1/11. neuraminidase inhibitors in the treatment of influenza A and B--overview and case reports.Influenza viruses type A and B can cause a wide spectrum of illness, and they are responsible for considerable mortality and morbidity. With the new neuraminidase inhibitors, of which zanamivir was the first drug to be licensed, the physician has antivirals at his disposal which are safe and effective against both influenza virus type A and type B. Available data from clinical Phase III studies indicate benefits in terms of a reduction in the median time to alleviation of major symptoms by 1.5 to 3 days when treatment is started within 36 to 48 h after onset of influenza. Similar results have been obtained with oseltamivir. neuraminidase inhibitors provide a valuable treatment option, particularly for individuals not protected by vaccination, and those at high risk of influenza-related complications. The study results obtained so far indicate that patients with pre-existing diseases and those with severe influenza symptoms profit most from the treatment. This is confimed by our own experience in treating severe influenza conditions.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/11. Electrocardiographic ST-segment elevation: correct identification of acute myocardial infarction (AMI) and non-AMI syndromes by emergency physicians.OBJECTIVE: To determine the emergency physician's (EP's) ability to identify the cause of ST-segment elevation (STE) in a hypothetical chest pain patient. methods: Eleven electrocardiograms (ECGs) with STE were given to EPs; the patient in each instance was a 45-year-old male with a medical history of hypertension and diabetes mellitus with the chief complaint of chest pain. The EP was asked to determine the cause of the STE and, if due to acute myocardial infarction (AMI), to decide whether thrombolytic therapy (TT) would be administered (the patient had no contraindication to such treatment). Rates of TT administration were determined; appropriate TT administration was defined as that occurring in an AMI patient, while inappropriate TT administration was defined as that in the non-AMI patient. RESULTS: Four hundred fifty-eight EPs completed the questionnaire; levels of medical experience included the following: postgraduate year 2-3, 193 (42%); and attending, 265 (58%). The overall rate of correct interpretation of the study ECGs was 94.9% (4,782 correct interpretations out of 5,038 instances). Acute myocardial infarction with typical STE, ventricular paced rhythm, and right bundle branch block were never misinterpreted. The remaining conditions were misinterpreted with rates ranging between 9% (left bundle branch block, LBBB) and 72% (left ventricular aneurysm, LVA). The overall rate of appropriate thrombolytic agent administration was 83% (1,525 correct administrations out of 1,832 indicated administrations). The leading diagnosis for which thrombolytic agent was given inappropriately was LVA (28%), followed by benign early repolarization (23%), pericarditis (21%), and LBBB without electrocardiographic AMI (5%). Thrombolytic agent was appropriately given in all cases of AMI except when associated with atypical STE, where it was inappropriately withheld 67% of the time. CONCLUSIONS: In this survey, EPs were asked whether they would give TT based on limited information (ECG). Certain syndromes with STE were frequently misdiagnosed. Emergency physician electrocardiographic education must focus on the proper identification of these syndromes so that TT may be appropriately utilized.- - - - - - - - - - ranking = 6keywords = physician (Clic here for more details about this article) |
3/11. pericarditis presenting and treated as an acute anteroseptal myocardial infarction.Early recognition and treatment of acute myocardial infarctions have been accepted as improving patient mortality. With the popular use of thrombolytic therapy, it is necessary to rule out contraindications and to consider other causes for ST segment elevation. A unique patient experiencing chest pain with marked and localized ST segment elevation in the anteroseptal leads is presented. He was treated with thrombolytic therapy. Subsequent investigations ruled out the diagnosis of myocardial infarction and confirmed the diagnosis of pericarditis. Although the patient's outcome was uncomplicated, physicians are urged to consider the diagnosis of pericarditis before using thrombolytic therapy to avoid life-threatening complications.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/11. Acute pleuritic chest pain.BACKGROUND: The differential diagnosis of acute pleuritic chest pain is large and includes a number of life threatening conditions. Clinical suspicion plays a major role in the choice of investigation and the interpretation of the results. OBJECTIVE: To outline the clinical features and diagnostic workup of three acute causes of pleuritic chest pain--acute pulmonary embolism, pneumothorax and acute pericarditis. DISCUSSION: The general practitioner plays an important role in the initiation of the investigative pathway for these conditions. Appropriate referral for ongoing assessment and care requires the primary care physician to be aware of the available investigations and their limitations.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/11. melioidosis complicated by pericarditis.A case of acute and recrudescent melioidosis complicated by pericarditis and pericardial effusion is described. The potential for the appearance of future cases in the united states and the necessity for physicians to remain aware of this potential diagnosis are discussed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/11. Cardiac adverse events following smallpox vaccination--united states, 2003.During January 24-March 21, smallpox vaccine was administered to 25,645 civilian health-care and public health workers in 53 jurisdictions as part of an effort to prepare the united states in the event of a terrorist attack using smallpox. Seven cases of cardiac adverse events have been reported among civilian vaccinees since the beginning of the smallpox vaccination program. In addition, 10 cases of myopericarditis have been reported among military vaccinees. This report summarizes data on the seven cases reported among civilians and provides background information on recent military vaccinees. Although a causal association between vaccination and adverse cardiac events in the civilian population is unproven, as a precautionary measure, CDC recommends that persons with physician-diagnosed cardiac disease with or without symptoms (e.g., previous myocardial infarction, angina, congestive heart failure, or cardiomyopathy) be excluded from vaccination during this smallpox preparedness program.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/11. ST. segment elevation: is it a possible infarct?In patients with acute substernal pain seen at Emergency Departments, ST segment elevations are considered the hallmark of an acute myocardial infarct. Acute substernal pain associated with ST segment elevations is the inclusion criteria for thrombolytic therapy. However, there are other conditions, which may present with ST segment elevation in which thrombolytic therapy is not indicated. Acute pericarditis and ECG variants of normal must also be considered in the differential diagnosis. Three cases are presented that illustrate this ECG presentation. It is of paramount importance, that the Emergency Department physician who does the triage for these patients be able to identify the various causes of ST segment elevation.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/11. Utility of hand-carried ultrasound for consultative cardiology.Although the stethoscope has been an important part of the bedside cardiac diagnostic examination for generations of physicians, this clinical tool has been relatively unchanged in over 150 years. echocardiography is established as an essential diagnostic imaging method for patients with known or suspected cardiovascular diseases. However, routine echocardiography systems are large and heavy, and although they are portable, they remain inconvenient for bedside patient rounds. Technologic advances have resulted in miniaturization of electronic components and small, lightweight ultrasound systems have been recently introduced. These hand-carried units offer clinically acceptable two-dimensional image quality for rapid "quick-look" bedside diagnostics, in particular focusing on global and regional left ventricular function and presence or absence of pericardial effusion. This article proposes a general approach to the rapid hand-carried ultrasound cardiac exam as an extension of the physical examination. It details case examples and reviews the initial clinical experience of hand-carried ultrasound on cardiac consultation rounds. hand-carried ultrasound has promise to have an immediate impact on bedside patient management though expediting and facilitating the delivery of medical care.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/11. Ovarian adenocarcinoma complicated by malignant pericarditis.Neoplastic pericarditis is a rare complication of gynecologic malignancies. However, as illustrated in the case presented, the physician involved in the care of patients with cancer should be aware of this possible life-threatening complication. The case report is followed by a brief review of the pertinent clinical, pathophysiologic, and therapeutic aspects of this condition.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/11. Haemophilus influenzae sepsis leading to pericarditis despite antimicrobial therapy.Acute purulent pericarditis is a well-recognized, though infrequently seen, manifestation of systemic haemophilus influenzae type b disease. We recently studied two pediatric patients who developed signs of this septic complication during appropriate antibiotic treatment for bacteremia. These case reports should alert physicians to the possibility that pericarditis may become clinically evident in patients with systemic H. influenzae infections many days after initiation of appropriate therapy. The pathophysiology, diagnostic modalities and therapy are briefly reviewed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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