Mean CRP Research Articles

Real-World Ustekinumab Experience in Ileum-Dominant versus Colonic Crohn’s Disease

Abstract Background Crohn’s disease (CD) presents with diverse phenotypes. It remains unclear if CD location affects therapy efficacy. The aim of this study was to compare the real-world performance of ustekinumab in ileum-dominant and colonic CD. Methods We performed a single center, IRB-approved, retrospective review of all adult CD patients who received ustekinumab. We stratified patients by ileal involvement: ileum-dominant (ileal and ileocolonic) and colonic CD. The primary outcome was absence of ulcers on follow-up colonoscopy. The secondary outcomes included CRP, calprotectin, surgery, and hospitalization. Chi-square tests (or Fisher’s exact test) and two-sample t-tests (or Wilcoxon’s rank sum test) were used to compare categorical and numeric variables between groups, respectively; analyses were performed using R Computing Software versions 3.6.1. Results 84 patients with ileum-dominant CD and 27 patients with colonic CD were treated with ustekinumab. The median time to follow-up endoscopy was 13 months. Follow-up colonoscopy after ustekinumab therapy was ulcer-free in 45% of ileum-dominant CD and 76% of colonic CD (p=0.02). Of patients with ulcers prior to starting ustekinumab, 24% of ileum-dominant CD and 67% of colonic CD were ulcer-free (p=0.01). There were similar rates of hospitalizations and surgery and no significant differences in mean calprotectin and CRP between the two groups on follow-up after ustekinumab therapy. Conclusions This real-world experience of ustekinumab demonstrates higher rates of endoscopic healing among colonic CD when compared to ileum-dominant CD. Disease location may predict endoscopic healing by ustekinumab. Further studies are necessary to expand our understanding of ustekinumab responsiveness to different CD phenotypes.

Decoding the variability in clinical and laboratory profiles of Chronic Inducible Urticaria vs. Chronic Spontaneous Urticaria - a retrospective study from a tertiary care center.

Chronic inducible urticaria (CIndU) is characterized by wheals and/or angioedema for longer than 6 weeks induced by specific triggers. The data regarding epidemiology of CIndU is scarce with limited available literature on urticaria severity, investigations, and treatment responses in CIndU compared to CSU. We performed a retrospective chart review of all CIndU patients(cases) enrolled in our Urticaria clinic, past seven years between January 2017 to December 2023. Equal number of CSU patients enrolled during study period were taken as controls. Patients with absence of weals and both CSU and CIndU were excluded from the study. Urticaria severity was assessed by Urticaria activity score over 7 days (UAS7). Statistical analyses were performed using SPSS V29 with P < 0.05 as significant. Out of all records screened, 222 CIndU (cases) and 226 CSU (controls) were eligible based on complete availability of data. Both groups were comparable in terms of age and gender with slight female preponderance. Mean UAS7 at baseline was comparable(p = 0.619) between two groups [(11.49 ± 10.37 in CIndU vs. 10.9 ± 12.2 in CSU)]. The mean CRP (mg/dl) levels for CIndU vs. CSU patients was 2.8 ± 4.2 vs. 6.9 ± 11.2 (p < 0.001). Serum D-dimer levels (mg/dl) were also significant between cases(167 ± 220) and controls(265 ± 452) (p = 0.020). The quality of life assessed by CU-QOL score was 9.39 ± 9.5 in CIndU vs. 16 ± 14.8 in CSU (p < 0.001). 80% of CIndU patients and 52% of CSU patients required updosing of antihistamines upto 4 times and the difference was statistically significant between two groups(p = < 0.001). The mean time taken to achieve remission i.e. UAS7 = 0 (T0) was 60 ± 42 days amongst CIndU while it was shorter in CSU (27.77 ± 27 days) (p < 0.001).Amongst all CIndU cases, commonest subtypes were symptomatic dermographism (SD) (39.5%) followed by cholinergic urticaria(4.2%) and cold urticaria(1.8%). Our study underscores the distinct clinical and laboratory profiles between CIndU and CSU patients. CIndU patients exhibit poorer response to standard antihistamine doses, requiring more frequent updosing and longer treatment duration. The time to attain remission as assessed by UAS7 score was also longer in CIndU patients than CSU patients (mean difference of 33 days). Further research is warranted to elucidate the underlying mechanisms and explore targeted treatment approaches for CIndU.

EFFECT OF SUPPLEMENTATION OF ACACIA HONEY AND PIOGLITAZONE ON INFLAMMATORY MEDIATORS AND OXIDATIVE STRESS IN STREPTOZOTOCIN INDUCED DIABETIC RATS

Background: Diabetes mellitus (DM) has emerged as a major health threat worldwide. There is an increasing advocacy of natural products in the treatment of DM and its complications. Objective of this study was to see the effect of supplementation of Pioglitazone and Acacia honey on inflammatory mediators and oxidative stress in streptozotocin (STZ) induced diabetic rats. Methods: The study was conducted in Al-Nafees Medical College in association with National Institute of Health, Islamabad. There were 150 male Sprague Dawley rats divided into 5 equal groups. Group-I was taken as normal control whereas Group-II was diabetic control. The Groups-II?V were given STZ through intraperitoneal route. Group-III received Acacia honey for 3 weeks. Group-IV was given intra-peritoneal injection of pioglitazone plus Acacia honey, and Group-V was administered pioglitazone through intraperitoneal route for same dose and duration. Serum catalase, hydrogen peroxide, CRP and TNF-? were measured after three weeks. Statistical analysis was done on SPSS-22. The values were presented as Mean±SEM and p?0.05 was considered significant. Results: On day 25 compared to Group-II, serum TNF-? and hydrogen peroxide levels were significantly decreased in Groups-III, IV and V. The mean serum CRP levels were significantly decreased in Group-III and IV while Group-II and III had significantly raised serum catalase levels. Conclusion: Acacia honey along with pioglitazone decreases oxidative stress as predicted by increase in levels of catalase. This combination also reduces inflammation as measured by decreased levels of CRP and TNF-? in STZ induced diabetic rats. Pak J Physiol 2024;24(3):18?22, DOI: https://doi.org/10.69656/pjp.v20i3.1536

Do all individuals benefit equally from non-surgical periodontal therapy? Secondary analyses of systematic review data.

This study aimed to assess the variability and treatment effect heterogeneity in response to non-surgical periodontal therapy (NSPT). Data from randomized controlled trials included in two recent systematic reviews on the effect of NSPT on mean clinical attachment loss (CAL), mean probing pocket depth (PPD), percentage of sites with bleeding on probing (%BOP), PPD ≤3 mm (%PD ≤3 mm), and C-reactive protein levels (CRP) at 3-12-month follow-up among adults with systemic diseases or conditions were used. In these trials, the control arms received no treatment, hygiene advice, or supragingival scaling. The Bayesian meta-regression models were utilized to assess the variability ratios between NSPT and control groups. Data from 36 trials on mean PPD, 32 trials on mean CAL, eight trials on %PD ≤3 mm, 31 trials on %BOP and 19 trials on CRP were used. Variability in mean CAL and CRP was approximately 10% higher in the NSPT arms than in the control arms, hinting that there may be room for treatment effect heterogeneity. Instead, variability in mean PPD, %BOP, and %PD ≤3 mm was lower in the NSPT arms than in the control arms. Potential treatment effect heterogeneity in response to NSPT was observed for CRP and mean CAL. However, substantial measurement error in CAL and natural variation in CRP may contribute to these findings. Conversely, treatment effect heterogeneity appears less pronounced for mean PPD, %BOP, and %PD ≤3 mm, potentially due to greater treatment effects in patients with more severe periodontitis and reduced measurement error in these parameters.

Correlation between neutrophil to lymphocyte ratio and C-reactive protein in diverse disease states in hospitalized patients.

This study aims to find if any significant correlation exists between C-reactive protein and Neutrophil to Lymphocyte Ratio as an indirect measure of inflammation. We selected 983 patients with any inflammatory condition who presented to a tertiary care hospital and were admitted in medical wards or Intensive Care Units (ICUs) of KRL Hospital Islamabad from December 2021 to December 2022. The study was a cross sectional study and convenience sampling was done. The patients were categorized into five groups depending upon their pathophysiology. Kolmogorov Smirnov test was used to assess the normality of the data, and Spearman's coefficient was used to calculate the correlation between NLR and CRP. A total of 983 patients were included. Mean CRP and NLR levels were 89.9±3.2 and 7.06±0.24, respectively. There was a significant positive correlation between CRP-NLR in the infectious, non-infectious non-inflammatory, and malignancy groups (0.420, 0.381, 0.642, p <0.01), and inflammatory group (0.322, p <0.05), and no correlation with chronic diseases. A significant correlation was shown to exist between CRP and NLR in patients with malignancies, non-infective non-inflammatory, inflammatory, and infective conditions and can therefore be used interchangeably to detect the presence of inflammation. Further exploration of these associations may contribute to a more nuanced understanding of the intricate relationships between different markers of inflammation and response to treatment.

Association of periodontitis with cardiometabolic and haemostatic parameters

ObjectiveTo investigate the association between periodontitis and cardiometabolic and haemostatic parameters.Materials and methodsBetween 2014 and 2019, 54 individuals needing full mouth extraction, and 50 control individuals, were recruited for a combined cross-sectional (individuals versus controls) and longitudinal (individuals before and after extraction) study. Periodontitis severity was measured using the periodontal inflamed surface area (PISA). Blood was drawn to measure the haemostatic (Factor VIII, von Willebrand factor [VWF], endogenous thrombin potential, d-dimer, clot lysis time) and cardiovascular risk (C-reactive protein [CRP], lipid profile) parameters, prior to and 12 weeks post-extraction. The results were analysed group-wise.ResultsThe mean VWF and CRP levels were higher and the high-density lipoprotein levels were lower in the individuals prior to extraction compared to the controls. The VWF was significantly correlated with the PISA (a 21% unit increase in VWF per 1000 mm2 increase in PISA, 95%CI: 6–36%, p = 0.01). The other analyses were comparable between the individuals and controls, and did not change in the individuals after the extraction.ConclusionVWF levels are associated with periodontitis severity; they do not improve after full-mouth extraction. Severe periodontitis in control individuals does not induce substantial changes in their haemostatic or inflammatory systems.Clinical relevanceTreatment of periodontitis has been shown to improve the cardiometabolic blood profile of patients with established cardiometabolic disease. However, whether periodontitis treatment improves cardiometabolic and haemostatic profiles in people without cardiometabolic disease is uncertain.

Evaluation of Neutrophil-Lymphocyte Ratio as Inflammatory Marker in Chronic Kidney Disease Stage 3 and 4

Chronic kidney disease (CKD) is a worldwide health problem because of the significant morbidity and mortality which is mostly due to chronic inflammation and proteinuria. Early detection of inflammation and its proper management can prevent further CKD progression and complications. This study aims to observe the association of neutrophil-lymphocyte ratio (NLR) with inflammatory markers in chronic kidney disease stage 3 and 4. In this study, a total of 100 adult patients of CKD stage-3 and 4 were included as study subjects and patient with acute illness, known case of malignancy, cardiovascular and cerebrovascular disease were excluded from the study. From each patient all the relevant history, clinical and laboratory findings were recorded in the data collection sheet. Study subjects were divided into two groups according to NLR value; those who have NLR 0- 3 were in group normal NLR and subjects with NLR &gt;3 in group high NLR. Then markers of inflammation ESR, CRP and serum albumin were compared between these groups. Statistical analysis was done by Statistical Package for Social Science (SPSS) version 22.0. The mean ESR of male and female patients was higher in high NLR subjects than normal NLR subjects. The mean CRP was higher in high NLR subjects than normal NLR subjects. The mean serum albumin was lower in high NLR subjects than normal NLR subjects. The difference of mean ESR, CRP was statistically significant between high NLR and normal NLR subjects but difference of mean serum albumin was not statistically significant. The study findings suggest that high NLR is significantly associated with of inflammatory markers-ESR, CRP. Hence, it can be concluded that NLR could be used as an indicator of inflammation in CKD. Mugda Med Coll J. 2024; 7(1): 4-8

Intestinal Ultrasound in Diagnosis and Follow up of Patients with Crohn’s Disease

Abstract Background Crohn's disease (CD) causes transmural ulceration of any section of the gastrointestinal tract (GI), with the terminal ileum and colon being the most commonly affected. Aim of the Work The aim of this study is to assess the sensitivity &amp; specificity of Intestinal ultrasound In diagnosis and follow up of patients with Crohn’s Disease, and related possible complications. Patients and Methods A Cross sectional study in Gastroenterology Department of Ain Shams University Hospitals for 30 Patients with Crohn’s disease and The Patients were selected from inpatient and outpatient clinic of gastroenterology department of Ain Shams University Hospitals, in the period from July to December 2021. Results The present study revealed that the mean age of our patients was 54.3± 7.69 years with range from 38-68 years. Male cases were more than females ones, as (70%) were males while (30%) were females, with male to female ratio was 2.33: 1. The present study revealed that the mean hemoglobin level was 11.66 ± 1.46 mg/dl, and the mean RBC, 4.18±0.48. The mean platelets was 267.73±61.94 (K/UL), mean WBCs was 9.94 ± 1.83 (K/UL), neutrophils was 7648.57 ± 1460.02 (/UL), and lymphocytic count was 1356.50 ±469.30 (UL) and neutrophil/ lymphocyte ratio (NLR) was 5.93 ±1.35. Regarding the renal function tests and electrolyte profile, the mean serum urea, creatinine and uric acid were 46.43-±10.18, 1.10-±0.25 and 5.30-±0.68 mg/dl respectively. The mean levels of Na and K were 140.43 ±3.50 and 3.82±0.26 mEq/L respectively, the mean AST was 37.63 ±8.27 U/L, the mean ALT was 26.30 ±8.36 U/L, the mean total bilirubin was 1.01±0.17 mg/dl and the mean direct bilirubin was 0.60 ±0.27 mg/dl. We found that the mean PT was 14.17±2.65 sec. and the mean Serum Albumin was 4.16 ± 0.29 g/dl. In this study the mean CRP was 4.91 ±4.55, the mean ESR at first was 21.67 ±4.22 and 2nd hour was 47.43±10.94. Conclusion Crohn's disease (CD) is a progressive, inflammatory disease that occurs in genetically predisposed individuals and necessitates continuous monitoring and development of various methods for diagnostic and therapeutic treatment options, as well as the discovery of new medications. While colonoscopy is the gold standard in CD, US, CT and MRI, can provide information not only about the luminal side of the bowel but also about the serous side and the peripheral structure; additionally, US is repeatable, safe, and well-accepted, but unlike CT is radiation-free, and unlike MRI is inexpensive, virtually hazard-free, and available to all patients without contraindications.

#2158 Circulating kidney injury molecule-1 a valuable marker of mortality in hemodialysis patients?

Abstract Background and Aims The importance of finding reliable biomarkers of mortality in CKD, and especially in patients treated with hemodialysis has become evident. Plasma KIM-1 has been mentioned as a marker of cardiovascular morbidity.. The aim of this study is to assess the level of plasma Kidney Injury Molecule- 1 (KIM-1) as a marker of mortality in patients treated with hemodialysis. Method We conducted a single-center study that included 63 CKD G5D patients (hemodialysis for 1-5 years) followed up for 48 months and a control group consisting of 52 patients diagnosed with CKD stages G1-G5, without HfrEF. All patients have been assessed at baseline, regarding cardiovascular disease (medical history, echocardiography and ECG). Circulating plasma KIM-1 levels were determined with single molecule counting immunoassay technology using the Enzyme-linked immunosorbent assay, we performed using standard methods blood biochemistry, and markers of inflammation (CRP, IL-6) and markers of anemia (complete blood count, serum ferritin, transferrin saturation- TSAT). Results Mean plasma KIM1 levels were 403.8 +/-546.8pg/ml) in the group of patients treated with hemodialysis, and was statistically significantly higher compared to the level in the control group (217.48 +/-267.10 pg/ml). In the group of patients treated with hemodialysis plasma KIM-1 levels showed a statistically significant correlation with inflammation (mean CRP- R=0.28, p=0.02 and IL6- R=0.36, p=0.005) and with anemia (hematocrit- R= -0.5, p=-0,0316; hemoglobin - R= -0.5, p=0.02 We found out using ANOVA that patients which presented left ventricular hypertrophy on echocardiography (37 out of 62) had significantly lower mean levels of plasma KIM-1 (155,51 vs 432,12 pg/ml; p=0,026). The group of patients with vascular calcifications on echocardiography (48 out of 62) had lower levels of serum KIM1 (210.01 vs 462.58 pg/ml, p=0.04). After 24 months of follow up we found a mortality rate of 22.23%, while after 48 months the mortality rate was of 50.73%. Using a Cox proportion-hazards regression analysis of predicting factors of mortality we found that regarding the relationship between plasma levels of KIM-1 and mortality there is a significantly decreased survival in patients with low KIM-1&amp;lt;81.98 pg/ml (p&amp;lt;0.001), with a cut-off point for plasma KIM-1 levels= 81.98 pg/ml. Conclusion Plasma KIM-1 levels were significantly higher in patients treated with hemodialysis compared to the control group (ND CKD patients). However, surprisingly, low levels of plasma KIM1 were associated with some cardiovascular changes and also to an increased risk of mortality (at 4 years, not after few months).

#1828 Venous thromboembolic events in ANCA associated vasculitis patients—data from Croatian referral center

Abstract Background and Aims Our aim was to investigate the prevalence of venous thromboembolic events (VTE) in a cohort of patients with ANCA-associated vasculitis (AAV) and define factors associated with the frequency of VTE considering there is data on high incidence of VTE in AAV patients. In these cohorts VTE occurred mostly early in the course of disease. Method This study included 114 consecutive AAV patients with biopsy proven renal involvement in the period from 2007-2017. Patients were classified according to clinical: granulomatosis with poliangitis (GPA), microscopic polingitis (MPA) and eosinophilic granulomatosis with poliangitis (EGPA) and serological phenotype: MPO-ANCA positive, PR3-ANCA positive, MPO- and PR3-ANCA positive and ANCA-negative. Ordinal variables were analysed using logistical regression test. Statistical analysis was done in MedCalc Statistical Software version 18.11.6 (MedCalc Software Bvba, Ostend, Belgium). Results In the cohort there were 64 (56%) females, mean age was 58 (IQR 16-84) with mean follow up time 46.9 months (IQR 1-127). Clinically there were 84 (73%) patients with MPA, 26 (22%) with GPA and 4 (5%) with EGPA. Serologically there were 20% PR3-ANCA, 54% MPO-ANCA, 8% MPO- and PR-3 ANCA positive patients and 18% ANCA-negative patients. Mean serum creatinine levels (SCr) was 380.9 μmol/l (IQR 65-1402). Mean BVAS (Brimingham vasculitis score) at the time of diagnosis of AAV was 17 (IQR 5-50) and at the time of VTE 0, 9 (0-22). Mean body weight was 71kg (IQR 48-110) and mean CRP was 84 mg/ml (IQR 0, 3-256). During the follow up 7 (6.14%) of the patients had VTE, with 4 having VTE in first month after the diagnosis and other two at month 14 and 19. Logistic regression showed the connection of weight (P = 0.0052) and CRP (0.0138) with VTE with odds ratio of 1,0829 for CRP (1.003-1.027) and 1.0150 for weight (1.0284-1.1736) respectively. There was no statistical significance for clinical or serological phenotype being associated with VTE nor for other clinical or laboratory parameters. Conclusion In our cohort patients with AAV were at risk of VTE, particularly within the first year following onset of disease. In this cohort the frequency of VTE did not depend of clinical or serological AAV phenotype, age or gender. Only CRP and body weight were associated significantly with VTE occurrence. Despite VTE rates in AAV patients, routine anticoagulation is not recommended in AAV patients, given the potential risk of bleeding complications. Prospective studies are needed to assess VTE risk stratification in AAV patients and to evaluate the both benefits and potential risks ratio of prophylactic anticoagulation in AAV patients.

Abstract PO5-15-01: Prospective Biomarker Assessment of Cardiotoxicity Among Ethnically Diverse Women with Early Breast Cancer

Abstract Background: Approximately 4.1 million women in the United States are living with breast cancer1. Cardiac dysfunction is a significant adverse effect of commonly used breast cancer therapies like doxorubicin (D) and trastuzumab (T). The cardiotoxicity (CTox) associated with these agents manifests as a reduction in left ventricular ejection fraction (LVEF) with or without signs and symptoms of heart failure. Purpose: The objective of this study is to evaluate serum cardiac and inflammatory biomarkers over time and their association with CTox development. Methods: A total of 133 newly diagnosed stage I-III invasive breast cancer patients were enrolled in a prospective clinical trial (2013-2017) and received standard of care T and/or D based systemic therapy. They underwent serial echocardiograms every 6 months for two years and then based on clinical need for a total of six years. CTox was defined as a &amp;gt;10% drop in LVEF, and/or LVEF &amp;lt; 50%. Biomarker data was collected at baseline, 12 and 24 months and included both cardiac biomarkers (Troponin-I, TN-I and amino terminal B-type natriuretic peptide, NT-proBNP) and measures of inflammation (C-reactive protein, CRP). Of the 32 with CTox patients, 15 had adequate serum samples and were matched with 15 patients without CTox (N=30), controlling for age, race, and treatment regimen prior to serum sample analysis. Results: The mean LVEF at baseline was similar between CTox and non-CTox patients (64% vs 62%, p=0.342). However, over the course of 12 and 24 months, CTox patients experienced a statistically significant decrease in LVEF compared to their baseline values (55% and 56%, respectively, p &amp;lt; 0.001). At baseline, CTox patients had higher CRP levels compared to non-CTox (13.4 mg/L vs 3.35 mg/L), however this difference did not reach statistical significance (P &amp;gt;0.05). Although this difference seemed to narrow at 12 months (3.88 mg/L vs 1.52 mg/L, p&amp;lt; 0.05) and 24 months (6.85 mg/L vs 2.36 mg/L, p&amp;lt; 0.05), CTox patients consistently had higher mean CRP levels. Mean TN-I levels increased at both 12 and 24 months compared to baseline (CTox 1.13 ng/L, 7.13 ng/L, 4.13 ng/L vs non-CTox 0.800 ng/L, 8.13 ng/L, 4.60 ng/L, p&amp;lt; 0.05) but there were no significant differences between the two groups (p &amp;gt;0.05). While baseline NT-proBNP levels did not differ significantly between the CTox and non-CTox patients, there were statistically significant increases in CTox patients at 12 and 24 months (205 pg/mL vs 74 pg/mL, and 200 pg/mL vs 96 pg/mL, p &amp;lt; 0.01, respectively). Conclusion: In a well characterized, diverse, matched subset of patients with early breast cancer who were prospectively followed with serial echocardiograms, distinct biomarker patterns were observed. Measures of inflammation (CRP) at baseline were different and these changes appeared to diminish over time. While the cardiac biomarker TN-I appeared to increase in both +CTox and -CTox group over time, only those with differential NT-proBNP elevations were associated with cardiotoxicity. 1Lisa Gallicchio, PhD and others, Estimation of the Number of Individuals Living With Metastatic Cancer in the United States, JNCI: Journal of the National Cancer Institute, Volume 114, Issue 11, November 2022, Pages 1476–1483 Citation Format: Shahzaad Jahangier, Rubina Qamar, Maharaj Singh, Vinay Thohan, James Weese, Bijoy Khandheria, Anna Kamke-Jordan. Prospective Biomarker Assessment of Cardiotoxicity Among Ethnically Diverse Women with Early Breast Cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-15-01.

Tuberculous Paraplegia: Outcome of Operative Intervention.

Tuberculosis of the spine, a common manifestation of extra-pulmonary tuberculosis is characterized by vertebral destruction, paradiscal involvement, abscess collection and varying degrees of neurologic affectation. The primary disease caused by mycobacterium tuberculosis complex infects the lungs, lymph nodes of the mediastinum and gastrointestinal tract/ viscera with spinal involvement being secondary and caused by haematogenous spread. Tuberculous paraplegia arises as a complication of spinal involvement. To determine the outcome of operative intervention in tuberculous paraplegia. Methodology: This was a retrospective study involving 10 patients with tuberculous spinal involvement with varying degrees of neurological deficit as defined by both Tuli and ASIA grading. The VAS score, ESR, ASIA grade (both pre-op and post op), Tuli's grade (pre-op and post op) were used to analyze the therapeutic effects of the surgery. The mean pre-operative VAS score was 5.9 ±1.8, which significantly decreased to 2.2 ±1.3 six weeks post operatively. The mean pre-operative ESR and CRP was 78.9 ± 11.3mm/hr and 83 ± 13.5 respectively; which both showed a statistically significant decrease post-operatively, p<0.05. All cases achieved an increase of more than one ASIA grade post-operatively. Early surgical intervention is beneficial in patients with tuberculous spinal disease with neurologic involvement.

Formula modifications to the Crohn's disease exclusion diet donot impacttherapy success in paediatric Crohn's disease.

The Crohn's disease exclusion diet (CDED) + partial enteral nutrition (PEN) is an emerging diet used to induce clinical remission in children with active Crohn's disease (CD). This study aims to determine the effectiveness of using the CDED+PEN to induce clinical remission in an Australian group of children with active CD using different PEN formulas and incorporating patient dietary requirements. We retrospectively collected data from children (both newly diagnosed and with existing CD while on therapy) with active CD (Paediatric Crohn's Disease Activity Index [PCDAI] ≥10)and biochemical evidence of active disease (elevated C-reactive protein [CRP], erythrocyte sedimentation rate [ESR] or faecal calprotectin [FC]) who completed at least phase 1 (6 weeks) of the CDED+PEN to induce clinical remission. Data werecollected at baseline, Week 6 and Week 12. The primary endpoint was clinical remission at Week 6 defined as PCDAI < 10. Twenty-four children were included in phase 1 analysis (mean age 13.8 ± 3.2 years). Clinical remission at Week 6 was achieved in 17/24 (70.8%) patients. Mean PCDAI, CRP, ESR and FC decreased significantly after 6 weeks (p < 0.05). Formula type (cow's milk based, rice based, soy based) did not affect treatment efficacy. A greater than 50% decrease in FC was achieved in 14/21 (66.7%) patients who completed phase 1 and 12/14 (85.7%) patients who completed phase 2 of the CDED+PEN. Formula modifications to the CDED+PEN do not impact the expected treatment efficacy in Australian children with active luminal CD.

LEVELS OF C-REACTIVE PROTEIN AND TOTAL PROTEIN IN MALARIA AND HIV CO INFECTED PREGNANT WOMEN, ATTENDING THE ANTENATAL CLINIC OF NNAMDI AZIKIWE UNIVERSITY TEACHING HOSPITAL, NNEWI, SOUTHEASTERN NIGERIA.

The goal of the study was to quantify the levels of C reactive protein and protein in pregnant HIV-positive malaria-infected women. Pregnant women in HIV stages 1 and 2 who were 18 to 40 (36.98 + 5.49) years old participated in the study. The participant groups consisted of 80 HIV-positive pregnant women with 40 co-infected with malaria and 80 HIV-negative pregnant women with 40 co-infected with malaria. Blood samples were obtained from participants for the thick and thin film methods of counting and identifying malaria parasites and the immunochromatographic method of determining HIV status. The total protein content of the serum was determined using the Biuret method, and the violetcoloured solution that was produced was measured spectrophotometrically at 540 nm. The Enzyme linked Immunosorbent assay using the Human CRP kit method was employed to measure the level of CRP in the participants’ blood sample and the developed yellow coloured solution read at 450 nm using a spectrophotometer. In all cases, there was a statistically significant difference in protein and CRP levels between the HIV seropositive group with malaria infection (p&lt;0.05) and HIV seropositive group without malaria infection. The mean protein and CRP level of HIV-positive pregnant women who have malaria infection was statistically lower than that of HIV-positive pregnant women who do not have malaria but statistically higher than those of HIV-negative pregnant women with and without malaria infection. The study suggests that pregnant HIV-positive women do experience a heightened increase in protein and CRP levels majorly due to HIV. However, malaria infection also contributes to the level of increase seen in these parameters in pregnant women with the coinfection.

COVID-19 Vaccination Leads to Less Pneumonia at Chest CT

The study’s objective was to assess, using CT scans, the impact of vaccinations and booster shots on the severity of COVID-19 pneumonia. In this retrospective analysis, 210 Covid-19 patients were included. Within six weeks of receiving a COVID-19 diagnosis, every patient who was included had at least one CT scan and had received a full, partial, or no vaccination. Patients were separated in three groups. A 6-point scale called the Pneumonia Score was used to compare the severity of pneumonia across the three groups. Hypertension, CAD, DM and CKD were the most common comorbidities among all cases. Mean CRP in group I was 94.7±15.63 mg/dl, in group II mean CRP was 96.9±11.44 mg/dl and in group III mean CRP was 97.3±5.35 mg/dl. We found that severity of pneumonia score 5 was higher in group III in 16 (22.8%) as compared to group I in 4 (5.7%) and group II in 8 (11.4%) cases with p value 0.003. Hospital stays and ICU admission was also higher in non-vaccinated case with p value 0.004. Rate of mortality in group I was 7 (10%), in group II was 13 (18.6%) cases while in group III was 15 (21.4%) cases.

Characteristics of Patients with Hypertension Admitted for COVID-19 Treatment in Khulna: Single-Centre Cross-Sectional Study

Background: The outbreak of coronavirus disease 2019 (COVID-19) has become a large threat to global health due to its high contagious nature and varied mortality. Arterial hypertension represents one of the most common comorbidities in patients with COVID-19. Close connections between inflammation and blood pressure (BP) have been described, and inflammation plays a key role in the outcome for patients with COVID-19. Objective: This study aims to investigate the clinical characteristics of patients with hypertension admitted for COVID-19 treatment in Gazi Medical College Hospital (GMCH), Khulna, Bangladesh. Methods: This was a cross-sectional type of observational study on patients with hypertension who were diagnosed with COVID-19 based on laboratory and/or radiological findings and admitted to Gazi Medical College Hospital, Khulna, Bangladesh, from July 1 to July 31, 2021. In that timeframe, overall, 215 patients with COVID-19 were admitted. Among them, 37 patients having hypertension fulfilled the inclusion criteria for the study. Demographic, clinical, laboratory and radiological data of those 37 patients were recorded and analyzed. Results: Among 37 study subjects, 54.1% were female. The mean age of the patients was 59.6±13.9 years. Among the study subjects, diabetes (56.8%) was the most common comorbidity. Regarding laboratory parameters, the mean Hb of the patients was 11.4±1.9 g/dl. In addition, the mean random blood sugar (RBS) level was 11.6±2.9 mmol/l. Neutrophilia and lymphocytopenia were observed in 86.5% and 83.8% cases, respectively. The mean D-dimer (2.4 mg/l) and CRP (72.5 mg/l) levels were well above their normal limits. In high resolution CT scan of the chest (HRCT chest), bilateral lung involvement was present in 89.2% cases. Ground-glass appearance was the most frequent (91.9%) radiologic pattern. Among antihypertensive drugs, losartan potassium was the most frequently used category (29.7%). Total 7 (18.9%) patients were severely affected with COVID-19 and admitted to the ICU, requiring mechanical ventilation. During our study, 2 patients (5.4%) died either due to multiple organ dysfunction syndrome or cardio-respiratory failure. Conclusion: The study provides key information to better understand the clinical characteristics of patients with hypertension admitted for COVID-19 treatment, which may help physicians to identify the factors associated with adverse outcomes in this disease. Mediscope 2024;11(1): 34-40

Moderate Intra-Abdominal Pressure Levels in Robot-Assisted Radical Prostatectomy Seem to Have No Negative Impact on Clinical Outcomes.

Introduction: Radical prostatectomy is increasingly performed laparoscopically with robot assistance (RALRP). RALRP, as with all laparoscopic procedures, requires a pneumoperitoneum, which might result in peritoneal inflammatory response reactions and postoperative pain. The aim of this retrospective single-centre study was to analyse the effects of a pneumoperitoneum during RARLP on clinical outcomes. Methods: All patients who underwent robot-guided prostatectomy in our clinic were included, with the exception of patients who were converted to open prostatectomy. C-reactive protein was used as a marker for the primary outcome, namely the postoperative inflammatory response. Intra-abdominal pressure (IAP) was evaluated as a potential factor influencing inflammation. In addition, the waist-hip ratio was used to estimate the amount of visceral adipose tissue, and the administration of dexamethasone was considered as a factor influencing inflammation. The Visual Analogue Scale (VAS) was used to determine postoperative pain. Patients were consecutively recruited between 1 September 2020 and 31 March 2022. Results: A total of 135 consecutive patients were included. The median waist-hip ratio was 0.55. The median duration of the pneumoperitoneum was 143 min. The median values of the average and maximum IAP values were 10 mmHg and 15 mmHg, respectively. The mean CRP of the first postoperative day was 6.2 mg/dL. The median VAS pain level decreased from 2 to 1 from the first to the third postoperative day. On the first postoperative day, 16 patients complained of shoulder pain. In addition, 134 patients were given some form of opioid pain treatment following surgery. Conclusion: We could not identify any relevant associations between the duration and IAP of the pneumoperitoneum and the indirect markers of inflammation or indicators of pain, or between the latter and the amount of visceral adipose tissue. In addition, we found no significant effect of the administration of dexamethasone on postoperative inflammation. The results point to a noninferior tolerability of moderate pressure during the procedure compared to the commonly utilised higher pressure, yet this must be confirmed in randomised controlled trials.

A258 ULTRASOUND ASSESSMENT OF CROHN’S DISEASE PATIENTS FOLLOWING RISANKIZUMAB INITIATION; BASELINE, 3 AND 6 MONTH FOLLOW UP

Abstract Background Risankizumab (RIS), an interleukin-23 inhibitor specific to the p19 subunit, was approved for the treatment of moderate to severe Crohn’s Disease (CD) in December 2022. Intestinal ultrasound (IUS) is an accurate and well-tolerated modality for evaluating response to therapy. Aims We aim to assess IUS response at 3 and 6 months following RIS therapy. Methods Consecutive patients initiating RIS for CD were recruited to be evaluated by IUS at baseline (within 14 days of initiation), 3 months, and 6 months. Baseline demographics, medication exposure, surgical history, and inflammatory biomarkers were obtained. IUS response (decrease in bowel wall thickness (BWT) ≥ 25%)) and transmural remission (TR) (normalization of BWT normalization, color doppler signal (CDS, modified Limberg (ML) score 0), wall stratification, inflammatory fat) for each segment were evaluated. Paired t-tests compared values at baseline, 3 and 6 months. Results Thirty-three (20, 60.6% female) patients were recruited; 30 completed baseline and 3 month IUS, while 18 patients have 6 month IUS. Median age was 55 years (IQR 39-63), with a 12 year median CD duration (IQR 5-28). Five had inflammatory, 19 stricturing, and 6 fistulizing behaviour. CD distribution was 18 ileal, 1 colonic, and 11 ileocolonic. 20% (6/30) were bio-naïve, while 30% (9/30) had failed ≥ 3 biologics. Baseline mean CRP (4.1 ± 4.9 mg/L) did not significantly differ at 3 months (5.0 ± 6.8 mg/L, p=0.16), nor at 6 months for patients with values available (6.2mg/L ± 8.3, p = 0.38). Of patients with FC concentrations, 3 month mean FC (129.4 ±70 mcg/g) (9 patients) had significantly decreased from baseline (427.6 ± 271 mcg/g) (p=0.008), and similarly at 6 months (9 patients; baseline 396 ± 299 vs. 129 ± 75, p = 0.02). 80.0% (4/5) patients with colonic BWT ampersand:003E 3mm had IUS response (baseline mean BWT 5.6 ±1.4mm vs 3.5 ± 0.8mm at 3 months (p=0.011). IUS response was not achieved in those with ileal CD at 3 months (BWT 6.3 ± 2.1mm vs 3 month 6.0 ± 2.5mm (p=0.31). However, 21.4% (3/14) of ileal CD patients had an IUS response at 6 months. There is a non-significant ileal BWT reduction (5.4 ± 1.6mm) from baseline (6.0 ± 1.7mm) at 6 months. Of the 9 with moderate to severe CDS, 55% (5/9) had reduction to mild CDS by 3 months. TR was achieved by one patient with ileal CD at 6 months. Conclusions IUS response was achieved in 80.0% of CD patients with colonic disease at 3 months follow RIS initiation. IUS response was not detected for ileal CD at 3 months, but detected in 21.4% at 6 months A significant FC reduction by 3 and 6 months was attained. Further prospective patient recruitment and IUS at 6 and 12 months to assess preliminary results and longer-term response is needed. Funding Agencies None

COVID-19 Pozitif Sağlık Çalışanlarının Semptom, Laboratuvar ve Toraks Bilgisayarlı Tomografi Bulgularının Değerlendirilmesi: Rektrospektif Çalışma

Objective: The study was carried out to examine the symptoms and laboratory and thoracic computed tomography findings of COVID-19-positive healthcare professionals in northeastern Turkey. &#x0D; Material and Method: The sample of this descriptive, cross-sectional, and retrospective study consisted of 146 healthcare professionals who had positive COVID-19. Data were collected using electronic data from the hospital information management system and the personal health records of healthcare professionals. &#x0D; Results: 50.6% of COVID-19-positive healthcare professionals were symptomatic, 49.4% were asymptomatic, 52.7% of nurses, midwives, and health officers, and those who were symptomatic experienced the most cough, muscle-joint pain, and fatigue. Healthcare workers had a high leukocyte, neutrophil, lymphocyte, platelet mean, C reactive protein, and D-dimer, and 24.1% had COVID-19-compatible thorax computed tomography. Symptomatic healthcare professionals had a lower median of leukocyte and a higher median of C reactive protein and procalcitonin compared to asymptomatic healthcare professionals. Healthcare professionals with COVID-19 compatible thorax computed tomography had a lower leukocyte, median, and platelet mean, lower high C reactive protein median, and higher D-dimer median. &#x0D; Conclusion: The study found that half of the healthcare professionals are symptomatic, and leukocyte, neutrophil, lymphocyte, C reactive protein, and platelet values affect the development of COVID-19-compatible thoracic computed tomography. The results can be used as a knowledge base for research and by health workers and institutional authorities to implement methods to improve prevention levels.

Diagnostic and Prognostic Roles of C-Reactive Protein in Childhood Pneumonia

A hospital-based, case-control study was conducted in the Department of Pediatrics in Community Based Medical College, Bangladesh (CBMC,B) Hospital, Mymensingh, Bangladesh, between February and September of 2013, to determine the role of CRP for the diagnosis of pneumonia as well as treatment response of pneumonia. A total of 180 children with pneumonia were enrolled – 90 as case (group A) and another 90 having ARI other than pneumonia as control (group B), based on specific inclusion and exclusion criteria. Necessary information was collected by detailed history taking, clinical examination and close follow-up in the hospital, by using a pre-designed data sheet. The mean±SD age of the participants as case (group A) and control (group B) were 8.53±10.24 and 6.68±3.59 respectively (P&gt;0.05). Male children were 66(73.3%) and 68(75.6%), while female children were 24(26.7%) and 22(24.4%) in group A and group B respectively (P&gt;0.05). In two groups, the mean CRP before treatment were 48.80±32.4 and 3.60±1.30 respectively; the difference was statistically significant (P&lt;0.001), which signifies that those who were suffering from pneumonia had an initial CRP response much higher than those who were suffering from other forms of respiratory diseases. Among antibiotic responders, symptoms and signs resolved in approximately 2-4 days; however, among non-responders, symptoms even persisted &gt;7 days. Among the responders, CRP was significantly reduced after treatment (P&lt;0.001); in contrast, among non-responders, even after treatment, no or little reduction in CRP was observed (P&gt;0.05). Hence, we suggest that measuring CRP to see the antibiotic response in childhood pneumonia is helpful. CBMJ 2024 January: vol. 13 no. 01 P: 46-52