Increase In CRP Levels Research Articles

CRP – a valuable source of information or just a laboratory test?

Background and Purpose: Laboratory tests are an inseparable element in modern medicine. They provide us with valuable clues for making a diagnosis or monitoring treatment. One of the most frequently ordered biochemical tests is the determination of the level of CRP in the blood. The aim of the study is to present the clinical usefulness of this study and to present knowledge about C-reactive protein. Current state of knowledge: It is produced mainly by the liver, but the latest reports confirm local synthesis, among others, in arterial endothelial cells. The most common reason for the increase in the level of CRP is the appearance of infection, during which time its concentration may increase by up to 1000 times. Elderly patients have a weaker immune system response than younger patients, therefore the rise in CRP may be less pronounced. Other reasons are autoimmune diseases, cancer, or acute or chronic inflammation. As a result of cel damage, pro-inflammatory cytokines are secreted, which stimulate the production of CRP. Most scientific sources consider CRP ≥ 10 mg/L to be significant. Values of 3-10mg/L are considered a slight increase in CRP levels. Such CRP values were found in about 1/3 of the American population. Conclusions: The CRP level should not be interpreted as an isolated medical parameter, but in conjunction with other tests and the patient's current state of health. Based on the amount of CRP in the blood and changes in its concentration over time, we can check the response to treatment and predict the course of some diseases.

Systemic Immune-Inflammation and Systemic Inflammation Response Indices are Predictive Markers of Mortality in Inpatients Internal Medicine Services.

Internal medicine services serve the patient population with many chronic diseases. Therefore, it is high mortality rates compared to other departments of the hospital. Estimating the prognostic risk of hospitalized patients may be useful in mortality for patients. İn this study, we evaluated the level of Systemic Immune Inflammation Index (SII) and Systemic Inflammation Response Index (SIRI) and its association with mortality in inpatients. This study was performed in 2218 patients who were hospitalized between January 1st-December 31th of 2019. Patients were followed up for three years about primary endpoint as all-cause (except for unnatural deaths) mortality. Participants were divided into 4 equal groups according to their increasing levels of SII and SIRI. (Quartile 1-4) Age, gender, diabetes mellitus, hypertension, coronary artery disease, chronic kidney disease, malignancies (solid), white blood cell, neutrophil, lymphocyte, monocytes, hemoglobin, hematocrit, platelet, CRP, albumin, Systemic Inflammation Response Index (Quartile 1-4), Systemic Immune Inflammation Index (Quartile 1-4) were compared between survival and non-survival groups. There were 1153 female and 1065 male participants enrolled. Compared with surviving patients, patients who died were older and had a higher prevalence of diabetes mellitus, hypertension, malignancy, chronic kidney disease and coronary artery disease (p < 0.001). There was a lower proportion of female patients among the patients who died. Compared to the survivor group, group who died exhibited a significant increase in CRP level, neutrophil, white blood cell and monocyte counts, but had a lower lymphocyte count, albumin level and hemoglobin count (P < 0.001). Results of Cox regression analysis showed that age, chronic kidney disease, malignancy, SIRI quartile 3, 4 and SII quartile 3, 4 pointed out a close relationship with mortality risk. (P < 0.001). The SIRI and SII have indicated the clinical importance of as novel markers for predicting mortality in inpatients.

ACUTE OSTEOMYELITIS OF THE MANDIBLE IN A GERIATRIC FEMALE INDIVIDUAL DURING PANDEMIC IN INDIA: A CASE REPORT AND LITERATURE REVIEW

A 75-year-old female patient reported to our hospital with pain and swelling on the left side of the face. Patient experienced severe throbbing pain a few days after extraction. Swelling developed 2 weeks after the extraction and progressively increased in size. Past dental history revealed that she had undergone extraction of lower left second molar 1 month back. Past medical history revealed that she was diabetic and hypertensive and was under medication for the same for the past 21 years. Patient had no history of jaw fracture and radiation exposure. Radiograph features showed cortical destruction and an increase in CRP level was observed through lab investigations. Radiograph revealed radiolucency with cortical bone destruction in relation to the lower left mandibular region. Laboratory investigations revealed an elevated CRP level and an increased albumin level in urine. Based on the history, clinical features, radiographic features and laboratory diagnosis a diagnosis of acute osteomyelitis was given. Incision and drainage were done followed by antibiotic therapy. The exposed bone was removed followed by curettage and irrigation. Patient was recalled after 10 days and exhibited no post-operative complications. This case was treated with antibiotic therapy and localized surgical management. The primary goal is treatment and or elimination of the causative factor followed by antibiotic therapy instituted according to antibiogram. Surgical therapy includes incision and drainage, jaw resection in invasive and extensive cases. Decortication, sequestrectomy and saucerization can also be done. Hyperbaric oxygen therapy can be given in patients with chronic osteomyelitis associated with necrotizing soft tissue. Improved patient survival, better outcome and a decreased need for surgical intervention have been observed in patients treated with hyperbaric oxygen. Osteomyelitis is a rare, invasive and destructive bacterial infection that can affect the quality of life. Further research in diagnosis criteria and techniques for management of osteomyelitis must be developed for better outcome and patient survival.

Evaluation of some biochemical markers in relation to COVID-19 mRNA vaccine

Background The coronavirus disease 2019 (COVID-19) has become a national pandemic for more than 2 years, and it continues to have an unimaginable impact on our way of life and quality of life. It is critical to gain a deeper understanding of how immunity is regulated in response to SARS-CoV-2 infection. The C-reactive.protein.(CRP) was the first acute phase protein to be identified, and it serves as a highly sensitive systemic indication of tissue damage, infection, as well as inflammation. Smooth muscle cells, lymphocytes, macrophages, endothelial cells, and adipocytes are all involved in the production of this protein. Interleukin.10.(IL-10), commonly described as human. cytokine.synthesis.inhibitory.factor (CSIF). The IL-10 gene in humans produces interleukin 10, a pleiotropic cytokine with strong anti-inflammatory as well as immunosuppressive activities. The Aim the aim of this study is to evaluate the vaccine effectiveness using diagnostic biochemical markers. Material and method this study included 125 patients (56 males and 69 females) with vaccinated and non-vaccinated COVID-19 with an age range of 20–70 years. These patients are divided into two main groups: 1. vaccinated (vaccinated with COVID-19 infection, vaccinated without COVID-19 disease, vaccinated recoveredfrom the CoV-19 virus), 2. Unvaccinated (infected with the CoV-19 virus and non-vaccinated, recovered from COVID-19 and unvaccinated). The outcome is measured using the enzyme-linked immunosorbent assay (ELISA) technique. This study was conducted during the period from November 2021 to May 2022 at Al-Shifaa medical center and the vaccine unit at Al-Diwaniyah Educational Hospital, Diwaniyah governorate, Iraq. Results The results showed an increase in CRP level for the vaccinated groups was significantly higher (P<0.0001) in group G2 (vaccinated with COVID) more than in G1 (vaccinated without COVID) and G3 (vaccinated recovered COVID). For non-vaccinated groups, it was significantly higher (P<0.01) in group G4 (no vaccine with COVID) more than in group G5 (no vaccine recovered COVID). The results also showed that the IL-10 in the 2nd and 4th weeks after vaccination had a higher level in G1 (vaccinated without COVID) and G2 (vaccinated with COVID) than in any other time incident. For G4 (no vaccine with COVID) showed that a significant increase was noticed in the 2nd week after diagnosis more than other time incidents. While G3 (vaccinated recovered COVID), G5 (no vaccine recovered COVID) showed that no significant increase was noticed among the different time incidents. Conclusion the use of mRNA for CoV-19 vaccination significantly modulates the increment of C-reactive protein and interleukin-10 and improves the immune response in patients with COVID-19 infection.

Early Dynamics of C-Reactive Protein Predict Risk of Venous Thromboembolism in Patients with Cancer Treated with Immune Checkpoint Inhibitors

Background: Patients with cancer treated with immune checkpoint inhibitors (ICI) have a substantial risk of venous thromboembolism (VTE). Conventional prothrombotic risk factors seem inefficient in the prediction of VTE under ICI-therapy. Recently, C-reactive protein (CRP) trajectories were proposed as prognostic and predictive biomarker for survival and therapy response in patients treated with ICI. The aim of the present study was to explore early dynamics of systemic CRP-levels after initiation of ICI for the prediction of VTE. Methods: Adults patients with cancer treated with ICI at the Medical University of Vienna were included in this retrospective cohort study. Levels of CRP were obtained at study baseline within 4 weeks prior to and longitudinally at 1, 2, and 3 months after ICI-initiation. Patients were stratified according to their CRP-dynamics relative to baseline measurements, defining a CRP-flare as an increase by the factor of 2.5 relative to baseline measurements and a CRP-response as a 50% relative decrease in CRP-levels within the first 3 months after ICI-initiation, respectively. Patients were followed for the time of ICI therapy, the initiation of any subsequent anti-cancer therapy, death, or a maximum of 3 months after the last ICI-cycle. Risk of VTE was analysed in a competing-risk framework, accounting for all-cause mortality as competing outcome event. Results: Overall, 405 patients treated with ICI were included (median age: 63 years [interquartile range, IQR: 53-72]; 38% female). The most frequent tumour types were melanoma (33%) and lung cancer (26%), with 91% of patients diagnosed with stage IV cancer at ICI-initiation. Over a median follow-up of 7.9 months (IQR: 4-16), we observed 29 VTE (cumulative incidence: 12.7% [95% confidence interval, CI: 6.9-20.5]). In patients with a CRP-flare after ICI-initiation (n=296; 73%), an increased risk of VTE was observed (sub-distribution hazard ratio (SHR): 3.58 [95%CI: 1.07-11.94], p=0.038), which prevailed upon multivariable adjustment for tumour type, cancer stage, age, sex, Charlson comorbidity index, and ECOG-performance status. Cumulative VTE-incidences in patients with a CRP-flare were 17.5% (95%CI: 8.8-28.7), compared to 2.9% (95%CI: 0.8-7.7) in the remainder of patients (Figure 1). Further, in patients with a CRP-response within the first 3 months after therapy initiation (n=126; 31%), numerically lower VTE rates were observed compared to the remainder of patients (SHR: 0.41 [95%CI: 0.16-1.06], p=0.066), with the lowest VTE-rates in those with CRP-responses without a prior CRP-flare (n=62; 15%; cumulative VTE-incidence: 1.6% [95%CI: 0.1-7.6]). Conclusion: Early dynamics of systemic CRP-levels are associated with risk of VTE during ICI-therapy, with the highest rates observed in patients with an initial CRP-flare. These data suggest a potential link between the ICI-induced systemic inflammatory response and subsequent risk of VTE. Figure 1: Cumulative incidence of VTE according to early CRP-flare after ICI-initiation. Competing risk cumulative incidence, accounting for all-cause mortality as competing outcome event. CRP-flare was defined as increase in CRP-levels by the factor of 2.5 within 3 months after ICI-initiation relative to baseline, pretherapeutic measurements. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

THE ROLE OF NEUTROPHIL TO LYMPHOCYTE RATIO AND PLATELET TO LYMPHOCYTE RATION IN DIAGNOSIS OF SUBACUTE THYROIDITIS

Purpose: Patients with subacute thyroiditis (SAT) usually apply to clinics with thyrotoxicosis and neck pain. Hemogram is frequently applied tests in primary health care services, and it can warn physicians for SAT in a thyrotoxic patient. In our study, the role and usability of neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) in the diagnosis of SAT were evaluated. Material and Methods: Between January 2015 and January 2020, 192 SAT patients who applied to endocrinology clinics and 85 healthy control were included in the study. Neutrophil (Neu), lymphocyte (Lym), platelet (PLT) leves were recorded. Results: The median NLR and PLR values of SAT patients before treatment were 2.78 (0.91-11.33) and 168.3 (25.7-818.3), respectively, and were significantly higher than the control group (p&amp;lt;0.001). The optimum cut-off values for NLR and PLR for SAT were 1.84 (specificity 85.9% and sensitivity 90.1%; p&amp;lt;0.001; AUC=0.934; 95% CI: 0.905-0.964 ) and 140.2 (specificity 83.5% and sensitivity 77.1%, p&amp;lt;0.001, AUC=0.821 95% CI: 0.767-0.874), respectively. Pretreatment NLR, PLR, CRP, and ESR levels were significantly higher than the posttreatment levels (all p&amp;lt;0.001). Correlation analysis revealed positive linear relations between pretreatment PLR and CRP (p=0.002, r=0.220), pretreatment PLR and ESR (p=0.018, r=0.171), pretreatment NLR and CRP (p&amp;lt;0.001, r=0.330), and pretreatment NLR and ESR (p=0.001, r=0.242). Multiple linear regression analysis revealed a 0.008 unit of increment of NLR per 1 unit increase in CRP levels (B=0.008; p&amp;lt;0.001; %95 CI=0.004-0.012). Conclusion: High NLR and PLR values accompanying thyrotoxicosis are both warning and helpful parameters for the diagnosis of SAT.

Evaluation of serum markers of the immune response and bone metabolism facilitates early detection of psoriatic arthritis in patients with psoriasis

Relevance: Psoriatic arthritis (PA) is a severe complication of psoriasis, leading to progressive damage to the musculoskeletal system, a decrease in the quality of life and early disability. CASPAR criteria, widely used for PA diagnosis, are highly sensitive and specific. However, some patients with psoriasis score 3 with CASPAR criteria without an established PA diagnosis. At present, there is a search for PA biomarkers, which could mirror the stages of pathogenesis of joint and enthesis destruction in this disease.&#x0D; Aim: To identify the most significant changes in biochemical parameters in patients with PA, that would be pathophysiologically associated with the disease.&#x0D; Materials and methods: We performed an open label comparative parallel groupstudy in 60 patients with PA and 40 patients with psoriasis without PA. Clinical assessments included filling in the questionnaires, past history, dermatologist consultation, severity of psoriasis by PASI, and PA activity. Clinical chemistry examination included the levels of antibodies to citrullinated peptide, erythrocyte sedimentation rate, C-reactive protein (CRP), human leukocyte antigen HLA B27, immunoglobulins A, M, and G, complement system components C3, C4, circulating immune complexes (CIC), as well as bone metabolism parameters (calcium, phosphorus, magnesium, seromucoid, alkaline phosphatase (AP), osteocalcin, parathyroid hormone, vitamin D, matrix metalloproteinases MMP-1, MMP-3, MMP-8, and cartilage oligomeric matrix protein (СОМР).&#x0D; Results: Psoriasis was diagnosed in 86.6% (n=52) of the patients with PA. Family history of psoriasis was confirmed in 55.0% (n=22) of the patients with psoriasis without PA and in 60.0% (n=36) of the patients with PA (p=0.681). Compared to the patients with psoriasis without PA, the patients with PA had higher prevalence of psoriatic onychodystrophy (71.6%, n=43, vs. 35.0%, n=14, p=0.0004), dactylitis (28.3%, n=17, vs. 5.0%, n=2, p=0.004), extra-articular bone proliferation signs (26.6%, n=16, vs. 5.0%, n=2, p=0.006). In the patients with PA, compared to those without PA, there was a significant increase in CRPlevels (27.4 vs. 9.5 mg/l, p=0.002), more than 2-fold increase in IgM and IgG (IgM, 2.35 vs. 1.2 g/l, p=0.023; IgG, 17.7 vs. 8.45 g/l, p 0.0001), and CIC (89.3 vs. 29.5 mU/ml, p=0.0003). Serum phosphorus and magnesium levels in the patients with PA were lower than in the psoriasis patients without PA (phosphorus 0.8 vs. 1.6 mmol/l, respectively, p=0.045, magnesium 0.5 vs. 1.0 mmol/l, respectively, p=0.001), with somewhat higher parathyroid hormone levels (67.3 vs. 25.1 ng/ml, respectively, p=0.013). Osteocalcin levels in the PA patients were by 37.3% lower than in the patients with psoriasis without PA (17.57 vs. 24.13 ng/ml, respectively, p=0.004). MMP-1 levels in the PA groupwere 12.3-fold higher than in the non-PA group(37.68 vs. 3.05 ng/ml, respectively, p 0.0001), and MMP-3 levels were 3.7-fold higher (42.35 vs. 11.36 ng/ml, respectively, p=0.022). In the patients with PA, APlevels were 2.52-fold higher than in the control group(150.2 vs. 59.5 U/ml, respectively, p=0.007), and COMPlevels were 2.08-fold higher (415.2 vs. 199.5 ng/ml, respectively, p=0.006).&#x0D; Conclusion: The patients with PA have higher serum CRP, IgM, IgG, CIC, MMP-1, MMP-3, AP, and COMPlevels and lower osteocalcin, phosphorus, and magnesium concentrations, than the patients with psoriasis. These parameters are not PA-specific; however, the search for the most sensitive biomarkers of the systemic immune response and bone remodeling seems to be a promising area of research, since identification of such markers would allow for timely prediction and detection of PA in patients with psoriasis.

C-reactive protein (CRP) trajectory as a predictor of anastomotic leakage after rectal cancer resection: A multicentre cohort study.

AimThis study aimed to identify whether CRP‐trajectory measurement, including increase in CRP‐level of 50 mg/l per day, is an accurate predictor of anastomotic leakage (AL) in patients undergoing resection for rectal cancer.MethodsA prospective multicentre database was used. CRP was recorded on the first three postoperative days. Sensitivity, specificity, positive and negative predictive values, and area under the receiver operator characteristic (ROC) curve were used to analyse performances of CRP‐trajectory measurements between postoperative day (POD) 1–2, 2–3, 1–3 and between any two days.ResultsA total of 271 patients were included in the study. AL was observed in 12.5% (34/271). Increase in CRP‐level of 50 mg/l between POD 1–2 had a negative predictive value of 0.92, specificity of 0.71 and sensitivity of 0.57. Changes in CRP‐levels between POD 2–3 were associated with a negative predictive value, specificity and sensitivity of 0.89, 0.93 and 0.26, respectively. Changes in CRP‐levels between POD 1–3 showed a negative predictive value of 0.94, specificity of 0.76 and sensitivity of 0.65. In addition, 50 mg/l changes between any two days showed a negative predictive value of 0.92, specificity of 0.66 and sensitivity of 0.62. The area under the ROC curve for all CRP‐trajectory measurements ranged from 0.593–0.700.ConclusionThe present study showed that CRP‐trajectory between postoperative days lacks predictive value to singularly rule out AL. Early and safe discharge in patients undergoing rectal surgery for adenocarcinoma cannot be guaranteed based on this parameter. High negative predictive values are mainly caused by the relatively low prevalence of AL.

Dyslipidemia’s influence on the secretion ovarian’s steroids in female mice

Introduction: The synthesis ovarian’s steroids is a process thats depends on the supply of cholesterol. Objective: to evaluate the influence of dyslipidemia on the secretion ovarian’s steroids. Methodology: wild female mice were used (C57BL6) and LDL (LDLR-/-), which they were separated into 4 groups (n = 10): WTS: fed a standard diet; WTHL: fed a high-fat diet; KOS: fed a standard diet; KOHL: fed a high-fat diet. After 60 days, the estrous cycle was analyzed and after anesthetized, blood was collected for the to assess the lipid profile, glucose, plasma insulin level and HOMA index was calculated. In addition, plasma levels of C-reactive protein, estrogen and progesterone were determined. Results: The hyperlipidic diet in both the WTHL and the KOHL group generated hypercholesterolemia when compared to the WTS and KOS, respectively, with a decrease in HDLc, associated with an increase in CRP levels. Severe hypercholesterolemia in the KOHL group generated insulin resistance, marked by an increase in HOMAir. Food hypercholesterolemia in the WTHL group, food and genetics in the KOHL group, compared to their WTS and KOS controls, was definitive in reducing plasma levels of estrogen and progesterone. The genetic hypercholesterolemia associated with insulin resistance observed in the KOS and KOHL groups reduced the levels of progesterone, this reduction being more severe in the KOHL group, which had the highest HOMAir. Conclusion: dyslipidemia affected ovarian steroidogenesis in mice by means of oxidative stress, inflammation and insulin resistance and / or by decreasing HDL cholesterol levels.

Outcome Measures in Large Vessel Vasculitis: Relationship Between Patient-, Physician-, Imaging-, and Laboratory-Based Assessments.

To assess the relationship between measures of disease assessment in patients with large vessel vasculitis. Patients with giant cell arteritis (GCA) or Takayasu arteritis (TAK) were recruited into a prospective, observational cohort. Assessments within the following outcomes were independently recorded: 1) patient-reported outcomes (Multidimensional Fatigue Inventory, patient global assessment of disease activity [PtGA], Short Form 36 health survey [SF-36], Brief Illness Perception Questionnaire), 2) physician global assessment of disease activity (PhGA), 3) laboratory outcomes (C-reactive protein [CRP] level, erythrocyte sedimentation rate [ESR]), and 4) imaging outcomes (PETVAS, a qualitative score of vascular 18 F-fluorodeoxyglucose-positron emission tomography activity). Analyses were performed on 112 patients (GCA = 56, TAK = 56), over 296 visits, with a median follow-up of 6 months. Correlation network analysis revealed assessment measures clustered independently by type of outcome. PhGA was centrally linked to all other outcome types, but correlations were modest (ρ = 0.12-0.32; P < 0.05). PETVAS, CRP level, and PtGA were independently associated with clinically active disease. All 4 patient-reported outcomes strongly correlated with each other (ρ = 0.35-0.60; P < 0.0001). Patient-reported outcomes were not correlated with PETVAS, and only PtGA correlated with CRP level (ρ = 0.16; P < 0.01). Patients whose clinical assessment changed from active disease to remission (n = 29) had a corresponding significant decrease in ESR, CRP level, and PETVAS at the remission visit. Patients whose clinical assessment changed from remission to active disease (n = 11) had a corresponding significant increase in CRP level and PtGA at the active visit. Measures of disease assessment in large vessel vasculitis consist of independent, yet complementary, outcomes, supporting the need to develop composite outcome measures or a standard set of measures covering multiple types of outcomes.

Study the relationship between CRP and Ferritin in people infection with COVID-19 in AL-Najaf Governorate, Iraq.

Coronavirus (COVID-19) is a viral disease transmitted from person to others by coughing and sneezing droplets.COVID-19 is a new virus spread over the world symptoms of COVID-19 that can range from mild to severe disease and can develop into multi-organ failures, caused death . Method:- The study included 68 people coming to the AL-Najaf Hospitals, who are suffering from infection by COVID-19 for a period of 2 months, from April to May month 2020. Draw 5 ml of blood for the measurement of CRP and Ferritin in patients' blood. Result:- The current study showed that infection with Covid-19 is affected by the age factor of the patient, the age group (40-46) years was the most affected group, where the rate of infection being (38. 24).)% also, the study showed the sex factor was an effect on spread infection where the men infection was more than from women. The study also showed that the injury caused a significant increase (p &lt;0.001) in the Ferritin level in both sexes compared to the healthy group (515, 222.382) ng/ml respectively in the Men and(470, 71 ) ng/ml respectively in the women. also, a significant increase in CRP level compared with the healthy group ( 44.82,3.41) IU/ ml respectively.

Persistent severe post-operative hypotension after pancreaticoduodenectomy is related to increased inflammatory response.

Hypotension during major surgery is frequent, resulting in increased need for observation in the post-anaesthesia care unit and treatment including vasopressors and fluids. However, although severe hypotension in the immediate post-operative recovery phase after major surgery is suggested to be related to increased morbidity and mortality, the underlying risk factors are not well described, hindering advancements in prevention and treatment. We performed a retrospective study assessing factors (age, gender, body-mass index, cardiac co-morbidity, haemoglobin, absolute and increase in c-reactive protein on the first post-operative day, bleeding, fluid balance at the end of surgery and the first post-operative day) related to severe persistent hypotension (SPH) (SPH: need for noradrenaline to maintain a mean arterial blood pressure (MAP) >65.0mm Hg on the morning after surgery) and occurrence of other early (24hours) complications. One hundred patients undergoing pancreaticoduodenectomy (PD) with pre-operative high-dose glucocorticoid and goal-directed fluid therapy were enrolled and perioperative data collected from anaesthetic and medical records. Forty-five patients had SPH, who had a significantly higher increase in CRP levels the morning after surgery (median 50mgL-1 vs 41mgL-1 , SPH vs non-SPH, respectively, P=.028), and a significantly more positive fluid balance at discharge (median 1457ml vs 1031ml, respectively, P=.027) vs patients without SPH. Severe persistent hypotension after PD was associated with significantly increased inflammatory response and increased need for fluids. Future studies should investigate the effect of further inflammatory control in PD to improve haemodynamics and morbidity.

Morphine consumption is associated with systemic inflammation in children undergoing allogeneic hematopoietic stem cell transplantation

Background: The majority of children undergoing allogenic hematopoietic stem cell transplantation (HSCT) experience severe pain due to chemotherapy-induced gastrointestinal toxicity. Inter-individual differences in pain perceived and opioid consumption remain unexplained, limiting the possibility for individualized pain control. The aim of this study was to investigate the associations between opioid consumption and markers of gastrointestinal toxicity (plasma citrulline) and systemic inflammation (plasma CRP and IL-6) in these patients.Methods: We retrospectively included 38 children undergoing HSCT in Denmark in 2010–2012. Opioids doses on days 0–21 post-HSCT were registered as intravenous morphine equivalents (MEs). CRP was measured daily on days 0–21. IL-6 was measured on day 7. Citrulline was measured before conditioning, on days 7 and 21.Results: Out of 38 children, 37 (97%) received opioids during days 0–21. CRP level and ME dose peaked on days 9–10 while citrulline level reached a nadir on day 7 indicating maximum enterocyte loss. CRP was associated with ME dose, with an estimated increase of 0.030 mg/kg (95% CI 0.024–0.035) in ME for a 50% increase in CRP level on the same day (p < .001). IL-6 was correlated with ME on day 7 (rho = 0.55, p = .002). Citrulline did not correlate with ME.Conclusions: Opioid consumption in the early post-HSCT period is associated with the degree of chemotherapy-induced systemic inflammation and not with the extent of enterocyte loss. These findings contribute to our understanding of mucositis-related pain and may be of interest for future studies on therapeutic strategies.

Efficacy of Intraoperative, Single-Bolus Corticosteroid Dose to Prevent Postoperative Respiratory Complication after Transhiatal Esophagectomy

Introduction: Esophageal cancer is among the most common malignancies. Hospital mortality in the past decade reduced; but its morbidity is still high. Pulmonary complications are the most common complications after esophageal resection. In this study we examined the effect of steroids administration during surgery to reduce postoperative morbidity with a focus on respiratory complications.Material and Methods: Patients with esophageal cancer who underwent transhiatal esophagectomy, randomly divided into two groups to thirty patients: The intervention group (received 125mg methylprednisolone sodium succinate). After surgery, patients admitted in the ICU for a day. Oral feeding initiated on day 7th and patients discharged home on the day 8th or 9th.Postoperative complications included anastomotic fistula, wound infection in the neck and abdomen and pulmonary complications. We analyzed pulmonary complications included pneumonia, Acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) occurred before the seventh day. The leukocyte counts and CRP levels measured on the 2nd and 7th days after surgery.Results: 60 patients enrolled in the study. Incidence of ARDS, ALI and pneumonia in the control group was 3, 5 and 2 and in steroid group 1, 1 and 1 respectively. CRP levels and blood leukocyte count was similar in two groups on the second day but seventh day values and difference between the two levels between the second and seventh days were significantly different between the two groups (p<0.001).Conclusion: Intraoperative single dose corticosteroids are effective in preventing pulmonary complications after transhiatal esophagectomy. Methylprednisolone reduced the increase in CRP levels after surgery and decreased blood leukocyte count more in postoperative period.

Serum C-reactive protein in adolescence and risk of Schizophrenia in adulthood: A prospective birth cohort study from Finland

Meta-analyses of cross-sectional studies confirm an increase in circulating inflammatory markers during acute psychosis. Longitudinal studies are scarce but are needed to understand whether elevated inflammatory markers are a cause or consequence of illness. We report a longitudinal study of serum CRP level in adolescence and subsequent risk of schizophrenia and related psychoses in adulthood in the Northern Finland Birth Cohort 1986. Serum high-sensitivity CRP was measured at age 15/16 years in 6,362 participants. ICD-10 diagnoses of schizophrenia and related psychoses were obtained from centralised hospital inpatient and outpatient registers up to age 27 years. Adolescent CRP was associated with subsequent schizophrenia. The adjusted odds ratio (OR) for schizophrenia by age 27 years for each standard deviation (SD) increase in CRP levels at age 15/16 years was 1.25 (95% CI, 1.07–1.46), which was consistent with a linear, dose–response relationship (p-value for quadratic term 0.23). Using CRP as a categorical variable, those with high (>3 mg/L) compared with low (

STUDY OF SOME BIOMARKERS IN FRAIL ELDERLY

Background: Frailty recognized as a common clinical syndrome associated wih a high rate of morbidity and mortality. Aim of the Study: This study aimed at assessing the value of determination of some biomarkers in identification and recruitment of frail elderly. The association between these biomarkers and stages of frailty were also assessed Subjects and Methods : A total number of 100 elderly subjects (above 65 years old) were included in the work divided into three groups : Group 1 (non-frail) included 34 subjects (19 males and 15 females), their ages ranged from 66.3 to 72.9 with mean 67.6 + 3.3 year; Group 2 (pre-frail) included 26 subjects (1 males and 15 females), their ages ranged from 65.5 to 73.1 with mean age of 69.3 + 3.8 year and Group 3 (frail) included 40 subjects (25 males and 15 females), their ages ranged from 67.9+ to 78.3 with mean age of 73.1+5.2 year.All subjects of this study were subjected to : thorough clinical examination, Anthropometric measures (including mid upper arm circumference, mid calf circumference, body mass index), Timed get-up-and-go test, hand grip strengh test and laboratory investigations (including complete blood picture, serum albumin, serum alanine transferase, INR. Prothrombin time and partial thromboplastin time, Cholesterol and C-reactive protein. Results: In our study; frailty recorded higher prevalence than most of epidemiological studies. Regarding CRP, there was significant increase in CRP level in frail group (27.4 + 8.1 mg/l) compared to both pre-frail (14.3 + 4.5 pg/ml) and non-frail groups (7.5 + 5.5 pg/ml). Regarding cholesterol, there was significant decrease in cholesterol level in frail group (125.7 + 54.9) compared to both pre-frail (168.1 + 17.2) and non-frail (165.3 + 29.7) groups. Regarding TGUGT, it was prolonged in frail group compared to both pre-frail and non-frail groups. Conclusions: There is high prevalence of frailty among studied elderly population, the causes of which need further studies to unravel. The changes in biomarkers noticed in our frail elderly may suggest its use in diagnosis and follow up of frailty, a suggestion that still in its infancy and needs further more studies to verify. Key words : Frailty, C-reactive Protein and Timed get up and go test.

Laparoscopic sigmoid resection with transrectal specimen extraction: a novel technique for the treatment of bowel endometriosis

Multidisciplinary laparoscopic treatment is the standard of care for radical treatment of deep infiltrating pelvic endometriosis. If bowel resection is necessary, a muscle-split or Pfannenstiel incision is also required. The avoidance of any laparotomy could decrease surgical stress response, give a faster return to normal bowel function, decrease post-operative pain and reduce wound complications and incisional hernias. We assessed post-operative outcome after a full laparoscopic sigmoid resection for bowel endometriosis. Twenty-one patients who underwent elective full laparoscopic sigmoid resection for bowel endometriosis from September 2009 to September 2010 were matched for age, American Society of Anesthesiologists class and BMI to 21 patients who underwent a conventional laparoscopic sigmoid resection. Groups were compared for peri-operative factors, complications, length of hospital stay, post-operative pain (Visual Analog Scale: VAS), analgesics consumption and inflammatory response (plasma C-reactive protein: CRP). Median operating time was 15 min shorter with transrectal specimen extraction (P = 0.003). VAS-scores and use of analgesics were higher in the conventional laparoscopic group (P = 0.0005). Mean CRP-level tended to be higher in the transrectal specimen extraction group (38%, P = 0.054) but there was no difference in increase in CRP level between groups (P = 0.15). There were no anastomotic leaks or reinterventions in either group, and the median hospital stay was similar. At follow-up, no wound infections or incisional hernias were observed and no patients reported anal dysfunction. Full laparoscopic sigmoid resection reduced operating times and decreased post-operative VAS-scores and analgesic requirements compared with the conventional laparoscopic sigmoid resection for bowel endometriosis.

Does Elevated High-Sensitivity Serum C-Reactive Protein Associate with Hypertension in Non-Obese Japanese Males?

The object of this study is to assess whether elevated hsCRP levels are independently related to hypertension in non-obese Japanese males. This cross-sectional study comprised 86 hypertensive and 109 normotensive subjects. We defined hypertension as a systolic blood pressure ≥140 mmHg and/or a diastolic blood pressure ≥90 mmHg and/or taking antihypertensive therapy. Log-hsCRP levels were significantly higher in hypertensive than normotensive subjects. In logistic regression analysis, subjects in the highest tertile had a two-fold higher risk than those in the lowest tertile. The association between hypertension and hsCRP levels was marginally significant. In addition, there was a significant tendency for hypertension to increase with an increase in CRP level (p < .05). These findings suggest that elevated hsCRP level is an independent risk factor for hypertension in non-obese Japanese males.

IMMUNO-INFLAMATORY RESPONSE IN ISCHEMIC HEART DISEASE

Aim. To estimate the role of immuno-inflammatory response in developing of angina pectoris in patients with ischemic heart disease (IHD). Material and methods: The study included 83 patients with IHD and angina pectoris of functional class (FC) II (30 patients), III (27 patients) and IV (26 patients). The control group included 25 healthy persons. Bicycle burden test, daily ECG monitoring and echocardiography were used to verify of IHD. Levels of С-reactive protein (CRP), pro-inflammatory cytokines: interleukin-1β, interleukin-6 (IL-1β, IL-6) and tumor necrosis factor alpha (TNF-α) were examined by immunoenzyme method. Levels of anti-inflammatory cytokines were also defined: interleukin-4 and interleukin-10 (IL-4, IL-10). Results. Increased levels of IL-4 and IL-10 with normal CRP and pro-inflammatory cytokine levels were observed in patients with angina of FC-II. Angina of FC-III was associated with a moderate increase in CRP level and normal levels of IL-4 and IL-10. The maximal levels of CRP and pro-inflam￾matory cytokines as well as minimal levels of anti-inflammatory cytokines were observed in patients with FC-IV angina pectoris. Conclusion. The immuno-inflammatory response depends on angina pectoris severity in patients with IHD. Severe angina pectoris is accompanied by raised expression of pro-inflammatory cytokines and deficiency of anti-inflammatory cytokines.

Les infections à salmonelles chez l’enfant : étude retrospective sur quatre ans

Objectives. – Epidemiological state of salmonella infections in Languedoc-Roussillon (France) and discussion of therapeutic indications. Material and method. – Retrospective study over a four-year period of paediatric salmonella infections requiring hospitalisation in Montpellier University Hospital. Analysis of clinical, bacteriological, laboratory and therapeutic data. Results. – One hundred and sixty nine cases of paediatric salmonella infections have been investigated. The clinical triad consisted of diarrhea, abdominal pain and fever. Six severe cases have been observed and seemed to have been independent of patient’s background. Laboratory findings showed inconstantly hyperleucocytosis and increase in CRP levels. Stool analysis remained the reference laboratory test to detect salmonella. Two major strains of salmonella have been identified: Salmonella enterica subsp. enterica serovar Typhimurium and Enteriditis. Treatments have been essentially symptomatic but 20% of the children (n=34) required antibiotic therapy. A favourable outcome was observed in all the children. Discussion. – Incidence of salmonella infections is increasing in France, particularly in the Languedoc-Roussillon area. Diagnosis of mild forms is generally easy but certain patient background seems to expose to severe forms. Treatment of salmonella infections is mainly symptomatic, only severe or specific cases (young age, immunodepression…) requiring antibiotic treatment. The growing antibiotic use and the increasing of resistance are currently the main problems in the management of salmonella infections. Those infections remain a public health problem in Languedoc-Roussillon.