Ein neuer Score für die tägliche Schweregradklassifizierung auf herzchirurgischen Intensivstationen

Zusammenfassung Einleitung: Das Ziel dieser Studie war die Entwicklung eines spezifischen Schweregradklassifizierungssystems für die Beurteilung und Vorhersage von Organfunktionsstörungen und Überleben bei herzchirurgischen Intensivpatienten. Methoden: Hierzu wurden konsekutiv alle erwachsenen Patienten nach einem herzchirurgischen Eingriff unter Einsatz der Herzlungenmaschine über einen Zeitraum von 3 Jahren in die Studie aufgenommen. Im Konstruktionsset erfolgte die Auswahl der Variablen mit Hilfe der Patienten, die mindestens 24 Stunden auf der Intensivstation verbrachten. Die Ergebnisse wurden dann in zwei Validierungssets mit allen Intensivpatienten überprüft. Die Qualität des Scores wurde mit dem Hosmer-Lemeshow-Test (HL) sowie der ROC-Analyse beurteilt, und mit dem APACHE-II- und dem MODS-Score verglichen. Ergebnisse: Insgesamt wurden 3230 Patienten über einen Zeitraum von 3 Jahren auf unserer Intensivstation aufgenommen. Die HL-Werte für den neuen Score waren 5,8 (APACHE-II: 11,3; MODS: 9,7) für das Konstruktionsset, 7,2 (APACHE-II: 8,0; MODS: 4,5) für das Validierungsset I und 5,9 für das Validierungsset II. Die Fläche unter der ROC-Kurve war 0,91 (APACHE-II: 0,86; MODS: 0,84) für den neuen Score im Konstruktionsset, 0,88 (APACHE-II: 0,84; MODS: 0,84) in dem Validierungsset I, und 0,92 in dem Validierungsset II. Schlussfolgerung: Der neue CASUS (Cardiac Surgery Score) zeigt für herzchirurgische Intensivpatienten eine exzellente Kalibrierung und Diskriminierung bezüglich der 30-Tage-Letalität. Die Variablen des CASUS sind einfach, reproduzierbar und werden routinemäßig in herzchirurgischen Intensivstationen erfasst. Der CASUS könnte als Expertensystem für das Diagnostizieren von Organfunktionsstörungen, der Entscheidungsfindung, der Ressourcenauswertung und Vorhersage der Letalität für herzchirurgische Intensivpatienten dienen.     

Associated coronary anomalies in 135 Iranian patients with tetralogy of Fallot

Coronary artery anomalies are common among patients with tetralogy of Fallot. One hundred and thirty-five patients (80 males and 55 females) with tetralogy of Fallot who underwent repair between 1995 and 2002 were studied to determine the incidence of coronary anomalies in Iranian patients. Eight (5.9%) patients (4 males and 4 females) had a surgically relevant coronary artery anomaly: single coronary ostium in 5, origin of the left anterior descending artery from the right coronary artery in 2, and origin of the right coronary artery from the left coronary artery in 1. The surgical technique in 3 of these patients was repair of the ventricular septal defect with a transverse incision on the right ventricle, without damage to the coronary arteries. In another patient, an allograft aortic valve cylinder was inserted. In the other 4 patients with a single coronary ostium, placement of a limited transannular patch was adequate. Consideration of these anomalies during primary repair could decrease the risk of operation in such patients. However, it seems that the presence of anomalous coronary arteries does not affect incremental risk after surgical repair.     

Experimental Life Cycle of Hypoderaeum conoideum (Block, 1872) Diez, 1909(Trematoda: Echinostomatidae) Parasite from the North of Iran

Background:

Human Echinostomiasis is an intestinal disease caused by the members of family Echinostomatidae parasites. The aim of present research was to identify echinostomatidae cercariae emitted by Lymnaea palustris snails from Mazandaran province in the north of Iran based on the morphological and morphometrical characteristics of the different stages of experimental parasite life cycle.

Methods:

Echinostomatidae cercariae were collected from L. palustris (Gastropoda: Lymnaeidae) of the north of Iran. To collect metacercaria, 50 healthy snails were infected with cercariae experimentally (50 cercariae for each). To obtain the adult stage, 9 laboratory animals (3 ducks, 2 rats, 2 mice and 2 quails) were fed with 60 metacercaria for each. To identify parasite, the different stages of worm were examined using light microscope and then the figures were draw under camera Lucida microscope and measures were determined.

Results:

Averagely, 15metacercaria were obtained from each snail that had been previously exposed with cercariae. Ducks presented worm eggs in feces after 10–15 days post-infection. Intestinal worms were collected and identified as Hypoderaeum conoideum on the bases of figures and measures of cephalic collar, the number of collar spine, suckers diameter ratio, testes arrangement, etc.

Conclusion:

H. conoideum cercariae and adult worm are described. This is the first report of the different stages of the experimental life cycle of this parasite in Iran.     

Molecular Survey of Toxoplasma gondii in Sheep,Cattle and Meat Products in Chaharmahal va Bakhtiari Province,Southwest of Iran

Background

Toxoplasmosis is a worldwide spread disease. The present study examined the prevalence of Toxoplasma gondii infection among animals of edible meat (cattle and sheep) in Chaharmahal va Bakhtiari Province (Southwest of Iran) in 2012. Furthermore, we attempted for the first time to identify this parasite from the meat products in the province.

Methods

The tongue, brain, femur muscle and liver of 50 sheep and 70 cattle as well as 50 samples of meat products were selected and collected to perform molecular survey using Nested-PCR method.

Results

Of the studied sheep, 38% were infected. The infection rate in the age groups under 1 year, 1-2 years, and more than 2 years was 25%, 35.29% and 52.94%, respectively. The infection rate in femur muscle, brain, liver and tongue was 28%, 32%, 30% and 16%, respectively. Of the studied cattle, 8.57% were infected. The infection rate in the age groups 1-2 years, 2-4 years, and more than 4 years was 3.7%, 9.09% and 14.28%, respectively. Sheep was infected 6 times more than cattle (OR = 6.53 CI = 2.374-18.005).The infection rate among samples of meat products was 12% (6 samples out of 50 samples).

Conclusion

Due to the high rate of this parasitic infection among the slaughtered animals as well as meat products in this region, the use of infected material can be one of the main risk factors of transmission of the parasite to humans.     

Urine macrophage migration inhibitory factor (MIF) in children with urinary tract infection: a possible predictor of acute pyelonephritis

Macrophage migration inhibitory factor (MIF) is an important pro-inflammatory cytokine expressed at sites of inflammation. We have assessed this factor (MIF) in urinary tract infections with the aim of determining a non-invasive and sensitive method to differentiate upper and lower renal involvement. Thirty-three pediatric patients with urinary track infection (25 with acute pyelonephritis, eight with acute cystitis) and 40 healthy subjects were recruited for this prospective case-control study. Pyelonephritis was differentiated from cystitis by dimercaptosuccinic acid (DMSA) scan. Urinary MIF concentration was determined using an enzyme-linked immunosorbent assay method. The urine MIF/creatinine (Cr) ratio was significantly higher in pyelonephritis patients than in those with acute cystitis and the control group (P < 0.001). The optimal cut-point of 4.90 pg/micromol Cr for the urine MIF/Cr ratio has the potential to be a biomarker for distinguishing patients with acute pyelonephritis from those with acute cystitis. Determination of the urinary MIF was also useful in selecting the patients at risk of permanent renal damage. Of those patients with pyelonephritis, based on the DMSA scan at the time of infection, scarring on follow-up DMSA scan 9-12 months later occurred in patients with the highest urinary MIF/Cr ratios. We conclude that the urine MIF/Cr ratio is a sensitive test for differentiating acute pyelonephritis from acute cystitis and also for detecting children with acute pyelonephritis who are at a higher risk for permanent renal scars in the future.