ABSTRACT
The Academic Life in Emergency Medicine (ALiEM) Approved Instructional Resources (AIR) Series and Approved Instructional Resources - Professional (AIR-Pro) Series were created in 2014 and 2015, respectively, in response to the growing need to curate online educational content as well as create a nationally available curriculum that meets individualized interactive instruction criteria for emergency medicine (EM) trainees. These two online series identify high-quality educational blog and podcast content using an expert-based approach. The AIR series is a continuously building curriculum originally based on the Council of Emergency Medicine Directors (CORD) testing schedule. In September 2019, 61 blog posts and podcasts published within the previous 12 months and relevant to infectious diseases were evaluated by eight attending physicians using the ALiEM AIR scoring instrument. In this review, we summarize the accredited posts on infectious diseases meeting our a priori quality criteria per evaluation by the reviewers.
ABSTRACT
BACKGROUND: Conventional extracorporeal membrane oxygenation is bulky and non-ambulatory and requires multiple blood transfusions. We hypothesized that a percutaneous, paracorporeal artificial lung (PAL) could be established through a single venous cannulation to provide long-term ambulatory respiratory support. METHODS: Our PAL system was tested in 11 healthy sheep. An Avalon Elite dual-lumen cannula (DLC), inserted through the right jugular vein into the superior vena cava, right atrium, and inferior vena cava, was connected to a CentriMag pump and compact hollow-fiber gas exchanger, forming a short-circuit PAL system. All sheep were moved to intensive care unit and were ambulatory after anesthesia recovery. Hemodynamics and device performance were measured daily. RESULTS: The ambulatory PALs were successfully established in all sheep. The sheep were awake, ate, and moved freely in the metabolic cage, with no need of artificial nutrition or blood transfusion. All sheep had stable hemodynamics, with 2 liters/min of average circuit flow and hemoglobin levels exceeding 9.2 g/dl throughout the experiment. A progressive decrease of oxygen transfer and carbon dioxide removal capacity was observed. Sheep were euthanized between 10 and 24 days for bleeding (n = 2), gas exchanger failure (n = 6), and DLC issues (n = 3). CONCLUSIONS: We successfully established long-term ambulatory PAL for up to 24 days in 11 animals using our patented DLC through a single-site percutaneous venous cannulation. Critical bleeding/thrombosis formation and gas exchanger durability remain two major challenges for long-term-ambulatory PAL.
Subject(s)
Artificial Organs , Lung , Monitoring, Ambulatory/instrumentation , Pulmonary Gas Exchange/physiology , Sheep, Domestic/physiology , Animals , Catheterization , Equipment Design , Extracorporeal Membrane Oxygenation/instrumentation , Female , Hemodynamics/physiology , Jugular Veins , Models, AnimalABSTRACT
The ribonucleotide reductase inhibitor hydroxyurea (HU) has demonstrated some benefit as a component of drug cocktails for the treatment of HIV-1 infection. However, HU is notoriously myelosuppressive and often administered only as salvage therapy to patients with late-stage disease, potentially exacerbating the bone marrow toxicity of HU. In this report we have compared the antiviral effects of HU and two novel RR inhibitors trimidox (3,4,5-trihydroxybenzamidoxime) and didox (3,4-dihydroxybenzohydroxamic acid) in combination with didanosine (2,3-didoxyinosine; ddI) in the LPBM5 MuLV retrovirus model (murine AIDS). We also evaluated the effects of these drug combinations on the hematopoietic tissues of LPBM5 MuLV-infected animals. The combination of RR inhibitors and ddI was extremely effective (DX>TX>HU) in inhibiting development of retrovirus-induced disease (splenomegaly, hypergammaglobulinemia, activated B-splenocytes and loss of splenic architecture). In addition, relative levels of proviral DNA were significantly lower in combination drug-treated animals compared to infected controls. Evaluation of femur cellularity, numbers of marrow-derived myeloid progenitor cells (CFU-GM and BFU-E) and peripheral blood indices revealed that TX and DX in combination with ddI were well-tolerated. However, treatment with HU and ddI induced moderate myelosuppression. These data demonstrate that RR inhibitors in combination with ddI provide significant protection against retroviral disease in murine AIDS. Moreover, the novel RR inhibitors TX and DX appear to be more effective and less myelosuppressive than HU when administered with ddI in this model.
