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)

Effects of flunixin meglumine, meloxicam, and firocoxib on the acute-phase proteins in horses following standing castration / Efeitos do flunixin meglumine, meloxicam e firocoxib na concentração de proteínas da fase aguda após em equinos após castração

Excessive infection and inflammation are the most common complications associated with castration. The objective of this study was to compare the efficacy of flunixin meglumine (FM), meloxicam (MX), or firocoxib (FX) for inflammation control after castration in horses using acute-phase proteins (APP) as markers of inflammation. Thirty healthy, unbroken, mixed-breed horses (body weight 358.62±45.57kg and age 4.99±2.63 years) were randomly (n=10 animals/group) allocated to receive one of three different post-castration anti-inflammatory medicines: Group 1 (FM 1.1mg/kg bwt, IV, s.i.d for 5 days); Group 2 (MX 0.6mg/kg bwt, IV, s.i.d for 5 days); and Group 3 (FX 0.1mg/kg bwt, IV, s.i.d for 5 days). All horses were castrated in standing position, using the open technique. Serum and peritoneal APP concentrations were measured by sodium dodecyl sulfate (SDS) polyacrylamide gel electrophoresis (PAGE) and determined before castration (0), and 3, 5, 24, 48, 72, 120 and 168 hours after castration. The results were submitted to analysis of variance using the SAS statistical program, and means were compared by the Student-Newman-Keuls test (p<0.05). Three animals from the MX group developed hyperthermia (with rectal temperatures of 39.8, 39.3 and 38.9°C on day 4, 5 and 6, respectively) and showed local clinical signs of inflammation (inguinal and excessive scrotal edema) and reluctance to walk, as well as a rigid gait of the hind limbs. The same complications were observed in one FX horse. No complications were observed among the FM animals. The castration resulted in significant changes in serum and peritoneal values of total proteins, ceruloplasmin (Cp), transferrin (Tf), albumin (Alb), haptoglobin (Hp) and α1-acid glycoprotein (Gp) in animals of all experimental groups. However, the animals of the MX and FX groups presented more intense acute phase response compared to the animals of the FM group. Changes in the APP were associated with the surgical trauma of castration, but the differences between groups were associated with the ability of the nonsteroidal anti-inflammatory drug to control the inflammation. In conclusion, and based on the findings of acute phase proteins, flunixin is more efficient to control the magnitude of inflammation following castration as compared to meloxicam and firocoxib.(AU)

Infecção e inflamação excessivas são as complicações mais comuns associadas à castração. O objetivo deste estudo foi comparar a eficácia do flunixin meglumine (FM), meloxicam (MX) ou firocoxib (FX) no controle da inflamação após a castração em cavalos usando proteínas da fase aguda (APP) como marcadores de inflamação. Trinta equinos saudáveis (358,62±45,57kg; 4,99±2,63 anos) foram em função dos anti-inflamatórios utilizados após as castrações aleatoriamente (n= 10 animais/grupo) alocados em três diferentes grupos: Grupo 1 (FM 1,1mg/kg de peso, IV, sid por 5 dias); Grupo 2 (MX 0,6mg/kg de peso, IV, s.i.d por 5 dias); e Grupo 3 (FX 0,1mg/kg de peso, IV, s.i.d por 5 dias). Todos os cavalos foram castrados em posição quadrupedal, utilizando a técnica aberta. As concentrações de APP sérica e peritoneal foram separadas por eletroforese em gel de poliacrilamida (PAGE) com dodecil-sulfato de sódio (SDS) e determinadas no momento 0 (antes da castração) e com 3, 5, 24, 48, 72, 120 e 168 horas após a castração. Os resultados foram submetidos à análise de variância pelo programa estatístico SAS e as médias foram comparadas pelo teste de Student-Newman-Keuls (p<0,05). Três animais do grupo MX desenvolveram hipertermia (com temperatura retal de 39,8, 39,3 e 38,9° C nos dias 4, 5 e 6, respectivamente) e mostraram sinais clínicos locais de inflamação (edema inguinal e escrotal excessivo) e relutância em andar, bem como marcha rígida dos membros posteriores. As mesmas complicações foram observadas em um cavalo do FX. Não foram observadas complicações entre os animais do FM. Independente do grupo, a castração resultou em alterações significativas nos valores séricos e peritoneais de proteínas totais, ceruloplasmina (Cp), transferrina (Tf), albumina (Alb), haptoglobina (Hp) e glicoproteína ácida α1 (Gp). No entanto, os animais dos grupos MX e FX apresentaram resposta de fase aguda mais intensa quando comparados aos animais do FM. Alterações na resposta de fase aguda deveram-se ao trauma cirúrgico da castração, mas as diferenças entre os grupos foram associadas à capacidade do anti-inflamatório em controlar a inflamação. Em conclusão, baseado da resposta de fase aguda, o flunixin em comparação com o meloxicam e o firocoxib é mais eficiente no controle da inflamação após a castração em equinos.(AU)

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

Utilidad de los reactantes de fase agua en el diagnóstico clínico / Usefulness of water phase reactants in clinical diagnosis

Los reactantes de fase aguda son proteínas plasmáticas que sufren alteraciones durante la inflamación. Las variadas reacciones del huésped a la infección, inflamación o trauma abarcan como respuesta una amplia gama de respuestas patofisiológicas tales como la pirexia, leucocitosis, las alteraciones hormonales entre otros

Transferrina como marcador de maturação pulmonar em cordeiros nascidos a termo ou prematuros / Transferrin as a marker of pulmonary maturation in lambs born at term or premature

O objetivo do estudo foi procurar proteínas de fase aguda que possam indicar sinais de maturação no neonato prematuro, por meio da quantificação sérica delas. Identificou-se a imunoglobulina A, a ceruloplasmina, a haptoglobina, a glicoproteína ácida, a transferrina, a albumina e as imunoglobulinas G de cadeias leve e pesada, pela comparação do perfil dos proteinogramas de cordeiros nascidos a termo com os prematuros submetidos a diferentes protocolos terapêuticos, a fim de estimular a atividade respiratória. Constituíram-se seis grupos: PN (n= 9): nascidos de parto normal; CN (n= 7): nascidos de cesariana em tempo normal de gestação; CP (n= 6): nascidos de cesariana prematura sem nenhum tipo de tratamento; DEX (n= 9): prematuros cujas mães receberam dexametasona pré-parto; SURF (n= 6): prematuros tratados com surfactante; e DEXSURF (n= 6): prematuros tratados com surfactante cujas mães receberam dexametasona pré-parto. As avaliações foram realizadas nos momentos imediatamente após o nascimento (M0), após 24 (M24) e após 48 horas (M48). As amostras foram processadas por meio de eletroforese em gel de poliacrilamida contendo dodecil sulfato de sódio (SDS-PAGE). A albumina, as imunoglobulinas e a proteína total dos cordeiros tiveram elevação após a ingestão de colostro. Maiores valores séricos de transferrina são referentes a maior período gestacional, podendo essa proteína ser utilizada como marcador de maturação neonatal.(AU)

The aim of this study was to search for acute phase proteins that could indicate signs of maturation in the premature neonate by quantifying them in serum. Immunoglobulin A, ceruloplasmin, haptoglobin, acid glycoprotein, tranferrin, albumin, light and heavy chain immunoglobulin G were quantified, comparing the profile of proteinograms from term to preterm lambs submitted to different protocols that stimulate respiratory activity. Six groups were used: PN (n= 9): born from normal birth; CN (n= 7): born from caesarean section at normal time of gestation; CP (n= 6): born from premature cesarean without any type of treatment; DEX (n= 9) preterm whose mothers received prepartum dexamethasone; SURF (n= 6) preterm treated with surfactant; DEXSURF (n= 6): preterm treated with surfactant whose mothers received prepartum dexamethasone. The evaluations were performed immediately after birth (M 0), after 24 and 48 hours (M 24 and M 48). Samples were processed with sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). Albumin, immunoglobulins, and serum total protein of the lambs were elevated, after colostrum ingestion. Higher serum transferrin values refer to a longer gestational period, and this protein may be used as a marker of neonatal maturation.(AU)

Serum amyloid A and muscle activity biomarkers in horses submitted to equestrian show jumping / Biomarcadores de amilóide sérica A e de atividade muscular em cavalos submetidos a salto equestre

The aim of this study was to evaluate the serum amyloid A (SAA) and biomarkers of muscle activity of horses submitted to show jumping activity. To do this, the variables SAA, glucose, lactate and the biomarkers creatine kinase (CK) and aspartate amino transferase (AST) were evaluated in 10 horses submitted to the show jumping exercise in a tournament for beginners. The evaluations occurred before exercise (T0), immediately after (T1), 30 minutes (T2), 60 minutes (T3) and 24 hours after the end (T4). Data were evaluated using analysis of variance for repeated measures. The statistical software SAEG 9.1 was used to verify the level of significance between the moments for P<0.05. Glucose presented a difference between the moments T0 (97.7±13.3mg/dL) and T1 (79.7±14.1mg/dL). Lactate presented elevation in T1 (15.3±6.1mmol/L) compared to the others T0 (3.8±0.8mmol/L), T2 (6.5±3.9mmol/L), T3 (5.3±2.2mmol/L) and T4 (5.1±1.6mmol/L). The CK showed a significant difference between T0 (82.8±51.2U/L) and T1 (140.1±58.5U/L) and between T4 (74.4±43.1U/L) with T1 (140.1±58.5U/L). The AST presented no difference between moments. The show jumping activity with one-meter obstacles did not induce changes in the SAA protein between the moments.(AU)

O objetivo deste estudo foi avaliar a amilóide sérica A (SAA) e biomarcadores de atividade muscular de equinos submetidos a atividade de salto, ou hipismo clássico. Para tanto, foram avaliadas as variáveis SAA, glicose, lactato e os biomarcadores creatina quinase (CK) e aspartatoaminotransferase (AST) em 10 equinos submetidos ao exercício de saltos em torneio para iniciantes. As avaliações ocorreram antes do exercício (T0), imediatamente após (T1), 30 minutos (T2), 60 minutos (T3) e 24 horas após o término (T4). Os dados foram avaliados utilizando análise de variância para medidas repetidas. O software estatístico SAEG 9.1 foi utilizado para verificar o nível de significância entre os momentos para P<0,05. A glicose diferenciou-se entre os momentos T0 (97.7±13.3mg/dL) e T1 (79.7±14.1mg/dL). O lactado apresentou elevação comparada com o momento T1(15.3±6.1mmol/L) e os demais T0 (3.8±0.8mmol/L), T2 (6.5±3.9mmol/L), T3 (5.3±2.2mmol/L) e T4 (5.1±1.6mmol/L). A CK mostrou diferença significativa entre T0 (82.8±51.2U/L) e T1 (140.1±58.5U/L) e entre T4 (74.4±43.1U/L) com T1 (140.1±58.5U/L). A AST não apresentou diferença entre os momentos. A atividade de hipismo clássico com obstáculos de um metro não induziu alterações na proteína SAA entre os momentos.(AU)

Concentrations of acute-phase proteins and immunoglobulins in serum and synovial fluid in clinically healthy heifers and steers / Concentração de proteínas de fase aguda e de imunoglobulinas no soro e no líquido sinovial de bovinos clinicamente saudáveis

The aim of the study was to determine the concentration pattern of intra-articular acute phase proteins (APPs) and immunoglobulins in healthy crossbred cattle. Synovial fluid (SF) samples were collected from the radiocarpal joint of 25 heifers and 25 steers. Concentrations of APPs were measured by SDS-PAGE. The results were submitted to analysis of variance using the SAS statistical program, and means were compared by the Student-Newman-Keuls test (P<0.05). Thirty-seven proteins with molecular weights ranging from 7 to 37kDa were identified in SF of all animals. Eight were nominally identified with immunoglobulin A (IgA) and G (IgG), ceruloplasmin (Cp), transferrin (Tf), albumin (Ab), α1-antitripsin (AAT), α1-acid glycoprotein (AGP), and haptoglobin (Hp). The α1-antitripsin was only identified in the Sf of the heifers. The SF values of Cp, Hp, AGP and IgA were significantly higher in heifers than in steers. In sera, 34 proteins with molecular weights between 7 and 244kDa were identified in heifers and steers. Similar proteins were nominally identified in the sera, however the α1-antitrypsin was identified only in SF. The serum values Tf, AGP and IgG were significantly higher in heifers compared with steers. In conclusion, the physiological acute-phase proteins concentrations in synovial fluid of healthy ruminants can be useful in the interpretation of samples from animals with joint diseases. The SF electrophoretic profile of healthy ruminants differs depending on gender. Similar proteins were nominally identified in the sera, but only the SF of α1-antitrypsin.(AU)

O objetivo do estudo foi determinar o padrão de concentração de proteínas de fase aguda e de imunoglobulinas intra-articulares (APPs) em bovinos mestiços saudáveis. As amostras de fluido sinovial (SF) foram coletadas da articulação radiocárpica de 25 novilhas e 25 novilhos. As concentrações de APPs foram mensuradas por SDS-PAGE. Os resultados foram submetidos à análise de variância usando o programa estatístico SAS, e os meios foram comparados pelo teste Student-Newman-Keuls (P<0,05). Trinta e sete proteínas com pesos moleculares variando de 7 a 37kDa foram identificadas no SF de todos os animais. Oito foram nominalmente identificadas como imunoglobulina A (IgA) e G (IgG), ceruloplasmina (Cp), transferrina (Tf), albumina (Ab), a1-antitripsina (AAT), glicoproteína a1-ácido (AGP) e haptoglobina (Hp). A α1-antitripsina foi identificada apenas no SF das novilhas. Os valores de Cp, Hp, AGP e IgA no SF foram significativamente maiores em novilhas do que em novilhos. No soro, 34 proteínas com pesos moleculares entre 7 e 244kDa foram identificadas nas novilhas e novilhos. Proteínas similares foram identificadas nos soros, mas apenas o SF das novilhas apresentou a α1-antitripsina. Os valores séricos de Tf, AGP e IgG foram significativamente maiores em novilhas em relação aos novilhos. Conclui-se que a mensuração das concentrações das proteínas da fase aguda no líquido sinovial de animais saudáveis pode ser útil na avaliação de amostras oriundas de bovinos com afecções articulares. O perfil eletroforético do SF de ruminantes saudáveis difere em função do gênero e as diferenças devem ser levadas em consideração na interpretação dos achados.(AU)

Human Immunity Against Campylobacter Infection

Campylobacter is a worldwide foodborne pathogen, associated with human gastroenteritis. The efficient translocation of Campylobacter and its ability to secrete toxins into host cells are the 2 key features of Campylobacter pathophysiology which trigger inflammation in intestinal cells and contribute to the development of gastrointestinal symptoms, particularly diarrhoea, in humans. The purpose of conducting this literature review is to summarise the current understanding of: i) the human immune responses involved in the elimination of Campylobacter infection and ii) the resistance potential in Campylobacter against these immune responses. This review has highlighted that the intestinal epithelial cells are the preliminary cells which sense Campylobacter cells by means of their cell-surface and cytosolic receptors, activate various receptors-dependent signalling pathways, and recruit the innate immune cells to the site of inflammation. The innate immune system, adaptive immune system, and networking between these systems play a crucial role in bacterial clearance. Different cellular constituents of Campylobacter, mainly cell membrane lipooligosaccharides, capsule, and toxins, provide protection to Campylobacter against the human immune system mediated killing. This review has also identified gaps in knowledge, which are related to the activation of following during Campylobacter infection: i) cathelicidins, bactericidal permeability-increasing proteins, chemokines, and inflammasomes in intestinal epithelial cells; ii) siglec-7 receptors in dendritic cell; iii) acute phase proteins in serum; and iv) T-cell subsets in lymphoid nodules. This review evaluates the existing literature to improve the understanding of human immunity against Campylobacter infection and identify some of the knowledge gaps for future research.

Evaluation of Point-of-Care Testing for C-Reactive Protein in Forensic Medicine

BACKGROUND: C-reactive protein (CRP) is an acute-phase protein whose level increases in response to tissue injury, infection, or other inflammation. It is used in clinical and forensic settings. Point-of-care (POC) testing has recently become available, and it is considered to be useful during postmortem examinations. However, laboratory testing of postmortem blood samples is difficult due to hemolysis and postmortem clotting. METHODS: The utility of POC testing for CRP during postmortem examination was evaluated using cardiac blood from the inferior vena cava. The whole blood sample was immediately tested using the POC instrument. Subsequently, the same sample was processed to obtain the serum, which was tested using common laboratory instruments. RESULTS: The postmortem POC test had a high positive predictive value and specificity, and the results strongly correlated with the laboratory test results. CONCLUSION: POC CRP testing is valid in postmortem examination and can be used in forensic medicine (postmortem inspection and autopsy).

Comparison of acute phase reactant levels of Kawasaki disease patients who visited with less than 5 days duration of fever and with 5 days or longer

PURPOSE: Kawasaki disease (KD) is a common, acute systemic vasculitis in children. Acute phase reactants (APRs) have been used to assist diagnosis, and to predict outcome in children with KD. However, it remains unknown on levels of APRs depending on duration of fever. We aimed to compare APR levels of children with KD who visited with < 5 days duration of fever and with ≥ 5 days. METHODS: Children (≤ 15 years) with complete KD who visited the emergency department were enrolled from March 2012 through February 2018. The children were divided into the early (fever < 5 days) and late (fever ≥ 5 days) presenters. The baseline characteristics, APR levels, such as platelet count, and outcomes were compared between the 2 groups. RESULTS: A total of 145 children with complete KD were enrolled. Median age was 27.0 (interquartile range [IQR], 12.0–46.5) months, and boys accounted for 60.0%. The early presenters (63 [43.4%]) had a younger age (17.0 [IQR, 7.0–45.0] vs. 32.5 [IQR, 14.0–48.0] months; P = 0.006), shorter duration of fever (3.0 [IQR, 2.0–4.0] vs. 6.0 [IQR, 5.0–7.0] days; P < 0.001), and a lower platelet count (336.7 ± 105.2 [× 10³/µL] vs. 381.6 ± 121.8 [× 10³/µL], P = 0.02) than the late presenters. The other APR levels, and frequency of resistance to intravenous immunoglobulin and coronary artery abnormalities showed no differences between the 2 groups. CONCLUSION: Children with KD who visited with < 5 days duration of fever had a lower platelet count compared to those with ≥ 5 days. No differences were found in the other APR levels and the outcomes. It may be necessary to consider the differences in APR levels depending on duration of fever when treating children with KD.

Predictores de Mortalidad en Infecciones de Pacientes Neutropénicos Febriles Críticos / Predictors of Mortality in Infections of Critical Febrile Neutropenic Patients

Introducción: La mortalidad relacionada a la neutropenia febril puede ser muy alta en ciertas poblaciones de alto riesgo. El objetivo del presente estudio fue identificar factores predictores tempranos de mortalidad en una cohorte de pacientes oncológicos con neutropenia febril admitidos en una unidad de cuidados intensivos (UCI). Métodos: Estudio observacional retrospectivo en pacientes con neutropenia febril mayores de 18 años ingresados en la UCI del Hospital Oncológico Solón Espinosa Ayala de Quito. Se recogieron variables sociodemográficas, clínicas, de laboratorio y microbiológicas de los registros clínicos al ingreso. Con dichas variables se construyeron modelos predictivos de mortalidad mediante análisis de regresión logística para identificar predictores de muerte. Resultados: Se registraron 107 pacientes con episodios de neutropenia febril, el 53.3 % de los casos presentaron neutropenia severa y en un 29.9 % de los casos la neutropenia duró más de 10 días. La prevalencia de bacteriemia fue del 34.6 %. El 34.6 % de los pacientes murieron (n=37), de estos el 22.4 % falleció en la UCI. Edad superior de 40 años, valores de procalcitonina superiores a 4 ng/ml, puntuaciones altas en APACHE II y la necesidad de apoyo ventilatorio se asociaron con mayor riesgo de muerte en el modelo multivariado; el valor predictivo en la validación interna tuvo una precisión de 81.3 %; sensibilidad de 63.6 %; especificidad de 90.5 %; valor predictivo positivo de 77.8 %; valor predictivo negativo de 82.6 %; área bajo la curva de 0.87. Conclusión: Factores como la edad mayor de 40 años, procalcitonina > 4 ug/ml al ingreso, valores de APACHE II y necesidad de ventilación mecánica están asociados con mayor riesgo de muerte.

Introduction: The mortality related to febrile neutropenia may be very high in certain populations. The aim of the present study was to identify early predictors of mortality in a cohort of oncologic patients with febrile neutropenia admitted to an intensive care unit (ICU). Methods: Retrospective observational study in patients with febrile neutropenia older than 18 years admitted to the intensive care unit of the "Solon Espinosa Ayala" Oncology Hospital in Quito. Sociodemographic, clinical, laboratory and microbiological variables were collected from clinical records at admission. With these variables, predictive mortality models were constructed usingclogistic regression analysis to identify predictors of death. Results: There were 107 episodes of febrile neutropenia, 53.3 % had severe neutropenia, and in 29.9 % of the cases neutropenia lasted more than 10 days. The prevalence of bacteremia was 34.6 %. 34.6 % of the patients died (n = 37), of which 22.4 % died in the ICU. A higher age of 40 years, procalcitonin values higher than 4 ng / ml, high APACHE II scores and the need for ventilatory support were associated with an increased risk of death in the multivariate model; The predictive value in the internal validation had an accuracy of 81.3 %; Sensitivity of 63.6 %; Specificity of 90.5 %; Positive predictive value of 77.8 %; Negative predictive value of 82.6 %; Area under the curve of 0.87. Conclusion: Factors such as age greater than 40 years, procalcitonin at admission > 4 ug/ml, APACHE II and requirement of mechanical ventilation support are associated with a higher risk of death.

Acute phase proteins in serum and cerebrospinal fluid in healthy cattle: possible use for assessment of neurological diseases / Proteínas de fase aguda no soro e no líquido cefalorraquidiano de bovinos hígidos: possíveis usos na avaliação de doenças neurológicas

Use of acute-phase proteins (APPs) for assessment of health and disease in animals has increased greatly within the last decade. The objective was to determine the normal concentration of APPs in the serum and cerebrospinal fluid (CSF) of healthy cattle by polyacrylamide gel electrophoresis. Fifty crossbred animals (350±70kg of BW and 18±1.2 months of age), 25 heifers and 25 steers were used. CSF samples were collected from atlanto-occipital (AO) site and blood samples were obtained from the jugular vein. CSF and serum protein electrophoresis were performed by means of sodium dodecyl sulphate-polyacrylamide gel electrophoresis. Thirty-seven proteins with molecular weights ranging from 7 and 37kDa were identified in CSF of all animals. These eight were nominally identified with immunoglobulin A and G, celuloplasmin, transferrin, albumin, α1-antitripsin, acidic glycoprotein, and haptoglobin. All protein fractions in CSF did not differ between heifers and steers. In sera, 34 proteins with molecular weights between 7 and 244kDa were identified in heifers and steers. Similar proteins were nominally identified in the sera, but only the CSF presented α1-antitripsin. The serum values of acidic glycoprotein and immunoglobulin G were significantly higher in steers compared with heifers. In conclusion, measurement of CSF acute phase protein concentrations can be useful in diagnosing and monitoring the progression of bovine neurological diseases, perhaps even to guide therapeutic procedures. The CSF electrophoretic profile of healthy cattle does not change depending on gender.(AU)

O uso de proteínas de fase aguda (PFAs) para a avaliação da saúde e da doença em animais de produção tem aumentado consideravelmente na última década. O objetivo deste estudo foi determinar a concentração normal de PAFs no soro e no líquido cefalorraquidiano (LCR) de bovinos sadios por meio da eletroforese em gel de poliacrilamida. Foram avaliados cinquenta animais mestiços (350±70kg de PV e 18±1,2 meses de idade), 25 novilhas e 25 novilhos. As amostras de LCR foram colhidas no espaço atlanto-occipital (AO) e as amostras de sangue obtidas da veia jugular. As PAFs do soro e do LCR foram determinadas através da eletroforese em gel poliacrilamida. Trinta e sete proteínas com pesos moleculares que variaram entre 7 e 37kDa foram identificadas no LCR de todos os animais, independente do sexo. Estas oito proteínas foram nominalmente identificadas como imunoglobulina A e G, ceruloplasmina, transferrina, albumina, α1-antitripsina, glicoproteína ácida, e haptoglobina. As frações de proteínas presentes no LCR não diferiram entre novilhas e novilhos. No soro de machos e fêmeas, 34 proteínas com pesos moleculares entre 7 e 244 kDa foram identificadas. As proteínas do soro foram similarmente identificadas, entretanto a α1-antitripsina foi identificada somente no LCR. Os valores séricos de glicoproteína ácida e imunoglobulina G foram significativamente mais elevados nas novilhas em comparação aos novilhos. Em conclusão, a determinação das concentrações de proteínas de fase aguda presentes do LCR pode ser útil no diagnóstico e monitoramento da progressão de doenças neurológicas bovinas, talvez possa ainda direcionar procedimentos terapêuticos. O perfil eletroforético do LCR de bovinos hígidos não se altera em função do sexo.(AU)

El valor de proteínas de fase aguda y la prueba LightCycler® SeptiFast en el diagnóstico de infecciones bacterianas y virales en niños / The value of acute phase reactants and LightCycler® SeptiFast test in the diagnosis of bacterial and viral infections in pediatric patients

Introducción. Evaluamos el nivel de reactantes de fase aguda y la prueba LightCycler® SeptiFast para diferenciar infecciones bacterianas vs.virales. Métodos. Estudio prospectivo en niños febriles. Se analizaron recuento de leucocitos, proteína C-reactiva y procalcitonina en días 1, 3 y 7 de hospitalización. El día 1 se realizaron hemocultivo y radiografía de tórax. Se evaluaron dos grupos de niños que presentaron infecciones bacterianas o virales. Resultados. Se incluyeron 94 niños febriles. La temperatura media de la fiebre fue significativamente más alta en niños con infecciones bacterianas que con infecciones virales (p < 0,001). En 34 (72,3%) niños con infecciones bacterianas, el hemocultivo fue negativo. De ellos, 12 (35,2%) presentaron prueba SeptiFast positiva. No hubo resultados positivos en hemocultivos de niños con infecciones virales y todos tuvieron resultado negativo para la prueba SeptiFast. La media de proteína C-reactiva el primer día de hospitalización fue significativamente más alta en el grupo con infecciones bacterianas (p < 0,001) y en los días 3 y 7 junto con la procalcitonina fueron significativamente más altas en niños con infecciones bacterianas (p <0,001). La sensibilidad y especificidad de los leucocitos, la proteína C-reactiva y la procalcitonina fueron 63,8%, 44,7%, 74,5% y 78,7%, 68,1% y 100%, respectivamente. Las áreas bajo la curva de los leucocitos, la proteína C-reactiva y la procalcitonina fueron 0,519, 0,764 y 0,835, respectivamente. Conclusiones. Los reactantes de fase aguda, en especial procalcitonina, y la prueba LightCycler® SeptiFast podrían ayudar a diferenciar infecciones bacterianas de virales.

Introduction: This study was performed to investigate the value of acute phase reactants and LightCycler® SeptiFast test to differentiate bacterial and viral infections. Population and methods: Children with fever were enrolled to this prospective study. Peripheral white blood cell (WBC), C-reactive protein (CRP) and procalcitonin (PCT) were studied from all patients on day 1, 3 and 7. Blood culture and chest X-ray were also obtained on day 1. Blood samples for LightCycler® SeptiFast test were obtained in all patients to use them if there was uncertain diagnosis between bacterial or viral infection. The patients were divided into two groups as bacterial and viral infection. Results: A total of 94 children with fever were enrolled. The mean value of fever was significantly higher in bacterial group than viral group (p <0.001). In bacterial infection group, 34 (72.3%) patients had negative blood culture. Of those, 12 (35.2%) had positive SeptiFast test. There were no positive blood culture in patients with viral infection group and all of them had negative SeptiFast test. The mean levels of CRP on the first day of admission were significantly higher in bacterial group than viral group (p <0.001). CRP and PCT levels of day 3 and 7 were significantly higher in bacterial group (p <0.001). The sensitivity and specificity levels of WBC, CRP and PCT were 63.8%, 44.7%, 74.5% and 78.7% ,68.1% and 100%, respectively. Conclusions: We found that acute phase reactants, especially PCT, and LightCycler® SeptiFast test may help to differentiate bacterial and viral infections.

Elimination half-lives of interleukin-6 and cytokine-induced neutrophil chemoattractant-1 synthesized in response to inflammatory stimulation in rats / 한국실험동물학회지

The elimination half-lives of in Interleukin-6 (IL-6) and cytokine-induced neutrophil chemoattractant-1 (CINC-1) in rats after inflammatory stimulation were investigated. Five male Sprague-Dawley rats were used (age, 9 weeks; body weight, 235–375 g). Turpentine oil was intramuscularly injected at a dose of 2 mL/kg body weight to induce acute inflammation. Blood was collected pre-injection and 6, 12, 24, 36, 48, 60, 72, 84, and 96 h after the turpentine oil injection. Serum concentrations of IL-6, CINC-1, and α₂-macroglobulin (α2M) were measured by enzyme-linked immunosorbent assay. Half-lives were calculated as 0.693/elimination rate constant. The serum concentration of α2M peaked at 48 h after turpentine oil injection. Serum concentrations of IL-6 and CINC-1 increased and peaked at 12 and 24 h, respectively. The terminal elimination half-lives of IL-6 and CINC-1 were 15.5 and 29.9 h, respectively. The half-life of CINC-1 was significantly longer than that of IL-6 (P=0.006). These results suggested that these cytokines synthesized in response to inflammatory stimulation were rapidly eliminated in rats. The serum concentrations of these cytokines should be measured at an early stage if these cytokines will be used as surrogate inflammatory markers instead of acute-phase proteins.

Monogenic Autoimmune Diseases

Monogenic autoimmune diseases (AD) present as lupus-like clinical manifestations with recurrent fever or various vasculopathies. Recurrent fever with an elevation of acute phase reactants and various skin lesions are similar in monogenic AD and autoinflammatory disease. The molecular pathogenesis of adult systemic erythematosus can be understood through monogenic AD based on gene defects: complement, apoptosis, interferonopathy via nucleic acid sensing, tolerance, rasopathies, and others. Skin vasculopathy with chilblains and livedo reticularis, interstitial lung disease, and panniculitis are common occurrences in type I interferonopathy. Some syndromes have been reported to present with autoimmune inflammation and the general clinical findings, including cerebral calcification. Various clinical manifestations in monogenic AD present in accordance with the gene loss- or gain-of-function mutations involved. The monogenic AD for the early onset of more severe lupus-like symptoms or vasculopathy needs to be considered. Furthermore, clinical trials were conducted via targeted therapy for related molecular pathways, because conventional treatments were not effective in managing monogenic AD.

Drug survival of tumor necrosis factor α inhibitors in patients with ankylosing spondylitis in Korea

BACKGROUND/AIMS: To evaluate drug survival of the tumor necrosis factor α inhibitors (TNFi) and risk factors for the drug discontinuation in patients with ankylosing spondylitis (AS). METHODS: We retrospectively evaluated 487 AS patients at a single tertiary hospital. Among the TNFi users, drug survival and risk factors of TNFi discontinuation were investigated. RESULTS: Among 487 patients, 128 AS patients were treated with at least one TNFi. Patients who were treated with TNFi were younger at disease onset, had more peripheral manifestations, and had higher level of acute phase reactants and body mass index than those of TNFi non-users at baseline. Of 128 patients, 28 patients (21.9%) discontinued first TNFi therapy during the follow-up period of 65.1 ± 27.9 months. In the multivariable analysis, female (hazard ratio [HR], 6.08; 95% confidence interval [CI], 2.27 to 16.27; p = 0.003), hip involvement (HR, 2.52; 95% CI, 1.08 to 5.87; p = 0.033) and a high C-reactive protein (CRP; HR, 1.10; 95% CI, 1.00 to 1.21; p = 0.044) were risk factors for drug discontinuation. Etanercept showed better survival rate than infliximab. The main reason for discontinuation of TNFi was inefficacy. CONCLUSIONS: TNFi discontinuation rate of Korean patients with AS seems to be similar to those with the European patients. Female sex, hip involvement, CRP, and the type of TNFi were associated with TNFi discontinuation.

Serum concentrations of acute phase proteins in goats and ewes with naturally acquired Staphylococcus aureus mastitis / Concentração de proteínas de fase aguda em cabras e ovelhas com mastite de ocorrência natural causada por Staphylococcus aureus

Serum protein concentrations, including acute phase proteins (APPs), of goats and ewes with naturally acquired Sthaphylococcus aureus mastitis were determined by means of SDS-PAGE electrophoresis to evaluate the relevance of these APPs as biomarkers of the disease in these species. Fifteen healthy goats and 5 goats with naturally acquired staphylococci mastitis, as well as fifteen healthy ewes and 5 ewes with staphylococci mastitis were submitted to daily blood sampling during 7 days. In goats, an increase of 570%, 125%, 621%, and 279% in serum concentrations of ceruloplasmin, fibrinogen, haptoglobin and α1-acid glycoprotein, respectively, was observed. In sheep the increase in serum concentrations of ceruloplasmin, fibrinogen, haptoglobin and α1-acid glycoprotein was of 337%, 90%, 461%, and 225%, respectively. Our results indicate that these APPs have considerable potencial as early and sensible biomarkers of mastitis caused by S. aureus in goats and sheep.(AU)

O proteinograma, incluindo proteínas de fase aguda (PFAs), de cabras e ovelhas com mastite de origem natural causada por Staphylococcus aureus, foi determinado por meio de eletroforese em gel de poliacrilamida contendo dodecil sulfato de sódio (SDS-PAGE) a fim de avaliar a importância destas PFAs como biomarcadores da enfermidade nestas espécies. Amostras de sangue foram colhidas diariamente de cinco cabras e cinco ovelhas com mastite estafilocócica naturalmente adquirida, bem como de quinze cabras e quinzes ovelhas saudáveis durante 6 dias consecutivos. Nas fêmeas caprinas, foi verificado aumento dos teores séricos de ceruloplasmina (570%), fibrinogênio (125%), haptoglobina (621%), e α1-glicoproteína ácida (279%). Nas fêmeas ovinas as concentrações de ceruloplasmina, fibrinogênio, haptoglobina e α1-glicoproteína ácida elevaram-se em 337%, 90,9%, 461% e 225%, respectivamente. Os resultados permitem inferir que estas PFAs são marcadores sensíveis e precoces de mastite causada por S. aureus em cabras e ovelhas.(AU)