Mean Serum C-reactive Protein Levels Research Articles

Effectiveness and safety of adalimumab in patients with intestinal Behçet’s disease: a real-world prospective observational study in South Korea

BackgroundIntestinal Behçet’s disease (BD) is characterized by typical gastrointestinal ulcers in patients with BD followed by complications such as bleeding, perforation and fistula. Biologic agents are currently under active investigation to delay the disease course. Various data regarding infliximab are available, but there is relatively lack of data regarding adalimumab.MethodsThis was a multicenter, real-world prospective observational study to evaluate the effectiveness and safety of adalimumab in intestinal BD. The primary endpoint was disease activity at each follow up, including disease activity index for intestinal Behçet’s disease (DAIBD), serum C-reactive protein (CRP) level, and endoscopic findings. The secondary endpoint was the incidence of adverse drug reactions (ADRs).ResultsA total of 58 patients were enrolled and 8 of them were excluded. Adverse events were reported in 72.0% of patients with 122 events. ADRs were reported in 24.0% with 28 events. For adverse events, arthralgia was most commonly reported (13.1%: 16/122) and only one experienced critical adverse event (0.82%, 1/122: death due to stroke). On multivariable regression analysis, a longer disease duration was significantly associated with decreased ADRs [Odds ratio 0.976 (0.953–0.999, 95% CI); p = 0.042]. Clinical response rates as assessed by DAIBD were 90.9% at Week 12 and 89.7% at Week 56, respectively. The mean serum CRP level at baseline was significantly decreased after 12 weeks (3.91 ± 4.93 to 1.26 ± 2.03 mg/dL; p = 0.0002).ConclusionAdalimumab was found to be safe and effective in Korean patients with intestinal BD. A longer disease duration was significantly associated with decreased ADRs.

Serum Selenium and Inflammation in Individuals with Human Immunodeficiency Virus Infection.

HIV infection has been linked to selenium deficiency and chronic inflammation. Both selenium deficiency and inflammation have been associated with poor health outcomes among individuals with HIV. However, the role of serum selenium levels in inflammation has not been studied among individuals with HIV. We assessed the relationship of serum selenium levels to C-reactive protein (CRP), a marker of inflammation, in individuals with HIV in Kathmandu, Nepal. In this cross-sectional study, we measured the normal serum CRP and selenium levels of 233 individuals with HIV (109 women and 124 men) using the latex agglutination turbidimetric and atomic absorption methods, respectively. We used multiple linear regression analysis in examining the association of serum selenium levels with CRP adjusting for sociodemographic and clinical parameters, including antiretroviral therapy, CD4+ T cell count, chronic diseases, and body mass index. The geometric means of CRP and selenium levels were 1.43 mg/liter and 9.65 μg/dL, respectively. Overall, serum selenium levels were inversely associated with CRP levels (β for one unit change in log selenium; β = -1.01, p = .06). Mean CRP levels significantly decreased with increasing selenium across selenium tertiles (p for trend = .019). The mean serum CRP levels were 40.8% lower in the highest selenium tertile than in the lowest. Our study suggests that high serum selenium levels may reduce serum CRP levels in individuals with HIV, although a longitudinal study is warranted to establish causality.

Evaluation of Peri-Implant Parameters and C-Reactive Protein Levels among Patients with Different Obesity Levels.

Assessment of correlation between peri-implant parameters and C-reactive protein levels among patients with different obesity levels. Evaluation of 60 subjects was performed who were scheduled to undergo dental implant therapy for missing mandibular first molars. Three study cohorts were formed, namely, Group A: obese group (BMI between 30 Kg/m2 and 34.9 Kg/m2), Group B: high obese group (BMI over 34.9 Kg/m2), and Group C: non-obese group (BMI under 25 Kg/m2). Each cohort comprised 20 subjects. Dental implant therapy was carried out in all the patients. Peri-implant variables were evaluated in all the patients. Blood samples were obtained, and C-reactive protein levels in subjects having different obesity levels. Statistical analysis was performed using SPSS software. Mean serum C-reactive protein levels among patients of groups A, B, and C occurred to be 3.28 mg/L, 3.65 g/L, and 3.61 g/L, respectively. On comparing numerically, noticeable outcomes were achieved. Mean probing depth among subjects of groups A, B, and C occurred to be 2.9 mm, 3.2 mm, and 1.3 mm, respectively. Mean marginal bone loss among subjects of groups A, B, and C occurred to be 2.1 mm, 2.7 mm, and 0.8 mm, respectively. On comparing numerically, noteworthy outcomes were gathered. There were significantly higher deranged peri-implant inflammatory variables among patients with higher levels of obesity.

Procalcitonin Level In COVID-19 Patients: A single center study

Objective: The study the association of procalcitonin (PCT) and c-reactive protein (CRP) levels in COVID-19 patients and it's role as a guide in progress and management of those patients. Methodology: This cross-sectional study analyzed 200 CIOVID-19 patients in a single privet center in Baghdad, Iraq from January 1, 2021 to January 1, 2022. Demographic data like age, sex, and clinical symptoms were recorded. High sensitivity CRP and PCT in the serum were measured via dry fluorescence immunoassay (Lansionbio-China). Results: Out of 200 patients, 50 had moderate Covid and 150 had severe disease. Mean serum PCT levels was 0.039±0.05 ng/mL in the moderate group (range 0.011-0.067) and 0.43±0.21 ng/mL in the severe group (range 0.211±0.513). Mean serum PCT and CRP levels were higher in severe patients than in moderate patients. Conclusions: PCT and CRP may be an indicator of disease severity in COVID-19.

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.

Inflammatory Markers are Quickly Improved by Tocilizumab in Early Polymyalgia Rheumatica and Might Predict Early Response to Interleukin-6 Blockade.

IntroductionIt is unclear whether polymyalgia rheumatica (PMR) should be considered an inflammatory disease or an autoimmune disease.MethodsEighteen untreated early PMR patients and 18 sex- and age-matched healthy controls (HCs) were included. PMR patients received tocilizumab from week 0 to week 12 and glucocorticoids from week 12 to week 24. Leukocytes, neutrophils, platelets, hemoglobin, γ-globulins, IgG, IgA, and IgM were compared between the PMR patients and HCs and before and after tocilizumab treatment in the PMR group.ResultsThe mean age was 68 ± 7 and 66 ± 11 years, and the mean serum C-reactive protein level was 82 ± 16 and 5 ± 2 mg/l for PMR patients and HCs, respectively. At inclusion, leukocytes (p < 0.0001), neutrophils (p < 0.0001), and platelets (p < 0.0001) were increased and hemoglobin (p < 0.0001) decreased in the PMR group compared to the HC group. After tocilizumab therapy, leukocytes, neutrophils, and platelets decreased, and hemoglobin increased. At inclusion, all four parameters were significantly associated with the serum IL-6 level, though it was not associated after tocilizumab therapy. Levels of γ-globulin were increased in the PMR patients compared to HCs (p = 0.0087), and PMR patients with γ-globulins levels over 11 g/l at inclusion responded more quickly to tocilizumab therapy. Autoantibody profiles did not differ between the PMR patients and HCs.ConclusionsThis study suggests that PMR is more an inflammatory disease than an autoimmune disease. Tocilizumab improves all markers of inflammation. Patients with elevated γ-globulins respond more quickly to tocilizumab.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40744-021-00299-8.

Estimation and correlation of serum and salivary C-reactive protein in oral potentially malignant disorders

Background: A large proportion of oral cancers arise from oral potentially malignant disorders (OPMDs). Very few studies have assessed serum and salivary C-reactive protein (CRP) levels in OPMDs warranting further research. Furthermore, no study has evaluated the correlation of serum and salivary CRP in OPMDs to the best of our knowledge. Objectives: The study aimed to compare serum and salivary CRP levels between subjects with OPMDs and controls along with their correlation. Materials and Methods: A total of 60 subjects with 30 subjects each in the study (Group 1) and control group (Group 2) were included. Group 1 was further categorized into group 1a, 1b, and 1c comprising 10 subjects each of Leukoplakia, Oral lichen planus (OLP), and Oral submucous fibrosis (OSMF). Group 2 comprised of 30 age and gender-matched controls. Results: Higher mean serum and salivary CRP levels were found in subjects of Group 1 (5.91 ± 3.11 mg/L and 1.00 ± 0.45 mg/L, respectively) as compared to group 2 (2.18 ± 0.66 mg/L and 0.48 ± 0.33 mg/L) with a statistically significant difference (P

C-reactive Protein and Hepcidin in Non-Dialysis Chronic Kidney Disease

Complications such as anemia and its clinical consequences arise as chronic kidney diseases progress,. One renal anemia pathophysiology is a disruption of iron metabolism, regulated by the main iron exporter hormone, hepcidin. Chronic kidney disease patients were constantly in an inflammatory state, represented by an increased in C-reactive protein. This inflammatory state would facilitate the liver to secrete hepcidin, which would subsequently follow a decrease of iron circulation, thus resulting in functional iron deficiency. Both acute phase reactants which used thoroughly as markers in tropical and infectious diseases, had their own roles in chronic kidney disease. The correlation of c-reactive protein and hepcidin in chronic kidney disease patients was still controversial. To analyse the relationship between c-reactive protein and hepcidin in non-dialysis chronic kidney disease patients. We conducted an observational cross-sectional study with 40 non-dialysis chronic kidney disease patients who met the inclusion and exclusion criteria. Patients were enrolled with consecutive sampling and were examined for serum c-reactive protein and hepcidin levels.A total of forty subjects (67.5% male with mean age of 50.23 ± 1.04 years) were eligible for enrolment in this study. The most comorbid factor was hypertension (62.5%). The common stage for chronic kidney disease was stage 3 (40%). The mean hemoglobin value was 10.74 ± 0.36 g/dL, mean blood urea nitrogen was 39.98 ± 29.59 mg/dL, and serum creatinine of 4.12 ± 3.39 mg/dL. Mean serum c-reactive protein levels were 3.52 ± 5.13 mg/l. Mean hepcidin level were 94,03 ± 95,39 ng/ml. Serum C-reactive protein levels correlated positively (r=0.487) and significantly (p-value=0.001) with serum hepcidin value. C-reactive protein and hepcidin was significantly correlated in non-dialysis chronic kidney disease patients.

Intermittent Appearance of Antibodies to Infliximab Is Not Associated With Reduced Efficacy in Patients With Inflammatory Bowel Diseases.

To assess the clinical significance of antibodies to infliximab (ATI) formation in patients with inflammatory bowel disease (IBD). Infliximab therapy in patients with IBD is highly effective though up to 50% of patients lose response to infliximab. ATI formation occurs in 6% to 60% of patients on scheduled infliximab maintenance therapy. Infliximab trough levels and ATI at trough were prospectively determined in patients with IBD on maintenance infliximab therapy. Patients on infliximab maintenance therapy with at least 3 ATI measurements were included. Patients were divided into 2 groups: sustained negative (<1 µg/mL) ATI levels, and fluctuating ATI levels (at least 1 sample with ATI <1 and at least one >1 µg/mL). Forty-eight patients with IBD with available clinical data and serum samples were included. 25 patients had sustained low ATI levels and 23 patients had fluctuating ATI levels. Both groups were similar in IBD subtype distribution (Crohn's disease in 73.9% and 60%), mean serum albumin levels (4.2 vs. 3.9 g/dL), and mean trough serum infliximab levels (3.3 vs. 4.6 µg/mL) in fluctuating ATI and low ATI groups, respectively. There were no significant differences in the rate of clinical response (64% vs. 76%) and mean serum C-reactive protein levels (9.4 vs. 8.5 mg/dL, ULN=5) in the fluctuating ATI and low ATI groups. Similar rates of clinical response in the fluctuating ATI and low ATI groups were observed in ulcerative colitis (33% vs. 40%) and Crohn's disease (76% vs. 100%). The fluctuating pattern of appearance of ATI in patients with IBD was not associated with loss of clinical response or a rise in C-reactive protein. The authors suggest that in clinical decision making, only sustained appearance of ATI should be considered as an adverse therapeutic factor.

Is There Any Relationship Between Cervical Disc Herniation and Blood Inflammatory Response?

ObjectiveInflammation plays an important role in the pathophysiology of disc herniation. The aim of this study was to evaluate blood neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and C-reactive protein (CRP) levels in cervical disc herniation (CDH) patients.Materials and methodsWe retrospectively analyzed the medical records of 126 patients with neck pain who were treated as inpatients at the Neurosurgery Department of Harran University Faculty of Medicine. The NLR, PLR, and CRP levels during hospital admissions were documented.ResultsThe study included 73 patients with CDH and neck pain, 53 patients with normal cervical MR examination and neck pain, and 50 healthy control subjects. The group with cervical disc hernia had a significantly higher mean serum leucocyte count, neutrophil count, NLR, and CRP level compared to those with a normal MR but neck pain and the control group. NLR was significantly higher in the multi-level CDH group compared to the control group, while the single-level CDH and multi-level CDH had no significant difference with respect to mean serum inflammatory parameters.ConclusionHigher NLR and CRP in patients with CDH compared to patients with neck pain but normal cervical MR and the controls may be due to a developing inflammatory response. It may be speculated that among patients with neck pain, those with non-elevated NLR and CRP levels may have normal neck MR imaging, and in patients with elevated NLR and CRP levels, early protective approaches may play a preventive role in disc degeneration and cervical disc hernia development.

Effect of Body Mass Index on the Disease Activity of Patients With Rheumatoid Arthritis in a Gender-Specific Manner and the Association of Respective Serum C-Reactive Protein Levels With the Body's Inflammatory Status.

BackgroundCurrent literature evaluating the effect of high body mass index (BMI) on the disease activity of patients with rheumatoid arthritis (RA) is mixed as some studies have shown a positive, linear relationship between BMI and disease activity while others have demonstrated an inverse correlation. Through this study, we have expanded the effect of BMI on disease activity in patients with RA. We have further expanded on whether BMI influences the disease activity depending on the gender being studied. Finally, we have studied whether there is a correlation between high BMI values and rising C-reactive protein (CRP) levels.MethodologyThis cross-sectional study was conducted at the Outpatient Clinical Department of Buffalo Rheumatology. The study was ethically approved by the Catholic Health Institutional Review Board. A total number of 451 patients’ clinical data was selected based on inclusion/exclusion criteria. The patients were divided into different BMI categories based on the guidelines of national obesity education initiative of the national heart, lung, and blood Institute. The following clinical parameters were studied: BMI, serum CRP level, and disease activity through routine assessment of patient index data questionnaire 3 (RAPID3). The minimum sample size (n = 358) was calculated via the world health organization sample size calculator. All data were entered and analyzed through Statistical Package for the Social Sciences (SPSS), version 16.0 (IBM Corp., Armonk, NY).ResultsOur study sample included 98 males and 353 females (22% and 78%, respectively). Collective data for both the genders showed significantly increased disease activity in RA patients with high BMI values (p = 0.04). When the data sets were categorized according to the two genders, it was noted that the aforementioned results remain significant for the females only (p = 0.02 for females and p = 0.57 for males). At all BMI values, mean RAPID3 scoring remained significantly higher for females as opposed to their male counterparts (p = 0.006). Mean serum CRP levels increased linearly with increasing BMI (p < 0.001); however, for the underweight patient population, mean CRP levels were the highest as compared to normal weight, overweight, moderately obese, and severely obese patients.ConclusionWe conclude that the association between the BMI and the severity of disease remains elusive. High BMI values increase the risk of a pro-inflammatory state of the body due to higher serum CRP levels. Estimating the clinically significant benefit of this theory would require a large-scale clinical trial that would highlight the role of losing weight in improving the patients’ quality of life, pain control, and mortality.

The importance of C-reactive protein levels for surgical decision-making and determination of response to conservative therapy in patients with acute sciatica

Aim: We aimed to determine C-reactive protein (CRP) levels in patients with intervertebral disc disease (IDD) and to evaluate these patients’ radiological and clinical characteristics. Material and Methods: A total of 102 patients were divided into four groups according to lumbar MRI results using the Macnab classification: bulging, protrusion, extrusion-sequestration, and normal. Straight leg raising test (SLR) and visual analogue scale (VAS) were used for clinical evaluation. Patients with bulging and protrusion were treated with conservative therapy within 5-10 days and bed-rest. Blood samples, SLR values and VAS scores were obtained from these patients before and after conservative therapy. The extrusion-sequestration group underwent lumbar spinal surgery. Medical treatment was not applied to this group and blood samples were collected only preoperatively. Individuals with normal MRI findings and no spinal complaints were evaluated as controls. Results: CRP levels were found to be 6.61 ± 7.78 in controls, 6.62 ± 5.28 in the bulging group, 11.50 ± 21.71 in the protrusion group and 17.18 ± 48.22 in the extruded-sequestration group (p=0.321). CRP levels were significantly decreased after treatment in the bulging group (p=0.001). Positive correlations were found between post-treatment VAS scores and pre-treatment WBC in the protrusion group, and with CRP levels in the bulging group. Conclusion: Although no statistically significant difference was determined, we observed higher mean serum CRP levels in the surgical group (extrusion-sequestration). We believe that further studies must be performed to determine whether serum CRP levels can be used as a prognostic marker in surgical decision making.

C-reactive protein levels in acute pancreatitis and its clinical significance

Background: Acute pancreatitis is one of the most common problems faced by surgeon in their practice. Alcohol being one of the most important etiology in country like India. The most common line of management has always been conservative until and unless surgery is indicated for its complications. Till date amylase and lipase have been used as diagnostic tool for it however certain prognostic tools like CRP are still under evaluation. Thus we have made an attempt to evaluate its significance as a prognostic tool in this study.Methods: A hospital based observational comparative prospective study was done with 100 patients to measure C-reactive protein (CRP) levels in patients of acute pancreatitis and evaluate if CRP levels predict the severity of pancreatitis.Results: The mean serum CRP level of patients with Ranson’s score &lt;3 was significantly higher as compared to mean serum CRP level of patients with Ranson’s score ≥3 (10.54±5.00 mg/l vs 7.29±3.94 mg/l). There was significant association of serum CRP and Ranson’s score of patients.Conclusions: The rapid response of CRP to changes in the intensity of the inflammatory stimulus suggests that it might be valuable in the assessment and monitoring of acute pancreatitis. It was observed in our study that measurement of CRP level is a simple method to assess the severity of disease.

Impact of energy deficit during hospitalization and biomarkers at admission on clinical outcomes in critically ill children: A longitudinal study

To evaluate the impact of energy deficit during hospitalization and the biomarkers albumin and C-reactive protein (CRP) on the clinical outcomes length of stay (LOS) and duration of mechanical ventilation (DMV) in children and adolescents admitted to the pediatric intensive care unit (PICU) of a private hospital in Rio de Janeiro. A longitudinal, retrospective study was conducted of the medical records of patients admitted to the PICU from May 2016 to June 2017 who received enteral nutrition (EN) for 72h or longer. The cut-off points for serum albumin and CRP were set at ≥3.5 and <2.0, respectively. The energy balance was calculated as the difference between the energy prescribed and the energy received by the patient. The comparison of continuous variables related to LOS and DMV was assessed using Student's t-test and the Mann-Whitney test. The significance value was set at p<0.05. Ninety-three patients were selected, with a median age of 32 (±39.49) months. The mean serum albumin and CRP levels were 4.04 (±0.59) and 4.67 (±7.40), respectively. In linear regression models adjusted for length of stay, reduced albumin, increased CRP, and negative energy balance were positively associated. In the models adjusted to DMV, the values for reduced albumin and increased CRP were significant. A significant association was found between serum albumin and CRP at admission and the outcomes under investigation, LOS and DMV. Energy deficit was also associated with LOS.

“STUDY OF C-REACTIVE PROTEIN, SUPEROXIDE DISMUTASE LEVEL AND BIOMARKERS IN RECENTLY DIAGNOSED HYPERTENSION”

Acute myocardial infarction (AMI) is a significant cause of morbidity and mortality worldwide, which results from occlusion of coronary artery. C-reactive protein (CRP) is an acute phase protein, synthesized by hepatocytes in response to cytokines released into circulation by activated leukocytes. It is a sensitive marker of coronary infl ammation as well as the extent of myocardial necrosis. We incorporated all the ambulant patients (over 18 years old) of both sex having hypertension and normotension going to in the general outpatient office (OPD) for one month. CRP measurement has many advantages in detection and monitoring the acute phase response.This study showed that mean serum CRP levels were increased in the study group. Among two subgroups, mean CRP level increased signifi cantly in the group with risk factors when compared with another group. Most of the male subjects were in 51 – 60 years old and the female were in 41 - 50 years. Among 75 of male subjects, 64% were hypertensive, and among 35females 61% were hypertensive. Mean CRP level in normotensive gathering was 1.072 mg/L (± 0.320) and in hypertensive gathering was 2.824 mg/L (± 0.258). The individuals who created LVH (n=75, 51.02%), their gauge CRP was 2.767 mg/L (±0.318).&#x0D; Key words: Acute myocardial infarction, C-reactive protein, Hypertension, superoxide dismutase.

Can Endocan Predict Late-Onset Neonatal Sepsis?

Objective Endocan, a proteoglycan secreted by endothelial cells, plays a role in the pathogenesis of sepsis. Endocan is an effective diagnostic and prognostic biomarker of sepsis in adult patients. We evaluate the utility of endocan as a new biomarker in the recognition of late-onset neonatal sepsis (LOS) in preterm infants. Methods This study included preterm infants at gestational age ≤ 32 weeks diagnosed with LOS. Sepsis was diagnosed in the presence of three or more clinical findings plus significant elevation of C-reactive protein (CRP) or interleukin 6 (IL-6) levels. Blood samples were obtained to determine leukocyte count, CRP, IL-6, and endocan levels immediately after the sepsis diagnosis and on the 3rd and 7th day after diagnosis. Results A total of 102 preterm infants, 52 with LOS (21 proven, 31 suspected sepsis) and 50 controls, were included in the study. Mean leukocyte count, serum CRP, IL-6, and endocan levels were significantly higher in the LOS group compared with healthy controls (p &lt; 0.001) at enrolment. Serial measurements showed no significant difference in CRP and IL-6 levels between the proven and suspected sepsis groups, while endocan levels were significantly higher at enrolment and on day 7 in the proven sepsis group (p = 0.003 and p = 0.01, respectively). The endocan levels of preterm infants who died were significantly higher at all time points (p &lt; 0.001, p = 0.001, and p = 0.004, respectively). Conclusion Endocan is an effective, reliable, and promising new biomarker for detecting LOS in preterm infants.

Serum procalcitonin levels in incisional surgical site infections requiring a secondary suture after cesarean sections

Purpose: Surgical site infections (SSIs) after cesarean section cause maternal morbidity and economic and emotional burdens on society. Our aim is to measure procalcitonin (PCT) levels in patients who developed incisional SSIs after cesarean section while also comparing PCT concentrations between patients who underwent a secondary suture and who did not require a secondary suture. Methods: Ninety-four patients who developed incisional SSI after cesarean section were enrolled in our study. At the time of admission, serum PCT, C-reactive protein (CRP), and white blood cell (WBC) counts were measured. The study population was grouped into two, based on the need of a secondary suture and the patients baseline blood tests were compared. Results: The mean serum CRP level was not significant among the groups; however, the median serum PCT level was significantly higher in patients who required a secondary suture (0.21 vs. 0.05 ng/ml, p ≤ .0001). Serum PCT levels were positively correlated with the length of hospital stay (r = 0.72, p = .0001). Area under the curve (AUC) for PCT in predicting the need of a secondary suture was 0.85 (95% CI: 0.772–0.922) and the cutoff point was 0.142 ng/ml with a sensitivity of 75% and specificity of 97.8% (p = .0001). Conclusion: Serum PCT is a promising marker for both diagnosing and predicting the severity of SSIs after cesarean sections.

English

Malaria and septicaemia, both major causes of infant and early childhood morbidity and mortality in Nigeria, often co-exist and are difficult to differentiate. This study was designed to test the hypothesis that C-reactive protein (CRP) levels could differentiate between malaria and malaria coexisting with septicaemia. One hundred and fifty-one children aged 6 to 60 months with fever without localising signs and 141 aged/sex-matched controls were studied. C-reactive protein levels in all the children were determined while the febrile children had their blood cultures done. ANOVA and students‘t’ test were used to determine the difference between groups. Sensitivity, negative predictive and positive predictive values for malaria coexisting unit septicaemia were calculated for various levels of CRP. One hundred and thirty (86.1%) of the subjects had malaria alone while 21 (13.9%) had malaria coexisting with septicaemia. Organisms isolated were mainly Enterobacteriaceae (7), Staphylococcus aureus (9), Salmonella spp. (4) and Streptococcus pneumoniae (1). The mean serum CRP levels in subjects with malaria alone and malaria coexisting with septicaemia were 82.16 ± 44.94 mg/l and 108.44 ± 55.65 mg/l respectively (P=0.0176). At the diagnostic level of 90 mg/l (value just greater than the mean for malaria alone), CRP was highly sensitive (sensitivity 76.2%) in detecting septicaemia in 21 subjects with co-morbidity while specificity (36.9%) was low. It is concluded that CRP can differentiate between malaria and malaria with septicaemia. In children with malaria, antibiotics should be started at the CRP level of ³ 90 mg/l. Key words: Malaria, septicaemia, C-reactive protein, diagnosis.

Predictors of Organ Damage Progression and Effect on Health-related Quality of Life in Systemic Lupus Erythematosus.

To describe organ damage accrual, predictors of damage progression, and effect on health-related quality of life (HRQOL) in patients with systemic lupus erythematosus (SLE). A longitudinal database of patients who met the American College of Rheumatology (ACR) classification criteria for SLE was used. Annual assessments included the Systemic Lupus International Collaborating Clinics/ACR Damage Index (SDI) and the Medical Outcomes Study Short Form-36 (SF-36). The prognostic significance of demographic, disease-related, and treatment-related factors on damage progression was examined using multivariable Cox regression. The effect of changes in SDI scores on HRQOL, measured using the SF-36 summary and subscale scores, was assessed using linear mixed-effects modeling. There were 273 patients with SLE studied over a mean (SD) duration of followup of 7.3 (4.3) years. During followup, 126 (46.2%) had an increase in SDI scores. Patients with preexisting damage at baseline were more likely to have earlier damage progression (HR 2.09, 95% CI 1.44-3.01). Older age, ≥ 8 ACR classification criteria, immunosuppressive drugs, cigarette smoking, and higher mean serum C-reactive protein levels were associated with an earlier increase in SDI scores in multivariable analysis. In general, changes in SDI scores were associated with initial declines in SF-36 scores at the time that damage occurred, with subsequent change comparable to that seen in patients without damage progression. This study identified multiple risk factors, some modifiable, associated with damage progression in patients with SLE. The negative effect on HRQOL emphasizes the need for treatment strategies to reduce the risk of organ damage over time.

C-reactive protein levels in girls with lower urinary tract symptoms

Daytime lower urinary tract (LUT) conditions are identified as daytime incontinence problems for children in whom any cause of neuropathy and uropathy has been excluded. C-reactive protein (CRP) is a common marker of acute or chronic inflammation and infection. Increased CRP levels have been detected in the studies conducted on adults diagnosed with overactive bladders and interstitial cystitis. This study aimed to investigate the role of serum CRP levels in girls suffering from daytime LUT conditions. Out of the 752 patients who presented to the outpatient clinics with lower urinary tract symptoms, 709 were excluded due to: being boys, having previous urinary tract surgery, an active urinary tract infection, a neurological anomaly, a urinary system anomaly, having rheumatic disease, any chronic disease, any febrile infection over the past week, a history of constipation, and enuresis nocturna. Forty-three girls with LUT conditions and aged 8-10 years were included in the study as the patient group. Forty girls who attended the urology outpatient clinic without LUT conditions, or active urinary tract infections and any chronic disease requiring follow-up constituted the control group. Under the control of the parents, all subjects were asked to fill out 3-day voiding diaries. The voiding diaries identified frequency, urgency, urgency urinary incontinence, and functional bladder capacity data. All subjects also completed a dysfunctional voiding scoring system (DVSS). The serum CRP levels of all subjects were measured. There was a significant difference in serum CRP levels and DVSS between the patient group and the control group (P = 0.001, P = 0.001). The mean serum CRP levels showed a significant increase when frequency and urgency scores were ≥8, the urge incontinence score was ≥2 and the DVS score DVSS was ≥14 in the voiding diaries of the patient group (Table). Lower urinary tract dysfunction is defined as a condition involving abnormalities of filling and/or emptying of the bladder. This frequently encountered problem constitutes >40% of all pediatric urology outpatient visits. The relationship between LUT conditions and serum CRP in both genders has been detected. However, it is believed that to our knowledge, this is the first study looking at the relationship between daytime LUTS and increased CRP levels in children. The most important limitations of the study were: having a small number of patients, and the sample consisting of only one gender and a specific age group. The serum CRP levels were significantly higher in the girls with daytime LUT conditions than in the control group. Also, the CRP levels significantly increased as DVSS, frequency, urgency, and urge incontinence scores increased.