Clinical epidemiology and high genetic diversity amongst Cryptococcus spp. isolates infecting people living with HIV in Kinshasa, Democratic Republic of Congo.

Neuromeningeal cryptococcosis (NMC) is a life-threatening opportunistic infection in advanced HIV disease patients (AHDP). It is caused by Cryptococcus spp. complexes and mainly occurs in sub-Saharan Africa.

Confirmed 6-Month Disability Improvement and Worsening Correlate with Long-term Disability Outcomes in Alemtuzumab-Treated Patients with Multiple Sclerosis: Post Hoc Analysis of the CARE-MS Studies.

Introduction: In the 2-year CARE-MS trials (NCT00530348; NCT00548405) in patients with relapsing-remitting multiple sclerosis, alemtuzumab showed superior efficacy versus subcutaneous interferon beta-1a. Efficacy was maintained in two consecutive extensions (NCT00930553; NCT02255656). This post hoc analysis compared disability outcomes over 9 years among alemtuzumab-treated patients according to whether they experienced confirmed disability improvement (CDI) or worsening (CDW) or neither CDI nor CDW.

Development and implementation of an end-of-shift clinical debriefing method for emergency departments during COVID-19.

Background: Multiple guidelines recommend debriefing after clinical events in the emergency department (ED) to improve performance, but their implementation has been limited. We aimed to start a clinical debriefing program to identify opportunities to address teamwork and patient safety during the COVID-19 pandemic.

Methods: We reviewed existing literature on best-practice guidelines to answer key clinical debriefing program design questions.

Efficacy of a Short Role-Play Training on Breaking Bad News in the Emergency Department.

Introduction: Breaking bad news (BBN) in the emergency department (ED) represents a challenging and stressful situation for physicians. Many medical students and residents feel stressed and uncomfortable with such situations because of insufficient training. Our randomized controlled study aimed to assess the efficacy of a four-hour BBN simulation-based training on perceived self-efficacy, the BBN process, and communication skills.

Fatigue-related risk perception among emergency physicians working extended shifts.

There is a growing body of studies indicating that extended shift duration has an adverse effect on fatigue, consequently leading to reduced work performance and higher risk of accident. Following modern fatigue risk management systems (FRMS), acceptable performance could be maintained by the mobilization of appropriate mitigation strategies. However, the effective deployment of such strategies assume that workers are able to assess their own level of fatigue-related impairments.

Fatigue-related risk management in the emergency department: a focus-group study.

Fatigue has major implications on both patient safety and healthcare practitioner's well-being. Traditionally, two approaches can be used to reduce fatigue-related risk: reducing the likelihood of a fatigued operator working (i.e.

Preseason Strength Assessment of the Rotator Muscles and Shoulder Injury in Handball Players.

Context:   Few researchers have identified intrinsic risk factors for shoulder injury in team handball players by analyzing measurements of maximal isokinetic rotator muscle strength.

Objective:   To identify possible intrinsic risk factors for shoulder injury by analyzing measurements of maximal isokinetic rotator muscle strength.

Design:   Cross-sectional study.

MicroRNAs and Inflammation in Colorectal Cancer.

Colorectal cancers (CRC) are known to be related to inflammatory conditions, and inflammatory bowel diseases increase the relative risk for developing CRC. The use of anti-inflammatory drugs prevents the development of colorectal cancer.Several molecular mediators are connecting the pathways that are involved in inflammatory conditions and in carcinogenesis.

Fully automated electrophoretically mediated microanalysis for CYP1A1 activity monitoring optimized by multivariate approach.

In this study, a fully automated incapillary system was developed to monitor the activity of CYP1A1 (Cytochrome P450, family 1, subfamily A, polypeptide 1) in physiological conditions. Ethoxycoumarin, the selected substrate, undergoes an inline bioreaction in the presence of CYP1A1 supersomes and Nicotinamide adenine dinucleotide phosphate reduced as cofactor, giving rise to hydroxycoumarin, the product that was assayed. The optimization of the experimental conditions was supported by the application of a design of experiment, providing a better understanding of electrophoretic mixing parameters that influence the metabolic reactions.

Quality of work life, burnout, and stress in emergency department physicians: a qualitative review.

A 2006 literature review reported that emergency department (ED) physicians showed elevated burnout levels and highlighted several environment and personal issues contributing toward burnout. Research on burnout in EDs is limited. We propose an updated qualitative review on the relationships between work stress, burnout, and quality of work life in ED physicians.

Procalcitonin for antibiotic treatment in intensive care unit patients.

Procalcitonin (PCT), a 116-aminoacids prohormone, has been substantially studied over the last 2 decades in the field of sepsis. Disappointingly low sensitivity values led to the abandonment of the concept of it as a diagnostic tool and then to its being considered more as a prognostic marker with a good correlation with severe infection. Later on, growing concerns about multidrug-resistant bacteria in the ICU environment and about the cost and side effects of antibiotics suggested that PCT might prove to be a valuable asset in stewardship programs.

Measuring end expiratory lung volume after cardiac surgery.

Background: The aim of this study was to evaluate the interest of end expiratory volume (EELV) measurement after cardiac surgery.

Methods: After stabilization, four EELV measurements were performed at one hour intervals during three hours using the nitrogen washout technique. EELV was compared to the predicted functional residual capacity (FRC) volume.

Endovascular repair of the left subclavian artery after gunshot wound: an alternative to surgical treatment.

Penetrating injuries of the subclavian artery are associated with a high morbidity and mortality rate. Endovascular treatment with covered stents (stent grafts) has emerged as an effective alternative to surgery, but this new technique is not exempt from complications. We report the case of a male gunshot victim, treated by a covered stent for haemorrhagic shock due to partial subclavian rupture.

Persistent hypocoagulability in patients with septic shock predicts greater hospital mortality: impact of impaired thrombin generation.

Purpose: Sepsis induces hypercoagulability, hypofibrinolysis, microthrombosis, and endothelial dysfunction leading to multiple organ failure. However, not all studies reported benefit from anticoagulation for patients with severe sepsis, and time courses of coagulation abnormalities in septic shock are poorly documented. Therefore, the aim of this prospective observational cohort study was to describe the coagulation profile of patients with septic shock and to determine whether alterations of the profile are associated with hospital mortality.

Nutrition disorders during acute renal failure and renal replacement therapy.

The physiological and biological modifications related to acute renal failure in critically ill patients, including the current use of continuous renal replacement therapies, have dramatically changed the type and importance of the metabolic and nutrition disturbances observed during treatment of renal failure. This review summarizes the current knowledge and makes recommendations for the daily nutrition management of these patients. The filtration of water-soluble substances of low molecular weight by continuous hemodiafiltration results in significant losses of glucose, amino acids, low-molecular-weight proteins, trace elements, and water-soluble vitamins.

Year in review 2009: Critical Care--metabolism.

Novel insights into the metabolic alterations of critical illness were published in Critical Care in 2009. The association between early hypoglycaemia/high glycemic variability and poor outcome was confirmed. Improvements in the understanding of the pathophysiological mechanisms of stress hyperglycemia and potential progress in the bedside management of glucose control were presented.

Fibromyalgia and related conditions: electromyogram profile during isometric muscle contraction.

Objectives: To evaluate electromyogram (EMG) profiles in patients with three related conditions: fibromyalgia, chronic fatigue syndrome, and depression.

Methods: We studied 44 healthy volunteers, 22 patients with fibromyalgia, 11 patients with chronic fatigue syndrome, and 10 patients admitted for depression. The trapezius electromyogram was recorded during maximally sustained, bilateral, 90 degrees abduction of the shoulders.

Which factors influence glycemic control in the intensive care unit?

Purpose Of Review: Intensive insulin therapy titrated to restore and maintain blood glucose between 80 and 110 mg/dl (4.4-6.1 mmol/l) was found to improve survival of critically ill patients in one pioneering proof-of-concept study performed in a surgical intensive care unit.

Year in review 2008: Critical Care--metabolism.

In 2008, the interest in metabolic and endocrine issues and their consequences in critically ill patients was high. A large proportion of the research papers related to these issues was related to the metabolism of glucose and its control and to the changes in body composition, including muscular weakness. In Critical Care, original reports from investigations of glucose physiology and clinical data from observational and interventional studies were published.

Current status of tight blood sugar control.

This review describes the current status and the clinical data related to the effects of tight glucose control in critically ill patients. In contrast to decreases in mortality and morbidity reported in one study in which insulin rate was titrated to keep blood glucose between 80 and 110 mg/dL, the benefits were not confirmed in multicenter prospective studies. Retrospective data found an association between a mean blood glucose level below 140 to 150 mg/dL and improved outcome.