A 76-year-old man with multiple medical problems was admitted to the hospital with fever, low white blood cell count, and lung infiltrates for over 5 weeks, and testing showed diffuse lung opacities and inflammation; a lung biopsy found granulomatous inflammation and he was started on tuberculosis treatment, but his condition worsened with continued fevers, hemoptysis, and hypoxemia. His past medical history included several cardiovascular and pulmonary conditions, as well as transitional cell carcinoma of the bladder treated with BCG therapy 7 months prior.
This document provides an overview of the radiological presentation of COVID-19 based on CT scans and chest x-rays. It finds that ground glass opacities are the most common CT finding and often appear bilaterally in the lower lobes in a peripheral or subpleural distribution. Later stages may also show consolidation, septal thickening, and traction bronchiectasis. Chest x-rays are less sensitive than CT early on but can still detect signs of disease progression like bilateral opacities and consolidation. Pediatric cases tend to be milder with fewer abnormal CT findings. The document outlines typical features, frequencies of signs, and comparisons between adult and pediatric presentations.
This document presents a case study of a 36-year-old man admitted to the hospital with fever, abdominal pain, and lack of appetite. Initial tests showed jaundice and liver abnormalities. Further evaluation found a liver abscess. The patient was treated but had a similar prior illness in Malaysia. Tests identified the cause as melioidosis, a tropical disease caused by the bacterium Burkholderia pseudomallei. The patient received long-term antibiotic treatment and follow-up showed the infection had resolved. The presentation discusses the epidemiology, pathogenesis, diagnosis and treatment of melioidosis.
This document discusses the classification and etiology of pneumothorax. It begins with an overview of the historical understanding and definitions of pneumothorax. It then discusses the epidemiology, including incidence and recurrence rates. Pneumothorax is classified based on size (partial, incomplete, complete), pathophysiology (tension vs spontaneous), and etiology (primary spontaneous, secondary spontaneous, traumatic). The exact causes are often unknown but involve an interplay between lung abnormalities and environmental factors in most cases.
The document discusses shock and sepsis. It defines shock as a clinical condition characterized by a fast pulse rate and low blood pressure. The main types of shock discussed are hypovolemic, cardiogenic, septic, anaphylactic, and neurogenic. Sepsis is defined as a life-threatening organ dysfunction caused by the body's response to an infection. As sepsis progresses it can lead to septic shock, which is associated with high mortality. The stages of shock and signs and symptoms of early and late sepsis are also summarized.
Presentation of Dr. Lluis Blanch at 10th Pulmonary Medicine Update Course, Cairo, Egypt. Pulmonary Medicine Update Course is organized by Scribe : www.scribeofegypt.com
1) Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. It is a major healthcare problem with high mortality rates, especially septic shock which has mortality rates of 50-60%.
2) The new Sepsis-3 definition defines sepsis as a life-threatening organ dysfunction caused by a dysregulated host response to infection represented by an increase of two or more points in the SOFA score.
3) Early goal-directed therapy (EGDT) is a protocol-based approach for initial resuscitation of sepsis patients. It aims to achieve specific goals for central venous pressure, mean arterial pressure, ScvO2, and other parameters within 6 hours and
This document discusses the treatment options for acute diverticulitis, including conservative treatment with antibiotics versus surgical intervention. It notes that there is debate around whether the optimal approach is laparoscopic surgery, open surgery, or conservative management with antibiotics. Additionally, there is a lack of strong evidence to guide decisions around the choice and duration of antibiotic therapy, as well as whether drainage or IV antibiotics are always necessary for abscesses. More research is still needed to determine best practices for managing both acute diverticulitis episodes and recurrent disease.
The document discusses anticoagulation in COVID-19 patients. It notes that COVID-19 infection can cause a cytokine storm and increased risk of thrombosis. Studies have shown that 1/3 of hospitalized COVID-19 patients develop thrombotic complications. Several guidelines recommend prophylactic anticoagulation for hospitalized COVID-19 patients to reduce the risk of thromboembolism and lower mortality. Early initiation of prophylactic anticoagulation is associated with a 27% reduced risk of death within 30 days. The document discusses diagnostic tests for coagulopathy in COVID-19 patients and potential radiological findings of thromboembolic complications.
This document provides an overview of the radiological presentation of COVID-19 based on CT scans and chest x-rays. It finds that ground glass opacities are the most common CT finding and often appear bilaterally in the lower lobes in a peripheral or subpleural distribution. Later stages may also show consolidation, septal thickening, and traction bronchiectasis. Chest x-rays are less sensitive than CT early on but can still detect signs of disease progression like bilateral opacities and consolidation. Pediatric cases tend to be milder with fewer abnormal CT findings. The document outlines typical features, frequencies of signs, and comparisons between adult and pediatric presentations.
This document presents a case study of a 36-year-old man admitted to the hospital with fever, abdominal pain, and lack of appetite. Initial tests showed jaundice and liver abnormalities. Further evaluation found a liver abscess. The patient was treated but had a similar prior illness in Malaysia. Tests identified the cause as melioidosis, a tropical disease caused by the bacterium Burkholderia pseudomallei. The patient received long-term antibiotic treatment and follow-up showed the infection had resolved. The presentation discusses the epidemiology, pathogenesis, diagnosis and treatment of melioidosis.
This document discusses the classification and etiology of pneumothorax. It begins with an overview of the historical understanding and definitions of pneumothorax. It then discusses the epidemiology, including incidence and recurrence rates. Pneumothorax is classified based on size (partial, incomplete, complete), pathophysiology (tension vs spontaneous), and etiology (primary spontaneous, secondary spontaneous, traumatic). The exact causes are often unknown but involve an interplay between lung abnormalities and environmental factors in most cases.
The document discusses shock and sepsis. It defines shock as a clinical condition characterized by a fast pulse rate and low blood pressure. The main types of shock discussed are hypovolemic, cardiogenic, septic, anaphylactic, and neurogenic. Sepsis is defined as a life-threatening organ dysfunction caused by the body's response to an infection. As sepsis progresses it can lead to septic shock, which is associated with high mortality. The stages of shock and signs and symptoms of early and late sepsis are also summarized.
Presentation of Dr. Lluis Blanch at 10th Pulmonary Medicine Update Course, Cairo, Egypt. Pulmonary Medicine Update Course is organized by Scribe : www.scribeofegypt.com
1) Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. It is a major healthcare problem with high mortality rates, especially septic shock which has mortality rates of 50-60%.
2) The new Sepsis-3 definition defines sepsis as a life-threatening organ dysfunction caused by a dysregulated host response to infection represented by an increase of two or more points in the SOFA score.
3) Early goal-directed therapy (EGDT) is a protocol-based approach for initial resuscitation of sepsis patients. It aims to achieve specific goals for central venous pressure, mean arterial pressure, ScvO2, and other parameters within 6 hours and
This document discusses the treatment options for acute diverticulitis, including conservative treatment with antibiotics versus surgical intervention. It notes that there is debate around whether the optimal approach is laparoscopic surgery, open surgery, or conservative management with antibiotics. Additionally, there is a lack of strong evidence to guide decisions around the choice and duration of antibiotic therapy, as well as whether drainage or IV antibiotics are always necessary for abscesses. More research is still needed to determine best practices for managing both acute diverticulitis episodes and recurrent disease.
The document discusses anticoagulation in COVID-19 patients. It notes that COVID-19 infection can cause a cytokine storm and increased risk of thrombosis. Studies have shown that 1/3 of hospitalized COVID-19 patients develop thrombotic complications. Several guidelines recommend prophylactic anticoagulation for hospitalized COVID-19 patients to reduce the risk of thromboembolism and lower mortality. Early initiation of prophylactic anticoagulation is associated with a 27% reduced risk of death within 30 days. The document discusses diagnostic tests for coagulopathy in COVID-19 patients and potential radiological findings of thromboembolic complications.
Pathogenesis and Acute Exacerbation of IPFGamal Agmy
Acute exacerbations in patients with idiopathic pulmonary fibrosis (AEx-IPF) occur in 5-10% of IPF patients annually and carry a poor prognosis. The pathophysiology of AEx-IPF involves acute lung injury superimposed on the underlying usual interstitial pneumonia pattern, and may be triggered by occult infection or gastroesophageal reflux disease. Management consists mainly of supportive care and corticosteroids, though outcomes remain poor. Preserving lung function and treating gastroesophageal reflux may help reduce the risk and impact of AEx-IPF.
Hemodialysis catheter related infection 5JAFAR ALSAID
This document discusses hemodialysis catheter-related infections. It provides statistics on catheter use and infection rates. It describes different types of catheter infections including exit site infections, tunnel infections, and bloodstream infections. Signs and symptoms of infection and methods for diagnosis are outlined. The document proposes a strict infection control protocol for catheters and discusses efforts at one facility to reduce infection rates through improved catheter care and adherence to infection guidelines.
The document provides information on sepsis definitions, pathophysiology, and assessment tools. It discusses:
1) The 1992 and 2001 consensus definitions of sepsis, severe sepsis, and septic shock based on SIRS criteria and organ dysfunction.
2) The key pathophysiological processes in sepsis including dysregulated inflammation, coagulation, fibrinolysis and endothelial dysfunction which can lead to organ failure.
3) Limitations of the SIRS criteria and introduction of newer assessment tools like qSOFA and SOFA score which include clinical variables and lab markers to better predict patient outcomes.
1. Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive fibrosing interstitial pneumonia of unknown cause that primarily affects older adults and is associated with poor prognosis.
2. The diagnosis of IPF requires exclusion of other known causes of lung fibrosis and demonstration of a usual interstitial pneumonia pattern on imaging or lung biopsy.
3. Current treatment recommendations strongly advise against monotherapies with corticosteroids, colchicine, cyclosporine A, or immunomodulators due to lack of proven efficacy and risk of side effects.
it is well known tha covid 19 has different clinical phenotypes and the above sometimes may induce coagulation alterations that conduct to thrombosis in different circulatory beds including the pulmonary one. D-dimer is a fundamental biomarker to investigate this condition together with a HRCT
This document summarizes information about idiopathic pulmonary fibrosis (IPF):
- IPF is a chronic, progressive lung disease characterized by scarring of the lungs that worsens over time. It typically affects older adults and has an unpredictable decline in lung function.
- Diagnosis involves ruling out other causes, high-resolution CT imaging showing a usual interstitial pneumonia pattern, and sometimes surgical lung biopsy.
- Current treatment options include pirfenidone, nintedanib, oxygen therapy, pulmonary rehabilitation, and sometimes lung transplantation. However, IPF has a generally poor prognosis with median survival of 2-5 years.
Hemodialysis catheter related infection JAFAR ALSAID
The document discusses hemodialysis catheter-related infections. It notes that catheter infections are a major cause of morbidity and mortality for hemodialysis patients. It provides statistics on catheter use and infection rates. It then describes different types of catheter infections including exit site infections, tunnel infections, and bloodstream infections. Signs and symptoms of infections are outlined. The document proposes a strict infection control protocol for nurses to follow during catheter care and dialysis to help reduce infection rates. This includes recommendations for site cleaning, dressing changes, tubing changes, and staff education.
This powerpoint (ppt) presentation describes in details Pathophysiology and Management of Acute Sepsis in Emergency Department. Acute sepsis has 30% mortality and further more Septic Shock has 50% mortality if untreated. It is the job of Emergency Physician to recognise and treat Sepsis in time.
PROSEVA trial - Prone position in severe ARDS.
Why did prone position improve outcome of ARDS while other measures aimed at improving oxygenation such as high PEEP, RM and HFO have failed to do so?
This document discusses coagulopathy and thrombosis in COVID-19 patients. It reviews a case where a clot-busting drug improved a patient's condition, suggesting blood clots play a bigger role in the disease than previously thought. Autopsies show COVID patients' lungs and other organs choked with microclots. The virus may directly infect blood vessels, impairing blood flow regulation and promoting clotting. Routine monitoring of coagulation markers and use of preventative doses of anticoagulants are recommended for COVID patients.
This case report describes a 27-year-old woman who was admitted to the hospital for polytrauma injuries. During her hospital stay, a blood smear unexpectedly revealed intracellular bacteria in her blood. Blood cultures grew Acinetobacter Baumannii and Enterobacter Cloacae from her central venous catheter. Despite being asymptomatic, the central line was removed and she was treated with antibiotics, to which the bacteria were sensitive. A review of previous literature found 20 similar cases where bacteria were detected on blood smears, often associated with central lines and sepsis. This case highlights the importance of carefully examining blood smears, as intracellular bacteria can indicate active infection even in asymptomatic patients with central lines.
Approach to sepsis- a primary physician perspectiveNaveen Kumar
1. The document discusses guidelines for the approach to sepsis management, including definitions of sepsis, severe sepsis, septic shock, and clinical impact.
2. It provides recommendations for initial resuscitation, diagnosis and antibiotic therapy, including performing early goal-directed therapy, administering early appropriate antibiotics and fluids, and taking early cultures and lactate levels.
3. Bundles are outlined to be completed within 3 and 6 hours, including measures like administering broad-spectrum antibiotics, fluid resuscitation, vasopressors, and measuring lactate, CVP and ScvO2.
Mechanical Ventilation of Patient with COPD ExacerbationDr.Mahmoud Abbas
Mechanical Ventilation of Patient with COPD Exacerbation lecture presented by Dr Andres Esteban at the Egyptian Critical care Summit 2015 held at Cairo, egypt.
The Egyptian Critical Care Summit is the leading medical event and exhibition for Intensive Care Medicine in Egypt.
Covid-19 Clinical Case: Lessons & Recommendations-updated Jan 2021Imad Hassan
This document describes the case of a 65-year-old male patient with diabetes, dyslipidemia, and vitamin D deficiency who was hospitalized for COVID-19 pneumonia. Over the course of his 16-day hospitalization, he received various treatments including antibiotics, steroids, anticoagulants, and supplements. His inflammatory markers initially increased but then decreased with treatment. He developed a pulmonary embolism but ultimately improved and was discharged. The document emphasizes using COVID-19 scoring tools to assess risk and employing current best practices for treatment.
1) Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. Septic shock is a subset of sepsis with circulatory and metabolic abnormalities associated with high mortality.
2) Early goal-directed therapy aims to optimize oxygen delivery by targeting central venous pressure, mean arterial pressure, and ScvO2 within 6 hours but recent large trials found no significant difference in mortality compared to usual care.
3) Management of sepsis involves early antibiotics, source control, and supportive care including vasopressors and fluids, with a focus on preventing complications and organ dysfunction.
This document provides an overview of idiopathic pulmonary fibrosis (IPF), including its definition, causes, diagnosis, and treatment options. It discusses various pharmacological therapies that have been studied such as corticosteroids, immunosuppressants, interferon-gamma, and anticoagulants, but found no convincing evidence of benefit. It also reviews newer agents like pirfenidone and nintedanib that have shown efficacy in reducing lung function decline in IPF patients. The overall consensus is that no pharmacological therapies prior to pirfenidone and nintedanib provided a clear survival benefit for IPF patients.
This document describes guidelines for the treatment of sepsis. It defines terms like sepsis, severe sepsis, and septic shock. It describes the pathophysiology of sepsis including the role of the microcirculation. It outlines the sepsis management bundle which includes measuring lactate, administering antibiotics and fluids within 3 hours, and maintaining mean arterial pressure above 65 mmHg within 6 hours. It stresses the importance of optimizing both macrocirculation and microcirculation to prevent mitochondrial injury.
This document summarizes a nephrology conference presentation on catheter-related bloodstream infections (CRBSI). It discusses the burden of CRBSI, guidelines for diagnosis and treatment, and measures to prevent CRBSI. It then presents a case study of a patient admitted with fever who was found to have CRBSI and infective endocarditis. The patient's clinical course involved complications of acute coronary syndrome and intracranial hemorrhage.
This study examined the relationship between volume overhydration and endothelial dysfunction in 81 stable patients on continuous ambulatory peritoneal dialysis. Volume status was assessed by normalized extracellular water and endothelial function was estimated by flow-mediated dilation of the brachial artery. There was an independent correlation between the index of volume status (normalized extracellular water) and endothelial function (flow-mediated dilation), with higher normalized extracellular water related to worse endothelial function. Multiple regression analysis identified calcium-phosphate product, normalized extracellular water, and dialysis vintage as independent determinants of endothelial function. The results suggest that volume overhydration may lead to increased cardiovascular risk in dialysis patients through its effects on endothelial dysfunction.
This document discusses sepsis and septic shock and provides guidelines for management. It defines sepsis as a systemic inflammatory response to infection and outlines the sepsis spectrum from sepsis to septic shock. It describes the typical host immune response and how an uncontrolled response can lead to systemic effects. Clinical presentation, diagnosis, bacteriology, and management including initial resuscitation, antimicrobial therapy and treatment duration are covered. Treatment aims to rapidly identify and treat the infection while stabilizing the patient and preventing further progression along the sepsis spectrum.
Impact assessment of active safety systems within the field operational test ...euroFOT
The document discusses a project called euroFOT that tested advanced driver assistance systems through field operational tests. It provides an introduction to road safety issues and increasing road fatalities. It then discusses the euroFOT project objectives of assessing the impacts of advanced driver assistance systems on safety, traffic efficiency, the environment and driver behavior through real-world testing. The project involved coordination between vehicle manufacturers in Sweden, Germany, France and Italy to collect field data on systems like adaptive cruise control, lane departure warning and curve speed warning.
Pathogenesis and Acute Exacerbation of IPFGamal Agmy
Acute exacerbations in patients with idiopathic pulmonary fibrosis (AEx-IPF) occur in 5-10% of IPF patients annually and carry a poor prognosis. The pathophysiology of AEx-IPF involves acute lung injury superimposed on the underlying usual interstitial pneumonia pattern, and may be triggered by occult infection or gastroesophageal reflux disease. Management consists mainly of supportive care and corticosteroids, though outcomes remain poor. Preserving lung function and treating gastroesophageal reflux may help reduce the risk and impact of AEx-IPF.
Hemodialysis catheter related infection 5JAFAR ALSAID
This document discusses hemodialysis catheter-related infections. It provides statistics on catheter use and infection rates. It describes different types of catheter infections including exit site infections, tunnel infections, and bloodstream infections. Signs and symptoms of infection and methods for diagnosis are outlined. The document proposes a strict infection control protocol for catheters and discusses efforts at one facility to reduce infection rates through improved catheter care and adherence to infection guidelines.
The document provides information on sepsis definitions, pathophysiology, and assessment tools. It discusses:
1) The 1992 and 2001 consensus definitions of sepsis, severe sepsis, and septic shock based on SIRS criteria and organ dysfunction.
2) The key pathophysiological processes in sepsis including dysregulated inflammation, coagulation, fibrinolysis and endothelial dysfunction which can lead to organ failure.
3) Limitations of the SIRS criteria and introduction of newer assessment tools like qSOFA and SOFA score which include clinical variables and lab markers to better predict patient outcomes.
1. Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive fibrosing interstitial pneumonia of unknown cause that primarily affects older adults and is associated with poor prognosis.
2. The diagnosis of IPF requires exclusion of other known causes of lung fibrosis and demonstration of a usual interstitial pneumonia pattern on imaging or lung biopsy.
3. Current treatment recommendations strongly advise against monotherapies with corticosteroids, colchicine, cyclosporine A, or immunomodulators due to lack of proven efficacy and risk of side effects.
it is well known tha covid 19 has different clinical phenotypes and the above sometimes may induce coagulation alterations that conduct to thrombosis in different circulatory beds including the pulmonary one. D-dimer is a fundamental biomarker to investigate this condition together with a HRCT
This document summarizes information about idiopathic pulmonary fibrosis (IPF):
- IPF is a chronic, progressive lung disease characterized by scarring of the lungs that worsens over time. It typically affects older adults and has an unpredictable decline in lung function.
- Diagnosis involves ruling out other causes, high-resolution CT imaging showing a usual interstitial pneumonia pattern, and sometimes surgical lung biopsy.
- Current treatment options include pirfenidone, nintedanib, oxygen therapy, pulmonary rehabilitation, and sometimes lung transplantation. However, IPF has a generally poor prognosis with median survival of 2-5 years.
Hemodialysis catheter related infection JAFAR ALSAID
The document discusses hemodialysis catheter-related infections. It notes that catheter infections are a major cause of morbidity and mortality for hemodialysis patients. It provides statistics on catheter use and infection rates. It then describes different types of catheter infections including exit site infections, tunnel infections, and bloodstream infections. Signs and symptoms of infections are outlined. The document proposes a strict infection control protocol for nurses to follow during catheter care and dialysis to help reduce infection rates. This includes recommendations for site cleaning, dressing changes, tubing changes, and staff education.
This powerpoint (ppt) presentation describes in details Pathophysiology and Management of Acute Sepsis in Emergency Department. Acute sepsis has 30% mortality and further more Septic Shock has 50% mortality if untreated. It is the job of Emergency Physician to recognise and treat Sepsis in time.
PROSEVA trial - Prone position in severe ARDS.
Why did prone position improve outcome of ARDS while other measures aimed at improving oxygenation such as high PEEP, RM and HFO have failed to do so?
This document discusses coagulopathy and thrombosis in COVID-19 patients. It reviews a case where a clot-busting drug improved a patient's condition, suggesting blood clots play a bigger role in the disease than previously thought. Autopsies show COVID patients' lungs and other organs choked with microclots. The virus may directly infect blood vessels, impairing blood flow regulation and promoting clotting. Routine monitoring of coagulation markers and use of preventative doses of anticoagulants are recommended for COVID patients.
This case report describes a 27-year-old woman who was admitted to the hospital for polytrauma injuries. During her hospital stay, a blood smear unexpectedly revealed intracellular bacteria in her blood. Blood cultures grew Acinetobacter Baumannii and Enterobacter Cloacae from her central venous catheter. Despite being asymptomatic, the central line was removed and she was treated with antibiotics, to which the bacteria were sensitive. A review of previous literature found 20 similar cases where bacteria were detected on blood smears, often associated with central lines and sepsis. This case highlights the importance of carefully examining blood smears, as intracellular bacteria can indicate active infection even in asymptomatic patients with central lines.
Approach to sepsis- a primary physician perspectiveNaveen Kumar
1. The document discusses guidelines for the approach to sepsis management, including definitions of sepsis, severe sepsis, septic shock, and clinical impact.
2. It provides recommendations for initial resuscitation, diagnosis and antibiotic therapy, including performing early goal-directed therapy, administering early appropriate antibiotics and fluids, and taking early cultures and lactate levels.
3. Bundles are outlined to be completed within 3 and 6 hours, including measures like administering broad-spectrum antibiotics, fluid resuscitation, vasopressors, and measuring lactate, CVP and ScvO2.
Mechanical Ventilation of Patient with COPD ExacerbationDr.Mahmoud Abbas
Mechanical Ventilation of Patient with COPD Exacerbation lecture presented by Dr Andres Esteban at the Egyptian Critical care Summit 2015 held at Cairo, egypt.
The Egyptian Critical Care Summit is the leading medical event and exhibition for Intensive Care Medicine in Egypt.
Covid-19 Clinical Case: Lessons & Recommendations-updated Jan 2021Imad Hassan
This document describes the case of a 65-year-old male patient with diabetes, dyslipidemia, and vitamin D deficiency who was hospitalized for COVID-19 pneumonia. Over the course of his 16-day hospitalization, he received various treatments including antibiotics, steroids, anticoagulants, and supplements. His inflammatory markers initially increased but then decreased with treatment. He developed a pulmonary embolism but ultimately improved and was discharged. The document emphasizes using COVID-19 scoring tools to assess risk and employing current best practices for treatment.
1) Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. Septic shock is a subset of sepsis with circulatory and metabolic abnormalities associated with high mortality.
2) Early goal-directed therapy aims to optimize oxygen delivery by targeting central venous pressure, mean arterial pressure, and ScvO2 within 6 hours but recent large trials found no significant difference in mortality compared to usual care.
3) Management of sepsis involves early antibiotics, source control, and supportive care including vasopressors and fluids, with a focus on preventing complications and organ dysfunction.
This document provides an overview of idiopathic pulmonary fibrosis (IPF), including its definition, causes, diagnosis, and treatment options. It discusses various pharmacological therapies that have been studied such as corticosteroids, immunosuppressants, interferon-gamma, and anticoagulants, but found no convincing evidence of benefit. It also reviews newer agents like pirfenidone and nintedanib that have shown efficacy in reducing lung function decline in IPF patients. The overall consensus is that no pharmacological therapies prior to pirfenidone and nintedanib provided a clear survival benefit for IPF patients.
This document describes guidelines for the treatment of sepsis. It defines terms like sepsis, severe sepsis, and septic shock. It describes the pathophysiology of sepsis including the role of the microcirculation. It outlines the sepsis management bundle which includes measuring lactate, administering antibiotics and fluids within 3 hours, and maintaining mean arterial pressure above 65 mmHg within 6 hours. It stresses the importance of optimizing both macrocirculation and microcirculation to prevent mitochondrial injury.
This document summarizes a nephrology conference presentation on catheter-related bloodstream infections (CRBSI). It discusses the burden of CRBSI, guidelines for diagnosis and treatment, and measures to prevent CRBSI. It then presents a case study of a patient admitted with fever who was found to have CRBSI and infective endocarditis. The patient's clinical course involved complications of acute coronary syndrome and intracranial hemorrhage.
This study examined the relationship between volume overhydration and endothelial dysfunction in 81 stable patients on continuous ambulatory peritoneal dialysis. Volume status was assessed by normalized extracellular water and endothelial function was estimated by flow-mediated dilation of the brachial artery. There was an independent correlation between the index of volume status (normalized extracellular water) and endothelial function (flow-mediated dilation), with higher normalized extracellular water related to worse endothelial function. Multiple regression analysis identified calcium-phosphate product, normalized extracellular water, and dialysis vintage as independent determinants of endothelial function. The results suggest that volume overhydration may lead to increased cardiovascular risk in dialysis patients through its effects on endothelial dysfunction.
This document discusses sepsis and septic shock and provides guidelines for management. It defines sepsis as a systemic inflammatory response to infection and outlines the sepsis spectrum from sepsis to septic shock. It describes the typical host immune response and how an uncontrolled response can lead to systemic effects. Clinical presentation, diagnosis, bacteriology, and management including initial resuscitation, antimicrobial therapy and treatment duration are covered. Treatment aims to rapidly identify and treat the infection while stabilizing the patient and preventing further progression along the sepsis spectrum.
Impact assessment of active safety systems within the field operational test ...euroFOT
The document discusses a project called euroFOT that tested advanced driver assistance systems through field operational tests. It provides an introduction to road safety issues and increasing road fatalities. It then discusses the euroFOT project objectives of assessing the impacts of advanced driver assistance systems on safety, traffic efficiency, the environment and driver behavior through real-world testing. The project involved coordination between vehicle manufacturers in Sweden, Germany, France and Italy to collect field data on systems like adaptive cruise control, lane departure warning and curve speed warning.
Andalusia is an autonomous community in Spain whose capital is Seville. It has a varied landscape that includes mountains like the Sierra Nevada, rivers like the Guadalquivir, lakes such as Lake Viñuela and Ardales Lakes, coastline along the Mediterranean Sea and Atlantic Ocean, and beaches including Victoria Beach and Caleta Beach. The document provides details about the physical geography of Andalusia.
Inscape makes smart workspaces through 16 approaches:
1. They focus on applications and customized solutions for unique client needs and spaces.
2. Their infrastructure accommodates power, lighting, and more, allowing infinite flexibility through movable walls, doors, and ceilings.
3. They maximize real estate through compact vertical storage and 2,808 paint colors.
The document discusses relative clauses in English. It defines relative clauses as clauses that provide information about a person or thing mentioned elsewhere in the sentence. There are two types of relative clauses: defining relative clauses, which provide essential information about the antecedent, and non-defining relative clauses, which provide extra information and are set off by commas. The document provides examples of different relative pronouns and adverbs used to form relative clauses based on people, objects, time, and place. It also discusses verbs that are commonly used with prepositions in English.
This short document pays tribute to all victims of war, regardless of their race, ideology, color, or religion. It acknowledges that war inflicts harm on people indiscriminately based on factors beyond their control. All who suffer the consequences of armed conflict deserve recognition and remembrance.
An operational perspective on the organisation of large scale field operation...euroFOT
The document discusses the organization of a large-scale field operational test of intelligent transport systems. It describes that the test involves 505 vehicles across Europe equipped with different data acquisition systems. The test is coordinated across multiple vehicle management centers and operation sites. The document outlines the step-wise preparation process including testing of the data collection systems and refining technical and organizational procedures. It also provides details on the vehicle-related and driver-related procedures for the test. An update on the status of the test ramp-up is given for different automakers involved.
This document discusses bubbles in economics, the role of central banks like the Federal Reserve in managing bubbles, and debates around regulating versus deregulating financial markets. It notes that bubbles involve trading assets at inflated prices and post-bubble economies are difficult to manage. While some deny bubbles occur, others think they stem from price coordination or social norms. Regulating financial markets could limit risky behavior but models would need to accurately map interlinkages, while deregulation allows economic freedom but risks bubbles. The Federal Reserve uses tools like adjusting interest rates and quantitative easing to stimulate or constrain the economy as needed to prevent overheating or recession.
1) The amount of digital data in the world will increase dramatically from 1.2 zetabytes to 35 zetabytes in the coming years as more devices and objects become connected to the internet.
2) This data explosion will allow marketers to target audiences with unprecedented precision by analyzing individual online behaviors and attributes across multiple databases and devices.
3) However, with great data comes great responsibility, and marketers must proactively address privacy and data protection to avoid a consumer backlash over improper use and sharing of personal information.
Dimitri DIDORENKO has developed over 20 web and software applications since 2009 as a senior web developer specializing in PHP, JavaScript, jQuery, and other technologies. His portfolio includes stock market, collaborative, and promotional applications, as well as content management systems and internal business software. He has experience with technologies such as PHP, ASP, Java, Flash, and SQL databases.
El documento lista varias obras de teatro y películas presentadas en la escuela Hölters en 2009, incluyendo Fiebre de sábado por la noche, ¿Quién quiere ser millonario?, Moulin Rouge, Chicago y Eva.
The document discusses green initiatives in corporate facilities and construction. It notes that corporate leaders are increasingly conscious of green practices and expect their impact to grow. It defines elements of being "green" like materials reduction and increased recycling. Key drivers include social responsibility, cost savings, and compliance with new regulations. Data centers, industrial, commercial, and institutional buildings are cited as key growth sectors for green design. The document outlines various environmental standards and organizations. It promotes Anixter's green products, services, and initiatives to help customers lower costs and comply with standards through offerings like their READY! Deployment Services.
The document provides a history of Sport for All (SFA) in Romania. It discusses how SFA has evolved from ancient times when people gathered for sports and entertainment, to the modern era where it became subordinate to political objectives. After 1990, Romania adopted the SFA framework to promote physical activity for all citizens. The Romanian Federation of Sport for All was founded in 1992 to develop SFA programs across the country. It is now organized across counties and municipalities to provide sports opportunities for people of all abilities.
This very short document discusses an idea and whether it is good or bad. It states "Buena idea" meaning "Good idea" followed by "Mala idea" meaning "Bad idea", leaving the reader to infer there was an idea presented that could be viewed either positively or negatively.
This document discusses Superior Vena Cava Syndrome (SVCS), which occurs when the Superior Vena Cava (SVC) is compressed, reducing blood flow from the head and upper body. The document covers the case presentation of a patient with SVCS, including symptoms, imaging findings, and treatment. It then provides details on the anatomy, etiologies, clinical features, imaging and classification of SVCS. Treatment options for malignant causes of SVCS such as radiation therapy, chemotherapy and stenting are described. A grading system and treatment algorithm for SVCS are also presented.
The document appears to be a medical exam containing multiple choice questions about various medical cases and diagnoses. Question 1 describes a patient found unconscious after resuscitation from drowning and asks for the diagnosis based on symptoms of unconsciousness, dilated pupils, and convulsions. Question 2 describes a welder complaining of weakness and fever with symptoms of anemia and asks for the cause of anemia.
This document contains a series of multiple choice questions related to medicine. The questions cover topics such as diagnosing a patient found unconscious after resuscitation, identifying the cause of anemia in a patient based on lab results, determining the appropriate secondary prevention measures for cardiovascular disease, and selecting the most likely diagnosis for various patient presentations and case histories.
COVID 19 radiology.ppt human education systemssuserb52e6c
1) The document discusses the chest CT findings of COVID-19 pneumonia based on a review of 1014 patient cases in Wuhan, China. 2) Key findings on CT included ground-glass opacities in 97% of positive cases as well as consolidations. 3) CT was found to have a sensitivity of 97% in detecting COVID-19 compared to PCR testing, and found positive findings in 75% of PCR-negative cases, suggesting CT may detect COVID-19 earlier than tests.
This document discusses the value of autopsies in medicine. It provides an example case study of a 38-year old woman with metastatic melanoma who died of pulmonary lymphangitic carcinomatosis. The autopsy findings revealed widespread melanoma metastases that were missed by clinical diagnosis and imaging. This provided a better understanding of the woman's symptoms and ruled out falsely attributing her declining health to an experimental vaccine therapy. The autopsy saved the therapy from being wrongly blamed and improved medical knowledge.
Case report :systemic torulopsis after gastric bypass operationAhmed Bahnassy
This case report describes a 50-year old woman who developed a systemic Torulopsis glabrata infection after undergoing gastric bypass surgery for morbid obesity 5 months prior. CT imaging revealed pulmonary nodules, liver and splenic lesions, lymphadenopathy, and ascites. Biopsy results showed necrotizing granulomatous inflammation and heavy growth of T. glabrata. Despite treatment, the patient developed multi-organ failure and died. The report emphasizes that systemic fungal infections can be life-threatening complications after gastric bypass and highlights the CT imaging findings of disseminated T. glabrata infection.
Austin Journal of Tropical Medicine & Hygiene is an open access, peer review journal publishing original research & review articles in all fields of Tropical Medicine & Hygiene. Tropical Medicine & Hygiene is a branch of medication that deals with health issues that arise unambiguously, or prove tough to manage in tropical and subtropic regions.
Austin Journal of Tropical Medicine & Hygiene is a comprehensive Open Access peer reviewed scientific Journal that covers multidisciplinary fields. We provide limitless access towards accessing our literature hub with colossal range of articles. The journal aims to publish high quality varied article types such as Research, Review, Short Communications, Case Reports, Perspectives (Editorials), Clinical Images.
Austin Journal of Tropical Medicine & Hygiene supports the scientific modernization and enrichment in Tropical Medicine & Hygiene research community by magnifying access to peer reviewed scientific literary works. Austin also brings universally peer reviewed member journals under one roof thereby promoting knowledge sharing, collaborative and promotion of multidisciplinary science.
Case Series: Mediastinal Mass Misdiagnosed As Extra Pulmonary Tuberculosisiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
The document discusses two conditions: paroxysmal nocturnal hemoglobinuria (PNH) and atypical hemolytic uremic syndrome (aHUS). PNH is a complement-mediated hemolytic anemia treated with the drug eculizumab, a C5a inhibitor. aHUS is a complement-mediated thrombotic microangiopathy that can cause stroke, heart attack, and kidney failure, and is also treated with eculizumab. The document asks the reader to identify PNH, aHUS, and the mode of action of eculizumab.
Dr. Escobar’s CMC X-Ray Mastery Project: December CasesSean M. Fox
Drs. Daniel Escobar, Angela Pikus, and Alex Blackwell are Emergency Medicine Residents and interested in medical education. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides. This set will cover:
- Blunt hemothorax
- Pulmonary contusion
- Lung Cancer with Bone Metastases
- Pneumomediastinum
- Pneumopericardium
Imaging of Diffuse B Cell Large Lymphoma in Liver, Kidneys, Pancreas and Myoc...semualkaira
A 41-year-old man was transferred to our Infectious Diseases Unit
with a history of three weeks of fever, abdominal pain, nausea,
vomiting and weight loss. He was HIV positive since 2013 but discontinued antiretroviral therapy in 2019. A
Imaging of Diffuse B Cell Large Lymphoma in Liver, Kidneys, Pancreas and Myoc...semualkaira
A 41-year-old man was transferred to our Infectious Diseases Unit
with a history of three weeks of fever, abdominal pain, nausea,
vomiting and weight loss. He was HIV positive since 2013 but discontinued antiretroviral therapy in 2019
Imaging of Diffuse B Cell Large Lymphoma in Liver, Kidneys, Pancreas and Myoc...semualkaira
A 41-year-old man was transferred to our Infectious Diseases Unit
with a history of three weeks of fever, abdominal pain, nausea,
vomiting and weight loss. He was HIV positive since 2013 but discontinued antiretroviral therapy in 2019. At admission he was afebrile, with haemoglobin level of 12.8 g/dL
Imaging of Diffuse B Cell Large Lymphoma in Liver, Kidneys, Pancreas and Myoc...semualkaira
A 41-year-old man was transferred to our Infectious Diseases Unit
with a history of three weeks of fever, abdominal pain, nausea,
vomiting and weight loss. He was HIV positive since 2013 but discontinued antiretroviral therapy in 2019. At admission he was afebrile, with haemoglobin level of 12.8 g/dL
Imaging of Diffuse B Cell Large Lymphoma in Liver, Kidneys, Pancreas and Myoc...semualkaira
A 41-year-old man was transferred to our Infectious Diseases Unit
with a history of three weeks of fever, abdominal pain, nausea,
vomiting and weight loss. He was HIV positive since 2013 but discontinued antiretroviral therapy in 2019.
Imaging of Diffuse B Cell Large Lymphoma in Liver, Kidneys, Pancreas and Myoc...semualkaira
A 41-year-old man was transferred to our Infectious Diseases Unit
with a history of three weeks of fever, abdominal pain, nausea,
vomiting and weight loss. He was HIV positive since 2013 but discontinued antiretroviral therapy in 2019
Imaging of Diffuse B Cell Large Lymphoma in Liver, Kidneys, Pancreas and Myoc...semualkaira
A 41-year-old man was transferred to our Infectious Diseases Unit
with a history of three weeks of fever, abdominal pain, nausea,
vomiting and weight loss. He was HIV positive since 2013 but discontinued antiretroviral therapy in 2019. At admission he was afebrile, with haemoglobin level of 12.8 g/dL, leucocytes 4,340 cells/
mm³, platelets 237,000 cells/mm³, reative C protein 14.1 mg/dL,
urea 48 mg/dL, creatinin 0.98 mg/dL, n
Imaging of Diffuse B Cell Large Lymphoma in Liver, Kidneys, Pancreas and Myoc...semualkaira
A 41-year-old man was transferred to our Infectious Diseases Unit
with a history of three weeks of fever, abdominal pain, nausea,
vomiting and weight loss. He was HIV positive since 2013 but discontinued antiretroviral therapy in 2019. At admission he was afebrile, with haemoglobin level of 12.8 g/dL, leucocytes 4,340 cells/
mm³, platelets 237,000 cells/mm³, reative C protein 14.1 mg/dL,
urea 48 mg/dL, creatinin 0.98 mg/dL, n
Kidney and vasculitis part 1 General approach and interactive casesAhmed Yehia
This document discusses vasculitis and provides a case study. It begins with an overview of vasculitis including what it is, which blood vessels can be affected, and classifications. It then presents a case of a 57-year-old male with renal dysfunction, anemia and hypertension. Tests showed p-ANCA positivity and a renal biopsy indicated RPGN. He developed endocarditis after steroid treatment. The diagnosis was determined to be infective endocarditis inducing vasculitis. Keys to differentiating secondary vasculitis from primary include double ANCA positivity, low complement levels, and multiple antibody positivities. The document concludes with recommendations when a patient has infection and is ANCA-positive.
1) The guideline provides recommendations for recognizing, diagnosing, and managing sepsis early. It outlines risk factors for sepsis and signs of clinical concern.
2) It recommends considering sepsis for anyone presenting with possible infection and assessing for risk factors and clinical concerns. It provides tools to stratify risk of severe illness from sepsis based on factors like vital signs.
3) Recommendations include considering anyone with altered mental status, respiratory distress, low blood pressure, or other concerning signs to be at high risk and warranting prompt treatment.
Un estudio sobre las caracteristicas del tratamiento sde la TB XDR en sudafrica y el pronostico de vida de los pacientes segun las estrategias terapeuticas
An 8-week regimen of sofosbuvir plus ledipasvir was found to be effective for many hepatitis C patients in real-world studies, even those who did not meet the official criteria for the shortened treatment. A review of five real-world studies involving over 600 patients found sustained viral response rates of 97% or higher with the 8-week regimen. The results provide reassurance that clinical trial results translate to real-world practice and suggest the criteria for the 8-week regimen could be expanded.
This randomized clinical trial compared two post-exposure prophylaxis (PEP) regimens for preventing HIV infection: tenofovir/emtricitabine plus ritonavir-boosted lopinavir versus tenofovir/emtricitabine plus raltegravir. The trial found that while overall PEP non-completion at 28 days was similar between the two regimens, the raltegravir-containing regimen had significantly fewer adverse events and better adherence. Specifically, the ritonavir-boosted lopinavir regimen was associated with higher rates of PEP non-completion, loss to follow up, and low adherence, as well as more reported adverse events.
The document presents new consensus definitions for sepsis and septic shock developed by an international task force. It summarizes limitations of previous definitions, which focused excessively on inflammation and lacked specificity. The task force developed updated definitions and clinical criteria through meetings, literature reviews, and consultation with international societies. The new definition of sepsis is "life-threatening organ dysfunction caused by a dysregulated host response to infection." Septic shock is defined as a subset of sepsis involving profound circulatory and metabolic abnormalities associated with higher mortality. Clinical criteria including changes in SOFA scores and vital signs were also developed to facilitate earlier recognition of at-risk patients. The task force aims to provide more consistency for research and management of sepsis.
Echinocandins remain the preferred treatment for invasive Candida infections. While mutations in FKS genes can cause reduced echinocandin susceptibility, overall rates of resistance remain low outside of certain high-risk settings. Susceptibility testing and detection of FKS mutations have limited roles in routine clinical practice due to low prevalence, testing uncertainties, and unclear relationships with treatment outcomes. These tools may be most useful for patients with prior echinocandin exposure who develop new infections or do not respond to treatment.
1) Antibiotic de-escalation refers to narrowing or reducing the spectrum of antibiotics administered to critically ill patients once culture results are available.
2) Observational studies have found de-escalation therapy to be safely practiced in ICU patients and possibly associated with lower mortality and shorter hospital stays.
3) However, randomized trials have found possible higher risks of reinfection with de-escalation, without effects on mortality. Overall, de-escalation appears to be a well-tolerated strategy but is not widely adopted in practice.
This document discusses strategies for developing broad-spectrum antiviral agents (BSAA) that can treat multiple virus families. It identifies four promising categories: 1) nucleoside analogues, as viral polymerases share similarities allowing broad inhibition; 2) viral protease inhibitors, as proteases are somewhat conserved; 3) host-targeting drugs that modulate host cell factors viruses require; and 4) immune-modulating agents that exploit the immune system's natural antiviral functions. While progress has been made, the field of BSAA is still young, but developing such agents will be important for addressing future viral threats.
This study found that cytomegalovirus (CMV) coinfection is associated with higher CD8 T-cell counts, lower CD4/CD8 ratios, and increased systemic inflammation in HIV-positive individuals on antiretroviral therapy (ART). The study compared 158 HIV-positive individuals, of which 32 were CMV-negative and 126 were CMV-positive, to 21 HIV-negative controls. It found that CD8 T-cell counts were significantly higher in HIV-positive/CMV-positive individuals compared to HIV-positive/CMV-negative individuals or controls. Additionally, plasma levels of inflammatory markers IP-10, TNF-RII, and D-dimer were higher in HIV
Etiologia de la celulitis y Predicción clínica de la enfermedad Estreptocócic...Alex Castañeda-Sabogal
Etiologia de la celulitis. Estudio prospectivo y predicción clínica de la infeccion por Estreptococcus basado en la frecuencia encontrada de las especies de estreptococo
This study found that CMV coinfection is associated with higher CD8 T-cell counts, lower CD4/CD8 ratios, and increased systemic inflammation in ART-treated HIV-infected individuals. The key findings were:
1) Median CD8 counts were significantly higher in HIV/CMV coinfected patients compared to HIV monoinfected or healthy controls.
2) HIV/CMV coinfection resulted in significantly lower CD4/CD8 ratios.
3) Levels of inflammatory markers IP-10, TNF-RII, and D-dimer were higher in HIV/CMV coinfected individuals.
CMV coinfection may contribute to the risk of morbid outcomes in treated HIV infection by driving
Early initiation of antiretroviral therapy (ART) within 6 months of HIV infection contributes to the normalization of CD8 T-cell counts. The study found that:
1) CD8 counts decreased significantly from 797 to 588 cells/μL over 24 months in individuals who started ART early, reaching lower levels than those without ART or with delayed ART.
2) CD4 T-cell recovery was more prominent in individuals who started ART early compared to those with delayed ART.
3) ART initiated early in HIV infection is associated with improved resolution of elevated CD8 T-cell counts compared to long-term ART initiated in chronic infection, which may help reduce non-AIDS related events.
This document summarizes the principles of tuberculosis treatment. It notes that while effective treatment has been available for 60 years, treatment takes at least 6 months. The standard treatment involves a 2-month induction phase with at least 3 drugs (isoniazid, rifampin, and pyrazinamide), followed by a 4-month consolidation phase with at least 2 drugs (isoniazid and rifampin). Challenges to treatment include bacterial populations with differing drug susceptibilities, sequestration of bacteria in tissues where drugs cannot reach, and factors influencing drug absorption and metabolism.
10 Benefits an EPCR Software should Bring to EMS Organizations Traumasoft LLC
The benefits of an ePCR solution should extend to the whole EMS organization, not just certain groups of people or certain departments. It should provide more than just a form for entering and a database for storing information. It should also include a workflow of how information is communicated, used and stored across the entire organization.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Kosmoderma Academy, a leading institution in the field of dermatology and aesthetics, offers comprehensive courses in cosmetology and trichology. Our specialized courses on PRP (Hair), DR+Growth Factor, GFC, and Qr678 are designed to equip practitioners with advanced skills and knowledge to excel in hair restoration and growth treatments.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Mercurius is named after the roman god mercurius, the god of trade and science. The planet mercurius is named after the same god. Mercurius is sometimes called hydrargyrum, means ‘watery silver’. Its shine and colour are very similar to silver, but mercury is a fluid at room temperatures. The name quick silver is a translation of hydrargyrum, where the word quick describes its tendency to scatter away in all directions.
The droplets have a tendency to conglomerate to one big mass, but on being shaken they fall apart into countless little droplets again. It is used to ignite explosives, like mercury fulminate, the explosive character is one of its general themes.