scholarly journals Phenytoin-induced rhabdomyolysis

2021 ◽  
Vol 10 (1) ◽  
pp. 277
Author(s):  
Burcu G. Çokal ◽  
Selda K. Guler ◽  
Nalan Guneş
Keyword(s):  
Alcohol Abuse ◽  
Muscle Injury ◽  
Muscular Activity ◽  
Common Causes ◽  
Life Threatening

Rhabdomyolysis is a potentially life-threatening syndrome that can develop from a variety of causes. The most common causes are muscle injury, alcohol abuse, drugs, toxins and increased muscular activity. Phenytoin is one of the drugs that rarely cause rhabdomyolysis. We present the case of a man who developed rhabdomyolysis following phenytoin treatment.

scholarly journals Development of a Vaccine against Human Cytomegalovirus: Advances, Barriers, and Implications for the Clinical Practice

Vaccines ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 551
Author(s):  
Sara Scarpini ◽  
Francesca Morigi ◽  
Ludovica Betti ◽  
Arianna Dondi ◽  
Carlotta Biagi ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Human Cytomegalovirus ◽  
Congenital Infection ◽  
Health Concern ◽  
Live Vaccines ◽  
Target Populations ◽  
Immune Correlates ◽  
Common Causes ◽  
The Status ◽  
Life Threatening

Human cytomegalovirus (hCMV) is one of the most common causes of congenital infection in the post-rubella era, representing a major public health concern. Although most cases are asymptomatic in the neonatal period, congenital CMV (cCMV) disease can result in permanent impairment of cognitive development and represents the leading cause of non-genetic sensorineural hearing loss. Moreover, even if hCMV mostly causes asymptomatic or pauci-symptomatic infections in immunocompetent hosts, it may lead to severe and life-threatening disease in immunocompromised patients. Since immunity reduces the severity of disease, in the last years, the development of an effective and safe hCMV vaccine has been of great interest to pharmacologic researchers. Both hCMV live vaccines—e.g., live-attenuated, chimeric, viral-based—and non-living ones—subunit, RNA-based, virus-like particles, plasmid-based DNA—have been investigated. Encouraging data are emerging from clinical trials, but a hCMV vaccine has not been licensed yet. Major difficulties in the development of a satisfactory vaccine include hCMV’s capacity to evade the immune response, unclear immune correlates for protection, low number of available animal models, and insufficient general awareness. Moreover, there is a need to determine which may be the best target populations for vaccine administration. The aim of the present paper is to examine the status of hCMV vaccines undergoing clinical trials and understand barriers limiting their development.

Anaphylaxis in the OR—Causes, Recognition, and Treatment

2018 ◽  
pp. 199-206
Author(s):  
Surangama Sharma ◽  
Lovkesh Arora
Keyword(s):  
Body Mass Index ◽  
Laparoscopic Cholecystectomy ◽  
Operating Room ◽  
Clinical Manifestations ◽  
Preventative Measures ◽  
Common Causes ◽  
Threatening Condition ◽  
Life Threatening ◽  
Elective Laparoscopic Cholecystectomy

Anaphylaxis in the operating room is a life-threatening condition that can evolve rapidly. As an anesthesiologist, it is important to understand the pathophysiology, diagnose the condition, recognize the inciting agent/agents, and manage it appropriately. It is equally important to confirm the diagnosis for preventing a catastrophic event from happening in future. This chapter defines anaphylaxis, discusses the clinical manifestations and most common causes, and describes ways it can be diagnosed. It also considers treatment and preventative measures. The chapter uses a case study of a 55-year-old female, weighing 85 kg and a body mass index of 36 with no other known comorbidities, who is scheduled to undergo elective laparoscopic cholecystectomy.

scholarly journals Unexpected source of Proteus mirabilis bacteraemia

2018 ◽  
Vol 11 (1) ◽  
pp. bcr-2018-226744
Author(s):  
Sureshkumar Nagiah ◽  
Rassam Badbess
Keyword(s):  
Proteus Mirabilis ◽  
Elderly Woman ◽  
High Morbidity ◽  
Vascular Risk ◽  
Infected Aneurysm ◽  
Gram Negative ◽  
Delay In Diagnosis ◽  
Common Causes ◽  
Threatening Condition ◽  
Life Threatening

Mycotic (infected) aneurysm involving the thoracic aorta is an exceedingly rare and life-threatening condition that is associated with high morbidity and mortality. We report an unusual source of Proteus mirabilis bacteraemia thought to be due to an infected aneurysm in the thoracic aortic arch in an elderly woman. Source of gram-negative bacteraemia is usually isolated to an intra-abdominal or a pelvic source. Proteus bacteraemia from an intrathoracic pathology is very uncommon, and in this case led to a delay in diagnosis. Although an infected aneurysm is a rare source of gram-negative bacteraemia, it must always be considered when common causes of bacteraemia have been ruled out especially in patients with vascular risk factors.

Management of meningitis and encephalitis in the critically ill

2016 ◽  
Author(s):  
Simon Nadel ◽  
Johnny Canlas
Keyword(s):  
Bacterial Meningitis ◽  
Care Setting ◽  
Antimicrobial Agents ◽  
Acute Bacterial Meningitis ◽  
Supportive Treatment ◽  
Intensive Care Setting ◽  
Vaccine Research ◽  
Common Causes ◽  
Life Threatening ◽  
The Common

Management of CNS infections requires specific antimicrobial agents, as well as specific supportive treatment targeted at reducing raised intracranial pressure and other life-threatening complications. It is important that the need for management in an intensive care setting is considered early in the illness. Antibiotic resistance amongst the most common organisms causing bacterial meningitis is becoming more common and antibiotic therapy should be adjusted accordingly. Anti-inflammatory treatment such as steroids should be started as soon as possible in patients with proven acute bacterial meningitis. Optimally, this should be before or with the first dose of antibiotics. Vaccine research is progressing so that effective vaccines should be available in the future against all the common causes of bacterial meningitis and encephalitis, including Neisseria meningitidis serogroup b.

scholarly journals A Clinical Study of Optic Disc Edema in a Tertiary Eye Center of Nepal

2019 ◽  
Vol 11 (2) ◽  
pp. 122-129
Author(s):  
Anil Parajuli ◽  
Ananda Kumar Sharma ◽  
Sanjeeta Sitaula
Keyword(s):  
Visual Acuity ◽  
Contrast Sensitivity ◽  
Color Vision ◽  
Optic Disc ◽  
Blind Spot ◽  
Optic Disc Edema ◽  
Disc Edema ◽  
Vision Defect ◽  
Common Causes ◽  
Life Threatening

Purpose: To evaluate the etiology and clinical presentation of cases with optic disc edema presenting to a tertiary eye center of Nepal. Background: The etiology of optic disc edema ranges from relatively benign to potentially sight and life threatening conditions. Till date very few studies have been done on disc edema in Nepal. Method: The authors conducted a prospective, descriptive study at B.P. Koirala Lions Center for Ophthalmic Studies (BPKLCOS), Nepal. All cases with disc edema presenting to the out patient department (OPD) from January 1, 2014 to June 30, 2015 were included in the study. Results: Total 112 patients were included in the study, out of which diagnosis could be established in 99. The mean age of the patients was 32.54 ± 13.97 years with the majority being female. The most common cause of disc edema was idiopathic intracranial hypertension (IIH) (37.5%,). Majority of the patients complained of isolated diminution of vision (38.4%). Among the eyes affected, 78.3% had best corrected visual acuity (BCVA) 6/6-6/18, 36.6% had color vision defect and 31.4% had reduced contrast sensitivity. The most common visual field defect was isolated enlarged blind spot (39.7 %). Conclusion: IIH followed by optic neuritis (ON) are the most common causes of disc edema. Conditions with disc edema mainly affect the age group 21-40 years with females affected 2.5 times more than males. Visual acuity, color vision and contrast sensitivity are deranged in majority of cases of ON and normal in majority of cases of IIH.

scholarly journals Human Soluble Recombinant Thrombomodulin, ART-123, Resolved Early Phase Coagulopathies, but Did Not Significantly Alter the 28 Day Outcome in the Treatment of DIC Associated with Infectious Systemic Inflammatory Response Syndromes

2019 ◽  
Vol 8 (10) ◽  
pp. 1553 ◽  
Author(s):  
Shusuke Mori ◽  
Tomohiko Ai ◽  
Toshiki Sera ◽  
Kanae Ochiai ◽  
Yasuhiro Otomo
Keyword(s):  
Inflammatory Response ◽  
Multiple Organ ◽  
Systemic Inflammatory Response ◽  
Clinical Severity ◽  
Major Life ◽  
Severity Scores ◽  
Common Causes ◽  
Systemic Disorder ◽  
Life Threatening ◽  
Recombinant Thrombomodulin

Disseminated intravascular coagulation (DIC) is a catastrophic systemic disorder of coagulation, resulting in uncontrollable bleeding, multiple organ failure, and death. Sepsis is one of the common causes of DIC. Despite many attempts to correct these coagulation pathologies, no adjunctive treatments have been shown to improve the mortality of DIC associated with sepsis. Although some clinical studies showed a recently developed human recombinant thrombomodulin, ART-123, might be effective in the treatment of DIC, few randomized, placebo-controlled studies have been conducted. In this study, we treated 60 DIC patients associated with systemic inflammatory response syndrome (SIRS) using ART-123 (n = 29) or saline as a placebo (n = 31). The basal clinical characteristics were similar in both groups. We compared clinical severity scores and DIC score in acute phase, and 28 day mortality between the two groups. Our study demonstrated the DIC score improved a few days earlier in the ART-123 group than the placebo group, and there were no major life-threatening adverse events in both groups. The overall survival rate at day 28 was not significantly altered. In conclusion, ART-123 can be used safely in DIC associated with infectious SIRS patients; however, its true efficacy in the treatment of DIC needs to be further investigated.

scholarly journals Two Different Life-Threatening Cases: Presenting with Torticollis

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Gülsüm Alkan ◽  
Melike Emiroğlu ◽  
Ayşe Kartal
Keyword(s):  
Respiratory Tract ◽  
Arachnoid Cyst ◽  
Upper Respiratory Tract ◽  
Cervical Muscles ◽  
Common Causes ◽  
Inflammatory Processes ◽  
Life Threatening ◽  
Spinal Arachnoid Cyst ◽  
Upper Respiratory

Acquired torticollis can be the result of several different pathological mechanisms. It is generally related to trauma, tumors, and inflammatory processes of the cervical muscles, nerves, and vertebral synovia. Although upper respiratory tract and neck inflammation are common causes of acute febrile torticollis in children, diseases with as yet undefined relationships may also result in torticollis. This is the case of spinal arachnoid cyst and pneumonia.

scholarly journals Inhalatory and intravenous colistin in treating ventilator-associated pneumonia due to acinetobacter species: Should we combine them?

2020 ◽  
Vol 77 (8) ◽  
pp. 832-838
Author(s):  
Jovan Matijasevic ◽  
Srdjan Gavrilovic ◽  
Ilija Andrijevic ◽  
Ana Andrijevic ◽  
Svetislava Milic ◽  
...  
Keyword(s):  
Nosocomial Infections ◽  
Demographic Data ◽  
Multidrug Resistant ◽  
Acinetobacter Species ◽  
Risk Of Death ◽  
Increased Risk ◽  
Inhaled Antibiotics ◽  
Common Causes ◽  
Life Threatening ◽  
Severity Of The Disease

Background/Aim. Acinetobacter is one of the most common causes of nosocomial infections, especially ventilatorassociated pneumonia (VAP). Considering the increased presence of multidrug-resistant microorganisms and the lack of novel antibiotics, colistin merged as the last-resort antibiotic for life threatening nosocomial infections. Intravenous use of antibiotics is accepted as a gold standard for the treatment of pneumonia, but additional administration of inhaled antibiotics in the treatment of VAP has shown to be advantageous in some clinical trials. The aim of this study was to investigate the effect of inhalatory colistin as an adjunct to intravenous colistin on the survival of patients with VAP caused by Acinetobacter species. Methods. We conducted a retrospective study to evaluate the efficacy of combination of inhalatory and intravenous colistin vs. intravenous colistin alone in 69 patients in the Intensive Care Units (ICU) with VAP caused by Acinetobacter baumannii. The patients were treated in the ICU at the Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica (Serbia) in the period from January, 2013 to March, 2018. Baseline demographic data, severity of the disease, comorbidities, colistin regimen and length of the treatment were collected. The primary outcome was 28-day mortality. Results. Twenty seven of total 69 (39.1%) patients received combined intravenous and inhalatory colistin. Forty two (60.9%) patients received only intravenous colistin. Compared to the combined use of the drug (intravenous and inhalatory colistin), patients receiving intravenous colistin alone had a significantly increased risk of death during 28 days [25.9% vs. 61.9%, respectively; odds ratio (OR) 4.464, 95% confidence interval (CI) 1.539?2.925; p = 0.006]. Length of colistin use (> 7 days) was also associated with reduced survival (OR 0.22; 95% CI 0.080?0.606; p = 0.003). After adjusting for baseline severity of the illness (APACHE score) and length of colistin treatment, patients receiving only intravenous colistin had greater 28-day mortality rate compared to patients receiving both intravenous and inhalatory colistin (OR 6.305; 95% CI 1.795?22.153; p = 0.004). Conclusion. Our results suggest that adding inhalatory to intravenous colistin might be beneficial in the treatment of VAP caused by Acinetobacter species.

scholarly journals “POTENTIALLY SURVIVABLE” CASUALTIES — RESERVE TO REDUCE PRE-HOSPITAL LETHAILITY IN INJURIES AND TRAUMAS

2019 ◽  
Vol 20 (3) ◽  
pp. 10-17
Author(s):  
I. M. Samokhvalov ◽  
A. V. Goncharov ◽  
V. S. Chirskij ◽  
A. M. Nosov ◽  
K. P. Golovko ◽  
...  
Keyword(s):  
Tension Pneumothorax ◽  
Point Of View ◽  
North Caucasus ◽  
Military Operation ◽  
Caucasus Region ◽  
The North ◽  
Common Causes ◽  
Life Threatening ◽  
The Military

Battlefield lethality remains the most underexplored problem from the surgical point of view. 540 battle­field fatalities during the military operation in the North Caucasus region of Russia (1994–1996) were ana­lyzed. It was found that 25.4% of all “Killed In Action” refer to the group of potentially survivable. Common causes of combat death in this group were prolonged hemorrhage (78.1%), tension pneumothorax (19.0%), and hemopneumothorax (2.9%). Reducing mortality can be attained due to introduction of new means of control for life-threatening consequences of injuries, improving tactical evacuation, as well as training mili­tary personnel in providing combat lifesaver care.  

Surgical management of esophageal perforation: role of primary closure

2019 ◽  
Vol 27 (3) ◽  
pp. 192-198 ◽  
Author(s):  
Vu Huu Vinh ◽  
Nguyen Viet Dang Quang ◽  
Nguyen Van Khoi
Keyword(s):  
Hospital Admission ◽  
Esophageal Perforation ◽  
Primary Closure ◽  
Primary Repair ◽  
Time Interval ◽  
Mortality And Morbidity ◽  
Thoracic Level ◽  
Common Causes ◽  
Threatening Condition ◽  
Life Threatening

Objective Esophageal perforation is a life-threatening condition associated with high mortality and morbidity. Ambiguous clinical presentation is one of the most common causes of delayed and difficult diagnosis of esophageal perforation. In this retrospective single-center study, we reviewed the outcome of primary closure in patients with esophageal perforation between 2009 and 2017. Methods The data of 65 patients attending our department of thoracic surgery (from 2009 to 2017) for esophageal perforation were reviewed. Primary repair was attempted in 63 patients irrespective of the site of perforation and time interval between injury and hospital admission. In intrathoracic lesions, continuous mediastinal and pleural irrigation was undertaken, whereas in cervical perforations, gauze packing and local irrigation were performed. Jejunotomy was carried out in patients with inadequate healing. Results Of the 65 patients, 63 underwent primary closure and 2 were left to heal spontaneously. The majority of patients ( n = 44) had an esophageal perforation at the thoracic level, and only one was admitted early (<24 h after injury). Among the 63 patients managed with primary closure, 55 had satisfactory healing with one surgery. Healing was delayed in the other 10 patients. No mortality was reported. Conclusions Esophageal perforation can be well managed by primary closure, irrespective of the time interval between injury and hospital admission and the site of perforation. Conservative management might lead to an increased rate of complications such as empyema or necrotizing mediastinitis, and increased morbidity and mortality.

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