Immunological responses in patients with tuberculosis and in vivo effects of acetyl-L-carnitine oral administration

Tuberculosis (TBC) is characterized by a complex immune response which parallels the clinical course of the disease. In this respect, acquired resistance, delayed hypersensitivity reaction and anergy are the main types of immune reactivity to mycobacterial antigens. In view of the presence of nonspecific and specific immune deficits in TBC patients, a clinical trial was carried out in a group of 20 individuals with active pulmonary TBC by oral administration of acetyl-L-carnitine (ALC). This drug, which has been shown to possess immunomodulating activities, was able to upregulate the T-dependent antibacterial activity in TBC patients after 30 days' treatment, while the same activity decreased in patients receiving placebo only. On the other hand, ALC did not modify serum levels of tumour necrosis factor-α, in the same individuals. This cytokine plays a detrimental rather than beneficial role in TBC pathogenesis. In the light of these data, ALC seems to be a powerful immunomodulator in the course of Mycobacterium tuberculosis infection and other mycobacteriosis

Metabolic syndrome and Chronic Obstructive Pulmonary Disease (COPD): The interplay among smoking, insulin resistance and vitamin D

A close relationship between Metabolic Syndrome (MetS) and Chronic Obstructive Pulmonary Disease (COPD) has been described, but the exact nature of this link remains unclear. Current epidemiological data refer exclusively to the MetS prevalence among patients with COPD and data about the prevalence of COPD in MetS patients are still unavailable

Early Prediction of In-Hospital Mortality in Patients with Acute Infections: Development of the Acute Severity Infection Score (ASIs)

Introduction: Early prognostic stratification in patients hospitalized for acute infections is a major clinical challenge. Existing tools, such as the Sequential Organ Failure Assessment (SOFA) score and Charlson Comorbidity Index (CCI), were not specifically developed for this purpose. Objectives: We aimed to design a novel multidimensional prognostic score, the Acute Severity Infection score (ASIs), to predict in-hospital mortality using routinely available clinical data. Methods: This retrospective cohort study included 149 adults admitted with acute infections to an internal medicine unit between January 2023 and December 2024. In-hospital all-cause mortality was the primary outcome. Demographic, clinical and laboratory variables obtained within 12 h of admission were analyzed. Variables significantly associated with mortality in both univariate and multivariate regression were incorporated into the ASIs, which ranges from 0 to 7 points. Its performance was compared to SOFA and CCI using ROC curve and Cox regression models. Results: In-hospital mortality occurred in 25.5% of patients. Five variables were independently associated with mortality: lactate ≥ 2.2 mmol/l, frailty composite (confined to bed status, long-term oxygen therapy or advanced malignancy), hemodynamic instability or need for non-invasive ventilation, age ≥ 79.5 years and symptom onset ≥ 3.5 days before admission. ASIs showed the highest discriminative ability (AUC = 0.883) compared to SOFA (AUC = 0.612) and CCI (AUC = 0.742). In multivariate models including all three scores, only ASIs retained independent prognostic significance. Conclusions: The ASIs is a simple tool for early prognostic stratification of patients hospitalized with acute infections. It outperforms existing scores and may enhance clinical decision-making in real-world medical settings

Predictive factors of body weight loss in patients with type 2 diabetes treated with GLP-1 receptor agonists: a 52-week prospective real-life study

IntroductionGlucagon-like peptide-1 receptor agonists (GLP-1RAs) are widely prescribed for their efficacy in glycemic control and weight reduction, but patient response is heterogeneous and predictors of weight loss remain insufficiently defined. This 52-week prospective, observational study aimed to identify predictors of weight reduction (≥5% from baseline) in patients with type 2 diabetes mellitus (T2D) undergoing GLP-1RA therapy (semaglutide or dulaglutide, including oral formulations).MethodsA total of 194 adults with T2D initiating GLP-1RA therapy were evaluated at baseline, and after 6, and 12 months of therapy. To identify predictors of weight loss, variables differing between Responders (weight loss ≥5% than baseline) and Non-Responders were evaluated by ROC analysis and tested in univariate and multivariate logistic regression models adjusted for age, gender, GLP-1RA type and dosage.ResultsAt 6 and 12 months, 58% and 49% of patients, respectively, achieved the primary outcome. Responders at 12 months exhibited elevated BMI, waist circumference, hepatic steatosis indices, fat mass, and insulin levels at baseline, along with reduced muscle-to-fat and muscle-to-visceral adipose tissue ratios. Moreover, female gender, younger age, shorter disease duration, and non-use of metformin prior to enrollment were significantly associated with response. Notably, early response at 6 months strongly predicted 12-month success.ConclusionsOur results highlight a valuable interplay between body composition, liver involvement, and the incretin response, also suggesting a maximal synergistic effect between metformin and GLP-1RAs when treatments are initiated concurrently rather than sequentially. These data provide valuable insights for the development of individualized treatment strategies