Clinical manifestations in patients with antiphospholipid antibodies: Beyond thrombosis and pregnancy loss

The clinical spectrum of the antiphospholipid syndrome (APS) encompasses additional manifestations other than thrombosis and pregnancy morbidity, which may potentially affect every organ and system. The pathophysiology of APS indeed cannot be explained exclusively by a prothrombotic state and the “extra-criteria” manifestations of the syndrome should be attributed to other mechanisms, such as inflammation, complement and platelet activation. In this case-series, we report patients with uncommon clinical APS presentations, to highlight relevant peculiarities of the syndrome, potentially paving the way for a further update of clinical as well as laboratory manifestations of this complex immunological condition.

The University of California San Diego performance-based skills assessment: a useful tool to detect mild everyday functioning difficulties in HIV-infected patients with very good immunological condition

Everyday functioning (EF) impairment is frequent in people living with HIV (PLWH). Our aim was to better explore EF and its association with PLWH cognition, by administering both the IADL scale, the most common functional scale, and a new and ecologic multi-domain (communication and financial skills) tool to measure EF as the University of California San Diego (UCSD) Performance-Based Skills Assessment-Brief Version (UPSA-B). Eighty-five PLWH on cART with very good immunological condition and 23 age- and education-matched healthy controls (HC) were enrolled. PLWH underwent a standardized neuropsychological battery plus IADL, and cognitive impairment was defined according to Frascati criteria. Both groups underwent the UPSA-B. Only 6 subjects (7%) were affected by cognitive impairment (asymptomatic profile). While IADL score was at ceiling for all patients, the UPSA-B total score was significantly worse in PLWH when compared with HC [mean 82.1 (SD 9.3) vs 89.2 (SD 6.2); p < 0.001]. At communication subtest, PLWH group and HC were significantly different (p = 0.002), while no difference emerged at financial skills (p = 0.096). Higher score at UPSA-B was independently associated with better global cognitive performance (composite Z-score) (β 7.79; p < 0.001). Also considering each single cognitive domain, UPSA-B performance (both total and at subtests) confirmed the association with neurocognitive performance. In conclusion, UPSA-B seems to better discriminate EF impairment than IADL in PLWH, and it was associated with cognitive functions, also in the absence of symptomatic cognitive impairment. Thus, it appears a promising tool in the context of HIV infection to avoid misdiagnosis and to better detect also mild EF.

Seasonal Differences in Immunological Condition of Three Species of Thrushes

Migratory birds are exposed to a diverse pathogen fauna by virtue of their long-distance travels. Although the immune system is an organism's primary defense against pathogenic microorganisms, few studies have investigated avian immune function during migration, much less shown seasonal differences in immune function. We describe the immunological condition of three intercontinental migratory species, Swainson's Thrush (Catharus ustulatus), Veery (C. fuscescens), and Wood Thrush (Hylocichla mustelina) during spring migration. In addition, we compare their immunological condition with conspecifics captured during fall migration and during the breeding season to provide a frame of reference for the spring immunological data. Measures of immunological condition presented include total leukocyte count, heterophil:lymphocyte (H:L) ratio, heterophil and lymphocyte counts, hematocrit, and IgG titers. In addition, we assessed each bird's energetic condition by measuring body mass and calculating a size-corrected condition index. Migrating birds had lower leukocyte and lymphocyte counts, lower hematocrit, reduced fat stores, and higher H:L ratios relative to nonmigrating individuals sampled during the breeding season. We also found that birds sampled during spring migration had lower lymphocyte counts and reduced fat stores, and higher heterophil counts and H:L ratios than fall migrants. Our results suggest that migrating birds are immunocompromised compared with conspecifics during the breeding season. Furthermore, compared with conspecifics sampled after a shorter overland flight, migrants sampled after crossing the Gulf of Mexico exhibited higher H:L ratios, which is indicative of heightened energetic stress.