ESR Levels Research Articles

Zhuifeng Tougu capsules in the treatment of knee osteoarthritis (cold dampness obstruction syndrome): a randomized, double blind, multicenter clinical study

BackgroundIn Traditional Chinese Medicine (TCM) theory, cold dampness obstruction is one of the common syndromes of osteoarthritis. Therefore, in clinical practice, the main treatment methods are to dispel wind, remove dampness, and dissipate cold, used to treat knee osteoarthritis (KOA). This report describes a mulitercenter clinical study to assess Zhuifeng Tougu Capsule’s efficacy and safety in the treatment of patients who are cold dampness obstruction syndrome in KOA, and to provide evidence-based medical for the rational use of Zhuifeng Tougu Capsules in clinical practice.MethodsThis randomized, parallel group controlled, double-blind, double dummy trial will include a total of 215 KOA patients who meet the study criteria. 215 patients underwent 1:1 randomisation, with 107 cases assigned the experimental group (Zhuifeng Tougu Capsules + Glucosamine Sulfate Capsules Simulator) and 108 assigned the control group (Glucosamine Sulfate Capsules + Zhuifeng Tougu Capsules Simulator). After enrolment, patients received 12 weeks of treatment. The main efficacy measure is the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) pain score. Visual analogue scale (VAS) pain score, Self-condition assessment VAS score, WOMAC KOA score, TCM syndrome score and TCM syndrome efficacy, ESR level, CRP level, suprapatellar bursa effusion depth, use of rescue drugs, and safety indicators are secondary efficacy indicators.ResultsCompared with before treatment, WOMAC pain score, VAS pain score, Self-condition assessment VAS score, WOMAC KOA score, and TCM syndrome score decreased significantly in both groups (P < 0.01). Also, the experimental group showed significant differences in the above indicators compared to control (P < 0.01). However, after treatment, no significant differences were showed in the ESR level, CRP level, and suprapatellar bursa effusion depth between the two groups (P > 0.05). No any serious adverse effects showed in the experimental group and control group.ConclusionsZhuifeng Tougu Capsules can effectively improve knee joint function and significantly alleviate the pain of KOA.Trial registration: Clinical trial registration was completed with the China Clinical Trial Registration Center for this research protocol (No. ChiCTR2000028750) on January 2, 2020.

FREE AIR FROM WHERE? SPONTANEOUS PNEUMOMEDIASTINUM AND SUBCUTANEOUS EMPHYSEMA IN A PATIENT WITH ULCERATIVE COLITIS IN THE ABSENCE OF COLONIC OR ESOPHAGEAL PERFORATION

Abstract INTRODUCTION The development of Spontaneous Pneumomediastinum and Subcutaneous Emphysema in patients with Inflammatory Bowel Disease (IBD) has often been associated with perforation related to toxic megacolon or prior endoscopic procedures. We describe a case of Ulcerative Colitis complicated by Clostridium difficile (C diff) colitis in which Spontaneous Pneumomediastinum and Subcutaneous Emphysema developed without any evidence of perforation. CASE REPORT A 20-year-old male with a past medical history of recently diagnosed Ulcerative Colitis presented for evaluation of rectal pain, dysphagia, hematochezia, fecal incontinence, and urinary hesitancy. He endorsed dysphagia with the inability to tolerate solids or liquids for 4 days. He was diagnosed with Ulcerative Colitis 5 months prior to presentation and had unintentionally lost 90 lbs over the past 2 months. His home medication regimen included infliximab started 2 weeks prior, mesalamine PO tablets and suppositories, and a prednisone taper initiated at 10 mg TID. Laboratory tests confirmed anemia, leukocytosis, thrombocytosis, and elevated ESR and CRP levels. Chest X-ray and CT scans of the neck and chest showed moderate pneumomediastinum and subcutaneous emphysema. Given the symptoms of dysphagia along with the imaging findings of pneumomediastinum and subcutaneous emphysema, there was concern for esophageal perforation. However, an Esophagram and Upper GI series were both unremarkable. Abdominal CT revealed colitis of the descending and sigmoid colon without any evidence of free air or free fluid. Fecal Occult Blood Test and C diff antigen and toxin assays were positive. He was treated with oral vancomycin, IV fluids, IV methylprednisolone, and total parenteral nutrition (TPN). His symptoms significantly improved with a decrease in stool frequency and bloody stools. TPN was weaned and he was able to tolerate an oral diet. A repeat CT scan of the chest showed a complete resolution of the pneumomediastinum. CONCLUSION There are only a few reported cases in the literature of spontaneous pneumomediastinum and subcutaneous emphysema in patients with IBD in the absence of colonic or esophageal perforation. The spontaneous isolated presentation of air leaking from a chronically diseased hollow organ remains rare. In our patient there was no evidence of perforation, therefore the pneumomediastinum and subcutaneous emphysema likely resulted from the release of free air from colonic micro-perforations caused by the severe inflammation related to his Ulcerative Colitis flare and C. diff infection. CT Chest demonstrating pneumomediastinum and subcutaneous emphysema of the neck CT Neck demonstrating subcutaneous emphysema

P937 A Retropective Analysis of Micronutrient Status in Inflammatory Bowel Disease

Abstract Background Researchers are increasingly focusing on the influence of micronutrient levels on the initiation and prognosis of Inflammatory Bowel Disease (IBD). Earlier investigations have highlighted a connection between deficiencies in zinc and selenium and an elevated risk of IBD development and unfavorable outcomes. This study seeks to investigate the existing micronutrient status among Chinese patients with IBD and assess whether deficiencies in trace elements are associated with disease activity, extent of intestinal involvement, and the use of biological treatments. Methods This cross-sectional study included patients diagnosed with Crohn's disease (CD) or ulcerative colitis (UC) who underwent plasma micronutrient testing during outpatient or inpatient visits to the Department of Gastroenterology at Peking Union Medical College Hospital from May 2022 to October 2023. Baseline data, the history of biological agent use, and laboratory inflammation parameters such as hsCRP, ESR, and Alb were extracted from the Electronic Medical Record System. Colonoscopy images were examined to assess the extent of intestinal involvement and endoscopic activity. The distribution of micronutrient deficiency among patients with varying disease statuses was explored using the Pearson chi-square test and Mann-Whitney U-test. Results Among the 168 participants with IBD in this study (77 with CD, 91 with UC), a frequent occurrence of deficiencies in copper, selenium, strontium, and zinc was noted. In CD patients in the endoscopic active phase, there was a higher incidence of selenium and zinc deficiencies compared to the remission phase (selenium 0% vs. 11.3%, p=0.17; zinc 4.2% vs. 24.5%, p=0.052). In UC patients during the endoscopic active phase, strontium (14.5% vs. 0%, p=0.053) and zinc (17.7% vs. 3.4%, p=0.094) deficiencies were more likely to occur. CD patients with zinc deficiency and UC patients lacking zinc or selenium showed higher levels of blood hsCRP and ESR but lower levels of serum albumin. UC patients with E3 type involvement were more prone to selenium and strontium deficiencies compared to those with only left colon involvement (selenium 18.5% vs. 2.7%, p=0.025; strontium 14.8% vs. 5.0%, p=0.078). Conclusion This study identified a notable prevalence of micronutrient deficiencies in individuals with IBD, particularly during active phases. Specifically, patients with CD in an inflammatory state are inclined to exhibit zinc deficiency. In the case of UC, the absence of selenium, strontium, and zinc signals a higher level of inflammation. UC patients with involvement of the entire colon are more prone to experiencing deficiencies in selenium and strontium. These findings warrant validation through multi-center study and mechanism invetigation.

Optimal reimplantation timing in two-stage exchange for periprosthetic joint infection: an observative cohort study in Asian population

BackgroundThe optimal timing for reimplantation for periprosthetic joint infection (PJI) has not been established and varies from a few weeks to several months. The aim of this study was to assess the commendable time between implant removal and reimplantation in patients who underwent two-stage exchange arthroplasty for PJI.MethodsWe retrospectively reviewed 361 patients who were treated with two-stage exchange arthroplasty for hip and knee chronic PJI at our institution between January 2000 and December 2018. Patient characteristics, comorbidities, surgical variables, microbiology data, and time to reimplantation were recorded. All patients were followed for a minimum of one year. Treatment failure was defined by Delphi criteria. Logistic regression analyses were used to calculate survival rates and adjusted odds ratios (ORs) of treatment failure.ResultsIn final analysis, 27 (7.5%) had treatment failure. Factors related to treatment failure including interim spacer exchange (OR, 3.13; confidence interval (CI), 1.04–9.09, p = 0.036), higher ESR level at reimplantation (OR, 1.85; CI, 1.05–3.57; p = 0.04), and time to reimplantation (OR, 1.00; CI, 1.003–1.005, p = 0.04). Performing revision arthroplasty surgery from 16 to 20 weeks had highest successful rate. The reimplantation over 24 weeks had a lower successful rate. However, no statistical significance in comparing each interval group.ConclusionOur study emphasized the importance of timely reimplantation in achieving successful outcomes. Factors such as ESR levels, spacer exchange, and the duration of time to reimplantation influenced the likelihood of treatment failure in two-stage exchange arthroplasty for hip and knee PJI.

Schnitzler’s syndrome – diagnostic experience, approaches to therapy, patient management according to a multicenter Russian cohort

The aim – to present the experience of diagnosis, management, and therapy with IL-1 inhibitors in patients with Schnitzler’s syndrome (SchS) according to a multicenter Russian cohort.Materials and methods. In an observational retrospective study for a 10-year period (2012–2022), 17 patients with SchS who were admitted to the hospital or were observed on an outpatient basis, among them 8 women, 9 men, were included in the study. The diagnosis of all corresponded to the Strasbourg diagnostic criteria.Results. The age of patients ranged from 25 to 81 years (Me 53 [46; 56] years). The age at the time of the onset of the disease ranged from 20 to 72 years (Me 46 [39; 54] years), the duration of the disease before diagnosis ranged from 1 to 35 years (Me 6.5 [3; 6] years), in 3 it exceeded 10 years, in the rest it ranged from 1 to 8 years. Infectious and lymphoproliferative diseases, monogenic AIDS (CAPS, TRAPS, HIDS) were excluded from all patients at the prehospital stage. The guiding diagnosis for all was Still’s disease in adults. Clinical manifestations of the disease included: fatigue, lethargy, fatigue, rash and fever in all, skin elements were urticular in all, accompanied by itching in 6 (37.5%). Bone pain had 12 (70.6%), arthralgia – 16 (94.1%), arthritis – 9 (52.9%), myalgia – 7 (41.2%), weight loss in 4 (23.5%). Lymphadenopathy (6), enlarged liver (6), pericarditis (4), angioedema (6), redness and dryness in the eyes (3), sore throat (2), abdominal pain (1), distal polyneuropathy (2), paraesthesia (1), chondritis of the auricles were less common (1). Monoclonal gammopathy was detected in all with a secretion level of 2.9–15.1 g/l: IgMk (n=10 (64.7%)), less often IgMλ (n=2), IgGk (n=2), IgGλ (n=1), IgAλ (n=1). Ben-Jones protein was not detected in any of them. All patients had an increase in the level of ESR, CRP. 16 patients before inclusion in the study received GC (94.1%) with a temporary effect and its escape with dose reduction or cancellation, DMARD – 7, among them methotrexate (5), hydroxychloroquine (2), cyclophosphamide (1), also NSAIDs and antihistamines in all, biological drugs: anti-B-cell the drug rituximab (1), monoclonal AT to IgE – omalizumab in 2 (1 – without effect, 1 – partial effect). 11 patients were prescribed IL-1: canakinumab – 9 (52.9%) subcutaneously once every 8 weeks, anakinra – 4 (23.5%) subcutaneously daily. The duration of taking anakinra, which was prescribed in the test mode, ranged from 1 week to 2.5 months with a further switch to canakinumab in 3. The duration of taking canakinumab at the time of analysis ranged from 7 months to 8 years. Against the background of treatment with IL-1, 10 out of 11 (90.9%) received a complete response from the clinical manifestations of the disease and a decrease in the level of ESR and CRP within a few days. In 1 patient, a partial response was received to the administration of anakinra, and when switching to canakinumab, the effect of treatment was finally lost. 1 patient received IL-6 for 8 months with incomplete effect and transition to IL-1 with positive dynamics. In 1 patient, due to the persistent absence of relapses, the interval between canakinumab injections was increased to 5 months without signs of reactivation, but subsequently, against the background of stress and relapses of the disease, the intervals were reduced to 4 months. A healthy child was born in the same patient on the background of treatment. The tolerability of therapy was satisfactory in all patients, no SAE was noted.Conclusion. SchS is a rare multifactorial/non–monogenic AID that needs to be differentiated from a number of rheumatic diseases and other AIDS. The onset in adulthood, the presence of recurrent urticarial rashes in combination with fever and other manifestations of a systemic inflammatory response are indications for examination for monoclonal secretion. The use of short- or long-acting IL-1 is a highly effective and safe option in the treatment of such patients.

Многокомпонентный характер болевого синдрома у пациентов с анкилозирующим спондилитом

The purpose — to evaluate the nature of pain syndrome in patients with ankylosing spondylitis (AS) in correlation with the course of the disease. Material and methods. 76 patients with a verified diagnosis of AS were examined. Men accounted for 60.5% of the patients, women — 39.5%. The mean age in the studied group of patients was 42 [34.25; 58.75] years. Disease activity was assessed by ASDAS-CRP, median 4.05 [2.91; 4.7]. The mean disease duration was 138 [96; 261] months. To assess the multicomponent of chronic pain, the following were used: neuropathic pain (NP) questionnaire — Pain Detect, Central Sensitisation Inventory scale to assess the relationship of pain with central sensitization (CS), EQ-5D and SF-36 questionnaires to assess the quality of life. Results. In the studied cohort of patients, only 10.5% had isolated inflammatory pain, all others had mixed pain. Three-component pain occurred in 52.8% of cases. Patients with mixed pain were older in age, had higher disease activity according to ASDAS-CRP, had radiological stage 3–4 and reduced quality of life according to EQ-5D-3L and SF-36 questionnaire. NP in patients with AS was significantly dependent on the presence and severity of peripheral arthritis (r = 0.468, p &lt; 0.001), the level of ESR (r = 0.552, p &lt; 0.001) and circulating immune complexes (r = 0.464, p = 0,005). CS was associated with greater pain intensity by VAS (r = 0.610, p &lt; 0.001), was dependent on inflammatory markers — CRP (r = 0.451, p = 0.004), influenced quality of life by EQ-5D (r = — 0.681, p &lt; 0.001) and SF-36 (physical comp r = -0.579, p &lt; 0.001, mental comp r = -0.587, p &lt; 0.001) questionnaires. Conclusions. In 89.5% of the studied patients with AS, the chronic pain syndrome was mixed in nature, with CS predominating over NP. Patients with AS and presence of several types of pain had higher clinical and laboratory activity of the disease and X-ray stage, peripheral arthritis was more frequent.

Evaluation of baseline F-18 FDG positron emission tomography in the diagnosis and assessment of giant cell arteritis.

The aim of this study is to evaluate the baseline F18-FDG PET/CT findings of individuals diagnosed with giant cell arteritis (GCA) and to explore its association with clinical findings and classification criteria. We analysed data from patients who underwent F18-FDG PET/CT scans to investigate large vessel (LV) involvement between 2010 and 2019. Only patients with a clinical diagnosis of GCA and at least 6 months of follow-up were included. We compared initial clinical features and laboratory findings based on the presence of LV vasculitis on PET/CT and the maximum standard uptake value (SUVmax) of vascular territories. Twenty-nine patients (median age at diagnosis: 70, F/M: 24/5) were included in the study. Among them, 21 patients (72.4%) presented with cranial symptoms, while 8 patients (27.5%) had isolated LV-GCA. Twenty-two patients (75.9%) met the ACR/EULAR 2022 GCA classification criteria. LV vasculitis was detected on PET/CT in 23 patients (79.3%). A positive correlation was observed between SUVmax in the thoracic aorta and both CRP and ESR levels (r = 0.50, p = 0.026 and r = 0.63, p = 0.002, respectively). PET/CT positive patients were found to be younger (p = 0.016) and more frequently female (p = 0.017). They also exhibited fewer headaches (56.5% vs. 100%, p = 0.04), experienced fewer flares during follow-up (p = 0.03), and had a lower cumulative glucocorticoid dose at the 6th month (p = 0.036). Comparison of PET/CT-positive patients (n = 23) based on the fulfilment of the ACR/EULAR 2022 classification criteria revealed that patients who met these criteria were older (p = 0.02) and had significantly lower CRP levels at diagnosis (p = 0.02). The performance of F18-FDG PET/CT in diagnosing LV involvement in GCA is favourable, and the severity of FDG uptake in the vessel wall correlates with the acute phase response. Patients with extracranial involvement on PET/CT exhibit distinct features, including a younger age and female predominance. Additionally, these patients appear to experience fewer relapses and require lower doses of glucocorticoids. However, the clinical significance of PET/CT in patients who met ACR/EULAR classification criteria, predominantly consisting of patients with ischemic cranial symptoms, could not be determined in our study.

Vatari Guggulu, Hingvashtaka Churna, and Brihat Saindhavadya Taila in the management of rheumatoid arthritis: An open-label, prospective, single-arm multi-center study

Abstract Background: Despite significant advances in the diagnosis and treatment of rheumatoid arthritis (RA), the clinical outcomes remain unsatisfactory in a significant proportion of patients. Ayurveda management for RA (Amavata) has shown promising clinical outcomes in routine clinical practice and as per published research studies. Objective: The study was designed to assess the therapeutic effect and safety of Ayurveda interventions, Vatari Guggulu (VG), Hingvashtaka Churna (HC), and Brihat Saindhavadya Taila (BS) in the management of RA. Materials and Methods: An open-label, prospective, single-arm multicenter study was conducted at Ayurveda Research Institutes in Patna, Bhubaneswar, and Guwahati with a sample size of 180 participants. Patients of any gender aged 20–60 years with clinically diagnosed RA as per the revised American College of Rheumatology criteria and willing to provide written informed consent to participate in the study were included in the study. Ayurveda interventions, VG, HC, and BS, were administered to the study participants for 12 weeks, with a follow-up at four weeks without intervention. The primary outcome measure was a change in the Disease Activity Score-28 (DAS28) from baseline. The other outcome measures included change in the Indian Health Assessment Questionnaire Disability Index score (HAQ-DI), changes in the acute phase reactants (erythrocyte sedimentation rate [ESR] and C-reactive protein [CRP]), and change in the quality of life parameters (assessed through the SF-36 questionnaire). Results: A total of 180 participants were enrolled in the study, and data of 179 participants were considered for the final analysis. A statistically significant difference was observed in the outcome parameters, such as a mean change in the DAS28 score, HAQ-DI score, SF-36 score, and ESR and CRP levels (P &lt; 0.001) after 12 weeks of treatment. The mean DAS28 score changed from 6.50 ± 0.790 at baseline to 4.21 ± 1.286 on week 16 follow-up (P &lt; 0.001). No participant withdrew from the study due to adverse events. The trial interventions were well-tolerated and safe. Conclusion: The study outcomes provide preliminary evidence of the safety and potential benefits of the Ayurveda interventions in the management of RA. Further, randomized controlled studies may be planned to generate robust evidence on the therapeutic potential of these interventions so that they can be recommended for use in routine clinical practice. Trial registration: CTRI/2014/12/005242.

Protective Effect of Prosopis Farcta Fruit Aqueous Extract Against Oxidative Stress Caused By Ethanol in Albino Rats

Prosopis farcta was previously used in folk medicine as a dry fruit to relieve pain before its active biological components that contribute to this were known. This study assessed the effectiveness of a dry fruit extract of P. farcta by measuring the indicators of inflammation in albino rats after they were dosed with ethanol. As such, looking at the antioxidant potential of P. farcta fruit aqueous extract (PFFAE) in resistance to ethanol's harm in rats given ethanol showed a notable increase in serum C reactive protein (CRP), malondialdehyde (MDA), CRP/ALB ratio (CAR), and WBC count. At the same time, glutathione peroxidase (GPx) and albumin were markedly reduced. PFFAE diminished ethanol-induced amounts of CRP, MDA, and CAR in plasma; additionally, it strengthened the ethanol-induced decline in GPx activity, and albumin had no apparent effect on the ESR level. Consequently, the current findings demonstrate that PFFAE counteracts the toxicity of ethanol and has a protective impact against the ethanol effect.

The correlation between biochemical indicators in COVID-19 patients with and without Diabetes Mellitus in Basra, Iraq.

The coronavirus disease (COVID-19) is an infectious viral illness that leads to the development of acute respiratory syndrome. It exhibits a high level of contagiousness. The aforementioned virus is accountable for an incidence of pneumonia that transpired in early December 2019 in Wuhan, situated in the People's Republic of China. The global pandemic declaration on March 11, 2020, marked a significant turning point in the world's demography, as the virus had tragically claimed the lives of over 5.3 million individuals worldwide. The emergence of the Coronavirus (COVID-19) pandemic has presented an unparalleled catastrophe, resulting in the loss of many lives via several channels including social, psychological, physical, and economic dimensions. The danger associated with the virus originates from its heightened transmissibility and extensive mutational variability, as well as its impact on several bodily systems including the circulatory, neurological, renal, hepatic, nervous, and endocrine systems. The pathogenesis of Coronavirus disease 2019 (COVID-19) is intricate, and its clinical presentation is diverse, exhibiting various imaging findings that vary based on the severity of the illness and its progression through time. A general statistical comparison was made for the biochemical markers in the patients infected with only Coronavirus and patients infected with Coronavirus and complications of diabetes mellitus compared to the control group according to gender, in order to monitor the role of different biomarkers in causing a disease, with an evaluation of the difference in their levels, and the study aimed to investigate biomarkers and study the relationship between these biomarkers for COVID-19 patients with and without Diabetes Mellitus, to provide a dynamic approach to understanding the disease to diagnosis and follow-up, so as to improve the development of patients' treatment. The study performed a representative sample of (238) participants between the ages (25-80) year, of whom (81) were in a healthy control group, (78) were infected only with Coronavirus, (79) were infected with Coronavirus and had complications of diabetes mellitus, who visited Al-Basra Teaching Hospital and Allmwanei Hospital in Al-Basra province between October 2021 and February 2022. The age average for the study population was (25-80) years. Serum and blood levels of human CBC, ESR, CRP, Ferritin, D-Dimer, IL 6, Albumin, FBS, HbA1c, Troponin, Cholesterol, Triglyceride, HDL, LDL, VLDL, Creatinine, Urea, Uric acid and GFR were measured. The results show a highly significant increase in WBcs, ESR, CRP, Ferritin, D-Dimer, IL-6, Creatinine, Urea and Uric acid. , and a highly significant decrease in lymphocyte, albumin, HDL and GFR for patients compared to the control group as a total number and the number of males and females separately, While the results of comparing biochemical markers in the patients infected with Coronavirus and who had a diabetic complication a higher significant increase than patients without diabetic complication. The study of these biomarkers provides a dynamic approach to understanding the disease to diagnosis and follow-up, so as to improve the development of patients' treatment and study the relationship between these biomarkers for COVID-19 patients with and without Diabetes Mellitus.

HEMATOLOGICAL CHANGES AND NUTRITIONAL CHANGES IN RHEUMATOID ARTHRITIS AND OSTEOARTHRITIS PATIENT AS COMPARED TO CONTROL

Background: Rheumatoid Arthritis is a chronic multisystem disease of unknown etiology. The characteristic feature of Rheumatoid arthritis is persistent inflammatory synovitis, usually involving peripheral joints in a symmetric distribution. Hematologic disorders including anemia, white blood cells abnormalities, platelet abnormalities, coagulopathy and hematological malignancies can be manifested in many autoimmune rheumatic diseases Objective: The objective of this study to calculate the energy intake and check the hematological changes in study group and compared with control. Material and Methods: The study was undertaken in the Department of Biochemistry, S.R.N. Hospital and Medical College Allahabad. In this study 300 samples collected of the age 20-70 year. In which 100 normal individuals they are free from any disease and 100 OA and RA patient collected. Conclusion: On the basis of data we have conclude that arthritis patients have lower level of hemoglobin, higher levels of hemolysis and ESR as compared to control. Lower level of Hb, Iron and increased levels of TIBC is a marker of IDA and ACD which plays a significant role in the etiopathogenesis in Anemia in Rheumatoid arthritis and Osteoarthritis.

Correlation of the COVID-19 Infection and Outcomes with Workload among Emergency Healthcare Workers in an Iranian Referral Hospital.

The immediate spread of COVID-19 posed a great deal of strain on healthcare personnel, particularly emergency personnel. Considering the critical role of frontline health care personnel (HCPs) during the pandemic and the life-threatening effects of COVID-19 on them, the present study aimed to evaluate the hospital database among frontline emergency personnel, and to assess the factors affecting the health status of the emergency HCPs. In the current study, we collected data on coronavirus clinical features from 58 HCPs with confirmed COVID-19 who worked in the emergency ward of Baqiyatallah Hospital, Tehran, one of the most referral hospitals in Iran. We also assessed the factors affecting the health status of the emergency HCPs from February 2020 to November 2020. All of the 58 HCPs infected with COVID-19 were the personnel of the emergency ward with an age range of 20-59 years old. The median (interquartile range) of hospital length of stay (LOS) among all patients was 8 days. Length of stay is a critical factor in predicting hospital resource needs. Twelve (21.8%) patients had ground-glass opacity (GGO) alone, and 20 (35.7%) patients had patchy GGO. In our multivariable analysis, high levels of patient liver enzymes (P=0.04) and lymphopenia (P=0.01) were significantly associated with the LOS. In our study, there was an association between high levels of patient's ESR and CRP and longer LOS. We also found that age and gender had no effect on LOS. Nurses contributed to the highest number of COVID-19 infection. It was also found that HCPs who had more working shifts were more infected, and the intensive care unit of the emergency ward was the most infected area of the Emergency Room.

Predictive values of circulating miR-146a and miR-155 for disease activity and clinical response to TNF-α blocking therapy in patients with ankylosing spondylitis.

Ankylosing spondylitis is an insidiously progressive and debilitating form of arthritis involving the axial skeleton. MicroRNAs have been reported to act as candidate biomarkers for ankylosing spondylitis diagnosis and progression. The study aimed to assess the roles of circulating miR-146a and miR-155 in ankylosing spondylitis and their prediction to clinical response to TNF-α blocking therapy. The study included 62 ankylosing spondylitis patients who were given originator TNFi with a 6-month period. Responders to anti-TNF treatment were defined as those reaching the Assessment of SpondyloArthritis international Society 40 (ASAS40) response at the 6-month interval, and nonresponders were defined those not (n = 24). The ankylosing spondylitis patients at M0 (before beginning TNFi treatment) had higher serum levels of miR-146a and miR-155 than the healthy controls (p < .0001). Lower serum levels of miR-146a and miR-155 were noted in the responders (n = 38) compared with the nonresponders (n = 24) at different time points after anti-TNF treatment (p < .0001). The serum levels of miR-146a and miR-155 alone or in combination used to predict treatment outcomes produced AUCs of 0.884, 0.902, and 0.936, respectively. We submitted the following variables: miR-146a and miR-155 levels, BASDAI, ASDASCRP, ESR (mm/h), and CRP (mg/L) into multivariate logistic regression analysis, and results showed that higher levels of miR-146a (OR: 13.75, 95%CI: 1.32 to 143.57, p = .029), miR-155 (OR: 5.74, 95% CI: 1.63 to 20.20, p = .006), and ESR (OR: 1.08, 95% CI: 1.01 to 1.15, p = .022) were independent baseline predictors of ASAS40 response at 6-month anti-TNF-a treatment. These findings obtained from the study suggest that high serum levels of miR-146a and miR-155 could aid in prediction of poor treatment outcomes after TNF-α blocking therapy.

Socio-Demographic and Clinical Findings between Pulmonary Tuberculosis and Bacterial Pneumonia

Background: Pulmonary tuberculosis (PTB) is a chronic infection of the lung caused by Mycobacterium Tuberculosis. On the other hand, bacterial pneumonia is another potentially fatal infection of the lower respiratory tract caused by various bacteria. In diagnosing and treating those diseases, a clear concept of the clinical features of those diseases is very important. Aim of the study: To assess the socio-demographic and clinical features between pulmonary tuberculosis and bacterial pneumonia patients in Bangladesh. Methods: This was a descriptive cross-sectional study that was conducted in the Department of Medicine, Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh, from March 2018 to September 2020. Confirming by proper investigations, 100 pulmonary tuberculosis (PTB) patients in group I and 100 bacterial pneumonia patients in group II were taken as the study subjects. A purposive sampling method was used in subject selection. Collected data were encoded as well as inputted into SPSS software 16.0 programs and analyzed. Categorical data were presented as frequency and percentage; continuous data were presented as mean ± standard deviation (SD). In all cases, a P-value &lt;0.05 was considered statistically significant. Results: The mean age of group I patients was 42.59 ±12.73 years, while in group II, patients were 54.02±9.49 years. In analyzing the signs and symptoms of the patients in both groups, we observed that 100% of PTB patients had cough while 81% had sputum, 73% had fever, and 46% had weight loss. Among pneumonia patients, 94% had a fever, 91% had a cough, 58% had sputum and 56% had chest pain. In comparing the ESR, CRP levels, Mantoux test results between group I (Pulmonary tuberculosis) and group II (Bacterial pneumonia), we found statistically significant correlations. Conclusion: Cough sputum and fever are common symptoms for both pulmonary tuberculosis and bacterial pneumonia patients, but weight loss was a symptom of pulmonary TB. ESR levels,

Assessment of Wnt-5a, Anti-SMA, FGF-23, and Anti-CCP Biomarkers in Patients with Rheumatoid Arthritis

Background: Rheumatoid arthritis (RA) is a multifactorial autoimmune disease with unknown etiology that mainly affects synovial joints.&#x0D; &#x0D; Objectives: To compare the level of serum biomarkers (Wnt5a, anti-SMA, FGF23, and anti-CCP) in RA patients and healthy control.&#x0D; &#x0D; Methodology: This case-control study was conducted on 88 patients with RA and 88 normal healthy individuals at the Rheumatology Center, Sulaimaniyah, from November 2021 to November 2022. A detailed questionnaire for the collection of sociodemographic measures was filled out for each participant. Then, the levels of Wnt5a, anti-SMA, FGF23, and anti-CCP were determined using the ELISA technique.&#x0D; &#x0D; Results: The patients reported higher levels of ESR and CRP than healthy controls. Most patients (63.7%) had moderate disease activity concerning DAS-28. There was a highly significant difference (p&lt;0.001) between patients’ serum Wnt5a, FGF23, and anti-CCP levels compared to healthy controls except for anti-SMA. Additionally, there was a significant correlation between Wnt5a and FGF23 (p&lt;0.001); Wnt5a and anti-SMA (p&lt;0.001); FGF23 and anti-SMA (p&lt;0.001). Finally, no correlation between the DAS-28 score and biomarkers was seen in RA patients.&#x0D; &#x0D; Conclusions: There was no significant correlation in the patient’s serum Wnt5a, FGF23, anti-SMA, and anti-CCP with different age groups, duration of RA and joint involvements.

Evaluation of diagnostic criteria and choice of treatment tactics for patients with infectious spondylodiscitis based on a case series

Objective. To present a brief description of a series of clinical cases of infectious spondylodiscitis with an assessment of the used diagnostic criteria in terms of their influence on the choice of sanifying treatment tactics.Material and Methods. A continuous retrospective study of 39 cases of spondylodiscitis was carried out. Level of evidence is IIIC. The level of ESR, serum C-reactive protein, the results of the study of biopsy materials, and CT and MRI data were evaluated. Criteria of neurological deficit, instability of the spinal motion segment, and recommendations for assessing the clinical and radiological severity of the disease were used to select the treatment tactics. Treatment success was defined as primary wound healing, absence of recurrent infection and/or death, and satisfaction with treatment according to the EQ-5D and EQ-VAS scales at a follow-up period of 22.5 months.Results. The average age of patients was 57.4 years. Primary spondylodiscitis accounted for 82 %, the predominant localization of the pathological focus was the lumbar spine (56.4 %), and staphylococci were predominant etiologic agents (59.1 %). On average, the increase in ESR was 45 mm/h, C-reactive protein – 57 ng/l, and D-dimer – 1235 pg/ml. The level of pain before sanation according to the VAS scale was 6.79 points, after the operation it was 2.3 points (p &lt; 0.05). Instability of the spinal motion segment according to the SINS scale was revealed in 36 cases, paravertebral abscess according to MRI – in 51.3 % of cases, and neurological deficit – in 38.5 % of cases. Severe spondylodiscitis according to the SponDT scale was noted in 53.8 %, moderate – in 43.6 %, and mild – in 2.6 % of patients. According to the clinical and radiological classification of infectious spondylodiscitis severity (SSC), grade I was present in 2 patients, grade II – in 21, and grade III – in 6. Compliance of the chosen treatment tactics with current recommendations was noted in 94,9 % of cases. Recurrence of infection was observed in 7.7 %; lethal outcome – in 5.1 %. Satisfaction with the quality of life according to EQ-5D was 0.74 points, and according to EQ-VAS – 73.88 points.Conclusions. The integrated use of criteria for neurological deficit, instability of spinal motion segments, and severity of the disease according to the SponDT classification with the account of Pola’s recommendations on treatment tactics made it possible to choose the optimal treatment tactics and achieve satisfactory results in the sanation of patients with infectious spondylodiscitis.

Diagnostic value of albumin/fibrinogen ratio and C-reactive protein/albumin/globulin ratio for periprosthetic joint infection: a retrospective study.

The study aims to explore diagnostic value of albumin/fibrinogen ratio (AFR) and C-reactive protein (CRP)/albumin (ALB)/globulin (GLO) ratio (CAGR) for periprosthetic joint infection (PJI). A retrospective analysis was conducted on clinical data collected from 190 patients who had joint replacement surgery in Qilu Hospital of Shandong University (Qingdao), from January 2017 to December 2022. Based on the occurrence of PJI after surgery, patients were divided as an infection group (10 cases) and non-infection group (180 cases). Diagnostic indicators were analyzed, univariate and multivariate logistic regression analyses were further performed to identify factors related to PJI. Sensitivity and specificity of AFR and CAGR, both individually and in combination, were calculated using ROC curves, and their diagnostic performance was compared based on the area under the curve (AUC). Levels of CRP, ESR, FIB, GLO, and CAGR were significantly higher in the infection group than in non-infection group (P < 0.05). Levels of ALB and AFR were significantly lower in infection group (P < 0.05). Multivariate logistic regression analysis reviewed that CRP (OR = 3.324), ESR (OR = 2.118), FIB (OR = 3.142), ALB (OR = 0.449), GLO (OR = 1.985), AFR (OR = 0.587), and CAGR (OR = 2.469) were factors influencing PJI (P < 0.05). The AUC for AFR and CAGR in diagnosing PJI were 0.739 and 0.780, while AUC for their combined detection was 0.858. Abnormal levels of AFR and CAGR are associated with PJI, and their combined use has certain diagnostic value for PJI.

Effects of Vitamin D3 level on the gene expression of Immune checkpoint Cytotoxic T-lymphocytes antigen-4 in Iraqi patients with rheumatoid arthritis

Background: Rheumatoid arthritis is chronic autoimmune inflammatory disease that affects synovium, rheumatoid arthritis. Antigen presentation cells (APCs) link B7-1 and B7-2 with cytotoxic T-lymphocyte related protein-4 (CTLA-4), the member of the immunoglobulin superfamily, that causes T-regulatory cells to cause APCs to produce an inhibitory signal to autoreactive T cells (Treg). This study looked at the effects of vitamin D3(Vit-D3) on the expression of the CTLA-4 gene in whole blood taken from RA patients.Methods: The case control study was conducted on 100RA patients acute and remission stages of the disease depending on DAS-28 and CDAI with respect to the level of vitamin D3. The cases and samples were obtained from Baghdad Teaching Hospital, Baghdad, Iraq from Jun 2022 to January 2023. In addition,45 healthy subjects were enrolled in this study. Standardized gene expression at a level of a reference gene (GAPDH) and enumerated by the ∆Ct-value and fold change (2-∆∆Ct) method using qPCR. The ESR was measured in all subjects and serum CTLA-4, anti-cyclic citrullinated peptide (ACCP), RF was measured using ELISA techniques. The D3 level was assessed using immunofluorescent technique.Results: Significantly increased ESR and serum CTLA-4 levels, ACCP, CRP, RF in RA patients compared to controls (p≤0.05), respectively. The vitamin D3 was significantly reduced in acute cases and substantial raised in remission case compared to the controls (p≤0.05) fold change of gene expression was dramatically elevated in patients excepts in acute male cases compared to 1. There was a significant positive correlation between vitamin D3 and CTLA-4 expression.Conclusion: The current study showed that Vit-D3 up-regulates CTLA-4 gene expression as the defensive mechanism in contradiction of a severity of a disease and possible therapeutic targets through the action of Treg population and immunotolerance.

Respiratory infection risk in primary Sjögren's syndrome complicated with interstitial lung disease: a retrospective study.

To explore clinical and laboratory characteristics of primary Sjögren's syndrome (pSS) complicated with interstitial lung disease (ILD) and investigate the risk factors for respiratory infections in pSS-ILD. A cohort of 162 pSS-ILD patients in Peking University People's Hospital from 2015 to 2020 were included, and all medical records were completely collected. We screened 53 patients suffering from respiratory infections as study cases, compared with 109 age- and sex-matched controls. Differences between infection group and control group were compared. Univariate and multivariate binary logistic regression tests were conducted to identify potential risk factors for respiratory infections in pSS-ILD patients. Among 162 pSS-ILD patients, 32.72% (53/162) suffered from respiratory infections. The most frequent type of ILD was nonspecific interstitial pneumonia (32.08%, 51/159), and the most common type of pathogen was bacteria (64.25%, 34/53). Infection group showed higher levels of ESSDAI (P < 0.001), CRP (P < 0.001), ESR (P = 0.003), and C3 (P = 0.020) but lower level of DLCO-SB (P = 0.015). Univariate logistic model revealed that PAH and the use of glucocorticoid increased infection risk in pSS-ILD patients. On multivariate logistic regression analysis, PAH (OR = 3.993, 95% CI = 1.192-13.373, P = 0.025) and severe reduction of DLCO (DLCO-SB < 40%, OR = 4.625, 95% CI = 1.281-16.702, P = 0.019) were significantly associated with increased risk of respiratory infections in pSS-ILD patients. Among pSS-ILD patients, the most frequent type of ILD was nonspecific interstitial pneumonia. In patients with infection, bacteria were the most common pathogen. Higher levels of ESSDAI, CRP, ESR, and C3 may be correlated with increased infection risk. PAH and reduction of DLCO were identifiedas independent risk factors. Key Points • ILD and infectious diseases severely affect pSS patient conditions. • Higher levels of ESSDAI, CRP, ESR, and C3 may be correlated with increased infection risks in pSS-ILD. • PAH and reduction of DLCO were identified as independent risk factors for lower respiratory infection.

Post-COVID-19 and Post-COVID-19 Vaccine Arthritis, Polymyalgia Rheumatica and Horton's Arteritis: A Single-Center Assessment of Clinical, Serological, Genetic, and Ultrasonographic Biomarkers.

The potential role of the COVID-19 vaccine and infection to induce autoimmunity is currently underestimated despite the literature emphasizing arthralgia as a common adverse event. We aimed to study the impact of rheumatological complications post-COVID-19 (PC) and post-COVID-19 vaccine (PCV), comparing undifferentiated arthritis (UA) to Polymyalgia Rheumatica, Horton's Arteritis (PMR-HA) and isolated arthritis to UA with "connective-like" accompanying symptoms. We retrospectively included 109 patients with at least 6 months of follow-up, analyzing serum biomarkers, joint ultrasound (US), lung HRCT, DLCO, and HLA haplotypes. There were 87 UA patients showing increased gastrointestinal and lung involvement (p = 0.021 and p = 0.012), higher anti-spike protein IgG levels (p = 0.003), and anti-SARS-CoV-2 IgG positivity (p = 0.003). Among them, 66 cases progressed to ACR-EULAR 2010 early arthritis after 3 months, whereas PMR-HA patients were more commonly PCV (81.8%, p = 0.008), demonstrating higher CRP (p = 0.007) and ESR (p = 0.006) levels, a lower rate of ANA positivity (p = 0.005), and a higher remission rate after six months (p = 0.050). In UA patients, the prevalent HLA was DRB1*11 and C*07 (36.8% and 42.1%). Serum calprotectin, interleukin-6, and C*07 (p = 0.021, 0.041, 0.018) seemed more specific for isolated UA. Conversely, "connective-like" arthritis showed poorer DLCO (p = 0.041) and more frequent US synovitis (p = 0.041). In conclusion, UA is a frequent common PC and PCV complication and may persist over time when compared to PMR-HA.