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1.
Medicine (Baltimore) ; 100(36): e27146, 2021 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-34516506

RESUMO

ABSTRACT: To evaluate the value of the combination schemes of 10 serological markers in the clinical diagnosis of acute cerebral infarction.The level of total cholesterol, triglycerides, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol, high-sensitivity C-reactive protein, homocysteine (HCY), lipoprotein-related phospholipase A2, ischemia-modified albumin, complement C1q, and lipoprotein a were analyzed in 154 patients with acute ischemic cerebral infarction. The optimized diagnostic combination for acute cerebral infarction was explored by calculating the maximum area under the receiver operating characteristic curves (AUC).The levels of total cholesterol, triglycerides, low-density lipoprotein cholesterol, high-sensitivity C-reactive protein, HCY, lipoprotein-related phospholipase A2, ischemia-modified albumin, complement C1q, and lipoprotein a were significantly higher in the patient vs the control group. Moreover, the positive rate of HCY reached 89.9%. The analysis of the receiver operating characteristic curve of each index and their combinations showed that the minimum AUC of HDL-C alone was 0.543, while the maximum AUC of HCY was 0.853. A multiple logistic regression analysis indicated that HDL-C was a slightly significant variate in the diagnosis of acute cerebral infarction.The value of individual serological markers in the diagnosis of acute cerebral infarction was slightly significant, while the combination of the markers significantly improved the efficiency of its diagnosis.


Assuntos
Biomarcadores/sangue , Isquemia Encefálica/diagnóstico , Doença Aguda , Área Sob a Curva , Isquemia Encefálica/sangue , Proteína C-Reativa/metabolismo , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Albumina Sérica Humana , Triglicerídeos/sangue
2.
Int Heart J ; 62(4): 837-842, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34334582

RESUMO

Chronic inflammation due to abdominal obesity plays a major role in the development of cardiovascular disease (CVD). Gender differences are well characterized in the development of CVD; however, in the association among abdominal obesity, chronic inflammation, and preclinical atherosclerosis, gender differences in the general population remain to be clarified. We retrospectively analyzed 1,163 subjects who underwent voluntary health checkups at our institute. We defined carotid artery plaque formation as carotid intima-media thickness ≥ 1.1 mm. Multiple regression analysis showed that waist circumference was a major independent predictor of increase in serum C-reactive protein (CRP) level in both men and women. Serum CRP level was significantly increased in men with carotid artery plaque formation, but not in women. Multivariable logistic regression analysis demonstrated that serum CRP level, as well as age and hypertension, was independently associated with carotid artery plaque formation only in men. This result may suggest a potential of gender-specific difference in the association between serum CRP level and the prevalence of carotid artery plaque formation. Further investigations are required to confirm our results and to clarify the underlying mechanism.


Assuntos
Aterosclerose/complicações , Inflamação/complicações , Obesidade Abdominal/complicações , Caracteres Sexuais , Idoso , Proteína C-Reativa/metabolismo , Espessura Intima-Media Carotídea , Feminino , Humanos , Inflamação/metabolismo , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Circunferência da Cintura
3.
Nutrients ; 13(7)2021 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-34371818

RESUMO

The association between immunity and metabolic syndrome (MetS) has been studied, but its interaction with lifestyles remains unclear. We studied their association and interactions with lifestyles in 40,768 adults aged over 40 years from a large-scale, hospital-based cohort study collected during 2010-2013. White blood cell counts (WBC) and serum C-reactive protein concentrations (CRP) were used as indexes of immune status. The participants were categorized into four groups by the cutoff points of 6.2 × 109/L WBC(L-WBC) and <0.5 mg/dL CRP(L-CRP): L-WBC+L-CRP(n = 25,604), H-WBC+L-CRP(n = 13,880), L-WBC+H-CRP(n = 464), and H-WBC+H-CRP(n = 820). The participants in the H-WBC+L-CRP were younger and had higher numbers of males than the L-WBC+L-CRP. MetS risk was higher by 1.75- and 1.86-fold in the H-WBC+L-CRP and H-WBC+H-CRP, respectively, than the L-WBC+L-CRP. MetS components, including plasma glucose and triglyceride concentrations, and SBP were elevated in H-WBC+L-CRP and H-WBC+H-CRP compared with L-WBC+L-CR+P. The risk of hyperglycemia and high HbA1c was the highest in the H-WBC+H-CRP among all groups. Areas of WBC counts and serum CRP concentrations were 0.637 and 0.672, respectively, in the receiver operating characteristic curve. Daily intake of energy, carbohydrate, protein, and fat was not significantly different in the groups based on WBC counts and CRP. However, a plant-based diet (PBD), physical activity, and non-smoking were related to lowering WBC counts and CRP, but a Western-style diet was linked to elevating CRP. A high PBD intake and smoking status interacted with immunity to influence MetS risk: a low PBD and current smoking were associated with a higher MetS risk in the H-WBC+H-CRP. In conclusion, overactivated immunity determined by CRP and WBC was associated with MetS risk. Behavior modification with PBD and physical activity might be related to immunity regulation.


Assuntos
Dieta Vegetariana/métodos , Ingestão de Alimentos/imunologia , Exercício Físico/fisiologia , Síndrome Metabólica/imunologia , Fenômenos Fisiológicos da Nutrição/imunologia , Adulto , Proteína C-Reativa/metabolismo , Fatores de Risco Cardiometabólico , Estudos de Coortes , Dieta Ocidental/efeitos adversos , Feminino , Humanos , Contagem de Leucócitos , Estilo de Vida , Masculino , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/prevenção & controle , Pessoa de Meia-Idade , República da Coreia/epidemiologia
4.
Viruses ; 13(8)2021 07 28.
Artigo em Inglês | MEDLINE | ID: mdl-34452349

RESUMO

INTRODUCTION: Since the COVID-19 pandemic outbreak, multiple promising treatment modalities have been tested, however, only several of them were proven to be effective. Therapeutic plasma exchange (TPE) has been recently discussed as a possible supportive treatment for severe cases. METHODS: To investigate a possible role of TPE in severe COVID-19 we used a structured systematic search strategy to retrieve all relevant publications in the field. We screened in PubMed, EMBASE, Web of Science, Cochrane Library and clinicaltrials.gov for data published until the 4 June 2021. RESULTS: We identified 18 papers, enrolling 384 patients, 220 of whom received TPE. The number of TPE sessions ranged from 1 to 9 and the type of replacement fluid varied markedly between studies (fresh frozen plasma or 5% albumin solution, or convalescent plasma). Biochemical improvement was observed in majority of studies as far as C-reactive protein (CRP), interleukin-6 (IL-6), ferritin, lactate dehydrogenase (LDH), D-dimer concentrations and lymphocyte count are concerned. The improvement at a laboratory level was associated with enhancement of respiratory function. Adverse effects were limited to five episodes of transient hypotension and one femoral artery puncture and thrombophlebitis. CONCLUSIONS: Although the effect of therapeutic plasma exchange on mortality remains unclarified, the procedure seems to improve various secondary end-points such as PaO2/FiO2 ratio or biomarkers of inflammation. Therapeutic plasma exchange appears to be a safe treatment modality in COVID-19 patients in terms of side effects.


Assuntos
COVID-19/terapia , Troca Plasmática , Adulto , Idoso , Idoso de 80 Anos ou mais , Proteína C-Reativa/metabolismo , COVID-19/mortalidade , COVID-19/virologia , Feminino , Humanos , Imunização Passiva , Interleucina-6/sangue , Masculino , Pessoa de Meia-Idade , SARS-CoV-2/genética , SARS-CoV-2/fisiologia , Índice de Gravidade de Doença , Resultado do Tratamento
5.
Medicine (Baltimore) ; 100(31): e26511, 2021 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-34397794

RESUMO

ABSTRACT: Pain sensitization leading to polyalgia can be observed during infectious diseases. The blood pressure cuff-evoked pain threshold (BPCEPT) has been used in previous studies as a screening tool for fibromyalgia.We aimed to use the BPCEPT as a screening test for detecting pain sensitization in patients suffering from infectious diseases. We also investigated whether specific factors were associated with pain sensitization.We performed a prospective comparative study including all patients of our infectious diseases center in a 1-year period. We created a positive control group of patients suffering from fibromyalgia and a negative control group of "apparently healthy" patients consulting for vaccination.The blood pressure (BP) cuff was inflated until the patient signaled that they experienced pain, and this pressure value was noted.A total of 2355 patients were included. The positive control group had significantly lower values of the BPCEPT than all other groups. Among hospitalized patients with infectious diseases, a low BPCEPT was significantly associated with high temperature (P < .0001), older age (P = .002), being a woman (P = .004), high serum glutamic-oxaloacetic transaminase (P = .007), and high C reactive protein levels (P = .02). Moreover, in multivariate analysis, respiratory infection, meningitis, urinary tract infection, febrile neutropenia, and Q fever were independently associated with a low BPCEPT. A significant negative dynamic correlation between the BPCEPT and temperature was also observed (P < .001).We demonstrated for the first time in a large sample of patients that the BPCEPT method can be used to detect pain susceptibility. We observed a significant dynamic correlation between pain sensitization and temperature. Additionally, pain sensitization was associated with some diseases, suggesting that they trigger pain sensitivity.


Assuntos
Determinação da Pressão Arterial , Temperatura Corporal , Infecções/complicações , Dor/etiologia , Fatores Etários , Aspartato Aminotransferases/sangue , Determinação da Pressão Arterial/efeitos adversos , Proteína C-Reativa/metabolismo , Suscetibilidade a Doenças/diagnóstico , Suscetibilidade a Doenças/microbiologia , Suscetibilidade a Doenças/fisiopatologia , Feminino , Fibromialgia/complicações , Humanos , Infecções/fisiopatologia , Masculino , Pessoa de Meia-Idade , Dor/fisiopatologia , Limiar da Dor , Pressão/efeitos adversos , Estudos Prospectivos , Fatores de Risco , Fatores Sexuais
6.
Front Immunol ; 12: 708101, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34408751

RESUMO

Background: Plasma levels of C-reactive protein (CRP), induced by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) triggering COVID-19, can rise surprisingly high. The increase of the CRP concentration as well as a certain threshold concentration of CRP are indicative of clinical deterioration to artificial ventilation. In COVID-19, virus-induced lung injury and the subsequent massive onset of inflammation often drives pulmonary fibrosis. Fibrosis of the lung usually proceeds as sequela to a severe course of COVID-19 and its consequences only show months later. CRP-mediated complement- and macrophage activation is suspected to be the main driver of pulmonary fibrosis and subsequent organ failure in COVID-19. Recently, CRP apheresis was introduced to selectively remove CRP from human blood plasma. Case Report: A 53-year-old, SARS-CoV-2 positive, male patient with the risk factor diabetes type 2 was referred with dyspnea, fever and fulminant increase of CRP. The patient's lungs already showed a pattern enhancement as an early sign of incipient pneumonia. The oxygen saturation of the blood was ≤ 89%. CRP apheresis using the selective CRP adsorber (PentraSorb® CRP) was started immediately. CRP apheresis was performed via peripheral venous access on 4 successive days. CRP concentrations before CRP apheresis ranged from 47 to 133 mg/l. The removal of CRP was very effective with up to 79% depletion within one apheresis session and 1.2 to 2.14 plasma volumes were processed in each session. No apheresis-associated side effects were observed. It was at no point necessary to transfer the patient to the Intensive Care Unit or to intubate him due to respiratory failure. 10 days after the first positive SARS-CoV-2 test, CRP levels stayed below 20 mg/l and the patient no longer exhibited fever. Fourteen days after the first positive SARS-CoV-2 test, the lungs showed no sign of pneumonia on X-ray. Conclusion: This is the first report on CRP apheresis in an early COVID-19 patient with fulminant CRP increase. Despite a poor prognosis due to his diabetes and biomarker profile, the patient was not ventilated, and the onset of pneumonia was reverted.


Assuntos
Remoção de Componentes Sanguíneos/métodos , Proteína C-Reativa/metabolismo , COVID-19/terapia , Insuficiência Respiratória/prevenção & controle , Proteína C-Reativa/análise , Proteína C-Reativa/imunologia , COVID-19/sangue , COVID-19/complicações , COVID-19/imunologia , Humanos , Pulmão/diagnóstico por imagem , Pulmão/imunologia , Masculino , Pessoa de Meia-Idade , Insuficiência Respiratória/imunologia , Insuficiência Respiratória/patologia , Insuficiência Respiratória/virologia , SARS-CoV-2/imunologia , SARS-CoV-2/isolamento & purificação , Resultado do Tratamento
7.
Front Immunol ; 12: 720363, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34447386

RESUMO

Severe coronavirus disease 2019 (COVID-19) can manifest as a viral-induced hyperinflammation with multiorgan dysfunction. It has been documented that severe COVID-19 is associated with higher levels of inflammatory mediators than a mild disease, and tracking these markers may allow early identification or even prediction of disease progression. It is well known that C-reactive protein (CRP) is the acute-phase protein and the active regulator of host innate immunity, which is highly predictive of the need for mechanical ventilation and may guide escalation of treatment of COVID-19-related uncontrolled inflammation. There are numerous causes of an elevated CRP, including acute and chronic responses, and these can be infectious or non-infectious in etiology. CRP are normally lacking in viral infections, while adaptive immunity appears to be essential for COVID-19 virus clearance, and the macrophage activation syndrome may explain the high serum CRP contents and contribute to the disease progression. Nevertheless, for the assessment of host inflammatory status and identification of viral infection in other pathologies, such as bacterial sepsis, the acute-phase proteins, including CRP and procalcitonin, can provide more important information for guiding clinical diagnosis and antibiotic therapy. This review is aimed to highlight the current and most recent studies with regard to the clinical significance of CRP in severe COVID-19 and other viral associated illnesses, including update advances on the implication of CRP and its form specifically on the pathogenesis of these diseases. The progressive understanding in these areas may be translated into promising measures to prevent severe outcomes and mitigate appropriate treatment modalities in critical COVID-19 and other viral infections.


Assuntos
Proteína C-Reativa/metabolismo , COVID-19/sangue , COVID-19/complicações , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Humanos , Inflamação/sangue , Vírus da Influenza A Subtipo H1N1 , Influenza Humana/sangue , Influenza Humana/complicações , Acidente Vascular Cerebral/sangue , Viroses
8.
Biomark Med ; 15(13): 1167-1175, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34406031

RESUMO

Aim: To investigate whether C-reactive protein/albumin ratio (CAR) has an association with new onset atrial fibrillation (NOAF) in SARS-CoV-2. Materials & methods: This study included 782 patients with SARS-CoV-2 infection, who were hospitalized in Turkey. The end point of the study was an occurrence of NOAF. Results: NOAF was identified in 41 patients (5.2%). Subjects who developed NOAF had a higher CAR compared with those who did not develop NOAF (p < 0.001). In the multivariate logistic regression analysis the CAR (odds ratio = 2.879; 95% CI: 1.063-7.793; p = 0.037) was an independent predictor of NOAF. Conclusion: A high level of CAR in blood samples is associated with an increased risk of developing NOAF in SARS-CoV-2.


Assuntos
Albuminas/metabolismo , Fibrilação Atrial/metabolismo , Proteína C-Reativa/metabolismo , COVID-19/complicações , Idoso , Fibrilação Atrial/complicações , COVID-19/virologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , SARS-CoV-2/isolamento & purificação , Turquia
9.
Eur Cytokine Netw ; 32(1): 8-14, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-34346869

RESUMO

Cytokine release syndrome is a serious complication of the new coronavirus infection (COVID-19). The aim of the study was to assess effectiveness and safety of the IL-17 antagonist nekatimab for its treatment. The retrospective study included COVID-19 patients with C-reactive protein levels >60 mg/L. Patients received either netakimab (group NET), IL-6 antagonist tocilizumab (group TOC) or no anti-cytokine treatment (group CON). Forty-four patients were enrolled in the NET group, 27 patients in the TOC group, and 47 patients in the CON group. Mortality was lower in the NET group than in TOC and CON groups (2.3% vs. 14.8% and 31.9%; p = 0.018 and p < 0.001). NET group patients required intensive care unit admission (6.8% vs. 25.9% and 46.3%; p = 0.025 and p < 0.001) and mechanical ventilation (4.6% vs. 22.2% and 31.9%; p = 0.022 and p = 0.002) less frequently than patients of the TOC and CON groups. After 7-10 days of anti-cytokine drug administration, a reduction in lung lesion volume (p = 0.016) and an increase in the proportion of patients who did not need oxygen support (p = 0.005) or stayed in prone position (p = 0.044) was observed in the NET group only group; C-reactive protein levels were the same in the TOC and NET groups (p = 0.136) and lower in the CON group (p < 0.001 and p = 0.005). IL-6 levels decreased in the NET group (p = 0.005) and did not change in the TOC group (p = 0.953). There was no difference in the incidence of side effects between groups. The IL-17 antagonist netakimab is effective and safe in the treatment of cytokine release syndrome in COVID-19.


Assuntos
Anticorpos Monoclonais Humanizados/efeitos adversos , Anticorpos Monoclonais Humanizados/uso terapêutico , COVID-19/tratamento farmacológico , Interleucina-17/antagonistas & inibidores , Proteína C-Reativa/metabolismo , COVID-19/sangue , COVID-19/virologia , Estudos de Casos e Controles , Humanos , Interleucina-17/metabolismo , Interleucina-6/sangue , Pulmão/patologia , Pulmão/virologia , SARS-CoV-2/fisiologia , Resultado do Tratamento
10.
Int J Mol Sci ; 22(16)2021 Aug 11.
Artigo em Inglês | MEDLINE | ID: mdl-34445350

RESUMO

Following an intraventricular hemorrhage (IVH), red blood cell lysis and hemoglobin (Hb) oxidation with the release of heme can cause sterile neuroinflammation. In this study, we measured Hb derivates and cellular adhesion molecules ICAM-1 and VCAM-1 with cell-free miRNAs in cerebrospinal fluid (CSF) samples obtained from Grade-III and Grade-IV preterm IVH infants (IVH-III and IVH-IV, respectively) at multiple time points between days 0-60 after the onset of IVH. Furthermore, human choroid plexus epithelial cells (HCPEpiCs) were incubated with IVH and non-IVH CSF (10 v/v %) for 24 h in vitro to investigate the IVH-induced inflammatory response that was investigated via: (i) HMOX1, IL8, VCAM1, and ICAM1 mRNAs as well as miR-155, miR-223, and miR-181b levels by RT-qPCR; (ii) nuclear translocation of the NF-κB p65 subunit by fluorescence microscopy; and (iii) reactive oxygen species (ROS) measurement. We found a time-dependent alteration of heme, IL-8, and adhesion molecules which revealed a prolonged elevation in IVH-IV vs. IVH-III with higher miR-155 and miR-181b expression at days 41-60. Exposure of HCPEpiCs to IVH CSF samples induced HMOX1, IL8, and ICAM1 mRNA levels along with increased ROS production via the NF-κB pathway activation but without cell death, as confirmed by the cell viability assay. Additionally, the enhanced intracellular miR-155 level was accompanied by lower miR-223 and miR-181b expression in HCPEpiCs after CSF treatment. Overall, choroid plexus epithelial cells exhibit an abnormal cell phenotype after interaction with pro-inflammatory CSF of IVH origin which may contribute to the development of later clinical complications in preterm IVH.


Assuntos
Hemorragia Cerebral/patologia , Plexo Corióideo/metabolismo , Síndrome de Resposta Inflamatória Sistêmica/patologia , Proteína C-Reativa/líquido cefalorraquidiano , Proteína C-Reativa/metabolismo , Estudos de Casos e Controles , Hemorragia Cerebral/complicações , Hemorragia Cerebral/congênito , Hemorragia Cerebral/metabolismo , Plexo Corióideo/patologia , Estudos de Coortes , Citocinas/líquido cefalorraquidiano , Citocinas/metabolismo , Células Epiteliais/metabolismo , Células Epiteliais/patologia , Feminino , Heme/metabolismo , Hemoglobinas/metabolismo , Humanos , Hungria , Recém-Nascido , Recém-Nascido Prematuro , Molécula 1 de Adesão Intercelular/líquido cefalorraquidiano , Molécula 1 de Adesão Intercelular/metabolismo , Masculino , Síndrome de Resposta Inflamatória Sistêmica/congênito , Síndrome de Resposta Inflamatória Sistêmica/etiologia , Síndrome de Resposta Inflamatória Sistêmica/metabolismo , Molécula 1 de Adesão de Célula Vascular/líquido cefalorraquidiano , Molécula 1 de Adesão de Célula Vascular/metabolismo
11.
Saudi Med J ; 42(8): 825-831, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34344805

RESUMO

OBJECTIVES: To assess the utility of ferritin and inflammatory biomarkers in the diagnosis of stages of breast cancer. METHODS: The study consisted of 4 groups of 20 women, including the healthy control. The patients of group 1 comprised of stages I and II, group 2: stage III and group 3: stage IV of the disease. High sensitive C-reactive protein (hsCRP) and hepcidin were estimated by enzyme linked immunosorbent assay and ferritin by chemiluminescence immunoassay. The study was carried out in 2018 at Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry-6, India. RESULTS: The breast cancer disease progression correlated negatively with hemoglobin (Hb) (r= -0.6937, p<0.0001) and with ferritin levels, had a positive correlation (r=0.8444, p<0.0001). Ferritin negatively correlated with Hb among the subjects of the study (r= -0.6130, p<0.0001). Hepcidin correlated positively with hsCRP (r=0.998, p<0.0001). The ferritin/Hb ratio >3.9516 was used to identify the possibility of breast cancer utilizing the receiver operator curve values (area under curve [AUC]=0.997, sensitivity: 96.7, specificity:100). Ferritin values >103.4 were used to differentiate stage 4 from stage 3 of the disease (AUC: 0.893, sensitivity: 100, specificity: 85). CONCLUSION: Ferritin and ferritin/Hb are helpful in the differential diagnosis of stages of breast cancer.


Assuntos
Neoplasias da Mama , Ferritinas , Biomarcadores , Neoplasias da Mama/diagnóstico , Proteína C-Reativa/metabolismo , Feminino , Hemoglobinas/metabolismo , Humanos
12.
Epidemiol Infect ; 149: e180, 2021 08 10.
Artigo em Inglês | MEDLINE | ID: mdl-34375576

RESUMO

Several studies have demonstrated that higher levels of vitamin D are associated with better prognosis and outcomes in infectious diseases. We aimed to compare the vitamin D levels of paediatric patients with mild/moderate coronavirus disease 2019 (COVID-19) disease and a healthy control group. We retrospectively reviewed the medical records of patients who were hospitalised at our university hospital with the diagnosis of COVID-19 during the period between 25 May 2020 and 24 December 2020. The mean age of the COVID-19 patients was 10.7 ± 5.5 years (range 1-18 years); 43 (57.3%) COVID-19 patients were male. The mean serum vitamin D level was significantly lower in the COVID-19 group than the control group (21.5 ± 10.0 vs. 28.0 ± 11.0 IU, P < 0.001). The proportion of patients with vitamin D deficiency was significantly higher in the COVID-19 group than the control group (44% vs. 17.5%, P < 0.001). Patients with low vitamin D levels were older than the patients with normal vitamin D levels (11.6 ± 4.9 vs. 6.2 ± 1.8 years, P = 0.016). There was a significant male preponderance in the normal vitamin D group compared with the low vitamin D group (91.7% vs. 50.8%, P = 0.03). C-reactive protein level was higher in the low vitamin D group, although the difference did not reach statistical significance (9.6 ± 2.2 vs. 4.5 ± 1.6 mg/l, P = 0.074). Our study provides an insight into the relationship between vitamin D deficiency and COVID-19 for future studies. Empiric intervention with vitamin D can be justified by low serum vitamin D levels.


Assuntos
COVID-19/sangue , COVID-19/complicações , Deficiência de Vitamina D/complicações , Vitamina D/sangue , Adolescente , Fatores Etários , Proteína C-Reativa/análise , Proteína C-Reativa/metabolismo , COVID-19/epidemiologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Hospitais Universitários , Humanos , Lactente , Masculino , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Turquia/epidemiologia , Deficiência de Vitamina D/epidemiologia
13.
Bone Joint J ; 103-B(9): 1534-1540, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34223770

RESUMO

AIMS: Monocyte-lymphocyte ratio (MLR) or neutrophil-lymphocyte ratio (NLR) are useful for diagnosing periprosthetic joint infection (PJI), but their diagnostic values are unclear for screening fixation-related infection (FRI) in patients for whom conversion total hip arthroplasty (THA) is planned after failed internal fixation for femoral neck fracture. METHODS: We retrospectively included 340 patients who underwent conversion THA after internal fixation for femoral neck fracture from January 2008 to September 2020. Those patients constituted two groups: noninfected patients and patients diagnosed with FRI according to the 2013 International Consensus Meeting Criteria. Receiver operating characteristic (ROC) curves were used to determine maximum sensitivity and specificity of these two preoperative ratios. The diagnostic performance of the two ratios combined with preoperative CRP or ESR was also evaluated. RESULTS: The numbers of patients with and without FRI were 19 (5.6%) and 321 (94.4%), respectively. Areas under the ROC curve for diagnosing FRI were 0.763 for MLR, 0.686 for NLR, 0.905 for CRP, and 0.769 for ESR. Based on the Youden index, the optimal predictive cutoffs were 0.25 for MLR and 2.38 for NLR. Sensitivity and specificity were 78.9% and 71.0% for MLR, and 78.9% and 56.4% for NLR, respectively. The combination of CRP with MLR showed a sensitivity of 84.2% and specificity of 94.6%, while the corresponding values for the combination of CRP with NLR were 89.5% and 91.5%, respectively. CONCLUSION: The presence of preoperative FRI among patients undergoing conversion THA after internal fixation for femoral neck fracture should be determined. The combination of preoperative CRP with NLR is sensitive tool for screening FRI in those patients. Cite this article: Bone Joint J 2021;103-B(9):1534-1540.


Assuntos
Artroplastia de Quadril , Proteína C-Reativa/metabolismo , Fraturas do Colo Femoral/cirurgia , Infecções Relacionadas à Prótese/sangue , Sedimentação Sanguínea , Feminino , Fixação Interna de Fraturas/efeitos adversos , Humanos , Linfócitos , Masculino , Pessoa de Meia-Idade , Neutrófilos , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Falha de Tratamento
14.
PLoS One ; 16(7): e0255154, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34324560

RESUMO

BACKGROUND: COVID-19 has been reported in over 40million people globally with variable clinical outcomes. In this systematic review and meta-analysis, we assessed demographic, laboratory and clinical indicators as predictors for severe courses of COVID-19. METHODS: This systematic review was registered at PROSPERO under CRD42020177154. We systematically searched multiple databases (PubMed, Web of Science Core Collection, MedRvix and bioRvix) for publications from December 2019 to May 31st 2020. Random-effects meta-analyses were used to calculate pooled odds ratios and differences of medians between (1) patients admitted to ICU versus non-ICU patients and (2) patients who died versus those who survived. We adapted an existing Cochrane risk-of-bias assessment tool for outcome studies. RESULTS: Of 6,702 unique citations, we included 88 articles with 69,762 patients. There was concern for bias across all articles included. Age was strongly associated with mortality with a difference of medians (DoM) of 13.15 years (95% confidence interval (CI) 11.37 to 14.94) between those who died and those who survived. We found a clinically relevant difference between non-survivors and survivors for C-reactive protein (CRP; DoM 69.10 mg/L, CI 50.43 to 87.77), lactate dehydrogenase (LDH; DoM 189.49 U/L, CI 155.00 to 223.98), cardiac troponin I (cTnI; DoM 21.88 pg/mL, CI 9.78 to 33.99) and D-Dimer (DoM 1.29mg/L, CI 0.9 to 1.69). Furthermore, cerebrovascular disease was the co-morbidity most strongly associated with mortality (Odds Ratio 3.45, CI 2.42 to 4.91) and ICU admission (Odds Ratio 5.88, CI 2.35 to 14.73). DISCUSSION: This comprehensive meta-analysis found age, cerebrovascular disease, CRP, LDH and cTnI to be the most important risk-factors that predict severe COVID-19 outcomes and will inform clinical scores to support early decision-making.


Assuntos
COVID-19/patologia , Proteína C-Reativa/metabolismo , COVID-19/metabolismo , Transtornos Cerebrovasculares/metabolismo , Transtornos Cerebrovasculares/virologia , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Humanos , L-Lactato Desidrogenase/metabolismo , Troponina I/metabolismo
15.
Nutrients ; 13(6)2021 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-34203015

RESUMO

The interplay between inflammation and oxidative stress is a vicious circle, potentially resulting in organ damage. Essential micronutrients such as selenium (Se) and zinc (Zn) support anti-oxidative defense systems and are commonly depleted in severe disease. This single-center retrospective study investigated micronutrient levels under Se and Zn supplementation in critically ill patients with COVID-19 induced acute respiratory distress syndrome (ARDS) and explored potential relationships with immunological and clinical parameters. According to intensive care unit (ICU) standard operating procedures, patients received 1.0 mg of intravenous Se daily on top of artificial nutrition, which contained various amounts of Se and Zn. Micronutrients, inflammatory cytokines, lymphocyte subsets and clinical data were extracted from the patient data management system on admission and after 10 to 14 days of treatment. Forty-six patients were screened for eligibility and 22 patients were included in the study. Twenty-one patients (95%) suffered from severe ARDS and 14 patients (64%) survived to ICU discharge. On admission, the majority of patients had low Se status biomarkers and Zn levels, along with elevated inflammatory parameters. Se supplementation significantly elevated Se (p = 0.027) and selenoprotein P levels (SELENOP; p = 0.016) to normal range. Accordingly, glutathione peroxidase 3 (GPx3) activity increased over time (p = 0.021). Se biomarkers, most notably SELENOP, were inversely correlated with CRP (rs = -0.495), PCT (rs = -0.413), IL-6 (rs = -0.429), IL-1ß (rs = -0.440) and IL-10 (rs = -0.461). Positive associations were found for CD8+ T cells (rs = 0.636), NK cells (rs = 0.772), total IgG (rs = 0.493) and PaO2/FiO2 ratios (rs = 0.504). In addition, survivors tended to have higher Se levels after 10 to 14 days compared to non-survivors (p = 0.075). Sufficient Se and Zn levels may potentially be of clinical significance for an adequate immune response in critically ill patients with severe COVID-19 ARDS.


Assuntos
COVID-19/tratamento farmacológico , Estado Terminal/terapia , Deficiências Nutricionais/tratamento farmacológico , Suplementos Nutricionais , Micronutrientes/uso terapêutico , Selênio/uso terapêutico , Zinco/uso terapêutico , Idoso , Proteína C-Reativa/metabolismo , COVID-19/sangue , COVID-19/imunologia , Deficiências Nutricionais/complicações , Humanos , Sistema Imunitário/efeitos dos fármacos , Inflamação/sangue , Inflamação/tratamento farmacológico , Unidades de Terapia Intensiva , Interleucinas/sangue , Masculino , Micronutrientes/sangue , Micronutrientes/deficiência , Pessoa de Meia-Idade , Oxigênio/metabolismo , Síndrome do Desconforto Respiratório/tratamento farmacológico , Estudos Retrospectivos , SARS-CoV-2 , Selênio/sangue , Selênio/deficiência , Selenoproteína P/sangue , Índice de Gravidade de Doença , Zinco/sangue , Zinco/deficiência
16.
Molecules ; 26(11)2021 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-34199645

RESUMO

Interest has arisen on the anti-inflammatory action of dietary components, including long-chain n-3 fatty acids (LCn3) and polyphenols (PP). The aim of this study was to evaluate the effects of diets rich in PP and oily fish (high-LCn3 diets) on markers of subclinical inflammation and growth factors in people at high cardiometabolic risk. Individuals with high waist circumference and one more component of metabolic syndrome were randomized to one of the following isoenergetic diets: low LCn3&PP, high LCn3, high PP, high LCn3&PP. Before and after 8 weeks, fasting and postprandial plasma concentrations of hs-CRP and fasting serum concentrations of IL-1, IL-4, IL-6, IL-10, IL-17, INF-, TNF-, FGF, VEGF, PDGF-, G-CSF, and GM-CSF were determined. An oily fish diet reduced fasting plasma hs-CRP (1.28 ± 12.0, -12.5 ± 6.9, 22.5 ± 33.6, -12.2 ± 11.9; 8-week percent change, Mean ± SEM; low LCn3&PP, high LCn3, high PP, high LCn3&PP group, respectively), postprandial 6h-AUC hs-CRP (4.6 ± 16.3, -18.2 ± 7.2, 26.9 ± 35.1, -11.5 ± 11.8, 8-week percent change) and fasting IL-6 (20.8 ± 18.7, -2.44 ± 12.4, 28.1 ± 17.4, -9.6 ± 10.2), IL-17 (2.40 ± 4.9, -13.3 ± 4.9, 3.8 ± 4.43, -11.5 ± 4.7), and VEGF (-5.7 ± 5.8, -5.6 ± 7.5, 3.5 ± 5.8, -11.1 ± 5.5) (8-week percent change; p < 0.05 for LCn3 effect for all; no significant effect for PP; 2-factor ANOVA). An oily fish diet improved subclinical inflammation, while no significant effect was observed for dietary polyphenols.


Assuntos
Proteína C-Reativa/metabolismo , Doenças Cardiovasculares/prevenção & controle , Citocinas/sangue , Óleos de Peixe/administração & dosagem , Sobrepeso/imunologia , Adulto , Idoso , Doenças Cardiovasculares/sangue , Jejum/sangue , Ácidos Graxos Ômega-3/administração & dosagem , Ácidos Graxos Ômega-3/farmacologia , Feminino , Óleos de Peixe/farmacologia , Humanos , Masculino , Pessoa de Meia-Idade , Sobrepeso/sangue , Polifenóis/administração & dosagem , Polifenóis/farmacologia , Período Pós-Prandial
17.
J Comput Assist Tomogr ; 45(3): 442-446, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34297513

RESUMO

OBJECTIVE: This study aimed to evaluate the magnetic resonance imaging (MRI) changes of the symphysis pubis in patients with axial spondyloarthritis (ax-SpA) and to assess its association with clinical factors. METHODS: A retrospective analysis of 172 patients with ax-SpA was performed to assess the presence of active inflammatory and structural changes of the symphysis pubis on MRI scans, and their association with clinical factors and the SPARCC (Spondyloarthritis Research Consortium of Canada) scoring of the sacroiliac joint were evaluated. RESULTS: The proportions of active inflammation and structural changes of the symphysis pubis were 69/172 (40.1%) and 54/172 (31.4%), respectively. When comparing the active inflammation and no-active inflammation symphysis pubis groups, the former had higher level C-reactive protein, higher erythrocyte sedimentation rate, and younger median age of patients. Moreover, no significant correlation was noted between the active inflammation of the symphysis pubis and SPARCC score of the sacroiliac joint. When comparing the normal and abnormal symphysis pubis groups, the latter had longer symptom duration. CONCLUSIONS: The MRI changes of the symphysis pubis were seen in 55.2% of the patients with ax-SpA and were associated with C-reactive protein, erythrocyte sedimentation rate, and symptom duration.


Assuntos
Proteína C-Reativa/metabolismo , Sínfise Pubiana/diagnóstico por imagem , Espondilartrite/sangue , Espondilartrite/diagnóstico por imagem , Adolescente , Adulto , Idoso , Sedimentação Sanguínea , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Sínfise Pubiana/patologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Espondilartrite/patologia , Adulto Jovem
18.
Nutrients ; 13(7)2021 Jun 23.
Artigo em Inglês | MEDLINE | ID: mdl-34201458

RESUMO

The effect of preoperative immunonutrition intake on postoperative major complications in patients following cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC) was assessed. The accuracy of C-Reactive Protein (CRP) for detecting postoperative complications was also analyzed. Patients treated within a peritoneal carcinomatosis program in which a complete or optimal cytoreduction was achieved were retrospectively analyzed. They were divided into two groups based on whether preoperative immunonutrition (IMN) or not (non-IMN) were administered. Clinical and surgical variables and postoperative complications were gathered. Predictive values of major morbidity of CRP during the first 3 postoperative days (POD) were also evaluated. A total of 107 patients were included, 48 belonging to the IMN group and 59 to the non-IMN group. In multivariate analysis immunonutrition (OR 0.247; 95%CI 0.071-0.859; p = 0.028), and the number of visceral resections (OR 1.947; 95%CI 1.086-3.488; p = 0.025) emerged as independent factors associated with postoperative major morbidity. CRP values above 103 mg/L yielded a negative predictive value of 84%. Preoperative intake of immunonutrition was associated with a decrease of postoperative major morbidity and might be recommended to patients with peritoneal carcinomatosis following CRS. Measuring CRP levels during the 3 first postoperative days is useful to rule out major morbidity.


Assuntos
Procedimentos Cirúrgicos de Citorredução/efeitos adversos , Quimioterapia Intraperitoneal Hipertérmica/efeitos adversos , Fenômenos Fisiológicos da Nutrição , Neoplasias Peritoneais/imunologia , Neoplasias Peritoneais/secundário , Cuidados Pós-Operatórios , Cuidados Pré-Operatórios , Idoso , Área Sob a Curva , Proteína C-Reativa/metabolismo , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Morbidade , Neoplasias Peritoneais/sangue , Neoplasias Peritoneais/cirurgia , Complicações Pós-Operatórias/etiologia , Curva ROC
19.
Biomed Pharmacother ; 139: 111691, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34243613

RESUMO

Lifestyle modifications such as increase in high-fat food consumption importantly increases the risks for cardiovascular disease. The principal objective of this study is to analyze effects of different high fat diet (HFD) sources on haemodynamic parameters, lipid and oxidative profile, myeloperoxidase activity, and markers of inflammation (IL-6/pentraxin-3). HFD containing 20% of fat, provided by lard (saturated) or soybean oil (unsaturated), as well as control diet were administering to three groups (L, SO and C). Food efficiency ratio and plasma lipids were significantly elevated in both HFD groups. However, only SO group showed an increase in systolic arterial pressure, oxidative stress index, myeloperoxidase activity, liver lipids as well as markers of inflammation: IL-6 and pentraxin-3 (PTX3). In summary, these results indicate inflammogenic potential of excessive soybean oil consumption in triggering liver damage.


Assuntos
Ácidos Graxos Insaturados/administração & dosagem , Inflamação/induzido quimicamente , Inflamação/metabolismo , Estresse Oxidativo/fisiologia , Animais , Biomarcadores/metabolismo , Proteína C-Reativa/metabolismo , Dieta Hiperlipídica/efeitos adversos , Gorduras na Dieta/efeitos adversos , Interleucina-6/metabolismo , Fígado/metabolismo , Masculino , Peroxidase/metabolismo , Ratos , Ratos Wistar , Componente Amiloide P Sérico/metabolismo , Óleo de Soja/efeitos adversos
20.
Medicine (Baltimore) ; 100(27): e26596, 2021 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-34232210

RESUMO

ABSTRACT: The objectives of this study were to understand the clinical presentations of febrile young infants with severe bacterial infection (SBI), and to investigate the pathogen variations throughout the vaccine era and after antenatal group B Streptococcus (GBS) screening.All infants < 90 days old with a body temperature of ≥38.0°C and admitted to the emergency department were retrospectively enrolled in our study. SBI was defined as a positive culture of urine, blood, or cerebrospinal fluid. All clinical variables were analyzed and compared between the SBI group and the non-SBI group, to identify the relevant risk factors for SBI in infants with pyrexia.A total of 498 infants were studied, 279 of whom (56%) had SBI. The body temperature at triage was higher in the SBI group, and the difference was highly obvious in the neonatal group. White blood cell count and C-reactive protein levels were both significantly higher in the SBI group (P < .05), whereas neutrophil percentage and band percentage demonstrated no significant differences. Escherichia coli was the most common pathogen and plasmid-mediated extended-spectrum lactamases were detected in up to 9.1%. GBS was detected in 16 cases of bacteremia (6 cases with concurrent meningitis).The body temperature at triage may provide a clue for differentiating sick babies, especially in the neonatal group. Complete serum analysis is required for infection survey, especially white blood cell and C-reactive protein. Escherichia coli is the most common pathogen, and clinician should raise awareness of drug resistance in some patients. The prevalence of GBS infection in the young infant group remains high after routine antenatal GBS screening.


Assuntos
Bactérias/isolamento & purificação , Infecções Bacterianas/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Febre/etiologia , Infecções Bacterianas/complicações , Infecções Bacterianas/diagnóstico , Biomarcadores/sangue , Proteína C-Reativa/metabolismo , Feminino , Febre/sangue , Febre/epidemiologia , Seguimentos , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Taiwan/epidemiologia
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