Gamma heavy-chain disease accompanied with follicular lymphoma: a case report

Heavy chain diseases (HCD) are B-cell lymphoprolipherative disorders characterized by the production of monoclonal heavy chains without associated light chains. Some cases of gamma-HCD (γ-HCD) are concurrent with other lymphoid neoplasm. The monoclonal component is not always detectable by serum electrophoresis, and often an immunofixation procedure is necessary to detect this component. Prognosis is variable, and no established guidelines for follow-up are available. We describe a case of a challenging diagnosis of γ-HCD due to the absence of clinical signs frequently reported in the disease (anaemia and palatal oedema among others). Haematological malignancy was the first suspicion but bone marrow examination was negative. In addition, the presence of an autoimmune bicytopenia and a Klinefelter syndrome complicated the clinical context of the patient. A thoracoabdominal computed tomography reported many small adenopathies whose pathological and immunohystochemical study revealed a follicular lymphoma. Shortly after, serum inmunofixation secondary to an abnormal electrophoretic pattern revealed a gamma paraprotein without light chains. Eventually, γ-HCD in association with follicular lymphoma was the final diagnosis. This is the first case reporting this association

Gamma heavy-chain disease accompanied with follicular lymphoma : a case report

Heavy chain diseases (HCD) are B-cell lymphoprolipherative disorders characterized by the production of monoclonal heavy chains without associated light chains. Some cases of gamma-HCD (γ-HCD) are concurrent with other lymphoid neoplasm. The monoclonal component is not always detectable by serum electrophoresis, and often an immunofixation procedure is necessary to detect this component. Prognosis is variable, and no established guidelines for follow-up are available. We describe a case of a challenging diagnosis of γ-HCD due to the absence of clinical signs frequently reported in the disease (anaemia and palatal oedema among others). Haematological malignancy was the first suspicion but bone marrow examination was negative. In addition, the presence of an autoimmune bicytopenia and a Klinefelter syndrome complicated the clinical context of the patient. A thoracoabdominal computed tomography reported many small adenopathies whose pathological and immunohystochemical study revealed a follicular lymphoma. Shortly after, serum inmunofixation secondary to an abnormal electrophoretic pattern revealed a gamma paraprotein without light chains. Eventually, γ-HCD in association with follicular lymphoma was the final diagnosis. This is the first case reporting this association

Molecular typing and study clonality of methicillin-resistant “Staphylococcus aureu”s, causing nosocomial and community acquired infections in Extremadura

La correcta vigilancia de la infección por Staphylococcus aureus Resistente a Meticilina(SARM) pasa por el conocimiento actualizado de las propiedades que la caracterizan en cada lugar. Los métodos de genotipaje, son armas valiosas para rastrear y limitar su propagación. Pretendemos describir las características actuales de la infección por SARM en Extremadura, además de evaluar el método de genotipaje rep-PCR/DiversiLab®(DL), más rápido y sencillo que la técnica de referencia, Electroforesis en Campo Pulsado(PFGE). Durante 2010 se coleccionan 309 SARM, aislados de muestras clínicas. Para cada uno se realiza un test de sensibilidad de 17 antibióticos, mediante tarjeta AST-588 Vitek 2® y E-test. Se genotipa mediante Electroforesis en Campo Pulsado(PFGE), spa-typing y DL, una muestra de 100 cepas, escogidas por muestreo aleatorio estratificado. La prevalencia de SARM en Extremadura es 20,2%. La adquisición extrahospitalaria predomina en las áreas de menor población. El patrón de multirresistencia más frecuente es Tobramicina-Levofloxacino-Eritromicina. No se obtienen resistencias a Linezolid, Daptomicina o Tigeciclina, aunque el 42% presentan Sensibilidad Disminuida a Vancomicina. PFGE revela la existencia de 27 genotipos, con predominio de E8 y E7. Mediante DL se obtienen 18 patrones, con 4 mayoritarios. Spa-typing reporta 17 genotipos. Los índices estadísticos de Simpson y Rand, revelan que PFGE es la técnica con mayor poder discriminativo y que existe discorcordancia ente DL y PFGE. No se obtienen diferencias significativas en la distribución de genotipos entre las áreas sanitarias, así como en los ratios de resistencia entre los diferentes clones, pero se observan algunas tendencias que deben tenerse en consideración.The correct surveillance and control of infeccion caused by methicillin-resistant Staphylococcus aureus (MRSA) needs of update knowledge of its specific properties in each place. Genotyping methods are valuable tools to monitor spread of SARM. We try to describe the current characteristics of infection caused of MRSA in Extremadura, also evaluate the rep-PCR/DiversiLab ® (DL ) typing method, faster and easier than gold standard technique, pulsed field gel electrophoresis (PFGE). During 2010 we collected 309 MRSA, isolates from clinical specimens. For each test susceptibility of 17 antibiotics were performed by Vitek 2 AST -588 and E -test ® card. A sample of 100 strains, selected by stratified random sampling, was genotyped by pulsed field gel electrophoresis (PFGE), spa -typing and DL. The prevalence of MRSA in Extremadura was 20.2%. The community acquired predominated in areas of lower population. The most common multidrug resistance pattern was Tobramycin - Levofloxacin - Erythromycin . No linezolid- , daptomycin- or tigecycline-resistant strains were identified, although 42 % were reduced susceptibility to vancomycin. PFGE revealed the existence of 27 genotypes , predominantly E7 and E8. 18 patterns were obtained by DL, with 4 majority. Spa -typing reported 17 clones. Rand and Simpson´s statistical indices reported respectively that PFGE was the most discriminative technique and existed discordance between DL and PFGE. No significant differences in genotype distribution between health areas and in the resistance ratios between the different clones were obtained, however some trends that should be taken into consideration were observed

Characteristics and laboratory findings on admission to the emergency department among 2873 hospitalized patients with COVID-19: the impact of adjusted laboratory tests in multicenter studies. A multicenter study in Spain (BIOCOVID-Spain study).

Identification of predictors for severe disease progression is key for risk stratification in COVID-19 patients. We aimed to describe the main characteristics and identify the early predictors for severe outcomes among hospitalized patients with COVID-19 in Spain. This was an observational, retrospective cohort study (BIOCOVID-Spain study) including COVID-19 patients admitted to 32 Spanish hospitals. Demographics, comorbidities and laboratory tests were collected. Outcome was in-hospital mortality. For analysis, laboratory tests values were previously adjusted to assure the comparability of results among participants. Cox regression was performed to identify predictors. Study population included 2873 hospitalized COVID-19 patients. Nine variables were independent predictors for in-hospital mortality, including creatinine (Hazard ratio [HR]:1.327; 95% Confidence Interval [CI]: 1.040-1.695, p = .023), troponin (HR: 2.150; 95% CI: 1.155-4.001; p = .016), platelet count (HR: 0.994; 95% CI: 0.989-0.998; p = .004) and C-reactive protein (HR: 1.037; 95% CI: 1.006-1.068; p = .019). This is the first multicenter study in which an effort was carried out to adjust the results of laboratory tests measured with different methodologies to guarantee their comparability. We reported a comprehensive information about characteristics in a large cohort of hospitalized COVID-19 patients, focusing on the analytical features. Our findings may help to identify patients early at a higher risk for an adverse outcome

Cardiac troponin and COVID-19 severity: Results from BIOCOVID study.

Myocardial injury is a common finding in COVID-19 strongly associated with severity. We analysed the prevalence and prognostic utility of myocardial injury, characterized by elevated cardiac troponin, in a large population of COVID-19 patients, and further evaluated separately the role of troponin T and I. This is a multicentre, retrospective observational study enrolling patients with laboratory-confirmed COVID-19 who were hospitalized in 32 Spanish hospitals. Elevated troponin levels were defined as values above the sex-specific 99th percentile upper reference limit, as recommended by international guidelines. Thirty-day mortality was defined as endpoint. A total of 1280 COVID-19 patients were included in this study, of whom 187 (14.6%) died during the hospitalization. Using a nonspecific sex cut-off, elevated troponin levels were found in 344 patients (26.9%), increasing to 384 (30.0%) when a sex-specific cut-off was used. This prevalence was significantly higher (42.9% vs 21.9%; P  In this multicentre study, myocardial injury was a common finding in COVID-19 patients. Its prevalence increased when a sex-specific cut-off and cardiac troponin T were used. Elevated troponin was an independent predictor of 30-day mortality, irrespective of cardiac troponin assay and cut-offs to detect myocardial injury. Hence, the early measurement of cardiac troponin may be useful for risk stratification in COVID-19

Harmonized D-dimer levels upon admission for prognosis of COVID-19 severity: Results from a Spanish multicenter registry (BIOCOVID-Spain study).

Coagulopathy is a key feature of COVID-19 and D-dimer has been reported as a predictor of severity. However, because D-dimer test results vary considerably among assays, resolving harmonization issues is fundamental to translate findings into clinical practice. In this retrospective multicenter study (BIOCOVID study), we aimed to analyze the value of harmonized D-dimer levels upon admission for the prediction of in-hospital mortality in COVID-19 patients. All-cause in-hospital mortality was defined as endpoint. For harmonization of D-dimer levels, we designed a model based on the transformation of method-specific regression lines to a reference regression line. The ability of D-dimer for prediction of death was explored by receiver operating characteristic curves analysis and the association with the endpoint by Cox regression analysis. Study population included 2663 patients. In-hospital mortality rate was 14.3%. Harmonized D-dimer upon admission yielded an area under the curve of 0.66, with an optimal cut-off value of 0.945 mg/L FEU. Patients with harmonized D-dimer ≥ 0.945 mg/L FEU had a higher mortality rate (22.4% vs. 9.2%; p