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Lethal triad

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https://www.readbyqxmd.com/read/28470638/-management-of-massive-intraoperative-blood-loss-using-a-case-study
#1
Andreas Pape, Angelo Ippolito, Joanna Warszawska, Florian Raimann, Kai Zacharowski
Massive intraoperative bleeding is a major and potentially life-threatening complication during surgical procedures. The lethal triade of hemorrhagic shock with metabolic acidosis, hypothermia and coagulopathy enhances bleeding tendency. Avoiding this vitious circle requires a well-structured and standardized procedure. Primary goals include the maintenance of adequate tissue oxygenation, restauration of proper coagulatory function, normothermia and homeostasis of acid-base and electrolyte balance. In the present article, these therapeutic goals and their pathophysiological background are illustrated with a clinical case example...
April 2017: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
https://www.readbyqxmd.com/read/28270616/structure-of-deformed-wing-virus-a-major-honey-bee-pathogen
#2
Karel Škubník, Jiří Nováček, Tibor Füzik, Antonín Přidal, Robert J Paxton, Pavel Plevka
The worldwide population of western honey bees (Apis mellifera) is under pressure from habitat loss, environmental stress, and pathogens, particularly viruses that cause lethal epidemics. Deformed wing virus (DWV) from the family Iflaviridae, together with its vector, the mite Varroa destructor, is likely the major threat to the world's honey bees. However, lack of knowledge of the atomic structures of iflaviruses has hindered the development of effective treatments against them. Here, we present the virion structures of DWV determined to a resolution of 3...
March 21, 2017: Proceedings of the National Academy of Sciences of the United States of America
https://www.readbyqxmd.com/read/28266699/rapidly-progressive-and-almost-lethal-pneumonia
#3
Juancarlo Martínez-González, Carlos Robles-Arias, William Rodríguez-Cintrón
We herein describe the case of a 65-year-old male patient who presented with Osler's triad, which is the combination of endocarditis, pneumonia, and meningitis. This report is even more unusual since the pathogen isolated was the invasive and virulent strain of Streptococcus pneumoniae serotype 3. The clinical entity described is also called Austrian syndrome. Even though rare in this antibiotic era, the syndrome remains one of high morbidity and mortality. This particular case is of paramount importance for the clinician reader...
March 2017: Puerto Rico Health Sciences Journal
https://www.readbyqxmd.com/read/28159434/-and-if-it-happened-to-children-adapting-medical-care-during-terrorist-attacks-with-multiple-pediatric-victims
#4
L Alix-Séguin, N Lodé, G Orliaguet, E Chamorro, F Kerroué, C Lorge, A Moreira
In light of the recent terrorist attacks in Europe, we need to reconsider the organization of rescue and medical management and plan for an attack involving multiple pediatric victims. To ensure quick surgical management, but also to minimize risk for on-site teams (direct threats from secondary terrorist attacks targeting deployed emergency services), it is crucial to evacuate patients in a swift but orderly fashion. Children are vulnerable targets in terrorist attacks. Their anatomical and physiological characteristics make it likely that pediatric victims will suffer more brain injuries and require more, often advanced, airway management...
March 2017: Archives de Pédiatrie: Organe Officiel de la Sociéte Française de Pédiatrie
https://www.readbyqxmd.com/read/27926660/radioembolization-induced-liver-disease-a-systematic-review
#5
Manon N G J A Braat, Karel J van Erpecum, Bernard A Zonnenberg, Maurice A J van den Bosch, Marnix G E H Lam
Radioembolization (RE) is a relatively novel treatment modality for primary and secondary hepatic malignancies. Microspheres embedded with a β-emitting radioisotope are injected into the hepatic artery, resulting in microsphere deposition in the tumor arterioles and normal portal triads. Microsphere deposition in nontumorous parenchyma can result in radiation-induced liver injury, with lethal RE-induced liver disease (REILD) at the outer end of the spectrum. The primary aim of this study was to evaluate RE-related hepatotoxicity and present an overview of the currently applied definitions and clinically relevant characteristics of REILD...
February 2017: European Journal of Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/27914759/fluid-management-in-patients-with-trauma-restrictive-versus-liberal-approach
#6
REVIEW
Lee Palmer
Massive hemorrhage remains a major cause of traumatic deaths. The ideal fluid resuscitative strategy is much debated. Research has provided inconsistent results regarding which fluid strategy is ideal; the optimum fluid type, timing, and volume remains elusive. Aggressive large-volume resuscitation has been the mainstay based on controlled hemorrhage animal models. For uncontrolled hemorrhagic shock, liberal fluid resuscitative strategies exacerbate the lethal triad, invoke resuscitative injury, and increase mortality while more restrictive fluid strategies tend to ameliorate trauma-induced coagulopathy and favor a greater chance of survival...
March 2017: Veterinary Clinics of North America. Small Animal Practice
https://www.readbyqxmd.com/read/27895932/coagulation-complications-following-trauma
#7
REVIEW
Wenjun Z Martini
Traumatic injury is one of the leading causes of death, with uncontrolled hemorrhage from coagulation dysfunction as one of the main potentially preventable causes of the mortality. Hypothermia, acidosis, and resuscitative hemodilution have been considered as the significant contributors to coagulation manifestations following trauma, known as the lethal triad. Over the past decade, clinical observations showed that coagulopathy may be present as early as hospital admission in some severely injured trauma patients...
2016: Military Medical Research
https://www.readbyqxmd.com/read/27854071/staged-laparotomies-based-on-the-damage-control-principle-to-treat-hemodynamically-unstable-grade-iv-blunt-hepatic-injury-in-an-eight-year-old-girl
#8
Takashi Kobayashi, Masayuki Kubota, Yuhki Arai, Toshiyuki Ohyama, Naoki Yokota, Kohei Miura, Hirosuke Ishikawa, Daiki Soma, Kazuyasu Takizawa, Jun Sakata, Masayuki Nagahashi, Hitoshi Kameyama, Toshifumi Wakai
BACKGROUND: Severe blunt hepatic injury is a major cause of morbidity and mortality in pediatric patients. Damage control (DC) surgery has been reported to be useful in severely compromised children with hepatic injury. We applied such a technique in the treatment of a case of hemodynamically unstable grade IV blunt hepatic injury in an eight-year-old girl. This case is the first to use multimodal approaches including perihepatic packing, temporary closure of the abdominal wall with a plastic sheet, transarterial embolization (TAE), and planned delayed anatomical hepatic resection in a child...
December 2016: Surgical Case Reports
https://www.readbyqxmd.com/read/27816374/in-vivo-screen-of-genetically-conserved-streptococcus-pneumoniae-proteins-for-protective-immunogenicity
#9
Richard J Anderson, Siradanahalli Guru, Risini Weeratna, Shawn Makinen, Derek J Falconer, Neil C Sheppard, Susanne Lang, Bingsheng Chang, Anne-Laure Goenaga, Bruce A Green, James R Merson, Stephen J Gracheck, Jim E Eyles
We evaluated 52 different E. coli expressed pneumococcal proteins as immunogens in a BALB/c mouse model of S. pneumoniae lung infection. Proteins were selected based on genetic conservation across disease-causing serotypes and bioinformatic prediction of antibody binding to the target antigen. Seven proteins induced protective responses, in terms of reduced lung burdens of the serotype 3 pneumococci. Three of the protective proteins were histidine triad protein family members (PhtB, PhtD and PhtE). Four other proteins, all bearing LPXTG linkage domains, also had activity in this model (PrtA, NanA, PavB and Eng)...
December 7, 2016: Vaccine
https://www.readbyqxmd.com/read/27811561/haemostatic-resuscitation-in-trauma-the-next-generation
#10
Jakob Stensballe, Sisse R Ostrowski, Pär I Johansson
PURPOSE OF REVIEW: To discuss the recent developments in and evolvement of next generation haemostatic resuscitation in bleeding trauma. RECENT FINDINGS: Mortality from major trauma is a worldwide problem, and massive haemorrhage remains a major cause of potentially preventable deaths. Development of coagulopathy further increases trauma mortality emphasizing that coagulopathy is a key target in the phase of bleeding. The pathophysiology of coagulopathy in trauma reflects at least three distinct mechanisms that may be present isolated or coexist: acute traumatic coagulopathy, coagulopathy associated with the lethal triad, and consumptive coagulopathy...
December 2016: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/27644948/idiopathic-pulmonary-haemosiderosis-in-paediatric-patients-how-to-make-an-early-diagnosis
#11
Luca Castellazzi, Maria Francesca Patria, Gemma Frati, Andrea Alessandro Esposito, Susanna Esposito
BACKGROUND: Idiopathic pulmonary haemosiderosis (IPH) is a rare but potentially lethal condition in paediatric patients. This condition is considered an immune-mediated disorder, but its pathogenesis is still unknown. Idiopathic pulmonary haemosiderosis is characterized by the classical triad of haemoptysis, iron-deficiency anaemia, and diffuse parenchymal consolidation on chest radiology. Unfortunately, this triad of signs is not frequent in children at the onset of this disease, resulting in a delay in diagnosis and a negative outcome...
September 20, 2016: Italian Journal of Pediatrics
https://www.readbyqxmd.com/read/27630820/three-atypical-lethal-cases-associated-with-acute-zika-virus-infection-in-suriname
#12
Rens Zonneveld, Jimmy Roosblad, Jan Willem van Staveren, Jan C Wilschut, Stephen G S Vreden, John Codrington
Acute Zika virus infection usually presents with a self-limiting triad of fever, rash and arthritis. There is limited information on severe or lethal cases. We report three cases of lethal acute Zika infection, confirmed with polymerase chain reaction, in adult patients with some co-morbidities. The patients showed rapid clinical deterioration with hemorrhagic and septic shock, and exaggerated acute and innate inflammatory responses with pronounced coagulopathy, and died soon after admission to the hospital...
2016: IDCases
https://www.readbyqxmd.com/read/27555780/alpers-huttenlocher-syndrome-the-role-of-a-multidisciplinary-health-care-team
#13
REVIEW
Russell P Saneto
Alpers-Huttenlocher syndrome (AHS) is a mitochondrial DNA-depletion syndrome. Age of onset is bimodal: early onset at 2-4 years and later adolescent onset at 17-24 years of age. Early development is usually normal, with epilepsy heralding the disorder in ~50% of patients. The onset of seizures is coupled with progressive cognitive decline. Hepatopathy is variable, and when present is a progressive dysfunction leading to liver failure in many cases. These features of seizures, cognitive degeneration, and hepatopathy represent the "classic triad" of AHS...
2016: Journal of Multidisciplinary Healthcare
https://www.readbyqxmd.com/read/27279610/virion-structure-of-iflavirus-slow-bee-paralysis-virus-at-2-6-angstrom-resolution
#14
Sergei Kalynych, Antonín Přidal, Lenka Pálková, Yevgen Levdansky, Joachim R de Miranda, Pavel Plevka
UNLABELLED: The western honeybee (Apis mellifera) is the most important commercial insect pollinator. However, bees are under pressure from habitat loss, environmental stress, and pathogens, including viruses that can cause lethal epidemics. Slow bee paralysis virus (SBPV) belongs to the Iflaviridae family of nonenveloped single-stranded RNA viruses. Here we present the structure of the SBPV virion determined from two crystal forms to resolutions of 3.4 Å and 2.6 Å. The overall structure of the virion resembles that of picornaviruses, with the three major capsid proteins VP1 to 3 organized into a pseudo-T3 icosahedral capsid...
August 15, 2016: Journal of Virology
https://www.readbyqxmd.com/read/27195187/granulomatosis-with-polyangiitis-wegener-s-disease-an-updated-review-of-ocular-disease-manifestations
#15
REVIEW
Buraa Kubaisi, Khawla Abu Samra, C Stephen Foster
Granulomatosis with polyangiitis (GPA) is a potentially lethal systemic disorder that is characterized by necrotizing vasculitis of small arteries and veins. The respiratory system is most commonly affected in limited forms of the disease, however upper and lower respiratory system, systemic vasculitis, and necrotizing glomerulonephritis are the characteristic components of the disease triad. The peak incidence is observed at 64-75 years of age, with a prevalence of 8-10 per million depending on geographic location...
May 2016: Intractable & Rare Diseases Research
https://www.readbyqxmd.com/read/27185009/accidental-hypothermia-in-severe-trauma
#16
REVIEW
Fanny Vardon, Ségolène Mrozek, Thomas Geeraerts, Olivier Fourcade
Hypothermia, along with acidosis and coagulopathy, is part of the lethal triad that worsen the prognosis of severe trauma patients. While accidental hypothermia is easy to identify by a simple measurement, it is no less pernicious if it is not detected or treated in the initial phase of patient care. It is a multifactorial process and is a factor of mortality in severe trauma cases. The consequences of hypothermia are many: it modifies myocardial contractions and may induce arrhythmias; it contributes to trauma-induced coagulopathy; from an immunological point of view, it diminishes inflammatory response and increases the chance of pneumonia in the patient; it inhibits the elimination of anaesthetic drugs and can complicate the calculation of dosing requirements; and it leads to an over-estimation of coagulation factor activities...
October 2016: Anaesthesia, Critical Care & Pain Medicine
https://www.readbyqxmd.com/read/27176127/controlled-hypotension-versus-normotensive-resuscitation-strategy-for-people-with-ruptured-abdominal-aortic-aneurysm
#17
REVIEW
Daniel H Moreno, Daniel G Cacione, Jose C C Baptista-Silva
BACKGROUND: An abdominal aortic aneurysm (AAA) is the pathological enlargement of the aorta and can develop in both men and women. Progressive aneurysm enlargement can lead to rupture. The rupture of an AAA is frequently fatal and accounts for the death from haemorrhagic shock of at least 45 people per 100,000 population. The outcome of people with ruptured AAA varies among countries and healthcare systems, with mortality ranging from 53% to 90%. Definitive treatment for ruptured AAA includes open surgery or endovascular repair...
May 13, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27133449/a-burkholderia-type-vi-effector-deamidates-rho-gtpases-to-activate-the-pyrin-inflammasome-and-trigger-inflammation
#18
Daniel F Aubert, Hao Xu, Jieling Yang, Xuyan Shi, Wenqing Gao, Lin Li, Fabiana Bisaro, She Chen, Miguel A Valvano, Feng Shao
Burkholderia cenocepacia is an opportunistic pathogen of the cystic fibrosis lung that elicits a strong inflammatory response. B. cenocepacia employs a type VI secretion system (T6SS) to survive in macrophages by disarming Rho-type GTPases, causing actin cytoskeletal defects. Here, we identified TecA, a non-VgrG T6SS effector responsible for actin disruption. TecA and other bacterial homologs bear a cysteine protease-like catalytic triad, which inactivates Rho GTPases by deamidating a conserved asparagine in the GTPase switch-I region...
May 11, 2016: Cell Host & Microbe
https://www.readbyqxmd.com/read/27046085/development-of-novel-criteria-of-the-lethal-triad-as-an-indicator-of-decision-making-in-current-trauma-care-a-retrospective-multicenter-observational-study-in-japan
#19
Akira Endo, Atsushi Shiraishi, Yasuhiro Otomo, Shigeki Kushimoto, Daizoh Saitoh, Mineji Hayakawa, Hiroshi Ogura, Kiyoshi Murata, Akiyoshi Hagiwara, Junichi Sasaki, Tetsuya Matsuoka, Toshifumi Uejima, Naoto Morimura, Hiroyasu Ishikura, Munekazu Takeda, Naoyuki Kaneko, Hiroshi Kato, Daisuke Kudo, Takashi Kanemura, Takayuki Shibusawa, Yasushi Hagiwara, Shintaro Furugori, Yoshihiko Nakamura, Kunihiko Maekawa, Gou Mayama, Arino Yaguchi, Shiei Kim, Osamu Takasu, Kazutaka Nishiyama
OBJECTIVES: To evaluate the utility of the conventional lethal triad in current trauma care practice and to develop novel criteria as indicators of treatment strategy. DESIGN: Retrospective observational study. SETTINGS: Fifteen acute critical care medical centers in Japan. PATIENTS: In total, 796 consecutive trauma patients who were admitted to emergency departments with an injury severity score of greater than or equal to 16 from January 2012 to December 2012...
September 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27040162/critical-controllability-in-proteome-wide-protein-interaction-network-integrating-transcriptome
#20
Masayuki Ishitsuka, Tatsuya Akutsu, Jose C Nacher
Recently, the number of essential gene entries has considerably increased. However, little is known about the relationships between essential genes and their functional roles in critical network control at both the structural (protein interaction network) and dynamic (transcriptional) levels, in part because the large size of the network prevents extensive computational analysis. Here, we present an algorithm that identifies the critical control set of nodes by reducing the computational time by 180 times and by expanding the computable network size up to 25 times, from 1,000 to 25,000 nodes...
April 4, 2016: Scientific Reports
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