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fever in acute and critical care

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...
September 14, 2016: 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...
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
Annesinah Hlengiwe Moloi, David Watkins, Mark E Engel, Sumaya Mall, Liesl Zühlke
INTRODUCTION: Rheumatic heart disease (RHD) is a chronic disease affecting the heart valves, secondary to group A streptococcal infection (GAS) and subsequent acute rheumatic fever (ARF). However, RHD cure and preventative measures are inextricably linked with socioeconomic development, as the disease mainly affects children and young adults living in poverty. In order to address RHD, public health officials and health policymakers require up-to-date knowledge on the epidemiology of GAS, ARF and RHD, as well as the existing enablers and gaps in delivery of evidence-based care for these conditions...
2016: BMJ Open
Nayomi Shermila Jayasinghe, Eranga Thalagala, Milanka Wattegama, Kanapathipillai Thirumavalavan
BACKGROUND: Neurological manifestations in dengue fever occur in <1 % of the patients and known to be due to multisystem dysfunction secondary to vascular leakage. Occurrence of wide spread cerebral haemorrhages with subdural hematoma during the leakage phase without profound thrombocytopenia and occurrence of cranial diabetes insipidus are extremely rare and had not been reported in published literature earlier, thus we report the first case. CASE PRESENTATION: A 24 year old previously healthy lady was admitted on third day of fever with thrombocytopenia...
2016: BMC Research Notes
Hakan Leblebicioglu, Alfonso J Rodriguez-Morales, Gian Maria Rossolini, Rogelio López-Vélez, Jean-Ralph Zahar, Jordi Rello
Depending on their destinations and activities, international travellers are at a significant risk of contracting both communicable and non-communicable diseases. On return to their home countries, such travellers may require intensive care. The emergence of severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV), and more recently Ebola haemorrhagic fever, has highlighted the risks. Other well-known communicable pathogens such as methicillin-resistant Staphylococcus aureus and carbapenemase-producing Enterobacteriaceae have been described previously...
July 2016: International Journal of Infectious Diseases: IJID
Yufeng Luo, Rong Ou, Yun Ling, Tiehe Qin
OBJECTIVE: To investigate the value of high flow nasal cannula (HFNC) in treating a patient with Middle East respiratory syndrome (MERS). METHODS: The effect of HFNC applied in the first imported MERS patient with complication of acute respiratory distress syndrome (ARDS) to China was observed. The patient was admitted to Department of Critical Care Medicine of Huizhou Municipal Central Hospital on May 28th, 2015, and the changes in various clinical parameters and their significance were analyzed...
October 2015: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Tokiko Miyaoka, Mitsuyo Itabashi, Saeko Kumon, Kenichi Akiyama, Yuko Iwabuchi, Hiroshi Kataoka, Takahito Moriyama, Takashi Takei, Kosaku Nitta
We report a patient treated with rituximab for interstitial pneumonia (IP) associated with microscopic polyangiitis (MPA) and who was undergoing hemodialysis. A 59-year-old woman who had been treated with tacrolimus for 1 year for rheumatic arthritis was referred to the Department of Nephrology for fatigue, fever, weight loss, and rapidly developing renal dysfunction. On the first admission, severe renal dysfunction, proteinuria, hematuria, and an elevated titer of MPO-ANCA were observed, and the woman was diagnosed with rapidly progressive glomerulonephritis because of MPA...
2016: Nihon Jinzo Gakkai Shi
Imran Khalid, Basem M Alraddadi, Youssef Dairi, Tabindeh J Khalid, Mazen Kadri, Abeer N Alshukairi, Ismael A Qushmaq
BACKGROUND: Data on the management, clinical course, and outcome of critical patients with Middle East Respiratory Syndrome coronavirus are scarce. We report here our experience and long-term outcome of such patients. METHODS: Subjects intubated for management of ARDS from Middle East Respiratory Syndrome coronavirus pneumonia and ARDS during the April-May 2014 outbreak were included. Their characteristics, ICU course, management, and outcome were evaluated. RESULTS: Fourteen subjects, including 3 health-care workers, met study criteria...
March 2016: Respiratory Care
Tom Møller, Claus Moser, Lis Adamsen, Grith Rugaard, Mary Jarden, Tina S Bøtcher, Liza Wiedenbein, Lars Kjeldsen
Long-lasting neutropenia associated with acute myeloid leukemia (AML) and its treatment gives rise to a high risk of pneumonia. The use of broad-spectrum antibiotic prophylaxis during outpatient management has not completely protected patients against admission due to infections and neutropenic fever, emphasizing the need to approach infection protection with complementary efforts. In a randomized controlled design, we examined the applicability of patient-performed daily spirometry [forced expiratory volume in one second (FEV1)] as an early warning tool and explored the effectiveness of positive expiratory pressure (PEP) in preventing pneumonia among 80 AML patients...
March 2016: American Journal of Hematology
Katherine Plewes, Richard J Maude, Aniruddha Ghose, Arjen M Dondorp
BACKGROUND: Severe falciparum malaria may be complicated by prolonged haemolysis and recurrent fever after parasite clearance. However, their respective etiologies are unclear and challenging to diagnose. We report the first case of severe falciparum malaria followed by prolonged haemolytic anaemia and rhinomaxillary mucormycosis in a previously healthy adult male. CASE PRESENTATION: A 30-year old Bangladeshi man was admitted with severe falciparum malaria complicated by hyperlactataemia and haemoglobinuria...
2015: BMC Infectious Diseases
Tanja Kaneko, Wolfgang Heinz
Despite the limitations (especially that ultrasound does not penetrate air containing lung tissue) ultrasound of the thorax is a very suitable method as a complementary or even primary diagnostic tool. Bedside availability and no radiation exposure are real advantages. However we always have to keep in mind that we are blind for deeper lung processes that do not have contact to the visceral pleura.This article illustrates where and how to look for pathologies and what we have to expect in patients. According to symptoms such as dyspnea, dyspnea with fever and thorax pain with and without trauma, the sonographic morphology of important illnesses in emergency situation are described...
November 2015: Deutsche Medizinische Wochenschrift
Martha Priedeman Skiles, Siân L Curtis, Paulin Basinga, Gustavo Angeles, Harsha Thirumurthy
BACKGROUND: Performance-based financing (PBF) strategies are promoted as a supply-side, results-based financing mechanism to improve primary health care. This study estimated the effects of Rwanda's PBF program on less-incentivized child health services and examined the differential program impact by household poverty. METHODS: Districts were allocated to intervention and comparison for PBF implementation in Rwanda. Using Demographic Health Survey data from 2005 to 2007-08, a community-level panel dataset of 5781 children less than 5 years of age from intervention and comparison districts was created...
2015: BMC Health Services Research
Ignacio Mastro-Martínez, Ana María Montes-Arjona, Margarita Escudero-Lirio, Bárbara Hernández-García, José Fernández-Cantalejo Padial
INTRODUCTION: Rhabdomyolysis is a rare paediatric condition. The case is presented of a patient in whom this developed secondary to severe hypernatraemic dehydration following acute diarrhoea. CASE REPORT: Infant 11 months of age who presented with vomiting, fever, diarrhoea and anuria for 15 hours. Parents reported adequate preparation of artificial formula and oral rehydration solution. He was admitted with malaise, severe dehydration signs and symptoms, cyanosis, and low reactivity...
July 2015: Revista Chilena de Pediatría
Yun Ling, Rong Qu, Yufeng Luo
OBJECTIVE: To report the treatment of the first imported Middle East respiratory syndrome ( MERS ) in China, and to investigate the clinical features and treatment of the patient. METHODS: On May 28th, 2015, the first patient of imported MERS to China was admitted to Department of Critical Care Medicine of Huizhou Municipal Central Hospital. The clinical features and treatments of this patient were analyzed. RESULTS: (1) A 43 years old male of South Korean nationality was admitted with the complaint of back ache for 7 days and fever 2 days with the following characteristics: back ache 7 days ago, without fever or cough or expectoration...
August 2015: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Kelebek Girgin Nermin, Iscimen Remzi, Akogul Zeynep, Cimen Ilker, Oner Torlar Meltem, Ozkaya Guven, Kahveci Ferda, Akalin Halis
BACKGROUND: H1N1 influenza A virus infections were first reported in April 2009 and spread rapidly, resulting in mortality worldwide. The aim of this study was to evaluate patients with H1N1 infection treated in the intensive care unit (ICU) in Bursa, Turkey. METHODS: Demographic characteristics, clinical features, and outcome relating to H1N1 infection were retrospectively analysed in patients treated in the ICU. RESULTS: Twenty-three cases of H1N1 infection were treated in the ICU...
June 2015: African Health Sciences
Ryan G O'Malley, Mahmoud M Al-Hawary, Ravi K Kaza, Ashish P Wasnik, Joel F Platt, Isaac R Francis
Small bowel obstruction (SBO) accounts for a considerable proportion of emergency room visits, inpatient admissions, and surgical interventions in the United States. Multi-detector computed tomography (MDCT) plays a key role in imaging patients presenting with acute symptoms suggestive of SBO, which helps in establishing the diagnosis, elucidating the cause of obstruction, and detecting complications, such as ischemia or frank bowel necrosis and perforation. Recently, management of patients with SBO has shifted toward a more conservative approach with supportive care and nasogastric tube decompression, as the obstruction in many cases can resolve spontaneously without the need for operative intervention...
October 2015: Abdominal Imaging
Alice Gallo de Moraes, Pratik A Patel, Elizabeth Mahal, Christopher L Kramer, Juan C Diaz Soto, Teng Moua
Patients undergoing radiofrequency ablation for treatment of atrial fibrillation may present critically ill with complications of atrial esophageal fistula, commonly manifesting as neurologic deficits and septicemia difficult to distinguish from other acute etiologies without a high index of suspicion. The temporal variability in fistula formation and symptom presentation, along with their nonspecific features, makes diagnosis often a late finding with historically high morbidity and mortality. We present a patient admitted to a medical intensive care unit with status epilepticus and recurrent positive blood cultures for organisms commonly associated with the gastrointestinal (GI) tract...
July 2015: Heart & Lung: the Journal of Critical Care
Tyler R Reese, Shad H Deering, Laurie B Kavanagh, Douglas M Maurer
BACKGROUND AND OBJECTIVES: Deployment away from regular clinical practice is necessary for Army family physicians, but no current information identifies specific procedures or clinical encounters where they feel less comfortable after deployment. This study identifies specific clinical areas and amount of perceived degradation in skills after deployment to combat zones. METHODS: Active duty Army family physicians were invited to participate in a web-based and anonymous survey rating comfort level performing clinical encounters or procedures prior to and after military deployment...
May 2015: Family Medicine
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