scholarly journals Significant Intercurrent Illness

2020 ◽  
Author(s):  
Keyword(s):  
Intercurrent Illness

Sick day advice for people with diabetes

2021 ◽  
Vol 32 (Sup3) ◽  
pp. S10-S13
Author(s):  
Martha Stewart
Keyword(s):  
Type 2 Diabetes ◽  
Diabetes Management ◽  
Glucose Levels ◽  
Emergency Hospital Admission ◽  
Intercurrent Illness ◽  
Martha Stewart ◽  
The Common ◽  
Tract Infections

In this article Martha Stewart discusses how illness affects diabetes management and outlines the ‘sick-day advice’ that should be shared with people living with type 1 and type 2 diabetes Intercurrent illness can cause glucose levels to rise in people with diabetes mellitus. These illnesses include the common cold, diarrhoea and vomiting, urinary tract infections and COVID-19. If diabetes is not managed well during illness it can escalate and result in more serious conditions, such as diabetic ketoacidosis (DKA) and hyperosmolar hyperglycaemic state (HHS), which would require emergency hospital admission. This article discusses how illness affects diabetes management and outlines the ‘sick-day advice’ that should be shared with people living with type 1 and type 2 diabetes.

Osteomyelitis

1995 ◽  
Vol 16 (10) ◽  
pp. 380-384
Author(s):  
Dennis R. Roy
Keyword(s):  
Immune System ◽  
Growth Plate ◽  
Pathogenic Bacteria ◽  
Chicken Pox ◽  
Hematogenous Osteomyelitis ◽  
Acute Hematogenous Osteomyelitis ◽  
Intercurrent Illness ◽  
Direct Inoculation ◽  
Focus Of Infection ◽  
Childhood Infection

Osteomyelitis, defined as an inflammation of bone generally caused by a pyogenic organism, is a common disorder of childhood. Infection most commonly is caused by blood-borne bacteria that localize in the metaphysis. Trauma or surgery also may result in direct inoculation or implantation of bacteria into the bone, or an adjacent focus of infection might extend directly to the bone, resulting in osteomyelitis. The etiology of acute hematogenous osteomyelitis is not understood completely. Bacteremia in childhood occurs frequently, if not daily; thus, the presence of bacteria alone may not explain why infection begins. Recent trauma coincidental with a bacteremia has been postulated. The presence of an intercurrent illness (ie, chicken pox) or infection may introduce a larger number of organisms or different pathogenic bacteria into the system or alter the immune system, making the host more susceptible. An understanding of the anatomy of bone and the pathogenesis of osteomyelitis is essential to appreciate the protean manifestations of the disorder. Pathogenesis In acute hematogenous osteomyelitis, infection is localized in the metapahysis. The circulation of the bone predisposes this region to the infection. Epiphyseal and metaphyseaal blood supplies generally are separate. The blood supply to the metaaphysis originagtes when the nutrient arteries send small terminala branches that end at the growth plate.

Unstable Diabetes and Unstable Families: A Psychosocial Evaluation of Diabetic Children with Recurrent Ketoacidosis

PEDIATRICS ◽  
1984 ◽  
Vol 73 (6) ◽  
pp. 749-755
Author(s):  
Kimberly White ◽  
Mary Lee Kolman ◽  
Phyllis Wexler ◽  
Gail Polin ◽  
Robert J. Winter
Keyword(s):  
Family Involvement ◽  
Emotional Support ◽  
Psychosocial Problems ◽  
Diabetic Control ◽  
Psychosocial Assessment ◽  
Psychosocial Characteristics ◽  
Psychosocial Dysfunction ◽  
Intercurrent Illness ◽  
Diabetic Children ◽  
Onset Of Diabetes

To investigate the physical and psychological factors associated with labile diabetic control, 30 children and adolescents with recurrent diabetic ketoacidosis were included in a retrospective longitudinal review covering an 8-year period. The details of the ketoacidosis episodes and the psychosocial characteristics of the patient and his family were summarized from the medical record. Only a minority of the ketoacidosis episodes were overtly and solely related to intercurrent illness or poor compliance. A majority of the subjects studied lived in families with substantial psychosocial dysfunction, including chronic unresolved interpersonal conflict, inadequate parenting, father not in home, financial stress, and lack of family involvement with the diabetes. Many of the children displayed behavioral and personality problems. In most of these 30 cases, there was evidence that these dysfunctions existed prior to the onset of diabetes. These psychosocial problems were not immediately apparent in many instances, thus requiring more comprehensive psychosocial assessment and involvement by a social worker and/or a psychologist. Ongoing emotional support and counseling were instrumental in reversing the pattern of recurrent ketoacidosis, in coordination with care by all members of the diabetes team. The findings from this experience suggest that recurrent ketoacidosis warrants prompt evaluation from a psychosocial as well as a physical perspective.

Fifteen-minute consultation: Assessing the child with a Blalock-Taussig shunt who is unwell in a district general hospital

2019 ◽  
Vol 105 (3) ◽  
pp. 142-146 ◽  
Author(s):  
Steven McVea ◽  
Anne McGettrick
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
General Hospital ◽  
Congenital Heart ◽  
District General Hospital ◽  
Univentricular Heart ◽  
Pulmonary Shunt ◽  
Intercurrent Illness ◽  
General Paediatrician ◽  
Blalock Taussig Shunt

Univentricular heart disease accounts for ~1.25% of all congenital heart disease. Such cases remain among the most challenging to manage, typically requiring a three-staged palliation. The first stage involves placement of a systemic to pulmonary shunt. While a variety of shunt types, including ductal stenting, can be used to manage univentricular conditions, the archetype remains the Blalock-Taussig (BT) shunt. While waiting future palliative intervention at home, intercurrent illness may necessitate presentation to a district general hospital where subspecialist advice and assessment is remote. This review aims to present the general paediatrician with a straightforward BT shunt physiology overview highlighting unique complications which may complicate intercurrent illness.

Chapter 12 Intercurrent illness in advanced dementia

Dementia ◽  
2011 ◽  
Author(s):  
Victor Pace ◽  
Adrian Treloar ◽  
Sharon Scott ◽  
Max Watson
Keyword(s):  
Advanced Dementia ◽  
Intercurrent Illness

Nutritional Management of the CAPO Patient

1980 ◽  
Vol 1 (4) ◽  
pp. 22-23 ◽  
Author(s):  
Michael J. Blumenkrantz ◽  
R. William Schmidt
Keyword(s):  
Protein Intake ◽  
Nutritional Support ◽  
Significant Contribution ◽  
Nutritional Therapy ◽  
Residual Renal Function ◽  
Glucose Absorption ◽  
Peripheral Vein ◽  
Intercurrent Illness ◽  
Malnourished Patient ◽  
Nutritional Needs

Malnutrition and wasting are common in patients undergoing maintenance dialysis. These problems may be more prevalent in patients undergoing peritoneal dialysis due to inadequate dialysis, poor protein intake, loss of nutrients in dialysate and tissue breakdown associated with intercurrent illnesses, particularly peritonitis. Periodic assessment of the nutritional status of these patients should be used as a guide to appropriate nutritional therapy. Protein and aminoacid loss <h1ring CAPD average only 8.0 and 3.0 g/day, respectively; with peritonitis, losses increase. Balance studies indicate that in a well-nourished patient 1.2 g protein/kg body weight is probably adequate; a malnourished patient should receive 1.4 –1.6 g/kg. Sufficient dialysis must be prescribed to enable ingestion of this diet; residual renal function makes a significant contribution to to∼al clearance. With CAPD, energy intake is supplemented by large amounts of glucose absorption; this is beneficial except for the obese or hyperlipoproteinemic patient. Nutritional support of the patient with intercurrent illness is crucial; nutrition administered via peripheral vein may be beneficial. Management of the nutritional needs of the diabetic presents additional problems which often test the skills of the clinician.

The Safety and Tolerability of Oral Fludarabine, ±oral Cyclophosphamide and Iv Rituximab Therapy In Previously Untreated Patients with Chronic Lymphocytic Leukaemia (CLL) Aged ≥65 Years – Interim Analysis From the Australasian Leukaemia and Lymphoma Group (ALLG) and CLL Australian Research Consortium (CLLARC) CLL5 Study.

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 699-699 ◽  
Author(s):  
Stephen P Mulligan ◽  
Devinder S Gill ◽  
William E. P. Renwick ◽  
Melanie L Sulda ◽  
O. Giles Best ◽  
...  
Keyword(s):  
Board Of Directors ◽  
Dose Reduction ◽  
Advisory Committees ◽  
Treatment Regimens ◽  
Intercurrent Illness ◽  
Treatment Dose ◽  
Clinical Responses ◽  
Binet Stage ◽  
Grade 3 ◽  
Research Consortium

Abstract Abstract 699 Background: Combination immunochemotherapy with fludarabine (F), cyclophosphamide (C) and rituximab (R) gave superior progression free and overall survival compared to FC in the German CLL8 Study. The median age in CLL8 was 61 years compared to a median age for overall CLL patients of 72 years. There is ongoing debate regarding the tolerability and safety of FCR in elderly patients. Arbitrary dose reductions are common practice. Oral FC is more convenient for many older patients. Methods: Previously untreated patients with progressive CLL aged ≥65 were randomised to one of three treatment regimens FR5, FCR3 and FCR5 as follows: (i) F 24mg/m2 po D1-5 + R (375 mg/m2 C1, 500mg/m2 C2-6) iv D1 (FR5), (ii) F 24mg/m2 po and C 150mg/m2 po D1-3 + R iv D1 (FCR3) or (iii) F 24mg/m2 po + C 150mg/m2 po D1-5 + R iv D1 (FCR5), all given at monthly intervals for an intended 6 cycles. The dosage of FCR5 is equivalent to standard intravenous FCR in the CLL8 Study. Patients were administered their therapy arm with no dose reduction. Fludarabine dosing was reduced according to renal function by calculated GFR. Therapy was delayed by 2 weeks if there was any grade 3 or 4 toxicity. If this was unresolved after 2 weeks, patients were taken off study. If toxicity resolved to grade 2 or less, therapy proceeded. Results: Over half the planned patients (65 of 120) were recruited by 1 August, 2010 from 21 centres in Australia and New Zealand with the study having been open for 18 months. Median age is 72 (range 65–85) years. Binet stage at registration was progressive A – 11 (16.9%), B – 32 (49.2%) and C – 22 (33.8%). Randomisations are FR5 – 22, FCR3 – 22 and FCR5 – 21. FISH data is available on 50 patients: 25 with 13q-, 9 with 12+, 4 with 11q−, and 6 with 17p−. P53 functional analysis is available on 15 patients. Interim reasons for cessation of treatment, dose delay and clinical responses are shown in tables 1, 2 and 3 respectively for the total patient cohort. Cessations for reasons other than toxicity occurred in 7 patients: intercurrent illness (N=2) with acute myocardial infarction (AMI) and recurrent episodes of amnesia, and other reasons (N=5). Deaths were recorded for 2 patients due to infection and AMI. Conclusions: Oral F(C)R therapy appears generally safe and well tolerated to date in CLL patients aged ≥65 years requiring first-line treatment. Using stringent stopping criteria with delay of 2 weeks for recovery of grade 3 or 4 toxicity but no dose reduction, about half the patients will stop early due to toxicity or intercurrent illness. Nevertheless, response rates are high. Accrual is ongoing. Disclosures: Mulligan: Roche: Honoraria, Membership on an entity's Board of Directors or advisory committees; Bayer Schering, now Genzyme: Honoraria. Seymour:Roche: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau.

Extended neoadjuvant chemotherapy (CT) in borderline resectable pancreas cancer (BRPC).

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 4043-4043
Author(s):  
J Bart Rose ◽  
Flavio G. Rocha ◽  
Bruce S. Lin ◽  
Adnan Alseidi ◽  
Thomas A. Biehl ◽  
...  
Keyword(s):  
Neoadjuvant Chemoradiation ◽  
R0 Resection ◽  
Significant Activity ◽  
Borderline Resectable ◽  
Nccn Guidelines ◽  
Prior Therapy ◽  
Intercurrent Illness ◽  
Ca 19.9 ◽  
Intent To Treat ◽  
Extended Course

4043 Background: The optimal surgical (S) approach to BRPC is unknown. We evaluated an approach to BPRC using extended course chemotherapy (CT) without routine neoadjuvant chemoradiation (CRT). Clinical outcomes were evaluated on an "intent to treat" basis. Methods: Patients (pts) were identified from a prospectively-maintained database started in 2008. Pts required 1) Dx BRPC with non-tail primary per radiographic staging using AHPBA/NCCN guidelines 2) No prior therapy (Rx) 3) Negative staging/exploratory laparoscopy prior to S 4) All cancer Rx at VMMC prior to S. Pts received gemcitabine/docetaxel (G/D) as initial CT. Pts with systemic progression/comorbid complication prior to 24 wks were not offered local Rx; pts with localized cancer at 24 wks judged likely to achieve R0 resection were offered S; all other pts were offered fluoropyrimidine-based CRT. Results: Of 76 identified pts (median age 66), 12 (16%) are on initial CT and not fully evaluable. G/D as sole CT achieved 24 wk disease control in 46/64 (72%) pts and >50% decline in baseline CA 19.9 in 39/55 pts (71%). 53/64 fully evaluable pts (83%) completed 24 wks CT, 11/64 pts (17%) did not (4 systemic progression, 3 Rx- related, 4 intercurrent illness). 50/53 pts attempted local Rx (40 S, 10 CRT, 2 unfit, 1 refused). 30/40 pts (75%) had successful S (all R0), 10/40 pts (25%) had inoperable disease (4 local-subsequently received CRT, 6 systemic). 23/30 pts (77%) have received some form Rx post R0 resection. With median f/o of 20 mo, 23/44 (52%), 17/30 (57%), and 6/14 (43%) receiving any local Rx, S, and CRT-only remain progression free. 13/30 S pts recurred, 3 local (10%) and 10 systemic (33%). 1-yr, 2-yr, 3-yr, and median overall survivals (OS) for fully evaluable pts respectively are 82%, 50%, 36%, and 27 mo. Median OS for pts receiving CT-only (20 pts), CT+CRT (14 pts), and R0 pts are 12 mo, 17 mo, and >20 mo, respectively. 25/30 R0 pts remain alive (range 6-54 mo). Conclusions: 1) Extended neoadjuvant CT without routine neoadjuvant CRT is a feasible approach to BRPC. 2) G/D has significant activity in BRPC. 3) Pretreatment surgical staging combined with the above Rx yields a high probability of R0 resection. 4) OS for both resected and non-resected pt was superior to usual literature comparators.

Trabectedin (T) as second line treatment option for patients with epithelioid malignant pleural mesothelioma (MPM) in progression following pemetrexed/platin-derivates chemotherapy: ATREUS trial.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 8513-8513 ◽  
Author(s):  
Diego Luigi Cortinovis ◽  
Lital Hannah Hollander ◽  
Luciano Carlucci ◽  
Federica Grosso ◽  
Giovanni Luca Ceresoli ◽  
...  
Keyword(s):  
Antineoplastic Agent ◽  
Safety Data ◽  
Progression Free Survival ◽  
Line Treatment ◽  
Second Line ◽  
Stage Design ◽  
Intercurrent Illness ◽  
Disease Stabilization ◽  
Elevated Rate ◽  
Grade 3

8513 Background: Systemic chemotherapy in MPM is inevitably followed by relapse, and response rates to second line treatment are limited. T is an antineoplastic agent targeting both the malignant cells and the tumor microenvironment with demonstrated activity against a range of tumors. We aimed to study the activity and safety of T in advanced MPM. Methods: ATREUS, an Italian multicenter single arm phase II trial, assessed the activity T in MPM evaluating the proportion of patients responding to treatment and achieving progression free survival for 12 weeks (PFS12w). Pre-treated epithelioid and naive or pre-treated biphasic/sarcomatoid pts were treated until progression or unacceptable toxicity. Initial dose was 1.3 mg/m2, over 3 hours every 21 days, later reduced to 1.1 mg/m2to improve tolerability. In the epithelioid cohort, sample size was based on a Simon's Optimal Two-Stage Design. The study was set to reject, at an alpha error of 10% the hypothesis that PFS12w was ≤25% and to demonstrate, with a power of 85% the hypothesis that PFS12w was ≥40%. At least 20 out of 62 pts with assessed disease, no major protocol violations, either receiving ≥12 weeks of treatment or interrupting before for progression or death (per protocol – PP analysis) were to reach PFS12w in order to consider T effective. Results: 71 pts were enrolled and evaluable. Average age was 65.8 ± 8.75 years. 71.8% were male and 82.5% presented stage III or IV disease. 42.4% (25/59) of pts included in the PP analysis obtained PFS12w (95% CI: 29.6% - 55.9%). In a second, more conservative analysis, including pts withdrawn prematurely for toxicity or intercurrent illness as failures, PFS12w rate reached 38.5% (25/65 pts). The most frequent grade ≥3 treatment-related toxicities werehepatic toxicity (60.5%), non-febrile neutropenia (21.1%), and fatigue (6.6%). Five pts (7%) interrupted treatment for toxicities (2 liver, 1 multi-organ failure, 1 thrombocytopenia, 1 T intolerance). Conclusions: In pts with advanced epithelioid MPM, second line treatment with T showed an elevated rate of disease stabilization. Safety data is promising but require further evaluation. Clinical trial information: NCT02194231.

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