Elevated Blood Research Articles

The Ghost Of Hip Arthroplasties Past: It Takes A Geriatrician To Mine For Metal

Abstract Background An 84-year-old female presented to Geriatric Medicine out-patient clinic with many years of persistent right hip pain, generalised myalgia; and several months of constipation, weight loss and persistent elevation of C-reactive protein and Erythrocyte Sedimentation Rate. The General Practitioner's concern was occult neoplasm. History of right hip arthroplasty in 2011. 6 years prior, she had wide local excision and adjuvant radiotherapy for a grade 3, “triple negative”, invasive ductal carcinoma of the right breast. Serial imaging identified a right parasternal, internal mammary chain neurofibroma. A Rheumatologist had administered intra-articular steroid to both glenohumeral joints for plain X-ray confirmed osteoarthritis, in the absence of serological vasculitic or autoimmune rheumatological disease. Benefit was transient. Her Oncologist had arranged MRI spine for “sciatica” demonstrating L3/4 and L4/5 stenosis and a large right adnexal cyst. Subsequently, the Gynaecology team assessed and planned interval MRI pelvis as initial MRI suggested a right partial hydrosalpinx, left internal chain lymphadenopathy and nodule adjacent to sacroiliac joint. Methods History, examination and imaging results were checked against the Medical Device Alert number 18 from the Medicines and Healthcare products Regulatory Agency (UK) in 2017. Oxford Hip Score Assessment was 29. Lymphatic drainage from medial hip joint is towards right iliac chain. Results In the absence of Gadolinium based contrast agents within 96hours, metal testing demonstrated: Serum Cobalt was 232nmol/L or 13.7 ug/L; Serum Chromium was 78.8nmol/L or 4.1ug/L; Chromium Urine: Creatinine Urine Ratio was 24.54nmol/mmol; and Cobalt Urine: Creatinine Urine Ratio73.96nmol/mmol. These elevated blood and urine results confirmed metal-on-metal hip disease. Conclusion Consider symptomatic metal-on-metal hip disease with soft-tissue involvement in patients presenting with post-hip arthroplasty joint pain, generalised myalgia and raised inflammatory markers; particularly if there is unexplained ipsilateral internal iliac chain lymphadenopathy and pelvic fluid collections. If confirmed, metalwork explanation is the treatment.

Increased blood 1,25 dihydroxyvitamin D levels in infants with Metabolic Bone Disease of Infancy in contested cases of child abuse

PurposeMetabolic Bone Disease of Infancy (MBDI) is a multifactorial disorder of bone fragility that presents with multiple unexplained fractures (MUF) and is often misdiagnosed as child abuse. The diagnosis of MBDI is made by the finding of radiographic features of healing rickets and risk factors for MBDI. Our anecdotal experience indicates blood 1,25-dihydroxyvitamin D (1,25-DiOHVD) is sometimes elevated. The purpose of this retrospective study was to review cases of MBDI in which child abuse was alleged and the alleged perpetrator denied wrongdoing. MethodsWe reviewed forensic cases of MBDI born between 2015 and 2021. The diagnosis was based on radiographic findings of healing rickets. Records were reviewed for blood 1,25-DiOHVD testing. Results22 of the 76 infants (29 %) had a blood 1,25-DiOHVD level performed at the time of presentation with fractures. The average age of presentation with fractures was 11 weeks.3 of the 22 infants (14 %) had a normal 1,25-DiOHVD blood level, and 19 of the 22 infants (86 %) had an elevated level. None had low levels. ConclusionBlood 1,25-DiOHVD is often elevated in infants with MBDI. Elevated blood 1,25-DiOHVD levels cause increased bone resorption and decreased bone mineralization, and thus this finding is not unexpected since all infants had evidence of healing rickets on imaging studies. These results indicate blood 1,25-DiOHVD should be done in contested cases of child abuse in infants with MUF as an elevated level indicates bone fragility.

What Is Brain Damage and Does Electroconvulsive Therapy Cause It?

Surveys show public misperceptions and confusion about brain damage and electroconvulsive therapy (ECT). Fictional movies have misrepresented ECT to suggest brain damage and to ridicule mental illness and psychiatric patients. "Brain damage" has become a colloquial expression without consistent meaning. In contrast, brain injury is the medical term for destruction of brain cells, such as from kinetic impact (concussion), hypoxia, or infection. Studies of both high-resolution magnetic resonance imaging (MRI) and enzyme assays find that causes of brain injury are accompanied by observable structural changes on MRI and elevated blood and cerebrospinal fluid levels of brain enzymes that leak from injured brain cells. Concussion is also followed by intracerebral bleeding, progressive brain atrophy, diffuse axonal injury, cranial nerve injury, and 2-4 fold increased risk for dementia. In contrast, there is no evidence that ECT produces any of these. Studies of ECT patients find no brain edema, structural change persisting 6 months, or elevated levels of leaked brain enzymes. Statistical comparisons between brain injury and ECT effects indicate no similarity ( P < 0.00000001). Moreover, the kinetic, thermal, and electrical effects of ECT are far below levels that could possibly cause harm. This robust evidence shows that there is no basis to claim that ECT causes brain injury.

Transient brain structure changes after high phenylalanine exposure in adults with phenylketonuria.

Phenylketonuria is a rare metabolic disease resulting from a deficiency of the enzyme phenylalanine hydroxylase. Recent cross-sectional evidence suggests that early-treated adults with phenylketonuria exhibit alterations in cortical grey matter compared to healthy peers. However, the effects of high phenylalanine exposure on brain structure in adulthood need to be further elucidated. In this double-blind, randomised, placebo-controlled crossover trial, we investigated the impact of a four-week high phenylalanine exposure on the brain structure and its relationship to cognitive performance and metabolic parameters in early-treated adults with phenylketonuria. Twenty-eight adult patients with early-treated classical phenylketonuria (19-48 years) underwent magnetic resonance imaging before and after the four-week phenylalanine and placebo interventions (four timepoints). Structural T1-weighted images were preprocessed and evaluated using DL+DiReCT, a deep-learning-based tool for brain morphometric analysis. Cortical thickness, white matter volume, and ventricular volume were compared between the phenylalanine and placebo periods. Brain phenylalanine levels were measured using 1H spectroscopy. Blood levels of phenylalanine, tyrosine, and tryptophan were assessed at each of the four timepoints, along with performance in executive functions and attention. Blood phenylalanine levels were significantly higher after the phenylalanine period (1441µmol/L) than after the placebo period (873µmol/L, P<0.001). Morphometric analyses revealed a statistically significant decrease in cortical thickness in 17 out of 60 brain regions after the phenylalanine period compared to placebo. The largest decreases were observed in the right pars orbitalis (point estimate=-0.095mm, P<0.001) and the left lingual gyrus (point estimate=-0.070mm, P<0.001). Bilateral white matter and ventricular volumes were significantly increased after the phenylalanine period. However, the structural alterations in the Phe-placebo group returned to baseline measures following the washout and placebo period. Additionally, elevated blood and brain phenylalanine levels were related to increased bilateral white matter volume (rs=0.43 to 0.51, P≤0.036) and decreased cortical thickness (rs=-0.62 to -0.39, not surviving FDR correction) after the phenylalanine and placebo periods. Moreover, decreased cortical thickness was correlated with worse cognitive performance after both periods (rs=-0.54 to -0.40, not surviving FDR correction). These findings provide evidence that a four-week high phenylalanine exposure in adults with phenylketonuria results in transient reductions of the cortical grey matter and increases in white matter volume. Further research is needed to determine the potential long-term impact of high phenylalanine levels on brain structure and function in adults with phenylketonuria.

Impact of bisphenol a on the levels of vascular calcification biomarkers in type 2 diabetes mellitus with vascular complications: A case-control study

Bisphenol A (BPA) is an endocrine disruptor present in polycarbonate plastics used in food containers and water bottles that resists insulin action and leads to type 2 diabetes mellitus (T2DM). However, there is scant research on the impact of BPA on T2DM-related vascular complications. Fetuin-A (FTA) and osteoprotegerin (OPG) are crucial markers for vascular calcification, which is the primary risk factor for developing vascular complications. This study aims to link external factor BPA levels with the vascular calcification markers FTA and OPG in diabetic subjects with and without vascular complications. Therefore, 120 study subjects were included and divided as control (n = 30), T2DM with cardiovascular diseases (CVD) (n = 30), T2DM with diabetic nephropathy (DN) (n = 30), and T2DM without vascular complications (n = 30). Serum and urinary FTA, OPG, and BPA levels were measured using an ELISA. FTA (AHSG) and OPG (TNFRSF11B) gene expression were analyzed using qPCR. Both serum (p < 0.001) and urinary BPA (p < 0.001) were found higher in T2DM with CVD and DN than T2DM without vascular complications and control. Also, T2DM with CVD and DN patients had lower serum and urinary FTA protein levels and increased serum and urinary OPG (p < 0.001) levels than T2DM without vascular complications and control. Moreover, FTA (AHSG) gene expression was negatively associated with serum BPA (p < 0.001) and urinary BPA (p < 0.01). Likewise, OPG (TNFRSF11B) gene expression was positively significant with serum BPA (p < 0.001) and urinary BPA (p < 0.01) in the study groups. These findings suggest that elevated blood and urinary BPA levels contribute to the severity of vascular complications in T2DM patients through vascular calcification.

Triple threat: how diabetes results in worsened bacterial infections.

Diabetes mellitus, characterized by impaired insulin signaling, is associated with increased incidence and severity of infections. Various diabetes-related complications contribute to exacerbated bacterial infections, including hyperglycemia, innate immune cell dysfunction, and infection with antibiotic-resistant bacterial strains. One defining symptom of diabetes is hyperglycemia, resulting in elevated blood and tissue glucose concentrations. Glucose is the preferred carbon source of several bacterial pathogens, and hyperglycemia escalates bacterial growth and virulence. Hyperglycemia promotes specific mechanisms of bacterial virulence known to contribute to infection chronicity, including tissue adherence and biofilm formation. Foot infections are a significant source of morbidity in individuals with diabetes and consist of biofilm-associated polymicrobial communities. Bacteria perform complex interspecies behaviors conducive to their growth and virulence within biofilms, including metabolic cross-feeding and altered phenotypes more tolerant to antibiotic therapeutics. Moreover, the metabolic dysfunction caused by diabetes compromises immune cell function, resulting in immune suppression. Impaired insulin signaling induces aberrations in phagocytic cells, which are crucial mediators for controlling and resolving bacterial infections. These aberrancies encompass altered cytokine profiles, the migratory and chemotactic mechanisms of neutrophils, and the metabolic reprogramming required for the oxidative burst and subsequent generation of bactericidal free radicals. Furthermore, the immune suppression caused by diabetes and the polymicrobial nature of the diabetic infection microenvironment may promote the emergence of novel strains of multidrug-resistant bacterial pathogens. This review focuses on the "triple threat" linked to worsened bacterial infections in individuals with diabetes: (i) altered nutritional availability in diabetic tissues, (ii) diabetes-associated immune suppression, and (iii) antibiotic treatment failure.

Associations between metal(loid) exposure with overweight and obesity and abdominal obesity in the general population: A cross-sectional study in China

Previous studies have revealed links between metal(loid)s and health problems; however, the link between metal(loid)s and obesity remains controversial. We evaluated the cross-sectional association between metal(loid) exposure in whole blood and obesity among the general population. Vanadium (V), chromium (Cr), manganese (Mn), cobalt (Co), nickel (Ni), copper (Cu), zinc (Zn), arsenic (As), selenium (Se), molybdenum (Mo), cadmium (Cd), antimony (Sb), thallium (T1), and lead (Pb) were measured in 3029 subjects in Guangdong Province (China) using ICP-MS. The prevalence of overweight and obesity (OWO) and abdominal obesity (AOB) was calculated according to body mass index (BMI) and waist circumference (WC), respectively. Multivariate analysis showed that elevated blood Cu, Cd, and Pb levels were inversely associated with the risk of OWO, and these associations were confirmed by a linear dose-response relationship. Elevated blood Co concentration was associated with a decreased risk of AOB. A quantile g-computation approach showed a significantly negative mixture-effect of 13 metal(loid)s on OWO (OR: 0.96; 95% CI: 0.92, 0.99). Two metals—Ni and Mo—were inversely associated with the risk of OWO but positively associated with AOB. We cross-grouped the two obesity measurement types and found that the extremes of metal content were present in people with AOB only. In conclusion, blood Cu, Mo, Ni, Cd, and Pb were inversely associated with the risk of OWO. The presence of blood Co may be protective, while Ni and Mo exposure might increase the risk of AOB. The association between metal(loid) exposure and obesity warrants further investigation in longitudinal cohort studies.

Lymphocyte Reconstitution after Naïve T Cell-Depleted Hematopoietic Cell Transplantation

Background: Allogeneic hematopoietic cell transplantation (HCT) is curative for many high-risk hematological malignancies. However, graft-versus-host disease (GVHD) causes morbidity, mortality, and reduced quality of life after HCT. Removal of all T cells from hematopoietic cell grafts (pan-T cell depletion; pan-TCD) significantly reduces GVHD but is associated with impaired immune reconstitution and increased non-relapse mortality due partly to opportunistic infections. We developed a novel strategy to remove CD45RA + naïve T cells (T N) from peripheral blood stem cell grafts (PBSC) that is associated with a low incidence of serious acute GVHD (aGVHD) and an exceptionally low incidence of chronic GVHD (cGVHD) (Bleakley, JCO 2022). Although CD45RA-depletion removes T N and other CD45RA-expressing effector T cell populations from PBSC along with most NK and B cells, T N-depletion (T ND) does not appear to increase infections or have a major negative impact on immune reconstitution. Understanding subtle differences in lymphocyte population dynamics after T ND compared to T cell-replete (TR) HCT will enable further graft engineering advances and may provide broader insights into human HCT immunobiology. Objective: To evaluate lymphocyte reconstitution after T ND HCT. Methods and Results: We compared blood lymphocyte populations in T ND HCT recipients (n=47) to those in TR HCT controls (n=19) at days 28, 56, 90, 180, and 360 post-HCT using multiparametric flow cytometry. To complement standard Boolean analysis, we employed a metaclustering approach to simultaneously evaluate ~20 cell surface markers for each class of lymphocytes (CD8 + and CD4 + T cells, NK cells, and B cells) over scores of batches of recipient and control samples. Absolute numbers of total CD8 + T cells were similar in T ND compared to TR at all timepoints, whereas total CD4 + T cell numbers were consistently lower in T ND until 1 year post-HCT. Using conventional gating and high-dimensional clustering analyses, we identified several key differences in T cells after T ND. CD45RA-expressing populations (T N and effector memory re-expressing CD45RA [T EMRA]) in CD8 + and CD4 + T cells were rare in CD45RA-depleted PBSC and remained decreased in T ND HCT recipients until around 1 year (CD8 +, Fig. 1). Activated CD8 + and CD4 + central and effector memory (T CM, T EM) T cells were increased proportionally and in absolute numbers in T ND early post-HCT (CD8 +, Fig. 1). Absolute numbers of regulatory T cells (Treg) were decreased in T ND; consequently, ratios of activated CD8 + and CD4 + to Treg were both markedly increased early post-HCT, despite a similar incidence of aGVHD in T ND and TR recipients. Although most NK cell populations were removed from CD45RA-depleted PBSC, absolute numbers of NK cells in all compartments, including both activated and inhibited, were increased in T ND recipients early post-HCT compared to TR. Like NK cells, most B cells except for plasmablasts and plasma cells were removed by CD45RA-depletion of PBSC. Immature, naïve, and memory B cells were reduced very early post-T ND HCT, but substantial B cell recovery occurred within the first 2-3 months. Conclusions: We present the first detailed description of lymphocyte reconstitution after T ND HCT. Despite the major effect CD45RA-depletion has on graft composition-removing all T N and T EMRA from the T cell compartment and most NK and B cells-NK and B cell recovery occurred early, and by 1 year post-HCT there was little difference in lymphocyte populations between T ND and TR. This is consistent with hematopoietic progenitors, not mature lymphocytes, as the source of B and NK cell reconstitution. Among T cells, the most striking findings were an increase in activated T CM and T EM CD4 + and CD8 + T cells early after T ND HCT, and increased ratios of activated T cells to Treg. Although elevated blood T effector/Treg ratios have been associated with cGVHD, cGVHD was uncommon and steroid-responsive after T ND HCT. Whether increased activated T cells reflect a reduction in Treg-mediated suppression after HCT, bystander T cell activation, activation by antigen (e.g., alloantigen, latent herpes viruses, microbiota), or multiple factors are questions we are now investigating. We are also exploring associations between lymphocyte populations early post-T ND HCT and clinical outcomes; these could serve as biomarkers to facilitate early intervention to prevent or treat GVHD, relapse, or infection.

Elevated blood and cerebrospinal fluid biomarkers of microglial activation and blood‒brain barrier disruption in anti-NMDA receptor encephalitis

BackgroundAnti-NMDA receptor (NMDAR) encephalitis is an autoimmune disease characterized by complex neuropsychiatric syndrome and cerebrospinal fluid (CSF) NMDAR antibodies. Triggering receptor expressed on myeloid cells 2 (TREM2) has been reported to be associated with inflammation of the central nervous system (CNS). Matrix metalloproteinase-9 (MMP9) and cluster of differentiation (CD44) were measured to evaluate blood‒brain barrier (BBB) permeability in anti-NMDAR encephalitis. The roles of microglial activation and BBB disruption in anti-NMDAR encephalitis are not well known.FindingsIn this work, we detected increased expression levels of CSF sTREM2, CSF and serum CD44, and serum MMP9 in anti-NMDAR encephalitis patients compared with controls. CSF sTREM2 levels were positively related to both CSF CD44 levels (r = 0.702, p < 0.0001) and serum MMP9 levels (r = 0.428, p = 0.021). In addition, CSF sTREM2 levels were related to clinical parameters (modified Rankin Scale scores, r = 0.422, p = 0.023, and Glasgow Coma Scale scores, r = − 0.401, p = 0.031).ConclusionIncreased sTREM2 levels in CSF as well as increased CD44 and MMP9 in serum and CSF reflected activation of microglia and disruption of the BBB in anti-NMDAR encephalitis, expanding the understanding of neuroinflammation in this disease. The factors mentioned above may have potential as novel targets for intervention or novel diagnostic biomarkers.

Long-term kidney follow-up after pediatric acute kidney support therapy for children less than 15kg.

In small children, acute dialysis (pediatric acute kidney support therapy (paKST)) is increasingly used; however, it is challenging for many reasons. We compared clinical characteristics and predictors of long-term outcomes of patients < 15kg on peritoneal dialysis (PD), hemodialysis (HD), and continuous kidney replacement therapy (CKRT). Patients with history of paKST (CKRT, HD, PD) weighing < 15kg and ≥ 6months of follow-up at Hacettepe University were included. Surviving patients were evaluated at last visit. 109 patients (57 females) were included. Median age at paKST was 10.1months (IQR: 2-27months). In total, 43 (39.4%) patients received HD, 37 (34%) PD, and 29 (26.6%) CKRT. 64 (58.7%) patients died a median 3days (IQR: 2-9.5days) after paKST. Percentages of patients using vasopressor agents, with sepsis, and undergoing mechanical ventilation were lower in those who survived. After mean follow-up of 2.9 ± 2.1years, 34 patients were evaluated at mean age 4.7 ± 2.4years. Median spot urine protein/creatinine was 0.19 (IQR: 0.13-0.37) and 12 patients (35.3%) had non-nephrotic proteinuria. Three patients had estimated glomerular filtration rate (eGFR) < 90mL/min/1.73m2 and 2 (6%) had hyperfiltration. In total 22 patients (64.7%) had ≥ 1 kidney risk factor (elevated blood pressure/hypertension, hyperfiltration, eGFR < 90ml/min/1.73m2, and/or proteinuria) at last visit. Among 28 patients on paKST < 32months, 21 had ≥ 1 risk factor (75%), whereas among 6 patients who had paKST ≥ 32months, one patient had ≥ 1 risk factor (16.7%), (p = 0.014). Patients on paKST who undergo mechanical ventilation and vasopressor treatment should be followed-up more closely. After surviving the acute period, patients on paKST need to be followed-up closely during the chronic stage. A higher resolution version of the Graphical abstract is available as Supplementary information.

Do blood metals influence lipid profiles? Findings of a cross-sectional population-based survey

Dyslipidemia, an imbalance of lipids and a major risk factor for cardiovascular disease, has been associated with elevated blood and urine levels of several heavy metals. Using data from a Canadian Health Measures Survey (CHMS), we tested associations between blood levels of cadmium, copper, mercury, lead, manganese, molybdenum, nickel, selenium, and zinc, and the lipids triglycerides (TG), total cholesterol (TC), low density lipoproteins (LDL), high density lipoproteins (HDL) and apolipoproteins A1 (APO A1), and B (APO B). All adjusted associations between single metals and lipids were positive and significant, except for APO A1 and HDL. The joint effect of an interquartile range increase in heavy metals was positively associated with percentage increases of TC, LDL and APO B of 8.82% (95%CI: 7.06, 10.57), 7.01% (95%CI: 2.51, 11.51) and 7.15% (95%CI: 0.51, 13.78), respectively. Future studies are warranted to determine if reducing environmental exposure to heavy metals favorably influences lipid profiles and the risk of cardiovascular disease.

Cardiovascular comorbidities in patients with a severe form of psoriasis: A case-controlled study assessing clinical, biochemical, and radiological parameters

Background: Psoriasis is a common, chronic, inflammatory, and proliferative disorder of the skin, and is associated with elevated lipid levels and exaggerated inflammatory status, which may lead to cardiovascular morbidities and mortalities. Aims: The aim was to estimate the cardiovascular risk profile among psoriatic patients when compared to controls. Settings and Design: This was a case-controlled study performed at a tertiary-care hospital. Methods and Material: One hundred patients with severe psoriasis were evaluated for clinical, biochemical, electrocardiographic, and radiological signs of cardiovascular comorbidities and were compared with one hundred age- and sex-matched controls. Statistical Analysis: IBM Corp. Released 2015. IBM SPSS Statistics for Windows, version 23.0. Armonk, NY: IBM Corp. Results: Males predominated (1.27:1), with the most common age group being 31 to 40 years old. Smoking and alcohol consumption were common among the psoriatic patients (odds ratio = 4.14 and 2.38, respectively). The mean PASI score among the cases was 26.19 ± 10.8, with an extreme effect on their quality of life. The psoriatic patients presented with independent cardiovascular risk factors, including systolic hypertension (148.67 ± 10.91 mm of Hg), elevated fasting blood sugars (129.46 ± 35.64 mg/dL), hypercholesterolemia (152.34 ± 44.56 mg/dL), and hypertriglyceridemia (186.29 ± 29.45 mg/dL), with metabolic syndrome among 41% of the cases. On the electrocardiogram, the P wave was elevated (22%) and the QTc interval was prolonged (20%) among the cases. On high-resolution ultrasonography, the intima–media of the carotid arteries were thickened (0.944 ± 0.132 mm), indicating subclinical atherosclerosis in the psoriatic patients. Conclusions: Early detection and periodic screening for cardiovascular risk factors among psoriatic patients and aggressive therapeutic management are recommended to reduce the disease burden and improve their quality of life.

Nutrition Indicators, Dyslipidemia and Arterial Pressure in the Pediatric Population Located in Low and High Marginalisation Zones in Mexico

Aim of the study. The objective of this investigation is to evaluate nutritional indicators, lipidic profile, and blood pressure in the pediatric population that live in low and high marginalisation zones in Mexico. Methods. In a cross-sectional analytical study, students 6 to 18 years old in low and high marginalisation areas of Mexico were selected. Participants were asked to take surveys related to anthropometrics, biochemical, arterial pressure, and evaluation of healthy nutrition index. Results. Less than 1% of the participants had a “healthy nutrition” for both areas. The joint prevalence of overweight and obesity was 40%. The combined prevalence of elevated systolic and diastolic blood pressure was almost 40%, a huge percentage of systolic blood pressure (32%) was observed as well. Half of the population had high levels of triglycerides. Marginalisation was inversely associated with systolic and diastolic blood pressure and positively associated with HDL-C. The population has a low consumption of fruits and vegetables together with high consumption of beverages containing sugar and sweets. It is evident in all the indicators that a significant percentage of subjects exceed the clinical cut-off values related to risk regardless of marginalisation level. Conclusions. It is necessary to insist on educational intervention to create a conscience in observing healthy nutrition at an early age and to preserve these healthy habits during adolescence. The inclusión of the measurement of clinical indicators like arterial pressure and the evaluation of biochemical indicators that assess cardiovascular risks in the public policies of pediatric health is necessary.

Mantle cell lymphoma negative for t(11,14) involving the kidneys: a case report

BackgroundMantle cell lymphoma is the rarest subtype of non-Hodgkin’s lymphoma. It can exhibit diverse extranodal manifestations. However, renal involvement is uncommon, and if it occurs, it usually only gets detected postmortem. There are several mechanisms by which mantle cell lymphoma can damage the kidneys. Renal failure is a potential complication, and prompt evaluation and diagnosis are critical steps to prevent long-term complications.Case presentationWe present the case of a 75-year-old non-Hispanic White male with past medical history significant for hypertension and dyslipidemia, presenting with fever, weight loss, and night sweats. Work-up showed markedly elevated white blood cells, multiple enlarged lymph nodes, and a kidney mass. The patient was diagnosed with mantle cell lymphoma with kidney involvement confirmed with a kidney biopsy. His disease was positive for cyclin D1 overexpression despite t(11; 14) absence. The patient received six cycles of alternating vincristine, rituximab, cyclophosphamide, doxorubicin, and prednisone then dexamethasone, high-dose cytarabine, and oxaliplatin, after which he was maintained on ibrutinib and rituximab, with resolution of symptoms and disease regression.ConclusionWe present a case of a rare presentation of Mantle cell lymphoma while describing the clinical presentation and diagnostic and treatment approaches. This case report can assist physicians in the clinical work-up and treatment of patients with similar diagnosis or presentation.

Cardiovascular reactivity to stress shows proneness to future blood pressure status in students of a teaching hospital in Nepal

Stress is a condition that disrupts or threatens to disrupt homeostasis. Stress may be physical or mental. Physical stress includes exercise (isometric or isotonic), pain, temperature (too hot or cold) etc. The development of hypertension is usually preceded by a prehypertensive state that may be manifested by abnormal cardiovascular reactivity to different types of stress viz., mental stress, cold water immersion, isotonic exercise, isometric handgrip, and valsalva maneuver. In present study, we have used isometric handgrip (IHG) exercise, as a stressor, aiming to identify individuals at increased risk for developing hypertension at early life. Normotensive, non-smoker sedentary two hundred male subjects, one hundred each from normotensive and hypertensive families, of age group 18-25 years participated in the study as volunteers. The causal blood pressure and heart rate of the participants were recorded in the sitting position by using mercury sphygmomanometer and stethoscope. Then, the isometric handgrip (IHG) exercise demonstrated to each of them using handgrip dynamometer. Maximum voluntary contraction (MVC) was noted as maximum pressure (in Kg) sustained during three seconds of handgrip using a handgrip dynamometer. The participants were asked to sustain isometric handgrip at one third of MVC for one minute with the same instrument (handgrip dynamometer). Both blood pressure and heart rate were recorded immediately after 1 and 3 minutes following isometric handgrip (IHG) exercise. The data analyzed using t-test showed that diastolic blood pressure didn’t return and stabilized to pre-exercise level even after 3 minutes following exercise in volunteers who were mostly from hypertensive family. More number of volunteers with family history of hypertensive (24%) showed elevated diastolic blood pressure even after 3 minutes whereas a few of the volunteers (8%) with no family history of hypertension showed rise in DBP even after 3 minutes following isometric handgrip (IHG) exercise. This present study indicated that the individuals having family history of hypertension are prone to develop hypertension in their early life, therefore, must adopt the healthier life style like avoidance of alcohol, smoking, and practice yogic exercise.

Efficacy of imatinib mesylate in combination with radiotherapy in acute leukemia, and the effect on immune function

Purpose: To evaluate the clinical efficacy of imatinib mesylate plus radiotherapy for the treatment of acute leukemia and its effect on immune function.Methods: A retrospective study was conducted on 88 patients with acute leukemia admitted to Zhuji Affiliated Hospital of Shaoxing University between July 2017 and July 2021. They were assigned (randomly, 1:1) to a control group (radiotherapy) or a study group (imatinib mesylate plus radiotherapy) according to different treatment regimens. Outcome measures assessed included the clinical efficacy of the treatments in the patients and their immune functions.Results: The two groups did not show any significant differences with regard to general patient profiles. After treatment, both groups presented reduced white blood cell (WBC) and platelet count (PLT) and elevated red blood cells count (RBC). The level of hemoglobin (Hb) level showed a slight decline in the control group but a significant increase in the study group (p &lt; 0.05). The study group showed better improvement in the levels of WBC, PLT, RBC, and Hb than the control group (p &lt; 0.05). The absolute values of peripheral blood mature neutrophils decreased in both groups after treatment, down to the lowest level at week 2, but rebounded, with higher absolute values in the study group at weeks 2, 3, and 4 of treatment (p &lt; 0.05). Imatinib mesylate plus radiotherapy was associated with higher efficacy, compared with radiotherapy alone (p &lt; 0.05).Conclusion: Radiotherapy plus imatinib mesylate effectively enhances the immune functions of acute leukemia patients, mitigates inflammatory responses, alleviates clinical symptoms, and boosts clinical efficacy. Further clinical trials are, however, required prior to general application in clinical practice.

THE EFFECTIVENESS TEST OF INFUSION CELERY ROOT (Apium graveolens L.) AS A DIURETIC IN WISTAR MALE WHITE RATS (Rattus Norvegicus)

Background: Hypertension is defined by persistently elevated arterial blood pressure. The increase in systolic blood pressure is generally&gt;140mmHg or diastolic blood pressure&gt; 90mmHg. The prevalence of hypertension increases with lifestyle changes. Objective: To determine the diuretic effect of celery (Apium graveolens L.) on male wistar rats (Rattus norvegicus). Methods: This research uses a literature study method, the type of the research is descriptive qualitative with literature research (library research) systematic. Results: Based on research data, there were 5 groups of mice that received different treatments. Among the five treatment groups, 0.5 % CMC suspension (KP-) showed the least mean cumulative urine volume, and furosemide suspension (KP+) showed a large mean cumulative urine volume when compared to negative controls. Conclusion: Celery root infusion can increase urine volume because it contains flavonoids that play a role in increasing urine volume (diuresis).&#x0D; Keywords: Diuretic, Celery (Apium graveolens L.), Furosemide, Hypertension, Wistar rats

Pattern of specific comorbidities and the association with overweight and obesity in adults attending a tertiary hospital in Rivers State, Nigeria

Aims: Overweight and obesity constitute a major risk to the development of chronic non communicable diseases such as hypertension, diabetes mellitus, dyslipidaemias, osteoarthritis which in turn impact on the individual, the family and the community. This study explored specific comorbidities associated with overweight and obesity among adults attending the Family Medicine Clinic of a tertiary health centre in Nigeria. Methods: This was a descriptive hospital-based study. A combination of structured questionnaires, physical examination and laboratory analysis were used to generate appropriate data. The information was analysed using Statistical Package for Social Sciences (SPSS) version 22. Chi square (x2) and Fisher’s exact test were used to investigate the association between variables and the level of significance was set at p&lt;0.05. Results: The mean age of the subjects was 44.9±13.8years. Females constituted the majority (64.4%) with a female to male ratio of 1.8:1. While 55 persons (28.4%) were normal weight, 63 (32.5%) were overweight, 36 (18.5%) had class 1, 27 (13.9%) had class 2 obesity and 8 (4.1%) were morbidly obese. The prevalence of overweight/obesity was 69.1%. There was a significant relationship between overweight/obesity with previous diagnosis of hypertension and osteoarthritis but not with a previous diagnosis of DM. There was no statistically significant relationship between overweight/obesity and elevated BP, abnormal gait and blood glucose; however, the relationship with total cholesterol was significant. Conclusion: This study highlights a high prevalence of overweight/obesity and the association with specific comorbidities in the Nigeria.

Relationship of cardiometabolic disease risk factors with age and spinal cord injury duration

Context/Objectives Cardiometabolic disease (CMD) is increased after spinal cord injury (SCI), with an increased number of CMD risk factors that relate to higher mortality. The study objective was to characterize the relationship of age and injury duration with CMD. Design Retrospective cohort assessment of CMD risks using unbiased recursive partitioning to divide for group comparison: (1) Lowest Risk, (2) Moderate Risk, and (3) Highest Risk based on classification and regression trees predicting CMD diagnosis by age and injury duration. Setting Academic rehabilitation center laboratory. Participants Adults (N = 103; aged 18–75) with traumatic SCI (C4-L2) of 3 months to 42 years duration. Interventions NA. Outcome measures CMD risk factors (obesity, insulin resistance, dyslipidemia, and hypertension) using Paralyzed Veterans of America SCI-specific guidelines. Results Obesity was prevalent (82%) and co-occurred with most other risk factors present. Age increased odds for CMD diagnosis by 1.05 per year (P = 0.02) and was directly related to elevated body mass index (BMI, β = 0.42, P < 0.05), fasting glucose (β = 0.58, P < 0.01), and higher systolic blood pressure (β = 0.31, P < 0.10). In contrast, time since injury contributed to lower risk factor count (β = −0.29, P < 0.10) and higher HDL-C (β = 0.50, P < 0.01), and was not related to odds of CMD diagnosis. Conclusion While SCI is linked to an increased risk of CMD, age is associated with higher CMD risk. Increased SCI duration related to improvement in individual CMD risk factors but did not decrease overall risk for CMD diagnosis. SCI may not uniformly increase CMD risks and highlight a necessary focus on weight management for risk prevention.

Unusual Pathogen in a Patient With Peritoneal Dialysis-Related Peritonitis: A Case Report

Peritoneal dialysis (PD) is an effective modality for renal replacement therapy. A serious complication that can arise from PD is peritonitis. Over the last few decades, there have been cases of PD-related peritonitis secondary to Pasteurella multocida infections. We present the case of a 44-year-old female who presented to the emergency department with a one-day history of abdominal pain and cloudy peritoneal fluid on evaluation. Along with her physical examination findings, laboratory results of the peritoneal fluid demonstrated elevated white blood cells and neutrophils, characteristic of peritonitis. Ultimately, the culture results were positive for P. multocida. Although P. multocida is not the most common cause of peritonitis, it is a common cause in PD patients who have domesticated animals. With two out of three people being pet owners and the increased number of people on home therapies such as PD for kidney failure, it is important to educate patients about the proper precautions and techniques to prevent peritonitis and its associated complications. Additionally, proper antibiotic management should be implemented for patients with an increased risk of infection.