C-reactive Proteins Research Articles

Comparison of cyclosporine and systemic corticosteroid for treating drug reaction with eosinophilia and systemic symptoms syndrome: A retrospective 20-year single-centre study in South Korea.

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a potentially life-threatening hypersensitive disorder. Cyclosporine has been indicated for adverse cutaneous drug eruptions. However, studies evaluating its clinical effectiveness in DRESS syndrome have been rare. This study aimed to evaluate the clinical efficacy of cyclosporine in DRESS syndrome compared to that of systemic corticosteroids. In the cyclosporine group, oral cyclosporine was administered twice a day for a total of 2-3mg/kg/day for 1week, and subsequently reduced to 1-1.5mg/kg/day for extended treatment. In the corticosteroid group, intravenous or oral methylprednisolone was administered at 1-1.5mg/kg/day for 1week, with variable tapering plans. Laboratory changes before and after treatment, hospitalized days, treatment periods, and time to normalization from clinical manifestations in each group were statistically evaluated. Adverse effects of these regimens were observed during the entire treatment period. Eighty patients were enrolled in this retrospective study. The cyclosporine and corticosteroid group had 27 and 53 patients, respectively. Total leucocyte and eosinophil counts, liver enzymes, and C-reactive proteins were significantly decreased after treatment in both groups. There were no statistically significant differences observed in hospitalized days, treatment period, and time to normalization from clinical manifestations between the two groups. The corticosteroid group experienced relatively more adverse effects than the cyclosporine group. Cyclosporine was discovered to be clinically effective in DRESS syndrome and this study suggests that cyclosporine could be a feasible primary therapeutic option for DRESS syndrome.

A study to evaluate the role of biomarkers in assessing the severity of COVID-19

Objectives: COVID-19 is a systemic multiorgan disease caused by severe acute respiratory syndrome coronavirus 2, a beta-type RNA coronavirus. Different laboratory markers are implicated as an indicator of disease severity, progression, and outcome. The objectives of the study are as follows: To study the role of laboratory biomarkers in assessing the severity of COVID-19. (1) To compare the values of various biomarkers (interleukin-6 [IL-6], C-reactive proteins [CRPs], D-Dimer, S. Ferritin) in clinically categorized mild-moderate and severe COVID-19 patients. (2) To compare clinical severity with computed tomography (CT) severity score in COVID-19 patients. (3) To determine association between laboratory markers and CT severity score in COVID-19 patients. Materials and Methods: A hospital-based, retrospective, and observational study was conducted at our tertiary care center on 200 patients to assess the role of different laboratory biomarkers in COVID-19 patients. Values of laboratory markers, serum urea, serum creatinine, serum sodium, and serum potassium were compared between clinically categorized mild/moderate and severe COVID-19 patients. Non-contrast CT chest was performed and CT severity score (mild ≤ 7, moderate 8–17, and severe ≥ 18) was assessed in COVID-19 patients. Results: Levels of total leukocyte count (TLC), D-dimer, CRP, lactate dehydrogenase (LDH), S. ferritin, CK-MB, IL-6, urea, sodium, and potassium were significantly elevated in severe COVID-19 group as compared to mild/ moderate group. Chest CT Severity Score ≥18 was found in 37.1% of patients in severe group; while only in 4.2% patients in mild-to-moderate group and chest CT Severity Score and clinical severity of COVID-19 showed statistically significant agreement (P < 0.001). CRP, LDH, NTPROBNP, S. Ferritin, and CPK showed statistically significant positive correlation with CT severity score whereas sodium and potassium levels showed significant negative correlation. Conclusion: Elevated levels of TLC, D-dimer, CRP, LDH, S. ferritin, CK-MB, and IL-6 were associated with severe COVID-19 cases. NTPROBNP, CRP, LDH, D-dimer, IL-6, and S. Ferritin demonstrated better ability to predict the severity of COVID-19 in comparison to other laboratory biomarkers.

Obesity Is Associated with Increased F2-Isoprostanes and IL-6 in Black Women

Obesity affects over 40% of the adult population and is a major risk factor for morbidity and mortality due to cardiovascular disease. Black women have one of the highest prevalences of obesity, insulin resistance, hypertension, and cardiovascular events in the US. We previously found that free radical-mediated lipid peroxidation contributes to IL-6 production in dendritic cells leading to inflammation and hypertension. Thus, we hypothesized that F2-isoprostanes (F2-IsoPs), products and biomarkers of endogenous lipid peroxidation, contribute to increased inflammation and IL-6 production among obese Black women. We studied a total of 88 obese Black women of age 42.0 ± 9.8 years, weight 102 ± 16 kg, and body mass index (BMI) 37.68 ± 5.08. Systolic and diastolic blood pressure were 124 ± 14/76.2 ± 9.9 mmHg, heart rate was 68.31 ± 10.26 beats/min, and fasting insulin was 15.0 ± 8.7 uU/mL. Plasma F2-IsoPs were measured using gas chromatography/negative ion chemical ionization mass spectrometry (GC/NICI-MS). Plasma cytokines, including IL-6, IL-8, IL-10, IL-1β, TNF-a, and C-reactive proteins were measured using multiplex Luminex technology. Anthropometric measurements were performed using dual-energy X-ray absorptiometry. Using Pearson’s correlation analysis, we found that BMI was positively correlated with plasma F2-IsoPs, while inversely correlated with insulin sensitivity in obese Black women. Further, F2-IsoPs were positively correlated with inflammatory marker IL-6 levels while negatively correlated with anti-inflammatory marker IL-10. In addition, we found that plasma F2-IsoPs levels were significantly associated with reduced insulin sensitivity. These results suggest that F2-IsoPs may be associated with obesity-induced cardiovascular risk in Black women by increasing the production of inflammatory cytokine IL-6 and decreasing the production of anti-inflammatory IL-10.

Isolation of Oral Bacteria, Measurement of the C-Reactive Protein, and Blood Clinical Parameters in Dogs with Oral Tumor.

Canine oral cancers have a poor prognosis and are related to chronic inflammation. This may pose a risk of secondary bacterial infection. This study aimed to compare the bacteria isolated from oral swab samples, values of C-reactive proteins (CRPs), and clinical blood profiles of dogs with and without oral mass. A total of 36 dogs were divided in three groups: no oral mass (n = 21), oral mass (n = 8), and metastasis groups (n = 7). Significantly, both the clinical groups (the oral mass group and metastasis group) showed anemia, a decrease in the albumin-to-globulin ratio (AGR), and an increase in the neutrophil-to-lymphocyte ratio (NLR), globulin-to-albumin ratio (GAR), CRP, and CRP-to-albumin ratio (CAR) compared to the normal group. CAR showed an increasing trend in the oral mass and metastasis groups (10 times and 100 times, respectively) compared to the no oral mass group (P < 0.001). Neisseria spp. (20.78%) was the main isolated bacteria in all groups. The main genera in the no oral mass group were Neisseria spp. (28.26%), Pasteurella spp. (19.57%), and Staphylococcus spp. (19.57%). Neisseria spp., Staphylococcus spp., Klebsiella spp., and Escherichia spp. were found equally (12.5%) in the oral mass group. Escherichia spp. (26.67%), Pseudomonas spp. (13.33%), and Staphylococcus spp. (13.33%) were the main genera in the metastasis group. Interestingly, Neisseria spp. decreased in the clinical groups (Fisher's exact = 6.39, P=0.048), and Escherichia spp. increased in the metastasis group (Fisher's exact = 14.00, P=0.002). The difference of oral bacteria in clinical dogs compared to healthy dogs may be related to microbiome alterations, and both the clinical groups showed the increment of inflammatory biomarkers. This suggested that further studies should be conducted on the correlation between the specific bacteria, CRP, blood clinical parameters, and type of canine oral mass.

Association Between Mean Platelet Volume And Disease Activity In Patients With Psoriatic Arthritis

Background: Mean platelet volume is an important marker that shows the activation and function of the platelet which is effective in the inflammatory process. Aim of the study: To show the relationship between mean platelet volume and disease activity score in psoriatic arthritis patients (PsA). Methods: a cross-sectional study was done. A total of 90 patients participated in the study. The sample was collected over 6 months. Mean platelet volume was measured and correlated with disease activity score, and the relation between mean platelet volume with other disease activity markers like erythrocyte sedimentation rate (ESR) and C-reactive proteins (CRP)was determined. The serum of (cholesterol, tri-glycerides, low density lipoproteins, and high density lipoproteins) were estimated and correlated with DAPSA scores. Results: The mean (SD) of MPV was 10.4fl .It is evident in Psoriatic arthritis patients that around two thirds (64.9%) of patients were with high MPV and 39.4% of patients were with normal MPV. There is statistically significant positive correlation between the MPV and the DAPSA score, and the positive significant correlation between disease activity score with ESR, and CRP. Also, there was a positive correlation between s. cholesterol, s. triglyceride, LDL and DAPSA score while a negative significant correlation was found between DAPSA score and HDL. Conclusion: Higher disease activity in PsA patients is associated with correspondingly high MPV and high level of inflammatory markers like ESR and CRP, and lipid profiles.

Hue-Recognition Strategy-Based Immunoassay Using Functionalized Dendritic Silica Colloids and Gold Nanoclusters for Point-of-Care Testing of C-Reactive Proteins

Considering that hue-recognition has drawn increasing research interests for visual detection because of its high accuracy and flexible analysis modalities, the exploration of a rational hue-recognition sensing system is highly demanded. Here, we report a hue-recognition-based lateral flow immunoassay (HLFIA) by ratiometric modulation of emission from two nanoprobes, in which red-emitting ruthenium(II)-doped dendritic silica colloids and green-emitting gold nanoclusters function as reporter and reference, respectively. The HLFIA strip can generate a visually discernible green-to-orange-red color gradient alternation, enabling the naked-eye semiquantitative inspection of successive C-reactive protein (CRP) concentration and concentration intervals (0–50, 50–150, and 150–500 ng mL–1) with a visual detection limit of 10 ng mL–1. By integrating with a customized smartphone-based portable imaging device and RGB color space recognition, the precise quantification of CRP can be achieved with a linear range of 0–100 ng mL–1 and a limit of detection of 0.64 ng mL–1. The HLFIA strip is robust and validated for CRP detection in real serum, holding great promise for noninstrumental and deprofessionalized point-of-care immunoassay of biomarkers.

Korelasi Temuan Limfosit Plasma Biru dengan Kadar C-Reaktif Protein sebagai Penunjang dalam Diagnosis Demam Berdarah Dengue

Dengue Hemorrhagic Fever diagnosis is supported by examining Blue Plasma Lymphocytes and C-Reactive Protein, in which Blue Plasma Lymphocytes can distinguish Dengue and Non-Dengue infections. At the same time, the C-Reactive Proteins are used to see the presence of inflammation due to infections such as Dengue Virus infection. Objectives: To analyzed the correlation of the number of Blue Plasma Lymphocytes with C-Reactive Protein (CRP) levels in Dengue Hemorrhagic Fever patients. Methods: This study was analytical observational research with a cross-sectional design. The sample used was a patient diagnosed with DHF with a positive Nonstructural protein 1 (NS1) or Rapid Diagnostic Test (RDT) IgG/IgM result. The data was collected and analyzed using Spearman's rank statistical test. Results: The average number of Blue Plasma Lymphocytes in positive samples was 8%, with the number of negative results, namely 4 (13.33%) samples and 26 (86.67%) samples with positive Blue Plasma Lymphocyte results. The average level of C–Reactive Protein in the positive samples was 29.36 mg/L, with results that had normal levels were 11 (36.67%) samples and 19 (63.33%) samples with abnormal C-Reactive Protein levels. Spearman's Rank statistical test results obtained a value of p = 0.000 &lt; 0.05, indicating a correlation between the number of Blue Plasma Lymphocytes and C–Reactive Protein levels in Dengue Hemorrhagic Fever patients. Conclusion: The more Blue Plasma Lymphocytes, the higher C–Reactive Protein levels in Dengue Hemorrhagic Fever.Keywords: blue plasma lymphocytes, C–reactive protein, dengue hemorrhagic fever

A Simple Label-Free Aptamer-Based Electrochemical Biosensor for the Sensitive Detection of C-Reactive Proteins

The level of C-reactive protein (CRP) in the human body is closely associated with cardiovascular diseases and inflammation. In this study, a label-free functionalized aptamer sensor was attached to an electrode trimmed with in-gold nanoparticles and carboxylated graphene oxide (AuNPs/GO-COOH) to achieve sensitive measurements relative to CRP. Gold nanoparticles were selected for this study due to super stability, remarkably high electrical conductivity, and biocompatibility. In addition, carboxylated graphene oxide was utilized to promote the anchorage of inducer molecules and to increase detection accuracies. The sensing signal was recorded using differential pulse voltammetry (DPV), and it produced a conspicuous peak current obtained at approximately -0.4 V. Furthermore, the adapted sensor manifested a broad linear span from 0.001 ng/mL to 100 ng/mL. The results also demonstrated that this aptamer sensor had superior stability, specificity, and reproducibility. This aptamer-based electrochemical sensor has enormous potential in complex application situations with interfering substances.

Predictors for Disease Severity in Covid-19

Background: Coronavirus disease 2019 affects millions of people to date. Age, comorbidities, fever, shortness of breath, and different Laboratory parameters like serum forum, C- reactive protein, and lactate dehydrogenase level are the important predictors for the severity of the disease. Material and methods: This case-control type study was conducted in April to June2021 in Khyber Teaching Hospital Peshawar. PCR-detected coronavirus disease 2019 patients were assessed. These patients were divided into four groups based on presenting symptoms, image findings for pneumonia, oxygen saturation, and ventilatory support. These groups were compared for different parameters, including the presenting symptoms and laboratory parameters. Results: Out of 140 patients, 54.3% were males. There was a statistically significant difference (p&lt; 0.05) in presenting complaints like fever, shortness of breath, body aches, loss of taste, anorexia, and laboratory parameters like serum ferritin, total leucocyte count, lactate dehydrogenase, C-reactive proteins, and d-dimers in these groups based on the severity of the disease. These parameters were independent predictors for disease severity in Coronavirus disease 2019. Further studies are recommended with a large sample size for more evaluation of these associations. Practical Implication: This study will be helpful in determing the disease severity prediction in patients suffering from COVID-19. For community benefit, this study will be important as it helps the people to determine either they are sufferimg from COVID-19 or not. It will also help them to take the necessary precautionary measures. Conclusion: The study concluded that there are several clinical predictors of COVID -19 like fever, old age anorexia, loss of taste, shortness of breath, and muscle aches. In addition, some laboratory markers such as serum ferritin, CRP level, total leucocyte count, and LDH are responsible for indicating the disease severity. Earlier disease prediction results in timely and early intervention, thereby helps in the prevention of progression toward critical stage. Keywords: Coronavirus disease 2019 (COVID-19), disease severity, mild and moderate disease, severe and critical disease

TMEM173 rs7447927 genetic polymorphism and susceptibility to severe enterovirus 71 infection in Chinese children.

This study was designed to explore the association between the TMEM173 polymorphism (rs7447927) and the severity of enterovirus 71 (EV71) infection among Chinese children. The TMEM173 polymorphism was identified in EV71-infected patients (n = 497) and healthy controls (n = 535) using the improved multiplex ligation detection reaction (iMLDR). The interferon-α (IFN-α) serum levels were detected using enzyme linked immunosorbent assay (ELISA). The frequencies of the GG genotype and G allele of TMEM173 rs7447927 in the mild EV71 infection and severe EV71 infection groups were markedly higher than those in the control group. The GG genotype and G allele frequencies in severely infected EV71 patients were significantly higher than those in mildly infected EV71 patients. Severely infected EV71 patients with the GG genotype had higher white blood cell counts (WBC), and C-reactive proteins (CRP), and blood glucose (BG) levels, longer fever duration, higher vomiting frequency, spirit changes, and electroencephalography (EEG) abnormalities. IFN-α serum concentration in severely infected patients was significantly higher than in the mildly infected group. The IFN-α concentration in the GG genotype was significantly higher compared with those in the GC and CC genotypes in severe cases. The TMEM173 rs7447927 polymorphism was associated with EV71 infection susceptibility and severity. The G allele and GG genotype are susceptibility factors in the development of severe EV71 infection in Chinese children.

Combining Complete Blood Count with Differential Count; C-Reactive Protein and Band Neutrophils in Diagnosis of Early onset Neonatal Sepsis

Aim: To assess the diagnostic accuracy of complete blood count with band versus total neutrophil ratio and C-reactive proteins as an efficient analytical procedure for determining early onset sepsis in neonates. Study design: Cross sectional analytical study Place and duration of study: Department of Paediatric Medicine, Abbas Institute of Medical Sciences Muzafarabad, AJ Kashmir from 01-02-2022 to 31-07-2022. Methodology: Fifty patients were enrolled. Coulter counter was used for analyzing leucocytes of the neonates. Thin film-smears were generated by the laboratory scientist for identifying band neutrophils separately from mature neutrophils. C-reactive proteins level &lt;5mg/dl was considered as negative. Thio-glycate-oxide in liquid form was used for 2ml neonatal blood culture analysis mixed in the 20ml medium at 36 degree celsius. Results: There were 28 (56%) males and 22 (44%) females. The mean age of the neonates was 1.6± 0.77 days. The mean weight of the neonates was 2.4±0.51kg with a range of 4-1.2kg. A variance of band versus total neutrophil ratio was significantly higher in cultures which were positive than negative such as 70% vs 25%. There was also significant percentage of C-reactive proteins positive in positive sepsis cultures in comparison to negative blood culture. Conclusion: A combination of complete blood count with differential count, white blood cell analysis with band versus total neutrophil ratio and c-reactive proteins is an efficient early analytical procedure for determining early onset sepsis in neonates as gold standard test blood culture is time taking. Key Words: Complete blood count, C-reactive protein, Total neutrophils ratio, Early onset neonatal sepsis.

The prospective relationship between subjective aging and inflammation: Evidence from the health and retirement study.

This study tested the prospective associations and potential mediators between subjective aging, indexed by subjective age and self-perceptions of aging (SPA), and a range of inflammatory markers, including C-reactive proteins (CRP) and pro- and anti-inflammatory cytokines among older adults. Participants (N=6099, 59% women, age range=50 to 94, Mean Age=65.32, SD=8.85) were drawn from the Health and Retirement Study. Subjective age, SPA, and demographic factors were assessed in 2008/2010. Assessments of soluble transformation growth factor-beta 1 (sTGF-β1), interleukin 10 (IL-10), interleukin-1 receptor antagonist (IL-1Ra), interleukin 6 (IL-6), soluble tumor necrosis factor receptors (sTNFR1), and high sensitivity CRP (hsCRP) were measured in 2016. Potential mediators (body mass index, disease burden, physical inactivity, and depressive symptoms) were asssessed at baseline and in 2012/2014. Linear regression analyses indicated that an older subjective age and negative SPA were related to higher level of IL-10, IL-1Ra, IL-6, sTNFR1 and hsCRP. These associations were mediated by higher disease burden and physical inactivity. Negative SPA (but not subjective age) was associated with lower sTGF-β1. The link between subjective aging and inflammatory markers was relatively independent from chronological age. The present study provides new evidence that subjective aging is prospectively associated with inflammation, including systemic inflammation and pro-and anti-inflammatory cytokines.

The Diagnostic Value of Circulating Biomarkers and Role of Drug-Coated Balloons for In-Stent Restenosis in Patients with Peripheral Arterial Disease.

Peripheral arterial disease (PAD) is an increasingly pathological condition that commonly affects the femoropopliteal arteries. The current fashionable treatment is percutaneous transluminal angioplasty (PTA), often with stenting. However, the in-stent restenosis (ISR) rate after the stenting of the femoropopliteal (FP) district remains high. Many techniques have been proposed for the treatment of femoropopliteal ISR, such as intravascular brachytherapy, laser atherectomy, second stenting and drug-coated balloons angioplasty (DCB). DCB showed a significantly lower rate of restenosis and target lesions revascularization (TLR) compared to conventional PTA. However, further studies and multi-center RCTs with dedicated long-term follow-up are needed to verify the true efficiency of this approach. Nowadays, the correlation between PAD and inflammation biomarkers is well known. Multiple studies have shown that proinflammatory markers (such as C-reactive proteins) and the high plasma levels of microRNA could predict the outcomes after stent placement. In particular, circulating microRNA-320a, microRNA-3937, microRNA-642a-3p and microRNA-572 appear to hold promise in diagnosing ISR in patients with PAD, but also as predictors of stent patency. This narrative review intends to summarize the current knowledge on the value of circulating biomarkers as predictors of ISR and to foster the scientific debate on the advantages of using DCB in the treatment of ISR in the FP district.

Vitamin D modulates systemic inflammation in patients with severe COVID-19

AimsThe ability of vitamin D (VitD) to modulate immune responses in the clinical setting of COVID-19 infection is not well investigated. This study aimed to evaluate the ability of VitD to attenuate inflammatory responses in patients with severe COVID-19. Materials and methodsBlood samples and nasopharyngeal swabs were obtained from patients with severe COVID-19 who had been treated (20 patients), or not (25 patients), with VitD, during their stay in the intensive care unit. Western blotting was used to evaluate the expressions of STAT3, JNK and AKT signaling pathways and ELISA was used to measure levels of IL-6, IL-17, and IL-1β in blood of these patients. Key findingsReduced levels of STAT3, JNK and AKT pathways and lower levels of proinflammatory cytokines such as IL-6, IL-17, and IL-1β were observed in VitD treated patients (50,000 IU of cholecalciferol weekly for 3 weeks), and in vitro following treatment of poly I:C stimulated PBMCs with VitD (50 nM of calcitriol). Moreover, lower circulatory levels of these proinflammatory cytokines following treatment with VitD were associated with lower serum levels of COVID-19-related severity markers such as D-dimer and C-reactive proteins (P < 0.001) which in overall resulted in shorter length of ICU stay for VitD treated compared to untreated patients (18 days for VitD treated vs. 28 days for VitD untreated; P = 0.01). SignificanceThis study reveals that VitD plays immunomodulatory role during COVID-19 infection, which further emphasizes the importance of maintaining a normal level of this vitamin for the prevention of hyperinflammatory conditions associated with COVID-19.

A novel intervention altering disease course in children with dengue: an observational study

Background: Dengue fever has emerged as a global public health problem in recent decade, clinical spectrum of disease ranges from mild fever to life threatening dengue shock syndrome. The disease is characterized by thrombocytopenia, hypoalbuminemia and increased capillary permeability leading to third space fluid loss viz ascites, pleural effusion pericardial effusion. This study aims to show that therapeutic intervention (viz albumin transfusion under supervised diuretic cover) during onset of critical phase significantly reduces progression of disease, morbidity and mortality.Methods: In this observational study enrolled confirmed dengue cases, requiring hospitalization. Basic lab parameters viz complete blood count, liver functions, renal functions, C-reactive proteins, chest X-ray were obtained. Pre requisites prior to albumin infusion were; urine output &gt;0.8 ml/kg/hour, normal renal functions and no shock/hypotension.Results: We found improved outcomes using this intervention in dengue patients early identification of onset of critical phase and intervening during that phase significantly reduced the morbidity/mortality. Out of remaining 78 cases, 24 children developed critical phase, they were managed and transfused albumin infusion under diuretic cover. None of children who received albumin transfusion had mortality.Conclusions: Early identification of onset of critical phase and intervening during that phase significantly reduced the morbidity/mortality as well duration of ICU/hospital stay. We believe albumin transfusion under supervised diuretic cover, also preventing development of major life-threatening complications viz dengue shock syndrome.

Proteomic analysis of Malaysian Horseshoe crab (Tachypleus gigas) hemocytes gives insights into its innate immunity host defence system and other biological processes.

Horseshoe crabs are one of the most studied invertebrates due to their remarkable innate immunity mechanism and biological processes. In this work, the proteins of the lipopolysaccharides (LPS)-stimulated and non-stimulated hemocytes of Malaysian Tachypleus gigas were profiled using LC-MS/MS. A total of 154 proteins were identified in both types of samples. Additionally, seventy-seven proteins were commonly found in both conditions, while 52 and 25 proteins were uniquely found in the LPS-stimulated and non-stimulated hemocytes, respectively. ATP-dependent energy-generating proteins such as actins and BLTX actin-related proteins were detected in both stimulated and non-stimulated T. gigas hemocytes, but more of such proteins were found in the former type. Proteins such as tachylectin-2, coagulogen, c-reactive proteins, histones, hemocyanin, and DNA polymerase, which play key roles in the organism’s innate immunity, were differentially expressed in the hemocytes following LPS challenge. In conclusion, the proteins identified in the hemolymph of T. gigas are vital for the organism’s molecular functions, biological processes, and activation of innate immunity.

EP-623 Can we count on serum hyperbilirubinemia to predict acute complicated appendicitis?

Abstract Introduction and Aims Acute appendicitis (AA) is usually a clinical diagnosis and surgical intervention is typically a preferred choice to avoid potentially lethal complications. The aim of this study was to evaluate hyperbilirubinemia as a predictor of complicated acute appendicitis (CA). Material and Methods A retrospective analysis of patients who underwent surgery for AA in a district general hospital in the UK from Jan 2018 to April 2019. It includes White cell count (WCC), C- reactive proteins (CRP), and liver function tests (LFTs). Results A total of 236 (Median age = xx, IQR , F: M = 1:1.4). The frequency of normal, uncomplicated, and complicated appendicitis was 25(10.6%), 161 (68.2%), and 50 (21.2%), respectively. There were significant differences in the rate of negative appendicectomy in females (9.3% F vs 1.3% M, p-VALUE=0.0001). The bilirubin levels mirrored the CRP levels and showed statistically significant difference in patients with normal versus uncomplicated/complicated appendicitis (Bilirubin = 8.36 in normal versus 12.39 in uncomplicated and 16.44 in complicated appendicitis, p value=0.0001; CRP= 34.09 in normal versus 44.38 in uncomplicated and 114.34 in complicated appendicitis, p value=0.0001). The Neutrophil count showed increased differences between normal and uncomplicated/complicated appendicitis (Neutrophil 8.4 vs 11.2, p-value0.016; WCC 11.8 vs 14.1, p-value=0.003). In the negative appendicectomy group, 17/25 had preoperative imaging. In 7/25 (28%) imaging was suspicious of appendicitis, 10/25 (40%) had normal findings and 8/25 patients did not have any prior imaging. Conclusion SB had low sensitivity and high specificity as compared to CRP and WCC for AA.

Anti-inflammatory potentials of ethanolic leaf extract of Gongronema latifolium in streptozotocin induced diabetic rats

Introduction: Inflammation due to diabetes mellitus has been understudied. Gongronema latifolium (GL) is reported to have anti-inflammatory potentials. This work was designed to evaluate the effect of ethanolic leaf extract of Gongronema latifolium on some inflammatory markers in Streptozotocin (STZ)-induced diabetic rats. Materials and methods: 40 Wistar rats of both sexes (150 g-200 g) were divided into 5 groups of eight (8) rats each. Group 1; control received normal saline placebo orally. Group 2; GL only received 200 mg/kg of GL orally. Group 3 DM only received 65 mg/kg bw of STZ intraperitoneally for two days with an interval of one day in between. Group 4; DM + GL received 65 mg/kg bw of STZ + 200mg/kg bw of GL. Group 5; DM + Insulin received 65mg/kgbw of STZ followed by 10 IU/kgbw of insulin subcutaneously. For further inflammatory study, paw oedema was induced by sub-plantar injection of 2% formalin in two groups before and after administration of 200 mg/kg bw of GL daily for 7 days. Blood samples were collected via cardiac puncture for biochemical analysis. Results: Results from this study showed a significant (p&lt;0.05) increase in blood glucose DM group, compared to the control. Intervention with GL and insulin significantly reduced the glucose level towards normal. Interleukin-6 concentration and C-reactive proteins were significantly (p&lt;0.01) higher in DM group compared with the GL and control groups. Paw oedema size was significantly (p&lt;0.05) increased in the formalin treated group compared with the control. Pretreatment and post treatment with GL significantly (p&lt;0.05) reduced the paw oedema size. Conclusion: In conclusion, GL (like insulin) has hypoglycemic and anti-inflammatory potentials.

Paediatric Acute Appendicitis: A Comparison of Diagnostic Accuracy of Three Pre-operative Diagnostic Modalities.

The diagnosis of acute appendicitis (AA) is usually clear cut but sometimes there is atypical presentation of this condition in children. There is a need to determine and compare the diagnostic accuracy of these three pre-operative diagnostic modalities: Paediatric Appendicitis Score (PAS), abdominal ultrasonographic scan (USS) findings, and serum C-reactive proteins (CRPs). The objective of this study was to determine the diagnostic accuracy of the three diagnostic modalities and to compare each diagnostic test result with the histopathological results of the appendix specimens. This was a prospective cross-sectional study that involved children aged 4-15 years with suspected AA who presented at the emergency paediatric unit of a tertiary health care hospital in North Central, Nigeria. The PAS, quantitative serum CRP, and abdominal USS were performed for all eligible patients. A total of 43 patients were included in this study. Forty appendicectomy specimens (93%) were histologically confirmed to be AA and three appendicectomy specimens (7%) were normal appendix. The diagnostic accuracy values of PAS, abdominal USS, and CRP were 95.3%, 93.0%, and 90.7%, respectively. This study demonstrated that PAS, abdominal USS, and serum CRP provided useful diagnostic accuracy for AA in children.

Clinical Presentation and Outcome of Covid-19 Infection in Patients Undergoing Maintenance Hemodialysis

Background: WHO declared Covid-19 a pandemic disease; although 80% of patients with CoV-2 infection have no or mild symptoms, the remaining 20% of patients develop complications. In patients undergoing dialysis, mortality could be higher than that in the general population. This study was conducted to assess the frequency, clinical presentation, and outcome of COVID-19 infection in patients of end-stage renal disease (ESRD) on maintenance hemodialysis.&#x0D; Methodology: This Cross-sectional study was conducted at Department of Nephrology, Jinnah Postgraduate Medical Centre, Karachi, from April to September 2020. This study included 130 patients of either gender of End-Stage Renal Disease on maintenance hemodialysis for at least 3 months. Two Samples for COVID-19 PCR were taken through nasal swab. Blood samples were collected for hemoglobin level, total and differential leucocyte count, platelet count, intact Parathyroid hormone, vitamin D level, Urea, Creatinine, ferritin, transferrin saturation, procalcitonin, D-Dimer, C-reactive proteins, and lactate dehydrogenase. Radiological assessment was done by X-ray Chest. Urea reduction ratio and single pool Kt/V was used for assessment of adequacy of hemodialysis.&#x0D; Results: Out of 130 patients on hemodialysis, COVID-19 was detected in 52 patients, of which males were 69.2% and females were 30.8%. The most common presentation was shortness of breath (28.8%), followed by cough (19.2%). Home isolation was advised to 38.5% while noninvasive ventilation was given to 34.6%. Mechanically ventilated patients were 26.9%. There were 63.5% patients who recovered and were discharged from the hospital or home-isolated, while 19 patients died (36.5%).&#x0D; Conclusion: COVID-19 pandemic has high chances of infection with increased mortality in people with chronic diseases, especially those having ESRD on hemodialysis. This spreading of infection can be hampered with standard measures of disinfection in centers, social distancing in patients, and the use of a face mask.&#x0D; Keywords: Covid-19, Cough, Hemodialysis, Home isolation, Ventilation&#x0D;