BackgroundSeptic shock is the first cause of death in Intensive Care Units. Despite experimental data showing increased inflammatory response of aged animals following infection, the current accepted hypothesis claims that aged patients are immunocompromised, when compared to young individuals.ResultsHere, we describe a prospective cohort study designed to analyze the immune profile of this population.ConclusionOlder people are as immunocompetent as the young individual, regarding the cytokines, chemokines and growth factors response to devastating infection.
IntroductIon.Effective strategies for prophylaxis of venous thromboembolism (VTE) are widely available, but remain underused, especially in Brazil. objectIve. The objective of this study was to assess the effect of implementing a guideline for VTE prophylaxis for surgical patients on the behavior of the health care staff regarding prophylaxis for patients submitted to orthopedic or abdominal surgery. Methods. This was a retrospective pre-intervention/post-intervention study. The charts of 150 patients before (BGI) and 150 ones after guideline implementation (AGI) were selected at random from all patients over the age of 40 admitted for major abdominal or orthopedic surgery. Data registered: demographic data, reference to VTE risk factors in chart, VTE prophylaxis prescription, VTE diagnosis during hospitalization. results. There was no difference between BGI and AGI in terms of demographic data and duration of prophylaxis (5.6 x 6.6 days). Frequency of BGI versus AGI prophylaxis before surgery was: pharmacological prophylaxis (PP), 6% versus 9%; graduated compression stockings (GCS), 4% versus 3%; intermittent pneumatic compression (IPC), 2% versus 3%. After surgery: PP, 53% versus 53%; GCS, 23% versus 40% (p < 0.05); IPC, 26% versus 32%. Including all patients, prophylaxis was prescribed for 60.5% of patients BGI and 66.5% AGI, but it was considered adequate for 34% of patients BGI and 32% AGI. conclusIon. Adoption of the guideline, despite the greater concern with prophylaxis, as expressed by higher rates of prescription of GCS, provided only minimal quality improvements, indicating that other active and continuous interventions are needed to increase compliance.
ObjectiveThe HLA haplotype has been associated with many autoimmune diseases, but no
associations have been described in sepsis. This study aims to investigate the HLA
system as a possible marker of genetic sepsis susceptibility.MethodsThis is a prospective cohort study including patients admitted to an intensive
care unit and healthy controls from a list of renal transplant donors. Patients
with less 18 years of age; pregnant or HIV positive patients; those with
metastatic malignancies or receiving chemotherapy; or with advanced liver disease;
or with end-of-life conditions were excluded. The DNA was extracted from the whole
blood and HLA haplotypes determined using MiliPlex®
technology.ResultsFrom October 2010 to October 2012, 1,121 patients were included (1,078 kidney
donors, 20 patients admitted with severe sepsis and 23 with septic shock).
HLA-A*31 positive subjects had increased risk of developing sepsis (OR 2.36, 95%CI
1.26-5.35). Considering a p value <0.01, no other significant association was
identified.ConclusionHLA-A*31 expression is associated to risk of developing sepsis.
The systemic inflammatory response syndrome probably leads to inappropriately high Parathyroid hormone levels during septic shock. In the recovery phase, Parathyroid hormone levels decrease, but calcium levels remain low, displaying evidence that the parathyroid is not responding as expected. Since Parathyroid hormone receptors and calcium-sensing receptors have been described in immune cells and other cell types, we propose that these effects may have a plethora of other deleterious effects, with important implications to the pathogenesis of septic shock.
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