Ultrasonography of temporal arteries is not commonly used in the approach of patients with suspected giant cell arteritis (GCA) in clinical practice. A meta-analysis of primary studies available ...through April 2004 concluded that ultrasonography could indeed be helpful in diagnosing GCA. We specifically re-examined the diagnostic value of the ultrasonography-derived halo sign, a dark hypoechoic circumferential thickening around the artery lumen, indicating vasculitic wall edema, in GCA.
Original, prospective studies in patients with suspected GCA that examined ultrasonography findings of temporal arteries using the ACR 1990 classification criteria for GCA as reference standard, published through 2009, were identified. Only eight studies involving 575 patients, 204 of whom received the final diagnosis of GCA, fulfilled technical quality criteria for ultrasound. Weighted sensitivity and specificity estimates of the halo sign were assessed, their possible heterogeneity was investigated and pooled diagnostic odds ratio was determined.
Unilateral halo sign achieved an overall sensitivity of 68% (95% CI, 0.61-0.74) and specificity of 91% (95% CI, 0.88-0.94) for GCA. The values of inconsistency coefficient (I2) of both sensitivity and specificity of the halo sign, showed significant heterogeneity concerning the results between studies. Pooled diagnostic odds ratio, expressing how much greater the odds of having GCA are for patients with halo sign than for those without, was 34 (95% CI, 8.21-138.23). Diagnostic odds ratio was further increased to 65 (95% CI, 17.86-236.82) when bilateral halo signs were present (sensitivity/specificity of 43% and 100%, respectively). In both cases, it was found that DOR was constant across studies.
Temporal artery edema demonstrated as halo sign should be always looked for in ultrasonography when GCA is suspected. Providing that currently accepted technical quality criteria are fulfilled, halo sign's sensitivity and specificity are comparable to those of autoantibodies used as diagnostic tests in rheumatology. Validation of revised GCA classification criteria which will include the halo sign may be warranted.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Although early antimicrobial discontinuation guided by procalcitonin (PCT) has shown decreased antibiotic consumption in lower respiratory tract infections, the outcomes in long-term sepsis sequelae ...remain unclear.
To investigate if PCT guidance may reduce the incidence of long-term infection-associated adverse events in sepsis.
In this multicenter trial, 266 patients with sepsis (by Sepsis-3 definitions) with lower respiratory tract infections, acute pyelonephritis, or primary bloodstream infection were randomized (1:1) to receive either PCT-guided discontinuation of antimicrobials or standard of care. The discontinuation criterion was ≥80% reduction in PCT levels or any PCT ≤0.5 μg/L at Day 5 or later. The primary outcome was the rate of infection-associated adverse events at Day 180, a composite of the incidence of any new infection by
or multidrug-resistant organisms, or any death attributed to baseline
or multidrug-resistant organism infection. Secondary outcomes included 28-day mortality, length of antibiotic therapy, and cost of hospitalization.
The rate of infection-associated adverse events was 7.2% (95% confidence interval CI, 3.8-13.1%; 9/125) versus 15.3% (95% CI, 10.1-22.4%; 20/131) (hazard ratio, 0.45; 95% CI, 0.20-0.98;
= 0.045); 28-day mortality 15.2% (95% CI, 10-22.5%; 19/125) versus 28.2% (95% CI, 21.2-36.5%; 37/131) (hazard ratio, 0.51; 95% CI, 0.29-0.89;
= 0.02); and median length of antibiotic therapy 5 (range, 5-7) versus 10 (range, 7-15) days (
< 0.001) in the PCT and standard-of-care arms, respectively. The cost of hospitalization was also reduced in the PCT arm.
In sepsis, PCT guidance was effective in reducing infection-associated adverse events, 28-day mortality, and cost of hospitalization.Clinical trial registered with www.clinicaltrials.gov (NCT03333304).
The aim of this study was to investigate the kinetics of immunoglobulin M (IgM) during the different stages of sepsis.
In this prospective multicenter study, blood sampling for IgM measurement was ...done within the first 24 hours from diagnosis in 332 critically ill patients; in 83 patients this was repeated upon progression to more severe stages. Among these 83 patients, 30 patients with severe sepsis progressed into shock and IgM was monitored daily for seven consecutive days. Peripheral blood mononuclear cells (PBMCs) were isolated from 55 patients and stimulated for IgM production.
Serum IgM was decreased in septic shock compared to patients with systemic inflammatory response syndrome (SIRS) and patients with severe sepsis. Paired comparisons at distinct time points of the sepsis course showed that IgM was decreased only when patients deteriorated from severe sepsis to septic shock. Serial measurements in these patients, beginning from the early start of vasopressors, showed that the distribution of IgM over time was significantly greater for survivors than for non-survivors. Production of IgM by PBMCs was significantly lower at all stages of sepsis compared with healthy controls.
Specific changes of circulating IgM occur when patients with severe sepsis progress into septic shock. The distribution of IgM is lower among non-survivors.
Traditionally, for the assessment of follicle growth during IVF, two-dimensional (2D) transvaginal ultrasound (US) is used. In the past few years three-dimensional (3D) US has also been introduced.
...To compare follicular sizes between 2 and 3D ultrasound imaging on the final day of controlled ovarian stimulation.
A prospective observational cohort study including 121 women undergoing controlled ovarian stimulation (COS) between January 2017 and July 2018. All women were assessed by transvaginal 2D and 3D ultrasonography to measure ovarian follicle dimensions on the final day of COS.
The mean difference in paired comparisons between the 3D and 2D US measurements in 25 women with monofollicular development was + 1.6 ± 2.5 mm for the x-dimension and + 1.7 ± 2.4 mm for the y-dimension; and in the total number of 1197 paired measurements of follicles the mean difference + 2.1 ± 3.3 mm and + 1.8 ± 3.9 mm for the x- and y-dimension respectively. In all cases the paired t-test showed that differences were statistically significant (p < 0.01). Further it was conjectured that the 2D underestimation results from the inherent difficulty to precisely place the US probe simultaneously on the perpendicular maximal of the x and y follicle diameters, leading to measurement errors that, by theory, are normally distributed. Running Monte-Carlo simulations based on these measurement errors it was found that both the mean difference and standard deviation are of the same magnitude as the ones found in real measurements, thus proving the conjecture.
The utilisation of 3D US results in different measurements of the follicular dimensions, and volumes, when compared to conventional 2D US. The differences in the x- and y-dimensions may affect the outcome of an IVF cycle as they are used to define the day of triggering final oocyte maturation, which is associated with the yield of mature oocytes and the probability of live birth.
The accuracy of a new optical biosensor (OB) point-of-care device for the detection of severe infections is studied.
The OB emits different wavelengths and outputs information associated with heart ...rate, pulse oximetry, levels of nitric oxide and kidney function. At the first phase, recordings were done every two hours for three consecutive days after hospital admission in 142 patients at high-risk for sepsis by placing the OB on the forefinger. At the second phase, single recordings were done in 54 patients with symptoms of viral infection; 38 were diagnosed with COVID-19.
At the first phase, the cutoff value of positive likelihood of 18 provided 100% specificity and 100% positive predictive value for the diagnosis of sepsis. These were 87.5 and 91.7% respectively at the second phase. OB diagnosed severe COVID-19 with 83.3% sensitivity and 87.5% negative predictive value.
The studied OB seems valuable for the discrimination of infection severity.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Whether past history of solid stage I/II inactive cancer has an impact on 28-day mortality of sepsis remains unclear. We aimed to determine the impact of history of stage I or II solid tumor ...malignancy in complete remission the last 3 years on sepsis outcome.
Using the database of the Hellenic Sepsis Study Group from 1553 patients with sepsis admitted in the ICU, 83 patients with sepsis by Sepsis-3 definition with past-history of stage I/II inactive solid malignancy the last 3 years were depicted. A comparator group of 83 patients fully matched for age, severity, type of infection and comorbidities was selected by propensity score matching.
Mortality after 28 days was 37.3% in the comparator group and 54.2% in the solid tumor stage I/II group (odds ratio for death 1.98; p: 0.030). Following step-wise forward Cox regression analysis, septic shock (hazard ratio 1.80), acute renal injury (hazard ratio 2.06), history of coronary heart disease (hazard ratio 0.36) and history of stage I/II solid tumor malignancy (hazard ratio 1.79) were the only independent variables associated with 28-day mortality. Serum levels of procalcitonin and of soluble urokinase plasminogen activator receptor were similar between the two groups of comparisons.
Past history of stage I/II solid malignancy is an independent risk factor for unfavorable outcome from sepsis the first 28 days.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Time perception deficiency has been implicated in schizophrenia; however the exact nature of this remains unclear. The present study was designed with the aim to delineate timing deficits in ...schizophrenia by examining performance of patients with schizophrenia and healthy volunteers in an interval discrimination test and their accuracy and precision in a pacing reproduction–replication test.
The first task involved temporal discrimination of intervals, in which participants (60 patients with schizophrenia and 35 healthy controls) had to judge whether intervals were longer, shorter or equal than a standard interval. The second task required repetitive self-paced tapping to test accuracy and precision in the reproduction and replication of tempos.
Patients were found to differ significantly from the controls in the psychoticism scale of EPQ, the proportion of correct responses in the interval discrimination test and the overall accuracy and precision in the reproduction and replication of sound sequences (p<0.01). Within the patient group bad responders concerning the ability to discriminate time intervals were associated with increased scores in the Positive and Negative Syndrome Scale (PANSS) and in the Brief Psychiatric Rating Scale (BPRS) in comparison to good responders (p<0.01). There were no gender effects and there were no differences between subgroups of patients taking different kinds or combinations of drugs.
Analysis has shown that performance on timing tasks decreased with increasing psychopathology and therefore that timing dysfunctions are directly linked to the severity of the illness. Different temporal dysfunctions can be traced to different psychophysiological origins that can be explained using the Scalar Expectancy Theory (SET).
► Timing deficits in schizophrenia studied in interval discrimination and pacing tests ► Performance on timing tasks decreased with increasing psychopathology. ► Temporal dysfunctions can be explained by scalar theory. ► Interval discrimination deficits linked to decision and memory stages dysfunction ► Faster tapping rates and temporal variability linked to internal clock deficits
Depression may essentially influence cognitive function contributing to poor school performance. The present study undertakes to determine the existence and strength of correlation between depressive ...symptomatology and other mental conditions with the acquired level of understanding of Newtonian physics taught in schools. The current study recruited 490 students (262 girls, 228 boys) attending the first semester of the Greek Second Grade of General Lyceum School. Force Concept Inventory (FCI) tested the depth of the students' understanding of Newtonian Physics. Symptom Checklist-90-R assessed general mental status. The tests took place in the classroom during a 1 h session. Low FCI scores significantly correlated with mental conditions, with depression ranking first. Girls had higher scores in all nine symptoms scales of SCL-90 and lower FCI scores. Stepwise regression models proved that the gender effect on FCI could be effectively explained through the significant effect of depression. An understanding of Newtonian physics among high school students may be restricted by common problematic mental conditions, with depression being the greatest among all. Further research, using a more systematic approach to measure depression among adolescents with poor understanding of physics, would help to elucidate the nature of the effect.
Objective Increased oxidative stress has been described in patients with Hashimoto’s thyroiditis (HT). The aim of the present study was to investigate whether high oxidative stress is further ...influenced by obesity and dietary habits in euthyroid women with HT. Methods Two hundred eighteen consecutive euthyroid women with HT were studied and separated in two groups; 102 with thyroxine replacement and 114 without. For the evaluation of oxidative stress, total lipid peroxide levels in serum (TOS) were measured and recoded as ‘high TOS’ vs ‘medium/low TOS’. The type of food and consumption frequency were recorded. Two binary variables were considered; normal vs low fruit consumption and daily vs sporadic vegetable consumption. Results ‘High TOS’ was more frequent in women under thyroxine replacement (31.4% vs 14.7%, OR = 2.7, 95% CI: 1.4–5.2). The prevalence of ‘high TOS’ was higher among overweight/obese women compared to women with normal BMI (30.4% vs 12.5%, OR = 3.1, 95% CI: 1.5–6.4). Low fruit consumption was associated with increased ‘high TOS’ prevalence (30.6% vs 12.9%, OR = 3.0, 95% CI: 1.4–6.2). Sporadic vegetable consumption was associated with increased ‘high TOS’ prevalence compared to daily consumption (29.9% vs 13.5%, OR = 2.7, 95% CI: 1.3–5.7). The examined risk factors were independent and additive in their effect on TOS. At least three risk factors had to be concomitantly present for the likelihood of ‘high TOS’ to be significantly elevated. Conclusions Oxidative stress is increased in women with HT under thyroxine replacement. Nevertheless, normal BMI, daily fruit and vegetable consumption, all contribute in maintaining oxidative stress at low levels.
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