Value of neutrophil/lymphocyte ratio in the differential diagnosis of sarcoidosis and tuberculosis

Introduction: The differential diagnosis of sarcoidosis creates a challange due to tuberculosis also having lung and lymph node involvement. Because both diseases show granulomatous inflammation, it may not be possible to distinguish tuberculosis and sarcoidosis in pathological specimens. As a result of the complexity in the differential diagnosis of sarcoidosis and tuberculosis, new markers for differentiation are being investigated. Objective: The aim of our study is to investigate the value of neutrophil/lymphocyte ratio (NLR) as a possible marker in differentiating sarcoidosis and tuberculosis. Materials and Methods: In our study, 51 acid-fast bacilli (AFB) positive and/or culture-positive patients with pulmonary tuberculosis, ​​40 patients with biopsy-proven sarcoidosis and a control group consisting of 43 patients were included. In our study, information was collected retrospectively based on hospital records. Results: Leukocyte and neutrophil counts, NLR, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) were significantly higher, and albumin was significantly lower in the tuberculosis group compared with sarcoidosis (for all parameters P < 0.001). The most appropriate cut-off value of NLR to distinguish tuberculosis from sarcoidosis was determined as 2.55. For this cut-off value of NLR there was 79% sensitivity, 69% specificity, 73% positive predictive value (PPV), 75% negative predictive value (NPV), and area under the curve (AUC) was 0.788. For differentiation of sarcoidosis from tuberculosis, accuracy of the NLR test according to this cut-off value was found as 76%. Conclusion: NLR as a little known marker in respiratory medicine was found to be supportive in differentiation of tuberculosis and sarcoidosis. More studies on this issue is needed

Use of cerebral and somatic regional tissue oxygen saturation in monitoring critically ill children who were admitted to the pediatric emergency department: A prospective descriptive study

Amaç: Çocuk acil servise başvuran kritik hastaların takibinde kalp tepe atımı, solunum sayısı, arteriyel tansiyon basıncı, nabız oksimetri, idrar çıkışı ve laktat günümüzde kullanılan en önemli takip parametreleridir. Bu çalışmanın amacı, akut solunum yetmezliği ya da şok tablosu ile acil servise başvuran hastalarda beyin ve splankinik bölgesel doku oksijenizasyonunun (rSO2) takibinin rutin takip sistemlerine bir üstünlüğü olup olmadığını araştırmaktır.Yöntem: Çocuk acil kliniğine Mayıs 2014-Mart 2016 tarihleri arasında başvuran, akut solunum yetmezliği ya da şok tablosunda olan hastalar prospektif olarak çalışmaya dahil edildi. Tüm hastaların, rutin takip parametrelerine (solunum sayısı, kalp tepe atımı, nabız oksimetri, arteriyel tansiyon basıncı) ek olarak, NIRS monitörü (INVOS 510°C serebral/somatik oximetre Covidien, Mansfield, MA, USA) ile beyin ve splankinik rSO2 değerleri kaydedildi. Hastaların tedavi öncesi ve sonrası değerleri Wilcoxon Signed Rank testi kullanılarak karşılaştırıldı. İstatistiksel anlamlılık p&lt;0,05 olarak kabul edildi.Bulgular: Çalışmaya 15 hasta dahil edildi. Hastaların ortanca (ÇAA) yaşı 16,0 (10,0-66,0) ay idi. Solunum sayısı, kalp tepe atımı değerleri tedavi ile anlamlı olarak azalırken (sırasıyla p=0,02 ve p=0,03), SpO2 ve SrSO2 değerleri istatistiksel olarak anlamlı yükselme gösterdi (sırasıyla p=0,01 ve p=0,04). Beyin rSO2 değeri ve beyin/splankinik rSO2 oranı (BSOO)’nda anlamlı değişiklik görülmedi (p&gt;0,05).Sonuç: Bu çalışmada kritik hastalarda SrSO2 değerinin tedavi sonrası anlamlı olarak artış gösterdiğisaptanmıştır.Objective: Heart rate, respiratory rate, arterial blood pressure, pulse oximetry, urine ouput, and lactate level are the most important parameters in the follow-up of the critically ill child who is admitted to the pediatric emergency department. The aim of this study is to determine if there is an advantage of follow-up with cerebral and splanchnic regional tissue saturation (rSO2) over routine monitoring systems in children who applied to the pediatric emergency department with manifestations of acute respiratory failure or shock. Method: Children admitted to pediatric emergency department between May 2014 and March 2016 with acute respiratory failure or shock were prospectively included into this study. The cerebral and splanchnic rSO2 levels were recorded via NIRS monitor (INVOS 510°C cerebral/ somatic oximetre Covidien, Mansfield, MA, USA) in addition to conventional monitoring parameters (heart rate, respiratory rate, pulse oxymeter, and arterial blood pressure). Prez-, and post-treatment values of the patients were compared with Wilcoxon Signed Rank test. Statistical significance was accepted as p&lt;0.05 for all tests.Results: Fifteen children were included into this study. The median age of the patients was 16.0 (10.0-66.0) months. The respiratory rate and hearth rate decreased significantly (p=0.02 and p=0.03, respectively) whereas SpO2 and splanchnic rSO2 increased (p=0.01 and p=0.04, respectively). A significant difference was not seen in cerebral rSO2 and cerebral/splanchnic rSO2 ratio (p&lt;0.05).Conclusion: In this study, we showed that the splanchnic rSO2 values in critically ill children increased after the treatment.</div

Burden of community-acquired pneumonia in adults over 18 y of age

This study aimed to determine the economic burden and affecting factors in adult community-acquired pneumonia (CAP) patients (≥ 18 years) by retrospectively evaluating the data of 2 centers in Istanbul province, Turkey. Data of outpatients and inpatients with CAP from January 2013 through June 2014 were evaluated. The numbers of laboratory analyses, imaging, hospitalization days, and specialist visits were multiplied by the relevant unit costs and the costs of the relevant items per patient were obtained. Total medication costs were calculated according to the duration of use and dosage. The mean age was 61.56 ± 17.87 y for the inpatients (n = 211; 48.6% female) and 53.78 ± 17.46 y for the outpatients (n = 208; 46.4% male). The total mean cost was €556.09 ± 1,004.77 for the inpatients and €51.16 ± 40.92 for the outpatients. In the inpatients, laboratory, medication, and hospitalization costs and total cost were significantly higher in those ≥ 65 y than in those <65 y. Besides the hospitalization duration, specialist visit, imaging, laboratory, medication, and hospitalization costs and total cost were significantly higher in those hospitalized more than once than in those hospitalized once. While the specialist visit cost was higher in the inpatients with comorbidities, the imaging cost was higher in the outpatients with comorbidities. CAP poses a higher cost in inpatients, elders, and individuals with comorbidities. Costs can be decreased by rational decisions about hospitalization and antibiotic use according to the recommendations of guidelines and authorities. Vaccination may decrease medical burden and contribute to economy by preventing the disease, especially in risk groups

Is lung ultrasonography a useful method to diagnose children with community-acquired pneumonia in emergency settings?

Background: Lung ultrasonography is a new method for diagnosing community-acquired pneumonia. Lung ultrasonography has some advantages over chest X-ray, such as lack of ionizing radiation risk, bedside performance, and cost-effectiveness. Objectives: In this study, we aimed to determine the feasibility of lung ultrasonography in emergency settings in children with community-acquired pneumonia. Methods: The study included patients younger than 18 years of age with suspicion of community-acquired pneumonia. On the first evaluation, patients with positive clinical and/or chest X-ray findings were defined to have community-acquired pneumonia, and this was accepted as the gold standard. The chest X-rays were evaluated by the chief of the pediatric emergency department, who was blinded to the patients and the lung ultrasonography results. Lung ultrasonography was performed by another pediatric emergency physician who was also blinded to the chest X-ray results and clinical findings such as fever, respiratory distress, rales, and wheezing. Results: Of the 91 patients enrolled, 71 (78.0%) were diagnosed with community-acquired pneumonia based on clinical and chest X-ray findings. The median (interquartile range) duration of the lung ultrasonography procedure was 4.0 (3.5-6.0) min. Shred sign, air bronchogram, and hepatization were significantly more frequent in the patients with community-acquired pneumonia (p < 0.01, p < 0.01, and p = 0.01, respectively). Sensitivity and specificity of lung ultrasonography were 78.5% (67.1-87.4) and 95.2% (76.1-99.8), respectively. Conclusion: Lung ultrasonography is a useful diagnostic method for children with suspicion of community-acquired pneumonia

Cerebral oxygen saturation monitoring in pediatric cardiopulmonary resuscitation patients in the emergency settings: A small descriptive study

SUMMARY:&nbsp;Near infrared spectroscopy (NIRS) is a new technology for monitoring cardiopulmonary resuscitation (CPR). The use of NIRS has advantages in monitoring cerebral oxygenation in cardiac arrest patients. The aim of this study was to describe cerebral regional oxygen saturation (CrSO2) values in a small cohort of pediatric out-of-hospital cardiac arrest patients and to determine if there is an association with CrSO2 and return of spontaneous circulation (ROSC).All the out-of-hospital cardiac arrest patients admitted to our pediatric emergency department were included in this prospective study. All patients were monitored through NIRS in addition to standard monitoring during CPR. All cerebral rSO2 measurements were obtained with an INVOS 5100C cerebral/somatic oximeter. Cardiopulmonary resuscitation was performed according to the Pediatric Advanced Life Support 2010 guidelines. The patients were classified as ROSC and non – ROSC. Ten patients were included in this study. The median age of patients was 40.0 (14.0–88.2) months. Three (30%) of the 10 patients achieved sustained ROSC. Abrupt increase in cerebral regional oxygen saturation (CrSO2) was observed in all 3 of these patients. Minimum values of the CrSO2 were significantly lower and the percentage of median time with CrSO2 under 30% of CrSO2 were significantly higher in the non - ROSC group (p=0.02). Our study indicated that the patients in the non – ROSC group have lower minimum CrSO2 value. Additionally, abrupt increase of CrSO2 during CPR could be an indicator for ROSC.</div

Early predictors of unresponsiveness to high-flow nasal cannula therapy in a pediatric emergency department

AbstractAim: High-flow nasal cannula (HFNC) is a new treatment option for pediatric respiratory distress and we aimed to assess early predictive factors of unresponsiveness to HFNC therapy in a pediatric emergency department (ED).Method: Patients who presented with respiratory distress and were treated by HFNC, were included. The age, gender, weight, medical history, diagnosis, vital signs, oxygen saturation/fraction of inspired oxygen (SpO2/FiO2) ratio, modified Respiratory Distress Assessment Instrument (mRDAI) scores, medical interventions, duration of HFNC therapy, time to escalation, adverse effects, and laboratory test results were obtained from medical and nursing records. The requirement of a higher level of respiratory support due to unchanged or increased RR compared to initial RR, incipient, or progressive respiratory acidosis, incipient hemodynamic instability was defined as unresponsiveness to HFNC.Results: The study enrolled 154 children with a median age of 10 months (interquartile range [IQR], 5.7-22.5 months). The diagnosis was acute bronchiolitis in 59 patients (38.3%), bacterial pneumonia in 64 patients (41.6%), and atypical or viralpneumonia in 31 patients (20.1%). Twenty-five patients (16.2%) were in the unresponsive group, and the median time for escalating respiratory support was 7 h (IQR: 4-20 h). The unresponsive group had lower SpO2 and SpO2/FiO2 (SF) ratio onadmission, lower venous pH, and higher partial pressure of carbon dioxide (pCO2) (P = 0.002, P = 0.012, and P = 0.001, respectively). Also the alteration of RR, mRDAI score, and SF ratio at the first hour was greater in the responsive group. The cut-off value of SF ratio at the first hour of HFNC was 195 for unresponsiveness.Conclusion: The low initial SpO2 and SF ratio, respiratory acidosis, and SF ratio less than 195 at the first hours of treatment were related to unresponsiveness to HFNC therapy in our pediatric emergency department.</div