European Journal of Molecular & Clinical Medicine

The purpose of this study is to evaluate the level of CRP in the serum as a potential biomarker of the disease activity in pulmonary TB.
Materials & Methods: In this particular research, there were a total of fifty cases of pulmonary TB, split evenly between males and females. After receiving their signed agreement, everyone was enrolled in the study. Cases that had extrapulmonary TB or secondary tuberculosis were not included in the study because they did not meet the exclusion criteria. Information such as age, gender, and other demographics was recorded. 2 ml blood was withdrawn from the patient and was sent was quantitative analysis to assess the CRP level.
Results: There were 52% newly detected cases of pulmonary TB, 22% undergoing anti-tubercular treatment, 14% cured cases, 8% treatment defaulters and 4% treatment resistant. The difference was significant (P< 0.05). The mean CRP level (mg/dl) in the newly detected TB patients was found to be 53.55±6.11. Those undergoing anti-tubercular treatment had a mean CRP value of 43.69±4.85. CRP in patients who had completed their treatment was 4.63±1.33. Defaulters had a mean CRP of 66.74±5.28 and the treatment resistant had a mean CRP of 86.11±4.98. The difference was significant (P< 0.05).
Conclusion: The authors discovered that CRP levels were elevated in TB, but that these levels dropped and returned to normal by the time therapy was complete

Aim: The aim of the present study was to assess levels of High Sensitivity C-reactive Protein in patients with Acute Ischemic and Hemorrhagic Stroke.
Methods: The present descriptive Prospective Observational Study was conducted on 100 CT/ MRI confirmed cases of Stroke admitted in Medicine Dr. DY Patil Medical College Hospital and Research Centre, Pimpri, Pune during the period from October 2020 to September 2022.
Results: The Mean Age group of study participants was 61.74±11.28 with 5% in 18-40 years, 6% in 41-50, 31% in 51-40, 41% in 61-70, 15% in 71-80 and 2%  were above 80. There were 32% were females and 68% males. In our study 33 patients had right side hemiparesis and 6 patients on right side had hemiplegia, 47 patients had left side hemiparesis, 12 patients had hemiplegia 2 had monoparesis. There were 10% cases had cranial nerve involvement in our study. In Hemorrhagic Pattern of Stroke there were 92% hypertensives and in Non-Hemorrhagic Ischemic type 77%. There are 84.6% of diabetics in hemorrhagic subjects and 67.5% in ischemic subjects. The data showed 22% patients had Hs-CRP levels <10 and 78% had CRP levels >10.
Conclusion: Our Study showed that HS-CRP are elevated and can be considered as independent risk factors of Stroke.

Aim: The aim of the present study was to assess haematological and inflammatory parameters in sepsis patients.
Methods: The study was conducted at Medical intensive care unit at Dr. DY Patil medical college and hospital, DY Patil Vidyapeeth, Pimpri, Pune from October 2020 – September 2022 and 100 cases were included in the present study. Approval was taken from institutional ethics committee before commencing the study. Informed and written consent was taken from all the patients.
Results: Among the study population, 68.00% of them were male, 32.00% of them were female. On study population, 44.00% of them diagnosed with DIC. On study population, 61.00% of them were Survivors, 39.00% of them were non-survivors. The mean platelet on admission was 117624 ± 89241.13, it was 105860 ± 85661.89 at 24 hours, it was 98990 ± 83391.29 at 48 hours. The mean D Dimer at Admission was 4073.37 ± 4361.13, it was 3956.39 ± 2432.91 at 24 hours, it was 5284.33 ± 8445.54 at 48 hours. The mean Fibrinogen at Admission was 2.07 ± 0.85, it was 1.76 ± 0.86 at 24 hours, it was 1.47 ± 0.95 at 48 hours.  Among the study population, the mean ESR was 86.75 ± 97.97, the mean CRP was 73.7 ± 72.45, the mean Lactate was 28.95 ± 25.06, the mean Pro Calcitonin was 6.62 ± 3.4.
Conclusion: In uncontrolled cases of sepsis, acute organ dysfunction and shock may develop. Because of this rapid progression, it is of utmost importance that patients should be diagnosed and treated in a requisite time frame. The current literature and changing guidelines demonstrate that the bedside physical examination along with laboratory testing (haematologic and inflammatory biomarkers) are the most effective combination of parameters that clinicians can rely upon to accurately predict or diagnose sepsis in a critically ill patient.

The COVID-19 pandemic has unfolded as one of the world’s worst health crisis. Viral RT-PCR, CRP, and CT scan thorax are the most common tools used for its diagnosis, prognosis and severity assessment. Hence, a parallel between these parameters can aid in better understanding and management of COVID-19 infection.
Methodology: Demographic data, history, cycle threshold values of RT-PCR from nasopharyngeal and oropharyngeal swabs, CRP and computed tomography score were obtained from 108 adult participants. Statistical analysis was performed using python programming (python 3.7) and inbuilt libraries.
Results: Mean age of the study group was 51.05 years. 63.89% were males. The mean CT score was 15.417 indicating severe disease. Men had a higher CRP. Cycle threshold value of N gene was directly proportional to CT score. Lower cycle threshold values were associated with higher CRP. Of the 37 deaths, 62.16% were males. Cycle threshold in non-survivors was significantly higher than survivors indicating lower nasopharyngeal viral load in non-survivors. Diabetes was the most common comorbidity associated with mortality.
Conclusion: Nasopharyngeal load can be low even with severe radiological CT findings probably due to migration of the virus to lower respiratory tract in later stages of the disease. Low nasopharyngeal viral loads cannot negate the possibility of a severe pulmonary infection. CRP values may not always correlate with CT findings in recovering stages of disease. Comorbidities adversely affect the disease outcome. These parameters should be used in conjunction to assess and veer the progression, management and outcome of patients with COVID-19 infection.

Introduction: Fever is the most frequent reason for hospital visit by the children. Paediatricians need markers, especially which increases early, to identify children at risk of severe bacterial infection. CRP and Interleukin-6 are such markers. Interleukin-6 is reported to rise earlier than CRP in children with fever.
Objective: To study the level and correlation of Interleukin-6 and C-reactive protein in children presenting with febrile illness
Study Design: Cross Sectional and descriptive study.
Methods: 45 children with history of fever within last 72 hours were enrolled. Immuno-compromised patient were excluded from the study. Serum levels of CRP and IL-6 were analyzed along with haematological parameters. Microsoft SPSS version 20 was used for data analysis. P- value less than 0.05 was considered as significant.
Results: Mean CRP value was 4.2±0.9mg/dl. Mean interleukin-6 was 60.5±10.9pg/ml. Interleukin-6 was found to be positively correlated with CRP (r=0.644). This correlation was found to be statistically significant.

From the beginning of time, tuberculosis (TB) has been one of the most significant contributors to poor health, and now it is one of the most common infectious agent that results in mortality. While it most often affects the lungs, it may also manifest in other locations. Around 45 percent of the world's TB burden may be attributed to the Indian subcontinent. Around fifteen percent of all cases of tuberculosis are classified as extrapulmonary tuberculosis (EPTB).
Aims and objective: To study the clinical diagnosis of abdominal tuberculosis
Materials and methods: It was determined that abdominal TB affected 50 individuals. Each patient had a full battery of diagnostic procedures, including an in-depth interview and physical examination, blood work (including a complete blood count and erythrocyte sedimentation rate [ESR]), regular biochemical testing, a skin test [Mantoux], a chest X-ray, and an (USG).
Results: There were 50 patients with abdominal TB (mean age 35.25±3.69 years; 20 females, 30 men). It showed that abdominal discomfort and weight loss were the most common of them. Anemia was found in 35 patients, which is 70% of the total, an increased ESR was found in 33 patients, which is 66% of the total, and hypoalbuminaemia was found in 25 patients, which is 50% of the total. Additional results included leucocytosis in three individuals (representing 6%), a positive CRP in nine patients (representing 18%), and increased transaminases in eleven patients (representing 22%). Four of these 12 patients were chronic HBV carriers, two of them had immunity to HBV, and two of them tested positive for anti-HCV antibodies. Seven individuals, or 14%, had completely normal results on all of their laboratory testing. Ten (or twenty percent) of the patients had positive results from the Mantoux skin test. Ascites was present in 21(42%) of the cases. The ascitic fluid analysis that was done on those individuals revealed that it had an exudative nature. Moreover, acid-fast bacilli were discovered in the smear of just one patient, and BacTec was only used to culture the ascitic fluid of one patient (4%).
Conclusion: When it comes to the diagnosis of abdominal tuberculosis, neither the clinical symptoms, laboratory, radiographic, and endoscopic procedures, nor the bacteriological and histological results give a gold standard by themselves.
Ascites, abdominal tuberculosis, CRP

Obesity comorbidities include coronary heart disease, hypertension and stroke, certain types of cancer, non-insulin-dependent diabetes mellitus, gallbladder disease, dyslipidaemia, osteoarthritis and gout, and pulmonary diseases, including sleep apnoea. The present study was conducted to assess hs-CRP in centrally obese patients.
Materials & Methods: 145 subjects of both genders were subjected to assessment of blood pressure, body weight, height and body mass index (BMI). Measurement of hs-CRP was performed.
Results: Out of 145 patients, males were 80 and females were 65. The mean height in males was 5.8 feet and in females was 5.4 feet, weight was 78.2 kgs and in females was 67.5 kgs. The mean BMI was 25.4 Kg/m² in males and 23.6 Kg/m² in females. The difference was significant (P< 0.05). The mean CRP level in normal subjects was 3.4 mg/dl, in overweight was 6.5 mg/dl, in class I obese was 8.2 mg/dl, in class II obese was 12.1 mg/dl and in class III obese was 14.3 mg/dl. The difference was significant (P< 0.05).
Conclusion: hs-CRP in centrally obese patients was significantly high as compared to normal subjects.

“Acute pancreatitis (AP) is defined as a sudden onset pancreatic inflammatory process” and is associated with complications such as Multi organ dysfunction syndrome leading to increased hospitalizations and mortality rates.
Aim: This study aims at studying the role of CRP done at admission and at 24 hours as a simple and effective prognostic predictor of Severe Acute Pancreatitis and as an alternative to the complex scoring systems available.
Methods: A hospital based observational study was conducted during October 2020 to September 2022 among 50 AP participants aged between 18- 65 years diagnosed using standard criteria. The study will help to translate the significance of CRP done at admission and at 24 hours as a prognostic predictor after comparisons within two clinical grades of AP - Mild Acute pancreatitis-(MAP) and Severe Acute pancreatitis (SAP).
Results: The mean difference of CRP done on admission and at 24hrs between Mild vs Severe Acute Pancreatitis was statistically significant with a P VALUE <0.05. Upon comparing the AUC for both CRP done on admission and CRP at 24 hours, CRP at 24 hours is found to be not of greater significance in predicting the outcomes of disease and is not a better prognostic marker than CRP done on admission.
Conclusion: In our study, both CRP at admission and CRP at 24 hours were statistically significant in predicting the severity of Acute pancreatitis but the CRP levels done at 24 hours were not found to be superior to CRP done on admission to assess disease severity

Aim and objectives: The present study assessed the correlation between rising levels of CRP and D-dimer with morbidity and mortality in adult Covid -19 patients.
Materials and method: This retrospective observational study was conducted at Max Super speciality Hospital I.P. Extension, Delhi a tertiary care centre in North India. CRP and D-Dimer values were collected at the time of admission and within 15 days after admission. The statistical analysis was done by independent t-test.
Results: The study population consisted of 194 (64.7%) males and 106 (35.3%) females. The mean age of the study population was 56.78±15.42 (28-94) years. The mean age of the non-survivors (58.83±15.64 years) was significantly more than survivors (54.43±14.85 years). The mean CRP and D-DIMER at the time of admission and within 15 days after admission was significantly more among non-survivors compared to survivors.
Conclusion: A high CRP and elevated D-Dimer levels among COVID-19 patients predict higher odds of mortality; however, large scale and longer-term studies are needed to validate our findings. The predictive model based upon CRP and D-DIMER levels can help the clinicians to improve individual treatment, make timely clinical decisions, and make optimal use of limited clinical resources.

Background and Objective
Coronaviruses are a family of viruses that can cause respiratory illness in humans. They are called “corona” because of crown-like spikes on the surface of the virus. Severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS) and the common cold are examples of coronaviruses that cause illness in humans.
The primary mode of transmission of SARS-CoV-2 is via exposure to respiratory droplets carrying the infectious virus from close contact or droplet transmission from pre-symptomatic, asymptomatic, or symptomatic individuals harbouring the virus
This study is conducted to analyse the extent of association between COVID-19 & Diabetes Mellitus and its correlation with the inflammatory markers as it is still unclear if diabetes interferes in the prognosis of COVID-19
Material & Methods
A Cross-sectional study was conducted over a period of 6 months from April 2021–September 2021.Among 149 RT-PCR positive COVID-19 patients the random blood sugar levels, CT chest severity score & C-Reactive Protein was compared among the diabetic & non-diabetic population in ACS Medical college & hospital Chennai.
Results
The study shows that out of 149 COVID-19 positive patients, 88 (59.1%) were diabetic & 61 (40.9%) were non-diabetic. Patients with diabetes had significantly higher CT chest severity score and elevated C-reactive protein than non-diabetic patients.
Conclusion
The interaction between covid-19 & diabetes could be bi-directional, with SARS-CoV-2 potentially worsening pre-existing diabetes.

Aim: The purpose of this research is to assess the function of CRP as a biomarker in COPD acute exacerbation.
Methods: The Department of Respiratory Medicineconducted this cross-sectional research. After washing their mouths twice with plain water, all patients were advised to collect deep coughed up phlegm into a sterile wide mouth container with a screw cover. The samples were promptly sent to the microbiology laboratory and processed within 30 minutes of being collected. Gram staining was performed on a sputum sample and results were reported using Bartlett's grading method. A appropriate sample was defined as one with a score of 1 or above. Mac Conkey's agar, chocolate agar, and blood agar plates were inoculated with appropriate sputum samples. Standard microbiological procedures established by the American Society for Microbiology were used to identify the isolated organisms. Sputum samples cultured for pathogenic bacteria were classed as Bacterial exacerbations, whereas samples with no pathogenic bacteria or oral commensals were classified as Non bacterial exacerbations.
Results: Among the 100 patients, 65 had bacterial growth on culture and were classed as Bacterial COPD exacerbation. The other 35 instances in which no bacterial growth or oral commensals were found were classed as Non Bacterial COPD exacerbation. Using the crude odds ratio, it was determined that the chances of Bacterial Exacerbation for patients with COPD "≥5 years" are 2.87 (95 percent CI: [1.26,6.88]) times greater than persons with COPD "<5 years." Furthermore, smokers had a 3.77(95 percent CI[1.50,10.28]) greater risk of bacterial exacerbation than nonsmokers. In our investigation, the optimal CRP cut-off point for separating Bacterial COPD patients with Bacterial Exacerbation from those without Bacterial Exacerbation was 8.77 mg/L (sensitivity:97%; specificity:40%; PPV:75%; NPV:87%, AUC:0.77).
Conclusion: Higher CRP levels are related with individuals experiencing Bacterial COPD exacerbations rather than Non Bacterial COPD exacerbations. CRP levels might therefore be utilised to anticipate Bacterial exacerbations and also to recommend antibiotic treatment.

Background:The aim of this study is to analyse the role of c- reactive protein and neutrophil lymphocyte ratio accuracy in diagnosis of acute appendicitis and perforated appendicitis.
Materials and Methods: The present study is ROLE OF C-REACTIVE PROTEIN AND NEUTROPHIL LYMPHOCYTE RATIO IN PREDICTING SEVERITY OF ACUTE APPENDICITIS done at Kamineni Institute of Medical Sciences, Narketpally from October 2018 to September 2020.
Results: 100 cases of acute appendicitis which were admitted in kamineni institute of medical sciences were studied. The statistical data and analysis of the cases studied during this period are presented in this study out of 100 cases 14 were managed conservatively and 86 were subjected to surgery, 4 had no inflammatory changes on histopathology and 82 had histopathological features confirming acute appendicitis. Acute appendicitis more common in males than females with a ratio of 2.22:1 with complications also being more common in males. Incidence of acute appendicitis was highest in age group ranging from 20-30 years , with complicated appendicitis being more common in the age distribution of 35.87 +/-18.31 years. Most patients present with pain predominantly in right iliac fossa (100%) followed by nausea/vomiting in 82% and fever in 78% cases. Total leucocyte count was found to be elevated in 86% of individuals with elevations in range of 15825+/-4575 in patients with complicated appendicitis. Neutrophil lymphocyte ratio was found to be elevated in 86% of individuals with elevation in range of 10.6+/-5.49 in patients with complicated appendicitis. CRP values were found to be elevated in 68% of cases. In patients with uncomplicated appendicitis 52% showed elevation of CRP levels whereas in patients with complicated appendicitis 87% showed elevation of CRP levels.
Conclusion: CRP and neutrophil lymphocyte ratio were found to be elevated in cases of acute appendicitis with complications. Elevation in neutrophil lymphocyte ration and c - reactive protein levels can be used to anticipate severity and complications in patients of acute appendicitis.

Background: Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection inside ICU. The aim of the present study was to assess the Relation between levels of procalcitonin and C-reactive protein as markers with severity of sepsis and septic shock.
Patients and methods: This observational study was involved 60 patients who diagnosed with sepsis or septic shock and admitted to Surgical intensive care unit, Zagazig University Hospitals, Egypt. Procalcitonin and C-reactive protein levels were estimated in the 1^st, 3^rd, and 5^th ICU day. APACHE II as well as SOFA Scores were estimated on ICU admission.
Results: Patients were classified according to the need for mechanical ventilation (MV group and non-MV group), CRP showed no significant difference between the two groups on the first day (100.51 and 83.21 mg/dl respectively- p=0.108). The remaining readings showed a significant rise in the patients that needed invasive mechanical ventilation. Serum PCT levels showed a significant rise in the MV group throughout the all study readings (p < 0.001). Likewise, SOFA score recordings were significantly higher in the MV patients (p < 0.001). On assessment of the predictors for vasopressor need, the highest sensitivity was reported for 3rd day CRP (84.1% - cut off = 62.01 mg/dl), and 5^th  day PCT (84.1% - cutoff = 0.505 ng/ml). Slight decrease in sensitivity (81.8%) was reported with the application of 1st day PCT and 3rd day SOFA.
Conclusion: PCT and CRP can be used as a  prognostic markers for evaluating the prognosis of patients with sepsis and septic shock.regarding need for vasopressors the highest sensitivity was reported for 3^rd day CRP and fifth day PCT, however the length of stay was found to be highly correlated with 3^rd day PCT, also 1^st day PCT value was better to Predict need for Mechanical ventilation.

Background: The ongoing worldwide Coronavirus Disease 2019 (COVID-19) pandemic has posed a huge threat to global public health¹. COVID-19 represents a spectrum of clinical severity ranged from asymptomatic to critical pneumonia, acute respiratory distress syndrome (ARDS) and even death. Therefore, full monitoring the severity of COVID-19 and effective early intervention are the fundamental measures for reducing mortality.
Accumulating evidence has suggested that inflammatory responses play a critical role in the progression of COVID-19 ³. Inflammatory responses induce the release of cytokines and chemokines. These cytokines and chemokines then attract immune cells and activate immune responses, leading to cytokine storms and aggravations⁴. Several inflammatory markers have some tracing and detecting accuracy for disease severity and fatality. But the results are inconclusive, with various studies giving different results. Our study intends to correlate levels of inflammatory markers with severity of Covid 19 infection and its final outcome.
Methods and materials:This is a retrospective study which includes 818 patients admitted to our hospital during the second wave of Covid 19 pandemic with confirmed Covid 19 infections by RTPCR. Admitted patients included mild disease to severe Covid 19 infections. Those patients who have received standardized treatment according to hospital protocol were included in the study. Data was collected and entered in pre-designed proforma. Results obtained will be compiled in excel sheet and will be analyzed statistically.
Results: Total of 818 patients were admitted to our hospital between May to July 2021. Of which 341 had mild disease, 241 had moderate disease, 237 patients had severe disease on presentation.While looking into the final outcome of the disease, 175 patients died due Covid 19 pneumonia or its complication, 52 patients were discharged with oxygen support.  Of 237 patients with severe disease 150 patients had CRP levels >75mg/dl. Of 175 patients who died, 121 had CRP levels >75 mg/dl. Of 237 patients with severe disease, 122 of them had D-dimer >1000 ng/ml. Of 175 patients who died with Covid 19, 103 of them had d-dimer levels >1000 ng/ml.CRP and D-dimer were significantly increased in patients with severe disease and in patients who died of Covid 19 with p value <0.0001.
Conclusion: Increasing levels of CRP and D-dimer were good predictors of severe disease in Covid 19. Also, increased levels of CRP and d-dimer were suggestive of poorer outcome of the disease in terms of mortality and morbidity in Covid 19 infection.

This study was conducted in Kirkuk city for the period from December, 2019 to June 2020, and included 50 children with acute appendicitisand 50 children without any other disease, where the ages of children in both groups ranged from 3-12 years. The study included collecting information from children in both groups, including gender, age, living situation, number of family members, standard of living and social as well as the number of family members, number of rooms in the house. Amount of 5 ml of blood samples were collected from all the children included in this study, where the blood samples were separated by the centrifuge device and the serum samples were separated from them and kept in the refrigerator until the tests for determination of calprotectin and lactoferrin by ELISA and CRP by immunofluorescence. In this study, there were no significant difference between the 2 groups regarding age, sex and residence. The study found that, 95% of children with appendicitis was suffered from abdominal pain , 50% with fever and weight loss, 48% with nausea and 40% with vomiting. The study revealed a significant elevated level of calprotectin in children with appendicitis as compared with healthy children(18.54±4.25 vs 11.37±3.28 ng/ml) (P<0.001). The study also exposed a significant higher level of lactoferrin in children with appendicitis as compared with healthy children(10.51±1.52 vs 2.18±0.19 ng/ml) (P<0.001).The study showed that the maximum means of calprotectin and lactoferrin in children with appendicitis were observed in those with abdominal pain, followed by vomiting. The study revealed a significant positive correlation between calprotectin and lactoferrinlevel among children with acute appendicitis.The mean serum level of CRP was significantly elevated in children with acute appendicitiscompared to control group (27.57 ± 4.22 and 5.57 ± 3.9 mg/dl) respectively at a P value < 0.001. Conclusions:The study showed a significant relation of calprotectin and lactoferrin withappendicitis.

Background: Plasma C-Reactive Protein (CRP) is an acute-phase protein whose serum level increases in response to inflammation, as happens in impacted ureteric calculus. Few studies have investigated the efficacy of silodosin, a selective alpha 1-A adrenoceptor antagonist, in medical expulsive therapy (MET) for distal ureteral calculi. The studies showed the efficacy of silodosin 8 mg/day as a potential treatment for distal ureteric calculus expulsion. In this study wedetermined the correlation of CRP Levels at the starting of MET and the success of METwith SILODOSIN after 3 weeks. Materials and Methods: 70 patients with distal ureteric calculus between 5-9 mm size were included in this study. They were divided into 2 groups based on the initial CRP level at the time of first presentation to the hospital.CRP level of 6mg/L was taken as cut-off. Group 1 with 35 patients having CRP value morethan 6and Group 2 with 35 patients having CRP value of less than 6.