BackgroundSepsis is a global healthcare problem, characterized by whole body inflammation in response to microbial infection, which leads to organ dysfunction. It is becoming a frequent complication in hospitalized patients. Early and differential diagnosis of sepsis is needed critically to avoid unnecessary usage of antimicrobial agents and for proper antibiotic treatments through the screening of biomarkers that sustains with diagnostic significance.Main body of abstractCurrent targeting conventional markers (C-reactive protein, white blood cell, tumour necrosis factor-α, interleukins, etc.) are non-specific for diagnosing sepsis. Procalcitonin (PCT), a member of the calcitonin super family could be a critical tool for the diagnosis of sepsis. But to distinguish between bacterial versus viral infections, procalcitonin alone may not be effective. Rapid elevation in the concentration of procalcitonin and other newly emerging biomarkers during an infection and its correlation with severity of illness makes it an ideal biomarker for bacterial infection. Beside this, the procalcitonin levels can be used for monitoring response to antimicrobial therapy, diagnosis of secondary inflammations, diagnosis of renal involvement in paediatric urinary tract infection, etc.The present article summarizes the relevance of procalcitonin in the diagnosis of sepsis and how it can be useful in determining the therapeutic approaches.ConclusionFurther studies are needed to better understand the application of PCT in the diagnosis of sepsis, differentiating between microbial and non-microbial infection cases and determining the therapeutic approaches for sepsis.

Objective:The prevalence of oxidative stress may be implicated in the etiology of many pathological conditions. Protective antioxidant action imparted by many plant extracts and plant products make them a promising therapeutic drug for free-radical-induced pathologies. In this study, we assessed the antioxidant potential and suppressive effects of Achyranthes aspera by evaluating the hepatic diagnostic markers on chemical-induced hepatocarcinogenesis.Materials and Methods:The in vivo model of hepatocarcinogenesis was studied in Swiss albino rats. Experimental rats were divided into five groups: control, positive control (NDEA and CCl4), A. aspera treated (100, 200, and 400 mg/kg b.w.). At 20 weeks after the administration of NDEA and CCl4, treated rats received A. aspera extract (AAE) at a dose of 100, 200, and 400 mg/kg once daily route. At the end of 24 weeks, the liver and relative liver weight and body weight were estimated. Lipid peroxidation (LPO), superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), glutathione-S-transferase (GST), and reduced glutathione (GSH) were assayed. The hepatic diagnostic markers namely serum glutamic oxaloacetic transminase (AST), serum glutamic pyruvate transminase (ALT), serum alkaline phosphatase (ALP), gamma glutamyl transpeptidase (GGT), and bilirubin (BL) were also assayed, and the histopathological studies were investigated in control, positive control, and experimental groups.Results:The extract did not show acute toxicity and the per se effect of the extract showed decrease in LPO, demonstrating antioxidant potential and furthermore no change in the hepatic diagnosis markers was observed. Administration of AAE suppressed hepatic diagnostic and oxidative stress markers as revealed by decrease in NDEA and CCl4 -induced elevated levels of SGPT, SGOT, SALP, GGT, bilirubin, and LPO. There was also a significant elevation in the levels of SOD, CAT, GPx, GST, and GSH as observed after AAE treatment. The liver and relative liver weight were decreased after treatment with AAE in comparison to positive control group. The architecture of hepatic tissue was normalized upon treatment with extract at different dose graded at 100, 200, and 400 mg/kg. b.w. in comparison to positive control group.Conclusion:These results suggest that A. aspera significantly alleviate hepatic diagnostic and oxidative stress markers which signify its protective effect against NDEA and CCl4-induced two-stage hepatocarcinogenesis.

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Background: Neonatal sepsis is an important cause of neonatal mortality and morbidity. Early diagnosis of sepsis is difficult due to its non- specific clinical presentation. The gold standard for diagnosis is blood culture, which is obtained in only 25%-40% of cases and requires 48-72 hours. There is a need for a sepsis screen for early diagnosis of septicemia and identification of culture negative cases. The objective of the study was to study the role of sepsis for early diagnosis of septicaemia and identification of culture negative cases and to compare the rapid diagnostic tests with blood culture singly and in combinations for specificity and sensitivity.Methods: 60 cases of suspected septicemia were studied. Total leucocyte count, bandforms peripheral smear examination, C-reactive protein assay, micro-ESR, and blood culture study was investigated. Results: Study revealed that CRP had maximum sensitivity while band neutrophil ratio had balanced sensitivity and specificity. In the two tests, CRP with PS/BF had balanced sensitivity and specificity. In the three tests combination, CRP with TC with micro-ESR had balanced sensitivity and specificity in proven sepsis, While CRP with BF with micro-ESR had balanced sensitivity and specificity in most probable sepsis cases.Conclusions: Neonatal sepsis has vague signs and symptoms, so high index of suspicion helps in arriving early diagnosis and management. CRP had maximum sensitivity in the individual tests. Using either two tests (CRP + PS/BF) or three tests (CRP + Micro ESR + BF/TC) most of the sepsis cases could be identified and sepsis negative cases can be ruled out. Sepsis screen is helpful in avoiding overuse of antibiotics.

In a letter to the editor, Raineri SM et al. have given an insight of another dimension of procalcitonin (PCT) use as a diagnostic tool in invasive candidiasis. But based on our preliminary information, PCT is reported as unconventional modes of diagnosis approach which yet to prove its stand-alone biomarker properties for invasive candidiasis.