Diagnostic value of systemic immune inflammation index in acute appendicitis

SUMMARY OBJECTIVE: Clinical diagnosis of acute appendicitis is often difficult and involves a synthesis of clinical, laboratory, and radiological findings. The aim of this study was to investigate whether the systemic immune inflammation index can be used as an effective parameter in the diagnosis of acute appendicitis and its reliability in the differentiation of complicated vs. non-complicated appendicitis. METHODS: The study was conducted retrospectively with patients admitted to the emergency department with abdominal pain and diagnosed with acute appendicitis. In total, 150 patients and 150 control cases were included in the study. Demographic data, medical history, white blood cell count, platelet count, neutrophil count, systemic immune inflammation index values, Alvarado score, adult appendicitis score, and pathology result of appendectomy material were retrieved from the hospital automation system and recorded in the data form. RESULTS: Neutrophil-lymphocyte ratio and systemic immune inflammation index were significantly higher, and platelet-neutrophil ratio and lymphocyte-neutrophil ratio were significantly lower in the patient group compared to the control group (p<0.001). Receiver operating characteristic analysis revealed that the sensitivity and specificity of systemic immune inflammation index with a cutoff value of 840.13 was 82 and 66.7%, respectively, for the diagnosis of acute appendicitis. Correlation analysis revealed that systemic immune inflammation index, Alvarado score, and adult appendicitis score were positively correlated, and this correlation was statistically significant. CONCLUSION: Systemic immune inflammation index may be used to promote the diagnosis of acute appendicitis and may reduce the need for radiation exposure and diagnostic imaging tests such as contrast-enhanced abdominal computed tomography. It can also be used to differentiate between complicated and non-complicated acute appendicitis cases.

Efficacy of montelukast sodium combined with methylprednisolone in the treatment of allergic purpura in children and its effects on inflammatory factors and immune function / 中国基层医药

Objective:To investigate the efficacy of montelukast sodium combined with methylprednisolone in the treatment of pediatric allergic purpura and its effects on inflammatory factors and immune function.Methods:A total of 94 children with allergic purpura who received treatment in Taizhou Women and Children's Hospital and Taizhou Hospital Medical Center (Group) Enze Hospital from March 2019 to March 2021 were included in this study. They were randomly divided into observation and control groups ( n = 47/group). The control group was treated with methylprednisolone. The observation group was treated with montelukast sodium combined with methylprednisolone. The course of treatment was 2 weeks in both groups. Efficacy and changes in inflammatory factors and immune function post-treatment relative to those pre-treatment were compared between the two groups. Results:Total response rate in the observation group [93.62% (44/47)] was significantly higher than that in the control group [74.47% (35/47), Z = 2.15, P < 0.05)]. After treatment, interleukin (IL-4), IL-6, and IL-18 levels in each group were significantly decreased compared with those before treatment ( tobservation group = 21.19, 22.26, 27.20, tcontrol group = 11.10, 13.21, 14.86, all P < 0.05). After treatment, IL-4, IL-6, and IL-8 levels in the observation group were (48.98 ± 5.21) ng/L, (34.10 ± 6.42) ng/L, and (53.29 ± 5.67) ng/L, respectively, which were significantly lower than (65.38 ± 7.08) ng/L, (47.83 ± 4.71) ng/L, (67.83 ± 7.10) ng/L in the control group ( t = 12.79, 11.82, 10.97, all P < 0.05). After treatment, CD3 +, CD4 +, and CD4 +/CD8 + in each group were significantly increased compared with those before treatment ( tobservation group = 14.27, 14.41, 17.61, tcontrol group = 6.90, 5.12, 7.40, all P < 0.05). After treatment, CD3 +, CD4 +, and CD4 +/CD8 + in the observation group were (68.94 ± 2.89)%, (39.94 ± 2.15)%, and (1.79 ± 0.13), respectively, which were significantly higher than (63.86 ± 3.28)%, (35.65 ± 2.31)%, and (1.53 ± 0.16) in the control group ( t = 7.96, 9.32, 8.64, all P < 0.05). After treatment, serum IgG and IgM levels in each group were significantly decreased compared with those before treatment ( tobservation group = 21.00, 7.99, tcontrol group = 8.38, 5.76, both P < 0.05). After treatment, serum IgG and IgM levels in the observation group were (1.43 ± 0.19) g/L and (9.74 ± 0.78) g/L, respectively, which were significantly lower than (1.95 ± 0.37) g/L and (10.89 ± 0.85) g/L in the control group ( t = 8.57, 6.83, both P < 0.05). Conclusion:Montelukast sodium combined with methylprednisolone is highly effective on allergic purpura in children. The combined therapy can reduce inflammatory responses and improve immune function in children.

Effects of different blood purification methods on nutritional status and inflammatory response in elderly patients with chronic renal failure / 中国医师进修杂志

Objective:To investigate the effects of different blood purification methods on their nutritional status and inflammatory response in elderly patients with chronic renal failure.Methods:A total of 120 elderly patients with chronic renal failure who were treated in Lishui People′s Hospital from January 2020 to January 2022 were selected as the research objects, and they were divided into the control group and the observation group according to the random number table method, with 60 cases in each group. The patients in the control group were given hemodialysis alone, and the patients in the observation group were given hemofiltration dialysis treatment on the basis of the patients in the control group. The nutritional status-related indicators, inflammation-related indicators and renal function-related indicators before and after treatment were compared between the two groups.Results:After treatment, the levels of serum total protein (TP), albumin (ALB), hemoglobin (HGB) and creatinine clearance (Ccr) in the observation group were significantly higher than those in the control group: (65.61 ± 4.82) g/L vs. (61.26 ± 3.51) g/L, (36.54 ± 4.52) g/L vs. (31.53 ± 3.32) g/L, (97.58 ± 5.84) g/L vs. (93.06 ± 5.17) g/L, (41.88 ± 4.87) ml/min vs. (34.51 ± 4.36) ml/min, while the levels of interleukin-6 (IL-6), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), creatinine (Cr) and blood urea nitrogen (BUN) were significantly lower than those in control group: (120.09 ± 9.36) ng/L vs. (157.17 ± 14.27) ng/L, (7.15 ± 1.16) mg/L vs. (14.17 ± 2.74) mg/L, (22.14 ± 6.67) ng/L vs. (33.87 ± 7.28) ng/L, (327.16 ± 44.35) μmol/L vs. (378.59 ± 48.27), (10.15 ± 2.03) mmol/L vs. (15.83 ± 3.31) mmol/L, there were statistical differences ( P<0.05). Conclusions:For elderly patients with chronic renal failure, the use of hybrid blood purification can significantly reduce toxins in the body and improve the nutritional status and inflammation of patients, which is worthy of clinical promotion.

Naringenin attenuates cerebral ischemia/reperfusion injury by inhibiting oxidative stress and inflammatory response via the activation of SIRT1/FOXO1 signaling pathway in vitro

Purpose: To explore the protection of naringenin against oxygen-glucose deprivation/reperfusion (OGD/R)-induced HT22 cell injury, a cell model of cerebral ischemia/reperfusion (I/R) injury in vitro, focusing on SIRT1/FOXO1 signaling pathway. Methods: Cytotoxicity, apoptosis, reactive oxygen species (ROS) generation, malondialdehyde (MDA) content, 4-hydroxynonenoic acid (4-HNE) level, superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and catalase (CAT) activities were measured by commercial kits. Inflammatory cytokines levels were determined by enzyme-linked immunosorbent assay (ELISA). The protein expressions were monitored by Western blot analysis. Results: Naringenin significantly ameliorated OGD/Rinduced cytotoxicity and apoptosis in HT22 cells. Meanwhile, naringenin promoted SIRT1 and FOXO1 protein expressions in OGD/R-subjected HT22 cells. In addition, naringenin attenuated OGD/R-induced cytotoxicity, apoptosis, oxidative stress (the increased ROS, MDA and 4-HNE levels, and the decreased SOD, GSH-Px and CAT activities) and inflammatory response (the increased tumor necrosis factor-α, interleukin [IL]-1ß, and IL-6 levels and the decreased IL-10 level), which were blocked by the inhibition of the SIRT1/FOXO1 signaling pathway induced by SIRT1-siRNA transfection. Conclusion: Naringenin protected HT22 cells against OGD/R injury depending on its antioxidant and anti-inflammatory activities via promoting the SIRT1/FOXO1 signaling pathway.

Relación entre la enfermedad periodontal y complicaciones en el Embarazo / Relationship between periodontal disease and complications in pregnancy

Resumen La periodontitis es una enfermedad multifactorial caracterizada por una respuesta inflamatoria desarrollada por el huésped frente a los microorganismos de la biopelícula bacteriana. El proceso localizado en la cavidad oral puede influir en el huésped a nivel sistémico provocando resultados adversos en el embarazo como parto prematuro, hipertensión materna y bajo peso del niño al nacer. Objetivo: Analizar el estado actual del conocimiento sobre los mecanismos probables que vinculan la periodontitis con resultados adversos en el embarazo. Material y métodos: Se efectuó una revisión de la literatura y una búsqueda de artículos publicados durante el periodo comprendido entre los años 2016 y 2021 en las bases de datos MEDLINE, PUBMED, SciELO, LILACS, idioma inglés y/o español. Las búsquedas se realizaron utilizando los siguientes términos: Periodontitis, mediadores de inflamación, complicaciones del embarazo, parto prematuro. Resultados: Se analizaron un total de 24 publicaciones, incluidas revisiones de la literatura, revisiones sistemáticas, estudios de cohorte, estudios de casos y controles y estudio observacionales, que cumplieron con los criterios de inclusión. Conclusión: La periodontitis es un factor de riesgo evitable por lo que se recomienda intensificar las medidas de prevención y tratamiento, en embarazadas y en mujeres en edad fértil.

Abstract Periodontitis is a multifactorial disease characterized by an inflammatory response developed by the host against the microorganisms of the bacterial biofilm. The localized process in the oral cavity can influence the host systemically causing adverse pregnancy outcomes such as premature delivery, maternal hypertension, and low birth weight. Objective: To analyze the current state of knowledge about the probable mechanisms that link periodontitis with adverse pregnancy outcomes. Material and methods: A literature review and a search for articles published during the period between 2016 and 2021 was carried out in the MEDLINE, PUBMED, SciELO, LILACS, English and / or Spanish databases. Searches were conducted using the following terms: Periodontitis, inflammatory mediators, pregnancy complications, preterm delivery. Results: 24 publications were analyzed, including literature reviews, systematic reviews, cohort studies, case-control studies, and observational studies, which met the inclusion criteria. Conclusion: Periodontitis is an avoidable risk factor, therefore it is recommended to intensify prevention and treatment measures in pregnant women and women of childbearing age.

A novel predictor in patients with coronary chronic total occlusion: systemic immune-inflammation index: a single-center cross-sectional study

SUMMARY OBJECTIVE: Severe inflammation is reportedly associated with subsequent cardiovascular events, including in patients with coronary artery disease. This study aimed to examine the prognostic value of systemic immune-inflammation index and determine mortality and clinical outcomes in patients with chronic coronary total occlusion. METHODS: Our study evaluated 366 consecutive coronary total occlusion patients. The clinical end points were all-cause mortality and major adverse cardiovascular events, which include target vessel revascularization, myocardial infarction, and cerebrovascular events during 105 months follow-up. RESULTS: The study findings showed 59 (16.1%) all-cause death, 22 (6%) target vessel revascularization cases, 32 (8.7%) myocardial infarction cases, and 13 (3.6%) cerebrovascular events cases, with a median follow-up of 49 months (26-74). Multivariate logistic regression analysis showed that systemic immune-inflammation index was not associated with target vessel revascularization, myocardial infarction, and cerebrovascular events. Multivariate Cox regression analysis found systemic immune-inflammation index to be associated with all-cause death. Kaplan-Meier analysis showed a lower survival rate and myocardial infarction-free survival time in patients with higher systemic immune-inflammation index scores. CONCLUSION: Although systemic immune-inflammation index is a preferable tool for the detection of mortality, it failed to give adverse outcomes. Larger multicenter studies are thus warranted to investigate the effect of systemic immune-inflammation index on clinical outcomes.

Research progress in risk factors, severity evaluation, and clinical nursing of acute pancreatitis / 中国基层医药

Acute pancreatitis is a clinically common acute abdominal disease with complex etiology. Acute pancreatitis is reportedly related to the history of biliary tract disease, drinking, hyperlipidemia, age, body mass index, and other related risk factors. In terms of the severity of acute pancreatitis, there are different scoring indicators, laboratory testing indicators, and imaging evaluation indicators. The paper reviews the risk factors and severity evaluation of acute pancreatitis to standardize the treatment of patients, strengthen clinical nursing, and improve prognosis.

High-flux versus low-flux hemodialysis for end-stage renal disease in the older adults / 中国基层医药

Objective:To investigate the effects of high-flux versus low-flux hemodialysis on end-stage renal disease in older adults and evaluate its effects on myocardial injury indexes and micro-inflammatory response indexes. Methods:Seventy-two patients with ESRD who received treatment in Affiliated Hospital of Shaoxing University from January 2019 to January 2020 were included in this study. They were randomly assigned to receive either low-flux hemodialysis (control group, n = 36) or high-flux hemodialysis (observation group, n = 36). All patients received 6 months of treatment. Micro-inflammatory response indexes and renal function indexes pre- and post-treatment, and reverse reactions were observed in each group. Results:Serum interleukin-6, tumor necrosis factor α, and high-sensitivity C-reactive protein levels post-treatment in the observation group were (7.16 ± 1.32) ng/L, (2.10 ± 0.36) pg/L, (2.20 ± 1.06) mg/L respectively, which were significantly lower than those in the control group [(10.45 ± 1.42) ng/L, (5.22 ± 0.65) pg/L, (3.84 ± 1.57) mg/L, t = 10.19, 25.19, 5.19, all P < 0.001]. Serum parathyroid hormone, B-type natriuretic peptide, and cardiac troponin T levels post-treatment in the observation group were (520.36 ± 95.65) pmol/L, (0.45 ± 0.10) μg/L, (15.05 ± 6.37) ng/L, respectively, which were significantly lower than those in the control group [(830.25 ± 102.35) pmol/L, (0.85 ± 0.13) μg/L, (30.25 ± 6.59) ng/L, t = 13.27, 14.63, 9.95, all P < 0.001]. The total response rate was significantly higher in the observation group than in the control group [75.00% (27/36) vs. 47.22% (19/36), χ2 = 3.85, P < 0.05]. The overall incidence of adverse reactions was significantly lower in the observation group than in the control group [19.44% (7/36) vs. 41.67% (15/36), χ2 = 4.18, P < 0.05). Conclusion:High-flux hemodialysis can highly improve the control effect of micro-inflammatory responses and alleviate myocardial injury in older adult patients with end-stage renal disease. High-flux hemodialysis is more effective and safer than low-flux hemodialysis.

Desloratadine combined with Tongqiao Biyan capsule for the treatment of allergic rhinitis / 中国基层医药

Objective:To investigate the effects of desloratadine combined with Tongqiao Biyan capsule on allergic rhinitis. Methods:100 patients with allergic rhinitis who received treatment in The Affiliated Hospital of Medical College of Ningbo University from February 2018 to February 2020 were included in this study. They were randomly assigned to receive treatment with either desloratadine tablets (control group, n = 50) or desloratadine tablets combined with Tongqiao Biyan capsule (observation group, n = 50) for 21 days. Improvement in clinical symptoms and changes in inflammatory factors were observed in each group. Results:Scores of nasal itch, nasal obstruction, runny nose, and sneezing in the observation group were (1.42 ± 0.10) points, (1.20 ± 0.13) points, (1.25 ± 0.13) points, and (1.33 ± 0.14) points, respectively, which were significantly lower than those in the control group [(1.80 ± 0.12) points, (1.68 ± 0.15) points, (1.68 ± 0.11) points, (1.68 ± 0.13) points, t = 17.20, 17.10, 17.85, 12.95, all P < 0.001]. After treatment, interleukin -4, -6, -8 levels in the observation group were (16.12 ± 5.05) ng/L, (5.33 ± 2.10) ng/L, (37.16 ± 9.80) ng/L, respectively, which were significantly lower than those in the control group [(21.52 ± 5.58) ng/L, (8.12 ± 2.15) ng/L, (48.55 ± 9.65) ng/L, t = 5.07, 6.56, 5.86, all P < 0.05]. Interferon-γ level was significantly higher in the observation group than in the control group [(26.58 ± 2.58) ng/L vs. (23.68 ± 2.69) ng/L, t = 5.50, P < 0.001]. After treatment, the total score of the quality of life questionnaire was significantly higher in the observation group than in the control group [(61.58 ± 8.57) points vs. (40.98 ± 8.35) points, t = 12.17, P < 0.001]. There was no significant difference in total incidence of adverse reactions between observation and control groups [10.00% (5/50) vs. 14.00% (7/50), χ2 = 0.38, P > 0.05]. Conclusion:Desloratadine combined with Tongqiao Biyan capsule can better improve the symptoms of allergic rhinitis and better reduce inflammation without increasing adverse drug reactions compared with desloratadine alone.

Inflammatory markers predict stroke associated infection in patients with anterior circulation large vessel occlusive stroke treated with endovascular therapy / 国际脑血管病杂志

Objective:To investigate the predictive value of inflammatory markers for the risk of stroke-associated infection (SAI) in patients with anterior circulation large vessel occlusive stroke who received endovascular therapy.Methods:Patients with anterior circulation large vessel occlusive stroke received endovascular treatment in Nanjing First Hospital, Nanjing Medical University from 2016 to 2020 were retrospectively enrolled. The clinical data of SAI group and non-SAI group were compared. Multivariate logistic regression analysis was used to screen the independent influencing factors of SAI, and then the predictive nomogram was established according to these influencing factors to verify its clinical application efficiency. Results:A total of 409 patients were enrolled during the study. Their age was 71.3±11.7 years, and 250 were male (61.1%). The median baseline Naitonal Institutes of Health Stroke Scale (NIHSS) score was 16. One hundred and nineteen patients (29.1%) received intravenous thrombolysis, 376 (91.9%) were successfully recanalized after endovascular therapy, and 293 (71.6%) developed SAI. Univariate analysis showed that age, atrial fibrillation ratio, NIHSS score at admission, fasting blood glucose, triglyceride, high sensitivity C reactive protein (hs-CRP), leukocyte count, neutrophil count, neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) were significantly higher than those in the non-SAI group (all P<0.05). Multivariate logistic regression analysis showed that age, NIHSS score at admission, fasting blood glucose, hs-CRP, leukocyte count, neutrophil count and NLR were the independent influencing factors of SAI ( P<0.05). Receiver operating characteristics curve analysis showed that the predictive value of multiple inflammatory markers (hs-CRP, leukocyte count, neutrophil count and NLR) for SAI was significantly better than that of the single inflammatory marker ( P<0.01). The area under the curve was 0.782 (95% confidence interval 0.719-0.846), and the predictive sensitivity and specificity were 80.6% and 64.5% respectively. Decision curve analysis showed that compared with the traditional indicators, the predictive nomogram based on inflammation related indicators (hs-CRP, leukocyte count and NLR) had a higher net profitability for predicting SAI. Conclusion:The hs-CRP, leukocyte count and NLR can be used to predict the risks of SAI in patients with acute ischemic stroke receiving endovascular therapy.

Research progress of clinical application of Zhibitai capsule / 中国基层医药

Dyslipidemia is the pathological basis of the occurrence and development of atherosclerosis. It is a major independent risk factor for hypertension, coronary heart disease and cerebrovascular disease. Regulating blood lipid level plays an important role in decreasing the incidence of cardio-cerebrovascular disease. Zhibitai capsule, a lipid-regulating Chinese medicine, has the similar effect to statins. We searched animal experiment studies, clinical trials and reviews in China National Knowledge Infrastructure to analyze the application value and advantages of Zhibitai capsule.

The correlation analysis between plasma sclerostin levels and bone turnover markers and inflammation factors in hemodialysis patients / 中国医师进修杂志

Objective:To explore the correlation between plasma sclerostin (SOST) and bone turnover markers and inflammatory factors in hemodialysis patients.Methods:One hundred and eight patients admitted to Changsha Central Hospital Affiliated to Nanhua University from January 2018 to May 2019 were selected. The levels of plasma SOST at admission and at 3, 6 and 12 months of dialysis were determined by enzyme-linked immunosorbent assay. They were divided into low- SOSTgroup (56 cases) and high- SOSTgroup (52 cases) based on the mean value of SOST. The levels of serum bone turnover markers β-Ⅰ collagen carboxy-terminal peptide (β-CTX) and osteocalcin (OC), propeptide of type Ⅰ procollagen (PINP), full parathyroid hormone (iPTH), N-terminal osteocalcin (N-MID-OC), inflammatory factors interleukin-1β (IL-1β), interleukin-6 (IL-6), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α) were compared between the two groups, abdominal aortic calcification (ACC) score was performed, and Pearson linear correlation analysis was used to analyze the relationship between SOST level of hemodialysis patients and bone turnover markers, inflammatory factors and ACC scores.Results:The baseline levels of β-CTX, OC, PINP, iPTH, and N-MID-OC in the low- SOST group were higher than those in the high- SOST group: (976.03 ± 205.27) ng/L vs. (781.34 ± 150.45) ng/L, (175.31 ± 50.49) ng/L vs. (125.75 ± 40.17) ng/L, (321.45 ± 82.14) μg/L vs. (259.41 ± 75.36) μg/L, (345.26 ± 102.65) ng/L vs. (198.52 ± 45.71) ng/L, (19.96 ± 5.01) μg/L vs. (17.41 ± 4.23) μg/L, the differences were statistically significant ( P<0.05). The baseline levels of IL-1β, IL-6, CRP, TNF-α and ACC scores in the low- SOST group were higher than those in the high- SOST group: (19.31 ± 6.01) ng/L vs. (15.23 ± 4.75) ng/L, (76.85 ± 20.34) ng/L vs. (57.98 ± 15.02) ng/L, (8.15 ± 2.36) mg/L vs. (7.23 ± 1.79) mg/L, (178.37 ± 55.52) ng/L vs. (157.42 ± 10.15) ng/L, (5.96 ± 1.78) scores vs. (5.11 ± 1.15) scores, the differences were statistically significant ( P<0.05). After treated for 3, 6 and 12 months, the levels of β-CTX, OC, PINP, iPTH, N-MIC-OC in hemodialysis patients were increased, the level of SOST was decreased, the levels of IL-1β, IL-6, CRP, TNF-α increased and ACC scores were increased, the differences were statistically significant ( P<0.05). The Pearson linear correlation analysis showed that SOST level and bone turnover markers β-CTX ( r = -0.465, P<0.001), OC( r = -0.498, P<0.001), PINP( r = -0.511, P<0.001), iPTH ( r = -0.396, P = 0.012), N-MID -OC ( r = -0.323, P = 0.031) and inflammatory factors IL-1β( r = -0.305, P = 0.046), IL-6( r = -0.318, P = 0.041), CRP( r = -0.327, P = 0.034) and TNF-α( r = -0.378, P = 0.024) in hemodialysis patients were negatively correlated, and negatively correlated with abdominal aortic calcification scores ( r = -0.301, P = 0.048). Conclusions:Plasma SOST level in hemodialysis patients is lower, which is negatively correlated with bone turnover markers, inflammatory factors, and calcification scores. Low SOST level can induce vascular calcification by mediating bone metabolism disorders and aggravating the body′s inflammatory response, and increase the risk of hemodialysis vascular calcification.

Association of inflammatory markers and thromboinflammatory factors before and after thrombolytic intervention with functional outcomes in elderly patients with acute cerebral infarction / 中华老年医学杂志

Objective:To explore the association of inflammatory markers and thromboinflammatory factors before and after thrombolytic intervention with functional outcomes in elderly patients with acute cerebral infarction.Methods:392 patients with acute cerebral infarction admitted to our hospital were randomly selected as study subjects and divided into an observation group(196 cases)treated with arterial thrombolytic therapy and a control group(196 cases)treated with intravenous thrombolysis.Functional outcomes of patients were assessed 72 hours after thrombolysis using the activities of daily living(ADL)scale and, based on the results, patients were divided into a poor functional outcome group and a good functional outcome group.Inflammatory markers such as neutrophil-to-lymphocyte ratio(NLR)and platelet-to-lymphocyte ratio(PLR)and thromboinflammatory factors such as monocyte chemoattractant protein-1(MCP-1), tissue plasminogen activator(t-PA), soluble CD40 ligand(sCD40L)and P-selectin before and after thrombolysis were measured.The relationship of these inflammatory markers and thromboinflammatory factors before thrombolysis with functional outcomes 72 hours after thrombolysis was analyzed.Results:NLR and PLR levels in the two groups after thrombolysis were significantly lower than those before thrombolysis(all P<0.05); Their levels in the observation group were lower than those in the control group(all P<0.05). After thrombolysis, MCP-1 levels in both groups were significantly higher and t-PA, sCD40L, P-selectin levels were significantly lower than pre-thrombolysis levels(all P<0.05); After thrombolysis, the observation group had better results than the control group(all P<0.05). Correlation analysis showed that NLR, PLR, MCP-1 and t-PA were positively correlated with NIHSS score( r=0.336, 0.264, 0.483, 0.549, all P<0.05). NLR, PLR, MCP-1, t-PA and sCD40L levels were significantly lower and P-selectin levels were significantly higher in the good functional outcome group than in the poor functional outcome group both before and 72 hours after thrombolysis( t=13.850, 18.208, 23.636, 22.371, 59.868, 96.646, 378.112, 141.213, 131.160, 110.039, 10.716, 11.108, P<0.05 for all). Logistic regression analysis showed that abnormal levels of NLR, PLR, MCP-1 and t-PA before and after thrombolysis were risk factors for adverse outcomes with thrombolytic intervention( P<0.05). ROC curves showed that the levels of NLR, PLR, MCP-1, t-PA, sCD40L and P-selectin before thrombolysis had a certain predictive value for the risk of adverse functional outcomes with thrombolysis. Conclusions:The levels of these inflammatory markers and thromboinflammatory factors before and after thrombolytic intervention have varying degrees of correlation with functional outcomes in elderly patients with acute cerebral infarction.

Características del SARS-CoV-2, COVID-19 y su diagnóstico en el laboratorio / Characteristics of SARS-CoV-2, COVID-19, and laboratory diagnosis

La enfermedad COVID­19 es causada por el virus SARS-CoV-2, descrito por primera vez en diciembre del 2019 en Wuhan, China, y declarada en marzo del 2020 como una pandemia mundial. Actualmente existen diversos métodos diagnósticos para COVID-19, siendo el estándar de oro la detección del material genético mediante la reacción en cadena de la polimerasa (PCR), en su variante, la RT-PCR, que detecta el material genético de tipo ARN presente en el virus. Sin embargo, es necesario disponer de pruebas rápidas con alta sensibilidad y precisión para realizarlas a gran escala y brindar un diagnóstico oportuno. Adicionalmente, se debe disponer de otras herramientas que, si bien no van a establecer un diagnóstico, le van a permitir al profesional brindar un mejor manejo clínico y epidemiológico que ayuden a predecir el agravamiento del paciente y su posible ingreso a UCI, destacando entre estas los niveles de dímero D, linfocitos, ferritina, urea y creatinina, entre otras. En esta revisión se evalúa la utilidad y limitaciones de los diferentes métodos diagnósticos para COVID-19, al igual que las características, fisiopatología y respuesta inmune al SARS-CoV-2, así como algunos aspectos preanalíticos de importancia que ayudan a minimizar errores en el diagnóstico como consecuencia de procedimientos incorrectos en la toma, transporte y conservación de la muestra, y que permiten al profesional emitir resultados veraces y confiables. Lo anterior se realizó basado en artículos originales, revisiones y guías clínicas

COVID­19 is caused by the SARS-CoV-2 virus, first described in December 2019 in Wuhan, China, and declared a global pandemic in March 2020. Currently there are various diagnostic methods for COVID-19, the gold standard is the detection of genetic material through polymerase chain reaction (PCR) in its variant, RT-PCR, which detects RNA-type genetic material present in the virus. However, it is necessary to have rapid tests with high sensitivity and precision to be performed on a large scale and provide timely diagnosis. Furthermore, other tools must be available, and although they will not establish the diagnosis, will allow the professional to provide better clinical and epidemiological management that will help predict the worsening of the patient and possible admission to the ICU. Among these, levels of D-dimer, lymphocytes, ferritin, urea and creatinine. In this review, the usefulness and limitations of the different diagnostic methods for COVID-19 are evaluated, as well as the characteristics, pathophysiology and immune response to SARS-CoV-2, and some important preanalytical aspects that allow minimizing diagnostic errors as a consequence of incorrect procedures in the collection, transport and conservation of the sample, that allow the professional to yield accurate and reliable results. This article was completed based on original articles, reviews and clinical guidelines

Associação entre a periodontite apical e as doenças cardiovasculares: uma revisão da literatura / Association between apical periodontitis and cardiovascular diseases: a review of the literature

Objetivo: o presente estudo tem como objetivo revisar os dados disponíveis na literatura para verificar se a periodontite apical (PA) é um fator de risco para as doenças cardiovasculares (DCVs). Materiais e Métodos: foi realizada uma busca nas bases de dados do Pubmed e Google Acadêmico sobre a possível associação da PA com o desenvolvimento de problemas cardiovasculares. Após os critérios de seleção, foram incluídos 8 artigos científicos para serem detalhadamente abordados. Revisão de literatura: embora a PA seja um processo inflamatório local, sua patogênese pode influenciar no desenvolvimento de complicações sistêmicas. Partindo do princípio que uma resposta inflamatória localizada é capaz de acarretar à liberação e ativação de mediadores pró-inflamatórios sistêmicos, como as citocinas interleucinas e fatores de necrose tumoral, alguns autores sugerem uma possível associação entre a PA crônica e as DCVs, devido o potencial de surgimento de danos endoteliais e formação de ateromas. Discussão: embora ainda seja questionável a correlação existente entre lesões inflamatórias periapicais e doenças sistêmicas, devido principalmente ao descrédito em que o assunto era tratado no passado e na quantidade limitada de informações conclusivas disponíveis atualmente, os dados revisados neste trabalho propõem que existe uma associação positiva entre a PA e as DCVs, podendo-se verificar uma maior prevalência de PA em pacientes com problemas cardiovasculares. Conclusão: tem-se disponível cientificamente uma quantidade limitada de achados. Portanto, sugere-se a realização de mais pesquisas sobre o tema, objetivando a busca por evidências relevantes e bem fundamentadas sobre esta associação.

Aim: The present study aims to review the data available in the literature to verify whether apical periodontitis (AP) is a risk factor for cardiovascular diseases (CVDs). Materials and Methods: a search was carried out in the databases of Pubmed and Google Scholar about a possible association of AP with the development of cardiovascular problems. After the selection criteria, 8 scientific arti-cles were included to be analyzed in detail. Literature Review: although BP is a local inflammatory process, its pathogenesis can result in the development of systemic complications. Assuming that a localized inflammatory response is capable of causing the release and activation of systemic pro-inflammatory mediators, such as interleukin cytokines and tumor necrosis factors, some automatic effects are a possible association between a chronic AP and CVDs, due to the potential for the emergence of en-dothelial damage and atheroma. Discussion: although the correlation between periapical inflammatory lesions and systemic diseases is still questionable, mainly due to the discredit in which the subject was treated in the past and the limited amount of conclusive information currently available, the data reviewed in this paper propose that there is a positive association between AP and CVDs, with a higher prevalence of AP in patients with cardiovascular problems. Conclusion: a limited amount of findings are scientifically available. Therefore, it is suggested to carry out more research on the subject, aiming the search for relevant and well-grounded evidence on this association

A review of Covid-19 and acute kidney injury: from pathophysiology to clinical results / Uma revisão da Covid-19 e lesão renal aguda: da fisiopatologia aos resultados clínicos

Abstract Acute kidney injury (AKI) in hospitalized patients with COVID-19 is associated with higher mortality and a worse prognosis. Nevertheless, most patients with COVID-19 have mild symptoms, and about 5% can develop more severe symptoms and involve hypovolemia and multiple organ dysfunction syndrome. In a pathophysiological perspective, severe SARS-CoV-2 infection is characterized by numerous dependent pathways triggered by hypercytokinemia, especially IL-6 and TNF-alpha, leading to systemic inflammation, hypercoagulability, and multiple organ dysfunction. Systemic endotheliitis and direct viral tropism to proximal renal tubular cells and podocytes are important pathophysiological mechanisms leading to kidney injury in patients with more critical infection, with a clinical presentation ranging from proteinuria and/or glomerular hematuria to fulminant AKI requiring renal replacement therapies. Glomerulonephritis, rhabdomyolysis, and nephrotoxic drugs are also associated with kidney damage in patients with COVID-19. Thus, AKI and proteinuria are independent risk factors for mortality in patients with SARS-CoV-2 infection. We provide a comprehensive review of the literature emphasizing the impact of acute kidney involvement in the evolutive prognosis and mortality of patients with COVID-19.

Resumo A lesão renal aguda (LRA) em pacientes hospitalizados com COVID-19 está associada a maior mortalidade e um pior prognóstico. No entanto, a maioria dos pacientes com COVID-19 tem sintomas leves e cerca de 5% podem desenvolver sintomas mais graves e envolver hipovolemia e síndrome de disfunção de múltiplos órgãos. Em uma perspectiva fisiopatológica, a infecção grave por SARS-CoV-2 é caracterizada por numerosas vias dependentes desencadeadas por hipercitocinemia, especialmente IL-6 e TNF-alfa, levando à inflamação sistêmica, hipercoagulabilidade e disfunção de múltiplos órgãos. A endotelite sistêmica e o tropismo viral direto às células tubulares proximais renais e podócitos são mecanismos fisiopatológicos importantes que levam à lesão renal em pacientes com infecção mais crítica, com uma apresentação clínica que varia de proteinúria e/ou hematúria glomerular a LRA fulminante, exigindo terapias renais substitutivas. Glomerulonefrite, rabdomiólise e drogas nefrotóxicas também estão associadas a danos renais em pacientes com COVID-19. Assim, a LRA e a proteinúria são fatores de risco independentes para mortalidade em pacientes com infecção por SARS-CoV-2. Fornecemos uma revisão abrangente da literatura, enfatizando o impacto do envolvimento renal agudo no prognóstico evolutivo e na mortalidade de pacientes com COVID-19.

Estudo prospectivo da reposta inflamatória em pacientes submetidas à abdominoplastia pós-cirurgia bariátrica / Prospective study of inflammatory response in patients submitted to abdominoplasty after bariatric surgery

Introdução: A obesidade é uma doença inflamatória crônica associada a alterações de marcadores inflamatórios como as interleucinas e PCR. O objetivo deste estudo é avaliar a resposta inflamatória, através das variações das interleucinas e PCR, em pacientes submetidas à abdominoplastia. Métodos: Quatorze pacientes foram submetidas à abdominoplastia após perda ponderal alcançada por meio da cirurgia bariátrica com manutenção da perda ponderal por, ao menos, 18 meses. Os níveis de IL4, IL6, IL10 e PCR foram verificados nos tempos: pré-operatório, durante a cirurgia, 24 horas após a cirurgia, 7o dia pós-operatório e 14o dia pós-operatório. Resultados: IL4 aumentou nas 24 horas de pós-operatório e seguiu em ascensão até o 14 o dia. IL10 subiu durante a cirurgia e começou a cair nas 24 horas de pós-operatório a níveis inferiores aos iniciais. IL6 começou a subir durante a cirurgia, mais expressivamente nas 24 horas de pós-operatório, seguida de queda até o 14o dia. A PCR aumentou nas 24 horas de pós-operatório e continuou alta até o 14o dia. Conclusão: A abdominoplastia promoveu uma amenização do quadro inflamatório sistêmico crônico.

Introduction: Obesity is a chronic inflammatory disease associated with changes in inflammatory markers such as interleukins and CRP. This study evaluates the inflammatory response, through variations in interleukins and CRP, in patients undergoing abdominoplasty. Methods: Fourteen patients underwent abdominoplasty after weight loss achieved through bariatric surgery to maintain weight loss for at least18 months. Il4, IL6, IL10 and PCR levels were verified at times: preoperative, during surgery, 24 hours after surgery, 7th postoperative day and 14th postoperative day. Results: IL4 increased in the 24 hours postoperatively and continued on the rise until the 14th day. IL10 went up during surgery and began to fall in the 24 hours postoperatively to levels lower than the initial ones. IL6 began to rise during surgery, being more expressive in the 24 hours postoperatively, followed by a fall until the 14th day. CRP increased 24 hours postoperatively and remained discharged until the 14th day. Conclusion: Abdominoplasty reduced the chronic inflammatory systemic condition.

Asociación entre la proteína C reactiva y el síndrome metabólico en la población peruana del estudio PERU MIGRANT / Association Between C-Reactive Protein And Metabolic Syndrome In The Peruvian Population Of The PERU MIGRANT Study

Introduction: Metabolic syndrome (MetS) is a group of cardiovascular risk factors characterized by the presence of low-grade chronic inflammation. Among all the inflammatory biomarkers associated with MetS, the best characterized and well standardized is C-Reactive protein (CRP). Objectives: To evaluate the association between C-Reactive protein and metabolic syndrome in the Peruvian population of the PERU MIGRANT study. Methods: Secondary database analysis of the PERU MIGRANT study. MetS was considered according to the Harmonizing the Metabolic Syndrome criteria. For CRP, a cutoff point of ≥ 3 mg/L was established. Results: We worked with a total of 958 subjects. The prevalence of MetS was 24.53%. In the simple regression analysis, it was found that people with high CRP levels had a 75% higher frequency of having MetS, compared to those who did not present high CRP levels (PR = 2.21, 95% CI: 1.40 - 2.18). In multiple regression, it was observed that patients with high CRP levels had a 31% greater frequency of having MetS, compared to those with normal CRP levels; adjusting for the rest of the covariates (PR = 1.31, 95% CI: 1.05 - 1.62). Conclusions: Plasma CRP was positively associated with MetS. This suggests that a low-grade inflammatory process may be related to the presence of MetS. Against this, physicians should pay attention to glucose, lipid profile, and central obesity in patients with elevated plasma CRP levels.

Introducción: El síndrome metabólico (MetS) es un grupo de factores de riesgo cardiovascular que se caracteriza por la presencia de inflamación crónica de bajo grado. Entre todos los biomarcadores inflamatorios asociados al MetS, el mejor caracterizado y bien estandarizado es la proteína C-Reactiva (PCR). Objetivo: Evaluar la asociación entre la proteína C-Reactiva y el síndrome metabólico en la población peruana del estudio PERU MIGRANT. Métodos: Estudio transversal analítico. Análisis de base de datos secundario del estudio PERU MIGRANT. Se consideró MetS según los criterios de Harmonizing the Metabolic Syndrome. Para la PCR, se dispuso un punto de corte ≥ 3 mg/L. Se usó modelos lineales generalizados de familia de Poisson para hallar la razón de prevalencias cruda y ajustada. Resultados: Se trabajó con un total de 958 sujetos. La prevalencia de MetS fue de 24,53%. En el análisis de regresión simple, se encontró que las personas con niveles altos de PCR tenían 75% mayor frecuencia de tener MetS, en comparación a quienes no presentaban niveles altos de PCR (RP=2,21, IC95%: 1,40 ­ 2,18). En la regresión múltiple, se observó que los pacientes con niveles altos de PCR tenían 31% mayor frecuencia de tener MetS, respecto a quienes presentaban niveles normales de PCR; ajustando por el resto de covariables (RP=1,31, IC95%: 1,05 ­ 1,62). Conclusiones: La PCR plasmática se asoció positivamente con MetS. Ello sugiere que un proceso inflamatorio de bajo grado puede estar relacionado con la presencia de MetS.

Cardiovascular damage due to COVID-19: what do we need to know?

SUMMARY Severe Acute Respiratory Syndrome Coronavirus 2 is part of the Cononaviridae family and is the causative agent of the 2019 (Covid-19) Coronavirus pandemic declared by the World Health Organization in March, 2020. This virus has a high rate of transmission, affecting several individuals, and has caused thousands of deaths. The clinical manifestations of Severe Acute Respiratory Syndrome Coronavirus 2 infection are not restricted only to the respiratory tract, and there is an express involvement of the cardiovascular system with a higher risk of death in this group. In such patients there is an overactivation of renin-angiotensin-aldosterone system, which promotes an increase in the expression of angiotensin-converting enzyme - 2 that acts as a receptor for the SPIKE protein expressed by the virus and enables the interaction between the host cell and Severe Acute Respiratory Syndrome Coronavirus 2. This process of infection causes a hyperinflammatory state that increases the inflammatory markers of cardiac injury. Hence, an adequate understanding and clinical guidance regarding the monitoring, and controlling the damage in these patients is essential to avoid worsening of their clinical condition and to prevent death.