Significant Differences In CRP Research Articles

Effect of n-3 unsaturated fatty acid diet on C-reactive protein and erythrocyte sedimentation rate in the anti-inflammatory effect of rheumatoid arthritis: A meta-analysis

AbstractThe work was carried out to explore whether the anti-inflammatory effect of n-3 unsaturated fatty acids on patients with rheumatoid arthritis is related to the levels of inflammatory markers CRP and ESR. Studies on the treatment of rheumatoid arthritis with n-3 unsaturated fatty acid diet therapy and the outcome index containing CRP and/or ESR were included, and studies on the subjects suffering from other diseases affecting the outcome index were excluded. PubMed, Web of Science, EMBASE and Google Scholar were systematically searched, and all studies published from the establishment of the library to 2024 were collected. The Cochrane Bias Risk Assessment tool was used to evaluate the quality of the included studies. Data analysis was performed using Stata 16.0 software. Seven studies were included in this analysis. A total of 399 subjects were studied to explore the effect of an n-3 unsaturated fatty acid diet on rheumatoid arthritis. The results showed that there was no significant difference in CRP (Hedges's g = 0.06, 95% CI: −0.48–0.37, P = 0.79) and ESR (Hedges's g = −0.14, 95% CI: −0.61–0.33, P = 0.55) between the intervention and control groups. The results of this study showed that the anti-inflammatory effect of unsaturated fatty acids on rheumatoid arthritis was not correlated with CRP and ESR levels. Due to the small number of included studies, more high-quality studies are still needed to confirm this.

Predictive performance of Metagenomic Next Generation Sequencing in early detection of post-liver transplantation infections

ObjectiveTo evaluate the predictive performance of metagenomic next-generation sequencing (mNGS) in identifying and predicting pulmonary infections following liver transplantation and to investigate its association with patient outcomes within the initial four-week post-transplantation period. MethodsWe retrospectively analyzed 41 liver transplant patients with suspected pulmonary infections from August 2022 to May 2023. Bronchoalveolar lavage fluid (BALF) samples were collected on the first postoperative day for metagenomic next generation sequencing (mNGS) and culture. The predictive capability of mNGS for subsequent infections was assessed by monitoring inflammatory biomarkers and comparing the detection rates with culture methods. Real-time Polymerase Chain Reaction (Rt-PCR) was used to monitor Human betaherpesvirus 5 (CMV) and Human parvovirus B19 (B19) weekly during a four-week postoperative period. Inflammatory biomarkers and blood coagulation function were evaluated on specific days throughout the first, third, fifth, and during four weeks following surgery. The study was conducted until August 2023 to evaluate the patients' prognostic survival outcome, classifying them into groups based on the mortality and survival. ResultsThe analysis included a total of 41 patients, comprising 32 males and 9 females, with an average age of 52 (47, 63) years. Within one week after liver transplantation, there were 7 cases of bacterial infections, 5 cases of fungal infections, 19 cases of mixed infections, 8 cases without any infection, and 2 cases with unidentified pathogen-associated infections. mNGS successfully predicted 39 (72 %) strains of pathogens, while culture-based methods only detected 28 (52 %) strains. Among the 8 patients diagnosed as non-infected, culture methods identified positive results in 4 cases (50 %), whereas mNGS yielded positive results in 7 cases (87.5 %). The detection rates of CMV and B19 by Rt-PCR within 4 weeks after liver transplantation were 61 % and 17 %, respectively (25/41, 7/41) among the patients. During the study period, a total of 9 patients succumbed while 32 patients survived. The death group and the survival group exhibited significant differences in CRP, HGB, and INR levels at specific monitoring time points. The proportion of CMV detection in blood was significantly higher in the death group compared to the surviving group. Elevated CRP level was identified as a prognostic risk factor. ConclusionsDespite the presence of false positives, mNGS still presents a potential advantage in predicting pulmonary infection pathogens following liver transplantation. Furthermore, the levels of CRP and CMV carrier status within four weeks post-surgery exhibit significant associations with patient survival and prognosis.

Childhood obesity is associated with a high degree of metabolic disturbance in children from Brazilian semi-arid region

Projected to impact 310 million children by the next decade, childhood obesity is linked to serious health issues like metabolic disturbance and cardiovascular diseases. This study introduces a novel approach for the integrated assessment of inflammatory, glycemic and lipid disorders in obese children in resources-limited settings and also identifies key factors contributing to these changes. Conducting a cross-sectional analysis of 231 children aged 5–12 years from public schools in Brazil's semi-arid region, the research involved collecting medical history, anthropometric measurements, and blood samples to analyze glycemic and lipid profiles, along with C-reactive protein levels. We used an adapted the Molecular Degree of Perturbation model to analyze deviations in metabolic markers from a healthy control group. Statistical analyses included Mann–Whitney and Fisher exact tests, backward logistic regression, and hierarchical cluster analysis. The study identified a direct and independent association between elevated Metabolic Disturbance Degree and both overweight and obesity in children, with significant differences in CRP, Triglycerides, and HDL levels noted between obese and healthy-weight groups. The findings highlight the critical need for early detection and comprehensive understanding of obesity-related changes to mitigate the severe health risks associated with childhood obesity.

Randomized clinical trial of astaxanthin supplement on serum inflammatory markers and ER stress-apoptosis gene expression in PBMCs of women with PCOS.

Polycystic ovarian syndrome (PCOS) is related to pro-apoptotic and pro-inflammatory conditions generated by Endoplasmic reticulum (ER) stress. This study aimed to determine the effect of Astaxanthin (ASX), as carotenoid with potent antioxidant and anti-inflammatory properties, on serum inflammatory markers, apoptotic factors and ER stress-apoptotic genes in peripheral blood mononuclear cells (PBMCs) of women with PCOS. This randomized, double-blind clinical trial included 56 PCOS patients aged 18-40. For 8 weeks, subjects were randomly assigned to one of two groups: either 12 mg ASX (n = 28) or placebo (n = 28). Real-time PCR was used to quantify gene expression associated with ER stress-apoptosis in PCOS women's PBMCs. The levels of TNF-α, IL18, IL6 and CRP were determined by obtaining blood samples from all patients before and after the intervention using Enzyme-linked immunosorbent assay (ELISA). Also, the levels of active caspase-3 and caspase-8 were detected in the PBMC by ELISA kit. Furthermore, we evaluated the efficacy of ASX on disease symptoms. Following the 8-week intervention, ASX supplementation was able to reduce the expression of GRP78 (p = 0.051), CHOP (p = 0.008), XBP1 (p = 0.002), ATF4 (0.038), ATF6 (0.157) and DR5 (0.016) when compared to the placebo. However, this decrease was not statistically significant for ATF6 (p = 0.067) and marginally significant for GRP78 (p = 0.051). The levels of TNF-α (p = 0.009), IL-18 (p = 0.003), IL-6 (p = 0.013) and active caspase-3 (p = 0.012) were also statistically significant lower in the therapy group. However, there was no significant difference in CRP (p = 0.177) and caspase-8 (p = 0.491) levels between the treatment and control groups. In our study, ASX had no significant positive effect on BMI, hirsutism, hair loss and regularity of the menstrual cycle. It appears that ASX may benefit PCOS by changing the ER stress-apoptotic pathway and reducing serum inflammatory markers; however, additional research is required to determine this compound's potential relevance.

Systemic inflammatory markers and their association with Alzheimer's disease: A cross-sectional analysis.

To investigate the possible role of systemic inflammatory markers (interleukin; IL-6, C-reactive protein; CRP, and albumin levels) in the development of Alzheimer's dementia (AD) and also find their association with the severity of disease. It was a cross-sectional study. Patients with Alzheimer's dementia (AD) and vascular dementia (VaD) from outpatient settings in tertiary care hospitals and non-demented controls (NDC) were recruited from the community. Individuals aged 50 years and older (n = 110) were included. Serum levels of IL-6, CRP, and albumin levels in patients with AD, VaD, and NDC were measured. The clinical Dementia Rating Scale was used for staging the severity of dementia. Serum levels of IL-6, CRP, and serum albumin were compared in study subjects and also analyzed with the severity of dementia in dementia subgroups. Our main finding was that serum levels of IL-6 were significantly elevated in patients with AD and VaD (7.79 and 6.60) as compared to NDC (2.98) (P < 0.001). No significant difference in CRP or albumin levels was observed between the three groups. Serum IL-6 and CRP showed a positive correlation with the severity of AD, though the correlation was significant only for IL-6 (r = 0.777). The serum albumin levels showed a statistically significant negative correlation with the severity of AD (r > 0.3 but <0.5). The study demonstrates a notable association between systemic inflammatory markers, particularly IL-6, and the severity of AD, indicating their potential role in its pathogenesis. These findings suggest that targeting these markers could offer new insights into therapeutic strategies for AD.

Protective effect of additional cathelicidin antimicrobial peptide PR-39 on prosthetic-joint infections.

Prosthetic-joint infection (PJI) is one of the severest complications after arthroplasty. However, antibiotics are not effective in the bacteria in biofilm outside the prosthetic-joint. Antimicrobial peptides have an efficient antimicrobial activity in staphylococcus aureus compared with conventional antibiotics. Bone marrow stem cells (BMSCs) were isolated, cultured and transfected with cathelicidins antimicrobial peptides proline-arginine-rich 39 amino acid peptide (PR-39) lentivirus. The expression of PR-39 gene in BMSCs was detected by RT-PCR, and the antibacterial activity of PR-39 was measured by agar diffusion method. The transfection efficiency was detected by fluorescence microscopy. The infection model of artificial knee joint in rabbits were established. Kirschner wire was used as the knee joint implant to implant the distal femur through the femoral intercondylar fossa of rabbits. 24 rabbits were randomly divided into 2 groups for the above operations: group A was inoculated 0.5mL into the joint cavity immediately after the incision was sutured 1 × 107 Staphylococcus aureus of colony forming unit (CFU), group B was inoculated with Staphylococcus aureus and PR-39. After operation, the wound conditions and histological changes were observed by X-ray and optical microscope respectively, CRP and erythrocyte sedimentation rate were measured by test assay. The transfection efficiency of lentivirus vectortransfected BMSCs was 74.09%. The supernatant of lentivirus vector had obvious inhibitory effect on Staphylococcus aureus, and the antibacterial rate was 98.43%. 100% infection observed in group A while few infection observed in group B; serum CRP and ESR at a high level in group A while decreased in group B after operation. There were no significant difference in CRP and ESR between the pLV/PR-39 group and pLV/EGFP group at day 1 and 3 respectively after surgery. However, CRP and ESR in the pLV/PR-39 groupwere significantly lower than the pLV/EGFP group at day 7 and 14 respectively after operation. Rabbits planted BMSCs expressing PR-39 were significantly increased resistance to Staphylococcus aureus in PJI than control group thus showing great potential for preventing implant-associated infection. It will provide a potential new therapeutic agent for implant-associated infection.

Barotrauma and its complications in COVID-19 patients: a retrospective study at tertiary care hospital of Eastern India

BackgroundThe development of barotrauma in COVID-19 patients who were ventilated and admitted to the intensive treatment unit seemed to have been a problematic issue in the COVID era. This study aimed to explore the possibility of developing the barotrauma-related issues with mechanical ventilation in the cases of individuals suffering from COVID-19.ResultsOut of 48 patients who developed barotrauma, 30 (62.5%) presented with pneumothorax, 22 (45.8%) with pneumomediastinum, 10 (20.8%) with subcutaneous emphysema, and 2 (4.1%) with pneumopericardium. Of those that developed barotrauma, 45 (93.7%) patients were in acute respiratory distress syndrome. In patients with and without barotrauma, significant factors were white blood cell count (p = 0.001), neutrophil percentage (p = 0.012), and lymphocyte percentage (p = 0.014). There were no statistically significant differences in CRP, procalcitonin, d-dimer test, LDH, or ferritin.ConclusionsPatients infected with COVID-19 have a high risk of barotrauma when on mechanical ventilation. As a result, the death rate in this patient group is higher.

Analysis of the Effect of Laparoscopic and Open Surgical Treatment in Children with Congenital Megacolon.

In this paper, we have compared and analyzed the effect of laparoscopic and open surgical treatments in children with congenital megacolon. To address this, a total of 64 children with congenital megacolon who underwent surgery in the hospital, particularly from April 2014 to December 2020, were selected as the research objects. They were divided into control and observation groups by the random number table method, with 32 cases in each group. The control and observation groups were treated with open surgical and laparoscopic treatments, respectively. The treatment effects of the two groups were compared. The enema time, operation time, blood loss, anal defecation time, and duration of postoperative hospital stay of the observation group were lower than those of the control group. The comparison between the two groups was statistically significant (P < 0.05). There was no significant difference in CRP and WBC between the two groups before surgery (P > 0.05). The CRP level and WBC of the two groups were both increased after operation, the CRP level of the observation group was lower than that of the control group, the difference was statistically significant (P < 0.05), the WBC of the two groups was not statistically significant (P > 0.05). The rate of excellent and good defecation in the observation group on the 7th day after surgery was higher than that in the control group, and the difference was statistically significant (P < 0.05). There was no significant difference in Krickenbeck scores between the two groups before surgery (P > 0.05); 6 months after the surgery, the score of Krickenbeck in both groups increased, and that of the observation group was higher than that of the control group, indicating a difference in the overall score (P < 0.05). The total complication rate within 7 days after surgery in the observation group was lower than that in the control group, and the difference was not statistically significant (P > 0.05). Laparoscopic treatment of congenital megacolon could improve surgical indicators and reduce stress response in children, improve defecation and anal function, reduce the risk of complications, and promote recovery.

STUDY OF INFLAMMATORY MARKERS IN HYPOXIC COVID 19 PATIENTS AND CORRELATION WITH DISEASE SEVERITY

Background: COVID-19 is global pandemic affecting mainly a respiratory system and causing hypoxemia in the majority of those been infected. In our study, we aimed to correlate the inflammatory markers with severity of hypoxemia and predicting the significant markers of disease severity. Aims and Objectives:To correlate the inflammatory markers with degree of hypoxemia and To determine the inflammatory markers useful in predicting the disease severity. Materials and Methods:A cross-sectional observational study was conducted in the month of may 2021 in tertiary care hospital chinnaoutpalli near Vijayawada in Andhra Pradesh. The 296 patients diagnosed as COVID-19 positive by real-time Polymerase chain reaction and admitted in our hospital requiring oxygen (hypoxemic) were included. These patients were divided into supplemental oxygen group (SuO2 Group) and non invasive ventilation group (NIV group) and inflammatory markers among these groups were compared. Results: Out of 296 hypoxemic patients, 148 were in ward, requiring SuO2,148 were in ICU requiring NIV. There was significant differences in mean D-dimer (p=0.001), and neutrophil-to-lymphocyte ratio (p=0.012),among NIV and SuO2 group .There was no significant difference in CRP, ferritin. Conclusion: The inflammatory markers are a good guide for predicting the hypoxemia and disease severity. The results concluded Neutrophil-to-Lymphocyte ratio, D-Dimer were effective biomarkers in predicting a severity and prognosis of COVID- 19 patients, but could not establish significant association of serum Ferritin, CRP with disease severity.

Neutrophil-to-lymphocyte ratio as a prognostic inflammatory factor in sudden sensorineural hearing loss

Objectives: Sudden sensorineural hearing loss (SSNHL) has recently been investigated in terms of chronic inflammation. In this study, the associations of immunologic inflammatory factors (C-reactive protein [CRP] and erythrocyte sedimentation rate [ESR]) and hematologic inflammatory factors (white blood cell [WBC] count, neutrophil percentage, lymphocyte percentage, neutrophil-to-lymphocyte ratio [NLR], and platelet-to-lymphocyte ratio [PLR]) with prognosis of SSNHL were evaluated. Methods: Fifteen patients with SSNHL were prospectively enrolled and followed. For the analysis of the prognostic factors for SSNHL, the patients were divided into two groups according to the final hearing threshold of the affected ear: ‘complete or partial recovery group’ and ‘slight improvement or no recovery group’. The CRP, ESR, WBC count, neutrophil percentage, lymphocyte percentage, NLR, and PLR obtained at the initial visit were compared. Results There were no significant differences in CRP, ESR, WBC count, and PLR between the two groups. In contrast, neutrophil percentage and NLR were significantly lower in the complete or partial recovery group than in the slight improvement or no recovery group ( p = 0.005 and 0.013, respectively). Lymphocyte percentage was significantly higher in the complete or partial recovery group than in the slight improvement or no recovery group ( p = 0.019). Conclusion NLR may be a useful prognostic inflammatory biomarker of SSNHL. Further evaluation of the association of immunologic and hematologic inflammatory factors with the prognosis of SSNHL is necessary with respect to inflammation to reveal additional significant biomarkers because inflammation is related to SSNHL.

Study on the correlations of different clinical types with imaging findings at initial diagnosis and clinical laboratory indexes in COVID-19 patients.

Objectives:To investigate the correlations of initial lab and imaging findings in COVID-19 patients of different clinical types.Methods:We retrospective analyzed patients confirmed with COVID-19 in the Fifth Medical Center of the People’s Liberation Army (PLA) General Hospital between February to April 2020, selected a total of 58 (N) patients with lab and imaging examinations that met the study criteria, using Artificial intelligence (AI) software to calculate the percentage of COVID-19 lesions in the volume of the whole lung, then the correlations of general information, initial chest CT examination after admission and laboratory examinations were analyzed.Results:The 58 (N) COVID-19 patients were divided into mild group [41(n) cases]: and severe group [17(n) cases]: according to patient’s condition. CT findings of the severe group and mild group mainly included single or multiple ground glass opacity (GGO), with lesions mainly distributed in the periphery of lungs or GGO mixed with consolidation, with lesions involved in peripheral and central areas of both lungs, accompanied other signs. A significant difference in CRP, IL-6, D-D, GGT was observed between the two groups (p < 0.05). The ratios regarding lymphocyte abnormality and neutrophil abnormality in the severe group were higher than those in the mild group (p < 0.05).Conclusion:The CT features at initial diagnosis of COVID-19 were mainly characterized by multiple GGO with or without partial consolidation in both lungs, with the lesions mainly distributed at the subpleural regions. Some lab test indexes were correlated with the clinical types of COVID-19.

The Role of Inflammatory Factors in the Covid-19 Disease

Late in 2019 a new pandemic was caused by a novel coronavirus which was later named as Covid-19 by WHO. Regarding the unknown behavior of the disease finding some predicting factors was important so it could be possible to curb the mortality and morbidity risk of the disease. Later studies showed the important role of inflammatory factors in the process of the disease. In this retrospective, multicenter study, 1199 adult patients were randomly selected. Patients were divided to three main groups: Severe/Moderate, ICU add/Non- ICU add and Expired/Alive. The clinical data (including heart rate, respiratory rate, systolic blood pressure and diastolic blood pressure) and the laboratory findings (including NLR, PLR, D-dimer, Troponin, and CRP) of their first date of admission were studied from their documents. The mean of each factor was compared within each group and the binary logistic regression was done for each factor. ROC curves were drawn separately based on the results of the binary logistic regression analysis (P-value&lt;0.05). Out of 1199 patients, 908 were in the severe group, 143 were ICU added and 144 were expired. Age and clinical factors were significantly higher (P-value=0.000) in the severe, ICU add, and expired groups. All the inflammatory factors were significantly higher in the severe group (P-value=0.000), were higher among ICU add patients with statistical significance of CRP, NLR, and PLR (P-value = 0.000, 0.000 and 0.001 respectively), and were higher in the expired group with the statistically significant difference in CRP, Troponin, NLR, and PLR (P-value=0.000).

Salivary levels of Interleukin-6, Interleukin-8 and Tumor Necrosis Factor-alpha in Smokers Aged 35-46 Years with Dental Caries Disease

Introduction: Dental caries is one of the most common infectious diseases prevalent in the oral cavity, andit is an inflammatory disease with a multi-factor etiology. IL-6, IL-8, and TNF-? are two types of cytokinesthat are major mediators of acute inflammation, and are necessary for the development of specific immuneresponses.Objective: The present study aimed to assess the level of pro-inflammatory cytokines (IL-6,IL-8,andTNF-?) in the saliva of smokers with dental caries and the control (non-smokers) according to different age,BMI,and sex.Materials and Method: Whole saliva from 32 smokers aged 35-46 years with dental caries and 16 healthysubjects, to measure IL-6,IL-8, and TNF-a levels by enzyme immunoassay (ELISA).Results: The mean BMI, age, and sex between the experimental group and the control group were similar,were not statistically significant (p=0.466, p=0.240, p=0.455), respectively while, there were a significantdifference in CRP between the two groups (p=0.037).Concentrations of salivary IL-6, IL-8 and TNF-? werenot affected by periodontal health. No statistically significant difference in periodontal health, assessed byCPITN, were observed between the groups (p=0.413). Salivary levels of IL-6 and IL-8 were significantlyhigher in smokers with dental caries compared with control (p&lt;0.05).Salivary levels of IL-6 and IL-8were increased significantly in smokers with dental caries compared with control (p&lt;0.05). No significantdifferences in salivary TNF-? in dental caries patients compared to control (p=0.063). The correlationbetween TNF-a, CRP, age, sex, and BMI with IL-8 were positive and statistically significant(p=0.01,p=0.036, p=0.009, p=0.007, and p=0.005), respectively. There was no significant correlation between IL-6and TNF-a cytokines and other parameters, except for a positive association with CRP levels (p=0.006,p=0.043), respectively.Conclusions: These data indicate links between production of tumor necrosis factor-alpha (TNF-a),interleukin-6 (IL-6), and Interleukin-8 (IL-8)in smokers’ saliva and dental caries disease. Also,the existenceof a statistically significant positive correlation between TNF-a,age, gender, and BMI with IL-8.

Association between local immune cell infiltration, mismatch repair status and systemic inflammatory response in colorectal cancer

BackgroundSystemic inflammatory response in colorectal cancer (CRC) has been established as a prognostic factor for impaired cancer-specific survival, predominantly in patients with right-sided tumors. On the other hand, defective mismatch repair (dMMR) tumors, primarily located in the right colon, are known to have favorable survival and dense local immune infiltration. The aim of this study was to see if there is any form of relationship between these seemingly diverse entities.MethodsComplete clinical and long-term survival data were retrieved for 316 CRC patients operated at Helsinki University Hospital between the years 1998 and 2003. Tissue microarrays were prepared from surgical specimens and further processed and analyzed for local immune cell infiltration using multispectral imaging with a Vectra quantitative pathology imaging system and Inform software. Multiplex immunohistochemistry was applied using antibodies against CD66b, CD8, CD20, FoxP3, CD68 and pan-Cytokeratin. After exclusions, data on immune infiltration were available for 275 patients. Mismatch repair status was determined by immunohistochemistry.ResultsCRP was seen to be an independent predictor of cancer-specific survival but not overall survival in uni- and multivariable (HR 1.01 (1.00–1.02); p = 0.028) analyses of non-irradiated patients. There was no significant difference in CRP according to mismatch repair status, but all cases (n = 10) with CRP ≥ 75 mg/l had proficient mismatch repair (pMMR). There was a significant negative correlation between intratumor stromal infiltration by T-regulatory FOXP3+ cells and CRP (p = 0.006). There was significantly lower intratumor stromal infiltration by FOXP3+ cells (p = 0.043) in the right colon compared to the rectum, but no significant difference in CRP (p = 0.44). CRP was not a predictor of overall survival (HR 0.99, 95% CI 0.98–1.01) nor cancer-specific survival in irradiated patients (HR 0.94, 95% CI 0.94–1.02).ConclusionsThere was a significant negative relationship between SIR, defined as an elevated CRP, and intratumor stromal infiltration by T-regulatory FOXP3+ cells. This and the fact that all cases with a CRP > 75 mg/l had pMMR suggests that SIR and dMMR are independent entities in CRC. Indeed, the general lack of difference in CRP between cases with dMMR and pMMR may be evidence of overlap in cases with a less pronounced SIR.

Effect of cardiac rhythm on serum levels of the inflammatory mediators; Interleukin-6 and C-Reactive Protein in patients with chronic rheumatic heart disease

Abstract Background Rheumatic fever has a marked tendency to recur leading to high risk of chronic heart lesions or worsening lesions in patients with previous rheumatic heart disease. For secondary prevention of RF, long acting penicillin can be used. Some rheumatic heart disease patients suffer from atrial fibrillation. Cardiac rhythm may affect the response of the body to the long acting penicillin, so it would be helpful to study the effect of cardiac rhythm on serum levels of inflammatory mediators in patients with chronic rheumatic heart disease. Objectives Our study is a prospective cross-sectional controlled study that aims to study the effect of cardiac rhythm on serum levels of the inflammatory mediators; C-Reactive Protein and Interleukin-6 in patients with chronic rheumatic heart disease. Methods The study included 70 rheumatic heart disease patients on regular long acting penicillin. Patients were divided into to 2 groups: Group A; 56 patients with rheumatic heart disease who have sinus rhythm, and Group B; 14 patients with rheumatic heart disease who have atrial fibrillation (AF) and Group C; control group of 10 healthy individuals. Results There was no significant difference between sinus patients and AF patients in CRP and IL-6 levels (p = 0.3050 and 0.6758, respectively). Also, there was no significant difference between 15, 21 and 30 days regimens of penicillin in CRP and IL-6 levels (p = 0.9467and 0.0795, respectively). IL6 values were significantly correlated with CRP values (r = 0.5435, p &amp;lt; 0.0001). There was a significant difference in CRP and IL-6 levels between compliant and non-compliant patients (p = 0.0053 and 0.0308). Conclusion Our study results disprove that cardiac rhythm has an effect on the serum levels of the inflammatory mediators C-Reactive Protein and Interleukin-6 in chronic rheumatic heart disease. Our study also disproves the preference of any regimen of long acting penicillin (15 days, 21 days and 30 days) over each other for secondary prevention of chronic rheumatic heart disease. Our study results emphasized that chronic rheumatic heart disease is an inflammatory process mediated with some mediators as CRP and IL-6 that are strongly correlated with each other.

P679 What is the best strategy after failure to anti-TNF? Ustekinumab or other anti-TNF?

Abstract Background After the appearance of new biologics are more treatment options for first and second-line individualising according to the characteristics of each patient. The efficacy of a second anti-TNF is lower than the initial treatment so a more efficient strategy could change the therapeutic target. Methods We included patients with an established diagnosis of Crohn’s disease who were on second-line biological treatment (ustekinumab or anti-TNF) after failure of a first anti-TNF (adalimumab or infliximab) treatment. Only patients in whom the indication was the ‘induction of remission of inflammatory activity’ so those patients in whom the indication was different from the intestinal activity (intestinal manifestations, perianal disease etc.) were selected were not considered valid for analysis. Patients who had undergone intestinal resection alone were included in the study if the indication of second-line biologic treatment was already established and no recurrence prophylaxis thereof. Results A total of 56 patients with an established diagnosis of Crohn’s disease stable tracking unit EII La Paz Hospital who were treated with second-line ustekinumab (21 patients, 37.5%) or anti-TNF (35 patients were included, 62.5%) for remission induction. Baseline characteristics of patients and their IBD are summarised in Table 1. The duration of biological treatment at the time of analysis was 1.48 years (SD: 1.2) for ustekinumab group and 3.55 years (SD 3.3) for the anti-TNF group. Ustekinumab group in 16/21 (76.2%) achieved clinical remission, 3/21 (14.3%) had no response while achieving remission (note that in one patient occurred exitus otherwise cause adenocarcinoma páncreas- unable to properly assess drug response), 2/21 patients (9.5%) did not answer. In the group of anti-TNF, 15/35 patients (42.8%) achieved clinical remission, 12/35 patients (34.3%) had response without remission, 8/35 patients (22.9%) No response. These differences between groups reached statistical significance (p = 0.015). Among patients who achieved a response / clinical remission included those wherein assessed by endoscopy identifying intestinal activity no statistically significant differences between groups vs. anti-TNF ustekinumab both SESCD (average 2 vs. 6.3 p = 0, 39) to the Ruttgerts in (mean 2.5 vs. 2, p = 0.67) postsurgical stage. Regarding the response/biological remission found no significant differences in CRP between ustekinumab and anti-TNF (4.55 vs. 5.79, p = 0.68) or with fecal calprotectin (276.25 vs. 268.82, p = 0.94). Conclusion In our experience, the second-line treatment with ustekinumab after the failure of a first anti-TNF has better remission rates and response to treatment with a second anti-TNF.

Switching From Originator Adalimumab to the Biosimilar SB5 in Patients With Inflammatory Bowel Disease: Short-term Experience From a Single Tertiary Clinical Centre.

Patients' perspectives after switching from originator to biosimilar adalimumab have yet to be assessed. We evaluated the efficacy of switching from the originator adalimumab to a biosimilar compound [SB5] in patients with inflammatory bowel disease [IBD]. Data on IBD patients who were switched from the originator to biosimilar adalimumab [SB5] at IBD Center ISCARE were analysed. Disease activity was assessed using standard clinical indices (Harvey-Bradshaw index [HBI] for Crohn's disease [CD] and partial Mayo score for ulcerative colitis [UC]), and laboratory parameters (C-reactive protein [CRP] and faecal calprotectin [FC]). Trough levels and anti-drug antibodies were measured. Patients were evaluated 10 weeks [W10] after the switch, and results were compared with the control group of patients on originator compound. A total of 93 patients switched to biosimilar adalimumab were included [CD 86%] and were matched to 93 controls for age, gender, diagnosis, and disease activity. There was no difference in the disease activity in either SWITCH or ORIGINATOR cohorts between Weeks 0 and 10. Similarly, no difference was found between cohorts at both prespecified time points. Moreover, no significant differences in CRP or FC concentrations were seen between W0 and W10 either in the SWITCH, or in the ORIGINATOR cohort [p >0.05]. Adalimumab serum trough levels remained stable after the switch. No new safety signals were detected. Our study confirmed that switching IBD patients from the originator adalimumab to a biosimilar compound [SB5] does not affect treatment efficacy.

CLINICAL RISK FACTORS FOR CARDIAC SARCOIDOSIS

SESSION TITLE: Wednesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM PURPOSE: Identification of risk factors associated with cardiac sarcoidosis. METHODS: Retrospective case control study with prospective follow up including 598 patients with biopsy proven sarcoidosis involving multi organs except cardiac involvement and 32 patients with cardiac sarcoidosis. Thorough chart review was done for all the cases and controls and data was collected for variables including demographics, diagnostic studies and treatment details. RESULTS: Univariate analysis was done using the SPSS program. There were no significant statistical differences for age, race, gender (P >0.05). We found significant differences between group in FEV1 % (p =0.022), FEV1/FVC (p=0.012), whereas there were no differences in FVC, DLCO, TLC (P value >0.05). We found significant difference in CRP (P=0.000), while ACE and Pro-BNP levels (p>0.05) were not significant. RVSP was elevated in cardiac sarcoidosis group (p= 0.011). Furthermore, OSA (P =0.002) and DM (p=0.000) were found to be associated with cardiac sarcoidosis. Patients with cardiac sarcoidosis were on long term oxygen therapy (P=0.000). However, co morbidities including asthma, HTN, anemia were not statistically significant (p>0.05) CONCLUSIONS: Elevated CRP levels, worsening lung volumes including FEV1/FVC and FEV1, long term oxygen therapy, OSA and DM and elevated RVSP on transthoracic echo are associated with cardiac sarcoidosis. CLINICAL IMPLICATIONS: CRP values can be used as an early diagnostic marker for cardiac sarcoidosis. Patients with OSA, elevated RVSP on TTE, those on Long term oxygen therapy and with worsening lung volumes on PFT’s could be monitored closely for progression to cardiac sarcoidosis, hence decreasing the incidence of sudden cardiac death associated with Cardiac sarcoidosis. DISCLOSURES: No relevant relationships by asil daoud, source=Web Response No relevant relationships by Amina Pervaiz, source=Web Response No relevant relationships by Lobelia Samavati, source=Web Response

Higher serum levels of systemic inflammatory markers are linked to greater inspiratory muscle dysfunction in COPD.

Chronic obstructive pulmonary disease (COPD) is associated with an inflammatory response that becomes more pronounced in acute exacerbations. Considerable attention has recently focused on the value of several inflammatory mediators in predicting worsening of COPD-related symptoms. Whereas respiratory muscle dysfunction is also widely present in this population, little is known about how systemic inflammation relates to inspiratory muscle dysfunction in COPD. Fifty-three males with mild-to-very severe airflow obstruction underwent blood sampling for 23 inflammatory markers, including acute-phase proteins, cytokines and adipokines. Inspiratory muscle performance was assessed via the test of incremental respiratory endurance, providing measures of maximal (MIP) and sustained maximal (SMIP) inspiratory pressures. The mean ± SD MIP and SMIP were 75.32±19.62 cmH2 O and 406.15±124.55 PTU. MIP negatively correlated with CRP, SAA and cystatin C (r-values from -0.333 to -0.378, P < 0.02), while SMIP was inversely related to SAA and cystatin C (r = -0.534 and r = -0.396, P = 0.00). Significant differences in CRP, SAA, cystatin C and PARC were also found between subjects with and without inspiratory muscle weakness. No additional significant relationships were observed between either MIP or SMIP and other inflammatory markers in the study. MIP and SMIP are markedly reduced with greater degrees of inflammation in COPD as expressed by higher levels of CRP, SAA and cystatin C. Future research is needed to further examine the above findings and determine the impact of systemic inflammation along with its underlying mechanisms on inspiratory muscle function in COPD.

Prior aspirin and/or nonsteroidal anti-inflammatory drug use in sepsis patients is associated with reduced intensive care unit morbidity and mortality: retrospective study

IntroductionSepsis is a life-threatening condition that is characterized by multi-organ dysfunction and a high mortality rate, and prevention may be cheaper and easier than treatment. The sequential organ failure assessment (SOFA) score is associated with mortality risk, and the Quick SOFA (qSOFA) is a shortened version. In this study, we examined whether there was any difference between the qSOFA and SOFA scores, procalcitonin and CRP levels, and mortality among patients with sepsis who either used or did not use aspirin and/or nonsteroidal anti-inflammatory drug (NSAID).Material and methodsThis study was designed as a retrospective analysis of 64 septic patients, 38 males and 26 females. SOFA, qSOFA and APACHE II scores, as well as gender, age, length of hospital stay, procalcitonin and CRP levels, blood culture results, mortality rates and the use of aspirin and/or NSAID were recorded from the files.ResultsThe median age of aspirin and/or NSAID users was 63 years and of non-users was 55. There were significant differences in the SOFA scores and mortality rates between aspirin and/or NSAID users and non-NSAID/aspirin users (p &lt; 0.05). There were no significant differences in the length of hospital stay or blood culture results (p &gt; 0.05). There were also significant differences in CRP and procalcitonin values (p &lt; 0.05).ConclusionsIn this study, patients that used aspirin and/or NSAID had lower SOFA, qSOFA and APACHE II scores and lower mortality rates. There have been recent studies on the prevention of sepsis in patients having already used these drugs before hospital admission, but there have been no publications in which sepsis is supported by SOFA and qSOFA scores with aspirin and/or NSAID users.