Bedside Cardiac Pocus in Emergency Setting: A Practice Review

2020 ◽  
Vol 15 ◽  
Author(s):  
Christian Zanza ◽  
Yaroslava Longhitano ◽  
Marco Artico ◽  
Gianmaria Cammarota ◽  
Andrea Barbanera ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Core Curriculum ◽  
Case Reports ◽  
Short Review ◽  
Rapid Identification ◽  
Cochrane Library ◽  
Emergency Setting ◽  
Holistic View ◽  
Questions And Answers ◽  
The Usa

Background: in the last years, ultrasound technology has entered in clinical practice as a tank and today, it has also allowed to no-cardiologists to extend and to deep their medical examination without the needing to call the consultant and having a good profile of diagnostic accuracy. The ultrasound bedside does not replace the consultant but it allows not to perform inappropriate consultations with more savings for hospitals. Objective: The aim was to review recently published literature to inform the clinician about the most up to date management of use bedside echography in emergency setting. In this short review we focused on two types of syndromes, no traumatichypotension and dyspnea, common to the three holistic disciplines of medicine, showing the main and basic questions and answers that ultrasound can give us for rapid identification of the problem Methods: We conducted a systematic review using Pubmed/Medline, Ovid/Willey and Cochrane Library, combining key terms such as “cardiac ultrasound, “cardiac diseases”,“emergency medicine”,“pocus”, “dyspnea”,“ hypotension”. We selected the most relevant clinical trials and review articles (excluding case reports) published in the last 19 years and in our opinion 59 publications appeared the best choice according to the PRISMA statement. In additional papers identified from individual article reference lists were also included. Conclusion: Recent studies have shown promise in establishing best practices for evaluation of heart, lung abdomen and deep vessels At the moment bedside US is widely used in an integrated ultrasound vision just like the holistic view have internal medicine, intensive care and emergency medicine and many medical schools in Europe and the USA are inserting ultrasonography into the core curriculum but we still have to find a standard method for the training program for minimum competence acquisition.

Hyperinsulinemic hypoglycemia in adults. Case reports and a short review

2008 ◽  
Vol 149 (35) ◽  
pp. 1659-1664 ◽  
Author(s):  
Erzsébet Kovács ◽  
Hajnalka Németh ◽  
Éva Pásztor ◽  
György Pfliegler
Keyword(s):  
Case Reports ◽  
Short Review ◽  
Hyperinsulinemic Hypoglycemia

A nem insulinoma eredetű tartós (perzisztáló) hyperinsulinaemiával járó hypoglykaemia oka a felnőttek körében ritkán előforduló nesidioblastosis. A nesidioblastosis hátterében álló inzulinszekréciós zavar molekuláris eltéréseken alapul. Morfológiailag különböző pancreassziget-, illetve béta-sejt-eltérések jellemzik, az inzulinhiperszekréció hátterében azonban körülhatárolható térfoglalás nem mutatható ki. A diagnózis alappillére az alacsony vércukorszint, a normoglykaemia intravénásan alkalmazott glükóz adásával történő fenntarthatósága, illetve az emelkedett inzulin- és C-peptid-szint. A hormontermelő tumor kizárásához mind invazív, mind nem invazív képalkotó módszerek szükségesek. A tartós, illetve ismétlődő hypoglykaemia káros hatásai gyógyszeres és/vagy sebészi kezeléssel előzhetők meg. Esetismertetés: A szerzők két betegük esetét ismertetik, akiknél felnőttkorban jelentkeztek a súlyos tünetekkel járó hypoglykaemiás epizódok. Nőbetegük „klasszikus” hypoglykaemiás tünetei 34 éves korban léptek fel: izzadás, szédülés, remegés, idegesség, illetve életveszélyes neuroglycopeniás jelek. Második, férfi betegük 22 éves, akinek fő panasza a hypoglykaemia ritka és szokatlan tünete, a nagyfokú éhségérzet mellett jelentkező puffadás volt. Az éhezési próbák mindkét esetben pozitívak voltak, vagyis hypoglykaemiás tünetek miatt fel kellett azokat függeszteni. Az inzulin- és a C-peptid-szintek magasak voltak, vénás inzulinszint-meghatározás az a. lienalis több pontjából és a képalkotó eljárások (komputertomográfia, mágneses rezonancia, pozitronemissziós tomográfia, angiográfia) nem tudtak igazolni térfoglalást. Az adatok alapján – szövettan hiányában is – a legvalószínűbb a felnőttkori nesidioblastosis diagnózisa. Diazoxid adásával mindkét esetben majdnem teljes tünetmentességet értek el, és neuroglycopeniás esemény a kezelés kezdete óta nem fordult elő. Következtetések: Ismeretlen eredetű hypoglykaemia esetén, ha a képalkotó eljárásokkal nincs körülírt képlet, a laboratóriumi adatok viszont egyértelműen emelkedett inzulinszekrécióra utalnak, gondolni kell nesidioblastosis lehetőségére. A sebészi beavatkozás veszélye pancreaselégtelenség éppúgy lehet, mint a betegség fennmaradása a hasnyálmirigy reszekciója miatt. Diazoxid adásával viszont tartós tünetmentesség érhető el ezen ritka kórképben, ezért érdemes elsőként ezt megkísérelni.

scholarly journals Efficacy and safety of urate-lowering therapy in people with kidney impairment: a GCAN-initiated literature review

2021 ◽  
Author(s):  
Hamish Farquhar ◽  
Ana B Vargas-Santos ◽  
Huai Leng Pisaniello ◽  
Mark Fisher ◽  
Catherine Hill ◽  
...  
Keyword(s):  
Renal Function ◽  
Renal Impairment ◽  
Case Reports ◽  
Serum Urate ◽  
Cochrane Library ◽  
Future Studies ◽  
Kidney Impairment ◽  
The Cochrane Library ◽  
Study Designs ◽  
Different Levels

Abstract Objectives To evaluate the efficacy, defined as achieving target serum urate <6.0 mg/dl, and safety of urate-lowering therapies (ULT) for people with gout and CKD stages 3–5. Methods PubMed, The Cochrane Library, and EMBASE, were searched from 1 January 1959 to 31 January 2018 for studies that enrolled people with gout, who had an estimated glomerular filtration rate (eGFR) or creatinine clearance (CrCl) of < 60 mL/min, and exposure to allopurinol, febuxostat, probenecid, benzbromarone, lesinurad or pegloticase. All study designs other than case reports were included, except for people on dialysis, for which we did include case reports. Results There were 36 reports with an analysis of efficacy and/or safety based upon renal function – allopurinol (n = 12), febuxostat (n = 10), probenecid (n = 3), benzbromarone (n = 5), lesinurad (n = 5), and pegloticase (n = 1). There were 108 reports that involved people with gout and renal impairment but did not contain any analysis on efficacy and/or safety based upon renal function – allopurinol (n = 84), febuxostat (n = 14), benzbromarone (n = 1), lesinurad (n = 3), and pegloticase (n = 6). Most studies excluded people with more severe degrees of renal impairment (eGFR or CrCl of < 30mL/min). For allopurinol in particular, there was significant variability in the dose of drug used, and efficacy in terms of urate lowering, across all levels of renal impairment. Conclusion There is a lack of evidence regarding efficacy and/or safety of currently used ULT according to different levels of renal function. Future studies should include patients with CKD and should report study outcomes stratified by renal function.

scholarly journals Newer Volatile Anesthetic Agents in Cardiac Anesthesia: Review of Literature

2021 ◽  
Author(s):  
Alka Mandke ◽  
Manjula Sarkar ◽  
Charulata Deshpande ◽  
Arun Maheshwari ◽  
Bhupesh Kumar ◽  
...  
Keyword(s):  
Volatile Anesthetic ◽  
Cochrane Library ◽  
Cochrane Central Register ◽  
Cardiac Anesthesia ◽  
Medical Subject Headings ◽  
Holistic View ◽  
Anesthetic Agents ◽  
Cardiac Anaesthesia ◽  
Mesh Terms ◽  
Inhalational Anaesthesia

AbstractMyocardial protection with volatile anesthetic agents have been suggested by multiple studies. These studies, however, are scattered and are often limited to a particular aspect of cardiac anesthesia. Older inhalational agents like halothane is known to cause significant hepatic damage in patients undergoing long duration surgeries while isoflurane is known to have marked vasodilating properties that also affects the coronary arteries leading to coronary “steal” phenomenon. Additionally, newer agents, like sevoflurane and desflurane, have shown more prominent cardioprotective effects than older agents. We searched ScholarOne, Medline, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library. The medical subject headings (MeSH) terms “anaesthesia, inhalational,” “anaesthesia, intravenous, or TIVA,” and “Cardiac anaesthesia or Cardiac Surgery” were used. Additional studies were identified by review of the reference sections of all eligible studies. The aim of this review article is to bring together the evidences with newer inhalational agents and provide a holistic view of their benefits and shortcomings in cardiac anesthesia.

scholarly journals Neurological manifestations and neuroimaging findings in patients with SARS-CoV2—a systematic review

2021 ◽  
Vol 57 (1) ◽  
Author(s):  
Nikita Mohan ◽  
Muhammad Ali Fayyaz ◽  
Christopher del Rio ◽  
Navpreet Kaur Rajinder Singh Khurana ◽  
Sampada Sandip Vaidya ◽  
...  
Keyword(s):  
Neurological Diseases ◽  
Case Reports ◽  
Healthcare Providers ◽  
Case Series ◽  
Altered Mental Status ◽  
Common Finding ◽  
Cochrane Library ◽  
Neurological Manifestations ◽  
The Cochrane Library ◽  
Ct And Mri

Abstract Background The COVID-19 pandemic has drastically affected everyone in a hit or miss manner. Since it began, evidence of the neuro-invasive potential of the virus has been intensifying significantly. Several pathways have been hypothesized to elucidate the neurotropic nature of SARS-CoV2. It is the need of the hour to collect vital information. Objective To evaluate and correlate the neuro-radiological and neurological manifestations in patients diagnosed with SARS-CoV2. To identify neuro-invasive pathways of COVID infection. Methods Relevant studies were identified through four databases—the Cochrane Library, PubMed, Science Direct, and Web of Science. These were searched using relevant keywords—“COVID-19,” “SARS-CoV2,” “neurological manifestations,” “neuroimaging,” “CT,” and “MRI.” Relevant articles were screened according to a pre-defined inclusion and exclusion criteria from December 2019 to August 2020. Results Our review included a total of 63 full text publications with 584 patients, composed mainly of observational studies, case reports, and case series. The most common neurological manifestations associated with COVID-19 were altered mental status, stroke, and paralysis. About 17.85% patients who underwent neuroimaging were found to be having ischemic changes suggestive of a stroke. This was followed by hemorrhagic changes as the second most common finding. The most commonly involved vessel was the Middle Cerebral Artery. Besides stroke, we found that SARS-CoV2 could be the cause for new-onset seizures, Guillain-Barre Syndrome, encephalitis, and many other severe neurological diseases. Conclusion The information that we have obtained so far will prove dynamic to healthcare providers working against the COVID-19 pandemic. It is necessary to be aware of these atypical neurological findings for the early diagnosis and treatment of COVID-19 infected patients. However, to completely understand the connection between SARS-CoV2 and the nervous system, further research is necessary.

Challenges in Treating Chlamydia trachomatis, Including Rectal Infections: Is It Time to Go Back to Doxycycline?

2021 ◽  
pp. 106002802110299
Author(s):  
S. Lena Kang-Birken
Keyword(s):  
Chlamydia Trachomatis ◽  
Treatment Failure ◽  
English Language ◽  
Treatment Guidelines ◽  
Case Reports ◽  
Controlled Trial ◽  
Absolute Difference ◽  
Cochrane Library ◽  
Increased Risk ◽  
Meta Analyses

Objective: To evaluate recent publications on efficacy of single-dose azithromycin and 7-day doxycycline when treating Chlamydia trachomatis. Data Sources: A literature search of MEDLINE, EMBASE, PubMed, and Cochrane library was conducted (1990 to June 13, 2021) using the terms: Chlamydia trachomatis, genital chlamydia, rectal chlamydia, extragenital chlamydia, azithromycin, doxycycline, and treatment guidelines. ClinicalTrials.gov was searched to identify ongoing trials. Study Selection and Data Extraction: English language studies, including controlled studies, retrospective analyses, systematic reviews, meta-analyses, and case reports, reporting microbiological or clinical outcomes in adolescents and adults were considered. Data Synthesis: Systemic reviews and meta-analyses of randomized trials reported azithromycin efficacy of 96% to 97% in genital chlamydia. However, reports of treatment failure have emerged, especially among symptomatic males, with an increased risk of microbiological failure after azithromycin than doxycycline (relative risk = 2.45; 95% CI = 1.36-4.41). Retrospective analyses and prospective observational cohort studies reported lower efficacy range following azithromycin than doxycycline (74%-87% vs 92%-100%, respectively) in rectal chlamydia. First randomized controlled trial comparing azithromycin and doxycycline reported significantly higher microbiological cure following doxycycline, with absolute difference of 26% (95% CI = 16%-36%; P < 0.001). The proposed 2021 Centers for Disease Control and Prevention treatment guidelines designate doxycycline as the preferred agent for treatment at any site. Relevance to Patient Care and Clinical Practice: A growing body of evidence for treatment failure following azithromycin, especially in rectal chlamydia supports updating current practice. Conclusions: Doxycycline continues to achieve high efficacy in genital and rectal chlamydia. Clinicians should consider efficacy with convenience of dosing regimen, medication compliance, and sexual behavior risks when treating chlamydia infections.

scholarly journals Emergency Medicine: The Core Curriculum

1999 ◽  
Vol 16 (6) ◽  
pp. 465-465
Author(s):  
A. McGowan
Keyword(s):  
Emergency Medicine ◽  
Core Curriculum ◽  
The Core

scholarly journals Is laryngeal involvement in pemphigus vulgaris rare? A review

2015 ◽  
Vol 1 (1) ◽  
pp. 3
Author(s):  
Mohan Bansal
Keyword(s):  
Case Reports ◽  
Pemphigus Vulgaris ◽  
Google Scholar ◽  
Cochrane Library ◽  
Laryngeal Lesions ◽  
Life Threatening ◽  
Laryngeal Involvement

<p>The lesions of pemphigus in the larynx have been reported as case reports. However, the frequency with which it occurs is not known. The purpose of this study was to investigate the incidence of laryngeal involvement in pemphigus vulgaris and to examine the laryngeal lesions and the treatment in detail. The databases searched were PubMed, EMBASE, Cochrane Library and Google scholar. The involvement of larynx in patients with pemphigus vulgaris is common. The most common parts involved are epiglottis and arytenoids. This study indicates that laryngeal symptoms are common in pemphigus vulgaris. Laryngeal findings must be considered at the beginning of diagnosis for the better management and to prevent life threatening complications.</p>

Dental implants survival after nasal floor elevation: a systematic review

2021 ◽  
Author(s):  
Eduardo Anitua ◽  
Beatriz Anitua ◽  
Mohammad Hamdan Alkhraisat ◽  
Laura Piñas ◽  
Asier Eguia ◽  
...  
Keyword(s):  
Systematic Review ◽  
Assessment Tool ◽  
Case Reports ◽  
Meta Analysis ◽  
Lateral Approach ◽  
Cochrane Library ◽  
Good Survival ◽  
Quality Level ◽  
Level Of Evidence ◽  
Nasal Floor

Purpose The aim of this work is to assess the clinical outcomes of implants placed after a nasal floor elevation procedure. Methods A systematic review was conducted using four electronic databases; Medline (Pubmed), Cochrane library, DOAJ and SCOPUS, following the PRISMA statement recommendations to answer the PICO question: “In patients undergoing dental implant placement in the maxillary anterior region (P), Do implants placed after nasal floor elevation (I) have a different survival (O) from those implants placed without grafting procedures (C)?. The study was pre-registered in PROSPERO (CRD42021229479). Included articles quality was assessed using the “NIH quality assessment tool”, “The Newcastle-Ottawa scale” and “JBI critical appraisal tools for case reports''. Results Twelve articles were finally selected, including 151 patients and 460 implants. The weighted mean follow-up was 32.2 months, and the weighted survival rate after this period was 97.64% (range 89.2-100%). No statistical differences could be inferred between the treatments performed in one-stage or two-stage, following a lateral approach or a transcrestal approach or using different grafting materials. A great heterogeneity was found in terms of study design and methodological aspects. For this reason, a quantitative analysis followed by meta-analysis was not possible. Conclusion Within the limitations of this study, implants placed after a nasal floor elevation present a good survival and a low range of complications. In absence of randomized studies, the level of evidence was low, attending the GRADE system and based on the study quality level, the strength of evidence attending the SORT taxonomy was B.

Rituximab for Eosinophilic Granulomatosis with Polyangiitis: a Systematic Review of Observational Studies

Rheumatology ◽  
2021 ◽  
Author(s):  
Vincenzo G Menditto ◽  
Giulia Rossetti ◽  
Diletta Olivari ◽  
Alessia Angeletti ◽  
Marco Rocchi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cohort Studies ◽  
Granulomatosis With Polyangiitis ◽  
Case Reports ◽  
Case Series ◽  
Biologic Agents ◽  
Cochrane Library ◽  
Eosinophilic Granulomatosis With Polyangiitis ◽  
Extensive Literature ◽  
Eosinophilic Granulomatosis

Abstract Objective to analyze the available evidence about the use of rituximab (RTX) and other biologic agents in Eosinophilic Granulomatosis with Polyangiitis (EGPA) patients and to provide useful findings to inform the design of future, reliable clinical trials. Methods A systematic review was performed. A systematic search was conducted in PubMed/MEDLINE, Scopus, Web of Science and the Cochrane library databases and an extensive literature search on other biologic agents. Results 45 papers pertinent to our questions were found: 16 retrospective cohort studies, 8 case series, 3 prospective cohort studies and 18 single case reports, for a total of 368 EGPA patients. More than 80% of evaluable patients achieved complete or partial remission with a tendency towards a higher rate of complete response in pANCA positive subgroup. Conclusion Although the majority of the evaluable EGPA patients treated with RTX appears to achieve complete remission, we strongly believe that a number of sources of heterogeneity impairs a clear interpretation of results and limits their transferability in clinical practice. Differences in design, enrollment criteria, outcome definition and measurement make a comparison among data obtained from studies on RTX and other biologic agents unreliable.

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