2011 November 16

Mineralocorticoid receptor antagonists for heart failure.

Expert Opin Pharmacother Start a Discussion »

Nov 162011

Mineralocorticoid receptor antagonists for heart failure.

Expert Opin Pharmacother. 2011 Nov 14;

Authors: Richards AM

Abstract
Introduction: Although mineralocorticoid receptor (MR) antagonists are indicated in systolic heart failure, they are underprescribed in patients with appropriate indications for their prescription and often used in those in whom the evidence for probable benefit is scant. The rate of adverse events in practice has exceeded that foreshadowed by randomized controlled trials (RCTs). With the recent publication of the landmark therapeutic trial (EMPHASIS), it is timely to review the appropriate use of these agents in heart failure. Areas covered: This review addresses the pathophysiological importance of MR activation in heart failure and summarizes pivotal RCTs of MR antagonists in heart failure. Expert opinion: MR antagonism reduces mortality and morbidity in heart failure with reduced systolic function in severe chronic disease, in heart failure complicating myocardial infarction and also in those with impaired systolic function (but only mild symptoms). Evidence for benefits in a significant proportion of ?real-life? patients with heart failure, including those with preserved left ventricular ejection fraction, is lacking. MR antagonism is an important part of the pharmaceutical armamentarium in managing heart failure but must be prescribed with careful case selection, taking note of the evidence of where risks are acceptable and benefits are likely.

PMID: 22082128 [PubMed - as supplied by publisher]

Link to Article at PubMed

Medical management of neurocysticercosis.

Expert Opin Pharmacother Start a Discussion »

Nov 162011

Medical management of neurocysticercosis.

Expert Opin Pharmacother. 2011 Nov 15;

Authors: Takayanagui OM, Odashima NS, Bonato PS, Lima JE, Lanchote VL

Abstract
Introduction: Neurocysticercosis (NCC) is considered to be the most common cause of acquired epilepsy worldwide. Formerly restricted to palliative measures, therapy for NCC has advanced with the advent of two drugs that are considered to be effective: praziquantel (PZQ) and albendazole (ALB). Areas covered: All available articles regarding research related to the treatment of NCC were searched. Relevant articles were then reviewed and used as sources of information for this review. Expert opinion: Anticysticercal therapy has been marked by intense controversy. Recent descriptions of spontaneous resolution of parenchymal cysticercosis with benign evolution, risks of complications and reports of no long-term benefits have reinforced the debate over the usefulness and safety of anticysticercal therapy. High interindividual variability and complex pharmacological interactions will require the close monitoring of plasma concentrations of ALB and PZQ metabolites in future trials. Given the relative scarcity of clinical trials, more comparative interventional studies ? especially randomized controlled trials in long-term clinical evolution ? are required to clarify the controversy over the validity of parasitic therapy in patients with NCC.

PMID: 22082143 [PubMed - as supplied by publisher]

Link to Article at PubMed

Central line-associated blood stream infection in the critically ill trauma patient.

Am Surg Start a Discussion »

Nov 162011

Central line-associated blood stream infection in the critically ill trauma patient.

Am Surg. 2011 Aug;77(8):1038-42

Authors: Smith JW, Egger M, Franklin G, Harbrecht B, Richardson JD

Abstract
Blood stream infections in the critically ill are a common cause of morbidity. Strict adherence to sterile technique can reduce central line-associated blood stream infections (CLBSIs) and has become a quality improvement measure. We did a retrospective review of 6,014 trauma admissions representing 10,370 catheter days. CLBSI was defined as a positive blood culture with central venous access without evidence of other infectious sources. Thirty-five CLBSIs were identified in the study period (3.26/1,000 line days). The average Injury Severity Score was 32, the average intensive care unit stay was 24 days, and the average overall length of stay was 34 days, which is higher than that of nonCLBSI patients. In 25/35 cases, there was a break in sterile technique during central venous catheter placement (71%). Of the 25 cases, 16 of them were performed in the intensive care unit (64%), five in the operating room (20%), and four in the emergency department (16%). Twenty of the 35 patients with CLBSI (57%) had a total of 24 infections, a 2-fold increase in infectious complications for a given Injury Severity Score. Seventeen (17) of the 25 "dirty" central lines (68%) were changed within 24 hours in an effort to reduce the risk of CLBSI without success. A large percentage of CLBSI can be traced to the initial placement of a central venous line under less than ideal sterile technique. Changing a line within 24 hours may not be sufficient to reduce the risk of CLBSI. Every effort should be made to adhere to proper sterile technique while placing central venous catheter.

PMID: 21944520 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Biomarkers for ventilator-associated pneumonia: review of the literature.

Heart Lung Start a Discussion »

Nov 162011

Biomarkers for ventilator-associated pneumonia: review of the literature.

Heart Lung. 2011 Jul-Aug;40(4):293-8

Authors: Palazzo SJ, Simpson T, Schnapp L

Abstract
OBJECTIVE: Ventilator-associated pneumonia (VAP) contributes significantly to morbidity and mortality in critically ill patients, but it can be difficult to diagnose. Clinical criteria, Clinical Pulmonary Infection Score, and quantitative culture of bronchoalveolar lavage have been used to distinguish between patients who are likely positive (sensitivity) and patients who are likely negative (specificity). Despite these test methods, patients continue to be misclassified. False-positive results may lead to inappropriate antibiotic use in patients. For those misclassified as test negative, appropriate treatment may be delayed. Biomarkers have been suggested as another method to enhance the ability to predict VAP. This article analyzes the evidence for the usefulness of 3 biomarkers that have been proposed as possible biomarkers of VAP: soluble triggering receptor expressed on myeloid type 1 cells, procalcitonin, and C-reactive protein.
METHODS: A Medline search was conducted for the years between 1990 and 2009 to locate articles on the subject of biomarkers for predicting VAP in critically ill adult patients.
RESULTS: Analysis of the literature does not currently support a clinical role for these biomarkers in predicting VAP. Variations in the diagnostic methods, antimicrobial use, cutoff values, and patient populations limit comparisons among the studies.
CONCLUSION: Recommendations are offered to strengthen and standardize methods in future studies to clarify the utility of biomarkers for predicting VAP in specific patient populations.

PMID: 21419491 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Risk stratification and short-term prognosis in acute heart failure syndromes: a review of novel biomarkers.

biomarkers Start a Discussion »

Nov 162011

Risk stratification and short-term prognosis in acute heart failure syndromes: a review of novel biomarkers.

Biomarkers. 2011 Aug;16(5):379-92

Authors: Avellino A, Collins SP, Fermann GJ

Abstract
BACKGROUND: Early risk stratification of patients with acute heart failure syndrome (AHFS) can guide the decision to admit the patient to hospital and the choice of therapy.
METHODS: Standard review methodology using Medline and Google scholar from the years 2006-present. Papers before 2006 were reviewed when necessary.
RESULTS: Biomarkers used in AHFS are broadly classified based on their mechanism of action: inflammation, renal stress, extracellular matrix remodeling, oxidative stress, cardiac myocyte stress, and neurohormonal regulation.
CONCLUSION: This paper provides a review for clinicians and medical scientists highlighting the most recent advances in biomarkers with application in AHFS.

PMID: 21534728 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Risk factors, inpatient care, and outcomes of pneumonia after ischemic stroke.

Neurology Start a Discussion »

Nov 162011

Risk factors, inpatient care, and outcomes of pneumonia after ischemic stroke.

Neurology. 2011 Oct 4;77(14):1338-45

Authors: Finlayson O, Kapral M, Hall R, Asllani E, Selchen D, Saposnik G, ,

Abstract
OBJECTIVES: Pneumonia is the most common medical complication after stroke. Although several risk factors have been reported, the role of common comorbidities in the development of pneumonia is not well established. Moreover, there is discrepancy in the literature regarding the impact of pneumonia on stroke outcomes.
METHODS: This is a multicenter retrospective cohort study including consecutive patients with ischemic stroke admitted to Regional Stroke Centers participating in the Registry of Canadian Stroke Network in July 2003-March 2007. Pneumonia was defined as a complication that occurred within the first 30 days of the stroke and was confirmed radiographically. The main outcome measure was adjusted 30-day mortality. Secondary outcomes were adjusted 7- and 365-day mortality, institutionalization, length of stay, and modified Rankin score on discharge. We also assessed the impact of organized stroke care on pneumonia development and mortality.
RESULTS: Overall, 8,251 patients were included in the study. Stroke-associated pneumonia was observed in 587 patients (7.1%). Pneumonia increased 30-day (odds ratio [OR] 2.2 [95% confidence interval (CI) 1.8-2.7]) and 1-year mortality (OR 3.0 [95% CI 2.5-3.7]), but not 7-day mortality. Pneumonia was associated with poor functional outcome. Higher access to organized inpatient care resulted in a reduction of 30-day mortality (OR 0.50 [95% CI 0.41-0.61]). Older age, male sex, stroke severity, dysphagia, chronic obstructive pulmonary disease, coronary artery disease, nonlacunar ischemic stroke, and preadmission dependency were independent predictors of pneumonia.
CONCLUSIONS: Development of pneumonia after stroke was associated with mortality at 30 days and 1 year, longer length of stay, and dependency at discharge. Patients who received more inpatient stroke services had reduced mortality after pneumonia.

PMID: 21940613 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

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