Journal of clinical medicine research
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Infections are a well-known complication of pregnancy. However, pregnancy-associated severe sepsis (PASS) has not been as well-characterized, with limited population-level data reported to date. We performed a population-based study of the evolving patterns of the epidemiology, clinical characteristics, resource utilization, and outcomes of PASS in Texas over the past decade. ⋯ The incidence, severity, and fiscal burden of PASS rose substantially over the past decade. Case fatality was lower than that for severe sepsis in the general population. Chronic liver disease and CHF pose especially high risk of PASS. Pregnant women with history of drug abuse and lacking health insurance are at high risk of both developing and dying with PASS, requiring extra vigilance for early diagnosis and targeted intervention.
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Toxocara infection is a cause of vision impairment and blindness. We aimed to determine the seroprevalence and correlates of Toxocara infection in patients suffering from vision impairment and blindness in Durango City, Mexico. ⋯ This is the first report of Toxocara exposure in patients with vision impairment and blindness in Mexico, and of an association of Toxocara exposure with living in a house with soil floors. Results suggest a low Toxocara exposure in these patients in Durango, Mexico. The risk factor associated with Toxocara exposure identified in this study warrants for further investigation.
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Sepsis is a major contributor to mortality in patients admitted to a general intensive care unit (ICU). Early recognition and treatment of sepsis is key in improving outcomes. The epidemiology and outcome of sepsis in neurologic ICU (NeuroICU) has not been evaluated. ⋯ Sepsis developed in 1.4% of patients admitted to a NeuroICU. Predictors of sepsis development were comorbidities and worsening acute physiologic variables. Patients who developed sepsis had significantly higher mortality. Vigilance to development of sepsis in NeuroICU is paramount, especially in this era when early recognition and intervention of sepsis significantly improves outcomes.
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The demand for specialized medical services such as critical care often exceeds availability, thus rationing of intensive care unit (ICU) beds commonly leads to difficult triage decisions. Many factors can play a role in the decision to admit a patient to the ICU, including severity of illness and the need for specific treatments limited to these units. Although triage decisions would be based solely on patient and institutional level factors, it is likely that intensivists make different decisions when there are fewer ICU beds available. The objective of this study is to evaluate the characteristics of patients referred for ICU admission during times of limited beds availability. ⋯ ICU beds are a scarce resource for which demand periodically exceeds supply, raising concerns about mechanisms for resource allocation during times of limited beds availability. At our institution, triage decisions were not related to the number of available beds in ICU, age, or gender. A linear correlation was observed between severity of illness, expressed by APACHE-II scores, and the likelihood of being admitted to ICU. Alternative locations outside the ICU in which care for critically ill patients could be delivered should be considered during times of extreme ICU-bed shortage.
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Current recommendations for colorectal cancer screening for kidney transplant candidates are the same as for the general population. However, few studies have established the prevalence and characteristics of colorectal polyps in this population. The aim of this study is to describe the prevalence and characteristics of colonic lesions detected by pre-transplant colonoscopies in our kidney transplant population. ⋯ The prevalence of colorectal polyps before transplant is high among renal transplant recipients. The high prevalence of proximal lesions supports the need for total colonoscopy.