Evidence for the Non-Infectious Etiology of Early Postoperative Fever

AbstractIn a prospective study of infections in 871 general surgery patients, we identified 81 patients who developed unexplained postoperative fevers. The majority of these episodes (72%) occurred early (within the first 48 hours) following surgery. Patients who developed early, unexplained fevers differed significantly from patients who developed documented postoperative infections. Patients with unexplained fevers were younger, had less severe underlying disease and underwent less extensive surgeries than patients who subsequently developed infections. In these respects, they were more similar to non-infected, non-febrile patients.We concluded that episodes of early, unexplained postoperative fever occur frequently in a wide range of general surgery patients. Most of these episodes are non-infectious in origin. Patients with early postoperative fevers should be evaluated to identify any obvious sources of infection. If no focus is identified, empiric antibiotic therapy should not be initiated nor should prophylactic antibiotics be extended for prolonged durations. Unexplained fevers will resolve in time without specific therapeutic interventions.

Download Full-text

Necrotizing pneumonia due to clonally diverse Staphylococcus aureus strains producing Panton-Valentine leukocidin: the Czech experience

Epidemiology and Infection ◽

10.1017/s0950268815001521 ◽

2015 ◽

Vol 144 (3) ◽

pp. 507-515 ◽

Cited By ~ 7

Author(s):

J. RÁJOVÁ ◽

R. PANTŮČEK ◽

P. PETRÁŠ ◽

I. VARBANOVOVÁ ◽

I. MAŠLAŇOVÁ ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Case Fatality ◽

Rapid Test ◽

Underlying Disease ◽

The Body ◽

Necrotizing Pneumonia ◽

Severe Underlying Disease ◽

A Prospective Study ◽

Panton Valentine Leukocidin ◽

Valentine Leukocidin

SUMMARYA prospective study (2007–2013) was undertaken to investigate clinical features and prognostic factors of necrotizing pneumonia caused by Staphylococcus aureus producing Panton–Valentine leukocidin (PVL) in the Czech Republic. Twelve cases of necrotizing pneumonia were detected in 12 patients (median age 25 years) without severe underlying disease. Eight cases occurred in December and January and the accumulation of cases in the winter months preceding the influenza season was statistically significant (P < 0·001). The course of pneumonia was very rapid, leading to early sepsis and/or septic shock in all but one patient. Seven patients died and mortality was fourfold higher in those patients presenting with primary pneumonia than with pneumonia complicating other staphylococcal/pyogenic infection elsewhere in the body. The S. aureus isolates displayed considerable genetic variability and were assigned to five lineages CC8 (n = 3), CC15 (n = 2), CC30 (n = 2), CC80 (n = 1), and CC121 (n = 3) and one was a singleton of ST154 (n = 1), all were reported to be associated with community-acquired infection. Four strains were methicillin resistant. The high case-fatality rate can only be reduced by improving the speed of diagnosis and a rapid test to detect S. aureus in the airways is needed.

Download Full-text

A Prospective Study of Postoperative Fever in a General Surgery Department

Infection Control ◽

10.1017/s0195941700063608 ◽

1985 ◽

Vol 6 (12) ◽

pp. 487-490 ◽

Cited By ~ 37

Author(s):

C. Galicier ◽

Herve Richet

Keyword(s):

Prospective Study ◽

Surgical Procedures ◽

General Surgery ◽

Postoperative Fever ◽

The Mean ◽

Febrile Episodes ◽

Clean Contaminated ◽

A Prospective Study ◽

Surgery Department

AbstractDuring a 4-month period, 693 patients undergoing surgical procedures were prospectively studied to investigate the etiology of postoperative fever (≥38°C during 48 hours or more). The overall rate of fever was similar for the three categories of surgical procedures studied (14%, 13.4% and 13.1% respectively after clean, clean contaminated and contaminated surgical procedures). No cause of fever was found in 5%, 2.7% and 1.7% of patients who underwent clean, clean contaminated and contaminated surgical procedures. Several episodes of fever were observed for 12 patients after clean surgery; for 11 of them this was due to infection. The mean interval between febrile episodes was 4.7 days. After clean wound surgery, fever documented as infectious began significantly later (2.7 vs 1.6 days) and lasted significantly longer (5.4 vs 3.5 days) than fever for which no source was determined. Only half of the infections were associated with fever.

Download Full-text

Urinary thrombin as a marker of local disseminated intravascular coagulation in patients with chronic kidney disease

Medicni perspektivi (Medical perspectives) ◽

10.26641/2307-0404.2021.4.248157 ◽

2021 ◽

Vol 26 (4) ◽

pp. 81-86

Author(s):

I.S. Mykhaloiko

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Disseminated Intravascular Coagulation ◽

Filtration Rate ◽

Underlying Disease ◽

Healthy Individuals ◽

Intravascular Coagulation ◽

Protein Excretion ◽

Severe Underlying Disease ◽

A Prospective Study

The aim of this research was to study the diagnostic markers of nonovert local disseminated intravascular coagulation (DIC) syndrome in the urine of patients with chronic kidney disease (CKD). We conducted a prospective study involving 140 patients with CKD, of these patients, 100 patients (71.4%; 95% CI 53.4-76.7) had glomerulonephritis (GN) and 40 patients (28.6%; 95% CI 21.3-36.8) had diabetic nephropathy (DN). We diagnosed overt DIC syndrome on the International Society of Thrombosis and Haemostasis (ISTH) scale (>5 points) in 18.6 % of patients. We determined the level of thrombin in the urine of patients who had <5 points on ISTH scale for the diagnosis of local nonovert DIC syndrome in the kidneys. In the urine of healthy individuals, the level of thrombin did not exceed 1 ng/ml, so we found no thrombinuria at a thrombin level <1 ng/ml. In 56.1% of patients, we found urinary thrombin levels >1 ng/ml. The average level of thrombin in the urine of these patients was 6.5 (4.8; 10.6) ng/ml. In our opinion, the presence of thrombinuria indicates the intensity of monocytic-macrophage inflammation in the glomeruli and may be a criterion for nonovert, local DIC syndrome in the kidneys. The association of overt DIC syndrome with decreased blood albumin, reduced glomerular filtration rate (GFR), increased daily protein excretion (DPE) indicates its occurrence in severe underlying disease, in the presence of nephrotic syndrome and in the severe stages of CKD. Early diagnosis of nonovert local DIC syndrome would be more useful, since the process is still reversible and controlled, and timely use of antiplatelet and anticoagulant therapy would affect the course and the progression of CKD.

Download Full-text

Update on Acute Bone and Joint Infections in Paediatrics: A Narrative Review on the Most Recent Evidence-Based Recommendations and Appropriate Antinfective Therapy

Antibiotics ◽

10.3390/antibiotics9080486 ◽

2020 ◽

Vol 9 (8) ◽

pp. 486 ◽

Cited By ~ 1

Author(s):

Giovanni Autore ◽

Luca Bernardi ◽

Susanna Esposito

Keyword(s):

Septic Arthritis ◽

Laboratory Data ◽

Underlying Disease ◽

Narrative Review ◽

Empiric Antibiotic Therapy ◽

Evidence Based ◽

First Line ◽

Joint Infections ◽

Bone And Joint Infections ◽

Empiric Antibiotic

Acute bone and joint infections (BJIs) in children may clinically occur as osteomyelitis (OM) or septic arthritis (SA). In clinical practice, one-third of cases present a combination of both conditions. BJIs are usually caused by the haematogenous dissemination of septic emboli carried to the terminal blood vessels of bone and joints from distant infectious processes during transient bacteraemia. Early diagnosis is the cornerstone for the successful management of BJI, but it is still a challenge for paediatricians, particularly due to its nonspecific clinical presentation and to the poor specificity of the laboratory and imaging first-line tests that are available in emergency departments. Moreover, microbiological diagnosis is often difficult to achieve with common blood cultures, and further investigations require invasive procedures. The aim of this narrative review is to provide the most recent evidence-based recommendations on appropriate antinfective therapy in BJI in children. We conducted a review of recent literature by examining the MEDLINE (Medical Literature Analysis and Retrieval System Online) database using the search engines PubMed and Google Scholar. The keywords used were “osteomyelitis”, OR “bone infection”, OR “septic arthritis”, AND “p(a)ediatric” OR “children”. When BJI diagnosis is clinically suspected or radiologically confirmed, empiric antibiotic therapy should be started as soon as possible. The choice of empiric antimicrobial therapy is based on the most likely causative pathogens according to patient age, immunisation status, underlying disease, and other clinical and epidemiological considerations, including the local prevalence of virulent pathogens, antibiotic bioavailability and bone penetration. Empiric antibiotic treatment consists of a short intravenous cycle based on anti-staphylococcal penicillin or a cephalosporin in children aged over 3 months with the addition of gentamicin in infants aged under 3 months. An oral regimen may be an option depending on the bioavailability of antibiotic chosen and clinical and laboratory data. Strict clinical and laboratory follow-up should be scheduled for the following 3–5 weeks. Further studies on the optimal therapeutic approach are needed in order to understand the best first-line regimen, the utility of biomarkers for the definition of therapy duration and treatment of complications.

Download Full-text

Cognitive Impact of Cerebellar Damage: Is There a Future for Cognitive Rehabilitation?

CNS & Neurological Disorders - Drug Targets ◽

10.2174/1871527317666180110125043 ◽

2018 ◽

Vol 17 (3) ◽

pp. 199-206 ◽

Cited By ~ 8

Author(s):

Kim van Dun ◽

Frank V. Overwalle ◽

Mario Manto ◽

Peter Marien

Keyword(s):

Affective Disorders ◽

Cognitive Rehabilitation ◽

Therapeutic Interventions ◽

Posterior Fossa Surgery ◽

Daily Life Activities ◽

Wide Range ◽

Affective Deficits ◽

Cerebellar Injury ◽

Cognitive Therapies ◽

The Impact

Background & Objective: During the past 3 decades, numerous neurophysiological, neuroimaging, experimental and clinical studies have evidenced a crucial role for the cerebellum in cognitive, affective and behavioral functions. As a result of the acknowledged modulatory role of the cerebellum upon remote structures such as the cerebral cortex, cerebellar injury may give rise to a constellation of behavioral, affective and cognitive symptoms (Schmahmann's Syndrome). In sharp contrast to the wide range of therapeutic interventions to treat cognitive and affective disorders following cerebral cortical lesions and despite the consequences of Schmahmann’s syndrome upon daily life activities, the literature is surprisingly only scantly documented with studies investigating the impact of cognitive therapies on cerebellar induced cognitive and affective disorders. This survey aims to present an overview of the therapeutic interventions available in the literature as a possible treatment for Schmahmann’s Syndrome after cerebellar injury, after posterior fossa surgery in children, and in children with neurodevelopmental disorders. Although systematical studies are clearly warranted, available evidence suggests that cerebellar-induced cognitive and affective disorders should be treated in a specific way. Approaches where the patients are explicitly made aware of their deficits and are considered to act as an “external cerebellum” are the most promising. Conclusion: The study of the anatomical connectivity of the cerebellar microcomplexes involved in cognitive/affective deficits is likely to play a major-role in the future.

Download Full-text

Multiplexed Genetic Analysis Using an Expanded Genetic Alphabet

Clinical Chemistry ◽

10.1373/clinchem.2004.034330 ◽

2004 ◽

Vol 50 (11) ◽

pp. 2019-2027 ◽

Cited By ~ 36

Author(s):

Scott C Johnson ◽

David J Marshall ◽

Gerda Harms ◽

Christie M Miller ◽

Christopher B Sherrill ◽

...

Keyword(s):

Newborn Screening ◽

Cftr Gene ◽

Transmembrane Conductance Regulator ◽

Transmembrane Conductance ◽

Genetic Tests ◽

Wide Range ◽

Additional Base ◽

A Prospective Study ◽

Cystic Fibrosis Transmembrane ◽

Made In

Abstract Background: All states require some kind of testing for newborns, but the policies are far from standardized. In some states, newborn screening may include genetic tests for a wide range of targets, but the costs and complexities of the newer genetic tests inhibit expansion of newborn screening. We describe the development and technical evaluation of a multiplex platform that may foster increased newborn genetic screening. Methods: MultiCode® PLx involves three major steps: PCR, target-specific extension, and liquid chip decoding. Each step is performed in the same reaction vessel, and the test is completed in ∼3 h. For site-specific labeling and room-temperature decoding, we use an additional base pair constructed from isoguanosine and isocytidine. We used the method to test for mutations within the cystic fibrosis transmembrane conductance regulator (CFTR) gene. The developed test was performed manually and by automated liquid handling. Initially, 225 samples with a range of genotypes were tested retrospectively with the method. A prospective study used samples from >400 newborns. Results: In the retrospective study, 99.1% of samples were correctly genotyped with no incorrect calls made. In the perspective study, 95% of the samples were correctly genotyped for all targets, and there were no incorrect calls. Conclusions: The unique genetic multiplexing platform was successfully able to test for 31 targets within the CFTR gene and provides accurate genotype assignments in a clinical setting.

Download Full-text

Tau and TDP-43 synergy: a novel therapeutic target for sporadic late-onset Alzheimer’s disease

GeroScience ◽

10.1007/s11357-021-00407-0 ◽

2021 ◽

Author(s):

Caitlin S. Latimer ◽

Nicole F. Liachko

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Late Onset ◽

Hippocampal Sclerosis ◽

Model Organism ◽

Amyloid Β ◽

Underlying Disease ◽

Therapeutic Interventions ◽

Disease Biology ◽

Rapid Cognitive Decline

AbstractAlzheimer’s disease (AD) is traditionally defined by the presence of two types of protein aggregates in the brain: amyloid plaques comprised of the protein amyloid-β (Aβ) and neurofibrillary tangles containing the protein tau. However, a large proportion (up to 57%) of AD patients also have TDP-43 aggregates present as an additional comorbid pathology. The presence of TDP-43 aggregates in AD correlates with hippocampal sclerosis, worse brain atrophy, more severe cognitive impairment, and more rapid cognitive decline. In patients with mixed Aβ, tau, and TDP-43 pathology, TDP-43 may interact with neurodegenerative processes in AD, worsening outcomes. While considerable progress has been made to characterize TDP-43 pathology in AD and late-onset dementia, there remains a critical need for mechanistic studies to understand underlying disease biology and develop therapeutic interventions. This perspectives article reviews the current understanding of these processes from autopsy cohort studies and model organism-based research, and proposes targeting neurotoxic synergies between tau and TDP-43 as a new therapeutic strategy for AD with comorbid TDP-43 pathology.

Download Full-text

Therapeutic Application of Monoclonal Antibodies in Pancreatic Cancer: Advances, Challenges and Future Opportunities

Cancers ◽

10.3390/cancers13081781 ◽

2021 ◽

Vol 13 (8) ◽

pp. 1781

Author(s):

Gustavo A. Arias-Pinilla ◽

Helmout Modjtahedi

Keyword(s):

Pancreatic Cancer ◽

Monoclonal Antibodies ◽

Antibody Therapy ◽

Therapeutic Targets ◽

Poor Response ◽

Therapeutic Agents ◽

Therapeutic Interventions ◽

Western World ◽

Wide Range ◽

Novel Therapeutic

Pancreatic cancer remains as one of the most aggressive cancer types. In the absence of reliable biomarkers for its early detection and more effective therapeutic interventions, pancreatic cancer is projected to become the second leading cause of cancer death in the Western world in the next decade. Therefore, it is essential to discover novel therapeutic targets and to develop more effective and pancreatic cancer-specific therapeutic agents. To date, 45 monoclonal antibodies (mAbs) have been approved for the treatment of patients with a wide range of cancers; however, none has yet been approved for pancreatic cancer. In this comprehensive review, we discuss the FDA approved anticancer mAb-based drugs, the results of preclinical studies and clinical trials with mAbs in pancreatic cancer and the factors contributing to the poor response to antibody therapy (e.g. tumour heterogeneity, desmoplastic stroma). MAb technology is an excellent tool for studying the complex biology of pancreatic cancer, to discover novel therapeutic targets and to develop various forms of antibody-based therapeutic agents and companion diagnostic tests for the selection of patients who are more likely to benefit from such therapy. These should result in the approval and routine use of antibody-based agents for the treatment of pancreatic cancer patients in the future.

Download Full-text

Cortical Excitability across the ALS Clinical Motor Phenotypes

Brain Sciences ◽

10.3390/brainsci11060715 ◽

2021 ◽

Vol 11 (6) ◽

pp. 715

Author(s):

Thanuja Dharmadasa

Keyword(s):

Motor Cortex ◽

Cortical Excitability ◽

Phenotypic Variability ◽

Specific Treatment ◽

Underlying Disease ◽

Selective Vulnerability ◽

Clinical Feature ◽

Cortical Hyperexcitability ◽

Wide Range

Amyotrophic lateral sclerosis (ALS) is characterized by its marked clinical heterogeneity. Although the coexistence of upper and lower motor neuron signs is a common clinical feature for most patients, there is a wide range of atypical motor presentations and clinical trajectories, implying a heterogeneity of underlying pathogenic mechanisms. Corticomotoneuronal dysfunction is increasingly postulated as the harbinger of clinical disease, and neurophysiological exploration of the motor cortex in vivo using transcranial magnetic stimulation (TMS) has suggested that motor cortical hyperexcitability may be a critical pathogenic factor linked to clinical features and survival. Region-specific selective vulnerability at the level of the motor cortex may drive the observed differences of clinical presentation across the ALS motor phenotypes, and thus, further understanding of phenotypic variability in relation to cortical dysfunction may serve as an important guide to underlying disease mechanisms. This review article analyses the cortical excitability profiles across the clinical motor phenotypes, as assessed using TMS, and explores this relationship to clinical patterns and survival. This understanding will remain essential to unravelling central disease pathophysiology and for the development of specific treatment targets across the ALS clinical motor phenotypes.

Download Full-text

Practice Guidelines: How Good are Medicine's New Recipes?

The Journal of Law Medicine & Ethics ◽

10.1111/j.1748-720x.1995.tb01329.x ◽

1995 ◽

Vol 23 (1) ◽

pp. 47-48 ◽

Cited By ~ 1

Author(s):

Alexander Morgan Capron

Keyword(s):

Health Care ◽

Nonprofit Organizations ◽

Medical Knowledge ◽

Medical Specialty ◽

Therapeutic Interventions ◽

Medical Interventions ◽

Practice Parameters ◽

Wide Range ◽

Standard Of Practice

Over the last decade, standards for when and how to undertake a wide range of medical interventions have poured forth from medical specialty groups, commercial and nonprofit organizations, and state and federal panels. Known by a variety of names—from practice parameters to clinical guidelines—and intended for a range of purposes—from diminishing the incidence of maloccurences in hospitals to cutting the costs of health care—these guidelines share one important feature: the intention of decreasing the range of variation in medical practice. Such standardization immediately appeals to anyone interested in improving the quality of health care and, in particular, reducing inappropriate medical interventions, in light of the difficulties for a conscientious physician today in adhering to the best standard of practice when faced with ever increasing medical knowledge and the growing number and complexity of diagnostic, preventive, and therapeutic interventions.

Download Full-text