Omadacycline for Community-Acquired Bacterial Pneumonia.

BACKGROUND: Omadacycline, a new once-daily aminomethylcycline antibiotic agent that can be administered intravenously or orally, reaches high concentrations in pulmonary tissues and is active against common pathogens that cause community-acquired bacterial pneumonia. METHODS: In a double-blind trial, we randomly assigned (in a 1:1 ratio) adults with community-acquired bacterial pneumonia (Pneumonia Severity Index risk class II, III, or IV) to receive omadacycline (100 mg intravenously every 12 hours for two doses, then 100 mg intravenously every 24 hours), or moxifloxacin (400 mg intravenously every 24 hours). A transition to oral omadacycline (300 mg every 24 hours) or moxifloxacin (400 mg every 24 hours), respectively, was allowed after 3 days; the total treatment duration was 7 to 14 days. The primary end point was early clinical response, defined as survival with improvement in at least two of four symptoms (cough, sputum production, pleuritic chest pain, and dyspnea) and no worsening of symptoms at 72 to 120 hours, without receipt of rescue antibacterial therapy. A secondary end point was investigator-assessed clinical response at a post-treatment evaluation 5 to 10 days after the last dose, with clinical response defined as resolution or improvement in signs or symptoms to the extent that further antibacterial therapy was unnecessary. A noninferiority margin of 10 percentage points was used. RESULTS: The intention-to-treat population included 386 patients in the omadacycline group and 388 patients in the moxifloxacin group. Omadacycline was noninferior to moxifloxacin for early clinical response (81.1% and 82.7%, respectively; difference, -1.6 percentage points; 95% confidence interval [CI], -7.1 to 3.8), and the rates of investigator-assessed clinical response at the post-treatment evaluation were 87.6% and 85.1%, respectively (difference, 2.5 percentage points; 95% CI, -2.4 to 7.4). Adverse events that emerged after treatment initiation were reported in 41.1% of the patients in the omadacycline group and 48.5% of the patients in the moxifloxacin group; the most frequent events were gastrointestinal (10.2% and 18.0%, respectively), and the largest difference was for diarrhea (1.0% and 8.0%). Twelve deaths (8 in the omadacycline group and 4 in the moxifloxacin group) occurred during the trial. CONCLUSIONS: Omadacycline was noninferior to moxifloxacin for the treatment of community-acquired bacterial pneumonia in adults. (Funded by Paratek Pharmaceuticals; OPTIC ClinicalTrials.gov number, NCT02531438 .).

Development of a SPE-LC-MS Method for the Quantitation of Palbociclib and Abemaciclib in Human Plasma.

Palbociclib and abemaciclib are two cyclin-dependent kinases 4 and 6 used for breast cancer treatment. Levels of these medicines present a significant interindividual variability, so monitoring those concentrations might be necessary in therapy. Most of the methods presented so far in the literature use simple protein precipitation of plasma proteins as sample preparation method followed by direct injection of the supernatant into the LC instrument, preceded or not by a simple filtration step. Within that approach, the probability of injecting proteins in the chromatographic system is increased. With the purpose of obtaining a cleaner extract of the drugs, we developed and validated a simple and accurate LC-MS method for determining palbociclib and abemaciclib in human plasma. Solid phase extraction (SPE) using Oasis PRiME HLB® cartridges was used for plasma sample preparation. The method provided clean extracts with a recovery extraction higher than 85% for both compounds. Separation was achieved by high-performance liquid chromatography (HPLC), using a C18 (4.6 × 50 mm) column, with a gradient elution of ammonium acetate/acetic acid-acetonitrile as the mobile phase. Detection was performed by mass spectrometry (MS) in single ion recording (SIR) mode. Intra-day and inter-day precision data for both analytes were 3.8-7.2% and 3.6-7.4%, respectively. Calibration curves were both linear between 2 and 400 ng/mL with a correlation coefficient higher than 0.998. The LC-MS method can be used to quantify the drugs in human plasma in routine analysis. The method proved to be useful in determining real plasma levels in patients involved in cancer therapy. Drug concentrations were determined in a 10 min run-time, including re-equilibration of the column.

Development and implementation of a COVID-19 near real-time traffic light system in an acute hospital setting.

Common causes of death in COVID-19 due to SARS-CoV-2 include thromboembolic disease, cytokine storm and adult respiratory distress syndrome (ARDS). Our aim was to develop a system for early detection of disease pattern in the emergency department (ED) that would enhance opportunities for personalised accelerated care to prevent disease progression. A single Trust's COVID-19 response control command was established, and a reporting team with bioinformaticians was deployed to develop a real-time traffic light system to support clinical and operational teams. An attempt was made to identify predictive elements for thromboembolism, cytokine storm and ARDS based on physiological measurements and blood tests, and to communicate to clinicians managing the patient, initially via single consultants. The input variables were age, sex, and first recorded blood pressure, respiratory rate, temperature, heart rate, indices of oxygenation and C-reactive protein. Early admissions were used to refine the predictors used in the traffic lights. Of 923 consecutive patients who tested COVID-19 positive, 592 (64%) flagged at risk for thromboembolism, 241/923 (26%) for cytokine storm and 361/923 (39%) for ARDS. Thromboembolism and cytokine storm flags were met in the ED for 342 (37.1%) patients. Of the 318 (34.5%) patients receiving thromboembolism flags, 49 (5.3% of all patients) were for suspected thromboembolism, 103 (11.1%) were high-risk and 166 (18.0%) were medium-risk. Of the 89 (9.6%) who received a cytokine storm flag from the ED, 18 (2.0% of all patients) were for suspected cytokine storm, 13 (1.4%) were high-risk and 58 (6.3%) were medium-risk. Males were more likely to receive a specific traffic light flag. In conclusion, ED predictors were used to identify high proportions of COVID-19 admissions at risk of clinical deterioration due to severity of disease, enabling accelerated care targeted to those more likely to benefit. Larger prospective studies are encouraged.

Lead-Induced Physiological, Biochemical and Enzymatic Changes in Asplenium scolopendrium L.

The paper aims to determine the lead-induced physiological, biochemical and enzymatic changes in Asplenium scolopendrium, which could represent biomarkers used in environmental assessment. Of all the physiological processes, photosynthesis and respiration were analyzed and the enzymatic and biochemical determinations focused on catalase activity, assimilatory pigment concentration, polyphenol content and lead presence in tissues.The stress induced by the exposure to Pb of the species Asplenium scolopendrium determined an increase in the carotenoid content, the catalase activity, the total polyphenol content and also enhanced the respiration potential. No significant changes were recorded regarding the chlorophyll content and the photosynthetic activity. The recorded changes may be used as non-specific markers in the assessment of the impact of Pb on plants (Asplenium scolopendrium).

[User Perception After Participating in Group Education in Which the Active Patient Therapy was Applied. Qualitative Study]. / Percepción del usuario tras participar en educación grupal aplicando la terapia del paciente activo. Estudio Cualitativo.

Introduction: The purpose of this study is to find the user opinion regarding the active patient dynamics, to analyze if the users think that their knowledge increased after taking part in the group education and to determine if they think that what they have learnt will help them modify their daily habits. Material and Methods: Phenomenological qualitative study. Participants: patients older than 14 years of age without cognitive impairment. Registering techniques: survey and field notes. The software NVIVO was used to analyze the results. Results: The active patient dynamics were positively valued by the participants, specially the following categories: attention, participation, personal resolutions, opinions, suggestions and recommendations. 74% of participants deemed their knowledge to have increased substantially and 52% expressed that the lessons learnt will help them modify their daily habits. Discussion and Conclusions: The Spanish department of health has a strategy to empower patients to take a more active role in their health through the Active Patient Therapy. This study concurs with it and it is positively valued by the users. This type of education is increasingly demanded and the nursing community is an ideal position to enlighten the population. The majority of participants thought that the lessons learnt will help them modify their daily habits. It would be interesting to analyze the realization of those resolutions in other workshops or as a follow-up in the nursing consults to reach healthy goals.

A Unique Case of a Gigantic Left Ventricular Myxoma Resulting in Embolic Acute Lower Limb Ischemia in a Pediatric Patient.

BACKGROUND: The presence of a primary cardiac tumor in a pediatric patient is a rare echocardiographic finding. CASE REPORT: We report the case of an 11-year-old female patient with multiple peripheral embolisms, due to a gigantic left ventricular tumor, with a unique echocardiographic appearance. The patient was referred to the emergency department due to acute pain and loss of sensitivity in both of her legs. Past medical history was significant for acute lymphoblastic leukemia. Upon physical examination, suspicion of bilateral lower leg ischemia was raised. Doppler arterial ultrasound of both legs confirmed the suspicion mentioned above, as the right lower extremity suffered from partial arterial occlusion of the external iliac artery and total occlusion of the femoral arteries. Meanwhile, in the left lower extremity, the occlusion was localized in the proximal tibio-peroneal artery. Cardiac sonography revealed a massive, mobile, left ventricular intracavitary mass. Aside from its large dimensions (6.3 cm by 3 cm), its aspect was striking as well as it had very mobile and friable edges. Emergency bilateral endarterectomy and excision of the left ventricular tumor were performed alongside systemic anticoagulant therapy, with excellent results, as no tumoral residual masses could be seen in the left ventricle, and the arterial blood flow was restored completely in both lower extremities. The histopathological aspect of the excised masses was that of a myxoma. The patient recovered well after surgery and was discharged on postoperative day 14. CONCLUSION: Despite only a handful of cases of cardiac myxomas being reported due to their rarity in the pediatric population, clinical presentation with peripheric embolism triggered a high index of suspicion of embolic mechanism in our patient and prompted a rapid assessment and successful management.

DNA Sequencing of CD138 Cell Population Reveals TP53 and RAS-MAPK Mutations in Multiple Myeloma at Diagnosis.

Multiple myeloma is a hematologic neoplasm caused by abnormal proliferation of plasma cells. Sequencing studies suggest that plasma cell disorders are caused by both cytogenetic abnormalities and oncogene mutations. Therefore, it is necessary to detect molecular abnormalities to improve the diagnosis and management of MM. The main purpose of this study is to determine whether NGS, in addition to cytogenetics, can influence risk stratification and management. Additionally, we aim to establish whether mutational analysis of the CD138 cell population is a suitable option for the characterization of MM compared to the bulk population. Following the separation of the plasma cells harvested from 35 patients newly diagnosed with MM, we performed a FISH analysis to detect the most common chromosomal abnormalities. Consecutively, we used NGS to evaluate NRAS, KRAS, BRAF, and TP53 mutations in plasma cell populations and in bone marrow samples. NGS data showed that sequencing CD138 cells provides a more sensitive approach. We identified several variants in BRAF, KRAS, and TP53 that were not previously associated with MM. Considering that the presence of somatic mutations could influence risk stratification and therapeutic approaches of patients with MM, sensitive detection of these mutations at diagnosis is essential for optimal management of MM.

COVID-19 pandemic and agriculture in Romania: effects on agricultural systems, compliance with restrictions and relations with authorities.

Like most economic sectors, agriculture has been significantly affected by the COVID-19 pandemic. This study was designed to understand the impact of the initial stages of the pandemic on the agricultural sector in Romania. A web-based research study of farmers was conducted using an online questionnaire. Participants (n = 148) were self-selected, by answering the questionnaire online. The results highlighted that the pandemic was having an impact on agricultural costs, labor, farm management and food security. Among the farmers who were asked to describe the effects of the COVID-19 pandemic on delays with agricultural work, only 35.1% indicated that they had not registered delays. When farmers were asked if they anticipated a future increase in costs in agriculture as a result of the COVID-19 pandemic, 45.9% of respondents felt that costs would increase. Fifty-seven percent of participants reported that they would continue to apply measures to reduce the impacts of the pandemic. Our findings and analysis indicated that agricultural systems were vulnerable and that the agricultural sector must be closely monitored and supported to maintain food security in times of crisis. For food security and better resilience of agri-food systems in Romania, the study identified needs for more automation and mechanization in farms, digital solutions for the public and private sector and continuous dialogue between farmers and authorities. We suggest the pandemic can be an opportunity for the reevaluation of agricultural production systems in Romania and beyond, and for the development of more innovative strategies, sustainable practices and digital solutions in agriculture. Supplementary Information: The online version contains supplementary material available at 10.1007/s12571-021-01239-8.

Myocardial Infarction in Children after COVID-19 and Risk Factors for Thrombosis.

Acute myocardial infarction (AMI) in children is rather anecdotic. However, following COVID-19, some conditions may develop which may favor thrombosis, myocardial infarction, and death. Such a condition is Kawasaki-like disease (K-lD). K-lD appears in children as a subgroup of the multisystem inflammatory syndrome (MIS-C). In some cases, K-lD patients may develop giant coronary aneurysms. The evolution and characteristics of coronary aneurysms from K-lD appear to be different from classical Kawasaki disease (KD) aneurysms. Differences include a lower percentage of aneurysm formation than in non-COVID-19 KD, a smaller number of giant forms, a tendency towards aneurysm regression, and fewer thrombotic events associated with AMI. We present here a review of the literature on the thrombotic risks of post-COVID-19 coronary aneurysms, starting from a unique clinical case of a 2-year-old boy who developed multiple coronary aneurysms, followed by AMI. In dehydration conditions, 6 months after COVID-19, the boy developed anterior descending artery occlusion and a slow favorable outcome of the AMI after thrombolysis. This review establishes severity criteria and risk factors that predispose to thrombosis and AMI in post-COVID-19 patients. These may include dehydration, thrombophilia, congenital malformations, chronic inflammatory conditions, chronic kidney impairment, acute cardiac failure, and others. All these possible complications should be monitored during acute illness. Ischemic heart disease prevalence in children may increase in the post-COVID-19 era, due to an association between coronary aneurysm formation, thrombophilia, and other risk factors whose presence will make a difference in long-term prognosis.

Disseminated Cunninghamella spp. Endocarditis in a Beta-Thalassemia Patient after Asymptomatic COVID-19 Infection.

Cunninghamella spp. is a group of fungi belonging to the Mucorales order. Cases of fungal endocarditis are sporadic, but more frequent in immunocompromised patients. COVID-19 (SARS-CoV-2 Infection Disease 2019) infections, prematurity, deferoxamine treatment, iron overload, neutropenia, diabetes, and malignant hemopathies proved to be risk factors for mucormycosis. We present the case of a 7-year-old boy who was treated every three weeks with blood transfusion for major beta-thalassemia, receiving deferoxamine for secondary hemochromatosis. After two weeks with nonspecific respiratory and digestive symptoms, he was admitted for fever, followed by lower limb ischemia and neurological signs. Echocardiography revealed massive endocarditis affecting the mitral and tricuspid valves with embolization phenomena in the brain, lungs, kidney, spleen, and lower limbs. As a particular finding, IgG antibodies for COVID-19 were positive. Emergency cardiac surgery was performed. The mitral valve necessitated replacement with CarboMedics prosthesis. Unfortunately, the patient did not survive. Cunninghamella spp. was confirmed via the PCR analysis of vegetations. Cunninghamella endocarditis in the context of a systemic infection presented as an opportunistic infection affecting a child who had several risk factors. Mucormycosis is challenging to treat, with high mortality. Prophylactic treatment in beta-thalassemia patients with iron-chelator deprivation drugs, such as deferiprone, may help in preventing these particular fungal infections.

Muscle involvement with pseudohypertrophy in systemic light chain amyloidosis: Case report.

RATIONALE: Muscle pseudohypertrophy is a rare manifestation of light chain amyloidosis (AL) amyloidosis. PATIENT CONCERNS: A 63-year-old woman presented with a 2-year history of progressive asthenia, macroglossia, dysphonia, cachexia, hypotension, paresthesia, and lower limb muscle hypertrophy. DIAGNOSIS: Free serum lambda light chains were increased, and fat pad biopsy demonstrated Congo red-positive deposits. Additionally, electromyography showed a myopathic pattern, whereas muscle biopsy revealed amyloid deposits. A diagnosis of λAL with cardiac, renal, nervous system, and skeletal muscle involvement was established. INTERVENTIONS AND OUTCOMES: The patient received 3 subsequent lines of therapy over the following 23 months, with very slow hematological remission followed by resolution of organ dysfunction. LESSONS: Despite its rarity, muscle involvement should be considered in patients diagnosed with AL amyloidosis associated with unexplained muscle hypertrophy or weakness associated with macroglossia or elevated troponin T levels in the absence of clear cardiac involvement.

Clinical characteristics in patients with hereditary amyloidosis with Glu54Gln transthyretin identified in the Romanian population.

BACKGROUND: In Romania, 23 patients have been diagnosed with hereditary transthyretin amyloidosis (ATTRh), 18 of whom have the Glu54Gln mutation. This retrospective cohort included all patients with Glu54Gln-mutated ATTRh who were diagnosed in Romania from 2005 to 2018. RESULTS: Of 18 patients, 10 were symptomatic, five were asymptomatic carriers and three died during the study. All originated from North-East Romania. Median age at symptom onset was 45 years; median age at death was 51 years. All patients had cardiac involvement, including changes in biomarkers (mean N-terminal-pro B-type natriuretic peptide: 2815.6 pg/ml), electrocardiography (15% atrial fibrillation, 38% atrioventricular block, 31% right bundle block), and echocardiography (mean interventricular septum: 16 mm, mean left ventricular ejection fraction: 49%). Scintigraphy showed myocardial radiotracer uptake in all patients. In addition, 92% of patients had polyneuropathy at diagnosis and 53% had carpal tunnel syndrome; 69% exhibited orthostatic hypotension and 31% suffered from diarrhea. No renal or liver involvement was observed. CONCLUSIONS: This is the largest Glu54Gln-mutated ATTRh cohort diagnosed to date, and to our knowledge the first describing this variant worldwide. Clinical features of this variant are early onset, neurological and cardiac involvement, aggressive disease progression and short survival. Early diagnosis and therapeutic intervention have potential to improve prognosis in ATTRh.

Idiotype-specific intravenous immunoglobulin for therapy of immunoglobulin kappa free light chain deficiency.

Deficient antibody production in patients with common variable immunodeficiency (CVID) is accompanied by an inability to produce free light chains (FLCs), particularly kappa (κ) FLC, due to B-cell dysfunction. We found that intravenous immunoglobulin (IVIg) administration, in a patient with CVID and (κ) FLC deficiency, for o short period of only 6 months, induced after discontinuation of treatment some kind of "long-lasting active immunity", leading to the secretion of immunoglobulin (κ) FLCs. A remarkable finding of our study is how effectively IVIg therapy led to a calculable (κ/λ) FLCs ratio, within the reference range. IVIg therapy may have functioned as an idiotype vaccine which induced a humoral response. To date, several questions remain open. For instance, from a clinical standpoint, we do not know whether this form of active immunotherapy has the potential to cure or just to control the immunoglobulin (κ) FLC deficiency. Further studies are necessary to confirm these findings.

[Blue-yellow full threshold automated perimetry in glaucoma diagnosis]. / Importanta diagnostica în glaucom a perimetriei computerizate Full Threshold Albastru-Galben.

PURPOSE: To compare White & White and Blue-Yellow Full Threshold automated perimetry. MATERIAL AND METHOD: Group of 37 patients; we used a Humphrey Zeiss automated perimeter. RESULTS: We obtained 49% abnormal white & white visual fields and 62% abnormal blue yellow fields. CONCLUSIONS: Blue Yellow perimetry has higher sensibility than white & white perimetry. We can detect earlier with this test the glaucoma defects.

[Post-inflammatory glaucoma--methods of treatment]. / Glaucomul postinflamator--particularitati de tratament pornind de la un caz clinic.

We show the mechanisms of postinflammatory secondary glaucoma and the possibilities of treatment of this, all of this concerning to an individual case. We evaluate the benefits and risks for every kind of therapeutical approach and we show our choice.

[Histopathological assessment of corneal preservation]. / Evaluarea histopatologica a posibilitatilor de conservare a corneei.

PURPOSE: To show corneal changes after corneal preservation. MATERIAL AND METHOD: There was studied 10 pig corneas: a fresh cornea; two corneas stored in wet chamber at 4 degrees C, 24 and 48 hours; seven corneas stored in Inosol at 31 degrees C, 24 hours, 7, 10, 14, 18, 20 and 22 days. RESULTS: We obtained images of every cornea; we followed epithelial, stromal and endothelial changes. CONCLUSIONS: 1. During corneal preservation there are progressive histological changes, early in epithelium and stroma, later at endothelial level. 2. The safe preservation period in wet chamber at 4 degrees C is 24 hours; the changes found after 48 hours are irreversibile. 3. The safe preservation period in Inosol at 31 degrees C is 14 days.

[Corneal preservation at 31 degrees C--experimental study]. / Conservarea corneei la 31 degrees C--studiu experimental.

PURPOSE: To study the cornea, specially the corneal endothelium in preservation media for different periods of time, trying to assess the best period of preservation. To evaluate the endothelial cell loss during preservation, trying to assess the endothelial cell minimum density for a cornea able to be preserved. MATERIAL AND METHODS: We studied 7 human corneas and 15 pig corneas. We used the inverted specular microscope, Axiovert 100. We used the soft KS 400 for image processing. We used to preservation medium: Inosol-like. We made an initial examination, then after 1,4,7,10 and 14 days. RESULTS: In human corneas the mean cell loss(%) was 4.1% from initial cell density after 4 days of preservation, 14.7% after 7 days, 18.6% after 10 days and 23.4% after 14 days. In pig corneas the mean cell loss (%) was 2.3% from initial cell density after 4 days of preservation, 8.8% after 7 days, 14.9% after 10 days and 23% after 14 days. CONCLUSIONS: The best period of preservation in Inosol-like medium is 7-10 days. This period may be extended to 14 days. During preservation there is an endothelial cell loss which after 14 days is about 23% from initial endothelial cell density (about 550 cell/mm2). The minimum initial endothelial cell density for a cornea to be able to be preserved is 2400 cell/mm2.

Percepción del usuario tras participar en educación grupal aplicando la terapia del paciente activo. Estudio cualitativo / User perception after participating in group education in which the active patient therapy was applied. Qualitative study

Introducción. Los objetivos de nuestro estudio son: conocer la opinión de los usuarios respecto a las dinámicas basadas en el paciente activo; analizar si los participantes creen que aumentaron sus conocimientos tras dicha educación grupal, y determinar si creen que lo aprendido les ayudará a modificar hábitos de vida. Material y métodos. Estudio cualitativo fenomenológico. Participantes: mayores de 14 años sin deterioro cognitivo. Técnicas de registro: cuestionario y notas de campo. Para analizar los resultados nos apoyamos en el software NVIVO. Resultados. Los usuarios valoraron positivamente las dinámicas del paciente activo y destacaron las categorías definitivas siguientes: atención, participación, propósitos individuales, opiniones, sugerencias y recomendaciones. El 74 % de los participantes consideraron haber aumentado 'bastante' o 'mucho' sus conocimientos, y el 52 % opinó que lo aprendido los ayudará 'bastante' a modificar hábitos de vida. Discusión y conclusiones. La estrategia del Ministerio de Sanidad, que tiene como objetivo impulsar el empoderamiento de la persona sobre su salud mediante la Terapia del Paciente Activo, según nuestro estudio, es acertada y los usuarios la valoran positivamente. La población demanda la realización y aumento de este tipo de educación, y las enfermeras somos los profesionales sanitarios idóneos para ello. La mayor parte de los participantes opinó que lo aprendido los ayudará a modificar sus hábitos de vida. Por ello, sería interesante analizar la consecución de estos propósitos en otros talleres o mediante el seguimiento en las consultas de enfermería para alcanzar objetivos de salud (AU)

Introduction. The purpose of this study is to find out the user opinion regarding the active patient dynamics, to analyze if the users think that their knowledge increased after taking part in the group education and to determine if they think that what they have learnt will help them modify their daily habits. Materials and methods. Phenomenological qualitative study. Participants: patients older than 14 years of age without cognitive impairment. Registering techniques: survey and field notes. The software NVIVO was used to analyze the results. Results. The active patient dynamics were positively valued by the participants, specially the following categories: attention, participation, personal resolutions, opinions, suggestions and recommendations. 74 % of participants deemed their knowledge to have increased substantially and 52 % expressed that the lessons learnt will help them modify their daily habits. Discussion and conclusions. The Spanish department of health has a strategy to empower patients to take a more active role in their health through the Active Patient Therapy. This study concurs with it and it is positively valued by the users. This type of education is increasingly demanded and the nursing community is in an ideal position to enlighten the population. The majority of participants thought that the lessons learnt will help them modify their daily habits. It would be interesting to analyze the realization of those resolutions in other workshops or as a follow-up in the nursing consults to reach healthy goals (AU)

Platelet-activating factor acetylhydrolase activity in patients with chronic stable angina (preliminary results).

Coronary atherosclerotic disease is related to endothelial inflammation and dysfunction, thrombosis and plaque instability. Different inflammatory markers are studied in stable angina and coronary acute syndromes, in order to stratify better the risk and to prevent the cardiovascular events. Platelet-activating factor (PAF) and platelet activating factor acetylhydrolase (PAF-AH) represent a complex with proinflammatory actions, possibly related to progression of atherosclerotic lesions. In our study, we investigated PAF-AH activity in 30 patients with stable angina, trying to demonstrate a relation of PAF-AH activity with the severity of the coronary disease.

Patients with primary antiphospholipid syndrome and coronary microvascular dysfunction--a distinct clinical subset.

UNLABELLED: Morbidity of patients with cardiac syndrome X (CSX) is high. Impairment of microvascular endothelial function has been suggested to be a mechanism of the disease. The study was undertaken to assess some of the characteristics of patients with primary antiphospholipid syndrome (pAPS) and CSX. METHODS: We studied 36 patients with CSX, 14 patients having pAPS and 10 healthy controls. Patients evaluation included: clinical examination, 12-lead ECG, effort treadmill test (protocol Bruce modified), determination of plasma triglycerides, cholesterol, antiphospholipid antibodies (APLA). There were determined as markers of the inflammatory state: serum phospholipase (PL-A2) and peripheral neutrophils activity. RESULTS: Patients with pAPS presented normal values of serum cholesterol and triglycerides levels, normal PL-A2 activity, moderate superoxide anion generation. Patients without APLA presented hyperlipidemia, increased PL-A2 activity, increased superoxide anion generation. During the follow-up period we found a correlation between P1-A2 activity and ischemic episodes, but only in patients with CSX and pAPS there were registered cardiovascular events. CONCLUSION: Patients with SCX and pAPS represent a distinct clinical subset, being characterized by minimal inflammation, absence of usual risk factors for coronary heart disease, more severe prognosis related to recurrent thromboses and the need for early anticoagulant therapy.