human albumin
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Author(s):  
Hadis Valapour ◽  
Mohammad Hossien Jarrahzadeh ◽  
Seyed Mojtaba Sohrevardi

Aims: The goal of this study was to evaluate the consumption pattern of human albumin according to the available and reliable guidelines. Methods:  This research was a descriptive-analytical study. The study sample consisted of patients admitted to the intensive care units (ICUs) of Shahid Sadoughi and Rahnemoon Yazd Teaching Hospitals. In this study, 67 patients were selected. The study was carried out over three months. During the study, the albumin request by ICUs was investigated. Along with observing albumin orders' para-clinic findings were evaluated. The specific form of albumin consumption and prescription prepared by the Hospital Steering Board of Pharmacy was completed for each patient individually. Results: In this study, 65.7% of prescribed albumin was infused for approved cases by the US food and drug administration (FDA). Administration after burn injury with 32.8% and hypoalbuminemia with 19.4% of cases were the most frequently reasonable prescribed albumin. About 34.3% of prescribed albumin (18 cases) did not have FDA-approved indications. Albumin infusion after patients edema in 14.9% of cases, nutritional support 6 % and Major surgery 6% have been the most frequently incorrect prescribed albumin. Conclusion: Based on the findings of this study, the prescription of albumin in patients admitted to ICUs of Sadoughi and Rahnemoon teaching hospitals from October to December 2015 was not completely in accordance with the guidelines. So , consulting with relevant health care professionals can be helpful to improve the proper administration of this essential and expensive drug.


Animals ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. 3480
Author(s):  
Wen-Lin Wang ◽  
Pei-Lun Sun ◽  
Chi-Fei Kao ◽  
Wen-Ta Li ◽  
I-Jiunn Cheng ◽  
...  

A sub-adult green sea turtle (Chelonia mydas) was rescued and treated for carapace and plastron shell fractures. The turtle was kept dry-docked for the first 2 months with a placement of a long-term jugular central venous catheter (CVC). Pain management, aggressive antibiotic and anthelmintic therapy, fluid therapy, force feeding, and wound debridement were provided to manage the shell fractures and control bacteremia. Human albumin was administered to treat severe hypoalbuminemia. On day 59, small budding yeasts were noted on the blood smears. Candidemia was confirmed by blood culture, as the yeasts were identified as Candida palmioleophila by the molecular multi-locus identification method. The CVC was removed, and the patient was treated with itraconazole. Although the carapace and plastron wounds had epithelized by 5.5 months after the rescue, the turtle died unexpectedly by 7.5 months. The postmortem examination revealed numerous necrogranulomas with intralesional yeasts, morphologically compatible with Candida spp., in joints, bones, brain, and lungs, suggestive of disseminated candidiasis. We describe a rare case of candidemia in the veterinary field. To our knowledge, this is the first report of candidiasis caused by C. palmioleophila in a reptile. The present results should improve veterinary medical care and, therefore, enhance the conservation of endangered sea turtle species.


ACS Omega ◽  
2021 ◽  
Author(s):  
Heejeong Yoon ◽  
Hanna Lee ◽  
Seon Young Shin ◽  
Yasamin A. Jodat ◽  
Hyunjhung Jhun ◽  
...  

2021 ◽  
Vol 6 (2) ◽  
pp. 65
Author(s):  
Naufal Agus Isamahendra ◽  
Lynda Hariani ◽  
Dwi Murtiastutik

Latar Belakang: Luka bakar adalah cedera pada kulit atau jaringan organik lainnya yang disebabkan oleh panas, radiasi, zat radioaktif, listrik, gesekan atau kontak dengan bahan kimia. Cedera pada saluran pernapasan akibat inhalasi asap, juga dianggap sebagai luka bakar (WHO, 2018). Bagian tubuh yang mengalami luka bakar akan vasodilatasi akibat adanya stimulus mediator inflamasi yang dilepaskan oleh sel endotel, platelet dan leukosit yang rusak, mengakibatkan peningkatan tekanan hidrostatik kapiler yang menyebabkan meningkatnya permeabilitas membran kapiler. Keadaan ini membuat cairan dan elektrolit di intravaskuler keluar ke ekstravaskuler. Albumin juga ikut keluar ke ekstraseluler pada proses ini, sehingga terjadi hipoalbuminemia. Hipoalbuminemia adalah kondisi dimana kadar albumin dalam darah berada dibawah 3,5 g/dl, sedangkan kadar normal albumin normal dalam darah adalah 3,8-5,0 g/dl. Berdasarkan Formularium Nasional sesuai Kepmenkes 2017 perihal pembatasan pemberian albumin infus yang didukung oleh JKN-KIS, ditetapkan bahwa pasien luka bakar diberikan transfusi human albumin bila kadar albumin kurang 2,5 g/dl. Diperlukan adanya solusi untuk peningkatan kadar albumin selain melalui transfusi, dengan syarat alternatif transfusi albumin ini diharapkan lebih hemat dan efisien dibandingkan dengan albumin transfusi yang terkenal mahal. Ekstrak Channa striata merupakan sebuah produk baru yang diharapkan dapat menjadi alternatif albumin transfusi ini. Tujuan: Tujuan penelitian adalah untuk mengetahui apakah pemberian kapsul ekstrak Channa striata dapat meningkatkan kadar albumin dalam darah pada kasus luka bakar. Metode: Metode penelitian ini menggunakan metode systematical review dengan mengambil jurnal melalui Google Scholer, PubMed dan ScienceDirect. Kesimpulan: Kesimpulan dari penelitian ini adalah kapsul ekstrak Channa striata dapat meningkatkan kadar albumin dalam tubuh serta mempercepat penyembuhan luka pasien luka bakar. Kapsul ekstrak Channa striata biasanya diberikan sebagai suplementasi bersama bahan lain untuk memenuhi kebutuhan gizi pasien. Penelitian yang saya temukan selain membuktikan efek kapsul ekstrak Channa striata terhadap kadar albumin juga memberikan hasil lain mengenai pemberian ekstrak Channa striata pada luka bakar yaitu penurunan kadar MDA serum dan meningkatkan balans nitrogen ke arah positif.


Author(s):  
С.В. Журавель ◽  
Н.К. Кузнецова ◽  
В.Э. Александрова ◽  
П.В. Гаврилов ◽  
А.М. Талызин ◽  
...  

Введение. Терапевтическое использование раствора человеческого альбумина у пациентов в периоперационном периоде трансплантации печени (ТП) представляет интерес в контексте осложнений и исходов операции. Цель исследования: оценить влияние интраоперационной трансфузии 25% раствора человеческого альбумина на течение раннего послеоперационного периода при ортотопической ТП от посмертного донора. Материалы и методы. В исследование включены 47 пациентов, которым была выполнена трупная ТП. Были сформированы 2 группы: пациенты группы 1 (n = 21) получали трансфузию 25% раствора человеческого альбумина в конце операции ТП и через 24 ч после операции; пациенты группы 2 (n = 26) получали трансфузию 25% раствора человеческого альбумина в первые сутки послеоперационного периода. Осуществляли контроль лабораторных параметров крови пациента перед началом оперативного вмешательства, через 24 ч и через 48 ч после операции. Интраоперационно оценивали значения систолического (САД) и диастолического (ДАД) артериального давления, частоту сердечных сокращений (ЧСС), дозу вазопрессоров, объем инфузионно-трансфузионной терапии, кровопотерю и диурез. В послеоперационном периоде фиксировали возможные осложнения, проведенные сеансы заместительной почечной терапии (ЗПТ), а также количество дней в стационаре. Результаты. Оценка значений САД, ДАД и ЧСС в начале и конце операции показала достоверно лучшие показатели гемодинамики и снижение дозировок вазопрессорной поддержки в конце вмешательства в группе 1 по сравнению с группой 2 (p < 0,05). В послеоперационном периоде инфекционные осложнения зарегистрированы у одного пациента группы 1 и у трех пациентов группы 2. Проведение ЗПТ потребовалось двум пациентам из группы 2. Все пациенты обеих групп были выписаны из стационара, при этом число дней госпитализации в группе 2 было статистически значимо больше по сравнению с пациентами группы 1: 26,9 ± 3,9 против 17,2 ± 4,3 (p < 0,05). Заключение. Интраоперационная инфузия 25% раствора альбумина позволяет стабилизировать показатели гемодинамики в конце операции ТП, снизить потребность в кардиотонической поддержке и сократить время госпитализации у пациентов после ТП. Background. The therapeutic use of human albumin solution in patients in the perioperative period of liver transplantation (LT) is of interest in the context of complications and outcomes of surgery. Objectives: to assess the effect of intraoperative transfusion of 25% human albumin solution on the early postoperative period in orthotopic LT from a postmortem donor. Patients/Methods. The study included 47 patients who underwent cadaveric LT. Two groups were formed: patients in group 1 (n = 21) received transfusion of 25% human albumin solution at the end of LT and 24 hours after surgery; patients in group 2 (n = 26) received transfusion of 25% human albumin solution on the first day of the postoperative period. The laboratory parameters of the patient’s blood were monitored before surgery, 24 hours later, and 48 hours after surgery. Intraoperatively, the values of systolic (SBP) and diastolic (DBP) blood pressure, heart rate (HR), dose of vasopressors, volume of infusion- transfusion therapy, blood loss and diuresis were assessed. In the postoperative period, possible complications, renal replacement therapy (RRT) sessions performed, and the number of days in the hospital were recorded. Results. Assessment of SBP, DBP and HR values showed significantly better hemodynamic parameters and reduced dosages of vasopressor support at the end of surgery in group 1 compared to group 2 (p < 0.05). In the postoperative period, infectious complications were registered in one patient of group 1 and in three patients of group 2. Two patients from group 2 required RRT. All patients were discharged from the hospital, while the number of hospitalization days in group 2 was statistically significantly greater than in patients in group 1: 26.9 ± 3.9 versus 17.2 ± 4.3 (p < 0.05). Conclusions. Intraoperative infusion of 25% albumin solution allows stabilizing hemodynamic parameters at the end of LT surgery, reducing the need for cardiotonic support and shortening the hospitalization time in patients after LT.


2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Martin A. Schick ◽  
Jonas Pippir ◽  
Manuel F. Struck ◽  
Jürgen Brugger ◽  
Winfried Neuhaus ◽  
...  

Abstract Objective Colloid solutions are commonly used to maintain perioperative fluid homeostasis. In regard to perioperative infant-centered care, data about the impact of colloids are rare. New data suggest a possible positive effect of hydroxyethyl starch (HES) concerning blood brain barrier. Therefore we conduct a retrospective single center study of children scheduled for neurosurgery, age < five with a blood loss > 10% of body blood volume, receiving either 6% HES 130/0.4 or 5% human albumin (HA). Results Out of 913 patients, 86 were included (HES = 30; HA = 56). Compared to HES [16.4 ± 9.2 ml/kg body weight (mean ± SD)] HA group received more colloid volume (25.7 ± 11.3), which had more blood loss [HA 54.8 ± 45.0; HES 30.5 ± 30.0 (%) estimated blood volume] and higher fluid balances. Fibrinogen was decreased and activated partial thromboplastin time was elevated in HA group. Urinary output, creatinine and urea levels did not differ between the two groups. Serum calcium, total protein levels were lower in HES group. HA treated infants tended to have shorter ICU and hospital stays. We conclude that none of the investigated colloid solutions were without leverage to infants. Consequently randomized controlled trials about perioperative goal-directed fluid replacement of children undergoing (neuro)-surgery with major blood loss are needed.


2021 ◽  
Vol 10 (22) ◽  
pp. 5226
Author(s):  
Giacomo Zaccherini ◽  
Manuel Tufoni ◽  
Giulia Iannone ◽  
Paolo Caraceni

Ascites represents a critical event in the natural history of liver cirrhosis. From a prognostic perspective, its occurrence marks the transition from the compensated to the decompensated stage of the disease, leading to an abrupt worsening of patients’ life expectancy. Moreover, ascites heralds a turbulent clinical course, characterized by acute events and further complications, frequent hospitalizations, and eventually death. The pathophysiology of ascites classically relies on hemodynamic mechanisms, with effective hypovolemia as the pivotal event. Recent discoveries, however, integrated this hypothesis, proposing systemic inflammation and immune system dysregulation as key mechanisms. The mainstays of ascites treatment are represented by anti-mineralocorticoids and loop diuretics, and large volume paracentesis. When ascites reaches the stage of refractoriness, however, diuretics administration should be cautious due to the high risk of adverse events, and patients should be treated with periodic execution of paracentesis or with the placement of a trans-jugular intra-hepatic portosystemic shunt (TIPS). TIPS reduces portal hypertension, eases ascites control, and potentially modify the clinical course of the disease. Further studies are required to expand its indications and improve the management of complications. Long-term human albumin administration has been studied in two RCTs, with contradictory results, and remains a debated issue worldwide, despite a potential effectiveness both in ascites control and long-term survival. Other treatments (vaptans, vasoconstrictors, or implantable drainage systems) present some promising aspects but cannot be currently recommended outside clinical protocols or a case-by-case evaluation.


2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Shaoyun Zhang ◽  
Haibo Si ◽  
Jinwei Xie ◽  
Yuangang Wu ◽  
Qinsheng Hu ◽  
...  

Abstract Background Enhanced recovery after surgery (ERAS) program advocates implementation of perioperative goal-directed fluid therapy and reduced application of colloidal fluids. It should be used reasonably selectively in high-risk patients despite the clear efficacy of human albumin (HA). Therefore, it is vital to identify the risk factors for the use of HA. This study aims to determine the incidence and risk factors of HA administration in patients undergoing total hip or knee arthroplasty (THA, TKA). Methods We identified patients undergoing THA or TKA in multiple institutions from 2014 to 2016 and collected patient demographics and perioperative variables. The criterion of HA administration was defined as a postoperative albumin level < 32 g/L or 32 to 35 g/L for at-risk patients. We compared 14 variables between patients who received HA administration and those who did not after stratification by the preoperative albumin (pre-ALB) level. Multivariable regressions identified the independent risk factors associated with HA administration. Results In total, 958 (20.3%) of 4713 patients undergoing THA and 410 (9.7%) of 4248 patients undergoing TKA received HA administration. In addition to pre-ALB < 35 g/L, preoperative anemia (odds ratio [OR] 2.12, P = 0.001; OR 1.39, P < 0.001) and drain use (OR 3.33, P = 0.001; OR 4.25, P < 0.001) were also independent risk factors for HA administration after THA regardless pre-ALB < 35 g/L or not, and patients undergoing TKA diagnosed of rheumatoid arthritis or ankylosing spondylitis tended to receive HA administration regardless pre-ALB < 35 g/L or not (OR 3.67, P = 0.002; OR 2.06, P < 0.001). Conclusions The incidence of HA administration was high in patients undergoing THA or TKA, and several variables were risk factors for HA administration. This finding may aid surgeons in preoperatively identifying patients requiring HA administration and optimizing perioperative managements.


2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Bo Liu ◽  
Junpeng Pan ◽  
Hui Zong ◽  
Zhijie Wang

Abstract Background Perioperative hypoalbuminemia of the posterior lumbar interbody fusion (PLIF) can increase the risk of infection of the incision site, and it is challenging to accurately predict perioperative hypoproteinemia. The objective of this study was to create a clinical predictive nomogram and validate its accuracy by finding the independent risk factors for perioperative hypoalbuminemia of PLIF. Methods The patients who underwent PLIF at the Affiliated Hospital of Qingdao University between January 2015 and December 2020 were selected in this study. Besides, variables such as age, gender, BMI, current and past medical history, indications for surgery, surgery-related information, and results of preoperative blood routine tests were also collected from each patient. These patients were divided into injection group and non-injection group according to whether they were injected with human albumin. And they were also divided into training group and validation group, with the ratio of 4:1. Univariate and multivariate logistic regression analyses were performed in the training group to find the independent risk factors. The nomogram was developed based on these independent predictors. In addition, the area under the curve (AUC), the calibration curve and the decision curve analysis (DCA) were drawn in the training and validation groups to evaluate the prediction, calibration and clinical validity of the model. Finally, the nomograms in the training and validation groups and the receiver operating characteristic (ROC) curves of each independent risk factor were drawn to analyze the performance of this model. Results A total of 2482 patients who met our criteria were recruited in this study and 256 (10.31%) patients were injected with human albumin perioperatively. There were 1985 people in the training group and 497 in the validation group. Multivariate logistic regression analysis revealed 5 independent risk factors, including old age, accompanying T2DM, level of preoperative albumin, amount of intraoperative blood loss and fusion stage. We drew nomograms. The AUC of the nomograms in the training group and the validation group were 0.807, 95% CI 0.774–0.840 and 0.859, 95% CI 0.797–0.920, respectively. The calibration curve shows consistency between the prediction and observation results. DCA showed a high net benefit from using nomograms to predict the risk of perioperative injection of human albumin. The AUCs of nomograms in the training and the validation groups were significantly higher than those of five independent risk factors mentioned above (P < 0.001), suggesting that the model is strongly predictive. Conclusion Preoperative low protein, operative stage ≥ 3, a relatively large amount of intraoperative blood loss, old age and history of diabetes were independent predictors of albumin infusion after PLIF. A predictive model for the risk of albumin injection during the perioperative period of PLIF was created using the above 5 predictors, and then validated. The model can be used to assess the risk of albumin injection in patients during the perioperative period of PLIF. The model is highly predictive, so it can be clinically applied to reduce the incidence of perioperative hypoalbuminemia.


2021 ◽  
Vol October 2021 - Online First ◽  
Author(s):  
Suchita Shah Sata ◽  
Omobonike Oloruntoba Sanders ◽  
Catherine A Curley
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