266 research outputs found
Massive Gastric Distension from Chronic Intestinal Pseudo-Obstruction
[West J Emerg Med. 2012;13(1):106â107.
Toxic Shock-like Syndrome Associated with Necrotizing Streptococcus Pyogenes Infection
Two patients with toxic shock-like syndrome are presented. Both patients had necrotizing cellulitis due to Streptococcus pyogenes, and both patients required extensive surgical debridement. The association of Streptococcus pyogenes infection and toxic shock-like syndrome is discussed
Impact of strokeâassociated pneumonia on mortality, length of hospitalization, and functional outcome
Objectives: Strokeâassociated pneumonia (SAP) is common and associated with adverse outcomes. Data on its impact beyond 1 year are scarce. Materials and methods: This observational study was conducted in a cohort of stroke patients admitted consecutively to a tertiary referral center in the east of England, UK (January 2003âApril 2015). Logistic regression models examined inpatient mortality and length of stay (LOS). Cox regression models examined longerâterm mortality at predefined time periods (0â90 days, 90 daysâ1 year, 1â3 years, and 3â10 years) for SAP. Effect of SAP on functional outcome at discharge was assessed using logistic regression. Results: A total of 9238 patients (mean age [±SD] 77.61 ± 11.88 years) were included. SAP was diagnosed in 1083 (11.7%) patients. The majority of these cases (n = 658; 60.8%) were aspiration pneumonia. After controlling for age, sex, stroke type, Oxfordshire Community Stroke Project (OCSP) classification, prestroke modified Rankin scale, comorbidities, and acute illness markers, mortality estimates remained significant at 3 time periods: inpatient (OR 5.87, 95%CI [4.97â6.93]), 0â90 days (2.17 [1.97â2.40]), and 91â365 days (HR 1.31 [1.03â1.67]). SAP was also associated with higher odds of long LOS (OR 1.93 [1.67â2.22]) and worse functional outcome (OR 7.17 [5.44â9.45]). In this cohort, SAP did not increase mortality risk beyond 1 year postâstroke, but it was associated with reduced mortality beyond 3 years. Conclusions: Strokeâassociated pneumonia is not associated with increased longâterm mortality, but it is linked with increased mortality up to 1 year, prolonged LOS, and poor functional outcome on discharge. Targeted intervention strategies are required to improve outcomes of SAP patients who survive to hospital discharge
A Crucial Role for Antimicrobial Stewardship in the Midst of COVID-19
As the world deals with a pandemic, there remains another global challenge that cannot be ignored. Use of broad-spectrum antibiotics may be justified, as we are trying to treat a novel disease condition, which, in turn, could lead to an increase in antimicrobial resistance. We can decrease morbidity, mortality, and health care costs by controlling antimicrobial resistance, but it requires antimicrobial stewardship. Major components of effective and timely antimicrobial stewardship are diagnostic stewardship, infection prevention and control, and integration of COVID-19-specific flags into electronic health records, all of which may be integrated into current strategies of COVID-19 mitigation and management. Going through the influenza season of 2020, implementation of antimicrobial stewardship education efforts in the United States can help us contend with influenza in addition to COVID-19 and any bacterial coinfections or secondary infections. Additional solutions include the development of vaccines, alternative therapies, such as antibodies, and advanced diagnostics using advances in genomics and computer science
Recommended from our members
The peripheral blood transcriptome in septic cardiomyopathy: an observational, pilot study.
BACKGROUND:Septic cardiomyopathy (SCM) is common in sepsis and associated with increased morbidity and mortality. Left ventricular global longitudinal strain (LV GLS), measured by speckle tracking echocardiography, allows improved identification of impaired cardiac contractility. The peripheral blood transcriptome may be an important window into SCM pathophysiology. We therefore studied the peripheral blood transcriptome and LV GLS in a prospective cohort of patients with sepsis. RESULTS:In this single-center observational pilot study, we enrolled adult patients (age >â18) with sepsis within 48âh of admission to the ICU. SCM was defined as LV GLS >â-â17% based on echocardiograms performed within 72âh of admission. We enrolled 27 patients, 24 of whom had high-quality RNA results; 18 (75%) of 24 had SCM. The group was 50% female and had a median (IQR) age of 59.5 (48.5-67.0) years and admission APACHE II score of 21.0 (16.0-32.3). Forty-six percent had septic shock. After filtering for low-expression and non-coding genes, 15,418 protein coding genes were expressed and 73 had significantly different expression between patients with vs. without SCM. In patients with SCM, 43 genes were upregulated and 30 were downregulated. Pathway analysis identified enrichment in type 1 interferon signaling (adjusted pâ<â10-5). CONCLUSIONS:In this hypothesis-generating study, SCM was associated with upregulation of genes in the type 1 interferon signaling pathway. Interferons are cytokines that stimulate the innate and adaptive immune response and are implicated in the early proinflammatory and delayed immunosuppression phases of sepsis. While type 1 interferons have not been implicated previously in SCM, interferon therapy (for viral hepatitis and Kaposi sarcoma) has been associated with reversible cardiomyopathy, perhaps suggesting a role for interferon signaling in SCM
Association of left ventricular longitudinal strain with central venous oxygen saturation and serum lactate in patients with early severe sepsis and septic shock
Syftet med denna studie Àr att synliggöra pedagogers syn pÄ förÀldrasamverkan i förskolan. Vi har Àven intresserat oss pÄ samverkan mellan pedagogerna och förÀldrar med annat modersmÄl Àn svenska. VÄr studie grundar sig pÄ observationer kring bemötande av förÀldrar pÄ förskolan. Vi undersökte hur pedagogerna sÄg pÄ förÀldrasamverkan och hur de arbetar kring samverkan med förÀldrar, för att kunna fÄ en bredare syn i vÄr studie om hur samverkan fungerar pÄ de aktuella förskolorna. Som metod anvÀnde vi kvalitativ intervju dÄ detta lÀmpade sig vÀl för oss för att vi skulle kunna fÄ en bredare syn om hur samverkan fungerar pÄ de aktuella förskolorna. Intervjuer ger mer exakta svar och det underlÀttar för oss som intervjuar att stÀlla följdfrÄgor. Resultatet visar att samverkan med förÀldrar har ökat i förskolan och blivit en stor del av verksamheten. Pedagogerna försöker engagera sig mycket i arbetet med förÀldrasamverkan och letar efter möjligheter för att skapa en bra kommunikation med förÀldrar som har annat modersmÄl Àn svenska. Resultaten visar Àven att pedagogerna menar att oavsett om förÀldrarna behÀrskar det svenska sprÄket eller inte sÄ anstrÀnger de sig för att visa förÀldrarna att de Àr viktiga i verksamheten
Associations among left ventricular systolic function, tachycardia, and cardiac preload in septic patients
The assessment of circulating volume using inferior vena cava collapse index and carotid Doppler velocity time integral in healthy volunteers: a pilot study
International audienceBackground: Assessment of circulating volume and the requirement for fluid replacement are fundamental to resuscitation but remain largely empirical. Passive leg raise (PLR) may determine fluid responders while avoiding potential fluid overload. We hypothesised that inferior vena cava collapse index (IVCCI) and carotid artery blood flow would change predictably in response to PLR, potentially providing a non-invasive tool to assess circulating volume and identifying fluid responsive patients.Methods: We conducted a prospective proof of concept pilot study on fasted healthy volunteers. One operator measured IVC diameter during quiet respiration and sniff, and carotid artery flow. Stroke volume (SV) was also measured using suprasternal Doppler. Our primary endpoint was change in IVCCI after PLR. We also studied changes in IVCCI after âsniffâ, and correlation between carotid artery flow and SV.Results: Passive leg raise was associated with significant reduction in the mean inferior vena cava collapsibility index from 0.24 to 0.17 (pâ<â0.01). Mean stroke volume increased from 56.0 to 69.2 mL (pâ<â0.01). There was no significant change in common carotid artery blood flow. Changes in physiology consequent upon passive leg raise normalised rapidly.Discussion: Passive leg raise is associated with a decrease of IVCCI and increase in stroke volume. However, the wide range of values observed suggests that factors other than circulating volume predominate in determining the proportion of collapse with respiration.Conclusion: In contrast to other studies, we did not find that carotid blood flow increased with passive leg raise. Rapid normalisation of post-PLR physiology may account for this
Association of left ventricular longitudinal strain with central venous oxygen saturation and serum lactate in patients with early severe sepsis and septic shock
- âŠ