Positive C-reactive Protein Research Articles

Investigating Specific Calprotectin and Immunological Markers Associated With Intestinal Infections Caused by Entamoeba histolytica

Background: Entamoeba histolytica is a parasitic organism that infects the intestines and causes dysentery, characterized by intestine inflammation. Objectives: We aimed to estimate calprotectin levels and their relationship to the severity and progression of intestinal inflammation. Methods: We conducted a cross-sectional study in Al-Habbobi Teaching Hospital Thi-Qar, Al-Nasseriah, Iraq, from March 10 to October 1, 2023. The sample included 50 men and 50 women aged in three groups: 25–29, 30-34, and >34 years. We employed microscopy, direct wet method, and formal-ether concentration approach to detect parasites. Also, we employed nzyme-linked immunosorbent assay (ELISA) for measuring fecal calprotectin (FC) and C-reactive protein (CRP), and XP-Sysmex for detecting white blood cells. Results: The calprotectin levels below 50 ng/mL were more common in the second age group. The third age group had calprotectin values of 50 ng/mL. In the first age group (25–29 years old), calprotectin frequency was similar. CRP levels were equal in the first age group. In the second age group (30–34 years), negative CRP outnumbered positive CRP. Positive CRP was more common than negative in the third age group of >34 years. The group above 35 had the highest general stool examination (GSE) and antigen Ag detection rates, while those aged 30–34 years in the control group had the highest. Conclusion: Calprotectin levels less than 50 ng/mL were more frequent in the age group of 30-34 years, while calprotectin levels greater than 50 ng/mL were more frequent in the age group <35 years. CRP levels were equal in frequency in the first age group. Negative CRP was more common than positive CRP in the second age group. Positive CRP was more common than negative CRP in the third age group.

Risk factors for bacteremia in infants with urinary tract infection

BackgroundSome infants with urinary tract infection (UTI) may exhibit concurrent bacteremia, potentially leading to septic shock or bacterial meningitis. Identifying risk factors for bacteremia in infants with UTI is crucial for prompt intervention to prevent subsequent adverse outcomes. MethodsBetween 2015 and 2021, a total of 632 infants with UTI aged ≤12 months were enrolled at Kaohsiung Veterans General Hospital (KSVGH), among whom 20 had concurrent bacteremia. We analyzed their differences in outcomes and demographic, clinical, and laboratory characteristics. Independent risk factors for bacteremic UTI were identified using binary logistic regression analysis. ResultsA positive underlying disease (including congenital anomalies of kidney and urinary tract [CAKUT] and prematurity), C-reactive protein (CRP) > 8mg/dL, lower body weight, and positive urinary nitrite were independent risk factors for infants with UTI and bacteremia. ConclusionsPhysicians should be mindful of the potential for bacteremia to develop in infants with UTI, particularly those with concurrent positive underlying diseases or CRP > 8 mg/dL.

The Efficacy of Colchicine as an Adjunct Therapy in Non-hospitalized COVID-19 Patients: A Randomized Placebo-Controlled Trial.

The therapeutic potential of oral colchicine administration may help combat COVID-19 infection due to reduced disease severity and mortality risk. This randomized trial aimed to assess the effect of colchicine treatment on the inflammatory and hematologic markers as well as clinical features in non-hospitalized patients with mild-to-moderate COVID-19 disease. In the present placebo-controlled randomized trial, 80 non-hospitalized COVID-19 patients were enrolled and followed for 14 days. Subjects randomly received oral colchicine or placebo tablets once a day for two weeks. The fever and cough clinical signs, as well as Creactive protein (CRP) and lymphopenia, were evaluated through the follow-up. No significant between-group differences were observed in terms of the duration of clinical symptoms, CRP, and lymphopenia at 0, 7, and 14 days of intervention. Although the proportion of participants with fever, cough, positive CRP, and lymphopenia was higher reduced in the colchicine group than the placebo during treatment, no significant differences were found between groups. Due to no adverse effects detected in this trial, colchicine therapy was well-tolerated and safe. Our findings revealed that colchicine adjuvant therapy had no beneficial effect on clinical and para-clinical parameters in non-hospitalized COVID-19 patients during 14 days of intervention. The present trial does not support colchicine as a potential treatment against COVID-19 disease.

Epidemiology, Clinical and Laboratory Findings of Pediatric Leptospirosis in Southeastern Turkey

Background: Leptospirosis is a significant zoonotic infection caused by Leptospira spirochetes, which are distributed globally. Infection typically occurs through exposure to water or soil contaminated by the urine of mammals, including dogs, cattle, pigs, or rodents. Objectives: The objective of this study was to elucidate the epidemiological, clinical, and laboratory characteristics of leptospirosis cases in Turkey. Methods: In a retrospective review, we analyzed the clinical and laboratory data of all individuals under 18 years diagnosed with leptospirosis at a secondary care center in Southeast Turkey from the beginning of 2020 to the end of 2022. Results: Over the two-year period, 36 confirmed cases of leptospirosis in individuals under 18 were identified. All patients had been engaged in activities at wells in cornfields, assisting their families with irrigation or related to well operations. Of these patients, 3 (8%) resided in urban areas, while 33 (92%) lived in rural settings. None required intensive care, and there were no fatalities reported. The most common symptoms at presentation were fatigue (83%), fever (75%), and nausea/vomiting (75%). Laboratory tests revealed that all patients had positive C-reactive protein (CRP) levels, with a significant portion (61%) showing highly positive results (CRP > 100). Conclusions: In conclusion, leptospirosis should be considered by clinicians when evaluating patients, especially those with risk factors like occupational exposure. Prompt testing for the disease is advisable under these circumstances.

Values of White Blood Cell Count and C-Reactive Protein in Diagnosis of Acute Appendicitis

Background and objectives. Acute appendicitis is one of the most common surgical emergencies. Accurate diagnosis of acute appendicitis is based on careful history, physical examination, and laboratory investigation. The purpose of this study is to investigate the value of white blood cells (WBC) and C-reactive protein (CRP) in the diagnosis of acute appendicitis. Methods. A retrospective analysis of 350 files of patients who underwent appendectomy was conducted. Selected files were those patients who were admitted to ALmasara clinic Tripoli Libya between Aug 2011 to July 2023, ages of patients ranged from 18 to 80 years. Statistical analysis was performed using SPSS version 26 software. A statistical procedure was implemented to compare the hematologic parameters in two groups (Males and Females) to determine if there was any significant difference between them. Means of WBC, Neutrophil, Lymphocyte and CRP were compared between two groups by an independent one-way analysis of variance (ANOVA). Results. This study consisted of 350 participants who were diagnosed with appendicitis. The results showed that about (69.4%) of appendicitis patients exhibited a high white blood cell count (leukocytosis). Slightly over half (52.6%) of the participants had an elevated neutrophil percentage (neutrophilia). Approximately (64.3%) of the appendicitis patients had decreased lymphocyte percentage (lymphopenia). In relation to CRP values, the study showed that most participants (76.5%) had positive CRP results. Conclusion. Individuals with appendicitis have higher levels of leukocytes, neutrophils, and C-reactive protein, and decreased lymphocyte counts. Elevated WBC and CRP values together provide a better specificity and positive predictive value than individual markers.

Diagnostic Values of Blood Indices for Neonatal Sepsis

Background: Sepsis is the leading cause of death in newborns, particularly in underdeveloped countries. Early diagnosis and appropriate treatment are critical in reducing neonatal mortality. Since blood culture results are often unavailable for 48 - 72 hours, other hematologic findings may provide useful information for early diagnosis. Objectives: We examined the relationship between neonatal sepsis and blood indices in order to achieve early diagnosis. Methods: In this hospital-based retrospective multiple-event case-control study, we allocated the neonates into three groups: Culture-positive sepsis, culture-negative sepsis, and neonates without sepsis. We compared the lab data within these three groups. Results: The study included 319 neonates: 209 cases of culture-positive sepsis, 65 cases of culture-negative sepsis, and 45 cases without neonatal sepsis. Pearson's test demonstrated a significant correlation between thrombocytopenia, positive C-reactive protein (CRP), and high cell distribution width with culture-positive sepsis (P = 0.000), indicating a statistical difference between the three groups. The mean CRP and eosinophil levels were higher in the culture-positive group with fungal sepsis. Conclusions: In septic neonates with high CRP levels, particularly in conjunction with eosinophilia, fungal coverage should be considered.

Complete Blood Count, C-reactive Protein, and Erythrocyte Sedimentation Rate Changes in People with Brucellosis

Background: Brucellosis is a major health and economic problem in many parts of the world, including the Middle East. Blood disorders such as anemia, leukopenia, and thrombocytopenia can be seen in brucellosis. However, laboratory findings of this disease are different. Therefore, this study aimed to investigate the changes in complete blood count (CBC), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) in people with brucellosis in Gonabad community health centers.
 Methods: During the 4 years from May 2016 to May 2019, a prospective study was performed on 221 patients with brucellosis. According to the national guidelines for brucellosis, titers greater than 1/80 for Wright and more than 1/40 for 2-ME were considered positive cases of brucellosis. Using the checklist, information related to CBC, CRP, and ESR test parameters was collected.
 Results: The results showed that out of 221 patients studied, 58.4% were male and 41.6% were female. The mean age was 44.9±19.8 years for men and 49.3±17.3 years for females. High ESR was seen in 43.4% and positive CRP in 59.7% of patients. Leukopenia in 8.6%, leukocytosis in 9%, neutropenia in 6.8%, neutrophilia in 9.5%, lymphopenia in 3.6%, lymphocytosis in 10%, anemia in 17.2% and thrombocytopenia in 9.5% of patients were seen.
 Conclusion: Brucellosis in endemic areas should be considered in the differential diagnosis of patients presenting with thrombocytopenia. Also in high Wright titers, CRP is a more valuable indicator than ESR.

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).

Distinct laboratory parameters as strict prognostic values in the setting of COVID-19 severity

Introduction: To the best of our knowledge, a new emerging viral infection induced by SARS-CoV-2 was named COVID-19 with high morbidity and mortality on a global scale. To date, COVID-19 is implied as a respiratory disease with varied manifestations from asymptomatic to long-standing complications. In this regard, discerning a potential prognostic value of critical outcomes in the early stages would be more appreciable to stratify the risk of disease severity and 28-day mortality. In this clinical study, we aimed to evaluate distinct laboratory biomarkers, including neutrophil to lymphocyte ratio (NLR), C-reactive protein (CRP), and lactate dehydrogenase (LDH), as reliable indicators to predict disease severity in COVID-19 patients admitted in a medical referral center. Methods: Following the COVID-19 diagnosis, all consecutive patients (n=685) with confirmed SARS-CoV-2 infection were included since September 2020 for one year. Data were collected using electronic medical records. Results: Based on obtained results, NLR and serum level of LDH showed a positive correlation with length of hospital stay. Moreover, the mortality rate and MV required in patients with either positive CRP or the high levels of LDH were remarkably greater than that of the non-severe group (P=0.01). Finally, we could not find significant differences between female and male patients regarding the evaluated parameters. Conclusion: Our findings highlighted those high values of NLR, CRP, and LDH can be considered valuable clinical prognostic aids for risk stratification, identification of disease severity, and triage of patients at the time of admission.

Description Of C-Reactive Protein (CRP) In Patients With Type 2 Diabetes Mellitus At Mulyorejo Health Center In Malang City

Diabetes Mellitus Type 2 is a metabolic disorder condition characterized by hyperglycemia, due to decreased insulin secretion. Many cytokines play a role in the acute phase response, so that markers such as CRP increase in patients with type 2 DM. The type of research used in this study is descriptive research, which describes the results of CRP examination in patients with type 2 diabetes. Examination of respondents' serum C-Reactive Protein (CRP) levels was carried out qualitatively using the Latex Agglutination method and followed by a semi-quantitative method, namely dilution to determine the level of inflammation. The results of CRP examination on 30 serum samples that have been carried out on patients with Type 2 Diabetes Mellitus found that 29 (96.7%) were positive and 1 (3.3%) of respondents were negative. The group of CRP levels for titer 12 was 5 samples (16.7%), titer 24 was 17 samples (56.7%), titer 48 was 5 samples (16.7%), and titer 96 was 2 samples (6.7). %). The results of the four groups with the highest CRP levels, namely a titer of 24 mg/L as many as 17 samples (56.7%) showed that some of the CRP levels were higher than normal. Conclusion Almost all respondents with type 2 Diabetes Mellitus had positive C-Reactive Protein examination results and a small proportion of type 2 Diabetes Mellitus patients had negative C-Reactive Protein examination results.

STUDY OF CLINICO-LABORATORY PROFILE IN ENTERIC FEVER AT TERTIARY CARE CENTRE IN RAJASTHAN

Objective: The objective is to know the clinical profile of hospitalized patients with enteric fever and study the association of those clinical profiles with laboratory investigations. Methods: It was a hospital-based, prospective, cross-sectional, observational study, performed in the Department of Paediatric Medicine, SMS Medical College, Jaipur, over a period of 1 year from May 2021 to November 2022 to know the clinical profile of hospitalized patients of enteric fever and study association of that clinical profile with laboratory investigations. Prior permission from the institutional ethical committee was obtained. This study included a total of 100 children diagnosed with enteric fever. Results: Among study participants, the most common symptoms were fever (95), vomiting (39) and diarrhea (32). Other symptoms were pain abdomen (31), cough (23), anorexia (16), and headache (13). Among the signs, pallor was present in 26, icterus in 17, and hepato-splenomegaly in 16 children. Various hematological abnormalities found were as follows-leucopenia (87), leukocytosis (27), thrombocytopenia (16), pancytopenia (6), eosinopenia (66), and anemia (53). Hyponatremia and hypokalemia were found in 16 and 17 participants, respectively. Transaminitis was present in 32 participants. Mean Serum glutamic-oxaloacetic transaminase and serum glutamic-pyruvic transaminase was 48.6±65.2 and 48.9±71.8 IU/L, respectively. Positive C-reactive protein was found in 84 participants and blood culture was positive in 61 children. Among study participants various complications found were hepatitis, and bronchitis in 10 participants each followed by bronchopneumonia and encephalopathy in 2 participants each.

Gender Disparities in Ankylosing Spondylitis: An Algerian Retrospective Analytical Cohort Study

Background: Ankylosing spondylitis (AS) is an inflammatory disease that can impair function and lower quality of life, which causes spinal bone fusion and new bone production. Several studies have been done on the differences in damage between women and men. Objectives: This study aimed to assess the differences between men and women with AS regarding clinical characteristics, structural damage, and treatment used by Algerian patients. Methods: In this study, 292 patients diagnosed with AS at the Hassani Abdelkader Hospital Rehabilitation Department of Sidi Bel Abbes Region between 2018 and 2021 were enrolled. The studied parameters were age, disease duration, age at disease onset, morning stiffness, joint involvements, laboratory data, disease activity, and treatments. All data were processed and analyzed via Excel and SPSS 20.0 (Statistical Package for the Social Sciences, IBM Corporation, Chicago, IL, August 2011). Results: We assessed 166 females and 126 males. The mean age at disease onset was 31.69 ± 10.675 vs. 30.38 ± 10.250 years, and morning stiffness duration was 26.08 ± 26.977 vs. 23.80 ± 26.529 minutes in females and males, respectively. Positive HLA-B27 was noted more in 71.9% of women and 69.6% of men. Also, the female group suffered more from their lumbar (100%) and high inflammation (83.8% elevated erythrocyte sedimentation rate (ESR) and 59.9% positive C-reactive protein (CRP)) rather than females who suffered from a long disease duration (7.28 ± 4.867 vs. 6.74 ± 3.584). Peripheral joints were primarily affected in males than females (knees involvement: 26.4% vs. 3.6% and hips involvement: 69.6% vs. 3%, respectively). In addition, high disease activity was more noted in men (52.8% vs. 41.9%, respectively). The most noted comorbidities, including uveitis, psoriasis, and diabetes, affected more females than males (40% vs. 29.9%, 4.8% vs. 2.4%, and 2.4% vs. 1.2%, respectively). Concerning the treatment, men used more sulfasalazine than women, 86.4% vs. 76%, while women used more Humira than men (88.6% vs. 74.4%, respectively). Conclusions: According to our findings, women had a higher inflammation rate and more damage in their lumbar, requiring more sulfasalazine and Humira treatment than men who suffered from their peripheral joints and higher disease activity.

Arthroscopic tissue biopsy as a preoperative diagnostic test for periprosthetic shoulder arthroplasty infections: a systematic review and meta-analysis.

The diagnosis of periprosthetic infection in shoulder arthroplasty remains a challenge. Conventional methods for evaluating periprosthetic joint infections are poor because of lower-virulence organisms affecting the shoulder. The aim of our systematic review was to evaluate the diagnostic accuracy of preoperative arthroscopic tissue cultures compared with tissue biopsy samples obtained at the time of revision surgery. We conducted a systematic search of the MEDLINE, Embase, and Cochrane Central databases. The inclusion criteria consisted of studies that used arthroscopy to obtain preoperative tissue cultures for the diagnosis of shoulder arthroplasty infections. Studies were excluded if they obtained non-arthroscopic tissue samples. We reported the sensitivity, specificity, positive predictive value, and negative predictive value. Culture findings from the arthroscopic biopsy samples were also compared with conventional tests of fluoroscopy-guided joint aspiration and serum inflammatory marker testing (positive erythrocyte sedimentation rate or C-reactive protein) within the included studies. A meta-analysis was performed to assess the overall diagnostic accuracy of the studies. Our search strategy yielded 795 potentially relevant publications; 572 underwent title and abstract screening, and 14 studies underwent full-text review, of which 7 were included in our systematic review. The studies represented a balance of shoulder arthroplasty types, including anatomic total shoulder arthroplasty (n=75, 38%), reverse total shoulder arthroplasty (n=60, 30%), and hemiarthroplasty (n=64, 32%). There were 56 of 120 arthroscopic procedures that returned positive tissue culture findings compared with 64 of 157 positive open biopsy culture findings obtained from revision surgery. The meta-analysis total for sensitivity and specificity for all studies combined indicated that arthroscopic tissue cultures (0.76 [95% confidence interval (CI), 0.57-0.88] and 0.91 [95% CI, 0.79-0.97], respectively) were superior to both aspiration (0.15 [95% CI, 0.03-0.48] and 0.93 [95% CI, 0.65-0.99], respectively) and a positive erythrocyte sedimentation rate or C-reactive protein level (0.14 [95% CI, 0.02-0.62] and 0.83 [95% CI, 0.56-0.95], respectively) in diagnosing periprosthetic shoulder infections. Our systematic review demonstrated that preoperative arthroscopic tissue biopsy used for microbiology cultures accurately predicts intraoperative culture findings obtained during revision surgery with high sensitivity and specificity. Additionally, arthroscopy appears to be superior to conventional techniques of joint aspiration and inflammatory marker testing. Therefore, arthroscopic tissue cultures may be an emerging useful tool to help guide the management of periprosthetic infections in shoulder arthroplasty.

Religious Attendance, Religious Coping, and Systemic Inflammation among Older African American Adults

Older African Americans bear a disproportionate burden of cardiovascular disease risk. One factor underlying these effects may be lifetime stressors exposure. Prior research has shown that religious attendance and positive religious coping, exhibiting a trusting relationship with God, are positively related to health outcomes. Mixed results emerged for negative religious coping. We examined whether these factors interacted with stress in predicting systemic inflammation, a key mechanism in stress-related chronic disease risk. Data was collected from the Health among Older Adults Living in Detroit study (N= 211, M= 67.6 yrs., 73.3% female). Measures included the number and severity of life stressors (measured via the Adult Stress and Adversity Inventory), religious attendance, positive/negative religious coping, and C-Reactive Protein (CRP). Number of participants (N= 114-119) varied in different analyses because of listwise deletion. Religious attendance and negative religious coping did not interact with any lifetime stressor indicators in predicting CRP. However, a significant interaction was found between stress severity and positive religious coping. A significant negative association emerged between positive religious coping and CRP for participants at -1.5 SD (but not +1.5 SD) from average stress severity. At very high levels of stress severity (~+2 SD), a positive link was found between positive religious coping and CRP. Positive religious coping may help to buffer against inflammation for older African American adults reporting low levels of lifetime stress severity. For participants reporting very high levels of stress, religious coping might have deleterious effects on inflammation.

Association of C-Reactive Protein with Parameters of Early Onset Sepsis and Blood Culture

Background: Blood culture is a gold standard technique to diagnose neonatal sepsis but the C-reactive protein (CRP) is also an important biomarker of acute phase reaction. CRP has a role in humoral immunity against infection, leading to inflammation. Very few of the data is available to conclude the diagnostic accuracy of CRP in association with parameters of early stage neonatal sepsis in pre-term or low birth weight babies. So the aim of current study was to find out the association of C-reactive protein with parameters of early onset sepsis and blood culture in pre-term and low birth weight babies. Methods: A cross-sectional study was conducted at the Pediatric Medicine department of Maternal and Child Health Center (MCH), Shaheed Benazirabad during August 2022 to January 2023. Early onset sepsis was diagnosed on the basis of maternal factors, prenatal history and clinical examination. Blood sample was collected and sent to the pathology laboratory of Peoples University of Medical and Health Sciences for Nawabshah for measurement of C-reactive protein, white blood cell count and culture and sensitivity testing. Data was analyzed by using the Statistical Package for Social Science (SPSS) version-20. p-value less than 0.05 was considered as significant. Results: A total of 120 patients of neonatal sepsis were enrolled in the study out of them 52 were positive for C-reactive protein. The mean age of the study participants was 1.6 ±0.69 days. Male participants were predominant (63.5%) over their female counterpart. Majority cases of septicemia (57.7%) were having birth weight less than 2.5kg. Odd ratio of C-reactive protein was estimated at 95% confidence interval and the results found that age had significant association with positive C-reactive protein. Birth weight less than 2.5kg also showed significant negative association with C-reactive protein but the term of birth found no any significant association. Patients having positive blood culture and those who had WBC count more than 25000/mm3 reported strongly significant association with C-reactive protein. Conclusion: It can be concluded that the C-reactive protein is significantly associated with parameters like age, WBC count more than 25000/mm3 and blood culture but no association has been found with maturity of neonate i.e. term or pre-term babies. The birth weight less than 2.5kg is negatively associated with the C-reactive protein. Keywords: Neonatal sepsis, C-reactive protein, Pre-term

Clinical Characteristics of Hemodialysis Patients with COVID-19 Referred to Hemodialysis Centers Affiliated with the Shahrekord University of Medical Sciences Between 2020 and 2021

Background: The coronavirus pandemic (COVID-19) seriously threatens the health and life of people with underlying diseases, such as patients undergoing hemodialysis. Objectives: This study aimed to determine the clinical characteristics of COVID-19 patients with chronic kidney disease undergoing hemodialysis referring to hemodialysis centers affiliated with the Shahrekord University of Medical Sciences between 2019 and 2021. Methods: This was a retrospective descriptive-analytical study with a sample size of 144 hemodialysis patients with COVID-19. The data were collected by a demographic questionnaire, a checklist based on the presence of underlying diseases, the cause of the kidney failure, drugs received during hemodialysis, medications used for COVID, the result of COVID-19 treatment, and outpatient or inpatient treatment, and the checklist of laboratory indices extracted from the patient’s medical records. Data were analyzed by SPSS version 20 and descriptive and analytical statistical tests. Results: The average age was 57.2 ± 14.42 years, and 64.6% were men, 35.4% were women, 64.6% recovered, and 35.4% died, although 42.4% of patients were treated on an outpatient basis, and 57.6% needed hospitalization. Also, 93.7% of patients were vaccinated. The average duration of hemodialysis treatment was 6.44 years, and diabetes accounted for 31.1% of the causes of kidney failure, and these people had a higher chance of mortality. Positive c-reactive protein (CRP) results were found in 72.2% of patients, and 54.2% had a positive erythrocyte sedimentation rate (ESR). In addition, 22.2% of patients used mechanical ventilation, and 88.2% had positive PCR results. Iron, ferritin, albumin, and hemoglobin index were lower than normal in all patients. Patients with positive hepatitis B antigens were treated with sofosbuvir. In outpatient treatment, 65.6% used remdesivir, and 70.5% used dexamethasone. Regarding inpatient treatment, 75.9% used methylprednisolone, 56.6% used tocilizumab, and 54.2% used pirfenidone. Conclusions: The rate of death and hospitalization in hemodialysis patients with COVID-19 was higher than that of normal people. Diabetes increases the chance of morbidity and mortality of COVID-19 in hemodialysis patients. The reduction of hemoglobin, iron, ferritin, and albumin weakened the therapeutic response of hemodialysis patients to COVID-19 and increased the chance of death. Although various drugs were used in the treatment of COVID-19 hemodialysis patients, the patients did not follow a single regimen.

The Role of Salivary C-Reactive Protein in Diagnosis of Neonatal Sepsis

Background Neonatal sepsis remains one of the leading causes of morbidity and mortality among neonates. Objective to evaluate the role of salivary C-reactive protein (CRP) as a diagnostic marker in neonatal sepsis. Methods This case-control study was carried out on 90 neonates including 45 neonates with symptoms and signs suggestive of neonatal sepsis and 45 healthy neonates as controls. All neonates were subjected to full history taking, thorough clinical examination, laboratory investigations including complete blood count (CBC), serum CRP, blood culture, and salivary CRP. Results Septic neonates showed significantly higher salivary CRP compared to controls; it was significantly associated with positive serum CRP, blood culture, and hematological scoring system (HSS). It was significantly higher in neonates who died compared to those who survived. Twenty one cases with positive salivary CRP showed significant positive correlations with the length of the neonatal intensive care unit stay, total white blood cell (WBC) count, mean platelet volume (MPV), neutrophils to lymphocytes ratio (NLR), serum CRP, HSS, significant negative correlations with gestational age, birth weight, APGAR at 1, 5 min, and platelet count. Receiver operating characteristic (ROC) curve for salivary CRP showed that at cut-off value of 0.135 mg/L, the sensitivity was (81.8%) and the specificity was (75.6%) for detecting neonatal sepsis. Conclusion Salivary CRP was significantly higher in the septic group, and was associated with positive serum CRP. Hence, salivary CRP could be considered a novel non-invasive biomarker for diagnosing neonatal sepsis.

Vitamin D Deficiency in Saudi Patients With Rheumatoid Arthritis.

Background Epidemiological studies indicate that vitamin D deficiency may increase the risk of developing autoimmune and chronic diseases such as rheumatoid arthritis (RA)and, therefore, is prevalent in patients with RA. Additionally, vitamin D insufficiency is associated with significant disease activity in patients with RA. This study aimed to assess the prevalence of vitamin D deficiency in Saudi patients with RA and determine whether there is an association between low vitamin D levels and RA disease activity. Methodology This cross-sectional retrospective study was conducted from October 2022 to November 2022 on patients who attended the rheumatology clinic at King Salman bin Abdulaziz Medical City, Medina, Saudi Arabia. Patients aged ≥18 years, diagnosed with RA, and not on vitamin D supplements were included. Demographic, clinical, and laboratory data were collected. Disease activity was measured using the disease activity score index of a 28-joint count using the erythrocyte sedimentation rate (DAS28-ESR). Results In total, 103 patients were included, with 79 patients being women (76.7%) and 24 being men (23.3%). The vitamin D level ranged from 5.13 to 94 ng/mL, with a median of 24. Of the studied cases, 42.7% had insufficient vitamin D levels, 22.3% had a deficiency, and 15.5% had severe deficiency. There were statistically significant correlations between the median vitamin D level and C-reactive protein (CRP), the number of swollen joints, and DAS. A lower median vitamin D level was detected among cases with positive CRP, swollen joints >5, and higher disease activity. Conclusions Patients with RA in Saudi Arabia were more likely to have low vitamin D levels. Moreover, vitamin D deficiency was linked to disease activity.Therefore, the measurement of vitamin D levels in patients with RA is essential, and vitamin D supplements might be important to improve disease outcomes and prognoses.

Comparison of the effect of atorvastatin and aspirin on C-reactive protein concentration in hemodialysis patients

Introduction: Chronic inflammation is one of the underlying causes of cardiovascular disease which is commonly seen in patients with chronic kidney disease (CKD) and especially in end-stage renal disease (ESRD), as well as the patients on stable dialysis. Hemodialysis patients suffer from high mortality due to cardiovascular diseases. Objectives: Therefore, the present study aimed to evaluate the effect of atorvastatin and aspirin on C-reactive protein (CRP) concentration in hemodialysis patients and compare the effect of these two drugs on CRP concentration in these patients. Patients and Methods: In this descriptive-analytical study, the dialysis patients who had been on dialysis for more than four months were selected through medical records (N=75). Serum CRP was checked and those who had positive CRP entered in the analysis (n=20). Ten patients had been used atorvastatin at a dose of 20 mg daily and the other 10 patients received aspirin at a dose of 80 mg daily for two months. Serum CRP concentration was measured in all patients at the end of these two months. Results: The mean age of the patients was 65.6 years and the mean number of years on dialysis was three years. In addition, 65% of patients were male and 35% were female. The only significant relationship was between the effect of atorvastatin and CRP concentration and the effect of aspirin on CRP concentration while no statistically significant relationship was found between the two groups of aspirin and atorvastatin in terms of serum CRP value after the intervention. Conclusion: The results indicated that the effect of aspirin and atorvastatin on CRP concentration was positive in hemodialysis patients and reduced the serum level of CRP, indicating the anti-inflammatory role of these two drugs in hemodialysis patients. It should be noted that drug preference was not determined in the present study.

Could combined rapid diagnostic testing for malaria and c-reactive protein be helpful for the diagnosis and management of febrile illnesses in children under-5 years of age in rural Burkina Faso?

BackgroundFebrile illnesses are among the most important reasons for medical consultation in sub-Saharan Africa and are frequently treated with antimicrobials due to the unavailability of appropriate diagnostic tools. This practice leads to antimicrobial resistance, with increasing mortality and morbidity as result. One of the few accessible diagnostic tools available in low resource settings is malaria rapid diagnostic tests (mRDTs) which contributed to reducing the over-prescription of anti-malarials, but cannot guide antibiotic prescriptions. To circumvent this problem, we explored whether combined testing with mRDT and c-reactive protein (CRP) could improve the diagnosis of febrile illnesses and subsequent prescription of antibiotics.MethodsClinical specimens (blood, stool and urine) collected from 396 febrile children (axillary temperature of ≥ 37.5 °C) were analyzed with rapid diagnostic tests (malaria and CRP) and microbiology culture to establish the possible cause of fever. Actual antimicrobial prescriptions given to the children were compared with those that could be given based on combined CRP-malaria testing.ResultsIn total, 68.7% (272/396) of malaria cases were diagnosed by mRDT-Pf-HRP-2. CRP test was positive in 84.3% (334/396) of the children, but bacterial infections were confirmed in 12.4% (49/396) of them. A possible cause of fever could not be established in 20.5% (81/396) of cases. Based on the diagnostic practice in place, 265 of the children with a positive mRDT-Pf-HRP-2 received anti-malarial treatment. Furthermore, 89.5% (111/124) of negative mRDT results received antibiotic treatment and 37.1% (46/124) received antimalarial treatment. Of these 124 cases, 80 had positive CRP tests and 44 negative CRP tests. If the results of CRP testing are considered, 44 CRP/mRDT negative children would not get antibiotic treatment, resulting in a 35.5% reduction in antibiotic prescriptions. However, 2 cases with a bacterial infection would be denied appropriate treatment.ConclusionCombining mRDT-PfHRP2 with CRP testing is particularly useful in children for whom both tests are negative as it results in a reduction of antibiotics prescriptions. However, there is a risk to miss potential severe bacterial infections and a close follow-up of these cases is strongly recommended.