C-reactive Protein Levels Research Articles

Weight loss, changes in body composition and inflammatory status after a very low-energy ketogenic therapy (VLEKT): does gender matter?

BackgroundConsidering differences in body composition and inflammatory status between sexes, as well as recent recommendations advocating for personalized dietary approaches, this study aimed to explore how sex influences weight loss, changes in body composition, and inflammatory status in subjects with grade I and II obesity undergoing a 45-day of the Very Low-Energy Ketogenic Therapy (VLEKT).MethodsParticipants (21 premenopausal females and 21 males), included in the study adhered to the 45-day of the VLEKT and underwent assessments of anthropometric parameters (weight, height, body mass index—BMI –, and waist circumference), body composition via bioelectrical impedance analysis, and inflammatory status measured by high sensitivity C-reactive protein (hs-CRP) levels at baseline and post-intervention.ResultsAt baseline, premenopausal females and males did not differ in BMI (p = 0.100) and hs-CRP levels (p = 0.948). Males demonstrated overall larger benefits than premenopausal females from the VLEKT in terms of weight loss (Δ% = − 11.63 ± 1.76 vs − 8.95 ± 1.65 kg, p < 0.001), fat mass (Δ% = − 30.84 ± 12.00 vs -21.36 ± 4.65 kg, p = 0.002), and hs-CRP levels (Δ% = − 41.42 ± 21.35 vs − 22.38 ± 17.30 mg/L, p = 0.003). Of interest, in males phase angle values are statistically improved compared to female (Δ% = 17.11 ± 9.00 vs 7.05 ± 3.30°, p < 0.001).ConclusionThese findings underscore the importance of considering sex-specific responses in personalized obesity treatment strategies, particularly dietary interventions like VLEKTs.Graphical

Experience with the use of janus kinase inhibitors in the treatment of COVID-19 in patients in Volgograd

The new coronavirus infection (COVID-19) is characterized by high morbidity and mortality. The main approach to COVID-19 therapy should be the proactive administration of treatment before the development of a complete symptom complex of life-threatening conditions, including acute respiratory distress syndrome. The use of a selective and reversible inhibitor of janus kinase 1 and 2 prevents viral endocytosis, reduces excessive inflammatory response. The purpose of the study - to evaluate the effectiveness of the use of the Janus kinase inhibitor of the drug Baricitinib (Olumiant, manufacturer Lilly del Caribe Inc., Spain) in the treatment of patients with moderate COVID-19 in a hospital setting. During the clinical use of Baricitinib, significant positive changes were obtained compared with the initial level of vital signs and laboratory data. Significant positive changes in the following indicators were obtained: oxygen saturation increased (from 95.3 ± 4.0 to 97.5 ± 3.2 %, p = 0.011), body temperature decreased (from 37.3 ± 0.7 to 36.7 ± 0.5 °C, p = 0.000), C-reactive protein decreased (from 47.1 ± 46.0 to 32.5 ± 41.7 g/l, p = 0.010), the number of platelets increased (from 178.0 ± 59.5 to 249.5 ± 84.5; p = 0.000), when assessing the condition of patients in points on the NEWS-2 scale positive dynamics (from 1.6 ± 1.2 to 1.1 ± 1.3, p = 0.001). The level of C-reactive protein increased simultaneously with an increase in interleukin-6, an increase to 200.0 ± 6.2 pg/ml was recorded. The positive dynamics is an increase in the number of lymphocytes to 2.0 • 109/l. By the end of inpatient treatment, ferritin levels had normalized to reference values of 27.7±2.1 mmol/l and D-dimer to the upper limit of normal. Positive dynamics of changes on the CT scan of the chest organs in the form of a decrease in infiltration. According to the combination of changes in clinical, laboratory signs and CT scan results, the therapy of patients was effective.

Comparison of a full tibial tunnel or an all-inside technique for anterior cruciate ligament reconstruction: An observational study.

This study aims to compare the effectiveness of anterior cruciate ligament (ACL) reconstruction performed with either a full tibial tunnel technique or an all-inside technique. Data from patients with ACL rupture who underwent ACL reconstruction using autogenous hamstring tendon grafts between January 2019 and July 2021 were retrospectively reviewed. Patients were followed up for a minimum of 24 months. Preoperative and postoperative International Knee Documentation Committee scores, Lysholm knee scores, visual analog scale pain scores, Tegner activity scale scores, C-reactive protein levels, erythrocyte sedimentation rate, white blood cell (WBC) count, D-dimer levels, and neutrophils were recorded. At the final follow-up, side-to-side differences were assessed with the pivot shift test, Lachman test, anterior drawer test, and a knee laxity-testing device. This study included 135 patients with ACL rupture, with 62 patients (43 males and 19 females, mean age: 34.42 ± 12.79 years) undergoing the full tibial tunnel technique, and 73 patients (58 males and 15 females, mean age: 32.41 ± 11.01 years) undergoing the all-inside techniques (AITs). There were no significant differences in postoperative International Knee Documentation Committee scores, Lysholm knee scores, or Tegner activity scale scores, except at postoperative 6 months. visual analog scale pain scores showed significant improvement in patients that underwent the AIT compared to the full tibial tunnel technique at postoperative 1 week, 2 weeks, and 1 month; however, there were no significant differences at postoperative 3, 6, 12, 18, and 24 months. C-reactive protein levels, erythrocyte sedimentation rate, WBC count, D-dimer levels, and neutrophils were significantly lower in patients that underwent the AIT compared to the full tibial tunnel technique at postoperative 1 month, but there were no other significant differences in these outcome measures, except for WBC count at postoperative 3 months. There was no significant difference in knee stability at the last follow-up. In ACL reconstruction, functional outcomes following the AIT are satisfactory and similar to the total tibial tunnel technique, but patients experience less pain and a reduced early postoperative inflammatory response. These results highlight the promising potential of AITs in the clinical management of ACL rupture and advocate for their widespread adoption.

The association of spinal morning stiffness with lumbar disc degeneration and C-reactive protein: The back complaints in older adults (BACE) study

ObjectiveTo determine the association between patient-reported spinal morning stiffness and lumbar disc degeneration (LDD) and systemic inflammation, as measured by C-reactive protein (CRP), in older patients with non-specific back pain. The ultimate objective is to help shape a future definition of spinal osteoarthritis (OA). DesignBaseline data from the Dutch “Back Complaints in the Older Adults” (BACE) study was used. The relationship between the severity and duration of patient-reported spinal morning stiffness, LDD (i.e., multilevel disc space narrowing and multilevel osteophytes), and CRP was assessed. Regression models adjusted for confounding variables were performed. ResultsSix hundred and seventy-five patients were included. The mean age was 66.52 years (SD 7.69), with a mean CRP of 3.20 ​mg/L (SD 7.61). The severity of spinal morning stiffness was associated with multilevel disc space narrowing: OR 2.89 (95 ​% CI: 1.24 to 6.74) for ‘mild’, OR 2.97 (95 ​% CI: 1.18 to 7.44) for ‘moderate’, OR 3.23 (95 ​% CI: 1.17 to 8.90) for ‘severe’, and OR 5.62 (95 ​% CI: 1.70 to 18.60) for ‘extreme’ morning stiffness severity. However, spinal morning stiffness severity was not associated with multilevel osteophytes, and both multilevel features of LDD showed no associations with the duration of spinal morning stiffness. No associations were found between spinal morning stiffness severity or duration, and CRP levels. ConclusionsOur results suggest that the severity of patient-reported spinal morning stiffness might be considered in future definitions of symptomatic spinal OA and that spinal morning stiffness is probably a symptom of a degenerative process in the spine rather than a symptom of systemic inflammation in patients with back pain.

Role of CT-based body composition parameters in the course of COVID-19.

A significant correlation is observed between the course of coronavirus disease 2019 (COVID-19) and body composition parameters including visceral fat quantification, muscle mass, and hepatic attenuation. The aim of the study was to investigate the correlation between the extent of lung involvement and various computed tomography (CT) parameters, as well as laboratory findings in COVID-19 patients. A retrospective analysis was conducted on 72 adult patients with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection who underwent two consecutive thorax CT scans at least 2 weeks apart. The patients were divided into two groups, as progressive and nonprogressive, based on the presence of two consecutive CT scans. Skeletal muscle area (SMA), subcutaneous fat area (SFA), visceral fat area (VFA), total fat area (TFA), liver-to-spleen (L/S) density ratio, and laboratory findings were compared between the groups. The correlation between the extent of lung involvement and CT parameters, as well as the laboratory findings were assessed. A total of 72 patients were included in the study, with 34 (47.2%) females and 38 (52.8%) males. Hemoglobin levels were significantly lower in the progressive group compared to the nonprogressive group. C-reactive protein (CRP) values were higher in the progressive group at follow-up. The nonprogressive group exhibited decreases in the SFA, VFA, and TFA, while liver density increased. The progressive group showed a decrease in the twelfth thoracic vertebra (T12) paravertebral muscle area and muscle index. In the comparison of the laboratory and radiological data in the course of COVID-19, white blood cell (WBC) and neutrophil counts increased, SMA T12, and the skeletal muscle index (SMI) decreased in the lung progressive group. Hemoglobin and CRP levels at admission may indicate disease progression. Future studies are warranted to increase the reliability with larger series.

The Role of 18F-FDG PET in the Diagnosis of Aortitis and Large Vessel Vasculitis

Background: 18F-FDG PET metabolic imaging provides significant help in the early diagnosis of inflammation of large and medium arteries, even before the appearance of structural vascular alterations. This retrospective study aims to evaluate the role of 18F-FDG PET in the diagnosis and management of large vessel vasculitis (LVV), including aortitis. Methodology: Fifty patients with clinical and/or biological suspicion of large vessel vasculitis but without a definitive diagnosis underwent 18F-FDG PET scanning. A qualitative visual scoring system and an average total vascular score (TVS) were used to compare 18F-FDG uptake in the vascular walls with that in the liver. Patients who had been on corticosteroids for more than 8 days were excluded from the study. Results: The study included 50 patients, 27 women and 23 men, with an average age of 65.8 ± 14.5 years. The analysis of 18F-FDG PET images allowed for the classification of subjects into two distinct groups. Among the 50 subjects, 16 (32%) showed higher 18F-FDG uptake in the vascular walls compared to hepatic uptake (PET-positive group), while 34 (68%) showed lower uptake (PET-negative group). In the positive group, 75% were diagnosed with Horton’s disease, and the remaining 25% with other inflammatory diseases such as Takayasu arteritis or polyarteritis nodosa. None of the subjects in the positive group had an aortic aneurysm. All patients with a positive 18F-FDG PET had elevated levels of C-reactive protein. The TVS obtained for aortitis alone was 5.9 ± 4.7, while the score for more global vasculitis was obviously higher, at 10.4 ± 6.3. Conclusion: 18F-FDG PET has become a valuable tool in the diagnosis of large vessel vasculitis, particularly in the early stages of the disease. It also allows for mapping of arterial involvement and estimation of disease severity using the TVS.

The effect of zinc-containing calcium phosphate coating on the osseointegration of transcutaneous implants for limb prosthetics

Introduction Increasing the integration of transcutaneous implants is an important goal for their application in clinical practice.The purpose of the work was to evaluate the osseointegration of transcutaneous titanium implants with calcium-phosphate coating containing zinc ions.Materials and methods The studies were performed on 12 male rabbits, who underwent implantation of an original implant into the tibial stump. After implantation, a compression device was installed on the bone, maintaining a load of 3.5 N for 5 weeks. Duration of observation was 26 weeks. The animals were divided into two groups: a control group (n = 6) with an implant without coating and an experimental group (n = 6) with a zinc-substituted calcium-phosphate coated implant.Results The implant fell out in one case in animals from the control group; no cases of implant loss were noted in the experimental group. It was revealed that the weight concentration of Ca and P in all zones of the bone-implant block of the animals in the experimental group significantly exceeded similar indicators in the control group. In the control group, long-term persistence of high levels of C-reactive protein was noted, which was not observed in the experimental group.Discussion This series of studies has shown that an implant with a zinc-modified calcium-phosphate coating exhibited a more effective integration, in contrast to an uncoated product. The absence of serious adverse reactions to the tested products indicates acceptable tolerability and safety of its use.Conclusion The implants with a zinc-modified calcium-phosphate coating showed signs of more effective osseointegration compared to the product without additional coating.

Evaluation of a Risk Model for Sepsis Early Prediction in Infants with Epidermolysis Bullosa

Abstract Objective Epidermolysis bullosa (EB) is a severe hereditary condition characterized by fragile skin that can lead to complications, including severe infections such as sepsis. Current research on sepsis in children with EB is limited, and there is a need for specific biomarkers that can aid in early detection and management. Methods This study analyzed blood samples from 92 children diagnosed with EB, 42 of whom developed sepsis. We investigated various inflammatory proteins and clinical parameters as potential biomarkers. Multivariate analysis was used to determine predictors of sepsis occurrence. Results Elevated levels of C-reactive protein (CRP), interleukin-6 (IL-6), lactate, and decreased oxygen saturation were significantly associated with sepsis in children with EB. The predictive model displayed an area under the receiver operating characteristic curve of 0.80 in the training set and 0.77 in the validation set, indicating good predictive accuracy. Conclusion Our findings suggest that CRP, IL-6, lactate, and oxygen saturation are reliable predictors of sepsis in children with EB. These biomarkers should be monitored closely to facilitate early diagnosis and improve outcomes in this vulnerable population. The study underscores the need for tailored research and diagnostic strategies for children with EB at risk of sepsis.

Predicting Survival Status in COVID-19 Patients: Machine Learning Models Development with Ventilator-Related and Biochemical Parameters from Early Stages: A Pilot Study.

Objective: Coronavirus disease 2019 (COVID-19) can cause intubation and ventilatory support due to respiratory failure, and extubation failure increases mortality risk. This study, therefore, aimed to explore the feasibility of using specific biochemical and ventilator parameters to predict survival status among COVID-19 patients by using machine learning. Methods: This study included COVID-19 patients from Taipei Medical University-affiliated hospitals from May 2021 to May 2022. Sequential data on specific biochemical and ventilator parameters from days 0-2, 3-5, and 6-7 were analyzed to explore differences between the surviving (successfully weaned off the ventilator) and non-surviving groups. These data were further used to establish separate survival prediction models using random forest (RF). Results: The surviving group exhibited significantly lower mean C-reactive protein (CRP) levels and mean potential of hydrogen ions levels (pH) levels on days 0-2 compared to the non-surviving group (CRP: non-surviving group: 13.16 ± 5.15 ng/mL, surviving group: 10.23 ± 5.15 ng/mL; pH: non-surviving group: 7.32 ± 0.07, survival group: 7.37 ± 0.07). Regarding the survival prediction performanace, the RF model trained solely with data from days 0-2 outperformed models trained with data from days 3-5 and 6-7. Subsequently, CRP, the partial pressure of carbon dioxide in arterial blood (PaCO2), pH, and the arterial oxygen partial pressure to fractional inspired oxygen (P/F) ratio served as primary indicators in survival prediction in the day 0-2 model. Conclusions: The present developed models confirmed that early biochemical and ventilatory parameters-specifically, CRP levels, pH, PaCO2, and P/F ratio-were key predictors of survival for COVID-19 patients. Assessed during the initial two days, these indicators effectively predicted the likelihood of successful weaning of from ventilators, emphasizing their importance in early management and improved outcomes in COVID-19-related respiratory failure.

Comparative efficacy of unilateral biportal endoscopic and full-endoscopic posterior cervical foraminotomy in the treatment of cervical spondylotic radiculopathy: a retrospective analysis.

The aim of this study was to compare the clinical efficacy of the full-endoscopic posterior cervical foraminotomy (FE-PCF) and the unilateral biportal endoscopic posterior cervical foraminotomy (UBE-PCF) in the treatment of cervical spondylotic radiculopathy (CSR). Patients who underwent posterior cervical spine surgery in our hospital from January 2020 to December 2022 were retrospectively analyzed. According to the surgical method, the patients were divided into two groups: FE-PCF group and UBE-PCF group. Perioperative data included operation time, Intraoperative blood loss and postoperative hospital stay were collected. The Visual Analog Scale (VAS)-arm, VAS-neck, and Neck Diability Index (NDI) was used to evaluate the clinical outcomes at preoperative, postoperative 1 week and Last follow-up. Serum creatine phosphokinase (CPK) and C-reactive protein (CRP) levels were recorded to evaluate surgical invasiveness. A total of 160 patients were included, including 89 cases of FE-PCF and 71 cases of UBE-PCF. The demographic and preoperative data showed no significant differences between the two groups (P > 0.05). The mean operating time was significantly shorter in the UBE-PCF group compared to FE-PCF group (P < 0.05). Serum CRP and CPK levels of the two groups both exhibited a pattern of rising and then falling, peaking one day following surgery and decreasing to near normal values three days after the operation. Compared with preoperative, both groups showed significant improvement in postoperative VAS and NDI scores, with a statistically significant difference (P < 0.05). However, the differences in results between the groups were not significant. Both UBE-PCF and FE-PCF are secure and efficient methods for treating CSR by continuous visualization. UBE-PCF offers predictable and adequate decompression within a reduced surgical duration, facilitated by its separate observation and operation channels.

Factors prolonging antibiotic duration and impact of early surgery in thoracolumbar pyogenic spondylitis treated with minimally invasive posterior fixation.

A standard 6-12-week course of antibiotics is recommended for pyogenic spondylitis. Recent evidence supports early minimally invasive posterior fixation surgery; however, its effect on antibiotic treatment duration is unclear. This study aims to identify factors associated with prolonged antibiotic treatment in thoracolumbar pyogenic spondylitis patients resistant to conservative treatment and assess whether early surgery can reduce treatment duration. We retrospectively reviewed 74 patients with thoracolumbar pyogenic spondylitis undergoing minimally invasive posterior fixation at nine facilities. Patients were grouped based on antibiotic duration (≥ 6 or < 6 weeks) and timing of surgery (≤ 3 weeks or > 3 weeks of starting antibiotics). Univariable and multivariable logistic regression analyses were used to identify factors associated with prolonged antibiotic treatment and study the outcomes of patients undergoing early surgery. Forty-nine patients (66%) required prolonged antibiotic treatment. The presence of an iliopsoas abscess (p = 0.0006) and elevated C-reactive protein (CRP) levels (≥ 10mg/dL, p = 0.015) were independently associated with prolonged antibiotic treatment. Early surgery significantly reduced total antibiotic duration (5.3 weeks vs. 9.9 weeks, p < 0.0001) without increasing the incidence of postoperative infection recurrences and unplanned additional surgeries. Despite factors associated with prolonged antibiotic treatment, early surgery consistently shortened the treatment duration compared to late surgery. Early surgery (within three weeks) with minimally invasive posterior fixation for thoracolumbar pyogenic spondylitis is associated with reduced antibiotic duration and overall treatment duration regardless of the presence of prolonging factors like iliopsoas abscess and elevated CRP levels.

Identification of Severe Acute Exacerbations of Chronic Obstructive Pulmonary Disease Subgroups by Machine Learning Implementation in Electronic Health Records.

Acute exacerbations of COPD (AECOPD) are heterogeneous. Machine learning (ML) has previously been used to dissect some of the heterogeneity in COPD. The widespread adoption of electronic health records (EHRs) has led to the rapid accumulation of large amounts of patient data as part of routine clinical care. However, it is unclear whether the implementation of ML in EHR-derived data has the potential to identify subgroups of AECOPD. Determine whether ML implementation using EHR data from severe AECOPD requiring hospitalization identifies relevant subgroups. This study used two retrospective cohorts of patients with AECOPD (non-COVID-19 and COVID-19) treated at Yale-New Haven Hospital (YNHHS). K-means clustering was used to identify patient subgroups. We identified three subgroups in the non-COVID cohort (n=1,736). Each subgroup had distinct clinical characteristics. The reference subgroup was the largest (n=904), followed by cardio-renal (n = 548) and eosinophilic (n=284). The eosinophilic subgroup had milder severity of AECOPD, including a shorter hospital stay (p<0.01). The cardio-renal subgroup had the highest mortality during (5%) and in the year after hospitalization (30%). Validation of the severe AECOPD classifier in the COVID-19 cohort recapitulated the characteristics seen in the non-COVID cohort. AECOPD subgroups in the COVID-19 cohort had different IL-1 beta, IL-2R, and IL-8 levels (FDR ≤ 0.05. These specific leukocyte and cytokine profiles resulted in inflammatory differences between the AECOPD subgroups based on C-reactive protein levels. Incorporating ML with EHR-data allows the identification of specific clinical and biological subgroups for severe AECOPD.

Distinct lower respiratory tract microbiota profiles linked to airway mucus hypersecretion in children with Mycoplasma pneumoniae pneumonia.

Airway mucus hypersecretion (AMH) can occur in children with acute respiratory diseases, but its underlying mechanisms and relationship with the lower respiratory tract microbiota (LRTM) are not yet fully understood. This study investigates the characteristics of LRTM in children with Mycoplasma pneumoniae pneumonia (MPP) and its impact on AMH. We collected bronchoalveolar lavage fluid and related clinical indicators from 202 children with MPP. 16S rRNA gene amplicon sequencing was used for detection and identification. Microbial diversity and characteristic genera were compared, and their abundance was analyzed for correlations with clinical factors. As the disease course (days from onset to bronchoscopy, grouped into T1, T2, T3) extended, α-diversity of the LRTM gradually increased, particularly in the T3 hypersecretion group. Moreover, significant differences were observed in the incidence of AMH, co-infection rates, peripheral white blood cell (WBC) count, and C-reactive protein levels. In AMH, Mycoplasmoides and Veillonella abundance and peripheral neutrophils were risk factors for increased secretions. In addition, in the T3 co-infection group, Streptococcus and Prevotella increased, replacing Stenotrophomonas as the dominant genus, possibly due to β-lactam antibiotic use. Prevotella abundance was strongly correlated with WBC. The composition and structure of LRTM in children with MPP played a crucial role in AMH and disease progression.

Therapeutic effect of Micro-Implant Anchorage in orthodontics

Objective: Micro implant anchorage (MIA), as a new orthodontic treatment technique, has the characteristics of simple operation, light trauma, and high stability, and has been widely used in clinical practice. This study compared the therapeutic effects of MIA and the traditional straight wire appliance (SWA) in orthodontic practice. Methods: Clinical data of 119 patients who underwent orthodontic treatment in Yulin First Hospital from January 2022 to January 2023 were retrospectively analyzed. According to the treatment records, 61 patients received MIA orthodontic treatment (MIA group), and 58 patients received traditional straight wire appliance (SWA) orthodontic treatment (SWA group). Treatment effect, periodontal index, and levels of osteoprotegerin (OPG), interleukin-6 (IL6) and high-sensitivity C-reactive protein (hsCRP) of the two groups were compared. Results: The total efficacy of MIA group was significantly higher than that of SWA group (P&lt;0.05). After the treatment, bleeding index (BI), plaque index (PLI), probing depth (PD) and looseness in the MIA group were significantly lower than those in the SWA group (P&lt;0.05). After the treatment, levels of OPG were significantly higher, while IL6 and hsCRP levels were significantly lower in the MIA compared to the SWA group (P&lt;0.05). MIA was associated with significantly lower complication rate compared to the SWA (P&lt;0.05). Conclusions: Compared with SWA, MIA is associated with better orthodontic effect. This mode of treatment can increase OPG levels, reduce inflammation, and lower the risk of complications. doi: https://doi.org/10.12669/pjms.40.10.10442 How to cite this: Shi Y, Mi L, Liu J, Liu X, Hao Y. Therapeutic effect of Micro-Implant Anchorage in orthodontics. Pak J Med Sci. 2024;40(10):2293-2298. doi: https://doi.org/10.12669/pjms.40.10.10442 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Extracorporeal Photopheresis with 5-Aminolevulinic Acid in Crohn's Disease-A First-in-Human Phase I/II Study.

Background/Objectives: With the increasing prevalence of Crohn's disease (CD), treatment options for patients who fail conventional and advanced therapy are highly needed. Therefore, we explored the safety and efficacy of extracorporeal photopheresis (ECP) using 5-aminolevulinic acid (ALA) and blue light (405 nm). Methods: Patients with active CD who failed or were intolerant to biological therapy were eligible. Mononuclear cells (90 mL) were collected from each patient using a Spectra Optia® apheresis system and diluted with 100 mL of 0.9% sodium chloride in a collection bag. The cells were incubated with ALA at a concentration of 3 millimolar (mM) for 60 min ex vivo and illumination with an LED blue light (405 nm) source (BLUE-PIT®) before reinfusion to the patient. Recording of vital signs and adverse events were regularly performed. At week 13, we assessed the patients with colonoscopy, the Harvey Bradshaw Index (HBI), the Inflammatory Bowel disease Health Related Quality of Life Questionnaire, and the measurement of serum C-reactive protein and fecal calprotectin (FC) levels. Biopsies of the intestines were taken for immunohistochemistry. Results: Seven patients were included. Four patients completed the treatments, with a total of 24 treatments. Three of the four patients achieved a favorable response, including a lower HBI, lower FC levels, and/or endoscopic improvement. No significant adverse events were observed. The remaining three patients received only one, three, or five treatments due to technical difficulties, medical reasons, or the withdrawal of informed consent. Conclusions: ALA-based ECP appears safe and seems to give some clinical improvement for the patients with active CD who failed to respond to conventional and advanced therapies.

Effectiveness of switching to subcutaneous infliximab in inflammatory bowel disease patients with inadequate biochemical response during intravenous administration

Infliximab (IFX) has transformed the management of inflammatory bowel diseases (IBD). While intravenous (IV) IFX has been effective, a subcutaneous (SC) formulation offers advantages in convenience and cost. However, there is lack of evidence regarding the transition from IV to SC-IFX, especially for patients with inadequate responses. This study investigates the effectiveness of switching from IV to SC-IFX in patients with inadequate responses during IV maintenance therapy. A retrospective study enrolled IBD patients who transitioned to SC-IFX after demonstrating inadequate responses during IV maintenance therapy. The study collected data of demographics of patients and dose and therapies administered prior to the IV-IFX. Primary outcomes included improvements in C-reactive protein (CRP) or fecal calprotectin (FC) levels. This study evaluated the trough levels and its differences between pre- and post-switching. Among 44 patients included, 10 exhibited CRP elevation before the switch, with 6 showing normalization post-switch. Similarly, 42 patients had elevated FC levels pre-switch, with 26 experiencing reductions post-switch. Trough levels increased after the switch. However, there were no significant differences between responders and non-responders. This study is the first study to investigate the transition therapy of IV to SC-IFX in patients with inadequate response. This suggests that SC-IFX could be a viable alternative in the management of IBD. However, further research is necessary to evaluate its efficacy in a larger population of patients who exhibit inadequate responses during IV-IFX maintenance therapy.

Unmasking bocavirus: is it a co-infectious agent or an actual respiratory pathogen?

ABSTRACT Objectives Although human bocavirus (HBoV) is primarily linked to respiratory tract infections, its exact role as a respiratory pathogen remains unclear. This study aims to investigate HBoV detection rates, as well as clinical, laboratory, microbiological, and radiological characteristics, length of stay in the emergency department (ED), rate of hospitalization, and severity of illness in cases where HBoV is detected in respiratory secretions. Methods We conducted a retrospective analysis of all consecutive patients under 18 years who visited a large-volume tertiary pediatric ED from January to December 2023 and tested positive for HBoV in their respiratory viral panel (RVP). Results Among the 14,315 patients who underwent RVP testing during the study period, 591 (4%) tested positive for HBoV. After excluding those with incomplete data, 528 patients (57% male) were included in the analyses. The median age was 2.8 [1.2–4.9] years. The most common symptoms were cough (67%), fever (58%), runny nose/nasal congestion/sore throat (34%), and respiratory distress (24%). Thirty percent of the patients had a history of antibiotic use before admission. Thirteen percent of the patients had at least one chronic illness. Co-infection with HBoV occurred in 37% of the patients, with respiratory syncytial virus (RSV) being the most frequently co-detected virus (45%). Lymphopenia was documented in 12% of patients, and 36% had elevated C-reactive protein levels (median 21 [12–38] g/dl). Abnormal chest X-rays were noted in 85% of patients. The management approach included outpatient care for more than half of the patients (69%). Clinical severity was classified as high in 11% of patients (n = 60), necessitating ICU admission. Conclusion Although typically mild, HBoV infections can escalate to severe respiratory illnesses, requiring respiratory support and intensive care.

Association of fish intake with all-cause mortality according to CRP levels or inflammation in older adults: a prospective cohort study

BackgroundThe relationship between inflammatory response, fish consumption, and mortality risk in older individuals is unclear. We investigated whether C-reactive protein (CRP) levels ≥ 0.1 mg/dL, fish intake, and inflammatory responses are associated with all-cause mortality risk in older adults.MethodsThis prospective cohort study included older adults aged 85–89 years from the Kawasaki Aging and Wellbeing Project, who did not require daily care. Cohort was recruited from March 2017 to December 2018 (follow-up ended on December 31, 2021). Dietary assessment was conducted using the Brief Self-Administered Diet History Questionnaire. Multivariate Cox proportional hazards regression was used to estimate the hazard ratio (HR) and 95% confidence interval (CI) for all-cause mortality in the CRP ≥ 0.1 mg/dL group; the CRP < 0.1 mg/dL group was used for reference. Within CRP ≥ 0.1 and < 0.1 mg/dL groups, participants were categorized into tertiles of fish intake. HRs and 95% CIs for all-cause mortality in the other groups were estimated using the lower tertile group as a reference.ResultsThe study included 996 participants (mean [standard deviation] age, 86.5 [1.37] years; 497 [49.9%] women) with a median CRP level of 0.08 (interquartile range [IQR] = 0.04–0.16). There were 162 deaths during 4,161 person-years of observation; the multivariable-adjusted HR for all-cause mortality in the CRP ≥ 0.1 mg/dL group was 1.86 (95% CI, 1.32–2.62); P < 0.001. In 577 individuals with median (IQR) fish intake of 39.3 g/1000 kcal (23.6–57.6) and CRP level of < 0.1 mg/dL, the multivariable-adjusted HR for all-cause mortality in the higher tertile group of fish intake was 1.15 (0.67–1.97); P = 0.59, non-linear P = 0.84. In 419 individuals with median (IQR) fish intake of 40.7 g/1000 kcal (25.0–60.1) and CRP level of ≥ 0.1 mg/dL, the multivariate-adjusted HR for all-cause mortality in the higher tertile group of fish intake was 0.49 (0.26–0.92); P = 0.026, non-linear P = 0.38, P-value for interaction = 0.040.ConclusionsA negative association between fish intake and all-cause mortality was seen in older adults with elevated CRP levels, which is a mortality risk factor. While the results may be limited owing to stringent methods ensuring impartiality, they offer valuable insights for future research.Trial registrationUMIN000026053. Registered February 24, 2017.

Circulating Baseline CXCR3+Th2 and Th17 Cell Proportions Correlate With Trabecular Bone Loss After 48 Weeks of Biological Treatment in Early Rheumatoid Arthritis.

The high prevalence of osteoporosis in rheumatoid arthritis (RA) is due to inflammation that stimulates differentiation of osteoclasts, a process involving circulating monocytes and T cell-derived factors. The aim of this study was to evaluate relations between circulating monocytes, T cell subsets, and changes in bone characteristics before and after treatment with biological disease-modifying antirheumatic drugs (bDMARDs) in RA. Thirty patients with untreated early RA who met the American College of Rheumatology/EULAR 2010 criteria were included. Data were collected before and 48 weeks after treatment with methotrexate (MTX) together with one of three bDMARDs (abatacept, tocilizumab, or certolizumab pegol). Disease activity was measured using the Clinical Disease Activity Index, swollen or tender joint counts, C-reactive protein levels, and erythrocyte sedimentation rates. Proportions of monocyte and CD4+ T cell subsets in blood samples were analyzed by flow cytometry. Bone densitometry was performed using high-resolution peripheral quantitative computed tomography (HR-pQCT). HR-pQCT revealed an overall decrease in cortical (P = 0.009) and trabecular (P = 0.034) bone mineral density, although a subset of patients showed no bone loss after 48 weeks of treatment. The overall bone loss was not associated with age, body mass index, sex, intraarticular glucocorticoid injections, or baseline disease activity. Loss of trabecular bone volume fraction correlated with high proportions of circulating CXCR3+Th2 cells (r = -0.38, P = 0.04) and CXCR3+Th17 cells (r = -0.36, P = 0.05) at baseline. Similarly, no loss of trabecular bone volume fraction correlated with high proportions of regulatory T cells (r = 0.4, P = 0.03) at baseline. However, the associations were not significant when corrected for confounders and multiple testing. MTX together with bDMARDs efficiently reduce disease activity but only prevent bone loss in a subset of patients with RA after 48 weeks of treatment. The correlations of circulating baseline T helper cell and regulatory T cell populations with trabecular bone changes suggest a potential novel role for these cells in systemic bone homeostasis during early RA.

Effect of fasting-induced headache on calcitonin gene related peptide (CGRP) and other clinical biomarkers on the first day of Ramadan: Sub-analysis from a randomized open label clinical trial

BackgroundFasting-induced headaches (FIHs) have been shown to occur on the first day of Ramadan and clearly decline thereafter. Despite the wealth of knowledge about different types of headaches (e.g., migraine-, cluster-, and tension-type headaches), research on the mechanism underlying FIHs, as well as their treatment, remains scarce. Our study aimed to investigate any association between FIHs during the first day of Ramadan and potential headache-related biomarkers, including fasting blood glucose (FBG), C-reactive protein (CRP), magnesium, vitamin B9, vitamin B12, homocysteine, and calcitonin gene related peptide (CGRP), and to assess whether a prophylactic use of paracetamol may influence these biomarkers.MethodsAs part of a randomized, open-label clinical trial that evaluated the effect of paracetamol as a prophylactic therapy for FIH, blood samples from stratified subjects in the prophylaxis and control groups were withdrawn while fasting after the 1st dose of paracetamol (in the prophylaxis group) and prior to reporting headache occurrence.ResultsPlasma and serum were separated for 61 subjects; 31 and 30 subjects from the prophylaxis and control groups, respectively. Overall, no significant differences were found in the levels of FBG, CRP, magnesium, vitamin B9, and vitamin B12 in headache-suffering subjects compared to those without headache despite the use of paracetamol for prophylaxis. Homocysteine, however, was significantly reduced in all subjects who experienced FIH compared to those without headache (median 6.9 [1.6] vs. 7.7 [2.7] umol/L; p = 0.041). On the contrary, when the CGRP was measured using immunoassay, it was found to be significantly elevated in all headache-suffering subjects compared to those without headache (median 126.1 [17.7] vs. 105.8 [19.6] pg/mL; p ≤ 0.0001). This difference was maintained upon comparing the headache to non-headache subjects in both the prophylaxis (median 121.5 [15.4] vs. 105.8 [9.4] pg/mL; p < 0.01) and control groups (median 128.5 [28.3] vs. 105.8 [23.8] pg/mL; p < 0.01). Additionally, an elevated CGRP level was found to increase the odds of having a FIH [OR = 1.32; 95%CI 1.06–1.22].ConclusionsOur findings revealed the role of CGRP in FIHs for the first time and suggest further investigation in signaling pathways downstream CGRP receptors. Furthermore, the modulation CGRP or CGRP receptors could have a clinical application in the prevention of FIHs.Trial registrationThis study was registered with the Saudi Food and Drug Authority in the Saudi Clinical Trials Registry (SCTR; No. 22122102).