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Outstanding Clinical Review

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https://www.readbyqxmd.com/read/28774701/fungal-infections-in-hiv-aids
#1
REVIEW
Andrew H Limper, Antoine Adenis, Thuy Le, Thomas S Harrison
Fungi are major contributors to the opportunistic infections that affect patients with HIV/AIDS. Systemic infections are mainly with Pneumocystis jirovecii (pneumocystosis), Cryptococcus neoformans (cryptococcosis), Histoplasma capsulatum (histoplasmosis), and Talaromyces (Penicillium) marneffei (talaromycosis). The incidence of systemic fungal infections has decreased in people with HIV in high-income countries because of the widespread availability of antiretroviral drugs and early testing for HIV. However, in many areas with high HIV prevalence, patients present to care with advanced HIV infection and with a low CD4 cell count or re-present with persistent low CD4 cell counts because of poor adherence, resistance to antiretroviral drugs, or both...
July 31, 2017: Lancet Infectious Diseases
https://www.readbyqxmd.com/read/28818190/aortic-bioprosthetic-valve-durability-incidence-mechanisms-predictors-and-management-of-surgical%C3%A2-and-transcatheter-valve-degeneration
#2
REVIEW
Tania Rodriguez-Gabella, Pierre Voisine, Rishi Puri, Philippe Pibarot, Josep Rodés-Cabau
In recent times, there has been a considerable increase in the use of aortic bioprostheses (vs. mechanical prostheses) for treating aortic valve disease, and this tendency is likely to continue in the near future. However, the occurrence of structural valve degeneration, limiting valve durability, remains an important drawback of surgical and transcatheter bioprostheses. In this paper, we provide an overview of bioprosthetic valve durability, focusing on the definition, incidence, mechanisms, predictive factors, and management of structural degeneration of aortic bioprostheses...
August 22, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/28818210/clinical-use-of-high-sensitivity-cardiac-troponin-in-patients-with-suspected-myocardial-infarction
#3
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/28817522/a-graphical-guide-to-the-reboa-five-life-saving-steps
#4
Jonathan P Wanderer, Naveen Nathan
No abstract text is available yet for this article.
September 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28817528/resuscitative-endovascular-balloon-occlusion-of-the-aorta-a-new-weapon-to-combat-exsanguinating-hemorrhage
#5
Richard P Dutton, Frank Herbstreit
No abstract text is available yet for this article.
September 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28795964/neuromuscular-monitoring-in-the-perioperative-period
#6
Glenn S Murphy
Neuromuscular monitoring devices were introduced into clinical practice in the 1970s. Qualitative neuromuscular monitors, or peripheral nerve stimulators, provide an electrical stimulus to a motor nerve and the response of corresponding muscle subjectively evaluated. A standard peripheral nerve stimulator provides several patterns of nerve stimulation, including train-of-four (TOF), double-burst, tetanic, and post-tetanic count. Qualitative (and quantitative) monitors are needed to determine onset of neuromuscular blockade, maintain the required depth of muscle relaxation during the surgical procedure, and assess an appropriate dose of reversal agent...
August 8, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28795966/the-coagulation-profile-of-end-stage-liver-disease-and-considerations-for-intraoperative-management
#7
Katherine T Forkin, Douglas A Colquhoun, Edward C Nemergut, Julie L Huffmyer
The coagulopathy of end-stage liver disease results from a complex derangement in both anticoagulant and procoagulant processes. With even minor insults, cirrhotic patients experience either inappropriate bleeding or clotting, or even both simultaneously. The various phases of liver transplantation along with fluid and blood product administration may contribute to additional disturbances in coagulation. Thus, anesthetic management of patients undergoing liver transplantation to improve hemostasis and avoid inappropriate thrombosis in the perioperative environment can be challenging...
August 8, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28784609/understanding-cardiac-troponin-part-1-avoiding-troponinitis
#8
REVIEW
Richard Body, Edward Carlton
Cardiac troponin (cTn) is a highly specific biomarker of myocardial injury and is central to the diagnosis of acute myocardial infarction (AMI). By itself, however, cTn cannot identify the cause of myocardial injury. 'Troponinitis' is the condition that leads clinicians to falsely assign a diagnosis of AMI based only on the fact that a patient has an elevated cTn concentration. There are many causes of myocardial injury other than AMI. Clinicians are required to differentiate myocardial injury caused by AMI from other causes...
August 7, 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/28806209/refractory-intracranial-hypertension-the-role-of-decompressive-craniectomy
#9
Martin Smith
Raised intracranial pressure (ICP) is associated with worse outcomes after acute brain injury, and clinical guidelines advocate early treatment of intracranial hypertension. ICP-lowering therapies are usually administered in a stepwise manner, starting with safer first-line interventions, while reserving higher-risk options for patients with intractable intracranial hypertension. Decompressive craniectomy is a surgical procedure in which part of the skull is removed and the underlying dura opened to reduce brain swelling-related raised ICP; it can be performed as a primary or secondary procedure...
August 10, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28803771/perioperative-management-of-patients-with-end-stage-renal-disease
#10
REVIEW
Hirotsugu Kanda, Yuji Hirasaki, Takafumi Iida, Megumi Kanao-Kanda, Yuki Toyama, Takashi Chiba, Takayuki Kunisawa
End-stage renal disease (ESRD) is associated with significant alterations in cardiovascular function; homeostasis of body fluid, electrolytes, and acid-base equilibrium; bone metabolism, erythropoiesis; and blood coagulation. The prevalence of ESRD is increasing rapidly worldwide, as is the number of patients requiring surgery under general anesthesia. Patients with ESRD have significantly higher risks of perioperative morbidity and mortality due to multiple comorbidities. The perioperative management of patients with ESRD under general anesthesia therefore requires special considerations and a careful multidisciplinary approach...
April 13, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28800865/contemporary-reviews-in-critical-care-medicine-anaphylaxis
#11
REVIEW
Daniel LoVerde, Onyinye I Iweala, Ariana Eginli, Guha Krishnaswamy
Anaphylaxis is a systemic, life threatening disorder triggered by mediators released by mast cells and basophils activated via allergic (IgE-mediated) or non-allergic (non-IgE-mediated) mechanisms. It is a rapidly evolving, multisystem process involving the integumentary, pulmonary, gastrointestinal and cardiovascular systems. Anaphylaxis and angioedema are serious disorders that can lead to fatal airway obstruction and culminate in cardiorespiratory arrest resulting in hypoxemia and/or shock. Often, these disorders can be appropriately managed in an outpatient setting...
August 8, 2017: Chest
https://www.readbyqxmd.com/read/28800994/perioperative-management-of-endovascular-thoracoabdominal-aortic-aneurysm-repair
#12
REVIEW
Alexander C P Fort, Lori A Rubin, Andrew J Meltzer, Darren B Schneider, Adam D Lichtman
No abstract text is available yet for this article.
August 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28794797/acute-mesenteric-ischemia-guidelines-of-the-world-society-of-emergency-surgery
#13
REVIEW
Miklosh Bala, Jeffry Kashuk, Ernest E Moore, Yoram Kluger, Walter Biffl, Carlos Augusto Gomes, Offir Ben-Ishay, Chen Rubinstein, Zsolt J Balogh, Ian Civil, Federico Coccolini, Ari Leppaniemi, Andrew Peitzman, Luca Ansaloni, Michael Sugrue, Massimo Sartelli, Salomone Di Saverio, Gustavo P Fraga, Fausto Catena
Acute mesenteric ischemia (AMI) is typically defined as a group of diseases characterized by an interruption of the blood supply to varying portions of the small intestine, leading to ischemia and secondary inflammatory changes. If untreated, this process will eventuate in life threatening intestinal necrosis. The incidence is low, estimated at 0.09-0.2% of all acute surgical admissions. Therefore, although the entity is an uncommon cause of abdominal pain, diligence is always required because if untreated, mortality has consistently been reported in the range of 50%...
2017: World Journal of Emergency Surgery: WJES
https://www.readbyqxmd.com/read/28781116/acceleration-time-and-ratio-of-acceleration-time%C3%A2-to-ejection-time-in-aortic-stenosis-new%C3%A2-echocardiographic-diagnostic-parameters
#14
Sergio Gamaza-Chulián, Enrique Díaz-Retamino, Santiago Camacho-Freire, Dolores Ruiz-Fernández, Alejandro Gutiérrez-Barrios, Jesús Oneto-Otero
BACKGROUND: Inconsistencies between gradients and aortic valve area are frequent in the echocardiographic evaluation of aortic stenosis (AS). Assessing AS severity is essential for the correct management of the disease. The aim of this study was to evaluate whether ejection dynamics, particularly acceleration time (AT) and the ratio of AT to ejection time (ET), could be diagnostic parameters in patients with AS. METHODS: Patients with AS (aortic peak velocity > 2 m/sec) were prospectively enrolled...
August 3, 2017: Journal of the American Society of Echocardiography
https://www.readbyqxmd.com/read/28781010/an-ishlt-consensus-document-for-prevention-and-management-strategies-for-mechanical-circulatory-support-infection
#15
EDITORIAL
Shimon Kusne, Martha Mooney, Lara Danziger-Isakov, Annemarie Kaan, Lars H Lund, Haifa Lyster, Georg Wieselthaler, Saima Aslam, Barbara Cagliostro, Jonathan Chen, Pamela Combs, Adam Cochrane, Jennifer Conway, Jennifer Cowger, Maria Frigerio, Rochelle Gellatly, Paolo Grossi, Finn Gustafsson, Margaret Hannan, Angela Lorts, Stanley Martin, Sean Pinney, Fernanda P Silveira, Stephan Schubert, Stephan Schueler, Martin Strueber, Nir Uriel, Neil Wrightson, Rachel Zabner, Shirish Huprikar
No abstract text is available yet for this article.
June 23, 2017: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/28780148/intra-abdominal-hypertension-abdominal-compartment-syndrome-and-the-open-abdomen
#16
REVIEW
William Kirke Rogers, Luis Garcia
Abdominal Compartment Syndrome (ACS) is the endpoint of a process whereby massive interstitial swelling in the abdomen or rapid development of a space-filling lesion within the abdomen (such as ascites or a hematoma) leads to a pathologically increased pressure. This results in so-called Intra-Abdominal Hypertension (IAH), causing decreased perfusion of the kidneys and abdominal viscera and possible difficulties with ventilation and maintenance of cardiac output. These effects contribute to a cascade of ischemia and multiple organ dysfunction with high mortality...
August 2, 2017: Chest
https://www.readbyqxmd.com/read/28774316/driving-pressure-a-marker-of-severity-a-safety-limit-or-a-goal-for-mechanical-ventilation
#17
Guillermo Bugedo, Jaime Retamal, Alejandro Bruhn
No abstract text is available yet for this article.
August 4, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28766156/a-primer-on-nerve-agents-what-the-emergency-responder-anesthesiologist-and-intensivist-needs-to-know
#18
Keith Candiotti
PURPOSE: The purpose of this review article is to familiarize first responders, anesthesiologists, and intensivists with the medical management of patients exposed to nerve agents. SOURCE: This review is based on the current medical literature available to the general medical community. PRINCIPAL FINDINGS: Nerve agents are some of the deadliest substances known to humanity. Though they kill primarily via muscle paralysis, which leads to respiratory arrest, these agents affect virtually every organ system in the body...
August 1, 2017: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/28767503/neuroendovascular-surgery-for-the-treatment-of-ischemic-stroke
#19
Arthur Wang, Meic H Schmidt
This review discusses modern therapeutic interventions for acute ischemic stroke with a focus on endovascular therapy. In 2015, the American Heart Association (AHA) made major changes to the guidelines for the endovascular treatment of acute ischemic stroke. The Class IA indications for endovascular therapy of stroke patients include symptom onset within 6 hours, proven large vessel occlusion of an artery in the anterior circulation, and the use of a stent retriever as part of the mechanical thrombectomy. Advanced perfusion imaging helps identify patients with a low ratio of ischemic core to salvageable penumbra...
June 22, 2017: Cardiology in Review
https://www.readbyqxmd.com/read/27777298/management-of-systemic-right-ventricular-failure-in-patients-with-congenitally-corrected-transposition-of-the-great-arteries
#20
REVIEW
Aleksei A Filippov, Pedro J Del Nido, Nikolay V Vasilyev
In recent decades, significant progress has been made in the diagnosis and management of congenitally corrected transposition of the great arteries (ccTGA). Nevertheless, gradual dysfunction and failure of the right ventricle (RV) in the systemic circulation remain the main contributors to mortality and disability for patients with ccTGA, especially after adolescence. Anatomic repair of ccTGA effectively resolves the problem of failure of the systemic RV and has good early and midterm results. However, this strategy is applicable primarily in infants and children up to their teens and has associated risks and limitations, and new challenges can arise in the late postoperative period...
October 25, 2016: Circulation
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