Rise In CRP Research Articles

Risk factors for PTSD symptoms following PICU admission for childhood septic shock.

ObjectivePaediatric intensive care unit (PICU) admission represents a traumatic event for many children. Follow-up studies have found post-traumatic stress disorder (PTSD) rates of 10-30%, with a particular prevalence following admission for sepsis. Dysregulated inflammatory responses are associated with PTSD. Sepsis involves a marked inflammatory response but the relationship between this and PTSD have not been clearly established. In this study we investigate associations between the inflammatory response, psychosocial risk factors, and PTS symptoms following PICU admission for septic shock.We investigate the outcomes for children aged > 3 years, discharged from one PICU following admission for septic shock between 2010 and 2017. The study was a retrospective analysis of PICU-specific PTS symptoms reported by parents at any time since discharge via the Trauma and Behavior Health screen. Demographics, pre-morbid health characteristics, and exposure to other traumatic events were assessed. Clinical characteristics and blood test results at admission and at 48 h were recorded from clinical records. Multiple linear regression was used to investigate relationships between PTS symptom scores and predictor variables.Data for 65 participants (48% male, median assessment age 8.0 years) was available. Median time since admission was 5.1 years. 30.8% children scored at risk of PTSD at any time since discharge Symptoms were significantly associated with acute CRP rise (p 0.03), other trauma exposures (p = 0.01), and female gender (p =0.04).PTS symptoms in children who have survived septic shock are prevalent. These findings support a possible contribution of acute inflammatory changes, cumulative traumatic exposure, and female gender in post-PICU PTSD development.

Multi-center study on mortality in children, and adults with sickle cell anemia-risk factors and causes of death

Sickle cell disease (SCD) is a major public health burden worldwide with increasing morbidity and mortality. The study evaluates the risk factors associated with mortality in SCD patients, between the years 2006 and 2020 at three hospitals in Oman. The analysis includes clinical manifestations, haematological, biochemical, and radiological parameters, use of antibiotics, and blood and exchange transfusions. Our cohort included 123 patients (82 males, 41 females), with a median age of 27 (Interquartile Range 21–35 years). SCD related complications included acute chest syndrome (ACS) in 52.8%, splenic sequestration in 21.1%, right upper quadrant syndrome in 19.5%, more than > 6 VOC/year in 17.9%, and stroke in 13.8%. At the terminal admission, patients had cough, reduced O2 saturation, crepitation and fever in 24.4%, 49.6%, 53.6% and 68.3% respectively. Abnormal chest X-ray and chest CT scan were seen in 57.7%, and 76.4% respectively. Laboratory parameters showed a significant drop in hemoglobin (Hb) and platelet counts from baseline, with a significant rise in WBC, LDH and CRP from baseline (p < 0.05, Wilcoxon Signed Ranks test). All patients received antibiotics, whereas, 95.9% and 93.5% received simple blood transfusions, and exchange transfusions respectively, and 66.6% required non-invasive ventilation. Among the causes of death, ACS is seen in 32 (26%), sepsis in 49 (40%), and miscellaneous in 42 (34%). Sudden death was seen in 32 (26%) of patients. Male gender, with low HbF, rapid drop in Hb and platelet, and increased in WBC, LDH, ferritin, and CRP, correlated significantly with mortality in this cohort.

Correlation of serum biomarker (LDH, CRP, IL-8) levels in pre-malignant and malignant lesions of head and neck

A precancerous lesion is often defined as morphologically altered tissue during which the occurrence of carcinoma is more likely than its normal counterpart. Head and neck cancers include cancers of the mouth and therefore the larynx, also as some rarer cancers like cancer of the sinuses, salivary glands, nose, and tympanic cavity. Head and neck cancers are often described as consistent with the sort of cell they begin with. A biomarker could be defined and interpreted as biological molecule which is mostly found in body fluids, blood or even tissues that indicates abnormalities of our body. Here we've taken three biomarkers (LDH, CRP, IL-8) to gauge their level rise in pre-malignant and malignant lesions which are present in our head and neck. Patients attending ENT OPD with primary symptoms indicating premalignant and malignant lesions in the region of head and neck had been included for the analytical study. Complete ENT examination followed by biopsy of the suspicious lesion and blood sample collection was done. A complete of 30 patients were included in each group of premalignant and malignant lesions. No mean serum rise of serum LDH was noted in premalignant and malignant lesions. A mean serum rise of serum CRP was noted in premalignant lesions but was not noted in malignant lesions. However, both premalignant and malignant lesions noted a mean serum rise of IL-8. From a future perspective serum evaluation of biomarkers can become a replacement diagnostic modality for the early evaluation of premalignant lesions and malignant lesions and for monitoring the prognosis of an equivalent.

Comparative studies on haemato-biochemical changes following pre-emptive analgesia with tramadol, pentazocine lactate and meloxicam inpain management of canine ovariohysterectomy

The present study was conducted to evaluate the effects of tramadol, pentazocine lactate and meloxicam as pre- emptive analgesics in dogs premedicated with glycopyrrolate, inducted with propofol and maintained with propofol continuous rate infusion (CRI) for certain haematological and biochemical parameters. The animals were randomly divided into three equal groups,viz. Group-T, Group-P and Group-M comprising six animals in each group and all the animals were premedicated with glycopyrrolate. After 10 min of pre-anaesthetic administration, pre-emptive analgesia was given. Blood was collected from cephalic or saphenous vein at intervals 0 (baseline) min before premedication, thereafter at 10 min, 30 min, 1 h, 2 h and 3 h after pre-emptive analgesic administration and haemato- biochemical parameters were recorded. Hb, PCV and TEC were significantly decreased at 30 min and 1 h interval in all the three groups. TLC and glucose concentration were significantly higher in group-M as compared to group-T and group-P at different time intervals. GGT level increased significantly at 30 min in all the three groups. CRP concentration was significantly higher in group-M as compared to group-T. Total protein was significantly decreased at 1 h interval in group-T and group-P, but in group-M such finding was noticed at 2 h interval. Cortisol was significantly lower in group-T in entire study period. The alterations in physiological and haematological parameters caused by tramadol, pentazocine lactate and meloxicam were found to be minimal and within the physiological limits. Tramadol produced less significant rise in CRP and cortisol concentrations which indicated better pain management. Based on the findings of the present study, it is concluded that tramadol is more effective as compared to pentazocine lactate and meloxicam in the management of post-operative pain due to canine ovariohysterectomy.

A O03 Host phenotypic adversity independently predicts progression to resection in neoadjuvantly-treated pancreatic cancer

Abstract Background Neoadjuvant treatment (NAT) offers a modest survival benefit to the otherwise dismal outcomes of pancreatic ductal adenocarcinoma (PDAC), however methods for assessing treatment response and disease trajectory during NAT are limited. Cachexia and sarcopenia are hallmark features of PDAC and defining host phenotypic adversity is crucial in understanding the tumour-host relationship and its influence on clinical outcomes. We sought to determine the relationship between body composition, systemic inflammation, and outcomes in NAT PDAC to lay foundations for improving assessment of treatment response. Methods This is a retrospective, observational study with an intention-to-treat design, analysing resected (n = 109) and non-resected (n = 117) NAT PDAC (total n = 226) from the tertiary West of Scotland Pancreatic Unit, Glasgow Royal Infirmary. Patients were included if they had resectable or borderline resectable disease and received NAT. Patients were excluded if they had locally advanced or metastatic disease. Body composition was determined by single-slice L3 cross-sectional measurements. Results Patients with an adverse phenotype defined by change in body composition were less likely to progress to resection (40.9% vs 68.8%, p &amp;lt; 0.001). Logistic regression confirms the independence of this effect (OR 3.79, 95% CI 1.99-7.22, p &amp;lt; 0.001). There was a trend towards systemic inflammation in the non-resected group (CRP rise 51.4% vs 29.9%, p = 0.008). Patients treated with Folfirinox who required dose reduction received higher doses of irinotecan, 5-fluorouracil (bolus) and 5-fluorouracil (infusion) per unit muscle mass (7.3 vs 6.9mg/cm2⋅m-2, p = 0.010; 16.2 vs 14.7mg/cm2⋅m-2, p = 0.002; 96.5 vs 91.1mg/cm2⋅m-2, p = 0.026). Conclusions Host phenotypic adversity during NAT presents a potentially valuable addition to a limited arsenal of tools to aid decision making in resectable and borderline resectable PDAC. Early assessment of body composition trend during chemotherapy may present an opportunity to switch the host phenotype from adverse to favourable in some patients, or highlight the futility of continuing aggressive treatment in others. Chemotherapeutic prescribing by body surface area overlooks crucial differences in lean body mass and may be exposing patients to avoidable and burdensome toxicities.

CRP – a valuable source of information or just a laboratory test?

Background and Purpose: Laboratory tests are an inseparable element in modern medicine. They provide us with valuable clues for making a diagnosis or monitoring treatment. One of the most frequently ordered biochemical tests is the determination of the level of CRP in the blood. The aim of the study is to present the clinical usefulness of this study and to present knowledge about C-reactive protein. Current state of knowledge: It is produced mainly by the liver, but the latest reports confirm local synthesis, among others, in arterial endothelial cells. The most common reason for the increase in the level of CRP is the appearance of infection, during which time its concentration may increase by up to 1000 times. Elderly patients have a weaker immune system response than younger patients, therefore the rise in CRP may be less pronounced. Other reasons are autoimmune diseases, cancer, or acute or chronic inflammation. As a result of cel damage, pro-inflammatory cytokines are secreted, which stimulate the production of CRP. Most scientific sources consider CRP ≥ 10 mg/L to be significant. Values of 3-10mg/L are considered a slight increase in CRP levels. Such CRP values were found in about 1/3 of the American population. Conclusions: The CRP level should not be interpreted as an isolated medical parameter, but in conjunction with other tests and the patient's current state of health. Based on the amount of CRP in the blood and changes in its concentration over time, we can check the response to treatment and predict the course of some diseases.

FTP3.2 Differences in the Acute Phase Response in Right-Sided Colorectal Surgery: Evaluation of the Kono-S Anastomosis

Abstract Aims CRP monitoring has become routine post-operative practice in resectional colorectal surgery and is useful as a predictive tool for identification of anastomotic leak. Day 3 CRP &amp;gt; 150 has been shown to be highly predictive of anastomotic leak. The acute phase response observed in surgery for Crohn’s disease (CD) is often more pronounced compared to malignancy and this is not accounted for in post-operative monitoring. This study looks at the difference in CRP in patients undergoing right hemicolectomy for cancer versus CD and evaluates any difference in CD patients who have conventional versus Kono-S anastomosis. Methods A single-center retrospective analysis of patients undergoing right hemicolectomy for malignancy and CD was undertaken, including CD patients with conventional and Kono-S anastomosis. Primary outcomes included CRP on Day 1 and 3 post-surgery. Length of stay, leak rate and post-operative infections were recorded. Analyses were carried out including and excluding patients with post-operative leak and infection. Results Day 1 CRP was significantly higher in patients undergoing surgery undergoing surgery for CD compared to malignancy (p &amp;lt;0.001). Day 3 CRP was significantly higher in patients undergoing surgery for CD compared to malignancy (p = 0.017). There was no significant difference between CD patients undergoing surgery with Kono-S anastomosis compared to conventional anastomosis. Kono-S anastomosis was not associated with any difference in leak, infection, or length of stay. Conclusions The rise in post-operative CRP is more pronounced in CD patients compared to cancer patients. CD patients with Kono-S anastomosis do not have significantly different post-operative CRP from patients with conventional anastomoses.

P91 MYOCARDITIS ASSOCIATED WITH CAMPILOBACTER J. INFECTION IN TWO BROTHERS: A COMMON FATE?

Abstract Myocarditis is an inflammatory process of the heart muscle and represents a potential complication of different infectious and non–infectious pathogens. Bacterial infections are more rarely counted than viral ones among the causes of myocarditis and, for example, few cases of myocarditis associated with Campilobacter J. infection are described in the literature. J. Piero, 28 years old, arrives in ED for oppressive chest pain. He does not report any CV risk factors, he had diarrhea in recent days after eating chicken meat. CRP rise and increase in myocardionecrosis enzymes are found in blood chemistry; ECG within limits; echocardiogram: mild left ventricular dysfunction due to hypokinesia of the basal middle segments of the lateral wall (EF 50%). Giulio is hospitalized in the UTIC for suspected myocarditis confirmed in the study with CMR after 1 week according to the Lake Louisse criteria: myocardial edema and early enhancement in the lower basal site of the LV. A few hours later, Piero‘s brother, Giulio, also went to the ED for atypical chest pain and diarrhea; immediately undergoes a cardiological examination with subsequent hospitalization in the cardiology department with a diagnosis of: suspected myocarditis. In fact, even Giulio in the blood chemistry tests shows: increase in PCR and myocardionecrosis enzymes, albeit with an electrocardiogram and an echocardiogram within normal limits. The MRI performed after about one week shows myocardial edema in the lower lateral area of ​​the left side confirming the diagnosis of myocarditis. In both cases, a gastrointestinal film array was performed during hospitalization which highlighted the presence of Campilobacter J. as a pathogen present in the faeces and antibiotic therapy with azithromycin was started for both Piero and Giulio. The CMR of Piero and Giulio, performed in Follow up, shows: subepicardial post–inflammatory scar of the basal inferior lateral wall of the left ventricle withb persistence of a subtle late impregnation of modest entity. The presented clinical case involving two brothers with myocardial involvement after campylobacter J. enteritis supports a hypothesis of "genetic predisposition" at the basis of the myocarditis process. Subsequent clinical evidence and scientific studies are needed to evaluate the genetic background of myocarditis, which is still unknown today.

Role of Serum Ferritin, D-Dimer, and C-Reactive Protein Parameters in COVID 19 Severity.

Following the epidemics caused by the transmission of the common virus between humans and animals (COVID-19), coronavirus 2 (SARS-CoV-2) is the third and most deadly strain of RNA virus that can cause respiratory, digestive, and nervous system problems, and there are many unknown complications. This study included 170 clinical samples of nasopharyngeal swaps (100 patients and 70 controls for both males and females). RT-PCR was performed, and blood samples were taken for biochemical analyses. They were obtained from Iraqi patients aged 25 to 92 years old. Between November 2021 and March 2022, COVID-19 patients were admitted to Dar al-salam Hospital, Alyarmok Teaching Hospital, and Alshefaa Hospital. AFIAS D-Dimer, AFIAS ferritin, and NycoCard CRP tests were performed on the patients and were classified depending on the severity of their infection (mild or moderate, severe and critical). The results showed a significant increase in ferritin in critically ill patients (545.58 ± 57.71). A significant increase of D-dimer was found with different severity with highly significant in the critical group (3.93 ± 0.79). With varying degrees of severity, a substantial rise in CRP was discovered with highly significant in the critical group (96.27 ± 14.55) between the severity group (p-value <0.001). Also, COVID-19 individuals in the age range (50 - 60) tended to be more severe than younger people, whereas the effect of gender is not significant in any patient group. The biochemical factors, including D-Dimer, ferritin, and CRP, are effective in the disease's occurrence of symptoms and severity.

C-Reactive protein rise in rheumatology patients following COVID-19 vaccination.

The aim was to determine the proportion of patients with inflammatory arthritis who have a flare of their rheumatological disease within 4 weeks of receiving a coronavirus disease 2019 (COVID-19) vaccine, using CRP as a surrogate marker. A retrospective review was conducted of notes for patients with inflammatory arthritis within 30 days of their COVID-19 vaccine. An electronic database (DAWN) was used to identify all patients who were currently on a DMARD or biologic therapy. This was then correlated with vaccine data from the National Immunisation and Vaccination System (NIVS) and CRP within 30 days of their vaccination. From the DAWN database, 1620 adults were identified (mean age 61 years, 64% female). Three types of vaccinations were administered: AstraZeneca (AZ), BioNTech-Pfizer or Moderna. Vaccine uptake was 1542 of 1620 (95.2% for the first dose), 1550 of 1620 (95.7% for the second dose) and 1437 of 1620 (88.7% for the third dose). One hundred and ninety-two of 1542 patients (12.5%) had a CRP rise of >10 mg/l within 30 days of their vaccine, which was higher than the baseline flare rate of 8.6% (P = 0.0004). Patients with inflammatory arthritis and on DMARDs have a high uptake of COVID-19 vaccine (95%), which is greater than the national average. A CRP rise >10 mg/l within 30 days of vaccination was observed in ∼1 in 10 patients in our study population after all three doses. There might be a slight increase in disease flare in patients with inflammatory arthritis after COVID-19 vaccinations, and additional research is required to assess this association further.

Higher Rate of Relapse of KSHV/HHV-8 Associated Multicentric Castleman Disease after Rituximab Therapy in HIV- Patients Than in HIV+ Patients

KSHV/HHV-8 associated multicentric Castleman disease (HHV-8 MCD) is a rare lymphoproliferative disorder associating lymphadenopathy, splenomegaly, fever and inflammatory symptoms with high serum CRP, hypergammaglobulinemia and high plasma HHV-8 DNA viral load. HHV-8 MCD mainly affects HIV infected patients but can also be observed in HIV negative patients born in countries with high HHV-8 prevalence. We retrospectively analysed a cohort of 99 patients (73 HIV+ and 26 HIV-) with HHV-8 MCD treated with rituximab (off-label). The baseline characteristics were similar in HIV- and HIV+ patients although HIV- patients were older at MCD diagnosis (median, 65 vs 42 years) and presented less frequently with previous Kaposi sarcoma lesions (15% vs 40%). Out of these 99 patients, 95 patients (25 HIV- and 70 HIV+) achieved CR after a rituximab based therapy. After a median follow-up of 51 months (743 visits), 36 patients were considered as in treatment failure because of MCD relapse, KS progression, lymphoma or death. The 5-year progression-free survival (PFS) was 54,4 % [IC95% 40,8-66,0]. Relapse or progression of HHV-8 disease occured in 12 /25 (48%) HIV- patients and in 24 /75 (32%) HIV+ patients. The 5-year PFS was lower in HIV- patients than in HIV+ patients : 25,7 % [IC95% 5,2-53,6] and 61,6% [IC95% 46,2-73,7], respectively (p= 0.02 ). We have retrospectively analysed the kinetics of blood HHV-8 DNA, CD19+ B-cells and serum CRP after a first rituximab induced CR. The median times for a rise of plasma HHV-8 DNA above 3 logs/mL (n=57), CD19+ B-cells above 1/mm3 (n=59) and serum CRP above 20 mg/L (n=42) were 5,8 months [IQR 2,8-19,8], 8 months [IQR 4,7-13,4] and 13,1 months [IQR 3,4-27,8], respectively. The median time for treatment failure after such events were 4,5 months [IQR 0-16,4] for HHV8-DNA, 13,9 months [IQR 2,7-22,5] for CD19+ B-cells and 2 months [IQR 0-6,9] for CRP. These data show that in most patients, B cells became detectable again and that plasma HHV-8 DNA rose above 3 logs/mL during the first year post-rituximab and that these events could be followed by a rise in serum CRP preceding treatment failure. We suggest that these covariates should be monitored every 4-6 months although the decision of reintroducing specific therapy should still rely on the occurrence of clinical symptoms. The lower rate of relapse observed in the HIV+ population despite a longer follow-up period, may be due to a younger age and to the possible immune reconstitution upon antiretroviral therapy in this population. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

S2164 An Unusual Case of Diarrhea in an Immunosuppressed Patient

Introduction: Amoebic Colitis, a frequent clinical manifestation of invasive intestinal infection due to Entamoeba histolytica, is a common cause of diarrhea mostly prevalent in developing countries due to unsanitary conditions. Although 90% of the cases may be asymptomatic carriers, one of the most common clinical manifestations include dysentery. It carries an excellent prognosis if diagnosed promptly and treated. However, establishing a diagnosis of Amoebic Colitis is often challenging. We highlight a unique case of Amoebic Colitis in a 73-year-old female in a setting of immunosuppression. Case Description/Methods: A 73-year-old female from Qatar with ESRD, DM, HTN, and Renal cell carcinoma was admitted for abdominal pain, bloody diarrhea, and on and off a fever for 3 months. She was on tacrolimus, mycophenolate, and prednisone for her renal transplant. Diffuse abdominal tenderness was noted on examination but vitals were normal. CT scan showed ascending and transverse colon colitis and colonoscopy showed congested rectal, rectosigmoid, and sigmoid colon mucosa with multiple ulcers in descending, transverse, and ascending colon and rectum. Stool calprotectin was >3000 mg/kg Biopsy results showed active colitis with ulcers. Intravenous steroids were started and she showed improvement but abdominal pain and bloody diarrhea recurred with rise in CRP (from 6.9 to 15.5 mg/kg) when she was switched to oral steroids. A repeat CT scan showed an increase in the involvement of the right colon and piperacillin-tazobactam was started. Repeat colonoscopy showed a vascular pattern in mucosa diffusely decreased and nonbleeding ulcerated mucosa. Meanwhile, the E. histolytica antibody was positive. Antibiotics were switched to oral metronidazole. Pathology showed chronic active colitis with ulcer and increase apoptotic crypt epithelial cells. The clinical condition continued to improve and she was discharged home on steroid taper with a plan to repeat the scope in 3 months. She is doing well and on regular follow-up (Figure). Discussion: Amoebic colitis should be a differential diagnosis for individuals from eastern countries where the prevalence of Entamoeba histolytica continues to be high as a delay in diagnosis may lead to adverse outcomes. Diagnosis often requires a combination of different modalities including stool microscopy, stool antigen testing, and colonic biopsies. Treatment with metronidazole, tinidazole, paromomycin, diiodohydroxyquin, or diloxanide furoate is often highly safe and effective.Figure 1.: A- Ascending and transverse colonic wall thickening consistent with colitis B - Congested, friable, and ulcerated mucosa C- The mucosa vascular pattern in the descending colon was diffusely decreased- after treatment.

P13 A case of Kikuchi-Fujimoto disease triggered by an episode of bacterial cellulitis, associated with features of SLE

P13 A case of Kikuchi-Fujimoto disease triggered by an episode of bacterial cellulitis, associated with features of SLE

Remdesivir Treatment in Moderately Ill COVID-19 Patients: A Retrospective Single Center Study.

Almost two years after remdesivir was approved and extensively used in numerous clinical studies for the treatment of COVID-19 patients, there is still no clear recommendation for the time and phase of the disease of remdesivir administration. This retrospective observational study included adults (≥18 years) with severe COVID-19, radiologically confirmed pneumonia, a need for supplemental oxygen and an interval from symptom onset to enrolment of 10 days or less. All patients were treated with remdesivir for 5 to 10 days, or with clinical improvement within that period. The primary goal was the outcome in patients treated with remdesivir during the early stage of the disease considering the different disease severity. The median time from symptom onset to treatment was 8.4 days (3–10). Clinical improvements and good outcomes were observed in 104 of 137 patients (75.9%); 33 (24.1%) of 137 patients died. Subgroup analyses showed that the mortality rate was significantly lower in moderately ill patients (3 out of 51 patients; 5.9%) than in the group of severely/critically ill patients (30 out of 86 patients; 34.8%; p < 0.005). Older age, rise of CRP and CT score were shown to be significant predictors of disease outcome. Overall, remdesivir was well tolerated, and the treatment was discontinued in only four patients. The results of this observational study in 137 patients with different disease severity contribute to the attitude concerning remdesivir administration in the early stage of COVID-19, at least in moderately ill patients with a high risk of progression, before the transition to a more severe stage.

Two cases of giant cell arteritis following ChAdOx1 nCoV-19 vaccination – complication or coincidence?

This 66 years old woman had the ChAdOx1 nCoV-19 vaccine on 25 February 2021 and about 6 hours later, she started to get pain in the right side of her head. She also had flu-like symptoms which lasted a couple of days, but these settled down whilst the headaches persisted. She also developed scalp tenderness and obvious swelling of possibly frontal branch of right temporal artery (see figure 1). She did not develop any jaw claudication, visual or systemic symptoms. She was seen in the out of hours GP clinic on 29 of February 2021 and was started on Prednisolone 40 mg daily with resolution of symptoms in a few days. Her blood tests in February 2021 showed rise in CRP to 16.8 mg/L (NR 0-5) compared to December 2020 value of 3.3. Ultrasound (US) showed normal appearances in the temporal or axillary arteries, although this was delayed 2 weeks post corticosteroid (CS) therapy. Her visible temporofrontal abnormalities had disappeared within a few days of treatment. CT scan head with venogram was normal and treatment for GCA was continued.

ASSOCIATION BETWEEN C-REACTIVE PROTEIN AND GLYCOSYLATED HEMOGLOBIN IN TYPE-2 DIABETES MELLITUS: AN INDIAN PERSPECTIVE

Background: Diabetes mellitus (DM) is a complex metabolic disorder that alters the glucose status of the human body. There has been a steady increase in the prevalence of DM in the past few decades leading to macro-and microvascular complications. There has been mounting evidence suggesting that inammation plays a role in the pathophysiology of DM. Methods: Asingle centre prospective study was conducted on 50 consecutive patients with de novo or prior Type-2 DM (T2DM) history between JANUARY 2021 to OCTOBER 2021. CRP and HbA1c samples were taken at the start of the study and were retaken after 12 weeks of pharmacotherapy and lifestyle modication. The relationship between CRPand HbA1c was analysed. Results: The mean HbA1c and CRP for the initial 50 participants were 9.6500 ± 1.8816 and 1.1520 ± 0.9984, respectively. At the 12th-week follow up, the mean HbA1c fell to 7.3952 ± 1.3155 (P&lt;0.05), and the mean CRP was reduced to 0.2857 ± 0.5237 (P&lt;0.05). Furthermore, the rise in HbA1c was correlated with a statistically signicant rise in CRP. Conclusion: This study establishes a positive correlation between serum CRP and HbA1c. Improving glycemic control can help reduce the risk of adverse events associated with sustained inammation

Association of Serum C- Reactive Protein with Severity of Acute Ischemic Stroke Patients

Introduction: Stroke is a leading cause of death and long-term disability worldwide. Of the total number of prevalent strokes, more than 80% are ischemic. Atherosclerosis being an inflammatory condition is associated with raised serum level of CRP. Hence the possible role of serum CRP in pathogenesis of AIS is being studied. Many studies support that serum CRP is a marker of stroke severity and prognosis. Materials and Methods: The observational and prospective study was carried out at Department of Neurology, Sheikh Sayera Khatun Medical College, Gopalganj, Bangladesh from January to December-2020.The present study ‘Serum C-reactive protein in Acute Ischemic stroke and its impact on stroke severity and prognosis. Total 51 neuroimaging confirmed cases of AIS were selected randomly for this non- interventional prospective study. Serum CRP was measured in all patients and NIHSSS was used for assessing stroke severity. Results: The mean CRP level was 21.93±3.60 mg/l and only 18% of cases were having normal CRP level. 60% of cases were having serum CRP level in the range of 3-30mg/L and 18% were having even the higher level. Age of the patient significantly correlated with the CRP level (r=0.294 at p-0.05) but the sex didn’t affect the rise in CRP (p= 0.490). Serum CRP level was affecting the stroke severity significantly (r=0.643, p-0.000).The mean CRP level in discharged patients was 10.51 ± 13.21 mg/l whereas it was 44.11 ± 29.7 mg/l in those who died in the hospital. Thus CRP level affected mortality of acute ischemic stroke significantly. (p-0.00). Conclusion: CRP is raised in most of the patients of acute ischemic stroke and its elevation reveals the underlying inflammation causing atherosclerosis as well as CRP as a marker of brain injury. Serum C-reactive protein elevation is associated with more severe stroke and poor prognosis.

EVALUATION OF C - REACTIVE PROTEIN AS A PROGNOSTICATOR OF THE COURSE OF COVID 19 DISEASE

Diagnosis of COVID 19 is based on clinical manifestations, history of exposure, positive CT scan findings and laboratory tests. Inflammation plays a key role in pathogenesis of COVID 19. CRP is an acute phase protein in the serum and is also a surrogate marker for the pro inflammatory cytokine IL 6. Significant rise in CRP indicates clinically relevant inflammation. Aim and Objectives: To analyse the CRP levels in COVID 19 infected patients and to validate CRP as an indicator of the severity of SARS CoV 2 infection. Materials and Methods: This retrospective study was carried out at Chettinad Hospital and Research Institute, a tertiary care hospital situated on the outskirts of Chennai, India, for a period of 4 months. A total of 10263 patients were tested for COVID-19 by RT PCR. Viral RNA Extraction was automated and SARS CoV2 RTPCR performed with ROTOR GENE Q(QIAGEN) using SD Biosensor Real Time PCR kit. The CRP levels were measured using QDx Instacheck Fluorescence immunoassay system, Indianapolis, IN. Results: Among 10263 patients, 2694 (26.2%) patients tested SARS CoV-2 positive. CRP levels were measured for 1472 SARS CoV 2 patients (including both OP and IP). Among them 745 (50.6%) patients were found to be CRP reactive. Of the CRP reactive patients, 7 patients (0.9%) were &lt;18 years, 190 patients (25.5%) were between 18 - 45 years and 548 patients (73.5%) were &gt;45 years. Of the 592 patients with elevated CRP levels, 167 patients were from ICU and 425 patients were from non-ICU. Highly elevated CRP levels of &gt;100mg/L were found in 65% (n=109) of the COVID positive ICU patients and 23% (n=101) of the non-ICU patients. Increased CRP levels were noted in SARS CoV- 2 infected individuals. Elevated CRP was common among elder patients aged &gt;45 years and in males. Conclusion This study concludes that the significant rise of CRP levels was noted in hospitalized SARS CoV 2 positive patients aged &gt; 45 years. Thus, estimating the early rise of serum CRP levels in SARS CoV-2 patients is a well affordable and less invasive parameter to guide the clinicians that is readily available in all the health care centers.

TP9.2.19Factors Associated with Multiple Presentations Prior to Appendicectomy in Children Presenting with Suspected Appendicitis

Abstract Aims Appendicectomy is amongst the most common emergency operations in children. We aim to audit the rate of re-presentation within 30-days prior to appendicectomy in children presenting to the emergency department (ED) with suspected appendicitis and identify the factors associated with re-presentations. Methods Retrospective review of the medical notes of all children that had an emergency appendicectomies between June 2016 and June 2019. Results A total of 231 appendicectomies were performed, all presented through ED, with 8.2%(n = 19) re-presenting within 30-days prior to appendicectomy. Negative appendicectomy rates were similar in those that had appendectomy at initial presentation or when they re-presented (13.2(n = 28)%vs.15.8%(n = 3), p = 0.752), respectively. Of those that re-presented, 84.2%(n = 16) were not reviewed by the surgical team at the index presentation. Female patients accounted for 62.5%(n = 10) of those that re-presented, compared with 31%(n = 57) of those that presented once(p = 0.010). Pyrexia(p = 0.029), Rovsing's sign(p = 0.032), nausea or vomiting(p = 0.012) was associated with histological appendicitis. Absence of migratory pain(p = 0.005), anorexia(p = 0.004), right iliac fossa tenderness(p &amp;lt; 0.001) or guarding(p &amp;lt; 0.001) was associated with higher successful discharge rate. Among those re-presented, there was significant CRP rise between first and second presentation (median(Q1,Q3): 6(1.25,28.5)vs.95.5(27,176.5), p = 0.016) however, white cell count was comparable (median(Q1,Q3): 14.6(11.98,16.05)vs.14.0(11.02,18.58), p = 0.815). Conclusion Clinical symptoms and signs correlated with histological appendicitis. A significant proportion of those that re-presented were not assessed by the surgical team at initial presentation. Early surgical consultation at initial presentation may reduce rates of re-presentation.

P–591 Mass spectrometry-based glycomic profiling of the follicular fluid total immunoglobulin G and proteome N-glycomes reveals deregulated inflammatory processes associated with specific controlled ovarian stimulation protocols

Abstract Study question Is there a significant inflammatory-related difference between analyzed follicular fluid (FF) glycome profiles regarding the ovarian stimulation protocol used in patients? Summary answer Observed differences between analyzed glycome profiles from patients that underwent different controlled ovarian stimulation (COS) protocols point to deregulated inflammatory processes associated with specific COS. What is known already Successful physiological folliculogenesis and ovulation require an adequate inflammatory response. On the other hand, COS application in ART relies on induced hormonal activation of systemic inflammatory processes. Several studies have confirmed a rise in inflammatory cytokines, CRP, and other markers of inflammation in patients subjected to different COS protocols, pointing to an enhanced inflammatory response during ovulation stimulation. Glycoproteins and glycans have an indisputable role in immune response modulation: proper glycosylation of glycoproteins plays a pivotal role in the regulation of normal physiological processes, and aberrant glycosylation of glycoproteins has been associated with various pathological states, including inflammation. Study design, size, duration Study design: Cross sectional – FFs from patients that underwent ART in modified natural cycle (MNC group) versus FFs from patients that underwent ART under GnRH antagonist COS (COS group). Size: 20 FFs from 20 patients undergoing ART. Duration: One year. Sampling procedure: Each FF was aspirated from the dominant follicle. In the COS group, only the fluid from the first aspirated follicle of each patient was collected. Participants/materials, setting, methods Study included 20 FF samples from 20 patients divided into two groups according to the applied ovarian stimulation protocol: MNC group (n = 10) and COS group (n = 10). The immunoglobulin G (IgG) was isolated from FF samples by immunoaffinity chromatography. The N-linked glycans derived from IgG molecule and the remaining FF total proteomes were enzymatically cleaved and subjected to derivatization procedure. N-glycomes of FF-isolated IgG and total proteomes were analyzed separately by MALDI-TOF-MS. Main results and the role of chance FF IgG N-glycome profiling The MALDI-TOF-MS based comparative analysis of the individual glycan relative abundances, revealed several significantly deregulated glycoforms between analyzed groups whose levels were significantly elevated (p˂0.05) in the COS vs. MNC group. Furthermore, additional low abundant N-glycan species were also found to be deregulated between the analyzed groups: two monogalactolysed and monosialylated N-glycan compositions were only identified in the COS group. The comparative analysis of FF IgG N-glycome features revealed statistically relevant differences in the levels of two derived traits: galactosylation and bigalactosylation levels of the FF IgG N-glycome, both significantly downregulated (p˂0.05) in the MNC vs. COS profile. Comparative analysis of FF total proteome N-glycome The majority of identified glycan compositions were complex type N-glycans representing more than 98% of the total N-glycome profiles in both analyzed groups. The comparative analysis of individual glycan relative abundances revealed relevant differences in regulation of ten N-glycan species between the two analyzed profiles. In the MNC group, six N-glycan species showed significantly increased abundances (p˂0.05) compared with the COS group. Moreover, two compositions were exclusively identified in the MNC group, while two compositions were identified only in the COS group. Limitations, reasons for caution Since this preliminary study was conducted on relatively small sample size, all results should be verified on a larger sample set. Moreover, focused glycosylation analysis of a panel of individual FF acute phase blood serum derived proteins and immunoglobulins, might additionally clarify the inflammatory mechanisms underlying different ART stimulation protocols. Wider implications of the findings: While glycome profiling of human FFs was conducted for the first time, previous evidence supports the shown association of aberrant inflammation in diverse ART stimulation protocols and in development of various pathological states (i.e. OHSS). Obtained results are in line with previous similar studies performed in the human plasma. Trial registration number uniri-biomed–18–161 1310