Hyperacute Liver Failure with Multi-organ Dysfunction Syndrome (MODS) by Leptospirosis: A Case Report

Introduction: Leptospirosis may have multi-organ involvement in its severe form with potentially life-threatening consequences. However, acute fulminant hepatic failure is very uncommonly reported. A case study is presented here with fulminant hepatic failure and a diagnostic dilemma for etiology. Case history: A 40-year-old man with no significant medical history presented with fever, muscle pain, weakness, and pain in the upper abdomen. On clinical work, he has developed multi-organ hepatic, respiratory, and renal failure. A timely workup was done, but due to the rapid progression of the disease, the patient succumbed to the disease in the intensive care unit by the time his report for positive leptospirosis test arrived. Conclusion: Leptospirosis must be considered as an important differential diagnosis of acute liver failure patients. An early suspicion for leptospirosis in patients with fulminant hepatic failure and multi-organ failure in India particularly in the rainy season is warranted owing to its high mortality rate.

Oxidative phosphorylation in septic organ injury / 国际儿科学杂志

Sepsis is a systemic inflammatory response syndrome caused by pathogenic microorganisms that infect the host.If treated improperly, it can progress to severe sepsis or even septic shock.As such, it′s one of the main reasons for the death of children in PICU.The inflammatory response of sepsis exerts great influence on a series of basic physiological functions of cells, including the oxidative phosphorylation of the mitochondria.Oxidative phosphorylation is a process during which oxygen is reduced to generate high-energy phosphate bonds in the form of adenosine triphosphate(ATP), which supplies energy for cells and produces a series of functional by-products.During sepsis, the process of oxidative phosphorylation in mitochondria undergoes a series of complex alterations, which in turn can further promote the development of septic organ injury.The present review aims to clarify the relationship between changes in oxidative phosphorylation and the impairment of various organs in sepsis.

Assessment of Predictors for Severity in Scrub Typhus-A Case-Control Study

Objective: Scrub typhus is a rickettsial febrile condition caused by bacteria called Orientia tsusugamushi. It spreads to people through bites of infected larval mites. The objective of this study was to predict the severity of scrub typhus. Methods: A case-control study was done at Kasturba Medical College Hospital (2012-2015) retrospectively on patients admitted with scrub typhus. Patient demographics, lab parameters, investigations and treatment courses were noted. Subjects were divided into two groups, non-severe and severe group. Patient clinical details and laboratory parameters were compared in both the groups. The lab parameters associated with the severity of disease and mortality were also analyzed. A total of 210 patients out of which 140 controls (non-severe group) and 70 were cases (severe group). Results: The overall mortality due to scrub typhus infection was 14.3%. Eschar was present in 21.4% of the patients. Among the cases, the common symptoms were cough, chest pain, abdominal pain and distension, pedal edema and facial puffiness. Lymphadenopathy was observed with non-severe cases of scrub typhus and was statistically significant whereas, icterus, maculopapular rash, and hepatomegaly were associated with severe scrub typhus infection. Hemoglobin, platelet count and serum albumin were considerably lower in patients who died, whereas AST, aPTT, serum urea and creatinine were higher in them. Conclusion: Lower levels of hemoglobin, platelet count, serum albumin and higher levels of total leucocyte count, hepatic transaminases and serum creatinine correlated with severity. Doctors need to be watchful for such lab parameters and act quickly.

Lung Involvement Is an Early Clue to Severe Dengue / 中山大学学报(医学科学版)

@#【Objective】To investigate the differences of lung involvement between dengue and severe dengue.【Methods】227 dengue patients admitted in The Third Affiliated Hospital of Sun Yat-sen University from July 2014 to October 2018 were enrolled. The clinical characteristics，treatment and outcome of the patients were analyzed to explore the differences of lung involvement between dengue and severe dengue （SD）. 【Results】 The rate of old age ，smoking ，hypertension，diabetes and cerebrovascular disease was higher in dengue with lung involvement group（DWLI）than dengue without lung involvement group（DWOLI）（χ2 were 25.146，3.847，10.326，7.177，and 5.355，P was 0.050 for smoking，the others were < 0.05）. The rate of cough and breathlessness was higher in DWLI（χ2 were 11.465 and 6.068，P were 0.001 and 0.014），as well as in SD subgroup（χ2 were 4.585 and 6.717，P were 0.032 and 0.010）. C-reactive protein and procalcitonin were increased in DWLI（Z were - 2.591 and - 3.033，P were 0.010 and 0.002）. The rate of pleural effusion was higher in SD subgroup（χ2 = 4.987，P = 0.026）. Bilateral lung infiltration was correlated with SD（χ2 = 5.910，P =0.015）. The rate of acute liver injury，acute kidney injury and multi-organ dysfunction syndrome（MODS）was higher in DWLI（χ2 were 7.044，7.059，and 11.315，P were 0.008，0.008 and 0.001）. The rate of anti-virus，anti-bacteria and combined therapy was higher in DWLI（χ2 were 13.156，32.845，and 12.684，P all were < 0.001）.【Conclusion】Dengue patients who were with old age，smoking，or suffered from underlying disease of hypertension，diabetes and cerebrovascular disease were vulnerable to lung involvement. Cough，breathlessness，pleural effusion and bilateral lung infiltration were signs of severe dengue. Attention should be paid to dengue with lung involvement.

Comparison of the Bama minipig and Juema minipig models of high altitude multi-organ dysfunction syndrome / 中国比较医学杂志

Objective To compare the Bama minipig and Juema minipig models of high altitude multi-organ dysfunction syndrome.Methods Six plateau-origin Juema minipigs and plain-origin Bama minpigs in each group received intravenous infusion of 0.35 mg/kg lipopolysaccharide ( LPS) , respectively.Blood samples were taken at 0 h, 3 h, 6 h, 12 h, 24 h, 48 h and 72 h after LPS infusion.Routine blood test was performed, blood CK, AST, ALT, TBIL, CRE were assayed, and histopathological examination of the lung tissues was performed at 24 h, 48 h after LPS infusion.Results The mortality of Bama minipigs was 33.3%, higher than that of 16.7%of Juema minipigs.The trend of physiological and biochemical changes was similar, but was milder in the Juema minipigs than in Bama minipigs.The lung injuries of the Bama minipigs at 24 h and 48 h were more severe than those in the Juema minipigs.Conclusions Both Bama and Juema minipig models of high altitude multi-organ dysfunction syndrome can be successfully established.Juema minipig models can be more closely and safely established, due to its own plateau biological properties, and avoid the influence by extrinsic injurious effects of plateau environment.

Analysis of the prevention effect of early individualized and comprehensive therapy on MODS in patients with severe acute pancreatitis / 重庆医学

Objective To investigate the effect of individualized and comprehensive therapy in treatment of severe acute pancrea-titis in early stage for preventing MODS .Methods 85 patients with severe acute pancreatitis treated in this Chengde medical college affiliated hospital from January 2008 to January 2012 were divided into two groups .The control group included 42 patients ,all used conventional basic treatment ;the test group included 43 patients ,and all used individualized and comprehensive therapy in early stage .The APACHEⅡ ,MODS and Ranson scores ,and serum inflammatory cytokines indexes of patients in each group before and after admission were all recorded .Results The APACHEⅡ and MODS scores after admission of test group were significantly low-er than the control group(P< 0 .05) .The TNF α,CRP and IL 10 after admission of two groups had significant difference (P<0 .05) .The MODS incidence of control group was 64 .3% (27/42) ,pancreatic encephalopathy incidence was21 .4% (9/43) ,the inci-dence of pancreatic infection was 33 .3% (14/42) ,hospital mortality incidence was 19 .1% (8/42) and length of hospital stay was (30 .4 ± 5 .7) d .The MODS incidence of test group was 27 .9% (12/43) ,pancreatic encephalopathy incidence was11 .6% (5/43) , pancreatic infection rate was 14 .0% (6/43) ,hospital mortality incidence was 4 .7% (2/43) and length of hospital stay was (23 .5 ± 4 .3) d .The incidence of MODS ,hospital mortality and pancreatic infection rates of test group were significantly lower than that of the control group (P<0 .05) .The average length of stay of test group were significantly lower than the control group (P<0 .05) . Conclusion To use individualized and comprehensive therapy in treatment of severe acute pancreatitis in early stage can reduce MODS ,protect organ function ,and reduce mortality .