ABSTRACT
AIMS: We hypothesized that critically ill patients with SARS-CoV-2 infection and insulin resistance would present a reduced Heat Shock Response (HSR), which is a pathway involved in proteostasis and anti-inflammation, subsequently leading to worse outcomes and higher inflammation. In this work we aimed: (i) to measure the concentration of extracellular HSP72 (eHSP72) in patients with severe COVID-19 and in comparison with noninfected patients; (ii) to compare the HSR between critically ill patients with COVID-19 (with and without diabetes); and (iii) to compare the HSR in these patients with noninfected individuals. METHODS: Sixty critically ill adults with acute respiratory failure with SARS-CoV-2, with or without diabetes, were selected. Noninfected subjects were included for comparison (healthy, n = 19 and patients with diabetes, n = 22). Blood samples were collected to measure metabolism (glucose and HbA1c); oxidative stress (lypoperoxidation and carbonyls); cytokine profile (IL-10 and TNF); eHSP72; and the HSR (in vitro). RESULTS: Patients with severe COVID-19 presented higher plasma eHSP72 compared with healthy individuals and noninfected patients with diabetes. Despite the high level of plasma cytokines, no differences were found between critically ill patients with COVID-19 with or without diabetes. Critically ill patients, when compared to noninfected, presented a blunted HSR. Oxidative stress markers followed the same pattern. No differences in the HSR (extracellular/intracellular level) were found between critically ill patients, with or without diabetes. CONCLUSIONS: We demonstrated that patients with severe COVID-19 have elevated plasma eHSP72 and that their HSR is blunted, regardless of the presence of diabetes. These results might explain the uncontrolled inflammation and also provide insights on the increased risk in developing type 2 diabetes after SARS-CoV-2 infection.
Subject(s)
COVID-19 , Diabetes Mellitus, Type 2 , Adult , Humans , Interleukin-10 , SARS-CoV-2 , Critical Illness , HSP72 Heat-Shock Proteins/metabolism , Glycated Hemoglobin , Heat-Shock Response , Cytokines , Inflammation , Molecular Chaperones , GlucoseABSTRACT
OBJECTIVE: to evaluate the main risk factors for postoperative complications in patients undergoing appendectomy for acute appendicitis. METHODS: we retrospectively analyzed 1241 patients undergoing open or laparoscopic appendectomy. Patients were allocated to four groups: Group 1, without postoperative complications, and Groups 2, 3, and 4, with postoperative complications defined according to their severity, following Clavien-Dindo classification (I, II, and ≥III, respectively). RESULTS: patients aged ≥38.5 years had more severe complications (p<0.0001). Patients in Group 1, without postoperative complications, had, for the most part, a laparoscopic approach. Groups 2, 3, and 4 underwent, predominantly, to an open surgery (p<0.0001). In cases of acute appendicitis, the odds ratio (OR) for complications was 3.09, 3.04, and 12.41 for Groups 2, 3, and 4, respectively (p<0.0001). Anesthetic risk, duration of the procedure, and length of hospital stay were related to a higher risk and severity of complications. CONCLUSION: the main predicting factors of postoperative complications in patients operated for acute appendicitis were: age ≥38.5 years, conventional or open surgical access, complicated appendicitis, ASA≥2, and surgical time >77 minutes.
OBJECTIVE: avaliar os principais fatores de risco para complicações pós-operatórias em pacientes submetidos à apendicectomia por apendicite aguda. METHODS: foram analisados retrospectivamente 1241 pacientes submetidos à apendicectomia aberta ou laparoscópica. Os pacientes foram alocados em quatro grupos: Grupo 1, sem complicações pós-operatórias, e Grupos 2, 3 e 4, com complicações pós-operatórias, definidas de acordo com sua gravidade, conforme classificação de Clavien-Dindo I, II e ≥III, respectivamente. RESULTS: pacientes com idade ≥38,5 anos tiveram complicações mais graves (p<0,0001). Os pacientes do Grupo 1, sem complicações pós-operatórias, foram predominantemente operados por via laparoscópica. Os Grupos 2, 3 e 4 foram, em sua maior parte, operados por via convencional (p<0,0001). Razão de chances de complicações para apendicite complicada foi de 3,09, 3,04 e 12,41 para os Grupos 2, 3 e 4, respectivamente (p<0,0001). Risco anestésico, duração do procedimento e tempo de internação hospitalar estiveram relacionados com maior risco e gravidade de complicações (p<0,0001). CONCLUSIONS: os principais fatores preditores de complicações pós-operatórias em pacientes operados por apendicite aguda foram: idade ≥38,5 anos, acesso cirúrgico convencional ou aberto, apendicite complicada, ASA≥2 e tempo cirúrgico >77 minutos.
Subject(s)
Appendectomy/adverse effects , Appendicitis/surgery , Postoperative Complications , Acute Disease , Adult , Age Factors , Appendectomy/methods , Female , Humans , Laparoscopy , Length of Stay , Male , Middle Aged , Retrospective Studies , Risk Factors , Severity of Illness IndexABSTRACT
BACKGROUND/AIM: Identification of changes in specific genes may help new attempts in finding targeted therapy for oesophageal cancer which still has a very poor prognosis. The aim of this study was to investigate CD117 expression in squamous cell carcinoma of the oesophagus (SCCO). MATERIALS AND METHODS: A preliminary study was performed for CD177 immunoreactivity using a monoclonal antibody against CD117 on 27 SCCO specimens from patients who underwent surgical resection. Specimens of oesophageal mucosa obtained from 10 healthy individuals were studied as a control group. RESULTS: Most patients had TNM American Joint Committee on Cancer stage IIb or III SCCO and mean overall survival was 21 (range=2-72) months. Cytoplasmic membrane CD117 immunoreactivity was demonstrated in only four (15%) out of 27 tumours and in none of the controls. CONCLUSION: Although immunohistochemical expression of CD117 was higher than previously demonstrated, the lack of expression does not warranty further use in targeted therapy of SCCO.
Subject(s)
Carcinoma, Squamous Cell/immunology , Esophageal Neoplasms/immunology , Proto-Oncogene Proteins c-kit/metabolism , Adult , Aged , Carcinoma, Squamous Cell/pathology , Case-Control Studies , Esophageal Neoplasms/pathology , Female , Humans , Immunohistochemistry , Male , Middle Aged , Retrospective Studies , Survival AnalysisABSTRACT
RESUMO Objetivo: avaliar os principais fatores de risco para complicações pós-operatórias em pacientes submetidos à apendicectomia por apendicite aguda. Métodos: foram analisados retrospectivamente 1241 pacientes submetidos à apendicectomia aberta ou laparoscópica. Os pacientes foram alocados em quatro grupos: Grupo 1, sem complicações pós-operatórias, e Grupos 2, 3 e 4, com complicações pós-operatórias, definidas de acordo com sua gravidade, conforme classificação de Clavien-Dindo I, II e ≥III, respectivamente. Resultados: pacientes com idade ≥38,5 anos tiveram complicações mais graves (p<0,0001). Os pacientes do Grupo 1, sem complicações pós-operatórias, foram predominantemente operados por via laparoscópica. Os Grupos 2, 3 e 4 foram, em sua maior parte, operados por via convencional (p<0,0001). Razão de chances de complicações para apendicite complicada foi de 3,09, 3,04 e 12,41 para os Grupos 2, 3 e 4, respectivamente (p<0,0001). Risco anestésico, duração do procedimento e tempo de internação hospitalar estiveram relacionados com maior risco e gravidade de complicações (p<0,0001). Conclusão: os principais fatores preditores de complicações pós-operatórias em pacientes operados por apendicite aguda foram: idade ≥38,5 anos, acesso cirúrgico convencional ou aberto, apendicite complicada, ASA≥2 e tempo cirúrgico >77 minutos.
ABSTRACT Objective: to evaluate the main risk factors for postoperative complications in patients undergoing appendectomy for acute appendicitis. Methods: we retrospectively analyzed 1241 patients undergoing open or laparoscopic appendectomy. Patients were allocated to four groups: Group 1, without postoperative complications, and Groups 2, 3, and 4, with postoperative complications defined according to their severity, following Clavien-Dindo classification (I, II, and ≥III, respectively). Results: patients aged ≥38.5 years had more severe complications (p<0.0001). Patients in Group 1, without postoperative complications, had, for the most part, a laparoscopic approach. Groups 2, 3, and 4 underwent, predominantly, to an open surgery (p<0.0001). In cases of acute appendicitis, the odds ratio (OR) for complications was 3.09, 3.04, and 12.41 for Groups 2, 3, and 4, respectively (p<0.0001). Anesthetic risk, duration of the procedure, and length of hospital stay were related to a higher risk and severity of complications. Conclusion: the main predicting factors of postoperative complications in patients operated for acute appendicitis were: age ≥38.5 years, conventional or open surgical access, complicated appendicitis, ASA≥2, and surgical time >77 minutes.
