Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0243026 (sepsis)
 52,417 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Obesity is on the advance in western industrialised countries and is therefore increasingly relevant also to intensive care medicine. In contrast to the common prejudice that obese patients probably have a higher ICU mortality than lean patients, convincing meta-analyses have revealed that this is not the case. Nevertheless, obese ICU patients are challenging. Especially mechanic ventilation has to be addressed: besides obesity-related anatomical problems that may complicate intubation, obstructive sleep apnoea, obesity hypoventilation syndrome and increased intra-abdominal pressure are of major relevance concerning ventilation, weaning and successful extubation. Also the risk of infections is increased in obese ICU patients, although this does not seem to increase the risk of sepsis. Nevertheless, the interplay of obesity and sepsis is a fascinating field in that adipous tissue is not just a passive reservoir of energy but an active endocrine and immunomodulating organ. However, the way of how adipokines interact with inflammation and coagulation in sepsis has yet to be clarified.
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PMID:Mortality, morbidity and special issues of obese ICU patients. 2036 11

Carnitine is a conditionally essential nutrient that plays a vital role in energy production and fatty acid metabolism. Vegetarians possess a greater bioavailability than meat eaters. Distinct deficiencies arise either from genetic mutation of carnitine transporters or in association with other disorders such as liver or kidney disease. Carnitine deficiency occurs in aberrations of carnitine regulation in disorders such as diabetes, sepsis, cardiomyopathy, malnutrition, cirrhosis, endocrine disorders and with aging. Nutritional supplementation of L-carnitine, the biologically active form of carnitine, is ameliorative for uremic patients, and can improve nerve conduction, neuropathic pain and immune function in diabetes patients while it is life-saving for patients suffering primary carnitine deficiency. Clinical application of carnitine holds much promise in a range of neural disorders such as Alzheimer's disease, hepatic encephalopathy and other painful neuropathies. Topical application in dry eye offers osmoprotection and modulates immune and inflammatory responses. Carnitine has been recognized as a nutritional supplement in cardiovascular disease and there is increasing evidence that carnitine supplementation may be beneficial in treating obesity, improving glucose intolerance and total energy expenditure.
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PMID:Role of carnitine in disease. 2039 44

Visfatin (NAMPT formerly known as PBEF1) is an adipokine that is strongly expressed in visceral fat and has caused much debate among researchers, regarding its involvement in glucose homeostasis and insulin resistance. It was initially isolated from bone marrow cells, and its involvement in inflammatory procedures such as sepsis and acute lung inflammation is now evident. Several studies have also reported an association of plasma visfatin levels with obesity. We undertook an evaluation of the involvement of the NAMPT gene in the development of type 2 diabetes (T2DM) in the Greek population. We studied 178 patients with T2DM and 177 controls that were matched for sex, age and body mass index. We genotyped three tagging SNPs selected from the HapMap II CEPH European population as reference for the Greek population. These three SNPs tag another 12 SNPs over the entire NAMPT gene with a mean r(2) of 0.92. No indications of association with disease status were found with any of the tested variants or the inferred haplotypes. Results were also negative when the quantitative traits of weight and BMI were tested. Although our study covers common variants across the NAMPT gene, the possible involvement of rare variants in T2DM etiology cannot be ruled out and will require the investigation of very large numbers of cases and controls.
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PMID:Genetic variation in the visfatin (PBEF1/NAMPT) gene and type 2 diabetes in the Greek population. 2045 5

The adipose-derived hormone leptin is well known for its contribution to energy metabolism and satiety signaling in the hypothalamus. Previous studies suggested that obesity is an independent risk factor for sepsis morbidity and mortality, and it is associated with elevated baseline levels of circulating leptin in normal, nonseptic patients. In mouse endotoxemia and cecal ligation puncture models of sepsis, we observed elevated levels of leptin and soluble leptin receptor (sLR). Exogenously administered leptin increased mortality in endotoxemia and cecal ligation puncture models and was associated with increased expression of adhesion and coagulation molecules, macrophage infiltration into the liver and kidney, and endothelial barrier dysfunction. Conversely, longform leptin receptor-deficient mice were protected from sepsis morbidity and mortality and had less endothelial dysfunction. Furthermore, an in vitro study revealed that leptin-induced endothelial dysfunction is likely mediated, at least in part, by monocytes. Moreover, administration of an sLR conferred a survival benefit. Human septic patients have increased circulating sLR concentrations, which were correlated with disease severity indices. Together, these data support a pathogenic role for leptin signaling during sepsis.
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PMID:Leptin exacerbates sepsis-mediated morbidity and mortality. 2051 46

Macrophage migration inhibitory factor (MIF) is an immunoregulatory cytokine, the effect of which on arresting random immune cell movement was recognized several decades ago. Despite its historic name, MIF also has a direct chemokine-like function and promotes cell recruitment. Multiple clinical studies have indicated the utility of MIF as a biomarker for different diseases that have an inflammatory component; these include systemic infections and sepsis, autoimmune diseases, cancer, and metabolic disorders such as type 2 diabetes and obesity. The identification of functional promoter polymorphisms in the MIF gene (MIF) and their association with the susceptibility or severity of different diseases has not only served to validate MIF's role in disease development but also opened the possibility of using MIF genotype information to better predict risk and outcome. In this article, we review the clinical data of MIF and discuss its potential as a biomarker for different disease applications.
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PMID:Macrophage migration inhibitory factor (MIF): a promising biomarker. 2052 Aug 54

The relationship between patient cross-sectional area and both volume CT dose index (CTDI) and dose length product was explored for abdominal CT in vivo, using a 16 multidetector row CT (MDCT) scanner with automatic exposure control. During a year-long retrospective survey of patients with MDCT for symptoms of abdominal sepsis, cross-sectional areas were estimated using customised ellipses at the level of the middle of vertebra L3. The relationship between cross-sectional area and the exposure parameters was explored. Scans were performed using a LightSpeed 16 (GE Healthcare Medical Systems, Milwaukee, WI) operated with tube current modulation. From a survey of 94 patients it was found that the CTDI increased with the increase in patient cross-sectional area. The relationship was logarithmic rather than linear, with a least-squares fit to the data (R(2) = 0.80). For abdominal CT the cross-sectional area gave a measure of patient size based on the region of the body to be exposed. Exposure parameters increased with increasing cross-sectional area and the greater radiation exposure of larger patients was partly a consequence of their size. Given increasing obesity levels we believe that cross-sectional area and scan length should be added to future dose surveys, allowing patient size to be considered as a factor of relevance when examining population doses.
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PMID:The in vivo relationship between cross-sectional area and CT dose index in abdominal multidetector CT with automatic exposure control. 2053 Aug 59

The authors present a case of a 52-year old female patient with sleeve gastrectomy for obesity. Two major complications occured after the surgery. The first one was a leakage on the third day after the surgery. The routine swallow examination on the first day after the surgery was normal. The pathological secretion from the drainage occurred on the third day after the surgery with a simultaneous increase in inflammatory markers. There were no clinical signs of sepsis. An indication for laparoscopic revision was done and a small defect in the staple line was identified. The oversewing of the small defect on the stomach was performed. Immediately after the second surgery the patient was clinicaly without any problems. The inflammatory markers decreased promptly after the surgery. The second complication was presented with decompensated psychosis, which developed on the 4th day after the second surgery. The patient complained of problems with swallowing despite the fact that the swallow contrast examination was normal. The patient received her psychiatric medication intravenously. The problem with swallowing was not based on any organic reason, and lasted for 4 weeks. During this period the patient was fed only parenterally. Almost 6 weeks after the surgery the patient became compensated and was dismissed. We would like to point out to the problems potentially occuring in patients with a psychiatric disease. Good compensation and stabilization of psychiatric disease is a condition that has to be met before a surgery (Tab. 1, Fig. 1, Ref. 21).
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PMID:Complicated course after sleeve gastrectomy for obesity. 2058 52

New Zealand Maori make up nearly 15% of the population of New Zealand, and their population has increased significantly in the last 20 years. Because of this, the average age of Maori is only 22.7 years with 35% of Maori aged 15 years or less. In spite of this youthful profile, the Maori population has high health needs with trauma, ear disease, respiratory disease and infectious diseases as significant causes of hospitalisation and death. The role of surgery in the management of three potentially preventable but significant health issues affecting Maori children - trauma, cutaneous sepsis (cellulitis and superficial abscess) and obesity - is reviewed.
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PMID:Indigenous child health in New Zealand: some surgical issues. 2085 13

The adipocyte-derived cytokine leptin was implicated to link inflammation and metabolic alterations. We investigated the potential role of leptin components in critically ill patients, because systemic inflammation, insulin resistance, and hyperglycemia are common features of critical illness. Upon admission to Medical Intensive Care Unit (ICU), free leptin and soluble leptin-receptor serum concentrations were determined in 137 critically ill patients (95 with sepsis, 42 without sepsis) and 26 healthy controls. Serum leptin or leptin-receptor did not differ between patients or controls and were independent of sepsis. However, serum leptin was closely associated with obesity and diabetes and clearly correlated with markers of metabolism and liver function. Leptin-receptor was an unfavourable prognostic indicator, associated with mortality during three years follow-up. Our study indicates a functional role of leptin in the pathogenesis of severe illness and emphasizes the impact of complex metabolic alterations on the clinical outcome of critically ill patients.
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PMID:Relevance of serum leptin and leptin-receptor concentrations in critically ill patients. 2087 18

Cushing's syndrome is a condition caused by high levels of glucocorticoids, or most commonly as a result of prolonged exposure to exogenous steroids. Clinical features include diabetes, hypertension, obesity, skin atrophy, immune suppression and delayed wound healing. We report a patient with iatrogenic Cushing's syndrome, in whom long-term topical steroid therapy was used to treat varicose eczema, which contributed to the development of type 2 diabetes, morbid obesity, sleep apnoea and chronic wound sepsis. In this case, repeated hospital admissions and systemic antibiotics were associated with considerable comorbidity. Aggressive local treatment, consisting of potassium permanganate soaks and irrigating gels, was highly effective in reducing the amount of exudate, pain and preventing from further deterioration of the patient's legs.
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PMID:Cushing's syndrome and chronic venous ulceration--a clinical challenge. 2107 30


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