Lancet
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In recent years, several risk factors for adverse outcome in patients undergoing anaesthesia have been identified. Besides human errors, cardiovascular and respiratory complications are associated with substantial morbidity. Assessment of complications has promoted the introduction of basic physiological monitoring in clinical practice. ⋯ Evidence is growing that patients with known or suspected coronary artery disease should be treated with beta blockers perioperatively. Whether the type of anaesthesia-ie, general or regional-is relevant to perioperative mortality remains unclear. In subgroups of patients at high risk, neuraxial anaesthesia reduces the rate of respiratory and cardiovascular complications.
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Since the 1990s, opportunistic fungal infections have emerged as a substantial cause of morbidity and mortality in profoundly immunocompromised patients. Hypercortisolaemic patients, both those with endogenous Cushing's syndrome and, much more frequently, those receiving exogenous glucocorticoid therapy, are especially at risk of such infections. ⋯ A better knowledge of the interplay between glucocorticoid-induced immunosuppression and invasive fungal infections should assist in earlier recognition and treatment of such infections. Efforts to decrease the intensity of glucocorticoid therapy should help to improve outcomes of opportunistic fungal infections.
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Severe acute respiratory syndrome (SARS) is a global health concern. In Hong Kong, two major outbreaks, one hospital based and the other in the Amoy Gardens apartments, were identified. The frequency of diarrhoea, admission to intensive care, and mortality differed significantly between the two outbreaks. ⋯ The virus sequence was identical in four of these five patients. The sequence data from one hospital case and the four identical community cases had only three nucleotide differences. Alterations in the SARS coronavirus genome are unlikely to have caused the distinctive clinical features of the Amoy Gardens patients, and these results highlight the importance of non-viral genomic factors in this outbreak.