The behavior and diagnostic utility of procalcitonin and five other inflammatory molecules in critically ill patients with respiratory distress and suspected 2009 influenza a H1N1 infection

OBJECTIVES: During the 2009 influenza A H1N1 pandemic, it became difficult to differentiate viral infections from other conditions in patients admitted to the intensive care unit. We sought to evaluate the behavior and diagnostic utility of procalcitonin, C-reactive protein and four other molecules in patients with suspected 2009 Influenza A H1N1 infection. METHODS: The serum levels of procalcitonin, C-reactive protein, tumor necrosis factor α, interferon γ, interleukin 1β, and interleukin 10 were tested on admission and on days 3, 5, and 7 in 35 patients with suspected 2009 H1N1 infection who were admitted to two ICUs. RESULTS: Twelve patients had confirmed 2009 influenza A H1N1 infections, 6 had seasonal influenza infections, and 17 patients had negative swabs. The procalcitonin levels at inclusion and on day 3, and the C-reactive protein levels on day 3 were higher among subjects with 2009 influenza A H1N1 infections. The baseline levels of interleukin 1b were higher among the 2009 influenza A H1N1 patients compared with the other groups. The C-reactive protein levels on days 3, 5, and 7 and procalcitonin on days 5 and 7 were greater in non-surviving patients. CONCLUSION: Higher levels of procalcitonin, C-reactive protein and interleukin-1β might occur in critically ill patients who had a 2009 H1N1 infection. Neither procalcitonin nor CRP were useful in discriminating severe 2009 H1N1 pneumonia. Higher levels of CRP and procalcitonin appeared to identify patients with worse outcomes.

O papel das quimiocinas na neuroinflamação / The role of chemokines in neuroinflammation

Inflamação é parte do processo fisiológico que visa reparar o dano tecidual causado por infecção, trauma, isquemia, autoimunidade. Entretanto, quando o processo inflamatório não é controlado, pode contribuir para o aumento da lesão tecidual. A regulação da resposta inflamatória no sistema nervoso central (SNC) envolve diferentes tipos celulares, como neutrófilos, macrófagos e linfócitos, células da glia, moléculas de adesão, citocinas e quimiocinas. As quimiocinas são uma família de citocinas de baixo peso molecular responsáveis pelo recrutamento seletivo de leucócitos, e subdividem-se em quatro subfamílias de acordo com a posição do resíduo cisteína N-terminal dessas moléculas: C, CC, CXC, CX3C. O objetivo desta revisão é apresentar o papel das quimiocinas na regulação da inflamação em doenças do SNC.

Inflammation is part of the physiological process that aims at repairing the tissue damage produced by infection, trauma, ischemia, autoimmune diseases. However, when this process is not controlled, it can increase the tissue lesion. The regulation of the inflammatory response in the central nervous system (CNS) involves different cell types such as neutrophils, macrophages, lymphocytes, glia cells, adhesion molecules, cytokines and chemokines. Chemokines are a large family of low-molecular weight cytokines associated with the selective trafficking of leukocytes, and are classified into four subfamilies on the basis of the arrangement of cysteine residues located in the N-terminal region of these molecules: C, CC, CXC and CX3C. This review will attempt to describe the role of chemokines in the regulation of inflammation in CNS diseases.

Neuropsiquiatria dos núcleos da base: uma revisão / Neuropsychiatry of the basal ganglia: a review

Os núcleos da base são classicamente associados a funções motoras, sendo referidos como sistema extrapiramidal. Nos últimos anos, pesquisas sugerem que eles participam de outras dimensões do comportamento humano, tendo sido descritos cinco circuitos paralelos envolvendo os núcleos da base e do córtex frontal. Cada um deles controla distintos tipos de comportamentos, abrangendo desde movimentos a ações cognitivas e emocionais. Esses circuitos frontoestriatais facilitam comportamentos determinados pelo córtex cerebral, inibindo comportamentos conflitantes. Os substratos neurobiológicos de uma série de transtornos neuropsiquiátricos, incluindo transtornos do espectro obsessivo-compulsivo, esquizofrenia, depressão e dependência de drogas, implicam o envolvimento desses circuitos frontoestriatais. A coréia de Sydenham é apresentada como modelo auto-imune de comprometimento de diferentes circuitos frontoestriatais