P5596Something is moving in acute aortic syndrome management and mortality. Results of Spanish registry of acute aortic syndrome (RESA-III)

Background

The impact of recent advances on the management of acute aortic syndrome (AAS) is usually reported by centres with great experience in aortic diseases. Current data on the management of this specific disease in Spain remains unknown.

Purpose

The Spanish Registry of Acute Aortic Syndrome (RESA-III) was established to assess current results in the management of AAS in a large cohort of hospitals from the same geographical area.

Methods

All patients admitted for AAS to 29 Spanish tertiary hospitals were enroled over 18 months (2017/2018).

Results

574 patients, (68% men; mean age 64±14y; range 18–99) were prospectively and consecutively included. Aortic dissection was the underlying disease in 474 (82.6%) (375 type A, 99 type B), aortic haematoma in 76 (13.2%) (43 type A and 33 type B) and penetrating ulcer in 24 (4.2%) (7 type A and 17 type B). From the subgroup of type A AAS (74% n=425), 81% underwent surgical treatment and medical management was chosen in the remaining 19%. 78 patients did not undergo surgery principally because of severe comorbidities (n=34) or advanced age (n=24), patient refusal (n=7), or presence of an intramural haematoma (n=2). Regarding the cohort of patients with type B AAS (26% n=149), 52% were managed only medically, 37% with endovascular treatment, and 11% underwent open surgery. Endovascular treatment was indicated owing to recurrent pain (n=19), progressive vessel dilation (n=9), dissection expansion (n=5), peripheral (n=5) or visceral ischaemia (n=4), high blood pressure (n=18), peripheral bleeding (n=17) or haemodynamical instability (n=8).

Overall type A mortality during hospitalisation was 36.4%; 26.4% in surgically treated and 79.4% in medically-treated patients (p=0.001). In type B AAS, overall mortality was 19.1%; 21.9% in the treated medically subgroup, 43.8% in those treated with open surgery and 7.8% in the endovascular treatment cohort (p=0.004).

Conclusion

Despite significant advances in acute aortic syndrome diagnosis and management, in-hospital mortality remains high. In type A AAS, medical management rate was too high (19%); however, in type B AAS, endovascular treatment yielded excellent results with less mortality than medical management (7.8% vs 19.1%, respectively). Our data support the need for continued improvement in the management of acute aortic syndrome.

Prevalence of asymptomatic chlamydial urethritis in military recruits in the Celje region, Slovenia

The aim of this research was to evaluate the prevalence of asymptomatic chlamydial urethritis in military recruits in the Celje region (population 300,000), Slovenia. A first-void urine specimen was tested for Chlamydia trachomatis using the polymerase chain reaction assay. The research was supported by a questionnaire to obtain information on sexual behaviour of the participants.

In the cross-sectional study from 1999 to 2001, 1272 asymptomatic recruits were included. None had received antibiotics in the previous two weeks. The mean age was 19.9 years. At the time of their first sexual experience the mean age was 16.6 years, whereas the age of their female sexual partners was 17.1 years. During their first sexual intercourse 77% of recruits used contraception (condom, diaphragm, contraceptive pill), most of those a condom (86%).

The prevalence of asymptomatic chlamydial urethritis was 2.6% (95% confidence interval: 1.7 to 3.5). The mean age of those infected was 19.8 years. At the time of their first sexual experience the mean age was 16.2 years, whereas the age of their female sexual partners was 16.9 years. During their first sexual intercourse 57% of infected subjects used protection, half of which was a condom. Those who never or only occasionally used condoms were at a greater risk of being infected with C. trachomatis (adjusted odds ratio 2.04).

Intrathecal antitreponemal antibody synthesis determination using the INNO-LIA Syphilis Score

BACKGROUND

Laboratory detection of intrathecal synthesis of specific antitreponemal antibodies remains a challenge. Traditional syphilis serology is unable to provide a satisfactory result; therefore, several other diagnostic procedures were used to demonstrate central nervous system (CNS) involvement in this disease. The introduction of molecular methods makes today's laboratory testing easier.

OBJECTIVE

Our study used a new commercially available test, the INNO-LIA Syphilis Score, intended for use on serum samples, to detect specific antitreponemal antibodies in the cerebrospinal fluid (CSF) of patients with the tertiary stage of syphilis.

PATIENTS AND METHODS

We tested 26 patients suspected of neurological complications of late syphilis with conventional immunological tests such as VDRL-RPR, TPHA, FTA-ABS IgG, FTA-ABS-IgM, and the molecular INNO-LI Syphilis Score test for the presence of nontreponemal and treponemal antibodies. All tests were performed simultaneously in serum and CSF. The test results were evaluated with descriptive statistics and the probability was tested with an ANOVA test.

RESULTS

All 26 samples of serum were LIA-S (line immune assay in serum) positive and presented anticardiolipin and antitreponemal antibodies in high titer. Seventeen samples of CSF were LIA-L (line immune assay in liquor) positive and nine were LIA-L negative. Anticardiolipin and antitreponemal antibodies were detected only in the group of LIA-L positive samples. Anticardiolipin antibodies were present in two cases, antitreponemal (TPHA) in five cases, specific IgG (FTA-ABS IgG) in six cases, and specific IgM (FTA-ABS IgM) in one case. Six patients with antitreponemal antibodies in CSF presented with pathologic albumin index, two with a milder form, and four with a severe form. Two had a pathological IgG index and four a pathological IgM index. Altogether, two of the patients had laboratory signs of neurosyphilis.

CONCLUSIONS

Detecting anticardiolipin and antitreponemal antibodies in CSF in patients with a late form of syphilis is laborious. Using the new INNO-LIA Syphilis Score molecular test, we were able to identify patients with silent neurosyphilis together with patients with active intrathecal synthesis of IgG antibodies. The development of a new generation of tests for the detection of specific antitreponemal antibodies in CSF offers a valuable tool for discovering possible CNS involvement in syphilis.

Distribution of human papillomavirus (HPV) genotypes in genital warts from males in Slovenia

BACKGROUND

Genital warts (GWs) are the most frequent benign tumors in the anogenital region of both males and females. Human papillomaviruses (HPV) are etiologically associated with the development of virtually all GWs. HPV-6 and HPV-11 are the most commonly detected HPV genotypes, but at least 20 other alpha-HPV genotypes have occasionally been found in GW tissue specimens.

OBJECTIVE

There is limited knowledge of GWs in Slovenia. Thus in this study we tested 55 GW tissue specimens collected from the same number of male patients using 2 different PCR protocols to obtain the first data concerning HPV and GWs in Slovenia.

MATERIAL AND METHODS

55 GW tissue specimens were tested for the presence of HPV using PGMY09/PGMY11 and CPI/CPIIg polymerase chain reaction (PCR). HPV genotypes were determined using restriction fragment length polymorphism analysis of PGMY09/11 PCR products or by sequencing of the CPI/CPIIg PCR products. In some GWs, the genotyping results were also confirmed using the Linear Array HPV Genotyping Test.

RESULTS

HPV DNA was detected in all 55 tissue specimens of GWs. HPV-6 or HPV-11 was detected in 53 cases of GWs, and HPV-44 and candHPV-91 in one GW each. HPV-6 was detected approximately 4 times more frequently than HPV-11. In addition, HPV-16, HPV-31, HPV-51, HPV-53, HPV-55, candHPV-62, HPV-66, HPV-70, HPV-73, and HPV-84 were detected in some GW specimens. According to the published data, our study is the first to report the presence of candHPV-62 and candHPV-91 in GW tissue specimens.

CONCLUSIONS

Our study showed that HPV can be found in virtually all GW tissue specimens obtained from male patients in Slovenia. Because HPV-6 or HPV-11 was detected in 96.4% of GWs studied, it seems that, if a quadrivalent HPV vaccine proves to be effective in males, this vaccine could prevent the great majority of incidental GWs in males in Slovenia.

Chlamydia trachomatis infections in heterosexuals attending sexually transmitted disease clinics in Slovenia

This study assessed the age and gender distribution of Chlamydia trachomatis infections among patients attending two clinics for sexually transmitted diseases (STDs) in Slovenia. Between January 1999 and December 2003, 1714 heterosexual male and 892 heterosexual female patients were tested for C. trachomatis. The prevalence of C. trachomatis infection was 19.5% (n = 334) for male patients and 10.7% (n = 96) for female patients, with the highest prevalence in the group aged 15-30 years. The prevalence decreased between 2000 and 2003 among female patients. The results support the implementation of routine screening for C. trachomatis genital infection among male and female patients aged < 30 years attending STD clinics in Slovenia.

Syphilis epidemic in Slovenia influenced by syphilis epidemic in the Russian Federation and other newly independent states

In 1994 an 18-fold increase in the annually reported incidence rate of early syphilis (to 1.81 cases per 100,000 total population) in comparison to the preceding year was observed in Slovenia. The reported incidence rates remained elevated for a period of five years. The possible link between the evolving syphilis epidemic in the Russian Federation and newly independent States (NIS) during the 1990s and the observed increases in the reported early syphilis incidence rates in Slovenia, was explored. Surveillance data obtained by mandatory reporting of all newly diagnosed syphilis cases between 1994 and 1999 were analysed according to the information on sexual partners, the country of probable source of infection, and occupation. More than half of all reported cases (62%) were directly or indirectly linked to a source of infection abroad. Among these, the majority of cases (73%) were linked to the Russian Federation or NIS. Of these, 68% occurred in males, a high proportion being long-distance lorry drivers.

Subclinical microbial infection in patients with chronic plaque psoriasis

Epidemiological evidence implicates bacterial infection as a common triggering stimulus for psoriasis. Recent studies suggest that continuing, subclinical streptococcal and staphylococcal infections might be responsible not only for relapse of acute guttate psoriasis but also for a new episode of chronic plaque psoriasis. In this study 195 patients suffering from a severe form of chronic plaque psoriasis hospitalized between 1996 and 1998 were examined. The presence of subclinical microbial infection of the upper respiratory tract was studied by the cultivation of pathogens from this area. Patients with other provoking factors, such as a positive history of taking any drugs that may exacerbate psoriasis, endocrine and metabolic factors, alcohol abuse, trauma, dental focus and clinically evident bacterial infection, were excluded. Subclinical streptococcal and/or staphylococcal infections were detected in 68% of tested patients and in only 11% of the control group. The results of this study indicate that subclinical bacterial infections of the upper respiratory tract may be an important factor in provoking a new relapse of chronic plaque psoriasis. Searching for, and eliminating, microbial infections could be of importance in the treatment of psoriasis.