2017 Feb - Approach to Fever in the Returning Traveler

Thwaites GE, Day NP.; N Engl J Med. 2017 Feb 9;376(6):548-560.

Travelers may be exposed to a variety of infectious agents that are endemic in the regions they visit. This review presents a systematic approach to the diagnosis and treatment of travel-acquired illnesses.

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2016 Dec - Myasthenia Gravis

Gilhus NE.; N Engl J Med. 2016 Dec 29;375(26):2570-2581.

Myasthenia gravis is an autoimmune disease associated with several autoantibodies that attack the neuromuscular junction. Some cases are associated with thymoma. The hallmark of management is individualized immunosuppressive therapy.

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2016 Dec - Hypothermia for Neuroprotection in Convulsive Status Epilepticus

Legriel S, Lemiale V, Schenck M, Chelly J, Laurent V, Daviaud F, Srairi M, Hamdi A, Geri G, Rossignol T, Hilly-Ginoux J, Boisramé-Helms J, Louart B, Malissin I, Mongardon N, Planquette B, Thirion M, Merceron S, Canet E, Pico F, Tran-Dinh YR, Bedos JP, Azoulay E, Resche-Rigon M, Cariou A; HYBERNATUS Study Group..; N Engl J Med. 2016 Dec 22;375(25):2457-2467.

Background: Convulsive status epilepticus often results in permanent neurologic impairment. We evaluated the effect of induced hypothermia on neurologic outcomes in patients with convulsive status epilepticus.

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2016 Oct - Effect of Short-Term vs. Long-Term Blood Storage on Mortality after Transfusion

Heddle NM, Cook RJ, Arnold DM, Liu Y, Barty R, Crowther MA, Devereaux PJ, Hirsh J, Warkentin TE, Webert KE, Roxby D, Sobieraj-Teague M, Kurz A, Sessler DI, Figueroa P, Ellis M, Eikelboom JW.; N Engl J Med. 2016 Oct 24. [Epub ahead of print]

Background: Randomized, controlled trials have suggested that the transfusion of blood after prolonged storage does not increase the risk of adverse outcomes among patients, although most of these trials were restricted to high-risk populations and were not powered to detect small but clinically important differences in mortality. We sought to find out whether the duration of blood storage would have an effect on mortality after transfusion in a general population of hospitalized patients.

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2016 May - Initiation Strategies for Renal-Replacement Therapy in the Intensive Care Unit

Stéphane Gaudry,  David Hajage, Fréderique Schortgen et al for the AKIKI Study Group. NEJM May 15, 2016

BACKGROUND: The timing of renal-replacement therapy in critically ill patients who have acute kidney injury but no potentially life-threatening complication directly related to renal failure is a subject of debate.

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2016 Feb - Adjunctive Dexamethasone in HIV-Associated Cryptococcal Meningitis

Beardsley J, Wolbers M, Kibengo FM, Ggayi AB, Kamali A, Cuc NT, Binh TQ, Chau NV, Farrar J, Merson L, Phuong L, Thwaites G, Van Kinh N, Thuy PT, Chierakul W, Siriboon S, Thiansukhon E, Onsanit S, Supphamongkholchaikul W, Chan AK, Heyderman R, Mwinjiwa E, van Oosterhout JJ, Imran D, Basri H, Mayxay M, Dance D, Phimmasone P, Rattanavong S, Lalloo DG, Day JN; CryptoDex Investigators.: N Engl J Med. 2016 Feb 11;374(6):542-54.

 

Background: Cryptococcal meningitis associated with human immunodeficiency virus (HIV) infection causes more than 600,000 deaths each year worldwide. Treatment has changed little in 20 years, and there are no imminent new anticryptococcal agents. The use of adjuvant glucocorticoids reduces mortality among patients with other forms of meningitis in some populations, but their use is untested in patients with cryptococcal meningitis.

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2016 Feb - Caplacizumab for Acquired Thrombotic Thrombocytopenic Purpura

Peyvandi F, Scully M, Kremer Hovinga JA, Cataland S, Knöbl P, Wu H, Artoni A, Westwood JP, Mansouri Taleghani M, Jilma B, Callewaert F, Ulrichts H, Duby C, Tersago D; TITAN Investigators.; N Engl J Med. 2016 Feb 11;374(6):511-22.

BACKGROUND: Acquired thrombotic thrombocytopenic purpura (TTP) is caused by aggregation of platelets on ultralarge von Willebrand factor multimers. This microvascular thrombosis causes multiorgan ischemia with potentially life-threatening complications. Daily plasma exchange and immunosuppressive therapies induce remission, but mortality and morbidity due to microthrombosis remain high.

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2015 Sep - Intravascular Complications of Central Venous Catheterization by Insertion Site

Parienti JJ, Mongardon N, Mégarbane B, Mira JP, Kalfon P, Gros A, Marqué S, Thuong M, Pottier V, Ramakers M, Savary B, Seguin A, Valette X, Terzi N, Sauneuf B, Cattoir V, Mermel LA, du Cheyron D; 3SITES Study Group.; N Engl J Med. 2015 Sep 24;373(13):1220-9.

BACKGROUND: Three anatomical sites are commonly used to insert central venous catheters, but insertion at each site has the potential for major complications.

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2015 Sep - Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy

Templin C, Ghadri JR, Diekmann J, Napp LC, Bataiosu DR, Jaguszewski M, Cammann VL, Sarcon A, Geyer V, Neumann CA, Seifert B, Hellermann J, Schwyzer M, Eisenhardt K, Jenewein J, Franke J, Katus HA, Burgdorf C, Schunkert H, Moeller C, Thiele H, Bauersachs J, Tschöpe C, Schultheiss HP, Laney CA, Rajan L, Michels G, Pfister R, Ukena C, Böhm M, Erbel R, Cuneo A, Kuck KH, Jacobshagen C, Hasenfuss G, Karakas M, Koenig W, Rottbauer W, Said SM, Braun-Dullaeus RC, Cuculi F, Banning A, Fischer TA, Vasankari T, Airaksinen KE, Fijalkowski M, Rynkiewicz A, Pawlak M, Opolski G, Dworakowski R, MacCarthy P, Kaiser C, Osswald S, Galiuto L, Crea F, Dichtl W, Franz WM, Empen K, Felix SB, Delmas C, Lairez O, Erne P, Bax JJ, Ford I, Ruschitzka F, Prasad A, Lüscher TF.; N Engl J Med. 2015 Sep 3;373(10):929-38.

BACKGROUND: The natural history, management, and outcome of takotsubo (stress) cardiomyopathy are incompletely understood.

METHODS: The International Takotsubo Registry, a consortium of 26 centers in Europe and the United States, was established to investigate clinical features, prognostic predictors, and outcome of takotsubo cardiomyopathy. Patients were compared with age- and sex-matched patients who had an acute coronary syndrome.

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2015 Jul - An Integrated View of Potassium Homeostasis

Gumz ML, Rabinowitz L, Wingo CS.; N Engl J Med. 2015 Jul 2;373(1):60-72.

The plasma potassium level is normally maintained within narrow limits by multiple mechanisms. This article reviews the mechanisms that regulate potassium homeostasis and describes the important role that the circadian clock exerts on these processes.

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2015 May - High-Flow Oxygen through Nasal Cannula in Acute Hypoxemic Respiratory Failure

Frat JP, Thille AW, Mercat A, Girault C, Ragot S, Perbet S, Prat G, Boulain T, Morawiec E, Cottereau A, Devaquet J, Nseir S, Razazi K, Mira JP, Argaud L, Chakarian JC, Ricard JD, Wittebole X, Chevalier S, Herbland A, Fartoukh M, Constantin JM, Tonnelier JM, Pierrot M, Mathonnet A, Béduneau G, Delétage-Métreau C, Richard JC, Brochard L, Robert R; FLORALI Study Group and the REVA Network.; N Engl J Med. 2015 May 17. [Epub ahead of print]

Background: Whether noninvasive ventilation should be administered in patients with acute hypoxemic respiratory failure is debated. Therapy with high-flow oxygen through a nasal cannula may offer an alternative in patients with hypoxemia.

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2015 May - Trial of short-course antimicrobial therapy for intraabdominal infection

Sawyer RG, Claridge JA, Nathens AB, Rotstein OD, Duane TM, Evans HL, Cook CH, O'Neill PJ, Mazuski JE, Askari R, Wilson MA, Napolitano LM, Namias N, Miller PR, Dellinger EP, Watson CM, Coimbra R, Dent DL, Lowry SF, Cocanour CS, West MA, Banton KL, Cheadle WG, Lipsett PA, Guidry CA, Popovsky K.; N Engl J Med. 2015 May 21;372(21):1996-2005.

BACKGROUND: The successful treatment of intraabdominal infection requires a combination of anatomical source control and antibiotics. The appropriate duration of antimicrobial therapy remains unclear.

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2015 May - Permissive Underfeeding or Standard Enteral Feeding in Critically Ill Adults

Arabi YM, Aldawood AS, Haddad SH, Al-Dorzi HM, Tamim HM, Jones G, Mehta S, McIntyre L, Solaiman O, Sakkijha MH, Sadat M, Afesh L; PermiT Trial Group.; N Engl J Med. 2015 May 20. [Epub ahead of print]

Background: The appropriate caloric goal for critically ill adults is unclear. We evaluated the effect of restriction of nonprotein calories (permissive underfeeding), as compared with standard enteral feeding, on 90-day mortality among critically ill adults, with maintenance of the full recommended amount of protein in both groups.

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2015 Mar - Liberal or restrictive transfusion after cardiac surgery

Murphy GJ, Pike K, Rogers CA, Wordsworth S, Stokes EA, Angelini GD, Reeves BC; TITRe2 Investigators. N Engl J Med. 2015 Mar 12;372(11):997-1008

BACKGROUND: Whether a restrictive threshold for hemoglobin level in red-cell transfusions, as compared with a liberal threshold, reduces postoperative morbidity and health care costs after cardiac surgery is uncertain.

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2014 Dec - Lactic Acidosis

Kraut JA, Madias NE.;N Engl J Med. 2014 Dec 11;371(24):2309-19.

When lactic acidosis accompanies low-flow states or sepsis, mortality rates increase sharply. This review summarizes our current understanding of the pathophysiological aspects of lactic acidosis, as well as the approaches to its diagnosis and management.

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2014 Nov - Early versus On-Demand Nasoenteric Tube Feeding in Acute Pancreatitis

 

Bakker OJ, van Brunschot S, van Santvoort HC, Besselink MG, Bollen TL, Boermeester MA, Dejong CH, van Goor H, Bosscha K, Ahmed Ali U, Bouwense S, van Grevenstein WM, Heisterkamp J, Houdijk AP, Jansen JM, Karsten TM, Manusama ER, Nieuwenhuijs VB, Schaapherder AF, van der Schelling GP, Schwartz MP, Spanier BW, Tan A, Vecht J, Weusten BL, Witteman BJ, Akkermans LM, Bruno MJ, Dijkgraaf MG, van Ramshorst B, Gooszen HG; Dutch Pancreatitis Study Group. ;N Engl J Med. 2014 Nov 20;371(21):1983-93.

 

BACKGROUND: Early enteral feeding through a nasoenteric feeding tube is often used in patients with severe acute pancreatitis to prevent gut-derived infections, but evidence to support this strategy is limited. We conducted a multicenter, randomized trial comparing early nasoenteric tube feeding with an oral diet at 72 hours after presentation to the emergency department in patients with acute pancreatitis.

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2014 Nov - Integration of Acid–Base and Electrolyte Disorders

Seifter JL.; N Engl J Med. 2014 Nov 6;371(19):1821-31.

 

This review, which describes an approach to acid–base disorders, incorporates insights and examples drawn from the traditional, bicarbonate-centered approach and the physicochemical, or strong ion, theory.

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2014 Oct - Goal-Directed Resuscitation for Patients with Early Septic Shock

The ARISE Investigators and the ANZICS Clinical Trials Group.; N Engl J Med. 2014 Oct 1.

Background: Early goal-directed therapy (EGDT) has been endorsed in the guidelines of the Surviving Sepsis Campaign as a key strategy to decrease mortality among patients presenting to the emergency department with septic shock. However, its effectiveness is uncertain.

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2014 Oct - Trial of the Route of Early Nutritional Support in Critically Ill Adults

Harvey SE, Parrott F, Harrison DA, Bear DE, Segaran E, Beale R, Bellingan G, Leonard R, Mythen MG, Rowan KM; the CALORIES Trial Investigators.; N Engl J Med. 2014 Oct 1. [Epub ahead of print]

Background Uncertainty exists about the most effective route for delivery of early nutritional support in critically ill adults. We hypothesized that delivery through the parenteral route is superior to that through the enteral route.

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2014 Oct - Lower versus Higher Hemoglobin Threshold for Transfusion in Septic Shock

Holst LB, Haase N, Wetterslev J, Wernerman J, Guttormsen AB, Karlsson S, Johansson PI, Aneman A, Vang ML, Winding R, Nebrich L, Nibro HL, Rasmussen BS, Lauridsen JR, Nielsen JS, Oldner A, Pettilä V, Cronhjort MB, Andersen LH, Pedersen UG, Reiter N, Wiis J, White JO, Russell L, Thornberg KJ, Hjortrup PB, Müller RG, Møller MH, Steensen M, Tjäder I, Kilsand K, Odeberg-Wernerman S, Sjøbø B, Bundgaard H, Thyø MA, Lodahl D, Mærkedahl R, Albeck C, Illum D, Kruse M, Winkel P, Perner A; the TRISS Trial Group and the Scandinavian Critical Care Trials Group.; N Engl J Med. 2014 Oct 1. [Epub ahead of print]

Background Blood transfusions are frequently given to patients with septic shock. However, the benefits and harms of different hemoglobin thresholds for transfusion have not been established.

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