Infectious Diseases News/Literature Review/2020

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Infectious Diseases Corner

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Infectious Diseases Corner

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Diseases of the Eye with Systemic Involvement and /or Acute Presentation

Opticneuritis is defined as an inflammation of the optic nerve, which is mostlyidiopathic. However, it can be associated with variable causes: demyelinatinglesions, autoimmune disorders, infectious conditions, compressive, toxic,metabolic and hereditary conditions. It is divided intoarteritic, which is commonly seen in temporal arteritis/polymyalgia rheumaticaand non arteritic, which is associated with advanced age, atherosclerosis,hypertension and hyperlipidemia. Among demyelinating disorders, multiplesclerosis is the most common cause. The term optic neuritis is indicated bysub-acute unilateral painful visual loss mostly in a young healthy female andby excluding glaucoma. The clinical diagnosis of optic neuritis consists of theclassic triad of visual loss, periocular pain and dyschromatopsia whichrequires careful ophthalmic, neurologic and systemic examinations todistinguish between typical and atypical optic neuritis. In neuromyelitis optica,optic neuritis is initially misdiagnosed as optic neuritis in multiplesclerosis or other conditions such as ischemic optic neuritis and Leber’sdisease. Therefore, differential diagnosis is necessary to make a propertreatment plan. According to Optic Neuritis Treatment Trial, the first line oftreatment is intravenous methylprednisolone with faster recovery and lesschance of recurrence of optic neuritis and conversion to multiple sclerosis.Apart from optic neuritis of various causes, loss of vision could be due toglaucoma or uveitis. Glaucoma is optic nerve damage due to an interruption ofthe production and/or abduction of vitreous gel of the eye. Uveitis refers to a group of heterogeneous diseasesthat share the features of intraocular inflammation, but whose etiologies includeidiopathic autoimmune disease, infections and masquerade syndromes. Acute retinal necrosis and detachment may have a debilitatingeffect on vision and must be rapidly diagnosed and confronted, too. Theabove-mentioned clinical entities, their etiologies and current therapies arebriefly discussed in this review.Key-words: optic neuritis; multiple sclerosis; age-relatedmacular degeneration; diabetic retinopathy; glaucoma; uveitisAbbreviations: AMD (age-related macular degeneration); DR (diabeticretinopathy); DME (diabetic macular edema); AGEs (advanced end glycationproducts

The Role of Levocarnitine in the Management of Valproic Acid Intoxication: A Case-Based Review

The administration of L-carnitine to patients with VPA intoxication and CNS depression with normal ammonia concentrations has a rationale, on the grounds that it is a safe compound with no severe adverse effects reported. Herein, we present a case of valproate poisoning with normal ammonia levels and discuss about the therapeutic as well as the prophylactic potential of L-carnitine administration in such cases

Resveratrol and Cancer

Resveratrol is a stilbene substance, belonging to the superfamily of phytoalexins, which are compounds synthesized by plants when stress occurs, usually an infection. It is abundant in red wine, red grapes, blueberries, peanuts and pistachios. Resveratrol induces p53-dependent apoptosis. A novel resveratrol analogue, HS-1793, has recently been demonstrated to inhibit vascular endothelial growth factor (VEGF) in human prostate cancer cells. Pterostilbene, an analog of resveratrol, has been demonstrated to exert both autophagy and apoptosis in human bladder and breast cancer cell lines. It has also been found to cause accumulation of autophagic vacuoles as well as promote cell death via a mechanism involving lysosomal membrane permeabilization in human melanoma, colon, lung and breast cancer cell lines. Identification of a receptor site for resveratrol in cancer cells, supports the potential of this compound as a therapeutic agent. The receptor could also serve as a vehicle for studies of future resveratrol analogues. Resveratrol has also been documented to overcome chemo-resistance by inhibiting NF-κB and STAT3 pathway. Resveratrol has shown much promise in preclinical trials and because of its good safety profile it may be an ideal chemo-preventive and chemotherapeutic agent

Milk Thistle: Its Anti-Tumor Potential

Milk thistle has been used for treating liver disorders since approximately 2000 years. Silybum marianum and its seeds contain a whole family of natural compounds, called flavonolignans. Silimarin is a dry mixture of these compounds, which are extracted after processing with ethanol, methanol, and acetone. Silimarin contains mainly silibin A, silibin B, taxifolin, isosilibin A, isosilibin B, silichristin A and silidianin. Milk thistle has been suggested to inhibit cell proliferation and to induce apoptosis, while having anti-angiogenic properties, too. Its mechanisms of action involve inhibition of tumor angiogenesis biomarkers (CD31 and nestin) and molecules regulating angiogenesis (VEGF, VEGFR1, VEGFR2, phospho-Akt and HIF-1a), while other pathways such as the Wnt/β-catenin pathway, cyclin-dependent kinases and MAPK have also been implicated in its actions. Ongoing research has focused on the improvement of milk thistle’s bioavailability and its use as an adjuvant in standardized chemotherapy in the near future

Invasive Aspergillosis as the Presenting Manifestation of Small-Cell Carcinoma

Invasive aspergillosisusually occurs in immunocompromised patients, particularly in patients with hematological malignancies because of severe and prolonged neutropenia and/orcytotoxic therapy. Therapy requires antifungal chemotherapy, with lipid-formulations of Amphotericin B or with azoles together with wide surgical excision of the fungal lesion. We report a case of invasive sino-orbital aspergillosis due to Aspergillus fumigatus in a patient with uncontrolled diabetes mellitus and small cell carcinoma. We support the notion that dual immunosuppression due to diabetes and small cell carcinoma with liver metastases was responsible for the invasive form of aspergillosis in this patient

The Impact of Demographic Characteristics and Lifestyle in the Distribution of Cystatin C Values in a Healthy Greek Adult Population

Background. The aim of the present study was to examine sources of variation for serum cystatin C in a healthy Greek population. Methods. Cystatin C together with basic clinical chemistry tests was measured in a total of 490 adults (46 ± 16 yrs, 40% males) who underwent an annual health check. Demographic, anthropometric, and lifestyle characteristics were recorded. Results. Higher values of cystatin C were observed among males (P = .04), participants aged over 65 years (P < .001), current smokers (P = .001) and overweight/obese participants (P = .03). On the contrary, alcohol consumption and physical activity seemed to have no influence on cystatin C levels (P = .61; P = .95, resp.). Conclusions. In interpreting serum cystatin C values in a healthy adult population, age, gender, Body Mass Index, and cigarette smoking need to be considered, and determination of reference ranges among distinct subpopulations seem to be prudent

Influence of Protein Intake from Haem and Non-haem Animals and Plant Origin on Inflammatory Biomarkers among Apparently-healthy Adults in Greece

Intake of different types of protein may be associated with differences in biomarkers among various populations. This work investigated the influence of protein intake from haem and non-haem animals as well as protein from plants on haematological and biochemical parameters in inflammation among apparentlyhealthy adults living in Greece, a Mediterranean country. Four hundred and ninety apparently-healthy subjects (46\ub116 years, 40% men), who consecutively visited Polykliniki General Hospital for routine examinations, voluntarily agreed to participate in the study (participation rate 85%). Demographic, anthropometric and lifestyle characteristics were recorded. Participants completed a valid, semi-quantitative food frequency questionnaire. Protein intake was classified into three sources: protein from haem animals, protein from non-haem animals, and protein from plant origin. Fasting blood samples were taken from all participants; uric acid, creatinine, lipids, cystatin C, haptoglobin, haemoglobin, haematocrit, iron, ferritin, white blood cells, monocytes, platelets, and C-reactive protein were measured. Protein intake from only haem animals was associated with increased haemoglobin and haematocrit levels (p&lt;0.05) whereas intake of protein from non-haem animals and plant origin was not associated with the investigated haematological and biochemical markers of low-grade chronic inflammation when lifestyle factors and overall dietary habits were taken into account. Intake of protein from only haem animals seems to be consistently associated with haematological markers. The confounding role of dietary habits and lifestyle variables on the tested parameters deserves further attention in future research