Can myocardial dysfunction be detected in patients with rheumatoid arthritis with no cardiac symptoms?

OBJECTIVE

The aim of our study was to investigate the role of tissue Doppler and Myocardial Performance Index (MPI) in evaluating cardiac involvement in patients with rheumatoid arthritis (RA) with no cardiac symptoms, to determine whether these measurements differ between healthy controls and RA patients, and whether they can be used to determine the risk of cardiovascular disease and predict prognosis.

PATIENTS AND METHODS

50 RA patients fulfilling the 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) RA criteria and 50 healthy volunteering controls were included in the study. All patients and controls were assessed using electrocardiography (ECG), echocardiography, conventional Doppler echocardiography and tissue Doppler echocardiography. MPI values were calculated. In addition, RA patients were compared after being divided into two subgroups: seropositive and seronegative RA. Disease activity levels of the patients were determined based on Disease Activity Score in 28 Joints (DAS28).

RESULTS

The control group and RA group were compared in terms of PR interval, left atrial diameter, E/A, E/e', and MPI values. Comparisons between the groups yielded statistically significant differences in left atrial diameter, E/A, E/e', and MPI values and no significant difference in PR intervals. These parameters were also compared between seropositive and seronegative patients. Left atrial diameter was significantly higher in seronegative patients than in seropositive patients. There was no significant difference in the other values. DAS28 scores had no correlation with cardiac parameters.

CONCLUSIONS

Early detection of ventricular dysfunction in RA may be useful in clinical practice when predicting prognosis and optimizing treatment. The present study found that RA patients had impaired tissue Doppler measurements and MPI results compared to controls. MPI and tissue Doppler may be useful in early detection of ventricular dysfunction.

Relationship between pathological response and molecular subtypes in locally advanced breast cancer patients receiving neoadjuvant chemotherapy

Majority of patients with breast cancer were diagnosed with locally advanced stages of the disease (54%). This study aimed to explain the pathological response received to neoadjuvant chemotherapy (NACT) according to the molecular classification of breast cancer in patients with locally advanced tumors. One hundred and one patients with locally advanced breast cancer treated with neoadjuvant chemotherapy were analyzed. Patients were classified into five molecular subtypes based on the profile of the estrogen receptor, progesterone receptor, HER2, and Ki-67. We determined associations between complete pathological response (no invasive tumor after neoadjuvant chemotherapy) and molecular subgroups. Most patients had luminal A tumors (n: 28, 27.7%). The overall rate of complete pathological response (pCR) was 34.7% (n:35). Tumors that presented with the highest rate of pCR were pure HER2-positive, at 60% (n:6; OR, 3.2; 95% CI, 0.8-12.2). According to logistic regression analysis, the factors affecting pCR were HER2 positivity and clinically positive axilla before NACT. Luminal A tumors had a significantly lower pCR rate. (7.1%,p: 0.001). Despite the low pCR rate, Luminal A tumor had the best survival rate in the subgroups (p < 0.001). However, there was no difference between EFS and OS according to pCR in any molecular subgroups. Pathological complete response is directly related to the subtypes of breast cancer. A high complete pathological response rate is observed in the pure HER2-positive group. However, EFS and OS were not statistically significant in patients with and without pCR.

Bevacizumab-induced isolated oculomotor nerve palsy in glioblastoma multiforme

INTRODUCTION

Bevacizumab, a monoclonal antibody against the vascular endothelial growth factor receptor, is the standard treatment of recurrent glioblastoma multiforme. In addition to common systemic side effects of bevacizumab, there are rare cases of cranial nerve palsy.

CASE REPORT

We report a case of transient oculomotor nerve palsy after systemic administration of bevacizumab. Twenty-four hours after the systemic infusion of bevacizumab, transient oculomotor nerve palsy developed in a 49-year-old male patient. In the cranial MRI, there was no malignancy-related progression.

MANAGEMENT AND OUTCOME

Bevacizumab treatment was discontinued. Methylprednisolone was started considering that bevacizumab increased the inflammatory response. Oculomotor nerve palsy resolved in 14 days.

DISCUSSION

There are many side effects of bevacizumab whose mechanisms of action have not been fully explained. Cranial nerve involvement is rarely reported. Our case is the first reported case of bevacizumab-induced oculomotor nerve palsy.

The demographic characteristics, prognosis, and relationship with cancer subtypes of hospitalized COVID-19 patients with malignancy: A single-center experience

Undoubtedly, cancer patients have suffered the most from the COVID-19 pandemic process. However, cancer is a heterogeneous disease, and each patient has responded differently to COVID-19. We aimed to describe the clinical characteristics and outcomes of patients with cancer and COVID-19. We retrospectively reviewed 45 cancer patients hospitalized in the Cerrahpaşa Medical Faculty COVID-19 department from March 23 to October 23, 2020. We analyzed the demographic characteristics, symptoms, laboratory findings, treatment, prognosis, and cancer subtypes of patients and mortality who were hospitalized for COVID-19. Between March 23 and October 23, 2020, 45 hospitalized cancer patients who had laboratory-confirmed COVID-19 infection were included, with a median age of 60 years (range: 23-92). Patients were divided into two groups a survivor and a non-survivor. Symptoms, demographic information, comorbidities, treatments for COVID-19, and laboratory findings of the two groups were evaluated separately. Two parameters were found, which showed a significant difference between non-survivors and survivors displaying a disadvantage for COPD and low platelet count (p = 0.044-0.038). The mortality rate of all patients was 66%. The presence of comorbidities such as COPD and low platelet count in cancer patients with COVID-19 infection may draw the attention of physicians.

POS0576 EFFECTS OF ACUTE EXERCISE ON SERUM BDNF LEVEL IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background:

Brain derived neurotrophic factor (BDNF) is a neurotrofic factor that may show healing, survival-promoting and protective effects on neurons in central and peripheral nervous system. The effect of physical exercise on serum BDNF is unclear. Also, BDNF level was found significantly lower in rheumatoid Arthritis (RA) patients with depression.

Objectives:

Aim of this study is to investigate the variation of BDNF levels following acute exercise and potential correlation between BDNF levels and depression.

Methods:

This study included 44 RA patients and 44 age and sex matched healthy controls (HC). Aerobic exercise was performed to all participants for a single session. The intervention was performed on a treadmill and included 5 minutes of warm-up, 20 minutes of walking exercise reaching at 60- 80% of Maximal heart rate and 5 minutes of cool-down. Depression and anxiety levels were evaluated with Beck Depression Inventory (BDI) and Hospital Anxiety and Depression Scale (HADS). Blood samples from all subjects were taken and centrifuged before and immediately after the exercise intervention.

Results:

Serum BDNF levels (both baseline and post-exercise) were similar in the RA and HC group (Table 1). Although after aerobic exercise serum BDNF levels were significantly decreased in both RA and HC groups (Wilcoxon Rank P < 0.05) ΔBDNF levels was significantly higher in the RA group than HC group. Serum BDNF level was increased in 30.2% of healthy subjects and 4.5% of RA patients (P = 0.002). On the other hand, BDI, HADS depression and HADS anxiety indices were correlated significantly with ΔBDNF levels in the RA group (p<0.05) but not in HC group.

Conclusion:

A single bout of exercise may be effective on serum BDNF levels in patients with RA and healthy subjects. However, psychological comorbidities affect the amelioration of BDNF level, in RA. The long-term effect of alterations on BDF level is candidate to evaluate by prospective studies.

Table 1.

Clinical and laboratory characteristics in the study groups

RA (n=44)HC (n=44)PMean age, years46.8±10.343.4±6.40.071*Females, n (%)32 (72.7)31 (70.5)0.813**Active smokers, n (%)12 (27.3)10 (22.7)0.622**BMI, kg/m226.8±4.625.6±2.40.127*HADS Depression10.2±3.92.2±2.1<0.001*HADS Anxiety10.4±4.12.4±2.1<0.001*BDI17.9±8.13.7±4.1<0.001*BDNF (baseline), pg/ml798.9±381.1688.7±469.90.069***BDNF (post-exercise), pg/ml469.5±193.5509.9±380.40.593***ΔBDNF, pg/ml329.5±258.4211.1±302.60.047***BDNF increased, n (%)2 (4.5)13 (30.2)0.002**

RA; rheumatoid arthritis, HC; healthy control, BMI; body mass index, HADS; Hospital Anxiety and Depression Scale, BDI; Beck Depression Inventory, BDNF; brain derived neurotrophic factor

*Student’s t test, **Chi square test and ***Mann Whitney U test

Disclosure of Interests:

None declared

Influence of feed particle size and feed form on productive performance, egg quality, gastrointestinal tract traits, digestive enzymes, intestinal morphology, and nutrient digestibility of laying hens reared in enriched cages

A total of 640 Lohmann LSL hens were randomly allotted to 4 dietary treatments arranged in 2 × 2 factorial with 2 feed particle sizes (fine and coarse) and 2 feed forms (mash and crumble). The 2 particle sizes were achieved by grinding whole corn and wheat in the hammer mill to pass through 4- and 8-mm sieves. The laying hen diet was isonutritive, and each diet was fed to 8 enriched cages of 20 hens from 21 to 52 wk of age. Screen size and feed form did not affect feed intake, egg production, egg weight, egg mass, and quality traits of the eggs, except for yolk color score, which decreased with crumbling of the feed. Feed conversion ratio was greater (P < 0.01) in hens fed the coarsely ground diet than in hens fed the finely ground diet. Crumbling the feed increased (P < 0.01) feed intake and feed conversion ratio compared to those after mashing. The relative weight of the liver and length of the small intestines were greater (P < 0.05) in hens fed crumble than in hens fed mash. Finely grinding cereals decreased (P < 0.01) the pancreas and gizzard weight compared to those after coarse grinding. The pH of digestive organs showed significant responses to feed form. Crumbling resulted in increased (P < 0.01) pancreatic activities of amylase, while lipase secretion was not affected by the manipulations in screen size and feed form. Ileal villus measurements (villus height, villus height/crypt depth ratio, villus surface area) were greater (P < 0.01) in hens fed crumble than in hens fed mash, whereas particle size had no effect. Total tract digestibility coefficients of crude ash and ether extracts were improved narrowing screen size from 8 to 4 mm. Data illustrated that grinding cereals to pass through a 4-mm screen could improve the efficiency of feed conversion. However, feeding crumbles provided no benefit to productive performance and egg quality, although the absorptive capacity of laying hens increased.

A rare complication in a patient taking rivaroxaban: Alveolar hemorrhage

Alveolar hemorrhage (AH) is a heterogeneous clinical syndrome with a high mortality rate that is characterized by extensive bleeding into the alveolar spaces. AH usually develops secondary to immunological disease and, less frequently, to drug use. Presently described is the case of an 86-year-old woman with AH who had been using rivaroxaban for 6 months.

Detection of parvovirus B19 DNA in the lesional skin of patients with Behçet's disease

BACKGROUND

There is disagreement in the current evidence for viral aetiologies in the pathogenesis of Behçet's disease (BD).

OBJECTIVES

To investigate the presence of B19 DNA in skin lesions of patients with BD, compare with the skin of healthy controls and evaluate its role in the pathogenesis.

METHODS

In total, 40 patients diagnosed with BD according to the criteria proposed by the International Study Group for Behçet's Disease and routinely followed up at our centre were enrolled into the study. All the patients selected were in the active phase of disease. Skin and blood samples of patients with BD and of the healthy volunteers were examined for B19 serology, histopathology and genome expression.

RESULTS

The quantity of B19 DNA in nonulcerative BD lesions of was significantly different from ulcerative lesions in the study group and from the skin of the healthy controls (P < 0.01). For the nonulcerative lesions, real-time PCR analysis for B19 DNA was found to be 64% sensitive (95% CI 42.5-82.0) and 85% specific (95% CI 62.1-96.6) with a cut-off value of > 154 IU/mL (P < 0.001).

CONCLUSIONS

To the best of our knowledge, this is the first study that provides evidence for a possible causal link between BD and parvovirus B19, and our data suggest the presence of the virus, particularly in intact, nonulcerative skin lesions of BD. Limitations to this study include the limited number of participants, and the fact that the exact source of B19 DNA was undetected.

Painful penile ulceration in a patient with malignant atrophic papulosis

Malignant atrophic papulosis (MAP) is a rare, obliterating vasculopathy affecting multiple systems, frequently with a poor prognosis. Although cutaneous lesions are often the initial presentation, systemic involvement is also common, usually with a fatal outcome. Involvement of the genitalia is very rare. We describe a 45-year-old male patient with multisytemic manifestation of MAP accompanied by painful penile ulceration. The pathogenesis of MAP is not yet fully understood and effective treatment choices are limited. In our case, the combination of pentoxifylline and dipyridamole failed to provide a beneficial effect on the progression of the disease and the patient died due to intestinal and intrathoracic manifestation of MAP. In the present case, attention should be drawn to the following clinical course and therapeutic properties: (i) we describe the second patient in the literature diagnosed with MAP and painful penile ulceration; (ii) to our knowledge, this is the first reported case with oesophageal fistula due to MAP; (iii) we could not confirm the efficacy of pentoxifylline, the recently reported treatment modality, in our patient.

Oxidant-antioxidant profiles of platelet rich plasma in smokers

Cigarette smoke is a major risk factor for both coronary heart disease and peripheral vascular disease and has been reported to contain many oxidizing agents that lead to generation of free radicals. In this study, we investigated the levels of lipid peroxides (LPO) and antioxidant vitamins (C and E), total thiol content (t-SH), the activities of superoxide dismutase (SOD), glutathione S-transferase (GST) and glutathione peroxidase (GPx) in the platelet-rich plasma (PRP) and plasma of 50 smokers and 30 non-smokers. Total cholesterol (TC), low density-cholesterol (LDL-C), triglyceride (TG) and phospholipid (PL) levels of the plasma were significantly higher (p < 0.001) and high density-cholesterol (HDL-C) levels were significantly lower in smokers (p < 0.001) when compared with non-smokers. In plasma and PRP, LPO levels, GST and SOD activities were found to be increased (p < 0.001) in smokers, whereas GPx activity, vitamin C levels and t-SH content were found to be decreased. On the other hand, the levels of vitamin E was unchanged in plasma and PRP. The relationships between plasma levels of lipids, LPO and antioxidant systems were also investigated in both groups. A strong positive correlation was found between TC and Vit E (r = 0.5575; p < 0.001), LPO and PL (r = 0.4270; p < 0.01), LPO and GST (r = 0.3770; p < 0.01) and t-SH and GPx (r = 0.3781; p < 0.01) in smokers. These findings reveal a disturbance of oxidant-antioxidant balance by free radicals present in cigarette smoke, which may cause reduction in platelet hyperreactivity and endothelial dysfunction in smokers.