Serum procalcitonin for the early recognition of nosocomial infection in the critically ill patients: a preliminary report

<p>Abstract</p> <p>Background</p> <p>The usefulness of procalcitonin (PCT) measurement in critically ill medical patients with suspected nosocomial infection is unclear. The aim of the study was to assess PCT value for the early diagnosis of bacterial nosocomial infection in selected critically ill patients.</p> <p>Methods</p> <p>An observational cohort study in a 15-bed intensive care unit was performed. Seventy patients with either proven (n = 47) or clinically suspected but not confirmed (n = 23) nosocomial infection were included. Procalcitonin measurements were obtained the day when the infection was suspected (D0) and at least one time within the 3 previous days (D-3 to D0). Patients with proven infection were compared to those without. The diagnostic value of PCT on D0 was determined through the construction of the corresponding receiver operating characteristic (ROC) curve. In addition, the predictive value of PCT variations preceding the clinical suspicion of infection was assessed.</p> <p>Results</p> <p>PCT on D0 was the best predictor of proven infection in this population of ICU patients with a clinical suspicion of infection (AUROCC = 0.80; 95% CI, 0.68–0.91). Thus, a cut-off value of 0.44 ng/mL provides sensitivity and specificity of 65.2% and 83.0%, respectively. Procalcitonin variation between D-1 and D0 was calculated in 45 patients and was also found to be predictive of nosocomial infection (AUROCC = 0.89; 95% CI, 0.79–0.98) with a 100% positive predictive value if the +0.26 ng/mL threshold value was applied. Comparable results were obtained when PCT variation between D-2 and D0, or D-3 and D0 were considered. In contrast, CRP elevation, leukocyte count and fever had a poor predictive value in our population.</p> <p>Conclusion</p> <p>PCT monitoring could be helpful in the early diagnosis of nosocomial infection in the ICU. Both absolute values and variations should be considered and evaluated in further studies.</p

Prevalence of Cannabis Lifetime Use in Iranian High School and College Students: A Systematic Review, Meta-Analyses,and Meta-Regression

Cannabis is the most widely used substance in the world. This study aimed to estimate the prevalence of cannabis lifetime use (CLU) in high school and college students of Iran and also to determine factors related to changes in prevalence. A systematic review of literature on cannabis use in Iran was conducted according to MOOSE guideline. Domestic scientific databases, PubMed/Medline, ISI Web of Knowledge, and Google Scholar, relevant reference lists, and relevant journals were searched up to April, 2014. Prevalences were calculated using the variance stabilizing double arcsine transformation and confidence intervals (CIs) estimated using the Wilson method. Heterogeneity was assessed by Cochran's Q statistic and I-2 index and causes of heterogeneity were evaluated using meta-regression model. In electronic database search, 4,000 citations were retrieved, producing a total of 33 studies. CLU was reported with a random effects pooled prevalence of 4.0 (95 CI = 3.0 to 5.0). In subgroups of high school and college students, prevalences were 5.0 (95 CI = 3.0 to -7.0) and 2.0 (95 CI = 2.0 to -3.0), respectively. Meta-regression model indicated that prevalence is higher in college students (beta = 0.089, p < .001), male gender (beta = 0.017, p < .001), and is lower in studies with sampling versus census studies (beta = -0.096, p < .001). This study reported that prevalence of CLU in Iranian students are lower than industrialized countries. In addition, gender, level of education, and methods of sampling are highly associated with changes in the prevalence of CLU across provinces

Moving towards a single labour contract : transition vs. steady-state

Published: December 2015This paper analyses the optimal design of a single open-ended contract (SOEC) and studies the political economy of moving towards such a SOEC in a labour market with dual employment protection. We develop a computationally tractable approach to compare two economic environments: one with flexible entry-level jobs and high employment protection at longer tenures, and another one with a SOEC featuring employment protection levels that increase smoothly with tenure. For illustrative purposes, we  specialise the discussion of such choices to Spain, a country often considered as an epitome of a dual labour market. We show that a SOEC has the potential of bringing substantial improvements in equilibrium allocations and welfare. We provide estimates for the eligibility rule and tenure profile of the optimal SOEC, defined as the contract maximising the steady-state lifetime utility of new labour- market entrants. Finally, we use the model to identify winners and losers among younger and older workers in the transitional path of such a reform, and evaluate its political support

Effects of Dietary Calcium on Body Weight, Carcass Fat Content and Adipocyte Size in Male Rats

Introduction & Objective: Calcium is a micronutrient and now receiving much attention for its doubtful effects on weight and body fatness. A few mechanisms has been suggested for calcium effects on body fatness and the most emphasized one is the reducing of lipolysis and increasing lipogenesis via reducing parathyroid hormone levels. The present study is designed to evaluate the effects of nondairy dietary calcium on adipogenesis and adipocyte size in male Sprague dawley rats. Materials & Methods: This experimental study was done from November to September of 2005 at Tehran school of health, nutrition department. 48 male Spragu-Dawley rats from Damgostar Company were used in three randomly selected groups. The rats were fed low (0.2% W/W), usual (0.5% W/W) and high (1.2% W/W) dietary calcium based on AIN-93M purified diet. Rats were housed in 12 hours light-dark cycle, 22-25°C room temperature with free access to their respective diets. At the end of the experiment, rats were decapitated and carcass fat content, carcass ash content and mean adipocyte size in testis, peritoneal and subcutaneous fat pads were compared in three groups. The SPSS 11.5 was used as statistical software, running analysis of variance for comparing the effects. Results: weight gain, carcass fat content and adipocyte size, in groups were not significantly different, while serum parathyroid hormone concentrations in high calcium group was significantly lower than low calcium group (p<0.05) and insignificantly lower than usual calcium group [12.36, 23.57 and 42.2 pg/dl respectively]. Serum concentrations of 25-hydroxy cholecalciferol were also insignificantly lower in high calcium group. Conclusion: Our findings suggested that physiological concentration of dietary calcium is not effective on weight gain, body fatness and adipocyte size. Relatively equal fat content beside significant difference in serum parathyroid hormone levels is against the parathyroid theory of calcium effects on body fatness. Finally we do not suggest any effect for calcium on body fatness and adipocyte size