1,720,968 research outputs found
Procalcitonin to guide antibiotic stewardship in intensive care
No full textThe usefulness of PCT trends in guiding the duration of antibiotic therapy in septic episodes is limited since it doesn’t take into account some aspects that can affect the PCT levels. In particular: 1) both the aetiology (Gram positive and Gram negative rods, fungi, parasites) and antibiotics prescribed for septic episodes (bactericidal/fungicidal vs bacteriostatic/fungistatic drugs) are not specified. 2) the surgical “source control” of septic episode (e.g. intra-abdominal infections) is not mentioned The lack of an infectious disease specialist in data processing team composed of an intensivist, a statistician and a pulmonologist, could explain the restricted classification of prevalent infections
Procalcitonin in intensive care: unresolved doubts
No full textProcalcitonin (PCT), a test marketed by some twenty years, is available virtually on all the platforms present in clinical laboratories of any size, even if its precise role is still debated. PCT is requested especially by intensive care units (ICU) and it has been included in algorithms to guide the administration of antibiotics (AB). However, several reports concluded that, despite a theoretical physio-pathological basis, there is no unambiguous evidence that the inclusion of PCT in algorithms is effective to guide AB treatment. In 2012 the Cochrane Collaboration concluded that "Further high-quality research is needed to confirm the safety of this approach in intensive care. Moreover, future studies should also establish cost-effectiveness by considering country-specific costs of procalcitonin measurement and potential savings in consumption of antibiotics and other healthcare resources, as well as secondary cost savings due to lower risk of side effects and reduced antimicrobial resistance". In 2015, the National Institute for Clinical Heath Excellence concluded that the test is promising but there is still insufficient evidence to recommend its use to guide the AB treatment of sepsis in ICU. Recently, in a paper published in the Clinical Chemistry journal among the limiting factors preventing widespread use of PCT in sepsis and antibiotic stewardship it was included: the limited availability (and high cost) of PCT, the reluctance showed by clinicians to deescalate antibiotics based on PCT results and the uncertainty about the generalizability of previous studies results. The duration of therapy generally tends to be longer compared to what was recommended by guidelines, and PCT-guided antibiotic discontinuation may be of little benefit in hospitals where duration of therapy is already optimized
Sorting the wheat from the chaff in macroprolactinaemia assessment.
No full textSorting the wheat from the chaff in macroprolactinaemia assessment; lette
How much and for how long does the neonatal myocardium suffer from mild perinatal asphyxia?
Full text linkCardiac troponins can be useful in monitoring cardiac injury following perinatal distress. We report here an increase of cardiac troponin I (cTnI) to 2.84 microg/l at 3 weeks (age-related median: 0.07 microg/l) followed by normalization in a newborn with an uneventful clinical course after resuscitation at birth. Serial echocardiographs showed normal cardiac function. Such a time course of cTnI, not previously reported, could be due to either a greater sensitivity of biochemical markers than of instrumental tools or birth asphyxia. Larger studies are neede
Critical Evaluation of the Association Between Elevated Mean Corpuscular Volume and Alcohol-Related Traffic Accidents: A Retrospective Study on 6244 Car Crash Cases.
No full textErythrocyte mean corpuscular volume (MCV) has been used for decades as a biomarker of chronic alcohol abuse and in the treatment of alcohol dependence. More recently, it has also been adopted to investigate the fitness of subjects to hold the driving license to prevent traffic accidents. So far, however, the studies on the association of MCV with an increased risk of alcohol‐associated car accidents are extremely scarce, if not totally absent. To the best of our knowledge, the present work is the first specifically aimed at studying a plausible association between elevated MCV and crash accidents correlated with alcohol abuse. Methods A total of 6,244 drivers involved in traffic accidents underwent mandatory laboratory analyses including blood alcohol concentration (BAC) determination and MCV analysis. BAC and MCV determinations were performed by headspace gas chromatography and complete blood count, respectively. Results The chi‐square test evaluating the proportions of subjects with elevated MCVs (>95 fl) yielded a highly significant result (χ2 = 68.0; p < 0.001) in the blood samples where the BAC was above the legal limit (i.e., >0.5 g/l). However, when considering only drivers showing BACs in the range of 0.51 to 1.5 g/l, the frequencies of elevated MCV values are fairly comparable (χ2 = 0.062, p = 0.80). In contrast, limiting the evaluation to BACs > 1.5 g/l, the frequency of elevated MCVs raised to 19.1% (χ2 = 58.9, p value < 0.001 vs. the group with BAC within the legal limits). Conclusions The present observations show that MCV increases are typically associated with drivers involved in accidents only if driving under severe alcohol intoxication, leading to a preliminary conclusion that, in the context of the certification of the fitness to the driving license, MCV fails to reveal individuals at risk who tend to drive in a condition of low‐to‐moderate alcohol intoxication
Urine analysis is a better predictor than blood analysis for increased risk of traffic accidents related to cannabis use
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