Micronutrients deficiencies in patients with spondylarthritis: the potential immunometabolic crosstalk in disease phenotype.

OBJECTIVE: Micronutrient deficiencies (MNDs) are common among patients with certain chronic inflammatory diseases. They are associated with a pro-inflammatory status and co-morbidities. However, no studies have specifically investigated MNDs in Spondyloarthritis (SpA). This paper aimed at analyzing the occurrence of anemia and deficiencies of ferritin (Fe), vitamin D [25(OH)D], vitamin B12 (B12), and folic acid (FA) in SpA patients. The interplay of MNDs with age, gender, and metabolic abnormalities was also explored. PATIENTS AND METHODS: MNDs were evaluated in 220 SpA outpatients (137 females and 83 age-matched males) with psoriatic arthritis (PsA, n=110) and non-psoriatic SpA (n=110). Metabolic parameters were analyzed. Disease activity was assessed by either Disease Activity in PSoriatic Arthritis (DAPSA) or Ankylosing Spondylitis Disease Activity Score with C-Reactive Protein (ASDAS-CRP) as appropriate, while the functional status was evaluated using Health Assessment Questionnaire modified for SpA (HAQ-S). RESULTS: Anemia occurred in 13.6% of subjects of the study cohort and almost wholly in females (p=0.004). Females showed higher Fe deficiency (p=0.04) and lower Fe levels (p=0.0003) than males. Hemoglobin (Hb) resulted inversely related to age and CRP (p=0.01 and p=0.008) in male group. The 25(OH)D deficiency (≤20 ng/ml) was present in 23.2% of the cohort with a higher prevalence in males than females (p=0.02): moreover, 25(OH)D inversely correlated with disease duration (p=0.02) in males. The B12 deficiency (≤200 pmol/l) was rare (13.2%), while FA ≤4 ng/ml was frequent (22%) and associated with B12 deficiency in 31% of cases. SpA patients in moderate/high disease activity had higher Body Mass Index (BMI) (p=0.04) and HAQ-S (p<0.0001), as well as lower Hb (p=0.02), and Fe (p=0.03) than patients in remission/low disease activity (LDA). In patients with extra-articular manifestations, female sex was prevalent (F:M=2) and B12 levels were lower than in patients without (p=0.005). Interestingly, 25(OH)D was lower (p=0.04) and both BMI and HAQ-S (p=0.036 and p=0.01) were higher in patients without extra-articular involvement than patients with. CONCLUSIONS: Our findings documented a relevant prevalence of MNDs in SpA patients, and its strict interplay with gender and metabolic abnormalities by highlighting the role of MNDs in inflammatory-dependent dysmetabolism in SpA.

Case report of polymyalgia rheumatica in a male patient with three different neoplasms treated with pembrolizumab.

In this manuscript we aim to describe a particular case of a 63 years-old man who developed three different malignancies (one was a rare case of breast cancer) among nearly five years. In particular, for the diagnosis of melanoma, he was treated with pembrolizumab, a PD-1 inhibitor. After few months of treatment with pembrolizumab, the patient reported the onset of musculoskeletal symptoms such as inflammatory pain at the shoulders and morning stiffness, with raised CRP and ESR and imaging evidence of bursitis and tenosynovitis. A polymyalgia-like syndrome was diagnosed. Understanding if these manifestations are linked to the use of pembrolizumab or to a paraneoplastic syndrome, and how to manage the patient, was the real challenge.

Survival of Escherichia coli O157:H7 and Salmonella on Bruised and Unbruised Tomatoes from Three Ripeness Stages at Two Temperatures.

Tomatoes are one of the major fresh produce commodities consumed in the United States. Harvesting tomato fruit at a later stage of development can enhance consumer acceptance but can also increase damage due to bruising. Bruising can affect the quality of whole tomatoes by causing an unacceptable appearance and accelerating decay. Bruising may also facilitate bacterial attachment to the fruit surface and support growth of pathogens. This study evaluated the survival and/or proliferation of Escherichia coli O157:H7 and Salmonella on the surface of artificially bruised and unbruised tomatoes at three ripeness stages (breaker, pink, and red) and two storage temperatures (10 and 20°C). A total of 1,440 tomatoes, 720 for each organism, were analyzed. Both E. coli O157:H7 and Salmonella counts declined significantly ( P < 0.05) on the bruised and unbruised tomatoes over the 7-day storage period, by approximately 2.5 and 2.0 log, respectively. E. coli O157:H7 was not detected on pink tomatoes on day 7, whereas Salmonella persisted on the tomato surfaces throughout the 7-day study at all ripeness stages. Bruising had no significant effect ( P > 0.05) on the survival of E. coli O157:H7 (CFU per tomato) compared with the unbruised tomatoes, in most cases. Tomatoes from the red ripeness stage showed a significant effect ( P < 0.05) of bruising on Salmonella survival at both 10 and 20°C. Similar to the colony count results, the frequency (presence or absence) of inoculated tomatoes with detectable levels of inoculated bacteria decreased significantly ( P < 0.05) over time. At the lower temperature, E. coli O157:H7 was recovered from significantly higher ( P < 0.05) numbers of breaker and pink tomatoes, whereas there was no effect of temperature on the overall survival of E. coli O157:H7 on red tomatoes. Results from this study are essential for understanding the effects of bruising on produce safety and for producers and packers to develop mitigation strategies to control pathogenic and spoilage organisms.

Salmonella SdiA recognizes N-acyl homoserine lactone signals from Pectobacterium carotovorum in vitro, but not in a bacterial soft rot.

Genomes of Salmonella enterica isolates, including those linked to outbreaks of produce-associated gastroenteritis, contain sdiA, which encodes a receptor of N-acyl homoserine lactones (AHL). AHL are the quorum-sensing signals used by bacteria to coordinately regulate gene expression within -their populations. Because S. enterica does not produce its own AHL, SdiA is hypothesized to function in the interspecies cross-talk with AHL-producing bacteria. Under laboratory conditions, S. enterica responded to AHL from phytobacteria by upregulating expression of srgE. AHL-dependent expression of srgE required a functional sdiA. Essentially, no sdiA-dependent resolution of the srgE recombinase-based (RIVET) reporter was observed inside a soft rot formed on a tomato by an AHL-producing strain of Pectobacterium carotovorum. The results of the control experiments suggest that sdiA is not expressed inside tomato, pepper, green onion, or carrot affected by the soft rot, and the lack of sdiA expression in planta prevents Salmonella spp. from responding to AHL. Despite its inability to detect and respond to AHL during colonization of soft rots, S. enterica reached higher final cell numbers inside a tomato soft rot compared with its growth in intact tomato fruit. The synergistic effect was the strongest under the conditions that are typical for the Florida fall/winter production season.