Early procalcitonin kinetics and adequate empiric antibiotic therapy in critically ill

Sepsis has become a major health economic issue, with more patients dying in hospitals due to sepsis related complications compared to breast and colorectal cancer together. Despite extensive research in order to improve outcome in sepsis over the last few decades, results of large multicenter studies were by-and-large very disappointing. This fiasco can be explained by several factors, but one of the most important reasons is the uncertain definition of sepsis resulting in very heterogeneous patient populations, and the lack of understanding of pathophysiology, which is mainly based on the imbalance in the host-immune response. However, this heroic research work has not been in vain. Putting the results of positive and negative studies into context, we can now approach sepsis in a different concept, which may lead us to new perspectives in diagnostics and treatment. While decision making based on conventional sepsis definitions can inevitably lead to false judgment due to the heterogeneity of patients, new concepts based on currently gained knowledge in immunology may help to tailor assessment and treatment of these patients to their actual needs. Early diagnosis of sepsis is crucial in treating septic patients and in these cases starting appropriate antibiotic therapy in time have a significant effect on survival. However, there is very little to help the clinician during the first 24 hours whether the administered empirical antibiotics treatment is effective or not. Procalcitonin is a reliable sepsis marker with short half life but its role in predicting bacterial infection and early decision making in assisting antibiotic therapy is undiscovered. Therefore we investigated the value of procalcitonin levels and changes from the day before (t-1) to the day when infection was suspected (t0), and after starting empirical antibiotic therapy 8 hourly (t8, t16, t24) then daily (day2-5) in predicting infection and if the antibiotic treatment is effective or ineffective inintensive care patients. Our results showed significant difference in procalcitonin kinetics in patients with and without bacterial infection and whom empiric antibiotic treatment is turned out afterwards to be effective or ineffective. There are three fundamental questions to be answered when treating patients with suspected or proven infections on the ICU: 1) is there infection, in other words should we start empirical antibiotic therapy; 2) is the commenced antibiotic effective; and finally 3) when should we stop antibiotic treatment? Our research team decided to give exact answers to these questions with the help of procalcitonin as it is a fundamental problem in our daily practice in the ICU

Nyárültetvények őszi lombszíneződésének vizsgálata három MODIS-színcsatorna alapján

A cikkben egy nemesnyárültetvény őszi lombszíneződésének kutatását összegezzük, mellyel előkészítjük egy – a 21. században várható éghajlatváltozás hatására bekövetkező lombszíneződés-változást elemző – fenológiai modell építését. Bemutatjuk a kutatásba vont taxon (Populus X canadensis) kiválasztásának szempontjait, valamint a vizsgálati helyszín (Tiszaroff) kijelölésének fontosabb ismérveit. Áttekintjük a szabadon hozzáférhető adatokat szolgáltató szenzorokat és a lombszínre vonatkozó, korábban publikált, különböző mérőszámokat. A MODIS-szenzor három kiválaszott színcsatornájára építve újabb lombszíneződési mérőszámokat alkotunk, és ezeket kiértékeljük abból a szempontból, hogy várhatóan mennyire alkalmazhatóak az őszi lombszíneződés jövőbeli fenológiai eltolódásának és megváltozásának modellezése során

Sepsis: From Pathophysiology to Individualized Patient Care

Sepsis has become a major health economic issue, with more patients dying in hospitals due to sepsis related complications compared to breast and colorectal cancer together. Despite extensive research in order to improve outcome in sepsis over the last few decades, results of large multicenter studies were by-and-large very disappointing. This fiasco can be explained by several factors, but one of the most important reasons is the uncertain definition of sepsis resulting in very heterogeneous patient populations, and the lack of understanding of pathophysiology, which is mainly based on the imbalance in the host-immune response. However, this heroic research work has not been in vain. Putting the results of positive and negative studies into context, we can now approach sepsis in a different concept, which may lead us to new perspectives in diagnostics and treatment. While decision making based on conventional sepsis definitions can inevitably lead to false judgment due to the heterogeneity of patients, new concepts based on currently gained knowledge in immunology may help to tailor assessment and treatment of these patients to their actual needs. Summarizing where we stand at present and what the future may hold are the purpose of this review

Early procalcitonin kinetics and appropriateness of empirical antimicrobial therapy in critically ill patients: a prospective observational study

PURPOSE: The purpose was to investigate the value of procalcitonin (PCT) kinetics in predicting the appropriateness of empirical antimicrobial treatment in critically ill patients. MATERIALS AND METHODS: This prospective observational study recruited patients in whom empirical antimicrobial therapy was started for suspected infection. Biochemical and physiological parameters were measured before initiating antimicrobials (t0), 8 hourly (t8, t16, t24), and then daily (day2-6). Patients were grouped post hoc into appropriate (A) and inappropriate (IA) groups. RESULTS: Of 209 patients, infection was confirmed in 67%. Procalcitonin kinetics were different between the IA (n = 33) and A groups (n = 108). In the IA group, PCT levels (median [interquartile range]) increased: t0= 2.8 (1.2-7.4), t16= 8.6 (4.8-22.1), t24= 14.5 (4.9-36.1), P< .05. In the A group, PCT peaked at t16 and started to decrease by t24: t0= 4.2 (1.9-12.8), t16= 6.99 (3.4-29.1), t24= 5.2 (2.0-16.7), P< .05. Receiver operating characteristic analysis revealed that a PCT elevation greater than or equal to 69% from t0 to t16 had an area under the curve for predicting inappropriate antimicrobial treatment of 0.73 (95% confidence interval, 0.63-0.83), P< .001; from t0 to t24, a greater than or equal to 74% increase had an area under the curve of 0.86 (0.77-0.94), P< .001. Hospital mortality was 37% in the A group and 61% in the IA group (P= .017). CONCLUSIONS: Early response of PCT in the first 24 hours of commencing empirical antimicrobials in critically ill patients may help the clinician to evaluate the appropriateness of therapy

Hátrányos helyzetű tanulók otthoni tanulása a jelenléti és a távolléti oktatás idején

A világméretű járvány kitörését követően a neveléstudományi vizsgálatok célkeresztjébe került a digitális – más kifejezéssel online vagy távolléti – oktatás, elsősorban didaktikai, oktatás- és nevelésszociológiai aspektusból. Utóbbi kutatásokban a család, a családi háttér, a szülői bevonódás a korábbiaktól (ti. jelenléti oktatás) eltérő figyelmet kapott, hiszen az otthoni tanulás új értelmet nyert az otthonokba beköltöző iskola miatt. A szülő és a pedagógus együttműködése pedig azon túl, hogy teljes mértékben az online térbe helyeződött át, új síkra lépett: a szülők eddig soha nem tapasztalt módon tekinthettek be a tanórai történésekbe, sőt a megfelelő helyszín és az IKT-eszközök biztosításától kezdve, a tananyag megértésén keresztül, a házi feladatok befotózásáig maguk is aktív részeseivé váltak a tanítási-tanulási folyamatnak. Mindezen újkeletű kihívások eredményessége természetesen a családi háttér által biztosított lehetőségek és feltételek függvénye is volt a pedagógusok és az iskola erőfeszítései mellett, tehát a klasszikus nevelésszociológiai tétel (ti. a társadalmi háttér, a szocioökonómiai státusz és az iskolai eredményesség, pályafutás szorosan összefügg) feltételezhetően az iskola falain kívül rekedt oktatásban is érvényesült. Tanulmányunkban a hátrányos helyzetű tanulók otthoni tanulásának jellegzetességeit tártuk fel két különböző vizsgálat adatainak segítségével. Az első kutatás közvetlenül a pandémia kitörése előtt, a jelenléti oktatás idején készült, a másik felmérés az első hullámot követő karantén miatt elrendelt távolléti oktatás tanulságait igyekezett megragadni. A két adatfelvétel szerencsés időzítésének köszönhetően az otthoni tanulást, a szülők bevonódását, a családi háttér által biztosított lehetőségeket hagyományos és atipikus körülmények között vizsgálhattuk a hátrányos helyzetű tanulók és családjaik körében

A New Approach in Determining the Decadal Common Trends in the Groundwater Table of the Watershed of Lake “Neusiedlersee”

Shallow groundwater is one of the primary sources of fresh water, providing river base-flow and root-zone soil water between precipitation events. However, with urbanization and the increase in demand for water for irrigation, shallow groundwater bodies are being endangered. In the present study, 101 hydrographs of shallow groundwater monitoring wells from the watershed of the westernmost brackish lake in Europe were examined for the years 1997–2012 using a combination of dynamic factor and cluster analyses. The aims were (i) the determination of the main driving factors of the water table, (ii) the determination of the spatial distribution and importance of these factors, and (iii) the estimation of shallow groundwater levels using the obtained model. Results indicate that the dynamic factor models were capable of accurately estimating the hydrographs (avg. mean squared error = 0.29 for standardized water levels), meaning that the two driving factors identified (evapotranspiration and precipitation) describe most of the variances of the fluctuations in water level. Both meteorological parameters correlated with an obtained dynamic factor (r = −0.41 for evapotranspiration &amp; r = 0.76 for precipitation). The strength of these effects displayed a spatial pattern, as did the factor loadings. On this basis, the monitoring wells could be objectively distinguished into two groups using hierarchical cluster analysis and verified by linear discriminant analysis in 98% of the cases. This grouping in turn was determined to be primarily related to the elevation and the geology of the area. It can be concluded that the application of the data analysis toolset suggested herein permits a more efficient, objective, and reproducible delineation of the primary driving factors of the shallow groundwater table in the area. Additionally, it represents an effective toolset for the forecasting of water table variations, a quality which, in the view of the likelihood of further climate change to come, is a distinctive advantage. The knowledge of these factors is crucial to a better understanding of the hydrogeological processes that characterize the water table and, thus, to developing a proper water resource management strategy for the area

Developments in water quality monitoring and management in large river catchments using the Danube River as an example

Effective management of water quality in large rivers requires information on the influence of activities within the catchment (urban and rural) throughout the whole river basin. However, traditional water quality monitoring programmes undertaken by individual agencies normally relate to specific objectives, such as meeting quality criteria for wastewater discharges, and fail to provide information on basin-scale impacts, especially in transboundary river basins. Ideally, monitoring in large international river basins should be harmonised to provide a basin-scale assessment of sources and impacts of human activities, and the effectiveness of management actions. This paper examines current water quality issues in the Danube River Basin and evaluates the approach to water quality monitoring in the context of providing information for a basin-wide management plan. Lessons learned from the monitoring programme in the Danube are used to suggest alternative approaches that could result in more efficient generation of water quality data and provide new insights into causes and impacts of variations in water quality in other large international river basins

Metasomatism-induced wehrlite formation in the upper mantle beneath the Nógrád-Gömör Volcanic Field (Northern Pannonian Basin): Evidence from xenoliths

Clinopyroxene-enriched upper mantle xenoliths classified as wehrlites are common (~20% of all xenoliths) in the central part of the Nógrád-Gömör Volcanic Field (NGVF), situated in the northern margin of the Pannonian Basin in northern Hungary and southern Slovakia. In this study, we thoroughly investigated 12 wehrlite xenoliths, two from each wehrlite-bearing occurrence, to determine the conditions of their formation. Specific textural features, including clinopyroxene-rich patches in an olivine-rich lithology, orthopyroxene remnants in the cores of newly-formed clinopyroxenes and vermicular spinel forms all suggest that wehrlites were formed as a result of intensive interaction between a metasomatic agent and the peridotite wall rock. Based on the major and trace element geochemistry of the rock-forming minerals, significant enrichment in basaltic (Fe, Mn, Ti) and high field strength elements (Nb, Ta, Hf, Zr) was observed, compared to compositions of common lherzolite xenoliths. The presence of orthopyroxene remnants and geochemical trends in rock-forming minerals suggest that the metasomatic process ceased before complete wehrlitization was achieved. The composition of the metasomatic agent is interpreted to be a mafic silicate melt, which was further confirmed by numerical modelling of trace elements using the plate model. The model results also show that the melt/rock ratio played a key role in the degree of petrographic and geochemical transformation. The lack of equilibrium and the conclusions drawn by using variable lherzolitic precursors in the model both suggest that wehrlitization was the last event that occurred shortly before xenolith entrainment in the host mafic melt. We suggest that the wehrlitization and the Plio–Pleistocene basaltic volcanism are related to the same magmatic event.This research was financially facilitated by Orlando Vaselli, supported by the Bolyai Postdoctoral Fellowship Program, a Marie Curie International Reintegration Grant (Grant No. NAMS-230937) and a postdoctoral grant (Grant No. PD101683) of the Hungarian Scientific Research Found (OTKA) to I. J. K., as well as a grant of the Hungarian Scientific Research Found (Grant No. 78425) to Cs. Sz. Work done at Virginia Tech was supported by a grant from the U. S. National Science Foundation (EAR-1624589) to R. J. B. L. Patkó was supported by the GINOP-2.3.2-15-2016-00009 research program. This is the 88 publication of the Lithosphere Fluid Research Lab (LRG)