Non-septic Cases Research Articles

The nasal microbiota is a potential diagnostic biomarker for sepsis in critical care units.

This study aimed to characterize the composition of intestinal and nasal microbiota in septic patients and identify potential microbial biomarkers for diagnosis. A total of 157 subjects, including 89 with sepsis, were enrolled from the affiliated hospital. Nasal swabs and fecal specimens were collected from septic and non-septic patients in the intensive care unit (ICU) and Department of Respiratory and Critical Care Medicine. DNA was extracted, and the V4 region of the 16S rRNA gene was amplified and sequenced using Illumina technology. Bioinformatics analysis, statistical processing, and machine learning techniques were employed to differentiate between septic and non-septic patients. The nasal microbiota of septic patients exhibited significantly lower community richness (P = 0.002) and distinct compositions (P = 0.001) compared to non-septic patients. Corynebacterium, Staphylococcus, Acinetobacter, and Pseudomonas were identified as enriched genera in the nasal microbiota of septic patients. The constructed machine learning model achieved an area under the curve (AUC) of 89.08, indicating its efficacy in differentiating septic and non-septic patients. Importantly, model validation demonstrated the effectiveness of the nasal microecological diagnosis prediction model with an AUC of 84.79, while the gut microecological diagnosis prediction model had poor predictive performance (AUC = 49.24). The nasal microbiota of ICU patients effectively distinguishes sepsis from non-septic cases and outperforms the gut microbiota. These findings have implications for the development of diagnostic strategies and advancements in critical care medicine.IMPORTANCEThe important clinical significance of this study is that it compared the intestinal and nasal microbiota of sepsis with non-sepsis patients and determined that the nasal microbiota is more effective than the intestinal microbiota in distinguishing patients with sepsis from those without sepsis, based on the difference in the lines of nasal specimens collected.

Circulating CitH3 Is a Reliable Diagnostic and Prognostic Biomarker of Septic Patients in Acute Pancreatitis.

PurposeAcute pancreatitis (AP) is an inflammatory disease. AP starts with sterile inflammation and is often complicated with critical local or systemic infection or sepsis in severe cases. Septic AP activates peptidyl arginine deiminase (PAD) and citrullinates histone H3 (CitH3), leading to neutrophil extracellular trap (NET) formation. Investigating the role of NETs and underlying mechanisms in septic AP may facilitate developing diagnostic and therapeutic approaches. In this study, we sought to identify the expression of CitH3 in septic AP patients and to analyze the correlation of CitH3 concentration with NET components as well as clinical outcomes.MethodsSeventy AP patients with or without sepsis (40 septic cases, 30 nonseptic cases) and 30 healthy volunteers were recruited in this study. Concentration of NET components (CitH3 and double-strain DNA) and key enzymes (PAD2/4) were measured. Clinical and laboratory characteristics of patients were recorded and analyzed.ResultsLevels of CitH3 were elevated significantly in septic AP patients compared with those in nonseptic AP and healthy volunteers. The area under the curve (AUC, 95% confidence interval) for diagnosing septic AP was 0.93 (0.86–1.003), and the cutoff was 43.05 pg/ml. Among septic AP cases (n = 40), the concentration of CitH3 was significantly increased in those who did not survive or were admitted to the intensive care unit, when compared with that in those who survived or did not require intensive care unit. Association analysis revealed that CitH3 concentration was positively correlated with PAD2, PAD4, dsDNA concentration, and Sequential Organ Failure Assessment scores.ConclusionCitH3 concentration increased in septic AP patients and was closely correlated with disease severity and clinical outcomes. CitH3 may potentially be a diagnostic and prognostic biomarker of septic AP.

Does performing total joint arthroplasty in the afternoon or evening increase the risk of prosthetic joint infection?

Does performing total joint arthroplasty in the afternoon or evening increase the rate of early prosthetic joint infection and the likelihood of early prosthetic joint infection? We evaluated patients retrospectively, who underwent primary total hip (THA) or knee arthroplasty (TKA) between January 2016 and December 2019, met the inclusion criteria and had at least 90days of follow-up. Patients were divided into two groups. Group I consisted of patients whose surgeries had been started and finished before 14:00, and group II included patients whose surgeries started after 14:01. All patients were operated after non-septic cases in specific orthopedic operating rooms. Their demographic data and comorbidities were noted. Primary outcome was to compare the risk of PJI between the groups. Group I and group II included 2309 and 1881 patients. Total number of patients with the diagnosis of PJI was 58 (1.4%). It was 31 (1.3%) and 27 (1.4%), respectively (p = 0.79). Performing total joint arthroplasty after 14:01 did not increase likelihood of infection (p = 0.83, OR 1.03). Among the parameters, PJI was significantly associated with age (p < 0.01, OR 0.99), smoking status (p < 0.01, OR 0.15) and operating time (p = 0.04, OR 0.99) in TKA and with direct anterior approach (p = 0.02, OR 4.72) in THA. Age (p = 0.06, OR 1.03) was the factor affecting the risk of subsequent PJI after total joint arthroplasty. Performing total joint arthroplasty in the afternoon or in the evening, after aseptic cases does not increase the risk of subsequent of PJI.

Serum Albumin Levels in Emergency Patients with Low BMI

A low body mass index (BMI) is often associated with low nutritional status and adverse health outcomes. While the BMI is used in describing “thinness” meaning cachexia, serum albumin levels were also used in assessing patient’s nutritional conditions. Object: A retrospective study was conducted to determine whether the extremes of BMI and/or cachexia increased the morbidity and mortality in our critical emergency department. Methods: A hundred and five cases with low BMI (≤18.5 kg/m2) were chosen from the patients who were admitted to our critical emergency department from Sept 2013 to Aug 2016. The relationship between serum albumin levels on admission and prognosis were analyzed. Results: No significant correlations were observed between body mass index and albumin levels in thin patients. Lower levels of serum albumin (<3.3 g/dL) group was associated with a higher incidence of death. However, there was no death in higher levels of serum albumin (≥3.3 g/dL) group. A significant difference (p < 0.01) in life prognosis was observed in patients with albumin of 3.3 g/dL or more and below. Moreover, the mean albumin level in septic cases was significantly lower than that of non-septic cases. Conclusions: Even with low BMI, if the albumin value was 3.3 g/dL or more, the prognosis was good in our emergency department. Estimation of albumin level on admission is not only a simple and objective way to assess the nutritional status but also a useful outcome predictor of critically ill patients coming to emergency centers.

Endocan and Soluble Triggering Receptor Expressed on Myeloid Cells-1 as Novel Markers for Neonatal Sepsis

Neonatal sepsis is an important cause of neonatal morbidity and mortality in the neonatal intensive care unit. Soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) has been evaluated in sepsis and septic shock, and it was found to be valuable in distinguishing septic cases from nonseptic cases. Endocan is constitutively expressed by endothelial cells, and high levels of endocan may be of relevance for the promotion of systemic inflammation. The aim of this study was to investigate whether the levels of sTREM-1 and endocan were increased in late-onset neonatal sepsis. Patients were classified into septic and nonseptic groups. Blood was collected from a peripheral vein of all septic newborns and healthy newborns at the time of initial laboratory evaluation before any treatment, and within 48-72 hours after initiation of treatment. Serum sTREM-1 and endocan measurements were performed when the study was finished. The study population comprised of 50 neonates: 20 nonseptic neonates and 30 septic neonates. The groups were similar with regards to baseline characteristics. The initial measurements of interleukin-6 (IL-6), sTREM-1, endocan, and immature/total neutrophil ratio (I/T ratio) were significantly higher in septic neonates in comparison with nonseptic neonates. Receiver operating characteristic (ROC) curve analyses revealed that IL-6, sTREM-1, endocan, and I/T ratio resulted in significant areas under the curve (AUC) with respect to early identification of septic neonates. Soluble TREM-1 and IL-6 performed best to distinguish septic neonates from nonseptic neonates. Univariate logistic regression analysis showed that increased IL-6 and sTREM-1 were strong predictors of neonatal late-onset sepsis. Serum sTREM-1, IL-6, endocan levels, and I/T ratio increased in septic neonates. However, the diagnostic accuracy of circulating sTREM-1 seemed to be better than endocan and I/T ratio, but lower than IL-6.

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Introduction: It is recognized that Methemoglobin (MetHb) levels are elevated in sepsis due to increased nitric oxide production. The degree of MetHb elevation may have prognostic significance, and unrecognized elevation may reflect outcome in non-septic acute hospital admissions. The additive outcome effect of MetHb, ionized calcium (iCa), and lactate may be of prognostic value. Methods: In a retrospective observational study. co-oximeter data from 1000 admissions over 18 months to a general ICU was interrogated for arterial MetHb, lactate, and iCa levels. Patient demographics, admission and ultimate diagnoses allowed classification into categories of Septic / Non-Septic, Survivor (S) / Non-Survivor (NS). T-testing after logistic transformation or Mann Whiney U testing was used to compare MetHb (%), lactate (mmol/L), iCa (mmol/L) levels between septic (n= 273) and non-septic (n=650) cases, also S (n=809) and NS (n=115). A regression analysis was also performed to determine the contribution of the above factors to outcome. p<0.05 was accepted for statistical significance. Results are expressed as median (Md) and range (R) or mean (Me) and 95% CI. The fit of the model was assessed with ROC analysis and the Hosmer Lemeshow (HL) test. Results: There was no age difference between the septic and non-septic groups. Of 1000 admissions, 927 had MetHb data. 2 patients had MetHb >2 (Md 1.0, range 0.5–3.1). Those with a diagnosis of sepsis (n=273) had significantly higher MetHb levels than non-septic patients (Md 1.0, R 0.5 – 3.1 vs 1.0, 0.5 – 2.0). NS with sepsis (n=46) had significantly higher MetHb levels than NS without sepsis (n=69) (Md 1.0, R 0.5 – 1.7 vs 0.9, 0.5 – 1.6). iCa was lower in NS than S (Md 1.04, R 0.45 – 1.9 vs 1.09, 0.35 – 1.76), and also lower in septic than non-septic patients, but with no difference between S and NS with sepsis. Lactate was significantly higher in NS than S (Me 2.7, 95% CI 2.3 – 3.2 vs 1.37, 1.3 – 1.4). Lactate was also significantly higher in septic compared to non-septic patients (1.6, 1.5 – 1.8 vs 1.4, 1.36 – 1.5) Age, presence or absence of sepsis, and lactate were included in the logistic regression analysis for outcome, with AUC for the ROC of 0.77 and HL>0.3. Conclusions: Methemoglobin levels above 2% are rare. MetHb is significantly elevated in our patient population with sepsis however the degree of elevation at admission in our group was not predictive of outcome. iCa, while lower in NS, does not predict outcome in a population with sepsis. Lactate elevation at admission, in this group, correlates with outcome, and the combination of lactate, age and sepsis shows comparable predictive value to established formulae.

Diagnostic value of lipopolysaccharide-binding protein and procalcitonin for sepsis diagnosis in forensic pathology

The aims of this study were twofold. The first was to investigate the diagnostic performance of two biochemical markers, procalcitonin (PCT) and lipopolysaccharide-binding protein (LBP), considering each individually and then combined, for the postmortem diagnosis of sepsis. We also tested the usefulness of pericardial fluid for postmortem LBP determination. Two study groups were formed, a sepsis-related fatalities group of 12 cases and a control group of 30 cases. Postmortem native CT scans, autopsy, histology, neuropathology, and toxicology as well as other postmortem biochemical investigations were performed in all cases. Microbiological investigations were also carried out in the septic group. Postmortem serum PCT and LBP levels differed between the two groups. Both biomarkers, individually considered, allowed septic states to be diagnosed, whereas increases in both postmortem serum PCT and LBP levels were only observed in cases of sepsis. Similarly, normal PCT and LBP values in postmortem serum were identified only in non-septic cases. Pericardial fluid LBP levels do not correlate with the presence of underlying septic states. No relationship was observed between postmortem serum and pericardial fluid LBP levels in either septic or non-septic groups, or between pericardial fluid PCT and LBP levels.

Circulating dendritic cells following burn

Burns are associated with immune suppression and subsequent development of sepsis. Dendritic cells (DCs) are potent antigen-presenting cells that serve as a critical link between the innate and acquired immune systems, and are essential in coordinating the host response to pathogens. Using multicolour flow cytometry, the percentages of LIN − DR + CD11c + myeloid (mDC) and LIN − DR + CD123 + plasmacytoid (pDC) subsets were determined in peripheral blood from 32 people (15 septic and 5 non-septic burn victims and 12 age- and gender-matched healthy controls, up to 20 days from injury). Analysis revealed significant reductions in circulating mDCs and pDCs in survivor as well as non-survivor septic cases compared with non-septic cases and controls ( p < 0.001). These findings suggest that deficiencies in mDCs and pDC subsets are related to sepsis following severe burn, and may contribute to immunosuppression among burn victims.

Tenoscopy in 33 horses with septic and nonseptic digital tenosynovitis (1997–2001)

Tenoscopy is the use of an arthroscope to access tendon sheaths. This article reports clinical findings, treatments, and outcomes of 33 horses with either septic or nonseptic digital tenosynovitis submitted to 36 tenoscopies during 34 occasions at the Marion duPont Scott Equine Medical Center (1997–2001). Two of the 16 horses with septic tenosynovitis were euthanized at the hospital. From the 32 horses discharged from the hospital, outcome was obtained in 31 cases: 12 horses (6 septic) could work at the same level. No difference was detected between the outcome groups regarding clinical and laboratory variables. In nonseptic cases, lameness grade, circulating white blood cells, and plasma fibrinogen before surgery were lower, while the period between the onset of clinical signs and surgery was longer and duration of phenylbutazone treatment and hospitalization was shorter. No difference in the outcome was detected when septic and nonseptic cases were compared. Tenoscopy was useful for diagnosis and treatment of nonseptic and septic digital tenosynovitis. The small number of cases and the lack of accurate information due to the retrospective nature of the study may have prevented detection of a difference between the outcomes of horses with septic versus nonseptic tenosynovitis.

Abortion at Gondar College Hospital, Ethiopia.

To review the pattern and magnitude of abortion in order to establish baseline facts and data for future studies. A descriptive cross-sectional study. Gondar College of Medical Sciences Hospital, Gondar, Ethiopia. Most of the subjects originated from the Gondar city and were married housewives, parous and relatively young. The abortion rate and ratio per 100 pregnancies and deliveries were 11.5 and 16.4, respectively. Only 13.4% of the patients admitted history of interference with the pregnancy. Previous history of abortion was obtained in 10.6% of the patients. The mean gestational ages for septic and non-septic cases were 14.6 and 15.2 weeks, respectively even though pregnancies less than 12 weeks from the last normal menstrual period accounted for 50.5%. The commonly diagnosed clinical type was incomplete, followed by inevitable and threatened abortion. The vast majority of the clinical conditions were non-septic (85.1 %) and spontaneous(85.6 %). The most common complications registered were anaemia, genital tract infection, shock of various causes and soft tissue injury. Four mothers died of abortion-related complications. The mean hospital stays for non-septic and septic abortion were three and five days, respectively. The study has attempted to address the issue of abortion in its general clinical pattern in relation to the various parameters. Being comprehensive, it also provides awareness and sensitivity on the magnitude of abortion and is assumed quite helpful for policy and decision makers.

The efficacy of extracorporeal membrane oxygenation (ECMO) in newborns with septic shock

The efficacy of extracorporeal membrane oxygenation (ECMO) for patients with septic shock has not yet been documented with certainty. Seven septic newborns who were resistant to conventional therapy were managed by ECMO in our hospital, and five (71.4%) survived. Veno-arterial ECMO thus was very beneficial in supporting cardiorespiratory insufficiency due to septic shock. Ultrafiltration or hemodialysis carried out on a bypass route in the ECMO circuit was also beneficial in controlling the fluid and electrolytic imbalance often encountered in septic newborns. On the other hand, despite activated clotting times being maintained at relatively low levels compared to non-septic cases, major hemorrhagic complications occurred in more than one-half of the cases and became the main cause of death in two. Some modifications will therefore be necessary in ECMO practice for septic newborns.

Septic and nonseptic olecranon bursitis. Utility of the surface temperature probe in the early differentiation of septic and nonseptic cases.

Forty-six consecutive cases of olecranon bursitis were prospectively analyzed during a 1-year period. Eleven cases were septic; 35 cases were nonseptic. In addition to bursal fluid analysis, the surface temperature over the involved olecranon bursa and the contralateral (control) olecranon process was obtained by using a surface temperature probe. We compared the temperature difference between the involved and control sides in all septic and nonseptic cases. In nonseptic cases, the mean surface temperature difference was 0.7 degree C vs 3.7 degrees C in septic cases. In all septic cases, the temperature difference was 2.2 degrees C or greater (range, 2.2 degrees C to 5.1 degrees C; SD, 1.1). Use of the surface probe temperature difference proved 100% sensitive and 94% specific in discriminating septic from nonseptic cases. It seems to be more helpful than the bursal fluid leukocyte count, the predominant cell type, or Gram's stain in the early differentiation of septic and nonseptic olecranon bursitis.

Statistical analysis of one thousand abortions

1.1. One thousand cases of abortion are reported.2.2. There is evidence of increasing number of abortions, principally in the self-induced group.3.3. Religion does not seem to be a deterrent to induction of abortion.4.4. As Taussig states, “abortion is a problem concerned with the married woman,” both induced and criminal, and it is in this group that the high death rate is contained.5.5. Most spontaneous and induced abortions occur under three months and most often under 30 years of age, increasing again in incidence after 35. The criminal abortions occur in greatest percentage in single women and early married life.6.6. The total abortion incidence is 1 abortion to 2.7 pregnancies and 1 abortion to 1.6 confinements. This is according to the histories of our abortion cases. The relation of hospital abortion to hospital confinements is as 1:5.3 and stillbirths to abortions as 1:5.2.7.7. Hemorrhage is a factor in lowering the resistance of the patient but not in the mortality.8.8. Missed abortions were of 0.3 per cent incidence; therapeutic abortions 0.5 per cent.9.9. The mortality rate was 1.9 per cent with the most frequent complications septicemia, peritonitis, pneumonia, phlebitis, and distant infarcts.10.10. Operative incidence 51 per cent.11.11. We have followed the conservative treatment established, here by Adair and Litzenberg, that is, in septic cases, we use expectant treatment unless complicated by hemorrhage; incision of abscesses if properly located, later evacuation if necessary when there is approximately normal leucocyte count and temperature for a period of at least five days. The sedimentation time does not seem to be of much value here. Nonseptic cases are evacuated, almost routinely, to conserve blood and shorten hospitalization. Repeated transfusions are of particular value in infected cases, and of course those with hemorrhage. Nearly all cases with a hemoglobin of 60 per cent or less received one or more transfusions. Sulfanilamide seems to give promise of potent therapy.12.12. Invalidism, more or less permanent, and the high maternal mortality of abortion may hopefully be combated through improvement in moral and economic standards, education in family limitation, and early prenatal care. Endocrine and vitamin therapy may eliminate many of the spontaneous abortions.