2009 Review Article: Rhabdomyolysis and Acute Kidney Injury
Xavier Bosch, M.D., Ph.D., Esteban Poch, M.D., Ph.D., and Josep M. Grau, M.D., Ph.D. NEJM. Volume 361:62-72 July 2, 2009 Number 1
Rhabdomyolysis — literally, the dissolution of striped (skeletal) muscle — is characterized by the leakage of muscle-cell contents, including electrolytes, myoglobin, and other sarcoplasmic proteins (e.g., creatine kinase, aldolase, lactate dehydrogenase, alanine aminotransferase, and aspartate aminotransferase) into the circulation. Massive necrosis, which is manifested as limb weakness, myalgia, swelling, and, commonly, gross pigmenturia without hematuria, is the common denominator of both traumatic and nontraumatic rhabdomyolysis.1,2 Acute kidney injury is a potential complication of severe rhabdomyolysis, regardless of whether the rhabdomyolysis is the result of trauma or some other cause, and the prognosis is substantially worse if renal failure develops. In . . .
2009 Routine Early Angioplasty after Fibrinolysis for Acute Myocardial Infarction
Warren J. Cantor, M.D., David Fitchett, M.D., Bjug Borgundvaag, M.D., et al, for the TRANSFER-AMI Trial Investigators; New England Journal of Medicine, Volume 360:2705-2718 June 25, 2009 Number 26
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Background Patients with a myocardial infarction with ST-segment elevation who present to hospitals that do not have the capability of performing percutaneous coronary intervention (PCI) often cannot undergo timely primary PCI and therefore receive fibrinolysis. The role and optimal timing of routine PCI after fibrinolysis have not been established.
2009 Managing and Reducing Uncertainty in an Emerging Influenza Pandemic
Marc Lipsitch, D.Phil., Steven Riley, D.Phil., Simon Cauchemez, Ph.D., Azra C. Ghani, Ph.D., and Neil M. Ferguson, D.Phil. Published at www.nejm.org May 27, 2009 (10.1056/NEJMp0904380)
The early phases of an epidemic present decision makers with predictable challenges1 that have been evident as the current novel influenza A (H1N1) virus has spread. The scale of the problem is uncertain when a disease first appears but may increase rapidly. Early action is required, but decisions about action must be made when the threat is only modest — and consequently, they involve a trade-off between the comparatively small, but nearly certain, harm that an intervention may cause (such as rare adverse events from large-scale vaccination or economic and social costs from school dismissals) and the uncertain probability of much greater harm from a widespread outbreak. This combination of urgency, uncertainty, and the costs of interventions makes the effort to control infectious diseases especially difficult.
2009 Clinical Therapeutics: Fomepizole for Ethylene Glycol and Methanol Poisoning
Jeffrey Brent, M.D., Ph.D. Volume 360:2216-2223 May 21, 2009 Number 21
A 35-year-old man is brought to the emergency department by his wife after ingesting automobile antifreeze in an attempt at self-harm. On presentation, the patient is somnolent. He is afebrile and has a blood pressure of 126/72 mm Hg, a pulse rate of 102 beats per minute, and a respiratory rate of 24 breaths per minute. Pulse oximetry shows a hemoglobin saturation of 97% while the patient is breathing ambient air. His physical examination is normal except for tachypnea. His serum electrolyte profile and creatinine level are normal except for a serum carbon dioxide level of 17 mmol per liter. Arterial blood gas measurement reveals a pH of 7.30. Urinalysis shows microscopic hematuria and needle-shaped crystals typical of calcium oxalate. The patient's calculated serum osmolarity is 308 mOsm per liter, and his measured serum osmolality 395 mOsm per kilogram. A medical toxicologist recommends treatment with fomepizole. Subsequently, the patient's serum ethylene glycol concentration is determined to be 580 mg per deciliter (93.4 mmol per liter).
Also Click Read More to see the presentation by Dr Christina YS CHAN (PMH) on this similar topic.
2009 MGH Case 15-2009 — A 25-Year-Old Man with Coma after Cardiac Arrest
NEJM, Volume 360:2118-2125 May 14, 2009 Number 20
Camille N. Kotton, M.D., Nahel Elias, M.D., Francis L. Delmonico, M.D., and Richard L. Kradin, M.D.
Presentation of Case
Dr. Mathias Lichterfeld (Infectious Disease): A 25-year-old man was admitted to this hospital because of coma after cardiac arrest.
2009 Antivenom for Critically Ill Children with Neurotoxicity from Scorpion Stings
Leslie V. Boyer, M.D., Andreas A. Theodorou, M.D., Robert A. Berg, M.D., Joanne Mallie, R.N., for the Arizona Envenomation Investigators, Ariana Chávez-Méndez, B.S., Walter García-Ubbelohde, M.D., Stephen Hardiman, Ph.D., and Alejandro Alagón, M.D., Ph.D. NEJM, Volume 360:2090-2098 May 14, 2009 Number 20
ABSTRACT
Background Clinically significant scorpion envenomation by Centruroides sculpturatus produces a dramatic neuromotor syndrome and respiratory insufficiency that often necessitate intensive supportive care. We hypothesized that a scorpion-specific F(ab')2 antivenom would promptly resolve clinical symptoms in children with this syndrome.
2009 Perspective: The Signature Features of Influenza Pandemics — Implications for Policy
Mark A. Miller, M.D., Cecile Viboud, Ph.D., Marta Balinska, Ph.D., and Lone Simonsen, Ph.D.
Published at www.nejm.org May 7, 2009
Vast amounts of time and resources are being invested in planning for the next influenza pandemic, and one may indeed have already begun. Data from past pandemics can provide useful insights for current and future planning. Having conducted archeo-epidemiologic research, we can clarify certain "signature features" of three previous influenza pandemics — A/H1N1 from 1918 through 1919, A/H2N2 from 1957 through 1963, and A/H3N2 from 1968 through 1970 — that should inform both national plans for pandemic preparedness and required international collaborations.
2009 Perspective: Influenza A (H1N1) Virus, 2009 — Online Monitoring
John S. Brownstein, Ph.D., Clark C. Freifeld, B.S., and Lawrence C. Madoff, M.D.
Published at www.nejm.org May 7, 2009 (10.1056/NEJMp0904012)
The value of Web-based information for early disease detection, public health monitoring, and risk communication has never been as evident as it is today, given the emergence of the current influenza A (H1N1) virus. Many ongoing efforts have underscored the important roles that Internet and social-media tools are playing in the detection of and response to this outbreak.
2009 Perspective: Digital Disease Detection — Harnessing the Web for Public Health Surveillance
John S. Brownstein, Ph.D., Clark C. Freifeld, B.S., and Lawrence C. Madoff, M.D.
Published at www.nejm.org May 7, 2009
The Internet has become a critical medium for clinicians, public health practitioners, and laypeople seeking health information. Data about diseases and outbreaks are disseminated not only through online announcements by government agencies but also through informal channels, ranging from press reports to blogs to chat rooms to analyses of Web searches (see Digital Resources for Disease Detection). Collectively, these sources provide a view of global health that is fundamentally different from that yielded by the disease reporting of the traditional public health infrastructure.1
2009 Editorial: Implications of the Emergence of a Novel H1 Influenza Virus
Robert B. Belshe, M.D.
Published at New England Journal of Medicine on May 7, 2009
In this issue of the Journal, there are two reports of recent transmissions of swine influenza viruses in humans. One group of viruses, described by Shinde et al.,1 are triple reassortants of viruses from pigs, humans, and birds, called triple-reassortant swine influenza A (H1) viruses, which have circulated in pigs for more than a decade. The other group, described by the Novel Swine-Origin Influenza A (H1N1) Virus Investigation Team,2 is a recent reassortant of the triple-reassortant swine influenza A (H1) viruses and a Eurasian swine influenza virus, resulting in the swine-origin influenza A (H1N1) virus (S-OIV), currently being transmitted among humans.
2009 Editorial: H1N1 Influenza A Disease — Information for Health Professionals
Lindsey R. Baden, M.D., Jeffrey M. Drazen, M.D., Patricia A. Kritek, M.D., Gregory D. Curfman, M.D., Stephen Morrissey, Ph.D., and Edward W. Campion, M.D.
Published at New England Journal of Medicine on May 7, 2009
In the first 2 weeks in April, cases of infection with an untypable influenza A virus began to be identified in Mexico and southern California.1 Although the exact sequence of events is uncertain, by the third week of April it was established that the illness resulted from a triple recombination of human, avian, and swine influenza viruses; the virus has been found to be H1N1. This virologic analysis allowed for the development of a polymerase-chain-reaction (PCR) test to determine whether, in any given person, illness with the protean manifestations of cough, fever, sore throat, diarrhea, and nausea could be confirmed as a case. Armed with this critical tool, clinicians and epidemiologists are able to make case assignments to define and track the outbreak and to determine disease severity.
2009 Triple-Reassortant Swine Influenza A (H1) in Humans in the United States, 2005–2009
Vivek Shinde, M.D., M.P.H., Carolyn B. Bridges, M.D., Timothy M. Uyeki, M.D., M.P.H, M.P.P., Bo Shu, B.S., Amanda Balish, B.S., Xiyan Xu, M.D., Stephen Lindstrom, Ph.D., Larisa V. Gubareva, M.D., Ph.D., Varough Deyde, Ph.D., Rebecca J. Garten, Ph.D., Meghan Harris, M.P.H., Susan Gerber, M.D., Susan Vagoski, D.V.M., Forrest Smith, M.D., Neal Pascoe, R.N., Karen Martin, M.P.H., Deborah Dufficy, D.V.M., M.P.H., Kathy Ritger, M.D., M.P.H., Craig Conover, M.D., Patricia Quinlisk, M.D., M.P.H., Alexander Klimov, Ph.D., Joseph S. Bresee, M.D., and Lyn Finelli, Dr.P.H.
Published at New England Journal of Medicine website on May 7, 2009
ABSTRACT
Background Triple-reassortant swine influenza A (H1) viruses — containing genes from avian, human, and swine influenza viruses — emerged and became enzootic among pig herds in North America during the late 1990s.
Methods We report the clinical features of the first 11 sporadic cases of infection of humans with triple-reassortant swine influenza A (H1) viruses, occurring from December 2005 through February 2009, until just before the current epidemic of swine-origin influenza A (H1N1) among humans. These data were obtained from routine national influenza surveillance reports and from joint case investigations by public and animal health agencies.
2009 Emergence of a Novel Swine-Origin Influenza A (H1N1) Virus in Humans
Novel Swine-Origin Influenza A (H1N1) Virus Investigation Team
Published at New England Journal of Medicine website on May 7, 2009
ABSTRACT
Background On April 15 and April 17, 2009, novel swine-origin influenza A (H1N1) virus (S-OIV) was identified in specimens obtained from two epidemiologically unlinked patients in the United States. The same strain of the virus was identified in Mexico, Canada, and elsewhere. We describe 642 confirmed cases of human S-OIV infection identified from the rapidly evolving U.S. outbreak.
Methods Enhanced surveillance was implemented in the United States for human infection with influenza A viruses that could not be subtyped. Specimens were sent to the Centers for Disease Control and Prevention for real-time reverse-transcriptase–polymerase-chain-reaction confirmatory testing for S-OIV.
2009 Case Records of the Massachusettes General Hospital: Case 13-2009 — A 54-Year-Old Woman with Respiratory Failure and a Cavitary Lesion in the Lung
Volume 360:1770-1779 April 23, 2009 Number 17
Michael E. Weinblatt, M.D., Gerald F. Abbott, M.D., and Aashiyana F. Koreishi, M.D.
Presentation of Case
A 54-year-old woman was admitted to the hospital because of respiratory failure, hypotension, and a cavitary lesion in the lung.
She had rheumatoid arthritis but had otherwise been well until approximately 1 week before admission, when upper respiratory symptoms, cough, and shortness of breath developed. On the day of admission, shortness of breath worsened. She called her physician, who advised her to go to a hospital for evaluation. While she was preparing to leave her home, her symptoms increased in severity; she collapsed, and emergency medical services (EMS) were called.
When they arrived, the patient was unconscious and showing minimal . . .
2009 Use of Electronic Health Records in U.S. Hospitals
Ashish K. Jha, M.D., M.P.H., Catherine M. DesRoches, Dr.Ph., Eric G. Campbell, Ph.D., Karen Donelan, Sc.D., Sowmya R. Rao, Ph.D., Timothy G. Ferris, M.D., M.P.H., Alexandra Shields, Ph.D., Sara Rosenbaum, J.D., and David Blumenthal, M.D., M.P.P.
NEJM Volume 360:1628-1638 April 16, 2009 Number 16
HKSCCM Editor's note: Hong Kong Hospital Authority hospitals are more electronically ahead than many American counterparts.
Abstract
Background Despite a consensus that the use of health information technology should lead to more efficient, safer, and higher-quality care, there are no reliable estimates of the prevalence of adoption of electronic health records in U.S. hospitals.
Methods We surveyed all acute care hospitals that are members of the American Hospital Association for the presence of specific electronic-record functionalities. Using a definition of electronic health records based on expert consensus, we determined the proportion of hospitals that had such systems in their clinical areas. We also examined the relationship of adoption of electronic health records to specific hospital characteristics and factors that were reported to be barriers to or facilitators of adoption.
2009 Intensive versus Conventional Glucose Control in Critically Ill Patients - The NICE-SUGAR Study Investigators
The NICE-SUGAR Study Investigators
NEJM, Volume 360:1283-1297 March 26, 2009 Number 13
Also see accompanying Editorial by Silvio E. Inzucchi, M.D., and Mark D. Siegel, M.D.Glucose Control in the ICU - How Tight Is Too Tight? Volume 360:1346-1349 March 26, 2009 Number 13
ABSTRACT
Background The optimal target range for blood glucose in critically ill patients remains unclear.
Methods Within 24 hours after admission to an intensive care unit (ICU), adults who were expected to require treatment in the ICU on 3 or more consecutive days were randomly assigned to undergo either intensive glucose control, with a target blood glucose range of 81 to 108 mg per deciliter (4.5 to 6.0 mmol per liter), or conventional glucose control, with a target of 180 mg or less per deciliter (10.0 mmol or less per liter). We defined the primary end point as death from any cause within 90 days after randomization.
2009 Carbon Monoxide Poisoning - Clinical Practice
Lindell K. Weaver, M.D., New England Journal of Medicine, Volume 360: 1217-1225, 19 March, 2009
A 39-year-old female executive has a several-month history of fatigue, headache, and memory lapse. Multiple specialists have performed evaluations, but no diagnosis has been established. During a period of feeling worse than usual, she called a friend, who arrived at the residence to find the woman semicomatose and called 911. The patient was given supplemental oxygen and transported to the emergency department, where she is alert and has nonfocal findings on examination. Her carboxyhemoglobin level is 18%. How should she be
treated? What is the expected outcome?
2000 Daily Interruption of Sedative Infusions in Critically Ill Patients Undergoing Mechanical Ventilation
Abstract
Background Continuous infusions of sedative drugs in the intensive care unit may prolong the duration of mechanical ventilation, prolong the length of stay in the intensive care unit and the hospital, impede efforts to perform daily neurologic examinations, and increase the need for tests to assess alterations in mental status. Whether regular interruption of such infusions might accelerate recovery is not known.
Methods We conducted a randomized, controlled trial involving 128 adult patients who were receiving mechanical ventilation and continuous infusions of sedative drugs in a medical intensive care unit. In the intervention group, the sedative infusions were interrupted until the patients were awake, on a daily basis; in the control group, the infusions were interrupted only at the discretion of the clinicians in the intensive care unit.
Results The median duration of mechanical ventilation was 4.9 days in the intervention group, as compared with 7.3 days in the control group (P=0.004), and the median length of stay in the intensive care unit was 6.4 days as compared with 9.9 days, respectively (P=0.02). Six of the patients in the intervention group (9 percent) underwent diagnostic testing to assess changes in mental status, as compared with 16 of the patients in the control group (27 percent, P=0.02). Complications (e.g., removal of the endotracheal tube by the patient) occurred in three of the patients in the intervention group (4 percent) and four of the patients in the control group (7 percent, P=0.88).
Conclusions In patients who are receiving mechanical ventilation, daily interruption of sedative-drug infusions decreases the duration of mechanical ventilation and the length of stay in the intensive care unit.
2004 A Comparison of Vasopressin and Epinephrine for Out-of-Hospital Cardiopulmonary Resuscitation
ABSTRACT
Background Vasopressin is an alternative to epinephrine for vasopressor therapy during cardiopulmonary resuscitation, but clinical experience with this treatment has been limited.
Methods We randomly assigned adults who had had an out-of-hospital cardiac arrest to receive two injections of either 40 IU of vasopressin or 1 mg of epinephrine, followed by additional treatment with epinephrine if needed. The primary end point was survival to hospital admission, and the secondary end point was survival to hospital discharge. Results A total of 1219 patients underwent randomization; 33 were excluded because of missing study-drug codes. Among the remaining 1186 patients, 589 were assigned to receive vasopressin and 597 to receive epinephrine. The two treatment groups had similar clinical profiles. There were no significant differences in the rates of hospital admission between the vasopressin group and the epinephrine group either among patients with ventricular fibrillation (46.2 percent vs. 43.0 percent, P=0.48) or among those with pulseless electrical activity (33.7 percent vs. 30.5 percent, P=0.65). Among patients with asystole, however, vasopressin use was associated with significantly higher rates of hospital admission (29.0 percent, vs. 20.3 percent in the epinephrine group; P=0.02) and hospital discharge (4.7 percent vs. 1.5 percent, P=0.04). Among 732 patients in whom spontaneous circulation was not restored with the two injections of the study drug, additional treatment with epinephrine resulted in significant improvement in the rates of survival to hospital admission and hospital discharge in the vasopressin group, but not in the epinephrine group (hospital admission rate, 25.7 percent vs. 16.4 percent; P=0.002; hospital discharge rate, 6.2 percent vs. 1.7 percent; P=0.002). Cerebral performance was similar in the two groups. Conclusions The effects of vasopressin were similar to those of epinephrine in the management of ventricular fibrillation and pulseless electrical activity, but vasopressin was superior to epinephrine in patients with asystole. Vasopressin followed by epinephrine may be more effective than epinephrine alone in the treatment of refractory cardiac arrest.