scholarly journals Continuous Veno-Venous Hemofiltration (CVVH) Improves Iron Metabolism Disorders in Patients with Sepsis:A Single-Center Prospective Cohort Study

Author(s):  
Meng-Meng An ◽  
Chenxi Liu ◽  
Yi Jiang ◽  
Bei-Bei Jin ◽  
Da Cao ◽  
...  

Abstract Background: Iron metabolism disorder is commonly seen in patients with sepsis. This study aimed to evaluate whether continuous veno-venous hemofiltration (CVVH) improved the iron metabolism disorders in sepsis. Methods: In a single-center, retrospective cohort study, totally 89 sepsis patients were prospectively enrolled and divided into the CVVH group (n=39) and the control group (n=50). Clinical and laboratory data were collected and compared between the groups on days 1, 3 and 7 of ICU admission. Plasma interleukin (IL)-6, hepcidin, erythropoietin (EPO), ferritin and soluble transferrin receptor (sTfR) were determined by enzyme linked immunosorbent assay (ELISA). Sequential organ failure scores (SOFA) on days 1 and 7, and 28-day survival between groups were compared. Results: Plasma IL-6, hepcidin, ferritin and RDW on days 3 and 7 were significantly reduced in the CVVH group compared with those in the control group (all P<0.05). The CVVH group had a significantly lower SOFA score on day 7 compared with the control group (P<0.05). Hemoglobin and EPO were gradually decreased within the first week of ICU admission in both groups although no significant differences between the groups were observed. There was no significant difference in sTfR between the two groups along with the time (all P > 0.05). In addition, there were no significant differences in 28-day survival rate and median survival time between the two groups. Conclusions: CVVH improves iron metabolism disorders and the disease severity in sepsis. However, it does not alleviate anemia and fails to improve the survival.

2020 ◽  
Author(s):  
Meng-Meng An ◽  
Yi Jiang ◽  
Bei-Bei Jin ◽  
Da Cao ◽  
Ping Gong

Abstract Background: Iron metabolism disorder is commonly seen in patients with sepsis. This study aimed to evaluate whether continuous veno-venous hemofiltration (CVVH) improved the iron metabolism disorders in sepsis. Methods: In a single-center, retrospective cohort study, totally 89 sepsis patients were prospectively enrolled and divided into the CVVH group (n=39) and the control group (n=50). Clinical and laboratory data were collected and compared between the groups on days 1, 3 and 7 of ICU admission. Plasma interleukin (IL)-6, hepcidin, erythropoietin (EPO), ferritin and soluble transferrin receptor (sTfR) were determined by enzyme linked immunosorbent assay (ELISA). Sequential organ failure scores (SOFA) on days 1 and 7, and 28-day survival between groups were compared.Results: Plasma IL-6, hepcidin, ferritin and RDW on days 3 and 7 were significantly reduced in the CVVH group compared with those in the control group (all P<0.05). The CVVH group had a significantly lower SOFA score on day 7 compared with the control group (P<0.05). Hemoglobin and EPO were gradually decreased within the first week of ICU admission in both groups although no significant differences between the groups were observed. There was no significant difference in sTfR between the two groups along with the time (all P > 0.05). In addition, there were no significant differences in 28-day survival rate and median survival time between the two groups. Conclusion: CVVH improves iron metabolism disorders and the disease severity in sepsis. However, it does not alleviate anemia and fails to improve the survival.


2019 ◽  
Author(s):  
Thais Dias Midega ◽  
Newton Carlos Viana Leite Filho ◽  
Antônio Paulo Nassar ◽  
Roger Monteiro Alencar ◽  
Antônio Capone Neto ◽  
...  

AbstractIntroductionHandover is a process of transferring information, responsibility and authority for providing care of critically ill patients from a departing intensivist to an oncoming intensivist. The effect of i admission during a medical handover on clinical outcomes is unknown.ObjectivesOur purpose was to evaluate the impact of ICU admission during a medical handover on clinical outcomes.MethodsPost hoc analysis of a cohort study addressing the effect of ICU admissions during the handover on outcomes. This retrospective, single center, propensity matched cohort study was conducted in a 41-bed open general ICU located in a private tertiary care hospital in São Paulo, Brazil. Based on time of ICU admission, patients were categorized into two cohorts: handover group (ICU admission between 6:30 am to 7:30 or 6:30 pm to 7:30 pm) or control group (admission between 7:31 am to 6:29 pm or 7:31 pm to 6:29 am). Patients in the handover group were propensity matched to patients in the control group at 1:2 ratio. Our primary outcome was hospital mortality.ResultsBetween June 1, 2013 and May 31, 2015, 6,650 adult patients were admitted to the ICU. Following exclusion of ineligible participants, 5,779 patients [389 (6.7%) in handover group and 5390 (93.3%) in control group] were eligible for propensity score matching, of whom 1,166 were successfully matched [389 (33.4%) handover group and 777 (66.6%) in control group]. Before matching, hospital mortality was 14.1% (55/389 patients) in handover group compared to 11.7% (628/5,390) in control group (p=0.142). After propensity-score matching, ICU admission during handover was not associated with increased risk of ICU (OR, 1.40; 95% CI, 0.92 to 2.11; p=0.11) and hospital (OR, 1.23; 95%CI, 0.85 to 1.75; p=0.26) mortality. ICU and hospital length of stay did not differ between the groups.ConclusionIn this propensity-matched single center cohort study, ICU admission during medical handover did not affect clinical outcomes.


2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S262-S262
Author(s):  
Kok Hoe Chan ◽  
Bhavik Patel ◽  
Iyad Farouji ◽  
Addi Suleiman ◽  
Jihad Slim

Abstract Background Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection can lead to many different cardiovascular complications, we were interested in studying prognostic markers in patients with atrial fibrillation/flutter (A. Fib/Flutter). Methods A retrospective cohort study of patients with confirmed COVID-19 and either with existing or new onset A. Fib/Flutter who were admitted to our hospital between March 15 and May 20, 2020. Demographic, outcome and laboratory data were extracted from the electronic medical record and compared between survivors and non-survivors. Univariate and multivariate logistic regression were employed to identify the prognostic markers associated with mortality in patients with A. Fib/Flutter Results The total number of confirmed COVID-19 patients during the study period was 350; 37 of them had existing or new onset A. Fib/Flutter. Twenty one (57%) expired, and 16 (43%) were discharged alive. The median age was 72 years old, ranged from 19 to 100 years old. Comorbidities were present in 33 (89%) patients, with hypertension (82%) being the most common, followed by diabetes (46%) and coronary artery disease (30%). New onset of atrial fibrillation was identified in 23 patients (70%), of whom 13 (57%) expired; 29 patients (78%) presented with atrial fibrillation with rapid ventricular response, and 2 patients (5%) with atrial flutter. Mechanical ventilation was required for 8 patients, of whom 6 expired. In univariate analysis, we found a significant difference in baseline ferritin (p=0.04), LDH (p=0.02), neutrophil-lymphocyte ratio (NLR) (p=0.05), neutrophil-monocyte ratio (NMR) (p=0.03) and platelet (p=0.015) between survivors and non-survivors. With multivariable logistic regression analysis, the only value that had an odds of survival was a low NLR (odds ratio 0.74; 95% confidence interval 0.53–0.93). Conclusion This retrospective cohort study of hospitalized patients with COVID-19 demonstrated an association of increase NLR as risk factors for death in COVID-19 patients with A. Fib/Flutter. A high NLR has been associated with increased incidence, severity and risk for stroke in atrial fibrillation patients but to our knowledge, we are first to demonstrate the utilization in mortality predictions in COVID-19 patients with A. Fib/Flutter. Disclosures Jihad Slim, MD, Abbvie (Speaker’s Bureau)Gilead (Speaker’s Bureau)Jansen (Speaker’s Bureau)Merck (Speaker’s Bureau)ViiV (Speaker’s Bureau)


2020 ◽  
Vol 44 (5) ◽  
pp. 275-282
Author(s):  
G. Seller-Pérez ◽  
J.E. Barrueco-Francioni ◽  
R. Lozano-Sáez ◽  
M.M. Arrebola-Ramírez ◽  
M.J. Diez-de-los-Ríos ◽  
...  

2021 ◽  
pp. 1-9
Author(s):  
Rebecca J. Bennett ◽  
Erin Kosovich ◽  
Steff Cohen ◽  
Cara Lo ◽  
Kevin Logan ◽  
...  

Purpose This study aimed to (a) identify participant factors associated with hearing aid review (HAR) appointment attendance, (b) investigate whether the completion of self-report survey identifying hearing aid–related problems affects HAR appointment attendance, and (c) investigate whether hearing aid problems and hearing aid management deficiencies are adequately addressed during HAR appointments. Method A prospective cohort study of adult hearing aid owners recruited from a single hearing clinic in Western Australia. Potential participants were invited to an annual HAR appointment via postal letter. The invitation included a paper-based self-report survey evaluating either (a) hearing aid problems, (b) hearing aid management skills, or (c) hearing aid outcomes, depending on which intervention/control group the potential participants were assigned to, and a reply paid addressed envelope. Two months later, potential participants were sent all three paper-based self-report surveys, irrespective of whether they had attended or not attended an HAR appointment. Results (a) There was no significant difference in gender or source of funding for hearing services between HAR appointment attendees and nonattendees. HAR nonattendees lived a greater distance from their clinic and were younger than attendees. (b) Survey completion did not influence HAR appointment attendance rates. (c) A significant reduction in individuals' self-reported hearing aid problems was recorded following the attendance at the HAR appointment. No significant changes in hearing aid management skills or overall hearing aid outcomes were detected. Conclusions Long travel distances may be a barrier to attendance at review appointments. HAR appointments appear to be effective in improving hearing aid problems.


2014 ◽  
Author(s):  
Γεώργιος Γεωργίου

Βackground: angiogenesis is seen during the multiple stages of carcinogenesis, aswell as during the process of surgical wound healing, a fact which has led tosubstantial debate over the last decades about the potential impact of surgery upon thefinal outcome of ceratin patients treated for breast cancer.Aim: the present research aims at investigating the potential effect of surgery on theprocess of angiogenesis, by studying a number of factors that are related to the latter,in patients suffering from breast cancer before and after the time of the procedure,whilst comparing these results with those of patients that were operated on their breastfor non-malignant disease.Material-Methods: blood from 10 female patients with breast adenocarcinoma(Study Group) was collected via venipuncture before surgery (labeled as PRO), aswell as on post-operative day 3 (labeled as D3) and day 7 (labeled as D7). Moreover,blood samples were also taken from 6 female patients with fibroadenoma (ControlGroup) before surgery (PRO) and on day 3 afetr surgery (D3). These samples weremeasured for detection of circulating levels of three established angiogenesisbiomarkers using ELISA (Enzyme-Linked ImmunoSorbent Assay): VascularEndothelial Growth Factor-A (VEFG-A), Interleukin-8 (IL-8) and basic FibroblastGrowth factor (bFGF or FGF-2). In addition, circulating transcripts of 84 agiogenesirelatedgenes were determined using RT-PCR (Real Time Polymerase ChainReaction). The two groups of patients were firstly compared to each other regardingtheir results. Also, patients belonging to the Study Group were analized at differenttime points regarding surgery. Finally, the results were investigated againstclinicopathological data and patient outcome.Results: using ELISA we were able to detect increased levels of circulating VEGF-Aand IL-8 in the Study Group patients compared to the Control Group patientspreoperatively (p=0,0381 and p=0,0218 respectively), while for bFGF there was nostatistically significant difference documented. Surgery resulted in a significantincrease in VEGF-A levels on D3 (p=0,0389) and D7 (p=0,0172) as compared toPRO levels. Perioperative kinetics of IL-8 showed a mild trend towards increase,which, however, was not statistically significant. Postoperative levels of bFGF wereslightly increased on D3, but on D7 they were even lower than preoperative values(p=0,0205). Using RT-PCR certain differences between the Study Group and theControl Group were recorded regarding the circulating transcripts of a great numberof angiogenesis-related genes preoperatively: upregulation of VEGF-C, EGF, IL-8,FGF-1, SPHK1, NRP1, LAMA5, COL4A3, TEK, EFNA3, EFNB2. AKT1, ITGB3,THBS1, CCL11, TIMP3 and downregulation of CXCL10. Moreover, mastectomyinduced an altered expression in several key-genes in breast cancer patients:upregulation of THBS1, COL4A3, BAI1, ITGB3 and downregulation of EREG,SERPIFN1, CXCL9, CXCL10, IL1B, CCL2, CXCL1, HIF1A, NOTCH4. Conclusions: patients suffering from breast cancer have a different angiogenic profilein comparison to patients with fibroadenoma, as documented through their differencesin circulating levels of angiogenic factors. These levels are greatly changed after thesurgical procedure. VEGF showed a transient increase, while bFGF initially increasedbut only to finally decrease to levels that were even lower than the preoperative ones.Moreover, mastectomy promoted a shift in the expression pattern of a broad panel ofangiogenesis-related gene transcripts.


Author(s):  
Nur Anna C Sa’dyah ◽  
Agung Putra ◽  
Bayu Tirta Dirja ◽  
Nurul Hidayah ◽  
Salma Yasmine Azzahara ◽  
...  

Introduction<br />Liver fibrosis (LF) results from the unregulated chronic wound healing process in liver tissue. Transforming growth factor-beta (TGF-β) is the major contributing cytokine of LF promotion through activation of quiescent hepatic stellate cells (HSCs) into myofibroblasts (MFs) and increased extracellular matrix (ECM) deposition such as collagen leading to scar tissue development. Mesenchymal stem cells (MSCs) have an immunomodulatory capability that could be used as a new treatment for repairing and regenerating LF through suppression of TGF-β. This study aimed to examine the role of MSCs in liver fibrosis animal models through suppression of TGF-β levels without scar formation particularly in the proliferation phase.<br /><br />Methods<br />In this study, a completely randomized design was used with sample size of 24. Male Sprague Dawley rats were injected intraperitoneally (IP) with carbon tetrachloride (CCl4), twice weekly, for eight weeks to induce LF. Rats were randomly assigned to four groups: negative control, CCl4 group, and CCL4 + MSC-treated groups T1 and T2, at doses of 1 x 106 and 2x106 cells, respectively. TGF-β levels were analyzed by enzyme-linked immunosorbent assay (ELISA). One-way ANOVA and a least significant difference (LSD) was used to analyse the data. <br /><br />Results<br />The TGF levels of LF rat models decreased on day 7 after MSC administration. The levels of TGF-β in both MSC groups T1 and T2 decreased significantly compared with the control group (p&lt;0.05). The TGF-β suppression capability of T2 was optimal and more significant than that of T1.<br /><br />Conclusion<br />MSCs can suppress TGF levels in liver fibrosis induced rats.


2021 ◽  
Vol 67 (3) ◽  
pp. 1-4
Author(s):  
Shler Ghafoor Raheem

The inflammatory reaction is one of the complications in patients with coronary atherosclerosis. This study aimed to determine the diagnostic value of platelet-activating factor (PAF) compared with high sensitivity C reactive protein (hs-CRP) in coronary atherosclerotic patients. Fifty patients with coronary atherosclerosis and 30 subjects with normal angiography were considered as the control group attending Cardiac Center-Surgical Specialty Hospital - in Erbil city / Iraq. The levels of PAF and hs-CRP were estimated quantitatively using a sandwich enzyme-linked immunosorbent assay and a particle-enhanced immune turbid metric assay, respectively. Lipid profiles and some hematological indexes were also used in this study. The levels of the inflammatory biomarkers of PAF and hs-CRP increased significantly in the patients group compared with controls (p<0.05). Although the patients group showed the highest level of low-density lipoprotein (LDL), the difference was not significant (p>0.05) compared with the healthy control. However, the incidence of risk factors such as smoking and obesity showed a significant difference (p<0.05) in the patients group. Additionally, the PAF level correlated positively and significantly with hs-CRP (p<0.05), and negatively with high-density lipoprotein (HDL) (p>0.05). Although hs-CRP was a valuable diagnostic marker for coronary atherosclerosis, the PAF level showed to be a better prognostic indicator than hs-CRP in coronary atherosclerosis patients.


2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S232-S232
Author(s):  
H Korkmaz ◽  
K Fidan

Abstract Background In this study, we investigated the importance of netrin-1 levels in ulcerative colitis (UC) in clinical activity of the disease, and its association with other proinflammatory cytokines IL-6 and TNF-α. Methods This study is a type of case–control study. Sixty-seven patients with UC (36 of them activation, 31 of remission) and 50 healthy controls were included in the study. UC patients; ‘Truelove Witts clinical activity index by remission (n = 31), mild activation (n = 21), moderate activation (n = 6) and severe activation (n = 9) were divided into groups. Netrin, IL-6 and TNF-α measurements in plasma samples were performed using enzyme-linked immunosorbent assay kit. Results Between the patient group and the control group; there was a statistically significant difference between netrin-1, IL-6, TNF-α, neutrophil, platelet (p &lt; 0.05 for all). The plasma netrin-1 mean of UC with severe activation group (139.21 ± 48.09 pg/ml) was statistically significantly higher than that of the mild activation (p = 0,037), remission group (p = 0,001) and control group(p = 0,011). The plasma netrin-1 mean of UC with moderate activation group was statistically significantly higher than that of the mild activation(p = 0,045) and remission group(p = 0,004). Conclusion Our results reveal that plasma netrin-1 levels have been shown to be associated with UC activation, similar to proinflammatory cytokines such as TNF-α and IL-6, in UC.


2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Duygu Alkan ◽  
Berrak Guven ◽  
Cigdem Coskun Turer ◽  
Umut Balli ◽  
Murat Can

Abstract Background The purpose of this study was to investigate gingival crevicular fluid (GCF) and serum folate-receptor 1 (FOLR1) levels in subjects with different periodontal status. Methods The study consists of three groups: Healthy group (n = 15), gingivitis group (n = 15) and chronic periodontitis group (n = 15). Clinical periodontal parameters including probing pocket depth (PPD), clinical attachment level (CAL), gingival index (GI) and bleeding on probing (BOP) were assessed. GCF and serum samples were collected from each patient and were analyzed FOLR1 levels by enzyme-linked immunosorbent assay. Results The values of FOLR1 in GCF were higher in gingivitis and periodontitis groups than among patient in control group (p < 0.016). Serum FOLR1 levels showed no significant difference between the groups. A significant correlation was observed between FOLR1 levels of GCF and BOP (p < 0.05). Conclusions Our preliminary data suggest that FOLR1 is not useful in monitoring the periodontal disease. Further studies are necessary to clarify the role, regulation and function of folate and it’s receptors in the pathogenesis of periodontal disease.


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