Irish journal of medical science
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Randomized Controlled Trial
A randomized trial to compare procalcitonin and C-reactive protein in assessing severity of sepsis and in guiding antibacterial therapy in Egyptian critically ill patients.
Procalcitonin (PCT) and C-reactive protein (CRP) are the main used biomarkers for sepsis and in guiding antibiotic therapy, although PCT high cost limits its use in developing countries. ⋯ PCT is a more accurate diagnostic and prognostic biomarker than CRP in patients with sepsis. PCT significantly shortened patients' exposure to antibacterial therapy and hospital length of stay.
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SARS-CoV-2, causing the lethal disease COVid-19, is a public health emergency in the 2020 global pandemic. The outbreak and fast spreading of SARS-CoV-2 have a high morbidity and mortality specifically in elder patients with chronic diseases such as diabetes mellitus, arterial hypertension, chronic kidney disease, and organ transplanted patients with immunosuppressive therapy. Preliminary results support different treatments such as chloroquine and convalescent plasma infusion in severe cases, with good outcome. ⋯ The data available today regarding the beneficial protective effect of vitamin D is unclear and with conflicting results. Large randomized control trials are necessary to test this hypothesis. In this review, we will explain the cross talk between the active vitamin D and the angiotensin-converting enzyme 2, and summarize the data from the literature.
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An amendment to the 1962 Coroner's Act in the Republic of Ireland mandated that all stillbirths and neonatal deaths were to be reported to the local coroner's office. In response to this, the bereavement team and department of anatomic pathology modified the pathway for placental examination following stillbirth and reporting deaths to the coroner. This paper is a review of the effect of this practice. ⋯ The introduction of the pathway has improved the care provided to bereaved parents by providing parents with timely information about the potential cause of stillbirth and thereby reduces the need for an autopsy examination.
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The difficult airway involves the complex interaction between patient factors, the clinical setting and the practitioner's skills (Apfelbaum in Anesthesiology 118(2):251-70, 2013 and Mark et al. in Anesth Analg 121(1):127-139, 2015). It can also be a result of preparedness and system failures. ⋯ We believe that these findings may aid institutions in establishing a difficult airway protocol or refining existing airway code workflows. Institutional board approval was granted for medical record review.
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The European and American colonoscopy guidelines recommend mandatory photodocumentation of caecal intubation to allow retrospective analysis and improve outcomes. We aim to demonstrate whether photodocumentation of caecal intubation improves colonoscopy outcomes. ⋯ While failing to reach statistical significance, there was a nominal difference in ADR and PDR demonstrated between the two groups, and with predominantly positive confidence intervals, this might suggest that a larger sample size could result in significance in favour of photodocumentation of caecal intubation. Future studies would be warranted. However, endoscopists that take more images were more likely to have proven caecal intubation.