Case Report: Disseminated Strongyloidiasis in a Patient with COVID-19.

The SARS-CoV-2 virus has emerged and rapidly evolved into a current global pandemic. Although bacterial and fungal coinfections have been associated with COVID-19, little is known about parasitic infection. We report a case of a COVID-19 patient who developed disseminated strongyloidiasis following treatment with high-dose corticosteroids and tocilizumab. Screening for Strongyloides infection should be pursued in individuals with COVID-19 who originate from endemic regions before initiating immunosuppressive therapy.

Hypertension is associated with an increased risk for severe imported falciparum malaria: a tertiary care hospital based observational study from Berlin, Germany.

BACKGROUND: Increasing numbers of aging individuals with chronic co-morbidities travel to regions where falciparum malaria is endemic. Non-communicable diseases are now leading risk factors for death in such countries. Thus, the influence of chronic diseases on the outcome of falciparum malaria is an issue of major importance. Aim of the present study was to assess whether non-communicable diseases increase the risk for severe imported falciparum malaria. METHODS: A retrospective observational study of all adult cases with imported falciparum malaria hospitalized between 2001 and 2015 in the tertiary care Charité University Hospital, Berlin, was performed. RESULTS: A total of 536 adult patients (median age 37 years; 31.3% female) were enrolled. Of these, 329 (61.4%) originated from endemic countries, 207 patients (38.6%) from non-endemic regions. Criteria for severe malaria were fulfilled in 68 (12.7%) cases. With older age, lack of previous malaria episodes, being a tourist, and delayed presentation, well-characterized risk factors were associated with severe malaria in univariate analysis. After adjustment for these potential confounders hypertension (adjusted odds ratio aOR, 3.06 95% confidence interval, CI 1.34-7.02), cardiovascular diseases (aOR, 8.20 95% CI 2.30-29.22), and dyslipidaemia (aOR, 6.08 95% CI 1.13-32.88) were individual diseases associated with severe disease in multivariable logistic regression. Hypertension proved an independent risk factor among individuals of endemic (aOR, 4.83, 95% CI 1.44-16.22) as well as of non-endemic origin (aOR, 3.60 95% CI 1.05-12.35). CONCLUSIONS: In imported falciparum malaria hypertension and its related diseases are risk factors for severe disease.

Imidazoline Receptor Agonists for Managing Hypertension May Hold Promise for Treatment of Intracerebral Hemorrhage.

Intracerebral hemorrhage (ICH), which accounts for 10% of all strokes, leads to higher morbidity and mortality compared with other stroke subtypes. Hypertension has been recognized as a major risk factor for ICH. Current antihypertensive options have not been fully effective for either prevention of ICH or ameliorating its complications. Therefore, attempts should be made to use novel antihypertensive medications for more effective management of blood pressure (BP) in the acute phase of ICH. Imidazoline receptor (IR) agonists can potentially be effective agents for BP control with the adjunctive ability to attenuate post-ICH brain injury. IR agonists render neuroprotective effects including inhibition of inflammatory reactions, apoptotic cell death, excitotoxicity, and brain edema. Given these properties, the present review aims to focus on the application of IR agonists for managing BP in ICH patients.

The association between Toxoplasma gondii infection and hypertensive disorders in T2DM patients: a case-control study in the Han Chinese population.

Type 2 diabetes mellitus (T2DM) is a major global health problem. The rate of infection with Toxoplasma gondii (T. gondii) is more than one-third of the total world population. The effects of T. gondii infection on the risk of diabetic complications and comorbidities are unclear. This study aims to determine the relationship between T. gondii infection and complications of T2DM in the Han Chinese population. We collected 1580 blood samples from T2DM patients and measured the levels of specific IgG antibodies against T. gondii in the sera of these patients using an ELISA assay. A logistic regression analysis was performed to estimate the effect of T. gondii infection on the complications of T2DM, while adjusting for age, gender, and triglyceride level (TG). We applied the multifactor dimensionality reduction (MDR) method to detect the interactions between T. gondii infections, demographic indexes and biochemical indicators among the different complications. Gender (the odds ratio (OR) = 0.63, 95%CI =0.45-0.89, P = 0.008) and TG level (OR = 0.64, 95%CI =0.45-0.89, P = 0.009) were influencing factors in T. gondii infections. T2DM patients who were infected with T. gondii had a 2.34 times risk of developing hypertension than those patients without T. gondii infection (OR = 2.34, 95%CI = 1.12-4.88, P = 0.024). The multiplicative interaction analysis and the additive interaction analysis did not reveal any evidence of interactive effects on diabetic complications and comorbidities. T. gondii might be a factor associated with hypertension in T2DM patients.

Exposición de criptoantígeno eritrocitario por larvas recién nacidas de Trichinella spiralis / Exposure of erythrocyte cryptic antigen by Trichinella spiralis newborn larvae / Exposição do cripto antígeno eritrocitário por larvas recém-nascidas de Trichinella spiralis

La desialización del eritrocito puede exponer determinantes antigénicas crípticas de la membrana, entre las cuales se encuentra el antígeno T. Se ha comunicado que las larvas recién nacidas de Trichinella spiralis (LRN), las cuales circulan por el torrente sanguíneo del hospedador, captan el ácido siálico eritrocitario. El objetivo de este trabajo fue estudiar in vitro la exposición del criptoantígeno T por la desialización producida por distintas concentraciones de LRN. Se trabajó con 30 suspensiones eritrocitarias en medio enzimático, que fueron incubadas en partes iguales con concentrados de LRN (GR Tratados) durante 2 horas a 37 ºC con agitación continua. Los respectivos GR Controles se pusieron en contacto con solución salina. El tratamiento de 10/30 suspensiones globulares se realizó con 500 LRN/mL, 10 con 300 LRN/mL y las últimas 10 con 150 LRN/mL. Se aplicó el Método de Aglutinación anti-T con antígeno T (en Placa y Tubo) enfrentando las suspensiones a suero de adulto y suero de cordón. El tratamiento de 9/10 de las suspensiones con 500 LRN/mL, el de 7/10 con 300 LRN/mL y el de 2/10 con 150 LRN/mL las expuso al criptoantígeno. Se concluye que en pacientes diabéticos, hipertensos o con otra patología que produzca disminución de ácido siálico eritrocitario y que cursen simultáneamente una infección por T. spiralis, en la etapa de circulación de larvas por el torrente sanguíneo podría producirse la activación T con la consecuente hemólisis, trombocitopenia y trombosis.

Erythrocyte desialylation can expose cryptic antigenic determinants of the membrane, among which is the T antigen. It has been reported that newborn larvae (NL), which circulate in the bloodstream of the host, capture erythrocyte sialic acid. The aim of this study was to study in vitro exposure of cryptic T antigen by the desialylation produced by different concentrations of NL. Work was carried out on 30 red cell suspensions in enzymatic medium, which were incubated in equal parts with NL concentrates (Treated RBC) for 2 hours at 37 ºC with continued agitation. The respective Control RBC was incubated with saline solution. Treatment of 10/30 globular suspensions was performed with 500 NL/mL, 10 with 300 NL/mL and the last 10 with 150 NL/mL. Anti T- antigen T Agglutination Tests (Plate and Tube) were made, facing the globular suspensions against adult and cord human sera. Treatment of 9/10 suspensions with 500 NL/mL, 7/10 with 300 NL/mL and 2/10 with 150 NL/mL exposed T antigen. It is concluded that in patients with diabetes, hypertension or other diseases with lower content of erythrocyte sialic acid and who simultaneously have a T. spiralis infection, T activation may occur in the stage of larvae circulating through the bloodstream, with consequent haemolysis, thrombocytopenia and thrombosis.

A dessialização do eritrócito pode expor determinantes antigênicos crípticos da membrana, entre os quais se encontra o antígeno T. Foi comunicado que as larvas recém-nascidas de Trichinella spiralis (LRN), as quais circulam na corrente sanguínea do hospedeiro, capturam o ácido siálico eritrocitário. O objetivo foi estudar in vitro a exposição do cripto antígeno T pela dessialização produzida por diferentes concentrações de LRN. Trabalhou-se com 30 suspensões eritrocitárias em meio enzimático, incubadas em partes iguais com concentrados de LRN (GV Tratados) durante 2 horas a 37 °C com agitação contínua. Os respectivos GV Controles entraram em contato com solução salina. Tratamento de 10/30 suspensões globulares foi realizado com 500 LRN/mL, 10 com 300 LRN/mL e as últimas 10 com 150 LRN/mL. Foi aplicado o Método de aglutinação anti T-antígeno T (em Placa e Tubo) enfrentando as suspensões a soro de adulto e soro de cordão. O tratamento de 9/10 suspensões com 500 NRL / mL, o de 7/10 com 300 LRN/mL e o de 2/10 com 150 LRN/mL expuseram o cripto antígeno. Conclui-se que em pacientes diabéticos, hipertensos ou com outra patologia que produza diminuição do ácido siálico eritrocitário, e que padeçam simultaneamente uma infecção por T. spiralis, na fase de circulação de larvas pela corrente sanguínea, poderia ocorrer a ativação T com a consequente hemólise, trombocitopenia e trombose.

Biomarcadores de função endotelial em doenças cardiovasculares: hipertensão / Biomarkers of endothelial function in cardiovascular diseases: hypertension

Resumo A incidência de hipertensão arterial sistêmica está aumentando mundialmente. Sua prevenção baseia-se na identificação dos hipertensos. Atualmente, biomarcadores são utilizados com fins de diagnosticar, estratificar e prognosticar doenças. Neste estudo, objetivou-se revisar artigos dos últimos cinco anos relacionados a biomarcadores nas doenças cardiovasculares. Pesquisaram-se dados de PubMed, SciELO, Science Direct e MEDLINE, mediante as palavras-chave: hipertensão arterial, biomarcadores cardiovasculares, óxido nítrico, função endotelial e dimetilarginina assimétrica. Os estudos levantados mostram que as doenças cardiovasculares possuem uma etiologia complexa. Neste artigo, evidenciaram-se interações entre o óxido nítrico e a dimetilarginina assimétrica na regulação, no metabolismo e na determinação dos níveis intracelulares, e reviram-se outros biomarcadores relacionados à hipertensão. Alguns estudos indicam os biomarcadores como uma ferramenta útil na predição de eventos cardíacos, e outros reportam que eles contribuem pouco para a avaliação. A seleção e combinação desses pode ser uma alternativa para validar o uso dos biomarcadores devido à pouca especificidade existente para diagnosticar a hipertensão.

Abstract The incidence of systemic arterial hypertension is increasing worldwide. The foundation of prevention is identification of people with hypertension. Nowadays, biomarkers are used to diagnose and stratify diseases and estimates prognosis. The objective of this study was to review articles published over the last 5 years on the subject of biomarkers of cardiovascular diseases. The PubMed, SciELO, Science Direct and MEDLINE databases were searched using the keywords: arterial hypertension, cardiovascular biomarkers, nitric oxide, endothelial function and asymmetric dimethylarginine. The studies reviewed show that cardiovascular diseases have complex etiologies. This article describes evidence demonstrating interactions between nitric oxide and asymmetric dimethylarginine that are involved in regulation, in metabolism, and in determination of intracellular levels, and also discusses other biomarkers related to hypertension. Some studies indicate that biomarkers are useful tools for prediction of cardiac events, whereas others state that they have little to contribute to assessments. Careful selection of tests and combinations of tests may be the key to validating use of biomarkers, in view of their low specificity for diagnosing hypertension.

The unacknowledged impact of urinary schistosomiasis in children: 5 cases from Kumasi, Ghana.

Urinary schistosomiasis is a parasitic disease caused by Shistosoma haematobium. It is prevalent in several parts of Africa particularly in areas where there are large water bodies. In most affected communities, the condition is often accepted as normal since to them, all growing children pass blood in their urine and "grow out of it". Mass treatment of school children has been a regular exercise often undertaken by stake holders to decrease the disease burden and reduce transmission in selected communities. Urinary schistosomiasis can have devastating impact on the urinary tract which is often unacknowledged and unevaluated. Such omission could have implication for progressive renal damage which, if not detected and treated, could lead to end stage renal failure and death. We present five (5) cases of urinary schistosomiasis with severe obstructive uropathy seen at the paediatric nephrology/urology units of Komfo Anokye Teaching Hospital, Ghana. All five cases had some degree of anaemia and hypertension. Two of the five cases presented with end stage renal failure and died subsequently whilst two underwent successful surgery. One made a spontaneous recovery from the urinary obstruction though still has significant renal impairment. This potential devastating effect of urinary schistosomiasis on the kidneys calls for thorough evaluation and assessment of each confirmed case to include blood pressure measurement, full blood count, and ultrasonography of the urinary system. Mass screening programmes should be combined with portable ultrasonography of the kidneys, ureters and bladder.

Comparison of alprazolam versus captopril in high blood pressure: a randomized controlled trial.

UNLABELLED: OBJECTIVE. Anxiety is an important cause of acute blood pressure (BP) elevation. However, the role of anxiolysis in this situation is still controversial. In this study, the relationship of anxiety with BP and the effect of anxiolytic treatment on BP were investigated. METHODS. Emergency department (ED) patients with an initial systolic BP (SBP) ≥ 160 mmHg or diastolic BP (DBP) ≥ 100 mmHg but no end organ damage were approached for inclusion in the study. In those consenting to participate, anxiety levels were measured using the State-Trait Anxiety Index (STAI) and Visual Analog Scale for Anxiety (VAS-A). Patients were randomly assigned to receive oral alprazolam 0.5 mg or captopril 25 mg. BP and anxiety levels were measured at baseline and at 1 and 2 h after administration of the study medication. RESULTS. Of 133 patients meeting inclusion criteria, 53 patients agreed to participate. Of these, 27 patients (50.9%) received captopril and 26 patients (49.1%) received alprazolam. The majority of the patients had a high-level trait (96.2%, n = 51) and state anxiety (81.1%, n = 43). The mean SBP and VAS-A values of both patient groups dropped significantly over the 2 h, with no significant difference between the two groups. A significant association between SBP and VAS-A scores was found (F((2,50)) = 6.27, p = 0.004). CONCLUSION: A significant association exists between the level of BP and anxiety in hypertensive ED patients. Alprazolam is as effective as captopril in lowering BP in ED patients with an initial SBP > 160 mmHg.

[Quality of life and 24 hour blood pressure profile in patients with hypertension].

122 patients aged 26 to 70 years (middle ages--54,1 +/- 2,8 years) who had history of arterial hypertension (AH) II stage have been observed. All patients conducted day's monitoring blood pressure (BP) and was determined their quality of life (QL) using the questionnaire of "SF-36 Health Status Survey". The results were conducted in accordance with instruction of the company of "Evidens are Clinico-pharmacological researches". Obtained results are represented in marks using 8 scales, more high mark specifies better QL. All observed patients with II stage hypertension have QL decreased. Decreased degree of night lowering of BP is associated with worsening of psychical status and more expressed limitation of physical activity in patients with hypertension than in those patients with hypertension who have normal day's type of BP.

Infection by Cryptosporidium parvum in renal patients submitted to renal transplant or hemodialysis.

The frequency of infection by Cryptosporidium parvum was determined in two groups of renal patients submitted to immunosuppression. One group consisted of 23 renal transplanted individuals, and the other consisted of 32 patients with chronic renal insufficiency, periodically submitted to hemodialysis. A third group of 27 patients with systemic arterial hypertension, not immunosuppressed, was used as control. During a period of 18 months all the patients were submitted to faecal examination to detect C. parvum oocysts, for a total of 1 to 6 tests per patient. The results showed frequencies of C. parvum infection of 34.8%, 25% and 17.4%, respectively, for the renal transplanted group, the patients submitted to hemodialysis and the control group. Statistical analysis showed no significant differences among the three groups even though the frequency of C. parvum infection was higher in the transplanted group. However, when the number of fecal samples containing C. parvum oocysts was taken in account, a significantly higher frequency was found in the renal transplanted group.