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Jonathan Gordon Best, Robert Bell, Mohammed Haque, Arvind Chandratheva, David John Werring
Neurologists and stroke physicians will be familiar with atrial fibrillation as a major cause of ischaemic stroke, and the role of anticoagulation in preventing cardioembolic stroke. However, making decisions about anticoagulation for individual patients remains a difficult area of clinical practice, balancing the serious risk of ischaemic stroke against that of major bleeding, particularly intracranial haemorrhage. Atrial fibrillation management requires interdisciplinary collaboration with colleagues in cardiology and haematology...
March 2, 2019: Practical Neurology
Anders Hviid, Jørgen Vinsløv Hansen, Morten Frisch, Mads Melbye
Background: The hypothesized link between the measles, mumps, rubella (MMR) vaccine and autism continues to cause concern and challenge vaccine uptake. Objective: To evaluate whether the MMR vaccine increases the risk for autism in children, subgroups of children, or time periods after vaccination. Design: Nationwide cohort study. Setting: Denmark. Participants: 657 461 children born in Denmark from 1999 through 31 December 2010, with follow-up from 1 year of age and through 31 August 2013...
March 5, 2019: Annals of Internal Medicine
Vincent Cottin, Lutz Wollin, Aryeh Fischer, Manuel Quaresma, Susanne Stowasser, Sergio Harari
Patients with certain types of fibrosing interstitial lung disease (ILD) are at risk of developing a progressive phenotype characterised by self-sustaining fibrosis, decline in lung function, worsening quality of life, and early mortality. It has been proposed that such progressive fibrosing ILDs, which show commonalities in clinical behaviour and in the pathogenetic mechanisms that drive progressive fibrosis, may be "lumped" together for the purposes of clinical research and, potentially, for treatment...
March 31, 2019: European Respiratory Review: An Official Journal of the European Respiratory Society
Brian E Driver, Lauren R Klein, Matthew E Prekker, Jon Cole, Rajesh Satpathy, Gautham Kartha, Aaron Robinson, James R Miner, Robert F Reardon
BACKGROUND: The optimal order of drug administration (sedative first versus neuromuscular blocking agent first) in rapid sequence intubation (RSI) is debated. STUDY OBJECTIVE: We sought to determine if RSI drug order was associated with the time elapsed from administration of the first RSI drug to the end of a successful first intubation attempt. METHODS: We conducted a planned secondary analysis of a randomized trial of adult ED patients undergoing emergency orotracheal intubation that demonstrated higher first attempt success with bougie use compared to a tracheal tube + stylet...
March 4, 2019: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Janani Rangaswami, Vivek Bhalla, John E A Blair, Tara I Chang, Salvatore Costa, Krista L Lentine, Edgar V Lerma, Kenechukwu Mezue, Mark Molitch, Wilfried Mullens, Claudio Ronco, W H Wilson Tang, Peter A McCullough
Cardiorenal syndrome encompasses a spectrum of disorders involving both the heart and kidneys in which acute or chronic dysfunction in 1 organ may induce acute or chronic dysfunction in the other organ. It represents the confluence of heart-kidney interactions across several interfaces. These include the hemodynamic cross-talk between the failing heart and the response of the kidneys and vice versa, as well as alterations in neurohormonal markers and inflammatory molecular signatures characteristic of its clinical phenotypes...
March 11, 2019: Circulation
Nozomi Watanabe
The diagnosis of acute mitral regurgitation (MR) is often missed or delayed because the clinical presentation is substantially different from that in patients with chronic MR. Management of acute MR depends on the specific aetiology of valve dysfunction and there is a lack of consensus on the optimal therapeutic approach in many patients. In particular, management of secondary MR due to acute ischaemia is challenging because of unique mechanisms of valve incompetence compared with chronic ischaemic MR. Another clinical challenge is management of acute MR due to transient systolic anterior motion of the mitral valve in the acute phase of Takotsubo cardiomyopathy, which commonly resolves within a few weeks...
March 1, 2019: Heart: Official Journal of the British Cardiac Society
Craig M Riley, Frank C Sciurba
Importance: There are 30 million adults (12%) in the United States who have chronic obstructive pulmonary disease (COPD). Chronic obstructive pulmonary disease accounts for 3.2% of all physician office visits annually and is the fourth leading cause of death (126 000 deaths per year). Most patients are diagnosed by their primary care clinicians who must address the highly variable clinical features and responses to therapy. The diagnosis and treatment of COPD is rapidly changing, so understanding recent advances is important for the delivery of optimal patient care...
February 26, 2019: JAMA: the Journal of the American Medical Association
Chao Liu, Guangming Lu, Dong Wang, Yi Lei, Zhi Mao, Pan Hu, Jie Hu, Rui Liu, Dong Han, Feihu Zhou
INTRODUCTION: Fluid resuscitation is a fundamental component of the management of critically ill patients, but whether choice of crystalloid affects patient outcomes remains controversial. Therefore, we performed this meta-analysis to compare the efficacy and safety of balanced crystalloids with normal saline. METHODS: We searched the MEDLINE, Cochrane Central and EMBASE up to October 2018 to identify randomized controlled trials (RCTs) that compared balanced crystalloids versus normal saline in critically ill patients...
March 1, 2019: American Journal of Emergency Medicine
Milena K Pavlova, Véronique Latreille
Sleep disorders are frequent and can have serious consequences on patients' health and quality of life. While some sleep disorders are more challenging to treat, most can be easily managed with adequate interventions. We review the main diagnostic features of 6 major sleep disorders (insomnia, circadian rhythm disorders, sleep-disordered breathing, hypersomnia/narcolepsy, parasomnias, and restless legs syndrome/periodic limb movement disorder) to aid medical practitioners in screening and treating sleep disorders as part of clinical practice...
October 4, 2018: American Journal of Medicine
Peter B Soeters, Robert R Wolfe, Alan Shenkin
Hypoalbuminemia is associated with inflammation. Despite being addressed repeatedly in the literature, there is still confusion regarding its pathogenesis and clinical significance. Inflammation increases capillary permeability and escape of serum albumin, leading to expansion of interstitial space and increasing the distribution volume of albumin. The half-life of albumin has been shown to shorten, decreasing total albumin mass. These 2 factors lead to hypoalbuminemia despite increased fractional synthesis rates in plasma...
October 4, 2018: JPEN. Journal of Parenteral and Enteral Nutrition
François Dépret, W Frank Peacock, Kathleen D Liu, Zubaid Rafique, Patrick Rossignol, Matthieu Legrand
PURPOSE: To review the mechanisms of action, expected efficacy and side effects of strategies to control hyperkalemia in acutely ill patients. METHODS: We searched MEDLINE and EMBASE for relevant papers published in English between Jan 1, 1938, and July 1, 2018, in accordance with the PRISMA Statement using the following terms: "hyperkalemia," "intensive care," "acute kidney injury," "acute kidney failure," "hyperkalemia treatment," "renal replacement therapy," "dialysis," "sodium bicarbonate," "emergency," "acute...
February 28, 2019: Annals of Intensive Care
Xiaozhi Qin, Ennan Fang, Megumi Narisawa, Xian Wu Cheng
No abstract text is available yet for this article.
February 26, 2019: Circulation
Shazli Azmi, Maryam Ferdousi, Alise Kalteniece, Hamad Al-Muhannadi, Abdulrahman Al-Mohamedi, Nebras H Hadid, Salah Mahmoud, Harun A Bhat, Hoda Y A Gad, Adnan Khan, Georgios Ponirakis, Ioannis N Petropoulos, Uazman Alam, Rayaz A Malik
The diagnosis and management of diabetic neuropathy can be a major challenge. Late diagnosis contributes to significant morbidity in the form of painful diabetic neuropathy, foot ulceration, amputation, and increased mortality. Both hyperglycaemia and cardiovascular risk factors are implicated in the development of somatic and autonomic neuropathy and an improvement in these risk factors can reduce their rate of development and progression. There are currently no US Food and Drug Administration (FDA)-approved disease-modifying treatments for either somatic or autonomic neuropathy, as a consequence of multiple failed phase III clinical trials...
2019: Therapeutic Advances in Endocrinology and Metabolism
Virginia Hernández-Gea, Andrea De Gottardi, Frank W G Leebeek, Pierre-Emmanuel Rautou, Riad Salem, Juan Carlos Garcia-Pagan
Budd-Chiari Syndrome (BCS) and non-cirrhotic non-tumoral portal vein thrombosis (NCPVT) are two rare disorders, with several similarities that are categorized under the term splanchnic vein thrombosis. Both disorders are frequently associated with an underlying pro-thrombotic disorder. They can cause severe portal hypertension and usually affect oung patients, negatively influencing life expectancy when the diagnosis and treatment is not done at an early stage. Yet, they have specific features that require individual considerations...
February 26, 2019: Journal of Hepatology
Trisha M Parab, Michael J DeRogatis, Alexander M Boaz, Salvatore A Grasso, Paul S Issack, David A Duarte, Olivier Urayeneza, Saloomeh Vahdat, Jian-Hua Qiao, Gudata S Hinika
Gastrointestinal stromal tumors (GISTs) are rare neoplasms of the gastrointestinal tract associated with high rates of malignant transformation. Most GISTs present asymptomatically. They are best identified by computed tomography (CT) scan and most stain positive for CD117 (C-Kit), CD34, and/or DOG-1. There have been many risk stratification classifications systems which are calculated based on tumor size, mitotic rate, location, and perforation. The approaches to treating GISTs are to resect primary low-risk tumors, resect high-risk primary or metastatic tumors with imatinib 400 mg daily for 12 months, or if the tumor is unresectable, neoadjuvant imatinib 400 mg daily followed by surgical resection is recommended...
February 2019: Journal of Gastrointestinal Oncology
Sidra Azim, Christian Nasr
Subclinical hypothyroidism is defined by an elevated serum thyroid-stimulating hormone (TSH) level along with a normal free thyroxine (T4 ) level. Whether it should be treated remains controversial. Currently, the best practical approach is to base treatment decisions on the degree of TSH elevation, thyroid autoimmunity, and associated comorbidities.
February 2019: Cleveland Clinic Journal of Medicine
Corey Heitz, Justin Morgenstern, Christopher Bond, William K Milne
Atrial fibrillation is the most common cardiac dysthrymia. Several rate-control strategies have been used, and magnesium sulfate has been investigated as an adjunct. In this review, we look at a trial by Bouida et al in which magnesium sulfate was studied in two different doses for rate control in atrial fibrillation. In addition, we review the social media commentary in response to the Skeptics Guide of Emergency Medicine Hot of the Press podcast. This article is protected by copyright. All rights reserved...
February 27, 2019: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Brendan O'Connell, Nicholas Martin Wragg, Samantha Louise Wilson
Osteoarthritis (OA) is a degenerative disease involving joint damage, an inadequate healing response and progressive deterioration of the joint architecture that commonly affects the knee and/or hip joints. It is a major world public health problem and is predicted to increase rapidly with an ageing population and escalating rate of obesity. Autologous blood-derived products possess much promise in the repair and regeneration of tissue and have important roles in inflammation, angiogenesis, cell migration and metabolism in pathological conditions, including OA...
February 13, 2019: Cell and Tissue Research
Katharina Mattishent, Menaka Thavarajah, Ashnish Sinha, Adam Peel, Matthias Egger, Joseph Solomkin, Stijn de Jonge, Asad Latif, Sean Berenholtz, Benedetta Allegranzi, Yoon Kong Loke
BACKGROUND: Evidence-based guidelines from the World Health Organization (WHO) have recommended a high (80%) fraction of inspired oxygen (FiO2 ) to reduce surgical site infection in adult surgical patients undergoing general anaesthesia with tracheal intubation. However, there is ongoing debate over the safety of high FiO2 . We performed a systematic review to define the relative risk of clinically relevant adverse events (AE) associated with high FiO2 . METHODS: We reviewed potentially relevant articles from the WHO review supporting the recommendation, including an updated (July 2018) search of EMBASE and PubMed for randomised and non-randomised controlled studies reporting AE in surgical patients receiving 80% FiO2 compared with 30-35% FiO2 ...
March 2019: British Journal of Anaesthesia
J A W Polderman, V Farhang-Razi, S van Dieren, P Kranke, J H DeVries, M W Hollmann, B Preckel, J Hermanides
In the peri-operative period, dexamethasone is widely and effectively used for prophylaxis of postoperative nausea and vomiting. The objective of this meta-analysis was to assess the adverse effects of an incidental steroid load of dexamethasone in adult surgical patients. We searched in MEDLINE, Embase, the Cochrane Central Register of Controlled Trials and the Web of Science for randomised controlled trials comparing an incidental steroid load of dexamethasone with a control intervention in adult patients undergoing surgery...
March 1, 2019: Anaesthesia
2019-03-11 00:24:58
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