Impact of Intermediate Hyperglycemia and Diabetes on Immune Dysfunction in Tuberculosis

Supplementary Data: Supplementary materials are available at Clinical Infectious Diseases online at https://academic.oup.com/cid/article/72/1/69/5857148#274319223 . Consisting of data provided by the authors to benefit the reader, the posted materials are not copyedited and are the sole responsibility of the authors, so questions or comments should be addressed to the corresponding author.Copyright © The Author(s) 2020. Background: People with diabetes have an increased risk of developing active tuberculosis (TB) and are more likely to have poor TB-treatment outcomes, which may impact on control of TB as the prevalence of diabetes is increasing worldwide. Blood transcriptomes are altered in patients with active TB relative to healthy individuals. The effects of diabetes and intermediate hyperglycemia (IH) on this transcriptomic signature were investigated to enhance understanding of immunological susceptibility in diabetes-TB comorbidity. Methods: Whole blood samples were collected from active TB patients with diabetes (glycated hemoglobin [HbA1c] ≥6.5%) or IH (HbA1c = 5.7% to <6.5%), TB-only patients, and healthy controls in 4 countries: South Africa, Romania, Indonesia, and Peru. Differential blood gene expression was determined by RNA-seq (n = 249). Results: Diabetes increased the magnitude of gene expression change in the host transcriptome in TB, notably showing an increase in genes associated with innate inflammatory and decrease in adaptive immune responses. Strikingly, patients with IH and TB exhibited blood transcriptomes much more similar to patients with diabetes-TB than to patients with only TB. Both diabetes-TB and IH-TB patients had a decreased type I interferon response relative to TB-only patients. Conclusions: Comorbidity in individuals with both TB and diabetes is associated with altered transcriptomes, with an expected enhanced inflammation in the presence of both conditions, but also reduced type I interferon responses in comorbid patients, suggesting an unexpected uncoupling of the TB transcriptome phenotype. These immunological dysfunctions are also present in individuals with IH, showing that altered immunity to TB may also be present in this group. The TB disease outcomes in individuals with IH diagnosed with TB should be investigated further.European Union’s Seventh Framework Programme (FP7 2007-2013 - Health) under grant agreement No 305279

EVENTRAŢIA DIAFRAGMULUI – FACTOR DE RISC PENTRU INFECŢIILE RESPIRATORII. PREZENTARE DE CAZ

Eventraţia diafragmului este o anomalie congenitală sau dobândită, cu o incidenţă de 1 la 10.000 de copii. Presupune ascensiunea anormală a domului diafragmatic, datorată înlocuirii fi brelor musculare cu un ţesut fi broelastic în exces. Simptomatologia este variată, putând fi absentă sau sub forma unor acuze respiratorii ce pot merge până la detresă respiratorie. Infecţiile respiratorii recurente sunt cele mai frecvente manifestări. Autorii prezintă cazul unui pacient în vârstă de 3 ani de sex masculin, spitalizat în repetate rânduri pentru infecţii respiratorii, „dextrocardie“ aparentă, datorate unei eventraţii diafragmatice stângi, pentru care s-a realizat cu succes plicatura diafragmului

EVENTRATION OF THE DIAPHRAGM, A RISK FACTOR FOR RECURRENT RESPIRATORY TRACT INFECTION – A CASE REPORT

Eventration of the diaphragm, congenital or acquired, represents a rare condition (1 to 10,000 live births), in which the dome of the diaphragm is abnormally elevated, due to an excessive amount of fi bro-elastic diaphragmatic tissue. The child may be asymptomatic or present with respiratory symptoms as aggressive as life threatening respiratory distress. Recurrent pulmonary infections are the commonest presenting complaints. We present the case of a 3 years old boy with recurrent chest infections and apparent “dextrocardia”, both caused by a left eventration of the diaphragm, successfully treated by plication

The Angle of Progression at Station 0 and in Magnetic Resonance and Transperineal Ultrasound Assessment

The transperineal ultrasound (TPU) value of the angle of progression (AOP) during fetal head engagement, at station 0, is a critical cut-off for current obstetrical practice, especially when intrapartum instrumental interventions are required. Still, controversial measurements were reported in previous high resolution imagistic studies. Our TPU and direct “gold-standard” magnetic resonance (MRI) measurements confirm that station 0 corresponds to a 120° AOP, concordantly. Based on these findings, the fact that an AOP of 120° or greater was previously strongly associated with vaginal delivery may be due to the achievement of head engagement in labor