Special Issue:
Challenges and Opportunities in Sepsis
D Streitova
Facultas Medicinae, Clinic of Anestesiology, resuscitation and Intensive Medicinae, Universitas Ostraviensis; Faculty Hospital Ostrava, Central Operating Rooms
R. Zoubkova
Facultas Medicinae, Clinic of Anestesiology, resuscitation and Intensive Medicinae, Universitas OstraviensisFaculty Hospital Ostrava, Clinic of Anestesiology, resuscitation and Intensive Medicinae
J. Vavrošová
Facultas Medicinae, Clinic of Anestesiology, resuscitation and Intensive Medicinae, Universitas Ostraviensis
Abstract
Background: Sepsis is one of the most serious complications in intensive care patients, which is associated with high mortality and morbidity of critically ill patients. Measures based on the effective prevention are one of the main strategies of treating patients. Aseptic procedures, barrier nursing techniques, selection of equipment used for the treatment as well as the replacement frequency of protective barriers are preferred nursing interventions of sepsis with regard to the prevention. The objective of this retrospective study was to assess the importance of nursing interventions and aspects of the incidence of sepsis and infectious complications in ICU patients, including analysis of erroneous nursing procedures that could affect the formation of sepsis.
Methods: A retrospective study was conducted by data collection from medical records and observation of patients hospitalized at the Clinic of Anesthesiology and Intensive-care during the period from January 2019 to December 2022. The overall sample consisted of 736 patients who were diagnosed with sepsis by a doctor according to confirmed infectious etiology. Data were processed by descriptive statistics, frequency tables and x2 (chi-square) test were used for evaluating and the Fisher’s exact test was used for small frequency (n <5). Statistical tests were assessed at the significance level of 5. There were identified 231 patients with sepsis, 106 patients with confirmed infectious etiology, 31 patients with confirmed non- infectious causes (SIRS) and 7 cases of other infectious cause was confirmed during hospitalization. Another category of patients was represented by cases, in which the positive sputum was found in injection site infection, in positive punctate in wound, in purulent secretion from the wound or bacterial findings in urine without general symptoms of infection. Nursing interventions were analyzed with regard to the prevention of sepsis patients in intensive care. Results: The largest number of sepsis was proved in 2019 (26.23%) and in 2020 (20.01%), while in 2021 (11.67%) and 202022 (14.02%) there was recognized a decrease in sepsis. According to the etiology there was significant share of VAP and catheter sepsis compared to uremic and early infection Out of the nursing procedures that have proven to be important for the prevention of VAP there were identified a closed suction method, the selection of the endotracheal tube, the use of semi recumbent position. Selection of the catheter, puncturesite selection, use of infusion filters or disinfection options were found as important examples in the prevention of catheter sepsis. Using a closed circuit system has proved to be the most effective in urinary tract infections. The results clearly show the effect of educational activities of working group on compliance with the rules of asepsis, compliance with barrier nursing activities and practices that are entirely in the hands of the nursing staff.
Conclusions: All preventive measures are in accordance with the recommendations of CDC (The Centers for Disease Control and Prevention) and SHEA (The Society for Healthcare Epidemiology of America) that recommend the education and training of the staff. The objective is to increase awareness of the necessity of preventive measures which help to reduce the incidence of infection with subsequent sepsis in patients in intensive care. Regular education and practical training can not only improve the quality of care, but we can also implement new procedures into the practice with regard to the nursing staff awareness of the importance of sepsis prevention at intensive care units.
François Ventura
Division of Anesthesiology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, CH-1211 Genève 14, Switzerland.; Intensive Care Unit, Hirslanden Clinique des Grangettes, Chemin des Grangettes 7, CH-1224 Chêne-Bougeries – Switzerland.
Philippe Eggimann
Department of locomotor apparatus, Lausanne University Hospital (CHUV), Rue du Bugnon 21, 1011 Lausanne, Vaud, Switzerland.
Thomas Daix
Medical-surgivcal ICU & Inserm CIC1435 & UMR1092, Centre Hospitalier Universitaire CHU Dupuytren, Avenue Martin Luther King 2, 87042 Limoges, France.
Bruno François
Medical-surgivcal ICU & Inserm CIC1435 & UMR1092, Centre Hospitalier Universitaire CHU Dupuytren, Avenue Martin Luther King 2, 87042 Limoges, France.
Jérôme Pugin
Division of intensive care, Geneva university hospitals, Rue Gabrielle-Perret-Gentil 4, CH-1211 Genève 14, Switzerland and faculty of medicine, University of Geneva, Switzerland.
Abstract
Sepsis occurs yearly in 48.9 million people worldwide of whom 11 million will die. Sepsis is defined as a life-threatening dysregulated reaction of the body in response to a bacterial infection, leading to organ dysfunction. The Surviving Sepsis Campaign made numerous recommendations for sepsis diagnosis and treatment using an evidence-based medicine approach. Frequently, levels of evidence of these recommendations are poor and lack clear clinical guidance. Interestingly, these guidelines strongly recommend, with a moderate quality of evidence, screening of nosocomial sepsis in acutely ill hospitalized high-risk patients. The definition of acutely ill and high-risk patients is not specified, nor it is indicated which tools should be used. The diagnosis of infection and the subsequent administration of antibiotics relies solely on rapid clinical assessment, as recommended by the Best Practice Statement. Again, the elements used for clinical assessment are poorly defined, encompassing patient history, clinical examination, and unspecified tests for both infectious and non-infectious causes of acute illness. In the real world and based on these recommendations, only 30 to 40% of empiric broad-spectrum antibiotic administrations are appropriate, contributing to the emergence of antimicrobial resistant bacteria, toxicity related to antibiotic administration, and costs. The aim of this review article is to show that the use of biomarkers, such as the Pancreatic Stone Protein, could be the specific tests and tools to help the clinician to diagnose and manage sepsis. Over 600 peer-reviewed publications have studied the physiology of Pancreatic Stone Protein and more than 50 evaluated its usefulness to screen for the development of nosocomial sepsis and diagnose sepsis.
Alison E. Fox-Robichaud, MD, FRCPC
Dept of Medicine and Thrombosis and Atherosclerosis Research Institute, McMaster University
Jaskirat Arora, MBBS, PhD
Thrombosis and Atherosclerosis Research Institute, McMaster University
Abstract
Despite years of research and multiple potential candidate biomarkers for sepsis, few have had sufficient sensitivity or specificity to be integrated into routine practice. There have been only 11 observational studies that have collected samples from patients presenting to the emergency department with suspected sepsis. This has resulted in gaps in the ability to accurately diagnose sepsis in patients presenting with infections and give an accurate prognosis for patients or their families. Recent work has shown the importance of immunothrombosis, particularly in the prognosis for patients admitted to the intensive care unit with sepsis. Significantly some of the most impactful markers are actually decreased. In this perspective we summarize the current sepsis biomarker literature, highlight the limitations, particularly in diagnosis, and suggest some strategies for moving this field forward.
Tasabeeh Hamad
Pharmacy Department, Sultan Qaboos Comprehensive Cancer Care and Research Center, Muscat, Oman.
Galal Abdalla
2 Department of Internal Medicine, Queen Elizabeth The Queen mother Hospital, Kent, United Kingdom.
Bushra Salman
1 Pharmacy Department, Sultan Qaboos Comprehensive Cancer Care and Research Center, Muscat, Oman.
Bashir A. Yousef
Department of Pharmacology, Faculty of Pharmacy, University of Khartoum, Khartoum, Sudan.
Abstract
Introduction: Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to an infection. Early recognition and administration of appropriate empirical antibiotic therapy are associated with lower mortality rate and shorter length of stay. This study aims to identify the risk factors for developing sepsis, the common sites of infection, the isolated microorganisms, and to evaluate the impact of appropriate empiric antibiotic on the mortality rate and length of stay the in two tertiary care hospitals in Sudan.
Methodology: A prospective hospital-based study was done on 30 patients who were admitted to the intensive care unit (ICU) during a four-month study period. Data were retrieved from patients’ records. Data were analyzed using SPSS Version 20.
Results: Out of the 30 study patients, 43% were females. The median age of the group was 68 years and 57% of the patients were above 65 years. The most common risk factor for developing sepsis was diabetes mellitus (23.33%), followed by malignancy (16.67%). The most common site of infection was the chest (33.33%). In total, 19 different regimens of empirical antibiotics were prescribed, where 43.4% were appropriate and 56.6% were inappropriate. Among the studied population, 18 patients died and the overall mortality was 60%. The study found that in patients who received appropriate empiric antibiotics, mortality significantly decreased (p = 0.006). Patients who received appropriate treatment were also found to have a numerically 4-days shorter length of ICU stay but this did not reach statistical significance due to small sample size.
Conclusions: The study concluded that diabetes mellitus is the most common risk factor for developing sepsis, followed by malignancy. Gram-negative organisms are the most common isolated microorganisms. Respiratory infection is the most common source of infections. The prescribed empirical antibiotics were mostly inappropriate. Moreover, patients with appropriate empirical antibiotics had shorter ICU stays and increased survival when compared with those who had inappropriate treatment.
Chun-Man Chen
TaiRx, Inc., Taipei 115602, Taiwan
Yen-Ling Chen
TaiRx, Inc., Taipei 115602, Taiwan
Shu-Min Lin
Department of Thoracic Medicine, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, Taoyuan 333423, Taiwan; Department of Respiratory Therapy, Chang Gung Memorial Hospital, Taoyuan 333423, Taiwan; School of Medicine, National Tsing Hua University, Hsinchu 300044, Taiwan
Huang-Pin Wu
Division of Pulmonary, Critical Care and Sleep Medicine, Keelung Chang Gung Memorial Hospital, Keelung 204201, Taiwan
Jiun-Nong Lin
School of Medicine, College of Medicine, I-Shou University, Kaohsiung 840203, Taiwan; Department of Critical Care Medicine, E-Da Hospital, I-Shou University, Kaohsiung 824005, Taiwan
Kai-Huang Lin
Division of Critical Care Internal Medicine, Department of Emergency Medicine and Critical Care, Changhua Christian Hospital, Changhua 500209, Taiwan
Chin-Ming Chen
Department of Intensive Care Medicine, Chi-Mei Medical Center, Tainan 710402, Taiwan; School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung 804201, Taiwan
Kuang-Yao Yang
Department of Chest Medicine, Taipei Veterans General Hospital, Taipei 112201, Taiwan; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
Shih-Chi Ku
Division of Chest Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei 100225, Taiwan
Fu-Tsai Chung
Department of Thoracic Medicine, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, Taoyuan 333423, Taiwan; Department of Thoracic Medicine, New Taipei Municipal TuCheng Hospital, New Taipei City 236043, Taiwan; Department of Respiratory Therapy, New Taipei Municipal TuCheng Hospital, New Taipei City 236043, Taiwan; School of Medicine, College of Medicine, Chang Gung University, Taoyuan City 333423, Taiwan
Chih-His Kuo
Department of Thoracic Medicine, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, Taoyuan 333423, Taiwan
Chien Tung Chiu
School of Medicine, College of Medicine, I-Shou University, Kaohsiung 840203, Taiwan
Chi-Kuei Hsu
School of Medicine, College of Medicine, I-Shou University, Kaohsiung 840203, Taiwan
Hsin-Hui Hsu
Division of Critical Care Internal Medicine, Department of Emergency Medicine and Critical Care, Changhua Christian Hospital, Changhua 500209, Taiwan
Chien-Ming Chu
Division of Pulmonary, Critical Care and Sleep Medicine, Keelung Chang Gung Memorial Hospital, Keelung 204201, Taiwan
Han-Chung Hu
Department of Thoracic Medicine, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, Taoyuan 333423, Taiwan
Chung-Shu Lee
Department of Thoracic Medicine, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, Taoyuan 333423, Taiwan; Department of Pulmonary and Critical Care Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City 236043, Taiwan
Shin-Hwar Wu
Division of Critical Care Internal Medicine, Department of Emergency Medicine and Critical Care, Changhua Christian Hospital, Changhua 500209, Taiwan
I-Chieh Mao
Division of Critical Care Internal Medicine, Department of Emergency Medicine and Critical Care, Changhua Christian Hospital, Changhua 500209, Taiwan
Ting-Yu Chao
TaiRx, Inc., Taipei 115602, Taiwan
Yi-Wen Chu
TaiRx, Inc., Taipei 115602, Taiwan
Du-Shieng Chien
TaiRx, Inc., Taipei 115602, Taiwan
Abstract
The relationship between serum selenium levels and mortality was investigated in septic patients with severe selenium deficiency (baseline selenium ≤ 80 ng/mL). Eligible patients of sepsis or septic shock were randomized to receive Placebo or High-Dose Selenium (1,000 μg/day) via intravenous injection. Safety, serum selenium, mortality, SOFA, and Glasgow Coma Scale (GCS) scores were monitored. Among all 330 subjects, 27.9% subjects (n=92) had severe selenium deficiency (mean serum selenium = 66.5 ng/mL). Mortality of severe selenium deficiency patients was 27.2%, significantly higher than 17.9% of all subjects. In severe selenium deficiency Placebo group (n=45), 62% subjects showed gradual increase of selenium levels to ~110 ng/mL (mortality ~21.4%), while 38% subjects remained at low selenium ≤ 110 ng/mL throughout study (mortality ~41.2%). Mortality for Placebo subjects with normal baseline selenium ≥ 110 ng/mL was 13.6%. With High-Dose Selenium treatment, 91% of severe selenium deficiency subjects showed quick selenium increase to ~110 ng/mL (mortality 25.5%). Mortality was reduced to 8.6% for High-Dose Selenium subjects with baseline selenium ≥ 110 ng/mL. The odds ratio showed significantly greater survival of High-Dose Selenium subjects with baseline selenium ≥ 110 ng/mL (91.4%) than severe selenium deficiency Placebo subjects (74.1%). Mean baseline SOFA scores for severe selenium deficiency patients were 9.1–9.4, decrease of SOFA scores in High-Dose Selenium subjects was significantly greater than Placebo subjects, along with significant improvement of GCS scores. Repeated infusion of High-Dose Selenium in severe selenium deficiency patients for 14 days was safe and well-tolerated. Mortality for patients with sepsis was clearly affected by serum selenium concentrations. High mortality (41–50%) was observed in the sepsis patients constantly with low selenium £ 80 ng/mL; mortality was reduced to 21–23% if their serum selenium could be increased to ≥ 110 ng/mL. High-Dose Selenium resulted in rapid restoration of serum selenium and improved the survival of severe selenium deficiency septic patients. Low mortality (9–14%) was observed in the sepsis patients starting with baseline selenium ≥ 110 ng/mL. Overall this study demonstrates the significant impact of insufficient selenium levels on the mortality of septic patients. Treatment with high-dose selenium reduced the mortality of severe selenium deficiency septic subjects.
Mairi C. Noverr
Department of Microbiology and Immunology, Tulane University School of Medicine
Junko Yano
Center of Excellence in Oral and Craniofacial Biology, LSU Health School of Dentistry
Michael E. Hagensee
Section of Infectious Diseases, Department of Medicine, LSU Health New Orleans
Hui-Yi Lin
Biostatistics Program, LSU Health School of Public Health
Mary C. Meyaski
Clinical and Translational Research Center, LSU Health New Orleans
Erin Meyaski
Clinical and Translational Research Center, LSU Health New Orleans
Jennifer Cameron
Department of Microbiology, Immunology, and Parasitology, LSU Health New Orleans
Judd Shellito
Section of Pulmonary Medicine, Department of Medicine, LSU Health New Orleans
Amber Trauth
Section of Infectious Diseases, Department of Medicine, LSU Health New Orleans
Paul L. Fidel, Jr.
Center of Excellence in Oral and Craniofacial Biology, LSU Health School of Dentistry
Abstract
Mortality in COVID-19 cases was strongly associated with progressive lung inflammation and eventual sepsis. There is mounting evidence that live attenuated vaccines commonly administered during childhood, also provide beneficial non-specific immune effects, including reduced mortality and hospitalization due to unrelated infections. It has been proposed that live attenuated vaccine-associated non-specific effects are a result of inducing trained innate immunity to function more effectively against broader infections. In support of this, our laboratory has reported that immunization with a live attenuated fungal strain induces a novel form of trained innate immunity which provides protection against various inducers of sepsis in mice via myeloid-derived suppressor cells. Accordingly, we initiated a randomized control clinical trial with the live attenuated Measles, Mumps, Rubella (MMR) vaccine in healthcare workers in the greater New Orleans area aimed at preventing/reducing severe lung inflammation/sepsis associated with COVID-19 (ClinicalTrials.gov Identifier: NCT04475081). Included was an outcome to evaluate the myeloid-derived suppressor cell populations in blood between those administered the MMR vaccine vs placebo. The unanticipated emergency approval of several COVID-19 vaccines in the midst of the MMR clinical trials eliminated the ability to examine effects of the MMR vaccine on COVID-19-related health status. Unfortunately, we were also unable to show any impact of the MMR vaccine on peripheral blood myeloid-derived suppressor cells due to several inherent limitations (low percentages of blood leukocytes, small sample size), that also included a collaboration with a similar trial (CROWN CORONATION; ClinicalTrials.gov Identifier: NCT04333732) in St. Louis, MO. In contrast, monitoring the COVID-19 vaccine response in trial participants revealed that high COVID-19 antibody titers occurred more often in those who received the MMR vaccine vs placebo. While the trial was largely inconclusive, lessons learned from addressing several trial-associated challenges may aid future studies that test the non-specific beneficial immune effects of live attenuated vaccines.
Sertaridou N. Eleni, MD, MSc, PhD
Surgeon – Intensivist, ICU Department, University Hospital of Alexandroupolis, Greece
Papaioannou E. Vasileios
Professor of Intensive Care Medicine and Computational Medicine at Democritus University of Thrace, Director of ICU Department, University Hospital of Alexandroupolis, Greece
Abstract
Sepsis represents a lethal dysregulated host response to infection leading to organ dysfunction. Extracorporeal blood purification is proposed as an adjuvant therapy for sepsis, aiming at controlling the associated dysregulation of the immune system, preventing multiorgan failure. Even in the absence of strong indications deriving from large clinical studies, the removal of mediators is increasingly used in septic shock and in other clinical conditions characterized by a hyperinflammatory response. Different therapies have been developed to address certain steps of the immune dysregulation besides classical renal replacement therapy, such us High Volume Hemofiltration, High-cut-off membrane hemofiltration, hemoadsorption treatments and coupled plasma filtration and adsorption. Despite the different underlying mechanisms of action, most of such available devices focus on a single target, such as endotoxins, cytokines, or both, that triggers the inflammatory cascade. The attention in this review is focused on presenting Blood Purification Techniques and the evidence of their clinical effectiveness, clarifying the indications, ideal patient selection, timing, dosing and biomonitoring, important issues that should be solved in the future, to enable usage of these therapies in the best possible and most targeted manner.
Campos-Martinez AM
Neonatal Intensive Care Unit, San Cecilio Clinical Hospital, Granada, Spain.
Fernández-Marín E
Neonatal Intensive Care Unit, San Cecilio Clinical Hospital, Granada, Spain.
Ruiz-López A
Neonatal Intensive Care Unit, San Cecilio Clinical Hospital, Granada, Spain.
Cubero-Millan I
Neonatal Intensive Care Unit, San Cecilio Clinical Hospital, Granada, Spain.
Gonzalez-Bolivar M
1. Neonatal Intensive Care Unit, San Cecilio Clinical Hospital, Granada, Spain
Uberos J
Neonatal Intensive Care Unit, San Cecilio Clinical Hospital, Granada, Spain; Pediatrics Department, Medicine Faculty, Granada, Spain.
Abstract
This article reviews the evidence for the use of different strains of probiotics in the prevention of prevalent pathologies in premature infants.
A systematic review was conducted of the use of probiotics in neonates with less than 37 weeks’ gestational age, based on a search for systematic reviews and observational and experimental studies performed during the period January 2014 to February 2021. For this purpose, the PubMed, MEDLINE and Cochrane Library databases were consulted. The aim of this article was to review the existing data on the relationship between the administration of probiotics (with different strains and doses) and the risk of necrotising enterocolitis (NEC), mortality, late sepsis and other disease parameters in premature infants.
The literature search obtained 240 articles, of which we selected 16, representing a total sample of over 200,000 premature infants. Analysis of the data obtained reveals statistical evidence that the combined administration of probiotics (especially Lactobacillus and Bifidobacterium strains) reduces the incidence of grade II or higher NEC, all-cause mortality, late sepsis, length of hospital stay and time until complete enteral nutrition is achieved. However, no benefits were apparent with respect to alleviating bronchopulmonary dysplasia, retinopathy of prematurity or intraventricular haemorrhage.
Further research is needed to determine the most appropriate strains, doses and treatment time for preterm infants to achieve the health benefits identified.
Yassine Bou-ouhrich
Department of Intensive Care Medicine, Ibn Rochd University Hospital, Faculty of medicine and Pharmacy of Casablanca, Hassan 2 University, Casablanca, Morocco.
Boubaker Charra
Head of the medical intensive care department, Ibn Rochd university hospital,Hassan 2 university, Casablanca, Morocco.
Abstract
Introduction: Thrombocytopenia is a platelet count below 150,000/mm3. It is a frequent abnormality in critically ill patients.
Methods: We conducted a retrospective study which included 603 patients admitted to the medical intensive care unit in the Ibn Rochd university hospital of Casablanca over a two years period, from January 1, 2018 to December 31, 2019. The aim of the study is to point out the incidence, risk factors, etiologies, therapeutic modalities, as well as the morbidity and mortality related to thrombocytopenia in critical care.
Results: During the study period, and out of these 603 patients, 168 patients had thrombocytopenia, that is an incidence of 27.8%; 38 patients among them were admitted with an already ongoing thrombocytopenia. Sepsis, Acute respiratory distress syndrome, renal failure, hemodialysis, and liver dysfunction were risk factors of thrombocytopenia and predictors of mortality. Thrombocytopenia was a factor of increased mortality, the percentage of death was higher in the thrombocytopenic group compared with the non-thrombocytopenic group with a rate of 42.26%. However, it was not an independent factor of mortality.
Conclusion: Sepsis is the major factor incriminated in the occurrence of thrombocytopenia in critically ill patients. Therapeutic management including platelet transfusion should depend on the etiology of thrombocytopenia along with the associated hemorrhagic risk.
Iulian Nusem
Logan Hospital, Metro South Health, Queensland, Australia; Queensland Tissue Bank, Queensland, Australia; Griffith University, Queensland, Australia
Marjoree Sehu
Peninsula Health, Victoria, Australia; Queensland University, Queensland, Australia
Abstract
Background: Septic arthritis of the hip is an orthopaedic emergency which requires prompt diagnosis and treatment. If treated late or inadequately, it can have devastating consequences for the development of the hip joint. Infection is most commonly caused by Staphylococcus aureus which spreads via the blood stream or from an adjacent area of osteomyelitis. Diagnosing and managing this condition continue to be challenging and poor outcomes may occur. Neonates may present with sepsis and failure to thrive. There may be no fever. The hip is held in flexed, abducted and externally rotated position. The limb is held still and any passive movement causes pain. Older children typically present with a limp or refusal to walk. Children typically have elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels. Needle aspiration is the most specific diagnostic test. Prompt surgical drainage and postoperative antibiotic therapy until signs of infection resolve are necessary to prevent late sequelae.
Objectives: The present review aims to discuss the published evidence related to the diagnosis of septic arthritis of the hip based on history, physical examination, laboratory tests, imaging studies and arthrocentesis, and management including antibiotic treatment and surgical joint debridement.
Conclusion: With prompt diagnosis and appropriate treatment, outcomes are generally good, with only few long-term sequelae. Delay in diagnosis and treatment may result in growth disturbances and joint destruction.
Thanet Pongcharoensuk
Phramongkutklao hospital
Chutika Srisuttiyakorn
Phramongkutklao hospital
Abstract
Erythroderma is a medical condition characterized by inflammation involving skin over 90% of the body’s surface area. This condition can result in high mortality rate and many systemic complications including fluid and electrolyte imbalance, infections, thermoregulatory disturbance and high output cardiac failure. In Thailand, limited data have been reported in the literature.
This study aims to investigate epidemiologic, clinical and histologic data relevant to etiologies of erythroderma among adults.
We performed a retrospective study among all patients acquiring erythroderma, aged above 16 years and visiting at the Division of Dermatology, Department of Internal Medicine, Phramongkutklao Hospital, Thailand from January 2015 to December 2019. The following data were recorded: personal data, medical history, clinical manifestations, histopathologic results, possible etiologies, laboratory profiles, treatment methods and outcomes.
During the 5-year study, 35 patients with erythroderma were collected. Men outnumbered women 6:1 (30 men and 5 women). The age of these patients ranged from 18-90 with mean age of 66.4 years. Idiopathic was the predominant etiology with 20/35 cases (57.1%), followed by drug eruption (17.1%). Herbal medicine (33.3%) and spironolactone (33.3%) were the most implicated drugs. Pre-existing skin diseases were observed including psoriasis (17.1%), pityriasis rubra pilaris (2.8%) and malignancy associated erythroderma (2.8%). Epidermal spongiosis was the most common histological feature observed in all etiologies (85.7%), (p=0.029). Complete clearance was obtained in 15/35 (42.8%). Death 2/35 (5.6%) occurred in one patient with drug reaction and one patient with pemphigus vulgaris associated erythroderma complicated with sepsis.
Although data are limited, erythroderma remains a serious condition effecting quality of life of patients. Our study demonstrated further epidemiology, etiologies and clinicopathologic information of erythroderma among Thai patients.
Akhila CNV, MDS
Oral and MaxilloficalPahology.
Ram Kumar Tirandas, MDS
Oral and Maxillofacial Pathology.
C. Kirthi, BDS, MBA (HHSM)., _ Keerthi, BDS, D.P.H, MBA (HHSM) Elamathi K, BDS, LLB, EPGDHA. Shanthi Priya Peddagopu, BDS
MPH in Western Illinois University
Abstract
Among the diseases of oral cavity, dental caries is the most common microbial diseases affecting the individual’s teeth globally along with the periodontal disease. There could be various reasons for the delay of the treatment for dental caries which includes socioeconomic status, lack of awareness about dental diseases and dental treatments. Life style habits also play a prominent role. Delay of dental caries treatment would lead to pulpitis. Here we present a case report of a 62-year-old male patient with chronic irreversible pulpitis in relation to 36. Patient had a history of smoking and chewing paan. After a month patient died due to septic shock. We also present a few case reports of pulpitis progressing to space infections. It has been documented in the literature that, individuals with systemic diseases such as diabetes mellitus, hypertension, cardiovascular disease etc are having highest morbidity and mortality due to dental sepsis. Along with case reports in this article, we are going to make a sincere effort to provide complications of pulpitis. Thus, it would help in educating general public, budding dentists and clinicians in spreading the awareness about pulpitis and its sequeale.
Ronaldo Afonso Torres
Governador Ozanan Coelho University Center (UNIFAGOC), Ubá, Minas Gerais, Brazil.
Tiago Ribeiro Torres
Federal University of Juiz de Fora, Minas Gerais, Brazil.
Tiago Ribeiro Torres
Federal University of Juiz de Fora, Minas Gerais, Brazil.
Filipe Moreira de Andrade
Governador Ozanan Coelho University Center (UNIFAGOC), Ubá, Minas Gerais, Brazil.
Marcus Gomes Bastos
Governador Ozanan Coelho University Center (UNIFAGOC), Ubá, Minas Gerais, Brazil.
Abstract
Introduction: Congenital heart diseases represent the most frequent form of malformation and can be diagnosed by fetal echocardiography, neonatal screening or clinical signs. Whenever this is suspected, a pediatric cardiologist should be contacted, and comprehensive echocardiography performed. But the availability of a specialist for immediate implementation is not the reality of many services. As functional echocardiography is often carried out in neonatal units because of its utility in several clinical situations, we consider its usefulness in diagnosing congenital heart diseases. Case reports: we report two cases of transposition of the great arteries diagnosed by functional echocardiography. Case 1 was a premature neonate transferred to the neonatal unit with a suspected diagnosis of respiratory distress syndrome and sepsis without improvement with initial treatment. Functional echocardiography on admission allowed the diagnosis of transposition of the great arteries. Case 2 was a full-term neonate with early cyanosis, with functional echocardiography suggesting transposition of the great arteries and the images used for discussion with a specialist from a reference center, speeding up the transfer. Discussion: early recognition of critical heart disease is essential to improve prognosis. Diagnosis of these diseases can be performed by fetal echocardiography, neonatal screening and clinical signs. When congenital heart structural defect is likely, pediatric cardiologist should be consulted and comprehensive echocardiography promptly performed. Functional echocardiography has been performed in neonatal units with the aim of analyzing the patent ductus arteriosus and ventricular function, diagnosing cardiac tamponade and neonatal persistent pulmonary hypertension. As not all services have a pediatric cardiologist readily available, we considered whether functional echocardiography could help in the diagnostic conclusion through systematic analysis of cardiac images.
Conclusion: we reinforce that comprehensive echocardiography performed by a specialist is the first option or performed as soon as possible when congenital heart disease is the main hypothesis.
Daishi Shimada
Division of Infectious Diseases and Infection Control, Tohoku Medical and Pharmaceutical University, Sendai City, Miyagi, Japan
Masafumi Seki
Division of Infectious Diseases and Infection Control, Tohoku Medical and Pharmaceutical University, Sendai City, Miyagi, Japan; Division of Infectious Diseases and Infection Control, Saitama Medical University, International Medical Center, Hidaka City, Saitama, Japan
Abstract
Different viral infections show characteristic imaging findings based on their particular pathophysiology. SARS-COV-2 shows characteristically high transmissibility and virulence, and it can evade the human immune system. COVID-19 patients frequently develop severe illness involving cytokine storm leading to acute respiratory distress syndrome (ARDS), as well as alveolar flood and severe vascular damage resulting in sepsis and organ damage. These basically develop from bilateral ground-glass infiltrations that are also found in the adult viral pneumonias, such as measles, respiratory syncytial virus, human metapneumovirus, and cytomegalovirus pneumonias. Secondary bacterial pneumonia due to co-infection with bacteria is a major issue in viral pneumonia, especially in influenza pneumonia, but patients with adult viral pneumonias are very different from bacterial pneumonia patients, and they are usually young, produce less sputum, and sometimes show characteristic skin lesions, including rash and vesicular lesions. Accurate diagnosis of the specific pathogen of viral pneumonia is important to perform the appropriate treatment and prevent infection, and it can recently be performed by multiplex PCR.
