C-reactive Protein Positivity Research Articles

Study of Cervical Mucus Cytology and Serum Inflammatory Biomarkers in Preterm Labour Compared to Term Pregnancy Cases in a Tertiary Care Center of Western Uttar Pradesh (UP), India.

The onset of labor prior to 37 weeks of gestation is preterm labor. Incidence ranges from 5% to 7% of live births in developed countries, but higher in developing countries (10-13%). Preterm birth is a major threat in perinatal health care, as well as a risk factor for neurological impairment and disability. Considering that infection is the major risk factor for preterm labor in rural areas, this study was performed to assess the cytological changes in the cervical mucus of normal-term and preterm labor cases. A hospital-based cross-sectional observational study was conducted in the Department of Obstetrics and Gynecology at a tertiary care center in western Uttar Pradesh (UP), India. The sample size calculated was 90. The neutrophil-to-lymphocyte ratio (NLR) in cervical mucus, along with serum inflammatory biomarkers such as CRP and serum alkaline phosphatase, were compared in both groups. The incidence of preterm labor increased with an increase in parity, and progression to preterm delivery is faster in the higher parity group. C-reactive protein (CRP) (pvalue= < 0.001) and serum alkaline phosphatases (taking 220IU/L as the cutoff value), as well as the NLR (pvalue < 0.001) in cervical mucus in preterm labor, are significantly higher than those in term labor cases, which can be used to predict preterm labor. Higher levels of serum alkaline phosphatase (> 220 IU/L) and CRP positivity can be used as prognostic markers. Using a cutoff value of 5 for the NLR in the cervical mucusof preterm labor patients proved to be a highly accurate predictor (82.2%) for preterm labor diagnosis.

CORRELATION OF C-REACTIVE PROTEIN AND BLOOD CULTURE IN NEONATAL SEPSIS AT INTEGRAL INSTITUTE OF MEDICAL SCIENCES AND RESEARCH, HOSPITAL LUCKNOW (UTTAR PRADESH)

Objective: Neonatal sepsis is a clinical condition of bacteremia characterized by systemic signs and symptoms of infection in children under 4 weeks of age. It involves systemic infections in newborns, including septicemia, meningitis, pneumonia, arthritis, osteomyelitis, and urinary tract infections. C-reactive protein (CRP) is an abnormal β-globulin produced by the liver during any inflammatory process. The gold standard method to diagnose neonatal sepsis is blood culture; however, it is time-consuming and requires a well-equipped laboratory and trained personnel. To study the correlation between CRP and blood culture in neonatal sepsis. Methods: The present study was a retrospective study conducted at the Integral Institute of Medical Sciences and Research, Hospital Lucknow. (UP) All the indoor neonates attending at the Integral Institute of Medical Science and Research Hospital who’s both parameters, CRP as well as blood culture were noted in the microbiology department register during my study period. In the blood culture, samples were collected aseptically and processed by either conventional or automated blood culture methods. CRP estimation was done by a latex agglutination card test. CRP was reported as positive if agglutination particles were seen. Results: CRP positivity rate: out of 235 samples, 72 (30.64%) were positive and 163 (69.36%) were negative. Blood culture positivity rate: out of 118 samples, 71 (60.17%) cases were culture positive and 47 (39.83%) were negative. After comparison of CRP samples with blood culture samples, 90 samples were tested for both blood culture and CRP, and the babies ages were under 4 weeks. Conclusion: So from our study, we are concluding that blood culture is the gold standard method for the diagnosis of neonatal sepsis, and although we can use CRP as the screening method, this test is not specific enough to be relied upon as the only indicator.

Effects of long term antiseizure medications on atherosclerosis

Long-term therapy with antiseizure medications (ASMs) has been associated with metabolic consequences that lead to an increase in the risk of atherosclerosis in patients with epilepsy. This study was conducted to assess the effects of ASMs on vascular risk factors namely, serum Lipid profile and C-reactive protein (CRP) in epileptic patients and to assess the correlation between the duration of the ASMs, and carotid intima media thickness (IMT). Forty three adult patient participants who were receiving ASM monotherapy for more than 2 years and 43 control patients were enrolled in this study. All participants received measurement of common carotid artery (CCA) and IMT by B-mode ultrasonography to assess the extent of atherosclerosis. Other measurements included body mass index (BMI), serum lipid profile and CRP. The correlation between duration of ASM and average carotid IMT was calculated by using the Pearson's correlation coefficient method. The majority of subjects on phenytoin 8 (66.7%) were positive for CRP. There was an equal proportion of patients on carbamazepine who were equally positive 5(50%) and negative 5(50%) for CRP. There was a statistically significant association between phenytoin consumption and CRP positivity. There was positive correlation between duration of phenytoin consumption and average IMT. There was a strong positive correlation between duration of phenobarbitone consumption and average IMT and was statistically significant. Our results also suggest that long-term use of ASMs with prominent effects on the enzyme system, including Carbamazepine, phenytoin, sodium valproate or phenobarbitone may contribute to the progression of atherosclerosis in patients with epilepsy. Keywords: epilepsy; ASMs; IMT; CRP; phenytoin; carbamazepine; sodium valproate; phenobarbitone

A study on bacteriological profile in suspected cases of neonatal sepsis and its correlation with various biomarkers in the rural population of a university hospital

ABSTRACT Introduction: Neonatal sepsis is an infection in newborns that may be caused by bacteria, fungi, or viruses and has a high death and morbidity rate. The clinical presentation of sepsis may be rather general, making it challenging to make a diagnosis. While blood culture is the most accurate method to diagnose sepsis, it is also time-consuming. Because of this, it is crucial to locate other biomarkers like C-reactive protein (CRP), high sensitive C-reactive protein (hs-CRP), and procalcitonin (PCT) that may aid in early identification. Aim: To learn about the bacterial composition of suspected cases of neonatal sepsis in a tertiary care hospital in western Uttar Pradesh and how that composition relates to the biomarkers CRP, hs-CRP, and PCT Materials and Methods: Hundred people who fulfilled the study’s inclusion criteria were included. All neonatal venous blood samples have been obtained after receiving written informed permission from either parent. The conventional method was used to perform the blood culture. The ELISA technique has been used to determine hs-CRP along with serum PCT levels, while the latex agglutination test was utilized for CRP detection. Result: A total of 100 cases were enrolled, 78% presented within 3 days of birth. Blood culture was positive in 33 neonates (33%). There were 17 Gram-positive, 15 Gram-negative, and in all 2 cases with poly bacterial culture. CRP positivity rate was significantly higher in culture positive (57.6%) as compared to culture-negative neonates (25.4%). It was shown that a CRP &gt;6 mg/l level was sensitive at 57.6% and specific at 74.6%. hs-CRP has a 100% sensitivity and 47.8% specificity. The PCT’s sensitivity was 69.7%, whereas its specificity was 89.6%. Conclusion: PCT is more specific for detecting sepsis, but hs-CRP is more sensitive than CRP. The combination of PCT along with hs-CRP has a negative predictive value and high sensitivity compared to other markers. Thus, the most accurate predictors of neonatal sepsis would be a combination of factors.

Outcome of COVID-19-Associated Acute Stroke: A Study from South India.

Coronavirus 2019 (COVID-19) infection is prevalent worldwide. COVID-19 infection can lead to various neurological disorders including acute stroke. We investigated the functional outcome and its determinants among our patients with acute stroke associated with COVID-19 infection in the present setup. This study is a prospective study in which we recruited acute stroke patients with COVID-19 positivity. Data on duration of COVID-19 symptoms and type of acute stroke were recorded. All patients underwent stroke subtype workup and measurement of D-dimer, C-reactive protein (CRP), lactate-dehydrogenase (LDH), procalcitonin, interleukin-6, and ferritin levels. Poor functional outcome was defined by modified Rankin score (mRS) ≥3 at 90 days. During the study period, 610 patients were admitted for acute stroke, of whom 110 (18%) tested positive for COVID-19 infection. Majority (72.7%) were men with a mean age of 56.5 years and mean duration of COVID-19 symptoms for 6.9 days. Acute ischemic and hemorrhagic strokes were observed in 85.5% and 14.5% patients, respectively. Poor outcome was observed in 52.7%, including in-hospital mortality in 24.5% patients. COVID-19 symptoms ≤5 days (odds ratio [OR]: 1.41, 95% confidence interval [CI]: 1.20-2.99), CRP positivity (OR: 1.97, 95% CI: 1.41-4.87), elevated levels of D-dimer (OR: 2.11, 95% CI: 1.51-5.61), interleukin-6 (OR: 1.92, 95% CI: 1.04-4.74), and serum ferritin (OR: 2.4, 95% CI: 1.02-6.07), and cycle threshold (Ct) value ≤25 (OR: 8.8, 95% CI: 6.52-12.21) were independent predictors of poor outcome. Poor outcomes were relatively higher among acute stroke patients with concomitant COVID-19 infection. In the present study, we established the independent predictors of poor outcome to be onset of COVID-19 symptoms (<5 days) and elevated levels of CRP, D-dimer, interleukin-6, ferritin, and Ct value ≤25 in acute stroke.

Loneliness, internalizing symptoms, and inflammatory markers in adolescent COVID‐19 survivors

BackgroundConcerns about the psychiatric sequelae after COVID‐19 infection have increased as the pandemic spreads worldwide. The increase in self‐isolation during this pandemic period has also revealed the importance of feelings of loneliness. This study aimed to examine the relationship between baseline inflammation levels, internalizing symptoms, and feelings of loneliness in adolescent COVID‐19 survivors in the long term.MethodsA total of 74 adolescents (41 girls, 55.4%, mean age 14.88) and their parents were included in the study. This cross‐sectional study assessed internalizing symptoms via Revised Children's Anxiety and Depression Scale (RCADS) and feelings of loneliness using the UCLA‐loneliness scale. Baseline inflammatory markers at COVID‐19 diagnosis were collected. Logistic regression analysis was used to determine predictors for depression in adolescents.ResultsThe most common disorder was Major Depressive Disorder (MDD) (25.7%), and 33.8% of the adolescents were in the clinical range in at least one internalizing domain. Baseline C‐Reactive Protein (CRP) levels correlated weakly with MDD scores. Loneliness scores correlated with all internalizing symptoms, strong association with MDD scores. Loneliness, anxiety, and parental anxiety were associated with an increased likelihood of MDD. Baseline CRP positivity did not predict MDD in adolescent COVID‐19 survivors.ConclusionsThis study indicates that anxiety, loneliness, and parental anxiety play an important role in adolescents' experience of depressive symptoms after COVID‐19 infection. Thus, screening parental psychopathology and loneliness in COVID‐19 survivors seems to be preventive for adolescent mental health problems.

Diagnostic potential of interleukin-40 (IL-40) in rheumatoid arthritis patients

BackgroundRheumatoid arthritis (RA) is the most common type of inflammatory arthritis. Newly emerging evidence has highlighted the role of B-cell produced cytokines in the development and progression of RA. Specifically, the expression of IL-40 has been shown to be significantly increased in affected patients. Patients and methodsThe study included 66 patients attending Rheumatology Unit, Baghdad Teaching Hospital and 66 matched controls. C-reactive protein (CRP), rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) were measured. Disease activity score (DAS28) was assessed. Serum IL-40 levels were assessed using an enzyme-linked immunosorbent assay (ELISA). ResultsThe mean ages of patients were 46.5 ± 10.2 years (23–68 years) and were 55 females and 11 males (F:M 5:1). 4 were smokers. Positivity of CRP, RF and anti-CCP were 75.8 %, 65.2 % and 62.2 % respectively. Steroids were received by 21.2 %, methotrexate by 56.1 %, biologics in the form of etanercept and adalimumab by 86.4 %. IL-40 was significantly higher in patients (9.1 ± 1.3 ng/ml) than in controls (7.5 ± 2.2 ng/ml; p < 0.001). The IL-40 level was comparable between females and males and was not related to smoking, CRP, RF or anti-CCP positivity or to receiving medications. Serum IL-40 showed good validity in diagnosing RA at a cut-off value (≥8.2 ng/ml) and area under curve (AUC) (0.74), the sensitivity was 73.2 %, specificity (66.7 %), and the accuracy (70.5 %)(p < 0.001). ConclusionThe increased level of serum IL-40 and its potential diagnostic role have been revealed in RA. Further studies are needed to be implement and elucidate the complete role of IL-40 in RA.

Association of serum 25-hydroxyvitamin D in COVID-19: A study from India

Background: Novel coronavirus infection 2019 (COVID-19), a pandemic has affected patients irrespective of gender and age. Existing studies have incriminated low levels of serum 25-hydroxyvitamin D to be associated with COVID-19 infection. The present study was to investigate serum 25-hydroxyvitamin D levels in patients with COVID-19 infection.&#x0D; Methods: We recruited prospectively 175 consecutive COVID-19 patients from the Department of Medicine, Yashoda hospital Hyderabad during the study period from May 2020 to December 2020. We measured in all patients, serum levels of 25-hydroxyvitamin D, calcium, phosphorus, alkaline phosphatase, C-reactive protein (CRP), D-Dimer, interleukin-6, procalcitonin, and ferritin.&#x0D; Results: Out of 175 patients 122(69.7%) were men, mean age was 57.2±13.6 years. Clinical symptoms were fever in 175 (100%) dry cough in 110(62.8%), tiredness in 105(60%), shortness of breath in 94(53.7%), and mechanical ventilator support requirement at admission in 40(22.8%). Serum 25-hydroxyvitamin D deficiency was noted in 108(61.7%), CRP was positive in 119(68%), abnormal D-dimer levels in 96(54.8%), abnormal procalcitonin levels in 107(61.1%) abnormal interleukin-6 levels in 98(56%), abnormal serum ferritin levels in 106 (60.5%) and overall mortality in 13(7.4%). Older age (p =0.006) hypertension (p=0.02), diabetes (p=0.01), CRP positivity (p&lt; 0.0001) and mortality (p=0.03) were significantly associated with serum25-hydroxyvitamin D deficiency in COVID-19 patients. Serum 25-hydroxyvitamin D deficiency and age &gt;60 years were significant predictors of mortality with odds of 7.4; (95%CI: 1.10-56.36) and 2.8: (95%CI: 0.81-9.50) respectively.&#x0D; Conclusion: In our study, serum 25-hydroxyvitamin D deficiency was seen in 61.1%, low levels of serum 25-hydroxyvitamin D was independently associated with &gt;60 years age group and mortality in COVID-19.

Steatotic and Steatohepatitic Hepatocellular Carcinomas: Features in a Series With Predominantly Viral Etiology.

Hepatocellular carcinomas (HCCs) with steatohepatitis and steatosis are reported with varying definitions and clinicopathologic features. We aimed to search the attributes of steatohepatitic hepatocellular carcinoma (SH-HCC) and steatotic-HCC in our series. A retrospective clinicopathologic analyses of 150 HCCs and immunostaining for C-reactive protein (CRP) and serum amyloid A (SAA) were performed. Tumors were reclassified as all SH-HCC, limited SH-HCC, typical SH-HCC (steatohepatitic features in >5%, 5% to 50%, and ≥50% of the tumor, respectively), steatotic-HCC, and classic HCC (C-HCC). Group comparisons were made using Kruskal-Wallis and Kaplan-Meier tests. The background etiology in all SH-HCCs was pure viral in 51.4%, nonalcoholic steatohepatitis (NASH)/alcoholic liver disease (ALD) alone/mixed in 34.3%, and unidentified in normal liver in 14.3%. All SH-HCCS (n=35, 23.3%) and typical SH-HCCs (n=13, 8.6%) had higher NASH/ALD. Limited SH-HCCs (n=22, 14.6%) had higher ALD (all P<0.05). Typical SH-HCCs tended to have more NASH (P=0.054). Steatotic-HCCs (n=13, 9%) and C-HCCs (n=102, 68%) had higher pure viral etiology and serum CRP (all P<0.05). CRP and SAA were positive in 69% and 27% of the tumors, respectively. SAA positivity correlated with ALD (P=0.026). In the overall group disease-free survival rates at 1, 5, 10, and 20 years were 97.0%, 82.3%, 79.6%, and 77.2%, respectively. Demographics, tumor characteristics, CRP and SAA positivity, and survival were similar between the groups (P>0.05). SH-HCC is heterogenous in terms of underlying etiologies, and can be seen in NASH/ALD, pure viral and noncirrhotic/normal background. The ≥50% cutoff for the definition of SH-HCC can lead to overlook ALD-related SH-HCC. Steatotic-HCC seems more similar to C-HCC rather than SH-HCC, but none of them feature as a different prognostic group.

Association of serum 25-hydroxyvitamin D levels with primary hypertension: a study from south India.

Hypertension is a major risk factor for cardiovascular and cerebrovascular disease. Recent studies have identified an association between low vitamin D levels and hypertension. We investigated the association between vitamin D levels and hypertension in the general population. We recruited 400 hypertensive subjects and compared them with 400 age- and sex-matched normotensive subjects. This study was carried out at Yashoda Hospital, Hyderabad, India from January 2015 to December 2017. Both groups underwent risk factor evaluation, estimation of serum 25-hydroxyvitamin D levels, and C-reactive protein (CRP) and liver function tests. Out of the 400 hypertensive subjects, 164 (40.2%) had serum 25-hydroxyvitamin D deficiency, compared with 111 (27.7%) normotensive subjects (p = 0.0001). Deficiency of serum 25-hydroxyvitamin D in hypertensive subjects was significantly associated with CRP positivity, low levels of mean serum calcium, low levels of mean serum phosphorous, high levels of mean alkaline phosphatase (p < 0.0001), and abnormal alanine transaminase (ALT) (p = 0.0015) compared with the same parameters in the normotensive subjects. After adjustment in the multiple logistic regression analysis, serum 25-hydroxyvitamin D deficiency (odds: 1.78; 95% CI: 1.31-2.41), CRP positivity (odds: 1.48; 95% CI: 1.48-2.32) and abnormal ALT (odds: 1.2; 95% CI: 0.98-1.94) were significantly associated with hypertension. Serum 25-hydroxyvitamin D deficiency was significantly associated with hypertension.

Prevalence of endothelial dysfunction in acquired immune deficiency syndrome patients and its correlation with degree of immunodeficiency

Background: Number of factors play a role in endothelial dysfunction observed in AIDS patients, which can lead to atherosclerosis along with cardiovascular mortality and morbidity. Human immunodeficiency virus (HIV), the etiologic agent of AIDS causes several vascular disorders characterized by an evident activation and perturbation of endothelial cells. Currently, there is lack of data in the Indian literature regarding study of endothelial dysfunction in HIV patients. The purpose of our research was to study the prevalence of endothelial dysfunction in HIV/AIDS patients.Methods: The study comprises a total number of 60 adult HIV positive patients of both sex (male and female) with confirmed HIV seropositivity. The patients were divided into two groups of 30 each, depending on the degree of immune dysfunction (CD 4 cell counts). Group I- patients with CD 4+T cell count&gt;200/µl and group II-patients with CD 4+T cell count&lt;200/µl. These patients were subjected to detailed clinical examination and markers of endothelial dysfunction-flow mediated vasodilatation (FMD) of brachial artery, S. nitrite and C-reactive protein (CRP) were performed.Results: The defect in endothelial function was most prevalent in patients with more severe immunosuppression. FMD of brachial artery was decreased in patients with CD 4+T cell count &lt; 200/µl (7.07±2.89, p=0.00). S. nitrite was also significantly lower in group II patients (26.43±15.38), and these patients also showed more CRP positivity and higher CRP titres ranging from 1.2 mg/dl to 9.6 mg/dl.Conclusions: The defect in endothelial function was most prevalent in patients with more severe immunosuppression. FMD of brachial artery was decreased in patients with CD 4+T cell count &lt;200/µl (7.07±2.89, p=0.00). S. nitrite was also significantly lower in group II patients (26.43±15.38), and these patients also showed more CRP positivity and higher CRP titres ranging from 1.2 mg/dl to 9.6 mg/dl.

Diagnostic Significance of White Blood Cell Count and C-Reactive Protein in Neonatal Sepsis; Asella Referral Hospital, South East Ethiopia.

Introduction:Nowadays various biochemical markers, such as C-Reactive Protein (CRP), Procalcitonin and tumor necrosis factor alpha, have been proposed as a potential marker for screening neonatal sepsis. In the current study, we tried to see the diagnostic significance of White Blood Cell (WBC) count and CRP in diagnostic screening of neonatal sepsis.Methods:A prospective cross-sectional study was conducted from May 2016 to April 2017 in Asella Teaching and Referral Hospital. Data were entered into EPI-INFO version 3.5.1 for cleanup and then exported to SPSS version 17 for further analysis. Sensitivity, specificity, positive predictive value (PPV) and negative predictive values (NPV) were used to assess the accuracy of CRP and WBC count taking blood culture as gold standard.Results:Data of 303 neonates with clinical sepsis were analyzed. Positive CRP and abnormal WBC were reported in 136(45%) and 99(32.7%) of study subjects respectively. Blood culture turned to be positive in 88(29.4%) of study subjects. The Sensitivity, Specificity, PPV and NPV of WBC count were 59.5 %, 79.6%, 52%, 64.5% respectively while the sensitivity, specificity, PPV and NPV of CRP were 65.6%, 78%, 42% and 91% respectively. By combining both WBC and CRP, the sensitivity, specificity, PPV and NPV improve to 78.5%, 83%, 60% and 93% respectively. CRP positivity rate was comparable across gram positive and gram negative bacteria while high WBC count were more reported among gram positive sepsis than gram negative ( OR 4.8, (95% CI 1.45-15.87, P 0.01)Conclusion:Based on this study’s finding, it can be concluded that CRP alone or in combination with WBC count showed better diagnostic accuracy in neonatal sepsis.

Role of C-Reactive Protein, White Blood Cell Counts, Bilirubin Levels, and Imaging in the Diagnosis of Acute Appendicitis as a Cause of Right Iliac Fossa Pain

BackgroundRight iliac fossa (RIF) pain is one of the most common modalities of presentation to surgical emergency. It remains a challenge to the treating clinicians to accurately diagnose or to rule out appendicitis.ObjectiveThe aim of the study was to compare the efficacy of clinical impression, biochemical markers, and imaging in the diagnosis of RIF pain with special reference to appendicitis and their implication in reducing the negative appendicectomy rates.MethodsAll patients presenting to casualty with RIF pain were included in the study. Blood investigations including C-reactive protein (CRP), serum bilirubin, white blood cell counts (WBC), and ultrasound (USG) were done. Based on the clinical impression, patients were either posted for appendicectomy or observed in equivocal cases. Patients who had recurrent pain on follow-up underwent appendicectomy or underwent contrast-enhanced computed tomography (CECT) in equivocal cases. Patients who only had a single self-limiting episode with no other alternative diagnosis or had a normal CECT report were included in a non-specific RIF pain group.ResultsThe negative appendicectomy rate was 8.2%. The mean value of WBC counts (9.57x109/L vs 7.88x109/L; p<0.05) and that of serum bilirubin (1.37 mg/dl vs 0.89mg/dl; p<0.05) in the appendicitis and non-appendicitis group, respectively, were statistically significant. The percentage of CRP positivity was higher in the appendicitis group (51.9% vs 15%; p<0.05). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for USG (84.2%, 77.17%, 85.4%, and 75.5%), for CRP (51.8%, 85%, 82%, and 57%), for WBC count (45.1%, 88%, 86.6%, and 48.3%), and for serum bilirubin (69.2%, 75%, 81.4%, and 60.5%) were statistically significant between the groups.ConclusionImaging and biochemical investigations including bilirubin can act as useful adjuncts to the clinical diagnosis of appendicitis.

Role of Procalcitonin in Evaluation of the Severity of Acute Cholecystitis.

The aim of this study is to investigate the relationship between procalcitonin (PCT) level and the severity of acute cholecystitis. This study included 200 patients diagnosed with acute cholecystitis. To diagnose and assess the severity of acute cholecystitis; physical examination and abdominal ultrasound findings were evaluated and blood samples were taken to determine white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and levels of coagulation factors, blood gas, C-reactive protein (CRP) and PCT. Patients were classified into three stages, namely, mild, moderate, and severe, according to the severity of acute cholecystitis using the Tokyo guidelines. The role of PCT level in the assessment of severity of acute cholecystitis and the correlation between the stages and PCT level were statistically analyzed. Among patients with acute cholecystitis, 110 (55%) were classified as mild, 61 (30.5%) as moderate, and 29 (14.5%) as severe. Leukocytosis or leukopenia was positive in 48.5%, ESR elevation was found in 72.5%, CRP positivity in 55.5%, PCT elevation in 27%, and positive findings of ultrasonographic imaging in 54.5% of the patients. Serum WBC count, ESR, and CRP and PCT levels increased as the severity of disease increased (p<0.05). PCT could discriminate grade I from grade II-III with 95.45% sensitivity and 46.67% specificity at the best cut-off value of ≤0.52 (p<0.001). PCT could also discriminate grade III from grade I-II with 72.4% sensitivity and 90.06% specificity at the best cut-off value of >0.8 (p<0.001). PCT level may be considered to be a parameter that could be added to the assessment of the severity of acute cholecystitis in the Tokyo guidelines, although further studies are needed to support our findings.

Assessment of health status by molecular measures in adults ranging from middle-aged to old: Ready for clinical use?

In addition to measures already used in clinical practice, molecular measures have been proposed to assess health status, but these have not yet been introduced into clinical practice. We aimed to test the association of functional capacity measures used in current practice and molecular measures with age and health status.The cohort consisted of 178 middle-aged to old participants of the Leiden Longevity Study (range 42–82years). We tested associations between functional capacity measures (physical tests: grip strength, 4-meter walk, chair stand test; cognitive tests: Stroop test, digit symbol substitution test and 15-picture learning test) with age and with cardiovascular or metabolic disease as a measure of the health status. These associations with age and health status were also tested for molecular measures (C reactive protein (CRP), numbers of senescent p16INK4a positive cells in the epidermis and dermis and putative immunosenescence (presence of CD57+ T cells)).All functional capacity measures were associated with age. CRP and epidermal p16INK4a positivity were also associated with age, but with smaller estimates. Grip strength and the Stroop test were associated with cardiovascular or metabolic disease, as was epidermal p16INK4a positivity. All associations with cardiovascular or metabolic disease attenuated when adjusting for age.In conclusion, in middle-aged to old persons, the molecular measures tested here were more weakly associated with age and health status than functional capacity measures. Whether these molecular measures associate more closely with health status in the elderly or in specific groups of patients needs to be explored further.

Significance of Anti-cyclic Citrullinated Peptide Autoantibodies in Immune-mediated Inflammatory Skin Disorders with and without Arthritis.

Background:Anti-cyclic citrullinated peptides (CCPs) are autoantibodies directed against citrullinated peptides. Rheumatoid factor (RF), an antibody against the Fc portion of IgG, is known to form immune complexes and contribute to the etiopathogenesis of various skin disorders. C-reactive protein (CRP), an acute-phase protein, increases following secretion of interleukin-6 from macrophages and T cells. Anti-CCP, RF, and CRP are well-established immune-markers, their diagnostic potential in immune-mediated skin disorders remains less widely studied.Aims and Objectives:To determine the correlation between anti-CCP, RF, and CRP in immune-mediated inflammatory skin diseases.Materials and Methods:About 61 clinically diagnosed cases of various immune-mediated skin diseases (psoriasis [n = 38], connective tissue diseases such as systemic lupus erythematosus and systemic sclerosis [n = 14], and immunobullous disorders including pemphigus vulgaris and pemphigus foliaceus [n = 9]) were included in the study. These patients were subclassified on the basis of presence or absence of arthritis. Arthritis was present in nine cases of psoriasis and seven connective tissue disorder patients. Detection of serum anti-CCP was done using enzyme-linked immunosorbent assay, whereas CRP and RF levels were detected using latex agglutination technique.Results:Of the 61 specimens, 14.75% had elevated serum anti-CCP levels. RF and CRP levels were elevated in 18.03% and 39.34% specimens, respectively. RF was elevated in 13.16% of inflammatory and 42.88% of connective tissue disorders, whereas anti-CCP was raised in 10.53% of inflammatory and 35.71% of connective tissue disorders. CRP positivity was highest in connective tissue disorders (50%), followed by 39.47% in inflammatory and 22.22% in immunobullous conditions. In none of the immunobullous patients, anti-CCP or RF levels were found to be elevated. Association of the presence of arthritis with elevated anti-CCP was found to be statistically significant.Conclusions:Although anti-CCP, RF, and CRP levels are valuable markers of chronic immune-mediated skin disorders, elaborate studies enrolling a larger number of patients are required to validate these diagnostic markers.

Clinical Presentation of Gastrointestinal Anisakiasis: A Comparison Between Gastric and Small Intestinal Anisakiasis

Introduction: Today sushi is popular in many countries. However, some fish harbor the nematode Anisakis simplex, which often causes damage to the gastrointestinal tract when ingested. In this study, we elucidated differences in the clinical features and treatment methods between the two types of anisakiasis. Methods: Subjects were 29 patients who were diagnosed with gastric or intestinal anisakiasis at Kyorin University Hospital between April 2012 and March 2015. Gastric anisakiasis was diagnosed upon confirmation of the nematode on upper gastrointestinal endoscopy. Intestinal anisakiasis was diagnosed based on the seroprevalence of anti-Anisakis IgE antibodies. The clinical features and treatment methods noted in the medical records were retrospectively compared between the groups. Results: One patient had anisakiasis infection in both the stomach and small intestine. The clinical picture of 14 patients with gastric anisakiasis alone was (1) 41 years of age(mean), (2) 1.4 days between the consumption of fish and hospital visit(mean), (3) 0.1 mg/dl of C-reactive protein (CRP) at initial examination(mean), (4) no ascites accumulation in any of 8 patients who had undergone computed tomography (CT), and (5) no hospital admission. The clinical picture of 14 patients with intestinal anisakiasis alone were (1) 56 years of age(mean), (2) 2.1 days between fish consumption and hospital visit(mean) (a history of fish consumption was unclear in 1 patient), (3) 4.8 mg/dl of CRP at initial examination(mean), (4) ascites accumulation in 11 of the 14 patients who had undergone CT, and (5) hospital stay of 9.4 days. With regard to treatment methods, the nematode was endoscopically removed in patients with gastric anisakiasis. Whereas we did not find the nematode in the small intestine in any of the patients. To treat ileus, neither gastric tube nor ireus tube were needed in 7 patients. Conclusion: Comparison of the two groups showed that patients with gastric anisakiasis tended to be young and have early onset, whereas those with intestinal anisakiasis were characterized by ascites accumulation and CRP positivity. CT was useful in the diagnosis of the latter group. Half the patients with intestinal anisakiasis did not require decompression of the intestinal tract, but all patients were required for hospitalization. For diagnosis of gastrointestinal anisakiasis, it was proved that clinical history taking, CRP, serum Anisakis IgE antibody testing, and CT was useful.

Proteinase-activated receptor 2 expression on peripheral blood monocytes and T-cells in patients with rheumatoid arthritis

Aim of the workProteinase-activated receptor 2 (PAR2) is a G protein-coupled receptor activated by serine proteinases with proinflammatory activity. The aim of this work was to evaluate the expression of PAR2 on peripheral blood monocytes and T-cells in rheumatoid arthritis (RA) patients and its correlation with disease activity. Patients and methodsForty RA patients and 16 healthy controls were enrolled in this study. Flow cytometry was performed to detect PAR2 expression. Disease activity score (DAS28) was assessed. ResultsPAR2 expression was significantly higher on monocytes in RA patients with active disease compared with patients in remission and healthy controls (75.4±7.68; 56±13.93 and 46.5±9.8 respectively; p<0.001). It was higher in RA patients in remission compared to healthy control (p=0.01). No significant difference was found between patients with moderate and high disease activity. It significantly correlated with the erythrocyte sedimentation rate (ESR) and DAS28 (p<0.001). It was significantly higher in patients with rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) positivity (p=0.01, p<0.001, respectively). It was not significantly associated with C-reactive protein (CRP) positivity and was not significantly different between early and long standing RA patients. PAR2 expression on CD3+ T-cells was not significantly different between patients with RA disease activity, patients in remission and healthy controls. Also it was not significantly associated with the ESR, DAS28, anti-CCP, RF and CRP positivity. ConclusionPAR2 expression on monocytes is consistent with a pathogenic role for PAR2 in RA and suggests that PAR2 may have utility as a marker for RA disease activity.

Tumor necrosis factor gene expression in regular hemodialysis patients.

This study evaluates tumor necrosis factor (TNF)-alfa gene expression in patients with end-stage renal disease (ESRD) on regular hemodialysis as an expression of cardiovascular disease (CVD) risk even on a sub-clinical level and its relation to some of the parameters incriminated in the pathogenesis and the establishment of uremic arteriopathy. A total of 51 patients with ESRD on regular hemodialysis and 20 healthy subjects matching in age and gender as a control group were recruited. All selected cases were subjected to serum lipid profile, Creactive protein (CRP), TNF-alfa gene expression and Doppler study of carotid arteries to estimate carotid intimal media thickness (cIMT). Serum triglycerides (TGS) level (P <0.001), CRP positivity (P = 0.002), relative quantification (RQ) of TNF-alfa gene expression (P = 0.007) and cIMT (P = 0.02) were significantly higher while high-density lipoprotein (HDL) level (P <0.001) was significantly lower among cases compared with controls. RQ showed a significant positive correlation with CRP titer (rho = 0.583, P = 0.011). Results also showed a significant strong negative correlation between with CRP titer and cIMT (rho = -0.590, P = 0.010). CRP titer showed only a significant strong negative correlation with age (rho = -0.589, P = 0.01) and positive correlation with HDL (rho = 0.51, P = 0.031). Patients with ESRD have increased gene expression of TNF-alfa and CRP titer together with increased atherosclerosis as expressed by increased cIMT.

A case-control study examining association between infectious agents and acute myocardial infarction.

Coronary heart disease is multi-factorial in origin and its burden is expected to rise in developing countries, including India. Evidence suggests that the inflammation caused by infection is associated with the development of atherosclerosis and heart disease. An increasing number of clinical and experimental studies point to a contribution of various infectious organisms to the development of atherosclerosis in humans. Acute myocardial infarction (AMI) is associated with atherosclerosis. The objective of the following study is to study the association between Helicobacter pylori, Chlamydia pneumoniae and C-reactive protein (CRP) with AMI. This group-matched case-control study was carried out in Government Medical College, Nagpur, Maharashtra, India. The study compared the risk of occurrence of AMI (outcome) if subjects were ever-infected with H. pylori or C. pneumoniae; and their CRP positivity (exposure). Incident cases of myocardial infarctions in a tertiary care hospital were included as cases. The study recruited 265 cases and 265 controls and detected an odds ratio (OR) of 2.50 (95% confidence interval [CI]: 1.69-3.70) and an OR of 2.50 (95% CI: 1.71-3.65) for C. pneumoniae and H. pylori, respectively. Raised CRP levels had an OR of 3.85 (95% CI: 2.54-5.87). Although our study indicates the role of infections in the etiology of AMI in study population, the relative public health impact of these agents in the overall prevalence of AMI needs urgent research attention.