Volume 7, Issue 1

Rheumatoid arthritis (RA) is a chronic autoimmune disease and is supposed to have both genetic and environmental backgrounds. Plenty of studies have demonstrated the roles of long non-coding RNAs (lncRNAs) in the initiation and development of RA. Numerous lncRNAs have been found to be dysregulated in RA and to be correlated with disease activity of RA, which indicates potential diagnostic roles of lncRNAs. In addition to working as biomarkers for RA, lncRNAs participate in many specific pathological processes including inflammation, aberrant proliferation, migration, invasion and apoptosis. Further screenings and researches are required to validate the clinical potentials of lncRNAs as diagnostic and therapeutic targets in RA.

One of the dreaded life-threatening complications of diabetes mellitus (DM) is diabetic ketoacidosis (DKA). American Diabetic Association (ADA) came out with 2018 guidelines on the management of DM and its complications, but these are woefully silent on the clinical conundrums that accompany DKA in elderly patients. In elderly patients, DKA is often complicated by sepsis, atrial fibrillation, polypharmacy, nonketotic hyperosmolar states, atypical clinical presentations, acute kidney injury (AKI), dementia, and noncompliance with medications. Here in we highlight these conundrums that need to be addressed to improve morbidity and mortality in elderly patients.

Background and Objective Hepcidin is the key regulator of iron metabolism and is a significant biomarker for systemic inflammatory states. Vitamin D is a powerful immunomodulator and plays a significant role in the inflammatory responses and fibrosis occurring due to hepatitis C virus (HCV) infection. This study assessed the level of vitamin D and serum hepcidin and its expression in peripheral blood of children with chronic hepatitis C (CHC) and correlated them with other serum markers to reflect iron metabolism and liver disease severity. Methods A total of 100 children were included in this study: 50 with HCV infection and 50 healthy controls. Biochemical parameters together with vitamin D, hepcidin, and its expression were all measured. Results The level of hepcidin and its expression together with vitamin D and hepcidin-to-ferritin (H/F) ratios were significantly reduced in patients, but the iron and ferritin levels were higher ( P <0.001). Serum hepcidin level showed significant positive correlation with hepcidin expression, HCV titer, iron, ferritin, and H/F ratio ( r = 0.43, 0.31, 0.34, 0.28, and 0.91, respectively) but significant negative correlation with vitamin D ( r = −0.37). Both hepcidin and ferritin were higher in patients with Child Pugh scores B and C than those with score A ( P <0.001). Conclusion Measuring serum hepcidin and its expression together with vitamin D levels in patients may have a prognostic value and is promising in the follow-up of the severity of liver disease.

Background and Objective Ostial LM stenting potentially induces turbulence in the aortic wall near the LM ostium, which might be correlated with aorta dilation and dissection. We investigated through a computational fluid dynamic analysis (CFD), the presence and potential consequences of flow turbulences both in the ascending aorta and arch after a stenting left main (LM) mid shaft or distal disease. Methods The model of the ascending aorta and left coronary artery was reconstructed reviewing both angiographic and echocardiographic measurements of 80 consecutive patients (43 males, mean age 75.1 ± 6.2 years) with significant LM mid shaft or distal disease treated in our institution. For stent simulation, a third-generation everolimus-eluting stent was reconstructed. Two stenting procedures (lesion 1:1 or ostial coverage) were investigated. Results The net area averaged WSS of the model resulted higher when the stent covered the lesion 1:1 compared to the ostial coverage (3.68 vs . 2.06 Pa, P =0.01 and 3.97 vs . 1.98 Pa, P < 0.001, respectively). LM ostial coverage generates more turbulences in the LM itself, in the aortic wall at ostium level, and at the sino-tubular junction compared with the stenting of the lesion 1:1. Conversely, in the ascending aorta, the WSS appears lower when stenting the lesion 1:1. Conclusion Extending the stent coverage up to the ostium, when the ostial region is not diseased, might induce unfavorable alterations of flow; not only both at the level of the LM lesion and ostium sites, but also in the ascending aorta and aortic arch, potentially predisposing the aortic wall to long-term damage.

Liver cirrhosis is a major risk factor for increased mortality and morbidity in patients undergoing non-hepatic surgery with overall mortality rates as high as 45–50%. However, cirrhotic patients are often in need of surgical procedures including urological surgeries like cystectomies for muscle invasive bladder cancer. Data on the prognosis of these patients undergoing cystectomy for bladder cancer are scarce in the literature. In the present case-study, we describe the outcomes of 3 patients with liver cirrhosis who underwent radical cystectomy for muscle invasive bladder cancer. To the best of our knowledge, this is the first study reporting on this kind of urological surgery in patients with liver cirrhosis. Accordingly, we provide a review in the literature on prognosis and factors influencing the survival of cirrhotic patients who undergo surgical procedures.

We present the case of a patient with sepsis following a traumatic intra-bladder instillation of Calmette-Guerin Bacillus with pneumonia and possibly hepatitis. These complications are rare and could be induced by both immuno-allergic reaction and bacteremia. There is no specific guideline to treat this condition, but many clinicians depicting similar cases seem to agree on prolonged anti-tuberculous antibiotics with associated corticosteroid therapy. Following this therapy, the prognosis is generally favorable depending upon the fact that diagnosis has correctly been made. Our case highlights the fact that correct diagnosis has to be made especially in the presence of sepsis without a clear septic source.

A 25-year-old male patient received high-dose intravenous steroids for life-threatening anaphylaxis because of bee sting only for 4 days resulted in reactivation of latent tuberculosis infection (LTBI). Clinical presentation is acute form of progressive pulmonary tuberculosis with pleural efusion that can be misdiagnosed as a community-acquired pneumonia. High index of suspicion with adequate evaluation is must in all cases to have satisfactory treatment outcome. Bronchoscopy is crucial in evaluation with histopathology expertise is must while managing such cases.