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2.
Article in Chinese | WPRIM | ID: wpr-888124

ABSTRACT

To systematically review the efficacy of Xuebijing Injection combined with western medicine in the treatment of systemic inflammatory response syndrome(SIRS). In this study, CBM, CNKI, Wanfang, VIP, PubMed and EMbase databases were retrieved for clinical randomized controlled trials on the effect of Xuebijing Injection combined with western medicine in the treatment of SIRS from the establishment of the database to July 31, 2020. After screening, Meta-analysis was conducted by RevMan 5.3 software, trial sequential analysis was conducted by TSA 0.9.5.10 beta software, and the evidence quality level was evaluated by GRADEprofiler 3.6.1 software. Meta-analysis showed that Xuebijing Injection combined with western medicine could reduce white blood cell count(MD=-2.32, 95%CI[-2.44,-2.21], P<0.000 01), C-reactive protein count(MD=-22.70, 95%CI[-29.61,-15.79], P<0.000 01), APACHE Ⅱ score(MD=-2.15, 95%CI[-2.43,-1.87], P<0.000 01), tumor necrosis factor alpha count(SMD=-1.23, 95%CI[-1.48,-0.99], P<0.000 01) and interleukin-6 count(SMD=-0.92, 95%CI[-1.15,-0.69], P<0.000 01), improve treatment efficiency(RR=1.39, 95%CI[1.23, 1.56], P<0.000 01), reduce incidence of multiple organ dysfunction(RR=0.47, 95%CI[0.35, 0.64], P<0.000 01) and mortality(RR=0.22, 95%CI[0.13, 0.37], P<0.000 01), which were better than western medicine treatment alone. Trial sequential analysis showed that in terms of reducing the incidence of multiple organ dysfunction and C-reactive protein count, the cumulative Z value passed through the traditional threshold, TSA threshold and expected information value, and reached the required number of cases. GRADE evaluation showed that the level of evidence was low or very low. According to the findings, Xuebijing Injection combined with western medicine is effective in treating SIRS. However, as the low quality of the included studies may affect the reliability of the conclusion, more high-quality studies shall be included for further verification in the future, so as to provide better suggestions for clinical medication.


Subject(s)
Drugs, Chinese Herbal , Humans , Injections , Randomized Controlled Trials as Topic , Reproducibility of Results , Systemic Inflammatory Response Syndrome/drug therapy
4.
Prensa méd. argent ; 104(8): 391-402, oct2018. tab, fig
Article in Spanish | LILACS, BINACIS | ID: biblio-1050463

ABSTRACT

Objetivo: Determinar la Relación de la saturación central venosa de oxígeno (ScvO2) >_70% con la mortalidad, en el choque séptico en pacientes que ingresan al servicio de terapia intensiva pediátrica del HGR 36, Puebla. Métodos: Estudio, descriptivo, longitudinal, observacional. Se identificaron todos los pacientes de un mes a 14 años de edad que ingresaron a unidad de terapia intensiva con el diagnóstico de choque séptico. Se corroboró la colocación de un catéter venoso central para la medición de la ScvO2 a su ingreso y las 6 horas. Calificamos con el Indice Pediátrico de Mortalidad (PIM2) para medir el riesgo de mortalidad en cada paciente. Se realizó estadística descriptiva. Resultados: Fueron 15 pacientes, 8 (53.3%) femeninos y 7 (46.7%) masculinos. El PIM2 obtuvo un promedio de 7.42 % al ingreso, y a las 6 horas fue de 13.4%. El promedio de la saturación venosa central de oxígeno al ingreso de los pacientes a la terapia intensiva pediátrica fue de 56% y a las 6 horas el promedio alcanzó 71%. Ningún paciente falleció durante la reanimación cardiiopulmonar desde su ingreso. Conclusión: En base a los resultados anteriores podemos concluir, que no hay una correlación entre la ScvO2 >_ 70% y la mortalidad en los pacientes pediátricos con choque séptico


Objective: To determine the ratio of central venous oxygen saturation (ScvO2) >_ 70% mortality in septic shock patients admitted to pediatric intensive care unit of the HGR 36, Puebla. Methods: A descriptive, longitudinal, observational study. We identified all patients from one month to 14 years of age who were admitted to ICU with a diagnosis of septic shock. It confirmed the placement of a central venous atheter for the measurrement of income and ScvO2 to 6 hours. Qualified with the Pediatric Index of Mortality (PIM2) to measure the risk of death in each patient. We performed descriptive statistics. Results: there were 15 patients,eight (53.3%) female and 7 (46.7%) male. The PIM2 obtained an average of 7.42%. To entry, and 6 hours was 13.4%. The mean central venous oxygen saturation on admission of patients to the pediatric intensive care was 56% and 6 hours on average reached 71%. No patient died during cardiopulmonary resuscitation from your income. Conclusion: Based on previous results we can conclude that there is no coelation between ScvO2 >_70% and mortality in pediatric patients with septic shock


Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Adolescent , Oxygen Consumption , Shock, Septic/mortality , Biomarkers , Systemic Inflammatory Response Syndrome/drug therapy , Sepsis/mortality , Critical Care , Anaerobiosis , Hypoxia/diagnosis
5.
Acta cir. bras ; 27(7): 487-493, jul. 2012. graf
Article in English | LILACS | ID: lil-640098

ABSTRACT

PURPOSE: To investigate the effects of pentoxifylline (PTX) in experimental acute pancreatitis (AP) starting drug administration after the induction of the disease. METHODS: One hundred male Wistar rats were submitted to taurocholate-induced AP and divided into three groups: Group Sham: sham-operated rats, Group Saline: AP plus saline solution, and Group PTX: AP plus PTX. Saline solution and PTX were administered 1 hour after induction of AP. At 3 hours after AP induction, peritoneal levels of tumor necrosis factor (TNF)-α, and serum levels of interleukin (IL)-6 and IL-10 levels were assayed by Enzyme-Linked Immunosorbent Assay (ELISA). Determinations of lung myeloperoxidase activity (MPO), histological analysis of lung and pancreas, and mortality study were performed. RESULTS: PTX administration 1 hour after induction of AP caused a significant decrease in peritoneal levels of TNF-α and in serum levels of IL-6 and IL-10 when compared to the saline group. There were no differences in lung MPO activity between the two groups with AP. A decrease in mortality was observed in the PTX treatment compared to the saline group. CONCLUSIONS: Administration of PTX after the onset of AP decreased the systemic levels of proinflammatory cytokines, raising the possibility that there is an early therapeutic window for PTX after the initiation of AP.


OBJETIVO: Investigar os efeitos da pentoxifilina (PTX) na pancreatite aguda (PA) experimental administrando a droga após a indução da doença. MÉTODOS: Cem ratos machos Wistar foram submetidos à indução da PA através da infusão de taurocolato de sódio e divididos em três grupos: Grupo Sham: sham-operated ratos, Grupo Salina: AP e solução salina, e Grupo PTX: AP e PTX. Solução salina e PTX foram administradas 1 hora após a indução da PA. Três horas após indução da PA os níveis de fator de necrose tumoral (TNF)-α no líquido peritoneal e os níveis séricos de interleucina (IL)-6 e IL-10 foram analisados pelo método de Enzima Imunoensaio (ELISA). A atividade da mieloperoxidase (MPO) foi analisada no pulmão e foram realizadas análises histológicas do pulmão e pâncreas, além do estudo da mortalidade. RESULTADOS: A administração de PTX 1 hora após a indução da PA reduziu significativamente os níveis de TNF-α peritoneal e os níveis séricos de IL-6 e IL-10 quando comparado ao grupo salina. Redução na mortalidade foi observado após o tratamento com PTX comparado ao grupo salina. CONCLUSÃO: A administração de PTX após a indução da PA diminuiu os níveis sistêmicos de citocinas pró-inflamatórias, sugerindo a possibilidade de que existe uma janela terapêutica para PTX após o início do PA.


Subject(s)
Animals , Male , Rats , Pancreatitis, Acute Necrotizing/drug therapy , Pentoxifylline/administration & dosage , Enzyme-Linked Immunosorbent Assay , /blood , /blood , Lung/chemistry , Lung/drug effects , Pancreas/drug effects , Pancreatitis, Acute Necrotizing/blood , Pancreatitis, Acute Necrotizing/pathology , Random Allocation , Rats, Wistar , Sodium Chloride/administration & dosage , Systemic Inflammatory Response Syndrome/drug therapy , Time Factors , Treatment Outcome , Tumor Necrosis Factor-alpha/analysis , Tumor Necrosis Factor-alpha/drug effects
6.
Rev. bras. cir. cardiovasc ; 23(1): 78-92, jan.-mar. 2008. ilus
Article in English, Portuguese | LILACS | ID: lil-489703

ABSTRACT

A presente revisão tem por objetivo ressaltar alguns aspectos pouco discutidos da circulação extracorpórea (CEC), levando-se em consideração fisiologia, fisiopatologia e algumas novas tecnologias de perfusão. Assim, alguns aspectos, até certo ponto filosóficos, motivaram a elaboração dessa revisão: a) Preservar e atualizar os conhecimentos do cirurgião sobre a CEC, pelo simples fato de manter a sua liderança pedagógica sobre a sua equipe; b) Questionar se pacientes idosos e diabéticos pelas suas características individuais, assim como adotado para crianças, talvez merecessem protocolos mais apropriados; c) Questionar a reação inflamatória sistêmica causada pela exposição do sangue à superfície não endotelizada do circuito de CEC diante da importância crescente do contato do sangue com a ferida cirúrgica; d) Em relação ao tratamento da síndrome vasoplégica, o azul de metileno continua sendo a melhor opção terapêutica, embora, muitas vezes não seja eficiente pela existência de uma "janela terapêutica" embasada na dinâmica da ação da guanilato ciclase (saturação e síntese "de novo") e; finalmente, e) Razão da escolha do título, ressaltando que, em seus moldes atuais, a CEC seria conseqüência do empirismo, arte, ou da ciência? A mensagem final vem com a convicção de que tanto o empirismo, a arte e a ciência são muito fortes em se tratando da CEC.


The aim of the present review is to highlight some less discussed aspects of the cardiopulmonary bypass (CPB), taking into consideration the physiology, physiopathology, and some new technologies of perfusion. Thus, some points, to a certain extent philosophical, have motivated this revision: a) To preserve and update the surgeon knowledge regarding CPB, even to keep his/her pedagogical leadership on his/her surgical team; b) To question if elderly and diabetic patients, as a result of their individual characteristics deserve more appropriate protocols similar to those adopted for children; c) One third aspect would be the questioning of the systemic inflammatory reaction caused by the blood exposure to CPB non-endothelized circuit surface, in face of the increasing importance of blood contact with the surgical wound; d) In relation to the treatment of the vasoplegic syndrome, methylene blue continues being the best therapeutical option, even so, many times are not efficient on account of a highly probable existence of a "therapeutical window" based on the guanylate cyclase dynamics of action (saturation and synthesis "de novo") and; finally, e) The reason of the title, highlighting that based on its current patterns, would the CPB be an outcome of empiricism, art, or science? The bottom line of this article carries the certainty of that as much as the empiricism, art, and science are highly related to CPB.


Subject(s)
Adult , Aged , Humans , Cardiopulmonary Bypass , Cardiovascular Surgical Procedures , Systemic Inflammatory Response Syndrome , Cardiopulmonary Bypass/adverse effects , Cardiopulmonary Bypass/instrumentation , Cardiopulmonary Bypass/methods , Cardiovascular Surgical Procedures/instrumentation , Cardiovascular Surgical Procedures/methods , Diabetes Mellitus/physiopathology , Empiricism , Extracorporeal Circulation/adverse effects , Methylene Blue/therapeutic use , Systemic Inflammatory Response Syndrome/drug therapy , Systemic Inflammatory Response Syndrome/etiology , Systemic Inflammatory Response Syndrome/physiopathology , Vascular Resistance/drug effects , Vasodilator Agents/therapeutic use
7.
LJM-Libyan Journal of Medicine. 2008; 3 (1): 34-38
in English | IMEMR | ID: emr-146621

ABSTRACT

Sepsis is a systemic inflammatory response syndrome in the presence of suspected or proven infection, and it may progress to or encompass organ failure [severe sepsis] and hypotension [septic shock]. Clinicians possess an arsenal of supportive measures to combat severe sepsis and septic shock, and some success, albeit controversial, has been achieved by using low doses of corticosteroids or recombinant human activated protein C. However, a truly effective mediator-directed specific treatment has not been developed yet. Treatment with low doses of corticosteroids or with recombinant human activated protein C remains controversial and its success very limited. Attempts to treat shock by blocking IPS, TNF or IL-1 were unsuccessful, as were attempts to use interferon-gamma or granulocyte colony stimulating factor. Inhibiting nitric oxide synthases held promise but met with considerable difficulties. Scavenging excess nitric oxide or targeting molecules downstream of inducible nitric oxide synthase, such as soluble guanylate cyclase or potassium channels, might offer other alternatives


Subject(s)
Nitric Oxide , Systemic Inflammatory Response Syndrome/drug therapy , Interferon-gamma/pharmacology , Shock, Septic , Protein C
8.
Rev. Inst. Med. Trop. Säo Paulo ; 49(4): 267-270, Jul.-Aug. 2007. ilus
Article in English | LILACS | ID: lil-460238

ABSTRACT

Immune reconstitution inflammatory syndrome (IRIS) is an atypical and unexpected reaction related to highly active antiretroviral therapy (HAART) in human immunodeficiency virus (HIV) infected patients. IRIS includes an atypical response to an opportunistic pathogen (generally Mycobacterium tuberculosis, Mycobacterium avium complex, cytomegalovirus and herpes varicella-zoster), in patients responding to HAART with a reduction of plasma viral load and evidence of immune restoration based on increase of CD4+ T-cell count. We reported a case of a patient with AIDS which, after a first failure of HAART, developed a subcutaneous abscess and supraclavicular lymphadenitis as an expression of IRIS due to Mycobacterium avium complex after starting a second scheme of HAART.


El síndrome inflamatorio de reconstitución inmune (SIRI) es una reacción atípica e inesperada relacionada con el tratamiento antirretroviral de gran actividad (TARGA) en pacientes infectados por el virus de la inmunodeficiencia humana (VIH). El SIRI representa una respuesta inflamatoria frente a un patógeno oportunista (generalmente Mycobacterium tuberculosis, Complejo Mycobacterium avium, citomegalovirus y herpes varicela-zóster) en pacientes que responden a la TARGA con una marcada reducción de la carga viral en plasma y evidencia de una recuperación inmunológica expresada por el incremento de los niveles de linfocitos T CD4+. Presentamos el caso de un paciente con síndrome de inmunodeficiencia adquirida que desarrolló un absceso subcutáneo en muslo derecho y una adenitis supraclavicular izquierda como manifestación de SIRI por Complejo Mycobacterium avium luego del inicio de un segundo esquema de TARGA.


Subject(s)
Adult , Humans , Male , AIDS-Related Opportunistic Infections/etiology , Abscess/microbiology , Antiretroviral Therapy, Highly Active/adverse effects , Lymphadenitis/microbiology , Mycobacterium avium-intracellulare Infection/etiology , Systemic Inflammatory Response Syndrome/etiology , AIDS-Related Opportunistic Infections/drug therapy , AIDS-Related Opportunistic Infections/immunology , Abscess/drug therapy , Abscess/immunology , Lymphadenitis/drug therapy , Lymphadenitis/immunology , Mycobacterium avium-intracellulare Infection/drug therapy , Mycobacterium avium-intracellulare Infection/immunology , Systemic Inflammatory Response Syndrome/drug therapy , Systemic Inflammatory Response Syndrome/immunology , Viral Load
9.
Säo Paulo med. j ; 124(2): 90-95, Mar. -Apr. 2006. tab, graf
Article in English | LILACS | ID: lil-432176

ABSTRACT

CONTEXTO E OBJETIVO: A síndrome da resposta inflamatória sistêmica (SRIS) acomete muitos pacientes internados em unidades de terapia intensiva. A evolução destes pacientes com SRIS para sepse, choque séptico e síndrome da disfunção de múltiplos órgãos (SDMO) pode conduzi-los rapidamente para o óbito. A proposta do trabalho é avaliar a eficácia da dexametasona em dose única como tratamento da SRIS. TIPO DE ESTUDO E LOCAL: Estudo prospectivo, aleatório, duplamente encoberto, realizado na Unidade de Terapia Intensiva pós-operatória (Unidade de Apoio Cirúrgico) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. MÉTODOS: Foram estudados 29 pacientes com diagnóstico de SRIS. Os participantes foram aleatoriamente divididos em dois grupos que receberam dexametasona (0,2 mg/kg em dose única) ou placebo após o diagnóstico de SRIS. Os pacientes foram acompanhados durante sete dias de internação na UTI através do escore SOFA (Sequential Organ Failure Assessment).RESULTADOS: Os pacientes que receberam dexametasona apresentaram melhora do sistema respiratório no primeiro dia, com aumento da relação PaO2/FiO2 (p < 0,05). Entre os pacientes que faziam uso de vasopressores, os que receberam dexametasona tiveram diminuição da necessidade destas medicações nos primeiros dois dias após a dose de dexametasona (p < 0,05).


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Anti-Inflammatory Agents/administration & dosage , Dexamethasone/administration & dosage , Systemic Inflammatory Response Syndrome/drug therapy , Vasoconstrictor Agents/administration & dosage , Double-Blind Method , Intensive Care Units , Multiple Organ Failure , Prospective Studies , Treatment Outcome
10.
Rev. cuba. med ; 43(4)jul.-ago. 2004. graf
Article in Spanish | LILACS | ID: lil-412064

ABSTRACT

Se realizó una revisión bibliográfica sobre el síndrome de respuesta inflamatoria sistémica, se definieron conceptos esenciales para la comprensión de este síndrome. Se describieron de forma precisa y resumida, la fisiopatología actualizada que comprende el papel de los mediadores, la importancia del endotelio, los leucocitos y los radicales libres. Se expuso la hipótesis actual en la génesis del síndrome así como la vigilancia y el seguimiento de estos pacientes afectados


Subject(s)
Humans , Inflammation Mediators , Intensive Care Units , Systemic Inflammatory Response Syndrome/physiopathology , Systemic Inflammatory Response Syndrome/drug therapy , Systemic Inflammatory Response Syndrome/therapy , Follow-Up Studies
11.
Rev. chil. med. intensiv ; 19(2): 83-87, 2004. ilus, graf
Article in Spanish | LILACS | ID: lil-418302

ABSTRACT

Presentamos el caso de un paciente con pancreatitis aguda grave (PAG) que evolucionó rápidamente con un Síndrome de Respuesta Inflamatoria Sistémica (SIRS) severo manejado con Proteína C humana recombinante (PCHR). Entre 10 a 15 por ciento de las pancreatitis agudas desarrollarán un SIRS, que lleva a un curso fulminante con extensa necrosis y falla multiorgánica. En series internacionales esta condición se asocia a una mortalidad mayor al 25 por ciento, pero existen escasas publicaciones sobre el uso de PCHR en pacientes con PAG. Algunos estudios ya han descrito que en presencia de una respuesta inflamatoria severa documentada con score de APACHE mayor a 25 existe una recuperación sustancial con el uso del PCRH. Comunicamos su cuadro clínico, evolución y resultado.


Subject(s)
Humans , Male , Middle Aged , Pancreatitis/drug therapy , Protein C/therapeutic use , Recombinant Proteins/therapeutic use , Systemic Inflammatory Response Syndrome/drug therapy , Acute Disease , Anti-Inflammatory Agents/therapeutic use , Fibrinolytic Agents/therapeutic use , Protein C/pharmacology , Recombinant Proteins/pharmacology
12.
Rev. chil. med. intensiv ; 18(4): 225-229, 2003. tab
Article in Spanish | LILACS | ID: lil-398863

ABSTRACT

Introducción: El diagnóstico de Sepsis en pacientes críticos que cursan un SIRS, sigue siendo un desafío para el intensivista, puesto que entre otros tópicos implica iniciar una terapia antibiótica, la mayoría de las veces de amplio espectro y de alto costo. Existen pocos marcadores inflamatorios que logren evidenciar la presencia de infección en su SIRS. La Procalcitonina (PCT) ha mostrado ser un parámetro útil en este sentido. No se encuentran mayores estudios que demuestren el impacto económico, utilizando una muestra de un test semicuantitativo (PCT-Q), en la decisión de iniciar antibioticoterapia; situación ésta de alto interés en nuestro quehacer público. Metodología. Estudio observacional, prospectivo, no randomizado. Resultados. Se estudiaron 22 pacientes cursando un SIRS, con alta sospecha de Sepsis, planteándose la duda de iniciar terapia antibiótica, entre diciembre 2002 y agosto 2003, tomándose un total de 24 test de PCT-Q. Se tabuló temperatura, Proteína C Reactiva, leucocitos entre otros. En todos ellos se decidió terapia antibiótico. Se observó que hubo una alta correlación entre los pacientes en quienes no se demostró finalmente infección (14 pacientes 63 por ciento) y niveles normales de PCT-Q, pudiendo haberse evitado un gasto cercano de $ 2.220.000 (US$ 3.200). Conclusiones. Un test semicuantitativo de PCT-Q puede ser útil en decidir conducta antibiótica, evitando gastos elevados en pacientes críticos.


Subject(s)
Humans , C-Reactive Protein , Calcitonin , Health Care Costs , Protein Precursors , Systemic Inflammatory Response Syndrome/diagnosis , Systemic Inflammatory Response Syndrome/drug therapy , Diagnosis, Differential , Drug Costs , Biomarkers , Prospective Studies
13.
Gac. méd. Méx ; 137(2): 127-134, mar.-abr. 2001. ilus
Article in Spanish | LILACS | ID: lil-310684

ABSTRACT

El síndrome de respuesta inflamatoria sistémica es desencadenado por diferentes disparadores y tiene como finalidad el limitar y revertir la lesión.La intensidad y evolución de la respuesta inflamatoria es determinada por la magnitud de la lesión disparadora y por el balance existente entre la respuesta inflamatoria y la respuesta antiinflamatoria compensadora.La interacción de los diferentes mediadores solubles de la respuestas inflamatoria y antiinflamatoria determinan las siguientes fases evolutivas: a) respuesta inflamatoria local; b) respuesta inflamatoria sistémica; c) respuesta inflamatoria sistémica masiva; d) parálisis inmunológica; e) disonancia inmune. Las últimas tres de no controlarse, amplifican el daño celular, condicionan y perpetúan el proceso infeccioso y llevan al enfermo a disfunción orgánica múltiple.Se han estudiado, en protocolos clínicos y experi-mentales, el interferón gama y los esteroides como moduladores de la respuesta inflamatoria, sobre todo en sus fases de parálisis y disonancia inmune con resultados promisorios, pero se requieren estudios a gran escala para validar su utilidad.


Subject(s)
Interferon-gamma , Systemic Inflammatory Response Syndrome/etiology , Systemic Inflammatory Response Syndrome/mortality , Systemic Inflammatory Response Syndrome/drug therapy , Steroids , Multiple Organ Failure
15.
Temas enferm. actual ; 7(34): 17-22, oct. 1999. ilus
Article in Spanish | LILACS | ID: lil-248604

ABSTRACT

El presente artículo actualiza la clínica de la sepsis neonatal, incluyendo factores de riesgo, signos de alarma, complicaciones como el shock séptico y los correspondientes cuidados de enfermería neonatal


Subject(s)
Humans , Male , Female , Infant, Newborn , Neonatal Nursing/education , Sepsis/diagnosis , Shock, Septic/physiopathology , Systemic Inflammatory Response Syndrome/diagnosis , Neonatal Nursing/standards , Cross Infection/prevention & control , Risk Factors , Sepsis/nursing , Sepsis/prevention & control , Shock, Septic/prevention & control , Systemic Inflammatory Response Syndrome/prevention & control , Systemic Inflammatory Response Syndrome/drug therapy
16.
Bol. méd. Hosp. Infant. Méx ; 56(2): 109-20, feb. 1999. tab, ilus, graf
Article in Spanish | LILACS | ID: lil-266203

ABSTRACT

La sepsis neonatal es una infección sistémica en el primer mes de vida que, según su gravedad, presenta las 4 fases del síndrome de respuesta inflamatoria sistémica (SRIS) que caracteriza a esta enfermedad en los adultos. El uso de antibióticos sigue siendo el pilar en su tratamiento; sin embargo, la morbi-letalidad de la sepsis neonatal no ha disminuido significativamente y la aparición de cepas resistentes es alarmante, lo cual plantea la necesidad de alternativas terapéuticas. En esta búsqueda, se pretende regular la respuesta inflamatoria a la infección a través de 3 grandes grupos de citocinas: interleucinas, interferones y los factores de crecimiento, algunas de las cuales se comportan como pro-inflamatorias, y otras como anti-inflamatorias al neutralizar, bloquear o inhibir a las pro-inflamatorias. Hasta ahora, los 2 mayores avances en la terapia auxiliar de sepsis neonatales son la inmunoglobulina para uso intravenoso (IgIV), que tiene su principal indicación en los neonatos prematuros y de bajo peso, y los factores estimulantes de colonias de granulocitos y de macrófagos (G-CSF y GM-CSF), indicados en neonatos pretérmino o a término con neutropenia por sepsis. Una actitud de extrema reserva entre muchos médicos ha postergado de manera poco justificable su aplicación clínica. En fases preliminares de investigación se encuentran los antagonistas naturales de la endotoxina bacteriana, como la BPI, proteína producida por los granulocitos, y las inmunoadhesinas, moléculas híbridas de inmunoglubulina y un receptor específico que bloquean la unión de citocinas pro-inflamatorias con sus receptores celulares, modulando así la respuesta inflamatoria a la infección


Subject(s)
Humans , Infant, Newborn , Infant, Newborn, Diseases/immunology , Infant, Newborn, Diseases/microbiology , Gram-Negative Bacteria/pathogenicity , Immunotherapy/trends , Systemic Inflammatory Response Syndrome/physiopathology , Systemic Inflammatory Response Syndrome/immunology , Systemic Inflammatory Response Syndrome/drug therapy , Anti-Bacterial Agents/administration & dosage , Diagnosis-Related Groups
18.
Medicina (B.Aires) ; 58(4): 386-92, 1998. graf
Article in English | LILACS | ID: lil-217519

ABSTRACT

The inflammatory response syndrome in shock-like states might frequently be accompained by an oxidative cell/tissue demage in one or more organ-systems in the body. The inflammatory response related hyperactivation of neutrophils can contribute to oxidative cell/tissue damage. Studies discussed in this review examined the role of cell sgnaling pathways in the hyperactivation of neutrophils in an early stage of burn injury shock. The studies were carried out in peripheral blood neutrophils isolated from rats with a 25 per cent body surface area scald burn. Neutrophil cell signaling responses were evaluated by measuring cytosolic [Ca2+] and protein kinase C activity, and were correlated with neutrophil superoxide production. The cytosolic [Ca2+] and protein kinase C responses were highly upregulated along with enhanced superoxide production in the early phase of burn injury. The treatment of burn-injured rats with the calcium antagonist diltiazem abrogated enhanced Ca2+ and protein kinase C signaling and superoxide generation. The signaling upregulation in neutrophils could result from potentiation of actions of burn-injury induced chemotactic mediators on the leukocytes. The neutrophil signaling upregulation leading to increased superoxide generation could thus be responsible for the oxidative cell/tissue damage. The organ-system dysfunction/failure accompanying burn shock may be initiated with the oxidative cell/tissue damage.


Subject(s)
Animals , Humans , Burns/complications , Calcium Channel Blockers/therapeutic use , Diltiazem/therapeutic use , Neutrophils/metabolism , Systemic Inflammatory Response Syndrome/etiology , Shock/complications , Signal Transduction , Burns/blood , Calcium/metabolism , Oxidative Stress , Oxygen/metabolism , Protein Kinases/metabolism , Systemic Inflammatory Response Syndrome/blood , Systemic Inflammatory Response Syndrome/drug therapy , Shock/blood , Shock/etiology , Superoxides/metabolism
19.
Rev. méd. Chile ; 124(4): 442-7, abr. 1996. tab, graf
Article in Spanish | LILACS | ID: lil-173354

ABSTRACT

To assess the acute effects of methylene blue infusion, an inhibitor of nitric oxyde synthesis, on hemodynamic parameters in patients with refractory septic shock. Fourteen patients admitted to intensive care units with septic shock of diverse etiologies and unable to maintain median arterial pressures over 60 mm Hg with the use of at least 2 vasoactive drugs, were studied. All received a 1 mg/kg bolus of methylene blue. Hemodinamic parameters were measured before and 30, 60, 120 and 180 min after the bolus. Systolic and diastolic blood pressure and systemic vascular resistance increased in all patients. There were no significant changes in cardiac output, oxygen consumption or extraction. Methylene blue has an acute pressor effect in patients with septic shock


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Guanylate Cyclase/antagonists & inhibitors , Methylene Blue/pharmacology , Nitric Oxide/antagonists & inhibitors , Systemic Inflammatory Response Syndrome/drug therapy , Clinical Protocols , Hemodynamics , Blood Pressure , Central Venous Pressure , Vascular Resistance/drug effects , Vasoconstrictor Agents/pharmacology
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