2013 Jan 25 - Effect of selective decontamination on antimicrobial resistance in intensive care unit

Dr Nick Daneman MD , Syed Sarwar BSc, Robert A Fowler MD, Brian H Cuthbertson MD, on behalf of the SuDDICU Canadian Study Group. The Lancet Infectious Diseases, Early Online Publication, 25 January 2013.
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.

Read more ...

2013 Feb - Rapidly growing mycobacterial bloodstream infections

Gilbert El Helou MD, Dr George M Viola MD , Ray Hachem MD, Prof Xiang Y Han MD, Prof Issam I Raad MD. The Lancet Infectious Diseases, Volume 13, Issue 2, Pages 166 - 174, February 2013
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.

Read more ...

2013 Jan 16 - Acute pneumonia and the cardiovascular system

Dr Vicente F Corrales-Medina MD , Prof Daniel M Musher MD, Svetlana Shachkina MD, Julio A Chirinos MD. Lancet Online First
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.

Read more ...

2012 Dec 3 - Optimization of energy provision with parental nutrition in critically ill patients

Optimisation of energy provision with supplemental parenteral nutrition in critically ill patients: a randomised controlled clinical trial
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.

Read more ...

2012 Oct 26-Outcomes of the Surviving Sepsis Campaign in intensive care units in the USA and Europe

Prof Mitchell M Levy MD , Prof Antonio Artigas MD, Gary S Phillips MAS, Andrew Rhodes MBBS, Richard Beale MBBS, Tiffany Osborn MD, Prof Jean-Louis Vincent MD, Sean Townsend MD, Prof Stanley Lemeshow PhD, Prof R Phillip Dellinger MD. The Lancet Infectious Diseases, Early Online Publication, 26 October 2012 
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.

Read more ...

2012 Oct - Lemierre's syndrome due to Fusobacterium necrophorum

Dr Krutika Kuppalli MD , Daniel Livorsi MD, Naasha J Talati MD, Melissa Osborn MD. The Lancet Infectious Diseases, Volume 12, Issue 10, Pages 808 - 815, October 2012
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. 

Read more ...

2012 Sep 22 - Haemorrhage control in severely injured patients

Prof Russell L Gruen MD , Prof Karim Brohi MD, Prof Martin Schreiber MD, Prof Zsolt J Balogh MD, Veronica Pitt PhD, Mayur Narayan MD, Prof Ronald V Maier MD. The Lancet, Volume 380, Issue 9847, Pages 1099 - 1108, 22 September 2012.
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.

Read more ...

2012 Sep 22 - Routine versus clinically indicated replacement of peripheral intravenous catheters

Prof Claire M Rickard PhD, Prof Joan Webster BA, Prof Marianne C Wallis PhD, Nicole Marsh BN, Matthew R McGrail PhD, Venessa French RN, Lynelle Foster MN, Peter Gallagher MBA, John R Gowardman FCICM/FRACP, Li Zhang PhD, Alice McClymont RN, Prof Michael Whitby PhD. The Lancet, Volume 380, Issue 9847, Pages 1066 - 1074, 22 September 2012.
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.

Read more ...

2012 Sep 22 - Early management of severe traumatic brain injury

Prof Jeffrey V Rosenfeld MD , Prof Andrew I Maas MD , Peter Bragge PhD, M Cristina Morganti-Kossmann PhD, Prof Geoffrey T Manley MD, Prof Russell L Gruen MD. The Lancet, Volume 380, Issue 9847, Pages 1088 - 1098, 22 September 2012.
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.

Read more ...

2012 Sep 22 - Mortality after surgery in Europe: a 7 day cohort study

Dr Rupert M Pearse MD , Prof Rui P Moreno PhD, Prof Peter Bauer PhD, Prof Paolo Pelosi PhD, Prof Philipp Metnitz PhD, Prof Claudia Spies PhD, Prof Benoit Vallet PhD, Prof Jean-Louis Vincent PhD, Prof Andreas Hoeft PhD, Andrew Rhodes FRCP, for the European Surgical Outcomes Study (EuSOS) group for the Trials groups of the European Society of Intensive Care Medicine and the European Society of Anaesthesiology. The Lancet, Volume 380, Issue 9847, Pages 1059 - 1065, 22 September 2012.
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.

Read more ...

2012 Sep 5 - Duration of resuscitation efforts and survival after in-hospital cardiac arrest

Zachary D Goldberger MD, Paul S Chan MD, Prof Robert A Berg MD, Steven L Kronick MD, Colin R Cooke MD, Mingrui Lu MPH, Mousumi Banerjee PhD, Prof Rodney A Hayward MD, Prof Harlan M Krumholz MD, Dr Brahmajee K Nallamothu MD , for the American Heart Association Get With The Guidelines—Resuscitation (formerly the National Registry of Cardiopulmonary Resuscitation) Investigators. The Lancet, Early Online Publication, 5 September 2012
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.

Read more ...

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
 

Read more ...

2012 Aug 10 - Serum sickness

Jui-Hung Ko MD, Dr Wen-Hung Chung MD.  The Lancet, Early Online Publication, 10 August 2012
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.

Read more ...

2012 July 17 - Effectiveness and safety of drotrecogin alfa (activated) for severe sepsis

Dr Andre C Kalil MD , Steven P LaRosa MD. The Lancet Infectious Diseases, Early Online Publication, 17 July 2012
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.

Read more ...

2012 July - HIV-associated opportunistic infections of the CNS

Ik Lin Tan MBBS, Bryan R Smith MD, Gloria von Geldern MD, Farrah J Mateen MD, Prof Justin C McArthur MBBS. The Lancet Neurology, Volume 11, Issue 7, Pages 605 - 617, July 2012
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.

Read more ...

2012 June 29 - An explosive urinary tract infection (Clinical Pictures)

Dr Grégory Verhoest MD , Tanguy Rohou MD, François Gerard MD, Romain Huet MD, Prof Karim Bensalah MD. The Lancet, Early Online Publication, 29 June 2012
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.

Read more ...

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.

Read more ...

2012 May 21 - Acute Kidney Injury

Prof Rinaldo Bellomo MD , John A Kellum MD, Claudio Ronco MD. The Lancet, Early Online Publication, 21 May 2012
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.

Read more ...

2012 May 25 - Lemierre's syndrome due to Fusobacterium necrophorum

Dr Krutika Kuppalli MD , Daniel Livorsi MD, Naasha J Talati MD , Melissa Osborn MD. The Lancet Infectious Diseases, Early Online Publication, 25 May 2012
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.

Read more ...

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.

The IST-3 collaborative group. The Lancet, Early Online Publication, 23 May 2012
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.

Read more ...