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Emerging Treatment

Emily L Fargo, Frank D'Amico, Aaron Pickering, Kathleen Fowler, Ronald Campbell, Megan Baumgartner
BACKGROUND:  Sepsis is a serious medical condition that can lead to organ dysfunction and death. Research shows that each hour delay in antibiotic administration increases mortality. The Surviving Sepsis Campaign Bundles created standards to assist in the timely treatment of patients with suspected sepsis to improve outcomes and reduce mortality. OBJECTIVE:  This article determines if the use of an electronic physician order-set decreases time to antibiotic ordering for patients with sepsis in the emergency department (ED)...
October 2018: Applied Clinical Informatics
Melvin Bonilla-Félix, Marta Suárez-Rivera
BACKGROUND: Puerto Rico suffered a major humanitarian -crisis after Hurricane Maria. We describe our experience with patients with renal disease in an academic medical center. SUMMARY: A comprehensive emergency response plan should be developed, shared and discussed with the team and the patients prior to the hurricane. The needs of the staff should not be ignored to ensure their ability to participate as responders. Physical damage to facilities, lack of basic services, shortage of disposable products, and the inability to get to treatment centers are the most common threats...
December 5, 2018: Blood Purification
Morgan M McNeil, Amanda F Nahhas, Taylor L Braunberger, Iltefat H Hamzavi
Afamelanotide, an α-melanocyte stimulating hormone analogue, has become an emerging therapeutic option for a variety of skin conditions previously refractory to other treatments. Its efficacy has been demonstrated in several dermatologic conditions, including erythropoietic protoporphyria (EPP), solar urticaria, polymorphic light eruption (PMLE), vitiligo, acne, and Hailey-Hailey disease. Its relatively low risk side effect profile makes it an attractive treatment option and also paves the way for innovative use in other disorders...
November 2018: Skin Therapy Letter
Sam Jones, Eva Maria Hodel, Raman Sharma, Katherine Kay, Ian M Hastings
Background: Standard treatment for severe malaria is with artesunate; patient survival in the 24 hours immediately posttreatment is the key objective. Clinical trials use clearance rates of circulating parasites as their clinical outcome, but the pathology of severe malaria is attributed primarily to noncirculating, sequestered, parasites, so there is a disconnect between existing clinical metrics and objectives. Methods: We extend existing pharmacokinetic/pharmacodynamic modeling methods to simulate the treatment of 10000 patients with severe malaria and track the pathology caused by sequestered parasites...
December 5, 2018: Journal of Infectious Diseases
Mahfuz Al Mamun, Kaiissar Mannoor, Jun Cao, Firdausi Qadri, Xiaoyuan Song
Cancer stem cells (CSCs), a minor subpopulation of tumor bulks with self-renewal and seeding capacity to generate new tumors, posit a significant challenge to develop effective and long-lasting anti-cancer therapies. The emergence of drug resistance appears upon failure of chemo-/radiation therapy to eradicate the CSCs, thereby leading to CSC-mediated clinical relapse. Accumulating evidence suggests that transcription factor SOX2, a master regulator of embryonic and induced pluripotent stem cells, drives cancer stemness, fuels tumor initiation, and contributes to tumor aggressiveness through major drug resistance mechanisms like epithelial-to-mesenchymal transition (EMT), ATP-binding cassette (ABC) drug transporters, anti-apoptotic and/or pro-survival signaling, lineage plasticity, and evasion of immune surveillance...
December 5, 2018: Journal of Molecular Cell Biology
Karla Cristina Petruccelli, Gabriel Castro Tavares, Márcio Pinheiro Lima, Jessica Vanina Ortiz, Alba Regina Brandão, Katia do Nascimento Couceiro, João Marcos Bemfica Barbosa-Ferreira, Mônica Regina Hosannah da Silva E Silva, Maria das Graças Vale Barbosa Guerra, Jorge Augusto de Oliveira Guerra
Cardiorenal syndrome type 1 (CRS 1) occurs when acute heart failure leads to acute kidney injury. There are several etiologies of CRS 1, including Chagas disease. Here, we present the first case report of CRS 1 in a patient with acute Chagas disease. Electrocardiography, transthoracic echocardiography, and cardiac magnetic resonance imaging showed signs of acute myocarditis. Laboratory examination revealed severe loss of kidney function, with a creatinine clearance of 30 mL/min, which fully normalized after treatment...
November 2018: Revista da Sociedade Brasileira de Medicina Tropical
Angela Mazzeo, Enrico Jardim Clemente Santos
The biology of stem cells is one of the most dynamic and promising fields of the biological sciences, since it is the basis for the development of organisms. Its biological complexity demands efforts from several lines of research aimed mainly at its therapeutic use. Nanotechnology has been emerging as a new field of study, which shows great potential in the treatment of various diseases. This new area of health has been called "Nanomedicine" or "Bionanotechnology", which can be applied in Medicine by transport and drug delivery systems, robotic tools to be used in diagnostic and surgical processes, nanobiomaterials, gene therapies, nanobiomedical devices, among others...
November 29, 2018: Einstein
Elizabeth Adams
In many Western democracies, nursing consumes a comparatively large proportion of the health service budget and delivers the highest proportion of direct patient care. Therefore, identifying and representing the contribution of nurses to clinical effectiveness as well as the wider social benefit to populations and the economy is crucial. Predictive models on health and social care requirements for the next quarter of a century report a staggering shift in population age, multimorbidity, and complexity of need...
January 2019: Nursing Administration Quarterly
Susanne Muehlschlegel
PURPOSE OF REVIEW: This article reviews the epidemiology, clinical presentation, diagnosis, and management of patients with aneurysmal subarachnoid hemorrhage (SAH). SAH is a type of hemorrhagic stroke and is a neurologic emergency with substantial morbidity and mortality. This article reviews the most common and potentially life-threatening neurologic and medical complications to promote their early recognition and prevent secondary brain injury. RECENT FINDINGS: Over the past 30 years, the incidence of SAH has remained stable; yet, likely because of improved care in specialized neurocritical care units, discharge mortality has considerably decreased...
December 2018: Continuum: Lifelong Learning in Neurology
Bruno L Ferreyro, Laveena Munshi
PURPOSE OF REVIEW: A wide spectrum of heterogeneous conditions can render a patient immunocompromised. Recent years have seen an increase in the number of immunocompromised patients given the earlier detection of conditions that require immunosuppressive therapies, changes in immunosuppressive regimens leading to increased survival or novel therapeutic advancements in oncologic care. Acute respiratory failure (ARF) is the leading cause of critical illness and mortality in this population...
December 3, 2018: Current Opinion in Critical Care
Anne-Charlotte Jonckheere, Dominique M A Bullens, Sven F Seys
PURPOSE OF REVIEW: The current review describes the role of different types of innate lymphoid cells (ILCs) in the pathogenesis of asthma inflammatory phenotypes by linking findings from murine asthma models with human studies. Novel treatment options are needed for patients with steroid-insensitive asthma. Strategies targeting ILCs, or their upstream or downstream molecules are emerging and discussed in this review. RECENT FINDINGS: In eosinophilic asthma, ILCs, and especially type 2 ILCs (ILC2s), are activated by alarmins such as IL-33 upon allergen triggering of the airway epithelium...
December 3, 2018: Current Opinion in Allergy and Clinical Immunology
R Abdullaiev, G Oleynik, V Kremen, A Gryazin, E Timchenko
The problem of treating patients with loss of the skin and with a complicated course of the wound process remains topical. The problem is that, despite the relative technical simplicity of the dermatension method, the most significant complication is the decubitus of the stretchable flap, which is associated with a relatively high incidence of acute blood circulatory disturbances in the stretch tissues due to vascular compression with an excessive amount of injected fluid. The aim of the work is to improve the method of dermatension in reconstructive and recovery surgery of soft tissue defects of various genesis by planning and implementing dermatension at all its steps with instrumental control of the process using ultrasound and ICT in a complex...
October 2018: Georgian Medical News
Noreen Kamal, Elaine Shand, Robert Swanson, Michael D Hill, Thomas Jeerakathil, Oje Imoukhuede, Irvin Heinrichs, Jackie Bakker, Carol Stoyberg, Laura Fowler, Sandy Duckett, Scott Holsworth, Balraj Mann, Shelley Valaire, Jennifer Bestard
BACKGROUND: Alteplase is an effective treatment for ischaemic stroke patients, and it is widely available at all primary stroke centres. The effectiveness of alteplase is highly time-dependent. Large tertiary centres have reported significant improvements in their door-to-needle (DTN) times. However, these same improvements have not been reported at community hospitals. METHODS: Red Deer Regional Hospital Centre (RDRHC) is a community hospital of 370 beds that serves approximately 150,000 people in their acute stroke catchment area...
December 5, 2018: Canadian Journal of Neurological Sciences. le Journal Canadien des Sciences Neurologiques
Vardhman Kumar, Shyni Varghese
The emergence of immunotherapies and recent FDA approval of several of them makes them a promising therapeutic strategy for cancer. While these advancements underscore the potential of engaging the immune system to target tumors, this approach has so far been efficient only for certain cancers. Extending immunotherapy as a widely acceptable treatment for various cancers requires a deeper understanding of the interactions of tumor cells within the tumor microenvironment (TME). The immune cells are a key component of the TME, which also includes other stromal cells, soluble factors, and extracellular matrix-based cues...
December 5, 2018: Advanced Healthcare Materials
Sarah A Pendergrass, Dana C Crawford
Electronic health records contain patient-level data collected during and for clinical care. Data within the electronic health record include diagnostic billing codes, procedure codes, vital signs, laboratory test results, clinical imaging, and physician notes. With repeated clinic visits, these data are longitudinal, providing important information on disease development, progression, and response to treatment or intervention strategies. The near universal adoption of electronic health records nationally has the potential to provide population-scale real-world clinical data accessible for biomedical research, including genetic association studies...
December 5, 2018: Current Protocols in Human Genetics
Nicolas Clementy, Yann Ancedy, Arnaud Bisson, Clémentine Andre, Bertrand Pierre, Laurent Fauchier, Dominique Babuty
INTRODUCTION: Ablation of premature ventricular contractions has emerged as a safe and effective treatment in patients experiencing a high premature ventricular contractions burden. Mapping of premature ventricular contractions origin may sometimes be challenging. We sought to evaluate the accuracy of a new electrophysiological criterion, the Distal-to-Proximal Delay, at localizing the optimal site for ablation of ventricular ectopic foci. METHODS AND RESULTS: Consecutive patients with ablation attempts of symptomatic premature ventricular contractions were included...
December 5, 2018: Journal of Cardiovascular Electrophysiology
Kıvılcım Karadeniz Cerit, Rabia Ergelen, Tural Abdullayev, Halil Tuğtepe, Tolga Emrullah Dağlı, Gürsu Kıyan
BACKGROUND: Although a nonoperative treatment approach is preferred for blunt liver and spleen trauma in childhood, there are significant differences between clinics in the algorithms used. The approach to high-grade liver and spleen injury is still controversial, particularly as grade V liver and spleen injuries are not included in the American Pediatric Surgical Association guideline. The aim of this study was to present experience with a non-operative treatment approach to children with high-grade liver and spleen injuries...
November 2018: Ulusal Travma Ve Acil Cerrahi Dergisi, Turkish Journal of Trauma & Emergency Surgery: TJTES
Selman Yeniocak, Özgür Karcıoğlu, Asım Kalkan, Fatma Saraç, Gökçe Akgül Karadana, Zehra Zeynep Keklikkıran, Alper Gümüş, Macit Koldaş, Semih Korkut
BACKGROUND: The aim of this study was to investigate the prognostic value of irisin by examining the serum level of this smooth muscle protein in patients presenting at the emergency department (ED) with acute abdominal pain. METHODS: This research was performed as a single-center, prospective, cross-sectional study. In all, 213 adult patients presenting at the ED with acute abdominal pain and 140 healthy controls were enrolled. The serum irisin level was correlated with the leukocyte, C-reactive protein, amylase, and creatine kinase values...
November 2018: Ulusal Travma Ve Acil Cerrahi Dergisi, Turkish Journal of Trauma & Emergency Surgery: TJTES
J P Haran, E Wilsterman, T Zeoli, M Goulding, E McLendon, M A Clark
The Infectious Disease Society of America (IDSA) publishes guidelines regularly for the management of skin and soft tissue infections; however, the extent to which practice patterns follow these guidelines and if this can affect treatment failure rates is unknown. We observed the treatment failure rates from a multicentre retrospective ambulatory cohort of adult emergency department patients treated for a non-purulent skin infection. We used multivariable logistic regression to examine the role of IDSA classification and whether adherence to IDSA guidelines reduced treatment failure...
December 5, 2018: Epidemiology and Infection
E Russo, D R Potenza, M Casella, R Massaro, G Russo, M Braccio, A Dello Russo, M Cassese
Transcather aortic valve implantation (TAVI) has become a safe and indispensable treatment option for patients with severe symptomatic aortic stenosis who are at high surgical risk. Recently, outcomes after TAVI have improved significantly and TAVI has emerged as a qualified alternative to surgical aortic valve replacement in the treatment of intermediate risk patients and greater adoption of this procedure is to be expected in a wider patients population, including younger patients and low surgical risk patients...
December 4, 2018: Current Cardiology Reviews
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