2011 July 12

Improved diagnostic and prognostic performance of a new high-sensitive troponin T assay in patients with acute coronary syndrome.

Jul 122011

Improved diagnostic and prognostic performance of a new high-sensitive troponin T assay in patients with acute coronary syndrome.

Am Heart J. 2011 Jul;162(1):81-8

Authors: Weber M, Bazzino O, Navarro Estrada JL, de Miguel R, Salzberg S, Fuselli JJ, Liebetrau C, Woelken M, Moellmann H, Nef H, Hamm C

In the present study, we aimed to analyze the diagnostic and prognostic potential of a newly developed high-sensitive troponin T assay and compared these results with those of a contemporary troponin T assay in 2 distinct patient cohorts, one including patients with evident ACS and the other one including patients with general chest pain.

PMID: 21742093 [PubMed - in process]

Link to Article at PubMed

Community-associated meticillin-resistant Staphylococcus aureus strains as a cause of healthcare-associated infection.

J Hosp Infect Start a Discussion »

Jul 122011

Community-associated meticillin-resistant Staphylococcus aureus strains as a cause of healthcare-associated infection.

J Hosp Infect. 2011 Jul 6;

Authors: Otter JA, French GL

Community-associated meticillin-resistant Staphylococcus aureus (CA-MRSA) was first noticed as a cause of infection in community-based individuals without healthcare contact. As the global epidemic of CA-MRSA has continued, CA-MRSA strain types have begun to emerge as a cause of healthcare-associated infections (HAIs) and hospital outbreaks have occurred worldwide. In areas where CA-MRSA clones have become established with high prevalence, for example USA300 (ST8-IV) in the USA, CA-MRSA are beginning to supplant or overtake traditional healthcare-associated MRSA strains as causes of HAI. The emergence of CA-MRSA as a cause of HAI puts a wider group of hospitalised patients, healthcare workers and their community contacts potentially at risk of MRSA infection. It also exposes CA-MRSA strains to the selective pressure of antibiotic use in hospitals, potentially resulting in increased antibiotic resistance, challenges traditional definitions of CA-MRSA and hampers control efforts due to the constant re-introduction of MRSA from an emerging community reservoir. There is thus an urgent need to clarify the definitions, prevalence and epidemiology of CA-MRSA and to develop systems for the identification and control of these organisms in the community, in hospitals and other healthcare facilities, and at the community-hospital interface.

PMID: 21741111 [PubMed - as supplied by publisher]

Link to Article at PubMed

Feedback to clinicians on preventable factors can reduce hospital onset Staphylococcus aureus bacteraemia rates.

J Hosp Infect Start a Discussion »

Jul 122011

Feedback to clinicians on preventable factors can reduce hospital onset Staphylococcus aureus bacteraemia rates.

J Hosp Infect. 2011 Jul 7;

Authors: Kok J, O'Sullivan MV, Gilbert GL

Staphylococcus aureus bacteraemia (SAB) is associated with significant morbidity and mortality, yet there are limited data on preventable factors. This study aimed to evaluate SAB episodes at a tertiary care hospital; to identify factors that, if avoided, might have prevented the episode of SAB; and to provide feedback to treating clinicians. Of 187 episodes of SAB over 19 months 59.9% were caused by meticillin-susceptible S. aureus (MSSA) and 40.1% meticillin-resistant S. aureus (MRSA), 65.8% of SAB were healthcare-associated (HA) and 34.2% were community-acquired. Seven- and 30-day mortality rates, overall, were 11.2% and 20.9% respectively. At least one preventable factor was identified in 50.4% of HA-SAB episodes, including recent nosocomial MRSA acquisition in 53.7% MRSAB episodes and one or more factors associated with intravenous access in at least 24.3% of HA (35.7% of hospital onset) cases. SAB was more likely to be associated with at least one identifiable, preventable factor in surgical than in medical inpatients (86.2% vs 54.5%, P=0.004). Patients with HA-MRSAB were more likely than those with HA-MSSAB to require intensive care unit admission (44.4% vs 18.8%, P=0.003). Identifying and addressing preventable factors will better target resources for prevention of SAB. Feedback about preventable factors was associated with a reduction in HA-SAB rates from 0.29 to 0.20 per 1000 occupied bed-days, from 2008 to 2009.

PMID: 21741724 [PubMed - as supplied by publisher]

Link to Article at PubMed

The incidence of recurrent venous thromboembolism and chronic thromboembolic pulmonary hypertension following a first episode of pulmonary embolism.

Curr Opin Pulm Med Start a Discussion »

Jul 122011

The incidence of recurrent venous thromboembolism and chronic thromboembolic pulmonary hypertension following a first episode of pulmonary embolism.

Curr Opin Pulm Med. 2011 Jul 7;

Authors: Poli D, Miniati M

PURPOSE OF REVIEW: Pulmonary embolism is the most serious complication of venous thromboembolism, with an elevated case/fatality rate. Patients who survived a first episode of pulmonary embolism should be evaluated for the risk of recurrence and of chronic thromboembolic pulmonary hypertension (CTEPH). RECENT FINDINGS: The risk of recurrence is higher in patients with unprovoked pulmonary embolism than in those with transient risk factors. Persistent risk factors, such as active cancer and antiphospholipid antibodies, are associated with high risk of recurrence. Recently, elevated D-dimer levels after discontinuation of therapy have been identified as a risk factor for recurrence. CTEPH is characterized by intravascular organization of emboli and occurs in 0.5-1% of cases. Some patients with CTEPH have impaired fibrinolysis, likely due to a structural abnormality of fibrin or fibrin clot. Echocardiography often reveals signs of pulmonary hypertension. This should be confirmed by direct measurement of pulmonary artery pressures at right heart catheterization. SUMMARY: CTEPH patients should receive life-long anticoagulation for preventing recurrent pulmonary embolism. Pulmonary endarterectomy is the treatment of choice for patients with proximal pulmonary vascular occlusion. Patients with predominantly distal pulmonary vascular occlusion are candidates for pharmacological treatment. All patients with unprovoked pulmonary embolism should be evaluated for long-term anticoagulation.

PMID: 21743331 [PubMed - as supplied by publisher]

Link to Article at PubMed

Cardiac sarcoidosis: a review 2011.

Curr Opin Pulm Med Start a Discussion »

Jul 122011

Cardiac sarcoidosis: a review 2011.

Curr Opin Pulm Med. 2011 Jul 7;

Authors: Yeboah J, Lee C, Sharma OP

PURPOSE OF REVIEW: Cardiac involvement in sarcoidosis is not always associated with a wide spread of disease, but when present, has been linked with a relatively poor prognosis. This review will delve into new genetic associations, recently reported clinical manifestations and complementary radiographic tools that aid with diagnosis and follow-up. RECENT FINDINGS: Clinical manifestations, diagnosis and management remain an intricate maze.Genetic predisposition and associations that include HLA class II molecules and polymorphisms in tumor necrosis factor-? have been reported due in part to weakened arguments suggesting autoimmune disorders or dysregulation. In addition, further symptomatologies have been reported that assist with diagnosis.Radiographic tools including Microvolt T wave alternans, cardiovascular magnetic resonance, late gadolinium enhancement and cardiac assist devices, recently being used, are shedding some light on the diagnostic challenges. SUMMARY: Cardiac involvement in sarcoidosis remains a challenging dilemma, relying on a combination of clinical findings and imaging abnormalities because no single diagnostic test has yet emerged with a high degree of specificity and sensitivity. Given its life-threatening nature, prompt establishment of a diagnosis, an aggressive management strategy and devices to prolong life should be pursued.

PMID: 21743332 [PubMed - as supplied by publisher]

Link to Article at PubMed

A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome.

Gastroenterology Start a Discussion »

Jul 122011

A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome.

Gastroenterology. 2011 Jul 7;

Authors: van Santvoort HC, Bakker OJ, Bollen TL, Besselink MG, Ali UA, Schrijver AM, Boermeester MA, van Goor H, Dejong CH, van Eijck CH, van Ramshorst B, Schaapherder AF, van der Harst E, Hofker S, Nieuwenhuijs VB, Brink MA, Kruyt PM, Manusama ER, van der Schelling GP, Karsten T, Hesselink EJ, van Laarhoven CJ, Rosman C, Bosscha K, de Wit RJ, Houdijk AP, Cuesta MA, Wahab PJ, Gooszen HG,

BACKGROUND & AIMS: Treatment of necrotizing pancreatitis has become more conservative and less invasive, but there are few data from prospective studies to support the efficacy of this change. We performed a prospective, multicenter study of treatment outcomes among patients with necrotizing pancreatitis. METHODS: We collected data from 639 consecutive patients with necrotizing pancreatitis, from 2004 to 2008, treated at 21 Dutch hospitals. Data were analyzed for disease severity, interventions (radiological, endoscopic, surgical), and outcome. RESULTS: Overall mortality was 15% (n=93). Organ failure occurred in 240 patients (38%), with 35% mortality. Treatment was conservative in 397 patients (62%), with 7% mortality. An intervention was performed in 242 patients (38%), with 27% mortality; this included early emergency laparotomy in 32 patients (5%), with 78% mortality. Patients with longer times between admission and intervention had lower mortality: 0-14 days, 56%; 14-29 days, 26%; and >29 days, 15%,P <.001. Two-hundred eight patients (33%) received interventions for infected necrosis, with 19% mortality. Catheter drainage was most often performed as the first intervention (63% of cases), without additional necrosectomy in 35% of patients. Primary catheter drainage had fewer complications than primary necrosectomy (42% vs. 64%,P =.003). Patients with pancreatic parenchymal necrosis (n=324), compared to patients with only peripancreatic necrosis (n=315), had a higher risk of organ failure (50% vs. 24%,P <.001) and mortality (20% vs. 9%,P <.001). CONCLUSIONS: Approximately 62% of patients with necrotizing pancreatitis can be treated without an intervention and with low mortality. In patients with infected necrosis, delayed intervention and catheter drainage as first treatment improves outcome.

PMID: 21741922 [PubMed - as supplied by publisher]

Link to Article at PubMed

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