Serum Tumor Necrosis Factor-a and Neopterin as Aid for Surgical Decision Making in Acute Intussusception
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This study was designed to evaluate the reliability of some biomarkers as predictors of disease severity and the possibility of guidance for surgical decision making in cases of acute intussusception and comprised 54 patients, (36 males and 18 females). After detailed history taking and full clinical examination, blood samples were collected (pre- and post-treatment) for estimation of serum levels of lipid peroxides expressed as malondialdehyde (MDA), tumor necrosis factor-a (TNF-a), interleukin-6 (IL-6), neopterin and C-reactive protein (CRP). All patients underwent an attempt at air enema reduction and cases with failed mm-operative reduction underwent laparotomy for either reduction of the intussusceptutn or intestinal resection and re-anastomosis for irreducible intussusceptum. There was a significant (P<0.05) decrease in post-treatment serum levels of INF-a, IL-6, neopterin and CRP compared to pre-treatment levels, whereas serum MDA levels showed a significant increase in post-treatment samples and, there was a positive significant correlation between the mode of treatment required (as a reflection of disease severity) and serum levels of neopterin, (r=0.836, P<0.001), TNF-a, (r=0.886, P<0.001) and MDA, (r=0.562, P<0.01) and CRP, (r=0.796, P=0.001), using Logistic regression analysis, estimation of serum INF-a and peopterin were found to be the most significant, (13=0.592, P<0.001 & 0=0.399, P=0.002, respectively), predictors of the need of operative interference and most probably there will be need of surgical resection and reanastomosis of intestine. We can conclude that estimation of serum levels of TNF-a and neopterin prior to management of acute intussusception is mandatory and provides a great help for surgical interference.