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treating septic shock

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https://www.readbyqxmd.com/read/28338533/sepsis-patients-in-the-emergency-department-stratification-using-the-clinical-impression-score-predisposition-infection-response-and-organ-dysfunction-score-or-quick-sequential-organ-failure-assessment-score
#1
Vincent M Quinten, Matijs van Meurs, Anna E Wolffensperger, Jan C Ter Maaten, Jack J M Ligtenberg
OBJECTIVE: The aim of this study was to compare the stratification of sepsis patients in the emergency department (ED) for ICU admission and mortality using the Predisposition, Infection, Response and Organ dysfunction (PIRO) and quick Sequential Organ Failure Assessment (qSOFA) scores with clinical judgement assessed by the ED staff. PATIENTS AND METHODS: This was a prospective observational study in the ED of a tertiary care teaching hospital. Adult nontrauma patients with suspected infection and at least two Systemic Inflammatory Response Syndrome criteria were included...
March 23, 2017: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
https://www.readbyqxmd.com/read/28337880/effects-of-anesthesia-using-propofol-and-etomidate-on-t-lymphocyte-subpopulation-of-infectious-shock-patients-in-perioperative-period
#2
Y Wang, J Zhang, S J Zhang
Infectious or septic shock is induced when a toxic microorganism invades blood circulation in the human body. Emergency operation is an effective method for treating infectious shock in the early stages although the use of anesthesia is more complex due to the internal disorders caused by the disease. This study explored the effects of propofol and etomidate anesthesia on the cellular immune function (T lymphocyte subpopulation) of infectious shock patients, aiming to provide a basis for the selection of the proper anesthetic method...
January 2017: Journal of Biological Regulators and Homeostatic Agents
https://www.readbyqxmd.com/read/28331537/combined-totally-mini-invasive-approach-in-necrotizing-pancreatitis-a-case-report-and-systematic-literature-review
#3
REVIEW
Luca Sorrentino, Osvaldo Chiara, Massimiliano Mutignani, Fabrizio Sammartano, Paolo Brioschi, Stefania Cimbanassi
BACKGROUND: Currently, both the step-up approach, combining percutaneous drainage (PD) and video-assisted retroperitoneal debridement (VARD), and endoscopic transgastric necrosectomy (ETN) are mini-invasive techniques for infected necrosis in severe acute pancreatitis. A combination of these approaches could maximize the management of necrotizing pancreatitis, conjugating the benefits from both the experiences. However, reporting of this combined strategy is anecdotal. This is the first reported case of severe necrotizing pancreatitis complicated by biliary fistula treated by a combination of ETN, PD, VARD, and endoscopic biliary stenting...
2017: World Journal of Emergency Surgery: WJES
https://www.readbyqxmd.com/read/28329088/short-course-adjunctive-gentamicin-as-empirical-therapy-in-patients-with-severe-sepsis-and-septic-shock-a-prospective-observational-cohort-study
#4
David S Y Ong, Jos F Frencken, Peter M C Klein Klouwenberg, Nicole Juffermans, Tom van der Poll, Marc Bonten, Olaf Cremer
Background.: Meta-analyses failed to demonstrate clinical benefits of beta lactam plus aminoglycoside combination therapy, compared to beta lactam monotherapy, in patients with sepsis. However, few data exist on the effects of short-course adjunctive aminoglycoside therapy in sepsis patients with organ failure or shock. Methods.: We prospectively enrolled consecutive patients with severe sepsis or septic shock in two intensive care units in the Netherlands from 2011 to 2015...
February 28, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/28301890/kasuistik-late-onset-small-fiber-neuropathie-nach-kritischer-erkrankung
#5
Susanne Koch, Rabih Moshourab, Tobias Wollersheim, Claudia Spies, Thomas Fritzsche, Steffen Weber-Carstens
A 42-year-old patient presented with acute allodynia and hyperalgesia in her distal limbs, most severe in the innervation area of the ulnar nerve. The patient developed critical illness myopathy/polyneuropathy after septic shock 5 months prior to her presentation. After exclusion of differential diagnosis, "late onset small fiber neuropathy" after critical illness was diagnosed. Recent studies showed small fiber lesions during critical illness and in follow-up exams, where additionally neuropathic pain were proved...
March 2017: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
https://www.readbyqxmd.com/read/28298525/the-induction-of-pro-il-1%C3%AE-by-lipopolysaccharide-requires-endogenous-prostaglandin-e2-production
#6
Zbigniew Zasłona, Eva M Pålsson-McDermott, Deepthi Menon, Moritz Haneklaus, Ewelina Flis, Hannah Prendeville, Sarah E Corcoran, Marc Peters-Golden, Luke A J O'Neill
PGE2 has been shown to increase the transcription of pro-IL-1β. However, recently it has been demonstrated that PGE2 can block the maturation of IL-1β by inhibiting the NLRP3 inflammasome in macrophages. These apparently conflicting results have led us to reexamine the effect of PGE2 on IL-1β production. We have found that in murine bone marrow-derived macrophages, PGE2 via the cAMP/protein kinase A pathway is potently inducing IL-1β transcription, as well as boosting the ability of LPS to induce IL-1β mRNA and pro-IL-1β while inhibiting the production of TNF-α...
March 15, 2017: Journal of Immunology: Official Journal of the American Association of Immunologists
https://www.readbyqxmd.com/read/28293000/-endobronchial-watanabe-spigot-in-treating-pleural-empyema-with-fistula
#7
Atsushi Sekimura, Takashi Yoshimatsu, Naoki Yamashita, Hanae Higa, Takeaki Miyata, Daigo Kawano, Tetsuya So
For pleural empyema with fistula, fenestration and subsequent omental plombage, and thoracoplasty are frequently necessary. A 57-year-old man was transported by ambulance because of impaired consciousness and septic shock due to pleural empyema on the right caused by a ruptured lung abscess. We performed empyema curettage urgently, drained 800 ml of purulent pleural effusion, and inserted 3 chest tubes. Postoperative air leakage from the ruptured lung abscess of the middle lobe was noted, and respiratory failure was prolonged...
March 2017: Kyobu Geka. the Japanese Journal of Thoracic Surgery
https://www.readbyqxmd.com/read/28288463/guide-to-treatment-of-tattoo-complications-and-tattoo-removal
#8
Jørgen Serup, Wolfgang Bäumler
Clinicians in the fields of general medicine, dermatology, and plastic surgery are in their work now and then confronted with tattoo complications. Recognizing the rather few important diagnostic groups and urgencies, the medical 'decision tree' of treatment becomes quite simple. Acute conditions are dominated by bacterial infections needing antibiotic treatment. Systemic infection is a matter of urgency and requires intravenous treatment in a hospital without delay to prevent septic shock. Inflammatory reactions are a real challenge...
2017: Current Problems in Dermatology
https://www.readbyqxmd.com/read/28288453/medical-treatment-of-tattoo-complications
#9
Jørgen Serup
Tattooing is a skin trauma and involves a special vulnus punctatum (with inserted tattoo ink, a vulnus venenatum), which should heal with no infection and no local complication. Local treatment in the healing phase ideally builds on the 'moist wound' principle using plastic film, hydrocolloids, silver dressing, and compression. Bacterial infections during healing are treated with oral antibiotics, and a list of first-line antibiotics is proposed. Notice is given to severe infections with affected general condition, and it is emphasized that intravenous antibiotic treatment must be instituted as early as possible to prevent septic shock and death...
2017: Current Problems in Dermatology
https://www.readbyqxmd.com/read/28281216/a-hypoperfusion-context-may-aid-to-interpret-hyperlactatemia-in-sepsis-3-septic-shock-patients-a-proof-of-concept-study
#10
Leyla Alegría, Magdalena Vera, Jorge Dreyse, Ricardo Castro, David Carpio, Carolina Henriquez, Daniela Gajardo, Sebastian Bravo, Felipe Araneda, Eduardo Kattan, Pedro Torres, Gustavo Ospina-Tascón, Jean-Louis Teboul, Jan Bakker, Glenn Hernández
BACKGROUND: Persistent hyperlactatemia is particularly difficult to interpret in septic shock. Besides hypoperfusion, adrenergic-driven lactate production and impaired lactate clearance are important contributors. However, clinical recognition of different sources of hyperlactatemia is unfortunately not a common practice and patients are treated with the same strategy despite the risk of over-resuscitation in some. Indeed, pursuing additional resuscitation in non-hypoperfusion-related cases might lead to the toxicity of fluid overload and vasoactive drugs...
December 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28263710/role-of-piperacillin-tazobactam-as-a-carbapenem-sparing-antibiotic-for-treatment-of-acute-pyelonephritis-due-to-extended-spectrum-%C3%AE-lactamase-producing-escherichia-coli
#11
Young Kyung Yoon, Jong Hun Kim, Jang Wook Sohn, Kyung Sook Yang, Min Ja Kim
Extended-spectrum β-lactamase-producing Escherichia coli (ESBL-Ec) is a frequent cause of acute pyelonephritis (APN), requiring carbapenem therapy. However, alternatives to carbapenems are needed due to the emergence of carbapenemase-producing micro-organisms. The purpose of this study was to compare the clinical efficacy of piperacillin/tazobactam (TZP) versus ertapenem in the treatment of adult patients with APN caused by ESBL-Ec. A retrospective observational study of APN caused by ESBL-Ec susceptible to TZP was performed at a university-affiliated hospital in the Republic of Korea between February 2011 and June 2013...
March 1, 2017: International Journal of Antimicrobial Agents
https://www.readbyqxmd.com/read/28261769/evaluation-of-risk-factors-and-development-of-acute-kidney-injury-in-aneurysmal-subarachnoid-hemorrhage-head-injury-and-severe-sepsis-septic-shock-patients-during-icu-treatment
#12
Ceren Kamar, Achmet Ali, Demet Altun, Günseli Orhun, Akın Sabancı, Altay Sencer, İbrahim Özkan Akıncı
BACKGROUND: There are few studies examining development of acute kidney injury (AKI) in the various types of patients in intensive care units (ICUs). Presently described is evaluation of risk factors and development of AKI in different groups of ICU patients. METHODS: Present study was performed in 3 different ICUs. Development of AKI was measured using Acute Kidney Injury Network (AKIN) classification system. Total of 300 patients who were treated in trauma, neurosurgery, or general ICU departments (due to head injury, aneurysmal subarachnoid hemorrhage [aSAH], or severe sepsis/septic shock, respectively) were assessed for incidence, risk factors, and development of AKI...
January 2017: Ulusal Travma Ve Acil Cerrahi Dergisi, Turkish Journal of Trauma & Emergency Surgery: TJTES
https://www.readbyqxmd.com/read/28257914/spontaneous-rupture-into-the-peritoneal-cavity-unusual-presentation-of-prostatic-abscess
#13
Sahbi Naouar, Nidhal Ati, Salem Braiek, Rafik El Kamel
INTRODUCTION: Prostatic abscess is a rare but relatively serious infectious disease; its association with spontaneous rupture is extremely unusual. PRESENTATION OF CASE: We present a case of peritonitis secondary to a rupture of prostatic abscess in a 87-year-old man. The diagnosis was made on computed tomography. Emergency laparotomy, transrectal ultrasonography guided aspiration of the residual abscess and antibiotics permitted a full recovery. DISCUSSION: Delay in diagnosis of prostatic abscess can have grave sequelae, including spontaneous rupture into the urethra, perineum, bladder or rectum and the development of septic shock...
February 14, 2017: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/28257752/efficacy-and-safety-of-idelalisib-in-combination-with-ofatumumab-for-previously-treated-chronic-lymphocytic-leukaemia-an-open-label-randomised-phase-3-trial
#14
Jeffrey A Jones, Tadeusz Robak, Jennifer R Brown, Farrukh T Awan, Xavier Badoux, Steven Coutre, Javier Loscertales, Kerry Taylor, Elisabeth Vandenberghe, Malgorzata Wach, Nina Wagner-Johnston, Loic Ysebaert, Lyndah Dreiling, Ronald Dubowy, Guan Xing, Ian W Flinn, Carolyn Owen
BACKGROUND: Idelalisib, a selective inhibitor of PI3Kδ, is approved for the treatment of patients with relapsed chronic lymphocytic leukaemia (CLL) in combination with rituximab. We aimed to assess the efficacy and safety of idelalisib in combination with a second-generation anti-CD20 antibody, ofatumumab, in a similar patient population. METHODS: In this global, open-label, randomised, controlled phase 3 trial, we enrolled patients with relapsed CLL progressing less than 24 months from last therapy...
March 2017: Lancet Haematology
https://www.readbyqxmd.com/read/28247301/il-6-rs1800795-polymorphism-is-associated-with-septic-shock-related-death-in-patients-who-underwent-major-surgery-a-preliminary-retrospective-study
#15
Maria Angeles Jiménez-Sousa, Luz Maria Medrano, Pilar Liu, Amanda Fernández-Rodríguez, Raquel Almansa, Esther Gomez-Sanchez, Alicia Ortega, María Heredia-Rodríguez, Estefanía Gómez-Pesquera, Eduardo Tamayo, Salvador Resino
BACKGROUND: Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection, being the primary cause of death from infection, especially if not recognized and treated promptly. The aim of this study was to analyze whether IL-6 rs1800795 polymorphism is associated with septic shock-related death in European white patients who underwent major surgery. METHODS: We performed a retrospective study on 202 septic shock patients who underwent major cardiac or abdominal surgery...
December 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28240688/repeated-piperacillin-tazobactam-plasma-concentration-measurements-in-severely-obese-versus-nonobese-critically-ill-septic-patients-and-the-risk-of-under-and-overdosing
#16
Boris Jung, Martin Mahul, Dominique Breilh, Rachel Legeron, Jeremy Signe, Helene Jean-Pierre, Anne-Catrin Uhlemann, Nicolas Molinari, Samir Jaber
OBJECTIVE: Obesity and critical illness modify pharmacokinetics of antibiotics, but piperacillin-tazobactam continuous IV infusion pharmacokinetics has been poorly studied in obese critically ill patients. We aimed to compare pharmacokinetics of piperacillin in severely obese and nonobese patients with severe sepsis or septic shock. We hypothesized that plasma concentration variability would expose the critically ill to both piperacillin under and overdosing. METHODS: Prospective comparative study...
February 24, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28229893/safety-and-efficacy-of-natalizumab-in-patients-with-acute-ischaemic-stroke-action-a-randomised-placebo-controlled-double-blind-phase-2-trial
#17
Jacob Elkins, Roland Veltkamp, Joan Montaner, S Claiborne Johnston, Aneesh B Singhal, Kyra Becker, Maarten G Lansberg, Weihua Tang, Ih Chang, Kumar Muralidharan, Sarah Gheuens, Lahar Mehta, Mitchell S V Elkind
BACKGROUND: In animal models of acute ischaemic stroke, blocking of the leukocyte-endothelium adhesion by antagonism of α4 integrin reduces infarct volumes and improves outcomes. We assessed the effect of one dose of natalizumab, an antibody against the leukocyte adhesion molecule α4 integrin, in patients with acute ischaemic stroke. METHODS: In this double-blind, phase 2 study, patients with acute ischaemic stroke (aged 18-85 years) from 30 US and European clinical sites were randomly assigned (1:1) to 300 mg intravenous natalizumab or placebo with stratification by treatment window and baseline infarct size...
March 2017: Lancet Neurology
https://www.readbyqxmd.com/read/28219612/hyperoxia-and-hypertonic-saline-in-patients-with-septic-shock-hypers2s-a-two-by-two-factorial-multicentre-randomised-clinical-trial
#18
Pierre Asfar, Frédérique Schortgen, Julie Boisramé-Helms, Julien Charpentier, Emmanuel Guérot, Bruno Megarbane, David Grimaldi, Fabien Grelon, Nadia Anguel, Sigismond Lasocki, Matthieu Henry-Lagarrigue, Frédéric Gonzalez, François Legay, Christophe Guitton, Maleka Schenck, Jean Marc Doise, Jérôme Devaquet, Thierry Van Der Linden, Delphine Chatellier, Jean Philippe Rigaud, Jean Dellamonica, Fabienne Tamion, Ferhat Meziani, Alain Mercat, Didier Dreyfuss, Valérie Seegers, Peter Radermacher
BACKGROUND: There is insufficient research into the use of mechanical ventilation with increased inspiratory oxygen concentration (FiO2) and fluid resuscitation with hypertonic saline solution in patients with septic shock. We tested whether these interventions are associated with reduced mortality. METHODS: This two-by-two factorial, multicentre, randomised, clinical trial (HYPERS2S) recruited patients aged 18 years and older with septic shock who were on mechanical ventilation from 22 centres in France...
February 14, 2017: Lancet Respiratory Medicine
https://www.readbyqxmd.com/read/28218357/prostatic-abscess-in-a-patient-with-chronic-granulomatous-disease-a-multi-disciplinary-intervention
#19
Alberto Martini, Ioannis Katafigiotis, Sofia Kalantzi, Ioannis Anastasiou, Ioannis Adamakis, Aggelos Toskas, Constantinos A Constantinides
INTRODUCTION: Chronic granulomatous disease (CGD) is a rare pathology that increases patients' susceptibility to infections, given the inability to generate oxygen radicals to fight microorganisms.In the context of CGD, primary prostatic involvement has been described only once in the past, in a pediatric patient. CASE REPORT: We report the case of a 35-year old patient with CGD presenting with persistent fever. After hospital admission, blood and urine were sent for culture and antibiotic therapy was initiated...
February 8, 2017: Urologia
https://www.readbyqxmd.com/read/28213892/opportunities-for-repurposing-of-poly-adp-ribose-polymerase-parp-inhibitors-for-the-therapy-of-non-oncological-diseases
#20
REVIEW
Nathan A Berger, Valerie C Besson, A Hamid Boulares, Alexander Bürkle, Alberto Chiarugi, Robert S Clark, Nicola J Curtin, Salvatore Cuzzocrea, Ted M Dawson, Valina L Dawson, György Haskó, Lucas Liaudet, Flavio Moroni, Pál Pacher, Peter Radermacher, Andrew L Salzman, Solomon H Snyder, Francisco Garcia Soriano, Robert P Strosznajder, Balázs Sümegi, Raymond A Swanson, Csaba Szabo
The recent clinical availability of the PARP inhibitor Lynparza (olaparib) opens the door for potential therapeutic repurposing for non-oncological indications. Considering (a) the preclinical efficacy data with PARP inhibitors in non-oncological diseases and (b) the risk-benefit ratio of treating patients with a compound that inhibits an enzyme that has physiological roles in the regulation of DNA repair, indications where (a) the severity of the disease is high, (b) the available therapeutic options are limited, and (c) the duration of PARP inhibitor administration could be short, provide first-line options for therapeutic repurposing...
February 18, 2017: British Journal of Pharmacology
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