We recently reported the COVID-19-induced circulating leukocytes DNA methylation profile. Here, we hypothesized that some of these genes would persist differentially methylated after disease resolution. Fifteen participants previously hospitalized for SARS-CoV-2 infection were epityped one year after discharge. Of the 1505 acute illness-induced differentially methylated regions (DMRs) previously identified, we found 71 regions with persisted differentially methylated, with an average of 7 serial CpG positions per DMR. Sixty-four DMRs persisted hypermethylated, and 7 DMR persisted hypomethylated. These data are the first reported evidence that DNA methylation changes in circulating leukocytes endure long after recovery from acute illness.
Introduction: Chronic kidney disease (CKD) is greatly affected by social determinants of health. Whether low educational attainment is associated with incident CKD in young adults is unclear. Methods: We evaluated the association of education with incident CKD in 3139 Coronary Artery Risk Development in Young Adults participants. We categorized education into low (high school and less), medium (college), and high (master's and professional studies) groups. Incident CKD was defined as new development of estimated glomerular filtration rate (eGFR) <60 ml/min per 1.73 m 2 or urine albumin to creatinine ratio $30 mg/g. Change in eGFR over 20 years was a secondary outcome. Results: At baseline, mean age was 35.0 AE 3.6 years, 47% were Black, and 55% were women. Participants with lower educational attainment were less likely to have high income and health insurance and to engage in a healthy lifestyle. Over 20 years, 407 participants developed CKD (13%). Compared with individuals with low educational attainment, those with medium and high educational attainment had an unadjusted hazard ratios for CKD of 0.79 (95% confidence interval [CI] 0.65-0.97) and 0.44 (95% CI, 0.30-0.63), respectively. This association was no longer significant after adjusting for income, health insurance, lifestyle, and health status. Low educational attainment was significantly associated with a change in eGFR in crude and adjusted analyses, although the association was attenuated in the multivariable models (low:-0.83 [95% CI,-0.91 to-0.75], medium:-0.80 (95% CI,-0.95 to-0.64), and high:-0.70 (95% CI,-0.89 to-0.52) ml/min per 1.73 m 2 per yr). Conclusions: Health care access, lifestyle, and comorbid conditions likely help explain the association between low educational attainment and incident CKD in young adults.
We present a 37-year-old man with history of incompletely treated testicular germ cell tumor presenting with persistent cough. Computed tomography(CT) demonstrated a large pulmonary mass invading the mediastinal vasculature, bronchi, and thrombus in the pulmonary vein extending into the left atrium. Biopsy of the lung mass confirmed germ cell tumor. Transthoracic echocardiography revealed a mass in the left atrium, consistent with a tumor or thrombus. Systemic chemotherapy was started with cisplatin and etoposide with curative intent.
INTRODUCTION: Bacterial pericarditis accounts for less than 1% of cases of pericarditis and carries a 40% risk of mortality. Enterococcus faecalis pericarditis has been very rarely described as a cause of pericardial effusion sufficient to cause cardiac tamponade. CASE PRESENTATION:A 73-year-old male with history of transfusion dependent primary myelofibrosis, on ruxolitinib, presented with one week of progressive fatigue, dyspnea, and generalized weakness. On admission, blood pressure was 113/65, heart rate 97, and he was afebrile. Hemoglobin was 8.0g/dl and platelet 41,000/mm3. Symptoms improved after transfusion with two units of red blood cells. Two days after admission, he was found obtunded by staff. His vitals were initially normal. CT angiography of the head and neck was normal other than presence of a large pericardial effusion. He rapidly became hypotensive (82/52) but heart rate remained 70. Norepinephrine was started. Bedside ultrasound demonstrated a large, circumferential pericardial effusion with right atrial diastolic collapse. He was intubated and placed on mechanical ventilation due to severe hypercapnic respiratory failure (pH 6.99, PaCO2 >165). His blood platelet count was 21,000/mm3. An emergent bedside pericardiocentesis with catheter drainage was performed, and 250ml of grossly bloody fluid was removed. Immediately following drainage, his blood pressure improved and his vasopressor requirements decreased by 50%. He developed fever and was started on broad-spectrum antibiotics with vancomycin and cefepime. The fluid was hemorrhagic and exudative(Table 1). CT chest the following day showed reaccumulation of the pericardial effusion and a right lower lobe consolidation. 90ml was drained on repeat pericardiocentesis. Culture of the initial pericardial fluid grew pan-sensitive Enterococcus faecalis. Over the next several days his multiorgan failure progressed until he ultimately passed away.DISCUSSION: This patient was transfusion-dependent, and his symptomatic improvement after transfusion provided false reassurance. In hindsight, volume expansion from transfusion may have inadvertently temporized his obstructive shock. He developed mixed obstructive and septic shock. Ultrasound was critical in identifying cardiac tamponade. The source of E. faecalis in the pericardial fluid remains obscure. Possibilities include direct spread from right lower lobe pneumonia. Alternatively, hemorrhage from thrombocytopenia may have caused metastatic infection from bacteremia. Potential sources for this are contaminated blood products or bacterial translocation from the GI tract into the bloodstream. However, blood, urine and sputum cultures did not grow any bacteria.CONCLUSIONS: Primary myelofibrosis causes chronic immunodeficiency and thrombocytopenia. Hemorrhagic bacterial pericarditis should be considered in the differential when evaluating the etiology of dyspnea in these patients.
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