摘要
SUMMARY: Experimental studies devoted to the study of the mechanisms of the pathogenesis of acute peritonitis and the development of new methods of medical and surgical treatment are becoming increasingly relevant. Today, experimental medicine knows many different ways to modeling septic peritonitis and eliminate it, but the role of the local immune system is underestimated, whereas it takes a direct part in inflammation. The objective of our work to study morphological features of results of experimental modeling of septic peritonitis in white rats. The study included 15 sexually mature white male rats weighing 276.75±6.56 grams. A simulation of septic peritonitis was performed by perforating the upper part of the cecum with four punctures with a G16 injection needle. As a result of the experiment, after examination of the peritoneal cavity, all 15 animals were diagnosed with omentum tamponade of perforated damage to the caecum. In 11 cases, the perforated wall of the caecum was covered by the greater omentum (73.34 %), and in the other 4 animals, tamponade was performed by one of the epididymal omentum (26.66 %). The initial stage of tamponade with the greater or epididymal omentums of a perforated caecum begins on the first day of the experiment and consists of tight interstitial consolidation between them, as well as in the invasion of blood vessels from the omentum side to the focus of infection, which ensure the delivery of the appropriate immunocompetent cells. As a result of this process, intensive lymphoid infiltrates are formed in this area, as well as the growth of adipose tissue, which isolates the inflammatory focus from the peritoneal cavity with a thick layer.
Las investigaciones experimentales dedicadas al estudio de los mecanismos de patogénesis de la peritonitis aguda y el desarrollo de nuevos métodos de tratamiento médico y quirúrgico son cada vez más relevantes. Hoy en día, la medicina experimental conoce muchas formas diferentes de modelar la peritonitis séptica y eliminarla, pero se subestima el papel del sistema inmunológico local, mientras que él participa directamente en la inflamación. El objetivo de nuestro trabajo fue estudiar las características morfológicas de los resultados del modelado experimental de peritonitis séptica en ratas blancas. El estudio incluyó 15 ratas macho blancas, sexualmente maduras que pesaban 276,75 ± 6,56 gramos. Se realizó una simulación de peritonitis séptica perforando la parte superior del ciego con cuatro punciones con una aguja de inyección G16. Como resultado del experimento, después del examen de la cavidad peritoneal, a los 15 animales se les diagnosticó taponamiento del omento o lesión perforada del ciego. En 11 casos, la pared perforada del ciego fue recubierta por el omento mayor (73,34 %), y en los otros 4 animales el taponamiento se realizó por uno de los epidídimos (26,66 %). La etapa inicial del taponamiento con omento mayor o epidídimo de un ciego perforado comienza el primer día del experimento y consiste en una estrecha consolidación intersticial entre ellos, así como en la invasión de los vasos sanguíneos desde el lado del omento hasta el foco de infección, que aseguran la entrega de las células inmunocompetentes apropiadas. Como resultado de este proceso, se forman intensos infiltrados linfoides en esta zona, así como el crecimiento de tejido adiposo, que aísla el foco inflamatorio de la cavidad peritoneal con una gruesa capa.
Subject(s)
Animals , Male , Rats , Peritonitis/pathology , Omentum/pathology , Lymphocytes , Cecum/pathology , Adipocytes , Disease Models, Animal , Duodenum/pathology摘要
ObjectiveTo investigate the clinical application value of a predictive model for the efficacy of third-generation cephalosporin in the treatment of community-acquired spontaneous bacterial peritonitis （CASBP）. MethodsThis prospective study was conducted among 50 patients with liver cirrhosis and CASBP who were admitted to The Ninth Hospital of Nanchang from January 2021 to June 2022， and the patients were randomly divided into optimized treatment group and traditional treatment group， with 25 patients in each group. The patients in the optimized treatment group received ceftazidime or imipenem for initial treatment based on the above predictive model， and those in the traditional treatment group received ceftazidime for initial treatment， with the subsequent use of antibiotics adjusted based on the efficacy of initial treatment. The two groups were compared in terms of the response rate of initial treatment， cure rate on day 5， and 30-day mortality rate. The independent-samples t test or the Mann-Whitney U test was used for comparison of continuous data between two groups， and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups. ResultsAll patients completed the study. The optimized treatment group had a significantly higher response rate of initial treatment than the traditional treatment group （88.0% vs 60.0%， χ2=5.094， P=0.024）， while there was no significant difference in the cure rate on day 5 between the two groups （80.0% vs 56.6%， χ2=3.309， P=0.069）. As for the patients who received ceftazidime for initial treatment， the optimized treatment group had a significantly higher response rate of initial treatment than the traditional treatment group （88.9% vs 60.0%， χ2=4.341， P=0.037）， while there was no significant difference in the cure rate on day 5 between the two groups （83.3% vs 56.0%， χ2=2.425， P=0.119）. There was no significant difference in 30-day mortality rate between the two groups （8.0% vs 20.0%， χ2=0.664， P=0.415）. For all patients， there was a significant association between response of initial treatment and cure on day 5 （odds ratio ［OR］=9.643， 95% confidence interval ［CI］： 2.292 — 40.564） and between cure on day 5 and 30-day mortality （OR=0.138， 95%CI： 0.023 — 0.813）. ConclusionThis predictive model for efficacy helps clinicians to identify the patients who can benefit from third-generation cephalosporin treatment and improve the efficacy of third-generation cephalosporin in the initial empirical treatment of CASBP.
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Objective To explore the effect and safety of Internet-based automated peritoneal dialysis(APD)compare to continu-ous ambulatory peritoneal dialysis(CAPD).Methods The study was a prospective control study and the patients with peritoneal dialysis(PD)admitted to the First Affiliated Hospital of Army Military Medical University from November 2020 to November 2021.Patients were divided into APD group and CAPD group according to the dialysis modes.After the inclusion of APD patients,the propensity score matc-hing method was used to match the patients 1:1 into the PD control group.A one-year follow-up was conducted on patients,52 patients in the APD group and 58 patients in the CAPD group were ultimately included in the analysis.Both groups were managed by the Internet-supported telemedicine platform.The quality of dialysis,incidence of peritonitis and adverse cardiovascular events were com-pared between the two groups,and the quality of life score was performed by Kidney Disease and Quality of Life Questionnaire(KDQOL-36)to compare the quality of life between the two groups.Results The quality of dialysis and life score in APD group were higher than those in CAPD group,the incidence of peritonitis and adverse cardiovascular events in APD group were lower than those in CAPD group,the above differences were statistically significant(P＜0.05).Conclusion Internet-based peritoneal dialysis management mode and further use of APD remote management platform can effectively improve the quality of dialysis and life,and reduce the incidence of perito-nitis and adverse cardiovascular events in PD patients.
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Objective To analyze the pathogenic bacteria and drug resistance of peritoneal dialysis-associated peritonitis(PDAP),and provide a clinical reference for the rational use of antibiotics.Methods The demographic data of PDAP patients admitted to the peritoneal dialysis(PD)Center of the First Affiliated Hospital of Soochow University from July 1,2015 to December 30,2021 were collected,and the pathogens,drug resistance and prognosis were retrospectively analyzed.Results A total of 150 episodes of PDAP occurred in 92 patients.The positive rate of PD fluid culture was 61.33％,including 65 cases(70.65％)of Gram-positive(G+)bacteria,mainly Staphylococcus and Streptococcus.Gram-negative(G-)bacteria were in 16 cases(17.39％),mainly Escherichia coli and Enterobacter cloacae.There were 11 cases(11.96％)of multiple infections,including 5 cases of combined fungal infection.From 2016 to 2021,the incidence of G+bacteria-related PDAP decreased from 14 to 8 cases.G+strains were resistant to methicillin(35.00％),and were sensitive to linezolid(100.00％),teicoplanin(100.00％)and rifampicin(100.00％).The sensitivity rate to vancomycin was 98.59％.G-strains were sensitive to ceftazidime(86.36％),ceftizoxime(88.89％)and amikacin(100.00％).The MIC of vancomycin against Staphylococcus showed an upward trend in 2019-2021.The overall cure rate of PDAP was 81.33％in patients who responded to antibiotic treatment,and the cure rate of G+bacteria was higher than that of multiple infections(89.23％vs.36.36％,P＜0.01).The outcome of patients with multiple infections,especially those with concurrent fungal infection was poor.Conclusion The incidence of PDAP in the PD center has shown a decreasing trend in recent years.G+bacteria are still the main pathogenic bacteria causing PDAP,and they are highly resistant to methicillin,so vancomycin should be used as empirical therapy.For G-bacteria,cefotaxime and amikacin can be chosen as empirical therapy.There is a drift in the MIC values of vancomycin against Staphylococcus in the study period,so it is necessary to monitor the MIC of vancomycin against Staphylococcus and its changing trend.
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Objective:To investigate the incidence and risk factors of ultrafiltration failure (UFF) in patients undergoing continuous ambulatory peritoneal dialysis (CAPD).Methods:The clinical data of 65 patients undergoing CAPD at the Hubei Provincial Corps Hospital of Chinese People's Armed Police Forces and the General Hospital of Central Theater Command from January 2016 to December 2021 were retrospectively analyzed. The clinical data included patient history, smoking history, duration of peritoneal dialysis, incidence of peritonitis, levels of hemoglobin, albumin, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, total cholesterol, and triglyceride. Univariate and multivariate regression analyses were conducted to investigate the correlation between UFF and various indicators in patients undergoing CAPD.Results:Among the 65 patients undergoing CAPD, the incidence of UFF was 35.4% (23/65). There were significant differences in duration of peritoneal dialysis, history of peritonitis, history of type 2 diabetes mellitus, serum albumin, low-density lipoprotein cholesterol, and triglyceride between patients with UFF and those without UFF ( t = -5.05, χ2 = 11.51, 6.83, t = 5.91, -3.28, -2.83, all P < 0.05). Multivariate regression analysis showed that albumin was negatively correlated with UFF ( r = -1.06, P < 0.05), while duration of peritoneal dialysis, level of low-density lipoprotein cholesterol, and peritonitis were positively correlated with UFF ( r = 0.43, 2.20, 1.67, all P < 0.05). Conclusion:Peritoneal dialysis duration, peritonitis, and low-density lipoprotein cholesterol are risk factors for UFF in patients undergoing CAPD, while albumin is a protective factor against UFF in these patients.
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Objective To explore the influencing factors of spontaneous bacterial peritonitis in patients with primary liver cancer complicated with ascites and establish a prediction model.Methods A total of 292 patients with primary liver cancer complicated with ascites who were hospitalized for the first time in the Third People's Hospital of Kunming from January 2012 to December 2021 were selected as the study objects.General data,etiological indicators,serological indicators and complications of these subjects were collected.Then they were divided into the infection group(n = 114)and the control group(n = 178)according to whether spontaneous bacterial peritonitis(SBP)was complicated.Univariate and multivariate logistic regression were used to analyze the influencing factors of SBP in patients with primary liver cancer complicated with ascites.Finally,ROC curves were constructed to more intuitively represent the individual and combined predictive value of these targets.Results Am-ong 292 hepatocellular carcinoma patients with ascites,there were 235 males(80.48%)and 57 females(19.52%),among which 114 patients with SBP were in the infection group and 178 patients without SBP were in the control group.The results of univariate analysis showed that compared with the control group,the levels of WBC,neutrophils,prothrombin time,total bilirubin,albumin,CD3,CD4,CD8,CD4/CD8 ratio,CD19 procalcitonin,serum amyloid A,hypersensitive C-reactive protein,sodium,chlorine,alcohol consumption,shock,hepatorenal syndrome,hepatic encephalopathy,massive ascites in the infection group had statistically significant difference(P<0.05).Multi-factor analysis revealed that CD8,CD4/CD8 ratio were protective factors for SBP in patients with liver cancer ascites,CD19,procalcitonin,serum amyloid A,and massive ascites were risk factors for SBP in patients with ascites.ROC curve construction showed that serum amyloid A,CD8,CD4/CD8 ratio,CD19,procalcitonin,massive ascites area under curve(AUC)of massive ascites were 0.724,0.637,0.653,0.820,0.705,0.686,respectively.Conclusion CD8,CD4/CD8 ratio,CD19,procalcitonin,serum amyloid A,and a large volume of ascites are significant factors contributing to the development of spontaneous bacterial peritonitis(SBP)in patients with hepatocellular carcinoma ascites.The predictive value of combination is substantial,demonstrating a level of accuracy in forecasting SBP occurrence
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Objective To investigate the clinical features,laboratory indicators and prognosis of patients with bacterial ascites,and to provide evidence for early clinical diagnosis and treatmen.Methods Clinical data of patients diagnosed with cirrhosis ascites from First Teaching Hospital of Tianjin University of Traditional Chinese Medicine from January 2019 to January 2022 were retrospectively analyzed.According to diagnostic criteria,they were divided into bacterial ascites group(n=24),spontaneous bacterial peritonitis group(n=20)and control group(n=26).The clinical features,laboratory indicators and prognosis of three groups were compared.Results Cirrhosis ascites caused by hepatitis B accounted for the highest proportion.The white blood cell count,neutrophil percentage,ascites white blood cell and polymorphonuclear leukocyte count of patients in bacterial ascites group were significantly higher than those in control group(P<0.05).Gram-positive bacteria was the main pathogens causing bacterial ascites,among which staphylococcus accounts for the highest proportion.Ten cases of bacterial ascites with symptoms of infection were treated with ascites culture and anti-infection therapy.The 14 patients without symptoms of infection were given different treatment according to the development of the disease,one patient died,and the other patients improved.Conclusion The number of patients with bacterial ascites was large,and the main pathogenic bacteria was Gram-positive coccus.The combination of clinical symptoms and laboratory indicators is beneficial to the early diagnosis of bacterial ascites and the decision of treatment.
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Objective To analyze the influencing factors of peritoneal dialysis associated peritonitis(PDAP)and the distribution characteristics of pathogenic bacteria.Methods The clinical data of 257 patients who underwent peritoneal dialysis(PD)and regular follow-up in Meizhou People's Hospital from January 2012 to October 2022 were retrospectively analyzed.According to the occurrence of PDAP,the patients were divided into the PDAP group(n=102)and the non-PDAP group(n=155).The exhaled liquid(5-10 mL)was extracted with a sterile syringe,and the pathogen was identified by blood culture method.General data such as gender,age,primary disease,education level,whether complicated with hypertension/diabetes/cardiovascular diseases,whether keeping pets or poultry,body mass index(BMI)and dialysis duration were collected.Fasting elbow venous blood was drawn in the morning of the next day after diagnosis,the levels of hemoglobin(Hb),albumin(ALB),serum potassium,serum phosphorus,and serum calcium were detected.The estimated glomerular filtration rate(eGFR)and urea clearance index(UCI)were recorded.Multivariate logistic regression was used to analyze the risk factors of PDAP in PD patients.Results There were 217 cases of PDAP in 102 patients with PDAP,and 124 cases(57.14％)were positive for pathogen culture.A total of 127 pathogenic bacteria were isolated,including 84 Gram-positive strains(66.14％),39 Gram-negative strains(30.71％)and 4 Fungi strains(3.15％).Among the 84 strains of Gram-positive bacteria,there were 25 strains of staphylococcus epidermidis(29.76％),17 strains of staphylococcus aureus(20.24％),12 strains of staphylo-coccus haemolyticus(14.29％),8 strains of staphylococcus warneri(9.52％),10 strains of streptococcus salivarius(11.90％),5 strains of streptococcus sanguis(5.95％),and 7 other strains(8.33％).Among the 39 strains of Gram-nega-tive bacteria,there were 20 strains of escherichia coli(51.28％),6 strains of pseudomonas aeruginosa(15.38％),6 strains of acinetobacter baumannii(15.38％),5 strains of klebsiella pneumoniae(12.82％),and 2 strains of enterobacter cloacae(5.13％).Among the 4 strains of Fungi,there were 3 strains of near-smooth candida(75.00％)and 1 strain of candida glabrata(25.00％).There was no significant difference in gender,age,primary disease,education level,BMI,and the propor-tion of comorbidities with hypertension,diabetes and cardiovascular diseases between the PDAP and non-PDAP groups(P＞0.05).The proportion of patients keeping pets or poultry in the PDAP group was higher than that in the non-PDAP group,and the dialysis duration was longer than that in the non-PDAP group(P＜0.05).There was no significant difference in serum phosphorus,serum calcium,eGFR and UCI between the PDAP and non-PDAP groups(P＞0.05).The levels of Hb,ALB and serum potassium in the PDAP group were significantly lower than those in the non-PDAP group(P＜0.05).Logistic regression analysis showed that keeping pets or poultry and long dialysis duration were risk factors for PDAP in PD patients(P＜0.05).High Hb and ALB levels were protective factors for PDAP in PD patients(P＜0.05).There was no correlation between serum potassium and PDAP in PD patients(P＞0.05).Conclusion Gram-positive bacteria are the main pathogenic bacteria of PDAP,among which staphylococcus epidermidis is the predominant one.Keeping pets or poultry and long dialysis duration are risk factors for PDAP,while high Hb and ALB levels are protective factors for PDAP in PD patients.
摘要
Resumen La peritonitis por neumococo comprende un pequeno subconjunto de pacientes con enfermedad invasiva (ENI). Durante 15 años (2005-2020) de vigilancia de ENI en un hospital de pediatría, se detectaron 5 casos de peritonitis primaria. Los pacientes, 3 ninas y 2ninos con una media de edad de 5 anos, experimentaron signos y síntomas peritoneales; 3 de ellos presentaban síndrome nefrótico. En coincidencia con los perfiles locales, todos los aislamientos fueron sensibles a betalactámicos, una cepa expresó resistencia a tetraciclina y cotrimoxazol y otra solo a cotrimoxazol. Los serotipos encontrados en 4/5 cepas (una resultó no viable) fueron 1, 19F, 15C y 23A. Los ninos fueron tratados con cefalosporinas de tercera generación o con ampicilina, gentamicina y metronidazol; todos evolucionaron favorablemente. Se destaca la importancia del hallazgo de Streptococcus pneumoniae en peritonitis primarias en niños. Este trabajo contribuye al conocimiento de esta enfermedad en particular y al de la epidemiología local de la ENI.
Abstract Pneumococcal peritonitis represents a small subset of patients suffering from inva-sive pneumococcal disease (IPD). We describe 5 cases of primary peritonitis documented in the pediatric hospital over 15 years (2005-2020) of IPD surveillance. The patients, 3girls and 2boys with a mean age of 5 years, experienced peritoneal signs and symptoms; 3of them suffered from nephrotic syndrome. Based on the local resistance profiles, all isolates were sensitive to beta-lactams, one strain showed resistance to cotrimoxazole and tetracycline while another strain, to cotrimoxazole only. Serotypes found in 4/5 strains (one was non-viable) were: 1, 19F, 15C and 23A. Children were treated with third-generation cephalosporins or ampicillin, gentamicin and metronidazole and all of them evolved favorably. Pneumococcal etiology should be included in the differential diagnosis of acute abdominal pain in children. Our study aims to contribute to the knowledge of this condition and to the local epidemiology of IPD.
摘要
La peritonitis asociada a diálisis peritoneal es una complicación grave en el paciente con este tipo de modalidad de terapia de reemplazo renal, siendo la etiología fúngica una de las que conlleva mayor morbimortalidad. Presentamos el caso de un paciente de 22 años que desarrolló una peritonitis asociada a diálisis peritoneal causada por el complejo Paecilomyces variotii; un hongo filamentoso poco frecuente en este grupo de pacientes.
Peritonitis associated with peritoneal dialysis is a serious complication in patients with this type of renal replacement therapy modality, with fungal aetiology being one of the most associated with morbidity and mortality. We present the case of a 22-year-old patient who developed fungal peritonitis associated with peritoneal dialysis caused by Paecilomyces variotii complex; a rare cause of peritonitis in this group of patients.
Subject(s)
Humans , Male , Young Adult , Peritonitis/etiology , Peritoneal Dialysis/adverse effects , Mycoses/complications , Peritonitis/drug therapy , Paecilomyces/genetics , Mycoses/drug therapy , Antifungal Agents/therapeutic use摘要
Objetivo: Describir la morbimortalidad de los pacientes con diagnóstico de peritonitis apendicular, sometidos a cirugía laparoscópica en el Servicio de Cirugía General del Hospital Universitario de Caracas, durante el periodo enero 2013 - diciembre 2018. Métodos: estudio retrospectivo, descriptivo, observacional de corte transversal. Se revisaron las historias clínicas de los pacientes con peritonitis apendicular que fueron sometidos a cirugía laparoscópica en los servicios de Cirugía I, II, III y IV del Hospital Universitario de Caracas, en el período enero 2013-diciembre 2018. Las variables cuantitativas se expresaron en media ± desviación estándar y variables cualitativas en frecuencia y porcentaje; los datos se procesaron en el programa estadístico SPSS 19 (SPSS, inc., Chicago, EEUU). Resultados: la muestra estuvo conformado por 60 pacientes con edades entre 12 y 78 años, con el 78,33% en el grupo etario de 10 a 29 años; el sexo masculino representó el 58,33% de la muestra, con un promedio de edad de 23,90± 11,84 años; las complicaciones se presentaron en el 18,33% de los casos, más frecuente la infección del sitio operatorio con 6,67% (n=4) de los pacientes. La estancia hospitalaria global fue de 4,80 ± 2,58 días. Un paciente falleció. Conclusiones: el abordaje laparoscópico para el tratamiento de la peritonitis apendicular difusa se relaciona con muy baja morbimortalidad postoperatoria. La complicación más frecuente fue la infección del sitio operatorio. La mayoría de los pacientes solo ameritó una intervención quirúrgica(AU)
Objective: To describe the morbimortality ofpatients with a diagnosis of appendicular peritonitis undegoinglaparoscopic surgery in the General Surgery Department of the University Hospital of Caracas, during the period January2013 - December 2018. Methods: A retrospective, descriptive,observational, cross-sectional, descriptive study was performed.the medical records of patients with appendicular peritonitis who underwent laparoscopic surgery in the Surgery I, II, III and IV services of the University Hospital of Caracas were reviewed. Period January 2013-December 2018. Quantitative variables are expressed as mean ± standard deviation and qualitative variablesas frequency and percentage. The data were processed in the SPSS 19 statistical program (SPSS, inc., Chicago, USA). Results: the sample consisted of 60 patients aged between 12 and 78 years, with 78.33% in the age group 10 to 29 years. Male sex represented 58.33% of the sample, with an average age of 23.90 ±11.84 years. Complications occurred in 18.33% of the cases, with6.67% (n=4) of the patients reporting surgical site infection. The overall hospital stays of 4.80 ± 2.58 days. One patientdied. Conclusions: the laparoscopic approach is of choice for the treatment of diffuse appendicular peritonitis. The most frequent complication was surgical site infection. Most of the patients only required one surgical intervention(AU)
Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Aged , Peritonitis/surgery , Peritonitis/mortality , General Surgery摘要
Bertholletia excelsa is native to the Amazon Rainforest and is popularly known as the Brazil nut. It has socioeconomic importance due its nuts being a great export product. There are few studies in the literature regarding the biotechnological potential of its bark, although it is used in folk medicine. The aim of this study was to determine the chemical constituents, anti-inflammatory and antioxidant properties of B. excelsa bark extract (BEB). Twelve substances were identified by LC/MS/MS, and cytotoxicity tests were carried out, as well as analyses of nitric oxide production and elimination of free radicals. BEB caused cytoprotection against oxidative stress in macrophages, increased HMOX-1 expression, overcame the antioxidant effects of GPx-1 and reduced its expression and was able to inhibit leukocyte migration in use peritonitis. BEB efficiently attenuated oxidative stress due to its antioxidant and anti-inflammatory properties and, as such, can be used as a safe and effective source of a natural herbal medicine.
Bertholletia excelsa es originaria de la selva amazónica y se la conoce popularmente como nuez de Brasil. Tiene importancia socioeconómica debido a que sus frutos secos son un gran producto de exportación. Existen pocos estudios en la literatura sobre el potencial biotecnológico de su corteza, aunque se utiliza en medicina popular. El objetivo de este estudio fue determinar los componentes químicos, las propiedades antiinflamatorias y antioxidantes del extracto de corteza de B. excelsa (BEB). Se identificaron 12 sustancias mediante LC/MS/MS y se realizaron pruebas de citotoxicidad, así como análisis de producción de óxido nítrico y eliminación de radicales libres. BEB causó citoprotección contra el estrés oxidativo en macrófagos, aumentó la expresión de HMOX-1, superó los efectos antioxidantes de GPx-1 y redujo su expresión y fue capaz de inhibir la migración de leucocitos en la peritonitis de uso. BEB atenuó eficazmente el estrés oxidativo debido a sus propiedades antioxidantes y antiinflamatorias y, como tal, puede utilizarse como una fuente segura y eficaz de un medicamento a base de hierbas naturales.
Subject(s)
Plant Extracts/pharmacology , Bertholletia/chemistry , Anti-Inflammatory Agents/pharmacology , Antioxidants/pharmacology , Plants, Medicinal , Brazil , Plant Bark/chemistry摘要
Resumen La definición de la enfermedad renal crónica (ERC) es la disminución del filtrado glomerular (FG) por debajo de 60 ml/min/1.73 m2, durante tres o más meses, acompañada por anormalidades estructurales o funcionales. México reporta una incidencia de 467/1 000 00 casos de ERC. La modalidad de diálisis más utilizada es la diálisis peritoneal y la complicación más común es la peritonitis. Se obtuvo la prevalencia de peritonitis en pacientes con diálisis peritoneal del HCM en 2021, determinar las comorbilidades asociadas a la ERC, la diferencia entre diálisis automatizada y continua ambulatoria, sus desenlaces y la mortalidad global. Estudio observacional, descriptivo, transversal. Pacientes con diálisis peritoneal atendidos durante 2021 en nefrología del HCM. Se recolectaron y analizaron los datos, utilizando estadística descriptiva e inferencial determinado la prevalencia de peritonitis, las diferencias entre la modalidad de diálisis peritoneal y los episodios de peritonitis. Se analizaron 339 pacientes atendidos en el HCM, durante un año, la prevalencia de peritonitis fue de 0.2625 peritonitis/paciente/año, las comorbilidades fueron la hipertensión (70.5%) y la diabetes mellitus (65.19%), entre los grupos de diálisis peritoneal automatizada y diálisis peritoneal continua ambulatoria no hubo diferencia y la mortalidad general fue 6.48%. La peritonitis es la principal complicación en diálisis peritoneal, la prevalencia en el HCM esta por abajo de la media del país y del mundo siendo esta del 26.25%. Las Guías de la Sociedad Internacional de la Diálisis Peritoneal recomiendan mantener una prevalencia por abajo de 0.5 episodios de peritonitis por paciente por año.
Abstract The definition of the Chronic Kidney Disease (CKD) is the decrease in glomerular filtration rate (GFR) below 60 ml/min/1.73 m2, for 3 or more months, accompanied by structural or functional abnormalities. Mexico reports an incidence of 467/1,000,000 cases of CKD. The most used dialysis modality is peritoneal dialysis, and the most common complication is peritonitis. We obtained the prevalence of peritonitis in patients with peritoneal dialysis in HCM in 2021, to determine the comorbidities associated with CKD, the difference between automated and continuous ambulatory dialysis, its outcomes, and overall mortality. Observational, descriptive, cross-sectional study. Patients with peritoneal dialysis attended during 2021 in HCM nephrology. Data were collected and analyzed using descriptive and inferential statistics to determine the prevalence of peritonitis and the differences between the modality of peritoneal dialysis and the episodes of peritonitis. The prevalence of peritonitis was 0.2625 peritonitis/patient/year, and the comorbidities were hypertension (70.5%) and diabetes mellitus (65.19%), between the groups of Automated Peritoneal Dialysis and Continuous Ambulatory Peritoneal Dialysis there was no difference, and the overall mortality was 6.48%. Peritonitis is the main complication in peritoneal dialysis, the prevalence of HCM is below the country and world average of 26.25%. International Guidelines recommend maintaining a prevalence below 0.5 episodes of peritonitis per patient per year.
摘要
The idiopathic form of sclerosing encapsulating peritonitis, also known as abdominal cocoon, is a rare entity of unknown cause that leads to intestinal obstruction due to complete or partial encapsulation of the small intestine by a fibro- collagenous membrane. As the initial clinical features are non-specific, they often remain unrecognized making it difficult to make a definite pre-operative diagnosis. Recurrent episodes of small intestinal obstruction along with relevant imaging findings and lack of other causative mechanisms, gives rise to a clinical suspicion. We report a young lady who presented to us with features suggestive of acute intestinal obstruction. Thorough enquiry revealed similar episodes on multiple occasions in the past which was temporarily relieved with conservative management. The need to keep an open mind regarding the uncommon causes of commonly encountered problems is the point of interest in our case.
摘要
Las peritonitis secundarias constituyen una causa frecuente de internación y de uso de antibioticoterapia dentro de las infecciones intraabdominales. Realizamos un estudio retrospectivo, descriptivo y observacional de centro único desde enero a diciembre de 2021. El objetivo del estudio fue conocer la epidemiología local y adecuar el tratamiento empírico de las peritonitis secundarias de la comunidad. Se incluyeron pacientes mayores a 16 años con peritonitis secundaria, intervención quirúrgica, envío de material a cultivo y desarrollo microbiano de bacterias aerobias a través de la revisión de historias clínicas. Se analizaron cultivos de 36 pacientes, 64% de sexo masculino con una media de edad de 48,8 años. El 22% requirió internación en unidad de cuidados intensivos. La principal causa fue apendicitis aguda en el 61%, seguido por perforación secundaria a tumores. Se aislaron 43 bacterias aerobias (1,2 bacterias por episodio) siendo E. coli el microorganismo más frecuente. En la institución se utiliza piperacilina-tazobactam como tratamiento empírico. De acuerdo a las recomendaciones de la Sociedad Argentina de Infectología de 2018, en infecciones no complicadas podría utilizarse aminoglucósidos + metronidazol, optando por piperacilina-tazobactam en casos graves. No es recomendado como tratamiento empírico el uso de ampicilina-sulbactam y ciprofloxacina para infecciones graves o con difícil control del foco por la alta tasa de resistencia. En base a nuestro estudio podemos concluir que la epidemiología de los pacientes coincide con lo descrito en publicaciones nacionales, lo que nos lleva a reconsiderar el tratamiento empírico en casos leves, pudiendo optar por aminoglucósidos + metronidazol.
Secondary peritonitis is a frequent cause of hospital admission and an usual cause of use of antibiotic therapy in abdominal infections. We did a retrospective and observational study in one health center between January 2021 and December 2021. The aim of the study was to analyze the local epidemiology and adapt antibiotic empirical therapy of secondary community peritonitis. Patients aged 16 years and older with secondary peritonitis were included in this study. These patients needed surgical intervention and they had a positive culture with aerobic microorganism. We analyzed abdominal cultures from 36 patients, 64% men with a median age of 48.8 years. Twenty- two percent of these patients were admitted to intensive care unit. Acute appendicitis was the principal cause of secondary peritonitis in 61% of cases, followed by tumors. We found 43 aerobic bacterias (1.2 bacteria/episode), E.coli was the most frequent microorganism. In our hospital we use piperacillin- tazobactam for empirical treatment. According to the 2018 recommendations from the Argentine Society of Infectious Diseases, aminoglycosides + metronidazole can be used for uncomplicated intra-abdominal infections, and piperacillin-tazobactam should be used only in severe cases. However, ampicillin-sulbactam or ciprofloxacin is not recommended for severe cases or complicated infections due to the high resistance rates. Based on the finding of the study, it could be said that the epidemiology of the patients coincides with what was described in other national medical journals. Therefore, we should reconsider the use of aminoglycosides + metronidazole as empirical treatment for mild cases.
Subject(s)
Humans , Male , Female , Peritonitis/therapy , Drug Resistance, Microbial , Intraabdominal Infections/therapy摘要
INTRODUCCIÓN: Las infecciones asociadas a diálisis peritoneal constituyen una de las causas de morbimortalidad más importante en estos pacientes y la terapia antimicrobiana empírica y dirigida adecuada es fundamental para mejorar el resultado, por lo que es importante establecer la microbiología local. OBJETIVO: Revisar la experiencia clínica de cinco años del Hospital Carlos Van Buren de Valparaíso, Chile, describiendo las características clínicas y microbiológicas de los pacientes con episodios de peritonitis asociada a diálisis peritoneal. METODOLOGÍA De forma retrospectiva se accedió a los registros clínicos de aquellos pacientes mayores de 18 años que presentaron al menos un evento de peritonitis asociada a diálisis peritoneal. RESULTADOS: De un total de 26 episodios, 62% de los pacientes fueron de sexo femenino, con un promedio de edad de 53 años. La principal comorbilidad fue la hipertensión arterial (100%), y el dolor abdominal fue el síntoma más frecuente (85%), con una mortalidad general de 7,7%. En el laboratorio la leucocitosis, la proteína C reactiva (PCR) y la velocidad de hemosedimentación (VHS) fueron los hallazgos más importantes. Predominaron las cocáceas grampositivas (54%), seguido de bacilos gramnegativos no fermentadores y Enterobacterales en igual proporción (11,5% cada grupo). Casos aislados de Candida albicans y Pasteurella canis fueron identificados, y en 15% de los casos el cultivo resultó negativo. CONCLUSIÓN: Se pudo conocer las características clínicas y microbiológicas locales de esta patología, para así redefinir las directrices de manejo en la institución.
BACKGROUND: Infections associated with peritoneal dialysis are one of the most important causes of morbidity and mortality in these patients, and adequate empirical and targeted antimicrobial therapy are essential to improve the outcome, so it is important to establish the local microbiology. AIM: To review the clinical experience of 5 years at the Carlos Van Buren Hospital in Valparaíso, Chile, in order to know the clinical and microbiological characteristics of patients with episodes of peritonitis associated with peritoneal dialysis. METHODS: Retrospectively, the clinical records of those patients over 18 years of age who presented at least one peritonitis event associated with peritoneal dialysis were accessed. RESULTS: Of a total of 26 episodes, 62% of the patients were female, with a mean age of 53 years. The main comorbidity was arterial hypertension (100%), and abdominal pain was the most frequent symptom (85%), with an overall mortality of 7.7%. In the laboratory parameters, leukocytosis, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were the most important findings. Gram-positive cocci (54%) predominated, followed by Gram-negative non-fermenting and enterobacterial bacilli in the same proportion (11.5% each group). Isolated cases of Candida albicans and Pasteurella canis were identified, and in 15% of the cases the culture was negative. CONCLUSION: It was possible to know the local clinical and microbiological characteristics of this pathology, in order to redefine management guidelines for our institution.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Peritonitis/microbiology , Peritoneal Dialysis/adverse effects , Peritonitis/etiology , Blood Sedimentation , C-Reactive Protein , Retrospective Studies , Gram-Negative Bacteria/isolation & purification , Gram-Positive Bacteria/isolation & purification摘要
Abstract Background: Few studies have compared the infectious and mechanical complications seen in planned-start and urgent-start peritoneal dialysis (PD) patients. Objectives: To compare the incidence and etiology of mechanical and infectious complications in patients offered planned- and urgent-start PD and assess potential differences in patient survival and time on PD. Methods: This retrospective cohort study included patients with chronic kidney disease on planned- and urgent-start PD seen from 2014 to 2020 and compared them for mechanical and infectious complications, clinical outcome, death rates, and need to switch to hemodialysis. Results: Ninety-nine patients on planned-start PD and 206 on urgent-start PD were included. Incidence of exit-site infection (18.9 vs. 17.17%, p=0.71) and peritonitis (24.27 vs. 27.27%, p=0.57) were similar between patients, while pathogens causing peritonitis were different, although non-fermenting Gram-negative bacilli were more commonly seen in the planned-start PD group. Leakage as a mechanical complication and hospitalization were more common among patients needing urgent-start PD (10.68 vs. 2.02%, p=0.0085 and 35.44 vs. 17.17%, p=0.0011, respectively). Patient survival was similar between groups. Cox regression found an association between death and age (HR=1.051, 95% CI 1.026-1.07, p=0.0001) and albumin (HR=0.66, 95% CI 0.501-0.893, p=0.0064), and between peritonitis and a diagnosis of diabetes (HR=2.016, 95% CI 1.25-3.25, p=0.004). Conclusion: Patient survival and time on PD were similar between the planned- and urgent-start PD groups, while leakage was more frequently seen in the urgent-start PD group. Death was associated with lower albumin levels and older age, while peritonitis was associated with diabetes.
Resumo Antecedentes: Poucos estudos compararam as complicações infecciosas e mecânicas relacionadas à diálise peritoneal (DP) de início planejado e não planejado. Objetivos: Comparar a incidência e etiologia das complicações mecânicas e infecciosas associadas à DP tanto de início planejado quanto não planejado e avaliar comparativamente a sobrevida da técnica e dos pacientes. Métodos: Estudo de coorte retrospectivo que avaliou pacientes com doença renal crônica em DP não planejada e planejada de 2014 a 2020 quanto às complicações mecânicas e infecciosas e desfechos clínicos óbito ou mudança para hemodiálise. Resultados: Foram avaliados 99 pacientes em DP planejada e 206 em DP não planejada. Foram semelhantes quanto à incidência de Infecção do Orifício de Saída (18,9x17,17%, p=0,71), peritonite (24,27x27,27%, p=0,57) e diferentes quanto aos agentes etiológicos das peritonites, sendo os bacilos Gram-negativos não fermentadores mais frequentes no grupo planejado. Diferiram quanto à complicação mecânica extravasamento e internação, ambas mais frequentes no grupo não planejado (10,68 x 2,02%, p=0,0085 e 35,44 x 17,17%, p=0,0011, respectivamente). Semelhantes quanto à sobrevida dos pacientes e da técnica. À regressão de Cox, associou ao óbito a idade (HR=1,051, IC 95% 1,026-1,07, p=0,0001) e a albumina (HR=0,66, IC 95% 0,501-0,893, p=0,0064), e à peritonite a presença de diabetes (HR=2,016, IC 95% 1,25-3,25, p=0,004). Conclusão: A sobrevida da técnica e dos pacientes foi semelhante nos grupos DP planejada e não planejada, enquanto o extravasamento foi mais frequente no grupo de início não planejado. Associaram-se ao óbito menores valores de albumina e maior idade, e à peritonite, o diabetes.
摘要
Polyserositis is defined as chronic inflammation of several serous membranes with effusions in serous cavities like Pericardial, Pleural and Peritoneal membranes, resulting in fibrous thickening of the serous membranes and sometimes constrictive pericarditis. There are various causes of polyserositis which include autoimmune diseases, neoplasia, endocrine diseases, drug � related causes and infectious diseases such as tuberculosis. Polyserositis in disseminated TB is a very rare presentation. Diagnosis is often delayed due to the non-specific presentation like polyserositis and its unusual nature. We herewith report a rare case of TB polyserositis, involving pleura, pericardium and peritoneum.
摘要
Objective To investigate the treatment outcomes,prognosis,and risk factors of treatment failure of peritoneal dialysis associated peritonitis (PDAP) caused by Klebsiella pneumoniae,and thus provide clinical evidence for the prevention and treatment of this disease. Methods The clinical data of PDAP patients at four peritoneal dialysis centers from January 1,2014 to December 31,2019 were collected retrospectively.The treatment outcomes and prognosis were compared between the patients with PDAP caused by Klebsiella.pneumoniae and that caused by Escherichia coli.Kaplan-Meier method was employed to establish the survival curve of technical failure,and multivariate Logistic regression to analyze the risk factors of the treatment failure of PADP caused by Klebsiella pneumoniae. Results In the 4 peritoneal dialysis centers,1034 cases of PDAP occurred in 586 patients from 2014 to 2019,including 21 cases caused by Klebsiella pneumoniae and 98 cases caused by Escherichia coli.The incidence of Klebsiella pneumoniae caused PDAP was 0.0048 times per patient per year on average,ranging from 0.0024 to 0.0124 times per patient per year during 2014-2019.According to the Kaplan-Meier survival curve,the technical failure rate of Klebsiella pneumoniae caused PDAP was higher than that of Escherichia coli caused PDAP (P=0.022).The multivariate Logistic regression model showed that long-term dialysis was an independent risk factor for the treatment failure of Klebsiella pneumoniae caused PDAP (OR=1.082,95%CI=1.011-1.158,P=0.023).Klebsiella pneumoniae was highly sensitive to amikacin,meropenem,imipenem,piperacillin,and cefotetan,and it was highly resistant to ampicillin (81.82%),cefazolin (53.33%),tetracycline (50.00%),cefotaxime (43.75%),and chloramphenicol (42.86%). Conclusion The PDAP caused by Klebsiella pneumoniae had worse prognosis than that caused by Escherichia coli,and long-term dialysis was an independent risk factor for the treatment failure of Klebsiella pneumoniae caused PDAP.
Subject(s)
Humans , Klebsiella pneumoniae , Retrospective Studies , Anti-Bacterial Agents/therapeutic use , Peritoneal Dialysis/adverse effects , Peritonitis/drug therapy , Risk Factors , Treatment Failure , Escherichia coli摘要
Fusarium is a kind of conditional pathogenic fungus. There are few reports of peritonitis caused by Fusarium at home and abroad. This paper reports a case of Fusariumverticillioides peritonitis complicated with bacteremia and reviews relevant literature. The patient was admitted to the hospital due to fever and abdominal pain. After peritonitis was diagnosed, the initial treatment was vancomycin plus ceftazidime kept in the abdominal cavity every night for 3 days, but the effect was not good. The antibiotic was upgraded to vancomycin plus meropenem for 2 days, but still, there was no effect. Subsequently, Fusarium was found after ascites fluid culture, and the treatment regimen was changed to voriconazole antifungal therapy and hemodialysis. However, the patient developed a dialysis catheter-related infection. After the infection was cured, the fever was still repeated, and the infection indexes did not improve. Further, the pathogenic microorganism of whole blood infection was detected by high-throughput gene detection, and it was clinically confirmed as Fusarium verticillioides. At last, the patient recovered and was discharged from the hospital after treatment with voriconazole combined with amphotericin B. Fusarium is highly pathogenic, and it is hoped to attract more attention of clinicians.