Sedimentation Rates, Erythrocyte

All samples were stored at − 80 °C until use. Serum levels of C-reactive protein (CRP) were determined by an immuno-turbidimetric technique using an Olympus AU 400 biochemical analyzer (Olympus Optical, Tokyo, Japan), and erythrocyte sedimentation rate (ESR) was measured according to the Fahreus and Westergren method. ANAs were detected using indirect immunofluorescence on HEP2 cells, and the autoantibodies of the ENA complex (anti-U1RNP, anti-Ro, anti-La, anti-DNA-topoisomerase I, anti-Jo-1, anti-P protein, anti-Sm, and anti-centromere) were assayed by immunoblot. Plasma levels of Hsp90 were assessed by a high-sensitivity ELISA kit (eBioscience, Vienna, Austria) according to the manufacturer's protocol. The assay recognizes human Hsp90 alpha. The calculated sensitivity is 0.03 ng/mL. The absorbance value was established at 450 nm by an ELISA reader (SUNRISE; Tecan, Grödig, Austria).

All the patients enrolled on our Early Arthritis Clinic (EAC) register between September 2001 and November 2006 were considered in this study. During this period 190 patients were included, although only 171 patients completed the two year follow-up (the last patient ended in November 2008). Data from 638 visits corresponding to these later patients were considered for the analysis.
There were 14 patients lost to follow-up and 5 exitus. Deceased patients were significantly older, had a lower educational level and they also displayed a tendency towards a higher HAQ and DAS28 at baseline than those who finished the follow-up (Table S1). Patients lost to follow-up did not differ significantly from completers (Table S1).
Our EAC covers a population of 500,000 inhabitants, >90% of whom are attended by public health insurance. In addition, all primary care physicians in the area are aware of the EAC. To be referred to the clinic, patients must have two or more swollen joints for at least four weeks and symptoms for less than a year. Patients with other specific causes of arthritis were excluded. Thus, only data from patients that fulfilled the ACR criteria for the diagnosis of RA [35] (link) or with chronic undifferentiated arthritis were analyzed. When the 171 patients that fulfilled the two year follow-up were considered, 71% fulfilled the 1987 criteria for RA classification, while 29% remained as undifferentiated arthritis (UA: Table S2) at the end of the follow-up. These two subpopulations did not differ significantly except that the RA patients had a more severe disease at baseline and the educational level of the UA subpopulation was higher (Table S2).
The register's protocol included four visits during a follow up period of two years (baseline, 6, 12 and 24 months). At each visit, the following data were collected and entered into an electronic database: clinical and demographic information; disease duration at the beginning of the follow up; 28 tender and swollen joint counts (TJC and SJC, respectively); global disease activity on a 100 mm visual analogue scale assessed both by the patient (GDAP) and the physician (GDAPh); Spanish version of the Health Assessment Questionnaire [36] (link); and laboratory tests including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and RF levels assessed by nephelometry (positive>20 UI/ml) and ACPA measured by enzyme immune assay (EIA) (Euro-Diagnostica Immunoscan RA; positive >50 UI/ml).

This hospital based unmatched case control study was conducted in Mekelle City, North Ethiopia, which is located at 783km from Addis Ababa (the capital city of Ethiopia) since December 2014 to June 2015. The study was carried out among neonates who were admitted to public hospitals of the city.
The hematological criteria along with the established IMNCI (Integrated Management of Neonatal and Childhood Illness) clinical features of neonatal sepsis were used to diagnose neonatal sepsis in this study. Neonates in the presence of one or more of the established IMNCI clinical features [either of fever (≥37.5°C) or hypothermia (≤ 35.5°C), fast breathing (≥60 breath per minute), severe chest indrawing, not feeding well, movement only when stimulated, convulsion, lethargic or unconscious] along with ≥ 2 of the hematological criteria; total leukocyte count (<4000 or >12000 cells/m³, absolute neutrophil count (<1500 cells/mm3 or >7500 cells/mm³), erythrocyte sedimentation rate (ESR) (>15/1 h) and platelet count (<150 or >440 cells/m³) and who were admitted to pediatric ward or neonatal ICU of the public hospitals of Mekelle City, North Ethiopia during the study period were included with their index mothers as cases. Neonates who were not fulfilled the criteria of sepsis and who were admitted to pediatric ward or neonatal ICU of the public hospitals in Mekelle City, North Ethiopia during the study period were also included with their index mothers as controls.
A two population proportion formula (using open Epi version 2.3.1) was used to estimate the sample size required for the study by considering that the proportion of mothers with UTI/ STI among the controls of 13% (main exposure variable), which was estimated from another study [13 ], 95% CI, 80% power of the study control to case ratio of 2:1 to detect an odds ratio of 2.87 which was estimated from a study done by others [13 ]. Accordingly, by adding 5% for the non response rate, 78 cases and 156 controls (a total sample size of 234) was the estimated sample size in this study. Cases and controls were selected using proportional systematic random sampling.
Data was collected using semi structured questionnaire and checklist prepared in English and then translated to the local language, Tigrigna (S1 Appendix). The tool was pretested on 5% (4 cases and 8 controls) of the sample size before the actual data collection period. The data were collected by 4 nurses with previous experiences and after being trained by the principal investigator about the purpose of the study and how to interview as well as fill the questionnaire and checklist properly. Finally, the data collectors collected the data through interviewing the mothers and reviewing neonates’ medical records throughout the data collection period.
The data were checked for completeness, inconsistencies, then entered using Epi-Info version 7 and cleaned and analyzed in SPSS version 20. Cross tabulation was done to see the distribution of cases and controls. The binary logistic regression model was used to test the association between dependent and independent variables. All variables with P value <0.29 in bivariate analysis were included in the multivariable analysis. Magnitude of association was measured by using an odds ratio at 95% confidence interval. Statistical significance was declared at P<0.05. Finally, the data are presented with texts and tables.

The EMRMS was established in November, 2016 to assist rheumatologists in conducting ASDAS assessments and comprehensively evaluating clinical outcomes in all patients with AS attending TCVGH. The EMRMS database contains information necessary to determite ASDAS, including CRP, level and erythrocyte sedimentation rate [ESR], patient comorbidities, patient history, and family history. The reliability and validity of the data have been verified^{14 (link)}.Patients with AS were consecutively enrolled in the TCVGH-AS cohort after they received a confirmed AS diagnosis from a TCVGH rheumatologist according to the 1984 modified New York criteria^{10 (link)}. The CRP and ESR data were automatically uploaded to the TCVGH healthcare information system (HIS) to reduce human error. The baseline information, which was collected by trained nurses during the initial visit, including clinical characteristics, onset age, comorbidities at presentation (hypertension, diabetes mellitus, hyperlipidemia, hepatitis B, hepatitis C, renal insufficiency, gout, coronary artery disease, stroke, periodontal disease, osteoporosis, and tuberculosis history), periarticular extraspinal features (synovitis, enthesitis, and dactylitis) and nonarticular manifestations (psoriasis, uveitis, and IBD), family history of autoimmune disease, and patient history of arthropathy, obtained through standardized questionnaires and worksheets to ensure reproducibility and adherence to good laboratory practice. The rheumatologist in charge then confirmed patients’ clinical characteristics, and nurses assisted the patients with AS to complete the self-assessment questionnaires for disease evaluation. The following measures were used: global assessment of disease activity on a numerical rating scale (NRS) of 0–10, back pain on an NRS of 0–10, duration of morning stiffness on an NRS of 0–10, and peripheral pain or swelling on an NRS of 0–10. Before every 3-month visiting clinic, the patient would first to have blood examination. Blood reports can be uploaded to EMRMS through the HIS system, trained nurses assist patient fills out the questionnaire on EMRMS, the assessment of disease activity completed before visiting the doctor. All laboratory data, including CRP and ESR, have been uploaded to the HIS. The IT at TCVGH help "feed-forward" the patient reported outcomes to HIS, and do the auto-calculation of ASDAS-ESR, ASDAS-CRP using the ESR, CRP data in HIS, then "feed-back" these data to both HIS and EMRMS, showing the data on the summary overview "dashboard" in the EMRMS, which was shown both in HIS and the devices (iPAD handled by a nurse in charge and smartphones of patients with AS).

All consecutive patients aged 3 months to 18 years old with a diagnosis of acute OM and/or SA according to the International Classification of Diseases, 9th Revision, Clinical Modification code were evaluated for inclusion. A case was defined by diagnosis of OM or SA on imaging, preferably magnetic resonance imaging (MRI, gold standard) for OM, or in alternative computed tomography (CT scan), Tc99 bone scintiscan, PET-TC scan, or ultrasound (US)/MRI for SA. Long bones were considered the typical site of infection for OM. The hips were considered a high-risk site for both OM and SA. Exclusion criteria were diagnosis of immunodeficiency or hemoglobinopathy or chronic granulomatous disease, immunosuppressive therapy, concomitant systemic bacterial infection, and ongoing antibiotic treatment on admission. Patients with complicated infections, not fully vaccinated, and/or with incomplete follow-up were excluded, as well as those with chronic osteomyelitis and Brodie's abscess.
The population was divided into two main groups, OM and SA. Each group was further divided into three groups: pre-intervention, post-intervention not following the guidelines (no GL), and post-intervention group with adherence to the guidelines (GL).
The following variables, selected a priori, were evaluated: age, sex, weight, fever, vaccination status, white blood cells, and neutrophil count, CRP, erythrocyte sedimentation rate (ESR), and procalcitonin (PCT) at onset, IV and oral antibiotic treatment with duration, diagnosis and imaging type, typical vs. atypical site, results of blood, pus, synovial fluid cultures, MRSA colonization status, Quantiferon results, PVL test positivity, treatment failure (defined as treatment escalation to broad spectrum antibiotics and/or need for surgery) and relapse at six months of follow-up. PCR tests for identification of K. kingae or other pathogens in case of culture-negative infections were not performed, as not included as standard of care at our facility.

Baseline clinical profiles were collected and reviewed, including sex, age, Montreal classification [13 (link)] and baseline treatment. The detailed baseline clinical characteristics of CD were evaluated at the time of diagnosis of intestinal fistula. The Crohn’s Disease Activity Index (CDAI) was used to evaluate the disease activity in brief [14 (link)]. The characteristics of the fistula were classified by type, location, and the existence of a complex fistula. The fistula was defined as complex fistula if there were multiple fistula tracts or the patient has history of abdominal abscess. History of abdominal infection or abcess were also collected.
Laboratory data related to CD were also collected, including blood routine, albumin, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). Due to the non-availability of data, serum IL-6 and TNF-α level and other indicators were not collected and included in the analysis. Serum IFX concentration were also not included.
Imaging data (enhanced abdominal and pelvic CT, CT enterography, or MR enterography) at baseline were reappraised. Data were collected including the characteritics of fistula, and other signs of CD activity, including thickening or strengthening of the intestinal wall, existence of stricture, thickened mesenteric vessels and enlarged mesenteric lymph nodes.