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https://www.readbyqxmd.com/read/29033819/an-unusual-presentation-of-pyoderma-gangrenosum-leading-to-systemic-inflammatory-response-syndrome
#1
Ali Didan, Alan Donnelly, Hock Chua
This is a report of an atypical presentation of pyoderma gangrenosum (PG) in a 26-year-old male who had a negative septic screen. The patient had a life-threatening presentation requiring an intensive care unit (ICU) admission for vasopressor support. It was thought that the likely cause of circulatory collapse was an overwhelming cytokine reaction or systemic inflammatory response syndrome (SIRS) secondary to extensive PG lesions rather than septic shock. The patient presented with multiple large ulcers, the largest being 4 cm in diameter on the central chest...
September 2017: Case Reports in Dermatology
https://www.readbyqxmd.com/read/29023988/molecular-dynamics-simulation-binding-free-energy-calculation-and-unbinding-pathway-analysis-on-selectivity-difference-between-fkbp51-and-fkbp52-insight-into-the-molecular-mechanism-of-isoform-selectivity
#2
Danfeng Shi, Qifeng Bai, Shuangyan Zhou, Xuewei Liu, Huanxiang Liu, Xiaojun Yao
As co-chaperones of the 90-kDa heat shock protein(HSP90), FK506 binding protein 51 (FKBP51) and FK506 binding protein 52 (FKBP52) modulate the maturation of steroid hormone receptor through their specific FK1 domains (FKBP12-like domain 1). The inhibitors targeting FK1 domains are potential therapies for endocrine-related physiological disorders. However, the structural conservation of the FK1 domains between FKBP51 and FKBP52 make it difficult to obtain satisfactory selectivity in FK506-based drug design. Fortunately, a series of iFit ligands synthesized by Hausch et al exhibited excellent selectivity for FKBP51, providing new opportunity for design selective inhibitors...
October 12, 2017: Proteins
https://www.readbyqxmd.com/read/28980027/-insertional-achilles-tendinopathy-differentiated-diagnostics-and-therapy
#3
REVIEW
S F Baumbach, M Braunstein, M G Mack, F Maßen, W Böcker, S Polzer, H Polzer
Achilles tendinopathy at the calcaneal insertion is classified into insertional tendinopathy, retrocalcaneal and superficial bursitis. The aim of this study was to present the current evidence on conservative and surgical treatment of insertional tendinopathy of the Achilles tendon. Conservative first-line therapy includes reduction of activity levels, administration of non-steroidal anti-inflammatory drugs (NSAID), adaptation of footwear, heel wedges and orthoses or immobilization. In addition, further conservative therapy options are also available...
October 4, 2017: Der Unfallchirurg
https://www.readbyqxmd.com/read/28971652/-the-morbidity-and-mortality-of-influenza-patients-treated-at-rambam-medical-center-intensive-care-unit-in-the-years-2009-2014
#4
Yaron Bar-Lavie, Khetam Hussein, Ami Mayo, Daniel King, Zipi Kra-Oz, Michal Paul
INTRODUCTION: Data regarding the characteristics and results of the treatment of patients hospitalized in intensive care units (ICUs) with influenza in Israel are limited. AIMS: We evaluated the characteristics and outcomes of patients treated at Rambam Medical Center at the adult department of critical care medicine for influenza between the years 2009-2014. METHODS: A retrospective cohort study was conducted. Patients were detected by laboratory reports and data were extracted from electronic medical records...
September 2017: Harefuah
https://www.readbyqxmd.com/read/28954408/history-and-outcome-of-febrile-neutropenia-outside-the-oncology-setting-a-retrospective-study-of-76-cases-related-to-non-chemotherapy-drugs
#5
Emmanuel Andrès, Rachel Mourot-Cottet, Frédéric Maloisel, Olivier Keller, Thomas Vogel, François Séverac, Martine Tebacher, Jacques-Eric Gottenberg, Jean-Christophe Weber, Georges Kaltenbach, Bernard Goichot, Jean Sibilia, Anne-Sophie Korganow, Raoul Herbrecht
BACKGROUND: Despite major advances in its prevention and treatment, febrile neutropenia remains a most concerning complication of cancer chemotherapy. Outside the oncology setting, however, only few data are currently available on febrile neutropenia related to non-chemotherapy drugs. We report here data on 76 patients with febrile neutropenia related to non-chemotherapy drugs, followed up in a referral center within a university hospital. PATIENTS AND METHODS: Data from 76 patients with idiosyncratic drug-induced febrile neutropenia were retrospectively reviewed...
September 26, 2017: Journal of Clinical Medicine
https://www.readbyqxmd.com/read/28941540/adjunctive-steroid-therapy-for-treatment-of-pediatric-septic-shock
#6
REVIEW
Jerry J Zimmerman
Septic shock remains the major cause of childhood morbidity and mortality worldwide. Although early sepsis recognition, fluid resuscitation, timely administration of antimicrobials, and vasoactive-inotropic drug infusions are all key to achieving good sepsis outcomes, therapy using various steroid drug classes remains an attractive adjunctive intervention to minimize the duration of septic shock and transition to multiple organ dysfunction syndrome. All steroid drug classes possess biological plausibility to affect a beneficial clinical effect among children with septic shock, but none has undergone rigorous, prospective assessment in a large, high-quality pediatric interventional trial...
October 2017: Pediatric Clinics of North America
https://www.readbyqxmd.com/read/28918911/mortality-of-severe-septic-patients-between-physician-s-high-and-low-care-volumes
#7
Chun-Yao Lin, Jo-Chi Tseng, Chih-Yu Huang, Chien-Ming Chu, Huang-Pin Wu
BACKGROUND: Patients with severe sepsis frequently require intensive care unit (ICU) admission and different ICU care models may influence their outcomes. The mortality of severe septic patients between physician's high and low care volume remains unclear. METHODS: We analyzed the data from a three-year prospective observation study, which was performed in an adult medical ICU of Chung Gung Memorial Hospital, Keelung. The data included initial bundle therapies based on the Surviving Sepsis Campaign (SSC) guidelines for patients with severe sepsis...
August 2017: Biomedical Journal
https://www.readbyqxmd.com/read/28916121/controversies-in-corticosteroid-use-for-sepsis
#8
Brit Long, Alex Koyfman
BACKGROUND: Severe sepsis and septic shock are potentially deadly conditions managed in the emergency department (ED). Management centers on source control, fluid resuscitation, broad-spectrum antimicrobials, and vasopressors as needed. The use of corticosteroids is controversial. OBJECTIVE: To evaluate the evidence behind corticosteroid therapy in patients with septic shock. DISCUSSION: Septic shock is associated with severe mortality and morbidity...
September 12, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28899001/a-role-for-autoantibodies-in-atherogenesis
#9
Rosebella A Iseme, Mark McEvoy, Brian Kelly, Linda Agnew, Frederick R Walker, Tonelle Handley, Christopher Oldmeadow, John Attia, Michael Boyle
An increased risk of cardiovascular disease (CVD) has long been recognized amongst people with autoimmune disease. It has been unclear whether this is due mainly to the ensuing treatment, particularly steroids, or whether some of this risk is due to the autoimmune process itself with subsequent inflammation. Indeed, a large body of evidence supports a role for chronic inflammation in atherogenesis, and autoantibodies have been identified as mediators in this complex inflammatory environment. Our aim is to carry out a systematic review of existing literature in order to formally establish the strength of the association between autoantibodies and atherosclerosis, amongst individuals without clinical autoimmune disease...
August 1, 2017: Cardiovascular Research
https://www.readbyqxmd.com/read/28879710/heat-shock-protein-90-alpha-lass-b-member-1-a-key-regulative-gene-of-monitoring-duodenal-tumor-for-obesity-induced-by-high-fat-diet
#10
Li Zheng, Jie Bai, Jin-Ling Zhang, Xia Meng, Yan-Na Hao
BACKGROUND: Effective methods of preventing and treating duodenal carcinoma, especially cancer induced by obesity (resulting from a high-fat diet) remains a longstanding challenge in medicine. METHODS: With regard to the objective, key genes were explored in the evolutional process in a group of normal, obese (high-fat diet), and duodenal tumor mice. Here, 23 genes were selected by the bioinformatics method. In order to correct the result, verification experiments were performed twice through online analysis...
September 1, 2017: Clinical Laboratory
https://www.readbyqxmd.com/read/28853293/predictors-of-vasopressin-responsiveness-in-critically-ill-adults
#11
Brittainy Allen, Bridgette Kram, Shawn Kram, Jennifer Schultheis, Steven Wolf, Daniel Gilstrap, Mark Shapiro
BACKGROUND: Vasopressin is commonly used as an adjunct vasopressor in shock. However, response to vasopressin varies among critically ill patients. OBJECTIVE: To identify patient-specific factors that are associated with vasopressin responsiveness in critically ill adults. METHODS: This retrospective, multicenter study included adult patients who were admitted to an intensive care unit (ICU) and received vasopressin for shock. Patients were excluded if they received vasopressin for less than 30 minutes, if vasopressin was initiated prior to ICU arrival, or if an additional vasopressor was initiated within 30 minutes of starting vasopressin...
August 1, 2017: Annals of Pharmacotherapy
https://www.readbyqxmd.com/read/28814247/fluid-and-medication-considerations-in-the-traumatized-patient
#12
Amita Misir
This article reviews fluid therapy and medications in pediatric trauma. For resuscitation in the setting of hemorrhagic shock, isotonic crystalloid solution is the first-line agent of choice. Colloid solutions offer no additional benefit, introduce possible increased risks and cost more than crystalloids. Blood products, starting with pRBCs, should be introduced after 20-40 ml/kg of crystalloid has been administered if there is ongoing need for volume replacement. The use of a massive transfusion protocol of 1:1:1 (if >30 kg) or 30:20:20 (if <30 kg) of pRBCs:FFP:platelets is suggested after an initial 30 ml/kg of pRBcs have been administered...
August 14, 2017: Current Pediatric Reviews
https://www.readbyqxmd.com/read/28813523/et-26-hydrochloride-et-26-hcl-has-similar-hemodynamic-stability-to-that-of-etomidate-in-normal-and-uncontrolled-hemorrhagic-shock-uhs-rats
#13
Bin Wang, Shouming Chen, Jun Yang, Linghui Yang, Jin Liu, Wensheng Zhang
OBJECTIVE: ET-26 HCl is a promising sedative-hypnotic anesthetic with virtually no effect on adrenocortical steroid synthesis. However, whether or not ET-26 HCl also has a sufficiently wide safety margin and hemodynamic stability similar to that of etomidate and related compounds remains unknown. In this study, the effects of ET-26 HCl, etomidate and propofol on therapeutic index, heart rate (HR), mean arterial pressure (MAP), maximal rate for left ventricular pressure rise (Dmax/t), and maximal rate for left ventricular pressure decline (Dmin/t) were investigated in healthy rats and a rat model of uncontrolled hemorrhagic shock (UHS)...
2017: PloS One
https://www.readbyqxmd.com/read/28768672/an-illusion-of-septic-shock-acute-generalised-exanthematous-pustulosis-with-multiorgan-dysfunction
#14
Manisha Jakkidi, Carine Basmadjian, Satyajeet Roy
Acute generalised exanthematous pustulosis (AGEP) is a rare cutaneous eruption, most often caused by commonly used antibiotics. It is characterised by an acute onset of non-follicular sterile pustular rash and erythema within hours or days of drug exposure and usually resolves spontaneously within 1-2 weeks once the drug is discontinued. Haemodynamic involvement in the form of shock is rare. Here, we present a severe case of AGEP, manifesting with systemic involvement and haemodynamic instability resulting in shock with multiorgan dysfunction...
August 2, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28744308/recent-pathophysiological-aspects-of-peyronie-s-disease-role-of-free-radicals-rationale-and-therapeutic-implications-for-antioxidant-treatment-literature-review
#15
REVIEW
Gianni Paulis, Gennaro Romano, Luca Paulis, Davide Barletta
Peyronie's disease (PD) is a chronic inflammation of tunica albuginea of the corpora cavernosa that causes an inelastic plaque resulting in penis deformation. Although its etiology is not completely known, there is general consensus that PD is genetically transmitted and secondary to penile trauma. In recent years, numerous studies demonstrated the role played by oxidative stress in PD pathogenesis, and other studies have described successful use of antioxidants in PD treatment. Oxidative stress is an integral part of this disease, influencing its progression...
2017: Advances in Urology
https://www.readbyqxmd.com/read/28739362/stroke-in-ehlers-danlos-syndrome-kyphoscoliotic-type-dissection-or-vasculitis
#16
Annegret Quade, Martin Wiesmann, Joachim Weis, Ingo Kurth, Houman Jalaie, Marianne Rohrbach, Martin Häusler
BACKGROUND: Patients with the kyphoscoliotic type of Ehlers-Danlos syndrome have an increased risk of vascular complications such as aortic dissection and perforation. Cerebral ischemia has only rarely been documented. PATIENT DESCRIPTION: This 13-year-old girl with the kyphoscoliotic type of Ehlers-Danlos syndrome experienced a large right middle cerebral artery distribution infarction. Full intravenous heparinization was started in response to presumed arterial dissection...
September 2017: Pediatric Neurology
https://www.readbyqxmd.com/read/28737623/an-observational-study-of-severe-pertussis-in-100-infants-%C3%A2-120-days-of-age
#17
James D Cherry, Kristen Wendorf, Brooke Bregman, Deborah Lehman, Delma Nieves, John S Bradley, Wilbert H Mason, Linette Sande-Lopez, Merrick Lopez, Myke Federman, Tempe Chen, Dean Blumberg, Samantha Johnston, Hayden T Schwenk, Peggy Weintrub, Kevin K Quinn, Kathleen Winter, Kathleen Harriman
BACKGROUND: Pertussis in young infants is a unique, severe, afebrile, cough illness that is frequently fatal. METHODS: All pertussis cases ≤ 120 days of age admitted to a pediatric intensive care unit (PICU) in California between October 1, 2013 and April 25, 2015 were evaluated. RESULTS: Of 100 pertussis patients ≤ 120 days of age admitted to PICU's, there were 5 deaths. The white blood cell (WBC) counts in the fatal cases were significantly higher than in the non-fatal cases...
July 20, 2017: Pediatric Infectious Disease Journal
https://www.readbyqxmd.com/read/28721327/two-catastrophes-in-one-patient-drug-reaction-with-eosinophilia-and-systemic-symptoms-and-toxic-shock-syndrome
#18
Moayed Ibrahim, Diana L Nunley
A 70-year-old, immunocompromised patient presented to the emergency room (ER) five weeks after she was started on clopidogrel. She complained of skin eruption, mouth ulcers, fatigue, and myalgia over the past two weeks. Labs showed severe hyponatremia, acute kidney injury, rhabdomyolysis, hyperkalemia, and elevated liver enzymes. She was treated with steroids and discharged after her condition improved. However, a month later, she returned to the ER, complaining of nausea, vomiting, diarrhea, dizziness, chills, and shortness of breath over the past two days...
June 15, 2017: Curēus
https://www.readbyqxmd.com/read/28719870/effects-of-endocrine-disrupting-chemicals-on-estrogen-receptor-alpha-and-heat-shock-protein-60-gene-expression-in-primary-cultures-of-loggerhead-sea-turtle-caretta-caretta-erythrocytes
#19
Paolo Cocci, Martina Capriotti, Gilberto Mosconi, Francesco Alessandro Palermo
The loggerhead turtle (Caretta caretta) can be considered a good indicator species for studying the ecological impact of endocrine disrupting chemicals (EDCs) on wildlife. However, the effect of these environmental pollutants on nuclear steroid hormone signaling has not yet been addressed in sea turtles mainly due to the legal constraints of their endangered status. Here we describe the use of primary erythrocyte cell cultures as in vitro models for evaluating the effects of different EDCs on the expression of estrogen receptor α (ERα)...
October 2017: Environmental Research
https://www.readbyqxmd.com/read/28716363/clinical-outcomes-and-prognostic-factors-of-patients-with-severe-influenza-receiving-intravenous-peramivir-salvage-therapy-in-intensive-care-units
#20
Ching-Yuan Yeh, Fu-Der Wang, Yu-Chung Chuang, Chia-Jui Yang, Shiang-Fen Huang, Wen-Sung Weng, Chun-Hsin Liaw, Wang-Huei Sheng
BACKGROUND: Few studies have investigated patients with severe influenza who receive intravenous peramivir for salvage therapy. METHODS: We retrospectively analyzed data from 71 patients with severe influenza who received intravenous peramivir therapy in the intensive care units of three medical centers between 2012 and 2016. All patients received oseltamivir or zanamivir before the administration of peramivir. RESULTS: A total of 44 men and 27 women with a median age of 55 years were enrolled...
June 26, 2017: Journal of Microbiology, Immunology, and Infection, Wei Mian Yu Gan Ran za Zhi
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