ABSTRACT
A associação entre infecção por SARS-CoV-2 e estados inflamatórios e autoimunes é motivo de grande interesse no cenário clínico atual. O vírus apresenta definidas características pró-inflamatórias. Inerente à doença em si, o SARS-CoV-2 ativa macrófagos e induz síntese exacerbada de interleucina (IL)-6, IL-1, fator de necrose tumoral, quimiocinas e fator tecidual. A conhecida "tempestade de citocinas" se associa a um mau prognóstico pulmonar, dano multiorgânico e tendência trombótica. Em paralelo, a presença viral, por mimetismo molecular ou por inibição de células T reguladoras, parece exacerbar respostas linfocíticas e, eventualmente, deflagrar doenças autoimunes. A presente revisão aborda os mecanismos de resposta inata deflagrados pelo SARS-CoV-2 e as doenças autoimunes mais provavelmente associadas à exposição viral.
The association between SARS-CoV-2 infection and inflammatory and autoimmune states is of great interest in the current clinical scenario. The virus has definite pro-inflammatory characteristics. Inherent to the disease itself, SARS-CoV-2 activates macrophages and induces exacerbated synthesis of interleukin (IL)-6, IL-1, tumor necrosis factor, chemokines, and tissue factor. The well-known "cytokine storm" is associated with a poor lung prognosis, multi-organ damage, and thrombotic tendency. In parallel, the viral presence, by molecular mimicry or by inhibiting regulatory T cells, appears to exacerbate lymphocytic responses and eventually trigger autoimmune diseases. The present review addresses the innate response mechanisms triggered by SARS-CoV-2 and the autoimmune diseases most likely associated with viral exposure.
Subject(s)
COVID-19ABSTRACT
Objective To explore the effects of probiotics on intestinal function, nutritional status and inflammatory response in critically ill patients with enteral nutrition (EN) support. Methods A total of 90 critically ill patients admitted to Intensive Care Unit (ICU) of the First Affiliated Hospital of Anhui Medical University from July 2016 to November 2018 were enrolled, and they were divided into a probiotics combined with EN group (27 cases) and an simple EN group (63 cases) according to random number table method. The patients in the simple EN group were treated with conventional nutrient preparations such as fresubin or fresubin energy fibre; the patients in probiotics combined with EN group were supplemented with probiotics on the basis of conventional EN support for consecutive 7 days in both groups. The changes of gastrointestinal function, nutritional index and inflammatory response index after treatment were observed in both groups. Results After treatment, the subjective global assessment (SGA) method was used to identify the gradation of the patients, it was shown that the proportion of SGA-B grade patients in simple EN group had an upward trend; while the proportion of SGA-B grade patients in probiotics combined with EN group had no significant change; and there was no significant difference in the proportion of SGA-B patients between simple EN group and probiotics combined with EN group after treatment [20.6% (13/63) vs. 7.4% (2/27),P > 0.05]. Compared with those before treatment, the levels of hemoglobin (Hb), white blood cell count (WBC), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α) and interleukins (IL-6, IL-12) in both groups were significantly decreased, while the levels of albumin (Alb), pre-albumin (PA), total lymphocyte count (TLC) in both groups were increased after treatment, and the changes of Hb, TNF-α, IL-6 in probiotics combined with EN group were more significant than those in the simple EN group [Hb (g/L): 95.0 (78.0, 107.0) vs. 93.0 (80.0, 107.0), TNF-α (pg/L): 21.2±4.0 vs. 28.0±5.7, IL-6 (pg/L): 161.3±37.6 vs. 186.2±51.8];the differences in levels of Hb, CRP, TNF-α before and after treatment between the probiotics combined with EN group and simple EN group were statistically significant [Hb (g/L): 1.0 (-4.0, 12.0) vs. 11.0 (1.0, 20.0), CRP (mg/L): 44.3 (13.7, 57.7) vs. 7.5 (-20.1, 62.4), TNF-α (pg/L): 13.3±6.3 vs. 7.9±5.5, all P < 0.05]. There were no statistical significant differences in the other indicators between the two groups (all P > 0.05). Conclusion Probiotics can improve the gastrointestinal function and inflammatory status of critically ill patients with EN support, regretfully, in a short term, the improvement of nutritional status of such patients is not obvious, but probiotics has certain significance in preventing the risk of aggravation of malnutrition and reduction of Hb level.
ABSTRACT
The present review evaluates the role of sleep and its alteration in triggering problems of glucose metabolism and the possible involvement of adipokines in this process. A reduction in the amount of time spent sleeping has become an endemic condition in modern society, and a search of the current literature has found important associations between sleep loss and alterations of nutritional and metabolic contexts. Studies suggest that sleep loss is associated with problems in glucose metabolism and a higher risk for the development of insulin resistance and type 2 diabetes mellitus. The mechanism involved may be associated with the decreased efficacy of regulation of the hypothalamus-pituitary-adrenal axis by negative feedback mechanisms in sleep-deprivation conditions. In addition, changes in the circadian pattern of growth hormone (GH) secretion might also contribute to the alterations in glucose regulation observed during sleep loss. On the other hand, sleep deprivation stress affects adipokines - increasing tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) and decreasing leptin and adiponectin -, thus establishing a possible association between sleep-debt, adipokines and glucose metabolism. Thus, a modified release of adipokines resulting from sleep deprivation could lead to a chronic sub-inflammatory state that could play a central role in the development of insulin resistance and type 2 diabetes mellitus. Further studies are necessary to investigate the role of sleep loss in adipokine release and its relationship with glucose metabolism.