Analysis and applications of respiratory surface EMG: report of a round table meeting.

Surface electromyography (sEMG) can be used to measure the electrical activity of the respiratory muscles. The possible applications of sEMG span from patients suffering from acute respiratory failure to patients receiving chronic home mechanical ventilation, to evaluate muscle function, titrate ventilatory support and guide treatment. However, sEMG is mainly used as a monitoring tool for research and its use in clinical practice is still limited-in part due to a lack of standardization and transparent reporting. During this round table meeting, recommendations on data acquisition, processing, interpretation, and potential clinical applications of respiratory sEMG were discussed. This paper informs the clinical researcher interested in respiratory muscle monitoring about the current state of the art on sEMG, knowledge gaps and potential future applications for patients with respiratory failure.

An Unexpected Case of Disseminated Amebiasis with Cerebral Involvement and Successful Recovery in a Non-Endemic Context.

BACKGROUND Amebiasis is a parasitic infection caused by the protozoan Entamoeba histolytica. Amebic brain abscesses are a rare form of invasive amebiasis frequently lethal due to the difficulty of its diagnosis and inadequate treatment. Cerebral amebiasis poses a therapeutic challenge as evidenced by the scarcity of papers reporting complete recovering after treatment. CASE REPORT We report the case of a 39-year-old Spanish man, with a history of alcohol and drug abuse. He had never traveled outside of Europe, no reported oral-anal sexual contact, and no history of immunosuppressant medication. He was admitted to the Emergency department with temperature of 38°C, abdominal pain, and diarrhea. An abdominal CT scan showed multiples abscesses in the liver. Therefore, empirical meropenem treatment was started on suspicion of pyogenic liver abscesses due to lack of epidemiological risk factors for parasitic infection. In the liver aspirate samples, E. histolytica trophozoites were directly visualized and a real-time PCR was also positive for it. After amebiasis diagnosis, intravenous (IV) metronidazole therapy was initiated. During his admission, the patient developed pulmonary, cutaneous and cerebral involvement amebiasis. The management of amebic brain abscesses includes surgical drainage and antiparasitic treatment, in our case IV metronidazole was maintained for 10 weeks. No surgical treatment was performed and even so, the patient evolved favorably. CONCLUSIONS Amebic brain abscesses have a high mortality rate if inadequate treatment. A timely diagnosis and suitable treat can reduce its mortality, so the diagnosis of amebic infection should not be precluded in non-endemic countries.

Association between treatment duration and mortality or relapse in adult patients with Staphylococcus aureus bacteraemia: a retrospective cohort study.

OBJECTIVES: The aim was to evaluate the effect of duration of therapy (DOT) on mortality and relapse for patients with Staphylococcus aureus bacteraemia (SAB). METHODS: We performed a retrospective single-centre cohort study including adult patients with SAB. We determined the association between DOT (≤14 days versus >14 days) and mortality by adjusted hazard ratios (aHR) and 95% confidence intervals through Cox regression adjusted for immortal-time bias and confounding by indication, stratified by presence of complicated SAB (any of: endocarditis, implant, duration of SAB >2 days, fever >3 days). The primary outcome was 90-day all-cause mortality, and the secondary outcome was 90-day relapse. RESULTS: Between January 2010 and December 2015, we included 530 patients, of whom 94 out of 530 (17.7%) had methicillin-resistant SAB and 305 out of 530 (57.6%) had complicated SAB. Ninety-day mortality was 27.0% (143/530), with no significant trend across the study period; median time to death was 17 days (interquartile range (IQR) 8-30) after onset of SAB. Median DOT was 20 days (IQR 13-39). Patients with complicated SAB had significantly reduced mortality with DOT >14 days (aHR 0.32, 95% CI 0.16-0.64). DOT was not associated with mortality in patients with uncomplicated SAB (aHR 0.85; 0.41-1.78). Eighteen (18/530) patients (3.4%) relapsed; on univariate analysis, DOT was not associated with relapse (HR 1.01; 0.97-1.06). CONCLUSIONS: DOT >14 days is associated with higher survival in patients with complicated SAB, but not for patients with uncomplicated SAB. No association was found for relapse, but 90-day relapse was very low in this cohort. Importantly, 90-day mortality remained high across the study period.

[Early diagnosis and treatment of infective endocarditis]. / Diagnostic et prise en charge précoce des endocardites infectieuses.

Despite progress in medical and surgical treatment, morbidity and mortality remain high in infective endocarditis. Multiple diagnostic tools are now available to decrease delays in the diagnosis and instauration of appropriate treatment. Identification of patients at high risk of developing complications and those who may benefit from early surgery could improve prognosis and outcome. This article reviews some of the existing tools and options available for the diagnosis, risk evaluation and treatment of infective endocarditis, as well as the evidence for their systematic use.

[Means and methods of acoustic protection in aviation: current status and outlook for development].

Analysis of the current status of acoustic protection in aviation shows that despite the material progress in the field, risk of professional pathologies in flying and technical personnel is still high. The situation is dramatized by the lack of effective personal and crew acoustic protectors. The authors speculate on applicability of innovative materials and technologies, ingenious designs of earphones and modular prefabricated demountable structures. Tests of proposed personal protectors demonstrated their competitiveness with foreign analogs. Prospective lines of development, e.g. incorporation of active sound absorption systems in existing passive protectors are discussed.

[Criteria of noise pathologies in aviation specialists and their prognostic implications].

The paper outlines the criteria of noise pathologies in aviation specialists after extended period of exposure to high-intensity noise and infrared sound. Analysis of morbidity and clinical researches shows prevalence of such pathologies as neurosensory deafness, hypertension and discirculatory encephalopathy. These disorders were correlated with career length.

[Current problems of nuclear medicine in immunology]. / Aktual'nye problemy iadernoi meditsiny v immunologii.

The authors describe in a systemic order the potentialities of the use of nuclear medicine methods in immunology. Two fields of their application were singled out: experimental and clinical immunology, each one including in vivo and in vitro methods. The authors cited examples of their use, emphasizing the importance and prospects of radioimmunoassays for determination of the level of hormones in patients with various immunological pathology.

[Study of cellular immunity and the opioid peptide system in patients with multiple sclerosis]. / Issledovanie kletochnogo immuniteta i sistemy opiatnykh peptidov u bol'nykh rassiannym sklerozom.

Twenty-five patients with chronic progressing multiple sclerosis were examined for the content of beta-endorphin in blood serum, supernatants of activated lymphocytes and CSF by RIA. At the same time the parameters of cellular immunity were appraised. Different relations were discovered between cellular immunity and the content of beta-endorphin in biological fluids which may play a material part in the pathogenesis of multiple sclerosis.

[Blood hormones in chronic ischemic heart disease and acute myocardial infarct]. / Gormony krovi pri khronicheskoi ishemicheskoi bolezni serdtsa i ostrom infarkte miokarda.

The activity of some blood hormones was determined by radioimmune analysis in 58 patients with chronic ischemic heart disease (CIHD), 60 patients with myocardial infarction (MI) and in 24 practically healthy individuals. Increased activity of pituitary hormones (ACTH and TTH) with simultaneous increase in the blood STH content in the absence of essential changes in the FSH and LH content was established. These shifts in the production of pituitary hormones are evidently due both to disorders in the hypothalamo-hypophyseal area and to changes in the activity of systems coordinated to the pituitary gland in patients with CIHD. In patients with MI the activity of these hormones in blood does not differ from that in the control group. In patients with CIHD, the activity of the thyroid is diminished due to a decrease in its thyroxin-producing ability against the background of high activity of the pituitary thyreotropic function. The discussed shifts in the activity of some hormones in CIND and MI are conducive to the advancement of atherosclerosis and changes in myocardial metabolism.

[Use of the aldosterone antagonist, canrenoate potassium for treating chronic circulatory insufficiency]. / Primenenie antagonista al'dosterona kanrenoata kaliia dlia lecheniia bol'nykh s khronicheskoi nedostatochnost'iu krovoobrashcheniia.

The results of studying the clinical effect of the diuretic soldacton and its effect on a number of indices of water-electrolyte metabolism are discussed. The drug was used in 16 patients with IIB--III stage of circulatory insufficiency. It was found that soldacton possesses a moderate diuretic and natriuretic effect and produces a potassium-preserving effect. The drug is effective in various initial concentrations of plasma aldosterone which does not change significantly under its effect. Soldacton promotes improvement of tolerance to cardiac glycosides and diminishes the risk of the development of digitalis intoxication.

[Hormones in ischemic heart disease with the presence of coronary atherosclerosis]. / Gormony pri ishemicheskoi bolezni serdtsa s nalichiem koronarnogo aterosckleroza.

The activity of the pituitary hormones (ACTH, STH, TTH, FSH, LH), the adrenal hormones (cortisol, aldosterone), the kidney hormone (renin), and the thyroid hormones (thyroxine tri-iodthyronine), the thyroxine binding capacity of blood proteins and the activity of the hormones of the pancreas (insulin) and the sex glands (testosterone, estradiol) were studied in 26 males suffering from ischemic heart disease verified by means of selective coronarography and in 20 healthy males with no atherosclerosis of the coronary arteries of the heart. Patients with ischemic heart disease were found to be marked by increased activity in the blood of ACTH, TTH, cortisol, aldosterone, insulin, and estradiol and reduced concentration of STH, thyroxine, and testosterone. These shifts in the activity of the hypothalamo-hypophyseal system and in its subordinate hormonal systems play an important role in the origin of the atherosclerotic process and assosiated ischemic heart disease.

[Renin and various factors of its regulation in acute myocardial infarct]. / Renin i nekotorye faktory ego reguliatsii pri ostrom infarkte miokarda.

The activity of blood plasma renin and the content of aldosterone were studied in dynamics in 55 patients with acute myocardial infarction following a different course. The dependence of renin activity and potassium content is analysed. The authors did not find any dependence between the degree of growth of blood plasma renin activity and the course of the disease; exception to this were patients with disorders of rhythm and conductivity. It is presumed that changes in potassium metabolism play an important role in the changes in renin activity in myocardial infarction.

[Clinical value of determination of digoxin concentration in blood during treatment of cardiac insufficiency]. / Klinicheskoe znachenie opredeleniia kontsentratsii digoksina v krovi pri lechenii bol'nykh s serdechnoi nedostatochnost'iu.

The concentration of digoxin in blood was determined by the radio-immunologic method in 41 patients with circulatory insufficiency and permanent form of auricular fibrillation who were treated with the drug. In 85.5% of cases the therapeutic digoxin concentrations did not exceed 2 ng/ml. The therapeutic concentrations ranged from 0.3 to 3.6 ng/ml, the toxic from 0.9 to 6 ng/ml. A relationship was established between the dose of digoxin and its concentration in the blood of patients with normal renal filtration. It is concluded that the blood digoxin concentrations alone, without the clinical data being taken into account, cannot be a reliable criterion in assessment of the level of saturation with cardiac glycosides. Study of the dynamics of blood digoxin concentration in each patient allows its determination to be used to assess the tolerance to the drug, choose the adequate maintenance dose and the time for its correction, and to confirm the clinical signs of digitalis intoxication if the concentration of digoxin is above 2.5 ng/ml.