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Case Reports in Critical Care 2022Methylenedioxymethamphetamine (MDMA) is a psychoactive substance that is used commonly as a recreational drug at rave music festivals. MDMA intoxication can cause a...
Methylenedioxymethamphetamine (MDMA) is a psychoactive substance that is used commonly as a recreational drug at rave music festivals. MDMA intoxication can cause a myriad of symptoms and side effects including the manifestation of hyperpyrexia in patients. Hyperpyrexia can mimic a heat stroke and ultimately lead to various forms of end-organ damage. The most common methods used in treating MDMA-induced hyperpyrexia focus on the rapid reduction of core body temperature. Various off-label medications have also been used in combating MDMA-induced hyperpyrexia. Dantrolene is one such medication, although its role in the treatment of MDMA intoxication remains uncertain. This case series preliminarily examines the efficacy of dantrolene in mitigating MDMA-induced hyperpyrexia and potentially reducing the risk of end-organ damage in patients suffering from MDMA overdose. This study focuses on nine patients who presented after ingesting various forms of MDMA at "rave" music events. All patients were found to be hyperthermic in the field with a maximum core body temperature of 109 degrees Fahrenheit. All patients were immediately managed by cooling measures, and seven patients additionally received dantrolene in the field before being transferred to Arrowhead Regional Medical Center. Upon arrival to the hospital, nearly every patient was found to have significantly decreased body temperatures when compared to previously measured body temperatures out in the field. However, nearly all patients in the study were also noted to have laboratory abnormalities consistent with various forms of end-organ damage. The degree and severity of end-organ damage observed in MDMA-induced hyperpyrexia seem to be a function of initial core body temperature. Higher core body temperature tends to correlate with more forms of end-organ damage and a higher severity of end-organ damage. Intervention with dantrolene and cooling measures appeared to have no effect on reducing the risk of developing end-organ damage in this patient population.
PubMed: 36065452
DOI: 10.1155/2022/5346792 -
Advances in Skin & Wound Care Jan 2018Diagnosis of wound infection can be challenging because it relies on a combination of clinical signs and symptoms that are often nonspecific. Increased periwound... (Comparative Study)
Comparative Study
OBJECTIVE
Diagnosis of wound infection can be challenging because it relies on a combination of clinical signs and symptoms that are often nonspecific. Increased periwound cutaneous temperature is a classic sign of deep and surrounding wound infection, and its quantitative measurement is one of the most reliable and valid clinical signs of deep and surrounding skin infection at the bedside. Skin surface temperature differences may be detected using commercially available noncontact infrared thermometers. However, techniques to detect temperature using noncontact infrared thermometers vary, and no studies have evaluated these methods. Two such measurement techniques include the "4-point" and "whole-wound" scanning methods. This study assessed the ability of different infrared thermometers using the aforementioned techniques to detect clinically meaningful differences in periwound cutaneous temperatures used in the diagnosis of wound infection.
METHODS
A prospective cohort study was conducted from 2015 to 2016 of consenting adult patients 18 years or older with an open wound attending a regional wound care clinic. One hundred patients with wounds underwent surface temperature measurement. Infection was not a specific inclusion criterion as the primary objective was to conduct a comparative assessment of infrared thermometry devices. Demographic data (age, height, weight, gender, and ethnicity) were also collected. Each wound was measured using 4 different noncontact infrared thermometers: Exergen DermaTemp 1001 (Exergen Corporation, Watertown, Massachusetts), Mastercraft Digital Temperature Reader (Mastercraft, Toronto, Ontario, Canada), Mastercool MSC52224-A (Mastercool Inc, Randolph, New Jersey), and Etekcity ETC-8250 Temperature Heat Pen (Etekcity, Anaheim, California). Data analysis was based on a comparison of 4 periwound skin surface temperature measurement differences (ΔT in degrees Fahrenheit) between the wound site and an equivalent contralateral control site.
OUTCOME MEASURES
The primary outcome of the ability of each thermometer to detect a clinically significant difference in temperature was assessed with χ analysis. Paired t tests were conducted to compare the ΔT measurements of each specific thermometry device between the 2 measurement techniques. Pearson product moment correlation coefficients were calculated for the temperature ΔT for both measuring techniques for all devices to determine level of agreement. A 1-way analysis of variance was conducted to compare temperature measurements among the infrared thermometry devices.
MAIN RESULTS
There was no significant difference in the ability of each thermometer to detect a clinically meaningful difference of 3° F by either the 4-point (P = .10) or whole-wound techniques (P = .67). When a definition of 4° F was used, results were similar (4-point, P = .15; whole wound, P = .20). Comparisons among devices and techniques showed strong correlations (>0.80). Etekcity ETC-8250 and the 4-point measurement compared with the Exergen device using the whole-wound technique had a correlation coefficient of 0.72. Spearman ρ demonstrated a similarly high degree of correlation between techniques and devices, and only the Etekcity ETC-8250 device had a coefficient of 0.71 to 0.90 when compared with others. Paired t testing for each thermometry device comparing measurement techniques for raw temperatures ΔT demonstrated no significant difference (P > .05). No statistical differences among the ΔT values for the 3 different thermometers were noted when using the whole-wound method (P = .095). Similarly, no significant differences among the ΔT values were noted for the 4 different thermometers when using the 4-point method (P = .10).
CONCLUSIONS
The results of this study demonstrate that both the 4-point and whole-wound methods of temperature acquisition using cost-efficient infrared thermometers provide accurate and similar results in clinical wound care settings.
Topics: Aged; Analysis of Variance; Cohort Studies; Female; Humans; Infrared Rays; Male; Middle Aged; Prospective Studies; Sensitivity and Specificity; Skin Temperature; Thermography; Thermometers; Wound Infection
PubMed: 29240589
DOI: 10.1097/01.ASW.0000527352.75716.70 -
Ear and Hearing Jun 1988Two case reports are presented to highlight the important effects of body temperature in clinical auditory brain stem response (ABR) measurement. Case 1 is an 11 year... (Review)
Review
Two case reports are presented to highlight the important effects of body temperature in clinical auditory brain stem response (ABR) measurement. Case 1 is an 11 year old boy in coma secondary to severe head injury. High dose barbiturate therapy suppressed brain stem neurologic signs and the ABR was relied on as a monitor of CNS status. Hypothermia during this period of intensive care was a crucial factor for meaningful interpretation of ABR findings. The second case was a 26 year old male undergoing hyperthermic therapy for advanced cancer. As body temperature increased from 38 to 42 degrees Centigrade (107.6 degrees Fahrenheit), there was a systematic decrease in latency for waves III and V. An overall hyperthermia-related decrease in the wave I-V latency interval of 0.5 to 0.6 milliseconds was observed on two test dates. ABR results for these two cases are discussed in the context of basic knowledge on body temperature and auditory electrophysiology.
Topics: Adult; Body Temperature; Brain Stem; Child; Coma; Evoked Potentials, Auditory; Humans; Hyperthermia, Induced; Hypothermia; Liver Neoplasms; Male; Melanoma
PubMed: 3044898
DOI: 10.1097/00003446-198806000-00006 -
Journal of Analytical Toxicology May 2017The clinical presentation, autopsy findings and toxicology results in an acute fatality involving N-ethylpentylone, a new cathinone derivative, are described. Law...
The clinical presentation, autopsy findings and toxicology results in an acute fatality involving N-ethylpentylone, a new cathinone derivative, are described. Law enforcement transported a male who was agitated and exhibiting unusual behavior to a local hospital. Upon arrival at the hospital, his body temperature was 105.5 degrees Fahrenheit and his blood pH was 6.7. Clinical laboratory analysis revealed elevated troponins, rhabdomyolysis, hypoglycemia, hepatic and renal injury, respiratory failure and disseminated intravascular coagulation. He was intubated and admitted to the intensive care unit, treated with cooling blankets, bicarbonate and intravenous fluids. Despite medical treatment, he went into cardiac arrest and was pronounced dead ~36 h after admission. Autopsy findings identified some abrasions on his arms and legs, a bloody nose and a mildly enlarged heart. Antemortem blood was analyzed by gas chromatography coupled with a mass spectrometer which identified N-ethylpentylone. Based on clinical presentation, autopsy findings and toxicology results, the medical examiner concluded the cause of death was intoxication by N-ethylpentylone and the manner of death was accident.
Topics: Autopsy; Benzodioxoles; Butylamines; Central Nervous System Stimulants; Fever; Forensic Toxicology; Heart Arrest; Humans; Male
PubMed: 28137731
DOI: 10.1093/jat/bkx004 -
Journal of Neurology May 2024Some people with multiple sclerosis (pwMS) avoid exercise due to overheating. Evidence from a variety of cooling treatments shows benefits for pwMS. (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Some people with multiple sclerosis (pwMS) avoid exercise due to overheating. Evidence from a variety of cooling treatments shows benefits for pwMS.
OBJECTIVE
Conduct a randomized controlled trial of antipyretic treatment before exercise in pwMS.
METHODS
Adults over age 18 diagnosed with relapsing-remitting MS reporting heat sensitivity during exercise were randomly assigned to one of six sequences counterbalancing aspirin, acetaminophen, placebo. At each of three study visits separated by ≥ one week, participants received 650-millograms of aspirin, acetaminophen, or placebo before completing a maximal exercise test. Primary outcomes were body temperature change and total time-to-exhaustion (TTE), secondary outcomes were physiological and patient-reported outcomes (PROs).
RESULTS
Sixty participants were enrolled and assigned to treatment sequence; 37 completed ≥ one study visit. After controlling for order effects, we found that body temperature increase was reduced after aspirin (+ 0.006 ± 0.32 degrees Fahrenheit, p < 0.001) and after acetaminophen (+ 0.31 ± 0.35; p = 0.004) compared to placebo (+ 0.68 ± 0.35). TTE after aspirin (331.6 ± 76.6 s) and acetaminophen (578.2 ± 82.1) did not differ significantly from placebo (551.0 ± 78.4; p's > 0.05). Aspirin benefited all secondary outcomes compared to placebo (all p's < 0.001); acetaminophen showed broadly consistent benefits.
CONCLUSION
These results support antipyretic treatment as effective for reducing overheating during exercise in pwMS and failed to support antipyretics for increasing TTE in the context of a maximal exercise test. Benefits were shown for physiological markers of exercise productivity and PROs of fatigue, pain, and perceived exertion.
Topics: Humans; Male; Female; Adult; Antipyretics; Acetaminophen; Aspirin; Middle Aged; Exercise; Multiple Sclerosis, Relapsing-Remitting; Body Temperature; Double-Blind Method; Administration, Oral; Exercise Test; Treatment Outcome
PubMed: 38413464
DOI: 10.1007/s00415-023-12147-6 -
PloS One 2017Heat-not-burn tobacco products, battery powered devices that heat leaf tobacco to approximately 500 degrees Fahrenheit to produce an inhalable aerosol, are being...
Heat-not-burn tobacco products, battery powered devices that heat leaf tobacco to approximately 500 degrees Fahrenheit to produce an inhalable aerosol, are being introduced in markets around the world. Japan, where manufacturers have marketed several heat-not-burn brands since 2014, has been the focal national test market, with the intention of developing global marketing strategies. We used Google search query data to estimate, for the first time, the scale and growth potential of heat-not-burn tobacco products. Average monthly searches for heat-not-burn products rose 1,426% (95%CI: 746,3574) between their first (2015) and second (2016) complete years on the market and an additional 100% (95%CI: 60, 173) between the products second (2016) and third years on the market (Jan-Sep 2017). There are now between 5.9 and 7.5 million heat-not-burn related Google searches in Japan each month based on September 2017 estimates. Moreover, forecasts relying on the historical trends suggest heat-not-burn searches will increase an additional 32% (95%CI: -4 to 79) during 2018, compared to current estimates for 2017 (Jan-Sep), with continued growth thereafter expected. Contrasting heat-not-burn's rise in Japan to electronic cigarettes' rise in the United States we find searches for heat-not-burn eclipsed electronic cigarette searches during April 2016. Moreover, the change in average monthly queries for heat-not-burn in Japan between 2015 and 2017 was 399 (95% CI: 184, 1490) times larger than the change in average monthly queries for electronic cigarettes in the Unites States over the same time period, increasing by 2,956% (95% CI: 1729, 7304) compared to only 7% (95% CI: 3,13). Our findings are a clarion call for tobacco control leaders to ready themselves as heat-not-burn tobacco products will likely garner substantial interest as they are introduced into new markets. Public health practitioners should expand heat-not-burn tobacco product surveillance, adjust existing tobacco control strategies to account for heat-not-burn tobacco products, and preemptively study the health risks/benefits, popular perceptions, and health messaging around heat-not-burn tobacco products.
Topics: Electronic Nicotine Delivery Systems; Hot Temperature; Internet; Search Engine; Tobacco Products
PubMed: 29020019
DOI: 10.1371/journal.pone.0185735 -
IPPF Medical Bulletin Oct 1991
Topics: Americas; Delivery of Health Care; Developed Countries; Diagnosis; Endoscopy; Equipment and Supplies; Family Planning Services; Health; Health Facility Planning; Health Planning; Health Planning Guidelines; Health Services; Health Services Administration; Hygiene; Laparoscopy; Maryland; North America; Organization and Administration; Physical Examination; Public Health; Quality Control; Surgical Equipment; Surgical Instruments; Syringes; United States
PubMed: 12284649
DOI: No ID Found -
BMC Surgery Jan 2020Pancreatic pseudocyst is a very common benign cystic lesion of the pancreas. It develops in 5-15% of patients with peri-pancreatic fluid collection following acute...
BACKGROUND
Pancreatic pseudocyst is a very common benign cystic lesion of the pancreas. It develops in 5-15% of patients with peri-pancreatic fluid collection following acute pancreatitis. Collection usually occurs within the lesser sac of the omentum (near the pancreatic head and body region). But in 20-22% cases, that may be extra-pancreatic like in the mediastinum, pleura, in the peritoneal cavity including the pelvis. The pancreatic pseudocyst typically contains brownish fluid with necrotic tissue sludge which may get infected giving rise to infected pseudocyst or pancreatic abscess. The present case is an unusual condition of a young alcoholic subject who was finally diagnosed as a case of a pancreatic abscess within hepato-gastric ligament and was managed with operative intervention. To the best of the author's knowledge, it is the first-ever reported case of a pancreatic abscess within the hepato-gastric ligament in the world. Literature was reviewed to explore potential etiopathogenesis and therapeutic strategies of this extremely rare condition.
CASE PRESENTATION
A 38 years old gentleman, chronic alcoholic, having a previous history of acute pancreatitis 3 months back, presented with fever (102 degrees Fahrenheit) and a huge [20 cm (horizontal) X 15 cm (vertical)] severely painful swelling in the epigastric region. The swelling was round-shaped, intra-abdominal, fixed to deeper tissue, tense-cystic, poorly trans-illuminant, non-pulsatile and irreducible. Routine blood tests showed leucocytosis (14,500/mm) with neutrophilia and elevated plasma pancreatic amylase and lipase levels. USG and MDCT scan of the whole abdomen revealed a thick-walled echogenic cystic swelling of size 18 cm × 12 cm in the epigastric region. USG guided aspiration of the cyst revealed mixed purulent brownish fluid. The cyst fluid was negative for mucin stain and contained high amylase level with low CEA level, suggesting infected pancreatic pseudocyst. An open drainage procedure was considered through an upper midline laparotomy. Aspiration of the pus mixed cyst fluid along with tissue debris was done. Through irrigation of the cyst was done with normal saline. The cyst wall was de-roofed leaving a small part adherent to the inferior surface of the left lobe of the liver. Later the cyst fluid culture showed significant growth of Escherichia coli. He was put on IV antibiotics. The patient was discharged in a stable condition after 5 days. The histopathological examination confirmed pancreatic abscess. Six months after the operation, the patient is doing well, remaining asymptomatic and there is no sign of recurrence.
CONCLUSIONS
Due to extreme rarity, pancreatic abscess formation within hepato-gastric ligament may be a diagnostic dilemma and requires a high index of suspicion. Surgeons should be aware of this rare clinical entity for prompt management of potential morbidity.
Topics: Abscess; Acute Disease; Adult; Cysts; Drainage; Humans; Laparotomy; Ligaments; Liver; Male; Pancreas; Pancreatic Pseudocyst; Stomach; Tomography, X-Ray Computed
PubMed: 32000756
DOI: 10.1186/s12893-020-0688-0 -
Public Health Reports (Washington, D.C.... 1990The authors studied total mortality in Allegheny County, PA, during the summer of 1988. A heat wave occurred in July of 1988, with daily maximum temperatures near or... (Comparative Study)
Comparative Study
The authors studied total mortality in Allegheny County, PA, during the summer of 1988. A heat wave occurred in July of 1988, with daily maximum temperatures near or above 90 degrees Fahrenheit on 15 consecutive days. During that period there were a total of 694 deaths from all causes in the county, compared with an expected 587 deaths (P less than .01). All 107 excess deaths were of persons ages 65 or older, with the majority (78) occurring to persons older than age 75. Daily mortality was most closely correlated with average temperature from the previous day (R = .49, P less than .01), suggesting the cumulative effects of successive high daytime and night-time temperatures on susceptible persons. Evaluation of a possible effect on mortality of high ambient ozone levels detected in early July suggested that ozone did not contribute to excess mortality during the heat wave. Comparison of the 1988 heat wave with a less intense hot spell of 1973 indicated that excess mortality was less than would have been expected in 1988. The authors speculate that increased public awareness and the wider use of air conditioning over the years may have reduced the lethality of periods of extreme summer temperatures in urban areas. Further research is needed to evaluate this hypothesis completely. Public health officials should continue to monitor weather forecasts for predictions of extended periods of unusual heat and should warn the public to take suitable precautions during such periods.
Topics: Age Factors; Aged; Death Certificates; Death, Sudden; Female; Hot Temperature; Humans; Male; Middle Aged; Pennsylvania; Seasons; Sex Factors
PubMed: 2113688
DOI: No ID Found -
Clinical Microbiology and Infection :... Oct 2009Seasonal variation in the rates of infection with certain Gram-negative organisms has been previously examined in tertiary-care centres. We performed a population-based...
Seasonal variation in the rates of infection with certain Gram-negative organisms has been previously examined in tertiary-care centres. We performed a population-based investigation to evaluate the seasonal variation in Escherichia coli bloodstream infection (BSI). We identified 461 unique patients in Olmsted County, Minnesota, from 1 January 1998 to 31 December 2007, with E. coli BSI. Incidence rates (IR) and IR ratios were calculated using Rochester Epidemiology Project tools. Multivariable Poisson regression was used to examine the association between the IR of E. coli BSI and average temperature. The age- and gender-adjusted IR of E. coli BSI per 100 000 person-years was 50.2 (95% CI 42.9-57.5) during the warmest 4 months (June through September) compared with 37.1 (95% CI 32.7-41.5) during the remainder of the year, resulting in a 35% (95% CI 12-66%) increase in IR during the warmest 4 months. The average temperature was predictive of increasing IR of E. coli BSI (p 0.004); there was a 7% (95% CI 2-12%) increase in the IR for each 10-degree Fahrenheit (c. 5.5 degrees C) increase in average temperature. To our knowledge, this is the first study to demonstrate seasonal variation in E. coli BSI, with a higher IR during the warmest 4 months than during the remainder of the year.
Topics: Adolescent; Adult; Aged; Bacteremia; Child; Child, Preschool; Escherichia coli; Escherichia coli Infections; Female; Humans; Incidence; Infant; Infant, Newborn; Male; Middle Aged; Minnesota; Seasons; Temperature; Young Adult
PubMed: 19845704
DOI: 10.1111/j.1469-0691.2009.02877.x