Pharmacotherapy
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Approximately 50% of patients hospitalized for stroke develop fever. In fact, experimental evidence suggests that high body temperature is significantly correlated to initial stroke severity, lesion size, mortality, and neurologic outcome. Fever occurring after stroke is associated with poor outcomes. ⋯ Nonpharmacologic approaches to cooling have been more effective in achieving normothermia, but whether stroke outcomes can be improved remains unclear. We recommend using body temperature as a biomarker and a catalyst for aggressive investigation for an infectious etiology. Care must be taken not to exceed the new standard of a maximum acetaminophen dose of 3 g/day to avoid patient harm.
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To determine the proportion of patients with coronary artery disease (CAD) and uncontrolled blood pressure who attained a blood pressure of less than 130/80 mm Hg, and to compare patient- and health system- specific characteristics and identify factors independently associated with attaining this blood pressure level. ⋯ Despite systematic and aggressive treatment of blood pressure in patients with CAD and uncontrolled blood pressure, a minority of patients attained a blood pressure of less than 130/80 mm Hg. Considering that higher utilization of the health care system was associated with reaching this blood pressure level and that a similar number of therapeutic interventions in the groups resulted in variable success for blood pressure lowering, attaining a blood pressure level of less than 130/80 mm Hg may be difficult for some patients with CAD.
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Randomized Controlled Trial
Atorvastatin for the treatment of plaque-type psoriasis.
To explore the efficacy and safety of oral atorvastatin for the treatment of plaque-type psoriasis. ⋯ Oral atorvastatin 40 mg/day was not associated with therapeutic benefit when given to patients with baseline PASI scores less than 12 who were also treated with standard topical therapies. Additional trials are needed to elucidate the place of statins for the treatment of psoriasis. A larger follow-up study, as well as testing atorvastatin in patients with more intensive disease characterized by high PASI scores, is needed. Studies using higher atorvastatin doses or dose-ranging studies should also be performed.
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The widespread emergence of antibiotic-resistant gram-negative organisms has compromised the utility of current treatment options for severe infections caused by these pathogens. The rate of gram-negative multidrug resistance is worsening, threatening the effectiveness of newer broad-spectrum antibiotic agents. Infections associated with multidrug-resistant Pseudomonas aeruginosa, Acinetobacter baumannii, and Enterobacteriaceae are having a substantial impact on hospital costs and mortality rates. ⋯ Although in vitro synergy tests have shown potential benefits of continued combination therapy, convincing clinical data that demonstrate a need for combination therapy once susceptibilities are known are lacking. Thus, deescalation to a single agent once susceptibilities are known is recommended for most patients and pathogens. Use of polymyxins, often in combination with other antimicrobials, may be necessary for salvage therapy.