Prospective Validation and Comparison of Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) and Site Other Than Lower Limb, Immunosuppression, Age, Renal Impairment, and Inflammatory Markers (SIARI) Scoring Systems for Necrotizing Fasciitis.

INTRODUCTION: Necrotizing fasciitis (NF) is a rapidly progressing infection of the soft tissues associated with high morbidity and mortality and hence it is a surgical emergency. Early diagnosis and treatment are of paramount importance. LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) and SIARI (Site other than lower limb, Immunosuppression, Age, Renal impairment, and Inflammatory markers) scoring systems have been established for early and accurate diagnosis of necrotizing fasciitis. This study compared the two scoring systems for diagnosing NF, predicting management, and elucidating the prognostic performance for re-operation and mortality. METHODS: This prospective study was conducted in PGIMER Chandigarh, India, between February 2020 and June 2021. The study was approved by the Institutional Review Board (No. INT/IEC/2020-90). The clinical presentation, laboratory parameters, and imaging were used to classify patients into NF or severe cellulitis groups. We also calculated the LRINEC and SIARI scores. Demographic variables and mortality were recorded. The area under the receiver operating characteristic was used to express the accuracy of both scores at a cut-off LRINEC and SIARI scores of ≥6 and ≥ 4, respectively. RESULTS: The study comprised 41 patients with NF and 11 with severe cellulitis. Informed written consent was taken from all the participants. At LRINEC score ≥6, the C-statistic for NF diagnosis was 0.839 (95% confidence interval [CI] 0.682-0.995, P 0.001), which was better than SIARI score at ≥ 4, C-statistic of 0.608 (95% CI 0.43-0.787, P 0.297). Both scores accurately predicted 30-day mortality. The LRINEC score showed a C-statistic of 0.912 (95% CI 0.798-1, P 0.001). Simultaneously, the SIARI score showed 70% sensitivity and 77% specificity, with a C-statistic of 0.805 (0.62-0.99, P = 0.017). CONCLUSIONS: LRINEC score is an effective diagnostic tool for distinguishing necrotizing fasciitis from severe cellulitis. Additional research is required to establish the SIARI score's external validity.

Lead-induced Hepatotoxicity and Evaluation of Certain Anti-stress Adaptogens in Poultry.

A total of 225 day-old sexed male broiler chicks (Vencobb strain) were divided randomly into 15 groups consisting of 15 chicks in each group to study the toxicity of lead on hepatocytes. Group 1 was maintained on basal diet, group 2 on polyherbal formulation (PHF; stressroak), group 3 on shilajith, group 4 on amla and group 5 on vit E + Se. Group 6 was maintained on lead for 6 weeks and group 7 on lead for 4 weeks and subsequently on basal diet without lead for the remaining 2 weeks. Groups 8, 9, 10 and 11 were given lead along with PHF, shilajith, amla and vit E + Se, respectively, throughout 6 weeks. Groups 12, 13, 14 and 15 were given lead containing diet for the first 4 weeks and subsequently treated with PHF, shilajith, amla and vit E + Se, respectively, for the remaining 2 weeks. The activity of alanine transaminase (ALT) was significantly (P<0.05) increased in the toxic control groups at the end of 4(th) week as compared to group 1. However, following treatment, there was a significant (P<0.05) reversal in groups 12-15. The activity of Na(+)/K(+)-ATPase, Ca(2+)ATPase, Mg(2+)ATPase and CYP(450) was significantly (P<0.05) reduced in the liver of toxic control groups 6 and 7 as compared to groups1 through 5, which had the maximum activity of all the groups. Groups 8 through 15 revealed a significant (P<0.05) increase in the activity of these hepatocytic enzymes. The histological sections of the liver in lead toxic control (group 6) showed moderate focal lymphoid aggregates in liver, whereas the lesions were mild to moderate in treated groups and there were no observable lesions in plain control groups. The study revealed protective effect of PHF (stressroak), shilajith, amla and vit E + Se in lead-induced hepatocytic damage.

Development and validation of RP-HPLC-fluorescence method for quantitative determination of quinidine, a probe substrate for P-glycoprotein inhibition assay using Caco-2 cell monolayer.

A simple, sensitive and specific reverse-phase high-performance liquid chromatographic (RP-HPLC) method with fluorescence detection was developed for quantitation of quinidine from HBSS buffer. The method was applicable in the bi-directional transport assay for evaluation of the inhibitory effect of test compounds on P-glycoprotein-mediated quinidine transport; quinidine was used as a probe P-glycoprotein substrate. The calibration curve was linear (correlation coefficient >/=99) in the range 0.30-100.00 nm. The method was validated and is specific and sensitive with limit of quantitation of 300 pm for quinidine. The method was found to be accurate and precise in the working calibration range. Stability studies were carried out at different storage conditions where the analyte was found to be stable. The applicability and reliability of the analytical method was evaluated by successful demonstration of efflux ratio (P(app)B --> A/P(app)A --> B) in the Caco-2 cell monolayer efflux assay. The efflux ratio for quinidine (100 nm) alone was 10.8, which reduced to less than 2 in the presence of the classical P-gp inhibitors verapamil and ketoconazole (100 mum each).