Multiple organ dysfunction syndrome due to tropical infections
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There is as yet no precise definition of the multiple organ failure syndrome, or what is today more appropriately termed the multiple organ dysfunction syndrome (MODS). Clinically MODS can be considered as a sequential or concomitant occurrence of a significant derangement of function in two or more organ systems of the body, against a background of a critical illness. Organ dysfunction may be mild, moderate or severe, and multiple organs may show varying degrees of dysfunction. There is no universally acceptable classification system which defines parameters of organ specific failure. An ACCP/SCCM Consensus Conference which was held in 1991, defined MODS as “the presence of altered function in an acutely ill patient such that homeostasis cannot be maintained without intervention”. 1 This conKeywords:
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Multiple organ dysfunction syndrome in the elderly (MODSE) is an important syndrome in the critical care of elderly patients. MODSE is defined as simultaneous or sequential dysfunction or failure of two or more organs on the top of advanced age and chronic multiple organ dysfunction. MODSE is triggered by precipitating factors such as infection (usually pulmonary infection) trauma,surgery, etc. It occurs in two phases. In the early phase, dysfunction of multiple organs (MODE) occurs,and in the later or severe phase, multiple organ failure (MOFE) occurs. MODSE is the most common cause of mortality in the critically iii elderly patient. It is important to understand its clinical characteristics and elucidate its pathogenesis in order to reduce mortality and improve quality of life for these patients.
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Objective To review the data demonstrating that central nervous system, pulmonary, and hepatic dysfunctions during hematopoietic stem cell transplantation have similar laboratory correlates and clinical outcomes, suggesting that they are individual organ manifestations of a systemic disorder at presentation, a disorder similar to the multiple organ dysfunction syndrome seen in other populations of critically ill patients. Data Sources and Study Selection Reports of clinical research studies on the natural history and laboratory correlates of central nervous system, pulmonary, and hepatic dysfunction (generally manifesting as the syndrome of hepatic veno-occlusive disease) during hematopoietic stem cell transplantation. Data Extraction and Synthesis During hematopoietic stem cell transplantation, pulmonary dysfunction (manifesting as hypoxia), central nervous system dysfunction (detected by alteration of the Mini-Mental Status Exam), and hepatic dysfunction (presenting as the syndrome of hepatic veno-occlusive disease) are all associated with significant decreases in the levels of antithrombin III and protein C and an increase in the platelet transfusion requirement. Each of these three organ dysfunctions is associated with a high likelihood of being followed by the other two and, eventually, death. Patients with these organ dysfunctions have higher levels of interleukin-6, interleukin-10, and tumor necrosis factor-α than patients who never develop these complications. Mortality rates for patients with these organ dysfunctions vary from 15% in patients with only one organ dysfunction to 100% in patients who have progressed to all three. Patients who develop none of these organ dysfunctions have a mortality rate that approaches zero. Conclusions Central nervous system, pulmonary, and hepatic dysfunctions are intimately involved in the mortal complications of hematopoietic stem cell transplantation. Because these organ dysfunctions have similar correlates and similar outcomes, the hypothesis that they are individual parts of a systemic disorder is proposed. The additional observation that these organ dysfunctions are associated with abnormally high levels of inflammation-related cytokines raises the possibility that their pathogenesis is similar to that of multiple organ dysfunction syndrome in other populations of critically ill patients.
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AbstractSystemic inflammatory response syndrome is a common clinical entity often presenting as a complication of neurological disease or trauma. Clear diagnostic criteria exist. Induced pathological mechanisms include both immunological and endothelial dysfunction, and coagulopathy, which may lead to multiple organ failure and significant morbidity. Possible therapeutic mechanisms are discussed, but this complex syndrome is poorly understood and successful treatment may depend on further research into control mechanisms.Blood Coagulation Disorders Central Nervous System Cytokines Endothelium Multiple Organ Failure Sepsis Syndrome Septic Shock
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Seizures and epilepsy commonly occur in patients with organ system failure, either as a consequence of trophic effects on cerebral function or of therapies used in such conditions. Acute organ failure results in an abrupt, but often reversible, lowering of seizure threshold, whereas chronic organ failure results in more pervasive and indolent cerebral compromise, often permanently altering both the seizure threshold and the physiologic responses to antiepileptic drugs (AEDs). Failure of an organ system is not typically a sudden, all-or-none phenomenon but occurs in stages with variable susceptibility to seizures as the condition worsens or remits. Although the principles of diagnosis and management of seizures in adult and pediatric patients with a specific organ dysfunction are similar, the underlying etiologies and influences of comorbid conditions differ between adults and children. Adult organ failure often involves multiple systems to different extents and is superimposed on other chronic diseases of adulthood. Pediatric organ failure is usually the result of inherited metabolic disorders, infections, and unique pediatric susceptibilities to metabolic effects of medications (Table 1).
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