cardiovascular-agents and Bacteremia

Cardiovascular diseases represent a widespread heterogeneous group of conditions that have significant morbidity and mortality. The various diseases and their treatments can have an impact upon the periodontium and the delivery of periodontal care.. In this paper we consider three main topics and explore their relationship to the periodontist and the provision of periodontal treatment.. The areas reviewed include the effect of cardiovascular drugs on the periodontium and management of patients with periodontal diseases; the risk of infective endocarditis arising from periodontal procedures; the inter-relationship between periodontal disease and coronary artery disease.. Calcium-channel blockers and beta-adrenoceptor blockers cause gingival overgrowth and tooth demineralisation, respectively. Evidence suggests that stopping anticoagulant therapy prior to periodontal procedures is putting patients at a greater risk of thromboembolic disorders compared to the risk of prolonged bleeding. The relationship between dentistry and infective endocarditis remains a controversial issue. It would appear that spontaneous bacteraemia arising from a patient's oral hygiene practices is more likely to be the cause of endocarditis than one-off periodontal procedures. The efficacy of antibiotic prophylaxis is uncertain (and unlikely to be proven), and the risk of death from penicillin appears to be greater than the risk of death arising from infective endocarditis. Finally, the association between periodontal disease and coronary artery disease has been explored and there seem to be many issues with respect to data handling interpretation. Many putative mechanisms have been suggested; however, these only further highlight the need for intervention studies.

Topics: Bacteremia; Cardiovascular Agents; Cardiovascular Diseases; Coronary Disease; Endocarditis, Bacterial; Humans; Periodontal Diseases; Periodontium; Risk Factors

To determine the association between fluid resuscitation volume following pediatric burn injury and impact on outcomes.. A retrospective chart review of pediatric patients (0-18 years) sustaining ≥15% TBSA burn, admitted to an American Burn Association verified pediatric burn center from 2010 to 2015.. Twenty-seven patients met inclusion criteria and had complete data available for analysis. Fifteen (56%) patients received greater than 6ml/kg/total body surface area burn in first 24h and twelve (44%) patients received less than 6ml/kg/percent total body surface area burn in first 24h. There were no differences between groups in median number of mechanical ventilator days (4 vs 8, p=0.96), intensive care unit length of stay (10 vs 13.5, p=0.75), or hospital length of stay (37 vs 37.5, p=0.56). Secondary analysis revealed that patients with a higher mean cumulative fluid overload (>253ml/kg, n=16) had larger burn size, higher injury severity scores, and were more likely to receive mechanical ventilation and invasive support devices. Controlling for burn size, odds of longer PICU length of stay and duration of mechanical ventilation were 20.33 [95% CI (1.7-235.6) p=0.02] and 27.9 [95% CI (2.1-364.7) p=0.01], respectively, among patients with a high cumulative fluid overload on day 3 compared to low cumulative fluid overload.. Resuscitation volume in the first 24h was not associated with adverse outcomes. Persistent cumulative fluid overload at day 3 and beyond was independently associated with adverse outcomes.

Topics: Adolescent; Bacteremia; Burns; Cardiovascular Agents; Catheterization, Central Venous; Child; Child, Preschool; Female; Fluid Therapy; Humans; Infant; Infant, Newborn; Injury Severity Score; Intensive Care Units; Length of Stay; Logistic Models; Male; Prognosis; Respiration, Artificial; Respiratory Insufficiency; Retrospective Studies; Time Factors; Trauma Severity Indices; Urinary Tract Infections; Water-Electrolyte Balance; Wound Infection

Takotsubo cardiomyopathy consists of a transient dysfunction of the left ventricle. It is characterised by an impaired left ventricular segmentary contractility, without significant coronary lesions in the coronary angiography. It usually occurs after an episode of physical or emotional stress. We present the case of a 70 year-old woman, who, in the postoperative period of an ankle osteosynthesis, developed a Takotsubo cardiomyopathy in the context of a sepsis caused by Staphylococcus aureus. She presented with acute lung oedema and a clinical picture of low cardiac output. The echocardiogram showed left ventricular medioapical akinesia. Coronary angiography was normal. She was treated with supportive measures with good progress. At 33 days from onset she was able to be discharged from hospital to home with normal systolic function on echocardiography.

Topics: Aged; Ankle Fractures; Atrial Fibrillation; Bacteremia; Cardiovascular Agents; Female; Fracture Fixation, Internal; Humans; Postoperative Complications; Staphylococcal Infections; Takotsubo Cardiomyopathy

Heart disease is the number one killer of women, and studies have shown connections between cardiovascular and oral health. However, interprofessional community-based participatory initiatives promoting women's oral health have received little research attention. This study evaluated the effectiveness of personalized oral health education (POHE) during a free one-day interprofessional women's health promotion event. The objectives were to 1) assess the participants' knowledge about the connection between oral health and heart disease; 2) disseminate information about oral-systemic linkages; 3) encourage comprehensive dental examinations; and 4) evaluate POHE outcomes. West Virginia University School of Dentistry faculty and students delivered POHE to the participants. These POHE instructors were calibrated with a standardized script regarding periodontal disease, health impact of tobacco, xerostomia-inducing medications, and oral hygiene instruction. Immediately prior to and following each POHE session, all the participants (N=165; 100 percent response rate) completed a number-coded questionnaire. The findings showed that the participants' knowledge of oral-systemic health linkages had increased following the POHE. The respondents received oral health kits and were offered discount vouchers toward the cost of a comprehensive oral examination at the dental school. This replicable model may prove useful to other dental schools in promoting women's oral health.

Topics: Aged; Attitude to Health; Bacteremia; Cardiovascular Agents; Dental Care; Female; Health Education, Dental; Health Fairs; Health Promotion; Heart Diseases; Humans; Information Dissemination; Memory Disorders; Middle Aged; Oral Health; Oral Hygiene; Periodontal Diseases; Precision Medicine; Stroke; Tobacco Products; Women's Health; Wound Healing; Xerostomia

We present three cases of pediatric patients with thrombocytopenia-associated multiple organ failure and the evidence for providing extracorporeal organ support. All three patients had severe cardiac dysfunction, respiratory failure, and acute kidney injury treated with venoarterial extracorporeal membrane oxygenation, continuous renal replacement therapy, and plasma exchange. Despite the presence of multiple organ failure and high risk of mortality, all three patients survived with minimal long-term sequelae.

Topics: ADAM Proteins; ADAMTS13 Protein; Adolescent; Bacteremia; Cardiopulmonary Resuscitation; Cardiovascular Agents; Child; Combined Modality Therapy; Extracorporeal Membrane Oxygenation; Fluid Therapy; Heart Arrest; Hemofiltration; Hemolytic-Uremic Syndrome; High-Frequency Ventilation; Humans; Infarction, Middle Cerebral Artery; Influenza A virus; Influenza, Human; Male; Methicillin-Resistant Staphylococcus aureus; Multiple Organ Failure; Osteomyelitis; Plasma Exchange; Staphylococcal Infections; Thrombotic Microangiopathies; Tracheostomy

Topics: Anti-Bacterial Agents; Bacteremia; Borrelia; Cardiopulmonary Resuscitation; Cardiovascular Agents; Ceftriaxone; Child; Combined Modality Therapy; Cytokines; Doxycycline; Endotoxins; Female; Humans; Hypotension; Positive-Pressure Respiration; Pulmonary Edema; Relapsing Fever; Shock, Cardiogenic; Tachycardia; Unconsciousness

In contrast to pharmaceutical manufacturers, compounding pharmacies adhere to different quality-control standards, which may increase the likelihood of undetected outbreaks. In 2005, the Centers for Disease Control and Prevention received reports of cases of Serratia marcescens bloodstream infection occurring in patients who underwent cardiac surgical procedures in Los Angeles, California, and in New Jersey. An investigation was initiated to determine whether there was a common underlying cause.. A matched case-control study was conducted in Los Angeles. Case record review and environmental testing were conducted in New Jersey. The Centers for Disease Control and Prevention performed a multistate case-finding investigation; isolates were compared using pulsed-field gel electrophoresis analysis.. Nationally distributed magnesium sulfate solution (MgSO(4)) from compounding pharmacy X was the only significant risk factor for S. marcescens bloodstream infection (odds ratio, 6.4; 95% confidence interval, 1.1-38.3) among 6 Los Angeles case patients and 18 control subjects. Five New Jersey case patients received MgSO(4) from a single lot produced by compounding pharmacy X; culture of samples from open and unopened 50-mL bags in this lot yielded S. marcescens. Seven additional case patients from 3 different states were identified. Isolates from all 18 case patients and from samples of MgSO(4) demonstrated indistinguishable pulsed-field gel electrophoresis patterns. Compounding pharmacy X voluntarily recalled the product. Neither the pharmacy nor the US Food and Drug Administration could identify a source of contamination in their investigations of compounding pharmacy X.. A multistate outbreak of S. marcescens bloodstream infection was linked to contaminated MgSO(4) distributed nationally by a compounding pharmacy. Health care personnel should take into account the different quality standards and regulation of compounded parenteral medications distributed in large quantities during investigations of outbreaks of bloodstream infection.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bacteremia; Cardiac Surgical Procedures; Cardiovascular Agents; Centers for Disease Control and Prevention, U.S.; Cross Infection; Disease Outbreaks; Drug Compounding; Drug Contamination; Female; Humans; Los Angeles; Magnesium Sulfate; Male; Middle Aged; New Jersey; Risk Factors; Serratia Infections; Serratia marcescens; United States