COVID-19 morbidity in patients after orthotopic heart transplantation - single center clinical observation.

INTRODUCTION: The study is a prospective clinical observation of patients after orthotopic heart transplantation in a large academic medical center in relation to COVID-19 morbidity. The study population was comprised of 552 patients. All patients were consulted and advised by telephone as regards the prophylaxis of SARS-CoV-2 infection. Hospital and outpatient follow-ups were limited to the minimum. Preventive modification of immunosuppression was not recommended in relation to the pandemic. Three patients with multiple comorbidities (a woman aged 60, a man aged 59, and another man aged 83; 2.25 years, 5.5 years, and 7.5 years after heart transplantation, respectively) and one patient with concomitant arterial hypertension (a woman aged 48, 5.5 years after heart transplantation) presented with a symptomatic COVID-19 infection. Three of the patients were on tacrolimus immunosuppression, and both female patients were additionally on therapy with mycophenolate mofetil, which was discontinued following the diagnosis of infection. One male patient received combined therapy of cyclosporine A and mycophenolate mofetil. The 60-year-old woman presented with gastrointestinal manifestations of the COVID-19 infection which were of moderate severity. The recovery was achieved. The 59-year-old man presented with myocardial infarction, exacerbated renal insufficiency that required hemodialysis and cardiorespiratory failure complicated by bacterial sepsis. As a result, the patient died. The 83-year-old male patient reporting fever, myalgia, fatigue, cough and dyspnea was admitted to hospital and deceased due to septic shock two days after admission. The 48-year old woman who presented with mild symptoms of the upper respiratory tract infection recovered after two weeks. Symptomatic treatment was used in all the patients. Another male patient (aged 45 years, 8 years after orthotopic heart transplant with no significant comorbidities) was an asymptomatic carrier of SARS-CoV-2 and remained under hospital care. CONCLUSIONS: Of 552 patients after orthotopic heart transplantation, two SARS-CoV-2-related deaths were reported.

The role of radioisotopic methods in imaging of intervertebral disc inflammation in children.

The authors present the case of a 17-year-old girl, with pain over lumbar spine area, treated by paediatricians and rehabilitation specialists, discussing diagnostic imaging and laboratory examinations together with clinical observations. Spondylodiscitis was diagnosed after bone scintigraphy with 99mTc-MDP, the course of disease was monitored by immunoscintigraphy amongst other techniques.

[Osteoporosis in glucocorticoid-treated asthmatic patients. Part I. Frequency and intensity of changes]. / Osteoporoza u chorych na astme oskrzelowa leczonych glikokortykosteroidami. Czesc I. Czestosc wystepowania i nasilenie zmian.

The purpose of this study was evaluation of the frequency and severity of osteoporosis in glucocorticoid-treated asthmatic patients. The examinations were performed in 82 patients aged 29-70 years, treated with different types of steroids for 1-25 years. In the analysed patients bone mineral density (BMD) of lumbar spine, assessed by quantitative computer tomography (QCT) was measured, and prevalence of osteoporosis was evaluated on the basis of spine radiograms. The results of BMD measurements in glucocorticoid-treated postmenopausal women were additionally compared with a control group of 28 postmenopausal healthy women. The QCT examination revealed osteoporosis in 39% patients, while spine radiograms demonstrated it in 33% patients. The highest incidence of osteoporosis and the highest reduction of bone mass were found in postmenopausal glucocorticoid-treated women. The statistical analysis revealed no significant differences in the diagnosis of osteoporosis established by QCT or spinal radiograms, but the sensitivity of radiograms was found to be of limited value, particularly in patients with slight reduction of bone mass.

[Osteoporosis in glucocorticoid-treated asthmatic patients. Part II. Dependence on asthma duration and its treatment as well as on type of applied steroids]. / Osteoporoza u chorych na astme oskrzelowa leczonych glikokortykosteroidami. Czesc II. Zaleznosc od czasu trwania astmy i jej leczenia oraz stosowanych steroidów.

The purpose of this study was an attempt at determination whether the risk of osteoporosis in glucocorticoid-treated asthmatic patients depends on duration and type of steroid therapy. The examinations were performed in 82 patients aged 29-70 years, treated with different types of steroids for 1-25 years. In the analysed patients osteoporosis was established by measuring bone mineral density (BMD) of lumbar spine, assessed by quantitative computer tomography (QCT). Increased osteoporosis incidence and decrease of bone mass with the duration of bronchial asthma and corticoid therapy were demonstrated, and significantly higher osteoporosis incidence and severity were found in patients treated exclusively or predominantly with intramuscular steroid preparations.

Phenotypic characterisation of cellular infiltrates in endomyocardial biopsies of heart transplant recipients with diagnosed steroid resistant cellular rejection.

OBJECTIVES: Aim of this study was to find features characteristic for steroid resistant cellular rejection (SRR) of the transplanted heart, using phenotypic identification of cells creating infiltrates in endomyocardial biopsies (EMBs) obtained before and after high dose steroids treatment. METHODS: 146 heart transplant recipients, treated with cyclosporine-A, azathioprine and prednisone, were taken under consideration. EMB results > or = 3A (ISHLT) were considered significant rejection, requiring treatment with 1 g i.v. methylprednizolone for 3 days followed by oral prednisone. SRR was diagnosed in case of increased grade of rejection in control EMB, lack of improvement in 2 consecutive EMBs or increasing hemodynamic compromise. SRR was found in 15 pts. (study group). Control group consisted of remaining 131 pts. Paraffin-embedded blocks containing EMB samples from 9 pts. from study group and randomly chosen 14 pts. from control group were used (2 EMBs per pt.). Significant rejection was present in the first EMB, the second EMB was performed 7 days after beginning of the treatment. In the study group, first 2 EMBs creating a sequence of SRR were analysed. Following antigens were identified: CD45RO (T-cells), CD8 (cytotoxic T-cells), CD20 (B-cells), and CD95 (marker of apoptosis). DR expression and macrophages presence were also quantified. RESULTS: CD45RO was predominant phenotype before and after treatment in both groups. Higher quantity of CD20 cells were observed in study group, however its number increased after treatment in control group. CDB-cells and macrophages were present in low amounts, that did not react to treatment. CD95 positive cells were present only in 3 EMBs. None of above differences was statistically significant. DR expression staining showed no difference either in biopsies taken before steroid treatment or after completing of high dose steroid therapy. CONCLUSION: Phenotype identification of cells infiltrating myocardium of the transplanted heart was not sufficient to predict or characterise steroid resistant rejection.

Diagnosis and treatment of steroid resistant cellular rejection in heart transplant recipients--single center experience.

OBJECTIVES: Aim of the study was to assess frequency and risk factors of steroid resistant cellular rejection (SRR) in heart transplant recipients, to determine methods of its treatment, and to evaluate influence of steroid resistant rejection and method of its treatment on short- and long-term results. METHODS: All pts. received cyclosporine-A, azathioprine and prednisone. Biopsy results > or = 3A (ISHLT) were considered a significant rejection, requiring treatment with 1 g i.v. methylprednizolone for 3 days followed by oral prednisone. SRR was recognized in case of biopsy-proven progression of rejection, lack of improvement in 2 consecutive biopsies, or increasing hemodynamic compromise despite treatment of biopsy-proven rejection. 146 pts. eligible for the study were divided into: study group--15 pts. with SRR (10%), and control group--131 pts. SRR was treated with: cytolytic therapy--ATG (10 pts.), mycophenolate mofetil (3 pts.) or steroids (2 pts.). Number of biopsies > or = 3A, cumulative biopsy score, average biopsy result, effectiveness of SRR treatment, side effects of therapy, and survival were analysed. RESULTS: All parameters characterizing rejection were significantly higher in the study group. No risk factors of SRR were found. In 6 pts. with SRR and hemodynamic compromise (all treated with ATG) improvement was observed in 4 pts, while death occurred in 2 pts. There were no deaths in pts. without hemodynamic compromise--none of 3 methods of treatment was superior, however ATG increased the infection risk. Survival in the 1st year was significantly lower in the study group (67% vs. 89% in the control group). CONCLUSIONS: SRR is recognized in about 10% of heart transplant recipients, increasing risk of death in the 1st year after surgery. Cytolytic therapy increases risk of infection, and should be avoided in pts. without hemodynamic compromise.