HLA genetic polymorphisms and prognosis of patients with COVID-19

Objective

Different genetic polymorphisms of human leukocyte antigen (HLA) have been associated with the risk and prognosis of autoimmune and infectious diseases. The objectives of this study were to determine whether there is an association between HLA genetic polymorphisms and the susceptibility to and mortality of coronavirus disease 2019 (COVID-19) patients.

Design

Observational and prospective study.

Setting

Eight Intensive Care Units (ICU) from 6 hospitals of Canary Islands (Spain).

Patients

COVID-19 patients admitted in ICU and healthy subjects.

Interventions

Determination of HLA genetic polymorphisms.

Main variable of interest

Mortality at 30 days.

Results

A total of 3886 healthy controls and 72 COVID-19 patients (10 non-survivors and 62 survivor patients at 30 days) were included. We found a trend to a higher rate of the alleles HLA-A*32 (p = 0.004) in healthy controls than in COVID-19 patients, and of the alleles HLA-B*39 (p = 0.02) and HLA-C*16 (p = 0.02) in COVID-19 patients than in healthy controls; however, all these p-values were not significant after correction for multiple comparisons. Logistic regression analysis showed that the presence of certain alleles was associated with higher mortality, such as the allele HLA-A*11 after controlling for SOFA (OR = 7.693; 95% CI = 1.063-55.650; p = 0.04) or APACHE-II (OR = 11.858; 95% CI = 1.524-92.273; p = 0.02), the allele HLA-C*01 after controlling for SOFA (OR = 11.182; 95% CI = 1.053-118.700; p = 0.04) or APACHE-II (OR = 17.604; 95% CI = 1.629-190.211; p = 0.02), and the allele HLA-DQB1*04 after controlling for SOFA (OR = 9.963; 95% CI = 1.235-80.358; p = 0.03).

Conclusions

The new finding from our preliminary study of small sample size was that HLA genetic polymorphisms could be associated with COVID-19 mortality; however, studies with a larger sample size before definitive conclusions can be drawn.

HLA genetic polymorphisms and prognosis of patients with COVID-19

Objective

Different genetic polymorphisms of human leukocyte antigen (HLA) have been associated with the risk and prognosis of autoimmune and infectious diseases. The objectives of this study were to determine whether there is an association between HLA genetic polymorphisms and the susceptibility to and mortality of coronavirus disease 2019 (COVID-19) patients.

Design

Observational and prospective study.

Setting

Eight Intensive Care Units (ICU) from 6 hospitals of Canary Islands (Spain).

Patients

COVID-19 patients admitted in ICU and healthy subjects.

Interventions

Determination of HLA genetic polymorphisms.

Main variable of interest

Mortality at 30 days.

Results

A total of 3886 healthy controls and 72 COVID-19 patients (10 non-survivors and 62 survivor patients at 30 days) were included. We found a trend to a higher rate of the alleles HLA-A*32 (p = 0.004) in healthy controls than in COVID-19 patients, and of the alleles HLA-B*39 (p = 0.02) and HLA-C*16 (p = 0.02) in COVID-19 patients than in healthy controls; however, all these p-values were not significant after correction for multiple comparisons. Logistic regression analysis showed that the presence of certain alleles was associated with higher mortality, such as the allele HLA-A*11 after controlling for SOFA (OR = 7.693; 95% CI = 1.063–55.650; p = 0.04) or APACHE-II (OR = 11.858; 95% CI = 1.524–92.273; p = 0.02), the allele HLA-C*01 after controlling for SOFA (OR = 11.182; 95% CI = 1.053–118.700; p = 0.04) or APACHE-II (OR = 17.604; 95% CI = 1.629–190.211; p = 0.02), and the allele HLA-DQB1*04 after controlling for SOFA (OR = 9.963; 95% CI = 1.235–80.358; p = 0.03).

Conclusions

The new finding from our preliminary study of small sample size was that HLA genetic polymorphisms could be associated with COVID-19 mortality; however, studies with a larger sample size before definitive conclusions can be drawn.

Single-Staged Management of Pediatric Neuropathic Scoliosis with Intradural-Extramedullary Schwannoma and Improvement in Intraoperative Neuromonitoring: A Case Report

CASE

A 16-year-old girl with lumbar prominence presented to our outpatient clinic complaining of sporadic back pain without paresthesia. Radiographic investigation revealed a 68° left thoracolumbar curve with the apex at L1. Preoperative magnetic resonance imaging identified a mass at T10-11, subsequently confirmed by pathology as a schwannoma. She was treated surgically with resection and posterior spinal fusion in a single-staged procedure under neuromonitoring guidance. Intraoperative improvement in motor evoked potentials after resection informed the decision to perform simultaneous deformity correction.

CONCLUSION

We discuss the unusual coincidence of a schwannoma with scoliosis and our management algorithm based on operative changes in neuromonitoring.

Alveolar antral artery in edentulous patients and their visualization through cone beam computed tomography

OBJECTIVE OF THE STUDY

The aim of this study was to assess the anatomical features of the alveolar antral artery (AAA) in edentulous patients using cone beam computed tomography (CBCT).

PATIENTS

The sample consisted of 191 CBCT scans of maxillary sinuses (n=382) of male (n=59) and female (n=132) edentulous patients (age: 38-89 years).

MATERIAL AND METHODS

The images were analyzed in Dolphin™ 11.9 software. Visualization, location, and diameter of the AAA was registered.

RESULTS

AAA was present in 88.5% of the assessed maxillary sinuses. Bilateral visualization was predominant 77% (P<0.0001). The mean vertical distance from the most anterior part of the AAA to the sinus floor was 7.9±6mm in female patients (both sides) and 12±7.22mm on the right side and 10.9±6.86mm on the left side in males. The mean diameter of the AAA was 1.2±0.7mm on both sides in females. In males, the diameter was significantly (P<0.05) larger: 1.5±0.62mm on the right side and 1.4±0.69 on the left side in females.

CONCLUSION

The AAA had a higher visualization rate, better visualization, and larger diameter when it was present bilaterally in male and female patients.

Characterization of circulating immune cells in acute Kawasaki disease suggests exposure to different antigens

Kawasaki disease (KD) is an acute pediatric vasculitis of unknown etiology that can cause coronary artery aneurysms, and is the leading cause of acquired heart disease in children. We studied aspects of the innate and adaptive immune response in 17 acute KD children prior to treatment with intravenous immunoglobulin. Distinct patterns within the innate immune response correlated with specific clinical features. Proinflammatory myeloid dendritic cells (mDC) were abundant in four of 17 (23·5%) subjects who were older and manifested severe inflammation with clinical myocarditis and elevated hepatobiliary enzyme levels. Of the nine subjects with low levels of anti‐inflammatory, tolerogenic mDC, six had enlarged cervical lymph nodes at diagnosis. In contrast, the adaptive immune repertoire varied greatly with no discernible patterns or associations with clinical features. Two subjects with aneurysms had numerous circulating CD8⁺ T cells. Ten subjects showed low CD4⁺ T cell numbers and seven subjects had CD4⁺ T cells in the normal range. CD4⁺ T cells expressed interleukin‐7 receptor (IL‐7R), suggesting repeated antigenic stimulation. Thymic‐derived regulatory T cells (nT_reg) and peripherally induced regulatory T cells (iT_reg) were also enumerated, with the majority having the nT_reg phenotype. Natural killer (NK) and NK T cell numbers were similar across all subjects. Taken together, the results of the immune monitoring suggest that KD may have multiple triggers that stimulate different arms of the innate and adaptive compartment in KD patients. Thus, it is possible that diverse antigens may participate in the pathogenesis of KD.

Predictors of incomplete viral response and virologic failure in patients with acute and early HIV infection. Results of Italian Network of ACuTe HIV InfectiON (INACTION) cohort

OBJECTIVES

The aim of this study was to evaluate the factors that can influence an incomplete viral response (IVR) after acute and early HIV infection (AEHI).

METHODS

This was a retrospective, observational study including patients with AEHI (Fiebig stages I-V) diagnosed between January 2008 and December 2014 at 20 Italian centres. IVR was defined by: (1) viral blip (51-1000 HIV-1 RNA copies/mL after achievement of < 50 HIV-1 RNA copies/mL); (2) virologic failure [> 1000 copies/mL after achievement of < 200 copies/mL, or ≥ 200 copies/mL after 24 weeks on an antiretroviral therapy (ART)]; (3) suboptimal viral response (> 50 copies/mL after 48 weeks on ART or two consecutive HIV-1 RNA levels with ascending trend during ART). Cox regression analysis was used to calculate the hazard ratios (HRs) and 95% confidence intervals (95% CIs) for IVR.

RESULTS

In all, 263 patients were studied, 227 (86%) males, with a median [interquartile range (IQR)] age of 38 (30-46) years. During a median follow-up of 13.0 (5.7-31.1) months, 38 (14.4%) had IVR. The presence of central nervous system (CNS) symptoms was linked to a higher risk of IVR (HR = 4.70, 95% CI: 1.56-14.17), while a higher CD4/CD8 cell count ratio (HR = 0.13, 95% CI: 0.03-0.51 for each point increase) and first-line ART with three-drug regimens recommended by current guidelines (HR = 0.40, 95% CI: 0.18-0.91 compared with other regimens including four or five drugs, older drugs or non-standard backbones) were protective against IVR.

CONCLUSIONS

Patients with lower CD4/CD8 ratio and CNS symptoms could be at a higher risk of IVR after AEHI. The use of recommended ART may be relevant for improving short-term viral efficacy in this group of patients.

Revisiting autopsies of death by mechanical asphyxia in the search for post-mortem pink teeth

BACKGROUND

In contemporary forensic practice, Medicine and Dentistry combine forces to improve the search for the cause of death and human identification. The pink tooth phenomenon (PTP) is a cadaveric sign that allegedly manifests more often in victims of asphyxia. However, the scientific literature is scarce and controversial on this aspect.

OBJECTIVE

This study aimed at screening victims of mechanical asphyxia in order to search for post-mortem pink teeth.

MATERIAL AND METHODS

Retrospectively, autopsy reports from a local medico-legal institute in South Brazil were revisited in the search for victims of death by asphyxia. Autopsy reports of twenty one victims aged between 6 and 67 years (mean age: 40.6 years ±19.20; median: 37 years) were found and analyzed.

RESULTS

The different modalities of asphyxia included drowning (n=7; 33.33%), strangulation (n=1; 4.76%) and hanging (n=13; 61.91%). A single case of PTP was detected (4.76%) - a 26-year-old male victim of hanging.

CONCLUSION

This study illustrates and highlights the unspecific aspect of the PTP. In practice, forensic experts must avoid interpretations of this phenomenon as conclusive evidence of the cause of death, such as asphyxia by drowning, strangulation or hanging.

Marginal bone loss in the second molar related to impacted mandibular third molars: comparison between panoramic images and cone beam computed tomography

Background

Deciding whether or not to extract third molars remains a controversial situation in dental practice. Image exams support this decision by enabling a close view of the third molar, its adjacent bone and its relationship with the second molar. This study aimed to assess and compare second molar bone loss adjacent to impacted mandibular third molar in panoramic radiographs (PAN) and cone beam computed tomography (CBCT) scans.

Material and Methods

A sample of 70 patients was selected (n=124 teeth). Each patient had a set of a panoramic radiograph and CBCT scans consecutively taken for dental treatment purposes. In PAN and CBCT, mandibular third molars were classified based on their position and bone loss of the adjacent second molar. Agreement between PAN and CBCT scans was assessed and quantified.

Results

Outcomes of bone loss assessment were different between PAN and CBCT scans (p<0.05). Bone loss was found in 62.9% of the PAN, while in CBCT scans it was found in 80%. In particular, nearly 29% (n=27) of the teeth that were classified without bone loss in PAN were classified with bone loss in CBCT scans. Mesioangular and horizontal third molars had a statistically significant association with bone loss of the adjacent second molars (p<0.05). In general, PAN underestimated the severity of bone loss compared to CBCT scans (p<0.05).

Conclusions

Diagnosing second molar bone loss due to impaction of adjacent third molar in PAN may be challenging because of false negatives. Impacted third molars justify preoperative CBCT scans if second molar bone loss needs to be precisely assessed for a more detailed and reliable treatment plan.

Key words:Bone, CBCT, panoramic radiograph, third molar.

Synthesis of ribonucleotides from the corresponding ribonucleosides under plausible prebiotic conditions within self-assembled supramolecular structures

Abiotic synthesis of ribonucleotides, mainly at the 5′ position, from the corresponding ribonucleosides within guanosine:borate hydrogels in the temperature range of 70–90 °C, using urea and a phosphate source (K₂HPO₄ or hydroxyapatite).

Morphologic alterations ear, nose and lip detected with aging through facial photoanthropometric analysis

BACKGROUND

Understanding the morphologic alterations of the human face over the time is an essential step towards optimal simulations of facial age progression. In practice, these simulations contribute to the forensic routine by tracking and recognizing missing persons.

OBJECTIVE

This study aimed to assess the morphometric facial alterations with aging - concerning specifically the development of ear, nose and lip in relation to other facial structures.

MATERIAL AND METHODS

The sample consisted of 700 photographs taken standardly in frontal view from male and female Caucasian subjects aged from 20 to 80 years old. The sample was divided in 7 age groups (20, 30, 40, 50, 60, 70 and 80 years old), in which 50 males and 50 females were distributed homogenously. Photoanthropometric analysis was applied with SAFF 2D® 2.0.05 (SEPAEL/INC, Federal Police, Brazil) software package considering 36 facial landmarks. A single examiner analyzed the sample aided by two other examiners for the assessment of intra-/inter-rater reliability.

RESULTS

The most evident alterations found in the facial structures consisted of the enlargement of the nose and ears with aging, as well the reduction in size of the lip thickness. These alterations varied considerably in the specific age ranges studied in this research being different between males and females.

CONCLUSION

The present outcomes indicated the possibility of quantifying morphometric alterations observed in the human face with aging. These alterations may support the forensic practice providing tools for age estimation based on photographic analyses.

Cone beam computed tomography study on the relation between mental foramen and roots of mandibular teeth, presence of anterior loop and satellite foramina

PURPOSE

To investigate the position of the mental foramen based on its relation with the roots of the mandibular teeth and quantify the prevalence of anterior loop and satellite foramina in the mandible in cone beam computed tomography (CBCT) scans.

METHODS

The sample consisted of 400 CBCT scans of males (n=190) and females (n=210) from Moscow, Russia. Using the system proposed by Tebo and Telford (1950), the position of the mental foramen was classified into: I) mesial to the mandibular first premolar; II) at the apex of the mandibular first premolar; III) between the roots of the mandibular first and second premolars; IV) at the apex of the mandibular second premolar; V) between the roots of the mandibular second premolar and first molar; and VI) at the apex of the roots of the mandibular first molar. Additionally, the images were assessed to investigate the prevalence of the anterior loop of the mandibular canal and the presence of satellite foramina.

RESULTS

Mental foramen position class III was the most prevalent (61%) followed by class IV (27%), II (8%), I, V and VI (together <4%). Statistically significant differences were not detected between males and females (P<0.05). In Russian males and females, the anterior loop of the mandibular canal was found in 15.78% and 3%, respectively; while satellite foramina were found in 31.58% and 19.62%, respectively.

CONCLUSION

The spatial position of the mental foramen and the morphological alterations of the mandibular canal and adjacent foramina must be known prior to surgical interventions in the mandible.