BACKGROUND Hypernatremia represents a significant electrolyte imbalance associated with numerous adverse outcomes,particularly in cases of intensive care unit(ICU)-acquired hypernatremia(IAH).Nevertheless,its relevanc...BACKGROUND Hypernatremia represents a significant electrolyte imbalance associated with numerous adverse outcomes,particularly in cases of intensive care unit(ICU)-acquired hypernatremia(IAH).Nevertheless,its relevance in patients with septic shock remains uncertain.AIM To identify independent risk factors and their predictive efficacy for IAH to improve outcomes in patients with septic shock.METHODS In the present retrospective single-center study,a cohort of 157 septic shock patients with concurrent hypernatremia in the ICU at The First Affiliated Hospital of Soochow University,between August 1,2018,and May 31,2023,were analyzed.Patients were categorized based on the timing of hypernatremia occurrence into the IAH group(n=62),the non-IAH group(n=41),and the normonatremia group(n=54).RESULTS In the present study,there was a significant association between the high serum sodium concentrations,excessive persistent inflammation,immunosuppression and catabolism syndrome and chronic critical illness,while rapid recovery had an apparent association with normonatremia.Moreover,multivariable analyses revealed the following independent risk factors for IAH:Total urinary output over the preceding three days[odds ratio(OR)=1.09;95%CI:1.02–1.17;P=0.014],enteral nutrition(EN)sodium content of 500 mg(OR=2.93;95%CI:1.13–7.60;P=0.027),and EN sodium content of 670 mg(OR=6.19;95%CI:1.75–21.98;P=0.005)were positively correlated with the development of IAH.Notably,the area under the curve for total urinary output over the preceding three days was 0.800(95%CI:0.678–0.922,P=0.001).Furthermore,maximum serum sodium levels,the duration of hypernatremia,and varying sodium correction rates were significantly associated with 28-day in-hospital mortality in septic shock patients(P<0.05).CONCLUSION The present findings illustrate that elevated serum sodium level was significantly associated with a poor prognosis in septic shock patients in the ICU.It is highly recommended that hypernatremia be considered a potentially important prognostic indicator for the outcome of septic shock.展开更多
BACKGROUND Cytomegalovirus(CMV)infections can cause significant morbidity and mortality in immunocompromised individuals.CMV targets dysfunctional lymphocytes.Chronic rituximab(RTX)therapy can cause B-lymphocyte dysfu...BACKGROUND Cytomegalovirus(CMV)infections can cause significant morbidity and mortality in immunocompromised individuals.CMV targets dysfunctional lymphocytes.Chronic rituximab(RTX)therapy can cause B-lymphocyte dysfunction,increasing CMV risk.Rarely,CMV infections present with critical illness such as septic shock.CASE SUMMARY A 64-year-old African American woman presented with generalized weakness and non-bloody watery diarrhea of 4-6 weeks duration.She did not have nausea,vomiting or,abdominal pain.She had been on monthly RTX infusions for neuromyelitis optica.She was admitted for septic shock due to pancolitis.Blood investigations suggested pancytopenia and serology detected significantly elevated CMV DNA.Valganciclovir treatment led to disease resolution.CONCLUSION This case illustrates an extremely rare case of CMV colitis associated with RTX use presenting with septic shock.High suspicion for rare opportunistic infections is imperative in individuals with long-term RTX use.展开更多
BACKGROUND Septic shock,the most severe form of sepsis,remains a major global health challenge with high mortality.The coronavirus disease 2019(COVID-19)pandemic has exacerbated this burden,as severe acute respiratory...BACKGROUND Septic shock,the most severe form of sepsis,remains a major global health challenge with high mortality.The coronavirus disease 2019(COVID-19)pandemic has exacerbated this burden,as severe acute respiratory syndrome coronavirus 2 infection often leads to sepsis and septic shock.Racial and ethnic differences in critical illness outcomes are well-documented,but their impact on COVID-19 associated septic shock remains unclear.AIM To examine epidemiologic data to explore racial and ethnic differences in outcomes in COVID-19 associated septic shock.METHODS Using the National Inpatient Sample(2020–2021),we conducted a retrospective cohort study to assess racial and ethnic disparities in septic shock outcomes among adults(≥18 years)with concurrent COVID-19.Primary and secondary outcomes included in-hospital mortality,acute kidney injury(AKI),AKI requiring dialysis,and mechanical ventilation.Adjusted multivariable logistic regression accounted for demographics,comorbidities,hospital characteristics,and inhospital events.RESULTS Among 396795 weighted hospitalizations,Non-Hispanic Black(NHB)(25.3%)and Hispanic(30.4%)populations were younger and had greater comorbidity burdens than Non-Hispanic White(NHW)patients.Compared to NHW,adjusted analyses showed higher in-hospital mortality[adjusted odds ratio(aOR)=1.21,95%CI:1.15-1.27],mechanical ventilation use(aOR=1.19,95%CI:1.12-1.27)and AKI requiring dialysis(aOR=1.16,95%CI:1.07-1.25,P<0.001)among Hispanic patients.NHB patients had similar mortality to NHWs but had higher risk of mechanical ventilation(aOR=1.15,95%CI:1.09-1.22)and AKI requiring dialysis(aOR=1.65,95%CI:1.54-1.76).Mean length of stay and cost were longest and highest for Hispanic patients.CONCLUSION Our study showed that there was higher mortality in Hispanic patients,and higher renal and respiratory complication in both NHB and Hispanic groups compared to NHW group.Future research identifying the causes of the observed differences in complications are required to inform targeted strategies that may mitigate modifiable risk factors and optimize early detection of organ failure to optimize outcomes in this population.展开更多
BACKGROUND Septic shock represents one of the most severe critical illness types,characterized by significant hemodynamic disorders and neuropsychiatric symptoms.This study aimed to investigate the association mechani...BACKGROUND Septic shock represents one of the most severe critical illness types,characterized by significant hemodynamic disorders and neuropsychiatric symptoms.This study aimed to investigate the association mechanism between hemodynamic indicators and neuropsychiatric symptoms in patients with septic shock,revealing potential pathophysiological connections.AIM To investigate the link between hemodynamic parameters and neuropsychiatric symptoms in septic shock.METHODS A retrospective case-control study involving 132 patients with septic shock.Multiple assessment tools were employed,including the Confusion Assessment Method,Hospital Anxiety and Depression Scale,Posttraumatic Stress Disorder Scale,and Mini-Mental State Examination,systematically evaluating patients’neuropsychiatric symptoms and hemodynamic indicators.RESULTS Patient mean age was 52.4±12.3 years,with 68.5%males.Multivariate analysis revealed significant correlations between neuropsychiatric symptom severity and mean arterial pressure<65 mmHg[odds ratio(OR)=2.7],lactate levels>4 mmol/L(OR=3.1),and elevated interleukin-6 inflammatory factors(OR=2.4).Neuropsychiatric symptom incidence rates were:Delirium 37.1%;anxiety 28.8%;depression 24.2%;and posttraumatic stress disorder 19.7%.CONCLUSION Hemodynamic disorders in patients with septic shock are closely associated with neuropsychiatric symptoms,influencing central nervous system function through complex inflammatory and neurotransmitter pathways.展开更多
BACKGROUND Sepsis and septic shock pose critical public health challenges with high mortality,particularly in critical care.While racial differences in sepsis incidence are documented,the impact of race on sepsis outc...BACKGROUND Sepsis and septic shock pose critical public health challenges with high mortality,particularly in critical care.While racial differences in sepsis incidence are documented,the impact of race on sepsis outcomes remains inconsistent.AIM To evaluate racial disparities in clinical outcomes among patients hospitalized with septic shock,focusing on in-hospital mortality,length of stay(LOS),and hospitalization costs.METHODS We conducted a retrospective cohort study using the National Inpatient Sample database from 2016 to 2021.Patients diagnosed with septic shock were identified using ICD-10 code R65.21.The primary outcome was in-hospital mortality;secondary outcomes included trends in septic shock hospitalizations,mortality,length of stay,and cost of hospitalizations.RESULTS Among 3581504 hospitalizations for septic shock,the racial distribution was 67%Non-Hispanic White(NHW),15%Non-Hispanic Black(NHB),11%Hispanic,and 7%other groups,with a mean age of 66.3 years.In-hospital mortality was 33.6%,highest among other racial groups(36.7%).Mortality was stable across racial groups from 2016-2019 but rose sharply in 2020-2021,especially among Hispanic patients.Adjusted in-hospital mortality were higher for NHB and Hispanic compared to NHW patients.NHB patients had the longest LOS,while other racial groups incurred the highest cost of hospitalizations.CONCLUSION We found higher mortality among NHB,Hispanic,and other racial groups in septic shock patients,likely driven by higher risk of in-hospital complications among these racial groups.This highlights the need for future research to identify the factors contributing to the adverse outcomes in these populations.展开更多
This article summarizes the nursing management of a pediatric patient with severe scrub typhus complicated by hemophagocytic syndrome(HPS)and septic shock.Key nursing interventions included early recognition and manag...This article summarizes the nursing management of a pediatric patient with severe scrub typhus complicated by hemophagocytic syndrome(HPS)and septic shock.Key nursing interventions included early recognition and management of septic shock,rational oxygen therapy,fluid resuscitation,administration of vasoactive agents,early and targeted anti-infective therapy,management of hyperpyrexia,care of eschar and edematous skin,strict infection prevention and isolation protocols,and family health education.After 11 days of intensive treatment and nursing care,the patient recovered and was discharged.展开更多
This study focused on realizing Sustainable Development Goal(SDG)6 for inclusive clean water and sanitation;in particular Target 6.3,which aims to reduce untreated wastewater by 2030 while promoting circular wastewate...This study focused on realizing Sustainable Development Goal(SDG)6 for inclusive clean water and sanitation;in particular Target 6.3,which aims to reduce untreated wastewater by 2030 while promoting circular wastewater reuse and recycling globally.The main objective was to assess the adequacy and efficiency of communal septic tank systems in informal settlements while helping local planners and authorities in their decision-making regarding Target 6.3.Quantitative and qualitative approaches were employed with secondary data from previous researchers,and primary data were collected from field surveys,observations,and interviews with members of the local community.The research was delimited to two village administrative divisions known as Rukun Warga(Village Administrative Division,RW):RW 7 and RW 8 of Lebak Siliwangi Kampung in Coblong District,Bandung,West Java,Indonesia.The findings were also compared with situations in other informal settlements in Brazil,Bangladesh,and Nairobi.The results indicated the inadequacy of communal septic tanks in informal settlements due to factors such as substandard system design,limited support and communication between authorities and residents,and the gap between septic tank availability and capacity vis-a-vis demand.Other limiting factors included limited land availability and irregular geomorphology,the latter of which affected the siting and operation of septic tanks due a lack of room for upgrades or expansion in response to continuous population growth.These findings illustrate the need to complement communal septic systems with flexible centralized or decentralized systems to achieve Target 6.3 of SDG 6.展开更多
Recent studies have revealed that patients with septic shock and acute skin failure(ASF)exhibit significantly higher levels of inflammatory cytokines,lactate,and C-reactive protein,along with elevated skin mottling sc...Recent studies have revealed that patients with septic shock and acute skin failure(ASF)exhibit significantly higher levels of inflammatory cytokines,lactate,and C-reactive protein,along with elevated skin mottling score;modified early warning score(MEWS);and anxiety,depression,and Pittsburgh sleep quality index scores compared to those without ASF.Notably,these indicators are significantly correlated.Patients with septic shock accompanied by ASF tend to have a mean MEWS greater than 9,indicating severe disease progression.Therefore,it is ess-ential to not only manage septic shock but also mitigate anxiety,depression,sleep disorders,and disturbances of consciousness.This article explores the impact of severe anxiety,depression,and sleep disorders on the prognosis of septic shock and discusses intervention strategies.展开更多
Non-O1/non-O139 Vibrio cholerae(NOVC)has multiple pathogenic pathways in humans.The cause of disease in influenced by the virulence genes carried by the infecting strain and the health condition of the host.[1-2]When ...Non-O1/non-O139 Vibrio cholerae(NOVC)has multiple pathogenic pathways in humans.The cause of disease in influenced by the virulence genes carried by the infecting strain and the health condition of the host.[1-2]When seafood,food and water sources are contaminated with feces,people are prone to gastroenteritis,and direct exposure to contaminated water may cause wound infection.展开更多
Group B Streptococcus(GBS;Streptococcus agalactiae)is a gram-positive coccus that colonizes the gastrointestinal and genital tracts in adults,as well as the upper respiratory tract in infants.While it has been thought...Group B Streptococcus(GBS;Streptococcus agalactiae)is a gram-positive coccus that colonizes the gastrointestinal and genital tracts in adults,as well as the upper respiratory tract in infants.While it has been thought that GBS only results in invasive disease in pregnant females and neonates,recent literature has suggested an increasing incidence of invasive GBS among non-pregnant individuals within the United States.展开更多
BACKGROUND:To investigate the prognostic value of the peripheral perfusion index(PPI)in patients with septic shock.METHODS:This prospective cohort study,conducted at the emergency intensive care unit of Peking Univers...BACKGROUND:To investigate the prognostic value of the peripheral perfusion index(PPI)in patients with septic shock.METHODS:This prospective cohort study,conducted at the emergency intensive care unit of Peking University People's Hospital,recruited 200 patients with septic shock between January 2023 and August 2023.These patients were divided into survival(n=84)and death(n=116)groups based on 28-day outcomes.Clinical evaluations included laboratory tests and clinical scores,with lactate and PPI values assessed upon admission to the emergency room and at 6 h and 12 h after admission.Risk factors associated with mortality were analyzed using univariate and multivariate Cox regression analyses.Receiver operator characteristic(ROC)curve was used to assess predictive performance.Mortality rates were compared,and Kaplan-Meier survival plots were created.RESULTS:Compared to the survival group,patients in the death group were older and had more severe liver damage and coagulation dysfunction,necessitating higher norepinephrine doses and increased fl uid replacement.Higher lactate levels and lower PPI levels at 0 h,6 h,and 12 h were observed in the death group.Multivariate Cox regression identifi ed prolonged prothrombin time(PT),decreased 6-h PPI and 12-h PPI as independent risk factors for death.The area under the curves for 6-h PPI and 12-h PPI were 0.802(95%CI 0.742-0.863,P<0.001)and 0.945(95%CI 0.915-0.974,P<0.001),respectively,which were superior to Glasgow Coma Scale(GCS),Sequential Organ Failure Assessment(SOFA)scores(0.864 and 0.928).Cumulative mortality in the low PPI groups at 6 h and 12 h was signifi cantly higher than in the high PPI groups(6-h PPI:77.52%vs.22.54%;12-h PPI:92.04%vs.13.79%,P<0.001).CONCLUSION:PPI may have value in predicting 28-day mortality in patients with septic shock.展开更多
Sepsis and septic shock are life-threatening conditions that are globally responsible for almost 20%of mortality,especially in low and middle-income countries.This review was conducted on PubMed and Google Scholar dat...Sepsis and septic shock are life-threatening conditions that are globally responsible for almost 20%of mortality,especially in low and middle-income countries.This review was conducted on PubMed and Google Scholar databases with keywords sepsis,septic shock,sepsis management,and sepsis complications.Articles published up to July 2023 in English were included.Diagnosis and management should be carried out without unnecessary delay.Cooperation between various medical specialties including intensive care doctors,neurologists,hepatologists,cardiologists,and pediatric doctors is needed if a child is affected.New strategies have to be implemented in low and middle-income countries to decrease the sepsis incidence and reduce mortality in the population.展开更多
BACKGROUND Septic shock is a severe form of sepsis characterised by deterioration in circulatory and cellular-metabolic parameters.Despite standard therapy,the outcomes are poor.Newer adjuvant therapy,such as CytoSorb...BACKGROUND Septic shock is a severe form of sepsis characterised by deterioration in circulatory and cellular-metabolic parameters.Despite standard therapy,the outcomes are poor.Newer adjuvant therapy,such as CytoSorb®extracorporeal haemoadsorption device,has been investigated and shown promising outcome.However,there is a lack of some guidance to make clinical decisions on the use of CytoSorb®haemoadsorption as an adjuvant therapy in septic shock in Indian Setting.Therefore,this expert consensus was formulated.AIM To formulate/establish specific consensus statements on the use of CytoSorb®haemoadsorption treatment based on the best available evidence and contextualised to the Indian scenario.METHODS We performed a comprehensive literature on CytoSorb®haemoadsorption in sepsis,septic shock in PubMed selecting papers published between January 2011 and March 20232021 in English language.The statements for a consensus document were developed based on the summarised literature analysis and identification of knowledge gaps.Using a modified Delphi approach combining evidence appraisal and expert opinion,the following topics related to CytoSorb®in septic shock were addressed:need for adjuvant therapy,initiation timeline,need for Interleukin-6 levels,duration of therapy,change of adsorbers,safety,prerequisite condition,efficacy endpoints and management flowchart.Eleven expert members from critical care,emergency medicine,and the intensive care participated and voted on nine statements and one open-ended question.RESULTS Eleven expert members from critical care,emergency medicine,and the intensive care participated and voted on nine statements and one open-ended question.All 11 experts in the consensus group(100%)participated in the first,second and third round of voting.After three iterative voting rounds and adapting two statements,consensus was achieved on nine statements out of nine statements.The consensus expert panel also recognised the necessity to form an association or society that can keep a registry regarding the use of CytoSorb®for all indications in the open-ended question(Q10)focusing on“future recommendations for CytoSorb®therapy”.CONCLUSION This Indian perspective consensus statement supports and provides guidance on the use of CytoSorb®haemoadsorption as an adjuvant treatment in patients with septic shock to achieve optimal outcomes.展开更多
BACKGROUND Both phases of euthyroid sick syndrome(ESS)are associated with worse prognosis in septic shock patients.Although there are still no indications for supplementation therapy,there is no evidence that both pha...BACKGROUND Both phases of euthyroid sick syndrome(ESS)are associated with worse prognosis in septic shock patients.Although there are still no indications for supplementation therapy,there is no evidence that both phases(initial and prolonged)are adaptive or that only prolonged is maladaptive and requires supplementation.AIM To analyze clinical,hemodynamic and laboratory differences in two groups of septic shock patients with ESS.METHODS A total of 47 septic shock patients with ESS were divided according to values of their thyroid hormones into low T3 and low T3T4 groups.The analysis included demographic data,mortality scores,intensive care unit stay,mechanical ventilation length and 28-day survival and laboratory with hemodynamics.RESULTS The Simplified Acute Physiology Score II score(P=0.029),dobutamine(P=0.003)and epinephrine requirement(P=0.000)and the incidence of renal failure and multiple organ failure(MOF)(P=0.000)were significantly higher for the low T3T4.Hypoalbuminemia(P=0.047),neutrophilia(P=0.038),lymphopenia(P=0.013)and lactatemia(P=0.013)were more pronounced on T2 for the low T3T4 group compared to the low T3 group.Diastolic blood pressure at T0(P=0.017)and T1(P=0.007),as well as mean arterial pressure at T0(P=0.037)and T2(P=0.033)was higher for the low T3 group.CONCLUSION The low T3T4 population is associated with higher frequency of renal insufficiency and MOF,with worse laboratory and hemodynamic parameters.These findings suggest potentially maladaptive changes in the chronic phase of septic shock.展开更多
Background:Septic shock is a common systemic inflammatory response syndrome for critical patients in the intensive care unit.Ulinastatin is currently used for the treatment of septic shock.Our study sought to evaluate...Background:Septic shock is a common systemic inflammatory response syndrome for critical patients in the intensive care unit.Ulinastatin is currently used for the treatment of septic shock.Our study sought to evaluate the efficacy and safety of ulinastatin in the treatment of septic shock patients.Methods:Three English databases(Embase,Medline,and Cochrane Library)and four Chinese databases(China National Knowledge Infrastructure,Wanfang data,SinoMed,and VIP)were searched for published randomized controlled trials.Stata 16.0 software was used to conduct the meta-analysis.Results:A total of 48 articles were included(Chinese article 47,1 in English).The results show that the treatment of ulinastatin could reduce mortality(risk ratio=0.63,95%confidence interval(CI)(0.55,0.72)),multiple organ dysfunction syndrome(risk ratio=0.6,95%CI(0.53,0.68)),length of intensive care unit stay(mean difference(MD)=-3.92,95%CI(-4.65,-3.18)),length of hospital stay(MD=-4.39,95%CI(-6.63,-2.15))and decrease Acute Physiology and Chronic Health Evaluation II score(MD=-4.55,95%CI(-5.63,-3.47))and Sequential Organ Failure Assessment score(MD=-2.02,95%CI(-2.59,-1.44))with P<0.001.Moreover,it lowers TNF-α(standardized mean difference(SMD)=-1.78,95%CI(-2.24,-1.32)),Interleukin-6(SMD=-1.17,95%CI(-1.55,-0.8)),C reactive protein(SMD=-1.49,95%CI(-1.99,-0.99)),hypersensitive C-reactive protein(SMD=-1.9,95%CI(-2.87,-0.94))and procalcitonin(SMD=-0.89,95%CI(-1.12,-0.67))levels in the body.Conclusions:Available evidence shows that ulinastatin reduces case mortality rate,multiple organ dysfunction syndrome,length of intensive care unit stay,and length of hospital stay and decreases Acute Physiology and Chronic Health Evaluation II score and Sequential Organ Failure Assessment score.Moreover,it also lowers TNF-α,Interleukin-6,C reactive protein,hypersensitive C-reactive protein,and procalcitonin levels in the body.展开更多
In the face of the elevated incidence and mortality rate of septic shock in the ICU,this retrospective study seeks to investigate the indicative and predictive value of high-mobility group box 1(HMGB1)and miR-146b in ...In the face of the elevated incidence and mortality rate of septic shock in the ICU,this retrospective study seeks to investigate the indicative and predictive value of high-mobility group box 1(HMGB1)and miR-146b in patients with septic shock.Quantitative RTPCR was employed in this study to quantify the HMGB1 and miR-146b levels in plasma samples obtained from the patient group and healthy controls.The investigation involved the comparison between the two groups and tracking changes in the patient group over time.The finding revealed that upon admission,the patient group exhibited markedly elevated relative expression levels of HMGB1,which subsequently decreased over time.Conversely,the patient group displayed significantly reduced relative expression levels of miR-146b upon admission,which subsequently increased over time compared to the control group.Receiver operating characteristic(ROC)curves showed good predictive value for HMGB1 and miR-146b.The experimental results suggest that HMGB1 and miR-146b serve as valuable and convenient biomarkers for evaluating the severity of septic shock and predicting mortality.Additionally,it is proposed that serum miR-146b may be inducible and potentially exerts a negative regulatory effect on the expression of HMGB1.展开更多
BACKGROUND Septic arthritis,whether native or prosthetic,poses a significant challenge in clinical practice due to its potentially devastating consequences.Despite its clinical importance,there remains a dearth of com...BACKGROUND Septic arthritis,whether native or prosthetic,poses a significant challenge in clinical practice due to its potentially devastating consequences.Despite its clinical importance,there remains a dearth of comprehensive studies and standardized diagnostic criteria,particularly in the Kingdom of Saudi Arabia.AIM To investigate the epidemiology,microbiological profiles,and clinical characteristics of native and prosthetic septic joints in the Saudi Arabian population.METHODS Medical records of patients diagnosed with septic arthritis between January 1,2015,and December 31,2022,were retrospectively reviewed.Data regarding patient demographics,clinical presentation,microbiological cultures,treatment modalities,and outcomes were analyzed.RESULTS In a retrospective review of 52 cases of septic arthritis,a balanced gender distribution was observed(1:1 ratio),with the knee being the most commonly affected joint(80.8%).Methicillin-resistant Staphylococcus aureus predominated in native joints(24.2%),while Brucella spp.was more prevalent in prosthetic joints(21.1%).Joint preservation was achieved in most cases(84.6%),with no significant difference in clinical features between native and prosthetic joints.However,certain comorbidities were more common in native joint cases,including renal impairment(P=0.002),hemodialysis(P=0.004),heart disease(P=0.013),and chronic liver disease(P=0.048).At the same time,osteoarthritis was more prevalent in prosthetic joint cases(P=0.013).Vancomycin was the most frequently used antibiotic(26.9%),and most patients received antibiotics before joint aspiration(57.7%).Surgical intervention,predominantly arthrotomy,was required in most cases(32.7%).Notably,a significant association was found between joint type and mortality(odds ratio=0.587,P=0.048),as well as the Charlson comorbidity index and mortality(P=0.001).CONCLUSION This study highlighted distinctive microbiological profiles and etiological factors in septic arthritis cases in the Saudi Arabian population.展开更多
Hippopotamus bites are rare in medical consultations, despite several studies exposing their aggressive character. A case of a hippopotamus bite on the shoulder of a fisherman has been reported. In addition to the ost...Hippopotamus bites are rare in medical consultations, despite several studies exposing their aggressive character. A case of a hippopotamus bite on the shoulder of a fisherman has been reported. In addition to the osteoarticular aspect representing a therapeutic problem, the infectious aspect was marked by sepsis, with a death in less than 48 hours. Based on this observation, a protocol for the initial management of large animal bites was submitted.展开更多
目的评价SEPTIC（sensing of phage—triggered ion cascade）技术在结核分枝杆菌快速检测中的应用价值。方法制备纳米阱微芯片，用于检测噬菌体感染细菌时导致细胞内离子释放发生的微范围内的电位变化。调整大肠杆菌、结核分枝杆菌、...目的评价SEPTIC（sensing of phage—triggered ion cascade）技术在结核分枝杆菌快速检测中的应用价值。方法制备纳米阱微芯片，用于检测噬菌体感染细菌时导致细胞内离子释放发生的微范围内的电位变化。调整大肠杆菌、结核分枝杆菌、耻垢分枝杆菌及其相应噬菌体的浓度。将细菌和噬菌体等体积混合，37℃孵育1min。取5μl混合液滴于探针上，30S后开始采集数据，每2min采集一个数据文件，共采集10min，计算机分析采集结果。结果当结核分枝杆菌与分枝杆菌噬菌体D29混合反应时，在0—8min内显示了非常明确的1／f功率谱特征。而且功率谱强度明显高于阴性反应的功率谱，并出现了明确的电压超出±4盯范围的波形，持续约0．2S的时间，可认为发生了一次细菌被噬菌体感染的事件，表明探针明确地捕获了细菌被噬菌体感染的事件。结论SEPTIC技术能在较短时间内检测、鉴定出活菌的存在，有可能为结核分枝杆菌的检测提供一种简便、快捷的方法。展开更多
BACKGROUND Caval vein thrombosis after hepatectomy is rare, although it increases mortality and morbidity. The evolution of this thrombosis into a septic thrombophlebitis responsible for persistent septicaemia after a...BACKGROUND Caval vein thrombosis after hepatectomy is rare, although it increases mortality and morbidity. The evolution of this thrombosis into a septic thrombophlebitis responsible for persistent septicaemia after a hepatectomy has not been reported to date in the literature. We here report the management of a 54-year-old woman operated for a peripheral cholangiocarcinoma who developed a suppurated thrombophlebitis of the vena cava following a hepatectomy.CASE SUMMARY This patient was operated by left lobectomy extended to segment V with bile duct resection and Roux-en-Y hepaticojejunostomy. After the surgery, she developed Streptococcus anginosus, Escherichia coli, and Enterococcus faecium bacteraemias, as well as Candida albicans fungemia. A computed tomography scan revealed a bilioma which was percutaneously drained. Despite adequate antibiotic therapy,the patient's condition remained septic. A diagnosis of septic thrombophlebitis of the vena cava was made on post-operative day 25. The patient was then operated again for a surgical thrombectomy and complete caval reconstruction with a parietal peritoneum tube graft. Use of the peritoneum as a vascular graft is an inexpensive technique, it is readily and rapidly available, and it allows caval replacement in a septic area. Septic thrombophlebitis of the vena cava after hepatectomy has not been described previously and it warrants being added to the spectrum of potential complications of this procedure.CONCLUSION Septic thrombophlebitis of the vena cava was successfully treated with antibiotic and anticoagulation treatments, prompt surgical thrombectomy and caval reconstruction.展开更多
基金Supported by The National Natural Science Foundation of China,No.82072130Key Medical Research Projects in Jiangsu Province,No.ZD2022021Suzhou Clinical Medical Center for Anesthesiology,No.Szlcyxzxj202102。
文摘BACKGROUND Hypernatremia represents a significant electrolyte imbalance associated with numerous adverse outcomes,particularly in cases of intensive care unit(ICU)-acquired hypernatremia(IAH).Nevertheless,its relevance in patients with septic shock remains uncertain.AIM To identify independent risk factors and their predictive efficacy for IAH to improve outcomes in patients with septic shock.METHODS In the present retrospective single-center study,a cohort of 157 septic shock patients with concurrent hypernatremia in the ICU at The First Affiliated Hospital of Soochow University,between August 1,2018,and May 31,2023,were analyzed.Patients were categorized based on the timing of hypernatremia occurrence into the IAH group(n=62),the non-IAH group(n=41),and the normonatremia group(n=54).RESULTS In the present study,there was a significant association between the high serum sodium concentrations,excessive persistent inflammation,immunosuppression and catabolism syndrome and chronic critical illness,while rapid recovery had an apparent association with normonatremia.Moreover,multivariable analyses revealed the following independent risk factors for IAH:Total urinary output over the preceding three days[odds ratio(OR)=1.09;95%CI:1.02–1.17;P=0.014],enteral nutrition(EN)sodium content of 500 mg(OR=2.93;95%CI:1.13–7.60;P=0.027),and EN sodium content of 670 mg(OR=6.19;95%CI:1.75–21.98;P=0.005)were positively correlated with the development of IAH.Notably,the area under the curve for total urinary output over the preceding three days was 0.800(95%CI:0.678–0.922,P=0.001).Furthermore,maximum serum sodium levels,the duration of hypernatremia,and varying sodium correction rates were significantly associated with 28-day in-hospital mortality in septic shock patients(P<0.05).CONCLUSION The present findings illustrate that elevated serum sodium level was significantly associated with a poor prognosis in septic shock patients in the ICU.It is highly recommended that hypernatremia be considered a potentially important prognostic indicator for the outcome of septic shock.
文摘BACKGROUND Cytomegalovirus(CMV)infections can cause significant morbidity and mortality in immunocompromised individuals.CMV targets dysfunctional lymphocytes.Chronic rituximab(RTX)therapy can cause B-lymphocyte dysfunction,increasing CMV risk.Rarely,CMV infections present with critical illness such as septic shock.CASE SUMMARY A 64-year-old African American woman presented with generalized weakness and non-bloody watery diarrhea of 4-6 weeks duration.She did not have nausea,vomiting or,abdominal pain.She had been on monthly RTX infusions for neuromyelitis optica.She was admitted for septic shock due to pancolitis.Blood investigations suggested pancytopenia and serology detected significantly elevated CMV DNA.Valganciclovir treatment led to disease resolution.CONCLUSION This case illustrates an extremely rare case of CMV colitis associated with RTX use presenting with septic shock.High suspicion for rare opportunistic infections is imperative in individuals with long-term RTX use.
文摘BACKGROUND Septic shock,the most severe form of sepsis,remains a major global health challenge with high mortality.The coronavirus disease 2019(COVID-19)pandemic has exacerbated this burden,as severe acute respiratory syndrome coronavirus 2 infection often leads to sepsis and septic shock.Racial and ethnic differences in critical illness outcomes are well-documented,but their impact on COVID-19 associated septic shock remains unclear.AIM To examine epidemiologic data to explore racial and ethnic differences in outcomes in COVID-19 associated septic shock.METHODS Using the National Inpatient Sample(2020–2021),we conducted a retrospective cohort study to assess racial and ethnic disparities in septic shock outcomes among adults(≥18 years)with concurrent COVID-19.Primary and secondary outcomes included in-hospital mortality,acute kidney injury(AKI),AKI requiring dialysis,and mechanical ventilation.Adjusted multivariable logistic regression accounted for demographics,comorbidities,hospital characteristics,and inhospital events.RESULTS Among 396795 weighted hospitalizations,Non-Hispanic Black(NHB)(25.3%)and Hispanic(30.4%)populations were younger and had greater comorbidity burdens than Non-Hispanic White(NHW)patients.Compared to NHW,adjusted analyses showed higher in-hospital mortality[adjusted odds ratio(aOR)=1.21,95%CI:1.15-1.27],mechanical ventilation use(aOR=1.19,95%CI:1.12-1.27)and AKI requiring dialysis(aOR=1.16,95%CI:1.07-1.25,P<0.001)among Hispanic patients.NHB patients had similar mortality to NHWs but had higher risk of mechanical ventilation(aOR=1.15,95%CI:1.09-1.22)and AKI requiring dialysis(aOR=1.65,95%CI:1.54-1.76).Mean length of stay and cost were longest and highest for Hispanic patients.CONCLUSION Our study showed that there was higher mortality in Hispanic patients,and higher renal and respiratory complication in both NHB and Hispanic groups compared to NHW group.Future research identifying the causes of the observed differences in complications are required to inform targeted strategies that may mitigate modifiable risk factors and optimize early detection of organ failure to optimize outcomes in this population.
文摘BACKGROUND Septic shock represents one of the most severe critical illness types,characterized by significant hemodynamic disorders and neuropsychiatric symptoms.This study aimed to investigate the association mechanism between hemodynamic indicators and neuropsychiatric symptoms in patients with septic shock,revealing potential pathophysiological connections.AIM To investigate the link between hemodynamic parameters and neuropsychiatric symptoms in septic shock.METHODS A retrospective case-control study involving 132 patients with septic shock.Multiple assessment tools were employed,including the Confusion Assessment Method,Hospital Anxiety and Depression Scale,Posttraumatic Stress Disorder Scale,and Mini-Mental State Examination,systematically evaluating patients’neuropsychiatric symptoms and hemodynamic indicators.RESULTS Patient mean age was 52.4±12.3 years,with 68.5%males.Multivariate analysis revealed significant correlations between neuropsychiatric symptom severity and mean arterial pressure<65 mmHg[odds ratio(OR)=2.7],lactate levels>4 mmol/L(OR=3.1),and elevated interleukin-6 inflammatory factors(OR=2.4).Neuropsychiatric symptom incidence rates were:Delirium 37.1%;anxiety 28.8%;depression 24.2%;and posttraumatic stress disorder 19.7%.CONCLUSION Hemodynamic disorders in patients with septic shock are closely associated with neuropsychiatric symptoms,influencing central nervous system function through complex inflammatory and neurotransmitter pathways.
文摘BACKGROUND Sepsis and septic shock pose critical public health challenges with high mortality,particularly in critical care.While racial differences in sepsis incidence are documented,the impact of race on sepsis outcomes remains inconsistent.AIM To evaluate racial disparities in clinical outcomes among patients hospitalized with septic shock,focusing on in-hospital mortality,length of stay(LOS),and hospitalization costs.METHODS We conducted a retrospective cohort study using the National Inpatient Sample database from 2016 to 2021.Patients diagnosed with septic shock were identified using ICD-10 code R65.21.The primary outcome was in-hospital mortality;secondary outcomes included trends in septic shock hospitalizations,mortality,length of stay,and cost of hospitalizations.RESULTS Among 3581504 hospitalizations for septic shock,the racial distribution was 67%Non-Hispanic White(NHW),15%Non-Hispanic Black(NHB),11%Hispanic,and 7%other groups,with a mean age of 66.3 years.In-hospital mortality was 33.6%,highest among other racial groups(36.7%).Mortality was stable across racial groups from 2016-2019 but rose sharply in 2020-2021,especially among Hispanic patients.Adjusted in-hospital mortality were higher for NHB and Hispanic compared to NHW patients.NHB patients had the longest LOS,while other racial groups incurred the highest cost of hospitalizations.CONCLUSION We found higher mortality among NHB,Hispanic,and other racial groups in septic shock patients,likely driven by higher risk of in-hospital complications among these racial groups.This highlights the need for future research to identify the factors contributing to the adverse outcomes in these populations.
文摘This article summarizes the nursing management of a pediatric patient with severe scrub typhus complicated by hemophagocytic syndrome(HPS)and septic shock.Key nursing interventions included early recognition and management of septic shock,rational oxygen therapy,fluid resuscitation,administration of vasoactive agents,early and targeted anti-infective therapy,management of hyperpyrexia,care of eschar and edematous skin,strict infection prevention and isolation protocols,and family health education.After 11 days of intensive treatment and nursing care,the patient recovered and was discharged.
文摘This study focused on realizing Sustainable Development Goal(SDG)6 for inclusive clean water and sanitation;in particular Target 6.3,which aims to reduce untreated wastewater by 2030 while promoting circular wastewater reuse and recycling globally.The main objective was to assess the adequacy and efficiency of communal septic tank systems in informal settlements while helping local planners and authorities in their decision-making regarding Target 6.3.Quantitative and qualitative approaches were employed with secondary data from previous researchers,and primary data were collected from field surveys,observations,and interviews with members of the local community.The research was delimited to two village administrative divisions known as Rukun Warga(Village Administrative Division,RW):RW 7 and RW 8 of Lebak Siliwangi Kampung in Coblong District,Bandung,West Java,Indonesia.The findings were also compared with situations in other informal settlements in Brazil,Bangladesh,and Nairobi.The results indicated the inadequacy of communal septic tanks in informal settlements due to factors such as substandard system design,limited support and communication between authorities and residents,and the gap between septic tank availability and capacity vis-a-vis demand.Other limiting factors included limited land availability and irregular geomorphology,the latter of which affected the siting and operation of septic tanks due a lack of room for upgrades or expansion in response to continuous population growth.These findings illustrate the need to complement communal septic systems with flexible centralized or decentralized systems to achieve Target 6.3 of SDG 6.
文摘Recent studies have revealed that patients with septic shock and acute skin failure(ASF)exhibit significantly higher levels of inflammatory cytokines,lactate,and C-reactive protein,along with elevated skin mottling score;modified early warning score(MEWS);and anxiety,depression,and Pittsburgh sleep quality index scores compared to those without ASF.Notably,these indicators are significantly correlated.Patients with septic shock accompanied by ASF tend to have a mean MEWS greater than 9,indicating severe disease progression.Therefore,it is ess-ential to not only manage septic shock but also mitigate anxiety,depression,sleep disorders,and disturbances of consciousness.This article explores the impact of severe anxiety,depression,and sleep disorders on the prognosis of septic shock and discusses intervention strategies.
基金supported by the National Natural Science Foundation(82372206)the Jiangsu Provincial Health Commission(H2023107)the project of basic and clinical research on cardiac arrest in the Emergency and Critical Care Department of the Second Affiliated Hospital of Soochow University(XKTJ-XK202408-2).
文摘Non-O1/non-O139 Vibrio cholerae(NOVC)has multiple pathogenic pathways in humans.The cause of disease in influenced by the virulence genes carried by the infecting strain and the health condition of the host.[1-2]When seafood,food and water sources are contaminated with feces,people are prone to gastroenteritis,and direct exposure to contaminated water may cause wound infection.
文摘Group B Streptococcus(GBS;Streptococcus agalactiae)is a gram-positive coccus that colonizes the gastrointestinal and genital tracts in adults,as well as the upper respiratory tract in infants.While it has been thought that GBS only results in invasive disease in pregnant females and neonates,recent literature has suggested an increasing incidence of invasive GBS among non-pregnant individuals within the United States.
基金supported by the Natural Science Foundation of Xinjiang Uygur Autonomous Region(2020D01C236)
文摘BACKGROUND:To investigate the prognostic value of the peripheral perfusion index(PPI)in patients with septic shock.METHODS:This prospective cohort study,conducted at the emergency intensive care unit of Peking University People's Hospital,recruited 200 patients with septic shock between January 2023 and August 2023.These patients were divided into survival(n=84)and death(n=116)groups based on 28-day outcomes.Clinical evaluations included laboratory tests and clinical scores,with lactate and PPI values assessed upon admission to the emergency room and at 6 h and 12 h after admission.Risk factors associated with mortality were analyzed using univariate and multivariate Cox regression analyses.Receiver operator characteristic(ROC)curve was used to assess predictive performance.Mortality rates were compared,and Kaplan-Meier survival plots were created.RESULTS:Compared to the survival group,patients in the death group were older and had more severe liver damage and coagulation dysfunction,necessitating higher norepinephrine doses and increased fl uid replacement.Higher lactate levels and lower PPI levels at 0 h,6 h,and 12 h were observed in the death group.Multivariate Cox regression identifi ed prolonged prothrombin time(PT),decreased 6-h PPI and 12-h PPI as independent risk factors for death.The area under the curves for 6-h PPI and 12-h PPI were 0.802(95%CI 0.742-0.863,P<0.001)and 0.945(95%CI 0.915-0.974,P<0.001),respectively,which were superior to Glasgow Coma Scale(GCS),Sequential Organ Failure Assessment(SOFA)scores(0.864 and 0.928).Cumulative mortality in the low PPI groups at 6 h and 12 h was signifi cantly higher than in the high PPI groups(6-h PPI:77.52%vs.22.54%;12-h PPI:92.04%vs.13.79%,P<0.001).CONCLUSION:PPI may have value in predicting 28-day mortality in patients with septic shock.
文摘Sepsis and septic shock are life-threatening conditions that are globally responsible for almost 20%of mortality,especially in low and middle-income countries.This review was conducted on PubMed and Google Scholar databases with keywords sepsis,septic shock,sepsis management,and sepsis complications.Articles published up to July 2023 in English were included.Diagnosis and management should be carried out without unnecessary delay.Cooperation between various medical specialties including intensive care doctors,neurologists,hepatologists,cardiologists,and pediatric doctors is needed if a child is affected.New strategies have to be implemented in low and middle-income countries to decrease the sepsis incidence and reduce mortality in the population.
文摘BACKGROUND Septic shock is a severe form of sepsis characterised by deterioration in circulatory and cellular-metabolic parameters.Despite standard therapy,the outcomes are poor.Newer adjuvant therapy,such as CytoSorb®extracorporeal haemoadsorption device,has been investigated and shown promising outcome.However,there is a lack of some guidance to make clinical decisions on the use of CytoSorb®haemoadsorption as an adjuvant therapy in septic shock in Indian Setting.Therefore,this expert consensus was formulated.AIM To formulate/establish specific consensus statements on the use of CytoSorb®haemoadsorption treatment based on the best available evidence and contextualised to the Indian scenario.METHODS We performed a comprehensive literature on CytoSorb®haemoadsorption in sepsis,septic shock in PubMed selecting papers published between January 2011 and March 20232021 in English language.The statements for a consensus document were developed based on the summarised literature analysis and identification of knowledge gaps.Using a modified Delphi approach combining evidence appraisal and expert opinion,the following topics related to CytoSorb®in septic shock were addressed:need for adjuvant therapy,initiation timeline,need for Interleukin-6 levels,duration of therapy,change of adsorbers,safety,prerequisite condition,efficacy endpoints and management flowchart.Eleven expert members from critical care,emergency medicine,and the intensive care participated and voted on nine statements and one open-ended question.RESULTS Eleven expert members from critical care,emergency medicine,and the intensive care participated and voted on nine statements and one open-ended question.All 11 experts in the consensus group(100%)participated in the first,second and third round of voting.After three iterative voting rounds and adapting two statements,consensus was achieved on nine statements out of nine statements.The consensus expert panel also recognised the necessity to form an association or society that can keep a registry regarding the use of CytoSorb®for all indications in the open-ended question(Q10)focusing on“future recommendations for CytoSorb®therapy”.CONCLUSION This Indian perspective consensus statement supports and provides guidance on the use of CytoSorb®haemoadsorption as an adjuvant treatment in patients with septic shock to achieve optimal outcomes.
基金approved by the Institutional Review Board(IRB)of Cantonal Hospital Zenica,and the protocols used in the study were approved by the Ethical Committee of Cantonal Hospital Zenica(00-03-35-38-14/22).
文摘BACKGROUND Both phases of euthyroid sick syndrome(ESS)are associated with worse prognosis in septic shock patients.Although there are still no indications for supplementation therapy,there is no evidence that both phases(initial and prolonged)are adaptive or that only prolonged is maladaptive and requires supplementation.AIM To analyze clinical,hemodynamic and laboratory differences in two groups of septic shock patients with ESS.METHODS A total of 47 septic shock patients with ESS were divided according to values of their thyroid hormones into low T3 and low T3T4 groups.The analysis included demographic data,mortality scores,intensive care unit stay,mechanical ventilation length and 28-day survival and laboratory with hemodynamics.RESULTS The Simplified Acute Physiology Score II score(P=0.029),dobutamine(P=0.003)and epinephrine requirement(P=0.000)and the incidence of renal failure and multiple organ failure(MOF)(P=0.000)were significantly higher for the low T3T4.Hypoalbuminemia(P=0.047),neutrophilia(P=0.038),lymphopenia(P=0.013)and lactatemia(P=0.013)were more pronounced on T2 for the low T3T4 group compared to the low T3 group.Diastolic blood pressure at T0(P=0.017)and T1(P=0.007),as well as mean arterial pressure at T0(P=0.037)and T2(P=0.033)was higher for the low T3 group.CONCLUSION The low T3T4 population is associated with higher frequency of renal insufficiency and MOF,with worse laboratory and hemodynamic parameters.These findings suggest potentially maladaptive changes in the chronic phase of septic shock.
基金funded Secondary Classroom Project fund of Capital Medical University (Project Number:D2KT 2021092).
文摘Background:Septic shock is a common systemic inflammatory response syndrome for critical patients in the intensive care unit.Ulinastatin is currently used for the treatment of septic shock.Our study sought to evaluate the efficacy and safety of ulinastatin in the treatment of septic shock patients.Methods:Three English databases(Embase,Medline,and Cochrane Library)and four Chinese databases(China National Knowledge Infrastructure,Wanfang data,SinoMed,and VIP)were searched for published randomized controlled trials.Stata 16.0 software was used to conduct the meta-analysis.Results:A total of 48 articles were included(Chinese article 47,1 in English).The results show that the treatment of ulinastatin could reduce mortality(risk ratio=0.63,95%confidence interval(CI)(0.55,0.72)),multiple organ dysfunction syndrome(risk ratio=0.6,95%CI(0.53,0.68)),length of intensive care unit stay(mean difference(MD)=-3.92,95%CI(-4.65,-3.18)),length of hospital stay(MD=-4.39,95%CI(-6.63,-2.15))and decrease Acute Physiology and Chronic Health Evaluation II score(MD=-4.55,95%CI(-5.63,-3.47))and Sequential Organ Failure Assessment score(MD=-2.02,95%CI(-2.59,-1.44))with P<0.001.Moreover,it lowers TNF-α(standardized mean difference(SMD)=-1.78,95%CI(-2.24,-1.32)),Interleukin-6(SMD=-1.17,95%CI(-1.55,-0.8)),C reactive protein(SMD=-1.49,95%CI(-1.99,-0.99)),hypersensitive C-reactive protein(SMD=-1.9,95%CI(-2.87,-0.94))and procalcitonin(SMD=-0.89,95%CI(-1.12,-0.67))levels in the body.Conclusions:Available evidence shows that ulinastatin reduces case mortality rate,multiple organ dysfunction syndrome,length of intensive care unit stay,and length of hospital stay and decreases Acute Physiology and Chronic Health Evaluation II score and Sequential Organ Failure Assessment score.Moreover,it also lowers TNF-α,Interleukin-6,C reactive protein,hypersensitive C-reactive protein,and procalcitonin levels in the body.
基金Supported by the Natural Science Foundation of Hubei Province(2021CFB026)Scientific Research Project of Hubei Pathophysiological Society(2021HBAP002)+2 种基金Medical Service Capacity Building and Health Personnel Training Project of the Central Government(New Finance Society[2022]No.255)Key Project of Science and Technology Program of Nanshan District,Shenzhen(NS2022014)Wu Jieping Medical Foundation Clinical Research Project(320.6750.2021-11-12)。
文摘In the face of the elevated incidence and mortality rate of septic shock in the ICU,this retrospective study seeks to investigate the indicative and predictive value of high-mobility group box 1(HMGB1)and miR-146b in patients with septic shock.Quantitative RTPCR was employed in this study to quantify the HMGB1 and miR-146b levels in plasma samples obtained from the patient group and healthy controls.The investigation involved the comparison between the two groups and tracking changes in the patient group over time.The finding revealed that upon admission,the patient group exhibited markedly elevated relative expression levels of HMGB1,which subsequently decreased over time.Conversely,the patient group displayed significantly reduced relative expression levels of miR-146b upon admission,which subsequently increased over time compared to the control group.Receiver operating characteristic(ROC)curves showed good predictive value for HMGB1 and miR-146b.The experimental results suggest that HMGB1 and miR-146b serve as valuable and convenient biomarkers for evaluating the severity of septic shock and predicting mortality.Additionally,it is proposed that serum miR-146b may be inducible and potentially exerts a negative regulatory effect on the expression of HMGB1.
文摘BACKGROUND Septic arthritis,whether native or prosthetic,poses a significant challenge in clinical practice due to its potentially devastating consequences.Despite its clinical importance,there remains a dearth of comprehensive studies and standardized diagnostic criteria,particularly in the Kingdom of Saudi Arabia.AIM To investigate the epidemiology,microbiological profiles,and clinical characteristics of native and prosthetic septic joints in the Saudi Arabian population.METHODS Medical records of patients diagnosed with septic arthritis between January 1,2015,and December 31,2022,were retrospectively reviewed.Data regarding patient demographics,clinical presentation,microbiological cultures,treatment modalities,and outcomes were analyzed.RESULTS In a retrospective review of 52 cases of septic arthritis,a balanced gender distribution was observed(1:1 ratio),with the knee being the most commonly affected joint(80.8%).Methicillin-resistant Staphylococcus aureus predominated in native joints(24.2%),while Brucella spp.was more prevalent in prosthetic joints(21.1%).Joint preservation was achieved in most cases(84.6%),with no significant difference in clinical features between native and prosthetic joints.However,certain comorbidities were more common in native joint cases,including renal impairment(P=0.002),hemodialysis(P=0.004),heart disease(P=0.013),and chronic liver disease(P=0.048).At the same time,osteoarthritis was more prevalent in prosthetic joint cases(P=0.013).Vancomycin was the most frequently used antibiotic(26.9%),and most patients received antibiotics before joint aspiration(57.7%).Surgical intervention,predominantly arthrotomy,was required in most cases(32.7%).Notably,a significant association was found between joint type and mortality(odds ratio=0.587,P=0.048),as well as the Charlson comorbidity index and mortality(P=0.001).CONCLUSION This study highlighted distinctive microbiological profiles and etiological factors in septic arthritis cases in the Saudi Arabian population.
文摘Hippopotamus bites are rare in medical consultations, despite several studies exposing their aggressive character. A case of a hippopotamus bite on the shoulder of a fisherman has been reported. In addition to the osteoarticular aspect representing a therapeutic problem, the infectious aspect was marked by sepsis, with a death in less than 48 hours. Based on this observation, a protocol for the initial management of large animal bites was submitted.
文摘目的评价SEPTIC（sensing of phage—triggered ion cascade）技术在结核分枝杆菌快速检测中的应用价值。方法制备纳米阱微芯片，用于检测噬菌体感染细菌时导致细胞内离子释放发生的微范围内的电位变化。调整大肠杆菌、结核分枝杆菌、耻垢分枝杆菌及其相应噬菌体的浓度。将细菌和噬菌体等体积混合，37℃孵育1min。取5μl混合液滴于探针上，30S后开始采集数据，每2min采集一个数据文件，共采集10min，计算机分析采集结果。结果当结核分枝杆菌与分枝杆菌噬菌体D29混合反应时，在0—8min内显示了非常明确的1／f功率谱特征。而且功率谱强度明显高于阴性反应的功率谱，并出现了明确的电压超出±4盯范围的波形，持续约0．2S的时间，可认为发生了一次细菌被噬菌体感染的事件，表明探针明确地捕获了细菌被噬菌体感染的事件。结论SEPTIC技术能在较短时间内检测、鉴定出活菌的存在，有可能为结核分枝杆菌的检测提供一种简便、快捷的方法。
文摘BACKGROUND Caval vein thrombosis after hepatectomy is rare, although it increases mortality and morbidity. The evolution of this thrombosis into a septic thrombophlebitis responsible for persistent septicaemia after a hepatectomy has not been reported to date in the literature. We here report the management of a 54-year-old woman operated for a peripheral cholangiocarcinoma who developed a suppurated thrombophlebitis of the vena cava following a hepatectomy.CASE SUMMARY This patient was operated by left lobectomy extended to segment V with bile duct resection and Roux-en-Y hepaticojejunostomy. After the surgery, she developed Streptococcus anginosus, Escherichia coli, and Enterococcus faecium bacteraemias, as well as Candida albicans fungemia. A computed tomography scan revealed a bilioma which was percutaneously drained. Despite adequate antibiotic therapy,the patient's condition remained septic. A diagnosis of septic thrombophlebitis of the vena cava was made on post-operative day 25. The patient was then operated again for a surgical thrombectomy and complete caval reconstruction with a parietal peritoneum tube graft. Use of the peritoneum as a vascular graft is an inexpensive technique, it is readily and rapidly available, and it allows caval replacement in a septic area. Septic thrombophlebitis of the vena cava after hepatectomy has not been described previously and it warrants being added to the spectrum of potential complications of this procedure.CONCLUSION Septic thrombophlebitis of the vena cava was successfully treated with antibiotic and anticoagulation treatments, prompt surgical thrombectomy and caval reconstruction.
