Association between TNF-α and IFN-γ levels and severity of acute viral bronchiolitis.

Acute bronchiolitis caused by the respiratory syncytial virus triggers an inflammatory response with the production and release of several pro-inflammatory cytokines. Evidence suggests that their levels are associated with the severity of the infection. This systematic review and meta-analysis aim to assess whether the levels of TNF-α and IFN-γ are associated with the severity of acute viral bronchiolitis. We searched MEDLINE libraries (via PUBMED), EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Scientific Electronic Library Online (SciELO), Latin American Caribbean Health Sciences Literature (LILACS), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and the gray literature through April 2020. Random effect models were used for general and subgroup analysis. In total, six studies were included with a total of 744 participants. The mean TNF-α levels between the severe group did not differ from the control group 0.14 (95% CI: -0.53 to 0.82, I2 = 91%, p < 0.01); the heterogeneity was high. The results remained insignificant when the analyses were performed including only studies with high quality 0.25 (95% CI: -0.46 to 0.96, I2 = 92%, p < 0.01) I2 = 95%, p = 0.815), when TNF-α was nasal 0.60 (95% CI: -0.49 to 1.69), I2 = 94%, p < 0.01), or serum -0.08 (95% CI: -0.48 to 0.31), I2 = 29%, p = 0.24). In the analysis of studies measuring IFN-γ, there was also no significance of -0.67 (95% CI: -1.56 to 0.22, I2 = 76%, p = 0.04). In conclusion, this meta-analysis suggests that the most severe patients do not have different mean TNF-α and IFN-γ values ​than patients with mild disease, but the heterogeneity of the studies was high. Supplemental data for this article is available online at https://doi.org/10.1080/08830185.2021.1889534.

Postpartum evaluation of cardiovascular disease risk for women with pregnancies complicated by hypertension.

OBJECTIVES: Postpartum stratification of cardiovascular risk for women with pregnancies complicated by pre-eclampsia is challenging. Our aim was to identify potential clinical and biomarker predictors of future cardiovascular risk at six weeks postpartum in women with hypertensive pregnancies. STUDY DESIGN: Prospective longitudinal cohort. MAIN OUTCOME MEASURES: Ten year-Framingham cardiovascular risk scores were calculated for 477 women (94 with gestational hypertension, 288 with pre-eclampsia, 30 with superimposed pre-eclampsia, 51 with chronic hypertension, 14 women with uncomplicated pregnancies). B-type natriuretic peptide (BNP), neutrophil gelatinase-associated lipocalin (NGAL) and placental growth factor (PlGF) were quantified at six weeks postpartum. RESULTS: Framingham cardiovascular risk scores were not higher in women with pregnancies complicated by pre-eclampsia than healthy controls, nor were scores higher in women with pre-existing chronic hypertension complicated with superimposed pre-eclampsia compared with those without superimposed pre-eclampsia. Women with gestational hypertension had higher risk scores than women with pre-eclampsia and healthy controls. Established risk factors of cardiovascular disease including diastolic blood pressure and previously diagnosed chronic hypertension were associated with higher scores, and African ethnicity, parity and estimated glomerular filtration rate also were independently associated with higher Framingham risk scores at six weeks postpartum. PlGF, BNP and NGAL concentrations were not associated with Framingham cardiovascular risk scores after adjustment for independent variables. CONCLUSIONS: A history of pre-eclampsia or superimposed pre-eclampsia in most recent pregnancy was not associated with elevated Framingham risk score at six weeks postpartum. Established clinical predictors may enable risk stratification at six weeks postpartum, which are not enhanced by the biomarkers included in this study.

Using the Reduced Uterine Perfusion Pressure model of preeclampsia to study the blood brain barrier permeability / Uso do modelo de Redução da Pressão de Perfusão Uterina de pré-eclâmpsia para estudar a permeabilidade da barreira hematoencefálica

AIMS: To use the Reduced Uterine Perfusion Pressure (RUPP) model for preeclampsia to describe and evaluate the blood brain barrier permeability in pregnant rats. METHODS: Forty-one pregnant Wistar rats were divided into different intervention groups between 13 to 15 days of gestation: PregnantControl (PC; n=12), Reduced Uterine Perfusion Pressure (RUPP; n=15), Invasive Blood Pressure-Control (IBP; n=7) and Reduced Uterine Perfusion Pressure and Invasive Blood Pressure (RUPP-IBP; n=7). The 14 rats of groups IBP and RUPP-IBP had their mean arterial pressure measured at day 21. All animals were then sacrificed, administered Evans Blue dye through the tail vein and perfused with paraformaldehyde 4%. Brains were removed and evaluated by a blinded pathologist. Results are presented as means and standard errors. Comparisons between the groups were performed using Student's t-test for continuous variables and Fisher's exact test for categorical variables. Statistical significance was set as a p value less than 0.05. RESULTS: Mean arterial pressure averaged 85.4±2.2 mmHg in the IPB group and 102.5±8.3 mmHg in the RUPP-IPB group (p=0.002). Among all the RUPP rats (RUPP and RUPP-IBP groups), 82% had a positive staining with Evans Blue dye for at least one of the brain hemispheres, while none of the pregnant control rats (PC and IBP groups) had brain staining (p<0.001). CONCLUSIONS: In this study, altered permeability of the blood brain barrier was successfully reproduced in pregnant rats exposed to the RUPP protocol. Therefore, we concluded that the RUPP model is a valid surrogate to study blood brain barrier abnormalities.

OBJETIVOS: Usar o modelo de Redução da Pressão de Perfusão Uterina / Reduced Uterine Perfusion Pressure (RUPP) de pré-eclâmpsia para descrever e avaliar a permeabilidade da barreira hematoencefálica. MÉTODOS: Quarenta e uma ratas Wistar prenhes foram estratificadas em diferentes grupos de intervenção entre 13 a 15 dias de gestação: grupo controle (PC; n=12), grupo modelo de redução da pressão de perfusão uterina (RUPP; n=15), grupo monitorização invasiva da pressão arterial (IBP; n=7) e grupo redução da pressão de perfusão uterina e monitorização invasiva da pressão arterial (RUPP-IBP; n=7). As 14 ratas dos grupos IBP e RUPP-IBP tiveram sua pressão arterial média aferida no dia 21. Logo após todos os animais foram sacrificados e foi administrado o corante Azul de Evans pela veia da cauda, seguido de formaldeído 4%. Os cérebros foram removidos e avaliados por um patologista cegado para os grupos. Os resultados são apresentados em médias e erros padrão. As comparações entre os grupos foram realizadas utilizando o teste t de Student para variáveis contínuas e o teste exato de Fisher para variáveis categóricas. A significância estatística foi definida como um valor de p inferior a 0,05. RESULTADOS: As médias e desvios padrões da pressão arterial média foram 85,4±2,2 mmHg no grupo IPB e 102,5±8,3 mmHg no grupo RUPP-IPB (p=0,002). Entre todas as ratas RUPP (grupos RUPP e RUPP-IBP), 82% tiveram marcação positiva pelo corante em pelo menos um dos hemisférios cerebrais, enquanto nenhuma das ratas controle (grupos PC e IBP) teve marcação cerebral positiva (p<0,001). CONCLUSÕES: Neste estudo, a permeabilidade alterada da barreira hematoencefálica foi reproduzida com sucesso em ratas prenhes expostas ao protocolo RUPP. Portanto, concluímos que o modelo RUPP é um substituto válido para estudar anormalidades da barreira hematoencefálica.

Phosphodiesterases and preeclampsia.

Antagonizing vasodilation has been considered one of the potential mechanisms underlying the pathophysiology of preeclampsia. Phosphodiesterases hydrolyze cGMP, interfering with the action of nitric oxide on vascular smooth muscle, thus causing vasoconstriction. We hypothesize that the phosphodiesterases in maternal plasma, phosphodiesterase-5 in particular, may be linked to clinical manifestations in preeclampsia syndrome.

Manifestações gastrointestinais relacionadas à síndrome da imunodeficiência adquirida: do diagnóstico / Gastrointestinal manifestations regarding the acquired immunodeficiency syndrome: from diagnosis to treatment

Os sinais e sintomas relacionados ao trato gastrointestinal em decorrência da síndrome da imunodeficiência adquirida (SIDA) são muito freqüentes. Por essa razão realizou-se uma revisão através do PubMed, para abordar os principais achados clínicos, diagnósticos e opções terapêuticas que orientem os médicos internistas frente a essas situações.