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2.
Infectio ; 25(4): 212-240, oct.-dic. 2021. tab, graf
Artículo en Inglés | LILACS, COLNAL | ID: biblio-1286716

RESUMEN

Abstract Intra-abdominal infections are frequent at all levels of health care, therefore, it is necessary to maintain a high level of clinical suspicion, performing the fastest and most cost-effective measures to confirm the diagnosis and offer a precise and targeted multidisciplinary therapy, this being the only way to have an impact on the morbidity of this infection, reducing mortality and minimizing the complications and costs of health care. Intra-abdominal infections are linked to the appearance and selection of resistant mutants in both bacteria and fungi, becoming currently a major public health problem. Increasing bacterial resistance when associated with a greater possibility of difficulties in antimicrobial treatment increases mortality. This evidence-based consensus brings together the recommendations for the diagnosis and treatment of intra-abdominal infections in the pediatric and adult population. With strict monitoring of bacterial resistance and stimulating the control of the risk factors that have the greatest impact on the appearance of this phenomenon, this consensus is intended to be a practical guide that is easy to implement, and with periodic updates it will favor and facilitate multidisciplinary and the adequacy of the therapeutic management of intra-abdominal infections.


Resumen Las infecciones intrabdominales son frecuentes en todos los niveles de atención en salud, por ende, es necesario mantener un alto nivel de sospecha clínica, realizando las medidas más rápidas y costoefectivas para confirmar el diagnóstico y así ofrecer de una forma precisa y dirigida la terapéutica multidisciplinaria, siendo esta la única manera de tener impacto en la morbilidad de esta infección, disminuyendo la mortalidad y minimizando las complicaciones y los costos de la atención en salud. Las infecciones intrabdominales se encuentran ligadas a la aparición y selección de las mutantes resistentes tanto en las bacterias como en los hongos, convirtiéndose en la actualidad en una gran problemática en la salud pública. La creciente resistencia bacteriana al asociarse a mayor posibilidad de dificultades en el tratamiento antimicrobiano incrementa la mortalidad. Este consenso basado en la evidencia, reúne las recomendaciones en el diagnóstico y en el tratamiento de las infecciones intrabdominales en la población pediátrica y de adultos. Con un estricto seguimiento de la resistencia bacteriana y estimulando el control de los factores de riesgo que tienen mas impacto en la aparición de este fenómeno, este consenso pretende ser una practica guía de fácil implementación, y con periódicas actualizaciones favorecerá y facilitará el manejo multidisciplinario y la adecuación del manejo terapéutico de las infecciones intrabdominales.


Asunto(s)
Humanos , Niño , Adulto , Infecciones Intraabdominales , Peritonitis , Bacterias , Factores de Riesgo , Mortalidad , Colombia , Sepsis , Atención a la Salud , Infecciones , Antibacterianos
3.
Zhonghua Nei Ke Za Zhi ; 60(7): 650-655, 2021 Jul 01.
Artículo en Chino | MEDLINE | ID: mdl-34619843

RESUMEN

Objective: To explore the difference of coagulation function and its correlation with prognosis in patients with acute respiratory distress syndrome (ARDS) caused by extrapulmonary sepsis and pulmonary infection. Methods: ARDS patients caused by extrapulmonary sepsis and pulmonary infection admitted to the ICU were retrospectively analyzed at the First Affiliated Hospital of China Medical University from July 2017 to June 2019. The clinical characteristics were collected including sequential organ failure assessment (SOFA), coagulation parameters [prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (APTT), fibrinogen (Fib), D-Dimer (D-D), fibrinogen degradation product (FDP), antithrombin Ⅲ(AT-Ⅲ), platelet (PLT)], duration of mechanical ventilation, length of stay (LOS) in ICU and 28-day mortality. According to the risk factors, the patients were divided into extrapulmonary sepsis group and pulmonary infection group. The correlation analysis between coagulation parameters and the prognosis of ARDS patients were analyzed by multivariate logistic regression analysis. Results: A total of 268 ARDS patients were screened and 28 cases were excluded. Finally, 240 ARDS patients were enrolled, including 145 caused by extrapulmonary sepsis and 95 by pulmonary infection. PT, INR and APTT in the extrapulmonary sepsis group were significantly higher than those in pulmonary infection group (P<0.05). AT-Ⅲ level was lower than that in pulmonary infection group (P<0.05). Ninty-three patients survived at 28 days in the non-pulmonary sepsis group, the mortality rate was 35.9% (52/145). PT, INR, APTT in patients who died at 28 days were significantly higher than those of the patients who survived (P<0.05), while AT-Ⅲ level was lower than those of the patients who survived (P<0.05). 49 patients survived at 28 days in the pulmonary infection group, the mortality rate was 48.4% (46/95). There was no significant difference in the coagulation parameters between two groups. Multivariate logistic regression analysis showed that SOFA score without PLT(OR=1.210,95%CI 1.067-1.372,P=0.003) and INR (OR=2.408,95%CI 1.007-5.760,P=0.048) were independent risk factors for 28-day mortality in extrapulmonary sepsis group. Coagulation parameters are not independent risk factors for 28-day mortality in ARDS patients related to pulmonary infection. Conclusion: There are significant differences in coagulation function between ARDS patients caused by extrapulmonary sepsis or pulmonary infection. INR is an independent risk factor for 28-day mortality in extrapulmonary sepsis group.


Asunto(s)
Neumonía , Síndrome de Dificultad Respiratoria , Sepsis , Humanos , Pronóstico , Estudios Retrospectivos
4.
Curr Urol Rep ; 22(10): 50, 2021 Oct 08.
Artículo en Inglés | MEDLINE | ID: mdl-34622358

RESUMEN

PURPOSE OF REVIEW: The prevalence of kidney stones is rising and historically carries a preponderance for males. However, recent evidence has questioned whether this gender gap is closing. The aim of this systematic review was to examine this further as well as evaluate possible underlying causes. RECENT FINDINGS: Recent evidence confirms the disparity in kidney stone disease between genders is closing. In the modern era, the rise in prevalence among females has been greater, especially in adolescence. Quality of life is also more adversely affected by kidney stone events among females who are also more likely to develop sepsis after endourological surgery. Males, however, are more likely to present with stone events during periods of high ambient temperatures Recent literature demonstrates a temporal change in the disease burden of KSD among men and women. The latter, especially adolescent females, are more likely to develop KSD in their lifetime compared to previous eras. Determining causation is complex and continued research is warranted.


Asunto(s)
Cálculos Renales , Sepsis , Adolescente , Femenino , Humanos , Cálculos Renales/epidemiología , Cálculos Renales/etiología , Masculino , Prevalencia , Calidad de Vida , Factores Sexuales
5.
Scand J Trauma Resusc Emerg Med ; 29(1): 145, 2021 Oct 03.
Artículo en Inglés | MEDLINE | ID: mdl-34602084

RESUMEN

BACKGROUND: Sepsis is a life-threatening organ dysfunction and a major healthcare burden worldwide. Although sepsis is a medical emergency that requires immediate management, screening for the occurrence of sepsis is difficult. Herein, we propose a deep learning-based model (DLM) for screening sepsis using electrocardiography (ECG). METHODS: This retrospective cohort study included 46,017 patients who were admitted to two hospitals. A total of 1,548 and 639 patients had sepsis and septic shock, respectively. The DLM was developed using 73,727 ECGs from 18,142 patients, and internal validation was conducted using 7774 ECGs from 7,774 patients. Furthermore, we conducted an external validation with 20,101 ECGs from 20,101 patients from another hospital to verify the applicability of the DLM across centers. RESULTS: During the internal and external validations, the area under the receiver operating characteristic curve (AUC) of the DLM using 12-lead ECG was 0.901 (95% confidence interval, 0.882-0.920) and 0.863 (0.846-0.879), respectively, for screening sepsis and 0.906 (95% confidence interval (CI), 0.877-0.936) and 0.899 (95% CI, 0.872-0.925), respectively, for detecting septic shock. The AUC of the DLM for detecting sepsis using 6-lead and single-lead ECGs was 0.845-0.882. A sensitivity map revealed that the QRS complex and T waves were associated with sepsis. Subgroup analysis was conducted using ECGs from 4,609 patients who were admitted with an infectious disease, and the AUC of the DLM for predicting in-hospital mortality was 0.817 (0.793-0.840). There was a significant difference in the prediction score of DLM using ECG according to the presence of infection in the validation dataset (0.277 vs. 0.574, p < 0.001), including severe acute respiratory syndrome coronavirus 2 (0.260 vs. 0.725, p = 0.018). CONCLUSIONS: The DLM delivered reasonable performance for sepsis screening using 12-, 6-, and single-lead ECGs. The results suggest that sepsis can be screened using not only conventional ECG devices but also diverse life-type ECG machines employing the DLM, thereby preventing irreversible disease progression and mortality.


Asunto(s)
COVID-19 , Aprendizaje Profundo , Sepsis , Electrocardiografía , Humanos , Estudios Retrospectivos , SARS-CoV-2 , Sepsis/diagnóstico
6.
Khirurgiia (Mosk) ; (10): 87-91, 2021.
Artículo en Ruso | MEDLINE | ID: mdl-34608785

RESUMEN

Purulent iliopsoitis is a quite rare and difficult disease regarding diagnosis and treatment. However, treatment outcomes are not so favorable, incidence of sepsis and mortality are still extremely high. Original up-to-date studies devoted to this issue were analyzed. The authors discuss the actual problems of etiology, pathogenesis, classification, clinical features, diagnosis and surgical treatment of iliopsoitis. Considering these data, they conclude that timely diagnosis and adequate surgical treatment are essential for favorable outcomes. Prevention of relapse is based on detection of possible cause of disease and its possible correction.


Asunto(s)
Absceso del Psoas , Sepsis , Humanos , Resultado del Tratamiento
7.
J Cardiothorac Surg ; 16(1): 301, 2021 Oct 15.
Artículo en Inglés | MEDLINE | ID: mdl-34654440

RESUMEN

BACKGROUND: This study sought to investigate the predictive value and regulatory mechanism of serum miR-499a-5p in sepsis-induced myocardial dysfunction (SIMD). METHODS: A total of 60 patients with sepsis and 60 healthy volunteers were enrolled in this study. The serum levels of miRNAs (miR-451, miR-378 and miR-499a-5p) were detected. Receiver operating characteristic curve and logistic regression analysis were used to evaluate the diagnostic and prognostic value of miR-499a-5p in SIMD patients. AC16 cells were used to establish SIMD model in vitro using lipopolysaccharide (LPS). An analysis was conducted for miR-499a-5p expression, cell viability, and the concentration of creatine kinase-MB isoform (CK-MB), brain natriuretic peptide (BNP), superoxide dismutase (SOD) and cytochrome C oxidase IV (COX IV). The downstream target of miR-499a-5p was verified. RESULTS: Our results revealed a poor expression of miR-499a-5p in the serum of SIMD patients, while no significant difference was evident for miR-451 and miR-378. The level of miR-499a-5p in the survival group was higher than the non-survival group. miR-499a-5p elicited good diagnostic and prognostic value for SIMD. Our findings revealed that miR-499a-5p was decreased significantly in LPS-treated cardiomyocytes. After overexpression of miR-499a-5p, the cell viability increased, and the concentrations of CK-MB and BNP were decreased, while the concentrations of SOD and COX IV were increased. EIF4E was validated as the target of miR-499a-5p. After overexpression of EIF4E, the cell viability was decreased and the concentrations of CK-MB and BNP were increased while the concentrations of SOD and COX IV were decreased. CONCLUSION: The level of miR-499a-5p is weak in SIMD patients. miR-499a-5p has a good diagnostic and prognostic value for SIMD by inhibiting EIF4E transcription.


Asunto(s)
Corazón/fisiopatología , MicroARNs , Sepsis , Forma MB de la Creatina-Quinasa , Humanos , MicroARNs/genética , Miocardio , Miocitos Cardíacos , Pronóstico , Sepsis/diagnóstico
8.
BMJ Case Rep ; 14(10)2021 Oct 13.
Artículo en Inglés | MEDLINE | ID: mdl-34645630

RESUMEN

Solitary fibrous tumours (SFTs) are rare mesenchymal tumours that are mostly seen in the pleura. Lately, they have also been described in other locations. Recent discovery of the NAB2-STAT6 fusion gene which is specific for SFTs has led to an accurate diagnosis of SFTs. The occurrence of SFTs in the mesentery is very rarely reported in the literature. We report a case of a 63-year-old female who presented with abdominal pain, rectal bleeding and Fusobacterium bacteraemia, who was ultimately found to have a mesenteric SFT.


Asunto(s)
Sepsis , Tumores Fibrosos Solitarios , Biomarcadores de Tumor , Femenino , Fusobacterium , Humanos , Inmunohistoquímica , Mesenterio , Persona de Mediana Edad , Proteínas Represoras/metabolismo , Factor de Transcripción STAT6/metabolismo , Tumores Fibrosos Solitarios/complicaciones , Tumores Fibrosos Solitarios/diagnóstico por imagen , Tumores Fibrosos Solitarios/cirugía
9.
Trials ; 22(1): 695, 2021 Oct 11.
Artículo en Inglés | MEDLINE | ID: mdl-34635151

RESUMEN

BACKGROUND: To evaluate the effect of screening for sepsis using an electronic sepsis alert vs. no alert in hospitalized ward patients on 90-day in-hospital mortality. METHODS: The SCREEN trial is designed as a stepped-wedge cluster randomized controlled trial. Hospital wards (total of 45 wards, constituting clusters in this design) are randomized to have active alert vs. masked alert, 5 wards at a time, with each 5 wards constituting a sequence. The study consists of ten 2-month periods with a phased introduction of the intervention. In the first period, all wards have a masked alert for 2 months. Afterwards the intervention (alert system) is implemented in a new sequence every 2-month period until the intervention is implemented in all sequences. The intervention includes the implementation of an electronic alert system developed in the hospital electronic medical records based on the quick sequential organ failure assessment (qSOFA). The alert system sends notifications of "possible sepsis alert" to the bedside nurse, charge nurse, and primary medical team and requires an acknowledgment in the health information system from the bedside nurse and physician. The calculated sample size is 65,250. The primary endpoint is in-hospital mortality by 90 days. DISCUSSION: The trial started on October 1, 2019, and is expected to complete patient follow-up by the end of October 2021. TRIAL REGISTRATION: ClinicalTrials.gov NCT04078594 . Registered on September 6, 2019.


Asunto(s)
Hospitales , Sepsis , Electrónica , Mortalidad Hospitalaria , Humanos , Pacientes , Ensayos Clínicos Controlados Aleatorios como Asunto , Sepsis/diagnóstico , Sepsis/terapia
10.
Ann Palliat Med ; 10(9): 9678-9684, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34628893

RESUMEN

BACKGROUND: Sepsis is a common disease in the intensive care unit, accompanied by many complications and high mortality. Organ dysfunction is a major risk factor for death in patients with sepsis. Analyzing the related factors of organ dysfunction caused by sepsis can provide more clinical prevention and treatment targets, and better predict patients' prognoses. This study aimed to investigate the relationship between blood pressure variability (BPV) and organ dysfunction in patients with sepsis. METHODS: One hundred and two patients with sepsis treated in our hospital from January 2019 to January 2021 were retrospectively collected as an observation group, and 102 healthy people were collected as a control group. The 24-hour systolic blood pressure variability (24h SBPV) and 24-hour diastolic blood pressure variability (24h DBPV) of the two groups were compared, and the correlation between 24h SBPV, 24h DBPV, and organ function damage to sepsis patients were analyzed. RESULTS: Compared with the control group, the 24h DBPV in the observation group was significantly higher (0.56±0.16 vs. 0.37±0.16, P=0.000). 24h SBPV increased significantly (0.56±0.16 vs. 0.36±0.17, P=0.000). Pearson linear correlation analysis showed 24h SBPV was positively correlated with the level of procalcitonin, APACHEII score, and SOFA score (r=0.301, 0.216 and 0.218, P<0.05). 24h DBPV was positively correlated with the level of procalcitonin, APACHEII score, and SOFA score (r=0.302, 0.212 and 0.210, P<0.05). 24h SBPV and 24h DBPV are of certain value in the diagnosis of multiple organ failure in patients with sepsis, and the area under the curve was [0.649 (95% CI: 0.539-0.759), P=0.010] and [0.650 (0.540-0.760), P=0.009], respectively. 24h SBPV and 24h DBPV are of certain value in the diagnosis of persistent organ failure in patients with sepsis, and the area under the curve was [0.647 (95% CI: 0.538-0.757), P=0.010] and [0.647 (95% CI: 0.538-0.757), P=0.010], respectively. CONCLUSIONS: The increase of BPV in patients with sepsis has a certain value in predicting the prognosis and organ function damage to patients with sepsis.


Asunto(s)
Insuficiencia Multiorgánica , Sepsis , Presión Sanguínea , Humanos , Unidades de Cuidados Intensivos , Insuficiencia Multiorgánica/etiología , Estudios Retrospectivos
11.
Front Immunol ; 12: 744799, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34594344

RESUMEN

Sepsis is a global health emergency, which is caused by various sources of infection that lead to changes in gene expression, protein-coding, and metabolism. Advancements in "omics" technologies have provided valuable tools to unravel the mechanisms involved in the pathogenesis of this disease. In this study, we performed shotgun mass spectrometry in peripheral blood mononuclear cells (PBMC) from septic patients (N=24) and healthy controls (N=9) and combined these results with two public microarray leukocytes datasets. Through combination of transcriptome and proteome profiling, we identified 170 co-differentially expressed genes/proteins. Among these, 122 genes/proteins displayed the same expression trend. Ingenuity Pathway Analysis revealed pathways related to lymphocyte functions with decreased status, and defense processes that were predicted to be strongly increased. Protein-protein interaction network analyses revealed two densely connected regions, which mainly included down-regulated genes/proteins that were related to the transcription of RNA, translation of proteins, and mitochondrial translation. Additionally, we identified one module comprising of up-regulated genes/proteins, which were mainly related to low-density neutrophils (LDNs). LDNs were reported in sepsis and in COVID-19. Changes in gene expression level were validated using quantitative real-time PCR in PBMCs from patients with sepsis. To further support that the source of the upregulated module of genes/proteins found in our results were derived from LDNs, we identified an increase of this population by flow cytometry in PBMC samples obtained from the same cohort of septic patients included in the proteomic analysis. This study provides new insights into a reprioritization of biological functions in response to sepsis that involved a transcriptional and translational shutdown of genes/proteins, with exception of a set of genes/proteins related to LDNs and host-defense system.


Asunto(s)
Leucocitos Mononucleares/metabolismo , Neutrófilos/metabolismo , Sepsis/metabolismo , Bases de Datos Factuales , Perfilación de la Expresión Génica , Regulación de la Expresión Génica , Humanos , Leucocitos Mononucleares/citología , Células Supresoras de Origen Mieloide/citología , Células Supresoras de Origen Mieloide/metabolismo , Neutrófilos/citología , Mapas de Interacción de Proteínas , Proteómica , Sepsis/genética , Sepsis/inmunología
12.
Trials ; 22(1): 714, 2021 Oct 18.
Artículo en Inglés | MEDLINE | ID: mdl-34663439

RESUMEN

BACKGROUND: Sepsis is triggered by an infection and represents one of the greatest challenges of modern intensive care medicine. With regard to a targeted antimicrobial treatment strategy, the earliest possible pathogen detection is of crucial importance. Until now, culture-based detection methods represent the diagnostic gold standard, although they are characterized by numerous limitations. Culture-independent molecular diagnostic procedures represent a promising alternative. In particular, the plasmatic detection of circulating, cell-free DNA by next-generation sequencing (NGS) has shown to be suitable for identifying disease-causing pathogens in patients with bloodstream infections. METHODS: The DigiSep-Trial is a randomized, controlled, interventional, open-label, multicenter trial characterizing the effect of the combination of NGS-based digital precision diagnostics with standard-of-care microbiological analyses compared to solely standard-of-care microbiological analyses in the clinical picture of sepsis/septic shock. Additional anti-infective expert consultations are provided for both study groups. In 410 patients (n = 205 per arm) with sepsis/septic shock, the study examines whether the so-called DOOR-RADAR (Desirability of Outcome Ranking/Response Adjusted for Duration of Antibiotic Risk) score (representing a combined endpoint including the criteria (1) intensive/intermediate care unit length of stay, (2) consumption of antibiotics, (3) mortality, and (4) acute kidney injury (AKI)) can be improved by an additional NGS-based diagnostic concept. We also aim to investigate the cost-effectiveness of this new diagnostic procedure. It is postulated that intensive/intermediate care unit length of stay, mortality rate, incidence of AKI, the duration of antimicrobial therapy as well as the costs caused by complications and outpatient aftercare can be reduced. Moreover, a significant improvement in patient's quality of life is expected. DISCUSSION: The authors´ previous work suggests that NGS-based diagnostics have a higher specificity and sensitivity compared to standard-of-care microbiological analyses for detecting bloodstream infections. In combination with the here presented DigiSep-Trial, this work provides the optimal basis to establish a new NGS-driven concept as part of the national standard based on the best possible evidence. TRIAL REGISTRATIONS: DRKS-ID DRKS00022782 . Registered on August 25, 2020 ClinicalTrials.gov NCT04571801 . Registered October 1, 2020.


Asunto(s)
Sepsis , Choque Séptico , Secuenciación de Nucleótidos de Alto Rendimiento , Humanos , Estudios Multicéntricos como Asunto , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Investigación , Sepsis/diagnóstico , Sepsis/tratamiento farmacológico , Choque Séptico/diagnóstico , Choque Séptico/tratamiento farmacológico
13.
Acta Cir Bras ; 36(8): e360802, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34644770

RESUMEN

PURPOSE: To evaluate the influence of atractylenolide (Atr) III on sepsis-induced lung damage. METHODS: We constructed a mouse sepsis model through cecal ligation and puncture. These mice were allocated to the normal, sepsis, sepsis + Atr III-L (2 mg/kg), as well as Atr III-H (8 mg/kg) group. Lung injury and pulmonary fibrosis were accessed via hematoxylin-eosin (HE) and Masson's staining. We used terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) and flow cytometry for detecting sepsis-induced lung cell apoptosis. The contents of the inflammatory cytokines in lung tissue were measured via enzyme-linked immunosorbent assay (ELISA). RESULTS: Atr III-H did not only reduce sepsis-induced lung injury and apoptosis level, but also curbed the secretion of inflammatory factors. Atr III-H substantially ameliorated lung function and raised Bcl-2 expression. Atr III-H eased the pulmonary fibrosis damage and Bax, caspase-3, Vanin-1 (VNN1), as well as Forkhead Box Protein O1 (FoxO1) expression. CONCLUSIONS: Atr III alleviates sepsis-mediated lung injury via inhibition of FoxO1 and VNN1 protein.


Asunto(s)
Amidohidrolasas/antagonistas & inhibidores , Proteína Forkhead Box O1/antagonistas & inhibidores , Lesión Pulmonar , Sepsis , Sesquiterpenos , Animales , Apoptosis , Proteínas Ligadas a GPI/antagonistas & inhibidores , Lactonas , Ratones , Sepsis/complicaciones , Sepsis/tratamiento farmacológico , Sesquiterpenos/farmacología
14.
Arch Esp Urol ; 74(8): 775-781, 2021 Oct.
Artículo en Inglés, Español | MEDLINE | ID: mdl-34605419

RESUMEN

OBJECTIVE: This study aims to compare infectious complications after a prostate biopsy in patients with or without chronic idiopathic constipation (CIC). METHODS: Six hundred and sixty-three patients who underwent a transrectal ultrasound-guided biopsy (TRUSBx) of the prostate between 2012 and 2018 were evaluated prospectively. Patients were divided into two groups according to their CIC status and monitored for complications. CIC was defined by the Rome III criteria. Multivariate analysis was performed to assess the risk factors. RESULTS: Thirty-five patients (5.8%) developed a urinary tract infection (UTI) while sepsis occurred in only three cases (0.5%). CIC was found as a risk factor for infection. Infection occurred in 18.1% of the men with CIC compared to 2.3% of those without CIC (p=0.001). Sepsis occurred in 1.4% of the men with CIC compared to vs 0.2% of those without CIC (p=0.68). In multivariate analysis, CIC (OR of 9.27 and 95% CI 4.40-19.54, p<0.05) and Diabetes Mellitus (OR of 3.11 and 95% CI 1.52-6.36, p=0.002) were associated with an increased risk factor of UTI and sepsis. CONCLUSIONS: We demonstrated that CIC is an important risk factor of infection after a prostate biopsy. Prevention is important to minimize complications after this very common worldwide procedure.


Asunto(s)
Sepsis , Infecciones Urinarias , Biopsia , Estreñimiento/etiología , Humanos , Biopsia Guiada por Imagen , Masculino , Próstata , Sepsis/epidemiología , Sepsis/etiología , Infecciones Urinarias/epidemiología , Infecciones Urinarias/etiología
15.
Scand J Trauma Resusc Emerg Med ; 29(1): 144, 2021 Sep 30.
Artículo en Inglés | MEDLINE | ID: mdl-34593001

RESUMEN

BACKGROUND: There is little evidence of which sepsis screening tool to use in the ambulance setting. The primary aim of the current study was to compare the performance of NEWS2 (National Early Warning score 2) and RETTS (Rapid Emergency Triage and Treatment System) with respect to identification of sepsis among ambulance patients with clinically suspected infection. The secondary aim was to compare the performance of the novel Predict Sepsis screening tools with that of NEWS2, RETTS and clinical judgment. METHODS: Prospective cohort study of 323 adult ambulance patients with clinically suspected infection, transported to hospitals in Stockholm, during 2017/2018. The sensitivity, specificity, and AUC (Area Under the receiver operating Curve) were calculated and compared by using McNemar´s test and DeLong's test. RESULTS: The prevalence of sepsis in the current study population was 44.6% (144 of 323 patients). No significant difference in AUC was demonstrated between NEWS2 ≥ 5 and RETTS ≥ orange. NEWS2 ≥ 7 demonstrated a significantly greater AUC than RETTS red. The Predict Sepsis screening tools ≥ 2 demonstrated the highest sensitivity (range 0.87-0.91), along with RETTS ≥ orange (0.83), but the lowest specificity (range 0.39-0.49). The AUC of NEWS2 (0.73) and the Predict Sepsis screening tools (range 0.75-0.77) was similar. CONCLUSIONS: The results indicate that NEWS2 could be the better alternative for sepsis identification in the ambulance, as compared to RETTS. The Predict Sepsis screening tools demonstrated a high sensitivity and AUCs similar to that of NEWS2. However, these results need to be interpreted with caution as the Predict Sepsis screening tools require external validation. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03249597. Registered 15 August 2017-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03249597 .


Asunto(s)
Ambulancias , Sepsis , Adulto , Humanos , Juicio , Estudios Prospectivos , Sepsis/diagnóstico , Sepsis/epidemiología , Triaje
16.
Arq Bras Cir Dig ; 34(2): e1605, 2021.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-34669893

RESUMEN

BACKGROUND: Enterocutaneous fistulas represent a connection between the gastrointestinal tract and adjacent tissues. Among them, there is a subdivision - the enteroatmospheric fistulas, in which the origin is the gastrointestinal tract in connection with the external environment through an open wound in the abdomen. Due to the high output in enterocutaneous fistulas, the loss of fluids, electrolytes, minerals and proteins leads to complications such as sepsis, malnutrition and electrolyte derangements. The parenteral nutrition has its secondary risks, and the fistuloclysis, that consist in the infusion of enteral feeding and also the chyme through the distal fistula, represents an alternative to the management of these patients until the definitive surgical approach. AIM: To evaluate the current evidence on the fistuloclysis technique, its applicability, advantages and disadvantages for patients with high output fistulas. METHOD: A systematic literature search was conducted in May 2020 with the headings "fistuloclysis", "chyme reinfusion" and "succus entericus reinfusion", in the PubMed, Medline and SciELO databases. Results: There were 29 articles selected for the development of this narrative synthesis, from 2003 to 2020, including reviews and case reports. CONCLUSION: Fistuloclysis is a safe method which optimizes the clinical, nutritional, and immunological conditions of patients with enteroatmospheric fistulas, increasing the chances of success of the reconstructive procedure. In cases where the definitive repair is not possible, chances of reducing or even stopping the use of nutrition through the parental route are increased, thus representing a promising modality for the management of most challenging cases.


Asunto(s)
Fístula Intestinal , Sepsis , Nutrición Enteral , Humanos , Fístula Intestinal/terapia , Estado Nutricional , Nutrición Parenteral , Sepsis/terapia
17.
Int Heart J ; 62(5): 1182-1185, 2021 Sep 30.
Artículo en Inglés | MEDLINE | ID: mdl-34544989

RESUMEN

A 20-year-old man with arrhythmogenic right ventricular cardiomyopathy (ARVC) was resuscitated from ventricular fibrillation. He was transferred to our hospital because of progressive multiorgan dysfunction despite mechanical circulatory support with peripheral venoarterial extracorporeal membrane oxygenation (VA-ECMO) and intra-aortic balloon pump (IABP). At admission to our hospital, chest X-ray showed bilateral complete lung opacification, and echocardiography revealed a massive thrombus occupying the left atrium (LA) and left ventricle (LV). Conversion to central ECMO with transapical LV venting and thrombectomy were performed. The huge LA thrombus occluded all pulmonary veins (PVs). Despite the surgery and intensive care, complete lung opacity remained, and he died of multiorgan failure associated with sepsis. Autopsy demonstrated bilateral pulmonary multiple red infarctions, and histopathology showed alveolar wall necrosis with extensive hemorrhage, confirming a diagnosis of pulmonary hemorrhagic infarction. Extensive pulmonary infarction was attributable to PV occlusion due to massive LA thrombus. PV thrombosis should be considered when refractory lung opacities are encountered during VA-ECMO and necessitates early intervention.


Asunto(s)
Displasia Ventricular Derecha Arritmogénica/complicaciones , Oxigenación por Membrana Extracorpórea/métodos , Insuficiencia Multiorgánica/complicaciones , Trombosis/diagnóstico , Fibrilación Ventricular/etiología , Autopsia/métodos , Ecocardiografía/métodos , Resultado Fatal , Atrios Cardíacos/diagnóstico por imagen , Atrios Cardíacos/patología , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/patología , Hemorragia/complicaciones , Hemorragia/diagnóstico , Humanos , Contrapulsador Intraaórtico/métodos , Masculino , Infarto Pulmonar/diagnóstico , Venas Pulmonares/diagnóstico por imagen , Venas Pulmonares/patología , Enfermedad Veno-Oclusiva Pulmonar/complicaciones , Enfermedad Veno-Oclusiva Pulmonar/diagnóstico , Resucitación/métodos , Sepsis/complicaciones , Trombectomía/métodos , Trombosis/patología , Trombosis/cirugía , Fibrilación Ventricular/terapia , Adulto Joven
19.
Nat Commun ; 12(1): 5552, 2021 09 21.
Artículo en Inglés | MEDLINE | ID: mdl-34548486

RESUMEN

Sepsis is a life-threatening condition caused by the extreme release of inflammatory mediators into the blood in response to infection (e.g., bacterial infection, COVID-19), resulting in the dysfunction of multiple organs. Currently, there is no direct treatment for sepsis. Here we report an abiotic hydrogel nanoparticle (HNP) as a potential therapeutic agent for late-stage sepsis. The HNP captures and neutralizes all variants of histones, a major inflammatory mediator released during sepsis. The highly optimized HNP has high capacity and long-term circulation capability for the selective sequestration and neutralization of histones. Intravenous injection of the HNP protects mice against a lethal dose of histones through the inhibition of platelet aggregation and migration into the lungs. In vivo administration in murine sepsis model mice results in near complete survival. These results establish the potential for synthetic, nonbiological polymer hydrogel sequestrants as a new intervention strategy for sepsis therapy and adds to our understanding of the importance of histones to this condition.


Asunto(s)
Hidrogeles/uso terapéutico , Nanopartículas/uso terapéutico , Sepsis/tratamiento farmacológico , Animales , Plaquetas/efectos de los fármacos , Adhesión Celular , Supervivencia Celular/efectos de los fármacos , Modelos Animales de Enfermedad , Histonas/antagonistas & inhibidores , Histonas/metabolismo , Histonas/toxicidad , Hidrogeles/química , Hidrogeles/metabolismo , Hidrogeles/farmacología , Pulmón/efectos de los fármacos , Pulmón/metabolismo , Pulmón/patología , Ratones , Nanopartículas/química , Nanopartículas/metabolismo , Agregación Plaquetaria/efectos de los fármacos , Polietilenglicoles/química , Polietilenglicoles/metabolismo , Polietilenglicoles/farmacología , Polietilenglicoles/uso terapéutico , Unión Proteica , Sepsis/mortalidad , Tasa de Supervivencia
20.
J Int Med Res ; 49(9): 3000605211042981, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34551615

RESUMEN

OBJECTIVE: To explore the effects of continuous renal replacement therapy (CRRT) on renal function and toxin clearance in patients with sepsis and concurrent acute kidney injury (AKI). METHOD: A retrospective analysis was performed using the medical records of 115 patients with sepsis and AKI. Among them, 60 patients received routine treatment (group A) and 55 patients received CRRT plus routine treatment (group B). RESULT: After treatment, the clearance rates of serum creatinine, lactic acid, and urea nitrogen were significantly lower in group A than in group B. The decrease in high-sensitivity C-reactive protein and tumor necrosis factor-α levels after treatment was significantly higher in group B than in group A. For the Acute Physiology Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores from the two groups, the scores were significantly lower in group B than in group A. The mortality rate within 28 days was significantly higher in group A than in group B. CONCLUSION: CRRT can effectively improve the condition of patients with sepsis and AKI, promote elimination of toxins (serum creatinine, lactic acid, and urea nitrogen) from the body, and reduce the mortality rate.


Asunto(s)
Lesión Renal Aguda , Terapia de Reemplazo Renal Continuo , Sepsis , Lesión Renal Aguda/terapia , Estudios de Casos y Controles , Humanos , Unidades de Cuidados Intensivos , Riñón/fisiología , Pronóstico , Terapia de Reemplazo Renal , Estudios Retrospectivos , Sepsis/terapia
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