Decrease In C-reactive Protein Levels Research Articles

A systematic review and meta-analysis of glucocorticoids treatment in severe COVID-19: methylprednisolone versus dexamethasone

ObjectiveThe preferred agent of glucocorticoids in the treatment of patients with severe COVID-19 is still controversial. This study aimed to compare the efficacy and safety of methylprednisolone and dexamethasone in the treatment of patients with severe COVID-19.MethodsBy searching the electronic literature database including PubMed, Cochrane Central Register of Controlled Trials, and Web of Science, the clinical studies comparing methylprednisolone and dexamethasone in the treatment of severe COVID-19 were selected according to the inclusion criteria and exclusion criteria. Relevant data were extracted and literature quality was assessed. The primary outcome was short-term mortality. The secondary outcomes were the rates of ICU admission and mechanical ventilation, PaO2/FiO2 ratio, plasma levels of C-reactive protein (CRP), ferritin, and neutrophil/lymphocyte ratio, hospital stay, and the incidence of severe adverse events. Statistical pooling applied the fixed or random effects model and reported as risk ratio (RR) or mean difference (MD) with the corresponding 95% confidence interval (CI). Meta-analysis was performed using Review Manager 5.1.0.ResultsTwelve clinical studies were eligible, including three randomized controlled trials (RCTs) and nine non-RCTs. A total of 2506 patients with COVID-19 were analyzed, of which 1242 (49.6%) received methylprednisolone and 1264 (50.4%) received dexamethasone treatment. In general, the heterogeneity across studies was significant, and the equivalent doses of methylprednisolone were higher than that of dexamethasone. Our meta-analysis showed that methylprednisolone treatment in severe COVID-19 patients was related to significantly reduced plasma ferritin and neutrophil/lymphocyte ratio compared with dexamethasone, and that no significant difference in other clinical outcomes between the two groups was found. However, subgroup analyses of RCTs demonstrated that methylprednisolone treatment was associated with reduced short-term mortality, and decreased CRP level compared with dexamethasone. Moreover, subgroup analyses observed that severe COVID-19 patients treated with a moderate dose (2 mg/kg/day) of methylprednisolone were related to a better prognosis than those treated with dexamethasone.ConclusionsThis study showed that compared with dexamethasone, methylprednisolone could reduce the systemic inflammatory response in severe COVID-19, and its effect was equivalent to that of dexamethasone on other clinical outcomes. It should be noted that the equivalent dose of methylprednisolone used was higher. Based on the evidence of subgroup analyses of RCTs, methylprednisolone, preferably at a moderate dose, has an advantage over dexamethasone in the treatment of patients with severe COVID-19.

Mortality, complication risks, and clinical outcomes after surgical treatment of spinal epidural abscess: a comparative analysis of patients aged 18–64 years, 65–79 years, and ≥ 80 years, with a 3-year follow-up

Spinal epidural abscess (SEA) with pyogenic vertebral osteomyelitis (PVO) is a rare illness with a steadily increasing incidence. However, comparative analyses of young and older patients with SEA are lacking. We aimed to compare the clinical course of patients aged 18–64 years, 65–79 years, and ≥ 80 years undergoing surgery for SEA. Clinical and imaging data were retrospectively collected from the institutional database between September 2005 and December 2021. Ninety-nine patients aged 18–64 years, 45 patients aged 65–79 years, and 32 patients ≥ 80 years were enrolled. Patients ≥ 80 years presented with a poorer baseline history (9.2 ± 2.4), as indicated by the CCI, than their younger counterparts (18–74 years: 4.8 ± 1.6;6.5 ± 2.5; p < 0.001). Patients aged 65–79 years and 80 years had a significantly longer length of stay. In-hospital mortality was significantly higher in those aged ≥ 80 years compared to their younger counterparts (≥ 80 years, n = 3, 9.4% vs. 18–64 years, n = 0, 0.0%; 65–79 years, n = 0, 0.0%; p < 0.001), while no differences in 90-day mortality or 30-day readmission were observed. After surgery, a significant decrease in C-reactive protein levels and leukocytes and amelioration of motor scores were observed in all the groups. Of note, older age (> 65 years), presence of comorbidities, and poor preoperative neurological condition were significant predictors of mortality. Surgical management led to significant improvements in laboratory and clinical parameters in all age groups. However, older patients are prone to multiple risks, requiring meticulous evaluation before surgery. Nevertheless, the risk profile of younger patients should not be underestimated. The study has the limitations of a retrospective design and small sample size. Larger randomized studies are warranted to establish the guidelines for the optimal management of patients from every age group and to identify the patients who can benefit from solely conservative management.

Potential interference of in vitro carbamylation on C-reactive protein laboratory measurement

Carbamylation is a nonenzymatic post-translational modification observed during the reaction between cyanate and amino acids and/or proteins that may occur during some pathologies such as chronic kidney disease. Evidence suggests that carbamylation may interfere with the quantification of some analytes measured using immunoturbidimetric assays. C-reactive protein (CRP) is an inflammatory response protein that is commonly quantified through immunoturbidimetry in clinical laboratories. Because the presence of modified proteins in serum can lead to impaired quantification, this study aimed to verify the impact of in vitro carbamylation on the measurement of CRP in a CRP standard solution and serum pool. The samples were incubated with 150 nM, 150 µM, or 150 mM potassium cyanate (KOCN) or 20, 100, or 500 mg/dL urea at 37 °C for 24 h. CRP concentrations were measured using an immunoturbidimetric assay. The results showed a 61%–72% decrease in the CRP detection rate after incubation with KOCN. Incubation with urea resulted in a 0.7%–8% lower CRP detection rate. The results of this study indicate that high concentrations of cyanate can lead to falsely decreased CRP levels, as measured by immunoturbidimetry.

Expression and prognostic value of C-reactive protein in adult immune thrombocytopenia (ITP) patients.

The aim of this study was to investigate the effect of C-reactive protein (CRP) on the prognosis of adult patients with Immune thrombocytopenia purpura (ITP). A retrospective study of 628 adult ITP patients, as well as 100 healthy and 100 infected patients, attending the Affiliated Hospital of Xuzhou Medical University from January 2017 to June 2022 was performed. The ITP patients were grouped according to their CRP levels, and the differences in clinical characteristics of each group and the influencing factors of efficacy in newly diagnosed ITP patients were analyzed. CRP levels were significantly higher in the ITP and infected groups compared with healthy controls (P < 0.001), and platelet counts were significantly lower in the ITP group (P < 0.001). Between the CRP normal and elevated group, their age, white blood cell count, neutrophil count, lymphocyte count, red blood cell count, hemoglobin, platelet count, complement C3 and C4, PAIgG, bleeding score, proportion of severe ITP, and proportion of refractory ITP were significantly different (P < 0.05). Patients of severe ITP (P < 0.001), refractory ITP (P = 0.002), and with active bleeding (P < 0.001) had significantly higher CRP levels. Patients with no response after treatment had significantly higher CRP levels than those who achieved CR or R (P < 0.001). Platelet counts (r = - 0.261, P < 0.001) in newly diagnosed ITP patients and treatment outcomes (r = - 0.221, P < 0.001) were negatively correlated with CRP levels, and bleeding score was positively correlated with CRP levels (r = 0.207, P < 0.001). Treatment outcome was positively correlated with decrease in CRP levels (r = 0.313, P = 0.027). A multifactorial regression analysis of the influencing factors of treatment outcomes on newly diagnosed patients found that CRP was an independent risk factor of the prognosis (P = 0.011). In conclusion, CRP can help assess the severity and predict the prognosis of ITP patients.

EFFECT OF YOGIC EXERCISES ON SERUM CRP AND RF LEVELS OF RA PATIENTS IN URBAN PART OF MP

Introduction: Rheumatoid Arthritis (RA) is a chronic inammatory auto immune disorder, where immune system attacks synovial lining of joints, resulting into, stiffness and dysfunction. In response to this the body releases CRP (C-Reactive Protein) in the bloodstream. Present study has Aim: been planned to see the effect of yogic exercises in order to subside the intensity of the RA symptoms and to determine the effects of yogic exercises on serum CRP and RF levels in RA patients. Present study was carried out in MGM Medical College and Material and method: Government Holkar Science College, Indore during December 2020-February 2022. Total 100 study subjects were taken out of which 50 were control and 50 RA cases. Fasting blood samples were collected from subjects and analyzed for CRP levels on fully automated biochemistry analyzer. Blood samples were also subjected for testing of RF. Medically healthy people of Inclusion criteria: 30-50 years of age and RA patients with 30-50 years of age. RA patients with diabetes, CHD and other major complications. Resul Exclusion criteria: Results: ts reveal that; Ÿ Increased level of CRP and RF has been observed in RA patients in comparison to healthy control. Ÿ Signicant decrease in levels of CRP and RF has been observed in RA patients with Yogic exercises as compared to RA patients without yogic exercises. Conclusion: Yogic exercises brought down the CRP and RF levels and because of which complications and pain in RA patients can be reduced. Some yogic exercises should be practiced as an add on therapy in management of RA

Genetically proxied inhibition of tumor necrosis factor and the risk of colorectal cancer: A drug-target mendelian randomization study.

Background: Previous studies suggested that anti-TNF drugs might be repurposed as a preventive treatment for colorectal cancer. We aimed to examine whether genetically proxied inhibition of tumor necrosis factor receptor 1 (TNFR1) reduces the absolute risk of colorectal cancer through mendelian randomization (MR) analysis. Methods: We obtained 28 single nucleotide polymorphisms (SNPs) that were located within a ±15 kilobase window of the TNFRSF1A-the gene that encodes the TNFR1 protein, and we used genetic data from three GWAS studies of circulating levels of TNFR1, C-reactive protein (CRP), and white blood counts (WBC) to screen SNPs that proxied the inhibition of TNFR1. Positive control analyses were then performed by using another three GWAS data from the ulcerative colitis cohort (n = 45,975), Crohn's disease cohort (n = 40,266), and multiple sclerosis cohort (n = 115,803) to confirm the effect of the included SNPs. A two-sample mendelian randomization analysis was performed to examine the association between TNFR1 inhibition and the absolute risk reduction (ARR) of colorectal cancer. Results: We finally included seven SNPs to proxy the anti-TNF effect, and these SNPs caused lower levels of TNFR1, CRP, and white blood counts. In positive control analyses, the included SNPs caused lower odds ratio of ulcerative colitis and Crohn's disease but a higher odds ratio of multiple sclerosis, consistent with drug mechanistic actions and previous trial evidence. By using the inverse-variance weighted analyses to combine the effects of the seven SNPs, we found that the anti-TNF effect was associated with a 0.988 (95%CI 0.985-0.991) mg/L decrease in CRP levels and a reduction in the risk of colorectal cancer (absolute risk reduction -2.1%, 95%CI -3.8% to -0.4%, p = 0.01). Conclusion: Our study confirmed that anti-TNF drugs were associated with a risk reduction in colorectal cancer. Physicians could consider using anti-TNF drugs for the prevention of colorectal cancer, especially in patients with high risks of developing cancer.

Improving the clinical effectiveness of the treatment of acute inflammatory diseases of the upper respiratory tract in children with the use of silver-based medicines

Introduction. Acute respiratory viral infection (ARVI) is the most common reason for visits to the physician by both children and adults.The aim of the study was to analyse the features of the course of ARVIs in patients with different immune status, to evaluate the effectiveness of standard therapy for these groups of patients, as well as the use of silver-based medicines in the combination therapy of patients.Materials and methods. For the period from July to September 2022, 26 children (Group 1) without immunodeficiency conditions and 26 immunocompromised children (Group 2) were identified, all of them had symptoms of acute respiratory viral infections. In Group 1, 69.2% of children (n = 18) were classified as frequently ill children with ARVI rate of more than 8 times per year, 38.4% (n = 10) had allergic rhinitis, 7.7% (n = 2) had a concomitant bronchial asthma. In Group 2, the distribution of underlying immunocompromised disease was as follows: primary immunodeficiency – 7.7% (n = 2), Hurler syndrome after bone marrow transplantation – 11.5% (n = 3), acute lymphoblastic leukemia during specific therapy – 26.9% (n = 7), with graft versus host disease – 30.7% (n = 8) and currently in remission – 23% (n = 6). Among patients in this Group, only 7.7% of children (n = 2) had a history of allergic rhinitis.Results. The criterion for recovery in Group 1 was reversal of all clinical symptoms, in Group 2 – clinical improvement, normalization or significant decrease in C-reactive protein levels, improvement of paranasal sinuses pneumatization.Conclusion. During ARVI, post-viral rhinosinusitis often occurs, the ability of the mucosa to regenerate becomes disturbed, which makes it more vulnerable to adhesion of viruses, bacteria, and fungi. In this case, especially effective is the intranasal use of a silver-based medicine to form a protective protein film on the injured mucosa. The use of silver-based medicines in the combination therapy of patients with inflammatory pathologies of the nose, nasopharynx and paranasal sinuses can greatly increase the effectiveness of treatment, while shortening the duration of therapy and being safe.

Low-normal serum unconjugated bilirubin levels are associated with late but not early carotid atherosclerotic lesions in T2DM subjects.

We aimed to examine the association of serum unconjugated bilirubin (UCB) within normal limits with carotid atherosclerosis in Chinese patients with type 2 diabetes mellitus (T2DM). This cross-sectional, real-world study was performed in 8,006 hospitalized T2DM patients including 4,153 men and 3,853 women with normal UCB. The subjects were stratified into quintiles based on serum UCB levels (<6.2, 6.2-7.9, 8.0-8.9, 9.0-10.9, and >10.9 μmol/l, respectively). Carotid atherosclerotic lesions detected by ultrasonography, including carotid intima-media thickness (CIMT), carotid plaque, and stenosis, were compared among the five groups. The associations of serum UCB levels and quintiles with carotid atherosclerotic lesions were also determined by multiple logistic regression. The prevalence of carotid plaque (55.3%, 49.5%, 47.4%, 43.8%, and 37.5%, respectively; p < 0.001 for trend) and stenosis (15.2%, 12.2%, 9.1%, 7.7%, and 5.4%, respectively; p < 0.001 for trend) was progressively lower across the UCB quintiles even after adjusting for age, sex, and duration of diabetes. Results of a fully adjusted multiple logistic regression analysis revealed that serum UCB levels and quintiles were significantly associated with carotid plaque and stenosis. Compared with the subjects in the lowest UCB quintile, the risk of carotid plaque decreased by 25.5%, 28.7%, 33.5%, and 42.8%, and that of carotid stenosis by 24.6%, 37.4%, 44.9%, and 47.3%, respectively, in those from the second to highest UCB quintiles. High serum UCB within the normal range was a protective factor against carotid plaque [odds ratio (OR) 0.810, 95% confidence interval (CI) 0.747-0.878; p < 0.001] and stenosis [OR 0.722, 95% CI 0.647-0.805; p < 0.001]. However, no significant association was observed between serum UCB and CIMT in T2DM patients. Furthermore, C-reactive protein (CRP) levels were significantly higher in the subjects with carotid atherosclerosis than in those without carotid atherosclerosis and clearly decreased across the UCB quintiles. Serum UCB within normal limits is inversely associated with late carotid atherosclerotic lesions including carotid plaque and stenosis but not CIMT, an early carotid atherosclerotic lesion in T2DM patients. High-normal UCB may be protective against carotid atherosclerosis by its anti-inflammation effect, which was indicated by significantly decreased CRP levels from the lowest to highest UCB quintiles.

Effects of probiotic and magnesium co-supplementation on mood, cognition, intestinal barrier function and inflammation in individuals with obesity and depressed mood: A randomized, double-blind placebo-controlled clinical trial.

BackgroundThe co-occurrence of obesity and mood impairments named as “metabolic mood syndrome” (MMS) is often neglected in the obesity management. This study aimed to evaluate effects of Probio-Tec ®BG-VCap-6.5 and magnesium co-supplementation on mood, cognition, intestinal barrier function and serum C reactive protein (CRP) levels in participants with obesity and depressed mood.DesignSeventy-four eligible participants were randomly allocated to either Probio-Tec®BG-VCap-6.5 [containing Lactobacillus rhamnosus (LGG®) and Bifidobacterium animalis subsp. Lactis (BB-12®)] + Magnesium chloride or placebo for 9 weeks. Sociodemographic data were collected in the beginning. Anthropometric, dietary and physical activity (PA) assessments were carried out. Beck Depression Inventory-II (BDI-II) and Montreal Cognitive Assessment (MoCA) scores were assessed through validated questionnaires. Fasting plasma zonulin, lipopolysaccharide (LPS) and (CRP) were measured by ELIZA kits.ResultsOf seventy-four participants (mean age 37.51 ± 8.10), 52 completed the study. Changes in serum LPS and zonulin were not different significantly between groups (−3.04 ± 44.75 ng/dl, 0.11 ± 5.13, ng/dl, p > 0.05 for LPS and 1.40 ± 48.78 ng/dl, −0.17 ± 6.60, p > 0.05 for zonulin, respectively). CRP levels reduced significantly in intervention group compared to placebo [−474.75 (−1,300.00, −125.00) mg/l vs. 175.20 (−957.75, 1,683.25) mg/l, p = 0.016]. Changes in BDI-II and MoCA scores were not significantly different between intervention (−7.13 ± 5.67, 1.20 ± 2.16, respectively) and placebo (−5.42 ± 6.71, 1.94 ± 1.86, respectively) groups (p > 0.05).ConclusionNine weeks of probiotic and magnesium co-supplementation resulted in decreased CRP levels as an indicator of inflammatory state with no significant effects on mood, cognition and intestinal integrity in individuals with obesity and depressed mood.

The Influence of Giving Biscuits of Yellow Pumpkin Seed and Capsule of Moringa Leaves on the Level of C-Reactive Protein on Pregnant Women

Pregnant women are likely to have the option of receiving supplementary nourishment in the form of pumpkin seed biscuits and Moringa leaves. The purpose of this study is to see how Pumpkin Seed Biscuits and Moringa Leaf Capsules affect C-Reactive Protein (C-RP) levels in pregnant women at the Stunting Locus, Bone Regency. A Quasi-Experimental method, also known as a field trial. The Non-Randomized Pre-Test - Post Test Group Design was adopted for the research design. Participants in this study were separated into two groups: group I was given pumpkin seed biscuits and a blood-added tablet, and group II was given Moringa leaf extract capsule supplements and a blood-added tablet, with a total of 30 persons in each group. The intervention lasted 90 days and included both a pre-test and a post-test. The levels of C-Reactive Protein in group I (Pumpkin Seed Biscuits) decreased by -0.11±0.04 g/mL. The decrease in C-Reactive Protein levels in group II (Moringa Leaf Extract) was -0.09±0.04 g/mL. Moringa capsules (p=0.001) and pumpkin seed biscuits (p=0.001) had an impact on reducing C-RP levels in pregnant women. Supplemental feeding of pumpkin seed biscuits and Moringa leaf extract capsules can enhance and improve the health condition of pregnant women by lowering C-Reactive Protein levels.

Effect of a 3-Week Multidisciplinary Body Weight Reduction Program on the Epigenetic Age Acceleration in Obese Adults.

Obesity and aging share common molecular and cellular mechanisms underlying the pathophysiology of cardiovascular diseases (CVD), which occur frequently in both conditions. DNA methylation (DNAm) age, a biomarker of the epigenetic clock, has been proposed as a more accurate predictor of biological aging than chronological age. A positive difference between an individual’s chronological age and DNAm age is referred to as epigenetic age acceleration. The objective of the present study was to evaluate the effects of a 3-week in-hospital body weight reduction program (BWRP) on the epigenetic age acceleration, as well as on other cardiometabolic outcomes, in a cohort of 72 obese adults (F/M: 43/29; (chronological) age: 51.5 ± 14.5 yrs; BMI: 46.5 ± 6.3 kg/m2). At the end of the BWRP, when considering the entire population, BMI decreased, and changes in body composition were observed. The BWRP also produced beneficial metabolic effects as demonstrated by decreases in glucose, insulin, HOMA-IR, total cholesterol, and LDL cholesterol. A post-BWRP improvement in cardiovascular function was also evident (i.e., decreases in systolic and diastolic blood pressures and heart rate). The BWRP reduced some markers of systemic inflammation, particularly C-reactive protein (CRP). Finally, vascular age (VA) and Framingham risk score (FRS) were reduced after the BWRP. When considering the entire population, DNAm age and epigenetic age acceleration did not differ after the BWRP. However, when subdividing the population into two groups based on each subject’s epigenetic age acceleration (i.e., ≤0 yrs or >0 yrs), the BWRP reduced the epigenetic age acceleration only in obese subjects with a value > 0 yrs (thus biologically older than expected). Among all the single demographic, lifestyle, biochemical, and clinical characteristics investigated, only some markers of systemic inflammation, such as CRP, were associated with the epigenetic age acceleration. Moreover, chronological age was correlated with DNAm age and VA; finally, there was a correlation between DNAm age and VA. In conclusion, a 3-week BWRP is capable of reducing the epigenetic age acceleration in obese adults, being the BWRP-induced rejuvenation evident in subjects with an epigenetic age acceleration > 0 yrs. Based on the BWRP-induced decrease in CRP levels, chronic systemic inflammation seems to play a role in mediating obesity-related epigenetic remodeling and biological aging. Thus, due to the strong association of CVD risk with the epigenetic clock and morbidity/mortality, any effort should be made to reduce the low-grade chronic inflammatory state in obesity.

Vitamin D Effects on Selected Anti-Inflammatory and Pro-Inflammatory Markers of Obesity-Related Chronic Inflammation.

BackgroundObesity is related to changes in adipokine secretion, activity of adipose tissue macrophages, helper T cells, and regulatory T cells. It has been confirmed that vitamin D has potent anti-inflammatory properties. It contributes to reduction in pro-inflammatory mediators and an increase in anti-inflammatory cytokines. There is also evidence that vitamin D could decrease C-reactive protein (CRP) and affect selected haematological indices.Aim of the StudyWe aimed to evaluate the effect of vitamin D on interleukin (IL)-10, IL-17, CRP, blood leukocyte profile, and platelet (PLT) count in overweight and obese children before and after six months of vitamin D supplementation.Material and MethodsThe study group consisted of 67 overweight and obese children aged 9.08-17.5 years. The control group included 31 normal weight peers age- and sex-matched. None of the studied children had received vitamin D supplementation before the study. Data were analyzed at baseline and after vitamin D supplementation.ResultsThe study group had lower baseline 25(OH)D (p<0.001) and higher white blood cell (WBC) (p=0.014), granulocyte (p=0.015), monocyte (p=0.009) and CRP (p=0.002) compared to the control group. In the study group, vitamin D levels were related negatively to nutritional status. Leukocyte profile parameters, PLT, CRP, IL-10 or IL-17 were not related to baseline 25(OH)D. Baseline IL-17 levels correlated with monocytes (R= 0.36, p=0.003) independently on 25(OH)D deficit. In children with vitamin D <15ng/ml, the baseline 25(OH)D was related to CRP (R=-0.42, p=0.017). After six months of vitamin D supplementation, we noticed a decrease in CRP levels (p=0.0003). Serum 25(OH)D correlated with IL-10 in that period (R=0.27, p=0.028). Moreover, we noticed that IL-10 correlated with monocyte (R=-0.28, p=0.023). We did not find any significant associations between 25(OH)D and leukocyte profile parameters, PLT, or IL-17. The multivariable stepwise regression analysis identified IL-10 as the parameter positively associated with 25(OH)D.ConclusionsOur study confirmed beneficial effects of vitamin D supplementation in overweight and obese paediatric populations. Vitamin D intake seems to exert its anti-inflammatory effect mainly via decreasing the CRP level and protecting stabile values of IL-10, rather than its impact on pro-inflammatory factors such as lL-17 and leukocyte profile parameters.

C-reactive protein as a disease activity marker in rheumatoid arthritis

Introduction: CRP is a valuable marker and regulator of systemic inflammation in RA that also appears to play a direct role in bone destruction and radiographic progression. CRP has also been implicated in the etiology of common comorbidities associated with RA. Decreasing CRP levels with RA treatment may contribute to reductions in disease activity, although beneficial effects of RA treatment seem to occur irrespective of CRP values. Aim: The purpose of this study was to examine whether levels of C-reactive protein (CRP), a sensitive marker of disease activity in rheumatoid arthritis (RA). Materials &amp; methods: This study was carried out on 39 RF Positive patients from both sexes male and female from different age group at NIMS Super-Specialty Hospital, Sobha Nagar, Jaipur, Rajasthan. Inflammatory markers were performed in the laboratory. Results: In the current study, the majority of Rheumatoid Arthritis patients belong to the age group of 41 to 60 (58.97%) and male to female ration were 1:2. C - reactive protein found highly significant positive correlation. Out of total Rheumatoid Arthritis patients, 7.69% patients have normal C - reactive protein level and 92.30% have highly increased CRP level. T

High dose melatonin as an adjuvant therapy in intubated patients with COVID-19: A randomized clinical trial

ObjectiveIn the COVID-19 pandemic, the SARS-CoV-2 virus has infected millions of people worldwide. Mortality primarily results from the inflammation state and its complications. High-dose melatonin has been established as an anti-inflammatory agent. This study evaluated high-dose melatonin as an adjuvant therapy in critically ill patients with SARS-CoV-2 infection. MethodsWe conducted a double-blinded, randomized clinical trial of 21 mg of melatonin per day compared with a placebo in 67 patients with COVID-19. We enrolled patients older than 18 years of age with documented SARS-CoV-2 infection, who were admitted to the intensive care unit and underwent invasive mechanical ventilation. Administration of melatonin and placebo through a nasogastric tube continued for 5 days. The main outcomes were mortality rate, duration of mechanical ventilation, changes in oxygenation indices, and C-reactive protein (CRP) levels. ResultsNo significant differences were observed in mortality and duration of mechanical ventilation between the control and intervention groups. After 5 days of the intervention, the mean (±standard deviation) CRP and platelet count were 47.28 (±38.86) mg/L and 195.73 (±87.13) × 1000/μL, respectively, in the intervention group and 75.52 (±48.02) mg/L and 149.62 (±68.03) × 1000/μL, respectively, in the control group (P < 0.05). ConclusionHigh-dose melatonin in intubated patients with COVID-19 was associated with a decrease in CRP levels. However, this treatment did not apparently affect patient outcomes.

MO543: Efficacy and Influence on the Key Indicators of Mineral-Bone Disorders of the Sucroferric Oxyhydroxide and Sevelamer Carbonate in Hemodialysis Patients

Abstract BACKGROUND AND AIMS Currently, the effectiveness of phosphate-binding agents in patients with CKD should be determined not only by the level of reduction in hyperphosphatemia, but also by the effect on other key factors involved in the development of CKD-MBD. The results of the effect of phosphate binders on the parameters of CKD-MBD, excluding phosphate, are unclear. Our prospective randomized controlled trial evaluated the effect of 16-week treatment with sucroferric oxyhydroxide versus sevelamer carbonate (‘sevelamer’) on the parameters of CKD-MBD in patients with hyperphosphatemia on programmed hemodialysis. METHOD A total of 50 stable patients with hyperphosphatemia (P ˃ 5.5 mg/dL) after a 4-week washout period, were randomized at a 1:1 ratio to receive sucroferric oxyhydroxide (n = 25) or sevelamer (n = 25) for treatment up to 16 weeks. In all patients were monthly evaluated levels of FGF23, soluble Klotho, c-reactive protein (CRP), hemoglobin (Hb), ferritin, transferrin saturation, phosphorus (P), calcium (Ca), parathyroid hormone (PTH). The dose of both medications was adjusted according to serum phosphate. RESULTS The average intact fibroblast growth factor 23 (FGF23), PTH, transferrin saturation and ferritin levels did not significantly change in both groups. Meanwhile, Klotho levels increased by 25% in the sucroferric oxyhydroxide group (P &amp;lt; 0.05). We observed a significant decrease in serum phosphate level from 6.8 ± 1.5 to 5.27 ± 0.99 mg/dL (P &amp;lt; 0.01) only in the group with sucroferric oxyhydroxide. However, treatment with sevelamer did not decrease the level of P: 6.32 ± 1.5 versus 6.35 ± 1.9 mg/dL by the end of the study. The number of prescribed tablets was lower in the sucroferric oxyhydroxide group (2.0 ± 1.5 tab/day, mean ± SD) compared with sevelamer group (6.1 ± 3.2 tab/day, mean ± SD). We noted also in group sucroferric oxyhydroxide an increased Hb level from 105.6 ± 15.7 to 111.9 ± 22.3 g/L (P &amp;lt; 0.05) and a simultaneous decrease of CRP level by 50% (P &amp;lt; 0.01). CONCLUSION Treatment with sucroferric oxyhydroxide significantly increased Klotho and Hb levels and lowered CRP levels. Sucroferric oxyhydroxide was more effective in lowering phosphorus levels than sevelamer, which can be explained by an insufficient dose of sevelamer and a short treatment period.

Relationship between a Self-Reported History of Depression and Persistent Elevation in C-Reactive Protein after Myocardial Infarction.

Background: Elevated levels of C-reactive protein (CRP) are associated with both an increased risk of cardiovascular disease (CVD) and depression. We aimed to test the hypothesis that a self-report history of depression is associated with a smaller decrease in CRP levels from hospital admission to 3-month follow-up in patients with acute myocardial infarction (MI). Methods: We assessed 183 patients (median age 59 years; 84% men) with verified MI for a self-report history of lifetime depression and plasma CRP levels within 48 h of an acute coronary intervention and again for CRP levels at three months. CRP values were categorized according to their potential to predict CVD risk at hospital admission (acute inflammatory response: 0 to <5 mg/L, 5 to <10 mg/L, 10 to <20 mg/L, and ≥20 mg/L) and at 3 months (low-grade inflammation: 0 to <1 mg/L, 1 to <3 mg/L, and ≥3 mg/L). Additionally, in a subsample of 84 patients showing admission CRP levels below 20 mg/L, changes in continuous CRP values over time were also analyzed. Results: After adjustment for a range of potentially important covariates, depression history showed a significant association with a smaller decrease in both CRP risk categories (r = 0.261, p < 0.001) and log CRP levels (r = 0.340, p = 0.005) over time. Conclusions: Self-reported history of depression may be associated with persistently elevated systemic inflammation three months after MI. This finding warrants studies to test whether lowering of inflammation in patients with an acute MI and a history of depression may improve prognosis.

The Clinical Value of High-Quality Nursing in Concurrent Radiotherapy and Chemotherapy after Glioma Surgery and Its Influence on the Stress Indicators Cor, ACTH, and CRP.

Objective The purpose of this study is to explore the clinical value of high-quality nursing in concurrent radiotherapy and chemotherapy after glioma surgery and its influence on the stress indicators such as cortisol (Cor), adrenocorticotrophic hormone (ACTH), and C-reactive protein (CRP). Methods A total of 94 glioma patients diagnosed and treated in our hospital were randomly divided into a research group and a control group, with 47 cases in each group. Both groups of patients were given concurrent radiotherapy and chemotherapy. On this basis, patients in the control group were given basic care, while patients in the research group were given a combination of basic care and high-quality care. The nursing satisfaction and adverse reactions of the two groups were compared. The pain degree and the levels of stress indicators Cor, ACTH, and CRP at different time points were compared between the two groups. The sleep quality, bad mood, and quality of life before and after nursing were compared between the two groups. Results After nursing, the nursing satisfaction of the research group (95.74%) was higher than that of the control group (80.85%), and the difference between the two groups was statistically significant (X2 = 11.678, P < 0.05). There was no significant difference between patients in the Visual Analogue Scale (VAS) score and the levels of stress indicators Cor, ACTH, and CRP at the T1 time point between the two groups (P > 0.05). With the passage of time, the levels of Cor and ACTH of the two groups showed an upward trend. At T4, the increased levels of Cor and ACTH in the research group were less than those in the control group, and the difference was statistically significant (P < 0.05). The VAS scores and CRP levels of the two groups showed an upward trend at T1 and T2 and a downward trend at T3 and T4. And, at T4, the decrease in CRP level of the research group was greater than that in the control group, and the difference was statistically significant (P < 0.05). Before nursing, there was no statistically significant difference between two groups of patients in the time to fall asleep, sleep time, number of awakenings, SAS score, self-rating depression scale (SDS) score, quality of life index scores, and total scores (P > 0.05). After nursing, the time to fall asleep and the number of awakenings in the two groups of patients showed an upward trend, and the increase in the control group was higher (P < 0.05). The sleep time of the two groups showed a downward trend, and the degree of decline in the control group was higher (P < 0.05). After nursing, the SAS score and SDS score of the two groups of patients decreased (∗P < 0.05), and the decrease in the research group was more obvious (#P < 0.05). After nursing, the scores of all indicators of the quality of life and the total score of the two groups increased and the score of the research group increased more significantly (P < 0.05). After nursing, the control group had 5 cases of gastrointestinal reactions, 7 cases of bone marrow suppression, 6 cases of leukopenia, 6 cases of thrombocytopenia, and 10 cases of dizziness and nausea. In the research group, there were 1 case of gastrointestinal reaction, 2 cases of bone marrow suppression, 1 case of leukopenia, 1 case of thrombocytopenia, and 2 cases of dizziness and nausea. The difference between the two groups was statistically significant (P < 0.05). Conclusion Glioma patients are given high-quality care during the course of concurrent radiotherapy and chemotherapy, which can reduce the pain and bad mood of the patient, reduce the stress response of the patient, and improve the quality of sleep and the quality of life of the patient, thereby improving nursing satisfaction and patients compliance, reducing adverse reactions, and having a good prognosis.

EFFECTS OF HYDROXYCHLOROQUINE PLUS FAVIPIRAVIR TREATMENT ON THE CLINICAL COURSE AND BIOMARKERS IN HOSPITALIZED COVID-19 PATIENTS WITH PNEUMONIA.

The novel coronavirus disease 2019 (COVID-19) has a broad spectrum of clinical manifestations, the most common serious clinical manifestation of the coronavirus infection being pneumonia. Unfortunately, the optimal treatment approach is still uncertain. However, many studies have been conducted on the effectiveness of several medications in the treatment of COVID-19 infection. The aim of this study was to evaluate the effectiveness of the hydroxychloroquine (HCQ) + favipiravir (FAV) treatment regimen and HCQ alone by comparing the patient's clinical response and laboratory results on the fifth day of treatment in patients hospitalized due to COVID-19 infection. This retrospective cohort study was conducted in Malatya Training and Research Hospital between March 2020 and July 2020. The study included 69 patients with confirmed COVID-19 with pneumonia. The patients were divided into 2 groups, those receiving HCQ alone and those receiving the HCQ + FAV combination. A total of 69 patients were included in the study, and the mean age was 60.09±15.56 years. A statistically significant decrease was observed in C-reactive protein (CRP) levels, at the end of the fifth day, in patients who received HCQ + FAV treatment (p=0.002), whereas there was no decrease in CRP levels in patients who received HCQ treatment alone. In addition, an increase in lymphocyte count and a better fever response was observed at the end of the fifth day in patients who received HCQ + FAV (p=0.008). However, there was no statistical difference between both treatment regimens in terms of hospital stay and treatment results (p=0.008, p=0.744, p=0.517). Although the combination of HCQ + FAV treatment was observed to be effective on CRP levels and fever response in patients with COVID-19 pneumonia, there was no difference in terms of hospital stay and discharge.

Calorie Restriction With Exercise Intervention Improves Inflammatory Response in Overweight and Obese Adults: A Systematic Review and Meta-Analysis.

Background/Purpose: In this systematic review and meta-analysis, we assessed the effects of exercise (EX) combined with calorie restriction (CR) intervention on inflammatory biomarkers, and correlations between biomarkers and participants’ characteristics were calculated in overweight and obese adults.Methods: An article search was conducted through PubMed, Web of Science, EMBASE, the Cochrane database, Scopus, and Google Scholar to identify articles published up to April 2021. Studies that examined the effect of EX + CR intervention on inflammatory biomarkers, including C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α), and compared them with a CR trial in overweight and obese adults were included. We calculated the pooled effect by meta-analysis, identified the correlations (between inflammatory biomarkers and participants’ characteristics) through meta-regression, and explored the beneficial variable through subgroup analysis. The Cochrane risk of bias tool and Methodological Index for Non-randomized Studies were used to assess the risk of bias for the included trials.Results: A total of 23 trials, including 1196 overweight and obese adults, were included in the meta-analysis. The pooled effect showed that EX + CR intervention significantly decreased CRP levels (P = 0.02), but had no effect on IL-6 (P = 0.62) and TNF-α (P = 0.11). Meta-regression analysis showed that the effect of EX + CR on CRP, IL-6, and TNF-α changes was correlated with lifestyle behavior of adults (Coef. = −0.380, P = 0.018; Coef. = −0.359, P = 0.031; Coef. = −0.424, P = 0.041, respectively), but not with age and BMI. The subgroup analysis results revealed that participants with sedentary lifestyle behavior did not respond to EX + CR intervention, as we found no changes in CRP, IL-6, and TNF-α concentrations (P = 0.84, P = 0.16, P = 0.92, respectively). However, EX + CR intervention significantly decreased CRP (P = 0.0003; SMD = −0.39; 95%CI: −0.60 to −0.18), IL-6 (P = 0.04; SMD = −0.21; 95%CI: −0.40 to −0.01) and TNF-α (P = 0.006; SMD = −0.40, 95%CI: −0.68 to −0.12) in adults without a sedentary lifestyle or with a normal lifestyle. Furthermore, the values between sedentary and normal lifestyle subgroups were statistically significant for CRP, IL-6, and TNF-α.Conclusion: Our findings showed that combination EX + CR intervention effectively decreased CRP, IL-6, and TNF-α in overweight and obese adults with active lifestyles, but not with sedentary lifestyle behavior. We suggest that ‘lifestyle behavior’ is a considerable factor when designing new intervention programs for overweight or obese adults to improve their inflammatory response.

Efficacy and Safety of Metformin Use in Rheumatoid Arthritis: A Randomized Controlled Study.

Objective: To evaluate the efficacy and safety of metformin use in rheumatoid arthritis (RA) patients receiving conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs).Methods: A prospective, randomized, controlled, single blinded, study was carried on 66 RA patients with moderate and high disease activity state, receiving csDMARDs. Patients were simply randomized to receive either metformin 850 mg twice daily (Metformin group, n = 33), or placebo twice daily (Control group, n = 33) in addition to their stable anti-rheumatic regimen and followed up for 6 months. Serum C-reactive protein (CRP), disease activity of 28 joints based on CRP (DAS-28-CRP), and quality of life (QOL) were evaluated at baseline and then every 3 months. Moreover, serum adiponectin was assessed at baseline and after 6 months.Results: Sixty patients completed the study. Drop out was due to intolerance to metformin side effects (n = 3) and non-compliance (n = 3). Metformin significantly decreased CRP levels and DAS-28-CRP after 6 months compared to the control group (p-value <0.001). A significant improvement in QOL of metformin group was observed as early as after 3 months (p-value = 0.006) with a continued improvement observed at 6 months (p-value <0.001) compared to the control group. Despite the significantly higher serum adiponectin in the metformin group at baseline, it was significantly reduced after 6 months in the metformin group with median percent change of −63.49% compared to the significant increase in the control group with median percent change of 92.40%.Conclusion: Metformin significantly improved inflammation, disease severity, and QOL in RA patients with high safety profile.Clinical Trial Registration: Clinical-Trials.gov, identifier [NCT08363405].