C-reactive Proteins Research Articles

Effects of Cashew Nuts (Anacardium occidentale L.) and Cashew Nut Oil on Intestinal Permeability and Inflammatory Markers during an Energy-Restricted 8-Week Intervention: A Randomized Controlled Trial (Brazilian Nuts Study).

Cashew nuts can contribute to improving intestinal permeability and inflammation as they contain essential nutrients and bioactive compounds, but no clinical trials have evaluated these potential effects. This randomized trial aimed to assess the effects of cashew nuts and their oil on intestinal permeability and inflammatory markers. Sixty-four adults with overweight or obesity were allocated into three groups receiving energy restriction (-500 kcal/day): control (CT, free nuts), cashew nuts (CN, 30 g/day), or cashew nut oil (OL, 30 mL/day). Urine lactulose and mannitol, plasma zonulin and the lipopolysaccharide-binding protein (LBP), plasma interleukins (IL-6, TNF-α, IL-10, IL-1β, IL-8, and IL-12p70), and C-reactive proteins were analyzed. Energy restriction reduced body fat and other indicators of adiposity without differences between the groups. Only the control group increased LBPs after an 8-week intervention. There were no statistically significant differences found between the groups in terms of intestinal permeability and inflammatory markers. In conclusion, incorporating cashew nuts or cashew nut oil into an energy-restricted 8-week dietary intervention did not change intestinal permeability and inflammatory markers. As studies evaluating cashew nuts on these markers remain scarce, further research is needed, perhaps with a longer study period and a higher concentration of cashew nuts and oil.

Association of Raised C-Reactive Proteins With Prolonged ICU Stay in Children with Bronchopneumonia: A Cross Sectional Study

Objective To study the association of raised CRP with prolonged ICU stay in children with bronchopneumonia at Ghurki Trust Teaching Hospital, Lahore, Pakistan. Methodology This cross-sectional study was conducted in Paediatric Intensive Care Unit of Ghurki Trust Teaching Hospital, Lahore, Pakistan, for a duration of six months (June 2023 to December 2023). Out of 127 children admitted into ICU, 82 met the inclusion criteria, aged 2-60 months, diagnosed with bronchopneumonia. Upon admission, blood sample was taken for CRP levels and these levels were correlated with ICU stay, TLC count, O2 dependency, and antibiotics duration of the patients. Patients were divided into five groups based on CRP counts. CRP counts less than 0.3 mg/dL were taken as normal. CRP counts from 0.4-0.9 mg/dL were taken as mild, 1-10 mg/dL were considered moderate, 11-49 mg/dL were considered marked, and ≥50 mg/dL were considered severe. Results Out of 82 patients, 45 (54.88%) were males and 37 (45.12%) were females. This study found that raised CRP was present in 73 (89.02%) out of 82 children (p<0.04). Amongst 73 (89.02%), 08 (10.96%) patients had mild elevation of CRP, 36 (49.32%) had moderate elevation, 22 (30.14%) had marked, 07 (9.59%) had severe elevation. Moreover, a direct relation was observed among CRP and ICU stay (3.82±3.12), O2 requirements (3.72±3.07), TLC (13.36±5.18), antibiotic treatment duration (9.52±3.94) of broncho pneumonic patients. Conclusion Higher CRP levels significantly result in longer ICU stays and higher oxygen requirements in children with bronchopneumonia.

Hematological parameters of COVID-19 patients at Jakarta Pondok Kopi Islamic Hospital

Background: The 2019 Corona Virus Disease (Covid-19) has become a pandemic. As of 15 January 2021, 223 countries have been infected, with a total number of 92,262,621 confirmed cases, and 1,995,037 deaths. In Indonesia, as of the same date, there were 896,642 confirmed cases and 25,767 deaths.1 Diagnosis of COVID-19 is based on real-time reverse transcriptase-polymerase chain reaction (RT-PCR) results on oropharyngeal/nasopharyngeal swab samples.2 A basic hematological examination is also conducted on patients with suspected COVID-19. The results of baseline hematological examinations are thought to be a predictor of the patient being infected with COVID-19 before the RT-PCR results are released. The purpose of this study is to identify the hematological parameters of COVID-19 patients at Pondok Kopi Islamic Hospital in Jakarta (RSIJ PK) in order to provide an overview of the hematological parameters that can be used to predict the possibility of a patient being infected with COVID-19. Methods: The study adopted a cross-sectional approach, using the database on COVID-19 patients at Pondok Kopi Islamic Hospital. Data variables were categorized and described by frequency and percentage. Statistical analysis was conducted using the likelihood ratio test and SPSS (statistical package for the social sciences) version 26. Results: The number of research respondents was 250, with 142 males (56.8%). The majority of participants were between the ages of 40 and 59, at 127 (50.8%). Most patients exhibited a moderate level of clinical severity, at 215 (86%). The three most common comorbidities were hypertension in 82 patients (32.8%), diabetes in 68 patients (27.2%), and chronic kidney disease in 27 patients (10.8%). The dominant hematological parameters were normal blood leukocytes in 157 patients (62.8%), increased Neutrophil/Lymphocyte Ratio (NLR) (>3.13) in 148 patients (59.2%), low Absolute Lymphocyte Count (ALC) (<1500/µL) in 133 patients (53.2%), increased C-Reactive Proteins (CRP) (>10 mg/L) in 171 patients (68.4%), and increased d-dimer (>0.5 µg/mL) in 148 patients (59.2%). There was a significant correlation between age (p 0.028), comorbid hypertension (p 0.002), comorbid diabetes (p 0.011), leukocyte levels (p 0.045), and ALC levels (p 0.025), and the severity of the COVID-19 disease. Conclusions: The majority of COVID-19 patients had normal blood leukocyte levels, increased NLR, low ALC, and increased CRP and d-dimer.

Evaluation of C-Reactive Proteins Levels in Peri-Implantitis Patients.

To evaluate C-reactive protein (CRP) levels in peri-implantitis patients. This study comprised a total of 100 participants. Fifty participants with a confirmed clinical and radiological diagnosis of peri-implantitis formed one group. Another group of 50 volunteers who came in for a normal health checkup served as healthy controls. All the patients were recalled in the morning. Fasting venous blood samples were collected. CRP concentrations in the laboratory were determined using an auto-analyzer. In this study, there were 40 females and 60 males. Mean CRP levels among subjects of the peri-implantitis group and the control group were 0.615 and 0.201 mg/dL, respectively. It was observed that mean CRP levels were higher among subjects having peri-implantitis as compared to the controls.

An efficient synthetic minority oversampling technique-based ensemble learning model to detect COVID-19 severity

The COVID-19 pandemic has highlighted the importance of accurately predicting disease severity to ensure timely intervention and effective allocation of healthcare resources, which can ultimately improve patient outcomes. This study aims to develop an efficient machine learning (ML) model based on patient demographic and clinical data. It utilizes advanced feature engineering techniques to reduce the dimensionality of dataset and address the issue of highly imbalanced data using synthetic minority oversampling technique (SMOTE). The study employs several ensemble learning models, including XGBoost, Random Forest, AdaBoost, voting ensemble, enhanced-weighted voting ensemble, and stack-based ensembles with support vector machine (SVM) and Gaussian Naïve Bayes as meta-learners, to develop the proposed model. The results indicate that the proposed model outperformed the top-performing models reported in previous studies. It achieved an accuracy of 0.978, sensitivity of 1.0, precision of 0.875, F1-score of 0.934, and receiver operating characteristic area under the curve (ROC-AUC) of 0.965. The study identified several features that significantly correlated with COVID-19 severity, which included respiratory rate (breaths per minute), c-reactive proteins, age, and total leukocyte count (TLC) count. The proposed approach presents a promising method for accurate COVID-19 severity prediction, which may prove valuable in assisting healthcare providers in making informed decisions about patient care.

A leaky gut contributes to postural imbalance in male patients with chronic obstructive pulmonary disease

AimsPatients with chronic obstructive pulmonary disease (COPD) frequently exhibit an inability to maintain postural balance. However, the contribution of increased intestinal permeability or leaky gut to the postural imbalance in COPD is not known. MethodsWe measured plasma zonulin, a marker of leaky gut, with relevance to postural balance in male controls (n = 70) and patients with mild (n = 67), moderate (n = 66), and severe (n = 58) COPD. We employed a short physical performance battery to evaluate postural balance in supine, tandem, and semi-tandem positions. We also measured handgrip strength (HGS), gait speed, plasma c-reactive proteins (CRP), and 8-isoprostanes as potential mechanistic connections between postural imbalance and leaky gut. ResultsCOPD patients demonstrated higher plasma zonulin, CRP, and 8-isoprostanes levels and lower balance, HGS, and gait speed than controls (all p < 0.05). These findings were more robust in patients with moderate and severe than mild COPD. In addition, plasma zonulin exhibited significant potential in diagnosing poor balance, low HGS, and gait speed in COPD patients (all p < 0.05). We also found significant correlations of plasma zonulin with CRP and 8-isoprostanes, providing heightened inflammation and oxidative stress as mechanistic connections between leaky gut and postural imbalance. ConclusionPlasma zonulin may be helpful in evaluating postural imbalance in COPD patients. Repairing intestinal leaks can be a therapeutic target to improve postural control in COPD.

A neutrophil elastase inhibitor, sivelestat, attenuates sepsis-induced acute kidney injury by inhibiting oxidative stress

BackgroundSivelestat, a selective inhibitor of neutrophil elastase (NE), can mitigate sepsis-related acute lung injury. However, the role of sivelestat in inhibiting oxidative stress and attenuating sepsis-related acute kidney injury (AKI) remains unclear. Here, we reported the effects of sivelestat against oxidative stress-induced AKI by suppressing the production of oxidative stress indicators. Materials and methodsA male Sprague-Dawley rat model of sepsis was established by cecal ligation and puncture (CLP). Sivelestat or normal saline was administered into jugular vein with a sustained-release drug delivery system. Indicators of inflammation and AKI, including white blood cells (WBC), neutrophils, lymphocytes, C-reactive proteins (CRP), procalcitonin (PCT), blood urea nitrogen (BUN), creatinine (Cr) and uric acid (UA), were assessed at 24 h post-sivelestat treatment. Indicators of liver injury, including direct bilirubin (DBIL), indirect bilirubin (IBIL), aspartate aminotransferase (AST) and alanine aminotransferase (ALT), were also assessed at 24 h post-sivelestat treatment. Indicators of oxidative stress, including superoxide dismutase (SOD), malondialdehyde (MDA) and glutathione peroxidase (GSH-Px), were assessed at 12 h and 24 h post-sivelestat treatment. At 24 h post-sivelestat treatment, H&E staining of kidney and liver tissue was performed to observe pathological alterations. ResultsAt 24 h post normal saline or sivelestat (0.2 g/kg body weight) treatment, WBC, neutrophil, CRP, PCT, MDA, BUN, Cr, UA, AST, ALT, DBIL and IBIL were increased, while SOD and GSH-Px were decreased, in septic rats treated with normal saline compared with that in non-septic rats treated with normal saline (all p < 0.05). The changes of these indicators were reversed in septic rats treated with sivelestat compared with that in septic rats treated with normal saline (all p < 0.05). Similar results were found regarding the levels of oxidative stress indicators at 12 h post-sivelestat treatment. The degenerative histopathological changes in both kidney and liver tissues were ameliorated upon sivelestat treatment. ConclusionsSivelestat plays a protective role in sepsis-related AKI by inhibiting oxidative stress. Our study reveals a possible therapeutic potential of sivelestat for oxidative stress-induced AKI.

Application Value of Serum Cytokines in Respiratory Syncytial Virus Pneumonia in Children

Objective: To analyze the relationship between cytokines and clinical manifestations of Respiratory Syncytial Virus (RSV) infection and to investigate the clinical value of cytokines in RSV pneumonia. Methods: Clinical data of RSV positive children admitted to the pediatrics department of Zhengzhou People’s Hospital from November 2021 to June 2023. They were divided into three groups according to different ages, 1-11 months, 12-23 months, 24-36 months, and wheezing group and no wheezing group according to the presence of complications. The clinical data of the children in different groups were compared, and the clinical significance of the children with RSV pneumonia was analyzed by measuring the serum cytokine levels. Results: A total of 64 children were included, 35 from 1-11,16 from 12-23 and 13 in 24-36. There were 35 patients with wheezing and 29 patients with no wheezing. Complications were found in 6 cases and 58 cases were without complications. SPO2 , N and CRP in the 1-November group were lower than those in the 12-2 March group, L was higher than that in the 12-23-month group, the proportion of severe, oxygen inhalation, three concave sign, R, P, IL-8, L were higher than those in the 23-36 month group, Oxygen Saturation (SPO2 ), C-Reactive Proteins (CRP), Procalcitonin (PCT) below the 23-3 June group, the difference is statistically significant; 12-23 month group: CDSS, R, IL-8 were higher than the 24-36 month group. The PCT was lower than that in the 24-3 June group. The difference was statistically significant (P&lt;0.05). Clinical characteristics and cytokine analysis of patients with wheezing group and no wheezing group: the fever days, IL-2, and lymphocyte count were higher in patients without wheezing, with statistically significant differences (P&lt;0.05). In terms of length of stay, R, P, IL-1 β, IL-6, and IL-8, patients with complications were higher than patients without complications, with a statistically significant difference (P&lt;0.05). Conclusion: IL-1β, IL-2, IL-4, IL-6, IL-8 and IL-10 are related with different clinical symptoms and have certain guiding significance for clinical application. IL-1β, IL-2, IL-4, IL-6, IL-8 and IL-10 have different expression levels. IL-2 may be related with wheezing, and IL-1β, IL-6 and IL-8 may be related to complications, which has certain guiding significance for clinical application.

Inflammatory Biomarkers and Gait Impairment in Older Adults: A Systematic Review.

Peripheral inflammation and gait speed alterations are common in several neurological disorders and in the aging process, but the association between the two is not well established. The aim of this systematic literary review is to determine whether proinflammatory markers are a positive predictor for gait impairments and their complications, such as falls in older adults, and may represent a risk factor for slow gait speed and its complications. The systematic review was performed in line with the Preferred Report Items for Systematic Review and Meta-Analyses (PRISMA). A protocol for literature searches was structured a priori and designed according to the International Perspective Register of Systemic Review (PROSPERO: CRD42023451108). Peer-reviewed original articles were identified by searching seven electronic databases: Excerpta Medica Database (EMBASE), SciVerse (ScienceDirect), Scopus, PubMed, Medline, Web of Science, and the Cochrane Library. The search strategy was formulated based on a combination of controlled descriptors and/or keywords related to the topic and a manual search was conducted of the reference lists from the initially selected studies to identify other eligible studies. The studies were thoroughly screened using the following inclusion criteria: older adults, spatiotemporal gait characteristics, and proinflammatory markers. A meta-analysis was not performed due to the heterogeneity of the studies, and the results were narratively synthesized. Due to the clinical and methodological heterogeneity, the studies were combined in a narrative synthesis, grouped by the type of biomarkers evaluated. A standardized data extraction form was used to collect the following methodological outcome variables from each of the included studies: author, year, population, age, sample size, spatiotemporal gait parameters such as gait velocity, and proinflammatory markers such as TNF-α, high sensitivity C-reactive (CRP) proteins, and IL-6. We included 21 out of 51 studies in our review, which examined the association between inflammatory biomarkers and gait impairment. This review highlights the role of TNF-α, CRP, and IL-6 in gait impairment. Biomarkers play an important role in the decision-making process, and IL-6 can be an effective biomarker in establishing the diagnosis of slow gait speed. Further longitudinal research is needed to establish the use of molecular biomarkers in monitoring gait impairment.

Risk factors for hospitalization and pneumonia development of pediatric patients with seasonal influenza during February-April 2023.

In China influenza remains a low activity for continuous 3 years due to COVID-19 controls. We here sought to study the clinical characteristics and risk factors of the influenza infection among children after the mandatory COVID-19 restrictions were lifted. We included 1,006 pediatric patients with influenza A virus (IAV) infection, enrolled in one tertiary hospital in Zhenjiang, Jiangsu Province, China, during February to April 2023. Patients were divided into the outpatient (n = 798) and inpatient (n = 208) groups, and their baseline characteristics were compared between two groups to conclude the risk factors for pediatric hospitalization. Separately, pediatric inpatients (n = 208) were further divided into the pneumonia and non-pneumonia groups with comparison of their clinical characteristics, including their laboratory test results and representative radiological features, to derive the key determinants for pneumonia development after hospitalization. Compared to outpatients, IAV-infected pediatric inpatients exhibited younger age, higher female: male ratio, more co-infection of influenza B virus (IBV) and hematological abnormality. Multivariate regression analysis determined the independent risk factors of hospitalization to be the clinical symptom of abdominal pain (OR = 2.63, [95% CI, 1.05-6.57], p = 0.039), co-infection of IBV (OR = 44.33, [95% CI, 25.10-78.30], p = 0.001), elevated levels of lymphocytes (OR = 2.24, [95% CI,1.65-3.05], p = 0.001) and c-reactive proteins (CRPs) (OR = 1.06, [95% CI, 1.03-1.08], p = 0.001) upon hospital admission. Furthermore, the cough symptom (OR = 17.39, [95% CI, 3.51-86.13], p = 0.001) and hospitalization length (OR = 1.36, [95% CI, 1.12-1.67], p = 0.002) were determined to be risk factors of pneumonia acquirement for pediatric inpatients. While the abdominal pain, viral co-infection and some hematological abnormality mainly contribute to hospitalization of pediatric patients with IAV infection, the length of hospital stay and clinical sign of coughing upon hospital admission constitute the key determinants for nosocomial pneumonia development.

Clinical and epidemiological profiles of pediatric COVID-19 in two private Kenyan hospitals.

COVID-19 infection has attracted global attention with limited published data on the burden in African children. hospital-based longitudinal survey in children with COVID-19 infection, aged 0-18 years admitted between August 2020 and December 2021. The main objective of the study was to describe socio-demographic, clinical and diagnostic manifestations of COVID-19 infection in children. the study enrolled 85 children. Median age was 5•1 years (IQR = 1•3 - 12•4) with equal gender distribution. Under five years were 52•9%. Average length of hospital stay among non-severe cases was three days (IQR=2•0-5•0). No deaths were reported. Fifteen patients (18•7%) were asymptomatic. The most common presenting symptoms were fever (51•8%), vomiting (36•5%), cough (27•1%), diarrhea (20•0%), nasal congestion (14•1%) and fast breathing (12•9%). Two patients presented in shock and features consistent with Multisystemic Inflammatory Syndrome in Childhood (MIS-C). Procalcitonin and C-reactive proteins were elevated in 76•9% and 45•8% respectively. Majority (n=80) had white cell counts within normal range and none had bacterial pathogens isolated from blood (n=63). Liver and Renal function tests were within the normal range in the majority of those tested (n=24 and n=64 respectively). Three of the five patients with elevated platelet count (>500 x109/L) had clinical diagnosis of MIS-C. Eight of 20 patients subjected to imaging had radiological features of bilateral ground glass opacifications while six of nine patients who presented with cardiovascular compromise had mild to moderate ventricular dysfunction on echocardiography. our study suggests that children in the African setting manifest a mild form of the COVID-19 infection with low mortality.

Associations of HDL-C and ApoA-I with Mortality Risk in PCI Patients Across Different hsCRP Levels.

The association between high-density lipoprotein cholesterol (HDL-C) and apolipoprotein A-I (ApoA-I) and cardiovascular risk in patients with coronary artery disease remains inconsistent. Recent investigations indicated potential dysfunctionality of HDL under inflammation. This study endeavors to explore whether the inflammatory status modifies the effects of HDL-C and ApoA-I on cardiovascular risk in individuals with percutaneous coronary intervention (PCI). Consecutive 10,724 PCI patients at Fuwai hospital in 2013 were enrolled. Inflammation status was defined by high-sensitivity C-reactive proteins (hsCRP) ≥ 2 mg/L. The study endpoint was cardiac mortality. Among 9569 PCI patients eventually included, 225 (2.4%) cardiac mortality happened during 5 years. In hsCRP ≥ 2 mg/L group, an U-shaped curve was observed for HDL-C and multivariate Cox regression showed that elevated risks of cardiac mortality correlated to both the lowest quintile (hazard ratio [HR], 2.50; 95% confidence interval [CI], 1.32-4.71) and the highest quintile of HDL-C (HR, 2.28; 95% CI, 1.23-4.25). However, an L-shaped curve existed in ApoA-I, indicating only the lowest quintile level of ApoA-I was associated with an increased cardiac mortality risk (HR, 2.19; 95% CI, 1.28-3.75). Nevertheless, in hsCRP < 2 mg/L group, no significant correlations between HDL-C and ApoA-I and cardiac mortality risk were identified (both P > 0.05). In PCI patients with hsCRP ≥ 2 mg/L. both low and high HDL-C levels correlated with higher cardiac mortality risk (U-shaped), while only low ApoA-I levels were linked to elevated risk (L-shaped). However, in patients with hsCRP < 2 mg/L, neither HDL-C nor ApoA-I levels were associated with higher cardiac mortality risk. These findings shed light on the importance of considering inflammation status, particularly hsCRP levels, in managing HDL-C and ApoA-I levels, and suggest targeting elevated ApoA-I levels as a potential therapeutic approach for PCI patients with hsCRP ≥ 2 mg/L.

Role of C-Reactive Proteins at Early Gestational Age in Predicting Pre-Eclampsia in Pregnant Females

Background: Pre-eclampsia remains a significant concern in obstetrics due to its potential complications for both mother and fetus. Early detection of pre-eclampsia (PE0 is crucial for timely intervention and management. C-Reactive Protein (CRP), an inflammatory marker, has shown promise as a potential predictor of pre-eclampsia when assessed during early gestational age. Objective: To evaluate the diagnostic accuracy of raised serum CRP levels in early gestation to predict the risk of pre-eclampsia in pregnant females. Study Design: Prospective validation Study. Settings: Outdoor Department of obstetrics and gynecology, Lady Atchison Hospital Lahore. Duration: 02-September 2021 to 01-March-2022. Methods: A total of 130 pregnant females having gestational age 16 to 20 weeks and presenting in the hospital for regular antenatal visits were included. A five ml venous blood sample was drawn and was sent to the central hospital laboratory for determination of CRP levels from each case. Patients having CRP ≥5.0 mg/L were labelled as high risk of pre-eclampsia. All patients followed till delivery to determine the development of pre-eclampsia. Results: The mean age of the patients was found to be 28.16±4.74 years, with a mean BMI of 26.27±5.05 kg/m². Among the 130 patients, 12 (9.23%) were identified as having elevated CRP levels, while the remaining 118 (90.77%) showed normal CRP levels. Additionally, pre-eclampsia was diagnosed in 11 (8.46%) of the patients. Evaluation of the diagnostic accuracy of CRP levels revealed a sensitivity of 81.8% and specificity of 97.5%. The positive predictive value (PPV) was calculated at 75%, while the negative predictive value (NPV) stood at 98.3%. Conclusion: The study observed that elevated CRP levels in early pregnancy serve as a significant predictor of pre-eclampsia, with sensitivity of 81.8%, indicating its ability to correctly identify those with pre-eclampsia, while the specificity was 97.5%, suggesting its accuracy in ruling out those without the condition.

Correlation of Body Mass Index with Inflammatory Markers in Rheumatoid Arthritis Patients

Objective: To study the correlation of body mass index with inflammatory markers among rheumatoid arthritis patients. Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of Biochemistry and Molecular Biology, Army Medical College, RawalpindiPakistan, in collaboration with the Rheumatology Department and laboratory of Pak Arab Emirates Military Hospital (PEMH), Rawalpindi Pakistan from Jan 2020 to Jan 2021. Methodology: The study sample was sixty in number and was divided into two groups. Diagnosed Rheumatoid Arthritis (RA) patients on modifying rheumatic Drugs (DMARDs) therapy constituted Group-I. At the same time, Group-II consisted of 30 healthy individuals. BMI, C reactive proteins (CRP) and erythrocyte sedimentation rate (ESR) of both groups were assessed and compared. The correlation of BMI with inflammatory markers was also assessed in both groups. Results: Sixty subjects with a mean age of 44.90±10 years were distributed evenly among two groups. Mean inflammatory markers for ESR and CRP, were 30.70±16.46 and 11.65±12.97, respectively, of Group-I. There was a significant difference in CRP and ESR (p ≤ 0.05) among the two groups. The mean BMI was 25.20±4.65, which was also raised for Group-I. BMI was positively correlated with inflammatory markers in both groups. Group-I showed a more positive correlation of BMI with ESR (r=0.23) than Group-II (r= 0.143). Conclusion: BMI is positively correlated with inflammatory status among RA patients.

The effect of crude extract of Cyathula prostrata leaves on serum c-reactive proteins levels of normal albino Wistar rats after an administration period of 7 days

Food fortification is considered a sustainable public health strategy because it can reach wider populations through existing food delivery systems without requiring major changes in existing consumption patterns (Das et al., 2013.). C-reactive Protein (CRP) is a major acute phase reactant synthesized primarily in the liver hepatocytes. CRP shows the strongest association with cardiovascular events. It is detectable on the surface of about 4% of normal peripheral blood lymphocytes. This research was designed to study the effects of the administration of graded doses (100mg/kg and 200mg/kg) of crude extracts of Cyathulaprotrata leaves on albino Wistar rats after a period of 7 days. The animals were sacrificed after the experimental period and blood collected and prepared for analysis to access the level of blood C-reactive protein. After the study, it was observed that the blood C-reactive protein levels for groups II and III animals were elevated significantly, indicating that there was tissue damage due to toxicity of xenobiotics. This research has led to the conclusion that the consumption of Cyathulaprostrata leaves extract was safe though it generated oxidative stress. Results show that experimental animals of group II, and III indicated elevated C-reactive protein levels (3.21±0.19 and 3.14±1.11 mg/dL respectively) significantly at p&lt;0.5 when compared to experimental animals of group 1 (control, 2.38±1.04 mg/dL) significantly at p&lt;0.05.

Efficacy and safety of Link Natural Sudarshana, an Ayurvedic herbal preparation in COVID-19 patients: A phase II multicenter double-blind randomized placebo-controlled trial

Ethnopharmacological relevanceIn vitro and in vivo studies have shown anti-viral and immunomodulatory actions in components of many traditional medicines. Various constituents of traditional medicines have been found to be effective against coronavirus disease (COVID-19) in several clinical trials and in-silico studies. Sudarshana cúrna, a polyherbal Ayurvedic medicine, has been used over thousands of years for a variety of infectious fevers. Aims of the studyThis study aimed to evaluate the efficacy and safety of Link Natural Sudarshana (LNS) tablets, in patients with COVID 19 disease. LNS is a polyherbal preparation comprising 49 medicinal plants included in the Sudarshana cúrna. Materials and methodsA randomized parallel-group double-blind placebo-controlled multi-center phase II clinical trial was conducted in patients with mild to moderate COVID-19 disease. They were randomly allocated to intervention and control groups. The intervention group received LNS tablets whereas the control group received placebo tablets for 10 days or until the patient was discharged from the hospital. All patients received standard symptomatic treatment. The primary outcome, a reduction in mean log viral load was assessed at day 5 of treatment. The secondary outcomes, clinical progression and safety, were assessed by, monitoring changes in symptoms daily on a Likert scale ranging from 1 to 4 and laboratory tests respectively. ResultsA total of 171 patients (treatment group 83, control group 88) completed the trial. There were no significant differences between the baseline status of the two groups except that body mass index was significantly higher in the placebo group. The mean log viral load reduction at day 5 was higher in the treatment group (2.20 ± 1.67) compared to the placebo group (1.93 ± 1.80), with a mean difference of −0.278. This difference was not statistically significant at the 5% significant level. Reduction of mean cumulative symptom score, which included 16 symptoms graded according to severity, was higher in the treatment group compared to the placebo group. This difference was not statistically significant. None of the study participants developed hypoxia. Among the 7 lymphopenia patients in the placebo group, 3 continued to have lymphopenia at day 10, whereas 9 lymphopenia patients in the treatment group, reverted to normal counts. C reactive proteins (CRP) showed a greater reduction in the treatment group. None reported adverse effects. No significant changes occurred in hematological and biochemical parameters that assessed safety. ConclusionsLNS is safe to use in COVID-19 patients and accelerated the decline in viral load, relieved symptoms, reduced CRP levels and reversed lymphopenia earlier, when compared to the placebo.

Analysis of anti-rheumatic activity of Nyctanthes arbor-tristis via in vivo and pharmacovigilance approaches.

Introduction: Rheumatoid arthritis (RA) is an immune-mediated disease associated with chronic inflammation of numerous joints. Nyctanthes arbor-tristis (NAT) is a traditional remedy for RA, a chronic inflammatory disorder. Aim: The current project aims to demonstrate the role of the NAT extracts in sub-acute toxicity, pharmacovigilance, and anti-rheumatic biomarkers. Method: Hydroethanolic extract (1:1) of plant leaves was prepared by using the reflux method. The safety of the dose was evaluated in Sprague-Dawley rats, and the anti-inflammatory effects of NAT on RA symptoms, including paw volumes, body weight, arthritic index, withdrawal latency, hematology and serological test, radiology, and histopathology, were evaluated in Freund's complete adjuvant (FCA)-induced arthritis Sprague-Dawley rat models. The inflammatory (TNF-α and COX-2) and anti-inflammatory markers (IL-10) were analyzed in control and experimental groups. Result: The study showed that 500mg/kg BW NAT leaf extract was found to be least toxic without showing any subacute toxicity symptoms. The pharmacovigilance study highlighted the potential side effects of NAT, such as drowsiness, sedation, and lethargy, at high dosages. Treatment with the plant extract mitigated paw edema, restored the immune organ and body weights, and ameliorated the level of blood parameters such as hemoglobin, red blood cells, platelets, white blood cells, aspartate aminotransferase (AST), alanine transaminase (ALT), C-reactive proteins, and rheumatoid factor. Treatment with the plant extracts also reduced the level of cyclooxygenase 2 and TNF-α and increased the level of IL-10 in the serum of arthritic rats dose-dependently. Radiographic analysis of the ankle joint showed an improvement in the hind legs. Histological examination of the ankle joints revealed that the plant extract treatment decreased pannus formation, inflammation, and synovial hyperplasia in arthritic animals. Conclusion: NAT 500mg/kg could serve as a promising therapeutic option for the treatment of inflammatory arthritis.

4 The Association Between Pro-Inflammatory Cytokines and C-Reactive Protein and the Cognitive and Neurological Outcome in Stroke Survivors: A Systematic Review

Objective:Childhood ischemic and hemorrhagic stroke is often associated with neuropsychological and cognitive deficits. Stroke induces an inflammatory response in the central and peripheral nervous systems. High levels of inflammatory markers in the plasma have been associated with poorer cognitive outcomes. The role of inflammation in neurological prognosis of stroke has been studied previously; however, there is a limited understanding of the association between inflammatory markers and neuropsychological outcome post-stroke. The present review examined the existing literature on the association between inflammatory markers and post-stroke functioning.Participants and Methods:Data bases (PsycINFO, PubMed, Web of Science, and Ovid) were reviewed in October 2020. Articles were restricted to English-language literature. Articles were included regardless of recruitment setting, number of strokes, mechanism of stroke, timing of blood collection and outcome assessment. The articles focused on patients with stroke (between the ages of 0 to 95), measured post-stroke outcome by neurological and cognitive outcome measures (i.e., it included findings on any aspect of cognition such as memory, information processing, or attention), and on pro-inflammatory cytokines and c-reactive proteins as measures of inflammation. The systematic literature search retrieved 954 articles to review against inclusion criteria. Descriptive statistics were performed using IBM SPSS 27.0 Statistics Software.Results:A total of 18 articles were included in this review. The population age ranged from 21 to 95, and, when reported (n=17), mean participant age was 66.31. Among stroke patient populations, ischemic stroke was most researched (n=15). The most widely investigated biomarkers were CRP (n=9), IL-6 (n=8), TNF- a (n=7), IL-1 b (n=5), and IL-10 (n=5). The time of initial blood collection ranged from on admission to within 3 months poststroke. Equal number of studies used both neurological and cognitive tests (n=7), or only neurological (n=7), 2 studies only used cognitive tests, and one study used all three types of measures. The most commonly used cognitive test was the Mini Mental State Examination, MMSE (n=7). The next commonly used cognitive test was the Montreal Cognitive Assessment (MoCA), (n=4). Only two studies used a comprehensive neuropsychological battery.Conclusions:There is a lack of research into diverse stroke populations. All the studies examined the association between inflammatory markers and the post-stroke outcomes in adult populations and mostly in patients with ischemic stroke. The lack of research on pediatric and young adult stroke represents a significant gap in understanding predictors of neurological and cognitive outcomes. Further, the review revealed a lack of comprehensive neurocognitive assessment post stroke, with most studies measuring neuropsychological outcome using brief cognitive instruments. Our findings highlight a critical need for addressing the above gaps to help elucidate the role of inflammatory markers in the neuropsychological prognosis of stroke in younger populations.

2-Hydroxybenzohydrazide as a novel potential candidate against nociception, inflammation, and pyrexia: in vitro, in vivo, and computational approaches.

The current study was designed to evaluate the 2-hydroxybenzohydrazide (HBH) as a drug having efficacy against pyrexia, inflammation, and nociception. Besides, the therapeutic effects of HBH on oxidative stress and C-reactive proteins were also evaluated. The pharmacological studies on HBH (20-60mg/kg) were conducted using nociception, inflammation, and pyrexia standard models. Naloxone antagonism was performed to assess the possible involvement of opioidergic mechanisms. The antioxidant study was conducted on ABTS and DPPH assays using gallic acid as a standard. Moreover, the binding capability of HBH with enzymes cyclooxygenase-I/II (COX-I/II) was determined using molecular modeling analysis. The findings indicated that the HBH dose-dependently inhibited pain, inflammation, and pyrexia. The HBH has significant anti-nociceptive and anti-inflammatory activities at 60mg/kg (***p < 0.001), similar to the lower doses of diclofenac sodium (50mg/kg) and tramadol (30mg/kg). The HBH at 60mg/kg reduced pyrexia as paracetamol (150mg/kg). The HBH at 20-60mg/kg doses declined the plasma C-reactive protein concentration. The mechanistic studies showed that the anti-nociceptive effect of HBH was antagonized by naloxone, indicating that the opioidergic mechanisms are involved. Furthermore, computational studies showed that the HBH exhibited an affinity for COX-I/II target receptors. The HBH significantly inhibited ABTS and DPPH radicals (IC50 = 33.81 and 26.74μg/ml). These results proposed that the HBH has significant antipyretic, anti-inflammatory, and anti-nociceptive activities involving opioidergic mechanism.

THE EFFECT OF ACUTE KIDNEY INJURY IN ELDERLY PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION

This study aims to determine the frequency of acute kidney injury (AKI) in patients who undergo percutaneous coronary intervention (PCI) and its impact on elderly patients. To achieve this, 80 patients admitted to Ayub Teaching Hospital from March 2019 to August 2020 for PCI were studied for AKI after the procedure. The primary endpoint was mortality from all causes, while the secondary was mortality due to major cardiovascular events. The results showed that out of the 80 patients, 29 developed AKI, with a higher incidence observed in the older age group. These patients reported a higher rate of congestive heart failure, increased C-reactive proteins, and an increased rate of major adverse cardiovascular events, which was 39.43%. Furthermore, all-cause mortality was higher in patients suffering from AKI. In conclusion, this study highlights that one-fourth of elderly patients undergoing PCI face a higher risk of AKI. Further research is required to mitigate the mortality and morbidity associated with AKI in this vulnerable group.