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treating septic shock

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https://www.readbyqxmd.com/read/28078833/clinical-profile-and-outcome-of-patients-with-severe-sepsis-treated-in-an-intensive-care-unit-in-india
#1
T T Paary, M S Kalaiselvan, M K Renuka, A S Arunkumar
Introduction: Sepsis is the leading cause of intensive care unit (ICU) admissions and is associated with high mortality. Objectives: To identify the incidence, risk factors and outcome of patients with severe sepsis and septic shock. Methods: A prospective observational study was done in a multidisciplinary ICU over a period of 18 months. We included all adult patients admitted to ICU with features of severe sepsis and septic shock as per SCCM/ACCP guidelines...
30, 2016: Ceylon Medical Journal
https://www.readbyqxmd.com/read/28072930/left-ventricular-outflow-tract-obstruction-be-prepared
#2
J S Evans, S J Huang, A S McLean, M Nalos
The current trend to treat hypotension in critically ill patients is to place a greater emphasis on inotropic support and less on fluid resuscitation in order to limit the potential harm from fluid overload. This combination may trigger left ventricular outflow tract obstruction (LVOTO) in susceptible patients. Although LVOTO is classically described in patients with hypertrophic cardiomyopathy it has been reported in other conditions including septic shock, apical ballooning syndrome, myocardial infarction, respiratory failure, and post valvular surgery...
January 2017: Anaesthesia and Intensive Care
https://www.readbyqxmd.com/read/28069912/idiosyncratic-drug-induced-neutropenia-agranulocytosis
#3
Emmanuel Andrès, Rachel Mourot-Cottet, Frédéric Maloisel, François Séverac, Olivier Keller, Thomas Vogel, Martine Tebacher, Jean-Christophe Weber, Georges Kaltenbach, Jacques-Eric Gottenberg, Bernard Goichot, Jean Sibilia, Anne-Sophie Korganow, Raoul Herbrecht
BACKGROUD: Few data is currently available on neutropenia and agranulocytosis related to drug intake. We report here data on 203 patients with established idiosyncratic drug-induced agranulocytosis, followed up in a referral centre within a university hospital. PATIENTS AND METHODS: Data from 203 patients with idiosyncratic drug-induced agranulocytosis were retrospectively reviewed. All cases were extracted from a cohort study on agranulocytosis in the Strasbourg University Hospital (Strasbourg, France) RESULTS: : The mean age was 61...
January 9, 2017: QJM: Monthly Journal of the Association of Physicians
https://www.readbyqxmd.com/read/28068437/association-between-early-lactate-levels-and-30-day-mortality-in-clinically-suspected-sepsis-in-children
#4
Halden F Scott, Lina Brou, Sara J Deakyne, Allison Kempe, Diane L Fairclough, Lalit Bajaj
Importance: Improving emergency care of pediatric sepsis is a public health priority, but optimal early diagnostic approaches are unclear. Measurement of lactate levels is associated with improved outcomes in adult septic shock, but pediatric guidelines do not endorse its use, in part because the association between early lactate levels and mortality is unknown in pediatric sepsis. Objective: To determine whether the initial serum lactate level is associated with 30-day mortality in children with suspected sepsis...
January 9, 2017: JAMA Pediatrics
https://www.readbyqxmd.com/read/28067685/association-between-initial-emergency-department-lactate-and-use-of-vasoactive-medication-in-children-with-septic-shock
#5
Michael J Miescier, Roni D Lane, Xiaoming Sheng, Gitte Y Larsen
OBJECTIVES: Current guidelines emphasize early recognition of pediatric septic shock using clinical examination findings. Elevated serum lactate has been associated with increased mortality in adult patients with septic shock. Our objective was to determine the association between the initial serum lactate obtained in the pediatric emergency department (PED) from patients treated for septic shock and the use of vasoactive medication within 24 hours. METHODS: This was a retrospective study from 2008 through 2012 of PED patients at a tertiary care children's hospital...
January 6, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28062334/intensity-of-vasopressor-therapy-for-septic-shock-and-the-risk-of-in-hospital-death
#6
Donald A Brand, Patricia A Patrick, Jeffrey T Berger, Mediha Ibrahim, Ajsza Matela, Shweta Upadhyay, Peter Spiegler
CONTEXT: Given the high mortality of 30-60% associated with septic shock, distinguishing which patients do or do not have a reasonable chance of surviving with aggressive treatment could help clinicians and families make informed decisions. OBJECTIVES: To determine if intensity of vasopressor therapy accurately predicts in-hospital death. METHODS: This observational cohort study analyzed in-hospital mortality as a function of intensity of vasopressor therapy in a consecutive series of adults with septic shock treated over a 4-year period...
January 3, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28056053/soluble-b-and-t-lymphocyte-attenuator-correlates-to-disease-severity-in-sepsis-and-high-levels-are-associated-with-an-increased-risk-of-mortality
#7
Anna Lange, Jonas Sundén-Cullberg, Anders Magnuson, Olof Hultgren
INTRODUCTION AND AIMS: B- and T-lymphocyte Attenuator (BTLA), Cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) and Programmed Death 1 (PD-1) are co-inhibitory receptors that regulate T cell activation. In the present study of ICU-treated patients we measured plasma concentrations of their soluble isoforms, with the aim to evaluate their potential as sepsis biomarkers and utility as prognostic indicators. METHODS: 101 patients with sepsis, 28 patients with non-infectious critical illness (ICU controls) and 31 blood donors (healthy controls, HC) were included in the study...
2017: PloS One
https://www.readbyqxmd.com/read/28054280/successful-bypass-operation-for-esophageal-obstruction-after-acute-esophageal-necrosis-a-case-report
#8
Yayoi Sakatoku, Masahide Fukaya, Kazushi Miyata, Masato Nagino
BACKGROUND: Acute esophageal necrosis (AEN) is a rare clinical disorder. Esophageal stenosis or obstruction is one of severe complications, but there are a few reports about surgical treatments. In such a situation, it still remains controversial which to choose, esophagectomy or bypass operation. CASE PRESENTATION: A 61-year-old woman was admitted to the local hospital for septic shock with diabetic ketoacidosis due to necrotizing fasciitis of the right thigh. Three days later, she had hematemesis, and gastrointestinal endoscopy revealed black mucosal coloration throughout the entire esophagus...
December 2017: Surgical Case Reports
https://www.readbyqxmd.com/read/28040425/safety-and-efficacy-of-folfirinox-in-elderly-patients-with-metastatic-or-locally-advanced-pancreatic-adenocarcinoma-a-retrospective-analysis
#9
C Baldini, A Escande, O Bouché, F El Hajbi, J Volet, V Bourgeois, T Renaut Vantroys, A Ploquin, C Desauw, M Hebbar
BACKGROUND: FOLFIRINOX is a polychemotherapy regimen currently used to treat inoperable pancreatic cancer in patients with a good performance status (PS). FOLFIRINOX lengthens overall survival time (OS), but no specific data are available in elderly patients. METHODS: All cases of inoperable pancreatic adenocarcinoma in patients over 70 years old treated with FOLFIRINOX were retrospectively reviewed between 2008 and 2015 in five institutions in France. The primary objective was to evaluate the safety and efficacy of FOLFIRINOX in the elderly...
December 24, 2016: Pancreatology: Official Journal of the International Association of Pancreatology (IAP) ... [et Al.]
https://www.readbyqxmd.com/read/28040370/benefit-of-extracorporeal-membrane-oxygenation-in-major-burns-after-stun-grenade-explosion-experience-from-a-single-military-medical-center
#10
Po-Shun Hsu, Yi-Ting Tsai, Chih-Yuan Lin, Shyi-Gen Chen, Niann-Tzyy Dai, Cheng-Jung Chen, Jia-Lin Chen, Chien-Sung Tsai
INTRODUCTION: Explosion injury is very common on the battlefield and is associated with major burn and inhalation injuries and subsequent high mortality and morbidity rates. Here we report six victims who suffered from explosion injuries caused by stun grenade; all were treated with extracorporeal membrane oxygenation (ECMO) as salvage therapy. This study was aimed to evaluate the indications and efficacy of ECMO in acute and critically ill major burn patients. METHODS: This was a retrospective analysis of six patients from Tri-Service General Hospital, National Defense Medical Center in Taiwan...
December 28, 2016: Burns: Journal of the International Society for Burn Injuries
https://www.readbyqxmd.com/read/28039606/development-of-a-physiologically-based-pharmacokinetic-modelling-approach-to-predict-the-pharmacokinetics-of-vancomycin-in-critically-ill-septic-patients
#11
Christian Radke, Dagmar Horn, Christian Lanckohr, Björn Ellger, Michaela Meyer, Thomas Eissing, Georg Hempel
BACKGROUND AND OBJECTIVES: Sepsis is characterised by an excessive release of inflammatory mediators substantially affecting body composition and physiology, which can be further affected by intensive care management. Consequently, drug pharmacokinetics can be substantially altered. This study aimed to extend a whole-body physiologically based pharmacokinetic (PBPK) model for healthy adults based on disease-related physiological changes of critically ill septic patients and to evaluate the accuracy of this PBPK model using vancomycin as a clinically relevant drug...
December 31, 2016: Clinical Pharmacokinetics
https://www.readbyqxmd.com/read/28013574/predictive-value-of-serum-albumin-level-for-the-prognosis-of-severe-sepsis-without-exogenous-human-albumin-administration
#12
Mei Yin, Lei Si, Weidong Qin, Chen Li, Jianning Zhang, Hongna Yang, Hui Han, Fan Zhang, Shifang Ding, Min Zhou, Dawei Wu, Xiaomei Chen, Hao Wang
BACKGROUND: The prognostic significance of serum albumin levels in patients with sepsis has previously been reported; however, these studies have not excluded the potential confounding effect of exogenous albumin administration. In this study, we investigate the predictive value of serum albumin for the prognosis of severe sepsis without the interference of exogenous albumin administration. METHODS: A prospective cohort study was conducted from April to November 2014 in the internal and surgical intensive care units of a tertiary care hospital...
January 1, 2016: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28007393/fournier-s-gangrene-during-acth-therapy
#13
Shingo Numoto, Hirokazu Kurahashi, Yoshiteru Azuma, Atsushi Numaguchi, Kozaburo Nakahara, Takahisa Tainaka, Michihiko Takasu, Kiyoshi Yamakawa, Nozomi Nago, Taichiro Muto, Yoshiro Kitagawa, Akihisa Okumura
Fournier's gangrene is an infectious necrotizing fasciitis of the perineal, genital, or perianal regions and is uncommon in children. Adrenocorticotropic hormone (ACTH) is effective for the treatment of infantile spasms; however, suppression of immune function is one of the major adverse effects of this approach. We encountered a 2-month-old boy with infantile spasms that had been treated with ACTH and had developed complicating Fournier's gangrene. Strangulation of a right inguinal hernia was observed after ACTH treatment...
December 19, 2016: Brain & Development
https://www.readbyqxmd.com/read/28005910/melioidosis-in-malaysia-a-review-of-case-reports
#14
Paul Vijay Kingsley, Mark Leader, Nandika Suranjith Nagodawithana, Meghan Tipre, Nalini Sathiakumar
BACKGROUND: Melioidosis is a tropical infectious disease associated with significant mortality due to early onset of sepsis. OBJECTIVE: We sought to review case reports of melioidosis from Malaysia. METHODS: We conducted a computerized search of literature resources including PubMed, OVID, Scopus, MEDLINE and the COCHRANE database to identify published case reports from 1975 to 2015. We abstracted information on clinical characteristics, exposure history, comorbid conditions, management and outcome...
December 2016: PLoS Neglected Tropical Diseases
https://www.readbyqxmd.com/read/27995459/epac-activation-inhibits-il-6-induced-cardiac-myocyte-dysfunction
#15
Huiling Jin, Takayuki Fujita, Meihua Jin, Reiko Kurotani, Yuko Hidaka, Wenqian Cai, Kenji Suita, Rajesh Prajapati, Chen Liang, Yoshiki Ohnuki, Yasumasa Mototani, Masanari Umemura, Utako Yokoyama, Motohiko Sato, Satoshi Okumura, Yoshihiro Ishikawa
Pro-inflammatory cytokines are released in septic shock and impair cardiac function via the Jak-STAT pathway. It is well known that sympathetic and thus catecholamine signaling is activated thereafter to compensate for cardiac dysfunction. The mechanism of such compensation by catecholamine signaling has been traditionally understood to be cyclic AMP-dependent protein kinase (PKA)-mediated enforcement of cardiac contractility. We hypothesized that the exchange protein activated by cAMP (Epac), a newly identified target of cAMP signaling that functions independently of PKA, also plays a key role in this mechanism...
December 19, 2016: Journal of Physiological Sciences: JPS
https://www.readbyqxmd.com/read/27995052/first-case-of-arthrographis-kalrae-fungemia-in-a-patient-with-cystic-fibrosis
#16
Julie Denis, Marcela Sabou, Tristan Degot, Ermanno Candolfi, Valérie Letscher-Bru
Arthrographis kalrae is a hyalin fungus. It is a saprophyte of the environment, mainly found in soil and compost. In recent years, cases of opportunistic infections attributed to this pathogen have been described. Our patient was a 19-year-old woman with cystic fibrosis. She presented a bacterial and fungal pulmonary colonization with Aspergillus fumigatus and Arthrographis. kalrae. After her lung transplantation, she developed an A. kalrae fungemia, treated with caspofungin 50 mg/day associated to liposomal amphotericin B i...
December 2016: Medical Mycology Case Reports
https://www.readbyqxmd.com/read/27993995/in-neonates-s100a8-s100a9-alarmins-prevent-the-expansion-of-a-specific-inflammatory-monocyte-population-promoting-septic-shock
#17
Anna S Heinemann, Sabine Pirr, Beate Fehlhaber, Lara Mellinger, Johanna Burgmann, Mandy Busse, Marco Ginzel, Judith Friesenhagen, Maren von Köckritz-Blickwede, Thomas Ulas, Constantin S von Kaisenberg, Johannes Roth, Thomas Vogl, Dorothee Viemann
The high susceptibility of newborn infants to sepsis is ascribed to an immaturity of the neonatal immune system, but the molecular mechanisms remain unclear. Newborn monocytes massively release the alarmins S100A8/S100A9. In adults, these are major regulators of immunosuppressive myeloid-derived suppressor cells (MDSCs). We investigated whether S100A8/S100A9 cause an expansion of monocytic MDSCs (Mo-MDSCs) in neonates, thereby contributing to an immunocompromised state. Mo-MDSCs have been assigned to CD14(+)/human leukocyte antigen (HLA)-DR(-)(/low)/CD33(+) monocytes in humans and to CD11b(+)/Gr-1(int)/Ly6G(-)/Ly6C(hi) cells in mice...
December 19, 2016: FASEB Journal: Official Publication of the Federation of American Societies for Experimental Biology
https://www.readbyqxmd.com/read/27993631/infectious-complications-after-out-of-hospital-cardiac-arrest-a-comparison-between-two-target-temperatures
#18
Josef Dankiewicz, Niklas Nielsen, Adam Linder, Michael Kuiper, Matthew P Wise, Tobias Cronberg, David Erlinge, Yvan Gasche, Matthew B Harmon, Christian Hassager, Janneke Horn, Jesper Kjaergaard, Tommaso Pellis, Pascal Stammet, Johan Undén, Michael Wanscher, Jørn Wetterslev, Anders Åneman, Susann Ullén, Nicole P Juffermans, Hans Friberg
BACKGROUND: It has been suggested that target temperature management (TTM) increases the probability of infectious complications after cardiac arrest. We aimed to compare the incidence of pneumonia, severe sepsis and septic shock after out-of-hospital cardiac arrest (OHCA) in patients with two target temperatures and to describe changes in biomarkers and possible mortality associated with these infectious complications. METHODS: Post-Hoc analysis of the TTM-trial which randomized patients resuscitated from OHCA to a target temperature of 33 °C or 36 °C...
December 16, 2016: Resuscitation
https://www.readbyqxmd.com/read/27988455/delayed-diagnosis-of-wernicke-encephalopathy-with-irreversible-neural-damage-after-subtotal-gastrectomy-for-gastric-cancer-a-case-of-medical-liability
#19
Pamela Tozzo, Luciana Caenazzo, Daniele Rodriguez, Matteo Bolcato
INTRODUCTION: Wernicke's encephalopathy (WE) is a neurological syndrome caused by thiamine deficiency, and clinically characterized by ophthalmoplegia, ataxia and acute confusion. In developed countries, most cases of WE have been seen in alcohol misusers. Other reported causes are gastrointestinal tract surgery, hyperemesis gravidarum, chronic malnutrition, prolonged total parenteral nutrition without thiamine supplementation, and increased nutrient requirements as in trauma or septic shock...
December 1, 2016: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/27984535/modulation-by-polymyxin-b-hemoperfusion-of-inflammatory-response-related-to-severe-peritonitis
#20
Rémi Coudroy, Didier Payen, Yoann Launey, Anne-Claire Lukaszewicz, Mahmoud Kaaki, Benoit Veber, Olivier Collange, Antoine Dewitte, Laurent Martin-Lefevre, Matthieu Jabaudon, Thomas Kerforne, Martine Ferrandière, Eric Kipnis, Carlos Vela, Stéphanie Chevalier, Jihad Mallat, Sandrine Charreau, Jean-Claude Lecron, René Robert
Conflicting results have been reported on the influence of Polymyxin-B hemoperfusion treatment on systemic inflammation markers. The aim of the study was to assess in a randomized control trial the influence on plasma cytokine concentrations of Polymyxin-B hemoperfusion in septic shock due to peritonitis. A panel of 10 pro- or anti-inflammatory cytokines was measured in 213 patients with peritonitis-induced septic shock enrolled in the randomized trial ABDOMIX testing the impact of 2 Polymyxin-B hemoperfusion sessions with standard treatment...
January 2017: Shock
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