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El-Hajj VG, Pettersson I, Gharios M, Ghaith AK, Bydon M, Edström E, Elmi-Terander A. Detection and Management of Elevated Intracranial Pressure in the Treatment of Acute Community-Acquired Bacterial Meningitis: A Systematic Review. Neurocrit Care 2024:10.1007/s12028-023-01937-5. [PMID: 38356077 DOI: 10.1007/s12028-023-01937-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 12/29/2023] [Indexed: 02/16/2024]
Abstract
Acute bacterial meningitis (ABM) is associated with severe morbidity and mortality. The most prevalent pathogens in community-acquired ABM are Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae. Other pathogens may affect specific patient groups, such as newborns, older patients, or immunocompromised patients. It is well established that ABM is associated with elevated intracranial pressure (ICP). However, the role of ICP monitoring and management in the treatment of ABM has been poorly described.An electronic search was performed in four electronic databases: PubMed, Web of Science, Embase, and the Cochrane Library. The search strategy chosen for this review used the following terms: Intracranial Pressure AND (management OR monitoring) AND bacterial meningitis. The search yielded a total of 403 studies, of which 18 were selected for inclusion. Eighteen studies were finally included in this review. Only one study was a randomized controlled trial. All studies employed invasive ICP monitoring techniques, whereas some also relied on assessment of ICP-based on clinical and/or radiological observations. The most commonly used invasive tools were external ventricular drains, which were used both to monitor and treat elevated ICP. Results from the included studies revealed a clear association between elevated ICP and mortality, and possibly improved outcomes when invasive ICP monitoring and management were used. Finally, the review highlights the absence of clear standardized protocols for the monitoring and management of ICP in patients with ABM. This review provides an insight into the role of invasive ICP monitoring and ICP-based management in the treatment of ABM. Despite weak evidence certainty, the present literature points toward enhanced patient outcomes in ABM with the use of treatment strategies aiming to normalize ICP using continuous invasive monitoring and cerebrospinal fluid diversion techniques. Continued research is needed to define when and how to employ these strategies to best improve outcomes in ABM.
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Affiliation(s)
| | - Ingrid Pettersson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Maria Gharios
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Abdul Karim Ghaith
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | - Mohamad Bydon
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | - Erik Edström
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Capio Spine Center Stockholm, Löwenströmska Hospital, Upplands-Väsby, Sweden
| | - Adrian Elmi-Terander
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Capio Spine Center Stockholm, Löwenströmska Hospital, Upplands-Väsby, Sweden
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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2
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O'Brien NF, Chetcuti K, Fonseca Y, Vidal L, Raghavan P, Postels DG, Chimalizeni Y, Ray S, Seydel KB, Taylor TE. Cerebral Metabolic Crisis in Pediatric Cerebral Malaria. J Pediatr Intensive Care 2023; 12:278-288. [PMID: 37970136 PMCID: PMC10631841 DOI: 10.1055/s-0041-1732444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/12/2021] [Indexed: 10/20/2022] Open
Abstract
Cerebral metabolic energy crisis (CMEC), often defined as a cerebrospinal fluid (CSF) lactate: pyruvate ratio (LPR) >40, occurs in various diseases and is associated with poor neurologic outcomes. Cerebral malaria (CM) causes significant mortality and neurodisability in children worldwide. Multiple factors that could lead to CMEC are plausible in these patients, but its frequency has not been explored. Fifty-three children with CM were enrolled and underwent analysis of CSF lactate and pyruvate levels. All 53 patients met criteria for a CMEC (median CSF LPR of 72.9 [interquartile range [IQR]: 58.5-93.3]). Half of children met criteria for an ischemic CMEC (median LPR of 85 [IQR: 73-184]) and half met criteria for a nonischemic CMEC (median LPR of 60 [IQR: 54-79]. Children also underwent transcranial doppler ultrasound investigation. Cerebral blood flow velocities were more likely to meet diagnostic criteria for low flow (<2 standard deviation from normal) or vasospasm in children with an ischemic CMEC (73%) than in children with a nonischemic CMEC (20%, p = 0.04). Children with an ischemic CMEC had poorer outcomes (pediatric cerebral performance category of 3-6) than those with a nonischemic CMEC (46 vs. 22%, p = 0.03). CMEC was ubiquitous in this patient population and the processes underlying the two subtypes (ischemic and nonischemic) may represent targets for future adjunctive therapies.
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Affiliation(s)
- Nicole F. O'Brien
- Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, United States
| | - Karen Chetcuti
- Department of Radiology, College of Medicine, Chichiri, Blantyre, Malawi
| | - Yudy Fonseca
- Division of Critical Care Medicine, Department of Pediatrics, University of Maryland Medical Center, University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - Lorenna Vidal
- Division of Neuroradiology, Department of Radiology Children's Hospital of Philadelphia, Clinical Instructor at Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Prashant Raghavan
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - Douglas G. Postels
- Department of Neurology, George Washington University/Children's National Medical Center, Washington, District of Columbia, United States
| | - Yamikani Chimalizeni
- Department of Pediatrics and Child Health, University of Malawi, Malawi College of Medicine, Chichiri, Blantyre, Malawi
| | - Stephen Ray
- Department of Paediatric, Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Karl B. Seydel
- Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, United States
- Blantyre Malaria Project, Blantyre, Malawi
| | - Terrie E. Taylor
- Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, United States
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Kozioł A, Pupek M, Lewandowski Ł. Application of metabolomics in diagnostics and differentiation of meningitis: A narrative review with a critical approach to the literature. Biomed Pharmacother 2023; 168:115685. [PMID: 37837878 DOI: 10.1016/j.biopha.2023.115685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/28/2023] [Accepted: 10/08/2023] [Indexed: 10/16/2023] Open
Abstract
Due to its high mortality rate associated with various life-threatening sequelae, meningitis poses a vital problem in contemporary medicine. Numerous algorithms, many of which were derived with the aid of artificial intelligence, were brought up in a strive for perfection in predicting the status of sepsis-related survival or exacerbation. This review aims to provide key insights on the contextual utilization of metabolomics. The aim of this the metabolomic approach set of methods can be used to investigate both bacterial and host metabolite sets from both the host and its microbes in several types of specimens - even in one's breath, mainly with use of two methods - Mass Spectrometry (MS) and Nuclear Magnetic Resonance (NMR). Metabolomics, and has been used to elucidate the mechanisms underlying disease development and metabolic identification changes in a wide range of metabolite contents, leading to improved methods of diagnosis, treatment, and prognosis of meningitis. Mass spectrometry (MS) and Nuclear Magnetic Resonance (NMR) are the main analytical platforms used in metabolomics. Its high sensitivity accounts for the usefulness of metabolomics in studies into meningitis, its sequelae, and concomitant comorbidities. Metabolomics approaches are a double-edged sword, due to not only their flexibility, but also - high complexity, as even minor changes in the multi-step methods can have a massive impact on the results. Information on the differential diagnosis of meningitis act as a background in presenting the merits and drawbacks of the use of metabolomics in context of meningeal infections.
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Affiliation(s)
- Agata Kozioł
- Department of Immunochemistry and Chemistry, Wrocław Medical University, M. Skłodowskiej-Curie Street 48/50, 50-369 Wrocław, Poland
| | - Małgorzata Pupek
- Department of Immunochemistry and Chemistry, Wrocław Medical University, M. Skłodowskiej-Curie Street 48/50, 50-369 Wrocław, Poland.
| | - Łukasz Lewandowski
- Department of Medical Biochemistry, Wrocław Medical University, T. Chałubińskiego Street 10, 50-368 Wrocław, Poland
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Raghu VK, Horvat CM, Kochanek PM, Fink EL, Clark RSB, Benos PV, Au AK. Neurological Complications Acquired During Pediatric Critical Illness: Exploratory "Mixed Graphical Modeling" Analysis Using Serum Biomarker Levels. Pediatr Crit Care Med 2021; 22:906-914. [PMID: 34054117 PMCID: PMC8490289 DOI: 10.1097/pcc.0000000000002776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Neurologic complications, consisting of the acute development of a neurologic disorder, that is, not present at admission but develops during the course of illness, can be difficult to detect in the PICU due to sedation, neuromuscular blockade, and young age. We evaluated the direct relationships of serum biomarkers and clinical variables to the development of neurologic complications. Analysis was performed using mixed graphical models, a machine learning approach that allows inference of cause-effect associations from continuous and discrete data. DESIGN Secondary analysis of a previous prospective observational study. SETTING PICU, single quaternary-care center. PATIENTS Individuals admitted to the PICU, younger than18 years old, with intravascular access via an indwelling catheter. INTERVENTIONS None. MEASUREMENTS About 101 patients were included in this analysis. Serum (days 1-7) was analyzed for glial fibrillary acidic protein, ubiquitin C-terminal hydrolase-L1, and alpha-II spectrin breakdown product 150 utilizing enzyme-linked immunosorbent assays. Serum levels of neuron-specific enolase, myelin basic protein, and S100 calcium binding protein B used in these models were reported previously. Demographic data, use of selected clinical therapies, lengths of stay, and ancillary neurologic testing (head CT, brain MRI, and electroencephalogram) results were recorded. The Mixed Graphical Model-Fast-Causal Inference-Maximum algorithm was applied to the dataset. MAIN RESULTS About 13 of 101 patients developed a neurologic complication during their critical illness. The mixed graphical model identified peak levels of the neuronal biomarker neuron-specific enolase and ubiquitin C-terminal hydrolase-L1, and the astrocyte biomarker glial fibrillary acidic protein to be the direct causal determinants for the development of a neurologic complication; in contrast, clinical variables including age, sex, length of stay, and primary neurologic diagnosis were not direct causal determinants. CONCLUSIONS Graphical models that include biomarkers in addition to clinical data are promising methods to evaluate direct relationships in the development of neurologic complications in critically ill children. Future work is required to validate and refine these models further, to determine if they can be used to predict which patients are at risk for/or with early neurologic complications.
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Affiliation(s)
- Vineet K. Raghu
- Department of Computer Science, University of Pittsburgh,
Pittsburgh, PA
| | - Christopher M. Horvat
- Department of Critical Care Medicine, University of
Pittsburgh School of Medicine, Pittsburgh, PA; Department of Pediatrics, University
of Pittsburgh School of Medicine, Pittsburgh, PA
- Safar Center for Resuscitation Research, University of
Pittsburgh School of Medicine, Pittsburgh, PA; Brain Care Institute, UPMC
Children’s Hospital of Pittsburgh, PA
| | - Patrick M. Kochanek
- Department of Critical Care Medicine, University of
Pittsburgh School of Medicine, Pittsburgh, PA; Department of Pediatrics, University
of Pittsburgh School of Medicine, Pittsburgh, PA
- Safar Center for Resuscitation Research, University of
Pittsburgh School of Medicine, Pittsburgh, PA; Brain Care Institute, UPMC
Children’s Hospital of Pittsburgh, PA
| | - Ericka L. Fink
- Department of Critical Care Medicine, University of
Pittsburgh School of Medicine, Pittsburgh, PA; Department of Pediatrics, University
of Pittsburgh School of Medicine, Pittsburgh, PA
- Safar Center for Resuscitation Research, University of
Pittsburgh School of Medicine, Pittsburgh, PA; Brain Care Institute, UPMC
Children’s Hospital of Pittsburgh, PA
| | - Robert S. B. Clark
- Department of Critical Care Medicine, University of
Pittsburgh School of Medicine, Pittsburgh, PA; Department of Pediatrics, University
of Pittsburgh School of Medicine, Pittsburgh, PA
- Safar Center for Resuscitation Research, University of
Pittsburgh School of Medicine, Pittsburgh, PA; Brain Care Institute, UPMC
Children’s Hospital of Pittsburgh, PA
| | - Panayiotis V. Benos
- Department of Computer Science, University of Pittsburgh,
Pittsburgh, PA
- Department of Computational and Systems Biology, University
of Pittsburgh, Pittsburgh PA
| | - Alicia K. Au
- Department of Critical Care Medicine, University of
Pittsburgh School of Medicine, Pittsburgh, PA; Department of Pediatrics, University
of Pittsburgh School of Medicine, Pittsburgh, PA
- Safar Center for Resuscitation Research, University of
Pittsburgh School of Medicine, Pittsburgh, PA; Brain Care Institute, UPMC
Children’s Hospital of Pittsburgh, PA
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Invasive neuromonitoring and neurological intensive care unit management in life-threatening central nervous system infections. Curr Opin Neurol 2021; 34:447-455. [PMID: 33935217 DOI: 10.1097/wco.0000000000000945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Patients with infectious diseases of the central nervous system (CNS) commonly require treatment in the intensive care unit (ICU). In a subset of patients with a life-threatening course, a more aggressive and invasive management is required. Treatment relies on the expertise of the intensivists as most recommendations are currently not based on a high level of evidence. RECENT FINDINGS Published data suggest that an invasive brain-focused management should be considered in life-threatening CNS infections. Brain resuscitation by adequate control of intracranial pressure (ICP) and optimization of cerebral perfusion, oxygen and glucose delivery supports the idea of personalized medicine. Recent advances in monitoring techniques help to guide clinicians to improve neurocritical care management in these patients with severe disease. Robust data on the long-term effect of decompressive craniectomy and targeted temperature management are lacking, however, these interventions can be life-saving in individual patients in the setting of a potentially fatal situation such as refractory elevated ICP. SUMMARY Advances in the neurocritical care management and progress in monitoring techniques in specialized neuro-ICUs may help to preserve brain function and prevent a deleterious cascade of secondary brain damage in life-threatening CNS infections.
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Grønhøj MH, Sejbaek T, Hansen RW, Larsen L, Dahl M, Schierbeck J, Poulsen FR. Serum levels of neurofilament light chain, neuron-specific enolase and S100 calcium-binding protein B during acute bacterial meningitis: a prospective cohort study. Infect Dis (Lond) 2021; 53:409-419. [PMID: 33583314 DOI: 10.1080/23744235.2021.1883730] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Acute bacterial meningitis (ABM) is a severe disease with an overall poor outcome. Neurofilament (NFL) has shown to be a promising biomarker of neuroaxonal injury in various neurological disorders but has not been investigated in ABM. The aims of this study were (i) to obtain a temporal profile of NFL, neuron-specific enolase (NSE) and S100B in serum during ABM, and (ii) to evaluate their use as biomarkers of severity (Glasgow coma score) and prognosis (Glasgow Outcome Score, GOS and death) in severe ABM. METHODS Fifteen adults with severe community-acquired ABM who were admitted to the intensive care unit (ICU) and fulfilled the inclusion criteria were included. Lumbar puncture and blood tests were performed on admission, and blood tests were performed three times daily during the ICU stay. GOS was obtained day 30. RESULTS Serum NFL was significantly elevated in ABM patients compared to healthy controls, both at admission and throughout the observation period (p < .01). NFL increased significantly from day 1 up to day 3-6 (p < .0001), peaking day 6. NSE increased significantly from admission up to day 3 (p < .01). At day 5-6, the serum values were not significantly different from values at admission. The highest median serum value of S100B was observed at admission (0.10 µg/L, IQR 0.06-0.14), significantly decreasing day 4-6 (p < .05). None of the investigated biomarkers revealed significant correlation with severity and prognosis. CONCLUSION This study represents a first clinical observation of the temporal profile of NFL in serum, in severe ABM. No correlation with severity or prognosis.
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Affiliation(s)
| | - Tobias Sejbaek
- Department of Neurology, Esbjerg Central Hospital, University Hospital of Southern Denmark, Esbjerg, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,BRIDGE, Brain Research - Inter-Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Lykke Larsen
- Research Unit for Infectious Diseases, Odense University Hospital, Odense, Denmark; University of Southern Denmark, Odense, Denmark
| | - Morten Dahl
- Department of Clinical Biochemistry, Zealand University Hospital, Koege, Denmark
| | - Jens Schierbeck
- Department of Anaesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
| | - Frantz Rom Poulsen
- Department of Neurosurgery, Odense University Hospital, Odense, Denmark.,BRIDGE, Brain Research - Inter-Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,OPEN, Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
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7
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Le ND, Muri L, Grandgirard D, Kuhle J, Leppert D, Leib SL. Evaluation of neurofilament light chain in the cerebrospinal fluid and blood as a biomarker for neuronal damage in experimental pneumococcal meningitis. J Neuroinflammation 2020; 17:293. [PMID: 33028339 PMCID: PMC7539528 DOI: 10.1186/s12974-020-01966-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/24/2020] [Indexed: 12/12/2022] Open
Abstract
Background Pneumococcal meningitis (PM) remains a global public health concern and affects all age groups. If acquired during infancy or childhood, permanent neurofunctional deficits including cognitive impairment, cerebral palsy, and secondary epilepsy are typical sequelae of neuronal injury. Determination of patients at risk for the development of brain injury and subsequent neurofunctional sequelae could help to identify patients for focused management. Neurofilament light chain (NfL) is an axonal cytoskeletal protein released upon neuronal injury into the cerebrospinal fluid (CSF) and blood. As little is known about the course of neurofilament release in the course of PM, we measured CSF and serum NfL levels longitudinally in experimental PM (ePM). Methods Eleven-day-old infant Wistar rats were infected intracisternally with Streptococcus pneumoniae and treated with ceftriaxone. At 18 and 42 h post-infection (hpi), the blood and CSF were sampled for NfL measurements by a single molecule array technology. Inflammatory cytokines and MMP-9 in CSF were quantified by magnetic bead multiplex assay (Luminex®) and by gel zymography, respectively. Results In ePM, CSF and serum NfL levels started to increase at 18 hpi and were 26- and 3.5-fold increased, respectively, compared to mock-infected animals at 42 hpi (p < 0.0001). CSF and serum NfL correlated at 18 hpi (p < 0.05, r = 0.4716) and 42 hpi (p < 0.0001, r = 0.8179). Both CSF and serum NfL at 42 hpi strongly correlated with CSF levels of IL-1β, TNF-α, and IL-6 and of MMP-9 depending on their individual kinetics. Conclusion Current results demonstrate that during the peak inflammatory phase of ePM, NfL levels in CSF and serum are the highest among CNS disease models studied so far. Given the strong correlation of CSF versus serum NfL, and its CNS-specific signal character, longitudinal measurements to monitor the course of PM could be performed based on blood sample tests, i.e., without the need of repetitive spinal taps. We conclude that NfL in the serum should be evaluated as a biomarker in PM.
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Affiliation(s)
- Ngoc Dung Le
- Neuroinfection Laboratory, Institute for Infectious Diseases, University of Bern, Friedbühlstrasse 51, 3001, Bern, Switzerland.,Graduate School for Cellular and Biomedical Sciences (GCB), University of Bern, Bern, Switzerland
| | - Lukas Muri
- Neuroinfection Laboratory, Institute for Infectious Diseases, University of Bern, Friedbühlstrasse 51, 3001, Bern, Switzerland
| | - Denis Grandgirard
- Neuroinfection Laboratory, Institute for Infectious Diseases, University of Bern, Friedbühlstrasse 51, 3001, Bern, Switzerland
| | - Jens Kuhle
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
| | - David Leppert
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
| | - Stephen L Leib
- Neuroinfection Laboratory, Institute for Infectious Diseases, University of Bern, Friedbühlstrasse 51, 3001, Bern, Switzerland.
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Larsen L, Nielsen TH, Nordström CH, Andersen AB, Schierbeck J, Schulz MK, Poulsen FR. Patterns of cerebral tissue oxygen tension and cytoplasmic redox state in bacterial meningitis. Acta Anaesthesiol Scand 2019; 63:329-336. [PMID: 30328110 DOI: 10.1111/aas.13278] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 09/14/2018] [Accepted: 09/17/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Compromised cerebral energy metabolism is common in patients with bacterial meningitis. In this study, simultaneous measurements of cerebral oxygen tension and lactate/pyruvate ratio were compared to explore whether disturbed energy metabolism was usually caused by insufficient tissue oxygenation or compromised oxidative metabolism of pyruvate indicating mitochondrial dysfunction. SUBJECT AND METHODS Ten consecutive patients with severe streptococcus meningitis were included in this prospective cohort study. Intracranial pressure, brain tissue oxygen tension (PbtO2 ), and energy metabolism (intracerebral microdialysis) were continuously monitored in nine patients. A cerebral lactate/pyruvate (LP) ratio <30 was considered indicating normal oxidative metabolism, LP ratio >30 simultaneously with pyruvate below lower normal level (70 µmol/L) was interpreted as biochemical indication of ischemia, and LP ratio >30 simultaneously with a normal or increased level of pyruvate was interpreted as mitochondrial dysfunction. The biochemical variables were compared with PbtO2 simultaneously monitored within the same cerebral region. RESULTS In two cases, the LP ratio was normal during the whole study period and the simultaneously monitored PbtO2 was 18 ± 6 mm Hg. In six cases, interpreted as mitochondrial dysfunction, the simultaneously monitored PbtO2 was 20 ± 6 mm Hg and without correlation with the LP ratio. In one patient, exhibiting a pattern interpreted as ischemia, PbtO2 decreased below 10 mm Hg and a correlation between LP and PbtO2 was observed. CONCLUSION This study demonstrated that compromised cerebral energy metabolism, evidenced by increased LP ratio, was common in patients with severe bacterial meningitis while not related to insufficient tissue oxygenation.
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Affiliation(s)
- Lykke Larsen
- Department of Infectious Diseases; Odense University Hospital; Odense Denmark
- Department of Clinical Research; University of Southern Denmark; Odense Denmark
| | - Troels H. Nielsen
- Department of Clinical Research; University of Southern Denmark; Odense Denmark
- Department of Neurosurgery; Odense University Hospital; Odense Denmark
| | - Carl-Henrik Nordström
- Department of Clinical Research; University of Southern Denmark; Odense Denmark
- Department of Neurosurgery; Odense University Hospital; Odense Denmark
| | - Aase B. Andersen
- Department of Clinical Research; University of Southern Denmark; Odense Denmark
- Department of Infectious Diseases; Copenhagen University Hospital Rigshospitalet; Copenhagen Denmark
| | - Jens Schierbeck
- Department of Clinical Research; University of Southern Denmark; Odense Denmark
- Department of Anaesthesiology and Intensive Care; Odense University Hospital; Odense Denmark
| | - Mette K. Schulz
- Department of Clinical Research; University of Southern Denmark; Odense Denmark
- Department of Neurosurgery; Odense University Hospital; Odense Denmark
| | - Frantz R. Poulsen
- Department of Clinical Research; University of Southern Denmark; Odense Denmark
- Department of Neurosurgery; Odense University Hospital; Odense Denmark
- OPEN, Odense Patient data Explorative Network; Odense University Hospital; Odense Denmark
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9
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Dogan HO, Alcigir ME. The Protective effect of P7C3 against DNA and neuron damage in rat pups with congenital hypothyroidism. Biomed Pharmacother 2018; 99:499-503. [DOI: 10.1016/j.biopha.2018.01.058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 01/03/2018] [Accepted: 01/05/2018] [Indexed: 10/18/2022] Open
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Pratamastuti D, Indra Gunawan P, Saharso D. Serum neuron specific enolase is increased in pediatric acute encephalitis syndrome. KOREAN JOURNAL OF PEDIATRICS 2017; 60:302-306. [PMID: 29042874 PMCID: PMC5638837 DOI: 10.3345/kjp.2017.60.9.302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 11/20/2016] [Accepted: 01/19/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE This study aimed to investigate whether serum neuron-specific enolase (NSE) was expressed in acute encephalitis syndrome (AES) that causes neuronal damage in children. METHODS This prospective observational study was conducted in the pediatric neurology ward of Soetomo Hospital. Cases of AES with ages ranging from 1 month to 12 years were included. Cases that were categorized as simple and complex febrile seizures constituted the non-AES group. Blood was collected for the measurement of NSE within 24 hours of hemodynamic stabilization. The median NSE values of both groups were compared by using the Mann-Whitney U test. All statistical analyses were performed with SPSS version 12 for Windows. RESULTS In the study period, 30 patients were enrolled. Glasgow Coma Scale mostly decreased in the AES group by about 40% in the level ≤8. All patients in the AES group suffered from status epilepticus and 46.67% of them had body temperature >40℃. Most of the cases in the AES group had longer duration of stay in the hospital. The median serum NSE level in the AES group was 157.86 ng/mL, and this value was significantly higher than that of the non-AES group (10.96 ng/mL; P<0.05). CONCLUSION AES cases showed higher levels of serum NSE. These results indicate that serum NSE is a good indicator of neuronal brain injury.
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Affiliation(s)
- Dian Pratamastuti
- Post Graduate PhD Program, College of Medicine, Airlangga University, Surabaya, Indonesia
| | - Prastiya Indra Gunawan
- Division of Pediatric Neurology, Department of Pediatrics, College of Medicine, Airlangga University, Soetomo Hospital , Surabaya, Indonesia
| | - Darto Saharso
- Division of Pediatric Neurology, Department of Pediatrics, College of Medicine, Airlangga University, Soetomo Hospital , Surabaya, Indonesia
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Thelin EP, Carpenter KLH, Hutchinson PJ, Helmy A. Microdialysis Monitoring in Clinical Traumatic Brain Injury and Its Role in Neuroprotective Drug Development. AAPS JOURNAL 2017; 19:367-376. [PMID: 28070712 DOI: 10.1208/s12248-016-0027-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 12/07/2016] [Indexed: 11/30/2022]
Abstract
Injuries to the central nervous system continue to be vast contributors to morbidity and mortality; specifically, traumatic brain injury (TBI) is the most common cause of death during the first four decades of life. Several modalities are used to monitor patients suffering from TBI in order to prevent detrimental secondary injuries. The microdialysis (MD) technique, introduced during the 1990s, presents the treating physician with a robust monitoring tool for brain chemistry in addition to conventional intracranial pressure monitoring. Nevertheless, some limitations remain, such as limited spatial resolution. Moreover, while there have been several attempts to develop new potential pharmacological therapies in TBI, there are currently no available drugs which have shown clinical efficacy that targets the underlying pathophysiology, despite various trials investigating a plethora of pharmaceuticals. Specifically in the brain, MD is able to demonstrate penetration of the drug through the blood-brain barrier into the brain extracellular space at potential site of action. In addition, the downstream effects of drug action can be monitored directly. In the future, clinical MD, together with other monitoring modalities, can identify specific pathological substrates which require tailored treatment strategies for patients suffering from TBI.
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Affiliation(s)
- Eric Peter Thelin
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK. .,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Keri L H Carpenter
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK.,Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Peter J Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK.,Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Adel Helmy
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
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Deitchman AN, Heinrichs MT, Khaowroongrueng V, Jadhav SB, Derendorf H. Utility of Microdialysis in Infectious Disease Drug Development and Dose Optimization. AAPS JOURNAL 2016; 19:334-342. [PMID: 27943149 DOI: 10.1208/s12248-016-0020-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 11/25/2016] [Indexed: 01/13/2023]
Abstract
Adequate drug penetration to a site of infection is absolutely imperative to ensure sufficient antimicrobial treatment. Microdialysis is a minimally invasive, versatile technique, which can be used to study the penetration of an antiinfective agent in virtually any tissue of interest. It has been used to investigate drug distribution and pharmacokinetics in variable patient populations, as a tool in dose optimization, a potential utility in therapeutic drug management, and in the study of biomarkers of disease progression. While all of these applications have not been fully explored in the field of antiinfectives, this review provides an overview of how microdialysis has been applied in various phases of drug development, a focus on the specific applications in the subspecialties of infectious disease (treatment of bacterial, fungal, viral, parasitic, and mycobacterial infections), and developing applications (biomarkers and therapeutic drug management).
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Affiliation(s)
- Amelia N Deitchman
- Department of Pharmaceutics, University of Florida, 1345 Center Drive, PO Box 100494, Gainesville, Florida, 32610, USA
| | - M Tobias Heinrichs
- Department of Pharmaceutics, University of Florida, 1345 Center Drive, PO Box 100494, Gainesville, Florida, 32610, USA
| | - Vipada Khaowroongrueng
- Department of Pharmaceutics, University of Florida, 1345 Center Drive, PO Box 100494, Gainesville, Florida, 32610, USA
| | - Satyawan B Jadhav
- Department of Pharmaceutics, University of Florida, 1345 Center Drive, PO Box 100494, Gainesville, Florida, 32610, USA
| | - Hartmut Derendorf
- Department of Pharmaceutics, University of Florida, 1345 Center Drive, PO Box 100494, Gainesville, Florida, 32610, USA.
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