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https://www.readbyqxmd.com/read/28435499/the-fast-and-the-furious-low-risk-chest-pain-and-the-rapid-rule-out-protocol
#1
REVIEW
Maite Anna Huis In 't Veld, Louise Cullen, Simon A Mahler, Barbra E Backus, Zachary D W Dezman, Amal Mattu
Accelerated diagnostic pathways (ADP) have been designed to identify low-risk chest pain patients in the emergency department. This review article discusses the Asia-Pacific Evaluation of Chest Pain Trial (ASPECT) score, the Accelerated Diagnostic Protocol for Chest Pain Trial (ADAPT) score, the Emergency Department Assessment of Chest Pain Score (EDACS), the HEARTScore and the HEART pathway. These ADPs have been validated in various studies and aid the emergency provider with identifying the low-risk chest pain patient who is appropriate for discharge home, while at the same time highlighting those patients who would benefit from further in-patient work up...
April 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28427932/reciprocal-changes-in-noradrenaline-and-gaba-levels-in-discrete-brain-regions-upon-rapid-eye-movement-sleep-deprivation-in-rats
#2
Rachna Mehta, Sudhuman Singh, Mudasir Ahmad Khanday, Birendra Nath Mallick
Rapid eye movement sleep (REMS) plays important role in maintenance of normal brain functions. Neurons containing various neurotransmitters in different brain regions interact to regulate this complex phenomenon in health and diseases. The number of neuronal projections, their firing rates and neurotransmitter levels vary in different brain regions under various conditions leading to normal or altered patho-physio-behavioral states. In this study using high performance liquid chromatography (HPLC) we quantified noradrenaline (NA) and gamma-amino butyric acid (GABA) levels in locus coeruleus (LC), dorsal raphe (DR), pedunculo-pontine tegmentum (PPT), frontal lobe (FL), cortex and hippocampus (Hippo) in control and after 96 h REMS deprivation (REMSD) rats...
April 17, 2017: Neurochemistry International
https://www.readbyqxmd.com/read/28418520/rapid-rule-out-of-acute-myocardial-infarction-with-a-single-high-sensitivity-cardiac-troponin-t-measurement-below-the-limit-of-detection-a-collaborative-meta-analysis
#3
John W Pickering, Martin P Than, Louise Cullen, Sally Aldous, Ewoud Ter Avest, Richard Body, Edward W Carlton, Paul Collinson, Anne Marie Dupuy, Ulf Ekelund, Kai M Eggers, Christopher M Florkowski, Yonathan Freund, Peter George, Steve Goodacre, Jaimi H Greenslade, Allan S Jaffe, Sarah J Lord, Arash Mokhtari, Christian Mueller, Andrew Munro, Sebbane Mustapha, William Parsonage, W Frank Peacock, Christopher Pemberton, A Mark Richards, Juan Sanchis, Lukas P Staub, Richard Troughton, Raphael Twerenbold, Karin Wildi, Joanna Young
Background: High-sensitivity assays for cardiac troponin T (hs-cTnT) are sometimes used to rapidly rule out acute myocardial infarction (AMI). Purpose: To estimate the ability of a single hs-cTnT concentration below the limit of detection (<0.005 µg/L) and a nonischemic electrocardiogram (ECG) to rule out AMI in adults presenting to the emergency department (ED) with chest pain. Data Sources: EMBASE and MEDLINE without language restrictions (1 January 2008 to 14 December 2016)...
April 18, 2017: Annals of Internal Medicine
https://www.readbyqxmd.com/read/28414663/not-another-acs-rule-out
#4
S Preston, R Nelson, M Watts, D Smith, T Dewenter, D Spruill
CASE: A 50 year old African-American woman with diabetes, hypertension, and hyperlipidemia presented with progressively worsening retro-sternal chest pain, exacerbated by activity and relieved by rest. She also endorsed a thirty-pound unintentional weight loss, and dysphagia. She was dysarthric with left-sided Bell's Palsy and a palpable left axillary lymph node. She had been evaluated at several hospitals in the previous months for similar typical chest pain. Her troponin values were normal, and an EKG showed T-wave inversions in leads I and aVL...
March 2017: Journal of the Louisiana State Medical Society: Official Organ of the Louisiana State Medical Society
https://www.readbyqxmd.com/read/28403679/levofloxacin-induced-acute-immune-mediated-thrombocytopenia-of-rapid-onset
#5
Andrew W Shih, Andy S Lam, Theodore E Warkentin
Drug-induced immune thrombocytopenia (D-ITP) typically occurs after the patient has been receiving the implicated drug for at least 1 week, due to newly forming drug-dependent antibodies ("typical-onset" D-ITP). A "rapid-onset" form of D-ITP can occur when previous sensitization has occurred, where antibodies have thus already been formed, and a precipitous platelet count fall occurs upon reexposure. Typical-onset D-ITP has been reported after levofloxacin, but the rapid-onset form with a well-documented previous exposure has not been described...
January 1, 2017: Journal of Pharmacy Practice
https://www.readbyqxmd.com/read/28400691/metastatic-endogenous-endophthalmitis-a-rare-presentation-with-methicillin-resistant-staphylococcus-aureus-prostatic-abscess
#6
Mrugank M Bhavsar, T V Devarajan, P Senthur Nembi, Nagarajan Ramakrishnan, Ashwin K Mani
A 62-year-old male with the previous history of uncontrolled diabetes and hypertension on irregular treatment presented with a history of fever, dysuria, and urinary retention with progressive painful loss of vision over a period of 2 days. His eye examination showed hypopyon, and he was diagnosed to have rapidly progressive endogenous endophthalmitis. He was started on vancomycin and piperacillin-tazobactam empirically. His blood and urine cultures grew methicillin-resistant Staphylococcus aureus (MRSA). Transesophageal echocardiography ruled out infective endocarditis...
March 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28398613/intramolecular-hydrogen-bonding-restricts-gd-aqua-ligand-dynamics
#7
Eszter Boros, Raja Srinivas, Hee-Kyung Kim, Arnold M Raitsimring, Andrei V Astashkin, Oleg G Poluektov, Jens Niklas, Andrew D Horning, Bruce Tidor, Peter Caravan
Aqua ligands can undergo rapid internal rotation about the M-O bond. For magnetic resonance contrast agents, this rotation results in diminished relaxivity. Herein, we show that an intramolecular hydrogen bond to the aqua ligand can reduce this internal rotation and increase relaxivity. Molecular modeling was used to design a series of four Gd complexes capable of forming an intramolecular H-bond to the coordinated water ligand, and these complexes had anomalously high relaxivities compared to similar complexes lacking a H-bond acceptor...
April 11, 2017: Angewandte Chemie
https://www.readbyqxmd.com/read/28379561/rule-out-outbreak-24-hour-metagenomic-next-generation-sequencing-for-characterizing-respiratory-virus-source-for-infection-prevention
#8
Alexander L Greninger, Alpana Waghmare, Amanda Adler, Xuan Qin, Janet L Crowley, Janet A Englund, Jane M Kuypers, Keith R Jerome, Danielle M Zerr
Background.: Metagenomic next-generation sequencing (mNGS) has been used to uncover unusual causes of infectious diseases but has not been used routinely for the investigation of putative nosocomial outbreaks. Here, we describe the use of mNGS during investigation of a cluster of human rhinovirus (HRV)-positive infections on a high-risk pulmonary ward. Methods.: We performed mNGS on 6 midnasal turbinate swabs from 4 case-patients and 10 swabs from 9 control outpatients that tested positive for enterovirus/rhinovirus by the FilmArray system...
April 4, 2017: Journal of the Pediatric Infectious Diseases Society
https://www.readbyqxmd.com/read/28378576/secondary-interactions-arrest-the-hemiaminal-intermediate-to-invert-the-modus-operandi-of-schiff-base-reaction-a-route-to-benzoxazinones
#9
Ketan Patel, Satej S Deshmukh, Dnyaneshwar Bodkhe, Manoj Mane, Kumar Vanka, Dinesh Shinde, Pattuparambil R Rajamohanan, Shyamapada Nandi, Ramanathan Vaidhyanathan, Samir H Chikkali
Discovered by Hugo Schiff, condensation between amine and aldehyde represents one of the most ubiquitous reactions in chemistry. This classical reaction is widely used to manufacture pharmaceuticals and fine chemicals. However, the rapid and reversible formation of Schiff base prohibits formation of alternative products, of which benzoxazinones are an important class. Therefore, manipulating the reactivity of two partners to invert the course of this reaction is an elusive target. Presented here is a synthetic strategy that regulates the sequence of Schiff base reaction via weak secondary interactions...
April 11, 2017: Journal of Organic Chemistry
https://www.readbyqxmd.com/read/28376265/evaluation-of-legionella-real-time-pcr-against-traditional-culture-for-routine-and-public-health-testing-of-water-samples
#10
Samuel Collins, David Stevenson, Jimmy Walker, Allan Bennett
AIMS: To evaluate the usefulness of Legionella qPCR alongside traditional culture for enumeration of Legionella from water samples as part of both routine and public health investigation testing. METHODS AND RESULTS: Routine water samples (n=2002) and samples from public health investigations (n=215) were analysed by culture and qPCR for Legionella spp., Legionella pneumophila and L. pneumophila sg-1. A negative qPCR result was highly predictive of a negative culture result for all water systems (negative predictive values (NPV) from 97...
April 4, 2017: Journal of Applied Microbiology
https://www.readbyqxmd.com/read/28364416/periodic-limb-movements-during-sleep-mimicking-rem-sleep-behavior-disorder-a-new-form-of-periodic-limb-movement-disorder
#11
Carles Gaig, Alex Iranzo, Montserrat Pujol, Hernando Perez, Joan Santamaria
Study Objectives: To describe a group of patients referred because of abnormal sleep behaviors that were suggestive of rapid eye movement (REM) sleep behavior disorder (RBD) in whom video-polysomnography ruled out RBD and showed the reported behaviors associated with vigorous periodic limb movements during sleep (PLMS). Aims and Methods: Clinical history and video-polysomnography review of patients identified during routine visits in a sleep center. Results: Patients were 15 men and 2 women with a median age of 66 (range: 48-77) years...
March 1, 2017: Sleep
https://www.readbyqxmd.com/read/28358593/a-case-of-amoxicillin-induced-acute-generalized-exanthematous-pustulosis-presenting-as-septic-shock
#12
Katherine A McDonald, Tadeusz A Pierscianowski
This case report demonstrates the challenges of diagnosing and managing acute generalized exanthematous pustulosis (AGEP) presenting as septic shock. The disseminated, erythematous, pustular rash is a common feature. However, extensive organ involvement and life-threatening hypotension are unusual. The constellation of signs has not previously been documented following amoxicillin therapy. Toxic epidermal necrolysis (TEN) and toxic shock syndrome (TSS) were considered in addition to AGEP because of the systemic presentation...
March 1, 2017: Journal of Cutaneous Medicine and Surgery
https://www.readbyqxmd.com/read/28356081/the-prevalence-of-hiv-among-adults-with-pulmonary-tb-at-a-population-level-in-zambia
#13
Pascalina Chanda-Kapata, Nathan Kapata, Eveline Klinkenberg, Martin P Grobusch, Frank Cobelens
BACKGROUND: Tuberculosis and HIV co-infection is one of the main drivers of poor outcome for both diseases in Zambia. HIV infection has been found to predict TB infection/disease and TB has been reported as a major cause of death among individuals with HIV. Improving case detection of TB/HIV co-infection has the potential to lead to early treatment of both conditions and can impact positively on treatment outcomes. This study was conducted in order to determine the HIV prevalence among adults with tuberculosis in a national prevalence survey setting in Zambia, 2013-2014...
March 29, 2017: BMC Infectious Diseases
https://www.readbyqxmd.com/read/28352627/treatment-of-cirrhosis-associated-hyponatremia-with-midodrine-and-octreotide
#14
Sharad Patel, Dai-Scott Nguyen, Anjay Rastogi, Minh-Kevin Nguyen, Minhtri K Nguyen
BACKGROUND: Hyponatremia in the setting of cirrhosis is a common electrolyte disorder with few therapeutic options. The free water retention is due to non-osmotic vasopressin secretion resulting from the cirrhosis-associated splanchnic vasodilatation. Therefore, vasoconstrictive therapy may correct this electrolyte abnormality. The aim of this study was to assess the efficacy of midodrine and octreotide as a therapeutic approach to increasing urinary electrolyte-free water clearance (EFWC) in the correction of cirrhosis-associated hyponatremia...
2017: Frontiers in Medicine
https://www.readbyqxmd.com/read/28348901/addison-s-disease-and-possible-cannabis-withdrawal-syndrome-presenting-as-an-eating-disorder-in-a-thirty-year-old-female
#15
Kimberly Lazare
A 30-year-old female with a history of anxiety, cannabis use, and Avoidant/Restrictive Food Intake Disorder presented for residential treatment of a Cannabis Use Disorder. Upon arrival, she had not eaten for two days and was found to be hypotensive with electrolyte disturbances. She was admitted to a nearby hospital, where the Internist diagnosed her with Addison's disease. She was treated with corticosteroid therapy, with rapid normalization of her electrolytes, eating, and anxiety. This is the first published case of undiagnosed Addison's disease presenting as an eating disorder, with cannabis use likely contributing to symptoms...
2017: Case Reports in Endocrinology
https://www.readbyqxmd.com/read/28348799/community-acquired-urinary-tract-infections-caused-by-burkholderiacepacia-complex-in-patients-with-no-underlying-risk-factor
#16
Laila Nimri, Mamuno Sulaiman, Osama Bani Hani
Introduction. Urinary tract infections (UTIs) remain common infections diagnosed in outpatients as well as hospitalized patients. Community-acquired UTIs are generally caused by Escherichia coli and other members of the family Enterobacteriaceae.Burkholderiacepacia is an opportunistic pathogen mainly affecting immunocompromised and hospitalized patients, particularly those who have received prior broad-spectrum antibacterial therapy. Case presentation. Urine samples were collected from 157 outpatients clinically diagnosed with UTI and from 100 healthy control subjects...
January 2017: JMM Case Reports
https://www.readbyqxmd.com/read/28348137/early-golgi-abnormalities-and-neurodegeneration-upon-loss-of-presynaptic-proteins-munc18-1-syntaxin-1-or-snap-25
#17
Tatiana C Santos, Keimpe Wierda, Jurjen H Broeke, Ruud F Toonen, Matthijs Verhage
The loss of presynaptic proteins Munc18-1, syntaxin-1 or SNAP-25 is known to produce cell death, but the underlying features have not been compared experimentally. Here, we investigated these features in cultured mouse CNS and dorsal root ganglion neurons. Side-by-side comparisons confirmed massive cell death, before synaptogenesis, within 1-4 days in vitro (DIV) upon loss of t-SNAREs (syntaxin-1, SNAP-25) or Munc18-1, but not v-SNAREs (synaptobrevins/VAMP1/2/3 using Tetanus Neurotoxin (TeNT), also in TI-VAMP/VAMP7 knock-out (KO) neurons)...
March 27, 2017: Journal of Neuroscience: the Official Journal of the Society for Neuroscience
https://www.readbyqxmd.com/read/28343173/fast-track-protocols-using-highly-sensitive-troponin-assays-for-ruling-out-and-ruling-in-non-st-elevation-acute-coronary-syndrome
#18
Simona Ferraro, Alberto Dolci, Mauro Panteghini
The introduction of "highly sensitive" cardiac troponin assays (hsTn) has reinforced the evidence that only serial testing incorporated in running algorithms allows a more accurate diagnosis of acute myocardial infarction. In this report, we consider the available evidence supporting the use of fast track protocols for ruling out and ruling in non-ST elevation myocardial infarction (NSTEMI) and compare it with the content of recently released guideline by the European Society of Cardiology, noting some uncomfortable aspects that need urgent clarification and/or revision...
March 27, 2017: Clinical Chemistry and Laboratory Medicine: CCLM
https://www.readbyqxmd.com/read/28343091/rapid-detection-and-ruling-out-of-neonatal-sepsis-by-pcr-coupled-with-electrospray-ionization-mass-spectrometry-pcr-esi-ms
#19
Cristina Delcò, Oliver Karam, Riccardo Pfister, Alain Gervaix, Gesuele Renzi, Stéphane Emonet, Jacques Schrenzel, Klara M Posfay-Barbe
BACKGROUND: Sepsis is an important cause of morbidity and mortality in neonates and clinicians are typically required to administer empiric antibiotics while waiting for blood culture results. However, prolonged and inappropriate use of antibiotics is associated with various complications and adverse events. Better tools to rapidly rule out bacterial infections are therefore needed. AIMS: We aimed to assess the negative predictive value of PCR coupled with Electrospray Ionization Mass Spectrometry (PCR/ESI-MS) compared to conventional blood cultures in neonatal sepsis...
March 23, 2017: Early Human Development
https://www.readbyqxmd.com/read/28329507/giant-benign-intradermal-melanocytic-nevus-of-rapid-onset
#20
Sarah J Coates, Andrew Avarbock, Garrett T Desman
Benign melanocytic nevi are slowly growing acquiredor congenital tumors with varied morphology,commonly encountered in dermatology clinics. Anytumor with rapid clinical growth must be assessedcarefully in order to exclude malignancy. We report awoman with a histopathologically benign intradermalnevus that presented as a rapidly evolving largecutaneous mass on the ear. Owing to the discrepancybetween the clinical and histopathological findings,an extensive histopathological work-up involvingmany deeper sections, immunohistochemical stains,and fluorescent in situ hybridization (FISH) analysiswas conducted in order to rule out malignancy...
February 15, 2017: Dermatology Online Journal
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