Guideline Promotes Early, Aggressive Sepsis Treatment to Boost Survival

JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 03/2013; 309(10):969-970. DOI: 10.1001/jama.2013.1295
Source: PubMed
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    • "However, inflammatory indices are normal or slightly elevated, differentiating the two conditions. Faced with a clinical suspicion of a septic status, the emergency room physician will treat the child promptly and aggressively, as indicated in such cases [38]. The treatment will include antibiotics – even before test results confirm the etiologic diagnosis – intravenous fluids to sustain blood pressure, dopamine or epinephrine, oxygen, and sometimes plasma infusion. "
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    ABSTRACT: To assess all the possible differential diagnosis of food protein-induced enterocolitis syndrome (FPIES), both in acute and chronic presentation, reviewing the data reported in published studies. There is an increase of reported cases of FPIES in recent years. As the disease presents with nonspecific symptoms, it can be misunderstood in many ways. The differential diagnosis includes, in acute presentations, the following: sepsis, other infectious diseases, acute gastrointestinal episodes, surgical emergencies, food allergies. In its chronic forms, FPIES may mimic malabsorption syndromes, metabolic disorders, primary immunodeficiencies, neurological conditions, coagulation defects, and other types of non-IgE-mediated food allergy. A thorough clinical evaluation, including symptoms, signs, and laboratory findings, is necessary to lead the clinicians toward the diagnosis of FPIES. The major reason for delayed diagnosis appears to be the lack of knowledge of the disease.This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivitives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.
    Current Opinion in Allergy and Clinical Immunology 04/2014; 14(3). DOI:10.1097/ACI.0000000000000057 · 3.57 Impact Factor
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    ABSTRACT: Objective: To develop predictive models for early triage of burn patients based on hypersusceptibility to repeated infections. Background: Infection remains a major cause of mortality and morbidity after severe trauma, demanding new strategies to combat infections. Models for infection prediction are lacking. Methods: Secondary analysis of 459 burn patients (>=16 years old) with 20% or more total body surface area burns recruited from 6 US burn centers. We compared blood transcriptomes with a 180-hour cutoff on the injury-to-transcriptome interval of 47 patients (<=1 infection episode) to those of 66 hypersusceptible patients [multiple (>=2) infection episodes (MIE)]. We used LASSO regression to select biomarkers and multivariate logistic regression to built models, accuracy of which were assessed by area under receiver operating characteristic curve (AUROC) and cross-validation. Results: Three predictive models were developed using covariates of (1) clinical characteristics; (2) expression profiles of 14 genomic probes; (3) combining (1) and (2). The genomic and clinical models were highly predictive of MIE status [AUROCGenomic = 0.946 (95% CI: 0.906-0.986); AUROCClinical = 0.864 (CI: 0.794-0.933); AUROCGenomic/AUROCClinical P = 0.044]. Combined model has an increased AUROCCombined of 0.967 (CI: 0.940-0.993) compared with the individual models (AUROCCombined/AUROCClinical P = 0.0069). Hypersusceptible patients show early alterations in immune-related signaling pathways, epigenetic modulation, and chromatin remodeling. Conclusions: Early triage of burn patients more susceptible to infections can be made using clinical characteristics and/or genomic signatures. Genomic signature suggests new insights into the pathophysiology of hypersusceptibility to infection may lead to novel potential therapeutic or prophylactic targets.
    Annals of Surgery 06/2014; 261(4). DOI:10.1097/SLA.0000000000000759 · 8.33 Impact Factor