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IntroductionINTRODUCTION: According to the Universal Declaration of Human Rights, everyone has the right to start a family. Under the Slovenian Infertility Treatment Act, everyone has the right to infertility treatment. A case of a patient in compulsory psychiatric treatment who participated in the process of IVF is presented.ObjectivesCASE REPORT: A 40-year-old male with paranoid schizophrenia has already been hospitalized thirteen times. He often discontinued therapy, abused drugs and repeatedly exhibited violent behaviour. He already had a child from a past relationship he didn’t care of.MethodsDuring the compulsory psychiatric treatment ordered by the court his mental status improved because his treatment with antipsychotics was supervised. He was in a relationship with a thirty-year-old partner. After unsuccessful attempts to become pregnant, they expressed a desire to conceive with biomedical assistance. Their application was considered and approved by the IVF Commission.ResultsThe procedure was successful but in the 13th week of pregnancy, the patient’s partner changed her mind due to his aggression. Because she was pregnant for more than 10 weeks, she had to submit a request for artificial termination to the Commission for abortion. Her request was granted and the pregnancy was terminated.ConclusionsCONCLUSION: We live in time of endless possibilities. Despite of violent acts in the past and severe form of mental illness, the couple was granted IVF procedure. Everyone has the right to start a family; however, the question that has to be raised is the extent and reasonableness of involvement of medical profession and/or health care system.DisclosureNo significant relationships.

Background and Aims Recently echinocytosis and subsequent haemolytic anaemia was described in a premature infant receiving omega-3 fatty acids (Omegaven) in parenteral nutrition. It was presumed that omega-3 fatty acids caused echinocytosis. No study has been done to compare the effect of different fatty acids used in parenteral nutrition on human red blood cell (RBC) morphology. We therefore studied the effect of omega-3 fatty acids (Omegaven) and omega –6 fatty acids (Intralipid) at different concentrations on RBC in vitro. Methods Blood samples were obtained from 12 healthy adult volunteers. Aliquots with 0.5 ml of washed RBC resuspended in autologous plasma to a hematocrit of 48% and containing 0%, 5%, 10%, 20%, 30% and 40% of Omegaven or Intralipid were prepared and incubated for 30 min at 37 °C. The cells were then fixed with 1% glutaraldehyde and inspected under an inverted brightfield microscope. The extent of echinocytosis was quantified by means of the morphological index (MI), calculated according to the standard protocol. Results It was found that at concentrations equal to and higher than 20%, Omegaven produced significantly higher RBC morphological index (MI) than Intralipid: mean MI at 20% for Intralipid was 0.61±0.24 and for Omegaven 1.12±0.43 (p<0.01), whereas at 40% MI was 1.47±0.37 and 2.48±0.66 for Intralipid and Omegaven, respectively (p<0.01). Conclusions At concentrations over 20% Omegaven is more likely to cause echinocytosis than Intralipid. The higher concentrations may occur in vivo if Omegaven is given separately from other parenteral nutrition fluids (two-in one).

Background and Aims Children with temporary external ventricular drains are prone to nosocomial infections. Diagnosis of bacterial ventriculitis in these children is challenging due to frequent blood contamination of cerebrospinal fluid (CSF), presence of chemical ventriculitis and elevation of blood laboratory markers by concomitant bacterial infection. Therefore determination of novel marker of bacterial infection CD64in in CSF seems to be promising. Methods We conducted a prospective, observational pilot study enrolling children with external ventricular drainage at surgical ward and paediatric intensive care unit. CD64in in CSF together with CSF leukocyte count, glucose, proteins and blood leukocyte count, CRP, PCT were studied at the time of suspected ventriculitis. CD64in was measured by flow cytometry (Trillium Diagnostics, LLC, Brewer, ME). Results Ten episodes of clinically suspected ventriculitis in 6 children (male 4, female 2, median age: 9 months, range: 4–167 months) were observed during a 6-month period. Episodes were classified into those with microbiologically proven ventriculitis (5 episodes) and into those with microbiologically negative CSF (5 episodes). CD64in was significantly higher in episodes with ventriculitis in comparison to episodes without ventriculitis (Table). Other blood and CSF markers did not differentiated between groups. Abstract 928 Figure 1CSF markers in diagnosing bacterial ventriculitis Conclusions CD64in might be a useful diagnostic marker of bacterial ventriculitis in children with external ventricular drainage before microbiological confirmation. A larger study is needed in the future.

Background and aimsBacterial ventriculitis is common in children with temporary external ventricular drains and diagnosis is challenging due to frequent reoperations, blood contamination of cerebrospinal fluid (CSF), presence of chemical ventriculitis and elevation of blood laboratory markers by concomitant bacterial infection.MethodsProspective, observational study enrolling children with external ventricular drainage at surgical ward and paediatric intensive care unit. CD64in in CSF together with CSF leukocyte count, glucose, proteins and blood leukocyte and differential count, CRP, PCT were studied at the time of suspected ventriculitis. CD64in was measured by flow cytometry (Trillium Diagnostics, LLC, Brewer, ME). Wilcoxon-test was used for comparison between groups and diagnostic accuracy determined by the area under the ROC curves (AUC) was defined for each marker.ResultsThirty-three episodes of clinically suspected ventriculitis in twenty-one children (male 14, female 7, median age: 9 months, range: 8 days-167 months) were observed during a 26-month period. Episodes were classified into those with microbiologically proven ventriculitis (13 episodes: 9 Gram-positive and 4 Gram-negative) and those with microbiologically negative CSF (20 episodes). CD64in was the only CSF marker that could differentiate between groups (p = 0.0003); its diagnostic accuracy was 0.875 (95% CI: 0.713-0.963). Among blood markers only CRP and band neutrophils differentiated between groups (p = 0.0032 and p = 0.0463) with their diagnostic accuracy of 0.808 (0.633-0.923) and 0.721 (0.524-0.870); respectively.ConclusionsCD64in in CSF is a promising diagnostic marker of bacterial ventriculitis in children with external ventricular drainage before microbiological confirmation.

To evaluate markers of infection in critically ill neonates and children, comparing lipopolysaccharide-binding protein (LBP) with procalcitonin (PCT), interleukin-6 (IL-6), and C-reactive protein (CRP). Prospective, observational study in the level III multidisciplinary neonatal and pediatric intensive care unit. Sixty patients with systemic inflammatory response syndrome (SIRS) and suspected infection classified into two groups: SIRS/sepsis ( n=33) and SIRS/no sepsis ( n=27). We included 29 neonates aged less than 48 h (neonates <48 h), 12 neonates older than 48 h (neonates >48 h), and 19 children. Median disease severity was high in neonates aged under 48 h and moderate in neonates aged over 48 h and children. Serum LBP, PCT, IL-6, and CRP were measured on two consecutive days. Area under the receiver operating characteristic (ROC) curve (AUC), sensitivity, specificity, and predictive values were evaluated. Serum LBP was higher in patients with SIRS/sepsis than in patients with SIRS/no sepsis. AUC for LBP on the first day of suspected infection was 0.89 in the younger neonates, 0.93 in the older neonates, and 0.91 in children. In critically ill neonates aged under 48 h LBP on the first day of suspected infection is a better marker of sepsis than IL-6 and PCT, and is similar to CRP. In critically ill neonates aged over 48 h and children LBP is a better marker than IL-6 and CRP, and is similar to PCT.

Background and aimsBacterial ventriculitis is common in children with temporary external ventricular drains and diagnosis is challenging due to frequent reoperations, blood contamination of cerebrospinal fluid (CSF), presence of chemical ventriculitis and elevation of blood laboratory markers by concomitant bacterial infection.MethodsProspective, observational study enrolling children with external ventricular drainage at surgical ward and paediatric intensive care unit. CD64in in CSF together with CSF leukocyte count, glucose, proteins and blood leukocyte and differential count, CRP, PCT were studied at the time of suspected ventriculitis. CD64in was measured by flow cytometry (Trillium Diagnostics, LLC, Brewer, ME). Wilcoxon-test was used for comparison between groups and diagnostic accuracy determined by the area under the ROC curves (AUC) was defined for each marker.ResultsThirty-three episodes of clinically suspected ventriculitis in twenty-one children (male 14, female 7, median age: 9 months, range: 8 days-167 months) were observed during a 26-month period. Episodes were classified into those with microbiologically proven ventriculitis (13 episodes: 9 Gram-positive and 4 Gram-negative) and those with microbiologically negative CSF (20 episodes). CD64in was the only CSF marker that could differentiate between groups (p = 0.0003); its diagnostic accuracy was 0.875 (95% CI: 0.713–0.963). Among blood markers only CRP and band neutrophils differentiated between groups (p = 0.0032 and p = 0.0463) with their diagnostic accuracy of 0.808 (0.633–0.923) and 0.721 (0.524–0.870); respectively.ConclusionsCD64in in CSF is a promising diagnostic marker of bacterial ventriculitis in children with external ventricular drainage before microbiological confirmation.

Very few data exist on phosphate metabolism in critically ill neonates. Therefore we studied the incidence of hypophosphataemia, the intracellular metabolism of phosphate by measuring adenosine 5'-triphosphate (ATP) and 2,3-diphosphoglycerate (2,3-DPG) in red blood cells, and excretion of phosphate in urine. The aims of the study were early detection of changes in phosphate metabolism as possible diagnostic markers of sepsis and defining the cause of hypophosphataemia. Neonates, treated in multidisciplinary paediatric intensive care unit (PICU), included in the study, were less than three days of age. Eighteen of them had respiratory distress syndrome (RDS) and 16 had microbiologically confirmed or clinical sepsis. The overall incidence of hypophosphataemia in critically ill neonates was over 80%, and was more common (88%) and more profound in those with sepsis than in those with RDS (79%). Therefore the septic neonates needed significantly larger amounts of phosphate to maintain normophosphataemia. In septic neonates ATP concentration in red blood cells was significantly lower than in neonates with RDS and controls, while the 2,3-DPG concentration was increased as a result of compensation. In septic neonates urinary losses of inorganic phosphate (Pi) were significantly higher than in neonates with RDS. Hypophosphataemia in critically ill neonates is at least partly due to higher urinary losses of phosphate.

We studied the value of serum interleukin-8 (IL-8) and procalcitonin (PCT) in the early diagnosis of early severe bacterial infection in 58 critically ill ventilated neonates. ELISA was used for determining IL-8 and immunoluminometric assay for PCT. IL-8 and PCT were compared with routinely used serum C-reactive protein (CRP). Neonates were divided into four groups: Ia--proven severe bacterial infection (n = 9), Ib--clinical sepsis (n = 16), II--respiratory distress without bacterial infection (n = 12), and III--various types of neonatal distress (n = 21). Sera were collected on admission, at 24 h and 48 h after admission. There was no significant difference between groups Ia and Ib for either parameter at any time interval. Significant difference was found between group Ia+b (septic neonates) and group II for PCT and CRP at 24 and 48 h, but not for IL-8. There was no difference between group Ia+b and group III except for CRP at 24 h. Diagnostic accuracy was best for PCT on admission and for CRP at 24 h. Serum PCT and IL-8 are not specific markers for early severe bacterial infection in critically ill neonates and are not better than CRP.