Sepsis – thoughtful management for the non-expert

Tidswell, Robert; Singer, Mervyn

doi:10.7861/clinmedicine.18-1-62

Cited by 11 publications

(14 citation statements)

References 23 publications

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“…Uncontrolled inflammatory immune response triggers upregulation or down-regulation of protein expression in multiple pathways, involving cardiovascular, endocrine, neurological, metabolic, coagulation, energy metabolism, etc., which leads to tissue hypoxia, mitochondrial dysfunction, and cell death and subsequently leads to impaired organ function (Tidswell and Singer, 2018). The treatment of sepsis needs to inhibit the development of inflammation.…”

Section: Discussionmentioning

confidence: 99%

Toddalolactone Protects Lipopolysaccharide-Induced Sepsis and Attenuates Lipopolysaccharide-Induced Inflammatory Response by Modulating HMGB1-NF-κB Translocation

Zhao

et al. 2020

Front. Pharmacol.

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Toddalolactone (TA-8) is a main compound isolated from Toddalia asiatica (L.) Lam., and its anti-inflammatory activity and anti-inflammatory mechanism are less studied. In the present study, we investigated the anti-inflammatory effects of TA-8. Our experimental results showed that TA-8 inhibited the production of pro-inflammatory cytokines by both lipopolysaccharide (LPS)-activated RAW 264.7 cells and septic mice. Moreover, TA-8 suppressed the NF-kB transcriptional activity, reduced the nuclear translocation and phosphorylation of NF-kB, blocked the translocation of HMGB1 from the nucleus to cytosol, and decreased LPS-induced up-regulation of TLR4 and IKBKB expression, and decreased IkBa phosphorylation. In addition, the administration of TA-8 decreased LPSinduced liver damage markers (AST and ALT), attenuated infiltration of inflammatory cells and tissue damage of lung, liver, and kidney, and improved survival in septic mice. Taken together, these results suggested that toddalolactone protects LPS-induced sepsis and attenuates LPS-induced inflammatory response by modulating HMGB1-NF-kB translocation. TA-8 could potentially be a novel anti-inflammatory and immunosuppressive drug candidate in the treatment of sepsis and septic shock.

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Section: Discussionmentioning

confidence: 99%

Toddalolactone Protects Lipopolysaccharide-Induced Sepsis and Attenuates Lipopolysaccharide-Induced Inflammatory Response by Modulating HMGB1-NF-κB Translocation

Zhao

et al. 2020

Front. Pharmacol.

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“…In particular, an unremitting, persistent fever warrants further assessment in regard to COVID-19 30 but also in relation to sepsis. 29 …”

Section: Methodsmentioning

confidence: 99%

“…Shortness of breath had its own severity scale and was crucial for staging level of complicated COVID-19, severity of pneumonia and sepsis. 29 30 Mild shortness of breath was defined as shortness of breath during activities that did not stop one completing the activity. Moderate shortness of breath was defined differently depending on age.…”

Section: Methodsmentioning

confidence: 99%

“…Even though it may only be present in less than half of COVID-19 cases at presentation, 28 the presence of fever permits greater focus on infective causes in relation to shortness of breath and cough. Fever also presents commonly in sepsis and pneumonia, 29 which are two of the key diagnoses that triage systems need to detect to prevent excess mortality. Open access Fever has also been shown to relate to disease severity and mortality outcomes in COVID-19.…”

Section: Case Scenariosmentioning

confidence: 99%

“…In particular, an unremitting, persistent fever warrants further assessment in regard to COVID-19 30 but also in relation to sepsis. 29 'Age' is a well-defined risk factor for severe complications of COVID-19. 9 10 As such, it was deemed useful to include age as a variable in the case simulations to test whether the symptom checker accounted for age when determining risk.…”

Section: Case Scenariosmentioning

confidence: 99%

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Performance of national COVID-19 ‘symptom checkers’: a comparative case simulation study

Mansab

Bhatti

Goyal

2021

BMJ Health Care Inform

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ObjectivesIdentifying those individuals requiring medical care is a basic tenet of the pandemic response. Here, we examine the COVID-19 community triage pathways employed by four nations, specifically comparing the safety and efficacy of national online ‘symptom checkers’ used within the triage pathway.MethodsA simulation study was conducted on current, nationwide, patient-led symptom checkers from four countries (Singapore, Japan, USA and UK). 52 cases were simulated to approximate typical COVID-19 presentations (mild, moderate, severe and critical) and COVID-19 mimickers (eg, sepsis and bacterial pneumonia). The same simulations were applied to each of the four country’s symptom checkers, and the recommendations to refer on for medical care or to stay home were recorded and compared.ResultsThe symptom checkers from Singapore and Japan advised onward healthcare contact for the majority of simulations (88% and 77%, respectively). The USA and UK symptom checkers triaged 38% and 44% of cases to healthcare contact, respectively. Both the US and UK symptom checkers consistently failed to identify severe COVID-19, bacterial pneumonia and sepsis, triaging such cases to stay home.ConclusionOur results suggest that whilst ‘symptom checkers’ may be of use to the healthcare COVID-19 response, there is the potential for such patient-led assessment tools to worsen outcomes by delaying appropriate clinical assessment. The key features of the well-performing symptom checkers are discussed.

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Effect of procalcitonin on the severity and prognostic value of elderly patients with a severe infection of oral and maxillofacial space

Lin

Lian

2022

Medicine

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This study aimed to investigate the effect on the severity and prognostic value of serum procalcitonin for elderly patients with oral and maxillofacial infections. We divided 163 elderly patients with severe oral and maxillofacial infection into survival and death groups according to the prognosis between June 2015 and May 2021, measured serum procalcitonin by enzyme-linked immunosorbent assay on the 1st, 2nd, 3rd, 5th, and 7th day after admission for the dynamic changes of serum procalcitonin level, collected the general physiological and biochemical indexes for the scores of acute physiology and general chronic condition, compared the correlation between serum procalcitonin, mean platelet count and APACHE score, analyzed the prognostic value of serum procalcitonin levels at different time after admission by ROC curve. The serum procalcitonin level increased significantly in both groups after admission, sharply increased at first and then rapidly decreased in the survival group, and continued to rise or declined slowly with fluctuation of high level in the death group. There was a negative correlation between serum procalcitonin level and mean platelet count (r = −0.698, P < .05) and a positive correlation between serum procalcitonin and APACHE II (R = 0.803, P < .05). The ROC curve showed that the serum procalcitonin level had little value on the first day and great value on the third day in predicting the prognosis of elderly patients with severe oral and maxillofacial infection (PCT1d = 0.539, PCT3d = 0.875, P < .05). The serum procalcitonin level is correlated with the severity of the disease in elderly patients with severe oral and maxillofacial space infection. Dynamic observation of it is helpful for the prognosis judgment of patients. After admission, serum procalcitonin level on the third day has a great value for the prognosis judgment of elderly patients with severe oral and maxillofacial space infection.

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Sepsis – thoughtful management for the non-expert

Cited by 11 publications

References 23 publications

Toddalolactone Protects Lipopolysaccharide-Induced Sepsis and Attenuates Lipopolysaccharide-Induced Inflammatory Response by Modulating HMGB1-NF-κB Translocation

Toddalolactone Protects Lipopolysaccharide-Induced Sepsis and Attenuates Lipopolysaccharide-Induced Inflammatory Response by Modulating HMGB1-NF-κB Translocation

Performance of national COVID-19 ‘symptom checkers’: a comparative case simulation study

Effect of procalcitonin on the severity and prognostic value of elderly patients with a severe infection of oral and maxillofacial space

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