Serum thyroid hormone antibodies are frequent in patients with polyglandular autoimmune syndrome type 3, particularly in those who require thyroxine treatment

Polyglandular autoimmune syndrome (PAS) type 3 consists of autoimmune thyroid disease (AITD) coexisting with ≥1 non-thyroidal autoimmune disease (NTAID) other than Addison’s disease and hypoparathyroidism. We evaluated the prevalence and repertoire of thyroid hormones antibodies (THAb) in PAS-3 patients. Using a radioimmunoprecipation technique, we measured THAb (T3IgM, T3IgG, T4IgM, and T4IgG) in 107 PAS-3 patients and 88 controls (patients with AITD without any NTAID). Based on the selective coexistence of AITD with one NTAID (chronic autoimmune gastritis, non-segmental vitiligo or celiac disease), patients were divided into group 1 (chronic autoimmune gastritis positive, n = 64), group 2 (non-segmental vitiligo positive, n = 24), and group 3 (celiac disease positive, n = 15). At least one of the four THAb was detected in 45 PAS-3 patients (42.1%) and 28 controls (31.8%, P = 0.14), with similar rates in the three PAS-3 groups. The rates of T3Ab, T4Ab, and T3 + T4Ab were similar in groups 1 and 2, while in group 3, T3Ab was undetected (P = 0.02). In PAS-3 patients, the rate of levothyroxine treatment was greater in THAb-positive patients compared to THAb-negative patients (76.7 vs. 56.1%, P = 0.03, RR = 1.4, 95% CI 1.03–1.81). Not unexpectedly, levothyroxine daily dose was significantly higher in group 1 and group 3, namely in patients with gastrointestinal disorders, compared to group 2 (1.9 ± 0.4 and 1.8 ± 0.3 vs. 1.5 ± 0.2 μg/kg body weight, P = 0.0005 and P = 0.004). Almost half of PAS-3 patients have THAb, whose repertoire is similar if chronic autoimmune gastritis or celiac disease is present. A prospective study would confirm whether THAb positivity predicts greater likelihood of requiring levothyroxine treatment

Partial childhood epilepsy and reaction time: the effect of interictal EEG discharges.

A study was conducted on seven children (five females and two males, aged 5.7-13.1 years) affected with partial epilepsy which was well controlled by therapy. A computer was connected on-line to a polygraph and during two EEG recordings, the subject had to react to the appearance of a colored rectangle on the display screen by pushing a key on the keyboard: these events were automatically marked on the trace of a polygraphic channel. By means of Anova analysis it was demonstrated that during the same recording, reactions simultaneous to paroxysmal discharges were not significantly slower than those measured during free intervals. However, in the same patient, reaction times were significantly prolonged during recordings characterized by a higher rate of EEG paroxysmal activity

[Continuous localized EEG discharge during sleep in children without neuropsychological problems].

After having reported continuous localized EEG discharge during slow sleep (CLEDS) in six children with congenital encephalopathy, we observed a similar EEG picture in six children free from both neuropsychological and neuroradiological defects. They suffered from partial idiopathic epilepsy; five presented a familial disposition towards febrile seizures. Continuous paroxysmal activity during sleep was observed from 4.8 yrs to 4.11 yrs (mean age: 4.9 yrs). Spontaneous remission of CLEDS was observed in three cases after 2-25 months, but one or more relapses occurred in two cases, and five children are still suffering from CLEDS. Seizures were controlled by drugs in all cases. Deterioration of intelligence level, although not severe, was observed in one case, after 24 months of CLEDS

A Clinical Patient Reporting Tool: Giving ADPKD Patients Back Their Data

Klinischer Patientenbericht: ADPKD-Patienten erhalten Zugriff auf ihre Daten Zusammenfassung. Studien zur Patientenbeteiligung in der medizinischen Versorgung deuten darauf hin, dass eine intensive Patientenbeteiligung die Gesundheit verbessert und die Vorsorgungszufriedenheit erhöht. Insbesondere bei Behandlungsentscheidungen, die sowohl Schaden als auch Nutzen verursachen, sind gemeinsame Entscheidungen von Patienten und Ärzten entscheidend um den Patienten auf den Behandlungsplan vorbereitet und ihn dafür zu motivieren. Allerdings sind Instrumente, die den Patienten in den klinischen Versorgungsprozess und gemeinsamen Entscheidungsfindung einbeziehen, nicht weit verbreitet. Wir entwickelten ein klinisches Patientendokument für Patienten mit autosomal-dominanter polyzystischer Nierenerkrankung (ADPKD), für die kürzlich eine neue Therapie – Tolvaptan, das die Progression verlangsamt, aber bemerkenswerte Nebenwirkungen hat – zur Verfügung steht. Untersuchungen vor und nach der Entwicklung zeigten, dass ADPKD-Patienten eine Anzeige individueller Schweregradindikatoren mit Benchmarks für vergleichbare Patienten wünschen. Die Kommunikation wird erleichtert und das Vertrauen der Patienten in die gemeinsam gefällten Behandlungsentscheidungen verbessert. Ein solcher Patientenbericht ist leicht auf andere Krankheitsbilder übertragbar und könnte als ein Aspekt eines Patienteninterventionsmodells in klinischen Zentren dienen. </jats:p

Unexpected elevated free thyroid hormones in pregnancy

Background: The use of thyrotropin and free thyroid hormone assays to evaluate thyroid function is widespread, but in some situations the results are inconsistent with the patient's thyroid status. Summary: A 35-year-old woman with a known diagnosis of chronic autoimmune thyroiditis was referred to the authors' clinic at week 26 of her second pregnancy. The patient was clinically euthyroid. Consistent with this, her serum thyrotropin (TSH) was normal (0.79 mIU/L), but she had elevated free thyroid hormones-free triiodothyronine (fT3) and free thyroxine (fT4)-As determined by a one-step chemiluminescent assay. The patient was taking levothyroxine replacement therapy (125 lg/day), and the dose was confirmed. Previous blood tests showed concordance between TSHand free thyroid hormone values. The patient was followed up throughout gestation and at 12months postpartum. During gestation, her free thyroid hormones remained high using one-step methods, while the total thyroid hormone concentration values were within the reference range, in agreement with the TSH values. Postpartum fT4 and fT3 values returned progressively to normality, in agreement with the TSH values. The presence of circulating thyroid hormone autoantibodies (THAb) was hypothesized, which are known to interfere, although to a variable extent, with thyroid hormone one-step assays. Using stored frozen sera, this hypothesis was confirmed indirectly by measuring normal levels of fT3 and fT4 with a two-step method, and directly by demonstrating THAb against the two hormones. Conclusion: Despite their relative rarity, circulating THAb may be suspected when laboratory data are not consistent and contrast with the clinical picture. To the authors' knowledge, no previous case of transient appearance of THAb in pregnancy has been described

Potential of Fibrin Glue and Mesenchymal Stem Cells (MSCs) to Regenerate Nerve Injuries: A Systematic Review

Cell-based therapy is a promising treatment to favor tissue healing through less invasive strategies. Mesenchymal stem cells (MSCs) highlighted as potential candidates due to their angiogenic, anti-apoptotic and immunomodulatory properties, in addition to their ability to differentiate into several specialized cell lines. Cells can be carried through a biological delivery system, such as fibrin glue, which acts as a temporary matrix that favors cell-matrix interactions and allows local and paracrine functions of MSCs. Thus, the aim of this systematic review was to evaluate the potential of fibrin glue combined with MSCs in nerve regeneration. The bibliographic search was performed in the PubMed/MEDLINE, Web of Science and Embase databases, using the descriptors (“fibrin sealant” OR “fibrin glue”) AND “stem cells” AND “nerve regeneration”, considering articles published until 2021. To compose this review, 13 in vivo studies were selected, according to the eligibility criteria. MSCs favored axonal regeneration, remyelination of nerve fibers, as well as promoted an increase in the number of myelinated fibers, myelin sheath thickness, number of axons and expression of growth factors, with significant improvement in motor function recovery. This systematic review showed clear evidence that fibrin glue combined with MSCs has the potential to regenerate nervous system lesions