Endocrinal disturbances and systemic inflammation in chronic obstructive pulmonary disease [COPD]

COPD is no longer considered to affect only the lungs and airways but also the rest of the body. The systemic manifestations of COPD include a number of endocrine disorders such as those involving the pituitary, thyroid, gonads, adrenals and pancreas. The aim of this work is to detect the endocrinal and inflammatory changes in COPD patients during stability of the disease and the effect of acute exacerbation on these changes. Twenty acute exacerbated COPD [AECOPD] male patients with acute respiratory failure [ARF] were included in this study as a patient group and a control group which included 10 healthy age-matched males with normal pulmonary functions and without any of the exclusion criteria. For patients enrolled in this study, measurement of serum levels of sex hormones [total testosterone, luteinizing hormone [LH] and follicle-stimulating hormone [FSH]], insulin like growth factor-1 [IGF-1] and C-reactive protein [CRP] were done on admission and 1 month after hospital discharge. For healthy group, the previous measurements were done once only. There were statistically significant decrease in serum testosterone and IGF-1 levels in patients after stabilization than those in the control group with more decrease of their levels during exacerbation and the difference between their levels in patients during exacerbation and after stabilization was statistically highly significant. As regards serum LH and FSH, there were statistically highly significant increase in their levels in COPD patients during exacerbation than those in the control group but there were non-significant differences in these hormones levels between the patients after stabilization and the control group. As regards serum CRP, there was highly significant increase in its serum level in patients in both exacerbation and after stabilization than that in the control group. The level of CRP in patients during exacerbation was higher than that after stabilization and the difference was statistically highly significant. As regards disease severity, there were statistically highly significant decrease in testosterone level in severe to very severe COPD patient group than that in mild to moderate one. There was also statistically significant decrease in serum IGF-1 level in severe to very severe COPD patient group than that in mild to moderate one. There was statistically highly significant increase in serum CRP level in severe to very severe COPD patient group than that in mild to moderate one. On the other hand, there was statistically non-significant increase in serum LH and FSH levels in severe to very severe CPOD patient group than those in mild to moderate one. There were statistically highly significant positive correlations between serum testosterone levels and both FEV[1%] predicted and PaCo[2]. There were also statistically highly significant positive correlations between serum IGF-1 levels and both FEV[1%] predicted and PaCo[2]and also between serum CRP levels and PaCo[2] in patients during exacerbation. Also during exacerbation, there was statistically highly significant negative correlation between serum CRP levels and FEV[1%] predicted. COPD leads to alterations in serum levels of sex hormones [testosterone, LH and FSH], IGF-1 and CRP. There was decrease in testosterone hormone levels of male stable COPD patients and this decrease was more evident, with compensatory increase in LH and FSH hormones levels, during exacerbation period when hypoxemia is more significant. CRP level is increased even in stable COPD and this rise is magnified with increased disease severity. IGF-1 decreased in stable COPD patients with more decrease in its level during acute exacerbation

Redução transitória nos níveis séricos de retinol em crianças com pneumonia e resposta de fase aguda / Transient decreased retinol serum levels in children with pneumonia and acute phase response

OBJETIVO: Comparar os níveis séricos de retinol em crianças pré-escolares durante um episódio de pneumonia e 45 dias após a resolução da infecção. MÉTODOS: O estudo foi conduzido com crianças pré-escolares sem infecção (grupo controle, n = 9) ou com pneumonia (n = 12), após a hospitalização (fase 1) e 45 dias após a alta (fase 2). A avaliação nutricional incluiu antropometria, questionário alimentar e exames laboratoriais, incluindo os níveis urinários e séricos de retinol. Aplicou-se o teste pareado de Student ou de Mann-Whitney. RESULTADOS: Não houve diferença na ingestão alimentar. Documentaram-se menores valores de hemoglobina sanguínea e dos níveis séricos de sódio e albumina durante a fase 1, além de maiores valores da proteína C reativa. Não houve mudança no retinol urinário, enquanto os níveis séricos aumentaram após a recuperação da pneumonia. CONCLUSÕES: Durante a pneumonia, as crianças apresentam redução transitória nos níveis séricos de vitamina A, um epifenômeno da resposta de fase aguda.

OBJECTIVE: To compare serum retinol levels in preschool children during an episode of pneumonia and 45 days after the resolution of the infection. METHODS: The study was conducted with preschool children without any infection (control group, n = 9) or children hospitalized for pneumonia (n = 12), who were evaluated soon after hospitalization (phase 1) and 45 days later (phase 2). Nutritional assessment included anthropometric measurements, a food questionnaire, and laboratory blood routine examination, including urinary and serum retinol levels. Paired Student t or Mann-Whitney tests were used as required. RESULTS: Food intake was similar between groups. Blood hemoglobin and serum sodium and albumin decreased during phase 1, while there were higher C-reactive protein serum values. Urinary retinol levels remained unchanged whereas serum retinol increased significantly after pneumonia recovery. CONCLUSIONS: During the course of pneumonia, children had transient decrease in serum levels of vitamin A, an epiphenomenon of the acute phase response.

Leucogram and serum acute phase protein concentrations in queens submitted to conventional or videolaparoscopic ovariectomy / Leucograma e concentrações séricas de proteínas de fase aguda de gatas submetidas à ovariectomia convencional ou por videolaparoscopia

Thirty health queens were submitted to ovariectomy by conventional technique or by videolaparoscopy. In order to study the intensity of inflammatory response by means of acute phase protein analysis and white blood cell count, serum samples were taken before and until 144 hours after the surgical procedures. The protein concentrations that were significantly increased 24 hours after surgical procedures were: ceruloplasmin, hemopexin, haptoglobin, and α1-acid glycoprotein, 69.8 percent, 103.5 percent, 117.3 percent, and 199.0 percent, respectively, for conventional ovariectomy; and 22.3 percent, 46.1 percent, 79.8 percent, and 74.6 percent, respectively, for laparoscopic ovariectomy. Therefore, inflammatory response was more intense in queens submitted to conventional ovariectomy. Results indicate that the increase or decrease in acute phase proteins, as well as in white blood cells count, may be useful in the evaluation of inflammatory response induced by these surgical procedures.

Trinta gatas, saudáveis, foram submetidas à ovariectomia pela técnica convencional e por videolaparoscopia. Amostras de sangue foram obtidas com o objetivo de verificar a intensidade da resposta inflamatória por meio da análise das concentrações de proteinas de fase aguda e contagem de leucócitos antes e até 144 horas após procedimento cirúrgico. As proteínas que apresentaram aumento significativo 24 horas após a cirurgia foram: ceruloplasmina, hemopexina, haptoglobina e α1-glicoproteína ácida, 69,8 por cento, 103,5 por cento, 117,3 por cento e 199,0 por cento, respectivamente, para ovariectomia convencional, e 22,3 por cento, 46,1 por cento, 79,8 por cento e 74,6 por cento, respectivamente, para ovariectomia por videolaparoscopia. A resposta inflamatória foi mais evidente nas gatas submetidas à ovariectomia convencional. Os resultados mostram aumento e diminuição na concentração de proteínas de fase aguda e na contagem de leucócitos, podendo ser utilizados na avaliação da resposta inflamatória induzida por procedimentos cirúrgicos.

Influência da resposta inflamatória de fase aguda nos níveis séricos de retinol e da proteína de ligação do retinol em pacientes com AIDS / Influence of acute-phase inflammatory response on serum levels of retinol and retinol binding protein in HIV/AIDS patients

INTRODUÇÃO: a hiporretinolemia constitui fator prognóstico independente em pacientes com AIDS, e a atividade inflamatória causa redução dos níveis séricos deste nutriente na população em geral. Entretanto, faltam estudos que avaliem o impacto da atividade inflamatória sobre o nível sérico do retinol em pacientes com AIDS. MÉTODOS: foram avaliados transversalmente 41 pacientes internados por complicações da AIDS, que tiveram quantificados alguns marcadores de inflamação (proteína C reativa e fator de necrose tumoral alfa) e concentrações séricas de retinol e da proteína de ligação do retinol. RESULTADOS: apesar da baixa (14,6 por cento) prevalência de hiporretinolemia evidenciou-se correlação negativa dos marcadores de inflamação com os níveis séricos de retinol e de sua proteína de ligação nos pacientes com AIDS. CONCLUSÕES: a atividade inflamatória de fase aguda está associada a baixos níveis séricos de retinol em indivíduos com AIDS.

INTRODUCTION: Hyporetinolemia is an independent prognostic factor in AIDS patients. Inflammatory activity causes a reduction in the serum levels of this nutrient in the general population. However, there are no studies assessing the impact of inflammatory activity on the serum retinol level in AIDS patients. METHODS: A cross-sectional assessment was conducted on 41 patients hospitalized due to AIDS complications. Inflammatory markers (C-reactive protein and tumor necrosis factor-alpha) and serum retinol and retinol binding protein concentrations were quantified. RESULTS: Despite the low (14.6 percent) prevalence of hyporetinolemia, a significant negative correlation was observed between the inflammatory markers and the serum retinol and retinol binding protein levels in AIDS patients. CONCLUSIONS: Acute-phase inflammatory activity is associated with low serum retinol levels in individuals with AIDS.

Interleukin-6 (IL-6) and tumour necrosis factor-alpha in open and laparoscopic cholecystectomy.

Injury to the human body alters normal physiology across several systems and these alterations are proportional to the extent of the injury. Physiological response to minimally invasive surgery appears to be different than those of traditional open surgery. Acute phase protein response appears to be one example. The important cytokines that are known as major mediators of acute phase response are interleukin-6 and TNF-alpha. Thirty patients were studied in which 14 underwent open cholecystectomy and 16 laparoscopic cholecystectomy. Three blood samples were taken from each patient, one pre-operatively and 2 post operatively at 4 and 24 hours. Interleukin-6 and Tumour Necrosis Factor-alpha (TNF-alpha) were raised significantly in post operative blood sample in both groups but the rise was much more in open group than laparoscopic group. This suggest less stress response in laparoscopic group which also showed a direct effect on patient convalescence in terms of less pain, less analgesic requirement and shorter hospital stay

Resposta de fase aguda e níveis séricos de magnésio em pacientes hospitalizados / Acute phase response and serum magnesium levels among hospitalized patients

Objetivo. A resposta de fase aguda (RFA), caracteriza-se por proteólise, com hipotrofia da massa celular corporal, hiperglicemia, retençao hídrica e disfunçao renal, fenômenos que potencialmente afetam os níveis de magnésio (Mg++) sérico. O objetivo do estudo foi comparar os níveis séricos de Mg++ entre pacientes hospitalizados, com ou sem RFA. Métodos. Obteve-se um banco de dados do mainframe do Hospital-Escola contendo informaçoes sobre dosagens bioquímicas simultâneas de creatinina, glicose e magnésio e outros eletrólitos séricos de 214 pacientes internados, sem diabetes mellitus, insuficiência renal crônica ou creatinina sérica > 1,5mg/dl. A presença de RFAÅ foi definida pela presença de febre mais diagnósticos de trauma, cirurgia recente ou infecçao, além de leucopenia ou leucocitose. Resultados. Dos casos, 32,2 por cento foram considerados RFA. Nao houve diferença entre os grupos quanto à idade, gênero e cor. Houve pareamento entre os grupos RFAÅ e RFAQ quanto à freqüência de uso de diuréticos (10,1 vs 11,7 por cento) e presença de edema (3 vs 6 por cento). Hipomagnesemia ocorreu em 154 casos (72 por cento do total), sendo 75,9 por cento no grupo RFAQ e 63,8 por cento no grupo RFAÅ (p=0,06). Os níveis de Mg++ (mediana; faixa de variaçao) foram maiores no grupo RFAÅ: (1,75; 1-3 vs 1,6; 0,9-2,9mg/dl), o mesmo ocorrendo com a glicemia (115; 49-236 vs 99; 61-191 mg/dl) e creatinina sérica (0,884 + 0,306 vs 0,803 + 0,257 mg/dl). Hipermagnesemia foi mais comum no grupo RFAÅ: 8,7 vs 2,1 por cento. Conclusoes. Pacientes RFAÅ apresentam maiores níveis de magnésio sérico, fenômeno possivelmente relacionado com aumentos da glicemia, uréia e creatinina séricas.

Niveles séricos de prealbúmina en niños desnutridos y controles con y sin infección clínica asociada / Serum levels of prealbumin in undernourished children and controls with or without associated clinical infection

Debido a su vida media corta, su elevado contenido en triptófano y su pequeño "pool" corporal, los niveles séricos de prealbúmina han sido considerados como un indicador sensible de la deficiencia proteica y/o calórica. Además, la prealbúmina disminuye durante la respuesta de fase aguda desencadenada por infección o injuria tisular. Se determinaron los niveles séricos de prealbúmina en niños desnutridos con o sin infección clínica asociada y en sus controles infectados o no infectados comparables por edad, sexo, raza y condición socieconómica. En los grupos sin infección clínica asociada, los niveles séricos de prealbúmina eran significativamente menores en los niños desnutridos, que en los controles. Los niveles de prealbúmina también se encontraron significativamente desprimidos en presencia de infección asociada, disminuyendo a niveles casi similares en los niños desnutridos y controles con infección clínica, al compararlos con los observados en niños pertenecientes al mismo estadío nutricional, pero sin infección manifiesta. Se encontró correlación positiva significativa entre la prealbúmiba sérica y tanto el score-Z de peso-edad como de talla-edad y peso-talla en el grupo sin infección manifiesta, las cuales desaparecían en presencia de infección. Portanto, la prealbúmina es un marcador adecuado de desnutrición en ausencia de infección y podría ser un indicador más precoz y sensible de desnutrición actual, causada por los efectos metabólicos de citoquinas inflamatorias producidas durante la infección, que las medidas antropométricas aquí utilizadas