The term atypical pneumonia was first used in 1938, and by the 1970s it was widely used to refer to pneumonia due to Mycoplasma pneumoniae, Legionella pneumophila (or other Legionella species), and Chlamydophila pneumoniae. However, in the purest sense all pneumonias other than the classic bacterial pneumonias are atypical. Currently many favor abolition of the term atypical pneumonia.This review categorizes atypical pneumonia pathogens as conventional ones; viral agents and emerging atypical pneumonia pathogens. We emphasize viral pneumonia because with the increasing availability of multiplex polymerase chain reaction we can identify the agent(s) responsible for viral pneumonia. By using a sensitive assay for procalcitonin one can distinguish between viral and bacterial pneumonia. This allows pneumonia to be categorized as bacterial or viral at the time of admission to hospital or at discharge from the emergency department and soon thereafter further classified as to the etiology, which should be stated as definite or probable.
Recent advances in microarray technology are helping to identify more genetic anomalies associated with tetralogy of Fallot and other congenital heart defects. We report on a 24-year-old woman with a syndromic form of tetralogy of Fallot who was found to have a novel de novo deletion of the proximal long arm of chromosome 13. History of developmental delay and learning difficulties, mild dysmorphic facial features, and anal atresia prompted genetic investigations. A review of the literature on deletions that overlap this region showed that several were associated with major congenital heart defects. The results suggest that the 13q13.1-q13.2 region may harbour a gene or genes important in cardiac development.
Introduction: Aortitis refers to abnormal inflammation of the aorta, most commonly caused by giant cell arteritis (GCA). Herein, we present a 57-year-old female with aortitis and arterial-embolic strokes secondary to GCA. Case Report: Our patient presented to the emergency department following an episode of transient, monocular, painless vision loss. Computed tomography angiogram head and neck demonstrated phase II aortitis, and magnetic resonance imaging revealed evidence of arterial-embolic strokes. Conclusion: Cerebrovascular accident is a rare complication of large-vessel vasculitis and can occur due to multiple underlying etiologies including intracranial vasculitis, aortic branch proximal occlusion, or arterial-embolic stroke.
Objectives Pain and bleeding complicate 30% of pregnancies, raising concerns for viability. The objective is to evaluate the diagnostic characteristics of a single serum progesterone level in assessing pregnancy viability among symptomatic patients. Methods We conducted a predefined literature search in MEDLINE, Embase (OVID), CINAHL and Cochrane databases for studies that enrolled patients in first trimester with miscarriage symptoms, measured progesterone and reported pregnancy viability, from inception to July 2020. We extracted data for 2 × 2 tables, progesterone threshold levels and viability. We obtained summary estimates of sensitivity, specificity, Diagnostic Odds Ratio (DOR), and predictive values at given prevalence rates. ResultsWe identified 54 publications. There was a total of 15,878 patients enrolled, of whom 7864 patients (49.5%) were confirmed to have a viable pregnancy and 8014 patients (50.5%) were confirmed to have a non-viable pregnancy. The cut-off value of progesterone ranged from 3.2 to 25 ng/mL (20.034-79.5 nmol/L). We evaluated the performance of the following progesterone cut-off categories: < 6.3, 6.3-12.6, 12.7-19.9, and 20-25 ng/mL. To detect non-viable pregnancy, progesterone with cut-off < 6.3 ng/mL had sensitivity 73.1%, specificity 99.2% and DOR 322.0 (PPV 0.91, 0.97 and 0.99 at prevalences 0.1, 0.25, 0.5, respectively, indicating higher likelihood of non-viable pregnancy), and cut-off category 20-25 ng/mL had sensitivity 91.3%, specificity 75% and DOR 31.4 (NPV 0.99, 0.96 and 0.89 at the prevalences above indicating higher likelihood of viable pregnancy). Conclusion A single progesterone level provides a clinically useful prognostic information on pregnancy viability. More than nine out of ten patients with a level < 6.3 ng/mL (< 20.034 nmol/L) will be diagnosed with a non-viable pregnancy, and more than 90% of patients with a level ≥ 20-25 ng/mL (63.6-79.5 nmol/L) will have a viable pregnancy confirmed.
Introduction: Approximately 15 years ago cell phones replaced portable VHF radios as the means of communication between paramedics and base hospital physicians. Cellphones, like VHF radio, do not allow voice transmission and reception to occur simultaneously. Radio use requires a learned technique to signal the end of each speaker's turn talking. These techniques are not used in normal cellphone conversation. Poor cellphone reception and poor technique result in breakdowns in communication. The literature about paramedic-physician telecommunication is almost nonexistent. There is an extensive literature in other industries, such as aviation, concerning problems in radio communication. This literature predicts that communication breakdowns are common and have critical consequences. We sought to determine how frequently problems attributable to cell phone technology arose in paramedic-physician communication. Methods: We conducted a retrospective analysis of all patch calls between physicians and paramedics from 4 municipal paramedic services from January 01-December 31, 2014. MP3 audio files, recorded during normal operating procedures by the Central Ambulance Communication Centre, were anonymized and transcribed. Transcripts were read multiple times by the authors and analyzed using mixed methods-qualitative thematic framework analysis and quantitative descriptive statistics. Results: 161 calls were identified. 155 tapes were usable for analysis. 127 (81.9%) patches involved termination of resuscitation orders, 28 (19.1%) were for advice or other orders. The data set consisted of 567 pages of transcripts. Communication problems were identified in 138 (89.0%) patches. Most had multiple problems. Technical problems included disconnections (13.5%), or difficulty hearing (56.8%)-indicated by phrases such as "what?", "I can't hear you". Disorganized cell phone technique was common-individuals interrupted each other (34.2%), and talked simultaneously (54.8%). Signalling the end of "talk turns"-using terms such as "10-4" or "over"-was never used. Introduction: Frailty is associated with functional decline and physiological impairments in seniors with minor injuries. Serum biomarkers have also been suggested as potential markers of these impairments in clinical studies. However, no study has addressed the usefulness of serum biomarkers among pre-frail seniors consulting emergency departments (ED) in order to detect these impairments. Objectives: The purpose of the present study was to explore the association between several serum biomarkers and the frailty status of seniors seen in ED for a minor injury who are at risk of functional decline and 2) assist professionals in clinical decisions while identifying frail seniors in whom interventions should be started in order to prevent potential functional decline. Methods: This cross-sectional study includes 190 seniors retrieved from the larger CETI cohort and discharged home from 4 EDs after treatment of minor injuries. Their frailty status was measured by the Canadian Stu...
Spontaneous bacterial peritonitis is a common complication of cirrhosis with high risk of deathBacterial infection of ascites fluid, most commonly from Escherichia coli or Klebsiella pneumoniae, causes the condition. 1 Its prevalence in patients with cirrhosis is 10.8% in North America, and nearly 25% of patients die despite appropriate antibiotic treatment. 2 2 The presentation varies and patients may not have abdominal pain or fever Spontaneous bacterial peritonitis is often a trigger for cirrhotic decompensation, which can manifest as isolated hepatic encephalopathy, gastro intestinal bleeding, renal failure, increasing ascites volume or any vital sign abnormalities, including hypothermia. 1,3 Given its highly variable presentation, the current guideline recommends that every patient who presents urgently to hospital with cirrhosis and ascites be tested for the condition. 1 3 Prompt diagnosis is required to reduce risk of death A paracentesis that shows ascites fluid with a polymorphonuclear leukocyte count of 250 cells/mm 3 (0.25 × 10 9 /L) or greater confirms the diagnosis. In 1 study, delaying paracentesis by 12 hours resulted in a 2.7-fold increase in odds of death. Clinicians should perform paracentesis as soon as possible. 4 Empiric antibiotic treatment requires consideration of local resistance patternsIn North America, antibiotic resistance in spontaneous bacterial peritonitis is 17.8%, with methicillin-resistant Staphylococcus aureus the most common resistant organism. 2 Empiric treatment in low-resistance areas is a third-generation cephalosporin, and in high-resistance areas is piperacillin-tazobactam. 1 5 Clinicians should prescribe albumin within 6 hours of diagnosis to confer a mortality benefit Albumin has a number needed to treat of 6 patients to prevent 1 death, and of 4 patients to prevent 1 case of renal failure, if given within 6 hours of diagnosis of spontanous bacterial peritonitis. 5 The latest guideline recommends that, in addition to fluid resuscitation, albumin be given to all patients with the condition. 1 Recommended dosing is albumin 1.5 g/kg on day 1 and 1 g/kg on day 3. 1
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.