Adrenaline [BSA]

Background: The most common role procalcitonin play in current-day medicine is in the diagnosis and management of sepsis. Aside from sepsis, there are other known causes of elevated procalcitonin, for example, trauma and severe pancreatitis. We herein present a case of markedly elevated procalcitonin levels with an unusual cause, that is, anaphylaxis. Case report: A young lady presented to our hospital consecutively for anaphylaxis. Both presentations were associated with a markedly elevated procalcitonin level. She was discharged with an epinephrine autoinjector after the second visit. Recognition of anaphylaxis as a cause of elevated procalcitonin level can potentially change management as shown in this case report. This case report also highlights the importance of history taking and not to over rely on investigation results for patient management.

Objective: Inhaled bronchodilators are commonly used in the treatment of patients hospitalized with the diagnosis of acute bronchiolitis. The mesh nebulizer, developed in recent years, allows to deliver the smaller particles of drugs to the distal airways. The aim of this retrospective study is to compare the effectiveness of mesh nebulizers with jet nebulizers in terms of clinical improvement, length of hospital stay and intensive care requirement. Method: The study was conducted in Haseki Research and Training Hospital. Seventy-five pediatric patients between 1-24 months of age who were hospitalized with the diagnosis of acute bronchiolitis were included in the study. Forty patients were treated with jet nebulizer and 35 patients were treated with mesh nebulizer. The responses to the treatment were evaluated with duration of hospitalization, changes in heart rates, respiratory rates and Wang respiratory scores at 24th and 48th hours of therapy and requirement of intensive care. Results: Respiratory syncytial virus was the most commonly isolated viral pathogen (37.3%), followed by rhinovirus. Wang respiratory scores were significantly decreased in patients using mesh nebulizers at the 24th (p<0.001) and 48th hours (p<0.001) of treatment. Respiratory and heart rates were significantly improved at the 48th hours of therapy (p=0.026, p=0.023, respectively). The patients who were treated with jet nebulizer had longer hospital stay than those treated with mesh nebulizer (p=0.006). Conclusion: It was concluded that mesh nebulizer contribute to rapid improvement in acute respiratory failure, shortened the duration of hospitalization and may decrease the requirement of intensive care in patients with acute bronchiolitis.