Is JJ Ureteral Stenting Inferior to Percutaneous Nephrostomy as a Drainage Method in Emphysematous Pyelonephritis?

Introduction: The aim of the study was to examine the efficacy of JJ stenting in comparison with percutaneous nephrostomy (PCN) as a drainage method in patients with emphysematous pyelonephritis (EPN). Methods: We retrospectively identified patients with EPN between January 2000 and January 2021. Platelet-to-leukocytic ratio (PLR) at the time of hospital admission and discharge, time taken to clear air locules and to normalize leukocytic count, and air locule volume in mm3 were identified. Renal drainage by either PCN or JJ stent was required if symptoms persist for ≥3 days or in obstructed renal units. Failure of drainage method was defined as conversion to another method of drainage, need for intensive care unit admission, salvage nephrectomy, and mortality. Results: Twenty-nine patients were managed by JJ stent. Treatment success was identified in 20 patients and 19 patients who were managed by PCN and JJ stent, respectively. Higher air locule volume ≥16.7 mm3 and lower PLR ≤18.4 increased the risk of drainage failure (p = 0.009 and 0.001, respectively). Conclusion: Ureteral JJ stenting is an effective method for EPN drainage with a comparable overall success to the PCN use. Higher air locule volume and lower PLR increased the risk of drainage failure.

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Faculty Opinions recommendation of A longitudinal investigation of posttraumatic stress and depressive symptoms over the course of the year following medical-surgical intensive care unit admission.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717989043.793472793 ◽

2013 ◽

Author(s):

O Joseph Bienvenu

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Depressive Symptoms ◽

Intensive Care Unit Admission ◽

Posttraumatic Stress ◽

Surgical Intensive Care Unit ◽

Surgical Intensive Care ◽

Longitudinal Investigation

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Faculty Opinions recommendation of [Examination of maternal extended spectrum beta-lactamase bacterial colonization and follow-up of newborns requiring Neonatal Intensive Care Unit admission].

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.727797260.793534178 ◽

2017 ◽

Author(s):

Jean-Ralph Zahar

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Intensive Care Unit Admission ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

Bacterial Colonization ◽

Beta Lactamase ◽

Extended Spectrum Beta Lactamase ◽

Extended Spectrum

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Mild thrombocytopenia indicating maternal organ damage in pre‐eclampsia: a cross‐sectional study

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03564-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Michinori Mayama ◽

Mamoru Morikawa ◽

Takashi Yamada ◽

Takeshi Umazume ◽

Kiwamu Noshiro ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Platelet Count ◽

Intensive Care Unit Admission ◽

Neonatal Intensive Care Unit ◽

Preterm Delivery ◽

Neonatal Intensive Care ◽

Organ Damage ◽

Severe Thrombocytopenia ◽

Relative Risks

Abstract Background Currently, there is a disagreement between guidelines regarding platelet count cut-off values as a sign of maternal organ damage in pre-eclampsia; the American College of Obstetricians and Gynecologists guidelines state a cut-off value of < 100 × 109/L; however, the International Society for the Study of Hypertension in Pregnancy guidelines specify a cut-off of < 150 × 109/L. We evaluated the effect of mild thrombocytopenia: platelet count < 150 × 109/L and ≥ 100 × 109/L on clinical features of pre-eclampsia to examine whether mild thrombocytopenia reflects maternal organ damage in pre-eclampsia. Methods A total of 264 women were enrolled in this study. Participants were divided into three groups based on platelet count levels at delivery: normal, ≥ 150 × 109/L; mild thrombocytopenia, < 150 × 109/L and ≥ 100 × 109/L; and severe thrombocytopenia, < 100 × 109/L. Risk of severe hypertension, utero-placental dysfunction, maternal organ damage, preterm delivery, and neonatal intensive care unit admission were analyzed based on platelet count levels. Estimated relative risk was calculated with a Poisson regression analysis with a robust error. Results Platelet counts indicated normal levels in 189 patients, mild thrombocytopenia in 51 patients, and severe thrombocytopenia in 24 patients. The estimated relative risks of severe thrombocytopenia were 4.46 [95 % confidence interval, 2.59–7.68] for maternal organ damage except for thrombocytopenia, 1.61 [1.06–2.45] for preterm delivery < 34 gestational weeks, and 1.35 [1.06–1.73] for neonatal intensive care unit admission. On the other hand, the estimated relative risks of mild thrombocytopenia were 0.97 [0.41–2.26] for maternal organ damage except for thrombocytopenia, 0.91 [0.62–1.35] for preterm delivery < 34 gestational weeks, and 0.97 [0.76–1.24] for neonatal intensive care unit admission. Conclusions Mild thrombocytopenia was not associated with severe features of pre-eclampsia and would not be suitable as a sign of maternal organ damage.

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Early prolonged neutrophil activation in critically ill patients with sepsis

Innate Immunity ◽

10.1177/1753425920980078 ◽

2021 ◽

Vol 27 (2) ◽

pp. 192-200

Author(s):

Sanna Törnblom ◽

Sara Nisula ◽

Suvi T Vaara ◽

Meri Poukkanen ◽

Sture Andersson ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Intensive Care Unit Admission ◽

Plasma Concentrations ◽

Neutrophil Activation ◽

Early Event ◽

Heparin Binding ◽

Activation Markers ◽

Heparin Binding Protein ◽

Pro Inflammatory Cytokines

We hypothesised that plasma concentrations of biomarkers of neutrophil activation and pro-inflammatory cytokines differ according to the phase of rapidly evolving sepsis. In an observational study, we measured heparin-binding protein (HBP), myeloperoxidase (MPO), IL-6 and IL-8 in 167 sepsis patients on intensive care unit admission. We prospectively used the emergence of the first sepsis-associated organ dysfunction (OD) as a surrogate for the sepsis phase. Fifty-five patients (of 167, 33%) developed the first OD > 1 h before, 74 (44%) within ± 1 h, and 38 (23%) > 1 h after intensive care unit admission. HBP and MPO were elevated at a median of 12 h before the first OD, remained high up to 24 h, and were not associated with sepsis phase. IL-6 and IL-8 rose and declined rapidly close to OD emergence. Elevation of neutrophil activation markers HBP and MPO was an early event in the evolution of sepsis, lasting beyond the subsidence of the pro-inflammatory cytokine reaction. Thus, as sepsis biomarkers, HBP and MPO were not as prone as IL-6 and IL-8 to the effect of sample timing.

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