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Rheumatic Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
The pathogenesis of IgG4-RD is not completely understood. The evidence is that it is a T-cell mediated autoimmune disease in which the IgG4 antibodies are not themselves pathogenic. The diagnosis, if possible, is confirmed with biopsy and, before treatment is initiated, the extent of the disease needs to be evaluated. Treatment is with immunosuppression and relapses are common following discontinuation of therapy. Significant organ dysfunction may arise from uncontrolled and progressive inflammatory and fibrotic changes in affected tissues.
Tropical, subtropical and vaccine preventable infections, including malaria
Published in Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar, Handbook of Refugee Health, 2021
Hugh Kingston, Paul Arkell, Ravi Mehta, Aula Abbara
Malaria should be considered in any febrile patient returning from an endemic area; although most patients with malaria present within 3 months of travel, presentations may be delayed for up to several years. Patients may present with undifferentiated fever or with false localising symptoms, such as diarrhoea or lower respiratory tract symptoms. Features of organ dysfunction may be present (see the next section). Also consider in anaemic children in or from high transmission areas. Parasitaemia may be an incidental finding in patients from high transmission areas, and the patient may be unwell due to other concurrent infection.
Intensive Care Management of Major Trauma
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
Multi-organ distress syndrome (MODS) can be the result of a pronounced SIRS reaction following trauma. Organ dysfunction is usually related to the lungs, cardiovascular system, kidneys (Acute Kidney Injury—AKI), liver, and central nervous system.
Efficacy and safety of nafamostat mesilate anticoagulation in blood purification treatment of critically ill patients: a systematic review and meta-analysis
Published in Renal Failure, 2022
Yao Lin, Yiming Shao, Yuchun Liu, Ruoxuan Yang, Shuanglin Liao, Shuai Yang, Mingwei Xu, Junbing He
Two reviewers (Lin Yao and Yi-Ming Shao) independently performed an initial eligibility screen of all article types, titles, and abstracts. Publications that specifically referred to the administration of NM in patients receiving BPT were collected for further review. Next, full-text reviews were conducted independently, and studies meeting the following criteria were candidates for inclusion: 1) observational cohort and/or randomized/quasi-randomized clinical trial design; 2) patients with various levels of organ dysfunction; and 3) all patients underwent BPT, and the conventional anticoagulant strategy was compared with NM. The exclusion criteria were as follows: 1) duplicate studies; and 2) review articles, case reports, letters, meta-analyses, animal experimental studies, and so on. Data extraction was carried out by two of the authors (Ruoxuan Yang and Shuanglin Liao) independently, and any disagreement between the two authors was resolved according to the assessment of a third author or discussion. The data extracted included the study ID, first author and year of publication, type of study, sample size, age of participants, etiology and diagnosis, details of BPT and endpoint.
Infective endocarditis by Klebsiella species: a systematic review
Published in Journal of Chemotherapy, 2021
Petros Ioannou, Eugenia Miliara, Stella Baliou, Diamantis P. Kofteridis
Data from each eligible study were extracted by two investigators (PI, EM). The extracted data included type of study, year of publication and country; patient demographic data (including age and gender); patients’ relevant medical history (previous cardiac surgery or cardiac valve replacement, time after cardiac valve replacement); data related to infection and microbiology of patients (infection site, isolated strains, presence of complications, presence of embolic phenomena); treatment administered for IE; and outcomes (ie cure or death). Data on microbiology and relation of death to the index infection was reported according to the study authors. Diagnosis of IE was confirmed by the investigators based on the extracted information and the modified Dukes’ criteria if the diagnosis was at least possible (at least 1 major and 1 minor criterion or at least 3 minor criteria) or if pathological data established a diagnosis of IE.17 The recorded complications involved any organ dysfunction or clinical deterioration that was considered by the authors to be related to the IE. The quality of evidence of included studies’ outcomes was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE).18
Epidemiology, management and costs of sepsis in Spain (2008–2017): a retrospective multicentre study
Published in Current Medical Research and Opinion, 2020
A predominance of cases caused by Gram-negative bacteria, principally E. coli, would coincide with previous estimations, while the origin of the infection could not be directly evaluated5,21. Most admissions registered symptoms of organ dysfunction, although chronic conditions including hypertension and diabetes were also present. Renal, cardiac and respiratory symptoms were associated with in-hospital mortality, as well as the disorders of fluid electrolyte and acid-base balance and malignant neoplasms. On the other hand, even though liver dysfunction is considered a common symptom of sepsis, liver affectation was not depicted clearly in this population22; the lack of laboratory test results impeded a formal analysis of laboratory abnormalities.