Everolimus and papillomavirus lesions in female renal transplant recipient: A case report.

We describe the case of a transplanted patient with high-risk HPV infection that manifested as multiple genital condylomas and abnormal Papanicolaou (Pap) smear. Her immunosuppressants were corticosteroids, cyclosporine, and azathioprine. Since gynecologic treatments to eradicate condylomas were completely unsuccessful, cyclosporine was replaced by everolimus. Soon after, condylomas disappeared, HPV status became negative, and Pap smear returned to normal and has remained normal since.

Renin-angiotensin-aldosterone system inhibitors lower hemoglobin and hematocrit only in renal transplant recipients with initially higher levels.

AIM: We have analyzed the effects of renin-angiotensin-aldosterone system (RAAS) inhibitors on evolution of hemoglobin (Hb) and hematocrit (Htc) levels as well as on the evaluation of kidney graft function in stable renal transplant recipients (RTRs) in respect with initially higher or lower Hb and Htc values. METHODS: The study group comprised of 270 RTRs with stable graft function. Besides other prescribed antihypertensive therapy, 169 of them have been taking RAAS inhibitors. RESULTS: We wanted to analyze the effect of the use of RAAS inhibitors on Hb and Htc in patients with initially higher or lower Hb/Htc values. For this analysis, only RTRs that were taking RAAS inhibitors were stratified into two groups: one with higher Hb and Htc (initial Hb≥150g/L and Htc≥45%) and another one with lower Hb and Htc (initial Hb<150g/L and Htc<45%) values. Thirty-four RTRs with initially higher Hb and 41 RTRs with initially higher Htc had a statistically significant decrease in Hb (p=0.006) and Htc (p<0.0001) levels after 12-months of follow-up. In the group of patients with initially lower Hb (135 RTRs) and Htc (128 RTRs) there was a significant increase in Hb (p=0.0001) and Htc (p=0.004) levels through the observed period. The use of RAAS inhibitors has been associated with a trend of slowing renal insufficiency in RTRs (p=0.03). CONCLUSION: RAAS inhibitors lower Hb and Htc only in RTRs with initially higher levels. In patients with initially lower Hb and Htc levels, the use of these drugs is followed by beneficial impact on erythropoiesis and kidney graft function.

Association studies of gene polymorphisms in toll-like receptors 2 and 4 in Croatian patients with acute myocardial infarction.

The aim of the study was to assess the frequency of SNP896A/G in the Toll-like receptor (TLR) 4 gene and SNP1350T/C in the TLR2 gene in patients with acute myocardial infarction (AMI) and to analyse the association of these SNPs with risk factors for atherosclerosis and clinical aspects of AMI in a sample of the Croatian population. We included 240 participants in the study: 120 AMI patients and 120 sex- and age-matched healthy blood donor controls. The SNP1350T/C variant in the TLR2 gene showed a lower frequency in the AMI patient group than in the control group (P = 0.033). The frequency of SNP896A/G variants in the TLR4 gene between the patients and the controls did not differ (P = 0.286). Significantly, fewer people had SNP1350T/C in the TLR2 gene (P = 0.003) among the participants with arterial hypertension than those without it. The frequency of SNP896A/G in TLR4 was the same in hypertensive patients compared with normotensive subjects (P = 0.088). SNP1350T/C in TLR2 was less frequent in the AMI patients and in those with hypertension. Thus, SNP1350T/C in TLR2 might play a protective role against AMI and arterial hypertension. The frequency of SNP896A/G in the TLR4 gene was not associated with AMI and arterial hypertension. Other risk factors for atherosclerosis and clinical aspects of myocardial infarction were not associated with the genotype distribution of the examined genes.

The relationship between interferon-γ gene polymorphism and acute kidney allograft rejection.

Cytokine gene polymorphisms have been associated with modified gene expression and cytokine production. Gamma interferon (IFN-γ) plays an important role in the pathogenesis of kidney transplant rejection. This study evaluated the association between IFN-γ gene polymorphisms and the history of acute allograft rejection in 53 adult first-transplant recipients receiving cadaveric kidney grafts. They were followed up in a single centre until 2006, for a median time of 4 years after transplantation (1-22 years). IFN-γ gene polymorphisms +874 T/A (rs2430561) were determined by polymerase chain reaction (PCR). T/T high IFN-γ genotype was found in 12, intermediate T/A in 29 and low A/A in 12 patients. Twenty-six acute kidney rejection episodes were evidenced in 20 patients, of which none occurred in the 12 patients with low IFN-γ genotype A/A. Age, gender, number of HLA (human leukocyte antigen) mismatches, ABO blood groups, HLA, time after transplantation, creatinine clearance and immunosuppressive regimens were excluded as confounding factors associated with IFN-γ genotype distribution between rejectors and non-rejectors. IFN-γ gene polymorphisms could be an important risk factor for acute kidney transplant rejection, whereas the low A/A IFN-γ genotype could be protective against rejection.

[The effect of cellulose diacetate dialysis membranes on lipids and lipoproteins in uremic patients]. / Utjecaj dijalizne membrane od celuloznog diacetata na lipide i lipoproteine uremicara.

The patients treated with hemodialysis have marked cardiovascular morbidity and mortality. Furthermore, lipid and lipoprotein disorders in these patients are well known. Since lipid and lipoprotein disorders are undoubtedly associated with cardiovascular morbidity and mortality, treatment of this group of patients should aim also at the correction of these disorders. The effect of hemodialysis with cellulose diacetate membranes on plasma lipids and lipoproteins was studied in 13 female patients followed-up for 4.5 months. Total cholesterol, triglycerides, HDL and LDL cholesterol, and apolipoproteins (a), AI and B were determined in each patient at the beginning and at the end of the study. Significant increases in HDL cholesterol (0.95 +/- 0.30-1.09 +/- 0.32 mmol/l), apolipoprotein B (1.14 +/- 0.35-1.35 +/- 0.36 g/l), and apolipoprotein (a) (272.38 +/- 281.66-357.36 +/- 400.30 U/l), nonsignificant increases in total cholesterol (5.61 +/- 1.18-5.63 +/- 1.23 mmol/l), LDL cholesterol (3.30 +/- 1.05-3.69 +/- 1.32 mmol/l) and apolipoprotein AI (1.03 +/- 0.25-1.11 +/- 0.19 g/l), and nonsignificant decrease in triglycerides (3.07 +/- 1.49-2.74 +/- 1.37 mmol/l) were found in the study. In conclusion, only some of the observed changes in plasma proteins and lipoproteins are beneficial for the patients.

View of a war from a pathology department: Croatian experience.

This report presents an analysis of autopsy records from the Department of Pathology and Forensic Medicine, Osijek General Hospital, in the period from 2 May 1991, when 12 Croatian policemen were killed in an ambush in Borovo Selo and the war against Croatia unofficially began, until 15 January 1992, when the last cease-fire agreement between Croatia and Serbia, sponsored by the United Nations, became effective. During that time, 651 war-related autopsies were performed, constituting 42 per cent of all the deaths recorded in eastern Slavonia for that period. This number presents an 11-fold increase in the number of violent deaths in comparison to the same period of the pre-war year 1989 to 90. Forty-four per cent of all deaths were civilian ones. Explosive wounds were the most frequent cause of death: they accounted for 60 per cent of the civilian and 49 per cent of all the deaths. This fact and the extensive destruction of the cities in eastern Slavonia, including their hospitals, indicate that a principal characteristic of this and many modern wars is sudden and unexpected ground and air attacks on civilian targets.