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Sararak Choosakul Kamin Harinwan Sakkarin Chirapongsathorn Krit Opuchar Theeranun Sanpajit Wanich Piyanirun Chaipichit Puttapitakpong 《Pancreatology》2018,18(5):507-512
Background/Objectives
Aggressive fluid resuscitation is recommended for initial management of acute pancreatitis. However, there are few studies which focus on types of fluid therapy.Methods
We performed a randomized controlled trial in patients with acute pancreatitis. The patients were randomized into two groups. Each group received Normal Saline solution (NSS) or Lactated Ringer's solution (LRS) through a goal-directed fluid resuscitation protocol. Systemic inflammatory response syndrome (SIRS) at 24 and 48?h, mortality, presence of local complications and inflammatory markers were measured.Results
Forty-seven patients were included. Twenty-four patients (51%) received NSS and 23 patients received LRS. There was significant reduction in SIRS after 24?h among subjects who resuscitated with LRS compared with NSS (4.2% in NSS, 26.1% in LRS, P?=?0.02). However, SIRS reduction at 48?h was not different between groups (33.4% in NSS, 26.1% in LRS, P?=?0.88). Mortality was not different between NSS and LRS (4.2% in NSS, 0% in LRS, P?=?1.00). CRP, ESR and procalcitonin increased at 24?h and 48?h after admission with no difference between the two groups. Local complications were 29.2% in NSS and 21.7% in LRS (P?=?0.74). The median length of hospital stay was not significantly different in the two groups (5.5 days in NSS, 6 days in LRS, P?=?0.915).Conclusions
Lactated Ringer's solution was superior to NSS in SIRS reduction in acute pancreatitis only in the first 24?h. But SIRS at 48?h and mortality were not different between LRS and NSS. 相似文献2.
Evaluation of phytochemicals from medicinal plants of Myrtaceae family on virulence factor production by Pseudomonas aeruginosa
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Khadar Syed Musthafa Wipawadee Sianglum Jongkon Saising Sakkarin Lethongkam Supayang Piyawan Voravuthikunchai 《APMIS : acta pathologica, microbiologica, et immunologica Scandinavica》2017,125(5):482-490
Virulence factors regulated by quorum sensing (QS) play a critical role in the pathogenesis of an opportunistic human pathogen, Pseudomonas aeruginosa in causing infections to the host. Hence, in the present work, the anti‐virulence potential of the medicinal plant extracts and their derived phytochemicals from Myrtaceae family was evaluated against P. aeruginosa. In the preliminary screening of the tested medicinal plant extracts, Syzygium jambos and Syzygium antisepticum demonstrated a maximum inhibition in QS‐dependent violacein pigment production by Chromobacterium violaceum DMST 21761. These extracts demonstrated an inhibitory activity over a virulence factor, pyoverdin, production by P. aeruginosa ATCC 27853. Gas chromatography–mass spectrometric (GC‐MS) analysis revealed the presence of 23 and 12 phytochemicals from the extracts of S. jambos and S. antisepticum respectively. Three top‐ranking phytochemicals, including phytol, ethyl linoleate and methyl linolenate, selected on the basis of docking score in molecular docking studies lowered virulence factors such as pyoverdin production, protease and haemolytic activities of P. aeruginosa to a significant level. In addition, the phytochemicals reduced rhamnolipid production by the organism. The work demonstrated an importance of plant‐derived compounds as anti‐virulence drugs to conquer P. aeruginosa virulence towards the host. 相似文献
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Adding C‐reactive protein and procalcitonin to the model of end‐stage liver disease score improves mortality prediction in patients with complications of cirrhosis
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Rashid Khan Sujan Ravi Sakkarin Chirapongsathorn Whitney Jennings Habeeb Salameh Kirk Russ Matt Skinner Sandhya Mudumbi Douglas Simonetto Yong-Fang Kuo Patrick S. Kamath Ashwani K. Singal 《Mayo Clinic proceedings. Mayo Clinic》2019,94(9):1799-1806
ObjectiveTo examine whether baseline model for end-stage liver disease (MELD) score in patients with cirrhosis and ascites predicts the future development of first spontaneous bacterial peritonitis (SBP) episode.MethodsA retrospective case-control study was performed at three academic centers to select patients admitted with first SBP episode (cases) and those with ascites admitted for decompensation without SBP (controls). Medical records from these centers were reviewed between January 1, 2008, and December 31, 2013. Cases and controls were matched (1:2) for age, sex, and race. Conditional logistic recession models were built to determine whether baseline MELD score (within a month before hospitalization) predicts first SBP episode.ResultsOf 697 patients (308, 230, and 159 from centers A, B, and C, respectively), cases and controls were matched in 94%, 89%, and 100% at three respective centers. In the pooled sample, probability of SBP was 11%, 31%, 71%, and 93% at baseline MELD scores less than or equal to 10, from 11 to 20, from 21 to 30, and greater than 30, respectively. Compared with MELD score less than or equal to 10, patients with MELD scores from 11 to 20, 21 to 30, and greater than 30 had six- (3- to 11-), 29- (12- to 69-), and 115- (22- to 598-) folds (95% CI) risk of SBP, respectively. Based on different MELD score cutoff points, MELD score greater than 17 was most accurate in predicting SBP occurrence. Analyzing 315 patients (152 cases) with available data on ascitic fluid protein level controlling for age, sex, and center, MELD score but not ascitic fluid protein associated with first SBP episode with respective odds ratios of 1.20 (1.14 to 1.26) and 0.88 (0.70 to 1.11).ConclusionBaseline MELD score predicts first SBP episode in patients with cirrhosis and ascites. 相似文献
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Panot Sainamthip Chutcharn Kongphanich Naiyarat Prasongsook Sakkarin Chirapongsathorn 《World Journal of Clinical Cases》2021,9(30):9059-9069
BACKGROUNDEven in the immuno-oncology era, transcatheter arterial chemoembolisation (TACE) is the most effective way to treat intermediate stage hepatocellular carcinoma (HCC). Postembolisation syndrome (PES) is the most common side effect from TACE and there is still no standard prevention guideline.AIMTo evaluate the efficacy of single dose intravenous dexamethasone regimen to prevent PES after TACE among patients with HCC. METHODSThis study enrolled patients with HCC who had eligible indication for TACE without macrovascular invasion/extrahepatic metastasis. Patients were randomly assigned to either an intravenous single dose of dexamethasone 8 mg or placebo one hour before TACE. The primary outcome was a negative result of PES at 48 h after TACE, which was defined as score < 2 of Southwest Oncology Group toxicity coding criteria using fever, nausea, vomiting and pain to calculated. And the secondary end point was duration of admission between two groups.RESULTSOne hundred patients were randomly assigned 1:1. Under intention-to-treat analysis, 49 patients were randomly assigned to the dexamethasone and 51 to the placebo groups. Both groups were similar for baseline characteristics. The negative PES rate was significantly higher in the dexamethasone group than in the placebo group (63.3% vs 29.4%; P = 0.005). Mean Southwest Oncology Group toxicity coding PES was 2.14 (95%CI: 1.41-2.8) vs 3.71 (95%CI: 2.97-4.45) between the dexamethasone and placebo groups, respectively. Cumulative incidence of fever was significantly lower in dexamethasone group with P < 0.001, pain, nausea and vomiting were also lower in the dexamethasone group compared with the placebo group (P = 0.16, P = 0.11, and P = 0.49). The dexamethasone regimen was generally well tolerated by patients with HCC patients including those with hepatitis B virus infection and well-controlled diabetes mellitus.CONCLUSIONSingle dose dexamethasone was effective at preventing PES among patients with HCC treated with TACE. The study showed no adverse events of special interest related to dexamethasone. 相似文献
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