A Comparison of Automated Segmentation and Manual Tracing of Magnetic Resonance Imaging to Quantify Lateral Ventricle Volumes

Objective: Ventricular volume measurements have been proposed as a useful biomarker for several neurological diseases. The goal of this study was to compare the performance of 3 fully-automated tools, volBrain (http://volbrain.upv.es), ALVIN (Automatic Lateral Ventricle Delineation) (https://sites.google.com/site/mrilateralventricle/), and MRICloud (http://mricloud.org), with expert hand tracing to quantify lateral ventricle (LV) volume using magnetic resonance images. Materials and Methods: The sample comprised 24 healthy subjects (age: 25.1±5.7 years, all male). Volumes derived from each automated measurement were compared to hand tracing results performed by 2 specialists to assess the percent volume difference using the intraclass correlation coefficient (ICC), concordance correlation coefficient (CCC), Dice index value, and Bland-Altman analysis. Results: The ICC agreement of the Manual_1 and Manual_2 was very good (0.979), and there was no statistically significant difference (p>0.001). The volume difference of all methods was similar. The CCC with MRICloud and ALVIN was higher than that of volBrain. Bland-Altman plots indicated that the 3 automated methods demonstrated acceptable agreement. Conclusion: Compared with hand tracing, the LV volumes generated by MRICloud were more accurate than those of volBrain and ALVIN. LV volume values can provide valuable data related to the volumetric dependencies of the anatomical structures in various clinical conditions that can now be easily obtained using automated tools

The importance of procalcitonin in early diagnosis of sepsis

Despite the advances and a wide range of studies conducted, sepsis is one of the most frequent causes of death in patients with critical health condition. Early diagnosis, rapid and effective treatment are extremely important. Use of procalcitonin (PCT) for this purpose has become widespread and notable recently. Procalcitonin is an important test as point-of-care testing (POCT) just like C-reactive protein (CRP). Procalcitonin is the prohormone of calcitonin. It is released from the parenchymal cells of the liver, kidneys and muscles, and in response to bacterial toxins, it is released from the adipocytes. As a response to bacterial infection, the serum procalcitonin level may increase by 5000-fold within 2-4 hours. C- reactive protein is synthesized in the liver as a result of interleukin-6 (IL-6) trigger due to tissue injury, inflammation and/or infections. The aim of our study was to emphasize the importance of PCT as an indicator in patients suspicious of sepsis in the early period. A total of 66 patients with critical situation were included in the study conducted at the Inonu University Medical Faculty Turgut Ozal Medical Center Investigation Hospital between February 2007 and August 2008. These patients were appropriate for the diagnostic criteria of systemic inflammatory response syndrome (SIRS). Appropriate antibiotiotherapy was begun for the patients. The PCT and CRP levels were investigated on the first day after having been included in the study, and on the third and seventh days. The mean C-reactive protein levels were 132.41, 108.39 and 83.47 mg/l on the 1st, 3rd and 7th days, respectively. The minimum level of procalcitonin was 0.095 ng/ml on the first day, and the maximum level was 316.054 ng/ml. The minimum/maximum levels were 0.091 and 306.043 ng/ml on the 3rd day, and 0.081 and 12.15136 ng/ml on the 7th days, respectively. No statistically significant difference was observed betweern the serum procalcitonin levels on the 1st and the 3rd days ( p [Med-Science 2017; 6(3.000): 424-6

Assessment of the effectiveness of a ventilator associated pneumonia prevention bundle that contains endotracheal tube with subglottic drainage and cuff pressure monitorization

The effectiveness of prevention bundles on the occurrence and mortality of ventilator associated pneumonia (VAP) was evaluated in many studies. However, the effectiveness of endotracheal tube with subglottic secretion drainage (ETT-SD) and cuff pressure monitorization in VAP bundles have not been adequately assessed. In this study, we aimed to evaluate the effectiveness of VAP bundle containing ETT-SD and cuff pressure monitorization. This was a prospective, controlled study that was carried out between March 2011 and April 2012 including intubated patients. The study was conducted at the Anesthesiology Intensive Care Unit 1 and 2 (10 beds each) in a 898-bed university hospital. Occurrence of VAP and compliance with the parameters of the VAP prevention bundles were assessed daily. Patients intubated with the standard endotracheal tube were recruited as controls, mainly in the first six months of the study as ETT-SD and cuff pressure monometer had not yet been implemented. In the second term, patients intubated with ETT-SD were included as cases. Occurrence of VAP, mortality, and compliance with VAP prevention bundles were monitored. A total of 133 patients, 37 cases and 96 controls were recruited. VAP incidence declined from 40.82 to 22.16 per 1000 ventilator days among controls and cases, respectively (p < 005). On average, VAP occurred 17.33 ± 21.09 days in the case group and 10.43 ± 7.83 days in the control group (p = 0.04). However, mortality of cases and controls at the 14th and 30th days was not different. VAP prevention bundles including the utilization of ETT-SD, monitoring cuff pressure, and oral care with chlorhexidine were efficient in reducing the rate of VAP. Keywords: Ventilator associated pneumonia, VAP prevention bundles, Subglottic secretion drainage, Cuff pressure monitorizatio

Potential Risk Factors for In-Hospital Mortality in Patients with Moderate-to-Severe Blunt Multiple Trauma Who Survive Initial Resuscitation

Introduction. The aim was to identify risk factors that influence in-hospital mortality for patients with moderate-to-severe blunt multiple trauma (BMT) who survive initial resuscitation. Methods. The prospective study involved 195 adult patients with BMT who were admitted to a referral hospital’s emergency department (ED) between May 1, 2015, and May 31, 2016. Results. Forty-three (22%) of the 195 patients died in hospital. Multivariate analysis identified low blood pH (odds ratio [OR] 6.580, 95% confidence interval [CI] 1.12-38.51), high serum lactate level (OR 1.041, 95% CI 1.01-1.07), high ISS (OR 1.109, 95% CI 1.06-1.16), high APACHE II score (OR 1.189, 95% CI 1.07-1.33), traumatic brain injury (TBI) (OR 4.358, 95% CI 0.76-24.86), severe hemorrhage (OR 5.314, 95% CI 1.07-26.49), and coagulopathy (OR 5.916, 95% CI 1.17-29.90) as useful predictors of acute in-hospital mortality. High ISS (OR 1.047, 95% CI 1.02-1.08), TBI (OR 8.922, 95% CI 2.57-31.00), sepsis (OR 4.956, 95% CI 1.99-12.36), acute respiratory distress syndrome (ARDS) (OR 8.036, 95% CI 1.85-34.84), respiratory failure (OR 9.630, 95% CI 2.64-35.14), renal failure (OR 74.803, 95% CI 11.34-493.43), and multiple organ failure [MOF] (OR 10.415, 95% CI 4.48-24.24) were risk factors for late in-hospital mortality. High Glasgow Coma Scale (GCS) was a good predictor for survival at 2, 7, and 28 or more days of hospitalization (OR 0.708 and 95% CI 0.56-0.09; OR 0.835 and 95% CI 0.73-0.95; OR 0.798 and 95% CI 0.71-0.90, resp.). Conclusion. Several factors signal poor short-term outcome for patients who present to the ED with moderate-to-severe BMT: low blood pH, high serum lactate level, presence of TBI, severe hemorrhage, coagulopathy, organ failure (respiratory, renal, and MOF), and ARDS. For this patient group, ISS and APACHE II scores might be helpful for stratifying by mortality risk, and GCS might be a good predictor for survival

Review of 15 Cases of Neurobrucellosis

Introduction: Brucellosis is a zoonotic disease remaining endemic worldwide and in Turkey. Central nervous system involvement is a rare complication in brucellosis. This study is an overview of 15 neurobrucellosis cases who were followed in our department as inpatients. Patients and Methods: This study is a retrospective analysis of fi fteen cases of neurobrucellosis in the Infectious Diseases and Clinical Microbiology Department of Inonu University Medical Faculty Hospital between the years 2005-2010. Clinical features, laboratory findings, diagnosis, and treatment strategies were recorded retrospectively. Results: Of the fi fteen patients, 6 were females and 9 were males. Mean age of the patientswas 36.2 years (range, 18-68 years). Mean disease duration before diagnosis was 2 months. The most common symptoms were headache and fever, 66 % and 60 %, respectively. Eight patients (53 %) had visual symptoms, 3 patients (20%) had senso-rineural hearing loss, and 2 patients (13%) had ataxia. Two patients had pancytopenia and four patients had abnormal liver function tests. Two patients did not give informed consent for lumbar puncture (LP). The diagnostic LP performed in all thirteen patients revealed high protein levels and pleocytosis in cerebrospinal fl uid (CSF). Seven patients (53.8 %) had low glucose levels in CSF. Twelve patients (80%) had a serum tube agglutination test value 1/160 or higher. Brucella spp. were isolated from the blood culture of six patients and from the CSF culture of three patients. All patients received antibiotic therapy initially with doxycycline, rifampin, ceftriaxone, and trimethoprim-sulfamethoxazole. None of the patients died, but sequelae resulted in two patients. Conclusion: Patients with unexplained fever, headache, and neurological symptoms should be considered for neurobrucellosis in endemic regions