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OBJECTIVE: Due to significant mortality and morbidity which may be reduced by prompts treatment, there is great interest in determining an ideal biomarker for the diagnosis of sepsis upon presentation to the Emergency Department. The most specific test is a positive blood culture, but its sensitivity is very low, and the results are usually available 2 days after sampling. For this reason, research is conducted into serum biomarkers with greater sensitivity for which results can be available within hours of presentation. High initial procalcitonin levels are a sensitive marker of bacterial infection, and the degree of procalcitonin elevation may determine which patients are at greater risk for adverse outcomes (mortality or ICU admission). The purpose of this narrative review is to evaluate the utility of procalcitonin as a diagnostic marker of sepsis in the emergency department and the use of procalcitonin-guided management algorithms. MATERIALS AND METHODS: A PubMed search was conducted in June 2020 for procalcitonin, resulting in the retrieval of 371 articles which were screened for relevance. 48 articles were included in the review. CONCLUSIONS: Procalcitonin elevation may be used as an indication for initiation of antibiotic treatment, and antibiotics may be discontinued once procalcitonin normalizes. This approach leads to reduced antibiotic consumption, but it is not yet clear whether it ensures better outcomes for patients. Procalcitonin in centers where it is available could be a useful diagnostic and prognostic biomarker for patients presenting to the Emergency Department with symptoms suggestive of sepsis. Further research is however required to determine whether the use of procalcitonin measurements in management algorithms leads to improved patient outcomes.

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BACKGROUND AND PURPOSE: The Oculus Pentacam® is one of the most commonly used devices in ophthalmology for assessment of the anterior eye segment. The purpose of this study was to determine the reproducibility of the corneal power as measured by the Pentacam® in a normal population. METHODS: We enrolled 25 eyes of 25 subjects aged between 13 and 68 (46.7 ± 21.7) years, within a spherical equivalent from - 4 D to + 4 D and refractive cylinder up to 5 D and without notable pathologies or history of surgery. A sequence of 5 measurements was performed using the Pentacam®, the Zeiss IOLMaster® as well as an autorefractometer after (re-)positioning the patient's head and the measurement device. From the Pentacam® we collected power data for the corneal front and back surfaces, apical corneal thickness at apex and internal anterior chamber depth. From the IOLMaster®, we extracted corneal power data, and from the autorefractometer we obtained refractive power data of both cardinal meridians. For statistical analysis, we used Cronbach's α as a measure of reproducibility and Spearman's rank correlation test for correlation of data. RESULTS: Pentacam® yields highly reproducible power data for both corneal surfaces, with Cronbach's α of greater than 0.97 for primary parameters (e.g. radii of curvature) and 0.9 for secondary parameters (e.g. vector components of astigmatism). Central corneal thickness and eccentricities of both surfaces as well as anterior chamber depth yielded highly reproducible values, with α of ≥ 0.97. Corneal power derived from IOLMaster® and objective refraction extracted from the autorefractometer yielded α values of around 0.9. Mean corneal power of Pentacam® and IOLMaster® correlated well, but there was no correlation to spherical equivalent. Astigmatism values from Pentacam® and IOLMaster® correlated well with each other and with refractive cylinder. CONCLUSION: Our results indicate that measurements of anterior segment using the Pentacam® yield highly reproducible results in a normal population without major pathologies of the anterior eye segment.

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BACKGROUND: Coats' disease is a non-hereditary acquired, usually unilateral eye disorder that predominantly occurs in young males (1/100,000) with the onset of symptoms generally appearing in the first two decades of life. Coats' disease is characterized by telangiectatic changes, blood leaks from the defective vessels with retinal exudation followed in advanced stages by retinal detachment. CASE REPORT: A 14-year-old male patient presented in our department with gradual visual loss in the right eye. Based on the clinical and diagnostic findings Coats' disease was diagnosed. The exudative retinal detachment in the right eye was initially treated with intravitreal bevacizumab injection (B-IVOM) followed by cryocoagulation and combined with a second administration of B-IVOM 2 weeks later. On the grounds of a persistent exudative retinal detachment a new round of cryotherapy was conducted. We proceeded with laser coagulation of the residual Coats areas and with three cycles of B-IVOM therapy. The subretinal and intraretinal exudates regressed over several weeks so that the patient remained symptom-free 22 months after therapy. At the last examination the visual acuity was 0.8 in the right eye. CONCLUSION: The favorable development for our patient demonstrates that adjuvant therapy with intravitreal anti-VEGF injections in addition to laser and cryocoagulation in a case of advanced Coats' disease with exudative retinal tissue damage could lead to the stabilization of the retinal findings and to preservation of good visual acuity.

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BACKGROUND: Primary corneal graft failure (PCGF) after penetrating keratoplasty (PKP) despite good endothelial cell count of the transplant in organ culture rarely occurs in young patients. A herpes simplex virus type I (HSV-1) infection (transmission through the donor or reactivation by the patient) can lead to PCGF. METHODS: We report on a 43-year-old man with pellucid marginal corneal degeneration and neurodermitis, who was underwent penetrating keratoplasty (PKP) on the left eye after acute corneal hydrops in both eyes. A repeat keratoplasty (re-PKP) had to be performed 15 days after the first PKP due to a primary graft failure. A re-re-PKP with simultaneous amniotic membrane transplantation (as a patch) and partial lateral tarsorrhaphy became necessary 4 months after the re-PKP due to melting on the edge of the graft with persistent epithelial defects. RESULTS: After intensive cooperation between ophthalmologists and pathologists the histopathological findings showed keratocytes which reacted immunohistochemically positive for HSV-1 antigens in the deep corneal stroma of both corneal grafts. The excised own cornea of the patient was histopathologically negative but the DNA-PCR for HSV-1 was weakly positive. After adequate topical and systemic antiviral therapy the third graft has remained clear for 12 months. CONCLUSION: In cases of PCGF after normal risk corneal transplantation the possibility of HSV infection should always be considered. After confirmation of the diagnosis with the help of the immunohistochemical tests and/or PCR, an adequate treatment with antiviral medication (acyclovir tablets 2 × 400 mg for more than 1 year) should be administered to the patient after repeat PKP.

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