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1.
J Hosp Infect ; 125: 44-47, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1773503

ABSTRACT

Transrectal ultrasound-guided (TRUS) biopsy of the prostate is associated with increased risk of post-procedural sepsis with associated morbidity, mortality, re-admission to hospital, and increased healthcare costs. In the study institution, active surveillance of post-procedural infection complications is performed by clinical nurse specialists for prostate cancer under the guidance of the infection prevention and control team. To protect hospital services for acute medical admissions related to the coronavirus disease 2019 (COVID-19) pandemic, TRUS biopsy services were reduced nationally, with exceptions only for those patients at high risk of prostate cancer. In the study institution, this change prompted a complete move to transperineal (TP) prostate biopsy performed in outpatients under local anaesthetic. TP biopsies eliminated the risk of post-procedural sepsis and, consequently, sepsis-related admission while maintaining a service for prostate cancer diagnosis during the COVID-19 pandemic.


Subject(s)
COVID-19 , Prostatic Neoplasms , Sepsis , Anesthetics, Local , Biopsy/adverse effects , Humans , Male , Pandemics/prevention & control , Prostate/diagnostic imaging , Prostate/pathology , Prostatic Neoplasms/complications , Prostatic Neoplasms/diagnosis , Sepsis/diagnosis , Sepsis/epidemiology , Sepsis/prevention & control , Ultrasonography, Interventional/adverse effects
2.
Lancet Child Adolesc Health ; 6(2): 129-136, 2022 02.
Article in English | MEDLINE | ID: covidwho-1677246

ABSTRACT

Sepsis is a worldwide public health problem due to its high incidence and accompanying mortality, morbidity, and financial burden. It is a major cause of admission to paediatric intensive care units; despite advances in the diagnosis and treatment, both incidence and mortality are high in low-income and middle-income countries. There are several barriers in addressing the enormous burden of paediatric sepsis in these countries, which include: lack of data of incidence and mortality; unfamiliarity of sepsis by the lay public, leading to failure to seek care early, and by health professionals, leading to failure to treat emergently; and insufficient government funding for sepsis care programmes leading to inadequate staffing, material, and financial resources, and therefore, poor health systems. Socioeconomic inequalities, such as inequity and marked variation in income and education, high rates of malnutrition, high percentage of young population, and health systems that do not meet the population's demands also represent barriers in the care of children with sepsis in Latin America. In this Viewpoint, we draw attention to the problem of paediatric sepsis in Latin America and call for action to reduce the disease burden by proposing some solutions.


Subject(s)
Cost of Illness , Health Priorities , Sepsis/epidemiology , Sepsis/prevention & control , Adolescent , Child , Child, Preschool , Delivery of Health Care/standards , Humans , Intensive Care Units, Pediatric/standards , Latin America/epidemiology , Social Class
5.
Exp Mol Med ; 53(7): 1116-1123, 2021 07.
Article in English | MEDLINE | ID: covidwho-1307318

ABSTRACT

Interleukin-6 (IL-6) plays a crucial role in host defense against infection and tissue injuries and is a bioindicator of multiple distinct types of cytokine storms. In this review, we present the current understanding of the diverse roles of IL-6, its receptors, and its signaling during acute severe systemic inflammation. IL-6 directly affects vascular endothelial cells, which produce several types of cytokines and chemokines and activate the coagulation cascade. Endothelial cell dysregulation, characterized by abnormal coagulation and vascular leakage, is a common complication in cytokine storms. Emerging evidence indicates that a humanized anti-IL-6 receptor antibody, tocilizumab, can effectively block IL-6 signaling and has beneficial effects in rheumatoid arthritis, juvenile systemic idiopathic arthritis, and Castleman's disease. Recent work has also demonstrated the beneficial effect of tocilizumab in chimeric antigen receptor T-cell therapy-induced cytokine storms as well as coronavirus disease 2019 (COVID-19). Here, we highlight the distinct contributions of IL-6 signaling to the pathogenesis of several types of cytokine storms and discuss potential therapeutic strategies for the management of cytokine storms, including those associated with sepsis and COVID-19.


Subject(s)
Antibodies, Monoclonal, Humanized/therapeutic use , COVID-19/prevention & control , Interleukin-6/genetics , Receptors, Interleukin-6/genetics , Antibodies, Monoclonal, Humanized/immunology , COVID-19/genetics , COVID-19/immunology , COVID-19/pathology , Cytokine Release Syndrome/genetics , Cytokine Release Syndrome/immunology , Cytokines/genetics , Cytokines/metabolism , Endothelium, Vascular/immunology , Humans , Interleukin-6/antagonists & inhibitors , Interleukin-6/immunology , Receptors, Interleukin-6/antagonists & inhibitors , Receptors, Interleukin-6/immunology , SARS-CoV-2/immunology , SARS-CoV-2/pathogenicity , Sepsis/genetics , Sepsis/immunology , Sepsis/pathology , Sepsis/prevention & control
6.
Intensive Care Med ; 47(7): 733-736, 2021 07.
Article in English | MEDLINE | ID: covidwho-1270502
8.
Int J Mol Sci ; 21(13)2020 Jun 30.
Article in English | MEDLINE | ID: covidwho-635461

ABSTRACT

By attaching to the angiotensin converting enzyme 2 (ACE2) protein on lung and intestinal cells, Sudden Acute Respiratory Syndrome (SARS-CoV-2) can cause respiratory and homeostatic difficulties leading to sepsis. The progression from acute respiratory failure to sepsis has been correlated with the release of high-mobility group box 1 protein (HMGB1). Lack of effective conventional treatment of this septic state has spiked an interest in alternative medicine. This review of herbal extracts has identified multiple candidates which can target the release of HMGB1 and potentially reduce mortality by preventing progression from respiratory distress to sepsis. Some of the identified mixtures have also been shown to interfere with viral attachment. Due to the wide variability in chemical superstructure of the components of assorted herbal extracts, common motifs have been identified. Looking at the most active compounds in each extract it becomes evident that as a group, phenolic compounds have a broad enzyme inhibiting function. They have been shown to act against the priming of SARS-CoV-2 attachment proteins by host and viral enzymes, and the release of HMGB1 by host immune cells. An argument for the value in a nonspecific inhibitory action has been drawn. Hopefully these findings can drive future drug development and clinical procedures.


Subject(s)
Betacoronavirus/physiology , HMGB1 Protein/metabolism , Respiratory Insufficiency/pathology , Sepsis/pathology , Angiotensin-Converting Enzyme 2 , HMGB1 Protein/antagonists & inhibitors , Humans , Macrophages/cytology , Macrophages/metabolism , Macrophages/virology , Peptidyl-Dipeptidase A/chemistry , Peptidyl-Dipeptidase A/metabolism , Plant Exudates/chemistry , Plant Exudates/pharmacology , Plants, Medicinal/chemistry , Plants, Medicinal/metabolism , Respiratory Insufficiency/metabolism , Respiratory Insufficiency/prevention & control , SARS-CoV-2 , Sepsis/metabolism , Sepsis/prevention & control , Virus Internalization/drug effects
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