CRP Levels Research Articles

Efficacy and Safety of GLP-1 Agonists on Metabolic Parameters in Non-diabetic Patients with Inflammatory Bowel Disease.

Obesity in patients with IBD is increasing, accompanied by an increase in metabolic comorbidities. Although GLP-1 agonists have shown promise in weight reduction, their efficacy and safety in patients with IBD are underexplored. This study evaluated the impact of GLP-1-based therapies on weight loss and metabolic parameters in non-diabetic patients with IBD. We conducted a single-center observational cohort study that included adult patients with IBD who were started on GLP-1-based therapy (semaglutide or tirzepatide) for weight loss from January 2021 to April 2024. The primary outcomes were changes in BMI and total body weight. Secondary outcomes included tolerability, safety, and changes in metabolic risk factors. The study included 36 patients with IBD, predominantly female (64%), with a median age of 45.5 years (IQR 41-51.5 years). The majority (67%) had Crohn's disease (CD) and on advanced therapy (86%). BMI significantly decreased from 34.0 (IQR 31.0-38.2) to 31.0 (IQR 29.0-36.1) with GLP-1-based therapy (p < 0.0001). Total body weight (TBW) significantly decreased by a median of 8.15 kg (IQR 15.9-2.2 kg; p < 0.0001). Although a decrease in total cholesterol and glycated hemoglobin was seen, this was not statistically significant (p = 0.0634 for total cholesterol, p = 0.0536 for glycated hemoglobin). No significant changes were observed in ALT or CRP levels. The most common side effects were nausea (31%) and constipation (25%). Semaglutide and tirzepatide can effectively reduce BMI in non-diabetic patients with IBD with manageable side effects. However, further studies are required to explore the long-term safety of GLP-1 agonists in the IBD population.

Impact of remimazolam on postoperative inflammatory markers and complications in thoracoscopic pulmonary lobectomy patients: A retrospective analysis.

Remazolam is widely used for procedural sedation in intensive care units. It has been shown to have anti-inflammatory and organ-protecting properties. However, the changes in inflammatory markers and analgesic effects of remazolam after thoracoscopic pulmonary lobectomy remain unclear. This study aims to assess the effects of the novel drug remimazolam on inflammatory factor levels and postoperative complications in thoracoscopic pulmonary lobectomy patients, providing a scientific basis for clinical use. This retrospective study analyzed 200 thoracoscopic pulmonary lobectomy patients, who were divided into a control group and a remimazolam group based on their anesthesia method. Patients in ramazolam group were anesthetized with ramazolam, while patients in control group were anesthetized with propofol. All patients were performed by the same physician team and anesthesia team. Inflammatory factors (including interleukin-6 [IL-6], C-reactive protein [CRP], including interleukin-8) were measured preoperatively and postoperatively, and postoperative complication rates were compared between the 2 groups. The levels of IL-6 and CRP were significantly higher in the remimazolam group at 7 days postoperatively compared to the control group. No significant differences were observed in preoperative inflammatory factors or postoperative including interleukin-8 levels between the 2 groups. Additionally, there were no significant differences in the overall incidence of postoperative complications or in specific complications such as pulmonary infection, atelectasis, subcutaneous emphysema, pneumothorax, surgical site infection, and arrhythmia. Patients receiving remimazolam had higher postoperative IL-6 and CRP levels compared to the control group, without an increase in postoperative complications. In clinical use, attention should be paid to the control of inflammatory indicators in patients using remazolam. However, due to potential confounding factors and the retrospective design, we cannot establish a causal relationship between remimazolam and elevated inflammatory markers. These findings suggest a possible association that requires cautious interpretation. Further research is needed to assess the clinical relevance and explore the underlying mechanisms.

Early mNGS testing for diagnose and prognostic prediction of early onset pneumonia among in-hospital cardiac arrest patients undergoing extracorporeal cardiopulmonary resuscitation

ObjectivesMetagenomic next-generation sequencing (mNGS) is emerging as a novel diagnostic technology for various infectious diseases; however, limited studies have investigated its application in etiological diagnosis of early onset pneumonia (EOP) among patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR) following in-hospital cardiac arrest (IHCA), The clinical significance of early mNGS in predicting short-term prognosis of IHCA patients after ECPR remains unclear.MethodsThis retrospective study included 76 patients with IHCA who underwent ECPR at the First Affiliated Hospital of Zhengzhou University from January 2018 to December 2022. Baseline characteristics and etiological data of all patients during their hospitalization were collected and statistically analyzed. The primary outcome of this study was the diagnosis of EOP, while the secondary outcomes included successful extracorporeal membrane oxygenation (ECMO) weaning and survival at discharge. Additionally, the characteristics of bronchoalveolar lavage fluid (BALF) flora in these patients were compared by analyzing both mNGS results and culture results.ResultsMultivariate logistic regression were employed to analyze the predictors of ECMO weaning failure, mortality at discharge, and the incidence of EOP. Ultimately, patients with lower SOFA scores on admission [OR (95%CI): 1.447 (1.107-1.890), p=0.007] and those who underwent early mNGS testing within 48 hours after ECPR [OR (95%CI): 0.273 (0.086-0.865), p=0.027] demonstrated a higher probability of successful weaning from ECMO. Patients with higher SOFA scores on admission [OR (95%CI): 2.404 (1.422-4.064), p=0.001], and elevated lactate levels [OR (95%CI): 1.176 (1.017-1.361), p=0.029] exhibited an increased likelihood of mortality at discharge. Furthermore, early mNGS detection [OR (95%CI): 0.186 (0.035-0.979), p=0.047], and lower CRP levels (48h-7d after ECMO) [OR (95%CI):1.011 (1.003-1.019), p=0.006] were associated with a reduced incidence of EOP. In addition, the pathogens detected by mNGS within 48 hours after ECPR were mainly oral colonizing bacteria and viruses, and viruses were in the majority, while all BALF cultures were negative. In contrast, between 48 hours and 7 days after ECPR, BALF cultures were positive in all EOP patients.ConclusionsEarly mNGS testing to identify microbial flora facilitates timely adjustment of antibiotic regimens, thereby reducing the incidence of EOP and improving short-term prognosis in patients undergoing ECPR following IHCA.

Protective Role of Anthraquinone Purpurin Against Cardiotoxicity Induced by Isoproterenol in Adult Wistar Rats

Background Purpurin are naturally occurring anthraquinones derived from the roots of Rubia species. Purpurin is a red-colored bioactive compound commonly used as a food colorant. In ancient times, Rubia species plants were used in Chinese medicine to treat rheumatoid arthritis. Research studies have proven purpurin exerts antimicrobial, neuromodulatory, antigenotoxic, anti-inflammatory, anticancer, and antioxidant effects. The present investigation was proposed to evaluate the efficacy of purpurin against myocardial infarction in rats. Materials and Methods Purpurin was pretreated in healthy adult male rats and subjected to a myocardial infarction with isoproterenol to assess the cardioprotective effect of purpurin. CRP, total protein, and uric acid levels were quantified to analyze the efficacy against myocardial infarction. Cardiac functional markers and antioxidant levels were measured to evaluate the role of purpurin on isoproterenol-induced myocardial infarction. Further to prove the cardioprotective efficacy of purpurin cardiac tissue ATPases and electrolytes were assessed in the experimental animals. The anti-inflammatory property of purpurin was analyzed by quantifying proinflammatory cytokines. Histopathological analysis of cardiac tissue was to confirm the protective effect of purpurin against isoproterenol-induced myocardial infarction. Results The present investigation demonstrated the significant protective effect of purpurin by decreasing the levels of CRP, uric acid levels, and total protein levels in myocardial infarction-induced rats. It restored the cardiac functional markers and glutathione system in the cardiac tissue of myocardial infarction-induced rats. It increased the levels of cardiac ATPases and reinstated the electrolytes in the cardiac tissue of myocardial infarction-induced rats. Purpurin significantly demonstrated an anti-inflammatory and cardioprotective effect that was evidenced with histopathological analysis. Conclusion Our findings prove purpurin suppresses the proinflammatory response of isoproterenol treatment and exerts a cardioprotective effect in myocardial infarction-induced rats.

Potential biomarkers in Behçet’s disease: monocyte, neutrophil, platelet, and C-reactive protein to albumin ratios

IntroductionThe objective of this cross-sectional study was to evaluate the monocyte to albumin ratio (MAR), neutrophil to albumin ratio (NAR), platelet to albumin ratio (PAR), and C-reactive protein to albumin ratio (CAR) as potential biomarkers for disease activity in patients with Behçet’s disease (BD).Material and methodsBoth BD cases and healthy controls were enrolled in this study. Demographic characteristics, disease duration, and current medications were recorded for all participants. The BD Current Activity Form (BDCAF) was utilized to assess the activity of BD. Additionally, ery­throcyte sedi­mentation rate, CRP, and serum albumin levels were measured. The MAR, NAR, PAR, and CAR were compared between the two groups. Correlation analysis and receiver operating characteristic curves (ROC) were employed to establish cut-off points for these biomarkers.ResultsIn the study, both BD cases and 45 controls were included, totaling 90 participants. Significant differences were observed in the mean ±SD values of ESR, MAR, PAR, CAR, and albumin between the BD cases and controls (&lt;i&gt;p&lt;/i&gt; = 0.008, &lt;i&gt;p&lt;/i&gt; = 0.009, &lt;i&gt;p&lt;/i&gt; = 0.029, &lt;i&gt;p&lt;/i&gt; = 0.034, &lt;i&gt;p&lt;/i&gt; = 0.006, respectively). However, despite these differences, no significant correlation was detected between BDCAF and the parameters under investigation. The cutoff point was determined as 150.59 (sensitivity 46.67%, specificity 82.22%, &lt;i&gt;p&lt;/i&gt; = 0.008, AUC = 0.655) for MAR; as 62,013.73 (sensitivity 60.00%, specificity 66.67%, &lt;i&gt;p&lt;/i&gt; = 0.03, AUC = 0.629) for PAR; and as 1.16 (sensitivity 35.56%, specificity of 95.567%, &lt;i&gt;p&lt;/i&gt; = 0.03, AUC = 0.629) for CAR. The results were not able to define any cut-off points for active-inactive BD.ConclusionsSignificantly higher levels of MAR, PAR, and CAR were observed in patients with BD than controls. Monocyte to albumin ratio, PAR, and CAR were notably elevated in patients with active BD. This finding suggests that these parameters possess discriminative ability and could potentially serve as biomarkers to aid in the clinical evaluation of BD.

Logistic Regression Model on Nutritional Status Based on Body Mass Index (BMI) in Women of Reproductive Age (WRA) in Indonesia

The aggregate analysis of Riskesdas data in Indonesia revealed that nearly all provinces face a serious double burden of malnutrition. Both undernutrition and overnutrition negatively affect the quality of human resources, especially when they occur in adolescent girls, Women of Reproductive Age (WRA), and pregnant and breastfeeding women, as this can lead to intergenerational nutritional problems. Body Mass Index (BMI) is a nutritional status measurement technique recommended by WHO. Nutritional problems occur when BMI is abnormal or not ideal, categorized as underweight (&lt;18.5 kg/m²), pre-obesity (25-29.9 kg/m²), obesity class I (30-34.9 kg/m²), obesity class II (35-39.9 kg/m²), and obesity class III (&gt;40 kg/m²). Data from laboratory results completed up to 2017, based on selected samples from the 2013 Basic Health Research (Riskesdas), were used to assess the nutritional status of the Indonesian population. This study used 9,418 respondent data samples from 33 provinces in Indonesia. Logistic regression analysis was applied because the response variable in this study is binary, representing ideal BMI (1) and non-ideal BMI (0). The independent variables used in this study include Hemoglobin level, Ferritin level, CRP level, age group, physical activity, living location, marital status, education, and risky food consumption patterns. All independent variables are categorical. The study found that the factors influencing nutritional status based on BMI in WRA are Hemoglobin level, Ferritin level, CRP level, age, and location. The resulting logit model is logit (π)=0.27695-0.1491 (Non-anemic Hemoglobin level)-0.1721 (Normal Ferritin level)+0.741 (Non-infectious CRP level)-0.2933 (Adult age group)-0.0976 (rural location). logit (π)=0.27695-0.1491 (Non-anemic Hemoglobin level)-0.1721 (Normal Ferritin level)+0.741 (Non-infectious CRP level)-0.2933 (Adult age group)-0.0976 (rural location). The largest odds ratio The largest odds ratio was produced by the CRP level variable, indicating that CRP level is the most influential factor affecting nutritional status based on BMI in WRA, where non infectious CRP compared to infectious CRP increases the likelihood of WRA having an ideal BMI.

Prediction of electroconvulsive therapy response and remission in late-life depression: a review.

Electroconvulsive therapy is an effective and well-tolerated antidepressant treatment for the elderly population. The place of electroconvulsive therapy in the treatment sequence for depression in the elderly is currently not well established. This review aims to identify the factors that contribute to a positive response and remission in elderly patients with depression undergoing electroconvulsive therapy treatment. We searched five bibliographic databases (Medline ALL Ovid, Embase.com, APA PsycInfo Ovid, Cochrane Library Wiley and Web of Science Core Collection) for articles published between 1995 and June 2023. Of the 2149 articles screened, 19 were included in the review. No significant associations were found between remission and/or response and salivary cortisol, baseline hippocampal and white matter hyperintensities, total amyloid load or global cortical atrophy. The reviewed articles did not show a significant difference in remission between unilateral and bilateral electroconvulsive therapy treatment. Other interesting findings are that moderately elevated levels of CRP and S100B levels, lower retardation scores, poorer performance on the word reading task at baseline and longer post-ictal reorientation time may be associated with higher remission and/or response rates. Medial temporal atrophy can be associated with lower Montgomery-Åsberg Depression Rating Scale (MADRS) decrease after electroconvulsive therapy. Finally, elderly patients had higher rates of electroconvulsive therapy response; retardation and psychotic features may mediate this association. Incorporation of this data into clinical practice may facilitate a personalised approach to electroconvulsive therapy. However, research on this topic is scarce and there are few studies that focus specifically on older people.

Uveitis as a Predictor for Myocardial Infarction in Patients with Behçet's Disease, Multi Centric Cohort Study from Aseer Region, Saudi Arabia

Introduction: Behçet's disease (BD) is a chronic, multisystem inflammatory disorder characterized by a diverse array of clinical manifestations, including recurrent oral and genital ulcers, ocular inflammation, skin lesions, and joint problems. Its presentation varies, requiring tailored diagnosis and management. Methods: Retrospective cohort study, though review of medical charts and data for patients who meet the diagnostic criteria for BD actively receiving care in rheumatology clinics. The primary objective was to investigate the correlation between uveitis and Myocardial infarction in this population. Results: This study included a total of 111 patients. Approximately 33% of the patients exhibited positive CRP levels. Approximately 10% (11 patients) of the subjects were diagnosed with uveitis. Notably, the majority of individuals with uveitis were males. Three patients with uveitis had arthritis, none of whom presented with gastrointestinal tract (GIT) Complaints. Remarkably, none of the patients diagnosed with uveitis had a documented history of myocardial infarction (MI). Conclusion: In our cohort, those with a history of MI did not have a documented history of uveitis. Larger, prospective studies are needed to evaluate the associations between MI and uveitis in a BD population.

Intramuscular methylprednisolone in hand osteoarthritis: a retrospective cohort study

Abstract Objectives To explore patient characteristics associated with response to intramuscular methylprednisolone (MP) therapy in hand osteoarthritis (OA). Methods We performed an exploratory monocentric retrospective study. Patients with a clinical diagnosis of hand OA who visited our outpatient clinic between July 2016 and June 2021, and received at least once an intramuscular MP injection, were included. Clinical data, including laboratory and radiologic results, were retrieved from electronic patient records (EPRs). Patients’ reported response to MP and its duration in the first six months after injection was based on free text from the EPRs. Response was categorized into three groups: no response or worsening of symptoms, modest response, and good response. Duration of response was categorized as short-term (&amp;lt;2 weeks), or long-term (≥2 weeks). Multivariable logistic regression models were performed to determine factors associated with good response to therapy with methylprednisolone. Results Data from 262 hand OA patients (76% female) were analyzed. A good response was experienced by 150 patients (57.2%). Among those with modest to good response, the perceived response of 162 patients (80.6%) lasted 2 weeks or longer. Univariate regression analysis indicated that the level of CRP was associated with good response (odds ratio(OR) 1.08; 95% CI 1.00 to 1.17). However, multivariate regression analysis showed no statistical significant associations. Conclusion In this retrospective study, more than half of hand OA patients displayed good response to intramuscular MP administration. The possible relation between the presence of low-grade inflammation and the response to this therapy warrants further investigation.

Promoting application of enhanced recovery after surgery protocols during perioperative localized abdominal and thoracic neuroblastomas.

To investigate the safety and efficacy of the application of enhanced recovery after surgery (ERAS) protocols in the perioperative period of abdominal and thoracic localized neuroblastomas (NBs). In this retrospective study, 68 children with NBs who underwent surgical resection of the tumor were enrolled. The ERAS protocols for NB excision were implemented in the ERAS group (n = 39) and the consequences were compared with children treated with traditional care (n = 29, TRAD group). The main outcomes of our interest included the incidence of surgery-related complications, the postoperative length of stay (LOS), and the Face/Legs/Activity/Cry/Consolability (FLACC) quantitative table from postoperative days (POD) 1-5. We also evaluated the median intraoperative fluid volume and anesthesia recovery time; blood glucose levels at the beginning of anesthesia, POD1, and 3; WBC counts, CRP values, and the concentration of plasma nutritional indicators on POD1 and 3; time of early ambulation, first anal exhaust, total enteral nutrition (TEN), and discontinue intravenous infusion postoperatively; usage proportion and duration of abdominal and thoracic drainages, nasogastric decompression tubes and urinary catheters; cost of hospitalization, parental satisfaction rate, and readmission rate of surgery ward within 30days. Compared to the TRAD group, the ERAS group had lower surgery-related complications, albeit not significantly (P > 0.05); the median postoperative LOS decreased from 11.0 to 8.0days (P < 0.001), the LOS of abdominal NB was significantly shortened (P < 0.001) compared to thoracic NB (P = 0.07) between the two groups; the FLACC scores decreased significantly from POD1-5 (all P < 0.01). The ERAS group had an improved median intraoperative infusion speed (5.0mL/kg/h vs 8.0mL/kg/h), time of early ambulation (1.0days vs 3.0days), first anal exhaust (2.0days vs 2.0days), TEN (5.0 vs 7.0days), discontinuation of intravenous infusion (5.0days vs 8.0days), and total cost of hospitalization (33,897.2 Yuan vs 38,876.3 Yuan); (all P < 0.01). The usage proportion and duration of surgical drainages and tubes were apparently reduced. The mean blood glucose level was higher at the beginning of anesthesia but lower on POD1 and 3 in the ERAS group (P < 0.01). No statistically significant difference was detected in WBC counts and concentrations of hemoglobin and albumin between the two groups of patients (P > 0.05), while the concentrations of prealbumin on POD3 were higher and the CRP level on POD1 was lower in the ERAS group than the TRAD group (P < 0.01). The satisfaction rate of parents was only slightly higher, but the difference was not statistically significant (P = 0.730). No obvious differences were observed in the aspects of NB resection (P = 0.462) and 30-day readmissions of surgery ward (P = 1.000). The application of ERAS protocols has a significant potential to accelerate perioperative rehabilitation in children undergoing abdominal and thoracic NBs' surgical resection.

Risk Classification of Patients With Advanced Urothelial Carcinoma Treated With Enfortumab Vedotin.

Enfortumab Vedotin (EV) is a widely used antibody-drug conjugate for patients with advanced urothelial carcinoma (UC) who have previously been treated with platinum-based chemotherapy and immune checkpoint inhibitors. However, limited information is currently available on prognostic factors and risk classification. Therefore, the present study attempted to identify clinical factors that predict outcomes in patients with advanced UC treated with EV and to develop a novel risk classification model. We conducted a multicenter retrospective study including patients with advanced UC treated with EV. Oncological outcomes were assessed using progression-free survival (PFS) and overall survival (OS), and prognostic factors for PFS and OS were investigated. We then examined the usefulness of risk classification based on the prognostic factors identified. Median PFS and OS were 7.1 and 16.3 months, respectively. High C-reactive protein levels (CRP level ≥0.5 mg/dl) and hypercalcemia (corrected calcium level >10.2 mg/dl) were identified as prognostic factors for PFS (p=0.012 and p=0.003, respectively) and OS (p=0.035 and p<0.001, respectively). We then divided patients into three risk groups: no prognostic factors group, one prognostic factor group, and two prognostic factors group. Significant differences were observed in PFS and OS among the three groups (p<0.001 and p<0.001, respectively) and c-indices were 0.766 for PFS and 0.800 for OS. The risk classification using CRP and hypercalcemia is useful for predicting the outcomes of patients with advanced UC treated with EV.

Early Elevated Inflammatory Markers in SARS-CoV-2 Vaccinated Patients Are Associated with Reduced Mortality, Morbidity, and Lung Injury

Background The development of vaccines against SARS-CoV-2 has proved to be a highly successful strategy. In this work, the aim is to study the effects of the SARS-CoV-2 vaccine on the production of inflammatory markers and how this affect morbidity and mortality. Electronic medical record (EMR) data from 210 patients diagnosed with COVID-19 from November 2020 to June 2021 were collected. The admitted patients were divided into three groups, the one-dose vaccinated, two-dose vaccinated, and the non-vaccinated. All patients were moderate or severe in disease level as defined by the WHO classification. The results show that CRP was 101 ± 5.3, 97 ± 10.8, and 145 ± 17.3 (p &lt; 0.05), fibrinogen 529 ± 16.3, 397 ± 33.8, and 610 ± 15 (p &lt; 0.05), D-dimer 1244 ± 89, 1279 ± 297, and 1615 ± 224 (p &lt; 0.05), ferritin was 1170 ± 122, 999 ± 202, and 1663 ± 409 (p &lt; 0.05), IL-6 was 196 ± 12, 96 ± 5, and 580 ± 402 (NS), for the non-vaccinated, one-dose vaccinated, and two-dose vaccinated groups, respectively. The high level of CRP up to 150–200 mg/dL was more common among the surviving vaccinated patients. Oxygen supplementation, mechanical ventilation, and mortality were higher in the non-vaccinated group. Blood urea nitrogen (BUN) level was higher in the vaccinated patients, 25 ± 0.14 vs. 33 ± 6.15, respectively (p &lt; 0.05). Inflammation markers were significantly higher in the vaccinated groups compared to non-vaccinated groups. On the other hand, extremely high levels of CRP (&gt;200 mg/dL) were correlated with high mortality incidence.

P17 Infectious sacroiliitis: an uncommon septic arthritis

Abstract Introduction Infectious sacroiliitis, an infection of the sacroiliac joint, can cause severe morbidity if not promptly treated. Staphylococcus aureus is a common pathogen, especially problematic in patients on chronic hydrocortisone therapy due to its immunosuppressive effects. This case report discusses the diagnosis and treatment challenges of infectious sacroiliitis in such immunocompromised patients, highlighting the necessity of a minimum six-week targeted antibiotic regimen to ensure bacterial eradication and prevent relapse. The report emphasises aggressive and sustained treatment for optimal outcomes in these vulnerable patients. Case description A 47-year-old man was admitted with fever, constant feeling of tiredness, and severe right-sided gluteal pain radiating to the right lower extremity, worsening with movement. He has a history of ACTH deficiency, managed with 25 mg of oral hydrocortisone daily. Examination revealed skin eczema, tenderness in the right gluteal region, and an inability to flex the right hip. His temperature was 39 °C, and CRP levels were over 400 mg/L (normal &amp;lt; 5 mg/L). Two sets of blood cultures showed Staphylococcus aureus. Echocardiogram ruled out of infective endocarditis. An MRI of the lumbar spine showed edema in the right posterior paraspinal muscles at L4, while a CT scan of the abdomen and pelvis revealed fat stranding around the second sacral vertebra and significant inflammation in the right iliacus and distal psoas muscles. The patient was treated with 21 days of intravenous flucloxacillin, resulting in negative blood cultures and improved inflammatory markers, leading to discharge. One week later, he was readmitted with severe gluteal pain and fever. Blood cultures again showed Staphylococcus aureus. A repeat MRI indicated an abnormal signal around the right sacroiliac (SI) joint, with extensive edema and swelling in the right gluteal, iliacus, posterior paraspinal, and obturator muscles, suggesting sacroiliitis. The patient received six weeks of intravenous flucloxacillin. After this extended antibiotic therapy, his pain and fever resolved, laboratory parameters normalised, and blood cultures were negative. Discussion Bacterial infection is a serious cause of arthritis, with infective sacroiliitis being particularly rare, accounting for just 1-2% of all septic arthritis cases. Diagnosing this condition can be challenging despite clear symptoms, often leading to delays. This case highlights several important aspects of managing severe musculoskeletal infections. Firstly, it emphasises the need for a comprehensive diagnostic approach, utilising blood cultures, imaging, and echocardiography to precisely identify the source and extent of the infection. Treating deep-seated musculoskeletal infections is especially challenging in patients with underlying conditions which can complicate the clinical picture and impact immune response. The recurrence of infection despite initial appropriate antibiotic therapy suggests the need for prolonged and potentially more aggressive antimicrobial treatment. Close monitoring for complications or recurrence is essential. The decision to restart IV flucloxacillin and extend the antibiotic course to at least six weeks represents a strategic adjustment based on clinical progression and imaging results. Given that the patient is currently on standard hydrocortisone therapy for ACTH deficiency, transitioning to modified-release hydrocortisone therapy may be a better option as it more closely mimics the circadian rhythm of glucocorticoids, normalises the immune cell profile, and reduces the incidence of recurrent infections. This case underscores the necessity for clinicians to remain vigilant for recurrent infections, considering extended or repeated imaging and microbiological studies in patients not responding as expected to initial therapy. It also highlights the importance of individualised treatment plans, especially for patients with complex medical histories and comorbidities, to achieve optimal clinical outcomes. Key learning points • Diagnostic challenges: Infectious sacroiliitis is rare and difficult to diagnose, requiring comprehensive approaches including blood cultures, imaging and echocardiography. • Immunocompromised patients: Patients on chronic hydrocortisone therapy are at higher risk for infections like sacroiliitis due to immunosuppression. Modified hydrocortisone may represent a superior option, as it more closely mimics the physiological circadian rhythm of glucocorticoids, normalises the immune cell profile, and reduces the incidence of recurrent infections. • Rare disease: Infectious sacroiliitis is a rare and often overlooked condition that requires a high index of suspicion for accurate diagnosis. Early recognition and prompt treatment are crucial to prevent serious complications and improve patient outcomes. • Prolonged treatment: Initial antibiotic therapy may lead to temporary improvement, but extended antimicrobial regimens (at least six weeks) are often necessary to prevent relapse. • Relapse management: The recurrent of symptoms and positive cultures necessitates vigilant monitoring and possibly more aggressive and prolonged antibiotic treatment. • Individualised care: Effective management of deep-seated infections in patients with complex medical histories requires tailored treatment plans and ongoing assessment to achieve optimal outcomes.

Reducing the prime cardiopulmonary bypass volume during paediatric cardiac surgery.

Despite technological advances, the use of homologous blood to prime the cardiopulmonary bypass (CPB) circuits of infants under 10kg remains common. However, such rapid massive transfusion may increase post-CPB morbidity. We retrospectively included consecutive patients weighing 2.3-10kg who underwent cardiac surgery under CPB. Patients were divided into two groups based on their priming volumes: low priming volume (LPV) (below the median volume) or high priming volume (HPV) (the median volume or above). The study included 208 patients, of whom 104 had priming volumes below the median [37.9 (28.4-51.7) mL/kg] and 104 had at least the median volume. We recorded positive correlations between the priming volume, on the one hand, and the peak creatinine and CRP levels within 5days postoperatively, the duration of intensive care unit (ICU) stay, and the mechanical ventilation time, on the other. A relationship was also observed between a higher median priming volume and the need for renal replacement therapy in the ICU and mediastinitis. Although the differences in priming volume between the twogroups were small, they significantly influenced the postoperative complications. Perfusionists should seek to limit the priming volume to reduce the post-CPB inflammatory response, the duration of ICU stay, and possibly the risk of mediastinitis.

Altered serum metabolome is associated with disease activity and immune responses in rheumatoid arthritis.

Rheumatoid arthritis (RA) is widespread globally, with the emergence of metabolites derived from both the host and microbes playing a pivotal role in its pathogenesis. This study aims to elucidate the relationships between serum metabolites and the immunological and clinical features of RA. Serum samples were collected from 35 RA patients and 37 healthy controls (HC). Metabolite profiling was performed using gas chromatography-mass spectrometry (GC/MS). Principal component analysis revealed a significant distinction between the RA and HC cohorts. Employing univariate statistical analysis, we identified 36 differential metabolites. Among these, 9 metabolites, including galactose and glucose, were found to be enriched, while the remaining metabolites, such as citric acid, fumaric acid, and inosine, were depleted in RA. These diverse metabolites encompassed various metabolic processes, including the biosynthesis of fatty acids, amino acids, and glucose. The enrichment of glucose and galactose in RA exhibited a substantial correlation with elevated IgG levels, as determined through correlation analysis. Conversely, the depletion of citric acid was correlated with elevated levels of C3 and CRP. Methionine, which also declined in RA patients, displayed a negative correlation with ESR. Furthermore, galactose and glucose exhibited significant positive correlations with naïve B cells, while the decreased eicosanoic acid level in RA was significantly associated with an increase in natural killer cells. Our findings suggest that the altered serum metabolite profile in RA is closely linked to disease severity and the dysregulated immune responses observed in RA patients. Key Points • Identified nine metabolites with upregulated expression and twenty-seven metabolites with downregulated expression. • Established a correlation between alterations in serum metabolite levels and inflammatory markers in RA patients. • Discovered a significant association between changes in serum metabolites and immune cell profiles in RA patients.

Effect of electronic fibrobronchoscope alveolar lavage combined with local administration of budesonide on the efficacy of Mycoplasma pneumoniae pneumonia in children.

This study investigates the effect of electronic fibrobronchoscope alveolar lavage combined with local administration of budesonide on the efficacy of treating Mycoplasma pneumoniae pneumonia (MPP) in children. A retrospective analysis was conducted on the clinical data of 100 children with MPP treated at our hospital from April 2022 to April 2024. The patients were divided into an experimental group (50 cases) and a control group (50 cases) based to the treatment method. Both groups received routine treatment, however, the control group was treated with electronic fibrobronchoscope alveolar lavage alone, while the experimental group received electronic fibrobronchoscope alveolar lavage combined with local administration of budesonide. The efficacy of the two treatments was compared. The experimental group showed a significantly higher overall effective rate than the control group (p<0.05). After treatment, the time for cough relief, lung rales resolution, fever reduction, and hospital stay were significantly shorter in the experimental group compared to the control group (p<0.05). One week after treatment, the levels of tidal volume, vital capacity, and peak expiratory flow in the experimental group were higher than those in the control group (p<0.05). Post-treatment levels of WBC and CRP were lower in the experimental group than in the control group (p<0.05). Additionally, the incidence of complications in the experimental group was lower than in the control group (p<0.05). Electronic fibrobronchoscope alveolar lavage combined with local administration of budesonide improves the efficacy of treatment for children with MPP, enhances clinical indicators, reduces inflammation levels, and has high safety, making it worthy of clinical promotion.

Association of thrombophilic genes (MTHFR, MTR and MTRR) polymorphisms and homocysteine level in relation to the increased risk of thrombosis among COVID-19 patients

BackgroundPatients with COVID-19 have an increased risk of thrombosis and coagulopathy. Homocysteine, an amino acid essential to coagulation, is thought to be involved in such conditions, as its level is mediated by the presence of some single nucleotide polymorphisms (SNPs) in certain genes including MTHFR, MTR and MTRR. AimThe current study aimed to assess the significant role of MTHFR (C677T and A1298C), MTR A2756G and MTRR A66G SNPs as risk factors for thrombosis among Egyptian COVID-19 patients and their effect on homocysteine level. Subjects and methodsThis case-control study was carried out on 90 Egyptian COVID-19 cases, divided into 45 non-complicated cases and 45 complicated cases with thrombosis, in addition to 80 healthy control individuals. DNA was isolated from blood samples of all the participants. The genotyping was performed using real-time PCR; in addition, serum homocysteine level was estimated. ResultsThe MTHFR (C677T and A1298C), MTR A2756G and MTRR A66G variants revealed a significant higher risk of thrombosis under different genetic models including the homozygous comparison of the co-dominant (20 % vs. 2.3 %, OR = 15.88, p = 0.007), the dominant (62.2 % vs. 33.3 % OR = 3.29, p = 0.006) and the allelic models (41.1 % vs. 17.8 %, OR = 3.2, p < 0.001) for MTHFR C677T and also the dominant (77.8 % vs. 51.1 %, OR = 3.3, p = 0.008) and the allelic models (52.2 % vs. 31.1 %, OR = 2.4, p = 0.004) for MTHFR A1298C. In addition, the heterozygous comparison of the co-dominant (60 vs. 11.1, OR = 12.7, p < 0.001), the dominant (62.2 % vs. 11.1 %, OR = 13.1, p < 0.001) and the allelic models (32.2 % vs. 5.6 %, OR = 8.08, p < 0.001) for MTR A2756G and the heterozygous and homozygous comparisons of the co-dominant model [(53.3 % vs. 31.1 %, OR = 3.4, p = 0.03) and (13.4 % vs. 2.2 %, OR = 12.0, p = 0.049), respectively], the dominant (66.4 % vs. 33.3 %, OR = 4.0, p = 0.001) and the allelic models (40 % vs. 17.8 %, OR = 3, p = 0.001) for MTRR A66G. Moreover, MTHFR (C677T and A1298C), MTR A2756G, and MTRR A66G variants were also associated with high levels of serum homocysteine (p = 0.045, 0.001, 0.005 and 0.039, respectively). The homocysteine level was related to the disease severity by its correlation with higher LDH (rs = 0.49, p < 0.001), CRP (rs = 0.44, p < 0.001), IL-6 (rs = 0.46, p < 0.001) and D-dimer (rs = 0.66, p < 0.001) levels. The multivariate regression analysis showed that homocysteine and the dominant models of MTHFR (C677T and A1298C), MTR A2756G and MTRR A66G were independent predictors of susceptibility to thrombosis among COVID-19 patients [(OR = 1.02, p = 0.007), (OR = 1.15, p = 0.043), (OR = 1.2, p = 0.024), (OR = 1.42, p < 0.001), (OR = 1.19, p = 0.021), respectively]. ConclusionMTHFR (C677T and A1298C), MTR A2756G, and MTRR A66G gene variants were associated with high homocysteine and D-dimer levels that carried a risk for thrombosis among COVID-19 patients and associated with the disease progression.

Correlation of biochemical markers and inflammatory cytokines in autism spectrum disorder (ASD)

IntroductionAutism Spectrum Disorder (ASD) is a disorder that severely affects neurodevelopment, and its underlying causes are not yet entirely understood. Research suggests that there may be a connection between the occurrence of ASD and changes in immune responses. This study aims to know if some biochemical and inflammatory cytokines are promising biomarkers for ASD and whether they are involved in the pathogenesis of ASD.MethodsThe serum levels of CRP, TNF-α, TGF-β, IL-1β, IL-10, 1 L-8, and IL-6 were measured in all of the patients (n = 22) and in the healthy (n = 12) children using ELISA method.ResultsThe serum concentrations of IL-10 and IL-8 were significantly lower in the ASD patients compared to the control group (p < 0.05) and there were not significant differences between CRP, TNF-α, TGF-β, IL-6 and IL-1β levels in two groups. There were positive correlations between CRP and IL-10, also CRP and IL-8, in ASD group. In contrast to the ASD patients, the correlations of IL-8, IL-10, and CRP were not significant in the control group.ConclusionIn conclusion, this study highlights the potential role of certain biochemical markers and inflammatory cytokines in ASD. Specifically, the lower levels of IL-10 and IL-8 in ASD patients, along with the significant correlations between CRP and these cytokines, suggest an altered immune response in individuals with ASD. These findings support the hypothesis that immune dysregulation may be involved in ASD pathogenesis. Further research is needed to explore these biomarkers and their mechanistic links to ASD, which could lead to improved diagnostics or therapeutic strategies.

Low handgrip strength as a marker of severity in the diagnostic criteria for cancer cachexia

Background & AimsThe diagnostic criteria for cachexia, as proposed by the Asian Working Group for Cachexia (AWGC), include weight loss, a low body mass index, and additional factors such as a low handgrip strength (HGS), anorexia, or elevated CRP levels. This study aimed to evaluate the significance of low HGS as a diagnostic criterion in patients with advanced cancer. MethodsThis single-centre, retrospective cohort study was conducted between April 2019 and March 2023. Patients aged ≥18 years with malignant diseases were included. Patients without records on HGS were excluded. Low HGS was defined as a HGS <28 kg for men and <18 kg for women. The overall median survival time (MST) was analysed by univariate and multivariate analyses. ResultsA total of 894 patients were analysed. Cachexia was prevalent in 74%, though only 3.4% were diagnosed based solely on low HGS. The MST in patients with cachexia was 122 days, and in those with low HGS was 73 days. The associations between low HGS and high mortality remained significant after adjusting for AWGC criteria, modified weight loss grading system, age, gender, performance status, calf circumferenceand fluid retention. The MST varied with the number of additional factors being met: 422 days for one criterion, 92 days for two, and 55 days for all three (p <0.0001). ConclusionThis study supports that HGS serve as important prognostic tool in patients with various cancers.

Relationship between Covid-19 pneumonia intensity with lymphopenia and CRP levels

Relationship between Covid-19 pneumonia intensity with lymphopenia and CRP levels