Jane A H Masoli, Frances A Kirkham, Chakravarthi Rajkumar
No abstract text is available yet for this article.
March 10, 2021: Age and Ageing
Aurélien Dinh, Jacques Ropers, Clara Duran, Benjamin Davido, Laurène Deconinck, Morgan Matt, Olivia Senard, Aurore Lagrange, Sabrina Makhloufi, Guillaume Mellon, Victoire de Lastours, Frédérique Bouchand, Emmanuel Mathieu, Jean-Emmanuel Kahn, Elisabeth Rouveix, Julie Grenet, Jennifer Dumoulin, Thierry Chinet, Marion Pépin, Véronique Delcey, Sylvain Diamantis, Daniel Benhamou, Virginie Vitrat, Marie-Christine Dombret, Bertrand Renaud, Christian Perronne, Yann-Erick Claessens, José Labarère, Jean-Pierre Bedos, Philippe Aegerter, Anne-Claude Crémieux
BACKGROUND: Shortening the duration of antibiotic therapy for patients admitted to hospital with community-acquired pneumonia should help reduce antibiotic consumption and thus bacterial resistance, adverse events, and related costs. We aimed to assess the need for an additional 5-day course of β-lactam therapy among patients with community-acquired pneumonia who were stable after 3 days of treatment. METHODS: We did this double-blind, randomised, placebo-controlled, non-inferiority trial (the Pneumonia Short Treatment [PTC]) in 16 centres in France...
March 27, 2021: Lancet
M Christ-Crain, B Winzeler, J Refardt
Diabetes insipidus is a disorder characterized by excretion of large amounts of hypotonic urine. Four entities have to be differentiated: central diabetes insipidus resulting from a deficiency of the hormone arginine vasopressin (AVP) in the pituitary gland or the hypothalamus, nephrogenic diabetes insipidus resulting from resistance to AVP in the kidneys, gestational diabetes insipidus resulting from an increase in placental vasopressinase and finally primary polydipsia, which involves excessive intake of large amounts of water despite normal AVP secretion and action...
March 13, 2021: Journal of Internal Medicine
Giacomo Grasselli, Emanuele Cattaneo, Gaetano Florio, Mariachiara Ippolito, Alberto Zanella, Andrea Cortegiani, Jianbo Huang, Antonio Pesenti, Sharon Einav
BACKGROUND: The mortality of critically ill patients with COVID-19 is high, particularly among those receiving mechanical ventilation (MV). Despite the high number of patients treated worldwide, data on respiratory mechanics are currently scarce and the optimal setting of MV remains to be defined. This scoping review aims to provide an overview of available data about respiratory mechanics, gas exchange and MV settings in patients admitted to intensive care units (ICUs) for COVID-19-associated acute respiratory failure, and to identify knowledge gaps...
March 20, 2021: Critical Care: the Official Journal of the Critical Care Forum
Anne F Peery
Left sided colonic diverticulitis is a common and costly gastrointestinal disease in Western countries, characterized by acute onset of often severe abdominal pain. Imaging is necessary to make an initial diagnosis and determine disease severity. Colonoscopy should be done six to eight weeks after diagnosis to rule out a missed colon malignancy. Antibiotic treatment is used selectively in immunocompetent patients with mild acute uncomplicated diverticulitis. The clinical course of diverticulitis commonly includes unpredictable recurrences and chronic gastrointestinal symptoms, which are a detriment to quality of life...
March 24, 2021: BMJ: British Medical Journal
Hanny Al-Samkari
No abstract text is available yet for this article.
March 18, 2021: JAMA
Atul Anand, Kuan Ken Lee, Andrew R Chapman, Amy V Ferry, Philip D Adamson, Fiona E Strachan, Colin Berry, Iain Findlay, Anne Cruickshank, Alan Reid, Paul O Collinson, Fred S Apple, David A McAllister, Donogh Maguire, Keith A A Fox, David E Newby, Chris Tuck, Ronald Harkess, Catriona Keerie, Christopher J Weir, Richard A Parker, Alasdair Gray, Anoop S V Shah, Nicholas L Mills
Background: High-sensitivity cardiac troponin assays enable myocardial infarction to be ruled out earlier, but the safety and efficacy of this approach is uncertain. We investigated whether an early-rule out pathway is safe and effective for patients with suspected acute coronary syndrome. Methods: We performed a stepped-wedge cluster randomized controlled trial in the Emergency Departments of seven acute care hospitals in Scotland. Consecutive patients presenting with suspected acute coronary syndrome between December 2014 and December 2016 were included...
March 23, 2021: Circulation
Sabrina Giglio, Giovanni Montini, Francesco Trepiccione, Giovanni Gambaro, Francesco Emma
Renal tubular acidosis (RTA) comprises a group of disorders in which excretion of hydrogen ions or reabsorption of filtered HCO3 is impaired, leading to chronic metabolic acidosis with normal anion gap. In the current review, the focus is placed on the most common type of RTA, Type 1 RTA or Distal RTA (dRTA), which is a rare chronic genetic disorder characterized by an inability of the distal nephron to secrete hydrogen ions in the presence of metabolic acidosis. Over the years, knowledge of the molecular mechanisms behind acid secretion has improved, thereby greatly helping the diagnosis of dRTA...
March 26, 2021: Journal of Nephrology
David Y Graham, Jyh-Ming Liou
We provide a primer to assist in the difficult transition of Helicobacter pylori therapy guidelines to those that adhere to the principles of antimicrobial stewardship. This transition will entail abandonment of many of the principles that heretofore formed the basis of treatment guidelines and recommendations. The goals of antimicrobial stewardship include optimization of the use of antibiotics while reducing antimicrobial resistance. The critical outcome measure is absolute cure rate which largely restricts comparative trials to those which reliably produce high cure rates (e...
March 25, 2021: Clinical Gastroenterology and Hepatology
George E Hiner, Julian Rf Walters
Chronic diarrhoea is common, occurring as the first presentation of several diagnoses, or as a prolonged disorder where stool frequency, urgency and incontinence have major impacts on quality of life. Good history taking is necessary, with different causes to be considered: onset and duration of symptoms, previous treatments, co-existing conditions, travel and drug use may all be relevant. Tests include blood and faecal screening. Exclusion of inflammatory bowel disease and colorectal neoplasia is important and may require colonoscopy...
March 2021: Clinical Medicine: Journal of the Royal College of Physicians of London
Marianna Sockrider, Lisa Roessel, Karen A Fagan, Mark Gillespie
No abstract text is available yet for this article.
March 15, 2021: American Journal of Respiratory and Critical Care Medicine
Keiko I Greenberg, Michael J Choi
Since maintenance hemodialysis (HD) first became available in the United States in 1962, there has been tremendous growth in the population of patients with kidney failure. HD has become a routine treatment carried out in outpatient clinics, hospitals, nursing facilities, and in patients' homes. Although it is a complex procedure, HD is quite safe. Serious complications are uncommon due to the use of modern HD machines and water treatment systems as well as the development of strict protocols to monitor various aspects of the HD treatment...
March 23, 2021: American Journal of Kidney Diseases
Azita H Talasaz, Parham Sadeghipour, Hessam Kakavand, Maryam Aghakouchakzadeh, Elaheh Kordzadeh-Kermani, Benjamin W Van Tassell, Azin Gheymati, Hamid Ariannejad, Seyed Hossein Hosseini, Sepehr Jamalkhani, Michelle Sholzberg, Manuel Monreal, David Jimenez, Gregory Piazza, Sahil A Parikh, Ajay J Kirtane, John W Eikelboom, Jean M Connors, Beverley J Hunt, Stavros V Konstantinides, Mary Cushman, Jeffrey I Weitz, Gregg W Stone, Harlan M Krumholz, Gregory Y H Lip, Samuel Z Goldhaber, Behnood Bikdeli
Endothelial injury and microvascular/macrovascular thrombosis are common pathophysiological features of coronavirus disease-2019 (COVID-19). However, the optimal thromboprophylactic regimens remain unknown across the spectrum of illness severity of COVID-19. A variety of antithrombotic agents, doses, and durations of therapy are being assessed in ongoing randomized controlled trials (RCTs) that focus on outpatients, hospitalized patients in medical wards, and patients critically ill with COVID-19. This paper provides a perspective of the ongoing or completed RCTs related to antithrombotic strategies used in COVID-19, the opportunities and challenges for the clinical trial enterprise, and areas of existing knowledge, as well as data gaps that may motivate the design of future RCTs...
March 11, 2021: Journal of the American College of Cardiology
Vincent Cottin, Claire Lafitte, Agathe Sénéchal, Julie Traclet
No abstract text is available yet for this article.
March 18, 2021: American Journal of Respiratory and Critical Care Medicine
Caitlyn L Holmes, Mark T Anderson, Harry L T Mobley, Michael A Bachman
SUMMARYGram-negative bacteremia is a devastating public health threat, with high mortality in vulnerable populations and significant costs to the global economy. Concerningly, rates of both Gram-negative bacteremia and antimicrobial resistance in the causative species are increasing. Gram-negative bacteremia develops in three phases. First, bacteria invade or colonize initial sites of infection. Second, bacteria overcome host barriers, such as immune responses, and disseminate from initial body sites to the bloodstream...
June 16, 2021: Clinical Microbiology Reviews
Jerry P Nolan, Claudio Sandroni, Bernd W Böttiger, Alain Cariou, Tobias Cronberg, Hans Friberg, Cornelia Genbrugge, Kirstie Haywood, Gisela Lilja, Véronique R M Moulaert, Nikolaos Nikolaou, Theresa Mariero Olasveengen, Markus B Skrifvars, Fabio Taccone, Jasmeet Soar
The European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM) have collaborated to produce these post-resuscitation care guidelines for adults, which are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. The topics covered include the post-cardiac arrest syndrome, diagnosis of cause of cardiac arrest, control of oxygenation and ventilation, coronary reperfusion, haemodynamic monitoring and management, control of seizures, temperature control, general intensive care management, prognostication, long-term outcome, rehabilitation and organ donation...
March 25, 2021: Intensive Care Medicine
Ani Nalbandian, Kartik Sehgal, Aakriti Gupta, Mahesh V Madhavan, Claire McGroder, Jacob S Stevens, Joshua R Cook, Anna S Nordvig, Daniel Shalev, Tejasav S Sehrawat, Neha Ahluwalia, Behnood Bikdeli, Donald Dietz, Caroline Der-Nigoghossian, Nadia Liyanage-Don, Gregg F Rosner, Elana J Bernstein, Sumit Mohan, Akinpelumi A Beckley, David S Seres, Toni K Choueiri, Nir Uriel, John C Ausiello, Domenico Accili, Daniel E Freedberg, Matthew Baldwin, Allan Schwartz, Daniel Brodie, Christine Kim Garcia, Mitchell S V Elkind, Jean M Connors, John P Bilezikian, Donald W Landry, Elaine Y Wan
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the pathogen responsible for the coronavirus disease 2019 (COVID-19) pandemic, which has resulted in global healthcare crises and strained health resources. As the population of patients recovering from COVID-19 grows, it is paramount to establish an understanding of the healthcare issues surrounding them. COVID-19 is now recognized as a multi-organ disease with a broad spectrum of manifestations. Similarly to post-acute viral syndromes described in survivors of other virulent coronavirus epidemics, there are increasing reports of persistent and prolonged effects after acute COVID-19...
March 22, 2021: Nature Medicine
Kay Choong See
Acute respiratory distress syndrome (ARDS)-related acute cor pulmonale (ACP) is found in 8%-50% of all patients with ARDS, and is associated with adverse hemodynamic and survival outcomes. ARDS-related ACP is an echocardiographic diagnosis marked by combined right ventricular dilatation and septal dyskinesia, which connote simultaneous diastolic (volume) and systolic (pressure) overload respectively. Risk factors include pneumonia, hypercapnia, hypoxemia, high airway pressures and concomitant pulmonary disease...
March 9, 2021: World Journal of Critical Care Medicine
Matthew J Stotts, Brian J Wentworth, Patrick G Northup
While portal vein thrombosis (PVT) is a frequently encountered complication in the cirrhosis population, its management can be challenging for even the most experienced clinicians. Multiple factors must be considered with regards to management, including the degree of underlying portal hypertension and liver dysfunction, risks of therapies including anticoagulation and transjugular intrahepatic portosystemic shunt placement, and extent of the thrombosis. Interpreting the available literature to determine the best treatment strategy for any individual patient can be especially challenging given the lack of prospective, randomized controlled trials and the heterogeneity of cohorts studied...
January 2021: Seminars in Liver Disease
Anthony Spadaro, Kevin R Scott, Alex Koyfman, Brit Long
INTRODUCTION: Cerebral venous thrombosis (CVT) is an uncommon neurologic emergency associated with significant morbidity and mortality that can be difficult to differentiate from other conditions. It is important for the emergency clinician to be familiar with this disease as it requires a high index of suspicion, and early diagnosis and management can lead to improved outcomes. OBJECTIVE: This narrative review provides an evidence-based update concerning the presentation, evaluation, and management of CVT for the emergency clinician...
March 16, 2021: American Journal of Emergency Medicine
2021-04-05 00:24:58
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