BACKGROUND Sepsis is a frequently encountered critical care problem wherein great emphasis is laid on early and accurate diagnosis of the infective organism. Blood culture though precise, is time consuming. Empiric antibiotic therapy leads to development of antibiotic resistance amongst organisms. Thus, there is a need for a biomarker that is cost effective, simple and rapid to perform. Procalcitonin elevates in response to chemical mediators produced due to bacteraemia within 2 - 4 hours and serves as an early marker. Neutrophil-Lymphocyte Ratio is available universally and is highly cost-effective. We wanted to assess the utility of Procalcitonin (PCT) and Neutrophil-Lymphocyte Ratio (NLR) in detecting the bloodstream infections and determine their usefulness in establishing the nature of infective organisms. METHODS A retrospective case control study was undertaken from January 2018 to December 2018 in a tertiary care teaching hospital in Madurai, Tamil Nadu. Patients tested for serum PCT, complete blood count and blood culture simultaneously prior to antibiotic therapy were included in the study (n = 288). The study cohort was classified into two groups. Group I, controls (n = 155) and group II, cases (n = 133). Out of 133 patients, 73 % (98) were infected by Gramnegative bacteria and 27 % (35) by Gram-positive bacteria. Data was analysed using SPSS V.16 software (SPSS Inc., Chicago, IL, USA). Students unpaired t test and Mann-Whitney U test were used for intergroup comparisons of continuous variables. p < 0.05 was considered to be statistically significant. Cut off for detecting bacteriemia and gram negative bacteriemia was created using Receiver Operating Characteristic (ROC) curve. RESULTS The area under ROC of PCT to detect gram negative bacteraemia was 0.752 (95 % CI = 0.692 – 0.812). CONCLUSIONS Escherichia coli was the most frequent cause of sepsis. Higher levels of PCT and NLR were associated with gram negative organisms. PCT levels can help in determining the cause of infection. NLR and PCT are able to establish the presence of bacteraemia in a short span of time, thus alleviating the over dependence on blood culture reporting. Such earlier decision-making tools help in reducing empirical antibiotic usage and thereby lessen the burden of bacterial resistance to antibiotics. KEYWORDS Procalcitonin, PCT, Neutrophil Lymphocyte Ratio, NLR, Gram Negative Bacteria, Sepsis, Biomarker
BACKGROUNDSex hormones have a great impact on energy metabolism, body composition, vascular function and inflammatory responses and insulin resistance. Ovarian hormones influence insulin sensitivity across the lifespan of women. DM prevalence also affects women's health across the life stages causing the second highest mortality in South Asians. DM has polyfactorial aetiological differences between males and females. There is need of search of sex/gender specific risk factors of DM in middle aged women. Therefore, this study is undertaken to analyse the association of sex hormones with insulin resistance, obesity and lipid profile thereby to assess the DM risk.
BACKGROUND Preeclampsia is one of the leading causes of morbidity and mortality in pregnant women, if not attended. Numerous methods have been used to predict the onset of preeclampsia with different degrees of accuracy. These methods used included foetal, placental and maternal markers in different stages of pregnancy. Our study attempts to find out if there is an association between preeclampsia and Insulin resistance, and whether insulin resistance can be used as a biomarker for diagnosis of preeclampsia. METHODS This study was performed among one hundred pregnant women of age ranging between 18-35 years and having gestational age between 28 to 34 weeks. Around 200 of them were screened for preeclampsia. Fifty obstetric patients identified as having preeclampsia were included in the study as cases. Fifty healthy pregnant subjects having uncomplicated pregnancies and who have been normotensive throughout gestation were taken as controls (total 100). Whole blood samples and 24 hour urine samples were collected. Serum was used for estimation of glucose and plasma for insulin concentrations. 24 hour urinary protein was measured. Insulin resistance was calculated by HOMA-IR method. RESULTS The mean value of fasting blood glucose in preeclamptic women is 87.27 ± 7.36 mg/dl and that in control is 75.3 ± 12.02 mg/dl and is statistically significant (p=0.0548). The mean value of plasma insulin in preeclamptic women is 57.27 ± 7.1 μ IU/ml and that in control is 26.43 ± 4.23 μ IU/ml and is statistically very significant (p=0.0005). The mean value of insulin resistance in preeclamptic women is 12.46 ± 2.61 and that in control is 5.69 ± 2.14 and is statistically very significant (p=0.0005). CONCLUSIONS Insulin resistance can be used as a biomarker in diagnosis of preeclampsia.
BACKGROUND Over the past decade, with the development of the genome-wide association studies, a dramatic increase of identification of many biological candidate gene mutations and polymorphisms have been examined in association with preeclampsia in its molecular etiopathogenesis. Preeclampsia is one of the leading causes of morbidity and mortality in pregnant women, if not attended. This study attempts to determine the association if any between C282Y allele of HFE gene with preeclampsia, and evaluate the serum iron status in women with preeclampsia and third trimester healthy pregnant women, as this polymorphism is closely associated with haemochromatosis, a hereditary disorder in which serum iron is elevated, which is also seen in pre-eclampsia. METHODS This is a hospital-based case-control study. Study was performed on one hundred pregnant women of 28 to 34 weeks gestation. Fifty preeclamptic women and fifty healthy pregnant women were taken as cases and controls respectively. Whole blood was taken for the extraction of DNA, followed by PCR and gel electrophoresis for the HFE gene polymorphism study and complete blood count analysis. Serum was used for iron, Total Iron Binding Capacity (TIBC) and ferritin estimations. Statistical significance was determined by calculating odds ratio for HFE gene polymorphism study and students t-test for other parameters. p-value of less than 0.05 was considered statistically significant. RESULTS There is no significant association between preeclampsia and HFE gene and C282Y allele polymorphism. 92% of the cases and 98% of the controls do not show mutation in the C282Y allele. Odds ratio for wild type is 1.065 and that of heterozygote is 4.261. 95% confidence interval is large (0.021-54.76), indicating a low level of precision in wild type. Z value for wild type is 0.031 and that of heterozygote is 1.275, p-value for both is not significant. Serum iron, ferritin and %age of transferrin saturation were significantly higher (p= 0.001) in preeclamptic women, in comparison with the control group. Unsaturated Iron Binding Capacity (UIBC) and TIBC were significantly lower (p=0.001) in preeclamptic group. CONCLUSIONS There are increased iron indices in preeclampsia when compared to the controls. Haemoglobin concentration and Haematocrit are raised in preeclampsia. There is no association of C282Y mutation of HFE gene with preeclampsia. Therefore, C282Y allele cannot be used as a molecular marker for preeclampsia.
BACKGROUND Smoking is one of the most common addictions of modern times and needs to be studied in a community as a public health issue. Also, smoking is a modifiable risk factor for type-2 DM. The smoking-related diseases share common pathophysiologies of imbalance of systemic oxidants and antioxidant status, increased inflammatory reactions, insulin resistance and dyslipidaemia. Biochemical assay of serum Gamma-Glutamyl Transferase (GGT) activity is a low cost and highly sensitive laboratory test. Studies have indicated GGT is moderately elevated before the onset of other traditional risk factors for type-2 DM. So, among hepatic markers, the baseline GGT analysis can be an early risk marker of type 2 diabetes in cigarette smokers has to be studied. MATERIALS AND METHODS This is a case-control study on male cigarette smokers. 57 smokers were studied clinically and biochemically for plasma insulin, glucose and liver enzymes including GGT using standard biochemical methods and compared with 42 age and sex matched non-smokers as controls. RESULTS The mean serum GGT in smokers (25.45 ± 10.8) was increased compared to non-smokers (18.8 ± 5.8). Smokers GGT (r=0.396) and HOMA-IR (r=0.352) showed significant positive association with duration of smoking (p<0.05) than fasting blood glucose. Multiple regression analysis showed only duration of smoking (p=0.001) as a dependable factor on GGT. 24.5% (14/57) smokers showed an increased GGT >24 IU/L. Regression analysis showed none of the diabetic risk factors were observed to be dependent on GGT including other liver enzymes. Regression analysis showed GGT is not an independent risk factor for DM. Although, the mean fasting blood glucose (91.4 ± 21.3), BMI (26.1 ± 9.3) and HOMA-IR (7.3 ± 2.3) was increased among cigarette smokers with GGT >24 IU/L. CONCLUSION The baseline GGT assay in cigarette smokers might be associated with the proinflammatory status or be a marker of oxidative stress of smoke toxins. Smokers with baseline GGT >24 IU/L develop insulin resistance should be investigated in future longitudinal studies for prediabetes to consider cigarette smoking as an important modifiable risk factor of type-2 DM.
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