The Surviving Sepsis Campaign: research priorities for the administration, epidemiology, scoring and identification of sepsis

Epidemiologia; Disfunció d'òrgans; SèpsiaEpidemiology; Organ dysfunction; SepsisEpidemiología; Disfunción de órganos; SepsisObjective To identify priorities for administrative, epidemiologic and diagnostic research in sepsis. Design As a follow-up to a previous consensus statement about sepsis research, members of the Surviving Sepsis Campaign Research Committee, representing the European Society of Intensive Care Medicine and the Society of Critical Care Medicine addressed six questions regarding care delivery, epidemiology, organ dysfunction, screening, identification of septic shock, and information that can predict outcomes in sepsis. Methods Six questions from the Scoring/Identification and Administration sections of the original Research Priorities publication were explored in greater detail to better examine the knowledge gaps and rationales for questions that were previously identified through a consensus process. Results The document provides a framework for priorities in research to address the following questions: (1) What is the optimal model of delivering sepsis care?; (2) What is the epidemiology of sepsis susceptibility and response to treatment?; (3) What information identifies organ dysfunction?; (4) How can we screen for sepsis in various settings?; (5) How do we identify septic shock?; and (6) What in-hospital clinical information is associated with important outcomes in patients with sepsis? Conclusions There is substantial knowledge of sepsis epidemiology and ways to identify and treat sepsis patients, but many gaps remain. Areas of uncertainty identified in this manuscript can help prioritize initiatives to improve an understanding of individual patient and demographic heterogeneity with sepsis and septic shock, biomarkers and accurate patient identification, organ dysfunction, and ways to improve sepsis care.The authors volunteered their time to producing this manuscript and no funding was used to produce it

Expression of cell surface receptors and oxidative metabolism modulation in the clinical continuum of sepsis

Background Infection control depends on adequate microbe recognition and cell activation, yet inflammatory response may lead to organ dysfunction in sepsis. the aims of this study were to evaluate cell activation in the context of sepsis and its correlation with organ dysfunction.Methods A total of 41 patients were prospectively enrolled: 14 with sepsis, 12 with severe sepsis and 15 with septic shock. A total of 17 healthy volunteers were included as a control group. Patients were admitted to the Intensive Care Units and Emergency Rooms of Hospital São Paulo ( Federal University of São Paulo) and Hospital Santa Marcelina, São Paulo, Brazil. Toll- like receptor ( TLR) 2, TLR4, CD11b, CD11c and CD66b expression on neutrophil surfaces and oxidative metabolism measured by non- fluorescent dichlorofluorescein ( DCFH) oxidation in neutrophils and monocytes, using whole blood, were evaluated using flow cytometry. Organ dysfunction was measured using the sepsis- associated organ failure assessment ( SOFA) score.Results TLR2 expression on neutrophils was found to be downregulated in septic shock patients compared to healthy volunteers ( p = 0.05). No differences were found in CD11b and CD11c expression. CD66b expression was increased in the patient group compared to the control group ( p = 0.01). Neutrophil and monocyte oxidative burst was increased in septic patients compared to the control group at baseline and after stimulation with phorbol myristate acetate ( PMA), formylmethionylleucyl- phenylalanine ( fMLP), lipopolysaccharide ( LPS) and Staphylococcus aureus ( p 7 was higher than in patients with SOFA scores < 7, both in neutrophils and monocytes. However, oxidative burst in patients with sepsis was as high as in septic shock.Conclusion Surface receptors expression on neutrophils may be modulated across the continuum of sepsis, and enhanced or decreased expression may be found depending on the receptor considered. ROS generation is upregulated both in neutrophils and monocytes in septic patients, and it is differently modulated depending on the stage of the disease and the stimuli used.Universidade Federal de São Paulo, Escola Paulista Med, Div Infect Dis, São Paulo, BrazilUniversidade Federal de São Paulo, Intens Care Unit, São Paulo, BrazilHosp St Marcelina, Intens Care Unit, São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Div Infect Dis, São Paulo, BrazilUniversidade Federal de São Paulo, Intens Care Unit, São Paulo, BrazilWeb of Scienc

Late recognition and illness severity are determinants of early death in severe septic patients

OBJECTIVE: To identify the independent variables associated with death within 4 days after the first sepsis-induced organ dysfunction. METHODS: In this prospective observational study, severe sepsis and septic shock patients were classified into 3 groups: Group 1, survivors; Group 2, late non-survivors; and Group 3, early non-survivors. Early death was defined as death occurring within 4 days after the first sepsis-induced organ dysfunction. Demographic, clinical and laboratory data were collected and submitted to univariate and multinomial analyses. RESULTS: The study included 414 patients: 218 (52.7%) in Group 1, 165 (39.8%) in Group 2, and 31 (7.5%) in Group 3. A multinomial logistic regression analysis showed that age, Acute Physiology and Chronic Health Evaluation II score, Sepsis-related Organ Failure Assessment score after the first 24 hours, nosocomial infection, hepatic dysfunction, and the time elapsed between the onset of organ dysfunction and the sepsis diagnosis were associated with early mortality. In contrast, Black race and a source of infection other than the urinary tract were associated with late death. Among the non-survivors, early death was associated with Acute Physiology and Chronic Health Evaluation II score, chronic renal failure, hepatic dysfunction Sepsis-related Organ Failure Assessment score after 24 hours, and the duration of organ dysfunction. CONCLUSION: Factors related to patients' intrinsic characteristics and disease severity as well as the promptness of sepsis recognition are associated with early death among severe septic patients

INTERSEPT study: we still need more clarity

Universidade Federal de São Paulo, Hosp São Paulo, Anesthesiol & Crit Care Dept, BR-04024900 São Paulo, BrazilHosp Dona Helena, BR-89204205 Joinville, SC, BrazilHosp Procardiaco, BR-22280000 Rio de Janeiro, BrazilUniv Fed Paraiba, Univ Hosp, BR-58000000 Joao Pessoa, Paraiba, BrazilHosp Base, Intens Care Div, Dept Internal Med, Fac Med Sao Jose Rio Preto, BR-15090000 Sao Jose Do Rio Preto, SP, BrazilHosp Copa DOr, BR-22031011 Rio de Janeiro, BrazilHosp Santo Amaro, BR-40210320 Salvador, BA, BrazilHosp Portugues, Salvador, BA, BrazilHosp Salvador, Salvador, BA, BrazilCtr Hosp UNIMED, BR-89204060 Joinville, SC, BrazilUniversidade Federal de São Paulo, Hosp São Paulo, Anesthesiol & Crit Care Dept, BR-04024900 São Paulo, BrazilWeb of Scienc

PlantRNA_sniffer : a SVM-based workflow to predict long intergenic non-coding RNAs in plants

Non-coding RNAs (ncRNAs) constitute an important set of transcripts produced in the cells of organisms. Among them, there is a large amount of a particular class of long ncRNAs that are difficult to predict, the so-called long intergenic ncRNAs (lincRNAs), which might play essential roles in gene regulation and other cellular processes. Despite the importance of these lincRNAs, there is still a lack of biological knowledge and, currently, the few computational methods considered are so specific that they cannot be successfully applied to other species different from those that they have been originally designed to. Prediction of lncRNAs have been performed with machine learning techniques. Particularly, for lincRNA prediction, supervised learning methods have been explored in recent literature. As far as we know, there are no methods nor workflows specially designed to predict lincRNAs in plants. In this context, this work proposes a workflow to predict lincRNAs on plants, considering a workflow that includes known bioinformatics tools together with machine learning techniques, here a support vector machine (SVM). We discuss two case studies that allowed to identify novel lincRNAs, in sugarcane (Saccharum spp.) and in maize (Zea mays). From the results, we also could identify differentially-expressed lincRNAs in sugarcane and maize plants submitted to pathogenic and beneficial microorganisms

Use of Hg-Electroplated-Pt Ultramicroelectrode for Determining Elemental Sulphur in Naphtha Samples

This paper describes the applicability of a Hg-electroplated-Pt ultramicroelectrode in the quantification of elemental sulphur in naphtha samples by square-wave voltammetry. A reproducible deposition methodology was studied and is reported in this paper. This methodology is innovative and relies on the quality of the mercury stock solution to obtain reproducible surfaces required for the analytical methodology. All analyses were performed using a Hg-electroplated-Pt ultramicroelectrode (Hg-Pt UME) due to the low sensibility of such devices to ohmic drops in resistive solutions. The responses of the peak areas in voltammetric experiments were linear in all of the range studied. The method developed here is accurate and reproducible, with a detection limit of 0.010 mg L-1 and a good recovery range for both standard solutions of elemental sulphur (85 to 99%) and real naphtha sample (79%). These results attest to the potential for the application of this electroanalytical methodology in determining elemental sulphur in naphtha samples containing mercaptans and disulphides.CNPqCNPqCenpes/PetrobrasCenpes/Petrobra

Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis

BACKGROUND: The comparative efficacy and safety of balanced crystalloid solutions and saline for fluid therapy in critically ill adults remain uncertain. METHODS: We systematically reviewed randomized clinical trials (RCTs) comparing the use of balanced crystalloids with saline in critically ill adults. The primary outcome was 90-day mortality after pooling data from low-risk-of-bias trials using a random-effects model. We also performed a Bayesian meta-analysis to describe the primary treatment effect in probability terms. Secondary outcomes included the incidence of acute kidney injury (AKI), new treatment with renal replacement therapy (RRT), and ventilator-free and vasopressor-free days to day 28. RESULTS: We identified 13 RCTs, comprising 35,884 participants. From six trials (34,450 participants) with a low risk of bias, the risk ratio (RR) for 90-day mortality with balanced crystalloids versus saline was 0.96 (95% confidence interval [CI], 0.91 to 1.01; I2 = 12.1%); using vague priors, the posterior probability that balanced crystalloids reduce mortality was 89.5%. The RRs of developing AKI and of being treated with RRT with balanced crystalloids versus saline were 0.96 (95% CI, 0.89 to 1.02) and 0.95 (95% CI, 0.81 to 1.11), respectively. Ventilator-free days (mean difference, 0.18 days; 95% CI, −0.45 to 0.81) and vasopressor-free days (mean difference, 0.19 days; 95% CI, −0.14 to 0.51) were similar between groups. CONCLUSIONS: The estimated effect of using balanced crystalloids versus saline in critically ill adults ranges from a 9% relative reduction to a 1% relative increase in the risk of death, with a high probability that the average effect of using balanced crystalloids is to reduce mortality

The practice of intensive care in Latin America: a survey of academic intensivists

Intensive care medicine is a relatively young discipline that has rapidly grown into a full-fledged medical subspecialty. Intensivists are responsible for managing an ever-increasing number of patients with complex, life-threatening diseases. Several factors may influence their performance, including age, training, experience, workload, and socioeconomic context. The aim of this study was to examine individual- and work-related aspects of the Latin American intensivist workforce, mainly with academic appointments, which might influence the quality of care provided. In consequence, we conducted a cross-sectional study of intensivists at public and private academic and nonacademic Latin American intensive care units (ICUs) through a web-based electronic survey submitted by email. Questions about personal aspects, work-related topics, and general clinical workflow were incorporated. RESULTS: Our study comprised 735 survey respondents (53% return rate) with the following country-specific breakdown: Brazil (29%); Argentina (19%); Chile (17%); Uruguay (12%); Ecuador (9%); Mexico (7%); Colombia (5%); and Bolivia, Peru, Guatemala, and Paraguay combined (2%). Latin American intensivists were predominantly male (68%) young adults (median age, 40 [IQR, 35-48] years) with a median clinical ICU experience of 10 (IQR, 5-20) years. The median weekly workload was 60 (IQR, 47-70) h. ICU formal training was between 2 and 4 years. Only 63% of academic ICUs performed multidisciplinary rounds. Most intensivists (85%) reported adequate conditions to manage patients with septic shock in their units. Unsatisfactory conditions were attributed to insufficient technology (11%), laboratory support (5%), imaging resources (5%), and drug shortages (5%). Seventy percent of intensivists participated in research, and 54% read scientific studies regularly, whereas 32% read no more than one scientific study per month. Research grants and pharmaceutical sponsorship are unusual funding sources in Latin America. Although Latin American intensivists are mostly unsatisfied with their income (81%), only a minority (27%) considered changing to another specialty before retirement. CONCLUSIONS: Latin American intensivists constitute a predominantly young adult workforce, mostly formally trained, have a high workload, and most are interested in research. They are under important limitations owing to resource constraints and overt dissatisfaction. Latin America may be representative of other world areas with similar challenges for intensivists. Specific initiatives aimed at addressing these situations need to be devised to improve the quality of critical care delivery in Latin America

CARACTERIZAÇÃO DO MODELO INFLAMATÓRIO DE CISTITE INDUZIDA POR CICLOFOSFAMIDA EM CAMUNDONGOS SWISS

A Cistite Hemorrágica é um problema de saúde importante no mundo causado pelo uso da oxazoforinas. Apesar dos tratamentos disponíveis, há uma incidência de 2 até 40% em pacientes tratados com Ciclofosfamida (CYP). O objetivo deste trabalho foi caracterizar um modelo experimental de cistite induzida por CYP em camundongos Swiss. Para isto, camundongos fêmeas foram distribuídos em 5 grupos com 7 animais, onde 4 grupos sofreram eutanásia após 0,5, 6, 12 e 24h da aplicação de 150mg/kg de CYP via intraperitoneal. O grupo controle recebeu salina tamponada pela mesma via. Foram avaliados o peso da bexiga e seu aspecto histopatológico, o hemograma, e a contagem celular de medula óssea e linfonodo ilíaco. Os resultados demonstraram que houve aumento significativo do peso da bexiga nos tempos de 6 e 12h. Houve aumento na infamação aguda nestes dois tempos. Após 24 horas houve diminuição da resposta inflamatória aguda e início da fibrose. O número de leucócitos foi menor em todos os tempos em relação ao controle. Da mesma forma, o número de células da medula óssea foi menor nos tempos de 6, 12 e 24h. Por outro lado, o número de células do linfonodo aumentou após 12 horas. Concluímos que houve aumento progressivo da inflamação até as 12h  e que após 24h já há um processo de resolução do quadro inflamatório. Sendo assim, sugerimos a utilização do tempo de 12h como padrão experimental por ser o de maior disponibilidade de parâmetros elevados para avaliação da inflamação.Descritores: Cistite. Ciclofosfamida. Camundongo. Modelo experimental.AbstractCharacterization of cyclophosphamide-induced cystitis inflammatory model in Swiss mice. The Hemorragic Cystitis (HC) is an important health problem over the world caused by oxazoforines. Despite the available treatments, still have an incidence of 2 to 40% of HC in patients following treatment with Cyclophosphamide (CYP). The aim of this work was characterize a model of CYP-induced cystitis  in Swiss mice. Female mice were divided  in 5 groups with 7 animals each, 4 groups were killed 0.5, 6, 12 and 24h after an injection of CYP (150mg/kg). The control group received phosphate buffered saline at the same way. In each time the bladders were collected, weighted and prepared to histopathology analyses. The complete blood count was evaluated. The cell number from lymph nodes and bone marrow was quantified. The results showed that bladder weight was increased at 6thand 12th hour pos cystitis induction. There was acute inflammation increased after 6 and 12h. After 24h there was an initial fibrosis. The leucocytes count was decreased in all times. The cells number was decreased at 6th,12th, and 24th hours in bone marrow and it was increased at 12th in lymph nodes. We concluded that there is an increase in inflammatory parameters until the 12th hour pos CYP injection which are decreased at 24th hour. We suggest using the time of 12h as the standard experimental time because of the biggest availability parameters for evaluating.Descriptors: Cyclophosphamide. Cystitis. Mice. Experimental model