Diagnostic performance of C-reactive protein level and its role as a potential biomarker of severe dengue in adults

Objective: To determine the relationship between C-reactive protein (CRP) level and the severity of dengue and the potential use of CRP in predicting acute dengue infection. Methods: A prospective observational study was performed on dengue patients admitted to a tertiary care hospital in southern India. All patients of age above 18 years, diagnosed with dengue were included in the study. The detailed laboratory parameters pertaining to dengue were recorded. CRP levels were estimated and compared between groups i.e. severe and non-severe dengue. CRP cut-off value was detected using the receiver-operator curve. Results: Totally 98 patients with a mean age of 40 years were included. Among them, 11.2% of the patients suffered from severe dengue, 54.1% of the cases had non-severe dengue without warning signs, and 34.7% had non-severe dengue with warning signs. The median CRP was significantly higher in patients with severe dengue compared to patients with non-severe dengue (96.2 mg/dL vs. 5.3 mg/dL). Univariate logistic regression analysis showed that the odd's ratio (OR) of CRP was 1.053 (P≤0.001, 95% CI=1.029-1.078). CRP at a cutoff value of 21.6 mg/L (0.929 AUC) had excellent sensitivity (100%) and specificity (81.6%) in predicting severe dengue infection. Multivariate logistic regression analysis showed that CRP (OR=1.089, P=0.013) and ALT (OR=1.010, P=0.034) were statistically significant independent predictors of dengue severity. Conclusions: CRP level could be used as a potential biomarker to predict severity of dengue in adults.

Diagnostic performance of C-reactive protein level and its role as a potential biomarker of severe dengue in adults

Objective: To determine the relationship between C-reactive protein (CRP) level and the severity of dengue and the potential use of CRP in predicting acute dengue infection. Methods: A prospective observational study was performed on dengue patients admitted to a tertiary care hospital in southern India. All patients of age above 18 years, diagnosed with dengue were included in the study. The detailed laboratory parameters pertaining to dengue were recorded. CRP levels were estimated and compared between groups i.e. severe and non-severe dengue. CRP cut-off value was detected using the receiver-operator curve. Results: Totally 98 patients with a mean age of 40 years were included. Among them, 11.2% of the patients suffered from severe dengue, 54.1% of the cases had non-severe dengue without warning signs, and 34.7% had non-severe dengue with warning signs. The median CRP was significantly higher in patients with severe dengue compared to patients with non-severe dengue (96.2 mg/dL vs. 5.3 mg/dL). Univariate logistic regression analysis showed that the odd's ratio (OR) of CRP was 1.053 (P≤0.001, 95% CI=1.029-1.078). CRP at a cutoff value of 21.6 mg/L (0.929 AUC) had excellent sensitivity (100%) and specificity (81.6%) in predicting severe dengue infection. Multivariate logistic regression analysis showed that CRP (OR=1.089, P=0.013) and ALT (OR=1.010, P=0.034) were statistically significant independent predictors of dengue severity. Conclusions: CRP level could be used as a potential biomarker to predict severity of dengue in adults.

The effect of anesthetic techniques on neutrophil to lymphocyte ratio in patients undergoing infraumbilical surgeries / 대한마취과학회지

BACKGROUND: Neutrophil to lymphocyte ratio (NLR) is a simple marker in peripheral blood and is used to assess inflammatory response and physiological stress during the peri-operative period. Anesthetic technique may influence NLR, thereby modulating the inflammatory response and surgical outcomes. The study aimed to evaluate the relationship between blood NLR and anesthetic techniques in patients undergoing infraumbilical surgeries. METHODS: Institutional ethical committee approval and patient consent were obtained. A prospective randomized double- blinded study was conducted between July 2017 and November 2017, involving 80 patients classified as the American Society of Anesthesiologists grade 1 and 2, aged 18–60 years, and scheduled for elective infraumbilical surgeries. Unwilling and those with infections were excluded. The patients were randomly divided into two groups: Group G (general anesthesia) and Group S (spinal anesthesia) as per the standardized protocol. Differential counts of leukocytes and NLR in the peripheral blood were obtained pre-operatively on the morning of surgery and at 2 h and 24 h after surgery in both the groups. The data were analyzed using appropriate statistical tests. RESULTS: The demographic parameters, basal total leukocyte count (TLC), and NLR were comparable between the groups. TLC and NLR were significantly higher in Group G as compared to that in Group S post-operatively. The post-operative rise in TLC and NLR from the basal values was significantly higher in Group G as compared to that in Group S. CONCLUSIONS: General anesthesia was associated with a greater increase in TLC and NLR when compared with spinal anesthesia.

The effect of anesthetic techniques on neutrophil to lymphocyte ratio in patients undergoing infraumbilical surgeries / 대한마취과학회지

BACKGROUND@#Neutrophil to lymphocyte ratio (NLR) is a simple marker in peripheral blood and is used to assess inflammatory response and physiological stress during the peri-operative period. Anesthetic technique may influence NLR, thereby modulating the inflammatory response and surgical outcomes. The study aimed to evaluate the relationship between blood NLR and anesthetic techniques in patients undergoing infraumbilical surgeries.@*METHODS@#Institutional ethical committee approval and patient consent were obtained. A prospective randomized double- blinded study was conducted between July 2017 and November 2017, involving 80 patients classified as the American Society of Anesthesiologists grade 1 and 2, aged 18–60 years, and scheduled for elective infraumbilical surgeries. Unwilling and those with infections were excluded. The patients were randomly divided into two groups: Group G (general anesthesia) and Group S (spinal anesthesia) as per the standardized protocol. Differential counts of leukocytes and NLR in the peripheral blood were obtained pre-operatively on the morning of surgery and at 2 h and 24 h after surgery in both the groups. The data were analyzed using appropriate statistical tests.@*RESULTS@#The demographic parameters, basal total leukocyte count (TLC), and NLR were comparable between the groups. TLC and NLR were significantly higher in Group G as compared to that in Group S post-operatively. The post-operative rise in TLC and NLR from the basal values was significantly higher in Group G as compared to that in Group S.@*CONCLUSIONS@#General anesthesia was associated with a greater increase in TLC and NLR when compared with spinal anesthesia.

Effects of bilateral superficial cervical plexus block on sevoflurane consumption during thyroid surgery under entropy-guided general anesthesia: a prospective randomized study / 대한마취과학회지

BACKGROUND: Bilateral superficial cervical plexus block (BSCPB) provides good postoperative analgesia, but its effect on anesthetic consumption is unknown. This study evaluated the effects of BSCPB on sevoflurane consumption during thyroid surgery. METHODS: Fifty patients were randomly allocated into groups A and B of 25 each in this prospective double-blind study. Group A received BSCPB with 20 ml 0.25% bupivacaine, whereas group B received 20 ml saline immediately before entropy-guided general anesthesia. Intraoperative hemodynamic parameters, end-tidal sevoflurane concentration, minimum alveolar concentration, and sevoflurane consumption were recorded. Postoperative pain was assessed using a visual analog scale, and the time of the first request for analgesia was noted. All side effects were recorded. RESULTS: Demographics were comparable. Mean sevoflurane consumption [for 30 min: group A = 7.2 (1.1) ml, group B = 8.8 (2.0) ml, P = 0.001; for 60 min: group A = 13.5 (1.7) ml, group B = 16.5 (3.9) ml, P = 0.002] and mean end-tidal sevoflurane concentration [for 30 min: group A = 1.2% (0.2%), group B = 1.4% (0.2%), P = 0.008; for 60 min: group A = 1.2% (0.1%), group B = 1.4% (0.2%), P = 0.010] were significantly lower in group A. Patients in group A had a longer duration of analgesia [361.6 (79.5) min vs. 151.0 (60.2) min, P < 0.001] compared to those in group B. CONCLUSIONS: Preinduction BSCPB during thyroid surgery significantly reduced sevoflurane consumption and increased the duration of postoperative analgesia.

Mycological study of dermatophytosis in a part of South India

Aims: Epidermophyton, Microsporum and Trichophyton are the genera of dermatophytes causing superficial mycoses. These infections are on rise due to increase in immunocompromised patients and favorable environmental conditions in countries like India. The present study was undertaken to identify dermatophytes causing superficial fungal infection by microscopy and culture techniques which helps in accurate diagnosis and appropriate treatment of cases. Methodology and results: Samples were collected from affected sites after cleaning the affected surface with 70% alcohol. All samples were microscopically examined for presence of hyphal structures by digesting in 10% to 40% KOH solution. All samples were inoculated into Sabouraud dextrose agar with chloramphenicol and Sabouraud dextrose agar with cycloheximide and chloramphenicol and incubated at room temperature for four weeks. Tease mount technique and slide culture technique were used for identification of dermatophytes. One hundred and ten samples from clinically suspected dermatophytoses which includes 77(70%) from male and 33(30%) from female patients were processed for identification of dermatophytes. Samples were subjected to microscopy and culture. In 61 samples (54.54%) fungal hyphae were seen by direct microscopic examination (KOH). Fifty six samples (50%) yielded dermatophyte growth in culture. Trichophyton rubrum was the predominant species isolated followed by T. violaceum and T. mentagrophytes. Conclusion, significance and impact of study: Accurate and rapid diagnosis of superficial fungal infection is essential for proper management of cases. Direct microscopy is very good method for routine diagnosis, however culture remains gold standard.

Formulation and evaluation of mini-tablets-filled-pulsincap delivery of lornoxicam in the chronotherapeutic treatment of rheumatoid arthritis

In this present research work, we have designed a pulsincap formulation comprising mini-tablets, which to the best of our knowledge this combination has not been reported yet. We successfully combined the advantages of minitablets technology to meet the optimized requirements of our pulsincap formulation. Our main aim was to target lornoxicam to treat rheumatoid arthritis as per the chronotherapeutic pattern of the disease. Directly compressing method was used to prepare mini-tablets. The drug, polymers and combine mixtures of drug and polymers was evaluated for preformulation testing. Prepared mini-tablets were also evaluated for physicochemical, dissolution and stability studies. From FTIR and DSC evaluation, we found no interaction between the drug and polymers used. For mini-tablets, all the physico-chemical parameters were in limit. The mini-tablets of lornoxicam were filled into an insoluble body of capsule, and its opening was sealed by plugging it with a polymer. The complete capsule body after sealing with a cap was given enteric coating. Different polymers in various concentrations were used as a plug, to identify the most suitable which gives a complete lag time of 5 hours when combined with 5% CAP coating. HPMC-K100M in 30% and sodium alginate in 40% concentrations were identified as the most suitable plugs. Our optimized pulsincap formulations releases lornoxicam after a lag time of 5 hrs and maximum portion of the drug will be released in the early morning hours. It was also found to be stable for a period of 6 months as per ICH guidelines

Comparison of the antiemetic effect of ramosetron with the combination of dexamethasone and ondansetron in middle ear surgery: a double-blind, randomized clinical study

Postoperative nausea and vomiting [PONV] is a frequent complication of middle ear surgery. Ondansetron has been shown to be effective for early PONV and dexamethasone has been shown to be effective for late PONV. Therefore, a combination of dexamethasone and ondansetron is commonly used for middle ear surgery. This study was conducted to compare the combination of ondansetron and dexamethasone with ramosetron for early and late PONV up to 48 h after middle ear surgery. One hundred and twenty adults scheduled for middle ear surgery were allocated to receive either dexamethasone 8 mg and ondansetron 4 mg [n=60] or ramosetron 0.3 mg [n=60]. General anesthesia with inhalation agents was used for all the patients. The incidence and severity of PONV, administration of rescue antiemetic, and the side effects of the antiemetic were documented during the first 48 h after surgery. The incidence of nausea was significantly lower in the dexamethasone and ondansetron group compared to the ramosetron group between 2 and 24 h. The complete response, which is patients with no nausea or vomiting, was significantly more in dexamethasone and ondansetron group compared to ramosetron group between 2 and 24 h and between 24 and 48 h [76% vs. 56%, P=0.02, 93% vs. 81%, P=0.05, respectively]. Overall, complete response was more in dexamethasone and ondansetron group compared to ramosetron group [71% vs. 40%, P=0.01]. The combination of dexamethasone and ondansetron is superior to ramosetron for prevention of PONV after middle ear surgeries

Evaluation of the relationship between pro-inflammatory cytokines and health hazards in workers involved in hazardous waste sites at Karnataka, India

Most of the studies have reported higher occupational health hazards on hazardous waste workers [HWW]. However reports regarding the association between health hazards and pro-inflammatory cytokines in HWW are scantly. The present study was undertaken to evaluate the relationship between occupational health hazards and serum pro-inflammatory cytokines in HWW. One hundred two subjects working in hazardous waste areas in different parts of Bangalore at Karnataka, India were enrolled into the study in 2009. Using questionnaire the respiratory morbidity and other work related problems in HWW was carried. The levels of pro-inflammatory cytokines in study subjects were determined by using Enzyme-linked-immunosorbent assay kits [Pierce Biotechnology, USA]. The differences of serum pro-inflammatory cytokines levels between the groups were computed by using non-parametric Mann-Whitney U test. SPSS 10.0 for windows version of statistical software was used in the analysis. The morbidity conditions such as respiratory [34%], musculo-skeletal [24.5%], past illnesses [12.7%], dermatological [11.8%], gastrointestinal [9.8%], injuries due to contact with sharp objects and heavy equipments [7.8%] and nose and eye [4.9%] problems were observed in HWW. The levels of serum pro-inflammatory cytokines such as IL-8 [P=0.041] and TNF-alpha were significantly associated with subjects having respiratory symptoms and further supporting that they are inflammatory markers in respiratory symptoms

Adult onset urticaria pigmentosa: a case report

Urticaria pigmentosa is a fairly indolent form of cutaneous mastocytosis, which is more prevalent in infants than in adults. Adult onset disease is usually supposed to be associated with systemic disease and has a propensity for polycythemia vera and leukaemia in a certain percentage, though regression has been reported in as many as 19% cases. A useful clue to diagnose indolent forms from malignant forms is that invariably there is thrombocytopenia with leukocytosis in malignant forms. We report an adult female with typical lesions of urticaria pigmentosa, proven by skin biopsy, who showed a good response to H1 and H2 receptor blockage treatment

Dermatological non disease

Dermatological non disease, popularly known as body dysmorphic disorder is encountered among 9-15%of patients visiting a dermatology clinic. It in significant emotional distress and can be associated with other psychiatric disorders. Unfortunately the diagnosis is often missed. Patients insist on undergoing cosmetological procedures but are invariably dissatisfied with the results. This leads to litigations and even physical assaults, hence it is worthwhile for all dermatologists to be well aware of this entity

Bacteremia in leprosy

Leprosy can infect many tissues besides peripheral nerves and skin. Mycobacterium leprae can occasionally invade blood stream. Objectives The aim of the study was to determine the frequency of bacteremia in leprosy patients. Buffy coat smears and smears from peripheral blood samples and slit-skin smears of 20 patients with Hansen`s disease [6 with lepromatous, 8 with borderline lepromatous, and 3 each with borderline tuberculoid and pure neuritic leprosy] were stained with Ziehl-Neelsen method for acid-fast bacilli. Out of 20 patients, slit-skin smears were positive in 10 patients [5 each with lepromatous and borderline lepromatous leprosy] while buffy coat smears and blood smears were positive in 2 and 1 patients of lepromatous leprosy, respectively. Bacteremia rarely occurs in leprosy

Certain immuno-haematological effects of laser irradiation.

The effects of low power He-Ne laser of 7 milliwatt power on certain immuno-haematological parameters were studied using fresh human blood samples. The parameters studied include electrophoretic mobility of haemoglobin, quantification of immunoglobulins, soluble immune complex levels, blood grouping, Rh typing and neutrophil function tests. Our results show that there is no significant change in the parameters studied after laser irradiation for 60 minutes except changes in the electrophoretic mobility of haemoglobin. In addition laser exposure causes haemolysis in all the samples examined.