Can serum procalcitonin be used for severity identification and guiding treatment of children admitted with community-acquired pneumonia? – A cross-sectional study

Background: Community-acquired pneumonia (CAP) remains one of the leading causes of mortality and morbidity in children under 5 years of age. Early diagnosis and effective management remain the cornerstone to reduce complications and fatalities associated with CAP. Lately, C-reactive protein (CRP) and procalcitonin (PCT) have gained much attention as useful biomarkers in CAP. Recent data suggest that a very low PCT value has a high negative predictive value while identifying a population of children at low risk of typical bacterial infections. Hence, we propose to take up this study to assess the clinical utility of PCT in pediatric CAP. Aims and Objectives: The aim of this study was to study serum PCT level in children with the clinical diagnosis of CAP admitted at R.G Kar Medical College and Hospital, Kolkata, and its role in severity identification and contribution in the treatment of CAP. Materials and Methods: This cross-sectional hospital-based observational study was performed from January 2020 to June 2021 in the R.G Kar Medical College and Hospital, Kolkata, West Bengal, India. A total of 50 children were included within the age group of 2 months–5 years with CAP admitted in the Children’s ward and intensive care unit at our hospital. Clinical characteristics such as age, sex, symptoms such as history of fever, difficulty feeding or drinking, convulsion, lethargy, cyanosis, chest in-drawing, respiratory rates, auscultatory findings such as air entry of bilateral lungs, added sounds like-(inspiratory crept, bronchial breathing), and oxygen saturation were studied. Routine investigations such as complete blood count, serum CRP, blood culture, and chest radiograph sent along with serum PCT. Results: Out of 50 children diagnosed with CAP, 30 (60%) fell within the age range of 2–5 months of age. Among the study population, 70% of children displayed weakly positive and 20% strongly positive serum PCT values. A strong correlation (P < 0.001) was revealed between the severity of pneumonia and PCT, and also a positive correlation (P < 0.001) between clinical outcome and PCT. However, the role in contribution in early diagnosis could not be concluded. Conclusion: This study concluded that serum PCT may be used as a valuable indicator for assessing the severity and prognosis of CAP. All children with elevated PCT who were prescribed antibiotics did not experience further complications of CAP.

Utilidad pronóstica de la procalcitonina, la proteína C reactiva, el índice PCR/PCT y el aclaramiento de ambas al ingreso a unidades de cuidados intensivos / Prognostic utility of procalcitonin, C-reactive protein, CRP/PCT index, and their clearance upon admission to intensive care units / Utilidade prognóstica da procalcitonina, proteína C reativa, índice PCR/PCT e clareamento de ambos na entrada em unidades de cuidados intensivos

Resumen El presente es un estudio retrospectivo, observacional, cuantitativo y descriptivo. Se evaluó la utilidad de la proteína C reactiva (PCR), la procalcitonina (PCT) y la relación PCR/PCT como marcadores de riesgo de sepsis, sumados al aclaramiento a las 72 h, como pronóstico de mortalidad y permanencia en unidades de cuidados intensivos (UCI). Se incluyeron 23 pacientes. Se clasificaron según qSOFA y se elaboraron curvas ROC. Se obtuvo un área bajo la curva de 0,79 para PCT. El valor umbral de PCT>0,88 ng/mL predice riesgo de sepsis con 77,78% de sensibilidad y 83,33% de especificidad. Utilizando PCR<31,23 mg/dL se obtuvo como parámetros destacados un 88,89% de sensibilidad y 83,33% de valor predictivo negativo, sin diferencias significativas (Mann-Whitney p<0,05) entre los grupos de sobrevivientes y óbitos y estadía prolongada vs. no prolongada. Se postula PCR como screening y PCT como marcador de riesgo de sepsis.

Abstract This is a retrospective, observational, quantitative and descriptive study. The utility of C reactive protein (CRP), procalcitonin (PCT) and the CRP/PCT ratio as sepsis risk markers was evaluated and these, added to clearance at 72 hours, as predictors of mortality and permanence in intensive care units (ICU). Twenty-three patients were included. They were classified according to qSOFA, and ROC curves were prepared, highlighting an area under the curve of 0.79 for PCT. The threshold value of PCT>0.88 ng/mL predicts the of sepsis with 77.78% sensitivity and 83.33% specificity. Using CRP>31.23 mg/dL, 88.89% sensitivity and 83.33% negative predictive value were obtained as outstanding parameters. No significant differences (Mann-Whitney p<0.05) were found between survivors and dead and prolonged vs. non-prolonged stay groups. CRP is postulated for screening and PCT as a sepsis risk marker.

Resumo Este é um estudo retrospectivo, observacional, quantitativo e descritivo. Foi avaliada a utilidade da proteína C reativa (PCR), da procalcitonina (PCT) e da relação PCR/PCT como marcadores de risco de sepse junto com o clareamento em 72 horas, como preditores de mortalidade e permanência em unidades de terapia intensiva (UTI). Vinte e três pacientes foram incluídos. Eles foram classificados de acordo com o qSOFA e foram elaboradas curvas ROC, destacando uma área sob a curva de 0,79 para PCT. O valor limite de PCT>0,88 ng/mL prediz o risco de sepse com sensibilidade de 77,78% e especificidade de 83,33%. Utilizando PCR>31,23 mg/dL, obtiveram-se como parâmetros em destaque 88,89% de sensibilidade e 83,33% de valor preditivo negativo. Não houve diferenças significativas (Mann-Whitney p<0,05) entre os grupos de sobreviventes e óbitos e permanência prolongada vs. não prolongada. A PCR é postulada como triagem e a PCT como marcador de risco de sepse.

Correlation between inflammatory markers and platelet metrics in predicting ischemic stroke outcomes

Background: The burden of ischemic stroke, a leading cause of death and long-term disability globally, underscores the need for predictive indicators that can guide clinical interventions. Exploring the relationship between inflammatory and thrombotic biomarkers, such as C-reactive protein (CRP) and mean platelet volume (MPV) offers insights into their potential role in forecasting clinical outcomes in stroke patients. Aims and Objectives: To investigate the association between MPV and CRP levels in predicting clinical outcomes in patients following ischemic stroke. Materials and Methods: The study was conducted at the government medical college in Kozhikode. There were 108 subjects with the same number of cases and age-matched controls. The levels of MPV and CRP were analyzed, and statistical methodology was applied to establish the correlation between the measured variables and clinical outcomes after stroke. Results: The results showed that the level of MPV and CRP was observed significantly in a stroke; there was a noticeably increased level of the above factors; an interesting result was obtained according to its correlation in the case where a positive relationship was established, which means that there is a strong connection between these biomarkers, the pathophysiologic mechanisms of a stroke, and further prognosis. Conclusion: MPV and CRP can be used as determining predictors for predicting ischemic stroke; this case can provide different viewpoints to understand the prognostic factor in clinical practice. This test can be the best method, in conjunction with routine testing, to determine the current and further, status of the patient. However, future longitudinal analysis will be needed to acquire patients’ general findings and test for validation results with predictive markers.

Effect of cigarette smoking on lipid profile, high sensitivity c-reactive protein, and malondialdehyde

Background: One of the most common reasons for preventable mortality is the smoking habit. Cigarette smoke promotes the process of atherogenesis by producing oxygen-derived free radicals which cause damage to the lipids. Cigarette smoking is associated with impaired endothelium-dependent vasodilatation and cardiovascular disease (CVD). Aims and Objectives: The objectives of the study were the following: (i) to compare the levels of total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and very LDL (VLDL) in asymptomatic male smokers and non-smokers of the age group 25–50 years; (ii) to determine and compare the levels of high sensitivity C-reactive protein (hs-CRP) in the above two groups, and (iii) to study and compare the levels of malondialdehyde (MDA) in the above groups. Materials and Methods: The study was conducted on 60 males in which 30 smokers and 30 non-smokers of the age group 25–50 years were incorporated. It was a cross-sectional comparative study, which included the participants who met all the inclusion and exclusion criteria. Before the conduct of the study, informed consent was obtained from all the participants. Moreover, the selection of participants was done in a consecutive manner until the sample size was achieved. TC and TGs were estimated by the enzymatic colorimetric method, HDL cholesterol by the phosphotungstic acid method, and LDL and VLDL by Friedwald’s formula. MDA was determined by spectrophotometry and hs-CRP by the immunoturbidometric method. The data acquired were analyzed by utilizing the Statistical Package for the Social Sciences version 18. Results: Dyslipidemia was seen in smokers as evidenced by significantly elevated levels of TC, TG, LDL, and VLDL; and significantly reduced levels of HDL. The mean values of hs-CRP were significantly elevated in smokers when compared to that of non-smokers. Oxidative stress was increased in subjects who were smokers. The mean values of MDA were significantly elevated in the smokers. Conclusion: The smoking habit is associated with dyslipidemia, oxidative stress, and inflammation which predisposes to the development of endothelial dysfunction and atherosclerosis. The significance of early screening measures to be undertaken in asymptomatic smokers for dyslipidemia, oxidative stress, and hs-CRP is unveiled by the present study. Therefore, early screening can be used to advise smokers to refrain from smoking to avoid complications of CVDs, so that they can upgrade the quality of their life.

Evaluating the Role of C-reactive Protein in Reducing the Rate of Negative Appendicectomies

Background: Acute appendicitis is a common surgical condition of the abdomen. However, diagnostic difficulties may arise, resulting in high rate of negative appendicectomies. This study aimed to assess the role of C-reactive protein (CRP) in improving the accuracy of diagnosis of acute appendicitis and thus reducing the rate of negative appendicectomies. Materials and Method: The study was a cross-sectional, hospital-based study carried out on 66 patients who had appendicectomy following a clinical diagnosis of acute appendicitis. Samples for CRP were collected from all recruited patients preoperatively. Following appendicectomy, the appendix was sent for histology. A proforma was used to collect data. All the statistical analyses were performed using IBM statistics package for social sciences (SPSS) version 21. At 95% confidence level, p-values less than 0.05 were considered significant. Results: Thirteen (13) of the appendices removed had normal histopathologic examination, giving a negative appendicectomy rate of 19.7%. The diagnostic accuracy, sensitivity, specificity and positive predictive value for preoperative CRP were 80%, 79%, 85% and 95% respectively. Conclusion: An elevated level of CRP is a useful aid for the diagnosis of acute appendicitis. Deferring surgery in patients with normal CRP would likely decrease the incidence of negative appendicectomies.

Exploring the diagnostic potential of mean platelet volume and C-reactive protein levels in ischemic stroke patients

Background: Ischemic stroke remains one of the leading causes of morbidity and mortality worldwide. Thus, developing more efficient tools to diagnose the condition promptly is critical. Mean platelet volume (MPV) and C-reactive protein (CRP), markers that reflect thrombotic and inflammatory pathways, respectively, are closely associated with the pathophysiology of ischemic stroke and may serve as biomarkers. Aims and Objectives: This study aimed to assess the diagnostic potential of MPV and CRP when measured in patients with ischemic stroke against these markers’ levels in healthy persons. The association between these two biomarkers, as measured in ischemic stroke cases, was also explored. Materials and Methods: A cross- sectional comparison study recruited 54 patients with acute ischemic stroke and 54 age- and sex-matched healthy persons at Government Medical College, Kozhikode. MPV and CRP were measured 24 h post-stroke. The variable comparisons across the groups were made using SPSS; similarly, correlation tests were run considering all subjects experiencing stroke. Results: Patients with ischemic stroke had higher MPV levels of 9.17 ± 0.48 fL than controls: 8.25 ± 0.45 fL P < 0.001. The CRP levels were similarly higher in the stroke group: 3.087 ± 1.11 mg/L versus 0.437 ± 0.24 mg/L, P < 0.001. MPV and CRP had a significant positive correlation after analyzing patients with ischemic stroke (r = 0.332, P = 0.014). Conclusion: The results show that MPV and CRP are robust biomarkers for diagnosing ischemic stroke early, as they represent the underlying inflammatory and thrombotic processes. Implementing them in routine checks can promote early detection and management, improving patient outcomes. Further, longitudinal research is critical to confirm and refine their predictive value.

Association between pre-operative high sensitive C-reactive protein and immediate post-operative radicular pain following prolapsed lumbar intervertebral disc surgery

Background: Nerve root compression is often inadequately understanding radicular pain due to prolapsed lumbar intervertebral disc, a common neurosurgical presentation. Inflammation is proved as an important etio-pathological component of radiculopathy, even after surgery. Methods: This cross-sectional intervention study conducted from March 2022 to September 2023. Data collected from 45 patients with prolapsed lumber intervertebral Disc, who underwent surgical intervention in Department of Neurosurgery, BSMMU. Results: The mean±SD age of the patients was 38.4±11.6 years, most of them 37 (82.2%) aged within 29 to 60 years. Majority 30 (66.7%) of them were male. Patients presented with pain, numbness and weakness was 45 (100%), 33 (73.3%) and 8 (17.8%) respectively. Among the participants most 36 (80%) had right sided and 9 (20%) had left sided radiation. The mean±SD level of pre-operative high sensitive C-reactive protein was 2.1±1.7. Pre-operative high sensitive C-reactive protein was significantly associated pre-operative, post-operative and mean change in visual analogue score (p<0.001, p<0.001, p= 0.006 respectively). Correlation of high sensitive C-reactive protein and VAS score (both pre and post-operative) were also statistically significant with p =0.017 and p <0.001 respectively. Conclusions: In our study, there is an association between pre-operative serum high sensitive C- reactive protein and post-operative radicular pain following surgical intervention in patients with prolapsed lumbar intervertebral disc.

Association of oropharyngeal colostrum administration with decreased inflammatory indices in premature newborns weighing less than 1500 g / Asociación de la administración de calostro orofaríngeo con la disminución de los índices inflamatorios en recién nacidos prematuros menor de 1500 g

Abstract Background: The administration of colostrum through its absorption at the oropharyngeal level stimulates the mucosa-associated lymphoid tissue, providing a local immunological protection barrier. The study aimed to investigate the association of oropharyngeal colostrum administration with the reduction of inflammatory indices. Materials and methods: This was an observational, ambispective, analytical study of newborns < 32 weeks of gestation at risk of sepsis. Oropharyngeal colostrum was administered at 0.2 mL every 4 h for 5 days. Inflammatory indices were analyzed. Statistical analysis included frequencies, percentages, mean and Standard deviation, contingency coefficient, and Kolmogorov–Smirnov test for the distribution curve of the numerical data. Results: There were 50 patients, 33 (66%) female and 17 (34%) male, with a median gestational age of 30-31 weeks (95% confidence interval [CI]). Nineteen patients had sepsis. A lower positivity rate in C-reactive protein was found, with a median of 0.5-0.6 (95% CI) at 5 days of colostrum administration versus 0.5-1.1 (95% CI) as the initial C-reactive protein. Analysis with χ2 yielded a p = 0.13, and the contingency coefficient showed a p = 0.196, indicating an association. Conclusion: Oropharyngeal colostrum administration was associated with a lower C-reactive protein positivity rate and clinical improvement in premature newborns at risk of sepsis.

Resumen Introducción: La administración del calostro a través de su absorción a nivel orofaríngeo estimula el tejido linfoide asociado a mucosas, proporcionando una barrera de protección local e inmunológica. Conocer la asociación de la administración de calostro orofaríngeo con la disminución de los índices inflamatorios. Material y métodos: Observacional, ambispectivo, analítico, recién nacidos < 32 semanas de gestación con riesgo de sepsis, se administró calostro orofaríngeo 0.2 ml cada 4 horas durante 5 días. se analizó índices inflamatorios, evolución clínica. Análisis estadístico: frecuencias, porcentajes, media y DS, coeficiente de contingencia y prueba de Kolmogorov Smirnov para la curva de distribución de los datos numéricos. Resultados: Fueron 50 pacientes, 33 (66%) femenino, 17 (34%) masculino, edad gestacional mediana 30-31 semanas (IC 95%), 19 pacientes cursaron con sepsis encontrando menor índice de positividad en la PCR, mediana de 0.5-0.6 (IC 95%) a los 5 días de administración de calostro vs 0.5-1.1 (IC 95%) como PCR inicial, analizando con Chi cuadrada con valor p = 0.13, mediante coeficiente de contingencia con p = 0.196, traduciendo asociación. Conclusión: La calostroterapia se asoció con menor índice de positividad en la PCR; clínicamente hacia la mejoría, en recién nacidos prematuros con riesgo de sepsis.

Proteína C reactiva, aspectos cardiovasculares de una proteína de fase aguda: una actualización para el médico / C-reactive protein, cardiovascular issues of an acute-phase protein: an update for the clinician

Resumen La inflamación es un factor patogénico importante para el desarrollo de la enfermedad cardiovascular aterosclerótica. Actualmente, el biomarcador utilizado con mayor frecuencia que refleja la inflamación sistémica es la proteína C reactiva (PCR), una proteína de fase aguda producida principalmente por los hepatocitos bajo la influencia de la interleucina 6, la interleucina 1 beta y el factor de necrosis tumoral. La evidencia proveniente de estudios epidemiológicos ha demostrado una fuerte asociación entre las concentraciones elevadas de PCR en suero o plasma y la incidencia de un primer evento cardiovascular (incluido infarto agudo de miocardio, accidente vascular cerebral isquémico y muerte cardíaca súbita) en la población general, así como la recurrencia de eventos cardiovasculares adversos en los pacientes con enfermedad establecida. El valor aditivo que la medición de la PCR otorga a los factores de riesgo tradicionales se refleja en novedosas calculadoras de riesgo cardiovascular y en los actuales regímenes de intervención, que ya consideran a la PCR como objetivo terapéutico. Sin embargo, las variaciones en los niveles de PCR, que dependen del sexo, la etnia, el estado hormonal y algunas peculiaridades de los ensayos de medición, deben tenerse en cuenta al decidir implementar la PCR como un biomarcador útil en el estudio y el tratamiento de la enfermedad cardiovascular aterosclerótica. Esta revisión pretende ofrecer una visión actualizada de la importancia de medir la PCR como biomarcador de riesgo cardiovascular más allá de los factores tradicionales que estiman el riesgo de enfermedad aterosclerótica.

Abstract Inflammation is an important pathogenic factor for the development of atherosclerotic cardiovascular disease. Currently, the most frequently used biomarker reflecting systemic inflammation is C-reactive protein (CRP), an acute-phase protein produced primarily by hepatocytes under the influence of interleukin-6, interleukin-1 beta, and tumor necrosis factor. Growing evidence from epidemiological studies has shown a robust association between elevated serum or plasma CRP concentrations and the incidence of a first cardiovascular adverse event (including acute myocardial infarction, ischemic stroke, and sudden cardiac death) in the general population, as well as recurrence of major adverse cardiovascular events among patients with established disease. The additive value that CRP measurement gives to traditional risk factors is reflected in novel cardiovascular risk calculators and in current intervention regimens, which already consider CRP as a target therapeutic. However, the variations in CRP levels, that depend on sex, ethnicity, hormonal status, and some peculiarities of the measurement assays, must be taken into consideration when deciding to implement CRP as a useful biomarker in the study and treatment of atherosclerotic cardiovascular disease. This review aims to offer an updated vision of the importance of measuring CRP levels as a biomarker of cardiovascular risk beyond the traditional factors that estimate the risk of atherosclerotic disease.

The role of inflammatory marker and vitamin D deficiency in dyslipidemia

The immunological and inflammatory systems are both modulated in large part by vitamin D. Lower vitamin D levels have been connected in several studies to an increased risk and worse course of acute infections. Many chronic diseases include inflammation, and concerns have been raised regarding how low vitamin D levels may affect inflammatory processes. Aim and Objective: Inflammatory markers and vitamin D levels in people with and without dyslipidemia were compared in this study. In addition, an effort was made to link the vitamin D levels of the research participants to the inflammatory alterations. Materials and Methods: A tertiary care teaching hospital conducted a cross-sectional study. A control population of 250 healthy, age- and sex-matched people without dyslipidemia was chosen, whereas 250 persons with dyslipidemia were included as test subjects. In the investigation of vitamin D, lipid profiles (total cholesterol, triglycerides, high-density lipoprotein, low-density lipoprotein, and very low density lipoprotein), and high-sensitivity C-reactive protein (hs-CRP), five milliliters of fasting blood samples from each individual were taken. Results: In comparison to the control groups, patients with dyslipidemia had significantly higher levels of hs-CRP and significantly lower levels of vitamin D. A statistically significant negative relationship between hs-CRP and vitamin D was revealed by the Pearson correlation. The deficiency of vitamin D may be root in the inflammation. Conclusion: People with dyslipidemia, hs-CRP levels are high and vitamin D levels are low. In test, population’s low levels of vitamin D showed negative connection with hs-CRP, indicating that low vitamin D levels may aggravate the inflammatory response.

Validez de herramientas diagnósticas en pacientes pediátricos hospitalizados con diagnóstico presuntivo de dengue en un Hospital de Referencia de Paraguay / Validity of diagnostic tools in pediatric patients hospitalized with a presumptive diagnosis of dengue in a Reference Hospital in Paraguay

Introducción: El dengue es la enfermedad arboviral más común en los seres humanos. Un diagnóstico temprano y preciso del dengue puede respaldar el manejo clínico, la vigilancia y el control de la enfermedad y es fundamental, por ello en el diagnóstico del dengue es importante contar con pautas clínicas y epidemiológicas que permitan la identificación oportuna y una conducta terapéutica adecuada. Objetivos: Evaluar la validez de herramientas diagnósticas en pacientes pediátricos hospitalizados con diagnóstico presuntivo de dengue en un Hospital de Referencia de Paraguay durante los años de 2012 a 2020. Materiales y métodos: Estudio analítico de tipo observacional, retrospectivo correspondientes a pacientes pediátricos (0 a 18 años) internados en el Hospital de Referencia de Paraguay el periodo enero 2012 a julio 2020 con diagnostico presuntivo de dengue al ingreso. Se realizó́ un análisis bivariado relacionando las frecuencias de 20 grupos de criterios diagnósticos combinados y 3 criterios diagnósticos aislados (OMS 2009, nexo epidemiológico y antigenemia NS1 para dengue) con el gold standard de diagnóstico que fue la conversión serológica. Resultados: Participaron del estudio 342 sujetos. EL 44% tenía edad escolar y 70% tenía 5 años o más. El 52,76% (191) fueron masculinos. Se encontraron desnutrición y sobrepeso en el 13% y 2%, respectivamente. La combinación de proteína C reactiva con plaquetopenia se encontró́ en 0.45% de los pacientes sin dengue y en el 6% de los pacientes con diagnóstico final de dengue (p=0.004). Conclusión: Este resultado aporta la alternativa de uso de una combinación sencilla de exámenes de laboratorio que puede replicarse en salas de urgencias como en salas de internación en un primer contacto con pacientes febriles con sospecha de fiebre dengue.

Introduction: Dengue is the most common arboviral disease in humans. An early and accurate diagnosis of dengue can support the clinical management, surveillance and control of the disease and is essential, therefore in the diagnosis of dengue it is important to have clinical and epidemiological guidelines that allow timely identification and appropriate therapeutic conduct. Objectives: To evaluate the validity of diagnostic tools in pediatric patients hospitalized with a presumptive diagnosis of dengue in a Reference Hospital in Paraguay during the years 2012 to 2020. Materials and methods: Analytical study of case and control type, observational, longitudinal, retrospective corresponding to pediatric patients (0 to 18 years) admitted to the Reference Hospital of Paraguay from January 2012 to July 2020 with a presumptive diagnosis of dengue at income. A bivariate analysis was performed relating the frequencies of 20 groups of combined diagnostic criteria and 3 isolated diagnostic criteria (WHO 2009, epidemiological link and NS1 antigenemia for dengue) with the gold standard of diagnosis, which was serological conversion. Results: 342 subjects participated in the study. 44% were school age and 70% were 5 years old or older. 52.76% (191) were male. Malnutrition and overweight were found in 13% and 2%, respectively. The combination of C-reactive protein with thrombocytopenia was found in 0.45% of patients without dengue and in 6% of patients with a final diagnosis of dengue (p=0.004). Conclusion: This result provides the alternative of using a simple combination of laboratory tests that can be replicated in emergency rooms and inpatient wards in a first contact with febrile patients with suspected dengue fever.

Profile of adenoviral infection in hospitalized children

This single-center, retrospective study was conducted at Marengo Asia Hospital, Haryana from January 2023 to November 2023. Children aged 1 month to 16 years, admitted with a positive adenovirus polymerase chain reaction (nasopharyngeal swab) were included. Symptomatic management was provided to all children. The study focuses on discussing the demographic, clinical, laboratory and radiological profiles of hospitalized children with human adenovirus infection. Among the 25 children with a positive adenovirus polymerase chain reaction, 18 (72%) were males, 15 (60%) were within the age group of 1 month to 5 years. Furthermore, 13 (52%) children were hospitalized during summer season. The most prevalent symptoms observed in children admitted with adenovirus infection were high-grade persistent fever in 25 cases (100%), cough and cold in 15 cases (60%), 14 (56%) vomiting in 14 cases (56%), pain abdomen and loose stools in 10 cases (40%), conjunctivitis in 6 cases (24%), and adenoviral pneumonia in 4 cases (16%). Notably all children were discharged successfully without encountering any complications. HAdV infections are commonly associated with high- grade fever, challenging the conventional perception that respiratory infections are their predominant manifestation. Equally noteworthy is the prevalence of gastrointestinal symptoms in HAdV infections

Some Acute Phase Proteins and Biochemistry Parameters of Female Dogs Affected with Pyometra

Canine pyometra is a common reproductive disorder of intact diestrual bitches. The disease is associated with inflammation and infection of the uterus leading to generalized illness. The varied reactions of the host to infection, inflammation, or trauma are collectively known as the acute-phase response (APR) and encompass a wide range of pathophysiological responses. One of these systemic responses to disease is an increase in the production by the liver of a number of serum proteins, which are known collectively as the acute-phase proteins (APP). The most important APPs in dogs are C-reactive protein (CRP) and serum amyloid A (SAA). When diagnosed with pyometra, the preferred and most effective treatment is ovariohysterectomy, a procedure that in itself causes systemic inflammation due to the tissue trauma caused by surgery. The purpose of this study was to identify the effect pyometra and ovariohysterectomy have on acute phase proteins and routinely measured biochemistry variables in serum of affected bitches. We achieved this by evaluating concentrations of CRP and SAA, as well as of some biochemistry parameters in serum before and after ovariohysterectomy in bitches with pyometra. Blood samples were collected from the cephalic vein immediately prior to and 24h, 72h and 168 hours after initiation of surgery. The levels of CRP, SAA and some biochemistry parameters - total protein (TP), albumin (ALB), globulin (GLOB), as well as activity of some enzymes: alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (AKLP) and lactate dehydrogenase (LDH) were determined Aims: The aim of this study was to investigate the impact of pyometra and its surgical treatment, ovariohysterectomy, on acute phase proteins, specifically C-reactive protein (CRP) and serum amyloid A (SAA), as well as on routine serum biochemistry variables in affected bitches. By evaluating the concentrations of CRP and SAA, alongside key biochemistry parameters before and after surgery, this research seeks to elucidate the physiological and biochemical responses to both the disease and its treatment, providing insight into the systemic effects of pyometra and the surgical stress response in dogs. Study Design: The study design involved a cohort of twenty-seven female dogs, divided into two groups: seventeen clinically healthy intact female dogs serving as the control group, which were examined for routine health care or vaccinations, and ten female dogs diagnosed with pyometra at the Faculty of Veterinary Medicine, University of Sarajevo. The diagnosis of pyometra was made based on case history, clinical signs, ultrasonography, and confirmed by gross examination of the pus-filled uterus during and after ovariohysterectomy. The surgical procedure was performed using a standard mid-line approach under general inhalation anesthesia, with no post-operative complications reported. Place and Duration of Study: Faculty of Veterinary Medicine, University of Sarajevo, between June 2012 and September 2012. Methodology: Blood samples were collected from the distal cephalic vein into serum separating tubes (Vacutainer SST; Becton Dickinson, USA) for CRP and SAA measurement and serum biochemical evaluation just before the ovariohysterectomy (base values) as well as after 24 hours (day one), 72 hours (day three) and 168 hours (day seven). Blood samples from control dogs were collected only once. Serum samples were prepared by centrifugation (1.500 × g for 10 min) and stored in plain micro tubes (Eppendorf, Germany) at ?20°C prior to analysis. Serum CRP concentrations in the dogs were measured with ELISA microplate reader (Anthos 2001 ELISA-reader, Anthos Mikrosysteme, Krefeld, Germany) using a commercial canine CRP enzyme-linked immunosorbent assay (ELISA) kit (Tridelta PhaseTM Range CRP Assay, Tridelta Development Limited, County Kildare, Ireland). For SAA, the analyses were performed using also a commercially available ELISA kit (Tridelta PhaseTM Range SAA Assay, Tridelta Development Limited, County Kildare, Ireland). Total protein (TP), albumin (ALB), globulin (GLOB) concentrations and alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALKP) and lactate dehydrogenase (LDH) activities were determined by using standard procedures and slides by Catalyst Dx Chemistry Analyzer, Idexx. Statistical analyses were performed using the SPSS software package (for Windows, Version 11.5, SPSS Inc, USA). All data were shown as mean ± standard deviation. The results were analyzed using the independent t-test. A P-value less than 0.05 were considered statistically significant. Results: Our results indicated significantly higher concentrations of CRP and SAA in dogs with pyometra throughout the study period compared to the control group, with CRP concentrations rising up to 15-fold and SAA up to 10-fold. Notably, these increases in CRP and SAA concentrations were mostly observed before surgery, with only limited additional increases post-surgery. This suggests that while ovariohysterectomy induces a proinflammatory response, it does not significantly escalate the levels of these proteins beyond the initial disease impact. The variability observed in CRP and SAA levels points to potential interindividual differences, impacting their diagnostic value. However, on the last postoperative day, the significantly elevated levels of both proteins in dogs with pyometra suggest a persistent, though less severe, inflammatory process, with a subsequent decline as homeostasis was gradually restored. Conclusion: The role of the acute phase response is to limit inflammation, remove the damaging factor and restore homeostasis. The systemic effects of pyometra are reflected by acute phase proteins and several biochemistry parameters.

Role Of Elevation Of C-Reactive Protein (CRP) As An Independent Marker For Surgical Intervention In Acute Appendicitis

Background: The treatment of acute appendicitis has been primarily by surgery .The rate of negative Appendicectomy still remains at 15�%. This study is designed to investigate effectiveness of CRP as a surgical indication marker as well as to analyze the levels of elevation in CRP so as to identify cut offs for deciding between surgical and conservative management in Acute Appendicitis. 200 patients who underwent emergency Appendicectomy wereMethod: subjected to clinical examination and routine investigations including pre operative CRP and imaging studies on admission. Intra operative findings and post operative histopathology report of the specimen were also used for analysis. The HPR of each Appendicectomy specimen was used to distinguish between inflamed appendix and negative Appendicectomy and this was correlated to the pre operative levels of serum CRP of each patient to assess the level of elevation. Results: Among the 200 patients who underwent Appendicectomy, 85.5% had elevated CRP levels above 10mg/dL and the sensitivity and specificity of CRP was found to be more than those of USG and Alvarado score in diagnosing the disease. Also among the 12 patients who underwent negative Appendicectomy, CRP was normal (below 10) in more than 83%. Hence CRP is effective as a marker for surgical intervention in acute appendicitis. The best cut off value for CRP to serve this function was calculated to be 10mg/dL according to this study. Pre operativeConclusion: serum CRP value can be used as an independent marker for surgical intervention and the cut off value for this function is 10mg/dL.

High-sensitivity C-reactive protein as a biomarker of cardiovascular events

Background: Development of high sensitivity CRP (Hs-CRP) assays has improved the role of this acute phase reactant in predicting the first cardiovascular events. Hs-CRP levels partially reflect the extent of myocardial necrosis and can be used to predict inhospital and long-term outcome in patients with acute myocardial infarction. Aims and Objectives: The objectives of the study are to study and correlate increased level of Hs-CRP with various traditional risk factors such as age, sex, lifestyle, and comorbidities and to establish increased level of Hs-CRP as an independent marker for cardiovascular events. Materials and Methods: A 100 patients’ prospective cross-sectional study was conducted at tertiary care center with traditional risk factors and existing cardiovascular diseases. Measurements of Hs-CRP levels were done with immunoturbidimetric methods with statistical correlation. The statistical analysis was done using IBM SPSS version 26 software. Results: In total 100 patients, 67 patients had Hs-CRP value more than 3 mg/L where-as 33 patients had Hs-CRP value <3 mg/L, 32% of patients belonged to age group 51–60 years and majority 78% were male. Among all the individual life style parameters and traditional risk factor which were considered, five parameters, namely, sedentary life style, smoking, pre-existing hypertension, diabetes mellitus, and electrocardiogram changes were proved statistically significant and correlation between elevated high sensitivity C reactive protein and cardiovascular disease was proved statistically significant. Conclusion: Hs-CRP is independent biomarker for cardiovascular disease and positive correlation was established between elevated level of Hs-CRP and major traditional risk factors such as sedentary life style, smoking, hypertension, and diabetes mellitus.

New serum biomarkers for the diagnosis of patients with ulcerative colitis: a review / Novos biomarcadores séricos para o diagnóstico de pacientes com colite ulcerativa: uma revisão

Objective: to conduct a literature review on possible serum markers in patients with UC to identify potential biomarkers. Methods: the descriptors "Colitis Ulcerative", "Biomarkers", and "Diagnosis" were used for the search in the PUBMED, LILACS, SciELO, and SCOPUS databases. After applying the inclusion and exclusion criteria in the databases, the 32 articles were classified as samples. Results: research indicates that biomarkers can play distinct roles in assessing activity and diagnosing UC. For instance, the peptide nesfatin-1 showed elevated serum levels during active periods of the disease, while the peptide trefoil factor 3 showed promise in predicting UC activity. It is worth highlighting that C-reactive protein (CRP) is a commonly used marker in which high values are observed in patients during the active phase of the disease; however, studies suggest the need to redefine CRP cutoff values to better predict endoscopic remission. Other approaches, such as the analysis of proteins, specific fatty acids, and proteins related to the extracellular matrix, have also been explored, highlighting their potential as biomarkers. Conclusion: in summary, there is a diversity of possible clinically important biomarkers that play different roles in the assessment and diagnosis of UC. However, it is essential to conduct further research to validate these biomarkers and achieve greater reliability.

Objetivo: realizar uma revisão da literatura sobre possíveis marcadores séricos em pacientes com RU com o objetivo de identificar potenciais biomarcadores. Métodos: os descritores "Colitis Ulcerative", "Biomarkers" e "Diagnosis" foram utilizados para a busca nas bases de dados PUBMED, LILACS, SciELO e SCOPUS. Após a aplicação dos critérios de inclusão e exclusão nas bases de dados, os 32 artigos foram classificados como amostras. Resultados: a pesquisa indica que os biomarcadores podem desempenhar papéis distintos na avaliação da atividade e no diagnóstico da RU. Por exemplo, o peptídeo nesfatin-1 apresentou níveis séricos elevados durante os períodos ativos da doença, enquanto o peptídeo trefoil factor 3 mostrou-se promissor na predição da atividade da RU. Vale destacar que a proteína C-reativa (PCR) é um marcador comumente utilizado, no qual valores elevados são observados em pacientes durante a fase ativa da doença; no entanto, estudos sugerem a necessidade de redefinir os valores de corte da PCR para melhor predizer a remissão endoscópica. Outras abordagens, como a análise de proteínas, ácidos graxos específicos e proteínas relacionadas à matriz extracelular, também têm sido exploradas, destacando seu potencial como biomarcadores. Conclusão: em resumo, há uma diversidade de possíveis biomarcadores de importância clínica que desempenham diferentes papéis na avaliação e diagnóstico da CU. No entanto, é essencial conduzir mais pesquisas para validar esses biomarcadores para obter maior confiabilidade.

Proteína-C reactiva de alta sensibilidad y homocisteína en pacientes con enfermedad cerebrovascular isquémica

Fundamento: la proteína C reactiva de alta sensibilidad (PCR-as) y la homocisteína (Hci) parecen relacionarse con la enfermedad cerebrovascular isquémica, pero sus hallazgos sobre el riesgo y pronóstico de esta enfermedad resultan controversiales y no concluyentes. Objetivo caracterizar la proteína C reactiva de alta sensibilidad y homocisteína en pacientes con enfermedad cerebrovascular isquémica. Métodos: se realizó un estudio descriptivo y retrospectivo de corte transversal en pacientes con enfermedad cerebrovascular isquémica, ingresados en el Servicio de Ictus del Instituto de Neurología y Neurocirugía entre 2016 y 2019. Se recogieron variables demográficas, manifestaciones clínicas, tiempo de evolución, etiología y localización del infarto y factores riesgo. Se cuantificaron la PCR-as (riesgo cardiovascular) y la Hci. Resultados las medias de PCR-as (7,0±8,3 mg/L) y Hci (17,1±7,3 µM) fueron elevadas. El riesgo cardiovascular moderado y alto se presentaron en igual proporción (46,8 %). Hubo diferencias estadísticas en la relación entre el riesgo cardiovascular y la edad (p=0,00); pero ni el tiempo de evolución ni los factores de riesgo de la enfermedad mostraron este comportamiento. Los pacientes con riesgo cardiovascular alto (PCR-as >3 mg/L) y elevada Hci (>15 (M) exhibieron mayores frecuencias de etiologías aterotrombótica o cardioembólica. Conclusiones el riesgo cardiovascular aumenta en la medida que se incrementa la edad de pacientes con enfermedad cerebrovascular isquémica. Las características demográficas, clínicas y neurológicas no mostraron relación con el alto riesgo cardiovascular y los valores elevados de Hci, aunque se encontró una tendencia asociativa de la etiología aterotrombótica con el incremento de PCR-as y Hci.

Foundation: High-sensitivity C-reactive protein and homocysteine seem to be related to ischemic cerebrovascular disease, but their findings on the risk and prognosis of this disease are controversial and inconclusive. Objective: to characterize high sensitivity C-reactive protein and homocysteine in patients with ischemic cerebrovascular disease. Methods: a descriptive and retrospective cross-sectional study was carried out in patients with ischemic cerebrovascular disease, admitted to the Stroke Service of the Neurology and Neurosurgery Institute between 2016 and 2019. Demographic variables, clinical manifestations, time of evolution, etiology and infarction location, risk factors. High-sensitivity C-reactive protein (cardiovascular risk) and homocysteine were quantified. Results: the means of C-reactive protein (7.0±8.3 mg/L) and homocysteine (17.1±7.3 µM) were high. Moderate and high cardiovascular risk occurred in equal proportions (46.8%). There were statistical differences in the relationship between cardiovascular risk and age (p=0.00); but neither the time of evolution nor the risk factors of the disease showed this behavior. Patients with high cardiovascular risk (hs-CRP >3 mg/L) and high homocysteine (>15 (M), exhibited higher frequencies of atherothrombotic or cardioembolic etiologies. Conclusions: cardiovascular risk increases as the age of patients with ischemic cerebrovascular disease increases. Demographic, clinical and neurological characteristics did not show a relationship with high cardiovascular risk and high homocysteine values, although an associative trend of atherothrombotic etiology was found with increased high-sensitivity C-reactive protein and homocysteine.

Analysis between Serum Correlation of Procalcitonin and C-reactive Protein in Patients with Sepsis: An Observational Study

Background: Physiological measures of malfunction in six organ systems (respiratory, cardiovascular, hepatic, coagulation, renal, and central nervous systems) were used to create the sequential organ failure assessment (SOFA) score. Each organ system is graded from 0 to 4 with increasing severity of dysfunction. Procalcitonin (PCT) and C-reactive protein (CRP) are recognised indicators of sepsis. Procalcitonin and C-reactive protein serum concentrations should be compared and correlated with the various degrees of organ dysfunction in the sepsis. Methods: A total number of 75 patients admitted to ICU were selected for this study. Routine investigations like CBC, LFT, RFT, arterial blood gas analysis and Special investigations like Serum Procalcitonin and serum CRP were done in all patients. Based on the SOFA score, four groups of patients were chosen for the study, each with varying degrees of organ dysfunction in sepsis. Results: In the study, 58.6% were males. About 60% of patients were above 50 years of age. In the study, the most common presentation in mild and severe sepsis was fever. The mean serum PCT levels were found to be significantly higher among patients with severe sepsis, i.e. 46.6±37 mg/mL, as compared to mild sepsis patients i.e.17.3±22.7 mg/mL with p-value of 0.001. The mean CRP value was found to be non-significantly lower among patients with severe sepsis. Conclusion: The degree of infection is highly correlated with PCT and SOFA. Because PCT levels closely correlate with the severity of sepsis and its outcome, PCT has a greater capacity for diagnosis than CRP

Role of Serum C-reactive Protein Levels in Oral Potentially Malignant Disorders and Oral Cancer: A Cross Sectional Study

Introduction: Inflammation plays an important role in the process of carcinogenesis. It is associated with initiation, progression as well as metastasis of cancer. C-reactive protein (CRP) is a reliable marker for inflammation. Aim: The present study is designed to determine and compare the serum CRP levels in Oral Submucous Fibrosis (OSMF), Oral Leukoplakia (OL), Oral Cancer (OC) and Healthy Controls (HC) in order to assess its possible role in carcinogenesis. Materials and Methods: A total of 40 participants were equally divided in four groups i.e. OSMF, OL, OC and HC. From each participant, 5 ml of blood was obtained from antecubital vein. The serum was analysed for CRP levels using nephelometric analysis method. Results: There were total 29 males and 11 females, who were between 16 to 77 years of age, with a mean age of 44.45 ± 7.45 years. The serum CRP levels were significantly increased in OSMF, OL and OC groups as compared to HC group (p<0.05). Conclusion: Serum CRP levels can be used as diagnostic and prognostic marker for oral premalignant and malignant lesions.

Evaluation of bone mineral density in patients of spondyloarthritis in a tertiary care center

Background: Spondyloarthritis (SpA) is the disease of young population. Low bone mineral density (BMD) has been well documented in patients of ankylosing spondylitis but less studied in patients of SpA which includes reactive, enteropathic, psoriatic, and undifferentiated SpA. Aims and Objectives: This study was done to evaluate the BMD in patients of SpA and its correlation with disease activity and inflammatory markers. Materials and Methods: This was a cross-sectional case–control study. Thiry- five newly diagnosed SpA patients and equal number of age and sex matched healthy controls were included. A detailed history, examination, and dual-energy X-ray absorptiometry scan of lumber spine and femur neck was done. Results: The mean age in our cases and control groups were 26.60 ± 6.63 years and 27.63 ± 4.10 years, respectively. The duration of illness was 2.3 ± 1.3 years. 71.4% patients were male and 28.6% were female. The mean C-reactive protein (CRP) values at the time of diagnosis was 7.56 ± 3.4 mg/L. The mean bath ankylosing spondylitis disease activity index (BASDAI) values in patients were 3.17 ± 2.9. BMD correlated with baseline BASDAI and male sex (P < 0.005) among cases and controls. However, we found no relationship between reduced BMD with the pattern of joint involvement, HLA B27 positivity, CRP levels, and duration of onset of symptoms. Conclusion: The result of this study shows that patients of SpA with high BASDAI score at a very early age are predisposed to low BMD.