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Marlies Ostermann, Michael Joannidis
Acute kidney injury (AKI) is common and is associated with serious short- and long-term complications. Early diagnosis and identification of the underlying aetiology are essential to guide management. In this review, we outline the current definition of AKI and the potential pitfalls, and summarise the existing and future tools to investigate AKI in critically ill patients.
September 27, 2016: Critical Care: the Official Journal of the Critical Care Forum
Rosemary Townsend, Patrick O'Brien, Asma Khalil
Preeclampsia is a potentially serious complication of pregnancy with increasing significance worldwide. Preeclampsia is the cause of 9%-26% of global maternal mortality and a significant proportion of preterm delivery, and maternal and neonatal morbidity. Incidence is increasing in keeping with the increase in obesity, maternal age, and women with medical comorbidities entering pregnancy. Recent developments in the understanding of the pathophysiology of preeclampsia have opened new avenues for prevention, screening, and management of this condition...
2016: Integrated Blood Pressure Control
Maureen A Smythe, Jennifer Priziola, Paul P Dobesh, Diane Wirth, Adam Cuker, Ann K Wittkowsky
Venous thromboembolism (VTE) is a serious and often fatal medical condition with an increasing incidence. Despite the changing landscape of VTE treatment with the introduction of the new direct oral anticoagulants many uncertainties remain regarding the optimal use of traditional parenteral agents. This manuscript, initiated by the Anticoagulation Forum, provides clinical guidance based on existing guidelines and consensus expert opinion where guidelines are lacking. This specific chapter addresses the practical management of heparins including low molecular weight heparins and fondaparinux...
January 2016: Journal of Thrombosis and Thrombolysis
Michael Klompas, Daniel J Diekema, Neil O Fishman, Deborah S Yokoe
No abstract text is available yet for this article.
November 18, 2014: Annals of Internal Medicine
Carlos Del Rio, Aneesh K Mehta, G Marshall Lyon, Jeannette Guarner
No abstract text is available yet for this article.
November 18, 2014: Annals of Internal Medicine
Julia Shaklee Sammons
No abstract text is available yet for this article.
July 15, 2014: Annals of Internal Medicine
Jeffrey M Rohde, Derek E Dimcheff, Neil Blumberg, Sanjay Saint, Kenneth M Langa, Latoya Kuhn, Andrew Hickner, Mary A M Rogers
IMPORTANCE: The association between red blood cell (RBC) transfusion strategies and health care-associated infection is not fully understood. OBJECTIVE: To evaluate whether RBC transfusion thresholds are associated with the risk of infection and whether risk is independent of leukocyte reduction. DATA SOURCES: MEDLINE, EMBASE, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, Cochrane Database of Sytematic Reviews, ClinicalTrials...
April 2, 2014: JAMA: the Journal of the American Medical Association
Moses Ocan, Freddie Bwanga, Godfrey S Bbosa, Danstan Bagenda, Paul Waako, Jasper Ogwal-Okeng, Celestino Obua
Self-medication with antimicrobial agents is a common form of self-care among patients globally with the prevalence and nature differing from country to country. Here we assessed the prevalence and predictors of antimicrobial self-medication in post-conflict northern Uganda. A cross-sectional study was carried out using structured interviews on 892 adult (≥18 years) participants. Information on drug name, prescriber, source, cost, quantity of drug obtained, and drug use was collected. Households were randomly selected using multistage cluster sampling method...
2014: PloS One
Sheetal Patel, Martin T Schechter, Nelson K Sewankambo, Stella Atim, Sam Lakor, Noah Kiwanuka, Patricia M Spittal
Despite growing knowledge of the dynamics of HIV infection during conflict, far less is known about the period that follows cessation of hostilities and its implications for population health. This study sought to fill a lacuna in epidemiological evidence by examining HIV infection and related vulnerabilities of young people living in resource-scarce, post-emergency transit camps that are now home to thousands of displaced people following two decades of war in northern Uganda. In 2010, a cross-sectional demographic and behavioural survey was conducted with 384 transit camp residents aged 15-29 years old in Gulu District...
2014: Global Public Health
Ploenchan Chetchotisakd, Wirongrong Chierakul, Wipada Chaowagul, Siriluck Anunnatsiri, Kriangsak Phimda, Piroon Mootsikapun, Seksan Chaisuksant, Jiraporn Pilaikul, Bandit Thinkhamrop, Sunchai Phiphitaporn, Wattanachai Susaengrat, Chalongchai Toondee, Surasakdi Wongrattanacheewin, Vanaporn Wuthiekanun, Narisara Chantratita, Janjira Thaipadungpanit, Nicholas P Day, Direk Limmathurotsakul, Sharon J Peacock
BACKGROUND: Melioidosis, an infectious disease caused by the Gram-negative bacillus Burkholderia pseudomallei, is difficult to cure. Antimicrobial treatment comprises intravenous drugs for at least 10 days, followed by oral drugs for at least 12 weeks. The standard oral regimen based on trial evidence is trimethoprim-sulfamethoxaxole (TMP-SMX) plus doxycycline. This regimen is used in Thailand but is associated with side-effects and poor adherence by patients, and TMP-SMX alone is recommended in Australia...
March 1, 2014: Lancet
Steven G Deeks, Sharon R Lewin, Diane V Havlir
The success of antiretroviral therapy has led some people to now ask whether the end of AIDS is possible. For patients who are motivated to take therapy and who have access to lifelong treatment, AIDS-related illnesses are no longer the primary threat, but a new set of HIV-associated complications have emerged, resulting in a novel chronic disease that for many will span several decades of life. Treatment does not fully restore immune health; as a result, several inflammation-associated or immunodeficiency complications such as cardiovascular disease and cancer are increasing in importance...
November 2, 2013: Lancet
Jacob A Udell, Rami Zawi, Deepak L Bhatt, Maryam Keshtkar-Jahromi, Fiona Gaughran, Arintaya Phrommintikul, Andrzej Ciszewski, Hossein Vakili, Elaine B Hoffman, Michael E Farkouh, Christopher P Cannon
IMPORTANCE: Among nontraditional cardiovascular risk factors, recent influenzalike infection is associated with fatal and nonfatal atherothrombotic events. OBJECTIVES: To determine if influenza vaccination is associated with prevention of cardiovascular events. DATA SOURCES AND STUDY SELECTION: A systematic review and meta-analysis of MEDLINE (1946-August 2013), EMBASE (1947-August 2013), and the Cochrane Library Central Register of Controlled Trials (inception-August 2013) for randomized clinical trials (RCTs) comparing influenza vaccine vs placebo or control in patients at high risk of cardiovascular disease, reporting cardiovascular outcomes either as efficacy or safety events...
October 23, 2013: JAMA: the Journal of the American Medical Association
Nicholas J White, Sasithon Pukrittayakamee, Tran Tinh Hien, M Abul Faiz, Olugbenga A Mokuolu, Arjen M Dondorp
Although global morbidity and mortality have decreased substantially, malaria, a parasite infection of red blood cells, still kills roughly 2000 people per day, most of whom are children in Africa. Two factors largely account for these decreases; increased deployment of insecticide-treated bednets and increased availability of highly effective artemisinin combination treatments. In large trials, parenteral artesunate (an artemisinin derivative) reduced severe malaria mortality by 22·5% in Africa and 34·7% in Asia compared with quinine, whereas adjunctive interventions have been uniformly unsuccessful...
February 22, 2014: Lancet
Emmanuel Ochola, Ponsiano Ocama, Christopher G Orach, Ziadah K Nankinga, Joan N Kalyango, Willi McFarland, Charles Karamagi
BACKGROUND: Worldwide 2 billion people are exposed to hepatitis B infection, 350 million have chronic infection, 65 million in sub-Saharan Africa. Uganda is highly endemic with 10% national prevalence of hepatitis B infection, rates varying across the country from 4% in the southwest and 25% in the Northeast. Childhood vaccination was rolled out in 2002, the effect of which on the burden of hepatitis B has not been examined. We determined the prevalence and risk factors for hepatitis B infection in the Northern Uganda Municipality of Gulu...
2013: BMC Public Health
Yongjun Wang, Yilong Wang, Xingquan Zhao, Liping Liu, David Wang, Chunxue Wang, Chen Wang, Hao Li, Xia Meng, Liying Cui, Jianping Jia, Qiang Dong, Anding Xu, Jinsheng Zeng, Yansheng Li, Zhimin Wang, Haiqin Xia, S Claiborne Johnston
BACKGROUND: Stroke is common during the first few weeks after a transient ischemic attack (TIA) or minor ischemic stroke. Combination therapy with clopidogrel and aspirin may provide greater protection against subsequent stroke than aspirin alone. METHODS: In a randomized, double-blind, placebo-controlled trial conducted at 114 centers in China, we randomly assigned 5170 patients within 24 hours after the onset of minor ischemic stroke or high-risk TIA to combination therapy with clopidogrel and aspirin (clopidogrel at an initial dose of 300 mg, followed by 75 mg per day for 90 days, plus aspirin at a dose of 75 mg per day for the first 21 days) or to placebo plus aspirin (75 mg per day for 90 days)...
July 4, 2013: New England Journal of Medicine
Mpiko Ntsekhe, Albertino Damasceno
The early part of the new millennium witnessed reports of a growing burden of cardiovascular disease in Sub-Saharan Africa (SSA). However the contribution of ischemic heart disease and stroke to this increasing burden relative to that caused by hypertensive heart disease, cardiomyopathy and rheumatic heart disease was not clear. Over the last decade, data from the continent has begun to clarify this issue and suggests three main points. The burden of ischemic heart disease relative to other causes of heart disease remains low particularly in the black Africans majority...
September 2013: Heart: Official Journal of the British Cardiac Society
O N Alema, D O Martin, T R Okello
BACKGROUND: Upper gastrointestinal bleeding (UGIB) is a common emergency medical condition that may require hospitalization and resuscitation, and results in high patient morbidity. Upper gastrointestinal endoscopy is the preferred investigative procedure for UGIB because of its accuracy, low rate of complication, and its potential for therapeutic interventions. OBJECTIVE: To determine the endoscopic findings in patients presenting with UGIB and its frequency among these patients according to gender and age in Lacor hospital, northern Uganda...
December 2012: African Health Sciences
Paul W Armstrong, Anthony H Gershlick, Patrick Goldstein, Robert Wilcox, Thierry Danays, Yves Lambert, Vitaly Sulimov, Fernando Rosell Ortiz, Miodrag Ostojic, Robert C Welsh, Antonio C Carvalho, John Nanas, Hans-Richard Arntz, Sigrun Halvorsen, Kurt Huber, Stefan Grajek, Claudio Fresco, Erich Bluhmki, Anne Regelin, Katleen Vandenberghe, Kris Bogaerts, Frans Van de Werf
BACKGROUND: It is not known whether prehospital fibrinolysis, coupled with timely coronary angiography, provides a clinical outcome similar to that with primary percutaneous coronary intervention (PCI) early after acute ST-segment elevation myocardial infarction (STEMI). METHODS: Among 1892 patients with STEMI who presented within 3 hours after symptom onset and who were unable to undergo primary PCI within 1 hour, patients were randomly assigned to undergo either primary PCI or fibrinolytic therapy with bolus tenecteplase (amended to half dose in patients ≥75 years of age), clopidogrel, and enoxaparin before transport to a PCI-capable hospital...
April 11, 2013: New England Journal of Medicine
Claudia Paula Heidegger, Mette M Berger, Séverine Graf, Walter Zingg, Patrice Darmon, Michael C Costanza, Ronan Thibault, Claude Pichard
BACKGROUND: Enteral nutrition (EN) is recommended for patients in the intensive-care unit (ICU), but it does not consistently achieve nutritional goals. We assessed whether delivery of 100% of the energy target from days 4 to 8 in the ICU with EN plus supplemental parenteral nutrition (SPN) could optimise clinical outcome. METHODS: This randomised controlled trial was undertaken in two centres in Switzerland. We enrolled patients on day 3 of admission to the ICU who had received less than 60% of their energy target from EN, were expected to stay for longer than 5 days, and to survive for longer than 7 days...
February 2, 2013: Lancet
2016-05-18 12:36:32
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