Can lactate be valuable in early diagnosis and prognosis of neonatal sepsis?

Background

Sepsis monitoring tissue perfusion is crucial for detecting circulatory failure early, implementing the right treatments, and assessing response. Insufficient oxygenation leads to a rise in lactate level and has been shown to be useful in predicting mortality and morbidity in newborns. There have not been many studies on how lactate measurement affects neonatal sepsis diagnosis and prognosis.

Aim

The aim of our study was to determine the impact of lactate on early diagnosis and prognosis in neonatal sepsis.

Materials and Methods

Eighty-seven newborns diagnosed with neonatal sepsis at a neonatal intensive care unit between January 2010 and July 2021 were included in the study. Venous blood gas, lactate, and C-reactive protein (CRP) levels and complete blood count on the first, second, and third day of hospitalization were noted. Lactate values were correlated with other variables to determine the impact of hyperlactatemia on morbidity and to determine factors affecting the length of stay. IBM SPSS Statistics version 22.0 for Windows was used to analyze the data (SPSS Inc., Chicago, IL, United States).

Results

A strong negative correlation between lactate and oxygenation and perfusion indicators (HCO3, BE, PaO2) during the therapeutic process was observed. With treatment, the initial measured lactate value decreased, and a significant increase in CRP and oxygen saturation was observed, which was interpreted as the observation of an early lactate response to infection before a CRP response. The initial lactate level, as well as the change in lactate levels, was not, however, significantly correlated with the length of stay.

Conclusion

Lactate can be used in the early diagnosis of neonatal sepsis and for determining prognosis.

The relationship between intracoronary thrombus burden and atherogenic index in patients with ST-elevation myocardial infarction

OBJECTIVE

Increased coronary thrombus load is a strong predictor of adverse cardiovascular (CV) outcomes. Identifying predictors of intracoronary thrombus burden may contribute to the management of ST-segment elevation myocardial infarction (STEMI). We aimed at evaluating the relationship between the atherogenic index (ATI) and coronary thrombus burden in patients presenting with STEMI.

PATIENTS AND METHODS

139 patients who presented with STEMI and underwent primary percutaneous coronary intervention were included in this study. Angiographic thrombus burden was classified as previously defined in the myocardial infarction (TIMI) study group.

RESULTS

The patients were divided into two groups as those with high and low thrombus load. Independent predictors of high thrombus burden were ATI (OR: 4.23, 95% CI: 2.38-7.5; p<0.001), serum creatinine level (OR: 17.4, 95% CI: 3.03-101.4; p=0.001) and non-LAD involvement (OR: 0.363, 95% CI: 0.14-0.92; p=0.034). The association of ATI with thrombus load was independent from HDL and TGL levels.

CONCLUSIONS

The atherogenic index can be used as a reliable marker for increased coronary thrombus burden, which is associated with adverse CV outcomes.

Primary hydatid disease of the soft tissue

Human hydatid disease is caused by the larval form of the tapeworm genus Echinococcus. The ova hatch in the small intestine, penetrate the intestinal wall, pass through the portal vein into the liver, lungs, and other tissues, and develop into a hydatid cyst. Hydatid disease is endemic in many parts of the world; in the Mediterranean Countries, the Middle and Far East and South America. Soft tissue hydatid disease without the liver and the lung involvement occurs in 2.3% of patients reported from endemic areas. Hydatid disease should be considered in the differential diagnosis of all cystic masses in all anatomic locations especially in endemic areas.

Effects of Taxol plus radiation on the apoptotic and mitotic indices of mouse intestinal crypt cells

PURPOSE

In this study we investigated the effect of Taxol, radiation, or Taxol plus radiation on highly proliferative normal tissue--the intestinal crypt cells of Swiss albino mice.

MATERIALS AND METHODS

Swiss-albino mice, 3-4 months old, were used in this study. Taxol was administered by bolus intravenously through the tail vein. Radiation was given using a linear accelerator. There were four treatment categories, which comprised a total of 34 groups. Each group consisted of five animals. The first category was a control category which comprised one group (n = 5). The second treatment category was Taxol alone which comprised three groups (n = 15). The third treatment category was radiation alone which comprised three groups (n = 15). The fourth treatment category was Taxol plus radiation which comprised 27 groups (n = 135). Mice were killed 24 h after Taxol or radiation or combined administration using ether anesthesia. Using a light microscope, apoptotic and mitotic indices were counted on jejunal crypt cells of mice that were stained with hematoxylin-eosin. Differences between groups were statistically evaluated with Student's t-test.

RESULTS

Taxol caused a dose-dependent increase in apoptosis (P = 0.045) and decreased the mitotic index (P = 0.006) at high doses. Similarly, radiation caused a dose-dependent increase in apoptosis (P = 0.046) and decreased the mitotic index (P = 0.299) at higher radiation doses. Compared to radiation alone, Taxol caused a significant induction of apoptosis (P = 0.010). In combination, no significant radiosensitizing effect of Taxol was observed (enhancement ratio < 1), when compared to radiation alone. However, an increase in apoptosis was observed after 24 h of Taxol exposure when compared to 12 or 48 h of Taxol exposure (P = 0.0001 and P = 0.0001).

CONCLUSION

These findings suggest that Taxol did not cause a radiosensitizing effect in intestinal crypt cells. However, a 24-hour pretreatment of Taxol exposure followed by radiation caused significant induction of apoptosis and reduction of the mitotic index when compared to other Taxol timing sequences. Thus, the lack of a radiosensitizing effect of Taxol in these proliferative cells may be due to enhanced mitotic death rather than apoptotic death.

The relationship between genetic susceptibility to head and neck cancer with the expression of common fragile sites

BACKGROUND

Numerous studies have recently been conducted to investigate genetic mechanisms in cancer causes and pathogenesis. Some of these studies have shown that there were certain specific chromosomal defects in normal cells of cancer patients and in their first-degree relatives. It was suggested that these individuals were susceptible to cancer development when compared with people without these defects. Materials and Methods Chromosomal anomalies, such as gaps, breaks, and acentric fragments, and fragile site expression rates were determined in peripheral blood lymphocyte cultures in 14 head and neck cancer patients, 17 first-degree relatives of these patients, and 20 healthy individuals as a control group in this study. RPMI 1640 medium, composed of aphidicolin, 5-bromodeoxyuridine, and caffeine were used for the induction of fragile sites.

RESULTS

In cytogenetic and statistical evaluation, it was observed that both chromosomal aberration rates and fragile site expression frequencies in head and neck cancer patients and in their first-degree relatives were significantly greater than the control group (p <.05). It was found that fragile site expression was site specific in head and neck cancer patients and in their first-degree relatives. These specific sites were determined to be 1p21-22, 1q21, 1q25, 2q21, 2q31-33, 3p14, 16q22-23, 18q21, and 22q12 sites.

CONCLUSIONS

These findings support studies showing that the fragile sites might be unstable factors in human genomes and their expression could be affected by some genetic factors, such as tumor suppressor genes and mismatch repair genes, and by some environmental factors, such as benzo (a) pyrene, dimethylnitrosamine, and dimethylsulfate. In conclusion, fragile sites may be playing an important role in the genetic tendency to head and neck cancer. Overexpression of these sites in normal lymphocytes may be used as a reliable marker to determine the genetic susceptibility in head and neck cancer patients and in their first-degree relatives.

In vivo dominant lethal effect of pyrimethamine in male mouse germ cells

Pyrimethamine is used for treatment of malaria and toxoplasmosis. The embryotoxicity and clastogenicity of pyrimethamine is known and our aim was to investigate its dominant lethal effect in vivo. For this purpose, we used three groups of Swiss-albino male mice and a control group. We injected males with doses of 16, 32 or 64 mg/kg pyrimethamine and housed them with 10 females/male for each mating interval. Females were sacrificed and their uteri were evaluated for dominant lethality. As a result of this study we found that pyrimethamine induced dominant lethal mutations in the third, fourth and sixth weeks at the 64 mg/kg dose level, without the effect being dose-dependent. We conclude that pyrimethamine is a suspected germ cell mutagen.