Pathological Conditions, Signs and Symptoms Commons^™

Trends And Demographic Disparities In Septicemia-Associated Cardiac Arrest Mortality In The United States, 1999–2023, Muhammad Owais, Maham Mehfooz, Hamza Nazir, Preeti Advani, Roha Riaz, Khanij Arya, Javeria Nawaz, Syed Hadi Raza Rizvi, Murtaza Aslam, Usman Nazeer, Jairo Melo, Bravein Amalakuhan

Central & West Texas and San Antonio GME Research Day 2026

No abstract provided.

Improving Sepsis Order Set Utilization Through Targeted Resident Education: A Lean Six Sigma Green Belt Quality Improvement Project, Sarah Sheikh, Puneeth Shridhar, Bushra Bangash, Valerie Chukelu, Tonya Meirhofer, Arunima Jose, Zainab Shakir, Shane Jenks, Augusto Sepulveda, Trung Nguyen, Rajeev Raghavan

Gulf Coast Division GME Research Day 2026

No abstract provided.

Code Strepsis: A Multicenter Study Of The Impact Of Emergency Department Stroke Alert On Sepsis Bundle Performance In Sepsis Patients, Jason Smith, Jennifer Chapman, W Angelo Kantrales, Edward Descallar, Martin Wegman

South Atlantic Division GME Research Days 2026

No abstract provided.

Vasoactive Drug Use In Children With Community Acquired Septic Shock In Australia And New Zealand, Elliot Long, Stephen Hearps, Amanda Williams, Ben Gelbart, Warwick Butt, Thomas Rozen, Sarah Mcnab, Meredith Borland, Simon Erickson, Shefali Jani, Marino Festa, Eunicia Tan, Natalie Phillips, Sainath Raman, Amit Kochar, Subodh Ganu, Simon Craig, Anna Lithgow, Arjun Rao, Emma Whyte, Stuart Dalziel, Shane George, Fran Balamuth, Scott Weiss, Nathan Kuppermann, Franz Babl

Department of Medicine Faculty Papers

BACKGROUND: Vasoactive agents are a critical supportive therapy for children with sepsis. We describe the choice and use patterns of vasoactive agents in children with sepsis.

METHODS: Prospective observational study conducted in 11 hospitals in Australia and New Zealand through the Paediatric Research in Emergency Departments International Collaborative (PREDICT) Network from April 2021 to December 2023. Children aged 0-< 18 years with suspected sepsis were included. Children admitted to hospital and treated with parenteral antibiotics and either 1) a provisional diagnosis of sepsis, and/or 2) treatment for suspected sepsis (fluid bolus to treat poor perfusion). The frequency and sequence of use of vasoactive agents, and contributors to the choice of initial vasoactive were collected.

FINDINGS: 6232 children with suspected sepsis were included; median age of 2.1 years (IQR 0.3-7.1 years), in-hospital mortality of 60 (1.0%), in whom a subset of 306 (4.9%) met Phoenix sepsis criteria. Vasoactive agents were used in 179 (2.9%) children overall …

Induction Of Myelopoiesis By Candida Dubliniensis Drives Protective Trained Immunity Against Sepsis In A Card9-Dependent Manner, Shannon Esher Righi, Elizabeth A. Lilly, Amanda J. Harriett, Patrick W. Daly, Maryjane Jones, Chad Steele, Mairi C. Noverr, Paul L. Fidel

School of Dentistry Faculty Publications

Trained immunity is a long-term functional reprogramming of innate cells that allows for the formation of immune memory akin to adaptive responses, but with a more rapid nonspecific response. We recently identified an anti-inflammatory trained immunity response, termed trained tolerogenic immunity (TTI), induced by low virulence Candida dubliniensis, that protects against acute lethal polymicrobial sepsis via myeloid-derived suppressor cells (MDSCs). Trained immunity and MDSCs arise following hematopoietic stem and progenitor cell (HSPC) expansion in the bone marrow. Here, we show that C. dubliniensis induces inoculum-dependent protection and HSPC expansion, whereas depletion of HSPCs following C. dubliniensis immunization abrogates protection. We …

Nitric Oxide Does Not Improve Liver Mitochondrial Function 48 Hours After Cecal Ligation And Perforation In Experimental Sepsis, Pierre Eyenga, Shey-Shing Sheu

Center for Translational Medicine Faculty Papers

Nitric oxide (NO) has a dual effect on mitochondria. Incubating liver mitochondria with NO improves oxidative phosphorylation (OXPHOS) efficiency by decreasing state 4 respiration more than ATP synthesis and preventing mitochondrial permeability transition pore (mPTP) opening. We evaluated the effect of L-arginine (L-arg), an NO donor, on isolated liver mitochondrial respiration and mPTP in sepsis. Male mice were subjected to cecal ligation and perforation (CLP) with saline resuscitation or sham. After 8, 24, and 48 h, with and without L-arg, we measured isolated liver mitochondrial respiration and cytochrome c oxidase (COX) activity using polarographic methods and calcium retention capacity (CRC) …

Impact Of Fluid Composition On Mortality And Kidney Injury In Sepsis: A Literature Review, Kush C. Patel, Simran Gandhi, Harmann Singh, Abdullah Noory, Akash M. Patel

Rowan-Virtua Research Day

Background

Fluid resuscitation is a cornerstone of early sepsis management. While normal saline (NS) has been widely used, emerging evidence suggests that balanced crystalloids such as lactated Ringer’s and Plasma-Lyte may offer improved renal outcomes and reduced mortality by avoiding hyperchloremic metabolic acidosis.

Hypothesis

In adult patients with sepsis, initial resuscitation with balanced crystalloids reduces mortality and the incidence of acute kidney injury (AKI) compared to normal saline.

Methods

A literature review was conducted using PubMed and MEDLINE databases focusing on randomized controlled trials and meta-analyses published from 2010–2024. Key studies included the SMART, SALT-ED, BaSICS, and PLUS trials. The …

An Unusual Cause Of Sepsis: Capnocytophaga Canimorsus, Capnocytophaga, Christopher Dellmyer, Kishan B. Patel

Rowan-Virtua Research Day

Septic shock can be caused by numerous different pathogens. A few of the more common causes are Streptococcus Pneumoniae, Staphylococcus Aureus, Escherichia Coli, Pseudomonas Aeruginosa, and Candida Albicans. Although these are the pathogens involved in the majority of septic shock cases, it is imperative to take the entire clinical picture into account when treating a patient with septic shock. Here we will discuss a seemingly unimpressive dog bite leading to Capnocytophaga canimorsus bacteremia, septic shock and end organ failure.

Case Report: When Confusion Signals A Crisis: Rethinking The Diagnosis Of Meningitis In Geriatric Sepsis, Asma Zahid

Rowan-Virtua Research Day

We report the case of an 88-year-old female who presented with altered mental status, initially suspected to have urosepsis but ultimately diagnosed with streptococcal meningitis. The patient had a history of lethargy and anorexia over the past few days and was found to have sepsis. Despite initial focus on urosepsis, blood cultures revealed Streptococcus, and cerebrospinal fluid analysis confirmed bacterial meningitis. This case highlights the potential for meningitis to be overlooked in elderly patients with suspected sepsis, underscoring the importance of broad diagnostic considerations and early intervention. This case highlights the importance of considering meningitis in elderly patients presenting with …

Association Of Inflammatory Biomarkers With New Functional Morbidity At Hospital Discharge In Children Who Survive Severe Sepsis, Mallory Perry-Eaddy, Walter Faig, Martha Curley, Scott Weiss

Department of Pediatrics Faculty Papers

OBJECTIVE: New functional morbidity is common in critically ill children who survive sepsis; yet, the underlying biological mechanisms, particularly the impact of inflammation, remain unknown. We sought to test the hypothesis that increased levels of inflammatory biomarkers during the acute phase of pediatric sepsis are associated with new functional morbidity at hospital discharge.

METHODS: We conducted a post hoc secondary analysis of the MitoPSe clinical study, including N = 119 critically ill children who survived sepsis. Data collected included demographic and clinical variables and 31 inflammatory biomarkers collected at three distinct timepoints (within days 1-2 of PICU admission, days 3-5, …

Pulmonary Pathology In Culture-Negative Sepsis: A Potential Confounder For Sepsis Treatment And Research, Brett Biebelberg

SKMC Student Presentations and Publications

No abstract provided.

Assessing And Improving Resident Understanding Of Inpatient Sepsis, Hamza Naveed, E'Joven Reed, Mike Wong

Gulf Coast Division GME Research Day 2025

No abstract provided.

The Role Of Bandemia In Clinical Outcomes Of Critically Ill Septic Patients., Yerandi Gil, Grettel Gonzalez Garcia, Ambar Sekulis, Rafael Miret, Siddarth Kathuria, Mauricio Danckers, Daniel Heller

East Florida Division GME Research Day 2025

Rationale: Bandemia, defined as the presence of immature neutrophils in circulation, is commonly used as an early marker of systemic inflammation and infection. 1 However, its prognostic significance in sepsis, severe sepsis, and septic shock remains uncertain. 1-2 This study aimed to determine whether bandemia is associated with adverse clinical outcomes and increased intensive care unit (ICU) resource utilization among critically ill septic patients admitted from the emergency department (ED).

Methods: A retrospective analysis was conducted using de-identified data from the HCA Healthcare database. Adult patients (aged 18–90 years) admitted to the ICU at HCA Florida Aventura Hospital from the …

Anaphylaxis Vs. Sepsis: A Case Of Distributive Shock After Receiving Hemodialysis, William Downs, Benjamin H. Bridges, Trey Embrey, Logan Reid, Meghan Rosenquist

South Atlantic Division GME Research Day 2025

No abstract provided.

Clostridium Perfringens Sepsis From A Hepatic Abscess With Hemolysis And Renal Failure, Requiring Hemodialysis, Joel Collins Ii, Katelyn Courtney, James A. Espinosa, Alan Lucerna

Rowan-Virtua Research Day

The prognosis of sepsis caused by Clostridium perfringens is extremely poor, with a mortality rate of 70%-100%. Management includes antibiotic regimens specific to toxin production as well as source control via surgical or interventional mechanisms. We report a case of a 64-year-old male who presented with right upper quadrant (RUQ) abdominal pain and was diagnosed with Clostridium perfringens bacteremia with associated acalculous cholecystitis, hepatic abscess, and acute renal failure requiring hemodialysis. It is felt that early hemodialysis was an associated factor in the patient's survival.

Management Considerations In A Case Of Sepsis Induced Takotsubo Cardiomyopathy In A Post-Operative Patient., Avraham Fox, Rachel Groening, Carsten Z. Steinmetz, Callaham A. Brock, Saptarshi Biswas

South Atlantic Division GME Research Day 2024

No abstract provided.

Differences In Clinical Interventions And Outcomes In Septic Patients With Heart Failure A Prospective Single Center Experience From The Sepsisquad Investigators, Jose Rodriguez Castro, Manjot Malhi, Rafael Miret, Kristen Santana, Anna Feliszek, Kevin Gopala Rao, Lyanne Rolon, Garrett Wagner, Siddarth Kathuria, Raiko Diaz, Daniel Heller, Mauricio Danckers

East Florida Division GME Research Day 2024

No abstract provided.

An Unusual Ed Case: Spontaneous Necrotizing Fasciitis Presenting As Hypoxic Pneumonia, Chetna Thawani, Kishan Patel

Rowan-Virtua Research Day

We present a case of necrotizing fasciitis initially presenting as septic hypoxic pneumonia, and discuss imaging modalities and diagnostic evaluation. Necrotizing soft tissue infection (NSTI) is a rapidly progressive surgical emergency with a mortality rate of 30%. In approximately 80% of cases, it is introduced through a break in the skin. It can also occur after any invasive procedure or surgery. It is most commonly associated with skin flora including staph and strep, though polymicrobial infections are most common. It usually presents with signs of systemic infection, including fever, chills, sepsis, altered mental status - and signs of cutaneous involvement …

When Constipation Becomes Lethal: Septic Shock Induced By Stercoral Colitis In A 77-Year-Old Female, Anna Delancy, Nicholas Tomasello, Joan Wiley, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Stercoral colitis is a form of colitis caused by fecal impaction distending the colon and causing fecaloma formation. Fecalomas lead to pressure necrosis of the colon and eventual perforation. The increased intraluminal pressure from the distention of the colon causes vascular compromise and ischemia. The most common locations of necrosis are in the sigmoid colon and rectum . When progressed to perforation, the mortality rate is as high as 60%. The most common cases of stercoral colitis occur in nursing home patients, mentally impaired patients, or those with chronic constipation. Here we describe an unusual case of stercoral colitis causing …

Mitochondrial Protective Effects Caused By The Administration Of Mefenamic Acid In Sepsis, Diogo Dominguini, Monique Michels, Leticia B Wessler, Emilio L Streck, Tatiana Barichello, Felipe Dal-Pizzol

Faculty, Staff and Student Publications

The pathophysiology of sepsis may involve the activation of the NOD-type receptor containing the pyrin-3 domain (NLPR-3), mitochondrial and oxidative damages. One of the primary essential oxidation products is 8-oxoguanine (8-oxoG), and its accumulation in mitochondrial DNA (mtDNA) induces cell dysfunction and death, leading to the hypothesis that mtDNA integrity is crucial for maintaining neuronal function during sepsis. In sepsis, the modulation of NLRP-3 activation is critical, and mefenamic acid (MFA) is a potent drug that can reduce inflammasome activity, attenuating the acute cerebral inflammatory process. Thus, this study aimed to evaluate the administration of MFA and its implications for …

The Geriatric Nutritional Risk Index As A Predictor Of Complications In Geriatric Trauma Patients: Author Reply In Response To: “The Admission Serum Level Of Albumin Cannot Thoroughly Represent The Nutritional Status Of Trauma Patients”, Heather R Kregel, Patrick B Murphy, Mina Attia, David E Meyer, Rachel S Morris, Ezenwa C Onyema, Sasha D Adams, Charles E Wade, John A Harvin, Lillian S Kao, Thaddeus J Puzio

Faculty, Staff and Student Publications

BACKGROUND: Malnutrition is associated with increased morbidity and mortality after trauma. The Geriatric Nutritional Risk Index (GNRI) is a validated scoring system used to predict the risk of complications related to malnutrition in nontrauma patients. We hypothesized that GNRI is predictive of worse outcomes in geriatric trauma patients.

METHODS: This was a single-center retrospective study of trauma patients 65 years or older admitted in 2019. Geriatric Nutritional Risk Index was calculated based on admission albumin level and ratio of actual body weight to ideal body weight. Groups were defined as major risk (GNRI98). The primary outcome was mortality. Secondary outcomes …

Listen To Your Heart, Or At Least Theirs: Maintaining A High Index Of Suspicion For Infective Endocarditis, Mollie Powell Do, Mahesh Setty Md

Emergency Medicine

After an endothelial injury, a fibrin and platelet cap forms. This cap is typically sterile but in times of infection can become colonized by microbes leading to a vegetation. When this occurs on the endothelium of the heart, it is termed infective endocarditis (IE). IE is a difficult diagnosis to make in the ED. The symptoms are vague. Classic exam findings are often absent, murmur auscultation can be challenging and there is not a single diagnostic test. A delayed or missed diagnosis can be fatal; therefore, it is essential that ED physicians maintain a high index of suspicion in high …

Sepsis, Sarah Jones

Nursing Student Class Projects (Formerly MSN)

Sepsis is a dysregulation of the inflammatory response, termed systemic inflammatory response syndrome or SIRS, caused by stimulation of an infectious process. Sepsis often leads to organ dysfunction and increased morbidity, mortality and financial burdens. The goal of treatment is to initiate appropriate antimicrobial therapies, target the underlying infection, optimize intravascular volume, provide fluid resuscitation and maintain adequate perfusion and stroke volume (Taeb, Hooper & Marik, 2017).

Timing of treatment and early detection of sepsis is critical to patients with early warning signs. Sharing this information and potentially making a difference in the outcomes of patients presenting with early signs …

Sepsis: Epidemiology, Pathophysiology, Classification, Biomarkers And Management, Noah Pirozzi, Nima Rejali, Matthew Brennan, Anuj Vohra, Trevor Mcginley, Murali G. Krishna

Touro College of Osteopathic Medicine (Middletown) Publications and Research

Every physician has been trained early in their careers on how to recognize and manage sepsis. Although sepsis has been one of the most researched ailments in medicine, it also remains one of the deadliest diseases in the face of recent advances. In this current article, we review the diagnostic and management criteria for Systemic Inflammatory Response Syndrome (SIRS), sepsis, severe sepsis, septic shock, and Multi Organ Dysfunction Syndrome (MODS). We then examine the implications of the “surviving sepsis” campaign as well as explore the philosophy of Early Goal Directed Therapy (EGDT) and its role in the modern day management …

Sepsis-Review Of Screening For Sepsis By Nursing, Nurse Driven Sepsis Protocols And Development Of Sepsis Hospital Policy/Protocols, Matthew Mccaffery, Omobola Onikoyi, Dilisha Rodrigopulle, Ali Syed, Suzanne Jones, Laura Mansfield, Murali G. Krishna

Touro College of Osteopathic Medicine (Middletown) Publications and Research

Sepsis is one of the leading causes of death in the United States. In order to decrease the morbidity and mortality associated with sepsis in patients, early detection is vital, and so screening protocols have been developed. The Surviving Sepsis Campaign has developed an evidence based screening guideline that has been adapted by various institutions. Having specific criteria in detecting a septic patient is the defining factor in screening for sepsis by nursing staff. In order for the sepsis protocol to be effective, it is necessary that nursing and other front line staff be educated. Institutional barriers regarding implementation of …

The Effects Of Lipoxin A4 (Lxa4) On Neutrophil Biology In Sepsis, Benedict Wu

Graduate School of Biomedical Sciences Theses and Dissertations

During sepsis, neutrophils are inappropriately activated and have prolonged lifespans, thus becoming dysfunctional. Excessive neutrophil activation can lead to tissue injury while neutrophil dysfunction can lead to decreased free radical production and reduced phagocytosis, preventing the host from clearing preexisting infections. Lipoxin A4 (LXA4) is a specialized pro-resolution mediator which reduces neutrophil migration and expression of proinflammatory mediators. Intact neutrophil functions are critical for the host to efficiently clear invading pathogens. The effects of LXA4 on neutrophil function in sepsis have not been established. Using the cecal ligation and puncture (CLP) model of sepsis, LXA4 administered 1 h after sepsis …