| Autor: |
Duc Hong Du, Nguyen Quan Nhu Hao, Nguyen Van Hao, Tran Tan Thanh, Huynh Thi Loan, Lam Minh Yen, Tran Thi Diem Thuy, Duong Bich Thuy, Nguyen Thanh Nguyen, Nguyen Thi Phuong Dung, Evelyne Kestelyn, Ha Thi Hai Duong, Nguyen Thanh Phong, Pham Thi Tuyen, Nguyen Hoan Phu, Ho Dang Trung Nghia, Bui Thi Bich Hanh, Pham Kieu Nguyet Oanh, Phan Vinh Tho, Phung Tran Huy Nhat, Phan Nguyen Quoc Khanh, Duncan Wyncoll, Nicholas P. J. Day, Nguyen Van Vinh Chau, H. Rogier van Doorn, Le Van Tan, Ronald B. Geskus, C. Louise Thwaites |
| Jazyk: |
angličtina |
| Rok vydání: |
2023 |
| Předmět: |
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| Zdroj: |
Tropical Medicine and Health, Vol 51, Iss 1, Pp 1-6 (2023) |
| Druh dokumentu: |
article |
| ISSN: |
1349-4147 |
| DOI: |
10.1186/s41182-023-00512-0 |
| Popis: |
Abstract Severe tetanus is characterized by muscle spasm and cardiovascular system disturbance. The pathophysiology of muscle spasm is relatively well understood and involves inhibition of central inhibitory synapses by tetanus toxin. That of cardiovascular disturbance is less clear, but is believed to relate to disinhibition of the autonomic nervous system. The clinical syndrome of autonomic nervous system dysfunction (ANSD) seen in severe tetanus is characterized principally by changes in heart rate and blood pressure which have been linked to increased circulating catecholamines. Previous studies have described varying relationships between catecholamines and signs of ANSD in tetanus, but are limited by confounders and assays used. In this study, we aimed to perform detailed characterization of the relationship between catecholamines (adrenaline and noradrenaline), cardiovascular parameters (heart rate and blood pressure) and clinical outcomes (ANSD, mechanical ventilation required, and length of intensive care unit stay) in adults with tetanus, as well as examine whether intrathecal antitoxin administration affected subsequent catecholamine excretion. Noradrenaline and adrenaline were measured by ELISA from 24-h urine collections taken on day 5 of hospitalization in 272 patients enrolled in a 2 × 2 factorial-blinded randomized controlled trial in a Vietnamese hospital. Catecholamine results measured from 263 patients were available for analysis. After adjustment for potential confounders (i.e., age, sex, intervention treatment, and medications), there were indications of non-linear relationships between urinary catecholamines and heart rate. Adrenaline and noradrenaline were associated with subsequent development of ANSD, and length of ICU stay. |
| Databáze: |
Directory of Open Access Journals |
| Externí odkaz: |
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