Jun Tsukiji, Shiro Koizume, Tomoko Takahashi
et al.
Background: Impaired smell/taste sensation (dysosmia/dysgeusia) are common manifestations of coronavirus disease 2019 (COVID-19). Scattered peripheral chemoreceptors and directly innervating central nerves from the brain to the receptors are responsible systems for perception in the human body. The shared neurotransmitter serotonin (5-HT) and neuroimmune modulators of the kynurenine (Kyn) pathway (KP) are metabolites derived from tryptophan (Trp). The synthesis of KP metabolites is initiated by the rate-limiting enzymes indoleamine 2,3-dioxygenase (IDO) and tryptophan 2,3-dioxygenase (TDO). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can activate Trp metabolism. Therefore, we investigated whether serum metabolites of Trp and IDO/TDO activity could serve as biomarkers for assessing smell/taste impairment (dysosmia/dysgeusia) in patients during the acute phase of COVID-19. Methods: We conducted a retrospective case-control study. Among patients admitted with acute COVID-19 to our hospital between September 13, 2021, and September 30, 2023, those whose chief complaints included dysosmia/dysgeusia at admission were identified. These symptoms were confirmed by the attending physician for COVID-19. Patients were stratified based on the presence or absence of dysosmia and/or dysgeusia.In both patient groups, serum concentrations of Trp, 5-HT, Kyn, kynurenic acid (KYNA), and quinolinic acid (QUIN) were measured using enzyme-linked immunosorbent assay. IDO/TDO activity was expressed as Kyn–Trp ratio (KTR). The relationships between these biomarkers and dysosmia/dysgeusia, as well as other clinical parameters and outcomes, were evaluated. Results: Of 520 patients admitted with COVID-19, 95 met the inclusion and exclusion criteria. Among them, 26 patients with dysosmia/dysgeusia (group A) and 26 patients without these symptoms (group B) were analyzed. No significant intergroup difference was observed in the average timepoint at blood sampling after COVID-19 onset (post-day from onset: pdo) (4.69 ± 2.51 days in group A vs. 3.62 ± 2.22 in group B). Group A showed significantly lower Trp levels [median 9.70 μg/mL (range 4.59–13.89) vs. 10.40 (7.52–13.34), p = 0.031], and higher KTR [61.34 (40.47–384.2) vs. 53.52 (26.13–86.64), p < 0.037] and QUIN levels [574.39 nM (100.39–11909) vs. 443.65 (83.09–998.3), p < 0.0169]. No significant differences were observed in 5-HT or KYNA levels between groups. Almost all cases of dysosmia involved anosmia/hyposmia and were significantly correlated with non-vaccination status with mRNA vaccine (p = 0.017). In contrast, dysgeusia exhibited heterogeneous manifestations, primarily ageusia or hypogeusia, followed by hypersensitivity to salty taste, and was not correlated with vaccination status. Conclusion: Clinically, serum KTR and QUIN levels may serve as useful biomarkers for assessing dysgeusia/dysomia during acute COVID-19. Furthermore, vaccination may play an important preventive role, particularly against dysosmia.
Elizabeth Konon MD, Anum Shahzad MD, Raymundo Quintana Quezada MD
et al.
Takayasu’s arteritis (TAK) is a rare, large-vessel vasculitis that typically involves the aorta and its major branches. Patients may experience coronary involvement, most commonly the left main coronary ostia. Patients with coronary artery occlusion often require emergent revascularization; however, there is debate regarding the optimal timing and type of surgical intervention in the setting of TAK. Herein we describe a 32-year-old female presenting with non-ST elevation myocardial infarction (NSTEMI) who underwent percutaneous intervention (PCI) with drug-eluting stent (DES) placement and was subsequently diagnosed with TAK. A 32-year-old female presented to the emergency department with chest pressure and dyspnea. Her electrocardiogram findings and troponin elevation were consistent with NSTEMI and she underwent coronary angiography with DES placement. During angiography, aortic insufficiency was noted. Transesophageal echocardiogram confirmed intimal thickening of the aortic root with aortic regurgitation. She was diagnosed with TAK, started on high-dose steroids, and transferred to a tertiary care center for rheumatology consultation. This patient’s clinical course raised several questions regarding surgical intervention in TAK. The optimal timing of surgery and preferred approach (endovascular intervention vs coronary artery bypass grafting [CABG]) were specifically critiqued. While endovascular intervention (PCI with angioplasty or stent) is typically less invasive than CABG, it may be associated with a higher risk of postsurgical re-stenosis and studies are conflicting regarding the optimal approach. Further research is necessary to determine the long-term efficacy and safety of these interventions, as well as their timing in the overall management plan.
Background: Coronary artery disease (CAD) is the leading global cause of death, with acute coronary syndrome (ACS) being a severe form leading to myocardial injury. Platelets and lipids play a key role in thrombosis and atherogenesis. Complete blood count (CBC) ratios may predict ACS outcomes.
Objectives: To assess the relationship between platelet and inflammatory indices and the severity of ACS.
Patients and methods: This cross-sectional study involved ACS patients aged 18+. Patients were divided into groups 1 (stable CAD) and 2 (acute myocardial infarction). Clinical and laboratory assessments included ECG, echocardiography, CBC, cardiac enzymes, and inflammatory markers.
Results: Cases had significantly higher systolic blood pressure; ECG was abnormal in 95%. ST depression was present in 59% of patients, 53% had an ejection fraction (EF) of less than 50%; and the mean EF was 48.09±8.93%. Patients with EF<50% had higher platelet count (336.962±73.198 vs 246.83±54.308, P<0.0001) and increased inflammatory indices (P < 0.05), but lower mean platelet volume (MPV) (8.91±2.72 vs 11.92±3.57, P<0.0001) and lymphocyte count (2.551±1.211 vs 2.989±1.298, P=0.0297). Neutrophil platelets score (NPS) and prognostic index (PI) scores of 1 and 2 were more prevalent among ACS cases with EF of < 50% (P<0.05). Platelet distribution width (PDW) and systemic immune-inflammation index (SII) were independent positive predictors of left ventricular ejection fraction (LVEF) (P<0.0001), whereas C-reactive protein (CRP) level was a significant independent negative predictor (P<0.0001).
Conclusion: Hematologic inflammatory indices and EF were correlated in ACS patients; higher ratios are associated with systemic inflammation and reduced EF.
Ghassan Barnawi, Sarah Kashkari, Arieh Gomolin
et al.
This case report describes a 61-year-old female who developed cutaneous small vessel vasculitis following a calcium-hydroxyapatite-based filler injection. The patient presented with a generalized purpuric and petechial rash, along with arthralgia. A skin biopsy confirmed features consistent with cutaneous small vessel vasculitis. Treatment with a 6-week prednisone taper resulted in complete symptom resolution. This observation warrants further investigation into the potential role of dermal fillers in triggering inflammatory conditions like cutaneous small vessel vasculitis.
Carlos Diego H. Lopes, Marcello M. Queiroz, Luana A.F. Sampaio
et al.
PURPOSETo investigate the discordance in sarcoma diagnoses between nonspecialized institutions following revision by dedicated sarcoma pathologists at a reference center in Brazil and the relevance of molecular pathology in this context.METHODSWe conducted a retrospective analysis of sarcoma samples initially analyzed at outside laboratories and subsequently reviewed by two specialized pathologists between January 2014 and December 2020. After obtaining demographic and tumor characteristics, pathology results were matched and classified as complete discordance (CD; benign v malignant, sarcoma v other malignancies), partial concordance (similar diagnosis of connective tumor, but different grade/histological subtype/differentiation), and complete concordance (CC). The concordance for histology or grade, and the role of molecular assessments supporting the diagnosis were also independently determined. Statistical analyses were conducted through the kappa coefficient of agreement and adherence by χ2 test, χ2 test by Person, and Fisher exact test.RESULTSIn total, 197 cases were included, with samples obtained predominately from male patients (57.9%) and localized/primary tumors (86.8%). Following revision, the most frequent final diagnoses were undifferentiated pleomorphic sarcoma (17.8%), well-differentiated/dedifferentiated liposarcoma (8.6%), and leiomyosarcoma (7.6%). CD was found in 13.2%, partial discordance in 45.2%, and CC in 41.6% of reviews (P < .001). We found a concordance for histology or grade of 53.5% (P < .001) and 51.8% (P < .001), respectively. Molecular assessments, comprising next-generation sequencing panels (79.5%) and fluorescent in situ hybridization (20.5%), were performed in 44 (22.3%) cases, with findings classified as of diagnostic relevance in 31.8%.CONCLUSIONIn nearly 60% of the cases, the initial sarcoma diagnosis was modified when revised by a reference center and dedicated pathologists, assisted by molecular pathology techniques. These results justify the assembly of referral networks in countries with limited health care resources.
Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Ovi Sofia, Muna Amalia, Herryanto Thomassawa
et al.
Introduction. The imbalance of the immune response is an important factor contributing to the incidence of ocular toxoplasmosis (OT). Regulatory T cells (Treg) play a key role in maintaining the balance between Th1 and Th17 immune responses, while interleukin-27 (IL-27) levels are related to the differentiation of Th17 cells. This study analyzes the differences in the number of Treg cells and the level of IL-27 between OT patients and seropositive individuals without ocular lesions and its correlation with retinal lesion size. Methods. This analytic observational study, conducted for 8 months, involved 11 OT patients and 10 seropositive individuals without ocular lesions. All subjects underwent a comprehensive ophthalmological examination. Retinal lesions were documented by fundus photographs and the size was measured using Digimizer 4.2.2.0 software. Isolation of peripheral blood mononuclear cells (PBMC) was performed to measure the number of Treg cells using flow cytometry and interleukin-27 levels were assessed using the Sandwich enzyme-linked immunosorbent assay (ELISA) technique. Data were analyzed with SPSS. Result. The number of Treg cells in the OT group (47.16 ± 15.66%) was lower than in the seropositive group without the ocular lesions (62.86 ± 17.08%) (p=0.029). The serum IL-27 levels in the OT group were not significantly different from the seropositive group without the ocular lesions (p=0.360). The number of Treg cells was significantly related to retinal lesion size (p=0.043), with a correlation coefficient of −0.648, indicating a strong and inverse correlation. There was no significant correlation between serum IL-27 levels and retinal lesion size (p=0.556). Conclusion. Ocular toxoplasmosis patients have a low number of Treg cells that are inversely related to the retinal lesion size. The size of the retinal lesion increases as the number of Treg cells decreases.
Mahesh Sultania, Priyansh Jain, Itisha Chaudhary
et al.
Objective The preoperative (clinical and radiological) depth of invasion (DOI) in early tumours can guide the surgeons in deciding elective neck dissection, the extent of invasive surgery, the need for reconstruction, potential adjuvant treatment and the patient's prognosis. This study aimed to validate the 8th AJCC clinical T stage using DOI, assess interobserver bias, and correlate the clinical, radiological and pathological T stages. Materials and methods: This was a prospective clinical study carried out from December 2019 to June 2023 at an academic tertiary care centre. Patients with squamous cell carcinoma of oral cavity and lip without involvement of skin or bone undergoing upfront surgery were included. The clinical assessment of T stage using DOI was done by three examiners, blinded to each other. The radiological T stage was assessed by an MRI and pathological T stage on fixed formalin surgical specimen. Results: A total of 173 patients were assessed during the study period, out of which 44 met the inclusion criteria. There was a fair agreement regarding the combined clinical T stage between all three examines. A statistically significant correlation was found between the clinical and pathological T stage (p-value 0.010), the radiological and pathological T stage (p-value 0.001) and clinical and radiological T stage (p-value 0.004). Conclusion: The clinical and radiological T stage using DOI correlated well with the pathological T stage. The 8th AJCC clinical T stage of oral squamous cell carcinoma was accurate in our study population.
Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Mild, moderate, severe, and critical COVID-19 are associated with hyperinflammation. The CRP and ferritin are acute phase proteins that marks incidence of inflammation and used as the paramaters of hyperinflammation. This study aimed to determine the validity of CRP and ferritin level examination in moderate and severe COVID-19 since the time of admission. This was a cross-sectional analytical retrospective study with on moderate and severe COVID-19 patients admitted to Dr. Hasan Sadikin General Hospital Bandung, Indonesia, during the period of March 2020 to December 2020. The CRP and ferritin levels were obtained since the beginning of admission to the fourth day since admission on patients without any history of anemia. Subjects in this study were divided into moderate and severe COVID-19 groups based on the 3rd edition of COVID-19 Prevention and Control Guideline issued by the Ministry of Health Republic of Indonesia. Each group consisted of 30 subjects. The cut-off value was 7.65 mg/dL (AUC 0.698) for CRP and 963.1 mcg/L (AUC 0.938) for ferritin. The validity of ferritin vs CRP were reflected respectively as follows: 93.3% vs 76.7% sensitivity; 80.0% vs 63.3% specificity; 82.4% vs 67.6% PPV; and 92.3% vs 73.1% NPV. The validity of ferritin was proven to be superior as it significantly increases since day one, persisted longer and reaches its peak on the16th day. Meanwhile, CRP increases within 6-8 hours and reaches its peak within 48 hours after inflammation, then declines soon afterwards.