Diagnostic Accuracy of Serum Presepsin as Biomarker of Bacterial Sepsis in Paediatric Patients.

OBJECTIVE: To determine the diagnostic accuracy of serum Presepsin for bacterial sepsis in paediatric patients keeping blood culture as the gold standard test. STUDY DESIGN: Cross-sectional study. Place and Duration of the Study: Department of Chemical Pathology, Paediatric Emergency Department and Intensive Care Unit, King Edward Medical University (KEMU), Mayo Hospital Lahore, from December 2020 to May 2021. METHODOLOGY: A total of 57 patients, aged >4 weeks and ≤12 years with suspicion of sepsis on the basis of Systemic Inflammatory Response Syndrome to be confirmed by blood culture were enrolled in the study after informed consent. Patients with renal dysfunction and congenital anomalies were excluded. Blood samples were taken for blood culture and Presepsin levels. Presepsin levels were measured by enzyme linked immunosorbent assay (ELISA). Data were analysed by SPSS-20. Quantitative variables were presented as median (IQR) or mean ± SD depending on data distribution. Qualitative variables were presented as frequency and percentage. ROC curve was plotted to determine the optimal cut-off value of Presepsin levels to differentiate between sepsis and non-sepsis. Sensitivity (Sn), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV) of Presepsin were calculated. RESULTS: The median (IQR) age and total leukocyte count, and male: female ratio was not significantly different in patients with and without sepsis. Using 600 pg/ml cut-off value, Sn, Sp, PPV, and NPV for Presepsin were calculated as 72.73, 71.43, 62 and 81%, respectively. CONCLUSION: Serum Presepsin level has overall good diagnostic accuracy to diagnose bacterial sepsis. KEY WORDS: Presepsin, Systemic Inflammatory Response Syndrome, Bacterial sepsis, Paediatric patients.

Co-supplementation of Zinc and Calcium Suppresses Bio-absorption of Lead in Sprague Dawley Rats.

Lead (Pb) is a widespread environmental toxicant and its toxicity causes huge health impacts. The present study was conducted to examine the protective role of zinc (Zn) and calcium (Ca) supplements against bio-absorption of Pb in blood and organs including the liver and kidney. Hence, Sprague Dawley rats were divided in to five groups. G1 served as negative control and was provided with standard diet, G2 as positive control receiving standard diet + PbAc (20 mg/kg BW), G3 was provided with standard diet + PbAc (20 mg/kg BW) + ZnSO4 (20 mg/kg BW), G4 with standard diet + PbAc (20 mg/kg BW) + CaCO3 (7.5 g/kg BW) whereas G5 was fed on standard diet + PbAc (20 mg/kg BW) + ZnSO4 (20 mg/kg BW) + CaCO3 (7.5 g/kg BW). The salts were provided as solution, dissolved in 0.5 mL distilled water via orogastric tube. After 35 days, the overnight fasted rats were decapitated, and blood and organs were collected for analysis of levels of metals and liver and kidney function tests. The results depicted significant decrease in Pb concentration in blood and organs while increase in Zn and Ca absorption was observed as a result of Zn and Ca supplementation with Zn being better than Ca alone, specially however, combined effect of these supplements was more profound in improving liver and kidney stress biomarkers and maintained the normal architecture of renal and hepatic parenchyma. It was concluded that Zn and Ca co-supplementation hinder Pb absorption in blood, the liver, and kidney thus suggesting that their intake may protect from Pb toxicity.

Evaluating the anti-arthritic potential of walnut (Juglans regia L.) in FCA induced Sprague Dawley rats.

Rheumatoid arthritis (RA) is an autoimmune progressive disease, associated with many pathophysiological consequences. Owing to the adverse effects and higher costs of pharmaceuticals, people are now looking for complementary and alternative remedies. In this milieu, the present study was designed to explore the therapeutic potential of walnuts against FCA-induced arthritis in rat models. Purposely, 50 Sprague Dawley rats were housed in a well-ventilated animal room and separated into 5 groups of 10 rats each. The rats were categorized as G0 (negative control), G1 (positive control, i.e., FCA induced untreated arthritic rats), G2 (arthritic rats treated with MTX), G3 (arthritic rats treated with walnut feed), and G4 (arthritic rats treated with walnut extract), with an efficacy trial lasting for 42 days. The physical analysis explicated that paw swelling was significantly improved by 10%-12.8% in treatment groups after the intervention when compared with positive control. Moreover, biochemical analyses revealed significantly lower levels of ESR, CRP, and RF in rats treated with walnut-based interventions when compared to positive control. ESR values were decreased by 62.4% and 69.92% in G3 and G4 , whereas CRP levels were improved by 56.20% and 77.78% in G3 and G4 when compared with G1 . Likewise, RF values decreased in G2 , G3 , and G4 by 64.71%, 55.88%, and 69.24%, respectively when compared to G1 . The histological examination demonstrated the potential role of walnut-based interventions in reducing the severity of disease by decreasing cell infiltration, bone erosion, and paw inflammation. Meanwhile, the gene expression analysis revealed that walnut-based interventions protected the paw joints from damage by downregulating the RANKL-OPG pathway. Conclusively, walnut feed and extract may serve as potent anti-arthritic interventions with no side effects. PRACTICAL APPLICATIONS: Plant-based therapeutics are effective in the prevention and management of various chronic diseases. The current research explored the anti-arthritic potential of walnuts. Walnut feed and extract effectively reduced the serum arthritic biomarkers as well as downregulated the genes involved in bone destruction. Thus, the inclusion of dietary ingredients having therapeutic potential such as walnuts may be synchronized in clinical practices to ameliorate arthritis.

Probing the antioxidant potential of Juglans regia (walnut) against arthritis-induced oxidative stress in Sprague Dawley rats.

Oxidative stress is the underlying cause of various chronic diseases and can contribute to its progression. Plant-based therapeutics are effective in the prevention of various chronic diseases through the management of underlying causes. Walnuts owing to their rich phytochemistry possess antioxidative potential. In this context, the present research was designed to explore the therapeutic potential of walnut against arthritis-induced oxidative stress in rat model. Purposely, 50 Sprague Dawley rats were separated into five groups of 10 rats each. The rats were categorized as G0 (negative control), G1 (positive control), G2 (methotrexate), G3 (walnut feed), and G4 (walnut extract). Walnut feed and extract significantly reduced oxidative stress by improving the antioxidant enzymes in arthritic rats. Total oxidative stress was reduced by 41.44% and 21.52% in G3 while 52.81% and 36.76% in G4 when compared with G1 and G2 , respectively. Antioxidant enzyme levels in serum were significantly improved after the walnut-based interventions. Evidently, superoxide dismutase level improved by 74.5% in G3 and 83.40% in G4 , while catalase level increased by 51.99% in G3 and 61.34% in G4 , respectively, when compared with G1 . Liver function biomarkers, that is, ALP and AST, were decreased in G3 and G4 when compared with G1 and G2 . The histopathological examination illustrated the promising role of walnut-based interventions in conserving the structural integrity of hepatic and renal tissues. Meanwhile, gene expression analysis revealed that walnut treatments protected from oxidative damage by the downregulation of Dual-oxidases expression. Conclusively, walnut feed and extract might serve as potent antioxidant intervention with no potential side effects. PRACTICAL APPLICATIONS: The present work was aimed to evaluate the efficacy of walnut-based interventions against arthritis-induced oxidative stress. The walnut-based interventions positively modulated the antioxidant enzymes, liver, and kidney functions, while downregulating the gene associated with oxidative stress in animal model. Consequently, the current findings suggest wider applications of walnuts to avoid free radical induced damage during arthritis; however, human intervention studies may be carried out to further understand the mechanism of their bioefficacy.

Wound Leakage With the Use of Calcium Sulphate Beads in Prosthetic Joint Surgeries: A Systematic Review.

Since its first use as a bone void filler at the end of the 19th century, calcium sulphate products have been adapted in different ways to aid orthopaedic surgeons. Calcium sulphate local antibiotic delivery systems offer a promising solution in the delivery of high antibiotic concentrations locally for an extended period of time. Over the years, multiple centres have reported side effects such as wound drainage, heterotrophic ossification and hypercalcaemia. This study was carried out to assess the risk of wound drainage in prosthetic joints after implantation of antibiotic-impregnated calcium sulphate beads. Two reviewers searched the literature in three online databases using the Cochrane methodology for systematic reviews. The search of databases yielded 182 articles. The studies without reported post-operative complications, mainly drainage outcomes, were excluded. After screening, seven articles were deemed suitable and selected. Out of the 1,112 cases identified, 43 joints developed wound drainage after calcium sulphate bead placement. This complication was resolved in all these cases by either conservative or operative approaches. The factors implicated in the development of wound drainage include the volume of the product used, procedural placement and host factors. The result of this systematic review shows that calcium sulphate products can be used for treatment and prophylaxis in prosthetic joints with a risk of post-procedural wound drainage. This risk, however, is lesser with the use of synthetic calcium sulphate products as compared with conventional calcium sulphate products.

The Risk of Iatrogenic Hypercalcemia in Patients Undergoing Calcium Sulphate Beads Implantation in Prosthetic Joint Surgery: A Systematic Review.

Calcium sulphate beads are increasingly being used in the management of prosthetic joint infections (PJI). Traditionally their use was limited to a void or dead space-filling combined with other additives such as Hydroxyapatite. Over the last decade, they have been developed to act more frequently as an antibiotics delivery system. Stimulan, a bio-absorbable form of Calcium sulfate, theoretically has an increased risk of hypercalcemia. Over the last few years, there have been published case reports which report it as an isolated cause of iatrogenic hypercalcemia. The sparsity of literature on this topic makes it difficult for surgeons to decide on the use of Calcium sulphate beads in patients with hypercalcemia predisposition in conditions like autoimmune disorders, sarcoidosis, malignancy, granulomatous diseases, heterotopic ossification, and hyperparathyroidism. The study was performed to assess the risk of hypercalcemia in patients after Calcium sulphate beads implantation in PJI. Two reviewers searched relevant literature in 3 online databases using cochrane methodology for systematic reviews. Studies reporting complications with the use of calcium sulphate beads in prosthetic joints were included. Studies reporting on less than five patients and studies reporting use in any other surgeries were excluded. The search of databases resulted in a total of 96 articles. After screening, a total of four articles were deemed suitable to be included in the analysis. A total of 1049 patients underwent calcium sulfate beads implantation, out of which 44 (4.2%) reported hypercalcemia with 41 (3.91%) transient in nature and 3 (0.28%) required management, including one with ICU admission. The result of this systematic review shows that calcium sulphate beads are safe and effective against PJI. There is a significant risk of transient hypercalcemia in susceptible patients and a low risk of symptomatic hypercalcemia.