The Aim : The aim of the study was to eveluate benefical effect of corticosterides in short treatment of community acquired pneumonia (CAP). Patients and Methods : We enrolled a total of 149 hospitalized patients, for a period of an year (Januay 2011 to Decembre 2011). The diagnose of CAP was made using standard clinical and radiological criteria. Disease severity was scored using Pneumonia Severity Index. Age, antibiotic treatment and PSI adjustement has been done between the groups. Patients received 50 mg prednisolone for 7 days, along with antibiotics. The outcomes were clinical cure at day seven, defervescence, length of stay, time to clinical stability, Results : Mean age of patients enrolled in study was 63±16.7 in prednisolone and 53±18.6 in group without prednisolone Therty (40 %) patients in prednisolone group and 16(22.2%) in without prednisolone group were in Peumonia Severity Index class IV-V. Clinical cure at days 7 was 61/75 (82.6%) in the prednisolone group and 44/72 (61.1%) in other group.[ P Conclusions : In this study we show that Prednisolone (at 50 mg) once daily for a short time, (a week), have a beneficial effects in patients hospitalized with mild to severe CAP, improving outcomes without adverse events.
Introduction: The biomarkers used in COPD are many, but studies of last decades are focused on the pulmonary surfactant, which plays a crucial role in normal lung function. Aim : Evaluation of the levels of SP-A, SP-D and other markers in patients with SPOK and their relation to inflammation and smoking. Material : We studied 118 patients with COPD . 10 cases were in stage B, 24 cases in stage C and 84 cases in stage D; 113 males and 5 females , mean age 69 ± 8 years and 70 ± 8 years respectively; Methodology: The SP-A and SP-D levels were measured on admission during acute exacerbation and in the day of discharge from hospital in remission of disease. We included a healthy control group. Results: In the healthy control group mean SP-A = 22.2 +/- 16.3 ng / ml and mean SP-D=90 +/- 36.8 ng / ml . In our study group ,on admission we found mean SP-A levels 46.8 + -35.2ng / ml and SP-D 175 +/- 99 ng / ml. In COPD Stage B mean SP-A was 33.78 +/- 19.7 ng / ml, Stage C 40.7 +/- 19.5ng / ml and stage D 50.2 +/- 39 ng / ml (p = 0.0001). Mean SP-D at Stage B was 168.3 +/- 121ng / ml, Stage C 160 +/- 78 ng / ml, and Stage D 181 +/- 102ng / ml (p = 0.0001).On the last day(remission) mean SP-A 38+ /23.5ng/ml and mean SP-D 147 +/- 91 ng / ml. In COPD Stage B mean SP-A was 42.7 +/- 26.2 ng / ml, Stage C 33 +/- 15.6ng / ml and stage D 38.5 +/- 25 ng / ml (p = 0.003). Mean SP-D at Stage B was 196 +/- 157ng / ml, Stage C 130 +/- 53 ng / ml, and Stage D 137 +/- 81ng / ml (p = 0.002). In exacerbation period smoking status has significant correlations with all biomarkers presented with the Spearman coefficient: SP-A( R s = 0.249, p = 0.002); SP-D( R s = 0.264 p = 0.001), IL6( R s = 0.255, p = 0.002) and CRP ( R s = 0.231, p = 0.004). In remission state smoking has significant positive correlation with SP-D (R s = 0.282, p = 0.002) and SP-A (R s = 0.273, p = 0.003) .In both evaluations the mean values of SP-A and SP-D were significantly higher in smokers compared to nonsmokers (p<0.05). Levels of IL6 measured in first day were significantly higher in smokers p=0.025, mean CRP levels had no significant diffierencies between two groups. Conclusion: SP-A and SP-D levels were higher in COPD patients compared to healthy control group. Their level were significantly higher AECOPD than in stable state of COPD and they correlated with the gravity of the disease. In remission state SP-A and SP-D levels reflects better the gravity of COPD. SP-A and SP-D levels are better related with smoking state and their levels are more increased in smokers . Keywords: COPD, acute exacerbation of COPD (AECOPD), SP-A and SP-D
Background: The aim of this study was to evaluate the usefulness of C-reactive protein(CRP) and Procalcitoni(PCT) to differentiate parapneumonic PE (PPPE), tuberculous PE(TBPE) and malignant PE (MPE). Methods: In 67 patients with exudative PE ,we performed biochemical (total protein, LDH, cholesterol,glucose,) studies in concurrently obtained pleural fluid and venous blood samples. Pleural CRP(pCRP) and pleural PCT(pPCT) and cytologic studies were performed in pleural fluid. 62.7% were males and 37.3% females . Results: The pCRP levels resulted higher in PPPE (79.7±40.8), TBPE( 29.19±19) and MPE associated with infection (31.87±19.2)and lower in MPE not associated with infection (12.38±13.2).pPCT levels resulted high in PPPE (0.672± 0.489 ng/mL) and in MPE associated with infection (0.843±1.33) but resulted low in TBPE (0.176± 0.098 ng/mL) and MPE not associated with infection(0.205±0.179 ng/mL). Conclusion: Taken separately,CRP has better sensitivity and specificity than PCT in diagnosis of PPPE and MPE. Taken together,this tests not only enhance diagnosis of PPPE,but also strengthen the differential diagnosis between benign PE and MPE.These biomarkers can be taken into consideration together with biochemical and Hematological laboratory , cytology and imaging studies,all tightly combined with clinical manifestations.
Background: The aim of this study was to determine the values of hematological markers and some other biomarkers in patients with stable COPD in order to define the presence of anemia,degree of systemic inflammation and correlations between the analytes. Methods: We evaluated CBC, biochemical, bloodgas and spirometry studies performed in 87 COPD patients (FEV 1 = 50 ± 5.75%) and 17 control subjects (FEV 1 = 103 ± 10%). Pursuant to GOLD guidelines, the patients were divided into 4 subgroups and for hematology, into 3 subgroups: subjects with anemia, without anemia and those with slight polyglobulia.Mean age resulted 65.7(38-84). 68.3% of cases were smokers.27% of patients had cardiac diseases,16.3% were hypertensive subjects ,11.5% had secondary infections, 8% renal disease and 6% with DM typeII. Results: No significant differences were found in the values of RBC,HBG and Htc either between the group of all COPD patients and control subjects or between GOLD subgroups and control subjects.Anemia was present in 8% of the COPD cases ,mostly subjects with renal disease and secondary infection.Polyglobulia was mostly present in Stage III- IV COPD patients >70 years(28.7%). ES revealed good negative correlation with RBC, Hb and Htc (r= -0.7, r= -0.673,r= -0.679 respectively;p Conclusion: Inflammation and comorbidities induce hemogram changes in COPD patient. especially in last stages.
The aim: To study the use of cut off values of fluid ADA level in differential diagnosis of tuberculous pleurisy. Materials and methods: 121 consecutive patients with pleural effusion were prospectively studied. The study included 82 males, 39 females with a mean age of 59.3±17 years. Exudative effusions were classified: malignant pleural effusions, 39 (39.8%), TB pleural effusions, 39 (39.8%), parapneumonic pleural effusions, 20 (20.4%).The photometric method was used. Results: In tuberculous group the mean of ADA level was 122.4±53.3UI/L, malignant effusion it was 59.7±31.7 UI/L (p= 0.0001) parapneumonic effusions 96±48UI/L. Fluid ADA in 24/39 of malignant effusions and 18/20 parapneumonic effusions was above diagnostic cut-off 40 UI/L; in four of 39 tuberculous pleurisy ADA was under 40 UI/L. Mean ADA level was greater in patients The sensitivity of ADA in TB effusions at cut-off > 40 U/L was 89.7%, specificity 28.8%, PPV 54.5%. The cut-off value at 95 UI/L had the greatest YOUDEN index (0.488), best Lahr+ (3.4), the highest specificity, PPV 79.6%, and 69.2% respectively,sensibility 69.2%. Conclusions: In countries with low incidence of TB the diagnostic cut off value of ADA level have to be different from countries with high incidence. The best cut off value of pleural fluid ADA level in diagnosis of TB was 95UI/L.In many cases ADA levels in non-tuberculous exudative pleural effusions exceeded the cut off values of tubercular disease (40 UI/L). Adenosine deaminase level of less than 40 U/L in patients
Introduction: Pulmonary embolism (PE) is a major international health problem and may be fatal. Its overestimation may enhance the cost of the hospitals, but underestimation risk the patient9s life as well. D-dimer has high sensitivity but low specificity for detection of PE. Objectives : To evaluate the effectiveness of D-dimer in patients with PE and its impact in the budget of our hospital. Materials and Methods: This is a retrospective study of 150 patients with PE confirmed by Angio-CT from January - May 2011. All patients of this group had high risk factors, clinical signs of PE and high score in clinical probability according to Geneva and Wells. D-dimer was performed in all of patients. Results : There were 105 male and 45 female. D-dimer was positive in 102 cases (68 %), and negative in 48 cases (12%). Discussion : The cost of D-dimer for 1 patient in Albania is 12€, for 150 patients is 1800€. Is evident: in 12% of cases D-dimer was negative in patients with confirmed PE. In the other group, the clinical data and high score clinical probability are sufficient as indication for the angio-CT. So, further laboratory examinations, including D-dimer may be avoided, especially in developing countries, where the cost of these tests is high for the hospitals. D-dimer is necessary in low and medium clinical probability cases. Conclusion: In patients with high risk factors and a clear anamnesis of PE, D-dimer is not necessary. Avoiding it may reduce the hospital expenses.
Background: In addition to their assessment on clinical presentation, a large number of biomarkers are used. Aim:The aim of this study was to investigate the diagnostic and prognostic value of plasma biomarkers in ECOPD. Methods: 57 patients treated with ECOPD have been evaluated at first consultation, and after 21days in relation to plasma concentration of Interleukin-6 (IL-6), Pulmonary and activation-regulated chemokine (PARC/CCL-18) and C-reactive protein (CRP). Plasma concentration are correlated with clinical parameters of ECOPD. Plasma concentration of IL-6 was measured by electrochemiluminescent immunoassay (ECLIA, Roche Diagnostics), PARC/CCL-18 by ELISA (Human CCL18/PARC PicoKine™ ELISA Kit), and CRP was obtained by Turbilatex test. Results: Mean concentration of serum markers studied were higher in first consultation of subjects for ECOPD, and significantly decreasing after 21 days (P < 0.0001) respectively: IL60 33.46pg/ml±45.9 (min 3.1 max 232.3), IL621 9.1pg/ml±7.5 (min 1.7 max 43.6); PARC/CCL-180 77ng/ml ±34.5 (min 24.6 max 168.8), PARC/CCL-1821 51.2ng/ml ±23.5 (min 10.7 max 107.2); CRP0 43.1mg/l ±49.2 (min 0.2 max 257), CRP21 11.2mg/l ±12 (min 0.1 max 48). There were no significant correlations among these biomarkers with clinical variables. Conclusions: IL-6, PARC/CCL-18, and CRP resulted useful for diagnosis of ECOPD and to follow-up stabilization.
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