The MIAMI Study (Markers of inflammation and Atorvastatin effect in previous myocardial infarction) : results of a prospective, multicenter study

Objective: MIAMI is a prospective multicenter clinical study designed to investigate the relationship between C-IMT progression and changes in circulating markers of inflammation, coagulation and endothelial dysfunction in patients with stable CAD treated for two years with 20 mg/day atorvastatin. Methods: C-IMT, blood lipids and soluble markers were measured at baseline, at the 12th month and at the end of the study in eighty-five patients. Results: Atorvastatin induced C-IMT regression. Fibrinogen, TFPI-total, sICAM-1, sE-selectin, IL-8 and vWF, but not hs-CRP, IL-18, TFPI-free, sVCAM-1, IL-6, TNF-α and sCD40L, decreased upon treatment. Changes in lipids did not correlate with C-IMT regression. Changes in single soluble markers correlated poorly with C-IMT regression, but strongly when combined in relevant composite scores (inflammation/coagulation-score, endothelial activation-score, soluble markers-score and total-score). Conclusions: In patients with stable CAD, a moderate dose of atorvastatin was associated with regression of C-IMT. This effect was correlated with changes of inflammation, thrombosis and endothelial dysfunction profiles. Funding: Partial support by a grant from Pfizer- Itali

High prevalence of splenic marginal zone lymphoma among patients with acquired C1 inhibtor deficiency

Marginal zone lymphoma represents about 10% of all non-Hodgkin lymphomas (NHLs). 33% of patients with acquired angioedema (AAE) due to acquired C1-inhibitor (C1-INH) deficiency (C1-INH-AAE) have or will develop NHLs. C1-INH-AAE is a rare condition. We report the follow-up of 72 C1-INH-AAE patients, followed for a median of 15\uc2\ua0years (range 1-24). Median age was 71 (range 64-79) years; median age at onset of angioedema symptoms was 57\uc2\ub75 (range 50-66) years and it was 63 [range 45-80) years at diagnosis]. Twenty patients were diagnosed with low-grade non-follicular B-cell lymphomas (75% were splenic MZL), one with follicular and three with high-grade lymphomas (two diffuse large B-cell lymphomas and one mantle cell lymphoma). Fifteen NHLs were diagnosed at onset of AAE or thereafter (3\uc2\ua0months to 7\uc2\ua0years), eight had already been diagnosed at onset of angioedema. Two of 24 patients remain on watchful wait. Thirthen of 24 received chemotherapy, two received rituximab. Three underwent splenectomy. All 18 patients receiving therapy for NHL experienced post-treatment reduction in AAE symptoms. Our study suggests that clonal B-cell proliferation is the pathology underlying AAE leading to production of C1-INH-neutralizing autoantibodies and to NHLs. The post-germinal centre origin of NHL suggests that immune stimulation may contribute to lymphomagenesis

Long-term fluvastatin reduces the hazardous effect of renal impairment on four-year atherosclerotic outcomes (a LIPS substudy)

peer reviewedMild renal impairment is an important risk factor for late cardiovascular complications. This substudy of the Lescol Intervention Prevention Study (LIPS) assessed the effect of fluvastatin on outcome of patients who had renal dysfunction and those who did not. Complete data for creatinine clearance calculation. (Cockcroft=Gault formula) were available for 1,558 patients (92.9% of the LIPS population). Patients were randomized to fluvastatin or placebo after successful completion of a first percutaneous coronary intervention. Follow-up time was, 3 to 4 years. The effect of baseline creatinine clearance on coronary atherosclerotic events (cardiac death, non-fatal myocardial infarction, and coronary reinterventions not related to restenosis) was evaluated. Baseline creatinine clearance (logarithmic transformation) was inversely associated with an incidence of adverse events among patients who received, placebo. (hazard ratio 0.99, 95% confidence interval 0.982 to 0.998, p = 0.01). However, no association was noted between creatinine clearance and the incidence of adverse events among patients who received fluvastatin (hazard ratio 1.0, 95% confidence interval 0.99 to 1.0, p = 0.63). No further deterioration in creatinine clearance was observed during follow-up; regardless of baseline renal function or allocated treatment. Occurrence of adverse events was not related to changes in renal function during follow-up. Fluvastatin therapy markedly decreased the risk of coronary atherosclerotic events after percutaneous intervention in: patients who had lower values of creatinine clearance at baseline: The benefit of fluvastatin was unrelated to any effect on renal function. (C) 2005 by Excerpta Medica Inc

Respiratory dysfunction as first presentation of myasthenia gravis misdiagnosed as COVID-19

Background: The outbreak of the coronavirus disease 2019 (COVID-19) has had profound impact on health care not only for its direct effects, but also because it deeply influenced the whole clinical practice and diagnostic pathways, particularly in the acute setting. Case report: We present the case of a patient with respiratory dysfunction due to myasthenia gravis (MG) initially misdiagnosed as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection due to ambiguity in the interpretation of radiological and microbiological findings during COVID-19 pandemic. Discussion: Respiratory dysfunction as first clinical manifestation of myasthenia gravis is rare, but potentially very harmful. Emergency physicians should always consider neurological diseases when dyspnea cannot be explained by cardiac or respiratory causes