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We aimed to explore the role of procalcitonin (PCT) for the diagnosis of Candida spp. bloodstream infections in a population of critically ill septic patients admitted to internal medicine units. This is a retrospective case-control study considering all cases of candidemia identified in three internal medicine units, from January 1st 2012 to May 31st 2016. For each case of candidemia, two patients with bacteremic sepsis were included in the study as control cases. The end point of the study was to evaluate the diagnostic performance of PCT for the diagnosis of Candida spp. blood stream infections in patients with objectively documented sepsis. Sixty-four patients with candidemia and 128 controls with bacteremia were enrolled. Median and interquartile range (IQR) PCT values are significantly lower in patients with candidemia (0.73; IQR 0.26-1.85 ng/mL) than in those with bacteremia (4.48; IQR 1.10-18.26 ng/mL). At ROC curve analysis, values of PCT greater than 2.5 ng/mL had a negative predictive value (NPV) of 98.3% with an AUC of 0.76 (0.68-0.84 95% CI) for the identification of Candida spp. from blood cultures. At multivariate analysis, a PCT value <2.5 ng/mL showed an odds ratio of 8.57 (95% CI 3.09-23.70; p < 0.0001) for candidemia. In septic patients at risk of Candida infection, a PCT value lower than 2.5 ng/mL should raise the suspicion of candidemia, adding value for considering prompt initiation of antifungal therapy. [ABSTRACT FROM AUTHOR]

Amyloidosis prognosis is often related to the onset of heart failure and a worsening that is concomitant with kidney-liver dysfunction; thus the Model for End-stage Liver disease (MELD) may be an ideal instrument to summarize renal-liver function. Our aim has been to test the MELD score as a prognostic tool in amyloidosis. We evaluated 128 patients, 46 with TTR-related amyloidosis and 82 with AL amyloidosis. All patients had a complete clinical and echocardiography evaluation; overall biohumoral assessment included troponin I, NT-proBNP, creatinine, total bilirubin and INR ratio. The study population was dichotomized at the 12 cut-off level of MELD scores; those with MELD score >12 had a lower survival compared to controls in the study cohort (40.7 vs 66.3 %; p = 0.006). Either as a continuous and dichotomized variable, MELD shows its independent prognostic value at multivariable analysis (HR = 1.199, 95 % CI 1.082-1.329; HR = 2.707, 95 % CI 1.075-6.817, respectively). MELD shows a lower prognostic sensitivity/specificity ratio than troponin I and NT-proBNP in the whole study population and AL subgroup, while in TTR patients MELD has a higher sensitivity/specificity ratio compared to troponin and NT-proBNP (ROC analysis-AUC: 0.853 vs 0.726 vs 0.659). MELD is able to predict prognosis in amyloidosis. A MELD score >12 selects a subgroup of patients with a higher risk of death. The predictive accuracy seems to be more evident in TTR patients in whom currently no effective scoring systems have been validated. [ABSTRACT FROM AUTHOR]

Keywords: Ancylostoma spp; ancylostomiasis; video capsule EN Ancylostoma spp ancylostomiasis video capsule 1 2 2 01/24/22 20220101 NES 220101 A 41-year-old Pakistani man came to the emergency department for dyspnea and dyspepsia. Graph: Figure 1 class="chapter-para">Panels A-F: video capsule endoscopy visualization of adult hookworms. [Extracted from the article]

Background: Renal Resistive Index (RRI), reflects changes in both renal vascular and tubular-interstitial compartments and in systemic vascular compliance related to age and comorbidities., Objectives: a) To investigate determinants of RRI in SSc population, b) its association with SSc-related features and c) to test its prognostic impact on organ specific worsening or death., Methods: 380 SSc patients ≥18 years were enrolled after giving informed consent. Baseline data on RRI, laboratory, instrumental and therapeutic features were retrospectively collected. Age-SSc adjusted cut-offs were created by dividing the population in age quartiles and considering RRI values >75th percentile as pathologic. Clinical follow-up was performed until last available visit or the development/worsening of specific internal organ involvement or death., Results: RRI was independently predicted by age and systolic pulmonary arterial pressure on Echo. Therefore, we created Age-SSc adjusted pathologic RRI cut-offs, which were significantly associated with various disease related skin and lung fibrotic manifestations, as well as vasculopathic complications. After a mean follow-up of 3.6 ± 2.6 years, RRI was one of the independent predictors (together with modified Rodnan skin score, interstitial lung disease, presence of dyspnoea and late nailfold-videocapillaroscopy pattern) for mortality, with 0.68 as best cut-off (sensitivity 88.5%, specificity 50.9%)., Conclusion: If corroborated, Renal Resistive Index cut-offs might be used to evaluate renal and extrarenal involvement in SSc and could serve as predictors of mortality., (Copyright © 2019 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.)