Reactive Protein Levels Research Articles

Surgical treatment of sacral pressure injury in ambulating patients during the COVID-19 pandemic: A prospective cohort with complications analysis and elaboration of a surgical treatment protocol

The sudden increase of intensive care unit patients during the coronavirus pandemic led to an increase in the incidence of sacral pressure lesions. Despite being ambulating patients, in many cases the lesions were deep (Grade III and IV), mainly due to the long-term intubation and being bedridden during the pandemic. Most of these wounds necessitated surgical repair. To measure the success and the rate of complications in reconstructions of grade III and IV hospital acquired sacral pressure lesions in ambulating patients after hospitalization for COVID-19. Developing a well-established protocol for surgical treatment of hospital acquired sacral pressure lesions during the COVID-19 pandemic. Prospective cohort involving ambulating patients with grades III and IV sacral pressure lesions developed after hospitalization for COVID-19 from May 2020 to August 2020 (4 months). All of them were submitted to reconstruction with fasciocutaneous flaps. Demographics, comorbidities, and preoperative laboratory tests were compared and multivariable-adjusted logistic regression was made in order to identify risk factors for complications. Thirty-eight patients were submitted to fasciocutaneous flaps to repair sacral pressure lesions with a total complication rate of 36.0%. Hemoglobin levels lower than 9.0mg/dl (p=0,01), leukocyte levels higher than 11.000/mm3 (p=0,1), and C Reactive protein levels higher than 142mg/dl (p=0,06) at the time of reconstruction and bilateral flaps were independent factors for complications. Specific preoperative laboratory tests and surgical techniques were associated with a statistically significant increased complication risk. It was established a protocol for surgical treatment of hospital-acquired sacral pressure lesions to diminish these risks, focusing on ambulating patients during the COVID-19 pandemic.

Disease evolution in systemic juvenile idiopathic arthritis: an international, observational cohort study through JIRcohort

BackgroundSystemic juvenile idiopathic arthritis (systemic JIA) is a severe disease with both systemic and joint inflammation. This study aims to identify predictors of disease evolution within the systemic JIA population enrolled in the Juvenile Inflammatory Rheumatism cohort (JIRcohort).MethodsObservational patient cohort study with 201 recruited children from 4 countries (3 European, 1 North Africa) from 2005 until 2019, using retrospectively (2005–2015) and prospectively (2015–2019) routine care collected data.ResultsSixty-five patients with complete follow-up data for 24 months after first diagnosis were classified as monophasic (n = 23), polyphasic (n = 6) or persistent group (n = 36) corresponding to their evolution (unique flare, recurrent flares, or persistent disease activity respectively). The patients of the persistent group were more likely to have an earlier disease onset, before the age of 6 (OR 2.57, 95%-CI 0.70–9.46), persistence of arthritis at 12-months post-diagnosis (OR 4.45, 95%-CI 0.58–34.20) and higher use of synthetic DMARD (sDMARD, OR 5.28, 95%-CI 1.39–20.01). Other variables like global assessment by physician and by patient and C Reactive Protein levels at 12-months post-diagnosis were assessed but without any predictive value after adjusting for confounding factors.ConclusionsOur results suggest that the earlier disease onset, the persistence of arthritis throughout the first year of disease evolution and the need of sDMARD might predict a persistent disease course.

Clinical characteristics and related factors analysis of adrenal crisis occurred in children with primary nephrotic syndrome

Objective: To investigate the clinical characteristics and related factors of corticosteroid induced adrenal crisis (AC) in children with primary nephrotic syndrome (NS). Methods: Case control study. The case group included 7 children aged 1 to 18 years with NS combined with AC hospitalized in Peking University First Hospital from January 2016 to May 2021 (AC group). According to the ratio of case group: control group 1: 4, 28 children aged 1 to 18 years who were diagnosed with NS without AC during the same period were matched as controls (non-AC group). Clinical data were collected. The clinical characteristics of AC were described. The clinical parameters were compared between the 2 groups by t test, Mann-Whitney U test or Fisher's test. Receiver operating characteristic (ROC) curve was used to analyze the cutoff values of clinical parameters for prediction of AC. Results: The AC group included 4 boys and 3 girls aged 6.9 (4.6, 10.8) years. The non-AC group included 20 boys and 8 girls aged 5.2 (3.3, 8.4) years. All AC events occurred during the relapse of NS with infection. Seven children had gastrointestinal symptoms such as nausea, vomiting and abdominal pain. Six children had poor mental state or impaired consciousness. No significant differences in NS course, corticosteroid treatment course, corticosteroid type, steroid dosage, steroid medication interval, the proportion of gastroenteritis and fever existed between the two groups (all P>0.05). Compared with the non-AC group, the duration from the onset of the relapse of NS until hospitalization in the AC group was significantly shorter (0.2 (0.1, 0.6) vs. 1.0 (0.4, 5.0) month,U=25.50, P=0.005). The 24 h urinary total protein (UTP) level was significantly higher in the AC group (193 (135, 429) vs. 81 (17, 200) mg/kg, U=27.00,P=0.036) than the non-AC group. The serum albumin level in the AC group was significantly lower((13.1±2.1) vs. (24.5±8.7) g/L,t=-6.22,P<0.001) than the non-AC group. There were significantly higher total white blood cell counts ((26±9)×109 vs. (11±5)×109/L,t=4.26,P=0.004), percentage of neutrophils (0.71±0.08 vs. 0.60±0.19,t=2.56,P=0.017) and the proportion of children with C reactive protein level≥8 mg/L (3/7 vs. 0,P=0.005) in the AC group than in the non-AC group. ROC curve analysis showed that the cutoff value of 24 h UTP was 122 mg/(kg·d) with a sensitivity of 100.0% and specificity of 70.4%. The cutoff value of serum albumin was 17.0 g/L with a sensitivity of 100.0% and specificity of 82.1%. Conclusions: Gastrointestinal symptoms and poor mental state were prominent manifestations of AC in children with NS. High 24 h UTP level, low serum albumin level, high peripheral white blood cell counts, high neutrophils percentage, and high C-reactive protein level during the early stage of NS relapse may be related to the occurrence of AC in children with NS.

Correlation of Rheumatoid arthritis disease severity with serum vitamin D levels

Rheumatoid arthritis (RA) is an autoimmune disorder marked by characteristic inflammation of the small joints in addition to diverse systemic manifestations. Vitamin D has immunomodulatory properties, and its deficiency has a significant role in the clinical course of RA. The present research was conducted to study the correlation between serum vitamin D levels and disease activity scores in RA patients. A cross sectional study was carried out on a sample of 50 patients presenting with RA. Disease activity was measured using Modified Disease Activity Score (DAS) criteria. Estimation of serum Vitamin D levels were done using the electrochemiluminescence method and values less than 20ng/ml were considered as deficiency. Vitamin D levels were then correlated with disease activity scores. The Vitamin D deficiency was observed in 50% of the study population. Rheumatoid arthritis showed female preponderance in this study. Inflammatory markers such as C - reactive protein (CRP) levels and Erythrocyte Sedimentation Rate (ESR) did not differ with RA disease activity. More the number of large joints involved lesser were the vitamin D levels. There was an inverse correlation between Vitamin D levels and RA disease activity. Vitamin D deficiency is significantly correlated with disease severity of RA. This study points to the importance of screening for deficit of vitamin D among RA patients and treat it as early as possible.

A comparison of Lipid Profile and Highly Sensitive C Reactive Protein (HsCRP) levels between prehypertensive individuals and those with normal blood pressure.

Objective: In the current study, hsCRP and lipid profile levels in prehypertensives were assessed and compared with those in normal subjects, as well as blood pressure and lipid profile correlations were examined. Study Design: Cross-sectional. Setting: Department of Physiology, Liaquat University of Medical &amp; Health Sciences (LUMHS) in Jamshoro. Period: Six months 1st November 2022 to 30th April 2023. Material &amp; Methods: From the general population, 50 pre-hypertensive and 50 normotensive subjects ranging in age from 25 to 55 were enrolled. A blood pressure measurement and an anthropometric measurement were taken. Student t tests were used to compare serum hsCRP with lipid profiles. In order to correlate blood pressure with hsCRP and lipid profile, Pearson correlation was used. Results: A significant correlation was not found between blood pressure (SBP and DBP) and hsCRP in either group. When compared to normal individuals, pre-hypertensives had significantly higher cholesterol and LDL (P-value &lt;0.001). Among prehypertensive patients, blood pressure and lipid parameters did not seem to be significantly correlated. Conclusions: We conclude that in both prehypertensive and normal subjects, hsCRP levels are not significantly different. Therefore, pre-hypertensive patients do not have inflammation. Prehypertensive patients have significantly higher total cholesterol and LDL levels than normal individuals. There is an alteration in the lipid profile of prehypertensive individuals.

Interaction of the variant in the adiponectin gene rs3774261 with serum lipid profile and adiponectin levels after 9 months with a high monounsaturated fat hypocaloric diet with Mediterranean pattern.

The role of ADIPOQ gene variants on weight loss and serum lipid changes after a dietary intervention is an important topic area with little scientific evidence. We designed a study in order to analyze the effects of rs3774261 of ADIPOQ gene on metabolic response and adiposity parameters after a hypocaloric Mediterranean diet pattern for 9 months and with a high amount of monounsaturated fatty acids. 133 patients with obesity were enrolled. Adiposity parameters, blood pressure, and serum parameters (lipid profile, insulin, HOMA-IR; glucose, C reactive protein, adiponectin, resistin, and leptin levels) were measured, at basal time and after dietary intervention (3 and 9 months). All patients were genotyped rs3774261 and evaluated in a dominant model (AA vs. GA+AA). Genotype frequencies were 46 (34.6%) AA, 66 (49.6%) AG, and 21 (15.8%) GG. After dietary intervention and in both genotypes, BMI, weight, fat mass, systolic blood pressure, waist circumference, glucose, insulin, HOMA-IR, and leptin decreased. In patients with the AA genotype, there was a significant improvement at (3 and 9 months) in low-density lipoprotein (LDL) cholesterol levels (-10.1±0.9 mg/dl vs. -5.6±1.7 mg/dl, p=0.01) (-19.1±0.9 mg/dl vs. -6.9±0.7 mg/dl, p=0.03), total cholesterol (-9.4±0.8 mg/dl vs. -5.8±0.9 mg/dl, p=0.02) (-17.4±1.8 mg/dl vs. -9.8±1.9 mg/dl, p=0.02), triglycerides (-12.3±0.8 mg/dl vs. -8.0±0.9 mg/dl, p=0.01) (-26.1±0.8 mg/dl vs. -11.0±0.3 mg/dl, p=0.01), C reactive protein (CRP) (-0.8±0.2 mg/ dl vs. -0.4± 0.3 mg/dl, p=0.01) (-1.1±0.2 mg/ dl vs. -0.7±0.1 mg/dl, p=0.01) and adiponectin (28.2±11.1 ng/ml vs. 4.1±2.8 ng/ml, p=0.02) (30.1±8.1 ng/ml vs. 7.1±4.8 ng/ml, p=0.02). Finally, higher values of adiponectin and adiponectin/leptin ratio were detected at 3- and 9-months post-treatment in patients with AA genotype. G allele carriers of ADIPOQ gene variant (rs3774261) showed no improvement in serum levels of adiponectin, adiponectin/leptin ratio, total-cholesterol, LDL-cholesterol, triglycerides, and CRP after weight loss with a hypocaloric fat monounsaturated diet.

Admission blood eosinophil count, inpatient death and death at 1 year in exacerbating patients with COPD

BackgroundBlood eosinophil counts have been studied in patients with stable chronic obstructive pulmonary disease (COPD) and are a useful biomarker to guide inhaled corticosteroid use. Less is known about eosinophil...

Evaluation of vitamin A and E deficiency with severity of SARS-COV-2 disease: a case–control study

BackgroundCoronavirus disease 2019 can cause severe inflammation and damage to the lungs. Vitamins A and E are essential in the enhancement of immunity and they tend to decrease in cases with inflammation. Determination of serum levels of vitamins A and E in COVID-19 patients was the aim of the study.MethodsThis case–control study was carried out on 30 ICU–admitted SARS-CoV-2–infected individuals (group A), 30 ward–admitted SARS-CoV-2–infected individuals (group B) and 30 healthy controls (group C). High-performance liquid chromatography was used to measure vitamin A and E levels.ResultsMedian levels of vitamin A in group A [0.16 (0.08–0.23) µg/ml] were significantly lower than those in group B [0.4 (0.15–0.65) µg/ml] and in group C [0.81 (0.70–1.16) µg/ml] with P value < 0.001, while there was no significant difference between groups concerning vitamin E levels (P value = 0.535). Vitamin A deficiency showed significant correlation with lower hemoglobin levels, lower platelet counts, higher total leucocyte counts, higher C- reactive protein levels, and higher D-dimer levels. ROC curve construction showed that vitamin A level with cut off < 0.65 µg/ml increases risk of acute respiratory distress syndrome (ARDS) development with sensitivity 90% and specificity 83.3%. Logistic regression analysis showed that cases with vitamin A levels < 0.65 µg/ml were more prone to develop ARDS (OR = 0.003 [0.000–0.036] P < 0.001).ConclusionLevels of vitamin A were reduced in COVID-19 patients particularly in ICU–admitted cases. This ensures the association of decreased vitamin A with disease morbidity and the importance of vitamin A supplementation as part of disease management.Trial registrationClinicaltrial.gov, NCT05946499. Registered 12 July 2023—Retrospectively registered. https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000DGLS&selectaction=Edit&uid=U00070DC&ts=2&cx=gieusm.

Can the ketogenic diet improve our dreams? Effect of very low-calorie ketogenic diet (VLCKD) on sleep quality

BackgroundObesity is a condition that is often associated with sleep disorders, including reduced sleep quality (SQ). Very low calorie ketogenic diet (VLCKD) has proven to be effective in the management of obesity and associated metabolic disorders. However, little is still known about the effects of this promising nutritional protocol on SQ. Thus, the purpose of this study was to investigate the short-term effect of VLCKD on SQ in women with overweight/obesity and if any changes, to identify the predictive factor that through VLCKD modified SQ.MethodsWere consecutively enrolled a total of 324 subjects, who met the inclusion criteria and accepted to adhere to VLCKD. Assessment of nutritional status, including anthropometric measurements (height, weight, and waist circumference), bioelectrical impedance analysis (phase-sensitive system, 50 kHz BIA 101 RJL, Akern Bioresearch, Florence, Italy Akern), high sensitivity C reactive protein levels (hs-CRP), and SQ were carried out at baseline and after 31 days of active stage of VLCKD. SQ was evaluated using the validated questionnaire Pittsburgh Sleep Quality Index (PSQI).ResultsIn addition to the expected general improvement of anthropometric parameters and body composition, VLCKD improved significantly SQ, as demonstrated by the improvement of all parameters included in the PSQI questionnaire (p < 0.001). Both at baseline and after 31 days of active stage of VLCKD, the PSQI score was significantly associated with BMI, waist circumference, fat mass, fat free mass (p < 0.001 for all) and hs-CRP (p = 0.023). PhA was negatively associated with PSQI score only at baseline (p < 0.001). ∆% PSQI positively correlated with ∆% BMI, ∆% fat mass, ∆% hs-CRP (p < 0.001 for all) and negatively correlated with ∆% fat free mass (p < 0.001), and ∆% PhA (p = 0.031). In the multiple regression analysis ∆% fat mass represented the only predictor of changes in SQ after VLCKD. Finally, in the ROC analysis, a threshold value of ∆% fat mass > − 8.4% predicted improvement in SQ (p < 0.001).ConclusionIn conclusion, VLCKD determines an improvement of SQ in women with overweight and obesity, that was mostly mediated by the reduction of fat mass related to this nutritional protocol.Graphical

High sensitivity C reactive protein levels and atrial fibrillation recurrence after catheter ablation for atrial fibrillation: A systematic review and meta-analysis.

Atrial fibrillation (AF) recurrence after AF ablation is not uncommon. High sensitivity C reactive protein (hs-CRP) is a widely used inflammatory marker with a potential property to predict AF recurrence. We conducted a systematic review and a meta-analysis to find an association between hs-CRP levels and AF recurrence after ablation. We searched PubMed, Embase, and Wiley-Cochrane Library from inception to January 2022 for studies that reported hs-CRP levels in patients who underwent AF ablation. Weighted mean difference (WMD) was used to evaluate the difference between hs-CRP levels in post-ablation AF recurrent and non-recurrent group. Also, the difference between hs-CRP levels in pre- and post-ablation was determined. We identified 10 studies, and a total of 789 patients were included (299 recurrent vs. 490 non-recurrent patients). The mean age was 57.7 years (76.4% male). There was no difference in baseline hs-CRP levels between AF recurrent and non-recurrent group (WMD = 0.05, 95% CI = -0.04 to 0.15, p = 0.045). However, higher hs-CRP levels post-ablation were found in AF recurrent group (WMD = 0.09, 95% CI = 0.03-0.15, p < 0.001). There is no significant difference in baseline hs-CRP levels between AF recurrent and non-recurrent patients after AF ablation. However, higher post-ablation hs-CRP level was found in AF recurrent group. High Sensitivity C reactive protein may play a role as a predictor of AF recurrence.

Does arterial stiffness predict mortality in patients with scleroderma: a long-term follow-up study.

Subclinical macrovascular impairment, which has been evaluated with various arterial stiffness (AS) parameters, has been defined in patients with systemic sclerosis (SSc). However, studies investigating the relationship between AS and clinical endpoints in SSc are lacking. This study aims to determine the prognostic value of AS parameters to predict all-cause mortality in SSc patients. AS parameters [carotid-radial pulse wave velocity (PWV) and augmentation index (AIx)] were assessed via applanation tonometry. The prognostic value of these parameters was quantified in patients with SSc (n=60) without pulmonary arterial hypertension (PAH) and obvious cardiac involvement against survival. The overall median follow-up time was 10.3 years, and a 29.4% (n=20) mortality was observed. Four significant predictors of mortality were observed: lung involvement (HR 2.608, p=0.04), the lower level of predicted carbon monoxide diffusing capacity (HR 0.978, p=0.03), lower level of estimated glomerular filtration rate (HR 0.979, p=0.04), and elevated serum C reactive protein (CRP) levels (HR 1.066, p<0.001). Among these variables, elevated CRP was found to be an independent predictor of all-cause mortality. AS parameters were not associated with all-cause mortality (HR 1.014, p=0.6 for AIx and HR 0.737, p=0.19 for PWV, respectively). Long-term data failed to demonstrate the prognostic value of AS parameters in predicting all-cause mortality in SSc patients. The exact mechanisms of cardiovascular (CV) mortality in SSc patients deemed to be atherosclerotic in origin needs to be determined in large-scale studies.

Host–pathogen interaction unveiled by immune, oxidative stress, and cytokine expression analysis to experimental Saprolegnia parasitica infection in Nile tilapia

The present study evaluated the pathogenicity, immunological, and oxidant/antioxidant responses against Saprolegnia parasitica (S. parasitica) infection in Nile tilapia (Oreochromis niloticus). Three groups of Nile tilapia were assigned as the control group (no zoospores exposure). The other two groups were challenged by Saprolegnia zoospores; one was used for sampling, and the other for mortality monitoring. The study lasted 3 weeks and was sampled at three point times at 1, 2, and 3 weeks. Results showed that S. parasitica zoospores were pathogenic to Nile tilapia, causing a cumulative mortality rate of 86.6%. Immunoglobulin M and C- reactive protein (IgM and CRP) levels showed a similar trend being significantly (P < 0.05, P < 0.001) higher in the infected group at weeks 1, 2, and 3, respectively, compared to the control group. Oxidant and antioxidant parameters in gills revealed that Malondialdehyde (MDA) level was significantly higher in the infected group compared to the control group. While catalase, glutathione peroxidase, and superoxide dismutase (CAT, GSH, and SOD) levels were significantly decreased in the infected group compared to the control group. Compared to the control, the tumor necrosis factor-α (TNF-α) gene was firmly upregulated in gill tissue at all-time points, particularly at day 14 post-infection. Meanwhile, Interleukin 1-β (IL-1 β) gene was significantly upregulated only at days 7 and 14 post-infection compared to control. Histopathological examination revealed destructive and degenerative changes in both skin and gills of experimentally infected Nile tilapia. Our findings suggest that Nile tilapia-S. parasitica infection model was successful in better understanding of pathogenicity and host (fish)-pathogen (oomycete) interactions, where the induced oxidative stress and upregulation of particular immune biomarkers in response to S. parasitica infection may play a crucial role in fish defense against oomycetes in fish.

Case Report: Spontaneous pneumothorax revealing multiple myeloma: a case report

Various causes like trauma, infection, pulmonary disease or neoplasm can lead to spontaneous pneumothorax. We report a rare case of a spontaneous pneumothorax as first manifestation of multiple myeloma. A 58-year-old patient presented suffering from dyspnea and right-sided chest pain, with no history of trauma. On examination, the patient had bilateral rib tenderness. The respiratory rate was 30 breaths/min and oxygen saturation was 88%. The chest physical exam revealed unequal breath sounds, an hyperresonance with percussion and decreased wall movement on the right side. The analysis of arterial blood gas revealed hypoxemia (arterial oxygen tension: 7.59 kPa) and hypercapnia (arterial carbon dioxide tension: 5.99 kPa). Laboratory data showed a raised C reactive protein level (133.8 mg/L), hyper-calcemia (serum calcium: 12.18 mg/dL) and a decreased plasma albumin level (31.9 g/L). Chest radiography and thoracic computed tomography revealed multiple ribs and sternum fractures leading to a partial pneumothorax on the right side. Subsequent workup for multiple myeloma showed elevated levels of immunoglobulin. Results of initial laboratory tests revealed an IgG gamma paraprotein, a urine protein electrophoresis of 1450 mg/24 hours and a β-2 microglobulin rate of 3.35. The diagnosis of multiple myeloma was confirmed with a bone marrow infiltration of 20% of atypical plasmatic cells. Cytogenetic investigations did not show any chromosomal abnormalities, especially the t (4,14) translocation. The patient was diagnosed with multiple myeloma stage IIIA according to Durie–Salmon classification. Appropriate treatment with oxygen therapy and systemic analgesic was started, associated with a cure of zoledronic acid in order to decrease the calcium level. The evolution was characterized by the complete resolution of the pneumothorax in 7 days and the normalization of the calcium level. The autologous stem cell transplant was the treatment of choice for this patient.

Frequency of anemia in patients with pulmonary TB presenting at Nishtar Hospital Multan

Objective: The present study aimed to determine the frequency of anemia in patients with pulmonary TB presenting at Nishtar Hospital Multan and its classification as per the severity and morphological characteristics.&#x0D; Methods: This retrospective cross-sectional study was conducted at Nishtar Hospital Multan. A total of 109 TB patients were enrolled and underwent physical and systemic examination. Blood samples were collected to estimate complete blood counts (CBC), liver and renal function tests (LFT; RFT), serum albumin, and C - reactive protein (CRP) levels. Abdominal ultrasound was performed when suspected of any organomegaly. Hemoglobin was estimated using an automated analyzer (SYSMEX-SP100) and repeated manually among doubted cases. Before inclusion, written informed consent was obtained from all patients before inclusion, and the collected data was analyzed using SPSS version 22.0.&#x0D; Results: The female majority (54%) in the studied sample, with a mean age of 38 ± 15.3 years, and most belonged to low socioeconomic status (80%). Moreover, 43% were from Multan, 30% from D.G. Khan, and the remaining were from Khanewal, Layyah, and Vehari districts. Anemia was found in 82.56% of the enrolled TB patients. Most patients were moderately weak (Hb &lt; 10 g/dl &gt; 7 g/dl), and microcytic anemia was found in more than 80% of the anemic patients. CRP level was raised in 70% of these patients, and there was hypoalbuminemia in 80%. Furthermore, females were more anemic than males.&#x0D; Conclusion: In our study, anemia was prevalent in TB patients, specifically microcytic anemia. Hence, TB patients must be monitored for dietary deficiencies and inflammatory modulators to avoid such complications

Bilateral Infectious Extensor Tenosynovitis: A Case Report.

Infectious extensor tenosynovitis is a rare infection spreading along the extensor tendons of the extremities. It presents a diagnostic challenge in the emergency department (ED) given the nonspecific signs and symptoms, as opposed to the more common flexor tenosynovitis that is diagnosed by the classic Kanavel signs on physical exam. Here we present a case of bilateral extensor tenosynovitis in a 52-year-old female denying past medical history who presented to the ED with two days of bilateral dorsal hand swelling and pain. She denied any risk factors such as direct trauma to the hands or intravenous drug use. The rare diagnosis was suspected in the ED due to a very high complement reactive protein level and a concerning point-of-care ultrasound. Extensor tenosynovitis was ultimately confirmed on computed tomography and by operative irrigation and drainage of the tendon sheaths. This case demonstrates the importance of keeping extensor tenosynovitis on the differential when seeing a patient with dorsal extremity edema and pain, even if the findings occur bilaterally.

Impact of the use of iron-fortified iodized salt on hemoglobin levels: a community based open randomized trial

Background: In India prevalence of iron deficiency and anemia is high across all age, sex and physiological groups because of inadequate iron intake and poor bioavailability of iron from habitual Indian diets. Research studies in school-age children have shown that use of iron-fortified iodized salt (DFS) resulted in small improvement in Hb level; there are very few studies reporting impact of DFS use in women and men. Methods: A community-based open three arm randomised study was carried out to assess the impact of DFS use on Hb in women, men and children. The control group received iodised salt and two intervention groups received two formulations of DFS. Results: Socio-demographic and nutrition profile of the families, mean Hb, ferritin and C reactive protein levels of women, men and children at enrolment were comparable in all three groups. The DFS use for 12 months resulted in improvement in mean Hb in children (0.8 gm/dl) women (0.4 gm/dl) and men (0.3 gm/dl). Improvement in Hb was higher in anemic women, men and children. There was no change in mean Hb in non-anemic persons. There was a small improvement in ferritin in women who have low ferritin but no change in ferritin in women and men with normal ferritin. Conclusions: DFS may be a safe, feasible, affordable, and sustainable method for improving the iron intake and Hb status and accelerating India’s progress towards the SDG goal of 50% reduction in prevalence of anemia.

C1 COMPLETE HEART BLOCK AS A RARE MANIFESTATION OF GRANULOMATOSIS WITH POLYANGITIS: A CASE REPORT

Abstract A 42–year–old male with prior smoking habit presented at our emergency department after atraumatic syncope preceded by severe pain in the left lower limb. One month prior to presentation, due to persistence of nonproductive cough he underwent a chest computed tomography (CT), which showed 2 pulmonary nodules with hypercaptation at PET performed later (figure 1). The 12–lead electrocardiogram showed sinus rhythm with complete atrioventricular block and ventricular escape rhythm at 40 bpm (figura 1). Ecofast revealed a mildly impaired left ventricular systolic function (left ventricular ejection fraction [LVEF] 45%) with basal septal hypokinesis. Laboratory assessment showed leukocytosis (marked neutrophilia and eosinophilia), thrombocytosis anemia, elevated C–reactive protein (193 mg/dl), troponin I (18483 ng/L), NTproBNP (14627 ng/l) and creatinine (2.27 mg/dL) levels. The patient was transported to the catheterization laboratory for temporary pacemaker insertion and coronary angiography, which depicted distal occlusion of the first septal branch (Figure 2A), the first diagonal branch (Figure 2B) and the obtuse marginal branch (Figure 2C). After the procedure due to persistent ischemia of the left lower limb, several unsuccessful procedures to restore limb vascularization by means of locoregional thrombolysis and percutaneous angioplasty were attempted, but a leg amputation above the knee was eventually performed after few days. Neoplastic markers, blood cultures and urine cultures resulted negative, urine sediment examination showed cylinders, leucocytes and microhematuria. A brain/facial bones CT scan was performed, showing left maxillary sinusitis (figure 1). A rheumatologic screening was also performed, showing high titer of cANCA(125 UI/ml) hinting at a systemic vasculitis. The histopathological results of the amputated limb depicted marked necrotizing vasculitis with extensive involvement of small–medium caliber and larger caliber arterial vessels (figure 2). Based on these clinical and laboratory findings, a diagnosis of granulomatosis with polyangiitis (GPA) was made. The patients was treated with ev methylprednisolone and rituximab. After the induction therapy, chest CT scan showed a marked reduction of the size of the pulmonary nodule (Figure 3); renal function progressively improved and physiological atrioventricular conduction being restored

572 Trace Element Supplementation in Burn Patients: A Quality Improvement Project

Abstract Introduction Patients with major burns suffer deficiencies in trace elements (TE), which can affect their clinical course. We established a quality improvement (QI) project to supplement TE (multivitamins with TE, vitamin C, and zinc). Herein, we assessed the impact of QI implementation on outcomes. Methods We queried the burn registry for burn patients admitted from 8/1/2019-5/31/2022 who weighed &amp;gt; 40 Kg and stayed &amp;gt;14 days. Demographics; comorbidities; injury, and hospital course information were collected. Post-implementation, TE levels (zinc, copper, and selenium) as well as C reactive protein levels were measured at 2 weeks. Analyses were performed to assess differences between the pre- and post-groups and post-group patients with major burns (≥20%TBSA) and smaller burns (&amp;lt; 20%TBSA). P &amp;lt; 0.05 was considered significant. Results We included 111 patients, 45 in the pre- and 66 in the post-group. Overall, the population was male (79.3%) with a median age of 53 years. Age and sex were not significantly different between the pre- and post-groups. The post-group had higher TBSA (p = 0.005). They were more likely to smoke (p =0.018) and have an alcohol use disorder (p = 0.035). There was no significant difference observed in mortality, complications, or LOS/TBSA (2.1 days [1.2-5.5] vs. 1.7 days [1.2-3.1], p = 0.300) between the groups. Focusing on the post-group, 37 presented with smaller burns and 29 with major burns. Patients with major burns were younger (p =0.003) and healthier than patients with smaller burns. At 14 days, 81.5% and 33.3% of patients with major burns were deficient in zinc and copper, respectively. Zinc (47.6 µg/dL vs.79.2 µg/dL p &amp;lt; 0.001), copper (80.2 µg/dL vs.121.9 µg/dL p &amp;lt; 0.001), and selenium (98.7 µg/L vs.135.5 µg/L, p = 0.003) levels were significantly lower in patients with major burns. C-reactive protein levels were high in both groups but significantly higher in patients with major burns (p &amp;lt; 0.001). Patients with major burns were more likely to have infectious complications (p = 0.004); however their LOS/TBSA was significantly lower than that of patients with smaller burns (1.21 days vs. 2.43 days, p &amp;lt; 0.001). Zinc levels of patients with major burns significantly increased overtime from 47.6 µg/dL at 14 days post-admission to 73.5 µg/dL at 53 ± 16 days (p &amp;lt; 0.01). Conclusions Our data show that TE supplementation was efficient in bringing zinc levels close to the normal range in patients with burns ≥20%TBSA who stayed up to 50 days in hospital. Controlled for TBSA burned, supplementation of TE significantly decreased LOS of patients with major burns compared to patients with smaller burns. Applicability of Research to Practice Further studies are needed to evaluate the correlation between supplementation of TE and improvement of patient LOS.

Association of Serum Ferritin with C Reactive Protein in Iron Deficiency Anaemia

Objective: The purpose of this study was to determine whether or not individuals with iron deficiency anemia and an underlying inflammatory condition had a connection between serum ferritin as an acute phase reactant and C - reactive protein. Study Design: Cross-sectional/Prospective study Place and Duration: Liaquat university of Medical and health sciences jamshoro Hyderabad. January 2022 to December 2022 Methods: This research comprised 136 individuals who were suffering from iron deficiency anemia. After getting informed written consent detailed demographics of enrolled cases were recorded. Using an automated hematology analyzer (Mindray BC-5000), the parameters of the blood were analyzed. Serum ferritin levels were used to classify each patient into one of three categories. Serum ferritin levels were divided into three groups: Group I (serum ferritin &lt;10 μg/L), Group II (11–150 μg/L), and Group III (&gt;150 μg/L).SPSS version 23.0 was used to analyze the data. Statistical analysis was conducted using Pearson's correlation tests. Results: In current study patients mean age was 31.13±6.75 years and had mean BMI 24.6±3.52 kg/m2. There were majority 74 (54.4%) males and 62 (45.6%) females in this study. Majority of the patients 81 (59.6%) were had low ferritin &lt;10 μg/L, followed by normal ferritin 11–150 μg/L in 45 (33.1%) cases and 10 (7.4%) cases had high ferritin &gt;150 μg/L. We found strong co-relation of C reactive protein and high level of serum ferritin with p value &lt;0.002. Serum ferritin levels were negatively correlated with hemoglobin. Conclusion: We concluded in this study that levels of serum ferritin was positively associated with C-reactive protein (CRP). In patients with underlying deficiency of iron, secondary inflammation may increase the level of ferritin in serum. Keywords: Ferritin, Haemoglobin, Iron Deficiency Anaemia, C-Reactive Protein

Incidence and clinical predictors of left ventricular thrombus after ST elevation myocardial infarction as detected by magnetic resonance imaging

Abstract Funding Acknowledgements Type of funding sources: None. Background The aim of the current study was to characterize clinical predictors and to develop clinical risk score for left ventricular (LV) thrombus as detected by cardiac magnetic resonance imaging (CMR). Methods We evaluated 337 patients without known prior coronary disease, who underwent primary percutaneous coronary intervention for STEMI. All patients underwent transthoracic echocardiography (TTE) and CMR during their index hospitalization. We developed a novel prognostic risk model (ThrombScore) to identify patients at risk for LV thrombus development. Results Upon CMR, LV thrombus was present in 34 patients (10%), of whom 33 (97%) had an anterior wall MI and most (77%) had at least mildly reduced left ventricular ejection fraction (LVEF&amp;lt;45%) upon the first TTE. Sensitivity for thrombus formation of the first and second TTE was 5.9% and 59%, respectively. Multivariate logistic regression model revealed that elevated C reactive protein (CRP) levels, lack of ST-segment elevation (STe) resolution, elevated creatine phosphokinase (CPK) levels, and STe in anterior ECG leads are robust independent predictors of LV thrombus in STEMI patients. These variables were incorporated to construct the ThrombScore: a simple six-point risk model. The odds ratio for thrombus development per one-point increase in the score was 3.2 (95% Confidence Interval 2.1–5.01; p&amp;lt;0.001). Discrimination analysis of the model revealed c-statistics of 0.86 for thrombus development. The model identified three distinct risk categories (I, II and III) with thrombus incidence of 0%, 1.6% and 27.6%, respectively. Conclusions ThrombScore is a simple, practical, clinical risk model for risk stratification of thrombus formation in patients with STEMI.