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1.
Arch. argent. pediatr ; 119(4): S198-S211, agosto 2021. tab, ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1281043

ABSTRACT

La pandemia ocasionada por el nuevo coronavirus (SARS-CoV-2), declarada por la Organización Mundial de la Salud OMS) en marzo de 2020, afecta a un reducido número de pacientes pediátricos, quienes presentan, en su mayoría, compromiso respiratorio leve y evolución favorable. Sin embargo, en niños previamente sanos, comenzó a observarse un aumento de casos definidos como síndrome inflamatorio multisistémico (SIM-C) o similar a Kawasaki (Kawasaki-like) asociado a la enfermedad por el nuevo coronavirus (COVID-19) (KL-C) que evolucionan al shock y requieren internación en la unidad de cuidados intensivos.Los cuadros de SIM-C y los KL-C se caracterizan por fiebre, signos de inflamación, síntomas gastrointestinales y disfunción cardiovascular; las formas graves de presentación tienen mayor incidencia de hipotensión y/o shock. En el laboratorio se observan marcadores de inflamación, hipercoagulabilidad y daño miocárdico. El tratamiento farmacológico de primera línea consiste en la administración de inmunoglobulina por vía intravenosa más ácido acetilsalicílico por vía oral.Se recomienda un abordaje multidisciplinario para un diagnóstico certero y un tratamiento temprano y eficaz para disminuir la morbimortalidad.


The pandemic caused by the SARS-CoV-2 virus declared by the WHO in March 11th 2020, affects a small number of pediatric patients, who mostly present mild respiratory compromise and favorable evolution.However began to be observed in previously healthy children, an increase in cases defined as "Multisystemic Inflammatory Syndrome" (MIS-C) or "Kawasaki-like" post-COVID 19 (KL-C) that evolve to shock and require hospitalization in the Pediatric Intensive Care Unit.MIS-C and KL-C are characterized by fever; signs of inflammation, gastrointestinal symptoms, and cardiovascular dysfunction, associated with sever forms of presentation with higher incidence of hypotension and/or shock. In the laboratory, markers of inflammation, hypercoagulability and myocardial damage are observed. First-line drug treatment consists of intravenous immunoglobulin plus oral acetylsalicylic acid.A multidisciplinary approach is recommended for an accurate diagnosis and an early and effective treatment, in order to reduce morbidity and mortality.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Systemic Inflammatory Response Syndrome/therapy , COVID-19/therapy , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Aspirin/therapeutic use , Immunoglobulins, Intravenous/therapeutic use , Systemic Inflammatory Response Syndrome/complications , Systemic Inflammatory Response Syndrome/diagnosis , Critical Care , Diagnosis, Differential , COVID-19/complications , COVID-19/diagnosis , Mucocutaneous Lymph Node Syndrome/complications , Mucocutaneous Lymph Node Syndrome/diagnosis , Mucocutaneous Lymph Node Syndrome/therapy
4.
Arch. argent. pediatr ; 119(1): e26-e35, feb. 2021. tab, ilus
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1147192

ABSTRACT

El síndrome inflamatorio multisistémico en niños asociado con enfermedad por coronavirus 2019 se define por la presencia de fiebre persistente, inflamación y disfunción orgánica, con evidencia de infección pasada o reciente por coronavirus tipo 2 del síndrome respiratorio agudo grave, y exclusión de otra causa microbiana. Acarrea la superposición con otras enfermedades inflamatorias (enfermedad de Kawasaki y síndrome de shock tóxico) y comparte características con entidades que presentan hipercitocinemia (linfohistiocitosis hemofagocítica y síndrome de activación macrofágica). Se diferencia de estas y de la forma aguda grave de enfermedad por coronavirus 2019 en su presentación clínica y parámetros de laboratorio. Su evolución es potencialmente grave y puede presentar falla cardiovascular; la mortalidad es baja (del 2 %).Se realiza una actualización de este síndrome, y se describe la presentación de 2 casos clínicos con disfunción cardiovascular, que requirieron sostén vasoactivo y asistencia ventilatoria invasiva. El laboratorio sérico evidenció parámetros de inflamación. Ambos recibieron tratamiento con gammaglobulina endovenosa y corticoides sistémicos, con evolución favorable


Multisystem inflammatory syndrome in children related to COVID-19 is defined as the presence of persistent fever, inflammation, and organ dysfunction, with evidence of past or recent severe acute respiratory syndrome coronavirus 2 infection, and excluding other microbial causes. It overlaps with other inflammatory diseases (Kawasaki disease and toxic shock syndrome) and shares some features with hypercytokinemia conditions (hemophagocytic lymphohistiocytosis and macrophage activation syndrome). It differs from these and severe acute COVID-19 in its clinical presentation and laboratory parameters. It has a potentially severe course and may occur with cardiovascular failure; mortality is low (2 %).Here we provide an update on this syndrome and describe the presentation of two clinical cases with cardiovascular dysfunction who required vasoactive support and invasive ventilation. Serum lab tests showed inflammation parameters. Both patients were treated with intravenous immunoglobulin and systemic corticosteroids and had a favorable course


Subject(s)
Humans , Child, Preschool , Child , Coronavirus Infections/diagnosis , Systemic Inflammatory Response Syndrome/diagnosis , Pediatrics , Coronavirus Infections/therapy , Systemic Inflammatory Response Syndrome/therapy
5.
Rev. baiana saúde pública ; 45(Especial 1): 46-61, 20210101.
Article in Portuguese | LILACS | ID: biblio-1178342

ABSTRACT

A Síndrome Inflamatória Multissistêmica Pediátrica (SIM-P) é uma nova apresentação clínica em crianças e adolescentes, na faixa etária de zero a 19 anos, temporalmente associada à infecção pelo SAR-CoV-2. O objetivo deste estudo é analisar o perfil epidemiológico dos casos de SIM-P na Bahia. Trata-se de um estudo exploratório descritivo, com revisão de literatura, análise documental e das notificações de SIM-P realizadas no formulário on-line do REDCap, no período de 20 de julho a 4 de dezembro de 2020, considerando a orientação do Ministério da Saúde para a realização de busca ativa de casos desde 26 de fevereiro de 2020, data da confirmação do primeiro caso de Covid-19 no país. Na Bahia, nesse período, foram realizadas 66 notificações, com a confirmação de 42 casos, dos quais três evoluíram para óbito, 38 tiveram alta e um continua internado. As faixas etárias foram agrupadas em intervalos de cinco anos, sendo a faixa de 5 a 9 anos a que concentrou o maior número de casos (N = 20; 47,6%) e a faixa de 15 a 19 anos a que apresentou o menor número (N = 2; 4,8%). A média de idade coincidiu com a mediana, que foi de oito anos. Houve predomínio do sexo masculino, com 25 casos, representando 59,5%. Em relação à análise de ocorrência dos primeiros sintomas, o mês de julho registrou a maior concentração de casos no período estudado (28,6%). As informações obtidas por meio da vigilância da SIM-P são fundamentais para o conhecimento do perfil epidemiológico, podendo contribuir para o melhor manejo clínico dos casos.


Multisystem Inflammatory Syndrome in Children (MIS-C) is a new clinical presentation in children and adolescents aged zero to nineteen, temporarily associated with SARS-CoV-2 infection. This study aims at analyzing the epidemiological profile of MIS-C cases in the state of Bahia. This is an exploratory descriptive study, with a literature review, document analysis and MIS-C notifications made on the REDCap online form, from July 20 to December 4, 2020, considering the guidance of the Ministry of Health to conduct an active search for cases since February 26, 2020, date of confirmation of the first case of Covid-19 in the country. In the state, during this period, 66 notifications were made, with the confirmation of 42 cases, of which three evolved to death, 38 were discharged and one is still hospitalized. The age groups were grouped into five-year intervals, with the range of 5 to 9 years old having the highest number of cases (N = 20; 47.6%) and the range of 15 to 19 years old having the lowest number (N = 2; 4.8%). The mean age coincided with the median, which was 8 years. There was a predominance of boys, with 25 cases, representing 59.5%. Regarding the analysis of the occurrence of the first symptoms, July registered the highest concentration of cases (28.6%). The information obtained by the surveillance of MIS-C is fundamental for the knowledge of the epidemiological profile and may contribute to the better clinical management of cases.


El síndrome inflamatorio multisistémico pediátrico (SIM-P) es una nueva presentación clínica en niños y adolescentes de 0 a 19 años, temporalmente asociada a la infección por SARS-CoV-2. El objetivo de este estudio es analizar el perfil epidemiológico de los casos de SIM-P en Bahía. Este es un estudio exploratorio descriptivo, con revisión de literatura, análisis de documentos y notificaciones SIM-P realizadas en el formulario en línea de REDCap, del 20 de julio al 4 de diciembre de 2020, considerando la orientación del Ministerio de Salud para realizar una búsqueda activa de casos desde el 26 de febrero de 2020, fecha de confirmación del primer caso del covid-19 en el país. En Bahía, durante ese período, se realizaron 66 notificaciones, con la confirmación de 42 casos, de los cuales tres evolucionaron a muerte, 38 fueron dados de alta y uno aún se encuentra hospitalizado. Los grupos de edad se agruparon en intervalos de cinco años, con el rango de 5 a 9 años con el mayor número de casos (N = 20; 47,6%) y el rango de 15 a 19 años con el número más bajo (N = 2; 4,8%). La edad media coincidió con la mediana, que fue de 8 años. Predominó el sexo masculino, con 25 casos, representando el 59,5%. En cuanto al análisis de la ocurrencia de los primeros síntomas, el mes de julio registró la mayor concentración de casos en el período analizado (28,6%). La información obtenida por la vigilancia del SIM-P es fundamental para conocer el perfil epidemiológico, lo que puede contribuir al mejor manejo clínico de los casos.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Young Adult , Systemic Inflammatory Response Syndrome/epidemiology , Health Profile , Residence Characteristics , Sex Distribution , Age Distribution , Systemic Inflammatory Response Syndrome/diagnosis , Systemic Inflammatory Response Syndrome/etiology , Temporal Distribution , COVID-19/complications
9.
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 11(5): 1307-1311, out.-dez. 2019. ilus
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1022248

ABSTRACT

Objective: The study's goal has been to describe the antecedent signs and symptoms of sepsis in patients hospitalized in the Medical Clinic of a Federal Hospital in Rio de Janeiro city, which are identified by a Registered Nurse; to analyze how the Nurse correlates the signs and symptoms with Sepsis-1, Sepsis-2 and Sepsis-3. Methods: It is a descriptive study with a quantitative approach; the population were 10 Registered Nurses who worked daytime shifts in the nursing ward. Data collection was performed through a structured questionnaire, addressing the identification of signs and symptoms that precede sepsis, including the characteristics and peculiarities of sepsis. Results: The Nurses have adequate understanding regarding the concept of sepsis, although they have showed difficulties in correlating some of the signs and symptoms. Conclusion: The Nurses are aware that sepsis is a health problem and that they provide direct care to the patient, therefore, it is important to identify the signs and symptoms that precede it in order to offer quality assistance and to help reducing new cases


Objetivo: Descrever os sinais e sintomas que antecedem a sepse em pacientes internados na Clínica Médica de um Hospital Federal no Rio de Janeiro identificados pelo Enfermeiro; analisar como o Enfermeiro correlaciona os sinais e sintomas com a Sepsis-1, Sepsis-2 e Sepsis-3. Métodos: Estudo descritivo com abordagem quantitativa, a população foram 10 Enfermeiros em plantões diurnos na enfermaria da Clínica. A coleta de dados foi um questionário estruturado, abordando identificação dos sinais e sintomas que antecedem a sepse, englobando as características e particularidades da sepse. Resultados: Evidenciou-se que possuem entendimento sobre o conceito de sepse, entretanto apresentaram dificuldades em correlacionar alguns dos sinais e sintomas dos tipos de sepse. Conclusão: Ciente que a sepse é um problema de saúde e o Enfermeiro presta cuidado direto ao paciente, percebe-se a importância na identificação dos sinais e sintomas que a antecedem para oferecer assistência de qualidade e auxiliar na redução dos casos


Objetivo: Describe los síntomas y antecedentes de la sepsis en pacientes internados en la Clínica Médica de un Hospital Federal en Río de Janeiro por el enfermero; analizar cómo el enfermero correlaciona los signos y síntomas con Sepsis-1, Sepsis-2 y Sepsis-3. Métodos: Estudio descriptivo con abordaje cuantitativo, la población fue 10 enfermeros en turnos diurnos en la enfermería de la Clínica. La recolección de datos fue un cuestionario estructurado, abordando identificación de los signos y síntomas que anteceden a la sepsis, englobando las características y particularidades de la sepsis. Resultados: Tienen un entendimiento adecuado sobre el concepto de sepsis, sin embargo, presentan dificultades en correlacionar algunos de los signos y síntomas. Conclusión: Es consciente de que la sepsis es un problema de salud y el enfermero presta atención directa al paciente, se percibe la importancia en la identificación de los signos y síntomas que la anteceden para ofrecer asistencia de calidad y auxiliar en la reducción de los casos


Subject(s)
Humans , Male , Female , Systemic Inflammatory Response Syndrome/diagnosis , Sepsis/nursing , Sepsis/prevention & control , Diagnosis , Vital Signs
10.
Rev. cuba. med ; 58(2): e196, abr.-jun. 2019. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1139011

ABSTRACT

Introducción: En la actualidad se revelan controversias sobre las escalas predictivas para el diagnóstico del choque séptico. Objetivo: Comparar la efectividad de los criterios de síndrome de respuesta inflamatoria sistémica y la escala quick SOFA en la predicción de choque séptico. Métodos: Se realizó un estudio descriptivo, longitudinal, prospectivo en pacientes ingresados en la unidad de cuidados intensivos del Hospital General Docente Dr. Agostino Neto, durante enero de 2018 y marzo de 2019. Se analizaron pacientes con sospecha de sepsis. Se seleccionó una muestra aleatoria de 50 pacientes, 25 que cumplieron los criterios del Síndrome de respuesta inflamatoria sistémica y 25 que cumplieron los criterios quick SOFA, y se monitorizó cuáles desarrollaron un choque séptico durante su estadía en la unidad de cuidados intensivos. Resultados: Fue superior el número de pacientes que cumplieron tres o más criterios del Síndrome de respuesta inflamatoria sistémica o dos o más criterios quick SOFA (p < 0,05). El cumplimiento de tres o más criterios del Síndrome de respuesta inflamatoria sistémica no mostró diferencias significativas con el cumplimiento de dos o más criterios quick SOFA (p = 0,08), pero sí se encontró significación cuando se comparó si el paciente cumplía tres o más criterios del Síndrome de respuesta inflamatoria sistémica y dos o más criterios quick SOFA. Conclusiones: El uso de los criterios del Síndrome de respuesta inflamatoria sistémica permite una aproximación diagnóstica de sepsis con mayor frecuencia en pacientes adultos hospitalizados por infección en comparación con la puntuación quick SOFA, pero esta posibilita mejor predicción de la mortalidad por choque séptico(AU)


Introduction: Controversies are currently being revealed about the predictive score for the diagnosis of septic shock. Objective: To compare the effectiveness of the criteria of systemic inflammatory response syndrome and the quick SOFA score in the prediction of septic shock. Methods: A descriptive, longitudinal, prospective study was conducted in patients admitted to the intensive care unit at Dr. Agostino Neto; Teaching General Hospital, from January 2018 to March 2019. Patients with suspected sepsis were studied. A random sample of 50 patients was selected: 25 met the criteria for Systemic Inflammatory Response Syndrome and 25 met the quick SOFA criteria. Those who developed septic shock during their stay in the intensive care unit were monitored. Results: The number of patients that fulfilled three or more criteria of the systemic inflammatory response syndrome, two or more quick SOFA score was higher (p <0.05). The fulfillment of three or more criteria of the systemic inflammatory response syndrome did not show significant differences with the fulfillment of two or more quick SOFA score (p = 0.08). However, significance was found when comparing if patients fulfilled three or more criteria of Systemic inflammatory response syndrome criteria and two or more quick SOFA score. Conclusions: The use of the systemic inflammatory response syndrome criteria allows a diagnostic approach of sepsis more frequent in adult patients hospitalized for infection compared to the quick SOFA score, but this allows a better prediction of mortality from septic shock(AU)


Subject(s)
Humans , Male , Female , Shock, Septic/diagnosis , Shock, Septic/prevention & control , Systemic Inflammatory Response Syndrome/diagnosis , Epidemiology, Descriptive , Prospective Studies , Longitudinal Studies , Clinical Decision Rules
13.
Rev. chil. cir ; 67(1): 79-87, feb. 2015. tab
Article in Spanish | LILACS | ID: lil-734744

ABSTRACT

Severe sepsis is a common condition, increasing in incidence and mortality. Despite it has always been part of the surgeon's clinical practice, severe sepsis of surgical origin remains difficult to manage. Decisions about initial resuscitation, timing of source control, surgical technique and antimicrobial therapy are challenging. The goal of this review is to ensure surgeons and other health professionals are aware of diagnostic and treatment choices actually recommended in order to reduce the high mortality of surgical severe sepsis.


La sepsis severa es una condición clínica frecuente, cuya incidencia y mortalidad van en aumento. Aunque siempre ha sido parte de la práctica clínica del cirujano, la sepsis severa de causa quirúrgica sigue siendo un cuadro clínico difícil de manejar. Las decisiones sobre reanimación del paciente, momento de la cirugía, técnica quirúrgica a utilizar y uso de antibióticos son un desafío. El objetivo de esta revisión es que el cirujano y el equipo médico conozcan las alternativas diagnósticas y terapéuticas actualmente recomendadas para reducir la alta mortalidad de la sepsis severa de causa quirúrgica.


Subject(s)
Humans , Surgical Procedures, Operative/adverse effects , Sepsis/diagnosis , Sepsis/etiology , Sepsis/therapy , Anti-Bacterial Agents/administration & dosage , Shock, Septic/diagnosis , Shock, Septic/etiology , Early Diagnosis , Systemic Inflammatory Response Syndrome/diagnosis , Systemic Inflammatory Response Syndrome/etiology
14.
Rev. cuba. invest. bioméd ; 32(3): 338-343, jul.-sep. 2013.
Article in Spanish | LILACS | ID: lil-705686

ABSTRACT

Objetivo: evaluar la asociación entre los niveles séricos de Proteína C Reactiva e índices Apoproteína B/Apoproteína A1, Apoproteína B/LDL colesterol, LDL/HDL colesterol, índice aterogénico, lipoproteína (a) y componentes C3 y C4 del complemento sérico; así como la capacidad predictiva de la proteína C Reactiva, C3 y C4 complemento sobre los parámetros del lipidograma mencionados, se realizó un estudio transversal en pacientes portadores de Artritis Reumatoide y controles sanos de la provincia Matanzas. Métodos: las determinaciones de los parámetros individuales fueron realizadas por método inmunoturbidimétrico y enzimocolorimétrico. El Software estadístico SPSS, versión 18,0 fue empleado para el procesamiento de los resultados. Resultados: la correlación de Spearman detectó asociación de la proteína C Reactiva con los índices ApoB/LDL colesterol y LDL/HDL colesterol exclusivamente en los pacientes, Rho de Spearman= 0,439 (p=0,002); -0,300 (p=0,043), respectivamente; mientras manifestó asociación de esta con el C4 complemento en ambos grupos, Rho de Spearman= 0,355 (p=0,015); 0,376 (p=0,000), pacientes y controles, respectivamente. La proteína C reactiva predijo el índice ApoB/LDL colesterol mediante el análisis de regresión lineal en los pacientes: R²=0,192 F=10,488 (p=0,002), en tanto las proteínas del complemento C3 y C4 estimaron significativamente el nivel de lipoproteína(a); R²=0,170 F=4,396 (p=0,018). Los resultados apoyan la hipótesis del vínculo entre respuesta inflamatoria y predominio de Lipoproteínas de baja densidad más proaterogénicas; así como la posible estimación de marcadores del riesgo coronario relacionados con el metabolismo lipoproteico a partir de los niveles séricos de Proteína C Reactiva, C3 y C4 complemento en pacientes con Artritis Reumatoide...


Objective: evaluate the association between serum levels of C-reactive protein and the indices apoprotein B/apoprotein A1, apoprotein B/LDL cholesterol, LDL/HDL cholesterol, atherogenic index, lipoprotein (a) and serum complement components C3 and C4, as well as the prediction capacity of C-reactive protein, C3 and C4 complement with respect to the above mentioned lipidogram parameters. A cross-sectional study was conducted of patients with rheumatoid arthritis and healthy controls from the province of Matanzas. Methods: individual parameters were determined by immunoturbidimetry and enzymatic colorimetry. Results were processed with the statistical software SPSS version 18.0. Results: spearman rank correlation spotted an association of C-reactive protein with indices ApoB/LDL cholesterol and LDL/HDL cholesterol exclusively in patients, Spearman's Rho = 0.439 (p=0.002); -0.300 (p=0.043); -0.300 (p=0.043), respectively; and an association of C-reactive protein with C4 complement in both groups, Spearman's Rho = 0.355 (p=0.015); 0.376 (p=0.000), patients and controls, respectively. C-reactive protein predicted the ApoB/LDL cholesterol index by linear regression analysis in patients: R²=0.192 F=10.488 (p=0.002), whereas C3 and C4 complement proteins significantly estimated the level of lipoprotein (a): R²=0.170 F=4.396 (p=0.018). Results support the hypothesis about the link between inflammatory response and the predominance of more proatherogenic low density lipoproteins, as well as the potential estimation of coronary risk markers related to lipoprotein metabolism based on serum levels of C-reactive protein, C3 and C4 complement in patients with rheumatoid arthritis...


Subject(s)
Humans , Arthritis, Rheumatoid/physiopathology , Arthritis, Rheumatoid/blood , Dietary Fats/analysis , Lipoproteins, LDL/blood , C-Reactive Protein/analysis , Systemic Inflammatory Response Syndrome/diagnosis
15.
Acta cir. bras ; 26(1): 38-43, jan.-fev. 2011. graf, tab
Article in English | LILACS | ID: lil-572232

ABSTRACT

Purpose: To evaluate the immediate pulmonary and systemic inflammatory response after a long-term operative period. Methods: Wistar rats in the experimental group were anaesthetized and submitted to tracheostomy, thoracotomy and remained on mechanical ventilation during three hours. Control animals were not submitted to the operative protocol. The following parameters have been evaluated: pulmonary myeloperoxidase activity, pulmonary serum protein extravasation, lung wet/dry weight ratio and measurement of levels of cytokines in serum. Results: Operated animals exhibited significantly lower serum protein extravasation in lungs compared with control animals. The lung wet/dry weight ratio and myeloperoxidase activity did not differ between groups. Serum cytokines IL-1ß, TNF-, and IL-10 levels were not detected in groups, whereas IL-6 was detected only in operated animals. Conclusion: The experimental mechanical ventilation in rats with a prolonged surgical time did not produce significant local and systemic inflammatory changes and permit to evaluate others procedures in thoracic surgery.


Objetivo: Investigar a resposta inflamatória pulmonar e sistêmica imediata após longo período operatório. Métodos: Ratos Wistar do grupo experimental foram anestesiados e submetidos à traqueostomia, toracotomia e permaneceram em ventilação mecânica por três horas. O grupo controle não foi submetido ao protocolo operatório. Os seguintes parâmetros foram avaliados: atividade da mieloperoxidase pulmonar, níveis de extravasamento de proteínas séricas pulmonares, relação peso pulmonar úmido/seco e medidas dos níveis séricos de citocinas. Resultados: Os animais operados apresentaram menor extravasamento de proteínas séricas nos pulmões comparados aos animais controle. A relação peso úmido/seco e a atividade de mieloperoxidase não diferiram entre os grupos. As citocinas séricas IL-1ß, TNF- e IL-10 não foram quantificáveis nos grupos, enquanto que IL-6 só foi detectada no soro dos animais operados. Conclusão: O modelo experimental de ventilação mecânica em ratos com tempo cirúrgico prolongado não apresentou alterações inflamatórias locais e sistêmicas significantes, permitindo avaliar a resposta inflamatória em outros procedimentos da cirurgia torácica.


Subject(s)
Animals , Male , Rats , Lung , Respiration, Artificial/standards , Systemic Inflammatory Response Syndrome/diagnosis , Thoracotomy/standards , Tracheostomy/standards , Blood Proteins/metabolism , Interleukin-1beta/blood , /blood , /blood , Lung/metabolism , Lung/pathology , Models, Animal , Organ Size , Peroxidase/analysis , Peroxidase/metabolism , Rats, Wistar , Respiration, Artificial/methods , Systemic Inflammatory Response Syndrome/blood , Systemic Inflammatory Response Syndrome/etiology , Time Factors , Thoracic Surgical Procedures/standards , Thoracotomy/methods , Tracheostomy/methods , Tumor Necrosis Factor-alpha/blood
16.
Article in English | WPRIM | ID: wpr-127691

ABSTRACT

The aim of this study was to evaluate and compare the Child-Turcotte-Pugh (CTP) classification system and the model for end-stage liver disease (MELD) score in predicting the severity of the systemic inflammatory response in living-donor liver transplantation patients. Recipients of liver graft were allocated to a recipient group (n = 39) and healthy donors to a donor group (n = 42). The association between the CTP classification, the MELD scores and perioperative cytokine concentrations in the recipient group was evaluated. The pro-inflammatory cytokines measured included interleukin (IL)-1beta, IL-6, and tumor necrosis factor (TNF)-alpha; the anti-inflammatory cytokines measured included IL-10 and IL-4. Cytokine concentrations were quantified using sandwich enzyme-linked immunoassays. The IL-6, TNF-alpha, and IL-10 concentrations in the recipient group were significantly higher than those in healthy donor group patients. All preoperative cytokine levels, except IL-6, increased in relation to the severity of liver disease, as measured by the CTP classification. Additionally, all cytokine levels, except IL-6, were significantly correlated preoperatively with MELD scores. However, the correlations diminished during the intraoperative period. The CTP classification and the MELD score are equally reliable in predicting the severity of the systemic inflammatory response, but only during the preoperative period.


Subject(s)
Adult , Cytokines/blood , Female , Humans , Interleukin-10/blood , Interleukin-1beta/blood , Interleukin-4/blood , Interleukin-6/blood , Kidney Failure, Chronic/classification , Liver/pathology , Liver Transplantation , Living Donors , Male , Middle Aged , Predictive Value of Tests , Severity of Illness Index , Systemic Inflammatory Response Syndrome/diagnosis , Treatment Outcome , Tumor Necrosis Factor-alpha/blood
18.
Braz. j. infect. dis ; 14(3): 252-255, May-June 2010. ilus, tab
Article in English | LILACS | ID: lil-556837

ABSTRACT

BACKGROUND: Fever as a common presenting complaint in pediatric patients can be due to various causes. Differentiating bacterial infection from other causes is important because the prompt use of antibiotics is critical in bacterial infection. Traditional markers of infection such as BT and WBC count may be unspecific and culture may be late or absent. CRP and Procalcitonin (PCT) have been considered to evaluate the evolution of infections and sepsis in patients presenting with SIRS. Neopterin has also been proposed to aid in the diagnosis of bacterial infection. In this study, we compared the value of the serum PCT, neopterin level, and WBC count for predicting bacterial infection and outcome in children with fever. METHODS: 158 pediatric (2-120-month-old) patients suspected to have acute bacterial infection, based on clinical judgment in which other causes of SIRS were ruled out were included in the study. WBC count with differential was determined and PCT and neopterin levels were measured. RESULTS: PCT level was higher in bacterial infection and patients who were complicated or expired. CONCLUSION: Rapid PCT test is superior to neopterin and WBC count for anticipating bacterial infection, especially in ED where prompt decision making is critical. ABBREVIATIONS: BT, body temperature; WBC, white blood cell; PCT, procalcitonin; CRP, C-reactive protein; SIRS, systemic inflammatory response syndrome; ED, emergency department.


Subject(s)
Child , Child, Preschool , Humans , Infant , Bacterial Infections/diagnosis , Calcitonin/blood , Neopterin/blood , Protein Precursors/blood , Systemic Inflammatory Response Syndrome/diagnosis , Acute Disease , Bacterial Infections/blood , Biomarkers/blood , Enzyme-Linked Immunosorbent Assay , Leukocyte Count , Predictive Value of Tests , Sensitivity and Specificity , Systemic Inflammatory Response Syndrome/blood
19.
Rev. bras. cir. cardiovasc ; 25(1): 85-98, Jan.-Mar. 2010. ilus, tab
Article in English, Portuguese | LILACS | ID: lil-552845

ABSTRACT

OBJETIVO: Avaliar se a aprotinina em altas doses hemostáticas pode reduzir o processo inflamatório após circulação extracorpórea (CEC) em crianças. MÉTODOS: Estudo prospectivo randomizado em crianças de 30 dias a 4 anos de idade, submetidas à correção de cardiopatia congênita acianogênica, com CEC e divididas em dois grupos, um denominado Controle (n=9) e o outro, Aprotinina (n=10). Neste, o fármaco foi administrado antes e durante a CEC. A resposta inflamatória sistêmica e disfunções hemostática e multiorgânicas foram analisadas por marcadores clínicos e bioquímicos. Foram consideradas significantes as diferenças com P<0,05. RESULTADOS: Os grupos foram semelhantes quanto às variáveis demográficas e intra-operatórias, exceto por maior hemodiluição no Grupo Aprotinina. Não houve benefício quanto aos tempos de ventilação pulmonar mecânica, permanência no CTIP e hospitalar, nem quanto ao uso de inotrópicos e função renal. A relação PaO2/FiO2 (pressão parcial de oxigênio arterial/fração inspirada de oxigênio) apresentou queda significativa com 24 h pós-operatório, no Grupo Controle. As perdas sanguíneas foram semelhantes nos dois grupos. No grupo Aprotinina surgiu leucopenia significativa, em CEC, seguida de leucocitose. Fator de necrose tumoral alfa (TNF-α), Interleucinas (IL)-6, IL-8, IL-10, proporção IL-6/IL-10 não apresentaram diferenças marcantes intergrupos. A proporção IL-6/IL-10 PO aumentou no grupo Controle. Não houve complicações com o uso da aprotinina. CONCLUSÃO: Nesta casuística, a Aprotinina em altas doses hemostáticas não minimizou as manifestações clínicas e os marcadores séricos de resposta inflamatória sistêmica.


OBJECTIVE: To evaluate if the hemostatic high-dose aprotinin seems to reduce the inflammatory process after extracorporeal circulation (ECC) in children. METHODS: A prospective randomized study was conducted on children aged 30 days to 4 years submitted to correction of acyanogenic congenital heart disease with ECC and divided into two groups: Control (n=9) and Aprotinin (n=10). In the Aprotinin Group the drug was administered before and during ECC and the systemic inflammatory response and hemostatic and multiorgan dysfunctions were analyzed on the basis of clinical and biochemical markers. Differences were considered to be significant when P<0.05. RESULTS: The groups were similar regarding demographic and intraoperative variables, except for a greater hemodilution in the Aprotinin Group. The drug had no benefit regarding time of mechanical pulmonary ventilation, permanence in the postoperative ICU and length of CONCLUSION: In this series, hemostatic high-dose aprotinin did not minimize the clinical manifestations or serum markers of the inflammatory systemic response.


Subject(s)
Child, Preschool , Female , Humans , Infant , Male , Aprotinin/pharmacology , Cardiopulmonary Bypass/methods , Heart Defects, Congenital/surgery , Inflammation Mediators/blood , Postoperative Complications/prevention & control , Systemic Inflammatory Response Syndrome/prevention & control , Anti-Inflammatory Agents/pharmacology , Cardiopulmonary Bypass/adverse effects , Interleukins/blood , Serine Proteinase Inhibitors/pharmacology , Systemic Inflammatory Response Syndrome/diagnosis , Tumor Necrosis Factor-alpha/blood
20.
Article in English | WPRIM | ID: wpr-79611

ABSTRACT

This study aimed to assess the influence of lobectomy and pneumonectomy on cardiac rhythm and on the dimensions and function of the right-side of the heart. Twelve dogs undergoing lobectomy and eight dogs undergoing pneumonectomy were evaluated preoperatively and one month postoperatively with electrocardiography and Doppler echocardiography at rest. Pulmonary artery systolic pressure (PASP) was estimated by the tricuspid regurgitation jet (TRJ) via the pulse wave Doppler velocity method. Systemic inflammatory response syndrome criteria (SIRS) were also evaluated based on the clinical and hematological findings in response to lobectomy and pneumonectomy. Following lobectomy and pneumonectomy, we predominantly detected atrial fibrillation and varying degrees of atrioventricular block (AVB). Dogs that died within seven days of the lobectomy (n = 2) or pneumonectomy (n = 1) had complete AVB. Preoperative right atrial, right ventricular, and pulmonary artery dimensions increased gradually during the 30 days (p<0.05) following pneumonectomy, but did not undergo significant changes during that same period after lobectomy. Mean PASP was 56.0 +/- 4.5 mmHg in dogs having significant TRJ after pneumonectomy. Pneumonectomy, but not lobectomy, could lead to increases (p<0.01) in the SIRS score within the first day post-surgery. In brief, it is important to conduct pre- and postoperative cardiac evaluation of dogs undergoing lung resections because cardiac problems are a common postoperative complication after such surgeries. In particular, complete AVB should be considered a life-threatening complication after pneumonectomy and lobectomy. In addition, pneumonectomy appears to increase the likelihood of pulmonary hypertension development in dogs.


Subject(s)
Animals , Atrial Fibrillation/diagnosis , Atrioventricular Block/diagnosis , Blood Pressure/physiology , Dogs , Echocardiography/veterinary , Electrocardiography/veterinary , Pneumonectomy/adverse effects , Postoperative Care/methods , Postoperative Complications/diagnosis , Preoperative Care/methods , Systemic Inflammatory Response Syndrome/diagnosis , Tricuspid Valve Insufficiency/diagnosis
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