The seemingly inexorable spread of antibiotic resistance genes among microbial pathogens now threatens the long-term viability of our current antimicrobial therapy to treat severe bacterial infections such as sepsis. Antibiotic resistance is reaching a crisis situation in some bacterial pathogens where few therapeutic alternatives remain and pan-resistant strains are becoming more prevalent. Non-antibiotic therapies to treat bacterial infections are now under serious consideration and one possible option is the therapeutic use of specific phage particles that target bacterial pathogens. Bacteriophage therapy has essentially been re-discovered by modern medicine after widespread use of phage therapy in the pre-antibiotic era lost favor, at least in Western countries, after the introduction of antibiotics. We review the current therapeutic rationale and clinical experience with phage therapy as a treatment for invasive bacterial infection as novel alternative to antimicrobial chemotherapy.
Background: Cardiogenic shock (CS) is associated with high mortality. We report on a "Shock Team" approach of combined interdisciplinary expertise for decision making, expedited assessment, and treatment. Methods: We reviewed 100 patients admitted in CS over 52 months. Patients managed under a Code Shock Team protocol (n ¼ 64, treatment) from 2016 to 2019 were compared with standard care (n ¼ 36, control) from 2015 to 2016. The cohort was predominantly male (78% treatment, 67% control) with a median age of 55 years (interquartile range [IQR], 43-64) for treatment vs 64 years (IQR, 48-69) for control (P ¼ 0.01). New heart failure was more common in the treatment group: 61% vs 36%, P ¼ 0.02. Acute myocardial infarction comprised 13% of patients in CS. There were no significant differences between treatment and control in markers of clinical acuity, including median left ventricular ejection fraction (18% vs 20%), prevalence of R ESUM E Contexte : Le choc cardiog enique (CC) est associ e à une mortalit e elev ee. Nous d ecrivons une approche où la prise de d ecision, l' evaluation rapide des cas et le traitement sont confi es à une « equipe de choc » interdisciplinaire. M ethodologie : Nous avons examin e les cas de 100 patients hospitalis es en raison d'un CC sur une p eriode de 52 mois. Les patients pris en charge par une equipe interdisciplinaire selon un protocole d'intervention d eclench e par un code-choc (n ¼ 64, groupe trait e) de 2016 à 2019 ont et e compar es à des patients ayant reçu des soins courants (n ¼ 36, groupe t emoin) de 2015 à 2016. Les patients de la cohorte etaient majoritairement de sexe masculin (78 % dans le groupe trait e, 67 % dans le groupe t emoin) et l'âge m edian etait de 55 ans (intervalle interquartile [IIQ]: 43-64) au sein du groupe trait e par rapport à 64 ans (IIQ : 48-69) au sein du groupe t emoin (p ¼ 0,01). Les nou-Cardiogenic shock (CS) is defined as a low cardiac output state with end-organ hypoperfusion. 1 The etiology is broad and includes acute myocardial infarction (AMI), acute decompensated heart failure (ADHF) of preexisting cardiomyopathy, fulminant myocarditis, and tachyarrhythmia. 1 Clinical presentation is variable ranging from rapid hemodynamic deterioration over hours to a more insidious onset over days. Heterogeneity of etiology, presentation, and clinical trajectory have contributed to difficulties standardizing definitions for diagnosis, leading to delayed recognition, management variability, and uncertain optimal practice. Consequently, despite medical advances, clinical outcomes in CS remain poor with up to 50% in-hospital mortality reported in most series. 2,3 An increasing number of institutions are adopting a multidisciplinary team-based strategy for CS and have shown feasibility associated with improved outcomes. [4][5][6][7] In 2016, a Code Shock Team approach was implemented at our institution, which uses an emergent "Code" activation similar to other high-acuity, time-sensitive conditions such as ST-elevation myocardial infarction, cardiac arrest, and...
IMPORTANCEComatose survivors of out-of-hospital cardiac arrest experience high rates of death and severe neurologic injury. Current guidelines recommend targeted temperature management at 32 °C to 36 °C for 24 hours. However, small studies suggest a potential benefit of targeting lower body temperatures.OBJECTIVE To determine whether moderate hypothermia (31 °C), compared with mild hypothermia (34 °C), improves clinical outcomes in comatose survivors of out-of-hospital cardiac arrest.DESIGN, SETTING, AND PARTICIPANTS Single-center, double-blind, randomized, clinical superiority trial carried out in a tertiary cardiac care center in eastern Ontario, Canada. A total of 389 patients with out-of-hospital cardiac arrest were enrolled between
Background. Tako-tsubo syndrome (TTS) refers to the apical ballooning of the left ventricle observed when angiographic ventriculography is performed in patients presenting with electrocardiographic changes suggestive of acute coronary syndrome (new transient ST-segment deviation (>0.05 mV) or T-wave inversion (>0.2 mV)), mild elevation of cardiac markers, but normal coronary arteries at the angiogram. Case report. A 54-year-old woman developed the characteristic features of TTS 44 hours following nortriptyline overdose. The admission ECG showed increased QRS duration rapidly reversible after sodium bicarbonate infusion. There was a minimal increase in troponin I level. The ECG performed at the time of chest pain revealed deeply negative T waves in leads I, II, III, aVF, V1 to V6 and remained abnormal at 5 weeks follow-up. In contrast, a complete recovery of left ventricular function was observed within one week. Discussion. The pathophysiology of TTS, a variant of myocardial stunning, is still incompletely understood but could be related to sympathetic overstimulation. The possibility of TTS following toxic exposure is discussed.
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