Hydrocortisone Continuous Infusion Versus Bolus Dose on Glycemic Control in Critically Ill Subjects.

BACKGROUND: Corticosteroid therapy in patients with septic shock can improve hemodynamics but can also cause hyperglycemia. Continuous infusion (CI) hydrocortisone has limited evidence that it may reduce hyperglycemia relative to bolus dose (BD) therapy, but CI can be cumbersome and requires attention to intravenous access and drug incompatibilities. OBJECTIVE: To compare the effects of CI hydrocortisone with BD on glycemic control. METHODS: A matched, retrospective cohort study of blood glucose, insulin requirements, and glycemic variability was performed between patients with shock receiving CI and BD hydrocortisone. Patients were matched based on history of type 2 diabetes and intensive care unit (ICU) admission. RESULTS: Baseline blood glucose was similar between groups, with higher baseline hourly insulin requirements in the CI group (CI: 12 [12.8] units, BD: 6.7 [7] units, P = .0012). For the first 72 hours of treatment, there was no difference in mean blood glucose with higher average hourly insulin requirements in the CI group (CI 7.8 [7.7] units, BD: 5.5 [6.9] units, P < .0001). There was no difference in glycemic variability between groups. CONCLUSIONS: CI hydrocortisone therapy for septic shock does not appear to have a favorable impact on mean blood glucose or influence glycemic variability relative to BD therapy.

Management of Viral Central Nervous System Infections: A Primer for Clinicians.

Viruses are a common cause of central nervous system (CNS) infections with many host, agent, and environmental factors influencing the expression of viral diseases. Viruses can be responsible for CNS disease through a variety of mechanisms including direct infection and replication within the CNS resulting in encephalitis, infection limited to the meninges, or immune-related processes such as acute disseminated encephalomyelitis. Common pathogens including herpes simplex virus, varicella zoster, and enterovirus are responsible for the greatest number of cases in immunocompetent hosts. Other herpes viruses (eg, cytomegalovirus, John Cunningham virus) are more common in immunocompromised hosts. Arboviruses such as Japanese encephalitis virus and Zika virus are important pathogens globally, but the prevalence varies significantly by geographic region and often season. Early diagnosis from radiographic evidence and molecular (eg, rapid) diagnostics is important for targeted therapy. Antivirals may be used effectively against some pathogens, although several viruses have no effective treatment. This article provides a review of epidemiology, diagnostics, and management of common viral pathogens in CNS disease.