Sepsis diagnosis and monitoring - procalcitonin as standard, but what next?

Sepsis is a life-threatening organ dysfunction caused by a systemic altered host response to infection. According to the newest guidelines the sepsis treatment should be personalized and based on an approach specified by use of biomarkers to tailor therapy to each patient's needs. The main features of such biomarkers should be high specificity, sensitivity and ability to monitor the progress of sepsis. There is limited application of procalcitonin (PCT), C-reactive protein (CRP) and interleukin-6 (IL-6) for reaching this target, because of their secretion during non-infectious processes. The purpose of this review was to introduce four biomarkers, i.e. kallistatin, testican-1, presepsin and mid-regional pro-adrenomedullin, and compare their usefulness in diagnosing sepsis with PCT, CRP and IL-6.

Recommendations for the management of trauma or surgery-related massive blood loss.

UNLABELLED: Exsanguination is an underestimated cause of treatment failures in patients with severe trauma or undergoing surgery. In some patients the primary dysfunction of blood clot formation is a direct cause of a massive blood loss. Patients without previous coagulation disorders are at risk of coagulopathy following intraoperative or post-traumatic bleeding, where the local haemostasis does not warrant bleeding cessation. THE AIM OF THE STUDY: was to assess the therapeutic value of various components of a complex interdisciplinary approach, based on the opinion of the experts treating patients with massive bleeding. MATERIAL AND METHODS: The study was conducted by anonymous questionnaire, using the analogue representation of the argument strength. The results were analyzed based on the techniques of descriptive statistics. The argument was considered a key parameter, when the median value of strength was located in the highest quartile. RESULTS: It was found that the arguments of the highest strength for the risk of developing the posthaemorrhagic coagulation disorders are: loss of more than one third of blood volume, fluid therapy in an amount greater than 35 ml/kg, administration of more than 5 units of packed red blood cells, insufficient supply of fresh frozen plasma and platelets in proportion to packed red blood cells, severe acidosis and hypothermia. The most important tests for post-haemorrhage coagulopathy are: anatomically non-localized bleed, abnormal values of the standard coagulation parameters and fibrinogen level below 1 g/L. In the treatment of post-haemorrhagic coagulopathy the team of experts pointed out the benefits of antifibrinolytic drugs, concentrates of prothrombin complex and recombinant activated coagulation factor VII. CONCLUSIONS: Multidisciplinary therapeutic management of bleeding patients is associated with employment of appropriate treatment methods to achieve the best possible outcome. Factors influencing the development of coagulopathy, the methods of diagnosis and proposed techniques of treatment may facilitate therapeutic decisions in bleeding patients requiring massive transfusion of blood components.

[Newborn-child of substance dependent mother--always actual problem]. / Noworodek matki uzaleznionej--wciaz aktualny problem.

The adverse effects on fetal development of alcohol and other drugs such as tobacco, psychostimulants and opioids are well known. Women who are pregnant or who may become pregnant are therefore a high priority for interventions to reduce drug use. Substances discussed in this article include the licit substances (alcohol and tobacco), illicit substances (opioids and other drugs), and prescription medication known for its misuse (benzodiazepines and barbiturates). Other topics covered include breastfeeding, vertical transmission of blood-borne viruses, psychosocial issues, the management of neonatal abstinence syndrome and early childhood development.

[A giant left atrial myxoma as a cause of a low cardiac output syndrome: a case report]. / Dyslokacja olbrzymiego sluzaka lewego przedsionka jako przyczyna zespolu malego rzutu.

A case of a 75-year-old female with a giant left atrial myxoma (54 x 42 mm in transthoracic echocardiography) is presented. She remained in a stable condition, however, developed a low cardiac output syndrome shortly after echocardiographic examination. This was caused by tumour displacement from the atrial wall into the left ventricle. The patient underwent urgent surgery during which the tumour was successfully removed. Histopathological examination confirmed the diagnosis of myxoma. Six months after surgery the patient is doing well.