Abdominal ultrasound findings in adult patients with cystic fibrosis

INTRODUCTION AND AIMS

Cystic fibrosis (CF) is a genetic disease whose gastrointestinal compromise mainly involves the pancreas, bile ducts, and liver. Our aim was to analyze abdominal ultrasound findings.

METHODS

A retrospective, descriptive study was conducted on adults (patients ≥ 16 years of age) diagnosed with CF, within the time frame of 2006-2019. Clinical and genetic parameters, body mass index, forced expiratory volume in one second, pancreatic insufficiency, CF-related diabetes, cirrhosis secondary to CF, and abdominal ultrasound images were analyzed.

RESULTS

Seventy patients, 39 of whom were men (55.8%), had a mean age of 27 years and a mean body mass index of 21.3 ± 2.8 kg/m2 (r: 17-30.9). Forty-seven (67.1%) presented with pancreatic insufficiency, 6 (8.5%) with cirrhosis secondary to CF, and 21 (30%) had CF-related diabetes. Median forced expiratory volume in one second was 47% and the F508del mutation was found in 56.1%. Images of the pancreas: no pathologic findings in 49 (70%), increased echogenicity in 18 (25.7%), and cysts in 3 (4.3%). Gallbladder images: microgallbladder in 3 (4.2%), biliary sludge in 2 (2.8%), gallstones in 7 (10%), and a history of cholecystectomy in 4 (5.8%). Liver and spleen images: no pathologic findings in 47 (67.2%), homogeneous hepatomegaly with splenomegaly in 2 (2.8%), a heterogeneous pattern of the parenchyma in 11 (15.8%), increased echogenicity in 4 (5.7%), and heterogeneous echo patterns, lobulated liver contour, and splenomegaly in 6 (8.5%).

CONCLUSION

Abdominal ultrasound is a safe, low-cost technique that enables the identification of some degree of chronic liver and pancreatic diseases, improving the approach and follow-up decisions in adult patients with CF.

AB0308 FALL RISK EVALUATION WITH COMPUTERIZED DYNAMIC POSTUROGRAPHY IN RHEUMATOID ARTHRITIS PATIENTS

Background

Patients with rheumatoid arthritis (RA) have a higher risk of falling due to pain and physiological/biomechanical deformities (decreased muscle density, decreased functional stability, changes in gait, etc.) [1]. Although high incidences of falls have been reported in RA patients [1], there are not sufficient data regarding patient-specific fall risk.

Objectives

The aim of this study was to evaluate patient-specific fall risk, via computerized dynamic posturography, in RA patients, and to compare the results with those of age-matched healthy participants.

Methods

A total of 29 patients with RA (9 males, 20 females; mean age: 54.4±6.5 years) and 18 healthy participants (7 males, 11 females; mean age: 53.6±7.1) were included in the study. Detailed demographic, physical, and medical characteristics of the participants were recorded. Dynamic balance was tested with a computerized dynamic posturography, which assesses balance responses to induced postural disruption [2]. A translational ramp test (speed: 0.1 m/s), sinusoid tests (frequencies: 0.25 Hz - 0.50 Hz), and limits of stability evaluations were applied. Ramp and sinusoid tests were evaluated with the eyes open and closed, in the antero-posterior direction, and the participants were instructed to keep their balance during the tests. Limits of stability was evaluated on a static platform, with the eyes open. During the test, the participants were told to carry their pressure center as far as possible by performing the movement only from the ankle (in all directions), without lifting their feet, and trying not to fall.

Results

The groups were similar in terms of demographic and physical characteristics (p>0.05). Patients with RA showed statistically significant dynamic balance alterations compared to healthy participants (p<0.05) (Table 1). The fall test was positive in 31% of the RA patients and 5.6% of the control group (Figure 1).

Table 1.

Comparison of the groups in terms of the fall risk assessment criteria

Test ParametersRA Group (n=29)Control Group (n=18)p1.Ramp Eyes OpenEnergy in AP (J)2051 (1071-2258)1409 (1224-1644)0.005*1.Energy in ML (J)213 (122-414)208 (138-259)0.3691.Time in ML (s)3.9 (3.0-4.4)3.5 (2.6-3.9)0.0832.Ramp Eyes ClosedEnergy in AP (J)1939 (1856-2147)1718 (1334-1929)0.024*1.Energy in ML (J)224 (174-364)189 (155-381)0.5391.Time in ML (s)3.9 (3.5-4.9)3.4 (3.2-4.5)0.007*3.SinusoidGain in AP1.1 (1.0-1.3)1.1 (1.0-1.3)0.809 Eyes closedGain in ML0.3 (0.3-0.4)0.2 (0.2-0.3)<0.001* Eyes openGain in AP1.0 (0.8-1.3)0.7 (0.6-0.8)0.003*4.Limits of StabilitySurface (cm2)13.0 (10.0-15.0)21 (17.7-21.5)<0.001*

Data are presented as median and interquartile range. p value; Mann Whitney U Significance Test results between groups. (*): statistically significant difference (p<0.05). AP: Antero-posterior, ML: Medio-lateral

Figure 1.

Distribution of participants according to the number of positive criteria. The fallers met at least three criteria.

Conclusion

The results of this study showed that dynamic postural responses to destabilizing conditions are significantly altered in patients with RA compared to healthy controls. Determining the patient-specific fall risk is important in designing personalized rehabilitation programs and reducing the risk of injury.

References

[1]Armstrong C, Swarbrick CM, Pye SR, O’Neill TW. Occurrence and risk factors for falls in rheumatoid arthritis. Ann Rheum Dis. 2005;64(11):1602-4.

[2]Ghulyan V, Paolino M. Posturography for evaluating risk of falls in elderly unstable patients. Fr ORL. 2005;88:97-103.

Disclosure of Interests

None declared

Antifungal susceptibility, species distribution and risk factors associated with mortality of invasive candidiasis in children in Turkey: A six-year retrospective, single-centre study

Invasive candidiasis (IC) is a life-threatening fungal infection with high morbidity and mortality. In this study, we aimed to investigate the Candida species distribution and antifungal drug susceptibility and to identify the risk factors associated with IC mortality in children. We conducted a retrospective, single-centre study of paediatric IC in patients from a tertiary care hospital in Turkey between January 2013 and February 2019. A total of 56 Candida isolates underwent antifungal susceptibility testing performed by Sensititre YeastOne YO10 panel, and the demographic and clinical data of 65 patients were examined during the study period. The most commonly isolated species was Candida albicans in 30 patients (46%), followed by C. parapsilosis in 25 patients (38%) and C. tropicalis in three patients (5%). According to the antifungal drug susceptibility testing, C. albicans was fully susceptible to fluconazole and the other antifungal agents (100%). None of the isolates displayed resistance to anidulafungin, micafungin, flucytosine, posaconazole, voriconazole or itraconazole. There were low rates of resistance to fluconazole (1.8%), caspofungin (1.8%) and micafungin (1.8%). In addition, 5.3% of the Candida isolates were susceptible in a dose-dependent manner to itraconazole, 3.6% were susceptible to voriconazole and fluconazole and 1.8% were susceptible to anidulafungin. The mortality rate of IC was 15.4%. Thrombocytopenia after IC treatment was significantly associated with mortality in the multivariate analysis. These results, which help determine the species distribution, antifungal susceptibility patterns and risk factors for mortality, could make a significant contribution to the management of these challenging infections, including choosing appropriate empirical antifungal therapy.

Insecticidal effects of extracts of Humulus lupulus (hops) L. cones and its principal component, xanthohumol

Insecticidal effects of the dichloromethane, ethyl acetate, acetone, ethanol and methanol extracts of Humulus lupulus (hops) L. cones and its principal components, xanthohumol was investigated on five stored pests, Sitophilus granarius (L.), Sitophilus oryzae (L.), Acanthoscelides obtectus (Say.), Tribolium castaneum (Herbst) and Lasioderma serricorne (F.). The mortality of adults of the insects treated with 2, 5, 5, 10 and 20 mg ml̠-1 concentrations of the extracts and xanthuhumol was counted after 24, 48, 72, 96 and 120 h. In order to determine the toxic effects of the substances tested against all tested insects, durations for 50% mortality of the adults, and LD50 values were also determined in the first 48 h by probit analysis. Our results also showed that xanthohumol was more toxic against the pests in comparison with the extracts applications. LD50 values for xanthohumol were found to be low dose as compared with the extracts. Xanthohumol was more toxic against S. granarius (L.) with 6.8 µg of LD50 value. Among the extracts, methanol extract was less effective than other extracts against all tested insects. The ethyl acetate extract of H. lupulus cones was the most effective extract against the tested pests. The quantitative amounts of xanthohumol in the extracts were determined using a high-performance liquid chromatography. The quantitative data indicated that amount of xanthohumol in the extracts increased with increase of polarity of the solvents used from methanol to dichloromethane. The methanol extract contained the high amount of xanthohumol with 5.74 g/100 g extract (0.46 g/100 g plant sample).

The role of selected neuropeptides in pathogenesis of atopic dermatitis

BACKGROUND

Atopic dermatitis (AD) is an inflammatory skin disease of a chronic course. The role of neuropeptides in pathogenesis of this disorder is probably not crucial; however, there is evidence that these substances influence the development and course of AD.

OBJECTIVE

The aim of this study was to evaluate the plasma level of substance P, neuropeptide Y (NPY) and calcitonin gene related peptide (CGRP) in AD patients during exacerbation and remission of the disease.

MATERIAL AND METHODS

Forty-nine patients with AD, aged 17 to 56 years, participated in the study. Among this group, there were 25 males (51%) and 24 females (49%). The disease lasted from 1 to 55 years. The severity of the disease was assessed with SCORAD index. The severity of pruritus was evaluated with Visual Analog Scale and a specially designed questionnaire. Neuropeptides plasma level was detected with radioimmunoassay.

RESULTS

Substance P plasma level in AD patients during exacerbation and remission was significantly higher than in the control group. There was a negative correlation between substance P plasma level and total IgE level. CGRP plasma level during exacerbation of AD was significantly lower than in healthy controls and increased in the remission. Significantly higher CGRP concentration was observed in patients suffering from severe pruritus; however, both in patients with more and less severe pruritus, CGRP plasma level was lower than in controls. Higher CGRP plasma level was also observed in patients with more severe disease. NPY plasma level in patients with AD was significantly increased both during exacerbation and remission. During remission of AD, NPY concentration was higher than during exacerbation.

Evaluation of quality of life in patients with toenail onychomycosis by Polish version of an international onychomycosis-specific questionnaire

BACKGROUND

Onychomycosis is the most frequent nail disease, which could impair the patient's quality of life.

OBJECTIVE

The present study was undertaken to evaluate the impact of toenail onychomycosis on quality of life among Polish population.

PATIENTS AND METHODS

Three thousand nine-hundred and four (3904: 2269 females and 1635 males) individuals fulfilled an international onychomycosis-specific quality-of-life questionnaire consisting of statements regarding social, emotional and symptoms problems. All patients had toenail onychomycosis confirmed by the positive direct microscopic examination and/or by the positive mycologic culture. Seven hundred and sixty-seven patients simultaneously had fingernail onychomycosis. All patients were divided into subgroups according to sex, age, education level, place of living, type of onychomycosis, number of involved toenails, fingernails involvement, duration of illness and previously used antimycotic therapy.

RESULTS

Most of the patients demonstrated significantly reduced quality of life. The degree of life impairment varied between analysed subgroups. Patients with more advanced toenail onychomycosis and with fingernail involvement were more seriously affected. Both social and emotional impairments were more pronounced in female than in male patients, although there were no differences according to symptoms. Moreover, patients with better educational level and people living in towns or cities were more emotionally and socially affected by onychomycosis, although people living in the country or with poorer education level presented with significantly more severe symptoms.

CONCLUSIONS

Toenail onychomycosis is still a serious medical problem, which can significantly reduce the patient's quality of life.

Analysis of the incidence of fungal pathogens in air of the Department of Dermatology, Venereology and Allergology of Medical University in Wrocław

PURPOSE

Analysis of incidence of fungal pathogens in air of Department of Dermatology, Venereology and Allergology of Medical University in Wrocław.

MATERIAL AND METHODS

Materials for the tests were: the air samples in front of the building, corridors, library, lecture hall, and mycological laboratory. The air pollution was determined using SAS SUPER 100. Humidity and temperature were evaluated by a termohigrometr. Classification of the isolated fungi was made with an accordance to the current procedures.

RESULTS

From the air was isolated: in library 69 colonies (mean CFU 138 +/- 41.5), from the bookstands--25 colonies (mean CFU-125 +/- 63.6), lecture hall--119 colonies (mean CFU-380 +/- 98.8), mason room--52 colonies (mean CFU-104 +/- 21.9), mycological laboratory--154 colonies (mean CFU-513 +/- 155.3). Temperature in the tested rooms ranged from 24.5 degrees C (mason room) to 26.1 degrees C (library), humidity ranged from 40.1%-53.1%. Temperature outside of the building was 23.6 degrees C, and humidity 51.6%. Moulds Peniciullium citricum and Aspergillus niger and the yeasts Candida albicans were isolated more frequently.

CONCLUSIONS

The highest number of fungi colonies were isolated from the air sampled at the lecture hall and mycological laboratory. Moulds were the most common airborne fungi. Temperature and huimidity in the tested rooms are good conditions for the development of fungi.

CTLA-4 gene polymorphisms and natural soluble CTLA-4 protein in psoriasis vulgaris

CTLA-4 molecule is an important inhibitor of T-lymphocyte activation. Several single nucleotide polymorphisms (SNPs) in the CTLA-4 gene were found, and their associations with many human diseases were described. So far, however, such studies have not been performed in psoriasis vulgaris in Caucasoids. Therefore, we examined the distribution of three CTLA-4 SNPs: -1147C/T, -318C/T and +49 A/G in 116 patients with psoriasis vulgaris and 123 healthy blood donors using the polymerase chain reaction-restriction fragment length polymorphism method. For all three SNPs, the frequencies of alleles, genotypes and three-point haplotypes were very similar in patients and controls, suggesting no contribution of these genetic variants to psoriasis.