Investigation of homocysteine, D-dimer and platelet count levels as potential predictors of thrombosis risk in COVID-19 patients

Thrombosis plays an important role in induction of Coronavirus disease 19 (COVID-19) complications including heart attack and stroke. Reliable biomarkers are needed to predict thrombosis risk for better management and improve patient outcomes. This study aimed to investigate the relationship between homocysteine, a thrombosis-related biomarker, and other thrombosis-related parameters, such as D-dimer and platelet count with disease outcome in COVID-19 patients. This case-control study including 50 intensive care unit hospitalized patients with Covid-19 with a positive RT-PCR test for SARS-CoV-2 infection and 50 healthy individuals as a control group was conducted. Both groups were matched for age and body mass index (BMI) and had no history of underlying diseases such as cardiovascular, liver, kidney or smoking. Blood samples were collected from both groups to measure serum homocysteine, platelet count and D-dimer levels. Data were analyzed using GraphPad Prism version 8.3 software. The study found no statistically significant difference in homocysteine levels between COVID-19 patients and the control group. However, D-dimer levels were significantly higher in the patient group. Platelet count analysis revealed a significant difference between patients who died and those who were discharged from the hospital (P < 0.05). Despite previous studies suggesting a link between homocysteine and thrombosis, this study found no significant difference in homocysteine levels between COVID-19 patients and the control group. The significantly elevated D-dimer levels in the death group patient suggest that D-dimer and thrombocytopenia may be more reliable predictors of thrombosis and worse outcome in COVID-19 patients without underlying diseases.

Role of cineole in alleviation of acute kidney injury and renal function recovery following gentamicin administration in rats

Objectives

Gentamicin leads to kidney failure by producing free radicals and inflammation in renal tissue. Cineole as a terpenoid has antioxidant properties. Antioxidants can play an effective role in preserving the oxidant-antioxidant balance. Hence, this study investigated the effects of cineole on acute kidney injury (AKI) and renal function recovery following gentamicin administration in rats.

Materials and Methods

36 male Wistar rats were randomly divided into 6 equal groups; healthy control, gentamicin, DMSO carriers, cineole 50, cineole 100, and vitamin E. After 12 days of treatment, the animals were anesthetized with ketamine and xylazine. Serum and kidney samples were taken for biochemical and gene expression experiments.

Results

Cineole 50 and 100 groups increased the levels of serum glutathione (GSH) (<0.05), kidney and serum glutathione peroxidase (GPX) (<0.001), kidney catalase (CAT) (<0.001), serum nitric oxide (NO) (<0.001), and the GPX gene (<0.05) compared with the gentamicin group. These treatment groups had decreased levels of kidney malondialdehyde (MDA) (<0.001), serum creatinine (<0.001), urine protein, and the Interleukin 6 (IL-6) gene (<0.05) compared with the gentamicin group. Cineole 50 increased the serum MDA (<0.001), urea, and CAT gene (>0.05) and decreased the kidney GSH (<0.05) and the tumor necrosis factor-alpha (TNF-α) gene (<0.05). Cineole 100 increased the kidney GSH (<0.05) and decreased the serum MDA (<0.001), urea, CAT gene (>0.05), and TNF-α gene (>0.05) compared with the gentamicin group. Improvement in histological alterations was displayed in cineole groups compared with the gentamicin group.

Conclusion

Cineole can reduce kidney damage caused by nephrotoxicity following gentamicin consumption through its antioxidant and anti-inflammatory properties.

Ameliorative Effects of Gallic Acid on Cisplatin-Induced Nephrotoxicity in Rat Variations of Biochemistry, Histopathology, and Gene Expression

BACKGROUND

Cisplatin is a powerful chemotherapeutic drug mainly used in the treatment of solid tumors. Aggregation of the drug in renal proximal tubule cells causes nephrotoxicity and renal failure. Investigations showed nephrotoxicity as Cisplatin's dose-limiting side effect. One of the Cisplatin toxicity mechanisms is generation of reactive oxygen species, which leads to oxidative stress and renal damage. The purpose of this study was evaluation of the modulating effects of Gallic acid on Cisplatin-induced variations including Caspase-3 and Clusterin expression and histopathological and biochemical parameters in adult male Wistar rats.

METHOD

Rats were kept under standard condition of temperature, light, and humidity. The animals were divided into 4 groups: GpI: control group (received distilled water for 10 days); GpII: Gallic acid (alone) (50 mg/kg bw, once a day for 10 days); GpIII: Cisplatin (alone), single dose (6 mg/kg bw, I.P. on 5th day of study); GpIV: Gallic acid (50 mg/kg bw, once a day for 10 days) and also injected with single dose of Cisplatin (6 mg/kg bw, I.P., on 5th day of study). After 10 days, all rats were anaesthetized and plasma collected to estimate urea, creatinine, and uric acid. The right kidneys were removed for the study of gene expression and biochemical parameters. The left kidneys were used for histopathological studies.

RESULTS

The Cisplatin-induced nephrotoxicity was evident from the elevated levels of creatinine, urea, uric acid, and renal tissue MDA and also decreased levels of SOD, CAT, GPX, and GSH in renal tissue. Administration of Gallic acid significantly modulated nephrotoxicity markers, gene expression variations, and histopathological damage.

CONCLUSION

Outcomes of the present investigation suggest that Gallic acid provides protection against CP-induced nephrotoxicity, but for application in people, further studies are needed.

Thrombosis in COVID-19 infection: Role of platelet activation-mediated immunity

Background

Thrombosis plays an important role in the Coronavrus Disease 2019 (COVID-19) infection-related complications such as acute respiratory distress syndrome and myocardial infarction. Multiple factors such as oxygen demand injuries, endothelial cells injury related to infection, and plaque formation.

Main body

Platelets obtained from the patients may have severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA, showing that the increased activation potential recommends platelet can be hyper-activated in severely ill SARS-CoV-2 cases. Platelets contain multiple receptors that interact with specific ligands. Pathogen’s receptors such as Toll-like receptors (TLRs), NOD-like receptor, C-type lectin receptor family, glycoprotein (GP) such as GPαIIbβ3 and GPIbα which allow pathogens to interact with platelets. Platelet TLRs and NOD2 are involved in platelet activation and thrombosis. Accordingly, TLRs are critical receptors that could recognize various endogenous damage-associated molecular patterns and exogenous pathogen-associated molecular patterns (PAMPs). TLRs are considered as important components in the activation of innate immunity response against pathogenic and non-pathogenic components like damaged tissues. TLRs-1,-2,-4,-6,-7 expression on or within platelets has been reported previously. Various PAMPs were indicated to be capable of binding to platelet-TLRs and inducing both the activation and promotion of downstream proinflammatory signaling cascade.

Conclusion

It is possible that the increased TLRs expression and TLR-mediated platelets activation during COVID-19 may enhance vascular and coronary thrombosis. It may be hypothesized using TLRs antagonist and monoclonal antibody against P-selectin, as the marker of leukocyte recruitment and platelet activation, besides viral therapy provide therapeutic advances in fighting against the thrombosis related complications in COVID-19.

Comparative Study of Children's' Blood Sugar in Fluid Therapy with Dextrose Saline, Ringer and Normal Saline 0.9% Serums and its Relationship with Depth of Anesthesia in Elective Surgery

Background: This study was aimed to determine the children's' blood sugar level in fluid therapy with DSS (dextrose saline serum), RS (ringer serum) and NS 0.9% serums (normal saline 0.9%) and its relationship with the depth of anesthesia in elective surgery. Method: This double-blind experimental study was performed with 90 children referred to the surgical ward, including: group A (receiving DSS), group B (receiving NS 0.9%) and group C (receiving RS) that the blood sugar of each group in 5 steps was measured: half an hour before induction of anesthesia, during induction of anesthesia, half and one hour after induction of anesthesia and after complete awakening in recovery. In addition, the monitoring the vital signs, measuring depth of anesthesia, pulse oximetry and electrocardiogram were performed for all groups. Results: The results showed that the mean blood sugar in the 5 steps measured had a significant difference in three groups under study (P <0.05). The mean blood sugar in the group receiving DSS was significantly higher than the two groups receiving RS and NS 0.9%. Also the mean depth of anesthesia in three groups did not show a significant difference. Conclusion: Finally, according to this study, the use of DSS from the beginning of anesthesia, RS half an hour after the start of anesthesia and NS 0.9% one hour after the start of anesthesia can increase blood sugar in children. Therefore, the use of DSS is not recommended due to the stressful nature of anesthesia and operating room and the possibility of hyperglycemia.

Coagulation abnormalities in SARS-CoV-2 infection: overexpression tissue factor

Among the pathways and mediators that may be dysregulated in COVID-19 infection, there are proinflammatory cytokines, lymphocyte apoptosis, and the coagulation cascade. Venous and arterial thromboembolisms also are frequent in COVID-19 patients with the increased risk of some life-threatening complications such as pulmonary embolism, myocardial infarction, and ischemic stroke. In this regard, overproduction of proinflammatory cytokines such as IL-6, IL-1β, and TNF-α induce cytokine storms, increase the risk of clot formation, platelet activation, and multiorgan failure that may eventually lead to death among these patients. Surface S protein of SARS-CoV-2 binds to its target transmembrane receptor, named as angiotensin converting enzyme 2 (ACE2(, on various cells such as lymphocyte, alveolar cells, monocytes/macrophages, and platelets. Notably, the activation of the coagulation cascade occurs through tissue factor (TF)/FVIIa-initiated hemostasis. Accordingly, TF plays the major role in the activation of coagulation system during viral infection. In viral infections, the related coagulopathy multiple factors such as inflammatory cytokines and viral specific TLRs are involved, which consequently induce TF expression aberrantly. SARS-COV-2 may directly infect monocytes/ macrophages. In addition, TF expression/release from these cells may play a critical role in the development of COVID-19 coagulopathy. In this regard, the use of TF- VIIa complex inhibitor may reduce the cytokine storm and mortality among COVID-19 patients.

A Histopathological Study of Cisplatin-induced Acute Vascular Injuries in Vital Organs and Protective Effect of Achillea millefolium

The aim was to study the protective effect of ethanolic extract of Achillea millefolium on acute vascular injuries induced by cisplatin in liver, heart and renal tissues 24 hour after administration and using histopathological surveys in wistar rats. 24 adult male wistar rats were randomly divided into four groups. Group I (control group) received physiological saline for 10 days. Animals of group II had single dose of injection of CP (cisplatin) (6 mg/kg, IP) on the ninth day. Group III received Achillea millefolium extract (250 mg/kg, gavage) for 10 consecutive days. Group IV had both Achillea millefolium extract (250 mg/kg, gavage) for 10 consecutive days and a single dose of injection of CP (6 mg/kg, IP) on the ninth day. Kidney, liver and heart organs were collected on 10th day from sacrificed rats and subjected to histopathological analysis. Then the possible histopathological vascular effects of cisplatin on liver, heart, kidney tissues and the protective effect of Achillea millefolium extract was analysed. Obtained data showed the vascular injuries in CP group as congestion of cardiac capillaries (p=0.00) and interstitial edema (p=0.03). In the kidney, shrinkage of glomeruli (p=0.04), widening of Bowman's space (p=0.04), dilatation of cortical capillaries (p=0.01) were significantly altered. The findings of liver organ were increased sinusoidal space (p=0.00) and infiltration of neutrophils in portal space (p=0.01). Pretreatment with ethanolic extract of Achillea millefolium could attenuate these vascular injuries. Briefly, 24 hour after single injection of cisplatin the inflammatory process was seen in vital organs and administration of Achillea millefolium could mitigate these side effects.

Multiple Sclerosis and Evaluation of Vitamin D Effect

Multiple sclerosis is an autoimmune disease of the central nervous system with symptoms of neurodegenerative diseases. The symptoms vary depending on damage location. Some of the symptoms include cognitive disorders, anxiety and depression, visual impairment, respiratory, speech and swallowing disorders, muscle spasm and fatigue. Due to the lack of a definitive treatment method, various therapeutic approaches are proposed to control the disease. Drugs are classified into attack control drugs, complication control drugs and disease-modifying drugs. Vitamin D is a hormone-like steroidal compound with immune modulatory and anti-inflammatory properties. Vitamin D deficiency is associated with a variety of inflammatory, neurologic and autoimmune diseases. Many studies on patients as well as experimental autoimmune encephalomyelitis studies have shown that the administration of vitamin D reduces inflammation in inflammatory diseases of the central nervous system. As argued, vitamin D level was significantly lower in MS compared to healthy subjects as controls.  Also, a higher level of vitamin D is reported in relapsing-remitting MS patients compared to patients with progressive MS. It is observed that higher serum levels of vitamin D can reduce the severity of symptoms, progress, and also delays the relapses. Few studies considered vitamin D to be ineffective in stopping or inhibition the disease. Despite the controversies concerning the role of vitamin D in MS progress, there is a lot of interest in further research in this regard with the hope of reaching a common ground. Therefore, frequent reviews of past and recent studies are essential to achieve the same results.

Inhibitory Effect of Hydroalcoholic Extract of Olive Leaf (Olea europaea) on Growth of Candida albicans

Introduction and Aim: Candida albicans is the most common and pathogenic species of Candida genus, known to be the fourth most common cause of blood infections. The present study investigates the inhibitory effect of hydroalcoholic extract of Olive leaf on growth of this yeast in vitro. Materials and Methods: In this experimental study, fresh Olive leaf were collected from its natural habitat in Gotvand city and after washing the leaves were dried in a sterile environment. After verifying the plant species and receiving the herbarium code, the leaf of the plant was completely ground and the 80% hydroalcoholic extract of the plant was prepared by maceration method. Serial dilutions of extract were then prepared in RPMI 1640 medium from 256 to 1 mg/mL. Afterwards, minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC) of this extract for fungus was achieved after 48 hours exposure of the extract to the yeast Suspension using micro broth dilution method and re-culturing on Sabouraud dextrose agar (SDA) medium and colony counting. Results: After counting the yeast colonies grown on Sabouraud dextrose agar and performing one-way ANOVA statistical analysis at the significance level less than 0.05, Although all concentrations of equal to or greater than 4 mg / mL of extract had a significant difference from positive control colonies count, according to the concepts of MIC and MFC, concentrations of 8 and 32 mg / mL were considered as them, respectively. Conclusion: Olive seems to be a proper complementary drug in the treatment of Candida albicans. Needless to say, this requires extensive pharmacological studies and the evaluation of the possible toxicity of the derivatives and compounds of this plant.