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3.
J Vasc Surg ; 78(4): 945-953.e3, 2023 10.
Artículo en Inglés | MEDLINE | ID: mdl-37385354

RESUMEN

BACKGROUND: Multiple organ failure (MOF) is associated with poor outcomes and increased mortality in sepsis and trauma. There are limited data regarding MOF in patients after ruptured abdominal aortic aneurysm (rAAA) repair. We aimed to identify the contemporary prevalence and characteristics of patients with rAAA with MOF. METHODS: We retrospectively reviewed patients with rAAA who underwent repair (2010-2020) at our multihospital institution. Patients who died within the first 2 days after repair were excluded. MOF was quantified by modified (excluding hepatic system) Denver, Sequential Organ Failure Assessment (SOFA) score, and Multiple Organ Dysfunction Score (MODS) for postoperative days 3 to 5 to determine the prevalence of MOF. MOF was defined as a Denver score of >3, dysfunction in two or more organ systems by SOFA score, or a MODS score of >8. Kaplan-Meier curves and log-rank testing were used to evaluate differences in 30-day mortality between multiple organ failure and patients without MOF. Logistic regression was used to assess predictors of MOF. RESULTS: Of 370 patients with rAAA, 288 survived past two days (mean age, 73±10.1 years; 76.7% male; 44.1% open repair), and 143 had data for MOF calculation recorded. From postoperative days 3 to 5, 41 (14.24%) had MOF by Denver, 26 (9.03%) by SOFA, and 39 (13.54%) by MODS criteria. Among these scoring systems, pulmonary and neurological systems were impacted most commonly. Among patients with MOF, pulmonary derangement occurred in 65.9% (Denver), 57.7% (SOFA), and 56.4% (MODS). Similarly, neurological derangement occurred in 92.3% (SOFA) and 89.7% (MODS), but renal derangement occurred in 26.8% (Denver), 23.1% (SOFA), and 10.3% (MODS). MOF by all three scoring systems was associated with increased 30-day mortality (Denver: 11.3% vs 41.5% [P < .01]; DOFA: 12.6% vs 46.2% [P < .01]; MODS: 12.5% vs 35.9% [P < .01]), as was MOF by any criteria (10.8% vs 35.7 %; P < .01). Patients with MOF were more likely to have a higher body mass index (55.9±26.6 vs 49.0±15.0; P = .011) and to have had a preoperative stroke (17.9% vs 6.0%; P = .016). Patients with MOF were less likely to have undergone endovascular repair (30.4% vs 62.1%; P < .001). Endovascular repair was protective against MOF (any criteria) on multivariate analysis (odds ratio, 0.23; 95% confidence interval, 0.08-0.64; P = .019) after adjusting for age, gender, and presenting systolic blood pressure. CONCLUSIONS: MOF occurred in only 9% to 14% of patients after rAAA repair, but was associated with a three-fold increase in mortality. Endovascular repair was associated with a reduced MOF incidence.


Asunto(s)
Aneurisma de la Aorta Abdominal , Rotura de la Aorta , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Humanos , Masculino , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Femenino , Insuficiencia Multiorgánica/diagnóstico , Insuficiencia Multiorgánica/epidemiología , Insuficiencia Multiorgánica/etiología , Estudios Retrospectivos , Procedimientos Endovasculares/efectos adversos , Presión Sanguínea , Resultado del Tratamiento , Factores de Riesgo , Implantación de Prótesis Vascular/efectos adversos
4.
Arch. argent. pediatr ; 119(3): e252-e255, Junio 2021. ilus
Artículo en Inglés, Español | LILACS, BINACIS | ID: biblio-1248221

RESUMEN

Las infecciones por coronavirus son habituales en los pacientes pediátricos. Por lo general, producen un cuadro clínico leve de infección del tracto respiratorio superior que no suele afectar a los pulmones, salvo en prematuros y niños con enfermedades crónicas de base. Excepcionalmente, afectan a otros órganos (corazón, cerebro, tracto gastrointestinal) e incrementan su gravedad.En relación con la coincidencia temporal con el inicio de la actual pandemia por el nuevo beta coronavirus (SARS-CoV-2), responsable de su enfermedad asociada (COVID-19), se presenta el caso clínico de un paciente de 5 años con fracaso multiorgánico y secuelas neurológicas por afectación bulbar y trombosis vascular ocasionados por un alfa coronavirus (CoV-NL63) debido a su gravedad y excepcionalidad


Coronavirus infections (CoV) are common in pediatric patients. In general, they produce a mild clinical presentation consisting of an upper respiratory tract infection that does not usually infect the lungs, with the exception of preterm infants and children with chronic diseases. These infections exceptionally affect other organs (heart, brain, gastrointestinal tract), thus increasing their severity.In relation to the temporal coincidence with the beginning of the current situation of pandemic by the new beta coronavirus SARS-CoV-2 responsible for its associated disease (COVID-19), this study presents a clinical case of a 5-year-old patient showing multiple-organ failure and neurological sequelae due to bulbar injury and vascular thrombosis caused by an alpha coronavirus (CoV-NL63) due to its severity and exceptionality


Asunto(s)
Humanos , Masculino , Preescolar , Infecciones del Sistema Respiratorio/diagnóstico , Infecciones por Coronavirus/diagnóstico , Coronavirus Humano NL63/aislamiento & purificación , Insuficiencia Multiorgánica/virología , Infecciones del Sistema Respiratorio/complicaciones , Infecciones por Coronavirus/complicaciones , Diagnóstico Diferencial , Insuficiencia Multiorgánica/diagnóstico
5.
Arch Argent Pediatr ; 119(3): e252-e255, 2021 06.
Artículo en Inglés, Español | MEDLINE | ID: mdl-34033432

RESUMEN

Coronavirus infections (CoV) are common in pediatric patients. In general, they produce a mild clinical presentation consisting of an upper respiratory tract infection that does not usually infect the lungs, with the exception of preterm infants and children with chronic diseases. These infections exceptionally affect other organs (heart, brain, gastrointestinal tract), thus increasing their severity. In relation to the temporal coincidence with the beginning of the current situation of pandemic by the new beta coronavirus SARS-CoV-2 responsible for its associated disease (COVID-19), this study presents a clinical case of a 5-year-old patient showing multiple-organ failure and neurological sequelae due to bulbar injury and vascular thrombosis caused by an alpha coronavirus (CoV-NL63) due to its severity and exceptionality.


Las infecciones por coronavirus son habituales en los pacientes pediátricos. Por lo general, producen un cuadro clínico leve de infección del tracto respiratorio superior que no suele afectar a los pulmones, salvo en prematuros y niños con enfermedades crónicas de base. Excepcionalmente, afectan a otros órganos (corazón, cerebro, tracto gastrointestinal) e incrementan su gravedad. En relación con la coincidencia temporal con el inicio de la actual pandemia por el nuevo beta coronavirus (SARSCoV- 2), responsable de su enfermedad asociada (COVID-19), se presenta el caso clínico de un paciente de 5 años con fracaso multiorgánico y secuelas neurológicas por afectación bulbar y trombosis vascular ocasionados por un alfa coronavirus (CoVNL63) debido a su gravedad y excepcionalidad.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Coronavirus Humano NL63/aislamiento & purificación , Insuficiencia Multiorgánica/virología , Infecciones del Sistema Respiratorio/diagnóstico , COVID-19/diagnóstico , Preescolar , Infecciones por Coronavirus/complicaciones , Diagnóstico Diferencial , Humanos , Insuficiencia Multiorgánica/diagnóstico , Infecciones del Sistema Respiratorio/complicaciones
6.
Acta Med Acad ; 49(1): 67-70, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32738119

RESUMEN

OBJECTIVE: To describe a severe case of infection by Leptospira in a woman in the northwest of Mexico. CASE REPORT: A 55-yearold woman from Sonora, México arrived at the Intensive Care Unit due to severe multiple organ failure primarily affecting the respiratory, renal and hepatic systems. Diagnostic tests were performed, and they were positive for anti-Leptospira antibodies, IgM and IgG; and spirochetes were observed on dark field microscopy and confirmed by Polymerase Chain Reaction (PCR). Doxycycline and platelet apheresis transfusion were used as treatment, which led to a very slow recovery. CONCLUSION: The information presented in this study may help in the identification of pathology caused by spirochetes. This case report is the first to present a case of severe leptospirosis in Sonora, México.


Asunto(s)
Leptospira , Leptospirosis , Insuficiencia Multiorgánica/microbiología , Antibacterianos/uso terapéutico , Anticuerpos Antibacterianos/sangre , Doxiciclina/uso terapéutico , Femenino , Humanos , Inmunoglobulina G/sangre , Inmunoglobulina M/sangre , Unidades de Cuidados Intensivos , Leptospira/genética , Leptospira/crecimiento & desarrollo , Leptospirosis/complicaciones , Leptospirosis/diagnóstico , Leptospirosis/microbiología , Leptospirosis/terapia , México , Microscopía/métodos , Persona de Mediana Edad , Insuficiencia Multiorgánica/diagnóstico , Insuficiencia Multiorgánica/etiología , Insuficiencia Multiorgánica/terapia , Transfusión de Plaquetas , Reacción en Cadena de la Polimerasa , Índice de Severidad de la Enfermedad
7.
Rev. cuba. med. gen. integr ; 36(2): e1162, abr.-jun. 2020. tab, graf
Artículo en Español | LILACS, CUMED | ID: biblio-1138970

RESUMEN

Introducción: El síndrome de Weil es una forma grave de la infección bacteriana causada por la bacteria Leptospira, conocida como leptospirosis. Este se caracteriza por la disfunción de múltiples órganos, entre ellos, hígado, riñón, músculos, serosas o el sistema neurológico, en este caso denominado neuroleptospirosis, genera una mortalidad muy elevada cuando no se brinda diagnóstico y tratamiento adecuado. Objetivo: Describir las manifestaciones clínicas, paraclínicos complementarios y tratamiento de un paciente con síndrome de Weil, una condición poco frecuente. Caso clínico: Paciente de 23 años quien consulta en el contexto de síndrome febril agudo asociado con neuritis óptica, dolor torácico y paraclínicos que evidenciaron afectación hepática y cardíaca. Se confirma el diagnóstico de síndrome de Weil dado por neuroleptospirosis, pericarditis y colestasis intrahepática. Conclusiones: mediante un caso clínico de síndrome de Weil, se describe la afectación multisistémica de complicaciones asociadas con leptospirosis, con manifestaciones poco habituales como neuroleptospirosis, pericarditis y colestasis intrahepática(AU)


Introduction: Weil syndrome is a serious form of the bacterial infection caused by the Leptospira bacterium; this is known as leptospirosis. This is characterized by multiple organ dysfunction; for example, the liver, kidney, muscles, of serous type, or the neurological system, in this case called neuroleptospirosis, which produces a very high mortality when adequate diagnosis and treatment are not provided. Objective: To describe the clinical manifestations, complementary paraclinic practice and treatment of a patient with Weil syndrome, as a rare condition. Clinical case: 23-year-old patient who presents with acute febrile syndrome associated with optic neuritis, chest pain, and paraclinical symptoms obviously consistent liver and cardiac involvement. The diagnosis of Weil syndrome is confirmed, specifically defined by neuroleptospirosis, pericarditis, and intrahepatic cholestasis. Conclusions: Through a clinical case of Weil syndrome, the multisystem involvement of complications associated with leptospirosis is described, along with its unusual manifestations, such as neuroleptospirosis, pericarditis, and intrahepatic cholestasis(AU)


Asunto(s)
Humanos , Masculino , Femenino , Enfermedad de Weil/epidemiología , Leptospirosis/tratamiento farmacológico , Leptospirosis/epidemiología , Insuficiencia Multiorgánica/diagnóstico
8.
Rev. Hosp. Ital. B. Aires (2004) ; 40(1): 25-28, mar. 2020. ilus
Artículo en Español | LILACS | ID: biblio-1102210

RESUMEN

Introducción: la zigomicosis es una infección fúngica poco frecuente, con alta tasa de mortalidad y de mal pronóstico. Afecta principalmente a pacientes inmunocomprometidos. La asociación con el síndrome hemofagocítico es extremadamente inusual, más aún en pacientes inmunocompetentes, con pocos ejemplos registrados en la literatura. Caso clínico: se presenta el caso de un paciente masculino inmunocompetente de 40 años con diagnóstico de mucormicosis y síndrome hemofagocítico que evoluciona desfavorablemente, con fallo multiorgánico, a pesar de los esfuerzos médicos. Conclusión: la asociación de mucormicosis con síndrome hemofagocítico en un paciente inmunocompetente es extremadamente rara; existen pocos casos informados en Latinoamérica. Debemos tener presente esta asociación, ya que requiere un tratamiento agresivo y soporte vital avanzado. (AU)


Introduction: zygomycosis is a rare fungal infection that carries with high mortality rates. This poor prognosis, rapidly progressive infection mainly affects immunocompromised patients. The association with hemophagocytic lymphohistiocytosis is extremely unusual, even more in immunocompetent patients, with few cases reported. Case: we present the case of an immunocompetent male patient who was diagnosed with zygomycosis and hemophagocytic lymphohistiocytosis. Despite medical efforts he developed multiorganic failure. Conclusion: the association of mucormycosis with hemophagocytic lymphohistiocytosis in an immunocompetent patient is exceptional with few cases reported in Latin America. We must always suspect this association considering they require aggressive treatment and advanced life support. (AU)


Asunto(s)
Humanos , Masculino , Adulto , Cigomicosis/diagnóstico , Linfohistiocitosis Hemofagocítica/diagnóstico , Pancitopenia/sangre , Agitación Psicomotora , Vancomicina/uso terapéutico , Norepinefrina/administración & dosificación , Norepinefrina/uso terapéutico , Anfotericina B/uso terapéutico , Exoftalmia/diagnóstico por imagen , Huésped Inmunocomprometido/inmunología , Colistina/uso terapéutico , Combinación Amoxicilina-Clavulanato de Potasio/administración & dosificación , Combinación Amoxicilina-Clavulanato de Potasio/uso terapéutico , Cigomicosis/etiología , Cigomicosis/mortalidad , Cigomicosis/epidemiología , Delirio , Linfohistiocitosis Hemofagocítica/etiología , Linfohistiocitosis Hemofagocítica/mortalidad , Fiebre , Meropenem/uso terapéutico , Inmunocompetencia/inmunología , Ictericia , Mucormicosis/complicaciones , Insuficiencia Multiorgánica/diagnóstico
9.
Pediatr Crit Care Med ; 21(2): e52-e106, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-32032273

RESUMEN

OBJECTIVES: To develop evidence-based recommendations for clinicians caring for children (including infants, school-aged children, and adolescents) with septic shock and other sepsis-associated organ dysfunction. DESIGN: A panel of 49 international experts, representing 12 international organizations, as well as three methodologists and three public members was convened. Panel members assembled at key international meetings (for those panel members attending the conference), and a stand-alone meeting was held for all panel members in November 2018. A formal conflict-of-interest policy was developed at the onset of the process and enforced throughout. Teleconferences and electronic-based discussion among the chairs, co-chairs, methodologists, and group heads, as well as within subgroups, served as an integral part of the guideline development process. METHODS: The panel consisted of six subgroups: recognition and management of infection, hemodynamics and resuscitation, ventilation, endocrine and metabolic therapies, adjunctive therapies, and research priorities. We conducted a systematic review for each Population, Intervention, Control, and Outcomes question to identify the best available evidence, statistically summarized the evidence, and then assessed the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. We used the evidence-to-decision framework to formulate recommendations as strong or weak, or as a best practice statement. In addition, "in our practice" statements were included when evidence was inconclusive to issue a recommendation, but the panel felt that some guidance based on practice patterns may be appropriate. RESULTS: The panel provided 77 statements on the management and resuscitation of children with septic shock and other sepsis-associated organ dysfunction. Overall, six were strong recommendations, 52 were weak recommendations, and nine were best-practice statements. For 13 questions, no recommendations could be made; but, for 10 of these, "in our practice" statements were provided. In addition, 49 research priorities were identified. CONCLUSIONS: A large cohort of international experts was able to achieve consensus regarding many recommendations for the best care of children with sepsis, acknowledging that most aspects of care had relatively low quality of evidence resulting in the frequent issuance of weak recommendations. Despite this challenge, these recommendations regarding the management of children with septic shock and other sepsis-associated organ dysfunction provide a foundation for consistent care to improve outcomes and inform future research.


Asunto(s)
Insuficiencia Multiorgánica/terapia , Pediatría/normas , Sepsis/terapia , Choque Séptico/terapia , Adolescente , Antibacterianos/uso terapéutico , Niño , Preescolar , Medicina Basada en la Evidencia , Fluidoterapia/métodos , Hemodinámica , Humanos , Lactante , Recién Nacido , Ácido Láctico/sangre , Insuficiencia Multiorgánica/diagnóstico , Insuficiencia Multiorgánica/etiología , Respiración Artificial/métodos , Resucitación/métodos , Sepsis/complicaciones , Sepsis/diagnóstico , Choque Séptico/diagnóstico , Vasoconstrictores/uso terapéutico
12.
Ned Tijdschr Geneeskd ; 1622018 09 24.
Artículo en Holandés | MEDLINE | ID: mdl-30358370

RESUMEN

BACKGROUND: Since 2016 outbreaks of yellow fever are reported in Brazil. This is a risk to unvaccinated travellers in that area. CASE DESCRIPTION: In early January, an unvaccinated traveller returning from São Paulo attended our outpatient clinic complaining of symptoms later diagnosed as yellow fever. The disease manifested itself as fever, lower back pain, nausea and highly elevated liver enzymes. A yellow fever infection has multiple stages. The first stage is acute infection which merges into the second stage which is when improvement occurs. Either improvement continues or transfers into a third stage which is characterized by multi-organ failure. In this particular patient, stage three did not occur. CONCLUSION: The goal of this case report is to show that vaccination against yellow fever is the most important preventive measure when travelling to an area where the yellow fever virus is in circulation. Yellow fever should not be forgotten in the differential diagnosis of a traveller with fever.


Asunto(s)
Viaje , Vacunación , Vacuna contra la Fiebre Amarilla , Fiebre Amarilla/prevención & control , Virus de la Fiebre Amarilla , Brasil/epidemiología , Brotes de Enfermedades , Fiebre , Humanos , Hígado/enzimología , Dolor de la Región Lumbar/diagnóstico , Dolor de la Región Lumbar/etiología , Insuficiencia Multiorgánica/diagnóstico , Insuficiencia Multiorgánica/etiología , Náusea/diagnóstico , Náusea/etiología , Fiebre Amarilla/complicaciones , Fiebre Amarilla/diagnóstico , Fiebre Amarilla/epidemiología
13.
Autops. Case Rep ; 7(4): 30-36, Oct.-Dec. 2017. ilus
Artículo en Inglés | LILACS | ID: biblio-905403

RESUMEN

Intravascular large B-cell lymphoma (IVLBCL) is a very rare extra nodal lymphoma that tends to proliferate within small blood vessels, particularly capillaries and postcapillary venules while sparing the organ parenchyma. The cause of its affinity for the vascular bed remains unknown. Because of its rarity and unremarkable clinical presentation, a timely diagnosis of IVLBCL is very challenging. Here, we describe a case of IVLBCL presenting as pancreatic mass that was ultimately diagnosed at autopsy. A 71-year-old Caucasian female presented with a 3-month history of fatigue, abdominal pain, and weight loss. She was referred to the emergency room with a new diagnosis of portal vein thrombosis and lactic acidosis. During her hospital course she was found to have a 1.9 × 1.8 cm lesion in the pancreatic tail on imaging; The cytologic specimen on the mass showed a high-grade lymphoma. A bone marrow biopsy showed no involvement. The patient's condition rapidly deteriorated and she, later, died due to multi-organ failure. An autopsy revealed diffuse intravascular invasion in multiple organs by the lymphoma cells. Based on our literature review­and to the best of our knowledge­there are virtually no reports describing the presentation of this lymphoma with a discernible tissue mass and associated multi-organ failure. The immunophenotypic studies performed revealed de novo CD5+ intravascular large B-cell lymphoma, which is known to be aggressive with very poor prognosis. Although it is a very rare lymphoma, it should be considered as a potential cause of multi-organ failure when no other cause has been identified. A prompt tissue diagnosis, appropriate high-dose chemotherapy and stem cell transplantation remain the only viable alternative to achieve some kind of remission.


Asunto(s)
Humanos , Femenino , Anciano , Linfocitos B/patología , Linfoma/patología , Insuficiencia Multiorgánica/diagnóstico , Neoplasias Pancreáticas/patología , Autopsia , Diagnóstico Diferencial , Resultado Fatal , Neoplasias Pancreáticas/diagnóstico
14.
Medicina (B Aires) ; 77(4): 337-340, 2017.
Artículo en Español | MEDLINE | ID: mdl-28825582

RESUMEN

Thyroid storm is a rare and potentially fatal condition. Unusual presentations in patients with thyroid storm have been described but multiorganic dysfunction is uncommonly seen. We describe the case of a 36-year-old woman with unknown underlying Graves's disease who developed thyroid storm. The thyroid storm score of Burch and Wartofsky was 50/140. This was complicated by acute liver failure, acute kidney injury, lactic acidosis, heart failure, bi-cytopenia, coagulopathy and rhabdomyolysis. The severe multiorgan dysfunction was reversed by prompt institution of steroids, cyclophosphamide and plasma exchange before thyroidectomy. Main difficulty lies in recognizing its varied presentations and offering appropriate treatment when physician faces either failure or contraindications of conventional therapy.


Asunto(s)
Insuficiencia Multiorgánica/etiología , Crisis Tiroidea/complicaciones , Adulto , Terapia Combinada , Femenino , Enfermedad de Graves/complicaciones , Humanos , Inmunosupresores/uso terapéutico , Insuficiencia Multiorgánica/diagnóstico , Plasmaféresis , Crisis Tiroidea/diagnóstico , Crisis Tiroidea/terapia , Tiroidectomía
15.
Medicina (B.Aires) ; Medicina (B.Aires);77(4): 337-340, ago. 2017. graf, tab
Artículo en Español | LILACS | ID: biblio-894491

RESUMEN

La tormenta tiroidea es una condición infrecuente y potencialmente fatal. En la literatura han sido descritas varias presentaciones inusuales de la misma; sin embargo, la disfunción multiorgánica es rara vez vista. Aquí describimos un caso en una mujer de 36 años de edad con enfermedad de Graves subyacente no diagnosticada hasta entonces, quien inició su sintomatología con una tormenta tiroidea. Su score de Burch y Wartofsky fue de 50/140. Desarrolló falla hepática aguda, falla renal aguda, acidosis láctica, falla cardíaca, bicitopenia, coagulopatía y rabdomiolisis. La disfunción multiorgánica se revirtió gracias a la pronta instauración de los esteroides, ciclofosfamida, plasmaféresis y posterior tiroidectomía. La dificultad reside en reconocer las variadas presentaciones de la enfermedad y ofrecer un tratamiento apropiado cuando se enfrenta a las contraindicaciones o las fallas terapéuticas del tratamiento convencional.


Thyroid storm is a rare and potentially fatal condition. Unusual presentations in patients with thyroid storm have been described but multiorganic dysfunction is uncommonly seen. We describe the case of a 36-year-old woman with unknown underlying Graves´s disease who developed thyroid storm. The thyroid storm score of Burch and Wartofsky was 50/140. This was complicated by acute liver failure, acute kidney injury, lactic acidosis, heart failure, bi-cytopenia, coagulopathy and rhabdomyolysis. The severe multiorgan dysfunction was reversed by prompt institution of steroids, cyclophosphamide and plasma exchange before thyroidectomy. Main difficulty lies in recognizing its varied presentations and offering appropriate treatment when physician faces either failure or contraindications of conventional therapy.


Asunto(s)
Humanos , Femenino , Adulto , Crisis Tiroidea/complicaciones , Insuficiencia Multiorgánica/etiología , Tiroidectomía , Crisis Tiroidea/diagnóstico , Crisis Tiroidea/terapia , Enfermedad de Graves/complicaciones , Plasmaféresis , Terapia Combinada , Inmunosupresores/uso terapéutico , Insuficiencia Multiorgánica/diagnóstico
16.
Pediatr Crit Care Med ; 17(11): e539-e542, 2016 11.
Artículo en Inglés | MEDLINE | ID: mdl-27679964

RESUMEN

OBJECTIVE: To summarize the scientific priorities and potential future research directions for pediatric critical care research discussed by a panel of experts at the inaugural Strategic Planning Conference of the Pediatric Trauma and Critical Illness Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development. DATA SOURCES: Expert opinion expressed during the Strategic Planning Conference. STUDY SELECTION: Not applicable. DATA EXTRACTION: Chaired by an experienced expert from the field, issues relevant to the conduct of pediatric critical care research were discussed and debated by the invited participants. DATA SYNTHESIS: Common themes and suggested priorities were identified and coalesced. CONCLUSIONS: Of the many pathophysiologic conditions discussed, the multiple organ dysfunction syndrome emerged as a topic in need of more study that is most relevant to the field. Additionally, the experts offered that the interrelationship and impact of critical illness on child development and family functioning are important research priorities. Consequently, long-term outcomes research was encouraged. The expert group also suggested that multidisciplinary conferences are needed to help identify key knowledge gaps to advance and direct research in the field. The Pediatric Critical Care and Trauma Scientist Development National K12 Program and the Collaborative Pediatric Critical Care Research Network were recognized as successful and important programs supported by the branch. The development of core data resources including biorepositories with robust phenotypic data using common data elements was also suggested to foster data sharing among investigators and to enhance disease diagnosis and discovery. Multicenter clinical trials and innovative study designs to address understudied and poorly understood conditions were considered important for field advancement. Finally, the growth of the pediatric critical care research workforce was offered as a priority that could be spawned in many ways including by expanded transdisciplinary and multiprofessional collaboration and diversity representation.


Asunto(s)
Investigación Biomédica/organización & administración , Cuidados Críticos/métodos , Pediatría/organización & administración , Planificación Estratégica , Investigación Biomédica/métodos , Niño , Humanos , Insuficiencia Multiorgánica/diagnóstico , Insuficiencia Multiorgánica/terapia , Pediatría/métodos
17.
Rev Med Chil ; 143(9): 1210-4, 2015 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-26530206

RESUMEN

Non-syndromic, multi-organ mitochondrial disorders (MIDs) are frequently missed if treating physicians are not aware of them. We report a 85 years old Caucasian male, referred for tonic-clonic seizures, presenting with a plethora of abnormalities, including neurodermitis, atopic dermatitis, diabetes, hypertension, renal insufficiency, non-specific colitis, urine bladder lithiasis, bilateral cataracts, atrial fibrillation, diverticulosis, polyneuropathy, vitamin-D-deficiency, renal cysts, left anterior hemi-block, right bundle branch block, pulmonary artery hypertension, and heart failure. Neurological investigations revealed ptosis, quadriparesis, fasciculations, dysarthria, dysdiadochokinesia, tremor, hyperkinesia, ataxia, leukoencephalopathy, and basal ganglia calcification. Based upon this combination of abnormalities a non-syndromic mitochondrial multi-organ disorder syndrome (MIMODS, encephalo-myo-cardiomyopathy) was diagnosed.


Asunto(s)
Enfermedades Mitocondriales/diagnóstico , Insuficiencia Multiorgánica/diagnóstico , Anciano de 80 o más Años , Cardiomiopatías/complicaciones , Cardiomiopatías/diagnóstico , Humanos , Leucoencefalopatías/complicaciones , Leucoencefalopatías/diagnóstico , Masculino , Convulsiones/complicaciones , Síndrome
18.
Arch. méd. Camaguey ; 19(5)sep.-oct. 2015.
Artículo en Español | CUMED | ID: cum-66272

RESUMEN

Fundamento: la escala SOFA (Acute Organ System Failure) es un sistema sencillo para identificar la disfunción o fracaso de órganos fundamentales.Objetivo: determinar el valor predictivo del SOFA en la mortalidad de pacientes quirúrgicos.Método: se realizó un estudio descriptivo y prospectivo en 173 pacientes quirúrgicos ingresados en la Unidad de Cuidados Intensivos del Hospital Joaquín Albarrán Domínguez durante el 2013.Resultados: el SOFA aplicado a las 24 y 48 horas mostró un alto poder discriminante con valores de 0.85 y 0.95 bajo la curva ROC, respectivamente y un adecuado porcentaje de acierto con el 76,9 por ciento para punto de corte >= 2 y 91.4 por ciento para punto de corte >= 3 respectivamente.Conclusiones: la escala SOFA fue útil para predicción de mortalidad en pacientes quirúrgicos sobre todo a las 48 horas donde hubo mejor porcentaje de aciertos y poder discriminante (AU)


Background: SOFA score (Sequential Organ Failure Assessment score) is a simple system to determine the dysfunction or failure of fundamental organs.Objective: to determine the predictive value of SOFA in the mortality of surgical patients.Method: a descriptive and prospective study was conducted in 173 surgical patients admitted in the Intensive Care Unit of Joaquín Albarrán Domínguez Hospital during the year 2013.Results: SOFA score, applied 24 and 48 hours after the patients were admitted, showed a high discriminating power (values of 0, 85 and 0, 95 under the ROC curve, respectively) and an adequate rate of success with a 76, 9 percent for a cut-point >= 2 and a 91, 4 percent for a cut-point >= 3 respectively.Conclusions: SOFA score was useful for predicting the mortality of surgical patients mainly 48 hours after the patients were admitted when there was a better rate of success and discriminating power (AU)


Asunto(s)
Humanos , Insuficiencia Multiorgánica/diagnóstico , Valor Predictivo de las Pruebas , Pesos y Medidas , Epidemiología Descriptiva , Estudios Prospectivos
19.
Rev. méd. Chile ; 143(9): 1210-1214, set. 2015. ilus, tab
Artículo en Inglés | LILACS | ID: lil-762691

RESUMEN

Non-syndromic, multi-organ mitochondrial disorders (MIDs) are frequently missed if treating physicians are not aware of them. We report a 85 years old Caucasian male, referred for tonic-clonic seizures, presenting with a plethora of abnormalities, including neurodermitis, atopic dermatitis, diabetes, hypertension, renal insufficiency, non-specific colitis, urine bladder lithiasis, bilateral cataracts, atrial fibrillation, diverticulosis, polyneuropathy, vitamin-D-deficiency, renal cysts, left anterior hemi-block, right bundle branch block, pulmonary artery hypertension, and heart failure. Neurological investigations revealed ptosis, quadriparesis, fasciculations, dysarthria, dysdiadochokinesia, tremor, hyperkinesia, ataxia, leukoencephalopathy, and basal ganglia calcification. Based upon this combination of abnormalities a non-syndromic mitochondrial multi-organ disorder syndrome (MIMODS, encephalo-myo-cardiomyopathy) was diagnosed.


Las alteraciones mitocondriales no sindrómicas y mutisistémicas pueden ser pasadas por alto si no se está consciente de su existencia. Presentamos un hombre de 85 años, referido por convulsiones tónico clónicas, que presentaba una plétora de anomalías tales como neurodermatitis, dermatitis atópica, diabetes, hipertensión, insuficiencia renal, colitis no específica, litiasis vesical, cataratas bilaterales, fibrilación auricular, diverticulosis, polineuropatía, deficiencia de vitamina D, quistes renales, hemibloqueo izquierdo anterior y bloqueo de rama derecha, hipertensión pulmonar e insuficiencia cardíaca. El estudio neurológico reveló la presencia de ptosis, cuadriparesia, fasciculaciones, disartria, disdiadocoquinesia, temblor, hiperquinesia, ataxia, leucoencefalopatía y calcificación de ganglios basales. Basados en estos hallazgos, se diagnosticó un síndrome mitocondrial no sindrómico con fallas de múltiples sistemas.


Asunto(s)
Anciano de 80 o más Años , Humanos , Masculino , Enfermedades Mitocondriales/diagnóstico , Insuficiencia Multiorgánica/diagnóstico , Cardiomiopatías/complicaciones , Cardiomiopatías/diagnóstico , Leucoencefalopatías/complicaciones , Leucoencefalopatías/diagnóstico , Convulsiones/complicaciones , Síndrome
20.
Rev. cuba. med. mil ; 42(2)abr.-jun. 2013.
Artículo en Español | CUMED | ID: cum-67327

RESUMEN

Introducción: el daño múltiple de órganos es el conjunto de alteraciones morfológicas, frecuentes en pacientes críticos, diagnosticadas en las autopsias como respuesta a la inflamación sistémica. En estudios realizados, las personas con edades jóvenes de la vida se han visto particularmente afectadas por esta entidad. Objetivo: analizar el comportamiento del diagnóstico del daño múltiple de órganos en autopsias pediátricas procedentes de dos unidades de terapia intensiva e identificar las manifestaciones histopatológicas, la edad y el sexo de los niños fallecidos.Métodos: se revisaron 13 autopsias de niños fallecidos en el Hospital Militar Central Dr. Luis Díaz Soto en 5 años (2003-2007) y 42 correspondientes al Hospital Pediátrico Docente de San Miguel del Padrón en un periodo de 7 años (2000-2006), y se extrajeron las que cumplieron los criterios diagnósticos del daño múltiple de órganos. Resultados: se destacó la elevada frecuencia del daño múltiple de órganos en las autopsias de la terapia pediátrica en ambos centros estudiados. Los primeros periodos de vida fueron los más afectados, mientras el sexo mostró variaciones entre ambos centros estudiados. Conclusiones: el diagnóstico del daño múltiple de órganos es expresión de la calidad del trabajo que se realiza con las autopsias y la preparación del personal médico, lo cual se muestra en las elevadas cifras de coincidencias diagnósticas. Modular la respuesta inflamatoria incontrolada, es prevenir que se establezca el referido daño y, por lo tanto, es salvar la vida de un niño(AU)


Introduction: multiple organ damage is a group of morphological alterations, frequent in critical patients, which are diagnosed in autopsies as a response to systemic inflammation. Different studies report that the youngest people have been particularly affected by this disease. Objective: to analyze the behaviour of the diagnosis of multiple organ damage in paediatric autopsies from two Intensive Care Units and identify the histopathological manifestations, the age, and the sex in dead children. Methods: 13 autopsies of dead children were checked in "Dr. Luis Diaz Soto" Central Military Hospital during 5 years (2003-2007). Other 42 corresponding to the Paediatric Teaching Hospital of San Miguel del Padr¥n were also checked over a period of 7 years (2000-2006). The ones that reported diagnostic criteria of multiple organ damage were selected. Results: a high frequency of multiple organ damage in autopsies of paediatric therapies in both cases under study was emphasized. The first periods of life were the most affected ones and the sex showed some variations in the two centres under study. Conclusions: the diagnosis of multiple organ damage is the reflection of both the quality of work carried out with autopsies and the training of the medical staff. It is shown in the high levels of diagnostic coincidences. To regulate the uncontrolled inflammatory response means preventing the referred damage, thus saving a child's life(AU)


Asunto(s)
Humanos , Niño , Insuficiencia Multiorgánica/diagnóstico , Autopsia/estadística & datos numéricos , Síndrome de Respuesta Inflamatoria Sistémica/diagnóstico , Registros Médicos/estadística & datos numéricos
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