No abstract

Our findings suggest that some patients without major criteria for severe community-acquired pneumonia, according to the recent Infectious Diseases Society of America/American Thoracic Society consensus guideline, may benefit from direct transfer to the intensive care unit. Further studies are needed to prospectively identify patients who may benefit from direct intensive care unit admission despite a lack of major severity criteria for community-acquired pneumonia based on the current guidelines.

Introduction To identify risk factors for early (< three days) intensive care unit (ICU) admission of patients hospitalised with community-acquired pneumonia (CAP) and not requiring immediate ICU admission, and to stratify the risk of ICU admission on days 1 to 3.

The routine use of the PSI was associated with a larger proportion of patients in PSI risk classes I and II who had pneumonia and who were treated in the outpatient environment without compromising their safety.

We observed a low survival rate and developed a risk score based on easily obtained variables that may be useful to clinicians managing casualties from future heat waves.

MultidisciplineR.pdf 4. Grosicki S, Simonova M, Spicka I, et al. Once-per-week selinexor, bortezomib, and dexamethasone versus twice-per-week bortezomib and dexamethasone in patients with multiple myeloma (BOSTON): a randomised, open-label, phase 3 trial.

BackgroundVaso-occlusive crisis (VOC), hallmark of sickle-cell disease (SCD), is the first cause of patients' Emergency-Room admissions and hospitalizations. Acute chest syndrome (ACS), a life-threatening complication, can occur during VOC, be fatal and prolong hospitalization. No predictive factor identifies VOC patients who will develop secondary ACS.MethodsThis prospective, monocenter, observational study on SS/S-β0thalassemia SCD adults aimed to identify parameters predicting ACS at Emergency-Department arrival. The primary endpoint was ACS onset within 15 days of admission. Secondary endpoints were hospitalization duration, morphine consumption, pain evaluation, blood transfusion(s) (BT(s)), requiring intensive care and mortality.FindingsAmong 250 VOCs included, 247 were analyzed. Forty-four (17.8%) ACSs occurred within 15 (median [IQR] 3 [2, 3]) days post-admission based on auscultation abnormalities; missing chest radiographs excluded three patients. Comparing ACS to VOC, respectively, median hospital stay was longer 9 [7–11] vs 4 [3–7] days (p < 0.0001), 7/41 (17%) vs 1/203 (0.5%) required intensive care (p < 0.0001), and 20/41 (48.7%) vs 6/203 (3%) required BTs (p < 0.0001). No patient died. The multivariate model retained reticulocyte and leukocyte counts, and spine and/or pelvis pain as being independently associated with ACS; the resulting ACS-predictive score's area under the ROC was 0.840 [95% CI 0.780–0.900], 98.8% negative-predictive value and 39.5% positive-predictive value for the real ACS incidence.InterpretationThe ACS-predictive score is simple, easily applied and could change VOC management and therapeutic perspectives. Assessed ACS risk could lead to earlier discharges or close monitoring and rapid medical intensification to prevent ACS.

Vaso-occlusive crisis (VOC) is the primary cause of hospitalization of patients with sickle-cell disease. Treatment mainly consists of intravenous morphine, which has many dose-related side effects. Nonsteroidal antiinflammatory drugs have been proposed to provide pain relief and decrease the need for opioids. Nevertheless, only a few underpowered trials of nonsteroidal antiinflammatory drugs for sickle-cell VOC have been conducted, and conflicting results were reported. We conducted a phase 3, double-blind, randomized, placebo-controlled trial with ketoprofen (300 mg/day for 5 days), a nonselective cyclooxygenase inhibitor, for severe VOC in adults. A total of 66 VOC episodes were included. The primary efficacy outcome was VOC duration. The secondary end points were morphine consumption, pain relief, and treatment failure. Seven VOC episodes in each group were excluded from the analysis because of treatment failures. No significant between-group differences were observed for the primary outcome or the secondary end points. Thus, although ketoprofen was well-tolerated, it had no significant efficacy as treatment of VOC requiring hospitalization. These findings argue against its systematic use in this setting. IntroductionPain is the most frequent manifestation of sickle-cell disease (SCD) and is thought to be a consequence of sickle-cell vaso-occlusion. Vaso-occlusive crisis (VOC) is the primary cause of hospitalization of patients with SCD and is among the main causes of death in affected adults. 1,2 To date, no specific therapeutic agents have been approved for VOC, and treatment of uncomplicated VOC is merely symptomatic: bed rest, analgesics and hydration. According to American and British recommendations,3,4 severe pain of VOC that requires hospitalization should be treated with intravenous morphine. However, pain relief is not easily obtained during episodes of VOC, and morphine has many dose-related side effects, including sedation, nausea, constipation, pruritus, and hypoventilation. In addition, it might contribute to the development of acute chest syndrome. 5 In light of these potentially severe adverse events, many physicians are still reluctant to administer high doses of potent narcotics, and many medical texts do not provide adequate information for the treatment of pain. 6 A drug that would provide pain relief in patients with SCD and decrease the need for narcotics would be of obvious benefit.According to the results of 2 trials, 7,8 corticosteroids had a potentially beneficial effect on VOC by reducing the duration of analgesics, but corticosteroids have been shown to induce recurrent pain episodes. 7-11 Pilot trials with inhaled nitric oxide 12 and poloxamer 188 13 yielded promising results but were experimental, and those treatments are not yet available for routine use.Nonsteroidal antiinflammatory drugs (NSAIDs) are an effective treatment to decrease surgical and posttraumatic pain. 14-21 NSAIDs and opioid analgesics have a synergic effect, 22 thereby achieving better pain control and an ...