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Ntwali F, Gilliaux Q, Honoré PM. Nivolumab-Induced Cytokine Release Syndrome: A Case Report and Literature Review. AMERICAN JOURNAL OF CASE REPORTS 2024; 25:e941835. [PMID: 38625840 PMCID: PMC11034389 DOI: 10.12659/ajcr.941835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 03/03/2024] [Accepted: 01/17/2024] [Indexed: 04/18/2024]
Abstract
BACKGROUND CRS (cytokine release syndrome) is a massive activation of the inflammatory system characterized by a supra-physiological rate of inflammatory cytokines. The interleukin 6 cytokine plays a central role in CRS. The main clinical sign of CRS is fever, but CRS can lead to multiple organ failure in severe cases. CRS is usually described in sepsis, more recently in SARS COV-2 infection, and in chimeric antigen receptor T-cell therapy. However, it can also be associated with immune checkpoint inhibitors (ICIs), which is infrequently described. ICI have growing indications and can lead to CRS by causing an uncontrolled activation of the immune system. There are currently no treatment guidelines for ICI-induced CRS. CASE REPORT We report a rare case of grade 3 CRS induced by nivolumab associated with 5-fluorouracil and oxaliplatin for gastric cancer. The patient was 65-year-old man with an adenocarcinoma of the cardia. CRS developed during the tenth course of treatment and was characterized by fever, hypotension requiring vasopressors, hypoxemia, acute kidney injury, and thrombopenia. The patient was transferred quickly to the Intensive Care Unit. He was treated for suspected sepsis, but it was ruled out after multiple laboratory examinations. There was rapid resolution after infusion of hydrocortisone. CONCLUSIONS The use of ICIs is expanding. Nivolumab-induced CRS is rarely described but can be severe and lead to multiple organ dysfunction; therefore, intensive care practitioners should be informed about this adverse effect. More studies are needed to better understand this condition and establish treatment guidelines.
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Affiliation(s)
- Francis Ntwali
- Intensive Care Unit, UCL Namur University Hospital, Yvoir, Belgium
| | - Quentin Gilliaux
- Department of Oncology, UCL Namur University Hospital, Yvoir, Belgium
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Phelippeau M, Marion E, Robbe-Saule M, Ganlanon L, Chauty A, Adeye A, Blanchard S, Johnson C, Marsollier L, Dubee V. Changes in Inflammatory Markers in Patients Treated for Buruli Ulcer and Their Ability to Predict Paradoxical Reactions. J Infect Dis 2023; 228:1630-1639. [PMID: 37221015 PMCID: PMC10681857 DOI: 10.1093/infdis/jiad176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 04/11/2023] [Accepted: 05/22/2023] [Indexed: 05/25/2023] Open
Abstract
Mycobacterium ulcerans causes Buruli ulcer, the third most frequent mycobacterial disease after tuberculosis and leprosy. Transient clinical deteriorations, known as paradoxical reactions (PRs), occur in some patients during or after antibiotic treatment. We investigated the clinical and biological features of PRs in a prospective cohort of 41 patients with Buruli ulcer from Benin. Neutrophil counts decreased from baseline to day 90, and interleukin 6 (IL-6), granulocyte colony-stimulating factor, and vascular endothelial growth factor were the cytokines displaying a significant monthly decrease relative to baseline. PRs occurred in 10 (24%) patients. The baseline biological and clinical characteristics of the patients presenting with PRs did not differ significantly from those of the other patients. However, the patients with PRs had significantly higher IL-6 and tumor necrosis factor alpha (TNF-α) concentrations on days 30, 60, and 90 after the start of antibiotic treatment. The absence of a decrease in IL-6 and TNF-α levels during treatment should alert clinicians to the possibility of PR onset.
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Affiliation(s)
- Michael Phelippeau
- Service des Maladies Infectieuses et Tropicales, University Hospital Angers
| | - Estelle Marion
- Université Angers, Nantes Université, Inserm, Immunology and New Concepts in ImmunoTherapy, Immunology and New Concepts in Immunotherapy (INCIT), Angers, France
| | - Marie Robbe-Saule
- Université Angers, Nantes Université, Inserm, Immunology and New Concepts in ImmunoTherapy, Immunology and New Concepts in Immunotherapy (INCIT), Angers, France
| | - Line Ganlanon
- Centre de dépistage et de traitement de la lèpre et de l’ulcère de Buruli, Centre de diagnostic et de traitement de la lèpre et de l’ulcère de Buruli, Pobè, Benin
| | - Annick Chauty
- Centre de dépistage et de traitement de la lèpre et de l’ulcère de Buruli, Centre de diagnostic et de traitement de la lèpre et de l’ulcère de Buruli, Pobè, Benin
| | - Ambroise Adeye
- Centre de dépistage et de traitement de la lèpre et de l’ulcère de Buruli, Centre de diagnostic et de traitement de la lèpre et de l’ulcère de Buruli, Pobè, Benin
| | - Simon Blanchard
- Université Angers, Nantes Université, Inserm, Centre National de la Recherche Scientifique (CNRS), Nantes - Angers Cancer and Immunology Research Center (CRCINA2)
- Laboratoire d’Immunologie et Allergologie, Centre Hopitalier Universitaire (CHU) d’Angers, Angers, France
| | - Christian Johnson
- Center inter facultaire de formation et de recherche en environnement (CIFRED), Université d’Abomey Calavi, Abomey Calavi, Benin
| | - Laurent Marsollier
- Université Angers, Nantes Université, Inserm, Immunology and New Concepts in ImmunoTherapy, Immunology and New Concepts in Immunotherapy (INCIT), Angers, France
| | - Vincent Dubee
- Service des Maladies Infectieuses et Tropicales, University Hospital Angers
- Université Angers, Nantes Université, Inserm, Immunology and New Concepts in ImmunoTherapy, Immunology and New Concepts in Immunotherapy (INCIT), Angers, France
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Okumura T, Kimura T, Iwadare T, Wakabayashi SI, Kobayashi H, Yamashita Y, Sugiura A, Joshita S, Fujimori N, Kunimoto H, Komatsu M, Fukushima H, Mori H, Umemura T. Prognostic Significance of C-Reactive Protein in Lenvatinib-Treated Unresectable Hepatocellular Carcinoma: A Multi-Institutional Study. Cancers (Basel) 2023; 15:5343. [PMID: 38001602 PMCID: PMC10670047 DOI: 10.3390/cancers15225343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 10/27/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Serum C-reactive protein (CRP) is an established biomarker for acute inflammation and has been identified as a prognostic indicator for hepatocellular carcinoma (HCC). However, the significance of the serum CRP level, specifically in HCC patients treated with lenvatinib, remains unclear. METHODS We retrospectively analyzed 125 HCC patients who received lenvatinib treatment at six centers. Clinical characteristics were assessed to identify clinical associations between serum CRP and HCC prognosis. RESULTS The median overall serum CRP level was 0.29 mg/dL. The cohort was divided into two groups: the low-CRP group with a serum CRP < 0.5 mg/dL and the high-CRP group with a serum CRP ≥ 0.5 mg/dL. The low-CRP group exhibited significantly longer overall survival (OS) than the high-CRP group (22.9 vs. 7.8 months, p < 0.001). No significant difference was observed for progression-free survival (PFS) between the high- and low-CRP groups (9.8 vs. 8.4 months, p = 0.411), while time-to-treatment failure (TTF) was significantly longer in the low-CRP group (8.5 vs. 4.4 months, p = 0.007). The discontinuation rate due to poor performance status was significantly higher in the high-CRP group (p < 0.001). CONCLUSION A baseline serum CRP level exceeding 0.5 mg/dL was identified as an unfavorable prognostic factor in HCC patients receiving lenvatinib treatment.
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Affiliation(s)
- Taiki Okumura
- Department of Medicine, Division of Gastroenterology and Hepatology, Shinshu University School of Medicine, Matsumoto 390-8621, Japan; (T.O.); (T.I.); (S.-i.W.); (H.K.); (Y.Y.); (T.U.)
- Department of Advanced Endoscopic Therapy, Shinshu University School of Medicine, Matsumoto 390-8621, Japan
| | - Takefumi Kimura
- Department of Medicine, Division of Gastroenterology and Hepatology, Shinshu University School of Medicine, Matsumoto 390-8621, Japan; (T.O.); (T.I.); (S.-i.W.); (H.K.); (Y.Y.); (T.U.)
| | - Takanobu Iwadare
- Department of Medicine, Division of Gastroenterology and Hepatology, Shinshu University School of Medicine, Matsumoto 390-8621, Japan; (T.O.); (T.I.); (S.-i.W.); (H.K.); (Y.Y.); (T.U.)
| | - Shun-ichi Wakabayashi
- Department of Medicine, Division of Gastroenterology and Hepatology, Shinshu University School of Medicine, Matsumoto 390-8621, Japan; (T.O.); (T.I.); (S.-i.W.); (H.K.); (Y.Y.); (T.U.)
- Department of Advanced Endoscopic Therapy, Shinshu University School of Medicine, Matsumoto 390-8621, Japan
| | - Hiroyuki Kobayashi
- Department of Medicine, Division of Gastroenterology and Hepatology, Shinshu University School of Medicine, Matsumoto 390-8621, Japan; (T.O.); (T.I.); (S.-i.W.); (H.K.); (Y.Y.); (T.U.)
- Department of Health Promotion Medicine, Shinshu University School of Medicine, Matsumoto 390-8621, Japan;
| | - Yuki Yamashita
- Department of Medicine, Division of Gastroenterology and Hepatology, Shinshu University School of Medicine, Matsumoto 390-8621, Japan; (T.O.); (T.I.); (S.-i.W.); (H.K.); (Y.Y.); (T.U.)
| | - Ayumi Sugiura
- Department of Internal Medicine, Sato Hospital, Nakano 389-2102, Japan;
| | - Satoru Joshita
- Department of Health Promotion Medicine, Shinshu University School of Medicine, Matsumoto 390-8621, Japan;
- Department of Internal Medicine, Yodakubo Hospital, Nagawa 386-0603, Japan
| | - Naoyuki Fujimori
- Department of Gastroenterology, Shinshu Ueda Medical Center, Ueda 386-8610, Japan;
| | - Hideo Kunimoto
- Department of Gastroenterology, Nagano Municipal Hospital, Nagano 381-0006, Japan;
| | - Michiharu Komatsu
- Department of Gastroenterology, Suwa Red Cross Hospital, Suwa 392-0027, Japan;
| | - Hideki Fukushima
- Department of Gastroenterology, Saku Central Hospital Advanced Care Center, Saku 385-0051, Japan;
| | - Hiromitsu Mori
- Department of Gastroenterology, Nagano Red Cross Hospital, Nagano 380-0928, Japan;
| | - Takeji Umemura
- Department of Medicine, Division of Gastroenterology and Hepatology, Shinshu University School of Medicine, Matsumoto 390-8621, Japan; (T.O.); (T.I.); (S.-i.W.); (H.K.); (Y.Y.); (T.U.)
- Consultation Center for Liver Diseases, Shinshu University Hospital, Matsumoto 390-8621, Japan
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Gaus S, Afif Y, Ala AA, Tanra AH, Ratnawati R, Rum M. Comparison of Pain Control and Inflammatory Profile in Cesarean Section Patients Treated with Multimodal Analgesia Utilizing Paracetamol and Ibuprofen. Open Access Maced J Med Sci 2023. [DOI: 10.3889/oamjms.2023.10853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
AIM: This single-blind study aimed to compare the combination of paracetamol with various doses of ibuprofen as multimodal analgesia in C-section surgery patients under spinal anesthesia. Levels of interleukin (IL)-6 and C-reactive protein (CRP) were analyzed as markers of inflammation.
METHODS: Treatment groups (20 patients each) were: Group A, 750 mg paracetamol and 400 mg ibuprofen; Group B, 750 mg paracetamol and 600 mg ibuprofen; and Group C, 750 mg paracetamol and 800 mg ibuprofen. Degree of pain (movement and rest), scored using the numeric rating scale (NRS) and levels of IL-6 and CRP were assessed at various time points within 24 h of surgery. Side effects and numbers of subjects requiring rescue fentanyl administration were also recorded.
RESULTS: Group C showed a rest NRS score of 1.00 ± 0.00 6 h postoperatively, compared with 2.00 ± 0.00 in Group B and 2.35 ± 0.87 in Group A. 4 h postoperatively, movement NRS scores were 1.00 ± 0.00 for Group C, compared to 3.00 ± 1.77 for Group B, and 4.85 ± 1.81 for Group A. At 12 h, IL-6 levels hours were 2.66 ± 0.04 pg/mL for Group A, 2.39 ± 0.02 pg/mL for Group B, and 2.05 ± 0.01 pg/mL for Group C. At 6 h, CRP levels were 1.18 ± 0.04 mg/L for Group A, 0.95 ± 0.01 mg/L for Group B, and 0.70 ± 0.02 mg/L for Group C. Overall, Group C showed the lowest values for all parameters analyzed, compared with other groups, and the differences were significant (p < 0.05). In addition, none of the patients in Group C required rescue fentanyl (p < 0.05), and no patients in any of the groups showed any side effects.
CONCLUSION: For pain management after C-section surgery, the combination of 750 mg paracetamol and 800 mg ibuprofen yielded the best results as assessed by NRS scores, levels of IL-6 and CRP, and fentanyl rescue.
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Duraiyarasan S, Adefuye M, Manjunatha N, Ganduri V, Rajasekaran K. Colon Cancer and Obesity: A Narrative Review. Cureus 2022; 14:e27589. [PMID: 36059323 PMCID: PMC9433794 DOI: 10.7759/cureus.27589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2022] [Indexed: 11/05/2022] Open
Abstract
Obesity has played a crucial role in the pathogenesis of various cancers, including colorectal cancer (CRC). Obesity has shown to increase the blood levels of insulin, insulin-like growth factor-1 (IGF-1), leptin, resistin, inflammatory cytokines such as interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), monocyte chemoattractant protein-1 (MCP-1) which in turn acts via various signaling pathways to induce colonic cell proliferation and in turn CRC development. It has been shown that estrogen can prevent and cause CRC based on which receptor it acts. Obese patients have relatively low levels of ghrelin and adiponectin that inhibit cell proliferation which further adds to their risk of developing CRC. Obesity can alter the microbial flora of the gut in such a way as to favor carcinogenesis. Weight loss and good physical activity have been related to a reduced incidence of CRC; obese individuals should be screened for CRC and counseled about the importance of weight reduction, diet, and exercise. The best way of screening is using BMI and waist circumference (WC) to calculate the CRC risk in obese people. This study has reviewed the association between obesity and its pathophysiological association with CRC development.
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Value Research of NLR, PLR, and RDW in Prognostic Assessment of Patients with Colorectal Cancer. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:7971415. [PMID: 35469225 PMCID: PMC9034903 DOI: 10.1155/2022/7971415] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 03/10/2022] [Accepted: 03/21/2022] [Indexed: 01/12/2023]
Abstract
Objective This study aimed to investigate the relevance of the study with the neutrophil count and lymphocyte count ratio (NLR), platelet count and lymphocyte count ratio (PLR), and red blood cell distribution width (RDW) in the prognostic evaluation of colorectal cancer patients. Methods 143 patients with colorectal cancer from January 2016 to January 2019 were selected by our hospital, and then, other 143 cases of physical examiners as normal groups were selecting to proceed colonoscopic biopsy to diagnose 106 cases of precancerous diseases related to colorectal cancer. Among them were the inflammatory bowel group (n = 56) and the colorectal polyp group (n = 50). Analysis of the survival impact factors of patients with carcinoma of the rectum, preoperative NLR, ROW, PLR, and prognostic relationship, and comparison of NLR, PLR, and RDW diagnostic rate and expression were performed. Results Tissue type, TNM stage, lymph node metastasis, NLR, RDW, and PLR had a predictive influence on patients with colorectal cancer (P0.05). There was no link between gender, age, aetiology, pathological type, and prognosis in patients with colorectal cancer (P > 0.05). Multiple variables in patients with colorectal cancer are affected by tissue categorization (poor differentiation), TNM stages (III, IV), lymph node metastases, NLR, ROW, and PLR (P0.05). When compared to solo NLR, Row, and PLR diagnostics, the combination diagnosis and malignancy rates were greater, and the differences were statistically significant (P0.05). Diagnostic sensitivity, specificity, and accuracy were greater when compared to single NLR, ROW, and PLR. When compared to the normal control group, NLR, ROW, and PLR have greater levels, and the differences are statistically significant (P0.05). The patient survival declines more slowly as PLR, NLR, and the severity of the condition rises. Conclusion NLR, ROW, and PLR combined diagnosis has high accuracy in colorectal cancer diagnosis, and the prognosis of patients with NLR, ROW, and PLR levels has a tight association; so, clinically, the above signs should be identified, and the optimal treatment time is grasped.
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Darmadi S, Warsinggih, Mappincara, Hendarto J, Labeda I, Lusikooy RE, Sampetoding S, Dani MI, Kusuma MI, Uwuratuw JA, Syarifuddin E, Faruk M. Profile of collagen prolines level of anterior rectus sheath tissue in indirect inguinal hernia: A cross-sectional study. Ann Med Surg (Lond) 2021; 68:102546. [PMID: 34367633 PMCID: PMC8326721 DOI: 10.1016/j.amsu.2021.102546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction A hernia is a protrusion of an organ or tissue through an abnormal anatomical channel or opening. Epidemiological data indicated an increased prevalence of inguinal hernias in patients with connective tissue diseases. The biomechanical strength of connective tissue is highly dependent on the constituent of the matrix, including collagen. Fibroblasts produce and secrete procollagen containing high concentrations of proline and lysine. Collagen integrity plays an essential role in preventing hernia formation in the abdominal wall. To investigate the relationship between collagen proline levels of the anterior rectus sheath tissue in patients with lateral inguinal hernias (indirect inguinal hernia). Methods The study participants consisted of 67 inguinal hernia patients. A sample of anterior rectus tissue was obtained at the time of surgery, then being washed in a PBS buffer (pH 7.4). The measurement of collagen proline levels was subsequently carried out with enzyme linked immunosorbent assay (ELISA). Results All study participants were male with mean age of 44 years, mean body mass index of 22.6 kg/m2 and mean onset of events of 27 months. Study subjects with reducible, irreducible, and incarcerated hernias were 45.7% (44/67 cases), 14.9% (10/67) and 19.4% (13/67), respectively. The mean proline level of the study subjects was 9.20. Correlation tests showed a correlation of proline levels and age (p = 0.001), body mass index (p = 0.006), and the onset of events (p = 0.023). Meanwhile, correlation of proline levels and occupation (p = 0.235) and clinical degree (p = 0.164) were not statistically significant. Conclusion Presence if relationship between proline levels with age, and onset of incidence among indirect inguinal hernia patients. Collagen is the main structural protein in the muscle wall layer. Defects in collagenases will result in abnormal collagen synthesis leading to pathological collagen degradation. Decreases in hydroxyproline and collagen were observed in the fascia and muscle tissue of patients with inguinal hernias. There are a relationship between proline levels with age, and onset of incidence among indirect inguinal hernia.
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Affiliation(s)
- Suluh Darmadi
- Division of Digestive, Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Warsinggih
- Division of Digestive, Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Mappincara
- Division of Digestive, Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Joko Hendarto
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Ibrahim Labeda
- Division of Digestive, Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Ronald Erasio Lusikooy
- Division of Digestive, Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Samuel Sampetoding
- Division of Digestive, Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Muhammad Iwan Dani
- Division of Digestive, Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Muhammad Ihwan Kusuma
- Division of Digestive, Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Julianus Aboyaman Uwuratuw
- Division of Digestive, Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Erwin Syarifuddin
- Division of Digestive, Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Muhammad Faruk
- Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
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