Sepsis in children is typically presumed to be bacterial in origin until proven otherwise, but frequently bacterial cultures ultimately return negative. Although viruses may be important causative agents of culture-negative sepsis worldwide, the incidence, disease burden and mortality of viral-induced sepsis is poorly elucidated. Consideration of viral sepsis is critical as its recognition carries implications on appropriate use of antibacterial agents, infection control measures, and, in some cases, specific, time-sensitive antiviral therapies. This review outlines our current understanding of viral sepsis in children and addresses its epidemiology and pathophysiology, including pathogen-host interaction during active infection. Clinical manifestation, diagnostic testing, and management options unique to viral infections will be outlined.
Background: Pandemics create challenges for medical centers, which call for innovative adaptations to care for patients during the unusually high census, to distribute stress and work hours among providers, to reduce the likelihood of transmission to health care workers, and to maximize resource utilization. Methods: We describe a multidisciplinary vascular access team’s development to improve frontline providers’ workflow by placing central venous and arterial catheters. Herein we describe the development, organization, and processes resulting in the rapid formation and deployment of this team, reporting on notable clinical issues encountered, which might serve as a basis for future quality improvement and investigation. We describe a retrospective, single-center descriptive study in a large, quaternary academic medical center in a major city. The COVID-19 vascular access team included physicians with specialized experience in placing invasive catheters and whose usual clinical schedule had been lessened through deferment of elective cases. The target population included patients with confirmed or suspected COVID-19 in the medical ICU (MICU) needing invasive catheter placement. The line team placed all invasive catheters on patients in the MICU with suspected or confirmed COVID-19. Results and conclusions: Primary data collected were the number and type of catheters placed, time of team member exposure to potentially infected patients, and any complications over the first three weeks. Secondary outcomes pertained to workflow enhancement and quality improvement. 145 invasive catheters were placed on 67 patients. Of these 67 patients, 90% received arterial catheters, 64% central venous catheters, and 25% hemodialysis catheters. None of the central venous catheterizations or hemodialysis catheters were associated with early complications. Arterial line malfunction due to thrombosis was the most frequent complication. Division of labor through specialized expert procedural teams is feasible during a pandemic and offloads frontline providers while potentially conferring safety benefits.
<p>Niclosamide (NCL) is an effective anthelmintic agent
that has been shown to possess broad-spectrum antiviral activity, including
against<b> </b>SARS-CoV-2. Due to its poor solubility in aqueous medium,
however, the commercially available NCL formulations can act only locally in
gastrointestinal worms and are not suitable to achieve plasmatic levels to
treat systemic diseases. Consequently, the repurposing of this drug represents
a challenge for formulation development with serious risks to the biological
availability and can compromise preclinical and clinical outcomes. Herein, we
report possible formulation, through the research and development, of stable
amorphous solid dispersions to improve its solubility. The results of exploratory
screening of NCL-polymer dispersions (performed through X-ray powder
diffraction and kinetic solubility studies) indicate that soluplus-niclosamide dispersions
can increase its aqueous solubility and, consequently, have the potential to
enhance NCL bioavailability. <a>This outcome can be used
for the development of oral dosage forms for clinical trials in SARS-CoV-2 and
other viruses. </a></p>
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