Periodontal disease and detection of human herpesviruses in saliva and gingival crevicular fluid of chronic kidney disease patients.

BACKGROUND: Patients with chronic kidney disease (CKD) have inability to maintain the normal levels of protein metabolism products, blood pressure and hematocrit. Periodontal disease involves an inflammatory destructive process. Identification of opportunistic viruses is extremely important as they are associated with co-morbidities. The objective of this study was to analyse the presence of human herpesviruses in saliva and gingival crevicular fluid (GCF) from patients with CKD. METHODS: One hundred and thirty one individuals were divided depending on the stage of CKD: Group 1 (clearance of creatinine > 75 mL/min) patients with no renal disease (n = 24); Group 2 (clearance of creatinine of 11-75 mL/min) patients with renal disease (n = 67); Group 3 (clearance of creatinine < 10 mL/min) patients on hemodialysis (n = 40). The parameters of periodontal disease were evaluated. The viral detection was assessed by PCR. RESULTS: considering the three groups, the prevalence of herpes simplex virus 1 (HSV-1) were 9% in saliva and 5% in GCF; Epstein-Barr virus 36% in saliva and 39% in GCF; human cytomegalovirus (HCMV) 11% in GCF; varicella zoster virus 6% in saliva and 3% in GCF; of human herpesvirus-6 (HHV-6) 6% in saliva and 2% in GCF; and HHV-7 44% in saliva and 8% in GCF. Of these patients, 46.48% presented with severe periodontitis. A statistically significant association between HSV-1 and HCMV was found in hemodialysis patients and severe periodontitis was also more frequent among them. CONCLUSION: These findings show the importance of evaluating the periodontal disease and detecting herpesviruses in patients with CKD as the inflammatory process observed in these clinical conditions may worsen the course of both periodontal disease and CKD.

Curcumin prevents potassium dichromate (K2Cr2O7)-induced renal hypoxia.

Curcumin exhibits several therapeutic properties. Potassium dichromate (K2Cr2O7)-induced nephropathy is associated with oxidative stress. Reactive oxygen species production affects renal oxygenation that may participate in the progression of renal damage. The aim of the present work was to elucidate whether K2Cr2O7-induced nephropathy is associated to partial O2 pressure (pO2) impairment and if curcumin is able to prevent it. Four groups of rats were studied: control group; K2Cr2O7 group (12.5 mg/kg, s.c.); curcumin + K2Cr2O7 group, in which animals were treated with curcumin (400 mg/kg/day, p.o.) for 10 days before K2Cr2O7 injection; and curcumin group. All animals were sacrificed 48 h after the end of the treatments. K2Cr2O7 administration increased renal function markers and decreased glomerular filtration rate, pO2 and renal perfusion. Concerning hemodynamic parameters, K2Cr2O7 increased mean arterial pressure and renal vascular resistance and reduced renal blood flow. The hemodynamic changes were attributed to decreased availability of nitric oxide and increased 3-nitrotyrosine levels. Moreover, increased superoxide anion production and vascular endothelial growth factor levels were observed after K2Cr2O7 administration. Curcumin attenuated all the above-described alterations. Our results suggest that the protective effects of curcumin in K2Cr2O7-induced nephropathy are associated with its ability to prevent O2 supply reduction.

Is C-reactive protein a good prognostic marker in septic patients?

RATIONALE: Several studies have shown that C-reactive protein (CRP) is a marker of infection. The aim of this study was to evaluate CRP as marker of prognosis outcome in septic patients and to assess the correlation of CRP with severity of sepsis. METHODS: During a 14-month period, we prospectively included all patients with sepsis admitted to an intensive care unit (ICU). Patients were categorized into sepsis, severe sepsis and septic shock. Acute Physiology and Chronic Health Evaluation (APACHE) II score, Simplified Acute Physiology Score (SAPS) II, Sequential Organ Failure Assessment (SOFA) score, CRP, body temperature and white cell count (WCC) of the day of sepsis diagnosis were collected. RESULTS: One hundred and fifty-eight consecutive septic patients (mean age 59 years, 98 men, ICU mortality 34%) were studied. The area under the receiver operating characteristics curves of APACHE II, SAPS II, SOFA, CRP, body temperature and WCC as prognostic markers of sepsis were 0.75 [95% confidence interval (CI) 0.67-0.83], 0.82 (95% CI 0.75-0.89), 0.8 (95% CI 0.72-0.88), 0.55 (95% CI 0.45-0.65), 0.48 (95% CI 0.38-0.58) and 0.46 (95% CI 0.35-0.56), respectively. In the subgroup of patients with documented sepsis we obtained similar results. The ICU mortality rate of septic patients with CRP < 10, 10-20, 20-30, 30-40 and >40 mg/dL was 20, 34, 30.8, 42.3 and 39.1%, respectively (P = 0.7). No correlation was found between CRP concentrations and severity of sepsis. CONCLUSIONS: In septic patients, CRP of the day of sepsis diagnosis is not a good marker of prognosis.

C-reactive protein as a marker of ventilator-associated pneumonia resolution: a pilot study.

The aim of this study was to evaluate C-reactive protein (CRP) levels, body temperature and white cell count (WCC) after prescription of antibiotics in order to describe the clinical resolution of ventilator-associated pneumonia (VAP). A cohort of 47 VAP patients with microbiological confirmation of disease was assessed. CRP levels, body temperature and WCC were monitored daily. On day 4 of the antibiotic therapy, the CRP level of survivors was 0.62 times the initial value, whereas, in nonsurvivors, it was 0.98. Body temperature and WCC remained almost unchanged. By day 4, a CRP of >0.6 times the initial level was a marker of poor outcome (sensitivity 0.92; specificity 0.59). Patients were divided according to their CRP patterns of response to antibiotics: fast response, slow response, nonresponse, and biphasic response. All patients with fast and slow response patterns survived, whereas those showing nonresponse and a biphasic response pattern exhibited a mortality of 78 and 75%, respectively. The adequacy of the initial antibiotic therapy had a marked influence on the rate of CRP decrease, as well as on mortality. In conclusion, daily C-reactive protein measurements after antibiotic prescription were useful in the identification, as early as day 4, of ventilator-associated pneumonia patients with poor outcome. The identification of the pattern of C-reactive protein response to antibiotics was useful in the recognition of individual clinical course, improving or worsening, as well as of the rate of improvement.

C-reactive protein as a marker of infection in critically ill patients.

A prospective, observational study was conducted in a medico-surgical intensive care unit to assess the value of C-reactive protein (CRP), temperature and white cell count (WCC) measurements for the diagnosis of infection in critically ill patients. CRP, temperature and WCC were monitored daily in 76 infected and 36 non-infected patients. Multiple receiver-operating characteristics (ROC) curves were used to compare each parameter for infection diagnosis. The area under the curve (AUC) of CRP was significantly higher than that of temperature (0.93 and 0.75, respectively; p < 0.001). A CRP concentration of >8.7 mg/dL and a temperature of >38.2 degrees C were associated with infection, with a sensitivity of 93.4% and 54.8%, and a specificity of 86.1% and 88.9%, respectively. The ROC curve of WCC showed a poor diagnostic performance. The combination of CRP and temperature increased the specificity for infection diagnosis to 100%. In the subgroup of patients with ventilator-associated pneumonia (n = 48), CRP measurements were more reliable than temperature (AUC 0.92 and 0.78, respectively; p 0.006). The CRP levels in infected patients with sepsis, severe sepsis and septic shock were 15.2 +/- 8.2, 20.3 +/- 10.9 and 23.3 +/- 8.7 mg/dL, respectively (p 0.044). It was concluded that CRP was a better marker of infection than temperature. However, the combination of CRP and temperature measurements further increased the specificity for infection diagnosis, even in the subgroup of patients with VAP.

Evaluation of a recruitment maneuver with positive inspiratory pressure and high PEEP in patients with severe ARDS.

BACKGROUND: To evaluate the effect of a recruitment maneuver (RM) with constant positive inspiratory pressure and high positive end-expiratory pressure (PEEP) on oxygenation and static compliance (Cs) in patients with severe acute respiratory distress syndrome (ARDS). METHODS: Eight patients with ARDS ventilated with lung-protective strategy and an arterial partial pressure of oxygen to inspired oxygen fraction ratio (PaO2/FIO2) < or =100 mmHg regardless of PEEP were prospectively studied. The RM was performed in pressure-controlled ventilation at FIO2 of 1.0 until PaO2 reached 250 mmHg or a maximal plateau pressure/PEEP of 60/45 cmH2O was achieved. The RM was performed with stepwise increases of 5 cmH2O of PEEP every 2 min and thereafter with stepwise decreases of 2 cmH2O of PEEP every 2 min until a drop in PaO2 >10% below the recruitment PEEP level. Data was collected before (preRM), during and after 30 min (posRM). RESULTS: The PaO2/FIO2 increased from 83 +/- 22 mmHg preRM to 118 +/- 32 mmHg posRM (P = 0.001). The Cs increased from 28 +/- 10 ml cmH2O(-1) preRM to 35 +/- 12 ml cmH2O(-1) posRM (P = 0.025). The PEEP was 12 +/- 3 cmH2O preRM and was set at 15 +/- 4 cmH2O posRM (P = 0.025). The PEEP of recruitment was 36 +/- 9 cmH2O and the collapsing PEEP was 13 +/- 4 cmH2O. The PaO2 of recruitment was 225 +/- 105 mmHg, with five patients reaching a PaO2 > or = 250 mmHg. The FIO2 decreased from 0.76 +/- 0.16 preRM to 0.63 +/- 0.15 posRM (P = 0.001). No major complications were detected. CONCLUSION: Recruitment maneuver was safe and useful to improve oxygenation and Cs in patients with severe ARDS ventilated with lung-protective strategy.

C-reactive protein as an indicator of sepsis.

OBJECTIVE: To determine the use of plasma C-reactive protein (CRP) concentrations, body temperature (BT) and white blood cell count (WBC) in the detection of sepsis in critically ill patients. DESIGN: All patients admitted for more than 24 h in the intensive care unit (ICU) were prospectively included. Patients were followed up to ICU discharge and each patient-day was classified in one of four categories according to the infectious status: 1) Negative, patient-day without systemic inflammatory response syndrome (SIRS); 2) Definite, patient-day with SIRS and a positive culture; 3) SIRS, patient-day with SIRS and negative or no cultures. The last group was subdivided according to the following criteria: a) new, or persistence of, pulmonary infiltrates, b) the presence of pus in a place known to be sterile. Patient-days without these criteria were classified as SIRS with improbable sepsis (Unlikely), and with one criteria or more as SIRS with probable sepsis (Probable). SETTING: Medical/surgical intensive care unit. PATIENTS: Twenty-three patients were followed. MEASUREMENTS AND RESULTS: A total of 306 patient-days were analysed: 20 Negative, 15 Definite, 63 Unlikely and 208 Probable. The median (range) CRP values for Negative, Unlikely, Probable and Definite groups were as follows: 24.5 (7-86), 34 (5-107), 143 (39-544), and 148 (52-320) mg/l. The plasma CRP levels were significantly related to the infectious status (Negative, Unlikely, Probable or Definite) of the patient-day classification (p < 0.05). Concentrations of CRP in the Negative and Unlikely groups were significantly lower than in the Probable and Definite ones (p < 0.05). A plasma CRP of 50 mg/l or more was highly suggestive of sepsis (sensitivity 98.5%, specificity 75%). CONCLUSIONS: Daily measurement of CRP is useful in the detection of sepsis and it is more sensitive than the currently used markers, such as BT and WBC.

[Ogilvie's syndrome. Therapeutic efficacy of cecostomy]. / Síndrome de Ogilvie. Eficácia terapêutica de cecostomia.

Ogilvie's syndrome is an uncommon clinical situation, which was first described in 1948. It is characterized by an acute colonic massive dilatation without evidence of organic obstruction. Association with extracolonic disease is a nearly constant feature. Clinically, the syndrome manifests itself as an acute abdominal distention the cecum being the site of greatest dilatation. This situation is rapidly progressive and, if untreated, may cause cecal necrosis and perforation. Treatment should be instituted early, beginning with medical measures, followed by surgery if no improvement is seen. We report a case of Ogilvie's syndrome, and discuss the treatment procedures.

Childhood vitamin A status and the risk of otitis media.

BACKGROUND: It has been suggested that vitamin A deficiency may predispose to otitis media. METHODS: We conducted a prospective, observational study of 200 children, ages 3 to 5 years, on the island of Saipan in the Commonwealth of the Northern Mariana Islands. Baseline measurements of serum retinol concentrations were obtained from the children, and incidence of otitis media was determined during the following year by review of medical records. The sera were also tested for concentration of other carotenoids (beta-carotene, alpha-carotene, lutein and zeaxanthin, beta-cryptoxanthin, lycopene), and alpha-tocopherol and baseline concentrations of these compounds were also examined for relationship to incidence of otitis media. RESULTS: Serum retinol concentrations of the children ranged from 13 to 58 microg/dl. Episodes of otitis media occurred in 22% of children during the follow-up period. Children with low serum retinol concentrations did not have an excess of episodes of otitis media (chi square for trend, 0.438; P = 0.508 for children grouped by serum retinol concentration; mean serum retinol concentrations were 29.1 and 28.6 microg/dl, respectively, for children who had and did not have a subsequent episode of otitis media). Controlling for potential confounding variables (duration of breast feeding, smoking in the household, illness or live virus vaccination in the 2 weeks before serum collection, day-care attendance) did not substantially alter this finding. Baseline serum concentrations of the other carotenoids and alpha-tocopherol also demonstrated no relation to incidence of otitis media. CONCLUSION: In the range of serum vitamin concentrations found in this population, the status of vitamin A and related compounds in children appeared to have no effect on the incidence of otitis media.

[Chronic hemodialysis: risk factors for intra-dialytic hypotension (IDH)]. / Hemodiálise crónica: factores de risco de hipotensão intradialítica (HID).

Haemodialysis is the most used among the different renal function replacement methods. Although the survival is acceptable the mobility is important; intradialytic hypotension is a main cause of such mobility. In this study which included stable chronic haemodialysis patients, the authors evaluate risk factors for IDH. Advanced age, female sex and autonomic insufficiency are risk factors for IDH. Patients with IDH had more serious ventricular arrhythmias, but a cause-effect relationship was not demonstrated.