Síndrome de Brown-Séquard como forma de presentación de mielitis transversa idiopática / Brown-Séquard syndrome as a presentation of idiopathic transverse myelitis

El síndrome de Brown-Séquard es el conjunto de signos y síntomas causado por hemisección medular de diversos orígenes. Puede generarse por múltiples causas; las traumáticas son las más frecuentes. Las causas menos frecuentes son patología inflamatoria, isquémica, tumoral o infecciosa. Se presenta un niño de 12 años, con instauración aguda y progresiva de un síndrome de hemisección medular derecho, con parálisis hipo/arrefléctica homolateral y afectación de sensibilidad termoalgésica contralateral. En la resonancia magnética de médula espinal, se observó compromiso inflamatorio en hemimédula derecha a nivel de segunda y tercera vértebras torácicas. Con diagnóstico de mielitis transversa idiopática, inició tratamiento con corticoide intravenoso a altas dosis con evolución clínica favorable y restitución de las funciones neurológicas.

Brown-Séquard syndrome refers to a set of signs and symptoms caused by hemisection of the spinal cord from various sources. It may have multiple causes; traumatic injuries are the most frequent ones. The less common causes include inflammation, ischemia, tumors, or infections. This report is about a 12-year-old boy with an acute and progressive course of right hemisection of the spinal cord, with ipsilateral hypo/areflexic paralysis and contralateral loss of thermalgesic sensation. The MRI of the spinal cord showed inflammation in the right side of the spinal cord at the level of the second and third thoracic vertebrae. The patient was diagnosed with idiopathic transverse myelitis and was started on intravenous high-dose corticosteroids; he showed a favorable clinical course and recovered neurological functions.

Pregnancy-associated neuromyelitis optical spectrum disorder combined with primary Sjögren's syndrome: A critical illness case report / 北京大学学报(医学版)

Central nervous system involvement in primary Sjögren's syndrome (pSS) is less common and usually presents as white matter lesions, neuromyelitis optica spectrum disorder (NMOSD), or transverse myelitis. NMOSD is an immune-mediated inflammatory demyelinating disease of the central nervous system with a high rate of relapse and significant disability. Studies have shown that patients with pSS combined with NMOSD have more severe symptoms and poorer prognosis. Here, we present a case of critical illness in pregnancy-associated NMOSD combined with Sjögren's syndrome. The patient was a 30-year-old pregnant woman with a history of Sjögren's syndrome who was diagnosed with NMOSD. She received combination therapy with steroids, intravenous immunoglobulin (IVIG), and hydroxychloroquine during pregnancy, resulting in partial resolution of numbness below the waist. However, due to irregular medication adherence outside the hospital setting, she developed weakness in her right lower limb accompanied by inability to move it, while her left lower limb still had some mobility but occasional numbness along with urinary and fecal incontinence. Ten days later, she was admitted to the emergency department where an emergency cesarean section was performed to deliver a healthy baby boy. However, her condition worsened postpartum as she developed high fever accompanied by bilateral lower limb paralysis and weakness along with loss of voluntary control over urination and defecation. The patient underwent ano-ther course of treatment consisting of steroids and IVIG; however there was limited improvement in symptoms observed after this intervention. Following administration of rituximab for the first time, the patient developed urinary tract infection which was successfully managed before continuing regular infusions. In later stages the patient could walk slightly with a limp and regained control over urination and defecation, allowing her to resume normal activities. This case suggests that combination therapy with steroids, IVIG, and hydroxychloroquine should be considered for the patients with pregnancy-associated NMOSD combined with Sjögren's syndrome. Rituximab can significantly improve symptoms such as postpartum paralysis in patients with NMOSD, however, there may be a risk of infection associated with its use.

The role of inflammation in heart failure with preserved ejection fraction / 生理学报

Heart failure with preserved ejection fraction (HFpEF) is a type of heart failure characterized by left ventricular diastolic dysfunction with preserved ejection fraction. With the aging of the population and the increasing prevalence of metabolic diseases, such as hypertension, obesity and diabetes, the prevalence of HFpEF is increasing. Compared with heart failure with reduced ejection fraction (HFrEF), conventional anti-heart failure drugs failed to reduce the mortality in HFpEF due to the complex pathophysiological mechanism and multiple comorbidities of HFpEF. It is known that the main changes of cardiac structure of in HFpEF are cardiac hypertrophy, myocardial fibrosis and left ventricular hypertrophy, and HFpEF is commonly associated with obesity, diabetes, hypertension, renal dysfunction and other diseases, but how these comorbidities cause structural and functional damage to the heart is not completely clear. Recent studies have shown that immune inflammatory response plays a vital role in the progression of HFpEF. This review focuses on the latest research progress in the role of inflammation in the process of HFpEF and the potential application of anti-inflammatory therapy in HFpEF, hoping to provide new research ideas and theoretical basis for the clinical prevention and treatment in HFpEF.

Efeitos do D-limoneno no metabolismo energético de camundongos C57/Bl6 com obesidade induzida pela dieta / Effects of D-limonene on the energy metabolism of C57/Bl6 mice with diet-induced obesity

A obesidade está associada ao desenvolvimento de doenças crônicas não transmissíveis como hipertensão, resistência insulínica, dislipidemia e esteatose hepática. O consumo de compostos bioativos impacta na manutenção da saúde e na prevenção de risco de desenvolvimento dessas doenças. Entre os compostos bioativos, os monoterpenos são pouco investigados, apesar da literatura demonstrar efeitos promissores desses compostos sobre o metabolismo. O D-limoneno, o principal monoterpeno encontrado na laranja, é caracterizado por possuir efeitos hipolipemiantes, anti-inflamatórios e anti-obesogênicos. Estudos in vitro e in vivo descrevem sua capacidade de promover a ß-oxidação de ácidos graxos em adipócitos e redução da inflamação. Este estudo teve como objetivo investigar o efeito do D-limoneno no metabolismo e inflamação em um modelo de obesidade induzida por dieta. Para isso, quarenta camundongos machos (C57/Bl6) de 11 semanas de idade, foram distribuídos em 4 grupos, sendo que um dos grupos recebeu ração normolipídica e os demais, ração hiperlipídica. O D-limoneno foi suplementado na ração de dois grupos que receberam dieta hiperlipídica nas concentrações de 0,1%, e 0,8%. Considerando-se a ingestão alimentar dos animais, a ração suplementada com 0,1% D-limoneno correspondeu à ingestão de 0,15 g/kg/dia e ração com 0,8% de D-limoneno correspondeu a 1,3 g/kg/dia. Os animais tiveram o peso e a ingestão alimentar monitorados ao longo da intervenção com duração de 7 semanas. Os camundongos que receberam D-limoneno a 0,1% apresentaram menor ganho de peso e de acúmulo de tecido adiposo, comparado com os animais sem suplementação alimentados com a dieta hiperlipídica. Além disso, o D-limoneno promoveu a diminuição da concentração plasmática de marcadores inflamatórios incluindo TNF-α, INF-γ e IL-6 nos animais dos grupos que foram suplementados com D-limoneno. Entretanto, não houve diferença nos marcadores bioquímicos e metabólicos. Uma limitação do estudo foi o fato das complicações metabólicas associadas ao modelo de obesidade não terem sido plenamente estabelecidas, dados o alojamento individual, à curta duração da exposição à ração hiperlipídica e idade dos animais no início da suplementação. Esse fato pode ter dificultado a observação dos efeitos do D-limoneno na reversão dos parâmetros que seriam normalmente deteriorados pelo desenvolvimento da obesidade. Concluímos que o D-limoneno pode interferir no metabolismo energético, com possível efeito anti-obesogênico e anti-inflamatório. Devido às limitações do modelo, são necessários mais estudos para confirmar esses resultados

Obesity is associated with the development of chronic non-communicable diseases such as hypertension, insulin resistance, dyslipidemia, and hepatic steatosis. The intake of dietary bioactive compounds is associated with the maintenance of health and the prevention of chronic diseases. Among the group of bioactive compounds, monoterpenes are poorly investigated, in spite of several reports of their promising effects on metabolism. D-limonene is the main monoterpene found in oranges, known for its hypolipemic, anti-inflammatory, and anti-obesogenic effects. in vitro and in vivo studies associate D-limonene to increased ß-oxidation of fatty acids in adipocytes and reduced inflammation. This study aimed at investigating the effects of D-limonene on metabolism and inflammation in a diet-induced obesity model. For this purpose, forty male mice (C57/Bl6) were distributed in 4 groups, with one group receiving a normolipidic diet and the others, a high-fat diet. D-limonene was supplemented in the diets of two groups that received high-fat diet at the concentrations of 0.1% and 0.8%. Considering the feed intake, mice receiving D-limonene supplementation at 0.1% ingested in average 0.15 g/kg/day, while the mice receiving the supplemmentation at 0.8%, ingested approximately 1.3 g of D-limonene /kg/day. The animals had their weight and food intake monitored throughout the intervention. Mice that received Dlimonene supplementation at 0.1% showed reduced weight gain and accumulation of adipose tissue compared to the non-supplemented mice fed the high-fat diet. In addition, D-limonene promoted a decrease in hepatic inflammatory markers including TNF-α, INF-γ, and IL-6. However, there was no difference in biochemical and metabolic markers. A limitation of the study was that the metabolic complications associated with the obesity model were not fully established, probably due to the age at the start of the protocol (11 weeks), individual housing and short duration of the exposure to the high-fat feed. This fact may have prevented the observation of the positive effects of D-limonene in reversing parameters that would normally be impaired by the development of obesity. We conclude that D-limonene may interfere in energy metabolism, with a possible anti-obesogenic and anti-inflammatory effect. Due to the limitations of the model, further studies are needed to confirm these findings

Extrapulmonary manifestations and complications of severe acute respiratory syndrome coronavirus-2 infection: a systematic review

INTRODUCTION@#We aimed to describe the extrapulmonary manifestations of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, including their frequency, onset with respect to respiratory symptoms, pathogenesis and association with disease severity.@*METHODS@#We searched the MEDLINE and Embase databases for SARS-CoV-2-related studies. Meta-analysis, observational studies, case series and case reports published in English or Chinese between 1 January 2020 and 1 May 2020 were included. Reports with only paediatric or obstetric cases were excluded.@*RESULTS@#169 articles were included. Early manifestations (preceding respiratory symptoms until Day 6 of onset) included olfactory and gustatory disturbance (self-reported in up to 68% and 85% of cases, respectively), gastrointestinal symptoms (up to 65.9%) and rash (up to 20.4%). From Day 7 onwards, hypercytokinaemia, paralleled multi-organ complications including acute cardiac injury (pooled incidence of 17.7% in 1,412 patients, mostly with severe disease and 17.4% mortality), kidney and liver injury (up to 17% and 33%, respectively) and thrombocytopenia (up to 30%). Hypercoagulability resulted in venous thromboembolic events in up to 31% of all patients. Uncommon disease presentation and complications comprised Guillain-Barré syndrome, rhabdomyolysis, otitis media, meningoencephalitis and spontaneous pneumomediastinum.@*CONCLUSION@#Although the systemic manifestations of SARS-CoV-2 infection are variegated, they are deeply interwoven by shared mechanisms. Two phases of extrapulmonary disease were identified: (a) an early phase with possible gastrointestinal, ocular and cutaneous involvement; and (b) a late phase characterised by multiorgan dysfunction and clinical deterioration. A clear, multidisciplinary consensus to define and approach thromboinflammation and cytokine release syndrome in SARS-CoV-2 is needed.

Research progress in association of neurological disorders and periodontal diseases / 中华口腔医学杂志

Periodontal diseases are inflammatory diseases caused by oral pathogens around the periodontal supporting tissues, leading to systemic and chronic inflammatory conditions. The continuous chronic systemic inflammation may be a trigger of neuroinflammation, which is the prominent feature of a variety of neurological disorders. It implies that there may be a causal link between periodontal diseases and neurological disorders. This article presents epidemiological and biological evidences that periodontal diseases can induce or exacerbate neurological disorders, including Alzheimer's disease, Parkinson's disease, multiple sclerosis and major depressive disorder, and analyzes the possible mechanisms. The importance of maintaining oral health as well as preventing and treating periodontal diseases are emphasized. At the same time, this may provide novel approaches to study the relationship between periodontal diseases and neurological disorders in the prevention and treatment strategies of neurological disorders.

Ultrasound analysis for pancreatic panniculitis: A case report / 中南大学学报(医学版)

Pancreatic panniculitis (PP) is a necrotizing inflammation of subcutaneous fat that is a rare complication of pancreatic disease appearing in 2% to 3% of all patients. It is more common in the elderly and often affects the extremities. It presents as skin inflammation with pain and erythema nodules. We report a case of acute pancreatitis associated with PP in an old female. She was admitted for vomiting and abdominal pain for 3 days and presented with a 2-week history of erythematous subcutaneous nodules on her legs. Laboratory and ultrasonic findings revealed acute pancreatitis. High frequency ultrasound showed hypoechoic foci in subcutaneous soft tissue layer and adipose layer. Histopathological examination confirmed the diagnosis of PP. Nodules disappeared with the resolution of acute pancreatic inflammation. PP may be the first manifestation of pancreatic disease. Imaging features of this pathology are seldom described and ultrasonic diagnosis experience is worth to be accumulated.

In vitro evaluation of the cytotoxicity and eye irritation potential of preservatives widely used in cosmetics

Abstract The consumption of cosmetics has been increasing every year and is expected to reach $675 billion by 2020 at an estimated growth rate of 6.4% per year. Exposure to skin irritants is the major cause of non-immunological inflammation of the skin. Therefore, the safety evaluation of cosmetic preservatives should be increased. Thus, the present work aimed to evaluate the cytotoxicity as the viability endpoint and the eye irritation potential of preservatives used in cosmetics. Cytotoxicity assays were performed using MTT and NRU in human keratinocytes (HaCaT), human dermal fibroblasts, adult (HDFa), and human hepatoma cells (HepG2). The eye irritation potential was evaluated using the Hen's Egg Test-chorioallantoic membrane (HET-CAM). The evaluated preservatives were methylparaben (MP), propylparaben (PP), phenoxyethanol (PE), and a mixture of methylchloroisothiazolinone and methylisothiazolinone (CMI/MI). All preservatives showed cytotoxic potential within the permitted concentrations for use in cosmetic products. In the HET-CAM test, PE and CMI/MI, MP, and PP were classified as severe, moderate, and poor irritants, respectively. Our results indicate that proper safety evaluations are required to ensure the beneficial properties of preservatives on cosmetic products without exceeding exposure levels that would result in adverse health effects for consumers.

Curcuma longa extract protects against 5-fluorouracil-induced oral mucositis in hamsters

Abstract Curcumin, contained at Turmeric (Curcumalonga), can exert many beneficial pleiotropic activities in the gastrointestinal tract. This study evaluated the antioxidant and anti-inflammatory activity of C. longa on 5-fluorouracil (5-FU)-induced oral mucositis (OM) in hamsters. Phytochemical analysis of crude C. longa extract (CLE) was performed to detect the presence of curcumin by TLC and HPLC. Golden Syrian hamsters were orally pre-treated with CLE (5, 50, or 100mg/kg). Cheek pouch samples were subjected to macroscopic and histopathological evaluation. ELISA was performed to quantify the inflammatory cytokines IL-1ß and TNF-α. Superoxide dismutase (SOD), glutathione (GSH) and malondialdehyde (MDA) levels were assessed by ultraviolet-visible spectroscopy analysis. Behavior analysis was conducted by the open field test. Curcumin content in the CLE was 0.55%m/m ± 0.0161 (2.84%). The group treated with 5mg/kg CLE showed healing evidence with macroscopic absence of ulceration (p<0.05) and microscopic aspect of re-epithelialization, discrete inflammatory infiltrate and absence of edema. Treatment with 5mg/kg CLE significantly increased GSH levels, and reduced MDA levels and SOD activity (p˂0.05), and decreased IL-1ß (p˂0.05) and TNF-α (p˂0.01) levels. A significant reduction in walking distance, ambulation, speed, and rearing was observed for motor activity. Curcumin reduced oxidative stress, inflammation, and motor activity in hamsters with 5-FU-induced OM.

Design and evaluation of dental pastes Containing anti-inflammatory drugs

Abstract Periodontitis is an oral disease associated with inflammation and pain with swollen and bleeding gums. In the present study, dental pastes containing NSAIDs, namely, diclofenac sodium and nimesulide (1 % w/w) were prepared to treat periodontitis. Dental pastes of diclofenac sodium and nimesulide (1 % w/w) were prepared with/without mucoadhesive hydrocolloid polymers such as sodium carboxy methyl cellulose (NaCMC), hydroxyl ethyl cellulose (HEC) and methyl cellulose (MC) by conventional trituration method. The pH, drug content, viscosity, tube spreadability and tube extrudability of these prepared dental pastes were measured. These dental pastes of diclofenac sodium and nimesulide (1 % w/w) were characterized by FTIR analyses for drug-excipient compatibility. The in vitro drug releases from these dental pastes in 6.4 pH phosphate buffer solution displayed sustained release over longer period and the drug release rate was found to be decreased when the concentration of mucoadhesive polymer was increased. These dental pastes displayed good adhesion to the oral mucosa revealing more retention time in mouth when tested for ex vivo mucoadhesion using bovine cheek pouch. The stability study results reveal that the DC3 and NC3 dental paste formulations were found stable enough over a longer period in different storage conditions. The present study revealed that the prepared mucoadhesive dental pastes of diclofenac sodium and nimesulide (1 % w/w) had good adhesion with the oral mucosa to maintain consistent release of drugs over prolonged time.

Tratamiento con tocilizumab en amiloidosis AA: informe de casos y revisión de la literatura / Tocilizumab treatment in aa amyloidosis: case report and literature review

Introducción: la amiloidosis AA puede ser una complicación de ciertos trastornos inflamatorios crónicos, aunque entre el 21% y 50% puede ser idiopática. No existe un tratamiento específico. El tocilizumab, dirigido contra el receptor de IL-6 y orientado a disminuir la producción de SAA, podría ser eficaz. Métodos: en este estudio informamos datos de 6 pacientes con amiloidosis AA tratados con tocilizumab monoterapia subcutáneo en el período 2011-2018. Los criterios de valoración principales fueron la mejora clínica y bioquímica de los órganos afectados y los parámetros bioquímicos marcadores de inflamación. Resultados: el riñón estaba afectado en todos los pacientes, manifestándose con caída del filtrado glomerular y síndrome nefrótico. La hemorragia digestiva se presentó en un paciente y otro tenía afectación pulmonar en la biopsia. Luego del posterior al tratamiento, todos mejoraron el hematocrito, la albúmina sérica y el índice de masa corporal. El SAA disminuyó en 5 pacientes. Un paciente mejoró su función renal, mientras 4 se mantuvieron estables. Tres pacientes disminuyeron los valores de proteinuria. Conclusión: el tratamiento con tocilizumab podría ser eficaz en el tratamiento de los pacientes con amiloidosis AA. (AU)

Introduction: AA amyloidosis can be a complication of certain chronic inflammatory disorders, although between 21% and 50% can be idiopathic. There is no specific treatment. Tocilizumab, directed against the IL-6 receptor and aimed at decreasing SAA production, could be effective. Methods: in this study, we report data from 6 patients with AA amyloidosis treated with subcutaneous tocilizumab monotherapy between the period 2011-2018. The main endpoints were the clinical and biochemical improvement of the affected organs and the biochemical parameters markers of inflammation. Results: the kidney was affected in all patients, manifesting with a fall in glomerular filtration rate and nephrotic syndrome. Gastrointestinal bleeding occurred in one patient and another had lung involvement on biopsy. After treatment, all improved hematocrit, serum albumin, and body mass index. SAA decreased in 5 patients. One patient improved his kidney function, while 4 remained stable. Three patients decreased proteinuria values. Conclusion: treatment with tocilizumab could be effective in the treatment of patients with AA amyloidosis. (AU)

Desórdenes del metabolismo glucídico y síndrome metabólico en pacientes de covid-19 / Glucide metabolism disorders and metabolic syndrome in COVID-19 patients

RESUMEN El síndrome metabólico comprende un conjunto de factores de riesgo cardiovascular asociado a resistencia a la insulina, que propicia la aparición de enfermedad cardiovascular y de diabetes mellitus tipo 2. Su etiología se atribuye a la combinación de factores genéticos y ambientales, asociados al estilo de vida, que favorecen un estado proinflamatorio y protrombótico que empeora el cuadro clínico de los pacientes con covid-19. El objetivo de la revisión consistió en analizar el estado actual del conocimiento científico en las investigaciones sobre la interrelación entre los desórdenes del metabolismo glucídico y el síndrome metabólico, asociados a la condición proinflamatoria exacerbada en pacientes de covid-19. Se hicieron búsquedas en las bases de datos PubMed, SciELO, ClinicalKey y LILACS. Al proceso proinflamatorio generado por malos hábitos alimentarios, la sobrealimentación calórica de alto índice glicémico, y estilos de vida sedentarios, se atribuye un papel relevante en la patogénesis del síndrome metabólico, así como en sus posibles complicaciones en pacientes de covid-19 con comorbilidades asociadas. Es posible reducir la condición inflamatoria del síndrome metabólico mediante modificaciones en el estilo de vida y hábitos alimentarios, que prevengan la obesidad y sus efectos en la resistencia a la insulina, lo cual propicia reducir la gravedad asociada a los procesos inflamatorios inherentes (AU).

ABSTRACT Metabolic syndrome includes a set of cardiovascular risk factors associated with resistance to insulin, favoring the appearance of cardiovascular disease and diabetes mellitus type 2. Its etiology is attributed to the combination of genetic and environmental factors, associated to lifestyle, and favoring a proinflammatory and prothrombotic status that worsens the clinical characteristics of the patients with COVID-19. The objective of the review was to analyze the current state of the scientific knowledge in research on the interrelationship between glucide metabolism disorders and metabolic syndrome, associated with the exacerbated proinflammatory condition in COVID-19 patients. Searches were conducted in PubMed, SciELO, CinicalKey, and LILACS databases. A relevant role in the metabolic syndrome pathogenesis is attributed to the inflammatory process generated by poor eating habits, high caloric overfeeding, and to sedentary lifestyle, and also to possible complications with associated comorbidities in COVID-19 patients. It is possible to reduce the metabolic syndrome inflammatory condition through life style and alimentary habits changes that prevent obesity and its effects on insulin resistance and propitiate the reduction of the disease severity associated with the inherent inflammatory processes (AU).

Correlación de índice PO2/FiO2 con parámetros inflamatorios y de coagulación en pacientes críticos con covid-19. Lombardía, 2020 / PO2/FiO2 index correlation with inflammatory and coagulation parameters in critically-ill patients with COVID-19 in Lombardy, 2020

RESUMEN Introducción: el conocimiento de la fisiopatología de la enfermedad ha revolucionado el enfoque tradicional en el tratamiento de las enfermedades causadas por virus respiratorios. Actualmente, se utilizan marcadores de la respuesta inflamatoria para diagnosticar, estratificar y predecir en muchos casos el comportamiento futuro del enfermo de covid-19. Objetivo: caracterizar la naturaleza de la relación entre el índice PO2/FiO2 y los parámetros inflamatorios y de coagulación en pacientes graves por la covid-19, en la región de Lombardía, Italia. Materiales y métodos: se realizó un estudio analítico, longitudinal, retrospectivo con 191 pacientes graves y críticos, que ingresaron con diagnóstico de covid-19 del 1 de abril al 20 mayo de 2020, en el Hospital Mayor de Crema, en la región de Lombardía, Italia. Resultados: las correlaciones evidenciadas fueron las siguientes: proteína C reactiva (-0,417) p = 0; procalcitonina (-0,152) p = 0,018; dímero D (-0,112) p = 0,061; fibrinógeno (-0,272) p = 0,000; creatinina plasmática (-0,320) p = 0,000; conteo de linfocitos (0,028) p = 0,000; troponina (-0,028) p = 0,142, y lactato (-0,191) p = 0,288. Conclusiones: los marcadores inflamatorios en la patogenia de la enfermedad juegan un rol capital, y el enfoque hacia este renglón del tratamiento médico antiinflamatorio de cualquier tipo es mandatorio. Se debe realizar un correcto monitoreo de la coagulación, usar heparinas de bajo peso molecular, así como mantener un adecuado soporte hemodinámico capaz de evitar las disoxias celulares que progresen al fallo multiorgánico (AU).

ABSTRACT Introduction: the knowledge of disease physiopathology has revolutionized the traditional approach in the treatment of diseases caused by respiratory viruses. Currently, the markers of inflammatory answer are used to diagnose, stratify and predict in many cases the future behavior of COVID-19 patients. Objective: to characterize the nature of the relationship between PO2/FiO2 (PAFI, Spanish acronym of PA= presión arterial [arterial pressure], FI=fracción inspirada [inspired fraction]) and coagulation and inflammatory parameters in seriously-ill patients with COVID-19, in the region of Lombardy, Italy. Materials and methods: a retrospective, longitudinal, analytic study was carried out in 191 severe and critical patients who were admitted in Hospadale Maggiori di Crema, in the region of Lombardy, Italy, with the diagnosis of COVID-19, in the period April 1st-May 20, 2020. Results: the evidenced correlations were the following: reactive C protein (-0.417) p=0; procalcitonin (PCT) (-0.152) p=0.018. D dimer (-0.112) p=0.061; Fibrinogen (-0.272) p=0.000; Plasma creatinine (-0.320) p=0.000; lymphocytes count (0,028) p=0,000; troponin (-0.028) p=0.142; and lactate (-0.191) p=0.288. Conclusions: inflammatory markers play a capital role in the disease pathogenesis, and approaching this item of the medical anti-inflammatory treatment is mandatory. It is useful to keep a correct coagulation screening, using low molecular weight heparins, and also keeping an adequate hemodynamic support able to avoid cell dysoxia progressing to multiorgan failure (AU).

Inflammatory signs and epileptic crisis in patients admitted in an emergency unit / Signos inflamatorios y crisis epiléptica en pacientes admitidos en una unidad de emergencia / Sinais inflamatórios e crise epiléptica em pacientes admitidos em unidade de emergência

ABSTRACT Objective: To evaluate inflammatory signs presented in medical records of patients with a main diagnosis of epileptic seizures, admitted in an emergency unit. Method: Cross-sectional and retrospective study. The sample was composed of 191 medical records, from children, adolescents, adults, and elders, with a clinical diagnosis of epileptic seizures, admitted between June 2016 and June 2017 at the emergency unit of a hospital in Porto Alegre/RS. Results: The prevalent inflammatory signs were tachypnea (33.5%) and/or fever (27.2%) associated with leukocytosis (P=0.030). Children/adolescents had seizures less frequently (P=0.010) and these were due to fever (P=0.000). Adults presented seizures more frequently (P=0.006), which were related to medication/intoxication (P=0.000). In elders, seizures occurred due to metabolic or circulatory abnormalities (P=0.000), less often due to fever (P=0.005). Conclusion: Seizures are related to fever and tachypnea, being caused by different etiologies according to age, being more frequent in adults. Fever is related to leukocytosis, regardless of age.

RESUMEN Objetivo: Evaluar signos inflamatorios registrados en prontuarios de pacientes con diagnóstico principal de crisis epilépticas, admitidos en unidad de emergencia. Método: Estudio transversal, retrospectivo. Muestra compuesta por 191 prontuarios de pacientes pediátricos, adolescentes, adultos y ancianos, diagnosticados con crisis epilépticas, admitidos entre junio de 2016 a junio de 2017 en unidad de emergencia de un hospital de Porto Alegre/RS. Resultados: Prevalencia del taquipnea (33,5%) y/o fiebre (27,2%) como signos inflamatorios, fiebre relacionada a leucocitosis (P=0,030). Niños/adolescentes tienen crisis menos frecuentes (P=0,010) de origen febril (P=0,000). Los adultos presentaron mayor número de eventos (P=0,006), provocados por medicamentos/intoxicaciones (P=0,000). En ancianos, crisis ocurrieron debido a disturbios metabólicos/circulatorios (P=0,000),menor ocurrencia de fiebre (P=0,005). Conclusión: Crisis epilépticas están relacionadas a fiebre y taquipnea, presentando diferentes etiologías según grupo de edad, con mayor ocurrencia entre adultos. Fiebre relacionada con el leucocitosis, independientemente de la edad.

RESUMO Objetivo: Avaliar os sinais inflamatórios registrados em prontuários de pacientes com diagnóstico principal de crise epiléptica, admitidos em unidade de emergência. Método: Estudo transversal, retrospectivo. Amostra composta por 191 prontuários de pacientes pediátricos, adolescentes, adultos e idosos, com diagnóstico clínico de crise epiléptica, admitidos entre junho de 2016 a junho de 2017, na unidade de emergência de um hospital de Porto Alegre/RS. Resultados: Prevalência do relato de taquipneia (33,5%) e/ou febre (27,2%) como sinais inflamatórios, estando febre relacionada à leucocitose (P=0,030). Crianças/adolescentes tiverem crises menos frequentes (P=0,010) ede origem febril (P=0,000). Adultos apresentaram maior número de eventos (P=0,006), provocados por medicações/intoxicações (P=0,000). Nos idosos, crises ocorreram por distúrbios metabólicos/circulatórios (P=0,000), com menor ocorrência de febre (P=0,005). Conclusão: Crises epilépticas estão relacionadas à presença de febre e taquipneia, apresentando diferentes etiologias conforme faixa etária, com maior frequência de ocorrência entre adultos. Febre está relacionada à leucocitose, independentemente da idade.

Fever of unknown origin in special groups

SUMMARY Fever of undetermined origin (FUO) is a challenging entity with a striking presence in hospitals around the world. It is defined as temperature ≥ 37.8 ° C on several occasions, lasting ≥ three weeks, in the absence of diagnosis after three days of hospital investigation or 3 outpatient visits. The main etiologies are infectious, neoplastic, and non-infectious inflammatory diseases. The diagnosis is based on the detailed clinical history and physical examination of these patients, in order to direct the specific complementary tests to be performed in each case. The initial diagnostic approach of the FUO patient should include non-specific complementary exams. Empirical therapy is not recommended (with few exceptions) in patients with prolonged fever, as it may disguise and delay the diagnosis and conduct to treat the specific etiology. The prognosis encompasses mortality of 12-35%, varying according to the baseline etiology.

RESUMO Febre de origem indeterminada (FOI) é uma entidade desafiadora com presença marcante nos hospitais de todo o mundo. É definida como temperatura ≥37,8 ° C em várias ocasiões, com duração ≥3 semanas, na ausência de diagnóstico após três dias de investigação hospitalar ou três consultas ambulatoriais. As principais etiologias são de ordem infecciosa, neoplásica e doenças inflamatórias não infecciosas. O diagnóstico é baseado na história clínica e no exame físico minuciosos desses pacientes, com a finalidade de direcionar os exames complementares específicos a serem realizados em cada caso. A abordagem diagnóstica inicial do paciente com FOI deve incluir exames complementares inespecíficos. A terapia empírica não é recomendada (com poucas exceções) em pacientes com febre prolongada, uma vez que ela pode camuflar e retardar o diagnóstico e a conduta para tratar a etiologia específica. O prognóstico engloba uma mortalidade de 12-35%, variando de acordo com a etiologia de base.

Impact of periodontal disease on late morbimortality (10 years) of pacientes with acute coronary syndrome / Impacto da doença periodontal na morbimortalidade tardia (10 anos) de pacientes com síndrome coronariana aguda

Background: It is known that predisposing factors for periodontal disease (PD) and cardiovascular diseases are similar, just as dissemination of oral flora pathogens can induce the development of cardiovascular diseases, which play a direct role on the morbimortality of patients. Objective: To assess the impact of periodontal disease in the presence of acute coronary syndrome on late morbimortality after long-term follow-up of patients (10 years). Methods: The historical prospective study of continuous assessment was based on the evaluation of 345 medical records of patients hospitalized for acute coronary syndrome, divided into 3 groups: edentulous, with periodontal disease and without periodontal disease. The patients studied were in the ICU, in 2006, with a clinical picture of acute coronary syndrome submitted to invasive stratification with coronary angiography on the basis of clinical indication and were reassessed over the next 10 years. The qualitative variables were compared using the Chi-square test. Long-term mortality was assessed using the Kaplan-Meier curves, quantified with the hazard ratio (HR) and a confidence interval of 95% and compared through Cox regression. P values of less than or equal to 0.05 were regarded as statistically significant. Results: Of the 345 patients, 233 had at least one coronary obstruction greater than or equal to 50%, being the main group for comparison according to the different status of periodontal disease (without periodontal disease, with periodontal disease and edentulous). In his cardiovascular condition, we found a difference in mortality among edentulous patients compared to those free of periodontal disease, with a p = 0.004 and a hazard ratio of 10.496 (95% CI: 4.988-22.089). A is ignificant difference was also noted between edentulous patients and patients with periodontal disease, with a p = 0.0017 and a hazard ratio of 2.512 (95% CI: 1.491-4.234). Conclusion: A significant increase in mortality was found according with the progression of periodontal disease, which justifies its classification as an important risk factor for the development of cardiovascular diseases, as well as the need for prevention and treatment of oral diseases

Associação dos ácidos graxos poli-insaturados da série ômega 3 com parâmetros inflamatórios e estresse oxidativo em mulheres com câncer de mama: impacto do estadiamento clínico / Association of omega-3 polyunsaturated fatty acids with inflammatory parameters and oxidative stress in women with breast cancer: impact of tumor staging

Introdução: O câncer de mama (CM) correspondeu a 29,5% das neoplasias femininas em 2018, sendo que fatores relacionados ao estilo de vida, tais como alimentação podem explicar até 35% dessa neoplasia. Embora multicausal, é provável que desequilíbrio entre a ingestão de ácidos graxos ômega-3 e ômega-6 promova aumento na inflamação e estresse oxidativo nas diferentes etapas do processo de carcinogênese. Objetivo: Avaliar o impacto do estadiamento tumoral clínico na associação dos ácidos graxos ômega 3 biodisponíveis no plasma e nas membranas eritrocitárias com o estresse oxidativo e a inflamação em mulheres com câncer de mama. Material e métodos: Estudo caso-controle, observacional e analítico, com 87 mulheres com CM e 100 mulheres controles selecionadas do Hospital Geral de Fortaleza (HGF) no período de 2011/12. As pacientes Caso foram distribuídas, segundo estadiamento clínico (0-IIIc): EC = estadiamento IIa-IIIc. De ambos os grupos, foram obtidos dados demográficos e clínicos, avaliação antropométrica e composição corporal. Os marcadores de inflamação foram compostos pelas citocinas IL-1ß, IL-6, IL-10, TNF-α e MCP-1. Ao nível plasmático avaliou-se adipocinas (leptina e adiponectina), marcadores de estresse oxidativo (TBARS, LDL (-) e 8-OHdG), assim como o conteúdo de ácidos graxos no plasma e nas membranas dos eritrócitos por cromatografia a gás. Realizou-se teste de qui-quadrado, t-student, correlação de Pearson, Mann-Whitney e regressão linear e logística e adotou-se p<0,05 para todos os testes. Resultados: Não houve diferença entre a idade nos grupos Caso e Controle, nem nos parâmetros antropométricos, com exceção da circunferência da cintura que foi maior no grupo Caso (96,2 cm versus 91,2 cm). O tempo de tabagismo nos Casos foi maior que nos Controles (20,4 anos versus 13,5 anos). Nas mulheres com CM houve predominância do subtipo tumoral ductal (79,3%) e não houve diferenças entre receptores de estrógeno, progesterona, marcador HER2 e de proliferação celular Ki67, segundo estadiamento clínico. Os Casos apresentaram maiores valores de TBARS (6,0 versus 4,7 µmol) e anticorpos anti-LDL (-) (4,6 versus 2,5 U/L) e de citocinas inflamatórias MCP-1 (357,8 versus 295,8 ng/mL) e IL-1ß (2,8 versus 1,3 ng/mL). Os controles apresentaram maior concentração de IL-6 (0,9 versus 1,6 ng/mL) e IL-10 (2,8 versus 5,5 ng/mL), porém as razões entre citocinas (MCP-1, IL-1ß, TNF-α, IL-6 com a IL10) dos Casos apresentaram valores maiores que os Controles. Não houve diferença entre concentrações de citocinas nos grupos segundo estadiamento. O Grupo >EC apresentou maior razão n-6/n-3 e menor concentração de DHA e maior razão linoleico/DHA incorporado nas membranas eritrocitárias. O anticorpo anti-LDL (-) se associou negativamente com tamanho tumoral, enquanto a IL-10 positivamente. Elevado conteúdo de DHA (>= 4,3%) se associou com altas concentrações de IL-10, enquanto que o EPA, DHA e a soma desses se associaram com baixa concentração de citocinas inflamatórias. Os ácidos linoleico e araquidônico apresentaram associação com altas concentrações de marcadores inflamatórios plasmáticos. Conclusão: Mulheres com diagnóstico de CM apresentaram concentrações superiores de biomarcadores inflamatórios e de estresse oxidativo quando comparadas às mulheres saudáveis. Pacientes com maior estadiamento clínico apresentaram menores concentrações de ômega-3 e maiores de ômega-6. De modo contrário, esses ácidos graxos poli-insaturados modularam parâmetros inflamatórios e oxidativos

Introduction: Breast cancer (BC) accounted for 29.5% of female neoplasms in 2018, and lifestyle factors such as diet may explain up to 35% of this cancer. Although multicausal, imbalance between omega-3 and omega-6 fatty acid intake is likely to promote increased inflammation and oxidative stress at different stages of the carcinogenesis process. Objective: To evaluate the impact of clinical tumor staging on the association of bioavailable omega 3 fatty acids in plasma and erythrocyte membranes with oxidative stress and inflammation in women with breast cancer. Material and methods: Case-control, observational and analytical study, with 87 women with BC and 100 control women selected from the General Hospital of Fortaleza (HGF) in 2011/12. Case patients were distributed according to clinical staging (0-IIIc): EC = staging IIa-IIIc. From both groups, demographic and clinical data, anthropometric assessment and body composition were obtained. The inflammation markers were composed of cytokines IL-1ß, IL-6, IL-10, TNF-α and MCP-1. At the plasma level, adipokines (leptin and adiponectin), oxidative stress markers (TBARS, LDL (-) and 8-OHdG), as well as fatty acid content in plasma and erythrocyte membranes were evaluated by gas chromatography. Chi-square, t-student, Pearson correlation, Mann-Whitney and linear regression and logistic tests were performed and p <0.05 was adopted for all tests. Results: There was no difference between age in the Case and Control groups, nor in the anthropometric parameters, except for waist circumference which was higher in the Case group (96.2 cm versus 91.2 cm). Smoking time in Cases was longer than in Controls (20.4 years versus 13.5 years). In women with BC there was a predominance of ductal tumor subtype (79.3%) and no differences between estrogen receptors, progesterone, HER2 marker and Ki67 cell proliferation, according to clinical staging. Cases had higher values of TBARS (6.0 versus 4.7 µmol) and anti-LDL (-) antibodies (4.6 versus 2.5 U / L) and inflammatory cytokines MCP-1 (357.8 versus 295 ng / mL) and IL-1ß (2.8 versus 1.3 ng / mL). Controls had a higher concentration of IL-6 (0.9 versus 1.6 ng / mL) and IL-10 (2.8 versus 5.5 ng / mL), but ratios between cytokines (MCP-1, IL-1ß, TNF-α, IL-6 with IL10) shows higher values than Controls. There was no difference between cytokine concentrations in the groups according to staging. Group >EC presented higher n-6 / n-3 ratio and lower DHA concentration and higher linoleic / DHA ratio incorporated in erythrocyte membranes. Anti-LDL antibody (-) was negatively associated with tumor size, while IL-10 was positively associated. High DHA content (≥ 4.3%) was associated with high IL-10 concentrations, while EPA, DHA and their sum were associated with low concentration of inflammatory cytokines. Linoleic and arachidonic acids were associated with high concentrations of plasma inflammatory markers. Conclusion: Women diagnosed with BC had higher concentrations of inflammatory biomarkers and oxidative stress when compared to healthy women. Patients with higher clinical staging had lower omega-3 and higher omega-6 concentrations. Conversely, these polyunsaturated fatty acids modulated inflammatory and oxidative parameters

Algorithm for diagnosis of primary vasculitides / Algoritmo diagnóstico de vasculites primárias

Primary vasculitides are diseases with a wide variety of anatomical, clinical, radiological, and laboratory presentations. Primary vasculitides are difficult to diagnose because of the complexity of clinical presentation, which may lead to delayed treatment and increased financial costs of workup investigations involving non-essential tests. Our objective in the present study is to create an algorithm that helps diagnosis of Primary vasculitides. The algorithm presented in this article allows fast, simple and cost-effective diagnosis of primary vasculitides using just clinical concepts and a few laboratory tests

As vasculites primárias são doenças que possuem apresentações anatômicas, clínicas, radiológicas e laboratoriais muito distintas. Em virtude da complexidade dos quadros clínicos apresentados, as vasculites primárias são de difícil diagnóstico, o que pode promover um retardo no início da terapêutica, além de aumentar os custos financeiros da investigação propedêutica com exames não essenciais. O objetivo deste estudo foi criar um algoritmo que auxilie o diagnóstico das vasculites primárias. O algoritmo apresentado neste artigo permite a realização de diagnóstico rápido, simples e de baixo custo nas vasculites primárias, com a utilização de alguns conceitos clínicos e poucos exames laboratoriais