ABSTRACT
BACKGROUND: Differential diagnosis of systemic inflammatory response syndrome (SIRS) with or without infectious cause is critically important in terms of initiating antimicrobial agents in case of infectious etiology such as ventilator-associated pneumonia (VAP). The aim of this study was to determine the diagnostic and prognostic roles of C-reactive protein (CRP) and tumor necrosis factor-alpha (TNF-α) in differentiating between ventilator-associated pneumonia and SIRS without infectious etiology. MATERIALS AND METHODS: In this prospective observational study, 91 adult intensive care unit (ICU) patients were enrolled. According to established diagnostic criteria, they were classified into three groups of "non-SIRS non-VAP", "SIRS non-VAP" and "SIRS-VAP". Serum CRP and TNF-α were measured on days 1, 3 and 7 of the study and compared using repeated measures ANOVA. RESULTS: With respect to diagnosis, there was no significant difference in the values of these biomarkers between groups (P>0.05). There was no statistically significant "time trend" for C-reactive protein and TNF-α (P>0.05). Considering both group effect and Time effect, the changes were not significantly different for CRP (P= 0.86) and TNF-α (P=0.69). In contrast, the clinical score and the clinical pulmonary infection score (CPIS) ≥ 6, had 100% specificity for diagnosing VAP. With respect to prognosis, only an unchanged or decreasing TNF-α from day 1 to day 3 was marginally associated with 28-day survival. However, day 1 and day 3 acute physiology and chronic health evaluation II (APACHE II) scores were highly associated with 28-day survival. CONCLUSION: Unlike clinical scoring system including CPIS and APACHE II, TNF-α and CRP levels were not useful as diagnostic or prognostic biomarkers for differentiating between SIRS with VAP etiology and SIRS without infectious etiology.
ABSTRACT
BACK GROUND: Sharing the same pathophysiologic principle which is insulin resistance, type 2 diabetes mellitus (T2DM) and poly cystic ovary syndrome (PCOS) are usually considered closely related and easily interchangeable medical entities. Numerous attempts have been made to document this illusory perspective. OBJECTIVE: Based on a delicate pathophysiologic notion, we believe that fully developed T2DM is infrequently observed with fully featured PCOS. MATERIALS AND METHODS: In an observational descriptive study 257 married T2DM women were consecutively included and meticulously investigated for fertility history and, albeit, clinical and biochemical features of PCOS. RESULTS: Of 257 married diabetic women only six (2.3%) had no children. In one case a male problem (azoospermia) and in the second case, late marriage (aged 45 at wedding ceremony) was the cause of infertility. Thus, only four (1.6%) might have been labeled as true female factor infertility. Astounding to report was the average pregnancies for each participant which was 5.1±2.5, ranging from zero to fifteen. CONCLUSION: we would suggest that, despite the well-established fact of insulin resistance as the common pathophysiologic process for T2DM and PCOS, they are definitely separate medical entities. As a matter of fact T2DM and PCOS are the two opposite aspect of the insulin resistance coin.
