[Show abstract][Hide abstract] ABSTRACT: Pseudoacromegaly is characterized by an acromegalic appearance without any abnormality of growth hormone function. It may be caused by several congenital and acquired conditions. One such condition is the acromegaloid facial appearance (AFA) syndrome. This condition has been described in approximately eight cases/families. It encompasses a spectrum of acromegaloid physical findings, normal growth hormone (GH) and insulin-like growth factor one (IGF-1) levels, and variable mode of inheritance. The most common physical findings are coarse facies, bulbous nose, and thickened lips. We present a case and a review of the literature on this illness. The patient is a 57-year-old woman who was referred to the endocrinology division for evaluation of suspected acromegaly. She had an acromegaloid appearance since birth as well as a terminal hypertrichosis. Her endocrine laboratory evaluation and chromosomal analyses were normal. AFA needs to be considered when evaluating any patient with pseudoacromegaly. Additional cases/families need to be identified in order to better understand the clinical spectrum, clinical implications, and mode of inheritance of AFA.
Case Reports in Endocrinology 02/2013; 2013:970396. DOI:10.1155/2013/970396
[Show abstract][Hide abstract] ABSTRACT: Background: Diagnosis of pneumonia in busy emergency rooms is often based on inconclusive CXR readings (edema vs. atelectasis vs. infiltrate) driving unnecessary antibiotic use to meet CMS guidelines. Recently, serum procalcitonin (PCT) has been used to guide antibiotic use in ARI, presumably by identifying bacterial infection (PCT ≥ 0.5 ng/ml). Thus, we correlated serum PCT with CXR findings, specifically to aid in evaluation of inconclusive CXR findings.
Methods: Patients hospitalized for ARI during the winters 2008 and 2009 were recruited. Evaluation included review of CXR reports, measurement of PCT on admission, and viral and bacterial diagnostics. A pulmonologist evaluated all patients and independently read all CXRs. For both the radiologist (RAD) and pulmonologist (PULM), CXRs were classified as (1) no acute disease (NAD), (2) other [i.e., atelectasis, mass, effusion, etc.], (3) possible infiltrate [inconclusive], or (4) infiltrate.
Results: 532 patients with 556 illnesses were recruited, of which 18 were excluded (No CXR or non-pulmonary infection) leaving 538 illnesses for evaluation. CXR reads by RAD were inconclusive in 31% of cases. Readings by PULM were; 31% infiltrates, 54% NAD, 14% other, and 0.9% inconclusive. Mean admission PCT levels were significantly higher in subjects with infiltrates vs. NAD classified by PULM (0.31±1.83 ng/ml vs. 4.84 ± 26.47 ng/ml, p=.004). PCT was >0.5ng/ml in 6% of patients with NAD and 42% of those with infiltrates. All patients with bacteremia had PCT > 0.5ng/ml. Of the 167 inconclusive RAD CXRs, those with PCT ≥ 0.5ng were more likely to have bacterial infections and infiltrates as read by PULM vs. those < 0.5ng/ml. (Table)
PCT ≥ 0.5ng/ml
PCT < 0.5ng/ml
Conclusion: Measurement of serum PCT levels in patients with ARI and inconclusive CXR may be useful in making antibiotic decisions. In stable patients with low PCT and inconclusive CXR findings, appropriate microbiologic specimens should be sought prior to hastily initiating antibiotics.
Infectious Diseases Society of America 2011 Annual Meeting; 10/2011
[Show abstract][Hide abstract] ABSTRACT: Lipopolysaccharide or endotoxin constitutes most part of the outer portion of the cell wall in the gram-negative bacteria. Subclinical endotoxemia could contribute to increased inflammation and mortality in hemodialysis (HD) patients. Endotoxin level and clinical effect are determined by its soluble receptor sCD14 and high-density lipoprotein. We examine the hypothesis that endotoxin level correlates with mortality.
In this cohort study, endotoxin levels were measured in 306 long-term HD patients who were then followed up for a maximum of 42 months. Soluble CD14 and cytokines levels were also measured.
The mean (±SD) endotoxin level was 2.31 ± 3.10 EU/mL (minimum: 0.26 EU/mL, maximum: 22.94 EU/mL, interquartile range: 1.33 EU/mL, median: 1.27 EU/mL). Endotoxin correlated with C-reactive protein (r = 0.11, P < .04). On multivariate logistic regression analysis, high body mass index and low high-density lipoprotein (HDL) cholesterol levels were associated with higher endotoxemia (endotoxin below or above of median). In multivariate Cox regression analysis adjusted for case-mix and nutritional/inflammatory confounders, endotoxin levels in the third quartile versus first quartile were associated with a trend toward increased hazard ratio for death (hazard ratio: 1.83, 95% confidence interval: 0.93 to 3.6, P = .08).
In this HD cohort, we found associations between endotoxemia and C-reactive protein, body composition, and HDL. Moderately high endotoxin levels tended to correlate with increased mortality than the highest circulating endotoxin level. Additional studies are required to assess the effect of endotoxemia on mortality in dialysis population.
[Show abstract][Hide abstract] ABSTRACT: Background: Antibiotics are often administered to adults hospitalized with documented viral respiratory infections due to concern for secondary bacterial infection. Procalcitonin (ProCT) levels are high in most patients with bacterial pneumonitis and may identify patients at low-risk for bacterial complications, thus avoiding antibiotics. Methods: Admission C-reactive protein (CRP), copeptin and ProCT levels (sensitive Kryptor assay; BRAHMS) were measured in patients with acute respiratory symptoms. Of 70 patients evaluated, 34 had virus infection alone, 9 had bacteremia (6 with viral infection), and 27 had adequate sputum samples with bacterial growth (17 with viral infection). Results: ProCT, Copeptin and CRP values for those with virus-infection alone were lower than for those with bacteremia (P <.001).
(n=9) Bacteria in sputum
6.0 ± 6.6
23.3 ± 13.7
10.4 ± 10.0
167.6 ± 19.6
61.2 ± 3.0
0.7 ± 2.3
19.0 ± 25.9
2.0 ± 5.0
Using a ProCT value of < 0.5 ng/ml to categorize viral infected subjects at low risk for bacterial infection, 0/9 bacteremic patients and 28/34 (82%) in the virus alone group would be categorized (P=.0002), as would 12/17 (71%) viral infected subjects with bacteria in sputum. Of these 12 low-bacterial risk patients, 8 had no acute disease or only questionable infiltrates on chest radiographs. Using a CRP cut off < 5 μg/ml or copeptin of < 20 pmol/L, none of the bacteremic group would be classified as low risk, but only 14/34(41%) or 23/34(68%), respectively, in the viral alone group would be considered low risk for bacterial infection. Combinations of markers did not improve specificity. Conclusion: Our data indicate that ProCT is superior to CRP and copeptin in assessing risk for bacterial infection in virus infected persons and may be useful in conjunction with clinical parameters.
Infectious Diseases Society of America 2008 Annual Meeting; 10/2008