Cognitive performance of GBA mutation carriers with early-onset PD: the CORE-PD study

OBJECTIVE

To assess the cognitive phenotype of glucocerebrosidase (GBA) mutation carriers with early-onset Parkinson disease (PD).

METHODS

We administered a neuropsychological battery and the University of Pennsylvania Smell Identification Test (UPSIT) to participants in the CORE-PD study who were tested for mutations in PARKIN, LRRK2, and GBA. Participants included 33 GBA mutation carriers and 60 noncarriers of any genetic mutation. Primary analyses were performed on 26 GBA heterozygous mutation carriers without additional mutations and 39 age- and PD duration-matched noncarriers. Five cognitive domains, psychomotor speed, attention, memory, visuospatial function, and executive function, were created from transformed z scores of individual neuropsychological tests. Clinical diagnoses (normal, mild cognitive impairment [MCI], dementia) were assigned blind to genotype based on neuropsychological performance and functional impairment as assessed by the Clinical Dementia Rating (CDR) score. The association between GBA mutation status and neuropsychological performance, CDR, and clinical diagnoses was assessed.

RESULTS

Demographics, UPSIT, and Unified Parkinson's Disease Rating Scale-III performance did not differ between GBA carriers and noncarriers. GBA mutation carriers performed more poorly than noncarriers on the Mini-Mental State Examination (p = 0.035), and on the memory (p = 0.017) and visuospatial (p = 0.028) domains. The most prominent differences were observed in nonverbal memory performance (p < 0.001). Carriers were more likely to receive scores of 0.5 or higher on the CDR (p < 0.001), and a clinical diagnosis of either MCI or dementia (p = 0.004).

CONCLUSION

GBA mutation status may be an independent risk factor for cognitive impairment in patients with PD.

The relation between depression and parkin genotype: the CORE-PD study

BACKGROUND

Mutations in parkin are a known genetic risk factor for early onset Parkinson's disease (EOPD) but their role in non-motor manifestations is not well established. Genetic factors for depression are similarly not well characterized. We investigate the role of parkin mutations in depression among those with EOPD and their relatives.

METHODS

We collected psychiatric information using the Patient Health Questionnaire and Beck Depression Inventory II on 328 genotyped individuals including 88 probands with early onset PD (41 with parkin mutations, 47 without) and 240 first and second-degree relatives without PD.

RESULTS

Genotype was not associated with depression risk among probands. Among unaffected relatives of EOPD cases, only compound heterozygotes (n = 4), and not heterozygotes, had significantly increased risk of depressed mood (OR = 14.1; 95% CI 1.2-163.4), moderate to severe depression (OR = 17.8; 95% CI 1.0-332.0), depression (score ≥ 15) on the Beck Depression Inventory II (BDI-II) (OR = 51.9; 95% CI 4.1-657.4), and BDI-II total depression score (β = 8.4; 95% CI 2.4-11.3) compared to those without parkin mutations.

CONCLUSIONS

Relatives of EOPD cases with compound heterozygous mutations and without diagnosed PD may have a higher risk of depression compared to relatives without parkin mutations. These findings support evidence of a genetic contribution to depression and may extend the phenotypic spectrum of parkin mutations to include non-motor manifestations that precede the development of PD.

Olfaction in Parkin heterozygotes and compound heterozygotes: the CORE-PD study

BACKGROUND

While Parkinson disease (PD) is consistently associated with impaired olfaction, one study reported better olfaction among Parkin mutation carriers than noncarriers. Whether olfaction differs between Parkin mutation heterozygotes and carriers of 2 Parkin mutations (compound heterozygotes) is unknown.

OBJECTIVE

To assess the relationship between Parkin genotype and olfaction in PD probands and their unaffected relatives.

METHODS

We administered the University of Pennsylvania Smell Identification Test (UPSIT) to 44 probands in the Consortium on Risk for Early-Onset Parkinson Disease study with PD onset ≤50 years (10 Parkin mutation heterozygotes, 9 compound heterozygotes, 25 noncarriers) and 80 of their family members (18 heterozygotes, 2 compound heterozygotes, 60 noncarriers). In the probands, linear regression was used to assess the association between UPSIT score (outcome) and Parkin genotype (predictor), adjusting for covariates. Among family members without PD, we compared UPSIT performance in heterozygotes vs noncarriers using generalized estimating equations, adjusting for family membership, age, gender, and smoking.

RESULTS

Among probands with PD, compound heterozygotes had higher UPSIT scores (31.9) than heterozygotes (20.1) or noncarriers (19.9) (p < 0.001). These differences persisted after adjustment for age, gender, disease duration, and smoking. Among relatives without PD, UPSIT performance was similar in heterozygotes (32.5) vs noncarriers (32.4), and better than in heterozygotes with PD (p = 0.001).

CONCLUSION

Olfaction is significantly reduced among Parkin mutation heterozygotes with PD but not among their heterozygous relatives without PD. Compound heterozygotes with PD have olfaction within the normal range. Further research is required to assess whether these findings reflect different neuropathology in Parkin mutation heterozygotes and compound heterozygotes.

Epidemiology of candidemia in oncology patients: a 6-year survey in a Portuguese central hospital

This study presents data on the incidence of candidemia in a Portuguese oncology hospital during a 6-year period. The species distribution and their antifungal susceptibility, as well as the clinical outcomes associated with candidemia were evaluated. A total of 119 episodes were reported, with the majority occurring among patients older than 56 years. The most common underlying medical conditions were solid tumors (64.5%) and hematological disease (28.2%). The most frequent species found was Candida albicans (48.7%), followed by C. parapsilosis (20.2%), C. tropicalis (8.4%), C. krusei (6.7%) and C. glabrata (5.0%), but Saccharomyces cerevisiae and Rhodotorula mucilaginosa were also isolated. Candida albicans was more frequently associated with solid tumors of the gastrointestinal and genitourinary tracts and breast (P=0.005), while non-C. albicans Candida species were most frequently recovered from hematological patients (P=0.007). The mortality rate associated with candidemia was 31.9% (P=0.016). All C. albicans and C. parapsilosis isolates were susceptible to fluconazole, voriconazole and itraconazole. Resistance to caspofungin was only observed in C. albicans and in the R. mucilaginosa isolates. Posaconazole was active against all C. parapsilosis isolates tested but resistant strains were found among C. albicans (4.9%), C. tropicalis (12.5%), C. krusei (25%) and C. glabrata (50%). This study provides useful information regarding the local epidemiology of candidemia in cancer patients.

[Inherited aplastic anemias]

The inherited aplastic anaemias are a heterogeneous group of disorders characterized by bone marrow failure, frequent association with one or more somatic anomalies and increased risk of cancer. They are rare disorders, usually diagnosed at paediatric age, and have significant premature mortality. The authors report 11 cases of inherited aplastic anaemias, 8 of Fanconi's anaemia and 3 of Dyskeratosis congenita. These cases were diagnosed in the last 14 years in the Dona Estefânia Hospital.

Relationship between Changes in Thymic Emigrants and Cell-Associated HIV-1 Dna in HIV-1-Infected Children Initiating Antiretroviral Therapy

Objectives and methods

To investigate the relationship between cell-associated HIV-1 dynamics and recent thymic T-cell emigrants, HIV-1 DNA and T-cell receptor rearrangement excision circles (TREC, a marker of recent thymic emigrants) were measured in peripheral blood mononuclear cells in 181 samples from 33 HIV-1-infected children followed for 96 weeks after antiretroviral therapy (ART) initiation.

Results

At baseline, HIV-1 DNA was higher in children with higher TREC ( P=0.02) and was not related to age, CD4 or HIV-1 RNA in multivariate analyses ( P>0.3). Overall, TREC increased and HIV-1 DNA decreased significantly after ART initiation, with faster HIV-1 DNA declines in children with higher baseline TREC ( P=0.009). The greatest decreases in HIV-1 DNA occurred in children with the smallest increases in TREC levels during ART ( P=0.002). However, this inverse relationship between changes in HIV-1 DNA and TREC tended to vary according to the phase of HIV-1 RNA decline ( P=0.13); for the same increase in TREC, HIV-1 DNA decline was much smaller during persistent or transient viraemia compared with stable HIV-1 RNA suppression.

Conclusions

Overall, these findings indicate that TREC levels predict HIV-1 DNA response to ART and suggest that immune repopulation by thymic emigrants adversely affects HIV-1 DNA decline in the absence of persistent viral suppression, possibly by providing a cellular source for viral infection and replication.

Treatment of children with haemophilia in Europe: a survey of 20 centres in 16 countries

A survey was made of the current status of treatment of haemophilic boys at 20 centres in 16 European countries and includes approximately 1500 of the estimated 6500 haemophiliacs in the participating countries. Many mild haemophiliacs are not seen, or seen infrequently, at haemophilia centres and this requires study. Nine of 18 centres provide continuous prophylaxis to 80-100% of their patients, five centres provide it to 55-80% and the remaining four centres to 15-40% of the boys. The median dose given was 6240 U kg-1 year-1 (range 3120-7800). Four centres administered only recombinant concentrates to children with severe haemophilia A, while seven centres administered recombinant concentrates to 75-90% and the remaining centres to less than 50% of the boys (two centres < 10%). When asked for the choice of concentrate for a newly diagnosed boy with severe haemophilia A, all but one centre preferred recombinant concentrate. Most boys below 6 years received concentrates via a peripheral vein but three centres preferred a central venous line for 80-100% of the boys. Thirteen of 18 centres applied home treatment to 84-100% of the boys and the remaining five centres to 57-77% of the boys.

Assessment of genetic relatedness of vaginal isolates of Candida albicans from different geographical origins

PCR fingerprinting with single non-specific primers was used to type vaginal isolates of C. albicans from Portugal, Angola, Madagascar, and two regions of Germany (Berlin and Munich). In addition to analysing isolates that exhibited the normal biotype of C. albicans, the study included atypical strains that failed to assimilate glucosamine and N-acetylglucosamine, which were isolated from women in Angola and Madagascar. A total of 212 strains of C. albicans were studied, representing 87 different multi-locus genotypes. The genotypes of strains from each geographical population were highly similar but not identical. There was one exception: a strain from Portugal grouped with the typical strains from Angola. The typical and especially the atypical populations from Africa displayed less genotype variation than the populations from Europe. The Portuguese samples exhibited the greatest genotypic heterogeneity. Distance analysis (UPGMA) revealed a statistically weak correlation between genotype and geographical origin of the C. albicans isolates.

[Cardiovascular morbidity in children with human immunodeficiency virus infection]

Abnormalities of cardiovascular structure and function have been described among children with human immunodeficiency virus (HIV). In order to evaluate their occurrence and clinical predictors, 32 children infected with HIV, aged three months to 13 years (mean age = 3.11 +/- 3.51 years) were studied. Perinatal transmission was identified in 90% of the children. Twenty-two patients (pts) (69%) had symptoms, nine being moderately symptomatic and eight severely symptomatic. Fourteen pts had immunological disturbances and eight of them were severely immunosuppressed. Twenty-eight pts (88%) had HIV-1 infection and 6 recent Ebstein-Barr virus coinfection. Nineteen were on zidovudine and 14 on intravenous immunoglobulin treatment. Nineteen cardiovascular abnormalities were found in 15 pts (47%): 11 cases of pulmonary hypertension by echocardiographic criteria (eight of them had interstitial lung infiltrates seen on chest X-ray) and four cases of left ventricular dysfunction requiring anticongestive therapy. Other abnormalities were: patent ductus arteriosus, septal hypertrophy, mitral valve prolapse and pericardial effusion (one case each). Surface ECG displayed right ventricular hypertrophy in four pts, left ventricular hypertrophy in one patient and unspecific ST-T wave changes in two pts. Fourteen pts (44%) had sinus tachycardia with mean heart rate above the 95th percentile on 24-hour Holter monitoring.

CONCLUSIONS

Cardiovascular abnormalities are frequent among children with HIV-1 infection in late stages; pulmonary hypertension is the most frequently found cardiovascular anomaly and seems to be related to either chronic or recurrent respiratory disease; cardiological follow-up is recommended for HIV-infected children.

Virological and molecular demonstration of human immunodeficiency virus type 2 vertical transmission

To demonstrate that human immunodeficiency virus type 2 (HIV-2) mother-to-child transmission exists, HIV-2 isolates were obtained from both an asymptomatic mother (HIV-2 strain ARM), and her child (HIV-2 strain SAR), who had a diagnosis of AIDS. To determine their biological phenotype, primary isolates were used to infect various primary mononuclear cells and cell lines. HIV-2 ARM replicates in primary cells and Jurkat-tat, while HIV-2 SAR infects these cells plus SupT1, which led us to classify HIV-2 ARM as a slow/low virus and HIV-2 SAR as having an intermediate (slow/low-3) phenotype. Molecular analysis of the env region corresponding to gp125 was performed. Viral DNA was cloned, sequenced, and used to construct phylogenetic trees. The DNA sequence analysis demonstrated an overall nucleotide diversity of 7.6%. The results present evidence that the child's strain is more virulent than the mother's strain, which is in agreement with the immunodeficiency of the child. The phylogenetic trees that were constructed demonstrate that the two isolates cluster together, being closer to each other than to any other isolate described until now.

The effects of improved hemodynamics on aortic dimensions in patients undergoing heart transplantation

PURPOSE

Retrospective studies have demonstrated an accelerated growth rate of abdominal aortic aneurysms in heart transplant patients. This prospective study was undertaken to define the relationship between cardiac hemodynamics and posttransplant aortic dilation.

METHODS

Sixty-eight patients undergoing heart (n = 60) or heart-lung (n = 8) transplantation were prospectively evaluated with abdominal ultrasonography before transplantation and annually after transplantation. Risk factors implicated in aneurysm growth, including age, indication for transplantation, immunosuppression, posttransplantation hypertension, and abdominal aortic dimension before transplantation were recorded. All patients underwent annual coronary artery catheterization and multiple gated acquisition scanning.

RESULTS

Thirty-seven patients (54%) had no change in aortic diameter after transplantation (pretransplantation and posttransplantation diameter = 1.8 +/- 0.3 cm), over a mean follow-up period of 28 +/- 14 months. In the remaining 31 (46%) patients, aortic diameter increased by 0.5 +/- 0.6 cm over 31 +/- 15 months (p < 0.05). Four (6%) of these 31 patients had abdominal aortic aneurysms (mean aortic diameter = 5.0 +/- 0.8 cm). The mean increase in aortic diameter among these 4 patients was 1.8 +/- 0.2 cm (annual rate of growth = 0.96 +/- 0.3 cm/year). Patients experiencing an increase in aortic dimension after transplantation had significantly lower (p < 0.005) pretransplantation ejection fractions (17.1% +/- 10.5% vs 28.6% +/- 18.1%) and, as a consequence, significantly greater (p < 0.05) increases in their ejection fractions after transplantation compared with patients with stable aortic dimensions (42.7% +/- 12.6% vs 31.8% +/- 18.0%).

CONCLUSIONS

Of 68 heart transplant patients prospectively evaluated, aortic diameter increased in 31 (46%); new aneurysms developed in four of these patients. Greater incremental increases in cardiac ejection fraction were significant correlates with aortic enlargement.

[Prognosis of myocardial infarction in women. Effect of the therapeutic effort and the socioeconomic status]

The causes of the high mortality of acute myocardial infarction in women as compared with men are controversial. The objective of this study is to assess the role of the therapeutic effort and socioeconomic factors on the genesis of this excess of mortality. We studied, using a retrospective cohort design, 491 men and 124 women admitted with the diagnosis of acute myocardial infarction. As a group, women were older (69 versus 61 years of age, p < 0.00001), showed a higher prevalence of cardiac failure on admission (44% versus 26%; p = 0.00008) and a higher mortality in the coronary care unit (29.3% versus 12.9%; p = 0.00002). In addition, the women showed an unfavorable socioeconomic profile and received a lower relative therapeutic effort, as assessed by the Therapeutic Intervention Scoring System. There was statistical interaction between gender and marital status, with a higher mortality in the unmarried male, comparable to that of women. Within the married group, the excess of mortality in women persisted after adjusting for age and Killip group (adjusted odds ratio = 2.48, 95% confidence interval between 1.26 and 4.89). None of the studied socioeconomic variables was independently associated to mortality, once age, Killip group and marital status were taken into account. After adjusting for therapeutic effort, the differences between men and women increased. Women admitted with acute myocardial infarction show a poor short-term prognosis that is not explained by their socioeconomic profile nor by the differences in therapeutic effort.

[Respiratory distress and multiple organ failure after intravesical instillation of BCG]

A case of probable hypersensitivity reaction with multi-organic failure, following bladder installation of BCG, in a male with a diagnosis of bladder carcinoma is presented. The patient developed respiratory, renal and liver failure as well as leukocytosis, thrombopenia and an increase in muscular enzymes. It was resolved with hemodynamic support. The rare complication, occasionally described in medical literature and its probable pathogenic mechanisms are discussed.

Rh blood group of grandmother and incidence of erythroblastosis

Maternal red cells may cross the placental barrier and enter the fetal circulation, and this transfer may cause primary sensitization in Rh-negative girls born to Rh-positive mothers. 60 families were studied. Each family consisted of the grandmother, her Rh-negative daughter, and the Rh-positive grandchildren. Only families with ABO compatibility in the three generations, and where the mothers had never been transfused or had never received blood intramuscularly, were selected. The families were divided into 2 groups: the group of the Rh-positive grandmothers, group (+), which consisted of 40 families, and the group of Rh-negative grandmothers, group (-), which consisted of 20 families. The 2 groups were analysed as to the presence of affected grandchildren in any pregnancy. There were 35 (87·5%) affected grandchildren in group (+), and 15 (75%) affected children in group (-). In group (+) the number of mothers with 3 or more Rh-positive pregnancies was 16, and of these, 4 (25%) had only unaffected children. In group (-) 15 mothers had 3 or more Rh-positive pregnancies, and of these, 4 (27%) had only unaffected children. There was a striking similarity in the percentage of affected children between the 1st birth in group (+), 20%, and the 2nd birth in group (-), 20%; the 2nd birth in group (+), 38%, and the 3rd birth in group (-), 30%; the 3rd birth in group (+), 28%, and the 4th birth in group (-), 25%. It was concluded that (1) an Rh-positive grandmother acts similarly to the antigenic stimulation caused by pregnancy and the birth of an Rh-positive fetus; (2) it might be advisable to inject all Rh-negative newborn females, born to Rh-positive mothers, with anti-D γ-globulin, soon after birth; (3) prediction of the risk of erythroblastosis, especially in the case of primigravidae or mothers with one non-affected Rh-positive child, requires the investigation of the blood group of the grandmother on the mother's side.