When a Diuretic Causes Pulmonary Oedema

Background: Hydrochlorothiazide (HCTZ) is one of the most popular drugs for the treatment of hypertension and heart failure. Most of its side effects are harmless and predictable, but some studies report a few life-threatening reactions to this drug, one of the most dangerous being acute pulmonary oedema. Case Report: A 73-year-old woman was admitted to the Emergency Department with acute respiratory failure due to pulmonary oedema. Her past medical history included long-lasting hypertension with permanent atrial fibrillation and mitral stenosis. Her blood pressure control had been suboptimal, so her cardiologist had changed amlodipine to combination therapy with ramipril and HCTZ. However, 20 min after taking the new drug, the patient experienced fever, vomiting and diarrhoea immediately followed by acute onset of dyspnoea. Conclusion: Since HCTZ is one of the most popular drugs for hypertension treatment and millions of patients take it every day, it is important to keep in mind both the common adverse reactions as well as the dangerous, although rare, ones

Lymphopaenia in cardiac arrest patients

Background: A decrease in circulating lymphocytes has been described as a marker of poor prognosis after septic shock; however, scarce data are available after cardiac arrest (CA). The aim of this study was to evaluate the impact of lymphopaenia after successful cardiopulmonary resuscitation. Methods: This is a retrospective analysis of an institutional database including all adult CA patients admitted to the intensive care unit (ICU) between January 2007 and December 2014 who survived for at least 24 h. Demographic, CA-related data and ICU mortality were recorded as was lymphocyte count on admission and for the first 48 h. A cerebral performance category score of 3â\u80\u935 at 3 months was considered as an unfavourable neurological outcome. Results: Data from 377 patients were analysed (median age: 62 [IQRs: 52â\u80\u9375] years). Median time to return of spontaneous circulation (ROSC) was 15 [8â\u80\u9325] min and 232 (62%) had a non-shockable initial rhythm. ICU mortality was 58% (n = 217) and 246 (65%) patients had an unfavourable outcome at 3 months. The median lymphocyte count on admission was 1208 [700â\u80\u932350]/mm3 and 151 (40%) patients had lymphopaenia (lymphocyte count <1000/mm3). Predictors of lymphopaenia on admission were older age, a shorter time to ROSC, prior use of corticosteroid therapy and high C-reactive protein levels on admission. ICU non-survivors had lower lymphocyte counts on admission than survivors (1100 [613â\u80\u932317] vs. 1316 [891â\u80\u932395]/mm3; p = 0.05) as did patients with unfavourable compared to those with favourable neurological outcomes (1100 [600â\u80\u932013] vs. 1350 [919â\u80\u932614]/mm3; p = 0.003). However, lymphopaenia on admission was not an independent predictor of poor outcomes in the entire population, but only among OHCA patients. Conclusions: A low lymphocyte count is common in CA survivors and is associated with poor outcome after OHCA

Red cells distribution width after cardiac arrest

SCOPUS: no.jinfo:eu-repo/semantics/publishe

Assessment of early lymphopenia after cardiac arrest

SCOPUS: no.jinfo:eu-repo/semantics/publishe

β-Lactam pharmacodynamics in Gram-negative bloodstream infections in the critically ill

OBJECTIVES: To determine the β-lactam exposure associated with positive clinical outcomes for Gram-negative blood stream infection (BSI) in critically ill patients. PATIENTS AND METHODS: Pooled data of critically ill patients with mono-microbial Gram-negative BSI treated with β-lactams were collected from two databases. Free minimum concentrations (fCmin) of aztreonam, cefepime, ceftazidime, ceftriaxone, piperacillin (co-administered with tazobactam) and meropenem were interpreted in relation to the measured MIC for targeted bacteria (fCmin/MIC). A positive clinical outcome was defined as completion of the treatment course or de-escalation, without other change of antibiotic therapy, and with no additional antibiotics commenced within 48 h of cessation. Drug exposure breakpoints associated with positive clinical outcome were determined by classification and regression tree (CART) analysis. RESULTS: Data from 98 patients were included. Meropenem (46.9%) and piperacillin/tazobactam (36.7%) were the most commonly prescribed antibiotics. The most common pathogens were Escherichia coli (28.6%), Pseudomonas aeruginosa (19.4%) and Klebsiella pneumoniae (13.3%). In all patients, 87.8% and 71.4% achieved fCmin/MIC ≥1 and fCmin/MIC >5, respectively. Seventy-eight patients (79.6%) achieved positive clinical outcome. Two drug exposure breakpoints were identified: fCmin/MIC >1.3 for all β-lactams (predicted difference in positive outcome 84.5% versus 15.5%, P 4.95 for meropenem, aztreonam or ceftriaxone (predicted difference in positive outcome 97.7% versus 2.3%, P 1.3 was a significant predictor of a positive clinical outcome in critically ill patients with Gram-negative BSI and could be considered an antibiotic dosing target

MOESM1 of Lymphopaenia in cardiac arrest patients

Additional file 1. This documents includes comparisons between patients with in-hospital (IHCA) and out-of-hospital cardiac arrest (OHCA—Suppl Table 1); analysis of mortality and neurological outcome in IHCA (Suppl Table 2) and OHCA (Suppl Table 3) patients; the characteristics of lymphopenic patients after having excluded those receiving immunosuppressive therapies (Suppl Table 4); a multivariable regression analysis to identify independent predictors of lymphopenia on admission in in-hospital (IHCA) or out-of-hospital (OHCA) cardiac arrest (Suppl Table 5); a multivariable regression analysis to identify independent predictors of ICU outcome in in-hospital (IHCA) or out-of-hospital (OHCA) cardiac arrest (Suppl Table 6); a multivariable regression analysis to identify independent predictors of long-term neurological outcome in in-hospital (IHCA) or out-of-hospital (OHCA) cardiac arrest (Suppl Table 7); a multivariable regression analysis to identify independent predictors of lymphopenia on admission in patients without therapy with corticosteroids or other immunosoppressive drugs (Suppl Table 8)

Prognostic implications for insulin-sensitive and insulin-resistant normal-weight and obese individuals from a population-based cohort

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