Criteria and Non-Criteria Antiphospholipid Antibodies and Cancer in Patients with Involuntary Weight Loss.

Cancer patients have higher prevalences of antiphospholipid antibodies (aPLs), occasionally associated with thrombotic events. A cross-sectional study regarding the presence of criteria (IgG/IgM anti-cardiolipin-aCL, anti-ß2 glycoprotein I-aß2GPI) and non-criteria (IgG/IgM anti-phosphatidylserine-aPS, anti-phosphatidylethanolamine-aPE, anti-prothrombin-aPT) aPLs in 146 patients with involuntary weight loss was performed. None of the patients had thrombotic events during the study. Out of the 36 cancer patients, 33 had non-hematologic malignancies. In the cancer subgroup, 60% of the patients had at least one positive aPL, with significantly more patients being positive for aß2GPI IgG compared with the non-cancer subgroup-p = 0.03, OR = 2.23 (1.02-4.88). When evaluating the titres, aCL IgG/IgM, aß2GPI IgG, aPE IgG, and aPS IgG had significantly higher values in cancer patients, the best cancer predictor being aß2GPI IgG-AUC 0.642 (0.542-0.742). Gastrointestinal cancer patients were studied separately, and aCL IgM positivity was significantly higher-p = 0.008, OR = 6.69 (1.35-33.02). Both the titres of aCL IgM (p = 0.006) and aPS IgM (p = 0.03) were higher in the gastrointestinal cancer subgroup, with aCL IgM being the best predictor for gastrointestinal cancer development-AUC 0.808 (0.685-0.932). Despite criteria and non-criteria aPLs being frequent in cancer, their connection with thrombosis in these patients is probably dependent on other important risk factors and needs further research.

Correlation between Osteoprotegerin Levels and Antiphospholipid Syndrome Parameters.

OBJECTIVE: To identify the osteoprotegerin (OPG) correlates with antiphospholipid syndrome (APS) parameters. METHODS: Our cohort included 40 patients with primary APS disease associated with systemic lupus erythematosus (SLE) (mean age, 43.7 years; 87% female). Data on cardiovascular risk factors and specific clinical events in APS were collected. Then we tested OPG and 10 criteria and noncriteria antiphospholipid antibodies (aPLs) on preserved specimens in all cases. RESULTS: A total of 26 patients (65%) had high serum OPG levels. Patients with high OPG were mostly overweight. In patients with SLE, the OPG levels were associated with anti-double-stranded DNA (anti-dsDNA) and anti-Sm titers. However, we did not find significant correlations of the OPG with any of the 10 aPLs tested. Also, we found no relationship regarding venous APS events. CONCLUSION: In APS, high OPG levels are not linked to serum aPL expression.

The impact of the molecular diagnosis in the surveillance of the Clostridium difficile infection.

Clostridium difficile is the agent of many cases of antibiotic associated diarrhea. The prevalence of the toxigenic Clostridium difficile strains was assessed by real-time PCR between May 2014- January 2015, at the Emergency University Hospital, Bucharest, Romania. The incidence of the Clostridium difficile infection was 0.47%. Among the 1119 stool specimens tested, 165 (13.8%) were positive for C. difficile toxins A and B by immunochromatography test. All 165 positive samples were investigated by real time PCR and 134 (81%) samples were positive for toxin B and for the binary toxin, while the rest were positive for toxin B. A high number of samples positive for binary toxin was recorded in the General surgery department (29.85%), Neurology (13.43%), and Internal medicine (12.68%). Many of the infected patients presented as underlying pathology, cancer, diabetes mellitus and stroke. A rapid decision concerning the antibiotic therapy was made, to decrease the risk of nosocomial spread.

Short communication: Could the genexpert system be a new tool for poliovirus detection in the sewage water?

Environmental enterovirus surveillance plays a key role in the detection and identification of importation of circulating vaccine-derived polioviruses into polio-free areas. In 2015, 2 cases of paralytic poliomyelitis caused by circulating vaccine-derived poliovirus type 1 (cVDPV1), from south-western Ukraine, bordering Romania, were confirmed. Romania was considered a country at risk and the environmental enterovirus surveillance was enhanced. In this context we tried to find a diagnosis algorithm for the rapid detection of poliovirus (PV) in the sewage water, using a combination between a rapid molecular method for human enterovirus (HEV) detection using the GeneXpert system and the virus isolation on cell culture lines. By using this algorithm, we would be able to give a rapid response in an emergency situation, such as the risk of polio importation.

Cancer and involuntary weight loss: failure to validate a prediction score.

BACKGROUND: Many patients who have involuntary weight loss have cancer. The Hernandez prediction rule includes 5 variables (elevated levels of alkaline phosphatase and lactate dehydrogenase, low albumin, high white blood cell count, and age >80 years). The purpose of this study was to evaluate the validity of the prediction rule. METHODS: We prospectively evaluated 290 consecutive inpatients and outpatients who had involuntary weight loss. Clinical, hematologic, and biochemical parameters were determined. There were 259 patients who had follow-up at 6 months to determine the cause of involuntary weight loss, and 31 other patients were lost to follow-up. The 5 variables were introduced into a regression logistic model with cancer as a dependent variable. RESULTS: Cancer was diagnosed in 72 of the 290 patients (25%) who had involuntary weight loss. Bivariate analysis showed that serum albumin, C-reactive protein, erythrocyte sedimentation rate, alkaline phosphatase, iron, lactate dehydrogenase, white blood cell count, hemoglobin, and ferritin levels were associated with cancer (range of area under the receiver operating characteristic curve, 0.589 to 0.688). Multivariate analysis showed that albumin, erythrocyte sedimentation rate, iron, white blood cell count, and lactate dehydrogenase levels were associated with cancer. When dichotomized, only low albumin (odds ratio, 2.6, CI [1.3-5.2]) and high alkaline phosphatase (odds ratio, 2.3, CI [1.7-4.7]) were associated with cancer. The area under the receiver operating characteristic curve of the 5-variable prediction rule was only 0.70 (95% confidence interval, 0.61-0.78). The negative predictive value of this model with 3 variables (age >60 y, alkaline phosphatase, and albumin level) increased from 85% to 95% when all tests were negative. CONCLUSIONS: In patients who had involuntary weight loss, those who have cancer are likely to have ≥1 abnormal laboratory test. The 5-variable prediction rule had a significantly lower accuracy than originally reported. Further evaluation of the 3-variable modification of the prediction rule may be useful.

Ferritin above 100 mcg/L could rule out colon cancer, but not gastric or rectal cancer in patients with involuntary weight loss.

BACKGROUND: A tenth of patients with involuntary weight loss (IWL) have gastrointestinal cancer. Ferritin is the first parameter to be modified during the process leading to iron deficiency anaemia, therefore it should be the most sensitive. The aim of this study was to assess the ability of ferritin to rule out gastrointestinal cancer in patients with involuntary weight loss. METHODS: All consecutive patients with IWL admitted in a secondary care university hospital were prospectively studied. Ferritin, haemoglobin with erythrocyte indices and serum iron were recorded for all patients. The reference standard was bidirectional endoscopy and/or 6 months follow-up. RESULTS: 290 patients were included, a quarter had cancer, of which 22 (7.6%) had gastrointestinal cancer (8 gastric cancer, 1 ileum cancer, 13 colorectal cancer). Ferritin had the best area under the curve (AUC), both for gastrointestinal cancer (0.746, CI: 0.691-0.794), and colorectal cancer (0.765, CI: 0.713-0.813), compared to the other parameters of iron deficiency. In the diagnosis of colorectal cancer, ferritin with a cut-off value of 100 mcg/L had a sensitivity of 93% (CI: 69-100%), and negative likelihood ratio of 0.13, with a negative predictive value of 99% (96-100%), while for gastrointestinal cancer, the sensitivity was lower (89%, CI: 67-95%), with a negative likelihood ratio of 0.24. There were three false negative patients, two with gastric cancer, and one with rectal cancer. CONCLUSION: In patients with involuntary weight loss, a ferritin above 100mcg/L could rule out colon cancer, but not gastric or rectal cancer.

Serum cytokines and cancer in involuntary weight loss.

BACKGROUND: Tumor necrosis factor α (TNF-α), interleukin 1ß (IL-1ß), and IL-6 may be associated with involuntary weight loss in patients with and without cancer. However, results of previous studies have been conflicting. We evaluated patients who had involuntary weight loss to determine cytokine levels and the correlation of these cytokines with weight loss, the association with inflammation, and the potential for use in cancer diagnosis. MATERIALS AND METHODS: In 290 consecutive patients with involuntary weight loss (74 patients [26%] with cancer and 216 patients [74%] without cancer), erythrocyte sedimentation rate (ESR), and serum levels of C-reactive protein, TNF-α, IL-1ß, and IL-6 were determined. RESULTS: Higher ESR and levels of C-reactive protein, TNF-α, IL-1ß, and IL-6 were associated with cancer. The levels of TNF-α, IL-1ß, and IL-6 did not correlate with the amount of weight loss. In multivariable analysis, only ESR was associated with cancer. CONCLUSIONS: In patients with involuntary weight loss, TNF-α, IL-1ß, and IL-6 were associated with cancer but were not weight loss mediators.

Utility of routine hematological and inflammation parameters for the diagnosis of cancer in involuntary weight loss.

INTRODUCTION: A quarter of patients with involuntary weight loss (IWL) have cancer. Inflammation and anemia are associated with cancer, and recent studies showed that red blood cell distribution width (RDW) is a predictor of mortality, including cancer-related death. The aim of this study was to assess the ability of routine hematological and inflammation parameters to diagnose cancer in patients with IWL. MATERIALS AND METHODS: A total of 253 consecutive patients with IWL admitted in a secondary care university hospital were included. Routine hematological and inflammatory parameters (hemoglobin level, mean corpuscular volume, RDW, serum iron level, erythrocyte sedimentation rate, C-reactive protein level, and ferritin level) were recorded for all patients. The investigative workup was not standardized, but the patients were followed up for 6 months to avoid misclassification concerning the final diagnosis. RESULTS: All parameters, excepting mean cellular volume, were statistically associated with cancer. The areas under the curve were 0.708 (95% confidence interval [CI], 0.627-0.790) for C-reactive protein level, 0.690 (95% CI: 0.620-0.760) for erythrocyte sedimentation rate, 0.651 (95% CI, 0.566-0.735) for serum iron level, 0.607 (95% CI, 0.526-0.687) for hemoglobin level, 0.598 (95% CI, 0.518-0.679) for ferritin level, 0.594 (95% CI, 0.517-0.671) for RDW, and 0.561 (95% CI, 0.474-0.649) for mean cellular volume. In the multivariable analysis, only erythrocyte sedimentation rate remained associated with cancer. CONCLUSIONS: In patients with IWL, the hematological and inflammation parameters were statistically different in patients with cancer and in those without cancer. However, in clinical practice, they were modest diagnostic tests for cancer.

Involuntary weight loss: case series, etiology and diagnostic.

Involuntary weight loss is an important clinical condition that has not been extensively covered in the medical literature. Searching MEDLINE, we identified twelve case series in different regions of the world, mostly in developed countries. Three series included ambulatory patients, while nine studied patients from secondary care hospitals. A quarter of patients with involuntary weight loss had a cancer, and many had psychiatric diseases. Organic causes of involuntary weight loss are usually revealed by a basic evaluation, and a normal result is generally reassuring. In this case it is recommended a watchful surveillance instead of blind investigations, because the prognosis of IWL of undetermined cause is good. On the contrary, patients with involuntary weight loss caused by cancers have a severe prognostic due to the advanced stage of the disease. On the other way, these patients are easy to diagnose.

[Fever of unknown origin: 1. Etiology. A prospective multicenter study of 164 patients]. / Febra de origine necunoscuta. I. Etiologie. Studiu prospectiv multicentric pe 164 de pacienti.

BACKGROUND: The spectrum of fever of unknown origin seems to be determined by geographic and economic factors, and it appears to change in time. Excepting a small retrospective study, no other study on fever of unknown origin has been performed in Central or Eastern Europe. METHODS: A multicenter cohort study was carried out on 164 consecutive patients who met the classic, modified criteria of fever of unknown origin. The study lasted 2 years (1997-1998) and included a follow-up period of another 2 years. MAIN OUTCOME MEASURED: The final diagnosis at the end of follow-up. RESULTS: 74 (45%) patients had infections (tuberculosis: 27 patients, 16%), 41 patients (25%) had neoplasms, 30 (18%) had non-infectious inflammatory diseases, three (2%) drug fever, and four (2%) other causes. The etiology remained obscure for 12 patients (7%). CONCLUSIONS: Infections represent the most important etiology, among them predominating tuberculosis.