Introduction
In critically ill patients, the hypothalamic‐pituitary‐adrenal axis is activated, resulting in increased serum cortisol concentrations. However, in some patients, especially those with sepsis, cortisol levels are relatively low for the degree of illness severity. Therefore, in the present project, we aim to characterize the time course of glucocorticoid receptor (GCR) alpha and beta expression in peripheral polymorphonuclear cells of critically ill septic or nonseptic patients using real‐time PCR.
Design
A prospective observational study conducted on 32 critically ill adults not receiving steroids, in a university‐affiliated, multidisciplinary intensive care unit (ICU). Blood samples were collected for measurement of glucocorticoid receptor expression within 24‐48 hours of admission to the ICU and at days 4, 8 and 13 after admission, reflecting the acute and chronic phase of the illness.
Results
During ICU stay, patients expressed over time reduced levels of both GCR‐α and GCR‐β mRNA. More specifically, GCR‐α mRNA expression was decreased fourfold 4 days after admission (P < 0.0001) and remained low up to 2 weeks after admission (P < 0.001). On the other hand, GCR‐β mRNA levels remained stable shortly after admission, but approx. one week after admission, its levels decreased threefold (P < 0.01) and remained reduced up to 2 weeks after admission (P < 0.001).
Discussion
Our results suggest that critically ill patients have highly variable expression of alpha and beta GCR, and moreover, the levels of both receptors decrease during ICU stay. Taken together, these might explain the differential responsiveness of patients to exogenous steroid administration or to endogenous cortisol secretion.
Background: Acceptance of vaccination against pandemic 2009 H1N1 influenza virus has been poor in some countries, perhaps because of concerns about safety of the new vaccine. Subjects and methods: We prospectively examined vaccination compliance and reasons for nonvaccination in the dialysis patients and the staff of a single hemodialysis unit, after on-site vaccination with a monovalent inactivated adjuvanted H1N1 vaccine. Safety profile was evaluated and compared to that of a control group without chronic kidney disease (CKD). Results: Vaccination acceptance among dialysis patients in our unit was 68% (110/161). Dialysis patients vaccinated against H1N1 had significantly higher compliance with vaccination for seasonal influenza and pneumococcus than those unvaccinated. Three out of 34 (9%) of the unit's staff received the vaccine. Fear of side effects was the main reason for not vaccinating in both groups, while several participants did not consider pandemic influenza a serious disease. At least one adverse reaction was observed in 37/110 (33.6%) of the vaccinated dialysis patients and in 22/42 (52.4%) of the non-CKD control group, p = 0.034. Local mild pain at injection site was the most common side effect of vaccination in both groups. All side effects were of short duration and no serious adverse reactions related to the vaccine or reactions of special interest occurred during the follow-up period. Conclusions: Our findings indicate that immunization against H1N1 virus in dialysis patients is safe and do not support the concerns about safety of the vaccine that was the main reason for nonvaccination in our study.
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