Article
Critical Care Medicine
Roshan Bisarya, Xing Song, John Salle, Mei Liu, Anurag Patel, Steven Q. Simpson
Summary: Delay in the administration of the first antimicrobial in patients with suspected infection is associated with an increased risk of progression to septic shock. The qSOFA score has higher specificity in predicting septic shock, but is associated with a worse prognosis.
Review
Medicine, General & Internal
Stephen Macdonald, Sandra L. Peake, Alasdair R. Corfield, Anthony Delaney
Summary: Intravenous fluid resuscitation is recommended as the first-line treatment for sepsis-associated hypotension and/or hypoperfusion, but there is limited high-level evidence to support this practice. Recent studies have found potential harms associated with large volume fluid resuscitation, leading to recommendations for a more conservative approach and earlier use of vasopressors. However, there is currently uncertainty and variation in practice regarding the choice between fluids or vasopressors for initial resuscitation in septic shock.
FRONTIERS IN MEDICINE
(2022)
Review
Critical Care Medicine
Brooke Barlow, Brittany D. Bissell
Summary: The review examined the pharmacology of vasoactive therapy and fluid administration in sepsis and septic shock, highlighting the physiologic interplay between these agents. While there is physiological rationale for potential synergy between fluid and vasopressor administration, few clinical studies have evaluated the impact of this interaction. Current guidelines do not align with available data, suggesting a potential benefit from low-dose fluid administration and early vasopressor exposure, indicating a need for further research to assess personalized therapy based on this interaction.
Article
Critical Care Medicine
Simon W. Lam, Gretchen L. Sacha, Abhijit Duggal, Anita J. Reddy, Seth R. Bauer
Summary: This study compared the outcomes of patients recovering from septic shock who had abrupt discontinuation or tapering discontinuation of AVP. The results showed no significant difference in time to ICU discharge, mortality rates, or incidence of hypotension between the two groups. However, patients in the tapering discontinuation group more frequently required an escalation of AVP dose.
Article
Critical Care Medicine
Sophia Bonnin, John J. Radosevich, Yong Gu Lee, Jeremy P. Feldman, Jeffrey F. Barletta
Summary: This multi-center retrospective study compared the shock reversal outcomes between low dose and high dose hydrocortisone regimens in patients with septic shock. High dose steroids were found to be associated with shock reversal, but this was not confirmed in propensity score matched analysis. High dose steroids were also associated with reduced need for additional vasopressor therapy and lower shock recurrence rates.
JOURNAL OF CRITICAL CARE
(2021)
Article
Nursing
Luciana Ramos Correa Pinto, Karina de Oliveira Azzolin, Amalia de Fatima Lucena, Miriane M. S. Moretti, Jaqueline S. Haas, Rafael B. Moraes, Gilberto Friedman
Summary: The study identified clinical indicators of septic shock in critical care patients, including hypotension, mechanical ventilation, lactate levels, hypothermia, radiotherapy-associated chemotherapy, Sequential Organ Failure Assessment score, and admittance through the emergency unit. Patients with septic shock presented hyperlactataemia and greater organic dysfunction compared to those with sepsis. Mechanical ventilation, chemotherapy, and radiotherapy were found to increase the risk of developing septic shock.
JOURNAL OF CLINICAL NURSING
(2021)
Article
Emergency Medicine
Ali Fuat Oduncu, Guclu Selahattin Kiyan, Sercan Yalcinli
Summary: The study compared the qSOFA, SIRS, and NEWS scoring systems in diagnosing sepsis and predicting mortality. It found that NEWS and qSOFA have similar prognosis and are superior to SIRS in both aspects.
AMERICAN JOURNAL OF EMERGENCY MEDICINE
(2021)
Review
Microbiology
Shiwani Kamath, Hiba Hammad Altaq, Tony Abdo
Summary: Sepsis is a clinical syndrome caused by a dysregulated host response to infection. Early identification and treatment are crucial for improving survival rates. In recent years, sepsis management has shifted towards a more conservative approach, avoiding excessive monitoring and fluid resuscitation, while exploring the use of peripheral vasopressors and balanced crystalloid resuscitation strategies.
Review
Critical Care Medicine
Elio Antonucci, Manuela Giovini, Sara Agosta, Yasser Sakr, Marc Leone
Summary: Sepsis and septic shock are serious conditions that often require intensive care. Norepinephrine is the primary vasopressor used, but high doses can have adverse effects. Researchers have suggested using non-adrenergic vasopressors, such as Selepressin, which can reduce the need for norepinephrine and limit its negative effects.
Review
Medicine, General & Internal
Olfa Hamzaoui, Antoine Goury, Jean-Louis Teboul
Summary: Septic shock is characterized by vasoplegia and arterial hypotension, requiring vasopressor therapy. Norepinephrine is the first-line vasopressor, and vasopressin can be added in cases of inadequate mean arterial pressure. There are some unanswered questions regarding the use of these vasopressors, such as dose titration and escalation.
JOURNAL OF CLINICAL MEDICINE
(2023)
Review
Critical Care Medicine
Ashwani Kumar, Brett Abbenbroek, Anthony Delaney, Naomi Hammond, Sarah Grattan, Simon Finfer
Summary: No single trigger or tool is universally applicable for the diagnosis of sepsis. However, the combined use of lactate and qSOFA shows promising results in adult patients.
AUSTRALIAN CRITICAL CARE
(2023)
Review
Infectious Diseases
Xia Qiu, Yu-Peng Lei, Rui-Xi Zhou
Summary: This study compared SIRS, SOFA, qSOFA, and NEWS for sepsis diagnosis and prognosis prediction. The results showed that NEWS independently demonstrated good diagnostic capability for sepsis, especially in high-income countries, while SOFA emerged as the optimal choice for predicting in-hospital mortality and can be used as a screening tool for 28/30-day mortality in low-income countries.
EXPERT REVIEW OF ANTI-INFECTIVE THERAPY
(2023)
Review
Critical Care Medicine
Gretchen L. Sacha, Seth R. Bauer
Summary: Experimental studies on the timing of vasopressin initiation in septic shock patients are limited, but recent observational studies have shown that initiating vasopressin at lower norepinephrine-equivalent doses or lower lactate concentrations is associated with lower mortality.
Article
Pharmacology & Pharmacy
Melissa M. Durst, Elizabeth A. Eitzen, Scott T. Benken
Summary: Patients with cirrhosis in septic shock have significantly longer durations and overall requirements of vasopressors compared with patients without cirrhosis. Increased durations and requirements are associated with poorer outcomes independent of the presence of cirrhosis.
ANNALS OF PHARMACOTHERAPY
(2021)
Article
Cell Biology
Lin Zhu, Hairong Zhang, Xiaoyu Zhang, Lei Xia
Summary: N6-methyladenosine (m6A) modification is a type of epitope modification that has gained attention for its role in diseases, including sepsis. Recent epigenetic research has focused on m6A modifications, which are regulated by three types of proteins: Writers (such as METTL3/METTL14/WTAP) responsible for modification, Erasers (FTO and ALKBH5) involved in de-modification, and Readers (YTHDC1/2, YTHDF1/2/3) responsible for recognition. This review summarizes recent studies on the involvement of m6A and its regulators in sepsis, highlighting their potential value in diagnosis, treatment, and prognosis.
MOLECULAR AND CELLULAR BIOCHEMISTRY
(2023)
Review
Oncology
Aasems Jacob, Bragadheeswar Thyagarajan, Monisha Priyadarshini Kumar, Nasreen Shaikh, David Sharon
JOURNAL OF CANCER RESEARCH AND CLINICAL ONCOLOGY
(2018)
Article
Medicine, General & Internal
Derek W. Russell, Jonathan D. Casey, Kevin W. Gibbs, Shekhar Ghamande, James M. Dargin, Derek J. Vonderhaar, Aaron M. Joffe, Akram Khan, Matthew E. Prekker, Joseph M. Brewer, Simanta Dutta, Janna S. Landsperger, Heath D. White, Sarah W. Robison, Joanne M. Wozniak, Susan Stempek, Christopher R. Barnes, Olivia F. Krol, Alejandro C. Arroliga, Tasnim Lat, Sheetal Gandotra, Swati Gulati, Itay Bentov, Andrew M. Walters, Kevin M. Dischert, Stephanie Nonas, Brian E. Driver, Li Wang, Christopher J. Lindsell, Wesley H. Self, Todd W. Rice, David R. Janz, Matthew W. Semler
Summary: In critically ill adults undergoing tracheal intubation, administering an intravenous fluid bolus did not significantly decrease the incidence of cardiovascular collapse.
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
(2022)
Article
Critical Care Medicine
Braghadheeswar Thyagarajan, Mariana Murea, Deanna N. Jones, Amit K. Saha, Gregory B. Russell, Ashish K. Khanna
Summary: This study found that among patients receiving ECMO treatment, the incidence of AKI was high, but the renal recovery status was not affected by the type of ECMO used. The VV group had a significantly higher proportion of patients receiving RRT, but the rate of AKI recovery at discharge was similar between the two groups.
JOURNAL OF CRITICAL CARE MEDICINE
(2021)
Article
Critical Care Medicine
Braghadheeswar Thyagarajan, Casey Bryant, Ashish K. Khanna
Summary: It is rare for a cardiac tumor to be associated with coronary-cameral fistulas. A case of metastatic cardiac melanoma involving both ventricles was diagnosed through various examinations in a 66-year-old Caucasian male presenting with worsening dyspnea.
INDIAN JOURNAL OF CRITICAL CARE MEDICINE
(2021)
Meeting Abstract
Critical Care Medicine
B. Thyagarajan, A. K. Saha, D. N. Jones, M. D. Font, M. Murea, A. K. Khanna
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
(2020)
Article
Hematology
Lubna Bashir Munshi, Braghadheeswar Thyagarajan, Aasems Jacob, Shil Patel, Steve Zheng Liu, Arpad Szallasi
ASIAN JOURNAL OF TRANSFUSION SCIENCE
(2019)
Article
Critical Care Medicine
Monisha P. Kumar, Braghadheeswar Thyagarajan, Nairmeen Haller, Daniela Ciltea
INDIAN JOURNAL OF CRITICAL CARE MEDICINE
(2019)
Article
Urology & Nephrology
Elizabeth M. Anderson, Jin Zhang, Greg Russell, Isai G. Bowline, Braghadheeswar Thyagarajan, DengFeng Li, Lijun Ma, Erica R. Anderson, Mariana Murea
KIDNEY INTERNATIONAL REPORTS
(2019)
Article
Cardiac & Cardiovascular Systems
Dileep Unnikrishnan, Radhika Annam, Aasems Jacob, Braghadheeswar Thyagarajan, Peter Farrugia
CASE REPORTS IN CARDIOLOGY
(2018)
Meeting Abstract
Urology & Nephrology
Braghadheeswar Thyagarajan, Elizabeth M. Anderson, Jin Zhang, Greg Russel, DengFeng Li, Lijun Ma, Timothy S. Pardee, Mariana Murea
AMERICAN JOURNAL OF KIDNEY DISEASES
(2018)
Meeting Abstract
Urology & Nephrology
Braghadheeswar Thyagarajan, Monisha Priyadarshini Kumar, Lijun Ma, Mariana Murea
AMERICAN JOURNAL OF KIDNEY DISEASES
(2018)
Review
Peripheral Vascular Disease
Ankur Kalra, Hasan Rehman, Sahil Khera, Braghadheeswar Thyagarajan, Deepak L. Bhatt, Neal S. Kleiman, Robert W. Yeh
CURRENT ATHEROSCLEROSIS REPORTS
(2017)
Review
Cardiac & Cardiovascular Systems
Braghadheeswar Thyagarajan, Monisha Priyadarshini Kumar, Shil Patel, Abhinav Agrawal
JOURNAL OF THE SAUDI HEART ASSOCIATION
(2017)
Review
Medicine, General & Internal
Braghadheeswar Thyagarajan, Monisha Priyadarshini Kumar, Rutuja R. Sikachi, Abhinav Agrawal
INTRACTABLE & RARE DISEASES RESEARCH
(2016)
Article
Medicine, General & Internal
Jeanne E. Conner, Joshua A. Steinberg
Summary: Diagnosis of anaphylaxis should involve comprehensive consideration, including detailed history and objective findings. Using diagnostic criteria and considering rare triggers, as well as evaluating for mast cell disorders, can aid in the diagnosis. Referral to specialists may be necessary.
MEDICAL CLINICS OF NORTH AMERICA
(2024)
Article
Medicine, General & Internal
Alejandra Escobar Vasco, Julie -Ann Talano, Larisa Broglie
Summary: HLH is a rare but fatal disease, and maintaining a high level of suspicion is crucial for patients with evidence of hyperinflammation. Adolescents with HLH should undergo genetic evaluation for familial HLH, and primary immune deficiencies and dysregulation disorders should also be considered. Early diagnosis and treatment are necessary to prevent morbidity and mortality related to HLH's hyperinflammation.
MEDICAL CLINICS OF NORTH AMERICA
(2024)
Article
Medicine, General & Internal
Kathleen Ryan
Summary: Fevers of unknown origin (FUO) present a diagnostic challenge, with a wide range of potential causes including infectious, autoimmune, and malignant. Some adolescents with FUO may never have an identifiable etiology, but the prognosis is generally favorable in the absence of red flag symptoms.
MEDICAL CLINICS OF NORTH AMERICA
(2024)
Article
Medicine, General & Internal
Brett J. Bordini, Ryan D. Walsh, Donald Basel, Tejaswini Deshmukh
MEDICAL CLINICS OF NORTH AMERICA
(2024)
Article
Medicine, General & Internal
Hsi Yen, Leah Lalor
Summary: The article emphasizes the importance of increased awareness among healthcare providers when faced with severe adolescent acne that may not be typical teenage acne. It provides a summary of uncommon causes of severe adolescent acne and a simplified diagnostic approach. Additionally, it discusses rare autoinflammatory syndromic causes of acne and acne associated with excess androgen states.
MEDICAL CLINICS OF NORTH AMERICA
(2024)
Article
Medicine, General & Internal
Bethany Auble, Justin Dey
MEDICAL CLINICS OF NORTH AMERICA
(2024)
Article
Medicine, General & Internal
Kaitlin V. Kirkpatrick, James J. Nocton
MEDICAL CLINICS OF NORTH AMERICA
(2024)
Article
Medicine, General & Internal
Louella Amos
MEDICAL CLINICS OF NORTH AMERICA
(2024)
Article
Medicine, General & Internal
Tracey Thompson, Ashley Phimister, Alexander Raskin
Summary: Heart failure occurs as a result of pressure or volume overload in congenital and acquired heart diseases, and its treatment varies depending on the underlying cause.
MEDICAL CLINICS OF NORTH AMERICA
(2024)
Article
Medicine, General & Internal
Allison Remiker, Kristina Bolling, James Verbsky
Summary: CVID is a heterogeneous group of disorders characterized by abnormal B-cell differentiation and impaired production of specific immunoglobulin. Clinical manifestations vary and include recurrent bacterial infections, lymphoproliferation, autoimmunity, pulmonary disease, gastrointestinal disease, granulomas, and increased cancer risk. The diagnosis of CVID is complex, requiring exclusion of other causes of immunoglobulin deficiency and assessment based on clinical criteria models. Treatment involves regular immunoglobulin replacement therapy, infection prevention, and surveillance for complications.
MEDICAL CLINICS OF NORTH AMERICA
(2024)
Article
Medicine, General & Internal
Bridget A. Rafferty, Pooja Thakrar
Summary: CNO/CRMO is an underrecognized autoinflammatory disorder of the skeletal system resulting from immune dysregulation. Diagnosis is often delayed due to vague symptoms and the lack of accepted diagnostic criteria or specific biomarkers. Untreated CRMO can lead to chronic skeletal deformities, arthritis, and chronic pain. Diagnosis requires MRI and WB-MRI. Treatment primarily involves antiinflammatory medications.
MEDICAL CLINICS OF NORTH AMERICA
(2024)
Article
Medicine, General & Internal
Vaishali Singh, Scott K. Van Why
Summary: Hypertension in adolescents is rare, and evaluation for identifiable causes beyond primary hypertension is necessary. Common causes of hypertension in this age group are usually acquired or congenital renal or vascular diseases. If these etiologies are not found, exploration for rare causes, including monogenic hypertension, should be pursued.
MEDICAL CLINICS OF NORTH AMERICA
(2024)
Article
Medicine, General & Internal
Dominic O. Co
Summary: Acquired demyelinating syndromes (ADS) are a group of inflammatory demyelinating conditions that include optic neuritis, transverse myelitis, and acute demyelinating encephalomyelitis. Differentiating between subtypes of ADS is important for optimal patient management, and this can be achieved by considering clinical features, laboratory tests (especially autoantibodies), and MRI findings.
MEDICAL CLINICS OF NORTH AMERICA
(2024)
Article
Medicine, General & Internal
Meghan K. Konda, Matthew Harmelink
Summary: Pediatric adolescent muscle weakness can have various causes. A methodical diagnostic evaluation is necessary to determine the specific disease category, which may require specialized care or extensive testing. The ultimate diagnosis is crucial for prognostication.
MEDICAL CLINICS OF NORTH AMERICA
(2024)
