Neuromeningeal cryptoccocosis revealing IgA-λ multiple myeloma.

Cryptococcosis is an opportunistic fungal infection that is commonly associated with an immune-compromised state. Cases of cryptococcosis have rarely been reported in patients with multiple myeloma (MM). However, cryptococcosis as a presenting symptom of MM has never been reported. We presented here a case of neuromeningeal cryptococcosis in a patient without underlying diseases, who has revealed IgA-λ MM. Early detection and treatment of cryptococcosis are essential to reduce morbidity.

The Association of IL-6, TNFα and CRP Gene Polymorphisms with Coronary Artery Disease in a Tunisian Population: A Case-Control study.

Coronary artery disease is an inflammatory disease. Systemic markers of inflammation such as Interleukin-6, Tumor Necrosis Factor alpha and C-reactive protein have previously been shown to be associated with increased risk of cardiovascular events. The aim of the present study is to assess the role of variants in the IL-6 (- 174 G/C), TNFα (- 308 A/G) and CRP (+ 1059G/C) genes as susceptibility markers for CAD in a Tunisian population. The investigation was conducted as a case-control study involving 204 patients and 400 age-gender matched controls. Genotyping was performed using polymerase chain reaction and restriction fragment length polymorphism analysis. There are significant differences between CAD patients and the control group with regard to BMI (p < 10-3) and family history of CAD (p < 10-3). The CAD patients are more likely to have a history of smoking (p < 10-3), have a higher value of TC (p = 0.003), LDLc (p = 0.016), hs-CRP (p = 0.01), IL6 (p < 10-3) and TNFα (p = 0.038). Our analysis showed significant differences between cases and controls in genotypic distribution of IL6-174CC (p = 0.003; OR = 7.71 CI (1.58-37.56)), TNFα - 308 AA (p = 0.004; OR = 2.95 (1.57-5.51)) and CRP + 1059 CC (p < 10-3; OR = 5.40 (2.30-12.68)). However, we failed to find an association between the different genotypes and the inflammatory markers levels. Our results suggest that the presence of IL-6 (- 174 G/C), TNFα (-308 A/G) and CRP (+ 1059G/C) polymorphisms, may be considered to be a risk factor for CAD in Tunisian population.

Hyperhomocysteinemia, C677T MTHFR polymorphism and ischemic stroke in Tunisian patients.

BACKGROUND: Hyperhomocysteinaemia has been identified as a strong risk factor for ischemic stroke (IS). A point mutation in methylene tetrahydrofolate reductase (MTHFR C677T) has been associated with increased plasma homocysteine (Hcy) levels. AIM: This preliminary study aimed to investigate whether hyperhomocysteinaemia and/or MTHFR C677T mutation are associated with ischemic stroke. METHODS: A case-control study including 50 consecutive patients with confirmed IS and 97 controls was performed. Fasting plasma homocysteine levels, MTHFR C677T genotypes were assessed. Other factors such as hypertension, obesity, dyslipidemia, diabetes mellitus, recurrent stroke tobacco and alcohol were investigated. RESULTS: Mean plasma homocysteine levels were significantly higher in IS patients than in controls (15.83+/-10.60) µmol/L vs 13.78+/-6.29 µmol/L, p=0.04), while no association of MTHFR C677T variant was observed even with homocysteine. The risk to develop ischemic stroke in hyperhomocysteinemic subjects was 2.4 times more than in subjects with normal Hcy levels (OR= 2.4; 95% CI: 1.13-5.06; p<0.05). CONCLUSION: Our findings suggest that high levels of homocysteine but not MTHFR C677T polymorphism represent risk factors for arterial ischemic stroke in Tunisian subjects.

Homocysteine and markers of inflammation in acute coronary syndrome.

BACKGROUND: An elevated level of homocysteine (Hcy) has been shown to be a cardiovascular risk factor in the majority of research studies. Recently, it was found to be associated with new risk factors such as inflammatory markers. OBJECTIVES: To investigate the distribution of plasma total Hcy (tHcy) and the levels of inflammatory markers in patients with acute coronary syndrome (ACS), and to evaluate the association between these parameters and the severity of the disease. METHODS: A total of 122 patients with ACS and 80 control subjects were recruited from the cardiac intensive care unit of the Military Hospital of Tunis, Tunisia. Lipid profile and the levels of tHcy, high-sensitivity C-reactive protein (HsCRP), interleukin (IL)-6, IL-8, IL-1beta and tumour necrosis factor-alpha (TNFalpha) were determined for all participants. The distribution of these parameters were compared between groups and according to the number of diseased vessels in patients with ACS. RESULTS: ACS patients had significantly elevated levels of tHcy (P<0.01), HsCRP (P<0.001), IL-6 (P<0.001), TNFalpha (P<0.001), folates (P<0.05) and vitamin B(12) (P<0.001), but lower high-density lipoprotein cholesterol (P<0.05) levels. The analysis of the association between these parameters and the number of diseased vessels showed significant differences in tHcy, HsCRP, IL-6 and TNFalpha, with positive correlations. Significantly negative correlations were found between the number of diseased vessels and folate (r=-0.34; P<0.01), and vitamin B(12) (r=-0.22; P<0.01). CONCLUSION: Elevated levels of tHcy, IL-6, TNFalpha and HsCRP appear to be associated with a greater number of diseased arteries and, consequently, the severity of coronary artery disease.

[Thyroglobulin: usefulness and limits in monitoring patients with thyroid carcinoma]. / La thyroglobuline: place et limites dans le suivi du cancer différencié de la thyroïde.

UNLABELLED: The aim of this study was to assess the role of thyroglobulin in monitoring patients with differentiated thyroid carcinoma. METHODS: We retrospectively sudied thirty patients who had total thyroidectomy and had been followed beteween 1999 and 2004 in nuclear medicine department. They have had iodine 131 whole body scans, repeated determination of thyroglobulin, thyreostimulin and thyroglobulin antibodies. RESULTS: One hundred twelve samples of thyroglobulin were done. In post surgical period thyroglobulin was ranging from 0.3 to 600 ng/ml. In 38 months follow up 4 patients (11.4%) had shown reccurent disease. Thyroglobulin sensitivity was 75%. One patient had diffuse lung metastases with high thyroglobulin level 600 ng/ml wich decreased after iodine 131 therapy. CONCLUSION: Serum thyroglobulin is the differentiated thyroid carcinoma marker of choice nevertheless one should establish the level of thyroid stimulation and seek for the antithyroglobulin antibodies.

Assessment of the accuracy of procalcitonin to diagnose postoperative infection after cardiac surgery.

BACKGROUND: Cardiopulmonary bypass induces a nonspecific inflammatory response. Procalcitonin has been advocated as a specific biomarker for infection. The authors studied the accuracy of procalcitonin to diagnose postoperative infection after cardiac surgery and compared it with those of C-reactive protein, white blood cell count, and interleukins 6 and 8. METHODS: The authors prospectively included 100 patients scheduled to undergo elective cardiac procedures with cardiopulmonary bypass. Blood samples were taken before surgery and each day over the 7-day postoperative period, and measurement of procalcitonin, C-reactive protein, white blood cell count, and interleukins 6 and 8 were performed. Diagnosis of infection was performed by a blinded expert panel. Data are expressed as value [95% confidence interval]. RESULTS: Infection was diagnosed in 16 patients. Procalcitonin was significantly higher in infected patients, with a peak reached on the third postoperative day. Only the areas under the receiver operating curve of procalcitonin (0.88 [0.71-0.95]) and C-reactive protein (0.72 [0.58-0.82]) were significantly different from the no-discrimination curve, and that of procalcitonin was significantly different from those of C-reactive protein, white blood cell count, and interleukins 6 and 8. A procalcitonin value greater than 1.5 ng/ml beyond the second day diagnosed postoperative infection with a sensitivity of 0.93 [0.70-0.99] and a specificity of 0.80 [0.70-0.87]. Procalcitonin was significantly higher in patients who died (27.5 [1.65-40.5] vs. 1.2 [0.7-1.5] ng/ml; P < 0.001). CONCLUSION: Procalcitonin is a valuable marker of bacterial infections after cardiac surgery.