The clinical relevance of oliguria in the critically ill patient : Analysis of a large observational database

Funding Information: Marc Leone reports receiving consulting fees from Amomed and Aguettant; lecture fees from MSD, Pfizer, Octapharma, 3 M, Aspen, Orion; travel support from LFB; and grant support from PHRC IR and his institution. JLV is the Editor-in-Chief of Critical Care. The other authors declare that they have no relevant financial interests. Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Urine output is widely used as one of the criteria for the diagnosis and staging of acute renal failure, but few studies have specifically assessed the role of oliguria as a marker of acute renal failure or outcomes in general intensive care unit (ICU) patients. Using a large multinational database, we therefore evaluated the occurrence of oliguria (defined as a urine output 16 years) patients in the ICON audit who had a urine output measurement on the day of admission were included. To investigate the association between oliguria and mortality, we used a multilevel analysis. Results: Of the 8292 patients included, 2050 (24.7%) were oliguric during the first 24 h of admission. Patients with oliguria on admission who had at least one additional 24-h urine output recorded during their ICU stay (n = 1349) were divided into three groups: transient - oliguria resolved within 48 h after the admission day (n = 390 [28.9%]), prolonged - oliguria resolved > 48 h after the admission day (n = 141 [10.5%]), and permanent - oliguria persisting for the whole ICU stay or again present at the end of the ICU stay (n = 818 [60.6%]). ICU and hospital mortality rates were higher in patients with oliguria than in those without, except for patients with transient oliguria who had significantly lower mortality rates than non-oliguric patients. In multilevel analysis, the need for RRT was associated with a significantly higher risk of death (OR = 1.51 [95% CI 1.19-1.91], p = 0.001), but the presence of oliguria on admission was not (OR = 1.14 [95% CI 0.97-1.34], p = 0.103). Conclusions: Oliguria is common in ICU patients and may have a relatively benign nature if only transient. The duration of oliguria and need for RRT are associated with worse outcome.publishersversionPeer reviewe

Temporal changes in the epidemiology, management, and outcome from acute respiratory distress syndrome in European intensive care units: a comparison of two large cohorts

Background: Mortality rates for patients with ARDS remain high. We assessed temporal changes in the epidemiology and management of ARDS patients requiring invasive mechanical ventilation in European ICUs. We also investigated the association between ventilatory settings and outcome in these patients. Methods: This was a post hoc analysis of two cohorts of adult ICU patients admitted between May 1–15, 2002 (SOAP study, n = 3147), and May 8–18, 2012 (ICON audit, n = 4601 admitted to ICUs in the same 24 countries as the SOAP study). ARDS was defined retrospectively using the Berlin definitions. Values of tidal volume, PEEP, plateau pressure, and FiO2 corresponding to the most abnormal value of arterial PO2 were recorded prospectively every 24 h. In both studies, patients were followed for outcome until death, hospital discharge or for 60 days. Results: The frequency of ARDS requiring mechanical ventilation during the ICU stay was similar in SOAP and ICON (327[10.4%] vs. 494[10.7%], p = 0.793). The diagnosis of ARDS was established at a median of 3 (IQ: 1–7) days after admission in SOAP and 2 (1–6) days in ICON. Within 24 h of diagnosis, ARDS was mild in 244 (29.7%), moderate in 388 (47.3%), and severe in 189 (23.0%) patients. In patients with ARDS, tidal volumes were lower in the later (ICON) than in the earlier (SOAP) cohort. Plateau and driving pressures were also lower in ICON than in SOAP. ICU (134[41.1%] vs 179[36.9%]) and hospital (151[46.2%] vs 212[44.4%]) mortality rates in patients with ARDS were similar in SOAP and ICON. High plateau pressure (> 29 cmH2O) and driving pressure (> 14 cmH2O) on the first day of mechanical ventilation but not tidal volume (> 8 ml/kg predicted body weight [PBW]) were independently associated with a higher risk of in-hospital death. Conclusion: The frequency of and outcome from ARDS remained relatively stable between 2002 and 2012. Plateau pressure > 29 cmH2O and driving pressure > 14 cmH2O on the first day of mechanical ventilation but not tidal volume > 8 ml/kg PBW were independently associated with a higher risk of death. These data highlight the continued burden of ARDS and provide hypothesis-generating data for the design of future studies

Synthesis and activity of cephalosporins containing an oxyiminomethylene functionality in the ortho-position of a phenyl- or phenoxyacetic acid C-7 side chain substituent

A new series of cephalosporins having in the C-7 side chain a phenyl- or a phenoxyacetamido group bearing an oxyiminomethyl function in the ortho-position of the aromatic ring was prepared. Their in vitro activity was tested against both Gram+ and Gram- strains. (C) 1998 Elsevier Science S.A. All rights reserved

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A case report of Dermanyssus gallinae infestation in three cats

Background: Dermanyssus gallinae is a major threat for the poultry industry; these mites also feed on the blood of many other birds, small mammals and potentially humans. Hypothesis/Objectives: Three cats with dermatitis attributed to D. gallinae infestation. Animals: Two 40-day-old kittens, living in a rural area, and one 7-year-old female indoor cat, were presented with a pruritic skin condition. Methods: Mite specimens were collected from the cats and examined by light and scanning electron microscopy. Cytological and histological examinations of the skin lesions were performed. Results: A diagnosis of D. gallinae infestation was made after identification of the mites. Histological findings were compatible with eosinophilic dermatitis. Clinical improvement was noted two weeks after treatment. Conclusions and clinical importance: The two kittens showed chronic blood loss which reflects the ability of D. gallinae mites to switch host. For the indoor cat, mites were presumed to be carried by birds regularly present on the balcony of the apartment. This demonstrates that mite infestation is possible even in urban areas, through contact with birds or their abandoned nests. When birds are not present, cats or other small mammals as well as humans, can be infested

Efficacies of 11% Lactoferricin and 0.05% Chlorhexidine Otological Solution compared, in the treatment of microbial otic overgrowth: A randomized single blinded study

Background:Topical therapy with antimicrobial agents is used in otitis treatment. Due to increase of antibiotic resistance, new strategies are needed. Antiseptics are used but they may induce contact dermatitis. Natural antimicrobial peptides may represent future effective drugs. Objectives:The objectives were to test the efficacy of an 11% lactoferricin otological solution (LCF) in bacterial and yeasts otic overgrowth and compare LCF with a commercial one containing chlorhexidine (CLX) 0.05%. Materials and methods:Forty-one dogs diagnosed with bacterial or yeasts otitis overgrowths were included according to general good practice. They were randomly assigned to lactoferricin or chlorhexidine group for treatment. Otological solution were applied twice a day for a week and then daily for another week. Clinical and cytological score was assessed at day 1 and day 14. At the end of the study, the owners had to express an opinion on the overall efficacy of the products. Statistical analyses were performed using Wilkoxon’s test and T test for paired samples. Results in lesional and cytological score were significative with a p<0.05. Results:Forty dogs completed the study. All cases, receiving lactoferricin or chlorhexidine, were successfully treated with clinical signs remission and regression of infection (p<0.05). The owners’ judgment was good in 87%, mild in 13% for LCF group. For CLX they scored good in 41%, mild in 24% and unuseful in 35% of cases. Conclusions:Lactoferricin, an antimicrobial natural peptide, showed the same efficacy of chlorhexidine in the treatment of otitis characterized by bacterial or/and yeast overgrowth

Linfoma cutaneo epiteliotropo: aspetti clinico-patologici in 20 cani

Canine epitheliotropic cutaneous lymphoma, also named mycosis fungoides, has been described as an uncommon cutaneous lymphoma of T-cell origin, which is histologically characterized by the epitheliotropism of neoplastic T-lymphocytes. Two variants have been reported in man, based upon clinical and histopathological features: classical mycosis fungoides and Sezary syndrome. The disease in dogs is clinically classified as cutaneous nodular form, exfoliative erythroderma, mucocutaneous form, and oral form. Aim of the study - The aim is to point out the most interesting clinical and histopathological findings for the diagnosis, also carrying out a comparison with the human species. Material and methods - We report the cases of 20 dogs, diagnosed with epitheliotropic cutaneous lymphoma. Medical records of these animals were reviewed for rilevant data on signalment, anamnesis, clinical examination and histopathologic diagnosis. Results - All the clinical variants described by Scott in veterinary medicine were present alone or in combination: exfoliative erythroderma (75% dogs), mucocutaneous form (65% dogs), cutaneous nodular form (55% dogs), and oral form (25% dogs). On the basis of histological features, the most represented variant was pagetoid reticulosis (14/20 dogs, 70%). Sezary syndrome could not be found. Discussion - The clinical and histopathological features that were observed reflected those previously reported in the published literature, and showed interesting findings to be compared with the homologous human neoplasia