High Mortality
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Anu Yarky ◽  
Vipan Kumar ◽  
Nidhi Chauhan ◽  
Neha Verma

Hemophagocytic lymphohistiocytosis (HLH) is a rare and life-threatening syndrome of excessive activation of immune system. It frequently affects infants from birth to 18 months of age, but is also observed in children and adults of all ages. HLH can occur as a familial or sporadic disorder, and it is triggered by a variety of events, Infection being the most common trigger both in familial and in sporadic cases. Prompt treatment is very critical in cases of HLH, but the greatest barrier is often delay in diagnosis due to the rarity of this syndrome, variable clinical presentation, and lack of specificity of the clinical and laboratory findings. The key clinical features of HLH are high persistent fever, hepatosplenomegaly, blood cytopenia, elevated aminotransferase and ferritin levels, and coagulopathy. A diagnosis of HLH is mostly under-recognized, and is associated with high mortality, especially in adults; thus, prompt diagnosis and treatment are essential. We here present a rare case of HLH in an adult which was non-familial and infection being the trigger causing secondary hemophagocytic lymphohistiocytosis.

2021 ◽  
Paniz Shirmast ◽  
Mahdi Abedinzade Shahri ◽  
Salar Pashangzadeh ◽  
Hessam Mirshahabi ◽  
Elham Samadi ◽  

Aim: Occult hepatitis B infection (OBI) is life threatening and has a high mortality rate despite applying antiviral treatments in cancer patients. This study aimed to investigate the prevalence of OBI in patients undergoing chemotherapy in Iran. Materials & methods: A total of 342 patients undergoing chemotherapy were enrolled. OBI detection in anti-HBc positive individuals was conducted using nested-PCR. Results: Among 342 subjects, 103 (30.1%) were positive for anti-HBc. Fifteen (14.6%) cases of 103 anti-HBc positive samples were also positive for HBsAg. Overall, HBV DNA was positive in three (3.4%) of 88 anti-HBc subjects. Conclusion: Our results indicated that OBI might occur in almost one in 25 anti-HBc-positive patients undergoing chemotherapy.

2021 ◽  
pp. 954-959
Valery I. Podzolkov ◽  
Anna E. Pokrovskaya ◽  
Aida I. Tarzimanova ◽  
Maria V. Vetluzhskaya

Choriocarcinoma (CC) is a very rare and aggressive neoplasm. The characteristic feature of this disease is a rapid hematogenous spread, mainly to the lungs and brain, which largely defines clinical signs of the disease and complicates the diagnosis. Gastrointestinal metastases are rare, and of those, only few cases with gastric location have been reported. There are publications describing choriocarcinoma syndrome (CCS). As a rule, it presents in patients with an advanced disease and is characterized by hemorrhage from metastatic foci, leading to hemoptysis and gastrointestinal bleeding. CCS development is associated with poor prognosis and high mortality. This article describes a case of testicular CC with rare few gastric metastases, complicated by CCS.

2021 ◽  
Vol 5 ◽  
pp. 173
Anna C. Seale ◽  
Nega Assefa ◽  
Lola Madrid ◽  
Stefanie Wittmann ◽  
Hanan Abdurahman ◽  

Background: Mortality rates for children under five years of age, and stillbirth risks, remain high in parts of sub-Saharan Africa and South Asia. The Child Health and Mortality Prevention Surveillance (CHAMPS) network aims to ascertain causes of child death in high child mortality settings (>50 deaths/1000 live-births). We aimed to develop a “greenfield” site for CHAMPS, based in Harar and Kersa, in Eastern Ethiopia. This very high mortality setting (>100 deaths/1000 live-births in Kersa) had limited previous surveillance capacity, weak infrastructure and political instability. Here we describe site development, from conception in 2015 to the end of the first year of recruitment. Methods: We formed a collaboration between Haramaya University and the London School of Hygiene & Tropical Medicine and engaged community, national and international partners to support a new CHAMPS programme. We developed laboratory infrastructure and recruited and trained staff. We established project specific procedures to implement CHAMPS network protocols including; death notifications, clinical and demographic data collection, post-mortem minimally invasive tissue sampling, microbiology and pathology testing, and verbal autopsy. We convened an expert local panel to determine cause-of-death. In partnership with the Ethiopian Public Health Institute we developed strategies to improve child and maternal health. Results: Despite considerable challenge, with financial support, personal commitment and effective partnership, we successfully initiated CHAMPS. One year into recruitment (February 2020), we had received 1173 unique death notifications, investigated 59/99 MITS-eligible cases within the demographic surveillance site, and assigned an underlying and immediate cause of death to 53 children. Conclusions: The most valuable data for global health policy are from high mortality settings, but initiating CHAMPS has required considerable resource. To further leverage this investment, we need strong local research capacity and to broaden the scientific remit. To support this, we have set up a new collaboration, the “Hararghe Health Research Partnership”.

Saurabh Rattan ◽  
Priya Sharma ◽  
Chahat Gupta ◽  
Vikram Katoch ◽  
Gurdarshan Gupta

Background: COVID-19 first reported in January 2020 in China has turned into a pandemic the kind that occurs only once in a century, with high mortality rate due to an infectious disease considered once as a thing of past. Caused by SARS-CoV-2 (an RNA virus) COVID-19 has caused over 170 million cases worldwide and around 3.8 million deaths worldwide. India alone has suffered the wrath of this nasty virus with cases approaching 30 million and over 0.4 million deaths till date. Occurring in various waves, the pandemic situation remains dynamic and evolving even today.Methods: We carried out retrospective analysis of all deaths due to COVID-19 occurring in district Kangra from March 2020 to June 2021. Descriptive data on all COVID-19 patients were collected and analysed including individuals who lost their life during the period.Results: From 20 March 2020 to 30 June 2021, a total of 45,871 cases and 1037 deaths (2.2%) were reported in Kangra district-33.8% of 3463 deaths that occurred in the entire state. The death rate per million population in Kangra was 64 compared to 47 for Himachal Pradesh and 30 for India as a whole. The mean age was 62.5 years (range 01 to 102 years); males 62.7 years and female 62.2 years.Conclusions: The biggest challenge for us as a country is that COVID-19 has penetrated into our densely placed population where practicing COVID-19 appropriate behaviour is merely an expectation that possibly can never be fulfilled despite most stringent of actions.

2021 ◽  
pp. 175342592110625
Ning An ◽  
Tao Yang ◽  
Xiao-Xia Zhang ◽  
Mei-xia Xu

Acute lung injury (ALI) is associated with a high mortality due to inflammatory cell infiltration and lung edema. The development of ALI commonly involves the activation of NF-κB. Since bergamottin is a natural furanocoumarin showing the ability to inhibit the activation of NF-κB, in this study we aimed to determine the effect of bergamottin on ALI. RAW264.7 mouse macrophages were pre-treated with bergamottin and then stimulated with LPS. Macrophage inflammatory responses were examined. Bergamottin (50 mg/kg body mass) was intraperitoneally administrated to mice 12 h before injection of LPS, and the effect of bergamottin on LPS-induced ALI was evaluated. Our results showed that LPS exposure led to increased production of TNF-α, IL-6, and monocyte chemoattractant protein-1 (MCP-1), which was impaired by bergamottin pre-treatment. In vivo studies confirmed that bergamottin pre-treatment suppressed LPS-induced lung inflammation and edema and reduced the levels of pro-inflammatory cytokines in lung tissues and bronchoalveolar lavage fluids. Mechanistically, bergamottin blocked LPS-induced activation of NF-κB signaling in lung tissues. Additionally, bergamottin treatment reduced NF-κB p65 protein acetylation, which was coupled with induction of SIRT1 expression. In conclusion, our results reveal the anti-inflammatory property of bergamottin in preventing ALI. Induction of SIRT1 and inhibition of NF-κB underlies the anti-inflammatory activity of bergamottin.

2021 ◽  
Rebeca Martinez Rodriguez ◽  
Maria Alejandra Fernandez-Trujillo ◽  
Liz Hernandez ◽  
Adrián Page ◽  
Julia Béjar ◽  

Abstract Aquaculture constitutes an alternative source for food production and contributes to the reduction of indiscriminate catch of aquatic organisms from their natural environment (Diaz & Neira, 2005; Beveridge et al., 2013). However, high mortality during larval state remains a challenge in this sector, mainly because of factors like diets and diseases induced by pathogens (Helvik et al., 2009; Stentiford et al., 2017). Therefore, growth and health management is a key strategy for sustainable aquaculture (Martinez et al., 2016a).

Eddy Lopez‐Huamanrayme ◽  
Claudia Cordova‐Huancas ◽  
Dioni Garate‐Chirinos ◽  
Frank Espinoza‐Morales ◽  
Francisco Pasquel

2021 ◽  
Vol 11 (1) ◽  
Jesús Villar ◽  
Rubén Herrán-Monge ◽  
Elena González-Higueras ◽  
Miryam Prieto-González ◽  
Alfonso Ambrós ◽  

AbstractSepsis is a common cause of acute respiratory distress syndrome (ARDS) associated with a high mortality. A panel of biomarkers (BMs) to identify septic patients at risk for developing ARDS, or at high risk of death, would be of interest for selecting patients for therapeutic trials, which could improve ARDS diagnosis and treatment, and survival chances in sepsis and ARDS. We measured nine protein BMs by ELISA in serum from 232 adult septic patients at diagnosis (152 required invasive mechanical ventilation and 72 had ARDS). A panel including the BMs RAGE, CXCL16 and Ang-2, plus PaO2/FiO2, was good in predicting ARDS (area under the curve = 0.88 in total septic patients). Best performing panels for ICU death are related to the presence of ARDS, need for invasive mechanical ventilation, and pulmonary/extrapulmonary origin of sepsis. In all cases, the use of BMs improved the prediction by clinical markers. Our study confirms the relevance of RAGE, Ang-2, IL-1RA and SP-D, and is novel supporting the inclusion of CXCL16, in BMs panels for predicting ARDS diagnosis and ARDS and sepsis outcome.

2021 ◽  
Vol 8 ◽  
James Jiqi Wang ◽  
Zuowen He ◽  
Yan Yang ◽  
Bo Yu ◽  
Hong Wang ◽  

Pheochromocytoma multisystem crisis (PMC) is a potentially lethal emergency due to catecholamine secretion. The condition manifests as severe hypertension to intractable cardiogenic shock and has a high mortality rate. This study explored the efficacy and safety of applying chlorpromazine on PMC patients. The study included seven patients (median age, 42 years; range, 14–57 years) diagnosed with pheochromocytoma. Four consecutive PMC patients were admitted to our critical care unit between 2016 and 2020 due to abdominal or waist pain, nausea, and vomiting. Their blood pressure (BP) fluctuated between 200–330/120–200 and 40–70/30–50 mmHg. Chlorpromazine (25 or 50 mg) was injected intramuscularly, followed by continuous intravenous infusion (2–8 mg/h). The patients' BP decreased to 100–150/60–100 mmHg within 1–3 h and stabilized within 3–5 days. Two weeks later, surgical tumor resection was successfully performed in all four patients. Similar clinical outcomes were also obtained in three patients with sporadic PMC reported in the literature who received chlorpromazine treatment, which reduced their BP readings from >200/100 mmHg to 120/70 mmHg. Our observations, combined with sporadic reports, showed that chlorpromazine efficiently controlled PMC. Thus, future studies on the use of chlorpromazine are warranted.

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