Internal and emergency medicine
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Observational Study
The effect of obesity on clinical outcomes in presumed sepsis: a retrospective cohort study.
Sepsis is a major cause of hospital admissions and mortality. Nevertheless, there are significant gaps in our knowledge of the epidemiology of sepsis in obese people, who now represent more than one-third of the population in the United States. The objective of this study was to measure the association between obesity and mortality from presumed sepsis. ⋯ Finally, there was no difference in the proportion of initial inadequate vancomycin levels (P = 0.1) after presumed sepsis. Obesity was not associated with increased mortality in patients with presumed sepsis. Further research is needed to determine how excess adiposity modulates inflammation from sepsis.
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Pneumonia is a common complication in stroke patients; it is associated with an adverse outcome, prolonged hospital stay and increased health costs. The aim of this study was to assess the ability of lung ultrasound to rule in or rule out pneumonia in patients with stroke. Patients with ischemic or hemorrhagic stroke were included in the study if they had a clinical suspicion of pneumonia. ⋯ Ultrasound imaging and chest X-ray studies were concordant in 42 out of 63 cases, 66.7 % (Pearson χ(2) = 11.97, p = 0.001). In conclusions, this study shows the utility of LUS imaging to rule in or rule out pneumonia in patients with stroke. We believe that lung ultrasound imaging can help clinicians in the diagnosis of stroke-associated pneumonia.
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The aims of this study were to evaluate the clinical characteristics and outcomes of patients with grayanotoxin poisoning due to mad honey brought from Nepal. Medical records of patients with mad honey poisoning admitted to the emergency department between 1 January 2004 and 31 May 2012 were retrospectively reviewed. A total of 15 patients were included in this study. ⋯ In all patients, the blood pressure and pulse rate returned to normal limits within 24 h. There were no deaths. The clinical characteristics and outcome of grayanotoxin poisonings caused by the ingestion of mad honey from Nepal are similar with those of mad honey from the Black Sea region of Turkey.
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Community acquired pneumonia (CAP) is a common reason for hospitalization and death in elderly people. Many predictors of in-hospital outcome have been studied in the general population with CAP. However, data are lacking on the prognostic significance of conditions unique to older patients, such as delirium and the coexistence of multiple comorbidities. ⋯ At multivariate analysis, independent predictors of in-hospital death were: chronic obstructive pulmonary disease (COPD) (OR 6.21, p = 0.005), occurrence of at least one episode of delirium (OR 5.69, p = 0.017), male sex (OR 5.10, p < 0.0001), and CURB-65 score (OR 3.98, p < 0.0001). Several predictors of in-hospital death (COPD, male gender, CURB-65) in patients with CAP older than 65 years are similar to those of younger patients. In this cohort of elderly patients, the occurrence of delirium was highly prevalent and represented a distinctive predictor of death.
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Comment Randomized Controlled Trial
Is it safe to withdraw etanercept in established rheumatoid arthritis after low disease activity achievement?