Telomere length dynamics over 10-years and related outcomes in patients with COPD

Background

Chronic obstructive pulmonary disease (COPD) has been proposed as a disease of accelerated aging. Several cross-sectional studies have related a shorter telomere length (TL), a marker of biological aging, with COPD outcomes. Whether accelerated telomere shortening over time relates to worse outcomes in COPD patients, is not known.

Methods

Relative telomere length (T/S) was determined by qPCR in DNA samples from peripheral blood in 263 patients at baseline and up to 10 years post enrolment. Yearly clinical and lung function data of 134 patients with at least two-time measures of T/S over this time were included in the analysis.

Results

At baseline, T/S inversely correlated with age (r = − 0.236; p < 0.001), but there was no relationship between T/S and clinical and lung function variables (p > 0.05). Over 10 years of observation, there was a median shortening of TL of 183 bp/year for COPD patients. After adjusting for age, gender, active smoking and mean T/S, patients that shortened their telomeres the most over time, had worse gas exchange, more lung hyperinflation and extrapulmonary affection during the follow-up, (PaO₂ p < 0.0001; K_CO p = 0.042; IC/TLC p < 0.0001; 6MWD p = 0.004 and BODE index p = 0.009). Patients in the lowest tertile of T/S through the follow-up period had an increased risk of death [HR = 5.48, (1.23–24.42) p = 0.026].

Conclusions

This prospective study shows an association between accelerated telomere shortening and progressive worsening of pulmonary gas exchange, lung hyperinflation and extrapulmonary affection in COPD patients. Moreover, persistently shorter telomeres over this observation time increase the risk for all-cause mortality.

Glaucomatous damage patterns by short-wavelength automated perimetry (SWAP) in glaucoma suspects

PURPOSE

To determine the glaucomatous visual field damage patterns by short-wavelength automated perimetry (SWAP) in glaucoma suspects, and to compare the frequency of diffuse visual field losses and localized defects.

METHODS

157 eyes of 157 ocular hypertensive subjects who met the selection criteria (intraocular pressure greater than 21 mm Hg and normal standard visual fields) were studied. SWAP was done with a modified Humphrey Field Analyzer. Total (TD) and Pattern Deviation (PD) probability maps were calculated for SWAP. The frequency of abnormlities in the TD and PD were determined, analyzing the visual field loss components.

RESULTS

The involvement of the test points was more frequent on the TD plots than on the PD plots for all levels of defects (p< 0.001). The glaucomatous defects also showed certain topographical distribution.

CONCLUSIONS

A diffuse sensitivity component of visual field loss was found at all SWAP defect depths in glaucoma suspects.

[Neuroretinal rim width in normal, hypertensive and glaucomatous subjects]

PURPOSE

To determine width and shape of neuro-retinal rim in normal hypertensive subjects and patients with glaucomatous damage.

MATERIAL AND METHOD

Patients underwent a perimetry and a photographic retinal nerve fiber evaluation. Patients were divided in three groups: normal subjects (n=34), ocular hypertension subjects (n=38) and glaucoma patients (n=34). Neuro-retinal rim was measured using 40 degrees stereoscopic photographs with center in the optic nerve head based on a biomorphometry technique.

RESULTS

In normal subjects neuro-retinal rim appeared wider in the lower pole, followed by the upper, nasal and temporal aspects. Optic nerve fiber layer showed a decreased thickness in hypertensive and glaucoma patients, particularly in sectors of the temporal aspect of the optic nerve (p<0.05).

CONCLUSIONS

A Planimetry study of the optic nerve is able to detect alterations in normal neuro-retinal rim configuration and can as well detect thinning of the rim, particularly in temporal, upper and lower areas.

[Experimental comparative study of the anti-inflammatory effectiveness of pranoprofen]

PURPOSE

To study the antiinflammatory capacity of topical pranoprofen in comparison with other ophthalmological nonsteroidal antiinflammatory drugs (diclofenac and flurbiprofen) in albino rabbits.

METHODS

We have produced an endotoxin-induced uveitis by intravitreal injection of 10 ng of Salmonella typhimurium endotoxin. We have used 48 albino rabbits (4 groups of 12 animals each), first group were control group (intravitreal saline solution), which were treated unilaterally every two hours with 2 drops of: Group II, pranoprofen (1 mg/ml). Group III, diclofenac (0.2 mg/ml). Group IV, flurbiprofen (0.3 mg/ml). We determined clinical signs of inflammation and protein concentration in the aqueous humor. The rabbits were sacrificed 24 hours after the endotoxin administration.

RESULTS

In all treated groups we observed a significant reduction (p<0.05) in all studied parameter as compared with control group, except for ciliar hyperemia. Different treatment groups did not show differences.

CONCLUSION

The antiinflammatory capacity of pranoprofen is comparable to other NSAIDs derived from propionic acid such as flurbiprofen, obtaining a good control of endotoxin-induced uveitis.

[Early glaucomatous changes in neuroretinal rim shape]

PURPOSE

To assess the differences in neuroretinal rim shape in ocular hypertensive patients (normal white-white automated perimetry) with and without perimetric injury in the short wave length automated perimetry (blue-yellow).

MATERIAL AND METHODS

72 eyes from 72 hypertensive ocular patients with normal achromatic automated perimetry examination were included. Forty eyes had normal short wave length automated perimetries while 32 subjects presented an abnormal condition. The neuroretinal rim morphology was quantified by means of a planimetric study from the papillary images obtained with confocal laser scanning.

RESULTS

The subjects with abnormal blue-yellow perimetry showed a decrease in the neuroretinal rim area in the inferior and temporal positions. The differences were significant (p<0.05) at the 9 o'clock position (below the middle line) and almost significant (p<0.10) at the 10 o'clock position.

CONCLUSIONS

There are differences in the neuroretinal rim shape in ocular hypertensive subjects with normal achromatic perimetry according to whether there are abnormalities in the blue-yellow perimetry.

Treatment of community-acquired pneumonia in outpatients: randomized study of clarithromycin alone versus clarithromycin and cefuroxime

OBJECTIVE

To evaluate the efficacy of clarithromycin alone in comparison with the combination of clarithromycin and cefuroxime in the treatment of nonhospitalized patients with community-acquired pneumonia (CAP) in a Mediterranean population.

METHODS

CAP was defined as the acute onset of fever (>38 degrees C) with pulmonary opacity on chest roentgenogram. The American Thoracic Society (ATS) criteria (1993) were used to decide on patient hospitalization. Ninety subjects, of whom 53 (59%) were men, with a mean age (+/-SD) of 38+/-15 years, were randomized: 45 received clarithromycin 500 mg b.i.d. orally for 14 days (CL group), and 45 received clarithromycin plus cefuroxime 500 mg b.i.d. orally for 7 days (CLCE group). Patients were monitored with clinical, radiological, and laboratory controls at 3 and 21 days. There were no significant differences between the two groups with regard to demographic, clinical, physical and laboratory data.

RESULTS

The mean time to defervescence was 2.4+/-1.4 and 2.4+/-1.5 days, respectively. Chest roentgenogram clearance was complete in all cases, without statistically significant differences in the time to resolution between both arms. Side effects were mild (no significant differences between groups): 5 patients in the CL group and 3 in the CLCE group showed gastrointestinal symptoms. Two patients (2.2%), both in the CLCE group, needed hospital admission during follow-up, but all 90 patients showed an excellent outcome. A causative agent was determined in 25 cases (28%). Legionella pneumophila, Streptococcus pneumoniae, and Mycoplasma pneumoniae were the most frequent pathogens.

CONCLUSION

Empirical treatment of outpatient CAP with clarithromycin can be considered adequate in the Mediterranean area, independently of the microbiological etiology. ATS criteria for admitting patients with CAP are appropriate in this population.

[Ambulatory arterial pressure and left ventricular hypertrophy in untreated hypertensive patients]

BACKGROUND

The study was designed to evaluate blood pressure (BP) values related to left ventricular hypertrophy (LVH) in a group of never treated middle-aged hypertensive subjects.

PATIENTS AND METHOD

Non-invasive ambulatory blood pressure monitoring (ABPM) and echocardiography were performed in 149 hypertensive patients (25-50 years old) with diastolic blood pressure (DBP) 90-114 mmHg. LVH was considered when left ventricular mass (LVM) was > 134 g/m2 in males and > 110 g/m2 in females.

RESULTS

43% of patients had LVH. Patients with LVH had higher clinic and ambulatory BP values. The greatest differences were in mean 24-h SBP (p = 0.001) and in 24-h DBP (p = 0.006). With respect to LVH, there were no differences between dippers and non-dippers, males or females, and circadian or BP variability. LVM was positively correlated with clinical DBP (p = 0.24), 24 h SBP (p = 0.41), pulse pressure (PP) (p = 0.36) and absolute BP variability (p = 0.23). Multiple regression analysis confirmed that 24-h SBP and sex where positively associated with LVH independent of others factors. The existence of 24-h SBP > 150 mmHg dramatically increased the risk of LVH (odds ratio [OR] = 9.2; CI 95%: 2.8-29.3; p = 0.002).

CONCLUSIONS

The present study indicates that in never treated middle-aged essential hypertensive patients the principal factor related to the presence of LVH is the value of systolic blood pressure throughout a 24-h period.

[Clinical manifestations of Stenotrophomas (Xanthomonas) maltophilia infection]

OBJECTIVE

Stenotrophomonas maltophilia (SM) is a gram-negative bacillus whose incidence like nosocomial pathogen has been incremented in the last years, especially in immunocompromised patients, subjected to invasive procedures and those receiving broad-spectrum antimicrobial therapy.

METHOD

We report 15 isolations of SM between 1994-1996.

RESULTS

The criteria for SM infection were fulfilled by 9 patients (60%), and 6 patients (40%) were colonized. The mean age of the patient was 60 +/- 12 years. Major predisposing factors in infections included venous catheterization (100%), prior surgery (86%), residence in ICU (80%), prior antibiotic therapy (80%) and intubation (66%). The most common underlying disease were heart disease (60%), treatment with immunosuppressors and/or steroids (46%) and chronic lung disease (46%). Ten cases (66%) had polymicrobial culture. The mortality rate was 40%. Risk factors associated with fatal outcome included the following: chronic lung disease (p = 0.043), nasogastric catheterization (p = 0.01), urinary tract catheterization (p = 0.02), intubation (p = 0.04) and the presence of pneumonia or sepsis by SM (p = 0.02). The most active agents were colistina (100%), cotrimoxazol (71%) and ceftazidima (53%). The isolates were highly resistant to first and second-generation cephalosporins (100%) tetracyclines (86%), aztreonam (91%) and imipenem (71%).

CONCLUSION

SM cause a wide range of clinical syndromes and is more likely to cause infection or colonization in patients who have underlying disease. Due to its inherent multiple-antimicrobial resistance, it would appear its potential as a nosocomial pathogen will continue to increase. Therapy of patients should include cotrimoxazole.

A survey of bovine, bubaline and swine sarcocystosis in the Philippines

In a survey conducted from January to December, 1994, muscle tissues in 12 out of 22 slaughtered carabaos ages 8-17 years old and obtained from the Food Terminal Inc, Abbatoir in Laguna showed numerous white and creamy elliptic-shaped soft bodied macrocysts in the throat muscles. Microscopic examination of the throat and cardiac muscle tissues revealed the presence of fusiform-shaped microcysts. Our observations are consistent with previous reports incriminating Sarcocystis fusiformis as the most important etiologic agent of bubaline sarcocystosis in the country. In a survey of bovine sarcocystosis in muscle tissues of imported Australian cattle (Brahman Breed) and native cattle obtained from various slaughter houses in Manila and suburbs, prevalence rates of 17% (98/577) and 3% (1/31) were noted, respectively. Sarcocysts were predominant in skeletal muscles and to a lesser extent in cardiac, esophageal and diaphragm muscle tissues. Light microscopic examination of sarcocysts morphology suggests Sarcocystis cruzi (= Sarcocystis bovis), and Sarcocystis hominis (= Sarcocystis bovihominis) or Sarcocystis hirsuta (= Sarcocystis bovifelis) as the likely etiologic agents of bovine sarcocystosis in the country. Of the 225 swines examined, only muscle tissues from a 6-month old swine revealed very young sarcocysts (= metrocytes). A review of available documented studies on sarcocystosis suggests that to date, our findings may represent the first data on the prevalence of bovine and swine sarcocystosis in the Philippines.

[Dysfunction of a TIPS (transjugular intrahepatic porto-systemic shunt) and chylous ascites]

We reported a 66 year old woman diagnosed of cirrhosis secondary to VHC. A TIPS (transjugular intrahepatic portosystemic shunt) placement was used for the treatment of recurrent variceal hemorrhage and, a chyloperitoneum with hepatorenal syndrome developed after shunt occlusion. We discuss the pathological processes that might be responsible and the poor prognosis of this no reported complication.

[Langerhans cell histiocytosis of lymph node]

Langerhans cell Histiocytosis or Histiocytosis X encompasses the syndromes of Letterer-Siwe disease, Hand-Schuller-Christian disease and eosinophilic granuloma. The localized disease usually consisted of isolated bone involvement as osteolytic areas. The isolated lymph node disease is uncommon. A case study of eosinophilic granuloma of lymph node in a 27 years-old woman who underwent several recurrences as lymphadenitis is presented. This case is presented in light of the cytologic, histologic and immunohistochemical findings of node-based eosinophilic granuloma and the favorable prognosis of this localized form treated with steroids.

[The prognostic value of plasma triglycerides in human immunodeficiency virus infection]

BACKGROUND

Infection with the human immunodeficiency virus (HIV) is associated with an increased prevalence of hypertriglyceridemia, which is more common in advanced stages of disease. Nevertheless, the role of hypertriglyceridemia as a predictive marker of progression of disease and/or mortality is not fully elucidated.

METHODS

One-hundred nineteen patients with HIV infection attended at our Outpatient Clinic or hospitalized in our Service were retrospectively studied. At the beginning of the study and every six months a complete medical history and physical examination were obtained, with a complete blood count, serum biochemistry, total lymphocytes and CD4 subpopulations, cholesterol, triglycerides and IgA. With comparative purposes cholesterol and triglyceride values were also determined in a control group of healthy subjects with the same age and gender. The relationship between triglyceride levels and the other clinical and analytical parameters was evaluated by means of the Pearson linear correlation. The risk for developing clinical disease and survival were studied by the method proposed by Kaplan and Meier.

RESULTS

The mean age of patients was 27 +/- 6 years and the male/female ratio was 86/33. Eighty-three percent (99) of patients consumed drugs parenterally. Compared with the control group, patients with HIV infection had hypertriglyceridemia (159 +/- 80 mg/dl vs 79 +/- 53 mg/dl) and hypocholesterolemia (143 +/- 41 mg/dl vs 174 +/- 36 mg/dl) (p < 0.05). There was a positive correlation between triglycerides and IgA levels (p < 0.01) and a negative correlation with serum albumin (p < 0.05). A higher risk towards progression of disease was not observed among patients with hypertriglyceridemia (TG > 143 mg/dl) in non-AIDS infected patients, nor mortality in the overall group.

CONCLUSIONS

HIV infected patients have a higher prevalence of hypertriglyceridemia and hypocholesterolemia. Plasma triglycerides were not useful as a prognostic factor for the development of disease nor as mortality risk.