European journal of internal medicine
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Eur. J. Intern. Med. · Jul 2014
ReviewPolyclonal intravenous immunoglobulin: an important additional strategy in sepsis?
Sepsis syndrome is characterized by a systemic inflammatory response to infection potentially leading to acute organ failure and rapid decline to death. Polyclonal intravenous immune globulin, a blood product derived from human donor blood, in addition to antiinfective activities, also exerts a broad antiinflammatory and immunomodulating effect. Intravenous immunoglobulin (IVIg) has been proposed as adjuvant therapy for sepsis even though the clinical studies demonstrating their efficacy and safety are relatively small. ⋯ As a result of heterogeneity across studies and inconsistencies in results, the majority have concluded that more evidence, coming from large, well-conducted randomized controlled trials (RCTs), is required. Moreover the appropriate timing of administration and the identification of specific clinical settings represent a key factor to maximizing their beneficial effect. The authors, in this revision, review the basic mechanisms of action of IVIg, the rationale for their use, and their clinical applications.
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Eur. J. Intern. Med. · Jul 2014
Influence of inadequate antimicrobial therapy on prognosis in elderly patients with severe urinary tract infections.
Inadequate empirical antimicrobial therapy (IEAT) in intensive care unit (ICU) is associated with adverse outcomes. However, the influence of IEAT on prognosis for elderly patients with urinary tract infection (UTI) in non-ICU settings is unknown. ⋯ IEAT is associated with mortality in elderly patients with UTI admitted to a non-ICU ward, suggesting that improving empirical antimicrobial therapy could have a favorable impact on prognosis.
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Eur. J. Intern. Med. · Jul 2014
ReviewA challenging diagnosis for potential fatal diseases: recommendations for diagnosing acute porphyrias.
Acute porphyrias are a heterogeneous group of metabolic disorders resulting from a variable catalytic defect of four enzymes out of the eight involved in the haem biosynthesis pathway; they are rare and mostly inherited diseases, but in some circumstances, the metabolic disturbance may be acquired. Many different environmental factors or pathological conditions (such as drugs, calorie restriction, hormones, infections, or alcohol abuse) often play a key role in triggering the clinical exacerbation (acute porphyric attack) of these diseases that may often mimic many other more common acute medical and neuropsychiatric conditions and whose delayed diagnosis and treatment may be fatal. In order to obtain an accurate diagnosis of acute porphyria, the knowledge and the use of appropriate diagnostic tools are mandatory, even in order to provide as soon as possible the more effective treatment and to prevent the use of potentially unsafe drugs, which can severely precipitate these diseases, especially in the presence of life-threatening symptoms. In this paper, we provide some recommendations for the diagnostic steps of acute porphyrias by reviewing literature and referring to clinical experience of the board members of the Gruppo Italiano Porfiria (GrIP).
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Eur. J. Intern. Med. · Jul 2014
Letter Meta AnalysisRisk of major bleeding and the standard doses of dabigatran.
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Eur. J. Intern. Med. · Jul 2014
Inflammatory bowel diseases increase future ischemic stroke risk: a Taiwanese population-based retrospective cohort study.
This cohort study assessed the association between inflammatory bowel disease (IBD) and the risk of future ischemic stroke. ⋯ IBD exhibited an increased risk of developing ischemic stroke.