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Severe sepsis

Yuki Maruchi, Masanobu Tsuda, Hisatake Mori, Nobuyoshi Takenaka, Takayoshi Gocho, Muhammad A Huq, Naoshi Takeyama
BACKGROUND: Recent studies have suggested that excessive formation of neutrophil extracellular traps (NETs) plays a critical role in the pathogenesis of sepsis. Although elevation of the plasma level of cell-free DNA (cf-DNA) has been reported in sepsis patients, there has been little direct measurement of circulating free NETs such as myeloperoxidase-conjugated DNA (MPO-DNA). The objectives of this study were to detect NETs in the bloodstream of patients with septic shock, and to assess the correlations of circulating NET levels with organ dysfunction, disease severity, and mortality...
July 13, 2018: Critical Care: the Official Journal of the Critical Care Forum
I A Iwuh, S Fawcus, L Schoeman
BACKGROUND: A maternal near-miss is defined as a life-threatening pregnancy-related complication where the woman survives. The World Health Organization (WHO) has produced a tool for identifying near-misses according to criteria that include the occurrence of a severe maternal complication together with organ dysfunction and/or specified critical interventions. Maternal deaths have been audited in the public sector Metro West maternity service in Cape Town, South Africa, for many years, but there has been no monitoring of near-misses...
February 27, 2018: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
Rajeshwari Dhandai, Mamta Jajoo, Amitabh Singh, Anirban Mandal, Rahul Jain
Background Vitamin D deficiency in mothers and neonates is being recognised increasingly as a leading cause of many adverse health effects in the newborn infant, including sepsis. Methods A prospective observational study was conducted at a tertiary care Paediatric teaching hospital in northern India to assess vitamin D deficiency as a possible risk factor for late-onset sepsis (LOS) in term and late preterm neonates and also to examine the correlation between maternal and infant vitamin D levels during the neonatal period...
July 13, 2018: Paediatrics and International Child Health
Sergey Shlyapnikov, Arturo Jauregui, Nana N Khachatryan, Asok Kurup, Javier de la Cabada-Bauche, Hoe N Leong, Li Li, Mark H Wilcox
INTRODUCTION: Tedizolid phosphate 200 mg, once daily for 6 days, has recently been approved for the treatment of patients with acute bacterial skin and skin structure infections (ABSSSIs) in several countries; however, clinical experience in real-life settings is currently limited. Here, we report on the use of tedizolid with an extended treatment duration for complex and severe ABSSSIs in real-world clinical settings. METHODS: Two patients with cellulitis and two patients with surgical site infection (SSI), aged 26-60 years, were treated with tedizolid phosphate 200 mg, intravenous/oral (IV/PO) or IV only, once daily at four different institutions...
July 12, 2018: Infectious Diseases and Therapy
Stelios F Assimakopoulos, Christos Triantos, Konstantinos Thomopoulos, Fotini Fligou, Ioannis Maroulis, Markos Marangos, Charalambos A Gogos
INTRODUCTION: Gut permeability is increased in critically ill patients, and associated with the development of the systemic inflammatory response syndrome and multiple organ dysfunction syndrome (MODS). The pathogenetic link(s) and potential therapies are an area of intense research over the last decades. METHODS: We thoroughly reviewed the literature on gut-origin sepsis and MODS in critically ill patients, with emphasis on the implicated pathophysiological mechanisms and therapeutic interventions...
July 12, 2018: Infection
Tomoya Hirose, Hiroshi Ogura, Hiroki Takahashi, Masahiro Ojima, Kang Jinkoo, Youhei Nakamura, Takashi Kojima, Takeshi Shimazu
Background: C1 inhibitor (C1-INH), which belongs to the superfamily of serine protease inhibitors, regulates the complement system and also the plasma kallikrein-kinin, fibrinolytic, and coagulation systems. The biologic activities of C1-INH can be divided into the regulation of vascular permeability and anti-inflammatory functions. The objective of this study was to clarify the serial change of C1-INH in patients with sepsis and evaluate the relationship with the shock severity. Methods: This was a single-center, prospective, observational study...
2018: Journal of Intensive Care
Victor B Talisa, Sachin Yende, Christopher W Seymour, Derek C Angus
Sepsis is life-threatening organ dysfunction due to dysregulated response to infection. Patients with sepsis exhibit wide heterogeneity stemming from genetic, molecular, and clinical factors as well as differences in pathogens, creating challenges for the development of effective treatments. Several gaps in knowledge also contribute: (i) biomarkers that identify patients likely to benefit from specific treatments are unknown; (ii) therapeutic dose and duration is often poorly understood; and (iii) short-term mortality, a common outcome measure, is frequently criticized for being insensitive...
2018: Frontiers in Immunology
Heng-Li Chen, Pei-Yi Su, Shu-Chen Kuo, Tsai-Ling Y Lauderdale, Chiaho Shih
The emergence of antibiotic-resistant bacteria has threatened our health worldwide. There is an urgent need for novel antibiotics. Previously, we identified a novel 37-mer antimicrobial peptide (AMP), HBcARD, with broad spectrum antimicrobial activity. Here, we improved the efficacy of HBcARD, by re-engineering the peptide, including the addition of a new cysteine to its C-terminus (CTC). The new 28-mer derivative, D-150-177C, contains all D-form arginines, in addition to a C-terminal cycteine. This peptide can kill antibiotic-resistant clinical isolates of Gram-negative bacteria, and is more potent than the parental HBcARD peptide in a mouse sepsis model...
2018: Frontiers in Microbiology
Romain Jouffroy, Anastasia Saade, Jean Pierre Tourtier, Papa Gueye, Emmanuel Bloch-Laine, Patrick Ecollan, Pierre Carli, Benoît Vivien
OBJECTIVES: The early identification of septic shock patients at high risk of poor outcome is essential to early initiate optimal treatments and to decide on hospital admission. Biomarkers are often used to evaluate the severity. In prehospital settings, the availability of biomarkers, such as lactate, is restricted. In this context, clinical tools such as skin mottling score (SMS) and capillary refill time (CRT) are more suitable. In this study, we describe prehospital SMS and CRT's ability to predict mortality of patients with septic shock initially cared in the prehospital setting by a mobile intensive care unit...
July 6, 2018: American Journal of Emergency Medicine
Edward E Conway
Sepsis is the body's systemic response to infection and is a serious health care concern that affects neonatal, pediatric, and adult populations worldwide. Severe sepsis (sepsis that has progressed to cellular dysfunction and organ damage or evidence of hypoperfusion) and septic shock (sepsis with persistent hypotension despite adequate fluid resuscitation) are still associated with high mortality rates despite improvements in the management of infectious processes. The cellular processes that occur as a result of the inflammatory response in sepsis, including impaired perfusion and microcirculatory coagulation, can lead to organ system dysfunction...
July 1, 2018: Pediatric Annals
Larissa Aleman, Julia Guerrero
Stress hyperglycemia is frequently diagnosed in septic patients in critical care units (ICU) and it is associated with greater illness severity and higher morbimortality rates. In response to an acute injury, high levels of counterregulatory hormones such as glucocorticoids and catecholamines are released causing increased hepatic gluconeogenesis and insulin resistance. Furthermore, during sepsis, proinflammatory cytokines also participate in the pathogenesis of this phenomenon. Septic patients represent a subtype of the critical ill patients in the ICU: this metabolic disarrangement management strategies and insulin therapy recommendations had been inconsistent...
April 2018: Revista Médica de Chile
Hugo Lo Pinto, Jérôme Allyn, Romain Persichini, Bruno Bouchet, Gilbert Brochier, Olivier Martinet, Caroline Brulliard, Dorothée Valance, Benjamin Delmas, Eric Braunberger, Laurence Dangers, Nicolas Allou
PURPOSE: Few data are available on the potential benefits and risks of red blood cell transfusion in patients undergoing extracorporeal membrane oxygenation. The aim of this study was to identify the determinants and prognosis of red blood cell transfusion in patients undergoing extracorporeal membrane oxygenation, with a special focus on biological parameters during extracorporeal membrane oxygenation treatment. METHODS: We conducted a single-center retrospective cohort study including all consecutive patients who underwent extracorporeal membrane oxygenation between January 2010 and December 2015...
July 1, 2018: International Journal of Artificial Organs
Elisa Meroni, Nathalie Stakenborg, Maria Francesca Viola, Guy E Boeckxstaens
Over the past decades, there has been an increasing understanding of cellular and molecular mechanisms that mediate modulation of the immune system by the autonomic nervous system. The discovery that vagal nerve stimulation (VNS) attenuates endotoxin-induced experimental sepsis paved the way for further studies investigating neuro-immune interaction. In particular, great attention is now given to intestinal macrophages: several studies report the existence of both intrinsic and extrinsic neural mechanisms by which intestinal immune homeostasis can be regulated in different layers of the intestine, mainly by affecting macrophage activation through neurotransmitter release...
July 11, 2018: Acta Physiologica
Stephen Statz, Giselle Sabal, Amanda Walborn, Mark Williams, Debra Hoppensteadt, Michael Mosier, Matthew Rondina, Jawed Fareed
It has been well established that angiopoietin 2 (Ang-2), a glycoprotein involved in activation of the endothelium, plays an integral role in the pathophysiology of sepsis and many other inflammatory conditions. However, the role of Ang-2 in sepsis-associated coagulopathy (SAC) specifically has not been defined. The aim of this study was to measure Ang-2 plasma levels in patients with sepsis and suspected disseminated intravascular coagulation (DIC) in order to demonstrate its predictive value in SAC severity determination and 28-day mortality outcome...
January 1, 2018: Clinical and Applied Thrombosis/hemostasis
Daniel A Brill, Nathan D Farley, Desiree C Albert, Therese M Sassalos, Amit A Sangave, Uday R Desai
PURPOSE: To report a case of bilateral endogenous endophthalmitis from Streptococcus pneumoniae with devastating sequelae. METHODS: Interventional case report. RESULTS: A 56-year-old man presented with acute bilateral blurred vision and floaters with fever and hemodynamic instability. Previously, he was diagnosed with acute otitis externa and reported manually extracting several of his own teeth. He underwent a vitreous tap and intravitreal antibiotic injections...
July 6, 2018: Retinal Cases & Brief Reports
Andreas Hohn, Ivan Iovino, Fabrizio Cirillo, Hendrik Drinhaus, Kathrin Kleinbrahm, Lennert Boehm, Edoardo De Robertis, Jochen Hinkelbein
During the last years, proteomic studies have revealed several interesting findings in experimental sepsis models and septic patients. However, most studies investigated protein alterations only in single organs or in whole blood. To identify possible sepsis biomarkers and to evaluate the relationship between protein alteration in sepsis affected organs and blood, proteomics data from the heart, brain, liver, kidney, and serum were analysed. Using functional network analyses in combination with hierarchical cluster analysis, we found that protein regulation patterns in organ tissues as well as in serum are highly dynamic...
2018: BioMed Research International
I-Ting Peng, Ming-Ting Chung, Ching-Chung Lin
Postpartum hemorrhage remains a major threat to maternal health. Intervention after critical blood loss or development of disseminated intravascular coagulation may lead to disastrous organ failure and poor outcomes. A 30-year-old woman was transferred to our emergency department due to massive postpartum hemorrhage. Shock and disseminated intravascular coagulation ensued, and the patient's condition quickly deteriorated. We performed an emergency hysterectomy, but blood loss had been massive. Moreover, there was another episode of internal bleeding that led to further blood loss...
2018: Case Reports in Obstetrics and Gynecology
Patrick M Ketter, Jieh-Juen Yu, M Neal Guentzel, Holly C May, Rishein Gupta, Mark Eppinger, Karl E Klose, J Seshu, James P Chambers, Andrew P Cap, Bernard P Arulanandam
Multidrug-resistant Acinetobacter baumannii is among the most common causes of infectious complications associated with combat-related trauma in military personnel serving overseas. However, little is currently known about its pathogenesis. While the gastrointestinal (GI) tract has been found to be a major reservoir for A. baumannii , as well as to potentially contribute to development of multidrug resistance, no studies have addressed the mechanisms involved in gut colonization. In this study, we address this critical gap in knowledge by first assessing the interaction between secretory IgA (SIgA), the principal humoral immune defense on mucosal surfaces, and the A...
July 10, 2018: MBio
Orlando Garner, Ana Ramirez, Alfredo Iardino
Posterior reversible encephalopathy syndrome (PRES) is a neurological disorder characterised by parieto-occipital vasogenic oedema seen on MRI. Infection and sepsis has been reported as a possible cause for this disorder.We present a 19-year-old immunocompetent Caucasian man with known type 1 diabetes mellitus who presented to the emergency department with acute onset of bilateral visual loss, headaches and hypertension; he had been discharged 2 weeks ago for severe diabetic ketoacidosis and Staphylococcus aureus bacteraemia...
July 10, 2018: BMJ Case Reports
Behnam Sadeghirad, Rebecca L Morgan, Dena Zeraatkar, Adriana M Zea, Rachel Couban, Bradley C Johnston, Ivan D Florez
CONTEXT: Human and bovine colostrum (HBC) administration has been linked to beneficial effects on morbidity and mortality associated with necrotizing enterocolitis (NEC). OBJECTIVES: To determine the effectiveness and safety of HBC for reducing NEC, mortality, sepsis, time to full-feed and feeding intolerance in preterm infants. DATA SOURCES: We conducted searches through Medline, Embase, Cumulative Index of Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, and gray literature...
July 10, 2018: Pediatrics
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