Lymphoid interstitial pneumonitis in a newly diagnosed late presenter of human immunodeficiency virus infection: a case report.

BACKGROUND: An increase has been described throughout the years in the frequency of various uncommon diseases in people living with human immunodeficiency virus (HIV). Particularly late presenters are associated with a significant risk not only for acquired immune deficiency syndrome (AIDS)-defining conditions but also for non AIDS-defining diseases which aggravate the prognosis of patients. Lymphoid interstitial pneumonitis (LIP) is one of these conditions described more often after the onset of HIV epidemic. LIP is a benign polyclonal lymphoproliferative disorder of the lung with not well characterized clinical and radiographic findings. CASE PRESENTATION: We report the diagnostic approach and clinical progress of a newly diagnosed late presenter of HIV infection with respiratory problems in our HIV unit. The findings of computed tomography indicated the diagnosis of HIV-associated LIP, although this condition is mainly described in a normal range of CD4 cell count. CONCLUSION: This case presentation highlights the importance of timely diagnosis and initiation of antiretroviral therapy. The increase of CD4 cell count and viral suppression may improve the symptoms of LIP.

Correlation of cardiac autonomic neuropathy with small and large peripheral nerve function in type 2 diabetes mellitus.

AIMS: To analyse the correlation of cardiac autonomic neuropathy (CAN), sympathetic and parasympathetic dysfunction with the different diagnostic tools for large and small peripheral nerve fibres in type 2 diabetes mellitus (T2DM). METHODS: We included 153 T2DM subjects (92 men) with mean age of 64.4 years. CAN, as well as sympathetic and parasympathetic dysfunction were diagnosed by the Ewing's cardiovascular reflex tests. Vibration perception threshold (VPT), monofilament, Ipswich Touch test, automated sural nerve conduction study and neuropathy disability score (NDS) evaluated large and small peripheral nerve fibre function. RESULTS: CAN (adjusted odds ratio [aOR]: 44.57), parasympathetic (aOR: 18.40) and sympathetic dysfunction (aOR: 5.50) correlated with measures of small fibre function evaluated by pinprick sensation and temperature perception. Among tools for large nerve fibres, positive correlation was shown between: (1) CAN and abnormal VPT (aOR: 16.78), (2) parasympathetic dysfunction and abnormal VPT (aOR: 39.47). CONCLUSIONS: CAN and parasympathetic dysfunction correlate with peripheral neuropathy, especially when the latter is assessed through VPT and measures of small fibre function as evaluated by pinprick sensation and temperature perception. The latter additionally correlate with sympathetic nervous system impairment.

Transformation of ring-Airy beams during efficient harmonic generation.

We theoretically study the evolution of ring-Airy beams during harmonic generation with the focus on the regime of pump energy depletion. We demonstrate that in this regime, ring-Airy beams still preserve their abrupt autofocusing properties, while transforming to a multiple ring-Airy structure. A similar transformation is observed on the beam of the generated harmonic. We suggest a simple analytical model that explains and predicts with precision our numerical findings.

Retinol Binding Protein-4 and Adiponectin Levels in Thyroid Overt and Subclinical Dysfunction.

Thyroid dysfunction is accompanied by numerous changes in intermediary metabolism. Retinol binding protein-4 (RBP-4) and adiponectin are 2 adipocytokines that have multiple metabolic functions. The aim of our study was to examine serum RBP4 and adiponectin levels in clinical (before and after therapy) and subclinical hyperthyroid and hypothyroid subjects as compared to controls.150 patients with thyroid dysfunction were recruited (65 hyperthyroid and 85 hypothyroid) while 28 euthyroid subjects served as a control group. We measured anthropometric, biochemical and hormonal (free T4, free T3, TSH, insulin) parameters in all participants. RBP-4 and adiponectin were measured using commercial ELISA kits.Mean baseline levels of RBP-4 were higher in patients with clinical hypothyroidism (29.0±10.2 ng/ml, 25.1±12.6 ng/ml, 38.8±16.5 ng/ml, 31.9±13.2 ng/ml, 20.4±8.2 ng/ml in patients with hyperthyroidism, subclinical hyperthryrodism, hypothyroidism, subclinical hypothyroidism and controls respectively, F=4.86, P<0.001) and decreased significantly in patients with clinical hyperthyroidism and hypothyroidism after normalization of thyroid hormones' levels (from 29.0±10.2 to 24.9±8.4 ng/ml, p=0.003 and from 38.8±16.5 to 29.0±10.8 ng/ml, p=0.001 respectively). We did not observe analogous changes in adiponectin levels in any of the studied groups.RBP-4 levels are higher in patients with clinical hypothyroidism and exhibit a marked decrease after normalization of thyroid function in both hyper and hypothyroid patients. We suggest that RBP-4 may play a role in the metabolic disturbances which accompany thyroid dysfunction.

Controlling high-power autofocusing waves with periodic lattices.

We show numerically that by using radial symmetric lattices, the focal spot characteristics and filament peak intensity of high-power autofocusing waves can be controlled. The lattice induced diffraction is able to isolate the main on-axis peak and control the focus position. In addition, at higher power the lattice can control and stabilize the peak intensity of the filament over an extended distance.

Sharply autofocused ring-Airy beams transforming into non-linear intense light bullets.

Controlling the propagation of intense optical wavepackets in transparent media is not a trivial task. During propagation, low- and high-order non-linear effects, including the Kerr effect, multiphoton absorption and ionization, lead to an uncontrolled complex reshaping of the optical wavepacket that involves pulse splitting, refocusing cycles in space and significant variations of the focus. Here we demonstrate both numerically and experimentally that intense, abruptly autofocusing beams in the form of accelerating ring-Airy beams are able to reshape into non-linear intense light-bullet wavepackets propagating over extended distances, while their positioning in space is extremely well defined. These unique wavepackets can offer significant advantages in numerous fields such as the generation of high harmonics and attosecond physics or the precise micro-engineering of materials.

Monocyte chemoattractant protein 1 is correlated with glycemic control and peripheral arterial disease in type 2 diabetic patients with metabolic syndrome.

We evaluated the serum levels of monocyte chemoattractant protein 1 (MCP-1) and their association with peripheral arterial disease (PAD) in 199 patients with type 2 diabetes mellitus (T2DM) and metabolic syndrome ([MetS], group A) in comparison with 109 healthy controls (group B). In group A, MCP-1 levels were significantly (P < .001) higher than group B and exhibited a positive correlation with HbA1c (P < .001) and a negative correlation with ankle-brachial index (P < .001). In the same group, patients with PAD had significantly higher MCP-1 levels compared with those without PAD (P < .001). In conclusion, T2DM patients with MetS exhibit higher serum MCP-1 levels. The latter is associated with worse glycemic control and PAD. These results suggest a potential contributory role for MCP-1 in the pathogenesis of PAD in the presence of hyperglycemia and MetS in T2DM.

Cavitation dynamics and directional microbubble ejection induced by intense femtosecond laser pulses in liquids.

We study cavitation dynamics when focusing ring-shaped femtosecond laser beams in water. This focusing geometry reduces detrimental nonlinear beam distortions and enhances energy deposition within the medium, localized at the focal spot. We observe remarkable postcollapse dynamics of elongated cavitation bubbles with high-speed ejection of microbubbles out of the laser focal region. Bubbles are ejected along the laser axis in both directions (away and towards the laser). The initial shape of the cavitation bubble is also seen to either enhance or completely suppress jet formation during collapse. In the absence of jetting, microbubble ejection occurs orthogonal to the laser propagation axis.

Observation and optical tailoring of photonic lattice filaments.

We demonstrate, for the first time, that photonic lattices support a new type of laser filaments, called lattice filaments (LF). The LF attributes (length, width, and intensity) can be tailored by both varying the photonic lattice properties and also dynamically through the interaction between filaments. This opens the way for extensive all-optical control of the nonlinear propagation of intense ultrafast wave packets. Our approach is generic and applicable to all transparent media, with potential strong impact on various photonic applications.

Measuring easily electron plasma densities in gases produced by ultrashort lasers and filaments.

We present an easy way to calibrate the simple plasma conductivity (PCo) technique for measuring electron plasma densities in gases. We show that calibration can be achieved using a single absolute plasma density measurement through an independent analytical technique, in our case the in-line holographic microscopy (i-HOM). We show the validity and power of the method by comparing the calibrated PCo with results from i-HOM over an extended range of experimental parameters.

Increased serum levels of uric acid are associated with sudomotor dysfunction in subjects with type 2 diabetes mellitus.

The aim of this paper was to assess serum uric acid (SUA) levels in patients with type 2 diabetes mellitus (T2DM) with or without sudomotor dysfunction (evaluated by the Neuropad test). We included 36 T2DM patients with sudomotor dysfunction (group A: mean age 63.1 ± 2.6 years) and 40 age-, gender-, renal function- and T2DM duration-matched patients without sudomotor dysfunction (group B: mean age 62.1 ± 3.1 years). SUA was significantly higher in group A (P < 0.001). There was a significant correlation between SUA and Neuropad time to colour change in both groups (group A: r(s) = 0.819, P < 0.001; group B: r(s) = 0.774, P < 0.001). There was also a significant positive correlation between SUA and CRP in both groups (group A: r(s) = 0.947, P < 0.001; group B: r(s) = 0.848, P < 0.001). In conclusion, SUA levels were higher in T2DM patients with sudomotor dysfunction than those without this complication. The potential role of SUA in sudomotor dysfunction merits further study.

Intense dynamic bullets in a periodic lattice.

Femtosecond filamentation inside a periodic lattice in air is numerically shown to form intense dynamic bullets. The long propagation distance of the bullet structure is primarily attributed to the effect of the lattice that regulates the competition between linear and nonlinear spatiotemporal effects in the region of normal dispersion.

The role of cytokines IL-6 and IL-8 in the pathogenesis of spontaneous abortions.

OBJECTIVE: The aim of this study was to investigate the role of interleukin-6 and interleukin-8 in the spontaneous abortion of the first and second trimester of pregnancy and the possibility of IL-6 and IL-8 being used as markers for the pregnancy outcome. METHOD: The patients were divided into three groups: group 1, women at the time of first trimester miscarriage (n = 35); group 2, women at the time of second trimester miscarriage (n = 35); group 3 included the women without previous history of abortions submitted to hysterectomy (n = 10). Plasma levels of interleukin-6 and interleukin-8 were measured by bioassays method (ELISA). Mann-Whitney U test and Kruskal-Wallis test were used to assess differences between two or more groups of patients, respectively. Post hoc analysis was performed using Mann-Whitney U test with Bonferroni's correction. RESULTS: Interleukin 6 levels in women who had a second trimester abortion were statistically higher compared to those who had a first trimester abortion. Interleukin-8 levels in patients with second trimester abortion were also statistically higher compared to the control group. No significant differences between women with first trimester abortions and those without previous history of abortions were found. CONCLUSIONS: Our data suggest that IL-6 and IL-8 might be crucial factors which take part in the defensive reaction of maternal organization during the 2nd trimester of pregnancy.

Peripheral neuropathy is associated with increased serum levels of uric acid in type 2 diabetes mellitus.

We assessed serum uric acid (SUA) levels in patients with type 2 diabetes mellitus (T2DM) with or without peripheral neuropathy (diagnosed by the Neuropathy Disability score [NDS]). We enrolled 64 patients with T2DM with peripheral neuropathy (group A: 31 men, mean age 63.0 ± 2.8 years) and 66 age-, gender-, renal function- and T2DM duration-matched patients without neuropathy (group B: 32 men, mean age 62.4 ± 3.1 years). Serum uric acid was significantly higher in group A (P < .001). There was a significant correlation between SUA and NDS in both groups (group A: r(s) = .93, P < .001; group B: r( s) = .95, P < .001). C-reactive protein (CRP) was also significantly higher in group A (P < .001) and correlated significantly with SUA in both groups (group A: r(s) = .93, P < .001; group B: r(s) = .87, P < .001). Serum uric acid is increased in patients with T2DM with neuropathy versus those without. Whether SUA is involved in the pathogenesis of T2DM peripheral neuropathy remains to be established.

A prospective study on the use of the indicator test Neuropad® for the early diagnosis of peripheral neuropathy in type 2 diabetes.

AIM: The aim of this prospective study was to evaluate the contribution of the indicator test for sudomotor function Neuropad® to the early diagnosis of peripheral neuropathy in patients with type 2 diabetes mellitus. Included were 109 type 2 diabetic patients (55 men, mean age 56.15 ± 6.14 years), whose initial clinical examination (Neuropathy Disability Score, NDS) was negative for neuropathy. Patients were first examined between January and June 2004 and re-examined 5 years later by the NDS and Neuropad ®. Initially, 70 patients (64.22%) had normal and 39 (35.78%) patients had abnormal Neuropad® (groups A and B, respectively). NDS was significantly higher in group B on both examinations (p < 0.001). On the second examination, 2 patients (2.86%) in group A and 10 patients (25.64%) in group B had developed neuropathy (p = 0.001). Neuropad® had 83.33% sensitivity and 68.04% specificity for neuropathy. There was a modest but significant agreement (kappa = 0.259, p < 0.001) between Neuropad® and NDS for neuropathy. CONCLUSIONS: Among type 2 diabetic patients with normal NDS, development of neuropathy is significantly more frequent in those with abnormal Neuropad®. These results suggest a potential utility of Neuropad® for the earlier diagnosis of neuropathy in type 2 diabetes.

Lanarkshire Oximetry Index as a diagnostic tool for peripheral arterial disease in type 2 diabetes: a pilot study.

We evaluated the Lanarkshire Oximetry Index (LOI) for the diagnosis of peripheral arterial disease (PAD) in type 2 diabetic patients, using the Ankle-Brachial Index (ABI) as gold standard. We included 161 patients (71 men, mean age 63.1 +/- 9.8 years). Peripheral arterial disease was defined as ABI < 0.9. Two cut-off values of LOI (<0.9 and <0.8) were assessed for the diagnosis of PAD. Sensitivity and specificity for PAD were 93.3% and 89.1%, respectively, using a LOI cut-off value of 0.9, while they were 40% and 99.3%, respectively, using a LOI cut-off value of 0.8. Agreement between LOI and ABI was moderate (P < .001). There was a significant positive correlation between ABI and LOI (r = .377, P < .001). Lanarkshire Oximetry Index is a potentially useful alternative diagnostic test for PAD in type 2 diabetes. A cut-off value of 0.9 has high sensitivity and modest specificity. Agreement between LOI and ABI is moderate.

Matrix metalloproteinase-1 and tissue inhibitor of metalloproteinases-1 levels in severely obese patients: what is the effect of weight loss?

INTRODUCTION: There is increased evidence that circulating levels of matrix metalloproteinases and their tissue inhibitors are altered in obesity and may be implicated in its pathogenesis. This study aimed to compare the serum concentrations of pro-matrix metalloproteinase-1 (pro-MMP-1) and tissue inhibitor of metalloproteinases-1 (TIMP-1) in severely obese patients with or without metabolic syndrome, and to investigate the potential effect of weight loss on their circulating levels. METHODS: A total of 102 severely obese subjects were included in our study. Of these, 61 had no other features of metabolic syndrome, while the rest were 41 age- and sex-matched subjects with severe obesity and metabolic syndrome according to the NCEP-ATP criteria. Fourty-two age and sex-matched healthy lean individuals were used as controls. RESULTS: Severely obese subjects had higher circulating levels of TIMP-1 than the lean ones (120.6 ± 50.6 vs. 89.0 ± 35.2 ng/ml) and obese patients with metabolic syndrome had higher TIMP-1 levels than their metabolically healthy counterparts (134.8 ± 38.4 vs. 111.0 ± 55.62 ng/ml). A positive association was also found between TIMP-1 levels and various anthropometric and metabolic parameters in the obese subjects. Moreover, weight loss of more than 5% resulted in a significant reduction of the TIMP-1 levels in obese subjects, irrespective of the presence or not of metabolic syndrome. No significant differences in pro-MMP-1 concentrations were found between the obese (2.8 ± 2.4 ng/ml) and lean individuals (2.8 ± 0.8 ng/ml). CONCLUSIONS: In conclusion, we demonstrated that increased TIMP-1 serum levels are found in severely obese patients and particularly in these with metabolic syndrome, while weight loss of more than 5% resulted in reduction of TIMP-1 levels.

Glycaemic control is correlated with well-being index (WHO-5) in subjects with type 2 diabetes.

UNLABELLED: The aim of this study was to examine the potential correlation of WHO-5 well-being index with glycaemic control and chronic complications in subjects with type 2 diabetes. The study included 156 subjects (73 men, mean age 64.05+/-9.11 years, mean diabetes duration 12.22+/-5.61 years). Well-being was assessed by the WHO-5 score via a validated questionnaire comprising 5 questions (Q1-Q5). HbA (1c) showed a significant negative correlation with overall WHO-5 score (r (s)=-0.248, p=0.002) and individual Q1-Q4 scores (r (s)=-0.262, p=0.001; r (s)=-0.248, p=0.002; r (s)=-0.207, p=0.009 and r (s)=-0.169, p=0.035 respectively). Subjects with adequate glycaemic control (HbA (1c) < 7%, n=67) had a significantly higher WHO-5 score in comparison to those with inadequate glycaemic control (HbA (1c) >or= 7%, n=89) (mean+/-SD: 19.69+/-5.47 vs. mean+/-SD: 17.11+/-6.38, p=0.011). Finally, WHO-5 score was significantly (p=0.013) lower in subjects with neuropathic pain than in those without neuropathic pain. CONCLUSIONS: In type 2 diabetic subjects, glycaemic control shows a significant correlation with well-being, while neuropathic pain is associated with lower well-being score.