Necrotizing Anterior Scleritis in a Woman with Terrien’s Marginal Degeneration: A Case Report

Purpose: The aim of the study was to report the first case of a patient with Terrien’s Marginal Degeneration (TMD) who developed necrotizing anterior scleritis without systemic disease association, requiring systemic immunosuppressive treatment. Case Report: A 32-year-old female consulted for bilateral ocular burning and hyperemia. Initially, she was diagnosed with conjunctivitis and treated with topical antibiotics and corticosteroids, with mild transitory improvement but the progression of the disease. Years later, she attended the ocular immunology consultation for a second opinion where TMD with ocular inflammatory component OU was diagnosed. Seven months later, she presented with severe pain, decreased visual acuity, and photophobia in OS. At the slit-lamp examination, necrotizing anterior scleritis with a high risk of perforation in OS was observed. The patient was referred to the rheumatologist and started treatment with systemic corticosteroids and cyclophosphamide, exhibiting a clinical improvement. The patient did not meet the criteria for any systemic illness associated with scleritis, such as autoimmune diseases or vasculitis. Thus, scleritis was related to the adjacent inflammatory process associated with TMD, as an atypical presentation of this disease. Conclusion: Although an inflammatory type of TMD has been proposed, it is essential to follow up closely these patients and consider necrotizing anterior scleritis, a severe ocular disease that requires prompt immunosuppressive management, as a possible atypical associated presentation of this disease.

Versatile Role of Prokineticins and Prokineticin Receptors in Neuroinflammation

Prokineticins are a new class of chemokine-like peptides involved in a wide range of biological and pathological activities. In particular, prokineticin 2 (PK2), prokineticin receptor 1 (PKR1) and prokineticin receptor 2 (PKR2) play a central role in modulating neuroinflammatory processes. PK2 and PKRs, which are physiologically expressed at very low levels, are strongly upregulated during inflammation and regulate neuronal-glial interaction. PKR2 is mainly overexpressed in neurons, whereas PKR1 and PK2 are mainly overexpressed in astrocytes. Once PK2 is released in inflamed tissue, it is involved in both innate and adaptive responses: it triggers macrophage recruitment, production of pro-inflammatory cytokines, and reduction of anti-inflammatory cytokines. Moreover, it modulates the function of T cells through the activation of PKR1 and directs them towards a pro-inflammatory Th1 phenotype. Since the prokineticin system appears to be upregulated following a series of pathological insults leading to neuroinflammation, we will focus here on the involvement of PK2 and PKRs in those pathologies that have a strong underlying inflammatory component, such as: inflammatory and neuropathic pain, Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, stroke, obesity, diabetes, and gastrointestinal inflammation.

Effects of Essential Oils and Selected Compounds from Lamiaceae Family as Adjutants on the Treatment of Subjects with Periodontitis and Cardiovascular Risk

Essential oils from different plant species were found to contain different compounds exhibiting anti-inflammatory effects with the potential to be a valid alternative to conventional chemotherapy that is limited in long-term use due to its serious side effects. Generally, the first mechanism by which an organism counteracts injurious stimuli is inflammation, which is considered a part of the innate immune system. Periodontitis is an infectious and inflammatory disease caused by a dysbiosis in the subgingival microbiome that triggers an exacerbated immune response of the host. The immune–inflammatory component leads to the destruction of gingival and alveolar bone tissue. The main anti-inflammation strategies negatively modulate the inflammatory pathways and the involvement of inflammatory mediators by interfering with the gene’s expression or on the activity of some enzymes and so affecting the release of proinflammatory cytokines. These effects are a possible target from an effective and safe approach, suing plant-derived anti-inflammatory agents. The aim of the present review is to summarize the current evidence about the effects of essentials oils from derived from plants of the Lamiaceae family as complementary agents for the treatment of subjects with periodontitis and their possible effect on the cardiovascular risk of these patients.

Impact of Adiposity and Fat Distribution, Rather Than Obesity, on Antibodies as an Illustration of Weight-Loss-Independent Exercise Benefits

Obesity represents a risk factor for a variety of diseases because of its inflammatory component, among other biological patterns. Recently, with the ongoing COVID-19 crisis, a special focus has been put on obesity as a status in which antibody production, among other immune functions, is impaired, which would impact both disease pathogenesis and vaccine efficacy. Within this piece of writing, we illustrate that such patterns would be due to the increased adiposity and fat distribution pattern rather than obesity (as defined by the body mass index) itself. Within this context, we also highlight the importance of the weight-loss-independent effects of exercise.

Pericarditis after SARS-CoV-2 Infection: Another Pebble in the Mosaic of Long COVID?

With the emerging success of the COVID-19 vaccination programs, the incidence of acute COVID-19 will decrease. However, given the high number of people who contracted SARS-CoV-2 infection and recovered, we will be faced with a significant number of patients with persistent symptoms even months after their COVID-19 infection. In this setting, long COVID and its cardiovascular manifestations, including pericarditis, need to become a top priority for healthcare systems as a new chronic disease process. Concerning the relationship between COVID-19 and pericardial diseases, pericarditis appears to be common in the acute infection but rare in the postacute period, while small pericardial effusions may be relatively common in the postacute period of COVID-19. Here, we reported a series of 7 patients developing pericarditis after a median of 20 days from clinical and virological recovery from SARS-CoV-2 infection. We excluded specific identifiable causes of pericarditis, hence we speculate that these cases can be contextualized within the clinical spectrum of long COVID . All our patients were treated with a combination of colchicine and either ASA or NSAIDs, but four of them did not achieve a clinical response. When switched to glucocorticoids, these four patients recovered with no recurrence during drug tapering. Based on this observation and on the latency of pericarditis occurrence (a median of 20 days after a negative nasopharyngeal swab), could be suggested that post-COVID pericarditis may be linked to ongoing inflammation sustained by the persistence of viral nucleic acid without virus replication in the pericardium. Therefore, glucocorticoids may be a suitable treatment option in patients not responding or intolerant to conventional therapy and who require to counteract the pericardial inflammatory component rather than direct an acute viral injury to the pericardial tissue.

Clinical use of cytomedin in patients with prostate diseases

Introduction. The use of extracts of the prostate of animals is one of the main directions in the treatment of patients with diseases of the prostate. Most studies describe the experience of using these drugs in a small number of patients for a limited time period. The aim of this work was to summarize the long-term experience of using drugs of the cytomedin group in the treatment of a large number of patients with chronic prostatitis (CP) and benign prostatic hyperplasia (BPH). Materials and methods. Cytomedins were used in 487 patients with CP / BPH from January 2015 to December 2018. Indications: rehabilitation of patients after pancreatic biopsy (63 patients, 13%), cystoscopy and other endoscopic surgical interventions (189 patients, 39%), as well as conservative therapy of chronic inflammation associated with BPH (235 patients, 48%). If an infectious-inflammatory process was suspected, the following scheme was used: Vitaprost Plus 1 candle 1 time per day for 20 days, in the presence of irritative complaints, Vitaprost Forte was used 1 candle 1 time per day for 20 days, in other cases Vitaprost was prescribed 1 candle 1 time per day for 20 days ... The second component of the complex treatment was the use of the Vitaprost tablet form for 20 days, 1 ton 2 times a day. Before and after the appointment of therapy, the quality of life was monitored according to the data of the visual analogue scale (VAS), ultrasound examination of the pancreas (ultrasound) and laboratory parameters. The results of therapy were assessed as successful with an improvement in the quality of life, a decrease in the level of leukocytes, and a decrease in the volume of the pancreas by more than 10% from the initial level. Results. The total efficacy of cytomedin therapy was 39%. The greatest effectiveness of therapy was with the initial VAS less than 60 points out of 100; with more severe pain syndrome, the effectiveness was statistically significantly reduced to 32%. The initial detection of an inflammatory component with an increase in the level of leukocytes in laboratory tests statistically significantly increased the effectiveness of therapy 48 versus 24%. Cytomedin therapy was equally effective regardless of the prostate volume (36% versus 42% versus 38%, p> 0.05). A survey was conducted in 102 patients after Vitaprost-Forte / Vitaprost therapy, the results of which revealed a decrease in the I-PSS score from 18 ± 6.4 points to 12 ± 4 points (p> 0.05), in the group with combination therapy with alpha adrenergic blockers – 8 ± 3.2 points, p <0.05. A control examination of 51 patients with the development of erectile dysfunction against the background of chronic intake of 5-ARI showed that the cancellation of 5-ARI inhibitors followed by the appointment of Vitaprost in the form of suppositories and tablets led to an increase in the IIEF-5 indicator by 5 points, the average indicator during the control examination was 23 ± 4.2 points (p> 0.05) versus 18 ± 3.4 points before treatment. Conclusions. the following prognostic criteria for the effectiveness of cytomedin therapy were determined: the level of the visual analogue scale is less than 60 out of 100 and the presence of a confirmed inflammatory component according to laboratory tests.

Knee osteoarthritis severity concerning neutrophil-lymphocyte ratio

Osteoarthritis (OA) is a disease with a significant inflammatory component. Neutrophil-lymphocyte ratio (NLR) level is a marker to determine inflammation. The study aimed to evaluate the association between the severity of knee OA and NLR. A case-control study was conducted in Al-Zahrawi from June 2017 to June 2018. A total of 100 knees OA were recruited and 50 healthy subjects as a control group. NLR was significantly higher in knee OA than controls, the mean value was (2.19±0.72) and (1.97±0.88), respectively. Older age, chronic pain, prolong the onset of diagnosis and high NLR were significantly associated with severe OA. Knee OA had higher NLR compared to healthy people. Higher NLR is associated with the severity of knee OA and it is a poor indicator.

Evaluation of retinal inflammatory biomarkers after intravitreal steroid implant and Ranibizumab injection in diabetic macular edema

Purpose: To compare the efficacy of intravitreal (IV) ranibizumab (IVR) injection with IV dexamethasone implant (IVDEX) in treatment naive diabetic macular edema (DME) patients with inflammatory component. Materials and methods: Treatment naive DME eyes with subfoveal neurosensorial detachment (SND) and hyperreflective spots (HRS) were treated either three loading doses of IVR (18 eyes) or one dose of IVDEX (19 eyes). Central macular thickness (CMT), height of SND, the number of HRSs scattered on the individual retinal layers and photoreceptor integrity were assessed using spectral domain- optical coherence tomography scans over 3-months follow-up. Results: The mean change in best-corrected visual acuity (BCVA) was −0.11 ± 0.08 logMAR in IVDEX group and −0.04 ± 0.06 logMAR in IVR group at 1-month ( p = 0.011). IVDEX group showed statistically significant more increase in BCVA compared to those receiving IVR injections at 2-months ( p = 0.004) and 3-months ( p = 0.017) visits. Compared to baseline, the number of total HRSs and the number of HRSs at each individual inner retinal layer significantly decreased in both groups at all follow-up visits. However, IVDEX group showed more decrease in the total number of HRSs at 2- and 3-months ( p < 0.001 at 2-months, and p = 0.006 at 3-months) and in the mean number of HRSs located at inner nuclear layer–outer plexiform layer level ( p = 0.016 at 1-month, p < 0.001 at 2-months, and p < 0.001 at 3-months). After treatment, the number of HRSs on the outer nuclear layer showed some non-significant increase in both groups. Conclusion: HRSs tended to migrate from inner retina to the outer retina in DME eyes by treatment. Dexamethasone seemed to be more effective option in such cases with inflammatory component.

Nutrition and immunity: lessons for COVID-19

The role of the immune system is to protect the individual against pathogenic organisms. Nutrition is one of multiple factors that determines the immune response and good nutrition is important in supporting the immune response. Immunity can be impaired in older people, particularly those who are frail, in those living with obesity, in those who are malnourished and in those with low intakes of micronutrients. The immune impairments associated with nutritional inadequacy increase susceptibility to infection and permit infections to become more severe, even fatal. The adverse impact of poor nutrition on the immune system, including its inflammatory component, may be one of the explanations for the higher risk of more severe outcomes from infection with SARS-CoV-2 seen in older people and in those living with obesity. Studies of individual micronutrients including vitamin D and zinc suggest roles in reducing severity of infection with SARS-CoV-2. Good nutrition is also important in promoting a diverse gut microbiota, which in turn supports the immune system. The importance of nutrition in supporting the immune response also applies to assuring robust responses to vaccination. There are many lessons from the study of nutrition and immunity that are relevant for the battle with SARS-CoV-2.