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1.
BMJ Case Rep ; 14(1)2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33514619

RESUMO

We report the case of a 43-year-old man, suffering from ankylosing spondylitis and treated with Infliximab 5 mg/kg every 2 months, with an excellent disease control. During a follow-up consultation, an incipient renal insufficiency is detected. A urine analysis showed haematuria and proteinuria and a renal puncture-biopsy revealed an image of IgA nephropathy.Several cases of IgA nephropathy have been reported in the literature associated with ankylosing spondylitis. Some of them occur in patients treated with antitumour necrosis factor, but it is unclear whether this pathology is caused by the treatment or whether treatment failed to prevent its occurrence.Our clinical case highlights the importance of regular monitoring of renal function in patients with ankylosing spondylitis, as well as urinary spotting.The question of whether the disease itself, the treatment or other factors such as immune dysregulation could be held responsible for kidney disease will be addressed in the discussion.


Assuntos
Antirreumáticos/uso terapêutico , Glomerulonefrite por IGA/patologia , Infliximab/uso terapêutico , Espondilite Anquilosante/complicações , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Antirreumáticos/administração & dosagem , Biópsia , Glomerulonefrite por IGA/diagnóstico , Glomerulonefrite por IGA/urina , Hematúria/diagnóstico , Humanos , Infliximab/administração & dosagem , Rim/patologia , Testes de Função Renal/normas , Masculino , Monitorização Fisiológica/normas , Proteinúria/diagnóstico , Remissão Espontânea , Espondilite Anquilosante/tratamento farmacológico
2.
Medicine (Baltimore) ; 100(1): e23790, 2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33429740

RESUMO

ABSTRACT: Lactic acidosis is one of the most fatal adverse effects of linezolid, an antibiotic used to treat serious infections caused by antibiotic-resistant bacteria. However, the measures to prevent lactic acidosis have not been well established.We performed a retrospective study to analyze the impact of applying a serum lactate monitoring recommendation policy in patients treated with linezolid.Since September 2011, we have recommended inpatient monitoring of serum lactate levels in patients treated with linezolid at our hospital. Patients were divided into two groups according to whether they were seen during the non-recommendation or recommendation periods. The frequency of serum lactate monitoring, linezolid-induced lactatemia, lactic acidosis, critical illness, and death were compared between the two periods.After September 2011, adherence to the recommendation to monitor serum lactate increased from 6.1% to 60.1%. No difference was observed in the incidence of linezolid-induced lactatemia and lactic acidosis between the two periods. However, there was a significant difference in the incidence of linezolid-induced critical illness between the non-recommendation and recommendation periods (3 vs 0 cases, P = .044).In patients treated with linezolid, serum lactate monitoring led to early detection of lactatemia, thus enabling rapid rescue. We recommend regular monitoring of serum lactate in all patients treated with linezolid.


Assuntos
Guias como Assunto/normas , Ácido Láctico/análise , Linezolida/efeitos adversos , Monitorização Fisiológica/normas , Adulto , Idoso , Feminino , Humanos , Incidência , Ácido Láctico/sangue , Linezolida/farmacologia , Linezolida/uso terapêutico , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/métodos , República da Coreia , Estudos Retrospectivos
3.
Rev Mal Respir ; 37(9): 756-765, 2020 Nov.
Artigo em Francês | MEDLINE | ID: mdl-33169687

RESUMO

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality, especially in cases of chronic hypercapnic respiratory failure. Following a prolonged debate, the indication and benefits of noninvasive ventilation (NIV) have been recently established. Although improved ventilation and reduction in hyperinflation appear to underlie the positive effect on NIV in COPD, only a few studies have focused on specific ventilatory algorithms for improving PaCO2. METHODS: The main objective of this study is to analyze the impact of Löwenstein's ventilatory algorithms, supposed to allow a better management of hyperinflation and its consequences on alveolar ventilation and blood gas parameters. This is an interventional study in routine care, prospective, single blind, randomized with cross over. The primary endpoint will be the transcutaneous partial pressure of nocturnal carbon dioxide. Secondary endpoints will be: abnormal respiratory events occurring during nocturnal NIV; the objective quality of sleep via polysomnography; the tolerance of ventilation and the subjective quality of sleep evaluated by auto questionnaires. EXPECTED RESULTS: The results of this study will clarify whether is it necessary to explore more the impact of the ventilatory modes developed by Löwenstein, dedicated to hypercapnic COPD patients, requiring a long-term NIV.


Assuntos
Algoritmos , Hipercapnia/terapia , Ventilação não Invasiva , Doença Pulmonar Obstrutiva Crônica/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Dióxido de Carbono/análise , Dióxido de Carbono/sangue , Estudos Cross-Over , Serviços de Assistência Domiciliar , Humanos , Hipercapnia/complicações , Hipercapnia/patologia , Monitorização Fisiológica/métodos , Monitorização Fisiológica/normas , Ventilação não Invasiva/métodos , Seleção de Pacientes , Polissonografia , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/patologia , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Projetos de Pesquisa , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/patologia , Insuficiência Respiratória/terapia , Tamanho da Amostra , Índice de Gravidade de Doença , Método Simples-Cego , Sono/fisiologia
4.
Medicine (Baltimore) ; 99(40): e22575, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019471

RESUMO

RATIONALE: Giant intra-abdominal liposarcomas weighing over 20 kg often increase the intra-abdominal pressure (IAP), which has severe effects on the cardiovascular and respiratory systems. Abdominal compartment syndrome is defined typically as the combination of a raised IAP of 20 mm Hg or higher and new onset of organ dysfunction or failure. The anesthetic management and perioperative management are very challenging. PATIENTS CONCERNS: We presented 2 patients with rare giant growing liposarcoma of the abdomen, weighing 21 kg and over 35 kg, respectively. Circulatory management was particularly difficult in the first case, while respiratory management and massive blood loss was very challenging in the second one. DIAGNOSIS: With a computed tomography scan and peritoneal-to-abdominal height ratio measurement, preoperatively the risk of developing intra-abdominal hypertension and abdominal compartment syndrome was recognized early in each patient. The inferior vena cava and right atrium of the first patient was compressed and malformed due to the uplifted diaphragm, while there was severe decreased lung volume and increased airway resistance, because of rare giant retroperitoneal liposarcomas in the second case. Histologic examination revealed dedifferentiated liposarcoma in both cases. INTERVENTIONS: Both of the patients underwent resection surgery with multiple monitoring; transesophageal echocardiography monitoring in the first case and pressure-controlled ventilation volume guaranteed mechanical ventilation mode in both cases. OUTCOMES: Intraoperatively and postoperatively no cardiopulmonary complications in both patients. The first patient was discharged without any complications on postoperative day 10, and the second patient underwent another surgery because of anastomotic leakage resulting from bowel resection. LESSONS: Multiple monitorings, in particular transesophageal echocardiography should be considered in patients with increased IAP due to a giant mass, while an appropriate lung protection ventilation strategy is crucial in these patients.


Assuntos
Hipertensão Intra-Abdominal/fisiopatologia , Lipossarcoma/complicações , Lipossarcoma/cirurgia , Neoplasias Retroperitoneais/complicações , Neoplasias Retroperitoneais/cirurgia , Adulto , Assistência ao Convalescente , Resistência das Vias Respiratórias/fisiologia , Fístula Anastomótica/cirurgia , Perda Sanguínea Cirúrgica , Sistema Cardiovascular/fisiopatologia , Ecocardiografia Transesofagiana/métodos , Feminino , Humanos , Cuidados Intraoperatórios/métodos , Cuidados Intraoperatórios/estatística & dados numéricos , Lipossarcoma/diagnóstico por imagem , Lipossarcoma/patologia , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/normas , Respiração Artificial/métodos , Neoplasias Retroperitoneais/diagnóstico por imagem , Neoplasias Retroperitoneais/patologia , Resultado do Tratamento
5.
J Diabetes Sci Technol ; 14(6): 1035-1064, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32985262

RESUMO

This article is the work product of the Continuous Glucose Monitor and Automated Insulin Dosing Systems in the Hospital Consensus Guideline Panel, which was organized by Diabetes Technology Society and met virtually on April 23, 2020. The guideline panel consisted of 24 international experts in the use of continuous glucose monitors (CGMs) and automated insulin dosing (AID) systems representing adult endocrinology, pediatric endocrinology, obstetrics and gynecology, advanced practice nursing, diabetes care and education, clinical chemistry, bioengineering, and product liability law. The panelists reviewed the medical literature pertaining to five topics: (1) continuation of home CGMs after hospitalization, (2) initiation of CGMs in the hospital, (3) continuation of AID systems in the hospital, (4) logistics and hands-on care of hospitalized patients using CGMs and AID systems, and (5) data management of CGMs and AID systems in the hospital. The panelists then developed three types of recommendations for each topic, including clinical practice (to use the technology optimally), research (to improve the safety and effectiveness of the technology), and hospital policies (to build an environment for facilitating use of these devices) for each of the five topics. The panelists voted on 78 proposed recommendations. Based on the panel vote, 77 recommendations were classified as either strong or mild. One recommendation failed to reach consensus. Additional research is needed on CGMs and AID systems in the hospital setting regarding device accuracy, practices for deployment, data management, and achievable outcomes. This guideline is intended to support these technologies for the management of hospitalized patients with diabetes.


Assuntos
Glicemia/análise , Equipamentos e Provisões , Hospitalização , Sistemas de Infusão de Insulina , Insulina/administração & dosagem , Monitorização Fisiológica/instrumentação , Adulto , Glicemia/efeitos dos fármacos , Glicemia/metabolismo , Automonitorização da Glicemia/instrumentação , Automonitorização da Glicemia/métodos , Automonitorização da Glicemia/normas , Criança , Consenso , Infecções por Coronavirus/sangue , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Complicações do Diabetes/sangue , Complicações do Diabetes/epidemiologia , Complicações do Diabetes/terapia , Diabetes Mellitus/sangue , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/terapia , Cálculos da Dosagem de Medicamento , Equipamentos e Provisões/normas , Feminino , Hospitais/normas , Humanos , Sistemas de Infusão de Insulina/normas , Monitorização Fisiológica/métodos , Monitorização Fisiológica/normas , Pandemias , Pneumonia Viral/sangue , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Gravidez
6.
Diabetes Res Clin Pract ; 168: 108379, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32853692
8.
Lancet Child Adolesc Health ; 4(10): 740-749, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32861271

RESUMO

BACKGROUND: Despite the availability of continuous conventional electroencephalography (cEEG), accurate diagnosis of neonatal seizures is challenging in clinical practice. Algorithms for decision support in the recognition of neonatal seizures could improve detection. We aimed to assess the diagnostic accuracy of an automated seizure detection algorithm called Algorithm for Neonatal Seizure Recognition (ANSeR). METHODS: This multicentre, randomised, two-arm, parallel, controlled trial was done in eight neonatal centres across Ireland, the Netherlands, Sweden, and the UK. Neonates with a corrected gestational age between 36 and 44 weeks with, or at significant risk of, seizures requiring EEG monitoring, received cEEG plus ANSeR linked to the EEG monitor displaying a seizure probability trend in real time (algorithm group) or cEEG monitoring alone (non-algorithm group). The primary outcome was diagnostic accuracy (sensitivity, specificity, and false detection rate) of health-care professionals to identify neonates with electrographic seizures and seizure hours with and without the support of the ANSeR algorithm. Neonates with data on the outcome of interest were included in the analysis. This study is registered with ClinicalTrials.gov, NCT02431780. FINDINGS: Between Feb 13, 2015, and Feb 7, 2017, 132 neonates were randomly assigned to the algorithm group and 132 to the non-algorithm group. Six neonates were excluded (four from the algorithm group and two from the non-algorithm group). Electrographic seizures were present in 32 (25·0%) of 128 neonates in the algorithm group and 38 (29·2%) of 130 neonates in the non-algorithm group. For recognition of neonates with electrographic seizures, sensitivity was 81·3% (95% CI 66·7-93·3) in the algorithm group and 89·5% (78·4-97·5) in the non-algorithm group; specificity was 84·4% (95% CI 76·9-91·0) in the algorithm group and 89·1% (82·5-94·7) in the non-algorithm group; and the false detection rate was 36·6% (95% CI 22·7-52·1) in the algorithm group and 22·7% (11·6-35·9) in the non-algorithm group. We identified 659 h in which seizures occurred (seizure hours): 268 h in the algorithm versus 391 h in the non-algorithm group. The percentage of seizure hours correctly identified was higher in the algorithm group than in the non-algorithm group (177 [66·0%; 95% CI 53·8-77·3] of 268 h vs 177 [45·3%; 34·5-58·3] of 391 h; difference 20·8% [3·6-37·1]). No significant differences were seen in the percentage of neonates with seizures given at least one inappropriate antiseizure medication (37·5% [95% CI 25·0 to 56·3] vs 31·6% [21·1 to 47·4]; difference 5·9% [-14·0 to 26·3]). INTERPRETATION: ANSeR, a machine-learning algorithm, is safe and able to accurately detect neonatal seizures. Although the algorithm did not enhance identification of individual neonates with seizures beyond conventional EEG, recognition of seizure hours was improved with use of ANSeR. The benefit might be greater in less experienced centres, but further study is required. FUNDING: Wellcome Trust, Science Foundation Ireland, and Nihon Kohden.


Assuntos
Algoritmos , Eletroencefalografia/métodos , Aprendizado de Máquina/estatística & dados numéricos , Monitorização Fisiológica/métodos , Convulsões/diagnóstico , Eletroencefalografia/normas , Humanos , Lactente , Terapia Intensiva Neonatal , Irlanda , Monitorização Fisiológica/normas , Países Baixos , Convulsões/prevenção & controle , Suécia , Reino Unido
9.
Rev Esp Anestesiol Reanim ; 67(8): 438-445, 2020 10.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32814634

RESUMO

COVID-19 infection also affects obstetric patients. Regular obstetric care has continued despite the pandemic. Case series of obstetric patients have been published. Neuroaxial techniques appear to be safe and it is important to obtain the highest possible rate of success of the blocks before a cesarean section. For this reason, it is recommended that the blocks be carried out by senior anesthesiologists. The protection and safety of professionals is a key point and in case of general anesthesia, so it is also recommended to call to the most expert anesthesiologist. Seriously ill patients should be recognized quickly and early, in order to provide them with the appropriate treatment as soon as possible. Susceptibility to thrombosis makes prophylactic anticoagulation a priority.


Assuntos
Anestesiologistas , Betacoronavirus , Cesárea/normas , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Complicações Infecciosas na Gravidez , Analgesia Epidural/métodos , Analgesia Epidural/normas , Analgesia Obstétrica/normas , Anestesia Geral , Anestesia Obstétrica/normas , Cesárea/métodos , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Infecção Hospitalar/prevenção & controle , Feminino , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Monitorização Fisiológica/métodos , Monitorização Fisiológica/normas , Pandemias/prevenção & controle , Isolamento de Pacientes/normas , Equipamento de Proteção Individual , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Cuidados Pós-Operatórios/métodos , Cuidados Pós-Operatórios/normas , Gravidez , Índice de Gravidade de Doença
10.
Washington; Organización Panamericana de la Salud; Aug. 7, 2020.
Não convencional em Inglês, Espanhol | LILACS, BRISA/RedTESA | ID: biblio-1118290

RESUMO

En este documento se presentan consideraciones técnicas y regulatorias para el uso de oxímetros de pulso como herramienta en el monitoreo clínico de pacientes con COVID-19. Asimismo, se resume la evidencia disponible sobre la eficacia, efectividad y seguridad de los diferentes tipos de oxímetros de pulso, sus limitaciones y recomendaciones de utilización. Está destinado a profesionales de la salud, así como a autoridades sanitarias y demás tomadores de decisiones sobre el uso de tecnologías sanitarias para la atención y cuidado de pacientes con COVID-19.


This document presents technical and regulatory considerations for the use of pulse oximeters as a tool in clinical monitoring of COVID-19 patients. It also summarizes available evidence on the efficacy, effectiveness, and safety of different types of pulse oximeters, their limitations, and recommendations for use. It is intended for health professionals, as well as health authorities and other decision makers responsible for health technologies for the care of COVID-19 patients.


Assuntos
Humanos , Pneumonia Viral/complicações , Oximetria/normas , Infecções por Coronavirus/complicações , Hipóxia/diagnóstico , Hipóxia/virologia , Monitorização Fisiológica/normas
11.
Eur J Endocrinol ; 183(4): D1-D13, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32698136

RESUMO

The literature on an association between acromegaly and cancer is particularly abundant on either colorectal cancer or thyroid cancer, and an endless debate is ongoing whether patients with acromegaly should be submitted to specific oncology screening and surveillance protocols. The aim of the present work is to review the most recent data on the risk of either colorectal cancer or thyroid cancer in acromegaly and discuss the opportunity for specific screening in relation to the accepted procedures in the general population.


Assuntos
Acromegalia/complicações , Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer , Programas de Rastreamento , Monitorização Fisiológica , Neoplasias da Glândula Tireoide/diagnóstico , Acromegalia/diagnóstico , Acromegalia/epidemiologia , Acromegalia/terapia , Adenoma/complicações , Adenoma/diagnóstico , Adenoma/epidemiologia , Adenoma/terapia , Neoplasias Colorretais/complicações , Neoplasias Colorretais/epidemiologia , Detecção Precoce de Câncer/métodos , Detecção Precoce de Câncer/normas , Endocrinologia/métodos , Endocrinologia/normas , Adenoma Hipofisário Secretor de Hormônio do Crescimento/complicações , Adenoma Hipofisário Secretor de Hormônio do Crescimento/diagnóstico , Adenoma Hipofisário Secretor de Hormônio do Crescimento/epidemiologia , Adenoma Hipofisário Secretor de Hormônio do Crescimento/terapia , Humanos , Programas de Rastreamento/métodos , Programas de Rastreamento/normas , Oncologia/métodos , Oncologia/normas , Monitorização Fisiológica/métodos , Monitorização Fisiológica/normas , Vigilância da População/métodos , Guias de Prática Clínica como Assunto/normas , Neoplasias da Glândula Tireoide/complicações , Neoplasias da Glândula Tireoide/epidemiologia
12.
Ann Biol Clin (Paris) ; 78(4): 454-460, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32616472

RESUMO

Blood angiotensin-converting enzyme (ACE) assay is now realized by the determination of enzyme activity on synthetic substrate, mostly furylacryloyl-phenylalanyl-L-glycyl-L-glycine (FAPGG). The matrix can be serum or heparin-plasma, with or without a separator; the assay developed on serum or plasma is not adapted to other matrix such as cerebrospinal fluid where the ACE activity is much lower. This assay has been adapted on a number of automated biochemistry analyzers with the specifications of the supplier of reagents, sometimes with modification of volumes or times for analysis. Samples can be stored at +4̊C for at least for one week, freezing at -20̊C is possible but refreezing is not advised. The assay is linear from 10 to 200 UI/L. Fidelity is excellent after calibration of the assay. Accuracy can be calculated from IQA and EQA results, and the analytical uncertainty is between 2% and 5% in function of the serum ACE value. Usual values will be soon available from studies on age brackets and sex, because ACE activity seems to be more elevated in boys during adolescence. At signature, it is interesting to have medical information on the diagnosis of sarcoidosis or its treatment including ACE inhibitors as a proof of intake; we can give a commentary on elevation of serum ACE activity from other causes than sarcoidosis and the causes for low activities.


Assuntos
Análise Química do Sangue/métodos , Peptidil Dipeptidase A/análise , Peptidil Dipeptidase A/sangue , Biomarcadores/análise , Biomarcadores/sangue , Análise Química do Sangue/normas , Coleta de Amostras Sanguíneas/métodos , Coleta de Amostras Sanguíneas/normas , Granuloma/sangue , Granuloma/diagnóstico , Granuloma/terapia , Humanos , Monitorização Fisiológica/métodos , Monitorização Fisiológica/normas , Fase Pré-Analítica , Reprodutibilidade dos Testes , Sarcoidose/sangue , Sarcoidose/diagnóstico , Sarcoidose/terapia , Sensibilidade e Especificidade , Estudos de Validação como Assunto
13.
Ann Am Thorac Soc ; 17(9): 1040-1046, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32521167

RESUMO

During the ongoing coronavirus disease (COVID-19) pandemic, reports in social media and the lay press indicate that a subset of patients are presenting with severe hypoxemia in the absence of dyspnea, a problem unofficially referred to as "silent hypoxemia." To decrease the risk of complications in such patients, one proposed solution has been to have those diagnosed with COVID-19 but not sick enough to warrant admission monitor their arterial oxygenation by pulse oximetry at home and present for care when they show evidence of hypoxemia. Though the ease of use and low cost of pulse oximetry makes this an attractive option for identifying problems at an early stage, there are important considerations with pulse oximetry about which patients and providers may not be aware that can interfere with successful implementation of such monitoring programs. Only a few independent studies have examined the performance of pocket oximeters and smart phone-based systems, but the limited available data raise questions about their accuracy, particularly as saturation falls below 90%. There are also multiple sources of error in pulse oximetry that must be accounted for, including rapid fluctuations in measurements when the arterial oxygen pressure/tension falls on the steep portion of the dissociation curve, data acquisition problems when pulsatile blood flow is diminished, accuracy in the setting of severe hypoxemia, dyshemoglobinemias, and other problems. Recognition of these issues and careful counseling of patients about the proper means for measuring their oxygen saturation and when to seek assistance can help ensure successful implementation of needed monitoring programs.


Assuntos
Infecções por Coronavirus/diagnóstico , Serviços de Assistência Domiciliar/normas , Monitorização Fisiológica/normas , Oximetria/normas , Pandemias , Pneumonia Viral/diagnóstico , Guias de Prática Clínica como Assunto , Betacoronavirus , Infecções por Coronavirus/sangue , Infecções por Coronavirus/epidemiologia , Humanos , Pneumonia Viral/sangue , Pneumonia Viral/epidemiologia
14.
Diabetes Metab Syndr ; 14(5): 753-756, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32502958

RESUMO

BACKGROUND AND AIMS: The coronavirus disease 2019 (COVID-19) pandemic has immensely strained healthcare systems worldwide. Diabetes has emerged as a major comorbidity in a large proportion of patients infected with COVID-19 and is associated with poor health outcomes. We aim to provide a practical guidance on screening of hyperglycemia in persons without known diabetes in low resource settings. METHODS: We reviewed the available guidelines on this subject and proposed an algorithm based on simple measures of blood glucose (BG) which can be implemented by healthcare workers with lesser expertise in low resource settings. RESULTS: We propose that every hospitalized patient with COVID-19 infection undergo a paired capillary BG assessment (pre-meal and 2-h post-meal). Patients with pre-meal BG < 7.8 mmol/L (140 mg/dL) and post-meal BG < 10.0 mmol/L (180 mg/dL) may not merit further monitoring. On the other hand, those with one or more value above these thresholds should undergo capillary BG monitoring (pre-meals and 2 hours after dinner) for the next 24 hours. When two or more (≥50%) such values are significantly elevated [pre-meal ≥8.3 mmol/L (150 mg/dL) and post-meal ≥11.1 mmol/L (200 mg/dL)], pharmacotherapy should be immediately initiated. On the other hand, in patients with modest elevation of one or more values [pre-meal 7.8-8.3 mmol/L (140-150 mg/dL) and post-meal 10.0-11.1 mmol/L (180-200 mg/dL)], dietary modifications should be initiated and pharmacotherapy considered only if BG control remains suboptimal. CONCLUSION: We highlight strategies for screening of hyperglycemia in persons without known diabetes treated for COVID-19 infection in low resource settings. This guidance may well be applied to other settings in the near future.


Assuntos
Infecções por Coronavirus/complicações , Hospitalização , Hiperglicemia/complicações , Hiperglicemia/diagnóstico , Pneumonia Viral/complicações , Pobreza , Guias de Prática Clínica como Assunto , Betacoronavirus/fisiologia , Glicemia/análise , Infecções por Coronavirus/sangue , Diabetes Mellitus/sangue , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/terapia , Humanos , Hiperglicemia/terapia , Monitorização Fisiológica/economia , Monitorização Fisiológica/métodos , Monitorização Fisiológica/normas , Pandemias , Pneumonia Viral/sangue , Guias de Prática Clínica como Assunto/normas
15.
Ann Biol Clin (Paris) ; 78(4): 433-437, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32576540

RESUMO

Iron deficiency anemia is frequently associated with thrombocytosis. However, in some rare cases of very severe iron deficiency, a thrombocytopenia may occur. This condition may lead to a misdiagnosis of immune thrombocytopenic purpura and thus to unnecessary tests in this context. Here we report two patients who presented with iron deficiency associated thrombocytopenia rapidly corrected after martial supplementation. We then discuss the value of measuring immature platelet fraction (IPF), which represents the population of newly formed platelets containing a greater amount of residual RNA. For both cases, low IPF values at admission indicated a central origin of thrombocytopenia with decreased platelet production, which is the pathophysiological mechanism of iron deficiency associated thrombocytopenia.


Assuntos
Anemia Ferropriva/diagnóstico , Plaquetas/patologia , Monitorização Fisiológica/métodos , Trombocitopenia/diagnóstico , Adolescente , Adulto , Anemia Ferropriva/sangue , Anemia Ferropriva/complicações , Anemia Ferropriva/tratamento farmacológico , Diagnóstico Diferencial , Feminino , Humanos , Ferro/administração & dosagem , Monitorização Fisiológica/normas , Contagem de Plaquetas/normas , Valor Preditivo dos Testes , Trombocitopenia/sangue , Trombocitopenia/complicações , Trombocitopenia/tratamento farmacológico
16.
J Med Internet Res ; 22(6): e19091, 2020 06 19.
Artigo em Inglês | MEDLINE | ID: mdl-32459655

RESUMO

BACKGROUND: Due to demographic change and, more recently, coronavirus disease (COVID-19), the importance of modern intensive care units (ICU) is becoming apparent. One of the key components of an ICU is the continuous monitoring of patients' vital parameters. However, existing advances in informatics, signal processing, or engineering that could alleviate the burden on ICUs have not yet been applied. This could be due to the lack of user involvement in research and development. OBJECTIVE: This study focused on the satisfaction of ICU staff with current patient monitoring and their suggestions for future improvements. We aimed to identify aspects of monitoring that interrupt patient care, display devices for remote monitoring, use cases for artificial intelligence (AI), and whether ICU staff members are willing to improve their digital literacy or contribute to the improvement of patient monitoring. We further aimed to identify differences in the responses of different professional groups. METHODS: This survey study was performed with ICU staff from 4 ICUs of a German university hospital between November 2019 and January 2020. We developed a web-based 36-item survey questionnaire, by analyzing a preceding qualitative interview study with ICU staff, about the clinical requirements of future patient monitoring. Statistical analyses of questionnaire results included median values with their bootstrapped 95% confidence intervals, and chi-square tests to compare the distributions of item responses of the professional groups. RESULTS: In total, 86 of the 270 ICU physicians and nurses completed the survey questionnaire. The majority stated they felt confident using the patient monitoring equipment, but that high rates of false-positive alarms and the many sensor cables interrupted patient care. Regarding future improvements, respondents asked for wireless sensors, a reduction in the number of false-positive alarms, and hospital standard operating procedures for alarm management. Responses to the display devices proposed for remote patient monitoring were divided. Most respondents indicated it would be useful for earlier alerting or when they were responsible for multiple wards. AI for ICUs would be useful for early detection of complications and an increased risk of mortality; in addition, the AI could propose guidelines for therapy and diagnostics. Transparency, interoperability, usability, and staff training were essential to promote the use of AI. The majority wanted to learn more about new technologies for the ICU and required more time for learning. Physicians had fewer reservations than nurses about AI-based intelligent alarm management and using mobile phones for remote monitoring. CONCLUSIONS: This survey study of ICU staff revealed key improvements for patient monitoring in intensive care medicine. Hospital providers and medical device manufacturers should focus on reducing false alarms, implementing hospital alarm standard operating procedures, introducing wireless sensors, preparing for the use of AI, and enhancing the digital literacy of ICU staff. Our results may contribute to the user-centered transfer of digital technologies into practice to alleviate challenges in intensive care medicine. TRIAL REGISTRATION: ClinicalTrials.gov NCT03514173; https://clinicaltrials.gov/ct2/show/NCT03514173.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Cuidados Críticos/métodos , Pesquisas sobre Serviços de Saúde , Unidades de Terapia Intensiva , Monitorização Fisiológica/métodos , Pandemias , Pneumonia Viral , Adulto , Inteligência Artificial , Cuidados Críticos/normas , Feminino , Alemanha , Hospitais Universitários , Humanos , Masculino , Monitorização Fisiológica/normas , Enfermeiras e Enfermeiros , Médicos , Pesquisa Qualitativa
17.
Transfusion ; 60(5): 897-907, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32319687

RESUMO

In the United States, postpartum hemorrhage (PPH) accounts for 4.6% of all maternal deaths and is responsible for major peripartum medical and surgical morbidity. Therefore, a national health priority is to ensure that women who experience severe PPH receive timely, appropriate, and effective treatment. In this article, we describe our system-wide approach for the planning and delivery of women with suspected placenta accreta spectrum disorder, a condition associated with life-threatening blood loss at the time of delivery. We also highlight current evidence related to transfusion decision making and hemostatic monitoring during active postpartum bleeding. Specifically, we describe how we activate and use the massive transfusion protocol to obtain sufficient volumes and types of blood products. We also describe how we use viscoelastic monitoring (thromboelastography) and standard laboratory tests to assess the maternal coagulation profile. Finally, we review the findings of recent studies examining the potential efficacy of tranexamic acid and fibrinogen concentrate as adjuncts for PPH prevention and treatment. We describe how we have incorporated these drugs into PPH treatment protocols at our institution.


Assuntos
Hemorragia Pós-Parto/terapia , Testes de Coagulação Sanguínea , Transfusão de Sangue/métodos , Transfusão de Sangue/normas , Feminino , Hemostáticos/uso terapêutico , Humanos , Monitorização Fisiológica/métodos , Monitorização Fisiológica/normas , Período Pós-Parto , Gravidez , Fatores de Risco , Índice de Gravidade de Doença , Tromboelastografia
18.
Ann Biol Clin (Paris) ; 78(2): 157-173, 2020 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-32319944

RESUMO

The main objective of our study was to carry out a statement of the knowledge and the management of the VKA by the General Practitioners (GPs) of Normandy and to evaluate their experience of the use of DOA with a questionnaire; 471 of the 1951 GPs requested responded. When the INR was stable in a patient affected with atrial fibrillation, the GPs participating dosed it again 4 weeks later, modified the dosage when the INR was below 1.9 or upper 3.2. The risk of stroke was overestimated to 6.2% per year with fluindione and to 31.5% without curative anticoagulation. The mean TTR was overstated to 84%. When the INR was at 4.4, the risk of serious cerebral bleeding was overestimated at 12.4%. 80.26% of the GPs skipped the next dose and 11.25% controlled the INR the day after. So, few GPs used the HAS protocol. After the INR decreased to 3.6, the GPs diminished the dose of 14.62%. 70% of the GPs, responded using only their experience for AVK management. Fluindione was the most to use VKA by 52.7% of them although 24.42% thought it was the most effective. The majority of GPs thought the DOA were a least as effective than the VKA, without being responsible of more bleeding (77.92%) and improved the quality of life of the patients (88.54%). Although the DOA's prescriptions increase, the improvement of the VKA management have to stay a concern for the GPs.


Assuntos
4-Hidroxicumarinas/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Fidelidade a Diretrizes/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Indenos/uso terapêutico , Coeficiente Internacional Normatizado , Médicos de Atenção Primária , Vitamina K/antagonistas & inibidores , Adulto , Fibrilação Atrial/sangue , Coagulação Sanguínea/efeitos dos fármacos , Estudos Transversais , Feminino , França/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/métodos , Monitorização Fisiológica/normas , Médicos de Atenção Primária/normas , Médicos de Atenção Primária/estatística & dados numéricos , Padrões de Prática Médica/normas , Padrões de Prática Médica/estatística & dados numéricos , Inquéritos e Questionários , Vitamina K/uso terapêutico
19.
BMC Health Serv Res ; 20(1): 262, 2020 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-32228583

RESUMO

BACKGROUND: Standard monitoring during anaesthesia is a core element of patient safety and practice of safe anesthesia has reduced morbidity and mortality worldwide. The main objective of this study was to assess the practice of standard monitoring during anaesthesia in the hospitals of North Kivu, so as to establish a baseline overview of the situation, and orientate plans towards safe anaesthesia in the region. METHODS: This study was a cross-sectional survey of health facilities of the Health Antenna of Butembo in Democratic Republic of Congo and was conducted from October to December 2018. Questionnaires were brought to anaesthesia providers in the health facilities. The study included 1 answer from the anaesthesia practitioners who accepted to participate. The practices of standard monitoring in the health facilities were compared to WHO-WSFA guidelines. Data was captured and analyzed with Epi Info 7. RESULTS: Forty out of 90 health facilities (44.4%) of 10 health zones responded on the questionnaire. Twenty-three health facilities (57.5%) were from private sector and 17 (42.5%) from public sector. Sixteen health facilities (40.0%) were from the Butembo health zone. The median number of anaesthesia providers was 2 per health facility. Of all the anaesthesia providers, none were physicians, 47.5% were nurses practicing anaesthesia without any training in anaesthesia and 47.5% were nurse anaesthetists. All the health facilities were providing general anaesthesia whereas spinal anaesthesia was provided in 22 out of 40 centers (55%). Seventy percent (28/40) of the facilities were below standard according to WHO-WSFA guidelines. Only 40% (16/40) were using a pulse oximeter and 10% (4/40) declared that ECG was occasionally used. CONCLUSION: The practice of standard monitoring is poor in health facilities of the Health Antenna of Butembo. Efforts should be made to improve monitoring which is a key element of safe anaesthesia.


Assuntos
Anestesia , Monitorização Fisiológica/normas , Centros de Cuidados de Saúde Secundários , Adulto , Congo , Estudos Transversais , Pesquisas sobre Serviços de Saúde , Humanos , Monitorização Fisiológica/métodos , Registros
20.
Crit Care ; 24(1): 100, 2020 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-32204723

RESUMO

This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2020. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2020. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.


Assuntos
Monitorização Fisiológica/instrumentação , Distúrbios Pupilares/diagnóstico , Encéfalo/diagnóstico por imagem , Estado Terminal/terapia , Medicina de Emergência/instrumentação , Medicina de Emergência/métodos , Humanos , Monitorização Fisiológica/métodos , Monitorização Fisiológica/normas , Manejo da Dor/instrumentação , Medição da Dor/instrumentação , Medição da Dor/métodos , Distúrbios Pupilares/fisiopatologia , Ultrassonografia Doppler Transcraniana/métodos
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