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https://www.readbyqxmd.com/read/28904677/-pulmonary-nocardiosis-in-immunocompetent-patients-about-2-cases
#1
Yasmina Rhofir, Rachida Zahraoui, Nabil Tiress, Hicham Naji-Amrani, Mouna Soualhi, Jamal Eddine Bourkadi
Nocardiosis is a rare but severe infection caused by bacteria of the genus nocardia, which belong to the order actinomycetales. If they can affect immunocompetent adult, nocardioses are pathologies affecting the individuals with weakened immune system. Pulmonary involvement is the most common manifestation, its correct management is based on diagnosis, which is often delayed due to non-specific symptoms and inconclusive specimens. We here report two cases of nocardiosis in immunocompetent patients. The first case concerns a 24-year old man with a history of smoking and alcoholism, hospitalized for chest pain and hemoptysis of low abundance evolving for two months, associated with the occurrence of dorsal subcutaneous fistulized abscess...
2017: Pan African Medical Journal
https://www.readbyqxmd.com/read/28888269/depression-is-associated-with-recurrent-chest-pain-with-or-without-coronary-artery-disease-a-prospective-cohort-study-in-the-emergency-department
#2
Yeunjung Kim, Morgan Soffler, Summer Paradise, Qurat-Ul-Ain Jelani, James Dziura, Rajita Sinha, Basmah Safdar
BACKGROUND: Only a small fraction of acute chest pain in the emergency department (ED) is due to obstructive coronary artery disease (CAD). ED chest pain remains associated with high rates of recidivism, often in the presence of nonobstructive CAD. Psychological states such as depression, anxiety, and elevation of perceived stress may account for this finding. The objective of the study was to determine whether psychological states predict recurrent chest pain (RCP). METHODS: We conducted a prospective cohort study of low- to moderate-cardiac risk ED patients admitted to the Yale Chest Pain Center with acute chest pain...
September 2017: American Heart Journal
https://www.readbyqxmd.com/read/28871936/xanthoma-like-skin-changes-in-an-elderly-woman-with-a-normal-lipid-profile
#3
Piotr Nockowski, Zdzisław Woźniak, Adam Reich, Joanna Maj
Dear Editor, An 83-year-old woman developed yellow-brownish infiltrates, nodules, and tumors mimicking xanthomas, mostly involving the periorbital and chest area within three months (Figure 1). She had no abnormalities in serum cholesterol or triglycerides levels. A detailed laboratory analysis revealed the presence of mild monoclonal gammopathy with a presence of immunoglobulin G (IgG) kappa light chains; however, according to hematologist consultation, it did not require medical intervention. Imaging assessment and ultrasound examination did not show any specific involvement of internal organs...
July 2017: Acta Dermatovenerologica Croatica: ADC
https://www.readbyqxmd.com/read/28870847/bundle-of-care-for-blunt-chest-trauma-patients-improves-analgesia-but-increases-rates-of-intensive-care-unit-admission-a-retrospective-case-control-study
#4
Cédric Carrie, Laurent Stecken, Elsa Cayrol, Vincent Cottenceau, Laurent Petit, Philippe Revel, Matthieu Biais, François Sztark
INTRODUCTION: This single-centre retrospective case-control study aimed to assess the effectiveness of a multidisciplinary clinical pathway for blunt chest trauma patients admitted in emergency department (ED). PATIENTS AND METHODS: All consecutive blunt chest trauma patients with more than 3 rib fractures and no indication of mechanical ventilation were compared to a retrospective cohort over two 24-month periods, before and after the introduction of the bundle of care...
September 1, 2017: Anaesthesia, Critical Care & Pain Medicine
https://www.readbyqxmd.com/read/28864718/assessment-of-the-2016-national-institute-for-health-and-care-excellence-high-sensitivity-troponin-rule-out-strategy
#5
Edward Watts Carlton, John William Pickering, Jaimi Greenslade, Louise Cullen, Martin Than, Jason Kendall, Richard Body, William A Parsonage, Ahmed Khattab, Kim Greaves
OBJECTIVE: We aimed to evaluate the limit of detection of high-sensitivity troponin (hs-cTn) and Thrombolysis In Myocardial Infarction (TIMI) score combination rule-out strategy suggested within the 2016 National Institute for Health and Care Excellence (NICE) Chest Pain of Recent Onset guidelines and establish the optimal TIMI score threshold for clinical use. METHODS: A pooled analysis of adult patients presenting to the emergency department with chest pain and a non-ischaemic ECG, recruited into six prospective studies, from Australia, New Zealand and the UK...
September 1, 2017: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/28837757/systemic-antibiotics-for-treating-malignant-wounds
#6
REVIEW
Darshini A Ramasubbu, Valerie Smith, Fiona Hayden, Patricia Cronin
BACKGROUND: Malignant wounds are a devastating complication of cancer. They usually develop in the last six months of life, in the breast, chest wall or head and neck regions. They are very difficult to treat successfully, and the commonly associated symptoms of pain, exudate, malodour, and the risk of haemorrhage are extremely distressing for those with advanced cancer. Treatment and care of malignant wounds is primarily palliative, and focuses on alleviating pain, controlling infection and odour from the wound, managing exudate and protecting the surrounding skin from further deterioration...
August 24, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28835219/clinical-decision-making-and-health-related-quality-of-life-during-first-line-and-maintenance-therapy-in-patients-with-advanced-non-small-cell-lung-cancer-nsclc-findings-from-a-real-world-setting
#7
Monika Sztankay, Johannes Maria Giesinger, August Zabernigg, Elisabeth Krempler, Georg Pall, Wolfgang Hilbe, Otto Burghuber, Maximilian Hochmair, Gerhard Rumpold, Stephan Doering, Bernhard Holzner
BACKGROUND: Maintenance therapy (MT) with pemetrexed has been shown to improve overall and progression-free survival of patients with non-squamous non-small cell lung cancer (NSCLC), without impairing patients' health-related quality of life (HRQOL) substantially. Comprehensive data on HRQOL under real-life conditions are necessary to enable informed decision-making. This study aims to (1) assess HRQOL during first-line chemotherapy and subsequent MT and (2) record patients' and physicians' reasons leading to clinical decisions on MT...
August 23, 2017: BMC Cancer
https://www.readbyqxmd.com/read/28833993/high-fidelity-simulation-in-training-dental-students-for-medical-life-threatening-emergency
#8
E Roy, V E Quinsat, O Bazin, P Lesclous, C Lejus-Bourdeau
INTRODUCTION: Any dental surgeon may be faced with a critical life-threatening emergency situation. In our university, all students in dentistry receive a standard course on emergency first aid. The aim of this prospective, comparative, single-centre study was to determine whether additional training on a high-fidelity patient simulator would improve student performance. METHODS: After approval by an Ethical Committee and written informed consent, the students of the Simulation group (n=42) had full-scale high-fidelity training on a patient simulator SimMan 3G(™) (3 hours by six students)...
August 23, 2017: European Journal of Dental Education: Official Journal of the Association for Dental Education in Europe
https://www.readbyqxmd.com/read/28829884/effect-of-oral-prednisolone-on-symptom-duration-and-severity-in-nonasthmatic-adults-with-acute-lower-respiratory-tract-infection-a-randomized-clinical-trial
#9
RANDOMIZED CONTROLLED TRIAL
Alastair D Hay, Paul Little, Anthony Harnden, Matthew Thompson, Kay Wang, Denise Kendrick, Elizabeth Orton, Sara T Brookes, Grace J Young, Margaret May, Sandra Hollinghurst, Fran E Carroll, Harriet Downing, David Timmins, Natasher Lafond, Magdy El-Gohary, Michael Moore
Importance: Acute lower respiratory tract infection is common and often treated inappropriately in primary care with antibiotics. Corticosteroids are increasingly used but without sufficient evidence. Objective: To assess the effects of oral corticosteroids for acute lower respiratory tract infection in adults without asthma. Design, Setting, and Participants: Multicenter, placebo-controlled, randomized trial (July 2013 to final follow-up October 2014) conducted in 54 family practices in England among 401 adults with acute cough and at least 1 lower respiratory tract symptom not requiring immediate antibiotic treatment and with no history of chronic pulmonary disease or use of asthma medication in the past 5 years...
August 22, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28818210/clinical-use-of-high-sensitivity-cardiac-troponin-in-patients-with-suspected-myocardial-infarction
#10
REVIEW
Raphael Twerenbold, Jasper Boeddinghaus, Thomas Nestelberger, Karin Wildi, Maria Rubini Gimenez, Patrick Badertscher, Christian Mueller
High-sensitivity cardiac troponin (hs-cTn) assays have been used clinically by thousands of physicians in many countries throughout the world since their clinical introduction 7 years ago. In the early diagnosis of myocardial infarction (MI), beyond doubt, the most important indication of hs-cTn assays, these simple, inexpensive, and highly reproducible tools complement detailed clinical assessment including chest pain characteristics and the electrocardiogram. Hs-cTn assays for the first time allowed the precise quantification of cardiomyocyte injury around the 99th percentile and thereby substantially increased the accuracy of MI detection from blood obtained at presentation to the emergency department (ED)...
August 22, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/28802985/clinical-analysis-of-48-h-emergency-department-visit-post-outpatient-extracorporeal-shock-wave-lithotripsy-for-urolithiasis
#11
Chin-Heng Lu, Junne-Yih Kuo, Tzu-Ping Lin, Yi-Hsiu Huang, Hsiao-Jen Chung, William J S Huang, Howard H H Wu, Yen-Hwa Chang, Alex T L Lin, Kuang-Kuo Chen
BACKGROUND: Patients suffering from renal or ureteral stones can undergo significant discomfort, even when timely diagnosed and treated. The aim of this study was to assess the risk factors and safety of outpatient Extracorporeal Shock Wave Lithotripsy (ESWL) in the management of patients with renal or ureteral stones. METHODS: In this study, our cohort consisted of 844 outpatients who underwent outpatient ESWL treated between February 2012 and November 2014 at Taipei Veterans General Hospital...
August 9, 2017: Journal of the Chinese Medical Association: JCMA
https://www.readbyqxmd.com/read/28793384/factors-that-influence-care-priority-for-chest-pain-patients-using-the-manchester-triage-system
#12
Carine Lais Nonnenmacher, Ananda Ughini Bertoldo Pires, Vitor Monteiro Moraes, Amália de Fátima Lucena
AIMS AND OBJECTIVES: Analyze crucial factors for determining care priority for patients with acute myocardial infarction based on the Manchester Triage System. BACKGROUND: Triage is the first potentially critical step in the care of myocardial infarction patients. However, there are still very few studies on the factors interfering in the lack of care priority for these patients, impacting their treatment and prognosis. DESIGN: Retrospective cohort study with 217 patients in the emergency department of a Brazilian hospital...
August 9, 2017: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/28776131/pure-distraction-injury-of-t1-2-with-quad-fever
#13
Jun-Yeong Seo, Chae-Moon Lim, Young-Hoon Kim, Kee-Yong Ha
INTRODUCTION: We report a pure distraction injury of the upper thoracic spine and uncontrolled hyperthermia without an infectious cause. Quad fever appears in the first several weeks to months after a cervical or upper thoracic SCI and is characterized by an extreme elevation in body core temperature beyond 40 °C without an infectious cause. Discriminating between infectious and noninfectious causes is important, and a thorough clinical assessment is required. MATERIALS AND METHODS: A 52-year-old male visited the emergency room complaining of back pain with complete paralysis [American Spinal Injury Association (ASIA) A] of both lower extremities after a pedestrian-motor vehicle accident...
August 3, 2017: European Spine Journal
https://www.readbyqxmd.com/read/28763554/does-this-child-have-pneumonia-the-rational-clinical-examination-systematic-review
#14
REVIEW
Sonal N Shah, Richard G Bachur, David L Simel, Mark I Neuman
Importance: Pneumonia is a leading cause of morbidity and mortality in children. It is important to identify the clinical symptoms and physical examination findings associated with pneumonia to improve timely diagnosis, prevent significant morbidity, and limit antibiotic overuse. Objective: To systematically review the accuracy of symptoms and physical examination findings in identifying children with radiographic pneumonia. Data Sources and Study Selection: MEDLINE and Embase (1956 to May 2017) were searched, along with reference lists from retrieved articles, to identify diagnostic studies of pediatric pneumonia across a broad age range that had to include children younger than age 5 years (although some studies enrolled children up to age 19 years); 3644 unique articles were identified, of which 23 met inclusion criteria...
August 1, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28761679/the-safety-efficacy-and-cost-effectiveness-of-stress-echocardiography-in-patients-with-high-pretest-probability-of-coronary-artery-disease
#15
Alexandros Papachristidis, Daniela Cassar Demarco, Damian Roper, Ioannis Tsironis, Michael Papitsas, Jonathan Byrne, Khaled Alfakih, Mark J Monaghan
OBJECTIVE: In this study, we assess the clinical and cost-effectiveness of stress echocardiography (SE), as well as the place of SE in patients with high pretest probability (PTP) of coronary artery disease (CAD). METHODS: We investigated 257 patients with no history of CAD, who underwent SE, and they had a PTP risk score >61% (high PTP). According to the National Institute for Health and Care Excellence guidance (NICE CG95, 2010), these patients should be investigated directly with an invasive coronary angiogram (ICA)...
2017: Open Heart
https://www.readbyqxmd.com/read/28760210/a-randomized-trial-of-a-1-hour-troponin-t-protocol-in-suspected-acute-coronary-syndromes-design-of-the-rapid-assessment-of-possible-acs-in-the-emergency-department-with-high-sensitivity-troponin-t-rapid-tnt-study
#16
RANDOMIZED CONTROLLED TRIAL
Cynthia Papendick, Andrew Blyth, Anil Seshadri, Michael J R Edmonds, Tom Briffa, Louise Cullen, Stephen Quinn, Jon Karnon, Anthony Chuang, Adam J Nelson, Matthew Horsfall, Erin Morton, Derek P Chew
BACKGROUND: Protocols incorporating high-sensitivity troponin to guide decision making in the disposition of patients with suspected acute coronary syndromes (ACS) in the emergency department have received a lot of attention. Traditionally, patients with chest pain have required long periods of observation in emergency department before being deemed safe for discharge. In an era of limited health service resources, a protocol that could discharge patients safely within an hour of presentation is extremely attractive...
August 2017: American Heart Journal
https://www.readbyqxmd.com/read/28747182/recurrent-primary-mediastinal-giant-cell-tumor-of-soft-tissue-with-radiological-findings-a-rare-case-report-and-literature-review
#17
Qiongjie Hu, Jian Peng, Liming Xia
BACKGROUND: Giant cell tumor of soft tissue (GCT-ST), which histologically resembles GCT of bone, is a rare tumor. Usually, it is located in the lower extremities and trunk. GCT-ST, occurring in mediastinum, is extremely rare. CASE PRESENTATION: We encountered an 18-year-old Chinese woman who had mild dull pain on the left side of back. The following chest computed tomography (CT) showed a heterogeneous mass deeply situated in the posterior mediastinum with compression of the lung and invasion of the adjacent rib...
July 26, 2017: World Journal of Surgical Oncology
https://www.readbyqxmd.com/read/28742837/risk-factors-associated-with-posttraumatic-stress-disorder-in-us-veterans-a-cohort-study
#18
Jan Müller, Sarmila Ganeshamoorthy, Jonathan Myers
OBJECTIVE: To assess the association between clinical and exercise test factors and the development of posttraumatic stress disorder (PTSD) in US Veterans. PATIENTS AND METHODS: Exercise capacity, demographics and clinical variables were assessed in 5826 veterans (mean age 59.4 ± 11.5 years) from the Veterans Affairs Healthcare System in Palo Alto, CA. The study participants underwent routine clinical exercise testing between the years 1987 and 2011. The study end point was the development of PTSD...
2017: PloS One
https://www.readbyqxmd.com/read/28730895/incidence-treatment-strategies-and-outcomes-of-acute-coronary-syndrome-with-and-without-ongoing-myocardial-ischaemia-results-from-the-czech-3-registry
#19
Petr Tousek, Klara Staskova, Anna Mala, Martin Sluka, Alexandra Vodzinska, Radek Jancar, Denisa Maluskova, Jiri Jarkovsky, Petr Widimsky
BACKGROUND: Patients with acute coronary syndrome with signs of ongoing myocardial ischaemia at first medical contact should be indicated for immediate invasive treatment. AIM: To assess the incidence, treatment strategies and outcomes of acute coronary syndrome in a large unselected cohort of patients with respect to the signs of ongoing myocardial ischaemia. METHODS: The CZECH-3 registry included 1754 consecutive patients admitted for suspected acute coronary syndrome to 43 hospitals during a 2-month period in the autumn of 2015...
July 1, 2017: European Heart Journal. Acute Cardiovascular Care
https://www.readbyqxmd.com/read/28730842/comparison-of-distinctive-clinical-and-cardiac-magnetic-resonance-features-between-st-elevation-myocardial-infarction-patients-with-incomplete-myocardial-rupture-and-those-with-moderate-to-severe-pericardial-effusion
#20
Víctor Pineda, Jaume Figueras, Sergio Moral, Jordi Bañeras, José Rodríguez-Palomares, Artur Evangelista, David García-Dorado
BACKGROUND: Whether patients with incomplete myocardial rupture (IMR) present distinctive clinical and cardiac magnetic resonance features from those with moderate-severe pericardial effusion (⩾10 mm (PE)) remains unknown Methods: We compared the clinical, angiographic and cardiac magnetic resonance characteristics of nine patients with IMR (diagnosed angiographically and/or by cardiac magnetic resonance) with 29 with PE, and also with 38 without IMR or PE with evidence of transmural necrosis (reference group) matched for age, gender and year of admission...
July 1, 2017: European Heart Journal. Acute Cardiovascular Care
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