Diagnostic performance of C-reactive protein level and its role as a potential biomarker of severe dengue in adults

Objective: To determine the relationship between C-reactive protein(CRP) level and the severity of dengue and the potential use of CRP in predicting acute dengue infection.Methods: A prospective observational study was performed on dengue patients admitted to a tertiary care hospital in southern India. All patients of age above 18 years, diagnosed with dengue were included in the study. The detailed laboratory parameters pertaining to dengue were recorded. CRP levels were estimated and compared between groups i.e. severe and non-severe dengue. CRP cut-off value was detected using the receiver-operator curve.Results: Totally 98 patients with a mean age of 40 years were included. Among them, 11.2% of the patients suffered from severe dengue, 54.1% of the cases had non-severe dengue without warning signs, and 34.7% had non-severe dengue with warning signs. The median CRP was significantly higher in patients with severe dengue compared to patients with non-severe dengue(96.2 mg/d L vs. 5.3 mg/d L). Univariate logistic regression analysis showed that the odd’s ratio(OR) of CRP was 1.053(P≤0.001, 95% CI=1.029-1.078). CRP at a cutoff value of 21.6 mg/L(0.929 AUC) had excellent sensitivity(100%) and specificity(81.6%) in predicting severe dengue infection. Multivariate logistic regression analysis showed that CRP(OR=1.089, P=0.013) and ALT(OR=1.010, P=0.034) were statistically significant independent predictors of dengue severity.Conclusions: CRP level could be used as a potential biomarker to predict severity of dengue in adults.

Prospective Analysis of Patients Treated with Chemotherapy in Metastatic Adenocarcinoma of Lung—Single Centre Experience

Background: Lung cancer is the leading cause of cancer-related death worldwide with an estimated 1.6 million new cases diagnosed each year. According to standard guidelines in NSCLC, the effectiveness of combined chemotherapy regimen comprises of pemetrexed and platinum, and very few reports are available in Indian population. This study shows the experience with pemetrexed and platinum combination chemotherapy in metastatic NSCLC in first line setting. Methods: Total 61 patients with following inclusion criteria were recruited such as: 1) PS of 1 and 2;2) NSCLC of non-squamous histology;3) locally advanced or metastatic disease at diagnosis;4) should have received minimum 3 cycles of pemetrexed and platinum as first line treatment and or continued for 6 cycles;5) EGFR/ALK mutated or EGFR/ALK unknown patients but must have received upfront chemo. Primary endpoint of the present study is to assess Disease Control Rate (DCR) (CR + PR + SD). Progression Free Survival, OS and Toxicity assessment were secondary endpoints. Results: The mean number of average chemotherapy cycles was found to be 4.38. The range of chemotherapy was 2 - 6 cycles. Disease control rate, defined as (CR + PR + SD), was seen in 44 (72.1%) patients. (PR in 26 (42.62%), SD 18 (29.5%)), Progressive disease (PD) was observed in 17 (27.9%) patients. Overall study showed that patients had PFS of 9.414 months (95% CI 6.709 - 12.120) and OS of 13.437 months (95% CI 10.721 - 16.153). Conclusion: Pemetrexed and platinum combination is effective and well-tolerated chemotherapy regimen in patients with metastatic adenocarcinoma lung cancer patients. Pemetrexed and cisplatin may be more effective in particular. Early switch over to TKIs is preferred immediately after obtaining molecular subtype result.