2009 Dec 17 - Lancet Viewpoint: A new law for allocation of donor organs in Israel
Israel's system for organ donation has been based, since its inception in 1968, on a model in which organs for transplantation are retrieved from brain-dead donors only after consent has been obtained from the appropriate first-degree relatives. This consent is needed even if the potential donor has expressed a wish for posthumous organ donation by signing a donor card, which is a government form that allows people to voluntarily indicate their wish to donate specified organs after their death. 1 ...
2009 Dec 12 - Risk of bleeding in patients with acute myocardial infarction treated with different combinations of aspirin, clopidogrel, and vitamin K antagonists in Denmark: a retrospective analysis of nationwide registry data
Background
Combinations of aspirin, clopidogrel, and vitamin K antagonists are widely used in patients after myocardial infarction. However, data for the safety of combinations are sparse. We examined the risk of hospital admission for bleeding associated with different antithrombotic regimens.
2009 Dec 10 - Lancet Comment: Molecular methods for pathogen detection in blood
Detection of blood-borne infection is done with a multistep approach, including blood culture, single-colony growth, and biochemical analysis ( figure ). With automation of biochemical analysis, the complete process typically takes 2 days, 1 during which time clinicians receive incremental information about culture positivity with microscopic description, speciation, and antimicrobial susceptibility. Timely initiation of adequate antimicrobial treatment is crucial to reduce morbidity and mortality i ...
2009 Dec 10 - Accurate and rapid identification of bacterial species from positive blood cultures with a DNA-based microarray platform: an observational study
The Prove-it Sepsis assay used in the study. Read more at its website here.Background: New DNA-based microarray platforms enable rapid detection and species identification of many pathogens, including bacteria. We assessed the sensitivity, specificity, and turnaround time of a new molecular sepsis assay.
2009 Dec - Stroke treatment with alteplase given 3·0—4·5 h after onset of acute ischaemic stroke (ECASS III): additional outcomes and subgroup analysis of a randomised controlled trial
Background: In the European Cooperative Acute Stroke Study III (ECASS III), alteplase administered 3·0—4·5 h after the onset of stroke symptoms resulted in a significant benefit in the primary endpoint (modified Rankin scale [mRS] score 0—1) versus placebo, with no difference in mortality between the treatment groups. Compared with the 0—3 h window, there was no excess risk of symptomatic intracranial haemorrhage. We assessed the usefulness of additional endpoints and did subgroup and sensitivity analyses to further investigate the benefit of alteplase.
2009 Nov 12 - Lancet Comment: Infection and death from influenza A H1N1 virus in Mexico
The scientific community is aware that pandemics other than the current influenza A H1N1 outbreak have existed throughout history. A characteristic of the H1N1 pandemic is how fast knowledge evolved, with medical groups confirming or declaring as controversial what had been stated weeks after the first outbreaks. This rapid evolution allowed other groups to establish better capabilities to face the pandemic.
2009 Nov 12 - Infection and death from influenza A H1N1 virus in Mexico: a retrospective analysis
Background
In April, 2009, the first cases of influenza A H1N1 were registered in Mexico and associated with an unexpected number of deaths. We report the timing and spread of H1N1 in cases, and explore protective and risk factors for infection, severe disease, and death.
2009 Nov 10 - Lancet Comment: InFACT - a global critical care research response to H1N1
H1N1 pandemic presents acute care researchers with an extraordinary challenge and an unprecedented opportunity. By early October, 2009, there had been more than 340 000 reported cases of H1N1 infection in 191 countries, with more than 4100 deaths.1 WHO initially projected that up to 2 billion people could become infected with the virus over the next 2 years.2
2009 Nov 5 - Lancet Comment: Routine daily vs on-demand chest radiographs in intensive care
Routine daily chest radiography is common in intubated and mechanically ventilated patients, in accord with professional society recommendations. 1 A key justification is the belief that routine chest radiographs allow prompt detection of problems that could be missed by clinical evaluation (eg, early pneumothoraces or malpositioned endotracheal tubes). 2
2009 Nov 5 - Comparison of routine and on-demand prescription of chest radiographs in mechanically ventilated adults: a multicentre, cluster-randomised, two-period crossover study
Figure. Near-total right lung collapse due to sputum retention (Photo courtesy: Intensive Care Unit, PYNEH)
Background
Present guidelines recommend routine daily chest radiographs for mechanically ventilated patients in intensive care units. However, some units use an on-demand strategy, in which chest radiographs are done only if warranted by the patient's clinical status. By comparison between routine and on-demand strategies, we aimed to establish which strategy was more efficient and effective for optimum patient care.
2009 Nov 3 - Seminar: Pulmonary embolism in pregnancy
Pulmonary embolism (PE) is the leading cause of maternal mortality in the developed world. Mortality from PE in pregnancy might be related to challenges in targeting the right population for prevention, ensuring that diagnosis is suspected and adequately investigated, and initiating timely and best possible treatment of this disease.
2009 Oct 31 - Seminar: Pathogenesis, treatment, and prevention of pneumococcal pneumonia
Pneumococcus remains the most common cause of community-acquired pneumonia worldwide. Streptococcus pneumoniae is well adapted to people, and is a frequent inhabitant of the upper airways in healthy hosts.
2009 Oct 3 - Case Report: Cyanide poisoning in Taiwan
In May, 2005, a 32-year-old woman lost consciousness soon after drinking a non-alcoholic beverage. She was transported to hospital within 5 min, found to be unresponsive, and intubated. Before intubation, blood gas measurements on room air (possible venous sample), were: pH 7·846, pCO2 24·2 mm Hg, pO2 28·7 mm Hg, HCO3− 41·8 mmol/L (base excess [BE] 26 mmol/L); O2 saturation was 79·4%.
2009 Sep 26 - Use of drains versus no drains after burr-hole evacuation of chronic subdural haematoma: a randomised controlled trial
Background
Chronic subdural haematoma causes serious morbidity and mortality. It recurs after surgical evacuation in 5—30% of patients. Drains might reduce recurrence but are not used routinely. Our aim was to investigate the effect of drains on recurrence rates and clinical outcomes.
2009 Sep 26 - Case Report: Serious postoperative syncope
In November, 2008, an arrest call was made for a 69-year-old woman after a syncopal episode in a rural hospital. The patient had had an elective right total hip replacement a day earlier.
2009 Oct - Susceptibility relationship between vancomycin and daptomycin in Staphylococcus aureus: facts and assumptions
The Lancet Infectious Diseases, Volume 9, Issue 10, Pages 617 - 624, October 2009
The decrease in vancomycin treatment efficacy that is accompanying increases in vancomycin minimum inhibitory concentration (MIC) within the susceptible range (so-called MIC creep) has led to the suggestion that vancomycin is losing its potency in treating serious Staphylococcus aureus infections. Understanding the clinical importance of the microbiological effects of glycopeptides on bacterial lipopeptides and lipoglycopeptides will be crucial in treating serious meticillin-resistant S aureus infections.
2009 Oct - Influenza as a trigger for acute myocardial infarction or death from cardiovascular disease: a systematic review
The Lancet Infectious Diseases, Volume 9, Issue 10, Pages 601 - 610, October 2009
Cardiac complications of influenza infection, such as myocarditis, are well recognised, but the role of influenza as a trigger of acute myocardial infarction is less clear. We did a systematic review of the evidence that influenza (including influenza-like illness and acute respiratory infection) triggers acute myocardial infarction or cardiovascular death. We examined the effectiveness of influenza vaccines at protecting against cardiac events and did a meta-analysis of data from randomised controlled trials.
Cardiac complications of influenza infection, such as myocarditis, are well recognised, but the role of influenza as a trigger of acute myocardial infarction is less clear. We did a systematic review of the evidence that influenza (including influenza-like illness and acute respiratory infection) triggers acute myocardial infarction or cardiovascular death. We examined the effectiveness of influenza vaccines at protecting against cardiac events and did a meta-analysis of data from randomised controlled trials.
2009 Sep 19 - Pharmacodynamic effect and clinical efficacy of clopidogrel and prasugrel with or without a proton-pump inhibitor: an analysis of two randomised trials
Background
Proton-pump inhibitors (PPIs) are often prescribed in combination with thienopyridines. Conflicting data exist as to whether PPIs diminish the efficacy of clopidogrel. We assessed the association between PPI use, measures of platelet function, and clinical outcomes for patients treated with clopidogrel or prasugrel.
2009 Oct - Review: Blood pressure as a prognostic factor after acute stroke
Stroke is the second most common cause of death worldwide and is the complication of hypertension that is most directly linked to blood pressure. Hypertension affects nearly 30% of the world's population; therefore, reducing blood pressure is key for the prevention of stroke.
2009 Oct - Review: Malignant middle cerebral artery infarction: clinical characteristics, treatment strategies, and future perspectives
Space-occupying, malignant middle cerebral artery (MCA) infarctions are still one of the most devastating forms of ischaemic stroke, with a mortality of up to 80% in untreated patients. An early diagnosis is essential and depends on CT and MRI to aid the prediction of a malignant course.