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J Crit Care 2021 Apr 20;64:184-192. Epub 2021 Apr 20.

Department of Anesthesiology, Surgical Intensive Care, Emergency and Pain Medicine, Ruhr-University Bochum, Klinikum Herford, Herford, Germany.

Background And Purpose: Hemoadsorption with CytoSorb® offers a possible therapeutic approach in septic shock, but modes of application and dosing are still undetermined.

Materials And Methods: Data from surgical patients with septic shock, treated with hemoadsorption adjunctive to renal replacement therapy were analyzed retrospectively. The 28-day mortality was compared to predicted mortality. Read More

Dimens Crit Care Nurs 2021 Mar-Apr 01;40(2):75-82

Background: Severe acute respiratory syndrome coronavirus 2 is the virus that causes coronavirus disease 2019 (COVID-19). COVID-19 is a disease characterized by a range of clinical syndromes including variable degrees of respiratory symptoms from mild respiratory illness and severe interstitial pneumonia to acute respiratory distress syndrome, septic shock, coagulopathies, and multiorgan dysfunction. This virus carries the potential to manifest in a wide range of pulmonary findings and hypoxemias, from mild respiratory symptoms to more severe syndromes, such as acute respiratory distress syndrome. Read More

Public Health Rep 2021 May 7:333549211013460. Epub 2021 May 7.

1242 Respiratory Diseases Branch, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.

Objectives: Routine surveillance for streptococcal toxic shock syndrome (STSS), a severe manifestation of invasive group A (GAS) infections, likely underestimates its true incidence. The objective of our study was to evaluate routine identification of STSS in a national surveillance system for invasive GAS infections.

Methods: Active Bacterial Core surveillance (ABCs) conducts active population-based surveillance for invasive GAS disease in selected US counties in 10 states. Read More

J Infect Dev Ctries 2021 Apr 30;15(4):480-489. Epub 2021 Apr 30.

Section of Infectious Diseases, Department of Medicine, Aga Khan University, Karachi, Pakistan.

Introduction: Limited data exist on clinical characteristics and outcomes of hospitalized COVID-19 patients in low-middle income countries. We aimed to describe the clinical spectrum and outcomes of hospitalized COVID-19 patients at a tertiary-care center in Karachi, Pakistan.

Methodology: We conducted an observational study of adult COVID-19 patients hospitalized between February-June 2020. Read More

J Appl Physiol (1985) 2021 May 6. Epub 2021 May 6.

PepsiCo R&D Life Sciences, Gatorade Sports Science Institute, United Statesgrid.418112.f.

Intestinal barrier integrity and function are compromised during exertional heat stress (EHS) potentially leading to consequences that range from minor gastrointestinal (GI) disturbances to fatal outcomes in exertional heat stroke or septic shock. This mini-review provides a concise discussion of nutritional interventions that may protect against intestinal permeability during EHS and suggests physiological mechanisms responsible for this protection. Although diverse nutritional interventions have been suggested to be protective against EHS-induced GI permeability, the ingestion of certain amino acids, carbohydrates, and fluid per se are potentially effective strategies, whereas evidence for various polyphenols and pre/probiotics is developing. Read More

Case Rep Infect Dis 2021 15;2021:8837493. Epub 2021 Apr 15.

Department of Pathology, Texas Tech University Health Sciences Center, 4800 Alberta Avenue, El Paso, TX 79905, USA.

Coccidioidomycosis is a fungal infection caused by and While infections are usually mild, severe disease occurs in immunocompromised patients. Dissemination is associated with severe morbidity and mortality. Because of the tendency of this disease to imitate many diseases, diagnosis may be difficult on presentation. Read More

Circ J 2021 Apr 29. Epub 2021 Apr 29.

Department of Cardiovascular Medicine, Toho University Graduate School of Medicine.

Background: Cardiovascular diseases and/or risk factors (CVDRF) have been reported as risk factors for severe coronavirus disease 2019 (COVID-19).Methods and Results:In total, we selected 693 patients with CVDRF from the CLAVIS-COVID database of 1,518 cases in Japan. The mean age was 68 years (35% females). Read More

Medicine (Baltimore) 2021 May;100(18):e25013

Department of Critical Care, King Saud University Medical City, King Saud University, Riyadh, Kingdom of Saudi Arabia.

Abstract: Acute physiology and chronic health evaluation II (APACHE-II) scoring system is used to classify disease severity of patients in the intensive care unit. However, several limitations render the scoring system inadequate in identifying risk factors associated with outcomes. Little is known about the association of platelet count patterns, and the timing of platelet count and other hematologic parameters in predicting mortality in patients with sepsis. Read More

Sci Rep 2021 May 4;11(1):9512. Epub 2021 May 4.

Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.

The role of high-mobility group box-1 (HMGB1) in outcome prediction in sepsis is controversial. Furthermore, its association with necroptosis, a programmed cell necrosis mechanism, is still unclear. The purpose of this study is to identify the association between the plasma levels of HMGB1 and the severity and clinical outcomes of sepsis, and to examine the correlation between HMGB1 and key executors of necroptosis including receptor-interacting kinase 3 (RIPK3) and mixed lineage kinase domain-like- (MLKL) proteins. Read More

Rev Esp Enferm Dig 2021 May 5. Epub 2021 May 5.

Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México.

A 42-year-old man with a history of type 2 diabetes mellitus (complicated by end stage renal disease on peritoneal dialysis) and chronic diarrhea was admitted to the emergency department for having an exacerbation in the number of evacuations. The patient was hypotensive and lethargic. Arterial blood gases were obtained and reported pH 7. Read More

Am J Respir Crit Care Med 2021 May 4. Epub 2021 May 4.

University Hospital Careggi, 18561, Department of Clinical and Experimental Medicine, Firenze, Italy.

Acta Biomed 2021 Apr 30;92(S1):e2021111. Epub 2021 Apr 30.

UO di Terapia Intensiva Neonatale, Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell'Adulto, AOU Policlinico di Modena, Modena.

Background: Bronchiolitis is a common cause of hospitalisation of infants less than a year old, with most infants recovering without complications. Respiratory syncytial virus (RSV) is a leading cause of bronchiolitis. Antimicrobial stewardship programmes do not recommend antibiotics for viral infections in neonates unless documented evidence of secondary bacterial infection is present. Read More

S Afr Med J 2021 Mar 2;111(3):245-249. Epub 2021 Mar 2.

Division of Pulmonology, Department of Medicine, Faculty of Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa.

Background: We previously retrospectively validated a 6-point severity-of-illness score aimed at identifying patients at risk of dying of tuberculosis (TB) in the intensive care unit (ICU). Parameters included septic shock, HIV infection with a CD4 count <200 cells/µL, renal dysfunction, a ratio of partial pressure of arterial oxygen to fraction of inspired oxygen (P/F) <200 mmHg, a chest radiograph demonstrating diffuse parenchymal infiltrates, and no TB treatment on admission.

Objectives: To prospectively validate the severity-of-illness scoring system in patients with TB requiring intensive care, and to refine and simplify the score in order to expand its clinical utility. Read More

J Pak Med Assoc 2021 Feb;71(2(B)):748-751

Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan.

This study aimed to assess knowledge, attitudes, practices, and perceived barriers of emergency healthcare providers regarding the management of sepsis and septic shock. This cross-sectional study was conducted in the Emergency Department of Aga Khan University Hospital, Karachi, Pakistan from August to October 2017. A total of 53 healthcare providers participated in the study. Read More

J Med Case Rep 2021 May 3;15(1):259. Epub 2021 May 3.

Faculty of Medicine, Department of Anesthesiology and Intensive Care, Universitas Pelita Harapan, Jl. M. H. Thamrin Boulevard 1100, Lippo Village Tangerang, Tangerang, Banten, 15811, Indonesia.

Background: Coronavirus disease 2019 (COVID-19) was first identified in Indonesia in March 2020, and the number of infections has grown exponentially. The situation is at its worst, overwhelming intensive care unit (ICU) resources and capacity.

Case Presentation: This is a single-center observational case study of 21 confirmed COVID-19 patients admitted to the ICU from March 20, 2020, to April 31, 2020. Read More

BMC Womens Health 2021 May 3;21(1):187. Epub 2021 May 3.

Department of Obstetrics and Gynecology, Shimane University Faculty of Medicine, Enyacho 89-1, Izumo, Shimane, 6938501, Japan.

Background: Neutropenic enterocolitis (NE) is a potentially life-threatening disease that primarily occurs in cancer patients treated with chemotherapy. NE has substantial morbidity and mortality, and its incidence has increased with the widespread use of chemotherapeutic agents such as taxanes, gemcitabine, and leucovorin in patients with lung, breast, gastric, and ovarian cancers. Sometimes NE can be a possible cause of death. Read More

World Neurosurg 2021 Apr 30. Epub 2021 Apr 30.

Institute for Data Science and Informatics, University of Missouri, Columbia, MO, USA; Department of Medicine, University of Missouri, Columbia, MO, USA; Department of Electrical Eng. and Computer Science, University of Missouri, Columbia, MO, USA.

Background: Intracranial hemorrhage (including subarachnoid hemorrhage) has been reported in 0.3 to 1.2% of patients with coronavirus disease 2019 (COVID-19). Read More

PLoS One 2021 3;16(5):e0250818. Epub 2021 May 3.

Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Baden-Württemberg, Germany.

Background: Postoperative abdominal infections belong to the most common triggers of sepsis and septic shock in intensive care units worldwide. While monocytes play a central role in mediating the initial host response to infections, sepsis-induced immune dysregulation is characterized by a defective antigen presentation to T-cells via loss of Major Histocompatibility Complex Class II DR (HLA-DR) surface expression. Here, we hypothesized a sepsis-induced differential occupancy of the CCCTC-Binding Factor (CTCF), an architectural protein and superordinate regulator of transcription, inside the Major Histocompatibility Complex Class II (MHC-II) region in patients with postoperative sepsis, contributing to an altered monocytic transcriptional response during critical illness. Read More

Am J Trop Med Hyg 2021 May 3. Epub 2021 May 3.

10School of Medicine, Walailak University, Nakhon Si Thammarat, Thailand.

Exuberant inflammation manifesting as a "cytokine storm" has been suggested as a central feature in the pathogenesis of severe coronavirus disease 2019 (COVID-19). This study investigated two prognostic biomarkers, the high mobility group box 1 (HMGB1) and interleukin-6 (IL-6), in patients with severe COVID-19 at the time of admission in the intensive care unit (ICU). Of 60 ICU patients with COVID-19 enrolled and analyzed in this prospective cohort study, 48 patients (80%) were alive at ICU discharge. Read More

Front Med (Lausanne) 2021 15;8:627830. Epub 2021 Apr 15.

Infectious Disease Unit, Department of Medicine, University of Udine, Udine, Italy.

Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection; no current clinical measure adequately reflects the concept of dysregulated response. Coagulation plays a pivotal role in the normal response to pathogens (immunothrombosis), thus the evolution toward sepsis-induced coagulopathy could be individuate through coagulation/fibrinolysis-related biomarkers. We focused on the role of D-dimer assessed within 24 h after admission in predicting clinical outcomes in a cohort of 270 patients hospitalized in a 79 months period for meningitis and/or bloodstream infections due to ( = 162) or ( = 108). Read More

Cureus 2021 Mar 30;13(3):e14190. Epub 2021 Mar 30.

Internal Medicine, Grand Strand Medical Center, Myrtle Beach, USA.

A hepatic artery pseudoaneurysm (HAP) is a rare complication of laparoscopic cholecystectomy. It can vary in its clinical presentation; however, given its severe nature, prompt assessment and management are crucial. We report a case of a 73-year-old male who underwent a laparoscopic cholecystectomy complicated by a right hepatic artery injury. Read More

Cureus 2021 Mar 28;13(3):e14162. Epub 2021 Mar 28.

Internal Medicine Residency, Kettering Medical Center, Dayton, USA.

() is a gram-negative, facultative anaerobe, and it is most commonly found in the oropharynx of healthy domestic animals, especially cats and dogs.  is classified as an opportunistic pathogen, infecting individuals only through direct contact via local trauma caused by animal bites or scratches. More serious infections, while rare, are typically associated with immunocompromised states, known pre-existing cavitary lung pathology, or malignancy. Read More

AMIA Annu Symp Proc 2020 25;2020:197-202. Epub 2021 Jan 25.

Division of Biomedical Informatics, University of California San Diego, La Jolla, CA, US.

Sepsis, a life-threatening organ dysfunction, is a clinical syndrome triggered by acute infection and affects over 1 million Americans every year. Untreated sepsis can progress to septic shock and organ failure, making sepsis one of the leading causes of morbidity and mortality in hospitals. Early detection of sepsis and timely antibiotics administration is known to save lives. Read More

Front Immunol 2021 15;12:637753. Epub 2021 Apr 15.

Department of Anesthesiology, Guangdong Medical University, HuiZhou First Hospital, Huizhou, China.

Acute kidney injury (AKI) occurs in half of patients with septic shock, resulting in unacceptably high mortality. However, effective preventive treatments are still lacking. We hypothesized that pretreatment with lipoxin A4 (LXA4), known to promote inflammation resolution, may attenuate septic AKI blocking crosstalk between inflammation and cellular senescence. Read More

Crit Care Med 2021 May 3. Epub 2021 May 3.

HTA Austria-Austrian Institute for Health Technology Assessment GmbH (Former: Ludwig Boltzmann Institute for HTA), Vienna, Austria. Klinik Favoriten, Wiener Gesundheitsverbund, Vienna, Austria.

Objectives: Evaluating whether there is a clinical benefit of using extracorporeal cytokine adsorption therapy in two indications.

Design: Systematic review.

Setting: Search on four databases, Medline, Embase, The Cochrane Library, and the European Network for Health Technology Assessment planned and ongoing projects database. Read More

HPB (Oxford) 2021 Apr 20. Epub 2021 Apr 20.

Department of Hepato-Biliary-Pancreatic Surgery and Liver Transplantation, Haut Lévêque Hospital, CHU de Bordeaux, Bordeaux, France; Department of Research, INSERM UMR 1035, CHU Bordeaux, France. Electronic address:

Background: Sacrificing a replaced right hepatic artery (rRHA) from the superior mesenteric artery is occasionally necessary to obtain an R0 resection after pancreaticoduodenectomy (PD) for pancreatic adenocarcinoma (PA). Preoperative embolization (PEA) of the rRHA has been proposed to avoid the onset of postoperative biliary and ischemic liver complications.

Methods: Eighteen patients with cephalic PA with an rRHA underwent PEA of the rRHA from 2013 to 2019. Read More

Surgery 2021 Apr 28. Epub 2021 Apr 28.

Colorectal Research Unit, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address:

Background: Preoperative steroid use has been associated with worse surgical outcomes. The purpose of this study was to determine whether laparoscopic surgery reduces the risk of septic shock/sepsis among ulcerative colitis patients with preoperative chronic steroid use.

Methods: Patients with ulcerative colitis undergoing a total abdominal colectomy were identified from the American College of Surgeons National Surgical Quality Improvement Program database (2005-2019). Read More

Br J Anaesth 2021 Apr 27. Epub 2021 Apr 27.

Intensive Care Medicine Unit, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise, Boulogne-Billancourt, France; INSERM UMR-1018, CESP, Team Kidney and Heart, University of Versailles Saint-Quentin en Yvelines, Villejuif, France.

Int J Clin Pract 2021 Apr 30:e14296. Epub 2021 Apr 30.

Department of Anesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605006.

Background: Arterial sampling, which is the gold standard for in measuring lactate levels in sepsis, is more painful, requires experience, and is associated with a higher incidence of morbidity, when compared to venous sampling. This study attempted to measure the correlation and agreement between arterial and peripheral venous (PV) lactate, and between arterial and central venous (CV) lactate, with the objective to test interchangeability of the two, and possibly support the use of venous lactate levels in resuscitating patients with sepsis.

Methods: 87 patients admitted to the critical care unit of our hospital with the diagnosis of sepsis or septic shock were included in the study after taking informed consent. Read More

Shock 2021 Apr 22. Epub 2021 Apr 22.

Department of Anesthesiology, Osaka Medical College, Intensive Care Unit, Osaka Medical College Hospital, Takatsuki, Japan Department of Anesthesiology, Osaka Medical College, Osaka Medical College Hospital, Takatsuki, Japan.