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The Trojan horse of sepsis bundles

“All is for the best in this best of all possible worlds” – Dr. Pangloss in Voltaire’s Candide Whether septic shock provides a defense to the host is an open question – one that is increasingly relevant to emergency and critical care. Even if certain features of sepsis represent host […]

Lessons from the ADRENAL trial

The ADRENAL trial is the recently published, and influential, randomized controlled trial of hydrocortisone in patients with sepsis. There are two lessons to be learned from the ADRENAL trial. Lesson #1. The first is a small lesson. Should we be using steroids in sepsis? Answer: no. This was a big […]

Better than nature

We are about to learn whether giving corticosteroids in sepsis is a good idea or bad. I am on record predicting a negative result. [Update – The ADRENAL trial, now published in the New England Journal of Medicine showed that corticosteroids did not improve mortality. It did shorten ICU stay […]

2018 ISEMPH Conference Announcement

As chair of the 2018 Program Committee for the International Society for Evolution, Medicine, and Public Health, I am delighted to announce our 4th annual meeting taking place this year in spectacular Park City, Utah, August 1-4, 2018. The conference will be anchored around presentations by six internationally-celebrated keynote speakers. […]

Toe fevers, nose fevers?

The Roman Celsus in the 1st century A.D. identified four classical signs of inflammation: Calor, dolor, rubor, and tumor; these are heat, pain, redness, and swelling. Some of the most annoying symptoms of influenza, for instance, involve vascular congestion of mucous membranes, from increased blood flow leading to tissue swelling […]

Fat fights back

Is fat a immune organ, vital for host defense? In 2015, an important study in Science suggested that fat has an important immune function that prevents invasion by pathogens From Dermal adipocytes protect against invasive Staphylococcus aureus skin infection: “Adipocytes have been suggested to be immunologically active, but their role […]

The PO challenge

While I worked a busy shift in the ER today I saw more than a dozen patients with flu symptoms. They complained of cough, congestion, headache, muscle pain, and often, stomach upset. It reinforced the idea that infection and fever are almost always accompanied by a loss of appetite, if […]

Killer vitamins

In 2008 the New York Times published an article, News keeps getting worse for vitamins. Since then, additional trials of vitamins have also spectacularly failed. The Cochrane review, a well-known publisher of meta-analyses, reviewed anti-oxidant vitamins, Vitamin C, Vitamin A, Vitamin E, and selenium, and concluded that while these compounds […]

Shock as a host defense

This is one of the most interesting ideas in (evolutionary) medicine. Is shock itself a host defense? Kathryn Maitland conducted the FEAST trial, a landmark study of fluid resuscitation in children with septic shock published in the New England Journal of Medicine, that we have discussed in a previous podcast […]