scholarly journals Ropivacaine: An Unusual Cause of Neuroleptic Malignant-Like Syndrome

2021 ◽  
Author(s):  
Miguel Santos ◽  
Sheila Arroja ◽  
Ana Luisa Antunes ◽  
Jose Mariz ◽  
Jorge Teixeira
Keyword(s):  
Creatine Phosphokinase ◽  
Blood Analysis ◽  
C Reactive Protein ◽  
Drug Infusion ◽  
Central Nervous System Toxicity ◽  
Reactive Protein ◽  
Presenting Symptoms ◽  
Post Operative Pain ◽  
Intrathecal Space ◽  
System Toxicity

Ropivacaine is commonly used for post-operative pain management. We describe a case of neuroleptic malignant-like syndrome in a woman administered ropivacaine delivered using a drug infusion balloon. The presenting symptoms were confusion, agitation and fever. Blood analysis showed elevated C-reactive protein, leucocytosis and increased creatine phosphokinase. As intoxication was suspected, ropivacaine was suspended and the patient gradually improved. Possible leakage of ropivacaine into the intrathecal space may have resulted in central nervous system toxicity.

scholarly journals Platelet agonist synergism by the acute phase reactant C-reactive protein

Blood ◽  
1985 ◽  
Vol 65 (2) ◽  
pp. 264-269
Author(s):  
BA Fiedel
Keyword(s):  
Acute Phase ◽  
Creatine Phosphokinase ◽  
Platelet Rich Plasma ◽  
Adenosine Diphosphate ◽  
Creatine Phosphate ◽  
Acute Phase Reactant ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Phase Reactant ◽  
Irreversible Aggregation

C-reactive protein is the prototypic acute phase reactant. A self- complexed form (H-CRP) can induce isolated platelets to undergo aggregation, secretion of dense and alpha-granule constituents, and generation of thromboxane A2, but fails to function in platelet-rich plasma (PRP) as a direct agonist. In contrast, when PRP was activated with an amount of adenosine diphosphate (ADP) that produced only reversible platelet aggregation, the presence of H-CRP resulted in irreversible aggregation and the secretion of adenosine triphosphate (ATP). Following a maximum stimulus with ADP alone, where platelet secretion occurred late during the aggregation response, the presence of H-CRP shifted and increased the secretory burst to a time simultaneous with the onset of aggregation. This hypersecretion required H-CRP to be present prior to platelet stimulation or to be added within 15 to 30 seconds following the addition of ADP. H-CRP also potentiated platelet activation stimulated with epinephrine, thrombin, and collagen. When the synergism generated in PRP by H-CRP in the presence of ADP or epinephrine was compared to the synergism similarly produced by aggregated human IgG, collagen, or thrombin, it more closely resembled that of collagen, as reflected by the kinetics and characteristics of synergism and sensitivity to creatine phosphate/creatine phosphokinase or 5,8,11,14-eicosatetraynoic acid. These data provide a philosophically ideal niche for the acute phase (and C-reactive protein) in that a platelet-directed activity associated with this acute phase reactant is not utilized unless platelets are otherwise challenged.

scholarly journals Presentation and Outcomes of Patients with ESKD and COVID-19

2020 ◽  
Vol 31 (7) ◽  
pp. 1409-1415 ◽  
Author(s):  
Anthony M. Valeri ◽  
Shelief Y. Robbins-Juarez ◽  
Jacob S. Stevens ◽  
Wooin Ahn ◽  
Maya K. Rao ◽  
...  
Keyword(s):  
Control Measures ◽  
C Reactive Protein ◽  
Blood Cell Count ◽  
Advanced Directives ◽  
Reactive Protein ◽  
Presenting Symptoms ◽  
Infection Control Measures ◽  
High Prevalence ◽  
Comorbidity Index

BackgroundThe relative immunosuppression and high prevalence of comorbidities in patients with ESKD on dialysis raise concerns that they may have an elevated risk of severe coronavirus disease 2019 (COVID-19), but outcomes for COVID-19 in such patients are unclear.MethodsTo examine presentation and outcomes of COVID-19 in patients with ESKD on dialysis, we retrospectively collected clinical data on 59 patients on dialysis who were hospitalized with COVID-19. We used Wilcoxon rank sum and Fischer exact tests to compare patients who died versus those still living.ResultsTwo of the study’s 59 patients were on peritoneal dialysis, and 57 were on hemodialysis. Median age was 63 years, with high prevalence of hypertension (98%) and diabetes (69%). Patients who died were significantly older than those still living (median age, 75 versus 62 years) and had a higher median Charlson comorbidity index (8 versus 7). The most common presenting symptoms were fever (49%) and cough (39%); initial radiographs most commonly showed multifocal or bilateral opacities (59%). By end of follow-up, 18 patients (31%) died a median 6 days after hospitalization, including 75% of patients who required mechanical ventilation. Eleven of those who died had advanced directives against intubation. The remaining 41 patients (69%) were discharged home a median 8 days after admission. The median initial white blood cell count was significantly higher in patients who died compared with those still living (7.5 versus 5.7×103/μl), as was C-reactive protein (163 versus 80 mg/L).ConclusionsThe association of COVID-19 with high mortality in patients with ESKD on dialysis reinforces the need to take appropriate infection control measures to prevent COVID-19 spread in this vulnerable population.

scholarly journals Platelet agonist synergism by the acute phase reactant C-reactive protein

Blood ◽  
1985 ◽  
Vol 65 (2) ◽  
pp. 264-269 ◽  
Author(s):  
BA Fiedel
Keyword(s):  
Acute Phase ◽  
Creatine Phosphokinase ◽  
Platelet Rich Plasma ◽  
Adenosine Diphosphate ◽  
Creatine Phosphate ◽  
Acute Phase Reactant ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Phase Reactant ◽  
Irreversible Aggregation

Abstract C-reactive protein is the prototypic acute phase reactant. A self- complexed form (H-CRP) can induce isolated platelets to undergo aggregation, secretion of dense and alpha-granule constituents, and generation of thromboxane A2, but fails to function in platelet-rich plasma (PRP) as a direct agonist. In contrast, when PRP was activated with an amount of adenosine diphosphate (ADP) that produced only reversible platelet aggregation, the presence of H-CRP resulted in irreversible aggregation and the secretion of adenosine triphosphate (ATP). Following a maximum stimulus with ADP alone, where platelet secretion occurred late during the aggregation response, the presence of H-CRP shifted and increased the secretory burst to a time simultaneous with the onset of aggregation. This hypersecretion required H-CRP to be present prior to platelet stimulation or to be added within 15 to 30 seconds following the addition of ADP. H-CRP also potentiated platelet activation stimulated with epinephrine, thrombin, and collagen. When the synergism generated in PRP by H-CRP in the presence of ADP or epinephrine was compared to the synergism similarly produced by aggregated human IgG, collagen, or thrombin, it more closely resembled that of collagen, as reflected by the kinetics and characteristics of synergism and sensitivity to creatine phosphate/creatine phosphokinase or 5,8,11,14-eicosatetraynoic acid. These data provide a philosophically ideal niche for the acute phase (and C-reactive protein) in that a platelet-directed activity associated with this acute phase reactant is not utilized unless platelets are otherwise challenged.

Pathophysiological significance of peroxidative stress, neuronal damage, and membrane permeability in acute mountain sickness

2004 ◽  
Vol 96 (4) ◽  
pp. 1459-1463 ◽  
Author(s):  
Damian M. Bailey ◽  
Gian-Reto Kleger ◽  
Manfred Holzgraefe ◽  
Peter E. Ballmer ◽  
Peter Bärtsch
Keyword(s):  
High Altitude ◽  
Creatine Phosphokinase ◽  
Neuronal Damage ◽  
Acute Mountain Sickness ◽  
Neuron Specific Enolase ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
High Altitude Pulmonary Edema ◽  
Total Creatine ◽  
Mountain Sickness

Free radical-mediated changes in vascular permeability and subsequent inflammatory response may be a contributory pathogenetic cofactor responsible for the development of neurological sequelae associated with acute mountain sickness (AMS). To investigate this, 49 subjects were examined at sea level and serially after rapid ascent to 4,559 m. Although the venous concentration of total creatine phosphokinase activity was measured in all subjects, a complementary examination of lipid peroxidation (F2-isoprostanes), inflammatory (TNF-α, IL-1β, IL-2, IL-6, IL-8, C-reactive protein), and cerebrovascular tissue damage (neuron-specific enolase) biomarkers was confined to a subcohort of 24 subjects. A selective increase ( P < 0.05) in total creatine phosphokinase was observed in subjects diagnosed with AMS at high altitude ( n = 25) compared with apparently healthy controls ( n = 24). However, despite a marked increase in IL-6 and C-reactive protein attributable primarily to subjects developing high-altitude pulmonary edema, subcohort analyses demonstrated no selective differences in F2-isoprostanes, neuron-specific enolase, or remaining proinflammatory cytokines due to AMS ( n = 14). The present findings are the first to demonstrate that free radical-mediated neuronal damage of sufficient degree to be detected in the peripheral circulation does not occur and is, therefore, unlikely to be an important, initiating event that is critical for the development of AMS. The pathophysiological significance of increased sarcolemmal membrane permeability and inflammatory response, either as a cause or epiphenomenon of AMS and/or high-altitude pulmonary edema, remains to be elucidated.

scholarly journals Clinical impact of creatine phosphokinase and c-reactive protein as predictors of postgastrectomy complications in patients with gastric cancer

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Keishi Okubo ◽  
Takaaki Arigami ◽  
Daisuke Matsushita ◽  
Takashi Kijima ◽  
Masataka Shimonosono ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Postoperative Complications ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Creatine Phosphokinase ◽  
Early Period ◽  
C Reactive Protein ◽  
Optimal Cutoff ◽  
Cutoff Value ◽  
Reactive Protein

Abstract Background Postoperative complications have been linked to the morbidity and mortality of several cancers. However, predicting whether complications will occur in the early period after surgery or not is challenging. Hence, this study aimed to examine the diagnostic accuracy of serum creatine phosphokinase (CPK) and c-reactive protein (CRP) in predicting the development of postgastrectomy complications. Methods We retrospectively analyzed 188 patients with gastric cancer (GC) who underwent gastrectomy. The diagnostic accuracy of serum CPK and CRP was investigated using the areas under the curves (AUC). The CPK ratio was defined as the CPK on postoperative day (POD) 1 to the CPK on a preoperative day. Results Out of 188 patients, 48 (25.5%) developed postoperative complications. The complications group had a greater operative time (p = 0.037), higher CPK ratio on POD1 (p < 0.0001), and a higher serum CRP level on POD3 (p = 0.001). The AUC for the CPK ratio was 0.772, with an optimal cutoff value of 7.05, whereas that for CRP was 0.659, with an optimal cutoff value of 11.4 mg/L. The CPK ratio on POD1 (p < 0.0001) and the CRP on POD3 (p = 0.007) were independent factors for predicting the development of postgastrectomy complications. The CPK ratio on POD1 and the CRP on POD3 predicted postgastrectomy complications in 41 patients (85.4%). According to combined value of both CPK ratio and CRP level, the positive predictive value and the negative predictive value was 0.70 and 0.829. And sensitivity and specificity were 0.438 and 0.936. Conclusion The CPK ratio on POD1 and the CRP on POD3 after gastrectomy for GC were predictive factors for complication development and may be employed to prevent the development of such complications and improve the prognosis of patients with GC.

scholarly journals OP0269-HPR ASSOCIATION OF SARC-F PERFORMANCE WITH COMORBIDITIES, PHYSICAL DISABILITY AND LOWER ALBUMIN LEVELS IN SYSTEMIC SCLEROSIS PATIENTS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 168.2-168
Author(s):  
L. Santos ◽  
R. Cavalheiro Do Espírito Santo ◽  
V. Hax ◽  
R. Mendonça Da Silva Chakr ◽  
R. Xavier
Keyword(s):  
Systemic Sclerosis ◽  
Sedimentation Rate ◽  
Physical Disability ◽  
Disease Duration ◽  
Creatine Phosphokinase ◽  
Rio Grande ◽  
Rio Grande Do Sul ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Erythrocyte Sedimentation

Background:Systemic sclerosis (SSc) is a multisystem autoimmune disease of complex etiopathogeny, heterogeneous in its phenotypic expression and with a limited prognosis (1). The loss of muscle mass is a serious consequence of many chronic diseases and also is observed in SSc (2). This body composition alterations results in weakness, limitations and physical disability (3). SARC-F simple questionnaire, validated, is a key diagnostic feature for the fast assessment of geriatric syndromes associated with skeletal muscle wasting. However, there is no data about the SARC-F in SSc.Objectives:To assess the association between the SARC-F questionnaire with clinical features in patients with systemic sclerosis (SSc).Methods:Ninety-four patients diagnosed with systemic sclerosis were recruited and evaluated. Sarcopenia was assessed by the SARC-F questionnaire. Clinical features as disease duration time, comorbidities, body mass index (BMI), functional capacity by the Health Assessment Questionnaire (HAQ), inflammatory markers (C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), creatine phosphokinase (CPK), hemoglobin, creatinin and albumin) were medical record. Frequency analysis, descriptive analysis and Pearson’s correlation were performed. Statistical significance was considered as p<0,05.Results:Of the 94 patients analyzed, most were women (87/94;92.6%) with mean age of 60.5±10.3 years, median disease duration time of 11.2 (7.5-18.9) and median number of comorbidities was 1.00 (1.00-2.00). The mean of BMI was 25.9±4.7 Kg/m2. Twenty-one of the patients were classified as active or passive smokers, thirty-five said they were former smokers and thirty-eight never smoked. Sixty-nine (80, 2%) out of the ninety-four patients in the study had at least one type of comorbidity (mean 1, 44±1, 04). Eighty-three patients (88.3%) showed a SARC-F score without signs suggestive of sarcopenia (0-5) and eleven patients (11.7%) showed suggestive to sarcopenia (6-10). In HAQ, fifty-seven (60.6%) patients had mild incapacity, thirty-five (37.2%) had moderate incapacity, and two patients (2.2%) had severe incapacity. Higher SARC-F scores were associated with greater number of comorbidities (r=0.2; p=0.027), higher physical disability by HAQ (r= 0.5;p=0.000) and lower albumin levels (r= -0.3; p= 0.048). On other hand, SARC-F was not associated with time of diagnosis, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), creatine Phosphokinase (CPK), hemoglobin, hematocrit and creatinine.Conclusion:SARC-F scores were associated with comorbidities, physical disability and lower albumin levels in systemic sclerosis patients. Considering that comorbidities, physical disability and the albumin deficit enhances the patient’s muscle loss, SARC-F appears to be a good tool to screen sarcopenia risk factors in systemic sclerosis patients. Longitudinal studies are necessary to validate the SARC-F questionnaire in this population.References:[1]Hochberg MC et al. Sixth edit. (Elsevier, ed.). Philadelphia; 2015;[2]Sakuma K et al. Pflügers Arch - Eur J Physiol. 2017;469(5-6):573-591.[3]Caimmi C, et al. Clin Rheumatol. 2018;37(4):987-997.Acknowledgments:We thank the Coordination for the Improvement of Higher Level Personnel (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—CAPES) institution, the Foundation for Research Support of the Rio Grande do Sul State (Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul—FAPERGS), the Research and Events Incentive Fund (Fundo de Incentivo à Pesquisa e Eventos—FIPE) of HCPA and Technological Development (Conselho Nacional de Desenvolvimento Científico e Tecnológico—CNPq).Disclosure of Interests:Leonardo Santos: None declared, Rafaela Cavalheiro do Espírito Santo: None declared, Vanessa Hax: None declared, Rafael Mendonça da Silva Chakr: None declared, Ricardo Xavier Consultant of: AbbVie, Pfizer, Novartis, Janssen, Eli Lilly, Roche

scholarly journals Persistent eosinophilia and associated organ involvement in Thai patients with systemic sclerosis: Data from the Siriraj scleroderma cohort

2021 ◽  
Vol 36 (4) ◽  
pp. 527-537
Author(s):  
Somsak Punjasamanvong ◽  
Chayawee Muangchan
Keyword(s):  
Systemic Sclerosis ◽  
Disease Duration ◽  
Creatine Phosphokinase ◽  
Total Lung Capacity ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Lung Capacity ◽  
Lower Baseline ◽  
One Year ◽  
Post Hoc

Objectives: This study aims to investigate the prevalence of persistent eosinophilia and associated organ complications in Thai patients with systemic sclerosis (SSc). Patients and methods: This post-hoc study included 107 adult patients (23 males, 84 females; mean age: 50.4±11.6 years; range, 18 to 79 years) diagnosed with SSc between November 2013 and June 2017. Eosinophilia was defined as an absolute eosinophil count of >500/μL or a percentage count of >7%. Eosinophil levels collected at every visit over one year were categorized as persistently high (PH), persistently low (PL), high-to-low (HL), low-to-high (LH), or variable levels (VL). The study compared variables between PH and non-PH (PL+HL+LH+VL) groups. The patients with baseline eosinophilia were also identified and compared with the non-eosinophilia group. Results: The median disease duration was 3.2 years. Of the patients, 79.4% had diffuse cutaneous SSc and 76.7% had anti-Scl-70 positivity. A total of 11.2%, 66.4%, 1.9%, 8.4%, and 12.1% of the patients were categorized into the PH, PL, HL, LH, and VL groups, respectively. Compared to non-PH groups, the PH group had a higher prevalence of anti-centromere antibody (ACA), higher baseline percent predicted total lung capacity, and lower baseline C-reactive protein and creatine phosphokinase (p<0.05 for all). The ACA positivity (odds ratio [OR]: 18.5; 95% confidence interval [CI]: 1.64-208.46) was associated with PH. The patients with baseline eosinophilia (17.8%) had a higher prevalence of non-specific interstitial pneumonia with periodic eosinophilia at the time of diagnosis (100% vs. 6.5%, p<0.0001; OR: 4.667; 95% CI: 1.712-12.724). Conclusion: The PH was seldom (11%) in patients with SSc compared to periodic eosinophilia, which was more prevalent (18%). It may be related to ACA positivity and better pulmonary outcomes, whereas periodic eosinophilia may involve interstitial lung disease.

Whole blood analysis using microfluidic plasma separation and enzyme-linked immunosorbent assay devices

2016 ◽  
Vol 8 (42) ◽  
pp. 7597-7602 ◽  
Author(s):  
Hisashi Shimizu ◽  
Mariko Kumagai ◽  
Emi Mori ◽  
Kazuma Mawatari ◽  
Takehiko Kitamori
Keyword(s):  
Immunosorbent Assay ◽  
Whole Blood ◽  
Blood Analysis ◽  
Enzyme Linked Immunosorbent Assay ◽  
C Reactive Protein ◽  
Separation Device ◽  
Plasma Separation ◽  
Reactive Protein ◽  
Whole Blood Analysis

In this study, a microfluidic plasma-separation device that realizes the whole blood analysis of C-reactive protein (CRP) using one drop of blood is developed.

scholarly journals C-reactive protein as a marker of infection in children with severe acute malnutrition in Khartoum state, Sudan

2017 ◽  
Vol 5 (1) ◽  
Author(s):  
Abdelmoneim E.M. Kheir ◽  
Balla G. Gebreel
Keyword(s):  
Severe Acute Malnutrition ◽  
Systemic Infection ◽  
Acute Phase Reactant ◽  
Study Data ◽  
Acute Malnutrition ◽  
C Reactive Protein ◽  
Cross Sectional ◽  
Reactive Protein ◽  
Presenting Symptoms ◽  
Severe Infections

Severe acute malnutrition and acute systemic infection are often synergistic in children and lead to considerable mortality. The main aim of this research was to determine whether children with severe acute malnutrition can mount an acute phase reactant response measured by C-reactive protein. This was a descriptive, cross-sectional, hospital-based study that was carried out in the five main children hospitals in Khartoum state, from November 1st, 2012 to March 1st, 2013. 132 children with severe acute malnutrition were included in the study. Data collection included history, examination and C-reactive protein measurement. The data were analyzed using Statistical Package for Social Sciences (SPSS) for descriptive and inferential statistics. The main results revealed that 93(70.5%) children between 12-23 months of age and most of them had marasmus. Diarrhoea was the commonest presenting symptoms in 86.4%, followed by fever and vomiting. Most of the children (82.6%) had positive C-reactive protein with variable levels. In conclusion malnourished children are able to synthesize C-reactive protein in response to an infectious process and the magnitude of this response is increased in those with severe infections.

scholarly journals Zonulin: A Potential Marker of Intestine Injury in Newborns

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Anna Tarko ◽  
Anna Suchojad ◽  
Marta Michalec ◽  
Małgorzata Majcherczyk ◽  
Aniceta Brzozowska ◽  
...  
Keyword(s):  
Necrotizing Enterocolitis ◽  
Statistical Significance ◽  
Demographic Data ◽  
C Reactive Protein ◽  
Rotavirus Infection ◽  
Reactive Protein ◽  
Presenting Symptoms ◽  
Potential Marker ◽  
Intestinal Pathology ◽  
Rotavirus Infections

Introduction.Zonulin (ZO), a new diagnostic biomarker of intestinal permeability, was tested in newborns presenting symptoms of infection and/or inflammation of the gut or being at risk of intestinal pathology.Material and Methods.Serum ZO was assessed in 81 newborns diagnosed with sepsis, necrotizing enterocolitis (NEC), rotavirus infection, and gastroschisis, also in extremely low gestational age babies, and in controls (healthy newborns). ZO concentration was compared to C-reactive protein (CRP) and procalcitonin (PCT) values, leucocyte and platelet count, basic demographic data, and the value of the Neonatal Therapeutic Intervention Scoring System (NTISS).Results.Median values of ZO were markedly higher in groups with rotavirus infection and gastroschisis (36.0 (1-3Q: 26.0–43.2) and 20.3 (1-3Q: 17.7–28.2) ng/ml, resp.) versus controls (3.5 (1-3Q: 2.7–4.8) ng/ml). Its concentration in the NEC group was twice as high as in controls but did not reach statistical significance. ZO levels were not related to NTISS, CRP, and PCT.Conclusions.Zonulin is a promising biomarker of intestinal condition, markedly elevated in rotavirus infections. Its role in defining the severity of necrotizing enterocolitis and the risk for perforation is not well described and needs further evaluation. An increase in zonulin may not be parallel to the release of inflammatory markers, and low CRP should not exclude an injury to neonatal intestine.

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