Subject(s)
Ginkgo biloba/adverse effects , Ubiquinone/analogs & derivatives , Ubiquinone/pharmacology , Warfarin/administration & dosage , Adult , Aged , Coenzymes , Double-Blind Method , Drug Interactions , Drug Monitoring , Female , Humans , International Normalized Ratio , Male , Middle Aged , Outpatients , Placebos , Time FactorsABSTRACT
During the last six months, the Poison Control Centre at Bispebjerg Hospital, Copenhagen, Denmark, has observed an increasing number of patients intoxicated with GHB, a drug of abuse. The patients are often admitted to the emergency ward shortly after having taken the drug, unconscious or comatose. If younger patients present with these symptoms, intoxication with GHB should be seriously considered. The effects are seen within 15 to 30 minutes after oral ingestion of the drug. Spontaneous recovery usually occurs within three to five hours. The most common effects are mild euphoria, sedation, vomiting, somnolence, bradycardia, aggressive behaviour, apnoea, respiratory depression, and coma. Normally the patient breathes adequately, but insufficient respiration may occur and deaths have been described. The drug is often consumed together with alcohol and other drugs of abuse, which strengthens the effect of GHB. Treatment is symptomatic. A review of the literature with special emphasis on clinical effects included toxicology and treatment is given.
Subject(s)
Central Nervous System Stimulants/poisoning , Illicit Drugs/poisoning , Poisoning/therapy , Sodium Oxybate/poisoning , Substance-Related Disorders/etiology , Central Nervous System Stimulants/administration & dosage , Central Nervous System Stimulants/pharmacokinetics , Drug Overdose , Emergencies , Humans , Poisoning/diagnosis , Sodium Oxybate/administration & dosage , Sodium Oxybate/pharmacokineticsABSTRACT
Pneumonia in patients in intensive care units (ICU) is associated with several diagnostic difficulties and high mortality. This study was conducted to describe the diagnostic procedures and clinical characteristics of the pneumonic and critically ill patient in relation to APACHE II score. The material consisted of 193 patients admitted to seven Danish ICUs and is also included in a European epidemiologic survey (EURO.NIS). Twenty-eight (14.5%) developed pneumonia and 18 (9.3%) of these were nosocomial (> 48h after admission). Patients with pneumonia had a significantly higher APACHE II score, duration of stay and mortality. The techniques used to diagnose pneumonia were mainly conventional and did not or only seldom include protected brush, bronchoalveolar lavage or pulmonary biosy. The predominant pathogens isolated in tracheal aspirate were Gram-negative bacilli (50%). The APACHE II scoring system was found to stratify patients with respect to mortality, duration of stay and pneumonia diagnosed in ICU.
Subject(s)
Cross Infection/epidemiology , Intensive Care Units , Pneumonia/epidemiology , Adult , Aged , Cross Infection/diagnosis , Cross Infection/microbiology , Denmark/epidemiology , Female , Humans , Incidence , Length of Stay , Male , Middle Aged , Pneumonia/diagnosis , Pneumonia/microbiology , Prospective Studies , Severity of Illness IndexABSTRACT
Nosocomial infections, especially pneumonias, are a common problem in Intensive Care Units (ICU) and are a major cause of morbidity and mortality. During the past ten years a new regime, selective decontamination of the digestive tract (SDD) has been introduced to prevent these infections which are often preceded by colonization with aerobic potentially pathogenic microorganisms. Topical antibiotics are applied both orally and by nasogastric tube to prevent secondary endogeneous infections with Gram-negative enteric rods, Staphylococcus aureus and yeasts, in combination with parenteral antibiotics for the treatment of early primarily exogeneous and endogeneous infections. The effect of SDD on morbidity and mortality has been studied in many papers which are very conflicting and their results are difficult to interpret. This article reviews 11 published randomized trials of SDD in ICU among intubated and artificially ventilated adult patients aged more than 15 years. Of the eleven available controlled studies, eight showed a significant reduction of nosocomial pneumonias among patients who received selective decontamination. Only two studies demonstrated a reduction in infection related mortality rates.