Systemic Inflammatory Component Research Articles

Endometriosis in the era of precision medicine and impact on sexual and reproductive health across the lifespan and in diverse populations.

Endometriosis is a common estrogen-dependent disorder wherein uterine lining tissue (endometrium) is found mainly in the pelvis where it causes inflammation, chronic pelvic pain, pain with intercourse and menses, and infertility. Recent evidence also supports a systemic inflammatory component that underlies associated co-morbidities, e.g., migraines and cardiovascular and autoimmune diseases. Genetics and environment contribute significantly to disease risk, and with the explosion of omics technologies, underlying mechanisms of symptoms are increasingly being elucidated, although novel and effective therapeutics for pain and infertility have lagged behind these advances. Moreover, there are stark disparities in diagnosis, access to care, and treatment among persons of color and transgender/nonbinary identity, socioeconomically disadvantaged populations, and adolescents, and a disturbing low awareness among health care providers, policymakers, and the lay public about endometriosis, which, if left undiagnosed and under-treated can lead to significant fibrosis, infertility, depression, and markedly diminished quality of life. This review summarizes endometriosis epidemiology, compelling evidence for its pathogenesis, mechanisms underlying its pathophysiology in the age of precision medicine, recent biomarker discovery, novel therapeutic approaches, and issues around reproductive justice for marginalized populations with this disorder spanning the past 100 years. As we enter the next revolution in health care and biomedical research, with rich molecular and clinical datasets, single-cell omics, and population-level data, endometriosis is well positioned to benefit from data-driven research leveraging computational and artificial intelligence approaches integrating data and predicting disease risk, diagnosis, response to medical and surgical therapies, and prognosis for recurrence.

Rheumatic disease Risk factors, pathophysiology and management

Rheumatic diseases, because of their systemic inflammatory component, are associated with several shared comorbidities. The high affinity of shared epitope for citrullinated peptides could accelerate the amount of human leukocyte antigen peptide complexes on the surface of antigen-presenting cells, thus leading to a (possible joint-specific) T- cell response. Molecules such as receptor activator of nuclear factor κB ligand, prostaglandins, and matrix metalloproteinases are induced by pro-inflammatory cytokines, involving tumor necrosis factor and interleukin 6, and mediate signs and symptoms of the disease, involving pain and swelling, and degradation of cartilage and bone. Steroids at dosages equivalent to less than 10 mg of prednisone daily are highly effective for relieving symptoms of rheumatoid arthritis and can slow joint injury.

León (Spain) Health professionals' knowledge and clinical practice towards the relationship between cardiovascular diseases and periodontal disease.

Cardiovascular pathologies have a high prevalence in the geriatric population, with acute myocardial infarction being one of the main causes of death in Spain. These pathologies have a systemic inflammatory component that is of vital importance. We also know in dentistry that the main gingival pathogens are capable of generating a systemic inflammatory response, being indirectly involved in the development of the atherosclerotic lesion, assuming, therefore, that periodontal disease is a cardiovascular risk factor. The objective of this study is to determine the knowledge of health professionals who treat cardiovascular diseases about periodontal disease and its relationship with heart disease. A health survey was carried out on 100 Cardiologists, Internists and General Practitioners in the province of León. Points of interest in this survey: the professional's own oral health, knowledge of the relationship between periodontal and heart disease and, lastly, the training received in medicine on oral health. 60% of professionals reviewed their oral health annually and 20% randomly. 48% of health professionals were unaware of periodontal diseases, 77% claimed to have not received university training in this regard, only 13% of those surveyed acknowledged having received more than 10 hours of training on oral health in their experience and finally, 90% thought that training in both Medicine and Dentistry should be collaborative. The degree of knowledge of health professionals regarding oral health is poor (77%), therefore the number of collaborative consultations with dental professionals is low (<63%). Training projects targeting a correct preventive medicine are shown to be necessary. Key words:Cardiovascular disease, oral-systemic health, periodontitis, knowledge, physicians.

The relationship of chronic odontogenic foci of infection with atherosclerosis

Modern studies have convincingly confirmed the rela-tionship between the state of the oral microflora and the risk of developing diseases with a systemic inflammatory component, including atherosclerosis. One of the media-tors of systemic inflammation is C-reactive protein (CRP), which is of particular interest to internists as a predictor of cardiovascular diseases. Purpose of the study. To study the relationship of chronic odontogenic foci of infection with the pathology of the cardiovascular system. Materials and methods of research. А clinical examination was performed with the determination of the OHI-S (Green-Vermillion) and periodontal index (PI); photo pro-tocol, CBCT analysis with a resolution of 12×8.5 in 30 pa-tients aged 41.1±4.1 years with coronary heart disease (CHD). The first group of patients consisted of 15 peo-ple with chronic periodontitis, the second — 15 people without signs of periodontal pathology. In all patients the levels of CRP and total cholesterol were determined before and 4 months after dental treatment. Results.In the first group of patients, before the start of dental treatment, the level of CRP was 8.63±0.12 mg/l, total cholesterol — 7.43±0.24 mmol/l; in the second group, the level of CRP was 4.44±0.36 mmol/l, total cholesterol — 5.76±0.17. 4 months after the dental treatment, the level of CRP in the first group was 5.41±0.23 mg/l, total cholesterol — 6.41±0.12 mmol/l; in the second group, the level of CRP was 4.21±0.12 mg/l, the level of total cholesterol was 5.34±0.13 mmol/l. Conclusion:chronic focal odontogenic infection contributes to the development of a systemic inflammatory response, ac-companied by an increase in the level of CRP. Timely de-tection and elimination of chronic odontogenic foci of infection is accompanied by normalization of the level of C-reactive protein.

Potential Therapeutic Applications of Natural Compounds in Diabetes-Associated Periodontitis.

Diabetes mellitus (DM) is a major worldwide health burden. DM is a metabolic disease characterized by chronic hyperglycemia, and if left untreated, can lead to various complications. Individuals with uncontrolled DM are more susceptible to periodontitis due to both a hyper-inflammatory host response and an impaired immune response. Periodontitis, on the other hand, may exacerbate DM by increasing both local and systemic inflammatory components of DM-related complications. The current standard for periodontal treatment in diabetes-associated periodontitis (DP) focuses mostly on reducing bacterial load and less on controlling the excessive host response, and hence, may not be able to resolve DP completely. Over the past decade, natural compounds have emerged as an adjunct approach for modulating the host immune response with the hope of curing DP. The anti-oxidant, anti-inflammatory, and anti-diabetic characteristics of natural substances are well-known, and they can be found in regularly consumed foods and drinks, as well as plants. The pathophysiology of DP and the treatment benefits of various bioactive extracts for DP will be covered in this review.

Revisiting differences between atopic and non-atopic asthmatics: When age is shaping airway inflammatory profile

BackgroundAtopic asthma is one of the most common asthma phenotypes and is generally opposed to the non-atopic counterpart. There have been very few large-scale studies comparing atopic and non-atopic asthmatics in terms of systemic and airway inflammation across the age spectrum. MethodsHere, we have undertaken a retrospective study investigating 1626 patients (924 atopic and 702 non-atopic asthmatics) recruited from our university asthma clinic who underwent extensive clinical investigations including induced sputum. Atopy was defined by any positive specific IgE to common aeroallergens (>0,35 kU/L). We performed direct comparisons between the groups and sought to appreciate the influence of age on the airway and systemic inflammatory components. The study was approved by the ethics committee of the University Hospital of Liege (Ref. 2016/276). Informed consents were obtained from healthy subjects. ResultsAtopic asthmatics were younger (P < .001), had a higher male/female ratio (P < .001), an earlier disease onset (P < .001) and a greater proportion of treated rhinitis (P < .001) while non-atopic asthmatics had greater smoke exposure (P < .001), lower FEV1/FVC ratio (P = .01) and diffusing capacity (P < .001). There was no difference between the 2 groups regarding FEV1 (% predicted), asthma control, asthma quality of life and exacerbations in the previous 12 months. Regarding inflammation, atopic patients had higher FeNO levels (median = 28 ppb, P < .001), were more eosinophilic both in blood (median = 2.8%, P < .001) and in sputum (median = 2.2%, P < .001) while non-atopic patients displayed greater blood (median = 57%, P = .01) and sputum (median = 58.8%, P = .01) neutrophilic inflammation. However, stratifying patients by age showed that non-atopic asthmatics above 50 years old became equally eosinophilic in the sputum (P = .07), but not in the blood, as compared to atopic patients. Likewise, FeNO rose in non-atopic patients after 50 years old but remained, however, lower than in atopic patients. ConclusionsWe conclude that, while sharing many features, atopic group still differentiates from non-atopic asthmatics by demographics, functional and inflammatory profiles. When atopic asthmatics showed a constant eosinophilic pattern across the age spectrum, non-atopic asthmatics were found to be neutrophilic before the age of 50 but eosinophilic above 50 years old.

Modulation of Immune Components on Stem Cell and Dormancy in Cancer.

Cancer stem cells (CSCs) refer to a certain subpopulation within the tumor entity that is characterized by restricted cellular proliferation and multipotent differentiation potency. The existence of CSCs has been proven to contribute to the heterogeneity of malignancies, accounting for intensified tumorigenesis, treatment resistance, and metastatic spread. Dormancy was proposed as a reversible state of cancer cells that are temporarily arrested in the cell cycle, possessing several hallmarks that facilitate their survival within a devastating niche. This transient period is evoked to enter an actively proliferating state by multiple regulatory alterations, and one of the most significant and complex factors comes from local and systemic inflammatory reactions and immune components. Although CSCs and dormant cancer cells share several similarities, the clear relationship between these two concepts remains unclear. Thus, the detailed mechanism of immune cells interacting with CSCs and dormant cancer cells also warrants elucidation for prevention of cancer relapse and metastasis. In this review, we summarize recent findings and prospective studies on CSCs and cancer dormancy to conclude the relationship between these two concepts. Furthermore, we aim to outline the mechanism of immune components in interfering with CSCs and dormant cancer cells to provide a theoretical basis for the prevention of relapse and metastasis.

To study biochemical markers in chronic obstructive pulmonary disease patients

Introduction: Chronic obstructive pulmonary disease (COPD) which includes chronic bronchitis and emphysema is considered as a progressive type of respiratory tract disease and is characterized by structural changes such as emphysema, airflow limitation, dynamic hyperinflation, air trapping, and peribronchial fibrotic remodeling of the lungs with significant systemic inflammatory components, induced by chronic exposures to smoking and/or occupational or environmental sources. Materials and Methods: This case control study was conducted on 60 subjects in which 30 were healthy controls and 30 were cases of COPD. Patients with history of respiratory disease other than COPD, cardiac diseases and neuromuscular disease were excluded. 30 healthy age and gender matched non-smoker adults were selected as control group. Results: Unpaired t test was performed and it was observed that Total Cholesterol, Triglyceride, Low Density Lipoprotein, Lactate dehydrogenase levels were significantly higher and serum concentrations of High Density Lipoprotein was decreased significantly in cases as compared to controls. Conclusion: Serum LDH levels are altered in many respiratory diseases but it has not been studied in depth in COPD patients. In view of this we conducted the study and our results shows that patients with COPD have raised serum LDH levels. Keywords: Smoking, COPD, Lactate dehydrogenase.

Association between faecal occult bleeding and medicines prescribed for chronic disease: a data linkage study

AimsThe presence of detectable faecal haemoglobin (f-Hb) has been shown to be associated with all-cause mortality and with death from a number of chronic diseases not known to cause gastrointestinal...

TO STUDY OF LDH LEVEL IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE PATIENTS

Background: Chronic obstructive pulmonary disease (COPD) is a progressive disease of the lungs characterized by structural changes such as emphysema, airflow limitation, dynamic hyperinflation, air trapping, and peribronchial fibrotic remodeling of the lungs with significant systemic inflammatory components, induced by chronic exposures to smoking and/or occupational or environmental sources.&#x0D; Methods: It is a case control study of 100 subjects divided into two groups including 50 healthy controls and 50 cases of COPD. Patients with history of respiratory infection, pneumonia, coronary heart disease, heart failure, and neuromuscular disease, renal and hepatic dysfunction were excluded.&#x0D; Results: The statistically significant increased value of serum lactate dehydrogenase in cases as compared to control group with p value&lt;0.05.&#x0D; Conclusion-Rise in serum LDH levels, though known to occur in many respiratory conditions, has not been studied in depth. Based on our study results, we have proved that patients with COPD have raised serum LDH levels.&#x0D; Keywords: COPD, Lactate dehydrogenase, Smoking.

Characteristics and prognosis of ANCA-positive retroperitoneal fibrosis: A systematic literature review.

Anti-neutrophil cytoplasmic autoantibody (ANCA)-positive retroperitoneal fibrosis (RPF) is extremely rare. This study aimed to clarify the clinical characteristics and prognosis of patients with ANCA-positive RPF. We conducted a systematic literature review of articles reporting on ANCA-positive RPF from the database inception dates until March 8, 2020. We identified 19 patients with ANCA-positive RPF with a mean age of 62 years; a male dominance (68.4%) was noted. Most patients presented with systemic symptoms and/or lower back or abdominal pain. Proteinase 3 (PR3) -ANCA positivity was predominant compared with myeloperoxidase (MPO)-ANCA (63.2% vs. 36.8%, respectively), and all patients showed elevated serum C-reactive protein levels. Of note, 26.7% of patients had isolated RPF without any other ANCA-associated systemic organ involvement. Regarding typical manifestations of ANCA- associated vasculitis, ear, nose, and throat involvement occurred in 26.3%, lung involvement in 36.8%, and kidney involvement (rapidly progressive glomerulonephritis) in 31.6% of patients. Necrosis and granulomatous inflammation, vasculitis, and multinucleated giant cells were pathologically observed in tissue sections of RPF, whereas tertiary lymphoid organ formation was not identified. Glucocorticoids with or without other immunosuppressive treatments were effective in most patients, but 4 patients experienced disease relapse during the clinical course. All relapsed patients were positive for PR3-ANCA. Clinical features of ANCA-positive RPF are associated with systemic inflammatory components such as fever and elevated serum C-reactive protein levels. ANCA-. positive RPF presents as an "isolated" involved organ in one-third of patients. Immunosuppressive treatments are effective, but the disease can recur, particularly in PR3-ANCA-positive patients.

Inflammatory mediators in saliva and gingival fluid of children with congenital heart defect.

(a) To compare levels of pro- and anti-inflammatory mediators in saliva and gingival crevicular fluid (GCF) in children with and without congenital heart defects (CHDcases and controls) and to test whether a systemic component exists in CHD cases by controlling for gingivitis and plaque scores. (b) To correlate the levels of pro- and anti-inflammatory mediators in GCF and saliva with plaque bacterial composition among CHD cases and controls. Whole un-stimulated saliva and GCF samples were collected (60 CHD cases, 60 controls [Sudan]) and were analysed for levels of prostaglandin E2 (PGE2), interleukin-1β (IL-1β), tumour necrosis factor-α (TNF-α), interleukin-1ra (IL-1ra) and interleukin-10 (IL-10) levels. These levels were correlated with the previously reported levels of four red complex bacteria. Significantly elevated levels of PGE2 and IL-1β in GCF and IL-1β and TNF-α in saliva were detected among CHD cases compared with controls. General linear model (GLM) analyses revealed that PGE2 and IL-1β levels remained significantly higher in GCF and saliva samples, respectively, among CHD cases after controlling for gingivitis and plaque score, whereas TNF-α and IL-10 levels were significantly lower in their GCF samples. Additionally, IL-1β level was significantly positively correlated to the counts of the four red complex species in their GCF. In addition to higher levels of some pro-inflammatory mediators in saliva and GCF corresponding to more gingivitis in CHD cases, also a systemic inflammatory component exists and is reflected in these two oral fluids.

Systemic inflammation and eye diseases. The Beijing Eye Study

PurposeSystemic inflammation is potentially associated with ocular diseases such as late age-related macular degeneration (AMD). Using the serum concentration of high-sensitive C-reactive protein (hs-CRP) as surrogate of systemic inflammation, we examined potential associations between the serum hs-CRP concentration and the presence and degree of eye diseases.MethodsThe population-based Beijing Eye Study included 3468 Chinese individuals. The study participants underwent a standardized interview and a detailed ophthalmic examination. The serum concentration of hs-CRP was determined.ResultsOut of 3468 participants, 2452 (70.7%) individuals (mean age:63.4±9.4 year; range:50–91 years) had hs-CRP measurements (mean:1.96±4.07mg/L). In multivariate analysis, higher serum concentration of hs-CRP was significantly (regression coefficient r: 0.21) associated with a higher level of diabetic retinopathy (P = 0.007; standardized regression coefficient beta:0.06; non-standardized regression coefficient B:1.35; 95% confidence interval (CI):0.37,2.22) and polypoidal choroidal vasculopathy (P = 0.002;beta:0.06;B:6.22;95%CI:2.24,10.2) after adjusting for higher serum concentration of high-density lipoproteins (P<0.001;beta:-0.12;B:-1.31;95%CI:-1.77,-0.85), higher body mass index (P = 0.01;beta:0.06;B:0.06;95%CI:0.01, 0.11), lower level of education (P = 0.04;beta:-0.06;B:-0.22;95%CI:-0.42,-0.02), lower cognitive function score (P = 0.01;beta:-0.07;B:-0.08;95%CI:-0.13,-0.02). If the presences of other ocular diseases were added to the model, the presence of glaucoma (P = 0.99), open-angle glaucoma (P = 0.80), angle-closure glaucoma (P = 0.67), pseudoexfoliation (P = 0.18), nuclear cataract (P = 0.30), cortical cataract (P = 0.15), subcapsular cataract (P = 0.59), retinal vein occlusions (P = 0.33), central serous choroidopathy (P = 0.44), early stage of age-related macular degeneration (AMD) (P = 0.46), intermediate stage of AMD (P = 0.20) and late stage of AMD (P = 0.91) including geographic atrophy (P = 0.60) or neovascular AMD (P = 0.68) were not significantly associated with the serum concentration of hs-CRP.ConclusionsIn Chinese aged 50+ years, higher serum concentration of hs-CRP was significantly associated with a higher level of diabetic retinopathy and higher frequency of polypoidal choroidal vasculopathy. Other major ocular disorders, namely glaucoma including open-angle glaucoma and angle-closure glaucoma, pseudoexfoliation, nuclear, cortical or subcapsular cataract, retinal vein occlusions, central serous choroidopathy, early, intermediate or late stage of AMD including geographic atrophy, were not significantly associated with hs-CRP serum concentrations. It suggests that these diseases, in contrast to diabetic retinopathy and polypoidal choroidal vasculopathy, were not associated with a major systemic inflammatory component.

Systemic administration of a nanoemulsion with tributyrin reduces inflammation in experimental colitis

Tributyrin (TBT) is a triacylglycerol formed by three molecules of butyrate that is able to improve colonic mucosal lesions and inflammation when given orally or as an enema. The effects of systemic TBT administration in inflammatory bowel disease (IBD) have been less well studied. We prepared a nanoemulsion containing tributyrin (nTBT) and studied its effects on a model of dextran sodium sulfate (DSS)‐induced colitis. Mice were kept in the experiment for 15 days. Animals in the Colitis group received DSS (2.5% in their drinking water), whereas Control mice received only water during the last 7 experimental days. Animals were injected intraperitoneally (IP) with a nanoemulsion lacking TBT (Control and Colitis group) or containing TBT (Control nTBT and nTBT‐Colitis) every other day for 15 days. Colonic mucosal damage and cytokine concentration were assessed by histopathological score and ELISA, respectively. Inflammatory infiltrates were assessed by enzymatic assay, and leukocyte rolling and adhesion in the colonic circulation were determined by intravital microscopy. Results revealed that the colonic architecture was not modified by nTBT administration. However, the colons of nTBT‐Colitis mice presented reduced eosinophilic and neutrophilic infiltration associated with increased TGF‐β concentrations compared to those of the Colitis group. Leukocyte rolling and adhesion were reduced in the nTBT‐Colitis group, suggesting a systemic anti‐inflammatory effect of nTBT. In conclusion, our results show that nTBT administered intraperitoneally is effective in reducing DSS‐induced inflammation, whereas the trophic effects described with oral or local administration of TBT were not present when it was injected systemically.Practical applications: In this study, we show that the intraperitoneal administration of a nanoemulsion with tributyrin (nTBT) is able to reduce the inflammation observed in DSS‐induced colitis. Due to its anti‐inflationary actions, nTBT could be used in the future as a potential auxiliary drug in the treatment of inflammatory bowel diseases as well as other disorders with a systemic (low‐grade) inflammatory component such as atherosclerosis and obesity.Nanoemulsion of tributyrin (nTBT) reduces inflammation related to DSS induced colitis. The determination of macrophage (i), neutrophil (ii), and eosinophil (iii) infiltration in colon and intravital microscopy of mesenteric vessels showing the rolling (iv) and the adhesion (v) of total leukocytes in the colons of mice from the Control group receiving water and a nanoemulsion lacking tributyrin, the nTBT group receiving water and nanoemulsion with nTBT, the Colitis group receiving DSS and a nanoemulsion lacking tributyrin, and the Colitis nTBT group receiving DSS and nTBT. Different letters indicate p &lt; 0.05.

Dyslipidemia in Dermatological Disorders.

Dyslipidemias are one of the common metabolic disorders. A link between dermatological disorders like psoriasis and dyslipidemia has been established in the recent past. Many dermatological disorders could have a systemic inflammatory component which explains such association. Chronic inflammatory dermatological disorders could also have other metabolic imbalances that may contribute to dyslipidemia. Presence of such abnormal metabolism may justify routine screening of these disorders for associated dyslipidemia and other metabolic abnormalities and early treatment of such comorbidities to improve quality of life. Some of the drugs used by dermatologists such as retinoids are also likely to be a cause of dyslipidemia. Hence, it is imperative that the dermatologists obtain scientific knowledge on the underlying mechanisms involved in dyslipidemia and understand when to intervene with therapies. A systematic review of the English language literature was done by using Google Scholar and PubMed. In this review, attempts are made to list the dermatological disorders associated with dyslipidemia; to simplify the understanding of underlying mechanisms; and to give a brief idea about the interventions.

Achalasia--An Autoimmune Inflammatory Disease: A Cross-Sectional Study.

Idiopathic achalasia is a disease of unknown etiology. The loss of myenteric plexus associated with inflammatory infiltrates and autoantibodies support the hypothesis of an autoimmune mechanism. Thirty-two patients diagnosed by high-resolution manometry with achalasia were included. Twenty-six specimens from lower esophageal sphincter muscle were compared with 5 esophagectomy biopsies (control). Immunohistochemical (biopsies) and flow cytometry (peripheral blood) analyses were performed. Circulating anti-myenteric autoantibodies were evaluated by indirect immunofluorescence. Herpes simplex virus-1 (HSV-1) infection was determined by in situ hybridization, RT-PCR, and immunohistochemistry. Histopathological analysis showed capillaritis (51%), plexitis (23%), nerve hypertrophy (16%), venulitis (7%), and fibrosis (3%). Achalasia tissue exhibited an increase in the expression of proteins involved in extracellular matrix turnover, apoptosis, proinflammatory and profibrogenic cytokines, and Tregs and Bregs versus controls (P < 0.001). Circulating Th22/Th17/Th2/Th1 percentage showed a significant increase versus healthy donors (P < 0.01). Type III achalasia patients exhibited the highest inflammatory response versus types I and II. Prevalence of both anti-myenteric antibodies and HSV-1 infection in achalasia patients was 100% versus 0% in controls. Our results suggest that achalasia is a disease with an important local and systemic inflammatory autoimmune component, associated with the presence of specific anti-myenteric autoantibodies, as well as HSV-1 infection.

Anemia in Patients with Chronic Obstructive Pulmonary Disease in a Tertiary Care Hospital in Bangladesh

Background: Chronic obstructive pulmonary disease (COPD) is usually associated with polycythemia. It is assumed that systemic inflammatory components of COPD can interfere with erythropoietin and can result in anemia of chronic disease which will impair the functional capacity of these patients and also increase morbidity and mortality. Objective: To evaluate anemia status in COPD patients. Materials and Methods: This cross-sectional study was conducted in clinically stable 50 COPD patients in the outpatient department of Medicine in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka during the period of July to December 2011. The demographic characteristics, smoking habit, duration of disease, types and severity of anemia, BMI and results of 6-minute walk test were recorded. Results: Out of 50 COPD patients, 76% were male and 24% were female. Among them 32% patients were anemic, 20% were polycythemic and 48% patients had normal hemoglobin. Among the anemic patients with COPD, 87% were male and 13% were female,75% were mildly anemic and 4% moderately anemic, 62.5% had normocytic and 37.5% had microcytic anemia. Conclusion: Anemia in COPD patients is often overlooked and underestimated. Clinicians should be aware of the presence of anemia in patients with COPD so that appropriate treatment could be initiated to improve the quality of life and prognosis DOI: http://dx.doi.org/10.3329/jemc.v4i3.20943 J Enam Med Col 2014; 4(3): 151-155

Dietary Interventions in Asthma

Asthma is a chronic inflammatory disorder of the airways. The inflammatory response in asthma is heterogeneous. Allergen specific responses lead to activation of the acquired immune system, via a predominantly IL-5 mediated, eosinophilic pathway. Stimuli such as viruses and bacteria activate the innate immune system, via a predominantly IL-8 mediated, neutrophilic pathway. Asthma has also been demonstrated to involve a systemic inflammatory component. Glucocorticoids are the predominant pharmacological treatment used to control inflammation in asthma. However, compliance with medications can be compromised due to patient concerns about side effects. Hence dietary interventions that target the inflammatory response in asthma have great potential. Various aspects of dietary intake are known to modulate inflammation. Saturated fatty acids can induce an inflammatory response via activation of pattern recognition receptors. Omega-3 fatty acids can be anti-inflammatory, via mechanisms such as modification of eicosanoid production. Antioxidants can have anti-inflammatory effects as they scavenge free radicals, preventing activation of transcription factors including NF-κB. Chronic excess energy intake can lead to obesity, which augments inflammation due to the release of inflammatory mediators by adipose tissue. Here we review the role of these dietary components in asthma.

Hemostasis in patients with acute kidney injury secondary to acute liver failure

Acute kidney injury (AKI) occurs in over half of patients with acute liver failure. Despite prolonged prothrombin times and thrombocytopenia, continuous renal replacement therapy circuits frequently develop clots during patient treatment. Here we assessed factors contributing to this by measuring coagulation parameters (standard coagulation tests, pro- and anticoagulant factors, thromboelastography, and thrombin generation) in 20 consecutive patients with acute liver failure; mean age 42 years. Within 48 h, 10 had developed stage 3 AKI and 9 required continuous renal replacement therapy, of whom 2 had frequent circuit clots. The patients with stage 3 AKI were found to have significantly lower platelet counts and levels of factor V and the natural anticoagulants antithrombin, Protein C and Protein S, but increased extrinsic pathway activation and von Willebrand factor levels. Tissue factor levels were greater in those with stage 3 AKI, as was microparticle activity. Although patients with acute liver failure and advanced AKI requiring continuous renal replacement therapy have an even more marked thrombocytopenia and more prolonged extrinsic pathway activation, this was not associated with increased bleeding. Thus, more frequent circuit clots during continuous renal replacement therapy appear to be due to a combination of increased tissue factor and microparticle release, endothelial activation, and reduction in natural anticoagulants.

Psoriasis and cardiovascular disease: an association or a reason to treat?

Conflicts of interest None declared. Worldwide psoriasis is a common systemic inflammatory illness. The majority of recent studies have shown an association between psoriasis and coronary artery disease (CAD).1 2–3 It has been hypothesized that the association between psoriasis and CAD is due to chronic systemic inflammation.1, 3 As a risk factor for CAD, psoriasis represents a disease that could potentially be modified, thereby decreasing the risk of morbidity and mortality due to CAD, a very important public health concern.3 In fact, this should be a directly testable hypothesis, which as a question is ‘Does the aggressive treatment of psoriasis prevent CAD?’. The study by Abuabara et al.4 attempted to answer this question. This well‐conducted study published in this issue of the BJD evaluated more than 25 000 individuals with psoriasis who are at highest risk for CAD – those with severe to moderate disease.4 They conducted this study using administrative claims data from a very large healthcare insurance programme. They basically compared two broad classes of therapy: those receiving light therapy and those receiving systemic agents such as ‘biologics’, methotrexate and ciclosporin.4 They assumed that the systemic therapies would have a greater effect on the systemic inflammatory components of psoriasis. While it is up to the reader to review this study comprehensively, overall they did not find a decreased risk of myocardial infarction in those treated with systemic agents compared with those who received light therapy. A more nuanced view might be that there was a trend toward an overall 30%increase among systemic therapy users and about a 30%decrease in a subset of those at highest risk of CAD, those aged < 50 years.4