Differences and similarities between COVID-19 related-headache and COVID-19 vaccine related-headache. A case-control study. / Diferencias y similitudes entre la cefalea relacionada con la COVID-19 y la cefalea relacionada con la vacuna de la COVID-19. Un estudio de casos y controles.

INTRODUCTION: Headache is a frequent symptom at the acute phase of coronavirus disease 2019 (COVID-19) and also one of the most frequent adverse effects following vaccination. In both cases, headache pathophysiology seems linked to the host immune response and could have similarities. We aimed to compare the clinical phenotype and the frequency and associated onset symptoms in patients with COVID-19 related-headache and COVID-19 vaccine related-headache. SUBJECTS AND METHODS: A case-control study was conducted. Patients with confirmed COVID-19 infection and COVID-19-vaccine recipients who experienced new-onset headache were included. A standardised questionnaire was administered, including demographic variables, prior history of headaches, associated symptoms and headache-related variables. Both groups were matched for age, sex, and prior history of headache. A multivariate regression analysis was performed. RESULTS: A total of 238 patients fulfilled eligibility criteria (143 patients with COVID-19 related-headache and 95 subjects experiencing COVID-19 vaccine related-headache). Patients with COVID-19 related-headache exhibited a higher frequency of arthralgia, diarrhoea, dyspnoea, chest pain, expectoration, anosmia, myalgia, odynophagia, rhinorrhoea, cough, and dysgeusia. Further, patients with COVID-19 related-headache had a more prolonged daily duration of headache and described the headache as the worst headache ever experienced. Patients with COVID-19 vaccine-related headache, experienced more frequently pain in the parietal region, phonophobia, and worsening of the headache by head movements or eye movements. CONCLUSION: Headache caused by SARS-CoV-2 infection and COVID-19 vaccination related-headache have more similarities than differences, supporting a shared pathophysiology, and the activation of the innate immune response. The main differences were related to associated symptoms.

TITLE: Diferencias y similitudes entre la cefalea relacionada con la COVID-19 y la cefalea relacionada con la vacuna de la COVID-19. Un estudio de casos y controles.Introducción. La cefalea es un síntoma frecuente en la fase aguda de la enfermedad por coronavirus 2019 (COVID-19) y también uno de los efectos adversos más comunes tras la vacunación. En ambos casos, la fisiopatología de la cefalea parece estar relacionada con la respuesta inmunitaria del huésped y podría presentar similitudes. Nuestro objetivo fue comparar el fenotipo clínico y la frecuencia de los síntomas asociados y los síntomas de inicio en pacientes con cefalea relacionada con la COVID-19 y cefalea relacionada con la vacuna de la COVID-19. Sujetos y métodos. Se realizó un estudio de casos y controles. Se incluyó a pacientes con infección confirmada por COVID-19 y receptores de la vacuna de la COVID-19 que experimentaron un nuevo inicio de cefalea. Se administró un cuestionario estandarizado que incluyó variables demográficas, antecedentes previos de cefaleas, síntomas asociados y variables relacionadas con la cefalea. Ambos grupos se emparejaron por edad, sexo y antecedentes previos de cefaleas. Se realizó un análisis de regresión multivariante. Resultados. Un total de 238 pacientes cumplieron con los criterios de elegibilidad (143 pacientes con cefalea relacionada con la COVID-19 y 95 sujetos con cefalea relacionada con la vacuna de la COVID-19). Los pacientes con cefalea relacionada con la COVID-19 presentaron una mayor frecuencia de artralgia, diarrea, disnea, dolor torácico, expectoración, anosmia, mialgia, odinofagia, rinorrea, tos y disgeusia. Además, los pacientes con cefalea relacionada con la COVID-19 experimentaron una duración diaria más prolongada de la cefalea y describieron la cefalea como la peor que habían experimentado. Los pacientes con cefalea relacionada con la vacuna de la COVID-19 experimentaron con más frecuencia dolor en la región parietal, fonofobia y empeoramiento de la cefalea por movimientos de la cabeza o de los ojos. Conclusión. La cefalea causada por la infección por el SARS-CoV-2 y la cefalea relacionada con la vacunación de la COVID-19 presentan más similitudes que diferencias, lo que respalda una fisiopatología compartida y la activación de la respuesta inmunitaria innata. Las principales diferencias estuvieron relacionadas con los síntomas asociados.

Chronic hepatitis C in children: a clinical and immunohistochemical comparative study with adult patients.

Limited information is available regarding the characteristics of the hepatitis C virus (HCV) infection in children. We compared the epidemiological background along with the virological and histological features as well as the intrahepatic immunologic phenotype of both children and adults with chronic hepatitis C (CHC). Serum samples of 24 pediatric and 32 adult patients were drawn for alanine transaminase (ALT) levels, HCV-typing, and viral load. The histological diagnosis and a semiquantitative immunohistochemical assessment were performed in all patients. The majority of children (62%) had been transfused and the mean duration of viral infection in these cases was 11 +/- 4 years, being similar in adults (11 +/- 9 years, not significant). Although genotype distribution was similar, viral load was lower in children than in adults. The mildest histological forms of chronic hepatitis along with a weak intrahepatic immunological phenotype were significantly more frequent among children than adult patients. In conclusion, in children with CHC, perinatal blood transfusion was the most frequent source of viral infection and the liver disease was characterized by both low ALT level and viral load, as well as the mildest histological and immunohistochemical forms of chronic hepatitis.

Inducible nitric oxide synthase expression in chronic viral hepatitis. Evidence for a virus-induced gene upregulation.

Increased nitric oxide (NO) production may contribute to the pathological changes featuring in some inflammatory diseases, but the role of NO in chronic viral hepatitis is still unknown. We compared the inducible NO synthase (NOS2) expression in the liver of patients with chronic viral hepatitis with that of both nonviral liver disease and histologically normal liver. NOS2 expression was assessed by immunohistochemical and in situ hybridization studies of liver biopsy sections. An intense hepatocellular NOS2 reactivity was detected in chronic viral hepatitis, whereas it was weakly or not observed in nonviral liver disease or normal liver, respectively. In addition, we determined whether the hepatitis B virus (HBV) might regulate the synthesis of this enzyme. NOS2 mRNA and protein levels as well as enzyme activity were assessed in cytokine-stimulated HBV-transfected and untransfected hepatoma cells. Transfection with either HBV genome or HBV X gene resulted in induction of NOS2 mRNA expression, and the maximal induction of this transcript and NO production was observed in cytokine-stimulated HBV-transfected cells. These results indicate that hepatotropic viral infections are able to upregulate the NOS2 gene expression in human hepatocytes, suggesting that NO may mediate important pathogenic events in the course of chronic viral hepatitis.

Immunohistochemical evidence of immunopathogenetic mechanisms in chronic hepatitis C recurrence after liver transplantation.

Viremia and genotype are implicated in a rapid course of posttransplant hepatitis C virus (HCV) infection recurrence, but the role played by host immune reactions has not yet been evaluated. We correlated the degree of liver injury with the intrahepatic expression of molecules involved in immune response. The study included 32 biopsies of 30 liver transplant recipients. Recurrence of viremia was detected by Amplicor assay. Genotype was tested by Inno-Lipa. Cryostat sections were assessed by immunohistochemistry, using a wide panel of monoclonal antibodies. Correlations between histological-immunohistochemical semiquantitative evaluation and levels of viremia were performed. In severe hepatic inflammation, high numbers of activated cytotoxic T cells were found, along with marked hepatocellular expression of beta 2-microglobulin (beta 2-MG) and intercellular adhesion molecules. Likewise, a strong vascular adhesion molecule expression was observed mainly in those areas that were more inflamed. A striking endoglin reactivity was detected in enlarged portal tracts, and the presence of neoformed microvessels was also noteworthy. By contrast, in mild hepatic inflammation only a few activated T cells were detected, together with a weaker reactivity for all molecules studied. The level of viremia did not correlate with the degree of liver damage. The severe forms of post-transplant HCV infection recurrence are associated with a marked and aberrant intrahepatic expression of molecules involved in antigen recognition, and intercellular and vascular adhesion, decisive in regulating the recruitment and activation of cytotoxic T lymphocytes.

Influence of plasma renin content, intrarenal angiotensin II, captopril, and calcium channel blockers on the vasoconstriction and renin release promoted by adenosine in the kidney.

Our study was undertaken to assess whether the effect of intrarenal infusion of adenosine on renal blood flow and renin release in dogs is modified by the degree of stimulation of the intrarenal renin-angiotensin system. This system was modified by sodium deprivation, extracellular volume expansion, beta-adrenergic blockade and stimulation, angiotensin II infusion, and inhibition of converting enzyme by captopril. In addition, the effect of blocking slow calcium channels with verapamil on the vasoconstrictor effect of adenosine was also studied. Results demonstrate that the vasoconstrictor effect of adenosine was not modified by the status of stimulation or inhibition of the renin-angiotensin system or by the status of expansion of the extracellular volume. In all cases adenosine inhibited the renal secretion of renin. Verapamil abolished the vascular actions of adenosine, but it had no effect on the inhibition of renin release. We conclude that plasma renin or angiotensin II levels are not a necessary determinant of the renal vasoconstriction induced by adenosine. This effect seems to be mediated by the entry of calcium into the cell.

Thyroxine an triiodothyronine kinetics and extrathyroidal peripheral conversion rate of thyroxine to triiodothyronine in healthy elderly humans.

The influence of age on the kinetics of thyroxine (T4) and triiodothyronine (T3), and on peripheral conversion of T4 to T3, has been studied, comparing a group of euthyroid, healthy, elderly individuals to a group of young individuals. A monocompartment model was adopted for the kinetics of T4, while a bicompartment model was used for T3. No significant difference (p greater than 0.05) could be found in any of the kinetic parameters of T4 between the elderly and young groups. However, the following significant (p less than 0.05) changes were noted for T3: an increased disposition constant in the phase of slow distribution (beta), shortening of the half-life of this phase (T 1/2 beta ), elevation of the central distribution volume Vc and the elimination constant K23, reduction of the K12: K23 ratio, and increased plasma metabolic clearance and hormonal daily turnover. No significant differences (p greater than 0.05) were observed for the percent turnover of T4 converted to T3.

The kinetics of the thyroid hormones and the peripheral conversion rate of thyroxine to triiodothyronine in acute liver insufficiency under experimental conditions.

The kinetics of triiodothyronine (T3) and thyroxine (T4) were studied in 20 ewes. Ten were used as the control group, the other 10 received massive hepatic lesions induced by the ingestion of carbon tetrachloride. Half of each group were i.v. injected with 125IT3 or 125IT4, following a plasma disappearance over 96 hours. The amount of hormone present in each plasma sample was determined by immunoextraction procedure. The data was adjusted to the open two-compartment model. The hepatic insufficiency provoked a decrease in the disposition consent of T3, an increase in th plasma half-life of the distribution phase as well as a moderately decreased turnover rate of this hormone. The T4 kinetics were altered during acute hepatic insufficiency in the decrease of the elimination constant K13 and hormone plasma turnover rate. The study of the peripheral conversion rate based on the kinetic data showed an extrathyroidal conversion of T4 to T3 in the control sheep, none being detected in the sheep with induced hepatic insufficiency.

Study of the kinetics of the thyroid hormones and the peripheral conversion rate of thyroxine to triiodothyronine in acute renal insufficiency under experimental conditions.

We studied the kinetic behavior of triiodothyronine (T3) and thyroxine (T4) in two groups of 10 sheep. One was used as the control group (I) and the other consisted of sheep with acute renal failure (A.R.F.) induced by an iv. injection of mercuric dichloride. Five sheep of each group were injected with 125IT3 and the remaining five with 125IT4, later taking periodical extractions throughout the first 96 hours. The radioactive contaminants in the plasma were eliminated by extracting the hormones through immunoextraction. The mathematical calculation of the kinetics was based on the open two-compartment model. The A.R.F. caused a decrease in the disposition constant of the slow phase in the T3 kinetics, while at the same time prolonging the plasma half-life of the phase. The steady state distribution volume increases and the distribution constant K21 decreases in the group suffering from renal insufficiency. As regards the T4, all the kinetic parameters were altered with the exception of the distribution volumes, the most significant changes being the shortening of the plasma half-life in the end phases, the rise of the elimination constant K13 and the increase in the plasma clearance and thyroxine turnover rates. The analysis of the peripheral conversion rate revealed with a great amount of variation, that there is evidence of the conversion of T4 to T3 in the healthy group while this phenomenon remains undetected in the sick animals.

Renal management of sodium under indomethacin and aldosterone in the elderly.

The tubular handling of sodium in two groups of healthy old people, under the action of indomethacin and aldosterone was studied. Urinary aldosterone elimination was measured. From the results obtained, it is deduced that the elderly lose sodium through incompetence of the distal nephron. The possibility is put forward of a Na-K-ATPase deficit and/or interstitial fibrosis as being related to salt losses.