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https://www.readbyqxmd.com/read/28749627/acute-kidney-injury-in-pediatric-patients-diagnosis-and-management-in-the-emergency-department-digest
#1
Daniel Mohrer, Melissa Langhan, Pradip Chaudhari
Pediatric acute kidney injury is a condition that is underdiagnosed among children seen in the emergency department, and it has been associated with significant morbidity and mortality, including increased risk for chronic kidney disease. The most common etiologies in pediatric patients are now known to be due to hypovolemia, sepsis, shock, and cardiac dysfunction. This issue compares 3 classification systems for the diagnosis and staging of acute kidney injury and reviews the etiologies that lead to kidney injury in children...
May 22, 2017: Pediatric Emergency Medicine Practice
https://www.readbyqxmd.com/read/28746898/circulating-levels-of-the-angiogenesis-mediators-endoglin-hb-egf-bmp-9-and-fgf-2-in-patients-with-severe-sepsis-and-septic-shock
#2
Vanessa Boury Faiotto, Daniel Franci, Rodolfo Monteiro Enz Hubert, Gleice Regina de Souza, Maiara Marx Luz Fiusa, Bidossessi Wilfried Hounkpe, Thiago Martins Santos, Marco Antonio Carvalho-Filho, Erich Vinicius De Paula
PURPOSE: Endothelial barrier dysfunction is a hallmark of sepsis, and is at least partially mediated by pathways that regulate endothelial barrier assembly during angiogenesis. Not surprisingly, increased levels of key angiogenic proteins such as VEGF-A and Angiopoietin-2 have been described in sepsis. The purpose of this study was to investigate if additional pathways that regulate endothelial barrier integrity during angiogenesis could also be involved in the host response of sepsis...
July 17, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28745253/-gastrointestinal-symptoms-with-meningococcal-infection-emergence-of-neisseria-meningitidis-serogroup-w
#3
H F Wunderink, I N Vlasveld, M J Knol, A van der Ende, E H R van Essen, E J Kuijper
BACKGROUND: Meningococcal disease usually presents as meningitis and/or septicaemia, but can also present as pneumonia or arthritis. Since 2000, a worldwide increase in meningococcal disease is reported which is caused by a new virulent clone of serogroup W (MenW:cc11). This subtype is more likely to give an atypical clinical presentation and results in high mortality rates. CASE DESCRIPTION: A 68-year-old woman with polymyalgia rheumatica, managed with prednisone, developed an acute gastrointestinal syndrome of nausea, diarrhoea, vomiting, fever and chills...
2017: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/28743646/sepsis-and-septic-shock-new-definitions-new-diagnostic-and-therapeutic-approaches
#4
REVIEW
Silvano Esposito, Giuseppe De Simone, Giovanni Boccia, Francesco De Caro, Pasquale Pagliano
Sepsis and septic shock are common life-threatening pathologies associated with high mortality and substantial costs for healthcare system. Clinical guidelines and bundles for the management of patients with sepsis have recently been updated. Herein, we review the history of sepsis and related conditions definitions from the first consensus conference in 1991 to nowadays, the epidemiologic data resulting from worldwide studies on incidence and mortality, the diagnostic approaches including the microbiological assessment of infection and the use of several prognostic and diagnostic biomarkers and finally we review the main therapeutic measures as the intravenous immunoglobulin therapy and the administration of appropriate antibiotic treatment to provide patients with sepsis a favourable outcome in the antibiotic-resistance era...
July 22, 2017: Journal of Global Antimicrobial Resistance
https://www.readbyqxmd.com/read/28743338/-clinical-characteristics-and-prognosis-in-patients-with-high-plasma-level-of-procalcitonin-an-analysis-in-188-patients
#5
Chuli Pan, Wei Cui, Feifei Zhou, Junwei Tu, Xiuhui Lin, Libin Li, Gensheng Zhang
OBJECTIVE: To investigate the clinical characteristics and prognosis of patients with high level of plasma procalcitonin (PCT > 100 μg/L), and to improve the clinician's understanding, diagnosis and treatment of this kind of patients. METHODS: A retrospective study was conducted. The clinical data of patients with plasma PCT over 100 μg/L within 48 hours of admission admitted to Second Affiliated Hospital of Zhejiang University School of Medicine from February 2013 to December 2016 were collected, and the clinical characteristics were analyzed...
July 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/28742549/readmissions-for-recurrent-sepsis-new-or-relapsed-infection
#6
Kimberley Marie DeMerle, Stephanie C Royer, Mark E Mikkelsen, Hallie C Prescott
OBJECTIVES: Sepsis hospitalizations are frequently followed by hospital readmissions, often for recurrent sepsis. However, it is unclear how often sepsis readmissions are for relapsed/recrudescent versus new infections. The aim of this study was to assess the extent to which 90-day readmissions for recurrent sepsis are due to infection of the same site and same pathogen as the initial episode. DESIGN: Retrospective cohort study. SETTING: University of Michigan Health System...
July 22, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28742082/bacterial-deception-of-mait-cells-in-a-cloud-of-superantigen-and-cytokines
#7
Johan K Sandberg, Anna Norrby-Teglund, Edwin Leeansyah
The bacterium Staphylococcus aureus is an important cause of the life-threatening condition toxic shock syndrome in humans. Bacterial toxins known as superantigens (SAgs) generate this illness by acting as broad activators of a substantial fraction of all T lymphocytes, bypassing the normally highly stringent T-cell receptor antigen specificity to cause a systemic inflammatory cytokine storm in the host. In a new study, Shaler et al. found that immune cells called mucosa-associated invariant T (MAIT) cells make an unexpectedly large contribution to the SAg response in a largely T-cell receptor-independent, cytokine-driven manner...
July 24, 2017: PLoS Biology
https://www.readbyqxmd.com/read/28739652/in-hospital-quality-of-care-measures-for-pediatric-sepsis-syndrome
#8
Folafoluwa O Odetola, Gary Freed, Caroline Shevrin, Brian Madden, Julie McCormick, Kevin Dombkowski
BACKGROUND AND OBJECTIVES: Sepsis syndrome, comprising sepsis, severe sepsis, and septic shock, is a leading cause of child mortality and morbidity, for which the delivery of time-sensitive care leads to improved survival. We aimed to describe the development and testing of quality measures for in-hospital care of pediatric sepsis syndrome. METHODS: Seven measures of quality of care for children hospitalized with sepsis syndrome were developed by using an iterative process including literature review, development of concepts and candidate measures, and selection of measures for feasibility and importance by 2 panels of experts...
July 24, 2017: Pediatrics
https://www.readbyqxmd.com/read/28739448/hydrocortisone-and-ascorbic-acid-synergistically-prevent-and-repair-lps-induced-pulmonary-endothelial-barrier-dysfunction
#9
Nektarios Barabutis, Vikramjit Khangoora, Paul E Marik, John D Catravas
BACKGROUND: Sepsis refers the dysregulated host immune response elicited by microbial infections resulting in life-threatening organ dysfunction. Sepsis represents a medical challenge, since it is associated with a rate of death as high as 60%. Septic shock is strongly associated with vascular dysfunction and elevated pulmonary capillary permeability. We recently reported that the combination of hydrocortisone (HC), ascorbic acid (VitC) and thiamine dramatically improves outcomes and reduces mortality in septic patients...
July 21, 2017: Chest
https://www.readbyqxmd.com/read/28738837/assessment-of-cerebral-circulation-in-a-porcine-model-of-intravenously-given-e-coli-induced-fulminant-sepsis
#10
Levente Molnár, Norbert Németh, Mariann Berhés, Endre Hajdú, Lóránd Papp, Ábel Molnár, Judit Szabó, Ádám Deák, Béla Fülesdi
BACKGROUND: The aim of the present work was to assess cerebral hemodynamic changes in a porcine model of E.coli induced fulminant sepsis. METHODS: Nineteen healthy female Hungahib pigs, 10-12 weeks old, randomly assigned into two groups: Control (n = 9) or Septic Group (n = 10). In the Sepsis group Escherichia coli culture suspended in physiological saline was intravenously administrated in a continuously increasing manner according to the following protocol: 2 ml of bacterial culture suspended in physiological saline was injected in the first 30 min, then 4 ml of bacterial culture was administered within 30 min, followed by infusion of 32 ml bacterial culture for 2 h...
July 24, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/28731900/micro-and-macro-circulatory-changes-during-sepsis-and-septic-shock-in-a-rat-model
#11
Tianfeng Hua, Xiaobo Wu, Wei Wang, Hao Li, Jennifer Bradley, Mary Ann Peberdy, Joseph P Ornato, Wanchun Tang
Microcirculation is the motor of sepsis. In the present study, we investigated whether microcirculatory alterations occur prior to changes of systemic hemodynamics in a rat model of cecum ligation and puncture (CLP)-induced sepsis. We further investigated renal microcirculatory changes during sepsis and compared those with buccal microcirculation. Twelve male Sprague-Dawley rats were randomized into a sham control group (n = 6) and a CLP group (n = 6). Perfused microvessel density (PVD) and microvascular flow index (MFI) were evaluated using sidestream dark field (SDF) video microscopy at baseline, 60, 120, 180, 240, 300, and 360 minutes following CLP...
July 20, 2017: Shock
https://www.readbyqxmd.com/read/28731836/mortality-rate-and-antibiotic-resistance-in-complicated-diverticulitis-report-of-272-consecutive-patients-worldwide-a-prospective-cohort-study
#12
Federico Coccolini, Mattia Trevisan, Giulia Montori, Massimo Sartelli, Fausto Catena, Marco Ceresoli, Antonio Costanzo, Arianna Heyer, Luca Ansaloni
BACKGROUND: Complicated diverticulitis (CD) is a common problem for surgeons. In treating it, as a general principle, every verified source of infection should be controlled. Supplementary antimicrobial management involves a delicate balance of optimizing empirical therapy while reducing unnecessary antibiotic use. The necessity to know the most frequent infecting pathogens and their spectra of resistance is becoming pivotal. The aim of this study was to determine the microbiologic profile of complicated intra-abdominal infections (IAIs) secondary to CD, to analyze the role of empirical antimicrobial therapy, and to describe the clinical aspects of CD worldwide...
July 21, 2017: Surgical Infections
https://www.readbyqxmd.com/read/28730906/mortality-intensive-care-treatment-and-cost-evaluation-role-of-a-polymerase-chain-reaction-assay-in-patients-with-sepsis
#13
Markota Andrej, Sinkovič Andreja
Objective We examined whether patients with a positive SeptiFast (SF) assay (LightCycler SeptiFast; Roche Diagnostics, Basel, Switzerland) developed higher long-term mortality, a more difficult course of treatment, and a higher antimicrobial treatment cost than patients with a negative SF assay. Methods We performed a post-hoc analysis of data collected in a 1-year prospective interventional study of adults with severe sepsis and septic shock. In addition to the standard treatment, an additional 5 ml of blood was obtained for an SF assay, and the antimicrobial treatment was changed according to the SF results...
January 1, 2017: Journal of International Medical Research
https://www.readbyqxmd.com/read/28729329/fluids-in-sepsis-and-septic-shock-fissh-protocol-for-a-pilot-randomised-controlled-trial
#14
Bram Rochwerg, Tina Millen, Peggy Austin, Michelle Zeller, Frédérick D'Aragon, Roman Jaeschke, Marie-Hélène Masse, Sangeeta Mehta, Francois Lamontagne, Maureen Meade, Gordon Guyatt, Deborah J Cook
INTRODUCTION: Observational evidence suggests physiological benefits and lower mortality with lower chloride solutions; however, 0.9% saline remains the most widely used fluid worldwide. Given uncertainty regarding the association of lower chloride on mortality, it is unlikely that practice will change without direct randomised clinical trial (RCT) evidence. This pilot RCT will investigate the feasibility of a large-scale trial directly comparing low chloride with high chloride fluids in patients with septic shock...
July 20, 2017: BMJ Open
https://www.readbyqxmd.com/read/28727802/diagnostic-accuracy-of-procalcitonin-neutrophil-lymphocyte-count-ratio-c-reactive-protein-and-lactate-in-patients-with-suspected-bacterial-sepsis
#15
Lars Ljungström, Anna-Karin Pernestig, Gunnar Jacobsson, Rune Andersson, Barbara Usener, Diana Tilevik
BACKGROUND: Early recognition is a key factor to achieve improved outcomes for septic patients. Combinations of biomarkers, as opposed to single ones, may improve timely diagnosis and survival. We investigated the performance characteristics of sepsis biomarkers, alone and in combination, for diagnosis of verified bacterial sepsis using Sepsis-2 and Sepsis-3 criteria, respectively. METHODS: Procalcitonin (PCT), neutrophil-lymphocyte count ratio (NLCR), C-reactive protein (CRP), and lactate were determined in a total of 1,572 episodes of adult patients admitted to the emergency department on suspicion of sepsis...
2017: PloS One
https://www.readbyqxmd.com/read/28727607/new-onset-heart-failure-and-mortality-in-hospital-survivors-of-sepsis-related-left-ventricular-dysfunction
#16
Saraschandra Vallabhajosyula, Jacob C Jentzer, Jeffrey B Geske, Mukesh Kumar, Ankit Sakhuja, Akhil Singhal, Joseph T Poterucha, Kianoush Kashani, Joseph G Murphy, Ognjen Gajic, Rahul Kashyap
BACKGROUND: The association between new-onset left ventricular (LV) dysfunction during sepsis with long-term heart failure outcomes is lesser understood. METHODS: Retrospective cohort study of all adult patients with severe sepsis and septic shock between 2007 and 2014 that underwent echocardiography within 72 hours admitted to the intensive care unit. Patients with prior heart failure, LV dysfunction, and structural heart disease were excluded. LV systolic dysfunction was defined as LV ejection fraction <50% and LV diastolic dysfunction as ≥grade II...
July 19, 2017: Shock
https://www.readbyqxmd.com/read/28726607/acute-febrile-illness-and-complications-due-to-murine-typhus-texas-usa1-2
#17
Zeeshan Afzal, Sunand Kallumadanda, Feng Wang, Vagish Hemmige, Daniel Musher
Murine typhus occurs relatively commonly in southern Texas, as well as in California. We reviewed records of 90 adults and children in whom murine typhus was diagnosed during a 3-year period in 2 hospitals in southern Texas, USA. Most patients lacked notable comorbidities; all were immunocompetent. Initial signs and symptoms included fever (99%), malaise (82%), headache (77%), fatigue (70%), myalgias (68%), and rash (39%). Complications, often severe, in 28% of patients included bronchiolitis, pneumonia, meningitis, septic shock, cholecystitis, pancreatitis, myositis, and rhabdomyolysis; the last 3 are previously unreported in murine typhus...
August 2017: Emerging Infectious Diseases
https://www.readbyqxmd.com/read/28724977/therapeutic-targeting-of-hmgb1-during-experimental-sepsis-modulates-the-inflammatory-cytokine-profile-to-one-associated-with-improved-clinical-outcomes
#18
Natalie E Stevens, Marianne J Chapman, Cara K Fraser, Tim R Kuchel, John D Hayball, Kerrilyn R Diener
Sepsis remains a significant health burden and a major clinical need exists for therapeutics to dampen the excessive and uncontrolled immune activation. Nuclear protein high mobility group box protein 1 (HMGB1) is released following cell death and is a late mediator in sepsis pathogenesis. While approaches targeting HMGB1 have demonstrated reduced mortality in pre-clinical models of sepsis, the impact of HMGB1 blockade on the complex septic inflammatory milieu and the development of subsequent immunosuppression remain enigmatic...
July 19, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28724580/il-7-restores-t-lymphocyte-immunometabolic-failure-in-septic-shock-patients-through-mtor-activation
#19
Fabienne Venet, Julie Demaret, Benjamin J Blaise, Christelle Rouget, Thibaut Girardot, Estellie Idealisoa, Thomas Rimmelé, François Mallet, Alain Lepape, Julien Textoris, Guillaume Monneret
T lymphocyte alterations are central to sepsis pathophysiology, whereas related mechanisms remain poorly understood. We hypothesized that metabolic alterations could play a role in sepsis-induced T lymphocyte dysfunction. Samples from septic shock patients were obtained at day 3 and compared with those from healthy donors. T cell metabolic status was evaluated in the basal condition and after T cell stimulation. We observed that basal metabolic content measured in lymphocytes by nuclear magnetic resonance spectroscopy was altered in septic patients...
July 19, 2017: Journal of Immunology: Official Journal of the American Association of Immunologists
https://www.readbyqxmd.com/read/28720602/a-reminder-of-escherichia-coli-sepsis-induced-reversible-cardiomyopathy
#20
Aung Naing Lin, Atif Shaikh, Sithu Lin, Deepika Misra
Cardiomyopathy is a progressive disease of myocardium causing either mechanical or electrical disturbances. Sepsis-induced cardiomyopathy (SICM) is an entity of cardiomyopathy which is reversible in 1â€"2 weeks after recovery from sepsis or septic shock. SICM is thought to have unpredictable cumulative mortality towards sepsis but its exact mechanism remains elusive. We report a case of Escherichia coli SICM in a 63-year-old woman presented with sudden onset of dyspnoea on exertion and orthopnoea following nausea, vomiting and diarrhoea after consuming Chinese foods...
July 18, 2017: BMJ Case Reports
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