Amalgamation of procalcitonin, C-reactive protein, and sequential organ failure scoring system in predicting sepsis survival.

BACKGROUND: The clinical value of inflammatory biomarkers is still questionable. AIM OF THE WORK: The aim of this study is to compare the clinical informative value of procalcitonin (PCT) and C-reactive protein (CRP) plasma concentration in the early detection of sepsis, as well as relating these biomarkers to other scoring systems. PATIENTS AND METHODS: A total of 138 patients were enrolled in our study. All were subjected to PCT, CRP, and sequential organ failure assessment (SOFA) scores daily for 7 days (starting from admission day). Blood samples were collected before starting antibiotics, with 28 days follow-up and patients were assigned to three groups: Group I: SOFA 2-7, Group II: SOFA 8-10, and Group III: SOFA ≥11. RESULTS: Underlying clinical diagnosis revealed pneumonia in 72 patients, urinary tract infections in eight, bloodstream infection in four, and other infections in 23, while infection could not be traced in 25 patients. The mean PCT was 3 ng/ml (95% confidence interval [CI]: 1-4), 12 ng/ml (95% CI: 9.1-14), and 19 ng/ml (95% CI: 16.3-22.3) in Groups I, II, and III, respectively, with a statistically significant difference in the mean PCT level among the three groups (P < 0.0001). On the other hand, CRP mean level did not significantly differentiate between the groups (147.1 mg/L in Group II, which was even higher than the level of Group III, 138.4 mg/L). CONCLUSION: PCT seems to do better than CRP in predicting the SOFA groups, giving its patronage display over a wide spectrum of insults.

Development and distribution of serotonin in the central nervous system of Manduca sexta during embryogenesis. II. The ventral ganglia.

The distribution of serotonin (5-HT) immunoreactive cells and their projections was mapped in the ganglia of the ventral nerve cord of the tobacco hornworm, Manduca sexta, during embryonic development, using an antiserum to 5-HT. Immunoreactive cells were first seen at 60% development. By 75% of embryonic development, a total of 94 immunoreactive cells were found in the ventral ganglia, including the suboesophageal ganglion. This number decreased to 80 neurons by 100% of development. About 50% of these cells were arranged in the abdominal ganglia and the rest were located in both the suboesophageal and thoracic ganglia. The suboesophageal ganglion exhibited immunoreactive segmental interneurons in areas corresponding to the mandibular, maxillary and labial neuromeres. Two pairs of immunoreactive interneurons were also observed to occur bilaterally in each of the thoracic and abdominal ganglia, with the exception of the prothoracic ganglion. This ganglion contained three pairs of bilaterally arranged immunoreactive neurons as early as 60% of embryonic development. Serotonin immunoreactivity was also found in a number of efferent neurons in the mandibular and labial neuromeres of the suboesophageal ganglion and in the prothoracic, mesothoracic and posterior abdominal ganglia. The occurrence of 5-HT in these efferent neurons suggests an involvement of serotonin in fore- and hindgut function via its effect on the visceral muscles. Immunoreactive lateral longitudinal fibers extended along the entire length of the ventral nerve cord together with dense segmental arborizations. The latter had regressed by the time the embryo was fully developed. This regression of the arborizations in the ganglia at the end of embryonic development indicates that a reorganization of 5-HT innervation occurs to support new larval functions. The time of appearance of 5-HT immunoreactive cells and fibers suggests that serotonin may play a role in the development of the ventral nerve cord.

Development and distribution of serotonin in the central nervous system of Manduca sexta during embryogenesis. I. The brain and frontal ganglion.

Development of the serotonergic system in the brain and frontal ganglion of the Manduca embryo between 35 and 100% of development was studied immunocytochemically with an antiserum to serotonin (5-HT). Serotonin immunoreactivity was initially detectable at 40-45% development in short fibers in the head region, prior to differentiation of the brain. Immunoreactive cell bodies were first seen in the brain at 60% development, located in the protocerebrum and tritocerebrum. Thick fiber tracts crossing the midline (commissures) could also be observed at this early stage. As development of the embryo progressed, eight immunoreactive cell groups, containing a total of about 38-40 cells, and four commissures with terminal arborizations appeared successively in the brain. From 75 to 100% development, no obvious changes occurred in the number or distribution of cells, and the brain exhibited the same pattern of 5-HT immunoreactive cells, fiber tracts and arborizations as in last instar larvae of Manduca. However, an increase in the size of the cells in both the brain and frontal ganglion was noted between 75 and 80% development, followed by a decrease by 100% development. The frontal ganglion was found to contain three 5-HT immunoreactive cells, which appeared to send bilateral projections into the frontal connectives and the recurrent nerve. During embryonic development, the dendritic arborizations of these frontal ganglion cells increased, while the amount of 5-HT immunoreactivity in the cell bodies decreased. Thus, the serotonergic system first appears in the Manduca embryo at an early stage of development, similar to the situation in other insects as well as vertebrates. By the end of the embryonic period, the same number of serotonergic neurons are present in the brain as in larval and adult Manduca, suggesting that once formed, these cells persist through postembryonic development and metamorphosis.