ABSTRACT
Summary Objective: To examine the diagnostic and prognostic performances of serum procalcitonin (PCT) in adult and elderly patients with bloodstream infections (BSIs). Method: A total of 176 patients with culture-proven BSIs and 200 healthy counterparts were studied prospectively. Participants were studied in two adult (age≤65 years, n=92) and elderly (age>65 years, n=84) groups. Admission serum PCT level was measured using a standard enzyme-linked immunosorbent assay (ELISA) technique. Results: The mean serum PCT level (in ng/mL) was significantly higher in cases than in controls (0.18 vs. 0.07, p=0.01 in adults; 0.20 vs. 0.07, p=0.002 in elderly). At cut-off values of 0.09 ng/mL in adults and 0.08 ng/mL in the elderly, the corresponding sensitivity and specificity were 82.6 and 82.0% in adults, and 69.1 and 70.0% in elderly, respectively. At a cut-off value of 0.2 ng/mL, the sensitivity and specificity of serum PCT in predicting 28-day mortality were 81 and 81.7% in adults, and 75 and 80.4% in elderly, respectively. Conclusion: Although admission serum PCT is a sensitive and specific biomarker for the diagnosis of BSIs in patients younger than 65 years old, its short-term prognostic value is comparable between adults and the elderly.
Subject(s)
Humans , Male , Female , Adult , Aged , Calcitonin/blood , Sepsis/diagnosis , Sepsis/blood , Prognosis , Enzyme-Linked Immunosorbent Assay , Biomarkers/blood , Case-Control Studies , Prospective Studies , Sensitivity and Specificity , Bacteremia/blood , Middle AgedABSTRACT
ABSTRACT INTRODUCTION: Preventing or reversing hearing loss is challenging in Ménière's disease. Betahistine, as a histamine agonist, has been tried in controlling vertigo in patients with Ménière's disease, but its effectiveness on hearing problems is not known. OBJECTIVE: To examine the effect of betahistine on hearing function in not-previously-treated patients with Ménière's disease and to define possible contributors in this regard. METHODS: A total of 200 not-previously-treated patients with definite unilateral Ménière's disease received betahistine by mouth (initial dose, 16 mg three times a day; maintenance dose, 24-48 mg daily in divided doses). Changes in indicators of hearing status before and six months after treatment were documented. Hearing loss was considered as the mean hearing level >25 dB HL at five frequencies. RESULTS: The mean duration of disease was 3.37 years. Six months after treatment the mean hearing level decreased by 6.35 dB compared to that at the baseline (p < 0.001). Both patients' age and the duration of disease correlated negatively with the improvement in hearing function. Post treatment hearing loss was independently associated with age, the initial hearing level and the chronicity of disease. The corresponding optimal cut-off points for predicating a persistent hearing loss 6 months after treatment were 47 years, 38 dB HL, and 1.4 years, respectively. CONCLUSION: Oral betahistine was significantly effective in preventing/reversing hearing deterioration in patients with Ménière's disease. Age, the hearing level on admission, and the disease duration were independent predictors of hearing status after treatment.
Resumo Introdução: Prevenir ou reverter a perda auditiva é um desafio na doença de Ménière. A betahistina, um agonista de histamina, tem sido testada no controle de vertigem em pacientes com doença de Ménière, mas sua eficácia em problemas de audição ainda não é conhecida. Objetivo: Analisar o efeito da betahistina na função auditiva em pacientes com doença de Ménière não tratados previamente, e definir possíveis contribuintes a esse respeito. Método: Um total de 200 pacientes sem tratamento prévio, e com diagnóstico definido de doença de Ménière unilateral, recebeu beta-histina por via oral (dose inicial de 16 mg três vezes ao dia; dose de manutenção de 24-48 mg por dia, em doses divididas). Alterações dolimiar auditivo antes e após seis meses de tratamento foram documentadas. Considerou-se como perda auditiva uma média do nível de audição > 25 dB NA em cinco frequências. Resultados: A média de duração da doença foi de 3,37 anos. Seis meses após o tratamento, a média do limiar auditivo diminuiu em 6,35 dB, em comparação com o valor da linha de base (p < 0,001). Tanto a idade dos pacientes quanto a duração da doença apresentaram correlação negativa com a melhora da função auditiva. A perda auditiva após o tratamento foi independentemente associada à idade, ao nível inicial de audição e à cronicidade da doença. Os pontos de corte ótimos correspondentes para prever uma perda auditiva persistente seis meses após o tratamento foram 47 anos, 38 dB HL e 1,4 ano, respectivamente. Conclusão: A betahistina oral foi significantemente eficaz na prevenção/reversão da deterioração auditiva em pacientes com doença de Ménière. Idade, nível de audição na admissão e duração da doença foram fatores preditivos independentes da condição auditiva após o tratamento.