Tejido adiposo epicárdico en personas que viven con VIH: ¿una ventana hacia el riesgo cardiovascular? / Epicardial adipose tissue in people living with HIV: a window towards cardiovascular risk?

Introducción: En las personas que viven con el virus de la inmunodeficiencia humana (PVVIH) se han descripto desregulaciones metabólicas que podrían vincularse a un mayor riesgo cardiovascular.Objetivo: Evaluar el espesor del tejido adiposo epicárdico (ETAE) y la relación del mismo con parámetros clínicos y bioquímicos de riesgo cardiovascular en adultos que viven con VIH, comparados con controles seronegativos.Materiales y métodos: Observacional, inclusión prospectiva. Se incluyeron PVVIH >18 años y controles seronegativos para VIH, a los cuales se les midió el espesor de TAE en dos ejes por ecocardiograma transtorácico, así como el espesor de íntima media carotídea por ecografía doppler color.Resultados: 75 pacientes, 58,7% del sexo masculino, edad de 36 años (RIQ 22). 50,7% con VIH (CD4+: 512 cél/mm3 RIQ 382; 80% indetectables). IMC de 25,2 kg/m2 (RIQ 5,3) y circunferencia de cintura de 88,5 cm (DS 12,4), sin diferencias. Las PVVIH tuvieron menor HDL, mayor proteína C reactiva, mayor dímero D y mayor glucemia en ayunas. El ETAE fue mayor en las PVVIH (4,05 vs. 3,49 mm p=0,021), y se correlacionó con la edad, glucemia en ayunas y dímero D. En las PVVIH, se correlacionó con insulinemia, índice HOMA2-IR, HDL-c y dímero D. El tratamiento con Efavirenz se asoció a un mayor ETAE.Conclusión: Las PVVIH presentaron mayor inflamación sistémica de bajo grado y un mayor espesor de TAE que los controles sanos, el cual se asoció en este grupo a insulinorresistencia

Introduction: For people living with Human Immunodeficiency Virus (PLHIV), metabolic deregulations have been described, which could be related to a higher cardiovascular risk.Objective: To assess the epicardial adipose tissue thickness (EATT), and the relationship between this value and clinical and biochemical parameters of cardiovascular risk in adults living with HIV, if compared to a healthy control group. Methods: Observational, with prospective inclusion. It included PLHIV >18 years and seronegative controls. All of them had their EAT measured in two axes by transthoracic echocardiogram, as well as the carotid intima-media thickness determined by color doppler ultrasound.Results: 75 patients, 58.7% male, age of 36 years (RIQ 22). 50.7% patients with HIV (CD4+ of 512 cells/mm3; and 80% undetectable). BMI was of 25.2 kg/m2 and waist circumference of 88.5 cm, without between-groups differences. PLHIV had lower HDL, higher C reactive protein, higher D-dimer and higher fasting blood glucose. EATT was higher in PLHIV (4.05 vs 3.49 mm, p=0.021), and this correlated with age, fasting blood glucose and D-dimer. In PLHIV, it correlated with insulinemia, HOMA2-IR index, HDL-c ; and D-dimer. Treatment with Efavirenz was associated with a higher EATT.Conclusion: PLHIV presented increased systemic inflammation of low grade and higher EATT than the seronegative control group. EATT was associated in PLHIV to insulin resistance

Gut dysbiosis, inflammation and type 2 diabetes in mice using synthetic gut microbiota from diabetic humans / Disbiose intestinal, inflamação e diabetes tipo 2 em camundongos usando microbiota intestinal sintética de humanos diabéticos

Abstract The study was aimed to assess impact of high fat diet (HFD) and synthetic human gut microbiota (GM) combined with HFD and chow diet (CD) in inducing type-2 diabetes (T2D) using mice model. To our knowledge, this is the first study using selected human GM transplantation via culture based method coupled dietary modulation in mice for in vivo establishment of inflammation leading to T2D and gut dysbiosis. Twenty bacteria (T2D1-T2D20) from stool samples of confirmed T2D subjects were found to be morphologically different and subjected to purification on different media both aerobically and anerobically, which revealed seven bacteria more common among 20 isolates on the basis of biochemical characterization. On the basis of 16S rRNA gene sequencing, these seven isolates were identified as Bacteroides stercoris (MT152636), Lactobacillus acidophilus (MT152637), Lactobacillus salivarius (MT152638), Ruminococcus bromii (MT152639), Klebsiella aerogenes (MT152640), Bacteroides fragilis (MT152909), Clostridium botulinum (MT152910). The seven isolates were subsequently used as synthetic gut microbiome (GM) for their role in inducing T2D in mice. Inbred strains of albino mice were divided into four groups and were fed with CD, HFD, GM+HFD and GM+CD. Mice receiving HFD and GM+modified diet (CD/HFD) showed highly significant (P<0.05) increase in weight and blood glucose concentration as well as elevated level of inflammatory cytokines (TNF-α, IL-6, and MCP-1) compared to mice receiving CD only. The 16S rRNA gene sequencing of 11 fecal bacteria obtained from three randomly selected animals from each group revealed gut dysbiosis in animals receiving GM. Bacterial strains including Bacteroides gallinarum (MT152630), Ruminococcus bromii (MT152631), Lactobacillus acidophilus (MT152632), Parabacteroides gordonii (MT152633), Prevotella copri (MT152634) and Lactobacillus gasseri (MT152635) were isolated from mice treated with GM+modified diet (HFD/CD) compared to strains Akkermansia muciniphila (MT152625), Bacteriodes sp. (MT152626), Bacteroides faecis (MT152627), Bacteroides vulgatus (MT152628), Lactobacillus plantarum (MT152629) which were isolated from mice receiving CD/HFD. In conclusion, these findings suggest that constitution of GM and diet plays significant role in inflammation leading to onset or/and possibly progression of T2D. .

Resumo O estudo teve como objetivo avaliar o impacto da dieta rica em gordura (HFD) e da microbiota intestinal humana sintética (GM) combinada com HFD e dieta alimentar (CD) na indução de diabetes tipo 2 (T2D) usando modelo de camundongos. Para nosso conhecimento, este é o primeiro estudo usando transplante de GM humano selecionado através do método baseado em cultura acoplada à modulação dietética em camundongos para o estabelecimento in vivo de inflamação que leva a T2D e disbiose intestinal. Vinte bactérias (T2D1-T2D20) de amostras de fezes de indivíduos T2D confirmados verificaram ser morfologicamente diferentes e foram submetidas à purificação em meios diferentes aerobicamente e anaerobicamente, o que revelou sete bactérias mais comuns entre 20 isolados com base na caracterização bioquímica. Com base no sequenciamento do gene 16S rRNA, esses sete isolados foram identificados como Bacteroides stercoris (MT152636), Lactobacillus acidophilus (MT152637), Lactobacillus salivarius (MT152638), Ruminococcus bromii (MT152639), Klebsiella aerogenides (MT152640), Bacteroides fragilis (MT152909), Clostridium botulinum (MT152910). Esses sete isolados foram, posteriormente, usados ​​como microbioma intestinal sintético (GM) por seu papel na indução de T2D em camundongos. Linhagens consanguíneas de camundongos albinos foram divididas em quatro grupos e foram alimentadas com CD, HFD, GM + HFD e GM + CD. Camundongos que receberam a dieta modificada com HFD e GM + (CD / HFD) mostraram um aumento altamente significativo (P < 0,05) no peso e na concentração de glicose no sangue, bem como um nível elevado de citocinas inflamatórias (TNF-α, IL-6 e MCP-1) em comparação com os ratos que receberam apenas CD. O sequenciamento do gene 16S rRNA de 11 bactérias fecais obtidas de três animais selecionados aleatoriamente de cada grupo revelou disbiose intestinal em animais que receberam GM. Cepas bacterianas, incluindo Bacteroides gallinarum (MT152630), Ruminococcus bromii (MT152631), Lactobacillus acidophilus (MT152632), Parabacteroides gordonii (MT152633), Prevotella copri (MT152634) e Lactobacillus Gasseri (MT152635D), foram tratadas com dieta modificada / CD) em comparação com as linhagens Akkermansia muciniphila (MT152625), Bacteriodes sp. (MT152626), Bacteroides faecis (MT152627), Bacteroides vulgatus (MT152628), Lactobacillus plantarum (MT152629), que foram isoladas de camundongos recebendo CD / HFD. Em conclusão, esses resultados sugerem que a constituição de GM e dieta desempenham papel significativo na inflamação levando ao início ou/e possivelmente à progressão de T2D.

Ovariectomy exacerbates glycerol-induced acute kidney injury in rats / A ovariectomia intensifica a lesão renal aguda induzida pelo glicerol em ratas

Objective: This study aimed to evaluate the effects of ovariectomy on glycerol-induced renal changes in rats. Methods: Twenty-four female Wistar rats were submitted to ovariectomized (OVX) or sham surgery. One week after surgery, the animals received an intramuscular injection (8ml/kg) of 50% glycerol or saline (0.15 M) solution. These animals were divided into the following groups (n=6 per group): Sham, sham-operated female rats injected with saline; OVX, ovariectomized female rats injected with saline; Sham+Gly, sham-operated female rats injected with glycerol; OVX+Gly, ovariectomized female rats injected with glycerol. All rats were euthanized 3 days after the injections and the kidneys were removed for histological and immunohistochemical studies. Blood and urine samples were also collected for renal function studies. Results: The OVX+Gly group presented higher creatinine serum levels, as well as greater fractional excretion of sodium and urinary flow than the Sham+Gly group. Histological lesions and tubulointerstitial staining for macrophages, nuclear factor-kappa B, and nitrotyrosine were more pronounced in the renal cortex of the OVX+Gly group compared to the Sham+Gly group. Conclusion: We conclude that ovariectomy aggravated changes in renal function and structure in glycerol-induced acute kidney injury by the intensification of the proinflammatory tissue response.

Objetivo: Avaliar os efeitos da ovariectomia nas alterações renais induzidas pelo glicerol em ratas. Métodos: Vinte e quatro ratas Wistar foram submetidas à ovariectomia (OVX) ou cirurgia sham (intervenção falsa). Uma semana após a cirurgia, os animais receberam injeção intramuscular (8ml/kg) de glicerol a 50% ou solução salina (0,15 M). As ratas foram divididas nos seguintes grupos (n=6 por grupo): Sham, fêmeas sham-operadas e injetadas com solução salina; OVX, fêmeas ovariectomizadas e injetadas com solução salina; Sham+Gly, fêmeas sham-operadas e injetados com glicerol; OVX+Gly, fêmeas ovariectomizadas e injetadas com glicerol. Todas as ratas foram eutanasiadas 3 dias após as injeções e os rins foram removidos para estudos histológicos e imuno-histoquímicos. Amostras de sangue e urina também foram coletadas para estudos de função renal. Resultados: O grupo OVX+Gly apresentou maiores níveis séricos de creatinina, assim como maiores fração de excreção de sódio e fluxo urinário do que o grupo Sham+Gly. As lesões histológicas e imunomarcação tubulointersticial para macrófagos, fator nuclear-kappa B e nitrotirosina foram mais pronunciadas no córtex renal do grupo OVX+Gly em comparação ao grupo Sham+Gly. Conclusão: Concluímos que a ovariectomia agravou as alterações na função e estrutura renal, na lesão renal aguda induzida por glicerol, pela intensificação da resposta tecidual pró-inflamatória.

A dieta inflamatória não está associada à qualidade do sono de estudantes universitários adultos jovens de uma cidade do Nordeste do Brasil / Inflammatory diet is not associated with sleep quality of young adult university students from a city in Northeast Brazil

Introdução: Estudantes universitários da área de saúde apresentam uma rotina que exacerba inadequações no estilo de vida e sono, as quais contribuem para um estado de inflamação crônica de baixo grau. Objetivo: investigar se há associação entre o consumo de uma dieta pró-inflamatória e a qualidade do sono de estudantes universitários. Materiais e métodos: Estudo transversal, com amostra de conveniência que incluiu 102 universitários, com 18 ou mais anos de idade, recrutados entre março de 2019 e março de 2020, matriculados em cursos de Nutrição de universidades públicas e privadas da cidade de Fortaleza. A qualidade do sono foi avaliada por meio da escala Pittsburgh Sleep Quality Index (PSQI) ou Índice de Qualidade do Sono de Pittsburgh, validado no Brasil (PSQI-BR). O consumo alimentar foi investigado a partir de um questionário de frequência alimentar. Foi determinado o Padrão Empírico de Inflamação da Dieta (EDIP-SP), validado para o Brasil, o qual quantifica ingestão de carnes processadas, verduras, legumes, frutas, arroz e feijão. Também foi determinada a presença de inflamação crônica por meio dos marcadores proteína C-reativa e Relação Neutrófilo/Linfócito. Resultados: A alimentação consumida é, em média, anti-inflamatória (-1,57 ± 0,69). Apenas 1,96% dos avaliados tinha boa qualidade do sono; 75,49% apresentavam distúrbio do sono. Não houve associação entre o EDIP-SP e os marcadores inflamatórios investigados, nem com a qualidade do sono. Discussão: A maioria dos estudantes apresentou má qualidade do sono e dieta anti-inflamatória. Esta homogeneidade pode ter determinado a ausência de associação e correlações. Conclusões: Os estudantes universitários avaliados têm má qualidade do sono, mas ingerem dieta anti-inflamatória, sem associação entre estas duas variáveis(AU)

Introduction: University students in the health area have a routine that exacerbates inadequacies in lifestyle and sleep, which contribute to a state of chronic low-grade inflammation. Objective: to evaluate whether there is an association between the consumption of pro-inflammatory diet and the sleep quality of university students. Material and Methods: Cross-sectional study, with a convenience sample that included 102 university students, aged 18 or over, recruited between March 2019 and March 2020, enrolled in Nutrition courses at public and private universities in the Fortaleza city. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), validated in Brazil (PSQI-BR). Food consumption was investigated using a food frequency questionnaire, and the Empirical Dietary Inflammation Pattern (EDIP-SP), validated by Brazil. The EDIP-SP quantifies the intake of processed meats, vegetables, fruits, rice and beans. The presence of inflammation was also determined through the markers C-reactive protein and Neutrophil/ Lymphocyte Ratio. Results: The food consumed is, on average, anti-inflammatory (-1.57 ± 0.69). Only 1.96% of those evaluated had good sleep quality; 75.49% had a sleep disorder. There was no association between EDIPSP and the inflammatory markers investigated, nor with sleep quality. Discussion: Most students had poor sleep quality and anti-inflammatory diet. This homogeneity may have determined the absence of association and correlations. Conclusions: The evaluated university students have poor sleep quality, but eat an antiinflammatory diet, with no association between these two variables(AU)

Analysis of the biocompatibility of a biocelulose and a poly L- lactic acid membrane

The use of selective barriers as resorbable membranes has become a routine clinical procedure for guided bone regeneration. Therefore, the production of membranes with a low inflammatory potential during their resorption process has become the goal of a considerable number of researches. Aim: The purpose of the present study was to evaluate the biocompatibility of poly (L- lactic acid) (PLLA) and biocelulose membranes (BC) inserted in the subcutaneous tissue on the dorsum of rats. Methods: Fifteen animals underwent surgical procedures for the insertion of 4 types of membranes: COL (Collagen membrane) ­ Control Group; BC (Biocellulose membrane); BCAg (Biocellulose membrane impregnated with Silver); PLLA (Poly (L-lactic acid) membrane). All membrane types were inserted into each animal. Animals were euthanized after 3, 7, and 15 days of the surgical procedure. Descriptive histological analyses were carried out to investigate host tissue reaction to membrane presence by assessing the anti-inflammatory process composition associated with the membrane resorption and the presence of foreign-body reaction or encapsulation. Results: The BC membranes showed a higher degree of inflammation and poor pattern of integration with the surrounding tissues than the PLLA and COL membranes. Conclusion: The PLLA and COL membranes present better biocompatibility than the BC membranes

Riscos de infecção por SARS-CoV-2 e COVID-19 em mulheres com síndrome dos ovários policísticos / Risks of SARS-CoV-2 and COVID-19 infection in women with polycystic ovary syndrome

Esta revisão narrativa teve como objetivo avaliar possíveis riscos da associação entre a infecção por SARS-CoV-2 (causa da COVID-19) e as características metabólicas e endócrinas frequentemente encontradas em mulheres com a síndrome dos ovários policísticos (SOP). A COVID-19 é mais grave em indivíduos com obesidade, diabetes mellitus, dislipidemia e hipertensão arterial. Como essas condições são comorbidades comumente associadas à SOP, foi hipotetizado que mulheres com SOP teriam maior risco de adquirir COVID-19 e desenvolver formas clínicas mais graves da doença. Considerando vários estudos epidemiológicos, a presente revisão mostra que mulheres com SOP têm risco 28% a 50% maior de serem infectadas pelo vírus SARS-CoV-2 em todas as idades e que, nessas mulheres, a COVID-19 está associada a maiores taxas de hospitalização, morbidade e mortalidade, especialmente naquelas com alterações no metabolismo de carboidratos e lipídios, hiperandrogenemia e aumento do tecido adiposo visceral. Os mecanismos que explicam o maior risco de infecção por COVID-19 em mulheres com SOP são considerados.(AU)

O índice de massa corporal tem algum papel na atividade inflamatória na artrite reumatoide / Does the body mass index have any role in inflammatory activity in rheumatoid arthritis?

Artrite reumatoide é doença reumática autoimune e crônica. Acredita-se que a obesidade pode intervir nos seus parâmetros inflamatórios. O objetivo deste estudo foi verificar se existe correlação entre atividade inflamatória dela e o índice de massa corporal (IMC).É estudo transversal retrospectivo nos quais foram obtidos dados de biometria (peso e altura) para cálculo do IMC e de atividade inflamatória. Estudaram-se 676 pacientes (87,5% mulheres com mediana de idade de 59,6 anos). Nesta população, 1,3% estava abaixo do peso normal; 28,1% dentro do peso normal; 35,3% sobrepeso; 31% obesidade grau I e 4,1% obesidade grau 2. Encontrou-se fraca correlação entre o DAS 28-PCR com o IMC. Correlações com os demais parâmetros de inflamação foram não significantes. Em conclusão existe alta proporção de pacientes com artrite reumatoide acima do peso normal e fraca correlação entre IMC e DAS28-PCR

Rheumatoid arthritis is an autoimmune and chronic rheumatic disease. It is believed that obesity can intervene in its inflammatory parameters. The objective of this study was to verify if there is a correlation between her inflammatory activity and the body mass index (BMI). It is a retrospective cross-sectional study in which biometric data (weight and height) were obtained to calculate BMI and inflammatory activity. We studied 676 patients (87.5% women with a median age of 59.6 years). In this population, 1.3% were underweight; 28.1% within normal weight; 35.3% overweight; 31% grade I obesity and 4.1% grade 2 obesity. We found a weak correlation between DAS 28-CRP and BMI. Correlations with the other inflammation parameters were not significant. In conclusion, there is a high proportion of patients with rheumatoid arthritis above normal weight and a weak correlation between BMI and DAS28-CRP

Qual é a influência da microbiota na obesidade e em seu quadro inflamatório? / What is the influence of microbiota on obesity and its inflammatory involvement?

A obesidade tem causa multifatorial que atinge atualmente mais da metade da população brasileira. Mais recentemente, a microbiota intestinal foi considerada um fator que contribui para essa condição. Os objetivos deste estudo foram revisar a influência da microbiota intestinal na obesidade e no processo inflamatório, e analisar os efeitos da utilização dos pré e probióticos. Foi realizada revisão sistemática sobre o assunto. Dos mais de 27.000 artigos, apenas 16 respeitaram os critérios de inclusão. Em conclusão, o desequilíbrio da microbiota aparece como fator favorável ao desenvolvimento da obesidade e do quadro inflamatório decorrente dela. Tanto o uso de prebióticos quanto probióticos são recursos válidos no tratamento da obesidade, porém os primeiros parecem proporcionar melhor qualidade de vida.

Obesity has a multifactorial etiological condition that involves more than half of the Brazilian population. More recently, the intestinal microbiota was considered a factor that contributes to this condition. The aims of this study were to review the intestinal microbiota influence in the obesity and in the inflammatory response, and to analyze the effects of using prebiotic and probiotic medications. A systematic review was firstly done. More than 27,000 articles were found, but only 16 contained the proper criteria. In conclusion, the microbiota imbalance seems to increase the obesity development and its inflammatory aspects. Both the use of pre and probiotics are good options in the obesity treatment, though the first ones seem to enhance bettere quality of life.

Relação da psoríase com doenças cardiovasculares: uma revisão integrativa / Relation between psoriasis and cardiovascular diseases: An integrative review

Psoriasis is an autoimmune disease that courses with chronic inflammation of the skin and exaggerated growth of keratinocytes, with a decrease in life expectancy mainly due to cardiovascular diseases. However, cardiometabolic conditions are poorly investigated. The objective of this study was to verify the relationship between psoriasis and cardiovascular diseases, seeking to answer: "What is the relationship between chronic inflammation present in psoriasis and cardiovascular diseases?" It is an integrative review using the PubMed platform and the descriptors "Psoriasis", "Cardiovascular diseases" and "Risk factors", with the boolean "AND." Was obtained 72 articles that, after analysis and exclusion, resulted in 12 publications. In conclusion, there was a relationship between several metabolic cytokines and those involved in the pathophysiology of psoriasis, directly associated with increased cardiovascular risks, due to chronic inflammation.

Psoríase é doença autoimune que cursa com inflamação crônica da pele e crescimento exagerado de queratinócitos, tendo a diminuição da expectativa de vida principalmente por doenças cardiovasculares. Contudo, as condições cardiometabólicas são pouco investigadas. O objetivo deste estudo foi verificar a relação entre a psoríase e as doenças cardiovasculares procurando responder: "Qual a relação da inflamação crônica presente na psoríase com as doenças cardiovasculares?". É revisão integrativa utilizando a plataforma PubMed e os descritores "Psoríase", "Doenças cardiovasculares" e "Fatores de risco", com o booleano "AND". Obteve-se 72 artigos que, após análise e exclusão, resultaram em 12 publicações. Em conclusão, observou-se relação entre várias citocinas metabólicas e envolvidas na fisiopatologia da psoríase, diretamente associadas ao aumento dos riscos cardiovasculares, devido a um quadro de inflamação crônica.

Echocardiographic epicardial fat thickness and immature granulocyte are novel inflammatory predictors of acute ischemic stroke: a prospective study

ABSTRACT BACKGROUND: Acute ischemic stroke (AIS) is the most common type of stroke. Inflammation is the primary factor in the pathogenesis of atherosclerosis. Use of immature granulocytes (IGs) has been recommended as a new indicator of systemic inflammation. However, data on the association between echocardiographic epicardial fat tissue thickness (EFT) and IGs in patients with AIS are limited. OBJECTIVE: To evaluate the association between the presences of IGs, epicardial fat tissue and AIS. DESIGN AND SETTING: Prospective study in a tertiary-care university hospital in Antalya, Turkey. METHODS: Our study included 53 AIS patients and 41 healthy controls with age and gender compatibility. Blood samples and transthoracic echocardiography of all participants were compared. RESULTS: IG levels were significantly higher in patients with AIS than in controls (0.62 ± 0.36 versus 0.28 ± 0.02, P < 0.001). The mean EFT was 3.74 ± 0.61 mm in the control group and 6.33 ± 1.47 mm in the AIS patient group. EFT was significantly greater in AIS patients than in controls (P < 0.001). For the optimum cut-off value for IG (0.95), the area under the curve (AUC) was determined to be 0.840; sensitivity was determined to be 81.1% and specificity, 92.5%. For the optimum cut-off value for EFT (4.95 mm), the AUC was determined to be 0.953; sensitivity was determined to be 90.6% and specificity, 90%. CONCLUSIONS: IG and echocardiographic EFT are clinical markers that can be used to predict AIS risk.

Parámetros del líquido amniótico para diagnóstico de respuesta inflamatoria en parto pretérmino / Amniotic fluid parameters for the diagnosis of inflammatory response in preterm delivery

OBJETIVO: Evaluar el rendimiento del Gram, la glucosa y los leucocitos en líquido amniótico para el diagnóstico de respuesta inflamatoria fetal y materna en pacientes con parto pretérmino. MÉTODO: Estudio de rendimiento de pruebas diagnósticas. Se incluyeron 63 pacientes a quienes se les realizó amniocentesis por sospecha de infección intraamniótica. Se estudió la placenta y se comparó con el Gram, la glucosa y el recuento de leucocitos en líquido amniótico para ver su relación con la respuesta inflamatoria. Se evaluaron la sensibilidad, la especificidad, las razones de verosimilitud (LR, likelihood ratio), los valores predictivos y el valor de kappa. RESULTADOS: Las pruebas con mejor rendimiento fueron en conjunto la glucosa 50/mm3 en líquido amniótico, con una especificidad del 94,3% (intervalo de confianza del 95% [IC95%]: 84,6-98,1), LR + 8,83 (IC95%: 2,5-31,2) y kappa de 0,48 (IC95%: 0,15-0,82). También se consideró la propuesta de un nuevo punto de corte para el recuento de leucocitos en líquido amniótico en la respuesta inflamatoria fetal. CONCLUSIONES: La combinación del recuento de leucocitos en líquido amniótico y los valores de glucosa mejora el rendimiento para el diagnóstico de respuesta inflamatoria fetal en comparación con la histopatología de la placenta, lo que proporciona información útil para el enfoque de los recién nacidos.

OBJECTIVE: To evaluate the performance of Gram, glucose and leukocytes in amniotic fluid for the diagnosis of fetal and maternal inflammatory response in patients with preterm delivery. METHOD: A diagnostic performance test study was carried out. Sixty-three patients with preterm labor were included who underwent amniocentesis due to suspected intra-amniotic infection. Histopathology of the placenta was studied and compared with the Gram result, glucose and leukocyte count in amniotic fluid, and their relationship with the maternal and fetal inflammatory response. Sensitivity, specificity, likelihood ratios, predictive values, and kappa were evaluated. RESULTS: The tests with the best performance were overall glucose 50/mm3 in amniotic fluid for the diagnosis of the fetal inflammatory response, with a specificity of 94.3% (95% confidence interval [95% CI]: 84.6-98.1%), likelihood positive ratio 8.83 (95% CI: 2.5-31.2) and kappa of 0.48 (95% CI: 0.15-0.82). A new cut-off point for leukocyte count in amniotic fluid to diagnose fetal inflammatory response was proposed. CONCLUSIONS: The combination of amniotic fluid leukocyte count and amniotic fluid glucose values improves performance for the diagnosis of inflammatory response compared with placental histopathology, providing useful information for newborns approach.

Association between inflammatory molecules, nitric oxide metabolites and leg ulcers in individuals with sickle cell anemia

Abstract Introduction Leg ulcers (LUs) are relatively common in patients with sickle cell anemia (SCA). The role of inflammation and nitric oxide (NO) pathways in the pathophysiology of the LU is not understood. Objective The aim of this study was to verify the association between inflammatory molecules and nitric oxide metabolites (NOx) and the occurrence of the LU in patients with SCA. Method It was a cross-sectional study on adult participants with SCA followed at Fundação Hemominas, a public blood center in Brazil. Eligible participants were recruited and included in one of two groups: Group 1, comprised of cases with SCA (Hb SS) and at least one LU at the time of inclusion in the study and Group 2, comprised of controls with SCA without a history of LU, matched by sex and age to cases. Participants were interviewed to obtain sociodemographic data and blood samples were collected. Clinical and laboratory data were abstracted from medical records. Nitric oxide metabolites (NOx) and inflammatory molecules were quantified using an immunoassay and Multiplex xMAP® technology, respectively. Eighty-seven individuals were included, ranging in age from 17 to 61 years (mean 40 ± 10.7 years); 30 had LU and 57 were controls without LU. Results Participants with LU had significantly higher levels of interleukin 8 (IL-8), IL-10, IL-15, NOx and platelet and white blood cell (WBC) counts, when compared to those without LU. Participants with LU had a significantly higher risk of having a history of osteomyelitis and a higher use of antiseptic soap in bathing, when compared to those without LU. Conclusion In conclusion, our results showed that NOx, inflammatory molecules and hematological features were associated with LU in Brazilian adults with SCA.

Role of systemic corticosteroids in orbital cellulitis: a meta-analysis and literature review / Papel dos corticosteroides sistêmicos na celulite orbitária: uma metanálise e revisão da literatura ,

Abstract Introduction: The standard management of orbital cellulitis is to administer a combination of intravenous broad-spectrum antibiotics along with treatment of associated sinusitis. Objective: The purpose of this study was to evaluate whether the addition of corticosteroids could lead to earlier resolution of inflammation and improve disease outcome. Methods: We independently searched five databases (PubMed, SCOPUS, Embase, the Web of Science, and the Cochrane database) for studies published as recent as December 2019. Of the included studies, we reviewed orbital cellulitis and disease morbidity through lengths of hospitalization, incidence of surgical drainage, periorbital edema, vision, levels or C-reactive protein, and serum WBC levels in order to focus on comparing steroid with antibiotics treated group and only antibiotics treated group. Results: Lengths of hospitalization after admission as diagnosed as orbital cellulitis (SMD = −4.02 [−7.93; −0.12], p -value = 0.04, I2 = 96.9%) decrease in steroid with antibiotics treated group compared to antibiotics only treated group. Incidence of surgical drainage (OR = 0.78 [0.27; 2.23], p -value = 0.64,I2 = 0.0%) was lower in the steroid with antibiotics treated group compared to the antibiotics only treated group. Conclusion: Use of systemic steroids as an adjunct to systemic antibiotic therapy for orbital cellulitis may decrease orbital inflammation with a low risk of exacerbating infection. Based on our analysis, we concluded that early use of steroids for a short period can help shorten hospitalization days and prevent inflammation progression.

Resumo Introdução: O tratamento padrão da celulite orbitária inicia-se com uma combinação de antibióticos intravenosos de amplo espectro concomitante ao tratamento do seio comprometido. Objetivos: O objetivo deste estudo foi avaliar se a adição de corticosteroides poderia levar a uma resolução mais precoce da inflamação e melhorar o desfecho da doença. Método: Fizemos uma pesquisa independente em cinco bancos de dados (PubMed, SCOPUS, Embase, Web of Science e o banco de dados Cochrane) em busca de estudos publicados até dezembro de 2019. Dos estudos incluídos, revisamos a celulite orbitária e a morbidade da doença através dos períodos de internação, incidência de drenagem cirúrgica, edema periorbital, visão, níveis de proteína C-reativa e níveis séricos de leucócitos com foco na comparação do grupo tratado com esteroides e antibióticos e do grupo tratado apenas com antibióticos. Resultados: Os tempos de internação após a admissão dos diagnosticados com celulite orbitária (SMD = -4,02 [-7,93; -0,12], p-valor = 0,04, I2 = 96,9%) diminuíram no grupo tratado com esteroides e antibióticos em comparação ao grupo tratado apenas com antibióticos. A incidência de drenagem cirúrgica (OR = 0,78 [0,27; 2,23], p-valor = 0,64, I2 =0,0%) foi menor no grupo tratado com esteroides e antibióticos em comparação com o grupo tratado apenas com antibióticos. Conclusão: O uso de esteroides sistêmicos como adjuvante da antibioticoterapia sistêmica para celulite orbitária pode diminuir a inflamação orbitária com baixo risco de agravar a infecção. Com base em nossa análise, concluímos que o uso precoce de esteroides por um curto período pode ajudar a encurtar os dias de internação e prevenir a progressão da inflamação.

Prognostic value of pre-operative peripheral inflammation markers in patients with squamous cell carcinoma of the external auditory canal / Valor prognóstico dos marcadores de inflamação periférica pré-operatórios em pacientes com carcinoma espinocelular do meato acústico externo

Abstract Introduction: Squamous cell carcinoma of the external auditory canal is a rare entity. Previous studies have suggested predictors for tumor recurrence. However, most of the prognostic factors were from the clinicopathological aspect. Objective: This study aims to analyze the correlation between pre-operative peripheral inflammation markers and survival outcomes, in order to identify prognostic biomarkers for patients with squamous cell carcinoma of the external auditory canal. Methods: We retrospectively analyzed patients diagnosed with squamous cell carcinoma of the external auditory canal who underwent surgery at our institute. The pre-operative circulating inflammatory markers, such as the neutrophil, lymphocyte, platelet, and monocyte counts were measured and their ratios including neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and lymphocyte-to-monocyte ratio were calculated. The prognostic value of the measured hematologic parameters in relation to the survival outcomes was also evaluated. Results: A total of 83 patients were included, of which 26 patients showed tumor recurrence and 57 without recurrence. Neutrophil counts and neutrophil-to-lymphocyte ratio were closely connected with tumor stage. In the patients with recurrence, neutrophil counts, neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio were elevated (p< 0.0001, p< 0.0001 and p = 0.001), while lymphocyte counts and lymphocyte-to-monocyte ratio were decreased (p = 0.013 and p = 0.016, respectively). The receiver operating curve analysis indicated that pre-operative neutrophil-to-lymphocyte ratio is a potential prognostic marker for recurrence of squamous cell carcinoma of the external auditory canal (area under curve = 0.816), and the cut-off points was 2.325. Conclusions: Pre-operative neutrophil and lymphocyte counts, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, lymphocyte-to-monocyte are significantly correlated with tumor recurrence in patients with external auditory canal squamous cell carcinoma. Furthermore, neutrophil-to-lymphocyte ratio may be unfavorable prognostic factors of this disease.

Resumo Introdução: O carcinoma espinocelular do meato acústico externo é uma doença rara. Estudos anteriores sugeriram preditores de recorrência do tumor. Entretanto, a maioria dos fatores prognósticos se originou do aspecto clínico-patológico. Objetivo: Analisar a correlação entre marcadores inflamatórios periféricos pré-operatórios e os desfechos de sobrevida e identificar biomarcadores prognósticos para pacientes com carcinoma espinocelular do meato acústico externo. Método: Analisamos retrospectivamente pacientes com diagnóstico de carcinoma espinocelular do meato acústico externo submetidos à cirurgia em nosso instituto. Os marcadores inflamatórios circulantes pré-operatórios, como as contagens de neutrófilos, linfócitos, plaquetas e monócitos, foram medidos e as suas relações calculadas, inclusive as relações neutrófilos/linfócitos, plaquetas/linfócitos e linfócitos/monócitos. O valor prognóstico dos parâmetros hematológicos medidos em relação aos desfechos de sobrevida também foi avaliado. Resultados: Foram incluídos 83 pacientes, entre os quais 26 apresentaram recorrência tumoral e 57 não apresentaram. A contagem de neutrófilos e a relação neutrófilo/linfócito estavam intimamente associadas ao estágio do tumor. Nos pacientes com recorrência, a contagem de neutrófilos, a relação neutrófilos/linfócitos e a relação plaquetas/linfócitos eram elevadas (p < 0,0001, p > 0,0001 e p = 0,001), enquanto a contagem de linfócitos e a relação linfócitos/monócitos estavam diminuídas (p = 0,012 ep = 0,016, respectivamente). A análise da curva, Receiver Operating Characteristic, indicou que a relação neutrófilos/linfócitos pré-operatória era um potencial marcador prognóstico para a recorrência de carcinoma espinocelular do meato acústico externo (Área sob a curva = 0,816) e o ponto de corte foi de 2,325. Conclusão: A contagem pré-operatória de neutrófilos e linfócitos, as relações neutrófilos/linfócitos, plaquetas/linfócitos e linfócitos/monócitos estão significativamente correlacionadas com a recorrência do tumor em pacientes com carcinoma espinocelular do meato acústico externo. Além disso, a relação neutrófilos/linfócitos pode ser um fator prognóstico desfavorável dessa doença.

Conhecimento etnobotânico sobre plantas medicinais utilizadas por moradores de um município ribeirinho no interior do estado do Amazonas, Brasil / Ethnobotanical knowledge of medicinal plants used by residents of a riverside city in the Amazonas state, Brazil

Mesmo com a evolução do conhecimento científico, a utilização de plantas medicinais é uma das práticas mais antigas ainda realizadas pelo homem, especialmente pelos habitantes de comunidades e municípios do interior do Brasil, principalmente em regiões com baixos índices de desenvolvimento humano. O objetivo deste trabalho foi realizar um estudo etnobotânico sobre as plantas medicinais utilizadas pelos moradores de um bairro localizado em um município ribeirinho do interior do estado do Amazonas. Participaram do estudo cem indivíduos, e os dados obtidos pela pesquisa foram compilados por meio de um formulário, contendo 14 questões (objetivas e discursivas). Os resultados demonstraram que 95% dos moradores faziam uso de plantas medicinais. Foram citadas 89 espécies, pertencentes a 48 famílias botânicas, com destaque para a Lamiaceae. As plantas mais citadas foram: Plectranthus barbatus (boldo) ­ 6,1%, Citrus sinensis (laranjeira) ­ 5,8% e Allium sativum (alho) ­ 4,7%. No entanto, quando analisado o índice de concordância (porcentagem de uso principal = CUP), a Citrus sinensis (laranjeira) apresentou um CUP de 80,9%, seguida por Plectranthus barbatus (boldo) e Disphania ambrosioides (mastruz), com 68,1% e 61,5%, respectivamente. Com relação ao modo de preparo, 61,1% citaram infusão, e as principais enfermidades tratadas foram as dores de estômago, com 13,1%. É importante enfatizar a necessidade de mais estudos acerca dos reais benefícios dessas ervas, a fim de que a divulgação de tais informações possa complementar o conhecimento empírico já difundido entre a população local. Dessa forma, será possível ampliar o conhecimento etnobotânico como um todo e, consequentemente, promover saúde e bem-estar.

Despite the evolution of scientific knowledge, the use of medicinal plants is one of the oldest practices still used by men and, especially by the inhabitants of communities and municipalities of the interior of Brazil, mainly in regions with low human development rates. The purpose of this work was to perform an ethnobotanical study on medicinal plants used by residents of a neighborhood located in a riverside city in the interior of the state of Amazonas. A total of 100 individuals participated in the study, with data being obtained through the use of a form containing 14 open and closed-ended questions. The results showed that 95% of the residents used medicinal plants. A total of 89 species, belonging to 48 botanical families were mentioned, with emphasis to Lamiaceae. The plants that were most frequently mentioned were Plectranthus barbatus (locally known as boldo) ­ 6.1%; Citrus sinensis (orange tree) ­ 5.8%; and Allium sativum (garlic) ­ 4.7%. However, when analyzing the agreement index (percentage of main use = CUP), Citrus sinensis (orange tree) presented a CUP of 80.9%, followed by Plectranthus barbatus (boldo) and Disphania ambrosioides (Mexican tea), with 68.1 and 61.5%, respectively. In relation to the method of preparation, 61.1% cited infusion, with the main disorder treated being stomachache, with 13.1%. It is important to emphasize the need for further studies on the actual benefits of these herbs so that the dissemination of the information can complement the already widespread empirical knowledge among the local population. Thus, it will be possible to expand the ethnobotanical knowledge as a whole and, consequently, promote health and well-being.

Estados depresivos en pacientes con enfermedades crónicas no transmisibles / Depressive States in Patients with Chronic Noncommunicable Diseases

Introducción: La relación entre las enfermedades crónicas no transmisibles y los trastornos mentales, como ansiedad y depresión, ocurren de modo bidireccional, es decir, que la presencia de una condición predispone el desarrollo de la otra. Objetivo: Indagar en la literatura revisada acerca de los aspectos relacionados con los estados depresivos en pacientes con enfermedades crónicas no transmisibles de mayor impacto en salud pública. Métodos: Investigación tipo documental por revisión bibliográfica sistemática de estudios sobre los estados depresivos y el padecimiento de enfermedades crónicas no transmisibles, publicados en revistas médicas de acceso abierto en español o inglés, que contribuyan a la comprensión del por qué la comorbilidad de estas enfermedades. Conclusiones: Un diagnóstico y control deficiente de las enfermedades crónicas no transmisibles y de los estados depresivos, pueden llevar a la falta de adherencia al tratamiento, lo que aumenta la morbimortalidad de las enfermedades crónicas no transmisibles. En los estados depresivos y las enfermedades crónicas no transmisibles se comparten mecanismos biológicos de actividad inmunológica que, en un complejo equilibrio, determinado por la activación de genes específicos, en conjunto contribuyen con la aparición de estados depresivos y agravamiento de las enfermedades crónicas no transmisibles. Es necesaria una visión integral a nivel diagnóstico y de control que permitan en conjunto decidir el tratamiento más adecuado según las características del paciente, para proceder con la derivación oportuna y apropiada en cada caso(AU)

Introduction: The relationship between chronic noncommunicable diseases and mental disorders, such as anxiety and depression, occur in a bidirectional way, that is, the presence of one condition predisposes the development of the other. Objective: To investigate, in the literature reviewed, about the aspects related to depressive states in patients with chronic noncommunicable diseases of major impact on public health. Methods: Documental research that consisted in the systematic literature review of studies about depressive states and being affected by chronic noncommunicable diseases, published in open access medical journals in Spanish or English and that contribute to the understanding the comorbidity of these conditions. Conclusions: Poor diagnosis and control of chronic noncommunicable diseases and depressive states can lead to lack of adherence to treatment, which increases the morbimortality of chronic noncommunicable diseases. Depressive states and chronic noncommunicable diseases share biological mechanisms of immune activity that, in a complex balance, determined by the activation of specific genes, together contribute to the onset of depressive states and aggravation of chronic noncommunicable diseases. It is necessary to have a comprehensive vision at the diagnostic and control levels that allows to decide together the most adequate treatment according to the patient's characteristics, in order to proceed with the opportune and appropriate referral in each case(AU)

Manifestaciones pulmonares al diagnóstico de 170 pacientes con vasculitis asociadas a anticuerpos anticitoplasma de neutrófilos: cohorte retrospectiva de un centro universitario / Pulmonary manifestations at the diagnosis of 170 patients with vasculitis associated with anticytoplasmic neutrophil antibodies: retrospective cohort of a university center

INTRODUCCIÓN: Las Vasculitis Asociadas a Anticuerpos Anticitoplasma de Neutrófilos (VAA) son infrecuentes, pero de amplio espectro de presentación. Si bien el consenso de clasificación de Chapel Hill del año 2012, sigue vigente, la tendencia actual es clasificarlas de acuerdo al marcador inmunológico: anti-Proteinasa 3 (PR3) o anti-mieloperoxidasa (MPO). Las manifestaciones pulmonares clásicas son la hemorragia alveolar y los nódulos pulmonares. En los últimos 10 años se ha descrito la enfermedad pulmonar difusa (EPD). Los estudios epidemiológicos son escasos, y suelen representar en su mayoría poblaciones norteamericanas o europeas. El objetivo es describir las características del compromiso pulmonar al debut en VAA en un centro universitario. PACIENTES Y MÉTODO: De un total de 190 pacientes con diagnóstico de VAA se incluyeron 170 en seguimiento en nuestro centro. Se revisaron aspectos clínicos, demográficos, laboratorio e imagenológicos de los pacientes incluidos. RESULTADOS: De los 170 pacientes, 112 (65,88%) presentaron compromiso pulmonar. 106 (94,64%) de los pacientes fueron anticuerpos anti citoplasma de neutrófilos (ANCA) positivos; de estos, 56 (53,27%) MPO (+) y 39 (36,45%) PR-3 (+). Un tercio de los pacientes de ambos grupos presentó hemorragia alveolar. En los pacientes MPO (+) predomina la EPD (53,5%) y en PR-3 (+) los nódulos pulmonares (69,23%). Destaca la baja frecuencia de patología obstructiva asociada. CONCLUSIONES: El compromiso pulmonar en las VAA es prevalente y heterogéneo. En nuestra serie, destaca la frecuencia de EPD en VAA MPO (+), lo que releva la importancia del estudio con ANCA en paciente con diagnóstico y seguimiento por EPD.

INTRODUCTION: Antineutrophil Cytoplasmic Antibodies (ANCA) associated vasculitis (AAV) are uncommon, but of broad spectrum of presentation. Although the 2012 Chapel Hill classification consensus remains valid, the current trend is to classify them according to the immunological marker: anti-Proteinase 3 antibody (PR-3) or anti-Myeloperoxidase antibody (MPO). The classic pulmonary manifestations are alveolar hemorrhage and pulmonary nodules. Interstitial lung disease (ILD) has been described in the last 10 years. Epidemiological studies are scarce, and they usually represent mostly North American or European populations. The objective is to describe the characteristics of lung involvement upon debut in AAV in a university center. PATIENTS AND METHODS: Of a total of 190 patients diagnosed with AAV, 170 were included in follow-up at our center. Clinical, demographic, laboratory and imaging aspects of the included patients were reviewed. RESULTS: Of the 170 patients, 112 (65.88%) had lung involvement. 106 (94.64%) of the patients were ANCA (+); of these, 56 (53.27%) MPO (+) and 39 (36.45%) PR-3 (+). One third of the patients in both groups had alveolar hemorrhage. In MPO (+) patients, ILD predominates (53.5%) and in PR-3 (+) pulmonary nodules (69.23%). The low frequency of associated obstructive pathology stands out. CONCLUSIONS: Pulmonary manifestations in AAVs are frequent and heterogeneous. Locally, the association of ILD and AAV MPO (+) stands out, which highlights the importance of ANCA study in patients with diagnosis and follow-up by ILD.

Basaloid follicular hamartoma associated with follicular mucinosis and inflammation

Abstract Basaloid follicular hamartoma is a benign, superficial malformation of hair follicles that can be mistaken both clinical and histopathologically for basal cell carcinoma. Basaloid follicular hamartoma has been linked to a mutation in the PTCH-1 gene, which is part of the same pathway involved in Gorlin-Goltz syndrome. Here we present a 9-year-old patient with an asymptomatic congenital lesion on the forehead, which increased in size over the years. Histopathology showed a basaloid follicular hamartoma associated with follicular mucinosis and inflammation. Gorlin-Goltz syndrome was ruled out by clinical examination.

Mecanismo de los AINES y antiinflamatorios derivados para el control del dolor y la inflamación. Uso de antiinflamatorios en odontología / Mechanism of NSAIDs and derived drugs for pain and inflammation control. Use of anti-inflammatories in odontology

Las urgencias odontológicas son, quizá, las razones principales de atención en el consultorio, muchas veces el significado de dolor se encuentra acompañado por inflamación; el uso de antiinflamatorios no esteroideos (AINES) es común en el ejercicio de la odontología por la excelente respuesta analgésica y antiinflamatoria que tiene, por lo que es importante conocer la fisiopatología de la inflamación y el dolor y cómo actúan los AINES, ya que algunos de estos fármacos tienen respuestas adversas y sitios de acción importantes. Los factores de riesgo por inflamación y dolor nos obligan a conocer la variedad de fármacos que no entran en la clasificación de AINES y que tenemos a disposición, hay más opciones para la elección ante la presencia de inflamación por un factor en particular, cada uno de éstos tienen indicaciones y contraindicaciones que conoceremos, lo cual nos ampliará el conocimiento para dar una prescripción ante la presencia de eventos inflamatorios. Se realizó un estudio detallado de artículos bibliográficos de cada tema, los fármacos más usados en odontología son los AINES, hay poco uso y conocimiento de antiinflamatorios que podemos usar en urgencias, el porcentaje de uso de los AINES derivados del ácido propiónico es alto por la excelente respuesta en pacientes y otras veces por el desconocimiento de más opciones (AU)

Dental emergencies are perhaps the main reasons for care in the office, many times the meaning of pain is accompanied by inflammation, the use of non-steroidal anti-inflammatory drugs is common in the practice of dentistry due to the excellent analgesic and anti-inflammatory response it has, important is knowing the pathophysiology of inflammation and pain, how NSAIDs act, some of these drugs have adverse responses and important sites of action, risk factors for inflammation and pain require us to know the variety of drugs that do not enter the classification of NSAIDs and we have at our disposal, there are more options for choosing in the presence of inflammation due to a particular factor, each of these have indications and contraindications that we will know, it expands our knowledge to give a prescription in the presence of inflammatory events. A detailed study of bibliographic articles on each topic was carried out, the drugs most used in dentistry are NSAIDs, there is little use and knowledge of anti-inflammatories that we can use in the emergency room, the percentage of use of NSAIDs derived from propionic acid is high, due to the excellent response in patients and others due to lack of knowledge of more options (AU)