Elevated Inflammatory Markers Research Articles

MRSA-positive sternoclavicular septic arthritis mimicking mediastinal malignancy in a patient with multiple injection history: a rare case report

Introduction and importance: Infection of the sternoclavicular joint is exceptionally rare, accounting for less than 1% of bone infections. The presence of MRSA-positive septic arthritis in the sternoclavicular joint, coupled with its resemblance to mediastinal conditions and a history of multiple injections, presents a rare and complex clinical case that demands thorough evaluation and management. Case presentation: A 60-year-old male with a complex medical history, including hypertension, diabetes mellitus, hepatitis C, and recurrent cellulitis due to multiple IV and IM injections, presented with drowsiness and a painful, erythematous swelling of the left anterior chest wall. Clinical examination revealed pallor, distended abdomen, and decreased left-sided airway entry. Diagnostic workup showed elevated creatinine, metabolic acidosis, and inflammatory markers. Imaging revealed extensive soft tissue swelling and a mediastinal mass. A core biopsy confirmed severe acute and chronic inflammation, abscess formation, and granulation tissue suggestive of an infectious etiology. CT scans further identified sternoclavicular septic arthritis, a rare diagnosis. Clinical discussion: This case report describes MRSA-positive sternoclavicular septic arthritis in a patient with a history of tramadol and multivitamin injections. Sternoclavicular joint (SCJ) infection is rare, complicating differentiation from mediastinal malignancies. Successful management required embolization, IV antibiotics, and physiotherapy. Conclusion: MRSA-positive sternoclavicular septic arthritis, mimicking mediastinal malignancy, presents diagnostic challenges. Successful management involves tailored strategies, interdisciplinary collaboration, and consideration of IV drug injections.

Clinical characteristics of Kawasaki disease with pulmonary radiographic abnormalities and its impact on the incidence of coronary artery lesions: a randomized retrospective cohort study

ObjectiveThe aim of this study was to investigate the characteristics of Kawasaki disease (KD) in patients demonstrating pneumonia-like changes and pulmonary complications, as well as the subsequent impact on coronary artery lesions, by comparing them with those of KD patients with normal pulmonary imaging.MethodFrom January 1, 2013 to October 1, 2022, this study included paediatric patients diagnosed with KD who were registered in the KD database at Yuying Children's Hospital affiliated with Wenzhou Medical University. Patients were divided into three distinct groups based on the presence and severity of abnormalities observed via lung imaging. We first compared the demographic and clinical characteristics across these groups. The imaging characteristics of KD patients with pneumonia-like changes and pulmonary complications were identified via chest radiography (x-ray) and chest computerized tomography (CT). Logistic regression models and stratified analyses were employed to further identify factors influencing coronary artery lesions (CALs).ResultsAmong the 2,686 KD children admitted to our centre in recent years, 115 presented with pneumonia-like changes, 366 presented with pulmonary complications, and 495 presented with no evident abnormalities on chest radiographs. In KD patients with pneumonia-like changes, there were significant elevations in inflammatory markers including the C-reactive protein (CRP) (P = 0.011), white blood cell (WBC) (P = 0.027), NT-proBNP (P = 0.007), and D-dimer (D-D) (P = 0.002) levels. Imaging studies have frequently revealed bilateral lung infections, predominantly in the mid-lower lung fields. Bronchitis-related changes were the most common manifestation of pulmonary complications in KD patients. A significant difference was observed in the incidence of CALs among patients with pneumonia-like changes. After adjusting for confounding variables, patients with pneumonia-like changes had a greater likelihood of developing CALs, with an adjusted odds ratio (OR) of 1.94 [95% confidence interval (CI): 1.21, 3.11]. Similar findings were obtained through stratification and sensitivity analyses.ConclusionPatients diagnosed with KD who develop pneumonia-like changes and related pulmonary complications can be identified based on their clinical manifestations and imaging characteristics. Moreover, patients with KD and pneumonia-like changes had a significantly increased risk of developing CALs.

Clinical Features and prognostic factors in pediatric deep neck infections: a retrospective study

Background Pediatric deep neck abscesses (PDNAs) are uncommon but can cause serious complications. Despite advances in diagnostics and antibiotic therapies, effective PDNA management remains challenging, necessitating prompt diagnosis and targeted treatment. Objectives This study evaluated the clinical characteristics, treatment approaches, and factors affecting hospital stay in pediatric patients with PDNAs. Associations between laboratory markers (hemoglobin, albumin, inflammatory indices) and abscess characteristics with clinical outcomes were analyzed. Methods A retrospective review of 72 PDNA cases at Ankara Bilkent City Hospital (2019–2024) was performed. Clinical presentation, laboratory findings (hemoglobin, albumin), abscess size, and inflammatory indices (SII, NLR, SIRI) were analyzed. Results The mean age was 6.69 years, with 51.38% under six. Peritonsillar abscesses were the most common (40.3%), followed by retropharyngeal abscesses. Antibiotic therapy alone was successful in 33.3% of cases, while 66.7% required surgical drainage. Prolonged hospitalization was associated with low hemoglobin (p = .003) and albumin (p = .034), larger abscess size (p = .047), and elevated inflammatory markers (SIRI: p = .007, SII: p = .015). Conclusions and Significance Prognostic factors such as hemoglobin, albumin, and inflammatory indices is essential in PDNA management. Surgical intervention plays a key role in severe cases, emphasizing the need for standardized protocols.

Association of First-Trimester Combined Inflammatory Markers (NLR, SII, SIRI, and AISI) With Poor Obstetric Outcomes in Pregnancies With Ulcerative Colitis.

To compare the first-trimester combined inflammatory markers between pregnant women diagnosed with ulcerative colitis (UC) and healthy pregnant women. Furthermore, to investigate the predictive value of these markers for adverse obstetric outcomes in pregnant women affected by UC. In this retrospective study, data were collected from pregnant women with UC who gave birth at our hospital between January 2021 and May 2024 and from a control group of healthy pregnant women. A comparison was made between the two groups in terms of their demographic characteristics, neonatal outcomes, and the values of the first-trimester neutrophil-to-lymphocyte ratio (NLR), systemic inflammation index (SII), systemic inflammatory response index (SIRI), and aggregated index of systemic inflammation (AISI). Furthermore, the relationship between these combined inflammatory markers and adverse obstetric outcomes in pregnant women with UC was investigated. No notable discrepancy was observed between the UC group and the control group with respect to SIRI and AISI. The first-trimester NLR and SII values were observed to be higher in the UC group in comparison to the control group. The data indicated that pregnant women with UC who experienced poor obstetric outcomes exhibited elevated levels of NLR, SII, SIRI, and AISI during the first trimester. In the ROC analysis, the predictive capacity of all four parameters for poor obstetric outcomes in UC patients was statistically significant. There is an association between elevated combined inflammatory markers in the first trimester and poor obstetric outcomes in pregnant women with UC.

Post-COVID-19 tuberculosis in southeastern Spain: incidence, risk factors and the role of latent tuberculosis infection screening

Introduction. The incidence of coinfections and superinfections following SARS-CoV-2 pneumonia has garnered increasing attention, with complications arising from various pathogens, including viruses, bacteria, and fungi. Nevertheless, the relationship between COVID-19 and tuberculosis (TB) is not fully understood. This study investigates the incidence and risk factors for post-COVID-19 pulmonary TB in a low TB prevalence area in southeastern Spain, alongside the influence of COVID-19 on indeterminate results in the Quantiferon-TB Gold Plus (QFT-Plus) test and its prognostic role. Material and methods. A retrospective cohort study was conducted involving 475 hospitalized COVID-19 from March 2020 to March 2022, all of them with a QFT-Plus performed. Results. The study found three cases of pulmonary TB in the post-COVID-19 period, yielding an incidence density of 3.56 cases per 1000 patient-years, all associated with chronic systemic corticosteroid therapy. Notably, the percentage of indeterminate QFT-Plus results during COVID-19 was significantly higher than when it was performed before the disease (16.82% vs. 3.37%). Patients with indeterminate results exhibited elevated inflammatory markers and a greater need for invasive mechanical ventilation, correlating with more severe disease, although without statistical significance. Conclusions. The findings suggest that prolonged systemic corticosteroid therapy is a common risk factor for pulmonary TB development and that systematic LTBI screening may not be necessary for all COVID-19 patients unless prolonged corticosteroid treatment is foreseen. This study highlights the need for further research to clarify the relationship between COVID-19 and post-COVID-19 pulmonary TB, as well as the prognostic implications of QFT-Plus results.

P-1673. Antibiotic Stewardship in a palliative care setting reduces antimicrobial consumption and is cost-effective

Abstract Background More than 50% of patients in palliative care (PC) receive antibiotics in the final days of their life. While infection commonly occurs in this heterogenic population, clinical signs such as fever, malaise and elevation of inflammatory markers may also be attributable to the underlying disease. We evaluated the impact of a PC antimicrobial stewardship (ASP) intervention on antimicrobial consumption and cost effectiveness. Methods Starting 08/2022, the ASP and PC team of our tertiary care hospital in Switzerland conducted an interdisciplinary stewardship intervention. During weekly visits, the ASP team provided review and feedback on cases selected by the PC physicians, recommendations made were contextualized with the patient’s superordinate goals. In added teaching sequences, general stewardship principles were explained to the PC team. Cases were documented prospectively, gathering patient characteristics (i.e. age, sex, diagnoses), the ASP recommendation made regarding antimicrobials (i.e. none, start, continuation, oral switch, stop), its acceptance by the PC team (defined as realization within 48h) and hospitalization markers (i.e. length of stay (LOS), discharge location). Impact of the intervention on LOS and days of antimicrobials were estimated independently by two members of the ASP; disagreements were resolved by an arbiter. Descriptive analysis was performed, associated cost savings were calculated and offset with ASP operational costs. Proportions of recommendations made by ASP team Results Between 08/2022 and 12/2023, 96 interventions were made in 90 patients (median age 72 years), malignancy was present in 61 (68%) (Table). The most frequent recommendation was to stop antimicrobials (45%), in 17% the initiation of antimicrobials was discouraged (Figure). Overall, 96% of recommendations were accepted by the PC team, leading to an overall saving of 63 hospitalization days and 177 days of parenteral antimicrobials. Calculating the net economic effect of the ASP intervention, savings of 140’314 USD were offset by 9767 USD operational cost, resulting in overall savings of 130’547 USD. Conclusion Weekly interdisciplinary case discussions between the ASP and the PC team reduces antimicrobial consumption and hospitalization days and can be cost-effective. Disclosures All Authors: No reported disclosures

P-134. Sarcina ventriculi, pathogen or commensal? Case series and review of the literature

Abstract Background Sarcina, or Clostridium, ventriculi (SV), is a non-motile, gram-positive coccus with anaerobic fermentative properties. Due to its rarity, comprehensive knowledge about it is lacking. This study aims to elucidate its epidemiology and common manifestations. Methods We searched PUBMED and EMBASE utilizing terms as 'Sarcina', 'Ventriculi', and 'Clostridium' with no restrictions. Figure 1 contains the PRISMA diagram for case selection. Results We identified 88 cases and included 2 cases from our institution. The mean age was 48 ranging from 10 months to 89 years with an equal distribution between genders. 21% had Diabetes mellitus type 2 and 50% had baseline GI comorbidity primarily affecting the esophagus or stomach in 27% respectively. 37% were concurrently on antacids and prokinetics. The most common symptoms were abdominal pain (58%), nausea/vomiting (41%), anorexia/weight loss (18%), and diarrhea (12%). Pertinent labs were anemia, leukocytosis, and elevated inflammatory markers. Mural inflammation, ulcers, retained food with distension, pneumatosis, perforation, necrosis, masses, or obstruction were common on radiological and endoscopic workup. Organism was mostly isolated from gastric (73%) and esophageal (18%) tissue using endoscopic and/or surgical procedures (76 and 27%, respectively). It was also isolated from respiratory tissue (3%), anaerobic blood culture (3%), lymph nodes (2%), urine (1%), and cerebral ventricles (1%). Co-infection with candida in 8% and H. Pylori in 4% was noted. 57% received antibiotics, being combination therapy with metronidazole and fluroquinolones, the most therapy used. 77% had successful clinical recovery, 11% expired; the outcome for 12% of patients remains unknown. Antibiotic therapy was used in 67% and 40% of patients who clinically recovered and expired respectively. Conclusion In most cases, SV is a true pathogen responsible for symptoms rather than a commensal; however, larger-scale studies are needed to discern pathophysiology. Most cases present with an underlying GI comorbidity including dysmotility which might predispose to colonization. Metronidazole and fluroquinolones provide optimal clinical response. Disclosures All Authors: No reported disclosures

P-81. A Decade of Culture-Negative Native Vertebral Osteomyelitis: Insights from the Mayo Clinic

Abstract Background Culture-negative native vertebral osteomyelitis (CN-NVO) is increasingly common, rising from 0.3 to 1.8 cases per 100,000 between 1995 and 2008. The lack of microbial identification complicates optimal treatment and creates prognostic uncertainties. We describe our decade-long clinical experience with CN-NVO, focusing on patient characteristics, treatment, and outcomes. Patient Characteristics Methods We retrospectively analyzed adult patients with radiographic evidence of NVO between January 1, 2011, and July 31, 2021. CN-NVO required clinical indicators such as back pain and fever, elevated inflammatory markers, and negative cultures from at least one spine biopsy. Patients with infected instrumentation were excluded. Diagnostic Evaluation Values represent median, lower quartile, and upper quartile for continuous variables unless otherwise specified, 2 whereas frequencies and percentages are presented for categorical variables. ^ All results returned negative *Biopsies number two and three did not result in additional findings or change clinical management. Results Seventy-two patients were included. Their characteristics are presented in Table 1. Most (77.8%) had received antibiotics within the 4 weeks preceding the biopsy. Disc space enhancement on MRI was the primary finding, with the lumbar spine being the most frequently involved (Table 2). Blood cultures were positive in 39.4% of the patients within 3 months of symptom onset. Streptococcus spp. (n=9, median time between positive culture and diagnosis: 6.5 days [IQR 2.25, 26.75]) and Staphylococcus aureus (n=7, 40 days [IQR 37.5, 51.5]) were most common. Definitive antibiotics were administered in 98.6% of the cases, primarily IV β-lactam + vancomycin. Oral antibiotics (PO) were used in 46.5% of the patients, primarily as step-down therapy (91%) (Table 3). Surgery was required in 8.5% of the patients for abscess drainage or relief of spinal cord compression. Treatment failure occurred in 9.4% of patients, and 37.5% died during the median follow-up of 568.5 days, with two deaths related to the infection. Treatment and Outcomes ^ defined as requiring another course of antibiotics and/or surgery for suspected ongoing infection ¶ Clinical findings include back pain or fevers; laboratory findings indicate abnormal or uptrend in inflammatory marker values # Defined as MRI findings concerning ongoing or worsening infection as per the interpretation of the Radiologist, Infectious Disease physician, and/or Orthopedic Surgeon Conclusion Patients with CN-NVO often require prolonged antibiotic therapy, typically combination regimens, with favorable treatment outcomes. Our treatment failure rate is similar to other studies, although comparability may be limited by heterogeneity in definitions. Mortality rates in the range of 6 and 36% have been reported, with the higher end driven mostly by comorbidities. Enhanced diagnostics and standardized treatment protocols are needed to further improve patient outcomes. Disclosures All Authors: No reported disclosures

P-669. Characteristics of hospitalized adult patients with hMPV infection in the post-covid era

Abstract Background Human Metapneumovirus (hMPV) is a recently described respiratory tract virus with significant morbidity among children of younger age. The widespread molecular diagnostic testing has identified hMPV as an important pathogen of the upper and lower respiratory tract even in adults, especially the older and immunosuppressed. The aim of this study was to identify patients hospitalized with hMPV infection and describe their characteristics. Methods Rhinopharyngeal samples of admitted patients with respiratory tract infection in the years 2021-22, 2022-23 and 2023-24 from October 1st – March 31st were tested by multiplex PCR analysis (Film array Respiratory panel, Biomerieux, France). Positive patients aged >18 years for hMPV were included in the analysis. Demographic data, clinical and laboratory characteristics were recorded, and correlated with the duration of admission. Results In total, 1993 samples were tested (76 in 2021-22, 554 in 2022-23, and 1363 in 2023-24). Among those, 0, 13 and 8 adults were found to be positive respectively, 8 male and 13 female with a mean age of 68,1 years (±17,8). Upon admission, 52,4% of the patients had pulmonary infiltrates on X-Ray. Median CRP was 101,1mg/L (nv < 5mg/L). In 39,1% of the patients another pathogen was isolated from clinical samples (in 4 patients from urine, in 2 from sputum and in 2 from blood cultures). All patients received antibiotics, 61,9% systemic steroids and 81,0% inhaled bronchodilators. One patient aged 94 years died. CRP levels were not associated with the detection of other pathogens (p=0,485). Mean duration of admission (7,3±4 days) was not associated with age. The co-isolation of other pathogens, and CRP levels tended to correlate with longer duration of hospitalization (p=0,100, and p=0,068 respectively), Table I. Conclusion HMPV is implicated in respiratory tract infections. Clinical presentation is associated with respiratory distress with significantly elevated inflammatory markers, requiring inhaled bronchodilators and systemic steroids. The significant majority of the patients recovers without sequelae. Disclosures Athina Pyrpasopoulou, MD PhD, Gilead: Honoraria|Pfizer: Honoraria

Systemic Inflammatory Diseases in Children with Sickle Cell Disease: A French Multicenter Observational Study on Diagnostic and Therapeutic Issues.

Systemic inflammatory diseases (SIDs) have been reported in patients with sickle cell disease (SCD), but clinical data in children are scarce. To identify clinical and laboratory features at diagnosis of SID in children with SCD and to describe their evolution. Data from children with SCD and SIDs were retrospectively collected in a French multicenter study from 1991 to 2018. Information included clinical characteristics, inflammatory markers, autoantibodies patterns, treatments, and complications. Inflammatory marker levels were compared at SID diagnosis and at the last follow-up. Statistical analyses were performed using Cran R software. Among a cohort of 3800 children with SCD, 43 SIDs were identified in 35 study participants: autoimmune liver disease (AILD, n = 13), inflammatory bowel disease (IBD, n = 7), juvenile idiopathic arthritis (JIA, n = 6), systemic lupus erythematosus (n = 4), autoimmune hemolytic anemia (n = 3), Sjögren syndrome (n = 1), histiocytic necrotizing lymphadenitis (n = 2), vasculitis (n = 2), myasthenia gravis (n = 1), sarcoidosis (n = 1), idiopathic inflammatory granulomatous uveitis (n = 1), mixed connective tissue disease (n = 2). Prevalence of SID was 0.9% in our cohort of children with SCD. The median time between initial symptoms and SID diagnosis was 10 (3-20) months, notably longer in children with JIA, IBD, and Sjögren syndrome. Sixteen patients (46%) exhibited hypergammaglobulinemia (>20g/L) at diagnosis. No significant differences were observed for other inflammatory parameters. Twenty-one children (60%) received systemic steroids and 13 (37%) biological therapies. Three patients (9%) underwent hematopoietic stem cell transplantation. Nine patients (26%) had severe infections; one died. Delayed diagnosis was frequent due to overlapping clinical presentations between SCD and SID. Clinicians must be aware of warning signs associated with elevated inflammatory markers, hypergammaglobulinemia, or specific antibodies. Therapeutic strategies remain challenging.

Joint fluid multi-omics improves diagnostic confidence during evaluation of children with presumed septic arthritis

BackgroundAn accurate diagnosis of septic versus reactive or autoimmune arthritis remains clinically challenging. A multi-omics strategy comprising metagenomic and proteomic technologies were undertaken for children diagnosed with presumed septic arthritis to advance clinical diagnoses and care for affected individuals.MethodsTwelve children with suspected septic arthritis were prospectively enrolled to compare standard of care tests with a rapid multi-omics approach. The multi-omics combined bacterial 16S rRNA metagenomics, single cell transcriptomics, and proteomics on knee joint fluid specimens. The diagnostic value of the multi-omics was ascertained relative to standard of care culture and PCR-negative results.ResultsTen children with suspected primary septic arthritis and two with acute hematogenous osteomyelitis (AHO) diagnoses were assessed. Joint fluid bacterial cultures were positive for 6/12 (50%) patients, consistent with elevated inflammatory markers (IL-4, IL-6, IL-17A, TNF-a, etc.). Metagenomic bacterial sequencing results were 100% concordant with the culture results. Six patients were culture- and PCR-negative. Multiomics analyses of the 6 culture negative patients established that 2/6 culture-negative children had inflammatory arthritis with potential Juvenile idiopathic arthritis (JIA) and 1 had post-Streptococcal Reactive Arthritis. The children without any bacteremia had autoantibodies (IgGs) in the joint-fluid targeting several nuclear antigens (i.e., dsDNA, histones, Jo-1, scl-70, Ro/SS-A, SmDs, CENP-A along with non-nuclear antigens i.e. Albumin, Collagens, Myosin, Laminin, etc. Single cell transcriptomics confirmed an abundance of CD4+ follicular helper T (Tfh), CD8 + T cells and B cells in the autoantibody positive subjects. The combination of 16S DNA sequencing (p = 0.006), cytokine assays (p = 0.009) and autoantibody profiling (p = 0.02) were significantly distinct between those children with and without infections. This improved the diagnostic confidence for 9 of 12 (75%) children, key for treatment decisions.ConclusionsThe multiomics approach rapidly identified children with bacterial or autoimmune inflammatory conditions, improving diagnostic and treatment strategies for those with presumptive septic arthritis.

DOP038 Impact of prenatal and breastfeeding exposure to biologic drugs on the first-year anthropometric development of infants born to mothers with inflammatory bowel disease from DUMBO registry of GETECCU

Abstract Background For children born to mothers with inflammatory bowel disease (IBD), the effects of maternal inflammation and exposure to biologic drugs during pregnancy may be significant. Elevated systemic inflammatory markers during pregnancy are linked to adverse birth outcomes and impaired infant growth. However, specific evaluation within the IBD context remains limited, and the impact of biologic drug exposure on early anthropometric outcomes is still uncertain. Aim: to analyze anthropometric development and malnutrition risk during the first year of life based on intrauterine and breastfeeding exposure to biologics in infants born to IBD mothers. Methods The study included mothers with IBD and infants from the DUMBO registry, a prospective registry started in 2019, involving 60 centers in Spain. Data of maternal status and treatments at conception, each trimester of gestation and postpartum, were included. Additionally, infants were assessed at birth, and at 3, 6, 9, and 12 months post-birth. Infant development and nutritional status were assessed through ASPEN anthropometric criteria. Nutritional status was assessed by weight-for-height/length z-scores: ≤ -1.0 indicated malnutrition (mild: -1.0 to -1.9, moderate: -2.0 to -2.9, severe: ≤ -3.0). A z-score between -1.0 and +1.0 was considered adequate for sex and age (or corrected age in premature infants). Active IBD was defined as a partial Mayo score >2 in ulcerative colitis or unclassified IBD, and a CDAI >150 in Crohn’s disease. Results A total of 352 children born to 343 women with IBD were studied. Among these, 134 infants (38%) were exposed to biologics during pregnancy, and 80 (23%) during pregnancy and lactation. No statistically significant differences were found in maternal characteristics, IBD activity during pregnancy, or child characteristics in the first year based on biologic exposure (Tables 1a, 1b). Infants exposed and non-exposed to biologics showed no differences in normal height and weight development during the first year of life (Tables 2a, 2b). Regarding the weight-for-height ratio, at 1 month of age, the proportion of infants with a malnutrition risk was significantly higher in non-exposed vs. exposed infants (33% vs. 21%, p<0.05). Similarly, non-exposed infants showed significantly higher prevalence of moderate to severe malnutrition at 3 months of age (47% vs. 20%; p<0.05) (Table 2c). Conclusion Our findings suggest that exposure to biologic therapies during pregnancy and breastfeeding is not only safe but may even have a beneficial effect on children's growth and weight development. This suggests that better control of maternal inflammation, beyond mere symptom relief, could positively impact child development.

P1047 Moderate and severe iron deficiency anaemia responds better to oral iron therapy than mild iron deficiency anaemia in Crohn’s Disease patients: a prospective study in a resource-limited setting

Abstract Background Iron deficiency anaemia (IDA) is the most common type of anaemia in patients with Crohn’s disease (CD). Due to the generally low absorption of oral iron, parenteral iron therapy is often the preferred treatment in these patients. However, in resource-limited countries like India, not all patients can afford the high costs and hospitalisations associated with parenteral therapy. This study aims to evaluate the effectiveness of oral iron therapy in CD patients. Methods Adult patients with CD presenting to our centre’s Inflammatory Bowel Disease clinic from July 2021 were screened for anaemia. Patients with IDA, defined as haemoglobin (Hb) <13 g/dL in males and <12 g/dL in non-pregnant females along with Transferrin saturation <20% and Serum Ferritin <30 µg/L or 30-100 µg/L (in the presence of elevated inflammatory markers)1, were prospectively included in this study after obtaining informed consent and Institutional review board approval (IRB no.14235). Patient demographics, disease characteristics and treatment details were noted. Anaemia was classified as mild (Hb: 10-11.9 g/dL in females and 10-12.9 g/dL in males), moderate (Hb: 7 - 9.9 g/dL) and severe (Hb: <7 g/dL). Response assessment was done by measuring Hb in patients who completed oral iron therapy for a period of 8 to 12 weeks. A response was defined as an increase in follow-up Hb by ≥2 g/dL from baseline or normalisation of Hb. Chi-square test was used to assess the difference between responders and non-responders among mild versus moderate and severe anaemia. Results Fifty three CD patients with IDA were included. Four patients switched to parenteral iron and 4 were noncompliant to oral iron. We analysed 45 patients who completed 8 to 12 weeks of oral iron therapy. Their details are in Table 1. Of these, 35 (77.8%) patients had exclusive IDA, while 10 (22.2%) patients had IDA alongside anaemia of chronic disease. Most common symptom was weight loss, seen in 23 (51.1%) patients. Mild anaemia was seen in 18 (40%) and moderate or severe anaemia was noted in 27 (60%) patients. Most patients received oral elemental iron dosage of 50mg per day, while only 2 patients received a dosage of 100mg. Response to oral iron was seen in 25 (55.6%) patients. Patients with moderate and severe anaemia showed a more pronounced response to oral iron therapy (n=19; 70.3%) compared to those with mild anaemia (n=6; 33.3%), which was statistically significant with a p-value of 0.014. A longer follow-up and a larger number of patients will be recruited to enhance these findings in the future. Conclusion Our study concludes that oral iron therapy is a decent option in CD patients to improve Hb levels, predominantly in patients with moderate and severe IDA, contrary to the traditional belief.

Association between abnormal systemic coagulation inflammation index and recurrence of deep venous thrombosis as well as quality of life: A retrospective study.

Deep vein thrombosis (DVT) of the lower limb is a significant clinical challenge with the potential for recurrence, which can lead to increased morbidity and reduced quality of life. A retrospective case-control study was conducted involving 367 patients diagnosed with lower limb DVT from June 2020 to June 2023. Patients were categorized into a recurrence group (n = 121) and a non-recurrence group (n = 246) based on DVT occurrence. Data were systematically collected from medical records, including demographic information, thrombus characteristics, patient compliance, coagulation parameters, inflammatory markers, and quality of life assessments using the CIVIQ-20 and SF-36 scales. The recurrence group had significantly higher mean age, history of orthopedic diseases, and pregnancy, reduced compliance with compression therapy and anticoagulation, and elevated inflammatory markers including IL-6, IL-8, and TNF-α. Prolonged coagulation times (PT, APTT, TT) were associated with a lower risk of recurrence. The SCI index was significantly lower in the recurrence group. Multivariate logistic regression identified age, IL-6, IL-8, PT, APTT, TT, and SCI index as significant predictors of recurrence. Quality of life scores were lower in the recurrence group, indicating a higher impact on mental and overall health. ROC analyses demonstrated strong predictive capacity (AUC = 0.905) of SCI index. The study underscores the multifactorial nature of DVT recurrence, highlighting the role of age, systemic inflammation, coagulation times, and compliance with therapeutic interventions. The SCI index emerges as a compelling prognostic marker for assessing the risk of DVT recurrence. These findings emphasize the need for comprehensive management strategies incorporating these parameters to prevent recurrence and improve patients' quality of life.

Inflammatory Markers and Severity in COVID-19 Patients with Clostridioides Difficile Co-Infection: A Retrospective Analysis Including Subgroups with Diabetes, Cancer, and Elderly.

The interplay of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection and Clostridioides difficile infection (CDI) poses a critical clinical challenge. The resultant inflammatory milieu and its impact on outcomes remain incompletely understood, especially among vulnerable subgroups such as elderly patients, those with diabetes, and individuals with cancer. This study aimed to characterize inflammatory markers and composite inflammatory severity scores-such as Acute Physiology and Chronic Health Evaluation II (APACHE II), Confusion, Urea, Respiratory rate, Blood pressure, and age ≥ 65 years (CURB-65), National Early Warning Score (NEWS), and the Systemic Immune-Inflammation Index (SII)-in hospitalized Coronavirus Disease 2019 (COVID-19) patients with and without CDI, and to evaluate their prognostic implications across key clinical subgroups. We conducted a retrospective, single-center study of 240 hospitalized adults with Reverse Transcription Polymerase Chain Reaction (RT-PCR)-confirmed COVID-19 between February 2021 and March 2023. Of these, 98 had concurrent CDI. We collected baseline demographics, comorbidities, and laboratory parameters including C-reactive protein (CRP), Interleukin-6 (IL-6), ferritin, neutrophil and lymphocyte counts, albumin, platelet counts, and calculated indices (C-reactive protein to Albumin Ratio (CAR), Neutrophil-to-Lymphocyte Ratio (NLR), Prognostic Nutritional Index (PNI), SII). Patients were stratified by CDI status and analyzed for inflammatory marker distributions, severity scores (APACHE II, CURB-65, NEWS), and outcomes (Intensive Care Unit (ICU) admission, mechanical ventilation, mortality). Subgroup analyses included diabetes, elderly (≥65 years), and cancer patients. Statistical comparisons employed t-tests, chi-square tests, and logistic regression models. Patients with CDI demonstrated significantly higher CRP, IL-6, SII, and CAR, coupled with lower albumin and PNI (p < 0.05). They also had elevated APACHE II, CURB-65, and NEWS scores. CDI-positive patients experienced increased ICU admission (38.8% vs. 20.5%), mechanical ventilation (24.5% vs. 12.9%), and mortality (22.4% vs. 10.6%, all p < 0.05). Subgroup analyses revealed more pronounced inflammatory derangements and worse outcomes in elderly, diabetic, and cancer patients with CDI. Concurrent CDI intensifies systemic inflammation and adverse clinical trajectories in hospitalized COVID-19 patients. Elevations in inflammatory markers and severity scores predict worse outcomes, especially in high-risk subgroups. Early recognition and targeted interventions, including infection control and supportive measures, may attenuate disease severity and improve patient survival.

Familial Mediterranean fever in Romania: a case report and literature review.

Familial Mediterranean Fever (FMF) is a hereditary autoinflammatory disease characterized by recurrent fever and systemic inflammation, most prevalent in Eastern Mediterranean populations. Rare in regions like Romania, FMF presents diagnostic challenges and risks severe complications if untreated. We report a 7-year-old Romanian girl, from a non-classical ethnic background, with recurrent febrile episodes and elevated inflammatory markers. Genetic testing confirmed a homozygous MEFV c.2082G>A (p.Met694Ile) variant. Colchicine therapy reduced flare frequency and normalized inflammatory markers. FMF should be considered in atypical populations with recurrent inflammation. Genetic testing aids diagnosis in non-endemic regions, enabling early colchicine treatment to prevent complications.

Genetic and Environmental Influences on Autism Spectrum Disorder: A Multi-Center Study Exploring Gene-Environment Interactions and Biomarkers in Indonesia

Introduction: Autism spectrum disorder (ASD) is a neurodevelopmental condition with a complex etiology involving genetic and environmental factors. This multi-center study investigated gene-environment interactions and potential biomarkers associated with ASD in the Indonesian population. Methods: Children diagnosed with ASD (n=500) and age-matched typically developing controls (n=500) were recruited across five major Indonesian cities. Whole-exome sequencing targeted genotyping, and environmental risk factor assessments were conducted. Biomarker analyses included cytokine levels, oxidative stress markers, and neurotransmitters. Results: Genetic analysis revealed both rare and common variants associated with ASD risk, including variants in CHD8, SCN2A, NRXN1, and novel genes. Prenatal exposures (maternal medication use, infections), perinatal complications (preterm birth, low birth weight), and postnatal factors (pesticide exposure, air pollution) were associated with increased ASD risk. Children with ASD exhibited elevated inflammatory markers (TNF-α, IL-6, IL-1β), increased oxidative stress (higher MDA, lower GSH), and altered neurotransmitter levels (lower serotonin and dopamine) compared to controls. Conclusion: This study provides insights into the interplay of genetic and environmental factors contributing to ASD risk in Indonesia. The identified genetic variants, environmental risk factors, and potential biomarkers may contribute to our understanding of ASD etiology and inform the development of targeted interventions and early detection strategies.

Adalimumab-induced optic neuropathy in a patient with Behçet’s syndrome

A 37-year-old woman with a diagnosis of Behçet’s syndrome, treated with colchicine and prednisolone, maintained low disease activity for a period of 10 years, after which, she developed a new episode of anterior uveitis. A cycle of high dose systemic corticosteroids was required but the patient presented with a new flare during dose tapering. A decision to initiate a corticosteroid-sparing agent was then made, with an initially satisfactory response. However, 3 months later the ocular symptoms recurred, and a new bout of oral ulceration appeared concurrently. As a result, adalimumab was then started, but the patient presented with a sudden and severe decrease of visual acuity in her right eye 4 months later. The initial bloodwork showed no elevated inflammatory markers. A lumbar puncture showed a normal cerebrospinal fluid composition. Although these findings made it less probable that the patient’s symptoms were caused by infectious or autoimmune disease, extensive investigations directed at these possible causes were performed, with negative results. Several imaging tests were also performed, which showed no alterations. However, a sensory evoked potentials test revealed a functional compromise at the pre-chiasmatic level. An iatrogenic optic neuropathy induced by adalimumab seemed the most probable cause and a decision to suspend the treatment was made. A new cycle of high dose systemic corticosteroids consisting of three pulses of methylprednisolone followed by pred-nisolone with a quick tapering over 4 weeks was also started, with gradual improvement of visual acuity.

Adalimumab-induced optic neuropathy in a patient with Behçet’s syndrome

A 37-year-old woman with a diagnosis of Behçet’s syndrome, treated with colchicine and prednisolone, maintained low disease activity for a period of 10 years, after which, she developed a new episode of anterior uveitis. A cycle of high dose systemic corticosteroids was required but the patient presented with a new flare during dose tapering. A decision to initiate a corticosteroid-sparing agent was then made, with an initially satisfactory response. However, 3 months later the ocular symptoms recurred, and a new bout of oral ulceration appeared concurrently. As a result, adalimumab was then started, but the patient presented with a sudden and severe decrease of visual acuity in her right eye 4 months later. The initial bloodwork showed no elevated inflammatory markers. A lumbar puncture showed a normal cerebrospinal fluid composition. Although these findings made it less probable that the patient’s symptoms were caused by infectious or autoimmune disease, extensive investigations directed at these possible causes were performed, with negative results. Several imaging tests were also performed, which showed no alterations. However, a sensory evoked potentials test revealed a functional compromise at the pre-chiasmatic level. An iatrogenic optic neuropathy induced by adalimumab seemed the most probable cause and a decision to suspend the treatment was made. A new cycle of high dose systemic corticosteroids consisting of three pulses of methylprednisolone followed by pred-nisolone with a quick tapering over 4 weeks was also started, with gradual improvement of visual acuity.

Klotho protein: A key modulator of aging and COVID-19 severity.

The COVID-19 pandemic has drawn significant attention to factors affecting disease severity, especially in older adults. This study explores the relationship between Klotho, an anti-aging protein, and COVID-19 severity. Conducted at Tehran's Firouzgar Hospital, this case-control study involved 279 participants, assessing serum levels of Klotho, inflammatory markers (C-reactive protein (CRP), Interleukin 6 (IL-6)), and Vitamin D. The findings indicate significantly lower Klotho levels in COVID-19 patients, especially those in the ICU, which correlate with elevated inflammatory markers and reduced Vitamin D levels. This inverse relationship between Klotho levels and disease severity underscores the protein's potential modulatory role in the inflammatory response to COVID-19. The study not only highlights the importance of Klotho as a biomarker for aging and disease severity but also suggests its potential therapeutic value in managing COVID-19, offering a novel perspective on targeting aging-related pathways to mitigate the impact of the disease. These insights open new avenues for research and intervention strategies to leverage anti-aging mechanisms to combat COVID-19 and potentially other age-related diseases.