Septic Conditions Research Articles

PROGNOSTIC EVALUATION OF LABORATORY BLOOD PARAMETERS IN SEPTIC PATIENTS OF INTENSIVE CARE UNIT

Sepsis is a serious disease accompanied by the development of a systemic inflammatory response syndrome. The informativeness of existing diagnostic markers of sepsis at various stages of its development remains controversial. Research into septic conditions has led to significant progress in determining the body’s response to infection. The search for laboratory indicators capable of indicating the prognosis of the disease is an important diagnostic criterion in the timely treatment and prevention of sepsis in hospital treatment. The publication presents data from a survey of the studied changes in arterial blood parameters in septic patients with a prognostic assessment. The indicators of biomarkers of inflammation in septic patients were analyzed, the tinctorial and other bacteriological properties of pathogens in the development of generalized sepsis were evaluated, the components influencing the favorable and unfavorable outcome of the disease were determined in the research. The identification of laboratory parameters that help to give the real assessment of the severity and prognosis of the disease in patients of the intensive care unit in a timely manner will allow you to choose effective treatment methods, timely adjust the prescribed therapy and reduce the number of deaths.

CHEMICAL TREATMENT OPTIONS OF WASTEWATER FROM SUGARCANE INDUSTRY AND ITS PRIORITY PARAMETERS COMPARISON AS PER SMART RULES OF SINDH ENVIRONMENTAL PROTECTION AGENCY


 
 
 Sugarcane industry is the largest consumer of freshwater and cause of adding wastewater in environment. Wastewater generation by sugarcane industry contains high chemical oxygen demand (COD), biological oxygen demand (BOD), total dissolved solids (TDS), and Total suspended solids (TSS), it ultimately reduces accessibility to oxygen. The Sindh Environmental Protection Agency (SEPA) also promulgated legal obligation regarding effluent pollutant level through the Sindh Environmental Quality Standards (Self-Monitoring and Reporting by Industry) Rules, 2014, including priority parameters of effluent discharge for sugar industry such as Effluent Flow, Temparature, pH, BOD5, COD, Oil and Grease. If wastewater by sugarcane industry is not treated rightly, it will create very worst situation in surrounding areas including, generating foul smelling and septic condition. This toxic wastewater reduces penetration, and threat to crops and aquatic life. There are many treatment techniques such as coagulation, adsorption, membrane, biological etc. by different research studies disclosed that coagulation with different chemicals alum, ferric chloride and ferrous sulphate are very effective for remove of pollution. The adsorption technique followed by coagulation is also a very effective and time saving for sugarcane industry wastewater treatment.
 
 

490. Brain-derived neurotrophic factor (BDNF) is a prognostic biomarker and therapeutic target through AMP-activated protein kinase (AMPK) signal pathway for sepsis

Abstract Background Brain-derived neurotrophic factor (BDNF) is a pleiotropic cytokine that not only acts on the central nervous system, but is also implicated in metabolic regulation, development of lung diseases, and support of hematopoiesis. Recently, a study report that the plasma levels of BDNF were independently associated with mortality in critically ill patients. We aimed to evaluate the role of BDNF in sepsis patients and animal sepsis model. Methods Prospectively enrolled adult sepsis patients (n=168) who visited the emergency room (ER) of Korea University Ansan Hospital from January 2017 to December 2018., and healthy volunteers (n=48) were included in the present study. Serum BDNF level was determined and analyzed in septic patients and healthy volunteers. The effects of BDNF on pro-inflammatory cytokines, AMP-activated protein kinase (AMPK) and NF-κB signaling in septic condition of RAW264.7 cells and mouse peritoneal macrophage, and mouse sepsis model by cecal ligation and puncture (CLP). Results Serum BDNF levels (mean) were significantly decreased in sepsis patients compared to healthy controls (11.78ng/ml vs 18.91ng/ml, p< 0.001) and significantly decreased in non-survivors compared to survivors at discharge (3.16ng/ml vs 13.86ng/ml, p< 0.05). BDNF treatment suppressed LPS-induced pro-inflammatory cytokine (TNF-α, iL-6, and iL-1β) in RAW264.7 cells. Although LPS stimulation diminished AMPK phosphorylation, BDNF was able to decrease the effects of LPS/toll-like receptor 4 (TLR4) engagement on down stream signaling events, particularly LPS-induced IκBα degradation in RAW cells and peritoneal macrophage. In CLP model, intra-muscular injection of BDNF after CLP significantly decreased serum levels of TNF-α which was increased compared to sham, and significantly improved survival of mouse (p< 0.01). Conclusion Sepsis results in a decreased production of BDNF, which might be a potential prognostic biomarker and therapeutic target through AMPK signal pathway for sepsis. Disclosures All Authors: No reported disclosures.

COVID-19 associated coagulopathy in septic critically ill patients - a retrospective cohort study.

Aim To determine the relationship between coagulation disorders and septic condition in COVID-19 critically ill patients. Methods Data from 99 patients who presented with COVID-19 acute hypoxemic respiratory failure (CAHRF) were divided into two groups: Group 1- patients who developed sepsis, and Group 2 - patients who developed septic shock. Age, sex, comorbidities, quick Sequential Organ Failure Assessment (qSOFA) score, vasopressor and inotrope requirement, laboratory findings (platelets, neutrophils, lymphocytes, procalcitonin - PCT, C-reactive protein, fibrinogen, D-dimer, sepsis-induced coagulopathy - SIC, and disseminated intravascular coagulation - DIC score) were recorded on the day of admission and on the day of starting invasive mechanical ventilation. The primary outcome was to establish COVID-19 associated coagulopathy with sepsis and septic shock; the secondary outcome measure was incidence of coagulopathy in septic COVID-19 critically ill patients. Results The most common coagulation abnormality was international normalized ratio (INR) (p=0.019) for Group 2, followed by the values of inflammatory parameters PCT (p=0.002) and lymphocytes (p=0.011) also for Group 2. The statistical significance of SIC score was observed for both groups (p=0.007) and p=0.012, respectively. Norepinephrine (p=0.000) and dobutamine (p=0.000) for Group 2, qSOFA for both groups (p = 0.000) were statistically significant. Conclusion The observed coagulation abnormalities met the criteria for a SIC diagnosis, therefore, the management of coagulation disorders at this stage of the disease should follow the management of a septic condition.

Obesity Influences the Expression of Key Immunomodulators in Normal Human Breast Tissue, Basal-like Breast Cancer Patients, and Cell Lines.

Among the different components of the breast cancer microenvironment are adipocytes, which are mainly composed of differentiated adipocytes and adipose progenitors. The role of obesity in tumor progression has become a key topic in clinical studies, but the mechanics of this are still misunderstood. There is significant evidence of serum amyloid (SAA1), an acute-phase protein, being heavily expressed in inflamed, septic conditions. VTCN1 and VSIR, members of the immunoglobulin family, are key players in T-cell regulation. The present study investigates the differentially expressed genes caused by adipose-conditioned media on the novel triple-negative breast cancer cell lines MDA MB 231 and MDA MB 468. RNA sequencing of adipocyte-conditioned media (ACM)-treated MDA MB 231 and MDA MB 468 cells were analyzed and compared using the gene sequencing enrichment analysis database (GSEA). GSEA was also done on microarray data from obese, non-tumorous breast tissue patients (GSE:33526) to show significantly upregulated immunomodulators. Obesity was also shown to influence gene expression related to immune sensing and evasion in a dataset analysis of basal-like obese patients (GSE:79858). We showed obesity significantly upregulated immunomodulators related to immune suppression in non-tumorous, basal-like patients, as well as in novel basal-like TNBC cell lines.

Benzoylpaeoniflorin Activates Anti-Inflammatory Mechanisms to Mitigate Sepsis in Cell-Culture and Mouse Sepsis Models.

Xuebijing injection (XBJI) (comprising of five herbs) is a widely used traditional Chinese medicine for sepsis treatment. However, the bioactive components of XBJI and the mechanisms responsible for its sepsis-mitigating action have not been experimentally determined. One of the main bioactive compounds in XBJI-benzoylpaeoniflorin (BPF)-inhibits the expressions of key mediators of inflammation such as nuclear factor kappa B (NF-κB), cyclooxygenase-1 (COX-1), and COX-2. However, its effects on sepsis have not been determined yet. Therefore, here, we investigated the immunomodulatory effect of BPF on severely inflamed endothelial cells, THP-1 macrophages, peritoneal macrophages, and mice. Human umbilical vein endothelial cells (HUVECs) and THP-1-macrophages were activated using lipopolysaccharide (LPS) after pretreatment with BPF. Subsequently, changes in the expression profiles of pro-inflammatory molecules including inducible nitric oxide synthase (iNOS), tumor necrosis factor (TNF)-α, and interleukin (IL)-6 were determined using quantitative real-time polymerase chain reaction (qPCR) and Western blot analysis. Furthermore, we monitored the phosphorylation of NF-kB and mitogen-activated protein kinases (MAPKs) to determine their activation levels. Using the LPS-induced mouse model of sepsis, we studied the effects of BPF on inflammatory cytokine production, pulmonary histopathology, and survival rates. Finally, we evaluated whether BPF protects against cecal ligation and puncture (CLP)-induced sepsis, as it closely mimics human sepsis. BPF pretreatment inhibited LPS-induced increase in mRNA and protein levels of iNOS, TNF-α, and IL-6 in HUVECs and THP-1-macrophages. It also suppressed LPS-mediated phosphorylation of p65, p38, JNK, and ERK. Mice with LPS-induced-sepsis who were treated with BPF had lower serum levels of IL-6, TNF-α, IL-1β, CXCL1, and CXCL2 than the control mice treated with BPF. Histopathology revealed that BPF treatment alleviated LPS-induced lung damage. In addition, in mice given a lethal dose of LPS, BPF treatment showed a dose-dependent improvement in survival rates. BPF treatment dose-dependently inhibited the LPS-induced IL-6, TNF-α, and CXCL1 production in peritoneal macrophages. BPF treatment also dose-dependently improved the survival rates in mice with CLP-induced sepsis. These results show that BPF alleviates LPS-stimulated septic conditions and protects mice from CLP-induced sepsis. Our research marks BPF as a potential drug in the treatment of sepsis and various inflammatory diseases.

TREM-1 induces pyroptosis in cardiomyocytes by activating NLRP3 inflammasome through the SMC4/NEMO pathway.

Sepsis often causes cell death via pyroptosis and hence results in septic cardiomyopathy. Triggering receptors expressed in myeloid cells-1 (TREM-1) may initiate cellular cascade pathways and, in turn, induce cell death and vital organ dysfunction in sepsis, but the evidence is limited. We set to investigate the role of TREM-1 on nucleotide-binding oligomerization domain-like receptors with pyrin domain-3 (NLRP3) inflammasome activation and cardiomyocyte pyroptosis in sepsis models using cardiac cell line (HL-1) and mice. In this study, TREM-1 was found to be significantly increased in HL-1 cells challenged with lipopolysaccharide (LPS). Pyroptosis was also significantly increased in the HL-1 cells challenged with lipopolysaccharide and an NLRP3 inflammasome activator, nigericin. The close interaction between TREM-1 and structural maintenance of chromosome 4 (SMC4) was also identified. Furthermore, inhibition of TREM-1 or SMC4 prevented the upregulation of NLRP3 and decreased Gasdermin-D, IL-1β and caspase-1 cleavage. In mice subjected to caecal ligation and puncture, the TREM-1 inhibitor LR12 decreased the expression of NLRP3 and attenuated cardiomyocyte pyroptosis, leading to improved cardiac function and prolonged survival of septic mice. Our work demonstrates that, under septic conditions, TREM-1 plays a critical role in cardiomyocyte pyroptosis. Targeting TREM-1 and its associated molecules may therefore lead to novel therapeutic treatments for septic cardiomyopathy.

Electrochemiluminescence in paired signal electrode (ECLipse) enables modular and scalable biosensing.

Electrochemiluminescence (ECL) has an inherently low background and enables precise chemical reactions through electrical control. Here, we report an advanced ECL system, termed ECLipse (ECL in paired signal electrode). We physically separated ECL generation from target detection: These two processes were carried out in isolated chambers and coupled through an electrode. The strategy allowed us to minimize cross-chemical reactions, design electrodes for high ECL signals, and integrate multiple sensors in a chip. As a proof of concept, we implemented an eight-plex ECLipse and applied it to detect host factors in human plasma. ECLipse achieved higher signal-to-noise ratio than conventional ECL assays and was >7000-fold more sensitive than enzyme-linked immunosorbent assay. In a pilot clinical study, we could detect septic conditions by measuring host factors [i.e., interleukin-3 (IL-3), IL-6, and procalcitonin (PCT)]. ECLipse assay further revealed distinct IL-3 and IL-6 patterns in patients with severe acute respiratory syndrome coronavirus 2 infection.

Manipulation of Nitric Oxide Levels via a Modified Hydroxyethyl Starch Molecule

IntroductionAlthough the improving effect of nitric oxide (NO) donors has experimentally been demonstrated in shock, there are still no NO donor medications clinically available. Thiol-nitrosothiol-hydroxyethyl starch (S-NO-HES) is a novel molecule consisting of NO coupled to a thiolated derivative of hydroxyethyl starch (HES). It was aimed to assess the ability of S-NO-HES to serve as an NO donor under a variety of in vitro simulated physiologic conditions, which might be the first step to qualify this molecule as a novel type of NO donor-fluid. MethodsWe studied the effect of temperature on NO-releasing properties of S-NO-HES in blood, at 34°C, 37°C, and 41°C. Ascorbic acid (Asc) and amylase were also tested in a medium environment. In addition, we evaluated the activity of S-NO-HES in the isolated aortic ring and Langendorff-perfused heart setup. ResultsThe NO release property of S-NO-HES was found at any temperature. Asc led to a significant increase in the production of NO compared to S-NO-HES incubation (P < 0.05). The addition of amylase together with Asc to the medium further increased the release of NO (P < 0.05). S-NO-HES exerted significant vasodilatory effects on phenylephrine precontracted aortic rings that were dose-dependent (P < 0.01). Furthermore, S-NO-HES significantly increased the heart rate and additionally reduced the duration of the cardiac action potential, as indicated by a reduction of QTc-B values (P < 0.01). ConclusionsWe demonstrated for the first time that the S-NO-HES molecule exhibited its NO-releasing effects. The effectiveness of this new NO donor to substitute NO deficiency under septic conditions or in other indications needs to be studied.

Necrotising Fasciitis following Intramuscular Injection in a Nigerian Neonate: A case report

Necrotizing fasciitis (NF) is a rare but severe, life-threatening bacterial infection of the fascia, with secondary necrosis of the subcutaneous tissues. Necrotizing fasciitis is caused by an infection of the skin, subcutaneous tissue, and fascia by one or more bacterial organisms, resulting in the death of these tissues. NF is rare in neonates, but it has been reported following omphalitis, balanitis, mastitis, and postoperative complications. The mortality in neonates with necrotizing fasciitis has been reported to be as high as fifty per cent. We report a case of NF in a term male neonate with an intramuscular injection at the left shoulder at birth under suspected septic conditions. The wound swab yielded Escherichia coli and Pseudomonas species, while the blood culture yielded Staphylococcus aureus and Pseudomonas species. The infant received antibiotics, and the wound was debrided. He was discharged after sixteen days of hospitalization. This case is reported to highlight the possible role of injections under septic conditions as a risk for necrotizing fasciitis in the newborn. Health workers are encouraged to ensure aseptic skin preparation before injections.

Tissue Oxygenation Measurement in Patients with Sepsis Compared to the Lactate Levels and Hemodynamical Monitoring

&#x0D; &#x0D; &#x0D; Near-infrared spectroscopy (NIRS) is a noninvasive method for measuring tissue oxygenation. The method allows for monitoring tissue perfusion in shock by revealing tissue hemoglobin oxygen saturation (StO2). The current study aims to compare tissue oxygenation levels with hemodynamical monitoring and lactate levels in patients in severe shock. Study encompasses 19 patients treated in intensive care unit (ICU) at Alexandrovska University Hospital. Ten of the patients cover the criteria for severe sepsis, the remaining nine patients have no data for septic condition. In both groups of patients tissue oxygenation levels measured with INVIOS monitor, mean arterial pressure (MAP), oxygen saturation in mixed venous blood (SvO2) and lactate levels within 72 h of intensive care unit admission are compared. The patients with severe sepsis have significantly lower levels of StO2 in comparison with patients without sepsis. Tissue oxygenation levels correspond to the mean arterial pressure levels, oxygen saturation in mixed venous blood. StO2 levels in the current study do not correlate significantly with the lactate levels in patients with sepsis. Near-infrared spectroscopy as StO2 levels correlate with the hemodynamical monitoring in patients with severe sepsis, but do not correlate significantly with the severity of the disease. This data might indicate that tissue oxygenation monitoring has clinical significance in patients with sepsis. Further profound studies are necessary for assessing the role of tissue oxygenation monitoring in the early phase of resuscitation in septic patients.&#x0D; &#x0D; &#x0D;

SIADH &amp; Diabetes insipidus: Neues zu Diagnosestellung und Therapie

Dysnatremia is a common occurrence in patients with COVID-19 and is associated with higher mortality and risk for septic conditions. The pathomechanisms are probably multifaceted, but severe hyponatremia may also occur as a result of underlying SIADH or hypocortisolism. Patients with preexisting AVP dysfunction, like SIADH or diabetes insipidus, are at high risk for severe electrolyte imbalances in the event of a COVID-19 infection.The recently growing use of immune checkpoint inhibitors in oncology is associated with a spectrum of endocrine immune-related adverse events (endocrine irAEs). These AEs usually occur unpredictably and may even manifest after discontinuation of the anticancer therapy. Hyponatremia is a common factor of several endocrine irAEs and may serve as a red flag biomarker for possibly underlying endocrine irAEs such as hypophysitis or adrenalitis. New-onset hyponatremia should always prompt a comprehensive diagnostic workup and exclusion of endocrine irAEs before the diagnosis of SIADH is made.Hyponatremia with severe symptoms should be treated with hypertonic (3 %) saline solution to resolve the cerebral edema and prevent from detrimental neurological sequelae. Both rapid intermittent bolus (RIB) therapy and continuous infusion therapy have now been reported to be safe and equally effective. The RIB therapy limits the risk of overcorrection and requires less often re-lowering treatment than continuous infusion therapy.Fluid restriction has long been considered as first-line treatment of chronic hyponatremia due to SIADH. Additional treatment with Furosemid and/or oral NaCl tablets does not improve efficacy but reduces tolerance to therapy.Copeptin-based dynamic tests show higher diagnostic accuracy in the differential diagnosis of patients with hypotonic polyuria polydipsia syndrome than the indirect water deprivation test.

A rare case of posttraumatic aortic rupture, treated with an endovascular stent graft implantation and complicated with esophageal rupture

BackgroundEsophageal necrosis and perforation after thoracic endovascular aortic repair (TEVAR) for ruptured traumatic aortic aneurysm is extremely rare. It is difficult to manage, and patients rarely survive without treatment. Although, there is no certain consensus in relation with the optimal treatment we present a subsequent successful management of both life-threatening conditions.Case presentationA 52-year-old man experienced a blunt chest trauma after motor vehicle collision with mild symptoms of pain and fractured ribs. On the 12th day he had severe chest pain and computed tomography (CT) revealed a ruptured traumatic thoracic aortic aneurysm with massive mediastinal hematoma. An emergency thoracic endovascular aortic repair (TEVAR) was performed. Several days later the patient developed a fever. CT suspected a pneumomediastinum, a sign of esophageal rupture, but no confirmation from esophagography and esophagoscopy was achieved. Because of deteriorated septic condition, patient was referred for exploratory thoracotomy. The rupture was found and esophagectomy was performed, with an esophagostomy and gastrostomy to enable enteral nutrition. Almost one year after the esophagectomy, gastric conduit reconstruction through the retrosternal route was performed. The patient was still alive and symptom-free more than 1 year after the reconstruction and no infection of the stent graft was observed.ConclusionWe successfully managed a rare case of esophageal necrosis after TEVAR for ruptured traumatic thoracic aortic aneurysm. It is essential to diagnose the esophageal necrosis at an early stage and provide appropriate treatment to increase survival.

Readmission after pancreaticoduodenectomy: Birmingham score validation

BackgroundThe Birmingham score predicts the risk of hospital readmission after pancreaticoduodenectomy (PD). This study aimed to validate the risk score in a different healthcare cohort. MethodsFrom 2017 to 2021, 301 patients underwent PD. The Birmingham score was applied to 276 patients. Postoperative deceased patients (n = 7) or those requiring a completion of pancreatectomy (n = 18) were excluded. ResultsForty-seven (17%) patients were readmitted after a median delay of 9 (range 1–49) days and stayed for 5 (range 1–27) days; 4 (8.5%) died during the hospital stay. The leading cause of readmission was a septic condition (53%), mostly resolved by medical treatment (77%). A multivariate analysis identified the occurrence of a clinically relevant postoperative pancreatic fistula, the score criteria, and the score itself as independent factors favouring readmission. Readmission rates in patients with low [n = 97 (35%)], intermediate [n = 98 (36%)], and high [n = 81 (29%)] scores were 5%, 17%, and 31%, respectively (P < 0.01). ConclusionThis study confirmed the relevance and robustness of the Birmingham risk score. Patients with a high risk of readmission after PD, identified based on the score, were discharged to a partnership medical centre close to the pancreatic centre to plan readmission and avoid futile unplanned hospitalisation.

Bacteriological Contamination of Groundwater Affected by Septic Tanks Condition in Koto Tangah District, Padang, Indonesia

Introduction: Padang City Sanitation Working Group reported that 34.32% of households in Padang City use unsafe latrines with septic tanks that still do not meet the standards which potentially causes the wastewater from the septic tanks to contaminate the water of the wells. This study was conducted to analyse the effects of the septic tank condition on the microbiological quality parameters of the well-water, namely total coliform and Escherichia coli in Koto Tengah District, Padang. Methods: This study uses a quantitative research method. The data were collected by questionnaires, observation, interviews, and laboratory tests. Water sampling was collected by using the purposive sampling method where the water is taken from 20 wells originating from 10 coastal and 10 non-coastal areas. Results and Discussion: Total coliform was found in all samples, while Escherichia coli was found in two samples from coastal and five from non-coastal regions. The septic tank condition had a strong correlation with the total coliform concentration (r= -0.531) and affected the total coliform concentration in the well-water by 30.8%. However, the Escherichia coli concentration was not related and not affected by the condition of the septic tank (p&gt;0.05). There was no significant difference in the concentration of the microbiological parameters in the coastal and non-coastal areas. Conclusion: The microbiological quality of the well-water did not comply with the quality standards to be used as water sources for the community. The total coliform concentration in the well-water was shown to have a close relationship with the septic tank's condition.

Open Anterior Component Separation for Complex Incisional and Ventral Hernias—When and How? Case Series Analysis

Abstract Closing the midline in patients with incisional hernias is the cornerstone for a functional reconstruction with low morbidity, low recurrence rates, and good cosmetic results, which is the ideal outcome for every hernia surgeon. However, in patients with large hernias (usually over 10 cm width) or in loss of domain cases, this goal is difficult to achieve. Anterior component separation with or without mesh reinforcement has been the procedure of choice for these patients despite its high rate of wound complications. The goal of our study is to evaluate the opportunity and necessity of the anterior component separation in patients with complex incisional or ventral hernias (defects larger than 10 cm, infected meshes). Data of patients with large incisional/ventral hernia operated using anterior component separation technique in the past 10 years were re-visited and analyzed from hospital records between January 2012 and December 2020. Demographic data (age, gender, body mass index, ASA score) and the main steps of the technique were recorded. Data were reported as mean and standard deviation. We used the anterior component separation in 66 cases, mainly for septic conditions (open abdomen, chronic and extended infections of the abdominal wall, chronic-infected meshes). For large parietal defects with aseptic local condition, we used mesh-reinforced anterior component separation (five patients). Mean age was 68.7 years. Among them, 29 patients developed wound complications (hematoma, seroma, infection). Mean hospital stay was 12.6 days. Recurrence was 18% in patients without mesh and zero in patients with mesh reinforcement after a minimum one-year follow-up. Anterior component separation is still a valid procedure in patients with large abdominal defects especially when a septic wound is to be closed. For large parietal defects, if a wide subcutaneous dissection is required, mesh-reinforced anterior component separation remains a valid alternative in abdominal wall reconstruction in certain cases (mainly aseptic conditions).

Molecular study of epstein Barr virus among patients with malignant diseases in al Najaf and Diwaniyah governorates

The present study is an effort to study the Epstein-Barr virus and it is relationship to the different types of cancers and their relationship to the virus and to the demographic distribution of the patients. our study started from Sep 2019 to Dec 2020 , blood samples were collected (2 ml of venous blood) were drawing by disposable syringe under a septic conditions. From patients with age grouped more 13 years old , represented by 47 specimens that subjected to molecular examination in Nested PCR technique detecting EBV LMP-1 in patients' blood as a main route. The study has included patients with different types of cancers from different areas. 47 specimens submitted to molecular examination, polymerase chain reaction (PCR) and nested PCR. Where EBV LMP-1 detected in 20 positive Specimens. All the virus isolates were sent to NCBI-BLAST to confirm the variation of the isolates. The study summarize that there is a strong relationship between EBV and some cancer diseases and show no significant difference according to age or gender or hereditary.

FORECASTING OF PREECLAMPSIA DEVELOPMENT

Preeclampsia (PE) is one of the most important problems in modern obstetrics. Togetherwith obstetric bleeding and septic conditions, it constitutes the so-called «fatal triad»,and in 18 % of cases it is the cause of antenatal fetal death.The аim of the research – to study the risk factors for preeclampsia development.Materials and methods. The main group consisted of 48 women with PE (main group).Of them, 20 were with mild PE (group I), 16 had a moderate PE (group II), 12womenwere with severe PE (group III). The control group included 20 healthy pregnant women.The severity degree of PE was judged by clinical data and laboratory examination results.The state of the intrauterine fetus was assessed according to the data of cardiotocography,ultrasound diagnostics, the biophysical profile of the fetus, doplerometry.Results. In pregnant women with PE, the frequency of a burdened obstetric andgynecological history (52.08 %) was significantly higher than in the control group (5 %)(p&lt;0.01). It is noteworthy that PE developed more often in primigravida – 30 (62.5 %)and in young women – 10 (20.83 %). In 30 examined women (62.5 %) PE proceededagainst a background of extragenital pathology. In pregnant women of the main groupwith diseases of kidneys (20 (41.67 %)), cardiovascular system (15 (31.25 %)), metabolicdisorders (12 (25 %)) henceforth PE of moderate and severe degree has developed. Inwomen with severe PE, the frequency of complications of pregnancy and childbirth istwice as high as in women with moderate PE (p&lt;0.05).Conclusions. A prerequisite for PE is a dysfunction of the hypothalamic- pituitary-ovariansystem. PE is more common in young women and in nulliparous women. Women with PE areat risk for miscarriage. Chronic kidney disease, vascular and endocrine pathology, metabolicsyndrome can be considered to be the main risk factors for PE development. The course ofpregnancy and childbirth in women with PE is accompanied by the development of variouscomplications. The greater the PE severity, the greater the frequency of complications.

In-hospital Mortalities in General Surgery Unit, Korle Bu Teaching Hospital

Background: In-hospital mortality data is an invaluable resource that has been employed over the years to assess the quality of care provided to patients.Materials and Methods: A retrospective study was carried out from January 1999 to December 2012. Data was collected from theinformation sheets provided by the Department of Surgery for the monthly morbidity and mortality meetings. Information extracted included the total number of admissions and deaths, the demography of the deaths, duration of admission, diagnosis and causeof death.Results: Total admissions were 37,034 with 2033 deaths giving a mean crude mortality rate of 5.5%. Detailed analysis in this study was based on 2011 cases whose complete data was available. Males accounted for 1074 (53.4%) and females 937 (46.6%). Their mean age was 53.8 ±18.6 years. Malignancies were 890 (44.3%) whilst non-malignant conditions were 1121 (55.7%). Of the non-malignant cases 1007 (89.9%) were emergency or urgent. The most frequent malignant conditions were breast cancer 204 (22.9%), colorectal cancer 144 (16.2%), pancreatic cancer 133 (14.9%) and gastric cancer 130 (14.6%); while that for the non-malignant conditions were diabetic septic conditions 219 (19.5%), gastro-intestinal bleeding 136 (12.1%), typhoid perforation 76 (6.8%) and perforated peptic ulcer 75(6.7%). The overall median length of stay was 7 days, Interquartile Range (IQR),was 2-16 days. Nonmalignant cases stayed shorter compared with the malignant cases, 5 as against 9 days, z = -8.9, Asymp. Sig. (2-sided) of 0.0001. Septicaemia and septic shockcombined were the commonest cause of death in 719 (35.8%) cases, followed by metastatic tumour - 629 (30%).Conclusion: Death was inevitable in a large proportion of the cases admitted to the General Surgery unit of Korle-Bu Teaching Hospital largely because of the nature of the surgical pathology at presentation.

The role of nitric oxide in sepsis-associated kidney injury.

Sepsis is one of the leading causes of acute kidney injury (AKI), and several mechanisms including microcirculatory alterations, oxidative stress, and endothelial cell dysfunction are involved. Nitric oxide (NO) is one of the common elements to all these mechanisms. Although all three nitric oxide synthase (NOS) isoforms are constitutively expressed within the kidneys, they contribute in different ways to nitrergic signaling. While the endothelial (eNOS) and neuronal (nNOS) isoforms are likely to be the main sources of NO under basal conditions and participate in the regulation of renal hemodynamics, the inducible isoform (iNOS) is dramatically increased in conditions such as sepsis. The overexpression of iNOS in the renal cortex causes a shunting of blood to this region, with consequent medullary ischemia in sepsis. Differences in the vascular reactivity among different vascular beds may also help to explain renal failure in this condition. While most of the vessels present vasoplegia and do not respond to vasoconstrictors, renal microcirculation behaves differently from nonrenal vascular beds, displaying similar constrictor responses in control and septic conditions. The selective inhibition of iNOS, without affecting other isoforms, has been described as the ideal scenario. However, iNOS is also constitutively expressed in the kidneys and the NO produced by this isoform is important for immune defense. In this sense, instead of a direct iNOS inhibition, targeting the NO effectors such as guanylate cyclase, potassium channels, peroxynitrite, and S-nitrosothiols, may be a more interesting approach in sepsis-AKI and further investigation is warranted.