Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 10.658
Filtrar
1.
Scand J Immunol ; 91(1): e12813, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31386235

RESUMO

BACKGROUND: Sepsis is a life-threatening disease that is an immune disorder response that causes multiple organ dysfunction. In this study, we investigated the dynamic changes in mRNA expression of HLA-DRA gene and the specific transcription factor of helper T cell subsets to explore long-term immunophenotyping and its relationship with prognosis. METHODS: Seventy-eight sepsis patients and twelve healthy controls were recruited in this study. Blood samples were collected at eight-time points during their septic course and were assayed for the gene expression of HLA-DRA and T helper cell subset-specific transcription factors (T-bet: Th1, GATA3: Th2, Foxp3: Treg, RORC: Th17). RESULTS: The levels of HLA-DRA in survivors gradually increased but were maintained at lower levels in non-survivors. The specific transcription factor of Th1 and Th2 cells, T-bet and GATA-3 were significantly lower in sepsis patients than in normal controls, and the non-survivors showed significantly lower levels than the survivors (P < .05). RORC and FOXP3, the specific transcription factor of Treg and Th17 were significantly higher in survivors than in non-survivors and normal controls (P < .05). T-bet and GATA-3 had a linear correlation with HLA-DRA expression (P < .01). CONCLUSIONS: The dynamic changes in HLA-DRA expression in peripheral blood could accurately reflect the immune status of sepsis patients, and the reduction in HLA-DRA may be an important reason for abnormal T cell differentiation. The sustained low levels of the Th cell subsets (Th1 and Th2) suggest the suppression of adaptive immunity, and this persistent immunosuppression may be the leading cause of death in septic patients.


Assuntos
Regulação da Expressão Gênica , Cadeias alfa de HLA-DR/genética , Sepse/etiologia , Linfócitos T Auxiliares-Indutores/imunologia , Linfócitos T Auxiliares-Indutores/metabolismo , Adulto , Idoso , Biomarcadores , Estudos de Casos e Controles , Comorbidade , Feminino , Humanos , Hospedeiro Imunocomprometido , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados da Assistência ao Paciente , Sepse/diagnóstico , Sepse/mortalidade , Subpopulações de Linfócitos T/imunologia , Subpopulações de Linfócitos T/metabolismo
2.
J Surg Res ; 245: 217-224, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31421366

RESUMO

BACKGROUND: Gastroschisis is an increasingly common congenital abdominal wall defect. Due to advances in neonatal critical care and early surgical management, mortality from gastroschisis and associated complications has decreased to less than 10% in most series. However, it has been recognized that the outcome of gastroschisis has a spectrum and that the disorder affects a heterogeneous cohort of neonates. The goal of this study is to predict morbidity and mortality in neonates with gastroschisis using clinically relevant variables. METHODS: A multicenter, retrospective observational study of neonates born with gastroschisis was conducted. Neonatal characteristics and outcomes were collected and compared. Prediction of morbidity and mortality was performed using multivariate clinical models. RESULTS: Five hundred and sixty-six neonates with gastroschisis were identified. Overall survival was 95%. Median hospital length of stay was 37 d. Sepsis was diagnosed in 107 neonates. Days on parenteral nutrition and mechanical ventilation were considerable with a median of 27 and 5 d, respectively. Complex gastroschisis (atresia, perforation, volvulus), preterm delivery (<37 wk), and very low birth weight (<1500 g) were associated with worse clinical outcomes including increased sepsis, short bowel syndrome, parenteral nutrition days, and length of stay. The composite metric of birth weight, Apgar score at 5 min, and complex gastroschisis was able to successfully predict mortality (area under the curve, 0.81). CONCLUSIONS: Clinical variables can be used in gastroschisis to distinguish those who will survive from nonsurvivors. Although these findings need to be validated in other large multicenter data sets, this prognostic score may aid practitioners in the identification and management of at-risk neonates.


Assuntos
Gastrosquise/mortalidade , Sepse/epidemiologia , Síndrome do Intestino Curto/epidemiologia , Índice de Apgar , Estudos de Viabilidade , Feminino , Gastrosquise/complicações , Gastrosquise/terapia , Idade Gestacional , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Tempo de Internação/estatística & dados numéricos , Masculino , Nutrição Parenteral/estatística & dados numéricos , Prognóstico , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Risco , Sepse/etiologia , Síndrome do Intestino Curto/etiologia , Taxa de Sobrevida
3.
JAMA ; 322(22): 2179-2190, 2019 12 10.
Artigo em Inglês | MEDLINE | ID: mdl-31821429

RESUMO

Importance: The clinical consequences of red blood cell storage age for critically ill pediatric patients have not been examined in a large, randomized clinical trial. Objective: To determine if the transfusion of fresh red blood cells (stored ≤7 days) reduced new or progressive multiple organ dysfunction syndrome compared with the use of standard-issue red blood cells in critically ill children. Design, Setting, and Participants: The Age of Transfused Blood in Critically-Ill Children trial was an international, multicenter, blinded, randomized clinical trial, performed between February 2014 and November 2018 in 50 tertiary care centers. Pediatric patients between the ages of 3 days and 16 years were eligible if the first red blood cell transfusion was administered within 7 days of intensive care unit admission. A total of 15 568 patients were screened, and 13 308 were excluded. Interventions: Patients were randomized to receive either fresh or standard-issue red blood cells. A total of 1538 patients were randomized with 768 patients in the fresh red blood cell group and 770 in the standard-issue group. Main Outcomes and Measures: The primary outcome measure was new or progressive multiple organ dysfunction syndrome, measured for 28 days or to discharge or death. Results: Among 1538 patients who were randomized, 1461 patients (95%) were included in the primary analysis (median age, 1.8 years; 47.3% girls), in which there were 728 patients randomized to the fresh red blood cell group and 733 to the standard-issue group. The median storage duration was 5 days (interquartile range [IQR], 4-6 days) in the fresh group vs 18 days (IQR, 12-25 days) in the standard-issue group (P < .001). There were no significant differences in new or progressive multiple organ dysfunction syndrome between fresh (147 of 728 [20.2%]) and standard-issue red blood cell groups (133 of 732 [18.2%]), with an unadjusted absolute risk difference of 2.0% (95% CI, -2.0% to 6.1%; P = .33). The prevalence of sepsis was 25.8% (160 of 619) in the fresh group and 25.3% (154 of 608) in the standard-issue group. The prevalence of acute respiratory distress syndrome was 6.6% (41 of 619) in the fresh group and 4.8% (29 of 608) in the standard-issue group. Intensive care unit mortality was 4.5% (33 of 728) in the fresh group vs 3.5 % (26 of 732) in the standard-issue group (P = .34). Conclusions and Relevance: Among critically ill pediatric patients, the use of fresh red blood cells did not reduce the incidence of new or progressive multiple organ dysfunction syndrome (including mortality) compared with standard-issue red blood cells. Trial Registration: ClinicalTrials.gov Identifier: NCT01977547.


Assuntos
Preservação de Sangue , Estado Terminal/terapia , Transfusão de Eritrócitos , Insuficiência de Múltiplos Órgãos/prevenção & controle , Adolescente , Criança , Pré-Escolar , Estado Terminal/mortalidade , Progressão da Doença , Transfusão de Eritrócitos/efeitos adversos , Feminino , Mortalidade Hospitalar , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Pediátrica , Estimativa de Kaplan-Meier , Masculino , Insuficiência de Múltiplos Órgãos/mortalidade , Gravidade do Paciente , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Sepse/etiologia
4.
Rev Bras Epidemiol ; 22Suppl 3(Suppl 3): e190012.supl.3, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31800851

RESUMO

INTRODUCTION: Sepsis represents the occurrence of systemic inflammatory response syndrome triggered by the initial infection of an organ or system. When sepsis is certified as the cause of death, the first diagnosis is lost, leading to inaccurate information as to its origin. OBJECTIVE: To analyze the underlying causes of death from sepsis after investigation in 60 Brazilian municipalities in 2017. METHODOLOGY: All deaths recorded in the Mortality Information System (SIM) as sepsis in 2017 were selected, and the proportions of reclassified deaths were calculated based on the results of research conducted in hospitals and other health services. RESULTS: Of the 6,486 deaths from sepsis that occurred in the 60 municipalities, 1,584 (24.4%) were investigated, and of these, 1,308 (82.6%) were reclassified with other underlying causes. Individuals aged from 70 to 89 years old showed the highest concentration in the records, with 49.3% of cases. More than 60% of the deaths from sepsis reclassified after the investigation had chronic non-communicable diseases as underlying causes (65.6%), with diabetes being the most common specific cause in this group. Communicable diseases (9.6%) and external causes (5.6%) such as falls were also detected as underlying causes. CONCLUSION: The investigation of deaths from sepsis made it possible to identify the true causes of death and the proportions of reclassification. This information will improve the quality of mortality data and support the planning of public health actions in Brazil.


Assuntos
Causas de Morte , Sepse/mortalidade , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Criança , Pré-Escolar , Cidades/epidemiologia , Atestado de Óbito , Feminino , Geografia , Humanos , Lactente , Sistemas de Informação/normas , Masculino , Pessoa de Meia-Idade , Sepse/etiologia , Distribuição por Sexo , Adulto Jovem
5.
Medicine (Baltimore) ; 98(52): e18546, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31876752

RESUMO

OBJECTIVE: The predictive accuracies of procalcitonin (PCT) in the diagnosis of catheter-associated bloodstream infection (CABSI) vary widely. This meta-analysis aimed to explore the predictive value of PCT for CABSI. METHODS: We searched PubMed, EMBase, Web of Science, ScienceDirect, Cochrane Library, and studies published up to 10 March 2019. Odds ratios (ORs) with 95% confidence intervals (95%CIs) were calculated to evaluate PCT predictive value using Stata 14.0 software. RESULTS: The meta-analysis was composed of 7 studies, consisting of 347 subjects. Pooled analysis demonstrated that a high PCT was significantly correlated with CABSI (pooled OR = 23.36, 95%CI 12.43-43.91, P < .001) and medium heterogenicity (I = 36.9%, P = .147). The pooled sensitivity and specificity were 85% (95%CI 0.76-0.91) and 89% (95%CI 0.68-0.97), respectively. Although Begg funnel plot (P = .007) indicated the presence of publication bias among the included studies, the stability of the pooled outcomes was verified by the trim-and-fill method. Furthermore, sensitivity analyses did not show important differences in effect estimation. CONCLUSION: PCT is an effective predictor of CABSI. However, high-quality randomized controlled trials are needed to determine whether PCT could predict CABSI.


Assuntos
Infecções Relacionadas a Cateter/sangue , Pró-Calcitonina/sangue , Sepse/sangue , Biomarcadores/sangue , Infecções Relacionadas a Cateter/diagnóstico , Humanos , Valor Preditivo dos Testes , Sepse/diagnóstico , Sepse/etiologia
6.
Heart Surg Forum ; 22(5): E325-E330, 2019 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-31596706

RESUMO

BACKGROUND: Delayed sternal closure commonly is used after pediatric cardiac surgery. Its benefits include relieving cardiac compression and stabilizing postoperative critically ill patients. METHODS: We retrospectively reviewed the records of 72 patients, who had undergone delayed sternal closure, among 1,254 patients operated for congenital heart diseases. Indications of delayed sternal closure, perioperative hemodynamic and metabolic status, postoperative infection, and mortality were reported. RESULTS: Transposition of great arteries was the most common preoperative cardiac pathology (26.3%). Bleeding and hemodynamic instability were the most frequent indications for delayed sternal closure, representing 38.8% and 34.7%, respectively. The mean duration of open chest was 3.45 days ± 1.46 days. The mean duration of ICU stay was 20.95 days ± 20.06 days. Two patients had deep sternal wound infection. Sepsis was found in 39 patients (54.1%), and the most common causative organism was coagulase negative (30.5%). ICU stay was a significant risk factor for sepsis (P = .003); duration of open sternum, period of mechanical ventilation (MV), and total hospital stay were not statistically significant risk factors. Sternal closure time (SCT) was affected by period of hemodynamic instability (P = .036). Bypass time, clamping time, and nonsurgical bleeding did not significantly affect SCT. The mortality rate was 15.2% (N = 11). CONCLUSION: Delayed sternal closure is a simple and effective technique that could prevent postoperative cardiac compression in hemodynamic instability states after pediatric cardiac operations.


Assuntos
Cardiopatias Congênitas/cirurgia , Esterno/cirurgia , Ferida Cirúrgica/cirurgia , Técnicas de Fechamento de Ferimentos , Criança , Pré-Escolar , Feminino , Hemodinâmica , Mortalidade Hospitalar , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Pediátrica , Tempo de Internação/estatística & dados numéricos , Masculino , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Estudos Retrospectivos , Sepse/epidemiologia , Sepse/etiologia , Infecção da Ferida Cirúrgica/epidemiologia , Fatores de Tempo , Transposição dos Grandes Vasos/cirurgia
7.
BMC Infect Dis ; 19(1): 836, 2019 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-31601195

RESUMO

BACKGROUND: Moraxella nonliquefaciens is a usually non-pathogenic biofilm-producing Gram-negative coccobacillus which may colonize the upper respiratory tract, rarely causing invasive disease. Although very rare, bloodstream infections caused by this organism have been described, showing often a fatal outcome. Here, we report the case of a pediatric cancer patient with bloodstream infection and sepsis due to M. nonliquefaciens showing full recovery after appropriate antibiotic treatment. CASE PRESENTATION: A three-year-old boy with stage IV neuroblastoma was admitted for high-dose chemotherapy with autologous stem cell rescue after standard neuroblastoma treatment. Despite receiving antimicrobial prophylaxis with trimethoprim/sulfamethoxazole, acyclovir and amphothericin B, the patient presented with fever of up to 39.5 °C and neutropenia. Besides a chemotherapy-related mucositis and an indwelling Broviac catheter (removed), no infection focus was identified on physical examination. Moraxella nonliquafaciens was identified in blood cultures. After antibiotic treatment and neutrophil recovery, the patient was fit for discharge. CONCLUSIONS: The case described highlights the importance of an otherwise non-pathogenic microorganism, especially in immunosupressed cancer patients. It should be kept in mind that, although very infrequently, Moraxella nonliquefaciens may cause bloodstream infections that can be successfully treated with prompt focus identification and antibiotic therapy.


Assuntos
Bacteriemia/diagnóstico , Moraxella/isolamento & purificação , Neoplasias/patologia , Sepse/diagnóstico , Antibacterianos/uso terapêutico , Antineoplásicos/uso terapêutico , Bacteriemia/complicações , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Pré-Escolar , Humanos , Masculino , Estadiamento de Neoplasias , Neoplasias/complicações , Neoplasias/tratamento farmacológico , Neutropenia/diagnóstico , Neutropenia/etiologia , Sepse/etiologia , Sepse/microbiologia
8.
Medicine (Baltimore) ; 98(41): e17511, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593121

RESUMO

Acute esophageal necrosis (AEN) is a serious disease which can causes gastrointestinal bleeding and death. Although black color change is not essential factor of organ necrosis, AEN is also known as "black esophagus." Because of its rarity, there are limited studies regarding risk factors of mortality and recurrence. Thus, we conducted a multicenter retrospective study in order to evaluate the clinical characteristics of AEN. Method Clinical datum of AEN patients from 7 tertiary hospitals located in Daejeon-Choongcheong province were evaluated based on medical records. Our primary endpoint was risk factors for mortality and the secondary endpoint was risk factors for recurrence and clarifying whether "black esophagus" is a right terminology.Fourty one patients were enrolled. Thirty six patients were male, mean age was 69.5 years. Nine patients had died, and 4 patients showed recurrence. Sepsis and white color change in endoscopy were related to high mortality (Chi-Squared test, P < .05). Old age, high pulse rate, low hemoglobin, and low albumin were also related to high mortality. Unexpectedly, heavy drinking showed favorable a mortality. Septic condition and high pulse rate showed poor mortality in logistic regression test (P < .05). Coexisting duodenal ulcer was related to recurrence (Chi-Squared test, P < .05). There was no difference in the underlying condition except patients with a coexisting cancer and white-form displayed lower hemoglobin level. Conclusion: Our results imply that white color change, septic condition, high pulse rate, and low hemoglobin & albumin are poor prognostic factors in AEN. Further evaluation may help clarify the findings of our study.


Assuntos
Doenças do Esôfago/mortalidade , Hemorragia Gastrointestinal/mortalidade , Necrose/diagnóstico por imagem , Necrose/mortalidade , Doença Aguda , Idoso , Albuminas/análise , Úlcera Duodenal/epidemiologia , Endoscopia do Sistema Digestório/métodos , Doenças do Esôfago/diagnóstico por imagem , Doenças do Esôfago/patologia , Esôfago/irrigação sanguínea , Esôfago/patologia , Feminino , Hemorragia Gastrointestinal/etiologia , Hemoglobinas/análise , Humanos , Masculino , Pessoa de Meia-Idade , Necrose/complicações , Necrose/patologia , Prognóstico , Recidiva , Estudos Retrospectivos , Fatores de Risco , Sepse/epidemiologia , Sepse/etiologia , Sepse/mortalidade
9.
J Clin Neurosci ; 69: 245-249, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31542299

RESUMO

BACKGROUND/OBJECTIVE: Stroke is the second leading cause of death globally that predisposed to sepsis. Therefore, this study was aimed to assess the risk factors and epidemiologic features of sepsis in ischemic stroke patients admitted to ICUs. METHODS: Throughout this prospective study, we investigated all severe ischemic stroke patients admitted to ICUs of Namazi and Ali-Ashghar Hospitals in Shiraz. After ICU admission and diagnosing stroke by a neurologist according to NIHSS (National Institute of Health Stroke Scale) criteria, sepsis work-up was performed in all patients suspected to have sepsis. Then the incidence of sepsis and its risk factors in ICU admitted stroke patients were determined. RESULTS: A total of 149 patients were screened in this study. The mean age of the participants was 65.37 ±â€¯15.40 years old and 57.4% of them were male. Hypertension was the most common coexistent disease (74.6%) in stroke patients. Seventy-six patients (62.3%) were diagnosed with sepsis and pneumonia was the most common infection leading to sepsis in stroke patients. Our data showed significant differences between two groups in terms of APACHE-IV score (P < 0.001), NIHSS and APS (P < 0.001) before ICU admission (P < 0.001) and NIHSS at admission (P < 0.001); however, age (P = 0.07) and sex (P = 0.17) were not significantly different between the groups. Logistic regression analysis displayed that severe stroke (NIHSS = 21-42, OR = 49.09) and severe loss of consciousness (GCS < 8, OR = 27.95) at admission were the most essential predictive factors for sepsis after ischemic stroke. CONCLUSIONS: This study showed that ICU patients with severe ischemic stroke were more susceptible to sepsis during the hospital course.


Assuntos
Sepse/epidemiologia , Sepse/etiologia , Acidente Vascular Cerebral/complicações , APACHE , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/complicações , Feminino , Humanos , Incidência , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco
10.
Chirurgia (Bucur) ; 114(4): 487-493, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31511135

RESUMO

Introduction: Crohn disease (CD) has seen a steady increase in incidence over the years in Romania. Laparoscopy had a slow evolution as a feasible therapeutic option for patients with CD. Material and Method: The study is retrospective. The period on which the data was gathered spread over 8 years (01.01.2011-01.01.2019). Data was retrieved from three Clinical Hospitals in Bucharest, Romania Results: the preoperative diagnosis of an intestinal fistula (p = 0,02), sepsis (p = 0.01 ) or increased age should be regarded as a limitation for a laparoscopic approach in CD complications. Also in emergency settings an open approach should be the mainstay treatment (approach p = 0.000001). Conclusion: Laparoscopy is a feasible surgical option in the treatment of surgical complication in CD. In order to increase the safety of the intervention, correct selection of patients is important.


Assuntos
Doença de Crohn/epidemiologia , Doença de Crohn/cirurgia , Fatores Etários , Doença de Crohn/complicações , Humanos , Fístula Intestinal/epidemiologia , Fístula Intestinal/cirurgia , Laparoscopia/estatística & dados numéricos , Laparotomia/estatística & dados numéricos , Seleção de Pacientes , Estudos Retrospectivos , Romênia/epidemiologia , Sepse/epidemiologia , Sepse/etiologia , Sepse/cirurgia , Resultado do Tratamento
11.
Int J Mol Sci ; 20(18)2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31491842

RESUMO

Sepsis is defined as life-threatening organ dysfunction caused by the dysregulated host response to infection. Despite serious mortality and morbidity, no sepsis-specific drugs exist. Endotoxemia is often used to model the hyperinflammation associated with early sepsis. This model classically uses lipopolysaccharide (LPS) from Gram-negative pathogens to activate the immune system, leading to hyperinflammation, microcirculatory disturbances and death. Other toxins may also be used to activate the immune system including Gram-positive peptidoglycan (PG) and lipoteichoic acid (LTA). In addition to these standard toxins, other bacterial components can induce inflammation. These molecules activate different signaling pathways and produce different physiological responses which can be taken advantage of for sepsis modeling. Endotoxemia modeling can provide information on pathways to inflammation in sepsis and contribute to preclinical drug development.


Assuntos
Inflamação/etiologia , Inflamação/metabolismo , Sepse/etiologia , Toxinas Biológicas/efeitos adversos , Animais , Endotoxemia/diagnóstico , Endotoxemia/etiologia , Endotoxemia/metabolismo , Interações Hospedeiro-Patógeno/imunologia , Humanos , Inflamação/diagnóstico , Lipopolissacarídeos/efeitos adversos , Lipopolissacarídeos/imunologia , Sepse/diagnóstico , Sepse/metabolismo , Transdução de Sinais
12.
Medicine (Baltimore) ; 98(33): e16800, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415389

RESUMO

BACKGROUND: The effects of early continuous renal replacement therapy (CRRT) on mortality in patients with septic acute kidney injury (AKI) remain controversial. A systematic review and meta-analysis was performed to investigate the impact of timing of CRRT on clinical outcomes in patients with septic AKI. METHODS: The PubMed, Cochrane, and Embase databases were searched from inception to the 31st of March 2019, to identify trials that assessed the timing of initiation of CRRT in patients with septic AKI. RESULTS: Five trials including 900 patients were included. The results of this meta-analysis showed that there was no significant difference between 28-day mortality (odds ratio = 0.76;95% CI, 0.58-1.00; P = .05) and 90-day mortality(odds ratio = 0.79;95% CI, 0.59-1.06; P = .12)of early and late initiation of CRRT group. In addition, compared with late initiation strategy, early initiation showed no significant advantage in length of stay in ICU (Mean difference = -0.9;95% CI, -2.37 to 0.57; P = .23) and length of stay in hospital (Mean difference = -1.43;95% CI, -5.28 to 2.41; P = .47). CONCLUSION: Our meta-analysis revealed that early initiation of CRRT could not reduce mortality in patients with septic AKI. The study also showed no significant difference in ICU length of stay or hospital length of stay between early and late CRRT group. To achieve optimal timing of CRRT for septic AKI, large multicenter randomized trials with better design are still needed.


Assuntos
Lesão Renal Aguda/mortalidade , Lesão Renal Aguda/terapia , Terapia de Substituição Renal/mortalidade , Sepse/mortalidade , Tempo para o Tratamento/estatística & dados numéricos , Lesão Renal Aguda/complicações , Adulto , Feminino , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Fatores de Risco , Sepse/etiologia , Fatores de Tempo
13.
J Med Microbiol ; 68(10): 1560-1572, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31460863

RESUMO

Introduction. Severely burned patients are susceptible to bacterial infection within their burn wounds, which frequently leads to sepsis, multiple organ failure and death. The opportunistic pathogen Pseudomonas aeruginosa, an organism inherently resistant to multiple antibiotics, is a common cause of sepsis in these patients.Aim. Development of a topical treatment unrelated to conventional antibiotics is essential for prevention of P. aeruginosa infection and sepsis, leading to a role for the direct application of probiotics or their by-products.Methodology. We examined the effectiveness of 20× concentrated supernatant from Lactobacillus gasseri strain 63 AM (LgCS) grown in de Man, Rogosa and Sharpe broth in inhibiting P. aeruginosa biofilms in vitro, as well as in reducing wound bioburden and P. aeruginosa sepsis in vivo.Results. LgCS inhibited the growth of P. aeruginosa strain PAO1, prevented its biofilm development and eliminated partially developed PAO1 biofilms. In the murine model of thermal injury, a single injection of LgCS following injury and PAO1 infection reduced mortality to 0 % and prevented systemic spread (sepsis). Furthermore, a second injection of LgCS 24 h after the first eliminated PAO1 from the wound. In the murine dorsal excision infection model, either LgCS or ceftazidime treatment of the PAO1-infected wound significantly reduced the mortality rate among infected mice, while combining LgCS with ceftazidime eliminated mortality.Conclusion. These results suggest the potential of LgCS in preventing sepsis from P. aeruginosa infection in severely burned and other immunocompromised patients.


Assuntos
Queimaduras/complicações , Lactobacillus gasseri/fisiologia , Infecções por Pseudomonas/terapia , Pseudomonas aeruginosa/crescimento & desenvolvimento , Sepse/terapia , Músculos Superficiais do Dorso/lesões , Animais , Antibiose , Biofilmes , Terapia Biológica , Modelos Animais de Doenças , Feminino , Humanos , Camundongos , Camundongos Endogâmicos BALB C , Infecções por Pseudomonas/etiologia , Infecções por Pseudomonas/microbiologia , Infecções por Pseudomonas/mortalidade , Pseudomonas aeruginosa/fisiologia , Sepse/etiologia , Sepse/microbiologia , Sepse/mortalidade , Músculos Superficiais do Dorso/microbiologia , Músculos Superficiais do Dorso/cirurgia , Infecção dos Ferimentos
14.
BMC Cancer ; 19(1): 770, 2019 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-31382912

RESUMO

BACKGROUND: Etoposide (E) at 100 mg/m2 combined with Cisplatin (P) at 20 mg/m2 represents an induction 2-day regimen embedded in our clinical practice for patients with advanced GCT or TN at high risk of early death. We evaluated 24/7 Em-EP administration to a combined GCT-TN cohort at our Emergency Cancer Treatment Centre (ECTC) to determine its efficacy within the acute setting. METHODS: Patients who received Em-EP during a five-year interval were identified from electronic databases at Imperial College Healthcare NHS Trust. Data collected included demographics, treatment details and clinical outcome. RESULTS: Em-EP was administered in the emergency setting to 104 patients, predominantly young adults (median age 35, range 17-71). Half the cases were GCT (n = 52): 22 male (6 seminomas, 13 non-seminomas); 30 female (2 dysgerminomas, 28 non-dysgerminomas). The other 50% were treated for TN (n = 52): 45 gestational (GTN) and 7 non-gestational. Most patients received Em-EP for a new cancer diagnosis (n = 100, 96%), within 24 h (n = 93, 89%) and out-of-hours (n = 74, 70%). Indications for Em-EP included symptomatic disease (n = 66, 63%), high-burden disease, (n = 51, 49%) and organ failure requiring Intensive Care Unit support (n = 9, 9%). Neutropenic sepsis was observed in 5%. Four-week overall survival after Em-EP administration was 98%. CONCLUSIONS: Despite the potentially fatal complications encountered in the acute setting, early mortality with Em-EP is low at our ECTC. Specialist units that treat unwell patients with advanced GCT or TN should consider making Em-EP available 24/7 for emergency administration. Its efficacy within a prospective cohort and in other platinum-sensitive malignancies requires evaluation.


Assuntos
Antineoplásicos Fitogênicos/uso terapêutico , Cisplatino/uso terapêutico , Serviços Médicos de Emergência , Etoposídeo/uso terapêutico , Doença Trofoblástica Gestacional/tratamento farmacológico , Doença Aguda , Adolescente , Adulto , Idoso , Antineoplásicos Fitogênicos/administração & dosagem , Antineoplásicos Fitogênicos/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Cisplatino/administração & dosagem , Cisplatino/efeitos adversos , Assistência à Saúde , Etoposídeo/administração & dosagem , Etoposídeo/efeitos adversos , Feminino , Febre/etiologia , Seguimentos , Doença Trofoblástica Gestacional/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Neutropenia/etiologia , Gravidez , Estudos Prospectivos , Estudos Retrospectivos , Sepse/etiologia , Taxa de Sobrevida , Resultado do Tratamento , Adulto Jovem
15.
J Cancer Res Clin Oncol ; 145(11): 2779-2791, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31446489

RESUMO

PURPOSE: To evaluate serum procalcitonin (PCT) and C-reactive protein (CRP) as diagnostic biomarkers of transplant-related adverse events (TRAE) in pediatric patients undergoing hematopoietic stem cell transplantation (HSCT). METHODS: This study analyzed PCT and CRP levels of 214 pediatric patients with a median age of 8.5 years (0.4-17.8 years) undergoing allogeneic HSCT with respect to major TRAE. RESULTS: 26 patients (12.1%) did not experience TRAE (control group), and 188 (87.9%) experienced median 2 (range 1-4) TRAE. Median CRP and PCT were highly and significantly increased during sepsis/SIRS and bacteremia (17.24 mg/dl | 6.30 ng/ml; p < 0.0001 vs. prior values), graft rejection (14.73 mg/dl | 3.20 ng/ml; p < 0.0001), and liver GvHD (6.88 mg/dl | 2.29 ng/ml; p < 0.01). Strong CRP increases and slight/minimal/no PCT increases occurred during fungemia (8.85 mg/dl | 0.72 ng/ml; p < 0.001), intestinal GvHD (8.73 mg/dl | 1.06 ng/ml; p < 0.0001), VOD (10.84 mg/dl | 0.59 ng/ml; p < 0.01), mucositis (8.84 mg/dl | 0.81 ng/ml; p < 0.0001), and viremia (3.62 mg/dl; p < 0.0001 | 0.43 ng/ml; below normal limit). During skin GvHD, CRP and PCT were slightly increased (2.03 mg/dl | 0.93 ng/ml; p < 0.0001). CONCLUSIONS: CRP and PCT did not show congruent changes during TRAE. PCT was a clinically relevant marker for the early detection and differentiation of severe mucositis and sepsis/SIRS and bacteremia during the critical neutropenic period after HSCT. PCT helped to discriminate acute intestinal GvHD from adenovirus viremia and liver GvHD from hepatic VOD. Thus, PCT may be a valuable parameter to enable a prompt and appropriate treatment during these complications, improving patient outcomes.


Assuntos
Bacteriemia/diagnóstico , Proteína C-Reativa/análise , Rejeição de Enxerto/diagnóstico , Doença Enxerto-Hospedeiro/diagnóstico , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Pró-Calcitonina/sangue , Sepse/diagnóstico , Adolescente , Bacteriemia/sangue , Bacteriemia/etiologia , Biomarcadores/sangue , Estudos de Casos e Controles , Criança , Pré-Escolar , Diagnóstico Precoce , Feminino , Seguimentos , Rejeição de Enxerto/sangue , Rejeição de Enxerto/etiologia , Doença Enxerto-Hospedeiro/sangue , Doença Enxerto-Hospedeiro/etiologia , Neoplasias Hematológicas/patologia , Neoplasias Hematológicas/terapia , Humanos , Lactente , Masculino , Prognóstico , Estudos Retrospectivos , Sepse/sangue , Sepse/etiologia , Transplante Homólogo
16.
Forensic Sci Med Pathol ; 15(4): 598-602, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31444700

RESUMO

In this report, a pediatric case of bowel obstruction with sepsis complicated by methamphetamine toxicity is described. The decedent, an eleven-year-old female with a clinical history of pica, was found unresponsive in her home and pronounced dead following unsuccessful resuscitative efforts. Radiologic imaging showed multiple radio-opaque foreign objects in the stomach and bowel. Autopsy revealed a green leafy substance, coins and other metallic items, folded paper, and plastic in her stomach and bowels. Postmortem iliac blood and urine tested positive for amphetamine and methamphetamine. While the decedent's medical history and autopsy findings provided evidence consistent with bowel obstruction with sepsis due to the ingestion of foreign materials, the high methamphetamine concentration was suggestive of concurrent methamphetamine toxicity. Unique complications associated with this case include the phenomenon that methamphetamine toxicity and bowel obstruction can present similarly in children and the reported opinion that accidental drug ingestion is uncommon in children over the age of five. This case emphasizes that the age range for suspected accidental drug ingestion should be expanded for those with pica, as these patients, despite being older, may not be able to differentiate between what they should and should not ingest. Furthermore, when treating a pediatric patient with pica that appears to present with bowel obstruction, unintentional drug ingestion should also be considered, particularly if there is a suspicion that the child lives in a household where drugs are abused, given the prospect that drug toxicity can present similarly.


Assuntos
Estimulantes do Sistema Nervoso Central/efeitos adversos , Obstrução Intestinal/etiologia , Metanfetamina/efeitos adversos , Pica/complicações , Sepse/etiologia , Anfetamina/sangue , Anfetamina/urina , Estimulantes do Sistema Nervoso Central/sangue , Estimulantes do Sistema Nervoso Central/urina , Criança , Colo Sigmoide/diagnóstico por imagem , Overdose de Drogas , Feminino , Corpos Estranhos/diagnóstico por imagem , Humanos , Obstrução Intestinal/diagnóstico por imagem , Metanfetamina/sangue , Metanfetamina/urina , Sepse/patologia , Estômago/diagnóstico por imagem
17.
Crit Care ; 23(1): 258, 2019 07 19.
Artigo em Inglês | MEDLINE | ID: mdl-31324202

RESUMO

Influenza virus affects the respiratory tract by direct viral infection or by damage from the immune system response. In humans, the respiratory epithelium is the only site where the hemagglutinin (HA) molecule is effectively cleaved, generating infectious virus particles. Virus transmission occurs through a susceptible individual's contact with aerosols or respiratory fomites from an infected individual. The inability of the lung to perform its primary function of gas exchange can result from multiple mechanisms, including obstruction of the airways, loss of alveolar structure, loss of lung epithelial integrity from direct epithelial cell killing, and degradation of the critical extracellular matrix.Approximately 30-40% of hospitalized patients with laboratory-confirmed influenza are diagnosed with acute pneumonia. These patients who develop pneumonia are more likely to be < 5 years old, > 65 years old, Caucasian, and nursing home residents; have chronic lung or heart disease and history of smoking, and are immunocompromised.Influenza can primarily cause severe pneumonia, but it can also present in conjunction with or be followed by a secondary bacterial infection, most commonly by Staphylococcus aureus and Streptococcus pneumoniae. Influenza is associated with a high predisposition to bacterial sepsis and ARDS. Viral infections presenting concurrently with bacterial pneumonia are now known to occur with a frequency of 30-50% in both adult and pediatric populations. The H3N2 subtype has been associated with unprecedented high levels of intensive care unit (ICU) admission.Influenza A is the predominant viral etiology of acute respiratory distress syndrome (ARDS) in adults. Risk factors independently associated with ARDS are age between 36 and 55 years old, pregnancy, and obesity, while protective factors are female sex, influenza vaccination, and infections with Influenza A (H3N2) or Influenza B viruses.In the ICU, particularly during the winter season, influenza should be suspected not only in patients with typical symptoms and epidemiology, but also in patients with severe pneumonia, ARDS, sepsis with or without bacterial co-infection, as well as in patients with encephalitis, myocarditis, and rhabdomyolysis.


Assuntos
Influenza Humana/fisiopatologia , Adulto , Estado Terminal/epidemiologia , Estado Terminal/mortalidade , Feminino , Humanos , Vacinas contra Influenza/normas , Vacinas contra Influenza/uso terapêutico , Influenza Humana/complicações , Influenza Humana/epidemiologia , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/mortalidade , Obesidade/fisiopatologia , Orthomyxoviridae/patogenicidade , Fatores de Proteção , Síndrome do Desconforto Respiratório do Adulto/epidemiologia , Síndrome do Desconforto Respiratório do Adulto/etiologia , Síndrome do Desconforto Respiratório do Adulto/fisiopatologia , Sepse/epidemiologia , Sepse/etiologia , Sepse/fisiopatologia , Fatores Sexuais
20.
Emerg Infect Dis ; 25(8): 1445-1451, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31310217

RESUMO

In the United States, fatal transfusion-transmitted infections from red blood cell units are rare. Although this pattern mostly reflects how inhospitable refrigerated red blood cell units are to contaminant growth, fatalities caused by microorganisms that can grow at storage temperature (4°C), but not in standard clinical blood cultures at 37°C, are probably underestimated. We analyzed a fatal red blood cell transfusion in Peoria, Illinois, USA, that occurred in 2017. Samples from the patient's whole blood and the red blood cell unit remained culture-negative during the investigation, despite direct visualization of gram-negative bacilli within the unit immediately after transfusion. We identified the bacteria as Pseudomonas poae, a nonpathogenic pseudomonad carrying multiple cold-shock domain protein genes, and confirmed its cold tolerance and inability to grow at 37°C. Our work indicates transfusion reaction workups need to include testing for psychrophilic organisms, which could explain the cause of other apparently culture-negative transfusion reactions.


Assuntos
Transfusão de Sangue , Infecções por Pseudomonas/diagnóstico , Infecções por Pseudomonas/etiologia , Pseudomonas , Sepse/diagnóstico , Sepse/etiologia , Reação Transfusional/diagnóstico , Transfusão de Eritrócitos/efeitos adversos , Evolução Fatal , Feminino , Humanos , Illinois/epidemiologia , Pessoa de Meia-Idade , Tipagem de Sequências Multilocus , Filogenia , Pseudomonas/classificação , Pseudomonas/genética , Pseudomonas/isolamento & purificação , Infecções por Pseudomonas/epidemiologia , Infecções por Pseudomonas/transmissão , RNA Ribossômico 16S/genética , Sepse/epidemiologia , Sepse/transmissão , Reação Transfusional/epidemiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA