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https://www.readbyqxmd.com/read/29786953/iatrogenic-botulism-outbreak-in-egypt-due-to-a-counterfeit-botulinum-toxin-a-preparation-a-descriptive-series-of-patient-features-and-outcome
#1
Eman Abdel Monaem Abdel Rashid, Nashwa Mohamed El-Mahdy, Huda Shehata Kharoub, Ahmed Salah Gouda, Naglaa Ahmed ElNabarawy, Bruno Mégarbane
Iatrogenic botulism resulting from the substantial increase in use of botulinum neurotoxin type-A (BoNT-A) treatment is rarely reported. We aimed to describe a large iatrogenic botulism outbreak in Egypt in June-July 2017. Nine patients developed botulism after receiving intramuscular injections of BoNT-A (dose: 200-300 IU) to treat cerebral palsy (N=7), spastic dystonia (N=1), and hyperhidrosis (N=1). Detailed findings were available in 5/9 cases. Patients were admitted to the hospital 5-10 days after the BoNT-A injection...
May 22, 2018: Basic & Clinical Pharmacology & Toxicology
https://www.readbyqxmd.com/read/29785554/interactions-between-kappa-and-mu-opioid-receptor-agonists-effects-of-the-ratio-of-drugs-in-mixtures
#2
Vanessa Minervini, Hannah Y Lu, Jahnavi Padarti, Daniela C Osteicoechea, Charles P France
RATIONALE: Pain is the leading reason for seeking health care, and mu opioid receptor agonists continue to be prescribed despite well-documented adverse effects. Kappa opioid receptor agonists have antinociceptive effects with little to no abuse liability and might be useful for treating pain in mixtures. Kappa:mu opioid mixtures might be useful if therapeutic effects of each drug can be selectively increased while reducing or avoiding the adverse effects that occur with larger doses of each drug alone...
May 22, 2018: Psychopharmacology
https://www.readbyqxmd.com/read/29783922/lethal-phlegmonous-colitis
#3
John D Gilbert, Roger W Byard
A 52-year-old man died soon after admission to hospital with a severe metabolic acidosis and likely sepsis. He had a past history of alcohol abuse with withdrawal seizures. An abdominal computed tomography scan showed thickened bowel loops but no obvious ischaemic changes, and a blood culture yielded a pure growth of Escherichia coli. At autopsy, the liver showed well-established micro-nodular cirrhosis with steatosis. The peritoneal cavity contained 200 mL of turbid yellow-brown fluid, and the caecum and ascending colon were unusually thickened...
January 1, 2018: Medicine, Science, and the Law
https://www.readbyqxmd.com/read/29781554/children-who-face-development-risks-due-to-maternal-addiction-during-pregnancy-require-extra-medical-and-psychosocial-resources
#4
Jenny Rangmar, Maria Lilja, Marie Köhler, Antonia Reuter
AIM: This study examined medical and psychosocial risk factors in children born to women with addiction problems during pregnancy and the children's needs for extra medical and psychosocial resources. METHODS: Swedish midwives routinely screen pregnant women for drugs and alcohol and refer women with addictions to the Maternity and Child Healthcare Resource Team. We investigated the medical records of 127 children (51% girls) whose mothers were referred to the Resource Team from 2009-2015...
May 21, 2018: Acta Paediatrica
https://www.readbyqxmd.com/read/29774388/withholding-or-withdrawing-of-life-sustaining-therapy-in-older-adults-%C3%A2-80-years-admitted-to-the-intensive-care-unit
#5
Bertrand Guidet, Hans Flaatten, Ariane Boumendil, Alessandro Morandi, Finn H Andersen, Antonio Artigas, Guido Bertolini, Maurizio Cecconi, Steffen Christensen, Loredana Faraldi, Jesper Fjølner, Christian Jung, Brian Marsh, Rui Moreno, Sandra Oeyen, Christina Agwald Öhman, Bernardo Bollen Pinto, Ivo W Soliman, Wojciech Szczeklik, Andreas Valentin, Ximena Watson, Tilemachos Zafeiridis, Dylan W De Lange
PURPOSE: To document and analyse the decision to withhold or withdraw life-sustaining treatment (LST) in a population of very old patients admitted to the ICU. METHODS: This prospective study included intensive care patients aged ≥ 80 years in 309 ICUs from 21 European countries with 30-day mortality follow-up. RESULTS: LST limitation was identified in 1356/5021 (27.2%) of patients: 15% had a withholding decision and 12.2% a withdrawal decision (including those with a previous withholding decision)...
May 17, 2018: Intensive Care Medicine
https://www.readbyqxmd.com/read/29774169/phase-2-study-of-everolimus-for-relapsed-or-refractory-classical-hodgkin-lymphoma
#6
Patrick B Johnston, Lauren C Pinter-Brown, Ghulam Warsi, Kristen White, Radhakrishnan Ramchandren
Background: The current standard of care for classical Hodgkin lymphoma (HL) is multiagent chemotherapy with or without radiation. In patients who relapse or fail to respond, additional high-dose chemotherapy with autologous hematopoietic stem cell transplantation (AHSCT) can improve progression-free survival (PFS). Novel therapies are required for patients refractory to chemotherapy and AHSCT. The mammalian target of rapamycin inhibitor everolimus has shown preliminary activity in preclinical models of HL and promising efficacy in patients with relapsed or refractory HL...
2018: Experimental Hematology & Oncology
https://www.readbyqxmd.com/read/29773072/formal-procedure-to-facilitate-the-decision-to-withhold-or-withdraw-life-sustaining-interventions-in-a-neonatal-intensive-care-unit-a-seven-year-retrospective-study
#7
G Sorin, R Vialet, B Tosello
BACKGROUND: Neonatal deaths are often associated with the complex decision to limit or withdraw life-sustaining interventions (LSIs) rather than therapeutic impasses. Despite the existence of a law, significant disparities in clinical procedures remain. This study aimed to assess deaths occurring in a Neonatal Intensive Care Unit (NICU) and measure the impact of a traceable Limitation or Withdrawal of Active Treatment (LWAT) file on the treatment of these newborns. METHODS: In this monocentric retrospective study, we reviewed all consecutive neonatal deaths occurring during two three-year periods among patients in the NICU at the North Hospital of Marseille: cohort 1 (from 2009 to 2011 without the LWAT file) and cohort 2 (from 2013 to 2015 after introduction of the LWAT file)...
May 17, 2018: BMC Palliative Care
https://www.readbyqxmd.com/read/29771804/preemptive-analgesia-decreases-pain-following-anorectal-surgery-a-prospective-randomized-double-blinded-placebo-controlled-trial
#8
Justin T Van Backer, Matthew R Jordan, Danielle T Leahy, Jesse S Moore, Peter Callas, Timothy Dominick, Peter A Cataldo
BACKGROUND: Postoperative pain is a frequent cause for delayed discharge following outpatient procedures, including anorectal surgery. Both central and peripheral pain receptor sensitization are thought to contribute to postoperative pain. Blocking these receptors and preempting sensitization prevents hyperalgesia leading to lower pain medication requirements. Studies in the orthopedic, urologic, and gynecologic literature support this practice, but the use of preemptive analgesia in anorectal surgery is understudied...
May 15, 2018: Diseases of the Colon and Rectum
https://www.readbyqxmd.com/read/29771249/-new-italian-law-about-end-of-life-self-determination-and-shared-care-pathway
#9
Rosagemma Ciliberti, Matteo Gulino, Ilaria Gorini
The Italian Parliament has recently approved the Law n. 219/2017 concerning "Rules on informed consent and advance directives". The manuscript points out the main key points of the new law, in order to clarify the role of the advance directives and to provide clear operational guidelines for healthcare personnel. Taking into consideration the Italian deontological and juridical context, along with the main jurisprudential judgements, the law has been analysed. The Authors discussed the new rules and the bioethical issues also in relation to the provisions stated by the Convention on Human Rights and Biomedicine (Convention of Oviedo)...
May 2018: Recenti Progressi in Medicina
https://www.readbyqxmd.com/read/29769809/managing-infants-born-to-mothers-who-have-used-opioids-during-pregnancy
#10
Thierry Lacaze-Masmonteil, Pat O'Flaherty
The incidence of infant opioid withdrawal has grown rapidly in many countries, including Canada, in the last decade, presenting significant health and early brain development concerns. Increased prenatal exposure to opioids reflects rising prescription opioid use as well as the presence of both illegal opiates and opioid-substitution therapies. Infants are at high risk for experiencing symptoms of abstinence or withdrawal that may require assessment and treatment. This practice point focuses specifically on the effect(s) of opioid withdrawal and current management strategies in the care of infants born to mothers with opioid dependency...
May 2018: Paediatrics & Child Health
https://www.readbyqxmd.com/read/29762777/the-intracerebral-hemorrhage-score-a-self-fulfilling-prophecy
#11
D Jay McCracken, Brendan P Lovasik, Courtney E McCracken, Jason M Frerich, Margaret E McDougal, Jonathan J Ratcliff, Daniel L Barrow, Gustavo Pradilla
BACKGROUND: The ICH Score has become the standard for risk-stratification of 30-d mortality in patients with intracerebral hemorrhage (ICH), but treatment has evolved over the last 17 yr since its inception. We sought to determine if the ICH Score remains an accurate predictor of 30-d mortality in these high acuity patients. OBJECTIVE: To determine the role the ICH Score has on mortality in current treatment of patients. METHODS: A retrospective review of 554 patients treated for acute, spontaneous ICH at 2 large academic institutions between 2010 and 2014 was carried out...
May 14, 2018: Neurosurgery
https://www.readbyqxmd.com/read/29756637/withdrawal-of-immunosuppressant-or-biologic-therapy-for-patients-with-quiescent-crohn-s-disease
#12
REVIEW
Ray K Boyapati, Joana Torres, Carolina Palmela, Claire E Parker, Orli M Silverberg, Sonam D Upadhyaya, Tran M Nguyen, Jean-Frédéric Colombel
BACKGROUND: Crohn's disease (CD) is a chronic, relapsing and remitting disease of the gastrointestinal tract that can cause significant morbidity and disability. Current treatment guidelines recommend early intervention with immunosuppressant or biological therapy in high-risk patients with a severe disease phenotype at presentation. The feasibility of therapeutic de-escalation once remission is achieved is a commonly encountered question in clinical practice, driven by patient and clinician concerns regarding safety, adverse events, cost and national regulations...
May 12, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29754123/psychiatry-trainees-attitudes-towards-euthanasia-and-physician-assisted-suicide
#13
M-I Kontaxaki, K Paplos, M Dasopoulou, V Kontaxakis
We investigated the attitudes towards Euthanasia (EUT) and Physician-Assisted Suicide (PAS) in a sample of Greek Psychiatry trainees (PT), (n=120, mean age 32.01±0.21, male 60.0%) and compared these to those of medical trainees of other specialties (OMT), i.e. internal medicine, surgery, intensive care (n=154, mean age 32.97±1.17, male 57.1%). Most of the responders were for the acceptance of EUT and PAS under some circumstances. More often PT answer "never" in the question regarding the permission to withdraw life-sustaining medical treatment to hasten death, if that requested by a terminally ill patient (p<0...
January 2018: Psychiatrikē, Psychiatriki
https://www.readbyqxmd.com/read/29748926/adjunctive-use-of-ketamine-for-benzodiazepine-resistant-severe-alcohol-withdrawal-a-retrospective-evaluation
#14
Poorvi Shah, Marc McDowell, Reika Ebisu, Tabassum Hanif, Theodore Toerne
INTRODUCTION: Benzodiazepine (BZD)-resistant alcohol withdrawal remains a challenge for most institutions due to limited evidence with available agents. One published study currently exists utilizing the N-methyl-D-aspartate antagonist, ketamine, for alcohol withdrawal. OBJECTIVE: The purpose of our study was to evaluate the effect of adjunctive ketamine continuous infusion on symptom control and lorazepam infusion requirements for BZD-resistant alcohol withdrawal patients in the intensive care unit...
May 10, 2018: Journal of Medical Toxicology: Official Journal of the American College of Medical Toxicology
https://www.readbyqxmd.com/read/29743764/definition-of-terms-used-in-limitation-of-treatment-and-providing-palliative-care-at-the-end-of-life-the-indian-council-of-medical-research-commission-report
#15
Naveen Salins, Roop Gursahani, Roli Mathur, Shivakumar Iyer, Stanley Macaden, Nagesh Simha, Raj Kumar Mani, M R Rajagopal
Background: Indian hospitals, in general, lack policies on the limitation of inappropriate life-sustaining interventions at the end of life. To facilitate discussion, preparation of guidelines and framing of laws, terminologies relating to the treatment limitation, and providing palliative care at the end-of-life care (EOLC) need to be defined and brought up to date. Methodology: This consensus document on terminologies and definitions of terminologies was prepared under the aegis of the Indian Council of Medical Research...
April 2018: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/29743380/tailored-adjunctive-cilostazol-therapy-based-on-cyp2c19-genotyping-in-patients-with-acute-myocardial-infarction-the-caldera-gene-study
#16
Koichi Kaikita, Hiromi Yoshimura, Masanobu Ishii, Takashi Kudoh, Yoshihiro Yamada, Eiichiro Yamamoto, Yasuhiro Izumiya, Sunao Kojima, Hideki Shimomura, Ryusuke Tsunoda, Kunihiko Matsui, Hisao Ogawa, Kenichi Tsujita
BACKGROUND: Patients with reduced-function CYP2C19 genotypes on dual antiplatelet therapy (DAPT) with aspirin and clopidogrel show higher clinical risk for acute myocardial infarction (AMI). We investigated the effect of CYP2C19 genotype-tailored adjunctive cilostazol therapy on treatment of AMI.Methods and Results:The study group of 138 patients with suspected AMI were screened for CYP2C19 genotype immediately after percutaneous coronary intervention (PCI) using a SPARTAN RX point-of-care device...
May 8, 2018: Circulation Journal: Official Journal of the Japanese Circulation Society
https://www.readbyqxmd.com/read/29742583/adjunct-ketamine-use-in-the-management-of-severe-ethanol-withdrawal
#17
Anthony F Pizon, Michael J Lynch, Neal J Benedict, Joseph H Yanta, Adam Frisch, Nathan B Menke, Greg S Swartzentruber, Andrew M King, Michael G Abesamis, Sandra L Kane-Gill
OBJECTIVES: Ketamine offers a plausible mechanism with favorable kinetics in treatment of severe ethanol withdrawal. The purpose of this study is to determine if a treatment guideline using an adjunctive ketamine infusion improves outcomes in patients suffering from severe ethanol withdrawal. DESIGN: Retrospective observational cohort study. SETTING: Academic tertiary care hospital. PATIENTS: Patients admitted to the ICU and diagnosed with delirium tremens by Diagnostic and Statistical Manual of Mental Disorders V criteria...
May 8, 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29739484/outpatient-pharmacologic-weaning-for-neonatal-abstinence-syndrome-a-systematic-review
#18
Jodie Murphy-Oikonen, Karen McQueen
AimThe purpose of this systematic review was to assess the literature regarding the effectiveness and safety of outpatient pharmacologic weaning for infants with neonatal abstinence syndrome (NAS). BACKGROUND: NAS is a multi-system disorder observed in infants experiencing withdrawal from opioid exposure in utero. Infants requiring pharmacologic treatment to manage withdrawal, traditionally receive treatment as a hospital inpatient resulting in lengthy hospitalization periods. However, there is evidence to suggest that some healthcare institutions are continuing outpatient pharmacologic weaning for select infants in a home environment...
May 9, 2018: Primary Health Care Research & Development
https://www.readbyqxmd.com/read/29735241/use-of-a-gabapentin-protocol-for-the-management-of-alcohol-withdrawal-a-preliminary-experience-expanding-from-the-consultation-liaison-psychiatry-service
#19
Jonathan G Leung, Daniela B Rakocevic, Nicholas D Allen, Elliot M Handler, Bruno A Perossa, Kristin L Borreggine, Amy L Stark, Hannah K Betcher, Daniel K Hosker, Blaine A Minton, Benjamin R Braus, Ross A Dierkhising, Kemuel L Philbrick
BACKGROUND: Benzodiazepines are the conventional mainstay to manage alcohol withdrawal; however, patients are subsequently at increased risk for poor sleep, cravings, and return to drinking. Research on alternative pharmacologic agents to facilitate safe alcohol withdrawal is scant. Gabapentin is one medication shown in small studies to reduce the need for benzodiazepines in the setting of alcohol withdrawal. The continuation of gabapentin after alcohol withdrawal appears to be safe during early sobriety and may aid in reducing alcohol-related cravings or returning to alcohol consumption...
March 21, 2018: Psychosomatics
https://www.readbyqxmd.com/read/29732188/weaning-from-veno-venous-extracorporeal-membrane-oxygenation-how-i-do-it
#20
REVIEW
Lars M Broman, Maximilian V Malfertheiner, Andrea Montisci, Federico Pappalardo
Veno-venous extracorporeal membrane oxygenation (VV ECMO) is a rescue treatment for acute respiratory distress syndrome (ARDS) failing protective mechanical ventilation. It temporarily provides proper gas exchange: hypoxia is treated by adjusting the blood flow rate and fraction in spired oxygen over the ventilator (FiO2 ) on the extracorporeal membrane oxygenation (ECMO) circuit while CO2 removal is regulated by the ECMO fresh gas flow. Therefore, ventilator settings can be gradually reduced allowing the lungs to rest and recover...
March 2018: Journal of Thoracic Disease
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