scholarly journals SEIZURES IN WOMEN WITH PREECLAMPSIA: MECHANISMS AND MANAGEMENT

2011 ◽  
Vol 22 (2) ◽  
pp. 91-108 ◽  
Author(s):  
MARILYN J CIPOLLA ◽  
RICHARD P KRAIG
Keyword(s):  
Cognitive Impairment ◽  
Prenatal Care ◽  
Mortality Rates ◽  
Western World ◽  
Brain Herniation ◽  
Tertiary Referral ◽  
Significant Life ◽  
Life Threatening

Eclampsia is defined in the obstetrical literature as the occurrence of unexplained seizure during pregnancy in a woman with preeclampsia. In the Western world, the incidence of eclampsia is ~1 per 2000 to 1 per 3000 pregnancies, but the incidence is 10-fold higher in tertiary referral centers and undeveloped countries where there is poor prenatal care, and in multi-fetal gestations. Nearly 1 in 50 women with eclampsia die as do 1 in 14 of their offspring, and mortality rates are considerably higher in undeveloped countries. Eclampsia is also associated with significant life-threatening complications, including neurological events. Seizure acutely can cause stroke, haemorrhage, oedema and brain herniation and thus lead to epilepsy and cognitive impairment later in life.

Evaluation of psychomotor/motor disturbances in elderly medical inpatients

2016 ◽  
Vol 33 (S1) ◽  
pp. S150-S150 ◽  
Author(s):  
G. McCarthy ◽  
O. Fitzpatrick ◽  
D. O’Neill ◽  
D. Meagher ◽  
D. Adamis
Keyword(s):  
Cognitive Impairment ◽  
Severity Of Illness ◽  
Mortality Rates ◽  
Entire Sample ◽  
Medical Inpatients ◽  
Dsm Iv ◽  
Competing Interest ◽  
One Year ◽  
Study Participants ◽  
Motor Disturbances

IntroductionTraditionally psychomotor subtypes have been investigated in patients with delirium in different settings and it has been found that those with hypoactive type is the largest proportion, often missed and with the worst outcomes.Aims and objectivesWe examined the psychomotor subtypes in an older age inpatients population, the effects that observed clinical variables have on psychomotor subtypes and their association with one year mortality.MethodsProspective study. Participants were assessed using the scales CAM, APACHE II, MoCA, Barthel Index and DRS-R98. Pre-existing dementia was diagnosed according to DSM-IV criteria. Psychomotor subtypes were evaluated using the two relevant items of DRS-R98. Mortality rates were investigated one year after admission day.ResultsThe sample consisted of 200 participants [mean age 81.1 ± 6.5; 50% female; pre-existing cognitive impairment in 126 (63%)]. Thirty-four (17%) were identified with delirium (CAM+). Motor subtypes of the entire sample was: none: 119 (59.5%), hypo: 37 (18.5%), mixed: 15 (7.5%) and hyper: 29 (14.5%). Hypoactive and mixed subtype were significantly more frequent to delirious patients than to those without delirium, and none subtype more often to those without delirium. There was no difference in the hyperactive subtype between those with and without delirium. Hypoactive subtype was significant associated with delirium and lower scores in MoCA (cognition), while mixed was associated mainly with delirium. Predictors for one-year mortality were lower MoCA scores and severity of illness.ConclusionsPsychomotor disturbances are not unique to delirium. Hypoactivity, this “silent epidemic” is also part of a deteriorated cognition.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Abstract 131: Cardiac Arrest Due to Cardiac Etiology: A Progress Report on the Past 20 Years in an Emergency Department in Vienna

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Patrick Sulzgruber ◽  
Pia Hubner ◽  
Andreas Schober ◽  
Alexander Spiel ◽  
Thomas Uray ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Mortality Rates ◽  
Western World ◽  
The Past ◽  
Initial Event ◽  
Long Term Study ◽  
Number Of Patients ◽  
Favorable Neurological Outcome

Background: Based on demographic changes in the western world, the number of patients with cardiac arrest due to a cardiovascular event is continuously rising. A large variety of factors impacting on favorable neurological outcome (CPC 1-2) and the 6-month survival, are well established. The question whether the knowledge about these predictive factors result in improved outcome over the last 20 years, has not been proven within a long-term study so far. Methods: We prospectively identified 2670 patients (out-of hospital [OOH], n = 1822; in-hospital [IH], n = 848) with cardiac arrest of cardiac etiology and ventricular fibrillation as a first rhythm treated at our emergency department between January 1992 and December 2012. Chi-square test and Cochran-Mantel-Haenszel test have been used to assess differences in CPC and 6-month survival within the observation-period. Results: Within our total cohort, 2189 patients (82.0%) survived the initial event. After a follow-up period of 6 months, 1007 patients (46%) with ROSC deceased. A favorable CPC (1-2) after 6 months has been detected in 1197 patients (54.7%). Within the last 20 years there was an improvement of favorable neurological outcome (CPC 1-2) (p<0.001) and as well a reduction of 6-month mortality rates (p=0.004). Independently in patients with IH cardiac arrest, 78.5% (n=666) survived the initial event, but the 6-month survival rate (n=381, 57.2%) and the favorable CPC outcome (n=443, 66.5%) were approximately higher. Independently within IH cardiac arrest patients a reduction of 6-month mortality rates (p=0.048) was found. Still there were constantly high rates of favorable neurological outcome (CPC 1-2) after 6 months, but there was no improvement within the past 20 years (p=0.665). Conclusion: We were able to demonstrate, that outcome of patients with cardiac arrest of a cardiac etiology has improved significantly within the last 20 years. This gives the impression, that critical care medicine on a high level for patients with cardiac arrest even in the emergency department could be important for outcome. If such specific cardiac arrest centers merged with emergency departments prove to be valuable for ideal patient care has to be further evaluated in detail.

Iatrogenic Injuries in Manual and Mechanical Cardiopulmonary Resuscitation

2021 ◽  
pp. 000313482110475
Author(s):  
Magnus J. Chun ◽  
Yichi Zhang ◽  
Eman A. Toraih ◽  
Patrick R. McGrew
Keyword(s):  
Systematic Review ◽  
Chest Compression ◽  
Meta Analysis ◽  
Sternal Fracture ◽  
Iatrogenic Injuries ◽  
Mechanical Chest Compression ◽  
Manual Chest Compression ◽  
Significant Life ◽  
Life Threatening ◽  
Meta Analyses

Purpose Mechanical chest compression has been shown to be equivalent to manual chest compression in providing survival benefits to patients experiencing cardiac arrest. There has been a growing need for a contemporary review of iatrogenic injuries caused by mechanical in comparison with manual chest compression. Our study aims to analyze the studies that document significant life-threatening iatrogenic injuries caused by mechanical and manual chest compression. Methods A systematic review of PubMed and Embase was performed according to Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. All studies published after January 1st, 2000 were reviewed using inclusion/exclusion criteria and completed by May 2020. A total of 7202 patients enrolled in 15 studies were included in our meta-analysis. Results Significant life-threatening iatrogenic injuries had higher odds of occurring when mechanical chest compression was used compared to manual chest compression, especially for hemothorax and liver lacerations. Mechanical chest compression involves consistently deeper compression depths compared to manual chest compression, potentially resulting in more injuries. In the mechanical chest compression cohort, chest wall fractures had the highest incidence rate (55.7%), followed by sternal fracture (28.3%), lung injuries (3.7%), liver (1.0%), and diaphragm (.2%) lacerations. Conclusions Mechanical chest compression was associated with more iatrogenic injuries as compared to manual chest compression. Further research is needed to define the appropriate application of mechanical in comparison with manual chest compression in different scenarios. Levels of provider training, different mechanical chest compression device types, patient demographics, and compression duration/depth may all play roles in influencing outcomes.

Roche and Tamiflu®: Doing Business in the Shadow of Pandemic

2017 ◽  
pp. 1-22 ◽  
Author(s):  
Timothy Feddersen ◽  
Jochen Gottschalk ◽  
Lars Peters
Keyword(s):  
Patent Protection ◽  
Antiviral Drug ◽  
Profit Maximization ◽  
Human Infection ◽  
Western World ◽  
Short Term ◽  
Bird Flu ◽  
Global Pandemic ◽  
Life Threatening ◽  
Spanish Flu

The spread of bird flu outside of Asia, particularly in Africa and Europe, topped headlines in 2006. The migration of wild birds brought the virus to Europe, where for the first time it spread to productive livestock, bringing it closer to the Western world. Due to today's globalized and highly interconnected world, the consequences of a potential bird flu pandemic are expected to be much more severe than those of the Spanish flu, which killed 50-100 million people between 1918 and 1921. A vaccine for the bird virus is currently not available. As of July 2006, 232 cases of human infection had been documented, mostly through direct contact with poultry. Of those, 134 people died. The best medication available to treat bird flu was Roche's antiviral drug Tamiflu. However, Tamiflu was not widely available; current orders of government bodies would not be fulfilled until the end of 2008. Well aware that today's avian flu might become a global pandemic comparable to the Spanish flu, Roche CEO Franz Humer had to decide how Roche should respond. While the pharmaceutical industry continued its research efforts on vaccines and medications, Tamiflu could play an important role by protecting healthcare workers and helping to contain the virus---or at least slow down its spread. Due to patent protection and a complicated production process with scarce raw ingredients, Roche had been the only producer of the drug. Partly in response to U.S. political pressure, in November 2005 Roche allowed Gilead to produce Tamiflu as well. Even so, it would take at least until late 2007 for Roche and Gilead to meet the orders of governments worldwide. The issue was a difficult one for Roche: What were the risks; what were the opportunities? If a pandemic occurred before sufficient stockpiles of Tamiflu had been built up, would Roche be held responsible? What steps, if any, should Roche take with respect to patent protection and production licensing in the shadow of a potential pandemic?Students will weigh the benefits of short-term profit maximization against the risks that a highly uncertain event could pose to a business and consider nonstandard approaches to mitigate these risks. Students will discuss the challenges of addressing low-probability, high-impact events; potential conflicts with the short-term view of the stock market and analyst community; and challenges of the patent protection model for drugs for life-threatening diseases.

scholarly journals Incidence and mortality trends and geographic patterns of follicular lymphoma in Canada

2019 ◽  
Vol 26 (4) ◽  
Author(s):  
M. Le ◽  
F. M. Ghazawi ◽  
A. Alakel ◽  
E. Netchiporouk ◽  
E. Rahme ◽  
...  
Keyword(s):  
Follicular Lymphoma ◽  
Geographic Distribution ◽  
Mortality Rates ◽  
Vital Statistics ◽  
Incidence Rates ◽  
Western World ◽  
Linear Regression Models ◽  
Mortality Trends ◽  
Comprehensive Overview ◽  
Incidence And Mortality

Background Follicular lymphoma (FL) is the most common indolent lymphoma and the 2nd most common non- Hodgkin lymphoma, accounting for 10%–20% of all lymphomas in the Western world. Epidemiologic and geographic trends of FL in Canada have not been investigated. Our study’s objective was to analyze incidence and mortality rates and the geographic distribution of FL patients in Canada for 1992–2010.Methods Demographic and geographic patient data for FL cases were obtained using the Canadian Cancer Registry, the Registre quebecois du cancer, and the Canadian Vital Statistics database. Incidence and mortality rates and 95% confidence intervals were calculated per year and per geographic area. Rates were plotted using linear regression models to assess trends over time. Overall data were mapped using Microsoft Excel mapping software (Redmond, WA, U.S.A.) to identify case clusters across Canada.Results Approximately 22,625 patients were diagnosed with FL during 1992–2010. The age-standardized incidence rate of this malignancy in Canada was 38.3 cases per million individuals per year. Geographic analysis demonstrated that a number of Maritime provinces and Manitoba had the highest incidence rates, and that the provinces of Nova Scotia and Quebec had the highest mortality rates in the nation. Regional data demonstrated clustering of FL within cities or regions with high herbicide use, primary mining, and a strong manufacturing presence.Conclusions Our study provides a comprehensive overview of the FL burden and its geographic distribution in Canada. Regional clustering of this disease in concentrated industrial zones strongly suggests that multiple environmental factors might play a crucial role in the development of this lymphoma.

Peripheral VA-ECMO with direct biventricular decompression for refractory cardiogenic shock

Perfusion ◽  
2018 ◽  
Vol 33 (6) ◽  
pp. 493-495 ◽  
Author(s):  
Prashant Rao ◽  
Jarrod Mosier ◽  
Joshua Malo ◽  
Vicky Dotson ◽  
Christopher Mogan ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Extracorporeal Membrane Oxygenation ◽  
Cardiogenic Shock ◽  
Mortality Rates ◽  
Left Ventricular ◽  
Off Pump ◽  
Novel Technique ◽  
Refractory Cardiogenic Shock ◽  
Life Threatening ◽  
Va Ecmo

Cardiogenic shock and cardiac arrest are life-threatening emergencies that result in high mortality rates. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) via peripheral cannulation is an option for patients who do not respond to conventional therapies. Left ventricular (LV) distention is a major limitation with peripheral VA-ECMO and is thought to contribute to poor recovery and the inability to wean off VA-ECMO. We report on a novel technique that combines peripheral VA-ECMO with off-pump insertion of a trans-apical LV venting cannula and a right ventricular decompression cannula.

scholarly journals Utility of Procalcitonin as a Biomarker for Sepsis in Children

2020 ◽  
Vol 58 (7) ◽  
Author(s):  
Kevin J. Downes ◽  
Julie C. Fitzgerald ◽  
Scott L. Weiss
Keyword(s):  
Host Response ◽  
Early Recognition ◽  
Mortality Rates ◽  
Sepsis Management ◽  
Complex Process ◽  
Significant Research ◽  
Sepsis Risk ◽  
Life Threatening ◽  
Adults And Children ◽  
Pediatric Sepsis

ABSTRACT Sepsis is a complex process defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. It is associated with significant morbidity and mortality rates in both adults and children, and emphasis has been placed on its early recognition and prompt provision of antimicrobials. Owing to limitations of current diagnostic tests (i.e., poor sensitivity and delayed results), significant research has been conducted to identify sepsis biomarkers. Ideally, a biomarker could reliably and rapidly distinguish bacterial infection from other, noninfectious causes of systemic inflammatory illness. In doing so, a sepsis biomarker could be used for earlier identification of sepsis, risk stratification/prognostication, and/or guidance of antibiotic decision-making. In this minireview, we review one of the most common clinically used sepsis biomarkers, procalcitonin, and its roles in sepsis management in these three areas. We highlight key findings in the adult literature but focus the bulk of this review on pediatric sepsis. The challenges and limitations of procalcitonin measurement in sepsis are also discussed.

scholarly journals The natural progression of a fistulizing gallstone resulting in massive gastrointestinal hemorrhage and Bouveret syndrome, a rare case

2019 ◽  
Vol 13 (3) ◽  
pp. 393-396 ◽  
Author(s):  
Elmer Hoekstra ◽  
Maarten Willem van den Berg ◽  
Roeland Andreas Veenendaal ◽  
Rogier Stuyt
Keyword(s):  
Rare Case ◽  
Gallstone Disease ◽  
Western World ◽  
Fatal Complication ◽  
Natural Progression ◽  
Massive Gastrointestinal Bleeding ◽  
Life Threatening ◽  
Massive Gastrointestinal Hemorrhage ◽  
Bouveret Syndrome ◽  
Asymptomatic Gallstones

Abstract Gallstones are seen very common, especially in the Western World. While most patients are asymptomatic, gallstones can cause life-threatening complications. Here, we present a rare and nearly fatal complication of gallstones, showing the natural progression of gallstone disease. With two very unusual complications of gallstones which occurred in the same patient. Massive gastrointestinal bleeding, and the Bouveret syndrome.

Life-threatening paradoxical brain herniation rapidly reversed by emergency cranioplasty repair: a case report

2015 ◽  
Vol 157 (11) ◽  
pp. 2031-2032 ◽  
Author(s):  
Ricardo Díaz-Romero ◽  
Pilar Avendaño ◽  
Gustavo Coloma
Keyword(s):  
Case Report ◽  
Brain Herniation ◽  
Life Threatening

Cancer-specific mortality and competing causes of death in older adults: A prospective, multicenter cohort study (ELCAPA-19).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 11547-11547 ◽  
Author(s):  
Deborah Assouan ◽  
Elena Paillaud ◽  
Philippe Caillet ◽  
Emmanuelle Kempf ◽  
Helene Vincent ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Cancer Mortality ◽  
Older Patients ◽  
Rating Scale ◽  
Mortality Rates ◽  
Test Time ◽  
Cancer Death ◽  
Multicenter Cohort Study ◽  
Patients With Cancer

11547 Background: Among older adults with cancer, comorbidities compete with cancer as the cause of death. The objectives were to quantify the proportion and rate of cancer-specific death in older patients with cancer, and to analyze the associations between geriatric factors and cancer death. Methods: Between January 2007 and December 2014, older patients with cancer were prospectively included by the ELCAPA cohort study’s eight investigating centers. Competing risk methods were used to estimate 6-month and 3-year cancer mortality rates and to probe associations between geriatric factors and cancer death. Results: A total of 1678 patients were included (mean ± standard deviation age: 81.3 ± 5.8; women: 49%). The most common cancers were colorectal (19%), breast (17%) and urinary (15%) cancers and 49% had metastasis. After a median follow-up period of 34 months, a total of 948 deaths were observed. Of the 282 deaths in non-metastatic patients, 203 (72%; 95% confidence interval (CI): [66%-77%]) were attributable to cancer. This proportion was 92% (89–94; N = 448/498) for metastatic patients. The 6-month and 3-year cancer mortality rates was respectively 12% (9–15) and 34% (29-38) for non-metastatic tumors and 45% (41–49) and 83% (80–87) for metastatic stage tumors. At 6 months, the geriatric factors independently associated with cancer death were a dependency in activities of daily living (ADL) score ≤ 5 (adjusted subhazard ratio: 2.11 (95%CI: [1.68–2.64]), mobility impairment (Timed Get Up and Go (TGUG) test time > 20 s (1.40 [1.05–1.87]) or inability to perform the TGUG (2.41 [1.67–3.48])) and comorbidities (total Cumulative Index Rating Scale-Geriatric score ≥13) (1.59 [1.23–2.06]). At 3 years, the independently associated factors were ADL ≤ 5 (1.60, [1.34–1.91]), TGUG > 20 s (1.28, [1.04–1.59]) or inability to perform TGUG (2.02 [1.47–2.79]), and cognitive impairment (1.23 [1.01–1.50]). Conclusions: Most older adults with cancer die from this disease and not from other comorbidities. However, geriatric parameters (dependency, impaired mobility, comorbidities, and cognitive impairment) are independently associated with cancer death. These geriatric impairments should be taken into account when assessing the cancer patient’s prognosis in clinical practice. Clinical trial information: NCT02884375.

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