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Introduction: Medullary thyroid carcinoma (MTC) is a rare type of thyroid cancer and the main treatment is surgery. The extent of surgery depends on the spread of tumour and often involves thyroidectomy and neck dissection. Recurrent or metastasis tumour can be detected with raising calcitoninand there are various options of treatment. Methods: This was a retrospective study of MTC over seven years in a tertiary cancer centre which evaluated the treatment outcome and the non-surgical options available in recurrent and metastatic tumours. Results: Among the 601 thyroid cancers, 34 patients (5.3%) were MTC, of which 29 were studied. Majority were women, below 60 years, were diagnosed with fine needle aspiration cytology of thyroid nodule or nodes and had raised calcitonin value (Ctn). The value of Ctn was correlated with tumour burden rather than extent (p=0.7). Recurrence was seen in 35% and all patients with locoregional recurrence had curative surgery whereas metastatic patients were offered palliative treatment. Acceptance of palliative treatment was less due to financial burden. The five year overall survival for nonmetastatic disease was 89.4 % and for patients with metastatic disease at presentation was 54.7 %. Conclusion: The incidence of medullary thyroid carcinoma is low compared to the differentiated thyroid carcinoma. The main treatment is surgery and other treatment options are limited. [ABSTRACT FROM AUTHOR]

Introduction: Bacterial Meningitis (BM) is a serious health problem worldwide with high mortality and permanent longterm neurological sequelae. Cerebrospinal Fluid (CSF) analysis is the cornerstone for diagnosing BM, but the lack of specificity creates a difficult clinical scenario for initiating proper treatment. Empiric antibiotic use in patients with suspected meningitis at primary care settings decreases the yield of CSF culture and alters CSF cytological and biochemical findings, making it further difficult to diagnose BM. To overcome this difficulty, there is a need for other biochemical markers with higher sensitivity and specificity. Aim: To determine the diagnostic sensitivity and specificity of Procalcitonin (PCT) in serum and CSF in patients with BM and compare its diagnostic accuracy in both sample types. Materials and Methods: A cross-sectional study was conducted in the Department of Internal Medicine at a tertiary care centre in eastern India from September 2018 to August 2020. A total of 82 adult patients with meningitis were recruited as per the protocol, and CSF analysis was done along with estimation of PCT in serum and CSF. Receiver Operating Characteristics (ROC) curve analysis of serum and CSF PCT was used to determine sensitivity and specificity with a 95% confidence interval. Results: Out of the 82 patients recruited, 30 (36.6%) had BM. CSF PCT with a cut-off value of >0.45 ng/mL had a sensitivity of 86.7% and specificity of 92.3%. The sensitivity of serum PCT with a cut-off value of >0.6 ng/mL was 83.3%, and specificity was 86.5%. There was no statistically significant difference in sensitivity and specificity between CSF and serum PCT in patients with BM (p-value=0.7988). Conclusion: Both serum and CSF PCT were found to have high sensitivity and specificity as markers for diagnosing BM without any statistically significant difference between them. [ABSTRACT FROM AUTHOR]

Background efficacy of therapeutic cholecalciferol supplementation for severe COVID-19 is sparingly studied. Objective effect of single high-dose cholecalciferol supplementation on sequential organ failure assessment (SOFA) score in moderate-to-severe COVID-19. Methods participants with moderate to severe COVID-19 with PaO2/FiO2 ratio < 200 were randomized to 0.6 million IU cholecalciferol oral (intervention) or placebo. Outcomes primary outcome was change in Day 7 SOFA score and pre-specified secondary outcomes were SOFA and 28-day all-cause mortality. Results in all, 90 patients (45 each group) were included for intention-to-treat analysis. 25(OH)D3 levels were 12 (10–16) and 13 (12–18) ng/ml (P  = 0.06) at baseline; and 60 (55–65) ng/ml and 4 (1–7) ng/ml by Day 7 in vitamin D and placebo groups, respectively. The SOFA score on Day 7 was better in the vitamin D group [3 (95% CI, 2–5) versus 5 (95% CI, 3–7), P  = 0.01, intergroup difference − 2 (95% CI, −4 to −0.01); r  = 0.4]. A lower all-cause 28-day mortality [24% compared to 44% (P  = 0.046)] was observed with vitamin D. Conclusions single high-dose oral cholecalciferol supplementation on ICU admission can improve SOFA score at Day 7 and reduce in-hospital mortality in vitamin D-deficient COVID-19. ClinicalTrials.gov   id: NCT04952857 registered dated 7 July 2021. What is already known on this topic —vitamin D has immunomodulatory role. Observational and isolated intervention studies show some benefit in COVID-19. Targeted therapeutic vitamin D supplementation improve outcomes in severe COVID-19 is not studied in RCTs. What this study adds —high-dose vitamin D supplementation (0.6 Million IU) to increase 25(OH)D > 50 ng/ml is safe and reduces sequential organ failure assessment score, in-hospital mortality in moderate to severe COVID-19. How this study might affect research, practice or policy— vitamin D supplementation in vitamin D-deficient patients with severe COVID-19 is useful may be practiced. [ABSTRACT FROM AUTHOR]

Introduction: Medullary thyroid carcinoma (MTC) is a rare thyroid malignancy originating from parafollicular C cells. It accounts for 5%-10% of all thyroid malignancies. Methods: An ambispective analysis of pathologically proven MTC presented in a tertiary care hospital in northwest India was performed after considering demography, clinical manifestation, RET mutation status, management, and outcome as denominators. Results: Among 2,735 thyroid malignancy cases who presented to our institute in the last 10 years (2012-2022), 78 (3%) had MTC with a mean age of presentation of 43 ± 11 years; 60% of them were female. The median duration of symptoms was 23 months (IQR 12-36 months). The most common presenting complaint was goiter with lymphadenopathy (80.8%). Among the atypical presentations, one each had ectopic Cushing's syndrome, hypertensive crisis in pregnancy due to pheochromocytoma, synchronous chondrosarcoma, and Von Hippel-Lindau disease spectrum. Median calcitonin and carcinoembryonic antigen (CEA) levels at presentation were 1,274 pg/mL (n = 64) and 149 ng/mL (n = 39), respectively. Twenty-two patients were germline RET mutation-positive, and they presented at a younger age. Majority of the patients presented with stage IV disease. Surgery was the primary modality of therapy. Twenty-nine patients received radiotherapy and 25 patients received tyrosine kinase inhibitors (TKIs). Nine patients received peptide receptor radiotherapy (PRRT) with Lu-177 with neoadjuvant capecitabine. Median progression-free survival (PFS) was 60 months. Patients without structurally and biochemically residual disease and stable disease after the first modality of therapy (Log-rank 11.4; p = 0.004) had a better PFS. Female patients (Log-rank: 9.5; p = 0.002) had a better PFS than male patients. Conclusion: This study showed that MTC comprises 3% of thyroid malignancies with a female preponderance. RET mutation-positive patients had a younger age at presentation. Surgery was the first-line therapy. Radiotherapy, TKI, and PRRT were given as a part of second-line or thirdline therapy due to persistent disease and/or disease recurrence. The median PFS was better in female patients and in patients who had no residual lesions and stable disease after the primary modality of therapy. [ABSTRACT FROM AUTHOR]

Introduction: It is unclear if serum procalcitonin (PCT) estimated at sepsis suspicion can help detect culture-positive sepsis in neonates. We evaluated the diagnostic performance of PCT in culture-positive sepsis in neonates. Methods: This was a prospective study (February 2016 to September 2020) conducted in four level-3 units in India. We enrolled neonates suspected of sepsis in the first 28 days of life. Neonates with birth weight <750 g, asphyxia, shock, and major malformations were excluded. Blood for PCT assay was drawn along with the blood culture at the time of suspicion of sepsis and before antibiotic initiation. The investigators labeled the neonates as having culture-positive sepsis or "no sepsis" based on the culture reports and clinical course. PCT assay was performed by electrochemiluminescence immunoassay, and the clinicians were masked to the PCT levels while assigning the label of sepsis. Primary outcomes were the sensitivity, specificity, and likelihood ratios to identify culture-positive sepsis. Results: The mean birth weight (SD) and median gestation (IQR) were 2,113 (727) g and 36 (32–38) weeks, respectively. Of the 1,204 neonates with eligible cultures, 155 (12.9%) had culture-positive sepsis. Most (79.4%) were culture-positive within 72 h of birth. The sensitivity, specificity, and positive and negative likelihood ratios at 2 ng/mL PCT threshold were 52.3% (95% confidence interval: 44.1–60.3), 64.5% (60.7–68.1), 1.47 (1.23–1.76), and 0.74 (0.62–0.88), respectively. Adding PCT to assessing neonates with 12.9% pretest probability of sepsis generated posttest probabilities of 18% and 10% for positive and negative test results, respectively. Conclusion: Serum PCT did not reliably identify culture-positive sepsis in neonates. [ABSTRACT FROM AUTHOR]

Background: Neonatal sepsis is a leading cause of newborn mortality in the developing world. Most of the newborn babies admitted to a neonatal ICU for different reasons acquire hospital-acquired infections. Early and optimal management is pivotal for successful outcomes. However, most of the places lack advanced automated culture facilities. Procalcitonin could potentially be used for early diagnosis of such infection. Objective: To study the diagnostic role of serum procalcitonin in newborn hospital-acquired sepsis. Materials and methods: A case–control study was conducted in a tertiary care hospital in northern India. Results: Culture-positive nosocomial sepsis group consisted of 59 patients and the control group of 41 patients. Gram-negative organisms were the most commonly isolated organisms (91.5%). The baseline median and interquartile range (IQR) serum PCT of the study population was 0.3 (0.18–.44) ng/ml. The median (IQR) serum PCT values at the time of clinical deterioration in the nosocomial sepsis and the sepsis-like illness groups are 4 (6.5) ng/ml and 1.2 (1.6) ng/ml, respectively (p = 000). The area under the ROC curve for the prediction of bacterial infection for PCT was 0.864. On the ROC curve, the PCT level that combined the greatest sensitivity and comparatively good specificity was 1.95 ng/ml, with a sensitivity of 88%, and specificity of 79%. Conclusion: We conclude that serum procalcitonin is a reliable marker for the diagnosis of neonatal nosocomial sepsis. [ABSTRACT FROM AUTHOR]

Background: Heart failure (HF) is a global health burden that is usually simple to diagnose, but concomitant respiratory infections are difficult to distinguish clinically. Inflammatory markers can be used to differentiate between the two conditions, especially procalcitonin (PCT), one of the most specific markers for bacterial infections. PCT-guided antibiotic treatment has shown good results and could help in decreasing the indiscriminate prescription of antibiotics in HF patients. Methodology: A prospective observational study was carried out in a tertiary care hospital in Western India. Three hundred HF patients were separated into either high-or low-PCT level groups. A novel clinical score for clinically suspecting superimposed respiratory infection in acute HF patients was devised and its association with PCT level was measured. Results: 62.87 years was the average age of the study population with a male preponderance. While breathlessness was the presenting complaint in all 300 patients, the presence of fever and edema was significantly associated with raised PCT. A higher total leukocyte count and neutrophil count were seen in patients with high PCT. A higher incidence of consolidation, pulmonary edema, and pulmonary hypertension was noted in those with high PCT. A significant association was found between the clinical scoring system and the PCT level. Conclusion: The novel clinical scoring system has a satisfactory sensitivity, specificity, positive predictive value, and negative predictive value in diagnosing superimposed respiratory infections in acute HF patients. It can aid in the judicious use of the PCT test in resource-limited settings. [ABSTRACT FROM AUTHOR]

Background: The phase 3 randomized PERSIST study demonstrated the efficacy and tolerability of galcanezumab, a humanized anti-calcitonin gene-related peptide (CGRP) monoclonal antibody for prevention of episodic migraines. We present findings from the open-label extension (OLE) of PERSIST, which evaluated the long-term efficacy and safety of galcanezumab in patients from China, India, and Russia. Methods: Patients completing the 3-month double-blind period of PERSIST were eligible for the 3-month OLE. Patients previously randomized to galcanezumab (GMB/GMB group) continued to receive galcanezumab 120 mg at all three visits during the OLE whereas patients randomized to placebo received a 240 mg loading dose of galcanezumab and then two 120 mg doses (PBO/GMB group). The primary outcome was the mean change (from double-blind baseline) in the number of monthly migraine headache days (MHDs) to month 6. Other endpoints included percent reduction in monthly MHDs from double-blind baseline to month 6, functional outcomes, safety and tolerability. Results: Overall, 99% of patients completing the double-blind period entered the OLE, and 96% completed through month 6. Patients in the GMB/GMB group achieved continued improvements in efficacy, with the reduction from baseline in the mean number of monthly MHDs, and slightly increasing from 4.01 days at the end of the double-blind period to 4.62 at the end of the OLE. Of patients who were ≥ 50% responders to galcanezumab at month 3, 66% maintained this response through to month 6. Patients in the PBO/GMB group experienced a rapid reduction in the number of monthly MHDs after initiation of galcanezumab, with a mean reduction from baseline of 4.56 days by month 6. The long-term benefits of galcanezumab were also supported by improvements in other efficacy and functional endpoints. All safety findings were consistent with the known long-term safety profile of galcanezumab; no patients experienced a treatment-related serious adverse event. Conclusions: Galcanezumab was efficacious and well-tolerated in patients with episodic migraine from China, India and Russia, for up to 6 months. Trial registration: ClinicalTrisABSTRACT_pals.gov NCT03963232, registered May 24, 2019. [ABSTRACT FROM AUTHOR]

Introduction: Acute pancreatitis is an acute inflammatory process ranging clinically from mild discomfort with localized inflammation to severe disease involving remote organ systems. Aim: Study of procalcitonin as an early predictor of severity in acute pancreatitis. Methods: This study was a Hospital based observational study conducted on 56 cases aged between 18 to 80 years at acute pancreatitis patients presenting in OPD and IPD of medicine and gastroenterology department at SMS Medical College and Hospital, Jaipur, Rajasthan, India. Data collection was started after approval from institutional research review board. Results: majority 46.4% patients were of 20-40 years age group, mean age was 43.69 years, 71.4% patients were male, 44.6% patients were alcoholic. Majority 37.5% patients were of Ranson score 2, as per Atlanta criteria, 66.07% patients were of mild acute pancreatitis, 10.7% patients died. Conclusion: We have observed that Procalcitonin has shown promising results as an early marker of development of complications. [ABSTRACT FROM AUTHOR]

Introduction: Sepsis is a life-threatening condition of human body. It is caused by improper response of host immune system to various infective conditions. Procalcitonin (PCT) has been a promising biomarker for aiding early diagnosis, risk stratification and treatment in patients with sepsis and septic shock. Aim: To study correlation of serial serum procalcitonin (day1, 3 and 7) with severity of sepsis and patient outcomes (in-hospital stay or mortality). Materials and Methods: The study was a descriptive, observational study conducted at Krishna Institute of Medical Sciences, Secunderabad, Telangana, India, on 100 patients admitted to Medical Intensive Care Unit (MICU), both males and females of age more than 18 years, with sepsis or septic shock, from August 2019 to January 2021. Serum procalcitonin was measured by BRAHMS PCT-Q immunochromatographic assay using a commercially available test kit. Blood, urine and wound cultures were performed to confirm specific infection. The Chi-square test, Fischer's-exact test and Pearson correlation tests were used to calculate association and correlations amongst qualitative data. Results: Total 100 patients (mean age was 49.9±17.0 years; 62 males and 36 females) were included in the study. A total of 74 patients were observed to be have sepsis and 26 patients Ihad septic shock. Mortality was 36%. There was a positive correlation with Sequential Organ Failure Assessment (SOFA) score on day 1 and 3, but not day 7. PCT was high in 85% of patients on admission (day 1). Higher levels of PCT was observed both in patients with sepsis (82.4%) and septic shock (92.3%), suggesting that it is a good diagnostic marker in these patients. Mean PCT was higher in death patients compared to discharged patients on day 1,3 and 7 (p-value<0.05). Majority of patients (71.8%) with higher PCT on admission stayed in ICU for less than 5 days, whereas over half (53.3%) with normal PCT had a short ICU stay (p-value=0.18). Conclusion: Procalcitonin is a useful marker for early diagnosis of sepsis and septic shock and also severity of infection on admission to ICU. High procalcitonin also predicts mortality and can be a useful tool for rational use of antibiotics in patients admitted to ICU. [ABSTRACT FROM AUTHOR]

Background: Kidney transplant recipients (KTRs) are deemed to be at a high risk of severe coronavirus disease (COVID-19). Herein, we describe the clinical, laboratory profiles, management, and outcomes of 26 KTRs who developed COVID-19 during the first and second waves of the pandemic from a tertiary care center in northern India. Methods: This retrospective observational study included KTRs detected with COVID-19 infection during the first wave (March--November 2020) and the second wave (March--July 2021). Their clinical and laboratory investigations, management aspects, and outcomes were compared, using data retrieved from clinical and telenephrology records, and the hospital information system. Results: Of the 23 KTRs, 20 were male (86%), 20 patients had fever (86%), and cough and breathlessness were seen in 19 (82%) and 12 (52%), respectively. Acute graft dysfunction was seen in 6 (26%) patients, and the need for renal replacement was seen in 4 (17%) patients. Supplemental oxygen by reservoir mask was utilized in 10 (43%) patients, high-flow nasal cannula in 3 (13%), noninvasive mechanical ventilation in 4 (17%), and invasive mechanical ventilation in 6 (26%) patients. All the KTRs with moderate and severe COVID illness and 6/7 nonsurvivors were infected during the second wave. Overall mortality in this group of patients was very high at 27%, and the mortality in the group on mechanical ventilation was 100%. Conclusions: The second wave of the COVID-19 pandemic was associated with greater severity of illness and high mortality in KTRs. [ABSTRACT FROM AUTHOR]

Background: Biomarkers have been extensively studied and used in the diagnosis and management of various diseases. The trend of biomarkers helps in prognosticating and managing critically ill patients. In resource-limited settings, the availability and feasibility of using these biomarkers are challenging. Our study aimed to see the trend of biomarkers and their effect on intensive care unit (ICU) mortality in coronavirus disease-2019 (COVID-19) patients. Materials and methods: A retrospective observational study was done from 1 April 2020 to 30 September 2020. The primary objective was to evaluate the trend of biomarkers in patients with COVID-19 pneumonia and their effect on ICU mortality. The secondary objectives were the duration of mechanical ventilation and length of ICU stay. Results: A total of 380 patients were included. The mean age was 54.9 (SD = 11.1) and 67% were males. The mean age, acute physiology and chronic health evaluation II (APACHE II) score was 29.54 (5.8). Among the biomarkers, total count (TC), ferritin, and procalcitonin (PCT) were higher in non-survivors than in survivors in bivariate analysis. The final multivariable logistic regression model showed age, APACHE II score, length of ICU stay, neutrophil:lymphocyte (NL) ratio, and ferritin as covariates. Among these variables, ferritin was the only biomarker [odds ratio (OR): 1.80, 95% confidence interval (CI) 1.17-2.77] with the APACHE II score (OR: 1.15, 95% CI 1.01-1.30) found to be significant. Conclusion: Ferritin was the only significant biomarker with higher values in non-survivors than in survivors. The trend of biomarkers was not found to be useful in predicting outcome of the patients. [ABSTRACT FROM AUTHOR]

Background: In pandemic situations, it is essential that the limited resources are used judiciously to achieve most benefits. Prediction of the disease severity at the earliest will help in better allocation, thus, positively affecting prognosis and treatment. Aim and objective: To investigate patient characteristics and specific biomarkers as possible early predictors of disease severity of SARS-COV-2 infection. Materials and methods: Retrospective single-centric observational study conducted at 70-bedded intensive care unit of tertiary care hospital at Haryana, India. 100 consecutive RT-PCR positive coronavirus disease-2019 (COVID-19) adult patients. Demographics, acute physiology and chronic health evaluation II (Apache-II) score, and Inflammatory markers were compared with respect to oxygenation defect (PaO2/FiO2 ratio: <300 or ≥300 mm Hg), need of invasive ventilation, ICU length of stay and 28-day mortality. Findings: Mean age was significantly more in lower PF ratio group (58.01 ± 15.33 vs 50.97 ± 13.78, p = 0.023) whereas sex ratio was comparable among patients in two groups. Significantly, higher APACHE-II score (p ≤0.001) and presence of hypertension (43.54% vs 23.68%; p = 0·045) in low PF ratio group along with higher C-reactive protein (171.78 ± 124.45 vs 101.52 ± 88.70), IL-6 (173.51 vs 53.18) and ferritin (1677.60 ± 2271.13 vs 643.54 ± 718.68) levels. Procalcitonin, lactate dehydrogenase, and creatine phosphokinase (CPK) levels were not significant. Interpretation: Age and APACHE II score and among laboratory parameters CRP, ferritin, and IL-6 levels were significantly higher in low PF ratio group, patients requiring invasive ventilation and in mortality group. Use of this triad (CRP, ferritin, and IL-6 levels) at admission may predict the disease severity early in the course. Addition of APACHE-II may further improve the accuracy of the score. [ABSTRACT FROM AUTHOR]

Aim: To compare between the expenses and benefits of procalcitonin testing in the diagnosis of early onset neonatal sepsis. Methods: This prospective analytical study was carried out in the Department of Paediatrics, Visakha Steel General Hospital Visakhapatnam, Andhra Pradesh, India for 15 months. 100 Full-term neonates (>37 weeks gestational age) admitted to NICU with the clinical symptoms or signs of sepsis within 72 h of birth, and those with risk factors for EONS. For all patients included in the study, complete blood count with differential (CBC), CRP, blood culture, procalcitonin was done on admission to NICU, and was repeated after 8 hours from the initial one, while CRP was repeated after 24 hrs. Cultures from other sites (including CSF), chest x ray and imaging were done as appropriate. Results: Their mean weight was 3.213 kg (range 2.2-4.8 kg). Mean age of presentation was 14 hours (range 2-68) hours. About 90 (90 %) patients presented with more than one symptoms and signs of sepsis For CBC results, mean WBC count was 19.8± 9.1, the mean neutrophils count was 15.55± 10.57) and the mean platelet count was 171.21±69.21. This study includes neonates with early onset sepsis. In the present study the most frequent presenting sign was hypothermia (63%), hypo activity and mottling (54%), followed by feeding intolerance (43%). Blood cultures were positive in 37 patients, who compromised the group of proven sepsis. Klebsiella was present in 14 patient, E coli in 10 patients, while group B streptococcus in 8 patients. Pseudomonas infection present in 3 patients, while MRSA (methicillin resistant staphylococcus aureus) was detected in 2 patients. The initial CRP (CRP1), was non-reactive in 42 patients (42%), The initial procalcitonin in the sepsis group (PCT1), was non-reactive 42 patients (42%), <2.6 in 32 patients (32%), 2.6-10 in 20 patients (20%), and more than that in 6 patients (6%). Sensitivity= 93.5%, Specificity=54%, PPV= 66.3%, NPV= 87.5%. PCT2: Sensitivity=96.8%, Specificity=88.7%, PPV=91.1%, NPV=99%. Conclusion: The expense of testing PCT twice is less than the expenses of one-day admission in NICU in developing countries. Application of such protocol could be of use in limiting period of stay in NICU. [ABSTRACT FROM AUTHOR]

Spinal brucellosis is the most common osteoarticular complication of brucellosis. It can affect any part of the spine with or without neural involvement. The objective of this study was to identify the clinical ministrations, diagnostic measures and treatment modalities of adult patients with spinal brucellosis. The data were collected from medical records of spinal brucellosis. In three years, 107 patients were treated for brucellosis, of which 28 (26.17%) patients had spinal brucellosis. Backache (p=0.0001), feeling of mass or lump along the spine (p=0.0335), pain while walking (p=0.0204) and altered sensation of lower limb (p=0.0011) were the significant clinical manifestations. Other symptoms were fever (75%), weight loss (42.86%) and night sweats (35.71%). Type 2 Diabetes mellitus was identified as a co-morbidity (p=0.0187). Nineteen patients had abnormal magnetic resonance imaging and lumbar (L4-L5) vertebrae were the most commonly infected area. Patients have received symptomatic management along with appropriate antibiotics. [ABSTRACT FROM AUTHOR]

Introduction: Early assessment of Systemic Inflammatory Response Syndrome (SIRS) through various biomarkers like Procalcitonin (PCT), C-reactive Protein (CRP), Interleukin-1 (IL-1) etc., is crucial to manage the outcome of patients. Levels of PCT concerning its likelihood to distinguish patients with SIRS and non-SIRS and the possibility to predict mortality in patients with sepsis has been variable. Aim: To investigate the role of PCT in early diagnosis of sepsis in patients admitted to Intensive Care Unit (ICU). Materials and Methods: In this prospective observational study, 136 patients hospitalised in ICU at Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India, between July 2019 to June 2020 were evaluated and PCT was analysed using Finecare™ PCT rapid test. Receiver Operating Characteristic (ROC) curve analysis and multiple logistic regression was carried out to detect the association of predictive PCT value with its outcomes. Results: PCT showed the best predictive value in the diagnosis of SIRS at 1.68 ng/mL (Area Under Curve (AUC)-0.87; p<0.05) having Positive Predictive Value (PPV) and Negative Predictive Value (NPV) of 90.43% and 73.81%, respectively. Multiple logistic regression model adjusted for age, weight, and duration of stay to predict the outcome of SIRS, positive blood culture and fatality case rate derived a significant association of PCT with Odds Ratio (OR) being 1.23 (1.11-2.31), 1.06 (1.01-1.98) and 1.76 (1.08-2.14), respectively. Conclusion: Early identification and treatment for sepsis significantly affects mortality. It appears that consecutive measurements of biomarkers could be valuable, but further prospective studies are important to characterise the role of PCT as a prognostic marker in sepsis and severe sepsis. [ABSTRACT FROM AUTHOR]

Prospective data on infections in systemic lupus erythematosus (SLE) from India are scarce. We studied the frequency and predictors of infections in hospitalized SLE patients. All data on infections were prospectively recorded. During the study period, 212 SLE patients (91% women) were hospitalised. Sixty-three (29.7%) had infections. The most common infections were pneumonia, skin and soft-tissue infections and urinary-tract infections. Mortality was higher in the infection group compared to the no infection group (11.1% vs. 0.7%; p =0.01). At three months, 10/63 developed another episode of infection. On logistic regression, the predictors of infection were fever [odds ratio (OR) = 4.17], vasculitis (OR = 2.64), thrombocytopaenia (OR = 3.59), presence of co-morbidities (OR = 3.59) and duration of hospital stay >11 days (OR = 3.55); p<0.001 for all. High-sensitivity CRP (hsCRP) and procalcitonin were measured in 95 patients. hsCRP was significantly higher in the infection group compared to the no infection group (median 27 vs. 6.5 mg/L; p <0.001). Procalcitonin was similar in both groups. A hsCRP of 11.5 mg/L had a sensitivity of 66.7% and specificity of 72.9% to diagnose infection. To conclude, 29.7% of Indian SLE patients who are hospitalized have infections, resulting in a significantly increased duration of hospital stay. The presence of fever and co-morbidities are predictors of infection. The role of high hsCRP to support the diagnosis of infection in SLE is once again confirmed. [ABSTRACT FROM AUTHOR]

Introduction: Differentiation between sepsis and systemic inflammation response syndrome (SIRS) remains a diagnostic challenge for clinicians as both may have similar clinical presentation. A quick and accurate diagnostic tool that can discriminate between these two conditions would aid in appropriate therapeutic decision-making. This prospective study was conducted to evaluate the diagnostic and prognostic utility of soluble urokinase-type plasminogen activator receptor (suPAR) and procalcitonin (PCT) in sepsis and SIRS patients. Materials and methods: Eighty-eight patients were enrolled, of which 29 were SIRS and 59 were sepsis patients. The levels of suPAR and PCT were measured on the day of admission (day 1), day 3, and day 7. Results: The levels of suPAR and PCT were significantly higher (p = 0.05 and p < 0.001, respectively) in sepsis group as compared to the SIRS group. The soluble urokinase-type plasminogen activator receptor was a better diagnostic tool in predicting sepsis over PCT [area under curve (AUC) 0.89 vs 0.82] on day 1. The best cutoff for suPAR was 5.58 pg/mL [96% sensitivity and 90% negative predictive value (NPV)] and the best cut-off for PCT was 1.96 ng/mL (93.1% sensitivity and 80% NPV). However, PCT had better prognostic trends (p = 0.006) to identify nonsurvivors in sepsis group. Conclusion: Our findings suggest that both suPAR and PCT can be used as potential test tools to differentiate between SIRS and sepsis. Procalcitonin showed significant prognostic trends to identify nonsurvivors. The soluble urokinase-type plasminogen activator receptor showed better diagnostic potential than PCT on day 1. Clinical significance: Both suPAR and PCT can be used as surrogate biomarkers to distinguish sepsis from SIRS. Procalcitonin showing a significant prognostic trend to identify nonsurvivors can help the clinicians to take relevant clinical decisions. Also, the use of biomarkers like PCT and suPAR could reduce the inappropriate use of antibiotics in noninfective SIRS. [ABSTRACT FROM AUTHOR]

Background & objectives: Bacteraemia is a serious form of infection in patients presenting with fever, thus, there is a necessity for a biomarker for rapid diagnosis of bacteraemia in such patients to make better therapeutic decisions. This study was conducted to measure the serum procalcitonin (PCT) levels at the time of initial presentation as a biomarker for identifying bacteraemia and as a predictor of mortality in patients admitted with acute fever. Methods: Four hundred and eighty patients, who presented with acute fever requiring admission to a tertiary care teaching hospital in south India, were prospectively studied. All patients were evaluated with a detailed history, physical examination, laboratory and imaging studies. Baseline serum PCT was measured for each patient within six hours of admission. Results: Among patients with single infectious cause (n=275), significantly higher median serum PCT levels were evident in bacteraemia compared to leptospirosis (P=0.002), dengue (P <0.001), scrub typhus (P <0.001) and evident focus of infection without bacteraemia (P=0.036). By receiver-operator characteristic curve analysis, at a cut-off value of >3.2 ng/ml, the sensitivity and specificity of serum PCT levels in predicting bacteraemia were 81.1 and 63.3 per cent, respectively. As per the worst-case scenario analysis, 91 (18.9%) patients had a poor outcome and these had significantly higher median serum PCT levels compared to survivors (n=389) [9.46 (2.03-44.4) vs. 1.23 (0.34-7.645); P <0.001]. At a cut-off value of >3.74 ng/ml, serum PCT levels at initial presentation predicted in-hospital mortality with a sensitivity and specificity of 67 and 67.5 per cent, respectively. Interpretation & conclusions: Our observations suggest that serum PCT level may be a useful biomarker for identifying bacteraemia as well as predicting mortality in patients with acute fever requiring admission to hospital. [ABSTRACT FROM AUTHOR]

Procalcitonin has been found to be a good marker for the diagnosis of sepsis. However, data on procalcitonin levels to predict the clinical outcome in patients with sepsis are limited. The aim of our study was to estimate serum procalcitonin levels in patients with sepsis and to identify its relationship with the clinical outcome. This was a prospective observational study conducted on 112 patients with sepsis admitted to the medical wards and medical intensive care unit of a tertiary care teaching hospital. Serum procalcitonin was measured at baseline before antibiotic administration and on day 5. The clinical outcome studied was death or survival on day 28. Baseline mean serum procalcitonin was highest in patients with septic shock and lowest in patients having sepsis without organ dysfunction. Mean values of procalcitonin at baseline and on day 5 were significantly higher in non-survivors when compared with survivors. There was a significant difference in the change in procalcitonin levels from baseline to day 5 between survivors and non-survivors, with survivors having declining values on day 5 while non-survivors had increasing values from baseline. The baseline APACHE II and SOFA scores also showed a significant correlation with the baseline procalcitonin level. Declining values of procalcitonin therefore indicate a favourable clinical outcome in patients with sepsis. [ABSTRACT FROM AUTHOR]

Background: Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality. Biomarkers are increasingly being used to distinguish bacterial pneumonia from other causes, to help reduce the duration of antibiotic therapy, and to assess the prognosis of CAP and thereby aiming to complement Pneumonia Severity Index (PSI) and other scores. Aims & Objective: To compare prognostic utility of procalcitonin (PCT) with existing biomarkers [C-reactive protein (CRP) and total leukocyte count (TLC)] and clinical risk scores (PSI and CURB-65). Materials and Methods: Fifty patients diagnosed with CAP were included in this study. Baseline serum PCT was measured, which was then stratified according to four predetermined tiers (tier I: <0.1; tier II: 0.1 to <0.25; tier III: 0.25 to <0.5; tier IV: ⩾0.5 μg/L). To calculate the severity of pneumonia, patients were classified according to PCT tier, PSI, and CURB-65 scores. Follow-up PCT and reclassification of PSI and CURB-65 were carried out on days 4 and 30. Results: PCT was more significantly associated with positive bacterial culture than CRP and TLC. Initial PCT level was significantly correlated with TLC (p = 0.044), CRP (p < 0.001), PSI (p < 0.001), and CURB-65 (p = 0.028). Conclusion: Findings in our study showed that the management of severe CAP would be greatly improved if it were possible to identify, early in the course of disease, those patients who are most likely to develop complications and are at the risk of mortality. [ABSTRACT FROM AUTHOR]

Febrile neutropenia is a common cause in morbidity and mortality during treatment of hematological neoplasms. Subjects included all cases admitted under hematology department with febrile neutropenia from February to June 2018. Each febrile episode was investigated by standard investigations (Blood culture, Chest x ray etc.); Procalcitonin (PCT) and c reactive protein (CRP) was sent at fever onset 0, 24, 48 h, day 7 and day 14. Data was analyzed for 52 febrile episodes in 50 patients. PCT cut off value at 24 h of ≤1.2 ng/ml had a sensitivity and specificity of 62.5% and 87.5% for discriminating Invasive fungal infection (IFI) and Microbiologically documented infection (MDI) (p = 0.033). PCT had a negative predictive value of 70% for the diagnosis of IFI as compared to MDI. CRP cut off >160 mg/dl at 48 h was suggestive of fever due to fungal infection with a sensitivity of 100%, specificity of 48%, PPV of 33.3% and NPV of 100%. CRP at 24 and 48 h of fever was useful to distinguish non-infectious causes of fever from infectious causes. PCT at 24 h and CRP at 48 h was useful in identifying fungal infection. CRP was a better marker when compared to PCT for identifying disease fever. • Procalcitonin (PCT) and c reactive protein (CRP) was sent at fever onset 0, 24 , 48h, day 7 and day 14 of the febrile episode • PCT cut off value at 24 h 1–21 of ≤1.2ng/ml had a sensitivity and specificity of 62.5% and 87.5% for discriminating Invasive fungal infection (IFI) and Microbiologically documented infection (MDI). • PCT had a negative predictive value of 70% for the diagnosis of IFI as compared to MDI. • CRP cut off >160mg/dl at 48 h was suggestive of fever due to fungal infection. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to evaluate the effect of prolonged residency at high altitude (HA) on different indices of bone health in sea level (SL) residents staying at an altitude of 3450 m for 4 months to 1 year. The assessment of bone health parameters included multisite quantitative bone speed of sound (SOS), and markers of bone metabolism such as serum alkaline phosphatase (ALP), bone specific alkaline phosphatase (BAP), urinary deoxypyridinoline (DPD), C-terminal propeptide of type I collagen (CICP), N-telopeptide of type I collagen (NTX), and hormonal regulators such as 25-hydroxy vitamin D3 (25Vit D), intact parathyroid hormone (i-PTH), and cortisol., Results: The body weight in all the age groups was significantly lower at HA as compared to SL values. Prolonged residency at HA led to a significant decline in bone strength in terms of SOS, both at radius and phalanx. There was a significant increase in circulating Ca and ALP levels. Serum i-PTH and 25VitD levels decreased significantly. Significant decreases were also observed in CICP and BAP, bone formation markers, and serum NTX, DPD/Cr ratio, markers of bone resorption., Conclusion: These observations suggest that prolonged residency under hypoxic environment is associated with a decline in both bone formation and bone resorption markers, reflecting a lower bone turnover at HA.