Mean C-reactive Protein Levels Research Articles

C-Reactive Protein Levels After Esophagectomy are Associated with Increased Surgical Complications and Poor Prognosis in Esophageal Squamous Cell Carcinoma Patients.

C-reactive protein (CRP) levels are reported to predict complications and survival after surgery in various cancers. However, the relationship between postoperative CRP levels and short- and long-term outcomes of esophageal squamous cell carcinoma (ESCC) patients after esophagectomy is unclear. We reviewed the records of 543 ESCC patients who underwent subtotal esophagectomy with gastric conduit reconstruction at Kumamoto University Hospital between August 2010 and July 2021. Blood tests for CRP were done on postoperative days (PODs) 1, 3, 5 or 6, and 7 or 8. The mean CRP levels on day 1, day 3, day 5/6, and day 7/8 were 6.68±0.13 mg/dL, 11.49±0.27 mg/dL, 7.48±0.26 mg/dL, and 5.38±0.22 mg/dL, respectively. Mean CRP levels were highest on day 3, and CRP levels after day 3 correlated with grade >2 complications based on the Clavien-Dindo classification. Receiver operating characteristic curve analysis established the optimal cut-off value for CRP day 3 levels to be 12.19 mg/dL. Multivariate logistic regression analyses found that high CRP day 3 levels significantly correlated with grade >2 complications (odds ratio [OR] 3.77, 95% confidence interval [CI] 2.56-5.35; p<0.001). Moreover, high day 7/8 CRP levels (>3.52) correlated with postoperative survival, and based on multivariate logistic regression analyses, were significantly associated with poor prognosis (hazard ratio 1.67, 95% CI 1.14-2.43; p = 0.008). Our findings suggest CRP day 3 levels as a potential biomarker for predicting postoperative complications and that CRP day 7/8 levels have potential prognostic value for ESCC patients after esophagectomy.

Lipoprotein (a) variability is associated with mean follow-up C-reactive protein in patients with coronary artery disease following percutaneous coronary intervention.

Increased lipoprotein (a) [lp (a)] has proinflammatory effects, which increase the risk of coronary artery disease. However, the association between lp (a) variability and follow-up C-reactive protein (CRP) level in patients undergoing percutaneous coronary intervention (PCI) has not been investigated. To explore the association between lp (a) variability and mean CRP levels within the 1st year post-PCI. Results of lp (a) and CRP measurements from at least three follow-up visits of patients who had received PCI were retrospectively analyzed. Standard deviation (SD), coefficient of variation (CV), and variability independent of the mean (VIM) are presented for the variability for lp (a) and linear regression analysis was conducted to correlate lp (a) variability and mean follow-up CRP level. The relationship of lp (a) variability and inflammation status was analyzed by restricted cubic spline analysis. Finally, exploratory analysis was performed to test the consistency of results in different populations. A total of 2712 patients were enrolled. Patients with higher variability of lp (a) had a higher level of mean follow-up CRP (P < 0.001). lp (a) variability was positively correlated with the mean follow-up CRP (SD: β = 0.023, P < 0.001; CV: β = 0.929, P < 0.001; VIM: β = 1.648, P < 0.001) by multivariable linear regression analysis. Exploratory analysis showed that the positive association remained consistent in most subpopulations. Lp (a) variability correlated with mean follow-up CRP level and high variability could be considered an independent risk factor for increased post-PCI CRP level.

Determined the Frequency of Neurosurgeries Canceled Due to the Asymptomatic COVID-19 in the Patients

Background: The COVID-19 pandemic has caused severe complications, deaths, and damage to societies, and the disease course is unpredictable and ranges from asymptomatic infections to multi-organ failure and death. Objectives: The present study determined the frequency of neurosurgeries canceled owing to the asymptomatic COVID-19 in the patients. Methods: The present study was descriptive-analytical and was conducted on all neurosurgeries in Kashani hospital, Isfahan, Iran in 2021. Moreover, 116 (52.5%) out of 2100 neurosurgeries were canceled, among which 41 cases (35.4%) were related to asymptomatic COVID-19. The necessary data were extracted from the information in the patients’ medical files and were included in the data collection forms. The data were analyzed in SPSS 22 after collection. Results: Among 41 people, whose neurosurgery was canceled, 7 had asymptomatic COVID-19 with few or mild symptoms, and 34 were asymptomatic. The patients of the two groups with asymptomatic and symptomatic COVID-19 were significantly different in age, albumin level, C-reactive protein, and serum creatinine (P&lt;0.05) as the mean age, albumin, and C-reactive protein levels were lower, and serum creatinine was higher in the group of patients with asymptomatic COVID-19. Conclusion: The prevention of asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections played a crucial role in the unhindered transmission of this virus and was the turning point in controlling the pandemic.

C-reactive protein and drain amylase: their utility in ruling out anastomotic leakage after minimally invasive Ivor-Lewis esophagectomy

Introduction Anastomotic leakage (AL) is one of the most feared complications after esophagectomy for esophageal cancer. We investigated the role of serum C-reactive protein (CRP) and drain amylase levels in the early detection of AL. Methods This is a retrospective study of 193 patients who underwent a minimally invasive Ivor-Lewis procedure between January 2017 and October 2021. Mean CRP and median drain amylase levels between patients with and without AL were compared during the first five postoperative days (POD). ROC curves on POD 3, 4 and 5 were plotted to calculate cut-off values for CRP. Results In 30 of the 193 patients (16%), AL was diagnosed with a median time to diagnosis of 9 days. Mean CRP was significantly higher in patients with AL on POD 3, 4 and 5. Cut-off values of 59, 110 and 106 mg/L had a high sensitivity of 93%, 90% and 90% on POD 3, 4 and 5. No difference in median drain amylase levels was observed. Conclusions CRP levels with a cut-off point of 110 mg/L on POD 4 do not improve earlier detection of AL, but have a high sensitivity for excluding AL. The value of drain amylase in the first 5 days after surgery is limited.

Inflammatory Mediators (CA125, CRP) and Uric Acid in Association with Severity of Preeclampsia in North Kordofan State, Western Sudan

Introduction: Inflammatory mediators could be laboratory markers of preeclampsia, as the induction of an inflammatory process within the placenta may trigger the expression of cancer antigen 125(CA125), C-reactive protein (CRP) and uric acid (UA). Regarding the pathophysiology of pre-eclampsia, there is defective trophoblastic invasion of uteroplacental blood vessels that leads to placental ischemia, and induction of an inflammatory process within the placenta.&#x0D; Objective: To evaluate the association of serum levels of cancer antigen (CA125), C-reactive protein (CRP) and serum uric acid with the Severity of Preeclampsia.&#x0D; Materials and Methods: The study recruited 200 singleton Sudanese pregnant women. These participants were divided into two groups: control (n = 100) and cases (n = 100). The cases were further subdivided into; mild preeclampsia (n =46), and severe preeclampsia (n = 54). The study groups were well-matched in maternal age, gestational age and body mass index. Blood samples were taken for measurement of serum cancer antigen-CA125, uric acid and C - reactive protein using immune- assay and enzymatic automated chemical analysis.&#x0D; Results: The mean levels of cancer antigen-CA125 in mild and severe preeclampsia groups were; 21.94±5.08 (IU/ml) and 40.77±9.82 (IU/ml) respectively, which were significantly higher, (P&lt;0.001) in comparison with the control group (16.88±7.36 (IU/ml). The mean levels of C-reactive protein in mild and severe preeclampsia were; 15.17±5.35 (mg/L), 31.49±12.56 (mg/L) respectively. There was significant difference in their levels, compared to the control group (4.79±1.78 (mg/L), (P&lt;0.01). Also, the mean levels of uric acid in mild and severe cases were; 6.44±1.98 and 7.37±2.00 which was significantly higher, in comparison with the control (4.00±0.61); (P&lt;0.001). The level of uric acid also, showed significant difference within the case (severe and mild) group (P&lt;0.05). CA125, CRP and UA level‎s correlated positively with Mean Arterial blood pressure (MAP), (r&gt;0.7; P &lt; 0.001). ROC curve validate the utility of these biomarker for the detection of preeclampsia severity (AUC&gt;0. 8; P &lt; 0.001).&#x0D; Conclusion: Serum cancer antigen 125(CA125), C- reactive protein and uric acid in studied preeclampsia groups were found to be significantly higher compared with the control group, and the rises were directly associated with the severity of preeclampsia.

Immune markers and microbial factors are related with periodontitis severity in people with HIV

ObjectiveThe objective of the study is to assess systemic immune markers and microbial factors related to periodontitis severity in people living with HIV.MethodsEighty people living with HIV (PLWH), who exhibited in the last two viral load measurements < 40 copies/mL, underwent full-mouth periodontal examinations and sub-gingival plaque sampling. Periodontitis was classified according to the CDC-AAP case definition. Inflammation, immune-activation, and immunosenescence markers were assessed, microbiological analyses were performed, and oral care routines and HIV characteristics were noted.ResultsFrom our group of PLWH, 42.5% and 57.5% suffered from moderate and severe periodontitis, respectively. Oral care habits did not differ between PLWH with moderate and severe periodontitis. Bacterial subgingival plaque loads were higher, and Porphyromonas gingivalis was more prevalent in PLWH with severe periodontitis than with moderate periodontitis (53% vs 7%, respectively). Mean C-reactive protein levels [CRP, 1.6 mg/L versus 0.8 mg/L, p = 0.020] and percentages of senescent CD28-CD57 + CD8 + T-cells in peripheral blood [16.5 versus 8.9, p = 0.035] were higher with severe periodontitis. Infection duration, CD4 count, CD4/CD8 ratio and type of antiretroviral therapy did not differ between both groups.ConclusionsPeriodontitis severity is related to increased prevalence of Porphyromonas gingivalis, elevated CRP levels, and higher frequencies of circulating CD8 + senescent cells in PLWH.

Association of C-Reactive Protein (CRP) with Bipolar Disorder &amp; Gender

Background: Bipolar disorder (BD) is a mental disorder with mood swings that fluctuate between mania, hypomania, and depression. C-reactive protein (CRP) levels in bipolar patients have been studied across the globe, but the results are variable. A very limited research has been conducted in this area in Pakistan. Therefore, the goal of the current investigation was to evaluate CRP in bipolar illness. Moreover any link between CRP and gender was also investigated. Materials and methods: In this cross-sectional study, 112 subjects (82 bipolar patients and 30 controls) were included. The patients were randomly selected from Punjab Institute of Mental Health (PIMH) and Sheikh Zayed Hospital, Lahore. After the consent of the subjects, venous blood samples were collected. CRP levels were semi-quantitatively estimated by agglutination method. The data obtained was analyzed through SPSS. Results: The difference in the mean CRP level among bipolar and control groups was statistically significant (p = 0.001). Moreover, males had higher CRP levels than females but the difference was non-significant (p=0.134). Comparison of CRP levels among various stages of BD and control showed a significant difference between the groups (p=0.009). Increased CRP levels give an idea about the inflammation and severity of the disease. CRP levels could be of help in the diagnosis and prognosis of BD. Conclusions: The present study suggests a significant association of CRP with bipolar disorder. No significant relation of CRP and gender was depicted. Keywords: Bipolar Disorder, C-reactive protein, Gender

Predictors and characteristics of post-acute COVID-19 syndrome in healthcare workers

Background Post-acute COVID-19 syndrome (PCS) is a multisystem disorder degrading the quality of life. The study determined characteristics and predictors of PCS in unvaccinated healthcare workers (HCWs) suffering from PCS based on a comparison with their fully recovered counterparts. Methods 305 HCWs were examined at least 12 weeks post COVID-19 symptom onset to obtain data about their acute phase of COVID-19 and current health status and tested for complete blood count, C-reactive protein (CRP), electrophoresis of plasma proteins and SARS-CoV-2-specific immunoglobulin (Ig) G and M. Results 181 (59.3%) HCWs reported persisting symptoms attributable to PCS during the examination and 124 (40.7%) HCWs stated no symptoms. In the entire sample, the mean CRP level slightly exceeded the normal range (6.63 mg/L, 95% confidence interval [CI] 5.96–7.3) while all other laboratory results were within the normal range. No statistically significant differences in laboratory results were revealed between both subgroups except for the mean Ig levels, which were higher in HCWs with PCS. The average number of symptoms of PCS was 1.9 (median 2). The most frequent symptoms of PCS were fatigue that interfered with daily life (47.5%), shortness of breath (38.1%), muscle or joint aches (16%), loss of smell (14.9%), headache (14.9%) and sleep disorders (11%). The only statistically significant predictors of PCS were female sex (odds ratio [OR] 1.48, 95% CI 1.059–2.067, p = .022) and increasing age (OR 1.04, 95% CI 1.01–1.07, p = .008). Conclusions PCS appears to be a prevalent condition determined by female sex and increasing age.

S100 Predictors of Need of Surgery in Patients With Acute Necrotic Collections Treated With Percutaneous Drainage

Introduction: Percutaneous drainage (PCD) is an important initial component of the “step-up” treatment strategy for the management of infected acute necrotic collections consequent to acute necrotizing pancreatitis (ANP). However, PCD alone has a high failure rate and these patients require additional necrosectomy. Delaying necrosectomy can increase morbidity and mortality and therefore, timely intervention is important. Identifying predictors of failure of percutaneous therapy can help in making timely management decisions. In this prospective single-center study, we attempted to identify predictors of failure of PCD in patients with infected ANC. Methods: Twenty-one patients (males:13, mean age:36.05years) (etiology: ethanol-related 47.6% (10/21), GSD related 28.6% (6/21) unknown19% (4/21) PEP 4.8% (1/21)) admitted with infected ANC who were treated with step-up strategy of initial PCD followed by endoscopic or surgical necrosectomy in non-responders were enrolled and studied prospectively. We studied the association between the success of PCD (survival without necrosectomy) & baseline clinical and investigational parameters including etiology, severity scores, C-reactive protein (CRP), computed tomography severity indices (CTSI), and PCD parameters (size of catheter & timing). Results: Nine (42.8%) patients with infected ANC were successfully treated with PCD alone whereas 12 (57.2%) patients either underwent necrosectomy or succumbed to the illness. The frequency of males was significantly higher (83.3% vs 33.33%) in the PCD failure group(p=0.03). The PCD was inserted later in the failure group as compared to the successful group (mean day of insertion of PCD being 20.5 days vs 15.1 days respectively; p=0.023). The mean SIRS score at admission (2.92 vs 2.33; p=0.102) & at 48 hours (3.5 vs 2.89; p=0.12), mean APACHE-II score (7.8 vs 7.0; p=0.508), mean ferritin levels (2916.9 vs 1033.4ng/mL; p= 0.394), and mean CRP levels (249.5 vs 209.6ng/mL; p=0.508.) were higher in the PCD failure group but did not reach statistical significance. The corrected calcium levels were lower(8.3 vs 9.0gm/dL p=0.069) in the PCD failure group. Also, the mean diameter of PCD catheters was more in the success group but the difference was not statistically significant (16.2 vs 14.7F; p=0.277). (Table) Conclusion: Male gender & delayed insertion of PCD seem to be associated with failure of PCD alone in patients with infected necrotic collections. Table 1. - Comparison of parameters between PCD Success and PCD Failure Group Parameter PCD Success group n=9 PCD failure group n=12 P Value Age 37.3±7.5yrs 36.8±13.4yrs 0.65 Males 3(33.33%) 10(83.33%) 0.03 BMI 24.5±4.3Kg/m2 22.4±3.8kg/m2 0.22 TLC 13871±6616.1/mm3 15014.2±7818.6/mm3 0.862 Platelet Count 321666.7±187813.7/mm3 304350.0±155671.1/mm 0.972 Ferritin Level 1033.4±628.2ng/mL 2916.9±2961.8ng/mL 0.394 Corrected Calcium 9.0±0.3gm/dL 8.3±1.2gm/dL 0.069 qCRP Levels 209.6±95.9mg/L 249±107.1mg/L 0.508 SIRS At admission 2.33±0.5 2.92±1.0 0.10 At 48hrs 2.89±0.93 3.50±0.52 0.12 APACHE-II 7.0±3.0 7.8±8.0 0.51 MMS 1.4±0.9 1.7±1.8 0.70 BISAP 2.1±0.3 2.3±0.8 0.55 Size of largest collection on CT 10.3±4.34cm 11.15±3.42cm 0.81 CTSI Score 7.3±2.5 7.8±2.5 0.65 mCTSI Score 8.7±1.7 9.2±1.3 0.60 Day of PCD placement 15.1±4.9 20.5±3.9 0.02 Size of largest PCD in the French scale 16.2±3.1 14.7±4.2 0.28

Choroidal ischemia as one cardinal sign in giant cell arteritis

PurposeTo describe chorioretinal signs in a case series of Giant Cell Arteritis (GCA).MethodsThis is a multicenter retrospective observational case series with GCA that presented with a headache and an abrupt, unilateral loss in vision. Workup included temporal artery biopsies, intravenous fluorescein angiography, optical coherence tomography (OCT), optical coherence tomography angiography (OCTA), blood levels of erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP).ResultsThere are a total of 8 GCA instances presented. Average age was 74.5. (Range 68–83 years). The patients reported that one eye's visual loss had suddenly started, along with a fresh headache and other systemic symptoms. Eight patients exhibited choroidal ischemia, five paracentral acute middle maculopathy (PAMM) lesions, five cotton wool spots, four anterior ischemic optic neuropathy, and one central retinal arterial occlusion at the time of presentation. The average ESR at presentation was 68 mm/hr (range 4–110), and 4/6 individuals had a significant increase. The mean CRP level was 6.2 mg/dL (range 2.0–15.4), and the level was always over the normal range. All patients' temporal artery biopsies were positive.ConclusionAlongside PAMM lesions, cotton wool spots, anterior ischemic optic neuropathy, and central retinal artery occlusion, choroidal ischemia is a key angiographic indicator in the diagnosis of GCA. It may be crucial to recognize these typical ischemic chorioretinal signs while diagnosing GCA.

Elevation of C-reactive protein in adolescent bipolar disorder vs. anxiety disorders

Bipolar disorder (BD) largely begins in adolescence, but diagnosis lags for years, causing significant morbidity and mortality, and demonstrating the need for better diagnostic tools. Suggesting an association between BD and immune activity, elevated levels of peripheral inflammatory markers, including C-reactive protein (CRP), have been found in adults with BD. As similar data are extremely limited in adolescents, this study examined CRP levels in adolescents with BD (n = 37) compared to those with anxiety disorders (ADs, n = 157) and healthy controls with no psychiatric diagnoses (HCs, n = 2760). CRP blood levels for patients aged 12–17 years were retrieved from a nationwide repository of deidentified clinical data. After excluding patients with inflammatory conditions, differences in CRP were examined using multivariate and weighted regressions (covariates: demographics and BMI). Mean CRP levels were significantly elevated in adolescents with BD relative to those with ADs and HCs. Mean CRP levels were lower in the ADs cohort versus HCs. Although CRP levels were significantly higher in males and younger patients, the significant between-cohort differences in CRP remained after controlling for multiple confounders. To our knowledge, our study is the first to compare CRP levels between adolescent BD, ADs, and HCs, comprising a novel and essential contribution. Our results suggest the presence of a unique immune process in adolescents with BD and indicate that CRP may represent a biomarker with a crucial role in the diagnostic assessment of adolescent BD.

Malnutrition-Inflammation complex syndrome in Libyan patients with end-Stage renal disease at Hun-Aljufrah

Malnutrition and inflammation complex syndrome in ESRD Patients on maintenance Hemodialysis therapy remains the most common cause of morbidity and mortality characterized by alteration in the structural and functional ability of plasma proteins. The aim of this study was to assess the serum level of albumin, BMI and hs-CRP as a marker of Malnutrition-Inflammation Complex Syndrome. This is a case-control study conducted at Alafia Hospital Hun-Aljufrah from December 2014 to December 2015. Libyan patients with ESRD who routinely attend to dialysis center at the above-mentioned hospital during the period of the study were randomly recruited for this study. The study included one hundred ESRD and one hundred age and sexmatched healthy controls. The patients’ information such as age, sex, height, weight, and clinical history were recorded. Blood samples (6 ml) were collected from patients in plain and EDTA containers from which EDTA and Serum samples were separated. The results of our study showed that there were significant decrease in the mean serum level of albumin (3.12±0.39) (p. value=0.000) and BMI (20.3±5.5) (p. value=0.000) as well as significant increase in the mean serum level of serum C-reactive protein (20.13±5.704) (p. value=0.000) in case group when compared to the control group. The DOT Blot Correlation test showed that there was a significant negative correlation between hs-CRP with albumin (r= -0.812, p=0.02). In conclusion, the significant decreased in the mean level of serum albumin and BMI, as well as the significant increase in the mean level of serum C-reactive protein among hemodialysis ESRD patients, might place them at risk of developing Malnutrition-Inflammation Complex Syndrome in the future. The significant negative correlation between serum albumin with hsCRP support the facts systemic inflammation is the main cause of malnutrition and cardiovascular disease in ESRD patient.

The role of ACE1 I/D and ACE2 polymorphism in the outcome of Iranian COVID-19 patients: A case-control study.

Background: Since the beginning of the pandemic of coronavirus disease 2019 (COVID-19), many countries have experienced a considerable number of COVID-19 cases and deaths. The etiology of a broad spectrum of symptoms is still debated. Host genetic variants might also significantly influence the outcome of the disease. This study aimed to evaluate the association of angiotensin-converting enzyme (ACE1) gene Insertion/Deletion (I/D) polymorphism (rs1799752) and ACE2 gene rs1978124 single nucleotide polymorphism with the COVID-19 severity. Methods: This study was conducted on 470 COVID-19 patients and a control group of 56 healthy individuals across several major cities in Iran. The blood sample and clinical data were collected from the participants, and their ACE1 I/D and ACE2 rs1978124 polymorphisms were determined using polymerase chain reaction and PCR-RFLP, respectively. Serum levels of C-reactive protein (CRP), interleukin 6 (IL-6), and ACE1 were measured in the blood samples. Results: We found that the ACE1 DD genotype frequency was inversely correlated with the risk of intubation (p = 0.017) and mortality in COVID-19 patients (p = 0.049). Even after adjustment, logistic regression demonstrated that this significant inverse association remained constant for the above variables at odds ratios of (OR) = 0.35 and Odds Ratio = 0.49, respectively. Also, in the expired (p = 0.042) and intubated (p = 0.048) groups with II + ID genotypes, the mean level of CRP was significantly higher than in the DD genotype group. Furthermore, in both intubated and expired groups, the mean serum level of ACE1 was higher compared with non-intubated and survived groups with II or II + ID genotypes. The results also indicated that ACE2 rs1978124 TT + CT genotypes in females have a significant positive role in susceptibility to COVID-19; however, in females, the TT + CT genotypes had a protective effect (OR = 0.098) against the severity of COVID-19. Conclusion: These findings suggest that ACE1 I/D and ACE2 rs1978124 polymorphism could potentially influence the outcome of COVID-19 in the Iranian population.

Comparative Evaluation of C-reactive Protein In Pregnant Women with or Without Periodontitis: A Randomized Control Trial

Background: Serum C-reactive protein (CRP) is non-specific in nature and is seen to be associated with adverse pregnancy outcomes. Thus we aim to compare serum CRP levels in pregnant women with and without periodontitis. &#x0D; Methods: A total of 222 pregnant women aged between 18-45 years were recruited in study and divided into two groups Group A:- Pregnant patient without periodontitis (n=100) and Group B:- Pregnant patient with periodontitis (n=122). Different clinical parameters such as plaque index (PI), gingival index (GI), probing depth (PD) and clinical attachment loss (CAL) were evaluated. A 2 ml of blood sample was taken from antecubital vein for quantative serum CRP analysis.&#x0D; Results: The mean CRP level in Group B was found to be higher (4.22 + 2.247 mg/L) than Group A (1.55 + 0.702 mg/L). In both the groups, statistically significant and positive correlation of PI with GI and CRP level was found (p &lt; 0.05). Similarly, in Group B, PI showed a positive correlation with PD &amp; CAL whereas, PD showed a similar correlation with CAL &amp; CRP level was statistically significant. (p &lt; 0.05).&#x0D; Conclusion: Periodontitis influenced the serum CRP levels in pregnant patients representing increased inflammatory burden.

Factors associated with elevated blood lactate levels in patients undergoing maintenance hemodialysis.

Factors associated with chronic elevation of the blood lactate levels in patients undergoing chronic maintenance hemodialysis (hereinafter, hemodialysis patients) have not yet been thoroughly investigated. The purpose of the present study was to clarify factors associated with elevated blood lactate levels in hemodialysis patients. We divided the hemodialysis patients into two groups according the blood lactate levels (the high blood lactate group [> 2mmol/L] and normal blood lactate group), and conducted a retrospective comparison of the following items between the two groups: (1) the creatinine generation rate (%CGR) and the geriatric nutrition risk index (GNRI) as indices of the nutritional status; (2) the left ventricular ejection fraction (LVEF) and E/A, an indicator of diastolic function; (3) the ankle-brachial index (ABI) and transcutaneous partial pressure of oxygen as indices of the adequacy of circulation in the peripheral blood vessels of the lower extremities; (4) the white blood cell count and serum level of C-reactive protein (CRP) before dialysis as markers of an inflammatory state. The mean age and serum CRP level were significantly higher in the high blood lactate group than in the normal blood lactate group. There were no significant differences in the markers of the nutritional status, cardiac function, or adequacy of circulation in the peripheral blood vessels of the lower extremities between the two groups. Advanced age and a state of chronic inflammation appear to be associated with elevated blood lactate levels in patients undergoing chronic maintenance hemodialysis.

Retinal small vessel dilatation in the systemic inflammatory response to surgery

Retinal microvascular calibre has been proposed as a predictor of cardiac events. Surgery is a major stimulus for inflammation which potentially affects small vessel calibre. This study examined the effects of surgery on retinal, and thus systemic, small vessel size, and the potentially confounding effect of surgery when retinal vessel calibre is used to predict cardiac risk in hospital patients. Consecutive participants were recruited from a preoperative assessment clinic at a teaching hospital. They provided demographic and clinical details, and underwent retinal imaging before and again, within 3 days after surgery, with a non-mydriatic retinal camera. Images were graded for vessel calibre using semi-automated software based on the Parr-Hubbard formula with Knudtson’s modification (IVAN, U Wisconsin). Differences were examined using Fisher’s exact test or a paired t-test, and calibre determinants identified from univariate and multiple linear regression analysis (STATA version 11.2). Sixty-eight participants (23 men, 34%) with a mean age of 55 ± 14.5 years, were recruited. Fourteen (21%) underwent a laparotomy which was considered major surgery and 54 (79%) had Other surgery. Mean C-reactive protein (CRP) levels increased post-operatively from 7.8 ± 20.2 mg/L to 43.9 ± 55.1 mg/L (p < 0.01), and mean serum albumin decreased from 38.9 ± 4.4 g/L to 33.9 ± 5.5 g/L (p < 0.01). Mean central retinal arteriole and venular equivalent calibre (CRAE, CRVE) increased post-operatively (142.4 ± 13.3 µm to 146.4 ± 13.0 µm, p < 0.01 and 213.1 ± 16.8 µm to 217.9 ± 18.3 µm, p < 0.01, respectively). The systemic microvasculature dilates post-operatively possibly secondary to inflammation and endothelial dysfunction. These changes were present within 3 days of surgery and may confound the use of small vessel calibre to predict cardiac risk in surgical inpatients. Microvascular dilatation in response to other inflammatory stimuli such as pneumonia is a known potential confounder in hospital patients.

Non-medical switch from the originator to biosimilar and between biosimilars of adalimumab in inflammatory bowel disease – a prospective, multicentre study

IntroductionClinical data on the efficacy and safety of non-medical switch between adalimumab(ADA) biosimilars are limited. AimsThe aim of this study was to evaluate medium-term clinical efficacy, drug sustainability and safety comparing non-medical switches from the originator to biosimilar ADA, and between ADA biosimilars. Methods276 consecutive patients on maintenance ADA therapy (n = 205 Crohn's disease, n = 71 ulcerative colitis) were included. Data on clinical efficacy, biomarkers and adverse events were collected at four time points: 8–12 weeks prior switch, at baseline/switch, 8–12 weeks and 20–24 weeks after switch. Drug survival was evaluated after a median 40(IQR:35–42) weeks follow-up. ResultsA total 174 patients underwent a non-medical switch from the originator to a biosimilar, and 102 patients had a biosimilar-to-biosimilar switch. No significant difference was found in clinical remission rates at any time point in patients switching from originator to biosimilar(87.3%/88.5%/86.5%/85.7%) or biosimilar to biosimilar(74.5%/78.4%/85.3%/79.8%). Mean C-reactive protein levels remained unchanged in both cohorts(p = 0.856 and p = 0.525). Drug survival was similar between the two cohorts with a probability of 91.6%(SE: 2.2) and 87.0%(SE:3.4) to stay on drug after 40 weeks(log-rank:0.96; p = 0.327). Five cases of injection related adverse events were reported. ConclusionClinical benefit was sustained following non-medical switch from originator to biosimilar, or between biosimilars in adalimumab treated IBD patients.

C-Reactive Protein as a Prognostic Marker in Hospitalized Patients with COVID-19

Introduction: COVID-19 is a new infectious disease for which there is currently no treatment and has become a new threat for the populations. Therefore, it is necessary to explore biomarkers to determine disease severity which may help to identify patient at risk of prolonged intensive care or death.&#x0D; Aims: To evaluate the ability of C-reactive protein to predict the severity of COVID-19 infection.&#x0D; Methods: This study was conducted on 83 patients with COVID-19 admitted at COVID Unit of Nepalgunj Medical College Teaching Hospital, Kohalpur from April 2021 to June 2021. COVID-19 infection was diagnosed by Reverse Transcription Polymerase Chain Reaction of nasopharyngeal or throat Swab. The study population was divided into mild, moderate and severe cases. The data on demographic characteristics, clinical features and laboratory findings were collected and analyzed using SPSS version 26. P value less than 0.05 was taken as significant.&#x0D; Results: The mean levels of C-reactive protein in mild, moderate and severe cases were 2.75 mg/L, 9.87 mg/L and 84.48 mg/L respectively (P value = 0.003). This shows that CRP levels were significantly higher in severe cases and could be used as important biomarker to predict the severity of disease in COVID-19.&#x0D; Conclusion: The serum level of C-reactive protein can predict the severity and progression of disease in patient with COVID-19. Thus, C-reactive protein should be used as a prognostic marker in COVID-19.

The Higher C-Reactive Protein Levels as a Risk Factor of Stunting in Children with Acyanotic Congenital Heart Disease

BACKGROUND: Children with acyanotic congenital heart disease (CHD) had a high risk of stunting. In addition to inadequate nutrition, chronic inflammatory process also plays an important role. An increase in serum c-reactive protein (CRP) suppresses insulin like growth factor 1 (IGF-1) production, causing disorder in child growth. AIM: The objective f the study was to prove that higher CRP levels as a risk factor of stunting in children with acyanotic CHD aged 6–24 months old. METHODS: This study is an observational analytic study with a case–control design, to assess higher CRP levels as a risk factor of stunting in children with acyanotic CHD aged 6–24 months old. This research was conducted at the Pediatric Cardiology Polyclinic, Sanglah Hospital from May to December 2021 with the consecutive sampling method. Data analysis was performed using the Chi-square test or Fisher’s absolute test. Multivariate analysis with binary logistic regression was performed on all variables. Significance level was p &lt; 0.05. RESULTS: This study involved 60 subjects, consisting of 30 subjects with stunting and 30 subjects with no stunting. Children with stunting had higher mean CRP levels, 2.4 (±3.7) and 1.2 (±0.6). CRP level ≥3 mg/dL (p = 0.031; aOR 22.89; 95% CI 1.32–395.39) was a risk factor of stunting in children with acyanotic CHD. Other risk factors that significant are male, living in rural areas, low birth weight, and under-nutrition. CONCLUSION: Higher CRP levels as a risk factor of stunting in children with acyanotic CHD. Other significant risk factors include males, living in rural areas, low birth weight, and under-nutrition.

Revision surgery for periprosthetic elbow infection: eradication rate, complications, and functional outcomes-a systematic review.

The aim of this systematic review was to investigate the outcomes of revision surgery after periprosthetic elbow infection (PEI). Eighteen studies with 332 PEI that underwent revision surgery were included. Demographics, laboratory and microbiological data, types of implants, surgical techniques with complications and reoperations, eradication rates, and clinical and functional outcomes were reported. Staphylococcus aureus was the most common microorganism (40%). Pre-operatively, the mean white blood cell count was 8400 ± 4000 per microliter; the mean C-reactive protein level was 41.6 ± 66.9mg/dl, and the mean erythrocyte sedimentation rate was 45 ± 66.9mm/h. The Coonrad-Morrey total elbow prosthesis represented 41.2% of the infected implant, and it also represented the most common system used for the PEI revision surgery. Two-stage revision and debridement and implant retention (DAIR) were the most common procedures performed for PEI, and, on the whole, they represented 35.7 and 32.7%, respectively. The eradication rate was 76% with 2-stage, 71% with resection arthroplasty (RA), 66.7% with 1-stage, 57.7% with DAIR, and 40% with arthrodesis (EA). DAIR showed a significantly lower eradication rate than 2-stage (P = 0.003). The mean postoperative Mayo Elbow Performance Score was significantly higher in patients who underwent DAIR, and 2-stage compared with RA (P < 0.001 for all). Postoperative flexion-extension ROM was significantly higher in patients who underwent DAIR compared with 1-stage, 2-stage, and RA (P < 0.001 for all). Moreover, 1-stage and 2-stage showed a significantly greater postoperative flexion-extension ROM compared with RA (P < 0.001 for all). Reoperations occurred in 40% of patients after EA, 33.3% after 1-stage, 26.9% after DAIR and RA, and 24.1% after 2-stage. Conversion to amputation occurred in 2.2% of patients after RA and 1% after DAIR. Two-stage revision and DAIR are the most common procedures used to manage PEI; however, the former procedure showed a significantly higher eradication rate. Resection arthroplasty showed a high eradication rate, but postoperative lower clinical and functional outcomes limit the indications for this technique. One-stage procedure showed a limited role in the current practice of PEI treatment. Level IV.