Usefulness of procalcitonin for diagnosis of sepsis in the intensive care unit

INTRODUCTION: The diagnosis of sepsis in critically ill patients is challenging because traditional markers of infection are often misleading. The present study was conducted to determine the procalcitonin level at early diagnosis (and differentiation) in patients with systemic inflammatory response syndrome (SIRS) and sepsis, in comparison with C-reactive protein, IL-2, IL-6, IL-8 and tumour necrosis factor-α. METHOD: Thirty-three intensive care unit patients were diagnosed with SIRS, sepsis or septic shock, in accordance with the American College of Chest Physicians/Society of Critical Care Medicine consensus criteria. Blood samples were taken at the first and second day of hospitalization, and on the day of discharge or on the day of death. For multiple group comparisons one-way analysis of variance was applied, with post hoc comparison. Sensitivity, specificity and predictive values of PCT and each cytokine studied were calculated. RESULTS: PCT, IL-2 and IL-8 levels increased in parallel with the severity of the clinical condition of the patient. PCT exhibited a greatest sensitivity (85%) and specificity (91%) in differentiating patients with SIRS from those with sepsis. With respect to positive and negative predictive values, PCT markedly exceeded other variables. DISCUSSION: In the present study PCT was found to be a more accurate diagnostic parameter for differentiating SIRS and sepsis, and therefore daily determinations of PCT may be helpful in the follow up of critically ill patients

Improving feeding skills and transition to breastfeeding in early preterm infants: a randomized controlled trial of oromotor intervention

IntroductionOromotor therapy exercises used for preterm infants in the NICU might promote oral-motor skills and shorten discharge day. This study investigates the impact of an oral-motor therapy program on the successful transition to breastfeeding (BF) and the enhancement of feeding skills in preterm infants below 30 weeks of gestational age who experience feeding intolerance.MethodsThe intervention group received oral-motor therapy programme for one month, while the control group did not. The feeding skills were evaluated by Early Feeding Skills Assessment Tool (EFS) and Preterm Oral Feeding Readiness Scales (POFRAS).ResultsThere was a significant difference in EFS and POFRAS scores, transition to bottle feeding at discharge and transition to BF after discharge between babies given oral-motor therapy programme and controls (p < 0.05). While the transition time to full enteral feeds did not vary significantly between the groups, noteworthy outcomes were observed in the intervention group, including differences in feeding type at discharge, the nature of feeds at discharge, and the success of transitioning to breastfeeding after discharge.DiscussionWe conclude that the oromotor therapy exercises in NICU improves the quality of sucking, contributes to better oromotor skills and promotes transition to enteral feeding and BF in preterm babies. Clinical Trial RegistrationClinicalTrials.gov, identifier (NCT05845684)

The Efficiency of Diffusion Weighted MRI and MR Spectroscopy On Breast MR Imaging

The main purpose of breast magnetic resonance imaging (MRI) in radiologically routine is to establish an imaging protocol that will create high quality images with a short period of time. Fort this purpose, an imaging protocol should include a conventional breast MRI and contrast enhanced sequences. Proton MR spectroscopy (MRS) and diffusion weighted imaging (DWI) are important MR techniques for evaluation to complicated breast lesions. In this article, we will evaluate that technical properties of the MRS and DWI as additional MR imaging

Use of cerebral oxygen saturation and hemoglobin concentration to predict acute kidney injury after cardiac surgery

Objective Acute kidney injury (AKI) is a common complication after cardiac surgery and is associated with significant morbidity and mortality. Near infrared spectroscopy (NIRS) is a noninvasive technique for real-time measurement of cerebral tissue oxygenation. The purpose of the present study was to evaluate the correlation of AKI with hemoglobin and regional cerebral oxygen saturation (rScO(2)) measured intraoperatively and postoperatively in patients undergoing cardiac surgery

Comparison of entropy and bispectral index values during propofol induction

Objectives: To identify the entropy levels that would correspond to bispectral index (BIS) levels in general anesthesia (GA) induction in patients who will undergo elective lumbar disc surgery (LDS). Methods: Thirty cases who underwent LDS under GA were included in our study after obtaining patient consent and approval of the Ethics Committee of Afyon Kocatepe University Medical School, Afyonkarahisar, Turkey, between January 01, 2004 to December 31, 2005. Bispectral index and entropy electrodes were applied at the same time to 30 cases in the study group. In order to assess the level of sedation during anesthesia and recovery, 'Observer's Assessment of Alertness/Sedation' (OAA/S) scale was used. Bispectral index, state-entropy (SE), response-entropy (RE), and OAA/S values were recorded simultaneously. Results: Induction OAA/S scores were in correlation with BIS and entropy values (RE-SE) in 30 cases. A significant difference was found between BIS and entropy induction values (p=0.0398). Induction mean arterial pressure and heart rate values at 30, 60, 90, and 120 seconds were lower than the values of the control, which was statistically significant (p=0.0412). Conclusion: During the induction of GA, we found entropy values to be more sensitive and they demonstrated a more rapid increase than BIS. Therefore, it would be safer to monitor entropy while using agents of induction that might cause severe hypotension. Induction agents that might cause severe hypotension could be more safely administered under entropy monitoring