scholarly journals An A-E assessment of post-ICU COVID-19 recovery

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Matthew Cadd ◽  
Maya Nunn
Keyword(s):  
Critical Care ◽  
Current Knowledge ◽  
Multiple Organ ◽  
Long Term Effects ◽  
Care Services ◽  
Global Pandemic ◽  
Wide Range ◽  
Assessment And Treatment ◽  
Critical Care Admission

AbstractThe COVID-19 global pandemic has placed unprecedented strain on healthcare and critical care services around the world. Whilst most resources have focused on the acute phase of the disease, there is likely to be an untold burden of patients chronically affected.A wide range of sequelae contribute to post intensive care syndrome (PICS); from our current knowledge of COVID-19, a few of these have the potential to be more prevalent following critical care admission. Follow-up assessment, diagnosis and treatment in an increasingly virtual setting will provide challenges but also opportunities to develop these services. Here, we propose an A to E approach to consider the potential long-term effects of COVID-19 following critical care admission.Anxiety and other mental health diagnosesBreathlessnessCentral nervous system impairmentDietary insufficiency and malnutritionEmbolic eventsDeveloping strategies to mitigate these during admission and providing follow-up, assessment and treatment of persistent multiple organ dysfunction will be essential to improve morbidity, mortality and patient quality of life.

scholarly journals Does "Flattening the Curve" Affect Critical Care Services Delivery for COVID-19? A Global Health Perspective

2020 ◽  
Author(s):  
Ramiro E. Gilardino
Keyword(s):  
Critical Care ◽  
Health Systems ◽  
Essential Element ◽  
Protective Equipment ◽  
Care Providers ◽  
Care Services ◽  
Services Delivery ◽  
Medical Supplies ◽  
Global Pandemic ◽  
Care Facilities

During this coronavirus disease 2019 (COVID-19) global pandemic, nations are taking bold measures to mitigate the spread of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in order to avoid the overwhelming its critical care facilities. While these "flattening the curve" initiatives are showing signs of impeding the potential surge in COVID-19 cases, it is not known whether these measures alleviate the burden placed on intensive care units. Much has been made of the desperate need for critical care beds and medical supplies, especially personal protective equipment (PPE). But while these initiatives may provide health systems time to bolster their critical care infrastructure, they do little to protect the most essential element – the critical care providers. This article examines bolder initiatives that may be needed to both protect crucial health systems and the essential yet vulnerable providers during this global pandemic.

scholarly journals Epigenetics and Neurological Disorders in ART

2019 ◽  
Vol 20 (17) ◽  
pp. 4169
Author(s):  
Marina La Rovere ◽  
Marica Franzago ◽  
Liborio Stuppia
Keyword(s):  
Neurological Disorders ◽  
Assisted Reproductive Technologies ◽  
Current Knowledge ◽  
Developed Countries ◽  
Reproductive Technologies ◽  
Epigenetic Modifications ◽  
Epigenetic Alterations ◽  
Long Term Effects ◽  
Increased Risk

About 1–4% of children are currently generated by Assisted Reproductive Technologies (ART) in developed countries. These babies show only a slightly increased risk of neonatal malformations. However, follow-up studies have suggested a higher susceptibility to multifactorial, adult onset disorders like obesity, diabetes and cardiovascular diseases in ART offspring. It has been suggested that these conditions could be the consequence of epigenetic, alterations, due to artificial manipulations of gametes and embryos potentially able to alter epigenetic stability during zygote reprogramming. In the last years, epigenetic alterations have been invoked as a possible cause of increased risk of neurological disorders, but at present the link between epigenetic modifications and long-term effects in terms of neurological diseases in ART children remains unclear, due to the short follow up limiting retrospective studies. In this review, we summarize the current knowledge about neurological disorders promoted by epigenetics alterations in ART. Based on data currently available, it is possible to conclude that little, if any, evidence of an increased risk of neurological disorders in ART conceived children is provided. Most important, the large majority of reports appears to be limited to epidemiological studies, not providing any experimental evidence about epigenetic modifications responsible for an increased risk.

Cholesterol Testing by General Practitioners in Grampian: Patterns and Outcomes

1996 ◽  
Vol 41 (3) ◽  
pp. 78-82 ◽  
Author(s):  
B.H. Smith ◽  
V. Vranjkovic ◽  
S.R. McEwan ◽  
L.D. Ritchie
Keyword(s):  
Current Knowledge ◽  
Clinical Chemistry ◽  
Chemistry Laboratory ◽  
Lipid Lowering ◽  
Biochemical Tests ◽  
Wide Range ◽  
Prescription Rates ◽  
Lipid Lowering Agents ◽  
Cholesterol Testing

Initiation, distribution, concomitants and follow-up of cholesterol testing were studied in Grampian. Data were examined for 4979 patients, representing all patients in one year from those general practices who made exclusive use of the clinical chemistry laboratory for cholesterol testing. A random sample of 215 patients was studied in further detail. Age and sex distribution, results of cholesterol tests and their follow-up, nature and results of associated biochemical tests, test initiation, testing rates by practice, and prescription rates of lipid lowering agents by practice were measured. Cholesterol testing was mostly in line with current knowledge of cardiovascular risk, and associated with further cardiovascular and biochemical assessment. There was a 90-fold range in practice cholesterol testing rates, and a similarly wide range in prescription rates of lipid lowering agents; there was a significant correlation between these. Rates and results of follow-up testing suggests a “rule of halves” for cholesterol testing.

scholarly journals Children Living a Global Pandemic: Anxiety Repercussions

2021 ◽  
Author(s):  
Salvador I. Garcia-Adasme ◽  
Alejandro López-Escobar
Keyword(s):  
Physical Activity ◽  
Social Media ◽  
Clinical Manifestations ◽  
Multiple Organ ◽  
School Closures ◽  
Balanced Diet ◽  
Global Pandemic ◽  
Wide Range ◽  
Anxiety Levels ◽  
Children’S Anxiety

A global pandemic caused by SARS-CoV-2 is still beaten our world. The disease, termed COVID-19 by the WHO, has a wide range of clinical manifestations, ranging from a mild, self-limiting form of the disease to multiple organ failure and death, forcing governments to take measures to mitigate the transmission and reduce the economic impact. However, the paediatric manifestation appears to take a milder form of the disease but they are not oblivious to the consequences of the disease. They suffered personal and parental lost, broke their social relationships, forced to home confinement, school closures, all of them with secondary implications. As a result, children’s anxiety levels and manifestations have increased during pandemic. To prevent and counteract this situation, measures were implemented like increase physical activity, a balanced diet, and regular sleep pattern; and in relationship sphere use social media to stay in touch with school mates and relatives.

scholarly journals Multiple Organ Lesions in a Case of Contamination With Multiple Radionuclides After 38 Years

Dose-Response ◽  
2018 ◽  
Vol 16 (4) ◽  
pp. 155932581881501
Author(s):  
Huahui Bian ◽  
Youyou Wang ◽  
Weibo Chen ◽  
Yusong Zhang ◽  
Zhixiang Zhuang ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Direct Evidence ◽  
Left Lung ◽  
Multiple Organ ◽  
Colorectal Polyps ◽  
Long Term Effects ◽  
Ground Glass Nodule ◽  
Medical Examinations

The patient was contaminated with multiple radionuclides 38 years ago due to an accident. To investigate the effects of radionuclide contamination on humans, he has been followed up by examinations for many years. Long-term effects gradually emerge in these years. Lung cancer was diagnosed by medical examinations. Besides, chronic gastritis with intestinal metaplasia was indicated by gastroscopic biopsies, while colorectal polyps found by colonoscopy. All 13 colorectal polyps were removed, and radical surgery for lung cancer was performed. Fortunately, pathological examinations indicated that it was early lung cancer. The ground glass nodule (GGN) in left lung identified during the follow-up will be resected when needed. It is speculated that multiple manifestations of the patient may be related to radiation, and different lesions in the organs may be related to systemic adaptive response. However, longer follow-up is needed due to a lack of effective and direct evidence. This work is expected to provide experiences for similar patients’ treatment and follow-up.

Some conclusions regarding long -term biological effects of some major oil spills

1982 ◽  
Vol 297 (1087) ◽  
pp. 335-351 ◽  
Keyword(s):  
Oil Spills ◽  
Biological Effects ◽  
Biologically Active ◽  
Long Term Effects ◽  
Sediment Grain Size ◽  
Petroleum Fractions ◽  
Wide Range ◽  
Time Courses

Many of the world ’s major spills exhibit long-term consequences, associated mainly with lagoons, estuaries and marshes. This is due to the persistence of oil or petroleum fractions in these low-energy environments. The bioavailability of residual oil to infauna is influenced by several factors, such as solubility in water, feeding habit, weathering rate and sediment grain size. The time-courses for these long-term effects vary, but may run into decades for some community perturbations. The effects are at all levels of organization, including cellular, organismic and the community. Although the number of documented long-term effects is small, they involve a wide range of biological processes: development, genetic, growth, feeding and assimilation, photosynthesis, recruitment and fecundity, and community stability. It is important to note that the known effects are probably only representative of a much wider range of possible disorders that have occurred, but which have not been detected. This is due mainly to the selective nature of spill follow-up studies. Long-term spill consequences are generally local phenomena and so far no single spill has, to our limited knowledge, significantly altered entire ecosystems or materially affected fisheries. The combination of several spills can, however, place considerable stress on an environment. Also, so far there is no indication of an increasing mutagenic or carcinogenic load in the marine environment due to biologically active petroleum fractions or to carcinogenic or mutagenic metabolites. There is, however, the possibility of local build-up of these compounds, as in ‘hydrocarbon sink’ areas, where such a burden may become a local problem .

scholarly journals Impact of a pharmacist intervention at an intensive care rehabilitation clinic

2019 ◽  
Vol 8 (3) ◽  
pp. e000580 ◽  
Author(s):  
Pamela MacTavish ◽  
Tara Quasim ◽  
Martin Shaw ◽  
Helen Devine ◽  
Malcolm Daniel ◽  
...  
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Tertiary Care ◽  
Service Evaluation ◽  
Pharmacist Intervention ◽  
Limited Information ◽  
Care Providers ◽  
Critical Care Admission ◽  
Specific Medication

ObjectiveWhile disruptions in medications are common among patients who survive critical illness, there is limited information about specific medication-related problems among survivors of critical care. This study sought to determine the prevalence of specific medication-related problems detected in patients, seen after critical care discharge.DesignConsecutive patients attending an intensive care unit (ICU) follow-up programme were included in this single-centre service evaluation.SettingTertiary care regional centre in Scotland (UK).Participants47 patients reviewed after critical care discharge at an ICU follow-up programme.InterventionsPharmacists conducted a full medication review, including: medicines reconciliation, assessing the appropriateness of each prescribed medication, identification of any medication-related problems and checking adherence.MeasurementsMedication-related problems in patients following critical care discharge. Interventions and medication-related problems were systematically graded and risk factors were identified using an adapted version of the National Patient Safety Agency Risk Matrix.Main results69 medication-related problems were identified in 38 (81%) of the 47 patients. The most common documented problem was drug omission (29%). 64% of the medication-related problems identified were classified as either moderate or major. The number of pain medications prescribed at discharge from intensive care was predictive of medication-related problems (OR 2.02, 95% CI 1.14 to 4.26, p=0.03).ConclusionsMedication problems are common following critical care. Better communication of medication changes both to patients and their ongoing care providers may be beneficial following a critical care admission. In the absence of highly effective communication, a pharmacy intervention may contribute substantially to an intensive care rehabilitation or recovery programme.

scholarly journals Pathogenic Basis of Thromboinflammation and Endothelial Injury in COVID-19: Current Findings and Therapeutic Implications

2021 ◽  
Vol 22 (21) ◽  
pp. 12081
Author(s):  
Yasutomi Higashikuni ◽  
Wenhao Liu ◽  
Takumi Obana ◽  
Masataka Sata
Keyword(s):  
Endothelial Dysfunction ◽  
Immune Responses ◽  
Current Knowledge ◽  
Multiple Organ ◽  
Endothelial Injury ◽  
Economic Activities ◽  
High Grade Fever ◽  
Mortality And Morbidity ◽  
Therapeutic Implications ◽  
Global Pandemic

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global pandemic with a great impact on social and economic activities, as well as public health. In most patients, the symptoms of COVID-19 are a high-grade fever and a dry cough, and spontaneously resolve within ten days. However, in severe cases, COVID-19 leads to atypical bilateral interstitial pneumonia, acute respiratory distress syndrome, and systemic thromboembolism, resulting in multiple organ failure with high mortality and morbidity. SARS-CoV-2 has immune evasion mechanisms, including inhibition of interferon signaling and suppression of T cell and B cell responses. SARS-CoV-2 infection directly and indirectly causes dysregulated immune responses, platelet hyperactivation, and endothelial dysfunction, which interact with each other and are exacerbated by cardiovascular risk factors. In this review, we summarize current knowledge on the pathogenic basis of thromboinflammation and endothelial injury in COVID-19. We highlight the distinct contributions of dysregulated immune responses, platelet hyperactivation, and endothelial dysfunction to the pathogenesis of COVID-19. In addition, we discuss potential therapeutic strategies targeting these mechanisms.

scholarly journals Contemporary radiosurgery of cerebral cavernous malformations: Part 1. Treatment outcome for critically located hemorrhagic lesions

2019 ◽  
Vol 130 (6) ◽  
pp. 1817-1825 ◽  
Author(s):  
Gábor Nagy ◽  
Wendy Burkitt ◽  
Stuart S. Stokes ◽  
Debapriya Bhattacharyya ◽  
John Yianni ◽  
...  
Keyword(s):  
Natural History ◽  
Current Knowledge ◽  
Neurological Deficits ◽  
Temporary Increase ◽  
Long Term Effects ◽  
Cavernous Malformations ◽  
Intention To Treat ◽  
Study Results

OBJECTIVELong-term benefits of radiosurgery (RS) applying modern protocols to treat cavernous malformations (CMs) remain unclear as critics may consider the decrease in the rebleed rate generally observed 2 years after RS as a reflection of the lesion’s natural history. The authors adopted an early intention-to-treat attitude since rehemorrhage from deep-seated CMs ultimately leads to stepwise neurological deterioration. The safety of this early policy was previously demonstrated. Here, the authors revisit their current practice in a larger population with a longer follow-up time to assess the long-term effects of RS in the context of current knowledge on the natural history of CMs.METHODSThe authors conducted a retrospective analysis of 210 patients with 210 hemorrhagic CMs located in the brainstem, thalamus, or basal ganglia and treated with Gamma Knife RS between 1995 and 2014. Two hundred six patients had available follow-up, which was a median of 5.5 years (range 1–20 years). The median age was 37 years (0.5–77 years) at presentation and 43 (2–78) at treatment. One hundred twenty-seven CMs had bled once and 83 had had multiple hemorrhages prior to treatment.RESULTSThe lifetime annual bleed rate of CMs having a single hemorrhage prior to treatment was 2.4% per lesion. The hemorrhage rate stabilized at 1.1% after a temporary increase of 4.3% within the first 2 years after RS. The annual pretreatment hemorrhage rate was 2.8% for the lesions having multiple bleeds prior to RS with a pretreatment rebleed rate of 20.7% and with a modest gradual decrease within the first 5 years and remaining stable at 11.55% thereafter. The rebleed rate fell to 7.9% for the first 2 years after RS and declined further to 1.3% thereafter, which was significantly lower than the long-term pretreatment rebleed risk. The rate of hemorrhage-free survival remained 86.4% and 75.1% (1 patient each) at 20 years after RS in the single- and multiple-bleed groups, respectively.Pretreatment hemorrhages resulted in permanent deficits in 48.8% of the cases with a single bleed and in 77.1% of the cases with multiple bleeds. Both the rate and severity of deficits were significantly lower in the first group. Only mild and a low rate of permanent neurological deficits were caused either by posttreatment hemorrhages (7.4%) or by radiation (7.2%). The rate of persistent morbidity in the single-bleed group remained significantly lower at the end of the study than pretreatment morbidity in the multiple-bleed group (OR 2.9, 95% CI 1.6–5.3). Lesion-specific mortality was < 1%.CONCLUSIONSThe hemorrhage rate of CMs after RS remained low after the first 2 years during the longer follow-up period. The benefit of early treatment appears to be confirmed by the study results as repeated hemorrhages carry the risk of significantly higher cumulative morbidity than the morbidity associated with RS.

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