399 research outputs found
Pitfalls in the assessment of ventriculo-arterial coupling from peripheral waveform analysis in septic shock. Comment on Br J Anaesth 2020; 125: 1018–1024
No full textComment les Anciens sont devenus figures d'autorité. Les Autorités. Dynamiques et mutations d'une figure de référence à l'Antiquité, sous la direction de Didier Foucault et de Pascal Payen
No full textLabarre Guy. Comment les Anciens sont devenus figures d'autorité. Les Autorités. Dynamiques et mutations d'une figure de référence à l'Antiquité, sous la direction de Didier Foucault et de Pascal Payen. In: Dialogues d'histoire ancienne, vol. 34, n°1, 2008. pp. 182-184
Comment les Anciens sont devenus figures d'autorité. Les Autorités. Dynamiques et mutations d'une figure de référence à l'Antiquité, sous la direction de Didier Foucault et de Pascal Payen
No full textLabarre Guy. Comment les Anciens sont devenus figures d'autorité. Les Autorités. Dynamiques et mutations d'une figure de référence à l'Antiquité, sous la direction de Didier Foucault et de Pascal Payen. In: Dialogues d'histoire ancienne, vol. 34, n°1, 2008. pp. 182-184
The Pressure Recording Analytical Method (PRAM):Technical Concepts and Systematic Review
No full textRenaissance of glucocorticoids in critical care in the era of COVID-19: ten urging questions
No full textThe 40-year-old experience with glucocorticosteroids (GCs) in the context of severe infections is complex and troublesome. Recently, however, a clear indication for GCs in severe COVID-19 has been established. This may constitute a harbinger of a wider use of GCs in critical illnesses. A fundamental prerequisite of such an action is a better understanding of the heterogeneity of critical illness and GCs operationalization within the precision medicine approach. In this perspective, we formulate ten major questions regarding the use of GCs in critical illness. Answering them will likely facilitate a new era of effective and personalized GCs use in modern critical care
Autorités des Anciens
No full text"Des nains sur des épaules de géants" : philosophes, savants et autorités des Anciens (XIIe-XVIIIe siècles) organisé par le Groupe de Recherche ERASME responsables : Pascal Payen, Didier Foucault. Salle des Ac
Autorités des Anciens
No full text"Des nains sur des épaules de géants" : philosophes, savants et autorités des Anciens (XIIe-XVIIIe siècles) organisé par le Groupe de Recherche ERASME responsables : Pascal Payen, Didier Foucault. Salle des Ac
Case Report: Interferon- γ Rescues Monocytic Human Leukocyte Antigen Receptor (mHLA-DR) Function in a COVID-19 Patient With ARDS and Superinfection With Multiple MDR 4MRGN Bacterial Strains
No full textBackgroundCD14+ monocytes present antigens to adaptive immune cells via monocytic human leukocyte antigen receptor (mHLA-DR), which is described as an immunological synapse. Reduced levels of mHLA-DR can display an acquired immune defect, which is often found in sepsis and predisposes for secondary infections and fatal outcomes. Monocytic HLA-DR expression is reliably induced by interferon- γ (IFNγ) therapy.Case ReportWe report a case of multidrug-resistant superinfected COVID-19 acute respiratory distress syndrome (ARDS) on extracorporeal membrane oxygenation (ECMO) support. The resistance profiles of the detected Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii and Citrobacter freundii isolates were equipped with resistance to all four antibiotic classes including carbapenems (4MRGN) and Cefiderocol in the case of K. pneumoniae. A causal therapeutic antibiotic strategy was not available. Therefore, we measured the immune status of the patient aiming to identify a potential acquired immune deficiency. Monocyte HLA-DR expression identified by FACS analysis revealed an expression level of 34% positive monocytes and suggested severe immunosuppression. We indicated IFNγ therapy, which resulted in a rapid increase in mHLA-DR expression (96%), rapid resolution of invasive bloodstream infection, and discharge from the hospital on day 70.DiscussionSuperinfection is a dangerous complication of COVID-19 pneumonia, and sepsis-induced immunosuppression is a risk factor for it. Immunosuppression is expressed by a disturbed antigen presentation of monocytes to cells of the adaptive immune system. The case presented here is remarkable as no validated antibiotic regimen existed against the detected bacterial pathogens causing bloodstream infection and severe pneumonia in a patient suffering from COVID-19 ARDS. Possible restoration of the patient’s own immunity by IFNγ was a plausible option to boost the patient’s immune system, eliminate the identified 4MRGNs, and allow for lung recovery. This led to the conclusion that immune status monitoring is useful in complicated COVID-19-ARDS and that concomitant IFNγ therapy may support antibiotic strategies.ConclusionAfter a compromised immune system has been detected by suppressed mHLA-DR levels, the immune system can be safely reactivated by IFNγ
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