Diagnostic value of C-reactive protein in suspected acute appendicitis - A prospective case control study.

Aim: To find out the Sensitivity, Specificity and Predictive value of C-reactive protein in the diagnosis of acute appendicitis. Materials and Methods: Hundred patients undergoing emergency appendicectomy were cases and thirty patients undergoing interval appendicectomy during the same period were controls. Creactive protein was measured pre-operatively. Results: CRP was reactive in 89% of cases and 3 of 30 controls (P = 0). Among the thirteen complicated cases, two had a CRP reactivity of 1.2 mg/dl, eight had 2.4 mg/dl and three had 3.6 mg/dl. In the uncomplicated cases, forty nine were reactive at 1.2 mg/dl, twenty six at 2.4 mg/dl and one at 3.6 mg/dl ( P = 0.0009). In histopathologically inflamed appendix, reactivity was 94.4% and in normal appendix reactivity was 40% ( P = 0.00007). CRP positivity had a sensitivity of 94.4% (CI 89.9-98.9) and a positive predictive value of 95.5% (CI 91.4-99.6). CRP reactivity and leucocytosis if combined, the sensitivity, specificity, PPV and NPV were 85%, 100%, 100% and 81% respectively. Threshold for CRP reactivity if raised to 2.4 mg/dl, the sensitivity, specificity, PPV and NPV are 42%, 100%, 100% and 16% respectively. Conclusion: CRP estimation is a good 'rule-in' test and not-so-good 'rule-out' test to diagnose acute appendicitis.

Association of insulin resistance with redox imbalance in patients with non diabetic hypertension.

Oxidative stress involved in the pathogenesis of several diseases. Hypertension itself acts as source of oxidative stress. Insulin resistance is involved in the pathogenesis of essential hypertension. In the present study an attempt was made to study the association between insulin resistance and oxidative stress in non diabetic hypertensive patients. Two hundred and three, non diabetic hypertensive patients and two hundred and ten, healthy normotensive subjects were enrolled in this study. Malondialdehyde, reduced glutathione, glutathione peroxidase, Fasting insulin and HOMA-IR levels were estimated in both groups. Fasting insulin, reduced glutathione, glutathione peroxidase and MDA shows significant difference between cases and controls. Among the patients HOMA-IR were significantly correlated with lipid peroxides and shows negative correlation between HOMAIR and glutathione peroxidase. Increased HOMA-IR was found in non diabetic hypertensive patients. This study reveals the link between oxidative stress and insulin resistance.