Serum procalcitonin as a marker of post-cardiac arrest syndrome and long-term neurological recovery, but not of early-onset infections, in comatose post-anoxic patients treated with therapeutic hypothermia

OBJECTIVE

To examine the relationship of early serum procalcitonin (PCT) levels with the severity of post-cardiac arrest syndrome (PCAS), long-term neurological recovery and the risk of early-onset infections in patients with coma after cardiac arrest (CA) treated with therapeutic hypothermia (TH).

METHODS

A prospective cohort of adult comatose CA patients treated with TH (33°C, for 24h) admitted to the medical/surgical intensive care unit, Lausanne University Hospital, was studied. Serum PCT was measured early after CA, at two time-points (days 1 and 2). The SOFA score was used to quantify the severity of PCAS. Diagnosis of early-onset infections (within the first 7 days of ICU stay) was made after review of clinical, radiological and microbiological data. Neurological recovery at 3 months was assessed with Cerebral Performance Categories (CPC), and was dichotomized as favorable (CPC 1-2) vs. unfavorable (CPC 3-5).

RESULTS

From December 2009 to April 2012, 100 patients (median age 64 [interquartile range 55-73] years, median time from collapse to ROSC 20 [11-30]min) were studied. Peak PCT correlated with SOFA score at day 1 (Spearman's R=0.44, p<0.0001) and was associated with neurological recovery at 3 months (peak PCT 1.08 [0.35-4.45]ng/ml in patients with CPC 1-2 vs. 3.07 [0.89-9.99] ng/ml in those with CPC 3-5, p=0.01). Peak PCT did not differ significantly between patients with early-onset vs. no infections (2.14 [0.49-6.74] vs. 1.53 [0.46-5.38]ng/ml, p=0.49).

CONCLUSIONS

Early elevations of serum PCT levels correlate with the severity of PCAS and are associated with worse neurological recovery after CA and TH. In contrast, elevated serum PCT did not correlate with early-onset infections in this setting.

Proliferative activity and cytometric characteristics in polyps of the nasal cavity and paranasal sinuses

Although several investigations have revealed the influence of cytokines, allergy, and environmental factors in polyp development, the etiology of nasal polyps is still unknown. To estimate the biology of this common disease the operative specimens of 50 patients who underwent surgery for polyps of the nasal cavity and the paranasal sinuses were examined; of these, 10 patients had recurrent disease and 23 patients had an allergy. The investigations included routine histology and quantitative DNA measurements, along with immunohistochemical identification of proliferation markers (i.e., MIB-1; proliferating cell nuclear antigen, PCNA). Histologically, most polyps revealed an infiltration with lymphocytes, eosinophilic granulocytes, and plasma cells. Twenty-five percent had a squamous metaplasia of the respiratory epithelium. Quantitative DNA analysis demonstrated diploid stemlines and lack of aneuploid cells with a DNA content exceeding 5c in most cases. Immunohistochemical detection of proliferation markers showed low proliferation rates in all cases. In 27 polyps no MIB-1 expression was detected, and in 7 polyps no PCNA expression was detected. The polyps of the 23 patients with proven allergic diathesis did not reveal higher scores for the parameters of DNA analysis (i.e., ploidy status and percentage of aneuploid cells) and proliferation scores. Nasal polyps of 10 patients with recurrent disease displayed higher scores for proliferation markers, and in five cases aneuploid cells with 5c exceeding rate (5cER) of 1.5-11.7% were detected. According to these results, polyps of the nasal cavity and paranasal sinuses showed low proliferation scores and were diploid. The data demonstrated that there was no increase of proliferation activity or ploidy shift toward aneuploidy in patients with allergy. Nevertheless, in recurrent disease some increase in proliferation activity and some changes in the parameters of the DNA analysis occurred, indicating more aggressive behavior of recurrent polyps in single cases.

[Correlation between dental status and dental anxiety]

The relationship between dental status and dental anxiety was analysed in 165 patients. To assess the dental status, D3.4 MFS-index and Bleeding-on-Probing-Index (BOP) were applied. Dental anxiety was assessed using dental anxiety rating, whereas aspects of state and trait anxiety were analysed by the State-Trait-Anxiety Inventory. The hypothesis was: higher levels of dental anxiety lead to avoiding check-ups and necessary treatment, the consequence of which is a deterioration of the dental status. No significant correlation was found between dental anxiety and dental status. A significant difference was found when comparing patients with high or low dental anxiety in respect of the D3.4 MFS-index, whereas a different trend was found on comparing these groups for BOP-index. In addition, a significant correlation was found between dental anxiety and trait anxiety. These results suggest that dental anxiety is a rather non-specific phenomenon, since it is an aspect of proneness to anxiety. In addition, in patients who display considerably high dental anxiety, this may lead to anxiety denial and abnormal behaviour (e.g. avoidance of dental hygiene or care) thus contributing to further deterioration of oral health.

Dental anxiety and illness behaviour

BACKGROUND

To analyse the relationship between dental anxiety and illness behaviour.

METHODS

Dental anxiety was assessed in 165 patients from private practice using the Dental Anxiety Scale (DAS), aspects of illness behaviour were evaluated by the Illness Attitude Scale (IAS), and aspects of general anxiety were analysed by the State Trait Anxiety Inventory (STAI). Dental status was documented using the DMFS index and Bleeding-on-Probing index (BOP).

RESULTS

Multiple regression analysis (explained proportion of variance = 32%) showed that dental anxiety was significantly correlated with female gender (t = 3.109, p < 0.002) and IAS health habits (t = -2.210, p < 0.03). In addition, a correlation trend was found between dental anxiety and BOP index (t = -1.789, p < 0.08).

CONCLUSION

Dental anxiety appears to be a gender-specific phenomenon. Results indicate a tendency towards abnormal illness behaviour (i.e. denial of dental anxiety) in a considerable proportion of subjects and as a consequence display of poor health habits (i.e. counterphobic behaviour). The latter may lead to an increased tendency to develop gingivitis as indicated by the correlation trend between dental anxiety and BOP index.

Prophylactic use of tetracycline for first trimester abortions

Because the efficacy of prophylactic antibiotic therapy has yet to be established and because numerous variables often hamper studies of such therapy, the results of prophylactic antibiotic therapy were studied in a homogeneous gynecologic population. The patients were 4000 women undergoing first trimester abortions. The surgical procedure, the gynecologists' skill, and the hospital environment were relatively uniform, as was the patient age range. Two groups of 1000 patients each received tetracycline; the other 2000 patients served as controls. The complications associated with abortion were then analyzed in those receiving tetracycline and in the 2000 controls. Complications were less frequent among patients receiving tetracycline. This finding supports the argument of those who favor the prophylactic use of antibiotics in the management of various high-risk surgical problems.