The interrelations of radiologic findings and mechanical ventilation in community acquired pneumonia patients admitted to the intensive care unit: a multicentre retrospective study

BACKGROUND: We evaluated patients admitted to the intensive care units with the diagnosis of community acquired pneumonia (CAP) regarding initial radiographic findings. METHODS: A multicenter retrospective study was held. Chest x ray (CXR) and computerized tomography (CT) findings and also their associations with the need of ventilator support were evaluated. RESULTS: A total of 388 patients were enrolled. Consolidation was the main finding on CXR (89%) and CT (80%) examinations. Of all, 45% had multi-lobar involvement. Bilateral involvement was found in 40% and 44% on CXR and CT respectively. Abscesses and cavitations were rarely found. The highest correlation between CT and CXR findings was observed for interstitial involvement. More than 80% of patients needed ventilator support. Noninvasive mechanical ventilation (NIV) requirement was seen to be more common in those with multi-lobar involvement on CXR as 2.4-fold and consolidation on CT as 47-fold compared with those who do not have these findings. Invasive mechanical ventilation (IMV) need increased 8-fold in patients with multi-lobar involvement on CT. CONCLUSION: CXR and CT findings correlate up to a limit in terms of interstitial involvement but not in high percentages in other findings. CAP patients who are admitted to the ICU are severe cases frequently requiring ventilator support. Initial CT and CXR findings may indicate the need for ventilator support, but the assumed ongoing real practice is important and the value of radiologic evaluation beyond clinical findings to predict the mechanical ventilation need is subject for further evaluation with large patient series

Characterization of greater middle eastern genetic variation for enhanced disease gene discovery

The Greater Middle East (GME) has been a central hub of human migration and population admixture. The tradition of consanguinity, variably practiced in the Persian Gulf region, North Africa, and Central Asia1-3, has resulted in an elevated burden of recessive disease4. Here we generated a whole-exome GME variome from 1,111 unrelated subjects. We detected substantial diversity and admixture in continental and subregional populations, corresponding to several ancient founder populations with little evidence of bottlenecks. Measured consanguinity rates were an order of magnitude above those in other sampled populations, and the GME population exhibited an increased burden of runs of homozygosity (ROHs) but showed no evidence for reduced burden of deleterious variation due to classically theorized ‘genetic purging’. Applying this database to unsolved recessive conditions in the GME population reduced the number of potential disease-causing variants by four- to sevenfold. These results show variegated genetic architecture in GME populations and support future human genetic discoveries in Mendelian and population genetics

A case of Hennekam syndrome presenting with massive pericardial effusion

Hennekam syndrome is an autosomal recessive disease characterized by intestinal lymphangiectasia accompanied by severe lymphedema of the limbs, genitalia, and face, and learning difficulties. A 38-month-old boy was admitted with breathing difficulty. He had facial abnormalities and preputial hyperplasia consistent with Hennekam syndrome. Lymphangiography showed lymphedema in the left eye and right foot. Teleradiography showed cardiomegaly and echocardiography showed massive pericardial effusion. He first underwent pericardiocentesis for the removal of pericardial effusion, but pericardial tube drainage was required upon recurrence of effusion. On the fifth day, the drain was removed because of significant decrease in the drainage

Effect of Coronatine on Antioxidant Enzyme Response of Chickpea Roots to Combination of PEG-Induced Osmotic Stress and Heat Stress

WOS: 000314295600007Abiotic stresses, such as high temperature and drought, are major limiting factors of crop production and growth. Coronatine (COR), a structural and functional analog of jasmonates, is suggested to have a role in abiotic stress tolerance. The aim of our study was to examine whether pretreatment with COR enhances the tolerance of chickpea (Cicer arietinum L. cv ICC 4958) roots to PEG-induced osmotic stress, heat stress, and their combination. Therefore, seedlings raised hydroponically in a growth chamber for 15 days were pretreated with or without COR at 0.01 mu M for 24 h and then exposed to 6 % PEG 6000-induced osmotic stress or heat (starting at 35 A degrees C and then gradually increased 1 A degrees C every 15 min and kept at 44 A degrees C for 1 h) stress for 3 days. After different treatment periods, the changes in relative growth rate (RGR); malondialdehyde (MDA), proline (Pro), and hydrogen peroxide (H2O2) contents; and the activities of antioxidant enzymes/isoenzymes in roots of chickpea seedlings with or without 0.01 mu M COR application were studied. RGR in roots was increased by COR application. Under all stress conditions, H2O2, MDA, and Pro levels increased sharply, but pretreatment with COR significantly reduced them. Moreover, COR increased the activities of H2O2 scavenger enzymes such as catalase (CAT) under heat stress, ascorbate peroxidase (POX) under PEG stress, and CAT and POX under combined stresses. Therefore, COR might alleviate adverse effects of PEG stress and heat stress and combined stresses on roots of chickpea by reduction of H2O2 production, enhancing or keeping the existent activity of antioxidant enzymes, thereby preventing membrane peroxidation.Ege University Research FoundationEge University [2009-FEN-014]This work was supported by Ege University Research Foundation (2009-FEN-014). The authors thank Dr. Carol Bender of Oklahoma State University for kindly providing pure coronatine and Prof. Dr. Cengiz Toker of Akdeniz University for providing Cicer arietinum ICC 4958 seeds

Association of ischemia-modified albumin with oxidative stress status and insulin resistance in obese patients

Objectives: Obesity is associated with oxidative stress due to the overproduction of free radicals in some accompanying states, such as hyperglycemia, elevated lipid levels and chronic inflammation. Free radical accumulation may modify the structure of human serum albumin, generating ischemia-modified albumin (IMA), and increased serum levels of IMA have been linked to obesity-related diseases and oxidative damage. The association of IMA levels with oxidative stress and insulin resistance (IR) has not been evaluated in the context of obesity. The aim of this study is to determine IMA levels in the context of obesity and their relationship with oxidative status and insulin resistance. Methods: Sixty-one adult obese cases with body mass index (BMI) ≥ 30 were evaluated, with 30 healthy adults with 18.5 ≤ BMI ≤ 24.9 included in the control group. IMA, total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index (OSI), total cholesterol, triglycerides, HDL and LDL-cholesterols were determined. Results: IMA, TAS, TOS, OSI, total cholesterol and LDL-cholesterol levels were not different between the control and obese groups (P-value >0.05), while triglyceride levels were determined to be higher and HDL-cholesterol levels were determined to be lower in the obese group (P-value 0.05), but the fasting blood glucose level was determined to be higher in the obese/IR(+) group than in the control group. Conclusions: We concluded that obesity and insulin resistance had no effect on IMA levels in the obese group, who showed no impairment in their oxidative balanc

Association of ischemia-modified albumin with oxidative stress status and insulin resistance in obese patients

Objectives: Obesity is associated with oxidative stress due to the overproduction of free radicals in some accompanying states, such as hyperglycemia, elevated lipid levels and chronic inflammation. Free radical accumulation may modify the structure of human serum albumin, generating ischemia-modified albumin (IMA), and increased serum levels of IMA have been linked to obesity-related diseases and oxidative damage. The association of IMA levels with oxidative stress and insulin resistance (IR) has not been evaluated in the context of obesity. The aim of this study is to determine IMA levels in the context of obesity and their relationship with oxidative status and insulin resistance. Methods: Sixty-one adult obese cases with body mass index (BMI) ≥ 30 were evaluated, with 30 healthy adults with 18.5 ≤ BMI ≤ 24.9 included in the control group. IMA, total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index (OSI), total cholesterol, triglycerides, HDL and LDL-cholesterols were determined. Results: IMA, TAS, TOS, OSI, total cholesterol and LDL-cholesterol levels were not different between the control and obese groups (P-value >0.05), while triglyceride levels were determined to be higher and HDL-cholesterol levels were determined to be lower in the obese group (P-value <0.05). When IMA, TAS, TOS, OSI levels were compared between the control/IR(-), obese/IR(+) and obese/IR(-) groups, no statistically significant differences were detected (P-value >0.05), but the fasting blood glucose level was determined to be higher in the obese/IR(+) group than in the control group. Conclusions: We concluded that obesity and insulin resistance had no effect on IMA levels in the obese group, who showed no impairment in their oxidative balanc

Comparison of monitored anaesthesia care and general anaesthesia in endobronchial coil treatment

Objective: The aim of this study was to evaluate the efficacy and complications of two different anaesthesia methods in endobronchial coil treatment

Serial determinations of neutrophil CD64 expression for the diagnosis and monitoring of sepsis in critically Ill patients

Background. Early identification of sepsis is important to be able to initiate timely therapy and optimize survival. Neutrophil CD64 (nCD64) expression has been proposed as a potential marker of sepsis.Methods. In this prospective observational study, adult patients admitted to our 34-bed medico-surgical department of intensive care over a 3.5-month period were included. Neutrophil CD64 expression was measured by flow cytometry at admission and daily until discharge or death. Blood C-reactive protein (CRP) level was measured routinely. Diagnosis of sepsis was recorded and appropriateness of empirical antibiotic treatment was established post hoc.Results. Of the 548 patients included, 468 had flow cytometry measurements within 24 hours after admission, of whom 103 had sepsis. Septic patients had higher admission nCD64 expression than did nonseptic patients (P <. 001). A cutoff admission nCD64 expression of 230 median fluorescence intensity (MFI) identified sepsis with a sensitivity of 89% (81%-94%) and specificity of 87% (83%-90%). When combining CRP and nCD64 expression, an abnormal result for both was associated with a 92% probability of sepsis, whereas sepsis was ruled out with a probability of 99% if both were normal. Septic patients receiving inappropriate empirical antibiotics had persistently elevated nCD64 expression, whereas expression decreased over time in patients receiving appropriate antibiotics. In nonseptic patients, an increase in nCD64 expression ≥40 MFI predicted intensive care unit (ICU)-acquired infection (n = 29) with a sensitivity of 88% and specificity of 65%.Conclusions. Measurement of nCD64 expression at ICU admission, especially when combined with CRP concentrations, is useful in diagnosing sepsis. Serial determinations of nCD64 could be used for monitoring purposes. © 2013 The Author 2013. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: [email protected]: ar.jinfo:eu-repo/semantics/publishe

Abdominal pain in a 5-year-old girl with bilateral nephromegaly: Answers

Renal involvement in non-Hodgkin lymphoma is a recognized development, but it mostly follows a diagnosis of lymphoma. We describe a rare case of a T-cell-type non-Hodgkin lymphoma that first presents as nephromegaly in a 5-year-old girl admitted to the emergency department with abdominal pain. Further investigation revealed bilateral nephromegaly, but the results of blood tests, imaging studies, and bone marrow aspiration were inconclusive. During the second week of hospitalization, significant physical examination revealed an enlarged lymph node in the anterior cervical chains, confirming a diagnosis of Non-Hodgkin's lymphoma. This case illustrates that it is important to have a high degree of suspicion in any patient presenting with unexplained enlarged kidneys without any identifiable cause because it could be the first presentation of a hematologic malignancy