their first blood transfusion, the degree of growth retardation and splenectomy. β-thalassaemia as well as SCA patients were analysed for the SNP, rs11886868 (T/C) in BCL11A gene and association between this polymorphism and severity of β-thalassaemia major as well as SCA was evaluated.Results:There was a significant difference in genotypic and allelic frequencies of BCL11A gene polymorphism between mild and moderate and mild and severe cases in both the groups. A significant (P<0.001) difference was observed in the mean HbF levels between the three genotypes in different severity groups. HbF levels were found to be high in CC genotype bearing individuals followed by TC and TT in β-thalassaemia major as well as SCA.Interpretation & conclusions:This study confirms that the T/C variant (rs11886868) of the BCL11A gene causing downregulation of BCL11A gene expression in adult erythroid precursors results in the induction of HbF and ameliorates the severity of β-thalassaemia as well as SCA.

Reversible Vitamin B12 Deficiency Presenting with Acute Dementia, Paraparesis, and Normal Hemoglobin

Vitamin B12 is essential for neurological function and its deficiency is associated with many neuropsychiatric disorders. We report the case of a previously healthy 53-year-old male patient presenting with delirium and multiple neurological findings. Complete blood analysis indicated megaloblastic anemia. All infectious causes were excluded owing to negative cultures (blood and urine). Tests for human immunodeficiency virus, syphilis, and toxoplasma were also negative. Metabolic workup showed severe vitamin B12 deficiency, decreased reticulocyte count, and increased direct bilirubin and lactate dehydrogenase. Intramuscular injection of cobalamin was started, and the patient showed significant improvement.

Clinico-hematological analysis of pancytopenia

Background: Pancytopenia is a manifestation of a wide variety of disorders which primarily or secondarily affect the bone marrow. It is a relatively common condition whose causative factors may vary with different geographical locations. Thus, to determine the causative agents and the clinical symptoms is essential for the management of this condition. Methods: This study was conducted on 56 patients above the age of 18 years presenting with pancytopenia. All the patients were subjected to thorough clinical and physical examination. Blood samples were collected for complete blood analysis and biochemical tests and peripheral blood smear was taken. Urine and stool samples were also taken for occult blood analysis. Bone marrow aspiration and trephine biopsies were performed wherever necessary as per the clinical symptoms. Results: Out of the 56 patients, 58.9% were males and 41.1% were females. The mean age of the patients was 34.9±4.3 years. The major presentation of the patients with pancytopenia was megaloblastic anemia, in 42.9 of the cases, followed by aplastic anemia in 23.2% of the cases. Among the common clinical symptoms, the most common one was pallor (73.2%) followed by weight loss (62.5%) and dyspnea (51.8%). Conclusions: Megaloblastic anemia is the most common cause of pancytopenia followed by aplastic anemia, with pallor being the most common clinical symptom. Therefore, the clinical findings along with the hematological analysis along with bone marrow aspiration examination are very important for an early diagnosis of pancytopenia so that early intervention can be taken for the patient and enhance the survival rate. Pancytopenia, Megaloblastic anemia, Aplastic anemia

Association of ABO and Colton Blood Group Gene Polymorphisms With Hematological Traits Variation.

Hematological parameters are appraised routinely to determine overall human health and to diagnose and monitor certain diseases. In GWASs, more than 30 loci carrying common deoxyribonucleic acid (DNA) polymorphisms have been identified related to hematological traits. In this study, we investigated the contribution of ABO rs2073823 along with AQP1 rs1049305 and rs10244884 polymorphisms in hematological traits variation in a cohort of Iranian healthy individuals.Genomic DNA was extracted from peripheral blood of 168 healthy volunteer. Genotyping was performed by ARMS-PCR or PCR-RFLP and confirmed by DNA sequencing. Complete blood analyses were conducted for the participants.Significant association was observed between AQP1 rs1049305 and the hematological traits including hemoglobin, hematocrit, and platelet count (P = 0.012, 0.008, and 0.011, respectively). The AQP1 rs10244884 status was also significantly linked to hemoglobin and hematocrit levels in the study cohort (P = 0.015 and 0.041, respectively). Furthermore, ABO rs2073823 polymorphism was identified as a hemoglobin and hematocrit levels modifier (both with P = 0.004).AQP1 and ABO variants appear to predict hemoglobin and hematocrit levels but not other erythrocyte phenotype parameters including red blood cell counts and red blood cell indices.

Three-way complex variant translocation involving short arm chromosome (1;9;22)(p36;q34;q11) in a chronic myeloid leukemia patient.

Chronic myeloid leukemia (CML) is a disease of the clonal hematopoietic stem cells caused by a balanced translocation between the long arms of chromosomes 9 and 22. Overall, 90-95% of CML patients present with a Philadelphia (Ph) chromosome t(9;22)(q34;q11) translocation and in addition, variant complex translocations, involving a third chromosome, are observed in 5-8% of CML patients. Cytogenic testing using bone marrow sample was performed and the FISH test was used for the detection of BCR-ABL fusion gene and complete blood analysis of CML patient was also performed. Results of hematological analysis showed the induced values of white blood cells (168,5000/mm3) and platelets (300,000/mm3) and FISH analysis test showed that 98% cells were positive for BCR/ABL gene translocation. The present study describes a three-way (1;9;22)(p36;q34;q11) Ph chromosome translocation in a 24-year-old female with CML. The patient, who was in the chronic phase of the disease, was treated with daily dose of 400 mg/dl with imatinib mesylateand was monitored constantly at various intervals over a 6-month period. Many studies reported that certain CML patents with variant translocation responded poorly to imatinib. In the current case report, the CML patient exhibited a suboptimal response to imatinib, denoting a poor prognosis.

Control glucémico y complicaciones crónicas a 20 años del comienzo de la diabetes tipo 1. Resultados de una unidad especializada

ObjectivesTo determine the prevalence of chronic complications in a group of patients with long duration type 1 diabetes (DM1), and their relationship with glycemic control since diagnosis of disease, as well as control and prevalence of cardiovascular risk factors (CVRF). Material and methodsThe study included patients diagnosed in our center between 1985 and 1994 and followed-up until the present. Anthropometric data, glycemic control, chronic complications, and CVRF were collected from medical records at baseline and annually. A visit was made that included a physical examination and complete blood analysis. ResultsA total of 77 patients were studied (46 males, and mean age 47±8.5 years, duration of follow-up, 22.4±2.2 years). Sixteen patients (20.4%) developed retinopathy, 8 (10.4%) nephropathy, 12 (15.6%) polyneuropathy, and 3 (3.9%) macroangiopathy. Hypertension, dyslipidemia and obesity were found in 28.6%, 46.8% and 20.8%, respectively, and 22.1% were sedentary, and 35.1% were smokers. Mean glycosylated hemoglobin (HbA1c) during the entire follow-up was 7.2±0.8%. In the first five years it was 6.4±1.2% and at the study visit, it was 7.6±1.1%. More than two-thirds (70%) of patients remained on target in the first five years, with 45% in the next five years, and about 25% from years 10 to 22. Patients with no complications showed better glycemic control during the entire follow-up (HbA1c 7.0±0.7% vs. 7.6±0.9%; P=.003), and also in the first five years (HbA1c 6.1±0.9 vs. 7.0±1.4%; P=.001). ConclusionPrevalence of complications after 20 years of follow-up in well controlled DM1 since diagnosis is low, and is related to the overall glycemic control during follow-up and in the early years of the disease. The prevalence of smoking is high.

Bilateral Mooren’s ulcer – Customised corneal graft with additional amniotic membrane graft

Mooren’s ulcer (MU) is a rare and painful peripheral corneal ulceration which occurs in the absence of any associated scleritis, and any detectable systemic disease. A 60-year-old male patient was referred to us with bilateral peripheral corneal ulceration. Best corrected visual acuity (BCVA) in both eyes was counting finger at one metre. The right eye showed a 180° thinning with perforation at 8 o’clock position. The left eye showed a 360° thinning with central contact lens type cornea. After complete blood analysis we started the patient on cyclophosphamide orally along with high doses of oral steroids. A crescentic excision of the thinned cornea and crescentic customised corneal graft with additional amniotic membrane graft (AMG) was done first for the right eye and a 360° peripheral lamellar corneal graft with additional AMG for the left eye. The BCVA of RE was 1/60 improving to 6/36 with plus ten aphakic glasses and LE was 3/60. Hand fashioned full thickness crescentic customised corneal graft with additional AMG and a peripheral 360° lamellar corneal graft with additional AMG in these cases are a novel approach to Mooren’s ulcer with gratifying results.

Renal function in children and adolescents with Duchenne muscular dystrophy

Improved life expectancy and the need for robust tools to monitor renal safety of emerging new therapies have fueled the interest in renal function in Duchenne muscular dystrophy (DMD) patients. We aimed to establish a methodology to accurately assess their renal function. Twenty DMD patients (5–22 years) were included in this prospective study. After obtaining medical history, all patients underwent a clinical examination, 24-hour ambulatory blood pressure monitoring, ultrasound of the kidneys, direct GFR measurement (51Cr-EDTA, mGFR), complete blood and urine analysis. Seventeen of 20 patients were treated with corticosteroids and 5/20 with angiotensin converting enzyme inhibitor (lisinopril). No patient suffered from urinary tract infections or other renal diseases. Hypertension (systolic or diastolic blood pressure >P95) was found in 9/20 patients (8/9 patients were on steroid treatment) and a non-dipping blood pressure profile in 13/20 subjects (10/13 patients were on steroid treatment). Urinary protein to creatinine ratio was elevated in 17/18 patients, whereas 24-hour urine protein excretion was normal in all subjects. Median interquartile range (IQR) mGFR was 130.4 (29.1) mL/min/1.73 m2. Hyperfiltration (mGFR >150 mL/min/1.73 m2) was found in 5/20 patients. Inverse correlation between mGFR and age was observed (R2 = 0.45, p = 0.001). Serum creatinine based estimated GFR (eGFR) equations overestimated mGFR up to 300%. eGFR based on cystatin C Filler equation was closest to the mGFR (median eGFR (IQR) of 129.5 (39.7) mL/min/1.73 m2). Our study demonstrates a high prevalence of hyperfiltration and hypertension in children and adolescents with DMD. Because the majority of hypertensive patients were under corticosteroid treatment, the iatrogenic cause of hypertension cannot be excluded. Serum or urine creatinine measurements are of no value to evaluate renal function in DMD patients due to the reduced skeletal muscle mass.

The relationship between red blood cell distribution width and myocardial ischemia in dobutamine stress echocardiography

Although elevated red blood cell distribution width (RDW) is associated with adverse outcomes in patients with cardiovascular disease, its role in demonstrating the presence and extent of myocardial ischemia for coronary artery disease is not known. The purpose of this study is to investigate the relationship between RDW and myocardial ischemia by using dobutamine stress echocardiography (DSE). A total of 917 patients were included in this prospective study. A complete blood analysis was performed for RDW before DSE. According to DSE results, patients were divided into two groups: DSE negative and DSE positive. According to the number of ischemic segments in DSE, patients were divided into three groups: no-ischemic segment, 1-3 ischemic segments, and ≥4 ischemic segments. In addition, coronary angiography results of DSE-positive groups were assessed in respect of RDW. The RDW of the DSE-positive group (n=277) was higher than for the DSE-negative group (n=640) (13.5±1.5 vs. 12.7±1.3%, P<0.001, respectively). Elevated RDW values were also related to higher number of ischemic segments (no-ischemic segment group: 12.7±1.3, 1-3 ischemic segments group: 13.2±1.5, and ≥4 ischemic segments group: 14.2±1.3, P<0.001). A receiver operating curve analysis showed a cut-off value of RDW greater than 13.5% for predicting myocardial ischemia (sensitivity: 57.0%, specificity: 77.8%, positive predictive value: 52.7%, negative predictive value: 80.7%). In addition, positive predictive value of DSE was increased from 82.4 to 94.2% for detecting coronary artery disease by coronary angiography, when RDW (>13.5%) was used. RDW is related to the presence and extent of myocardial ischemia in DSE. A high RDW increases the diagnostic accuracy of DSE.

Effect of Ascorbic Acid on Mental Depression Drug Therapy: Clinical Study

Introduction: Depression disorders are very common in clinical practice. Ascorbic acid is a cofactor in synthesis of Noradrenalin from Dopamine and serotonin from tryptophan. The objective of this work was to study the effect of ascorbic acid on the action of antidepressant drugs in a clinical setting. Clinical prospective double blind study was conducted to investigate the effect of ascorbic acid on mental depression therapy and the possible therapeutic interaction with the pharmacotherapy of the disease. Methods: Patients (outpatients) were diagnosed for mental depression according to DSM-IV, with a base line Hamilton rating scale for depression. Patients were made aware of the objectives and the methods of the study, bearing in mind the interference of their knowing with experimental results. Patients were divided into two groups; one group received a tablet of ascorbic acid with the antidepressant (Group A; n=13 at the end of the study) and the other a tablet of placebo with the antidepressants (Group B; n=9 at the end of the study), for eight weeks. Laboratory investigation was conducted for all patients, at the beginning and at the end of the study, and included complete blood analysis, lipid profile, liver function test, renal function tests, serum electrolytes and complete urine analysis. The ascorbic acid levels in plasma were measured by HPLC. Results: Ascorbic acid with antidepressants significantly decreased the total Hamilton depression rating scale. The main overall finding from this study is that ascorbic acid was therapeutically beneficial with antidepressant in the treatment of depression, and predicts a good response in treated patients using combined ascorbic acid with antidepressants. Conclusion: The combination of ascorbic acid with antidepressants therapy is supported; a large scale trial with placebo control is warranted; also experimental work is needed for the effect of ascorbic acid on individual antidepressant drugs.

Purulent pericarditis due to Klebsiella oxytoca in two lions: clinicopathological and microbiological findings

Pericarditis caused by gram-negative bacteria is uncommon in human and animals. Two about 2-month-old male African lions were referred with a history of lethargy, anorexia, and progressive weight loss. The complete blood cell count and analysis revealed severe neutrophilic leukocytosis with left shift, and also an increase in band neutrophils. Despite intensive antibiotic and supportive therapies, the lions died. Postmortem examinations showed hydropericardium with more than 20 ml malodorous milky dark purulent exudates. Bacteriologic examination of the pericardial exudates showed round-shaped colonies containing rod-shaped gram-negative bacteria. Klebsiella oxytoca was identified on the basis of colony morphology, microscopic Gram stain, and biochemical tests characteristics. Histopathologic examination revealed the severe necrosis and inflammation associated with the thickening of pericardium due to the infiltration of neutrophils as purulent epicarditis and pericarditis. Based on the bacteriological and histopathological findings, purulent pericarditis due to K. oxytoca was diagnosed. To the best of our knowledge, up to now, K. oxytoca pericarditis has not been reported in animals, including lions.

AB0217 Dendritic cells and apoptosis in peripheral blood of patients with systemic lupus erythematosus

BackgroundSystemic lupus erythematosus (SLE) persists as a chronic inflammatory autoimmune disease. It is characterized by the production of autoantibodies and immune complexes that affect multiple organs (Seitz, 2010). The etiology...

Compliance and echographic carotid plaque evolution in patients with acute ischemic stroke treated with atorvastatin according to usual care

The aim of the paper is to assess the compliance and efficacy of atorvastatin treatment according to usual care on carotid atheromatous plaque and lipids during follow-up for one year in patients with acute ischemic stroke. Sixty-six patients were included. Morphological plaque characteristics were described and a complete blood analysis was performed at admission and at one year. Nineteen patients stopped treatment. Lipid reduction was significant in triglycerides, cholesterol and LDL cholesterol, with an increase in HDL cholesterol. Morphological characteristics of carotid plaque were not modified. In conclusion, an irregular compliance has been seen in patients with acute ischemic stroke treated with atorvastatin according to usual care. Nearly one-third of our patients stopped the treatment before the course of a year. The effect on lipids and its pleiotropic effect on atheromatous carotid artery disease might support the long-term use of atorvastatin, regardless of the dose, in patients with acute ischemic stroke.

The effect of preoperative clinical variables on the 30- and 90-day morbidity and mortality after radical cystectomy: A single-centre study

ObjectiveTo analyse the effect of preoperative clinical variables and comorbidity on the early, late and cumulative 90-day morbidity and mortality rates, as well as hospital re-admissions, after radical cystectomy (RC), in one centre. Patients and methodsAll patients undergoing RC over a period of 3months were included. Preoperative investigations included measurements of serum albumin, a complete blood analysis, body mass index (BMI), Charlson comorbidity index (CCI) and the age-adjusted CCI (ACCI). We recorded the length of hospital stay (LOS) and all postoperative events for 90days, and graded them according to the five-grade modification of the original Clavien system. ResultsIn all there were 31 patients undergoing RC (mean age 58.4years). The mean preoperative serum albumin and haemoglobin level, BMI, CCI and ACCI were 3.82g/dL, 12.53g/dL, 29.29kg/m2, 3.0 and 4.58, respectively. The mean LOS was 20.03days; seven patients needed re-admission and three died within the 90days. There were postoperative complications in 20 patients. The age, CCI and ACCI were significantly associated with complications (P=0.009, 0.001 and<0.001, respectively). Preoperative haemoglobin, BMI and smoking had no effect on the morbidity or mortality rate. The LOS increased in older patients (P=0.031) and those with a higher ACCI (P=0.042). Postoperative mortality increased among patients with a lower serum albumin level (P=0.048). ConclusionsAge, CCI and ACCI are related to early postoperative complications. Older patients and patients with a higher ACCI have a longer LOS. A low preoperative albumin level needs to be evaluated more thoroughly.

A red vine leaf extract reduces leg swelling in healthy women in a placebo-controlled clinical trial

In the present study, we investigated whether oral intake of a hydroalcoholic extract from red vine leaf (Vitis vinif. fol extra. s. sicc.) extract improves swelling of lower limbs in a single-blinded, placebo-controlled clinical study conducted in Japan using the crossover design. Seventeen healthy women, recurring suffering from swollen legs participated in the trial. Participants ingested 600 mg daily of the extract during 6 weeks, then matching placebo capsules for the same duration after a wash-out period of 2 months. Limb volume was determined by water displacement volumetry at the beginning and at the end of the study. For this purpose, the leg volumes were measured twice a day, in the morning and in the evening of the assessment day. Changes in volume were calculated by substracting the leg volume in the morning from the leg volume in the evening. Additional assessments included complete blood analysis and vital signs to monitor for safety of the treatment.

Zotarolimus-eluting stent-induced hypersensitivity pneumonitis

Zotarolimus-eluting stent-induced hypersensitivity pneumonitis