Identification of driver genes for critical forms of COVID-19 in a deeply phenotyped young patient cohort

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Promoting access to innovation for frail old persons. IAGG (International Association of Gerontology and Geriatrics), WHO (World Health Organization) and SFGG (Société Française de Gériatrie et de Gérontologie) Workshop--Athens January 20-21, 2012

Frailty tends to be considered as a major risk for adverse outcomes in older persons, but some important aspects remain matter of debate.

OBJECTIVES

The purpose of this paper is to present expert's positions on the main aspects of the frailty syndrome in the older persons.

PARTICIPANTS

Workshop organized by International Association of Gerontology and Geriatrics (IAGG), World Health Organization (WHO) and Société Française de Gériatrie et de Gérontologie (SFGG).

RESULTS

Frailty is widely recognized as an important risk factor for adverse health outcomes in older persons. This can be of particular value in evaluating non-disabled older persons with chronic diseases but today no operational definition has been established. Nutritional status, mobility, activity, strength, endurance, cognition, and mood have been proposed as markers of frailty. Another approach calculates a multidimensional score ranging from "very fit" to "severely frail", but it is difficult to apply into the medical practice. Frailty appears to be secondary to multiple conditions using multiple pathways leading to a vulnerability to a stressor. Biological (inflammation, loss of hormones), clinical (sarcopenia, osteoporosis etc.), as well as social factors (isolation, financial situation) are involved in the vulnerability process. In clinical practice, detection of frailty is of major interest in oncology because of the high prevalence of cancer in older persons and the bad tolerance of the drug therapies. Presence of frailty should also be taken into account in the definition of the cardiovascular risks in the older population. The experts of the workshop have listed the points reached an agreement and those must to be a priority for improving understanding and use of frailty syndrome in practice.

CONCLUSION

Frailty in older adults is a syndrome corresponding to a vulnerability to a stressor. Diagnostic tools have been developed but none can integrate at the same time the large spectrum of factors and the simplicity asked by the clinical practice. An agreement with an international common definition is necessary to develop screening and to reduce the morbidity in older persons.

IAGG workshop: health promotion program on prevention of late onset dementia

IAGG, WHO, and SFGG organized a international workshop on Health promotion programs on prevention of late on-set dementia. Thirty world specialists coming from Europe, North America, Asia, South America, Africa and Australia, shared their experience on methods and results of large epidemiological interventions to reduce incidents of dementia or delay its on-set. Chaired by Laura FRATIGLIONI, an expert in Epidemiological studies on dementia issues, the workshop gave opportunity for discussions and controversies about the state-of-the-art. Based on different national and international trials (ADAPT, MAPT, FINGER, GUDIAGE, GEM etc) the questions remained opened for different aspects of methodology, the choice of domain or multi domain intervention, the choice and the definition of the target populations, the best age of candidates, the issues related to the discrepancy between late effects, and interventions' duration. We are please to publish in the Journal, the presentations presented to this workshop. These publications will complete previously task force published in the journal in the last two years on methodological issues for Alzheimer's trials including end point, biomarkers, and the experience of past therapeutic trials.

Two SNPs in NLRP3 gene are involved in the predisposition to type-1 diabetes and celiac disease in a pediatric population from northeast Brazil

Recent findings provide evidence of the critical role of innate immunity NALP1/NLRP1 and NALP3/NLRP3/CIAS1 genes in inflammatory diseases, and also in the predisposition to autoimmune disorders. We evaluated the possible association of five single nucleotide polymorphisms (SNPs), two in NLRP1 gene and three in NLRP3 gene, in pediatric patients from the north eastern region of Brazil affected by type-1 diabetes (T1D, n = 196), celiac disease (CD, n = 59), and atopic dermatitis (AD, n = 165), and in healthy individuals (n = 192). Our results demonstrated that NLRP3 rs10754558 SNP was associated specifically to T1D (p = 4exp-3) and NLRP3 rs358294199 SNP to CD (p = 5exp-4) in the Brazilian population. Despite its strong association with T1D in Norwegian population, NLRP1 was not associated with T1D, in the Brazilian population. According to previous studies in Caucasoid cohorts, NLRP1 and NLRP3 seemed not to be associated to AD. Since it has been reported that IL-1 beta has a systemic effect in the lost of the immunologic tolerance and that NALP3 inflammasome is directly involved in the production of this pro-inflammatory cytokine, we hypothesized that variations in NLRP3 could belong to a predisposing genetic background that contribute to the development of autoimmune diseases.

Speeding up coeliac disease diagnosis in the developing countries

BACKGROUND

Anti-transglutaminase antibodies are highly predictive markers of active coeliac disease. Because limited facilities are available for routine use of anti-transglutaminase antibodies assays in developing countries, a simple, economical immunological test would represent a great step forward in the screening of coeliac disease.

AIM

We determined the prevalence of coeliac disease in two different populations living in an urban area and in a sub-urban impoverished area of Recife (Brazil), using two rapid tests based on detection of anti-transglutaminase antibodies in serum and in one drop of whole blood.

METHODS

Whole-blood and serum samples from 1074 individuals were analysed by the two rapid tests; 580 subjects were university students and 494 subjects were coming from sub-urban impoverished areas, characterized by the endemic presence of filariasis. The positive subjects were evaluated by anti-tranglutaminase enzyme linked immunosorbent assay (ELISA) assay, the coeliac disease-related HLA DQ2/8 and intestinal biopsy.

RESULTS

Both rapid assays were positive in 25/1074 subjects, but only 9/25 (4/4 in urban areas, specificity 100%; 5/21 in poor areas, specificity 76%) were confirmed positive by ELISA assay. The nine subjects testing positive for HLA DQ2 and the intestinal biopsy showed the typical coeliac disease lesions (coeliac disease-prevalence: 0.84%, 9/1074); seven coeliacs were asymptomatic and two presented recurrent abdominal pain.

CONCLUSIONS

The rapid assays were accurate in finding new coeliacs at a remarkably low cost. We are convinced that this new way of testing for coeliac disease can be successfully used by non-specialized personnel in daily practice in developing countries.

MR lymphography with superparamagnetic iron nanoparticles in rats: pathologic basis for contrast enhancement

OBJECTIVE

The purpose of this study in rodents was to determine the pathologic basis for enhancement patterns of hyperplastic and tumours lymph nodes shown by MR lymphography after IV injection of superparamagnetic iron oxide nanoparticles (AMI-227).

MATERIALS AND METHODS

Hyperplastic and tumorous lymph nodes were imaged in vivo at 1.5 T 1 day after IV administration of AMI-227 (40-200 mumol Fe/kg) to rats. Inguinal and axillary lymph nodes were surgically resected, and in vitro imaging was done by using the same magnet with a prototype coil that allowed a pixel size of 70 x 230 microns. Imaging findings were correlated with histologic findings and iron staining of the nodes.

RESULTS

With all sequences, at doses of 80 mumol Fe/kg or higher, the signal intensity of hyperplastic nodes was lower than on unenhanced images. The same pattern was seen in the remaining normal tissue of tumourous lymph nodes. This T2* effect was a result of clustered particles inside macrophages in the lymphatic sinuses. At doses of 200 mumol/kg, the tumor itself consistently showed an increase in signal intensity on T1-weighted images. This T1 effect probably resulted from particles leaking into the interstitial spaces of the tumor.

CONCLUSION

After IV injection of superparamagnetic nanoparticles, a decrease in signal intensity indicates active uptake of particles into macrophages, whereas an increase in signal intensity indicates altered capillary permeability in tumor. These findings in rats may prove to be clinically useful in the future for differentiating benign from malignant enlarged lymph nodes.

Intraabdominal serous fluid collections after appendectomy: a normal sonographic finding

OBJECTIVE

The significance of sonographic findings 1 week or less after appendectomy is difficult to evaluate without knowing the inconsequential abnormalities that may occur in these patients. Accordingly, we performed postoperative sonography on patients who had a normal course after appendectomy to determine the findings that can be considered normal within 1 week after surgery.

SUBJECTS AND METHODS

Forty-four patients who had an appendectomy for acute appendicitis and who had normal findings at clinical follow-up 5 days and 6 months later were included in the study. In all patients, sonograms were obtained on the fifth postoperative day and interpreted by a radiologist who did not know the surgical findings.

RESULTS

Ten fluid collections (23%) were found in the pericecal area, ranging in size from 10 x 10 mm to 40 x 20 mm. The collections were hypoechoic or anechoic, crescent-shaped, and immobile. Fluid collections were more common in cases of suppurative appendixes (6/20, 30%) than in cases of inflamed appendixes (4/19, 21%) and in retrocecal appendixes (3/9, 33%) than in normally located appendixes (7/34, 21%). However, the differences were not statistically significant (p > .05).

CONCLUSION

Inconsequential fluid collections are detected with considerable frequency on postoperative sonograms 5 days after an appendectomy. Consequently, not every fluid collection should be considered an abscess.

An in vivo study of corneal surface morphologic features in patients with keratoconjunctivitis sicca

We used wide-field color specular microscopy to study the corneal epithelium of 13 normal subjects and 13 patients with keratoconjunctivitis sicca. The frequencies of small, medium, and large cells were different in the two groups, with a shift to small cells in patients with keratoconjunctivitis sicca. Increased uptake of rose bengal dye, filaments, coarse mucus plaques, and pre-exfoliative sheets were also found in the patients with keratoconjunctivitis sicca. These findings suggest accelerated epithelial cell loss from the surface of the eye in keratoconjunctivitis sicca.

Color specular microscopy of disorders involving the corneal epithelium

Color specular microscopy, a noninvasive, in vivo microscopic technique, was utilized to study the corneal epithelium in 17 patients including eight with keratoconus, seven with bullous keratopathy, and two with Fuchs' corneal dystrophy. Color specular microscopy was also performed on rabbit corneas with experimental surgical trauma. Changes observed by specular microscopy in these diseased states correlated with alterations noted by light microscopy and scanning and transmission electron microscopy. Specular microscopy can provide detailed in vivo cellular morphology of the ocular surface, obviating the need for tissue biopsy. Thus, specular microscopy is a valuable diagnostic technique available for the clinician to monitor changes of the diseased ocular surface.

The effect of concentrated antibiotics on the rabbit's corneal epithelium

The effect of concentrated antibiotics on the healing rate of epithelial erosions in rabbit was measured by serial standardized photography. Histological studies were also performed. Our results suggest that Kanamycin 30 mg/ml (p less than 0.001), Penicillin 100,000 units/ml (p less than 0.001) and Vancomycin 31 mg/ml (p less than 0.01) administered six times a day retard the epithelial wound healing compared with control animals which received isotonic NaCl.

Comparison of the effects of EGF, pFGF and EDGF on corneal epithelium wound healing

EDGF, a growth factor purified from bovine retina is able to increase the rate of wound healing of rabbit corneal epithelium in a dose dependent way. Two applications a day are enough to obtain the maximum rate. The most purified preparation of EDGF is as effective as EGF or pFGF in promoting this phenomenon and allows the epithelium to reach its normal organization earlier. Excess addition of EDGF did not adversely affect the normal or healed epithelium.

[Urrets-Zavalia syndrome and glaucomatous cataract. Etiopathogenic and nosologic discussion]

After penetrating keratoplasties for different congenital or acquired corneal diseases, the presence of characteristic cataracta glaucomatosa lens opacities was noted in 9 cases of fixed, dilated pupil iris atrophy of Urrets-Zavalia. This association--rarely mentioned in the literature--is an opportunity to study again the different physiopathological theories on this syndrome (pupillary block by mydriasis with hypertony, upsetting of iris neurovegetative balance, particular sensitivity of ocular tissues to the surgical aggression in keratoconus), to analyze their arguments, and the preventive measures that proceed from them. The almost complete extinction of this type of complication of the corneal graft surgery, since the routine use of these preventive measures, proves the multifactorial origin of this syndrome.

Antibiotics and corneal epithelial wound healing

The healing of a de-epithelialized cornea was measured by serial standardized photography after treatment with different antibiotics. Histological studies were also performed. Low doses of bacitracin (500 units/mL), gentamicin sulfate (3 mg/mL), neomycin (3.5 mg/mL), and chloramphenicol (4 mg/mL) did not retard normal epithelial healing. However, higher doses of bacitracin (10,000 units/mL), gentamicin sulfate (10 mg/mL), and neomycin (8 mg/mL) significantly inhibited reepithelialization.

Corticosteroids and corneal epithelial wound healing

Images

Effect of acetylcysteine (Mucomyst) on epithelial wound healing

The rate of reepithelialization of the rabbit cornea, receiving isotonic NaCl solution and acetylcysteine (Mucomyst) solution at 10 and 20% concentrations, following a superficial epithelial ulcer was studied by fluorescein staining, photography and light microscopy. Acetylcysteine solution does not seem to retard normal epithelial healing compared with control animals which received isotonic NaCl solution.