The leprosy reaction is associated with salivary anti-Porphyromonas gingivalis IgA antibodies.

The aim of the study was to evaluate the association between salivary anti-Porphyromonas gingivalis IgA antibodies and the leprosy reaction. The levels of salivary anti - P. gingivalis IgA antibodies, together with salivary flow and pH were measured in individuals diagnosed with leprosy and associated with the development of the leprosy reaction. Saliva was collected from 202 individuals diagnosed with leprosy at a reference leprosy treatment center, 106 cases with the leprosy reaction and 96 controls without the leprosy reaction. Anti - P. gingivalis IgA was evaluated by indirect immunoenzyme assay. Non-conditional logistic regression analysis was employed to estimate the association between antibody levels and the leprosy reaction. There was a positive statistically significant association between the levels of anti - P. gingivalis IgA and the presence of the leprosy reaction, controlling for confounders: age, sex, level of education and alcoholic beverage consumption: ORajusted: 2.55; IC 95%: 1.34-4.87. Individuals with leprosy who had high levels of salivary anti - P. gingivalis IgA had approximately twice as many chances of developing the leprosy reaction. The findings suggest a possible relationship between salivary anti - P. gingivalis IgA antibodies and the leprosy reaction.

Comparative Proteomic Analyses Between Biofilm-Forming and Non-biofilm-Forming Strains of Corynebacterium pseudotuberculosis Isolated From Goats.

Caseous lymphadenitis (CLA) is a chronic disease that affects small ruminants and causes economic losses in the associated breeding system. The causative agent of CLA is Corynebacterium pseudotuberculosis, a Gram-positive bacterium that exhibits tropism for external and internal lymph nodes and induces abscess formation in the host. Bacterial communities often produce a biofilm matrix that serves various functions, including protection against hostile environmental conditions, antibiotics, and the host immune response. Although biofilm formation has been reported for C. pseudotuberculosis, not all strains demonstrate this property in culture. In this work, we report the first comparative proteomic analysis of one biofilm-forming (CAPJ4) and one biofilm-non-forming strain (CAP3W) of C. pseudotuberculosis isolated from goats. Bacterial whole cell protein extracts were obtained for mass spectrometry analyses. Using LC-MS/MS, our studies reveal three and four proteins exclusively found in the CAPJ4 and CAP3W proteome, respectively. In addition, label-free quantitative analysis identified 40 proteins showing at-least 2-fold higher values in CAPJ4 compared CAP3W proteome Notably, CAPJ4 differentially synthesized the penicillin-binding protein, which participates in the formation of peptidoglycans. CAPJ4 also exhibited upregulation of N-acetylmuramoyl-L-alanine amidase and galactose-1-phosphate uridylyltransferase, which are involved in biofilm formation and exopolysaccharide biosynthesis. Here, we demonstrate that biofilm formation in C. pseudotuberculosis is likely associated with specific proteins, some of which were previously shown to be associated with virulence and biofilm formation in other organisms. Our findings may drive studies related to the bacterial mechanisms involved in the biofilm formation, in addition to providing targets for the treatment of CLA.

rSodC is a potential antigen to diagnose Corynebacterium pseudotuberculosis by enzyme-linked immunoassay.

Caseous lymphadenitis (CL) is a chronic infectious disease that affects sheep and goats. Many serological tests have been developed to detect the disease; one of the most widely used is the enzyme-linked immunosorbent assay (ELISA), due to its advantages, which include acceptable cost-effectiveness, applicability, sensitivity and specificity. ELISA formulations using recombinant proteins can exhibit significant sensitivity and specificity when using a single purified antigen. DTxR, Trx, TrxR, LexA, SodC, SpaC, NanH, and PknG recombinant proteins can be considered target proteins for ELISA development due to its extracellular or on the cell surface location, which allows a better recognition by the immune system. Therefore, the objectives of this study were to evaluate the antigenic reactivity of Corynebacterium pseudotuberculosis recombinant proteins in goat and sheep serum. Of eight proteins evaluated, rSodC was selected for validation assays with small ruminant serum samples from the semiarid region of the state of Bahia, Brazil. Validation assays with goat serum samples showed that ELISA-rSodC presented sensitivity and specificity of 96% and 94%, respectively. Validation assays with sheep serum showed that ELISA-rSodC exhibited sensitivity and specificity of 95% and 98%, respectively. Analysis of 756 field serum samples showed that rSodC identified 95 positive samples (23%) in goats and 75 positive samples (21%) in sheep. The ELISA with recombinant SodC protein developed in this study discriminated positive and negative serum samples with high levels of sensitivity and specificity. This formulation is promising for epidemiological surveys and CL control programs.Trial registration AEC No 4958051018. 12/18/2018, retrospectively registered.

Cinética da proteína total, fibrinogênio e ceruloplasmina em cordeiros Santa Inês durante os primeiros cinco meses de vida / Kinetics of total protein, fibrinogen, and ceruloplasmin in Santa Inês lambs during the first five months of life

Objetivou-se estudar a cinética da proteína total, fibrinogênio e ceruloplasmina durante os primeiros cinco meses de vida, em cordeiros saudáveis da raça Santa Inês, no município de São Gonçalo dos Campos, Bahia, Brasil. Amostras de sangue foram colhidas de 22 animais, ao longo de onze momentos: logo após o parto (T0), 12 (T1), 24 (T2), 48 horas (T3), sete (T4), 15 (T5), 30 (T6), 60 (T7), 90 (T8), 120 (T9) e 150 dias de vida (T10). A proteína total e o fibrinogênio plasmáticos foram analisados por meio de refratômetro clínico e pela técnica de desnaturação pelo calor, respectivamente, enquanto que a determinação da ceruloplasmina sérica se baseou em sua atividade oxidásica. Para análise estatística utilizou-se o programa SPSS versão 18; os dados com distribuição não paramétrica foram submetidos ao teste de Friedman para avaliar o efeito do tempo, enquanto que as comparações múltiplas pelo teste de Wilcoxon permitiram a identificação das diferenças entre os momentos, adotando-se nível de significância de 5% (p<0,05). A proteína total apresentou o menor valor no T0 diferindo estatisticamente dos demais tempos, com pico às 12 horas (T1), porém estabilizando-se até o final do experimento. O fibrinogênio não apresentou diferença estatística entre os tempos. De T1 (12h) a T3 (48h) constatou-se baixos valores de ceruloplasmina, muito embora às 24 horas (T2) tenha diferido estatisticamente (p<0,05), em relação ao T0. A partir do sétimo dia (T4) a concentração desta proteína aumentou significativamente, atingindo pico nos tempos T8 (90 dias) e T9 (120 dias). Foi possível estabelecer a cinética das proteínas estudadas, identificar os principais momentos com alterações e sugerir os fatores associados com as mudanças observadas.

The objective was to study the kinetics of the total protein, fibrinogen, and ceruloplasmin during the first five months of life in healthy lambs Santa Inês, in São Gonçalo dos Campos, Bahia, Brazil. Blood samples were collected from 22 animals, over eleven times: immediately after birth (T0), 12 (T1), 24 (T2), 48 hours (T3), seven (T4), 15 (T5), 30 (T6), 60 (T7), 90 (T8) 120 (T9), and 150 days of age (T10). The total protein and plasma fibrinogen were analyzed by means of a clinical refractometer and the heat denaturation technique, respectively, while the determination of serum ceruloplasmin was based on its oxidase activity. For statistical analysis, the SPSS version 18 program was used; the non-parametric data were submitted to the Friedman test to evaluate the effect of time, whereas the multiple comparisons by the Wilcoxon test allowed the identification of the differences between the moments, adopting a significance level of 5% (P < 0.05). The total protein presented the lowest value at T0 differing statistically from the other times, with a peak at 12 hours (T1), but stabilizing until the end of the experiment. Fibrinogen is not able to differentiate between the times. Between T1 (12h) and T3 (48h), low values of ceruloplasmin were observed, although at 24 hours (T2) it differed statistically (p <0.05) in relation to T0. On the seventh day (T4) the concentration of this protein increased significantly, reaching a peak at T8 (90 days) and T9 (120 days). It was possible to establish the kinetics of the proteins studied, to identify the main moments with alterations and to suggest the factors associated with the observed changes.

Takayasu's or tuberculous arteritis?

Takayasu's arteritis (TA) is a large vessel vasculitis of unknown aetiology characterised by involvement of the aorta and its major branches. Tuberculous arteritis of the aorta is an uncommon condition usually secondary to the dissemination of Mycobacterium tuberculosis infection from the mediastinum and/or lung to the adjacent aorta; this may mimic TA. We report a case of a 23-year-old woman with cutaneous granulomatous vasculitis and saccular aneurysmal dilation of the aorta and large vessels, and highlight the findings shared by TA and tuberculous arteritis.

Quality of life of patients with rheumatoid arthritis under biological therapy.

OBJECTIVE: assessing health-related quality of life (HRQL) in patients with rheumatoid arthritis (RA), before and after treatment with biological therapy. METHODS: a longitudinal study, conducted from November 2010 to September 2011, with implementation of the instruments HAQ II (health assessment questionnaire) and SF-36 (medical outcomes short-from health survey). Barlett test, Anova, Friedman and paired t-test were performed for multiple extracts. RESULTS: 30 patients were evaluated, mean age of 47.6 (SD: 12.25) years and prevalence of females (90%). The mean score of HAQ II before treatment was 1.97, with significant reduction of up to 1.23 after six months of biological therapy (p<0.01). Most of the SF-36 domains showed significant improvement after six months of treatment (p<0.01), highlighting the social aspects, pain, physical functioning, emotional issues, vitality and physical aspects. CONCLUSION: the use of biologic therapy in patients with RA refractory to standard therapies proved to be an important pharmacological strategy for improving HRQL.

Spinal cord compression after radiolabeled metaiodobenzylguanidine analogue therapy in advanced malignant insulinoma.

Malignant insulinomas are frequently diagnosed at a late stage. Medical management is necessary to slow progression of the disease and control of hypoglycemic symptoms when cure by surgical treatment is not possible. Multimodal treatment, in these cases, has been used with variable clinical response. We describe a 68-yr-old woman who presented response failure to usual treatment and was alternatively treated with radiolabeled metaiodobenzylguanidine ([131I]-MIBG) analogue therapy with development of neurologic complications. We also present a review of the current role of [131I]-MIBG treatment in insulinomas.

Quality of life of patients with rheumatoid arthritis under biological therapy / Qualidade de vida de portadores de artrite reumatoide em terapia biológica.

Summary Objective: assessing health-related quality of life (HRQL) in patients with rheumatoid arthritis (RA), before and after treatment with biological therapy. Methods: a longitudinal study, conducted from November 2010 to September 2011, with implementation of the instruments HAQ II (health assessment questionnaire) and SF-36 (medical outcomes short-from health survey). Barlett test, Anova, Friedman and paired t-test were performed for multiple extracts. Results: 30 patients were evaluated, mean age of 47.6 (SD: 12.25) years and prevalence of females (90%). The mean score of HAQ II before treatment was 1.97, with significant reduction of up to 1.23 after six months of biological therapy (p<0.01). Most of the SF-36 domains showed significant improvement after six months of treatment (p<0.01), highlighting the social aspects, pain, physical functioning, emotional issues, vitality and physical aspects. Conclusion: the use of biologic therapy in patients with RA refractory to standard therapies proved to be an important pharmacological strategy for improving HRQL. .

Resumo Objetivo: avaliar a qualidade de vida relacionada à saúde (QVRS) em portadores de artrite reumatoide (AR), antes e após o tratamento com terapia biológica. Métodos: estudo longitudinal, realizado no período de novembro de 2010 a setembro de 2011, com aplicação dos instrumentos HAQ II (Health Assessment Questionnaire) e SF-36 (Medical Outcomes Short-From Health Survey). Foram realizados testes de Barlett, Anova, Friedman e teste- t pareado para múltiplos extratos. Resultados: foram avaliados 30 pacientes, com idade média de 47,6 (DP: 12,25) anos e prevalência do gênero feminino (90%). A média do escore do HAQ II antes do tratamento foi de 1,97, com diminuição significativa de até 1,23 após seis meses de uso de terapia biológica (p<0,01). A maioria dos domínios do SF-36 apresentou significativa melhora após seis meses de tratamento (p< 0,01), destacando os aspectos sociais, dor, capacidade funcional, aspectos emocionais, vitalidade e aspectos físicos. Conclusão: o uso de terapia biológica em pacientes com AR, refratários aos tratamentos tradicionais, demonstrou ser uma importante estratégia farmacológica para a melhoria da QVRS. .

Spinal cord compression after radiolabeled metaiodobenzylguanidine analogue therapy in advanced malignant insulinoma

Malignant insulinomas are frequently diagnosed at a late stage. Medical management is necessary to slow progression of the disease and control of hypoglycemic symptoms when cure by surgical treatment is not possible. Multimodal treatment, in these cases, has been used with variable clinical response. We describe a 68-yr-old woman who presented response failure to usual treatment and was alternatively treated with radiolabeled metaiodobenzylguanidine ([131I]-MIBG) analogue therapy with development of neurologic complications. We also present a review of the current role of [131I]-MIBG treatment in insulinomas.

Intervenções a partir da análise custo-benefício em prescrições de estatinas e fibratos do Componente Especializado de Assistência Farmacêutica / Interventions by cost-benefit analysis in prescriptions for statins and fibrates of the Specialized Component of Pharmaceutical Assistance

O objetivo deste estudo foi avaliar a qualidade das intervenções interdisciplinares médico-farmacêutico a partir da análise custo-benefício das prescrições de estatinas e fibratos em uma unidade pública estadual, dispensadora de medicamentos especializados da alta complexidade. Trata-se um estudo de intervenção, prospectivo longitudinal com 502 pacientes, no período de janeiro a setembro de 2009. A maioria das prescrições realizadas para o tratamento de dislipidemias em 2008 estava relacionados com atorvastatina (72,3%) e o custo anual do medicamento foi de aproximadamente R$ 1,9 milhões. Na análise custo-benefício, 272 (54%) prescrições apresentaram a indicação da atorvastatina como fármaco de 1ª escolha terapêutica. Após as intervenções, 81% dos problemas encontrados foram resolvidos, consistindo em geral, em ações interdisciplinares médico-farmacêutico. As intervenções trouxeram mudanças significativas nas prescrições, reduzindo gastos com a farmacoterapia e maior economia aos cofres públicos.

The purpose of this study was to assess the quality of interdisciplinary medical-pharmaceutical interventions, from a cost-benefit analysis of the medical prescriptions of statins and fibrates in a state public health unit that dispenses specialized high-complexity drugs. This is a prospective longitudinal intervention study, involving 502 patients, of the period January-September 2009. Most prescriptions issued for the treatment of dyslipidemia in 2008 included atorvastatin (72.3%) and the annual cost of the drug was approximately R$ 1.9 million. In the cost-benefit analysis, 272 (54%) prescriptions indicated atorvastatin as the first therapeutic choice drug. After the interventions, 81% of the problems encountered were resolved, in general, by interdisciplinary medical-pharmaceutical actions. The interventions led to significant changes in prescriptions, reduced spending on pharmacotherapy and great savings for public coffers.

Impacto da atenção farmacêutica na função pulmonar de pacientes com asma grave / Impact of pharmaceutical care on lung function in patients with severe asthma

O estudo avaliou a influência do serviço de Atenção Farmacêutica na otimização dos resultados terapêuticos de pacientes com asma grave não controlada, em uso de formoterol associado à budesonida. Utilizou-se o Método Dáder de Seguimento Farmacoterapêutico e o Teste do Controle de Asma (ACT™) para avaliação de resultados, assim como a espirometria. Foram acompanhados 26 pacientes por um período não inferior a seis meses, cuja média de idade foi 55 ± 11 anos, destes, 22 (84%) foram do gênero feminino. Na pesquisa verificou-se que 22 (84,6%) pacientes apresentaram mais de uma enfermidade associada à asma grave e 24 (92%) faziam uso de dois ou mais fármacos. Foram detectados 58 resultados negativos associados aos medicamentos (RNM), com incidência de 2,2 ± 0,99 RNM por usuário. O RNM mais frequente foi insegurança não quantitativa identificada em 11 usuários (43%), sendo 31% desses devido às reações adversas ao medicamento. Foram realizadas 65 intervenções farmacêuticas para resolver os RNM, com média de 2,5 ± 1,2 por paciente, das quais 85% ocorreram na farmácia sem a necessidade de voltar ao médico. Dos resultados clínicos, após as intervenções farmacêuticas, todos os usuários tiveram melhora significativa da asma (p<0,05), porém 2 deles (7,6%) ainda apresentaram asma não controlada. Assim, o estudo sinalizou a necessidade do acompanhamento farmacoterapêutico aos usuários com asma grave não controlada para otimização dos resultados clínicos.

The aim of the present study was to analyze the influence of pharmaceutical care on the optimization of therapeutic results in patients with severe asthma using formoterol combined with budesonide. Evaluations were performed with spirometry, the Dáder Pharmacotherapeutic Follow Up method and Asthma Control Test (ACT™). Twenty-six patients (mean age: 55 ± 11 years; 22 females) were monitored for not less than six months. Twenty-two patients (84.6%) had more than one health condition associated with severe asthma and 24 (92%) made use of two or more drugs. The research identified 58 negative results associated with medication (NRM), corresponding to an individual incidence of 2.2 ± 0.99 NRMs per patient. The most frequent NRM was a non-quantitative uncertainty identified in 11 patients (43%), with 31% of cases due to adverse reactions to the drug. Sixty-five pharmaceutical interventions were carried out to resolve the NRMs, with a mean of 2.5 ± 1.2 per patient, 85% of which occurred in the pharmacy without the need to see a doctor. Subsequently to medical treatment following pharmaceutical intervention, all patients experienced a clear improvement in symptoms (p < 0.05). However, two subjects (7.6%) continued to experience uncontrolled asthma. The present findings reveal a need for the pharmacotherapeutic monitoring of patients with severe uncontrolled asthma in order to optimize clinical outcomes.

Acompanhamento farmacoterapêutico em pacientes com dislipidemia em uso de sinvastatina no componente especializado de assistência farmacêutica: um estudo piloto / Pharmacotherapeutic monitoring of simvastatin-treated patients with dyslipidemia in the specialized component of pharmaceutical care: a pilot study

As doenças do aparelho circulatório estão entre as principais causas de morte no mundo. Apesar das recomendações de acompanhamento e avaliação farmacoterapêutica, ainda são desenvolvidos no Brasil poucos estudos científicos, especialmente no componente especializado de assistência farmacêutica. Este estudo teve como objetivo avaliar a influência do serviço-piloto de monitoramento farmacoterapêutico em 14 pacientes idosos com dislipidemia em uso de sinvastatina. O estudo foi realizado na Farmácia de Pernambuco durante um período de seis meses onde se utilizou a metodologia denominada Pharmacist?s Workup of Drug Therapy. O grupo apresentou média de idade 63,3±3,1 anos, com renda familiar e escolaridade baixa, com prevalência de 10 mulheres (71,4%). Além disso, os idosos apresentaram uma média de 5,1±0,8 doenças crônicas, com um consumo de 8,8±2,2 fármacos por idoso. Durante o estudo foram identificados 45 problemas farmacoterapêuticos, cuja média foi de 3,2±1,6 problemas por indivíduo. Dentre os problemas, os associados à segurança da terapia foram os mais frequentes (35,6%), sendo a administração incorreta a causa mais frequente (31,25%). As intervenções farmacêuticas resolveram 37 (82,2%) dos problemas encontrados, reduzindo significativamente os níveis de lipoproteínas aterogênicas, bem como a pressão arterial (p<0,001). Deste modo, o serviço farmacêutico pode ter influenciado nos resultados clínicos destes idosos

Circulatory diseases are among the major causes of death worldwide. Despite the fact that pharmacotherapy assessment and follow-up are strongly recommended, few scientific studies have yet been conducted in Brazil, particularly in the specialized component of pharmaceutical care. The aim of this study was to evaluate the influence of a pilot service of pharmacotherapy follow-up on the condition of 14 elderly patients with dyslipidemia treated with simvastatin. The study was conducted in the Pharmacy of Pernambuco during a 6-month period, employing the Pharmacist?s Workup of Drug Therapy methodology. The group had a mean age of 63.3 ± 3.1 years, with low family income and education levels, 10 of them (71.4%) being women. On average, the patients presented with 5.1 ± 0.8 chronic diseases and consumed 8.8 ± 2.2 drugs each. During the study, 45 pharmacotherapy problems were identified, with a mean of 3.2 ± 1.6 problems per user. Among these problems, those related to therapy safety were the most frequent (35.6%), incorrect administration being the most frequent cause (31.25%). Pharmaceutical interventions solved 37 (82.2%) of the problems encountered, significantly reducing levels of atherogenic lipoproteins and blood pressure (p<0.001). Thus, the pharmaceutical service may have influenced positively the clinical outcomes of these elderly patients

Quantification of coronary stenosis by dual source computed tomography in patients: a comparative study with intravascular ultrasound and invasive angiography.

OBJECTIVE: To determine the accuracy of dual-source CT (DSCT) to quantify coronary stenosis compared to intravascular ultrasound (IVUS) and quantitative coronary angiography (QCA). METHODS: 21 patients (23 vessels) were examined with DSCT, IVUS and invasive coronary angiography. Coronary minimal luminal diameter (MLD) and area (MLA) were measured in cross-sectional multi-planar reformatted images perpendicular to the vessel long-axis. The vessel cross-sectional area stenosis (MLA/CSA ratio) was calculated. DSCT results were compared with IVUS and QCA. RESULTS: A good correlation between DSCT and IVUS was noted for diameter and area stenosis (r=0.69 and r=0.73), with an overestimation of MLD stenosis by DSCT (+9.1%) and an underestimation of MLA stenosis (-5.8%). For MLD and MLA, high correlation coefficients (r=0.78 and r=0.90, respectively) were found between DSCT and IVUS; and the bias was almost zero (-0.41 mm and +0.1mm(2), respectively). The correlation between DSCT and QCA was moderate (r=0.60) for MLD stenosis with minor overestimation by DSCT (+4.0%) and moderate (r=0.59) for MLD (bias, +0.01 mm). The cross-sectional area stenosis showed a moderate correlation (r=0.59) between DSCT and IVUS (+0.00). CONCLUSIONS: DSCT allows accurate quantification of coronary stenosis as compared to IVUS. An excellent correlation was found for the MLA between DSCT and IVUS.

Perfil clínico-epidemiológico de pacientes com enurese assistidos em centro de referência / Clinical and epidemiological profile of patients with enuresis assisted in a reference center

Enurese é definida como qualquer perda urinária durante o sono em crianças maiores de 5 anos, podendo ser classificada em primária e secundária, quanto ao seu início, em monossintomática ou não monossintomática, quanto a sua associação com outros sintomas. A falta de padronização na seleção de pacientes e a influência de fatores geográficos, sociais e culturais prejudicam a exatidão dos dados em relação à prevalência da enurese. Métodos: Estudo descritivo, observacional, do tipo transversal, aplicado em 182 pacientes com suspeita diagnóstica de enurese atendidos pela equipe multiprofissional do Centro Interprofissional de Enurese e Distúrbios das Eliminações, do Hospital Materno Infantil Presidente Vargas, em Porto Alegre. Resultados: Dos pacientes analisados, 37,9% eram do sexo feminino e 62,1% do sexo masculino. Quanto à classificação da enurese, 87,6% apresentavam a forma primária e 12,4% a forma secundária, bem como 15,9% eram monossintomáticos e 84,1% não monossintomáticos. Conclusão: As informações obtidas podem auxiliar na elaboração e implementação de políticas públicas, bem como orientar estratégias de proteção e promoção da saúde.

Enuresis is defined as any urine loss during sleep in children over five years and may be classified into primary and secondary as to its onset, and into monosymptomatic and non-monosymptomatic as to its combination with other symptoms. Lack of standardization in patient selection and influence of geographical, social and cultural factors impair the accuracy of data regarding the prevalence of enuresis. Methods: A descriptive, observational, cross-sectional study of 182 patients with suspected diagnosis of enuresis treated by a multidisciplinary team of the Interprofessional Center for Enuresis and Disorders of Elimination in the Mother-Children Hospital Presidente Vargas in Porto Alegre. Results: Of the patients studied, 37.9% were females and 62.1% males. Concerning the classification of enuresis, 87.6% had the primary form and 12.4% the secondary; 15.9% were monosymptomatic and 84.1% were non-monosymptomatic. Conclusion: The information obtained can help in the preparation and implementation of public policies, as well as suggesting strategies to protect and promote health.

Increased epicardial adipose tissue volume in HIV-infected men and relationships to body composition and metabolic parameters.

Epicardial fat accumulation may have important clinical consequences, yet little is known regarding this depot in HIV patients. We compared epicardial fat volume in 78 HIV-infected men and 32 HIV-negative controls. Epicardial fat volume was higher in HIV-infected patients than that in controls (P = 0.04). In HIV patients, epicardial fat volume was strongly associated with visceral adipose tissue area (rho = 0.76, P < 0.0001), fasting glucose (rho = 0.41, P = 0.001) and insulin (rho = 0.44, P = 0.0003). Relationships with glucose and insulin remained significant controlling for age, race, BMI, adiponectin, visceral adipose tissue and antiretroviral therapy. Epicardial fat may be an important fat depot in HIV-infected patients.

Intravenous leiomyoma extending into the right ventricle.

We present a case of a retroperitoneal leiomyoma invading the inferior vena cava and extending to the right ventricle. The tumor was visualized with electrocardiographic-gated dual-source computed tomography, showing a low-density, lobulated mass invading the inferior vena cava and prolapsing through the tricuspid valve during diastole. Cardiac computed tomography is useful in assessing the extension and hemodynamic effect of intracardiac masses.

Incremental value of adenosine-induced stress myocardial perfusion imaging with dual-source CT at cardiac CT angiography.

PURPOSE: First, to assess the feasibility of a protocol involving stress-induced perfusion evaluated at computed tomography (CT) combined with cardiac CT angiography in a single examination and second, to assess the incremental value of perfusion imaging over cardiac CT angiography in a dual-source technique for the detection of obstructive coronary artery disease (CAD) in a high-risk population. MATERIALS AND METHODS: Institutional review board approval and informed patient consent were obtained before patient enrollment in the study. The study was HIPAA compliant. Thirty-five patients at high risk for CAD were prospectively enrolled for evaluation of the feasibility of CT perfusion imaging. All patients underwent retrospectively electrocardiographically gated (helical) adenosine stress CT perfusion imaging followed by prospectively electrocardiographically gated (axial) rest myocardial CT perfusion imaging. Analysis was performed in three steps: (a)Coronary arterial stenoses were scored for severity and reader confidence at cardiac CT angiography, (b)myocardial perfusion defects were identified and scored for severity and reversibility at CT perfusion imaging, and (c)coronary stenosis severity was reclassified according to perfusion findings at combined cardiac CT angiography and CT perfusion imaging. The sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of cardiac CT angiography before and after CT perfusion analysis were calculated. RESULTS: With use of a reference standard of greater than 50% stenosis at invasive angiography, all parameters of diagnostic accuracy increased after CT perfusion analysis: Sensitivity increased from 83% to 91%; specificity, from 71% to 91%; PPV, from 66% to 86%; and NPV, from 87% to 93%. The area under the receiver operating characteristic curve increased significantly, from 0.77 to 0.90 (P < .005). CONCLUSION: A combination protocol involving adenosine perfusion CT imaging and cardiac CT angiography in a dual-source technique is feasible, and CT perfusion adds incremental value to cardiac CT angiography in the detection of significant CAD.

Direct comparison of rest and adenosine stress myocardial perfusion CT with rest and stress SPECT.

INTRODUCTION: We have recently described a technique for assessing myocardial perfusion using adenosine-mediated stress imaging (CTP) with dual source computed tomography. SPECT myocardial perfusion imaging (SPECT-MPI) is a widely utilized and extensively validated method for assessing myocardial perfusion. The aim of this study was to determine the level of agreement between CTP and SPECT-MPI at rest and under stress on a per-segment, per-vessel, and per-patient basis. METHODS: Forty-seven consecutive patients underwent CTP and SPECT-MPI. Perfusion images were interpreted using the 17 segment AHA model and were scored on a 0 (normal) to 3 (abnormal) scale. Summed rest and stress scores were calculated for each vascular territory and patient by adding corresponding segmental scores. RESULTS: On a per-segment basis (n = 799), CTP and SPECT-MPI demonstrated excellent correlation: Goodman-Kruskall gamma = .59 (P < .0001) for stress and .75 (P < .0001) for rest. On a per-vessel basis (n = 141), CTP and SPECT-MPI summed scores demonstrated good correlation: Pearson r = .56 (P < .0001) for stress and .66 (P < .0001) for rest. On a per-patient basis (n = 47), CTP and SPECT-MPI demonstrated good correlation: Pearson r = .60 (P < .0001) for stress and .76 (P < .0001) for rest. CONCLUSIONS: CTP compares favorably with SPECT-MPI for detection, extent, and severity of myocardial perfusion defects at rest and stress.

Increased prevalence of subclinical coronary atherosclerosis detected by coronary computed tomography angiography in HIV-infected men.

OBJECTIVE: The degree of subclinical coronary atherosclerosis in HIV-infected patients is unknown. We investigated the degree of subclinical atherosclerosis and the relationship of traditional and nontraditional risk factors to early atherosclerotic disease using coronary computed tomography angiography. DESIGN AND METHODS: Seventy-eight HIV-infected men (age 46.5 +/- 6.5 years and duration of HIV 13.5 +/- 6.1 years, CD4 T lymphocytes 523 +/- 282; 81% undetectable viral load), and 32 HIV-negative men (age 45.4 +/- 7.2 years) with similar demographic and coronary artery disease (CAD) risk factors, without history or symptoms of CAD, were prospectively recruited. 64-slice multidetector row computed tomography coronary angiography was performed to determine prevalence of coronary atherosclerosis, coronary stenosis, and quantitative plaque burden. RESULTS HIV-infected men demonstrated higher prevalence of coronary atherosclerosis than non-HIV-infected men (59 vs. 34%; P = 0.02), higher coronary plaque volume [55.9 (0-207.7); median (IQR) vs. 0 (0-80.5) microl; P = 0.02], greater number of coronary segments with plaque [1 (0-3) vs. 0 (0-1) segments; P = 0.03], and higher prevalence of Agatston calcium score more than 0 (46 vs. 25%, P = 0.04), despite similar Framingham 10-year risk for myocardial infarction, family history of CAD, and smoking status. Among HIV-infected patients, Framingham score, total cholesterol, low-density lipoprotein, CD4/CD8 ratio, and monocyte chemoattractant protein 1 were significantly associated with plaque burden. Duration of HIV infection was significantly associated with plaque volume (P = 0.002) and segments with plaque (P = 0.0009) and these relationships remained significant after adjustment for age, traditional risk factors, or duration of antiretroviral therapy. A total of 6.5% (95% confidence interval 2-15%) of our study population demonstrated angiographic evidence of obstructive CAD (>70% luminal narrowing) as compared with 0% in controls. CONCLUSION: Young, asymptomatic, HIV-infected men with long-standing HIV disease demonstrate an increased prevalence and degree of coronary atherosclerosis compared with non-HIV-infected patients. Both traditional and nontraditional risk factors contribute to atherosclerotic disease in HIV-infected patients.