INVESTIGATION OF INFLAMMATORY MARKERS IN INDIVIDUALS INFECTED WITH THE SARS-COV-2 VIRUS AND THEIR EFFECT ON COURSE Текст научной статьи по специальности «Клиническая медицина»

MEDICAL SCIENCES

INVESTIGATION OF INFLAMMATORY MARKERS IN INDIVIDUALS INFECTED WITH THE SARS-COV-2 VIRUS AND THEIR EFFECT ON COURSE

Abasova D.,

Head of Immunodiagnostic Department Cabrayilova E., Senior Laboratory Assistant Rzayeva N., Researcher Qadimli M., Senior Laboratory Assistant Qurbanova G. Senior Laboratory Assistant DOI: 10.5281/zenodo.7467549

Abstract

The coronavirus disease (SARS-CoV-2), also known as the COVID-19 pandemic, has caused acute respiratory syndrome. One of the questions that interested researchers was whether it was possible to protect against this virus with a strong immune system. In accordance with the standard protocol, clinical, etiological and laboratory data of 600 patients who underwent diagnostic tests on different dates in 2021 in Baku were collected. Symptoms of the disease were detected at the time of admission, and it was found that the most common symptoms were fatigue (81%), cough (63%), fever (57%), chest tightness or shortness of breath (32.7%). 35.7% of patients complained of gastrointestinal tract symptoms, additional nausea, diarrhea, loss of appetite, abdominal pain and vomiting.As a result of Real Time PCR analysis performed between 236 women (mean age 52.3) and 364 men (mean age 52.8), significant differences were observed in neutrophil, lymphocyte and monocyte counts.

Keywords: COVID-19, interleukin-6, CRP, Cytokine, ferritin.

Introduction

SARS-CoV-2 infection causes fever, fatigue, dry cough and, in severe cases, pneumonia, acute respiratory syndrome and kidney failure. In some cases, SARS-CoV-2 infection can be fatal, with approximately 80% of patients having a mild and asymptomatic infection [12]. A significant part of the deaths caused by this disease occurred in the elderly and those suffering from co-morbidities [9]. One of the questions that interested the researchers was to determine whether it is possible to protect against this virus with a strong immune system. Because immunity is a defense mechanism that protects the stability of the internal environment of a person [6]. C-reactive protein (CRP) is a non-specific acute phase reagent during infections or inflammation. A higher level indicates a more severe infection and is considered an indicator of the severity of the disease. However, evidence that CRP is a prognostic indicator remains to be established [2]. A CRP threshold of 40 mg/L is suitable for predicting death [8]. Serum immunological biomarkers such as IL-6 and ferritin have been reported to be significantly increased in non-survivors and critically ill patients compared to survivors [5]. During acute lung injury and CRDS, a significant increase in inflammatory cytokines such as IL-6 is associated with a "cytokine storm" and causes further tissue damage [7]. Ferritin and CRP are used as initial markers in the detection of inflammatory reactions. The increase of these substances in inflammatory reactions leads to an increase in the number of cytokines. These are the main biomarkers used in clinical and laboratory settings to predict mortality and severity of COVID-19 infection. Neutrophils, lympho-penia (decreased levels of lymphocytes in white blood

cells), and dramatic changes in the neutrophil-to-lym-phocyte ratio (NLR) can be used to predict the severity of a COVID-19 infection. This study aims to evaluate the relationship of leukocytes, CRP, and ferritin with the severity of COVID-19 in patients with a positive PCR test for COVID-19.

Material and methods

Investigations In 2021-2022, investigations were conducted at the New Clinic specializing in Covid-19 patients. Also, the electronic medical data of the Central Neftchilar Hospital and Reference Clinic were used.

The polymerase chain reaction (PCR) analysis was taken from suspected patients referred to the laboratory. Necessary information, such as drug use and underlying diseases, was also recorded. A nasopharyngeal sample was collected for PCR. A blood sample was also taken from the cubital vein. Anti-preservative tubes were used for testing in all tests. After the formation of a clot, the samples were centrifuged at 2500 rpm for 15 minutes; the serum samples were separated and sent to the biochemistry department. Blood for CBC testing was collected in EDTA K2 anticoagulant tubes. After daily testing, patients' sera are stored at -20 C for one week. Cobas 6000 device, Sysmex XN 1000 Hematology inurement, and real-time PCR Roche was used for testing. The Medical Laboratory Group analyzed nasopharyngeal swabs and venous blood samples.

The authors collected data from the medical laboratory backup system and patient questionnaires according to a standard protocol. The diagnosis was made by real-time RT-PCR testing of nasal and pharyngeal swab samples according to the guidelines of the World

Health Organization [5]. At this stage, 236 women and 364 men entered the test. We considered patient demographic characteristics, including age, gender, co-morbidities (hypertension, diabetes, cardiovascular), respiratory disease, blood group, clinical symptoms, including fever, and respiratory and digestive symptoms. Data were analyzed regarding various variables such as age, leukocyte parameters, neutrophil-to-lymphocyte ratio (NLR), CRP and ferritin tests.

Determination of sample size for research activities provided by Cochrane (d=0.05). Statistical Package for the Social Sciences (SPSS), version 25 (SPSS Inc.,

Patient symptoms, biochemical serum tests, and

Chicago, IL, USA) was used for data analysis. An independent t-test was performed for inferential statistical methods. The level of significance was considered as P-value<0.05 in all analyses.

Results

The average age in women was 52.3 and in men 52.8. Patient's symptoms were determined at the time of admission, and it was found that the most common symptoms were fatigue (81%), cough (63%), fever (57%), chest tightness, or shortness of breath (32.7%). 35.7% of patients complained of gastrointestinal symptoms, including nausea, diarrhea, loss of appetite, abdominal pain, and vomiting.

Table 1

leukocyte parameters in patients with COVID-19

Parameters Female (n=236) Median (SD) COVID19 (+) P-va-lue Male (n=364) Median (SD) COVID19(+) P- value

Analysis of leukocytes

WBC (1000/pL) 5.65(3.73) 1 4.94(3.42) 0.51

RBC 4.73(0.53) 0.63 4.94(0.88) 0.00

Lymphocyte (109 / L) 1.42(0.82) 1 1.39(1.56) 0.81

Neutrophil (109 / L) 3.56(3.84) 1 3.61(2.83) 1.00

PLT 237(105.34) 0.99 216(90.49) 0.77

Acute protein phase

PCT 0.20(0.10) 0.00 0.23(0.10) 0.00

CRP (mg/L) 6.50(9.24) 0.64 15.56(32.45) 0.46

Ferritin (ng/mL) 230.9(154.75) 0.98 227.95(175.14) 0.94

IL-6 8.20(14.37) 0.29 8.50(13.63) 0.51

ESR 20(22) 0.00 24(20.61) 0.00

Mann-Whitney U test analysis of inflammatory markers by gender and age

AGE GENDER

Mann-Whitney U P-value Mann-Whitney U P-value

WBC (1000/^L) 2885.5 0.136 39678.5 0.114

RBC 2181 0.001 33234.5 0.000

Lymphocyte (109 / L) 2288 0.002 41046 0.358

Neutrophil (109 / L) 2387 0.005 40862 0.314

PLT 2981.5 0.215 37279 0.006

CRP (mg/L) 3199.5 0.502 39135.5 0.066

Ferritin (ng/mL) 3007 0.241 41526 0.492

IL-6 2541 0.017 41874 0.603

ESR 3375 0.831 42226 0.726

Regarding the laboratory results, 189 patients (31.90%) had CRP values greater than five mg/l. These 189 people had signs of pulmonary involvement and respiratory distress. Analysis of patients' serum ferritin showed that 312 patients (52.10%) had higher than normal ferritin. This study shows abnormality of IL-6, Neutrophil, Lymphocyte, ferritin, CRP, and RBC parameters in COVID-19 patients (Table 1).

Table 2

According to the Mann-Whitney U test, PCT, sedimentation rate, and Interleukin-6 variables were PLT, and RBC variables were significantly different at significantly different at 99% P-value when compared 99% P-value, and PCT, Lymphocyte, Erythrocyte by age. (Table 2).

Figure 1. Abnormality percentage of RBC, Neutrophil, Lymphocyte, ferritin, and CRP parameters in patients

with COVID-19 in this study.

100% 60,00% 50,00% 40,00% ¡j 30,00% - 20,00% CE 10,00% £ 0,00%

Pflfl!

Lymphocyte 30,25%

Ferritin 52,10%

IL-6 25,50%

Lymphocyte «Neutrophil ■ CRP «Ferritin ■ IL-6

It was found that the number of Ferritin, lymphocytes, and IL-6 in patients changed more than other parameters. Also, according to the diagram, ferrite has the least change (figure 1).

Discussion

In our study, only 52.10% of patients had ferritin levels higher than the normal reference range. In studies of ferritin levels in COVID-19 patients, only patients with an acute condition had very high ferritin levels. In a study of twenty COVID-19 patients, individuals with severe and very severe COVID-19 infections were found to have elevated serum ferritin levels [3]. Chen et al. analyzed the clinical characteristics of 99 patients and reported that serum ferritin levels were above the normal range in 63 [10]. CRP levels can be used to diagnose pneumonia initially. Elevated CRP levels have been observed in patients with severe pneumonia [4]. Our study results are consistent with recent publications showing that CRP level in patients is a sensitive and early indicator of the severity of COVID-19. As a result of the study, 31.9% of the patients had CRP levels above five mg/L, and respiratory disorders were observed in them. A positive correlation between CRP levels, lung lesions, and disease severity has been established [1, 4, and 11].

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TREATMENT OF PERIODONTITIS BY SPLINTING AND SELECTIVE GRINDING

Aliyev M.,

Doctor of Philosophy in Medicine Department of Therapeutic Dentistry Assistant Azerbaijan Medical University Baku, Azerbaijan Yagubova F.,

Department of Pediatric Dentistry Assistant Azerbaijan Medical University Baku, Azerbaijan Kalbiyeva N.

Department of Pediatric Dentistry Assistant Azerbaijan Medical University Baku, Azerbaijan DOI: 10.5281/zenodo.7467564

Abstract

An important link in the complex treatment of periodontal diseases is the selective grinding of teeth, aimed at eliminating increased occlusal loads and creating a stimulating, functional tension in the supporting tissues of the teeth in order to rehabilitate and prevent traumatic occlusion. Traumatic occlusion develops against the background of an intact periodontium as a result of the action of an occlusal load that is excessive in magnitude or unusual in direction. The load begins to exceed the tolerance of the tissues surrounding the tooth and turns into a traumatic factor. Combined traumatic occlusion occurs when an increased load is combined with periodontal disease.

Keywords: periodontitis, selective grinding, splinting of teeth.

Compared with gingivitis, chronic generalized periodontitis at the organ level is characterized by the presence of persistent progressive morphological and functional changes, and at the level of the organism as a whole - by the formation of a locally chronic odonto-genic focus [1]. Accordingly, the dentist faces qualitatively different tasks in the treatment of this disease: the need to eliminate the chronic odontogenic focus of infection and reconstruct the affected periodontium. It is possible to achieve positive results only with the use of complex treatment of the disease [2]. Given the nature of inflammatory and destructive changes in the perio-dontium, the general treatment, planned depending on the degree of organ damage, is aimed at:

• treatment and stabilization of the affected organ or system;

• normalization of the organism's reactivity;

• restorative treatment;

• Correction of inflammatory, metabolic, micro-circulatory disorders in periodontal tissues and increase of local resistance of these tissues.

A necessary link in solving this problem during local treatment is the selective grinding of optimal chewing surfaces by eliminating premature tooth contacts and ensuring unhindered movements of the lower jaw. Supracontacts are determined using carbon paper or clasp wax plates in the position of central, anterior and lateral occlusion, as well as during movement of the lower jaw. Preliminary grinding of teeth can be carried out during the period of exacerbation of periodontitis. It consists in shortening the teeth that have protruded

from the hole and eliminating significant irregularities of the teeth [3.4]. The final grinding of the teeth is carried out in several visits only after conservative treatment of periodontal diseases and before the surgical stage. The intervals between visits should be at least 1014 days. If it is necessary to increase the interalveolar height or make a fixed splint, the final grinding of the teeth is carried out after these measures. We started grinding teeth by eliminating premature contacts in the position of central occlusion.

In the anterior section, the cutting edges of the lower incisors are often ground, in some cases both antagonists. Supracontacts on the lateral teeth are eliminated by grinding off the bumps or depressions (fissures) after analyzing the lateral movements of the lower jaw [5]. When studying anterior occlusion, su-pracontacts are eliminated depending on the nature of the closing of the incisors in the position of central occlusion. With point or linear contact, the cutting edges of the upper teeth are ground, with planar contact, both antagonists. With orthognathic bite, premature contacts in the position of lateral occlusion are eliminated by grinding the upper buccal and lower lingual tubercles [6]. The buccal slopes of the palatine tubercles of the upper teeth and the lingual slopes of the buccal tubercles of the lower teeth fix the interalveolar height. Therefore, during transversal movements, the jaws should not grind. Grinding the surface of the teeth during anterior and lateral movements of the jaw should ensure uniform contact of multiple interdental contacts