Circulating levels of GH predict mortality and complement prognostic scores in critically ill medical patients.

Background: Circulating levels of GH are increased during critical illness and correlate with outcome in children with meningococcal sepsis. We assessed the prognostic implications of GH on admission and during follow-up in critically ill adult patients admitted to a medical intensive care unit.

Materials And Methods: We measured GH, IGF1 and IGF-binding protein3 (IGFBP-3) plasma concentrations in 103 consecutive critically ill patients and compared it with two clinical severity scores (APACHE II, SAPS II).

Lymphocyte counts in patients with ANCA-associated vasculitis.

How lymphocyte counts relate to treatment-response in patients with ANCA-associated vasculitis (AAV) is controversial, and data on short-term variability of lymphocyte counts are lacking. Retrospective single center evaluation of disease activity and lymphocyte counts in patients with AAV, and of lymphocyte counts in kidney transplant-recipients, were done; both at the University Hospital Basel, Switzerland. Twenty-three patients with AAV were included.

Procalcitonin-guided antibiotic use vs a standard approach for acute respiratory tract infections in primary care.

Background: Acute respiratory tract infections are the most common reason for antibiotic therapy in primary care despite their mainly viral etiology. A laboratory test measuring procalcitonin levels in blood specimens was suggested as a tool to reduce unnecessary prescribing of antibiotics. We consider whether antibiotic therapy guided by procalcitonin reduces the use of antibiotics without increasing the restrictions experienced by patients by more than 1 day.

Multistep greedy algorithm identifies community structure in real-world and computer-generated networks.

We have recently introduced a multistep extension of the greedy algorithm for modularity optimization. The extension is based on the idea that merging l pairs of communities (l>1) at each iteration prevents premature condensation into few large communities. Here, an empirical formula is presented for the choice of the step width l that generates partitions with (close to) optimal modularity for 17 real-world and 1100 computer-generated networks.

Biomarkers in the management of pneumonia.

A novel approach to improve diagnosis and prognosis of pneumonia is the use of biomarkers. An ideal diagnostic biomarker for pneumonia should allow an early diagnosis and differential diagnosis from other, noninfectious conditions. Procalcitonin (PCT) has emerged as a reliable diagnostic marker in pneumonia, and is better when compared with other markers, namely C-reactive protein, leukocyte count and proinflammatory cytokines.

[Procalcitonin - importance for the diagnosis of bacterial infections].

In contrast to Calcitonin that is primarily synthesized in the thyroid, Procalcitonin is the prohormon that is synthesized in many different tissues of infected organs. In order to be useful for the diagnosis of mild, localized or early infections the assay needs to have a sensitivity that can measure within normal limits (0.02 microg/L).

Prognostic value of procalcitonin in Legionella pneumonia.

The diagnostic reliability and prognostic implications of procalcitonin (PCT) (ng/ml) on admission in patients with community-acquired pneumonia (CAP) due to Legionella pneumophila are unknown. We retrospectively analysed PCT values in 29 patients with microbiologically proven Legionella-CAP admitted to the University Hospital Basel, Switzerland, between 2002 and 2007 and compared them to other markers of infection, namely, C-reactive protein (CRP) (mg/l) and leukocyte count (10(9)/l), and two prognostic severity assessment scores (PSI and CURB65). Laboratory analysis demonstrated that PCT values on admission were >0.

Serum procalcitonin for discrimination between septic and non-septic arthritis.

Background: Early differentiation between septic and non-septic arthritis is difficult. A previous study showed promising diagnostic accuracy of serum Procalcitonin (PCT) in septic arthritis, limited by a low sensitive PCT test kit.

Objective: To investigate the diagnostic value of PCT in patients with septic and non-septic arthritis using a novel test with low detection limit.

Efficient modularity optimization by multistep greedy algorithm and vertex mover refinement.

Identifying strongly connected substructures in large networks provides insight into their coarse-grained organization. Several approaches based on the optimization of a quality function, e.g.

The effect of PEO block lengths on the size and stability of complex coacervate core micelles.

We report on a series of polyion complexes from mixtures of poly(ethylene oxide)-block-poly(N,N-diethylaminoethylmethacrylate) (PEO-PDEAMA) and poly(ethylene oxide)-block-poly(aspartic acid) (PEO-PAsp). As expected, the micelle size, polydispersity and stability are dependant on the relative and absolute lengths of the polyelectrolyte chains. However, we also demonstrate that whilst the length of the charged polyelectrolyte blocks is important, the length of the PEO chains is an equally relevant variable in determining both the size and stability of the final micelles as well as the degree of charge neutralisation at which micellisation occurs.

Endothelin-1 precursor peptides correlate with severity of disease and outcome in patients with community acquired pneumonia.

Background: Circulating levels of endothelin-1 are increased in sepsis and correlate with severity of disease. A rapid and easy immunoassay has been developed to measure the more stable ET-1 precursor peptides proET-1. The objective of this study was to assess the diagnostic and prognostic value of proET-1 in a prospective cohort of mainly septic patients with community-acquired pneumonia.

Predicting mortality with pneumonia severity scores: importance of model recalibration to local settings.

In patients with community-acquired pneumonia (CAP) prediction rules based on individual predicted mortalities are frequently used to support decision-making for in-patient vs. outpatient management. We studied the accuracy and the need for recalibration of three risk prediction scores in a tertiary-care University hospital emergency-department setting in Switzerland.

Effect of a 14-day course of systemic corticosteroids on the hypothalamic-pituitary-adrenal-axis in patients with acute exacerbation of chronic obstructive pulmonary disease.

Background: As supra-physiological intake of corticosteroids is a well known risk factor for the development of adrenal insufficiency, we investigated the function of the hypothalamic-pituitary-adrenal (HPA) axis during a 14-day course of systemic corticosteroids in patients with acute exacerbation of chronic obstructive pulmonary disease using clinical and laboratory measures.

Methods: A systematic clinical and laboratory assessment including measurement of basal cortisol levels and the response to low dose (1 mug) ACTH stimulation was performed in nine patients before, on the first and the last day of treatment, as well as 2, 7 and 21 days after corticosteroid withdrawal.

Results: At baseline, all nine patients had normal responses to 1 mug ACTH.

Circulating precursor levels of endothelin-1 and adrenomedullin, two endothelium-derived, counteracting substances, in sepsis.

Plasma levels of endothelin-1 (ET-1) and adrenomedullin (ADM), two opposingly acting peptides, correlate with mortality in endotoxemia, but their measurement is cumbersome. New sandwich assays have been introduced that measure more stable precursor fragments. The objective of this study was to investigate the counterplay of their precursor peptides in septic patients and to compare them with disease severity and other biomarkers.

Circulating biomarkers as surrogates for bloodstream infections.

The use of biomarkers provides a novel approach to diagnosing infection, its severity and treatment response. Biomarkers, especially procalcitonin and, to a lesser extent, C-reactive protein and interleukin 8, can improve the diagnostic and prognostic assessment of bloodstream infections. Both strengths and weaknesses of biomarkers must be recognized for rational and safe use in clinical settings.

Serum procalcitonin for discrimination of blood contamination from bloodstream infection due to coagulase-negative staphylococci.

The diagnostic value of serum procalcitonin (PCT) to distinguish blood contamination from bloodstream infection (BSI) due to coagulase-negative staphylococci was evaluated. Patients with BSI had higher PCT concentration than those with blood contamination at day -1, day 0 and day +1 with regard to blood culture collection (p < 0.05), whereas serum C-reactive protein values were significantly higher only on day +1.

Biomarkers to improve diagnostic and prognostic accuracy in systemic infections.

Purpose Of Review: We review the advantages and drawbacks of biomarkers in the diagnostic and prognostic assessment of systemic infections.

Recent Findings: Since the signs and symptoms of severe infections can be ambiguous, biomarkers provide a more reliable tool in ascertaining the presence of a relevant bacterial infection, its severity and treatment response. Procalcitonin and, to a lesser extent, C-reactive protein and interleukin-8 can improve the diagnostic assessment of infections and guide antibiotic therapy.

Free and total cortisol levels as predictors of severity and outcome in community-acquired pneumonia.

Rationale: High cortisol levels are of prognostic value in sepsis. The predictive value of cortisol in pneumonia is unknown. Routinely available assays measure serum total cortisol (TC) and not free cortisol (FC).

Procalcitonin guided antibiotic therapy and hospitalization in patients with lower respiratory tract infections: a prospective, multicenter, randomized controlled trial.

Background: Lower respiratory tract infections like acute bronchitis, exacerbated chronic obstructive pulmonary disease and community-acquired pneumonia are often unnecessarily treated with antibiotics, mainly because of physicians' difficulties to distinguish viral from bacterial cause and to estimate disease-severity. The goal of this trial is to compare medical outcomes, use of antibiotics and hospital resources in a strategy based on enforced evidence-based guidelines versus procalcitonin guided antibiotic therapy in patients with lower respiratory tract infections.

Methods And Design: We describe a prospective randomized controlled non-inferiority trial with an open intervention.

Circulating levels of copeptin, a novel biomarker, in lower respiratory tract infections.

Background: Vasopressin has haemodynamic as well as osmoregulatory effects, and reflects the individual stress response. Copeptin is co-synthesized with vasopressin, directly mirroring vasopressin levels, but is more stable in plasma and serum. Both levels are increased in patients with septic shock.

The hypothalamic-pituitary-adrenal axis in critical illness.

The hypothalamic-pituitary-adrenal response to stress is a dynamic process. The homeostatic corrections that have emerged in the course of human evolution to cope with the catastrophic events during critical illness involve a complex multisystem endeavor. Although the repertoire of endocrine changes has been probed in some detail, discerning the vulnerabilities and failures of this system is far more challenging.

Circulating levels of pro-atrial natriuretic peptide in lower respiratory tract infections.

Objective: To analyse the mid region of plasma N-terminal pro-atrial natriuretic peptide (MR-proANP) levels in patients with lower respiratory tract infections to evaluate its prognostic use for the severity of disease and outcome.

Design: Prospective observational study. Setting.

[Amiodarone-induced thyrotoxicosis: a diagnostic and therapeutic challenge].

Amiodaron is a widely used antiarrhytmic drug in a number of cardiac conditions. The most common side effects affect the thyroid gland (14-18% of treated patients) resulting in hypothyroidism or hyperthyroidism. We describe a complex case of amiodaron-induced thyrotoxicosis (AIT) and discuss the pathogenesis of the different subtypes (AIT I, II and mixed forms) and the diagnostic and therapeutic challenges in such patients.

Procalcitonin-guided antibiotic use versus a standard approach for acute respiratory tract infections in primary care: study protocol for a randomised controlled trial and baseline characteristics of participating general practitioners [ISRCTN73182671].

Background: Acute respiratory tract infections (ARTI) are among the most frequent reasons for consultations in primary care. Although predominantly viral in origin, ARTI often lead to the prescription of antibiotics for ambulatory patients, mainly because it is difficult to distinguish between viral and bacterial infections. Unnecessary antibiotic use, however, is associated with increased drug expenditure, side effects and antibiotic resistance.