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2.
J Trop Pediatr ; 68(3)2022 04 05.
Artigo em Inglês | MEDLINE | ID: mdl-35657202

RESUMO

We aimed to study the diagnostic utility of cerebrospinal fluid (CSF) procalcitonin (PCT) in neonates with meningitis. All the neonates with sepsis who qualified for lumbar puncture were prospectively evaluated. The neonates were classified into Meningitis and No meningitis group based on predefined criteria. CSF PCT was estimated in these neonates along with cytological and biochemical parameters. A total of 113 neonates were included in the study with 29 in the meningitis group and 84 in the no meningitis group. The median PCT levels were higher in babies with meningitis as compared to those without meningitis [0.194 (0.034-0.534) in meningitis group vs. 0.012 (0.012-0.012) ng/ml in no meningitis group, p < 0.001]. The area under curve for CSF PCT was 0.867 (0.77-0.95) and at a cut-off level of 0.120 ng/ml CSF PCT had a sensitivity of 83%, specificity of 84% and positive and negative predictive likelihood ratios of 5.35 and 0.20, respectively for the diagnosis of meningitis. CSF PCT has a good diagnostic accuracy similar to other parameters in the diagnosis of neonatal meningitis and can be considered as an additional diagnostic marker particularly when CSF culture is negative and cytochemical analysis is inconclusive.


Assuntos
Doenças do Recém-Nascido , Meningites Bacterianas , Biomarcadores , Proteína C-Reativa , Calcitonina/líquido cefalorraquidiano , Líquido Cefalorraquidiano , Humanos , Recém-Nascido , Meningites Bacterianas/líquido cefalorraquidiano , Meningites Bacterianas/diagnóstico , Pró-Calcitonina , Curva ROC , Sensibilidade e Especificidade
3.
Medicine (Baltimore) ; 101(24): e29361, 2022 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-35713436

RESUMO

ABSTRACT: Menstrual migraine (MM) has a longer duration and higher drug resistance than non-perimenstrual migraine. Calcitonin gene-related peptide (CGRP) and CGRP receptors are expressed in the peripheral and central nervous systems throughout the trigeminovascular system. The CGRP/CGRP receptor axis plays an important role in sensory physiology and pharmacology. CGRP receptor antagonists and anti-CGRP monoclonal antibodies (mAbs) have shown consistent efficacy and tolerability in the prevention of chronic or episodic migraine and are now approved for clinical use. However, few studies have reported the use of these drugs in MM, and no specific treatment for MM has been approved. This review aimed to shed light on the recent advances in targeting calcitonin gene-related peptides for the treatment of menstrual migraines in PubMed. In this review, we first discuss the axis of the CGRP/CGRP receptor. We then discuss the role of CGRP receptor antagonists and anti-CGRP mAbs in MM treatment. Finally, we discuss the role of the combination of anti-CGRP mAbs and CGRP receptor antagonists in migraine treatment and the drugs that inhibit CGRP release. Altogether, the anti-CGRP mAbs or CGRP receptor antagonists showed good efficacy and safety in the treatment of MM.


Assuntos
Peptídeo Relacionado com Gene de Calcitonina , Transtornos de Enxaqueca , Calcitonina , Antagonistas do Receptor do Peptídeo Relacionado ao Gene de Calcitonina/farmacologia , Antagonistas do Receptor do Peptídeo Relacionado ao Gene de Calcitonina/uso terapêutico , Humanos , Transtornos de Enxaqueca/tratamento farmacológico , Transtornos de Enxaqueca/prevenção & controle , Receptores de Peptídeo Relacionado com o Gene de Calcitonina/uso terapêutico
4.
Rev Med Liege ; 77(5-6): 258-264, 2022 May.
Artigo em Francês | MEDLINE | ID: mdl-35657180

RESUMO

Biomarkers of inflammation such as sedimentation rate, C-reactive protein and procalcitonin are used in daily clinical practice for the diagnosis, prognosis and follow-up of patients with fever or inflammatory syndrome. The purpose of this article is to summarize the current knowledge about these main biological tests and to discuss new biomarkers and new assay approaches such as multiplex technology.


: Le dosage des biomarqueurs de l'inflammation, tels que la vitesse de sédimentation, la protéine-C réactive et la procalcitonine, est utilisé quotidiennement dans le cadre du diagnostic, du pronostic et du suivi des patients fébriles ou souffrant de syndrome inflammatoire. Le but de cet article est de résumer les connaissances actuelles quant à ces principaux tests biologiques et d'aborder les nouveaux biomarqueurs ainsi que les nouvelles approches de dosage comme la technologie multiplex.


Assuntos
Calcitonina , Inflamação , Biomarcadores , Sedimentação Sanguínea , Proteína C-Reativa/análise , Proteína C-Reativa/metabolismo , Humanos , Inflamação/diagnóstico
5.
BMC Pediatr ; 22(1): 272, 2022 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-35550043

RESUMO

Sepsis is among the leading causes of critical illness worldwide. It includes physiologic, pathologic, and biochemical abnormalities, induced by infection. Novel methods for recognizing a dysregulated inflammatory response and predicting associated mortality must be developed. Our aim was to investigate biomarkers that characterize a pro-inflammatory and anti-inflammatory response in patients with fever by comparing predictive validity for sepsis. 165 patients with fever were enrolled in this study, 55 of them had sepsis according to pSOFA criteria. All patients had blood samples drawn at the time of inclusion and after 24 h. CRP, PCT and also IL-6, IL-8 and sFAS levels were significantly higher in patients with sepsis. The AUC of CRP to predict sepsis was 0.799, all the other biomarkers had AUC's lower than that. Cytokines, when used as a single marker, did not show a significant diagnostic performance We analyzed various models of biomarker combinations. CRP combined with sFAS showed increase in sensitivity in predicting sepsis (88% vs. 83%). The highest AUC was achieved, when CRP, IL-6, sFAS and sVCAM-1 markers were combined 0.830 (95% CI 0.762-0.884) with a sensitivity of 70% and specificity of 84%. vs. 0.799 for CRP alone.


Assuntos
Calcitonina , Sepse , Biomarcadores , Proteína C-Reativa , Peptídeo Relacionado com Gene de Calcitonina , Criança , Criança Hospitalizada , Febre/diagnóstico , Febre/etiologia , Humanos , Interleucina-6 , Prognóstico , Precursores de Proteínas , Curva ROC , Sepse/diagnóstico
6.
Neurol India ; 70(2): 721-726, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35532646

RESUMO

Background: The literature regarding the utility of cerebrospinal fluid (CSF) procalcitonin (PCT) in the diagnosis of post-craniotomy bacterial meningitis and differentiating it from aseptic meningitis is sparse. Materials and Methods: CSF total WBC count, sugar, protein, and PCT were measured in febrile patients with suspected post-craniotomy meningitis during the first 30 days following an intradural cranial procedure for non-trauma indications. Patients were diagnosed as postoperative bacterial meningitis if CSF culture was positive (PBM, n = 28) or postoperative aseptic meningitis if CSF culture was sterile and there was no evidence of systemic infection (PAM, n = 31). CSF cytochemical parameters and PCT values were compared between the groups. Normal values of CSF PCT were obtained from 14 patients with noninfectious indications with hydrocephalus. Results: There was no significant difference in CSF total WBC count, sugar, and protein levels between PAM and PBM groups. The median PCT level in CSF in the normal group was 0.03 ng/mL (interquartile range [IQR] 0.02-0.07 ng/mL). CSF PCT in the PBM group (median 0.37 ng/mL, IQR 0.2-1.4 ng/mL) was significantly higher than normal values as well as PAM group (median 0.12 ng/mL, IQR 0.07-0.26 ng/mL (P = 0.0004). The area under the receiver operating characteristic (ROC) curve for CSF PCT was 0.767. A cutoff value of 0.12 ng/mL yielded a sensitivity of 85.7% (95% CI: 67.3% to 96%), specificity of 51.6% (95% CI: 33% to 69.9%), positive predictive value of 61.5% (95% CI: 51.9% to 70.3%), and negative predictive value of 80% (95% CI: 60.3.8% to 91.3%). Conclusions: CSF PCT assay in patients who are febrile during the first 30 days post-non-trauma neurosurgical procedures has a role in the early diagnosis of bacterial meningitis.


Assuntos
Meningite Asséptica , Meningites Bacterianas , Biomarcadores/líquido cefalorraquidiano , Calcitonina/líquido cefalorraquidiano , Craniotomia , Progressão da Doença , Febre , Humanos , Meningites Bacterianas/líquido cefalorraquidiano , Meningites Bacterianas/diagnóstico , Pró-Calcitonina/líquido cefalorraquidiano , Estudos Prospectivos , Curva ROC , Açúcares
7.
Curr Oncol ; 29(5): 3494-3498, 2022 05 12.
Artigo em Inglês | MEDLINE | ID: mdl-35621672

RESUMO

Selpercatinib, a RET kinase inhibitor, is an effective treatment for patients with medullary thyroid cancer with RET mutations. In this paper, we present the case of a 62-year-old man with ectopic Cushing's syndrome due to medullary thyroid cancer who received treatment with selpercatinib. Six months later, all the cushingoid features had resolved, and s-calcitonin had decreased from 580 pmol/L to 3.5 pmol/L (normal < 3). After further 6 months, s-calcitonin had normalized (1.5 pmol/L), and radiological evaluation showed a profound tumour volume reduction. We are aware of two other cases where treatment with selpercatinib has also been successful. Thus, selpercatinib may be a promising treatment alternative in patients with ectopic Cushing's syndrome due to medullary thyroid cancer, especially when other treatment options are ineffective or not tolerated.


Assuntos
Carcinoma Neuroendócrino , Síndrome de Cushing , Neoplasias da Glândula Tireoide , Calcitonina/uso terapêutico , Carcinoma Neuroendócrino/tratamento farmacológico , Síndrome de Cushing/tratamento farmacológico , Síndrome de Cushing/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pirazóis , Piridinas , Neoplasias da Glândula Tireoide/complicações , Neoplasias da Glândula Tireoide/tratamento farmacológico , Neoplasias da Glândula Tireoide/patologia
9.
Cells ; 11(9)2022 05 09.
Artigo em Inglês | MEDLINE | ID: mdl-35563897

RESUMO

BACKGROUND & AIMS: Cholangiocytes are the target cells of liver diseases that are characterized by biliary senescence (evidenced by enhanced levels of senescence-associated secretory phenotype, SASP, e.g., TGF-ß1), and liver inflammation and fibrosis accompanied by altered bile acid (BA) homeostasis. Taurocholic acid (TC) stimulates biliary hyperplasia by activation of 3',5'-cyclic cyclic adenosine monophosphate (cAMP) signaling, thereby preventing biliary damage (caused by cholinergic/adrenergic denervation) through enhanced liver angiogenesis. Also: (i) α-calcitonin gene-related peptide (α-CGRP, which activates the calcitonin receptor-like receptor, CRLR), stimulates biliary proliferation/senescence and liver fibrosis by enhanced biliary secretion of SASPs; and (ii) knock-out of α-CGRP reduces these phenotypes by decreased cAMP levels in cholestatic models. We aimed to demonstrate that TC effects on liver phenotypes are dependent on changes in the α-CGRP/CALCRL/cAMP/PKA/ERK1/2/TGF-ß1/VEGF axis. METHODS: Wild-type and α-CGRP-/- mice were fed with a control (BAC) or TC diet for 1 or 2 wk. We measured: (i) CGRP levels by both ELISA kits in serum and by qPCR in isolated cholangiocytes (CALCA gene for α-CGRP); (ii) CALCRL immunoreactivity by immunohistochemistry (IHC) in liver sections; (iii) liver histology, intrahepatic biliary mass, biliary senescence (by ß-GAL staining and double immunofluorescence (IF) for p16/CK19), and liver fibrosis (by Red Sirius staining and double IF for collagen/CK19 in liver sections), as well as by qPCR for senescence markers in isolated cholangiocytes; and (iv) phosphorylation of PKA/ERK1/2, immunoreactivity of TGF-ß1/TGF- ßRI and angiogenic factors by IHC/immunofluorescence in liver sections and qPCR in isolated cholangiocytes. We measured changes in BA composition in total liver by liquid chromatography/mass spectrometry. RESULTS: TC feeding increased CALCA expression, biliary damage, and liver inflammation and fibrosis, as well as phenotypes that were associated with enhanced immunoreactivity of the PKA/ERK1/2/TGF-ß1/TGF-ßRI/VEGF axis compared to BAC-fed mice and phenotypes that were reversed in α-CGRP-/- mice fed TC coupled with changes in hepatic BA composition. CONCLUSION: Modulation of the TC/ α-CGRP/CALCRL/PKA/ERK1/2/TGF-ß1/VEGF axis may be important in the management of cholangiopathies characterized by BA accumulation.


Assuntos
Peptídeo Relacionado com Gene de Calcitonina , Fator de Crescimento Transformador beta1 , Animais , Calcitonina , Cirrose Hepática/metabolismo , Camundongos , Ácido Taurocólico , Fator de Crescimento Transformador beta1/metabolismo , Fator A de Crescimento do Endotélio Vascular/metabolismo
10.
Elife ; 112022 05 23.
Artigo em Inglês | MEDLINE | ID: mdl-35604755

RESUMO

Background: Monoclonal antibodies (mAbs) against calcitonin gene-related peptides (CGRP) are novel treatments for migraine prevention. Based on a previous functional imaging study which investigated the CGRP receptor mAb (erenumab), we hypothesized that (i) the CGRP ligand mAb galcanezumab would alter central trigeminal pain processing; (ii) responders to galcanezumab treatment would show specific hypothalamic modulation in contrast to non-responders; and (iii) the ligand and the receptor antibody differ in brain responses. Methods: Using an established trigeminal nociceptive functional magnetic imaging paradigm, 26 migraine patients were subsequently scanned twice: before and 2-3 weeks after administration of galcanezumab. Results: We found that galcanezumab decreases hypothalamic activation in all patients and that the reduction was stronger in responders than in non-responders. Contrasting erenumab and galcanezumab showed that both antibodies activate a distinct network. We also found that pre-treatment activity of the spinal trigeminal nucleus (STN) and coupling between the STN and the hypothalamus covariates with the response to galcanezumab. Conclusions: These data suggest that despite relative impermeability of the blood-brain barrier for CGRP mAb, mAb treatment induces certain and highly specific brain effects which may be part of the mechanism of their efficacy in migraine treatment. Funding: This work was supported by the German Ministry of Education and Research (BMBF) of ERA-Net Neuron under the project code BIOMIGA (01EW2002 to AM) and by the German Research Foundation (SFB936-178316478-A5 to AM). The funding sources did not influence study conduction in any way. Clinical trial number: The basic science study was preregistered in the Open Science Framework (https://osf.io/m2rc6).


Assuntos
Anticorpos Monoclonais , Antineoplásicos Imunológicos , Encéfalo , Antagonistas do Receptor do Peptídeo Relacionado ao Gene de Calcitonina , Transtornos de Enxaqueca , Anticorpos Monoclonais/farmacologia , Anticorpos Monoclonais/uso terapêutico , Antineoplásicos Imunológicos/farmacologia , Antineoplásicos Imunológicos/uso terapêutico , Encéfalo/diagnóstico por imagem , Encéfalo/efeitos dos fármacos , Calcitonina/uso terapêutico , Peptídeo Relacionado com Gene de Calcitonina/antagonistas & inibidores , Antagonistas do Receptor do Peptídeo Relacionado ao Gene de Calcitonina/farmacologia , Antagonistas do Receptor do Peptídeo Relacionado ao Gene de Calcitonina/uso terapêutico , Humanos , Ligantes , Imageamento por Ressonância Magnética , Transtornos de Enxaqueca/diagnóstico por imagem , Transtornos de Enxaqueca/tratamento farmacológico
11.
J Vis Exp ; (183)2022 05 16.
Artigo em Inglês | MEDLINE | ID: mdl-35635478

RESUMO

Calcitonin gene-related peptide (CGRP) was first discovered in the 1980s as a splice variant from the calcitonin gene. Since its discovery, its role in migraine pathophysiology has been well established, first by its potent vasodilator properties and subsequently by its presence and function as a neurotransmitter in the sensory trigeminovascular system. The migraine-provoking ability of CGRP gave support to the pharma industry to develop monoclonal antibodies and antagonists inhibiting the effect of CGRP. A new treatment paradigm has proven effective in the prophylactic treatment of migraine. One of the useful tools to further understand migraine mechanisms is the ex vivo model of CGRP release from the trigeminovascular system. It is a relatively simple method that can be used with various pharmacological tools to achieve know-how to further develop new effective migraine treatments. The present protocol describes a CGRP release model and the technique to quantify the effect of pharmacological agents on the amount of CGRP released from the trigeminovascular system in rodents. A procedure describing the experimental approach from euthanasia to the measurement of protein levels is provided. The essential isolation of the trigeminal ganglion and the trigeminal nucleus caudalis from both mice and rats and the preparation of rat dura mater are described in detail. Furthermore, representative results from both species (rats and mice) are presented. The technique is a key tool to investigate the molecular mechanisms involved in migraine pathophysiology by using various pharmacological compounds and genetically modified animals.


Assuntos
Peptídeo Relacionado com Gene de Calcitonina , Transtornos de Enxaqueca , Animais , Calcitonina/metabolismo , Peptídeo Relacionado com Gene de Calcitonina/metabolismo , Camundongos , Transtornos de Enxaqueca/tratamento farmacológico , Ratos , Roedores/metabolismo , Gânglio Trigeminal/metabolismo
12.
Sci Signal ; 15(733): eabj8204, 2022 05 10.
Artigo em Inglês | MEDLINE | ID: mdl-35536884

RESUMO

Variants in the gene encoding ankyrin repeat and SOCS box-containing 4 (ASB4) are linked to human obesity. Here, we characterized the pathways underlying the metabolic functions of ASB4. Hypothalamic Asb4 expression was suppressed by fasting in wild-type mice but not in mice deficient in AgRP, which encodes Agouti-related protein (AgRP), an appetite-stimulating hormone, suggesting that ASB4 is a negative target of AgRP. Many ASB4 neurons in the brain were adjacent to AgRP terminals, and feeding induced by AgRP neuronal activation was disrupted in Asb4-deficient mice. Acute knockdown of Asb4 in the brain caused marked hyperphagia due to increased meal size, and Asb4 deficiency led to increased meal size and food intake at the onset of refeeding, when very large meals were consumed. Asb4-deficient mice were resistant to the meal-terminating effects of exogenously administered calcitonin and showed decreased neuronal expression of Calcr, which encodes the calcitonin receptor. Pro-opiomelanocortin (POMC) neurons in the arcuate nucleus in mice are involved in glucose homeostasis, and Asb4 deficiency specifically in POMC neurons resulted in glucose intolerance that was independent of obesity. Furthermore, individuals with type 2 diabetes showed reduced ASB4 abundance in the infundibular nuclei, the human equivalent of the arcuate nucleus. Together, our results indicate that ASB4 acts in the brain to improve glucose homeostasis and to induce satiety after substantial meals, particularly those after food deprivation.


Assuntos
Diabetes Mellitus Tipo 2 , Neuropeptídeos , Proteína Relacionada com Agouti/genética , Proteína Relacionada com Agouti/metabolismo , Proteína Relacionada com Agouti/farmacologia , Animais , Calcitonina/metabolismo , Calcitonina/farmacologia , Diabetes Mellitus Tipo 2/metabolismo , Glucose/metabolismo , Homeostase , Hipotálamo/metabolismo , Camundongos , Neurônios/metabolismo , Neuropeptídeos/metabolismo , Obesidade/genética , Obesidade/metabolismo , Pró-Opiomelanocortina/genética , Pró-Opiomelanocortina/metabolismo , Pró-Opiomelanocortina/farmacologia
13.
Front Immunol ; 13: 843067, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35547733

RESUMO

The diagnostic value of procalcitonin and the prognostic role of PCT clearance remain unclear in neutropenic period after allogeneic hematopoietic stem cell transplantation introduction. This study evaluated 219 febrile neutropenic patients (116, retrospectively; 103, prospectively) who underwent allo-HSCT from April 2014 to March 2016. The area under the receiver operator characteristic curve (AUC) of PCT for detecting documented infection (DI) was 0.637, and that of bloodstream infection (BSI) was 0.811. In multivariate analysis, the inability to decrease PCT by more than 80% within 5-7 days after the onset of fever independently predicted poor 100-day survival following allo-HSCT (P = 0.036). Furthermore, the prognostic nomogram combining PCTc and clinical parameters showed a stable predictive performance, supported by the C-index of 0.808 and AUC of 0.813 in the primary cohort, and C-index of 0.691 and AUC of 0.697 in the validation cohort. This study demonstrated the diagnostic role of PCT in documented and bloodstream infection during the neutropenic period after allo-HSCT. PCTc might serve as a predictive indicator of post-HSCT 100-day mortality. A nomogram based on PCTc and several clinical factors effectively predicted the 100-day survival of febrile patients and may help physicians identify high-risk patients in the post-HSCT neutropenic period.


Assuntos
Transplante de Células-Tronco Hematopoéticas , Sepse , Calcitonina , Febre/etiologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Humanos , Pró-Calcitonina , Estudos Retrospectivos , Sepse/etiologia
14.
PLoS One ; 17(5): e0266652, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35500008

RESUMO

OBJECTIVES: Procalcitonin (PCT) is an acute-phase reactant with concentrations ≥0.5 µg/L indicative of possible bacterial infection in patients with SARS-CoV-2 infection (COVID-19). Some with severe COVID-19 develop cytokine storm secondary to virally driven hyper-inflammation. However, increased pro-inflammatory cytokines are also seen in bacterial sepsis. This study aimed to assess the clinical utility of a cytokine panel in the assessment of COVID-19 with bacterial superinfections along with PCT and C-reactive protein (CRP). METHODS: The retrospective analysis included serum cytokines (interleukins; IL-1ß, IL-6, IL-8 and tumour necrosis factor (TNFα)) measured using Ella™ (Bio-Techne, Oxford, UK) and PCT measured by Roche Cobas (Burgess Hill, UK) in patients admitted with COVID-19 between March 2020 and January 2021. Patients enrolled into COVID-19 clinical trials, treated with Remdesivir/IL-6 inhibitors were excluded. The cytokine data was compared between intensive care unit (ICU) patients, age matched non-ICU patients and healthy volunteers as well as ICU patients with high and normal PCT (≥0.5 vs. <0.5 µg/L). RESULTS: Cytokine concentrations and CRP were higher in COVID-19 patients (76; ICU & non-ICU) vs. healthy controls (n = 24), all p<0.0001. IL-6, IL-8, TNFα and were higher in ICU patients (n = 46) vs. non-ICU patients (n = 30) despite similar CRP. Among 46 ICU patients, the high PCT group (n = 26) had higher TNFα (p<0.01) and longer ICU stay (mean 47 vs. 25 days, p<0.05). There was no difference in CRP and blood/respiratory culture results between the groups. CONCLUSIONS: Pro-inflammatory cytokines and PCT were higher in COVID-19 patients requiring ICU admission vs. non-ICU admissions despite no difference in CRP. Furthermore, TNFα was higher in those with high PCT and requiring longer ICU admission despite no difference in CRP or rate of bacterial superinfection.


Assuntos
COVID-19 , Pró-Calcitonina , Proteína C-Reativa/metabolismo , Calcitonina , Peptídeo Relacionado com Gene de Calcitonina , Cuidados Críticos , Citocinas , Humanos , Unidades de Terapia Intensiva , Interleucina-6 , Interleucina-8 , Estudos Retrospectivos , SARS-CoV-2 , Fator de Necrose Tumoral alfa
16.
J Assoc Physicians India ; 70(4): 11-12, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35443495

RESUMO

Acute Pancreatitis is an acute inflammation of the pancreas.Acute pancreatitis is an acute inflammatory process ranging clinically from mild discomfort with localized inflammation to severe disease involving remote organ systems. There is a continuum from the development of systemic inflammatory response syndrom, to the onset of multiple organ dysfunction (MODS), which is seen in about 24% of patients with acute pancreatitis and carries the highest mortality rate of 36%, and imaging tests showing characteristic findings of acute pancreatitis. Several inflammatory markers are being used routinely in various hospitals in India to assess the prognosis of patients with acute pancreatitis. Among these are the total and differential leukocyte counts, erythrocyte sedimentation rate, and C-reactive protein (CRP), interleukin-6, thioredoxin-1, and polymorphonuclear elastase. serum procalcitonin is one of the components to assess the severity of pancreatitis. Procalcitonin is an acute phase reactant that has been extensively investigated as early marker in systemic bacterial infection, sepsis, and multi organ failure. Because severe acute pancreatitis is associated with sepsis, infected pancreatic necrosis, and multi organ failure. Procalcitonin can be used as a useful marker in early prediction of severity. MATERIAL: a prospective observational hospital based study conducted on patients of Department of General Medicine with collaboration from Department of Biochemistry and Radio diagnosis of SMS Medical College Jaipur. Patient who were diagnosed as case of acute pancreatitis on basis of diagnostic criteria as per Atlanta classification 2013 guidelines7 were included. Total of 56 cases were included in this study. OBSERVATION: The finding observed are as under:- 1) The mean age of the population was 38.5 ±11.83 years. CONCLUSION: In present, study serum PCT was done in patients diagnosed as acute pancreatitis on basis of Atlanta classification within 48 hours of admission and was found to be increased (value is significant if it is more than 0.5ng/ml) in 23 patients out of 60, with mean of 1.94±2.4ng /ml. These 23 patients were later on found to have severe acute pancreatitis on the basis Atlanta classification and rest 37 patients who had mild pancreatitis had mean PCT 0.38±0.66ng/ml. A study conducted on 40 patients of acute pancreatitis which was confirmed by Computed tomography was conducted in Poland, where they collected blood samples on admission and 24 hour thereafter, in which they tried to evaluate the role of procalcitonin as an early predictor of course of acute pancreatitis and they found that procalcitonin concentration was significantly higher in patients of acute pancreatitis and cut off was estimated at 0.5ng/ml.79 Similarly, in this study PCT was found to be high in patients of severe acute pancreatitis only.


Assuntos
Pancreatite , Sepse , Doença Aguda , Adulto , Biomarcadores , Proteína C-Reativa/análise , Calcitonina , Humanos , Inflamação , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos , Pancreatite/diagnóstico , Pró-Calcitonina , Prognóstico , Índice de Gravidade de Doença
17.
BMC Pediatr ; 22(1): 226, 2022 04 26.
Artigo em Inglês | MEDLINE | ID: mdl-35473509

RESUMO

INTRODUCTION: Procalcitonin (PCT) offers better specificity than C-reactive protein (CRP) to detect SBI. However, their cost limited their use and routine application. The objective of this work is to determine the cost-effectiveness of PCT against CPR or Rochester scale in infants between 1 and 3 months from the perspective of the third payer in Colombia. METHODS: A Monte Carlo simulation was performed with a hypothetical cohort of 10,000 patients with fever without focus (FWS) between 1 to 3 months, to estimate the number of cases correctly diagnosed for each test and the associated costs with each test. RESULTS: The test with the highest number of correctly diagnosed cases was PCT 79%, followed by C-reactive protein 75%, and the Rochester scale 68%. The test with the lowest cost per patient was PCT $645 (95% CI US$646-US$645) followed by C-reactive protein U$ 653 (95% CI US$655-$645) and Rochester scale US$804 (95% CI US$807-US$804). This position of dominance of PCT eliminated the need to calculate an incremental cost effectiveness ratio. CONCLUSIONS: PCT is the most cost-effective strategy for the detection of IBS in infants with FWS. These results should be interpreted within the clinical context of the patient and not as a single method for therapeutic decision-making.


Assuntos
Infecções Bacterianas , Pró-Calcitonina , Infecções Bacterianas/diagnóstico , Proteína C-Reativa/análise , Calcitonina , Peptídeo Relacionado com Gene de Calcitonina , Criança , Análise Custo-Benefício , Febre/complicações , Febre/etiologia , Humanos , Lactente , Precursores de Proteínas
18.
Egypt J Immunol ; 29(2): 41-47, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35436053

RESUMO

Sepsis is a major public healthcare problem. It remains a significant cause of morbidity and mortality in intensive care units (ICU) all over the world. A lifesaving early specific diagnosis and treatment is a challenge as no gold standard technique exists that can alone allow a rapid and reliable diagnosis of sepsis. Histidine-rich glycoprotein (HRG) is a promising new biomarker of sepsis that can contribute to enhance current sepsis diagnostic tools. The current study aimed to evaluate HRG as a diagnostic biomarker for sepsis compared to the conventionally used biomarkers, procalcitonin (PCT) and C-reactive protein (CRP). The study included 67 participants classified into 3 groups: Control (n=19), systemic inflammatory response syndrome (SIRS) patients (n=24) and sepsis patients (n=24). Serum HRG, CRP and PCT levels were measured by ELISA techniques. HRG level was significantly reduced in sepsis patients compared with SIRS patients (P < 0.001) and controls (P < 0.001) with overall statistically significant differences between the three groups (P < 0.001). Serum levels of the 3 biomarkers revealed increased PCT level in SIRS and sepsis groups, (P=0.002 and p < 0.001 respectively), CRP level significantly increased in sepsis (P < 0.001) but not in SIRS patients (P=0.525). The area under the curve (AUC) value was 0.988 for HRG, 0.966 for PCT and 0.859 for CRP respectively. The sensitivity, specificity, PPV and NPV for diagnosis of HRG were 95.8%, 93%, 88.5%, and 97.6%, respectively. In conclusion, HRG could be a good indicator for sepsis, that can discriminate sepsis and SIRS patients in ICU.


Assuntos
Histidina , Sepse , Adulto , Biomarcadores , Proteína C-Reativa/análise , Calcitonina , Glicoproteínas , Humanos , Unidades de Terapia Intensiva , Pró-Calcitonina , Precursores de Proteínas , Proteínas , Sepse/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico
19.
Emergencias (Sant Vicenç dels Horts) ; 34(2): 119-127, abr. 2022. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-203357

RESUMO

Introducción. Existen múltiples variables demográficas y clínicas predictivas de mortalidad en pacientes con COVID-19. Sin embargo, hay menos información sobre el valor pronóstico de los biomarcadores inflamatorios. Métodos. Estudio de cohorte retrospectivo. Se incluyeron de forma consecutiva todos los pacientes con COVID-19, confirmado por laboratorio, atendidos en un servicio de urgencias hospitalario (SUH) y con valor basal de los siguientes biomarcadores: recuento linfocitario, índice neutrófilo/linfocito (INL), proteína C reactiva (PCR) y procalcitonina (PCT). La relación entre los biomarcadores y la mortalidad total a 30 días se analizó mediante una regresión de Cox y gráficos de dosis-respuesta. Resultados. Se incluyeron 896 pacientes, 151 (17%) fallecieron en los primeros 30 días. La mediana de edad fue de 63 años (51-78) y 494 (55%) eran hombres. El valor de INL, PCR y PCT fue mayor, mientras que el recuento linfocitario fue menor, en los pacientes que fallecieron respecto a los que sobrevivieron (p < 0,001). La PCT fue superior al recuento linfocitario, INL y PCR en la predicción de mortalidad a 30 días (ABC 0,79 [IC 95%: 0,75-0,83] vs 0,70 [IC 95%: 0,65-0,74], p < 0,001; 0,74 [IC 95%: 0,69-0,78], p = 0,03; y 0,72 [IC 95%: 0,68-0,76], p < 0,001). Los puntos de decisión de PCT propuestos, 0,06 ng/l para exclusión y 0,72 ng/l para inclusión de muerte a 30 días, podrían facilitar la toma de decisiones en urgencias. Hubo 357 pacientes (40%) con valores de PCT en estas categorías. El análisis multivariable mostró una mayor asociación con la mortalidad para PCT que en los otros biomarcadores estudiados. Conclusión. PCT es el biomarcador con mejor capacidad para predecir mortalidad a 30 días por cualquier causa en pacientes con COVID-19 valorados en un SUH.


Background. Although many demographic and clinical predictors of mortality have been studied in relation to COVID-19, little has been reported about the prognostic utility of inflammatory biomarkers. Methods. Retrospective cohort study. All patients with laboratory-confirmed COVID-19 treated in a hospital emergency department were included consecutively if baseline measurements of the following biomarkers were on record: lymphocyte counts, neutrophil-to-lymphocyte ratio NRL, and C-reactive protein (CRP) and procalcitonin (PCT) levels. We analyzed associations between the biomarkers and all-cause 30-day mortality using Cox regression models and dose–response curves. Results. We included 896 patients, 151 (17%) of whom died within 30 days. The median (interquartile range) age was 63 (51-78) years, and 494 (55%) were men. NLR, CRP and PCT levels at ED presentation were higher, while lymphocyte counts were lower, in patients who died compared to those who survived (P < .001). The areas under the receiver operating characteristic curves revealed the PCT concentration (0.79; 95% CI, 0.75-0.83) to be a better predictor of 30-day mortality than the lymphocyte count (0.70; 95% CI, 0.65-0.74; P < .001), the NLR (0.74; 95% CI, 0.69-0.78; P = .03), or the CRP level (0.72; 95% CI, 0.68-0.76; P < .001). The proposed PCT concentration decision points for use in emergency department case management were 0.06 ng/L (negative) and 0.72 ng/L (positive). These cutoffs helped classify risk in 357 patients (40%). Multivariable analysis demonstrated that the PCT concentration had the strongest association with mortality. Conclusion. PCT concentration in the emergency department predicts all-cause 30-day mortality in patients with COVID-19 better than other inflammatory biomarkers.


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Ciências da Saúde , Infecções por Coronavirus/diagnóstico , Contagem de Linfócitos , Pró-Calcitonina , Calcitonina , Serviços Médicos de Emergência , Neutrófilos/química , Estudos Retrospectivos , Proteína C-Reativa/análise
20.
PLoS One ; 17(4): e0267412, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35476639

RESUMO

BACKGROUND: Diabetes foot ulcer (DFU) is a complication of diabetes mellitus. Accurate diagnosis of DFU severity through inflammatory markers will assist in reducing impact on quality of life. We aimed to ascertain the diagnostic test accuracy of commonly used inflammatory markers such as erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), procalcitonin (PCT), and white cell count (WCC) for the diagnosis and differentiation between DFU grades based on the International Working Group on the Diabetic Foot classification system. METHODS: This systematic review explored studies that investigated one or more of the above-listed index tests aiding in diagnosing infected DFU. This review was registered on PROSPERO database (ID = CRD42021255618) and searched 5 databases including an assessment of the references of included studies. Records were manually screened as per Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. A total of 16 studies were included which were assessed for quality using QUADAS-2 tool and meta-analysed using Meta-Disc v1.4. RESULTS: CRP had the greatest area under the curve (AUC) of 0.893 for diagnosing grade 2 DFU. This returned a pooled sensitivity and specificity of 77.4% (95% CI: 72% to 82%) and 84.3% (95% CI: 79% to 89%) respectively. In terms of diagnosing grade 3 DFU, procalcitonin had the highest AUC value of 0.844 when compared with other markers. The pooled sensitivity of PCT was calculated as 85.5% (95% CI: 79% to 90%) and specificity as 68.9% (95% CI: 63% to 75%). CONCLUSION: CRP and PCT are the best markers for diagnosing grade 2 and grade 3 DFU respectively. Other markers are also valuable when used in conjunction with clinical judgement. The findings accentuate the necessity of further research to establish standardised cut-off values for these inflammatory markers in diagnosing diabetic foot ulcers.


Assuntos
Diabetes Mellitus , Pé Diabético , Osteomielite , Biomarcadores , Proteína C-Reativa/metabolismo , Calcitonina , Pé Diabético/complicações , Pé Diabético/diagnóstico , Humanos , Osteomielite/diagnóstico , Pró-Calcitonina , Qualidade de Vida
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