Interferon gamma release assays based on M. tuberculosis- -specific antigens in sarcoidosis patients

Wstęp: Prezentowana praca jest częścią projektu dotyczącego testów opartych na wydzielaniu interferonu gamma pod wpływem antygenów swoistych dla prątka gruźlicy przeprowadzonego na dużej grupie nieleczonych chorych na sarkoidozę w populacji powszechnie i wielokrotnie szczepionej przeciwko gruźlicy. Celem pracy była ocena wyników testów IGRA w tej grupie chorych. W pracy dyskutowany jest problem przydatności testów IGRA w wykrywaniu zakażenia prątkiem gruźlicy w kontekście współcześnie prezentowanych poglądów dotyczących roli antygenów prątka gruźlicy w etiopatogenezie sarkoidozy.Materiał i metody: W badaniu uczestniczyło 151 chorych na sarkoidozę, w wieku 38 ± 10,3 roku, nigdy nieleczonych. Wszyscy uczestnicy badania mieli wykonany test QFT-GIT. Z grupy badanej utworzono podgrupę 81 chorych na sarkoidozę, którym wykonano w tym samym czasie drugi test IGRA: T-SPOT.TB.Wyniki: Dodatni wynik testu QFT-GIT stwierdzono u 7/151 badanych, a wynik testu T-SPOT-TB u 3/81 badanych. Nie stwierdzono wyników nieokreślonych. Nie stwierdzono statystycznie istotnej zależności pomiędzy wynikiem testu IGRA a wybranymi parametrami klinicznymi sarkoidozy.Wnioski: U chorych na sarkoidozę szczepionych w przeszłości przeciwko gruźlicy szczepionką BCG odsetek dodatnich wyników IGRA wynosił 4,6% dla QFT-GIT oraz 3,7% dla T-SPOT.TB. Nie wykazano wpływu wybranych parametrów klinicznych sarkoidozy na wynik testów IGRA.Introduction: This study is a part of the project on interferon gamma release assays performed in the group of untreated sarcoidosis patients formerly BCG vaccinated. The aim of the study was to assess the rate of positive commercial interferon g release assays in sarcoidosis patients. We discussed the results in the context of hypothesis that M. tuberculosis antigens may play a role in the pathogenesis of sarcoidosis.Material and methods: 151 patients, mean age 38 ± 10.3, treatment naive, with newly diagnosed pulmonary sarcoidosis were enrolled into the study. All participants underwent QFT-GIT assay. A subgroup of 81 patients underwent also T-SPOT.TB assay.Results: QFT-GIT was positive in 7/151. T-SPOT.TB was positive in 3/81. There were no indeterminate results in both IGRAs. There was no statistically significant relationship between IGRAs results and sarcoidosis parameters such as the radiologic stage, disease duration and the presence of Löfgren’s syndrome.Conclusions: In sarcoidosis patients formerly BCG vaccinated, positive rate of IGRAs was 4.6% for QFT-GIT and 3.7% for T-SPOT. TB. We did not find the influence of the selected parameters of sarcoidosis on IGRAs results

Mycobacterial infection caused by Mycobacterium avium in allogenic bone marrow transplant recipient with concomittant bronchiolitis obliterans as a manifestation of graft versus host disease - case report and review of the literature

Chorzy po przeszczepieniach narządów są zaliczani do grupy ryzyka zachorowania na mikobakteriozy. Częstość tych zakażeń po przeszczepieniu komórek krwiotwórczych nie jest jednak tak wysoka, jak by się można spodziewać i szacuje się ją na 0,4-4,9% chorych. W niniejszej pracy przedstawiono przypadek mikobakteriozy wywołanej przez M. avium u pacjentki po allogenicznym przeszczepieniu szpiku kostnego przeprowadzonym z powodu przewlekłej białaczki szpikowej. U chorej występowała również patologia płucna pod postacią zarostowego zapalenia oskrzelików płucnych, będąca wyrazem przewlekłej reakcji przeszczep przeciw gospodarzowi, leczonej glikokortykosteroidami. Chora została przyjęta z powodu pojawienia się duszności spoczynkowej, kaszlu z obfitym odkrztuszaniem i stanów podgorączkowych. W badaniach czynnościowych stwierdzono częściową niewydolność oddechową (O2 - 47,9 mm Hg, CO2 - 41 mm Hg) oraz zaburzenia wentylacji typu obturacyjnego (FEV1 - 0,67 l, tj. 22% w.n.) z obniżeniem VC (2,23 l, tj. 64% w.n.). W tomografii komputerowej wysokiej rozdzielczości (HRCT) uwidoczniono zmiany naciekowe i rozstrzenie oskrzeli w polach górnych i środkowych obu płuc, które były nieobecne w badaniu przeprowadzonym w 2002 roku. Z wydzieliny oskrzelowej wyhodowano prątki kwasoodporne oraz Pseudomonas aeruginosa ESBL (+). W badaniu metodą wysokosprawnej chromatografii cieczowej (HPLC) zidentyfikowano Mycobacterium avium. Wdrożono leczenie klarytromycyną, ciprofloksacyną, izoniazydem (INH), etambutolem (EMB), amikacyną oraz optymalne leczenie infekcji współistniejącej, nie uzyskując odprątkowania w okresie 3 miesięcy ani też eradykacji Ps. aeruginosa. Leczenie kontynuowano w ośrodku macierzystym, gdzie po wielu miesiącach uzyskano odprątkowanie. Po ponad roku chora zmarła wskutek postępu choroby podstawowej - zarostowego zapalenia oskrzelików płucnych. Pacjentka należała do grupy ryzyka infekcji atypowymi mikobakteriami, przebieg zakażenia zaś był typowy, zdecydowano się jednak opisać ten przepadek ze względu na niewielką liczbę doniesień na ten temat.Patients after organ transplantations are at risk for mycobacteriosis development. Frequency of the mycobacterial infection after bone marrow transplantation (BMT) is not as high as one could expect. It ranges from 0.4 to 4.9%. We present a case of a female patient after allogenic BMT as a treatment of chronic myelogenous leucaemia, with bronchiolitis obliterans as a symptom of graft versus host disease (GvHD), treated with corticosteroids and infected with Mycobacterium avium. She was admitted to the hospital with dyspnoea, cough with large amount of sputum production and subfebrile status. She had partial respiratory insufficiency and obturative disturbances of respiration (FEV1 0.67 l i.e. 22% of normal) with decline of VC (2.23 l i.e. 64% of normal). The high-resolution computed tomography (HRCT) revealed multifocal infiltrations and bronchiectases in the upper and middle pulmonary fields, which were absent in the previous HRCT taken 3 years earlier. In the bronchial secretion acid-fast bacilli were found by smear and culture. The isolate was classified as Mycobacterium avium complex (MAC) by high performance liquid chromatography (HPLC). The patient was treated with clarithromycin, ciprofloxacin, isoniazide (INH), ethambutol (EMB), amikacin, but M. avium was still present in the sputum after 3 months. Treatment was continued in her parent hospital, where after a few months her sputum became negative for M. avium. But she died over a year later from progressive respiratory insufficiency in the course of bronchiolitis obliterans. The patient was in the group of high risk for mycobacterial infection development and the course of her illness was typical. We decided however to present the case as the topic seems to be quite neglected in the literature

Heart failure with preserved ejection fraction in patient with chronic kidney disease

Częstość występowania przewlekłej choroby nerek  oraz niewydolności serca wzrasta istotnie szczególnie  u pacjentów w podeszłym wieku i stanowi  bardzo istotny problem kliniczny i społeczny. Każda  osoba z przewlekłą chorobą nerek powinna być  traktowana jako chory z wysokim ryzykiem sercowo-  naczyniowym, a u pacjentów z niewydolnością  serca i przewlekłą chorobą nerek należy się liczyć  ze znacznie gorszym rokowaniem. U pacjentów ze  współistniejącą niewydolnością serca oraz przewlekłą  chorobą nerek zarówno diagnostyka, jak i leczenie  jest znacznie utrudnione i wymaga szczególnej  uwagi, wielodyscyplinarnego podejścia oraz ścisłej  współpracy nefrologa z kardiologiem, co w wielu  przypadkach pozwala na uzyskanie wieloletniego  stabilnego przebiegu klinicznego. W pracy przedstawiono  opis przypadku pacjenta z rozkurczową  niewydolnością serca oraz towarzyszącą przewlekłą  chorobą nerek, omówiono postępowanie diagnostyczne  i terapeutyczne.Patients with chronic kidney disease and heart  failure have already become the clinical and social  issue of great importance. Moreover, the improvement  of health care and aging of the society  contribute to the escalation of the scope of the  issue. Every patient with chronic kidney disease  should be considered at increased cardiovascular  risk. Additionally, in patients with heart failure and  chronic kidney disease worse prognosis should be  taken into account. The treatment of such patients  includes the elimination of reversible causes of the  diseases and the prevention of their progression  with optimal risk factors control. In patients with  heart failure and coexisting chronic kidney disease  diagnostic work-up and treatment are difficult and  require much attention, multi-professional approach  with constant cooperation of nephrologist  and cardiologist, which in many cases results in  stable clinical course of the diseases over the  years. We present a case of heart failure with preserved  ejection fraction. We also presented diagnostic  and therapeutic strategy in this patient

Hypercalcemia and renal failure in the course of sarcoidosis — case report

Disturbances of calcium metabolism such as hypercalcemia or/and hypercalciuria in the course of sarcoidosis can be a cause of renal failure in some patients. Life threatening hypercalcemia in sarcoidosis patients is not very frequent. Severe hypercalcemia leading to renal insufficiency is a very rare condition. We present a case of 53-year old man who was admitted to Department of Lung Diseases because of hypercalcemic syndrome and renal failure, and in whom diagnosis of sarcoidosis was made. He was successfully treated with systemic corticosteroids. In this article we present physiological mechanism of hypercalcemia in sarcoidosis patients, mechanism of renal damage and management of these difficult problems.Zaburzenia gospodarki wapniowej w przebiegu sarkoidozy pod postacią hiperkalcemii lub/i hiperkalciurii mogą u niektórych chorych powodować uszkodzenie nerek. Zagrażająca życiu hiperkalcemia nie jest zjawiskiem częstym u chorych na sarkoidozę. Niewydolność nerek spowodowana ciężką hiperkalcemią zdarza się rzadko. W pracy zaprezentowano przypadek 53-letniego mężczyzny przyjętego do Kliniki Chorób Płuc z powodu objawów zespołu hiperkalcemicznego i niewydolności nerek, u którego rozpoznano sarkoidozę. Zastosowanie glikosteroidów systemowych spowodowało normalizację kalcemii oraz poprawę parametrów nerkowych. W artykule omówiono przyczyny hiperkalcemii u chorych na sarkoidozę, mechanizmy uszkodzenia nerek oraz postępowanie u tych chorych

Enhanced Specific Mechanism of Separation by Polymeric Membrane Modification—A Short Review

Membrane technologies have found a significant application in separation processes in an exceeding range of industrial fields. The crucial part that is decided regarding the efficiency and effectivity of separation is the type of membrane. The membranes deal with separation problems, working under the various mechanisms of transportation of selected species. This review compares significant types of entrapped matter (ions, compounds, and particles) within membrane technology. The ion-exchange membranes, molecularly imprinted membranes, smart membranes, and adsorptive membranes are investigated. Here, we focus on the selective separation through the above types of membranes and detect their preparation methods. Firstly, the explanation of transportation and preparation of each type of membrane evaluated is provided. Next, the working and application phenomena are evaluated. Finally, the review discusses the membrane modification methods and briefly provides differences in the properties that occurred depending on the type of materials used and the modification protocol

Mycobacterial Infection Caused by Mycobacterium avium in Allogenic Bone Marrow Transplant Recipient with Concomittant Bronchiolitis Obliterans as a Manifestation of Graft Versus Host Disease—Case Report and Review of the Literature

Patients after organ transplantations are at risk for mycobacteriosis development. Frequency of the mycobacterial infection after bone marrow transplantation (BMT) is not as high as one could expect. It ranges from 0.4 to 4.9%. We present a case of a female patient after allogenic BMT as a treatment of chronic myelogenous leucaemia, with bronchiolitis obliterans as a symptom of graft versus host disease (GvHD), treated with corticosteroids and infected with Mycobacterium avium. She was admitted to the hospital with dyspnoea, cough with large amount of sputum production and subfebrile status. She had partial respiratory insufficiency and obturative disturbances of respiration (FEV1 0.67 l i.e., 22% of normal) with decline of VC (2.23 l i.e., 64% of normal). The high-resolution computed tomography (HRCT) revealed multifocal infiltrations and bronchiectases in the upper and middle pulmonary fields, which were absent in the previous HRCT taken 3 years earlier. In the bronchial secretion acid-fast bacilli were found by smear and culture. The isolate was classified as Mycobacterium avium complex (MAC) by high performance liquid chromatography (HPLC). The patient was treated with clarithromycin, ciprofloxacin, isoniazide (INH), ethambutol (EMB), amikacin, but M. avium was still present in the sputum after 3 months. Treatment was continued in her parent hospital, where after a few months her sputum became negative for M. avium. But she died over a year later from progressive respiratory insufficiency in the course of bronchiolitis obliterans. The patient was in the group of high risk for mycobacterial infection development and the course of her illness was typical. We decided however to present the case as the topic seems to be quite neglected in the literature

Mycobacterium szulgai Lung Disease or Breast Cancer Relapse—Case Report

Cancers are one of the risk factors of non-tuberculous mycobacterial (NTM) lung disease. The majority of data in this group of patients concern infections caused by Mycobacterium avium—the most prevalent NTM species worldwide. In contrast, limited information can be found regarding the uncommon NTM such as Mycobacterium szulgai. We present the case of M. szulgai lung disease in a patient with a history of breast cancer. Coexistence of NTM lung disease and breast cancer lung metastasis as well as primary lung cancer was suspected. Finally, neoplastic disease was ruled out based on negative results of endobronchial biopsy and negative tumor markers for lung and breast cancer. M. szulgai lung disease was successfully treated with rifampicin, ethambutol and clarithromycin

Solubility, Permeability, and Dissolution Rate of Naftidrofuryl Oxalate Based on BCS Criteria

The Biopharmaceutics Classification System (BCS) was conceived to classify drug substances by their in vitro aqueous solubility and permeability properties. The essential activity of naftidrofuryl oxalate (NF) has been described as the inhibition of the serotonin receptors (5-HT2), resulting in vasodilation and decreasing blood pressure. Since the early 1980s, NF has been used to treat several venous and cerebral diseases. There is no data available on the BCS classification of NF. However, based on its physical-chemical properties, NF might be considered to belong to the 1st or the 3rd BCS class. The present study aimed to provide data concerning the solubility and permeability of NF through Caco-2 monolayers and propose its preliminary classification into BCS. We showed that NF is a highly soluble and permeable drug substance; thus, it might be suggested to belong to BCS class I. Additionally, a high dissolution rate of the encapsulated NF based on Praxilene® 100 mg formulation was revealed. Hence, it might be considered as an immediate-release (IR)

Permeability of the Perindopril Arginine under In Vitro Conditions across Caco-2 Monolayer and Biomimetic Phospholipid Membrane

Perindopril arginine (PA) as an angiotensin-converting enzyme (ACE) inhibitor is widely used in cardiovascular diseases, especially in systemic hypertension and heart failure. Although the pharmacokinetics of PA are well documented, there is no available detailed data on its permeation in in vitro conditions. The present study aimed to assess the transport of PA across both biological membranes and artificial biomimetic ones. For the determination of PA transport, the Caco-2 cell line was selected as a reliable in vitro model of gastrointestinal biological barriers. Additionally, a novel 96-well plate with phospholipid membrane PermeaPad was used to evaluate the transport of PA by passive diffusion. We confirmed that PA is relatively poorly permeable across the Caco-2 monolayer. The permeability results obtained from the non-cell-based model demonstrated higher transport of PA as compared to that of Caco-2. Thus, PA transport across the biological membranes might be suggested to be regulated by the membrane transporters