Noninvasive ventilation (NIV) improves oxygenation and ventilation, prevents endotracheal intubation, and decreases the mortality rate in select patients with acute respiratory failure. Although NIV ...is used commonly for acute exacerbations of chronic obstructive pulmonary disease and acute cardiogenic pulmonary edema, there are emerging indications for its use in the emergency department. Emergency physicians must be knowledgeable regarding the indications and contraindications for NIV in emergency department patients with acute respiratory failure as well as the means of initiating it and monitoring patients who are receiving it.
Vaping is associated with an increased risk of lung injury; however, each case of vaping-associated lung injury leads to varying degrees of lung injury, and the response to therapy can be ...heterogeneous. Corticosteroid use has been suggested as a treatment for lung injuries associated with vaping. We report a case of e-cigarette or vaping product use-associated lung injury (EVALI) that resulted in acute hypoxic respiratory failure. A 20-year-old woman presented with complaints of sore throat, dry cough, shortness of breath, and pleuritic chest pain. The patient admitted to vaping regularly for the past three years. The patient was found to be severely hypoxemic with respiratory distress and was intubated shortly after her arrival at the emergency department. She was treated with a short course of corticosteroids with tapering of the dose based on her response with significant improvement, and she was extubated on the seventh day of her admission. EVALI is a syndrome associated with severe lung injury that results in acute respiratory failure that is clinically indistinguishable from acute respiratory distress syndrome, and it is largely a diagnosis of exclusion. The use of systemic corticosteroids in treating these patients should be considered after excluding an infectious etiology.
El Salvador: A Far Cry from Peace Allison, Michael E
Revista de ciencia política (Santiago),
01/2017, Letnik:
37, Številka:
2
Journal Article
Recenzirano
Odprti dostop
El Salvador continues to struggle with elevated levels of criminal violence perpetrated by street gangs, drug trafficking organizations, members of the security forces, and other criminal groups. The ...Attorney General’s Office and courts have taken some positive steps towards tackling impunity for current and civil war-era crimes. However, a history of corruption and favoritism within those institutions continues to undermine citizens’ faith in the legitimacy of their actions. Finally, El Salvador confronts a challenging road ahead characterized by uncertainty over the implications of an overturned amnesty law, low rates of economic growth, and a new U.S. president in the White House.
The field of environmental DNA (eDNA) has advanced over the past decade, with multiple approaches available for a variety of sampling media and species. While using eDNA for the purpose of simply ...detecting species is becoming a routine process, the utility of eDNA to estimate species abundance is not well understood. Here, we quantify salmon environmental DNA upstream of a fish counting fence along with river velocity, and together, use these values to determine the correlation between the number of salmon passing by the fish fence daily with daily eDNA rates in water before, during, and after the salmon spawning season for four Pacific salmonids (Oncorhynchus gorbuscha, O. kisutch, O. tshawytscha, and O. nerka; pink, coho, chinook, and sockeye, respectively). Throughout the spawning season, approximately 182,000 salmon were counted passing through the fence, of which >98% were pink salmon. Pink salmon exhibited strong correlation between human counts (effect size = 0.65, SE = 0.040) to eDNA rates in the present study and exhibited day‐to‐day variation and a unimodal profile rising and falling with human fish counts. However, the salmon species observed in much lower numbers exhibited a much weaker correlation with eDNA levels higher during the pre‐migratory period than during the migratory period for sockeye, coho, and chinook. Thus, for salmon spawning runs with less than ~1000 adults and daily counts of less than ~100, the juvenile and/or prior seasons eDNA signal appears to be indistinguishable from the adult spawning eDNA signal in our river system. However, for the large pink salmon run, eDNA rates appeared to reflect a local signal of salmon in space and time, essentially tracking these fish within days of passing through the eDNA sampling site.
Comparing daily environmental DNA measurements and up‐migrating salmon counts for pink salmon shows a clear predictive ability and correlation between the two. Pink salmon exhibited strong correlation between human counts (effect size = 0.65, SE = 0.040) to eDNA rates and exhibited day‐to day variation and a unimodal profile rising and falling with human fish counts.
Hematological Issues in Liver Disease Allison, Michael G; Shanholtz, Carl B; Sachdeva, Ashutosh
Critical care clinics,
07/2016, Letnik:
32, Številka:
3
Journal Article
Recenzirano
Acute and chronic liver failure are associated with numerous alterations in different features of the coagulation system. Consequently, there is widespread confusion regarding the potential for both ...bleeding and thrombosis in patients with liver disease. The risk of bleeding is related to the hemodynamic changes in portal pressures and venous congestion whereas the thrombotic risk stems from changes in the coagulation system. Antithrombotic prophylaxis and treatment of patients with hemorrhage and thrombosis requires careful assessment, interpretation of laboratory workup, and attention to coexistent morbidities. A framework for the management of these conditions is presented for clinicians.
Amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD) comprise a spectrum of neurodegenerative diseases linked to TDP-43 proteinopathy, which at the cellular level, is characterized ...by loss of nuclear TDP-43 and accumulation of cytoplasmic TDP-43 inclusions that ultimately cause RNA processing defects including dysregulation of splicing, mRNA transport and translation. Complementing our previous work in motor neurons, here we report a novel model of TDP-43 proteinopathy based on overexpression of TDP-43 in a subset of Drosophila Kenyon cells of the mushroom body (MB), a circuit with structural characteristics reminiscent of vertebrate cortical networks. This model recapitulates several aspects of dementia-relevant pathological features including age-dependent neuronal loss, nuclear depletion and cytoplasmic accumulation of TDP-43, and behavioral deficits in working memory and sleep that occur prior to axonal degeneration. RNA immunoprecipitations identify several candidate mRNA targets of TDP-43 in MBs, some of which are unique to the MB circuit and others that are shared with motor neurons. Among the latter is the glypican Dally-like-protein (Dlp), which exhibits significant TDP-43 associated reduction in expression during aging. Using genetic interactions we show that overexpression of Dlp in MBs mitigates TDP-43 dependent working memory deficits, conistent with Dlp acting as a mediator of TDP-43 toxicity. Substantiating our findings in the fly model, we find that the expression of GPC6 mRNA, a human ortholog of dlp, is specifically altered in neurons exhibiting the molecular signature of TDP-43 pathology in FTD patient brains. These findings suggest that circuit-specific Drosophila models provide a platform for uncovering shared or disease-specific molecular mechanisms and vulnerabilities across the spectrum of TDP-43 proteinopathies.
The novel coronavirus SARS-CoV-2 (COVID-19) affects all three branches of Virchow's triad. It increases the risk of thrombosis and thromboembolic events. Pulmonary embolism and stroke are most ...commonly reported. However, there is an increasing number of cases demonstrating thrombosis in otherwise uncommon anatomical areas. In this presentation, we will explore the potential causes of pulmonary vein thrombosis secondary to COVID-19.
Alcoholic metabolic emergencies Allison, Michael G; McCurdy, Michael T
Emergency medicine clinics of North America,
05/2014, Letnik:
32, Številka:
2
Journal Article
Recenzirano
Ethanol intoxication and ethanol use are associated with a variety of metabolic derangements encountered in the Emergency Department. In this article, the authors discuss alcohol intoxication and its ...treatment, dispel the myth that alcohol intoxication is associated with hypoglycemia, comment on electrolyte derangements and their management, review alcoholic ketoacidosis, and end with a section on alcoholic encephalopathy.
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