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)

Protein synthesis and degradation are particularly sensitive to malnutrition and catabolic states. Intracellular protein degradation is determined by the conformation, molecular weight, isoelectric point, and carbohydrate content of the proteins. ATP-stimulated endoproteases appear to catalyse the rate-limiting steps. In the liver, proteolysis is reduced by amino acids and/or insulin, whereas glucagon stimulates protein degradation, probably due to depletion of intracellular gluconeogenic amino acids. In the muscle, protein degradation is promoted by interleukin-1 and inhibited by Ep-475, which specifically inactivates cathepsin B,H, and L. Myofibrillar alkaline proteinase activity increases postoperatively and in patients suffering from malignant tumors, whereas normal proteinase values were observed in these patients following total parenteral nutrition. Increased alkaline proteinase activity is also observed in diabetes mellitus and is normalized by insulin. Extracellular proteolysis has been reported in patients with hypercatabolic acute renal failure and in patients with sepsis or acute pancreatitis. Plasma fractions obtained from hypercatabolic patients with postoperative acute renal failure were proteolytic. Plasma proteinase activity decreases during hemodialysis due to elimination of a metallo-proteinase. Plasma alpha 2-macroglobulin decreases in patients with acute renal failure and also during acute pancreatitis. Proteolytic degradation of parathyroid hormone by sera obtained from patients with acute pancreatitis has been observed. Also, there is a decrease of high molecular weight kininogen during experimental acute pancreatitis. Granulocyte elastase increases postoperatively, mainly in patients with sepsis. Sepsis also causes increased proteolytic activity in the urine. In conclusion, intracellular protein degradation can supply important precursors for hepatic and renal gluconeogenesis during malnutrition.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Proteinases in catabolism and malnutrition. 331

Cellular damage is the pathophysiologic basis for the postoperative multiple organ failure syndrome. This damage may be caused by pre- and intraoperative shock. Postoperative organ failure is manifested when cellular repair does not occur. Three factors may contribute to this progression to multiple organ failure: inadequate resuscitation, malnutrition, and sepsis.
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PMID:Postoperative multiple organ failure. 333 8

After a general discussion of the factors contributing to maternal mortality and morbidity, a solution to both of these problems is suggested for India: an initiative at the district level to improve support, supervision, training, essential midwifery and obstetric care. The general causes of the 200 or more times higher maternal morality risks in developing countries act throughout the woman's lifetime: powerlessness, illiteracy, malnutrition, deficiency of calcium, vitamin D and iron, heavy physical labor, unchecked fertility, lack of prenatal and obstetric care and illegal abortion. The most common causes of maternal morality and morbidity, eclampsia, obstructed labor, hemorrhage and sepsis, have been prevented in developed countries and in China. We know how to prevent them, by technical support and management at the district level. 4 elements are required: 1) adequate primary health care, food and universal family planning; 2) prenatal care and nutrition with referral if needed; 3) assistance of a trained person at every childbirth; 4) access to obstetric care for those at high risk. Rather than spend money or urban specialized hospital centers, half to 2/3 of all fatal complications of childbirth can be eliminated by local hospitals with the ability to do basic obstetrics such as caesareans and blood transfusions. There is a need for further health systems research in the given locale, but what we need now is an initiative on making pregnancy and childbirth safe for all women.
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PMID:On safe motherhood. 342

A group of nine well-nourished patients, with normal serum vitamin K1 levels (mean 546, range 310-1350 pg/ml), maintained normal prothrombin times (PTs) and factor VII clotting activities throughout a 7 d course of i.v. cefotetan disodium, an N-methyl-thiotetrazole (NMTT) containing cephalosporin antibiotic. However, 11 of 20 patients, with acute intra-abdominal sepsis and initially normal PTs who underwent emergency surgery, developed prolonged PTs (INR 1.4-3.1) associated with reduction in factor VII activities (0.74-0.38 u/ml) after 3-7 d of antibiotic therapy. Nine of these 11 patients had clinical evidence of malnutrition and nine had subnormal serum vitamin K1 levels (mean 119, range 43-354 pg/ml) on admission. Seven received cefotetan but four were treated with a non-NMTT-containing cephalosporin or antibiotics belonging to other groups. The nine patients who maintained normal PTs all had normal nutritional status and normal serum vitamin K1 levels (mean 279, range 103-915 pg/ml) at presentation. The PT is a relatively insensitive indicator of vitamin K stores, and malnourished patients with low serum vitamin K1 levels are at risk of developing hypoprothrombinaemia following intravenous antibiotic therapy.
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PMID:The development of hypoprothrombinaemia following antibiotic therapy in malnourished patients with low serum vitamin K1 levels. 342 16

The clinical and microbiologic characteristics of 29 episodes of sepsis caused by Acinetobacter calcoaceticus were reviewed in 25 children with underlying malignancies. Of the 29 episodes of sepsis with this organism 28 occurred from 1980 through 1984, compared with 1 episode from 1973 to 1979. Risk of infection was associated with the presence of intravascular cannulae, osteosarcoma and recent administration of antitumor chemotherapy. There was no association with neutropenia, malnutrition or focal infection. Of 28 organisms for which the biotypes were known, 14 (50%) were var. lwoffi and 14 (50%) were var. anitratus; 11 episodes (38%) were part of a polymicrobial bacteremia. All patients responded favorably to antimicrobial therapy.
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PMID:Acinetobacter calcoaceticus sepsis in children with malignancies. 346 39

The hypermetabolism organ failure complex remains the predominant reason for both prolonged stay and death in the surgical intensive care unit. What was perceived as isolated organ failure, such as adult respiratory distress syndrome, is now seen as part of the systemic response to injury and repair. Sepsis has become the systemic inflammatory response due to invading microorganisms. What was once perceived as diagnostic of sepsis has been recognized after severe perfusion deficits and in the presence of continuing sources of dead and injured tissue. The transition to organ failure is usually a distinct clinical event and probably represents the onset of clinical hepatic failure. Once present, the organ failure syndrome has a high mortality rate. From a treatment perspective, it is recognized that there is probably no "magic bullet"; that regimens will probably be time dependent and "multiple drug"; and that the best treatment is prevention. Malnutrition, as opposed to changes in body composition that occur as a result of disease process, has become a recognized cofactor in morbidity and death in patients with persistent hypermetabolism and organ failure. The metabolic processes of hypermetabolism have become increasingly categorized and understood. The result has been the development of metabolic support principles that are distinct from those of nutritional support and are designed to prevent the end-organ changes of malnutrition and the development of substrate-limited metabolism, to support organ structure and function, and to attempt to arrest the metabolic processes. The initial problem was to learn to do no harm, an outcome reasonably achieved. In addition, several beneficial results have been recognized including new techniques to better support total body protein synthesis, hepatic protein synthesis, and energy production. Techniques to better support organ structure and function are being tested. No techniques are currently available to control proteolysis and the redistribution of skeletal muscle nitrogen. A great deal of research is still necessary in this field, which is still in its infancy.
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PMID:Hypermetabolism, organ failure, and metabolic support. 354 Dec 66

The possibility of bilateral femoral neuropathy after microsurgical tuboplasty for the reversal of sterilization is possible. There seems to be little awareness of this condition by gynecologists and fertility surgeons. This type of femoral neuropathy has an excellent prognosis and only physiotherapy is necessary to aid muscular function. Some cases have been reported where recovery has been extremely slow, normal functions had taken months, and some disability lasted years. The femoral nerve is not included in the pelvis, therefore injury through operative procedures are unlikely. The self-retaining retractors were used in all reported cases and verified through clinical experience. There are 2 types of injury to the femoral nerve: Direct pressure on the nerve itself by retractor blades, and impingement of the psoas muscle and the nerve against the lateral pelvic muscle. Factors that increase the possibility of this condition include diabetes mellitus, rheumatism, gout, alcoholism, malnutrition, syphilis, tuberculosis, typhoid fever, tetanus, liver abscesses, sepsis of distal parts of the body, polyarteritis nodosa, anticoagulants, and bleeding diseases. Femoral neuropathy has been observed after using self-retaining retractors such as O'Connor, O'Sullivan, Mann, Collin and Balfour. The preventive measures suggested are to use a retractor with appropriate blade depth.
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PMID:Bilateral femoral neuropathy after microsurgical reversal of tubal sterilization: case report and analysis of contributing factors. 362 33

Forty-two patients with proven intra-abdominal sepsis were studied in a prospective clinical trial. The following parameters were evaluated: (1) Nine parameters on admission: age, sex, obesity, malnutrition, history of cardiac, respiratory or renal disease, diabetes mellitus and malignant neoplasia. Four of these parameters had a prognostic value (p less than 0.05): age 65 years, diabetes mellitus and cardiac disease. (2) Thirty parameters representing the functional status of six organic systems during sepsis: respiratory, cardiovascular, nervous, kidneys, blood coagulation, liver. Six of these parameters had a prognostic values: PEEP 0-10 cm H2O to keep PaO2 greater than 60 mmHg (p less than 0.001), serum creatinine greater than 3.6 mg/dl (p less than 0.01), prothrombin time greater than 15'' or platelet count less than 100,000/mm3 (p less than 0.001), need of vasoconstrictive drug to keep arterial pressure greater than 100 mmHg (p less than 0.001), bilirubin greater than 3 mg/dl (p less than 0.01) and mental confusion. The combination of these ten statistically significant prognostic criteria for each patient showed that the mortality was 0 with 0-2 criteria, 36% with 3-5 criteria, 94% with 6-8 criteria and 100% with 8-10 criteria. Patients with more than five of these criteria had a significant higher mortality risk (p less than 0.001).
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PMID:Prognostic criteria in intra-abdominal sepsis. 367 39

The ability to provide successful rehabilitation in 57 uremic children from a low socioeconomic background was prospectively evaluated by means of assessment of growth and development, incidence of complications, compliance, mortality rate and final outcome. Forty-three patients were on intermittent peritoneal dialysis (PD) and 14 on continuous ambulatory peritoneal dialysis (CAPD). The overall incidence of peritonitis was 5.6 episodes per patient-year; 41 patients are alive; 12 continue on intermittent dialysis; 16 received a renal allograft and 13 shifted to hemodialysis. Hypervolemia, sepsis due to peritonitis and abandonment of treatment were the main causes of death in 16 children. Malnutrition and non-compliance were the main factors leading to unsatisfactory rehabilitation.
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PMID:Adequacy of chronic peritoneal dialysis in low socioeconomic class uremic children. 372 29

A randomized, prospective trial was conducted of 93 patients with operatively confirmed intra-abdominal sepsis. The study compared clindamycin-gentamicin and chloramphenicol-gentamicin for treatment of carefully stratified patient groups. Malnutrition, age over 65 years, shock, alcoholism, gastrointestinal tract bleeding, steroid administration, diabetes, obesity, and organ malfunction were present with equal frequencies in each group. The duration of antibiotic treatment averaged 8 1/2 days, and the average length of postoperative hospitalization was 29 days. Study antibiotics were changed for bacteriologic reasons in 11 patients taking clindamycin-gentamicin and 12 patients taking chloramphenicol-gentamicin (25% of the total), and two patients in the clindamycin-gentamicin group had a minor adverse reaction. Initial satisfactory clinical responses were obtained in 59 (63%) patients. Twenty-five patients (27%) subsequently developed unsatisfactory courses, but 48 (52%) patients remained well through the 30-day period. Septic-related mortality occurred in 18 (19%) patients, and two (2%) patients had unrelated deaths. There were no significant differences between the study regimens by the outcome criteria evaluated.
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PMID:Stratified outcome comparison of clindamycin-gentamicin vs chloramphenicol-gentamicin for treatment of intra-abdominal sepsis. 389 87


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