Sensitivity and Specificity of Soluble Triggering Receptor Expressed on Myeloid Cells-1, Midregional Proatrial Natriuretic Peptide and Midregional Proadrenomedullin for Distinguishing Etiology and to Assess Severity in Community-Acquired Pneumonia

This study aimed to evaluate the diagnostic accuracy of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), midregional proatrial natriuretic peptide (MR-proANP) and midregional proadrenomedullin (MR-proADM) to distinguish bacterial from viral community-acquired pneumonia (CAP) and to identify severe cases in children hospitalized for radiologically confirmed CAP. Index test results were compared with those derived from routine diagnostic tests, i.e., white blood cell (WBC) counts, neutrophil percentages, and serum C-reactive protein (CRP) and procalcitonin (PCT) levels.This prospective, multicenter study was carried out in the most important children’s hospitals (n = 11) in Italy and 433 otherwise healthy children hospitalized for radiologically confirmed CAP were enrolled. Among cases for whom etiology could be determined, CAP was ascribed to bacteria in 235 (54.3%) children and to one or more viruses in 111 (25.6%) children. A total of 312 (72.2%) children had severe disease.CRP and PCT had the best performances for both bacterial and viral CAP identification. The cut-off values with the highest combined sensitivity and specificity for the identification of bacterial and viral infections using CRP were ≥7.98 mg/L and ≤7.5 mg/L, respectively. When PCT was considered, the cut-off values with the highest combined sensitivity and specificity were ≥0.188 ng/mL for bacterial CAP and ≤0.07 ng/mL for viral CAP. For the identification of severe cases, the best results were obtained with evaluations of PCT and MR-proANP. However, in both cases, the biomarker cut-off with the highest combined sensitivity and specificity (≥0.093 ng/mL for PCT and ≥33.8 pmol/L for proANP) had a relatively good sensitivity (higher than 70%) but a limited specificity (of approximately 55%).This study indicates that in children with CAP, sTREM-1, MR-proANP, and MR-proADM blood levels have poor abilities to differentiate bacterial from viral diseases or to identify severe cases, highlighting that PCT maintains the main role at this regard

Enterovirus D68-associated community-acquired pneumonia in children living in Milan, Italy

Background: An increasing number of children infected by enterovirus D68 (EV-D68) and affected by severe respiratory illness, muscle weakness and paralysis were described in the USA and Canada in 2014 Objectives: To investigate the potential involvement of EV-D68 in determining community-acquired pneumonia (CAP) in hospitalised children in order to acquire information concerning the clinical problems associated with EV-D68 in Italy. Study design: This prospective study of children hospitalised for CAP in the largest Pediatric Department in Milan, Italy, was carried out between 1 June and 31 December 2014. All of the children's admission nasopharyngeal swabs were investigated for the presence of EV-D68. Results: One hundred and seventy-six children with radiographically confirmed CAP were hospitalised during the 7-month study period: 97 (55.1%) had enterovirus/rhinovirus-positive nasopharyngeal samples, including four (2.3%) positive for EV-D68. These four samples were collected between 9 and 21 October, a month in which 21 cases of CAP were recorded. Phylogenetic analysis showed that all of the sequences fell into clade B. The most severe case was diagnosed in a 14-year-old girl with mitochondrial encephalopathy, lactic acidosis and stroke-like episodes (MELAS syndrome), who died after 12 days of hospitalisation. Conclusions: EV-D68 was detected in few children with usually mild-to-moderate lower respiratory tract infection, although the disease lead to the death of a girl with a severe chronic underlying disease. Further studies capable of better defining the epidemiological, genetic and pathogenetic characteristics of the virus are required in order to be able to prepare appropriate preventive and therapeutic measures. (C) 2015 Elsevier B.V. All rights reserved

Radio-Frequency atrial flutter isthmus ablation: a component in the long-term strategy to prevent atrial tachyarrhythmias?

Problem istraživanja ovog rada predstavlja važnost analize financijskih izvještaja i promjena na pozicijama financijskih izvještaja za planiranje i nadzor poslovanja. Cilj rada je objasniti računovodstvene postupke analize promjena pozicija financijskih izvještaja na praktičnom primjeru, odnosno na primjeru poduzeća Podravka d.d. Sama analiza se radi kako utvrdilo u kojem se smjeru kreće poslovanje poduzeća. Horizontalnom i vertikalnom analizom je prikazano poslovanje poduzeća Podravke d.d kroz razdoblje od 2014 do 2016 godine. Horizontalnom analizom utvrđeno je da poduzeće najvišu dobit ostvarila u 2015 godini, dok vertikalna analiza pokazuje da je poduzeće najviše ostvarilo prihoda od prodaje u 2016 godini i da je to u strukturi prihoda najveći prihod. Nakon što su provedene analize može se zaključiti da poduzeće Podravka d.d uspješno posluje.The problem of this paper is the importance of analyzing financial statements and changes in positions of financial statements for business planning and supervision. The aim of the paper is to explain the accounting procedures of the analysis of changes in the positions of the financial statements on a practical example, ie on the example of Podravka d.d. The analysis itself is to determine the direction in which the company's business is moving. Horizontal and vertical analysis shows the business operations of Podravka dd through the period from 2014 to 2016. Horizontal analysis found that the company had the highest profit in 2015, while the vertical analysis shows that the company had the highest sales revenue in 2016 and that it was the largest income in the revenue structure. After the analyzes carried out it can be concluded that the company Podravka d.d successfully operates

Enterovirus-D68 in the Cerebrospinal Fluid of Two Children with Aseptic Meningitis

This case report describes two previously healthy children with aseptic meningitis whose cerebrospinal fluid was positive for enterovirus-D68, which indicates direct involvement of this infectious agent in the development of this neurologic disease