Role of annular pentameric molecule: C-Reactive protein in periodontal disease and its association with systemic health

Various acute phase reactants are produced in response to inflammatory stimuli, one of them is C-reactive protein which is. Serum levels of C-Reactive protein are useful to monitor and diagnose inflammatory process associated with disease as it being one of the valuable biomarkers in various clinical conditions, increase in level of C-Reactive protein is found in subjects with periodontal disease, which in turn can act as useful biomarker to diagnose cardiovascular disease, adverse pregnancy outcome as they being associated with periodontal disease. This manuscript is brief overview of C-Reactive protein and its relation with periodontal disease and systemic health.

Association of ABO blood group with COVID-19 severity, acute phase reactants and mortality

Introduction Coronavirus disease 2019 (COVID-19) is the ongoing pandemic with multitude of manifestations and association of ABO blood group in South-East Asian population needs to be explored. Methods It was a retrospective study of patients with COVID-19. Blood group A, B, O, and AB were identified in every participant, irrespective of their RH type and allotted groups 1, 2,3, and 4, respectively. Correlation between blood group and lab parameters was presented as histogram distributed among the four groups. Multivariate regression and logistic regression were used for inferential statistics. Results The cohort included 1067 patients: 521 (48.8%) participants had blood group O as the prevalent blood type. Overall, 10.6% COVID-19-related mortality was observed at our center. Mortality was 13.9% in blood group A, 9.5% in group B, 10% in group C, and 10.2% in AB blood group (p = 0.412). IL-6 was elevated in blood group A (median [IQR]: 23.6 [17.5,43.8]), Procalcitonin in blood group B (median [IQR]: 0.54 [0.3,0.7]), D-dimers and CRP in group AB (median [IQR]: 21.5 [9,34]; 24 [9,49], respectively). Regarding severity of COVID-19 disease, no statistical difference was seen between the blood groups. Alteration of the acute phase reactants was not positively associated with any specific blood type. Conclusion In conclusion, this investigation did not show significant association of blood groups with severity and of COVID-19 disease and COVID-19-associated mortality.

Role of Pentraxin-3 in Periodontal Inflammation - A Comprehensive Review

Acute phase reactants like C-reactive protein (CRP), and pentraxin 3 (PTX3) are increased with inflammation and tissue injury. PTX3 is an acute phase protein and a member of the long pentraxin family. CRP is synthesized in the liver but PTX3 is generated locally at the inflammatory site. It is a fluid-phase pattern-recognition molecule that regulates antimicrobial immunity and inflammation by interfering with selectin-dependent neutrophil recruitment and regulating the complement cascade. Hence, PTX3 could be used as a potential biomarker to identify inflammatory response in both acute and chronic diseases. In this review, we discuss the role of PTX3 in periodontal inflammation.

Trends of variation of the laboratory parameters during the course of COVID-19 Illness

Background: The coronavirus pandemic which had its origin in the Wuhan China has been spreading across the globe with far reaching complications and a variable clinical course. A variation of the laboratory parameters during the disease course remains a constant parameter to monitor the disease course and progression. Since the laboratory parameters are standardized globally, these may also act as uniform guidelines for the patients monitoring and treatment. Aims and Objectives: The aim of the study was to serial charting of the laboratory parameters in the recovered and expired patients of COVID-19 and to determine an associated prognostic significance. Materials and Methods: A retrospective observational study from the laboratory and medical records was conducted on the patients admitted from March 17, 2020, to May 31, 2020, at the tertiary care center dedicated to the treatment of RT-PCR confirmed COVID-19 positive patients. Results: The group of parameters showing a poor prognosis include a rising WBC count, high neutrophilic percentage, low lymphocyte percentage (<10) an NLR > 15, low lymphocyte monocyte ratio < 3, rising blood urea nitrogen, serum creatinine levels, and serum electrolyte levels. The liver function tests variation reflecting a poor metabolic activity of the liver, namely, a low serum albumin and albumin globulin ratio, rising SGOT levels, and total bilirubin levels. A highly significant variation in the acute phase reactants showing an exponential rise such as the serum lactate dehydrogenase levels, serum ferritin, fibrinogen, C-reactive protein, and IL 6 levels an increased level of D Dimer (>3) and a prolongation of the APTT. Conclusion: The variation of the laboratory parameters acts as a fair marker for the disease progression. Since the disease shows a variable progression with a sudden worsening of the clinical symptoms, a comprehensive monitoring of the laboratory parameters serves to diagnose and treat the disease progression.

Comparison of ankylosing spondylitis patients with and without fibromyalgia syndrome according to the disease activation scores and response to treatment

Objectives: The aim of this study was to investigate the association of fibromyalgia (FM) syndrome with ankylosing spondylitis (AS) and to compare the AS patients with and without FM according to the disease activity, clinical and laboratory findings, and response to treatment. Patients and methods: Between September 2016 and September 2020, a total of 511 patients (312 males, 119 females; mean age: 43.0±11.2 years; range, 18 to 77 years) who were diagnosed with AS were retrospectively analyzed. Age, sex, disease duration, disease onset age, and extra-articular findings were recorded. Medical treatments used by the patients for the treatment of AS and FM were noted. The erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), human leukocyte antigen-B27 (HLA-B27) status, and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score (ASDAS) with ESR (ASDAS-ESR) and ASDAS-CRP values were recorded. Results: The frequency of FM in AS patients was 23.2%. Totally, 75.4% of the FM patients were female. The HLA-B27 positivity, extra-articular involvement frequency, disease duration, and acute phase reactants levels were similar between AS patients with and without FM (p=0.118, p=0.154, p=0.829, p=0.113, and p=0.763, respectively). The AS patients with FM had lower rates of achieving remission or low disease activity, compared to those without FM. The mean of all three disease activity scores between these two groups was also higher in the AS patients with FM (p<0.001). The rate of use of biological therapy was significantly higher in the AS patients with FM than those without FM (p=0.037). Conclusion: Since the treatment plan of AS is made based on the disease activity scores, unnecessary biological therapy may be initiated for patients or the biological therapies they use may be switched unnecessarily. Therefore, it should be kept in mind that FM may present with AS in patients who do not respond to treatment clinically, and this may be misinterpreted as treatment unresponsiveness.

Role of Biomarkers in the Stratification of COVID-19 Disease Severity – A Review

Background: There have been a wide variety of clinical publications on coronavirus disease 19 (COVID-19) focused on specific biomarkers. Acute-phase reactants, such as C-reactive protein (CRP), ferritin, serum amyloid A (SAA), and procalcitonin, have been identified as sensitive markers of acute COVID-19 illness, even though they are nonspecific markers. Objective: The purpose of this study is to summarize the role of several biomarkers in the stratification of COVID-19 disease severity. Methods: This study followed systematic literature review method. The systematic review followed the review process as it was well developed and planned to reduce biases and eliminate irrelevant and low-quality studies. The steps for implementing a systematic review include correctly formulating the COVID-19 question to answer, developing a protocol based on inclusion and exclusion criteria, performing a detailed and broad literature search and screening the abstracts of the studies identified in the search and subsequently of the selected complete texts. After selecting the study, the next steps were synthesis of the evidence like extract the necessary data into a form designed in the protocol to summarise the included studies, assess the biases of each study, identifying the quality of the available evidence, and develop tables and text that synthesise the evidence. The secondary sources of data for this study included different published topics from national & international journals. Good number of Journal articles was taken regarding “Role of Biomarkers in the Stratification of COVID-19”. Published articles were collected from renowned indexing data source like PubMed, Medline, and Scopus. Etc. Conclusion: Significantly increased white blood cell count, lymphopenia, decreased CD3, CD4, or CD8 T-lymphocyte counts, high neutrophil count, thrombocytopenia, and dramatically elevated inflammatory biomarkers were all linked to severe disease and the probability of developing sepsis as the disease progressed. Progressive decreases with lymphopenia, thrombocytopenia, elevated CRP, procalcitonin, increased liver enzymes, impaired renal function, and coagulation derangements were more common in critically sick patients and were linked to a higher rate of clinical sequelae. In seriously and critically ill patients, elevated interleukin levels and significantly increased SAA were most frequently reported. The neutrophil to lymphocyte ratio, the systemic immune inflammation index, and the COVID-19 Severity Score are all indicators of systemic inflammation that can be used to predict disease severity, outcome, and death.

Endocan: A Novel Marker for Colchicine Resistance in Familial Mediterranean Fever Patients?

Introduction: Familial Mediterranean fever (FMF) patients had 5–10% colchicine resistance. Although FMF attacks are characterized by acute phase elevation, there are no biomarkers that can show colchicine resistance yet. The serum endocan levels may elevate in inflammatory and auto-inflammatory diseases.Objectives: This study aimed to evaluate serum endocan levels in FMF patients according to whether attack and colchicine resistance or not and also compare them with classical acute phase reactants.Methods: In this single-center and cross-sectional study, a total of 111 FMF patients and 60 healthy individuals were enrolled. All patients' basic demographic and clinical data were recorded and blood samples were collected.Results: A total of 46 (41.4%) FMF patients had colchicine resistance. In comparison to the FMF patients according to colchicine response, colchicine resistance patients had a significantly higher median (IQR) endocan levels than colchicine responsive patients [36.98 ng/ml (97.41) vs. 13.57 ng/ml (27.87), p = 0.007], but there were no differences between in terms of median ESR and CRP levels. Inversely, serum endocan levels were similar during an attack and attack-free period in FMF patients, although ESR and CRP levels were significantly different. Interestingly, the highest serum endocan levels were in the control group.Conclusion: In conclusion, serum endocan levels were higher in colchicine resistance than colchicine responsive patients, but attack state had no effect on serum endocan levels in our study. Unlike ESR and CRP, serum endocan may be a novel biomarker for detection of colchicine resistance and distinguish the FMF attacks.

Objective Evaluation of Efficacy of Decortication in Chronic Pleural Empyema in Adult Patients

Background: Chronic pleural empyema (CPE) is the last phase of the triphasic process of pleural empyema development. Lung decortication is the corner stone in management of chronic empyema. This study aimed to objectively evaluate the efficacy of conventional decortication operation in chronic pleural empyema in adult patients. Also to prove that decortication of variable sizes of chronic empyema thoracis lesions is followed by improvement considering respiratory impairment. Methods: This prospective clinical study was conducted on 103 patients undergoing elective lung decortication operation for management of chronic empyema. All patients were subjected to the history taking, general examination, chest examination, computed tomography (CT), pulmonary function test and arterial blood gases. Postoperative evaluation was done in outpatient clinic 6 months post operatively including: Full clinical examination, investigations (acute phase reactants, CT chest, PFT and arterial blood gases. Results: Total leucocytic count, ESR 1st hour, ESR 2nd hour and CRP were significantly decreased in post than pre. FEV1 and FVC were significantly increased in post than pre (P <0.001). FEV1 / FVC Ratio was significantly decreased in post than pre (P <0.001). Transverse and antero-posterior diameters of affected hemithorax were significantly increased in post than pre (P <0.001, 0.019 respectively). Transverse and antero-posterior diameters of normal hemithorax were insignificantly different between post and pre. PaO2 and SpO2 were significantly increased in post than pre (P <0.001). PaCO2 was significantly decreased in post than pre (P <0.001). Conclusions: The improvement in the lung function, arterial blood gases, transverse and antero-posterior diameter of affected and normal hemithorax was proposed to have resulted from the decortication in chronic empyema thoracis. Decortication of variable sizes of chronic pleural empyema lesions is followed by objective improvement considering respiratory impairment.

Loneliness: An Immunometabolic Syndrome

Loneliness has been defined as an agonizing encounter, experienced when the need for human intimacy is not met adequately, or when a person’s social network does not match their preference, either in number or attributes. This definition helps us realize that the cause of loneliness is not merely being alone, but rather not being in the company we desire. With loneliness being introduced as a measurable, distinct psychological experience, it has been found to be associated with poor health behaviors, heightened stress response, and inadequate physiological repairing activity. With these three major pathways of pathogenesis, loneliness can do much harm; as it impacts both immune and metabolic regulation, altering the levels of inflammatory cytokines, growth factors, acute-phase reactants, chemokines, immunoglobulins, antibody response against viruses and vaccines, and immune cell activity; and affecting stress circuitry, glycemic control, lipid metabolism, body composition, metabolic syndrome, cardiovascular function, cognitive function and mental health, respectively. Taken together, there are too many immunologic and metabolic manifestations associated with the construct of loneliness, and with previous literature showcasing loneliness as a distinct psychological experience and a health determinant, we propose that loneliness, in and of itself, is not just a psychosocial phenomenon. It is also an all-encompassing complex of systemic alterations that occur with it, expanding it into a syndrome of events, linked through a shared network of immunometabolic pathology. This review aims to portray a detailed picture of loneliness as an “immunometabolic syndrome”, with its multifaceted pathology.

P080 Acroosteolysis: a rare complication or a co-occurrence with Juvenile Idiopathic Arthritis?

Background Acroosteolysis refers to a destructive process involving the distal phalanges of the fingers and toes that may extend to metacarpals or metatarsals. Rarely idiopathic, the diagnosis of primary acroosteolysis requires ruling out other causes. Juvenile idiopathic arthritis is an exceptional aetiology of acroosteolysis occurring mainly in psoriatic arthritis. Here by a case of juvenile idiopathic arthritis associated with acroosteolysis of the toes. Methods A 13-year-old girl with no past medical history, presented to our department of rheumatology with oligoarthritis affecting both wrists and knees. She had no familiar history of psoriasis nor rheumatic diseases. She described a dull ache and recurring swelling of knees evolving for &gt;6 years associated with a macular rash of the chest without fever. On examination, the knees were swollen with a limited range of motion of &lt; 90°. Examination of the spine and sacroiliac joints was unremarkable. There was no deformity, no dysmorphic syndrome nor ligamentous hyper laxity. The mucocutaneous examination was normal. Similarly, there was no hepatosplenomegaly or swollen lymph nodes. Laboratory investigations showed high acute phase reactants and normal blood count. Rheumatoid factor, anti-cyclic citrullinated peptide antibodies and antinuclear antibodies were also negative. Besides, she was negative for HLAB-27. Ophthalmic examination did not show any sequelae of uveitis. Results Plain radiograph of the feet revealed bone resorption of the second and fifth distal phalanges without signs of reconstruction. Other secondary causes of acroosteolysis were ruled out. The diagnosis of oligoarticular juvenile idiopathic arthritis was made. In view of the involvement of the distal phalanges, the phenotype of psoriatic arthritis was probable. The patient was initially treated with non-steroidal anti-inflammatory drugs as well as intraarticular injections of corticosteroids in knees. As the flares persisted, she was put on Methotrexate at a dosage of 15 mg per week with marked clinical improvement. Conclusion Our case illustrates a possible occurrence of acroosteolysis of the feet in the field of an active juvenile idiopathic arthritis. It is important to rule out other causes and make a rapid diagnosis in order to ensure appropriate management decisions.