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121 papers 25 to 100 followers
James F Doyle, Lui G Forni
Sepsis-associated acute kidney injury (SA-AKI) is an independent predictor of increased mortality and morbidity. It is essential that further advances in the treatment of sepsis should prioritize targeted therapies in SA-AKI in order to improve these bleak outcomes. As yet, a unique therapy that effectively reduces the impact of acute kidney injury has not been demonstrated. However, the emergence of novel targeted therapies, perhaps in combination, has the possibility of significantly reducing the long-term sequelae of an episode of SA-AKI...
2016: Biologics: Targets & Therapy
Anne-Maree Kelly, Sharon Klim
BACKGROUND: To determine the rate of all cause and cardiac death, new myocardial infarction (MI) or coronary revascularisation at over three years from index visit in emergency department chest pain patients without known coronary artery disease (CAD) at index presentation who had a negative electrocardiogram (ECG) and biomarker workup for acute coronary syndrome (ACS). METHODS: An unplanned sub-study of a prospective observational study of consecutive adult patients presenting to the ED with atraumatic chest pain (or equivalents)...
September 13, 2016: Heart, Lung & Circulation
Alberto Conti, Simone Bianchi, Caterina Grifoni, Federica Trausi, Sofia Bigiarini, Delia Lazzeretti, Elena Angeli, Francesca Innocenti, Stefano Grifoni
BACKGROUND: The novel analysis of high-frequency QRS components (HF/QRS) has been proposed in patients with chest pain (CP) referred for exercise tolerance test (ex-ECG). We sought to evaluate the prognostic role of exercise high-frequency QRS-analysis (ex-HF/QRS) in patients with recent-onset stable CP, in the emergency setting. METHODS: Patients with CP underwent ex-ECG. A decrease greater than or equal to 50% of the signal of HF/QRS intensity was considered as index of ischemia as ST-segment depression greater than or equal to 2 mm or greater than or equal to 1 mm associated with CP...
March 2016: American Journal of Emergency Medicine
Clint L Miller, Milos Pjanic, Ting Wang, Trieu Nguyen, Ariella Cohain, Jonathan D Lee, Ljubica Perisic, Ulf Hedin, Ramendra K Kundu, Deshna Majmudar, Juyong B Kim, Oliver Wang, Christer Betsholtz, Arno Ruusalepp, Oscar Franzén, Themistocles L Assimes, Stephen B Montgomery, Eric E Schadt, Johan L M Björkegren, Thomas Quertermous
Coronary artery disease (CAD) is the leading cause of mortality and morbidity, driven by both genetic and environmental risk factors. Meta-analyses of genome-wide association studies have identified >150 loci associated with CAD and myocardial infarction susceptibility in humans. A majority of these variants reside in non-coding regions and are co-inherited with hundreds of candidate regulatory variants, presenting a challenge to elucidate their functions. Herein, we use integrative genomic, epigenomic and transcriptomic profiling of perturbed human coronary artery smooth muscle cells and tissues to begin to identify causal regulatory variation and mechanisms responsible for CAD associations...
July 8, 2016: Nature Communications
Daniel S Strand, Daejin Kim, David A Peura
Proton pump inhibitors (PPIs) were clinically introduced more than 25 years ago and have since proven to be invaluable, safe, and effective agents for the management of a variety of acid-related disorders. Although all members in this class act in a similar fashion, inhibiting active parietal cell acid secretion, there are slight differences among PPIs relating to their pharmacokinetic properties, metabolism, and Food and Drug Administration (FDA)-approved clinical indications. Nevertheless, each is effective in managing gastroesophageal reflux disease and uncomplicated or complicated peptic ulcer disease...
November 14, 2016: Gut and Liver
Luis A Serrano, Erik P Hess, M Fernanda Bellolio, Mohammed H Murad, Victor M Montori, Patricia J Erwin, Wyatt W Decker
STUDY OBJECTIVE: We assess the methodological quality and prognostic accuracy of clinical decision rules in emergency department (ED) syncope patients. METHODS: We searched 6 electronic databases, reviewed reference lists of included studies, and contacted content experts to identify articles for review. Studies that derived or validated clinical decision rules in ED syncope patients were included. Two reviewers independently screened records for relevance, selected studies for inclusion, assessed study quality, and abstracted data...
October 2010: Annals of Emergency Medicine
Qi Fu, Benjamin D Levine
Syncope is a common clinical condition occurring even in otherwise healthy people without underlying cardiovascular disease. Neurally mediated syncope is by far the most common cause of syncope in individuals without any structural heart disease. Based on traditional wisdom, loss of sympathetic tone with relaxation of vascular smooth muscle is the key mechanism underlying the pathophysiology of syncope, especially in patients without an acute decrease in heart rate. However, this concept has recently been challenged...
September 2014: Autonomic Neuroscience: Basic & Clinical
Christian Meyer, Paulo Carvalho, Christoph Brinkmeyer, Malte Kelm, Ricardo Couceiro, Jens Mühlsteff
Syncope is a common disorder with a lifetime prevalence of about 40%. Implantable cardiac electronic devices, including implantable loop recorders (ILR) and implantable cardioverter-defibrillators (ICD), are well established in syncope management. However, despite the successful use of ILR and ICD, diagnosis and therapy still remain challenging in many patients due to the complex hemodynamic interplay of cardiac and vascular adaptations during impending syncopes. Wearable sensors might overcome some limitations, including misdiagnosis and inappropriate defibrillator shocks, because a variety of physiological measures can now be easily acquired by a single non-invasive device at high signal quality...
January 22, 2015: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
Monica Solbiati, Giovanni Casazza, Franca Dipaola, Anna Maria Rusconi, Giulia Cernuschi, Franca Barbic, Nicola Montano, Robert Stanley Sheldon, Raffaello Furlan, Giorgio Costantino
AIMS: Data on adverse events and death rates following syncope are heterogeneous among studies, and knowledge of syncope prognosis could help to better define the correct management of patients. METHODS AND RESULTS: We performed a systematic review of literature by searching for prospective observational studies enrolling consecutive patients presenting to the Emergency Department because of syncope. The outcomes considered were syncope recurrence and short- and long-term mortality...
February 2015: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
David O Arnar
Syncope is a common condition. It is frequently due to a benign cause, but may occasionally be due to a potentially life-threatening disorder. The presence of structural heart disease in patients with syncope is associated with a poor prognosis and may be a predictor of sudden cardiac death. In patients who present with syncope, the presence of structural heart disease and primary electrophysiological disorders should be considered and further cardiac evaluation performed as indicated by the clinical history, physical examination and electrocardiographic findings...
April 2013: Journal of Internal Medicine
Michele Brignole, Mohamed H Hamdan
Significant progress has been made in the past 3 decades in our understanding of the various causes of loss of consciousness thanks to the publication of several important studies and guidelines. In particular, the recent European Society of Cardiology guidelines provide a reference standard for optimal quality service delivery. This paper gives the reader brief guidance on how to manage a patient with syncope, with reference to the above guidelines. Despite the progress made, the management of patients with syncope remains largely unsatisfactory because of the presence of a significant gap between knowledge and its application...
May 1, 2012: Journal of the American College of Cardiology
David G Benditt, Brian Olshansky, Wouter Wieling
No abstract text is available yet for this article.
December 19, 2006: Journal of the American College of Cardiology
Camiron L Pfennig, Corey M Slovis
Identifying and correcting sodium abnormalities is critical, since suboptimal management potentially leads to substantial morbidity and mortality. Manifestations of hyponatremia, which is one of the more common electrolyte abnormalities in clinical medicine, depend on multiple factors, including the chronicity of the symptoms, the absolute level of sodium, and the patient's overall health. In symptomatic hyponatremia, emergency clinicians must understand the importance of determining the proper rate of sodium correction in order to avoid encephalopathy, cerebral edema, and death...
October 2012: Emergency Medicine Practice
Ramin Sam, Iraj Feizi
Understanding hypernatremia is at times difficult for many clinicians. However, hypernatremia can often be deciphered easily with some basic understanding of water and sodium balance. Here, the basic pathophysiological abnormalities underlying the development of sodium disorders are reviewed, and case examples are given. Hypernatremia often arises in the hospital, especially in the intensive care units due to the combination of (1) not being able to drink water; (2) inability to concentrate the urine (most often from having kidney failure); (3) osmotic diuresis from having high serum urea concentrations, and (4) large urine or stool outputs...
2012: American Journal of Nephrology
Csaba P Kovesdy
Both hypo- and hypernatremia are common conditions, especially in hospitalized patients and in patients with various comorbid conditions such as congestive heart failure or liver cirrhosis. Abnormal serum sodium levels have been associated with increased mortality in numerous observational studies. Patients with chronic kidney disease (CKD) represent a group with a high prevalence of comorbid conditions that could predispose to dysnatremias. In addition, the failing kidney is also characterized by a gradual development of hyposthenuria, and even isosthenuria, which results in further predisposition to the development of hypo- and hypernatremia in those with advancing stages of CKD...
March 2012: Nephrology, Dialysis, Transplantation
Airton Leonardo de Oliveira Manoel, Alberto Goffi, Fernando Godinho Zampieri, David Turkel-Parrella, Abhijit Duggal, Thomas R Marotta, R Loch Macdonald, Simon Abrahamson
Spontaneous intracerebral hemorrhage (ICH), defined as nontraumatic bleeding into the brain parenchyma, is the second most common subtype of stroke, with 5.3 million cases and over 3 million deaths reported worldwide in 2010. Case fatality is extremely high (reaching approximately 60 % at 1 year post event). Only 20 % of patients who survive are independent within 6 months. Factors such as chronic hypertension, cerebral amyloid angiopathy, and anticoagulation are commonly associated with ICH. Chronic arterial hypertension represents the major risk factor for bleeding...
September 18, 2016: Critical Care: the Official Journal of the Critical Care Forum
Surat Tongyoo, Chairat Permpikul, Wasineenart Mongkolpun, Veerapong Vattanavanit, Suthipol Udompanturak, Mehmet Kocak, G Umberto Meduri
BACKGROUND: Authors of recent meta-analyses have reported that prolonged glucocorticoid treatment is associated with significant improvements in patients with severe pneumonia or acute respiratory distress syndrome (ARDS) of multifactorial etiology. A prospective randomized trial limited to patients with sepsis-associated ARDS is lacking. The objective of our study was to evaluate the efficacy of hydrocortisone treatment in sepsis-associated ARDS. METHODS: In this double-blind, single-center (Siriraj Hospital, Bangkok), randomized, placebo-controlled trial, we recruited adult patients with severe sepsis within 12 h of their meeting ARDS criteria...
October 15, 2016: Critical Care: the Official Journal of the Critical Care Forum
Mohd Raffiz, Jafri M Abdullah
INTRODUCTION: Bedside ultrasound measurement of optic nerve sheath diameter (ONSD) is emerging as a non-invasive technique to evaluate and predict raised intracranial pressure (ICP). It has been shown in previous literature that ONSD measurement has good correlation with surrogate findings of raised ICP such as clinical and radiological findings suggestive of raised ICP. OBJECTIVES: The objective of the study is to find a correlation between sonographic measurements of ONSD value with ICP value measured via the gold standard invasive intracranial ICP catheter, and to find the cut-off value of ONSD measurement in predicting raised ICP, along with its sensitivity and specificity value...
September 23, 2016: American Journal of Emergency Medicine
Biykem Bozkurt, Monica Colvin, Jennifer Cook, Leslie T Cooper, Anita Deswal, Gregg C Fonarow, Gary S Francis, Daniel Lenihan, Eldrin F Lewis, Dennis M McNamara, Elfriede Pahl, Vasan S Ramachandran, Kumudha Ramasubbu, Kismet Rasmusson, Jeffrey A Towbin, Clyde Yancy
No abstract text is available yet for this article.
November 3, 2016: Circulation
Eugene Braunwald
No abstract text is available yet for this article.
October 31, 2016: New England Journal of Medicine
2016-11-24 19:14:29
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