Diagnostic and prognostic value of heparin-binding protein in sepsis: A systematic review and meta-analysis.

BACKGROUND: Sepsis remains a leading cause of death worldwide. In this context, heparin-binding protein (HBP) has emerged as a possible biomarker, drawing significant attention for its diagnostic and prognostic usefulness in septic patients. Despite this advancement, the literature yields conflicting results. This study is intended to critically evaluate the diagnostic and prognostic value of HBP in critically ill septic patients. METHODS: We searched multiple databases, including PubMed, SCOPUS, Web of Science, and EBSCO, to identify relevant studies on April 27, 2023. We included studies investigating sepsis or its severe outcomes that reported HBP levels and the required data to create 2 × 2 tables. We used R version 4.2.2 and R Studio to analyze the pooled diagnostic accuracy outcomes. The diagmeta package was utilized to calculate the optimum cutoff value. RESULTS: In our meta-analysis, we incorporated 28 studies including 5508 patients. The analysis revealed that HBP has a sensitivity of 0.71 (95% CI: 0.60; 0.79) and a specificity of 0.68 (95% CI: 0.51; 0.81) in diagnosing sepsis, respectively. HBP demonstrated moderate prognostic accuracy for mortality at a cutoff value of 161.415 ng/mL, with a sensitivity and specificity of 72%, and for severe sepsis outcomes at a cutoff value of 58.907 ng/mL, with a sensitivity and specificity of 71%. CONCLUSION: Our findings indicate a relatively moderate diagnostic and prognostic accuracy of HBP for sepsis. Future studies are required to verify the accuracy of HBP as a biomarker for sepsis.

The diagnostic utility of heparin-binding protein among patients with bacterial infections: a systematic review and meta-analysis.

BACKGROUND: Bacterial infections are considered a leading cause of hospitalization and death globally. There is still a need for a rapid and feasible biomarker for bacterial infections. Heparin-binding protein (HBP) was shown to be related to bacterial infections. The objective of the study is to investigate the diagnostic accuracy of HBP in bacterial infections. METHODS: Articles were screened in PubMed, SCOPUS, Web of Science, and Cochrane to recognize eligible studies. We included studies investigating the diagnostic accuracy of HBP and reported the necessary data to construct 2 × 2 tables. A univariate analysis was conducted to determine the pooled sensitivity and specificity, and a bivariate diagnostic random-effects model was used to calculate the optimal cut-off point. RESULTS: The analysis comprised sixteen studies in total. Plasma HBP showed a sensitivity of 0.90 (95% CI: [0.79, 0.96]) and a specificity of 0.87 (95% CI: [0.66, 0.96]) in diagnosing bacterial infections using blood samples. Pooling data from seven studies revealed that HBP in cerebrospinal fluid (CSF) has sensitivity and specificity of 96% (95% CI: [0.85, 0.99]), and 95% (95% CI: [0.89, 0.97]), respectively, for the diagnosis of bacterial meningitis. In urinary tract infections (UTI), urine-HBP was revealed to have a high diagnostic value in discriminating bacterial from non-bacterial UTI infection at a cut-off value of 32.868 ng/ml with sensitivity and specificity of 87%. CONCLUSION: HBP has shown a high diagnostic accuracy of bacterial infections, including UTI and meningitis. Further studies are needed to determine its prognostic value and whether it could guide antibiotic therapy.

Successful surgical treatment of desmoplastic small round cell tumor in a postmenopausal woman: A rare case report.

INTRODUCTION AND IMPORTANCE: Desmoplastic small round cell tumor (DSRCT) is a type of soft tissue sarcoma that arises from mesenchymal cells and primarily affects young males. CASE PRESENTATION: We present a case of a 58-year-old multiparous woman who presented with colic abdominal pain in the epigastric area and hypogastric area, along with dyspeptic complaints, nausea, constipation every 2-3 days, and a gradual increase of the size of the abdomen. CLINICAL DISCUSSION: DSRCT is an uncommon and extremely aggressive tumor that occurs in the abdomen. It is typically associated with a grim prognosis and primarily affects young males aged 20 to 30. In our case, the patient underwent a surgical procedure to remove the entire tumor, without the need for chemotherapy or radiotherapy. This decision was made considering the absence of metastasis and cancerous cells in the ascites and the potential adverse effects of these treatments. Throughout a 12-month follow-up period, the patient's health condition improved, as indicated by weight gain. CONCLUSION: This case report highlights the importance of considering DSRCT in the differential diagnosis of abdominal masses in postmenopausal women and emphasizes the potential for successful treatment through surgical intervention.

Amelanotic nodular melanoma misdiagnosed as a benign skin lesion: A rare case report from Syria.

INTRODUCTION: and importance: Amelanotic melanoma is a rare and aggressive type of melanoma. It is often diagnosed late because of the lack of melanin in its cells, and this causes treatment delay and, eventually, poor prognosis. CASE PRESENTATION: We report a case of a 79-year-old female patient that presented to the dermatology clinic with an asymptomatic lesion on the medial heel of the right foot, with no medical history of previous melanoma or related skin cancer. To get the right diagnosis, an incisional biopsy was performed, and the sample was sent to the pathology laboratory. The sample was stained with S100 and HMB-45 stains, and both were positive. Also, no melanin pigmented cells were seen, so the diagnosis was amelanotic nodular melanoma. The patient was then referred to surgery. The lesion was successfully excised with 5cm safety margins, and the whole lesion was sent to the pathology laboratory to ensure that the edges are malignancy-free. After 18 months of follow-up, the patient is in good health. CONCLUSION: Accurate and early diagnosis with appropriate clinical intervention can improve the prognosis and reduce mortality and morbidity rates.