Journal de médecine légale

Monoclonal Gammopathy (MG) is characterized by the excessive production of monoclonal proteins, potentially leading to the onset of hyperviscosity syndrome. This study aims to evaluate retinal circulation utilizing optical coherence tomography angiography parameters in individuals with monoclonal gammopathy. The study involved OCTA measurements using the Optovue AngioVue system, analyzing 44 eyes of 27 MG patients and 62 eyes of 36 control subjects. Parameters such as superficial and deep retinal capillary vessel density (VD SVP and DVP) across the entire 3 × 3 mm macular and parafoveal region, foveal avascular zone (FAZ) area, and central retinal thickness (CRT) were quantified using AngioAnalytics software. Employing a multivariate regression model, the OCTA parameters were compared between the two groups, with adjustments for imaging quality (SQ). Age showed no significant difference between monoclonal gammopathy subjects and controls (63.59 ± 9.33 vs. 58.01 ± 11.46 years; p>0.05). After accounting for image quality, VD SVP was notably lower in the MG group than the control group (44.54 ± 3.22% vs. 46.62 ± 2.84%; p<0.05). No significant disparities were observed in the other OCTA parameters between the groups (p>0.05). The reduced superficial retinal capillary vessel density, as indicated by OCTA, in MG patients implies sluggish blood flow, diminished capillary circulation, and subsequent tissue hypoperfusion. This investigation proposes that OCTA assessment of retinal circulation in cases of monoclonal gammopathy could serve as a sensitive non-invasive method for detecting and monitoring early microcirculatory dysfunction resulting from heightened viscosity.

Commencing in May 2021, the utilization of sotrovimab in Italy for early-stage treatment of SARS-CoV-2 infection and disease progression prevention has been established. Nevertheless, certain in vitro investigations have cast doubt on its efficacy against Omicron variants. As a result, our objective was to conduct a more extensive inquiry into the real-world efficacy of sotrovimab. Through a retrospective analysis, we gathered medical records of SARS-CoV-2 patients assessed in the infectious diseases units of Sassari, Foggia, and Bari, Italy. Our study encompassed both individuals who received sotrovimab treatment and those who were untreated throughout 2022. Our primary focus was to assess the impact of sotrovimab on curtailing disease progression (defined as the initiation of oxygen supplementation) and COVID-19-related fatalities. Additionally, we sought to evaluate the safety profile of sotrovimab.

We present a series of cases involving individuals with the homozygous MCPggaac haplotype, a genetic configuration associated with an increased likelihood and severity of atypical hemolytic uremic syndrome (aHUS), particularly when combined with other high-risk aHUS mutations. Complement blockade therapy was administered at a median age of 92 months (with an interquartile range of 36 to 252 months). Prior to initiating CBT (Eculizumab), patients experienced a median of two disease relapses. These relapses transpired within an average span of 22.16 months (median of 17.5, ranging from a minimum of 8 months to a maximum of 48 months) following the initial subsequent disease onset (observed in 6 out of 8 patients). Treatment encompassed plasmapheresis/intravenous plasma exchange (PI/PEX), occasionally supplemented by renal replacement therapy (RRT). Upon the implementation of complement blockade, the occurrence of disease relapses ceased in the pediatric population. For children possessing the MCPggaac haplotype, with or without additional genetic mutations, achieving remission was feasible through renal replacement therapy, without an immediate imperative for complement blockade. However, in cases where aHUS relapse manifested shortly after disease onset or when relapses transpired recurrently, sustained complement blockade emerged as a necessary course of action. The specific duration of such blockade, however, remains uncertain. Failure to initiate complement inhibition prior to experiencing 4–5 relapses could potentially lead to the development of proteinuria and chronic renal failure over time.

Approximately 30% of patients with gastrointestinal cancer undergoing 5-Fluorouracil (5-FU)-based chemotherapy experience severe toxicity. Presently, there is a dearth of effective tools for identifying individuals at risk within this context. This study aims to fill this gap by constructing a predictive model using a Bayesian network, a robust probabilistic graphical model known for its interpretable predictions. Employing a dataset encompassing 267 gastrointestinal cancer patients, the data underwent preprocessing and was partitioned into TRAIN and TEST sets in an 80%:20% ratio. Variable importance was assessed using the RandomForest algorithm, employing the MeanDecreaseGini coefficient. The Bayesian network model was designed using the bnlearn R library, utilizing a 10-fold cross-validation on the TRAIN set, and optimizing the network structure with the aic-cg method. Model performance was evaluated through accuracy, sensitivity, and specificity, employing cross-validation on the TRAIN set and independent validation on the TEST set. The model displayed favorable performance, achieving an average accuracy of 0.85 (±0.05) and 0.80 on the TRAIN and TEST datasets, respectively. Sensitivity and specificity were 0.82 (±0.14) and 0.87 (±0.07) for the TRAIN dataset, and 0.71 and 0.83 for the TEST dataset. A user-friendly tool was developed for clinical deployment. Despite some limitations, our Bayesian network model exhibited a strong capacity to predict the likelihood of severe hematological toxicity in gastrointestinal cancer patients undergoing 5-FU-based chemotherapy. Future investigations should concentrate on validating the model using larger patient cohorts and in diverse clinical scenarios.

Allogeneic hematopoietic stem cell transplantation is a potential curative therapy often employed for patients with haematological malignancies. Over the past two decades, numerous randomized controlled trials, reviews, and meta-analyses have investigated the effectiveness of rabbit anti-thymocyte globulin in preventing graft vs. host disease. However, only a limited number of these studies have aimed to compare different formulations of r-ATG. Given that the most recent article comparing various r-ATGs for GvHD prevention dates back to 2017, we conducted a systematic review of literature published from 2017 to the present using Indexed at, Scopus, Cochrane, and MEDLINE. Our primary focus was on acute GvHD (aGvHD) and chronic GvHD (cGvHD) prevention. We meticulously analyzed five studies in total; among these, four studies examined differences between Thymoglobulin (ATG-T) and Grafalon (ATG-G), while one investigated the impact of ATG-T dosage. Overall, the utilization of different r-ATG types does not appear to significantly influence cGvHD, aGvHD grades II–IV, transplant-related mortality (TRM), overall survival (OS), non-relapse mortality (NRM), leukemia-free survival (LFS), relapse rates, overall infection rates, and reactivation of the Epstein-Barr virus (EBV). However, conflicting data exists for aGvHD grades III–IV, graft vs. host-free survival (GRFS), moderate to severe cGvHD, and reactivation of the cytomegalovirus (CMV). Through our comprehensive research, our aim was to succinctly present the latest findings on r-ATGs in allo-HCT and provide insights into the distinctions among various ATG formulations in terms of their targets and origins.

Numerous evidence-based health interventions, especially within low-income contexts, have not yielded the anticipated outcomes. To tackle systemic obstacles in healthcare delivery, we devised the Adaptive Diseases Control Expert Programme (ADEPT) in Tanzania. Our focus was on examining the workability, acceptability, and effectiveness of this model using tuberculosis (TB) and diabetes mellitus (DM) as prototypes. This initiative followed an effectiveness-implementation hybrid type-3 design, which was executed in the Dar es Salaam, Iringa, and Kilimanjaro regions. The approach involved a gradual training methodology facilitated by web-based platforms that incorporated Gibbs' reflective cycle. We expanded health facilities providing TB services to encompass DM diagnostic capabilities, including glycated hemoglobin A1c (HbA1c) measurements. To ensure adherence, a clinical audit was employed as an evaluative tool. To evaluate the model's adherence, acceptability, and feasibility, we employed both retrospective and cross-sectional methodologies. Our findings from 2019 to 2021 demonstrated that health facilities implementing the ADEPT intervention consistently identified a greater number of individuals with both TB and DM (median of 8, IQR 6-19) compared to control facilities (median of 1, IQR 0-3) (p=0.02). Moreover, the application of HbA1c in TB/DM cases within intervention sites proved to be clinically valuable, reaching 63% (IQR: 35-75%), while control sites exhibited no utilization at any level. Although other aspects of the standard clinical management for patients with both TB and DM showed no significant differences, the positive impact of the ADEPT intervention was evident.

This study aims to investigate the influence of free-living amoebas on the excretion of both macroelements and microelements in urine. The research focuses on analyzing the concentrations of macroelements, including calcium (Ca), phosphorus (P), sodium (Na), potassium (K), and magnesium (Mg), as well as microelements like manganese (Mn), zinc (Zn), copper (Cu), iron (Fe), and chromium (Cr), during acanthamoebiasis, while taking into consideration the immunological status of the host. This groundbreaking study reveals, for the first time, notable changes in the urinary excretion of several elements in response to Acanthamoeba sp. infection in immunocompetent mice. Specifically, 16 days post-infection, there is an observed increase in the excretion of calcium, manganese, copper, iron, sodium, and chromium, alongside a decrease in potassium excretion. As the infection progresses to its later stage (24 days post-infection), there is a further reduction in urinary potassium excretion and lower levels of phosphorus in Acanthamoeba sp. infected immunocompetent hosts. In the context of acanthamoebiasis within immunosuppressed hosts, an initial increase in excretion of zinc, iron, and chromium is noted at the early phase of infection, accompanied by increased sodium excretion only at 16 days post-infection with Acanthamoeba sp. Furthermore, the immunosuppressive state of the host has an impact on the urinary concentrations of iron, chromium, zinc, copper, manganese, and calcium.

HIV Viral Load (VL) assessment serves as a pivotal tool in HIV clinical management, offering insights into adherence and antiretroviral effectiveness. Over time, both national and global antiretroviral treatment guidelines have evolved to recommend regular VL testing. South Africa (SA) has advocated for routine VL testing since 2004. The centralized HIV VL program, overseen by the National Health Laboratory Service (NHLS), has experienced substantial expansion. An analysis of de-identified retrospective VL data spanning from 2013 to 2022 was conducted to assess program performance. The volume of tests performed exhibited remarkable growth, surging from 1,961,720 tests in 2013 to an impressive 45,334,864 tests in 2022. Median total in-laboratory Turn Around Times (TAT) fluctuated, ranging from 94 hours in 2015 to 51 hours in 2022. The introduction of two novel assays contributed to enhanced median TATs across all laboratories. The occurrence of VL levels exceeding 1000 copies/ mL exhibited a steady decline. While experiencing initial growth, instances of VL counts below 50 copies/mL plateaued at around 70% starting in 2019, gradually decreasing to 68% by 2022. Some discrepancies among assays were noted. In summation, South Africa's VL program has achieved significant success. Remarkably, the program stands as the world's largest of its kind, offering valuable insights for future public health initiatives reliant on laboratory support for patient outcomes and program performance assessment.

Exploring the Therapeutic Potential of Stem Cell Cultured Conditioned Media: Insights from Zebrafish Embryo Evaluation Conditioned media obtained from stem cell cultures offer promising prospects as innovative therapeutic interventions against a range of diseases, owing to their rich reservoir of growth, trophic, and protective factors. Crucially, thorough in vivo assessment of these products' effects and safety is imperative. Zebrafish emerges as an ideal testing ground for high-throughput toxicological analysis, presenting an opportunity to minimize reliance on mammalian models while maintaining reliability. In this study, we delved into the biological ramifications of exposing zebrafish embryos to conditioned medium derived from Wharton's jelly mesenchymal stem cells. Employing a multifaceted approach involving molecular, embryological, behavioral, and in vivo imaging techniques, we unearthed a spectrum of outcomes arising from non-toxic/non-lethal dosages of the conditioned medium. Notably, this exposure triggered an array of responses including antioxidant fortification, anti-apoptotic activity, and pro-regenerative potential. This was underscored by the upregulation of several genes associated with antioxidant defense, glycolysis, and cell survival (bcl2l1, mcl1a, and bim). Simultaneously, the conditioned medium downregulated pro-apoptotic markers. Of note, this comprehensive investigation marks the pioneering attempt to thoroughly analyze the effects of conditioned medium on an entire organism, encompassing developmental, molecular, and behavioral perspectives. We hold a strong belief that these findings will lay a robust foundation for the future therapeutic utility of conditioned media.

Sickle Cell Anemia (SCD) stands as a life-threatening hematological condition primarily prevalent in sub-Saharan Africa. It originates from a genetic mutation in the β-chain hemoglobin gene, leading to the substitution of valine for glutamic acid. This genetic alteration gives rise to an aberrant hemoglobin variant known as hemoglobin S (HbS). Under deoxygenated conditions, HbS undergoes polymerization, causing red blood cells to assume a rigid, sickle-like shape and significantly reducing their lifespan. Scientific investigations have underscored a robust correlation between oxidative stress, inflammation, immune response, and the development of sickle cell disease. The cumulative effects of these processes contribute to the emergence of vasculopathy, affecting blood vessels, and a range of other complications. While recent research has elucidated the pivotal role of the innate immune system in SCD pathogenesis, insights into the involvement of the adaptive immune system remain limited. This comprehensive review delves into the intricate interplay among the immune system, inflammation, oxidative stress, blood transfusion, and their collective impact on the progression of sickle cell anemia.