scholarly journals A Young Diabetic Lady with Emphysematous Pyelonephritis

1970 ◽  
Vol 13 (1) ◽  
pp. 72-74
Author(s):  
Ahmad Mursel Anam ◽  
Farzana Shumy ◽  
Mohammad Mufizul Islam Polash ◽  
Raihan Rabbani ◽  
Abed Hussain Khan ◽  
...  
Keyword(s):  
Septic Shock ◽  
Paralytic Ileus ◽  
Clinical Suspicion ◽  
Abdominal Radiograph ◽  
Emphysematous Pyelonephritis ◽  
Plain Abdominal Radiograph ◽  
Threatening Condition ◽  
Life Threatening ◽  
Fluid Levels ◽  
High Degree

A rare and potentially life-threatening condition is reported. A young diabetic lady presented with septic shock and features of paralytic ileus. A plain abdominal radiograph suggested “megacolon with gas-fluid levels”. But high degree of clinical suspicion persuaded us to perform a CT scan of abdomen, which revealed emphysematous pyelonephritis. This enabled us to start early effective treatment and eventually save the patient. DOI: http://dx.doi.org/10.3329/jom.v13i1.10055 JOM 2012; 13(1): 72-74

scholarly journals Emphysematous Pyelonephritis Caused by a Giant Fecaloma

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Mikael Abi Abdallah ◽  
Nehme Raad ◽  
Naim Yarak ◽  
Jean Paul Noujeim ◽  
Antoine Noujeim
Keyword(s):  
Septic Shock ◽  
Fecal Impaction ◽  
Routine Clinical Practice ◽  
Rapid Progression ◽  
Aggressive Treatment ◽  
Emphysematous Pyelonephritis ◽  
First Case ◽  
Threatening Condition ◽  
Life Threatening ◽  
High Index Of Suspicion

Emphysematous pyelonephritis (EPN) is a gas-producing necrotizing bacterial infection that involves the renal parenchyma and perirenal tissue. It is a life-threatening condition that requires a high index of suspicion, an early diagnosis and an aggressive treatment. Rapid progression to septic shock may occur. We report, to the best of our knowledge, the first case of obstructive EPN caused by a giant fecaloma. The patient was successfully treated with percutaneous drainage and broad-spectrum antibiotics, in addition to fecaloma evacuation using fleet enemas and oral laxatives. This shows how fecal impaction, a common pathology in routine clinical practice, can cause some serious complications if left untreated, including extrinsic ureteral compression.

scholarly journals Penetration of Isavuconazole in Ascites Fluid of Critically Ill Patients

2021 ◽  
Vol 7 (5) ◽  
pp. 376
Author(s):  
Tobias Lahmer ◽  
Gonzalo Batres Baires ◽  
Roland M. Schmid ◽  
Johannes R. Wiessner ◽  
Jörg Ulrich ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Ascites Fluid ◽  
Candida Spp ◽  
Fungal Peritonitis ◽  
Penetration Ratio ◽  
Threatening Condition ◽  
Liquid Chromatography Tandem Mass ◽  
Life Threatening ◽  
Fluid Levels

Fungal peritonitis is a life-threatening condition which is not only difficult to diagnose, but also to treat. Following recent guidelines, echinocandins and azoles are the recommended antimycotics for the management of intra-abdominal Candida spp. infections, with a favor for echinocandins in critically ill patients. However, the new extended spectrum triazole isavuconazole also has a broad spectrum against Candida spp. Data on its target-site penetration are sparse. Therefore, we assessed isavuconazole concentrations and penetration ratios in ascites fluid of critically ill patients. Obtaining of Isavuconazole plasma and ascites fluid levels as well penetration ratios using paracentesis in critically ill patients. Isavuconazole concentrations were quantified in human plasma and ascites by a liquid chromatography/tandem mass spectrometry (LC-MS/MS) method. Isavuconazole concentrations in plasma and ascites fluid were measured in sixteen critically ill patients. Isavuconazol levels in ascites fluid (1.06 µg/mL) were lower than plasma levels (3.08 µg/mL). Penetration ratio was 36%. In two out of sixteen patients, Candida spp., in detail C. glabrata and C. tropicalis, could be isolated. Cmax/MIC Ratio in plasma of 560 for C. glabrata and 2166 for C. tropicalis could be observed. Following our results, isavuconazole penetrates into ascites. Successful treatment in Candida spp. peritonitis depends on pathogen susceptibility.

Assessment and care of the patient with sepsis

2020 ◽  
pp. 225-257
Author(s):  
Kevin Barrett
Keyword(s):  
Septic Shock ◽  
Early Recognition ◽  
Scoring Systems ◽  
Cardiovascular Responses ◽  
Physiological Changes ◽  
Assessment Framework ◽  
Threatening Condition ◽  
Life Threatening ◽  
Support Mechanisms ◽  
Sepsis And Septic Shock

There has been considerable recent focus on sepsis in both the clinical arena and within the general public to raise awareness of the importance of early recognition of this potentially life-threatening condition. The early recognition of sepsis by ward nurses can both reduce progression of this lethal disease and improve survival for patients in hospital. This chapter focuses on definitions of sepsis and septic shock, physiological changes associated with inflammatory and cardiovascular responses to sepsis, and a clinical assessment framework to guide practice. There is also a discussion of the use of scoring systems and how to escalate support mechanisms for patients with sepsis and septic shock.

scholarly journals Favorable 90-Day Mortality in Obese Caucasian Patients with Septic Shock According to the Sepsis-3 Definition

2019 ◽  
Vol 9 (1) ◽  
pp. 46 ◽  
Author(s):  
Caspar Mewes ◽  
Carolin Böhnke ◽  
Tessa Alexander ◽  
Benedikt Büttner ◽  
José Hinz ◽  
...  
Keyword(s):  
Septic Shock ◽  
Protective Effect ◽  
Cox Regression ◽  
Obese Patients ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
Threatening Condition ◽  
Life Threatening ◽  
Caucasian Patients ◽  
Patient Prognosis

Septic shock is a frequent life-threatening condition and a leading cause of mortality in intensive care units (ICUs). Previous investigations have reported a potentially protective effect of obesity in septic shock patients. However, prior results have been inconsistent, focused on short-term in-hospital mortality and inadequately adjusted for confounders, and they have rarely applied the currently valid Sepsis-3 definition criteria for septic shock. This investigation examined the effect of obesity on 90-day mortality in patients with septic shock selected from a prospectively enrolled cohort of septic patients. A total of 352 patients who met the Sepsis-3 criteria for septic shock were enrolled in this study. Body-mass index (BMI) was used to divide the cohort into 24% obese (BMI ≥ 30 kg/m2) and 76% non-obese (BMI < 30 kg/m2) patients. Kaplan-Meier survival analysis revealed a significantly lower 90-day mortality (31% vs. 43%; p = 0.0436) in obese patients compared to non-obese patients. Additional analyses of baseline characteristics, disease severity, and microbiological findings outlined further statistically significant differences among the groups. Multivariate Cox regression analysis estimated a significant protective effect of obesity on 90-day mortality after adjustment for confounders. An understanding of the underlying physiologic mechanisms may improve therapeutic strategies and patient prognosis.

scholarly journals Tuberculosis in an infant with Hirschsprung-associated enterocolitis: a case report

2021 ◽  
Vol 49 (9) ◽  
pp. 030006052110434
Author(s):  
Yue Song ◽  
Changqiang Yang ◽  
Hua Wang
Keyword(s):  
Case Report ◽  
Early Diagnosis ◽  
Complete Resolution ◽  
Pulmonary Nodules ◽  
Hirschsprung Disease ◽  
Abdominal Radiograph ◽  
Threatening Condition ◽  
Life Threatening ◽  
Pull Through ◽  
Small Pulmonary Nodules

Hirschsprung-associated enterocolitis (HAEC) is a serious and life-threatening condition, and atypical tuberculosis (TB) associated with HAEC is even more serious. A male newborn aged 4 days was diagnosed with Hirschsprung disease and transanal Soave pull-through was performed at 4 months old. Six months later, he suffered from enterocolitis. Although he was treated with multiple broad-spectrum antibiotics for 2 weeks, he developed a fever without any other symptoms for TB infection. We found numerous, bilateral, uniformly distributed, small pulmonary nodules in the lower lobes in an abdominal radiograph by chance. He was then discharged with complete resolution of all symptoms after anti-TB therapy. Early diagnosis and treatment of TB can effectively improve the prognosis of children with HAEC.

scholarly journals Importance of haemodynamic stability and adjuvant therapy in the treatment of patients with sepsis and septic shock

2020 ◽  
Vol 45 (4) ◽  
pp. 153-158
Author(s):  
Vesna Marjanović ◽  
Ivana Budić ◽  
Saša Ignjatijević ◽  
Marija Stević ◽  
Dušica Simić
Keyword(s):  
Septic Shock ◽  
Adjuvant Therapy ◽  
Isotonic Saline ◽  
Fluid Replacement ◽  
Initial Assessment ◽  
Hemodynamic Stability ◽  
Threatening Condition ◽  
Life Threatening ◽  
Sepsis And Septic Shock ◽  
Vasoactive Medications

Sepsis represents a life-threatening condition that requires prompt recognition, detailed initial assessment and energetic administration of therapy. Guidelines published in 2016 emphasized the importance of early fluids replacement and infection control together with assessment based on laboratory parameters and precise monitoring of hemodynamic status of septic patients within the first 3-6 hours after diagnosis. Revision that followed in 2018 stressed that all therapeutic actions should be initiated within the first hour after diagnosis. Urgent administration of isotonic saline and balanced crystalloids in a dose of 30ml/kg should provide adequate hemodynamic stability of septic patients. If the fluid replacement fails to achieve hemodynamic stability and mean arterial pressure >65 mmHg, addition of vasopressors is mandatory. The vasopressor of choice for septic patients is norepinephrine. It may be used alone or in combination with other vasopressors such as epinephrine, vasopressin, terlipresine or phenylephrine. Septic patients with inadequate cardiac output after fluid replacement, and cardiomyopathy induced by sepsis or those with combined shock may need treatment with inotropic medication such as epinephrine or dobutamine. Adjuvant therapy with steroids, immunoglobulins, anticoagulants, statins, vitamin C and Bl, may be useful, but no benefit regarding the overall outcome was observed. In conclusion, early detection of sepsis and septic shock within the first hour and immediate adequate fluid administration with vasoactive medications to maintain hemodynamic stability, are crucial for achievement of better outcome of these patients.

scholarly journals Erastin Inhibits Septic Shock and Inflammatory Gene Expression via Suppression of the NF-κB Pathway

2019 ◽  
Vol 8 (12) ◽  
pp. 2210 ◽  
Author(s):  
Byung Moo Oh ◽  
Seon-Jin Lee ◽  
Gyoung Lim Park ◽  
Yo Sep Hwang ◽  
Jeewon Lim ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Septic Shock ◽  
Inflammatory Response ◽  
Nuclear Translocation ◽  
Cecal Ligation ◽  
Abnormal Immune Response ◽  
Iκb Kinase ◽  
Tnf Α ◽  
Threatening Condition ◽  
Life Threatening

Sepsis is a life-threatening condition that is caused by an abnormal immune response to infection and can lead to tissue damage, organ failure, and death. Erastin is a small molecule capable of initiating ferroptotic cell death in cancer cells. However, the function of erastin in the inflammatory response during sepsis remains unknown. Here, we showed that erastin ameliorates septic shock induced by cecal ligation and puncture or lipopolysaccharides (LPS) in mice, which was associated with a reduced production of inflammatory mediators such as nitric oxide, tumor necrosis factor (TNF)-α, and interleukin (IL)-1β. Pretreatment with erastin in bone marrow-derived macrophages (BMDMs) significantly attenuated the expression of inducible nitric oxide synthase, cyclooxygenase-2, TNF-α, and IL-1β mRNA in response to LPS treatment. Furthermore, we also showed that erastin suppresses phosphorylation of IκB kinase β, phosphorylation and degradation of IκBα, and nuclear translocation of nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) in LPS-stimulated BMDMs. Our findings suggest that erastin attenuates the inflammatory response by suppressing the NF-κB signaling pathway, resulting in inhibition of sepsis development. This study provides new insights regarding the potential therapeutic properties of erastin in sepsis.

scholarly journals DRESS Syndrome due to Nevirapine Treated with Methylprednisolone

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Henrique Pott Junior ◽  
Gisele Cristina Gosuen ◽  
Ana Cristina Gales
Keyword(s):  
Clinical Presentation ◽  
Mortality Rates ◽  
Multiple Organ ◽  
Clinical Suspicion ◽  
Significant Morbidity ◽  
Dress Syndrome ◽  
Infected Female ◽  
Threatening Condition ◽  
Life Threatening ◽  
Systemic Symptoms

Nevirapine-induced DRESS syndrome is uncommon but a potentially life-threatening condition, with significant morbidity and mortality rates due to multiple-organ involvement. The authors report a case of a 47-year-old HIV-infected female patient who presented with fever, right hypochondrium pain, jaundice, and skin rash. The Nevirapine-induced DRESS syndrome was suspected based on clinical presentation and RegiSCAR scoring system. This case highlights the need for a high index of clinical suspicion among HIV-infected patients with severe skin eruption and systemic symptoms.

scholarly journals Atypical Presentation of Lemierre’s Syndrome Causing Septic Shock and Acute Respiratory Distress Syndrome

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Divyesh Reddy Nemakayala ◽  
Manoj P Rai ◽  
Shilpa Kavuturu ◽  
Supratik Rayamajhi
Keyword(s):  
Septic Shock ◽  
Young Female ◽  
Sudden Onset ◽  
Lemierre’S Syndrome ◽  
Oropharyngeal Infection ◽  
Threatening Condition ◽  
Life Threatening ◽  
Chest X Ray ◽  
Lemierre’S Disease ◽  
Lemierre's Syndrome

Lemierre’s disease is a rare but life-threatening condition characterized by an oropharyngeal infection complicating with thrombophlebitis of the internal jugular vein and disseminated abscesses. We are presenting a case of a young female who initially presented with fevers, chills, sore throat, and swollen neck later developed progressively worsening shortness of breath along with sudden onset pleuritic chest pain. She then developed progressively worsening acute hypoxic respiratory failure requiring intubation and mechanical ventilation. Interval chest X-ray showed worsening bilateral effusions. She also developed septic shock requiring pressors. Blood culture showed Fusobacterium, and antibiotics were changed accordingly following which there was a clinical improvement. The diagnosis of Lemierre’s syndrome was then established based on her presenting age and bilateral pulmonary empyema in the setting of septicemia with Fusobacterium.

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