Hydrocortisone plus Fludrocortisone -- Promising rescue in septic Shock:

Septic shock is defined by a dysregulated host response to infection, resulting in life-threatening circulatory, cellular, and metabolic abnormalities. The short-term mortality is approximately 45-50%, and around half of survivors of sepsis may have subsequent long-term cognitive decline. Apart from early hemodynamic, respiratory resuscitation and appropriate antimicrobial treatments, there is no approved adjunct therapy for sepsis. JMS 2018: 21 (2):134-135

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Comparison of Prognostic Accuracy of the quick Sepsis-Related Organ Failure Assessment between Short- & Long-term Mortality in Patients Presenting Outside of The Intensive Care Unit - A Systematic Review & Meta-analysis

10.1101/296459 ◽

2018 ◽

Cited By ~ 1

Author(s):

TOH LEONG TAN ◽

Ying Jing Tang ◽

Ling Jing Ching ◽

Noraidatulakma Abdullah ◽

Hui-min Neoh

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Short Term ◽

Suspected Infection ◽

Failure Assessment ◽

Short Term Mortality ◽

Short And Long Term ◽

Qsofa Score ◽

Long Term Mortality

Objective: In year 2016, quick Sepsis-Related Organ Failure Assessment (qSOFA) was introduced as a better sepsis screening tool compared to systemic inflammatory response syndrome (SIRS). The purpose of this systematic review and meta-analysis is to evaluate the ability of the qSOFA in predicting short- and long-term mortality among patients outside the intensive care unit setting. Method: Studies reporting on the qSOFA and mortality from MEDLINE (published between 1946 and 15th December 2017) and SCOPUS (published before 15th December 2017). Hand-checking of the references of relevant articles was carried out. Studies were included if they involved inclusion of patients presenting to the ED; usage of Sepsis-3 definition with suspected infection; usage of qSOFA score for mortality prognostication; and written in English. Study details, patient demographics, qSOFA scores, short-term (<30 days) and long-term (≥30 days) mortality were extracted. Two reviewers conducted all reviews and data extraction independently. Results and Discussion: A total of 39 studies met the selection criteria for full text review and only 36 studies were inclided. Data on qSOFA scores and mortality rate were extracted from 36 studies from 15 countries. The pooled odds ratio was 5.5 and 4.7 for short-term and long-term mortality respectively. The overall pooled sensitivity and specificity for the qSOFA was 48% and 85% for short-term mortality and 32% and 92% for long-term mortality, respectively. Studies reporting on short-term mortality were heterogeneous (Tau=24%, I2=94%, P<0.001), while long-term mortality studies were homogenous (Tau=0%, I2<0.001, P=0.52). The factors contributing to heterogeneity may be wide age group, various clinical settings, variation in the timing of qSOFA scoring, and broad range of clinical diagnosis and criteria. There was no publication bias for short-term mortality analysis. Conclusion: qSOFA score showed a poor sensitivity but moderate specificity for both short and long-term mortality prediction in patients with suspected infection. qSOFA score may be a cost-effective tool for sepsis prognostication outside of the ICU setting.

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Systematic review of clinical outcomes after prophylactic surgery

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2016.0089 ◽

2016 ◽

Vol 98 (6) ◽

pp. 353-357 ◽

Cited By ~ 2

Author(s):

CR Davis ◽

AEJ Trevatt ◽

A Dixit ◽

V Datta

Keyword(s):

Systematic Review ◽

Acute Appendicitis ◽

Prophylactic Surgery ◽

Cochrane Central Register ◽

Short Term ◽

Asymptomatic Patients ◽

Central Register ◽

Life Threatening ◽

History Of

Introduction Prophylactic appendicectomy is performed prior to military, polar and space expeditions to prevent acute appendicitis in the field. However, the risk–benefit ratio of prophylactic surgery is controversial. This study aimed to systematically review the evidence for prophylactic appendicectomy. It is supplemented by a clinical example of prophylactic surgery resulting in life-threatening complications. Methods A systematic review was performed using MEDLINE® and the Cochrane Central Register of Controlled Trials. Keyword variants of ‘prophylaxis’ and ‘appendicectomy’ were combined to identify potential papers for inclusion. Papers related to prophylactic appendicectomy risks and benefits were reviewed. Results Overall, 511 papers were identified, with 37 papers satisfying the inclusion criteria. Nine reported outcomes after incidental appendicectomy during concurrent surgical procedures. No papers focused explicitly on prophylactic appendicectomy in asymptomatic patients. The clinical example outlined acute obstruction secondary to adhesions from a prophylactic appendicectomy. Complications after elective appendicectomy versus the natural history of acute appendicitis in scenarios such as polar expeditions or covert operations suggest prophylactic appendicectomy may be appropriate prior to extreme situations. Nevertheless, the long-term risk of adhesion related complications render prophylactic appendicectomy feasible only when the short-term risk of acute appendicitis outweighs the long-term risks of surgery. Conclusions Prophylactic appendicectomy is rarely performed and not without risk. This is the first documented evidence of long-term complications following prophylactic appendicectomy. Surgery should be considered on an individual basis by balancing the risks of acute appendicitis in the field with the potential consequences of an otherwise unnecessary surgical procedure in a healthy patient.

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CXCL5-mediated recruitment of neutrophils into the peritoneal cavity ofGdf15-deficient mice protects against abdominal sepsis

Proceedings of the National Academy of Sciences ◽

10.1073/pnas.1918508117 ◽

2020 ◽

Vol 117 (22) ◽

pp. 12281-12287 ◽

Cited By ~ 3

Author(s):

Isa Santos ◽

Henrique G. Colaço ◽

Ana Neves-Costa ◽

Elsa Seixas ◽

Tiago R. Velho ◽

...

Keyword(s):

Septic Shock ◽

Organ Dysfunction ◽

Peritoneal Cavity ◽

Host Response ◽

Abdominal Sepsis ◽

Neutrophil Recruitment ◽

Life Threatening ◽

Pathogen Control ◽

Circulating Levels ◽

Deficient Mice

Sepsis is a life-threatening organ dysfunction condition caused by a dysregulated host response to an infection. Here we report that the circulating levels of growth and differentiation factor-15 (GDF15) are strongly increased in septic shock patients and correlate with mortality. In mice, we find that peptidoglycan is a potent ligand that signals through the TLR2-Myd88 axis for the secretion of GDF15, and thatGdf15-deficient mice are protected against abdominal sepsis due to increased chemokine CXC ligand 5 (CXCL5)-mediated recruitment of neutrophils into the peritoneum, leading to better local bacterial control. Our results identify GDF15 as a potential target to improve sepsis treatment. Its inhibition should increase neutrophil recruitment to the site of infection and consequently lead to better pathogen control and clearance.

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P1520Management and outcome of women with NSTEMI. Have there been any changes in recent years?

European Heart Journal ◽

10.1093/eurheartj/ehz748.0282 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

C Cacho ◽

T Gonzalez Ferrero ◽

A Torrelles Fortuny ◽

M Perez Dominguez ◽

C Abbou Johk ◽

...

Keyword(s):

P Value ◽

Evidence Based ◽

Short Term ◽

Killip Class ◽

Hospitalization Period ◽

Short Term Mortality ◽

Baseline Characteristics ◽

Long Term Mortality

Abstract Introduction Women have been less represented in every NSTEMI clinical trial. Moreover, it has been observed that this group of patients have usually received less revascularization and evidence based treatment, therefore presenting with a greater long and short-term mortality. Purpose The purpose of our study is to analyze the presence of differences in baseline characteristics, management and outcome of women with NSTEMI during the last decade. Methods and results Retrospective study including 861 women admitted for NSTEMI between 2003 and 2015 in our center. We divided 2 groups according to hospitalization period (2003–2008 and 2009–2015) with a medium follow up of 4.5±2.9 years. Baseline characteristics and treatment at discharge are described on table 1. We noticed a greater use of statins and ACEI/ARB on the second period as well as a greater percentage of patients receiving early revascularization. It is remarkable on women a non-significant reduction of heart failure hospitalization at follow up (6.8% vs 4.5%; p=0.091), neither differences on 30-day mortality (1.3% vs 0,4%) or 1-year mortality (7.1% vs 5.8%). However, long-term mortality for the second group is reduced (HR 0.69; CI 95% 0.52–0.89), even after performing a multivariate analysis (HR 0.64; CI 95% 0.48–0.85). Characteristic Population (n=861) 2003–2008 (n=395) 2009–2015 (n=466) p-value Age (years) 73±12 73±12 72±12 0.316 Hypertension 629 (73.1%) 285 (72.2%) 344 (73.8%) 0.318 Hypercholesterolemia 414 (48.1%) 190 (48.1%) 224 (48.1%) 0.523 Killip class 0.292 I 664 (77.1%) 299 (75.7%) 365 (78.3%) II 143 (16.6%) 74 (18.7%) 69 (14.8%) III 47 (5.5%) 20 (5.1%) 27 (5.8%) IV 4 (0.5%) 2 (0.5%) 2 (0.4) GRACE score 129±32 130±37 128±33 0.897 Early PCI 249 (29.3%) 76 (19.2%) 173 (38.0%) <0.005 Treatment at discharge AAS 698 (81.1%) 313 (79.2%) 385 (82.6%) 0.120 Clopidogrel 465 (54.0%) 221 (55.9%) 244 (52.4%) 0.162 ACEI/ARB 466 (54.1%) 191 (48.4%) 275 (59.0%) 0.001 Beta-blocker 509 (59.1%) 238 (60.3%) 271 (58.2%) 0.290 Statins 643 (74.7%) 275 (69.6%) 368 (79.0%) 0.001 Conclusions In recent years, early interventionist management and greater use of evidence-based therapies have been observed in women with NSTEMI. This has been associated with a lesser long-term mortality, although short-term events have remained the same.

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Metabolic aspects of polycystic ovary syndrome

Reproductive Medicine Review ◽

10.1017/s0962279900001423 ◽

1997 ◽

Vol 6 (2) ◽

pp. 69-79

Author(s):

Robert A Wild

Keyword(s):

Polycystic Ovary ◽

Clinical Approach ◽

Metabolic Abnormalities ◽

Short Term ◽

Chronic Disorder ◽

Clinical Syndromes ◽

Study Results ◽

The Many ◽

Pco Syndrome

Metabolic abnormalities in patients with PCO syndrome demand that we change our clinical approach to PCO syndrome. No longer should the approach be short-term and driven by symptoms, rather it must recognize that PCO syndrome is a chronic disorder. Associated metabolic abnormalities may have long-term sequelae and their recognition influences not only how we evaluate patients, but also how we implement prevention. Observational, interventional, epidemiological and now mechanistic studies need to focus on interactive issues. Outcome study results are awaited to determine the likelihood of sequelae and to optimize preventive strategies. The PCO paradigm is a complex biological experiment on nature that offers a superb opportunity to begin to understand the many ways in which hormones affect atherogenesis. It is important to understand the clinical syndromes encompassed in this paradigm. Atherogenic consequences are still responsible for the majority of deaths in the industrialized world!

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Parallels in Sepsis and COVID-19 Conditions: Implications for Managing Severe COVID-19

Frontiers in Immunology ◽

10.3389/fimmu.2021.602848 ◽

2021 ◽

Vol 12 ◽

Author(s):

Charles Ochieng’ Olwal ◽

Nora Nghuchuzie Nganyewo ◽

Kesego Tapela ◽

Alexandra Lindsey Djomkam Zune ◽

Oloche Owoicho ◽

...

Keyword(s):

Septic Shock ◽

Respiratory Failure ◽

Host Response ◽

Cytokine Production ◽

Opportunistic Infections ◽

Global Burden ◽

Life Threatening ◽

Patients Experience ◽

Sepsis Care ◽

Multi Organ Dysfunction Syndrome

Sepsis is a life-threatening systemic illness attributed to a dysregulated host response to infection. Sepsis is a global burden killing ~11 million persons annually. In December 2019, a novel pneumonia condition termed coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged and has resulted in more than 1,535,982 deaths globally as of 8th December 2020. These two conditions share many pathophysiological and clinical features. Notably, both sepsis and COVID-19 patients experience consumptive thrombocytopenia, haemolytic anaemia, vascular microthrombosis, multi-organ dysfunction syndrome, coagulopathy, septic shock, respiratory failure, fever, leukopenia, hypotension, leukocytosis, high cytokine production and high predisposition to opportunistic infections. Considering the parallels in the immunopathogenesis and pathophysiological manifestations of sepsis and COVID-19, it is highly likely that sepsis care, which has a well-established history in most health systems, could inform on COVID-19 management. In view of this, the present perspective compares the immunopathogenesis and pathophysiology of COVID-19 and non-SARS-CoV-2 induced sepsis, and lessons from sepsis that can be applicable to COVID-19 management.

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Iliofemoral deep vein thrombosis and the problem of post-thrombotic syndrome

Acute Medicine Journal ◽

10.52964/amja.0708 ◽

2018 ◽

Vol 17 (2) ◽

pp. 99-103

Author(s):

Nicholas Denny ◽

◽

Shreshta Musale ◽

Helena Edlin ◽

Jecko Thachil ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Compression Stockings ◽

Short Term ◽

Vein Thrombosis ◽

Post Thrombotic Syndrome ◽

Catheter Directed Thrombolysis ◽

Short Term Mortality ◽

Considerable Morbidity ◽

Deep Vein

Deep vein thrombosis (DVT) is an important cause of short-term mortality and long-term morbidity. Among the different presentations of DVT, thrombus in the iliofemoral veins may be considered the severest form. Although anticoagulation is the mainstay of the management of iliofemoral thrombosis, despite adequate anticoagulant treatment, complications including post-thrombotic syndrome is not uncommon. The latter is often overlooked but can cause considerable morbidity to the affected individuals. Preventing this condition remains a challenge but recent clinical trials of catheter directed thrombolysis and elasticated compression stockings provide some advance in this context. In this article, with the aid of a clinical case, we review the particular considerations to take into account when managing patients with an iliofemoral DVT.

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The Effect of Early Vasopressin Use on Patients With Septic Shock: A Systematic Review and Meta-analysis

10.21203/rs.3.rs-99744/v1 ◽

2020 ◽

Author(s):

Haijun Huang ◽

Chenxia Wu ◽

Qinkang Shen ◽

Hua Xu ◽

Yixin Fang ◽

...

Keyword(s):

Septic Shock ◽

Length Of Stay ◽

Meta Analysis ◽

Mean Difference ◽

Short Term ◽

Vasopressin Infusion ◽

Icu Length Of Stay ◽

Short Term Mortality ◽

Length Of Hospitalization ◽

New Onset

Abstract Background: The effect of early vasopressin initiation on clinical outcomes in patients with septic shock is uncertain. A systematic review and meta-analysis was performed to evaluate the impact of early start of vasopressin support within 6 hours after the diagnosis on clinical outcomes in septic shock patients.Methods: We searched the PubMed, Cochrane, and Embase databases for randomized controlled trials (RCTs) and cohort studies from inception to the 1st of October 2020. We included studies involving adult patients (> 16 years)with septic shock. All authors reported our primary outcome of short-term mortality and in the experimental group patients in the studies receiving vasopressin infusion within 6 hours after diagnosis of septic shock and in the control group patients in the studies receiving no vasopressin infusion or vasopressin infusion 6 hours after diagnosis of septic shock, clearly comparing with clinically relevant secondary outcomes(use of renal replacement therapy(RRT),new onset arrhythmias, ICU length of stay and length of hospitalization). Results were expressed as odds ratio (OR) and mean difference (MD) with accompanying 95% confidence interval (CI).Results: Five studies including 788 patients were included. The primary outcome of this meta-analysis showed that short-term mortality between the two groups was no difference (odds ratio [OR] = 1.09; 95% CI, 0.8 to 1.48; P =0.6; χ2 =0.83; I2 = 0%). Secondary outcomes demonstrated that the use of RRT was less in the experimental group than that of the control group (OR =0.63; 95% CI, 0.44 to 0.88; P =0.007; χ2 =3.15; I2 =36%).The new onset arrhythmias between the two groups was no statistically significant difference (OR =0.59; 95% CI, 0.31 to 1.1; P =0.10; χ2 =4.7; I2 =36%). There was no statistically significant difference in the ICU length of stay(mean difference = 0.16; 95% CI, - 0.91 to 1.22; P = 0.77; χ2 = 6.08; I2 =34%) and length of hospitalization (mean difference = -2.41; 95% CI, -6.61 to 1.78; P = 0.26; χ2 = 8.57; I2 =53%) between the two groups.Conclusions: Early initiation of vasopressin in patients within 6 hours of septic shock onset was not associated with decreased short-term mortality, new onset arrhythmias, shorter ICU length of stay and length of hospitalization, but can reduce the use of RRT. Further large-scale RCTs are still needed to evaluate the benefit of starting vasopressin in the early phase of septic shock.

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diagnosis and trEatmEnt of patiEnts in sEptiC shoCK

New Medicine ◽

10.5604/01.3001.0009.7846 ◽

2017 ◽

Vol 21 (1) ◽

pp. 31-36

Author(s):

Jacek wadełek

Keyword(s):

Septic Shock ◽

Organ Dysfunction ◽

Host Response ◽

Signs And Symptoms ◽

Intravenous Fluids ◽

Failure Assessment ◽

Acute Change ◽

Life Threatening ◽

Sepsis And Septic Shock ◽

Clinical Emergency

sepsis and septic shock are a clinical emergency. sepsis is defined as a life-threatening organ dysfunction due to a dysregulated host response to infection, and organ dysfunction is defined as an acute change in sequential organ failure assessment (sofa) score greater than 2 points secondary to an infectious cause. septic shock is defined as sepsis with persisting hypotension requiring vasopressors to maintain a mean arterial pressure of 65 mm hg or higher, and blood lactate level greater than 2 mmol/l (18 mg/dl) despite adequate volume resuscitation. the diagnosis of septic shock begins with medical history and physical examination focused on the signs and symptoms of infection, with the aim of recognizing complex physiologic manifestations of shock. Clinicians should understand the importance of prompt administration of antibiotics, vasopressors and intravenous fluids aimed at restoring adequate circulation. they should also be aware of the limitations of the protocol-based therapy.

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The predictive value of lymphocyte-to-monocyte ratio in the prognosis of acute coronary syndrome patients: A systematic review and meta-analysis

10.21203/rs.2.17238/v2 ◽

2020 ◽

Author(s):

Xiao-Qing Quan ◽

Run-Chang Wang ◽

Qing Zhang ◽

Cun-Tai Zhang ◽

Lei Sun

Keyword(s):

Systematic Review ◽

Acute Coronary Syndrome ◽

Meta Analysis ◽

Cochrane Library ◽

Short Term ◽

Coronary Syndrome ◽

Lymphocyte To Monocyte Ratio ◽

Short Term Mortality ◽

Long Term Mortality

Abstract Background: The association between the lymphocyte-to-monocyte ratio (LMR) and prognosis of patients with acute coronary syndrome (ACS) is not fully understood. We performed this systematic review and meta-analysis to evaluate the correlation between LMR and mortality or major adverse cardiac events (MACE) in patients with ACS. Methods: A systematic search was performed in PubMed, MEDLINE, EMBASE, the Cochrane Library, Scopus and Web of science. The association between LMR and mortality or MACE was analyzed in patients with ACS. The search was updated to April 15, 2020. Results: A total of 5 studies comprising 4343 patients were included in this meta-analysis. The results showed that lower LMR predicted short-term mortality/MACE (hazard ratio [HR] = 3.44, 95% confidence interval [CI]: 1.46–8.14, P < 0.05) and higher long-term mortality/MACE (HR = 1.70, 95% CI: 1.36– 2.13, P < 0.05). According to our subgroup analysis, there is still has a statistical significance for LMR to predict long-term mortality/MACE in any subgroups. Conclusions: This study suggested that lower LMR value might be associated with higher short-term mortality/MACE and long-term mortality/MACE in ACS patients. Especially for younger ACS patients, low LMR was more closely associated with poor prognosis.

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