Effects of femtosecond laser assistcataract extraction on the levels of inflammatory factors in aqueous humor, corneal perception and high order aberration / 中国医师进修杂志

Objective:To investigate the effects of femtosecond laser assistcataract extraction on the levels of inflammatory factors in aqueous humor, corneal perception and high order aberration.Methods:Forty-eight patients (56 eyes) undergoing cataract surgery in the Shouguang People′s Hospital from June 2018 to February 2020 were enrolled in this study, and they were divided into observation group (24 patients and 27 eyes, femtosecond laser cataract phacoemulsification) and control group (24 patients and 29 eyes, coaxial microincision phacoemulsification) by random number table method. The levels of prostglndin E2 (PGE2), interleukin (IL)-6 and IL-1β in aqueous humor were detected before and after operation. Upper corneal and central corneal perception thresholds were recorded before surgery, 7 d after surgery, 1 month after surgery and 3 months after surgery. High order aberrations of the whole eye and cornea at 4mm pupil diameter before and after operation were recorded.Results:After operation, the levels of PGE2, IL-6 and IL-1β in aqueous humor in the observation group were lower than those in the control group: (45.62 ± 5.71) ng/L vs. (63.65 ± 5.62) ng/L, (15.25 ± 3.21) ng/L vs. (24.59 ± 6.13) ng/L, (17.16 ± 1.28) ng/L vs. (25.74 ± 4.62) ng/L, the differences were statistically significant ( P<0.05). The upper and central corneal perception threshold of observation group after operation for 7 d were higher than those in the control group: 4.55 ± 0.50 vs. 4.20 ± 0.33, 5.68 ± 0.49 vs. 5.52 ± 0.45, the differences were statistically significant ( P<0.05). The indexes of high order aberration of the whole eye decreased in the two groups ( P<0.05), while the indexes of cornea did not change significantly. The indexes of high order aberration of the whole eye and cornea between before and after surgery between the two groups had no significant differences ( P>0.05). Conclusions:Femtosecond laser assist cataractextraction can relieve inflammation, reduce the whole eye high order aberration, but not affect the cornea, and can improve corneal perception.

Interleukin-17 plays a role in dental pulp inflammation mediated by zoledronic acid: a mechanism unrelated to the Th17 immune response?

Abstract Objective To evaluate the influence of RORγT inhibition by digoxin on inflammatory changes related to interleukin-17 (IL-17) in the pulp of rats treated with zoledronate (ZOL). Methodology Forty male Wistar rats were divided into a negative control group (NCG) treated with saline solution, a positive control group (PCG) treated with ZOL (0.20 mg/kg), and three groups treated with ZOL and co-treated with digoxin 1, 2, or 4 mg/kg (DG1, 2, and 4). After four intravenous administrations of ZOL or saline solution in a 70-day protocol, the right molars were evaluated by histomorphometry (number of blood vessels, blood vessels/µm2, cells/µm2, total blood vessel area, and average blood vessel area) and immunohistochemistry (IL-17, TNF-α, IL-6, and TGF-β). The Kruskal-Wallis/Dunn test was used for statistical analysis. Results PCG showed an increase in total blood vessel area (p=0.008) and average blood vessel area (p=0.014), and digoxin treatment reversed these changes. DG4 showed a reduction in blood vessels/µm2 (p<0.001). In PCG odontoblasts, there was an increase in IL-17 (p=0.002) and TNF-α (p=0.002) immunostaining, and in DG4, these changes were reversed. Odontoblasts in the digoxin-treated groups also showed an increase in IL-6 immunostaining (p<0.001) and a reduction in TGF-β immunostaining (p=0.002), and all ZOL-treated groups showed an increase in IL-17 (p=0.011) and TNF-α (p=0.017) in non-odontoblasts cells. Conclusion ZOL induces TNF-α- and IL-17-dependent vasodilation and ectasia, and the classical Th17 response activation pathway does not seem to participate in this process.

Feature Deconstruction Strategy Based Identification of Acute Features Associated With Impairment of Activities of Daily Living in Patients With Traumatic Brain Injury / 中山大学学报(医学科学版)

ObjectiveTo identify acute phase features associated with the prognosis of traumatic brain injury （TBI）. MethodsThrough two traditional strategies， correlation analysis and prediction model， and one innovative research strategy based on feature deconstruction， a retrospective analysis was conducted using demographic， acute phase and chronic phase features of 354 TBI patients to identify acute phase features associated with activities of daily living （ADL） in chronic phase of TBI. For feature deconstruction strategy， the LASSO （Least Absolute Shrinkage and Selection Operator） algorithm was used to build a prediction model that could effectively predict ADL based on non-ADL chronic phase features. The model could indicate the key chronic phase dimensions determining the ADL in TBI patients. We then identified demographic and acute phase variables that were significantly associated with these key chronic phase features. ResultsThe feature deconstruction strategy revealed that ADL could be deconstructed into chronic phase dimensions such as weak limbs in TBI population. Importantly， to the best of our knowledge， this strategy revealed for the first time the association of these important acute phase features with specific chronic phase impairment features. For example， TBI patients had a higher risk for chronic phase recent memory impairment if they had a prolonged coma time and low GCS scores at acute phase ［scaled coma time OR95%CI = 94.288 （35.095， 273.231）； scaled GCS OR95%CI = 0.068 （0.030， 0.147）］； the patients had a higher risk for insight impairment and disorientation at chronic phase if they had hydrocephalus at acute phase ［insight impairment OR95%CI = 6.760 （3.653，12.855） ； disorientation OR95%CI = 6.538 （3.530， 12.490）］. All strategies showed that the strongest risk factors for ADL damage in the chronic phase included prolonged coma time and low GCS scores as well as hydrocephalus. ConclusionThis study provides an innovative research strategy to establish the association between acute injury features and chronic recovery features， and to identify demographic and acute phase features associated with the prognosis of TBI.

Effects of acute-phase monotherapy and combination therapy on quality of life in patients with depressive disorders / 四川精神卫生

BackgroundThe treatment of patients with depressive disorders is short of targeted outcome assessment. As a secondary outcome that is guided by patient values， quality of life is thus of relatively high evaluative value. In China， there exists a lack of large sample prospective cohort studies evaluating the effect of different treatment protocols on quality of life in patients with acute depressive disorder. ObjectiveTo explore the effects of monotherapy and combination therapy on the quality of life of patients with depressive disorder in acute phase， so as to provide references for optimizing the outcome of treatment for such patients. MethodsA prospective follow-up cohort study from August 24， 2020 to November 29， 2021 was conducted， including 1 330 patients from 22 hospitals across 18 cities in China. All these patients met the diagnostic criteria for depressive episodes， recurrent depressive disorder from the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5）. Patients were divided into monotherapy group （n=969） and combination therapy group （n=361） according to the acute phase treatment protocol. At baseline， the end of the first half month as well as the 1st， 2nd， 3rd， 6th， 9th and 12th months of treatment， patients were assessed with Inventory of Depressive Symptomatology Self-report （IDS-SR30）， Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form （Q-LES-Q-SF）， Concise Health Risk Tracking Scale （CHRT） and Siehan Disability Scale （SDS）. Frequency， Intensity， and Burden of Side Effects Rating （FIBSER） was adopted for assessment at each visit time point of treatment. Spearman correlation analysis was adopted to examine the correlation of quality of life with suicide risk， adverse reactions and impaired social functioning among patients. ResultsAt the end of three months of treatment， the Q-LES-Q-SF score of monotherapy group was higher than that of combination therapy group， and the difference was statistically significant （Z=2.008， P<0.05）. The time effects of both treatment protocols possessed statistical significance （F=111.393， P<0.01）. At the end of three months of treatment， the Q-LES-Q-SF score was negatively correlated with CHRT and SDS scores， respectively， in both monotherapy group and combination treatment group （r=-0.660， -0.712， -0.634， -0.718， P<0.01）. ConclusionBoth monotherapy and combination therapy can facilitate the improvement of the life quality of patients with acute depressive disorder， but monotherapy may achieve better than the combination therapy in this aspect. ［Funded by The National Key Research and Development Program of China "Research on the Prevention and Control of Major Chronic Non-communicable Diseases" （number， 2017YFC1311101）］

Correlation between C-reactive Protein (CRP) Level and Clinicoradiological Profile in COVID-19 Patients Admitted in a Tertiary Care Hospital in Eastern India

Background : Coronavirus disease 2019, first reported in December 2019 mainly presented with the symptoms of Cough, Fever, Shortness of breath, Myalgia, Weakness and anosmia. C-reactive Protein (CRP) is an acute-phase reactant protein which is synthesized by the liver in response to raised levels of interleukin-6 (IL-6) which is a biomarker of inflammation. Methods : This was a prospective observational study, done on 110 COVID-19 patients after applying inclusion and exclusion criteria. Detailed history, vaccination status, presence of comorbidities and thorough clinical examination was performed. Serum CRP levels was assessed and Computed Tomographic scan (CT scan) of Thorax was done. CORADS scoring and CT severity grading as per CT scan was done. All the above parameters were recorded in the preformed proforma and data was entered in excel spreadsheet and was analysed using SPSS v26 software. Results : Majority were males (56.3%) and majority were from 61-80 years of age. Majority (57.3%) patients were non-smokers. Hypertension was the most common associated comorbidity (86.4%)(r=0.743, p=0.000). There is a strong positive correlation between CRP levels and CTSS in COVID 19 patients and a strong negative correlation between the CRP levels and outcome of COVID-19 patients (r= -0.449, p=0.000). Conclusion : Elevated serum CRP value is associated with disease progression and poorer outcome.

A rare case of acute thyroid eye disease in a young male

Thyroid Eye Disease also known as Thyroid Associated Orbitopathy, Grave’s Disease is typically a self-limiting autoimmune process associated with dysthyroid states usually manifesting in middle age. The clinical presentation may vary from very mild disease to severe irreversible sight threatening complications. Primary risk factors for TED are environmental influences especially smoking, previous pathogen exposures, stress, previous use of radio iodine and complex genetic components. Here we report a case of 25-year-old male who presented to our OPD with complaints of swelling of eyes, photophobia, lacrimation since 3days. Bilateral mild proptosis, severe congestion and conjunctival injection with 20/20 vision in both eyes were noted on examination. Blood investigations showed Eu-clinical Thyroid state whereas MRI Brain and Orbits showed all four Recti muscle belly enlargement. This case emphasizes one of the rare presentations of TED in accordance to Age, Sex and Clinical status of the thyroid.

Acute Phase Response and its Effect on Short Term Outcome of Bangladeshi patients after On-Pump Cardiac Surgery

Background: Throughout any surgical procedure, the immune system is generally activated as a physiological response to the surgical trauma. Cardiopulmonary bypass can trigger the inflammatory response in three ways: direct contact activation of the immune system due to exposer of blood to foreign surfaces, ischaemia-reperfusion injury to vital organs as a result of aortic cross clamping, and splanchnic hypoperfusion. Objective: The aim of the study was to observe the acute phase response variables in Bangladeshi patients and to assess the acute phase response and morbidity of the patients after prolonged bypass surgery.Methods:This cross sectional study was conducted in the Department of Cardiac Surgery, BSMMU from January 2009 to December 2010. Fifty patients were selected for the study and were divided into 2 groups on the basis of cardiopulmonary bypass time. Group I was cardiopulmonary bypass time less than 90 minutes and Group II was more than 90 minutes. Data were stored and analyzed with standard computer software (SPSS-15). P < 0.05 was considered statistically significant.Results:The mean duration of cardiopulmonary bypass (CPB) time (55.76�.8 in group I, 131�.35 in group II; P<0.001) and Aortic cross clamp time (28.48�31 in group I, 83.48�.99 in group II; P<0.001) was higher in group II than group I. Analysis of outcome variables showed that mean postoperative ventilation time was 6.24�20 in group I and 9.16�33 in group II. There was significant difference in the ventilation time between two groups (P<0.001). This study showed that there is a definite relationship of wound infection with the prolonged cardiopulmonary bypass time (P<0.001) and also persistently rising CRP increases the chance of wound infection.Conclusions:We may conclude that prolonged cardiopulmonary bypass time is associated with increased acute phase response and morbidity of Bangladeshi patients.

Analysis of therapeutic effects on endovascular recanalization of symptomatic non-acute middle cerebral artery occlusion / 中国综合临床

Objective:To investigate the preoperative evaluation, safety and clinical efficacy of intravascular recanalization for patients with symptomatic non-acute middle cerebral artery occlusion .Methods:Twenty-six patients with symptomatic non-acute middle cerebral artery occlusion admitted between January 2018 to June 2021 were retrospectively analyzed. The clinical symptoms, cerebral perfusion, occlusive site, occlusive length, collateral circulation and distal capillary were evaluated. There were 17 cases accorded with intravascular recanalization. The cerebral blood flow , cerebral blood volume, MTT, peak time and scores of 17 patients before and after revascularization were compared by paired t test.Results:Endovascular recanalization was performed in 17 patients and extracranial-intracranial artery bypass grafting was performed in 9 patients. Among the 17 cases, there were 7 cases of hemiplegia of contralateral limbs, 6 cases of recurrent cerebral infarction, 4 cases of paroxysmal contralateral limb numbness or weakness, 3 cases of cognitive dysfunction and 3 cases of headache. The cerebral perfusion of the occluded side of the middle cerebral artery in 17 cases was significantly lower than that of the healthy side. One patient failed to pass through the occlusion with micro guide wire, and gave up the operation after repeated attempts. The occluded vessels were successfully recanalized in 16 cases (thrombolytic grade of cerebral infarction=2b-3), and recanalized in 16 cases, including 9 cases of simple balloon dilatation and 7 cases of stent implantation. Three months after the operation, the National Institute of Health Stroke Scale (NIHSS) score of 17 patients decreased from (9.57±2.32) to (3.75±1.42). The cerebral blood flow, cerebral blood volume, mean transit time and peak time were also significantly improved compared with those before the operation（ t value was 9.08，5.54，4.26，8.56，6.00，respectively，all P<0.001）. The Montreal Cognitive Assessment (MoCA) score of cognitive function was (22.70±1.70) before the operation, and there months after operation (26.30±2.30) points ( t=6.66, P<0.001) were statistically significant. After operation, CT cerebral angiography or whole cerebral angiography showed that 1 case was occluded, 15 cases had good recanalization, no intracranial hemorrhage occurred during the perioperative period, and no new stroke occurred during the 6-month follow-up period. Conclusion:For patients with symptomatic non acute middle cerebral artery occlusion, the patients who may benefit from multi-dimensional evaluation are selected for intravascular recanalization treatment. There are few complications and high recanalization rate. The short-term follow-up clinical effect is good, but the long-term effect needs to be further observed.

Eritrosedimentación extremadamente elevada en pacientes adultos hospitalizados en una institución de alta complejidad en la ciudad de medellín, colombia entre 2016 y 2018 / Extremely elevated erythrosedimentation in adult patients hospitalized in a high complexity institution in the city of medellín, colombia between 2016 and 2018

Resumen Introducción: La eritrosedimentación es una medida indirecta de inflamación, se eleva ante un aumento de proteínas (reactantes de fase aguda) durante trastornos inflamatorios, un valor extremadamente elevado ≥100mm/hora) tiene una alta especificidad para el diagnóstico de enfermedades infecciosas, neoplásicas y autoinmunes. Objetivo: Caracterizar a los pacientes hospitalizados con una elevación extrema de la eritrosedimentación, y explorar su asociación con otros factores determinantes. Métodos: Estudio descriptivo de corte transversal. Se incluyeron pacientes mayores de 18 años, con eritrosedimentación extrema, internados en el Hospital Pablo Tobón Uribe de la ciudad de Medellín, desde Noviembre de 2016 hasta Junio de 2018. Resultados: Se seleccionaron 1007 pacientes de la base de datos del hospital, las infecciones, con 743 (73,8%) afectados, fueron el principal diagnóstico relacionado. Se evidenció una correlación negativa de la eritrosedimentación con la hemoglobina -0.092(-0.155 a -0.029) P <0.01 y con el hematocrito -0.087(-0.150 a -0.024) P 0.01, y una positiva significativa débil con la PCR 0.080 (0.014 a 0.146) p 0.02. Discusión: Acorde a otros estudios, las infecciones representaron el primer grupo de elevación extrema, contrario a otro estudio se evidenció una correlación directa, débil y estadísticamente significativa entre la Proteina C reactiva y la eritrosedimentación extremadamente elevada. Conclusión: Las infecciones fueron el principal grupo de enfermedades con eritrosedimentación extrema, se evidenció una correlación inversa entre la eritrosedimentación con la hemoglobina y el hematocrito, y una correlación positiva débil con la proteína C reactiva. MÉD.UIS.2021;34(3): 39-45.

Abstract Sedimentation rate is an indirect inflammation measure, it rises when increase proteins (acute phase reactants) during inflammatory disorders, extreme high value (≥100mm / hour) has a high specificity for the diagnosis of infectious, neoplastic, and autoimmune diseases. Objective: To characterize inpatients with an extreme elevation of the sedimentation rate, and to establish the correlation between determinant factors and extreme sedimentation. Methods: Observational and cross-sectional study, including patients older than 18 years, with an extremely sedimentation rate, hospitalized in Hospital Pablo Tobon Uribe in Medellin city, during November of 2016 to June of 2018. Results: We selected 1007 patients from the data base, Infections were the most common diagnosis (743, 73.8%), and the main type were urinary tract infections (133, 13%). We evidence a negative correlation with the hemoglobin -0.092(0.155 a -0.029) and with the hematocrit -0.087(0.150 a -0.024), and a positive and weak significant correlation with the C-reactive protein 0.080 (0.014 a 0.146) p 0.02. Discussion: The infections, as in other studies, represent the main etiology associated with an extreme sedimentation. Different to other analyzed investigations, we observed a direct, weak and statistically significant correlation between the PCR and the extreme VSG. Conclusions: Infections were the main cause of extreme sedimentation rate. We evidence an inverse correlation between the blood sedimentation and the hemoglobin and the hematocrit, and a weak correlation with the C-reactive protein. MÉD.UIS.2021;34(3): 39-45.

Haptoglobin and its association with naturally occurring diseases in Holstein heifer calves / [Haptoglobina e sua associação com doenças ocorridas naturalmente em bezerras da raça Holandesa]

The present study evaluated the use of haptoglobin (Hp) as an indicator of health and performance in 166 Holstein heifer calves reared in an intensive production system. Calves were evaluated at D6-9; D10-13; D20-23; D35-38 and D65-68, corresponding to the days of life. The absence or presence of diseases was evaluated by physical examination and classification of scores. The performance parameters evaluated were body weight, height at withers and hind width. Hp was measured by spectrophotometric technique. The highest prevalence of diarrhea (59.4%; 98/165) was observed in D10-13, bovine respiratory disease (BRD) was on D35-38 (25.8%; 42/163), and umbilical inflammations in D6-D9 (7.8%; 13/166). Highest values of Hp were observed in animals with diarrhea (P=0.02), and umbilical inflammation (P=0.057), in comparison with the group of healthy calves. A significant negative correlation was observed between Hp and performance index. This protein presented an important relation with diarrhea and performance of the calves, opening perspectives on its utilization as a biomarker of diseases.(AU)

O presente estudo avaliou o uso da haptoglobina (Hp) como indicadora de sanidade e desempenho em 166 bezerras Holandesas criadas em um sistema de produção intensivo. As bezerras foram avaliadas nos momentos D6-9; D10-13; D20-23; D35-38 e D65-68, sendo estes correspondentes aos dias de vida. A ausência ou a presença de doenças foi avaliada por meio do exame físico e da classificação por escores. Os parâmetros de desempenho avaliados foram peso corporal, altura de cernelha e largura de garupa. A Hp foi mensurada por técnica espectrofotométrica. A maior prevalência de diarreia (59,4%; 98/165) foi observada em D10-13, doença respiratória bovina (DRB) ocorreu em D35-38 (25,8%; 42/163) e inflamações umbilicais em D6-D9 (7,8%; 13/166). O valor de Hp foi maior nos animais que apresentaram diarreia (P=0,02) e inflamações umbilicais (P=0,057), em comparação ao grupo de bezerras saudáveis. Houve correlação negativa significativa entre a Hp e os índices de desempenho. Essa proteína apresentou uma importante relação com a diarreia e com o desempenho das bezerras, abrindo perspectivas sobre a sua utilização como biomarcadora de doenças.(AU)

Progress in the treatment of Kawasaki disease in acute phase / 国际儿科学杂志

Kawasaki disease is an acute systemic vasculitis and its etiology is still unknown.About 15%~25% of untreated children suffer from coronary artery damage, so it has attracted more and more attention around the world.Although high-dose intravenous immunoglobulin and oral aspirin are currently recognized as the most effective treatment.Immunoglobulin resistance and coronary artery damage are still big challenge for some patients.In recent years, new treatments(such as glucocorticoids, TNF-α antagonists, interleukin-1 antagonists, cyclosporin A, cytotoxic drugs, plasma exchange, et al)have been clinically affirmed, and some of them are still controversial.This article reviews the treatment progress of Kawasaki disease in the acute phase at home and abroad in recent years.

Clinical Efficacy of Modified Shentong Zhuyutang in Treatment of Acute Discogenic Low Back Pain Due to Wind-Cold and Stasis Obstruction Syndrome / 中国实验方剂学杂志

Objective:To evaluate of modified Shentong Zhuyutang combined with celecoxib capsules in the treatment of acute discogenic low back pain due to wind-cold and stasis obstruction sydrome. Method:One hundred and forty eligible patients were randomly divided into control group （70 cases） and observation group （70 cases）. Patients in both groups took the celecoxib capsules orally， 200 mg/time. On this basis， patients in the control group were further treated with Tongluo Huoxue capsule orally， 6 capsules/time， 3 times/day， while those in the observation group received the modified Shentong Zhuyutang， 1 bag/day， for three weeks. The short-form McGillpain questionnaire （SF-MPQ）， including pain rating index （PRI）， present pain intensity （PPI）， and visual analog scale （VAS）， Oswestry disability index （ODI）， wind-cold obstruction and stasis syndrome， and abilities of daily living （ADL） scoring and the Schober's test were conducted before and after treatment. The tumor necrosis factor-<italic>α</italic> （TNF-<italic>α</italic>）， interleukin-1<italic>β</italic> （IL-1<italic>β</italic>）， IL-6， thromboxane B₂ （TXB₂）， and 6-keto prostaglandin F₁<italic>_α</italic> （6-keto-PGF₁<italic>_α</italic>） levels before and after treatment were measured， followed by the safety evaluation. Result:The PRI， VAS， and PPI scores in SF-MPQ of the observation group were reduced in contrast to those in the control group （<italic>P</italic><0.01）. The wind-cold and stasis obstruction syndrome and ODI scores in the observation group also declined as compared with those of the control group （<italic>P</italic><0.01）， while the ADL and Schober's test scores were elevated （<italic>P</italic><0.01）. The TNF-<italic>α</italic>， IL-1<italic>β</italic>， IL-6， and TXB₂ levels in the observation group were lower than those in the control group （<italic>P</italic><0.01）， whereas the 6-keto-PGF₁<italic>_α</italic> was higher （<italic>P</italic><0.01）. The excellent and good rate of the observation group was （51/63） 80.95%， significantly better than （39/63） 61.90% of the control group （<italic>χ</italic>²＝5.601， <italic>P</italic><0.05）. No adverse reactions occurred after the intake of Chinese medicinal prescriptions. Conclusion:The modified Shentong Zhuyutang combined with celecoxib capsules is efficient and safe in inhibiting inflammation， easing back pain， enhancing lumbar spine mobility， and improving the ADL of patients with acute DLBP of wind-cold obstruction syndrome.

Correlation of serum acute-phase proteins with bone repair in rabbits (Oryctolagus cuniculus) submitted to partial radio ostectomy / Correlação do proteinograma sérico com a reparação óssea em coelhos (Oryctolagus cuniculus) submetidos à ostectomia parcial do rádio

ABSTRACT: Bone trauma triggers an acute inflammatory response, which can alter the serum concentration of acute-phase proteins (PFA). We aimed to evaluate the effectiveness of PFA measurement as a laboratory biomarker for inflammation related to bone regeneration. A partial ostectomy of the right radius was performed on 22 young male rabbits. The complete blood count, albumin, ceruloplasmin, haptoglobin, C-reactive protein, and transferrin levels were recorded and correlated with the radiographic evolution of bone healing. Statistically the best correlations with the inflammatory process and radiological findings were reported with haptoglobin and transferrin compared to the other measured PFAs. Haptoglobin and transferrin showed a maximum peak 24 and 36 hours after surgery, respectively. Transferrin displayed signs of decrease in the first 6 hours after surgery, in advance of the leukocyte response. The measurement of acute-phase proteins proved to be viable, considering the conditions in which the present study was carried out. Among all variables studied, haptoglobin and transferrin showed best correlation with the inflammatory process of bone healing. Additional studies are needed to determine the sensitivity of acute-phase proteins as predictors of complications in the treatment of fractures.

RESUMO: Os traumas ósseos desencadeiam resposta inflamatória aguda e consequentemente alteram a concentração sérica das proteínas de fase aguda (PFA), podendo essas representarem um parâmetro para avaliação da evolução do processo inflamatório relacionado à cicatrização óssea, assim como complicações. Objetivou-se avaliar a inter-relação da mensuração de PFAs com a repação óssea em coelhos submetidos à ostectomia parcial do rádio. Foram utilizados 22 coelhos, machos, jovens (160 a 180 dias) e peso médio (3,8 ± 0,3). Para acompanhamento da evolução do processo inflamatório foram realizados hemograma completo e mensuração de albumina, ceruloplasmina, haptoglobina, proteína C reativa e transferrina, além do acompanhamento radiológico. Foi observado a melhor correlação da haptoglobina e da transferrina junto ao processo inflamatório e achados radiológicos frente às demais PFAs mensuradas. A haptoglobina apresentou pico máximo 24 horas do pós-operatório e a transferrina após 36 horas, entretanto, essa última já mostrou indícios de diminuição nas primeiras 6 horas do pós-cirúrgico, antecipadamente à resposta leucocitária. Nas condições em que o presente estudo foi realizado, a mensuração das proteínas de fase aguda mostrou-se factível. Das proteínas estudadas, a haptoglobina e transferrina foram as que mostraram maior correlação com o processo inflamatório da cicatrização óssea. Estudos adicionais são necessários para determinar a sensibilidade das proteínas de fase aguda como previsores de complicações do tratamento das fraturas.

Acute-phase protein concentration in bronchoalveolar lavage fluid from healthy horses / Proteínas de fase aguda do lavado broncoalveolar de equinos hígidos

Bronchoalveolar lavage fluid (BALF) was analyzed to obtain information on leakage of acute-phase proteins from the blood into the respiratory lumen and about local synthesis. Ceruloplasmin, transferrin, albumin, α1-antitripsin, immunoglobulin G heavy, immunoglobulin G light, immunoglobulin A, haptoglobin, acidic glycoprotein, and P23 were measured in BALF from 30 horses without inflammatory disease by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). In serum, the same proteins were identified except for α1-antitrypsin. In conclusion, this study demonstrated that polyacrylamide gel electrophoresis (SDS-PAGE) can be used for the determination of acute-phase proteins in BALF samples from horses. In healthy horses, the values are very low, but they can be compared with reference values to assist in the diagnosis of animals with respiratory diseases.(AU)

O líquido obtido através da lavagem broncoalveolar (LBA) foi analisado para obter informações sobre as proteínas da fase aguda. Ceruloplasmina, transferrina, albumina, α1-antitripsina, imunoglobulina G pesada, imunoglobulina G leve, imunoglobulina A, haptoglobina, glicoproteína ácida e P23 foram medidas nos LBA de 30 cavalos sem doença inflamatória por eletroforese em gel de poliacrilamida com dodecilsulfato de sódio (SDS-PAGE). No soro, as mesmas proteínas foram identificadas, exceto a α1-antitripsina. Em conclusão, este estudo demonstra que a eletroforese em gel de poliacrilamida (SDS-PAGE) pode ser usada para a determinação de proteínas de fase aguda em amostras de LBA em cavalos. Em cavalos saudáveis, os valores são muito baixos, no entanto, podem ser comparados e auxiliar no diagnóstico de animais com doenças respiratórias.(AU)

Análisis de los primeros 100 pacientes internados por COVID-19 en el Hospital de Clínicas José de San Martín, Universidad de Buenos Aires / Analysis of the first 100 patients with COVID-19 admitted to internal medicine wards at the Hospital de Clínicas José de San Martin, Buenos Aires University

Resumen Se analiza, en un estudio descriptivo retrospectivo, las características clínicas y epidemiológicas, la evolución de la enfermedad y su asociación con los marcadores del laboratorio de mal pronóstico, en los primeros 100 pacientes internados en clínica médica con COVID-19 en el Hospital de Clínicas José de San Martín de la Universidad de Buenos Aires. El 31% de los pacientes provenían de geriátricos, las manifestaciones clínicas más comunes fueron fiebre, tos y odinofagia. En relación a las comorbilidades, la obesidad fue la más frecuente y la hipertensión arterial la más prevalente en los pacientes con neumonía. La edad y la presencia de neumonía fueron los predictores más importantes de mortalidad. Los pacientes mayores de 70 años presentaron reactantes de fase aguda más elevados mostrando una respuesta inflamatoria exagerada. La mortalidad fue elevada (13%), en comparación con la mayoría de las comunicaciones (5%), probablemente como consecuencia de la edad avanzada de nuestra población y las condiciones clínicas desfavorables que presentaron a su ingreso.

Abstract This retrospective descriptive study analyzes the clinical and epidemiological characteristics, the disease evolution and its association with laboratory markers of poor prognosis of the first 100 patients with COVID-19 admitted to internal medicine wards at the Hospital de Clínicas José de San Martín, University of Buenos Aires. Thirty-one patients were nursing home residents, the most common clinical manifestations were fever, cough and odynophagia. Regarding comorbidities, obesity was the most frequent one and hypertension was the most prevalent in patients with pneumonia. The most important predictors of mortality were age and pneumonia. Patients older than 70 years had higher acute phase reactants showing an exaggerated inflammatory response. Mortality was high (13%), compared to most reports (5%), probably because of the advanced age of our population and the unfavorable clinical conditions they presented at admission.

Manifestaciones agudas en infección por virus del chikungunya en una ciudad endémica de Colombia / Acute manifestations in the infection by Chikungunya virus in a city of Colombia

Introducción: La infección aguda por chikungunya genera una alta carga de enfermedad y discapacidad dada principalmente por poliartralgias en fase aguda y artritis en fase crónica, sin embargo, presenta una sintomatología similar a otras arbovirosis, particularmente a las del dengue, lo que dificulta su diagnóstico. Objetivos: Caracterizar las manifestaciones clínicas de la infección aguda por chikungunya en los pacientes atendidos en el departamento de urgencias de la ciudad de Ibagué, Colombia, durante el brote epidémico transcurrido entre octubre de 2015 y octubre de 2016. Métodos: Estudio descriptivo, de corte transversal, en el cual se describieron las manifestaciones clínicas de la infección aguda por chikungunya, a través del instrumento desarrollado a partir de la revisión de la literartura que recogía las principales manifestaciones clínicas de la infección en fase aguda por chikungunya, como anexo a las fichas epidemiológicas de notificación obligatoria individual del Instituto Nacional de Salud que se reportan a la Secretaría Municipal de Ibagué-Tolima. Resultados: Se recolectaron 6752 fichas de pacientes atendidos en los servicios de urgencias, los que experimentaron fiebre de 38,5 ºC de 1-7 días (91,3 por ciento), mialgias (81,3 por ciento), eritema maculopapular (74,3 por ciento), artralgias severas (70,6 por ciento), poliartritis (41,1 por ciento) y adenomegalias retroauriculares (8 por ciento). Conclusiones: Los resultados obtenidos en el presente estudio aportan información importante para el diagnóstico clínico del chikungunya en sitios con características similares a las de ciudades hiperendemicas y facilita distinguir la enfermedad en fase aguda entre las diferentes arbovirosis circulantes con signos como las mialgias, adenoapatias retro-auriculares y artralgia severa(AU)

Introduction: The acute infection by Chikungunya generates a high burden of illness and disability mainly due to polyarthralgias in acute phase and artritis in chronic phase. However, it presents symptoms similar to other arboviruses, specially like dengue, which difficults its diagnosis. Objective: To characterize the clinical manifestations of the acute infection by Chikungunya in patients attended in the emergencies service of Ibagué city, Colombia, during the epidemic outbreak that occured from October, 2015 to October, 2016. Methods: Descriptive, cross-sectional study in which were described the clinical manifestations of the acute infection by chikungunya using an instrument developed from the review of the literature that comprises the main clinical manifestations of the infection by chikungunya in its acute phase, as an information attached to the epidemiologic records of individual obligatory notification of the National Institute of Health, which are reported to Ibagué-Tolima Municipal Secretary. Results: There were collected 6752 records of patients attended in emergency services, whom experienced fever of 38,5 ºC from 1 to 7 days (91,3 percent), myalgias (81,3 percent), maculopapular erythema (74,3 percent), severe arthralgias (70,6 percent), polyarthritis (41,1 percent) and retroarticular adenomegalies (8 percent). Conclusions: The results obtained in the present study provide important information for the clinical diagnosis of chikungunya in places with similar characteristics to the hyperepidemic cities and it facilitates to differentiate the disease in its acute phase among the different current arboviruses with signs of myalgia, retroarticular adenopathies and severe arthralgia(AU)

ELISA of amyloid A in paired bronchoalveolar lavage fluid and serum samples of healthy horses / Detecção de amilóide A no lavado broncoalveolar de equinos hígidos

Pulmonary disorders are common in horses, and treatment efficiency depends on an adequate diagnosis. Amyloid A is the most sensitive indicator of pathology in horses. The objective of this study was to establish the concentration of amyloid A of bronchoalveolar lavage fluid (BALF) in healthy horses. Health condition of horses was considered normal based on physical examination, complete blood count, biochemical parameters, and BALF cytology. Blood and BALF were collected from thirty adult female horses. Amyloid A concentrations in serum and BALF were measured using commercial ELISA tests. Amyloid A was detected in serum (mean ± SD = 3.71±2.51) and BALF (mean ± SD = 0.000745±0.000785) of all horses. In conclusion, SAA can also be measured in bronchoalveolar fluid, affording early detection of respiratory infections or inflammatory conditions.(AU)

Distúrbios pulmonares são comuns nos cavalos e a eficiência do tratamento depende de um diagnóstico adequado e precoce. A amilóide A é um biomarcador sensível na deteccção de patologias inflamatórias e infecciososa em cavalos. O objetivo deste estudo foi estabelecer a concentração de amilóide A no líquido broncoalveolar (LBA) em cavalos saudáveis. Os cavalos foram considerados saudaveis baseado nos achados de normalidade do exame físico, hemograma, parâmetros bioquímicos e citologia do LBA. Sangue e LBA foram coletados de 30 fêmeas equinas adultas. Os níveis de Amilóide A no soro e no LBA foram mensurados por meio do teste de ELISA. A amilóide A foi detectada no soro (média ± DP = 3,71±2,51) e no LBA (média ± DP = 0,000745±0,000785) de todos os animais. Conclui-se que a amilóide A também pode ser mensurada no LBA, auxiliando no diagnóstico precoce de processos inflamatórios e infecciosos pulmonares.(AU)

New laboratory perspectives for evaluation of vivax malaria infected patients: a useful tool for infection monitoring

ABSTRACT In recent years, the number of cases with severe Plasmodium vivax malaria has shown an increasing trend. It is, therefore, important to identify routine laboratory markers that best characterize the acute disease phase and can serve as a tool for clinical follow-up of patients. In a cohort study, we followed 87 patients with acute P. vivax monoinfection acquired in an endemic region of the Brazilian Amazon. Forty-two different biochemical and hematological parameters frequently tested in clinical routine were evaluated at the acute phase and the convalescent phase. A total of 42 laboratory tests were performed: biochemical parameters measured were serum lipids levels, aminotransferases, bilirubin, amylase, glucose, urea, creatinine, albumin, globulin, uric acid, C-reactive protein, and alpha-1-acid glycoprotein. Hematological parameters included total and differential white blood cell and platelet counts, hemoglobin concentration, mean platelet volume, platelet width distribution, and plateletcrit. Our results show that several biochemical and hematological parameters were associated with acute phase P. vivax malaria and these parameters reverted to normal values in the convalescent phase. The use of these parameters during diagnosis and follow-up of the infection is a useful clinical tool to evaluate the clinical course and therapeutic response of patients with uncomplicated vivax malaria.

Diagnóstico etiológico de la neumonía: un problema en la práctica clínica pediátrica / Etiological diagnosis of pneumonia: a problem of pediatric clinical practice

Resumen La neumonía en niños es causa frecuente de morbilidad y mortalidad, especialmente en países de bajos ingresos; es indispensable proporcionar una adecuada conducta terapéutica, idealmente orientada por etiología, pues la principal consecuencia de no establecer un diagnóstico etiológico preciso es el abuso de antibióticos. La evaluación clínica y radiológica son los pilares básicos para el diagnóstico de neumonía, y el conocimiento del comportamiento epidemiológico de los gérmenes y los biomarcadores ayudan a su aproximación etiológica. Se revisaron aspectos prácticos sobre el diagnóstico de la neumonía en niños, abordando criterios clínicos y epidemiológicos (edad y género), reactantes de fase aguda, hallazgos radiológicos y modelos de predicción etiológica utilizados como herramientas para la diferenciación de neumonía bacteriana de viral en menores de 18 años, en escenarios donde no se dispone rutinariamente de técnicas más precisas para diagnóstico rápido, como aquellas de tipo inmunológico o moleculares. MÉD.UIS.2020;33(1):39-52.

Abstract Pneumonia in children is a frequent cause of morbidity and mortality, especially in low-income countries. Due to this, it is indispensable to get a right therapeutic behavior, ideally focused by etiology, because the main consequence of not establishing an accurate etiological diagnosis is the abuse of antibiotics. The radiologic and clinic evaluations are basic pillars for pneumonia diagnosis and the knowledge in epidemiological behavior and biomarkers is very useful for an etiological approximation. Practical aspects were reviewed about pneumonia diagnosis in children, addressing clinic and epidemiological criteria (age and gender), acute phase reactants, radiological findings and etiological prediction models used as tools for differentiation between viral and bacterial pneumonia in children under 18 years old, in scenarios where it is not possible to find techniques for a right diagnostic, as those of immunologic and molecular types. MÉD.UIS.2020;33(1):39-52.

Relación entre niveles de proteína c-reactiva y Síndrome de Burnout en médicos de postgrado / Relationship between c-reactive proteins and burnout syndrome in postgraduate physicians / Relação entre os níveis de proteína c-reativa e a síndrome de burnout nos médicos pós-graduação

Introducción. El Síndrome de Burnout afecta mundialmente a más de 100,000,000 personas, con prevalencia entre 47 y 76% en médicos residentes. El objetivo de este trabajo fue determinar la relación entre el Síndrome de Burnout y los niveles de proteína C-reactiva ultrasensible en médicos residentes de un hospital universitario en Caracas, Venezuela. Metodología. Estudio transversal y descriptivo. El instrumento de recolección de datos, así como el test Maslach Burnout Inventory, fueron enviados en formato electrónico. Posteriormente, se seleccionó dos submuestras, a quienes se les determinó la concentración de proteína C-reactiva ultrasensible Resultados. La muestra inicial fue de 174 residentes, de los cuales 57 (32.8%) presentaban Burnout. Los residentes positivos para la presencia del síndrome tenían niveles más elevados de proteína C-reactiva ultrasensible (>0.50mg/dl) (р=0.001) con respecto al grupo sin Burnout. Igualmente, los residentes de género femenino (р=0.046), aquellos que dormían menos de 8 horas al día (р=0.032) y que estaban sometidos a estrés familiar (р=0.036) presentaron una asociación estadísticamente significativa para desarrollar el síndrome de bornout. Finalmente, se evidenció cómo los residentes de menor edad tenían mayores puntajes en la subescala despersonalización (p=0.036). Discusión. El estrés crónico (entre ellos el Síndrome de Bornout) puede activar de manera continua ejes fisiológicos estresores (hipotálamo-hipófisis- suprarrenal y simpático-adrenal); conllevando a la producción de citosinas y proteínas de fase aguda (como proteína C-reactiva ultrasensible), promoviendo un estado proinflamatorio en el individuo y el desarrollo de patologías crónicas. Conclusiones. El síndrome de bornout y las variables sociodemográficas/laborales representan una condición de estrés crónico que pueden asociarse entre sí y conducir al desarrollo de distintas enfermedades a largo plazo. Cómo citar. González-Moret YA, Guzmán Cuárez NE. Relación entre niveles de proteína c-reactiva y síndrome de burnout en médicos de postgrado. MedUNAB. 2020;23(3): 423-433. doi: https://doi.org/10.29375/01237047.3870

Introduction. Burnout Syndrome affects over 100,000,000 people worldwide, with a prevalence of between 47% and 76% in resident physicians. This project's objective is to determine the relationship between Burnout Syndrome and ultrasensitive C-reactive protein in resident physicians in a university hospital in Caracas, Venezuela. Methodology. Cross-sectional and descriptive study. The data collection tool, as well as Maslach Burnout Inventory test, were sent digitally. Two sub-samples were subsequently collected, whose concentration of us ultrasensitive C-reactive protein was determined. Results. The initial sample was 174 residents, of which 57 (32.8%) had Burnout. Residents who tested positive for the syndrome had higher levels of us-CRP (>0.50mg/dl) (р=0.001) with respect to the group without Burnout. Moreover, female residents (р=0.046), those who slept less than 8 hours every day (р=0.032) and those who were subject to family stress (р=0.036) demonstrated a statistically significant association with developing Burnout Syndrome. Finally, it was evident how younger residents had higher scores on the Depersonalization Subscale (p=0.036). Discussion. Chronic stress (among which is burnout syndrome) can continuously activate physiological stress axes (hypothalamic-pituitary-suprarenal and sympathetic-adrenal), which leads to producing cytosines and acute-phase proteins (such as ultrasensitive C-reactive protein), promoting a proinflammatory state in individuals and the development of chronic pathologies. Conclusion. Burnout Syndrome and sociodemographic/work variables represent a chronic stress condition and can be related to each other. They may lead to developing various long-term diseases. Cómo citar. González-Moret YA, Guzmán Cuárez NE. Relación entre niveles de proteína c-reactiva y síndrome de burnout en médicos de postgrado. MedUNAB. 2020;23(3): 423-433. doi: https://doi.org/10.29375/01237047.3870

Introdução. A Síndrome de Burnout afeta mais de 100 milhões de pessoas em todo o mundo, com uma prevalência de 47-76% em médicos residentes. O objetivo deste trabalho foi determinar a relação entre a síndrome de burnout e os níveis de proteína C-reativa ultrassensível em médicos residentes de um hospital universitário em Caracas, Venezuela. Metodologia. Trata-se de um estudo transversal e descritivo. O instrumento de coleta de dados, assim como o teste Maslach Burnout Inventory, foram enviados em formato eletrônico. Posteriormente, foram selecionadas duas subamostras, nas quais foi determinada a concentração de níveis de proteína C-reativa. Resultados. A amostra inicial foi de 174 residentes, dos quais 57 (32.8%) apresentaram Burnout. Os residentes positivos para a presença da síndrome apresentaram níveis mais elevados de níveis de proteína C-reativa (> 0.50mg/dl) (р = 0.001) em comparação com o grupo sem Burnout. Da mesma forma, residentes do sexo feminino (р = 0.046), aqueles que dormiam menos de 8 horas por dia (р = 0.032) e aqueles que foram submetidos a estresse familiar (р = 0.036) apresentaram uma associação estatisticamente significativa para o desenvolvimento da síndrome de burnou. Por fim, evidenciou-se que os residentes mais jovens apresentaram escores mais elevados na subescala de despersonalização (p = 0.036). Discussão. O estresse crônico (incluindo a síndrome de burnout) pode ativar continuamente os eixos fisiológicos dos estressores (hipotálamo-hipófise-suprarrenal e simpático-adrenal), levando à produção de citocinas e proteínas de fase aguda (como níveis de proteína C-reativa), promovendo um estado pró-inflamatório no indivíduo e o desenvolvimento de patologias crônicas. Conclusão. A síndrome de burnout e as variáveis sociodemográficas/laborais representam uma condição de estresse crônico que podem estar associadas entre si e levar ao desenvolvimento de diferentes doenças a longo prazo. Cómo citar. González-Moret YA, Guzmán Cuárez NE. Relación entre niveles de proteína c-reactiva y síndrome de burnout en médicos de postgrado. MedUNAB. 2020;23(3): 423-433. doi: https://doi.org/10.29375/01237047.3870