A Comparative study of the administration of a single bolus of ketamine versus bolus administration followed by continuous infusion in the management of traumatic limb pain in a low income country

Introduction Ketamine has proven its analgesic efficacy in the management of pain due to limb trauma. There is still doubt about how to integrate ketamine into medical practice in emergency departments, including continuous infusion and bolus. The aim of this study is to compare the efficacy of ketamine administered in a single bolus with ketamine administered in a bolus relayed by a continuous infusion on traumatic limb in a context of under-equipment Methods This was a randomized, double-blind clinical trial. It took place at Ouahigouya teaching hospital over a three-month period. Any adult patient aged 18 to 65 admitted to the emergency room for limb trauma with severe pain ≥ 7 on a numerical scale (EN) was included in the study. Patients were randomized into two groups. Group 1 received a bolus of ketamine relayed by continuous infusion and group 2 received a bolus of ketamine relayed by isotonic saline infusion. The main endpoint was total morphine consumption at the end of treatment (maximum 60 minutes). Results A total of 66 patients were included; 33 in each group. The groups were statistically comparable. There was no significant difference between the two groups in morphine requirements. Indeed, 27.27% of Group 1 patients and 21.21% of Group 2 patients used morphine to relieve their pain (p = 0.29).The average dose of morphine received at the end of management (T + 60 minutes) was 6 ± 2.6 mg in Group 1 and 5.14 ± 1.46 mg in Group 2. There was no significant difference between these doses (p = 0.44). No serious side effects were noted in either group. The patient satisfaction index was on average 7.24 ± 0.75 and 7.3 ± 0.77 respectively in Group 1 and 2 (not significant difference p = 0.74). Conclusion The administration of ketamine as a single bolus is as effective as the bolus followed by continuous infusion. It is therefore up to practitioners to develop protocols for the safe use of this molecule, which will undoubtedly contribute to improving pain management in emergency departments, especially those in low income countries.

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Effect of metformin on blood lipids in patients with diabetes mellitus

IMC Journal of Medical Science ◽

10.3329/imcjms.v13i2.45277 ◽

2020 ◽

Vol 13 (2) ◽

pp. 23-27

Author(s):

Tahniyah Haq ◽

Sabah Haq

Keyword(s):

Diabetes Mellitus ◽

Blood Lipids ◽

Plasma Lipid ◽

Average Dose ◽

Lipid Levels ◽

Cross Sectional ◽

Significant Difference ◽

Patients With Diabetes ◽

Group 2 ◽

Group 1

Background and objectives: Metformin improves macrovascular complications in people with diabetes mellitus (DM). Although the exact mechanism is not known, metformin has beneficial effects on dyslipidaemia. The aim of the study was to find out if there was an effect of metformin on blood lipids in people with diabetes mellitus. Method: This was a cross-sectional study which included 80 patients with diabetes mellitus. They were divided into 2 groups – (a) Group 1: on metformin and (b) Group 2: without metformin medication. None of the patients were on any other anti-diabetic medication. All data were obtained from patients’ medical records. Individual blood lipids and lipid ratios were compared between two groups. Result: Group 1 included 42 patients with a mean HbA1c of 7.58 ± 0.24% taking an average dose of 820.83 ± 60.40 mg/day of metformin. Group 2 consisted of 38 patients with mean HbA1c of 7.58 ± 0.29%. There was no significant difference in individual plasma lipid levels, lipoprotein ratio or frequency of dyslipidaemia between patients taking and not taking metformin (p>0.05). Also, different doses of metformin had no significant effect on the plasma lipid levels. Conclusion: Metformin did not affect the lipid profile of patients with diabetes mellitus. Ibrahim Med. Coll. J. 2019; 13(2): 23-27

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Characterization, Nutrient Intake, and Nutritional Status of Low-Income Students Attending a Brazilian University Restaurant

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18010315 ◽

2021 ◽

Vol 18 (1) ◽

pp. 315

Author(s):

Ygraine Hartmann ◽

Rita de Cássia C. de A. Akutsu ◽

Renata Puppin Zandonadi ◽

António Raposo ◽

Raquel B. A. Botelho

Keyword(s):

University Students ◽

Food Consumption ◽

Low Income ◽

Sodium Intake ◽

Low Income Students ◽

Significant Difference ◽

Group 2 ◽

The University ◽

Sodium Consumption ◽

Group 1

In Brazilian universities, the university restaurant (UR) is essential in supporting students to complete their courses, as the UR offers free or low-cost food. In this sense, this research aimed to evaluate public policy effectiveness in offering food to low-income students attending the UR of the University of Brasília. This cross-sectional study compared low-income students (participating in the Student Assistance Program—Group 1) and students that did not participate in the Program (Group 2). Researchers assessed food consumption through direct observation of students while serving their plates at UR (in all meals consumed at UR) and completed food consumption with diet recalls for the meals outside the UR. In total, three complete days, including one weekend day, were evaluated for each student. Researchers also evaluated the participants’ body mass composition and body fat percentage. The results of the comparisons between the evaluated groups showed that the groups presented similar intakes. Only sodium intake was significantly different for males, being higher for Group 1. The median sodium consumption among females and males in group 1 was 55% and 119%, respectively, above the upper limit (UL). In Group 2, sodium intake levels reached consumption percentages above UL by 36% for females and 79% for males. The prevalence of inadequate sodium consumption was 100% for both genders and groups. Extra salt was added to dishes by 19.7% of the students. For females, only fiber ingestion was statistically different, with higher intake for Group 1. The other evaluated parameters showed similarities among groups for each gender. The statistical analysis revealed a significant difference in the consumption of calories, fibers, sodium, iron, and calcium for the students who had three meals at the UR in the two weekdays. There was a statistical difference in nutrients for those who had three meals in the UR, reinforcing the importance of the UR’s meals. The current food and nutrition policy at the UR proved to be extremely important in university students’ lives and in maintaining healthy nutritional aspects. However, changes in sodium use, more calcium intake, and less cholesterol consumption should receive attention to better balance dietary elements of the food offered. Dish preparation should be carefully followed to ensure the quality of the food for university students.

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Surgical management of consecutive exotropia: Long-term outcomes

European Journal of Ophthalmology ◽

10.1177/1120672120983199 ◽

2021 ◽

pp. 112067212098319

Author(s):

Osman Melih Ceylan ◽

Yeşim Gedik Oğuz ◽

Önder Ayyıldız ◽

Serkan Köksal ◽

Erhan Yumuşak ◽

...

Keyword(s):

Early Postoperative Period ◽

Dose Effect ◽

Average Dose ◽

Success Rates ◽

Chi Square ◽

Significant Difference ◽

Consecutive Exotropia ◽

Group 2 ◽

Group 1

Purpose: To compare lateral rectus recession (LRc) and medial rectus advancement (MRadv) for correction of consecutive exotropia (CXT). Methods: Of the 43 exotropic patients 20 of them underwent LRc (group 1) and 23 of them underwent MRadv (group 2). Postoperative exodrift, strabismic angle, dose effect relationship were compared with minimum 2 years follow‑up. Results: An average dose-effect in group 2 is higher than group 1 in the early postoperative period, however there was no significant difference at the second year follow-up (p=0,109). An average exodrift after 2 year follow-up was 6,6±7,12 PD in group 1, and 8,13±7,45 PD in group 2. Postoperative overall success rate was 50% in group 1 and 65% in group 2 at the last follow-up. The success rates were not significantly different between the groups (chi-square, p =0.31). Conclusion: Although there was no statistically significant difference at the last follow-up, better results were obtained with MRadv than LRc in the treatment of CXT.

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In-vivo evaluation of the effect of cyanoacrylate on prosthetic vascular graft infection – does cyanoacrylate increase the severity of infection?

VASA ◽

10.1024/0301-1526/a000867 ◽

2020 ◽

Vol 49 (4) ◽

pp. 281-284

Author(s):

Atıf Yolgosteren ◽

Gencehan Kumtepe ◽

Melda Payaslioglu ◽

Cuneyt Ozakin

Keyword(s):

Vascular Graft ◽

Graft Infection ◽

Vascular Graft Infection ◽

Group 4 ◽

Significant Difference ◽

Group 3 ◽

Group 2 ◽

Prosthetic Vascular Graft Infection ◽

Group 1

Summary. Background: Prosthetic vascular graft infection (PVGI) is a complication with high mortality. Cyanoacrylate (CA) is an adhesive which has been used in a number of surgical procedures. In this in-vivo study, we aimed to evaluate the relationship between PVGI and CA. Materials and methods: Thirty-two rats were equally divided into four groups. Pouch was formed on back of rats until deep fascia. In group 1, vascular graft with polyethyleneterephthalate (PET) was placed into pouch. In group 2, MRSA strain with a density of 1 ml 0.5 MacFarland was injected into pouch. In group 3, 1 cm 2 vascular graft with PET piece was placed into pouch and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. In group 4, 1 cm 2 vascular graft with PET piece impregnated with N-butyl cyanoacrylate-based adhesive was placed and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. All rats were scarified in 96th hour, culture samples were taken where intervention was performed and were evaluated microbiologically. Bacteria reproducing in each group were numerically evaluated based on colony-forming unit (CFU/ml) and compared by taking their average. Results: MRSA reproduction of 0 CFU/ml in group 1, of 1410 CFU/ml in group 2, of 180 200 CFU/ml in group 3 and of 625 300 CFU/ml in group 4 was present. A statistically significant difference was present between group 1 and group 4 (p < 0.01), between group 2 and group 4 (p < 0.01), between group 3 and group 4 (p < 0.05). In terms of reproduction, no statistically significant difference was found in group 1, group 2, group 3 in themselves. Conclusions: We observed that the rate of infection increased in the cyanoacyrylate group where cyanoacrylate was used. We think that surgeon should be more careful in using CA in vascular surgery.

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Tuberculosis of the meninges and central nervous system. Experience of clinical diagnostics in St. Petersburg for 50 years

MedAlliance ◽

10.36422/23076348-2020-8-1-14-24 ◽

2020 ◽

Vol 8 (1) ◽

pp. 14-24

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Medical Errors ◽

Clinical Diagnostics ◽

Lethal Outcome ◽

Significant Difference ◽

Group 2 ◽

Allergic Vasculitis ◽

Tuberculosis Meningitis ◽

Group 1

The clinic and diagnostics of tuberculosis meningitis (TM) in 926 patients treated in St. Petersburg hospitals in 1965–1994 (group 1) and in 1995–2018 (group 2) is presented. The TM clinic is demonstrated to be determined by the form of tuberculosis and its characteristic generalization nature in the presence of repeated waves of bacteremia and allergic vasculitis of greater or lesser severity. There is clinical peculiarity of TM in primary pulmonary tuberculosis and its early large-focal and late miliar generalization, as well as in hematogenous tuberculosis. In patients of the 1st and 2nd groups the TM clinic shows in some respects a noticeable similarity, in others — a significant difference. Despite the typical symptoms, early diagnosis of TM took place in less than 20% of patients. Clinical examples illustrating the unusual development of TM, contrasting with its usual course, are given. A number of objective and subjective factors contributing to the adverse evolution of TM and its lethal outcome are discussed. These include the peculiarity of modern tuberculosis, especially when associated with HIV infection, as well as medical errors associated with ignorance of the pathogenesis of tuberculosis and failure to comply with the minimum examination for tuberculosis.

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Two Adhesive Systems-effect on Adhesion to Tooth Structure

Revista de Chimie ◽

10.37358/rc.19.7.7389 ◽

2019 ◽

Vol 70 (7) ◽

pp. 2608-2613

Author(s):

Larisa Simona Deac ◽

Kamel Earar ◽

Adela Loredana Colceriu Burtea ◽

Alexandra Stefania Berghe ◽

Aurora Antoniac ◽

...

Keyword(s):

Adhesive Systems ◽

Hybrid Layer ◽

Tooth Structure ◽

Selective Etch ◽

Etch And Rinse ◽

Significant Difference ◽

Wisdom Teeth ◽

Group 2 ◽

Self Etch ◽

Group 1

This study evaluates and compares by dye penetration method and SEM photomicrographs the sealing obtained using two different classes of adhesive systems (etch-and-rinse and self-etch with selective etching) with SDR (Dentsply) bulk fill composite. 84 class V cavities were prepared on oral and vestibular face of 42 intact, freshly extracted wisdom teeth. The cavities were randomly divided in two groups and restored: Group 1 with prime &bond one select (Dentsply) and SDR (Dentsply) and Group 2 with prime&bond one Etch&Rinse (Dentsply) and SDR (Dentsply). Prime&bond one Select (Dentsply) is a single component adhesive and can be used in self etch mode, in selective enamel etch mode, or in etch-and-rinse mode. We chosen for this study the selective etch of the enamel mode. Prime&bond one Etch Rinse (Dentsply) is a universal etch-and-rinse one-bottle dental adhesive, designed to be used in two steps. The bulk fill composites are commonly used in modern dentistry due to their properties of low polymerization shrinkage and curing in layer of 4 mm depth, offering the practitioner a fast clinical procedure with good results. The results showed a good sealing at enamel and dentin margins with no statistically significant difference between adhesives, even though the mean of enamel infiltration was smaller for Group1. Furthermore the results show that there were differences between the two groups, for the infiltrations at the enamel, the values of microleakage being arithmetically higher for Group 1, but with no statistically difference between the two groups.SEM images showed for both groups a good adhesion surface with the tooth, but the hybrid layer of the total-etch adhesives is different from the hybrid layer formed by self etch adhesives, in terms of thickness, uniformity. In conclusion both adhesive systems have equivalent sealing qualities and can be successfully used with SDR.

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Reducing Gingivitis Remotely using the iGAM mHealth app (part 2): Prospective Observational Study (Preprint)

10.2196/preprints.24955 ◽

2020 ◽

Author(s):

Guy Tobias ◽

Assaf B Spanier

Keyword(s):

Oral Health ◽

Tooth Loss ◽

Prospective Observational Study ◽

Dental Clinics ◽

Significant Difference ◽

Observational Cohort ◽

Group 2 ◽

And Behavior ◽

Oral Hygiene Habits ◽

Group 1

BACKGROUND Gingivitis is a non-painful, inflammatory condition that can be treated with home remedies. Left untreated gingivitis can lead to tooth loss. Periodic dental examinations are important for early diagnosis and treatment of gum diseases. In order to contain the spread of the corona virus, governments, including in Israel, have restricted movements of their citizens which has caused routine dental checkups to be postponed. OBJECTIVE This study aimed to examine the ability of an mHealth app- iGAM to reduce gingivitis. METHODS A prospective observational cohort study was performed, 160 unpaid participants were divided into 2 equal groups and downloaded the iGAM app. Group 1 photographed their gums weekly for eight weeks. Group 2 photographed their gums at the time of recruitment and 8 weeks later. After photo submission, the participants received the message "It is recommended to read the information contained within the app regarding maintaining oral hygiene habits". A single blinded researcher examined the images and scored them according to the Modified Gingival Index (MGI). RESULTS The average age of group 1 was 26.77 (S.D. ± 7.43), and 28.53 (S.D. ± 10.44) for group 2. The majority were male (74.7% in group 1 vs. 66.7% in group 2), most participants described themselves as "secular", most were "single", non-smokers (74.7% vs. 78.4%) and did not take medications (85.3% vs. 78.4%). 126 subjects completed the study. A statistically significant difference (P <.001) was found in the dependent variable (MGI) in a linearly negative manner. As time passed, the gum condition improved, there were significantly lower gingivitis scores in group 1 (M = 1.16, S.D. ± 1.18) compared to group 2 (M = 2.16, S.D. ± 1.49), after eight weeks. Those with more recent dental visits had a lower MGI (p = .037). No association was found between knowledge and behavior, most participants were familiar with the recommendations for maintaining oral health, yet they only performed some. CONCLUSIONS A dental selfie taken once a week using an mHealth app (iGAM) reduced the signs of gingivitis and promoted oral health. During the current pandemic where social distancing recommendations may be causing people to avoid dental clinics, this app can remotely promote gum health. CLINICALTRIAL The protocol was approved by Hadassah research ethics committee (IRB, 0212-18-HMO)

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Scanning Electron Microscopy Analysis of the Anterior Capsulotomy Edge: A Comparative Study between Femtosecond Laser-Assisted Capsulotomy and Manual Capsulorhexis

Journal of Ophthalmology ◽

10.1155/2018/8620150 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Daniele Tognetto ◽

Chiara De Giacinto ◽

Alberto Armando Perrotta ◽

Tommaso Candian ◽

Alessandro Bova ◽

...

Keyword(s):

Electron Microscopy ◽

Scanning Electron Microscopy ◽

Femtosecond Laser ◽

Comparative Study ◽

Surface Irregularity ◽

Significant Difference ◽

Group 2 ◽

Cut Surface ◽

Scanning Electron ◽

Group 1

Purpose. To compare the capsule edges ultrastructure obtained by two femtosecond laser-assisted cataract surgery (FLACS) platforms and manual continuous curvilinear capsulorhexis (CCC) using scanning electron microscopy (SEM). Setting. Eye Clinic, University of Trieste, Italy. Design. Experimental comparative study. Methods. 150 anterior capsules were collected and divided into three groups as follows: Group 1 (50 capsules) obtained with manual CCC, Groups 2 and 3 (each with 50 capsules) obtained with the Catalys Laser and the LenSx Laser, respectively. All samples were imaged by means of SEM and regularity of the cut surface, and thickness of the capsule edge were evaluated and compared. Results. All femtosecond laser (FSL) capsules were perfectly circular, whereas some alteration of the circular shape was observed in the manual ones. Group 1 showed a smooth and regular capsule edge without any surface irregularity, conversely Groups 2 and 3 showed postage-stamp perforations on the capsule edge. The cut surface irregularity value in Group 2 was 1.4 ± 0.63, while it was 0.7 ± 0.49 in Group 3 (p<0.05). Group 1 had a significantly lower thickness of the capsule edge than the FSL groups (p<0.05). No statistically significant difference in the capsule edge thickness between the FSL groups was found (p=0.244). Conclusions. Despite the presence of slight cut surface irregularities, both FSL capsulotomies showed a better geometry and circularity than the manual ones. Capsulotomy specimens obtained using both FSL capsulotomies showed laser-induced alterations of the capsule edge when compared with smooth and regular edges obtained using manual CCC.

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Isometric Handgrip Exercise Training Improves Spirometric Parameters and Pulmonary Capacity

Pathophysiology ◽

10.3390/pathophysiology28030022 ◽

2021 ◽

Vol 28 (3) ◽

pp. 328-338

Author(s):

Ogbutor Udoji Godsday ◽

Nwangwa Eze Kingsley ◽

Nwogueze Bartholomew Chukwuebuka ◽

Chukwuemeka Ephraim ◽

Ezunu Emmanuel ◽

...

Keyword(s):

Pulmonary Function ◽

Isometric Exercise ◽

Handgrip Exercise ◽

Isometric Handgrip ◽

Post Exercise ◽

Significant Difference ◽

Isometric Handgrip Exercise ◽

Group 3 ◽

Group 2 ◽

Group 1

Decline in normal physiological pulmonary function has been attributed to premorbid conditions such as prehypertension. Research evidence suggests that physical activity reduces age-related decline in pulmonary function and improves the efficiency of the lungs in prehypertensive patients. However, there is a scarcity of data evidence relating to isometric exercise and pulmonary function. Furthermore, the interrelationship between the intensity and duration of isometric exercise and pulmonary function in these patients is still uncertain. Therefore, this study was undertaken to investigate the effect of isometric handgrip exercise on pulmonary function capacity in adults with prehypertension. To determine the effectiveness of isometric handgrip exercise on pulmonary function capacity in adults with prehypertension. A quasi experiment using a pre- and post-exercise method was carried out in two out-patients hospital settings. The sample comprised 192 sedentary pre-hypertensive subjects, aged between 30–50 years, that were randomly distributed into three groups of 64 participants each. The subjects performed, for 24 consecutive days, an isometric handgrip exercise at 30% Maximum Voluntary Contraction (M.V.C.). At the end of the 24 days, group one (GP1) discontinued, while group two (GP2) continued the exercise protocol for another 24 consecutive days and group three (GP3) continued with the exercise protocol for another 24 consecutive days but at 50% M.V.C. Determinants of lung function (outcomes) were Forced Expiratory Volume in 1 s (FEV1), Forced Vital Capacity (FVC), FEV1/FVC Ratio and Peak Expiratory Flow Rate (PEFR). The study shows that there was no statistically significant difference in the pre- and post-exercise outcomes for FEV1, FVC, FEV1/FVC Ratio and PEFR after 24 days for group 1. In group 2, there was a statistically significant difference in the FVC [(mean = 0.12 ± 0.12), (p = 0.002)], FEV1 [(mean = 0.15 ± 0.17), (p = 0.003)] and PEF [(mean = 0.85 ± 0.35), (p = 0.001)] after 48 days. In group 3, there was a statistically significant difference (p = 0.001) in all the outcomes assessed after 48 days. There was a between groups difference in favour of group 2 compared with group 1 for outcomes of FEV1 [(mean = 0.142 ± 0.68), (p = 0.005)] and PEF [(mean = 0.83 ± 0.19), (p = 0.0031)]. There was statistically significant difference in favour of group 3 compared to group 2, by increasing the exercise intensity from 30% to 50% M.V.C., for outcomes of FVC [mean change = 0.10 ± 0.052), (p = 0.005)], FEV1/FVC [mean change = 3.18 ± 0.75), (p = 0.017)] and PEF [(mean change = 0.86 ± 0.35), (p = 0.001)] after 48 days. Isometric handgrip exercise (after 48 days at 30% to 50% M.V.C.) improves outcomes of pulmonary function capacity in adults with prehypertension. Meanwhile, duration and/or increase in intensity of the isometric effort significantly contributed to the affects attained.

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Hybrid cardiac rehabilitation program as a potential enhancer of adherence to cardiac rehabilitation in smoking patients with coronary heart disease - a retrospective single-centre analysis

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.347 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

M Cabral ◽

R Santos ◽

F Januario ◽

A Antunes ◽

R Fonseca-Pinto

Keyword(s):

Mental Health ◽

Cardiac Rehabilitation ◽

Smoking Status ◽

Rehabilitation Program ◽

Anxiety And Depression ◽

Cardiac Rehabilitation Program ◽

Phase 2 ◽

Significant Difference ◽

Group 2 ◽

Group 1

Abstract Funding Acknowledgements Type of funding sources: None. Cardiac rehabilitation (CR) has well known beneficial effects on physical capacity, health-related quality of life, morbidity and mortality following an acute cardiac event. It is also known that smoking status is a powerful predictor of recurrent cardiovascular disease events. However, it has been noted that smoker patients may be less likely to access or complete CR. The aim of this study was to determine the levels of anxiety and depression and its improvement, depending on the smoking status of patients with coronary artery disease (CAD) on phase 2 of the Cardiac Rehabilitation Program (CRP). Additionally, we intend to investigate the mental health impact on smoker patients" group in conventional CR versus telemonitored CR. A retrospective study was conducted and patients in CRP between 2017 and 2020 were included. Patient selection and information collection were obtained through medical records. The outcomes of anxiety and depression were evaluated through the Hospital Anxiety and Depression Scale (HADS). Patients were divided into two groups: group 1 for non-smokers or ex-smokers and group 2 for smokers. For group 2 patients, a sub-analysis was performed for patients following the conventional CR versus the telemonitored CR, with the use of MOVIDA mobile application. Variables were analysed in the beginning (T0) and in the end (T1) of phase 2, around 3 months after. Group comparisons tests and statistical analysis were performed using SPSS software v25.0. A p-value less than 0.05 is statistically significant. We analysed 107 patients, which 93 of these were assiduous and 69 concluded the phase 2 of CRP: 39 patients in group 1 and 30 patients in group 2. Two groups have similar baseline characteristics, except for the higher presence of diabetes (p = 0.02) in group 1. It was noted an improvement in both anxiety and depression items for group 1 (p < 0.01 for both), but only for anxiety item for group 2 (p = 0.03). In subgroup analysis, we observed no improvement for smoking patients following the conventional CR for both anxiety and depression items (p = 0.60 and p = 0.71, respectably) versus a significant difference in telemonitored CR patients (p = 0.02 and p = 0.04). We hypothesise that, when compared to conventional CR, cardiac telemonitored exercise using modern communication methods may result in an improved mental health state among smoking patients, which can lead to a better adherence for CRP. Further studies including more patients and phase 3 of CRP are needed to confirm these results.

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