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Çöllüoğlu T, Aksu MH, Önalan O, Akın Y. An interesting observation: prolonged green urine can be a combined effect of decreased liver and renal function in a patient with heart failure-a case report. Eur Heart J Case Rep 2023; 7:ytad570. [PMID: 38089126 PMCID: PMC10711430 DOI: 10.1093/ehjcr/ytad570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 10/19/2023] [Accepted: 11/14/2023] [Indexed: 03/07/2024]
Abstract
Background The administration of propofol and methylene blue (MB) can be associated with the appearance of prolonged green urine discoloration, particularly in patients with heart failure (HF) concomitant with renal and liver dysfunction. Understanding the reasons behind this phenomenon is of clinical significance. Case summary A 79-year-old woman with a history of HF experienced dyspnoea and persistent green urine discoloration for a week, leading to her hospitalization for acutely decompensated HF. A recent dual-chamber rate-modulated-pacemaker implantation had necessitated propofol sedation and the administration of 100 mg of MB due to methaemoglobinaemia. Upon admission, the patient exhibited elevated levels of brain natriuretic peptide (BNP) and liver function tests, as well as a significant decrease in glomerular filtration rate (GFR). Initial therapy with intravenous furosemide yielded an inadequate response, requiring the initiation of combined diuretic therapy (CDT). The patient's condition improved with CDT, resulting in the normalization of BNP, liver function tests, and GFR, along with the restoration of normal urine colour lasting 12 days. Discussion Our case report sheds light on the complex interaction between drug metabolic pathways and their potential for prolonged side effects, particularly in patients with multiorgan dysfunction. The association between propofol, MB, and green urine discoloration in the context of HF warrants further investigation, emphasizing the need for increased awareness of drug interactions and their implications in complex clinical scenarios.
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Affiliation(s)
- Tuğçe Çöllüoğlu
- Faculty of Medicine, Department of Cardiology, Karabük University, Karabük, Türkiye
| | - Melahat Hicran Aksu
- Faculty of Medicine, Department of Cardiology, Karabük University, Karabük, Türkiye
| | - Orhan Önalan
- Faculty of Medicine, Department of Cardiology, Karabük University, Karabük, Türkiye
| | - Yeşim Akın
- Faculty of Medicine, Department of Cardiology, Karabük University, Karabük, Türkiye
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Fan CY, Zhang CG, Zhang PS, Chen Y, He JQ, Yin H, Gong XJ. Acute diquat poisoning case with multiorgan failure and a literature review: A case report. World J Clin Cases 2023; 11:6565-6572. [PMID: 37900248 PMCID: PMC10600979 DOI: 10.12998/wjcc.v11.i27.6565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/11/2023] [Accepted: 08/25/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND With the withdrawal of paraquat from the market, diquat is widely used, so the treatment of diquat poisoning has become one of the focuses of emergency poisoning diagnosis and treatment. CASE SUMMARY We studied the case of a 17-year-old male patient who drank 200 mL (20 g/100 mL) of diquat solution two hours before arriving at the hospital. Despite the use of treatments such as gastric lavage, hemoperfusion, continuous hemodialysis, glucocorticoids, and organ support, the patient's condition rapidly progressed to multiorgan failure, and he died 23.5 h after admission. CONCLUSION We summarized the clinical characteristics and treatment strategies of diquat poisoning through this case and performed a literature review to provide a basis and direction for clinical treatment.
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Affiliation(s)
- Chun-Yang Fan
- Emergency Department, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - Chen-Guang Zhang
- Emergency Department, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - Peng-Shu Zhang
- Emergency Department, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - Yu Chen
- Emergency Department, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - Jian-Qiang He
- Emergency Department, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - He Yin
- Emergency Department, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - Xiao-Jie Gong
- Emergency Department, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
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Shin J, Toyoda S, Nishitani S, Onodera T, Fukuda S, Kita S, Fukuhara A, Shimomura I. SARS-CoV-2 infection impairs the insulin/IGF signaling pathway in the lung, liver, adipose tissue, and pancreatic cells via IRF1. Metabolism 2022; 133:155236. [PMID: 35688210 PMCID: PMC9173833 DOI: 10.1016/j.metabol.2022.155236] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/11/2022] [Accepted: 06/01/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND COVID-19 can cause multiple organ damages as well as metabolic abnormalities such as hyperglycemia, insulin resistance, and new onset of diabetes. The insulin/IGF signaling pathway plays an important role in regulating energy metabolism and cell survival, but little is known about the impact of SARS-CoV-2 infection. The aim of this work was to investigate whether SARS-CoV-2 infection impairs the insulin/IGF signaling pathway in the host cell/tissue, and if so, the potential mechanism and association with COVID-19 pathology. METHODS To determine the impact of SARS-CoV-2 on insulin/IGF signaling pathway, we utilized transcriptome datasets of SARS-CoV-2 infected cells and tissues from public repositories for a wide range of high-throughput gene expression data: autopsy lungs from COVID-19 patients compared to the control from non-COVID-19 patients; lungs from a human ACE2 transgenic mouse infected with SARS-CoV-2 compared to the control infected with mock; human pluripotent stem cell (hPSC)-derived liver organoids infected with SARS-CoV-2; adipose tissues from a mouse model of COVID-19 overexpressing human ACE2 via adeno-associated virus serotype 9 (AAV9) compared to the control GFP after SARS-CoV-2 infection; iPS-derived human pancreatic cells infected with SARS-CoV-2 compared to the mock control. Gain and loss of IRF1 function models were established in HEK293T and/or Calu3 cells to evaluate the impact on insulin signaling. To understand the mechanistic regulation and relevance with COVID-19 risk factors, such as older age, male sex, obesity, and diabetes, several transcriptomes of human respiratory, metabolic, and endocrine cells and tissue were analyzed. To estimate the association with COVID-19 severity, whole blood transcriptomes of critical patients with COVID-19 compared to those of hospitalized noncritical patients with COVID-19. RESULTS We found that SARS-CoV-2 infection impaired insulin/IGF signaling pathway genes, such as IRS, PI3K, AKT, mTOR, and MAPK, in the host lung, liver, adipose tissue, and pancreatic cells. The impairments were attributed to interferon regulatory factor 1 (IRF1), and its gene expression was highly relevant to risk factors for severe COVID-19; increased with aging in the lung, specifically in men; augmented by obese and diabetic conditions in liver, adipose tissue, and pancreatic islets. IRF1 activation was significantly associated with the impaired insulin signaling in human cells. IRF1 intron variant rs17622656-A, which was previously reported to be associated with COVID-19 prevalence, increased the IRF1 gene expression in human tissue and was frequently found in American and European population. Critical patients with COVID-19 exhibited higher IRF1 and lower insulin/IGF signaling pathway genes in the whole blood compared to hospitalized noncritical patients. Hormonal interventions, such as dihydrotestosterone and dexamethasone, ameliorated the pathological traits in SARS-CoV-2 infectable cells and tissues. CONCLUSIONS The present study provides the first scientific evidence that SARS-CoV-2 infection impairs the insulin/IGF signaling pathway in respiratory, metabolic, and endocrine cells and tissues. This feature likely contributes to COVID-19 severity with cell/tissue damage and metabolic abnormalities, which may be exacerbated in older, male, obese, or diabetic patients.
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Affiliation(s)
- Jihoon Shin
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan; Department of Diabetes Care Medicine, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan.
| | - Shinichiro Toyoda
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Shigeki Nishitani
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Toshiharu Onodera
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Shiro Fukuda
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Shunbun Kita
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan; Department of Adipose Management, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Atsunori Fukuhara
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan; Department of Adipose Management, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Iichiro Shimomura
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
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4
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Zhan Z, Li CF, Liu J, Cao CS, Huang L. Metagenomic next-generation sequencing to diagnose atypical severe scrub typhus. J Microbiol Immunol Infect 2022; 55:556-557. [PMID: 34996709 DOI: 10.1016/j.jmii.2021.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/23/2021] [Accepted: 12/21/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Zuan Zhan
- Emergency Department, The First Affiliated Hospital of Nanchang University, Jiangxi, China.
| | - Chun-Fan Li
- Emergency Department, The First Affiliated Hospital of Nanchang University, Jiangxi, China.
| | - Jian Liu
- Emergency Department, The First Affiliated Hospital of Nanchang University, Jiangxi, China.
| | - Chun-Shui Cao
- Emergency Department, The First Affiliated Hospital of Nanchang University, Jiangxi, China.
| | - Liang Huang
- Emergency Department, The First Affiliated Hospital of Nanchang University, Jiangxi, China.
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Ajouri J, Muellenbach RM, Rolfes CB, Weber K, Schuppert F, Peivandi AA, Reyher C. [Cardiogenic shock following yew needle poisoning : Digoxin immune fab, va-ECMO and albumin dialysis for the treatment of a suicidal yew leaf poisoning]. Anaesthesist 2021; 71:210-213. [PMID: 34608518 DOI: 10.1007/s00101-021-01048-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/30/2021] [Accepted: 09/06/2021] [Indexed: 10/20/2022]
Abstract
We present the case of a 46-year-old male who developed refractory bradycardia with cardiogenic shock after attempting suicide by ingestion of yew leaves. Due to delayed availability of the Digoxin immune fab, a va-ECMO was established to maintain sufficient circulation. Administration of the digoxin fab resulted in recovery of spontaneous circulation. Continuous venovenous hemodiafiltration with hemoadsorption and albumin dialysis were initiated with the intention to remove immune fab-toxin complexes and as organ support in acute kidney and liver failure. Within 5 days the patient was successfully weaned from ECMO, liver support and renal replacement and discharged without physical sequelae.
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Affiliation(s)
- Jonas Ajouri
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Klinikum Kassel, Campus Kassel of the University of Southampton, Mönckebergstraße 41-43, 34125, Kassel, Deutschland.
| | - R M Muellenbach
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Klinikum Kassel, Campus Kassel of the University of Southampton, Mönckebergstraße 41-43, 34125, Kassel, Deutschland
| | - C B Rolfes
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Klinikum Kassel, Campus Kassel of the University of Southampton, Mönckebergstraße 41-43, 34125, Kassel, Deutschland
| | - K Weber
- Notfallzentrum Nordhessen, Klinikum Kassel, Campus Kassel of the University of Southampton, Kassel, Deutschland
| | - F Schuppert
- Medizinische Klinik I, Klinikum Kassel, Campus Kassel of the University of Southampton, Kassel, Deutschland
| | - A A Peivandi
- Klinik für Herzchirurgie, Klinikum Kassel, Campus Kassel of the University of Southampton, Kassel, Deutschland
| | - C Reyher
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Klinikum Kassel, Campus Kassel of the University of Southampton, Mönckebergstraße 41-43, 34125, Kassel, Deutschland
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Biegus J, Niewinski P, Josiak K, Kulej K, Ponikowska B, Nowak K, Zymlinski R, Ponikowski P. Pathophysiology of Advanced Heart Failure: What Knowledge Is Needed for Clinical Management? Heart Fail Clin 2021; 17:519-531. [PMID: 34511202 DOI: 10.1016/j.hfc.2021.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Understanding of heart failure (HF) has evolved from a simple hemodynamic problem through a neurohormonally and proinflammatory-driven syndrome to a complex multiorgan dysfunction accompanied by inadequate energy handling. This article discusses the most important clinical aspects of advanced HF pathophysiology. It presents the concept of neurohormonal activation and its deleterious effect on cardiovascular system and reflex control. The current theories regarding the role of inflammation, cytokine activation, and myocardial remodeling in HF progression are presented. Advanced HF is a multiorgan syndrome with interplay between cardiovascular system and other organs. The role of iron deficiency is also discussed.
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Affiliation(s)
- Jan Biegus
- Department of Heart Diseases, Wrocław Medical University, ul. Borowska 213, 50-556 Wrocław, Poland; Centre for Heart Diseases, Wrocław University Hospital, ul. Borowska 213, 50-556 Wrocław, Poland
| | - Piotr Niewinski
- Department of Heart Diseases, Wrocław Medical University, ul. Borowska 213, 50-556 Wrocław, Poland; Centre for Heart Diseases, Wrocław University Hospital, ul. Borowska 213, 50-556 Wrocław, Poland
| | - Krystian Josiak
- Department of Heart Diseases, Wrocław Medical University, ul. Borowska 213, 50-556 Wrocław, Poland; Centre for Heart Diseases, Wrocław University Hospital, ul. Borowska 213, 50-556 Wrocław, Poland
| | - Katarzyna Kulej
- Department of Heart Diseases, Wrocław Medical University, ul. Borowska 213, 50-556 Wrocław, Poland; Centre for Heart Diseases, Wrocław University Hospital, ul. Borowska 213, 50-556 Wrocław, Poland
| | - Barbara Ponikowska
- Student Scientific Organization, Department of Heart Diseases, Wroclaw Medical University, ul. Borowska 213, 50-556 Wrocław, Poland
| | - Krzysztof Nowak
- Department of Heart Diseases, Wrocław Medical University, ul. Borowska 213, 50-556 Wrocław, Poland; Centre for Heart Diseases, Wrocław University Hospital, ul. Borowska 213, 50-556 Wrocław, Poland
| | - Robert Zymlinski
- Department of Heart Diseases, Wrocław Medical University, ul. Borowska 213, 50-556 Wrocław, Poland; Centre for Heart Diseases, Wrocław University Hospital, ul. Borowska 213, 50-556 Wrocław, Poland
| | - Piotr Ponikowski
- Department of Heart Diseases, Wrocław Medical University, ul. Borowska 213, 50-556 Wrocław, Poland; Centre for Heart Diseases, Wrocław University Hospital, ul. Borowska 213, 50-556 Wrocław, Poland.
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Balan S, Beauchamps L, Gonzales-Zamora JA, Vu C, Amoros A, Quiroz T, Stevenson M, Sharkey M, Andrews DM, Abbo L. Recovery does not always signal the end of the battle: A case of post SARS-CoV-2 multisystem inflammatory syndrome in an adult. IDCases 2021; 24:e01067. [PMID: 33747788 PMCID: PMC7968306 DOI: 10.1016/j.idcr.2021.e01067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 01/27/2021] [Accepted: 03/09/2021] [Indexed: 11/28/2022] Open
Abstract
We describe a case of SARS-CoV-2 post-infectious inflammatory syndrome in an adult who presented with multiorgan failure two months following his initial diagnosis of SARS-CoV-2 infection. This case highlights clinician’s early recognition of this devastating sequela and challenges in appropriate management of this patient.
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Affiliation(s)
- Shuba Balan
- Department of Medicine, Division of Infectious Diseases, Jackson Memorial Hospital/University of Miami Miller School of Medicine, Miami, FL, United States
| | - Laura Beauchamps
- Department of Medicine, Division of Infectious Diseases, Jackson Memorial Hospital/University of Miami Miller School of Medicine, Miami, FL, United States
| | - Jose Armando Gonzales-Zamora
- Department of Medicine, Division of Infectious Diseases, Jackson Memorial Hospital/University of Miami Miller School of Medicine, Miami, FL, United States
| | - Christine Vu
- Jackson Memorial Hospital, Department of Pharmacy, Miami, FL, United States
| | - Annette Amoros
- Division of Infectious Diseases and Critical Care, Jackson Memorial Hospital, Miami, FL, United States
| | - Tanya Quiroz
- Division of Infectious Diseases, Jackson Memorial Hospital, Miami, FL, United States
| | - Mario Stevenson
- Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Mark Sharkey
- Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL, United States
| | - David M Andrews
- Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Lilian Abbo
- Department of Medicine, Division of Infectious Diseases, Jackson Memorial Hospital/University of Miami Miller School of Medicine, Miami, FL, United States.,Department of Infection Prevention and Antimicrobial Stewardship, Jackson Health System, Miami, FL, United States
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Villa G, Romagnoli S, De Rosa S, Greco M, Resta M, Pomarè Montin D, Prato F, Patera F, Ferrari F, Rotondo G, Ronco C. Blood purification therapy with a hemodiafilter featuring enhanced adsorptive properties for cytokine removal in patients presenting COVID-19: a pilot study. Crit Care 2020; 24:605. [PMID: 33046113 PMCID: PMC7549343 DOI: 10.1186/s13054-020-03322-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 10/04/2020] [Indexed: 02/07/2023]
Abstract
Background Systemic inflammation in COVID-19 often leads to multiple organ failure, including acute kidney injury (AKI). Renal replacement therapy (RRT) in combination with sequential extracorporeal blood purification therapies (EBP) might support renal function, attenuate systemic inflammation, and prevent or mitigate multiple organ dysfunctions in COVID-19. Aim Describe overtime variations of clinical and biochemical features of critically ill patients with COVID-19 treated with EBP with a hemodiafilter characterized by enhanced cytokine adsorption properties. Methods An observational prospective study assessing the outcome of patients with COVID-19 admitted to the ICU (February to April 2020) treated with EBP according to local practice. Main endpoints included overtime variation of IL-6 and multiorgan function-scores, mortality, and occurrence of technical complications or adverse events. Results The study evaluated 37 patients. Median baseline IL-6 was 1230 pg/ml (IQR 895) and decreased overtime (p < 0.001 Kruskal-Wallis test) during the first 72 h of the treatment, with the most significant decrease in the first 24 h (p = 0.001). The reduction in serum IL-6 concentrations correlated with the improvement in organ function, as measured in the decrease of SOFA score (rho = 0.48, p = 0.0003). Median baseline SOFA was 13 (IQR 6) and decreased significantly overtime (p < 0.001 at Kruskal-Wallis test) during the first 72 h of the treatment, with the most significant decrease in the first 48 h (median 8 IQR 5, p = 0.001). Compared to the expected mortality rates, as calculated by APACHE IV, the mean observed rates were 8.3% lower after treatment. The best improvement in mortality rate was observed in patients receiving EBP early on during the ICU stay. Premature clotting (running < 24 h) occurred in patients (18.9% of total) which featured higher effluent dose (median 33.6 ml/kg/h, IQR 9) and higher filtration fraction (median 31%, IQR 7.4). No electrolyte disorders, catheter displacement, circuit disconnection, unexpected bleeding, air, or thromboembolisms due to venous cannulation of EBP were recorded during the treatment. In one case, infection of vascular access occurred during RRT, requiring replacement. Conclusions EBP with heparin-coated hemodiafilter featuring cytokine adsorption properties administered to patients with COVID-19 showed to be feasible and with no adverse events. During the treatment, patients experienced serum IL-6 level reduction, attenuation of systemic inflammation, multiorgan dysfunction improvement, and reduction in expected ICU mortality rate.
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Affiliation(s)
- Gianluca Villa
- Department of Health Sciences, Section of Anaesthesiology, Intensive Care and Pain Medicine, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy. .,Department of Anaesthesia and Intensive Care, Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
| | - Stefano Romagnoli
- Department of Health Sciences, Section of Anaesthesiology, Intensive Care and Pain Medicine, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy.,Department of Anaesthesia and Intensive Care, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Silvia De Rosa
- Department of Anesthesia and Intensive Care Unit, St. Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
| | - Massimiliano Greco
- Department of Anesthesiology and Intensive Care, Humanitas Clinical and Research Center-IRCCS, Milano, Italy.,Department of Biomedical Sciences, Humanitas University, Milano, Italy
| | - Marco Resta
- Department of General Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
| | - Diego Pomarè Montin
- Department of Health Sciences, Section of Anaesthesiology, Intensive Care and Pain Medicine, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy.,International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
| | - Federico Prato
- Anesthesia and Intensive Care, Ospedale degli Infermi, Ponderano, Biella, Italy
| | - Francesco Patera
- Department of Nephrology, Dialysis and Transplantation Ospedale Santa Maria della Misericordia, Perugia, Italy
| | - Fiorenza Ferrari
- International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy.,Department of Anaesthesia and Intensive Care Unit, IRCCS San Matteo Hospital and University of Pavia, Pavia, Italy
| | | | - Claudio Ronco
- International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy.,Department of Medicine, Università di Padova, Padova, Italy.,Department of Nephrology, Dialysis and Kidney Transplantation, San Bortolo Hospital, Vicenza, Italy
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Abstract
Accidental poisoning in children is very common, making up 10.9% of all unintentional injuries worldwide. Africa has the highest incidence of fatal poisonings worldwide, at 4 per 100,000. Poisoning with podophyllin is rare, with most cases documented around the 1970s to 1980s. Podophyllin is a resin mixture obtained from the dried Rhizome and roots of Podophyllin peltatum (North America) and Podopyllin emodi (India). Podophyllotoxin is the most toxic chemical present in the podophyllin, which is lipid soluble; so crosses the cell membrane easily and inhibits mitotic spindle formation. Both topical application and oral consumption can cause podophyllin poisoning. Neurotoxicity is the most serious effect along with bone marrow depression, gastrointestinal irritation, and hepatic and renal dysfunction. Management of podophyllin toxicity is mainly symptomatic, and no specific antidote exists. We report a case of a 2-year-old-year girl with accidental podophyllin poisoning, who presented with neurotoxicity followed by multiorgan dysfunction and then succumbed. Education of parents and healthcare workers on home safety still remains the mainstay of prevention. How to cite this article: Jain MK, Patnaik S, Rup AR, Gaurav A. A Rare Case of Podophyllin Poisoning: Early Intervention is Lifesaving. Indian J Crit Care Med 2020;24(6):477-479.
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Affiliation(s)
- Mukesh K Jain
- Department of Pediatrics, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Sibabratta Patnaik
- Department of Pediatrics, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Amit R Rup
- Department of Pediatrics, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Abhinav Gaurav
- Department of Pediatrics, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Dalugama C, Nanayakkara M, Rathnayaka N, Medagama A. Atypical case of hantavirus infection in Sri Lanka mimicking leptospirosis: a case report. J Med Case Rep 2020; 14:71. [PMID: 32552909 PMCID: PMC7301464 DOI: 10.1186/s13256-020-02417-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 05/28/2020] [Indexed: 11/22/2022] Open
Abstract
Background Hantavirus infection is an emerging zoonotic infection which has two characteristic patterns of presentation: hantavirus pulmonary syndrome and hemorrhagic fever with renal syndrome. The clinical presentation of hantavirus infection closely mimics leptospirosis. Case presentation This case report describes a previously apparently well 36-year-old Sri Lankan Sinhalese man who presented with an acute febrile illness with myalgia, with liver involvement in the form of transaminitis, cardiac involvement in the form of myocarditis, acute kidney injury, and pulmonary involvement. He was initially managed as severe leptospirosis with multiorgan dysfunction with antibiotics, steroids, and N-acetyl cysteine. A diagnosis of acute hantavirus infection was made subsequently. He made an uneventful recovery. Conclusion Hantavirus infections need to considered in the differential diagnosis of patients presenting with acute febrile illness with multiorgan involvement. Larger studies are needed to evaluate the seroprevalence of hantavirus in Sri Lanka because it could be an emerging serious public health problem.
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Affiliation(s)
- Chamara Dalugama
- Department of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
| | | | | | - Arjuna Medagama
- Department of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
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Abstract
COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a major public health crisis threatening humanity at this point in time. Transmission of the infection occurs by inhalation of infected droplets or direct contact with soiled surfaces and fomites. It should be suspected in all symptomatic children who have undertaken international travel in the last 14 d, all hospitalized children with severe acute respiratory illness, and asymptomatic direct and high-risk contacts of a confirmed case. Clinical symptoms are similar to any acute respiratory viral infection with less pronounced nasal symptoms. Disease seems to be milder in children, but situation appears to be changing. Infants and young children had relatively more severe illness than older children. The case fatality rate is low in children. Diagnosis can be confirmed by Reverse transcriptase - Polymerase chain reaction (RT-PCR) on respiratory specimen (commonly nasopharyngeal and oropharyngeal swab). Rapid progress is being made to develop rapid diagnostic tests, which will help ramp up the capacity to test and also reduce the time to getting test results. Management is mainly supportive care. In severe pneumonia and critically ill children, trial of hydroxychloroquine or lopinavir/ritonavir should be considered. As per current policy, children with mild disease also need to be hospitalized; if this is not feasible, these children may be managed on ambulatory basis with strict home isolation. Pneumonia, severe disease and critical illness require admission and aggressive management for acute lung injury and shock and/or multiorgan dysfunction, if present. An early intubation is preferred over non-invasive ventilation or heated, humidified, high flow nasal cannula oxygen, as these may generate aerosols increasing the risk of infection in health care personnel. To prevent post discharge dissemination of infection, home isolation for 1-2 wk may be advised. As of now, no vaccine or specific chemotherapeutic agents are approved for children.
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Affiliation(s)
- Jhuma Sankar
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Nitin Dhochak
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - S K Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India.
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Nagendra V, Thakkar KD, Prasad Hrishi A, Prathapadas U. A Rare Case of Rhinocerebral Mucormycosis Presenting as Garcin Syndrome and Acute Ischemic Stroke. Indian J Crit Care Med 2020; 24:1137-1138. [PMID: 33384525 PMCID: PMC7751051 DOI: 10.5005/jp-journals-10071-23643] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Mucormycosis is a rare fungal infection affecting immunocompromised patients, with the rhinocerebral variant as the most common presentation.1 Garcin syndrome is the progressive involvement of the cranial nerves resulting in total unilateral paralysis of cranial nerves, absence of sensory or motor deficits, and not associated with features of raised intracranial pressure.2 We report a case of invasive rhinocerebral mucormycosis presenting as Garcin syndrome and acute ischemic stroke. How to cite this article Nagendra V, Thakkar KD, Prasad Hrishi A, Prathapadas U. A Rare Case of Rhinocerebral Mucormycosis Presenting as Garcin Syndrome and Acute Ischemic Stroke. Indian J Crit Care Med 2020;24(11):1137–1138.
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Affiliation(s)
- Vijetha Nagendra
- Division of Neuroanesthesia, Department of Anesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Keta Deepak Thakkar
- Division of Neuroanesthesia, Department of Anesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Ajay Prasad Hrishi
- Division of Neuroanesthesia, Department of Anesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Unnikrishnan Prathapadas
- Division of Neuroanesthesia, Department of Anesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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13
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Yuan XW, Dong SM, Zhao SX, Zhang XX, Qin XJ, Ren WG, Nan YM. [A case with multiple organ damage mainly clinically manifested through eosinophilia]. Zhonghua Gan Zang Bing Za Zhi 2019; 27:391-392. [PMID: 31177667 DOI: 10.3760/cma.j.issn.1007-3418.2019.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- X W Yuan
- Department of Traditional and Western Medical Hepatology, Third Hospital of Hebei Medical University, Shijiazhuang 050051
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14
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Ahmad A, Vieira JDC, de Mello AH, de Lima TM, Ariga SK, Barbeiro DF, Barbeiro HV, Szczesny B, Törö G, Druzhyna N, Randi EB, Marcatti M, Toliver-Kinsky T, Kiss A, Liaudet L, Salomao R, Soriano FG, Szabo C. The PARP inhibitor olaparib exerts beneficial effects in mice subjected to cecal ligature and puncture and in cells subjected to oxidative stress without impairing DNA integrity: A potential opportunity for repurposing a clinically used oncological drug for the experimental therapy of sepsis. Pharmacol Res 2019; 145:104263. [PMID: 31071432 DOI: 10.1016/j.phrs.2019.104263] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 04/25/2019] [Accepted: 05/03/2019] [Indexed: 12/15/2022]
Abstract
Poly(ADP-ribose) polymerase (PARP) is involved in the pathogenesis of cell dysfunction, inflammation and organ failure during septic shock. The goal of the current study was to investigate the efficacy and safety of the clinically approved PARP inhibitor olaparib in experimental models of oxidative stress in vitro and in sepsis in vivo. In mice subjected to cecal ligation and puncture (CLP) organ injury markers, circulating and splenic immune cell distributions, circulating mediators, DNA integrity and survival was measured. In U937 cells subjected to oxidative stress, cellular bioenergetics, viability and DNA integrity were measured. Olaparib was used to inhibit PARP. The results show that in adult male mice subjected to CLP, olaparib (1-10 mg/kg i.p.) improved multiorgan dysfunction. Olaparib treatment reduced the degree of bacterial CFUs. Olaparib attenuated the increases in the levels of several circulating mediators in the plasma. In the spleen, the number of CD4+ and CD8+ lymphocytes were reduced in response to CLP; this reduction was inhibited by olaparib treatment. Treg but not Th17 lymphocytes increased in response to CLP; these cell populations were reduced in sepsis when the animals received olaparib. The Th17/Treg ratio was lower in CLP-olaparib group than in the CLP control group. Analysis of miRNA expression identified a multitude of changes in spleen and circulating white blood cell miRNA levels after CLP; olaparib treatment selectively modulated these responses. Olaparib extended the survival rate of mice subjected to CLP. In contrast to males, in female mice olaparib did not have significant protective effects in CLP. In aged mice olaparib exerted beneficial effects that were less pronounced than the effects obtained in young adult males. In in vitro experiments in U937 cells subjected to oxidative stress, olaparib (1-100 μM) inhibited PARP activity, protected against the loss of cell viability, preserved NAD+ levels and improved cellular bioenergetics. In none of the in vivo or in vitro experiments did we observe any adverse effects of olaparib on nuclear or mitochondrial DNA integrity. In conclusion, olaparib improves organ function and extends survival in septic shock. Repurposing and eventual clinical introduction of this clinically approved PARP inhibitor may be warranted for the experimental therapy of septic shock.
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Affiliation(s)
- Akbar Ahmad
- Department of Anesthesiology, The University of Texas Medical Branch at Galveston, Galveston, TX, USA.
| | - Juliana de Camargo Vieira
- Laboratório de Investigação Médica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| | - Aline Haas de Mello
- Department of Anesthesiology, The University of Texas Medical Branch at Galveston, Galveston, TX, USA.
| | - Thais Martins de Lima
- Laboratório de Investigação Médica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| | - Suely Kubo Ariga
- Laboratório de Investigação Médica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| | - Denise Frediani Barbeiro
- Laboratório de Investigação Médica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| | - Hermes Vieira Barbeiro
- Laboratório de Investigação Médica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| | - Bartosz Szczesny
- Department of Anesthesiology, The University of Texas Medical Branch at Galveston, Galveston, TX, USA.
| | - Gábor Törö
- Department of Anesthesiology, The University of Texas Medical Branch at Galveston, Galveston, TX, USA.
| | - Nadiya Druzhyna
- Department of Anesthesiology, The University of Texas Medical Branch at Galveston, Galveston, TX, USA.
| | - Elisa B Randi
- Chair of Pharmacology, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland.
| | - Michela Marcatti
- Department of Anesthesiology, The University of Texas Medical Branch at Galveston, Galveston, TX, USA.
| | - Tracy Toliver-Kinsky
- Department of Anesthesiology, The University of Texas Medical Branch at Galveston, Galveston, TX, USA.
| | - András Kiss
- Second Department of Pathology, Semmelweis University Medical School, Budapest, Hungary.
| | - Lucas Liaudet
- Department of Intensive Care Medicine and Burns, Lausanne University Hospital Medical Center, Lausanne, Switzerland.
| | - Reinaldo Salomao
- Division of Infectious Diseases, Department of Medicine, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
| | - Francisco Garcia Soriano
- Laboratório de Investigação Médica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| | - Csaba Szabo
- Department of Anesthesiology, The University of Texas Medical Branch at Galveston, Galveston, TX, USA; Chair of Pharmacology, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland.
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15
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Pérez-González A, Almudí-Ceinos D, López Del Moral O, Martín-Alfonso S, Rico-Feijoo J, López Del Moral J, Aldecoa C. Is mortality in elderly septic patients as high as expected? Long-term mortality in a surgical sample cohort. Med Intensiva 2018; 43:464-473. [PMID: 30025749 DOI: 10.1016/j.medin.2018.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 05/14/2018] [Accepted: 05/14/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE To determine the differences in short- and long-term mortality in elderly septic patients with multiorgan dysfunction syndrome and establish the factors related to non-survival. MATERIALS AND METHODS A retrospective cohort study was made of 206 patients over 65 years of age with septic and septic shock criteria admitted to the ICU of Rio Hortega Hospital between January 2011 and February 2017. Study variables were obtained from electronic database records. RESULTS A total of 206 patients were included, divided into three groups of age (65-74, 75-85, >85 years). There were no significant differences in mortality according to age group after 28 days, 90 days or one year (28.6%, 32.1% and 45.2% in the 65-74 years age group; 32.5%, 38.6% and 45.8% in the 75-85 years age group, 41%, 48.7% and 56.4% in the >85 years age group). The factors related to mortality were: chronic heart failure, non-haematological cancer, liver dysfunction and central nervous system dysfunction. CONCLUSIONS The results indicate that there is no significant difference in mortality among the different age groups. About 50% of the elderly patients survive a septic process. There is a close relationship between the number of affected organs and days of dysfunction, the use of interventional techniques and long-term mortality.
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Affiliation(s)
- A Pérez-González
- Anaesthesia and Surgical Intensive Care Department, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - D Almudí-Ceinos
- Anaesthesia and Surgical Intensive Care Department, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - O López Del Moral
- Anaesthesia and Surgical Intensive Care Department, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - S Martín-Alfonso
- Anaesthesia and Surgical Intensive Care Department, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - J Rico-Feijoo
- Anaesthesia and Surgical Intensive Care Department, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - J López Del Moral
- Clinical Medicine Department, Alfonso X Medical School, Madrid, Spain
| | - C Aldecoa
- Anaesthesia and Surgical Intensive Care Department, Hospital Universitario Rio Hortega, Valladolid, Spain.
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16
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Prabhakar U, Singh A. Atypical Presentation Of Rickettsial Spotted Fever. J Ayub Med Coll Abbottabad 2017; 29:692-693. [PMID: 29331008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Acute febrile illness is a common entity in tropics and often is challenging due a host of pathogenic bacteria, viruses and fungi. Extensive work up is required for better management. Rickettsiosis is uncommon and hence comes lower down in the differentials of multiorgan failure being superseded by the more common diseases as malaria, enteric fever and Dengue. We document a case of young male presenting with high grade fever, multiorgan dysfunction (hepatic, renal, neurological and respiratory involvement), conjunctival suffusion, retiform rash and without lymphadenopathy. The diagnosis was further challenging because the rashes appeared late at 8th day in the course of illness, unlike the typical disease where rashes come on early in day 3-6 of the disease. Patient responded to timely treatment with doxycycline. Thus, a high index of suspicion is needed to diagnose Rickettsiosis in geographical areas apparently free of the disease.
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Affiliation(s)
- Uday Prabhakar
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, India
| | - Anup Singh
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, India
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17
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Ovchinsky N, Frazier W, Auletta JJ, Dvorak CC, Ardura M, Song E, McArthur J, Jeyapalan A, Tamburro R, Mahadeo KM, Traube C, Duncan CN, Bajwa RPS. Consensus Report by the Pediatric Acute Lung Injury and Sepsis Investigators and Pediatric Blood and Marrow Transplantation Consortium Joint Working Committees on Supportive Care Guidelines for Management of Veno-Occlusive Disease in Children and Adolescents, Part 3: Focus on Cardiorespiratory Dysfunction, Infections, Liver Dysfunction, and Delirium. Biol Blood Marrow Transplant 2018; 24:207-18. [PMID: 28870776 DOI: 10.1016/j.bbmt.2017.08.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 08/29/2017] [Indexed: 12/19/2022]
Abstract
Some patients with veno-occlusive disease (VOD) have multiorgan dysfunction, and multiple teams are involved in their daily care in the pediatric intensive care unit. Cardiorespiratory dysfunction is critical in these patients, requiring immediate action. The decision of whether to use a noninvasive or an invasive ventilation strategy may be difficult in the setting of mucositis or other comorbidities in patients with VOD. Similarly, monitoring of organ functions may be very challenging in these patients, who may have fulminant hepatic failure with or without hepatic encephalopathy complicated by delirium and/or infections. In this final guideline of our series on supportive care in patients with VOD, we address some of these questions and provide evidence-based recommendations on behalf of the Pediatric Acute Lung Injury and Sepsis Investigators and Pediatric Blood and Marrow Transplantation Consortium Joint Working Committees.
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18
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Mahadeo KM, McArthur J, Adams RH, Radhi M, Angelo J, Jeyapalan A, Nicol K, Su L, Rabi H, Auletta JJ, Pai V, Duncan CN, Tamburro R, Dvorak CC, Bajwa RPS. Consensus Report by the Pediatric Acute Lung Injury and Sepsis Investigators and Pediatric Blood and Marrow Transplant Consortium Joint Working Committees on Supportive Care Guidelines for Management of Veno-Occlusive Disease in Children and Adolescents: Part 2-Focus on Ascites, Fluid and Electrolytes, Renal, and Transfusion Issues. Biol Blood Marrow Transplant 2017; 23:2023-2033. [PMID: 28823876 DOI: 10.1016/j.bbmt.2017.08.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 08/10/2017] [Indexed: 01/19/2023]
Abstract
Even though hepatic veno-occlusive disease (VOD) is a potentially fatal complication of hematopoietic cell transplantation (HCT), there is paucity of research on the management of associated multiorgan dysfunction. To help provide standardized care for the management of these patients, the HCT Subgroup of the Pediatric Acute Lung Injury and Sepsis Investigators and the Supportive Care Committee of the Pediatric Blood and Marrow Transplant Consortium, collaborated to develop evidence-based consensus guidelines. After conducting an extensive literature search, in part 2 of this series we discuss the management of fluids and electrolytes, renal dysfunction; ascites, pleural effusion, and transfusion and coagulopathy issues in patients with VOD. We consider the available evidence using the GRADE criteria.
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Affiliation(s)
- Kris M Mahadeo
- Pediatric Stem Cell Transplantation and Cellular Therapy, MD Anderson Children's Cancer Hospital Houston, The University of Texas, Houston, Texas
| | - Jennifer McArthur
- Department of Pediatric Critical Care Medicine, St Jude Children's Research Hospital Memphis, Memphis, Tennessee
| | - Roberta H Adams
- Center for Cancer and Blood Disorders, Phoenix Children's Hospital, Phoenix, Arizona; Hematology/Oncology, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Mohamed Radhi
- Department of Pediatrics, Children's Mercy Hospital, University of Missouri Kansas City, Kansas City, Missouri
| | - Joseph Angelo
- Division of Nephrology, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas
| | - Asumthia Jeyapalan
- Division of Pediatric Critical Care Medicine, University of Miami- Miller School of Medicine, Miami, Florida
| | - Kathleen Nicol
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Leon Su
- Department of Pathology and Laboratory Medicine, Phoenix Children's Hospital, Phoenix, Arizona
| | - Hanna Rabi
- Division of Pediatric Hematology Oncology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Jeffery J Auletta
- Division of Infectious Diseases, Nationwide Children's Hospital, Columbus, Ohio; Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, Ohio
| | - Vinita Pai
- College of Pharmacy and Pharmacy Department, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
| | - Christine N Duncan
- Division of Pediatric Stem Cell Transplant, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Robert Tamburro
- Division of Pediatric Critical Care Medicine, Pennsylvania University, Penn State Hershey Children's Hospital, Hershey, PA
| | - Christopher C Dvorak
- Division of Pediatric Allergy, Immunology, and Bone Marrow Transplant, Benioff Children's Hospital, University of California San Francisco, San Francisco, California
| | - Rajinder P S Bajwa
- Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, Ohio.
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Marchel D, Hart AL, Keefer P, Vredeveld J. Multiorgan eosinophilic infiltration after initiation of clozapine therapy: a case report. BMC Res Notes 2017; 10:316. [PMID: 28743303 PMCID: PMC5526284 DOI: 10.1186/s13104-017-2662-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 07/21/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The eosinophilic response to clozapine is well described in the literature, causing a variety of responses, from serositis to colitis. However, there are not case reports describing a clozapine-induced marked eosinophilia resulting in multiorgan dysfunction. CASE PRESENTATION In this case report, we describe a 24 year old Caucasian male who presented with severe systemic eosinophilia resulting in eosinophilic GI tract infiltration, myocarditis, pericardial and pleural effusions with dramatic improvement following drug withdrawal. CONCLUSIONS Clozapine associated eosinophilia should be suspected in the setting of eosinophilic infiltration of multiple organs.
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Affiliation(s)
- Dorota Marchel
- Pediatric Primary Care Clinic, Rutledge Tower, 3rd Floor, 135 Rutledge Avenue, MSC 560, Charleston, SC 29425 USA
| | - Anita L. Hart
- University of Michigan Health System, 1500 East Medical Center Drive, Room 3119 TC, Ann Arbor, MI 48109-5376 USA
| | - Patricia Keefer
- University of Michigan Health System, 1540 East Medical Center Drive, SPC 4280, Mott 12-525, Ann Arbor, MI 48109-4280 USA
| | - Jennifer Vredeveld
- University of Michigan Health System, 1540 East Medical Center Drive, SPC 4280, Mott 12-525, Ann Arbor, MI 48109-4280 USA
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Richardson PG, Smith AR, Triplett BM, Kernan NA, Grupp SA, Antin JH, Lehmann L, Shore T, Iacobelli M, Miloslavsky M, Hume R, Hannah AL, Nejadnik B, Soiffer RJ. Defibrotide for Patients with Hepatic Veno-Occlusive Disease/Sinusoidal Obstruction Syndrome: Interim Results from a Treatment IND Study. Biol Blood Marrow Transplant 2017; 23:997-1004. [PMID: 28285079 DOI: 10.1016/j.bbmt.2017.03.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 03/06/2017] [Indexed: 12/14/2022]
Abstract
Hepatic veno-occlusive disease, or sinusoidal obstruction syndrome (VOD/SOS), is a serious and potentially fatal complication of conditioning for hematopoietic stem cell transplantation (HSCT) or of chemotherapy regimens alone. Defibrotide is a complex mixture of single-stranded polydeoxyribonucleotides that is approved in the United States for treating hepatic VOD/SOS with renal or pulmonary dysfunction post-HSCT and in the European Union, Israel, and South Korea for treating severe hepatic VOD/SOS post-HSCT. Defibrotide was previously available in the United States as an investigational drug through a treatment protocol (treatment IND) study. Interim results of that large, treatment IND study of patients with VOD/SOS and with or without multiorgan dysfunction (MOD; also known as multiorgan failure) are presented here. Defibrotide was administered i.v. at 6.25 mg/kg every 6 hours (25 mg/kg/day), with a recommended treatment duration of at least 21 days. Enrolled patients (n = 681) were diagnosed with VOD/SOS based on Baltimore or modified Seattle criteria or liver biopsy analysis. Among the 573 HSCT recipients, 288 (50.3%; 95% confidence interval [CI], 46.2% to 54.4%) were alive at day +100 post-HSCT. Day +100 survival for the pediatric (≤16 years) and adult (>16 years) subgroups was 54.5% (95% CI, 49.1% to 60.0%; n = 174 of 319) and 44.9% (95% CI, 38.8% to 51.0%; n = 114 of 254), respectively. In the MOD subgroup, 159 of 351 patients (45.3%; 95% CI, 40.1% to 50.5%) of patients were alive at day +100 post-HSCT. Treatment with defibrotide was generally well tolerated, and drug-related toxicities were consistent with previous studies. Adverse events were reported in 69.6% of safety-evaluable patients (399 of 573). Other than VOD/SOS and associated MOD symptoms, the most commonly reported treatment-emergent adverse event was hypotension (13.8%). Day +100 survival results observed in this trial were consistent with results seen in previous trials of defibrotide for VOD/SOS in adult and pediatric patients. These data support the potential benefit of defibrotide in treating a VOD/SOS patient population that includes those with and without MOD.
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Affiliation(s)
- Paul G Richardson
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.
| | | | | | - Nancy A Kernan
- Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Stephan A Grupp
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Joseph H Antin
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Leslie Lehmann
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Robin Hume
- Jazz Pharmaceuticals, Palo Alto, California
| | | | | | - Robert J Soiffer
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
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Frantzeskaki FG, Karampi ES, Kottaridi C, Alepaki M, Routsi C, Tzanela M, Vassiliadi DA, Douka E, Tsaousi S, Gennimata V, Ilias I, Nikitas N, Armaganidis A, Karakitsos P, Papaevangelou V, Dimopoulou I. Cytomegalovirus reactivation in a general, nonimmunosuppressed intensive care unit population: incidence, risk factors, associations with organ dysfunction, and inflammatory biomarkers. J Crit Care 2014; 30:276-81. [PMID: 25457114 DOI: 10.1016/j.jcrc.2014.10.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Revised: 09/23/2014] [Accepted: 10/06/2014] [Indexed: 12/23/2022]
Abstract
PURPOSE Cytomegalovirus (CMV) reactivation, a significant cause of morbidity and mortality in immunosuppression, may affect "immunocompetent" seropositive critically ill patients. The aim of this prospective, observational study was to define the incidence, risk factors, and the association with morbidity and mortality of CMV reactivation in a general population of critically ill immunocompetent patients. We also studied the relationship between reactivation and patients' inflammatory response, as expressed by cytokine levels and stress up-regulation by salivary cortisol. METHODS This study included mechanically ventilated CMV-seropositive patients. A quantitative real-time polymerase chain reaction (PCR) was performed for CMV plasma DNAemia determination, upon intensive care unit (ICU) admission and weekly thereafter until day 28. Cytomegalovirus reactivation was defined as CMV plasma DNAemia greater than or equal to 500 copies/mL. Upon ICU admission, interferon γ, interleukin (IL) 10, IL-17A, IL-2, IL-6, and tumor necrosis factor α were quantified in plasma, and morning saliva was obtained to measure cortisol. Disease severity was assessed by Acute Physiology and Chronic Health Evaluation II score, whereas the degree of organ dysfunction was quantified by Sequential Organ Failure Assessment score. Mortality, duration of mechanical ventilation, and ICU length of stay were recorded. RESULTS During the study period, 80 (51 men) patients with a median age of 63 years fulfilled the inclusion criteria. Reactivation of CMV occurred in 11 patients (13.75%). Median day of reactivation was day 7 post ICU admission. Total number of red blood cell units transfused (odds ratio [OR], 1.50; confidence interval [CI], 1.06-2.13; P = .02) and C-reactive protein levels upon ICU admission (OR, 1.01; CI, 1.00-1.02; P = .02) were independently associated with CMV reactivation. High IL-10 was marginally related to reactivation (P = .06). Sequential Organ Failure Assessment scores were higher in the group with CMV reactivation compared with patients without reactivation during the entire 28-day observation period (P < .006). Salivary cortisol, mortality, length of ICU stay, and duration of mechanical ventilation were similar in the 2 groups. CONCLUSIONS Cytomegalovirus reactivation occurred in 13.75% of critically ill, immunocompetent patients. The degree of inflammation and the total number of transfused red blood cells units constituted risk factors. Cytomegalovirus reactivation was associated with more severe of organ dysfunction, but not with a worse clinical outcome.
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Affiliation(s)
- Frantzeska G Frantzeskaki
- Second Department of Critical Care Medicine, University of Athens, Medical School, "Attikon" Hospital, Athens, Greece.
| | - Eirini-Sofia Karampi
- Second Department of Critical Care Medicine, University of Athens, Medical School, "Attikon" Hospital, Athens, Greece
| | - Christina Kottaridi
- Department of Cytopathology, University of Athens, Medical School, "Attikon" Hospital, Athens, Greece
| | - Maria Alepaki
- Department of Cytopathology, University of Athens, Medical School, "Attikon" Hospital, Athens, Greece
| | - Christina Routsi
- First Department of Critical Care Medicine, University of Athens, Medical School, "Evangelismos" Hospital, Athens, Greece
| | | | - Dimitra Argyro Vassiliadi
- Endocrine Unit, Second Department of Internal Medicine, University of Athens, Medical School, "Attikon" Hospital, Athens, Greece
| | - Evangelia Douka
- First Department of Critical Care Medicine, University of Athens, Medical School, "Evangelismos" Hospital, Athens, Greece
| | - Sofia Tsaousi
- First Department of Critical Care Medicine, University of Athens, Medical School, "Evangelismos" Hospital, Athens, Greece
| | - Vasiliki Gennimata
- Department of Microbiology, University of Athens, Medical School, Athens, Greece
| | - Ioannis Ilias
- Department of Endocrinology, "Elena" Hospital, Athens, Greece
| | - Nikitas Nikitas
- Second Department of Critical Care Medicine, University of Athens, Medical School, "Attikon" Hospital, Athens, Greece
| | - Apostolos Armaganidis
- Second Department of Critical Care Medicine, University of Athens, Medical School, "Attikon" Hospital, Athens, Greece
| | - Petros Karakitsos
- Department of Cytopathology, University of Athens, Medical School, "Attikon" Hospital, Athens, Greece
| | - Vassiliki Papaevangelou
- Third Department of Pediatrics, University of Athens, Medical School, "Attikon" Hospital, Athens, Greece
| | - Ioanna Dimopoulou
- Second Department of Critical Care Medicine, University of Athens, Medical School, "Attikon" Hospital, Athens, Greece
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Kaur G, Vinayak N, Mittal K, Kaushik JS, Aamir M. Clinical outcome and predictors of mortality in children with sepsis, severe sepsis, and septic shock from Rohtak, Haryana: A prospective observational study. Indian J Crit Care Med 2014; 18:437-41. [PMID: 25097356 PMCID: PMC4118509 DOI: 10.4103/0972-5229.136072] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Information regarding early predictive factors for mortality and morbidity in sepsis is limited from developing countries. Methods: A prospective observational study was conducted to determine the clinical outcome and predictors of mortality in children with sepsis, severe sepsis, and septic shock. Children aged 1 month to 14 years admitted to a tertiary care pediatric intensive care unit (PICU) with a diagnosis of sepsis, severe sepsis, or septic shock were enrolled in the study. Hemodynamic and laboratory parameters which discriminate survivors from nonsurvivors were evaluated. Results: A total of 50 patients (30 [60%] males) were enrolled in the study, of whom 21 (42%) were discharged (survivors) and rest 29 (58%) expired (nonsurvivor). Median (interquartile range) age of enrolled patients were 18 (6, 60) months. Mortality was not significantly predicted individually by any factor including age (odds ratio [OR] [95% confidence interval [CI]]: 0.96 [0.91-1.01], P = 0.17), duration of PICU stay (OR [95% CI]: 1.18 [0.99-1.25], P = 0.054), time lag to PICU transfer (OR [95% CI]: 1.02 [0.93-1.12], P = 0.63), Pediatric Risk of Mortality (PRISM) score at admission (OR [95% CI]: 0.71 [0.47-1.04], P = 0.07) and number of organ dysfunction (OR [95% CI]: 0.03 [0.01-1.53], P = 0.08). Conclusion: Mortality among children with sepsis, severe sepsis, and septic shock were not predicted by any individual factors including the time lag to PICU transfer, duration of PICU stay, presence of multiorgan dysfunction, and PRISM score at admission.
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Affiliation(s)
- Gurpreet Kaur
- Department of Paediatrics, Pt B D Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Nikhil Vinayak
- Department of Paediatrics, Pt B D Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Kundan Mittal
- Department of Paediatrics, Pt B D Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Jaya Shankar Kaushik
- Department of Paediatrics, Pt B D Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Mohammad Aamir
- Department of Paediatrics, Pt B D Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
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