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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Although preservation of the spleen following abdominal trauma and spleen-preserving surgical procedures have become gold standards, about 22,000 splenectomies are still conducted annually in the USA. Infections, mostly by encapsulated organisms, are the most well-known complications following splenectomy. Recently, thrombosis and cancer have become recognized as potential adverse outcomes post-splenectomy. Among more than 4 million hospitalized USA veterans, we assessed incidence and mortality due to infections, thromboembolism, and cancer including 8,149 cancer-free veterans who underwent splenectomy with a follow-up of up to 27 years. Relative risk estimates and 95% confidence intervals were calculated using time-dependent Poisson regression methods for cohort data. Splenectomized patients had an increased risk of being hospitalized for pneumonia, meningitis, and septicemia (rate ratios=1.9-3.4); deep venous thrombosis and pulmonary embolism (rate ratios=2.2); certain solid tumors: buccal, esophagus, liver, colon, pancreas, lung, and prostate (rate ratios =1.3-1.9); and hematologic malignancies: non-Hodgkin lymphoma, Hodgkin lymphoma, multiple myeloma, acute myeloid leukemia, chronic lymphocytic leukemia, chronic myeloid leukemia, and any leukemia (rate ratios =1.8-6.0). They also had an increased risk of death due to pneumonia and septicemia (rate ratios =1.6-3.0); pulmonary embolism and coronary artery disease (rate ratios =1.4-4.5); any cancer: liver, pancreas, and lung cancer, non-Hodgkin lymphoma, Hodgkin lymphoma, and any leukemia (rate ratios =1.3-4.7). Many of the observed risks were increased more than 10 years after splenectomy. Our results underscore the importance of vaccination, surveillance, and thromboprophylaxis after splenectomy.
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PMID:Long-term risks after splenectomy among 8,149 cancer-free American veterans: a cohort study with up to 27 years follow-up. 2405 15

Diabetes Mellitus is one of the important non communicable disease affecting the adult populations around the world. Incidence of diabetes increasing in South Asia. Nepal is also experiencing increasing in diabetes disease burden. Diabetes mellitus is one of the important causes of hospital admission in the western world. In this study we evaluated the causes of hospital admission amongst diabetic population. Most common cause is of diagnosis is some forms of infections commonest (20%) being urinary tract infections. Ten out of total 69 patients had septicemia. Six patients out of 69 had sputum positive pulmonary tuberculosis only one patient presented with metabolic complications of diabetes i.e. diabetic ketoacidosis. Coronary artery disease with heart failure was present in 14 patients. Five patients had diabetic nephropathy and 3 had retinopathy. This shows that infections is the major cause of hospital admission for diabetics followed by heart failure. Tuberculosis is important diagnosis in person with diabetes. This study shows more female patients get admitted and amongst admitted patents glycemic control is poor. This signify that women had more complications than male counter parts.
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PMID:Common reasons for hospitalization among adult patients with diabetes in a private medical college in Kathmandu. 2457 42

Vascular hyperpermeability induced by lipopolysaccharide (LPS) is a common pathogenic process in cases of severe trauma and sepsis. Vascular endothelial cadherin (VE-cad) is a key regulatory molecule involved in this process, although the detailed mechanism through which this molecule acts remains unclear. We assessed the role of clathrin-mediated and caveolae-mediated endocytosis of VE-cad in LPS-induced vascular hyperpermeability in the human vascular endothelial cell line CRL-2922 and determined that vascular permeability and VE-cad localization at the plasma membrane were negatively correlated after LPS treatment. Additionally, the loss of VE-cad at the plasma membrane was caused by both clathrin-mediated and caveolae-mediated endocytosis. Clathrin-mediated endocytosis was dominant early after LPS treatment, and caveolae-mediated endocytosis was dominant hours after LPS treatment. The caveolae-mediated endocytosis of VE-cad was activated through the LPS-Toll-like receptor 4 (TLR4)-Src signaling pathway. Structural changes in the actin cytoskeleton, specifically from polymerization to depolymerization, were important reasons for the switching of the VE-cad endocytosis pathway from clathrin-mediated to caveolae-mediated. Our findings suggest that clathrin-mediated and caveolae-mediated endocytosis of VE-cad contribute to LPS-induced vascular hyperpermeability, although they contribute via different mechanism. The predominant means of endocytosis depends on the time since LPS treatment.
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PMID:Different contributions of clathrin- and caveolae-mediated endocytosis of vascular endothelial cadherin to lipopolysaccharide-induced vascular hyperpermeability. 2518 Jul 71

Acute kidney injury (AKI) is common in intensive care unit (ICU) and carries a high mortality rate. Reliable and comparable data about the clinical spectrum of AKI is necessary for optimizing management. The study was conducted to describe epidemiology, etiology, clinical characteristics and outcome of AKI in critically ill patients without pre-existing renal disease, diagnosed using RIFLE criteria. We retrospectively analyzed data of 500 adult patients admitted to ICU with AKI or who developed AKI in ICU. Patients with pre-existing renal disease, renal transplant recipients were excluded. AKI was predominantly encountered in older males. Diabetes, hypertension, coronary artery disease were the most commonly prevalent comorbidities. Sepsis was the most common cause of AKI, accounting for 38.6% of patients. 24.4% belonged to risk class, 37.0% to injury class, 35.0% to failure class, 3% to loss and 0.6% to ESRD class of the RIFLE criteria. Renal replacement therapy (RRT) was required in 37.2% (n = 186) of patients. About 60% recovered complete renal function. Chronic kidney disease (CKD) was a sequel in 2.4% (n = 12) of patients. Average duration of ICU stay was 5.6 days. Crude mortality rate was 37.6% (n = 188). In critically ill patients without pre-existing renal disease, elderly age, male sex, type 2 diabetes along with a primary diagnosis of sepsis were most commonly associated with AKI. Majority of the patients' recovered complete renal function.
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PMID:Spectrum of acute kidney injury in critically ill patients: A single center study from South India. 2524 16

As major mediators of stress regulation, glucocorticoids have an essential role in maintaining cardiovascular homeostasis under both physiological and pathological conditions. The release of glucocorticoids into the peripheral circulation is adjusted by the hypothalamic-pituitary-adrenal axis in response to various pathological challenges such as sepsis, starvation, and psychological stress. Clinically, dysregulation of the glucocorticoid-mediated signaling as a result of either excess ligand or receptor hypersensitivity is connected with the progression of unfavorable cardiovascular events such as cardiac hypertrophy, atherosclerosis, and coronary artery disease. The direct effects of glucocorticoids on cardiac tissues are mediated by two steroid receptors, the glucocorticoid receptor and mineralocorticoid receptor, which are both expressed by cardiomyocytes. Although each receptor has some shared responses to glucocorticoids, each receptor also has unique effects on cardiac functions. Elucidating the selective actions of each receptor is critical for determining the proper pharmaceutical targets in cardiovascular diseases.
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PMID:Glucocorticoid signaling in cardiac disease. 2596 Dec 32

Oxidative and nitrosative stress are primary contributors to the loss of myocardial tissue in insults ranging from ischemia/reperfusion injury from coronary artery disease and heart transplantation to sepsis-induced myocardial dysfunction and drug-induced myocardial damage. This cell damage caused by oxidative and nitrosative stress leads to mitochondrial protein, DNA, and lipid modifications, which inhibits energy production and contractile function, potentially leading to cell necrosis and/or apoptosis. However, cardiomyocytes have evolved an elegant set of redox-sensitive mechanisms that respond to and contain oxidative and nitrosative damage. These responses include the rapid induction of antioxidant enzymes, mitochondrial DNA repair mechanisms, selective mitochondrial autophagy (mitophagy), and mitochondrial biogenesis. Coordinated cytoplasmic to nuclear cell-signaling and mitochondrial transcriptional responses to the presence of elevated cytoplasmic oxidant production, e.g., H2O2, allows nuclear translocation of the Nfe2l2 transcription factor and up-regulation of downstream cytoprotective genes such as heme oxygenase-1 which generates physiologic signals, such as CO that up-regulates Nfe212 gene transcription. Simultaneously, a number of other DNA binding transcription factors are expressed and/or activated under redox control, such as Nuclear Respiratory Factor-1 (NRF-1), and lead to the induction of genes involved in both intracellular and mitochondria-specific repair mechanisms. The same insults, particularly those related to vascular stress and inflammation also produce elevated levels of nitric oxide, which also has mitochondrial protein thiol-protective functions and induces mitochondrial biogenesis through cyclic GMP-dependent and perhaps other pathways. This brief review provides an overview of these pathways and interconnected cardiac repair mechanisms.
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PMID:Redox mechanisms of cardiomyocyte mitochondrial protection. 2657 67

Dyslipidemia is a primary, major risk factor for coronary artery disease CAD. The prevalence of dyslipidemia had decreased over the past 30 years, which may in part be explained by the steady increase in the use of lipid-lowering drug therapy, especially statins. Cardiovascular risk has been shown to be greater in liver disease (20% in the liver cirrhosis vs. 12% in the general population), where statins can play an important role as a primary and secondary prevention for CAD. Given patients with chronic liver disease, especially liver cirrhosis are at risk of decreased hepatic clearance, there is concern that this patient population may be at higher risk for complications from statin therapy. Several retrospective studies showed that statin use in chronic liver disease and cirrhosis is safe, and even it was associated with lower mortality and lower rate of hepatic decompensation. This review discusses the safety and the different mechanisms where statins can decrease the rate of complications in liver cirrhosis, including portal hypertension, sepsis and the incidence of hepatocellular carcinoma.
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PMID:The Safety and Benefit of Statins in Liver Cirrhosis: a Review. 2660 51

The estimated prevalence of diabetes is 9.78% in Taiwan. The lifetime risk for patients with diabetes to have foot ulcers might be as high as 25%. About 15% of these patients require major limb amputation because of ischemia and infection. Peripheral artery disease is still a major problem involved in diabetic foot disease and the cause for major amputation despite an increase in the prevalence of revascularization surgery and new revascularization techniques over the past 20 years. We investigated the major limb amputation rates in patients with diabetic foot and critical limb ischemia who had undergone revascularization surgery in our hospital. The records of 42 patients who had undergone revascularization surgery for diabetic foot were retrospectively reviewed. Nineteen patients (45%) required major limb amputation despite revascularization. The affected limbs of only 15 patients (36%) were salvaged. Four patients died soon after surgery because of comorbidities, and another 4 were lost to follow-up. Two patients died from procedure-related sepsis, and overall perioperative mortality was 4.8%. Ten predictive risk factors (duration of diabetes, history of smoking, coronary artery disease, congestive heart failure, cerebral vascular accident, contralateral amputation, end-stage renal disease, fever episode, wound infection severity score, and arterial obstruction level) were included for analysis. Although none was significant, long-duration diabetes (OR: 1.13), end-stage renal disease (OR: 10.02), wound infection (OR: 1.56), and infrapopliteal lesions (OR: 3.00) tended to be unfavorable predictive risk factors of limb amputation. Revascularization surgery is still potentially beneficial for these patients--eg, it decreases the contralateral limb amputation rate by 7.5%--if done early in high-risk patients.
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PMID:Revascularization Surgery: Its Efficacy for Limb Salvage in Diabetic Foot. 2680 65

The SYNTAX score (SX score) is a useful score for assessing the severity of coronary artery disease (CAD). Previous studies have demonstrated a close relationship between SX score and inflammation. Procalcitonin (PCT) is an early inflammatory marker, especially during sepsis. Thus, in this study, we aimed to investigate the relationship between SX score and serum PCT levels. A total of 545 patients were enrolled in this prospective cross-sectional study and were divided into 2 subgroups, according to their SX score. Serum PCT and high-sensitivity C-reactive protein levels were measured. Serum PCT levels were higher in the high SX score group compared to the low-intermediate SX score group (P < .001). Serum PCT levels were an independent predictor of a high SX score in patients with acute coronary syndrome (P = .001). As patients with a higher SX score had increased serum PCT levels on admission, serum PCT may be useful for identifying patients with severe CAD.
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PMID:The Association Between Serum Procalcitonin Levels and Severity of Coronary Artery Disease Assessed by SYNTAX Score in Patients With Acute Coronary Syndrome. 2720 41

In the present study, the levels of NT-proBNP, troponin T, and troponin I were measured in postmortem serum from femoral blood in a series of sepsis-related fatalities that had undergone forensic autopsies. We aimed to assess whether a possible increase in the concentrations of these biomarkers was correlated to macroscopic or microscopic observations that suggest myocardial damage or cardiac dysfunction. Two study groups were retrospectively formed, a sepsis-related fatalities group and a control group. Both groups consisted of 16 forensic autopsy cases. Unenhanced computed tomography scan, autopsy, histological, toxicological, microbiological, and biochemical analyses were performed for all cases in both groups. Levels of procalcitonin, C-reactive protein, NT-proBNP, troponin T, and troponin I were systematically measured in postmortem serum from femoral blood. The preliminary results suggest that the postmortem serum troponin I, troponin T, and NT-proBNP levels are increased in sepsis-related deaths in the absence of any relevant coronary artery disease, myocardial ischemia, or signs of heart failure. These findings corroborate clinical data from previous studies pertaining to the usefulness of troponins and natriuretic peptides as indicators of toxic and inflammatory damage to the heart in cases of severe sepsis and septic shock without concomitant underlying coronary syndromes.
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PMID:Elevation of NT-proBNP and cardiac troponins in sepsis-related deaths: a forensic perspective. 2700 27


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