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Antibody testing successfully identified 7 patients whose encephalitis was due to the free-living amoeba, Balamuthia mandrillaris, a pathogen that should be suspected in individuals with soil contact, high CSF protein, and mass-like or ring-enhancing brain lesions.
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Acute Q fever may progress to endocarditis in patients with clinically silent valvulopathy. Those at risk require either extended antibiotic prophylaxis or close serological follow-up. All patients with acute Q fever should undergo transthoracic echocardiography, or in some instances transesophageal echocardiography, to exclude occult valvular abnormalities.
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All of the currently available non-invasive techniques for carotid artery imaging give accurate results when there is a high-grade stenosis (70-99%), but contrast-enhanced MRA is slightly more sensitive.
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In this retrospective case-control study, carotid stenting with cerebral protection and carotid endarterectomy were not significantly different in early morbidity and mortality.
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Seventeen cases of community acquired pneumonia due to Staphylococcus aureus are described. Most were methicillin resistant and caused severe disease with high mortality.
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This study in patients presenting to the emergency department with acute dyspnea showed that rapid BNP testing is cost-effective during the initial hospital encounter as well as at 180 days.
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Fatigue occurs commonly in patients with cancer, particularly when receiving chemotherapy or radiation. Furthermore, in long term survivors, persistent fatigue occurs in up to one third. Although anemia is one contributing factor, fatigue certainly occurs in its absence as well. Two recent reports are reviewed; one addressing the mechanisms and biochemical markers of persistent fatigue, and the other introducing a novel therapeutic approach directed at chemotherapy-associated fatigue. It is quite apparent that dysregulation of inflammatory mechanisms accounts for some component of fatigue and anti-inflammatory treatments may be of great value.
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In a retrospective analysis, medical ICU patients requiring mechanical ventilation for 2 days or more had lower ICU and hospital mortality (but more ventilator-associated pneumonia) if they were begun on enteral feeding during that time than if they were not.
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A prospective randomized trial carried out over a 6-year period of time enrolled 180 patients with ARDS of at least 7 days duration, and randomized them to receive either methylprednisolone or placebo. There was no significant difference noted in mortality at 60 days, though there was some improvement in ventilator-free and shock-free days during the first 28 days in patients treated with steroids. Steroids were also associated with an increased risk of death if started more than 2 weeks after the onset of ARDS.
