scholarly journals Acute pancreatitis : a newly recognised potential complication of canine babesiosis

2000 ◽  
Vol 71 (4) ◽  
Author(s):  
A.J. Möhr ◽  
R.G. Lobetti ◽  
J.J. Van der Lugt
Keyword(s):  
Renal Failure ◽  
Acute Pancreatitis ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Haemolytic Anaemia ◽  
Distress Syndrome ◽  
Pathophysiological Mechanism ◽  
Canine Babesiosis ◽  
Immune Mediated

This retrospective study describes 4 cases of canine babesiosis with histologically confirmed acute pancreatitis. In addition, 16 dogs with babesiosis are reported with serum amylase (>3500 U/l ) and/or lipase (>650 U/l ) activity elevations of a magnitude that would support a diagnosis of probable acute pancreatitis, although extra-pancreatic sources of the enzymes could not be excluded in these cases. Median time of pancreatitis diagnosis was 2.5 days post-admission, with primarily young (median age 3 years), sexually intact dogs affected. The development of pancreatitis was unrelated to the degree of anaemia at time of admission. In addition to pancreatitis, 80 % of cases suffered from other babesial complications, namely icterus (13), acute respiratory distress syndrome (6), immune-mediated haemolytic anaemia (6), renal failure (3), haemoconcentration (2) and cerebral syndrome (2). Acute respiratory distress syndrome, renal failure and cerebral syndrome were associated with a poor prognosis, with 4 of the 5 dogs included in the overall 26 % mortality rate having at least 1 of these complications. Haemolytic anaemia with ischaemia-reperfusion injury to the pancreas is proposed as a possible primary pathophysiological mechanism in babesial pancreatitis. Hypotensive shock, immune-mediated haemolytic anaemia, haemoconcentration and possibly altered lipid metabolism in babesiosis may also be involved. The previously postulated pro-inflammatory cytokine milieu of complicated babesiosis may underlie the progression, if not the primary initiation, of pancreatic pathology. Acute pancreatitis may represent the previously reported 'gut' form of babesiosis.

scholarly journals Nomogram for the prediction of in-hospital incidence of acute respiratory distress syndrome in patients with acute pancreatitis

2020 ◽  
Author(s):  
Ning Ding ◽  
Cuirong Guo ◽  
Yuchai Huang ◽  
Changluo Li ◽  
Yang Zhou ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Primary Outcome ◽  
Distress Syndrome ◽  
Validation Cohort ◽  
Predicted Probability ◽  
Tertiary Hospitals ◽  
Retrospective Nature

AbstractObjectiveThe aim of this study was to formulate and validate an individualized predictive nomogram for in-hospital incidence of acute respiratory distress syndrome (ARDS) in patients with acute pancreatitis(AP).DesignIt was a retrospective cohort study.SettingDepartments of Emergency Medicine of two university-affiliated tertiary hospitals, Changsha, China.ParticipantsFrom January 2017 to December 2018, 779 individuals with AP were included in this study.Primary outcome measuresThe in-hospital incidence of ARDS was assessed.ResultsAP patients were randomly distributed into primary cohort(n=560)and validation cohort(n=219). Based on the primary cohort, risk factors were identified by logistic regression model and a nomogram was performed. Five independent factors including white blood counts(WBC),prothrombin time(PT),albumin(ALB),serum creatinine(SCR) and triglyceride (TG) were associated with in-hospital incidence of ARDS in AP patients. A nomogram was constructed based on the five independent factors with primary cohort of AUC 0.821 and validation cohort of AUC 0.822. Calibration curve analysis indicated that the predicted probability was in accordance with the observed probability in both primary and validation cohorts.ConclusionsThe study developed an intuitive nomogram with easily available laboratory parameters for the prediction of in-hospital incidence of ARDS in patients with AP. The incidence of ARDS for an individual patient can be fast and conveniently evaluated by our nomogram.Strengths and limitations of this studyThis is the first study to develop a nomogram for predicting the in-hospital incidence of ARDS in AP patients.For each AP patient, our nomogram enables physicians to directly and conveniently calculate a numeric probability of ARDS.There might be patient selection biases owing to retrospective nature of our study.

Does acute kidney injury affect survival in adults with acute respiratory distress syndrome requiring extracorporeal membrane oxygenation?

Perfusion ◽  
2018 ◽  
Vol 33 (5) ◽  
pp. 375-382 ◽  
Author(s):  
Richard Devasagayaraj ◽  
Nicholas C. Cavarocchi ◽  
Hitoshi Hirose
Keyword(s):  
Acute Kidney Injury ◽  
Renal Failure ◽  
Acute Respiratory Distress Syndrome ◽  
Extracorporeal Membrane Oxygenation ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Kidney Injury ◽  
Membrane Oxygenation ◽  
Vv Ecmo

Introduction: Patients who develop severe acute respiratory distress syndrome (ARDS) despite full medical management may require veno-venous extracorporeal membrane oxygenation (VV ECMO) to support respiratory function. Survival outcomes remain unclear in those who develop acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT) during VV ECMO for isolated severe respiratory failure in adult populations. Methods: A retrospective chart review (2010-2016) of patients who underwent VV ECMO for ARDS was conducted with university institutional review board (IRB) approval. Patients supported by veno-arterial ECMO were excluded. AKI was defined by acute renal failure receiving CRRT and the outcomes of patients on VV ECMO were compared between the AKI and non-AKI groups. Results: We identified 54 ARDS patients supported by VV ECMO (mean ECMO days 12 ± 6.7) with 16 (30%) in the AKI group and 38 (70%) in the non-AKI group. No patient had previous renal failure and the serum creatinine was not significantly different between the two groups at the time of ECMO initiation. The AKI group showed a greater incidence of complications during ECMO, including liver failure (38% vs. 5%, p=0.002) and hemorrhage (94% vs. 45%, p=0.0008). ECMO survival of the AKI group (56% [9/16]) was inferior to the non-AKI group (87% [33/38], p=0.014). Conclusions: Our study demonstrated that VV ECMO successfully manages patients with severe isolated lung injury. However, once patients develop AKI during VV ECMO, they are likely to further develop multi-organ dysfunction, including hepatic and hematological complications, leading to inferior survival.

scholarly journals Histological Changes in the Components of Aerogematic Barrier in 24 Hours after Modeling of Acute Renal Failure

2021 ◽  
Vol 6 (3) ◽  
pp. 96-101
Author(s):  
I. P. Klishch ◽  
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Acute Respiratory Distress Syndrome ◽  
Acute Lung Injury ◽  
Lung Injury ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Ultrastructural Changes ◽  
Blood Capillaries

Nowadays, acute renal failure remains one of the most complex problems in modern medicine. Multiple studies have proved that acute renal failure is frequently accompanied by the development of acute lung injury and its most severe form – acute respiratory distress syndrome. According to the literature, lethality in case of acute lung injury or acute respiratory distress syndrome is extremely high and is 30-65%. In case of combination of acute renal failure and acute lung injury or acute respiratory distress syndrome, the most frequently observed in critical patients, lethality reaches 80%. The purpose of the study was to study the possibility of ultrastructural changes of the respiratory tract in the lungs due to experimental modeling of acute renal failure. Materials and methods. The experiments were performed on 30 mature white male rats weighting 180-220 grams. Acute renal failure was induced by intramuscular administration of 50% glycerol water solution in dose of 10 ml per 1 kg of body mass. The sampling of lung tissue for electron microscopy study was carried out under the ketamine anaesthesia in 24 hours after beginning of the experiment. The pieces of lung tissue were fixed in 2.5% solution of gluteraldehyde with further postfixation in 1% solution of osmium tetroxide. After dehydration, the material was poured over epon araldite. The cuts, obtained on ultramicrotome “Tesla BS-490”, were studied using electron microscope “PEM-125K”. Results and discussion. In 24 hours after the beginning of the experiment, the changes in the alveolocytes of types I and II, endotheliocytes, alveolar macrophages are accompanied by the development of intracellular edema with ultrastructural disorder of organelles. Because of endotheliocytes edema and aggregation of forming blood elements, some blood capillaries lumens are closed or drastically narrowed. In some blood capillaries, we observe disorder of the luminal membrane integrity of endothelial cells accompanied by exit of the intracellular content into the micro blood vessel lumen. The expressed disorders of structural organization of the components of pulmonary aero-hematic barrier cause the exit of forming blood elements into the interstitial tissue and alveoli. Conclusion. Тhe detected changes in 24 hours of the experiment have a dystrophic-destructive character and are manifested by the development of edema in alveolocytes of types I and II, alveolar macrophages, endotheliocytes of hemocapillaries. Perspective for further research. Considering the severity of ultrastructural changes that develop in experimental acute renal failure, it would be reasonable to conduct a further study in order to find possible methods of prevention and timely correction

scholarly journals Complement Inhibition in Severe COVID-19 Acute Respiratory Distress Syndrome

2020 ◽  
Vol 8 ◽  
Author(s):  
Sharmila Raghunandan ◽  
Cassandra D. Josephson ◽  
Hans Verkerke ◽  
W. Matthew Linam ◽  
Treva C. Ingram ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Kidney Injury ◽  
Complement Inhibition ◽  
Immune Mediated ◽  
Detailed Evaluation

Most children with COVID-19 have asymptomatic or mild illness. Those who become critically ill suffer from acute respiratory distress syndrome (ARDS) and acute kidney injury (AKI). The rapid deterioration of lung function has been linked to microangiopathic and immune-mediated processes seen in the lungs of adult patients with COVID-19. The role of complement-mediated acute lung injury is supported by animal models of SARS-CoV, evaluation of lung tissue in those who died from COVID-19 and response of COVID-19 ARDS to complement inhibition. We present a summary of a child with COVID-19 disease treated with convalescent plasma and eculizumab and provide a detailed evaluation of the inflammatory pathways.

scholarly journals Outcomes of Extracorporeal Membrane Oxygenation in Acute Respiratory Distress Syndrome due to COVID-19, lessons learned from the first wave of COVID 19

2021 ◽  
Author(s):  
Cameron Blazoski ◽  
Michael Baram ◽  
Hitoshi Hirose
Keyword(s):  
Septic Shock ◽  
Renal Failure ◽  
Acute Respiratory Distress Syndrome ◽  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Extracorporeal Membrane Oxygenation ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Culture Negative

Introduction: Extracorporeal membrane oxygenation (ECMO) has been used as a refractory treatment for acute respiratory distress syndrome (ARDS) due to COVID-19, but there has been little evidence of its efficacy. We conducted this study to share our experience using ECMO as a bridge to recovery for ARDS due to COVID-19. Methods: All adult patients who were placed on ECMO for ARDS due to COVID -19 between April 2020 and June 2020 (during the first wave of COVID-19) were identified. The clinical characteristics and outcomes of these patients were analyzed with a specific focus on the differences between patients who survived to hospital discharge and those who did not. Results: 20 COVID-19 patients were included in this study. All patients were placed on veno-veno ECMO. Comparing between survivors and non-survivors, older age was associated with hospital mortality (p=0.02). The following complications were observed: renal failure requiring renal replacement therapy (35%, n=7), bacteremia during ECMO (20%, n=4),coinfection with bacterial pneumonia (15%, n=3), cannula site bleeding (15%, n=3), stroke (10%, n=2), gastrointestinal bleeding (10%, n=2), and liver failure (5%, n=1). The complications associated with patient mortality were culture positive septic shock (p=0.01), culture-negative systemic inflammatory response syndrome (p=0.01), and renal failure (p=0.01). The causes of death were septic shock (44%, n=4), culture-negative systemic inflammatory response syndrome (44%, n=4), and stroke (11%, n=1). Conclusions: Based on our experience, ECMO can improve refractory ARDS due to COVID-19 in select patients. Proper control of bacterial infections during COVID-19 immunomodulation therapy may be critical to improving survival.

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