Antineutrophil cytoplasmic antibody (ANCA) in pyoderma gangrenosum, a serologic marker for associated systemic diseases: a study of eight cases

BACKGROUND: The pathogenesis of Ulcerative Colitis (UC) and its extraintestinal manifestations remain uncertain, although involvement of the immune system is emphasized. The likely importance of neutrophils is demonstrated by detection of the antineutrophil cytoplasmic antibody (ANCA) in this inflammatory bowel disease. Pyoderma Gangrenosum (PG) is an idiopathic skin condition and a rare cutaneous manifestation of UC. ANCA has also been reported in the latter dermatosis. OBJECTIVES: To invetigate the relationship between clinical features of UC and the appearance of PG and its association with ANCA. PATIENTS AND METHODS: ANCA was determined in sera from eight patients with PG. Four out of eight patients had pyoderma gangrenosum associated-UC, and in four cases no identified systemic disease was associated. RESULTS: The search for ANCA yielded negative results in sera from all four patients with pyoderma not associated with systemic disease. Two cases with active and extensive colitis associated with PG and primary sclerosing cholangitis (PSC) were positive for ANCA. Sera from two other patients with both UC and PG had negative test results. CONCLUSIONS: The presence of ANCA in patients with PG associated with UC and PSC suggests that its association with PSC is responsible for ANCA positivity in this subset of patients.FUNDAMENTOS: A etiopatogenia da retocolite ulcerativa inespecífica (RCUI) e de suas manifestações extra-intestinais permanece em discussão, embora o envolvimento do sistema imune seja enfatizado, e uma possível participação dos neutrófilos é demonstrada pela detecção do anticorpo anticitoplasma de neutrófilo (ANCA) nessa doença inflamatória intestinal. O pioderma gangrenoso (PG) é considerado manifestação cutânea rara da retocolite ulcerativa, e o Anca também tem sido detectado nessa dermatose. OBJETIVOS: Investigar a relação entre o comportamento clínico da RCUI e o aparecimento do PG e sua associação com ANCA. CASUÍSTICA E MÉTODOS: Anca foi pesquisado nos soros de oito pacientes com PG, quatro apresentando RCUI, e os outros, PG não associado a doenças sistêmicas. RESULTADOS: Não se detectou o Anca nos soros dos portadores exclusivamente de pioderma gangrenoso. Dois casos de pancolite em atividade inflamatória acompanhada de pioderma e colangite esclerosante primária (CEP) apresentaram positividade para ANCA, enquanto os soros de dois outros pacientes com RCUI e PG tiveram resultados negativos. CONCLUSÕES: A Presença de ANCA nos soros de pacientes com PG associado a RCUI e CEP sugere que a associação com CEP seja responsável pela positividade do ANCA na presente amostra.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaFaculdade de Medicina do ABCUNIFESP, EPMSciEL

Hypoalbuminemia as a risk factor for thromboembolic events in inflammatory bowel disease inpatients

Background/Aims Inflammatory bowel disease (IBD) are chronic entities characterized by local and systemic inflammation and may be associated with thrombosis. The aim of this study was to identify the prevalence of thromboembolic events (TEE) in hospitalized IBD patients and identify risk factors for their occurrence. Methods This retrospective, single-center study included patients treated at a Brazilian IBD referral unit between 2004 and 2014. Patients hospitalized for more than 48 hours due to active IBD and who did not receive prophylaxis for TEE during hospitalization were included. Patients were allocated to 2 groups: those with TEE up to 30 days or at the time of hospitalization (TEE-group) and patients without TEE (control-group). Clinical and laboratory characteristics were evaluated. Results Of 53 patients evaluated, 69,8% with Crohn’s disease (CD) and 30.2% with ulcerative colitis (UC). The prevalence of TEE 30 days before or during hospitalization was 15.1%, with 10.8% in CD and 25% in UC. In the TEE group, mean serum albumin was 2.06 g/dL versus 3.30 g/dL in the control group. Patients with albumin levels below 2.95 g/dL (43.18%) had a higher risk of developing TEE (relative risk, 1.72; 95% confidence interval, 1.17–2.53) (P<0.001). Conclusions Albumin levels were significantly lower in patients with TEE, and hypoalbuminemia was considered a risk factor for the development of TEE in this population

Importance of serum albumin values in both nutritional and inflammatory activity assessment in patients with Crohn's disease

Background - The serum albumin concentration has frequently been regarded as an indicator of nutritional status, although the hypoalbuminemia may reflect an acute phase protein response during inflammation mediated by cytokines. Both hypoalbuminemia and malnutrition are observed in Crohn's disease. Objectives To correlate the serum albumin values to disease activity and also to nutritional status in patients with Crohn's disease. Patients/Methods Thirty six patients were studied. Nutritional status was assessed by anthropometry measures and inflammatory activity determined by Harvey's simple clinical index and erythrocyte sedimentation rate. Results - No correlation was found between malnutrition and hypoalbuminemia. The serum albumin levels correlated inversely with the disease activity. Hypoalbuminemia was 100% sensitive for detection of disease activity. Conclusion - This study suggests that serum albumin concentration is a very sensitive marker of inflammatory activity and not good indicator of the nutritional status in Crohn's disease. It is necessary a suitable laboratorial parameter for routine nutrition assessment in patients with this inflammatory bowel disease.Racional A albumina sérica é freqüentemente definida como um indicador de estado nutricional. No entanto, hipoalbuminemia pode refletir reação de fase aguda mediada por citocinas durante um evento inflamatório. Tanto desnutrição, como hipoalbuminemia são achados relevantes na doença de Crohn. Objetivo - Estudar a relação da albumina sérica com atividade inflamatória e com estado nutricional em pacientes com doença de Crohn. Casuística/Método Trinta e seis pacientes avaliados quanto ao estado nutricional por parâmetros antropométricos e a atividade inflamatória da doença intestinal definida por índice clínico e velociodade de hemossedimentação. Resultados - Não se encontrou associação entre desnutrição e hipoalbuminemia. A utilização dessa proteína como parâmetro bioquímico na avaliação nutricional foi dispensável para se diagnosticar desnutrição. Houve significativa relação entre atividade inflamatória e hipoalbuminemia, demonstrando 100% de sensibilidade na identificação de inflamação ativa. Conclusão - Estes resultados sugerem a dosagem de albumina sérica como marcador sensível de doença de Crohn ativa e a necessidade de um parâmetro laboratorial mais adequado para avaliação nutricional rotineira nos portadores desta doença inflamatória intestinal.Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM) Departamento de Medicina ClínicaUNIFESP, EPM, Depto. de Medicina ClínicaSciEL

Anti-tissue transglutaminase antibodies (IgA and IgG) in both Crohn's disease and autoimmune diabetes

Objective: a strong association has been observed between celiac disease, generally its silent clinical form, and autoimmune disorders. A potential correlation with inflammatory bowel disease has also been suggested. Anti-tissue transglutaminase antibodies have been detected in Crohn's disease. We investigated the prevalence of celiac disease in patients with autoimmune diabetes and in Crohn's disease patients and also evaluated the correlation between anti-transglutaminase antibody positivity and the clinical status of these diseases. Methods: anti-tissue transglutaminase and anti-endomysium antibodies were assessed by enzyme-linked immunosorbent assay and indirect immunofluorescence, respectively. Upper digestive endoscopy and duodenal biopsy were indicated for cases with positive serology. Results: anti-transglutaminase antibodies were detected in five diabetic patients (prevalence of 11.1%), only one serum sample was positive for IgG isotypes. Nine of thirty-three patients with Crohn's disease had low positive levels for IgA anti-transglutaminase. Anti-endomysium antibodies were detected only in celiac patients. Celiac disease was confirmed in all diabetic patients submitted to duodenal biopsies who presented both anti-transglutaminase and anti-endomisyum antibodies positivity. In Crohn's disease, its clinical status and the diagnosis of celiac disease were not associated with positive anti-transglutaminase result. Conclusions: the prevalence of celiac disease was high in diabetic patients. Anti-tissue transglutaminase antibodies were sensitive and specific markers of celiac disease in this diabetic group, while these antibodies were of limited value for celiac disease screening in patients with Crohn's disease

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved