Hemodynamic impact of molecular adsorbent recirculating system in refractory vasoplegic shock due to calcium channel blocker poisoning

OBJECTIVE

To report the hemodynamic effect of to the molecular adsorbent recirculating system (MARS™) therapy for patients in refractory vasoplegic shock due to calcium channel blocker (CCB) poisoning.

METHODS

We report a retrospective cohort of patients who were hospitalized for CCB poisoning with refractory vasoplegic shock and treated by MARS therapy, at Amiens Hospital University, from January 2010 to December 2019. Improvement in hemodynamic was assessed by dynamic changes in mean arterial pressure (MAP) and norepinephrine levels over a 24-h period after MARS therapy. Cardiac function was assessed by transthoracic echocardiography.

RESULTS

MARS therapy was performed on seven patients for CCB poisoning. CCB poisoning included nicardipine (n = 3, 43%) amlodipine (n = 3, 43%), and verapamil (n = 1, 14%). The median time to start MARS therapy was 24 [14-27] h after drug ingestion and 6 [2-9] h after ICU admission. Cardiac output was preserved for all patients. MAP values improved from 56 [43-58] to 65 [61-78] 16 mmHg (p = 0.005). Norepinephrine dose significantly decreased from 3.2 [0.8-10] µg/kg/min to 1.2 [0.1-1.9] µg/kg/min (p = 0.008) and lactate level decreased from 3.2 [2.4-3.4] mmol/l^-1 to 1.6 [0.9-2.2] mmol/l^-1 (p = 0.008). The median length of ICU stay was 4 (2-7) days and hospital stay was 4 (4-16) days. No complication related to the MARS therapy were reported. No patient died and all were discharged from the hospital.

CONCLUSION

We reported the largest case-series of MARS therapy for refractory vasoplegic shock due to CCB poisoning. We observed that MARS therapy was associated with an improvement of hemodynamic parameters.

Invasive Tracheobronchial Aspergillosis in Critically Ill Patients with Severe Influenza. A Clinical Trial

Rationale: Invasive tracheobronchial aspergillosis (ITBA) is an uncommon but severe clinical form of invasive pulmonary aspergillosis in which the fungal infection is entirely or predominantly confined to the tracheobronchial tree.Objectives: To analyze the diagnostic and prognostic differences between tracheobronchial aspergillosis and pulmonary aspergillosis without tracheobronchial lesions among patients admitted to the ICU with severe influenza.Methods: This retrospective, observational study included critically ill patients with influenza associated with pulmonary aspergillosis from three hospital ICUs between 2010 and 2019. Patient characteristics and clinical and mycologic data at admission and during ICU stay were collected in a database to evaluate variables in the two groups.Measurements and Main Results: Thirty-five patients admitted to the ICU with severe influenza and pulmonary aspergillosis were included. Ten patients were included in the group with ITBA (n = 10 of 35; 28.6%), and 25 patients were included in the group without ITBA. The group with ITBA comprised more patients with active smoking, diabetes mellitus, and higher severity scores (Simplified Acute Physiology Score II). Ninety-day mortality rates in the groups with and without ITBA were 90% and 44%, respectively (P = 0.02). Moreover, significantly higher serum 1,3-β-d-glucan and galactomannan and BAL fluid galactomannan concentrations were observed in the group with ITBA compared with the group without ITBA (P < 0.0001, P = 0.003, and P = 0.008, respectively).Conclusions: ITBA was associated with higher severity scores, mortality, and serum and BAL fluid galactomannan and 1,3-β-d-glucan concentrations than invasive pulmonary aspergillosis without tracheobronchial lesions. ITBA should be systematically researched by bronchoscopic examination in ICU patients with concomitant pulmonary aspergillosis and influenza.Clinical trial registered with www.clinicaltrials.gov (NCT04077697).

Acute Cor Pulmonale in COVID-19-Related ARDS: Improvement With Almitrine Infusion

Coronavirus disease-19 (COVID-19)-related severe acute respiratory distress syndrome can lead to acute cor pulmonale. We report a case of acute cor pulmonale secondary to severe COVID-19 acute respiratory distress syndrome diagnosed with transesophageal echocardiography. Almitrine infusion allowed rapid enhancement of right ventricular function as well as improvement in oxygenation. (Level of Difficulty: Intermediate.)

Making better use of technological advances to meet shakeholder needs

Controlling transboundary diseases requires an inclusive and collaborative international approach. Decisions should be taken (and seen to be taken) on advice from multidisciplinary teams of scientists and representatives from all groups significantly affected by the disease (the 'stakeholders'). Changes in trade and travel mean that, unless a new model is developed for disease prevention, there is a real possibility that transboundary animal diseases will become increasingly difficult to control. The traditional government approach of dealing almost exclusively with the commercial sector of the livestock industry is no longer sufficient, and new ways must be found to include all sectors, including 'grey' husbandry (fragmented, disparate groups whose involvement with animals may range from the legal and responsible to the unsanctioned and/or illegal). The increasing convergence of human and animal health issues makes it imperative to make the best possible use of new tools. The particular challenges confronting veterinary science are: preventing the introduction of disease, rapidly identifying disease and controlling epidemics. This paper focuses on the United Kingdom to investigate the inadequacies of current approaches, identify needs, offer recommendations and propose a new approach to disease control, which emphasises global considerations. The objectives are: better participation across the entire sector, better communication, better science and better decision-making, all of which should lead to better security from disease.

The 2001 foot and mouth disease epidemic in the United Kingdom: animal welfare perspectives

The management of the foot and mouth disease (FMD) epidemic which occurred in the United Kingdom (UK) in 2001 resulted in widespread animal welfare problems. These problems arose firstly because of the large numbers of animals slaughtered to bring the epidemic under control, which meant that the conditions under which animals were slaughtered and the manner in which this was carried out often breached regulations concerning welfare at slaughter. Secondly, the restrictions imposed on movements, especially animal movements, resulted in what appeared to be readily avoidable difficulties with livestock dying from, for example, food shortages and pregnant animals giving birth under unsuitable conditions. This brief review is based on the personal experiences of the authors as well as relevant observations and reports from a variety of sources.

Methanobacterium oryzae sp. nov., a novel methanogenic rod isolated from a Philippines ricefield

A rod (0.3-0.4 micron x 3-10 microns) to filamentous (up to 40 microns) non-motile methanogenic bacterium, designated strain FPiT (T = type strain), was isolated from ricefield soil in the Philippines. The strain uses H2 + CO2 or formate for growth and produces CH4. Optimum growth temperature is 40 degrees C; no growth is observed at 15 degrees C or 45 degrees C. Optimum pH for growth is 7; no growth is observed at pH 5.5 or 9.0. Strain FPiT is halotolerant and grows at NaCl concentrations of 0-25 g l-1. The G + C content of its DNA is 31 mol%. Based on 16S rRNA gene sequence analysis, the isolate was identified as a new species of the genus Methanobacterium: Methanobacterium oryzae sp. nov. The type strain is FPiT (= DSM 11106T).

Effects of pesticides on soil and water microflora and mesofauna in wetland ricefields: a summary of current knowledge and extrapolation to temperate environments

This review summarises information on the behaviour of pesticides and their impacts on microorganisms and non-target invertebrates that was collected in, or is applicable to, temperate wetland ricefields. An extensive bibliographic survey shows that current knowledge is fragmentary and partly outdated. Pesticides applied on soil at recommended levels rarely had a detrimental effect on microbial populations or their activities. They had more effect on invertebrate populations, inducing the blooming of individual species of floodwater zooplankton and reducing populations of aquatic oligochaetes in soil. Available information raises concerns regarding the long-term effects of pesticides on (i) microorganisms, primary producers, and invertebrates of importance to soil fertility, (ii) predators of rice pests and vectors, and (iii) microbial metabolism of pesticides.