Blood C-reactive Protein Levels Research Articles

Management of Recurrent Ventriculoperitoneal Shunt Infections in Adult Patients

Objective: The objective of this study was to evaluate the demographic, clinical, laboratory, and microbiological features of ventriculoperitoneal shunt (VPS) infections through a 13-year retrospective study. VPS bacterial agents and their antibiotic susceptibility were also investigated through the occurrence of single VPS (SVPS) and recurrent VPS (RVPS) infections. Methods: This study included 110 patients with SVPS infections and 55 patients with RVPS infections. Results: In patients who developed multiple infections, Gram-negative organisms were found to be the most predominant (60%, 54/90). The resistance rates were 85.2% for third-generation cephalosporins (3GCs), 83.3% for piperacillin–tazobactam, and 10.4% for carbapenem. Of the patients in the SVPS infection group, 49% were treated with combinations with carbapenem; of the patients in the RVPS infection group, 84.4% were treated in the same way. Central nervous system (CNS) tuberculosis as the etiology of hydrocephalus; short duration of antibiotics used for treatment; high cerebrospinal fluid (CSF) protein and blood C-reactive protein (CRP) levels; and prolonged use of prophylactic antibiotics were found to be related to an increased rate of recurrent infection occurrence. A two-stage shunt change approach decreased the risk of recurrent infections. Conclusions: Based on the findings of our study, it is essential to closely monitor patients with independent risk factors for RVPS infection development, due to the high rates of resistant Gram-negative bacterial growth and the initiation of empirical antimicrobial treatment with glycopeptide plus carbapenem. Certain treatment options, such as 3GCs plus glycopeptide, should be revised based on clinical progress and microbiological culture results.

Modified single-incision MIS-TLIF with expandable tubular assistance for degenerative lumbar spine diseases

ObjectiveEvaluating the clinical value of the modified single-incision posterior median approach with expandable tubular assistance for lumbar interbody fusion in managing degenerative lumbar spine diseases.MethodA retrospective analysis was conducted on 121 patients with single-level degenerative lumbar spine disease treated in our spine surgery department from January 2017 to December 2021. Of these, 72 patients underwent a modified single-incision posterior median approach with expandable tubular assistance lumbar interbody fusion (single-incision MIS-TLIF group), while 49 patients received the classic open posterior median incision P-TLIF (open surgery group). We collected basic demographic data including age, gender, BMI, and surgical level. Surgical-related indicators such as operation time, intraoperative blood loss, postoperative drainage, length of hospital stay, hospital costs, and complication rates were compared between the two groups. Laboratory results [whole blood C-reactive protein (CRP), serum creatine kinase (CK)] and clinical outcomes [VAS scores for low back and leg pain, Oswestry Disability Index (ODI), excellent and good rate according to the modified MacNab criteria, and interbody fusion rate according to the Brantigan criteria] were also evaluated.ResultThere were no significant differences in the basic demographics between the two groups. The operation time, postoperative hospital stay, and hospital costs were also similar between the groups. However, significant differences were observed in intraoperative blood loss, postoperative drainage, and complication rates. On postoperative days 1 and 3, whole blood CRP and CK levels showed marked differences between the groups. At 3, 6, and 12 months postoperatively, the single-incision MIS-TLIF group had lower ODI scores and VAS scores for back pain compared to the open surgery group. The excellent and good rate according to the MacNab criteria was higher in the single-incision MIS-TLIF group. There were no significant differences in leg pain VAS scores and interbody fusion rates at 12 months postoperatively between the groups.ConclusionThe modified single-incision posterior median approach with expandable tubular assistance lumbar interbody fusion is highly effective in treating degenerative lumbar spine diseases. It results in less postoperative pain, faster recovery, and significant improvement in postoperative functional outcomes, making it a valuable treatment option.

Effects of adjuvant hyperbaric oxygen therapy and real-time fluorescent imaging on deep sternal wound infection: a retrospective study.

Deep sternal wound infection (DSWI) is a rare but devastating complication that is estimated to occur in 1-2% of patients after median sternotomy. Current standard of care (SoC) comprises antibiotics, debridement and negative pressure wound therapy (NPWT). Hyperbaric oxygen therapy (HBOT) appears to be an effective adjuvant therapy for osteomyelitis. The aim of this study was to determine the effectiveness of HBOT and real-time fluorescence imaging (RTFI) in a DSWI treatment protocol and their benefits on infection control. A retrospective analysis of DSWI management was performed. Enrolled patients were divided into two groups: HBOT group and RTFI group. Patients in the HBOT group received SoC, HBOT, NPWT and reconstructive flap surgery. Patients in the RTFI group received the same therapeutic plan as well as treatment with a RTFI device (MolecuLight i:X (MolecuLight, Inc., Canada) to achieve high-quality debridement. Infection status and short-term outcomes within three months were measured. Long-term outcomes were analysed at a 12-month follow-up. Of the 55 patients enrolled: 22 in the HBOT group and 33 in the RTFI group. Infection control status, evaluated in terms of white blood cell counts and C-reactive protein levels, antibiotic use duration, antibiotic costs, reinfection rate and osteomyelitis recurrence rate, were statistically significantly improved in the RTFI group (<0.001, <0.001, 0.042, 0.022, 0.049 and 0.022, respectively). Length of total intensive care unit stay and duration of complete healing were statistically significantly decreased in the RTFI group (<0.001 and 0.046, respectively). Patients with DSWI can benefit from HBOT, especially in terms of in-hospital mortality. RTFI can be used to eliminate bacterial burden and achieve high-quality debridement, which considerably improves infection control and clinical outcomes.

Evaluation of the C-reactive protein serum levels in periodontitis patients with or without atherosclerosis – A clinical study

Background: Periodontitis is a bacterial infection that can originate in the gums and progress to damage the bone and other structures supporting the teeth. One indicator of systemic inflammation caused by various triggers such as injuries, infections, and hypoxia is the highly potent C-reactive protein (CRP). Atherosclerosis is a progressive arterial disease that is characterized by the thickening of subintimal layers in muscular and elastic arteries of intermediate-to-large size due to the accumulation of athermanous plaque. Therefore, our objective in this research is to evaluate CRP levels in individuals with periodontitis, with or without atherosclerosis, after diagnosis. It is important to determine if there is a correlation between periodontitis, a common inflammatory condition of the gums, and elevated CRP levels, which could potentially contribute to the development of atherosclerosis. Methodology: The Department of Periodontics and Implantology at Bhabha College of Dental Sciences conducted the study, which involved the random assignment of 60 participants of both sexes, aged between 30 and 60 years, using a cross-sectional design. The participants were selected from the Department of Periodontics and Implantology, and venous blood samples were taken before and after nonsurgical periodontal treatment to evaluate serum CRP and complete blood count levels. Results: Higher blood CRP levels were seen in individuals with chronic periodontitis, regardless of the presence or absence of atherosclerosis. When comparing the groups of people with and without atherosclerosis and chronic periodontitis, the rise in blood CRP levels was almost double in the group with atherosclerosis. To prevent the progression of atherosclerotic lesions, chronic periodontitis must be treated aggressively. Conclusion: Chronic periodontitis, with or without atherosclerosis, leads to high CRP levels in the blood. Those with both conditions have almost twice the CRP levels compared to those without atherosclerosis. Proper treatment is necessary due to chronic periodontitis’ association with atherosclerotic lesions.

Impact of Thrombomodulin Polymorphism -33G>A on Acute Myocardial Infarction Risk and Circulating Inflammatory Markers.

There is increasing evidence that thrombomodulin (THBD) polymorphisms, along with inflammatory markers [i.e., C-reactive protein (CRP), fibrinogen, albumin], may increase the risk of acute myocardial infarction (AMI). The aim of the study was to investigate the role of the THBD -33G>A polymorphism (rs1042579) as a marker of AMI risk and to correlate it with serum levels of inflammatory markers. Case-control study of 277 AMI patients and 329 healthy controls. A binary logistic regression analysis was performed to evaluate the association between the parameters studied and AMI risk. The frequencies of genotypes AA, GA, and GG of the THBD -33G>A polymorphism were 31.4%, 45.5%, and 23.1% in patients and 21.6%, 44.1%, and 34.3% in controls. A significant association was found between the AA genotype of the THBD -33G>A polymorphism (AA: OR = 2.011, 95% CI 1.561-3.074, P < .001) or A allele (A: OR = 1.725, 95% CI 1.493-2.510, P < .001) and AMI risk. A backward stepwise logistic regression method combining AMI status as the dependent variable and conventional risk factors (age, smoking, arterial hypertension (HTA), diabetes, dyslipidemia, CRP, albumin, fibrinogen, serum angiotensin converting enzyme (ACE) activity, serum malondialdehyde, conjugated dienes, glutathione peroxidase, cardiac troponin-I (cTnI) and THBD AA genotype) as independent variables showed that the most predictive risk factors for AMI were smoking, HTA, albumin, fibrinogen, CRP, ACE activity, cTnI, and the THBD AA-genotype with odds ratios of 2.942, 2.203, 2.352, 1.323, 1.652, 1.014, 2.105, and 3.781 respectively. The AA genotype was associated with increased diastolic blood pressure, CRP, ACE activity, and albumin levels. The study shows that the THBD -33G>A polymorphism should be included in the stratification of AMI risk.

Neutrophil lymphocyte coefficient as a tool for assessing the risk of cardiac complications in elderly patients with type 2 diabetes mellitus

An elevated neutrophil-to-lymphocyte ratio (NLR) is an indicator of inflammatory processes and predicts the development of various cardiac diseases and non-cardiac disorders. Objective. To evaluate the relationship between NLR and various indices of glucose control in elderly patients with type 2 diabetes mellitus (DM2). Materials and methods. The observational study was conducted from September 2022 to February 2023. The study included 330 patients with DM2, were randomly assigned to three groups based on disease control: group 1 – glycated hemoglobin (HbA1c) level ≤7% (excellent control); group 2 – HbA1c from 7.0 to 9.0% (poor control); group 3 – HbA1c ≥9% (critical control). Patients' condition was assessed based on complete blood count and C-reactive protein levels. Results. When compared with the excellent control group (group 1), patients with the worst control (group 3) had significantly higher leukocyte (p &lt; 0.001) and neutrophil (p &lt; 0.003) counts, as well as lower lymphocyte (p = 0.44) levels. At the same time, no significant differences were found among patients with poor control (group 2) with patients with excellent disease control (group 1). The NLR parameter increased significantly in the worst control group (group 3) compared with the poor (group 2) and excellent (group 1) diabetes control groups: 4.3±2.8, 2.7±1.0, and 2.0±0.5, respectively (p &lt; 0.001). NLR was found to be an independent predictor of poor diabetes control, along with fasting glucose and C-reactive protein. Conclusions. An increase in NLR is associated with an increase in HbA1c and inadequate glycemic control in patients with DM2. This indicator can serve as a useful tool for health monitoring in the process of monitoring patients with DM.

Modern differential diagnosis of various types of anemia in patients with HIV-associated disease

This article substantiates the development of a diagnostic algorithm to differentiate between anemia of chronic disease (ACD) and iron deficiency anemia (IDA) in patients with HIV-associated disease. A cross-sectional descriptive study included 125 patients with HIV-associated disease, 101 of whom had anemia syndrome and 24 were without it (control group). Patients with anemia were divided into three groups: Group 1 with ACD only, Group 2 with ACD and IDA, and Group 3 with IDA only. Upon admission, all patients underwent assessments for red blood cell count, hemoglobin, IL-6, IL-10, and IL-1β, IFN-γ, TNF-α, ferritin, C-reactive protein, transferrin, hepcidin, and soluble transferrin receptor levels. Discriminant analysis followed by obtaining a canonical linear discriminant function was used to calculate a mathematical model for the differential diagnosis of ACD and IDA. Canonical analysis was also used to obtain centroids for ACD (2.86 arbitrary units) and IDA (2.54 arbitrary units). A patient with a calculated canonical linear discriminant function was to be assigned to the group of ACD or IDA based on the minimal distance to the corresponding centroid. The resulting mathematical model has 88.8% sensitivity and 100% specificity. The use of IL-6 and ferritin concentrations is also proposed as independent laboratory markers for the differential diagnosis of ACD and IDA. The canonical linear discriminant function obtained from the calculations, along with the levels of IL-6 and ferritin in the blood, have high diagnostic value for verifying ACD and IDA in patients with HIV-related disease. Their use enables the determination of the type of anemia during the initial contact between the physician and the patient.

Auricular point sticking therapy as an adjunctive treatment for pediatric bacterial pneumonia: a randomized controlled trial

To observe the clinical efficacy of auricular point sticking therapy combined with antibiotics for pediatric bacterial pneumonia of wind-heat accumulating in lung. Ninety-four children with bacterial pneumonia were divided into an observation group (47 cases, 3 cases dropped out) and a control group (47 cases, with 4 cases terminated). The patients in the control group were treated with intravenous drip of latamoxef sodium injection, twice daily for 7 days. The patients in the observation group were treated with auricular point sticking therapy in addition to the treatment given to the control group. Acupoints selected included Fei (CO14), Qiguan (CO16), Jiaogan (AH6a), Shenshangxian (TG2P), and Shenmen (TF4), with treatment applied once daily, alternating ears, for 7 days. The TCM syndrome scores, Canadian acute respiratory illness and flu scale (CARIFS) scores, and levels of white blood cell count (WBC), C-reactive protein (CRP), and procalcitonin (PCT) were compared before and after treatment between the two groups, along with clinical efficacy. Compared before treatment, both groups showed a reduction in TCM syndrome scores, CARIFS scores, and levels of WBC, CRP, and PCT after treatment (P<0.05). Compared with the control group, the observation group had lower TCM syndrome scores in fever, cough, expectoration, lung auscultation, sneezing, runny nose, sleep, and bowel symptoms, as well as lower CARIFS scores in fever, cough, nasal congestion and runny nose, and irritability (P<0.05). The curative and remarkably effective rate was 70.5% (31/44) in the observation group, which was higher than 44.2% (19/43) in the control group (P<0.05). Auricular point sticking therapy combined with antibiotics is more effective in improving symptoms such as fever, cough, and runny nose in children with bacterial pneumonia of wind-heat accumulating in lung.

Construction of a back propagation neural network model for predicting urosepsis after flexible ureteroscopic lithotripsy based on heparin-binding protein and C-reactive protein levels.

To analyze the association of serum heparin-binding protein (HBP) and C-reactive protein (CRP) levels with urosepsis following flexible ureteroscopic lithotripsy (FURL) and to construct a back propagation neural network prediction model. A total of 428 patients with kidney stones who underwent FURL were enrolled. Patients were divided into sepsis group (n=42) and control group (n=386) according to whether post-operative urosepsis developed. Logistic regression analysis was used to determine the risk factors and interactions of post-FURL urosepsis. A Logistic regression model and a neural network model were developed for predicting post-FURL urosepsis following FURL, and their predictive performance was evaluated using ROC curves. Univariate analysis showed that stone surgery history, gender, urine culture, stone diameter, diabetes, operation time, white blood cell (WBC), platelet, CRP, and HBP levels were significantly associated with post-FURL urosepsis (P<0.05). Multivariate analysis identified positive urine culture, CRP, and HBP levels as independent risk factors for post-FURL urosepsis (P<0.05). Interaction analysis revealed that CRP and HBP showed both additive (RERI=8.453, 95%CI: 2.645-16.282; AP=0.696, 95%CI: 0.131-1.273; S=3.369, 95%CI: 1.176-7.632) and multiplicative (OR=1.754, 95%CI: 1.218-3.650) interactions, while CRP and urine culture demonstrated multiplicative interaction (OR=2.449, 95%CI: 1.525-3.825). The neural network model showed superior predictive performance compared to the Logistic regression model. CRP and HBP levels are independent risk factors for post-FURL urosepsis. The neural network model based on CRP and HBP exhibits higher predictive accuracy than the Logistic regression model, which may provide a reliable risk assessment tool for early discrimination and intervention of post-FURL urosepsis.

Predicting Surgical Site Infections in Spine Surgery: Association of Postoperative Lymphocyte Reduction.

Postoperative lymphopenia is reported as an excellent indicator to predict surgical-site infection (SSI) after spine surgery. However, there is still controversy concerning which serological markers can predict spinal SSI. This study aims to evaluate excellent and early indicators for detecting SSI, focusing on spine instrumented surgery. This study included 268 patients who underwent spinal instrumented surgery from January 2022 to December 2023 (159 female and 109 male, average 62.9 years). The SSI group included 20 patients, and the non-SSI group comprised 248 patients. Surgical time, intraoperative blood loss, and glycemic levels were measured in both groups. The complete blood cell counts, differential counts, albumin, and C-reactive protein (CRP) levels were measured pre-surgery and postoperative on Days 1, 3, and 7. In comparing the groups, the Mann-Whitney U test analysis was used for continuous variables, while the chi-squared test and Fisher's exact test were used for dichotomous variables. The incidence of SSI after spinal instrumentation was 7.46% and was relatively higher in scoliosis surgery. The SSI group had significantly longer surgical times (248 min vs. 180 min, p = 0.0004) and a higher intraoperative blood loss (772 mL vs. 372 mL, p < 0.0001) than the non-SSI group. In the SSI group, the Day 3 (10.5 ± 6.2% vs. 13.8 ± 6.0%, p = 0.012) and Day 7 (14.4 ± 4.8% vs. 18.8 ± 7.1%, p = 0.012) lymphocyte ratios were lower than the non-SSI group. Albumin levels on Day 1 in the SSI group were lower than in the non-SSI group (2.94 ± 0.30 mg/dL vs. 3.09 ± 0.38 mg/dL, p = 0.045). There is no difference in CRP and lymphocyte count between the two groups. SSI patients had lower lymphocyte percentages than non-SSI patients, which was a risk factor for SSI, with constant high inflammation. The Day 3 lymphocyte percentage may predict SSI after spinal instrumented surgery.

Assessing the association between cigarette smoking and blood C-reactive protein levels using restructured cohort data

IntroductionCigarette smoke exposure is known to induce inflammation, leading to elevated levels of inflammatory markers such as white blood cell (WBC) count and C-reactive protein (CRP). Despite extensive research on this relationship, longitudinal studies are limited. We aimed to explore the association between cigarette smoke exposure and WBC count and CRP levels by restructuring community cohort data. MethodsData from a community cohort of the Korean population, followed biennially from 2001 to 2018, were utilized. Smoking status was determined through self-administered questionnaires. WBC and CRP levels were measured in a central laboratory with stringent quality control. Cohort data were restructured into pairs representing before and after measurements. We analyzed smoking effects on WBC and CRP using pairwise before-after tests based on changes in smoking status. Furthermore, parallel group analyses comparing changes in smoking status to no change were conducted. ResultsAnalysis included 4336 pairs for WBC and 3068 pairs for CRP from 10,030 participants. Pairwise analysis showed a significant decrease in WBC transitioning from current smoker to non-smoker and an increase from non-smoker to current smoker. Parallel group analysis demonstrated a significant decrease in WBC transitioning from current smoker to non-smoker compared to remaining current smoker, and an increase from non-smoker to current smoker compared to remaining non-smoker. CRP did not exhibit significant associations in either analysis. ConclusionsIn a community cohort, cigarette smoking was associated with elevated WBC count. However, CRP levels did not consistently reflect inflammation associated with cigarette smoking.

Clinical Insights and Outcomes in Community-Acquired Acute Bacterial Meningitis versus Postoperative Bacterial Meningitis.

To compare the demographics, clinical characteristics, and in-hospital mortality rates between community-acquired bacterial meningitis cases and postoperative bacterial meningitis. Analytical study. Place and Duration of the Study: Department of Infectious Diseases and Clinical Microbiology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkiye, from 2016 to 2022. A total of 153 patients diagnosed with bacterial meningitis were included and categorised into two groups: 95 (62.1%) with community-acquired bacterial meningitis (CABM) and 58 (37.9%) with postoperative bacterial meningitis (POBM). Demographics, clinical features, laboratory, paraclinical findings, treatments, and outcomes of the cases were compared. Data were retrieved using a standard data collection form from the electronic medical records. A substantial portion (58.8%) of all patients had comorbidities. Fever was the common symptom in all groups. Headache, neck stiffness, nausea, and vomiting were more often observed in the CABM group (p <0.001). Upon admission, the CABM exhibited higher levels of white blood cell count, C-reactive protein, and procalcitonin (p = 0.017, p = 0.004, p = 0.007, respectively). Overall 33.1% had positive cerebrospinal fluid cultures. The overall mortality rate was 26.8%. POBM was associated with longer hospital and intensive care unit (ICU) stays (p <0.001). Shorter treatment durations, lower Glasgow coma scale scores (GCS), higher Charlson Comorbidity Index values, and elevated markers of inflammation were related to mortality. This study illuminates the differences in clinical presentations and outcomes between community-acquired and postoperative bacterial meningitis. It also suggests that factors such as lower GCS scores, comorbidities, and elevated inflammation markers at the last follow-up may be associated with unfavourable clinical outcomes in bacterial meningitis. Postoperative meningitis, Central nervous system infection, Cerebrospinal fluid, Antibiotics.

Systemic Immune Inflammation Index, Systemic Inflammation Response Index, Aggregate Index of Systemic Inflammation, and Follistatin-Like Protein-1 Levels in Children Diagnosed with Pneumonia.

Background: This study aims to evaluate systemic immune inflammation index, systemic inflammatory response index (SIRI), aggregate index of systemic inflammation (AISI), and follistatin-like protein-1 (FSTL-1) levels in children with pneumonia and healthy controls. Methods: The study was carried out at the Seydisehir State Hospital between February 1, 2024 and June 1, 2024. The patient group included 44 children diagnosed with pneumonia and the control group included 45 healthy children without any disease. Index values obtained from hemogram data. Enzyme-linked immunosorbent assay was used to measure FSTL-1 levels. Results: A total of 89 participants, 44 in the patient group and 45 in the healthy control group, were included in the study. White blood cells, monocyte, eosinophil, neutrophil, c-reactive protein, SIRI, and AISI levels were significantly higher in the patient group than in the control group. FSTL-1 levels were higher in the patient group, but did not differ statistically significant. The patient and control groups were compared in the receiver operating characteristics analysis, we found the highest area under curve (AUC) in the SIRI (AUC: 0.754) and AISI (AUC: 0.713) parameters. Conclusion: In conclusion, compared to healthy controls, SIRI and AISI levels were significantly higher in the patient group, and the highest AUC values belonged to these indices. Therefore, we believe that SIRI and AISI indices, which are inexpensive and simple tests, are useful for early diagnosis and treatment of pneumonia.

Analyzing prognosis and comparing predictive scoring systems for mortality of COVID-19 patients with liver cirrhosis: a multicenter retrospective study

BackgroundLimited research suggested that liver cirrhosis is an independent risk factor for severe COVID-19, leading to higher hospitalization and mortality rates. This study aimed to identify the prognostic factors and validate scoring systems for predicting mortality in COVID-19 patients with liver cirrhosis.MethodsThis retrospective cohort study extracted electronic health records of patients with COVID-19 who visited the emergency department between April 2021 and September 2022. Adult COVID-19 patients with liver cirrhosis were included, excluding those aged < 18 years and who did not require hospitalization. The primary outcome was in-hospital mortality. The effectiveness of the scoring systems were analyzed for COVID-19 in-house mortality prediction.ResultsA total of 1,368 adult COVID-19 patients with liver cirrhosis were included in this study. Compared with the survival group, the non-survival group had lower vital signs such as systolic blood pressure and blood oxygen saturation, higher levels of white blood cells, creatinine, bilirubin, and C-reactive protein, and longer prothrombin time. Higher rates of intubation, oxygen use, and dexamethasone use were observed in the non-survivor group. The WHO ordinal scale, MELD, and MELD-Na scores showed good predictive ability for in-hospital mortality.ConclusionsThe WHO ordinal scale showed the best performance in predicting mortality in patients with cirrhosis and COVID-19. MELD and MELD-Na scores were also found good performance for mortality prediction. Coagulation function, intubation, and dexamethasone administration were the most significant prognostic factors.

Predictive value of mNUTRIC score for chronic critical illness in patients of sepsis complicated with ARDS

Background To explore the predictive value of the modified NUTrition Risk in the Critically ill (mNUTRIC) for patients with sepsis and acute respiratory distress syndrome (ARDS) developing into chronic critical illness (CCI). Methods A retrospective observational study was conducted on 118 patients admitted to the Intensive Care Unit (ICU) of Yiwu Central Hospital from January 2020 to May 2022. Patients were categorized into two groups: CCI and rapid recovery (RAP), based on the occurrence of CCI. Age, gender, white blood cell count, C-reactive protein, albumin, serum creatinine, sequential organ failure assessment (SOFA), acute physiology and chronic health evaluation II (APACHE II), mNUTRIC score, ICU length of stay, mechanical ventilation duration, and continuous renal replacement therapy (CRRT) were compared between the two groups. The association between mNUTRIC and CCI in patients with sepsis complicated by ARDS was further examined using three models and multivariate logistic regression.The receiver operating characteristic (ROC) curve was utilized to analyze the predictive values of mNUTRIC score, SOFA score, and APACHE II score for predicting the occurrence of CCI in patients with sepsis complicated by ARDS. Results The age, mNUTRIC score, SOFA score, APACHE II score, ICU length of stay, mechanical ventilation duration, and CRRT ratio were significantly higher in the CCI group compared to the RAP group (all P &lt; 0.05). Conversely, there were no statistically significant differences in white blood cell count, C-reactive protein, and albumin levels between the two groups (all P &gt; 0.05). Multivariate logistic regression analysis identified the mNUTRIC score as an independent risk factor for CCI in patients with sepsis complicated by ARDS. The constructed models showed that the mNUTRIC score remained significant, while the SOFA score and APACHE II score did not.The area under the ROC curve analysis demonstrated that the mNUTRIC score had the highest AUC of 0.880, 95% Confidence Interval (CI): 0.808–0.933. The AUC for the SOFA score was 0.864, and for the APACHE II score was 0.825, all of which were statistically significant. Conclusions The mNUTRIC score is valuable in predicting the progression of sepsis combined with ARDS to CCI, and may even be superior to the SOFA score and APACHE II score.

Excess Weight Impairs Oocyte Quality, as Reflected by mtDNA and BMP-15.

This prospective, case-control study evaluated the impact of obesity on oocyte quality based on mtDNA expression in cumulus cells (CC), and on bone morphogenetic protein 15 (BMP-15) and heparan sulfate proteoglycan 2 (HSPG2) in follicular fluid (FF). It included women 18 to <40 years of age, divided according to BMI < 24.9 (Group 1, n = 28) and BMI > 25 (Group 2, n = 22). Demographics, treatment, and pregnancy outcomes were compared. The mtDNA in CC, BMP-15, HSPG2, the lipid profile, the hormonal profile, and C-reactive protein were evaluated in FF and in blood samples. The BMP-15 levels in FF and the mitochondrial DNA in CC were higher in Group 1 (38.8 ± 32.5 vs. 14.3 ± 10.8 ng/mL; p = 0.001 and 1.10 ± 0.3 vs. 0.87 ± 0.18-fold change; p = 0.016, respectively) than in Group 2. High-density lipoprotein levels in blood and FF were higher in Group 1 (62 ± 18 vs. 50 ± 12 mg/dL; p = 0.015 and 34 ± 26 vs. 20.9 ± 7.2 mg/dL; p = 0.05, respectively). Group 2 had higher blood C-reactive protein (7.1 ± 5.4 vs. 3.4 ± 4.3 mg/L; p = 0.015), FF (5.2 ± 3.8 vs. 1.5 ± 1.6 mg/L; p = 0.002) and low-density lipoprotein levels (91 ± 27 vs. 71 ± 22 mg/dL; p = 0.008) vs. Group 1. Group 1 demonstrated a trend toward a better clinical pregnancy rate (47.8% vs. 28.6%: p = 0.31) and frozen embryo transfer rate (69.2% vs. 53.8; p = 0.69). Higher BMI resulted in lower BMP-15 levels and reduced mtDNA expression, which reflect decreased oocyte quality in overweight women.

Distinguishing Gram-positive and Gram-negative bloodstream infections through leukocytes, C-reactive protein, procalcitonin, and D-Dimer: an empirical antibiotic guidance.

This retrospective study aimed to compare the difference of the levels of white blood cells (WBC), C-reactive protein (CRP), procalcitonin, and D-Dimer in the bloodstream infection (BSI) patients, and their values in distinguishing bacterial categories. A total of 847 BSI patients were analysed and divided into Gram-positive BSI (GP-BSI) and Gram-negative BSI (GN-BSI) groups. Most frequently isolated pathogens in GP-BSI were Staphylococcus epidermidis (35.75%), followed by Staphylococcus hominis (18.33%), and Streptococcus haemolyticus (10.16%), while in GN-BSI, Escherichia coli (30.07%), Klebsiella pneumoniae (23.98%), and Acinetobacter baumannii (13.18%) were the most common. The predictive value was evaluated based on 3 years of patient data, which showed an area under the curve (AUC) of 0.828. It was further validated using 2 years of data, which yielded an AUC of 0.925. Significant differences existed in the procalcitonin, D-Dimer, and CRP levels between GN-BSI and GP-BSI. The current results provide a more effective strategy for early differential diagnosis in bacterial categorization of BSI when combining WBC, CRP, procalcitonin, and D-Dimer measurements.

Relationship of inflammatory factors with migraine in patients with patent foramen ovale undergoing percutaneous closure

Abstract Background Observational studies have reported the incidental reduction of the frequency and severity of migraine attacks following transcatheter patent foramn ovale (PFO) for established indications. Possible physiologic mechanisms for a relationship between PFO and migraine, if such a link does exist, have been the subject of much speculation, with some researchers suggesting the possible role of PFO as a conduit for the passage of various migraine-inducing inflammatory, vasoactive triggers in cerebral circulation. Purpose The aim of this study was to compare the levels of inflammatory mediators between migraineurs and non –migraineurs and to investigate the impact of PFO closure on the inflammatory state of individuals with migraine and alleviation of migraine symptoms. Methods Forty-five patients (mean age 48.2 ± 10.8 years, 48% male) undergoing percutaneous PFO closure were enrolled in the study. Among them, 15 patients reported recurrent migraine episodes (mean age 46.4 ± 8.90 years, 86% female) while 30 individuals (mean age 49 ± 12.32 years, 70% male) were non-migraineurs. White blood cell count, C-reactive protein (CRP), ferritin and d-dimers levels, as well as the erythrocyte sedimentation rate (ESR) were compared between migraineurs and non-migraineurs. We additionally analyzed the inflammatory levels before and after the percutaneous PFO closure in migraineurs, correlating these changes with migraine relief assessed using the Migraine Disability Assessment Questionnaire (MIDAS) over a 6-month follow-up period. Results White blood cell count, d-dimers levels and ESR were similar in migraineurs and non-migraineurs (6,583 ± 2,251 Χ1 0.e3/uL vs 6,115 ± 1,958 Χ10.e3/uL; p-value = 0.48; 0.54 ± 0.49 μg/L vs 0.45 ± 0.29 μg/L; p- value= 0.49; 23.08 ± 16.68 mm vs 18.51 ± 14.98 mm; p- value 0.402; respectively). However, CRP and ferritin levels were significantly greater in patients with migraine compared to non- migraineurs (3.82 ± 1.87 mg/L vs 1.34 ± 1.52 mg/L; p- value =0.037 and 111.21 ± 82.70 ng/ml vs 50.12 ± 47.9 ng/ml; p- value = 0.023, respectively). Moreover, there was no significant difference between pre- and post-procedural inflammatory levels in migraineurs undergoing percutaneous PFO closure. Of note, following the procedure a reduction in CRP levels was observed without, however, reaching statistical significance. Finally, all patients observed a cessation in the occurrence of migraine attacks after closure. Conclusions Our study revealed significantly higher baseline levels of CRP and ferritin in migraineurs compared to non-migrainers with PFO. Although no alteration in inflammatory factors was observed following the procedure in migraineurs with PFO, all individuals experienced relief from migraine symptoms. Given the limitation of our study due to the small sample size, future studies may provide more insights into the potential benefits of PFO closure in specific migraine patient phenotypes.

Assessment of Inflammatory Markers (CBC and CRP) and their Impact on Severity and Recurrence of Pneumonia in Under-Five Children

Background: Pneumonia remains a leading cause of morbidity and mortality in children under five. This study evaluates the association between inflammatory markers complete blood count (CBC) parameters and C-reactive protein (CRP) levels and pneumonia severity and recurrence. Methods: A prospective study was conducted with 110 children diagnosed with pneumonia at Dr. Sirajul Islam Medical College &amp; Hospital and Islami Bank Hospital, Motijheel, Dhaka, from January to December 2023. Clinical assessments included demographic data, pneumonia severity classification, and inflammatory marker measurements. Results: The study population comprised 62 males (56.4%) and 48 females (43.6%), with a mean age of 24.6 months. Inflammatory marker analysis revealed significant differences in WBC count, neutrophil percentage, lymphocyte percentage, and CRP levels across mild, moderate, and severe pneumonia groups (p &lt; 0.001). Higher levels of WBC count (14,500 ± 3,500), neutrophils (72.2 ± 8.6%), and CRP (38.5 ± 11.2) were observed in patients with pneumonia recurrence compared to those without recurrence. Multivariate regression analysis identified WBC count, neutrophil count, and CRP levels as significant predictors of pneumonia recurrence. Conclusion: Elevated inflammatory markers, particularly CBC parameters and CRP levels, correlate with increased severity and recurrence of pneumonia in young children. Monitoring these markers can aid in early identification and management of at-risk pediatric patients, potentially improving clinical outcomes. Further research is needed to explore additional biomarkers and their implications in pediatric pneumonia management.

Non-Surgical Management of Methicillin-Sensitive Staphylococcus Aureus Bacteremia-Related Mediastinitis.

Acute mediastinitis is rarely caused by haematogenous spread of a remote infection. In this respect, since the only medical therapy is usually unsuccessful, treating acute mediastinitis with no source of infection detected is very challenging and management not standardized. In this case report, we describe non-surgical management experience of acute mediastinitis caused by methicillin-sensitive Staphylococcus aureus. In a 79-year-old man judged not eligible for cardiac surgery, we attempted the infection source control through vacuum-assisted closure therapy, together with antimicrobial therapy. We observed gradual clinical, laboratory and radiologic improvements: reduced swelling and normalization of the white blood cell count and C-reactive protein level were associated with reduction in size of a periaortic abscess. We managed a clinical condition with high mortality risk with chronic antimicrobial therapy alone, a strategy that is rarely considered. With this medical strategy we achieved an optimal response to a clinical picture that does not allow any other approach. Mediastinitis is a rare but severe infection with a high mortality rate.Chronic antimicrobial therapy can be an effective strategy in high surgical risk patients.The present case demonstrates good tolerability of lifelong antibiotic therapy.