INTRODUÇÃO: Pacientes diabéticos têm maior risco de eventos coronários quando submetidos a implante de stent, refletindo, provavelmente, uma resposta pró-inflamatória. OBJETIVOS: Caracterizar a resposta inflamatória a stent coronário em portadores de angina estável, com e sem diabetes. METODOLOGIA: Amostras sangüíneas foram obtidas de 41 pacientes diabéticos e 46 não diabéticos, antes, 24h, 48h e 4 semanas após o implante eletivo de stent coronário. Todos os pacientes usaram clopidogrel e os procedimentos obtiveram sucesso. Foram mensurados a proteína C-reativa (PCR) por nefelometria, a P-selectina solúvel (s) e a molécula de adesão intercelular-1 solúvel (sICAM-1) através da técnica ELISA. RESULTADOS: Diabéticos e não diabéticos apresentaram, respectivamente, concentração préprocedimento de PCR 5,2 ± 7,3 e 7,1 ± 12.1 mg/L, com p=0,74. A sP-selectina variou entre os diabéticos de 136,7 ± 75,5, e entre os não diabéticos de 111,1 ± 61,2 ng/ml, com p=0.09. ICAM-1 variou de 149,7 ± 56,1 e 143,2 ± 40,4 ng/mL, p=0,62. Após o procedimento os níveis de PCR aumentaram significativamente para ambos, diabéticos ou não, com pico às 48h: 13,0 ± 10,8 e 14,0 ± 11,4 mg/L, respectivamente (p= 0,001 vs níveis pré-procedimento). Em relação à sPselectina, diabéticos e não diabéticos apresentaram marcada redução : 114,2 ± 70ng/mL (p=0,03) e 87,7 ± 39,3 ng/mL (p=0,02), respectivamente. Contudo, apenas os diabéticos mantiveram por 48h essa redução. Os níveis de sICAM-1 diminuíram significativamente apenas entre os diabéticos, 48h após o procedimento (redução de 7,7%, p=0,01 vs níveis pré-procedimento). Análise de regressão logística multivariável não mostrou associação entre os marcadores estudados e eventos adversos após um ano de seguimento entre pacientes diabéticos. Por outro lado, níveis de sICAM-1, pré e pós procedimento, para todos os pacientes, estiveram associados com a presença de eventos após um ano: necessidade de nova intervenção (5 pacientes), revascularização cirúrgica (3 pacientes), óbito (1 paciente), infarto agudo do miocárdio (1 paciente) e acidente vascular cerebral (2 pacientes). CONCLUSÃO: Diabéticos e não diabéticos apresentaram elevação nos níveis de marcadores inflamatórios mesmo antes da intervenção. Este achado confirma a presença de um estado inflamatório sistêmico em pacientes com doença coronária estável, quer sejam diabéticos ou não. Todavia, nenhuma diferença marcante na resposta inflamatória após o procedimento ocorreu entre diabéticos e não diabéticos. Ainda mais, sICAM-1 foi um preditor independente de resultados adversos após um ano de stent coronário eletivo para todos os pacientes / Patients with diabetes are at increased risk for adverse events after coronary stenting, perhaps reflecting a proinflammatory response. AIM: Characterize the inflammatory response to coronary stenting in stable angina patients with and without diabetes. METHODS: Blood samples were obtained from diabetic (n=41) and nondiabetic (n=46) patients before and 24 hours, 48 hours and 4 weeks after elective stenting. All patients were on clopidogrel and underwent successful procedures. C-reactive protein (CRP, by nepholometry), soluble (s) P-selectin (ELISA) and soluble intercellular adhesion molecule (sICAM)-1 (ELISA) were determined. Results: Diabetic and nondiabetic patients presented enhanced and comparable preprocedural concentrations, respectively, of CRP as 5.2±7.3 and 7.1±12.1 mg/L, p=0.74; sP-selectin as 136.7±75.5 and 111.1±61.2 ng/mL, p=0.09; and, sICAM-1 as 149.7±56.1 and 143.2±40.4 ng/mL, p=0.62. CRP levels increased significantly after stenting for both sets of patients, with peak levels at 48 hours: 13.0±10.8 and 14.0±11.4 mg/L, respectively (p=0.001 vs preprocedural levels). Following 24 hours the procedure, diabetic and nondiabetic patients presented marked reductions of sP-selectin levels: 114.2±70 ng/mL (p=0.03) and 87.7±39.3 ng/mL (p=0.02), respectively. However, only diabetic patients had this reduction persist up to 48 hours. Soluble ICAM-1 levels decreased significantly only among diabetic patients after 48 hours of the procedure (7.7% reduction, p=0.01 vs preprocedural levels). In a multivariate logistic regression analysis, no association was found between the inflammation markers studied and one-year adverse events among diabetic patients. Nevertheless, for all patients, preprocedural and postprocedural levels of sICAM-1 had a marked association with major adverse cardiac events after a one-year follow-up (n=14, p< 0,05), such as new PTCA (5 patients), cardiac revascularization (3 pacientes), death (1 patient), AMI (1 patient) and cerebral vascular accident (2 patients). CONCLUSIONS: Before undergoing elective coronary stenting, diabetic and nondiabetic patients present increased levels of inflammatory markers. This evidence confirms the presence of systemic inflammation in stable coronary artery disease patients - regardless if the patient has diabetes or not. However, no major difference in postprocedural inflammatory response occurred between diabetic and nondiabetic patients. In addition, for all patients, sICAM-1 was an independent predictor of adverse outcomes after one year of elective coronary stenting

INTRODUÇÃO: Em pacientes com síndromes isquêmicas miocárdicas instáveis (SIMI), tanto a hiperatividade simpática quanto a resposta inflamatória exacerbada se associam a pior prognóstico. No entanto, ainda é desconhecido se existe alguma correlação entre esses dois marcadores de evolução desfavorável. OBJETIVOS: Correlacionar a atividade nervosa simpática muscular com marcadores inflamatórios nas fases precoce e tardia de pacientes portadores de SIMI. MÉTODOS: Pacientes hospitalizados com diagnóstico de SIMI e evolução favorável foram incluídos de forma prospectiva desde que apresentassem idade entre 18 e 65 anos e aterosclerose coronária comprovada por cinecoronariografia. Logo após a inclusão no estudo foram coletadas informações basais, e no quarto dia (± 1 dia) de internação os pacientes foram submetidos à avaliação da ANSM e coleta concomitante de amostra sanguínea para dosagem de proteína CReativa ultrassensível (PCR-us), interleucina-6 (IL6), e fosfolipase A2 associada à lipoproteína (Lp-PLA2). ANSM foi obtida pela técnica de microneurografia do nervo fibular. As medidas e respectivas análises de correlação foram repetidas em 1, 3 e 6 meses após a hospitalização. Correlações entre ANSM e marcadores inflamatórios foram analisadas por meio do teste de Pearson (variáveis de distribuição não-paramétrica foram transformadas logaritmicamente). Modelos de regressão linear múltipla foram criados para avaliar os efeitos independentes. RESULTADOS: Foram estudados 34 pacientes com idade média de 51,7±7,0 anos, sendo 79,4% do sexo masculino. A prevalência de hipertensão arterial foi de 64,7%, diabetes mellitus 8,8%, e doença arterial coronária prévia de 20,6%. A apresentação foi IAM com supradesnível de ST em 18 pacientes (52,9%), IAM sem supra de ST em 14 (41,2%) e angina instável em 02 pacientes (5,9%). Tanto ANSM quanto biomarcadores inflamatórios estavam elevados durante a fase aguda das SIMI e diminuíram ao longo do tempo. Na fase hospitalar, a mediana da PCR-us foi 17,75 (8,57; 40,15) mg/L, e IL-6 6,65 (4,45; 8,20) pg/ml, a Lp- PLA2 média foi 185,8 ± 52,2 nmol/min/ml, e ANSM média 64,2 ± 19,3 impulsos/100bpm. Após 6 meses, houve diminuição significativa de todas essas variáveis quando comparadas com a fase hospitalar. Entretanto, não houve correlação significativa entre a atividade simpática e qualquer dos marcadores inflamatórios analisados, em nenhuma das fases analisadas (p > 0,05), Por outro lado, ANSM se correlacionou independentemente com níveis de CKMB na fase aguda (p=0,027), e com fração de ejeção do VE na fase crônica (p=0,026). CONCLUSÃO: Apesar do aumento inicial dos níveis de marcadores inflamatórios e da atividade simpática em pacientes com SIMI, não houve correlação significativa entre esses parâmetros em nenhuma das fases analisadas, sugerindo que as alterações dessas variáveis estariam relacionadas a diferentes vias fisiopatológicas / INTRODUCTION: Previous publications have shown that both sympathetic hyperactivity and enhanced inflammatory response are associated with worse outcomes during acute coronary syndromes (ACS). However, little is known about the correlation between these two pathologic pathways. OBJECTIVE: To correlate muscle sympathetic nerve activity with inflammatory biomarkers in both acute and chronic phase of ACS. METHODS: Patients hospitalized with uncomplicated ACS were enrolled if they were 18-65 years old and have significant atherosclerosis. Baseline characteristics information were collected and at fourth day (± 1 day) of hospitalization they were submitted to muscle sympathetic nerve activity (MSNA) analysis and blood sample were collected for ultrasensitive C-reactive protein (usCRP), interleukin-6 (IL-6) and Lipoprotein-associated phospholipase A2 activity (Lp-PLA2) measurements. MSNA was recorded directly from the peroneal nerve using the microneurography technique. Measurements were repeated at 1, 3 and 6 months after hospitalization. Correlations between MSNA and inflammatory markers and baseline characteristics were made using Pearson\'s test (nonnormally distributed variables were logarithmically transformed) and multivariate regression models were performed to assess the independent effects. RESULTS: Thirty-four patients were included, 79.4% male, mean age 51.7 (SD 7.0 years). The prevalence of hypertension was 64.7%, diabetes mellitus 8.8%, and previous coronary heart disease 20.6%. The ACS presentation was STEMI in 18 patients (52.9%), NSTEMI in 14 (41.2%) and UA in 02 patients (5.9%). Both MSNA and inflammatory markers were elevated during acute phase of ACS and decreased over time. In the hospitalization phase the median usCRP was 17.75 (8.57; 40.15) mg/L, median IL-6 6.65 (4.45; 8.20), mean Lp-PLA2 185.8 ± 52.2 nmol/min/mL, and mean MSNA 64.2 ± 19.3 bursts/100heart beats. All of these variables decreased significantly over 6 months when compared to in-hospital phase. However, there were no significant correlations between the sympathetic activity and inflammatory markers in any of the analyzed phases (p>0.05). After adjusted analyzes, MSNA was independently associated with CKMB levels at acute phase (p=0.027) and with left ventricular ejection fraction at 6 months (p=0.026). CONCLUSION: Despite the increased levels of inflammatory markers and sympathetic activity among patients with ACS, there was no correlation between these assessments, suggesting that although they may be present concomitantly during an ACS they might follow different pathological pathways

No description available.

Evidence is limited regarding whether periodontal treatment improves hemoglobin A1c (HbA1c) among people with prediabetes and periodontal disease, and it is unknown whether improvement of metabolic status persists >3 mo. In an exploratory post hoc analysis of the multicenter randomized controlled trial “Antibiotika und Parodontitis” (Antibiotics and Periodontitis)—a prospective, stratified, double-blind study—we assessed whether nonsurgical periodontal treatment with or without an adjunctive systemic antibiotic treatment affects HbA1c and high-sensitivity C-reactive protein (hsCRP) levels among periodontitis patients with normal HbA1c (≤5.7%, n = 218), prediabetes (5.7% < HbA1c < 6.5%, n = 101), or unknown diabetes (HbA1c ≥ 6.5%, n = 8) over a period of 27.5 mo. Nonsurgical periodontal treatment reduced mean pocket probing depth by >1 mm in both groups. In the normal HbA1c group, HbA1c values remained unchanged at 5.0% (95% CI, 4.9% to 6.1%) during the observation period. Among periodontitis patients with prediabetes, HbA1c decreased from 5.9% (95% CI, 5.9% to 6.0%) to 5.4% (95% CI, 5.3% to 5.5%) at 15.5 mo and increased to 5.6% (95% CI, 5.4% to 5.7%) after 27.5 mo. At 27.5 mo, 46% of periodontitis patients with prediabetes had normal HbA1c levels, whereas 47.9% remained unchanged and 6.3% progressed to diabetes. Median hsCRP values were reduced in the normal HbA1c and prediabetes groups from 1.2 and 1.4 mg/L to 0.7 and 0.7 mg/L, respectively. Nonsurgical periodontal treatment may improve blood glucose values among periodontitis patients with prediabetes (ClinicalTrials.gov NCT00707369).

Background Coronavirus Disease-2019 (COVID-19) affected elderly individuals disproportionately in terms of hospitalization and adverse outcome. Objective This cross-sectional study examined the associations of COVID-19 diagnosis (COVID-negative versus COVID-positive) with levels of four clinical markers – cardiac troponin T (cTnT), high-sensitive C-reactive protein (hsCRP), D-dimer and b-type natriuretic peptide (NT-proBNP) – along with potential differences in associations by sex in a hospital-based sample of elderly individuals. Methods The sample comprised individuals aged ≥80 years visiting the Emergency at Karolinska universitetssjukhuset (Huddinge) between January 2020 and December 2021 for whom data on polymerase chain reaction-based COVID-19 testing were available (n=2668). Plasma levels of the markers were measured using standard methods. Right skewed outcome variables were natural-log (Ln) transformed. Multivariable linear regression models were fitted. Results Participants’ median age was 87 years (interquartile range: 85–90) and 58.4% were female. Approximately 13% of the participants were COVID-19 positive. There was no statistically significant association between COVID-positive diagnosis and any of the markers after controlling for age and sex. On sex stratification, COVID-19 positive males had 55.3% (95% confidence interval (CI): 1.1%–138.4%; P=0.044) higher hsCRP levels than COVID-negative males. Additionally, age was positively associated with cTnT (Ln cTnT βadjusted: 0.041; 95% CI: 0.033–0.050; P&lt;0.001) and NT-proBNP (Ln NTproBNP βadjusted: 0.059; 95% CI: 0.015–0.102; P=0.008). Conclusion COVID-positive diagnosis was not related with the markers apart from a sex-specific, positive association with hsCRP observed among males. Future studies should explore the relationship of these markers with mortality to determine their prognostic utility among elderly individuals.

No description available.

No description available.

Background: Despite recent advances and refinements in perioperative management of simultaneous pancreas–kidney transplantation (SPKT) early pancreatic graft dysfunction (ePGD) remains a critical problem with serious impairment of early and long-term graft function and outcome. Hence, we evaluated a panel of classical blood serum markers for their value in predicting early graft dysfunction in patients undergoing SPKT. Methods: From a prospectively collected database medical data of 105 patients undergoing SPKT between 1998 and 2018 at our center were retrospectively analyzed. The primary study outcome was the detection of occurrence of early pancreatic graft dysfunction (ePGD), the secondary study outcome was early renal graft dysfunction (eRGD) as well as all other outcome parameters associated with the graft function. In this context, ePGD was defined as pancreas graft-related complications including graft pancreatitis, pancreatic abscess/peritonitis, delayed graft function, graft thrombosis, bleeding, rejection and the consecutive need for re-laparotomy due to graft-related complications within 3 months. With regard to analyzing ePGD, serum levels of white blood cell count (WBC), C-reactive protein (CRP), procalcitonin (PCT), pancreatic lipase as well as neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR) were measured preoperatively and at postoperative days (POD) 1, 2, 3 and 5. Further, peak serum levels of CRP and lipase during the first 72 h were evaluated. Receiver operating characteristics (ROC) curves were performed to assess their predictive value for ePGD and eRGD. Cut-off levels were calculated with the Youden index. Significant diagnostic biochemical cut-offs as well as other prognostic clinical factors were tested in a multivariate logistic regression model. Results: Of the 105 patients included, 43 patients (41%) and 28 patients (27%) developed ePGD and eRGD following SPKT, respectively. The mean WBC, PCT, NLR, PLR, CRP and lipase levels were significantly higher on most PODs in the ePGD group compared to the non-ePGD group. ROC analysis indicated that peak lipase (AUC: 0.82) and peak CRP levels (AUC: 0.89) were highly predictive for ePGD after SPKT. The combination of both achieved the highest AUC (0.92; p < 0.01) in predicting ePGD. Concerning eRGD, predictive accuracy of all analyzed serological markers was moderate (all AUC < 0.8). Additionally, multivariable analysis identified previous dialysis/no preemptive transplantation (OR 2.4 (95% CI: 1.41–4.01), p = 0.021), donor age (OR 1.07 (95% CI: 1.03–1.14), p < 0.010), donor body mass index (OR 1.32 (95% CI: 1.01–1.072), p = 0.04), donors cerebrovascular cause of death (OR 7.8 (95% CI: 2.21–26.9), p < 0.010), donor length of ICU stay (OR 1.27 (95% CI: 1.08–1.49), p < 0.010), as well as CIT pancreas (OR 1.07 (95% CI: 1.03–1.14), p < 0.010) as clinical relevant prognostic predictors for ePGD. Further, a peak of lipase (OR 1.04 (95% CI: 1.02–1.07), p < 0.010), peak of CRP levels (OR 1.12 (95% CI: 1.02–1.23), p < 0.010), pancreatic serum lipase concentration on POD 2 > 150 IU/L (OR 2.9 (95% CI: 1.2–7.13), p = 0.021) and CRP levels of ≥ 180 ng/mL on POD 2 (OR 3.6 (95% CI: 1.54–8.34), p < 0.01) and CRP levels > 150 ng/mL on POD 3 (OR 4.5 (95% CI: 1.7–11.4), p < 0.01) were revealed as independent biochemical predictive variables for ePGD after transplantation. Conclusions: In the current study, the combination of peak lipase and CRP levels were highly effective in predicting early pancreatic graft dysfunction development following SPKT. In contrast, for early renal graft dysfunction the predictive value of this parameter was less sensitive. Intensified monitoring of these parameters may be helpful for identifying patients at a higher risk of pancreatic ischemia reperfusion injury and various IRI- associated postoperative complications leading to ePGD and thus deteriorated outcome.

No description available.

Background: African-Americans are a vulnerable population group with disproportionately elevated rates of type 2 Diabetes Mellitus (DM). Resistant starch is a promising food ingredient that has the potential to reduce the risk factors involved in the development of type 2 DM. To date, there is a dearth of published research studies on the effect of resistant starch on African-Americans who are at increased risk for type 2 DM. Objective: The major objective of this study was to determine if daily consumption of approximately twelve grams of high-maize™ 260 resistant starch (RS) added to bread improved glucose homeostasis by monitoring changes in fasting plasma glucose, fructosamine, hemoglobin A1c, insulin, glucagon-like peptide-1, C-reactive protein, homeostasis model assessment insulin resistant (HOMA- IR) and beta-cell function (HOMA-Beta), serum acetate, propionate, and butyrate levels. Design: A fourteen-week, randomized, double-blind, within-subject crossover design feeding study was carried out in African-American males (n=8) and females (n=7) at increased risk for type 2 DM who resided in Southwest Virginia. All participants consumed bread containing added RS or control bread (no added RS) for six-weeks. RS and control bread feedings were separated by a two-week washout period. Results: Fasting Plasma Glucose (FPG) levels were significantly lower (P = 0.0179) after six-week control bread feedings compared to baseline. FPG levels were also significantly lower (P < 0.0001) after two-week washout period than at baseline. FPG levels were significantly higher (P < 0.0001) after six-week resistant starch bread feeding than at washout. FPG levels due to consumption of resistant starch versus control bread approached significance (P = 0.0574). Fructosamine levels were significantly lower (P = 0.0054) after control bread and resistant starch bread (P < 0.0012) consumption compared to baseline. No significant differences were found in fructosamine levels due to resistant bread intake versus control (P = 0.9692). Mean baseline HbA1c levels were 6.9% (n=15). This value was slightly lowered to 6.79% (n=14) at the end of the fourteen-week study, although statistical significance was not found. Mean ± standard errors for HbA1c values were 6.9% ± 0.18% and 6.9% ± 0.14% at baseline for the sequence groups, resistant starch first (n=7) and control treatment first (n=8) groups, respectively. Mean± standard error HbA1c values were 6.7%± 0.27% and 6.9% ± 0.27% at the conclusion of fourteen-week study for sequence groups, resistant starch first group (n=7) and control treatment first group, respectively. Baseline mean and standard errors C-reactive Protein (CRP) levels for male and female combined results were 0.62 ± 0.16 mg/dL (n=15). Mean CRP levels were 0.53 ± 0.12 mg/dL for resistant starch bread and 0.64 ± 0.21 mg/dL for control bread feeding periods. No significant differences were found for treatment, gender, or sequence effects for C-reactive protein levels during the fourteen-week study (P > 0.05). Mean HOMA-IR levels following six-week resistant starch and control bread consumption decreased to normal values (> 2.5), although no significant differences were found for treatment (P = 0.5923). Conclusions: Eighty-seven grams of Hi- maize™ 260 Resistant Starch added to baked loaves of bread consumed by a free-living African-American population at increased risk for type 2 diabetes did not consistently show significance in all clinical indicators and biochemical markers assessed. On the basis of the evidence in this study we do not have evidence that this amount of resistant starch in this population's diet will prevent the onset of diabetes. However, results are suggestive that higher levels of resistant starch in a more controlled experiment could reduce clinical risk factors for type 2 diabetes. / Ph. D.