Genetic Association between TNFA Polymorphisms (rs1799964 and rs361525) and Susceptibility to Cancer in Systemic Sclerosis.

Tumor necrosis factor (TNF)-α is a proinflammatory cytokine that plays an important role in the pathogenesis of autoimmune diseases. The aim of the study was to establish an association between TNF-α promoter variability and systemic sclerosis (SSc). The study included 43 SSc patients and 74 controls. Four single nucleotide polymorphisms (rs361525, rs1800629, rs1799724, and rs1799964) located at the promoter of the TNFA gene were genotyped using commercially available TaqMan allelic discrimination assays with real-time PCR. The rs1799724 allele was associated with an increased SSc susceptibility (p = 0.028). In turn, none of the polymorphisms studied were related to the clinical and laboratory parameters of SSc patients, except for a higher prevalence of anti-Ro52 antibodies in the AG rs1800629 genotype in comparison to GG carriers (p = 0.04). Three of four cancer patients had both CT rs1799964 and AG rs361525 genotypes; thus, both of them were related to the increased risk of cancer, as compared to the TT (p = 0.03) and GG carriers (p = 0.0003), respectively. The TNFA C rs1799724 variant is associated with an increased risk of SSc, while the CT rs1799964 and AG rs361525 genotypes might enhance cancer susceptibility in SSc patients, although large observational and experimental studies are needed to verify the above hypothesis.

Severe hypereosinophilic syndrome successfully treated with a monoclonal antibody against interleukin 5 receptor α - benralizumab.

Hypereosinophilic syndrome (HES) is a group of a rare diseases characterized by marked eosinophilia in blood or tissue and eosinophil-related clinical manifestations. Benralizumab is a humanized, monoclonal antibody against interleukin 5 (IL-5) receptor α, which is expressed on human eosinophils. Here, we present the case of a patient with severe HES in whom treatment with benralizumab, an anti-IL-5 receptor monoclonal antibody, was initiated 6 months ago. Prior to benralizumab administration, the patient was treated with glucocorticoids (GS) and mepolizumab. However, instead of the applied treatment and normal level of peripheral eosinophils the patient presented with fluctuating lower respiratory tract symptoms and recurrent exacerbations of HES. Treatment with benralizumab (30 mg s.c. every 4-6 weeks) was started, resulting in significant improvement of respiratory signs and symptoms, normalization of eosinophil count and significant reduction of the methylprednisolone dose (after 5 doses of benralizumab administration). No substantial side effects have been noted during treatment and 6-month follow-up. We argue that in the severe and relapsing course of HES, rescue treatment with benralizumab should be taken into account, particularly in cases of relative inefficacy of GS and mepolizumab.

Knowledge and prevalence of risk factors for coronary artery disease in patients after the first and repeated percutaneous coronary intervention.

BACKGROUND: Percutaneous coronary intervention (PCI) is an effective method for the treatment ofcoronary artery disease (CAD) that allows for a short hospital stay and fast recovery. It has been shown that PCI is a predictor of nonattendance at cardiac rehabilitation and correlates with poor adherence to lifestyle changes. AIMS: The study was conducted to evaluate the influence of education offered during PCI­related hospitalization on knowledge, awareness, and prevalence of self­reported risk factors for CAD. METHODS: We collected data using a self­designed 56­item questionnaire. Questions assessed the knowledge of CAD risk factors and the level of their control. The maximal knowledge score was 31 points and the maximal control score, 15 points. RESULTS: The study group consisted of 200 consecutive patients undergoing PCI. Patients with a history of PCI performed at least 8 weeks prior to their current hospitalization were included in the prior­PCI group (64%), whereas the pre­PCI group comprised patients with no history of revascularization (36%). The median (interquartile range [IQR]) knowledge score was 19 (12.5-23) points in the pre­PCI and 21 (12.5-24) points in the prior­PCI group (P = 0.35). The median (IQR) risk control score was 5 (4.5-7) points in the pre­PCI and 6 (4-8) points in the prior­PCI group (P = 0.4). There was no correlation between the level of knowledge and the actual prevalence of CAD risk factors. We found that 50% of the prior­PCI patients did not attend any rehabilitation, which correlated with poor control of CAD risk factors (P = 0.001). CONCLUSIONS: Currently used models of postprocedural education do not have an adequate effect on patient knowledge and do not bring recommended lifestyle changes.

Clinical outcomes in nonagenarians undergoing a percutaneous coronary intervention: data from the ORPKI Polish National Registry 2014-2016.

BACKGROUND: Despite an increase in the proportion of nonagenarians in demographic structure, there is still a paucity of data on the utilization and outcome of percutaneous coronary interventions (PCIs) in this population. Also, very old patients are under-represented in randomized clinical trials and their treatment is still an emerging challenge. Thus, we sought to compare patient profiles and periprocedural outcomes of PCI in nonagenarians and patients younger than 90 years. PATIENTS AND METHODS: Data were based on the Polish National Registry of PCI (ORPKI). A total of 651 080 consecutive patients with stable angina (SA) (n=260 920) or acute coronary syndrome (ACS) (n=390 160) undergoing PCI with at least one stent implanted were included. Patients were stratified according to age (<90 and ≥90 years). RESULTS: Of all included patients, 4413 (0.7%) were older than or equal to 90 years. A similar rate of periprocedural complications was observed in both groups. However, cardiac arrest during both angiography and PCI occurred more often in nonagenarians (0.21 vs. 0.83%; 0.42 vs. 1.07%, respectively, for both P=0.001). Similarly, periprocedural mortality was higher in patients older than or equal to 90 years (0.27 vs. 1.88%; P=0.001). There were no differences in periprocedural outcomes between groups in the SA setting. However, a higher rate of periprocedural cardiac arrest [1971 (0.51%) vs. 43 (1.15%); P=0.001] and mortality [1622 (0.42%) vs. 83 (2.2%); P=0.001] were observed in nonagenarians compared with younger counterparts admitted with ACS. CONCLUSION: Nonagenarians undergoing PCI because of SA may have similar outcomes as patients younger than 90 years. In ACS presentation, they may have worse outcomes than younger counterparts.