Interleukin-6, infection and cardiovascular outcomes in acute heart failure: Findings from the EDIFICA registry.

AIMS: Interleukin-6 (IL-6) is upregulated in response to infectious and inflammatory triggers and independently predicts all-cause mortality in acute heart failure (AHF). However, the association of IL-6 with cardiovascular outcomes and its interplay with C-reactive protein and infection, a major precipitating factor in AHF, remains poorly understood. METHODS AND RESULTS: The association between IL-6 and clinical outcomes (180 days) in AHF was evaluated using a cohort of 164 patients from the EDIFICA registry. Median IL-6 levels at admission were 17.4 pg/mL. Patients in the higher admission IL-6 tertile presented with lower blood pressure and more congestion, were diagnosed more frequently with infection, and had a longer hospital stay. Higher IL-6 levels were associated with increased risk of HF rehospitalization (hazard ratio per log2 3.69, 95% confidence interval (CI) 1.26-10.8, p =.017) and the composite of HF rehospitalization or cardiovascular death (hazard ratio per log2 3.50; 95% CI 1.28-9.57; p =.014), independently of major AHF prognosticators, including B-type natriuretic peptide and renal function. However, no independent associations were found for all-cause rehospitalization or mortality. Despite a moderate correlation of IL-6 with C-reactive protein (CRP) levels (R = .51), the latter were not associated with clinical outcomes in this population. CONCLUSIONS: IL-6 levels associate with higher rate of cardiovascular events in AHF, independently of classical prognosticators and evidence of infection, outperforming CRP as an inflammatory outcome biomarker.

Virchow node of an unusual aetiology - the experience of a clinical case.

BACKGROUND: The cause of adult adenomegalies may be defiant. On the other hand, ectopic thyroid is a rare condition that happens in every 1:100000 to 300,000 of healthy individuals. Here, we present a case report that joins these two clinical rare and defiant challenges. CLINICAL CASE: Forty-seven-year-old woman, with known thyroid nodules for several years. She had no other relevant personal or familiar history. At our appointment she had no complaints. At the physical examination she had a palpable right thyroid nodule (previously known). The routine blood analysis showed normal thyroid function. The routine cervical ultrasonography showed no dimensional progression of the known thyroid nodules and identified a 31x18mm nodule at the left supraclavicular fossa. The patient underwent a cervical, thoracic, and abdominal computed tomography that exhibited no relevant findings, such as abdominal malignancies. The cytology of the nodule showed characteristics that were "compatible with a benign follicular nodule in ectopic thyroid tissue". CONCLUSION: This is a rare case in which we incidentally found a follicular nodule in ectopic thyroid tissue in the left supraclavicular fossa. Given the rarity of the situation, clinical sense is the mainstay of treatment and follow-up.

Nonalcoholic Fatty Liver Disease and Endocrine Axes-A Scoping Review.

Nonalcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease. NAFLD often occurs associated with endocrinopathies. Evidence suggests that endocrine dysfunction may play an important role in NAFLD development, progression, and severity. Our work aimed to explore and summarize the crosstalk between the liver and different endocrine organs, their hormones, and dysfunctions. For instance, our results show that hyperprolactinemia, hypercortisolemia, and polycystic ovary syndrome seem to worsen NAFLD's pathway. Hypothyroidism and low growth hormone levels also may contribute to NAFLD's progression, and a bidirectional association between hypercortisolism and hypogonadism and the NAFLD pathway looks likely, given the current evidence. Therefore, we concluded that it appears likely that there is a link between several endocrine disorders and NAFLD other than the typically known type 2 diabetes mellitus and metabolic syndrome (MS). Nevertheless, there is controversial and insufficient evidence in this area of knowledge.