Minerva anestesiologica
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Minerva anestesiologica · Mar 2016
ReviewThe role of genomics to identify biomarkers and signaling molecules during severe sepsis.
Early strategies to diagnose, manage and predict outcome of sepsis are essential to further improve morbidity and mortality of sepsis. Whereas biomarkers have become mainstay in other fields of medicine, their clinical utility in sepsis remains generally much less proven and so biomarkers are much less used clinically. The Human Genome Project embellished genomics, transcriptomics, proteomics and metabolomics and continues to expand our knowledge of the genetic, gene expression, protein translational and metabolic discoveries that could lead to clinical biomarker tests related to sepsis thereby allowing insight into the disease as never seen before. We explore the genomic approach to biomarker identification and validation by reviewing pertinent studies related to the diagnosis (diagnostic biomarkers), prediction of response to therapies (predictive biomarkers) and (prognostic biomarkers) outcomes of sepsis.
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Minerva anestesiologica · Mar 2016
Comparative StudyComparison of blood culture and multiplex real-time pcr for the diagnosis of nosocomial sepsis.
In many cases of suspected sepsis, causative microorganisms cannot be isolated. Multiplex real-time PCR generates results more rapidly than conventional blood culture systems. ⋯ SeptiFast may be useful when added to blood culture in the diagnosis and management of sepsis.
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Minerva anestesiologica · Mar 2016
ReviewImmunonutrients in critically ill patients: an analysis of the most recent literature.
Modulation of inflammatory and immune response to critical illness has been the goal of much research in the last decade and a variety of drugs and nutrients (so called "immunonutrients") have been tested in experimental models with promising results. Though, in the clinical setting of intensive care, their efficacy have been inconsistently proven, most likely because the effects of each drug may vary in relation to the timing, the dose, the route of administration, the interaction with other nutrients, the severity of illness and many other factors. ⋯ Reviewing the latest evidence-based documents on this subject (multicenter trials, systematic reviews, meta-analyses and international guidelines), there is no convincing evidence that immunonutrients may be beneficial in the critically ill. Considering that these substances invariably increase the costs of health care and may be unsafe or even harmful in some subgroups, particularly in septic patients, we conclude that routine administration of immune-nutrients (glutamine, arginine, omega-3 fatty acids, selenium, etc.) cannot be currently recommended in the critically ill.