Chronic Chagas heart disease (CCHD affects about 30% of patients with chronic Chagas disease (CCD). Systemic arterial hypertension (SAH) afflicts about 25% of patients with CCD. The association of CCHD with SAH (CCHD-SAH) predisposes patients to develop chronic heart failure. The role of cytokines in disease progression in patients with CCHD-SAH is unknown. Accordingly, the aim of this study was to evaluate the plasma levels of cytokines expressing the Th1, Th2, Th17 pattern, as well as Treg cytokines, TNF-alpha, IL-1β, IL-8, IL-7 in patients with SAH-CCHD to get insight into the immunomodulation process in patients with this condition. Fifteen patients with CCHD, 22 patients with CCHD-SAH, and 28 controls were studied. All patients underwent history-taking, physical examination, 12-lead resting ECG, chest X-ray, and Doppler-echocardiogram. Ten of 15 (66%) patients with CCHD, and 16 of 22 (73%) patients with CCHD-SAH had decreased left ventricular ejection fraction (p > 0.05). Cytokines levels were performed on plasma samples using the ELISA method. Overall, proinflammatory, anti-inflammatory, and regulatory cytokine levels were increased in patients with CCHD-SAH in comparison to patients with CCHD and controls. However, such a difference was higher regarding IL-2, IL-5, IL-17, IL-12, and TNF-alpha cytokine levels, respectively. Cytokine levels were higher in CCHD patients in comparison to controls. Patients with CCHD-SAH have increased plasma levels of pro-inflammatory, anti-inflammatory, and regulatory cytokines in comparison with CCHD patients, thus suggesting a higher level of immunomodulation in patients with CCHD-SAH.
PURPOSE: Adequate tissue oxygenation is essential for healing. Hyperbaric oxygen therapy (HBOT) has potential clinical applications to treat ischemic pathologies, however the exact nature of any protective effects are unclear at present. We therefore investigated the potential role of HBOT in modulating the ischemia/reperfusion (I/R) injury response in intestinal model of I/R injury. METHODS: Male Wistar rats were subjected to surgery for the induction of intestinal ischemia followed by reperfusion. HBOT was provided before and/or after intestinal ischemia. Cell viability in the intestinal tissue was assessed using the MTT assay and by measuring serum malondealdehyde (MDA). Microvascular density and apoptosis were evaluated by immunohistochemistry. RESULTS:The results indicate that HBOT treatment pre-and post-ischemia reduces lesion size to the intestinal tissue. This treatment increases cell viability and reduces the activation of caspase-3, which is associated with increased number of tissue CD34 cells and enhanced VEGF expression. CONCLUSION: The hyperbaric oxygen therapy can limit tissue damage due to ischemia/reperfusion injury, by inducing reparative signaling pathways. Keywords: Reperfusion Injury. Hyperbaric Oxygenation. Rats. RESUMO OBJETIVO:Oxigenação tissular adequada é essencial para cicatrização. Oxigenoterapia hiperbárica (HBOT) tem aplicação clínica para tratar lesões isquêmicas, entretanto a natureza exata dos mecanismos envolvidos permanece incerta. Procuramos investigar o papel potencial da HBOT na modulação da resposta a uma lesão por isquemia reperfusão (I/R) intestinal em modelo de lesão de I/R. MÉTODOS: Ratos machos Wistar foram submetidos à cirurgia para a indução da isquemia intestinal seguida de reperfusão. HBOT foi fornecido antes e / ou após a isquemia intestinal. A viabilidade das células no tecido intestinal foi avaliada através do ensaio de MTT e pela medição malondealdeido (MDA) no plasma. Densidade microvascular e apoptose foram avaliados por imuno-histoquímica. RESULTADOS: Os resultados indicam que o tratamento HBOT pré e pós-isquemia reduz o tamanho da lesão ao tecido intestinal. Este tratamento aumenta a viabilidade celular e reduz a ativação da caspase-3, que está associada com aumento do número de células CD 34 no tecido e da expressão da VEGF. CONCLUSÃO: A oxigenoterapia hiperbárica pode limitar os danos do tecido devido à lesão por isquemia/reperfusão, induzindo às vias de sinalização reparadora. Descritores: Traumatismo por Reperfusão. Oxigenação Hiperbárica. Ratos.Daniel RAF et al.
Mild to moderate COVID-19 can be found in about 80% of patients. Although mortality is low, mild to moderate COVID-19 may progress to severe or even critical stages in about one week. This poses a substantial burden on the health care system, and ultimately culminates in death or incapacitation and hospitalization. Therefore, pharmacological treatment is paramount for patients with this condition, especially those with recognized risk factors to disease progression. We conducted a comprehensive review in the medical literature searching for randomized studies carried out in patients with mild to moderate COVID-19. A total of 14 randomized studies were identified, enrolling a total of 6848 patients. Nine studies (64%) were randomized, placebo-controlled trials, whereas five were open-label randomized trials (35%). We observed that Bamlanivimab and nitazoxanide reduced viral load, whereas ivermectin may have shortened time to viral clearance; Interferon Beta-1 reduced time to viral clearance and vitamin D reduced viral load; Favirapir, peginterferon, and levamisole improved clinical symptoms, whereas fluvoxamine halted disease progression; inhaled budesonide reduced the number of hospitalizations and visits to emergency departments; colchicine reduced the number of deaths and hospitalizations. Collectively, therefore, these findings show that treatment of early COVID-19 may be associated with reduced viral load, thus potentially decreasing disease spread in the community. Moreover, treatment of patients with mild to moderate COVID-19 may also be associated with improved clinical symptoms, hospitalization, and disease progression. We suggest that colchicine, inhaled budesonide, and nitazoxanide, along with nonpharmacological measures, based on efficacy and costs, may be used to mitigate the effects of the COVID-19 pandemic in middle-income countries.
Nonpharmaceutical Interventions (NPI) consist of compulsory (isolation, quarantine, stay-at-home orders, banning public gatherings, nonessential business closures, school closures), and voluntary (social distancing, handwashing, respiratory etiquette, and universal mask wearing) measures. The aim of this narrative review is to evaluate the different forms of NPI and their effectiveness in combating the pandemic. Isolation can be indicated for symptomatic and asymptomatic infected people at home or at hospitals depending on the patient’s clinical picture. Quarantine is a social distancing intervention in asymptomatic uninfected people who had contact with SARS-CoV-2 infected individuals. Stay-at-home orders refer to statewide mandates imposing nonessential business closures, prohibition of public events and gatherings, and travel restrictions. Studies have suggested that stay-at-home orders may be associated with a reduction in the incidence of COVID-19 in some countries. Mask wearing decreases the risk of COVID-19 in the community, especially when the surgical masks are used for vulnerable people. N-95 respirators protect health workers from COVID-19. NPI may be helpful to curb the COVID-19 pandemic while mass vaccination worldwide is not attainable, and the threat of SARS-COV-2 variants remain on the horizon.
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