Pub Date : 2014-12-01DOI: 10.1093/BJACEACCP/MKT067
M. Beed, R. Sherman, S. Holden
Fungi are eukaryotes (i.e. having membranes that cover the nucleus and other intracellular organelles); this makes them structurally similar to animals and plants, but different from prokaryotes such as bacteria. Fungi have rigid cell walls containing chitin, chitosan, mannan, and glucan. Fungi also have cell membranes structurally different from that of animals as they contain ergosterol rather than cholesterol. The simplest subclassification of fungi responsible for human infections is as either moulds (e.g. Aspergillus species) or yeasts (e.g. Candida species). Under the microscope, yeasts are small rounded cells that can bud, while moulds demonstrate a stranded, filamentous appearance caused by hyphae. Some fungi can exist in both forms (these are said to be dimorphic, e.g. Blastomyces), and some yeasts can develop pseudo-hyphae (e.g. Candida species). When the hyphae of filamentous fungi develop a matted, intermeshed network, this is referred to as a mycelium. Fungi are slow-growing, with cell-doubling times often as long as days, which can affect the ability to identify clinically relevant infections. Reproduction may be sexual, asexual, or both; and may result in the production of ‘daughter cells’ or spores. Many fungi and spores are environmentally ubiquitous, for example, Aspergillus species are commonly found in soil, and their spores are prevalent in the atmosphere. Several fungi are common human flora (for example, Candida occur within the human gut) or are able to colonize structures such as the gut, oropharynx, or upper and lower airways. It can sometimes be difficult to tell whether or not a positive fungal culture is indicative of invasive disease or simply the result of the capture of normal flora.
{"title":"Fungal infections and critically ill adults","authors":"M. Beed, R. Sherman, S. Holden","doi":"10.1093/BJACEACCP/MKT067","DOIUrl":"https://doi.org/10.1093/BJACEACCP/MKT067","url":null,"abstract":"Fungi are eukaryotes (i.e. having membranes that cover the nucleus and other intracellular organelles); this makes them structurally similar to animals and plants, but different from prokaryotes such as bacteria. Fungi have rigid cell walls containing chitin, chitosan, mannan, and glucan. Fungi also have cell membranes structurally different from that of animals as they contain ergosterol rather than cholesterol. The simplest subclassification of fungi responsible for human infections is as either moulds (e.g. Aspergillus species) or yeasts (e.g. Candida species). Under the microscope, yeasts are small rounded cells that can bud, while moulds demonstrate a stranded, filamentous appearance caused by hyphae. Some fungi can exist in both forms (these are said to be dimorphic, e.g. Blastomyces), and some yeasts can develop pseudo-hyphae (e.g. Candida species). When the hyphae of filamentous fungi develop a matted, intermeshed network, this is referred to as a mycelium. Fungi are slow-growing, with cell-doubling times often as long as days, which can affect the ability to identify clinically relevant infections. Reproduction may be sexual, asexual, or both; and may result in the production of ‘daughter cells’ or spores. Many fungi and spores are environmentally ubiquitous, for example, Aspergillus species are commonly found in soil, and their spores are prevalent in the atmosphere. Several fungi are common human flora (for example, Candida occur within the human gut) or are able to colonize structures such as the gut, oropharynx, or upper and lower airways. It can sometimes be difficult to tell whether or not a positive fungal culture is indicative of invasive disease or simply the result of the capture of normal flora.","PeriodicalId":100332,"journal":{"name":"Continuing Education in Anaesthesia Critical Care & Pain","volume":"385 1","pages":"262-267"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84973893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-12-01DOI: 10.1093/BJACEACCP/MKT070
J. Scott-Warren, A. Bhaskar
In 2008, there were more than 2 million people in the UK with a present or past history of cancer, with the lifetime risk of developing the disease estimated at one in three (http://www. cancerresearchuk.org/cancer-info/cancerstats/). Breast cancer is the single most common form of cancer, followed by lung, prostate, and bowel. Over the last 10 yr, there has been an overall increase in incidence of 3%, with cancers strongly linked to lifestyle choices such as melanoma or oral cancers seeing the greatest increase. Fifty-three per cent of patients with cancer will experience pain, including 59% of those undergoing active treatment and increasing to 64% of patients with advanced or metastatic disease. Thirty-three per cent of those considered cured or in remission will have a chronic pain condition related to their cancer or treatment received. The three-step World Health Organization analgesic ladder (Fig. 1) was developed in 1986 to specifically address the worldwide problem of under, poorly treating cancer pain, or both. Designed in a format that can be implemented easily, with clinical and cost-effectiveness in mind, it is reported to be successful in 80–90% of patients (http://www.who.int/cancer/palliative/ painladder/en/), and emphasizes regular ‘by the clock’ administration of appropriate, effective oral analgesia. Methods of pain control in patients with cancer can be divided into pharmacological, oncological, surgical, interventional, physical therapy, psychotherapy, and complementary therapy. A holistic, multidisciplinary and multimodal approach is essential to optimize outcomes for patient benefit and this can be delivered only by established and effective communication between surgeons, oncologists, pain specialists, palliative care teams, primary care teams, and other allied healthcare professionals, thus ensuring that patients receive the best possible seamless and continuing care. Mechanisms of pain in cancer
{"title":"Cancer pain management—Part I: General principles","authors":"J. Scott-Warren, A. Bhaskar","doi":"10.1093/BJACEACCP/MKT070","DOIUrl":"https://doi.org/10.1093/BJACEACCP/MKT070","url":null,"abstract":"In 2008, there were more than 2 million people in the UK with a present or past history of cancer, with the lifetime risk of developing the disease estimated at one in three (http://www. cancerresearchuk.org/cancer-info/cancerstats/). Breast cancer is the single most common form of cancer, followed by lung, prostate, and bowel. Over the last 10 yr, there has been an overall increase in incidence of 3%, with cancers strongly linked to lifestyle choices such as melanoma or oral cancers seeing the greatest increase. Fifty-three per cent of patients with cancer will experience pain, including 59% of those undergoing active treatment and increasing to 64% of patients with advanced or metastatic disease. Thirty-three per cent of those considered cured or in remission will have a chronic pain condition related to their cancer or treatment received. The three-step World Health Organization analgesic ladder (Fig. 1) was developed in 1986 to specifically address the worldwide problem of under, poorly treating cancer pain, or both. Designed in a format that can be implemented easily, with clinical and cost-effectiveness in mind, it is reported to be successful in 80–90% of patients (http://www.who.int/cancer/palliative/ painladder/en/), and emphasizes regular ‘by the clock’ administration of appropriate, effective oral analgesia. Methods of pain control in patients with cancer can be divided into pharmacological, oncological, surgical, interventional, physical therapy, psychotherapy, and complementary therapy. A holistic, multidisciplinary and multimodal approach is essential to optimize outcomes for patient benefit and this can be delivered only by established and effective communication between surgeons, oncologists, pain specialists, palliative care teams, primary care teams, and other allied healthcare professionals, thus ensuring that patients receive the best possible seamless and continuing care. Mechanisms of pain in cancer","PeriodicalId":100332,"journal":{"name":"Continuing Education in Anaesthesia Critical Care & Pain","volume":"38 1","pages":"278-284"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83973642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-12-01DOI: 10.1093/BJACEACCP/MKT065
C. Gaunt, T. Woolley
Major trauma is a significant cause of death worldwide, leading to 5 million deaths annually. A large proportion of deaths are due to bleeding, with haemorrhage accounting for 80% of deaths in the operating theatre and 40% of all deaths from trauma within the UK. Treatment approaches to the management of major haemorrhage have transformed during recent decades, based mainly on retrospective evidence. Contemporary approaches emphasize rapid control of bleeding, early management of coagulopathy, maintenance of adequate perfusion, and minimizing the inflammatory response. Developments in the early resuscitation phase and prevention or early management of coagulopathy combined with better understanding of point-of-care diagnostic tests are leading to more targeted interventions for haemorrhage control resulting in improved patient outcomes and less demand for blood products.
{"title":"Management of haemorrhage in major trauma","authors":"C. Gaunt, T. Woolley","doi":"10.1093/BJACEACCP/MKT065","DOIUrl":"https://doi.org/10.1093/BJACEACCP/MKT065","url":null,"abstract":"Major trauma is a significant cause of death worldwide, leading to 5 million deaths annually. A large proportion of deaths are due to bleeding, with haemorrhage accounting for 80% of deaths in the operating theatre and 40% of all deaths from trauma within the UK. Treatment approaches to the management of major haemorrhage have transformed during recent decades, based mainly on retrospective evidence. Contemporary approaches emphasize rapid control of bleeding, early management of coagulopathy, maintenance of adequate perfusion, and minimizing the inflammatory response. Developments in the early resuscitation phase and prevention or early management of coagulopathy combined with better understanding of point-of-care diagnostic tests are leading to more targeted interventions for haemorrhage control resulting in improved patient outcomes and less demand for blood products.","PeriodicalId":100332,"journal":{"name":"Continuing Education in Anaesthesia Critical Care & Pain","volume":"34 1","pages":"251-255"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79995138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-10-01DOI: 10.1093/bjaceaccp/mkt057
Peter Bromley MBBS FRCA, James Bennett MBBS FRCA
{"title":"Anaesthesia for children with liver disease","authors":"Peter Bromley MBBS FRCA, James Bennett MBBS FRCA","doi":"10.1093/bjaceaccp/mkt057","DOIUrl":"10.1093/bjaceaccp/mkt057","url":null,"abstract":"","PeriodicalId":100332,"journal":{"name":"Continuing Education in Anaesthesia Critical Care & Pain","volume":"14 5","pages":"Pages 207-212"},"PeriodicalIF":0.0,"publicationDate":"2014-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/bjaceaccp/mkt057","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84256720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-10-01DOI: 10.1093/bjaceaccp/mkt060
Craig Johnstone MBChB BSc FRCA, Alison Hall BSc MBChB FRCA FFICM MD, Ian J Hart BSc MBChB PhD FRCPath
Early references to viral illnesses are found in ancient Egyptian texts with stone tablet depictions of patients suffering from poliomyelitis. Despite this, early experimentation into viral infections, led by Jenner, did not begin until 1798 with later contributions from Pasteur in the early 1880s. Viruses as a distinct biological entity, however, were not discovered until 1892 when Ivanovsky identified non-bacterial pathogens affecting tobacco plants. Subsequent work by Beijerink, Loeffler, and Frosch in 1898 distinguished the tobacco mosaic disease and footand-mouth disease agents from pathogenic bacteria and recorded their ‘obligate parasite’ nature. The first recorded human illness to be confirmed of viral origin was yellow fever in 1901, a discovery made by Reed et al. Since then, large numbers of viral pathogens have been identified. This review does not attempt to be exhaustive but deals with some of the more common viral illnesses that can necessitate ICU admission. Despite this, there remain notable exclusions including arboviruses (including those which cause viral haemorrhagic fever), zoonotic viruses (including rabies), and the hepatitis viruses, which could in themselves constitute a review article. In cases where rare viruses are the cause for ICU admission and where the patient is immunocompromised, early involvement from a medical virologist or medical microbiologist is required.
{"title":"Common viral illnesses in intensive care: presentation, diagnosis, and management","authors":"Craig Johnstone MBChB BSc FRCA, Alison Hall BSc MBChB FRCA FFICM MD, Ian J Hart BSc MBChB PhD FRCPath","doi":"10.1093/bjaceaccp/mkt060","DOIUrl":"10.1093/bjaceaccp/mkt060","url":null,"abstract":"Early references to viral illnesses are found in ancient Egyptian texts with stone tablet depictions of patients suffering from poliomyelitis. Despite this, early experimentation into viral infections, led by Jenner, did not begin until 1798 with later contributions from Pasteur in the early 1880s. Viruses as a distinct biological entity, however, were not discovered until 1892 when Ivanovsky identified non-bacterial pathogens affecting tobacco plants. Subsequent work by Beijerink, Loeffler, and Frosch in 1898 distinguished the tobacco mosaic disease and footand-mouth disease agents from pathogenic bacteria and recorded their ‘obligate parasite’ nature. The first recorded human illness to be confirmed of viral origin was yellow fever in 1901, a discovery made by Reed et al. Since then, large numbers of viral pathogens have been identified. This review does not attempt to be exhaustive but deals with some of the more common viral illnesses that can necessitate ICU admission. Despite this, there remain notable exclusions including arboviruses (including those which cause viral haemorrhagic fever), zoonotic viruses (including rabies), and the hepatitis viruses, which could in themselves constitute a review article. In cases where rare viruses are the cause for ICU admission and where the patient is immunocompromised, early involvement from a medical virologist or medical microbiologist is required.","PeriodicalId":100332,"journal":{"name":"Continuing Education in Anaesthesia Critical Care & Pain","volume":"14 5","pages":"Pages 213-219"},"PeriodicalIF":0.0,"publicationDate":"2014-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/bjaceaccp/mkt060","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83333960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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