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pre-hospital sepsis

Lourdes A Blanco Esquivel, Jorge Macia Urbina, Hugo Mendieta Zerón
BACKGROUND: Severe obstetric morbidity constitutes a serious problem worldwide; however, an effective obstetrical prognosis scale is still missing. OBJECTIVE: To propose a modified Sequential Organ Failure Assessment Score (SOFA) score based on time before reaching specialized medical attention. METHOD: This was an ambispective, descriptive study, including all women treated at the Obstetrical Intensive Care Unit (OICU) of the "Mónica Pretelini Sáenz" Maternal-Perinatal Hospital (HMPMPS), Toluca, Mexico, from June 2009 to June 2013...
September 2016: Ghana Medical Journal
Aristine Cheng, Hsin-Yun Sun, Mao-Song Tsai, Wen-Je Ko, Pi-Ru Tsai, Fu-Chang Hu, Yee-Chun Chen, Shan-Chwen Chang
BACKGROUND: To identify novel factors associated with the survival of septic adults receiving extracorporeal membrane oxygenation (ECMO) to improve patient selection and outcomes. METHODS: Cases were identified from our ECMO registry from 2001 to 2011 if they were ≥16 years and received ECMO for life-threatening sepsis. RESULTS: A total of 151 adults with a median (25th-75th percentile) age of 51 (37-63) years were analyzed. Pneumonia (50%), myocarditis (20%), and primary bloodstream infections (15%) were the main types of infection, caused by predominantly nonfermentative Gram-negative bacteria (NFGNB) (26%), Enterobacteriaceae (24%), and Gram-positive cocci (21%)...
August 30, 2016: Journal of Thoracic and Cardiovascular Surgery
Liang Luo, Ciara M Shaver, Zhiguo Zhao, Tatsuki Koyama, Carolyn S Calfee, Julie A Bastarache, Lorraine B Ware
BACKGROUND: Direct (pulmonary) and indirect (extrapulmonary) ARDS are distinct syndromes with important pathophysiologic differences. The goal of this study was to determine whether clinical characteristics and predictors of mortality differ between direct or indirect ARDS. METHODS: A retrospective observational cohort study of 417 ARDS patients. Each patient was classified as having direct (pneumonia or aspiration, n=250) or indirect ARDS (non-pulmonary sepsis or pancreatitis, n=167)...
September 20, 2016: Chest
Dimitry S Davydow, Anette Riisgaard Ribe, Henrik Søndergaard Pedersen, Mogens Vestergaard, Morten Fenger-Grøn
OBJECTIVE: While depression is associated with higher risk of death due to chronic medical conditions, it is unknown if depression increases mortality following serious infections. We sought to determine if pre-existing unipolar depression is associated with increased mortality within 30days after hospitalization for a serious infection. METHODS: We conducted a population-based cohort study of all adults hospitalized for an infection in Denmark between 2005 and 2013...
October 2016: Journal of Psychosomatic Research
Tamara McColl, Mathieu Gatien, Lisa Calder, Krishan Yadav, Ryan Tam, Melody Ong, Monica Taljaard, Ian Stiell
BACKGROUND: In 2008-2009, the Canadian Institute for Health Information reported over 30,000 cases of sepsis hospitalizations in Canada, an increase of almost 4,000 from 2005. Mortality rates from severe sepsis and septic shock continue to remain greater than 30% in Canada and are significantly higher than other critical conditions treated in the emergency department (ED). Our group formed a multidisciplinary sepsis committee, conducted an ED process of care analysis, and developed a quality improvement protocol...
September 9, 2016: CJEM
Alessandro Capitanini, Luca Rosso, Laura Giannecchini, Ophelia Meniconi, Adamasco Cupisti
A 47-year old, Caucasian man underwent extracorporeal shock wave lithotripsy (ESWL) of a 14mm calcium stone in the right renal pelvis, without urinary tract obstruction or sepsis. 24 hours after ESWL septic shock occurred and the patient was admitted to the Intensive Care Unit (ICU). Escherichia coli emerged from the blood and urine culture. The patient developed acute renal failure and it was necessary to start a continuous renal replacement therapy (CRRT). Infection was successfully treated, patient recovered renal function and an improvement of general condition occurred...
September 1, 2016: International Braz J Urol: Official Journal of the Brazilian Society of Urology
Andrew J Hale, Mary LaSalvia, James E Kirby, Allison Kimball, Rachel Baden
Asplenic patients are at increased risk for sepsis and fulminant infection. Sepsis in these patients is typically secondary to encapsulated bacteria, with Streptococcus pneumoniae being the most frequent pathogen. Rare complications of severe sepsis include purpura fulminans and bilateral adrenal hemorrhage (Waterhouse-Friderichsen syndrome). We present the case of a 36-year-old woman, healthy except for splenectomy years prior for idiopathic thrombocytopenic purpura treatment, who presented with fever. Upon presentation to our hospital, three hours after symptoms onset, she had purpura fulminans and shock...
2016: IDCases
Christian D Weber, Rolf Lefering, Thomas Dienstknecht, Philipp Kobbe, Richard M Sellei, Frank Hildebrand, Hans-Christoph Pape
BACKGROUND: A broad range of systemic complications has been described to occur in patients with open major fractures. Various causes have been claimed to play a role. We therefore surveyed a nationwide trauma registry to assess risk factors associated with closed and various types of open femur fractures. METHODS: Cohort study in a nationwide population-based prospective database. Inclusion criteria for selection from database: individuals with femur fracture, age ≥16 years, and survival until primary admission...
August 16, 2016: Journal of Trauma and Acute Care Surgery
Christopher T Martin, Yubo Gao, Andrew J Pugely
BACKGROUND: Unplanned hospital readmission following orthopedic procedures results in significant expenditures for the Medicare population. In order to reduce expenditures, hospital readmission has become an important quality metric for Medicare patients. The purpose of the present study is to determine the incidence and risk factors for 30-day readmissions after hip fracture surgery. METHODS: Patients over the age of 18 years who underwent hip fracture surgery, including open reduction internal fixation (ORIF), intramedullary nailing, hemi-arthroplasty, or total hip arthroplasty, between the years 2012 and 2013 were identified from the American College of Surgeons National Surgical Quality improvement Program (NSQIP) database...
2016: Iowa Orthopaedic Journal
A M Van Niekerk, R M Cullis, L L Linley, L Zühlke
BACKGROUND: Early detection of critical congenital heart disease (CCHD) through newborn pulse oximetry (POx) screening is an effective strategy for reducing paediatric morbidity and mortality rates and has been adopted by much of the developed world. OBJECTIVES: To document the feasibility of implementing pre-discharge POx screening in well babies born at Mowbray Maternity Hospital, a busy government hospital in Cape Town, South Africa. Parent and staff acceptance was assessed...
August 2016: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
Malvin Torsvik, Lise Tuset Gustad, Arne Mehl, Inger Lise Bangstad, Liv Jorun Vinje, Jan Kristian Damås, Erik Solligård
BACKGROUND: Systemic inflammatory response syndrome (SIRS) and sepsis are now frequently identified by observations of vital signs and detection of organ failure during triage in the emergency room. However, there is less focus on the effect on patient outcome with better observation and treatment at the ward level. METHODS: This was a before-and-after intervention study in one emergency and community hospital within the Mid-Norway Sepsis Study catchment area. All patients with confirmed bloodstream infection have been prospectively registered continuously since 1994...
2016: Critical Care: the Official Journal of the Critical Care Forum
Aida Hamzić-Mehmedbašić, Senija Rašić, Merima Balavac, Damir Rebić, Marina Delić-Šarac, Azra Durak-Nalbantić
INTRODUCTION: Data regarding prognostic factors of post-discharge mortality and adverse renal function outcome in acute kidney injury (AKI) hospital survivors are scarce and controversial. OBJECTIVES: We aimed to identify predictors of post-discharge mortality and adverse renal function outcome in AKI hospital survivors. PATIENTS AND METHODS: The study group consisted of 84 AKI hospital survivors admitted to the tertiary medical center during 2-year period...
2016: Journal of Renal Injury Prevention
Neil Ruparelia, Vasileios F Panoulas, Angela Frame, Ben Ariff, Nilesh Sutaria, Michael Fertleman, Jonathan Cousins, Jon Anderson, Colin Bicknell, Andrew Chukwuemeka, Sayan Sen, Iqbal S Malik, Antonio Colombo, Ghada W Mikhail
AIM: To determine the effect of procedural and clinical factors upon C reactive protein (CRP) dynamics following transcatheter aortic valve implantation (TAVI). METHODS: Two hundred and eight consecutive patients that underwent transfemoral TAVI at two hospitals (Imperial, College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom and San Raffaele Scientific Institute, Milan, Italy) were included. Daily venous plasma CRP levels were measured for up to 7 d following the procedure (or up to discharge)...
July 26, 2016: World Journal of Cardiology
Michael P Thompson, Mathew J Reeves, Brittany L Bogan, Bruno DiGiovine, Patricia J Posa, Sam R Watson
OBJECTIVES: To evaluate the impact of a multi-ICU quality improvement collaborative implementing a protocol-based resuscitation bundle to treat septic shock patients. DESIGN: A difference-in-differences analysis compared patient outcomes in hospitals participating in the Michigan Health & Hospital Association Keystone Sepsis collaborative (n = 37) with noncollaborative hospitals (n = 50) pre- (2010-2011) and postimplementation (2012-2013). Collaborative hospitals were also stratified as high (n = 19) and low (n = 18) adherence based on their overall bundle adherence...
July 20, 2016: Critical Care Medicine
Denice S Feig, Kellie Murphy, Elizabeth Asztalos, George Tomlinson, Johanna Sanchez, Bernard Zinman, Arne Ohlsson, Edmond A Ryan, I George Fantus, Anthony B Armson, Lorraine L Lipscombe, Jon F R Barrett
BACKGROUND: The incidence of type 2 diabetes in pregnancy is rising and rates of serious adverse maternal and fetal outcomes remain high. Metformin is a biguanide that is used as first-line treatment for non-pregnant patients with type 2 diabetes. We hypothesize that metformin use in pregnancy, as an adjunct to insulin, will decrease adverse outcomes by reducing maternal hyperglycemia, maternal insulin doses, maternal weight gain and gestational hypertension/pre-eclampsia. In addition, since metformin crosses the placenta, metformin treatment of the fetus may have a direct beneficial effect on neonatal outcomes...
2016: BMC Pregnancy and Childbirth
Guangsheng Wang, Shaodan Wang, Yeting Zhou, Xiaodong Chen, Xiaobo Ma, Daoming Tong
OBJECTIVE: To investigate whether the presence of sepsis associated encephalopathy (SAE) would predict nosocomial coma (NC) and poor outcome in patients with supratentorial intracerebral hemorrhage (SICH). METHODS: A retrospective cohort study was conducted. The adult acute SICH patients with or without coma admitted to intensive care unit (ICU) of Shuyang People' Hospital Affiliated to Xuzhou Medical University from December 2012 to December 2015 were enrolled...
August 2016: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
F Heidemann, H Diener, S Debus, D Perez, T Kölbel, N Tsilimparis
Complex aortic aneurysm such as paravisceral aneurysm represent a challenging condition especially in the case of rupture. The presence of an aortoenteric fistula in this setting is associated with a very high mortality and morbidity. We report the case of a 72-year-old patient with contained ruptured paravisceral aortic aneurysm who underwent surgeon-modified fenestrated EVAR (sm-fEVAR) with fenestrations for multiple renal arteries and the superior mesenteric artery. The patient successfully recovered from the repair but developed an aortogastric fistula on the basis of a pre-existing gastric ulceration so that second-stage atypical gastrectomy was conducted...
July 13, 2016: Annals of Vascular Surgery
Francisco Colomina-Climent, Carola Giménez-Esparza, Cristina Portillo-Requena, José Manuel Allegue-Gallego, María Galindo-Martínez, Cristina Mollà-Jiménez, José Luis Antón-Pascual, Manuel Rodríguez-Serra, José Luis Martín-Ruíz, Pablo Juan Fernández-Arroyo, Eugenia María Blasco-Císcar, José Cánovas-Robles, Miguel Herrera-Murillo, Enrique González-Hernández, Fernando Sánchez-Morán, Manuel Solera-Suárez, Jesús Torres-Tortajada, José María Nuñez-Martínez, David Martín-Langerwerf, Eugenio Herrero-Gutiérrez, Isabel Sebastián-Muñoz, Antonio Palazón-Bru, Vicente Francisco Gil-Guillén
INTRODUCTION: There is a lack of evidence in the efficacy of the coupled plasma filtration adsorption (CPFA) to reduce the mortality rate in septic shock. To fill this gap, we have designed the ROMPA study (Mortality Reduction in Septic Shock by Plasma Adsorption) to confirm whether treatment with an adequate dose of treated plasma by CPFA could confer a clinical benefit. METHODS AND ANALYSIS: Our study is a multicentric randomised clinical trial with a 28-day and 90-day follow-up and allocation ratio 1:1...
2016: BMJ Open
Melissa A Kottke, Thomas J Walters
Edema is typically presented as a secondary effect from injury, illness, disease, or medication, and its impact on patient wellness is nested within the underlying etiology. Therefore, it is often thought of more as an amplifier to current preexisting conditions. Edema, however, can be an independent risk factor for patient deterioration. Improper management of edema is costly not only to the patient, but also to treatment and care facilities, as mismanagement of edema results in increased lengths of hospital stay...
September 2016: Shock
Ceri Evans, Jean H Humphrey, Robert Ntozini, Andrew J Prendergast
The ZVITAMBO trial recruited 14,110 mother-infant pairs to a randomized controlled trial of vitamin A between 1997 and 2000, before the availability of antiretroviral therapy for HIV prophylaxis or treatment in Zimbabwe. The HIV status of mothers and infants was well characterized through 1-2 years of follow-up, leading to the largest cohort to date of HIV-exposed uninfected (HEU) infants (n = 3135), with a suitable comparison group of HIV-unexposed infants (n = 9510). Here, we draw on 10 years of published findings from the ZVITAMBO trial...
2016: Frontiers in Immunology
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