Clinical markers of immune disorders in the pathogenesis of Escherichia coli enteritis

Background. Escherichia coli enteritis is one of the most common causes of diarrhea in developed countries and is caused usually by pathogenic strains of Escherichia coli. Objectives. To investigate the role of reactive response of polymorphonuclear neutrophilic granulocytes (NG) of peripheral blood in the systemic inflammatory response mechanisms of acute Escherichia enterocolitis (AEC), depending on genes polymorphism of heat shock proteins (HSP) family 70-2 (HSP70-2, 1267A®G) and interleukin 10 (IL-10, C-592A). Material and methods. The genes polymorphism was analysed by PCR based method in 95 patients with AEC and 30 healthy individuals. Clinical markers of immune disorders were evaluated after hematological indices, based upon an extended general clinical blood analysis, using verified formulas. Results. The endogenous intoxication severity did not depend reliably on genotypes of IL-10 gene (rs1800872), however it was significantly 23.68% (р=0.043) higher in GG-genotype carriers of HSP70-2 gene (rs1061581). The reduction of cellular reactivity by 14.71-19.08% (р<0.01) did not depend on the analyzed genes genotypes. But general non-specific immune reactivity decreases 3.49-4.24 times (р<0.001) was deeper in GG-genotype carriers of HSP70-2 gene and AA-genotype carriers of IL-10 gene by 17.78% (р=0.009) and 12.37% (р=0.023) respectively. The immunologic resistance index was lower by 18.75% (р=0.024) in GG-genotype carriers than in patients with А allele. Conclusions. Hematological indices, based upon an extended general clinical blood analysis, are indicative and reliable non-specific clinical markers of immune disorders in case of AEC

The cytochrome 11B2 aldosterone synthase gene rs1799998 single nucleotide polymorphism determines elevated aldosterone, higher blood pressure, and reduced glomerular filtration, especially in diabetic female patients

Objective. The cytochrome 11B2 aldosterone synthase gene (CYP11B2) that links to aldosterone synthase enzyme synthesis changes and blood pressure regulation is of particular interest among the renin-angiotensin-aldosterone system encoding genes

The ChoCO-W prospective observational global study: Does COVID-19 increase gangrenous cholecystitis?

BACKGROUND: The incidence of the highly morbid and potentially lethal gangrenous cholecystitis was reportedly increased during the COVID-19 pandemic. The aim of the ChoCO-W study was to compare the clinical findings and outcomes of acute cholecystitis in patients who had COVID-19 disease with those who did not. METHODS: Data were prospectively collected over 6 months (October 1, 2020, to April 30, 2021) with 1-month follow-up. In October 2020, Delta variant of SARS CoV-2 was isolated for the first time. Demographic and clinical data were analyzed and reported according to the STROBE guidelines. Baseline characteristics and clinical outcomes of patients who had COVID-19 were compared with those who did not. RESULTS: A total of 2893 patients, from 42 countries, 218 centers, involved, with a median age of 61.3 (SD: 17.39) years were prospectively enrolled in this study; 1481 (51%) patients were males. One hundred and eighty (6.9%) patients were COVID-19 positive, while 2412 (93.1%) were negative. Concomitant preexisting diseases including cardiovascular diseases (p < 0.0001), diabetes (p < 0.0001), and severe chronic obstructive airway disease (p = 0.005) were significantly more frequent in the COVID-19 group. Markers of sepsis severity including ARDS (p < 0.0001), PIPAS score (p < 0.0001), WSES sepsis score (p < 0.0001), qSOFA (p < 0.0001), and Tokyo classification of severity of acute cholecystitis (p < 0.0001) were significantly higher in the COVID-19 group. The COVID-19 group had significantly higher postoperative complications (32.2% compared with 11.7%, p < 0.0001), longer mean hospital stay (13.21 compared with 6.51 days, p < 0.0001), and mortality rate (13.4% compared with 1.7%, p < 0.0001). The incidence of gangrenous cholecystitis was doubled in the COVID-19 group (40.7% compared with 22.3%). The mean wall thickness of the gallbladder was significantly higher in the COVID-19 group [6.32 (SD: 2.44) mm compared with 5.4 (SD: 3.45) mm; p < 0.0001]. CONCLUSIONS: The incidence of gangrenous cholecystitis is higher in COVID patients compared with non-COVID patients admitted to the emergency department with acute cholecystitis. Gangrenous cholecystitis in COVID patients is associated with high-grade Clavien-Dindo postoperative complications, longer hospital stay and higher mortality rate. The open cholecystectomy rate is higher in COVID compared with non -COVID patients. It is recommended to delay the surgical treatment in COVID patients, when it is possible, to decrease morbidity and mortality rates. COVID-19 infection and gangrenous cholecystistis are not absolute contraindications to perform laparoscopic cholecystectomy, in a case by case evaluation, in expert hands