Interleukin-6 Levels in Early Diagnosis of Neonatal Sepsis

Interleukin-6 Levels in Early Diagnosis of Neonatal Sepsis Study of Interleukin-6 Levels in Early Diagnosis of Neonatal Sepsis Dr. Sonawane Vijay B., Dr. Mehkarkar Nitin S., Dr. Jadhav Pradnya B., Dr. Gaikwad Sonali U., Dr. Kadam Nitin N. Department of Pediatrics, MGM Medical College and Hospital, Navi Mumbai, Maharashtra, INDIA ABSTRACT Introduction: Neonatal septicemia is one of the commonest causes of neonatal mortality and morbidity. Interleukin-6 Levels appears to be one of the most promising candidate cytokine for early diagnosis of neonatal septicemia. The aim and objectives of this study was to study the role of IL-6 levels as an early marker for diagnosis of neonatal sepsis and to compare IL-6 levels with other septic markers. Materials and Methods: This is a hospital based prospective study to evaluate the efficacy of IL-6 as an early diagnostic marker of neonatal sepsis. Eighty neonates, delivered in the hospital, having risk factors for neonatal sepsis, along with those coming to hospital with signs and symptoms of sepsis up to 28 days of life (as study group ) along with normal newborns admitted to the postnatal ward without high risk factors (control group) were enrolled for this study. Results: IL-6 Levels has shown maximum Sensitivity of 95.83%, Specificity of 87.50%, Positive Predictive Value of 92 %, Negative Predictive Value of 93.33 % and Accuracy of 92.50 %. E.Coli was the most common organism responsible for sepsis. CRP was reported to be highly sensitive(84.21%), and CBC was highly specific (75.00%), IT ratio has sensitivity of 62.5% and specificity of 56.25% while Micro-ESR has shown sensitivity of 50.0% and specificity of 62.5%, Out of 80 cases, blood culture (BacTalert) showed growth in 48 cases in study group while two cases in control group. Thus blood culture positivity was 60%. Conclusion: IL-6 test has maximum sensitivity as well as specificity in comparison with other septic markers. Blood culture is the gold standard for the diagnosis of septicemia.CRP is most sensitive while CBC is most specific marker in neonatal sepsis. KEY WORDS: Neonatal Sepsis, Diagnostic Markers, Mortality, IL-6 Levels. INTRODUCTION Neonatal Septicemia is the leading cause neonatal mortality and morbidity in India. It is estimated that 20% of all neonates develop sepsis1 and is responsible for 30-50% of total neonatal death in developing countries2. Accurate and timely diagnosis of neonatal sepsis still remains a major challenge to the pediatricians and neonatologists. Mortality due to neonatal sepsis is preventable and if diagnosed early the outcome is better. Several indicators have been evaluated as septic screen for the early diagnosis of neonatal sepsis like CBC, CRP, Micro-ESR, IT ratio, and Blood Culture. There is a constant search for better and ideal diagnostic marker. Ideal marker should be sensitive, specific and easily available. Its results should be immediate and reproducible. Recently various new markers are being studied such as IL-6, TNF-ÃŽ ±, Procalcitonin, G-CSF etc. IL-6 is an inducer of hepatic protein synthesis which promotes production and liberation of CRP and can be detected early when t here is bacterial bloodstream invasion. It appears to be one of the most promising candidate cytokine for early diagnosis of neonatal septicaemia.3,4 In the present study conducted at Mahatma Gandhi Mission Medical College and Hospital, Navi Mumbai, IL-6 levels were assessed in normal healthy newborns as well as newborns with high risk factors for sepsis and the usefulness of IL-6 was evaluated as an early marker for sepsis detection and its effectiveness was compared with other septic markers. MATERIALS AND METHODS Study Design: A prospective study design was used to evaluate the efficacy of IL-6 as an early diagnostic marker of neonatal sepsis. This is a hospital based study conducted in M.G.M Medical College and Hospital, Navi Mumbai. Study Period: July-2005 to August-2007 Sample Size: Eighty neonates, delivered in the hospital, having risk factors for neonatal sepsis, along with those coming to hospital with signs and symptoms of sepsis up to 28 days of life (as Study Group) also normal newborns admitted to the postnatal ward without high risk factors (Control Group) were enrolled for this study. Newborns were treated with antibiotics for clinical evidence of sepsis positive septic score as per neonatal sepsis score system (Table 1). Table 1: Neonatal sepsis score system5 Score1=risk of infection, Score2=need septic work up to exclude, Score 3 or more=investigate and treat A detailed history was taken and examination was done. Following laboratory tests were done as soon as presumptive diagnosis of sepsis was made based on septic score system and on clinical grounds. All investigations were done within 24 hours of birth or at presentation before starting antibiotics like IL-6 levels, CBC, CRP with titer, Micro ESR, Immature to Total (IT) ratio, peripheral smear for toxic granules and band forms, blood culture (BacTalert), x-ray chest, CSF whenever indicated etc. Soon after birth, 1 ml of venous blood was drawn for blood culture. Also 5 ml of venous blood was collected for TLC, DLC, peripheral blood smear, micro-ESR and CRP. CRP was sent at 12 hours of life in newborns with high risk factors for sepsis. This study was approved by Ethical Committee of this hospital. Informed Written Consent was obtained from parents before entry into this study. Information of selected neonates including detailed history and clinical examination was recorded on a predesi gned proforma. Interleukin-6 Levels Determination3,4 : 1 ml blood was collected in plain bulb and serum was tested by Chemiluminescent Immunometric technique in IMMULITE Machine1000 (Table 2). IMMULITE 1000 IL-6 is a solid phase, enzyme labeled, Chemiluminescent sequential immunometric assay. The use of an ultracentrifuge is recommended to clear lipemic samples. Volume required – 100  µL serum, EDTA or Heparinized Plasma (Sample cup must contain at least 250  µL more than the total volume required). Interpretation6,7: Table 2 – Interpretation Guide for Immune Monitoring DATA ANALYSIS Data was collected, classified, tabulated and analyzed. Tests of significance were applied at appropriate places and interpretation was done accordingly. To evaluate the difference between the categories, McNemar Chi Square test was used as a test of significance. A p-value of less than 0.05 was considered statistically significant. RESULTS AND DISCUSSION Of total of 80 cases, with risk factor and clinical signs and symptoms of sepsis (40 cases as study group) and normal healthy newborns without risk factors (40 cases as control group). The study group consists of 28 males (70%) and 12 females (30%) while control group consists of 21 males (52.50%) and 19 females (47.50%). Among 40 babies of study group, 24(60%) are blood culture (BacTalert) positive and 16 (40%) are blood culture (BacTalert) negative while in control group, 1(2.50%) is blood culture (BacTalert) positive and 39(97.50%) are blood culture(BacTalert) negative (Fig. 1). Fig. 1: Bar Chart Showing Distribution of Cases According to Blood Culture In study group, E-coli comprised the maximum number of cases accounting for sepsis i.e. 7 (17.5%) followed by 5 cases (12.5%) of Acinetobacter baumanii, 5 cases (12.5%) of Klebsiella Pneumoniae, 2 cases(5%) each for Citrobacter and Staphylococcus aureus and 1 case (2.5%) has shown Pseudomonous Sp., Burkholderia cepacia and Fungus while no growth in 16 (40% ) cases. In control group, only 1 case (2.5%) shows growth of Acinetobacter baumanii and 39 cases (97.5%) are sterile (Fig. 2). Bhargava et al8 noted in their study that the incidence of E.Coli as the causative organism of neonatal sepsis was 45%. Mirfet al9 in their study of 50 cases also showed similar results. McCraken10 , Faridi and Gupta11 , Kumar GD et al12 have also reported that gram negative septicemia is more common than gram positive septicemia Study Group Control Group Fig. 2: Pie Chart Showing Distribution of Cases According to Microbiological Growth on Blood Culture Out of 40 cases in study group, CBC is abnormal in 13 cases (32.5%), Blood Culture (BacTalert) was positive in 24 cases (60%) and 4 cases (10%) has CBC abnormal with sterile blood culture. In this study CBC had low sensitivity (37.50%) and high specificity ( 75.00%). Chan and Ho13 revealed in their study that abnormal CBC had the lowest sensitivity and PPV while abnormal ANC had the lowest specificity and NPV among them. (Fig. 3) Fig. 3: Bar Chart Showing Distribution of Cases According to CBC Out of 40 cases in study group, CRP is reactive in 31 cases (77.5%), Blood culture is positive in 24 cases (60%) and 15 cases (37.5%) are having CRP reactive with sterile blood culture. In this study CRP was reported most sensitive (84.21%) but low specific(28.57%), Franz AR et al14 showed that there is generally a delay of up to 24 hours between onset of symptoms of infection and a rise in serum CRP. Sensitivity of the test at presentation is only 40% that is, 60% of subsequently proven sepsis episodes will have a normal initial CRP. (Fig. 4). Fig. 4: Bar Chart Showing Distribution of Cases According to CRP Out of 40 cases in study group, IT Ratio is abnormal in 22 cases (55%), Blood Culture is positive in 24 cases (60%) and 7 cases (17.5%) are having IT Ratio abnormal with sterile blood culture. In our study IT ratio was reported NPV of 50.0%. Ghosh et al15 studied 103 high risk neonates having predisposing perinatal factors or clinical suspicion of sepsis and found that an abnormal immature to total neutrophil (IT) ratio were the most sensitive indicators in identifying neonates with sepsis showing high negative predictive value over 94%. (Fig. 5) Fig. 5: Bar Chart Showing Distribution of Cases According to IT Ratio Out of 40 cases in study group, Micro-ESR is abnormal in 18 cases (45%), Blood Culture is positive in 24 cases (60%) and 6 cases (15%) has Micro ESR abnormal with sterile blood culture. In our study Micro-ESR has shown sensitivity of 50.0%, specificity of 62.5. K.K. Diwakarand Rosul G16 studied on 114 term neonates for early neonatal sepsis. The sensitivity and specificity of the revised Micro-ESR was 62.5% and 60.9% respectively in diagnosing culture proven sepsis. (Fig. 6) Fig. 6: Bar Chart Showing Distribution of Cases According to Micro-ESR Among 40 babies of study group, 25 (62.50%) has IL-6 Test positive and 15 (37.50%) has IL-6 Test negative while in control group, 3 (7.5%) has IL-6 Test positive and 37 (92.5%) has IL-6 Test negative. In present study, neonatal mortality is seen in 4 cases (5%) of the total 80 cases. Of these 4 cases, all cases have shown elevated IL-6 levels. Hence, strongly elevated IL-6 levels in this study have found to be associated with bad prognosis as indicated by death. Statistical analysis of IL-6 levels concentration >100 pg/ml in this study of 40 cases (study group) yielded a sensitivity of 95.83% and specificity of 87.50 % whereas Positive predictive value and the Negative predictive value is 92% and 93.33% respectively. Many studies have also reported similar results. The recent study of IL-6 in early neonatal sepsis by Silveira et al17 using normal newborns as controls, showed similar sensitivity of 96%. Recently, Silveira and Procianoy18 reported that IL-6 and TNF-ÃŽ ± are likely cand idate cytokines for use in early diagnosis of neonatal sepsis. (Fig. 7) Fig. 7: Bar Chart Showing Distribution of Cases According to IL-6 Assay Out of 40 cases in study group, blood culture is positive in 24 cases (60%), IL-6 is positive in 25 cases (62.5%) and 2 cases (5%) have IL-6 positive with sterile blood culture. (Fig. 8) Fig. 8: Bar Chart Showing IL-6 Levels in Sepsis Same group of patients are tested with both Blood Culture (BacTalert) as well as IL-6 levels. Therefore McNemars (ChiSquare) test is used to evaluate whether results of these tests vary significantly from each other. It is observed that the results of both tests are not statistically significant from each other with x2 = 0.083, p-value equal to 1.00 and degree of freedom equal to 1. There is no statistically significant difference between Blood Culture (BacTalert) and IL-6 assay (p=1). Hence use of IL-6 levels for early diagnosis of neonatal sepsis can be justified. (Table 3) Table 3 – IL-6 Parameters: Sensitivity, Specificity, PPV, NPV and Accuracy Chi-square (X2) = 0.083, Degree of Freedom = 1, p-value = 1.00 Thus, IL-6 test has maximum sensitivity as well as specificity in comparison with other septic markers in early detection of neonatal sepsis. (Table 4) Table 4 – Comparative Parameters: Sensitivity, Specificity, PPV, NPV and Accuracy Hence, it can be concluded that IL-6 concentration increases to significant level in the patient having bacterial septicemia. IL-6 test has maximum sensitivity as well as specificity in comparison with other septic markers. Therefore, IL-6 levels can be used as an early diagnostic marker for neonatal sepsis. SUMMARY AND CONCLUSION Thus, IL-6 has shown Sensitivity of 95.83%, Specificity of 87.5%, Positive Predictive Value of 92%, Negative Predictive Value of 93.33% and Accuracy of 92.5%. Neonatal mortality was seen in 4(5%) of the 80 cases studied. Of these 4 mortalities, all 4 cases showed IL-6 levels strongly positive. Hence, strongly elevated IL-6 levels, in this study, are found to be associated with bad prognosis as indicated by death. The result of the present study appears to emphasize that serum IL-6 levels increases to a significant level in the patients having bacterial septicemia. The level of rise depends upon the severity of the sepsis. Hence, it can be concluded that IL-6 levels can be used as an early diagnostic marker of neonatal sepsis. ACKNOWLEDGEMENTS Authors are thankful Dr. V. Kotrashetti for guidance during study period. We also express thanks to Mr. Dattatray Parle and Dr. Tabish Pathan for editing this study. Funding: None Conflict of Interest: None Permission from IRB: Yes REFERENCES â€Å"NNF Teaching Aids: Newborn Care† www.newbornwhocc.org/pdf/ teaching-aids/neonatalsepsis.pdf. Siegel J, McCracken G, â€Å"Sepsis Neonatarum† NEJM, 1981(304):642-646. â€Å"IMMULITE: IL-6† Manual on IMMULITE Published by Siemens Medical Solutions and Diagnostics, Los Angels, CA, USA, 2006. Saunders, B. M., Z. Liu, Y. Zhan and C. Cheers, â€Å"Interleukin- 6 production during chronic experimental infection† Immunol. Cell Biol. 1993(71):275-280 Gupte S., â€Å"The Short Text Book of Paediatrics† 9th Ed., Jaypee Brothers, New Delhi, 2001:559-561. Milenia QuickLine IL-6 Published by Milenia Biotec, USA SepsisNeoEnglish, 2005. de Bont, E., A. Martens, J. van Raan, G. Samson, W. P. Fetter, A Okken and L. H. F. M. de Lei, â€Å"Tumor necrosis factor-alpha, interleukin-1 beta and interleukin-6 plasma levels in neonatal sepsis† Pediatr. Res., 1993(33):380-383. Bhargav SK, Gupta A, Bhargav M. Bacterial Infections in Newborn. Newer Development in Pediatric[A1] Research 1977; 1. MirfAmans and Khan SR. Neonatal sepsis; a review with study of 50 cases. Journal[A2] of Tropical Pediatrics 1987; 33(3):131-5. McCraken and Shinefield. Changes in the pattern of neonatal septicemia and meningitis. Am J Dis. Child 1966; 112:33. Faridi et al[A3]. Chest radiograph in neonatal sepsis. Ind. Ped[A4]. 1972; 29:871. Kumar GD et al[A5]. Bacteriological analysis of blood culture isolates from neonate in tertiary care hospital in India. J Health, Population and Nutrition, 2002; 20(4): 343-347. Chan DK and Ho LY. Usefulness of C-reactive protein in the diagnosis of neonatal sepsis. Singapore MedicalJournal[A6] 1997; 38(6): 252-5. Franz AR, et al. Reduction of unnecessary antibiotic therapy in newborn infants using interleukin-8 and C-reactive protein as markers of bacterial infections. Pediatrics 1999; 104:447-53. .Ghosh S, Mittal M, Jaganathan G. Early diagnosis of neonatal sepsis using a hematological scoring system 2000;54(9):495-500. Diwakar KK, Rosul G, â€Å"Revised Look at Micro-Erythrocyte Sedimentation Rate in Neonates† Indian Pediatrics[A7] 1999; 36:703-705. Silveira RC, Procianoy RS, â€Å"Evaluation of interleukin-6, tumour necrosis factor-a and interleukin-1 for early diagnosis of neonatal sepsis† Acta. Paediatr ,1999(88): 647-650. Renato S. Procianoy, Rita C. Silveira, â€Å"The role of sample collection timing on interleukin-6 levels in early-onset neonatal sepsis† J Pediatr (Rio J), 80(5):407-10, 2004. [A1]AS ABOVE [A2]BBR [A3]ET AL ONLY IF THERE ARE MORE THAN SIX AUTHORS, PLEASE CHECK [A4]CORRECT AS ABOVE; NO FULL STOPS AND CORRECTLY ABBREVIATED NAMES OF JOURNALS. [A5]CHECK ET AL [A6]Sing Med J [A7]Abbr

Life as a Female Slave Under the Code of Hammurabi Essay

I am a female slave, given into slavery for 4 years by my father, he owed a debt that he could not pay. A debt for grain that he was to pay back 3 fold. The debt collector would have taken what little we had and perhaps would have made father pay with his life if Hammurabi had not made a way for my family to cancel our debt in this way. It is only for 4 years, such a long time for so little a debt, but we are fortunate to have this option. I will be provided with the basic necessities for survival. I am counted as nothing more than property, or currency, for my Master. I am not considered human. I was formerly a member of the middle class, paupers that can farm. There are only three classes in our society, the wealthy, the poor, and the slaves. Now, I am a slave for the next four years. It is very common practice, so much so that even the poor have slaves. Our most common forms of currency are grain, silver, slaves, cattle, and livestock. As you can imagine, I am not alone in my experience in slavery. Many of my peers are or have been enslaved at least once in their lives. Both my mother and father were slaves at some point. Many female slaves usually end up with their Master for many more years than the 4 required by law. After 4 years, they are no longer slaves and are often in the same class as the man they have lived with. In our society many children are products of those relationships. Until the time of slavery is up, I must work off a debt. I am not permitted to deny my Master, or I could be punished. One such punishment could involve having my ears cut off. This is not very common. Many of us understand we are here to work and that we must be submissive to avoid conflict. As I mentioned we will be allowed the basic necessities, food and water, and protection from the environment if the weather is harsh. The laws of how I live as a female and as a slave are outlined in Hammurabi’s Code. Hammurabi is a fair and just man. I feel his laws are fair and just given my position and given the alternatives that could have taken place if my father’s debt went unpaid. And to lose an ear and not a life for disobedience is more than fair. Hammurabi has provided us with options which has been beneficial for us at this time. We all know the laws. We can all read and understand them. Our officials rule by the law and laws pertain to everyone. For example, I am safe with my Master, should anyone take me from my Master- he could be put to death.. Everyone in the city knows this law and should someone see another take me from my Master, they will notify officials. The officials will investigate the matter. The person who takes me could be put to death. Few people risk this. Also, should my Master lend me out to another man and that man harm me, he would have to pay my Master fines for the damage he caused. It is very difficult for the common man to pay fines, so little harm is ever done to a slave that is on loan. Slavery here is not a social stigma. I am of the same class as the majority and speak the same language. Business and practicality are more important here than ideology, thus it is more beneficial for a Master to have strong, healthy slaves for commercial purposes. The law is clear and written out and encourages this kind of a society. Physical abuse is not very common among our people, but it is used in extreme cases. I was very surprised when studying this to discover that laws regarding slavery in the United States, while similar in many ways, were more harsh than the laws for the slaves in a more primitive environment. For example, the Code of Hammurabi stipulates that if a slave is given in trade for a debt it is for a period of 4 years. In the Unites States, the slave codes suggested that slavery was a life long event. There was no limit to the length of time a person could be a slave. I could not find many similarities, with the exception that it was not uncommon for female slaves to bear children with their Masters. In further research I found evidence that slaves in Babylonian captivity not too long after the Code of Hammurabi was implemented, owned property and were allowed to trade. Some even made more money than their Masters. So, I could not really compare and contrast the Code of Hammurabi with the Slave Codes of the Southern States, which was not only disappointing but deeply troubling. The one thing that does stand out as the most obvious similarity to something we are familiar with today is the epilogue to the Code of Hammurabi and the Preamble of the US Constitution. Both introduced a set of laws that were created to protect the people, provide a basis for justice, promote the welfare, ensure prosperity. Actually, I believe Hammurabi said it best, â€Å"That the strong might not injure the weak†.

The Confidential Secrets of Essay 4th Grade Samples Exposed

The Confidential Secrets of Essay 4th Grade Samples Exposed Most men and women work so as to afford things which actually do the job. They really don't want to pay for defective products and services. A tiny palate cleanser goes quite a distance! Fourth grade science activities are an excellent way to provide your students practice mastering the numerous steps involved in a science experiment. The 1 area of education that is important for everyone is the capability to communicate and we still do that with words. The more knowledge your son or daughter builds during the prewriting stage, the simpler it is going to be to write. If you own a lot of students, this is perfect because it's possible to make them in bulk. Employing unusual objects assists the concept stick. Put simply, perhaps it's a mistake to even attempt identifying excellent teachers in the very first location. Quite simply, you shouldn't compose a statement that looks rigid or final in the opinion of readers. For example, a statement like, `Die hard is an excellent movie'' would not be a very good thesis because it shows that you've already made up your mind on the discipline. Anyway, it also needs to indicate that you understand what you are going to be discussing in the paper. The opening statement of the thesis needs to be claim or something that others can additionally have a possibility of countering. A thesis statement on the opposite hand, is defined as the essential argument which you will be looking towards defending in the paper. Keep away from vague statements and just concentrate on the basis of the paper. The Debate Over Essay 4th Grade Samples Describe several matters you would search for in your ideal high school. The school day needs to be shorter. Be ready for your very first day of school. Actually, a lot of the school feels joyfully traditional. Essay 4th Grade Samples Secrets Each writing workshop starts with a mini lesson about the genre they're currently studying, but students are extremely rarely extended a prompt. Describe how you believe you've matured in the past calendar year. Highlight your scholarship achievements inside your essay. Having found the side that you're standing for, you want to ensure you fully grasp the perspective of the opposite side. Think freely, but you're not permitted to take into consideration anything else besides the topic accessible. In case the answer is no, it is a craft you might want to work on with your child at home. Well, just one way to learn. Enrollment of students was expected to rise in the next few years, particularly in the Southwest. Homework is not just for the continued mastering of the 3Rs. Students will perform a game in which they have to change direction quickly. They will discuss the 7 principals of Kwanzaa and then draw pictures of an example of each. Students are to pretend they are on a sailboat that's in the midst of a storm. They will create a visual reminder of some of the more common homophones. The Debate Over Essay 4th Grade Samples Finding fun 4th grade activities can be very an uphill job. It is possible to print a set here free of charge. Ditch the conventional paper-and-pencil testing for internet quizzes and tests it is possible to create and automatically grade using these sites. When it has to do with math, it's critical for children to understand and grasp fully each and every degree of all the various topics. There are several ways to create math fun for 4th graders. To locate the poisonous bug, kids must first locate the answers to every one of the subtraction issues. From a wide variety of exciting math games and activities to challenging worksheets, they have plenty of options when it comes to practicing math. Whispered Essay 4th Grade Samples Secrets Describe how you would address a fantastic friend who's angry with you. The individual who wins stays and the following class member takes the other space. While teachers ought to be there to help, your little one ought to be doing the job. Persuade your sister or brother to assist you talk your parents into something you would like to do.

The Incas - 1875 Words

The Inca were South American Indian people who ruled one of the largest and richest empires in the Americas. The Inca Empire began to expand about 1438 and occupied a vast region that centered on the capital, Cusco, in southern Peru. The Empire extended more than 2,500 miles (4,020 kilometers) along the western coast of South America. It included parts of Present - Day Colombia, Ecuador, Peru, Bolivia, Chile, and Argentina. The Inca Empire was conquered by Spanish Forces soon after their arrival in 1532. brbrInca emperors ruled their far - reaching territory through a complex political system. The Inca took over many areas by military force. Their political system kept a balance between the central authority of the emperor and local†¦show more content†¦The members of an ayllu owned an area of land in common. The leader of an ayllu gave each family as much land as it needed to produce its own food. Men with noble rank could have no more than one wife,and many marriages were arranged for political reasons. Emperors sometimes gave chosen women to favored nobles or men who had performed a service for the emperor. These women, who were selected by government officials, had great beauty and intelligence. Nobles had to marry within the ayllu. Husbands and wives were expected to help each other with work in the fields and other tasks. Inca children had little time for play because their families kept them very busy. Most children helped with the family work after learning to walk. Boys were initiated into manhood when they were 14 years old. Girls were initiated into womanhood after they started to menstruate. Boys and girls received permanent adult names during the initiation ceremonies. However, young people did not achieve full adult status until they married and started to pay taxes.brbrReligion for the Inca played an important role in the public and private lives of the Inca. 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