Evaluation of serum neuron specific enolase levels among patients with primary and secondary burning mouth syndrome.

INTRODUCTION: Burning mouth syndrome is a painful condition of the oral cavity with ambiguous pathogenesis and diagnosis. Neuron-specific enolase is increased in several conditions including peripheral neuropathy of diabetes, ophthalmopathies, spinal cord injuries and tumors. Evidence on association of burning mouth syndrome and neuron-specific enolase is limited. AIM: This study aims to evaluate neuron-specific enolase levels in primary and secondary burning mouth syndrome patients and compare the levels of neuron-specific enolase with associated conditions in secondary burning mouth syndrome. METHODS: One hundred and twenty-eight patients of more than 18 years of age with no gender predilection and having clinical symptoms of burning mouth syndrome and 135 healthy subjects were included. All the patients fulfilled Scala's criteria for the diagnosis of burning mouth syndrome, including "primary" (idiopathic) and "secondary" (resulting from identified precipitating factors) burning mouth syndrome patients. Blood samples were obtained from burning mouth syndrome patients. Serum neuron-specific enolase was evaluated using enzyme-linked immunosorbent assay. To compare means and standard deviations, among primary and secondary burning mouth syndrome, data was analysed with analysis of variance and multiple comparisons test. RESULTS: The mean age of the study participants for burning mouth syndrome and healthy subjects was 53.30 and 51.6 years, respectively. Amongst the secondary burning mouth syndrome group, 32 (25%) of the patients had menopause, 15 (11.7%) had diabetes, eight (6.2%) of the patients had nutritional deficiency, seven (5.4%) had combined diabetes, menopause, and depression, six (4.6%) had combined diabetes and depression, four (3.1%) were diagnosed with Sjögren's syndrome. A minor percentage of 2.3% (three) had gastroesophageal reflux disease, while the remaining three (2.3%) patients in the secondary burning mouth syndrome group were on anti-depressants. There was a statistically significant increase in the levels of neuron-specific enolase in primary burning mouth syndrome as compared to the secondary burning mouth syndrome and healthy groups. Among the subgroups of secondary burning mouth syndrome, diabetic individuals showed a significant increase in neuron-specific enolase level when compared with other conditions in the secondary burning mouth syndrome patients.Discussion and conclusion: The raised serum neuron-specific enolase levels in patients suffering from primary burning mouth syndrome highlight a possible neuropathic mechanism. It was also increased in the sub-group of secondary burning mouth syndrome patients having diabetes. Although it cannot be ascertained whether the deranged values in the diabetic group were due to burning mouth syndrome or due to diabetes, the raised quantity of neuron-specific enolase in the primary burning mouth syndrome group is a reliable diagnostic indicator. Future studies on the assessment of neuron-specific enolase levels as a diagnostic tool for onset and management of primary and secondary burning mouth syndrome are recommended.

Diagnostic Accuracy of Serum Procalcitonin (PCT) as an Early Biomarker of Neonatal Sepsis using Blood Culture as Gold Standard.

OBJECTIVE: To ascertain the diagnostic accuracy of serum PCT as an early biomarker of neonatal sepsis using blood culture as gold standard, so that the condition could be diagnosed and managed early to prevent and reduce morbidity and mortality in neonates.  Study Design: Cross-sectional study. PLACE AND DURATION OF STUDY: Dr. Ziauddin University Hospital, Karachi, from March 2019 to December 2019. METHODOLOGY: A total of 171 neonates, 1-29 days of age, presented with clinical diagnosis of neonatal sepsis, were included in this study. Patients' data regarding age, gender, birth weight, prematurity and premature rupture of membranes (PROM) were collected. Blood cultures were performed in Microbiology Department; and Serum PCT was analyzed on Electrochemiluminescence Immunnoassay Analyzer (Cobas e601). Diagnostic accuracy, including sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of PCT were calculated with contingency tables using blood culture findings as gold standard. RESULTS: Out of 171 clinically diagnosed cases of neonatal sepsis, 86 (50.3%) were confirmed as having neonatal sepsis (blood culture positive). There was a significant difference in serum PCT levels in both the groups. The sensitivity of PCT was 97.7%; specificity 70.6%; PPV 77.1; NPV 96.8%; likelihood ratio of a positive test (LR+ve) 3.32; likelihood ratio of a negative test (LR -ve) 0.03, and cumulative diagnostic accuracy of PCT 84.2%. CONCLUSION: PCT is a very useful biomarker for the early diagnosis of neonatal sepsis, showing 84.2% diagnostic accuracy. Thus PCT can help in making early clinical decisions regarding management of patients. Key Words: Diagnostic accuracy, PCT, Neonatal sepsis.

Differential expression of salivary S100A7 in oral submucous fibrosis.

AIM: To investigate the expression of salivary S100A7 levels among patients with oral submucous fibrosis (OSF) and healthy controls. METHOD: A total number of 60 participants were included in the study (30 OSF cases and 30 healthy controls). Demographic data was collected using a structured baseline questionnaire. Salivary S100A7 levels were quantified using enzyme-linked immunosorbent assay. Data was analyzed using Student t-test. Pearson correlation test was used to evaluate correlation between S100A7 levels and independent variables such as frequency and duration of areca nut use, gutka use, and mouth opening. RESULTS: The mean value of salivary S100A7 for OSF group was 0.275 ng/ml, whereas mean value of salivary S100A7 for healthy controls was 0.195 ng/ml. Student t-test indicated that there was statistically significantly higher levels of S100A7 in OSF group as compared to healthy controls (p < .001). When the clinical variables of individual groups were analysed, a significant negative correlation was found between salivary S100A7 and duration of areca nut (p = .009) and gutka chewing (p = .03), whereas a significant positive correlation was found for mouth opening (p = .04). CONCLUSION: OSF presented higher levels of salivary S100A7 levels as compared with healthy individuals and may be used as surrogate measure to identify subjects at risk for OSF.

Diagnostic Accuracy of Risk of Ovarian Malignancy Algorithm (ROMA) in Post-Menopausal Patients with Ovarian Mass.

OBJECTIVE: To determine the diagnostic accuracy of ROMA in postmenopausal women with history of ovarian mass. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Dr. Ziauddin University Hospital, Karachi, from May 2014 to June 2015. METHODOLOGY: Two hundred and sixty postmenopausal women of 40-65 years of age with ovarian masses, planned for surgery, were included in the study. Their samples were obtained preoperatively and analysed on Abbot Architect i1000 SR immunoassay analyser for quantitative estimation of tumor markers, i.e. HE4 and CA125. By combination of these two tumor markers, ROMA scores were calculated and studied after histopathological verification of masses. RESULTS: Total number of patients were 260, out of which 122 (46.9%) were diagnosed as having ovarian cancer, while 138 (53.0%) were diagnosed as benign condition. Median ROMA score levels in patients with malignant masses were 95.58 (IQR=44.4) as compared to 20.6 (IQR=14) in benign masses. ROMA had sensitivity 92.6% (CI=86.47-96.04), specificity 78.3% (CI=70.09-83.82), positive predictive value 79% (CI=70.87-84.29), negative predictive value 92.3% (CI=86.02-95.9) and positive likelihood ratio 4.26, while negative likelihood ratio 0.1. Diagnostic accuracy of ROMA was 85%, based on ROC curve analysis. ROMA had the highest sensitivity in detecting ovarian carcinoma. CONCLUSION: ROMA is a very useful diagnostic tool for the preoperative stratification of patients with ovarian masses showing 85% diagnostic accuracy. However, there is need of more studies with homogenous laboratory procedures for HE4 and CA125 assays as well as patients, selection criteria, so we can draw firm conclusion about utility of ROMA in clinical setups.