Diagnostic value of different interleukins and procalcitonin in critically ill patients admitted with suspected sepsis

Background: Many biomarkers have now been studied such as C-reactive Protein (CRP), procalcitonin (PCT), etc., and are widely used for the diagnosis of sepsis in clinical practice which may determine the appropriate antibiotic treatment. A flowcytometric cytokine bead array (CBA) assay has now been used to determine multiple interleukins (IL), simultaneously. The aim of this study was to determine the cytokine (IL2, IL4, IL6, IL10, TNF?, INF?, and IL17) profiles of interleukins in plasma of sepsis patients by using multiplex Flowcytometric CBA array assay. Materials and Methods: A total of 99 consecutive patients admitted with the suspected sepsis were studied. PCT concentrations were measured by using the enzyme-linked fluorescent immunoassay (ELFA) technique and flow cytometry-based BD™ CBA Cytokine Kit was used to evaluate levels of 7 cytokines [IL-2, IL-4, IL-6, IL-10, Tumour Necrosis Factor (TNF), Interferon- ? (IFN-?), and IL-17A]. Results: Microbiologically defined infection (MDI) demonstrated a positive culture report in 79/99 (79.7%) of patients. The IL6 [1873.7 (4-5000)] and IL10 [(154.7 (0-1764)] levels were significantly higher in septic patients than those in the negative MDI IL6 [901 (4-5000)] and IL10 [110.4 (4-1372)] levels. The AUROC value of IL6 [0.66 (0.53-0.79)] was found to be the highest among all followed by IL10 [0.65 (0.51-0.79)], IFN? [0.63 (0.51-0.77)], PCT [0.61 (0.48-0.75)], and TNF? [0.55 (0.42-0.69)]. Conclusion: Our study suggests that that IL6 is substantially more economical and can reduce the investigation cost to half as compared with the procalcitonin assay.

A Comparative Evaluation of Rapid Card Test with Enzyme- Linked Immunosorbent Assay for the Detection of HBsAg Among Pregnant Women in a Tertiary Care Hospital

Background: Hepatitis B virus infection is an important health problem and a leading cause of death worldwide. The most important marker for HBV infection is HBsAg. A proper identification of kit is required for proper diagnosis of infection, as well as disease management and prevention. Aims& Objective: - The aim of the present study was to compare rapid HBsAg detection ICT kits for the screening of HBV infection with gold standard ELISA method. Methods: The study comprised 500 blood samples of pregnant women. These samples were tested with ICT kits of (Hepa Card Company) and ELISA (HEPLISA by J. Mitra.). Results: In present study we found 100% sensitivity, 99.59% specificity, 81.81% positive predictive value ,100%Negative predictive value and 99.60% diagnostic efficiency of rapid card test with comparison to ELISA for HBsAg detection. Conclusion: The present study concluded that the overall performance of the rapid ICT kit for HBsAg was equally sensitive to ELISA and yet they were cheap and quicker. It can be recommended that ELISA comparable rapid devices may be allowed to be used for preliminary screening of HBsAg especially in remote areas or where cost is an issue.

Seroprevalence & Risk Factors of Hepatitis B Surface Antigen among Pregnant Women Attending a Tertiary Care Hospital of Southern Rajasthan, India

Background: Hepatitis B virus infection is a major global health problem and India accounts for 10- 15%of the entire pool of HBV carriers of the world. Prevalence of Hepatitis B in pregnant women worldwide is 2.5 to 1.5%, whereas in India it is 2 to 7%. Hepatitis B virus is a double stranded DNA virus. The study was undertaken to determine the seroprevalence of Hepatitis B among the pregnant women in southern part of Rajasthan at a rural based tertiary care teaching hospital. Methods: This is a prospective study conducted at a tertiary care hospital, Udaipur, Rajasthan, from August 2015 to December 2017.Blood samples were collected from 1011 pregnant women with age ranging from 15- 45 years. Screening of HBsAg was done by RPHA method and positive HBsAg tests were confirmed by ELISA. The data of those , who were found to be positive for HBsAg was statistically analyzed with the chi square tests, and results were considered significant if the p value was <0.05. Results: The overall HBsAg seroprevalence rate was 1.28%, among the total 1011 pregnant women included in this study. HBsAg seroprevalence was highest, (1.64%) in 15-25 years of age group, and 1.71% in the second trimester of pregnancy. The correlations of seroprevalence rate of HBsAg among selected age groups and according to second trimester of pregnancy were not found statistically significant. (p value>0.05) Conclusion: In this study the seroprevalence of Hepatitis B surface antigen was 1.28%. To prevent vertical transmission in the pregnant women, they should be screened for HBsAg at the first antenatal visit for appropriate management.

The IRF5 rs2004640 (G/T) polymorphism is not a genetic risk factor for systemic lupus erythematosus in population from south India

Background & objectives: Genetic aberrations disrupting toll-like receptor and interferon homeostasis enhance the risk of systemic lupus erythematosus (SLE). Raised serum interferon-alpha (IFN-?) levels in SLE patients have been ascribed to polymorphism (rs2004640 G/T) in interferon regulatory factor 5 (IRF5) gene, resulting in enhanced transcript splicing. A positive association between IRF5 polymorphism and SLE risk has been reported in many populations. This study was aimed to find out frequency of IRF5 rs2004640 G/T polymorphism in patients with SLE and healthy controls and to assess its influence on susceptibility, clinical and serological characteristics of SLE. Methods: IRF5 rs2004640 (G/T) polymorphism was analyzed in 300 SLE patients and 460 age and sex matched controls by real-time PCR. Results: The IRF5 rs2004640 (G/T) polymorphism did not confer risk of SLE or influence clinical or serological phenotype. However, the mutant allele conferred a borderline risk to develop thrombocytopenia (odds ratio: 2.05, 95% confidence interval: 0.97�3, P=0.06) in patients with SLE. Interpretation & conclusions: Our study revealed that the IRF5 rs2004640 polymorphism was not a risk factor for SLE in population from south India. It may, however, be a useful genetic marker for thrombocytopenia in SLE patients. Although we could not demonstrate susceptibility toward lupus in the presence of IRF5 rs2004640 (G/T) polymorphism, further exploration of the genetic variability of IRF5 may help uncover its pathogenic role in Indian SLE patients.

Seroprevalence of Hepatitis B Virus Infection among OPD Patients Attending Tertiary Care Hospital

Background: Hepatitis B infection is a major global health problem. The hepatitis B surface antigen (HBsAg) in serum is the first seromarker to indicate active HBV infection either acute or chronic. The seroprevalence of Hepatitis B surface antigen among general population attending OPD at a tertiary care hospital is useful in assessing true nature of problem, which can help to estimate the magnitude of HBV infection and aid in devising preventive measures. The aim of the study was to determine the seroprevalence of Hepatitis B infection among OPD patients attending a tertiary care hospital. Methods: Data from Dec 2015- April-2017 for OPD patients underwent HBsAg screening were collected and analysed. Results: A total number of 3891 patients were screened for HBsAg among them 1731 (44.48%) were males and 2160 (55.51%) were females. The seroprevalence of HBsAg in total OPD patients was 90(2.31%), was higher in males 46(2.65%) as compared to females 44(2.03%). The highest seroprevalence was found in 60-71 (4%) age group. Conclusions: The seroprevalence of Hepatitis B positive cases was 2.31% among OPD patients. Also, the rising seroprevalence rates of hepatitis B in males need urgent attention.

Use of Novel Oral Anticoagulants Post-cardioversion in Atrial Fibrillation: A Safety Review.

Atrial fibrillation is considered the most common sustained arrhythmia worldwide, especially in geriatric population and is associated with significant morbidity and mortality. Arterial embolization is the most serious complication of atrial fibrillation. Vitamin K antagonists were the only form of oral anticoagulant medication approved for long-term use since 1940s, till the advent of three novel oral anticoagulants- dabigatran, rivaroxaban and apixaban. The new anticoagulants are more convenient to administer than warfarin. Pivotal trials of these drugs showed that they are not only as effective as warfarin, but also cause less intracranial bleeding. There is data emerging regarding the safety of these agents in the context of cardioversion. The purpose of this review is to examine the current published safety data for the use of novel oral anticoagulants around the time of cardioversion.

Rifampicin induced thrombocytopenia.

Thrombocytopenia is an uncommon but potentially life threatening complication of certain anti-tubercular drugs and is characterized by rapid destruction of platelets whenever an offending drug is taken by a susceptible person. Here is a case report of Rifampicin induced Thrombocytopenia. This case is being reported for purpose of its rare occurrence and documentation.

Endoscopic Management of Cornual Pregnancy

Cornual interstillal pregnancy is a rate form of ectopic pregnancy. It usually has catastrophic prcsentations but in this case patient presented as missed abortion and was diagnosed as degenerating cornual my oma on ultrasound. This case was managed endoscopically by cornual evacuation of small friable ball of tissue which on histopathology was confirmed to be products of conception. Endoscopic management has man) advantages over conventional methods.

Rapid detection of sex chromosomal aneuploidies by PCR.

In this report we present a method to determine sex chromosomal aneuploidies by duplex polymerase chain reaction with sufficient precision to distinguish between one, two and more copies of X and Y sequences. We coamplified an autosomal gene segment (exon 33 of neurofibromatosis type I gene on chromosome 17) as an internal standard for our sequence of interest (AMXY) on X and Y chromosomes. By using this standard as a reference for two gene copies we could visually estimate the relative gene dosage for the X-, and Y-specific AMXY sequences in the DNA sample under consideration. We have evaluated this method in normal males and females and in patients with known sex chromosomal aneuploidies and have found it to be a reliable and quick tool for detection of numerical sex chromosomal abnormalities.

Experimental hepatic amoebiasis in inbred mice.

A model of hepatic amoebiasis in two inbred strains of mouse (Swiss and BALB/c, has been developed by introducing Entamoeba histolytica-infected hamster liver tissue in between the adjacent liver lobes of mouse. It is expected that this model might be useful in studying various parameters of host-parasitic interactions and experimental chemotherapy of amoebiasis with relative ease.

Effect of clofazimine: detailed studies of small intestine functions.

Twenty one patients of leprosy were studied for gastrointestinal symptoms and submitted to detailed intestinal absorption tests and jejunal biopsy before and after the institution of Clofazimine therapy. Fifteen patients were administered 100 mg orally daily for 3 months, while six patients with ENL received 300 mg of the drug for 6 weeks initially and then 100 mg daily. Mild diarrhoea and abdominal symptoms occurred in four patients, fecal fat excretion increased in one patient but Schilling's and d-Xylose tests did not alter. No significant changes were produced by Clofazimine therapy in jejunal mucosa. Clofazimine crystals were seen in the lamina properia of one patient, the overlying mucosa was normal. No correlation was found between the abnormality in mucosal pattern, crystal deposition, absorption parameters or symptomatology and doses of drug taken.