2013 Jan 25 - Effect of selective decontamination on antimicrobial resistance in intensive care unit
Summary
Background
Many meta-analyses have shown reductions in infection rates and mortality associated with the use of selective digestive decontamination (SDD) or selective oropharyngeal decontamination (SOD) in intensive care units (ICUs). These interventions have not been widely implemented because of concerns that their use could lead to the development of antimicrobial resistance in pathogens. We aimed to assess the effect of SDD and SOD on antimicrobial resistance rates in patients in ICUs.
2013 Feb - Rapidly growing mycobacterial bloodstream infections
Summary
About 20 species of rapidly growing mycobacteria species that are capable of infecting human beings and causing bloodstream infections have been identified. Many more of these species are being discovered worldwide, especially in resource-poor settings.
2013 Jan 16 - Acute pneumonia and the cardiovascular system
Summary
Although traditionally regarded as a disease confined to the lungs, acute pneumonia has important effects on the cardiovascular system at all severities of infection. Pneumonia tends to affect individuals who are also at high cardiovascular risk. Results of recent studies show that about a quarter of adults admitted to hospital with pneumonia develop a major acute cardiac complication during their hospital stay, which is associated with a 60% increase in short-term mortality.
2012 Dec 3 - Optimization of energy provision with parental nutrition in critically ill patients
Claudia Paula Heidegger MD, Prof Mette M Berger MD, Séverine Graf BSc, Walter Zingg MD, Patrice Darmon MD, Prof Michael C Costanza PhD, Ronan Thibault MD, Prof Claude Pichard MD. The Lancet, Early Online Publication, 3 December
Summary
Background
Enteral nutrition (EN) is recommended for patients in the intensive-care unit (ICU), but it does not consistently achieve nutritional goals. We assessed whether delivery of 100% of the energy target from days 4 to 8 in the ICU with EN plus supplemental parenteral nutrition (SPN) could optimise clinical outcome.
2012 Oct 26-Outcomes of the Surviving Sepsis Campaign in intensive care units in the USA and Europe
Background
Mortality from severe sepsis and septic shock differs across continents, countries, and regions. We aimed to use data from the Surviving Sepsis Campaign (SSC) to compare models of care and outcomes for patients with severe sepsis and septic shock in the USA and Europe.
2012 Oct - Lemierre's syndrome due to Fusobacterium necrophorum
Summary
We present a case of a patient with Lemierre's syndrome caused by Fusobacterium necrophorum who developed a right frontal lobe brain abscess. We summarise the epidemiology, microbiology, pathogenesis, clinical presentation, diagnosis, complications, therapy, and outcomes of Lemierre's syndrome.
2012 Sep 22 - Haemorrhage control in severely injured patients
Summary
Most surgeons have adopted damage control surgery for severely injured patients, in which the initial operation is abbreviated after control of bleeding and contamination to allow ongoing resuscitation in the intensive-care unit.
2012 Sep 22 - Routine versus clinically indicated replacement of peripheral intravenous catheters
Summary
Background
The millions of peripheral intravenous catheters used each year are recommended for 72—96 h replacement in adults. This routine replacement increases health-care costs and staff workload and requires patients to undergo repeated invasive procedures. The effectiveness of the practice is not well established. Our hypothesis was that clinically indicated catheter replacement is of equal benefit to routine replacement.
2012 Sep 22 - Early management of severe traumatic brain injury
Summary
Severe traumatic brain injury remains a major health-care problem worldwide. Although major progress has been made in understanding of the pathophysiology of this injury, this has not yet led to substantial improvements in outcome.
2012 Sep 22 - Mortality after surgery in Europe: a 7 day cohort study
Summary
Background
Clinical outcomes after major surgery are poorly described at the national level. Evidence of heterogeneity between hospitals and health-care systems suggests potential to improve care for patients but this potential remains unconfirmed. The European Surgical Outcomes Study was an international study designed to assess outcomes after non-cardiac surgery in Europe.
2012 Sep 5 - Duration of resuscitation efforts and survival after in-hospital cardiac arrest
Summary
Background
During in-hospital cardiac arrests, how long resuscitation attempts should be continued before termination of efforts is unknown. We investigated whether duration of resuscitation attempts varies between hospitals and whether patients at hospitals that attempt resuscitation for longer have higher survival rates than do those at hospitals with shorter durations of resuscitation efforts.
2012 Aug 28 - Aggressive versus conservative initiation of antimicrobial treatment
Tjasa Hranjec, Laura H Rosenberger, Brian Swenson, Rosemarie Metzger, Tanya R Flohr, Amani D Politano, Lin M Riccio, Kimberley A Popovsky, Robert G Sawyer. The Lancet Infectious Diseases, Early Online Publication, 28 August 2012
Background
Antimicrobial treatment in critically ill patients can either be started as soon as infection is suspected or after objective data confirm an infection. We postulated that delaying antimicrobial treatment of patients with suspected infections in the surgical intensive care unit (SICU) until objective evidence of infection had been obtained would not worsen patient mortality.
Methods
2012 Aug 10 - Serum sickness
Serum sickness
Showing multiple purpuric macules and confluent patches on both lower legs and feet.
A 61-year-old man was bitten by a poisonous snake (Taiwan bamboo viper, Viridovipera Stejnegeri) on his right hand 10 days before visiting our dermatology clinic. He received antivenom (polyvalent haemorrhagic) at our emergency department immediately after the accident. He had severe painful erythematous swelling of the right hand and forearm.
2012 July 17 - Effectiveness and safety of drotrecogin alfa (activated) for severe sepsis
Background
Drotrecogin alfa (activated) was approved for use in severe sepsis in 2001 on the basis of the Recombinant Human Activated Protein C Worldwide Evaluation in Severe Sepsis (PROWESS) trial, but controversies about its effectiveness remain. We aimed to assess effectiveness and safety of use of this drug in the past 10 years and compare them with the original PROWESS results.
2012 July - HIV-associated opportunistic infections of the CNS
Summary
Survival in people infected with HIV has improved because of an increasingly powerful array of antiretroviral treatments, but neurological symptoms due to comorbid conditions, including infection with hepatitis C virus, malnutrition, and the effects of accelerated cardiovascular disease and ageing, are increasingly salient.
2012 June 29 - An explosive urinary tract infection (Clinical Pictures)
A 68-year-old man complained of urinary frequency and hypogastric discomfort. He was a smoker and had hypertension. Digital rectal examination showed a painful prostate but he had no fever. Urine analysis showed a pyuria and a bacteriuria of enterococcus species. The patient was treated with amoxicillin. 2 days after his admission, he suddenly developed acute right flank pain with hypotension. Blood tests showed a decrease in haemoglobin from 140 g/L on admission to 70 g/L.
2012 Jun 26 - Estimated global mortality associated with pandemic influenza A H1N1 virus circulation: a modelling study
Dr Fatimah S Dawood MD , A Danielle Iuliano PhD, Carrie Reed DSc, Martin I Meltzer PhD, David K Shay MD, et al. The Lancet Infectious Diseases, Early Online Publication, 26 June 2012
Background
18 500 laboratory-confirmed deaths caused by the 2009 pandemic influenza A H1N1 were reported worldwide for the period April, 2009, to August, 2010. This number is likely to be only a fraction of the true number of the deaths associated with 2009 pandemic influenza A H1N1. We aimed to estimate the global number of deaths during the first 12 months of virus circulation in each country.
2012 May 21 - Acute Kidney Injury
Summary
Acute kidney injury (formerly known as acute renal failure) is a syndrome characterised by the rapid loss of the kidney's excretory function and is typically diagnosed by the accumulation of end products of nitrogen metabolism (urea and creatinine) or decreased urine output, or both. It is the clinical manifestation of several disorders that affect the kidney acutely. Acute kidney injury is common in hospital patients and very common in critically ill patients. In these patients, it is most often secondary to extrarenal events.
2012 May 25 - Lemierre's syndrome due to Fusobacterium necrophorum
Summary
We present a case of a patient with Lemierre's syndrome caused by Fusobacterium necrophorum who developed a right frontal lobe brain abscess. We summarise the epidemiology, microbiology, pathogenesis, clinical presentation, diagnosis, complications, therapy, and outcomes of Lemierre's syndrome.
2012 May - The benefits and harms of IV thrombolysis with rt-PA within 6h of acute ischaemic stroke
The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke (the third international stroke trial [IST-3]): a randomised controlled trial.
Background
Thrombolysis is of net benefit in patients with acute ischaemic stroke, who are younger than 80 years of age and are treated within 4·5 h of onset. The third International Stroke Trial (IST-3) sought to determine whether a wider range of patients might benefit up to 6 h from stroke onset.