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Anthony R Cai, Erica I Hodgman, Puneet B Kumar, Alvand J Sehat, Alexander L Eastman, Steven E Wolf
A significant proportion of patients appeared to arrive at our American Burn Association-verified burn center intubated without clear benefit. The current study aims to evaluate regional prehospital intubation practices and their outcomes. All consecutive admissions from November 2012 to June 2014 were reviewed for data points associated with intubation. Demographics and outcomes for patients who were intubated before arrival or within 24 hours of admission were compared using χ, Fisher's exact test, and the Kruskal-Wallis test as appropriate...
October 17, 2016: Journal of Burn Care & Research: Official Publication of the American Burn Association
Samuel Y Ash, Alejandro A Diaz
PURPOSE OF REVIEW: The present review aims to summarize the most recent evidence related to imaging and severe asthma, both with regard to advances in imaging research and to their current and potential clinical implications. RECENT FINDINGS: Recent work in imaging in severe asthma has principally been using computed tomography (CT) and MRI, as well as the integration of the two. Some of the most notable findings include the use of CT imaging biomarkers to create unique clusters of asthmatics, and the use of co-registration to link CT images of airways with regional variation in ventilation in MRI...
October 20, 2016: Current Opinion in Pulmonary Medicine
Richard Ac Hughes, Ruth Brassington, Angela A Gunn, Pieter A van Doorn
BACKGROUND: Guillain-Barré syndrome (GBS) is an acute paralysing disease caused by inflammation of the peripheral nerves, which corticosteroids would be expected to benefit. OBJECTIVES: To examine the ability of corticosteroids to hasten recovery and reduce the long-term morbidity from GBS. SEARCH METHODS: On 12 January 2016, we searched the Cochrane Neuromuscular Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Embase...
October 24, 2016: Cochrane Database of Systematic Reviews
Q-L Ma, H-J Wang, M-N Shi, J-H An, J Ma, D Yu, M Tang, F-W Shi
OBJECTIVE: Coronary heart disease (CHD) is a frequent medical condition in developed countries and is one of the most serious diseases threatening patients' lives. Perioperative myocardial infarction is the major cause of perioperative cardiac death and cardiac arrest, but is difficult to be precisely identified by observing clinical symptoms or assessing cardiac enzyme levels or by ECG examination. Therefore, assessment of patient prognosis requires reliable predictors. In this regard, we tested the prognostic value of serum troponin I (TnI) concentrations...
October 2016: European Review for Medical and Pharmacological Sciences
P Deltell Colomer, N Albertos Mira-Marcelí, N Gallego Mellado, M E Kuan Argüello, M F Bordallo Vázquez, J Mira Navarro, J Gonzálvez Piñera
INTRODUCTION: In more than 50% of the necrotizing enterocolitis that underwent surgery will require an ileostomy. The optimal time to reestablish intestinal transit still is a controversial subject. Many times ileostomies cause medical issues that require early intestinal reconstruction. Our objective is to compare the early closure against late close, being the shift point 35 days according to other published research. MATERIAL AND METHODS: Retrospective study off all patients that in the last 10 years have had an episode of necrotizing enterocolitis which required an intestinal derivation like ileostomy...
January 15, 2016: Cirugía Pediátrica: Organo Oficial de la Sociedad Española de Cirugía Pediátrica
M P A Clark, B D Westerberg, J E Mitchell
OBJECTIVE: Chronic suppurative otitis media is a neglected condition affecting up to 330 million people worldwide, with the burden of the disease in impoverished countries. The need for non-governmental organisations to hardwire training into their programmes has been highlighted. An ear surgery simulator appropriate for training in resource-poor settings was developed, and its effectiveness in facilitating the acquisition of headlight and microsurgical skills necessary to safely perform procedures via the ear canal was investigated...
October 2016: Journal of Laryngology and Otology
Orso Pusterla, Grzegorz Bauman, Mark O Wielpütz, Sylvia Nyilas, Philipp Latzin, Claus P Heussel, Oliver Bieri
PURPOSE: To introduce a reproducible, nonenhanced 1H MRI method for rapid in vivo functional assessment of the whole lung at 1.5 Tesla (T). METHODS: At different respiratory volumes, the pulmonary signal of ultra-fast steady-state free precession (ufSSFP) follows an adapted sponge model, characterized by a respiratory index α. From the model, α reflects local ventilation-related information, is virtually independent from the lung density and thus from the inspiratory phase and breathing amplitude...
October 23, 2016: Magnetic Resonance in Medicine: Official Journal of the Society of Magnetic Resonance in Medicine
Alexander J Sweidan, Navneet K Singh, Natasha Dang, Vinh Lam, Jyoti Datta
INTRODUCTION: Amiodarone is often used in the suppression of tachyarrhythmias. One of the more serious adverse effects includes amiodarone pulmonary toxicity (APT). Several pulmonary diseases can manifest including interstitial pneumonitis, organizing pneumonia, acute respiratory distress syndrome, diffuse alveolar hemorrhage, pulmonary nodules or masses, and pleural effusion. Incidence of APT varies from 5-15% and is correlated to dosage, age of the patient, and preexisting lung disease...
2016: Clinical Medicine Insights. Case Reports
Jun Takei, Ran Takei, Satoshi Nozuma, Keiichi Nakahara, Osamu Watanabe, Hiroshi Takashima
A 40-year-old man presented with a series of generalized tonic-clonic seizures after febrile illness. He developed status epilepticus and required mechanical ventilation with anesthetics. Steroid pulse, intravenous immunoglobulin, and immunoadsorption therapy were administrated, and the status epilepticus improved; however, drug-resistant seizures remained. Despite the use of several antiepileptic drugs, seizures frequently occurred. Additional administration of potassium bromide resulted in significant suppression of seizures...
October 21, 2016: Rinshō Shinkeigaku, Clinical Neurology
Ankana Daga, Fredrick Dapaah-Siakwan, Sharina Rajbhandari, Cassandra Arevalo, Agnes Salvador
BACKGROUND: Acute kidney injury (AKI) is common in critically ill premature infants. There is a lack of consensus on the diagnostic definition of AKI in very low birth weight (VLBW) infants. The primary aim of this study was to determine the incidence and risk factors for AKI in VLBW infants using the AKI network (AKIN) and pRIFLE (pediatric Risk, Injury, Failure, Loss, End-Stage) criteria and to evaluate whether Clinical Risk Index for Babies (CRIB II) score is a predictor of AKI. The secondary objective was to determine the extent of agreement between the AKIN and pRIFLE criteria in the diagnosis of AKI in VLBW infants...
September 28, 2016: Pediatrics and Neonatology
Mitsumasa Hata, Yukihiko Orime, Shinji Wakui, Tetsuya Nakamura, Rei Hinoura, Atsushi Harada, Kenji Akiyama
OBJECTIVE: We assessed the efficacy of distal limited open stenting procedure in octogenarians with distal aortic arch aneurysm. METHODS: During the last 5 years, 24 patients underwent distal limited open stenting. Mean patient age was 81.6 ± 2.5 years, ranging from 80 to 90 years. The hemicircumference of the anterior surface of the arch around the left common carotid artery was obliquely incised, and a J-Graft Open Stent (Japan Lifeline Co, Ltd, Tokyo, Japan) was inserted into the descending aorta...
September 24, 2016: Journal of Thoracic and Cardiovascular Surgery
Alina Kurolap, Anja Armbruster, Tova Hershkovitz, Katharina Hauf, Adi Mory, Tamar Paperna, Ewald Hannappel, Galit Tal, Yusif Nijem, Ella Sella, Muhammad Mahajnah, Anat Ilivitzki, Dov Hershkovitz, Nina Ekhilevitch, Hanna Mandel, Volker Eulenburg, Hagit N Baris
Glycine is a major neurotransmitter that activates inhibitory glycine receptors and is a co-agonist for excitatory glutamatergic N-methyl-D-aspartate (NMDA) receptors. Two transporters, GLYT1 and GLYT2, regulate extracellular glycine concentrations within the CNS. Dysregulation of the extracellular glycine has been associated with hyperekplexia and nonketotic hyperglycinemia. Here, we report four individuals from two families who presented at birth with facial dysmorphism, encephalopathy, arthrogryposis, hypotonia progressing to hypertonicity with startle-like clonus, and respiratory failure...
October 18, 2016: American Journal of Human Genetics
Jiangquan Yu, Ruiqiang Zheng, Hua Lin, Qihong Chen, Jun Shao, Daxin Wang
PURPOSE: This study aimed to investigate the clinical effects of early goal-directed therapy according to the global end-diastolic volume index (GEDI) on chronic obstructive pulmonary disease (COPD) patients with septic shock. METHODS: A total of 71 COPD patients with septic shock were randomly assigned to 2 groups. In the control group (n = 37), fluid resuscitation was performed based on the central venous pressure. In the study group (n = 34), fluid resuscitation was performed until GEDI reached 800 mL/m(2)...
October 8, 2016: American Journal of Emergency Medicine
Petter Sandstedt, Sverker Johansson, Charlotte Ytterberg, Caroline Ingre, Lotta Widén Holmqvist, Marie Kierkegaard
BACKGROUND: Knowledge of factors influencing health-related quality of life (HRQL) in people with amyotrophic lateral sclerosis (ALS) is important because some factors might be amenable to intervention. OBJECTIVES: The aim was to describe and explore the effects of disease severity, fatigue, anxiety, depression, frequency of social and lifestyle activities, coping capacity and mechanical ventilator use on HRQL in people with ALS. METHODS: Sixty people with ALS were enrolled in this cross-sectional study...
November 15, 2016: Journal of the Neurological Sciences
Yunzhou Fan, Fang Gao, Yanyan Wu, Jie Zhang, Ming Zhu, Lijuan Xiong
BACKGROUND: Ventilator-associated event (VAE) is a new surveillance paradigm for monitoring complications in mechanically ventilated patients in intensive care units (ICUs). The National Healthcare Safety Network replaced traditional ventilator-associated pneumonia (VAP) surveillance with VAE surveillance in 2013. The objective of this study was to assess the consistency between VAE surveillance and traditional VAP surveillance. METHODS: We systematically searched electronic reference databases for articles describing VAE and VAP in ICUs...
October 24, 2016: Critical Care: the Official Journal of the Critical Care Forum
Matthew P Schreiber, Andrew F Shorr
Ventilator-associated pneumonia (VAP) is a distinct clinical entity characterized by an onset after 48 hours of the application of mechanical ventilation (MV). Protocols exist to aid in the prevention of VAP, but this infection carries a devastating impact on patient morbidity and potentially mortality. Areas covered: In this review we present key concepts from existing guidelines to aid clinicians. Challenges remain in defining this disease and, most importantly appropriate empiric antimicrobial treatment is the main determinant of outcome...
October 24, 2016: Expert Review of Anti-infective Therapy
Emmanuel Futier, Catherine Paugam-Burtz, Thomas Godet, Linda Khoy-Ear, Sacha Rozencwajg, Jean-Marc Delay, Daniel Verzilli, Jeremie Dupuis, Gerald Chanques, Jean-Etienne Bazin, Jean-Michel Constantin, Bruno Pereira, Samir Jaber
PURPOSE: High-flow nasal cannula (HFNC) oxygen therapy is attracting increasing interest in acute medicine as an alternative to standard oxygen therapy; however, its use to prevent hypoxaemia after major abdominal surgery has not been evaluated. Our trial was designed to close this evidence gap. METHODS: A multicentre randomised controlled trial was carried out at three university hospitals in France. Adult patients at moderate to high risk of postoperative pulmonary complications who had undergone major abdominal surgery using lung-protective ventilation were randomly assigned using a computer-generated sequence to receive either HFNC oxygen therapy or standard oxygen therapy (low-flow oxygen delivered via nasal prongs or facemask) directly after extubation...
October 22, 2016: Intensive Care Medicine
Luigi Olper, Elena Bignami, Ambra L Di Prima, Santina Albini, Simona Nascimbene, Luca Cabrini, Giovanni Landoni, Ottavio Alfieri
BACKGROUND: Noninvasive ventilation (NIV) is a common technique to manage patients with acute respiratory failure in the intensive care unit. However, use of NIV in general wards is less well described. The authors' aim was to demonstrate efficacy of NIV, applied in a cardiac surgery ward, in improving oxygenation in patients who developed hypoxemic acute respiratory failure after being discharged from the intensive care unit. DESIGN: Randomized, open-label trial...
August 10, 2016: Journal of Cardiothoracic and Vascular Anesthesia
Francisco Álvarez-Lerma, Judith Marín-Corral, Clara Vila, Joan Ramón Masclans, Francisco Javier González de Molina, Ignacio Martín Loeches, Sandra Barbadillo, Alejandro Rodríguez
BACKGROUND: Patients infected with influenza A (H1N1)pdm09 virus requiring admission to the ICU remain an important source of mortality during the influenza season. The objective of the study was to assess the impact of a delay in diagnosis of community-acquired influenza A (H1N1)pdm09 virus infection on clinical outcome in critically ill patients admitted to the ICU. METHODS: A prospective multicenter observational cohort study was based on data from the GETGAG/SEMICYUC registry (2009-2015) collected by 148 Spanish ICUs...
October 23, 2016: Critical Care: the Official Journal of the Critical Care Forum
T Akhvlediani, N Akhvlediani, T Kuchuloria
Health care associated infections are the most frequent adverse event accompanying healthcare delivery worldwide. Of these, respiratory tract infections, including ventilator-associated pneumonia (VAP), have been recognized as the most common infections in acute hospitals. Sparse anecdotal and epidemiologic data from intensive care units (ICU) and infectious diseases physicians, as well as several publications in this field, suggest that the etiology of VAP in Georgia is most likely Klebsiella pneumoniae. This review article discusses the challenges of infection control in the Georgian health care system, with a focus on VAP...
September 2016: Georgian Medical News
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