Necrosis Syndrome Research Articles

Acute Retinal Necrosis: Virological Features Using Quantitative Polymerase Chain Reaction, Therapeutic Management, and Clinical Outcomes

To evaluate outcomes of patients treated with intensive intravitreal therapy and to describe the evolution of quantitative real-time polymerase chain reaction (qPCR) in patients treated for acute retinal necrosis (ARN) syndrome. Retrospective observational case series. This study included 25 eyes of 24 patients with ARN who were treated and followed up in 2 departments of ophthalmology in Lyon, France. Assessed outcomes included qPCR viral load profile during treatment, number of antiviral intravitreal injections (IVT), retinal detachment rate, and best-corrected visual acuity. Final visual acuity was 20/200 or less in 20% of cases; the rate of retinal detachment was 16%. Viral load kinetics changed in 3 phases: a first plateau period that was not consistent, a logarithmic decrease phase, and a negativation phase. Mean decay of the logarithm of the viral load was estimated at 0.076 per day; mean time of negativation was 56.1days. Median IVT number was 9 (range, 0-28). Ten patients were treated with injections until the viral load was undetectable. Resistance to acyclovir was observed in a patient with a prolonged initial plateau of the viral load. Numerous and prolonged IVTs, used as adjunctive therapy, could improve the prognosis of treated patients by decreasing the risk of retinal detachment and improving visual acuity. QPCR enables monitoring of the response to treatment and can provide evidence for resistance to antiviral treatment by enabling the detection of cases with a prolonged initial plateau of viral load.

SERUM CYSTATIN C AS A BIOMARKER OF KIDNEY DYSFUNCTION IN PATIENTS WITH ADVANCED CIRRHOSIS

Background: Liver cirrhosis (LC) is associated with considerably high morbidity and mortality rates. Disturbed renal function is among the main complications of liver cirrhosis, frequently accompanying its later stages. It is related to poorer prognosis, especially if it has resulted from acute complications (sepsis) or has followed liver transplantation. Acuterenal failure (ARF) is relatively common – it occurs in approximately 20% of hospitalized patients with liver cirrhosis and includes prerenal azotemia, acute tubular necrosis and hepatorenal syndrome (HRS). With the progression of liver cirrhosis and portal hypertension, the renal dysfunction usually evolves to HRS, which is associated with highmortality rate, especially type I HRS. Aim of the Work: Assessment of the role of Cystatin C as a biomarker in renal dysfunction in patients with end stage liver disease. Patients and Methods: This study was conducted in TropicalMedicine Department, Ain-Shams University and ain shams center for organ transplantation (ASCOT). This study included 60 patients with End Stage Liver Disease (ESLD) and 30 healthy subjects as control group. Patients groups: Group I: 30 patients ESLD, with renal impairment. Group II: 30 patients ESLD, without renal impairment. All patients were subjected to: complete blood count, liver function tests, kidney function tests, 24 hours urinary proteins, bleeding profile.Results: The current study was conducted in Tropical Medicine Department at Ain Shams University, and Ain Shams Center for Organ Transplantation (ASCOT). Our study included 90 candidates, 60 patients with End Stage Liver Disease (ESLD), whom were further divided into group I of 30 patients ESLD, with renal impairment and group II of 30 patients ESLD, without renal impairment, and a third group of 30 healthy persons. Cystatin C level was measured in all candidates in the three groups to assess its role as a biomarker in renal dysfunction in patients with end stage liver disease on thewaiting list for liver transplantation. Conclusion: Creatinine clearance was found to be significantly lower in ESLD patients with and without renal impairment in comparison to control group. It was also significantly lower in ESLD patients with renal impairment in comparison to ESLD patients without renal impairment. Cystatin C level was found to be significantly lower in ESLD patients with and without renal impairment in comparison to control group. It was also significantlylower in ESLD patients with renal impairment in comparison to ESLD patients without renal impairment.

Correlation of Serum and Ascitic Fluid Soluble Form Urokinase Plasminogen Activator Receptor Levels With Patient Complications, Disease Severity, Inflammatory Markers, and Prognosis in Patients With Severe Acute Pancreatitis.

Objectives The aim of the study was to investigate the correlation of serum and ascitic fluid soluble form urokinase plasminogen activator receptor (suPAR) levels with patients' complications, disease severity, inflammatory markers, and prognosis in patients with severe acute pancreatitis (SAP). Methods Fifty patients with SAP, 47 patients with mild acute pancreatitis, and 50 healthy controls were enrolled. Serum samples were obtained from all participants after enrollment; meanwhile, ascitic fluid samples were collected from 20 patients with SAP who developed ascites. Serum and ascitic fluid suPAR levels were determined by enzyme-linked immunosorbent assay. Results Serum suPAR level was greatly elevated in patients with SAP than patients with mild acute pancreatitis and healthy controls. Receiver operating characteristic curve showed that serum suPAR presented with good value in predicting risk of pancreatic necrosis, pancreatic infection, and multiple organ dysfunction syndrome, whereas serum suPAR did not predict mortality. Serum suPAR level was also positively correlated with Acute Physiology and Chronic Health Evaluation II score, Balthazar index, and Sequential Organ Failure Assessment score. As to ascitic fluid suPAR, it was positively correlated with serum suPAR level, Acute Physiology and Chronic Health Evaluation II score, Sequential Organ Failure Assessment score, risk of pancreatic infection, and multiple organ dysfunction syndrome. Conclusions Serum and ascetic fluid suPAR levels could be served as markers for disease severity and risk of severe complications in patients with SAP.

Inflammation and necrosis syndrome (SINS) in swine.

Abstract Minimizing pain, suffering and damage are essential factors in animal welfare. However, swine inflammation and necrosis syndrome (SINS) leads to significant clinical findings of inflammation and necrosis at the extremities in pigs. Tail, ears, coronary bands, soles, heels, claw walls, navel and face are frequently included. Early symptoms include loss of bristles, redness and swelling and can develop into exudative inflammation and necrosis. A high proportion of pigs seem to be affected, and suckling piglets have been born with SINS. Significant differences in the expression of genes involved in metabolic pathways of the liver underline the importance of metabolism in the development and expression of SINS. The aim of the current review is to compile the most important factors of SINS and identify the most probable causes. Given the significant impairment of animal welfare caused by the lesions, there is an urgent need to raise awareness among pig farmers and to understand and counteract the multifactorial causality, including genetics, involved in SINS in swine.

Prevalence of an inflammation and necrosis syndrome in suckling piglets

The current study describes the results obtained from clinical examination of over 4700 suckling piglets from 19 individual herds in Germany. In this cohort the prevalence of inflammation and necrosis in the tails, ears, claw coronary bands, heels and teats was determined using a pre-defined scoring system. Results show that already in the 1st days of life, piglets were affected by inflammation and necrosis of the heels (80%), claw coronary bands (50%) and tail base (20%). The praevalences of these alterations in piglets were influenced by genetics (P <0.001) and age, decreasing gradually in the 2nd week of life (P <0.001). Moreover, a correlation between tail length after tail docking and the prevalence of tail necrosis (P⩽0.04) was found. Tail and ear biting as a behavioural trait was not detected during this study. The early onset, appearance and multiple locations of clinical signs of inflammation and the positive correlation with the genetic background of the piglets may suggest an impairment of the innate immune system by infectious and non-infectious agents. This is in contrast to previously described behavioural abnormalities seen in fattening pigs. Considering the obvious reduction of animal welfare due to the described lesions, there is a need to create awareness among pig farmers and to understand the multifactorial causality involved in this inflammation and necrosis syndrome in piglets.

Respiratory mechanics and gas exchange during respiratory support in patients with necrotizing pancreatitis depending on the outcome

Objective. To compare the dynamics of ventilation parameters, mechanical properties of the lungs and gas exchange in the process of respiratory support in patients with a favorable and unfavorable outcome of intensive treatment of necrotic pancreatitis. Methods. The work is based on the results of a single-center observational study. The results of treatment of 94 patients aged from 25 to 65 years with necrotic pancreatitis complicated by acute respiratory distress syndrome and sepsis are analyzed. All patients were divided into two groups: group 1 (68 patients with severe sepsis), group 2 (26 patients with severe sepsis complicated by septic shock). Within each group, patients were divided into two subgroups: the group of sepsis — patients with a favorable outcome (28 patients) and unfavorable outcome (40 patients), in the group of septic shock — patients with a favorable outcome (5 patients) and unfavorable outcome (21 patients). All patients were treated with complex therapy according to international and Russian guidelines for the treatment of pancreatic necrosis, sepsis, and acute respiratory distress syndrome. The evaluation of the mechanical properties of the lungs was performed in patients based on the parameters recorded in the IVL card: F, Vt, MV, PIP, PEEP, CPAP, Clt, Flow. Dynamic assessment of gas exchange was carried out by continuous monitoring of SpO2, PetCO2, plethysmography and according to gas analysis. The data were recorded in the mechanical ventilation map with the subsequent calculation of some indicators: FiO2, PaO2, PaCO2, pH, AaDO2, PaO2/FiO2. Results. Patients with necrotizing pancreatitis with a favorable outcome in the process of artificial ventilation of the lungs to ensure sufficient oxygenation during septic shock use significantly higher (by 16.0–18.3 %) levels of PIP and PEEP than in sepsis, as well as more significant disorders of gas exchange in the lungs (by AaDO2 and PaO2/FiO2) compared with sepsis. In sepsis and septic shock with an unfavorable outcome (in comparison with a favorable one), during respiratory support, more pronounced disorders of oxygen status are observed, which indicates the presence of a more severe acute respiratory distress syndrome. In sepsis with a favorable outcome, as opposed to unfavorable, there is a direct correlation between positive changes in oxygen status (PaO2/FiO2) and Vt, PIP, PEEP levels, whereas in septic shock there is no such relationship. Conclusion. The obtained results allowed us to offer a starting regimen of respiratory support for ARDS in patients with necrotic pancreatitis.

Identification and Characterization of Vibrio Bacteria Isolated from Shrimp Infected with Early Mortality Syndrome/acute Hepatopancreatic Necrosis Syndrome (EMS/AHPNS) in Viet Nam

Identification and Characterization of Vibrio Bacteria Isolated from Shrimp Infected with Early Mortality Syndrome/acute Hepatopancreatic Necrosis Syndrome (EMS/AHPNS) in Viet Nam

PARL deficiency in mouse causes Complex III defects, coenzyme Q depletion, and Leigh-like syndrome

The mitochondrial intramembrane rhomboid protease PARL has been implicated in diverse functions in vitro, but its physiological role in vivo remains unclear. Here we show that Parl ablation in mouse causes a necrotizing encephalomyelopathy similar to Leigh syndrome, a mitochondrial disease characterized by disrupted energy production. Mice with conditional PARL deficiency in the nervous system, but not in muscle, develop a similar phenotype as germline Parl KOs, demonstrating the vital role of PARL in neurological homeostasis. Genetic modification of two major PARL substrates, PINK1 and PGAM5, do not modify this severe neurological phenotype. Parl-/- brain mitochondria are affected by progressive ultrastructural changes and by defects in Complex III (CIII) activity, coenzyme Q (CoQ) biosynthesis, and mitochondrial calcium metabolism. PARL is necessary for the stable expression of TTC19, which is required for CIII activity, and of COQ4, which is essential in CoQ biosynthesis. Thus, PARL plays a previously overlooked constitutive role in the maintenance of the respiratory chain in the nervous system, and its deficiency causes progressive mitochondrial dysfunction and structural abnormalities leading to neuronal necrosis and Leigh-like syndrome.

P2.16-19 Feasibility and Outcomes of Radiofrequency Ablation as Salvage Modality After Hypofractionated Radiation/SBRT for Early NSCLC

Local recurrences after radiotherapy (RT) for early non-small cell lung cancers (NSCLC) may be amenable to curative treatments. One such modality is Radio Frequency Ablation (RFA). There is paucity of data about outcomes after RFA salvage. We aim to evaluate the feasibility and outcomes of RFA when used as salvage therapy after hypo-fractionated radiation for early NSCLC. We retrospectively reviewed consecutive early NSCLC patients treated with SBRT or hypo-fractionated radiation followed by RFA salvage in an ethics board approved study. RFAs were performed using CT guidance and under general anesthesia using LeVeenTM needle. Its immediate and follow up complications were assessed. The end points of interest were local recurrence free survival (LRFS), distant relapse free survival (DRFS) and overall survival (OS). The end points were compared by the tumour size and Positron Emission Tomography (PET) maximum Standardized Uptake Value (SUVmax) 20 individuals with 21 tumours were treated with salvage RFA after RT for early tumours between 2005 and 2017. The median age was 76 years(52-94). Initial treatment was SBRT in 55%(11/20) tumours. 55%(11) tumours were adenocarcinomas, 25%(5) were squamous and 20%(4) were NSCLC- not otherwise specified. The median tumour size (long axis diameter) was 31.5mms. PET was available for 16 tumours and the median SUVmax was 6.15. The median interval since prior radiation was 24 months(8-56). The procedure was well tolerated. One individual developed pneumothorax requiring pigtail catheter drainage. The median hospitalization period was 1 day. One procedure was aborted midway due to lancinating ipsilateral arm pain. Two patients required 3 and 5 days of hospitalization respectively because of post-procedural pain. Chronically, one individual developed tissue necrosis syndrome, one individual developed hydropneumothorax and one individual developed dysphonia. The median LRFS was 31.8 months. When stratified by ≤ or >30 mms, there was no statistically significant difference in mean LRFS, but a trend was noted. Onset of distant metastases was slightly earlier in larger tumors but not statistically significant. The median overall survival for tumours ≤ or >30 mms was 42.8 months and 17.4 months respectively (p-0.015). THE LRFS was 27.7 and 60.45 months (p-0.29), DMFS was 27.8 and 54.7 months (p-0.11) for patients with PET SUV >5 and ≤5 respectively . RFA is an effective and feasible salvage modality in early NSCLC after radiation. This study is limited by its retrospective nature and limited numbers. A larger prospective analysis will help ascertain its role.

Toxic epidermal necrosis syndrome after taking nonsteroidal antiinflammatory drugs: a case report

Toxic epidermal necrosis syndrome after taking nonsteroidal antiinflammatory drugs: a case report

The extracellular proteases produced by Vibrio parahaemolyticus.

Vibrio parahaemolyticus, a Gram-negative bacterium, inhabits marine and estuarine environments and it is a major pathogen responsible globally for most cases of seafood-associated gastroenteritis in humans and acute hepatopancreatic necrosis syndrome in shrimps. There has been a dramatic worldwide increase in V. parahaemolyticus infections over the last two decades. The pathogenicity of V. parahaemolyticus has been linked to the expression of different kinds of virulence factors including extracellular proteases, such as metalloproteases and serine proteases. V. parahaemolyticus expresses the metalloproteases; PrtV, VppC, VPM and the serine proteases; VPP1/Protease A, VpSP37, PrtA. Extracellular proteases have been identified as potential virulence factors which directly digest many kinds of host proteins or indirectly are involved in the processing of other toxic protein factors. This review summarizes findings on the metalloproteases and serine proteases produced by V. parahaemolyticus and their roles in infections. Identifying the role of V. parahaemolyticus virulence-associated extracellular proteases deepens our understanding of diseases caused by this bacterium.

Genome characterization of piscine 'Scale drop and Muscle Necrosis syndrome'-associated strain of Vibrio harveyi focusing on bacterial virulence determinants.

Genomic characterization of Harveyi clade vibrio strain Y6 causing 'Scale drop and Muscle Necrosis syndrome' (SDMN) isolated from barramundi (Lates calcarifer) in Vietnam. A bacterial genome was sequenced using Illumina MiSeq platform. Multilocus sequence analysis confirmed that the bacterium belongs to Vibrio harveyi species. Further phylogenetic analysis inferred from core genome SNPs revealed a close relationship between our bacterium and the V. harveyi isolated from groupers in Taiwan and China. blastp results indicated that V. harveyi piscine strains carried numerous adhesin, secretion system, siderophore and toxin-related genes. Genome comparison between Y6 and 32 strains of V. harveyi from different origins showed that at least 17 potential virulence genes were present exclusively in the strain Y6. Many of these (six of 17 genes) were homologous to pyoverdine siderophore, a secreted high-affinity iron chelator, clusters originally found in Pseudomonas aeruginosa. Genome of V. harveyi Y6 was incorporated by a bacteriophage VHY6φ and replication protein of the phage was most similar to CTXφ described previously in Vibrio cholerae and Vibrio fischeri. However, the cholera toxin-encoding genes, namely ctxA and ctxB, were absent from VHY6φ, while the CTXφ-enterotoxin gene (zonula occludens toxin; zot) remained intact. Several putative virulence genes and a phage carrying toxin gene were identified in the genomes of SDMN-associated V. harveyi Y6. This study confers genomic information of the piscine pathogenic V. harveyi which recently caused widespread mortality. Such information is of importance to gain insight into bacterial molecular pathogenesis.

Acute exposure to crotonaldehyde induces dysfunction of immune system in male Wistar rats.

Crotonaldehyde is a ubiquitous air pollutant in the environment. It is reported to be harmful to the biosystems in vivo and in vitro. The exposure to crotonaldehyde irritates the mucous membranes and induces edema, hyperemia, cell necrosis, inflammation, and acute respiratory distress syndrome in the lungs. However, the effects of crotonaldehyde on the immune system have not been reported. In the present study, 6-8 weeks old male Wistar rats were exposed to crotonaldehyde by intratracheal instillation at doses of 4, 8, and 16 μL/kg body weight (b.w.). The general damage in the animals was investigated; the cell counting and the biochemical analysis in the peripheral blood were tested. Furthermore, we investigated the functions of alveolar macrophages (AMs), the alterations of the T-lymphocyte subsets, and the cell composition in the bronchoalveolar lavage fluid (BALF). We found that the activities of the animals were changed after exposure to crotonaldehyde, the cellular ratios and the biochemical components in the peripheral blood were altered, the ratio of mononuclear phagocytes decreased, and the ratios of lymphocytes and granulocytes elevated significantly in BALF. Meanwhile, crotonaldehyde altered the ratio of the T-lymphocyte subsets, and the phagocytic rates and indices of AMs increased obviously. In conclusion, crotonaldehyde induces dysfunction of immune system in male Wistar rats.

Compartment Syndrome of the Upper Extremity Induced by Extravasation of Contrast Media after Computed Tomography: A Case Report

The incidence of contrast media extravasation has been increasing gradually. Most contrast media extravasations only can cause pain, swelling and erythema. However, in more severe cases, skin necrosis, ulceration, or compartment syndrome may occur, often necessitating a surgery. Early diagnosis and treatment should be established on the spot in order to avoid such a severe damage. We present a case of 42-year-old woman with a compartment syndrome in the right upper extremity caused by extravasation of computed tomography contrast media.

A rare case of bilateral acute retinal necrosis due to varicella zoster virus in a patient of Multiple myeloma

Acute retinal necrosis syndrome (ARN) is a well-defi ned entity with characteristic clinical picture of progressive intraretinal infl ammation and necrosis and is caused by one of the members of the Herpes group of viruses. The condition occurs typically in otherwise healthy patients.

Biomarkers of Renal Injury in Cirrhosis: Association with Acute Kidney Injury and Recovery after Liver Transplantation

Background: To define urine or serum biomarkers in predicting renal function recovery after liver transplantation (LT). Methods: Adults listed for LT (February 2011-July 2014) and with modified diet for renal disease-6 (MDRD-6) <60 mL/min provided urine/blood samples at baseline and serially until LT for biomarkers in serum (pg/mL) and urine (pg/mg creatinine). Results: Of 271 LT listed patients (mean age 57 years, 63% males, median listing MELD 17.5), 1 year acute kidney injury (AKI) probability was 49%, with odds of 1.3-, 3.0-, 4.6-, and 8.5-fold times for listing MELD 16-20, 21-25, 26-30, and >30, compared to MELD <16. Thirty-seven people died over 1 year from the time of listing, with twofold increased odds with AKI. Among 67 patients with MDRD <60, only urinary epidermal growth factor was different comparing AKI (increase in serum creatinine ≥0.3 mg/dL from baseline within past 3 months) vs. no AKI (2,254 vs. 4,253, p = 0.003). Differences between acute tubular necrosis (ATN) and hepatorenal syndrome could not be ascertained for a small sample of 3 patients with ATN. Analyzing 15 of 43 receiving LT and MDRD-6 <30 prior to LT, biomarkers were not different comparing 5 patients recovering renal function (MDRD-6 >50 mL/min) at 6 months vs. 10 without recovery. Conclusions: AKI is common among LT listed patients, with a negative impact on transplant-free survival. Serum and urine biomarkers are not associated with the recovery of renal function after LT. Multicenter studies are suggested to (a) develop strategies to reduce the development of AKI and (b) derive novel biomarkers for use in accurately predicting renal recovery after LT.

Spectrum of hepatitis B and renal involvement.

Renal involvement in hepatitis B occurs in various spectrums and its knowledge is important for clinicians in management of patients. The renal diseases most commonly associated with hepatitis B virus (HBV) infection include membranous nephropathy, membranoproliferative glomerulonephritis and Polyarteritis nodosa. The widespread use of hepatitis B vaccination has decreased the incidence of HBV-related renal diseases. The incidence of HBV infection in dialysis patients has significantly decreased over the past few decades because of screening of blood products for hepatitis B surface antigen (HBsAg) and hepatitis B core antibody, implementation of infection control measures and hepatitis B vaccination. The definition of acute kidney injury has been recently modified in cirrhotic population, helping in prognosis and prediction of mortality. The most common etiologies of acute kidney injury in this cirrhotic population, which account for 80% to 90% of all cases, include volume depletion, acute tubular necrosis and hepatorenal syndrome. Treatment with oral nucleoside/tide analogues (NA) brought a new paradigm in the management of HBsAg positive glomerulonephritis, kidney transplant recipients and dialysis patients, resulting in effective viral suppression, reduced hepatic complications and improved patient survival, without compromising renal allograft outcome. NAs are cleared by the kidneys and therefore their dosage has to be adjusted in all patients with impaired renal function. This article reviews the recent knowledge of the pathogenesis and treatment of HBV-related glomerulonephritis and discusses the management of hepatitis B in patients on dialysis, kidney transplant recipients and cirrhotics, which is continuously evolving.

Advancement in diagnosis and treatment of acute retinal necrosis syndrome

Advancement in diagnosis and treatment of acute retinal necrosis syndrome

Porcine ear necrosis syndrome by coinfection of porcine reproductive and respiratory syndrome virus and Staphylococcus hyicus

Porcine ear necrosis syndrome by coinfection of porcine reproductive and respiratory syndrome virus and Staphylococcus hyicus

Plasmid dynamics in Vibrio parahaemolyticus strains related to shrimp Acute Hepatopancreatic Necrosis Syndrome (AHPNS)

Vibrio parahaemolyticus is a causative agent of acute hapatopancreatic necrosis syndrome (AHPNS) which causes early mortality in white shrimp. Emergence of AHPNS has caused tremendous economic loss for aquaculture industry particularly in Asia since 2010. Previous studies reported that strains causing AHPNS harbor a 69-kb plasmid with possession of virulence genes, pirA and pirB. However, genetic variation of the 69-kb plasmid among AHPNS related strains has not been investigated. This study aimed to analyze genetic composition and diversity of the 69-kb plasmid in strains isolated from shrimps affected by AHPNS. Plasmids recovered from V. parahaemolyticus strain VPE61 which represented typical AHPNS pathogenicity, strain VP2HP which did not represent AHPNS pathogenicity but was isolated from AHPNS affected shrimp and other AHPNS V. parahaemolyticus isolates in Genbank were investigated. Protein coding genes of the 69-kb plasmid from the strain VPE61 were identical to that of AHPNS strain from Vietnam except the inverted complement 3.4-kb transposon covering pirA and pirB. The strain VP2HP possessed remarkable large 183-kb plasmid which shared similar protein coding genes to those of the 69-kb plasmid from strain VPE61. However, the 3.4-kb transposon covering pirA and pirB was absent from the 183-kb plasmid in strain VP2HP. A number of protein coding genes from the 183-kb plasmid were also detected in other AHPNS strains. In summary, this study identified a novel 183-kb plasmid that is related to AHPNS causing strains. Homologous recombination of the 69-kb AHPNS plasmid and other naturally occurring plasmids together with loss and gain of AHPNS virulence genes in V. parahaemolyticus were observed. The outcome of this research enables understanding of plasmid dynamics that possibly affect variable degrees of AHPNS pathogenicity.