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fever in acute and critical care

Bishnu Rath Giri, Ram Hari Chapagain, Samana Sharma, Sandeep Shrestha, Sunita Ghimire, P Ravi Shankar
BACKGROUND: Earthquakes impact child health in many ways. Diseases occurring immediately following an earthquake have been studied in field based hospitals but studies on the inpatient disease pattern among children without trauma in a permanent hospital setup is lacking. METHODS: We examined the diagnoses of all children without trauma, admitted to Kanti Children's Hospital, Kathmandu for fifteen-week duration (from 4th week to end of the 18th week) following the 7...
February 5, 2018: BMC Pediatrics
Lawrence J Hirsch, Nicolas Gaspard, Andreas van Baalen, Rima Nabbout, Sophie Demeret, Tobias Loddenkemper, Vincent Navarro, Nicola Specchio, Lieven Lagae, Andrea O Rossetti, Sara Hocker, Teneille E Gofton, Nicholas S Abend, Emily J Gilmore, Cecil Hahn, Houman Khosravani, Felix Rosenow, Eugen Trinka
We convened an international group of experts to standardize definitions of New-Onset Refractory Status Epilepticus (NORSE), Febrile Infection-Related Epilepsy Syndrome (FIRES), and related conditions. This was done to enable improved communication for investigators, physicians, families, patients, and other caregivers. Consensus definitions were achieved via email messages, phone calls, an in-person consensus conference, and collaborative manuscript preparation. Panel members were from 8 countries and included adult and pediatric experts in epilepsy, electroencephalography (EEG), and neurocritical care...
February 5, 2018: Epilepsia
Avantika Dang, Lauren N Gjolaj, Myka Whitman, Gustavo Fernandez
PURPOSE: The purpose of this study was to improve the care of patients with neutropenic fever in an academic acute care hospital's emergency room (ER). METHODS: Using the define, measure, analyze, improve, control method, a two-phase project with three critical to quality metrics (reduction in time to antibiotic administration, increase in percentage of patients with neutropenic fever identified as an oncology emergency, and increase in patients cohorted on oncology units) was completed...
January 2018: Journal of Oncology Practice
Jung Hyun Park, Jong Yeol Kim
Spinal subarachnoid hematoma (SSH) following diagnostic lumbar puncture is very rare. Generally, SSH is more likely to occur when the patient has coagulopathy or is undergoing anticoagulant therapy. Unlike the usual complications, such as headache, dizziness, and back pain at the needle puncture site, SSH may result in permanent neurologic deficits if not properly treated within a short period of time. An otherwise healthy 43-year-old female with no predisposing factors presented with fever and headache. Diagnostic lumbar puncture was performed under suspicion of acute meningitis...
December 2017: Korean Journal of Spine
Somia Iqtadar, Nabeel Akbar, Mehreen Mehmood, Sajid Abaidullah
Background and Objective: Dengue infection has evolved into an epidemic during last few years in Pakistan and has been associated with poor outcomes. Literature with respect to mortality risk factors in Dengue infection is not sufficient. This compelled us to conduct this study to find out major contributory factors to death in patients with dengue viral infection at one of Asia's ancient hospital setting with an aim to recognize complications at earliest and improve case management in future...
September 2017: Pakistan Journal of Medical Sciences Quarterly
Chien-Ming Chao, Chih-Cheng Lai, Khee-Siang Chan, Kuo-Chen Cheng, Willy Chou, Kuo-Shu Yuan, Chin-Ming Chen
PURPOSE: This study assessed clinical manifestations and prognostic factors of critically ill patients with severe influenza admitted to the intensive care unit (ICU) in Taiwan's recent outbreak. METHODOLOGY: Patients admitted to ICU for severe influenza between January 1, 2015, and March 31, 2016, were identified and their medical records were retrospectively reviewed. The primary endpoints were outcomes and predictors of in-hospital mortality. RESULTS: There were 125 patients with an average Acute Physiology and Chronic Health Evaluation II (APACHE II) score of 20...
October 2017: Journal of Medical Microbiology
Shigeo Godo, Shigemi Irino, Atsuhiro Nakagawa, Yu Kawazoe, Motoo Fujita, Daisuke Kudo, Ryosuke Nomura, Hiroaki Shimokawa, Shigeki Kushimoto
Paroxysmal sympathetic hyperactivity (PSH) is a distinct syndrome of episodic sympathetic hyperactivities following severe acquired brain injury, characterized by paroxysmal transient fever, tachycardia, hypertension, tachypnea, excessive diaphoresis and specific posturing. PSH remains to be an under-recognized condition with a diagnostic pitfall especially in the intensive care unit (ICU) settings due to the high prevalence of concomitant diseases that mimic PSH. A consensus set of diagnostic criteria named PSH-Assessment Measure (PSH-AM) has been developed recently, which is consisted of two components: a diagnosis likelihood tool derived from clinical characteristics of PSH, and a clinical feature scale assigned to the severity of each sympathetic hyperactivity...
September 2017: Tohoku Journal of Experimental Medicine
Rajeev Nayak
Acute neuromuscular paralysis (ANMP) is a clinical syndrome characterized by rapid onset muscle weakness progressing to maximum severity within several days to weeks (less than 4 wk). Bulbar and respiratory muscle weakness may or may not be present. It is a common neurological emergency which requires immediate and careful investigations to determine the etiology because accurate diagnosis has significant impact on therapy and prognosis. Respiratory failure caused by neuromuscular weakness is considered as more critical than lung disease because its development may be insidious or subtle until sudden decompensation leads to life threatening hypoxia...
July 16, 2017: World Journal of Clinical Cases
Liwei Duan, Sheng Zhang, Zhaofen Lin
OBJECTIVE: To explore the method and performance of using multiple indices to diagnose sepsis and to predict the prognosis of severe ill patients. METHODS: Critically ill patients at first admission to intensive care unit (ICU) of Changzheng Hospital, Second Military Medical University, from January 2014 to September 2015 were enrolled if the following conditions were satisfied: (1) patients were 18-75 years old; (2) the length of ICU stay was more than 24 hours; (3) All records of the patients were available...
February 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Elizabeth Margolskee, Jad Saab, Julia T Geyer, Alexander Aledo, Susan Mathew
BACKGROUND The reciprocal translocation t(1;22)(p13;q13) involving the RBM15 and MKL1 genes is an uncommon abnormality that occurs in a subset of acute myeloid leukemia with megakaryocytic differentiation (AMKL). Variant translocations have been infrequently described in this subtype of leukemia. CASE REPORT We describe the case of a 3-month-old girl who presented with progressive abdominal distension, vomiting, and fever. Although there was no morphologic evidence of leukemia in the bone marrow, cytogenetic and metaphase fluorescence in situ hybridization analysis identified an insertion of p13p31 bands of chromosome 1 onto the long arm of chromosome 22, resulting in the karyotype: 46,XX,ins(22;1)(q13;p13p31)...
April 19, 2017: American Journal of Case Reports
Annesinah H Moloi, Sumaya Mall, Mark E Engel, Renae Stafford, Zhang Wan Zhu, Liesl J Zuhlke, David A Watkins
BACKGROUND: Rheumatic heart disease (RHD) is an important and preventable cause of cardiovascular disease. OBJECTIVES: As part of a recent RHD initiative in Uganda and Tanzania, we systematically reviewed group A streptococcal disease (GAS), acute rheumatic fever (ARF), and RHD in these countries. METHODS: Using a systematic review and meta-analysis/meta-synthesis, we searched PubMed, Embase, and grey literature for quantitative and qualitative studies conducted in Uganda and Tanzania that included individuals affected by GAS, ARF, and RHD...
March 14, 2017: Global Heart
Antonella Frattari, Giustino Parruti, Rocco Erasmo, Luigi Guerra, Ennio Polilli, Rosamaria Zocaro, Giuliano Iervese, Paolo Fazii, Tullio Spina
BACKGROUND: In critically ill patients with colonization/infection of multidrug-resistant organisms, source control surgery is one of the major determinants of clinical success. In more complex cases, the use of different tools for sepsis management may allow survival until complete source control. CASE PRESENTATION: A 42-year-old white man presented with traumatic hemorrhagic shock. Unstable pelvic fractures led to emergency stabilization surgery. Fever ensued with diarrhea, followed by septic shock...
February 22, 2017: Journal of Medical Case Reports
G Korbakis, P M Vespa
Neurocritical care has two main objectives. Initially, the emphasis is on treatment of patients with acute damage to the central nervous system whether through infection, trauma, or hemorrhagic or ischemic stroke. Thereafter, attention shifts to the identification of secondary processes that may lead to further brain injury, including fever, seizures, and ischemia, among others. Multimodal monitoring is the concept of using various tools and data integration to understand brain physiology and guide therapeutic interventions to prevent secondary brain injury...
2017: Handbook of Clinical Neurology
Bingumal Jayasundara, Lalith Perera, Ajith de Silva
OBJECTIVE: To review the management experience of a consecutive series of patients presenting as acute surgical abdomen whom were ultimately diagnosed to have DF (Dengue fever)/DHF (Dengue hemorrhagic fever). METHODS: Clinical data of all cases of apparent acute abdomen (AA) which were later confirmed as having DF/DHF reviewed by two surgical units from December 2012 to December 2013 were analyzed. Initially confirmed patients with DF/DHF who developed abdominal symptoms were not considered...
January 2017: Asian Pacific Journal of Tropical Medicine
Akilesh Honasoge, Neal Lyons, Kathleen Hesse, Braden Parker, Robert Mokszycki, Kelly Wesselhoff, Rolla Sweis, Erik B Kulstad
The available routes of administration commonly used for medications and fluids in the acute care setting are generally limited to oral, intravenous, or intraosseous routes, but in many patients, particularly in the emergency or critical care settings, these routes are often unavailable or time-consuming to access. A novel device is now available that offers an easy route for administration of medications or fluids via rectal mucosal absorption (also referred to as proctoclysis in the case of fluid administration and subsequent absorption)...
November 9, 2016: Journal of Visualized Experiments: JoVE
Sheung-Yin Fan, Hoi-Ping Shum, Wing-Yee Cheng, Yat-Hei Chan, Sik-Yin McShirley Leung, Wing-Wa Yan
STUDY OBJECTIVE: To determine whether critically ill patients receiving extended-infusion (EI) piperacillin/tazobactam would have improved clinical outcomes compared with patients receiving intermittent infusions. DESIGN: Single-center, open-label, prospective study. SETTING: Twenty-two-bed intensive care unit (ICU) in a regional hospital in Hong Kong. PATIENTS: A total of 367 adults who had a diagnosis of either bacterial infection or neutropenic fever and had received treatment with piperacillin/tazobactam for at least 48 hours between December 1, 2013, and August 31, 2015...
January 2017: Pharmacotherapy
Julie C Fitzgerald, Scott L Weiss, Shannon L Maude, David M Barrett, Simon F Lacey, J Joseph Melenhorst, Pamela Shaw, Robert A Berg, Carl H June, David L Porter, Noelle V Frey, Stephan A Grupp, David T Teachey
OBJECTIVE: Initial success with chimeric antigen receptor-modified T cell therapy for relapsed/refractory acute lymphoblastic leukemia is leading to expanded use through multicenter trials. Cytokine release syndrome, the most severe toxicity, presents a novel critical illness syndrome with limited data regarding diagnosis, prognosis, and therapy. We sought to characterize the timing, severity, and intensive care management of cytokine release syndrome after chimeric antigen receptor-modified T cell therapy...
February 2017: Critical Care Medicine
Aleksandra Leligdowicz, William A Fischer, Timothy M Uyeki, Thomas E Fletcher, Neill K J Adhikari, Gina Portella, Francois Lamontagne, Christophe Clement, Shevin T Jacob, Lewis Rubinson, Abel Vanderschuren, Jan Hajek, Srinivas Murthy, Mauricio Ferri, Ian Crozier, Elhadj Ibrahima, Marie-Claire Lamah, John S Schieffelin, David Brett-Major, Daniel G Bausch, Nikki Shindo, Adrienne K Chan, Tim O'Dempsey, Sharmistha Mishra, Michael Jacobs, Stuart Dickson, G Marshall Lyon, Robert A Fowler
As of 20 May 2016 there have been 28,646 cases and 11,323 deaths resulting from the West African Ebola virus disease (EVD) outbreak reported to the World Health Organization. There continue to be sporadic flare-ups of EVD cases in West Africa.EVD presentation is nonspecific and characterized initially by onset of fatigue, myalgias, arthralgias, headache, and fever; this is followed several days later by anorexia, nausea, vomiting, diarrhea, and abdominal pain. Anorexia and gastrointestinal losses lead to dehydration, electrolyte abnormalities, and metabolic acidosis, and, in some patients, acute kidney injury...
July 29, 2016: Critical Care: the Official Journal of the Critical Care Forum
Fawaz Al-Mufti, Elie Dancour, Krishna Amuluru, Charles Prestigiacomo, Stephan A Mayer, E Sander Connolly, Jan Claassen, Joshua Z Willey, Philip M Meyers
Acute ischemic stroke continues to be one of the leading causes of morbidity and mortality worldwide. Recent advances in mechanical thrombectomy techniques combined with prereperfusion computed tomographic angiography for patient selection have revolutionized stroke care in the past year. Peri- and postinterventional neurocritical care of the patient who has had an emergent large-vessel occlusion is likely an equally important contributor to the outcome but has been relatively neglected. Critical periprocedural management issues include streamlining care to speed intervention, blood pressure optimization, reversal of anticoagulation, management of agitation, and selection of anesthetic technique (ie, general vs monitored anesthesia care)...
July 19, 2016: Journal of Intensive Care Medicine
Yasufumi Nakajima
Although body temperature is a classic primary vital sign, its value has received little attention compared with the others (blood pressure, heart rate, and respiratory rate). This may result from the fact that unlike the other primary vital signs, aging and diseases rarely affect the thermoregulatory system. Despite this, when humans are exposed to various anesthetics and analgesics and acute etiologies of non-infectious and infectious diseases in perioperative and intensive care settings, abnormalities may occur that shift body temperature up and down...
October 2016: Journal of Anesthesia
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