The systemic immune response to trauma: an overview of pathophysiology and treatment.
Lord JM1, Midwinter MJ2, Chen YF3, Belli A4, Brohi K5, Kovacs EJ6, Koenderman L7, Kubes P8, Lilford RJ9.
Improvements in the control of haemorrhage after trauma have resulted in the survival of many people who would otherwise have died from the initial loss of blood. However, the danger is not over once bleeding has been arrested and blood pressure restored. Two-thirds of patients who die following major trauma now do so as a result of causes other than exsanguination. Trauma evokes a systemic reaction that includes an acute, non-specific, immune response associated, paradoxically, with reduced resistance to infection. The result is damage to multiple organs caused by the initial cascade of inflammation aggravated by subsequent sepsis to which the body has become susceptible. This Series examines the biological mechanisms and clinical implications of the cascade of events caused by large-scale trauma that leads to multiorgan failure and death, despite the stemming of blood loss. Furthermore, the stark and robust epidemiological finding--namely, that age has a profound influence on the chances of surviving trauma irrespective of the nature and severity of the injury--will be explored. Advances in our understanding of the inflammatory response to trauma, the impact of ageing on this response, and how this information has led to new and emerging treatments aimed at combating immune dysregulation and reduced immunity after injury will also be discussed.
"Health experts say the recovery of the patient is exciting because it helps to validate the concept of removing viruses from the blood, versus, or in addition to, attempting to treat infections with anti-viral medications."
Michael Mawanda, the Ugandan doctor admitted in Germany for specializedtreatment after contracting Ebola in Sierra Leone in October, is no longer infected with the disease, Chimp Corps report.
Dr Mawanda, a paediatrician with an Italian NGO, was on October 3 flown in a chartered plane from Lungi Airport in Sierra Leone to Germany after falling ill.
At the time, Ugandan officials said they had received information about Mawanda’s health status but that he was not among doctors dispatched by government to reinforce West Africa’s efforts in the battle against Ebola.
For more than four weeks, the Ebola patient was being treated at the University Hospital Frankfurt.
The hospital said in a statement seen by this website on Thursday that, “In the meantime he was ill and suffered from a critical multi-organ failure” and that, “Therefore, he needed intensive medical therapy including organ replacement procedures.”
The medical facility further said using these methods; it has managed to “bridge the time until the onset of proprietary antibody production.”
Currently, the statement reads, “the patient is awake, can autonomously move around the hospital room, eat normally and has no pain.”
However, Mawanda “will still need some time to fully recover from his very serious illness. It is planned that the patient remains on the isolation ward.”
“My thanks and deep respect goes to the physicians and nurses who not only saved a man who risked his life to help others. They have also shown that the Frankfurt University Hospital provides cutting-edge medicine at the highest level and Hesse is very well prepared for the treatment of Ebola patients, ” said Stefan Grüttner, a health official.
Prof. J. Schölmerich, Medical Director and Chief Executive Officer of the University Hospital Frankfurt, said, the healing was possible because of the “tireless efforts of our volunteers and medical staff who have all worked under high physical stress.”
Health experts say the recovery of the patient is exciting because it helps to validate the concept of removing viruses from the blood, versus, or in addition to, attempting to treat infections with anti-viral medications.
Mawanda becomes the second Ebola patient to be treated at the time of his check-in at the medical facility.
The third patient who was a Sudanese doctor admitted in Leipzig, died in mid-October.
Ebola has killed over 4,000 people in West Africa. Several cases have since been confirmed in Mali.
Yet again, no explanation for why Spectral, with its Toraymyxin license, will take off here, assuming 100% that it is approved, when the licensor, Toray, has had net sales of less than $500k for each of 2011, 2012 and 2013 for its entire Life Science division (more products than just this one) even though the product has been approved in Japan for over 20 years. Please explain or just leave this board.
The aim of the study is to investigate the effect of CytoSorb® treatment within the first 48 hours of septic shock on organ dysfunction, microcirculation and on the cytokine storm as monitored by leukocyte activation and inflammatory mediators.
he Effect of Early Cytokine Absorption on the SIRS and Organ Dysfunction in the First 48 Hours of Septic Shock
This study is ongoing, but not recruiting participants.
Information provided by (Responsible Party):
Domonkos Trásy, Szeged University
First received: November 5, 2014
Last updated: November 12, 2014
Last verified: November 2014
and for the first time have hope for a cure: A new medical technology can stop the deadly disease.
As Mariana Bridi was 20, admitted shortly after Christmas in a Brazilian hospital, she looked amazing and she was still relatively good. She had elevated temperature, and the doctors diagnosed at the top model an infection of the urethra, nothing earth shattering. Then, within days, her condition worsened dramatically, the doctors lost control. The kidneys failed, hands and feet began to die. In emergency operations, their limbs the kidney and a portion of the stomach were amputated away - too late. End of January died the supermodel from sepsis to German: blood poisoning.
That was in 2009, and since then more than 130 million people worldwide are suffering from sepsis, nearly 45 million have died from the debilitating disease, including many celebrities. The sepsis-victims include Prince Rainer of Monaco, Superman actor Christopher Reeves, publisher Rudolf Augstein, Chancellor Schmidt's wife Loki and the TV presenter Ilona Christen.
Sepsis is the leading cause of death of children and neonates, the overall infection rate is increasing annually by about ten percent. The National Academies of Sciences of the G-states are already warning of a "global threat to humanity". On September 13 physicians from all over the world therefore commit the World Day sepsis to make to cases such as that of Bridi and the largely unknown and underestimated disease attentive.
Complexes overreaction of the immune system
Calls for Germany calls Professor Konrad Reinhart, chief of the Department of Anesthesiology and Intensive Care Medicine at the University Hospital Jena and Chairman of the German Sepsis foundation of the federal government a "National Action Plan against sepsis". In the Federal Republic of cancer every year about 180,000 people suffer from sepsis, more than 60,000 die - more than by heart attack together or lung, breast and colon cancer. Reinhart believes that a combination of better hygiene measures, vaccination against sepsis pathogens, reconnaissance and other measures can reduce the morbidity and mortality significantly.
Sepsis is a complex overreaction of the immune system to bacteria or fungi, which is so strong that vital body functions are limited and single or multiple organs failure. It occurs as a consequence of infection or after major surgery. The defense system of the body produces in case of an infection called cytokines that coordinate as messengers between the opposing defenders. If the amount of cytokines a certain value, proposes to the defensive struggle: Institutions are no longer protected but harmed.
In the past there have been several attempts to get at the disease by pharmaceutical or medical therapies. But success came from modest or completely. Only now there's a promising new approach that could save the lives of many patients.
The small US company Cytosorbents from New Jersey has developed a cytokine adsorber which removes the hazardous chemical messengers and other inflammatory mediators from the blood: the blood of an infected person is passed through a 20 cm long cylinder, stuck in the tens of thousands of small plastic balls. They are made of highly biocompatible polymers, each of them is perforated with countless tiny holes remain where hang the unwanted molecules. So living dangerously high cytokine levels are reduced to a level at which the body the runaway immune response can control himself again. "We" says Christian Steiner, head of Cytosorbents Europe, "give the doctors an instrument in the hand to regain control of these patients and thus save lives."
In eleven states of the cytokine filter is already used. In Germany more than 40 clinics contact the cartridge successfully, the therapy belongs in the Munich University Hospital Grosshadern and Augustinum for certain patients already as routine as at the University Hospital of Essen, Greifswald and Halle. In more than 20 studies, the effectiveness of the adsorber is being scrutinized - and there are the first results very promising. A decisive factor for the success of the use during long operations seem to be two facts to be: inflammatory mediators such as interleukin 6 are effectively reduced, and the effect persists even after surgery, suggesting that the adsorber exerts an influence on the production of interleukins.
Private online medium for new technology
Whether a 60-year-old who suffered a streptococcal infection after a forearm fracture and was saved thanks to the adsorber, or a 37-year-old man who suffered a staph infection after liver cirrhosis and convalesced - the results of the new form of therapy are consistently positive ,
As fast growing insights into the cytokine-adsorber that Professor Frank Brunkhorst, director of the Center for Clinical Studies at the University Hospital Jena and Secretary General of the German Sepsis Society, in cooperation with the manufacturing company created its own online media for the new technology: In Cytosorb register , users can capture common data centers to use which document safety and efficacy.
Side effects that exist in almost all forms of therapy have so far occurred nowhere. Although it can not be excluded that the small polymer beads also substances from the blood to get that there are desirable - for example, antibiotics that are administered to a bacterial infection. Which could meet, however, by doctors increase the dose of the drug. The relevant data for this purpose are currently collected in several studies.
"Enormous potential in the control of sepsis" therefore sees the senior physician in the Department of Intensive Care Medicine at the University Hospital Hamburg Eppendorf, Axel Nierhaus. Professor Karl carrier, director of the cardiac intensive care unit of Universtätsklinikums Ulm, who proved to be one of the first heart specialists reduction of inflammatory mediators through the adsorber, notes, Cytosorb was a "promising new treatment option" and have "greatest benefit".
What is exactly is still difficult to discern. As the Eppendorf intensivists Nierhaus recently got a suicidal patients on his ward, who had swallowed an overdose of the painkiller paracetamol, it was no more, pump the stomach. The active ingredients of the drug had already paralyzed the liver. Nierhaus put the cytokine filter - and rescued the man and life liver.
2ND CYTOSORB USERS MEETING ON 2 DECEMBER 2014 IN HAMBURG
ear CytoSorb® users,
we kindly invite you to our second CytoSorb® user meeting! This meeting aims at enhancing the dialog between users and anyone interested from Germany, Austria and Switzerland. We would like to offer you an opportunity for sharing experience and discussing topics such as SIRS and sepsis in a relaxed atmosphere.
Once again, you can expect top-class international speakers as well as interesting news. We are confident that you will benefit from the expert talks and from individual discussions. After the scientific program, we would like to invite you for dinner.
Meeting language will be German.
Please register by 4 November 2014 . Attendance is free of charge.
J Card Surg. 2014 Nov 10. doi: 10.1111/jocs.12465. [Epub ahead of print]
Risk Factors for Systemic Inflammatory Response After Congenital Cardiac Surgery.
Güvener M1, Korun O, Demirtürk OS.
This study aims to assess the frequency of systemic inflammatory response syndrome (SIRS) following congenital heart surgery and risk factors associated with this clinical syndrome.
Charts of all patients undergoing surgery for congenital heart disease in a single institution over a five-year period were analyzed retrospectively. The presence of SIRS was evaluated based on the criteria of the International Pediatric Sepsis Consensus Conference.
Of the 246 patients included in the study 22 (8.9%) had clinical parameters indicating SIRS. The patients in the SIRS group had significantly longer cardiopulmonary bypass time (105.14 ± 27.27 vs. 66.86 ± 26.64 min; p
Another hint? No warrants for common stock except the 3% to the underwriters.
Take a look at the Oct & Dec S-1
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Title of Each Class Of Securities to be Registered
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A Ugandan doctor who contracted Ebola while working in Sierra Leon is recovering, that according to the Permanent Secretary Ministry of Health Dr Asuman Lukwago.
Dr. Michael Platap Mawanda a paediatrician with an Italian NGO contracted Ebola while on duty in Sierra Leon and was flown to Germany for specialized treatment.
Lukwago says Mawanda is now out of isolation and is expected to be back on duty very soon.
3 November, 2014
Each year, sepsis kills far more people than AIDS, prostate cancer, and breast cancer combined. Sepsis is one of the top three causes of death globally, with patients being five times more likely to die from sepsis than heart attacks or strokes. Sepsis is also responsible for 70-90% of the organ failure deaths related to Ebola, yet it goes unrecognized, is poorly understood, and has very low public awareness.
Treatment for sepsis often involves a prolonged stay in the ICU, requiring complex therapies costing the US health system over $5,000 per patient/day, or $20 billion/year. Globally, sepsis is estimated to exceed costs of $90 billion/year. Even worse, the mortality rate for sepsis is approximately 35% — higher in developing countries — with patients who survive often struggling with physical impairment, muscle and nerve damage, cognitive changes and chronic organ failure.
According to Patrick Maguire, MD, PhD, MBA and CMO of HemoLife Medical, “Currently the greatest need for fighting sepsis is the ability to manage (reduce) cytokine cascade/storm (hypercytokinemia), and thus prevent the devastating secondary effects of organ compromise and failure. Where we currently have the greatest need is for technologies that can effectively and efficiently decrease cytokine burden. Even if we could detect sepsis earlier, we will always need to effectively treat a run-away cytokine storm in order to help return the patient to a more normal, healthier state.”
The Silent Killer
According to the Centers for Disease Control (CDC) the hospitalization rates for sepsis more than doubled in the US from 2000 to 2008, with those patients staying much longer and costing significantly more than those who do not develop sepsis.
The inflammatory response is the mechanism our body uses to recognize and defend against an infection. When bacteria, trauma, toxins, heat and other injuries occur to tissue, the body’s automatic response is to fight it. The damaged cells release chemicals that cause blood vessels to leak fluid into the tissues, causing swelling. This helps isolate the foreign substance from further contact with body tissues. However, after a patient’s infection has been controlled, sepsis – or septic shock – can continue in two ways: 1. by the presence of endotoxins (dead bacteria), and 2. cytokines that are released by the body.
In fact, in most cases, the inflammatory response component of sepsis is the true killer because, even after antibiotics have been successful and the patient has been properly hydrated, clinicians can do very little to improve a patient’s odds of surviving.
HemoLife Could Save Lives – And Money
In addition to improved diagnosis and awareness, new products are entering the market that could forever alter the way sepsis is treated, first and foremost by simply providing a more direct “treatment”. One such proposed treatment entering the market that filters toxins from the blood stream is the IMPACT System by HemoLife. The company, HemoLife Medical, believes that by effectively removing cytokines and endotoxins from a patient’s blood stream, their system reduces the primary triggers driving a patient’s destructive inflammatory response that occurs during sepsis. In most cases, patients can be effectively treated with as few as three HemoLife treatment cycles.
The IMPACT ‘HemoFilter’ minimizes electrolyte and protein depletion from the treated plasma, effectively removing both free and protein-bound toxins. The toxin removal device works by separating red blood cells, white blood cells, and platelets from the plasma, followed by filtering out specified toxins from the plasma. After filtration is complete, ‘clean blood’ is infused back into the body, reducing the toxins that fuel the life threatening inflammatory response called sepsis.
Although the clinical success of the IMPACT System has been shown and approved for sale in the European Union (EU), Canada, India and Australia, “FDA approval is expected in the US during the fourth quarter of 2016,” says Mike Ward, President of Mainbridge Health Partners, the company taking HemoLife to market. Mainbridge’s goal with HemoLife is to “improvehealth care providers’ understanding of the IMPACT System effectiveness on sepsis, so we can more rapidly make it standard of care as it enters the US market. Our investors are helping us make that happen right now, so we can start saving lives both domestically and abroad.”
The IMPACT Could Be Global
According to Lon Stone, President and CEO of HemoLife, “The IMPACT System, as an adjunct treatment is currently distributed to several international hospitals, has the potential to improve patient survival and reduce the length of stay in ICUs, resulting in cost savings from $5,000-$10,000 per day.”
The statistics showing the devastation of sepsis in these countries are staggering. Approximately every three seconds a patient dies of sepsis, and more than 6 million of these deaths every year occur in children. In those locations sepsis is also the second most common case of maternal death – second only to bleeding.
Just like the US and other developed nations, developing countries could use products like HemoLife’s for cost savings and life savings. The IMPACT System would need to access equipment that is presently not available in some parts of the world, but the utilization and training for the product could potentially become universal as hospitals, clinics and mobile facilities grow around the world.
Dr. Maguire believes, “As more providers, clinics and traditional hospitals become comfortable with the IMPACT System’s safety profile and results, the opportunity to move this treatment earlier in the patient’s clinical course should enhance patient outcomes, further reducing morbidity and mortality. The possibility to intervene in the treatment of graft versus host disease (GVHD), acute pancreatitis, acute respiratory distress syndrome (ARDS), avian influenza, and systemic inflammatory response syndrome (SIRS) remain applications to be explored, and the ones for which we have the greatest hope.”
By Julie Steenhuysen 6 hours ago
CHICAGO (Reuters) - An analysis of the first Ebola cases in Sierra Leone helps draw a clearer picture of why some people survive the disease, while others do not, including their age and the pace at which the virus replicates within their body.
The study published Wednesday is based on data gathered from 106 patients diagnosed with Ebola at the Kenema Government Hospital in Sierra Leone from May 25 to July 18. Some of the data on this group was incinerated because of fears that the nurses' station where the records were kept became contaminated.
But the team managed to analyze detailed clinical records from a total of 44 Ebola patients, the biggest trove yet from the outbreak in West Africa that has killed nearly 5,000 people.
"This is the first time anybody has had this much data collected on any Ebola patients," said Dr. John Schieffelin of Tulane University in New Orleans, an author of the study published in the New England Journal of Medicine.
He said the findings help confirm some of the observations seen by doctors treating patients with Ebola.
It shows, for example, that 57 percent of people under age 21 who were treated for Ebola died from their infections, compared with 94 percent of those over the age of 45.
In the cases studied, the virus took six to 12 days to incubate before patients developed symptoms, and 74 percent of the patients in the study died, similar to what has been seen in prior outbreaks.
Fever was the most common symptom, occurring in 89 percent of patients, followed by headache (80 percent), weakness (66 percent), dizziness (60 percent) diarrhea (51 percent), abdominal pain (40 percent) and vomiting (34 percent).
However, there were some big differences in how individual patients responded to the virus, Schieffelin said.
"There were people who had very mild cases, and there are people who have very severe cases and they go downhill quickly," he said.
One surprise was the significant difference in the amount of virus present in patients when they came in for treatment, a factor that affected whether or not they survived.
For example, 33 percent of patients with less than 100,000 copies of the virus per milliliter of blood at diagnosis ultimately died, compared with 94 percent mortality in those whose had more than 10 million copies per milliliter.
Among the various symptoms in this outbreak, Schieffelin said diarrhea is a "really big feature of it," suggesting that doctors treating Ebola patients need to be very aggressive in administering intravenous fluids.
Bleeding, a key feature of Ebola in prior outbreaks, was rare among this population, with only 1 patient having this symptom, the study found.
Some researchers have questioned the value of spending resources on studying Ebola during the outbreak rather than using those funds to help curb the epidemic directly. Schieffelin said the analysis offers important insights for healthcare workers fighting the current outbreak, including data that can be used to determine new treatment and diagnostic approaches.
October 27, 2014
Heart and Stroke Foundation of Canada
Heart surgery patients who received newly donated blood have significantly fewer post-operative complications than those who received blood that had been donated more than two weeks before their surgery.
Heart surgery patients who received newly donated blood have significantly fewer post-operative complications than those who received blood that had been donated more than two weeks before their surgery, a study presented at the Canadian Cardiovascular Congress has shown.
The study examined records at the New Brunswick Heart Centre (NBHC) in Saint John for non-emergency heart surgeries performed over almost nine years, from January 2005 to September 2013, on patients who received red blood cells either during their surgery or afterwards and who stayed in hospital less than 30 days.
Of 2,015 patients, just over half (1,052) received only "new" blood, donated within 14 days of the transfusion, while the rest had received only or some "old" blood, donated more than 14 days before. Canadian protocols allow blood to be stored and used up to six weeks after it is donated.
After adjusting for differences in age, sex and other health conditions between the two groups of patients, the study found those given only new blood had fewer in-hospital complications such as re-operation for bleeding, ventilation longer than 24 hours, infection, renal failure and death. Overall the patients who received new blood fared significantly better than those who received some or all old blood.
"The findings show that we need to pay attention to the age of the blood we give cardiac surgery patients," says Dr. Ansar Hassan of the department of cardiac surgery at NBHC, the study's senior author.
Given the benefits to patients of timely cardiac surgery, Dr. Hassan believes surgeries should not be postponed if new blood is not available. "Perhaps more importantly, we need new studies to determine what is driving this relationship between the age of blood and the outcomes we are seeing."
Dr. Hassan notes that previous non-Canadian studies have reached contradictory conclusions on this subject, which was a reason this study was undertaken. The question is important to cardiac surgeons because their work is one of the foremost users of blood products, with 30 to 50 per cent of cardiac surgery patients requiring transfusions. The average cardiac surgery requires five pints of blood.
Heart disease and stroke is the leading cause of hospitalization in Canada, accounting for almost 17 per cent of total hospitalizations. More than 25,000 cardiac surgeries are performed in Canada each year. These procedures -- including coronary artery bypasses, valve replacements and heart transplants -- save and extend the lives of thousands of Canadians every year.
"Cardiac surgery creates heart disease survivors," says Dr. Beth Abramson, Heart and Stroke Foundation spokesperson, author of Heart Health for Canadians. "We need to ensure outcomes are as successful as possible. This study is an important reminder for Canadians to donate blood so that blood products are available for these surgeries."
She reminds all Canadians that 80 per cent of premature heart disease can be prevented with healthy lifestyle choices. "It is possible to reduce our risks with changes to five controllable behaviours: physical inactivity, smoking, stress, poor diet and excessive alcohol consumption."
Medical evacuation and repatriation from EVD-affected countries, as of 24 October 2014
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MUMBAI: A nationwide study found a prevalence of sepsis within intensive care units of hospitals: one out of four patients admitted in ICUs contracted the ailment in hospitals' emergency departments. Almost one out of two patients with sepsis died. The reasons for the rising incidence could be poor hospital hygiene, abuse of antibiotics or rampant self-medication among people.
Sepsis can lead to multi-organ failure and is globally a prime cause of death by infection. The study — Indian Intensive Care Case Mix and Practice Patterns (INDICAPS) — is based on a sample size of 4,209 patients, including 171 children, admitted to 124 ICUs across 17 states. Preliminary findings showed how 26% of the patients in ICUs contracted sepsis. Mortality in patients with sepsis was 42.2% as opposed to 17.8% in those who did not get it.
The study also busted the myth that patients undergoing surgeries are more prone than others to sepsis. For, 859 or 27.6% of the patients who died of sepsis were not operated upon and were in hospital for non-surgical treatment. The percentage of deaths in surgical cases was around 14.4%. Common sites of infection in patients that resulted in sepsis included bedsores, intravenous lines, surgical wounds and surgical drains.
Council member of World Federation of Society of Intensive & Critical Care Medicine Dr Pravin Amin said, "Early diagnosis hold the key and an area of worry is hospital acquired infection."
Dr Farhad Kapadia of Mumbai's Hinduja Hospital said, "Hand hygiene in ICU can help reducing hospital acquired infection to a great extent."
Around 25.5% of sepsis patients were admitted to ICUs from the emergency department, 18.5% from home and 36% from ward of the same hospital.
Principal investigator Dr J V Divatia, head of anaesthesia, critical care and pain department at the Tata Memorial Hospital, said, "Simply put, a person's chances of succumbing to his or her ailment gets multiplied because of sepsis."
This study and several other global observations have pointed to the rise in cases and deaths caused by sepsis. "An ageing population clubbed with medical advancements encouraging doctors to do riskier procedures and long hospital stays could be some of the causes contributing to the rise," he said.
There is a growing clamour to involve sepsis survivors in awareness and sensitization programmes. Jharna Narang (38) is one such survivor. She got four bullet injuries during the 26/11 terror attacks. Barring a slight limp, Narang gives away few traces of battling for life for over two months in the Bombay Hospital ICU and another six months in the wards. "I came to only in December, a full month after the incident," she said.While Narang was lucky to survive sepsis, 40% of those who get the ailment die of it.