Hakim Azfar Ali

Omega-3 fatty acids in cardiac biopsies from heart transplantation patients: correlation with erythrocytes and response to supplementation.

Background—Omega-3 fatty acids (FAs) appear to reduce the risk of sudden death from myocardial infarction. This reduction is believed to occur via the incorporation of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) into the myocardium itself, altering the dynamics of sodium and calcium channel function. The extent of incorporation has not been determined in humans. Methods and Results—We first determined the correlation between red blood cell (RBC) and cardiac omega-3 FA levels in 20 heart transplant recipients. We then examined the effects of 6 months of omega-3 FA supplementation (1 g/d) on the FA composition of human cardiac and buccal tissue, RBCs, and plasma lipids in 25 other patients. Cardiac and RBC EPA+DHA levels were highly correlated (r=0.82, P<0.001). Supplementation increased EPA+DHA levels in cardiac tissue by 110%, in RBCs by 101%, in plasma by 139%, and in cheek cells by 73% (P<0.005 versus baseline for all; responses among tissues were not significantly different). Conclusions—Although any of the tissues examined could serve as a surrogate for cardiac omega-3 FA content, RBC EPA+DHA was highly correlated with cardiac EPA+DHA; the RBC omega-3 response to supplementation was similar to that of the heart; RBCs are easily collected and analyzed; and they have a less variable FA composition than plasma. Therefore, RBC EPA+DHA (also called the Omega-3 Index) may be the preferred surrogate for cardiac omega-3 FA status.

Bilateral nodular pulmonary infiltrates in an immunocompromised host

A 74-year-old man of Jamaican origin residing in the USA for 20 years presented to the hospital with progressively increasing shortness of breath and low-grade fever for 3 weeks. He had been diagnosed with non-Hodgkin’s lymphoma 6 …

Complement system in lung transplantation

The complement system is a cascade of multiple proteins that have been known to mediate inflammatory response. This tightly regulated system has been recognized to play a role in adaptive immunity via humoral and cell‐mediated processes. There is evidence from animal and human studies that the complement system is involved in various outcomes of solid organ transplantation. Most of the studies have been done in the field of kidney transplantation. In this paper, we review the studies looking at lung transplantation. The complement cascade appears to have a prominent role in mediating lung allograft damage in the setting of ischemia‐reperfusion injury, humoral rejection, as well as chronic allograft dysfunction. In this review, we look at the available data regarding the role of complement in these outcomes and propose some ideas about future direction of research in this field.

Special Considerations for Long-Term Survivors After Solid Organ Transplantation

Survival from solid organ transplantation has improved markedly over the last few decades due to progress in surgical techniques, newer antibiotics, and more effective immunosuppression. While short-term complications have decreased with improved management there remains an important focus on the long-term complications. These long-term complications include both infectious and non-infectious issues which will limit further improvement in graft and patient survival. The infectious causes mostly include community-acquired bacterial and viral infections. The metabolic and cardiovascular complications are prominent amongst non-infectious causes of long-term morbidity being driven by additional risk factors like effects of immunosuppression that increase the risk for hypertension, obesity, renal failure, and diabetes. Chronic immunosuppression leads to a higher incidence of most malignancies particularly skin cancers and these neoplastic processes appear to have an accelerated course in this population. Post-transplant lymphoproliferative disorder is a neoplasm related to EBV infection that is unique to the immunosuppressed population. A systematic health maintenance regimen which includes vaccinations, management of cardiovascular risk factors, and cancer screening will ensure that the long-term transplant survivors will be able to avoid significant morbidity and mortality from these complications.

Clinical Features of Thymus Pathology

Thymus pathology embraces a broad spectrum of features, varying from major immunologic abnormalities affecting all organ systems to minor abnormalities with limited clinical consequences. Some individuals with thymus pathology may have all the features of the disease while others may have only a few features. In this chapter we will review clinical features of common thymus pathologies. Tables 7.1 and 7.2 list the localized and systemic symptoms due to mediastinal tumors [1].