Cause Of Inflammation Research Articles

Optimizing Anti-Myelin-Associated Glycoprotein and IgM-Gammopathy Testing for Neuropathy Treatment Evaluation.

Patients with typical anti-myelin-associated glycoprotein (anti-MAG) neuropathy have IgM-gammopathy, mimic distal chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), and are treatment resistant. Anti-MAG patients go unrecognized when IgM-gammopathy is undetected or with atypical phenotypes. We investigated an optimal anti-MAG titration cutoff for excluding CIDP and the impact of IgM-gammopathy detection on neuropathy treatment evaluation without anti-MAG antibodies. European Academy of Neurology/Peripheral Nerve Society 2021 guidelines were used to assess patients with neuropathy using anti-MAG Bühlmann titration units (BTU) and IgM-gammopathy with Mass-Fix (mass spectrophotometry) and serum protein immunofixation electrophoresis (SPIEP). The immunotherapy outcome was reviewed by inflammatory neuropathy cause and treatment (INCAT) and summated compound muscle action potential (CMAP) nerve conduction changes. Seven hundred and fifty-two patients (average age: 63.8 years, female: 31%) were identified over 30 months: (1) typical anti-MAG neuropathy (n = 104); (2) atypical anti-MAG neuropathy (n = 13); (3) distal or sensory-predominant CIDP (n = 25), including 7 without IgM-gammopathy; (4) typical CIDP (n = 47), including 36 without IgM-gammopathy; (5) axonal IgM-gammopathy-associated neuropathy (n = 104); and (6) IgM-gammopathy-negative, anti-MAG-negative axonal neuropathies (n = 426); and (7) without neuropathy (n = 33) anti-MAG negative. IgM-gammopathy was evaluated by Mass-Fix (n = 493), SPIEP (n = 355), or both (n = 96). Mass-Fix detected 4 additional IgM-gammopathies (3%, 4/117) among patients with anti-MAG antibodies and 7 additional patients (2%, 7/376) without anti-MAG not detected by SPIEP testing. Immunotherapy follow-up was available in 123 (mean: 23 months, range: 3-120 months) including 47 with CIDP (28 without IgM-gammopathy) and 76 non-CIDP (5 without IgM-gammopathy, 45 anti-MAG positive). Treatments included IVIG (n = 89), rituximab (n = 80), and ibrutinib or zanubrutinib (n = 24). An optimal anti-MAG-positive cutoff was identified at ≥1,500 BTU (78% sensitivity, 96% specificity) and at ≥10,000 BTU (74% sensitivity, 100% specificity) for typical anti-MAG neuropathy. Improvements in INCAT scores (p < 0.0001) and summated CMAP (p = 0.0028) were associated with negative anti-MAG (<1,500 BTU, n = 78) and absence of IgM-gammopathy (n = 34). Among 47 patients with electrodiagnostically confirmed CIDP, all anti-MAG negative, the presence of IgM-gammopathy (n = 19) also correlated with a worse treatment response (INCAT scores p = 0.035, summated CMAP p = 0.049). A cutoff of 10,000 BTU seems optimal for typical anti-MAG neuropathy while ≥1,500 BTU reduces the likelihood of immune-treatable CIDP. Mass-Fix improves IgM-gammopathy detection in anti-MAG and other IgM-gammopathy neuropathies. Patients with IgM-gammopathy lacking MAG antibodies show reduced treatment response.

Red Leg Dilemma: Development and Validation of Clinical Decision Tools for Non-Necrotizing Bacterial Dermohypodermitis, Necrotizing Fasciitis, and Eczematous Dermatitis.

Diagnosing red legs on first presentation is challenging. There exists a lack of robustly developed and validated diagnostic red leg tools in clinical practice. Physicians fear missing cases of infectious red legs and treat many patients unnecessarily with antibiotics. Develop and validate easy-to-use diagnostic tools applicable at bedside of patients to orient diagnosis of the commonest and most serious causes of infectious red legs (non-necrotizing bacterial dermohypodermitis (NNBDH), and necrotizing fasciitis (NF)) versus the commonest inflammatory cause (eczema). We collected data of patients presenting to our dermatology department from January first 2012 until May 17th 2017 with a diagnosis of red leg. Three models were developed using fast frugal trees. Validation was performed in a second cohort of patients. A total of 187 patients (mean age 56, SD = 21 years, 48.1% women) were included in the development phase and 62 patients (mean age 64, SD = 19, 52% women) in the validation phase. In the validation data set, sensitivity and specificity were respectively 67% and 91% for NNBDH, 83% and 66%, for NF and 88% and 93%, for eczema. Presentations of suspected lower-limb infections are commonly misdiagnosed, resulting in avoidable antibiotic prescription and hospitalization. We developed an easy-to-use clinical diagnostic tool applicable at the bedside of patients to help orient physicians in certain situations and avoid unnecessary initiation of antibiotics. Future work should focus on validating this tool in primary care to minimize misdiagnosis of red legs and overprescription of antibiotics.

Dysphonia in children

Abstract Dysphonia is a frequent symptom in paediatric patients and it has a prevalence between 6 - 24%. In young patients, dysphonia has a direct importance because it impairs their communicative behaviour, their psychological status and also their social life. The most diagnosed voice pathologies in children are vocal nodules followed by vocal cord cysts, infectious and inflammatory causes, sulcus vocalis, laryngeal membranes, iatrogenic vocal cord paralysis, neurological causes, psychogenic factors, traumatic or irritative factors or, less commonly, laryngeal neoplasms. A correct diagnosis of dysphonia in paediatric patients is important for learning, voice training and their psychological development. Children with dysphonia have to be assessed with adequate equipment. It is recommended to use tools that are appropriate to the tolerance and cooperation of the patients and allow to have a good visualization of the vocal folds. Suitable preventive methods, early diagnosis, appropriate treatment of voice disorders should be taken into consideration in these cases. In this article, some of the most frequent causes of dysphonia in paediatric patients and their treatment options in order to achieve a proper voice are reviewed.

American Football-associated Whiplash Maculopathy Presenting With Bilateral Bacillary Detachments: Case Report and Review of Literature.

Ocular trauma is a rare cause of bacillary layer detachments (BALAD). A case report was evaluated and a literature review was performed. A 15-year-old boy presented with bilateral scotomas after a routine American football tackle and was found to have bilateral BALADs. Inflammatory and infectious causes of BALAD were excluded, and he was diagnosed with whiplash maculopathy. Without intervention, the patient's visual acuity and macular anatomy rapidly improved. Novel indocyanine green angiography findings of this condition are reported. Bacillary detachments resulting from whiplash injuries generally resolve spontaneously with good visual outcomes. Even when other sequelae of trauma are not obvious, the presence of BALAD should prompt a targeted history around recent trauma including sports-associated whip-lash injuries. Patients with thicker choroids may be at increased risk of posterior segment sequalae from whiplash injury and choroidal status should be commented on in future reports. [Ophthalmic Surg Lasers Imaging Retina 2024;55:XX-XX.].

ULTRASONOGRAPHY EVALUATION OF PEDIATRIC NECK MASSES

Background: Neck masses are a frequent discovery in children and pose challenges in diagnosis. These masses can stem from congenital, inflammatory, neoplastic, or vascular origins. Understanding the cervical anatomy and compartments is crucial for differential diagnosis. There are different cystic lesions like ranula, thyroglossal cyst, brachial cyst, lymphangioma and vascular malformation and solid lesions like reactive lymph nodes,thyroid lesions,ectopic thymus etc.Rare lesions like teratoma,rhabdomyosarcoma,neurofibroma also exists. Aims: To assess congenital and acquired neck masses in children using ultrasonography (USG) and correlate imaging findings with pathology. Materials and Methods: This prospective observational study involved 30 pediatric patients with clinically palpable neck swellings referred for USG. Imaging was followed by necessary USG-guided procedures, and radiological findings were compared with histopathology. Results: Among 30 patients, 68% were male and 32% female. Most patients (53%) were aged 1-10 years. Right-sided lesions were most common (41.15%), with bilateral (17.25%) and midline (11.5%) presentations noted. Inflammatory causes were predominant (76.1%), followed by congenital (16.3%) and neoplastic (7.5%). USG revealed features such as reactive lymphadenitis (14 cases), TB lymphadenitis (6 cases), abscesses (2 cases, confirmed by aspiration), thyroglossal cysts (3 cases), lipomas (2 cases, confirmed by histopathology), malignancies (2 cases, confirmed by biopsy), and a branchial cyst (1 case). Conclusion: Pediatric neck masses are common and diagnostically challenging. Detailed clinical history, physical examination, and knowledge of cervical anatomy are crucial for accurate diagnosis. Utilizing neck compartments and multimodality imaging aids in precise diagnosis and appropriate management.

ULTRASONOGRAPHY EVALUATION OF PEDIATRIC NECK MASSES

Background: Neck masses are a frequent discovery in children and pose challenges in diagnosis. These masses can stem from congenital, inflammatory, neoplastic, or vascular origins. Understanding the cervical anatomy and compartments is crucial for differential diagnosis. There are different cystic lesions like ranula, thyroglossal cyst, brachial cyst, lymphangioma and vascular malformation and solid lesions like reactive lymph nodes,thyroid lesions,ectopic thymus etc.Rare lesions like teratoma,rhabdomyosarcoma,neurofibroma also exists. Aims: To assess congenital and acquired neck masses in children using ultrasonography (USG) and correlate imaging findings with pathology. Materials and Methods: This prospective observational study involved 30 pediatric patients with clinically palpable neck swellings referred for USG. Imaging was followed by necessary USG-guided procedures, and radiological findings were compared with histopathology. Results: Among 30 patients, 68% were male and 32% female. Most patients (53%) were aged 1-10 years. Right-sided lesions were most common (41.15%), with bilateral (17.25%) and midline (11.5%) presentations noted. Inflammatory causes were predominant (76.1%), followed by congenital (16.3%) and neoplastic (7.5%). USG revealed features such as reactive lymphadenitis (14 cases), TB lymphadenitis (6 cases), abscesses (2 cases, confirmed by aspiration), thyroglossal cysts (3 cases), lipomas (2 cases, confirmed by histopathology), malignancies (2 cases, confirmed by biopsy), and a branchial cyst (1 case). Conclusion: Pediatric neck masses are common and diagnostically challenging. Detailed clinical history, physical examination, and knowledge of cervical anatomy are crucial for accurate diagnosis. Utilizing neck compartments and multimodality imaging aids in precise diagnosis and appropriate management.

When and What to Test for Diarrhea: Focus on Stool Testing.

To review stool diagnostic tests in acute and chronic diarrhea. Narrative review of published literature. (A). In acute diarrhea, stool tests are indicated when there is strong pre-test probability of infectious etiology or C. difficile infection (CDI) suggested by >3 unformed bowel movements per 24h, symptoms lasting >7 days, and circumstances that are suggestive of infection. Several commercially available rapid tests for bacterial, viral or protozoal infections may be offered in addition to traditional methods (e.g. culture, microscopy), and provide a result within 6 hours. For CDI infection, a highly sensitive test such as glutamate dehydrogenase test is required; however, this does not distinguish infection from carrier state. That differentiation requires specialized nucleic acid amplification test (for toxin B) or enzyme immunoassays for toxin A or B, which are unfortunately not generally offered by microbiology labs. (B). Chronic diarrhea may result from inflammatory, fatty, osmotic or secretory causes; the commonest causes are IBS-D/functional diarrhea. Current recommendations in societal guidelines or clinical practice updates regarding stool tests in IBS-D/functional diarrhea in the absence of alarm symptoms include testing for giardia, calprotectin, fecal immunochemical test (FIT), and bile acid diarrhea (BAD). Comprehensive stool biochemical analyses (osmolality, pH, electrolytes) differentiate osmotic from secretory diarrhea and identify laxative abuse. Specific stool diagnostic tests for BAD and exocrine pancreatic insufficiency can lead to specific diagnosis and treatments. Surrogate markers associated with high fecal output and rapid transit in chronic diarrhea are stool form and colonic transit. Fecal testing is still very relevant in the practice of gastroenterology and deserves introduction of advanced microbiological and biochemical tests.

The diagnostic value of endomyocardial biopsy in the era of precision medicine: data from over 8,000 patients with comprehensive biopsy diagnostics

Abstract Background Endomyocardial biopsy (EMB) is an important diagnostic tool for evaluating various cardiac diseases such as myocarditis and storage disorders as well as for the monitoring heart transplant patients. Despite advances in non-invasive imaging techniques to characterize myocardial tissue, EMB remains the gold standard for definitive diagnosis and initiation of specific therapy. Here we report EMB laboratory results from over 8,000 patients and demonstrate the diagnostic utility of EMB. Methods and results We retrospectively reviewed EMB analyses performed at our institution. EMBs for monitoring graft rejection were not included in this study. Clinical data, suspected clinical diagnoses and EMB-based laboratory results were collected. Histopathological, immunohistochemical and molecular biology biopsy findings were recorded and reviewed for degree of concordance with clinical diagnosis. In total, EMBs from N=8,085 consecutive patients with unexplained heart failure were analyzed. The comprehensive EMB analysis revealed that N=616 (7.6%) patients had cardiac storage disease, most of whom had cardiac amyloidosis (N=606). N=357 (4.4%) patients were diagnosed with acute forms of myocarditis, including N=95 cases with active myocarditis, N=148 cases with giant cell myocarditis, N=95 cases with sarcoidosis and N=19 cases with eosinophilic myocarditis. A total of N=3,392 (42%) patients were found to have inflammatory heart disease such as inflammatory cardiomyopathy and borderline myocarditis, whereby a differentiation of the inflammatory infiltrates revealed considerable differences in the quality of inflammation. Viral genomes were found in the myocardium of N=6,072 (75%) patients, with treatment-relevant viral infections detected in N=2,015 (25%) cases. The remaining N=1,705 (21%) patients were diagnosed with other cardiomyopathies, including dilated cardiomyopathy (N=1,252), heart failure with preserved ejection fraction (N=325), hypertrophic cardiomyopathy (N=117) and arrhythmogenic right ventricular cardiomyopathy (N=11). Conclusions This retrospective study of over 8,000 patients with heart failure clearly shows that a definitive diagnosis is only possible with a comprehensive EMB diagnosis and leads to specific therapy in 79% of the cases. In the remaining 21% of patients, infectious and inflammatory causes could be excluded in order to initiate standard heart failure therapy. It is important to emphasize here that the quality of the inflammation and therapy-relevant viral infections cannot be detected with imaging techniques, which underlines the clinical-therapeutic importance of endomyocardial biopsy.

The challenge of etiologic diagnosis of subacute and chronic meningitis: an analysis of 183 patients.

Subacute and chronic meningitis (SCM) presents significant diagnostic challenges, with numerous infectious and non-infectious inflammatory causes. This study examined patients aged 16 and older with SCM admitted to referral centers for neuroinfections and neuroinflammations in Mashhad, Iran, between March 2015 and October 2022. Among 183 episodes, tuberculous meningitis was the most common infectious cause (46.5%), followed by Brucella meningitis (24.6%). The cause of SCM was definitively proven in 40.4%, presumptive in 35.0%, and unknown in 24.6% of cases. In-hospital mortality was 14.4%, and 30.5% of survivors experienced unfavorable outcomes (Glasgow Outcome Scale 2-4). Patients with unknown causes had a significantly higher risk of death compared to those with presumptive or proven diagnoses (risk ratio 4.18). This study emphasizes the diagnostic difficulties of SCM, with one-quarter of cases remaining undiagnosed and over one-third having only a presumptive diagnosis. Improving diagnostic methods could potentially enhance prognosis and reduce mortality.

Effectiveness of surgical approach in the management of non-traumatic corneal perforations

ABSTRACT Clinical relevance Non-traumatic aetiologies are one of the leading causes of corneal perforations. The management of corneal perforation is quite challenging and complex for anterior segment surgeons. The appropriate surgical approach for each case is usually determined on the basis of a combination of many different parameters. Background The study aimed to evaluate surgical approach options and outcomes in the treatment of non-traumatic corneal perforations. Methods Patient data who underwent surgery for non-traumatic corneal perforation between 2016 and 2023 were retrospectively evaluated. Medical records were assessed in terms of age, gender, perforation aetiology, the first and last examination notes, surgical approach, follow-up time, and additional surgeries and outcomes according to anatomical, therapeutic and functional success. Anterior segment photographs were investigated for thorough explanation of the examinations. Results Forty-five eyes of 45 patients were included (mean age 61.2 ± 22.4 (90-2), female/male ratio 20/25). Surgical approaches applied according to the size and location of the perforation site included fibrin glue application (6), amniotic membrane transplantation (AMT) (9), corneal patch graft application(15), and tectonic keratoplasty (15). The ratio of inflammatory and infectious causes as the two main indications was 29/16. Globe integrity was ensured with the first surgery in 27 eyes. However, 17 eyes required secondary surgical attempts due to failure of the first approach and 1 eye underwent evisceration. AMT was the least successful method among other methods in anatomical, therapeutic, and functional assessment. Conclusion There are various surgical approaches for repairing non-traumatic corneal perforations, each with its own advantages and disadvantages. These include high tissue resistance, the ability to remove necrotic tissue, ease of access, and anti-inflammatory activity. It is possible to successfully repair corneal perforations with single and combined methods, considering the above-mentioned features, especially depending on the size and location of the defect. While AMT is a viable and time-saving choice − especially in the lack of donor tissues − further interventions are necessary in most circumstances.

B-082 Clinical Investigation of Rods and Rings Pattern in Anti-Nuclear Antibody Test in Korean Patients

Abstract Background In the mid-2000s, a novel pattern in antinuclear antibody (ANA) testing was reported. Indirect immunofluorescence assays on HEp-2 cells, conducted with sera from patients with Hepatitis C virus (HCV) infection, revealed cytoplasmic structures in the form of rods and rings (RR). These structures typically displayed rod lengths of 3-10μm and ring diameters of 2-5μm. Inosine monophosphate dehydrogenase (IMPDH) was identified as the primary component of the RR structures. Research on the administration of interferon/ribavirin (IFN/RBV) showed that ribavirin, an IMPDH inhibitor, induced RR formation in over 95% of cells. Additionally, RR patterns were reported in patients receiving other IMPDH inhibitors such as mycophenolic acid and azathioprine. While cytidine triphosphate synthase 1 (CTPS1) was suggested to be associated with RR structures, there were no reported cases in patients. Interestingly, patients receiving methotrexate, which does not directly inhibit IMPDH but hinders GTP biosynthesis, also exhibited RR structures. To explore the clinical implications of specimens showing RR patterns, a study was conducted to investigate the actual clinical scenarios associated with these findings. Methods This is a retrospective study conducted at a single center, covering the period from January 2022 to December 2023, focusing on the results of ANA testing. The ANA tests were performed using HEp-2 cells (FLUORO HEPANA TEST, MBL, Nagoya, Japan) on slides manufactured with AP 16 IF Plus (das, Palombara Sabina, RM, Italy). ANA results were obtained through qualitative testing, ranging from 1+ to 4+, or quantitative testing based on dilutions ranging from 1:40 to 1:640, depending on clinical requirements. Results Out of the 7,648 ANA test results, the RR pattern was observed in 40 cases (0.5%). Among these, 2.5% had a history of HCV infection with IFN/RBV treatment, and an additional 2.5% had concurrent use of IMPDH inhibitors. There were no reported cases of medication history related to the synthetic pathway of nucleic acids, including CTPS1. Cases where RR patterns coexisted with autoimmune diseases accounted for 35%, infections for 25%, and other inflammatory conditions for 22.5%. RR patterns reported with an intensity of 3+ or at dilutions of 1:160 or higher constituted 27.5%. Among cases displaying strong fluorescence, 45% were associated with infections, 18% with autoimmune conditions, and another 18% with unexplained inflammatory causes. In the overall sample, elevated CRP or ESR was noted in 54.5% of cases with infections, autoimmune diseases, or other inflammatory conditions. Among samples with intense intensity, 55.5% showed elevated CRP or ESR when inflammatory conditions were present. Conclusions The majority of cases exhibiting the RR pattern showed no history of exposure to IMPDH inhibitors or drugs affecting the nucleic acid synthetic pathway. A high proportion of cases clinically diagnosed with inflammation showed a concurrent RR pattern, with only approximately half of them demonstrating elevated CRP or ESR levels. This study suggests the possibility of identifying inflammatory responses not captured by conventional acute inflammation markers through the RR pattern observed in ANA testing.

473 - Inflammatory breast cancer: the case of a swollen arm mimicking deep vein thrombosis as the cause of inflammation

473 - Inflammatory breast cancer: the case of a swollen arm mimicking deep vein thrombosis as the cause of inflammation

Patients and clinicians have different priorities when discussing pain in the IBD clinic.

Pain in inflammatory bowel disease (IBD) is frequently neglected/overlooked, particularly in ulcerative colitis, and communication about pain can be suboptimal. The current study juxtaposes clinicians' conceptualisations of patients' pain with patient narratives. The aim was to inform the development of a pain reporting tool and provide guidance for better communication about IBD pain. In-depth semistructured interviews with 13 IBD clinicians in the UK: gastroenterologists (n=5), colorectal surgeons (n=2), specialist nurses (n=4) and psychologists (n=2). Primary analysis of these data and secondary analysis of earlier interviews about pain in IBD with clinicians (n=12) and patients (n=71) followed principles of reflexive thematic analysis. Themes were compared across participant groups. Clinicians state that they regularly ask about pain in Crohn's disease, but not ulcerative colitis. Patients, however, report inconsistent attention to pain in either condition, with power dynamics constraining their pain report. Some clinicians acknowledged that they assume that patients manage their pain independently, leading to insufficient follow-up (Theme 1: Contradictions and ambiguities when discussing pain in IBD). Inadequate acknowledgement of pain by clinicians was attributed to time constraints and systemic issues. Where inflammatory or structural causes were lacking, some clinicians default to attributing pain to irritable bowel syndrome, contributing to patients feeling uncared for (Theme 2: Consequences of limited tools and time for pain). Addressing pain was further complicated by the reluctance of some patients to express discomfort or pain and others who avoided activities that might lead to pain (Theme 3: Addressing pain in patients who do not complain). The study emphasises the importance of consistent pain evaluation and management, advocating for more open dialogues between clinicians and patients.

Study the Effect of IL-1beta on Thyroid Hormones Levels in Women with Hypo- and Hyperthyroidism in the City of Ramadi

Thyroiditis is a medical condition of particular concern due to its diverse causes, including autoimmune factors, drug-induced inflammatory causes or fibrotic process, the most common of which is thyroiditis and includes hypothyroidism and hyperthyroidism. The study aimed to measure interleukin 1 beta (IL-1β) and compare it with the studied groups and the hormones TSH, T3, T4 and their relationship with IL-1β. The study included investigating the relationship between IL-1β and thyroid patients in females aged between (18-60) in the city of Ramadi as well as knowing the relationship between thyroid hormones (TSH, T4, T3) and IL-1β. 45 samples were collected from Ramadi Teaching Hospital. The current study showed that there was a significant increase in the level of IL-1β compared to the control group in hypothyroid patients at a significant level (P≤0.05), which was (2.3497ng/dl). There were no significant differences in the level of IL-1β in patients with hyperthyroidism at a significant level (P≤0.05), which was (ng/dl 2.0690) compared to the control group. The study showed that there is an inverse relationship between TSH and IL-1β (0.858) and a positive relationship between T4 and IL-1β (0.809) .We conclude from the study that interleukin 1 beta (IL-1β) has an effect on the thyroid gland, especially hypothyroidism, as it showed a highly significant increase in IL-1β in patients with hypothyroidism and no significant differences in IL-1β, as IL-1β affects thyroid hormones

Radiological clinical profile of multiple cranial neuropathy and recurrence risk factors

Multiple cranial neuropathies (MCN) are the dysfunction of 2 or more cranial nerves, simultaneously or sequentially. The most common causes are tumors, followed by vascular and traumatic causes, central nervous system infections and Guillain-Barré syndrome and its variants. To identify the radiological clinical profile of MCN in patients of a tertiary-care hospital. Observational, cross-sectional, retrospective and analytical study in patients of 18 years of age or older, with a diagnosis of MCN. It was used descriptive statistics, and normality curves were determined. To establish differences, it was used chi-squared or Student's t test with the statistical package SPSS, version 29. 46 patients with a mean age 49 years (± 16) were studied. 29 (63%) were male. Findings in the magnetic resonance of the skull were normal in 34%; the reinforcement of the cavernous sinus in 26%. Non-infectious inflammatory was the most frequent etiology (43%). 83% of the inflammatory etiology presented improvement at discharge while those of non-inflammatory etiology were discharged without improvement (odds ratio [OR] 8, p 0.001). 87% had pain in their clinical picture unlike subjects with non-inflammatory etiology (OR 4, p < 0.01). 73% of the population with inflammatory etiology presented recurrence, and none of the subjects with a non- inflammatory cause (OR 0.5, p 0.022). The most common presentation of MCN in our study was cavernous sinus syndrome or sphenoidal cleft, with a non-acute course. The possibility of documenting an inflammatory etiology impacts the risk of recurrence and improvement upon hospital discharge.

Inflammatory setting, therapeutic strategies targeting some pro-inflammatory cytokines and pathways in mitigating ischemia/reperfusion-induced hepatic injury: a comprehensive review.

Ischemia/reperfusion injury (IRI) is a key determining agent in the pathophysiology of clinical organ dysfunction. It is characterized by an aseptic local inflammatory reaction due to a decrease in blood supply, hence deprivation of dependent oxygen and nutrients. In instances of liver transplantation, this injury may have irreversible implications, resulting in eventual organ rejection. The deterioration associated with IRI is affected by the hepatic health status and various factors such as alterations in metabolism, oxidative stress, and pro-inflammatory cytokines. The primary cause of inflammation is the initial immune response of pro-inflammatory cytokines, while Kupffer cells (KFCs) and neutrophil-produced chemokines also play a significant role. Upon reperfusion, the activation of inflammatory responses can elicit further cellular damage and organ dysfunction. This review discusses the interplay between chemokines, pro-inflammatory cytokines, and other inflammatory mediators that contribute to the damage to hepatocytes and liver failure in rats following IR. Furthermore, it delves into the impact of anti-inflammatory therapies in safeguarding against liver failure and hepatocellular damage in rats following IR. This review investigates the correlation between cytokine factors and liver dysfunction via examining databases, such as PubMed, Google Scholar, Science Direct, Egyptian Knowledge Bank (EKB), and Research Gate.

Analysis of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios as inflammatory biomarkers in chronic kidney disease: impact of parathyroidectomy.

Secondary hyperparathyroidism (SHPT) is one of the causes for inflammation in CKD. We assessed the impact of parathyroidectomy (PTX) on neutrophil-to-lymphocyte (N/L) and platelet-to-lymphocyte (P/L) ratios in SHPT patients. A total of 118 patients [hemodialysis (HD, n = 81), and transplant recipients (TX, n = 37)] undergoing PTX between 2015 and 2021 were analyzed. There was a significant reduction in calcium and PTH levels in both groups, in addition to an increase in vitamin D. In the HD group, PTX did not alter N/L and P/L ratios. In the TX group, there was a reduction in N/L and P/L ratios followed by a significant increase in total lymphocyte count. N/L and P/L ratios are not reliable biomarkers of inflammation in SHPT patients undergoing PTX. Uremia, which induces a state of chronic inflammation in dialysis patients, and the use of immunosuppression in kidney transplant recipients are some of the confounding factors that prevent the use of this tool in clinical practice.

Evaluation of Serum Levels of Vitamin D3 and IgE in Patients with Chronic and Allergic Sinusitis: A Cross-sectional Study.

Chronic rhinosinusitis is known as a common problem with inflammatory and allergic causes. Several factors are associated with developing chronic rhinosinusitis, including immunoglobulin E (IgE) production and vitamin D deficiency. In this study, we investigated the role of IgE and Vitamin D deficiency and differences between patients with chronic, allergic sinusitis and controls. A total of 90 subjects were included in 3 groups (n=30) in this cross-sectional, correlational descriptive study. The subjects were divided into three groups, including control (healthy subjects), chronic sinusitis patients, and allergy patients. A checklist was used to collect the necessary data, including age, gender, and body mass index (BMI). To evaluate serum levels of vitamin D3 and IgE, ELISA kits were used. The mean vitamin D was 22 g/ml. Fifty-four participants (60%) out of all included people had insufficient vitamin D, 13% had a deficiency, and the high deficiency and insufficiency were in the group of allergic sinusitis. Our results indicated that gender (female) was significantly associated with vitamin D deficiency (p =0.01). Thirty-nine participants (43.3%) out of all studied subjects had high IgE, and the highest level of abnormality of IgE was in the allergic sinusitis group. Furthermore, it was found that gender and IgE were not significantly related. However, IgE was significantly associated with vitamin D deficiency in the allergic sinusitis group. Our findings highlighted that most of the patients with chronic and allergic sinusitis had insufficient vitamin D. A possible association was also found between low vitamin D and IgE levels and the prevalence of allergic sinusitis. This study showed that patients with allergic sinusitis may be more vulnerable to lower serum levels of vitamin D. Therefore, vitamin D supplementation as an adjunctive therapy may be considered in these patients.

Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in bacterial infections: contributions to diagnostic strategies in a tertiary care hospital in Tunisia.

Bacterial infections continue to pose a global health challenge, driven by antibiotic resistance and septicemia. This study aimed to assess the diagnostic utility of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in bacterial infections versus non-infectious causes of inflammation. A prospective study included 164 adult patients who were divided into two groups: a group of patients with confirmed bacterial infections and a second group of patients with other diagnoses (inflammatory pathologies, neoplasms, venous thromboembolic diseases, etc.). NLR and PLR values were compared between the bacterial infection group and the non-infectious causes group and the diagnostic performances of NLR and PLR for detecting bacterial infections were evaluated in comparison with other infection markers. NLR and PLR were significantly higher in bacterial infections (p < 10 ^-6), and NLR was correlated positively with inflammation markers. NLR and PLR demonstrated significant potential in diagnosing bacterial infections, with an AUC of 0.72 and 0.60, respectively, using the following cutoff values: 4.3 for NLR and 183 for PLR. These findings underscore the importance of NLR and PLR as adjunctive tools for bacterial infection diagnosis.

NLRP3 inflammasomes as a target for hesperidin and diosmin flavonoids in varicose vein disease and its complications

Varicose vein disease of the lower extremities is an inflammatory disorder with abnormal structure and functional activity of the venous valves, venous walls and cells, as well as with abnormal activity of the infiltrating leukocytes. The abnormally changed varicose vein are characterized by increased venous pressure, blood accumulation and congestion, ischemia, and metabolic and energy turnover derangement, which result in clinical manifestations of complications, such as pain, edema and formation of trophic ulcers. For many years, flavonoids have been used to treat varicose veins. The most effective flavonoids used in varicose vein disease and its complications, are hesperidin and diosmin, as well as their combinations. The review sets forth the state-of-the-art knowledge on the universal inflammatory processes playing a leading role in the pathophysiology of many cardiovascular disorders, including venous ones. In the recent years, it has been found that one of the main causes of inflammation is the formation of intracellular protein complexes (inflammasomes), which both produce a set of proinflammatory cytokines and are responsible for their excretion from the cells. In addition, inflammasomes control the development of regulated necrosis (pyroptosis) that takes part in the process of ulceration. The inflammasome activity can be modified by various mechanisms, of which the gene independent synthesis of the inflammasomal proteins has been recognized as the leading one. It has been shown that flavonoids inhibit the activation of a key factor NF-kappa B and suppress the synthesis of proteins, including NOD-like receptor protein 3 (NLRP3) inflammasome components, decrease the expression of NLRP3 receptor, protein ASC and caspase 1, as well as diminish interleukin 1 beta, interleukin 6 and tumor necrosis factor-alpha expression. Thus, this is the explanation of positive effects observed with the use of hesperidin, diosmin and their combination in clinical practice.