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Yang Z, Fang W, Wang Q, Li Y. A case report of transcatheter aortic valve replacement in a patient with Sjögren's syndrome and aortic stenosis. Eur Heart J Case Rep 2024; 8:ytad622. [PMID: 38152120 PMCID: PMC10751622 DOI: 10.1093/ehjcr/ytad622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 11/29/2023] [Accepted: 12/07/2023] [Indexed: 12/29/2023]
Abstract
Background The co-existence of Sjögren's syndrome and aortic stenosis (AS) is infrequent, and there lack cases of transcatheter aortic valve replacement (TAVR) for these patients with detailed management decision-making. Case summary We report a case of a female patient who had AS and Sjögren's syndrome with leukopaenia and thrombocytopaenia. To overcome co-existing hyper-coagulation and high thrombogenesis risk, difficult lifetime valve management, and high infection risk, we performed TAVR with 3D printing and formulated antithrombotic and antibiotic schemes. Conclusion This case provided a successful experience of TAVR in patients with Sjögren's syndrome. Long-term follow-up will be conducted, and optimization of the therapeutic regimen requires further exploration.
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Affiliation(s)
- Zhenyu Yang
- Department of Cardiology, Tangdu Hospital, Air Force Medical University, Tangdu Hospital, 1 Xinsi Road, Baqiao District, Xi'an, Shaanxi, Province, China
| | - Wei Fang
- Department of Cardiology, Tangdu Hospital, Air Force Medical University, Tangdu Hospital, 1 Xinsi Road, Baqiao District, Xi'an, Shaanxi, Province, China
| | - Qiuhe Wang
- Department of Cardiology, Tangdu Hospital, Air Force Medical University, Tangdu Hospital, 1 Xinsi Road, Baqiao District, Xi'an, Shaanxi, Province, China
| | - Yan Li
- Department of Cardiology, Tangdu Hospital, Air Force Medical University, Tangdu Hospital, 1 Xinsi Road, Baqiao District, Xi'an, Shaanxi, Province, China
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Malve H, More D, More A. Effects of two formulations containing Phyllanthus emblica and Tinospora cordifolia with and without Ocimum sanctum in immunocompromised mice. J Ayurveda Integr Med 2021; 12:682-688. [PMID: 34799208 PMCID: PMC8642715 DOI: 10.1016/j.jaim.2021.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 05/30/2021] [Accepted: 06/26/2021] [Indexed: 11/06/2022] Open
Abstract
Background Current pandemic has led us to explore the role of traditional system of medicine to look for formulations that enhance immunity. Objective The obejctive of this experimental study was to evaluate the immunomodulatory effects of two formulations, Tinospora cordifolia (Tc) and Phyllanthus emblica (Pe) with and without coating of Ocimum sanctum (Os). Materials and methods After obtaining Institutional Animal Ethics Committee approval, present experimental study was conducted to evaluate the immunomodulatory effects of plant drug formulations against infection induced in mice subjected to major surgical stress. Hemisplenectomy was selected to induce major stress and the procedure for hemisplenectomy was standardized. A model of secondary fungal infection after hemisplenectomy was established followed by the treatment of mice with plant drugs and controls. They were subjected to hemisplenectomy or sham operation and 105 C. albicans were injected intravenously. The therapy continued for next 14 days. Kidneys were isolated to estimate fungal load. Fungal load of the kidneys was estimated on post-operative Day 15. Results The test formulations Tc + Pe and Tc + Pe + Os showed significant reduction in the fungal burden of kidneys as compared to hemisplenectomized control group. However, Tc alone exerted better degree of protection as compared to Tc + Pe and Tc + Pe + Os. Conclusion The formulations, Tc + Pe and Tc + Pe + Os that were developed on the basis of theoretical concepts were not found to be superior to Tc. Though the individual ingredients have been shown to possess immunnostimulant activities, in combination, Pe and Os blunted the effects of Tc. The basis for this drug interaction needs further exploration. Thus, the current experimental study validates immunomodulatory role of Tc. However, the addition of Pe with bhavana of Os does not lead to any augmentation of immunomodulatory activity of Tc. This study also underlines the need to generate data on Ayurveda formulations to understand the rationality of the multi-ingredient Ayurvedic formulations.
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Affiliation(s)
- Harshad Malve
- Department of Pharmacology, Vedanta Institute of Medical Sciences, Dahanu, India.
| | - Dipti More
- Department of Pediatrics, Lokmanya Tilak Municipal General Hospital and Medical College, Sion, Mumbai, India
| | - Ashwini More
- Department of Medicine, Vedanta Institute of Medical Sciences, Dahanu, India
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McDonald JA, Cherubin S, Goldberg M, Wei Y, Chung WK, Schwartz LA, Knight JA, Schooling CM, Santella RM, Bradbury AR, Buys SS, Andrulis IL, John EM, Daly MB, Terry MB. Common Childhood Viruses and Pubertal Timing: The LEGACY Girls Study. Am J Epidemiol 2021; 190:766-778. [PMID: 33128063 DOI: 10.1093/aje/kwaa240] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 10/13/2020] [Accepted: 10/20/2020] [Indexed: 12/12/2022] Open
Abstract
Earlier pubertal development is only partially explained by childhood body mass index; the role of other factors, such as childhood infections, is less understood. Using data from the LEGACY Girls Study (North America, 2011-2016), we prospectively examined the associations between childhood viral infections (cytomegalovirus (CMV), Epstein-Barr virus (EBV), herpes simplex virus (HSV) 1, HSV2) and pubertal timing. We measured exposures based on seropositivity in premenarcheal girls (n = 490). Breast and pubic hair development were classified based on mother-reported Tanner Stage (TS) (TS2+ compared with TS1), adjusting for age, body mass index, and sociodemographic factors. The average age at first blood draw was 9.8 years (standard deviation, 1.9 years). The prevalences were 31% CMV+, 37% EBV+, 14% HSV1+, 0.4% HSV2+, and 16% for both CMV+/EBV+ coinfection. CMV+ infection without coinfection was associated with developing breasts an average of 7 months earlier (hazard ratio (HR) = 2.12, 95% confidence interval (CI): 1.32, 3.40). CMV infection without coinfection and HSV1 and/or HSV2 infection were associated with developing pubic hair 9 months later (HR = 0.41, 95% CI: 0.24, 0.71, and HR = 0.42, 95% CI: 0.22, 0.81, respectively). Infection was not associated with menarche. If replicated in larger cohorts with blood collection prior to any breast development, this study supports the hypothesis that childhood infections might play a role in altering pubertal timing.
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King T, Faiman B. Steroid-Associated Side Effects: A Symptom Management Update on Multiple Myeloma Treatment
. Clin J Oncol Nurs 2017; 21:240-249. [PMID: 28315528 DOI: 10.1188/17.cjon.240-249] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND One constant and relatively unchanged aspect of treatment of multiple myeloma (MM) is the use of glucocorticosteroids, or steroids, which can cause a wide range of adverse side effects and harm patients' quality of life.
. OBJECTIVES The objective of this study was to provide updated recommendations on the management of steroid-associated side effects in patients with MM.
. METHODS A study of steroid-associated side effects in MM treatment regimens was reviewed to provide updated recommendations to healthcare professionals. FINDINGS Identifying the side effects of steroids and managing them promptly contribute to the success of steroid-containing regimens for patients with MM.
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The impact of hyperglycemia on risk of severe infections during early period of induction therapy in patients with newly diagnosed multiple myeloma. BIOMED RESEARCH INTERNATIONAL 2014; 2014:413149. [PMID: 24822205 PMCID: PMC4009179 DOI: 10.1155/2014/413149] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 04/08/2014] [Accepted: 04/08/2014] [Indexed: 12/29/2022]
Abstract
The association between hyperglycemia and infections during induction chemotherapy has been reported in a number of hematologic disorders. This retrospective study evaluated the incidence of hyperglycemia during induction therapy in 155 patients with newly diagnosed multiple myeloma (MM) and its effect on serious infections during the first 60 days of induction. A total of 20 (12.9%) patients developed overt hyperglycemia (≥200 mg/dL) during induction therapy. Serious infections occurred in 28 (18.1%) of 155 patients and infection-related mortality within 2 months after treatment was 0.6% (1 patient). In a univariate analysis, overt hyperglycemia, poor performance status (≥2), International Staging System III, lymphopenia (<500/μL), and elevated serum creatinine (≥2 mg/dL) were found to be associated with serious infections. In multivariate analysis, only overt hyperglycemia (HR 7.846, 95% CI 2.512–24.503, P < 0.001) and poor performance status (HR 5.801, 95% CI 1.974–17.050, P = 0.001) remained significant. In conclusion, this study demonstrated an association between hyperglycemia and serious infections during induction therapy in patients with MM.
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Escribese MM, Rodríguez-García M, Sperling R, Engel SM, Gallart T, Moran TM. Alpha-defensins 1-3 release by dendritic cells is reduced by estrogen. Reprod Biol Endocrinol 2011; 9:118. [PMID: 21861873 PMCID: PMC3175176 DOI: 10.1186/1477-7827-9-118] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 08/23/2011] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND During pregnancy the immune system of the mother must protect any activation that may negatively affect the fetus. Changes in susceptibility to infection as well as resolution of some autoimmune disorders represent empirical evidence for pregnancy related alterations in immunity. Sex hormones reach extremely high levels during pregnancy and have been shown to have direct effects on many immune functions including the antiviral response of dendritic cells. Among the immunologically active proteins secreted by monocyte derived DCs (MDDC) are the alpha-defensins 1-3. This family of cationic antimicrobial peptides has a broad spectrum of microbicidal activity and has also been shown to link innate to adaptive immunity by attracting T cells and immature DCs, which are essential for initiating and polarizing the immune response. METHODS We compare culture-generated monocyte derived DCs (MDDCs) with directly isolated myeloid dendritic cells (mDCs) and plasmacytoid dendritic cells (pDCs) and measure their alpha-defensins 1-3 secretion by ELISA both, in basal situations and after hormone (E2 or PG) treatments. Moreover, using a cohort of pregnant women we isolated mDCs from blood and also measure the levels of these anti-microbial peptides along pregnancy. RESULTS We show that mDCs and pDCs constitutively produce alpha-defensins 1-3 and at much higher levels than MDDCs. Alpha-defensins 1-3 production from mDCs and MDDCs but not pDCs is inhibited by E2. PG does not affect alpha-defensins 1-3 in any of the populations. Moreover, alpha-defensins 1-3 production by mDCs was reduced in the later stages of pregnancy in 40% of the patients. CONCLUSIONS Here, we demonstrate that mDCs and pDCs secrete alpha-defensins 1-3 and present a novel effect of E2 on the secretion of alpha-defensins 1-3 by dendritic cells.
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Affiliation(s)
- Maria M Escribese
- Department of Microbiology, Mount Sinai School of Medicine, New York, NY, USA
- Immunology Institute, Mount Sinai School of Medicine, New York, NY, USA
- Department of Molecular Microbiology and Infections Biology, CIB, CSIC, Madrid, Spain
| | - Marta Rodríguez-García
- Service of Immunology, Hospital Clinic Universitari de Barcelona, Barcelona, Spain
- Department of Physiology, Dartmouth Medical School, Lebanon, New Hampshire, USA
| | - Rhoda Sperling
- Department of Obstetrics, Gynecology and Reproductive Sciences, Mount Sinai School, of Medicine, New York, NY,USA
| | - Stephanie M Engel
- Department of Preventive Medicine, Mount Sinai School of Medicine, New York, NY, USA
| | - Teresa Gallart
- Service of Immunology, Hospital Clinic Universitari de Barcelona, Barcelona, Spain
| | - Thomas M Moran
- Department of Microbiology, Mount Sinai School of Medicine, New York, NY, USA
- Immunology Institute, Mount Sinai School of Medicine, New York, NY, USA
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Veverka DV, Wilson C, Martinez MA, Wenger R, Tamosuinas A. Use of zinc supplements to reduce upper respiratory infections in United States Air Force Academy Cadets. Complement Ther Clin Pract 2009; 15:91-5. [DOI: 10.1016/j.ctcp.2009.02.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Escribese MM, Kraus T, Rhee E, Fernandez-Sesma A, López CB, Moran TM. Estrogen inhibits dendritic cell maturation to RNA viruses. Blood 2008; 112:4574-84. [PMID: 18802009 PMCID: PMC2597128 DOI: 10.1182/blood-2008-04-148692] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2008] [Accepted: 08/26/2008] [Indexed: 12/29/2022] Open
Abstract
Dendritic cells (DCs) play a central role in initiating and polarizing the immune response. Therefore, DC maturation represents a key control point in the shift from innate to adaptive immunity. It is suspected that during pregnancy, hormones are critical factors that modulate changes reported to occur in maternal immunity. Here we examined the effect of 17-beta-estradiol (E2) on the maturational response triggered by virus in human DCs and its influence on their ability to activate naive T cells. We developed an in vitro system to measure the response of DCs to virus infection with Newcastle disease virus (NDV) after a 24-hour E2 treatment. Using this system, we demonstrated that E2 pretreatment down-regulated the antiviral response to RNA viruses in DCs by profoundly suppressing type I interferon (IFN) synthesis and other important inflammatory products. In addition, the DCs capacity to stimulate naive CD4 T cells was also reduced. These results suggest an important role for E2 in suppressing the antiviral response and provide a mechanism for the reduced immunity to virus infection observed during pregnancy.
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Affiliation(s)
- Maria M Escribese
- Department of Microbiology, The Immunology Institute, Mount Sinai School of Medicine, New York, NY 10029, USA
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