False positive elevation in serum creatinine: a case report

Background

Paraproteins can interfere with several substances, producing erroneous laboratory measurements. The diagnosis of kidney disease in patients with hematological disorders has important prognosis implications. An elevated creatinine with no other signs of kidney disease should prompt the idea of a spurious creatinine. Communication between the clinical team and the laboratory is key.

Case presentation

In this case, we present a 68-year-old woman with an elevated creatinine and an IgM lambda paraprotein. Interestingly, there were no other signs of chronic kidney disease besides the creatinine value, with no albuminuria or microhematuria. A kidney biopsy showed normal parenchyma and ruled out the possibility of paraprotein-related damage. The monoclonal component and creatinine levels raised parallelly during follow-up while maintaining normal urea levels. This prompted the hypothesis of a falsely elevated creatinine. It was confirmed with a normal glomerular filtration rate determined by a radioisotope, a cystatin C measurement and a reduction in creatinine when diluting the sample.

Conclusion

It is important to consider the possibility of a falsely elevated creatinine in patients with paraproteinemia and no other signs of kidney disease to avoid unnecessary diagnostic tests and for the prognostic implications.

Basal oxidation of conserved cysteines modulates cardiac titin stiffness and dynamics

Titin, as the main protein responsible for the passive stiffness of the sarcomere, plays a key role in diastolic function and is a determinant factor in the etiology of heart disease. Titin stiffness depends on unfolding and folding transitions of immunoglobulin-like (Ig) domains of the I-band, and recent studies have shown that oxidative modifications of cryptic cysteines belonging to these Ig domains modulate their mechanical properties in vitro. However, the relevance of this mode of titin mechanical modulation in vivo remains largely unknown. Here, we describe the high evolutionary conservation of titin mechanical cysteines and show that they are remarkably oxidized in murine cardiac tissue. Mass spectrometry analyses indicate a similar landscape of basal oxidation in murine and human myocardium. Monte Carlo simulations illustrate how disulfides and S-thiolations on these cysteines increase the dynamics of the protein at physiological forces, while enabling load- and isoform-dependent regulation of titin stiffness. Our results demonstrate the role of conserved cysteines in the modulation of titin mechanical properties in vivo and point to potential redox-based pathomechanisms in heart disease.

The Bacterial Mucosal Immunotherapy MV130 Protects Against SARS-CoV-2 Infection and Improves COVID-19 Vaccines Immunogenicity

COVID-19-specific vaccines are efficient prophylactic weapons against SARS-CoV-2 virus. However, boosting innate responses may represent an innovative way to immediately fight future emerging viral infections or boost vaccines. MV130 is a mucosal immunotherapy, based on a mixture of whole heat-inactivated bacteria, that has shown clinical efficacy against recurrent viral respiratory infections. Herein, we show that the prophylactic intranasal administration of this immunotherapy confers heterologous protection against SARS-CoV-2 infection in susceptible K18-hACE2 mice. Furthermore, in C57BL/6 mice, prophylactic administration of MV130 improves the immunogenicity of two different COVID-19 vaccine formulations targeting the SARS-CoV-2 spike (S) protein, inoculated either intramuscularly or intranasally. Independently of the vaccine candidate and vaccination route used, intranasal prophylaxis with MV130 boosted S-specific responses, including CD8⁺-T cell activation and the production of S-specific mucosal IgA antibodies. Therefore, the bacterial mucosal immunotherapy MV130 protects against SARS-CoV-2 infection and improves COVID-19 vaccines immunogenicity.

Coronavirus Disease 2019 (COVID-19) in Solid Organ Transplant Recipients: A Case-Control Study

Background

It is unclear whether solid organ transplant (SOT) patients have more severe coronavirus disease 2019 (COVID-19) and worse outcome than the general population.

Material/Methods

We conducted a case-control study on 32 SOT recipients and 84 non-SOT controls matched for age and sex admitted for confirmed COVID-19. The primary endpoint was in-hospital all-cause mortality rate. Secondary endpoints included severe acute respiratory distress syndrome (ARDS), use of high-flow oxygen therapy, and length of hospital stay.

Results

The median (IQR) Charlson comorbidity index (CCI) at admission was significantly higher in SOT recipients (6 (3–8) vs 3 (2–4); P<0.01). Fever was less frequent in SOT recipients (78% vs 94%, P=0.01). SOT recipients had a higher median SaO2/FiO2 at admission (452 [443–462] vs 443 [419–452], P<0.01) and reached the worst SaO2/FiO2 value later during hospitalization 15 (10–21) vs 11 (9–14) days, P=0.01). Both groups had a similar severe ARDS rate during hospitalization (33% vs 28%) (p=0.59). There were no significant differences during hospitalization in terms of highest level of respiratory support needed, or length of hospital stay: 8.5 (5.5–21) vs 11.5 (6.5–16.5) days; P=0.34) in SOT recipients when compared to controls. In-hospital all-cause mortality rates were significantly higher in SOT recipients (21.9% vs 4.7%, P<0.01; OR 1.08; 95% CI 0.10–10.98), but among patients who died, median CCI was similar between groups (8 [6–8] vs 7 [6–8]).

Conclusions

In our experience, hospitalized SOT recipients for COVID-19 had higher in-hospital mortality compared to non-SOT patients, probably due to the greater number of underlying comorbidities, and not directly related to chronic immunosuppression.

Age and growth of the endangered fan mussel Pinna nobilis in the western Mediterranean Sea

The present work, which is the first comparative study of the growth of the fan mussel Pinna nobilis in the western Mediterranean, encompasses 12 populations of this species living in different environments in France and Spain. Two hundred nine shells were processed and used to obtain growth records from the posterior adductor muscle scar. Size-at-age data were fitted to the Von Bertalanffy growth model. Considerable variability in growth parameters and age was detected among the populations. The results show that the only two fan mussel populations remaining in Spain, which live in an estuary and a coastal lagoon, occupy habitats that are optimal for fast growth, but individuals show low longevity, complicating the long-term conservation of the species. Multivariate analyses groups the populations into three groups (SO, EO and LG), and a general model is proposed for each group; the model can be used as an approximation to calculate the ages of individuals living in similar environments.

Abstract 617: In vivo Titin Oxidation as a Modulator of Sarcomeric Contractibility

Titin is the sarcomeric protein responsible for the passive elasticity of muscle. Its function is based on the unfolding and refolding of the immunoglobulin-like (Ig) domains located in the I-band, thus described as the mechanically active region of the protein. Previous in vitro studies have shown that oxidation of cysteines located in these domains modulates the mechanical properties of the protein. However, the extent of these redox modifications and the identity of the modified residues in vivo remains unexplored. Here we show for the first time that titin is oxidized in vivo and that oxidative modifications target conserved cysteines of the mechanically active Ig domains. We have set up a biochemical method for in-gel determination of oxidized thiols by which we found that titin is remarkably oxidized when compared to myosin, which is not a target of cysteine redox modifications. By mass spectrometry, we also detected that the conserved cysteines previously described as mechanically relevant are in fact oxidized. We propose that characterizing the oxidation of titin Ig domains will lead to a better understanding of the regulation of muscle elasticity, and could explain the pathological effects of an imbalanced redox status, such as during myocardial infarction or ischemia.

[Congenital portosistemic shunt. Importance of early treatment]

AIM

Congenital portosistemic shunt (CPSS) is an uncommon condition that can cause serious complications such as encephalopathy and liver tumors at risk of malignant degeneration. Occlusion of the shunt by surgery or interventional radiology can prevent and even improve such complications. In some cases, liver transplantation is the only curative option. We describe our experience with this condition.

PATIENTS AND METHODS

Between 1992 and 2013, eight children (four male and four female) were diagnosed with CPSS (four extrahepatic and four intrahepatic) in our center, of which seven were diagnosed after 2007. The mean age at diagnosis was 5.5 years (1 month-15 years). Five patients had associated comorbidities.

RESULTS

Five patients had developed hyperammonemia and intellectual impairment, one of those manifested with an onset of coma. Four patients have developed at diagnosis liver tumors, including focal nodular hyperplasia/regenerative nodules (n=3) and adenomas (n=3). One patient with multiple tumors required a hepatectomy owing to compressive symptoms. Two patients, developed malignant degeneration, a child under five years treated with liver transplantation and another in adulthood treated with hepatectomy. In one patient, diagnosed in the neonatal period, the shunt occlusion occurred spontaneously. Direct portography with the occlusion test was performed in five patients, the shunt was occluded with interventional radiology in three cases, surgery in one and liver transplantation in the remaining.

CONCLUSIONS

The treatment of the SPSC must be early to prevent and even to reverse its complications, avoiding liver transplantation. Currently, interventional radiology is essential in the strategy to follow and treatment of these patients.

[Uveal melanoma: clinical characteristics, treatment and survival in a series of 500 patients]

OBJECTIVE

To analyse the clinical features, treatment and survival of uveal melanoma patients diagnosed in a referral Intraocular Tumours Unit over a twenty-year period.

METHODOLOGY

A prospective study was performed including five hundred patients, diagnosed between January 1992 and December 2011. Clinical tumour characteristics and treatment were collected in a database in Microsoft@ Access@. The numeric variables were expressed as means of frequency and standard deviation, and the quantitative variables using frequency tables.

RESULTS

The mean age of the sample was 62.19 years, with 51.2% females, and 64.2% presented with symptoms. The tumours were small in 31.12% of cases, and large in 23.09%, according to COMS criteria. Hazel green was the iris colour in 42.2% of the cases. The initial treatment was episcleral brachytherapy in 42.4% of the total. The overall mortality rate was 17% and 31.3%, and melanoma-related mortality rate was 11.6% and 14.8%, at 5 and 10 years, respectively.

CONCLUSIONS

In the serie studied melanomas were more frequent in women, and a higher proportion of darker irides were observed than in other previous studies. Most of the tumours were diagnosed when they became symptomatic and in the early or medium stages, allowing conservative therapies to be used, with brachytherapy being the predominant treatment. The melanoma-related mortality appeared to be lower than previously data published. However, further studies are required on the factors influencing survival.

3D automatic quantification applied to optically sectioned images to improve microscopy analysis

New fluorescence microscopy techniques, such as confocal or digital deconvolution microscopy, allow to easily obtain three-dimensional (3D) information from specimens. However, there are few 3D quantification tools that allow extracting information of these volumes. Therefore, the amount of information acquired by these techniques is difficult to manipulate and analyze manually. The present study describes a model-based method, which for the first time shows 3D visualization and quantification of fluorescent apoptotic body signals, from optical serial sections of porcine hepatocyte spheroids correlating them to their morphological structures. The method consists on an algorithm that counts apoptotic bodies in a spheroid structure and extracts information from them, such as their centroids in cartesian and radial coordinates, relative to the spheroid centre, and their integrated intensity. 3D visualization of the extracted information, allowed us to quantify the distribution of apoptotic bodies in three different zones of the spheroid.

[Predictors of behavioural disorders and consultation-liaison psychiatry in patients with HIV disorders]

OBJECTIVE

The aim was to identify the features of patients admitted into an Infectious Disease Unit in a Hospital due to pathology related to HIV and/or addiction that originate the demand for consultation liaison psychiatry.

METHOD

During the first six months of 1997, 232 admissions into the Infectious Disease Unit at Ramón y Cajal Hospital (191 patients) were systematically evaluated by the nursery staff. A specific questionnaire was designed for this interview. After having performed univariants analysis, a logistic regression was used to identify the most relevant variables in the claim for consultation liaison.

RESULTS

The claim for consultation liaison was associated to: consume in the unit OR (yes/no)= 7.9, confusional syndrome OR (yes/no)= 5.6, social worker consultation liaison OR (yes/no)= 2.1. use of benzodiazepines OR (yes/no)= 2.4. No medical treatment respect to bad accomplishment OR= 3.6. Only taking into account the known features after the first examination: use of benzodiazepines OR (yes/no)= 2.1, use of cocaine OR (yes/no)= 1.8, recognized income (yes/no)= 2.2, no medical treatment due to bad accomplishment OR= 2.1.

CONCLUSIONS

In our environment the demand for consultation liaison psychiatry is related to behavioural problems due to the use of substances and marginality. The variables which predict the demand and may be identified at the time of admission are: the use of benzodiazepines, cocaine, the lack of a recognized income and the absence of medical treatment for the HIV infection. Recognizing these features will allow us to identify patients who are going to have behavioural problems and demand psychiatric assistance.

Psychogenic paranoid psychosis: an empirical study

The present study was aimed at assessing the psychopathological manifestations, stress factors, evolution and social adaptation of 29 patients diagnosed with psychogenic paranoid psychosis. This syndrome is seen as an entity in itself, and is closely related to trigger factors; stability in the symptomatology of each relapse; favourable response to treatment; tendency to relapse, and recovery of the previous level of functioning.

[Update on the morbidity of psychiatric disorders in patients with AIDS: results of a clinical follow-up]

A follow-up study after one or two years of treatment was carried out on 107 AIDS patients who were seen by the Consultation-Liaison Psychiatry Unit of the Ramon y Cajal Hospital. The sample was reduced to 52 patients (49%) mainly due to the lack of check-ups in 43% and to the death of 8% of the cases. 36% of patients suffered from Delirium or Dementia and these had the greater mortality rate. Grade IV patients and those with a diagnosis of Adjustment Disorders came to the check-ups most frequently.

[Correlation between the concentration of lead in a gastropod mollusc (Monodonta turbinata, Born) and the temperature of sea water]

The study of marine organism contamination by heavy metals was carried out during an annual cycle in a Mediterranean lagoon (Lagoon of Brusc, Var, France). Lead concentrations measured in several specimens of the gastropod mollusc Monodonta turbinata, Born, from a littoral station, vary with the sea water temperature, and a very significant correlation between both parameters is obvious.