Activity of systemic juvenile idiopathic arthritis in children immunized with pneumococcal 13-valent conjugate vaccine: prospective cohort study

2020 ◽  
Vol 15 (5) ◽  
pp. 40-50
Author(s):  
D.D. Vankova ◽  
◽  
E.I. Alekseeva ◽  
T.M. Dvoryakovskaya ◽  
R.V. Denisova ◽  
...  

Evaluation of the safety profile of vaccines in patients with rheumatic diseases requires an assessment of their impact on disease activity. The effect of antipneumococcal vaccination on the activity of systemic juvenile idiopathic arthritis (sJIA) has not been studied so far. Objective. To evaluate the dynamics of sJIA activity after immunization with pneumococcal 13-valent conjugate vaccine (PCV13) of patients receiving biologicals. Patients and methods. This study included patients with sJIA in remission or active disease receiving biologicals during inpatient treatment and vaccinated with PCV13. To evaluate the effect of immunization on sJIA activity, we measured serum levels of high-sensitivity C-reactive protein (hs-CRP) and calprotectin. In addition to that, we assessed the number of new cases, when concentration of these markers was above the upper limit (UL) 4 weeks after PCV13 administration. Results. In 18 out of 53 patients in remission (34%) and 3 out of 25 patients with active sJIA (12%), hs-CRP levels were undetectable (0.1 mg/L) at both time-points (baseline and after 4 weeks). Among those with detectable hs-CRP levels in at least one time-point 4 weeks after vaccination, patients in remission (n = 35) had no significant changes in hs-CRP (median -0.17 mg/mL; 95% CI -0.84…0.41), whereas patients with active sJIA (n = 22) demonstrated a 3-fold decrease in hs-CRP level (median -0.94 mg/mL (95% CI -3.93…0.05). We observed no significant difference in calprotectin levels in the groups. Concentration of hs-CRP above the UL 4 weeks after vaccination was detected in 2 out of 53 sJIA patients in remission (4%) and none of the patients with active sJIA. Сoncentration of calprotectin above the UL 4 weeks after vaccination was detected in 8 out 53 (15%) and 5 out 25 (20%) sJIA patients in remission and with active disease, respectively. Conclusion. Vaccination against pneumococcal infection in patients with sJIA led to an increase in the level of highly sensitive laboratory markers of sJIA activity in 4–20% of patients. Key words: disease activity, safety, high-sensitivity C-reactive protein, biological drugs, calprotectin, juvenile idiopathic arthritis, pneumococcal 13-valent conjugate vaccine

Author(s):  
Meily Manoppo ◽  
Hermie MM Tendean ◽  
Joice MM Sondakh

Objective: To compare the level of high sensitivity C-Reactive Protein (hs-CRP) on patients with premature rupture of membranes (PROM) at term pregnancy. Methods: The study was cross-sectional design. The data collection included age, parity, gestational age, birth weight, and APGAR score on 28 pregnant women at term pregnancy consisting of 14 subjects of Premature Rupture of Membrane (PROM) less than 12 hours and the remaining one was equal or more than 12 hours. We took blood samples from the subjects for the examination of hs-CRP level. Data were analyzed using non-parametric statistical test and processed using Statistical Package for Social Sciences (SPSS) version 20. Results: The mean hs-CRP level on PROM <12-hour and 12-hour group was 12.9 and 17.8 mg/l. There was not significant difference on hs-CRP level between both of group at term pregnancy (p=0.734). Conclusion: The level of hs-CRP does not have association with the incidence of PROM. [Indones J Obstet Gynecol 2017; 5-1: 12-15] Keywords: high sensitivity C-Reactive Protein, premature ruptures of membranes, term pregnancy


2013 ◽  
Vol 33 (suppl_1) ◽  
Author(s):  
Archana Rajdev ◽  
Oana Penciu ◽  
Jacqueline Bradley ◽  
Cristina Mihu ◽  
Alan Siqueros ◽  
...  

INTRODUCTION Implantation of bare metal or drug eluting stents supported by dual antiplatelet therapy (DAPT) is standard treatment for the management of patients with ST elevation myocardial infarction (STEMI). Individual response to aspirin and clopidogrel is heterogeneous, and decreased response is associated with thrombotic events following stenting. We postulated that systemic inflammation at the time of STEMI would diminish responsiveness to DAPT. The aim of this study is to evaluate the correlation between elevated high-sensitivity C-reactive protein (hs-CRP) as a marker of inflammation and decreased platelet sensitivity to DAPT in STEMI. METHODS We recruited patients with STEMI undergoing percutaneous coronary intervention (PCI) who received oral clopidogrel 600 mg loading dose followed by 75 mg daily maintenance dose and aspirin 325 mg daily. Platelet reactivity and hs-CRP were measured within 72 hours of PCI and at 6 weeks. For patients receiving eptifibatide, blood samples were taken 48 hours after discontinuation. Platelet reactivity was assessed using the VerifyNow platelet function analyzer. A cut-off value of 208 platelet reaction units (PRU) was used to define high on-clopidogrel platelet reactivity (HCPR) and a value of 454 aspirin reaction units (ARU) was used to define high on-aspirin platelet reactivity (HAPR). RESULTS In 20 patients aged 31 to 85, in hospital and 6 weeks after STEMI, hs-CRP was 6.7 (SD 4.0) and 2.6 (SD 3.2) respectively, p< 0.01. Changes in ARU from 408.3 (SD 54.3) to 425.2 (SD 68.2) and PRU from 157.8 (SD 74.7) to 164.2 (SD 75) were not statistically significant. 2 patients had HAPR in hospital; 1 became sensitive at follow up. 2 patients developed HAPR and HCPR. We saw a trend towards higher PRU in diabetic patients and those prescribed statins. CONCLUSIONS Although we found a significant difference in hs-CRP levels between the first and second time point, no significant difference was found in on-aspirin and on-clopidogrel platelet reactivity between the time points.Thus, in this small series, the acute inflammatory state associated with STEMI did not appear to influence the on-DAPT reactivity at the dosages used. Trends among those with diabetics and prescribed statins will be discussed


2020 ◽  
Vol 8 (A) ◽  
pp. 706-710
Author(s):  
Edy Ardiansyah ◽  
M. F. G. Siregar ◽  
R. A. Ganie ◽  
I. B. Utra

BACKGROUND: The prevalence of overactive bladder (OAB) appears to increase with age (aging), and free radicals most contribute to an increase in the aging process. But now, some researchers have found the efficacy of Morinda citrifolia in inhibiting the oxidative stress process so that it is expected to be beneficial for the treatment of OAB. AIM: The aim of this study was to find out the effect of M. citrifolia extract on overactive women bladder (OAB) through observation of high-sensitivity C-reactive protein (hs-CRP) urine level. METHODS: This research is an experimental study using double-blind randomized controlled trial design conducted at General Hospital H. Adam Malik Medan, USU Pharmacy Laboratory for extraction of noni fruit (M. citrifolia) and the Integrated Laboratory of Biochemical-Biomolecular USU Faculty of Medicine for the examination of hs-CRP urine levels. A t-dependent test is performed if data distribution is normally distributed or if not normally distributed, the median values are compared with the Mann–Whitney U-test. The effect of noni in hs-CRP levels performed by wilcoxon signed-Ranks Test. The statistical significance test with CI 95% and significant difference value p<0,05. RESULTS: These results indicate that the noni fruit extract has weak antioxidant activity (IC50 >150 ppm). From the statistical analysis, a significant difference (p < 0.05) was obtained in hs-CRP urine level after compared to before treatment. These results indicate that after treatment, there was an improvement in the degree of OAB symptom scores in Group A and Group B. CONCLUSIONS: Noni fruit extract (M. citrifolia) is proven to be able to inhibit oxidative stress in urothelium through observation of hs-CRP urine levels in overactive women bladder (OAB).  


2019 ◽  
Vol 18 (3) ◽  
pp. 180-186
Author(s):  
Ekaterina I. Alekseeva ◽  
Dar’ya D. Van’kova ◽  
Tatyana M. Dvoryakovskaya ◽  
Kseniya B. Isaeva ◽  
Rina V. Denisova ◽  
...  

Background. Vaccination coverage in patients with rheumatic diseases remains extremely low. Moreover, infections are the leading cause of death in such patients. Respiratory infections mortality is 2–5 times higher in adults with rheumatoid arthritis than in overall population. The most frequent infectious complications in patients receiving Tocilizumab (first-line drug for treatment of patients with systemic juvenile idiopathic arthritis (SJIA)) are pneumonia and acute sinusitis. Their clinical course differs: slight clinical presentation, reference ranges of laboratory tests of disease activity (ESR, C-reactive protein), significant changes in lungs and paranasal sinuses according to the computer tomography. Infectious complications development can cause aggravation of prior disease itself or due to temporary immunosuppressive therapy cessation. Clinical Case Description. The experience of immunization with 13-valent pneumococcal conjugate vaccine (PCV13) and haemophilus influenzae-tetanus toxoid conjugate vaccine in the 1,5 years old boy with SJIA receiving interleukin-6 receptor monoclonal antibody Tocilizumab is presented. The result of such vaccination was increase of pneumococcal and haemophilus influenzae antibodies levels by more than two times. Meanwhile vaccination had no negative impact on the prior disease course: the levels of predictors of prior disease aggravation such as protein S100 and highly sensitive C-reactive protein did not increase significantly in comparison with the period before vaccination. Conclusion. The efficiency and safety of immunization with PCV13 and haemophilus influenzae-tetanus toxoid conjugate vaccine in the child with SJIA receiving Tocilizumab is presented.


2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1797.1-1797
Author(s):  
M. G. Villarreal ◽  
S. Bonaldi ◽  
L. Perez ◽  
M. Katsikas

Background:Systemic juvenile idiopathic arthritis (SJIA) is a category of Juvenile Idiopathic Arthritis (JIA). Different clinical patterns (articular/systemic/both of them combined) have been recognized, possibly identifying distinct subpopulations. Serum biomarkers that reflect disease activity include S100A8/S100A9 (S100A8/9), however to date patterns of SJIA and their association with S100A8/9 has not been tested.Objectives:To evaluate S100A8/9 levels in a cohort of patients with SJIA. To determinate S100A8/9 inactive vs inactive visits. To distinguish patterns on SJIA and their association with S100A8/9. To compare serum levels of S100A8/9 with other JIA categories and autoinflammatory diseases.Methods:An unicenter, observational, cross sectional study was conduced. Patients with SJIA according ILAR whom S100A8/9 was measured as part of standard care were enrolled. Consecutive visits were included. Variables recorded were: clinical (systemic: fever, serositis, adenopathy, hepatomegaly, splenomegaly and arthritis); biochemical (S100A8/9, hemoglobin, platelet, erythrosedimentation, c-reactive protein, ferritin). Activity measures: Juvenile Arthritis Disease Activity Score (JADAS -10) and physician visual analogue scale (phy VAS).Visits were divided into active/inactive. Active visit was defined as at least one clinical feature.(systemjc and/or arthritis). Inactive visit no clinical symptoms neither JADAS-10> 1 and phy VAS: 0. SJIA patterns were defined as: “articular pattern”: those patients with arthritis without systemic features, “systemic pattern”: any systemic feature without arthritis, “mixed pattern”: both articular and systemic. Levels of S100A8/9 were tested using Calprotectin Elisa Kit. For comparisons others JIA: enthesitis related arthritis (ERA), polyarticular and autoinflammatory diseases who had at least one S100A8/9 determination were included. Descriptive statistics, Mann- Whitney U test and ANOVA were used as appropiate.Results:Forty-two patients with SJIA were included (25 F). Age at evaluation 13 (1-16.5) years. Clinical features at study baseline: arthritis 57 %, rash 19%, fever 15 %, adenopathies 6%, splenomegaly 4%, hepatomegaly 1.5%. Laboratory features (median): hemoglobin 12.2 gr/dl, platelet 314000 cel/mm3, erythrosedimentation 12.5 mm/h, c-reactive protein 0.7 mg/dl, ferritin 235 ng/ml. JADAS -10 ≥ 1: 62%. Number of active patients were 29 (69%). Scheduled Medical visits were 129 (active 65%, inactive 35%). Active visits were divided according patterns into: articular 54%, mixed 35%, systemic 11%.Serum Levels of S100A8/9 according to SJIA’ patterns.SJIAOverallActiveArticularSystemicMixedInactiveVisits129844692945S100A8/9 ng/mlMedian (range)7590(300-2625)16788(300-26250)10750(300-26250)5200(850-12250)25000(3290-2625)3103(1140-1010)S100A8/9 analysis revealed significant differences among active vs inactive medical visits (p: 0,00001). ANOVA test among SJIA`patterns showed, F:86.48, (p:0.00001). Mixed pattern was distinctive to others. S100A8/9 (medians ng/ml) in comparable diseases were: ERA: 4320, polyarticular: 4120, autoinflammatory: 6532. SJIA had the higher S100A8/9. SJIA was different than others comparable diseases (F: 11,62,p: 0.00001). Comparisons among SJIA`patternss and others disease found that systemic and articular pattern did not show differences (F.2.78, p:0.067)Conclusion:S100A8/9 was higher in SJIA compared to others diseases. It reflected disease activity. Mixed pattern evidenced to be different to others (systemic/articular). Mixed pattern was the unique that showed significative difference compared to other diseases. SJIA is probably not a single disease, but not only clinical patterns and biomarkers as S100A8/9, if not, genetic variants and their expression would be able to identify homogeneous groups towards tailored treatments.Disclosure of Interests:None declared


Neonatology ◽  
2020 ◽  
Vol 118 (1) ◽  
pp. 28-36
Author(s):  
Tetsuo Naramura ◽  
Hiroko Imamura ◽  
Hidetaka Yoshimatsu ◽  
Kaname Hirashima ◽  
Shinji Irie ◽  
...  

<b><i>Introduction:</i></b> Evidence on the reliability of using procalcitonin (PCT) and high-sensitivity C-reactive protein (hs-CRP) as diagnostic markers for early-onset neonatal bacterial infections is still insufficient because of their physiological elevation during the early neonatal period. This study aimed to assess the respiratory influence of serum PCT and hs-CRP levels and evaluate their predictive value for bacterial infections during the first 72 h of life in preterm neonates. <b><i>Methods:</i></b> The preterm neonates enrolled in this single-center retrospective cohort study were categorized into 3 groups: reference, infection-unlikely respiratory failure, and probable bacterial infection; their serum PCT and hs-CRP levels were assessed. Subsequently, age-specific 95th percentile curves were plotted and the median and cutoff PCT and hs-CRP levels for predicting bacterial infections at birth and 7–18, 19–36, and 37–72 h after birth were determined. Moreover, the analysis of PCT and hs-CRP with a neonatal sequential organ failure assessment (nSOFA) score was performed in very low birth weight neonates. <b><i>Results:</i></b> Serum PCT levels were influenced by respiratory failure. A significant difference was found in the median PCT and hs-CRP levels among the 3 groups at each time point. PCT sensitivities for predicting bacterial infection were slightly higher than those of hs-CRP in each time frame during the first 72 h of life. In both PCT and hs-CRP, there was no significant difference between infants with nSOFA scores of &#x3e;4 and those with nSOFA scores of ≤4. <b><i>Discussion/Conclusion:</i></b> Age-specific evaluation showed that PCT has better predictive value than hs-CRP for early-onset bacterial infections in preterm neonates.


2014 ◽  
Vol 61 (4) ◽  
Author(s):  
Şerafettin Demir ◽  
Gulhan Karakoyun ◽  
Mehmet Kanadasi

The aim of this study is to examine uric asid (UA) and high sensitive C-Reactive protein (Hs-CRP) levels in patients with coronary artery ectasia (CAE). Ninety-eight patients with isolated CAE (mean age 57.5±10.3), (group-I), 110 patients with CAD but without CAE (mean age 56.3±10.7), (group-II), and 105 patients with normal coronary angiographies (mean age 58.1±10.8), (group-III) were included in the study. Blood samples of all individual were taken after coronary angiography from an antecubital vein, the patients uric acid and Hs-CRP levels were assessed. The severity of ectasia was evaluated and categorized according to Markis. A significant difference was not seen in serum uric acid and Hs-CRP levels between CAE and CAD groups. However, relative to the control group, uric acid and Hs-CRP levels in CAE and CAD groups were higher to a significant degree (p=0.001, p


2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Masaki Shimizu ◽  
Natsumi Inoue ◽  
Mao Mizuta ◽  
Yasuo Nakagishi ◽  
Akihiro Yachie

To investigate whether serum leucine-rich α2-glycoprotein (LRG) levels are useful as a marker of disease activity in systemic juvenile idiopathic arthritis (s-JIA), we determined serum LRG levels in fifty-nine s-JIA patients, 15 with other subtypes of JIA, 7 with Kawasaki disease (KD), 7 with influenza A infection (flu), 7 with enterohemorrhagic Escherichia coli (EHEC) infection, and 20 healthy controls (HC). Results were compared with the clinical features of s-JIA and serum cytokine levels including interleukin- (IL-) 6, IL-18, and soluble tumor necrosis factor receptors I and II. Serum LRG levels in active s-JIA were higher compared to those in other subtypes of JIA, EHEC, flu patients, and HC. Serum LRG levels were normalized in the inactive s-JIA phase after treatment. Serum LRG levels were positively correlated with serum C-reactive protein and ferritin levels. Serum LRG levels reflected s-JIA disease activity and thus may be useful for monitoring s-JIA disease activity.


2020 ◽  
Vol 7 (4) ◽  
pp. 666 ◽  
Author(s):  
Sonal Rajesh Kumar ◽  
T. A. Vidya

Background: Stroke is the second leading cause of death worldwide according to WHO. High sensitivity C-Reactive Protein (hs-CRP) is an acute phase reactant which is being studied extensively to delineate its role in development of stroke as well as in prognostication.  This study was done to assess correlation of hs-CRP with risk factors of stroke and its association with types of stroke and prognosis.Methods: A prospective case control study of 100 patients with acute stroke along with 100 controls was conducted with informed consent.  At baseline, hs-CRP levels were measured and Modified Rankin Scale (MRS) was assessed. On day 90 the Modified Rankin Scale was assessed again. Patients were divided into groups based on hs-CRP levels and MRS and the results were analysed.Results: Prevalence of stroke was more in men than women (p=0.0002).  Statistically significant difference was found between mean hs-CRP levels in men (4.722±0.8982 mg/L) and women (4.133±0.9446 mg/L) (p=0.005) and between cases and controls (p=0.0003). There was no significant association with type of stroke (p=0.456).  Mean total cholesterol levels between cases and controls showed statistically significant difference (p=0.0005). High MRS was significantly associated with high hs-CRP levels (p=0.003).  Higher hs-CRP on day 1 correlated with higher MRS on day 90.Conclusions: hs-CRP level is increased in stroke and shows significant association with severity of stroke and prognosis.


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