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Sepsis & Low BP

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https://www.readbyqxmd.com/read/27540463/methimazole-induced-insulin-autoimmune-syndrome
#1
REVIEW
Nidhi Jain, Malvi Savani, Manyoo Agarwal, Dipen Kadaria
BACKGROUND: Hypoglycemia in a critical care setting is often multifactorial with iatrogenic insulin use, sulfonylurea (SU) use, sepsis, adrenal insufficiency and insulinoma among the common causes. Insulin autoimmune syndrome (IAS) is a rare cause of hypoglycemia characterized by the presence of insulin-binding autoantibodies to the sulfhydryl group-containing agents. We report a case of methimazole-induced IAS managed in the intensive care unit. CASE PRESENTATION: A 76-year-old woman with a history of primary hyperthyroidism was sent from a nursing home for unresponsiveness...
August 2016: Therapeutic Advances in Endocrinology and Metabolism
https://www.readbyqxmd.com/read/26368562/adverse-events-during-bowel-preparation-and-colonoscopy-in-patients-with-acute-lower-gastrointestinal-bleeding-compared-with-elective-non-gastrointestinal-bleeding
#2
RANDOMIZED CONTROLLED TRIAL
Ryota Niikura, Naoyoshi Nagata, Takuro Shimbo, Toshiyuki Sakurai, Tomonori Aoki, Shiori Moriyasu, Katsunori Sekine, Hidetaka Okubo, Kazuhiro Watanabe, Chizu Yokoi, Atsuo Yamada, Yoshihiro Hirata, Kazuhiko Koike, Junichi Akiyama, Naomi Uemura
BACKGROUND: There are limited data on the safety of colonoscopy in patients with lower gastrointestinal bleeding (LGIB). We examined the various adverse events associated with colonoscopy in acute LGIB compared with non-GIB patients. METHODS: Emergency hospitalized LGIB patients (n = 161) and age- and gender-matched non-GIB controls (n = 161) were selected. Primary outcomes were any adverse events during preparation and colonoscopy procedure. Secondary outcomes were five bowel preparation-related adverse events--hypotension, systolic blood pressure <100 mmHg, volume overload, vomiting, aspiration pneumonia and loss of consciousness--and four colonoscopy-related adverse events--including hypotension, perforation, cerebrocardiovascular events and sepsis...
2015: PloS One
https://www.readbyqxmd.com/read/26209157/low-systemic-oxygen-delivery-and-bp-and-risk-of-progression-of-early-aki
#3
Mario Raimundo, Siobhan Crichton, Yadullah Syed, Jonathan R Martin, Richard Beale, David Treacher, Marlies Ostermann
BACKGROUND AND OBJECTIVES: The optimal hemodynamic management of patients with early AKI is unknown. This study aimed to investigate the association between hemodynamic parameters in early AKI and progression to severe AKI and hospital mortality. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This study retrospectively analyzed the data of all patients admitted to the adult intensive care unit in a tertiary care center between July 2007 and June 2009 and identified those with stage 1 AKI (AKI I) per the AKI Network classification...
August 7, 2015: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/26111524/sepsis-caused-by-listeria-monocytogenes-during-chemotherapy-for-small-cell-carcinoma-of-the-thymus
#4
Masamichi Itoga, Yuko Asari, Takeshi Morimoto, Kageaki Taima, Kunihiko Nakamura, Yoshihito Tanaka, Hisashi Tanaka, Shingo Takanashi, Hiroyuki Kayaba, Ken Okumura
BACKGROUND: Listeria monocytogenes is a facultative intracellular parasitic bacterium that is Gram positive, catalase positive, oxidase negative, and a facultative anaerobe. It is known to infect humans through food. It is a bacillus with low virulence, but can cause meningitis and sepsis in infants and immunocompromised patients. CASE PRESENTATION: A case of 75-year-old Japanese female with small cell carcinoma of the thymus and pleural dissemination is described...
2015: BMC Research Notes
https://www.readbyqxmd.com/read/26070235/prehospital-recognition-of-severe-sepsis-development-and-validation-of-a-novel-ems-screening-tool
#5
Carmen C Polito, Alex Isakov, Arthur H Yancey, Duncan K Wilson, Blake A Anderson, Ingrid Bloom, Greg S Martin, Jonathan E Sevransky
OBJECTIVE: To derive and validate a predictive model and novel emergency medical services (EMS) screening tool for severe sepsis (SS). DESIGN: Retrospective cohort study. SETTING: A single EMS system and an urban, public hospital. PATIENTS: Sequential adult, nontrauma, nonarrest, at-risk, EMS-transported patients between January 1, 2011, and December 31, 2012 were included in the study. At-risk patients were defined as having all 3 of the following criteria present in the EMS setting: (1) heart rate greater than 90 beats/min, (2) respiratory rate greater than 20 beats/min, and (3) systolic blood pressure less than 110 mm Hg...
September 2015: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/26020367/accuracy-validation-of-the-microlife-3as1-2-blood-pressure-device-in-a-pregnant-population-with-low-blood-pressure
#6
COMPARATIVE STUDY
Hannah L Nathan, Annemarie de Greeff, Natasha L Hezelgrave, Lucy C Chappell, Andrew H Shennan
OBJECTIVE: To assess the accuracy of the Microlife 3AS1-2 blood pressure (BP) device in pregnant women with low BP to investigate suitability for hypotensive detection in low-income and middle-income countries. METHODS: A prospective observational study was carried out evaluating the Microlife 3AS1-2, a hand-held, upper-arm, semiautomated BP device, according to British Hypertension Society (BHS) protocol methods. Thirty (stable) pregnant women with a clinical systolic BP less than 100 mmHg and/or diastolic BP less than 60 mmHg were recruited from antenatal wards and clinics and their BP was measured by three trained observers at a district-level hospital in South Africa...
October 2015: Blood Pressure Monitoring
https://www.readbyqxmd.com/read/25966743/the-dynamic-cerebral-autoregulatory-adaptive-response-to-noradrenaline-is-attenuated-during-systemic-inflammation-in-humans
#7
Ronan M G Berg, Ronni R Plovsing, Damian M Bailey, Niels-Henrik Holstein-Rathlou, Kirsten Møller
Vasopressor support is used widely for maintaining vital organ perfusion pressure in septic shock, with implications for dynamic cerebral autoregulation (dCA). This study investigated whether a noradrenaline-induced steady state increase in mean arterial blood pressure (MAP) would enhance dCA following lipopolysaccharide (LPS) infusion, a human-experimental model of the systemic inflammatory response during early sepsis. The dCA in eight healthy males was examined prior to and during an intended noradrenaline-induced MAP increase of approximately 30 mmHg...
July 2015: Clinical and Experimental Pharmacology & Physiology
https://www.readbyqxmd.com/read/25954646/prognosis-of-left-ventricular-systolic-dysfunction-in-septic-shock-patients
#8
M Mukhyaprana Prabhu, Suresh Kumar Yalakala, Ranjan Shetty, Ashok Thakkar, Tulsee Sitapara
INTRODUCTION: The prognosis of myocardial dysfunction in critically ill patients with sepsis and its association with mortality is controversial. We aim to determine the significance of left ventricular systolic dysfunction in septic shock patients and their associated outcome. MATERIALS AND METHODS: A prospective, single center, observational study was carried out at an intensive care unit of a tertiary care hospital. A total of 66 patients diagnosed with septic shock were enrolled in the study from September 2010 to June 2012...
March 2015: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/25914716/circulatory-contributors-to-the-phenotype-in-hereditary-hemorrhagic-telangiectasia
#9
Claire L Shovlin
Hereditary hemorrhagic telangiectasia (HHT) is mechanistically and therapeutically challenging, not only because of the molecular and cellular perturbations that generate vascular abnormalities, but also the modifications to circulatory physiology that result, and are likely to exacerbate vascular injury. First, most HHT patients have visceral arteriovenous malformations (AVMs). Significant visceral AVMs reduce the systemic vascular resistance: supra-normal cardiac outputs are required to maintain arterial blood pressure, and may result in significant pulmonary venous hypertension...
2015: Frontiers in Genetics
https://www.readbyqxmd.com/read/25592556/acute-kidney-injury-among-adult-patients-with-sepsis-in-a-low-income-country-clinical-patterns-and-short-term-outcomes
#10
Peace Bagasha, Frederick Nakwagala, Arthur Kwizera, Emmanuel Ssekasanvu, Robert Kalyesubula
BACKGROUND: Acute kidney injury (AKI) is a common complication of sepsis. We determined the prevalence of AKI among adult patients with sepsis on the medical wards in a low-income country and described their clinical pattern and outcomes at discharge. METHODS: We conducted a cross-sectional study of sepsis-related AKI on the adult medical wards of Mulago National Referral Hospital between January and April 2013. All patients meeting the American College of Chest Physicians (ACP) sepsis criteria were recruited...
January 16, 2015: BMC Nephrology
https://www.readbyqxmd.com/read/25576199/developing-the-surveillance-algorithm-for-detection-of-failure-to-recognize-and-treat-severe-sepsis
#11
Andrew M Harrison, Charat Thongprayoon, Rahul Kashyap, Christopher G Chute, Ognjen Gajic, Brian W Pickering, Vitaly Herasevich
OBJECTIVE: To develop and test an automated surveillance algorithm (sepsis "sniffer") for the detection of severe sepsis and monitoring failure to recognize and treat severe sepsis in a timely manner. PATIENTS AND METHODS: We conducted an observational diagnostic performance study using independent derivation and validation cohorts from an electronic medical record database of the medical intensive care unit (ICU) of a tertiary referral center. All patients aged 18 years and older who were admitted to the medical ICU from January 1 through March 31, 2013 (N=587), were included...
February 2015: Mayo Clinic Proceedings
https://www.readbyqxmd.com/read/25561281/therapeutic-value-of-blood-purification-and-prognostic-utilities-of-early-serum-procalcitonin-c-reactive-protein-and-brain-natriuretic-peptide-levels-in-severely-burned-patients-with-sepsis
#12
Hongxu Zu, Qinghua Li, Peixin Huang, Xiaorong Wang
The objective of this study was to evaluate therapeutic effectiveness of blood purification (BP) in severely burned patients with sepsis and to assess the prognostic utilities of early serum levels of procalcitonin (PCT), C reactive protein (CRP), brain natriuretic peptide (BNP). One hundred and ninety-five burn sepsis patients admitted in our hospital during May, 2008-May, 2014 were selected for the study and randomly divided into BP treatment (n = 98) and the control groups (n = 97). All of these patients received conventional therapy, while the BP group underwent additional BP treatment...
May 2015: Cell Biochemistry and Biophysics
https://www.readbyqxmd.com/read/25542518/acute-kidney-injury-in-septic-patients-admitted-to-emergency-clinical-room-risk-factors-and-outcome
#13
Pâmela Medeiros, Hong Si Nga, Precil Menezes, Ramaiane Bridi, André Balbi, Daniela Ponce
PURPOSE: Acute kidney injury (AKI) is a common source of morbidity in sepsis. We sought to determine risk factors for AKI, by acute kidney injury network (AKIN) criteria, in septic patients admitted in emergency clinical room (ER). MATERIALS AND METHODS: Prospective cohort study of 200 patients admitted to the ER of a University Hospital, followed for development of AKI over 5 days. RESULTS: AKI developed in 144/200 (72 %) patients. In multivariable regression analysis, independent risk factors for AKI included age over 65 years (OR 1...
October 2015: Clinical and Experimental Nephrology
https://www.readbyqxmd.com/read/25524592/the-arterial-blood-pressure-associated-with-terminal-cardiovascular-collapse-in-critically-ill-patients-a-retrospective-cohort-study
#14
Andreas Brunauer, Andreas Koköfer, Otgon Bataar, Ilse Gradwohl-Matis, Daniel Dankl, Martin W Dünser
INTRODUCTION: Liberal and overaggressive use of vasopressors during the initial period of shock resuscitation may compromise organ perfusion and worsen outcome. When transiently applying the concept of permissive hypotension, it would be helpful to know at which arterial blood pressure terminal cardiovascular collapse occurs. METHODS: In this retrospective cohort study, we aimed to identify the arterial blood pressure associated with terminal cardiovascular collapse in 140 patients who died in the intensive care unit while being invasively monitored...
2014: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/25446705/modified-obstetric-early-warning-scoring-systems-moews-validating-the-diagnostic-performance-for-severe-sepsis-in-women-with-chorioamnionitis
#15
Sian E Edwards, William A Grobman, Justin R Lappen, Cathy Winter, Robert Fox, Erik Lenguerrand, Timothy Draycott
OBJECTIVE: We sought to compare the predictive power of published modified obstetric early warning scoring systems (MOEWS) for the development of severe sepsis in women with chorioamnionitis. STUDY DESIGN: This was a retrospective cohort study using prospectively collected clinical observations at a single tertiary unit (Chicago, IL). Hospital databases and patient records were searched to identify and verify cases with clinically diagnosed chorioamnionitis during the study period (June 2006 through November 2007)...
April 2015: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/25310788/-sepsis-during-pregnancy-case-report
#16
Renato Laks, José L Pedroso, Juliana E Marques Pinto, Aécio F T Gois
BACKGROUND AND OBJECTIVES: Sepsis during pregnancy is a rare complication. This potentially fatal disease often occurs due to maternal infectious and can lead to fetal loss. Therefore, any attempted treatment must be aimed at the mother’s well being. As a matter of fact, there are few recent medical publications about sepsis in pregnancy. In spite of this, the treatment based on Surviving Sepsis Campaign seems suitable and practical. The aim of this article is making a case report highlighting a very well succeeded treatment of a pregnant woman with urinary sepsis...
June 2007: Revista Brasileira de Terapia Intensiva
https://www.readbyqxmd.com/read/25245463/sepsis-venous-return-and-teleology
#17
R G McNeilly
An understanding of heart-circulation interaction is crucial to our ability to guide our patients through an episode of septic shock. Our knowledge has advanced greatly in the last one hundred years. There are, however, certain empirical phenomena that may lead us to question the wisdom of our prevailing treatment algorithm. Three extreme but iatrogenically possible haemodynamic states exist. Firstly, inappropriately low venous return; secondly, overzealous arteriolar constriction; and finally, misguided inotropy and chronotropy...
November 2014: Medical Hypotheses
https://www.readbyqxmd.com/read/25239655/endothelial-nos3-e298d-and-inducible-nos2-exon-22-nitric-oxide-synthase-polymorphisms-as-well-as-plasma-nox-influence-sepsis-development
#18
Guadalupe Martin, Víctor Asensi, A Hugo Montes, Julio Collazos, Victoria Alvarez, Laura Pérez-Is, José A Carton, Francisco Taboada, Eulalia Valle-Garay
INTRODUCTION: Nitric oxide (NO) influences susceptibility to infection and hemodynamic failure (HF) in sepsis. NOS3 and NOS2 SNPs might modify plasma nitrite/nitrate (NOx) levels, sepsis development, hemodynamics and survival. METHODS: 90 severely septic and 91 non-infected ICU patients were prospectively studied. NOS3 (E298D), NOS3 (-786 T/C), NOS3 (27 bp-VNTR), and NOS2A (exon 22) SNPs and plasma NOx levels were assessed. RESULTS: 21 patients (11...
November 15, 2014: Nitric Oxide: Biology and Chemistry
https://www.readbyqxmd.com/read/25039051/trends-in-pharmacotherapy-for-neonatal-hypotension
#19
MULTICENTER STUDY
Danielle R Rios, Brady S Moffett, Jeffrey R Kaiser
OBJECTIVE: To determine trends in pharmacotherapy for neonatal hypotension in all infants and in extremely low birth weight (ELBW, birth weight 300-1000 g) infants. STUDY DESIGN: We queried the Pediatric Health Information System database for all infants ≤28 days with a diagnosis code for hypotension that were discharged between January 2001 and December 2012. Patients were excluded if they had complex congenital heart disease or cardiac surgery, sepsis or meningitis, or had extracorporeal membrane oxygenation...
October 2014: Journal of Pediatrics
https://www.readbyqxmd.com/read/25012270/glycine-selectively-reduces-intestinal-injury-during-endotoxemia
#20
Katharina Effenberger-Neidnicht, Johannes Jägers, Rabea Verhaegh, Herbert de Groot
BACKGROUND: Glycine is well known to protect the intestine against ischemia-reperfusion injury and during mechanical manipulation. Here, we studied whether glycine protects the small intestine during endotoxemia, even without being the site of the infection. MATERIALS AND METHODS: Lipopolysaccharide (LPS) was infused at a rate of 1 mg/kg × h over a period of 7 h (subacute endotoxemia) in male Wistar rats. Glycine (single dose: 50 mg/kg × 15 min) was applied intravenously at 180 and 270 min after the beginning of the LPS infusion...
December 2014: Journal of Surgical Research
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