Correlation of serum SARS-CoV-2 IgM and IgG serology and clinical outcomes in COVID-19 patients:Experience from a tertiary care centre

BACKGROUND The severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)virus has become a pandemic for the last 2 years.Inflammatory response to the virus leads to organ dysfunction and death.Predicting the severity of inflammatory response helps in managing critical patients using serology tests IgG and IgM.AIM To investigate the correlation of the serology(IgM and IgG)with reverse transcriptase polymerase chain reaction(RT-PCR)status,disease severity[mild to critical],intensive care unit(ICU)admission,septic shock,acute kidney injury,and in-hospital mortality.METHODS We conducted a longitudinal study to correlate serum SARS-CoV-2 immunoglobulin M(IgM)and immunoglobulin G(IgG)serology with clinical outcomes in coronavirus disease 2019(COVID-19)patients.We analyzed patient data from March to December 2020 for those who were admitted at All India Institute of Medical Sciences Rishikesh.Clinical and laboratory data of these patients were collected from the e-hospital portal and analyzed.A correlation was seen with clinical outcomes and was assessed using MS Excel 2010 and SPSS software.RESULTS Out of 494 patients,the mean age of patients was 48.95±16.40 years and there were more male patients in the study(66.0%).The patients were classified as mild-moderate 328(67.1%),severe 131(26.8%),and critical 30(6.1%).The mean duration from symptom onset to serology testing was 19.87±30.53 d.In-hospital mortality was observed in 25.1%of patients.The seropositivity rate(i.e.,either IgG or IgM>10 AU)was 50%.IgM levels(AU/mL)(W=33428.000,P≤0.001)and IgG levels(AU/mL)(W=39256.500,P≤0.001),with the median IgM/IgG levels(AU/mL),were highest in the RT-PCR-Positive group compared to RT-PCR-Negative clinical COVID-19.There was no significant difference between the two groups in terms of all other clinical outcomes(disease severity,septic shock,ICU admission,mechanical ventilation,and mortality).CONCLUSION The study showed that serology levels are high in RT-PCR positive group compared to clinical COVID-19.However,serology cannot be useful for the prediction of disease outcomes.The study also highlights the importance of doing serology at a particular time as antibody titers vary with the duration of the disease.In week intervals there was a significant correlation between clinical outcomes and serology on week 3.

Celiac disease serology in patients with different pretest probabilities: Is biopsy avoidable?

AIM: To establish the diagnostic performance of sev-eral serological tests, individually and in combination, for diagnosing celiac disease (CD) in patients with different pretest probabilities, and to explore potential se- rological algorithms to reduce the necessity for biopsy. METHODS: We prospectively performed duodenal biopsy and serology in 679 adults who had either high risk (n = 161) or low risk (n = 518) for CD. Blood samples were tested using six assays (enzyme-linked immunosorbent assay) that detected antibodies to tissue transglutaminase (tTG) and deamidated gliadin peptide (DGP). RESULTS: CD prevalence was 39.1% in the high-risk population and 3.3% in the low-risk group. In high-risk patients, all individual assays had a high diagnostic efficacy [area under receiving operator characteristic curves (AU ROC): 0.968 to 0.999]. In contrast, assays had a lower diagnostic efficacy (AU ROC: 0.835 to 0.972) in the low-risk group. Using assay combinations, it would be possible to reach or rule out diagnosis of CD without biopsy in 92% of cases in both pretest populations. We observed that the new DGP/tTG Screen assay resulted in a surplus compared to more conventional assays in any clinical situation. CONCLUSION: The DGP/tTG Screen assay could be considered as the best initial test for CD. Combinations of two tests, including a DGP/tTG Screen, might be able to diagnose CD accurately in different clinical scenarios making biopsy avoidable in a high proportion of subjects.

Cost effectiveness analysis of population-based serology screening and ^(13)C-Urea breath test for Helicobacter pylori to prevent gastric cancer:A markov model

AIM:To compare the costs and effectiveness of no screening and no eradication therapy, the population- based Helicobacter pylori (H pylori) serology screening with eradication therapy and 13C-Urea breath test (UBT) with eradication therapy. METHODS:A Markov model simulation was carried out in all 237 900 Chinese males with age between 35 and 44 from the perspective of the public healthcare provider in Singapore. The main outcome measures were the costs, number of gastric cancer cases prevented, life years saved, and quality-adjusted life years (QALYs) gained from screening age to death. The uncertainty surrounding the cost-effectiveness ratio was addressed by one-way sensitivity analyses. RESULTS:Compared to no screening, the incremental cost-effectiveness ratio (ICER) was $16 166 per life year saved or $13 571 per QALY gained for the serology screening, and $38 792 per life year saved and $32 525 per QALY gained for the UBT. The ICER was $477 079 per life year saved or $390 337 per QALY gained for the UBT compared to the serology screening. The cost- effectiveness of serology screening over the UBT was robust to most parameters in the model. CONCLUSION:The population-based serologyscreening for H pylori was more cost-effective than the UBT in prevention of gastric cancer in Singapore Chinese males.

Accuracy of Helicobacter pylori serology in two peptic ulcer populations and in healthy controls

AIM： To estimate the test characteristics of Heli- cobacter pylori （H pylori） serology and of C14-urea breath test （C14-UBT） in two different peptic ulcer populations and in community controls. Second, the aim was to explore the association between the level of Hpylori IgG antibodies and severity of inflammation as to active peptic ulceration in the same populations. METHODS： Vagotomized （n = 83）, medically treated peptic ulcer patients （n = 73） and one reference group of community controls （n = 88） were gastroscoped. H pylori status was determined by histology, bacterial growth, C14-UBT and serology. Based on the updated Sydney System, cumulative scores from biopsies from the prepyloruos, incisura angularis, corpus and fundus were calculated. RESULTS： The prevalence of Hpylori infection varied from 70% to 79%. The C14-UBT had high accuracy compared to the serology test. The sensitivity of the serology test was good, but the specificity was low （41%-71%）. The association between H pylori IgG antibodies and scores of gastric mucosal inflammation and current or previous peptic ulcer were weak. CONCLUSION： The accuracy of CI4-UBT to diagnose Hpylori infection was good, and the clinical utility of a negative H pylori serology test was substantial, while the gain in clinical information of a positive test was meagre. Positive H pylori titres could not distinguish between subjects with or those without active peptic ulceration.

Molecular and serology methods in the diagnosis of COVID-19: An overview

Coronavirus disease-19(COVID-19)has become a pandemic,being a global health concern since December 2019 when the first cases were reported.Severe acute respiratory syndrome coronavirus 2,the COVID-19 causal agent,is aβ-coronavirus that has on its surface the spike protein,which helps in its virulence and pathogenicity towards the host.Thus,effective and applicable diagnostic methods to this disease come as an important tool for the management of the patients.The use of the molecular technique PCR,which allows the detection of the viral RNA through nasopharyngeal swabs,is considered the gold standard test for the diagnosis of COVID-19.Moreover,serological methods,such as enzyme-linked immunosorbent assays and rapid tests,are able to detect severe acute respiratory syndrome coronavirus 2-specific immunoglobulin A,immunoglobulin M,and immunoglobulin G in positive patients,being important alternative techniques for the diagnostic establishment and epidemiological surveillance.On the other hand,reverse transcription loop-mediated isothermal amplification also proved to be a useful diagnostic method for the infection,mainly because it does not require a sophisticated laboratory apparatus and has similar specificity and sensitivity to PCR.Complementarily,imaging exams provide findings of typical pneumonia,such as the ground-glass opacity radiological pattern on chest computed tomography scanning,which along with laboratory tests assist in the diagnosis of COVID-19.

Case Report of Cardiac Tamponade Due to Acute Chagas Disease after Misdiagnosis of Visceral Leishmaniasis Based on Serology

Protozoan diseases such as Visceral Leishmaniasis (VL) have re-emerged in Northern Brazil and cases of Chagas Disease also occur. This VL increase leads to early therapy for the public. Confirmatory parasitological diagnoses in VL are performed by bone marrow or spleen aspiration, but ELISA, IFA or immunochromatographic tests for antibody detection are easily performed and can be used in the presence of clinical signs as confirmatory for specific therapy. This approach is successful in providing therapy and prevention of death in VL, but there is a chance of confusion with the emerging disease, Chagas Disease (CD), due to cross-reacting and similar clinical pictures, as in this case. Both VL and CD presented many asymptomatic or oligosymptomatic cases, complicating the picture. Our case report emphasizes these aspects. Positive serology, with an IIF titer of 1/160, and epidemiological correlation, suggests the diagnosis of VL and imposes antimony therapy. Despite the unfavorable evolution and signs of cardiac involvement, the presence of pericarditis and cardiac tamponade confirmed by the echocardiogram suggests CD. We reassessed the profiles of a suggested CD serology, the diagnosis was corrected and treatment with CD specific benznidazole. The good evolution started with benznidazole corroborates the diagnosis of CD and discards the hypothesis of double infection.

Inflammatory bowel disease serology in Asia and the West

AIM:To study serological antibodies in Caucasians and Asians,in health and inflammatory bowel disease(IBD),in Australia and Hong Kong(HK).METHODS:Anti-glycan antibodies[anti-chitobioside(ACCA),anti-laminaribioside(ALCA)],and anti-mannobioside(AMCA),anti-Saccharomyces cervisiae(gASCA);and atypical perinuclear anti-neutrophil cytoplasmic antibody(pANCA)were tested in IBD patients,their unaffected relatives,and healthy controls in Australia and HK(China).Antibody status(positive or negative)and titre was compared between subjects of different geography,ethnicity and disease state.RESULTS:Ninety subjects were evaluated:21 Crohn’s disease(CD),32 ulcerative colitis(UC),29 healthy controls,and 8 IBD patient relatives.Forty eight subjects were Australian(29 Caucasian and 19 ethnic Han Chinese)and 42 were from HK(all Han Chinese).Caucasian CD patients had a significantly higher antibody prevalence of gASCA(67%vs 3%,P<0.001),ALCA(44%vs 6%,P=0.005),and AMCA(67%vs 15%,P=0.002),whereas HK CD patients had a higher prevalence of only AMCA(58%vs 25%,P=0.035),when compared with UC and healthy subjects in both countries.Caucasian CD had significantly higher gASCA prevalence(67%vs 0%,P<0.001)and titre(median59 vs 9,P=0.002)than HK CD patients.Prevalence and titres of ALCA,ACCA and AMCA did not differ between CD in the two countries.Presence of at least one antibody was higher in Caucasian than HK CD patients(100%vs 58%,P=0.045).pANCA did not differ between countries or ethnicity.CONCLUSION:Serologic CD responses differ between HK Asian and Australian Caucasian patients.Different genetic,environmental or disease pathogenic factors may account for these differences.

Analysis of Clinical Characteristics and Diagnostic Value of Fungal Serology in Patients with Invasive Candidiasis

Objective: To evaluate the diagnostic value of (1 - 3)-β-D glucan and mannan assay for invasive candidiasis. Methods: A retrospective study was conducted on 32 cases in the disease group (18 proven invasive candidiasis and 14 probable invasive candidiasis) and 48 cases in the control group. The subjects were recruited from January 2018 to March 2019 in Clinical Laboratory of Hainan General Hospital. All subjects were detected by (1 - 3)-β-D glucan and mannan assay. Results: The mean concentration of (1 - 3)-β-D glucan in the disease group was 97.45 (43.23, 224.35) pg/ml and it was significantly higher than the mean concentration of the control group which was 49.85(41.91, 56.07) pg/ml (P = 0.005). The mean concentration of mannan in the disease group and the control group were 161.36 (34.96, 224.49) pg/ml and 25.80 (25.00, 29.31) pg/ml, respectively, which were significantly different (P < 0.001). The sensitivity, specificity, positive predictive value and negative predictive value of (1 - 3)-β-D glucan assay were 59.38%, 89.58%, 79.17%, 76.79%, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of mannan assay were 65.63%, 95.83%, 91.30%, 80.70%, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of combination of two types of assays were 81.25%, 85.42%, 78.79% and 87.23%, respectively. Conclusions: Combination of (1 - 3)-β-D glucan and mannan assay can improve diagnostic specificity and it has essential clinical diagnostic value for invasive candidiasis.

Gastrointestinal tuberculosis:Diagnostic approaches for this uncommon pathology

A case report entitled“Primary gastroduodenal tuberculosis presenting as gastric outlet obstruction”recently published in the World Journal of Clinical Cases presented a rare cause of gastric outlet obstruction and highlighted the atypical manner in which gastrointestinal tuberculosis(TB)can present.The literature with regards to this rare pathology is limited to case reports and case series with the largest being published using data from between 2003 and 2013.However,since then the diagnostic tools available have significantly changed with more modern and increasingly accurate tests now available.This editorial reviews the current state of the art with regards to diagnosis in gastrointestinal TB.

Diagnosis of West Nile virus infections:Evaluation of different laboratory methods

BACKGROUND The diagnosis of West Nile virus(WNV)is challenging due to short-term and low-level viremia,flavivirus cross-reactivity,and long immunoglobulin M(IgM)persistence.AIM To evaluate different methods for WNV detection[reverse transcription-polymerase chain reaction(RT-PCR),IgM/IgG antibodies,IgG avidity]in serum,cerebrospinal fluid(CSF),and urine samples of patients with confirmed WNV infection.METHODS The study included patients with confirmed WNV neuroinvasive infection(n=62),asymptomatic WNV seropositive individuals(n=22),and individuals with false-positive WNV IgM antibodies(n=30).WNV RNA was detected using RT-PCR.A commercial ELISA was used to detect WNV IgM/IgG antibodies with confirmation of cross-reactive samples using a virus neutralization test(VNT).IgG-positive samples were tested for IgG avidity.RESULTS The WNV-RNA detection rates were significantly higher in the urine(54.5%)/serum(46.4%)than in CSF(32.2%).According to the sampling time,the WNV-RNA detection rates in urine collected within 7 days/8-14/≥15 days were 29.4/66.6/62.5%(P=0.042).However,these differences were not observed in the CSF.The median RT-PCR cycle threshold values were significantly lower in urine(32.5,IQR=28-34)than in CSF(34.5,IQR=33-36).The frequency of positive WNV IgM and IgG significantly differed according to the sampling time in serum but not in CSF.Positive IgM/IgG antibodies were detected in 84.3/9.3%of serum samples collected within 7 days,100/71.1%of samples collected 8-14,and 100%samples collected after≥15 days.Recent WNV infection was confirmed by low/borderline avidity index(AI)in 13.6%of asymptomatic individuals.A correlation between ELISA and AI was strong negative for IgM and strong positive for IgG.No significant correlation between ELISA IgG and VNT was found.CONCLUSION The frequency of WNV RNA and antibody detection depends on the sampling time and type of clinical samples.IgG avidity could differentiate recent WNV infections from long-persisting IgM antibodies.

Multiplex Rapid Test with Acceptable Diagnosis Performance as a Solution to Increase Diagnosis of Hepatitis B and C Viruses in Pregnant Women in an Area of High Prevalence of Both Hepatitis Viruses Associated with HIV

Background and Objective: HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV) are very widespread in the world, however, less than 20% of the people affected are diagnosed and treated. This study aimed to determine the prevalence of HIV, HCV and HBV co-infections in pregnant women at Bangui Community University Hospital and the cost of screening. Methods: A cross-sectional study involving consenting pregnant women who came for antenatal care was performed. HIV, HCV antibodies and HBV antigens were detected using Exacto Triplex? HIV/HCV/HBsAg rapid test, cross-validated by ELISA tests. Sociodemographic and professional data, the modes of transmission and prevention of HIV and both hepatitis viruses were collected in a standard sheet and analyzed using the Epi-Info software version 7. Results: Pregnant women aged 15 to 24 were the most affected (45.3%);high school girls (46.0%), and pregnant women living in cohabitation (65.3%) were the most represented. Twenty-five (16.7%) worked in the formal sector, 12.7% were unemployed housewives and the remainder in the informal sector. The prevalence of HIV, HBV, and HCV viruses was 11.8%, 21.9% and 22.2%, respectively. The prevalence of co-infections was 8.6% for HIV-HBV, 10.2% for HIV-HCV, 14.7% for HBV-HCV and 6.5% for HIV-HBV-HCV. All positive results and 10% of negative results by the rapid test were confirmed by ELISA tests. The serology of the three viruses costs 39,000 FCFA (60 Euros) by ELISA compared to 10,000 FCFA (15.00 Euros) with Exacto Triplex? HIV/HCV/AgHBs (BioSynex, Strasbourg, France). Conclusion: The low level of education and awareness of hepatitis are barriers to development and indicate the importance of improving the literacy rate of women in the Central African Republic (CAR). Likewise, the high prevalence of the three viruses shows the need for the urgent establishment of a national program to combat viral hepatitis in the CAR.

Establishment of an indirect immunofluorescence assay for the detection of African swine fever virus antibodies

African swine fever(ASF)continues to cause enormous economic loss to the global pig industry.Since there is no safe and effective vaccine,accurate and timely diagnosis of ASF is essential to implement control measures.Indirect immunofluorescence assay(IFA)is a gold standard serological method recommended by the World Organization for Animal Health(WOAH).In this study,we used primary fetal kidney cells to establish a wild boar cell line(BK2258)that supported the efficient replication of ASF virus(ASFV)SD/DY-I/21 and showed visible cytopathic effect(CPE).Moreover,using BK2258,we established a sensitive and specific IFA for ASFV antibody detection.To standardize and evaluate the performance of this assay,we used serum samples from pigs infected with the low virulent genotype I SD/DY-I/21 and genotype II HLJ/HRB1/20,and immunized with the vaccine candidate HLJ/18-7GD,field samples,and negative serum samples.The IFA reacted with the ASFV-positive sera and displayed bright fluorescence foci.There was no non-specific green fluorescence due to cellular senescence or other cell damage-causing factors.Compared to a commercial indirect enzyme-linked immunosorbent assay(iELISA),ASFV antibodies were detected 1–4 days earlier using our IFA.The detection limits of the IFA and iELISA for the same ASFV-antibody positive serum samples were 1:25,600 and 1:6,400,respectively,indicating that the IFA is more sensitive than iELISA.The newly established IFA was highly specific and did not cross-react with sera positive for six other important porcine pathogens(i.e.,Classical swine fever virus(CSFV),Porcine reproductive and respiratory syndrome virus(PRRSV),Porcme circovirus type 2(PCV2),Pseudorabies virus(PRV),Foot-and-Mouth disease virus type O(FMDV/O),and Porcine epidemic diarrhea virus(PEDV)).This study thus provides a sensitive,specific,and reliable detection method that is suitable for the serological diagnosis of ASF.

Serological Investigation into the Infected Genotypes of Patients with Japanese Encephalitis in the Coastal Provinces of China

Objective Genotypes(G)1,3,and 5 of the Japanese encephalitis virus(JEV)have been isolated in China,but the dominant genotype circulating in Chinese coastal areas remains unknown.We searched for G5 JEV-infected cases and attempted to elucidate which JEV genotype was most closely related to human Japanese encephalitis(JE)in the coastal provinces of China.Methods In this study,we collected serum specimens from patients with JE in three coastal provinces of China(Guangdong,Zhejiang,and Shandong)from 2018 to 2020 and conducted JEV cross-neutralization tests against G1,G3,and G5.Results Acute serum specimens from clinically reported JE cases were obtained for laboratory confirmation from hospitals in Shandong(92 patients),Zhejiang(192 patients),and Guangdong(77 patients),China,from 2018 to 2020.Seventy of the 361 serum specimens were laboratory-confirmed to be infected with JEV.Two cases were confirmed to be infected with G1 JEV,32 with G3 JEV,and two with G5 JEV.Conclusion G3 was the primary infection genotype among JE cases with a definite infection genotype,and the infection caused by G5 JEV was confirmed serologically in China.

Real-world utility of serological tests in patients with suspected scrub typhus in the Republic of Korea:A single-center,retrospective,observational study

Objective:Serological tests are widely used for scrub typhus diagnosis;however,their limitations are evident.This study aims to assess their practical value in clinical settings.Methods:We analyzed the data of adult patients with suspected scrub typhus who visited a tertiary care hospital in the Republic of Korea from September to December from 2019 to 2021.The included patients had an acute fever and at least one of the following ten secondary findings:myalgia,skin rash,eschar,headache,thrombocytopenia,increased liver enzyme levels,lymphadenopathy,hepatomegaly,splenomegaly,and pleural effusion.The diagnoses were grouped as scrub typhus or other diseases by two infectious disease physicians.Results:Among 136 patients who met the eligibility criteria,109 had scrub typhus and 27 had different diseases.Single and paired total antibodies using immunofluorescence assay(IFA),and total antibodies using immunochromatography-based rapid diagnostic testing(ICT)were measured in 98%,22%,and 75%of all patients,respectively.Confirmation using paired samples for scrub typhus was established at a median of 11[interquartile range(IQR)10-16]days following the first visit.Among the 82 admitted patients,the median admission time was 9(IQR 7-13)days.According to IFA,58(55%)patients with scrub typhus had total immunoglobulin titers≥1:320,while 23(85%)patients with other disease had titers<1:320.Positive ICT results were observed in 64(74%)patients with scrub typhus and 10(67%)patients with other diseases showed negative ICT results.Conclusions:Serological testing for scrub typhus is currently insufficient for decision-making in clinical practice.

Global strategy for prevention of gastric cancer

Global prevention of gastric cancer needs to increase its level of effectiveness.The prevention strategy should include all stages of primary and secondary prevention.The necessary steps to prevent gastric cancer are the following:Maintaining a healthy lifestyle and diet,avoiding smoking and alcohol;serological screening of Helicobacter pylori infections and eradication;serological screening of atrophic gastritis in the population over 45 years of age and identification of severe atrophic gastritis with a high risk of developing gastric cancer;verification of atrophic gastritis and precancerous changes in the gastric mucosa using modern endoscopic(confocal laser endomicroscopy,narrow-spectrum imaging,and magnifying endoscopy)and morphological methods among patients with severe atrophic gastritis who were identified using serological screening;treatment of patients with atrophic gastritis during diagnosis verification;annual endoscopic and morphological monitoring of patients with atrophic gastritis during permanent treatment;annual serological monitoring of patients with atrophic gastritis who refused endoscopic and morphological monitoring;and radical treatment of patients with verified early gastric cancer.Ways to implement the algorithm for the global strategy for the prevention of gastric cancer(protocol of practical recommendations)are:State,government,and municipal programs;departmental programs of health departments;family doctors for patients who have a contract at the initiative of the doctor;family doctors for patients with a contract at the patient’s initiative;and within private healthcare system where both doctors and patients can initiate the implementation of algorithm.

Effects of Pearl Yangxin Anshen Decoction on HAMD and PTSD-SS Scores, Cytokines and Related Metabolites in Patients with Post-Traumatic Stress Disorder

Objective: This paper aims to observe the Pearl Yangxin Anshen Decoction to influence the score of HAMD and PTSD-SS, the changes of the cytokines and the related metabolic product in patients with PTSD. Methods: From June 2015 to May 2016, in the traditional Chinese medicine clinics of Hainan Province People’s Hospital, there were 50 patients with PTSD, the age were from 30 to 60, they were randomly divided into treatment group (25 cases) and control group (25 cases), then compared the scores of HAMD and PTSD-SS between the two groups, searched the changes of cytokines and the related metabolic product. Results: In the treatment group: before and after treatment the scores of PTSD-SS were 65.64 ± 7.02, 28.32 ± 4.18, and the scores of HAMD were 29.28 ± 1.97, 11.72 ± 2.13;In the control group: before and after treatment the scores of PTSD-SS were 63.24 ± 6.16, 31.40 ± 4.29, the scores of HAMD were 30.24 ± 2.05, 13.08 ± 2.30. After 3 months patients in treatment group the scores of PTSD-SS and HAMD were lower than the control group (t = 2.570, P = 0.013, t = -2.1640, P = 0.035). In the control group: before and after 3 months treatment the IL-2 levels respectively were 79.84 ± 26.46 pg/ml, 56.18 ± 22.67 pg/ml, the IL-6 levels respectively were 110.83 ± 47.65 pg/ml, 59.67 ± 44.68 pg/ml, the IL-8 levels respectively were 73.11 ± 78.51 pg/ml, 55.83 ± 81.94 pg/ml, the NE levels respectively were 420.04 ± 674.75 pg/ml, 185.31 ± 417.91 pg/ml, the MDA levels respectively were 112.35 ± 62.87 ng/ml, 60.42.33 ± 53.64 ng/ml, the NO levels were 126.6 ± 47.4 μmol/L, 78.6 ± 45.7 μmol/L, the VIP levels were 396.6 ± 144.4 pg/ml, 122.4 ± 111.5 pg/ml. In the treatment group: before and after 3 months treatment the IL-2 levels respectively were 86.00 ± 32.29 pg/ml, 53.84 ± 27.01 pg/ml, the IL-6 levels respectively were 108.21 ± 44.60 pg/ml, 42.46 ± 42.16 pg/ml, the IL-8 levels respectively were 81.48 ± 94.19 pg/ml, 54.07 ± 84.15 pg/ml, the NE levels respectively were 392.93 ± 592.84 pg/ml, 243.85 ± 588.45 pg/ml, the MDA levels respectively were 117.58 ± 63.37 ng/ml, 45.91 ± 38.94 ng/ml, the NO levels respectively were 135.9 ± 46.4 μmol/L, 72.6 ± 46.6 μmol/L, the VIP levels respectively were 414.0 ± 140.1 pg/ml, 185.8 ± 105.3 pg/ml. In the two groups as the extension of treatment time, the content of IL-2, IL-8, IL-6, NE, MDA, NO, and VIP were gradually reduced, and the level of reduction of the treatment group patients was higher than the control group, the change of ACTH and SOD levels just the opposite. Conclusion: The Pearl Yangxin Anshen Decoction could improve the symptoms of psychological anxiety, depression and other psychological problems in patients with PTSD, and influence the change of cytokines and related metabolites product.

Study on the Application Value of Liver Function and Serological Index Levels in the Diagnosis of Fatty Liver

Objective:To explore the application value of liver function and serological index detection in diagnosing fatty liver.Methods:Ninety patients with fatty liver disease(disease group)and ninety healthy subjects(healthy group)were selected as the subjects of this study.They all underwent liver function index testing and serological index testing.Test results were compared,and the diagnostic accuracy of single and combined tests was evaluated.Results:Liver function indicators of patients in the disease group were higher than those in the healthy group,with severe patients exhibiting higher levels than moderate patients and mild patients(P<0.05).Serological indicators in patients in the disease group were higher than those in the healthy group,with severe patients showing higher levels than moderate patients and mild patients(P<0.05).The diagnostic accuracy of liver function index testing was higher than that of serological index testing,and the accuracy of combined testing was higher than that of single testing(P<0.05).Conclusion:In diagnosing fatty liver,combining liver function testing and serological testing enables the initial diagnosis of the disease and facilitates the accurate assessment of its severity.

Clinical value of serum pepsinogen in the diagnosis and treatment of gastric diseases

Pepsinogen,secreted from the gastric mucosa,is the precursor of pepsin.It is categorized as pepsinogen 1 and pepsinogen 2 based on its immunogenicity.The pepsinogen content that can enter the blood circulation through the capillaries of the gastric mucosa is approximately 1%and remains stable all the time.The pepsinogen content in serum will change with the pathological changes of gastric mucosa.Therefore,the level of pepsinogen in serum can play a role in serologic biopsy to reflect the function and morphology of different regions of gastric mucosa and serve as an indicator of gastric disease.This study conducts relevant research on serum pepsinogen 1,pepsinogen 2,and the ratio of pepsinogen 1 to pepsinogen 2,and reviews their important value in clinical diagnosis of Helicobacter pylori infection,gastric ulcer,and even gastric carcinoma,providing ideas for other researchers.

Maculopapular Rash with Fever: Reporting of a Case with Imported Measles and Diagnostic Difficulties in Non-Epidemic Times

Background: Measles is a highly contagious infection caused by the measles virus with a worldwide distribution. Measles is one of the diseases that have been reported in our country since 1945. It is known that international travelers are an important source of infectious pathologies. Our goal is to document a case of imported Measles and the difficulty of diagnosing it, especially in non-epidemic times. Cases Presentation: We presently report a 20-year-old woman who was hospitalized at the Infectious Disease Service for fever and maculopapular rash. She had traveled outside of Albania. Measles ELISA IgM (blood) resulted positive while other serological examinations resulted negative. Our case was treated with antibiotics, multivitamins and intravenous fluids. She was subsequently discharged home in good clinical condition. Conclusions: Measles should be included in the differential diagnosis of patients with symptoms of fever and rash, in particular when they have traveled abroad. Patients who have received the Measles vaccine should not be excluded from clinical suspicion and further diagnostic tests for this disease as it can affect this group of patients as well.