RESUMO
Background: Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by autoantibody production and diverse tissue and organ inflammatory affections. Interleukin 21 (IL-21) is implicated in B cell survival, proliferation, differentiation, class switching, and immunoglobulin production; therefore, it is considered a key cytokine in the pathogenesis of SLE. However, its association with disease activity and clinical phenotypes remains unclear. We aimed to evaluate the association of IL-21 levels with the disease activity and clinical phenotypes in patients with SLE. Also, we analyzed the IL21 polymorphisms associated with increased IL-21 levels. Methods: The IL-21 serum levels were determined using the enzyme-linked immunosorbent assay (ELISA) method. The rs2221903 and rs2055979 polymorphisms were assessed in 300 healthy controls (HCs) and 300 patients with SLE by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique. The levels of IL-21 were monitored during follow-up visits in 59 patients with SLE. Results: The patients with SLE showed higher IL-21 levels compared to the HCs. The IL-21 levels did not correlate with Mex-SLEDAI and were not different in patients with inactive, mild-moderate, and severe disease. The IL-21 levels were increased in patients with hematological affection. The ROC curve analysis revealed that the IL-21 levels had good predictive power in discriminating among patients with SLE and HCs. In a follow-up analysis, the levels of IL-21 remained higher in the patients with SLE even when the patients were in remission. Also, the rs2221903 polymorphism was associated with increased IL-21 levels. Conclusions: This study highlights the importance of IL-21 as a key cytokine in SLE. IL-21 levels are higher in patients with SLE and remain increased regardless of disease activity. According to the ROC analysis, IL-21 is a potential biomarker of SLE. Further longitudinal studies are needed to explore the relationship between IL-21 and the clinical phenotypes of SLE.
RESUMO
We aimed to analyze the association between food insecurity (FI) and academic performance in university students, including mental health and sleep quality (SQ), in an association model. A cross-sectional design included university students (n = 466, 72.5% women) from Mexico. We applied the Latin American and Caribbean Food Security Scale, the Depression Anxiety and Stress Scale (DASS-21), and the Pittsburgh Sleep Quality Index. Students self-reported their academic grading (AG) and perceptions about their academic performance. Spearman's rho and multiple logistic regression models were used. Almost half (47%) experienced some level of FI. The median AG was 95. AG was not significantly (p > 0.05) correlated with FI, nor with depression, anxiety, stress, and SQ. Considering mental health and SQ, moderate/severe FI remained significantly associated with perceived overall progress in college (OR: 2.96; 95%CI: 1.49, 5.88) and attendance to classes (OR:3.14; 95%CI: 1.19, 8.28) as poor or regular, and it was positively related to perceiving difficulties in completing their studies (OR:2.75; 95%CI: 1.43, 5.29). Stress, anxiety, depression symptoms, and poor SQ were also significantly associated with poor/regular perception of academic performance. These findings highlight the need to address psychological and nutritional factors in university students to promote their well-being and academic success.