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https://www.readbyqxmd.com/read/28806049/electrolytes-oral-electrolyte-solutions
#1
Lisa Harris
Oral electrolyte solutions are used widely for rehydration in diarrheal illness and to maintain hydration during vigorous exercise. In diarrheal illness, an oral rehydration solution (ORS) typically is preferred over intravenous fluids except for patients with severe dehydration. The preferred ORS is one similar to the glucose-containing reduced osmolarity World Health Organization ORS. There also are polymer-based solutions that use rice or wheat as the source of carbohydrates but these are not widely recommended...
August 2017: FP Essentials
https://www.readbyqxmd.com/read/28806046/electrolytes-sodium-disorders
#2
Michael M Braun, Megan Mahowald
Sodium disorders (ie, hyponatremia, hypernatremia) are common electrolyte disturbances in clinical medicine and are associated with increased rates of morbidity and mortality. Etiologies of hyponatremia are classified into four categories. The first is pseudohyponatremia, in which the sodium level is low due to hyperproteinemia, hyperlipidemia, or hyperglycemia. The other three categories are based on overall patient fluid status and include hypovolemic (commonly due to fluid loss), hypervolemic (commonly due to fluid retention from heart failure, cirrhosis, or renal failure), and euvolemic (most often because of syndrome of inappropriate secretion of antidiuretic hormone)...
August 2017: FP Essentials
https://www.readbyqxmd.com/read/28803996/perioperative-hemodynamics-and-outcomes-of-patients-on-metyrosine-undergoing-resection-of-pheochromocytoma-or-paraganglioma
#3
James J Butz, Toby N Weingarten, Alexandre N Cavalcante, Irina Bancos, William F Young, Travis J McKenzie, Darrell R Schroeder, David P Martin, Juraj Sprung
INTRODUCTION: To describe outcomes of patients with metyrosine (MET) pretreatment for abdominal surgical resection of pheochromocytoma or paraganglioma (PCC/PGL) compared with patients who had phenoxybenzamine (PBZ) pretreatment. METHODS: Retrospective review of perioperative outcomes for PCC/PGL patients treated with MET and propensity-matched comparison of MET and PBZ (MET + PBZ) with PBZ alone. RESULTS: MET preparation was given in 63 cases (26 laparoscopic and 37 open, of which 55 also received PBZ)...
August 10, 2017: International Journal of Surgery
https://www.readbyqxmd.com/read/28802766/a-phase-i-trial-of-intraperitoneal-gen-1-an-il-12-plasmid-formulated-with-peg-pei-cholesterol-lipopolymer-administered-with-pegylated-liposomal-doxorubicin-in-patients-with-recurrent-or-persistent-epithelial-ovarian-fallopian-tube-or-primary-peritoneal-cancers
#4
REVIEW
Premal H Thaker, William E Brady, Heather A Lankes, Kunle Odunsi, William H Bradley, Kathleen N Moore, Carolyn Y Muller, Khursheed Anwer, Russell J Schilder, Ronald D Alvarez, Paula M Fracasso
OBJECTIVE: The study's purpose was to assess safety and efficacy of escalating doses of weekly GEN-1 with pegylated liposomal doxorubicin (PLD) in patients with recurrent or persistent epithelial ovarian, fallopian tube or primary peritoneal cancers (EOC). METHODS: Patients had persistent or recurrent platinum-resistant EOC. The trial was a standard 3+3 phase I dose escalation design with patients receiving intravenous PLD 40mg/m(2) (dose level 1 and 2) or 50mg/m(2) (dose level 3) every 28days and intraperitoneal GEN-1 at 24mg/m(2) (dose level 1) or 36mg/m(2) (dose level 2 and 3) on days 1, 8, 15, and 22 of a 28day cycle...
August 9, 2017: Gynecologic Oncology
https://www.readbyqxmd.com/read/28795486/a-reassessment-of-the-blood-brain-barrier-transport-of-large-neutral-amino-acids-during-acute-systemic-inflammation-in-humans
#5
Rasmus H Dahl, Ronan M G Berg, Sarah Taudorf, Damian M Bailey, Carsten Lundby, Fin S Larsen, Kirsten Møller
We reassessed data from a previous study on the transcerebral net exchange of large neutral amino acids (LNAAs) using a novel mathematical model of blood-brain barrier (BBB) transport. The study included twelve healthy volunteers who received a 4-h intravenous lipopolysaccharide (LPS) infusion (total dose: 0·3 ng/kg), a human experimental model of the systemic inflammatory response during the early stages of sepsis. Cerebral blood flow and arterial-to-jugular venous LNAA concentrations were measured prior to and after LPS, and the BBB transport and brain extracellular concentrations of LNAAs were calculated...
August 9, 2017: Clinical Physiology and Functional Imaging
https://www.readbyqxmd.com/read/28794842/mega-acer-kit%C3%A2-is-more-effective-for-warming-the-intravenous-fluid-than-ranger%C3%A2-and-thermosens%C3%A2-at-440-ml-h-of-infusion-rate-an-experimental-performance-study
#6
Dong Joon Kim, Sang Hun Kim, Keum Young So, Tae Hun An
BACKGROUND: Few studies have investigated the effectiveness of intravenous fluid warmers at low and moderate flow rates below 1,000 ml/h. In this study, we compared the effectiveness of three different fluid warmers at a low flow rate (440 ml/h). METHODS: We experimentally investigated the fluid warming performances of Mega Acer Kit® (Group M, n = 10), Ranger™ (Group R, n = 10), and ThermoSens® (Group T, n = 10) at 440 ml/h for 60 min. All devices were set at a warming temperature of 41℃ with preheating for 10 min...
August 2017: Korean Journal of Anesthesiology
https://www.readbyqxmd.com/read/28794282/partial-efficacy-of-a-broadly-neutralizing-antibody-against-cell-associated-shiv-infection
#7
Matthew S Parsons, Sarah B Lloyd, Wen Shi Lee, Anne B Kristensen, Thakshila Amarasena, Rob J Center, Brandon F Keele, Jeffrey D Lifson, Celia C LaBranche, David Montefiori, Bruce D Wines, P Mark Hogarth, Kristine M Swiderek, Vanessa Venturi, Miles P Davenport, Stephen J Kent
Broadly neutralizing antibodies (BnAbs) protect macaques from cell-free simian/human immunodeficiency virus (SHIV) challenge, but their efficacy against cell-associated SHIV is unclear. Virus in cell-associated format is highly infectious, present in transmission-competent bodily fluids, and potentially capable of evading antibody-mediated neutralization. The PGT121 BnAb, which recognizes an epitope consisting of the V3 loop and envelope glycans, mediates antibody-dependent cellular cytotoxicity and neutralization of cell-to-cell HIV-1 transmission...
August 9, 2017: Science Translational Medicine
https://www.readbyqxmd.com/read/28794087/euglycaemic-ketoacidosis-a-potential-new-hazard-to-plastic-surgery-day-case-and-inpatient-procedures
#8
Aseel Sleiwah, Michael McBride, Claire E Black
A woman aged 44 underwent elective standard abdominoplasty and bilateral mastopexy (superiorly based pedicle with vertical scar) following weight loss of 8.5 stone (53.9 kg) over a 5-year period. She had type 2 diabetes and her antidiabetic medications included metformin, liraglutide and empagliflozin. Towards the end of the first postoperative day, she reported gradual onset of nausea, vomiting and abdominal pain. Her condition continued to deteriorate overnight, becoming tachycardic and tachypnoeic. Urgent investigations showed severe diabetic ketoacidosis with euglycaemia...
August 9, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28792295/medical-care-at-a-large-vertical-running-event
#9
Christopher J Nash, Christopher T Richards, Gina Schwieger, Sanjeev Malik, George T Chiampas
OBJECTIVE: Vertical running events, during which participants race up the stairwells of skyscrapers, are becoming increasingly popular. Such events have unique and specific operational and clinical considerations for event medical directors, but descriptions of the medical care provided at these events are lacking. We sought to perform a descriptive analysis of the medical care delivered at a single, large vertical running event. METHODS: A retrospective chart review of medical encounters at a large vertical running event from 2011-2017 was performed...
August 9, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28792258/utilization-of-intravenous-catheters-by-prehospital-providers-during-pediatric-transports
#10
Timothy VanderKooy, Kelsey Spaur, Lina Brou, Sean Caffrey, Kathleen M Adelgais
INTRODUCTION: Prehospital intravenous (IV) access in children may be difficult and time-consuming. Emergency Medical Service (EMS) protocols often dictate IV placement; however, some IV catheters may not be needed. The scene and transport time associated with attempting IV access in children is unknown. The objective of this study is to examine differences in scene and transport times associated with prehospital IV catheter attempt and utilization patterns of these catheters during pediatric prehospital encounters...
August 9, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28790256/-safe-handling-of-hazardous-drugs-in-nursing-practice
#11
Kazue Hirai
Handling of hazardous drugs in nursing practice, there are risks of a wide variety of occupational exposures such as drug administration, management of spills, care of patients after administration, etc. Using a general infusion set for intravenous administration, there are risk of exposure such as scattering when the bottle needle is spiked into the infusion bag, leakage when priming the infusion line with antineoplastic drug, spillage when removing the side tube. For intravenous administration, use of CSTD for administration is most effective, but in many facilities, a general infusion set is used due to cost considerations...
July 2017: Gan to Kagaku Ryoho. Cancer & Chemotherapy
https://www.readbyqxmd.com/read/28790092/abdominal-aortic-aneurysm-in-the-setting-of-clostridium-perfringens-pancreatitis
#12
Paul Anthony Karam, Maitham A Moslim, Woosup Michael Park, Gareth Morris-Stiff
We report a case of a 56-year-old woman who presented with worsening abdominal pain located in the left upper quadrant together with abdominal distention, nausea and anorexia. One month prior to this admission, she had presented and had been diagnosed with concurrent acute pancreatitis and rapidly expanding abdominal aortic aneurysm. The aneurysm was prioritised over the pancreatitis and she underwent uncomplicated endovascular repair. Cross-sectional imaging was consistent with infected pancreatic necrosis and also revealed a large collection located in the anterior pararenal space with extensive gas formation...
August 7, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28789803/preliminary-performance-on-the-new-cms-sepsis-1-national-quality-measure-early-insights-from-the-emergency-quality-network-e-qual
#13
Arjun K Venkatesh, Todd Slesinger, Jessica Whittle, Tiffany Osborn, Emily Aaronson, Craig Rothenberg, Nalani Tarrant, Pawan Goyal, Donald M Yealy, Jeremiah D Schuur
STUDY OBJECTIVE: We describe current hospital-level performance for the Centers for Medicare & Medicaid Services' Severe Sepsis/Septic Shock Early Management Bundle (SEP-1) quality measure and qualitatively assess emergency department (ED) sepsis quality improvement best practice implementation. METHODS: Using a standardized Web-based submission portal, we surveyed quality improvement data from volunteer hospital-based EDs participating in the Emergency Quality Network Sepsis Initiative...
August 5, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28782112/lower-vs-higher-fluid-volumes-in-sepsis-protocol-for-a-systematic-review-with-meta-analysis
#14
T S Meyhoff, M H Møller, P B Hjortrup, M Cronhjort, A Perner, J Wetterslev
BACKGROUND: Intravenous fluid administration with crystalloids is recommended in the initial management of sepsis. However, the quality of evidence supporting the recommendation on fluid volumes is low, and clinical equipoise exists. Potential benefits of restricting fluid volumes has been suggested, but the overall benefit or harm in patients with sepsis is unknown. Accordingly, we aim to assess patient-important benefits and harms of lower vs. higher fluid volumes in resuscitation of adult patients with sepsis...
September 2017: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/28780040/long-term-direct-visualization-of-passively-transferred-fluorophore-conjugated-antibodies
#15
Jeffrey R Schneider, Ann M Carias, Arangaserry R Bastian, Gianguido C Cianci, Patrick F Kiser, Ronald S Veazey, Thomas J Hope
The use of therapeutic antibodies, delivered by intravenous (IV) instillation, is a rapidly expanding area of biomedical treatment for a variety of conditions. However, little is known about how the antibodies are anatomically distributed following infusion and the underlying mechanism mediating therapeutic antibody distribution to specific anatomical sites remains to be elucidated. Current efforts utilize low resolution and sensitivity methods such as ELISA and indirect labeling imaging techniques, which often leads to high background and difficulty in assessing biodistribution...
August 2, 2017: Journal of Immunological Methods
https://www.readbyqxmd.com/read/28777862/-abcc8-gene-analysis-treatment-and-follow-up-of-an-infant-with-neonatal-diabetes-mellitus
#16
Hong Chen, Ruimin Chen, Xin Yuan, Xiaohong Yang, Shijun Chen
OBJECTIVE: To analyze the clinical characteristics of an infant with neonatal diabetes mellitus (NDM) and to sequence the ABCC8 gene of this family in order to provide a theoretical basis for the diagnosis and treatment. METHODS: The clinical data of the patient was collected, and the proband and his direct relatives within three generations were sequenced. RESULTS: The patient was 1-month-old, random blood glucose was more than 27.8 mmol/L, C-peptide was 33...
August 10, 2017: Zhonghua Yi Xue Yi Chuan Xue za Zhi, Zhonghua Yixue Yichuanxue Zazhi, Chinese Journal of Medical Genetics
https://www.readbyqxmd.com/read/28776532/etiology-and-outcome-of-moderate-to-massive-hemoptysis-experience-from-a-tertiary-care-center-of-north-india
#17
Ashish Bhalla, Ashok Kumar Pannu, Vikas Suri
BACKGROUND: The aim of this study was to evaluate the etiology of hemoptysis in patients presenting to emergency department of Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. METHOD: Prospectively 110 patients presenting to the emergency department with history of hemoptysis were screened for a period of one and half years. Out of these, 64 patients having true hemoptysis were enrolled in the study. The patients were clinically evaluated with detailed history...
July 2017: International Journal of Mycobacteriology
https://www.readbyqxmd.com/read/28770093/the-clinical-practice-guideline-for-the-management-of-ards-in-japan
#18
Satoru Hashimoto, Masamitsu Sanui, Moritoki Egi, Shinichiro Ohshimo, Junji Shiotsuka, Ryutaro Seo, Ryoma Tanaka, Yu Tanaka, Yasuhiro Norisue, Yoshiro Hayashi, Eishu Nango
BACKGROUND: The Japanese Society of Respiratory Care Medicine and the Japanese Society of Intensive Care Medicine provide here a clinical practice guideline for the management of adult patients with ARDS in the ICU. METHOD: The guideline was developed applying the GRADE system for performing robust systematic reviews with plausible recommendations. The guideline consists of 13 clinical questions mainly regarding ventilator settings and drug therapies (the last question includes 11 medications that are not approved for clinical use in Japan)...
2017: Journal of Intensive Care
https://www.readbyqxmd.com/read/28769863/application-of-texture-analysis-to-study-small-vessel-disease-and-blood-brain-barrier-integrity
#19
Maria Del C Valdés Hernández, Victor González-Castro, Francesca M Chappell, Eleni Sakka, Stephen Makin, Paul A Armitage, William H Nailon, Joanna M Wardlaw
OBJECTIVES: We evaluate the alternative use of texture analysis for evaluating the role of blood-brain barrier (BBB) in small vessel disease (SVD). METHODS: We used brain magnetic resonance imaging from 204 stroke patients, acquired before and 20 min after intravenous gadolinium administration. We segmented tissues, white matter hyperintensities (WMH) and applied validated visual scores. We measured textural features in all tissues pre- and post-contrast and used ANCOVA to evaluate the effect of SVD indicators on the pre-/post-contrast change, Kruskal-Wallis for significance between patient groups and linear mixed models for pre-/post-contrast variations in cerebrospinal fluid (CSF) with Fazekas scores...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/28769592/drug-induced-dyspnea-versus-cystic-fibrosis-exacerbation-a-diagnostic-dilemma
#20
Saqib Walayat, Nooreen Hussain, Jaymon Patel, Faiz Hussain, Preeti Patel, Sonu Dhillon, Bhagat Aulakh, Subramanyam Chittivelu
Cystic fibrosis (CF) is a disease caused by a mutation in the cystic fibrosis transmembrane conductance regulator protein in the epithelial membrane, and affects at least 30,000 people in the USA. There are between 900 and 1000 new cases diagnosed every year. Traditionally, CF has been treated symptomatically with pancreatic enzymes, bronchodilators, hypertonic saline, and pulmozyme. In July 2015, the US Food and Drug Administration approved Orkambi (lumacaftor/ivacaftor), a combination drug that works on reversing the effects of the defective cystic fibrosis transmembrane conductance regulator protein...
2017: International Medical Case Reports Journal
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