To transfuse or not to transfuse: thinking outside the box

The commentary by Dr Walsh [1] discussed our study in a systematic way and highlighted several important aspects in relation to our analysis. Indeed, our study has limitations that we acknowledged in our paper. It should be noted, however, that the Transfusion Requirements in Critical Care (TRICC) study [2] excluded cardiac surgical patients and patients who had received blood transfusions before ICU admission. Thus, surgical patients who received intraoperative transfusions were probably excluded. The results of the TRICC study may not, therefore, be extrapolated to surgical ICU patients. Hence, we do not agree with Dr Walsh that the current evidence is consistent with hemoglobin triggers less than 9 g/dL in surgical ICU patients. In the absence of large cohort studies and randomized controlled trials in thi

Diagnostic value and prognostic implications of serum procalcitonin after cardiac surgery: a systematic review of the literature

INTRODUCTION: Systemic inflammatory response syndrome is common after surgery, and it can be difficult to discriminate between infection and inflammation. We performed a review of the literature with the aims of describing the evolution of serum procalcitonin (PCT) levels after uncomplicated cardiac surgery, characterising the role of PCT as a tool in discriminating infection, identifying the relation between PCT, organ failure, and severity of sepsis syndromes, and assessing the possible role of PCT in detection of postoperative complications and mortality. METHODS: We performed a search on MEDLINE using the keyword 'procalcitonin' crossed with 'cardiac surgery,' 'heart,' 'postoperative,' and 'transplantation.' Our search was limited to human studies published between January 1990 and June 2006. RESULTS: Uncomplicated cardiac surgery induces a postoperative increase in serum PCT levels. Peak PCT levels are reached within 24 hours postoperatively and return to normal levels within the first week. This increase seems to be dependent on the surgical procedure and on intraoperative events. Although PCT values reported in infected patients are generally higher than in non-infected patients after cardiac surgery, the cutoff point for discriminating infection ranges from 1 to 5 ng/ml, and the dynamics of PCT levels over time may be more important than absolute values. PCT is superior to C-reactive protein in discriminating infections in this setting. PCT levels are higher with increased severity of sepsis and the presence of organ dysfunction/failure and in patients with a poor outcome or in those who develop postoperative complications. PCT levels typically remain unchanged after acute rejection but increase markedly after bacterial and fungal infections. Systemic infections are associated with greater PCT elevation than is local infection. Viral infections are difficult to identify based on PCT measurements. CONCLUSION: The dynamics of PCT levels, rather than absolute values, could be important in identifying patients with infectious complications after cardiac surgery. PCT is useful in differentiating acute graft rejection after heart and/or lung transplantation from bacterial and fungal infections. Further studies are needed to define cutoff points and to incorporate PCT levels in useful prediction models

Study on the effect of wormseed plants; artemisia cina L. and chamomile; matricaria chamomilla L. on Growth Parameters and Immune Response of African Catfish, Clarias gariepinus

A number of 420 fingerlings of catfish were used to examine the effect of wormseed plants and chamomile on the growth parameters and on non-specific immune response of the African catfish; Clarias gariepinus. Both types of herbs were used in rates of 1, 3 and 5% with 3 replicates per each of the 6 treatments. The 7th treatment was kept as a control group. The experimented catfish were fed with the 7 examined diets in the rate of 3% of fish biomass for 1 month. Different growth parameters as well as blood parameters were estimated to evaluate the growth performance and immune response of the experimented catfish. Results revealed that wormseed plants Artemisia cina L. in the rate of 3 and 5% and chamomile Matricaria chamomilla. L. in the rate of 1% showed the best figures of growth parameters as well as immune response parameters of the examined catfish

Infections of respiratory or abdominal origin in ICU patients: what are the differences?

There are few data related to the effects of different sources of infection on outcome. We used the Sepsis Occurrence in Acutely ill Patients (SOAP) database to investigate differences in the impact of respiratory tract and abdominal sites of infection on organ failure and survival.Comparative StudyJournal ArticleMulticenter StudyResearch Support, Non-U.S. Gov'tSCOPUS: ar.jinfo:eu-repo/semantics/publishe

Characteristics and outcomes of cancer patients in European ICUs

Increasing numbers of cancer patients are being admitted to the intensive care unit (ICU), either for cancer-related complications or treatment-associated side effects, yet there are relatively few data concerning the epidemiology and prognosis of cancer patients admitted to general ICUs. The aim of this study was to assess the characteristics of critically ill cancer patients, and to evaluate their prognosis.SCOPUS: ar.jinfo:eu-repo/semantics/publishe