Infections in Patients with Cirrhosis: A Concise Review.
Clin Gastroenterol Hepatol. 2011 Mar 10;
Authors: Bonnel AR, Bunchorntavakul C, Reddy KR
PMID: 21397731 [PubMed - as supplied by publisher]
Link to Article at PubMedMar 152011
Mar 152011
Impact of non-exacerbated COPD on mortality in critically ill patients.
Chest. 2011 Mar 10;
Authors: Rodríguez A, Lisboa T, Solé-Violán J, Gomez F, Roca O, Trefler S, Gea J, Masclans JR, Rello J
Abstract BACKGROUND: The real contribution of non-exacerbated chronic obstructive pulmonary disease (COPD) on mortality has not been studied. The aim of our study was to evaluate the impact of non-exacerbated COPD on mortality in patients requiring mechanical ventilation. METHODS: Prospective, observational study that included critically ill ventilated patients without evidence of respiratory infection. COPD patients were the study group. Clinical and demographics variables were recorded. The main end-point was ICU mortality. RESULTS: Of the 235 patients included, 60 (25.5%) intubated patients had COPD (Study group). The remaining 175 (74.5%) patients were considered as the control group. COPD patients were more often medical, older and had higher number of comorbidities and APACHE II score than intubated without COPD (p<0.05). The overall ICU mortality was 26.3% (62/235) and significantly higher in non-exacerbated COPD patients (36.7% vs. 22.9%, p<0.05), with an attributable mortality to COPD of 13.8%. Ventilator-associated pneumonia (VAP) incidence was not significantly different between non-exacerbated COPD (11.9/1000 MV days) and non-COPD patients (16.0 /1000 MV days; p=0.40). In the multivariate analysis, only COPD (HR=2.1 95%CI 1.10-3.94) and shock at ICU admission (HR= 2.0 95%CI 1.01-4.01) and medical condition (HR=1.7 95%IC 1.01-3.18) were variables independently associated with mortality. CONCLUSION: Intubated non-exacerbated COPD patients were not exposed to higher risk of VAP but had higher mortality.
PMID: 21393392 [PubMed - as supplied by publisher]
Link to Article at PubMedMar 152011
Prevalence and Risk of Pre-existing Heparin-induced Thrombocytopenia Antibodies in Patients with Acute Venous Thromboembolism.
Chest. 2011 Mar 10;
Authors: Warkentin TE, Davidson BL, Buller HR, Gallus A, Gent M, Lensing AW, Piovella F, Prins MH, Segers AE, Kelton JG
Abstract BACKGROUND: Some patients with acute venous thromboembolism who may previously have been exposed to heparin products have unrecognized antibodies implicated in heparin-induced thrombocytopenia (HIT). Antibody prevalence and patient consequences upon exposure to heparin, low-molecular-weight heparin, and fondaparinux are uncertain. METHODS: In this secondary analysis, we tested patients in the Matisse venous thromboembolism studies at study entry for heparin-dependent antibodies and further tested ELISA-positive patients for platelet-activating antibodies. We compared the risk of HIT (>50% platelet count fall, heparin-dependent antibodies, no contradicting features) between those treated with heparin (either unfractionated or low-molecular-weight [enoxaparin]) versus those who received fondaparinux. Comparison groups for thrombocytopenia occurrence were ELISA-positive, platelet-activating antibody-positive patients, ELISA-positive but platelet-activating antibody-negative patients, and randomly-selected antibody-negative patients. RESULTS: 127 (3.2%) of 3994 patients were ELISA-positive at baseline but only 14 (0.4%; 95% CI, 0.2-0.6%) had platelet-activating antibodies. Among these 14, four treated with unfractionated or low-molecular-weight heparin developed HIT, compared to none of 10 fondaparinux-treated patients (OR 95, 95% CI, 8-1123; p<0.001). This frequency (4/4, 100%) significantly differed from that of both heparin-treated patients who were ELISA-positive but platelet-activating antibody-negative, and from heparin-treated antibody-negative controls (0/15 and 0/27, respectively; p<0.001 for both). CONCLUSION: 0.4% of patients with venous thromboembolism had pathologic platelet-activating heparin-dependent antibodies, rather than the 3.2% detected by the commercial ELISA's recommended cut-off. Among study patients with acute venous thromboembolism who have platelet-activating antibodies, treatment with fondaparinux reduces the risk of precipitating rapid-onset HIT.
PMID: 21393394 [PubMed - as supplied by publisher]
Link to Article at PubMedMar 152011
Troponin elevations after electroconvulsive therapy: the need for caution.
Am J Med. 2011 Mar;124(3):229-34
Authors: Martinez MW, Rasmussen KG, Mueller PS, Jaffe AS
Electroconvulsive therapy is used to treat patients with severe or resistant depression. Troponin elevations are associated with an adverse prognosis, and it is well known that central nervous system insults can cause biochemical evidence of cardiac injury. No study previously has studied this with electroconvulsive therapy.
PMID: 21396506 [PubMed - in process]
Link to Article at PubMedMar 152011
Incidence of cardiovascular events after hospital admission for pneumonia.
Am J Med. 2011 Mar;124(3):244-51
Authors: Perry TW, Pugh MJ, Waterer GW, Nakashima B, Orihuela CJ, Copeland LA, Restrepo MI, Anzueto A, Mortensen EM
Several studies have suggested an increased risk of cardiovascular events, primarily acute myocardial infarction, around the time of hospital admission for pneumonia. Therefore, we examined cardiovascular events, including myocardial infarction, congestive heart failure, unstable angina, stroke, and serious cardiac arrhythmias, within 90 days after hospitalization for pneumonia.
PMID: 21396508 [PubMed - in process]
Link to Article at PubMedMar 152011
Venous thromboembolism in heart failure: preventable deaths during and after hospitalization.
Am J Med. 2011 Mar;124(3):252-9
Authors: Piazza G, Goldhaber SZ, Lessard DM, Goldberg RJ, Emery C, Spencer FA
Our aim was to compare the clinical characteristics, prophylaxis, treatment, and outcomes of patients with venous thromboembolism with and without heart failure.
PMID: 21396509 [PubMed - in process]
Link to Article at PubMed