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OBJECTIVE: Patterns of cytokine levels and their association with stroke severity, infarct size, and muscle strength are obscure. We aimed to analyze the immune mediators linked to T helper (Th)1, Th2, Th17, and regulatory T cell patterns and their association with stroke severity, infarct size, and muscle strength. MATERIALS AND METHODS: We included patients with acute stroke (n = 15) and healthy non-disabled individuals (n = 20) aged > 18 years. The dependent variables were stroke severity according to the National Institute of Health Stroke Scale (NIHSS), infarct size on computed tomography, handgrip strength by dynamometry, and global muscle strength according to the Medical Research Council (MRC) scale. The independent variables were the circulating cytokine levels. The cytokine levels were compared between the groups, and correlations between the clinical data were verified. RESULTS: The stroke group had higher interleukin (IL)-6 (p < 0.0001) and IL-10 (p < 0.0001) levels, but lower tumor necrosis factor (TNF)-α (p = 0.036) levels than the control group. IL-10 and soluble tumor necrosis factor receptor (sTNF-RII) levels were correlated with each other (r = 0.533; p = 0.042) and infarct size (r = 0.653; p = 0.033 and r = 0.689; p = 0.018, respectively). MRC scores were positively and negatively correlated with handgrip strength of the affected side (r = 0.78; p = 0.001) and NIHSS scores (r = -0.87; p < 0.0001), respectively. CONCLUSIONS: Plasma levels of some cytokines were associated with changes in the acute phase of stroke, and IL-10 and sTNF-RII levels are potential biomarkers of infarct size.

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BACKGROUND: Pulmonary involvement in COVID-19 is characterized pathologically by diffuse alveolar damage (DAD) and thrombosis, leading to the clinical picture of Acute Respiratory Distress Syndrome. The direct action of SARS-CoV-2 in lung cells and the dysregulated immuno-coagulative pathways activated in ARDS influence pulmonary involvement in severe COVID, that might be modulated by disease duration and individual factors. In this study we assessed the proportions of different lung pathology patterns in severe COVID-19 patients along the disease evolution and individual characteristics. METHODS: We analysed lung tissue from 41 COVID-19 patients that died in the period March-June 2020 and were submitted to a minimally invasive autopsy. Eight pulmonary regions were sampled. Pulmonary pathologists analysed the H&E stained slides, performing semiquantitative scores on the following parameters: exudative, intermediate or advanced DAD, bronchopneumonia, alveolar haemorrhage, infarct (%), arteriolar (number) or capillary thrombosis (yes/no). Histopathological data were correlated with demographic-clinical variables and periods of symptoms-hospital stay. RESULTS: Patient´s age varied from 22 to 88 years (18f/23 m), with hospital admission varying from 0 to 40 days. All patients had different proportions of DAD in their biopsies. Ninety percent of the patients presented pulmonary microthrombosis. The proportion of exudative DAD was higher in the period 0-8 days of hospital admission till death, whereas advanced DAD was higher after 17 days of hospital admission. In the group of patients that died within eight days of hospital admission, elderly patients had less proportion of the exudative pattern and increased proportions of the intermediate patterns. Obese patients had lower proportion of advanced DAD pattern in their biopsies, and lower than patients with overweight. Clustering analysis showed that patterns of vascular lesions (microthrombosis, infarction) clustered together, but not the other patterns. The vascular pattern was not influenced by demographic or clinical parameters, including time of disease progression. CONCLUSION: Patients with severe COVID-19 present different proportions of DAD patterns over time, with advanced DAD being more prevalent after 17 days, which seems to be influenced by age and weight. Vascular involvement is present in a large proportion of patients, occurs early in disease progression, and does not change over time.

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Se realizaó un estudio descriptivo de los pacientes atendidos en el servicio de cardiología del HospitalEscuela "Oscar Danilo Rosales A" (HEODRA) con diagnóstico de sufrir infarto del miocardio por primera vez, durante el período julio 1997- diciembre 1999. El universo corresponde a todos los pacientes diagnósticados en el servicio de cardiología del HEODRA como infarto del miocardio, excluyendose a aquellos pacientes con antecedentes de infarto. Se estudiaron un total de 71 pacientes con el mayor número de casos para el sexo masculino 47(66 porciento) y 24 mujeres (34 porciento), la edad promedio según el sexo, enlos hombres el grupo etáreo más afectado fue el de mayores 40 años a 80 años de edad, y para el femenino fue de 70 a 90 años en relación a los factores de riesgo conocidos el 43 porciento refirieron haber estado expuestos al humo de cigarrillos, el 97 porciento de los factores de alto riesgo fue el sedentarismo ya que no realizaban ningún deporte. El tipo de infarto más frecuente encontrado en relación a su localización fue el de cara anterior. El manejo terapeutico que se les instauro a todos estos pacientes fué aplicación de nitritos

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As variaçöes circadianas säo conhecidas, há tempos, por influenciar os diversos sistemas fisiológicos, entre eles o cardiovascular. O estudo de mecanismos com variaçäo circadiana que alteram o funcionamento do sistema cardiovascular e suas doenças têm aumentado muito nos últimos anos devido à sua relevância clínica. Através desses trabalhos se pôde conhecer melhor a fisiopatologia, a epidemiologia e os fatores envolvidos nas doenças cardiovasculares. Dessa forma ficou evidente a maior incidência de eventos cardíacos pelas horas da manhä, assim como os possíveis mecanismos envolvidos nessa variaçäo durante as horas do dia. A pressäo arterial sanguínea, os níveis plasmáticos de catecolaminas e cortisol, a agregabilidade plaquetária e a açäo do sistema fibrinolítico säo os mecanismos que mais se destacam. Desse modo, tornou-se possível o desenvolvimento de novas estratégias terapêuticas, levando-se em consideraçäo o momento do dia de maior risco para o desenvolvimento das doenças cardiovasculares.

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Se presentan 5 pacientes intervenidos quirúrgicamente por infarto al epiplón mayor, en un lapto de 15 años, analizándo los diagnósticos pre y post operatorios, la incidencia, los factores predisponentes, sus posibles causas, los criterios diagnósticos se compara el cuadro clínico con los descrito en la literatura

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Renal infarction (RI) is usually secondary to arterial obstruction due to emboli originating from the heart. Chronic chagasic patients may present cardiac alterations originating from intracavitary thrombi, even without congestive heart failure (CHF). In this study RI incidence was comparatively evaluated in chronic chagasic individuals, in different anatomoclinic forms and in non chagasic individuals. There has been a review on necropsy reports of individuals aged 20 or over. In 259 necropsies, 78 (30.1 per cent) were chagasics, and 19 of them (24.4 per cent) developed RI, while 27 (15.0 per cent) of the non chagasic individuals presented RI. The ages of chagasics with RI were similar to those of non chagasic individuals. A significant prevalence of RI and thrombosis among chronic chagasic individuals has been found. A significantly higher prevalence of RI among chronic chagasics having CHF (52.6 per cent) was observed when they were compared to other forms of chronic Chagas disease and when compared to non chagasic individuals. It was concluded that RI was more frequent in chronic chagasic individuals, specially those who developed CHF, which probably played a role in the renal manifestations and systemic hemodynamic changes in those patients.

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Renal infarction (RI) is usually secondary to arterial obstruction due to emboli originating from the heart. Chronic chagasic patients may present cardiac alterations originating from intracavitary thrombi, even without congestive heart failure (CHF). In this study RI incidence was comparatively evaluated in chronic chagasic individuals, in different anatomoclinic forms and in non chagasic individuals. There has been a review on necropsy reports of individuals aged 20 or over. In 259 necropsies, 78 (30.1%) were chagasics, and 19 of them (24.4%) developed RI, while 27 (15.0%) of the non chagasic individuals presented RI. The ages of chagasics with RI were similar to those of non chagasic individuals. A significant prevalence of RI and thrombosis among chronic chagasic individuals has been found. A significantly higher prevalence of RI among chronic chagasics having CHF (52.6%) was observed when they were compared to other forms of chronic Chagas disease and when compared to non chagasic individuals. It was concluded that RI was more frequent in chronic chagasic individuals, specially those who developed CHF, which probably played a role in the renal manifestations and systemic hemodynamic changes in those patients.

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