Plasma Glycated Hemoglobin A1c Could Predict 30-Day All-cause Mortality of Intensive Care Unit Patients with Hyperglycemia.

Background: An increased serum glucose level is a common finding among patients admitted to hospital with acute illness, including the intensive care unit (ICU), even without a history of previous diabetes mellitus (DM). Glycated hemoglobin (HbA1c) is not only a diagnostic tool for DM but may also has prognostic value for diabetic and non-diabetic populations.

Objectives: To assess the relationship between HbA1c level on admission and clinical outcome among patients admitted to the ICU due to cardiopulmonary disorders with hyperglycemia.

Spotted Fever Group Rickettsioses in Israel, 2010-2019.

In a multicenter, nationwide, retrospective study of patients hospitalized with spotted fever group rickettsiosis in Israel during 2010-2019, we identified 42 cases, of which 36 were autochthonous. The most prevalent species was the Rickettsia conorii Israeli tick typhus strain (n = 33, 79%); infection with this species necessitated intensive care for 52% of patients and was associated with a 30% fatality rate. A history of tick bite was rare, found for only 5% of patients; eschar was found in 12%; and leukocytosis was more common than leukopenia.

Consecutive Measures of CRP Correlate with Length of Hospital Stay in Patients with Community-Acquired Pneumonia.

Background: Accurate diagnosis of community acquired pneumonia (CAP) is crucial to its proper management and to combating antibiotic resistance. Levels of C-reactive protein (CRP) have been shown to distinguish pneumonia from other pathological conditions and can be used to control the severity of infection during admission.

Objectives: To investigate an association between consecutive measurements of CRP and the severity of CAP in hospitalized patients.

[SURVIVAL OF PATIENTS WITH WORSENING CHRONIC OBSTRUCTIVE PULMONARY DISEASE].

Background: Chronic Obstructive Pulmonary Disease (COPD), a common disease worldwide, refers to two frequently coexisting lung diseases, chronic bronchitis and emphysema. Physiologically, COPD represents a disruption in ventilation and in the exchange of gases in the lungs. A sharp worsening obstructive pulmonary disease with respiratory acidosis leads to repeated hospitalizations and high mortality rates.

Switching therapy to bedtime for uncontrolled hypertension with a nondipping pattern: a prospective randomized-controlled study.

Objective: Uncontrolled hypertension is present in most patients treated with only a single morning dose or fixed dose drug combination; usually a third of them have a high prevalence of a nondipper blood pressure pattern, especially patients with chronic illness. In most cases, nondipping is related partly to the absence of 24-h therapeutic coverage of the single morning doses. We have investigated the usefulness of shifting therapy to evening instead of the morning.

Hypophosphatemia as a prognostic value in acute exacerbation of COPD.

Background: Phosphorus (P) is an essential element in all living cells, it is extremely important in the process of production of adenosine triphosphate, main element in the structure of nucleic acids. Low levels of phosphorus in blood is very rare, however, it may be caused by unbalance between components participating in phosphorus cycle and affect performances of several systems. A low level of phosphorus in the blood increases the exacerbation and the severity of chronic obstructive pulmonary disease (COPD) and requires prolonged ventilation process.

Impact of serum C-reactive protein measurements in the first 2 days on the 30-day mortality in hospitalized patients with severe community-acquired pneumonia: a cohort study.

Introduction: The purpose of the study is to evaluate the impact of daily consecutive measurements of C-reactive protein (CRP) in the initial 2 days of hospitalization on the 30-day all-cause mortality in patients with severe community-acquired pneumonia (CAP).

Methods: We used 4 different thresholds of fractional decrease (FD) in CRP at the second day of admission (CRP2) of 25%, 30%, 40%, and 60%. In addition, we studied the association of each of these thresholds with the 30-day all-cause mortality.

Posterior mediastinal goiters: Report of two cases and literature review.

Intrathoracic goiters represent substantial enlargement and descent of cervical thyroid tissue into the thoracic cavity, usually in the anterior mediastinum. Rarely, they extend posteriorly, causing obstructive symptoms, sometimes with acute onset. Posterior mediastinal goiters should be differentiated from other mediastinal masses by appropriate work-up, while computed tomography is the most valuable technique.

Optimal time needed for withdrawal of mechanical ventilation in patients with chronic obstructive pulmonary disease.

Background: Exacerbations of chronic obstructive pulmonary disease (COPD) are a major problem worldwide and are usually the main indication for mechanical ventilation (MV), especially in the intensive care unit (ICU). The rate of weaning failure is also high and prolonged MV leads to complications of intubation. The goal is to wean these patients as soon as possible.

Usefulness of various inflammatory markers to differentiate pulmonary edema from pneumonia.

Background: Community-acquired pneumonia requiring hospitalization is a severe illness with high mortality, especially if the appropriate treatment is delayed. Sometimes diagnosis is difficult due to an equivocal clinical picture or chest film, or to accompanying diseases that mask or simulate pneumonia.

Objectives: To assess the usefulness of certain inflammatory markers in differentiating pulmonary edema from pneumonia throughout the hospital stay in patients admitted for pneumonia or pulmonary edema of non-infectious origin and to monitor the response to treatment.

[Fat embolism syndrome following injuries and limb fractures].

Fat embolism syndrome is a clinical entity characterized by varying degrees of cerebral dysfunction, pulmonary changes and petechial rash that usually develop within 24-48 hours in a small percentage of victims after trauma and Long bone fractures. Deterioration can occur within a few hours Leading to unconsciousness or acute respiratory insufficiency, similar to adult respiratory distress syndrome (ARDS). The pathophysiology is still not clearly understood and there are two theories--the mechanical and biochemical cascade of events.

Red blood cell transfusions--are we narrowing the evidence-practice gap? An observational study in 5 Israeli intensive care units.

Purpose: The aim of the study was to document transfusion practices in a cross section of general intensive care units (ICUs) in Israel and to determine whether current guidelines are being applied.

Materials And Methods: This prospective study was performed in 5 general ICUs in Israel over a 3-month period. Red cell transfusion data collected on consecutive patients included the trigger, units transfused per transfusion event, and indications, categorized either to treat a specified condition for which transfusions may be beneficial (acute hemorrhage, acute myocardial ischemia, or severe sepsis) or to treat a low hemoglobin concentration.

[Weaning of COPD patients from mechanical ventilation].

Background: Chronic Obstructive Pulmonary Disease (COPD), a common disease worldwide, refers to two frequently coexisting lung diseases, chronic bronchitis and emphysema. Physiologically, COPD represents a disruption in ventilation and in the exchange of gases in the lungs. Laboratory tests indicate elevated CO2 level, gradual reduction of the levels of oxygen and pH in arterial blood and elevated PeCO2.

Can dead space fraction predict the length of mechanical ventilation in exacerbated COPD patients?

Background: Chronic obstructive pulmonary disease (COPD) is a condition in which there is limited airflow during expiration (exhaling, or breathing out) that is not fully reversible and usually worsens over time. The disease is estimated to kill more than 100,000 Americans each year, and costs related to care of patients with COPD are significant. Physiologically, COPD represents a disruption in ventilation and in the exchange of gases in the lungs.

Pneumomediastinum as a presenting symptom of perforated sigmoid cancer: a case report.

We report a rare case of spontaneous pneumomediastinum due to perforation of sigmoid cancer in a patient suffering from Vogt-Koyanagi-Harada syndrome and temporal arteritis, two rare diseases. This patient, who generally receives corticosteroid and methotrexate therapy, was admitted to hospital with vague abdominal and left flank pain, urinary disorders and low grade fever one day prior to admission. Initial evaluation including X-ray and laboratory tests was normal.

High blood pressure response to stress ergometry could predict future hypertension.

Background: Previous studies have shown that exaggerated blood pressure (BP) during exercise is a valid risk predictor for future hypertension in most men and women, yet the use of ergometry as a means of early detection of incipient hypertension still requires confirmation.

Objectives: To assess the clinical utility of exercise BP measurement for the evaluation of risk for developing new-onset hypertension.

Methods: Thirty individuals with normal BP were enrolled in this study and were subsequently divided into two groups: 13 persons with in-exercise hypertension were compared with 17 matched persons who were normotensive during ergometry.

[The effect of dead space fraction on weaning from mechanical ventilation in COPD patients].

Background: Chronic Obstructive Pulmonary Disease (COPD) is a common disease that tends to occur worldwide. Physiologically, COPD represents a disruption in ventilation and in the exchange of gases in the lungs. Laboratory tests indicate elevated CO2 level, gradual reduction of the levels of oxygen and pH in arterial blood, and a consequent rise in the Dead Space Fraction (DSF) of the lungs.

Insulin therapy of hyperglycemia in intensive care.

Background: Hyperglycemia is common among patients admitted to intensive care units, and carries the risk for complications and prolonged ICU stay. With intensive insulin control of blood glucose, morbidity and mortality can be reduced.

Objectives: To determine whether intensive or conventional insulin control of blood glucose in hyperglycemic ICU patients correlated with the prognosis.

[Severe hypercapnia in asthmatic attack].

This is an unusual case, of an adult man who was hospitalized with a severe asthmatic attack and severe hypercapnia, refractory to intensive medical treatment, which responded to pressure mechanical ventilation. We advise to consider this mode of treatment in similar cases.

[Levels of fibrinogen compared to crp in plasma as new marker in diagnosis of pulmonary edema of non septic origin].

Introduction: Community-acquired pneumonia, that requires hospitalization, is a severe illness with high mortality rates, especially in cases of delay of appropriate treatment. At times, the correct diagnosis of the disease is difficult due to equivocal clinical picture or chest film, accompanying diseases that could mask or simulate the pneumonia.

The Aims Of Our Study Were: 1.

Severe hypercalcemia as a presenting sign of systemic lupus erythematosus.

The association of hypercalcemia and systemic lupus erythematosus is quite uncommon, with only three cases having been reported in the literature. We present a case in which this association is highlighted and demonstrate the presumed mechanism of high calcium level and the usefulness of early diagnosis and aggressive treatment.

Fatal venous thromboembolism associated with antipsychotic therapy.

Objective: To describe the occurrence of pulmonary embolism (PE) as a rare adverse effect of clozapine that is treatable, but sometimes fatal, and survey the literature on the subject in the hope of increasing awareness of the potential danger that may result from drug interactions.

Case Summary: A 47-year-old woman treated with clozapine and paroxetine was admitted to the hospital with dyspnea and swelling of the leg. The patient was diagnosed as having PE and was treated with intravenous heparin.