[CRYOGLOBULINEMIA AND ENDOCARDITIS AS A PRESENTATION OF COXIELLA BURNETII (Q-FEVER) INFECTION].

INTRODUCTION: An infection with Coxiella burnetii (Q FEVER) can be manifested as an autoimmune or rheumatologic disease as it was presented in our patient, showing cryoglobulinemia and massive destruction of the aortic valve. In the differential diagnosis we must consider an infection with Coxiella burnatii which may change the course of the disease and may cause life-threatening manifestations.

Anti-phospholipid syndrome associated with schizophrenia description of five patients and review of the literature.

Anti-phospholipid syndrome is an autoimmune disorder characterized by anti-phospholipid antibodies, arterial and venous thrombosis, pregnancy morbidity, and various neurological manifestations including psychiatric disorders. Higher incidence of various autoimmune disorders was found in schizophrenia. In addition, an association between the presence of anti-phospholipid antibodies and schizophrenia or psychosis was previously described, mainly as case reports. Although initially believed to be a result of neuroleptic treatment, the reasons for this association remain obscure. Several theories on the etiologic basis of schizophrenia that may explain this association were proposed including an immune basis of schizophrenia and a genetic locus of the disease in the human leukocyte antigens area. Herein, we present a series of five patients diagnosed with both schizophrenia and anti-phospholipid syndrome and their characteristics along with a comprehensive review of the current available literature on the subject in an attempt to deepen our understanding of these disorders and their pathogenesis.

The effect of chemotherapy on telomere dynamics: clinical results and possible mechanisms.

Telomeres are the chromosomal end components, and their length in hematopoietic stem cells correlates with the bone marrow proliferative reserve. There are few data regarding telomere dynamics in hematopoietic stem cells after exposure to chemotherapy. We show that the attrition of telomeres after cytotoxic treatment correlates with the intensity of chemotherapy. Using cytotoxic drugs with differential effects on hematopoietic stem cells, our data imply that chemotherapy-induced telomere shortening results from direct damage to hematopoietic stem cells and/or the induction of proliferative stress on bone marrow while sparing repopulating stem cells. These results gain importance considering the current long survival of patients with cancer.

Soluble transferrin receptor as a diagnostic laboratory test for detection of iron deficiency anemia in acute illness of hospitalized patients.

BACKGROUND: Many patients in the internal medicine ward have anemia. The etiology for the anemia may be multifactorial and, in the setting of inflammatory process when the ferritin is increased, it is difficult to diagnose iron deficiency anemia. Soluble transferrin receptor (sTfR) had been suggested as an indicator for iron deficiency. No study has investigated the meaning of high sTfR as the only positive marker of iron deficiency anemia (IDA) caused by gastrointestinal tract (GIT) bleeding in hospitalized patients. OBJECTIVES: To demonstrate the importance of high levels of sTfR as a marker for further GIT investigation in cases of anemia where the level of ferritin was normal or increased. METHODS: We retrospectively assessed all patients in an internal medicine ward in our facility who had anemia, high sTfR levels (> 5.0 mg/L) and normal or high ferritin levels and who underwent esophagogastroduodenoscopy and colonoscopy. RESULTS: Of 32 patients with anemia and normal or high ferritin levels and high sTfR, 22 patients (68%) had findings that explained IDA (in some patients more than one finding). Those findings were colonic polyps (n=9), carcinoma of colon (n=4), duodenal ulcer (n=4), carcinoma of stomach (n=3), colitis (n=3), atrophic gastritis (n=1), erosive gastritis (n=1) and angiodysplasia (n=1). CONCLUSIONS: High sTfR may be a good indicator of IDA caused by GIT bleeding when the ferritin level is normal or high. GIT investigation is warranted in such cases.