ESR Values Research Articles

Evaluation of temporomandibular joint involvement in juvenile idiopathic arthritis patients

ObjectiveJuvenile idiopathic arthritis (JIA) is a common, chronic and inflammatory rheumatological disease of childhood. The disease can affect all synovial joints in the body. Temporomandibular joints (TMJs) are important areas of involvement in JIA, which are frequently involved but often not noticed because the involvement is usually asymptomatic. The aim of this study is to determine the frequency and risk factors of TMJ joint involvement in juvenile idiopathic arthritis patients admitted to our clinic, and to guide for early diagnosis and treatment.MethodsPatients who applied to this study with the diagnosis of JIA between January 2014 and May 2017 at Pediatric Rheumatology Clinic, were followed up regularly in our clinic, had a accessible medical history, and a rheumatology polyclinic record. Patients with contrast-enhanced TMJ Magnetic Resonance Imaging (MRI) taken and reported by the radiologist were included.ResultsTMJ involvement was detected in 51.2% of the 41 patients included in the study. It was found that 71.5% of the patients with TMJ involvement were asymptomatic and 71.5% of the patients had chronic involvement. When the patients with and without TMJ involvement were compared according to the contrast-enhanced TMJ MRI results; In the patient group with involvement, the polyarticular onset subtype was seen at a higher rate (p = 0.005), the age of onset was earlier (p = 0.003), the disease duration was longer (p = 0.037), more joints were involved (p = 0.005), the ESR values ​​were higher (p = 0.0001), and the treatment compliance and treatment responses of the patients in this group were worse (p = 0.001, p = 0.0001).ConclusionTMJ involvement is common in JIA patients and can occur at any stage of the disease. It is often asymptomatic and progresses insidiously, leading to chronic and degenerative changes in the mandible at an early stage. Due to its asymptomatic nature, the insidious progression, and the risk of causing chronic, irreversible sequelae, it is crucial to screen high-risk JIA patients regularly with contrast-enhanced TMJ MRI, which remains the gold standard method. While specific risk factors are difficult to pinpoint, some factors may increase the likelihood of TMJ involvement. To better identify these high-risk patients and determine which individuals require regular screening, larger-scale and multicenter studies are essential.

Abstract 4138717: Infective Root Aortitis: Medical Therapy Alone or Medical Therapy and Surgery?

Clinical presentation: A 75-year-old male with previous 3 vessel CABG and bioprosthetic aortic valve (BAV) surgical replacement in 2013 was admitted with severe sepsis from diabetic foot ulcer complicated with Group A Streptococcus bacteremia and infective root aortitis. Imaging Findings: Initial technically limited transthoracic echocardiogram was followed by a transesophageal echocardiogram (TEE) that demonstrated a well seated BAV with mildly thickened leaflets but no vegetations, mild intra-valvular regurgitation, and 9 mm end-diastolic soft tissue echoreflectant thickening of the posterior aortic root (AoR) extending up 3 cm from the aortic annulus to the ascending aorta (Fig 1A,B). There were no signs of perivalvular abscess formation. Initial FDG PET-CT demonstrated heterogenous hypermetabolic activity at the annulus of the BAV (Fig 1C) and AoR (Fig 1D) consistent with aortitis. Decision-making: In the absence of guidelines for the management of these patients, a multidisciplinary team including cardiology, cardiothoracic surgery, and infectious disease opted for a conservative medical therapy instead of high-risk surgery. Patient then underwent left foot first digit amputation to achieve infectious source control. Upon completion of 4 out of 6 weeks of intravenous ceftriaxone 2 grams daily, repeat TEE showed improved AoR thickening to 6 mm (Fig 1E,F), no AoR abscess, and unchanged BAV structure and function. Repeat FDG PET-CT at the same time of TEE demonstrated persistent but improved hypermetabolic activity of the BAV annulus and AoR. After 10 weeks of IV antibiotics, repeat FDG PET-CT showed further decrease in metabolic activity on both areas. However, an Indium-111 labeled leukocyte scan showed no activity at the BAV annulus and root (Fig 1G) and therefore indicated healed AoR aortitis, which was further supported by significant decrease of ESR and CRP initial values of 126 mm/hr and 122.7 mg/L to 11 mm/hr and 3 mg/L, respectively. Patient is currently clinically stable 8 months later. Conclusion: This case illustrates that a conservative management of infective AoR aortitis with an extended course of intravenous antibiotics is a reasonable alternative to high-risk re-do valve and root surgery.

The Effect of Children with Acute Tonsillitis on the Rate of Sedimentation of Red Blood Cells and the Complete Blood Count Test of Children in the Hawija City, Kirkuk Governorate

The current study aimed to know the negative effect of children with acute tonsillitis on CBC values and inflammatory indicators. ESR where the study included 50 children whose ages ranged from 5-10 years. Examples of experiment were divided into two groups 25 children for the first group, who were healthy from the injury. As for the second group, they are 25 children with acute tonsillitis. Al -Razi Laboratory, Al -Rafah and Al -Ahly Hospital Laboratory in Al -Hawija district. The current study's findings demonstrated a noteworthy rise in White Blood Cell (WBC) in children with acute tonsillitis compared to healthy children, while the results of the study in Red Blood Cell (RBC) showed a significant increase in healthy people compared to the affected children, while platelet values and values showed PCV is that there are no moral differences between the injured and the healthy, as the results showed that there is a moral rise in random sugar values and ESR values.

Predictive Factors for Total Knee Arthroplasty: An Observational Study.

Introduction Knee osteoarthritis (KOA) is the most common form of osteoarthritis. It is diagnosed based on clinical symptoms, physical examination, and imaging, most frequently by knee X-ray in at least two views. In front of a patient with early KOA, all the predictive factors and risk factors that can be modified, but also that can lead to a rapid evolution of the symptoms and the need for total knee arthroplasty (TKA), must be taken into account and identified. There were a series of prognostic factors associated with KOA, such as age, sex, BMI, degree of physical activity, decrease in bone mineral density, C-reactive protein, malalignment, clinical severity at baseline, and previous traumas. The treatment of KOA is varied and involves pharmacological and non-pharmacological measures and surgical treatment in the final stages of evolution. Materials and methods In the University Emergency Hospital of Bucharest, Bucharest, Romania, patients with KOA presented to the Department of Orthopedics and Traumatology, and those who required surgical treatment, such as TKA, arthroscopy, or non-surgical treatment, were enrolled. We conducted a descriptive and prospective observational study that included 70 patients clinically and imaging diagnosed with KOA. The inclusion criteria consisted of a patient over 45 years old with knee pain and radiological signs of KOA. The exclusion criteria referred to patients with recent traumatic history, signs of active osteoarticular infection, the lack of radiological changes of KOA that imposed the differential diagnosis, patients known to have rheumatological diseases in the Algic phase, and patients in whom it was not possible to collect complete required data. Results Patients who required TKA were older (65.12 ± 8.19 years) than patients who required other therapeutic interventions (52.55 ± 3.63 years), the difference of 12.57 years being statistically significant (t = -8.882, p ≤ 0.001). Women were more than three times more likely to require TKA than men (80.85% vs. 52.17%, OR = 3.87, CI [1.29, 11.56]). Patients with HBP were more than four times more likely to require TKA than patients without HBP (78.57% vs. 42.86%, OR = 4.88, CI [1.42, 16.82]). Patients with elevated ESR were more than 26 times more likely to require TKA than patients with normal ESR (96.67% vs. 52.50%, OR = 26.23, CI [3.25, 211.67]). There are statistically significant differences between the non-TKA group (mean rank = 60.20) and TKA patients' score (mean rank = 25.62) (U = 6.000, Z = -6.606, p ≤ 0.001). Thus, patients who required TKA had a significantly lower KSS score than patients who required other treatments. Conclusion According to the data obtained in the studied group of patients, the characteristics of the patient at high risk of requiring TKA are the following: a female patient over 65 years of age who associates hypertension, high ESR, and fibrinogen values ​​with KSS score and KSS function with low values, recording an average value of 56.70.

Diagnostic Values of Serum Inflammatory Biomarkers after Hip and Knee Arthroplasty in Patients with Periprosthetic Joint Infection.

One of the complications after total hip arthroplasty (THA) or total knee arthroplasty (TKA) is periprosthetic joint infection (PJI). Numerous studies have been performed to explore the value of biological parameters in the early identification of infection rates after THA and TKA. This study investigates alterations in inflammatory markers associated with PJI. This retrospective study focused on a cohort of patients with hip and knee arthroplasty treated between 2016 and 2022. CRP, ESR, and fibrinogen were observed preoperatively, on days one, three, six, and twenty-one postoperatively. From a total of 4076 THA and TKA performed during this period, 62 patients were identified with periprosthetic infections. We also identified the pathogens responsible for infections in order to assess if asymptomatic preoperative infections were involved in PJI. In patients with acute infections following TKA, days one and three postoperative recorded a CRP value below the expected range. The value of CRP in patients with early infection after THA was significantly increased on day six postoperative. ESR and fibrinogen values were not statistically significantly correlated with early PJI. The CRP level in acute PJI shows different patterns than those shown in the literature.

Prediction of the activity of early ankylosing spondylitis using radiomics texture analysis on short tau inversion recovery (STIR).

The study aimed to explore the value of texture analysis of radiomics based on the short tau inversion recovery (STIR) sequence to evaluate the activity of bone marrow oedema of sacroiliac joints in early AS. 43 patients with early AS whose data were randomly divided into the training cohort (n=116) and verification cohort (n=56) according to the ratio of 7:3. The optimal feature subsets were obtained by Mann-Whitney U-test, the minimum-Redundancy Maximum-Relevancy (mRMR), and then least absolute shrinkage and selection operator (LASSO) using these texture feature parameters, which were used to construct the final prediction model and obtained the Radscore. The ROC curve was performed to evaluate the performance of the model. The Spearman correlation test was used to analyse the correlation of various indicators. In the training cohort, to differentiate early AS sacroiliac joint bone marrow oedema between the active and stable groups, the AUCs of the Radscore, SPARCC and ADC were 0.81, 0.91, 0.78, respectively. In the validation cohort, the AUCs were 0.87, 0.89, 0.85. In the two cohorts, there were no significant differences in AUCs between values of the Radscore and SPARCC, ADC (p>0.05). There was a significant difference in AUC between SPARCC and ADC in the training cohort (p<0.05), with no statistical significance in the validation cohort (p>0.05). The correlations were all low between the Radscore values and the values of ESR, CRP, tI, ASDAS-ESR and ASDAS-CRP (p<0.05). Radiomics analysis based on STIR texture analysis has a good prediction for the evaluation of bone marrow oedema activity of sacroiliac joints in AS. It can be a new non-invasive and objective evaluation method for AS activity.

Results of a 24-week open-label, non-interventional study on the efficacy and safety of olokizumab therapy in patients with rheumatoid arthritis after switching from anti-B-cell therapy during the SARS-CoV-2 pandemic

In the context of the new coronavirus infection (NCI) COVID-19 pandemic, the rheumatological community is facing new challenges in the treatment of immune-inflammatory rheumatic diseases (IIRDs). It has been shown that rheumatological patients have an increased risk of infections and a severe course of NCI and that IIRD therapy also influences the disease outcomes. In particular, the use of the anti-B-cell medication rituximab (RTM) is associated with a higher risk of severe NCI and increased mortality. The COVID-19 pandemic has highlighted the need to find alternative and safe treatment options for these patients. This work is the continuation of a 12-week study on the efficacy and safety of olok-izumab (OKZ) therapy in patients with rheumatoid arthritis (RA) after switching from anti-B-cell therapy during the SARS-CoV-2 pandemic. Objective: to evaluate the efficacy and safety of OKZ (Artlegia®; solution for subcutaneous administration, 160 mg/ml – 0.4 ml) for the treatment of patients with RA in real-life clinical practice after switching from RTM during the COVID-19 pandemic. Material and methods. The study included 19 patients with a confirmed diagnosis of RA who had received RTM at a dose of 500–1000 mg twice every 14 days at least 6 months ago. As disease activity increased, RTM was replaced with OKZ while therapy with synthetic disease-modifying anti-rheumatic drugs (DMARDs) was continued. At weeks 0, 4, 8, 12 and 24 after switching the biologic DMARD, the number of tender (TJN) and swollen (SJN) joints out of 28, pain intensity on a visual analogue scale, ESR, CRP level, disease activity indices CDAI, DAS28-ESR, DAS28-CRP, HAQ index and the safety profile of the therapy were assessed at each visit. Results and discussion. After 4, 8, 12 and 24 weeks of OKZ administration, there was a statistically significant decrease in mean TJN (from 10 to 6.0, 3.0, 5.0 and 4.0, respectively; p &lt; 0.05) and SJN (from 7.0 to 3.0 by week 4 and to 2.0 by weeks 8, 12 and 24; p &lt; 0.05). At the same time, a decrease in CRP and ESR values was also observed: median CRP decreased from 18 to 0.6 mg/l by week 4 and to 0.5 mg/l by weeks 8, 12 and 24 (p &lt; 0.05), ESR from 30 to 5 mm/h in each study period (p &lt; 0.05). CRP levels normalized by week 4, regardless of baseline values. All RA activity indices showed a positive dynamic compared to baseline values from week 4 onwards in each assessment period. After weeks 4, 8, 12 and 24, the median DAS28-ESR decreased from 5.50 to 3.57; 3.30; 3.08 and 3.01 (p &lt; 0.05); DAS28-CRP – from 5.30 to 3.46; 3.23; 3.26 and 3.12 (p &lt; 0.05); CDAI – from 27.0 to 17.0; 12.0; 15.0 and 12.0 (p &lt; 0.05), respectively. All patients showed a decrease in pain by the 4th week of observation. A statistically significant improvement in functional status was observed after the 4th week of therapy and was maintained until week 24. The median HAQ index decreased from 1.62 to 1.50 at weeks 4, 8 and 12 and to 1.12 at week 24 (p &lt; 0.05). Conclusion. The study showed that the non-medical switch from RTM to OKZ during the COVID-19 pandemic was effective and safe.

Olokizumab in patients with inflammatory phenotype of osteoarthritis, treatment experience

Objective: to investigate the efficacy and safety of olokizumab (OKZ) in patients with knee osteoarthritis (OA) with synovitis, persistent pain and ineffectiveness of previous conservative therapy. Material and methods. The study included 15 patients with stage II–III knee OA who fulfilled the ACR criteria and had pain ≥50 mm on a visual analogue scale (VAS), synovitis and treatment failure. The age of patients ranged from 54 to 75 years; the duration of the disease was from 1 to 23 years. The duration of the study was 12 weeks, during which the patients received 3 subcutaneous injections of OKZ at a dose of 64 mg. The effectiveness of the treatment was assessed by the dynamics of pain intensity according to VAS, WOMAC and KOOS indices, the values of the DN4 questionnaire and the quality of life according to EQ-5D. In addition, the general assessment of the patient's health (GHA) according to VAS, the assessment of treatment efficacy by doctor and patient and the need for non-steroidal anti-inflammatory drugs (NSAIDs) were considered. All patients underwent laboratory testing. Results and discussion. During treatment, there was a significant decrease in pain intensity according to VAS, a statistically significant improvement in the KOOS and WOMAC indices (p&lt;0.05), quality of life according to the EQ-5D questionnaire and GHA. Patients and doctors rated the treatment results very positively: an improvement or significant improvement was observed in 92.3% of cases. Adverse events were identified in 4 patients, which in 2 cases served as the reason for discontinuation of OKZ treatment and termination of participation in the study. During treatment with OKZ, a statistically significant decrease in CRP and ESR values, an increase in the concentration of interleukin 6 (p = 0.003), COMP (p = 0.03) and PIINP (p = 0.01) were observed. Conclusion. The results obtained suggest a significant symptomatic and anti-inflammatory effect of OKZ in patients with the inflammatory phenotype of OA.

Ultrasound Examination of Common Carotid Adventitial Thickness Can Differentiate Takayasu Arteritis and Large Vessel Giant Cell Arteritis.

Pathological studies have demonstrated that the adventitial layer is markedly thickened in Takayasu (TAK) as compared to large vessel giant cell arteritis (LV-GCA). An ultrasound (US) examination of the arterial vessels allows the determination of intima media thickness (IMT) and of adventitial layer thickness (extra media thickness (EMT)). No previous study has evaluated if there are differences in EMT thickness between TAK and LV-GCA. In this cross-sectional retrospective study of stored ultrasound (US) imaging, we have compared common carotid artery (CCA) EMT and IMT in a series of consecutive TAK and LV-GCA patients. US examination CCA IMT and EMT were significantly higher in TAK as compared to LV-GCA. With ROC curve analysis, we have found that an EMT > 0.76 mm has high sensitivity and specificity for TAK CCA examination. The percentage of CCA at EMT > 0.76 mm and the total arterial wall thickening were significantly higher in TAK group examinations. EMT thickness correlated with disease duration and IMT in the TAK group, as well as with the IMT and ESR values in the LV-GCA group. Upon multivariate logistic regression analysis, factors independently associated with TAK CCA were EMT > 0.76 mm and age. No significant variation in IMT and EMT could be demonstrated in subsequent US CCA examinations.

Serum leukemia inhibitory factor (LIF) levels in patients with Takayasu's and Giant cell arteritis: A cross-sectional study

Introduction and objectivesIn this study, we aimed to evaluate LIF levels and its possible relationship with disease activity in patients with Takayasu's (TAK) and Giant cell arteritis (GCA) patients. Materials and methods23 Takayasu's arteritis, 9 Giant cell arteritis patients and 25 healthy volunteers were included in the study. Serum LIF levels were measured ELISA. ResultsThe mean age of Giant cell arteritis patients was statistically significantly higher than the other groups (p<0.001). The rate of women was found to be higher in Takayasu's arteritis (p=0.021). When healthy control, patients with GCA and Takayasu arteritis were compared, there was a difference in LIF values (p=0.018). In subgroup analyzes, LIF values were found to be higher in GCA patients compared to healthy controls (p<0.05). There was no statistically significant correlation between LIF and CRP (Rho=−0.038, p=0.778), ESR (Rho=0.114, p=0.399) and ITAS (Rho=−0.357, p=0.094). While CRP was statistically significantly higher in patients with disease activity (p=0.003), there was no statistically significant difference between patients in terms of ESR and LIF values. While there was a statistically significant relationship between CRP (OR=1.19 [1.03–1.37], p=0.018) and disease activity in univariate analyses, no statistically significant variable was found in multivariable analyses. ConclusionsLIF values were significantly higher in patients with Giant cell arteritis compared to healthy controls.

Evaluation of Serum Amyloid A and some Biochemical markers in Iraqi patients with systemic lupus erythematosus

An autoimmune condition called systemic lupus erythematosus (SLE) is caused by long-term inflammation. Amyloid A (AA) amyloidosis results in nephropathy and other internal symptoms, including death. The current study set out to look at the relationship between serum amyloid A (SAA) levels in circulation and SLE patients. Methods: Sixty SLE patients and 30 healthy with age range (19-55) yearswere involved in this study. A SLE patient wasidentified in the teaching hospital in Baghdad. In this study, laboratory indicators such as blood lipid, kidney function, test results, and total cholesterol (TC), triglyceride (TG), SAA, and ALB were assessed using an automated biochemical analyzer. Results: Patients with active SLE had serum amyloid A (SAA) values 5.83 mg/L [IQR: 2.08–10.87], 4.92 mg/L [IQR: 1.57–11.43], and 1.33 mg/L [IQR: 0.13–3.12], respectively, substantially upper than personswith inactive SLE or healthy control subjects (P &lt; 0.001). ESR values in healthy control subjects, patients with inactive SLE, and patients with active SLE. In conclusion, the current study's findings offered more proof of SAA's potential involvement in SLE and suggested that it might be valuable biomarkers that could reveal more details about the disease's activity.

Results of a non-interventional multicenter study of management of patients with non-radiological axial spondyloarthritis in real-life clinical practice in the Russian Federation (NiSpAR)

NiSpAR is a non-interventional, multicenter study whose aim was to describe a cohort of patients with non-radiological axial spondyloarthritis (nr-axSpA) and approaches to its diagnosis in the Russian Federation.Material and methods. The study involved 20 research centers in different regions of the Russian Federation. The work consisted of two phases: retrospective data collection 12 months before enrolment in the study and prospective observation of patients in whom the diagnosis of nr-axSpA was confirmed (104 weeks).The study included 272 patients who met the inclusion and exclusion criteria (Full Analysis Set, FAS). The mean age of the FAS-population was 38.7±11.0 years. The diagnosis of nr-axSpA was confirmed in 159 (58.5 %) of the 272 patients. Of the remaining 113 (41.5%) participants, 57 (50.4%) did not have the information required to confirm the diagnosis, 34 (30.1%) did not have pelvic radiographs, and 22 (19.5%) did not fulfil the ASAS criteria for nr-axSpA.Results and discussion. The mean age of patients with nr-axSpA was 37.6±10.4 years, more than half of them (52.8%) were women. The median disease duration was 36 [12; 80] months. In half of the patients the disease duration was more than 2 years, in more than one third – less than 2 years. The median CRP and ESR values were 5.0 [2.0; 12.0] mg/l and 11.0 [5.0; 18.0] mm/h, respectively. The BASDAI averaged 3.5±2.0 and was &gt;4 in more than half of the cases (64.2%). The mean ASDAS-CRP value reached 2.6±1.1. Only 1 in 5 participants (20.8%) had low axSpA activity, while in 61.1% it was high (44.7%) or very high (16.4%). An inactive state was found in a small number of patients (9.4%). Twenty two (13.8%) patients had treatment with biologic disease-modifying antirheumatic drugs (bDMARDs) in anamnesis, and 21 (13.2%) patients were still taking them.Conclusion. The results of the retrospective phase of the study show that in real-life clinical practice in the Russian Federation there is a continued positive trend towards improving the diagnosis of nr-axSpA. The median duration of the disease at the time of enrolment in the study was 3 years. The frequency of use of magnetic resonance imaging has increased by more than 1.8 times. At the same time, practitioners still have difficulties in establishing the diagnosis of nr-axSpA and a shortage of bDMARDs for treatment of these patients.

Analysis of the value of potential biomarker S100-A8 protein in the diagnosis and pathogenesis of spinal tuberculosis.

The objective of this study is to evaluate the value of S100-A8 protein as a diagnostic marker for spinal tuberculosis and to explore its role in the potential pathogenesis of spinal tuberculosis (STB). The peripheral blood of 100 spinal tuberculosis patients admitted to the General Hospital of Ningxia Medical University from September 2018 to June 2021 were collected as the observation group, and the peripheral blood of 30 healthy medical examiners were collected as the control group. Three samples from the observation group and three samples from the control group were selected for proteomics detection and screening of differential proteins. Kyoto Encyclopedia of Genes (KEGG) was used to enrich and analyze related signaling pathways to confirm the target protein. The serum expression levels of the target proteins were determined and compared between the two groups using enzyme-linked immunosorbent assay (ELISA). Statistical methods were used to evaluate the value of target protein as a diagnostic marker for STB. A macrophage model of Mycobacterium tuberculosis infection was constructed and S100-A8 small interfering RNA was used to investigate the molecular mechanism of the target protein. S100-A8 protein has the value of diagnosing spinal tuberculosis (AUC = 0.931, p < 0.001), and the expression level in the peripheral blood of the observation group (59.04 ± 19.37 ng/mL) was significantly higher than that of the control group (43.16 ± 10.07 ng/mL) (p < 0.05). S100-A8 protein expression showed a significant positive correlation with both CRP and ESR values (p < 0.01). Its AUCs for combined bacteriological detection, T-SPOT results, diagnostic imaging, antacid staining results, and pathological results were 0.705 (p < 0.05), 0.754 (p < 0.01), 0.716 (p < 0.01), 0.656 (p < 0.05), and 0.681 (p < 0.01), respectively. Lack of S100-A8 leads to a significant decrease in the expression levels of TLR4 and IL-17A in infected macrophages. S100-A8 protein is differentially expressed in the peripheral blood of patients with spinal tuberculosis and healthy individuals and may be a novel candidate biomarker for the diagnosis of spinal tuberculosis. The feedback loop on the S100-A8-TLR4-IL-17A axis may play an important role in the inflammatory mechanism of spinal tuberculosis.

Clinical profile and laboratory parameters of febrile seizures: a hospital based cross-sectional study in sub-Himalayan region

Background: Febrile seizures occur commonly in the age group of 6 to 60 months, clinical spectrum is variable and range from single, brief episode to status epilepticus which can further progress to long term consequences. There is very limited data available from sub-Himalayan belt of northern India, hence the present study was planned to know the clinical spectrum, pattern of lab parameters and their association as a risk factor for occurrence of seizures. Methods: A hospital based cross-sectional study was conducted in the department of paediatrics of Indira Gandhi Medical college, Shimla, Himachal Pradesh. All children between 6 to 60 months admitted in our institute during the study period of July 2021 to June 2022 with diagnosis of febrile seizure were considered for the study. Results: A total of 120 children were included in the present study with a mean age of 26.6±14.2 months. Majority of the study subjects were from rural area (74.2%) and male had slightly higher representation (55.8%). Generalised tonic-clonic seizure (78.3%) was the most common phenotypic presentation, cases with SFS constituted 61.7% and CFS was observed in 38.3% of study subjects. Raised ESR values, elevated CRP values and leucocytosis had significant association in occurrence of CFS. Conclusions: The study provides valuable insights into the different phenotypic presentations and characteristics of febrile seizures in the study population. The study further identifies a statistically significant association between certain inflammatory markers and CFS.

Acute phase reactants in non-COVID-19 community-acquired pneumonia

BackgroundAcute phase reactants (APR) are markers of inflammation that could be applied for the assessment of community-acquired pneumonia (CAP) severity in association with various pneumonia severity scores. So, the aim of the study was to assess levels of APR such as total leucocytic count (TLC), platelets, neutrophils, neutrophils-to-lymphocyte ratio (NLR), CRP, D-dimer, ferritin, and ESR in patients with CAP and to correlate between their values and disease severity.MethodologyThe study included 51 patients diagnosed as non-COVID-19 (CAP). Patients were classified into two groups group A (pneumonia only) and group B (pneumonia complicated with empyema/complicated para-pneumonic effusion). All patients underwent clinical evaluation, CURB65, radiological assessment, and blood sampling to measure APR.ResultsThe mean age of patients was 47 ± 17 years. The main symptoms were productive cough (90.2%) and Fever (92.2%).TLC, platelets, neutrophils, CRP, D-dimer, ferritin, and ESR were elevated than normal values. Significant positive correlations were found between the duration of fever and CRP, D-dimer, and ferritin with p values = 0.024, 0.012, and 0.034 respectively. Significant positive correlations were found between CURB65 and both CRP and ferritin with p values = 0.007 and 0.020. A significant increase in platelet count and ESR values was found in group B than in group A.ConclusionAPR are important markers that can be used in the assessment of CAP in collaboration with clinical evaluation and severity scores. CRP, D-dimer, and ferritin were positively correlated with CURB65, while ESR and platelets could be considered predictors of the development of complications.Trial registrationRetrospectively registered, registration number NCT05926089, date of registration is 06/29/2023.

Are Absorbable Plates More Resistant to Infection Than Titanium Implants? An Experimental Pre-Clinical Trial in Rabbits.

Background: Infection of orthopaedic implants after internal fixation of bone fractures remains a major complication with occasionally devastating consequences. Recent studies have reported that the use of absorbable materials, instead of metallic ones, may lead to a lower incidence of postoperative infection. In this experimental pre-clinical animal study, we compared the infection rate between absorbable implants consisting of copolymers composed from trimethylene carbonate, L-polylactic acid, and D, L-polylactic acid monomers, and titanium implants after the inoculation of a pathogenic microorganism. Material and Methods: We used an experimental implant-related infection model in rabbits. Sixty animals were randomly and equally divided into two groups. In all animals, the right femur was exposed via a lateral approach and a 2.5 mm two-hole titanium plate with screws (Group A), or a two-hole absorbable plate and screws (Group B), were applied in the femoral shaft. Afterwards, the implant surface was inoculated with Pseudomonas Aeruginosa at a concentration of 2 × 108 CFU/mL. The primary outcome was the comparison of the incidence of developed infection between the two groups. The wound condition was monitored on a daily basis and radiographies were obtained at 12 weeks postoperatively. Infection-related laboratory markers (white blood cell count, erythrocyte sedimentation rate, and C-reactive protein values) were assessed at 3, 6, and 16 weeks postoperatively. Histologic analysis and cultures of tissue samples were also performed to evaluate the presence of infection. Results: Clinical and laboratory signs of infection were evident in 11 rabbits in Group A (36.7%), and 4 in Group B (13.3%). The difference between the groups was statistically significant (p = 0.04). Five animals in Group B (16.7%) had clinical and histologic signs of a foreign-body reaction with significantly elevated CRP and ESR values but no simultaneous presence of infection was identified (p = 0.04). Bone remodelling with thickening of the periosteum and surrounding sclerosis was demonstrated radiologically in animals developing infection or foreign-body reactions. Conclusions: Absorbable plates and screws show lower susceptibility to infection compared to titanium ones. However, their application is associated with foreign-body reaction and the potential need for a second surgical intervention.

Investigation of Deep Eutectic Solvent Based Super Dielectric Electrolytes for Supercapacitors

This study investigates a new type of electrolyte based on deep eutectic solvents. Choline chloride based deep eutectic solvents were prepared and they were used as base ionic solvents for super dielectric theory. Deep eutectic solvent was mixed with a non-conducting material such as fumed silica, alumina. The mixture shows a super dielectric behavior which is used as electrolyte for electrochemical double layer capacitors also known as supercapacitors. The supercapacitor cells were composed of an electrode, a paper-based separator and this super dielectric electrolyte. The electrode of commercial standard supercapacitor is used first as an electrode. Second an electrode slurry was prepared in order to make custom electrode. Then the performance of both cells was investigated. The specific capacitances of cells were measured and the amount of increase at the capacitances was evaluated. The results showed that up to 14-fold increase of the specific capacitances of the commercial supercapacitor have been achieved. Also, up to 12-fold increase of the specific capacitances of our custom-made cells have been achieved. The charge-discharge characteristics and ESR values of the cells confirms that the cells show outperforming properties. Deep eutectic solvents based super dielectric electrolytes are very promising electrolytes for high energy density supercapacitors.

ANALYTICAL EVALUATION OF ANA, ANTI-CCP AND ANTI-DS DNA ANTIBODIES IN PATIENTS WHO SUFFERED FROM RHEUMATOID ARTHRITIS AND ATTENDED IN A TERTIARY CENTER OF NEPAL

Background: Rheumatoid arthritis is a heterogeneous group of diseases. Based on the data related to risk factors and autoantibodies, it has been divided into the positive and negative types. The objective of our study was to compare and contrast seropositive and seronegative rheumatoid arthritis in terms of inflammatory markers and autoantibodies. Methods: This was a hospital-based cross-sectional analytical study and carried out for a period of 9 months between August, 2022 and April, 223, and samples were collected prospectively, in 196 patients suffering from rheumatoid arthritis. The sera were separated immediately from blood samples and stored in the refrigerator at 4 ⁰C until further investigation. The circulating investigation parameters like inflammatory biomarkers (such as Erythrocyte sedimentation rate, C-reactive proteins &amp; Rheumatoid factor) and autoimmune assay-based antibodies (like Antinuclear antibodies, Anti-cyclic citrullinated peptide &amp; Anti-ds DNA) were included. The results obtained were recorded and data analysis was done using Statistical Package for Social Sciences (SPSS) version 20.0. Results: Highly significant differences (P value &lt; 0.01) were found in mean values of ESR (29.8 vs 42.4 mm/h), CRP (10.2 vs 23.6 mg/dl), RF (2.5 vs 28.4 IU/L), ANA (36 vs 80.6 AU/ml), Anti-CCP (33.5 vs 48.4 IU/ml) and Anti-ds DNA (16.4 vs 32.7 IU/ml). In Group-A of seronegative patients, significant correlation of Anti-ds DNA was found with CRP and RF. Meanwhile, in Group-”B” of seropositive patients, highly significant correlations (P value &lt; 0.01) were found in ESR, CRP &amp; RF. Additionally in this Group-B, both Anti-CCP &amp; Anti-ds DNA correlated significantly (P value &lt; 0.05) with ESR and RF. Conclusions: Among the clinically important autoimmune antibodies, Anti-ds DNA significantly correlated in both seronegative and seropositive rheumatic patients.

Anti-Inflammatory Property Establishment of Fulvic Acid Transdermal Patch in Animal Model

The formulation of the transdermal patch with fulvic acid (FA) on an emulsion basis using pluronic Kolliphor® p237 as a permeability enhancer was developed and studied for anti-inflammatory properties. FA was isolated from the peat in the Nizhny Novgorod region of Russia and characterized as a potential active pharmaceutical ingredient. In vitro studies of the release of FA from the transdermal patch, as well as the FA penetration through the acetyl cellulose membrane using the Franz diffusion cell, showed its high efficiency (56% and 90%, respectively, in 8 h). In the in vivo experiment, qualitative and quantitative features of the rat knee caused by complete Freund’s adjuvant-induced arthritis (morphological changes, the FA influence on the biochemical indexes) were studied. The inflammatory process that developed within 15 days was accompanied by the activation of antioxidant oxidoreductase enzymes (by 50–70%), the increase in the cross-sectional diameter of the cartilage, and the increase in the values of marker indicators of the process of rheumatoid arthritis. Within 7 days of treatment, under the influence of FA, the values of ESR, RF, leukocytes, C-reactive protein, as well as the biochemical parameters characterizing oxidative stress (SOD, catalase, glutathione reductase, LDH, G6PD) normalized, and the edema reduced. These results may be useful for arthritis treatment using the transdermal patch with FA.

Hazardous Impact of Coal Dust on Hematological Parameters of Underground Coal Mine Workers

Due to the nature of their work, coal miners have historically faced significant exposure to large amounts of dust, placing them at a heightened risk. The present study was conducted to explore the hazardous effects of inhalation of coal dust on the haematological parameters of underground coal miners. 120 underground coal miners (60 workers having 5-10 years of experience and the other 60 having 10-20 years of experience) and 62 matched non-exposed to coal dust subjects as control from the locality were recruited for the study. After obtaining consent, different physiological parameters were measured, and blood was collected for assessment of haematological parameters. Observations revealed that there were lower mean values of total RBC count, haemoglobin level, MCV, PCV, MCHC and MCH in coal mine workers whereas mean values of Red Cell Distribution Width (RDW) and ESR were increased in the workers group. Further, coal dust exposure causes increased total leucocyte to count as well as a differential count of lymphocyte, neutrophil, monocyte, and eosinophil in the workers group but, a decreased differential count of basophils was detected among coal dust-exposed workers. All the changes in haematological parameters were found to occur experience-dependent and maximum changes were observed in workers having 10-20 years of working experience. There is a significant likelihood of coal mine workers experiencing changes in their blood composition, which suggests the harmful impact of coal dust on this group. Further, haematological parameters will help health professionals to screen any pathologic conditions and may help to prevent coal dust exposure-associated haematological disorders and complications thereof.