Diabetic ketoacidosis is an emergency medical condition that can be life-threatening if not treated properly. The incidence of this condition may be increasing, and a 1 to 2 percent mortality rate has stubbornly persisted since the 1970s. Diabetic ketoacidosis occurs most often in patients with type 1 diabetes (formerly called insulin-dependent diabetes mellitus); however, its occurrence in patients with type 2 diabetes (formerly called non-insulin-dependent diabetes mellitus), particularly obese black patients, is not as rare as was once thought. The management of patients with diabetic ketoacidosis includes obtaining a thorough but rapid history and performing a physical examination in an attempt to identify possible precipitating factors. The major treatment of this condition is initial rehydration (using isotonic saline) with subsequent potassium replacement and low-dose insulin therapy. The use of bicarbonate is not recommended in most patients. Cerebral edema, one of the most dire complications of diabetic ketoacidosis, occurs more commonly in children and adolescents than in adults. Continuous follow-up of patients using treatment algorithms and flow sheets can help to minimize adverse outcomes. Preventive measures include patient education and instructions for the patient to contact the physician early during an illness. (+info)
Diagnosis of stridor in children.
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Stridor is a sign of upper airway obstruction. In children, laryngomalacia is the most common cause of chronic stridor, while croup is the most common cause of acute stridor. Generally, an inspiratory stridor suggests airway obstruction above the glottis while an expiratory stridor is indicative of obstruction in the lower trachea. A biphasic stridor suggests a glottic or subglottic lesion. Laryngeal lesions often result in voice changes. A child with extrinsic airway obstruction usually hyperextends the neck. The airway should be established immediately in children with severe respiratory distress. Treatment of stridor should be directed at the underlying cause. (+info)
Triggers and circadian distribution of the onset of acute aortic dissection.
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The purpose of this study was to clarify the activities that trigger the onset of acute aortic dissection (AAD) and their relation to the occurrence of AAD. The study group comprised 444 consecutive patients referred for spontaneous AAD. From the hospital medical records, the activities that triggered AAD could be identified in 307 of these: most (86.6%) AAD episodes occurred in relation to physical (73.6%) or mental (13%) activities. In the older (> or =61 years) population, AAD occurred significantly more frequent during sleep or rest than in the younger (< or =60 years) population (16.9% vs 7.6%, p=0.020). The relationship between the time of onset and the triggering activity of AAD could be assessed in 267 patients. The onset of AAD was predominantly during the day: 63.3% of the episodes occurred between 06.00h and 18.00h, and were significantly more related to physical or mental activities than the nighttime events (95.3% vs 70.4%, p<0.0001). Most (86.6%) of the AAD episodes were related to physical or mental stress, particularly those that occurred during the day. (+info)
Contrast media triggering cutaneous graft-versus-host disease.
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Adverse reactions to iodinated contrast media are varied and known to develop in patients with asthma and a history of allergy. We describe three successful allogeneic bone marrow transplantation (BMT) patients, who all developed dermal graft-versus-host disease (GVHD) after receiving contrast media. Cutaneous GVHD triggered by contrast media has not been reported to date and has implications for the assessment, monitoring and treatment of patients during the post-transplant period. (+info)
Heart failure in the elderly.
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Heart failure is common in the elderly population. Approximately 6 to 10 percent of the population 65 years or older have heart failure. Heart failure is the most common reason for hospitalization in elderly patients. Etiology of heart failure is often multifactorial in the elderly. The common causes of heart failure include ischemic heart disease, valvular heart disease, hypertensive heart disease, and cardiomyopathy. Exacerbation of heart failure in the elderly is often accompanied by precipitating factors which include arrhythmia, renal failure, anemia, infection, adverse effect of drugs and non-compliance with medication and/or diet. Diagnosis of heart failure may be difficult in the elderly because symptoms of heart failure are often atypical or even absent. Heart failure with preserved systolic function is common in the elderly because aging has a greater impact on diastolic function. It is important to recognize that very old patients with heart failure are underrepresented in clinical trials. (+info)
The role of the intestinal tract as a reservoir and source for transmission of nosocomial pathogens.
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The intestinal tract provides an important reservoir for many nosocomial pathogens, including Enterococcus species, Enterobacteriaciae, Clostridium difficile, and Candida species. These organisms share several common risk factors and often coexist in the intestinal tract. Disruption of normal barriers, such as gastric acidity and the indigenous microflora of the colon, facilitates overgrowth of pathogens. Factors such as fecal incontinence and diarrhea contribute to the subsequent dissemination of pathogens into the health care environment. Selective pressure exerted by antibiotics plays a particularly important role in pathogen colonization, and adverse effects associated with these agents often persist beyond the period of treatment. Infection-control measures that are implemented to control individual pathogens may have a positive or negative impact on efforts to control other pathogens that colonize the intestinal tract. (+info)
Coffee and alcohol consumption as triggering factors for sudden cardiac death: case-crossover study.
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AIM: To estimate the relative risk of triggering sudden cardiac death after coffee or alcohol consumption in out-of-hospital sudden cardiac death victims. METHODS: A case-crossover design with usual frequency approach was used and the study population included persons who died out of hospital due to sudden cardiac death. By mailing 2 questionnaires, 1 to the family members of the deceased and the other to the attending physician, necessary data on the mode of cardiac death, life style, health, and several socio-demographic variables were obtained. Cases were those who died of sudden cardiac death within 1 hour after coffee consumption or within 2 hours after ingesting alcohol; but controls were those who died in the hours when they were not exposed to these stimulans. The relative risk of dying within exposed hours in comparison to non-exposed hours was parameter estimated for each risk factor. RESULTS: Among 309 sudden cardiac death victims who died in the period from January 2000 to March 2001 in Slovenia, there were 253 men and 56 women with median age at death of 57.1 and 57.7, respectively. On average, each of them had 2.8 risk factors for ischemic heart disease, and the estimated relative risk of dying during 1 hour after coffee consumption was 1.73 (95% confidence interval [CI]=1.13-2.65), and within 2 hours after alcohol consumption 3.00 (95%CI=1.61-5.68). Within both coffee drinking and alcohol consuming groups, the relative risk was different among persons with different life style habits. It ranged from 1.50 for the coffee drinkers who had been receiving medication due to risk factors of heart diseases, to 2.63 for former alcohol drinkers. Among alcohol consumers it varied from 2.66 among those who were performing less than 104 hours of physical activity of six metabolic equivalents at least, to 52.15 among those of 90 heart beats or more per minute. CONCLUSION: Our research confirmed the hypothesis that coffee or alcohol consumption is a potential trigger for sudden cardiac death in persons with risk factors for ischemic heart disease. (+info)
Air pollution and daily hospital admissions for cardiovascular diseases in Windsor, Ontario.
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OBJECTIVE: To examine the role that ambient air pollution plays in exacerbating cardiovascular disease hospitalization in Windsor, Ontario. METHODS: The number of daily cardiac hospital admissions was obtained from all Windsor hospitals from April 1, 1995 to December 31, 2000 and linked to concentrations of ambient air pollutants and weather variables. The logarithm of daily counts of hospitalization was regressed on the levels of pollutants, after adjusting for seasonal, weekly cycles, and weather variables using time series analysis with natural splines as smoothing functions. RESULTS: Of all the pollutants considered, sulphur dioxide (SO2) had the strongest effect on cardiac hospitalization among the > or = 65 age group. The percentage increase in daily admission was 2.6% for current day sulphur dioxide level (95% CI: 0.5-6.4), 4.0% for 2-day mean level (95% CI: 0.1-6.9), and 5.6% (95% CI: 1.5-9.9) for 3-day mean level for an increase in interquartile range of 19.3 ppb. When particulate PM10 was included in the model, the contributing effect of sulphur dioxide remained significant for the > or = 65 age group for all three levels. CONCLUSIONS: Short-term effects of sulphur dioxide are associated significantly to daily cardiac hospital admissions for people > or = 65 years of age living in Windsor. Since Windsor is a border city, additional monitoring and assessment is recommended to determine if air quality and resultant health effects have deteriorated since traffic congestion at the border has increased following the events of September 11, 2001. (+info)