Southern medical journal
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Geographic variations in adverse health outcomes have long been recognized in the United States, with specific focus on the southeastern region of the country. Cerebrovascular disease mortality rates have identified the Southeast as the "stroke belt" for decades, though rates are also high for other hypertension-related diseases including ischemic heart disease, diabetes, and end-stage renal disease. ⋯ In addition to mortality from stroke, this assessment identified excessive risks from diabetes, ischemic heart disease, and end-stage renal disease for some states in the Southeast. Trend variations in health outcomes were also detected.
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Noninvasive positive pressure ventilation (NPPV) has been used in treatment of a variety of clinical conditions, including acute respiratory failure (ARF) due to status asthmaticus. We present the case of a patient admitted with acute exacerbation of asthma who had ARF and required mechanical ventilation. ⋯ Despite the benefits of NPPV (ie, improved patient comfort, reduced need for sedation, and avoidance of complications associated with mechanical ventilation), it has not been widely used. Understanding the clinical indications for and limitations of NPPV allows successful use of this noninvasive method of mechanical ventilation.
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Southern medical journal · Jan 1997
Aminoglycoside levels in critically ill surgical patients: the implications of physiologic criteria of sepsis.
We retrospectively reviewed medical records and computerized critical care data for 40 consecutive critically ill surgical patients receiving "standard" doses (1.5 to 2.0 mg/kg loading dose and 3 to 5 mg/kg/day) of gentamicin or tobramycin for gram-negative infections. End points measured were serum drug levels and clearance of infection. ⋯ Among the remaining 33 patients, significantly fewer septic than nonseptic patients had clearance of their infection (11% vs 92%). Specific physiologic criteria of sepsis may be used to identify critically ill patients who will most likely benefit from aggressive initial aminoglycoside dosing when these drugs are used to treat gram-negative infections.
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Delayed cardiac tamponade is a rare phenomenon with two primary causes: delayed hemorrhage after an acute injury or delayed pericarditis with effusion. We present a case of cardiac tamponade 4 weeks after injury, with findings compatible with delayed hemorrhage and pericarditis. Our case emphasizes the need for follow-up of patients with penetrating chest trauma for several months after injury; echocardiography should be used if symptoms of tamponade appear.