8 research outputs found
The Importance of Fever as a Predictive Symptom for the Potency of Host's Monocytes to Release Pro- and Anti-Inflammatory Mediators
Objective. To clarify whether time lapsing from advent of fever as a first sign of sepsis may be indicative of the potency of monocytes for the release of pro- and anti-inflammatory mediators.
Methods. Monocytes were isolated from blood of 51 septic patients and 9 healthy donors. Monocytes were incubated in the absence and presence of patients' serum and concentrations of tumour necrosis factor-alpha (TNF
α), interleukin (IL)-6, IL-10, and malondialdehyde (MDA) were estimated in supernatants. Patients were divided into three groups: group A:
<12 hours; group B: 12—24 hours, and group C:
>24 hours between initiation of fever and blood sampling.
Results. TNF
α of supernatants of groups B and C was higher than controls, as also were IL-6 of A and C, IL-10 of A and B, and MDA of A. IL-6 of group A was increased after addition of patients serum. A negative correlation was found between time from initiation of symptoms and IL-6 of monocyte supernatants incubated in the presence of patients serum. Median IL-6 of survivors was higher than nonsurvivors.
Conclusion. Monocytes are potent for the release of pro- and anti-inflammatory mediators within the first 24 hours upon advent of fever related to sepsis; serum stimulates further release of IL-6 within the first 12 hours
Critically ill cancer patient in intensive care unit: Issues that arise
Advances in the management of malignancies and organ failures have led
to substantial increases in survival as well as in the number of cancer
patients requiring intensive care unit (ICU) admission. Although
effectiveness of ICU in this group remains controversial, the
heterogeneity of its population in terms of the nature and curability of
their disease and the severity of critical illness and underlying
conditions may explain the plethora of issues arising when considering
cancer patients for ICU admission, especially from the view of limited
resources and ICU beds.
The most frequent reasons leading a cancer patient to ICU are
postoperative, respiratory failure, infection, and sepsis. Although
reasons of admission, nature and number of organ failures, type of
malignancy, and therapies that have preceded ICU admission may affect
outcome, reliable scoring systems or survival predictors are missing.
Literature suggests that organ dysfunction should be managed at its
onset, whereas aggressive ICU management should be reappraised after a
few days of full support.
A multidisciplinary treating team of physicians should aid in changing
the goals from restorative to palliative care when there appears to be
no possible benefit from any treatment. End-of life-decisions and code
status should be made by consensus, based on patients’ autonomy and
dignity. Further interventional multicenter studies are required to
assess post-ICU burden, long-term medical outcomes, and quality of life
in this cohort of patients. (C) 2014 Elsevier Inc. All rights reserved
Immune Response to Mycobacterial Infection: Lessons from Flow Cytometry
Detecting and treating active and latent tuberculosis are pivotal elements for effective infection control; yet, due to their significant inherent limitations, the diagnostic means for these two stages of tuberculosis (TB) to date remain suboptimal. This paper reviews the current diagnostic tools for mycobacterial infection and focuses on the application of flow cytometry as a promising method for rapid and reliable diagnosis of mycobacterial infection as well as discrimination between active and latent TB: it summarizes diagnostic biomarkers distinguishing the two states of infection and also features of the distinct immune response against Mycobacterium tuberculosis (Mtb) at certain stages of infection as revealed by flow cytometry to date
The importance of fever as a predictive symptom for the potency of host's monocytes to release pro- and anti-inflammatory mediators
Objective. To clarify whether time lapsing from advent of fever as a
first sign of sepsis may be indicative of the potency of monocytes for
the release of pro-and anti-inflammatory mediators. Methods. Monocytes
were isolated from blood of 51 septic patients and 9 healthy donors.
Monocytes were incubated in the absence and presence of patients’ serum
and concentrations of tumour necrosis factor-alpha (TNF alpha),
interleukin (IL)-6, IL-10, and malondialdehyde (MDA) were estimated in
supernatants. Patients were divided into three groups: group A: < 12
hours, group B: 12 -24 hours, and group C: > 24 hours between initiation
of fever and blood sampling. Results. TNFa of supernatants of groups B
and C was higher than controls, as also were IL-6 of A and C, IL-10 of A
and B, andMDA of A. IL-6 of group A was increased after addition of
patients serum. A negative correlation was found between time from
initiation of symptoms and IL-6 of monocyte supernatants incubated in
the presence of patients serum. Median IL-6 of survivors was higher than
nonsurvivors. Conclusion. Monocytes are potent for the release of
pro-and anti-inflammatory mediators within the first 24 hours upon
advent of fever related to sepsis; serum stimulates further release of
IL-6 within the first 12 hours. Copyright (C) 2008 Magdalini
Kyriakopoulou et al
Factor XIII deficiency as a potential cause of supratentorial haemorrhage after posterior fossa surgery
Postoperative intracranial haemorrhage can be a dramatic event, carrying
significant morbidity and mortality. Bleeding at sites remote from the
operation area represents a small percentage of haemorrhages whose
aetiology remains unclear (Harders et al. Acta Neurochir (Wien)
74(1-2):57-60, 1985).
We present the case of a 60-year-old patient who underwent posterior
fossa craniotomy for the removal of a space-occupying lesion and
suffered supratentorial haemorrhage soon after the operation.
A thorough postoperative investigation revealed low levels of factor
XIII (FXIII), the factor mainly responsible for fibrin clot
stabilisation.
We suggest that reduced FXIII activity may be an important but
preventable predisposing factor to remote postoperative haemorrhage in
neurosurgical patients
Factor XIII deficiency as a potential cause of supratentorial haemorrhage after posterior fossa surgery
BACKGROUND: Postoperative intracranial haemorrhage can be a dramatic event, carrying significant morbidity and mortality. Bleeding at sites remote from the operation area represents a small percentage of haemorrhages whose aetiology remains unclear (Harders et al. Acta Neurochir (Wien) 74(1-2):57-60, 1985).
AIM: We present the case of a 60-year-old patient who underwent posterior fossa craniotomy for the removal of a space-occupying lesion and suffered supratentorial haemorrhage soon after the operation.
RESULTS: A thorough postoperative investigation revealed low levels of factor XIII (FXIII), the factor mainly responsible for fibrin clot stabilisation.
CONCLUSION: We suggest that reduced FXIII activity may be an important but preventable predisposing factor to remote postoperative haemorrhage in neurosurgical patients
Is prolonged infusion of piperacillin/tazobactam and meropenem in critically ill patients associated with improved pharmacokinetic/pharmacodynamic and patient outcomes? An observation from the Defining Antibiotic Levels in Intensive care unit patients (DALI) cohort
Objectives: We utilized the database of the Defining Antibiotic Levels in Intensive care unit patients (DALI) study to statistically compare the pharmacokinetic/pharmacodynamic and clinical outcomes between prolonged- infusion and intermittent-bolus dosing of piperacillin/tazobactam and meropenem in critically ill patients using inclusion criteria similar to those used in previous prospective studies. Methods: This was a post hoc analysis of a prospective, multicentre pharmacokinetic point-prevalence study (DALI), which recruited a large cohort of critically ill patients from 68 ICUs across 10 countries. Results: Of the 211 patients receiving piperacillin/tazobactam and meropenem in the DALI study, 182 met inclusion criteria. Overall, 89.0% (162/182) of patients achieved the most conservative target of 50% fT 65MIC (time over which unbound or free drug concentration remains above the MIC). Decreasing creatinine clearance and the use of prolonged infusion significantly increased the PTA for most pharmacokinetic/pharmacodynamic targets. In the subgroup of patients who had respiratory infection, patients receiving \u3b2-lactams via prolonged infusion demonstrated significantly better 30 day survival when compared with intermittent-bolus patients [86.2% (25/29) versus 56.7% (17/30); P=0.012]. Additionally, in patients with a SOFA score of 65 9, administration by prolonged infusion compared with intermittent-bolus dosing demonstrated significantly better clinical cure [73.3% (11/15) versus 35.0% (7/20); P=0.035] and survival rates [73.3% (11/15) versus 25.0% (5/20); P=0.025]. Conclusions: Analysis of this large dataset has provided additional data on the niche benefits of administration of piperacillin/tazobactam and meropenem by prolonged infusion in critically ill patients, particularly for patients with respiratory infection