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2.
Arch. argent. pediatr ; 119(3): e252-e255, Junio 2021. ilus
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1248221

ABSTRACT

Las infecciones por coronavirus son habituales en los pacientes pediátricos. Por lo general, producen un cuadro clínico leve de infección del tracto respiratorio superior que no suele afectar a los pulmones, salvo en prematuros y niños con enfermedades crónicas de base. Excepcionalmente, afectan a otros órganos (corazón, cerebro, tracto gastrointestinal) e incrementan su gravedad.En relación con la coincidencia temporal con el inicio de la actual pandemia por el nuevo beta coronavirus (SARS-CoV-2), responsable de su enfermedad asociada (COVID-19), se presenta el caso clínico de un paciente de 5 años con fracaso multiorgánico y secuelas neurológicas por afectación bulbar y trombosis vascular ocasionados por un alfa coronavirus (CoV-NL63) debido a su gravedad y excepcionalidad


Coronavirus infections (CoV) are common in pediatric patients. In general, they produce a mild clinical presentation consisting of an upper respiratory tract infection that does not usually infect the lungs, with the exception of preterm infants and children with chronic diseases. These infections exceptionally affect other organs (heart, brain, gastrointestinal tract), thus increasing their severity.In relation to the temporal coincidence with the beginning of the current situation of pandemic by the new beta coronavirus SARS-CoV-2 responsible for its associated disease (COVID-19), this study presents a clinical case of a 5-year-old patient showing multiple-organ failure and neurological sequelae due to bulbar injury and vascular thrombosis caused by an alpha coronavirus (CoV-NL63) due to its severity and exceptionality


Subject(s)
Humans , Male , Child, Preschool , Respiratory Tract Infections/diagnosis , Coronavirus Infections/diagnosis , Coronavirus NL63, Human/isolation & purification , Multiple Organ Failure/virology , Respiratory Tract Infections/complications , Coronavirus Infections/complications , Diagnosis, Differential , Multiple Organ Failure/diagnosis
3.
Arch. argent. pediatr ; 119(5): e578-e578, oct. 2021.
Article in English | LILACS, BINACIS | ID: biblio-1292837
4.
5.
Rev. bras. ter. intensiva ; 33(2): 298-303, abr.-jun. 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1289083

ABSTRACT

RESUMO Objetivo: Avaliar como a funcionalidade e a disfunção orgânica aguda influenciam a mortalidade hospitalar de pacientes oncológicos admitidos com suspeita de sepse. Métodos: Os dados foram obtidos de uma coorte retrospectiva de pacientes oncológicos com suspeita de infecção admitidos em uma unidade de terapia intensiva. Estes receberam antibióticos por via parenteral e tiveram suas culturas coletadas. Utilizamos uma regressão logística, para avaliar a mortalidade hospitalar como desfecho, Sequential Organ Failure Assessment e Eastern Cooperative Oncology Group como preditores, além de suas interações. Resultados: Dentre os 450 pacientes incluídos, 265 (58,9%) morreram no hospital. Para os pacientes admitidos na unidade de terapia intensiva com Sequential Organ Failure Assessment baixo (≤ 6), o comprometimento da funcionalidade influenciou a mortalidade hospitalar, que foi de 32% entre os pacientes sem comprometimento ou com comprometimento mínimo da funcionalidade e 52% entre os pacientes com comprometimento moderado e grave (p < 0,01). Nos pacientes com Sequential Organ Failure Assessment elevado (> 6), a funcionalidade não influenciou a mortalidade hospitalar (73% entre os pacientes sem comprometimento ou com comprometimento mínimo, e 84% entre os pacientes com comprometimento moderado e grave; p = 0,1). Conclusão: O comprometimento da funcionalidade parece influenciar a mortalidade hospitalar de pacientes oncológicos com suspeita de sepse sem disfunções orgânicas agudas ou que apresentem disfunções leves no momento da admissão na unidade de terapia intensiva.


ABSTRACT Objective: To evaluate how performance status impairment and acute organ dysfunction influence hospital mortality in critically ill patients with cancer who were admitted with suspected sepsis. Methods: Data were obtained from a retrospective cohort of patients, admitted to an intensive care unit, with cancer and with a suspected infection who received parenteral antibiotics and underwent the collection of bodily fluid samples. We used logistic regression with hospital mortality as the outcome and the Sequential Organ Failure Assessment score, Eastern Cooperative Oncology Group status, and their interactions as predictors. Results: Of 450 patients included, 265 (58.9%) died in the hospital. For patients admitted to the intensive care unit with lower Sequential Organ Failure Assessment (≤ 6), performance status impairment influenced the in-hospital mortality, which was 32% among those with no and minor performance status impairment and 52% among those with moderate and severe performance status impairment, p < 0.01. However, for those with higher Sequential Organ Failure Assessment (> 6), performance status impairment did not influence the in-hospital mortality (73% among those with no and minor impairment and 84% among those with moderate and severe impairment; p = 0.1). Conclusion: Performance status impairment seems to influence hospital mortality in critically ill cancer patients with suspected sepsis when they have less severe acute organ dysfunction at the time of intensive care unit admission.


Subject(s)
Humans , Critical Illness , Neoplasms/complications , Retrospective Studies , Cohort Studies , Hospital Mortality , Organ Dysfunction Scores , Intensive Care Units , Multiple Organ Failure
6.
Arch. argent. pediatr ; 119(1): e1-e10, feb. 2021. tab, ilus
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1147178

ABSTRACT

Ningún órgano se encuentra exento de la disfunción ocasionada por la sepsis. La actividad inflamatoria sostenida y no controlada pone en marcha una secuencia de mecanismos sistémicos tendientes a alterar la homeostasis vascular y tisular. Esto es potenciado por el efecto propio de los microorganismos, lo que genera graves consecuencias funcionales para el paciente.El organismo del niño es particularmente sensible a los efectos de la sepsis, en parte, debido a la inmadurez de numerosas variables fisiológicas. En consecuencia, el impacto clínico suele ser precoz y se asocia con mayor gravedad.Si bien los mecanismos que generan disfunción orgánica son múltiples, complejos y muchos de ellos no completamente dilucidados, su conocimiento facilita la comprensión del escenario clínico y permite decidir la estrategia terapéutica apropiada para cada caso en particular


No organ is exempt from sepsis-induced dysfunction. Sustained, uncontrolled inflammatory activity triggers a sequence of systemic mechanisms that tend to affect tissue and vascular homeostasis. This is boosted by the effect typical of microorganisms, which leads to severe functional consequences for the patient.A child's body is particularly sensitive to the effects of sepsis, partly due to the immaturity of several physiological variables. As a result, there is usually an early clinical impact associated with a greater severity.Although several intricate mechanisms lead to organ dysfunction, and many of them have not been fully elucidated, knowing them facilitates the understanding of the clinical picture and allows to establish an adequate therapeutic approach for each specific case.


Subject(s)
Humans , Systemic Inflammatory Response Syndrome , Multiple Organ Failure , Pediatrics , Shock, Septic , Sepsis , Organ Dysfunction Scores
7.
Autops. Case Rep ; 11: e2021273, 2021. graf
Article in English | LILACS | ID: biblio-1249008

ABSTRACT

First described by Rokitansky in 1842, and further characterized by Virchow in 1854, amyloidosis is a disorder caused by amyloid deposition, a fibrillary insoluble protein. The clinical spectrum of amyloidosis is broad, as the amyloid deposition may virtually occur in all tissues. Herein, we report the case of a 66-year-old man with a long-lasting emaciating disease, diagnosed, at autopsy, with primary systemic amyloidosis. Amyloid protein deposition was found in many tissues and organs. The involvement of the vessels' wall rendered ischemic injury most prominent in the intestinal loops causing mesenteric ischemia. Despite the thorough organic involvement, the immediate cause of death was aspiration bronchopneumonia. Massive amyloid deposition was found in virtually all major organs, such as the heart, liver, kidneys, spleen, pancreas, adrenals, prostate, skin, and thyroid: the latter, a complication of the amyloidosis known as amyloid goiter. Post-mortem review of the deceased's laboratory workup showed a slightly abnormal kappa:lambda ratio in the blood; however, no clonal lymphoplasmacytic disorder was confirmed in the bone marrow and other lymphoreticular system organs either by the microscopic examination and immunohistochemical staining. Laser-capture microdissection and tandem mass spectrometry of the splenic tissue detected a peptide profile consistent with an immunoglobulin Kappa light chain. The presence of amyloid purpura favors the diagnosis of primary systemic amyloidosis.


Subject(s)
Humans , Male , Aged , Amyloidosis/pathology , Pneumatosis Cystoides Intestinalis , Autopsy , Tandem Mass Spectrometry , Multiple Organ Failure
8.
Rev. ecuat. pediatr ; 21(2): 1-8, 31 de agosto del 2020.
Article in Spanish | LILACS | ID: biblio-1140937

ABSTRACT

Introducción: El síndrome de disfunción multiorgánica (SDMO) es la falla de dos o más órganos en pacientes críticamente enfermos, por lo que se han creado puntajes que permiten estimar su mortalidad. El objetivo del presente estudio fue determinar el valor diagnóstico de la escala Disfunción Pediátrica Logística de órganos-2 (PELOD-2) como predictor de mortalidad en los pacientes ingresados en la Unidad de Cuidados Intensivos (UCIP) en el Hospital Baca Ortiz. Métodos: Este estudio observacional analítico fue realizado en la UCI del Hospital Pediátrico Baca Ortiz , Quito-Ecuador en Marzo a Agosto 2018. Se incluyeron todos los posibles casos analizables. Las variables edad gestacional, sexo, variables clínicas del puntaje PELOD-2 y mortalidad. El Grupo 1 (G1): niños con fallecimiento, Grupo 2 (G2): niños vivos. Se calculó Sensibilidad (S), Especificidad (E), Valor Predictivo Positivo (VPP), Valor Predictivo Negativo (VPN) de cada Puntaje. Resultados: 188 casos fueron incluidos. Fueron 97 mujeres (51.6%). Pacientes de 1 a 4 años de edad 66/188 (35.1%) Con falla respiratoria 100 casos/188 (53.7%). Mortalidad de 35 casos/188 (18.6% IC 95% 18.21-19.02%). PELOD2>16mortalidad 63%. OR 511.7 (IC95% 29.4-8909) P<0.0001. S:62.9%, E:100%, VPP:100%, VPN:92.2%. Exactitud: 93.1%. Conclusión: El puntaje PELOD-2 es un predictor de mortalidad aceptable, y altamente específico


Introduction: The multiorgan dysfunction syndrome (MOMS) is the failure of two or more organs in critically ill patients, for which scores have been created that allow estimating their mortality. The objective of this study was to determine the diagnostic value of the "Pediatric Logistic Organ Dysfunction- -2) scale as a predictor of mortality in patients admitted to the Intensive Care Unit (PICU) at Baca Ortiz Hospital. Methods: This analytical observational study was carried out in the ICU of the Pediatric Hospital "Baca Ortiz", Quito-Ecuador from March to August 2018. All possible analysable cases were included. The variables gestational age, sex, clinical variables of the PELOD-2 score and mortality. Group 1 (G1): children with death, Group 2 (G2): living children. Sensitivity (S), Specificity (E), Positive Predictive Value (PPV), Negative Predictive Value (NPV) of each Score were calculated. Results: 188 cases were included. There were 97 women (51.6%). Patients aged 1 to 4 years 66/188 (35.1%) With respiratory failure 100 cases / 188 (53.7%). Mortality of 35 cases / 188 (18.6% 95% CI 18.21- 29.4-8909) P <0.0001. S: 62.9%, E: 100%, PPV: 100%, NPV: 92.2%. Accuracy: 93.1%. Conclusion: The PELOD-2 score is an acceptable and highly specific predictor of mortality


Subject(s)
Humans , Child , Intensive Care Units , Multiple Organ Failure
9.
Medisan ; 24(4): 627-640, jul.-ago. 2020. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1125137

ABSTRACT

Introducción: La albúmina sérica constituye uno de los parámetros utilizados para predecir el riesgo de complicaciones en pacientes intervenidos quirúrgicamente. Objetivo: Evaluar la utilidad de la albúmina sérica como factor pronóstico de fallo múltiple de órganos en pacientes con peritonitis difusa secundaria. Método: Se realizó un estudio observacional, analítico, de cohortes de 54 pacientes con peritonitis difusa secundaria atendidos en la Unidad de Cuidados Intensivos del Hospital General Universitario Carlos Manuel de Céspedes de Bayamo, de la provincia de Granma, durante el 2016. La variable marcadora del pronóstico fue el fallo múltiple de órganos, que se evaluó con la escala Secuencial Organ Failure Assessment. Resultados: En 37,7 % de los pacientes se desarrolló fallo múltiple de órganos; asimismo, el valor promedio de la albúmina sérica al ingreso (desviación estándar) fue 30,3 g/L (+ 3,4) en pacientes con dicha afectación y 33,2 g/L (+ 4,1) sin esta (p=0,012). El riesgo relativo de fallo múltiple de órganos resultó ser de 1,9 (IC: 95 % 1,1-3,2) con albúmina de 30 g/L o menos. En el análisis multivariado la albúmina sérica constituyó un factor independiente de fallo múltiple de órganos junto al índice de APACHE II; mientras que el área bajo la curva receptor operador presentó un valor de 0,7 cuando se estimó la capacidad discriminativa de la albúmina para predecir la no aparición de fallo múltiple de órganos y de 0,2 para predecir su desarrollo. Conclusiones: La albúmina sérica es útil como factor pronóstico de fallo múltiple de órganos en pacientes con peritonitis difusa secundaria.


Introduction: Seric albumin constitutes one of the parameters used to predict the risk of complications in patients surgically intervened. Objective: To evaluate the utility of seric albumin as prediction factor of multiple failure of organs in patients with secondary diffuse peritonitis. Method: An observational, cohorts analytic study of 54 patients with secondary diffuse peritonitis was carried out, they were assisted in the Intensive Cares Unit of Carlos Manuel de Céspedes University General Hospital in Bayamo, Granma, during 2016. The marker variable of prediction was the multiple failures of organs that was evaluated with the Sequential scale Organ Failure Assessment. Results: In the 37.7 % of patients multiple failure of organs was developed; also, the average value of seric albumin at admission (standard deviation) was 30.3 g/L (+ 3.4) in patients with this disorder and 33.2 g/L (+ 4.1) without this disorder (p=0.012). The relative risk of multiple failure of organs was 1.9 (CI: 95 % 1.1-3.2) with albumin of 30 g/L or less. In the multivariate analysis seric albumin constituted an independent factor of multiple failure of organs along with APACHE II index; while the area under the curve receiving operator presented a value of 0.7 when the discriminative capacity of the albumin was considered to predict if the multiple failure of organs was not present and 0.2 to predict its development. Conclusions: Seric albumin is useful as prediction factor of multiple failure of organs in patients with secondary diffuse peritonitis.


Subject(s)
Peritonitis , Serum Albumin , Multiple Organ Failure , Risk Factors
10.
Rev. cuba. med. gen. integr ; 36(2): e1162, abr.-jun. 2020. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1138970

ABSTRACT

Introducción: El síndrome de Weil es una forma grave de la infección bacteriana causada por la bacteria Leptospira, conocida como leptospirosis. Este se caracteriza por la disfunción de múltiples órganos, entre ellos, hígado, riñón, músculos, serosas o el sistema neurológico, en este caso denominado neuroleptospirosis, genera una mortalidad muy elevada cuando no se brinda diagnóstico y tratamiento adecuado. Objetivo: Describir las manifestaciones clínicas, paraclínicos complementarios y tratamiento de un paciente con síndrome de Weil, una condición poco frecuente. Caso clínico: Paciente de 23 años quien consulta en el contexto de síndrome febril agudo asociado con neuritis óptica, dolor torácico y paraclínicos que evidenciaron afectación hepática y cardíaca. Se confirma el diagnóstico de síndrome de Weil dado por neuroleptospirosis, pericarditis y colestasis intrahepática. Conclusiones: mediante un caso clínico de síndrome de Weil, se describe la afectación multisistémica de complicaciones asociadas con leptospirosis, con manifestaciones poco habituales como neuroleptospirosis, pericarditis y colestasis intrahepática(AU)


Introduction: Weil syndrome is a serious form of the bacterial infection caused by the Leptospira bacterium; this is known as leptospirosis. This is characterized by multiple organ dysfunction; for example, the liver, kidney, muscles, of serous type, or the neurological system, in this case called neuroleptospirosis, which produces a very high mortality when adequate diagnosis and treatment are not provided. Objective: To describe the clinical manifestations, complementary paraclinic practice and treatment of a patient with Weil syndrome, as a rare condition. Clinical case: 23-year-old patient who presents with acute febrile syndrome associated with optic neuritis, chest pain, and paraclinical symptoms obviously consistent liver and cardiac involvement. The diagnosis of Weil syndrome is confirmed, specifically defined by neuroleptospirosis, pericarditis, and intrahepatic cholestasis. Conclusions: Through a clinical case of Weil syndrome, the multisystem involvement of complications associated with leptospirosis is described, along with its unusual manifestations, such as neuroleptospirosis, pericarditis, and intrahepatic cholestasis(AU)


Subject(s)
Humans , Male , Female , Weil Disease/epidemiology , Leptospirosis/drug therapy , Leptospirosis/epidemiology , Multiple Organ Failure/diagnosis
11.
Medisan ; 24(2)mar.-abr. 2020. ilus
Article in Spanish | LILACS, CUMED | ID: biblio-1098397

ABSTRACT

Se describe el caso clínico de un paciente de 51 años de edad con antecedente patológico personal de ser un fumador empedernido, el cual acudió al Cuerpo de Guardia del Hospital Provincial Docente Dr. Joaquín Castillo Duany de Santiago de Cuba por presentar disnea asociada a cifras elevadas de tensión arterial y livedo reticular en la cara anterior abdominal. Debido al cuadro clínico y a los resultados de los exámenes complementarios, fue trasladado a la Unidad de Cuidados Intensivos, donde posteriormente se le diagnosticó pancreatitis aguda grave, tras realizar una laparotomía exploratoria y hallar zonas isquémicas en las asas intestinales. El paciente mantuvo una evolución tórpida y falleció a causa de una disfunción múltiple de órganos.


The case report of a 51 years patient with personal pathological history of being a heavy smoker is described, who went to the emergency room of Dr. Joaquín Castillo Duany Teaching Provincial Hospital in Santiago de Cuba due to a dyspnea associated with high figures of blood pressure and livedo reticularis in the abdominal anterior face. Due to the clinical pattern and the results of the complementary tests, he was referred to the Intensive Cares Unit, where later on he was diagnosed serious acute pancreatitis, after an exploratory laparotomy where ischemic areas in the intestinal loops were found. The patient maintained a torpid clinical course and he died because of a multiple dysfunction of organs.


Subject(s)
Pancreatitis/diagnosis , Multiple Organ Failure , Tobacco Use Disorder/complications , Hypertension , Intensive Care Units
12.
Medellín; Unidad de Evidencia y Deliberación para la Toma de Decisiones UNED. Facultad de Medicina, Universidad de Antioquia; 20200000. 57 p.
Monography in Spanish | PIE, LILACS, PIE | ID: biblio-1095463

ABSTRACT

Los hallazgos de esta síntesis rápida están organizados de tal manera que responden las 4 preguntas planteadas. Cada subsección presenta los hallazgos relevantes de las revisiones sistemáticas, y los resultados del metaanálisis realizado con 20 estudios observacionales específicos para COVID-19 no incluidos en las revisiones sistemáticas. Los factores clínicos y paraclínicos considerados en el metaanálisis de efectos aleatorios fueron la edad, comorbilidades como la hipertensión arterial, diabetes mellitus, enfermedad cardiovascular, malignidad, y enfermedad renal crónica; y los paraclínicos dímero D, proteína C reactiva (PCR), interleuquina 6 (IL-6), procalcitonina, deshidrogenasa láctica (LDH), y recuento linfocitario.


Subject(s)
Humans , Mortality , Respiratory Distress Syndrome , Coronavirus Infections , Delivery of Health Care , Multiple Organ Failure
13.
Rev. Hosp. Ital. B. Aires (2004) ; 40(1): 25-28, mar. 2020. ilus
Article in Spanish | LILACS | ID: biblio-1102210

ABSTRACT

Introducción: la zigomicosis es una infección fúngica poco frecuente, con alta tasa de mortalidad y de mal pronóstico. Afecta principalmente a pacientes inmunocomprometidos. La asociación con el síndrome hemofagocítico es extremadamente inusual, más aún en pacientes inmunocompetentes, con pocos ejemplos registrados en la literatura. Caso clínico: se presenta el caso de un paciente masculino inmunocompetente de 40 años con diagnóstico de mucormicosis y síndrome hemofagocítico que evoluciona desfavorablemente, con fallo multiorgánico, a pesar de los esfuerzos médicos. Conclusión: la asociación de mucormicosis con síndrome hemofagocítico en un paciente inmunocompetente es extremadamente rara; existen pocos casos informados en Latinoamérica. Debemos tener presente esta asociación, ya que requiere un tratamiento agresivo y soporte vital avanzado. (AU)


Introduction: zygomycosis is a rare fungal infection that carries with high mortality rates. This poor prognosis, rapidly progressive infection mainly affects immunocompromised patients. The association with hemophagocytic lymphohistiocytosis is extremely unusual, even more in immunocompetent patients, with few cases reported. Case: we present the case of an immunocompetent male patient who was diagnosed with zygomycosis and hemophagocytic lymphohistiocytosis. Despite medical efforts he developed multiorganic failure. Conclusion: the association of mucormycosis with hemophagocytic lymphohistiocytosis in an immunocompetent patient is exceptional with few cases reported in Latin America. We must always suspect this association considering they require aggressive treatment and advanced life support. (AU)


Subject(s)
Humans , Male , Adult , Zygomycosis/diagnosis , Lymphohistiocytosis, Hemophagocytic/diagnosis , Pancytopenia/blood , Psychomotor Agitation , Vancomycin/therapeutic use , Norepinephrine/administration & dosage , Norepinephrine/therapeutic use , Amphotericin B/therapeutic use , Exophthalmos/diagnostic imaging , Immunocompromised Host/immunology , Colistin/therapeutic use , Amoxicillin-Potassium Clavulanate Combination/administration & dosage , Amoxicillin-Potassium Clavulanate Combination/therapeutic use , Zygomycosis/etiology , Zygomycosis/mortality , Zygomycosis/epidemiology , Delirium , Lymphohistiocytosis, Hemophagocytic/etiology , Lymphohistiocytosis, Hemophagocytic/mortality , Fever , Meropenem/therapeutic use , Immunocompetence/immunology , Jaundice , Mucormycosis/complications , Multiple Organ Failure/diagnosis
14.
Autops. Case Rep ; 10(1): e2020146, Jan.-Mar. 2020. tab, ilus
Article in English | LILACS | ID: biblio-1053539

ABSTRACT

Phosphorus is a nonmetallic irritant used in various sectors like rodenticide, firecracker industries, match industries, and fertilizers. Phosphorus poisoning is responsible for deaths among children and adults. Accidental yellow phosphorus poisoning is frequently reported in children, whereas suicidal consumption is not uncommon amongst adults. Herein, we present the case of a 30-year-old female patient who ingested Ratol paste containing yellow phosphorus in an attempt to commit suicide. Her initial chief complaints were nausea, vomiting along with loose motion during hospitalization, followed by a symptomless phase with stable vitals on the 2nd day, and managed conservatively. She took discharge against the medical advice. Later on, she was readmitted in the same hospital, after two days, complaining of generalized weakness, bodily pain, drowsiness, loss of appetite, and breathing difficulties. She developed severe complications due to the intoxication and died. An autopsy was performed. The histopathological and the toxicological examination were carried out. We found characteristic features in different organs due to yellow phosphorus toxicity. We concluded the cause of death as hepatic encephalopathy and multi-organ dysfunction syndrome caused by the yellow phosphorus poisoning.


Subject(s)
Humans , Female , Adult , Phosphorus/poisoning , Autopsy , Hepatic Encephalopathy/pathology , Fatal Outcome , Multiple Organ Failure/pathology
15.
Autops. Case Rep ; 10(3): e2020194, 2020. graf
Article in English | LILACS | ID: biblio-1131834

ABSTRACT

We report on a 3-month old infant male who had a seven-days history of fever and rhinorrhea associated with wheezing prior to his death, during the Covid-19 pandemic. Viral testing for Covid-19 (SARS-CoV-2) was negative but was positive for Coronavirus 229E and RP Human Rhinovirus. The pulmonary histological examination showed diffuse alveolar damage along with thrombotic microangiopathy affecting alveolar capillaries. Also, thrombotic microangiopathy was evident in the heart, lungs, brain, kidneys and liver. Thrombotic microangiopathy is a major pathologic finding in Acute Respiratory Distress Syndrome and in the multiorgan failure. This is the first report that illustrates thrombotic microangiopathy occurring in lung, heart, liver, kidney and brain in Acute Respiratory Distress Syndrome with Coronavirus 229E with Rhinovirus co-infection. The clinical presentation and pathological findings in our case share common features with Covid-19.


Subject(s)
Humans , Male , Infant , Respiratory Distress Syndrome , Rhinovirus , Coronavirus Infections/complications , SARS Virus , Thrombotic Microangiopathies/complications , Autopsy , Fatal Outcome , Coinfection , Multiple Organ Failure
17.
Article in Chinese | WPRIM | ID: wpr-781699

ABSTRACT

OBJECTIVE@#To study the clinical effect and complications of continuous blood purification (CBP) in the treatment of multiple organ dysfunction syndrome (MODS) in neonates.@*METHODS@#A retrospective analysis was performed for the clinical data of 21 neonates with MODS who were admitted to the neonatal intensive care unit from November 2015 to April 2019 and were treated with CBP. Clinical indices were observed before treatment, at 6, 12, 24, and 36 hours of CBP treatment, and at the end of treatment to evaluate the clinical effect and safety of CBP treatment.@*RESULTS@#Among the 21 neonates with MODS undergoing CBP, 17 (81%) had response to treatment. The neonates with response to CBP treatment had a significant improvement in oxygenation index at 6 hours of treatment, a significant increase in urine volume at 24 hours of treatment, a stable blood pressure within the normal range at 24 hours of treatment, and significant reductions in the doses of the vasoactive agents epinephrine and dopamine at 6 hours of treatment (P<0.05), as well as a significant reduction in serum K+ level at 6 hours of treatment, a significant improvement in blood pH at 12 hours of treatment, and significant reductions in blood lactic acid, blood creatinine, and blood urea nitrogen at 12 hours of treatment (P<0.05). Among the 21 neonates during CBP treatment, 6 experienced thrombocytopenia, 1 had membrane occlusion, and 1 experienced bleeding, and no hypothermia, hypotension, or infection was observed.@*CONCLUSIONS@#CBP is a safe, feasible, and effective method for the treatment of MODS in neonates, with few complications.


Subject(s)
Blood Gas Analysis , Blood Urea Nitrogen , Hemofiltration , Humans , Infant, Newborn , Multiple Organ Failure , Retrospective Studies
18.
Protein & Cell ; (12): 707-722, 2020.
Article in English | WPRIM | ID: wpr-827023

ABSTRACT

The 2019 novel coronavirus disease (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has occurred in China and around the world. SARS-CoV-2-infected patients with severe pneumonia rapidly develop acute respiratory distress syndrome (ARDS) and die of multiple organ failure. Despite advances in supportive care approaches, ARDS is still associated with high mortality and morbidity. Mesenchymal stem cell (MSC)-based therapy may be an potential alternative strategy for treating ARDS by targeting the various pathophysiological events of ARDS. By releasing a variety of paracrine factors and extracellular vesicles, MSC can exert anti-inflammatory, anti-apoptotic, anti-microbial, and pro-angiogenic effects, promote bacterial and alveolar fluid clearance, disrupt the pulmonary endothelial and epithelial cell damage, eventually avoiding the lung and distal organ injuries to rescue patients with ARDS. An increasing number of experimental animal studies and early clinical studies verify the safety and efficacy of MSC therapy in ARDS. Since low cell engraftment and survival in lung limit MSC therapeutic potentials, several strategies have been developed to enhance their engraftment in the lung and their intrinsic, therapeutic properties. Here, we provide a comprehensive review of the mechanisms and optimization of MSC therapy in ARDS and highlighted the potentials and possible barriers of MSC therapy for COVID-19 patients with ARDS.


Subject(s)
Adoptive Transfer , Alveolar Epithelial Cells , Pathology , Animals , Apoptosis , Betacoronavirus , Body Fluids , Metabolism , CD4-Positive T-Lymphocytes , Allergy and Immunology , Clinical Trials as Topic , Coinfection , Therapeutics , Coronavirus Infections , Allergy and Immunology , Disease Models, Animal , Endothelial Cells , Pathology , Extracorporeal Membrane Oxygenation , Genetic Therapy , Methods , Genetic Vectors , Therapeutic Uses , Humans , Immunity, Innate , Inflammation Mediators , Metabolism , Lung , Pathology , Mesenchymal Stem Cell Transplantation , Methods , Mesenchymal Stem Cells , Physiology , Multiple Organ Failure , Pandemics , Pneumonia, Viral , Allergy and Immunology , Respiratory Distress Syndrome , Allergy and Immunology , Pathology , Therapeutics , Translational Medical Research
19.
Protein & Cell ; (12): 707-722, 2020.
Article in English | WPRIM | ID: wpr-828750

ABSTRACT

The 2019 novel coronavirus disease (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has occurred in China and around the world. SARS-CoV-2-infected patients with severe pneumonia rapidly develop acute respiratory distress syndrome (ARDS) and die of multiple organ failure. Despite advances in supportive care approaches, ARDS is still associated with high mortality and morbidity. Mesenchymal stem cell (MSC)-based therapy may be an potential alternative strategy for treating ARDS by targeting the various pathophysiological events of ARDS. By releasing a variety of paracrine factors and extracellular vesicles, MSC can exert anti-inflammatory, anti-apoptotic, anti-microbial, and pro-angiogenic effects, promote bacterial and alveolar fluid clearance, disrupt the pulmonary endothelial and epithelial cell damage, eventually avoiding the lung and distal organ injuries to rescue patients with ARDS. An increasing number of experimental animal studies and early clinical studies verify the safety and efficacy of MSC therapy in ARDS. Since low cell engraftment and survival in lung limit MSC therapeutic potentials, several strategies have been developed to enhance their engraftment in the lung and their intrinsic, therapeutic properties. Here, we provide a comprehensive review of the mechanisms and optimization of MSC therapy in ARDS and highlighted the potentials and possible barriers of MSC therapy for COVID-19 patients with ARDS.


Subject(s)
Adoptive Transfer , Alveolar Epithelial Cells , Pathology , Animals , Apoptosis , Betacoronavirus , Body Fluids , Metabolism , CD4-Positive T-Lymphocytes , Allergy and Immunology , Clinical Trials as Topic , Coinfection , Therapeutics , Coronavirus Infections , Allergy and Immunology , Disease Models, Animal , Endothelial Cells , Pathology , Extracorporeal Membrane Oxygenation , Genetic Therapy , Methods , Genetic Vectors , Therapeutic Uses , Humans , Immunity, Innate , Inflammation Mediators , Metabolism , Lung , Pathology , Mesenchymal Stem Cell Transplantation , Methods , Mesenchymal Stem Cells , Physiology , Multiple Organ Failure , Pandemics , Pneumonia, Viral , Allergy and Immunology , Respiratory Distress Syndrome , Allergy and Immunology , Pathology , Therapeutics , Translational Medical Research
20.
Protein & Cell ; (12): 707-722, 2020.
Article in English | WPRIM | ID: wpr-828586

ABSTRACT

The 2019 novel coronavirus disease (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has occurred in China and around the world. SARS-CoV-2-infected patients with severe pneumonia rapidly develop acute respiratory distress syndrome (ARDS) and die of multiple organ failure. Despite advances in supportive care approaches, ARDS is still associated with high mortality and morbidity. Mesenchymal stem cell (MSC)-based therapy may be an potential alternative strategy for treating ARDS by targeting the various pathophysiological events of ARDS. By releasing a variety of paracrine factors and extracellular vesicles, MSC can exert anti-inflammatory, anti-apoptotic, anti-microbial, and pro-angiogenic effects, promote bacterial and alveolar fluid clearance, disrupt the pulmonary endothelial and epithelial cell damage, eventually avoiding the lung and distal organ injuries to rescue patients with ARDS. An increasing number of experimental animal studies and early clinical studies verify the safety and efficacy of MSC therapy in ARDS. Since low cell engraftment and survival in lung limit MSC therapeutic potentials, several strategies have been developed to enhance their engraftment in the lung and their intrinsic, therapeutic properties. Here, we provide a comprehensive review of the mechanisms and optimization of MSC therapy in ARDS and highlighted the potentials and possible barriers of MSC therapy for COVID-19 patients with ARDS.


Subject(s)
Adoptive Transfer , Alveolar Epithelial Cells , Pathology , Animals , Apoptosis , Betacoronavirus , Body Fluids , Metabolism , CD4-Positive T-Lymphocytes , Allergy and Immunology , Clinical Trials as Topic , Coinfection , Therapeutics , Coronavirus Infections , Allergy and Immunology , Disease Models, Animal , Endothelial Cells , Pathology , Extracorporeal Membrane Oxygenation , Genetic Therapy , Methods , Genetic Vectors , Therapeutic Uses , Humans , Immunity, Innate , Inflammation Mediators , Metabolism , Lung , Pathology , Mesenchymal Stem Cell Transplantation , Methods , Mesenchymal Stem Cells , Physiology , Multiple Organ Failure , Pandemics , Pneumonia, Viral , Allergy and Immunology , Respiratory Distress Syndrome , Allergy and Immunology , Pathology , Therapeutics , Translational Medical Research
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