The Inflammation Syndrome: The Complete Nutritional Program to Prevent and Reverse Heart Disease, Arthritis, Diabetes, Allergies, and Asthma

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The Inflammation Syndrome: The Complete Nutritional Program to Prevent and Reverse Heart Disease, Arthritis, Diabetes, Allergies, and Asthma

The Inflammation Syndrome: The Complete Nutritional Program to Prevent and Reverse Heart Disease, Arthritis, Diabetes, Allergies, and Asthma

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As demonstrated above, the progressive nature of COVID-19 is characterized by its hyperinflammatory effect. The pediatric population has mostly been left unscathed with only mild to moderate disease trajectory ( 115). Recently, however, a rare but critical complication of COVID-19 known as the multisystem inflammatory disease in children (MIS-C) has been reported in a small subset of children about 2-6 weeks post-SARS-CoV-2 infection ( 115). Presentations include persistent fever for at least 24 hours and multi-organ impairment involving gastrointestinal, dermatological, neurological, renal, respiratory, cardiac and/or hematological systems ( 115). In comparison to non-MIS COVID-19 patients, MIS-C displayed more pronounced T cell activation and proliferation, particularly the CD8+ T cells, as well as prolonged and altered plasmablast responses ( 116). MIS-C also had marked T cell lymphopenia compared to its other COVID-19 pediatric counterpart ( 116).

In the longest follow-up study to date (up to 9 months), persistent symptoms including fatigue (13.6%), anosmia or ageusia (13.6%), and brain fog (2.3%) were reported ( 62). About a third of patients also reported a decline in health-related quality of life due to COVID-19 compared to the baseline level ( 62). A 6-months study on 1733 COVID-19 patients yields similar results, with 76% of the patients had at least one symptom, with the commonest being fatigue, muscle weakness or sleep disturbances ( 63). The severity of disease and female gender were identified as risk factors for post-COVID-19 consequences ( 63). Another 3-months study on COVID-19 patients revealed that females were more susceptible to fatigue, post-activity polypnea and hair loss compared to males ( 64). and Immunity Research Strength, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia Conceptualization by LT and VR. Methodology by LT. Writing—original draft preparation by LT. Writing, review and editing by LT, TK, and VR. Supervision by VR. All authors contributed to the article and approved the submitted version. Conflict of Interest Anakinra was used either as a primary or additional therapy during hospitalization. Initial therapy was defined as administration of IVIG or first dose of steroids. Additional therapy was defined as administration of an immunomodulatory agent more than 24 h after treatment initiation of either IVIG and/or steroids (first dose). Additional therapies were prescribed for any of the following indications: fever (38.0 °C or greater) occurring more than 24 h after finishing initial therapy, a new onset fever after 24 h period of initial improvement following the administration of intravenous immunoglobulin (IVIG) or steroids, continued need for vasoactive medications, worsening echocardiogram findings, and/or laboratory evidence of persistently high or worsening markers of inflammation including CRP, D-dimer, and ferritin levels.

Polymyalgia rheumatica

Harthan AA, Nadiger M, McGarvey JS, et al. Early combination therapy with immunoglobulin and steroids is associated with shorter ICU length of stay in Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19: a retrospective cohort analysis from 28 U.S. hospitals. Pharmacotherapy Jul. 2022;42(7):529–39. We included children admitted from May 2020 to May 2021 diagnosed with MIS-C based on CDC criteria. The exposure of interest was anakinra use at any point during admission. The anakinra exposed group and the anakinra unexposed group were propensity score matched based on demographic and clinical severity indicators at initial presentation. Our primary outcome was length of hospital stay. Secondary outcomes were duration of vasoactive support, vasoactive inotropic score (VIS), level of respiratory support, time to fever resolution, reduction of CRP levels, and length of ICU stay. We used Wilcoxon rank sum, t-test, Chi square and Fisher’s exact tests. Results

The OS is an imbalance between the production of RS and the endogenous antioxidant defense, indicating an imbalance of the pro-oxidant-antioxidant balance in favor of pro-oxidants ( 24). Two types of reactive species are distinguished: reactive oxygen species (ROS) and reactive nitrogen species (RNS) ( 25) both types of RS are highly reactive, and their interaction with macromolecules can lead to permanent modifications and altered cell signaling events ( 26). In severe cases of COVID-19, there is a significant decrease in oxygen saturation (less than 90%), which produces significant hypoxic changes ( 46, 47). This events also lead to the development of OS just as the reduction in oxygen saturation enhances the formation of ROS such as superoxide Inflammation is your immune system's natural response to injury or infection. It causes swelling and can help the body deal with invading germs.Respiratory support was applied to 18 patients (58%) in the anakinra group and 24 patients (77%) in the no anakinra group. The median duration of respiratory support was 5 vs. 2 days in anakinra vs. no anakinra group with no difference. Similar to SIRS, there is evidence of OS involvement in KD, Some OS biomarkers, such as reactive oxygen metabolites (ROM), were increased in patients with KD naïve to treatment and favorably decreased in cases responding to treatment, in contrast to non-responding patients ( 80). It has also been described that there is a late increase in plasma levels of malondialdehyde and hydroperoxide after acute disease in patients with KD ( 81). Bhat CS, Shetty R, Ramesh D, Banu A, Ramanan AV. Anakinra in Refractory Multisystem Inflammatory Syndrome in Children (MIS-C). Indian Pediatr Oct. 2021;15(10):994–6. Besides that, the high mutative potential of SARS-CoV-2 arouses a cause of concern. Many virus variants, Alpha and Eta from the United Kingdom, Beta from South Africa and Gamma from Brazil have been identified and conferring higher risk than its predecessor, with increased transmissibility and severity ( 117, 118). Although there may be cross-reactivity between variants, vaccination responses can prove challenging since vaccines are pivotally derived based on the viral spike protein ( 118). Many, if not all of the SARS-CoV-2 variants contain some form of mutation on its spike protein. For instance, spike protein deletion is seen in the Alpha variant, while the Beta and Gamma present E484K mutation in their spike protein ( 118). Valverde I, Singh Y, Sanchez-de-Toledo J, et al. Acute Cardiovascular manifestations in 286 children with Multisystem Inflammatory Syndrome Associated with COVID-19 Infection in Europe. Circulation Jan. 2021;5(1):21–32.

Strand V, et al. (2017). Immunogenicity of biologics in chronic inflammatory diseases: A systematic review. Cytokine release syndrome, also known as cytokine storm, correlates with COVID-19 severity and has been recognised as a major cause of mortality among COVID-19 patients ( 43). It is defined as a life-threatening condition involving the excessive cytokine and chemokines produced by the dysregulation of the immune response ( 43). Considering that these inflammatory mediators are interdependent and can be both protective and pathologic, distinguishing them can be challenging. In the serum of COVID-19 patients with cytokine storm, various raised cytokine levels are reported. This includes IL-1β, interleukin-6 (IL-6), tumor necrosis factor (TNF), macrophage inflammatory protein (MIP) 1α and 1β, interferon-γ, inducible protein 10 (IP-10), and VEGF ( 19, 44).

Lee PY, Day-Lewis M, Henderson LA, et al. Distinct clinical and immunological features of SARS-CoV-2-induced multisystem inflammatory syndrome in children. J Clin Invest Nov. 2020;2(11):5942–50.

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