Jan 242015
 

New Oral Anticoagulants in the Treatment of Heparin- Induced Thrombocytopenia.

Thromb Res. 2015 Jan 10;

Authors: Sharifi M, Bay C, Vajo Z, Freeman W, Sharifi M, Schwartz F

Abstract
BACKGROUND: Heparin induced thrombocytopenia (HIT) is a potentially catastrophic syndrome with a high incidence of vascular thrombosis. There are little data on the efficacy of new oral anticoagulants (NOAC) in this setting. This study reports on the outcome of patients with HIT, treated with NOAC.
MATERIALS AND METHODS: We retrospectively identified 22 patients with HIT who were treated by our group with a combination of NOAC and a short course of argatroban. These patients were evaluated in a prospective fashion for development of outcomes at a mean follow up of 19±3months.
RESULTS: There were a total of 5 deep and 2 superficial vein thromboses diagnosed at index hospitalization. No patient developed arterial thrombosis. All patients tolerated NOAC and their platelet count normalized before discharge. At 19months of follow-up, 6 patients had died of non-thrombotic causes. There was no bleeding, limb loss or recurrent venous thromboembolism in any patient.
CONCLUSIONS: In patients with HIT, a short course of parenteral treatment with argatroban followed by administration of a NOAC is highly safe and effective in prevention of thrombosis and normalization of platelet count. Development of HIT however, portends a poor prognosis independent of vascular thrombosis.

PMID: 25613925 [PubMed - as supplied by publisher]

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Jan 242015
 

Group A streptococcal meningitis in adults.

J Infect. 2015 Jan 20;

Authors: Lucas MJ, Brouwer MC, Bovenkerk S, Man WK, van der Ende A, van de Beek D

Abstract
OBJECTIVES: We report on the incidence, clinical characteristics, and bacterial genotype of group A streptococcal (GAS) meningitis in the Netherlands.
METHODS: We assessed the incidence, clinical characteristics, and outcome of patients with GAS meningitis from a nationwide cohort study of adults with community-acquired bacterial meningitis in the Netherlands from 2006 to 2013.
RESULTS: GAS was identified in 26 of 1322 patients with community-acquired bacterial meningitis (2%); 9 cases (35%) occurred in the first four months of 2013. GAS meningitis was often preceded by otitis or sinusitis (24 of 26 [92%]) and a high proportion of patients developed complications during clinical course (19 of 26 [73%]). Subdural empyema occurred in 8 of 26 patients (35%). Nine patients underwent mastoidectomy and in 5 patients neurosurgical evacuation of the subdural empyema was performed. Five of 26 patients (19%) died and 11 of 21 surviving patient had neurologic sequelae (52%). Infection with the emm1 and cc28 GAS genotype was associated with subdural empyema (both 4 of 6 [67%] vs. 2 of 14 [14%]; P=0.037).
CONCLUSIONS: GAS meningitis is an uncommon but severe disease. Patients are at risk for empyema, which is associated with infection with the emm1 and cc28 genotype.

PMID: 25614959 [PubMed - as supplied by publisher]

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Jan 242015
 

Clinically Significant Novel Biomarkers for Prediction of First Ever Myocardial Infarction: The Tromsø Study.

Circ Cardiovasc Genet. 2015 Jan 22;

Authors: Wilsgaard T, Mathiesen EB, Patwardhan A, Rowe MW, Schirmer H, Løchen ML, Sudduth-Klinger J, Hamren S, Bønaa KH, Njølstad I

Abstract
BACKGROUND: -Identification of individuals with high risk for first-ever myocardial infarction (MI) can be improved. The objectives of the study were to survey multiple protein biomarkers for association with the 10-year risk of incident MI and identify a clinically significant risk model that adds information to current common risk models.
METHODS AND RESULTS: -We employed an immunoassay platform that utilizes a sensitive, sample efficient molecular counting technology to measure 51 proteins in samples from the fourth survey (1994) in the Tromsø Study, a longitudinal study of men and women in Tromsø, Norway. A case control design was used with 419 first-ever MI cases (169 females/250 males) and 398 controls (244 females/154 males). Of the proteins measured, 17 were predictors of MI when considered individually after adjustment for traditional risk factors either in men, women or both. The 6 biomarkers adjusted for traditional risk factors that were selected in a multivariable model (odds ratios per standard deviation) using a stepwise procedure were apolipoprotein B/apolipoprotein A1 ratio (1.40), kallikrein (0.73), lipoprotein a (1.29), matrix metalloproteinase 9 (1.30), the interaction term IP-10/CXCL10*women (0.69), and the interaction term thrombospondin 4*men (1.38). The composite risk of these biomarkers added significantly to the traditional risk factor model with a net reclassification improvement of 14% (p=0.0002), while the ROC area increased from 0.757 to 0.791, p = 0.0004.
CONCLUSIONS: -Novel protein biomarker models improve identification of 10-year MI risk above and beyond traditional risk factors with 14% better allocation to either high or low risk group.

PMID: 25613532 [PubMed - as supplied by publisher]

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Jan 242015
 

CT Correlation With Outcomes in 15 Patients With Acute Middle East Respiratory Syndrome Coronavirus.

AJR Am J Roentgenol. 2015 Jan 23;:1-7

Authors: Das KM, Lee EY, Enani MA, AlJawder SE, Singh R, Bashir S, Al-Nakshbandi N, AlDossari K, Larsson SG

Abstract
OBJECTIVE. The purpose of this article is to retrospectively analyze chest CT findings for 15 patients with Middle East respiratory syndrome coronavirus and to identify features associated with survival. MATERIALS AND METHODS. Patients were assigned to group 1 if they died (n = 9) and to group 2 if they made a full recovery (n = 6). Two reviewers scored chest radiographs and CT examinations for segmental involvement, ground-glass opacities, consolidation, and interstitial thickening. RESULTS. Eight patients had ground-glass opacity (53%), five had ground-glass and consolidation in combination (33%), five had pleural effusion (33%), and four patients had interlobular thickening (27%). Of 281 CT findings, 151 (54%) were peripheral, 68 (24%) were central, and 62 (22%) had a mixed location. The number of involved lung segments was higher in group 1. The lower lobe was more commonly involved (mean, 12.2 segments) than in the upper and middle lobes combined (mean, 6.3 segments). The mean number of lung segments involved was 12.3 segments in group 1 and 3.4 segments in group 2. The CT lung score (mean ± SD, 15.78 ± 7.9 vs 7.3 ± 5.7, p = 0.003), chest radiographic score (20.8 ± 1.7 vs 5.6 ± 5.4; p = 0.001), and mechanical ventilation duration (13.11 ± 8.3 vs 0.5 ± 1.2 days; p = 0.002) were higher in group 1. All nine group 1 patients and three of six group 2 patients had pleural effusion (p = 0.52). CONCLUSION. CT of patients with Middle East respiratory syndrome coronavirus predominantly showed ground-glass opacities, with peripheral lower lobe preference. Pleural effusion and higher CT lung and chest radiographic scores correlate with poor prognosis and short-term mortality.

PMID: 25615627 [PubMed - as supplied by publisher]

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Jan 232015
 
Related Articles

A general consideration of the importance of nutrition for critically ill patients.

Turk J Med Sci. 2014;44(6):1055-9

Authors: Dumlu EG, Özdedeoğlu M, Bozkurt B, Tokaç M, Yalçin A, Öztürk L, Kiliç M

Abstract
BACKGROUND/AIM: Malnutrition is a common medical condition among intensive care unit patients. It should be monitored carefully, since early management of malnutrition can dramatically improve the medical condition of the patients. A general consideration of enteral feeding shows that it is much more useful than parenteral administration, because it is more physiological and poses a lower risk of hyperalimentation.
MATERIALS AND METHODS: In this retrospective study, we scanned all files and personal information of patients hospitalized in intensive care units between 2009 and 2012 due to various medical conditions. We evaluated the nutritional status of patients with biochemical parameters that were retrieved from the files.
RESULTS: In total, 198 patients were identified from hospital records. Almost every patient was given nutritional support either through enteral or parenteral feeding. The albumin levels of 56 patients did not increase, even when they were fed with calculated nutritional support (36.6%). The prealbumin levels of the patients had a tendency to increase after the provision of nutritional additives.
CONCLUSION: In appropriately selected critically ill patients, the role of nutritional support in the management of nutritional deficiencies is important. In order to calculate proper feeding goals, a full nutritional assessment is necessary.

PMID: 25552161 [PubMed - indexed for MEDLINE]

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Jan 232015
 
Related Articles

Review of clinical experience with acute cholecystitis on the development of subsequent gallstone-related complications.

Turk J Med Sci. 2014;44(5):883-8

Authors: Hasbahçecı M, Alımoğlu O, Başak F, Canbak T, Şışık A, Çalişkan Evren M, Baş G

Abstract
BACKGROUND/AIM: Recently, surgery during admission has been advocated for acute cholecystitis, rather than delayed surgery after conservative treatment. This study was designed to perform early surgeries and analyze the criteria used for conservative management followed by delayed surgery.
MATERIALS AND METHODS: After implementation of a study with the aim of performing early surgery, a retrospective review using a prospective database during the period of June 2009 to June 2011 was established. Early surgery during index hospitalization was offered to all patients, except those having criteria for conservative management.
RESULTS: There were 118 patients admitted for acute cholecystitis. Early and delayed surgeries were performed for 18 (15%) and 23 (20%) patients, respectively. Percutaneous cholecystostomy was performed for 10 (8%) patients with a success rate of 90% and significantly higher length of hospital stay (P = 0.001). Gallstone-related complications developed in 33 (28%) patients, causing significantly higher readmission rates (P = 0.001). Ofthe patients, 34 (29%) were neither operated on nor had complications. The subsequent cholecystectomy rate was calculated as 35%. The overall mortality rate was 1.7% for all groups.
CONCLUSION: Although surgical treatment of acute cholecystitis, either by early or delayed surgery, has some specific morbidity and mortality, it should be kept in mind that conservative treatment modalities have a higher rate of recurrences and subsequent complications, which all cause additional morbidity and mortality in patients.

PMID: 25539562 [PubMed - indexed for MEDLINE]

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