A Case of Non-Operative Management for Sulfuric Acid Burns

It is thought that severe chemical burns usually require a treatment of extended deep skin and subcutaneous tissue debridement and subsequent skin grafting. However, in this report we discuss the successful treatment of a severe dorsal chemical burn caused by sulfuric acid without skin grafting. A 45-year-old man was showered with highly concentrated (80%) sulfuric acid from a pipe burst at a factory. He sustained severe chemical burn injuries to the limbs and back. On arrival at the hospital, total body surface area burned, the burn index, and the prognostic burn index were 61.5%, 57.7, and 102.7, respectively. Considering the patient\u27s functional prognosis, surgical treatment of the limbs involving skin grafting was performed early in the treatment process. Additionally, daily bedside debridement of necrotic tissue of the back resulted in complete epithelialization without skin grafting. It is difficult to accurately assess the depth of dorsal burns due to the thickness of dorsal skin. In cases of chemical burns, skin color changes associated with chemical reaction make the assessment of burn depth even more difficult. The dorsal burn was estimated to be thirddegree on arrival in the present case. However, complete epithelialization without skin grafting suggests that it was a second degree burn. The patient was discharged 218 days after injury. The patient\u27s functional prognosis was satisfactory with soft skin texture and no contractures

A wide spectrum of clinical and brain MRI findings in patients with SLC19A3 mutations

<p>Abstract</p> <p>Background</p> <p>SLC19A3 (solute carrier family 19, member 3) is a thiamin transporter with 12 transmembrane domains. Homozygous or compound heterozygous mutations in <it>SLC19A3 </it>cause two distinct clinical phenotypes, biotin-responsive basal ganglia disease and Wernicke's-like encephalopathy. Biotin and/or thiamin are effective therapies for both diseases.</p> <p>Methods</p> <p>We conducted on the detailed clinical, brain MRI and molecular genetic analysis of four Japanese patients in a Japanese pedigree who presented with epileptic spasms in early infancy, severe psychomotor retardation, and characteristic brain MRI findings of progressive brain atrophy and bilateral thalami and basal ganglia lesions.</p> <p>Results</p> <p>Genome-wide linkage analysis revealed a disease locus at chromosome 2q35-37, which enabled identification of the causative mutation in the gene <it>SLC19A3</it>. A pathogenic homozygous mutation (c.958G > C, [p.E320Q]) in <it>SLC19A3 </it>was identified in all four patients and their parents were heterozygous for the mutation. Administration of a high dose of biotin for one year improved neither the neurological symptoms nor the brain MRI findings in one patient.</p> <p>Conclusion</p> <p>Our cases broaden the phenotypic spectrum of disorders associated with <it>SLC19A3 </it>mutations and highlight the potential benefit of biotin and/or thiamin treatments and the need to assess the clinical efficacy of these treatments.</p

Diagnostic accuracy of 16S ribosomal RNA gene polymerase chain reaction in bacteremia: A prospective observational study

　The standard method for diagnosing bacteremia is blood culture. However, the sensitivity of blood culture is low when the number of bacteria in the blood is low or when antibiotics have already been administered. Furthermore, some bacteria are difficult to detect in blood cultures. 16S ribosomal RNA (rRNA) contains conserved sequences that are targeted for PCR amplification using universal primers. We investigated whether the threshold cycle (Ct) value of 16S rRNA real-time PCR in whole-blood samples can be used for early diagnosis of bacteremia. Ct values of the 16S rRNA real-time PCR in 307 collected specimens showed a bimodal distribution. Ct values of the blood culture-positive group were significantly lower than those of the blood culture-negative group (P < 0.001). The cutoff value of the receiver operating characteristic curve was 38.80, as determined using finite-mixture modeling and expectation-maximization algorithm. Analysis of the diagnostic accuracy at this cutoff value showed a sensitivity of 91.4%, specificity of 33.5%, positive predictive value of 15.0%, and negative predictive value of 96.8%. The Ct value of 16S rRNA real-time PCR shows high negative predictive value, it may be useful for excluding bacteremia when the cutoff value is set appropriately

The diagnostic accuracy of biomarkers for the prediction of bacteremia in patients with suspected infection: a prospective observational study

　Rapid recognition of bacteremia is important for critical care, especially in patients with suspected bloodstream infections. Procalcitonin and presepsin are widely used biomarkers in point-of care medical testing for identifying infectious diseases and sepsis; however, the diagnostic accuracy for the prediction of bacteremia is not well established. Therefore, this study aimed to evaluate the diagnostic accuracy of procalcitonin and presepsin for the prediction of bacteremia in patients with suspected bacteremia. We performed a prospective observational study at our hospital. A total of 210 patients (307 samples) who had been admitted from December 2014 through September 2016 with a suspected infection were included. Presepsin and procalcitonin were tested simultaneously with blood cultures and routine laboratory tests. One hundred and four blood samples were obtained at the emergency room (ER). Others were obtained during hospital admission. Blood cultures were positive in 34 samples; 25 samples were obtained in the ER. Presepsin and procalcitonin levels were significantly higher in patients with positive blood cultures than in those with negative blood cultures (1028.5 pg/mL vs. 485.0 pg/mL, P < 0.001 and 4.53 ng/mL vs. 0.33 ng/mL, P < 0.001, respectively). For predicting bacteremia, receiver operating characteristic curve analysis for presepsin showed an area under the curve (AUC) of 0.718 and negative predictive value (NPV) of 95%. The analysis for procalcitonin showed an AUC of 0.778 and NPV of 94.8%. C-reactive protein tests and the quick Sequential Organ Failure Assessment score in the ER failed to be useful tools for predicting bacteremia. Based on our results, procalcitonin and presepsin showed good diagnostic accuracy and NPV for predicting bacteremia among patients with suspected infection. Therefore, these biomarkers may be useful for ruling out bacteremia in patients with suspected infection