The American journal of medicine
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Sepsis is a clinical syndrome defined by a systemic response to infection. With progression to sepsis-associated organ failure (ie, severe sepsis) or hypotension (ie, septic shock) mortality increases. Sepsis is a cause of considerable mortality, morbidity, cost, and health care utilization. ⋯ Early identification of septic patients allows for evidence-based interventions, such as prompt antibiotics, goal-directed resuscitation, and activated protein C. Appropriate care for sepsis may be more easily delivered by dividing this clinical entity into various stages and with changes in structures of delivery that extend across traditional boundaries. Better description of the molecular basis of the disease process also will allow for more targeted therapies.
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It is uncertain to what extent high C-reactive protein (CRP) concentrations reflect the presence of inflammatory conditions in the community. ⋯ There is high prevalence of common and uncommon inflammatory conditions in individuals with high CRP concentrations. Higher CRP concentrations should be interpreted with caution in cardiovascular disease risk assessment.
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Oxidative stress has been implicated in sarcopenia and the loss of muscle strength with aging, but the relationship between oxidative stress and decrease in muscle strength and physical performance has not been well characterized. Serum protein carbonyls are markers of oxidative damage to proteins and are caused by oxidative stress. ⋯ High oxidative stress, as indicated by oxidative damage to proteins, is an independent predictor of decrease in walking speed and progression to severe walking disability among older women living in the community.
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Health care-associated infections are those that do not meet the definition of nosocomial but are acquired by patients with extensive exposure to the health care system placing them at higher risk for resistant organisms. This category is particularly common among elderly patients. The objective of this study was to describe and compare the epidemiologic characteristics of community-acquired, health care-associated and nosocomial bloodstream infections in a geriatric population. ⋯ The category of health care-associated infection identified a unique group of geriatric patients at increased risk of methicillin-resistant Staphylococcus aureus infection and with increased mortality.