Signs Of Multiple Organ Failure Research Articles

Prenatal transmission of severe acute respiratory syndrome coronavirus 2, resulting in neonatal severe acute pneumonia, from an asymptomatic mother: a case report

BackgroundWe report a case of prenatal coronavirus disease 2019, which evolved 6 days after birth into severe pneumonia with signs of multiple organ failure, in a mother with asymptomatic coronavirus disease 2019.Case presentationAt minute 11 of life, our patient from Afro-Caribbean had polypnea with mild signs of struggle; Silverman’s index was scored at three. Chest radiography showed bilateral opacities consistent with respiratory distress syndrome. On the 6th day of life, a thoracic computed tomography scan showed bilateral parenchymatous lesions (10–20%) in ground glass, compatible with coronavirus disease 2019-type infection. At the same time, the neonate showed signs of multiple organ failure (elevated liver and cardiac enzyme levels). She was treated with azithromycin (20 mg/kg/day) for 5 days. All the signs recovered fully by day 12. Real-time polymerase chain reaction results were positive in the first 30 min of life, suggesting prenatal transmission. Our patient has been followed until 2 years old and is developing well with no sequelae.ConclusionThis case report demonstrates the incompatibility between maternal asymptomatic coronavirus disease 2019 and severe neonatal lung involvement. We emphasize the need for vigilance to avoid missing the most severe forms of neonatal coronavirus disease 2019.

Breast cancer with scalp metastases: a case report

BackgroundWhile breast cancer is the most common cancer in women, cutaneous metastases are rare in breast cancer. Additionally, scalp involvement in breast cancer metastasis is extremely rare. That being said, scalp lesions should always be thoroughly investigated to distinguish metastatic lesions from other neoplasms.Case presentationA 47-year-old female Middle-Eastern patient presented with metastatic breast cancer in the lungs, bone, liver, and brain with no signs of multiple organ failure, in addition to cutaneous metastases, including the scalp. Between 2017 and 2022, she was managed through modified radical mastectomy, radiotherapy, and several lines of chemotherapy. She presented in September of 2022 with enlarging scalp nodules, which started developing 2 months prior to her presentation. Physical examination revealed firm, non-tender, and immobile skin lesions. Magnetic resonance imaging scan of the head showed soft tissue nodules in different sequences. A punch biopsy was taken from the largest scalp lesion and showed metastatic invasive ductal carcinoma. A panel of immunohistochemistry stains was applied, because a single specific marker for differentiating primary cutaneous adnexal tumors or other malignant neoplasms from breast cancer has not yet been identified. The panel showed positive estrogen receptor 95%, progesterone receptor 5%, negative human epidermal growth factor receptor 2, positive GATA binding protein 3, positive cytokeratin-7, negative P63, and negative KIT (CD117).ConclusionBreast cancer metastases to the scalp are extremely uncommon. When a scalp metastasis is present, it might be the only symptomatic sign of disease progression or widespread metastatic lesions. However, such lesions warrant a comprehensive radiologic and pathologic workup to rule out other possibilities of skin pathologies, such as sebaceous skin adenocarcinoma as it effects the management plan.

THE SIGNIFICANCE OF PLATELET-DERIVED GROWTH FACTOR CONCENTRATIONS IN ENDOTHELIOTROPIC NATURAL FOCI INFECTIONS

In recent years, the clinical symptomatology of Astrakhan spotted fever and coxiellosis has worsened. The pathogenesis of these two natural focal, endothelium-dependent infections is rather complicated, multifactorial and not properly studied. The current clinical symptomatology is characterized by severe intoxication syndrome, frequently signs of multiple organ failure, development of hemocoagulation and vascular complications [3, 4, 5]. To date, no early markers of endothelial vascular damage have been proposed for use in practical health care, which enable accurately assessing the severity degree and predicting the further course of the rickettsiae and coxiellosis. Platelet-derived growth factor (PDGF), which is widely used in the diagnosis and prognosis of cardiovascular diseases, various injuries and diabetes mellitus, may become such a marker.

Organ changes after SARS-CoV-2 infection in a patient with systemic sclerosis according to autopsy

The article presents a description of a clinical case with a fatal outcome due to SARS-CoV-2 coronavirus-induced bilateral viral pneumonia with areas of pneumofibrosis, complicated by acute respiratory failure. The presence of systemic sclerosis in this patient aggravated the course of the disease and became one of the causes of death. Autopsy revealed signs of bilateral pneumonia with lesions in both lungs and areas of pneumofibrosis.Histological examination revealed alveoli with rupture of interalveolar septa, areas of atelectasis, serous-purulent exudate with desquamated alveolocytes, places with organization of exudate, zones of pneumofibrosis. Scleroderma cardiosclerosis, linear necrosis of cardiomyocytes were present in the heart. There were signs of multiple organ failure – pulmonary edema, cerebral edema.

СASE STUDY OF HEPATO-RENAL FAILURE IN A PATIENT AFTER ORTHOTOPIC HEART TRANSPLANTATION

Introduction. Heart transplantation remains the only radical treatment for end-stage heart failure (HF). Liver and / or renal dysfunction is common in patients with HF, which is also exacerbated by the use of artificial circulation and immunosuppressive therapy, and leads to postoperative complications and mortality. Case description. Patient P., 49 years old, after orthotopic heart transplantation was admitted to the intensive care unit (ICU) with signs of multiple organ failure. Graft rejection syndrome was suspected, but was not confirmed after the detailed clinical and laboratory examinations and according to the myocardial biopsy. Because of severe renal and hepatic insufficiency, patient at the ICU started to receive hemodiaultrafiltration with a flow of 190 ml/min; ultrafiltration – 100 ml/h. The condition, that developed was due to the direct effect of tacrolimus as the patient had a critically high plasma concentration of this drug (> 30 ng / ml) after the standard recommended postoperative dose (0.2 mg / kg per day). According to the literature, the elimination of the tacrolimus is provided by the liver, with microsomal cytochrome P450 3A4. Thus, the patient most likely had a failure of hepatic metabolism. Conclusion: Because of the systemic toxicity of tacrolimus, it is important to monitor its concentration after the first dose. Diagnosis of metabolic disorders at an early stage will prevent further systemic toxicity of tacrolimus. Efferent methods at ICU are the important tools for the correction of hepatic and renal insufficiency throughout toxic effects of tacrolimus.

Verified chronic severe giant cell myocarditis: an inevitable choice for heart transplantation

Myocarditis has polymorphic clinical manifestations and is one of the main causes of heart transplantation. We present a clinical case of a 43-year-old female patient who was admitted to the clinic with biventricular heart failure (NYHA class 3–4). She periodically noted exacerbations of bronchitis against the background of prolonged smoking. Twenty-one months prior to hospitalization, she first noted a shortness of breath without an obvious connection with the infection. Her ejection fraction (EF) decreased to 34%, pleural and pericardial effusion was revealed. Coronary angiography found no abnormalities. However, MRI showed subendocardial contrasting of the left ventricular (LV) apex. The diagnosis was myocarditis. Within six months, the patient received therapy with 30 mg/day prednisolone and cardiotropic therapy. Her shortness of breath intensified, and the lower extremities swelled. Examination in the clinic showed a sharp decrease in QRS voltage, QS complexes in the V1–V6 leads, dilation of all heart chambers, thrombus in the LV apical aneurysm, 16% EF, 3.9 cm VTI, 454 mmHg dp/dt, and a sharp increase in anticardiac antibody titers (up to 1:320). Endomyocardial biopsy was not performed due to the patient’s rapidly deteriorating condition, the need for cardiotonics, and signs of multiple organ failure. She was transferred to Shumakov National Medical Research Center of Transplantology and Artificial Organs, where extracorporeal membrane oxygenation was performed; orthotopic heart transplant was successfully performed. The patient’s condition was stable for the next year. Investigation of the explanted heart revealed a picture of giant cell myocarditis. Issues of diagnosis, possibility of a long-term chronic course, as well as methods of treatment of this variant of myocarditis, including the key role of heart transplantation, are discussed.

Occult bacteremia as a manifestation of invasive pneumococcal infection

Objective. To describe a case of occult bacteremia caused by Streptococcus pneumoniae. Results . A 1 year and 1 month old child was diagnosed with pneumococcal infection without a focus of infection. After examination of the child, the doctors excluded foci of infection characteristics of pneumococcal infection, and the discharge of St. pneumoniae from the blood enabled to diagnose occult bacteremia. Despite bacteremia and signs of systemic inflammatory response, the absence of severe clinical manifestations and signs of multiple organ failure gave grounds to exclude sepsis. Conclusion. This case demonstrates that bacteriological blood test in children with fever and without a focus of infection with pronounced inflammatory changes in the blood has important diagnostic value and helps to prescribe effective specific antibacterial therapy.

Sepsis like a severe complication of autoimmune liver disease in gastroenterological patients

In article we present particular qualities of disease pattern and methods of treatment in patients with ulcer colitis associated with primary sclerosing cholangitis and autoimmune hepatitis. Course of disease was complicated by bacterial cholangitis, sepsis, multiple organ failure. There are described pathogenetic features of autoimmune livers and bowel illness. It was shown the role of bacterial translocation of microbes. There are described about differential diagnostic of primary and secondary cholangitis. Features of curing the patients are reminded in critical conditions are reviewed in article. There sketched role of glucocorticosteroids in critical care. Modern guidelines for the management the patients with overlap syndrome are highlighted. Patient D. was admitted to hospital in intensive care unit. There disease patterns of collapse, systemic inflammation response syndrome. The examination was established exacerbation of ulcer colitis complicated inflectional morbidity with sclerosing cholangitis and autoimmune hepatitis. This condition led to sepsis and multiple organ failure. Instead of intensive care there was a progressive deterioration until near death experience. Resuscitation procedure within 6 minutes were successful. Multiple areas of necrosis have developed on the limbs because of multiple organ failure and intensive vasopressors therapy. Glucocorticosteroids were prescribed in combination with antibacterial drugs were assigned because of ulcerative colitis’s exacerbation and cytolysis, regardless sepsis. On the thirtieth day of stay in hospital, the patient D. was transferred from the intensive care unit to the gastroenterology department, where the treatment was continued. Because of the cure signs of multiple organ failure, infectious complications, exacerbation of ulcerative colitis and primary sclerosing cholangitis were regressed. We supervise of patient.

THE IMPORTANCE OF INDIVIDUAL CLINICAL AND LABORATORY INDICA - TORS IN THE DIFFERENTIAL DIAGNOSIS OF POSTPARTUM SEPTIC COMPLI - CATIONS

Aims: To perform a comparative analysis of individual clinical and laboratory indicators in the differential diagnosis of conditionally limited and generalized forms of postpartum septic complications. Methods: The study included 34 patients at Gynecology Department of the Zaporizhzhia Regional Clinical Hospital from 2013 to 2016 with postpartum purulent-septic diseases. Patients were divided into 2 groups. Group I consisted of 15 women who were diagnosed with a conditionally limited postpartum purulent-inflammatory disease (endometritis). Group II included 19 women with generalized forms of postpartum purulent-inflammatory diseases (peritonitis, sepsis). For the diagnosis of Multiple Organ Failure due to sepsis, we used the Sequential (Sepsis-Related) Organ Failure Assessment and quick Sequential (Sepsis-Related) Organ Failure Assessment. The differences between the first and second group were assessed by using the Mann-Whitney U test and STATISTICA Version 10. Results: Body temperature was increased in all 34 patients. The average heart rate in group I was 91.6 ± 8.35 beats/ min and 102.26 ± 16.42 beats/min in group II. The average respiratory rate was 19.07 ± 2.49 breaths/min in group I and 24.16 ± 5.09 breaths/min in group II. In group I, none of the patients scored a total of two or more points on the Sequential (Sepsis-Related) Organ Failure Assessment and quick Sequential (Sepsis-Related) Organ Failure Assessment scales; in group II, there were 5 (26.32%) patients who had scored two points or more on the Sequential (Sepsis-Related) Organ Failure Assessment scale; and 2 (10.53%) patients had scored 2 points or more in the quick Sequential (Sepsis-Related) Organ Failure Assessment scale. Conclusion: Clinical cases of postpartum period with inflammation of uterus and signs of multiple organ failure should be; regarded as a septic state, assessed by the Sequential (Sepsis-Related) Organ Failure Assessment scale as they require urgent medical help.

Intra-abdominal pressure monitoring in postoperative period in patients with diffuse peritonitis

Epidemiology, etiology, pathologic and morphologic changes associated with increased intra-abdominal pressure are described. The most common ways of its measuring and monitoring are presented. Intra-abdominal pressure is increased by more than 15 mm Hg in patients with diffuse peritonitis. Increased intra-abdominal pressure is associated with the disease severity: the higher the intra-abdominal pressure, the more severe is the disease. If intra-abdominal pressure is increased over 20 mm Hg, treatment strategy depends on the signs of organ failure. In the absence of organ failure, intra-abdominal pressure should be monitored every 4 hours as long as the patient is in critical condition. Intra-abdominal pressure monitoring in case of peritonitis must be attributed to the mandatory manipulation, as pressure changes precede the clinical manifestations of intra-abdominal complications. Measurement of intra-abdominal pressure allows to detect the early signs of multiple organ failure, which is essential for the correction of systemic complications in pancreatogenic peritonitis. In this case, monitoring of intra-abdominal pressure in diffuse postoperative peritonitis should be considered only as a screening test for assessing of the organ dysfunction severity, as the development of multiple organ dysfunction syndrome involves complex pathophysiological mechanisms. Predictions that are more accurate can be made using such integrated indicators as APACHE II (Acute Physiology And Chronic Health Evaluation scale, which is used for assessing various acute and chronic diseases), SAPS (Simplified Acute Physiology Score - a simplified scale for acute functional changes assessment), SOFA (Sepsis-related Organ Failure Assessments Score - scale for dynamic assessment of organ failure in sepsis), MPI (Mannheim Peritonitis Index) scales.

Venoarterial Extracorporeal Membrane Oxygenation Support for Refractory Cardiovascular Dysfunction During Severe Bacterial Septic Shock*

Profound myocardial depression can occur during severe septic shock. Although good outcomes of venoarterial extracorporeal membrane oxygenation-treated children with refractory septic shock have been reported, little is known about adults' outcomes. This study was designed to assess the outcomes and long-term health-related quality-of-life of patients supported by venoarterial extracorporeal membrane oxygenation for refractory cardiac and hemodynamic failure during severe septic shock. A retrospective, single-center, observational study and a cross-sectional survey to assess health-related quality of life by the Short Form-36 questionnaire and frequencies of anxiety, depression and posttraumatic stress disorder symptoms by the Hospital Anxiety and Depression Scale and the Impact of Event Scale, respectively. A 26-bed tertiary intensive care unit in a university hospital. We evaluated the outcomes of patients who received venoarterial extracorporeal membrane oxygenation rescue therapy for refractory cardiovascular failure during bacterial septic shock. Results are expressed as medians (range). From January 2008 to September 2011, 14 patients, 45 years old (28-66), seven males, none with a history of left ventricular dysfunction, received venoarterial extracorporeal membrane oxygenation for septic shock refractory to conventional treatment, 24 hours (3-108) after shock onset. All exhibited severe myocardial dysfunction at extracorporeal membrane oxygenation implantation. Left ventricular ejection fraction was 16% (10% to 30%), cardiac index was 1.3 L/min/m (0.7-2.2 ) and systemic resistance vascular index was 3162 (2047-7685). All were receiving high-dose catecholamines and had signs of multiple organ failure: pH 7.16 (6.68-7.39), blood lactate 9 (2-17) mmol/L, PaO2/FIO2 87 (28-364), Simplified Acute Physiology Score III 84 (75-106) and Sepsis-Related Organ Failure Assessment score 18 (8-21). Twelve patients (86%) could be weaned off venoarterial extracorporeal membrane oxygenation after 5.5 days (2-12) days of support and 10 patients (71%) were discharged to home and were alive after a median follow-up of 13 months (3-43). All 10 survivors had normal left ventricular ejection fraction and reported good health-related quality of life at long-term follow-up. Venoarterial extracorporeal membrane oxygenation rescued more than 70% of the patients who developed refractory cardiovascular dysfunction during severe bacterial septic shock. Survivors reported good long-term quality of life. Venoarterial extracorporeal membrane oxygenation might represent a valuable therapeutic option for adults in severe septic shock with refractory cardiac and hemodynamic failure.

Tissue Plasminogen Activator–Assisted Hematoma Evacuation to Relieve Abdominal Compartment Syndrome After Endovascular Repair of Ruptured Abdominal Aortic Aneurysm

To describe our experience with a novel technique to decompress abdominal compartment syndrome after endovascular aneurysm repair (EVAR) of ruptured abdominal aortic aneurysm (rAAA). From January 2003 to April 2010, 13 patients (12 men; mean age 75 years) treated for rAAA with EVAR underwent tissue plasminogen activator (tPA)-assisted decompression for intra-abdominal hypertension. All of the patients but one had intra-abdominal pressure >20 mmHg, with signs of multiple organ failure or abdominal perfusion pressure <60 mmHg. With computed tomography guidance, a drain was inserted into the retroperitoneal hematoma, and tPA solution was injected to facilitate evacuation of the coagulated hematoma and decrease the abdominal pressure. In the 13 patients, the mean intra-abdominal pressure decreased from 23.5 mmHg (range 12-35) to 16 mmHg (range 10-28.5). A mean 1520 mL (range 170-2900) of blood was evacuated. Urine production (mean 130 mL/h, range 50-270) increased in 7 patients at 24 hours after tPA-assisted decompression; among the 5 patients in which urine output did not increase, 3 underwent hemodialysis by the 30-day follow-up. One patient did not respond with clinical improvement and required laparotomy. The 30-day, 90-day, and 1-year mortality was 38% (5/13 patients); none of the deaths was related to the decompression technique. tPA-assisted decompression of abdominal compartment syndrome after EVAR can decrease the intra-abdominal pressure and could be useful in preventing multiple organ failure. It is a minimally invasive technique that can be used in selected cases but does not replace laparotomy or retroperitoneal surgical procedures as the gold standard treatments.

Atypical haemolytic uremic syndrome complicated by microangiopathic antiphospholipid-associated syndrome

A 4-year-old boy with an atypical course of haemolytic uremic syndrome (HUS), who developed microangiopathic antiphospholipid-associated syndrome (MAPS) with signs of multiple organ failure during the course of his disease, is reported. Early and aggressive treatment with intravenous gammaglobulin, pulse methylprednisolone and plasmapheresis resulted in an excellent clinical recovery. Our patient showed a concomitant presence of multiple factors that could precipitate atypical HUS, including positive antiphospholipid antibodies, decreased level of factor H and positive anti-ADAMTS-13 antibodies. We suggest that, along with infections, autoimmune conditions or defined genetic abnormalities of complement regulatory genes, MAPS should be considered among the pathogenic mechanisms in patients with atypical HUS.

Tyrphostin AG-490 inhibited the acute phase of zymosan-induced inflammation

Tyrphostins, derivatives of benzylidene malononitrile are recognized as tyrosine kinase inhibitors that have been applied in some models of acute inflammatory conditions, like LPS and zymosan-induced shock. In the present study, we have investigated the effects of tyrphostin AG-490, on the development of multiple organ failure induced by i.p. injection of zymosan (1 mg/g body weight) in mice. Organ dysfunction and systemic inflammation was estimated 24 h after zymosan administration. Treatment of mice with AG-490 (dose, 5 mg/kg i.p. simultaneously with zymosan) decreased the number of cells and the level of NO in the peritoneal lavage. The substance attenuated the elevation of creatinine (indicator of renal failure), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and bilirubin (indicators for liver dysfunction) and prevented the accelerated coagulation time. The injection of zymosan resulted in a substantial increase in the serum level of TNF-α and IL-6, which was strongly inhibited by AG-490. Tyrphostin abolished the expression of iNOS and TNF-αR in the liver. Moreover, immunohistochemistry of liver showed decreased phosphorylation of Stat1 and Stat3. In conclusion, the administration of tyrphostin AG-490 in zymosan-induced nonseptic shock significantly improved the rate of survival and lead to less exerted signs of multiple organ failure.

Respiratory quotient and patterns of substrate utilization in human sepsis and trauma.

Three hundred measurements of indirect calorimetric and hemodynamic variables were performed in 99 critically ill septic and nonseptic surgical patients. Septics manifested, with respect to nonseptics, higher O2 consumption, metabolic rate and cardiac index, and lower respiratory quotient in the presence of higher glucose infusion rates and glucose infusion rate/metabolic rate ratios. Among septics there was a group of more severely ill patients with signs of multiple organ failure who manifested a dissociated pattern characterized by a tendency to decreased O2 consumption in the presence of increasing cardiac index and central venous O2 partial pressure: they had higher respiratory quotients, with respect to the other septics, for a given glucose infusion rate/metabolic rate ratio. The lower mean respiratory quotient of septics indicates that they depend generally more than nonseptic trauma patients on fat as an energy substrate and confirms a previously obtained evidence of limited hepatic lipogenesis in sepsis. At the same time, however, it is suggested that fat utilization becomes impaired (and hepatic lipogenesis becomes prominent) in sepsis at a stage in which signs of impaired oxidative metabolism and major metabolic abnormalities also develop.