First confirmed case of multisystem inflammatory syndrome in adult in Egypt

Key Clinical Message

Our case report demonstrates extremely uncommon data associated with MIS-A, such as cholestatic jaundice, anemia, and quickly progressing pneumonia. IVIG and pulse steroid medications are the best treatments for improving clinical outcomes.

Abstract

We report a case of multiple organ dysfunctions due to MIS-A in an adult with a history of suspected COVID-19. Our case demonstrates extremely uncommon data associated with MIS-A, such as cholestatic jaundice, anemia, and quickly progressing pneumonia. IVIG and pulse steroid medications are the best treatments for improving clinical outcomes.

Exploring plasma metabolomic changes in sepsis: a clinical matching study based on gas chromatography-mass spectrometry

Background

Sepsis is a deleterious systemic inflammatory response to infection, and despite advances in treatment, the mortality rate remains high. We hypothesized that plasma metabolism could clarify sepsis in patients complicated by organ dysfunction.

Methods

Plasma samples from 31 patients with sepsis and 23 healthy individuals of comparable age, gender, and body mass index (BMI) were collected. Plasma metabolites were detected through gas chromatography–mass spectrometry (GC–MS), and relevant metabolic pathways were predicted using the Kyoto Encyclopedia of Genes and Genomics (KEGG) pathway database. Student’s t-test was employed for statistical analysis. In addition, to explore sepsis organ dysfunction, plasma samples of sepsis patients were further analyzed by metabolomics subgroup analysis according to organ dysfunction.

Results

A total of 222 metabolites were detected, which included 124 metabolites with statistical significance between the sepsis and control groups. Among these, we found 26 were fatty acids, including 3 branched fatty acids, 10 were saturated fatty acids, and 13 were unsaturated fatty acids that were found in sepsis plasma samples but not in the controls. In addition, 158 metabolic pathways were predicted, 74 of which were significant. Further subgroup analysis identified seven metabolites in acute kidney injury (AKI), three metabolites in acute respiratory distress syndrome (ARDS), seven metabolites in sepsis-induced myocardial dysfunction (SIMD), and four metabolites in acute hepatic ischemia (AHI) that were significantly different. The results showed that the sepsis samples exhibited extensive changes in amino acids, fatty acids, and tricarboxylic acid (TCA)–cycle products. In addition, three metabolic pathways—namely, energy metabolism, amino acid metabolism, and lipid metabolism—were downregulated in sepsis patients.

Conclusions

The downregulated energy, amino acid, and lipid metabolism found in our study may serve as a novel clinical marker for the dysregulated internal environment, particularly involving energy metabolism, which results in sepsis.

Treating acute fatty liver of pregnancy with artificial liver support therapy: Systematic review

BACKGROUND

Acute fatty liver of pregnancy (AFLP) is a serious disease with high mortality. Recent data suggest that postpartum application of artificial liver support therapy (ALST) in AFLP management improves disease outcome. In current study, we tend to further evaluate whether the type, the timing, and the number of postpartum ALST sessions and other clinical factors including complications and liver and renal function will influence disease outcome in ALST era.

METHODS

Medical records of 15 AFLP patients having postpartum ALST in our hospital from 2010 to 2016 were first retrospectively reviewed. A systematic review and statistical analysis was then conducted with our cases and those having postpartum ALST reported in PubMed, Embase, Cochrane, and ClinicalTrials.gov till the end of June 2016.

RESULTS

Nine relevant studies were identified in the public databases. A total of 104 cases were enrolled for analysis including 15 cases from our hospital and 89 cases from the identified 9 studies. Univariate analysis revealed that 2 complications, postpartum hemorrhage and multiple organ dysfunctions (MODS), were associated with the outcome of AFLP patients undergoing postpartum ALST. Binary logistic regression analysis further indicated that MODS was the only independent factor affecting disease outcome. Surprisingly, factors including pre-ALST serum levels of total bilirubin and creatinine, the type and number of postpartum ALST sessions, time interval between delivery and ALST were unrelated to disease outcome.

CONCLUSION

Current data suggest that postpartum ALST improves the outcome of AFLP patients but more properly designed experiments are needed to confirm this point. Our study further indicates that occurrence of MODS carries a bad prognosis even in ALST era. Our study provides valuable information on guiding the clinical application of postpartum ALST in AFLP management.

Polyethylene-oxide improves microcirculatory blood flow in a murine hemorrhagic shock model

BACKGROUND

Polyethylene oxide (PEO) is a synthetic polymer commonly used in medicine production to reduce toxicity. In the present study, we assessed whether PEO can have a functional effect on improving microcirculatory blood flow after hemorrhagic shock in an animal model.

METHODS

Hemorrhagic shock (HS) was introduced in 78 C57BL/6 mice, which were then equally divided into two groups. One group of mice was intravenously injected with PEO (diluted in Ringer's solution (RS), PH = 7.4), and the other with RS only. The parameters of microcirculatory hemodynamics, arterial blood gas analysis and multi-organ functions were compared between two groups, 0, 3, 12 and 24 hours after resuscitation.

RESULTS

After HS, the hemodynamics, including microvascular diameter, red blood cell velocity, and blood flow rates were significantly improved in time-dependent manners in PEO treated mice. Most parameters of arterial blood gas analysis, except PCO2, were also significantly improved by PEO. Multi-organ immunohistochemistry demonstrated that congestions and inflammatory responses in liver and lung were markedly ameliorated by PEO.

CONCLUSIONS

Our results demonstrated that PEO infusion could effectively improve microcirculation after hemorrhagic shock and increase the chance of survival in animal models.

Proinflammatory cytokines in peritonitis

RATIONALE

We performed this study with the purpose of revealing different aspects of the systemic inflammatory response syndrome in peritonitis.

OBJECTIVES

The aim of the presentation was to make a research on some of the immune response mediators in secondary peritonitis and to observe their capacity to anticipate the evolution towards septic complications.

METHODS AND RESULTS

We have undertaken a study on a group of 100 patients with acute diffuse peritonitis, between 2009 and 2011, in which we have accomplished the dosage of IL-1 beta, IL-6 and TNF alpha cytokines in the serum of patients, in dynamics, for 7 days by using the Elisa method. Subsequently, we have compared the results to the ones of a control group. The data obtained indicated high levels of proinflammatory cytokines in the patients who subsequently suffered an unfavorable evolution towards septic complications.

DISCUSSION

The study of IL-1 beta, IL-6 and TNF alpha blood dynamics, offers valuable information about the severity of a systemic inflammatory response syndrome in peritonitis. They can be valuable biomarkers in establishing the unfavorable evolution of patients, helping the physician to establish a sustained and specific treatment, even from the early phases of the illness.