A firefighter with pancreatitis Metkus, Andrea P; Trabulsy, Philip P; Schlobohm, Richard S ...
The Lancet (British edition),
12/1996, Letnik:
348, Številka:
9043
Journal Article
Recenzirano
The case of a 34-year-old previously healthy woman firefighter who was admitted to San Francisco General Hospital on Mar 9, 1995 with a severe inhalation injury and 40% partial thickness burns ...involving her face, neck, abdomen and legs is described. A laparotomy revealed necrotizing pancreatitis.
We report the first measurements of the total cross section of the reaction K{sup -}p{yields}{sigma}{sup 0}{gamma} at eight beam momenta from 514 to 750 MeV/c. The data were obtained at the ...Alternating Gradient Synchrotron (AGS) at Brookhaven National Laboratory using the Crystal Ball detector consisting of 672 NaI crystals. All charged particles were vetoed by a barrel of plastic scintillators, resulting in a study of only the neutral decays of the {sigma}{sup 0}. The prompt photon and the photons from the decay products of {sigma}{sup 0} were detected for each reconstructed event; the neutron was also detected in a small fraction of the events.
A firefighter with pancreatis METKUS, A. P; TRABULSY, P. P; SCHLOBOHM, R. S ...
The Lancet (British edition),
1996, Letnik:
348, Številka:
9043
Journal Article
•Continuous infusion vancomycin (CIV) provides more rapid target level attainment.•CIV provides protection from nephrotoxicity compared to intermittent infusion.•There are practical advantages in ...dose adjustment and monitoring with CIV.
Vancomycin is a common and critical drug for empiric antimicrobial therapy in the infected burn patient. However, profound physiologic changes may impede the clinical effectiveness and amplify the potential nephrotoxicity of vancomycin.
This was a retrospective cohort study at a large academic medical center and regional burn center. Patients with ≥10% total body surface area burn that received intravenous vancomycin were considered for study inclusion. Patients were assigned to the intermittent infusion or continuous infusion cohort if they received vancomycin for ≥48 h with ≥1 documented vancomycin serum concentration. The target steady state drug level for continuous infusion was 17−22 mg/L. The target steady state trough drug level for intermittent infusion was 15−20 mg/L. The primary efficacy and safety outcomes were time to therapeutic drug level and nephrotoxicity respectively.
Thirty continuous infusion subjects with 88 plasma drug levels and thirty intermittent infusion subjects with 80 plasma drug levels were analyzed within the study period. There was a significant difference in the number of subjects that achieved a plasma vancomycin level within the target range during the course of therapy (73.3% for continuous infusion vs. 26.7% for intermittent infusion, p = 0.0003). The time to therapeutic level was 3.90 days for continuous infusion and 5.22 days for intermittent infusion (p = 0.0393). Nephrotoxicity occurred less frequently in the continuous infusion cohort (23.3% vs. 53.8%).
Continuous infusion vancomycin was associated with more rapid attainment of target levels and a lower rate of nephrotoxicity.
Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): ESC training grant; DZHK Background Genetic cardiomyopathies contribute to a ...significant proportion of morbidity and mortality among young people. Over the past decades, a wide range of underlying molecular mechanisms has been discovered. The current project arose from the clinical observation of a left ventricular non-compaction and sudden cardiac death overlap syndrome in a large family in northern Italy. Whole exome sequencing performed on family members of different generations revealed a single nucleotide polymorphism in the RYR2 gene (RYR2 c.5654G>A homozygous – RyR2 p.G1885E - exon37:missense) with an autosomal-recessive inheritance pattern. The mutation is localized in the DR3 region of the RyR2 protein, adjacent to the FKBP12.6 binding site, a protein that is known to stabilize RyR2, preventing aberrant activation of the channel. Methods and Results Patient-derived, human induced pluripotent stem cells (hiPSCs), carrying the variant homo- and heterozygously, were generated by reprogramming patient-derived peripheral blood mononuclear cells using a non-integrative Sendai virus protocol. The lines were fully characterized and expressed high levels of pluripotency markers at the RNA and protein level. Patient lines were all able to efficiently differentiate into cardiomyocytes. Subsequently, 3D strip-format, force-generating Engineered Heart Tissues (EHTs) were cast and structurally and functionally characterized. Contraction analysis over 60 days showed differences in force development of the patient-derived lines. In particular, the EHTs carrying the homozygous pathogenic variant showed progressive reduction in both beating rate and force over time, increased spontaneous arrhythmogenicity and reduced inotropic response after exposure to isoprenaline, compared to the heterozygous line and unrelated healthy controls. Starting from day 30 after casting, patient-derived EHTs developed morphological changes with areas of marked cellular overgrowth and reduced troponin expression. Transcriptomic and proteomic analysis at 30 and 60 days after EHTs generation, as well as in 2D cardiomyocytes, complement the phenotyping and provide molecular insights into the underlying pathophysiology. To directly evaluate pathogenicity of the genetic variant identified, we generated isogenic homo- and heterozygously corrected hiPSCs, using CRISPR/ Cas9 technology, starting from the homozygous patient-line. The characterization of these corrected clones is currently ongoing. The genetically corrected 3D tissue models will be critical not only in defining the role of the novel RyR2 variant in the familial phenotype described, but also to unveil mechanistic roles of ryanodine receptor in cardiac disease. Conclusion We describe a novel recessive RYR2 variant associated with a left ventricular non- compaction and sudden cardiac death overlap syndrome. 3D cardiac tissue modelling based on patient-derived hiPSCs uncovered a proarrhythmic and structural phenotype of the mutated lines.
OBJECTIVESTo estimate the frequency of acute withdrawal syndrome related to the administration of analgesic and sedative medications in mechanically ventilated adult intensive care unit (ICU) ...patients; to identify associated clinical factors.
DESIGNRetrospective review of medical records.
SETTINGAn adult trauma/surgical ICU in an urban Level I trauma center.
PATIENTSTwenty-eight mechanically ventilated adult trauma/surgical ICU patients requiring >7 days of ICU care.
INTERVENTIONSNone.
MEASUREMENTS AND MAIN RESULTSDaily doses of all opioid, sedative, hypnotic, and major tranquilizer drugs administered to each patient were measured, as was duration of ICU stay, duration of mechanical ventilation, and duration of the administration of analgesic, sedative, and neuromuscular blocking agents (NMBAs) for each patient. All opioids and benzodiazepines were converted to their respective fentanyl and lorazepam equivalent units based on potency and bioavailability. Calculation of the weaning rate for each patient during tapering from opioid and benzodiazepine medications was performed. The presence or absence of acute withdrawal syndrome was identified for each patient.Nine (32.1%) patients developed acute withdrawal syndrome potentially related to the administration of analgesic or sedative medications. Patients in the withdrawal group received significantly higher mean daily (p = .049) and peak (p = .032) doses of fentanyl equivalents, as well as higher mean daily lorazepam equivalents (p = .049) compared with patients not experiencing withdrawal. Patients in the withdrawal group were also significantly more likely to have received neuromuscular blocking agents (p = .004) or propofol (p = .026) for >1 day during ICU admission compared with patients not experiencing withdrawal. Duration of mechanical ventilation (p = .049), benzodiazepine therapy (p = .048), and propofol therapy (p = .049) was also significantly longer in the group experiencing withdrawal. Withdrawal patients received a significantly lower mean daily dose of haloperidol (p = .026). There was a significant association between the development of withdrawal syndrome and the presence of ARDS (p = .017). Finally, the slopes of the lines representing opioid and benzodiazepine drug weaning were more steep for the withdrawal group, although these results did not achieve statistical significance.
CONCLUSIONSThese results suggest that mechanically ventilated adult patients with extended ICU care (>or=to7 days) who receive large doses of analgesic and sedative medications are at risk for acute withdrawal syndromes during drug weaning. The association between ARDS and withdrawal syndrome, combined with the observation that withdrawal syndromes were also associated with the use of neuromuscular blocking agents and prolonged mechanical ventilation, suggests that patients with ARDS may be more likely to receive high doses of analgesic and sedative medications, and are therefore at increased risk for withdrawal syndrome. (Crit Care Med 1998; 26:676-684)
Emergency medicine pharmacists (EMPs) have been demonstrated to have a positive impact on patient outcomes in a variety of clinical scenarios in the emergency department (ED), yet their distribution ...across the nation is suboptimal. An emergency medicine pharmacy intensity score tool (EMPIST) would not only facilitate the quantification of EMP staffing needs and ideal resource deployment times, but would also allow practitioners to triage patient care activities. The purpose of this investigation was to develop an EMPIST and evaluate its relationship to EMP activities.
This was a multicenter, prospective, observational analysis of an EMPIST developed by practicing EMPs. EMPs prospectively documented their clinical activities during usual care for patients in their ED. Spearman's rank-order correlation was used to determine any correlation between the EMPIST and pharmacist activities.
In total, 970 EMP activities and 584 EMPIST items were documented in 352 patients by 7 EMPs across 7 different EDs. The most commonly documented EMP interventions performed were bedside monitoring (12.7%), initiation of nonantimicrobial therapy (12.6%), and antimicrobial therapy initiation and streamlining (10.6%). The total EMPIST was found to significantly correlate with EMP activities, and this correlation was consistent across both "diagnostic/presentation" and "medication" items (P < 0.001 for all comparisons).
The EMPIST significantly correlated with EMP activities, with consistent correlation across all subgroups. Its utilization has the potential to enhance bedside clinical practice and optimize the deployment of limited EMP services. Additional investigations are needed to examine the validity of this tool and identify any relationship it may have to patient outcomes.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Global nitrogen use efficiency (NUE) for cereal production is estimated to be only 33%. Providing producers with efficient methods to increase the effectiveness of their N applications is integral to ...agricultural sustainability and environmental quality. This study was conducted to evaluate the effect of urea ammonium nitrate (UAN) injected at different depths on grain yield and uptake of N in grain. Liquid UAN (28–0–0) was applied in bands at depths of 5 and 10 cm, along with surface applications, all at various N rates around Feekes growth stage 5. Placement depth had the most significant impact on yield at low N rates. Subsurface application at 10 cm was most beneficial in low N no‐till (NT) soils, whereas surface treatments produced higher yields in low N environments of conventional till (CT) systems. Three of the four locations experienced higher rates of N uptake from subsurface applications when compared with surface treatments. No difference in grain N uptake was apparent between application depths of 5 and 10 cm. Subsurface N applications were beneficial in reducing rates of ammonia volatilization from urea‐based fertilizers. While there was no clear separation between 5 and 10 cm application depths, subsurface depths of 10 cm provide the most significant promise in benefiting yield in low N environments of NT soils and increasing grain N across CT and NT systems.
We describe an experimental curriculum innovation that creates a safe space for students to engage in courageous conversations —to openly share diverse thoughts and opinions as well as vigorously ...debate politically charged issues of critical business importance. Course evaluations and online surveys of student experiences and reactions strongly suggest that the courageous conversation model is an excellent way to prepare the next generation of successful business leaders. In a world where politically polarizing issues embedded in America’s culture wars increasingly impact business viability, profitability, and competitiveness, such leaders are both highly coveted and key to organizational success.
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