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Matteo Bassetti, Maddalena Peghin, Antonio Vena, Daniele Roberto Giacobbe
The treatment of multidrug-resistant Gram-negative bacteria (MDR-GNB) infections in critically ill patients presents many challenges. Since an effective treatment should be administered as soon as possible, resistance to many antimicrobial classes almost invariably reduces the probability of adequate empirical coverage, with possible unfavorable consequences. In this light, readily available patient's medical history and updated information about the local microbiological epidemiology remain critical for defining the baseline risk of MDR-GNB infections and firmly guiding empirical treatment choices, with the aim of avoiding both undertreatment and overtreatment...
2019: Frontiers in Medicine
William T Davis, Tim Montrief, Alex Koyfman, Brit Long
INTRODUCTION: Patients with acute myocardial infarction (AMI) may suffer several complications after the acute event, including dysrhythmias and heart failure (HF). These complications place patients at risk for morbidity and mortality. OBJECTIVE: This narrative review evaluates literature and guideline recommendations relevant to the acute emergency department (ED) management of AMI complicated by dysrhythmia or HF, with a focus on evidence-based considerations for ED interventions...
April 27, 2019: American Journal of Emergency Medicine
James Brian Byrd, Robert D Brook
Recent guidelines on diagnosis and management of high blood pressure (BP) include substantial changes and several new concepts compared with previous guidelines. These are reviewed and their clinical implications are discussed in this article. The goal is to provide a practical reference to assist clinicians with up-to-date management of patients with high BP. Important issues include new diagnostic thresholds, out-of-office BP monitoring, intensified treatment goals, and a different approach to resistant hypertension...
May 7, 2019: Annals of Internal Medicine
Katie Linden, Conor McQuillan, Paul Brennan, Ian B A Menown
INTRODUCTION: Many important clinical trials in cardiology were published or presented at major international meetings throughout 2018. This paper aims to offer a concise overview of these significant advances and to put them into clinical context. METHODS: Trials presented at the major international cardiology meetings during 2018 were reviewed including The American College of Cardiology, EuroPCR, The European Society of Cardiology, PCR London Valves, Transcatheter Cardiovascular Therapeutics, and the American Heart Association...
May 7, 2019: Advances in Therapy
Paul A Gurbel, Keith A A Fox, Udaya S Tantry, Hugo Ten Cate, Jeffrey I Weitz
Antiplatelet therapy is the mainstay for the treatment of acute and chronic arterial disease involving the coronary and peripheral beds. However, questions remain about optimal antithrombotic therapy for long-term treatment of chronic vascular disease. The observation that dual antiplatelet therapy with acetylsalicylic acid and clopidogrel was associated with lower thrombotic event rates than acetylsalicylic acid monotherapy in patients with acute coronary syndromes and those undergoing percutaneous coronary intervention changed the treatment paradigm...
April 30, 2019: Circulation
Marie Warrer Petersen, Anders Perner, Fredrik Sjövall, Andreas Bender Jonsson, Morten Steensen, Jakob Steen Andersen, Michael Patrick Achiam, Niels Frimodt-Møller, Morten Hylander Møller
INTRODUCTION: Early empirical broad-spectrum antimicrobial therapy is recommended for patients with severe infections, including sepsis. β-lactam/β-lactamase inhibitor combinations or carbapenems are often used to ensure coverage of likely pathogens. Piperacillin/tazobactam is proposed as a carbapenem-sparing agent to reduce the incidence of multidrug-resistant bacteria and superinfections. In the recently published MERINO trial, increased mortality from piperacillin/tazobactam was suggested in patients with bacteraemia with resistant Escherichia coli or Klebsiella species...
April 24, 2019: Acta Anaesthesiologica Scandinavica
Joaquín Rodríguez Sánchez, Mónica Sánchez Alonso, María Pellisé Urquiza
No abstract text is available yet for this article.
May 9, 2019: Endoscopy
Laura M Mazer, George A Poultsides
Cancer of the gastroesophageal junction (GEJ) is increasing in incidence, likely as a result of rising obesity and gastroesophageal reflux disease rates. The tumors that arise here share features of esophageal and gastric cancer, and are classified based on their location in relationship to the GEJ. The definition of the GEJ itself, as well as optimal resection strategy, extent of lymph node dissection, resection margin length, and reconstruction methods are still very much a subject of debate. This article summarizes the available evidence on this topic, and highlights specific areas for further research...
June 2019: Surgical Clinics of North America
Henry Ma, Bruce C V Campbell, Mark W Parsons, Leonid Churilov, Christopher R Levi, Chung Hsu, Timothy J Kleinig, Tissa Wijeratne, Sami Curtze, Helen M Dewey, Ferdinand Miteff, Chon-Haw Tsai, Jiunn-Tay Lee, Thanh G Phan, Neil Mahant, Mu-Chien Sun, Martin Krause, Jonathan Sturm, Rohan Grimley, Chih-Hung Chen, Chaur-Jong Hu, Andrew A Wong, Deborah Field, Yu Sun, P Alan Barber, Arman Sabet, Jim Jannes, Jiann-Shing Jeng, Benjamin Clissold, Romesh Markus, Ching-Huang Lin, Li-Ming Lien, Christopher F Bladin, Søren Christensen, Nawaf Yassi, Gagan Sharma, Andrew Bivard, Patricia M Desmond, Bernard Yan, Peter J Mitchell, Vincent Thijs, Leeanne Carey, Atte Meretoja, Stephen M Davis, Geoffrey A Donnan
BACKGROUND: The time to initiate intravenous thrombolysis for acute ischemic stroke is generally limited to within 4.5 hours after the onset of symptoms. Some trials have suggested that the treatment window may be extended in patients who are shown to have ischemic but not yet infarcted brain tissue on imaging. METHODS: We conducted a multicenter, randomized, placebo-controlled trial involving patients with ischemic stroke who had hypoperfused but salvageable regions of brain detected on automated perfusion imaging...
May 9, 2019: New England Journal of Medicine
Stuart J Pocock, Tim J Collier
In the past 12 months, many important new clinical trials in cardiology have had their first conference presentation and publication. This paper presents a constructive critical appraisal of 6 key studies. In time order of first presentation, they are CABANA, ATTR-ACT, COAPT, DECLARE, REDUCE-IT, and AUGUSTUS. For each study, the aim herein is to document and interpret the main findings, paying attention to new findings, their research context, and study limitations. These topical examples also provide methodological insights pertinent to future clinical trials research...
April 29, 2019: Journal of the American College of Cardiology
Megan Jaynes, Avinash B Kumar
Proton pump inhibitors (PPIs) are among the most frequently prescribed medications. Their use is likely even higher than estimated due to an increase in the number of PPIs available without a prescription. Appropriate indications for PPI use include Helicobacter pylori infection, erosive esophagitis, gastric ulcers, and stress ulcer prevention in high-risk critically ill patients. Unfortunately, PPIs are often used off-label for extended periods of time. This increase in PPI usage over the past two decades has called into question the long-term effects of these medications...
2019: Therapeutic Advances in Drug Safety
Kalani L Raphael
Maintenance of normal acid-base homeostasis is one of the most important kidney functions. In chronic kidney disease, the capacity of the kidneys to excrete the daily acid load as ammonium and titratable acid is impaired, resulting in acid retention and metabolic acidosis. The prevalence of metabolic acidosis increases with declining glomerular filtration rate. Metabolic acidosis is associated with several clinically important complications, including chronic kidney disease progression, bone demineralization, skeletal muscle catabolism, and mortality...
April 26, 2019: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Wenjuan Zhang, Lei Xu, Tingting Luo, Feng Wu, Bin Zhao, Xianqi Li
Bell's palsy is the most common condition involving a rapid and unilateral onset of peripheral paresis/paralysis of the seventh cranial nerve. It affects 11.5-53.3 per 100,000 individuals a year across different populations. Bell's palsy is a health issue causing concern and has an extremely negative effect on both patients and their families. Therefore, diagnosis and prompt cause determination are key for early treatment. However, the etiology of Bell's palsy is unclear, and this affects its treatment. Thus, it is critical to determine the causes of Bell's palsy so that targeted treatment approaches can be developed and employed...
March 28, 2019: Journal of Neurology
Laszlo Littmann, Elizabeth G Olson, Michael A Gibbs
The evaluation and treatment of wide QRS-complex tachycardia remains a challenge, and mismanagement is quite common. Diagnostic aids such as wide-complex tachycardia algorithms perform poorly in the real-life setting. The purpose of this review is to offer a simple clinical-electrocardiographic approach for the initial evaluation and management of the adult patient with stable wide-complex tachycardia that does not require recollection of complex guidelines or algorithms.
April 12, 2019: American Journal of Emergency Medicine
P Syamasundar Rao
Since the description of surgery for patent ductus arteriosus in late 1930s, an innumerable number of advances have taken place in the management of congenital heart defects (CHDs). In this review the current status of treatment of seven of the most common acyanotic CHDs was reviewed. The discussion included indications for, and timing of, intervention and methods of intervention. The indications are, by and large, determined by the severity of the lesion. Pressure gradients in obstructive lesions and the magnitude of the shunt in left-to-right shunt lesions are used to assess the severity of the lesion...
March 8, 2019: Children
Emanuele Durante-Mangoni, Roberto Andini, Rosa Zampino
BACKGROUND: Carbapenem resistance is defined as in vitro nonsusceptibility to any carbapenem and/or documented production of a carbapenemase. This feature has rapidly spread worldwide among clinical isolates of Enterobacteriaceae, mostly Klebsiella spp, and is associated with diverse molecular mechanisms. Carbapenem resistance is often associated with resistance to all traditional beta-lactams and other classes of antibiotics, denoting a typical example of extensively drug-resistant phenotype...
April 17, 2019: Clinical Microbiology and Infection
P Syamasundar Rao
In this review management of the most common cyanotic congenital heart defects (CHDs) was discussed; the management of acyanotic CHD was reviewed in Part I of this series. While the need for intervention in acyanotic CHD is by and large determined by the severity of the lesion, most cyanotic CHDs require intervention, mostly by surgery. Different types of tetralogy of Fallot require different types of total surgical corrective procedures, and some may require initial palliation, mainly by modified Blalock-Taussig shunts...
April 4, 2019: Children
Andrew A House, Christoph Wanner, Mark J Sarnak, Ileana L Piña, Christopher W McIntyre, Paul Komenda, Bertram L Kasiske, Anita Deswal, Christopher R deFilippi, John G F Cleland, Stefan D Anker, Charles A Herzog, Michael Cheung, David C Wheeler, Wolfgang C Winkelmayer, Peter A McCullough
The incidence and prevalence of heart failure (HF) and chronic kidney disease (CKD) are increasing, and as such a better understanding of the interface between both conditions is imperative for developing optimal strategies for their detection, prevention, diagnosis, and management. To this end, Kidney Disease: Improving Global Outcomes (KDIGO) convened an international, multidisciplinary Controversies Conference titled Heart Failure in CKD. Breakout group discussions included (i) HF with preserved ejection fraction (HFpEF) and nondialysis CKD, (ii) HF with reduced ejection fraction (HFrEF) and nondialysis CKD, (iii) HFpEF and dialysis-dependent CKD, (iv) HFrEF and dialysis-dependent CKD, and (v) HF in kidney transplant patients...
April 30, 2019: Kidney International
Jeaneth Indira Gonzalez Ayerbe, Bruno Hauser, Silvia Salvatore, Yvan Vandenplas
The diagnosis and management of gastro-esophageal reflux (GER) and GER disease (GERD) in infants and children remains a challenge. Published guidelines and position papers, along with Embase, MEDLINE, and the Cochrane Database were reviewed and summarized with the intent to propose a practical approach and management of GER and GERD for healthcare providers and to standardize and improve the quality of care for infants and children. For this purpose, 2 algorithms were developed, 1 for infants <12 months of age and the other for older children...
March 2019: Pediatric Gastroenterology, Hepatology & Nutrition
2019-05-13 00:24:58
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