Diskitis

2018 ◽  
pp. 225-234
Author(s):  
Jacob R. Joseph ◽  
Brandon W. Smith ◽  
Mark E. Oppenlander

Spinal osteomyelitis/diskitis is a common problem encountered by neurosurgeons and requires urgent workup. Common risk factors include intravenous drug use or immunocompromised states. The presence or absence of neurologic deficit is critical in determining the treatment algorithm. Magnetic resonance imaging is the preferred imaging modality to diagnose osteomyelitis/diskitis, as well to identify concomitant epidural abscess. Inflammatory markers such as erythrocyte sedimentation rate and c-reactive protein can also be useful in diagnosis. Gram-positive organisms such as Staphylococcus aureus are the most common pathogens. Surgical indications include neurologic deficit, progressive deformity, recalcitrant pain, and inability to clear systemic infection without other source. Surgical goals are typically to decompress the neural elements, debride the infected disc or bone, and stabilize the spine if necessary.

2017 ◽  
Vol 4 (1) ◽  
pp. 5-8
Author(s):  
T.V. Ashcheulova ◽  
O.A Kochubiei O.A ◽  
T.G. Ovrakh

PREVENTIVE CARDIOLOGY, PRECLINICAL DIAGNOSES: OLD PROBLEMS – NEW APPROACHESAshcheulova T.V., Kochubiei O.A., Ovrakh T.GThe article discusses the new Guidelines on cardiovascular disease prevention in clinical practice (2016) which summarized novel approaches of detection of such risk factors as overweigh, obesity, abdominal obesity, smoking, dyslipidemia (cholesterolemia, triglyceridemia), blood pressure (BP) levels, glucose, insulin, insulin resistance, inflammatory markers, such as c-reactive protein, which can be widely used in practice.KeyWords: Cardiovascular disease, preventive cardiology, risk assessment and stratification, strategy for prevention of cardiovascular diseases. ПРЕВЕНТИВНА КАРДІОЛОГІЯ, ДОКЛІНІЧНА ДІАГНОСТИКА: СТАРІ ПРОБЛЕМИ - НОВІ ПІДХОДИАщеулова Т.В., Кочубєй О.А., Оврах Т.Г. У статті розглядаються нові рекомендації з профілактики серцево-судинних захворювань в клінічній практиці (2016 г.), що узагальнюють нові підходи виявлення таких факторів ризику, як надмірна маса тіла, ожиріння, абдомінальне ожиріння, куріння, дисліпідемія (холестеринемія, тригліцеридемія),  артеріальний тиск (АТ), рівень глюкози, інсуліну, резистентність до інсуліну, запальні маркери, такі як С-реактивний білок, які можуть знайти широке застосування у практичній охороні здоров’я.Ключові слова: Серцево-судинні захворювання, профілактична кардіологія, оцінка і стратифікація ризику, стратегія профілактики серцево-судинних захворювань. ПРЕВЕНТИВНАЯ КАРДИОЛОГИЯ, ДОКЛИНИЧЕСКАЯ ДИАГНОСТИКА: СТАРЫЕ ПРОБЛЕМЫ - НОВЫЕ ПОДХОДЫАщеулова Т.В., Кочубей О.А., Оврах Т.Г. В статье рассматриваются новые рекомендации по профилактике сердечно-сосудистых заболеваний в клинической практике (2016 г.), обобщены новые подходы выявления таких факторов риска, как избыточная масса тела, ожирение, абдоминальное ожирение, курение, дислипидемия (холестеринемия, гипертриглицеридемия), повышение артериального давления, уровень глюкозы, инсулина, резистентность к инсулину, маркеры воспаления, такие как С-реактивный белок, которые могут найти широкое применение в практическом здравоохранении.Ключевые слова: сердечно-сосудистые заболевания, профилактическая кардиология, оценка и стратификация риска, стратегия профилактики сердечно-сосудистых заболеваний. 


2012 ◽  
Vol 64 (3) ◽  
pp. 1173-1180 ◽  
Author(s):  
Gordana Perunicic-Pekovic ◽  
Zorica Rasic-Milutinovic ◽  
Z. Gluvic ◽  
Milena Lackovic ◽  
Danijela Ristic-Medic ◽  
...  

Patients with end-stage renal disease (ESRD) include a significant percentage of malnourished patients with other risk factors: dyslipoproteinemia, insulin resistance, increased oxidative stress and inflammation that together impair endothelial function. Abnormal polyunsaturated fatty acids (PUFA) patterns are reported in patients with ESRD. The basic mechanisms of these disorders are connected with changes in cell functions at the membrane level. Vascular smooth muscle cell proliferation plays an important role in the pathogenesis of atherosclerosis. We have examined the association between atherosclerotic risk factors and nutritional status in hemodialysis (HD) patients. Mortality was followed for up to 18 month. Forty-three HD patients were examined (20 males, 23 females, ages 55?12 years). Nutritional and inflammatory markers, including serum concentrations of C-reactive protein (CRP), tumor necrosis factor alpha (TNF-alpha), and interleukin 6 (IL-6), were measured. There was significant positive correlation between the plasma albumin level and CRP. Significant correlation was found between plasma the cholesterol level and some PUFA. Increasing inflammation and endothelial dysfunction predict the development of vascular disease. We report on the relationship between inflammatory markers and nutritional parameter, indices of atherosclerosis and other cardiovascular risk factors in patients on hemodialysis.


Author(s):  
Ali Elbeddini ◽  
Rachel Gerochi

Abstract Objectives Clostridium difficile infection (CDI) is responsible for 15–25% cases of health-care-associated diarrhea. The CDI treatment algorithm used at our hospital is adapted from the Infectious Diseases Society of America 2010 C. difficile guideline. The primary objective of this study was to assess the treatment adherence to our algorithm; this was defined as therapy consisting of the appropriate antibiotic, dose, route, interval, and duration indicated based on the disease severity and episode within 24 h of diagnosis. Furthermore, our study also described the population and their risk factors for CDI at our hospital. Methods This was a single-centre, retrospective cohort chart review of CDI cases that were diagnosed at admission or during hospitalization from June 1st, 2017 to June 30th, 2018. Cases were identified by a positive stool test along with watery diarrhea or by colonoscopy. Results Sixty cases were included, of which adherence to our algorithm was 50%. Overall, severe CDI had the highest treatment non-adherence (83%), and the biggest contributing factor was prescribing the wrong antibiotic (72%). In severe CDI, which warrants vancomycin monotherapy, wrong antibiotic consisted of metronidazole monotherapy (55%) or dual therapy with metronidazole and vancomycin (45%). Patients were mostly older, females being treated for an initial episode of mild-to-moderate CDI. Common risk factors identified were age over 65 years (80%), use of antibiotics (83%) and proton pump inhibitors (PPI) (68%) within the previous 3 months. The use of a PPI in this study, a modifiable risk factor without a clear indication, was 35%. Conclusion An area for antimicrobial stewardship intervention in CDI treatment at our hospital is prescribing the right antibiotic based on the CDI indication. In severe CDI, an emphasis should be on prescribing vancomycin monotherapy as the drug of choice. PPI use should be reassessed for tapering when appropriate.


Blood ◽  
2005 ◽  
Vol 105 (6) ◽  
pp. 2294-2299 ◽  
Author(s):  
Luigi Ferrucci ◽  
Annamaria Corsi ◽  
Fulvio Lauretani ◽  
Stefania Bandinelli ◽  
Benedetta Bartali ◽  
...  

AbstractWe hypothesized that the rising levels of inflammatory markers with aging is explained by cardiovascular risk factors and morbidity becoming progressively more prevalent in older persons. Information on inflammatory markers, cardiovascular risk factors, and diseases was collected in 595 men and 748 women sampled from the general population (age, 20-102 years). In both men and women, older age was associated with higher levels of interleukin-6 (IL-6), IL-1 receptor antagonist (IL-1ra), IL-18, C-reactive protein (CRP), and fibrinogen, while soluble IL-6 receptor (sIL-6r) increased significantly with age only in men. Adjusting for cardiovascular risk factors and morbidity, the age regression coefficients became substantially smaller in models predicting IL-6, IL-1ra, IL-18, and fibrinogen and larger in the model predicting sIL6r. Adjustment for cardiovascular morbidity substantially reduced the effect of age on CRP in men but not in women. Findings were confirmed in a subgroup of 51 men and 45 women with low risk profile and no cardiovascular morbidity. Part of the “proinflammatory state” in older persons is related to the high prevalence of cardiovascular risk factor and morbidity.


Author(s):  
Alan P. Koretsky ◽  
Afonso Costa e Silva ◽  
Yi-Jen Lin

Magnetic resonance imaging (MRI) has become established as an important imaging modality for the clinical management of disease. This is primarily due to the great tissue contrast inherent in magnetic resonance images of normal and diseased organs. Due to the wide availability of high field magnets and the ability to generate large and rapidly switched magnetic field gradients there is growing interest in applying high resolution MRI to obtain microscopic information. This symposium on MRI microscopy highlights new developments that are leading to increased resolution. The application of high resolution MRI to significant problems in developmental biology and cancer biology will illustrate the potential of these techniques.In combination with a growing interest in obtaining high resolution MRI there is also a growing interest in obtaining functional information from MRI. The great success of MRI in clinical applications is due to the inherent contrast obtained from different tissues leading to anatomical information.


2012 ◽  
Vol 82 (1) ◽  
pp. 41-52 ◽  
Author(s):  
P. Earnest ◽  
S. Kupper ◽  
M. Thompson ◽  
Guo ◽  
S. Church

Homocysteine (HCY), C-reactive protein (hsCRP), and triglycerides (TG) are risk factors for cardiovascular disease (CVD). While multivitamins (MVit) may reduce HCY and hsCRP, omega-3 fatty acids (N3) reduce TG; yet, they are seldom studied simultaneously. We randomly assigned 100 participants with baseline HCY (> 8.0 umol/L) to the daily ingestion of: (1) placebo, (2) MVit (VitC: 200 mg; VitE: 400 IU; VitB6: 25 mg; Folic Acid: 400 ug; VitB12: 400 ug) + placebo, (3) N3 (2 g N3, 760 mg EPA, 440 mg DHA)+placebo, or (4) MVit + N3 for 12 weeks. At follow-up, we observed significant reductions in HCY (umol/L) for the MVit (- 1.43, 95 %CI, - 2.39, - 0.47) and MVit + N3 groups (- 1.01, 95 %CI, - 1.98, - 0.04) groups, both being significant (p < 0.05) vs. placebo (- 0.57, 95 %CI, - 1.49, 0.35) and N3 (1.11, 95 % CI, 0.07, 2.17). hsCRP (nmol/L) was significantly reduced in the MVit (- 6.00, 95 %CI, - 1.04, - 0.15) and MVit + N3 (- 0.98, 95 %CI, - 1.51, - 0.46) groups, but not vs. placebo (- 0.15, 95 %CI, - 0.74, 0.43) or N3 (- 0.53, 95 %CI, - 1.18, 0.12). Lastly, we observed significant reductions in TG for the N3 (- 0.41, 95 %CI, - 0.69, - 0.13) and MVit + N3 (- 0.71, 95 %CI, - 0.93, - 0.46) groups, both significant vs. placebo (- 0.10, 95 %CI, - 0.36, 0.17) and MVit groups (0.15, 95 %CI, - 12, 0.42). The co-ingestion of MVit + N3 provides synergistic affects on HCY, hsCRP, and plasma TG.


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