Rabab Mahmoud Ahmed, Amin R. Soliman, Ahmad Yousry, Khaled Marzouk and Farouk Faris
Background: Early intervention for septic shock is crucial to reduce mortality and improve outcome. There is still a great debate over the exact time of Therapeutic plasma exchange (TPE) administration in septic shock patients. This study aims to investigate the effect of early initiation (within 4 hours) of TPE in severe septic shock on hemodynamics & outcome.
Methods: We conducted a prospective, before-after case series study on 16 septic shock patients requiring high doses of vasopressors admitted in two ICUs from Cairo, Egypt. All of our patients received TPE within 4 hours of ICU admission. The fresh frozen plasma exchange volume = 1.5 x plasma volume.
Results: In the 16 patients included in the study, mean arterial pressure was significantly improved after the initial TPE (p>0.002) and Norepinephrine dose which significantly reduced post TPE (p<0.001).In addition, Norepinephrine dose to mean arterial pressure significantly improved (p<0.001). There was reduction of a net 6 hours fluid balances following the first TPE were observed in all the patients (p>0.03) by a mean of 757 ml. Systemic vascular resistance index was markedly improved post-TPE along with statistically improved cardiac index (p<0.01). Stroke volume variance was also significantly decreased after the TPE sessions (p<0.01). C-reactive protein significantly improved after TPE (P<0.01).
Conclusion: Early initiation of TPE in severe septic shock patients might improve hemodynamic measures.
Guillain–Barré syndrome (GBS) is an inflammatory disorder and an acute immune-mediated demyelinating neuropathy that causes reduced signal transmissions, progressive muscle weakness, and paralysis. The etiology of the syndrome still remains controversial and uncertain. GBS can be initiated and triggered by respiratory tract infections such as influenza, and intestinal infections such as Campylobacter jejuni. In addition, there is considerable evidence suggesting links between influenza vaccination and GBS. As reported previously, the incidence of GBS in individuals receiving swine flu vaccine was about one to two cases per million. Despite the influenza vaccine efficacy, its association with an immune-mediated demyelinating process can be challenging as millions of people get vaccinated every year. In this review we will discuss the association between influenza infection and vaccination with GBS by focusing on the possible immunopathological mechanisms.
Dominique Breilh, Patrick M. Honore, David De Bels, Jason A. Roberts, Jean Baptiste Gordien, Catherine Fleureau, Antoine Dewitte, Julien Coquin, Hadrien Rozé, Paul Perez, Rachid Attou, Sebastien Redant, Luc Kugener, Marie-Claude Saux, Herbert D. Spapen, Alexandre Ouattara, Olivier Joannes-Boyau and on behalf of the IVOIRE study group
Hemofiltration rate, changes in blood and ultrafiltration flow, and discrepancies between the prescribed and administered doses strongly influence pharmacokinetics (PK) and pharmacodynamics (PD) of antimicrobial agents during continuous veno-venous hemofiltration (CVVH) in critically ill patients.
Ancillary data were from the prospective multicenter IVOIRE (hIgh VOlume in Intensive caRE) study. High volume (HV, 70 mL/kg/h) was at random compared with standard volume (SV, 35 mL/kg/h) CVVH in septic shock patients with acute kidney injury (AKI). PK/PD parameters for all antimicrobial agents used in each patient were studied during five days.
Antimicrobial treatment met efficacy targets for both percentage of time above the minimal inhibitory concentration and inhibitory quotient. A significant correlation was observed between the ultrafiltration flow and total systemic clearance (Spearman test: P < 0.005) and between CVVH clearance and drug elimination half-life (Spearman test: P < 0.005). All agents were easily filtered. Mean sieving coefficient ranged from 38.7% to 96.7%. Mean elimination half-life of all agents was significantly shorter during HV-CVVH (from 1.29 to 28.54 h) than during SV-CVVH (from 1.51 to 33.85 h) (P < 0.05).
This study confirms that CVVH influences the PK/PD behavior of most antimicrobial agents. Antimicrobial elimination was directly correlated with convection rate. Current antimicrobial dose recommendations will expose patients to underdosing and increase the risk for treatment failure and development of resistance. Dose recommendations are proposed for some major antibiotic and antifungal treatments in patients receiving at least 25 mL/kg/h CVVH.
Da Sun, Jiaojiao Wang, Li Yao, Zilong Li and Shinichi Ohno
Arterial hypertension has a large prevalence in the general population and as a major hypertensive target organ, the involvement of kidney is usually hard to avoid and gradually develops into chronic kidney disease (CKD). Acute hypertension is defined as a blood pressure greater than 180/120, also known as hypertensive emergency (HE). In acute severe hypertension, the pathophysiology damage to the kidney tends to worsen on the basis of chronic damage, and accounts for more significant mortality. However, the mechanisms of renal injury induced by acute hypertension remain unclear. This review summarizes the clinical and histopathological features of hypertensive renal injury by using “in vivo cyrotechnique” and focusses on the interplay of distinct systemic signaling pathways, which drive glomerular podocyte injury. A thorough understanding of the cellular and molecular mechanisms of kidney damage and repair in hypertension will provide significant insight into the development of new research methods and therapeutic strategies for global CKD progression.
Rheumatoid arthritis (RA) is an inflammatory autoimmune disease characterized by inflammatory cell infiltration, high levels of cytokines, and erosion of cartilage and bone in joints. Calprotectin (CLP), as a recently described member of S100 family proteins, is a heterodimeric complex of S100A8 and S100A9. Currently, plenty of studies have indicated significantly increased serum and synovial fluid levels of CLP in patients with RA. It was reported that CLP was related to cell differentiation, migration, apoptosis, and production of pro-inflammatory factors in RA. In addition, there are the positive relationships between serum, synovial CLP and traditional acute phase reactants, disease activity, ultrasound and radiographic progression of joints, and treatment response of RA. In this review, we mainly discuss the role of CLP in the pathogenesis of RA as well as its potential to estimate clinical disease progression of RA patients.
Jinlong Hu, Nan Ge, Sheng Wang, Xiang Liu, Jintao Guo, Guoxin Wang and Siyu Sun
Background and Objectives
Preoperative diagnosis of gastric glomus tumor is very difficult, and there are few reports regarding the endoscopic treatment of glomus tumor of the stomach. Our aim is to provide a retrospective assessment of the imaging features of endoscopic ultrasound (EUS) and treatment of choice of gastric glomus tumor.
A database of all patients with gastric glomus tumor who was treated at Shengjing Hospital of China Medical University between March 2011 and March 2017 was retrospectively analyzed. The EUS characteristics and patients’ clinical data as well as their treatment were reviewed. At the same time, we compared EUS characteristics of gastric glomus tumor with that of gastrointestinal stromal tumor (GISTs), leiomyomas, schwannomas, and ectopic pancreas.
Eleven patients (3 male and 8 female patients) were included in the present study. The patients’ age ranged from 37 to 62 years (mean age, 50.1 years). Ten patients received EUS examination. Eight lesions were presented with mild-hyperechoic round or oval mass; one lesion was mild-hyperechoic oval mass with hypoechoic spots; one lesion was hypoechoic oval mass. One patient received endoscopic full-thickness resection; 3 patients were treated by endoscopic submucosal dissection; and laparoscopic resection was performed for 7 patients.
Gastric glomus has typical EUS features to differentiate from other submucosal tumors. Compared with surgery, endoscopic resection is also a safe and effective treatment of choice for gastric glomus tumor.
Non-alcoholic fatty liver disease (NAFLD) is closely associated with metabolic diseases like type 2 diabetes and obesity. In recent decades, accumulating evidence has revealed that the hepatokines, proteins mainly secreted by the liver, play important roles in the development of NAFLD by acting directly on the lipid and glucose metabolism. As a member of organokines, the hepatokines establish the communication between the liver and the adipose, muscular tissues. In this review, we summarize the current understanding of the hepatokines and how they modulate the pathogenesis of metabolic disorders especially NAFLD.
Nonthikorn Theerasuwipakorn, Abbas Ali Tasneem, Pradermchai Kongkam, Phontep Angsuwatcharakon, Wiriyaporn Ridtitid, Patpong Navicharern, Krit Kitisin, Peerapol Wangrattanapranee, Rungsun Rerknimitr and Pinit Kullavanijaya
Background and Objectives
Drainage of symptomatic walled-off peripancreatic fluid collections (WPFCs) can be achieved by endoscopic, percutaneous, and surgical techniques. The aim of this study was to determine the current trends in management of WPFCs and the outcome of such modalities in Asian population.
In this retrospective analysis, all patients diagnosed with pancreatitis from 2013 to 2016 in King Chulalongkorn Memorial Hospital, Bangkok, Thailand, were analyzed. Relevant clinical data of all patients with peripancreatic fluid collections (PFCs) was reviewed. Clinical success was defined as improvement in symptoms after drainage.
Of the total 636 patients with pancreatitis, 72 (11.3%) had WPFCs, of which 55 (8.6%) and 17 (2.7%) had pancreatic pseudocyst (PP) and walled-off necrosis (WON), respectively. The commonest etiologies of WPFCs were alcohol (38.9%) and biliary stone (29.2%). Post-procedure and pancreatic tumor related pancreatitis was found in 8.3% and 6.9% patients, respectively. PP was more common in chronic (27.8%) than acute (5.5%) pancreatitis. Of the 72 patients with WPFCs, 31 (43.1%) had local complications. Supportive, endoscopic, percutaneous, and surgical drainage were employed in 58.3%, 27.8%, 8.3%, and 5.6% with success rates being 100%, 100%, 50%, and 100%, respectively. Complications that developed after percutaneous drainage included bleeding at procedure site (n = 1), infection of PFC (n = 1), and pancreatic duct leakage (n = 1).
Over the past few years, endoscopic drainage has become the most common route of drainage of WPFCs followed by percutaneous and surgical routes. The success rate of endoscopic route is better than percutaneous and comparable to surgical modality.
Meliha Bayram, Mehmet Emin Derin, Halef Okan Doğan, Gökmen Asan, Mehtap Şahin and Ali Şahin
İntroduction: Familial Mediterranean Fever (FMF) is an autoinflammatory disease. Prolidase is a specific imidodipeptidase that plays a role in collagen degradation. Prolidase plays an important role in inflammation and wound healing. Hypoxia-inducible factor-1α (HIF-1) is an important protein in the regulation of immunological response, hemostasis, vascularization. The aim of the study was to compare serum prolidase and HIF-1α levels in patients with FMF in attack-free period and healthy control group.
Methods: Between August 2017 and December 2017, sixty patients who diagnosed FMF according to the criteria of the Tel-hashomer who admitting to Sivas Cumhuriyet University Medical Faculty Internal Medicine Rheumatology Department and sixty healthy volunteers were enrolled in the study.
Results: Median serum prolidase level were 72.1 (25.1-114.9) ng/ml in FMF group and 30.7 (21.3-86.2) ng/mL in healthy control (HC) group (p=0.018). ROC analysis showed that the sensitivity was 65% and the specificity was 68.3% at serum prolidase levels 54.03 ng/mL (p<0.05). The median serum levels of HIF-1α in the FMF group was 482.0(292.0-3967.0) pg/mL and 632.0(362.0-927.0) pg/mL in the HC group (p>0.05). There was no significant correlation between laboratory findings, sex, age, and prolidase (p>0.05).
\Conclusion: Serum prolidase enzyme levels in FMF patients with attack-free period were significantly higher than in the HC group. However, the role of prolidase and HIF1-α in the FMF disease needs to be clarified with more extensive and comprehensive studies.