2012 July 05

Sarcoidosis and tuberculosis: the same disease with different manifestations or similar manifestations of different disorders.

Jul 052012

Sarcoidosis and tuberculosis: the same disease with different manifestations or similar manifestations of different disorders.

Curr Opin Pulm Med. 2012 Jun 29;

Authors: Gupta D, Agarwal R, Aggarwal AN, Jindal SK

Abstract

PURPOSE OF REVIEW: Ever since sarcoidosis was first described, its relationship with tuberculosis has been debated. Whereas some consider sarcoidosis and tuberculosis as two extremes of the same disease process, other researchers have negated the role of mycobacteria in causation of sarcoidosis. Whether or not linked causally, there are obvious clinical similarities that make differential diagnosis of the two conditions very challenging, particularly in countries with high burden of tuberculosis. Herein we analyze the relationship between sarcoidosis and tuberculosis and its implications in clinical practice. RECENT FINDINGS: Initial studies had focused on finding an epidemiological link between the two conditions or demonstration of mycobacteria in sarcoid lesions on histology. Results from these studies were at best suggestive. Recent molecular and immunological studies suggest mycobacterial antigens are the inciting agents in a proportion of sarcoidosis patients. Evidence is stronger from countries with high burden of tuberculosis. Tuberculosis can manifest as a complication of treatment in sarcoidosis and the two conditions can rarely co-exist. SUMMARY: The balance of evidence favors mycobacteria or their products as a trigger for inciting immune responses leading to sarcoidosis in a proportion of patients, which is likely to be higher in countries with high tuberculosis burden. This evidence also highlights the limitations of molecular or serological studies to discriminate between the two conditions.

PMID: 22759770 [PubMed - as supplied by publisher]

Link to Article at PubMed

Unsuspected pulmonary embolism: impact on mortality among cancer patients.

Curr Opin Pulm Med Start a Discussion »

Jul 052012

Unsuspected pulmonary embolism: impact on mortality among cancer patients.

Curr Opin Pulm Med. 2012 Jun 29;

Authors: Piatek C, O'Connell C

Abstract

PURPOSE OF REVIEW: Symptomatic pulmonary embolism is associated with significant morbidity and mortality, but whether the same is true of unsuspected pulmonary embolism (UPE) has only recently become the subject of clinical research. Interest in the impact of UPE on patient outcomes has emerged, as their detection has become more common with the standard use of multirow detector computed tomography scans. Serial CT scanning of patients with cancer, in conjunction with a higher incidence of venous thromboembolism, makes UPE the most frequent in this population. This review will explore the recent studies which evaluate the impact of UPE on outcomes, especially mortality, among patients with cancer. RECENT FINDINGS: Several recent studies have attempted to explore the impact that UPE has on cancer patients, mainly with respect to mortality. These studies have all been retrospective and most have used as a comparator cancer patients with suspected pulmonary embolism based on suggestive symptoms. Regardless, the findings in all but one study conclude that UPE adversely impacts survival among cancer patients, even with proper anticoagulation. However, unsuspected subsegmental pulmonary embolism may not impact survival, regardless of the treatment. SUMMARY: Recent data suggest that cancer patients who develop UPE have mortality rates as well as bleeding rates that parallel those of cancer patients in whom pulmonary embolism is detected on dedicated scans performed because of the presence of pulmonary embolism-related symptoms. Cancer patients who are truly asymptomatic, based on careful screening, may have improved survival, although no prospective studies support definitive treatment recommendations for this group.

PMID: 22759768 [PubMed - as supplied by publisher]

Link to Article at PubMed

Bed occupancy rates and hospital-acquired infections-should beds be kept empty?

Clin Microbiol Infect Start a Discussion »

Jul 052012

Bed occupancy rates and hospital-acquired infections-should beds be kept empty?

Clin Microbiol Infect. 2012 Jun 18;

Authors: Kaier K, Mutters NT, Frank U

Abstract

Clin Microbiol Infect ABSTRACT: There is growing evidence that bed occupancy (BO) rates, overcrowding and understaffing influence the spread of hospital-acquired infections (HAIs). In this article, a systematic review of the literature is presented, summarizing the evidence on the adverse effects of high BO rates and overcrowding in hospitals on the incidence of HAIs. A Pubmed database search identified 179 references, of which 44 were considered to be potentially relevant for full-text review. The majority (62.9%) focused on methicillin-resistant Staphylococcus aureus-associated infection or colonization. Only 12 studies were found that provided a statistical analysis of the impact of BO on HAI rates. The median BO rate of the analysed studies was 81.2%. The majority of studies (75%) indicated that BO rates and understaffing directly influence the incidence of HAIs. Only three studies showed no significant association between BO rates and the incidence of HAIs. Interestingly, only one of the included studies detected a seasonal trend in the BO rate. The present review shows an association between BO rates and the spread of HAIs in various settings. Because the evidence on this topic is limited, we conclude that further research is needed in order to analyse the rationale of a threshold BO rate, because keeping beds empty is comparatively costly.

PMID: 22757765 [PubMed - as supplied by publisher]

Link to Article at PubMed

Critical illness polyneuromyopathy.

Am J Health Syst Pharm Start a Discussion »

Jul 052012

Critical illness polyneuromyopathy.

Am J Health Syst Pharm. 2012 Jul 15;69(14):1199-205

Authors: Confer J, Wolcott J, Hayes R

Abstract

Purpose The clinical characteristics of and treatment approaches for critical illness polyneuromyopathy (CIPNM) are reviewed. Summary CIPNM is an acute axonal sensory-motor polyneuropathy that tends to occur after the development of respiratory insufficiency in patients with systemic inflammatory response syndrome, sepsis, or multiple-organ dysfunction syndrome. Numerous mechanisms have been proposed to explain the pathophysiology of CIPNM, most of which are complex and not fully understood or proven. While the rate of intensive care unit-acquired weakness varies greatly among patients, an estimated 25-85% of critically ill adult patients will develop neuromuscular weakness, most commonly CIPNM, during hospitalization. While no specific pharmacologic treatments exist for CIPNM, the outcome for most patients is related to the severity of the illness and neuromyopathy, as well as early intervention to treat the underlying condition. Electrophysiologic studies, such as electromyography, electroneurography, and muscle and nerve biopsies, are considered the gold standard for aiding in the diagnosis of CIPNM. Preventive measures such as the early provision of appropriate nutrition, glucose control, physical rehabilitation, and the cautious use of medications such as corticosteroids and neuromuscular blocking agents (NMBAs) can help reduce the occurrence of CIPNM. Conclusion CIPNM is an acute axonal sensory-motor polyneuropathy commonly seen in critically ill patients with sepsis and multiorgan failure. While no specific pharmacologic treatments exist, preventive measures such as the early provision of appropriate nutrition, glucose control, physical rehabilitation, and the cautious use of medications, including corticosteroids and NMBAs, can help reduce the incidence of CIPNM.

PMID: 22761073 [PubMed - in process]

Link to Article at PubMed

Comparison of intravenous and oral magnesium replacement in hospitalized patients with cardiovascular disease.

Am J Health Syst Pharm Start a Discussion »

Jul 052012

Comparison of intravenous and oral magnesium replacement in hospitalized patients with cardiovascular disease.

Am J Health Syst Pharm. 2012 Jul 15;69(14):1212-7

Authors: Reed BN, Zhang S, Marron JS, Montague D

Abstract

Purpose The results of an investigation of serum magnesium concentrations (SMCs) after i.v. versus oral delivery of magnesium in cardiovascular critical care are presented. Methods A retrospective case review was conducted to compare the net gain of magnesium after i.v. (n = 188) or oral (n = 164) magnesium therapy for the prevention of ventricular fibrillation and arrhythmias in patients hospitalized for serious cardiovascular disorders, as determined by assessing SMCs. The primary study outcome was the change from baseline SMC values 6-24 hours after the completion of magnesium courses; secondary outcomes included the impact of renal impairment, concomitant medication use, and other clinical variables on SMC changes. Results Although consistent elevations in SMC were produced by oral magnesium delivery, i.v. administration resulted in greater and more rapid elevations relative to baseline SMC. The degree of change in SMC was significantly influenced by the timing of SMC measurement after a magnesium course, by renal function, and by concomitant use of i.v. loop diuretics. Conclusion A comparison of 24-hour courses of magnesium replacement therapy showed that magnesium sulfate 2 g i.v. was associated with larger changes in SMC than magnesium oxide 800, 1200, or 1600 mg orally when the baseline SMC was 1.4-1.8 mg/dL. At baseline SMCs of 1.4-1.8 mg/dL, oral magnesium oxide provided a consistent median increase in SMC of 0.1 mg/dL. The change in the number of bowel movements did not differ significantly between courses of i.v. magnesium sulfate and oral magnesium oxide.

PMID: 22761075 [PubMed - in process]

Link to Article at PubMed

Effectiveness of multifaceted hand hygiene interventions in long-term care facilities in Hong Kong: a cluster-randomized controlled trial.

Infect Control Hosp Epidemiol Start a Discussion »

Jul 052012

Effectiveness of multifaceted hand hygiene interventions in long-term care facilities in Hong Kong: a cluster-randomized controlled trial.

Infect Control Hosp Epidemiol. 2012 Aug;33(8):761-7

Authors: Ho ML, Seto WH, Wong LC, Wong TY

Abstract

Objective.Ã¢ÂÂTo determine the effectiveness of World Health Organization (WHO) multimodal strategy in promoting hand hygiene (HH) among healthcare workers (HCWs) in long-term care facilities (LTCFs). Design.Ã¢ÂÂCluster-randomized controlled trial. Setting.Ã¢ÂÂEighteen homes for the elderly in Hong Kong were randomly allocated to 2 intervention arms and a control arm. Direct observation of HH practice was conducted by trained nurses. Either handrubbing with alcohol-based handrub (ABHR) or handwashing with liquid soap and water was counted as a compliant action. Disease notification data during 2007-2010 were used to calculate incidence rate ratio (IRR). Participants.Ã¢ÂÂManagers and HCWs of the participating homes. Interventions.Ã¢ÂÂThe WHO multimodal strategy was employed. All intervention homes were supplied with ABHR (WHO formulation I), ABHR racks, pull reels, HH posters and reminders, a health talk, video clips, training materials, and performance feedback. The only difference was that intervention arms 1 and 2 were provided with slightly powdered and powderless gloves, respectively. Results.Ã¢ÂÂA total of 11,669 HH opportunities were observed. HH compliance increased from 27.0% to 60.6% and from 22.2% to 48.6% in intervention arms 1 and 2, respectively. Both intervention arms showed increased HH compliance after intervention compared to controls, at 21.6% compliance (both [Formula: see text]). Provision of slightly powdered versus powderless gloves did not have any significant impact on ABHR usage. Respiratory outbreaks (IRR, 0.12; 95% confidence interval [CI], 0.01-0.93; [Formula: see text]) and methicillin-resistant Staphylococcus aureus infections requiring hospital admission (IRR, 0.61; 95% CI, 0.38-0.97; [Formula: see text]) were reduced after intervention. Conclusions.Ã¢ÂÂA promotion program applying the WHO multimodal strategy was effective in improving HH among HCWs in LTCFs.

PMID: 22759542 [PubMed - in process]

Link to Article at PubMed

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