Positive Acute Phase Reactants Research Articles

Which one predicts mortality better in acute ischemic stroke: negative vs positive acute-phase reactants

ABSTRACT Aim The aim of the study is to investigate the relationship between negative acute-phase reactants and positive acute-phase reactants with in-hospital mortality in patients diagnosed with acute ischemic stroke (AIS) in the emergency department (ED). Methods and Materials Patients aged 18 and older who presented to the ED of a tertiary hospital with AIS were included in the study. Demographic and clinical characteristics, laboratory parameters, acute-phase reactants, National Institutes of Health Stroke Scale (NIHSS), and outcome data of the included patients were recorded on a standard data form. Results A total of 588 patients were included in the study. When the in-hospital mortality of patients was examined, the mortality rate was 17.7%. In the analysis for predicting mortality, it was determined that albumin had the highest predictive power between the area under the curve (AUC) and the determined predictive values (AUC: 0.759, 95% CI 0.707–0.810, p < 0.001). The analyses of the study data revealed that albumin (<0.001) and TF (p = 0.049), which are negative acute-phase reactants, were independent predictors of mortality. According to our study data, in patients with AIS, for each unit decrease in albumin level at the time of ED admission, the risk of mortality increased by 0.868 times, and for each unit decrease in TF level, the risk of mortality increased by 0.593 times. Conclusion According to the study data, albumin and TF levels, which are negative acute-phase reactants, are independent determinants of in-hospital mortality in patients with acute ischemic stroke in the emergency department.

Ludwig's Angina, Clinical Challenge in Pediatrics. – A Case Report

BACKGROUND: Ludwig's angina is a rapidly progressing cellulitis that occurs in the sublingual, submandibular, and submental spaces, with a high mortality rate due to its potential to obstruct the airway. Its primary cause is odontogenic, with polymicrobial infection being the most common scenario. The occurrence of this condition is less common in the pediatric population, but children are more susceptible to life-threatening complications. THE CASE: A two-year-old male preschooler, with no significant medical history, presented with a clinical picture evolving over six days. This was characterized by recurrent fever spikes (up to a maximum of 38.7 degrees Celsius) and a growing, stony, painful mass in the right cervical region measuring 5cm x 5cm. The patient had not shown improvement despite self-medication with amoxicillin at home. Upon admission to a regional hospital, a fixed, painful, stony mass was found in the right submandibular region. Blood tests revealed leukocytosis with a left shift, positive acute-phase reactants, and a neck ultrasound indicating upper cervical adenitis without abscess formation. Antibiotic treatment was initiated for six days. However, the fever persisted, and there was an increase in the size of the lesion, along with the formation of an abscess and limited neck rotation. Consequently, on the 12th day of illness, the patient was referred to a tertiary-level hospital where a large, fixed, stony lesion was observed in neck regions II and III, with no exclusion of a neoplastic process. The patient also experienced difficulty swallowing, necessitating a liquid diet. It was decided to perform drainage under sedation and a biopsy, which revealed a stony mass in the right neck region II extending into the submental space and midline. There were severe inflammatory changes in the subcutaneous tissue, necrotic lymph nodes, but no abscess was found. Pathological examination showed inflammatory infiltrate, recent hemorrhage and vascular congestion, with the initial suspicion being an infectious process. Flow cytometry of the cervical lymph node showed no alterations in the lymphoid series but an elevation of neutrophils. However, due to the characteristics and location of the lesion, a consultation with pediatric hematologic-oncology was sought, and they considered a low likelihood of malignancy. A tuberculin test was requested and returned negative results. A culture of the lesion also yielded negative results. During hospitalization, the condition was considered Ludwig's angina, and the patient continued to show a progressive reduction in temperature and adenitis. On the 21st day, the patient exhibited a reduction of approximately 90% in the size of the lesion, leading to the discontinuation of antibiotic treatment and subsequent medical discharge. CONCLUSION: Ludwig's angina is an infection that primarily affects the floor of the mouth, progressing rapidly and potentially compromising the patient's airways, thus warranting a medical emergency status. It is uncommon and can be mistaken for neoplastic diseases or other infections, highlighting the need for knowledge about this condition and a high degree of suspicion due to its potentially life-threatening consequences. The goal is to establish appropriate management through a multidisciplinary team, given the complexity of its manifestations.

Cutaneous Mucormycosis Due to Rhizopus oryzae in Immunocompromised Pediatric Patient

Abstract Introduction Mucormycosis is an infection predominantly in immunocompromised patients by fungi of the Mucorales order, the most frequent being Rhizopus spp., Mucor spp. and Lichteimia spp. Characterized by vascular invasion, necrosis in the lung, CNS, paranasal sinuses, gastrointestinal system, and skin. Case Presentation 2-year-old female patient, native and resident of Valle de Chalco, State of Mexico. Recent diagnosis of B lineage acute lymphoblastic leukemia, in remission induction phase. Medical/surgical history: December 10 2021: Bone marrow aspirate -January 10 2022: Remission induction chemotherapy with vincristine and daunorubicin -January 17 2022: Central venous catheter placement -Family history: Parents are reported healthy. Positive drug addiction for smoking. They have two doses of vaccine for SARS COV2 -Epidemiologic history: Protective isolation was indicated in this patient -Allergies, rash, transfusion and traumatic: Denied -Adequate nutrition, adequate hygiene, complete vaccination schedule. Neurodevelopment according to age -Hospitalized on January 17 for fever and neutropenia, treatment with fourth-generation cephalosporin as initial management. -On January 20, 2022, she presented an erythematousviolaceous papular lesion, raised in the center, without central necrosis, without elevation, and painful on palpation on the right forearm -Treatment with fourth generation cephalosporin and glycopeptide was started, a biopsy culture of the lesion was taken and Central and peripheral blood cultures -On physical examination, an erythematous-violaceous maculopapular lesion was observed on the right forearm, without necrosis, without exudate and painful on palpation. Vital Signs in normal ranges. Relevant labs Leukopenia was found with profound neutropenia and thrombocytopenia. Positive acute phase reactants, with positive procalcitonin and C-reactive protein. Final Diagnosis For the study of the tissue, debridement of the wound, samples of the spindle center and external edges for biopsy and Lactophenol cotton blue staining were performed. Final diagnosis is Cutaneous Mucormycosis. The culture reports Rhizopus oryzae. For treatment, start Liposomal Amphotericin B 5 milligrams per kilogram per dose every 24 hours. It was increased to 10 milligrams per kilogram per dose for progression of the lesion. Teaching Points Mucormycosis is produced by opportunistic fungi of the order Mucorales. It presents an acute and fatal course that requires early diagnosis and treatment to avoid complications and death (1) A timely diagnosis is very important, since with surgical and antifungal treatment the survival rate increases to 70% (2) Isavuconazole showed activity against mucormycosis with efficacy similar to Amphotericin B. Isavuconazole can be used for the treatment of mucormycosis and is well tolerated (3,4).

The study of some biochemical parameters in the serum of infected and recovered patients with COVID-19

Few biochemical and immunological studies have been conducted on Iraqis infected with novel coronaviruses, and also Patients' post-recovery condition is unknown. Therefore, we aimed to study the impact of COVID-19 on some biochemical compounds in the serum of the infected subjects and to follow up the impact after 6-7 months. The research was conducted in Baghdad-Iraq from October to December 2021, and the study included four groups (each group consisted of 20 subjects): Group (A) Infected subjects without vaccination; group (B) Recovered subjects without vaccination; group (C) Recovered subjects after vaccination; and group (D) Non-infected subjects after vaccination. Subjects with COVID-19 infection confirmed by PCR and vaccinated individuals received the same type of vaccine. The authors measured some positive acute phase reactants (ferritin, C-reactive protein, and D-dimer), antibodies (IgM and IgG), and enzymes (LDH, AST, and ALT) in the subjects' serum. The study result showed an Increase in ferritin, CRP, D-dimer and LDH levels in the serum of infected subjects (group A). The antibody levels in the four groups were elevated, while the liver enzymes (ALT and AST) were in the normal values. Elevation of LDH level also in the serum of recovered subjects (groups B and C). Elevated ferritin, CRP, and D-dimer levels may not remain in infected patients after recovery from COVID-19 except for LDH, which is still elevated in some Iraqi subjects in Baghdad. Keywords: Iraq, COVID-19, Vaccine, Acute Phase Reactants, Antibodies, Liver enzymes

What a Lower Value of Fasting Plasma Glucose in Smokers

Background: There may be a significant relationship between smoking and fasting plasma glucose (FPG) in the human body. Method: Consecutive daily smokers at least for a period of six months and age and sex-matched non-smokers were included into the study. Cases with regular alcohol consumption (one drink a day) and patients with inflammatory, infectious, or devastating disorders including eating disorders, malignancies, acute or chronic renal failure, cirrhosis, chronic obstructive pulmonary disease, hyper- or hypothyroidism, or heart failure were excluded from the study. Results: The study included 150 smokers (99 males) and 162 non-smokers. The mean age of smokers was 45.9 years, and 66.0% of them were male. Although the mean body weight, body mass index, systolic and diastolic blood pressures, and hematocrit values were similar in both groups, FPG value was lower in the smokers (101.9 versus 111.9 mg/dL, p&lt;0.01), significantly. Similarly, high density lipoproteins (HDL) value was lower in the smokers (41.1 versus 44.0 mg/dL, p&lt;0.05), again. On the other hand, triglycerides (163.3 versus 151.8 mg/dL, p&lt;0.05), low density lipoproteins (LDL) (126.1 versus 117.4 mg/dL, p&lt;0.05), erythrocyte sedimentation rate (ESR) (10.8 versus 9.4 mm/h, p&lt;0.05), and C-reactive protein (CRP) (2.5 versus 2.1 mg/L, p&lt;0.05) values were all higher in the smokers, significantly. Conclusion: Smoking causes a low-grade systemic inflammation on vascular endothelium terminating with an accelerated atherosclerosis-induced end-organ insufficiencies all over the body. FPG and HDL may be negative whereas triglycerides, LDL, ESR, and CRP positive acute phase reactants indicating the inflammatory effects of smoking in the human body.

Fasting Plasma Glucose May İnitially Behave as a Positive But Eventually Negative Acute Phase Reactant in The Body

Background: Smoking may cause a low-grade inflammation on vascular endothelium terminating with an accelerated atherosclerosis-induced end-organ insufficiencies. Plasma triglycerides may be positive acute phase reactants (APRs) whereas fasting plasma glucose (FPG) negative APR indicating the inflammatory effects of smoking. Method: Consecutive patients with irritable bowel syndrome (IBS) and age and sex-matched control cases were included. IBS was diagnosed according to Rome II criteria in the absence of red flag symptoms including pain, nocturnal diarrhea, weight loss, fever, or any abnormal finding of the physical examination.

What a lower prevalence of diabetes mellitus but higher incidence of dyslipidemia in smokers

Background: We tried to understand whether or not there is a relationship between smoking and diabetes mellitus (DM). Methods: Current regular smokers for the last six months and age and sex-matched non-smokers were included. Patients with current alcohol consumption (one drink a day) and patients with malignancies or inflammatory, infectious, or devastating disorders were excluded. Results: The study included 247 smokers and 167 non-smokers. The mean age and body mass index (BMI) of smokers were 46.2 years and 26.6 kg/m2, respectively, and 70.0% of them were male. Although the mean weight, BMI, systolic and diastolic blood pressures, and hematocrit values were similar in both groups, fasting plasma glucose (FPG) and DM were lower in the smokers (102.3 versus 111.6 mg/dL, p=0.007 and 8.9% versus 14.3%, p&lt;0.05, respectively). Similarly, high density lipoproteins (HDL) were lower in the smokers, again (40.9 versus 44.0 mg/dL, p&lt;0.05). On the other hand, triglycerides (163.1 versus 151.3 mg/dL, p&lt;0.05) and low density lipoproteins (LDL) (123.8 versus 117.5 mg/dL, p&lt;0.05) were higher in the smokers. Parallel to triglycerides and LDL, erythrocyte sedimentation rate (ESR) (10.6 versus 9.3 mm/h, p&lt;0.05) and C-reactive protein (CRP) (2.3 versus 2.0 mg/L, p&lt;0.05) were also higher in them. Conclusion: Smoking-induced low-grade inflammation on vascular endothelium in whole body may terminate with the endothelial dysfunction, accelerated atherosclerosis, end-organ insufficiencies, early aging, and premature death. FPG and HDL may be negative whereas triglycerides, LDL, ESR, and CRP positive acute phase reactants terminating with lower prevalence of DM but higher incidence of dyslipidemia in smokers. Key words: Smoking, fasting plasma glucose, diabetes mellitus, high density lipoproteins, triglycerides, low density lipoproteins, dyslipidemia

POSITIVE AND NEGATIVE ACUTE PHASE REACTANTS IN SMOKERS

Background: We tried to understand whether or not there are some positive and negative acute phase reactants (APR) indicating the possible inflammatory effects of smoking on vascular endothelium. Method: Consecutive daily smokers at least with a history of one pack-year and age and sex-matched non-smokers were taken into the study. Cases with regular alcohol consumption (one drink a day) and patients with inflammatory, infectious, or devastating disorders, or heart failure were excluded. Results: The study included 247 smokers (173 males) and 167 non-smokers. Interestingly, the mean age of the smokers was 46.2 years, and 70.0% of them were males. Although the mean body weight, body mass index, systolic and diastolic blood pressures, and hematocrit values were similar in both groups, plasma triglycerides (163.1 versus 151.3 mg/dL, p&lt;0.05), low density lipoproteins (LDL) (123.8 versus 117.5 mg/dL, p&lt;0.05), erythrocyte sedimentation rate (ESR) (10.6 versus 9.3 mm/h, p&lt;0.05), and C-reactive protein (CRP) (2.3 versus 2.0 mg/L, p&lt;0.05) values were all higher in the smokers, significantly. On the other hand, high density lipoproteins (HDL) (40.9 versus 44.0 mg/dL, p&lt;0.05) and fasting plasma glucose (FPG) (102.3 versus 111.6 mg/dL, p= 0.007) values and prevalence of diabetes mellitus (8.9% versus 14.3%, p&lt;0.05) were all lower in the smokers, significantly. Conclusion: Smoking may cause a low-grade systemic inflammation on vascular endothelium terminating with an accelerated atherosclerotic process-induced end-organ insufficiencies all over the body. Plasma triglycerides, LDL, ESR, and CRP may be positive whereas HDL and FPG may be negative APR indicating such inflammatory effects in the body. Key words: Smoking, triglycerides, low density lipoproteins, erythrocyte sedimentation rate, C-reactive protein, high density lipoproteins, fasting plasma glucose

SMOKING CAUSES A LOW-GRADE SYSTEMIC INFLAMMATION IN THE HUMAN BODY

Background: There may be some positive and negative acute phase reactants (APR) indicating the possible inflammatory effects of smoking on vascular endothelium all over the body. Method: Consecutive daily smokers at least for a period of six months and age and sex-matched non-smokers were taken into the study. Cases with regular alcohol consumption (one drink a day) and patients with inflammatory, infectious, or devastating disorders including eating disorders, malignancies, acute or chronic renal failure, cirrhosis, chronic obstructive pulmonary disease, hyper- or hypothyroidism, or heart failure were excluded. Results: The study included 150 smokers (99 males) and 162 non-smokers. Interestingly, the mean age of the smokers was 45.9 years, and 66.0% of them were male. Although the mean weight, body mass index, systolic and diastolic blood pressures, and hematocrit values were similar in both groups, triglycerides (163.3 versus 151.8 mg/dL, p&lt;0.05), low density lipoproteins (LDL) (126.1 versus 117.4 mg/dL, p&lt;0.05), erythrocyte sedimentationrate (ESR) (10.8 versus 9.4 mm/h, p&lt;0.05), and C-reactive protein (CRP) (2.5 versus 2.1 mg/L, p&lt;0.05) values were all higher in the smokers, significantly. On the other hand, high density lipoproteins (HDL) (41.1 versus 44.0 mg/dL, p&lt;0.05) and fasting plasma glucose (FPG) (101.9 versus 111.9 mg/dL, p&lt;0.01) values were lower in the smokers, significantly. Conclusion: Smoking causes a low-grade systemic inflammation on vascular endothelium terminating with an accelerated atherosclerosis-induced end-organ insufficiencies in the body. Plasma triglycerides, LDL, ESR, and CRP may be positive whereas HDL and FPG negative APR indicating the inflammatory effects of smoking in the human body .Key words: Smoking, triglycerides, low density lipoproteins, erythrocyte sedimentation rate, C-reactive protein, high density lipoproteins, fasting plasma glucose

Positive and negative acute phase reactants in sickle cell diseases

Background: We tried to understand some positive and negative acute phase reactants (APR) in sickle cell diseases (SCD). Methods: Consecutive patients with the SCD and controls were studied. Results: The study included 193 patients (98 females) and 132 controls (67 females). Although the body weight and body mass index (BMI) were retarded in the SCD (58.9 versus 71.1 kg and 21.5 versus 26.8 kg/m2, respectively, p&lt;0.000 for both), the body heights were similar in both groups (164.8 versus 162.8 cm, p&gt;0.05). Parallel to the retarded body weight and BMI, fasting plasma glucose (FPG) (93.4 versus 102.4 mg/dL, p=0.025), low density lipoproteins (LDL) (70.4 versus 98.1 mg/dL, p&lt;0.000), high density lipoproteins (HDL) (24.2 versus 35.8 mg/dL, p&lt;0.000), and systolic (117.6 versus 127.9 mmHg, p=0.001) and diastolic blood pressures (BP) (77.3 versus 86.0 mmHg, p&lt;0.000) were all retarded in the SCD. On the other hand, total bilirubin (TB) and lactate dehydrogenase (LDH) were both increased (4.0 versus 0.7 mg/dL and 638.9 versus 268.4 U/L, respectively, p&lt;0.000 for both) in the SCD. Similarly, white blood cell (WBC) and platelet (PLT) counts (16.338 versus 7.407 /µL and 421.424 versus 268.612 /µL, respectively) and mean corpuscular volume (MCV) (90.3 versus 78.3 fL) were all increased whereas the hematocrit (Hct) level was decreased (23.2 versus 36.6%) in the SCD (p&lt;0.000 for all). Conclusion: Body weight, BMI, FPG, LDL, HDL, systolic and diastolic BP, and Hct may be some negative whereas TB, LDH, WBC and PLT counts, and MCV may be some positive APR in the body. Keywords: Sickle cell diseases, positive acute phase reactants, negative acute phase reactants, chronic endothelial damage, atherosclerosis, body weight, body mass index

The Prognostic Capabilities of Positive Acute Phase Reactants in Stratifying Hospitalized Covid-19 Infected Patients

Background/Aim: Several biochemical parameters in mechanically ventilated intensive care unit severe acute respiratory syndrome conronavirus-2 (MVICU-SARS-CoV-2) are strongly correlated with affected COVID-19 patients’ clinical outcomes. Of particular, C-reactive protein (CRP) and ferritin (FER) levels are commonly used in clinical practices for theirs diagnostic and prognostic performances. So, in this study we aimed to explore the two tested positive acute-phase reactants prognosticating capabilities in MVICU-affected COVID-19 patients. Methods: A single-center study was retrospectively processed for eligible admitted MVICU-SARS-CoV-2 infected patients between March 2020 and September 2021. One-Sample and Independent T-Tests were conducted to analyze parametric data while in contrary, Mann Whitney-U and Chi Square Tests were conducted to analyze non-parametric data. A Receiver Operating Characteristic Test followed by Sensitivity Analysis were also conducted to plot the area of each tested prognosticator and to pick the operating optimal dichotomous levels with their corresponding sensitivity indices. Results: Overall 28-day ICU mortality was detected in 94 (48.70%) during an average of 12.40±4.79 days of ICU length of stay. The whole study cohort mean age was 58.37±9.96 years. and the Non-Survivors Cohort were insignificantly younger than the Survivors Cohort (58.09±10.05 years vs 58.55±9.95 years, respectively, p&gt;0.05). Significantly, males were distributed in the study in approximately a 2: 1 ratio compared to females. Biochemically, the c-reactive protein and ferritin were significantly higher in the Non-Survivors Cohort than in the Survivors Cohort [143.09±59.28 mg/dl and 891.51±377.82 ng/ml vs 88.38±34.38 mg/dl and 465.76±154.07 ng/ml, respectively, p LESS THAN 0.05]. Conclusion: In global ever-shrinking in medical teams and facilities, elevated levels of CRP and FER can be potentially used for their reasonable performances and prognostic utilities in early risk stratification and clinical trending tracking in MVICU-SRAS-CoV-2 infected patients. Both tested biochemical prognosticators may facilitate in optimum resource provision and swift management protocols implementation.

The Prognostic Capabilities of Positive Acute Phase Reactants in Stratifying Hospitalized Covid-19 Infected Patients

Background/Aim: Several biochemical parameters in mechanically ventilated intensive care unit severe acute respiratory syndrome conronavirus-2 (MVICU-SARS-CoV-2) are strongly correlated with affected COVID-19 patients’ clinical outcomes. Of particular, C-reactive protein (CRP) and ferritin (FER) levels are commonly used in clinical practices for theirs diagnostic and prognostic performances. So, in this study we aimed to explore the two tested positive acute-phase reactants prognosticating capabilities in MVICU-affected COVID-19 patients. Methods: A single-center study was retrospectively processed for eligible admitted MVICU-SARS-CoV-2 infected patients between March 2020 and September 2021. One-Sample and Independent T-Tests were conducted to analyze parametric data while in contrary, Mann Whitney-U and Chi Square Tests were conducted to analyze non-parametric data. A Receiver Operating Characteristic Test followed by Sensitivity Analysis were also conducted to plot the area of each tested prognosticator and to pick the operating optimal dichotomous levels with their corresponding sensitivity indices. Results: Overall 28-day ICU mortality was detected in 94 (48.70%) during an average of 12.40±4.79 days of ICU length of stay. The whole study cohort mean age was 58.37±9.96 years. and the Non-Survivors Cohort were insignificantly younger than the Survivors Cohort (58.09±10.05 years vs 58.55±9.95 years, respectively, p&gt;0.05). Significantly, males were distributed in the study in approximately a 2: 1 ratio compared to females. Biochemically, the c-reactive protein and ferritin were significantly higher in the Non-Survivors Cohort than in the Survivors Cohort [143.09±59.28 mg/dl and 891.51±377.82 ng/ml vs 88.38±34.38 mg/dl and 465.76±154.07 ng/ml, respectively, p LESS THAN 0.05]. Conclusion: In global ever-shrinking in medical teams and facilities, elevated levels of CRP and FER can be potentially used for their reasonable performances and prognostic utilities in early risk stratification and clinical trending tracking in MVICU-SRAS-CoV-2 infected patients. Both tested biochemical prognosticators may facilitate in optimum resource provision and swift management protocols implementation.

Pattern of serum protein capillary electrophoretogram in SARS- CoV-2 infection

Background and aimsMonoclonal/biclonalgammopathy of unknown significance (MGUS/BGUS) is observed in COVID-19. This study was conducted to determine the changes in serum protein electrophoresis (SPEP) in COVID-19. Materials and methodsIn this descriptive (cross-sectional) study, serum inflammatory markers (CRP, IL-6 and ferritin) were measured and SPEP was carried out by capillary electrophoresis method in 35 controls and 30 moderate & 58 severe COVID-19 cases. ResultsSerum inflammatory markers were increased in COVID-19 cases with severity. M−band(s), β-γ bridging and pre-albumin band(s) on SPEP were observed in 15.5, 11 & 12% of severe cases and 3, 4 & 0% moderate COVID-19 cases respectively. Area under curve (AUC) of α 1 and α 2 bands of SPEP increased significantly in severe COVID-19. ConclusionsWe conclude that SPEP changes like the appearance of M−band(s) indicating MGUS(BGUS), β- γ bridging indicating the presence of fast-moving immunoglobulins, pre-albumin band indicating the rise in serum transthyretin level and the increase in AUC of α 1 and α 2 bands indicating the rise in positive acute phase reactants occur in COVID-19. The occurrence and magnitude of these changes are higher in severe COVID-19 than that in moderate COVID-19. The diagnostic and prognostic significance of these SPEP changes are worth exploring.

Are Changes in Thyroid Hormones Associated with Mortality in Non-Thyroidal Illness Syndrome?

Introduction: Non-thyroidal illness syndrome (NTIS) can be defined as afunctional impairment of the hypothalamic-pituitary-thyroid axis accompanied by signs of non-thyroidal disease with changes in thyroid stimulating hormone (TSH), free T3 (fT3) and free T4 (fT4) levels. NTIS and thyroid hormone levels in this syndrome are thought to be related with mortality. This study was performed to evaluate the relationship between hormone levels and mortality in this syndrome.&#x0D; Methods: The 5-year mortality data of patients who were hospitalized in the first 6 months of 2014 and whose thyroid hormone levels could be checked twice within 5 years were evaluated. In our study conducted with 405 patients whose thyroid function tests was repeated, the follow-up period was 5 years. Biochemical parameters including thyroid function tests were sent from all patients. NTIS was defined as a condition in patients with low fT3 levels (&lt;2.5 pg/mL) and TSH levels within the normal range (0.38-5.33 mIU / L).&#x0D; Results: 128 patients died, and the number of surviving patients was 277 during the follow-up period. Positive acute phase reactants such as CRP, sedimentation, ferritin was high and albumin (negative acute phase reactant) and fT3 levels were low in patients who died. In addition, these changes in biochemical values were statistically significant. The mortality rate was increased in patients with low fT3 and high fT4 levels. In the follow-up period, changes in TSH levels were not significantly associated with mortality.&#x0D; Conclusion: Both the decrease in fT3 levels and the increase in fT4 levels can be used as predictors and independent risk factors for long-term mortality risk in chronically ill and hospitalized patients with NTIS.

The role of C1 inhibitor and complement as acute phase reactants: are we missing the diagnosis of hereditary angioedema?

BackgroundC1 inhibitor (C1-INH) and complement 4 (C4) have historically been referred to as positive acute phase reactants, however this has never been evaluated in hereditary angioedema (HAE) patients. Low function of C1-INH and low levels of C4 are important in the diagnosis of HAE type 1 and 2. If C1-INH and/or C4 are significant acute phase reactants, their levels may be falsely “normal” in patients with HAE when measured during times of infection or inflammation resulting in missed or delayed diagnosis.Case presentationWe present a case series of four HAE patients who had C4, C1-INH, c-reactive protein (CRP) and ferritin measured at baseline and again during a self-reported upper respiratory tract infection (URTI) or flu-like illness. We did not identify any HAE patients who had a significant change in their C1-INH functional level in the context of a mild infection. However, the C4 level did increase into the normal range on three occasions (2 patients, with 1 patient having elevation during two separate illnesses).ConclusionsC1 inhibitor may not be a clinically significant acute phase protein and appears to still be a reliable diagnostic marker of hereditary angioedema, even in times of modest acute inflammation, unlike complement C4 which can be elevated in this setting.

Cholesterol May be a Negative Whereas Triglycerides Positive Acute Phase Reactants in the Plasma

Cholesterol May be a Negative Whereas Triglycerides Positive Acute Phase Reactants in the Plasma

Clinical manifestation, laboratory findings, and outcome of children with cystic fibrosis over a 10-year period in South Iran

BackgroundCystic fibrosis (CF) is a monogenic hereditary disease with diverse complications, which substantially reduce the quality of life and longevity of patients. With regard to the scarcity of information on epidemiological aspects of this disease in Iran, we aimed to examine the current status of pediatric CF patients in a tertiary referral center in south Iran.ResultsMedical records of 105 patients (51% female) with the mean age of 16.3 ± 34.4 months were reviewed. Twelve patients (13.3%) had siblings with CF. Failure to thrive and respiratory symptoms were the most common presentations. Elevated liver enzymes and steatorrhea were detected in over half of tested patients, while abnormal serum albumin level, urinalysis, positive urine cultures, and positive acute phase reactants were noticed in less than half of the patients. Mild increase in pulmonary artery blood pressure was the most common finding of echocardiography. Increased liver echogenicity was the top finding of abdominopelvic sonography. Out of 42 available patients, 19 (45.2%) died with the mean age of 54.4 ± 101.8 months. The highest rate of mortality was observed in the 2–6 years old age group (42.9%).ConclusionIncreased liver echogenicity was the most common finding in hepatobiliary evaluation. Mild increase in pulmonary artery blood pressure was the most common finding of echocardiography.

Comparative effect of immunomodulators on the contents of hydrolase inhibitors and lactoferrin in community-acquired pneumonia in adults

The purpose of our study was to examine the effect of immunomodulators (broncho-vaxom, immunovac-VP4 vaccine and polyoxidonium) upon the kinetics of serum hydrolase inhibitors and lactoferrin in the treatment of community-acquired pneumonia (CAP). The study included 71 CAP patients at the age of 18 to 70 years. The patients were divided into 4 groups: Group I (15 people) was a control group treated with basic antibacterial and symptomatic therapy, according to the standard treatment regimen, without use of immunomodulators; the patients from group II (19 patients) were additionally administered bronchovaxom (the drug was prescribed upon admission: 1 course over 30 days, then 2 rounds for 10 days each, with an interval in 20 days); group III (20 cases) contained the patients who additionally received polyoxidonium (the drug was prescribed from the 1st day of hospitalization, 6 mg daily i/m for 3 days, then 10 injections over 10 days); group IV (17 cases): Immunovac-VP4 vaccine was administered orally 4 ml and intranasally 2 drops on days 1, 4, 7, 10, 13, 19, 25, 31, along with antibacterial and symptomatic therapy. This vaccine consists of antigens from opportunistic microorganisms (a multicomponent mixture of water-soluble antigens of S. aureus, K. pneumoniae, P. vulgaris, E. coli). Serum concentrations of α2-macroglobulin and α1-antitrypsin hydrolase inhibitors were determined by the method of quantitative immunoelectrophoresis using the research test systems; lactoferrin (LF) levels were evaluated by enzyme-linked immunosorbent assay using commercial test systems. These indicators were studied in blood serum before treatment, on the 2nd, 13th, and 60th days of observation. It was shown that administration of immune modulators combined with antibiotic therapy in patients with CAP can affect the kinetics of acute phase inflammatory proteins. The effect of broncho-vaxom corresponds to the classical pathway of the response to inflammatory process, i.e., activation of complex of positive acute phase reactants (α1-antitrypsin and lactoferrin) and inhibition (blocking) of negative acute phase reactants (α2macroglobulin). Polyoxidonium has a noticeable effect only upon neutrophils secreting lactoferrin. ImmunovacVP4 promotes only short-term secretion of this protein. One may assume that activation of hydrolase inhibitors and lactoferrin after use of immunotropic drugs enhances clinical effect of therapy, with decreased severity and duration of symptoms, as well as lower exacerbation risk of chronic diseases and lesser volume of drug intake. Antibacterial therapy does not significantly affect the kinetics of acute phase inflammation reactants in patients with CAP. Administration of immunomodulators in combination with standard basic therapy may affects the inflammatory process to different degree, thus, in turn, leading to improved prognosis in this disease.

Impacts of Time-Fed Concentrate-Based Diets on Plasma Metabolites, Rumen Histology, and mRNA Expression of Hepatic Enzymes of Wethers.

Simple SummaryIn modern ruminant meat production systems, wethers and steers are commonly fed diets containing 80% grain, or more. These diets are commonly fed to increase fat deposition in meat-producing ruminants. However, when wethers and steers are not appropriately transitioned to grain-based diets, they can experience metabolic and inflammatory conditions that negatively affect health and production. It is still unclear how meat-producing ruminants adapt to grain-based diets over time. This study evaluated the effects of an abrupt dietary change, from 80% forage to 80% grain, on rumen, plasma, and liver metabolism in growing wethers and monitored their ability to adapt over time. The results of the study suggest that wethers fed an 80% grain diet adapt over time by altering the expression of key enzymes involved in the systemic inflammation, iron metabolism, and cholesterol and glucose synthesis. This study provides novel insight into the physiology of fattening ruminants that have been abruptly fed grain-based diets and highlights the fact that meat-producing animals can be fed grain-based diets to meet increasing human meat requirements.Transition to grain increases inflammation and causes parakeratosis, which can decrease growth performance in fattening animals. It is unknown if ruminants adapt to these inflammatory responses over time. In a three-phase, 49-day experiment, all wethers (n = 13, BW = 50.6 ± 4.7 kg; 4.9 ± 0.3 months of age) were fed an 80% forage diet during P1(day 0 to 21). On day 21, 4 wethers were slaughtered to obtain baseline liver and rumen tissue. During P2 (day 22 to 25), the remaining wethers were fed an 80% concentrate diet. Four wethers were slaughtered on day 25 to obtain P2 liver and rumen tissue. During P3 (day 22 to 49), the remaining five wethers were fed 80% concentrate diets and were slaughtered on day 49 to obtain P3 liver and rumen tissue. Rumen parakeratosis was greater (p ≤ 0.02) in wethers sampled in P2 and P3 when compared to those sampled in P1. Among positive acute phase reactants, expression of serum α-amyloid (SAA) and haptoglobin (HPT) tended (p ≤ 0.12) to be 6- and 10-fold greater, respectively, in wethers sampled in P2 compared to wethers sampled in P1; however, SAA and HPT expression was not different between wethers sampled in P3 and P1. Plasma glucose and β-hydroxybutyric acid (BHBA) increased (p ≤ 0.03) in wethers sampled in both P2 and P3 compared to the wethers sampled in P1, while total protein and cholesterol decreased (p ≤ 0.06) only in wethers sampled from P2 compared to those sampled in P1. Hepatic acute phase responses suggest that the wethers adapted to an 80% concentrate diet over time.

Depression and Inflammation in Patients With Lung Cancer: A Comparative Analysis of Acute Phase Reactant Inflammatory Markers

Depression and inflammation are intertwined, which is particularly relevant for patients with lung cancer who have an abundance of inflammation and experience depression. Acute phase reactants (APRs), albumin and C-reactive protein (CRP), are easily interpretable indirect markers of inflammation that have never been concomitantly compared with depression. Inflammation increases CRP (positive APR) and decreases albumin (negative APR). We hypothesize that albumin will be similarly associated with depression, thereby helping to inform the diagnosis of inflammatory depression. Compares the relationship between depression and representative positive and negative acute phase reactants in patients with metastatic lung cancer. Patients (n= 109) with metastatic lung cancer were evaluated for depression using the Hospital Anxiety and Depression Scale. Inflammation as measured by positive (CRP) and negative (albumin) APRs along with demographic and treatment variables were analyzed for associations with depression. Depression was associated with lower albumin (r=-0.35, P < 0.001), higher CRP (r= 0.47, P < 0.001), and the CRP/albumin ratio (r= 0.45, P < 0.001). Hierarchical linear regression modeling found that albumin was associated with depression when controlling for demographics, disease, and treatment types (β=-0.28, P= 0.01). When both APRs were in the model, only CRP predicted depression (β= 0.31, P= 0.01), and albumin did not moderate CRP and depression. CRP/albumin ratio did not add to understanding depression variability, but patients with both low albumin and high CRP had particularly severe depression. Albumin is associated with depression but not to a greater extent than CRP. The coupling of lower albumin and higher CRP describes more severe depression. Positive and negative APRs may form a distinct biologic signature to help identify patients with inflammatory depression in the lung cancer setting.