Application of the Midi Parasep® SF technique for the detection of L1 larvae of Angiostrongylus cantonensis in faeces of infected rats.

We investigated parasitic zoonoses caused by protozoans and helminths in urban and peri-urban rat populations (Rattus norvegicus and R. rattus) in Spanish cities. Rats were trapped and then dissected to remove adult helminths, and the contents of the large intestine were retrieved for the study of parasitic forms. The Midi Parasep® solvent free (SF) technique was used to concentrate the parasites in the intestinal contents. Some of the rats studied (n = 8) were infected by the rat lungworm, Angiostongylus cantonensis, whose first stage larvae (L1) are shed in rat faeces. After the concentration technique, L1 larvae were found in the sediment of 6 of the 8 positive rats. The two negative sediment samples were due to the presence of either only adult females or, in addition to males, only young females in the lungs of the rats. In view of our results, Midi Parasep® SF turned out to be a simple, rapid, inexpensive, and sensitive method to detect nematode larvae, such as the L1 larvae of A. cantonensis (or A. costaricensis), in natural and experimentally infected rats.

[Atypical femoral fractures due to the use of bisphosphonates. Experience of two institutions]. / Fracturas femorales atípicas por el uso de bifosfonatos. Experiencia de dos instituciones.

INTRODUCTION: bisphosphonates are used for the management of postmenopausal osteoporosis with high risk of fracture, glucocorticoid-induced osteoporosis, Paget's disease and hypercalcemia; as well as an adjuvant for the management of hyperparathyroidism. Bisphosphonates have been associated with previously unknown adverse effects, including atypical femur fractures. OBJECTIVE: to analyze the relationship of the history of bisphosphonate (BF) use as a risk factor for presenting atypical femur fractures (AFF). MATERIAL AND METHODS: patients aged 40 years or older from two hospital centers seen from 2009 to 2018 for femur fracture were included. The radiographic studies of 441 records were reviewed, from which the fracture site was defined. Subtrochanteric (SF) and diaphyseal (DF) femur fractures were analyzed applying the criteria of the second report of the American Society for Bone and Mineral Research for case definition of AFF. Finally, the consumption of bisphosphonates in these groups was investigated to estimate a measure of association. RESULTS: of the 441 clinical records, 98 (22.2%) were male and 343 (77.7%) were female with a mean age of 77.8 (40-103) years. Fifty-nine FS/FD were identified, of which 53% (31 records) were categorized as AFF. BF use was determined in 80.6% of patients with AFF and 3.57% in FS/FD. BF use was significantly associated with the presence of AFF (OR: 112, p 0.000, CI 95%: 12.6-1001). CONCLUSIONS: BF use significantly increases the risk of presenting AFF. AFF in patients who used BF occurred after a minimum consumption of 24 months.

INTRODUCCIÓN: los bifosfonatos se usan para el manejo de osteoporosis postmenopáusica con riesgo elevado de fractura, osteoporosis inducida por glucocorticoides, enfermedad de Paget e hipercalcemia; así como coadyuvante para manejo del hiperparatiroidismo. Los bifosfonatos se han asociado a efectos adversos previamente desconocidos dentro de los que se encuentran fracturas de fémur de trazo atípico. OBJETIVO: analizar la relación del antecedente de uso de bifosfonatos (BF) como factor de riesgo para presentar fracturas atípicas de fémur (FAF). MATERIAL Y MÉTODOS: se incluyeron pacientes de 40 años o más de dos centros hospitalarios atendidos desde 2009 a 2018 por fractura de fémur. Se revisaron los estudios radiográficos de 441 registros, de los cuales se definió el sitio de fractura. Se analizaron las fracturas de fémur subtrocantéricas (FS) y diafisarias (FD) aplicando los criterios del segundo reporte de la American Society for Bone and Mineral Research para la definición de caso de FAF. Finalmente, se indagó el consumo de bifosfonatos en estos grupos para para estimar una medida de asociación. RESULTADOS: de los 441 registros clínicos, 98 (22.2%) fueron del sexo masculino y 343 (77.7%) del femenino, con edad promedio de 77.8 (40-103) años. Se identificaron 59 FS/FD, de las cuales 53% (31 registros) fueron catalogadas FAF. El consumo de BF se determinó en 80.6% de pacientes con FAF y en 3.57% con FS/FD. El uso de BF se asoció significativamente con la presencia de FAF (OR: 112, p 0.000, IC 95%: 12.6-1001). CONCLUSIONES: el uso de BF aumenta significativamente el riesgo de presentar FAF. Las FAF en pacientes que usaron BF se presentó tras un consumo mínimo de 24 meses.

Sociodemographic and clinical characteristics related with hyperprolactinaemia in psychiatric clinical population.

BACKGROUND: Hyperprolactinaemia (HyperPRL) induced by psychotropic drugs is a high-prevalence consequence which has repercussions in psychical and mental health in the psychiatric population, so this research had the objective to expand which sociodemographic and clinical features are associated with prolactin (PRL) elevation in patients treated with antidepressant and/or antipsychotic drugs. METHODS: An observational, cross-sectional, comparative and retrolective study was conducted on 300 patients who received clinical attention in a third level of psychiatric care unit in Mexico during 2017. These patients have been reported to show PRL levels greater than 25 ng/mL among women and greater than 20 ng/mL among men. In the same way, sociodemographic and clinical variables were collected, as well as psychiatric diagnosis and type of psychopharmacological treatment used by the patients. RESULTS: HyperPRL was more frequent in women (80.7%) than men (19.3%). The mean levels of PRL were 68.94 ± 62.28 ng/mL with higher levels in women (71.9 ± 67.3, p=.02). Regarding the treatment, 78.3%, 71.3% and 49.7% consumed antipsychotics, antidepressants, and both drugs, respectively. The relationship between hyperPRL (>100 n/mL) and typical antipsychotics was dose-dependent (33.23 ± 13.24 mg, p=.01). In the multivariate regression models according to the type of treatment, as well as the demographic and clinical features, hyperPRL was associated independently with the use of antipsychotic treatment, pituitary adenoma and hypertension (R2=0.05). CONCLUSIONS: HyperPRL is a complex clinical syndrome frequent in the psychiatric population with detrimental long-term consequences, as well as its relationship with the use of psychotropic drugs as in the case of antipsychotics. Effective actions should be implemented in the prevention, approach and treatment of this condition paying special attention to the accompanying medical comorbidities.

Personas mayores y sexualidad: Reflexión desde Terapia Ocupacional acerca de las limitaciones de la sexualidad como limitación / Elderly and sexuality: reflection from occupational therapy on the limitations of sexuality as occupation

La población de Personas Mayores, ha aumentado durante estos últimos años y se espera que siga así, llevándonos a indagar sobre la participación ocupacional de esta población en la Participación Social con compañeros/amigos y Actividades Básicas de la Vida Diaria, como la actividad sexual. Ambas ocupaciones se ligan a un solo fenómeno llamado sexualidad, considerado como fuente de bienestar global, de calidad de vida y un derecho. Frente a lo cual, surge como objetivo señalar el abordaje de la Terapia Ocupacional y sus profesionales en la sexualidad de Personas Mayores de acuerdo a la información empírica disponible, e identificar las teorías desde Terapia Ocupacional que guían el abordaje de la sexualidad como ocupación, desde una metodología argumentativa según las directrices que componen un ensayo. Se obtuvo que las investigaciones indican escasez del abordaje de la actividad sexual como ocupación y se encontró que el fenómeno de la actividad sexual y su problemática ocupacional, no cuenta con modelos e instrumentalización disciplinar.

La población de Personas Mayores, ha aumentado durante estos últimos años y se espera que siga así, llevándonos a indagar sobre la participación ocupacional de esta población en la Participación Social con compañeros/amigos y Actividades Básicas de la Vida Diaria, como la actividad sexual. Ambas ocupaciones se ligan a un solo fenómeno llamado sexualidad, considerado como fuente de bienestar global, de calidad de vida y un derecho. Frente a lo cual, surge como objetivo señalar el abordaje de la Terapia Ocupacional y sus profesionales en la sexualidad de Personas Mayores de acuerdo a la información empírica disponible, e identificar las teorías desde Terapia Ocupacional que guían el abordaje de la sexualidad como ocupación, desde una metodología argumentativa según las directrices que componen un ensayo. Se obtuvo que las investigaciones indican escasez del abordaje de la actividad sexual como ocupación y se encontró que el fenómeno de la actividad sexual y su problemática ocupacional, no cuenta con modelos e instrumentalización disciplinar.

False-positive fecal immunochemical test results in colorectal cancer screening and gastrointestinal drug use.

PURPOSE: The study aimed to determine the influence of drug treatments (proton pump inhibitors [PPIs] combined with other drugs) on the false-positive (FP) rate in the fecal immunochemical test (FIT). METHODS: Patients undergoing colonoscopy in the setting of a CRC screening program due to a positive FIT result were included prospectively. Demographic data and drug intake of PPIs, antiplatelet therapy (APA), anticoagulants, selective serotonin reuptake inhibitors (SSRIs), and nonsteroidal anti-inflammatory drugs (NSAIDs) were collected. An FP FIT result was considered normal colonoscopy or with nonneoplastic pathology (NNP). Logistic regression models were used to evaluate the effect of these drugs on the rate of FP FIT results. RESULTS: We included 515 patients, and 59% (304/515) were males. The rate of FP FIT results was 48% (249/515). Study drug use was higher in patients > 60 years old and females than in those < 60 years old and males (p < 0.001 and p = 0.049, respectively). Multivariate logistic regression revealed that female sex (OR = 2.7 95% CI 1.9-3.9), NNP (OR = 1.5 95% CI 1.1-2.2), and the use of any of the study drugs (OR = 1.4 95% CI 0.9-2.0) were independent risk factors for FP FIT results. The risk of FP FIT results was significantly higher in PPI users than in nonusers (OR = 1.8 95% CI 1.1-2.9), specifically when PPIs were combined with other drugs (OR = 2.01 95% CI 1.1-3.6) only in men. CONCLUSION: Female sex, NNP, and PPIs combined with other drugs in males were identified as independent risk factors for FP FIT results.

Vertical cutoff methods in serum protein electrophoresis for the measurement of monoclonal protein concentrations: Which is best?

BACKGROUND: Monoclonal protein (M-protein) concentrations are measured by serum protein electrophoresis (SPE). Two methods are used for demarcating the M-protein area in the electropherogram: perpendicular drop (PD) and tangent skimming (TS). The aim of this study was tocompare both methods and to establish which is the most accurate and precise. METHODS: We studied 24 sera containing M-protein (5-44 g/L). The systematic error (SE) was evaluated in a dilution series of 12 sera. Within-day, between-day, and interobserver variability were assessed. SPE was performed by capillary and agarose gel electrophoresis. M-protein concentrations were measured using both cutoff methods. RESULTS: The PD method shows a constant SE ranged 1.00-2.27 g/L, while constant SE for TS is ranged -0.30--0.57 g/L. None of the cutoff methods or electrophoretic methods showed a proportional SE, with the exception of the TS method in capillary electrophoresis for ß-migrating M-protein. The PD method was more precise than the TS method in all three estimates of imprecision. An increased CV for concentrations < 10 g/L in between-day imprecision was observed with the TS method. Interobserver imprecision was greater for M-protein concentrations < 17 g/L for both cutoff methods (14.85%, 26.42% respectively). CONCLUSIONS: Despite being less precise, the TS method provides a more accurate measurement of M-protein concentration.

Estudio de la ferropenia en el laboratorio clínico / Laboratory evaluation of iron deficiency

El hierro es un elemento químico esencial para todos los organismos vivos, necesario para un amplio espectro de funciones metabólicas vitales. La exploración del metabolismo del hierro puede ser difícil en algunas situaciones, tales como en el paciente con una enfermedad crónica, por la respuesta de los biomarcadores frente a la inflamación. En los últimos años el laboratorio clínico ha incorporado nuevos biomarcadores a los tradicionalmente empleados, con el fin de mejorar su contribución al diagnóstico y seguimiento de la ferropenia. Se ha realizado una búsqueda sistemática de la evidencia científica publicada en los diez últimos años para los siguientes biomarcadores: el diagnóstico morfológico de la sangre periférica, los índices hematimétricos, y las concentraciones plasmáticas de transferrina (y sus índices), ferritina, receptor soluble de transferrina y hemoglobina, en la ferropenia. Se emiten recomendaciones para estos biomarcadores en relación al diagnóstico y manejo del paciente ferropénico

Iron is an essential chemical element for all living organisms, and is required for a broad spectrum of vital metabolic functions. The study of iron metabolism can be challenging in some situations, such as in patients with chronic diseases, due to the effect of inflammation response. In recent years, clinical laboratory research has introduced new biomarkers to those commonly used, with the aim of improving the diagnosis and management of iron deficiency. In this work, a systematic search of the scientific evidence reported during the last decade has been made for the following biomarkers: morphological diagnosis of peripheral blood, hematimetric indices, and plasma concentrations of transferrin (and its indices), ferritin, transferrin receptor, and haemoglobin, in iron deficiency. Recommendations are made for these biomarkers related to the diagnosis and management of the iron-deficient patient

Esclerosis múltiple, maternidad y cuestiones relacionadas con el género / Multiple sclerosis: Pregnancy and women's health issues

Antecedentes: La esclerosis múltiple (EM) es una enfermedad en cuyo curso influyen el género, los factores hormonales y el embarazo. Objetivos: Realizar un análisis de la influencia de esos factores para aportar información sobre los mecanismos etiopatogénicos involucrados en la enfermedad. Métodos: Revisión exhaustiva de publicaciones científicas (búsqueda en la base de datos PubMed utilizando los términos: esclerosis múltiple, EM, EAE, embarazo, factores hormonales, tratamiento y términos relacionados), de los avances presentados en una reunión organizada por el Comité Europeo para el Tratamiento e Investigación de Esclerosis Múltiple (ECTRIMS), celebrado en marzo de 2013 en Londres, así como de las recomendaciones de reconocidos expertos internacionales. Resultados y conclusiones: Se ofrecen recomendaciones para el asesoramiento y la gestión de personas con EM antes de la concepción, durante el embarazo y después del parto. Se comentan también los conocimientos actuales sobre el efecto del tratamiento en la madre, el feto y el recién nacido. Realizamos recomendaciones para investigaciones futuras a fin de subsanar deficiencias de conocimiento y aclarar incoherencias de los datos actualmente disponibles

Background: The course of multiple sclerosis (MS) is influenced by sex, pregnancy and hormonal factors. Aims: To analyse the influence of the above factors in order to clarify the aetiopathogenic mechanisms involved in the disease. Methods: We conducted a comprehensive review of scientific publications in the PubMed database using a keyword search for 'multiple sclerosis', 'MS', 'EAE', 'pregnancy', 'hormonal factors', 'treatment', and related terms. We reviewed the advances presented at the meeting held by the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) in March 2013 in London, as well as recommendations by international experts. Results and conclusions: We provide recommendations for counselling and treating women with MS prior to and during pregnancy and after delivery. Current findings on the effects of treatment on the mother, fetus, and newborn are also presented. We issue recommendations for future research in order to address knowledge gaps and clarify any inconsistencies in currently available data

Multiple sclerosis: Pregnancy and women's health issues. / Esclerosis múltiple, maternidad y cuestiones relacionadas con el género.

BACKGROUND: The course of multiple sclerosis (MS) is influenced by sex, pregnancy and hormonal factors. AIMS: To analyse the influence of the above factors in order to clarify the aetiopathogenic mechanisms involved in the disease. METHODS: We conducted a comprehensive review of scientific publications in the PubMed database using a keyword search for 'multiple sclerosis', 'MS', 'EAE', 'pregnancy', 'hormonal factors', 'treatment', and related terms. We reviewed the advances presented at the meeting held by the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) in March 2013 in London, as well as recommendations by international experts. RESULTS AND CONCLUSIONS: We provide recommendations for counselling and treating women with MS prior to and during pregnancy and after delivery. Current findings on the effects of treatment on the mother, fetus, and newborn are also presented. We issue recommendations for future research in order to address knowledge gaps and clarify any inconsistencies in currently available data.

Porfiria eritropoyética congénita: reporte de un caso y recomendaciones de manejo / Congenital erythropoietic porphyria: case report and management recommendations

La porfiria eritropoyética congènita es una porfiria cutánea no aguda, extremadamente poco frecuente, autosómica recesiva, producida por la deficiencia de la enzima uroporfirinógeno III sintetasa codificada en el gen UROS, en el cromosoma 10q26.2. Esto genera el depósito y la acumulación de porfirinas en las córneas, los huesos y los dientes. Se presenta desde los primeros meses de vida con intensa fotosensibilidad, que se manifiesta con fragilidad cutánea con formación de vesículas, bulas y costras. El curso grave lleva a la mutilación de tejidos acrales, compromiso ocular, anemia hemolítica e hiperesplenismo. El manejo es complejo, basado, sobre todo, en la fotoprotección. Un correcto diagnóstico y enfrentamiento puede mejorar notablemente la calidad y expectativas de vida de estos pacientes. Se presenta el caso de un lactante con porfiria eritropoyética congénita confirmada con el estudio genético.

Congenital erythropoietic porphyria is an extremely rare, autosomal recessive, non-acute cutaneous porphyria, caused by uroporphyrinogen III synthase deficiency, codificated by UROS gene on the chromosome 10q26.2. Porphyrins deposit in cornea, bones and teeth. The first symptoms could be manifested in early childhood, with skin fragility, vesicles and bullae. Severe course produces acral tissues mutilation, eye involvement, hemolytic anemia and hypersplenism. The treatment is complex and it is based in the photoprotection. A correct diagnosis can significantly improve the quality and life expectancy of these patients. We present the case of a child with congenital erythropoietic porphyria confirmed by genetic analysis.

[Congenital erythropoietic porphyria: case report and management recommendations]. / Porfiria eritropoyética congénita: reporte de un caso y recomendaciones de manejo.

Congenital erythropoietic porphyria is an extremely rare, autosomal recessive, non-acute cutaneous porphyria, caused by uroporphyrinogen III synthase deficiency, codificated by UROS gene on the chromosome 10q26.2. Porphyrins deposit in cornea, bones and teeth. The first symptoms could be manifested in early childhood, with skin fragility, vesicles and bullae. Severe course produces acral tissues mutilation, eye involvement, hemolytic anemia and hypersplenism. The treatment is complex and it is based in the photoprotection. A correct diagnosis can significantly improve the quality and life expectancy of these patients. We present the case of a child with congenital erythropoietic porphyria confirmed by genetic analysis.

La porfiria eritropoyética congènita es una porfiria cutánea no aguda, extremadamente poco frecuente, autosómica recesiva, producida por la deficiencia de la enzima uroporfirinógeno III sintetasa codificada en el gen UROS, en el cromosoma 10q26.2. Esto genera el depósito y la acumulación de porfirinas en las córneas, los huesos y los dientes. Se presenta desde los primeros meses de vida con intensa fotosensibilidad, que se manifiesta con fragilidad cutánea con formación de vesículas, bulas y costras. El curso grave lleva a la mutilación de tejidos acrales, compromiso ocular, anemia hemolítica e hiperesplenismo. El manejo es complejo, basado, sobre todo, en la fotoprotección. Un correcto diagnóstico y enfrentamiento puede mejorar notablemente la calidad y expectativas de vida de estos pacientes. Se presenta el caso de un lactante con porfiria eritropoyética congénita confirmada con el estudio genético.

Prediction of the presence of esophageal varices using spleen stiffness measurement by transient elastography in cirrhotic patients.

BACKGROUND AND STUDY AIMS: Upper gastrointestinal endoscopy (UGE) is currently recommended in cirrhotic patients to detect the presence of esophageal varices (EV). Spleen stiffness measurement (SSM) with FibroScan has been used for this purpose, showing variable sensitivity (S) and specificity (Sp). The aim of this study was to evaluate the capability of SSM to detect the presence and size of EV in cirrhotic patients in comparison to other noninvasive modalities. PATIENTS AND METHODS: Sixty-six patients with cirrhosis who had undergone UGE in the previous 6 months underwent SSM and liver stiffness measurement (LSM) using FibroScan. Biochemical parameters and ultrasonography data were also collected to calculate other noninvasive indexes. RESULTS: Valid spleen stiffness measurements were obtained for 60 of the 66 patients initially included in the study (90.1%). In the multivariate analysis only splenomegaly and SSM were predictive of esophageal varices. SSM was the most accurate diagnostic tool, obtaining an area under the ROC curve of 0.8 for values below 48 KPascals, with S = 87%, Sp = 69%, and 76.7% of successfully diagnosed patients. CONCLUSIONS: SSM with FibroScan was significantly higher for cirrhotic patients with EV. Our study suggests that spleen stiffness may be useful to identify cirrhotic patients at risk of having EV, although further studies are needed.

Disposition of levetiracetam in healthy adult horses.

Nine horses received 20 mg/kg of intravenous (LEVIV ); 30 mg/kg of intragastric, crushed immediate release (LEVCIR ); and 30 mg/kg of intragastric, crushed extended release (LEVCER ) levetiracetam, in a three-way randomized crossover design. Crushed tablets were dissolved in water and administered by nasogastric tube. Serum samples were collected over 48 hr, and levetiracetam concentrations were determined by immunoassay. Mean ± SD peak concentrations for LEVCIR and LEVCER were 50.72 ± 10.60 and 53.58 ± 15.94 µg/ml, respectively. The y-intercept for IV administration was 64.54 ± 24.99 µg/ml. The terminal half-life was 6.38 ± 1.97, 7.07 ± 1.93 and 6.22 ± 1.35 hr for LEVCIR , LEVCER, and LEVIV , respectively. Volume of distribution at steady-state was 630 ± 73.4 ml/kg. Total body clearance after IV administration was 74.40 ± 19.20 ml kg-1  hr-1 . Bioavailability was 96 ± 10, and 98 ± 13% for LEVCIR and LEVCER , respectively. A single dose of Levetiracetam (LEV) was well tolerated. Based on this study, a recommended dosing regimen of intravenous or oral LEV of 32 mg/kg every 12 hr is likely to achieve and maintain plasma concentrations within the therapeutic range suggested for humans, with optimal kinetics throughout the dosing interval in healthy adult horses. Repeated dosing and pharmacodynamic studies are warranted.

Posterior reversible encephalopathy syndrome presenting in the anterior circulation with malignant intracranial hypertension requiring surgical decompression: a case report and literature review.

Posterior reversible encephalopathy syndrome (PRES) is thought to result from endothelial dysfunction and breakdown of the blood-brain barrier with subsequent vasogenic edema. Abrupt hypertension has been identified as one of its risk factors. We present a rare case of PRES in the anterior circulation with sudden onset of left hemiparesis and rapid neurological deterioration on the basis of hypertensive crisis. Due to refractory intracranial hypertension, the patient required emergent right decompressive craniectomy. Further investigations, including a biopsy, revealed an atypical form of PRES. This case illustrates the importance of aggressive medical and early surgical management to prevent permanent neurological deficits.

Clinical features and microbiological in bacterial keratitis in a tertiary referral hospital. / Características clínicas y microbiológicas en queratitis infecciosas bacterianas en un hospital de tercer nivel.

OBJECTIVE: To describe the clinical features, bacterial agents, and antibiotic sensitivity of bacterial keratitis in the Ophthalmology Department at the University Hospital Fundación Jiménez Díaz (HUFJD) in Madrid. MATERIALS AND METHODS: A retrospective observational descriptive study using clinical records and reports of corneal scrapings in patients with bacterial keratitis at the HUFJD conducted between 2009 and 2014. RESULTS: In a sample of 160 patients, gram-positive bacteria were the most prevalent with 64.3% (n=103). Coagulase negative staphylococcus (20.6%), Staphylococcus aureus (19.4%), and Pseudomonas aeruginosa (12.5%) were the most frequent bacteria. The most common risk factor was the use of contact lenses, followed by disease of the ocular surface, and previous ocular surgeries. The antibiotics to which the bacteria were most commonly susceptible were gentamicin (n=114), cotrimoxazole (n=107), vancomycin (n=106), and ciprofloxacin (n=97). The antibiotics to which the bacteria were most commonly resistant were ampicillin (n=59) and erythromycin (n=45). CONCLUSIONS: In the initial management of bacterial keratitis, the sensitivity and resistance of bacteria to antibiotics should be taken into account. Based on our findings, the use of aminoglycosides, vancomycin and fluoroquinolones is recommended, and, although widely used today, the discontinuation of erythromycin.

Added value of diffusion-weighted magnetic resonance imaging for the diagnosis of perianal fistula.

PURPOSE: To evaluate the added value of diffusion-weighted (DWI) magnetic resonance imaging (MRI) by comparison with T2-weighted images alone in the diagnosis of perianal fistula. MATERIAL AND METHODS: MRI examinations of 123 patients (97 men, 26 women; mean age, 41.9 years) with suspected perianal fistula were retrospectively evaluated by two radiologists. Fat-suppressed T2-weighted fast spin echo images, DWI (b values, 0 and 1000s/mm2) and fat-suppressed gadolinium chelate-enhanced T1-weighted images were evaluated for each patient by using a four-point scale. Confidence scores and sensitivities were calculated for T2-weighted images alone, the combination of DWI and T2-weighted images and the combination of gadolinium chelate-enhanced T1-weighted images and T2-weighted images. The combination of gadolinium chelate-enhanced and T2-weighted images was used as reference standard. RESULTS: Perianal fistulas were present in 92/123 patients (74.8%). An almost perfect interobserver agreement was found for T2-weighted images (kappa=0.868), the combination of gadolinium chelate-enhanced T1-weighted images and T2-weighted images (kappa=0.96) and the combination of DWI and T2-weighted images (kappa=0.90). The confidence scores for the diagnosis of perianal fistula for the combination of gadolinium chelate-enhanced T1-weighted images and T2-weighted images were greater than those of T2-weighted images alone for observer 1 (P<0.001) and observer 2 (P=0.009). The confidence scores of the combination of DWI and T2-weighted images were greater than those of T2-weighted images alone for observer 1 (P<0.001) and observer 2 (P=0.032). Sensitivity and specificity of the combination of DWI and T2-weighted images were greater than those of T2-weighted images alone for both observers. CONCLUSION: DWI has a significant added value compared to T2-weighted imaging alone in the diagnosis of perianal fistula.

Procalcitonin to guide taking blood cultures in the intensive care unit; a cluster-randomized controlled trial.

OBJECTIVES: We aimed to study the safety and efficacy of procalcitonin in guiding blood cultures taking in critically ill patients with suspected infection. METHODS: We performed a cluster-randomized, multi-centre, single-blinded, cross-over trial. Patients suspected of infection in whom taking blood for culture was indicated were included. The participating intensive care units were stratified and randomized by treatment regimen into a control group and a procalcitonin-guided group. All patients included in this trial followed the regimen that was allocated to the intensive care unit for that period. In both groups, blood was drawn at the same moment for a procalcitonin measurement and blood cultures. In the procalcitonin-guided group, blood cultures were sent to the department of medical microbiology when the procalcitonin was >0.25 ng/mL. The main outcome was safety, expressed as mortality at day 28 and day 90. RESULTS: The control group included 288 patients and the procalcitonin-guided group included 276 patients. The 28- and 90-day mortality rates in the procalcitonin-guided group were 29% (80/276) and 38% (105/276), respectively. The mortality rates in the control group were 32% (92/288) at day 28 and 40% (115/288) at day 90. The intention-to-treat analysis showed hazard ratios of 0.85 (95% CI 0.62-1.17) and 0.89 (95% CI 0.67-1.17) for 28-day and 90-day mortality, respectively. The results were deemed non-inferior because the upper limit of the 95% CI was below the margin of 1.20. CONCLUSION: Applying procalcitonin to guide blood cultures in critically ill patients with suspected infection seems to be safe, but the benefits may be limited. TRIAL REGISTRATION: ClinicalTrials.gov identifier: ID NCT01847079. Registered on 24 April 2013, retrospectively registered.