Shortage of doctors, Irregularities in drug procurement in Chhattisgarh: CAG Report

Raipur: The Comptroller and Auditor General (CAG) has flagged significant issues in Chhattisgarh’s healthcare system, including a severe shortage of medical personnel and alleged irregularities in the procurement process for medicines and equipment.

The CAG’s performance audit report on Public Health Infrastructure and Management for the fiscal year ending March 2022 was presented to the state assembly on Friday.

It said there was an overall shortage of 34 per cent (25,793 personnel) against the sanctioned strength of 74,797 in the health department.

According to a PTI report, though the doctor per-population ratio (1: 2492) improved during 2016-22, it was far behind the WHO benchmark of one doctor for 1,000 people and national ratio of 1:1456. The posts of doctors were not sanctioned uniformly on the basis of population, resulting in uneven distribution of doctors under the Directorate Health Services across districts, the CAG said. In 23 district hospitals, there was a shortage of specialist doctors (33 per cent), medical officers (four per cent) and paramedics (13 per cent) against the sanctioned strength.

Also Read:88 percent Funds Not Utilised: CAG slams Jhakhand on medical and health infrastructure

172 Community Health Centres faced shortages of specialist doctors (72 per cent) and general doctors (15 per cent).

In 4,996 Sub Health Centres, 17 per cent posts of ANM (auxiliary nurse midwife) were vacant against the sanctioned strength. In 502 SHCs, no ANMs were posted, and hence, maternity services could not be provided to pregnant women, the CAG said, adds PTI.

The Chhattisgarh State Medical Services Corporation Limited (CGMSCL) was set up in 2010 as a centralised nodal agency for all procurement and supply of drugs, medicines and equipment. During 2016-22, the Health and Family Welfare department procured drugs, medicines and equipment worth Rs 3,753.18 crore, the report said. Despite this centralized procurement agency, purchases of drugs, medicines and consumables were made locally, ranging from 26.79 to 50.65 per cent of total procurement during 2016-22, it said. Equipment was purchased without ensuring availability of required infrastructure, resulting in idling of equipment worth Rs 49.68 crore.

He said drugs worth Rs 23.98 crore were purchased from blacklisted firms, CAG pointed out. Commenting on the CAG report, Health and Family Welfare Minister Shyam Bihari Jaiswal told reporters that the present BJP government has started the recruitment process of healthcare personnel and launched a probe into allegations of irregularities in some purchases of medicines and equipment. “This report covers the period upto 2022, not the last six months of our government. If Congress says there are irregularities then it is good as the report is about their tenure”, news agency PTI reported.

Also Read:Serious lapses in admissions in medical colleges in Bihar: CAG

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Former KGMU Neurosurgeon Assault Case: Two accused arrested in connection

Lucknow: In the latest update regarding the alleged brutal assault on a former King George’s Medical University (KGMU) neurosurgeon by relatives over the death of their patient, two people have been arrested for their alleged involvement with the case. 

This comes after the duo confessed to their crime of allegedly assaulting and thrashing the doctor who is also the owner of of a private hospital in Gomti Nagar Extension. The duo are residents of Banthara in Lucknow and Rae Bareli district.

Also read- Mob Attack: Former KGMU Neurosurgeon Brutally Attacked After Patient Death, IMA Condemn Assault

During the investigation, the police identified these two people in connection with the case and interrogated them. Subsequently, the two accused also revealed the names of their aides. The police are now working on locating the rest of the suspects involved in this matter, as per TOI news report. 

Medical dialogues recently reported that a former King George’s Medical University (KGMU) neurosurgeon, also the owner of a private hospital in Gomti Nagar Extension was allegedly brutally thrashed by relatives of a patient who died during treatment at the medical facility. Holding the doctor responsible for the death of the patient, the relatives of the deceased allegedly slapped, punched and thrashed the doctor using sticks, and rods leaving him injured.

The video captured on the hospital’s CCTV went viral on social media sparking outrage within the medical community and among the general public. The viral video depicted each relative taking turns brutally attacking the doctor, while he attempted to shield himself by using his hands to protect his head.

Later, the hospital staff intervened and protected the doctor from the attack. After sustaining serious injuries, the doctor was admitted to a private hospital in Chowk. He is currently undergoing treatment. 

Condemning the attack on the doctor, the Lucknow Branch of the Indian Medical Association (IMA) held a protest demanding immediate action against the attackers. Around 150 doctors marched from the IMA building in River Bank Colony to Shaheed Smarak on Thursday.

Submitting a memorandum to the Deputy Commissioner of Police, the association requested the police administration to investigate the matter thoroughly and take strict action against those responsible for the attack on the doctor. They also threatened to initiate a nationwide strike if the police failed to arrest the culprits.

Also read- Goa Medical College Resident Doctor Assaulted By Two Women, Doctors Association Demands Action

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HIV serostatus does not influence HbA1c levels in people living with HIV: Insights from continuous glucose monitoring

UK: Recent research has delved into the influence of HIV serostatus on glycated hemoglobin (HbA1c) levels, employing continuous glucose monitoring (CGM) for a prospective analysis. The study, published in the Diabetes Care, offers valuable insights into how HIV status may impact glucose metabolism and glycemic control.

The researchers performed a comprehensive assessment of glycemia to assess if HIV serostatus influences HbA1c. They did not find strong evidence that HIV serostatus influenced HbA1c. The findings support HbA1c incorporation into routine clinical blood work in people living with HIV (PLWH).

In people living with HIV, type 2 diabetes (T2D) is reported to be common. Clinical guidelines recommend diabetes screening in PLWH, but there is no agreed method due to studies reporting that HbA1c is falsely low in PLWH. These studies were performed in the era of early HIV when participants were taking older preparations of antiretroviral therapy that are rarely used today.

Harriet Daultrey, Brighton and Sussex Medical School, Brighton, East Sussex, U.K, and colleagues aimed to investigate whether HIV serostatus influences HbA1c.

For this purpose, they conducted a prospective cohort study of PLWH and sex- and age-matched HIV-negative participants who were purposely recruited from clinics in Brighton, U.K. Each participant wore a Dexcom G6 continuous glucose monitor (CGM) for up to 10 days, had glucose measured during an oral glucose tolerance test, and fructosamine and paired HbA1c were measured.

The research team performed regression analysis to assess the impact of HIV on HbA1c and used a separate model for CGM glucose, fructosamine, and venous glucose. Additionally, predictor variables used in previous studies were included that explored HbA1c discrepancy.

The following were the key findings of the study:

  • Sixty people living with HIV (90% men, 50% with T2D, mean ± SD age 57 ± 10.7 years, 100% undetectable viral load) and 48 people without HIV (92% men, 30% with T2D, mean age 57.7 ± 8.9 years) were recruited.
  • HIV serostatus did not have a significant influence on HbA1c within the regression models.

To summarize, a study in the UK utilized CGM and oral glucose tolerance tests to examine the influence of HIV serostatus on HbA1c levels in PLWH compared to HIV-negative individuals.

“Despite previous concerns about HbA1c accuracy in PLWH, the findings showed no significant influence of HIV status on HbA1c levels, indicating that HbA1c remains a reliable marker for glycemic assessment in PLWH,” the researchers wrote.

Reference:

Harriet Daultrey, Nick S. Oliver, Juliet Wright, Tom J. Levett, Ali Jason Chakera; What Is the Influence of HIV Serostatus on HbA1c? A Prospective Analysis Using Continuous Glucose Monitoring. Diabetes Care 2024; dc240225. https://doi.org/10.2337/dc24-0225

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Digoxin and beta-blockers have equivalent effects on heart rate at rest and on exertion in AF patients: Study

A new study by Simrat Gill and team unveiled that Digoxin and beta-blockers had similar effects on heart rate in atrial fibrillation at rest and during exercise which implies that dynamic monitoring of persons with arrhythmia using wearable technology might be a viable alternative to in-person examination. The findings of this study were published in the journal of Nature Medicine.

The patients with cardiovascular illness may require several clinical visits to acquire tests such as electrocardiograms (ECG) for heart rate measurement or 6-minute walk (6MW) assessments to determine physical capability. One prominent illustration of the potential clinical utility of wearable sensor data is medication selection and dose modification for heart rate control in people who have atrial fibrillation (AF). And so, this study was set to determine if digoxin is weaker than beta-blockers for long-term heart rate regulation among individuals with AF at rest and during exercise, as well as to see if wearable sensor data are equivalent to traditional assessments.

The RATE-AF trial wearables research evaluated heart rates in elderly, multimorbid individuals with persistent atrial fibrillation and heart failure who were randomly assigned to either digoxin or beta-blockers. Over a 20-week period, 53 volunteers with mean age of 75.6 years (40% female) used a wrist-worn wearable connected to a smartphone. This study included 143,379,796 participants to measure their heart rate and 23,704,307 participants to measure physical activity.

The outcomes of this research found no statistically significant difference in heart rates between the individuals treated with digoxin and beta-blockers. After controlling for physical activity or patients with high activity levels (≥30,000 steps per week), there was no change observed in heart rate between the two patient groups.

This research discovered that wearable device data could predict New York Heart Association functional class five months after baseline assessment in a manner similar to standard clinical measurements of electrocardiographic heart rate and 6-minute walk test, using a convolutional neural network built to account for missing data. Overall, to assess continuous, ambulatory heart rate and physical activity, a consumer-grade wearable device and smartphone can be effectively used for older, multimorbid patients. 

Reference:

Gill, S. K., Barsky, A., Guan, X., Bunting, K. V., Karwath, A., Tica, O., Stanbury, M., Haynes, S., Folarin, A., Dobson, R., Kurps, J., Asselbergs, F. W., Grobbee, D. E., Camm, A. J., Eijkemans, M. J. C., Gkoutos, G. V., & Kotecha, D. (2024). Consumer wearable devices for evaluation of heart rate control using digoxin versus beta-blockers: the RATE-AF randomized trial. In Nature Medicine (Vol. 30, Issue 7, pp. 2030–2036). Springer Science and Business Media LLC. https://doi.org/10.1038/s41591-024-03094-4

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Cryoablation Safe for Breast Cancer Patients who are poor surgical candidates: Study

Researchers have found that breast cancer cryoablation can be safely applied to a broader patient population, including those ineligible for clinical trials due to unfavorable patient or tumor characteristics. A recent study was published in the the American Journal of Roentgenology by Karim O. and colleagues. This study highlights the safety and effectiveness of cryoablation in treating breast cancer without surgical excision, offering a viable alternative for patients who are poor surgical candidates.

Cryoablation is a minimally invasive treatment to kill cancer cells through extreme cold. While clinical trials have shown this to be effective, highly stringent inclusion criteria exclude those patients whose diseases are potentially treatable. This study evaluated the safety and outcomes of cryoablation in a real-world setting on patients excluded from clinical trials.

This was a retrospective study of women with cryoablation of biopsy-proven unifocal primary breast cancer treated with locally curative intent without surgical excision at seven institutions between January 1, 2000, and August 26, 2021. Adverse events were recorded. Cryoablation procedures were considered to be technically successful when they were not aborted prematurely and intended treatment parameters had been reached with no residual disease on the first imaging follow-up. Follow-up biopsy results were noted, and ipsilateral breast tumor recurrences were identified and classified as true recurrence versus new primary disease. A competing-risk model estimated the cumulative incidence of IBTR accounting for death before IBTR.

• Their median age was 71 years, and a total of 112 patients were studied. Slight AEs occurred in 7 of 112 patients (6.3%). No moderate or major AEs were reported. The technical success rate for cryoablation procedures reached 110 of 112 (98.2%).

• With a median follow-up of 2.0 years, 22 of the 110 patients underwent biopsy for suspicious imaging findings in the ipsilateral breast, which demonstrated benign findings in 9 of the 22 and IBTR in 12 of the 22.

• In total, 12 of the 110 developed IBTR: 7 were cases of true recurrence, while 5 were of new primary disease.

• Of these 12 patients with IBTR, three had prior adjuvant or neoadjuvant treatment.

• Their cumulative incidence of IBTR was 5.3%, 12.2%, and 18.2% at 1, 2, and 3 years, respectively, when accounting for death as a competing risk.

This paper demonstrates that breast cancer cryoablation is a very safe and effective treatment for patients who do not meet the inclusion criteria of clinical trials due to unfavorable characteristics. The high rate of technical success, together with a low severe adverse event rate, underlines the potential for cryoablation to form part of the armamentarium for breast cancer treatment, in particular in patients not suitable for surgery.

In select individuals with unfavorable patient or tumor characteristics, breast cancer cryoablation provides a safe alternative to surgery with good outcomes. These findings may be particularly relevant in patients who are also poor surgical candidates, supporting the broader application of cryoablation beyond the strict criteria of clinical trials.

Reference:

Oueidat, K., Baird, G. L., Barclay-White, B., Kozlowski, K., Plaza, M. J., Aoun, H., Tomkovich, K., Littrup, P. J., Pigg, N., & Ward, R. C. (2024). Cryoablation of primary breast cancer in patients ineligible for clinical trials: A multiinstitutional study. AJR. American Journal of Roentgenology. https://doi.org/10.2214/ajr.24.31392

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Psoriasis in hypertension patients significantly increases mortality risk, claims study

Psoriasis in hypertension patients significantly increases mortality risk, claims study published in PLoS One.

The linkage between psoriasis and hypertension has been established through observational studies. Despite this, a comprehensive assessment of the combined effects of psoriasis and hypertension on all-cause mortality is lacking. The principal aim of the present study is to elucidate the synergistic impact of psoriasis and hypertension on mortality within a representative cohort of adults residing in the United States. The analysis was conducted on comprehensive datasets derived from the National Health and Nutrition Examination Study spanning two distinct periods: 2003–2006 and 2009–2014. The determination of psoriasis status relied on self-reported questionnaire data, whereas hypertension was characterized by parameters including systolic blood pressure ≥ 140 mmHg, diastolic blood pressure ≥ 90 mmHg, self-reported physician diagnosis, or the use of antihypertensive medication.

The assessment of the interplay between psoriasis and hypertension employed multivariable logistic regression analyses. Continuous monitoring of participants’ vital status was conducted until December 31, 2019. A four-level variable amalgamating information on psoriasis and hypertension was established, and the evaluation of survival probability utilized the Kaplan-Meier curve alongside Cox regression analysis. Hazard ratios (HRs) and their associated 95% confidence intervals (CIs) were computed to scrutinize the correlation between psoriasis/hypertension and all-cause mortality. Results: In total, this study included 19,799 participants, among whom 554 had psoriasis and 7,692 had hypertension.

The findings from the logistic regression analyses indicated a heightened risk of hypertension among individuals with psoriasis in comparison to those devoid of psoriasis. Throughout a median follow-up spanning 105 months, 1,845 participants experienced all-cause death. In comparison to individuals devoid of both hypertension and psoriasis, those with psoriasis alone exhibited an all-cause mortality HR of 0.73 (95% CI: 0.35–1.53), individuals with hypertension alone showed an HR of 1.78 (95% CI: 1.55–2.04), and those with both psoriasis and hypertension had an HR of 2.33 (95% CI: 1.60–3.40). In the course of a stratified analysis differentiating between the presence and absence of psoriasis, it was noted that hypertension correlated with an elevated risk of all-cause mortality in individuals lacking psoriasis (HR 1.77, 95% CI: 1.54–2.04). Notably, this association was further accentuated among individuals with psoriasis, revealing an increased HR of 3.23 (95% CI: 1.47–7.13). The outcomes of our investigation demonstrated a noteworthy and positive association between psoriasis, hypertension, and all-cause mortality. These findings indicate that individuals who have both psoriasis and hypertension face an increased likelihood of mortality.

Reference:

Zhao H, Wu J, Wu Q. Synergistic impact of psoriasis and hypertension on all-cause mortality risk: A prospective cohort study. PLoS One. 2024;19(7):e0306048. Published 2024 Jul 5. doi:10.1371/journal.pone.0306048

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Diabetes drug reduces drug resistance in lung cancer and improves effectiveness of chemotherapy: Study

A medication used to treat diabetic neuropathy may make chemotherapy treatments more effective for patients with lung cancer, according to new findings from the University of Missouri School of Medicine published in Clinical Cancer Research, a journal of the American Association for Cancer Research.

Despite surgical and chemotherapy treatment, more than 50% of non-metastatic, non-small lung cancer patients see recurrences, in large part because of drug-resistant cancer cells. Researchers identified a way to make these cells more susceptible to chemotherapy, said study author Dr. Jussuf Kaifi.

“Traditional treatments for lung cancer, including chemotherapy, often have little to no effect on the cancer because of drug resistance,” Kaifi said. “It is a major cause of mortality in patients, so finding ways to circumvent drug and chemotherapy resistance is vital to improving patient outcomes.”

The study examined 10 non-small cell lung cancer tumors, half of which were identified as drug resistant. The drug-resistant tumors showed overexpression of a certain enzyme, AKR1B10. When treated with the diabetic neuropathy medication, epalrestat, the tumors became less drug resistant, causing their sensitivity to chemotherapy to significantly increase.

Epalrestat is available in several countries and well-tolerated by patients, but it is not yet approved for use by the Food and Drug Administration in the United States. The medication is currently in high-level clinical trials as part of the FDA’s approval process. If given FDA approval, epalrestat could be fast-tracked as an anti-cancer drug for lung cancer patients.

“In general, developing new drugs for cancer treatment is an extremely lengthy, expensive and inefficient process,” Kaifi said. “In contrast, ‘repurposing’ these drugs to other diseases is much faster and cheaper. In view of overcoming drug resistance, epalrestat can rapidly be advanced to the clinic to improve cure rates in lung cancer patients.”

Dr. Jussuf Kaifi, MD, PhD is a thoracic surgeon at MU Health Care and an assistant professor of surgery at the MU School of Medicine. He is also the Chief of Thoracic Surgery. His areas of expertise include general and minimally invasive thoracic surgery, including malignant and benign conditions of the lung. He received his medical degree and doctorate from the University of Hamburg in Germany.

Reference:

Dr. Jussuf Kaifi, Kanve Suvilesh, Yariswamy Manjunath, Targeting AKR1B10 by drug repurposing with epalrestat overcomes chemoresistance in non-small cell lung cancer patient-derived tumor organoids, Clinical Cancer Research, DOI:10.1158/1078-0432.CCR-23-3980.

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Study assesses association between Gestational Weight Gain, Preterm Birth, and Metabolic Factors

The increasing rate of preterm birth (PTB) has garnered greater attention from the medical community and society as a whole. Recent study investigated the association between gestational weight gain (GWG) and preterm birth (PTB) according to pre-pregnancy body mass index (pp-BMI) and glycated hemoglobin (HbA1c) levels within the normal range. The researchers conducted a population-based retrospective cohort study involving 23,699 pregnant women.

Results on GWG and PTB Risk

The results showed that 4.7% of the women experienced PTB. The women were classified into three GWG groups: inadequate GWG (21.2%), appropriate GWG (43.2%), and excessive GWG (35.6%). The analysis revealed that women with inadequate GWG had a significantly higher risk of PTB compared to those with appropriate GWG, even after adjusting for confounding factors. In contrast, women with excessive GWG had a reduced risk of PTB.

Variations in PTB Risk based on BMI and HbA1c

Interestingly, the relationship between GWG and PTB varied based on pp-BMI and HbA1c levels. Among women with pp-BMI <18.5 kg/m2 (underweight) and 18.5-24.9 kg/m2 (normal weight), the risk of PTB increased with rising HbA1c levels when GWG was inadequate. For example, underweight women with HbA1c <5.6% and inadequate GWG had a significantly higher PTB risk compared to those with HbA1c 4.6-5.0% and appropriate GWG, and the risk increased further with higher HbA1c levels.

PTB Risk Among Overweight Women

Similar results were observed in the normal weight group – women with HbA1c >4.6% and inadequate GWG had an elevated PTB risk. However, among overweight women (pp-BMI 25-29.9 kg/m2) with inadequate GWG, the significantly increased PTB risk was only observed in the HbA1c 5.6-6.0% subgroup.

Association Between Excessive GWG and PTB Risk

In contrast, the negative association between excessive GWG and reduced PTB risk was seen in some but not all HbA1c subgroups.

Conclusion and Recommendations

In conclusion, the study found a significant association between GWG and PTB risk, but the risk varied based on pp-BMI and HbA1c levels, even when HbA1c was within the normal range. Inadequate GWG conferred a higher PTB risk, especially among underweight and normal weight women with higher HbA1c levels. The findings suggest that close monitoring of GWG, pp-BMI, and HbA1c is crucial to prevent PTB.

Key Points

Here are the 6 key points of the research paper: 1. The study investigated the association between gestational weight gain (GWG) and preterm birth (PTB) based on pre-pregnancy body mass index (pp-BMI) and glycated hemoglobin (HbA1c) levels within the normal range. 2. The results showed that women with inadequate GWG had a significantly higher risk of PTB compared to those with appropriate GWG, even after adjusting for confounding factors. In contrast, women with excessive GWG had a reduced risk of PTB. 3. The relationship between GWG and PTB varied based on pp-BMI and HbA1c levels. Among underweight and normal weight women, the risk of PTB increased with rising HbA1c levels when GWG was inadequate. 4. For overweight women with inadequate GWG, the significantly increased PTB risk was only observed in the HbA1c 5.6-6.0% subgroup. 5. The negative association between excessive GWG and reduced PTB risk was seen in some but not all HbA1c subgroups. 6. The findings suggest that close monitoring of GWG, pp-BMI, and HbA1c is crucial to prevent PTB, as the risk varies based on these factors, even when HbA1c is within the normal range.

Reference –

Xiaoxiao Zhang, Binbin Yin, Kaiqi Wu, Lei Fang & Yan Chen (2024) Association between maternal gestation weight gain and preterm birth according to pre-pregnancy body mass index and HbA1c, Journal of Obstetrics and Gynaecology, 44:1, 2359671, DOI: 10.1080/01443615.2024.2359671

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Can Use of flurbiprofen ester in 4-dimensional hysterosalpingography relieve pain during an infertility evaluation?

Announcing a new article publication for BIO Integration journal. The purpose of this study was to determine the analgesic effect of a flurbiprofen ester injection via continuous intravenous drip during transvaginal 4-dimensional hysterosalpingography (TVS 4D-HyCoSy).

Two hundred thirty patients who underwent TVS 4D-HyCoSy for infertility from May 2018 to August 2021 at our hospital were selected. The participants were grouped based on tubal patency, flurbiprofen ester use, and uterine cannula diameter, as follows: bilateral tubal patency group; non-bilateral tubal patency group; atropine group; atropine + flurbiprofen ester group; coarse tube group; and fine tube group. The analgesic effect during TVS 4D-HyCoSy and pain relief were compared between groups using visual analog scoring (NRS). Additionally, the incidence of adverse effects was recorded and factors related to the influence of pain were analyzed.

Tubal patency reduced pain during ultrasound tubal examination, flurbiprofenate provided significant analgesia after ultrasound tubalography and reduced adverse effects (P < 0.001). The tube diameter thickness had no effect on tubal ultrasonography procedure-related pain. Multivariable analysis of pain relief during imaging suggested that the use of flurbiprofen for bilateral tubal patency had a significant positive effect on pain relief within 30 min after the examination with an AUC of 0.732 (95% CI: 0.665–0.798).

A flurbiprofen ester continuous intravenous drip had a good analgesic effect in patients with TVS 4D-HyCoSy. Specifically, the pain relief effect after examination was significant and reduced the incidence of adverse reactions during the contrast examination. Flurbiprofen ester can be administered independently and is worthy of clinical promotion and application.

Reference:

Long Tan, Shiji Wu and Ailin Ma et al. Use of Flurbiprofen Ester in 4-Dimensional Hysterosalpingography: Does Flurbiprofen Ester Relieve Pain During an Infertility Evaluation?. BIOI. 2024. Vol. 5(1). DOI: 10.15212/bioi-2024-0026.

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Serum Procalcitonin Shows Promise but Limited Sensitivity for Diagnosing Pediatric Osteomyelitis: Study

Researchers believe that serum procalcitonin (PCT) may turn out to be a helpful biomarker in the diagnosis of pediatric osteomyelitis, even when its sensitivity is low. A recent study by Han Qi and colleagues has tried to determine the sensitivity, specificity, and predictive utility of PCT for the diagnosis of osteomyelitis in children through systematic review with meta-analysis of relevant literature. This study was published in BMC Musculoskeletal Disorders.

An elaborate computer-based search was undertaken for studies that considered PCT for the diagnosis of pediatric osteomyelitis. Accordingly, records were screened and selected according to PRISMA guidelines for systematic reviews and meta-analysis. Review Manager software 5.3, Meta-disc software 1.4, STATA 12.0, and R 3.4 software were used for statistical analyses.

Key Findings

  • A total of five studies were included in the analysis, encompassing 148 children diagnosed with osteomyelitis who were tested for bacterial cultures in PCT.

  • The diagnostic meta-analysis revealed a pooled sensitivity of 0.58 (95% confidence interval [CI]: 0.49 to 0.68) and a pooled specificity of 0.92 (95% CI: 0.90 to 0.93) for PCT in diagnosing pediatric osteomyelitis.

  • The area under the curve (AUC) for PCT in the diagnosis of osteomyelitis in children was 0.80, indicating a good level of diagnostic accuracy.

  • The Deeks’ regression test for asymmetry showed no publication bias (P = 0.90).

The results indicate that the sensitivity of PCT is relatively low against high specificity, which suggests it is good at correctly excluding those without the disease but less good at picking up most of those with the disease. This therefore raises the potential utility of PCT as a part of a larger diagnostic strategy rather than as a standalone test for pediatric osteomyelitis.

This is a comprehensive literature review for the application of PCT in diagnosing pediatric osteomyelitis. Although PCT may represent an interesting biomarker, low sensitivity indicates that the use of the marker by itself is not plausible; therefore, it would have to be combined with other diagnostic tools. Further studies in bigger populations are needed to prove the accuracy of PCT for this indication.

Reference:

Qi, H., Zhu, D., Wang, X., & Wu, J. (2024). Meta-analysis of the accuracy of the serum procalcitonin diagnostic test for osteomyelitis in children. BMC Musculoskeletal Disorders, 25(1). https://doi.org/10.1186/s12891-024-07716-3

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