scholarly journals Reliable and questionable diagnostic criteria for early0onset sepsis

2021 ◽  
pp. 68-74
Author(s):  
M.M. Kiselyova ◽  
◽  
O.V. Potsiurko ◽  
A.V. Komar ◽  
N.V. Kamut ◽  
...  
Keyword(s):  
Diagnostic Criteria ◽  
Neonatal Sepsis ◽  
Clinical Signs ◽  
Clinical Manifestations ◽  
Intrauterine Infection ◽  
Diagnostic Value ◽  
Immunoglobulin M ◽  
Middle Income ◽  
Pregnancy And Childbirth ◽  
Early Neonatal Sepsis

Neonatal sepsis is a significant cause of mortality among newborns, especially in low and middle income countries with poor economic development. It is important to start the appropriate treatment as soon as possible, as this prevents most deaths from sepsis and reduces the occurrence of residual neurological lesions due to septic meningitis. The article provides an overview of modern literature data on the principles of diagnosis of early neonatal sepsis; mentions the main etiological factors and ways of infection by potential pathogens. Diagnostic criteria for early neonatal sepsis have been analyzed and have been classified as doubt-ful or credible. An important role is given to the assessment of potential risk factors for the development of the septic process, including data on history of pregnancy and childbirth, clinical and laboratory indicators of the baby after birth. The nonspecificity of most clinical signs of sepsis and their comparison with clinical manifestations in meningitis was carried out. The importance of the bacteriological method of detecting the pathogen in the blood, urine and cerebrospinal fluid was analyzed, which remains the «gold» standard diagnosis of neonatal sepsis, and the method of multiplex polymerase chain reaction. There is a need to detect sepsis through visual examination, such as chest radiography, computed tomography, magnetic resonance imaging and ltrasonography of the head. The diagnostic value of indicators is described with the complete blood cell count and differential, including some of its components, and markers of inflammatory process, especially the immature-to-total (I/T) neutrophil ratio, C-reactive protein, procalcitonin. The article mentions a method of determining the concentration of immunoglobulin M in the serum, the elevated level of which indicates intrauterine infection. The diagnostic value of glutathione is considered, which is a marker of the functioning of the immune system. Emphasis is placed on the expediency of using Kaiser Permanente calculator to detect signs of sepsis in the first days of a newborn's life and the choice of optimal tactics management in such patients. No conflict of interest was declared by the authors. Key words: sepsis, newborn, diagnosis of infection, neonatal.

scholarly journals CARDIAL MANIFESTATIONS OF NON-DIFFERENTIATED CONNECTIVE TISSUE DYSPLASIA AND THEIR INFLUENCE ON PREGNANCY

2021 ◽  
pp. 14-22
Author(s):  
V. Yu. DOBRIANSKA ◽  
S. M. HERYAK ◽  
L. M. MALANCHUK ◽  
M. I. SHVED ◽  
I. V. KORDA
Keyword(s):  
Mitral Valve ◽  
Connective Tissue ◽  
Ventricular Arrhythmia ◽  
Pregnant Women ◽  
Mitral Valve Prolapse ◽  
Clinical Signs ◽  
Clinical Manifestations ◽  
Adequate Treatment ◽  
Pregnancy And Childbirth ◽  
Connective Tissue Dysplasia

Among the visceral manifestations of NDST in pregnant women most often diagnosed mitral valve prolapse (20-25%) that accompanied by more cardiovascular and obstetric complications during pregnancy. It demonstrates the high clinical significance of the problem of connective tissue dysplasia with mitral valve prolaps for pregnancy and requires adequate treatment programs for prevention of complications and management of pregnant women with connective tissue dysplasia. Aim. Determination of the frequency of pregnancy pathology in women with clinical signs of NDST and MVP complicated by extrasystolic arrhythmia. Materials and methods. 138 pregnant women with MVP and concomitant signs of NDST and 54 healthy pregnant women were selected for analysis. Clinical manifestations of NDST, different variants of arrhythmias and the total number of complications of pregnancy and childbirth were evaluated. Results. In pregnant women with clinical signs of NDST and MVP complicated by extrasystolic arrhythmia, cases of frequent sinus extrasystole were significantly more often compared to frequent ventricular arrhythmia (47.8% vs. 18.1%, p<0.001) and cases of combination of frequent sinus extrasystole and ventricular arrhythmia (13.3 % vs. 1.5%, p <0.05). They significantly more often identified both symptoms of arrhythmological nature and symptoms that indicated a violation of autonomic status. The presence of NDST syndrome is more often accompanied by the development of complications of pregnancy and childbirth. These pregnant women have genetic and phenotypic risk factors for the development of pathological pregnancy and childbirth, birth trauma, disability of mother and newborn, which justifies such patients in a separate risk group for individualized programs of the prevention and treatment of visceral (cardiac) manifestations of NDST and possible complications of pregnancy and childbirth. Conclusions. 3.1% of pregnant women are diagnosed with phenotypic signs (stigma) of undifferentiated connective tissue dysplasia, and the most common visceral cardiac manifestation is mitral valve prolapse. The presence of mitral valve prolapse and extrasystolic arrhythmia in pregnant women with NDST is accompanied by significantly more frequent development of pregnancy and childbirth complications in these patients.

scholarly journals Diagnostic value of mean platelet volume in neonatal sepsis

2019 ◽  
Vol 59 (6) ◽  
pp. 289-93
Author(s):  
Kristopher May Pamudji ◽  
I Made Kardana
Keyword(s):  
Neonatal Sepsis ◽  
Predictive Value ◽  
Mean Platelet Volume ◽  
Severe Disease ◽  
Diagnostic Testing ◽  
Clinical Signs ◽  
Diagnostic Value ◽  
Platelet Volume ◽  
Good Potential ◽  
Sensitivity Specificity

Background Neonatal sepsis is a severe disease with potentially serious impacts if not treated early. However, the symptoms and clinical signs are not specific. Several studies have been conducted to find early infection markers for detection of neonatal sepsis, but without satisfactory results. Mean platelet volume (MPV) is a new marker of infection that has good potential for diagnosing neonatal sepsis. Objective To assess the diagnostic value of MPV in early detection of neonatal sepsis. Methods This retrospective study with diagnostic testing was done with data collected from medical records of neonates with neonatal sepsis who were admitted to the Neonatology Department in Sanglah Hospital, Denpasar from December 2018 to March 2019. Mean platelet volume cut-off point was determined using a receiver-operating characteristic (ROC) curve. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MPV in neonatal sepsis were determined using a 2x2 table. Results Of 82 subjects, 55 subjects were male (67%). Positive blood culture results were found in 25 subjects (30%). Mean platelet volume with a cut-off point of 7.44 fL had 80% sensitivity, 84.2% specificity, 69% PPV, and 90.6% NPV. Conclusion Mean platelet volume with a cut-off point of 7.44 fL can be used to diagnose neonatal sepsis with a sensitivity of 80% and specificity of 84.2%.

scholarly journals Clozapine-induced myocarditis: electronic health register analysis of incidence, timing, clinical markers and diagnostic accuracy

2021 ◽  
pp. 1-8
Author(s):  
Aviv Segev ◽  
Ehtesham Iqbal ◽  
Theresa A. McDonagh ◽  
Cecilia Casetta ◽  
Ebenezer Oloyede ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Language Processing ◽  
Clinical Signs ◽  
Clinical Manifestations ◽  
Area Under The Curve ◽  
Signs And Symptoms ◽  
Diagnostic Value ◽  
Clinical Markers ◽  
Reactive Protein ◽  
Increased Risk

Background Clozapine is associated with increased risk of myocarditis. However, many common side-effects of clozapine overlap with the clinical manifestations of myocarditis. As a result, there is uncertainty about which signs, symptoms and investigations are important in distinguishing myocarditis from benign adverse effects of clozapine. Clarity on this issue is important, since missing a diagnosis of myocarditis or discontinuing clozapine unnecessarily may both have devastating consequences. Aims To examine the clinical characteristics of clozapine-induced myocarditis and to identify which signs and symptoms distinguish true myocarditis from other clozapine adverse effects. Method A retrospective analysis of the record database for 247 621 patients was performed. A natural language processing algorithm identified the instances of patients in which myocarditis was suspected. The anonymised case notes for the patients of each suspected instance were then manually examined, and those whose instances were ambiguous were referred for an independent assessment by up to three cardiologists. Patients with suspected instances were classified as having confirmed myocarditis, myocarditis ruled out or undetermined. Results Of 254 instances in 228 patients with suspected myocarditis, 11.4% (n = 29 instances) were confirmed as probable myocarditis. Troponin and C-reactive protein (CRP) had excellent diagnostic value (area under the curve 0.975 and 0.896, respectively), whereas tachycardia was of little diagnostic value. All confirmed instances occurred within 42 days of clozapine initiation. Conclusions Suspicion of myocarditis can lead to unnecessary discontinuation of clozapine. The ‘critical period’ for myocarditis emergence is the first 6 weeks, and clinical signs including tachycardia are of low specificity. Elevated CRP and troponin are the best markers for the need for further evaluation.

scholarly journals Value of Resistin in Early Onset Neonatal Sepsis

2017 ◽  
Vol 07 (01) ◽  
pp. e146-e150
Author(s):  
Abdurrahman Ozdemir ◽  
Yusuf Elgormus
Keyword(s):  
Neonatal Sepsis ◽  
Early Onset ◽  
Neonatal Intensive Care ◽  
Clinical Signs ◽  
Area Under The Curve ◽  
Scoring Systems ◽  
Diagnostic Value ◽  
Sepsis Group ◽  
Control Group ◽  
Reactive Protein

AbstractThe diagnosis of neonatal sepsis is usually difficult because the sign and symptoms are nonspecific. Although C-reactive protein (CRP) and procalcitonin (PCT) are the most commonly used auxiliary tests, they are not reliable enough markers to be used for diagnosis of neonatal sepsis. This study aimed to evaluate the efficacy of resistin in diagnosing early onset neonatal sepsis and to compare its effectiveness to CRP and PCT. This prospective study was performed in the neonatal intensive care unit of Medicine Hospital between June and September 2016. Twenty-nine infants in the sepsis group and 33 infants in the control group were recruited. The Töllner scoring system was used for clinical signs. The hematologic parameters were evaluated using the Manroe and Rodwell scoring systems. The blood samples for CRP, PCT, and resistin were collected at admission (T0), and at 72 hours (T3). Mean plasma resistin level at T0 was 54.20 ± 39.3 ng/mL in the sepsis group and 34.92 ± 6.9 ng/mL in the control group. The sensitivity at T0 for resistin was 76%, and the specificity was 67%. The values of area under the curve (AUC) for CRP, PCT, and resistin were 0.84, 0.66, and 0.72, respectively. We found the diagnostic value of resistin to be lower than CRP, although its plasma levels were elevated. Therefore, we propose that resistin has limited value in diagnosis and follow-up of early-onset neonatal sepsis.

scholarly journals Prognostic Factors of Early Neonatal Sepsis in the City of Cartagena Colombia

2018 ◽  
Vol 10 (12) ◽  
pp. 30 ◽  
Author(s):  
Jaime Lorduy Gómez ◽  
Stephanye Carrillo González ◽  
Ruby Elena Muñoz Baldiris ◽  
Anderson Díaz-Pérez ◽  
Iris Perez
Keyword(s):  
Risk Factors ◽  
Neonatal Sepsis ◽  
Scientific Evidence ◽  
Clinical Manifestations ◽  
Exclusion Criteria ◽  
Level Of Education ◽  
Membrane Rupture ◽  
Early Neonatal Sepsis ◽  
Early Sepsis ◽  
The City

INTRODUCTION: The obstetirc or noenatal risk factors, are in many cases the major evidence to define and forecast of an early neonatal sepsis, considering that a newborn that has lived less tan 72 hours presents unspecified clinical manifestations and the diagnostic exams utilize infectious and inflammatory markers, with there being very litttle scientific evidence to support and establish an early diagnosis. Objective: Associate the obstetric and neonatal risk factors with the presence of early sepsis in Cartagena. MATERIALS &amp; METHODS: A retrospective study of cases and controls was conducted. The sample consisted of 183 cases and 366 controls, including pacients who met simultaneously inclusion and exclusion criteria. A bivariated analysis and a multivariated model of regression logistics were used. RESULTS: Among the associtated variables and early sepsis in which it was able to define the risk that is found when there is a premature membrane rupture &gt; 18 hours (OR 9,57 IC 95% 4,12-22,26), premature newborn (OR 8,19 IC 95% 3,66-18,3), the presence of maternal fever (OR 6,49 IC 95% 3,43-12,3), marital status (OR 5,89 IC 95% 3,42-10,15) and level of education (OR 4,80 IC 95% 2,63-8,77). CONCLUSIONS: The mechanisms of fetal evaluation and maternal prophylaxis should be prioritized in the cases of pregnant women that present a premature membrane rupture &gt;18 hours, and have kids who were born premature and living in couple with a low level of education.

scholarly journals A retrospective study of clinical and laboratory features and treatment on cats highly suspected of feline infectious peritonitis in Wuhan, China

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yiya Yin ◽  
Ting Li ◽  
Chaohao Wang ◽  
Xiaoya Liu ◽  
Hehao Ouyang ◽  
...  
Keyword(s):  
Clinical Signs ◽  
Clinical Manifestations ◽  
Viral Disease ◽  
Diagnostic Value ◽  
Diverse Range ◽  
Feline Infectious Peritonitis ◽  
Amyloid A ◽  
Laboratory Features ◽  
Clinical Records ◽  
G Ratio

AbstractFeline infectious peritonitis (FIP) is a systemic, potentially fatal viral disease. The objectives of this study were to review clinical and laboratory features and treatment of cats highly suspected of FIP in Wuhan, China. The clinical records of 127 cats highly suspected of FIP were reviewed for history, clinical signs, physical findings, and diagnostic test results. Sex, neutering status, breed, age, and month of onset of disease were compared with the characteristics of the clinic population. Age and neutering status were significantly correlated with FIP-suspicion. Sex, breed and onset month were not associated with FIP. There were many more FIP-suspected cases in cats in young cats or male intact cats. Effusion was observed in 85.8% of the FIP-suspected cats. Increased serum amyloid A (SAA) and lymphopenia were common laboratory abnormalities in the FIP cases. Furthermore, 91.7% of the cats highly suspected of FIP had an albumin/globulin (A/G) ratio < 0.6, while 85.3% had an A/G ratio < 0.5. The mortality rate for FIP-suspected cats was 67%, and six submitted cases were confirmed by FIP-specific immunohistochemistry. Of the 30 cats treated with GS-441524 and/or GC376, 29 were clinically cured. The study highlights the diverse range of clinical manifestations by clinicians in diagnosing this potentially fatal disease. A/G ratio and SAA were of higher diagnostic value. GS-441524 and GC376 were efficient for the treatment of FIP-suspected cats.

scholarly journals Diagnostic value of standard and alternative markers in blood serum of newborns with early neonatal sepsis

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Angelina Kalmykova ◽  
Alexandr Obedin ◽  
Aleksandr Vasilyev ◽  
Volkov Evgeny
Keyword(s):  
Blood Serum ◽  
Neonatal Sepsis ◽  
Diagnostic Value ◽  
Early Neonatal Sepsis

scholarly journals Liberal Diagnosis and Treatment of Intrauterine Infection Reduces Early-Onset Neonatal Group B Streptococcal Infection but not Sepsis by Other Pathogens

2000 ◽  
Vol 8 (3-4) ◽  
pp. 143-150 ◽  
Author(s):  
H. Wolf ◽  
A. H. P. Schaap ◽  
B. J. Smit ◽  
L. Spanjaard ◽  
A. H. Adriaanse
Keyword(s):  
Neonatal Sepsis ◽  
Early Onset ◽  
Group B Streptococcus ◽  
Clinical Signs ◽  
Intrauterine Infection ◽  
Incidence And Mortality ◽  
Group B ◽  
Second Period ◽  
Onset Group ◽  
Early Onset Group

Objective:Comparison of the incidence and case fatality of early-onset group B streptococcus sepsis and sepsis caused by other pathogens in neonates after change of management of intrauterine infection.Methods:All infants delivered from 1988 through 1997 at a gestational age ≥ 24 weeks with a birth weight ≥ 500 gram without lethal congenital abnormalities were eligible for inclusion. Infants delivered by cesarean section before the onset of labor or rupture of membranes were excluded. During the first period (1988–1991) intrauterine infection was diagnosed by a temperature > 38℃, during the second period (1992–1997) this diagnosis was made at a lower temperature (≥ 37.8℃) or by fetal tachycardia ≥ 160/min. Treatment of intrauterine infection was similar during both periods with 3 × 2 gram amoxicillin and 1 × 240 mg gentamicin every 24 hours intravenously during labor. Prophylactic treatment during labor was only given to women with a history of an earlier infant with early-onset group B streptococcus sepsis.Results:During the first period 6,103 infants were included, during the second period 8,504. Intrauterine infection was diagnosed and treated more often in the second period (7.1% vs. 2.6%). The incidence of early-onset group B streptococcus sepsis was significantly lower in the second period than in the first period [0.2% vs. 0.4%; OR 0.5 (0.3–0.9)] and survival without disability higher [80% vs. 52%; OR 4.5 (1.4–16.5)]. However, in both periods the overall incidence of neonatal sepsis (3.6% vs. 3.5%) and overall mortality because of sepsis (14.3% vs.13.1%) were similar.Conclusions:Although the early detection of clinical signs of intrauterine infection might have been effective for the prevention of serious sequelae of early-onset group B streptococcus sepsis the overall incidence and mortality from neonatal sepsis remained unchanged. Evaluation of preventive measures for early-onset group B streptococcus sepsis should always take the incidence of neonatal sepsis caused by other pathogens into account. Infect. Dis. Obstet. Gynecol. 8:143–150, 2000.

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