Presepsin as a novel diagnostic marker in neonatal septicemia

Neonatal septicemia is a serious life-threatening condition with high mortality. The accurate diagnosis of sepsis is one of the main challenges in emergency medicine. A great effort to reduce the neonatal mortality rate is put into looking for new reliable biomarkers. Among biomarkers, presepsin could be one of the most promising and reliable biomarker for early diagnosis of sepsis. We aimed to evaluate the diagnostic value of presepsin in the early diagnosis of neonatal sepsis. By chemiluminescent enzyme immunoassay [CLEIA], the level of presepsin was assessed in 40 full term neonates with suspected sepsis [Proven sepsis group: 23 patients with +ve blood culture and Probable sepsis group: 17 patients with -ve blood culture] and15 healthy full term neonates. Presepsin level was found to be significantly higher in patient group than control group as well as in proven sepsis group than probable sepsis group. The cut off value for presepsin was 875pg/ml at which the sensitivity and specificity of presepsin were [95.7%, 87.5%] respectively. Presepsin level was found to be significantly higher in females than males. There was no significant difference in the presepsin level as regard mode of delivery nor onset of sepsis. Presepsin is a novel biomarker with high sensitivity and good specificity for sepsis and its measurement can be useful for early diagnosis of neonatal sepsis

Phenotypic and genotypic methods for detection of metallobeta-lactamase [MbetaL] producing pseudomonas aeruginosa

The occurrence of a MbetaL-positive isolate in a hospital setting represents a therapeutic problem, as well as a serious concern for infection control management. The accurate identification and reporting of MbetaL-producing P. aeruginosa will aid infection control practitioners in preventing the spread of these multidrug-resistant isolates. This study aimed to detect and characterize MbetaL producing P. aeruginosa in Benha and to evaluate IMP- EDTA CDT as phenotypic screening method for MbetaL detection. This study was conducted on 100 P.aeruginosa strains isolated from 220 different clinical specimens collected from patients admitted to Benha University Hospital and Benha Teaching Hospital. The isolated P. aeruginosa strains were subjected to antibiotic susceptibility testing by disc diffusion test and MbetaL detection both phenotypically by IMP- EDTA CDT and genotypically by multiplex PCR. Out of 100 P.aeruginosa isolates, 25 strains [25%] were imipenem resistant and 15 strains of them [60%] were carrying genes responsible for MbetaL production [15% of the total number of P.aeruginosa]. Thirteen strains [13%] were carrying VIM gene while two strains [2%] were carrying both VIM and SPM genes together. IMP, GIM-1, SIM-1 genes were not detected. None of the imipenem sensitive strains were carrying genes of MbetaL production. Nearly all MbetaL producers were resistant to most antibiotics used while all strains were sensitive to colistin and polymyxinB. There is very good strength of agreement between IMP-EDTA CDT and PCR. The sensitivity and specificity of the IMPEDTA CDT in relation to PCR was 93.3% and 100% respectively. MbetaL producers is a serious problem as they are highly resistant to most antibiotics used making treatment options very limited, VIM gene is the most prevelant one in comparison with other genes of MbetaL production and IMP-EDTA CDT is a good and sensitive test in detecting MbetaL production

Leptin, insulin sensitivity and TNF as parameters for metabolic changes in chronic heart failure with and without cardiac cachexia

Background: The development of cachexia is a particular predictor of adverse prognosis in chronic heart failure [CHF]. Less is known about anabolic metabolism in CHF. Leptin -the hormone product of obesity gene has been shown to inhibit food intake, increase energy expenditure and fat oxidation. Insulin sensitivity and secretion is related to leptin. Leptin has been reported also to stimulate proliferation of CD4 T cells and increases cytokine production. The study aimed to investigate leptin. Insulin sensitivity and tumor necrosis factor-alpha [TNF-alpha] in chronic heart failure with and without cachexia

Methods: We studied 31 male patients with CHF, mean age [59.87 +/- 6.91 years], mean New York Heart Association Functional Class [2.52 +/- 0.81], mean left ventricular ejection fraction [LVEF] [0.33+0.08] and 13 male healthy control subjects, mean age [59.87 +/- 6.91]. Of the CHF patients, 14 were cachectic [cCHF] with non-oedematous weight loss >7.5% over at least6 months and 17 non-cachectic. Serum insulin was measured by enzyme immunoassay, insulin sensitivity was assessed by intravenous glucose tolerance. Serum leptin and TNF were meas ured using commercially available ELISA kit

Results: Compared with the healthy control subjects, patients had elevated levels of leptin, fasting insulin and TNF-alpha [P<0.001], with reduced insulin sensitivity [P<0.001]. Both ncCHF and cCHF subgroups had higher leptin and TNF levels than the control group [P<0.001]. The cCHF subgroup-compared with ncCHF subgroup-showed reduced leptin and fasting insulin levels [P<0.001 and P<0.01] respectively and elevated TNF-alpha levels [P<0.001]. In both patients and control subjects there was a positive correlation between leptin and fasting insulin levels [r=0.59, P<0.001 and r=0.54, P<0.05] respectively. The relative risk of incidence of cCHF in NYHA Functional class [I and II] versus NYHA Functional class [III and IV] was 0.427 [P<0.05]

Conclusion: CHF is hyperleptinaemic state and is associated with decreased insulin sensitivity and elevated fasting plasma insulin levels. The state of cardiac cachexia is associated with higher TNF-alpha levels and more worse NYHA Functional Class. Leptin and TNF-alpha may be valid targets for novel therapeutic interventions in patients with CHF

cluster analysis of normal soft tissue patterns for a group of Egyptian adults

This study was carried out to establish a mathematical classification of normal soft tissue pattern by cluster analysis based on lateral cephalometric radiographic measurements. The sample consisted of 96 Egyptian adults [53 females and 43 males] having normal occlusion with pleasing face, balanced facial profile and competent lips with ages ranging between 18-25 years. For each subject linear and angular soft tissue measurements were recorded and ratios between the linear facial profile parameters were calculated. Two cluster analyses were applied for the collected data which reflected the size and shape of the normal soft tissue pattern. Each cluster analysis resulted in classification of normal sample into three clustered groups. Most of the linear and angular soft tissue parameters shoed significant differences between the centers of each cluster, with no obvious variation regarding the lower lip length and the degree of its protrusion with the upper lip in relation to soft tissue-nasion. However, clustering of the calculated ratios revealed that the length of the frontal third in relation to the total facial height, the prominence of the nose in relation to the nasal third length and the proportion of the upper and lower lip length to each other and in relation to the gnathic thirds were all considered as significant dependent factors in the differentiation between the shape of the soft tissue pattern within the three clustered groups