The Role of Tocilizumab in Cytokine Storm and Improving Outcomes in COVID-19

2020 ◽  
Vol 15 (2) ◽  
pp. 104-112
Author(s):  
Afroze Ali ◽  
Milad H. Kamjani ◽  
Marc M. Kesselman
Keyword(s):  
Standard Of Care ◽  
Underlying Mechanism ◽  
Vital Role ◽  
Cytokine Storm ◽  
Treatment Target ◽  
Inflammatory Conditions ◽  
Increased Risk ◽  
Symptom Progression ◽  
Viable Treatment

: To date, severe acute respiratory syndrome coronavirus 2 (SARSCoV- 2) has infected millions of individuals worldwide. This virus causes coronavirus disease 2019 (COVID-19) and has led to numerous deaths worldwide. A large percentage of infected patients present asymptomatically, augmenting the spread of the virus. Symptomatic COVID-19 commonly causes mild to severe respiratory disease and fever, but some individuals experience serious complications resulting in death. Immune compromised, high risk, and elderly individuals are at an increased risk of more severe consequences of the illness such as respiratory failure, organ dysfunction, and shock. Cytokine storm (also known as cytokine release syndrome (CRS)), a systemic inflammatory response that can be triggered by an infection, has been associated with the symptom progression of COVID-19. This review evaluates several published studies that have implemented tocilizumab (TCZ), an IL-6 receptor antibody (US20120253016A1), in COVID-19 treatment. Outcomes and biomarkers of patients treated with TCZ are compared to patients treated with standard of care regimens. Interleukin-6 (IL-6), a prominent inflammatory cytokine involved in CRS in various inflammatory conditions, may have a vital role in the underlying mechanism involved in debilitating SARS-CoV-2 infections and could serve as a viable treatment target. Studies suggest that TCZ may aid in the recovery of patients with COVID-19 and reduce mortality.

scholarly journals Role of Tracheostomy in Respiratory Distress: A Study of 50 Cases

2015 ◽  
Vol 8 (1) ◽  
pp. 20-23
Author(s):  
Dimple Sahni
Keyword(s):  
Respiratory Distress ◽  
Head And Neck ◽  
Vital Role ◽  
Trauma Patients ◽  
Excessive Bleeding ◽  
Inflammatory Conditions ◽  
Life Saving ◽  
Respiratory Passage ◽  
Emergency Tracheostomy

ABSTRACT Tracheostomy plays a vital role in respiratory distress caused by different conditions, like respiratory passage of obstruction, head and neck tumor, surgeries, trauma patients and inflammatory conditions. Timing of the operation and postoperative care deserves more emphasis. Delay in the performance of this operation defeats the purpose of tracheostomy and if managed properly, it is a life saving procedure. The aim of the study was not only to give immediate relief to the patients of respiratory distress. But also to study age and sex distribution indication and evaluate factors associated with morbidity and mortality, intraoperative and postoperative complications associated with this procedure. This study was done on 50 cases of respiratory distress admitted in different department of Rajindra Hospital, Patiala, who underwent tracheostomy as an emergency or elective procedure. Most of the patients (24%) were of 50 to 60 years of age of which 60% were males. Emergency tracheostomy was done in most of the cases (64%). Most common complication was wound infection and granuloma formation (16%). Mortality due to primary disease (tumors of head and neck) was 34%. Followed by head injury (29%). Only one patient died of tracheostomy due to excessive bleeding. How to cite this article Sahni D. Role of Tracheostomy in Respiratory Distress: A Study of 50 Cases. Clin Rhinol An Int J 2015;8(1):20-23.

scholarly journals The Adenosine Pathway and HIV-Associated Inflammation

2021 ◽  
Author(s):  
Emily A Hixson ◽  
Priya V Borker ◽  
Edwin K Jackson ◽  
Bernard J Macatangay
Keyword(s):  
Human Immunodeficiency Virus ◽  
Chronic Inflammation ◽  
Viral Suppression ◽  
Purinergic Signaling ◽  
The Body ◽  
Inflammatory Conditions ◽  
Persistent Inflammation ◽  
Increased Risk ◽  
Immunodeficiency Virus

Abstract Human immunodeficiency virus (HIV) is associated with an increased risk of age-associated comorbidities and mortality compared to people without HIV. This has been attributed to HIV-associated chronic inflammation and immune activation despite viral suppression. The adenosine pathway is an established mechanism by which the body regulates persistent inflammation in order to limit tissue damage associated with inflammatory conditions. However, HIV infection is associated with derangements in the adenosine pathway that limits its ability to control HIV-associated inflammation. This article reviews the function of purinergic signaling and the role of the adenosine signaling pathway in HIV-associated chronic inflammation. This review also discusses the beneficial and potential detrimental effects of pharmacotherapeutic strategies targeting this pathway among people with HIV.

scholarly journals Transcriptome Profiling Unravels a Vital Role of Pectin and Pectinase in Anther Dehiscence in Chrysanthemum

2019 ◽  
Vol 20 (23) ◽  
pp. 5865
Author(s):  
Qian Li ◽  
Ze Wu ◽  
Huijun Wu ◽  
Weimin Fang ◽  
Fadi Chen ◽  
...  
Keyword(s):  
Transcriptome Profiling ◽  
Underlying Mechanism ◽  
Chrysanthemum Morifolium ◽  
Vital Role ◽  
Anther Dehiscence ◽  
Physiological Indicators ◽  
Significant Difference ◽  
Transient Overexpression ◽  
Chrysanthemum Morifolium Ramat

Chrysanthemum (Chrysanthemum morifolium (Ramat.) Kitamura) plants have great ornamental value, but their flowers can also be a source of pollen contamination. Previously, morphological and cytological studies have shown that anthers of some chrysanthemum cultivars such as ‘Qx-115′ fail to dehisce, although the underlying mechanism is largely unknown. In this study, we investigated the molecular basis of anther indehiscence in chrysanthemum via transcriptome analysis of a dehiscent cultivar (‘Qx-097′) and an indehiscent cultivar (‘Qx-115′). We also measured related physiological indicators during and preceding the period of anther dehiscence. Our results showed a difference in pectinase accumulation and activity between the two cultivars during dehiscence. Detection of de-esterified pectin and highly esterified pectin in anthers during the period preceding anther dehiscence using LM19 and LM20 monoclonal antibodies showed that both forms of pectin were absent in the stomium region of ‘Qx-097′ anthers but were abundant in that of ‘Qx-115′ anthers. Analysis of transcriptome data revealed a significant difference in the expression levels of two transcription factor-encoding genes, CmLOB27 and CmERF72, between ‘Qx-097′ and ‘Qx-115′ during anther development. Transient overexpression of CmLOB27 and CmERF72 separately in tobacco leaves promoted pectinase biosynthesis. We conclude that CmLOB27 and CmERF72 are involved in the synthesis of pectinase, which promotes the degradation of pectin. Our results lay a foundation for further investigation of the role of CmLOB27 and CmERF72 transcription factors in the process of anther dehiscence in chrysanthemum.

scholarly journals Acute Myocardial Infarction Complicating Active Ulcerative Colitis: A Case Report

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Eva D. Papadimitraki ◽  
Mubarak Ahamed ◽  
Nicholas H. Bunce
Keyword(s):  
Myocardial Infarction ◽  
Ulcerative Colitis ◽  
Acute Myocardial Infarction ◽  
Myocardial Damage ◽  
Chronic Inflammatory Disease ◽  
Inflammatory Conditions ◽  
Increased Risk ◽  
Venous Thromboembolic ◽  
Cardiac Manifestations

Ulcerative colitis (UC) is a chronic inflammatory disease that predominantly affects the gastrointestinal (GI) tract but can involve extraintestinal organs including musculoskeletal system and skin. The most frequent cardiac manifestations of UC are pericarditis and myocarditis. Patients display an increased risk for venous thromboembolic complications and mesenteric ischemia, but the association with ischemic heart disease and myocardial infarction is uncertain. We present the case of a 27-year-old man with anti-PRIII ANCA-positive ulcerative colitis and increased factor VIII activity who presented with an acute myocardial infarction. We discuss possible causative links between these clinical entities and demonstrate the role of cardiac magnetic resonance (CMR) in patients with underlying inflammatory conditions who present with chest pain and evidence of myocardial damage.

scholarly journals A Concise Review on the Role of Endoplasmic Reticulum Stress in the Development of Autoimmunity in Vitiligo Pathogenesis

2021 ◽  
Vol 11 ◽  
Author(s):  
Shahnawaz D. Jadeja ◽  
Jay M. Mayatra ◽  
Jayvadan Vaishnav ◽  
Nirali Shukla ◽  
Rasheedunnisa Begum
Keyword(s):  
Oxidative Stress ◽  
Endoplasmic Reticulum ◽  
Er Stress ◽  
Underlying Mechanism ◽  
Tissue Level ◽  
Vital Role ◽  
Organ Specific ◽  
The Unfolded Protein Response ◽  
Destruction Of Melanocytes

Vitiligo is characterized by circumscribed depigmented macules in the skin resulting due to the autoimmune destruction of melanocytes from the epidermis. Both humoral as well as cell-mediated autoimmune responses are involved in melanocyte destruction. Several studies including ours have established that oxidative stress is involved in vitiligo onset, while autoimmunity contributes to the disease progression. However, the underlying mechanism involved in programing the onset and progression of the disease remains a conundrum. Based on several direct and indirect evidences, we suggested that endoplasmic reticulum (ER) stress might act as a connecting link between oxidative stress and autoimmunity in vitiligo pathogenesis. Oxidative stress disrupts cellular redox potential that extends to the ER causing the accumulation of misfolded proteins, which activates the unfolded protein response (UPR). The primary aim of UPR is to resolve the stress and restore cellular homeostasis for cell survival. Growing evidences suggest a vital role of UPR in immune regulation. Moreover, defective UPR has been implicated in the development of autoimmunity in several autoimmune disorders. ER stress-activated UPR plays an essential role in the regulation and maintenance of innate as well as adaptive immunity, and a defective UPR may result in systemic/tissue level/organ-specific autoimmunity. This review emphasizes on understanding the role of ER stress-induced UPR in the development of systemic and tissue level autoimmunity in vitiligo pathogenesis and its therapeutics.

Perspective and Potential of A2A and A3 Adenosine Receptors as Therapeutic Targets for the Treatment of Rheumatoid Arthritis

2019 ◽  
Vol 25 (26) ◽  
pp. 2859-2874 ◽  
Author(s):  
Yogendra Pal ◽  
Nabamita Bandyopadhyay ◽  
Rashmi S. Pal ◽  
Sarfaraz Ahmed ◽  
Shantanu Bandopadhyay
Keyword(s):  
Rheumatoid Arthritis ◽  
Adenosine Receptors ◽  
Vital Role ◽  
Receptor Subtypes ◽  
Immune Disorder ◽  
Inflammatory Conditions ◽  
Tnf Α ◽  
Near Future ◽  
Inflammatory Effect

Adenosine is a purine nucleoside which is an effective controller of inflammation. The inflammatory effect of adenosine is expressed via its four receptor subtypes viz. A1, A2A, A2B and A3. The various inflammatory conditions including rheumatoid arthritis (RA) are initiated by adenosine receptors of which A2A and A3 play a vital role. RA primarily is an auto-immune disorder which is manifested as chronic inflammation in the synovial lining of joints. In order to develop an effective treatment, the role of cytokines, IL–1, TNF-α and IL–6 is crucial. Besides, the knowledge of PI3K-PKB/Akt and NF-kB signaling pathway is also important to understand the antiinflammatory targets. Methotrexate along with various other molecules like, NSAIDs and DMARDs are presently used as treatment lines for controlling RA. The enhanced knowledge of the preclinical stages and pathogenesis along with recent potent therapeutics raises the hopes that RA can be prevented in the near future.

Cancer Microbiome: Opportunities and Challenges

2020 ◽  
Vol 20 ◽  
Author(s):  
Nallanchakravarthula Srivathsa ◽  
Narayanappa Amruta ◽  
Chitteti Ramamurthy
Keyword(s):  
Literature Search ◽  
Cancer Metabolism ◽  
Standard Of Care ◽  
Modern Medicine ◽  
Vital Role ◽  
Cancer Therapies ◽  
Metabolic Plasticity ◽  
Cancer Initiation ◽  
Modern Era

Background: The microbes and host association emerged as a modulator in the modern era of medicine.The cancer and its associated host microbes are collectively referred to as a Cancer Microbiome. Cancer and microbiome have complex characteristics in terms of metabolic plasticity, micro environment remodelling, cellular communications and unique signatures within the host. These hallmark signs have a vital role in homeostasis and pathogenesis of host physiology.However, in the cancer the role of microbiome still needs to be explored. It is pivotal to review such hall mark signatures of microbiome and its role in cancer initiation, progression and therapy. Objective: The objective of this review is to elucidate the role of microbiome in cancer metabolism and tumour microenvi-ronment. It also focuses on importance of therapeutic opportunities and challenges in terms of manipulation of cancer mi-crobiome. Methods: The literature search is based on the notion of microbiome has role in cancer initiation, progression and therapy. Conclusion: The tumour micro environment and cancer metabolism are playing a significant in host-microbiome interactions. Microbiome can modulate the typical cancer therapies like chemo and immuno therapies in standard of care. The microbiome transplantation has been demonstrated as an effective therapy against cancer. Furthermore, the modulation of microbiome also has potential clinical outcomes in modern medicine.

Toll-like receptor 4 regulates colitis-associated adenocarcinoma development in interleukin-10-deficient (IL-10−/−) mice

2007 ◽  
Vol 35 (5) ◽  
pp. 1375-1376 ◽  
Author(s):  
R. Zhang ◽  
Y. Li ◽  
P.L. Beck ◽  
D.-M. McCafferty
Keyword(s):  
Interleukin 10 ◽  
Bacterial Toxins ◽  
Deficient Mouse ◽  
Toll Like Receptor ◽  
Toll Like Receptor 4 ◽  
Inflammatory Conditions ◽  
Increased Risk ◽  
Growing Body ◽  
Leucocyte Recruitment

Chronic inflammatory conditions such as ulcerative colitis and Crohn's disease are associated with an increased risk of developing adenocarcinoma. It has been hypothesized that this increased risk may be related to soluble mediators present in the inflammatory environment and that factors involved in exacerbating the inflammatory response could increase the risk of developing colitis-associated cancer. There is a growing body of evidence from both clinical studies and animal models which suggests that colitis occurs due to an aberrant immune response to enteric flora in genetically susceptible individuals. It is well documented that bacterial toxins such as endotoxin have potent pro-inflammatory effects through activation of TLR4 (Toll-like receptor 4) and therefore this molecule could potentially play a prominent role in the initiation/exacerbation of colitis and adenocarcinoma development. Using genetic mutant mice, we have examined the role of TLR4 in a spontaneously developing mouse model of colitis-associated adenocarcinoma: the IL-10−/− (interleukin-10-deficient) mouse. Surprisingly, our evidence suggests that the absence of TLR4 promotes colitis-associated adenocarcinoma in IL-10−/− mice. TLR4-dependent chemokine induction may play a part in modulating the development of colitis-associated neoplasia through altered leucocyte recruitment.

scholarly journals The Role of TEG Analysis in Patients with COVID-19-Associated Coagulopathy: A Systematic Review

Diagnostics ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 172
Author(s):  
Jan Hartmann ◽  
Alexis Ergang ◽  
Dan Mason ◽  
Joao D. Dias
Keyword(s):  
Systematic Review ◽  
Whole Blood ◽  
Patient Population ◽  
Standard Of Care ◽  
Future Studies ◽  
Increased Risk ◽  
Coagulation Tests ◽  
Thrombotic Complications ◽  
Coagulation Status

Coronavirus disease 2019 (COVID-19)-associated coagulopathy (CAC), characterized by hypercoagulability and an increased risk of thrombotic complications, is an important consideration in the management of patients with COVID-19. As COVID-19 is a new disease, no standard of care for the diagnosis or management of its associated coagulopathy is yet established. Whole blood viscoelastic tests, such as thromboelastography (TEG® hemostasis analyzer), analyze whole blood to provide a complete overview of the coagulation status. We conducted a systematic review of thromboelastography for management of patients with COVID-19, using MEDLINE (PubMed) and Cochrane databases. TEG® parameter measurements and clinical outcomes data were extracted for analysis. Our review found 15 publications, with overall results showing thromboelastography can identify and assess a hypercoagulable state in patients with COVID-19. Furthermore, utilization of thromboelastography in this patient population was shown to predict thrombotic complications. The benefits of thromboelastography presented here, in addition to advantages compared with laboratory coagulation tests, position thromboelastography as an important opportunity for optimizing diagnosis of CAC and improving patient management in COVID-19. Given that the benefits of thromboelastography have already been demonstrated in several other clinical applications, we anticipate that clinical data from future studies in patients with COVID-19 will further elucidate the optimal use of thromboelastography in this patient population.

scholarly journals Overview of Beta-Lactam Allergy and the Role of the Pharmacist in Management

Allergies ◽  
2021 ◽  
Vol 1 (2) ◽  
pp. 128-136
Author(s):  
Nicole Bradley ◽  
Yuman Lee ◽  
Dana Weinstein
Keyword(s):  
Public Health ◽  
Antibiotic Therapy ◽  
Skin Testing ◽  
Public Health Problem ◽  
Cross Reactivity ◽  
Vital Role ◽  
Beta Lactam ◽  
Increased Risk ◽  
Clinically Significant

Unverified beta-lactam allergies are a substantial public health problem, as the majority of patients labeled as beta-lactam allergic do not have clinically significant allergies that may hinder the use beta-lactam therapy when indicated. Outdated or inaccurate beta-lactam or penicillin allergies can result in serious consequences, including suboptimal antibiotic therapy, increased risk of adverse effects, and use of broader spectrum antibiotics than indicated, which may contribute to antimicrobial resistance. The purpose of this review is to provide an overview of beta-lactam allergy and highlight the role of pharmacists in managing beta-lactam allergies. Studies have shown that pharmacists can play a vital role in allergy assessment, penicillin skin testing, beta-lactam desensitization, evaluation of beta-lactam cross-reactivity and recommending appropriate antibiotic therapy in patients with beta-lactam allergies.

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