scholarly journals Austrian Syndrome: a report of an exceptionally rare and deadly syndrome

2020 ◽  
Vol 53 (4) ◽  
pp. 468-471
Author(s):  
Gustavo Nobre de Jesus ◽  
Tânia Carvalho ◽  
Alexandre Caldeira ◽  
Susana M. Fernandes
Keyword(s):  
Respiratory Failure ◽  
High Mortality ◽  
Cardiac Involvement ◽  
Medical Condition ◽  
Pneumococcal Infection ◽  
Neurological Complications ◽  
High Morbidity ◽  
Transesophageal Echocardiogram ◽  
Pneumococcal Bacteremia ◽  
Very High

Austrian Syndrome is the rare combination of a triad of endocarditis, meningitis, and pneumonia in the context of pneumococcal infection. Due to the involvement of several anatomical sites, the Austrian syndrome has a high mortality. Importantly, endocarditis is usually not considered during pneumococcal infection. We present a case of Austrian syndrome in a previously healthy 67-year-old woman. She featured with mental state alteration, respiratory failure, and shock, and was diagnosed with ceftriaxone-sensitive pneumococcal bacteremia, meningitis, and pneumonia. A transesophageal echocardiogram revealed vegetation of the mitral valve. Despite an improvement in her medical condition, she remained in a coma and died due to neurological complications. Even though the major cause of mortality in Austrian syndrome is cardiac involvement, meningitis is also linked with high morbidity and eventually death. We emphasize the relevance of an early diagnosis of the triad in order to decrease the very high mortality associated with this syndrome.

Increased Mortality among Patients Sustaining Hip Fractures Requiring Surgery in a District General Hospital

2007 ◽  
Vol 17 (3) ◽  
pp. 160-163 ◽  
Author(s):  
P.D. Hamilton ◽  
A. Whelan ◽  
D. Isaacs ◽  
P. Mestha ◽  
A. Armitage ◽  
...  
Keyword(s):  
High Mortality ◽  
Risk Group ◽  
Medical Condition ◽  
District General Hospital ◽  
High Risk Group ◽  
Common Condition ◽  
Neck Of Femur ◽  
One Year ◽  
Type Of Fracture ◽  
Very High

Fractures of the femoral neck are a common condition the incidence of which continues to rise. Associated mortality remains very high and knowledge of factors contributing to this high mortality is crucial in understanding outcome for both patient and surgeon. A retrospective review of 1254 patients operated on for fracture neck of femur was conducted to identify mortality at 30 days, 90 days and one year. Age, type of fracture, sex and waiting time for surgery were evaluated along with mortality for 47 patients who sustained their fracture while already inpatients with other concurrent illnesses. Those patients who sustained an inpatient fracture were found to have significantly higher mortality at 30 days, 90 days and one year. We concluded that these patients represent a very high-risk group that needs special consideration in management of their fracture and concurrent medical condition to reduce their high mortality.

scholarly journals A metabolomic endotype of bioenergetic dysfunction predicts mortality in critically ill patients with acute respiratory failure

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Raymond J. Langley ◽  
Marie E. Migaud ◽  
Lori Flores ◽  
J. Will Thompson ◽  
Elizabeth A. Kean ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Patient Outcomes ◽  
Medical Intensive Care Unit ◽  
Close Association ◽  
Treatment Options ◽  
Feature Model ◽  
High Morbidity ◽  
Medical Intensive Care ◽  
Poor Outcomes

AbstractAcute respiratory failure (ARF) requiring mechanical ventilation, a complicating factor in sepsis and other disorders, is associated with high morbidity and mortality. Despite its severity and prevalence, treatment options are limited. In light of accumulating evidence that mitochondrial abnormalities are common in ARF, here we applied broad spectrum quantitative and semiquantitative metabolomic analyses of serum from ARF patients to detect bioenergetic dysfunction and determine its association with survival. Plasma samples from surviving and non-surviving patients (N = 15/group) were taken at day 1 and day 3 after admission to the medical intensive care unit and, in survivors, at hospital discharge. Significant differences between survivors and non-survivors (ANOVA, 5% FDR) include bioenergetically relevant intermediates of redox cofactors nicotinamide adenine dinucleotide (NAD) and NAD phosphate (NADP), increased acyl-carnitines, bile acids, and decreased acyl-glycerophosphocholines. Many metabolites associated with poor outcomes are substrates of NAD(P)-dependent enzymatic processes, while alterations in NAD cofactors rely on bioavailability of dietary B-vitamins thiamine, riboflavin and pyridoxine. Changes in the efficiency of the nicotinamide-derived cofactors’ biosynthetic pathways also associate with alterations in glutathione-dependent drug metabolism characterized by substantial differences observed in the acetaminophen metabolome. Based on these findings, a four-feature model developed with semi-quantitative and quantitative metabolomic results predicted patient outcomes with high accuracy (AUROC = 0.91). Collectively, this metabolomic endotype points to a close association between mitochondrial and bioenergetic dysfunction and mortality in human ARF, thus pointing to new pharmacologic targets to reduce mortality in this condition.

scholarly journals Occupational health risk among healthcare workers during COVID-19 pandemic: actions to limit the risk

2021 ◽  
Vol 96 (1) ◽  
Author(s):  
Eman Casper
Keyword(s):  
Occupational Health ◽  
Health Risk ◽  
Healthcare Workers ◽  
World Health ◽  
High Morbidity ◽  
Wuhan City ◽  
Coronavirus Infection ◽  
Health Organization ◽  
Respiratory Droplets ◽  
Very High

AbstractThe World Health Organization declared coronavirus infection 2019 (COVID-19) as a pandemic in March 2020. The infection with coronavirus started in Wuhan city, China, in December 2019. As of October 2020, the disease was reported in 235 countries. The coronavirus infection 2019 (COVID-19) is a disease with high morbidity and mortality. As of February 2021, the number of confirmed cases of COVID-19 globally is 102,942,987 and 2,232,233 deaths according to WHO report. This infection is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), which is a ribonucleic acid (RNA) β-coronavirus. The infection is mainly transmitted through respiratory droplets.Healthcare workers (HCWs) play an essential role at the front lines, providing care for patients infected with this highly transmittable disease. They are exposed to very high occupational health risk as they frequently contact the infective persons. In order to limit the number of infected cases and deaths among healthcare workers, it is crucial to have better awareness, optimistic attitude, efficient PPE, and adequate health practices about COVID-19.

scholarly journals 1002. Epidemiology of Pneumococcal Bacteremia in a Large Tertiary Center

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S298-S298
Author(s):  
Aristotle Asis ◽  
Esmeralda Gutierrez-Asis ◽  
Ali Hassoun
Keyword(s):  
Mechanical Ventilation ◽  
Hospital Stay ◽  
The United States ◽  
Morbidity And Mortality ◽  
Hospital Length Of Stay ◽  
Smoking History ◽  
High Morbidity ◽  
Icu Stay ◽  
Pneumococcal Bacteremia ◽  
Tertiary Center

Abstract Background Streptococcus pneumoniae remains an important cause of bacteremia in the United States with high morbidity and mortality despite readily available treatment and vaccines. Increased incidence of bacteremia observed during 2017–2018 season. Methods Retrospective chart review of patients admitted with pneumococcal bacteremia over the last two winter seasons. Demographics, laboratory data, ICU stay, need for ventilation or pressor, comorbidities, and mortality were collected. Results Fifty-three patients enrolled. 62% admitted during 2017–2018. Sixty-six percent white, 60% male, mean BMI 27 (38% had normal BMI). Mean age was 55 years (1–93) (57% > 61). Mean hospital length of stay was 7.8 days (1–30). More than 40% required ICU stay. The use of NPPV, vasopressors, and mechanical ventilation were 6%, 15%, and 17%, respectively. Most common presentation: dyspnea 30% and fever 18%. Smoking history (55%). Eighty percent of these patients had pneumonia. Resistance to penicillin 9% and intermediate susceptibility 6%. Resistance to erythromycin 44% and trimethoprim-sulfamethoxazole 12% which increased during winter 2017 (52% and 12%) compared with winter 2016 (30% and 10%). Only 2% of patients with pneumonia had positive sputum culture for pneumococcus and 62% had positive serum pneumococcal antigen with bacteremia. Positive co-detection of bacterial or viral targets in sputum using Multiplex PCR did not correlate with mortality and hospital stay but they were more likely needed ICU stay, use of vasopressor and mechanical ventilation. 43% of empiric therapy was as recommended by IDSA guidelines. Comparing 2016 vs. 2017 seasons, mortality (15% vs. 6%), hospital stay (9 days vs. 7 days), use of NPPV (5% vs. 6%) mechanical ventilation (15% vs. 18%) and vasopressor (5% vs. 21%). No correlation between influenza infection and bacteremia. Overall 6-month mortality and re-admission rate was 9% and 2%, respectively. Mortality was higher in overweight patients (60% vs. 20%), non-smokers (40% vs. 20%), coronary artery disease (40%) and congestive heart failure (40%). Conclusion Pneumococcal bacteremia cause significant morbidity and mortality, we observed less mortality and hospital stay, but more use of NPPV, mechanical ventilation, and vasopressor during 2017–2018 season which had widespread influenza like activity. Disclosures All authors: No reported disclosures.

scholarly journals Alternative Cell Sources for Liver Parenchyma Repopulation: Where Do We Stand?

Cells ◽  
2020 ◽  
Vol 9 (3) ◽  
pp. 566 ◽  
Author(s):  
Tine Tricot ◽  
Jolan De Boeck ◽  
Catherine Verfaillie
Keyword(s):  
Metabolic Diseases ◽  
Medical Condition ◽  
Liver Parenchyma ◽  
Cell Types ◽  
Human Hepatocytes ◽  
High Morbidity ◽  
Primary Human Hepatocytes ◽  
Cell Sources ◽  
Alternative Sources ◽  
Preclinical Animal Models

Acute and chronic liver failure is a highly prevalent medical condition with high morbidity and mortality. Currently, the therapy is orthotopic liver transplantation. However, in some instances, chiefly in the setting of metabolic diseases, transplantation of individual cells, specifically functional hepatocytes, can be an acceptable alternative. The gold standard for this therapy is the use of primary human hepatocytes, isolated from livers that are not suitable for whole organ transplantations. Unfortunately, primary human hepatocytes are scarcely available, which has led to the evaluation of alternative sources of functional hepatocytes. In this review, we will compare the ability of most of these candidate alternative cell sources to engraft and repopulate the liver of preclinical animal models with the repopulation ability found with primary human hepatocytes. We will discuss the current shortcomings of the different cell types, and some of the next steps that we believe need to be taken to create alternative hepatocyte progeny capable of regenerating the failing liver.

scholarly journals Ventricular septal rupture presented with chronic heart failure symptoms: a case report

2019 ◽  
Vol 3 (2) ◽  
Author(s):  
Ioannis Michelis ◽  
Ioannis Kontonasakis ◽  
Christina Tsakliadou ◽  
Nikolaos Kouvelas
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Chronic Heart Failure ◽  
Mortality Rate ◽  
High Mortality ◽  
Medical Attention ◽  
Mechanical Complication ◽  
Ventricular Septal Rupture ◽  
Elective Repair ◽  
Very High

Abstract Background Ventricular septal rupture (VSR) is a rare mechanical complication following acute myocardial infarction, with very high mortality rate. Haemodynamic deterioration and cardiogenic shock is common in such cases. Rarely, however, patients may show only signs of chronic heart failure or be completely asymptomatic. Case summary We report a case of a 72-year-old male patient with VSR following a transmural myocardial infarction. He sought medical attention only after gradually experiencing symptoms of chronic heart failure, weeks after the onset of the myocardial infarction. The patient successfully underwent elective repair surgery, after optimizing the medical therapy and completing the necessary workup. Discussion Ventricular septal rupture repair is necessary in all cases due to the high mortality rate if left untreated. The timing of the operation, however, should be decided individually for every patient. Haemodynamically unstable patients may require early surgery, but in stable patients responding to medical treatment, delayed repair may be the best option.

scholarly journals Acute Febrile Encephalopathy in Children: A Prospective Study of Clinical Features, Etiology, Mortality, and Risk Factors from Western India

2018 ◽  
Vol 09 (01) ◽  
pp. 019-025 ◽  
Author(s):  
Kirti Gupta ◽  
Charul S. Purani ◽  
Anirban Mandal ◽  
Amitabh Singh
Keyword(s):  
Risk Factors ◽  
Respiratory Failure ◽  
Clinical Features ◽  
High Mortality ◽  
Tertiary Care ◽  
Primary Objective ◽  
Medical Emergency ◽  
Western India ◽  
Care Hospital ◽  
Factors Associated

ABSTRACT Introduction: Acute febrile encephalopathy (AFE) in children is a medical emergency and could be a manifestation of many systemic and central nervous system pathologies. The clinical features of AFE are nonspecific and etiological spectrum variable depending on the studied population. Materials and Methods: A prospective, observational study was carried out including children aged between 1 month and 12 years with AFE admitted to the Pediatric Intensive Care Unit of a tertiary care hospital in Western India. The primary objective was to assess the clinical presentation and etiology of AFE while the secondary objectives were to correlate the clinical and etiological findings and to determine the risk factors associated with mortality. Results: Out of the ninety children with AFE included in this study, male:female ratio was 1.2:1; most of them were aged between 1 and 5 years and came with a history of <7 days (82.2%). All of them had altered sensorium, about 2/3rd had seizures and 47.8% having a Glasgow Coma Score (GCS) <8. Etiology remained elusive in about 40% of the cases, and viral infections were the most common among the ones with an identifiable cause. A variety of morbidity (shock, disseminated intravascular coagulopathy, respiratory failure, etc.) and high mortality (40%) was observed with risk factors associated with mortality being GCS <8, the presence of raised intracranial pressure, shock, and respiratory failure. Conclusion: AFE, though a rare diagnosis in children, is associated with significant morbidity and high mortality in a developing country like India.

Giant iliac artery aneurysm

Open Medicine ◽  
2010 ◽  
Vol 5 (2) ◽  
pp. 156-158
Author(s):  
Murat Ugurlucan ◽  
Filiz Erdim ◽  
Ufuk Alpagut ◽  
Emin Tireli ◽  
Enver Dayioglu
Keyword(s):  
Mortality Rate ◽  
High Mortality ◽  
Iliac Artery ◽  
Vascular Malformations ◽  
Artery Aneurysm ◽  
Iliac Artery Aneurysm ◽  
Pelvic Region ◽  
Deep Location ◽  
Very High

AbstractIsolated iliac artery aneuryms are very rare vascular malformations. They can remain unnoticed for long periods of time because of their deep location in the pelvic region. Most of the patients present to the clinic with rupture of the aneurysm, and thus the condition has a very high mortality rate. We report here the case of an 84-year-old man with giant iliac artery aneuryms who was treated successfully by aneurysmectomy and aortoiliac bypass.

Bypass surgery in patients with intracranial stenotic lesions

1985 ◽  
Vol 62 (4) ◽  
pp. 532-538 ◽  
Author(s):  
Collice Massimo ◽  
Arena Orazio ◽  
Filizzolo Felice
Keyword(s):  
Cerebral Artery ◽  
Postoperative Morbidity ◽  
Neurological Complications ◽  
High Rate ◽  
Arterial Stenosis ◽  
Content Type ◽  
Stenotic Arteries ◽  
Stenotic Lesions ◽  
Very High

✓ Postoperative morbidity in patients with intracranial stenotic lesions following extracranial-intracranial arterial (EC-IC) bypass is not well defined. A high rate of neurological complications associated with occlusion of the stenotic arteries after surgery has recently been reported. In the period June, 1976, to March, 1984, the authors performed EC-IC bypass procedures in 19 patients with intracranial stenotic arteries. Most of the patients were initially treated pharmacologically (usually by anticoagulant therapy). Surgery was performed if the symptoms recurred while the patients were under pharmacological treatment and if angiography confirmed arterial stenosis. Antiplatelet therapy was given until the day of surgery and during the entire follow-up period. No permanent postoperative morbidity was observed in the series. One patient, with stenosis of the left siphon, the A1 segment of the anterior cerebral artery, and the M1 segment of the middle cerebral artery, had a transient dysphasia and right hemiparesis (lasting 3 days) in the presence of an unchanged arterial stenosis. In five patients early postoperative angiography (at 5 to 21 days) revealed occlusion of previously stenotic arteries. In one patient the occlusion was disclosed only on a later angiographic study, 2 months after surgery. Although EC-IC bypass is generally not a very high-risk operation in patients with intracranial arterial stenosis, there is a high percentage of immediate postoperative occlusion, and the authors suggest caution in determining indication for surgical treatment.

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