Role of Midodrine on Vasopressor Duration in Patients with Sepsis

Existing literature evaluating the off-label use of midodrine has focused primarily on postoperative hypotensive patients requiring a single vasopressor. This study aimed to evaluate the impact of midodrine on vasopressor duration and length of stay in patients receiving vasopressors for sepsis-related hypotension. This is an institutional review board-approved, single-center, retrospective analysis of critically ill patients with hypotension secondary to sepsis who received midodrine and intravenous vasopressors compared to those who received intravenous vasopressors alone. Patients were matched by Acute Physiology and Chronic Health Evaluation II score, suspected source of infection, and presence of bacteremia. One hundred patients were included in this analysis. The median duration of vasopressors in the midodrine group (n = 50) was 36 hours (interquartile range [IQR] 18.94-61.94) compared to 26 hours (IQR 13.75-59.88) in the vasopressor-only group (P = .127). Patients in the midodrine group were in the intensive care unit (ICU) for a median of 3.9 days compared to 2.6 days in the vasopressor-only group (P = .017). Midodrine patients had a median hospital length of stay 3.7 days longer than the vasopressor-only group (P = .008). Eight patients (16%) were discharged on midodrine without an indication for therapy. This report assesses the use of midodrine in patients with sepsis requiring one or more vasopressors. Initiation of midodrine did not decrease the time to vasopressor discontinuation. The evaluation of midodrine indication and potential for its discontinuation is an intervention pharmacists can target at the transition of care from the ICU

Acute stress affects peripersonal space representation in cortisol stress responders.

Peripersonal space is the representation of the space near the body. It is implemented by a dedicated multisensory-motor network, whose purpose is to predict and plan interactions with the environment, and which can vary depending on environmental circumstances. Here, we investigated the effect on the PPS representation of an experimentally induced stress response and compared it to a control, non-stressful, manipulation. We assessed PPS representation in healthy humans, before and after a stressful manipulation, by quantifying visuotactile interactions as a function of the distance from the body, while monitoring salivary cortisol concentration. While PPS representation was not significantly different between the control and experimental group, a relation between cortisol response and changes in PPS emerged within the experimental group. Participants who showed a cortisol stress response presented enhanced visuotactile integration for stimuli close to the body and reduced for far stimuli. Conversely, individuals with a less pronounced cortisol response showed a reduced difference in visuotactile integration between the near and the far space. In our interpretation, physiological stress resulted in a freezing-like response, where multisensory-motor resources are allocated only to the area immediately surrounding the body

Social inequalities in heat-attributable mortality in the city of Turin, northwest of Italy: a time series analysis from 1982 to 2018

Background: Understanding context specific heat-health risks in urban areas is important, especially given anticipated severe increases in summer temperatures due to climate change effects. We investigate social inequalities in the association between daily temperatures and mortality in summer in the city of Turin for the period 1982–2018 among different social and demographic groups such as sex, age, educational level, marital status and household occupants. Methods: Mortality data are represented by individual all-cause mortality counts for the summer months between 1982 and 2018. Socioeconomic level and daily mean temperature were assigned to each deceased. A time series Poisson regression with distributed lag non-linear models was fitted to capture the complex nonlinear dependency between daily mortality and temperature in summer. The mortality risk due to heat is represented by the Relative Risk (RR) at the 99th percentile of daily summer temperatures for each population subgroup. Results: All-cause mortality risk is higher among women (1.88; 95% CI = 1.77, 2.00) and the elderly (2.13; 95% CI = 1.94, 2.33). With regard to education, the highest significant effects for men is observed among higher education levels (1.66; 95% CI = 1.38, 1.99), while risks for women is higher for the lower educational level (1.93; 95% CI = 1.79, 2.08). Results on marital status highlighted a stronger association for widower in men (1.66; 95% CI = 1.38, 2.00) and for separated and divorced in women (2.11; 95% CI = 1.51, 2.94). The risk ratio of household occupants reveals a stronger association for men who lived alone (1.61; 95% CI = 1.39, 1.86), while for women results are almost equivalent between alone and not alone groups. Conclusions: The associations between heat and mortality is unequal across different aspects of social vulnerability, and, inter alia, factors influencing the population vulnerability to temperatures can be related to demographic, social, and economic aspects. A number of issues are identified and recommendations for the prioritisation of further research are provided. A better knowledge of these effect modifiers is needed to identify the axes of social inequality across the most vulnerable population sub-groups

Differential Expression of mRNA Encoding Cytokines and Chemokines in the Reproductive Tract after Infection of Mice with \u3cem\u3eChlamydia trachomatis\u3c/em\u3e

Infection with Chlamydia trachomatis targets epithelial cells within the genital tract which respond by secreting chemokines and cytokines. Persistent inflammation can lead to fibrosis, tubal infertility and/or ectopic pregnancy; many infections are asymptomatic. Most studies have investigated the inflammatory response in the initial stages of infection, less is known about the later stages of infection, especially with a low, potentially asymptomatic, bacterial load. Our objective was to determine the inflammatory mediators involved in clearance of low-grade infection and the potential involvement in chronic inflammation. Six to eight week old C3H/HeJ mice were pretreated with 2.5 mg medroxyprogesterone acetate on day -10 and -3 before infection. Mice (n=3 for 28 d, n=3 for 35 d) were infected with 5 × 102 inclusion-forming units of C. trachomatis, serovar D; vaginal cultures were obtained weekly to monitor infection. Control mice (n=3 for 28 d, n=3 for 35 d) were sham infected. Mice were killed on day 28 (experiment 1) and day 35 (experiment 2) post-infection and vaginal tissue, uterine horns and oviducts collected for analysis of mRNAs encoding inflammatory cytokines and chemokines. Total RNA was isolated and a superarray analysis performed using mouse Cytokines and Chemokines PCR arrays (Qiagen, Valencia, CA). Statistical differences in gene expression were determined using a paired Students t-test. At 28 days after infection, the expression of mRNA encoding 6, 35 and 3 inflammatory genes differed from controls in vaginal, uterine and oviductal tissues, respectively (P \u3c 0.05). At 35 days after infection, the expression of mRNA encoding 16, 38 and 14 inflammatory genes differed from controls in vaginal, uterine and oviductal tissues, respectively (P \u3c 0.05). Understanding the mechanisms involved in the inflammatory response at later stages of infection should aid in the development of treatment options that minimize the development of asymptomatic, chronic inflammation-induced infertility

Experiencia de implementación de una Historia Clínica Electrónica en el servicio de Internación de un Hospital Polivalente de Córdoba, Argentina

La implementación de un sistema de registro médico informatizado presenta una serie de ventajas que permiten mejorar la calidad de la atención médica brindada y a la vez reducir los costos de prestar estos servicios. En este trabajo se presenta la experiencia del desarrollo e implementación de un sistema de Historia Clínica Electrónica en el Servicio de Internación de un Hospital General Polivalente donde coexistían una Historia Clínica Electrónica para el servicio ambulatorio y una Historia Clínica única por paciente en papel para el Internado. Se relata la experiencia de desarrollo, integración con los sistemas existentes, la capacitación e implementación, el manejo del cambio cultural necesario y la transición entre el uso de la historia clínica en papel y la electrónica.Sociedad Argentina de Informática e Investigación Operativ

1-(2-Furo­yl)-3-(o-tol­yl)thio­urea

The title compound, C13H12N2O2S, was synthesized from furoyl isothio­cyanate and o-toluidine in dry acetone. The thio­urea group is in the thio­amide form. The central thio­urea fragment makes dihedral angles of 2.6 (1) and 22.4 (1)° with the ketofuran group and the benzene ring, respectively. The mol­ecular structure is stabilized by N—H⋯O hydrogen bonds. In the crystal structure, centrosymmetrically related mol­ecules are linked by a pair of N—H⋯S hydrogen bonds to form a dimer with an R 2 2(6) ring motif

8-Hydr­oxy-5,6,7-trimeth­oxy-2-phenyl-4H-chromen-4-one

In the title compound, C18H16O6, the benzopyran group is essentially planar, with the O atoms of the substituent groups lying close to its mean plane. The mol­ecular conformation is governed by intra­molecular inter­actions. The crystal packing is mainly determined by one classical inter­molecular hydrogen bond which gives rise to the formation of an infinite chain along the a axis

Experiencia de implementación de un Kardex electrónico de Enfermería en un Hospital Polivalente de Córdoba, Argentina

La implementación de un sistema de registro médico informatizado presenta una serie de ventajas que permiten mejorar la calidad de la atención médica brindada y a la vez reducir los costos de prestación de estos servicios. Para llegar al objetivo mayor se deben trazar líneas estratégicas que disminuyen la complejidad de los pasos subsiguientes. En este trabajo se presenta la experiencia del desarrollo e implementación de un sistema Kardex Electrónico de Enfermería para el servicio de Internación como paso estratégico para el éxito de las sub siguientes fases del proyecto HCE para Internación. Se encuentra desarrollado en un Hospital General Polivalente donde coexistían una Historia Clínica Electrónica para el servicio ambulatorio y funcionalidad parcial de HCE para el servicio de internación. Se relata la experiencia de desarrollo, integración con los sistemas existentes, adquisición y distribución del equipamiento tecnológico, capacitación e implementación, manejo del cambio cultural necesario y transición entre el uso de registros en papel y el formato digital.Sociedad Argentina de Informática e Investigación Operativ

Low-temperature study of a new nevirapine pseudopolymorph

The title compound (systematic name: 11-cyclo­propyl-4-methyl-5,11-dihydro-6H-dipyrido[3,2-b:2′,3′-e][1,4]diazepin-6-one butanol 0.3-solvate), C15H14N4O·0.3C4H9OH, was crystallized in a new triclinic pseudopolymorphic form, a butanol solvate, and the crystal structure determined at 150 K. The mol­ecular conformation of this new form differs from that reported previously, although the main inter­molecular hydrogen-bond pattern remains the same. N—H⋯O hydrogen bonds [N⋯O = 2.957 (3) Å] form centrosymmetric dimers and the crystal packing of this new pseudopolymorph generates infinite channels along the b axis