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2019 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; P...
https://www.ahajournals.org/doi/10.1161/CIR.0000000000000734
Circulation Soar J et al

Nov 16th, 2019 - The International Liaison Committee on Resuscitation has initiated a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation science. This is the third annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. It addresses the m...

2019 American Heart Association Focused Update on Advanced Cardiovascular Life Support: Use of Advanced Airways, Vasopressors, and Extracorporeal Cardiopulmonary Resuscitation During Cardiac Arrest...
https://www.ahajournals.org/doi/10.1161/CIR.0000000000000732
Circulation Panchal AR et al

Nov 16th, 2019 - The fundamentals of cardiac resuscitation include the immediate provision of high-quality cardiopulmonary resuscitation combined with rapid defibrillation (as appropriate). These mainstays of therapy set the groundwork for other possible interventions such as medications, advanced airways, extracorporeal cardiopulmonary resuscitation, and post–cardiac arrest care, including targeted temperature...

Melinta Therapeutics Announces U.S. FDA Approval of Supplemental New Drug Application for BAXDELA® (delafloxacin) for the Treatment of Community-Acquired Bacterial Pneumonia (CABP)
http://ir.melinta.com/news-releases/news-release-details/melinta-therapeutics-announces-us-fda-approval-supplemental-new

Oct 23rd, 2019 - Melinta Therapeutics, Inc. (NASDAQ: MLNT), a commercial-stage company focused on the development and commercialization of novel antibiotics to treat serious bacterial infections, today announced the U.S. Food and Drug Administration (FDA) has approved BAXDELA® (delafloxacin) for the treatment of adult patients with community-acquired bacterial pneumonia (CABP) caused by designated susceptible b...

Metoprolol for the Prevention of Acute Exacerbations of COPD
https://www.nejm.org/doi/full/10.1056/NEJMoa1908142
The New England Journal of Medicine; Dransfield, M. et. al.

Oct 19th, 2019 - Observational studies suggest that beta-blockers may reduce the risk of exacerbations and death in patients with moderate or severe chronic obstructive pulmonary disease (COPD), but these findings have not been confirmed in randomized trials.

Predicting the Risk of Postoperative Pulmonary Complications
https://www.aafp.org/afp/2019/1015/p499.html
American Family Physician;

Oct 14th, 2019 - The incidence of pulmonary complications following major surgery is estimated to be 1% to 23%, with the risk varying based on patient factors and the type of surgery.1 Postoperative pulmonary complications include pneumonia, tracheobronchitis, pulmonary edema, pulmonary embolism, atelectasis, pleural effusion, pneumothorax, bronchospasm, aspiration, respiratory failure, and acute respiratory di...

Risk of rhabdomyolysis with donepezil compared with rivastigmine or galantamine: a population-based cohort study
http://www.cmaj.ca/content/191/37/E1018
CMAJ

Sep 15th, 2019 - BACKGROUND: Donepezil, rivastigmine and galantamine are popular cholinesterase inhibitors used to manage the symptoms of Alzheimer disease and other dementias; regulatory agencies in several countries warn about a possible risk of rhabdomyolysis with donepezil, based on information from case reports. Our goal was to investigate the 30-day risk of admission to hospital with rhabdomyolysis associ...

FDA approves new antibiotic to treat community-acquired bacterial pneumonia
https://www.fda.gov/news-events/press-announcements/fda-approves-new-antibiotic-treat-community-acquired-bacterial-pneumonia

Aug 18th, 2019 - The U.S. Food and Drug Administration today approved Xenleta (lefamulin) to treat adults with community-acquired bacterial pneumonia. “This new drug provides another option for the treatment of patients with community-acquired bacterial pneumonia, a serious disease,” said Ed Cox, M.D., M.P.H., director of FDA’s Office of Antimicrobial Products. “For managing this serious disease, it is impor...

Blood Purification and Mortality in Sepsis and Septic Shock: A Systematic Review and Meta-analysis of Randomized Trials
https://anesthesiology.pubs.asahq.org/article.aspx?articleid=2737141&resultClick=3
Anesthesiology Putzu, A. et. al.

Jun 26th, 2019 - Background: Sepsis and septic shock are severe inflammatory conditions related to high morbidity and mortality. We performed a systematic review with meta-analysis of randomized trials to assess whether extracorporeal blood purification reduces mortality in this setting. Methods: Electronic databases were searched for pertinent studies up to January 2019. We included randomized controlled tr...

FDA approves new treatment for hospital-acquired and ventilator-associated bacterial pneumonia
https://www.fda.gov/news-events/press-announcements/fda-approves-new-treatment-hospital-acquired-and-ventilator-associated-bacterial-pneumonia

Jun 2nd, 2019 - The U.S. Food and Drug Administration today approved a new indication for the previously FDA-approved drug, Zerbaxa (ceftolozane and tazobactam) for the treatment of hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia (HABP/VABP) in patients 18 years and older. The FDA initially approved Zerbaxa in 2014 to treat complicated intra-abdominal infections and for comp...

Head‐to‐head oral prophylactic antibiotic therapy for chronic obstructive pulmonary disease
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013024.pub2/full
The Cochrane Database of Systematic Reviews; Threapleton, C. et. al.

May 23rd, 2019 - Chronic obstructive pulmonary disease (COPD; including chronic bronchitis and emphysema) is a chronic respiratory condition characterised by shortness of breath, cough and recurrent exacerbations. Long‐term antibiotic use may reduce both bacterial load and inflammation in the airways. Studies have shown a reduction of exacerbations with antibiotics in comparison to placebo in people with COPD, ...

The Use of qSOFA in the Emergency Department
https://www.aaem.org/UserFiles/UseofqSOFAintheED.pdf

Apr 7th, 2019 - The quick Sequential Organ Failure Assessment (qSOFA) tool performs poorly in comparison to Systemic Inflammatory Response Syndrome (SIRS) as a diagnostic tool for Emergency Department (ED) patients who may have sepsis or septic shock. However, qSOFA is a good prognostic indicator in ED patients diagnosed with sepsis or septic shock.

Circassia Announces FDA Approval of Duaklir® for Maintenance Treatment of Chronic Obstructive Pulmonary Disease
https://www.circassia.com/media/press-releases/circassia-announces-fda-approval-of-duaklir-for-maintenance-treatment-of-chronic-obstructive-pulmonary-disease/

Mar 31st, 2019 - Circassia Pharmaceuticals plc (“Circassia” or “the Company”; LSE: CIR), a specialty pharmaceutical company focused on respiratory disease, today announces the US Food and Drug Administration (FDA) has approved Duaklir® for the maintenance treatment of chronic obstructive pulmonary disease (COPD). Duaklir® is a fixed-dose combination of the long-acting muscarinic antagonist (LAMA) aclidinium bro...

AAP Updates Recommendations to Prevent Drowning in Children
https://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/AAP-Updates-Recommendations-to-Prevent-Drowning-in-Children.aspx

Mar 14th, 2019 - Drowning can be silent and quick, and it kills nearly 1,000 children every year. To refocus the attention of parents and physicians on one of the leading causes of death among children, the American Academy of Pediatrics is publishing updated recommendations on water safety.

Prevention of Drowning
https://pediatrics.aappublications.org/content/pediatrics/early/2019/03/13/peds.2019-0850.full.pdf

Mar 14th, 2019 - Drowning is a leading cause of injury-related death in children. In 2017, drowning claimed the lives of almost 1000 US children younger than 20 years. A number of strategies are available to prevent these tragedies. As educators and advocates, pediatricians can play an important role in the prevention of drowning.

Barotrauma - StatPearls
https://www.ncbi.nlm.nih.gov/books/NBK482348/
Battisti, A. et. al.

Mar 11th, 2019 - Barotrauma is physical tissue damage caused by a pressure difference between an unvented space inside the body and surrounding gas or fluid. The damage is due to shear or overstretching of tissues. As a gas-filled space expands or contracts, it can cause damage to the local tissue. Occasionally, tears in tissue can allow gas to enter the body through the initial trauma site. This causes potenti...

Effective management of opioid withdrawal symptoms: A gateway to opioid dependence treatment
https://onlinelibrary.wiley.com/doi/full/10.1111/ajad.12862
Kosten, T. et. al.

Jan 30th, 2019 - The opioid crisis has taken an immense toll in the United States. On average, five lives are lost to an opioid overdose every hour of the day; estimated costs associated with opioid misuse exceed $500 billion annually. Illicit opioid discontinuation is the first step in the treatment of opioid use disorder (OUD), and transition to an opioid agonist may initiate treatment. However, discontinuati...

Association of Childhood Lead Exposure With Adult Personality Traits and Lifelong Mental Health
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2720691
Reuben, A. et. al.

Jan 22nd, 2019 - Question: Is childhood lead exposure associated with the risk of mental illness or difficult personality traits in adulthood? Findings: In this longitudinal cohort study of 579 New Zealand children followed up for more than 30 years, greater lead exposure in childhood was significantly associated with greater psychopathology across the life course and with difficult personality traits in adulth...

Vibrio Cholerae - StatPearls
https://www.ncbi.nlm.nih.gov/books/NBK526099/

Nov 17th, 2018 - Cholera is a well-known disease caused by intestinal infection with the toxin-producing bacteria Vibrio cholerae. This potentially fatal diarrheal disease results in large volumes of watery stool, causing rapid dehydration that can progress to hypovolemic shock and metabolic acidosis.

Bacteremia - StatPearls
https://www.ncbi.nlm.nih.gov/books/NBK441979/

Nov 14th, 2018 - Bacteremia in the strictest sense refers to viable bacteria in the blood. Asymptomatic bacteremia can occur in normal daily activities such as conducting oral hygiene and after minor medical procedures. In a healthy person, these clinically benign infections are transient and cause no further sequelae. However, when immune response mechanisms fail or become overwhelmed, bacteremia becomes a blo...

Acetaminophen Toxicity - StatPearls
https://www.ncbi.nlm.nih.gov/books/NBK441917/

Nov 13th, 2018 - Acetaminophen (N-acetyl-para-aminophenol, paracetamol, APAP) toxicity is common primarily because the medication is so readily available and there is a perception that it is very safe. More than 60 million Americans consume acetaminophen on a weekly basis. Acetaminophen is used in many products in combination with other preparations, especially with opioids and diphenhydramine. Many people are ...

Colloids versus crystalloids for fluid resuscitation in critically ill people
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000567.pub7/full
The Cochrane Database of Systematic Reviews; Lewis, S. et. al.

Aug 2nd, 2018 - Critically ill people may lose fluid because of serious conditions, infections (e.g. sepsis), trauma, or burns, and need additional fluids urgently to prevent dehydration or kidney failure. Colloid or crystalloid solutions may be used for this purpose. Crystalloids have small molecules, are cheap, easy to use, and provide immediate fluid resuscitation, but may increase oedema. Colloids have lar...

Fentanyl and Other Synthetic Opioids Drug Overdose Deaths
https://www.drugabuse.gov/related-topics/trends-statistics/infographics/fentanyl-other-synthetic-opioids-drug-overdose-deaths

Apr 30th, 2018 - In 2016, synthetic opioids (primarily illegal fentanyl) passed prescription opioids as the most common drugs involved in overdose deaths in the United States.

Rotavirus Clinical Information
https://www.cdc.gov/rotavirus/clinical.html

Apr 22nd, 2018 - Rotavirus disease is characterized by vomiting and watery diarrhea for 3 to 8 days. Fever and abdominal pain also frequently occur. Additional symptoms include loss of appetite and dehydration.

Amphetamines
https://www.msdmanuals.com/professional/special-subjects/recreational-drugs-and-intoxicants/amphetamines
Malley, G. et. al.

Mar 1st, 2018 - Amphetamines are sympathomimetic drugs with CNS stimulant and euphoriant properties whose toxic adverse effects include delirium, hypertension, seizures, and hyperthermia (which can cause rhabdomyolysis and renal failure). Toxicity is managed with supportive care, including IV benzodiazepines (for agitation, hypertension, and seizures) and cooling techniques (for hyperthermia). There is no ster...

Sepsis and Septic Shock - Merck Manuals Professional Edition
https://www.merckmanuals.com/professional/critical-care-medicine/sepsis-and-septic-shock/sepsis-and-septic-shock

Jan 31st, 2018 - Sepsis is a clinical syndrome of life-threatening organ dysfunction caused by a dysregulated response to infection. In septic shock, there is critical reduction in tissue perfusion; acute failure of multiple organs, including the lungs, kidneys, and liver, can occur. Common causes in immunocompetent patients include many different species of gram-positive and gram-negative bacteria. Immunocompr...

Xerostomia in Primary Care
https://contemporaryclinic.pharmacytimes.com/journals/issue/2017/april2017/xerostomia-in-primary-care

Apr 18th, 2017 - Xerostomia, also known as dry mouth, is a relatively common condition that can present acutely or chronically and has a variety of different causes. Xerostomia, or hypo salivation, is often caused by several temporary and chronic conditions that lead to salivary gland hypofunction. Temporary causes include, most commonly, the short-term use of certain medications, infections, and dehydration.

Causes and Evaluation of Chronic Dyspnea
https://www.aafp.org/afp/2012/0715/p173.html
AAFP

Jul 11th, 2015 - Chronic dyspnea is shortness of breath that lasts more than one month. The perception of dyspnea varies based on behavioral and physiologic responses. Dyspnea that is greater than expected with the degree of exertion is a symptom of disease. Most cases of dyspnea result from asthma, heart failure and myocardial ischemia, chronic obstructive pulmonary disease, interstitial lung disease, pneumoni...

Dry Mouth - American Cancer Society
https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/mouth-problems/dry-mouth.html

Jun 7th, 2015 - Dry mouth happens when there’s not enough saliva. It can be caused by mouth-breathing, or it could be a side effect of medicine, radiation treatment to the head and neck, or dehydration.

Complications following “Brazilian” waxing for pubic hair removal
https://www.ajog.org/article/S0002-9378(14)00812-6/abstract
American Journal of Obstetrics & Gynecology; Baxi, L. et. al.

Aug 5th, 2014 - We read with interest the article by Demaria et al1 as pubic hair removal has gained more popularity in recent years. Various methods of hair removal may also be associated with sexually transmitted diseases. Primary genital herpes from contamination from a waxing salon has been described in the literature.2 Cases of molluscum contagiosum outbreak and septic shock due to staphylococcal infectio...

Deaths Attributed to Heat, Cold, and Other Weather Events in the United States, 2006–2010
https://www.cdc.gov/nchs/data/nhsr/nhsr076.pdf

Jul 29th, 2014 - Objectives—This report examines heat-related mortality, cold-related mortality, and other weather-related mortality during 2006–2010 among subgroups of U.S. residents. Methods—Weather-related death rates for demographic and area-based subgroups were computed using death certificate information. Adjusted odds ratios for weather-related deaths among subgroups were estimated using logistic r...

Management of Iron Deficiency Anemia
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4836595/
Gastroenterology & Hepatology; Jimenez, K. et. al.

Mar 31st, 2011 - Anemia affects one-fourth of the world’s population, and iron deficiency is the predominant cause. Anemia is associated with chronic fatigue, impaired cognitive function, and diminished well-being. Patients with iron deficiency anemia of unknown etiology are frequently referred to a gastroenterologist because in the majority of cases the condition has a gastrointestinal origin. Proper managemen...

Hydration and health: a review
https://onlinelibrary.wiley.com/doi/full/10.1111/j.1467-3010.2009.01795.x
Nutrition Bulletin; Benelam, B. et. al.

Feb 21st, 2010 - Water is essential for life and maintaining optimal levels of hydration is important for humans to function well. Water makes up a large proportion of our body weight (60% on average), distributed between the intracellular (inside cells) and extracellular (water in the blood and in between cells) compartments. Water is the major component of body fluids, such as blood, synovial fluid (fluid in ...

STRIVERDI® RESPIMAT® (olodaterol) Prescribing Information
https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/203108s000lbl.pdf

STRIVERDI RESPIMAT Inhalation Spray is a long-acting beta2-adrenergic agonist indicated for: The long-term, once-daily maintenance bronchodilator treatment of airflow obstruction in patients with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and/or emphysema

NUZYRA® (omadacycline)
https://www.nuzyra.com/hcp/

NUZYRA is indicated for treatment of Community-Acquired Bacterial Pneumonia (CABP) and Acute Bacterial Skin and Skin Structure Infections (ABSSSI) in adults caused by select susceptible microorganisms.

XENLETA™ (lefamulin) Website for Healthcare Professionals
https://www.xenleta.com/

community-acquired bacterial pneumonia See XENLETA™ (lefamulin) clinical trial results and product attributes

Postextubation laryngeal injury has lasting effects
https://www.mdedge.com/surgery/article/214247/critical-care/postextubation-laryngeal-injury-has-lasting-effects?channel=27970
Jim Kling

Dec 13th, 2019 - More than half of patients who undergo prolonged mechanical ventilation experience an acute laryngeal injury (ALgI), and the injury is associated with worse breathing and speaking at 10 weeks, according to a study published in Critical Care Medicine (2019 Dec;47[12]:1669-1706). The researchers, led by Alexander Gelbard, MD, of Vanderbilt Medical Center, Nashville, Tenn.

NAMDRC legislative initiatives take shape
https://www.mdedge.com/chestphysician/article/212332/society-news/namdrc-legislative-initiatives-take-shape?channel=28399
Phil Porte, MDedge News

Dec 9th, 2019 - Two priorities of NAMDRC have moved into the formal congressional arena. The issues focus on access to pulmonary rehabilitation and CMS’s move to include home mechanical ventilation in competitive bidding.

This month in the journal CHEST®
https://www.mdedge.com/chestphysician/article/212512/society-news/month-journal-chestr?channel=28399
Peter J. Mazzone, MD, MPH, FCCP, MDedge News

Dec 9th, 2019 - Editorials Pulmonary Embolism Cardiac Arrest: Thrombolysis During Cardiopulmonary Resuscitation and Improved Survival. By Drs.

British Hiker Survives Six-Hour Cardiac Arrest in "Exceptional" Case - Spanish Doctor
https://www.medscape.com/viewarticle/922223

Dec 5th, 2019 - BARCELONA (Reuters) - A 34-year-old British hiker was revived in Spain after a six-hour cardiac arrest brought on by severe hypothermia, with the low mountain temperatures that made her ill also helping to save her life in what a doctor described as an "exceptional case." Audrey Mash's ordeal began on Nov. 3 when she and her husband were out hiking in the Catalan Pyrenees. As the weather took a...

Holding Intubated Infants Safe, Well Received
https://www.medscape.com/viewarticle/922045

Dec 3rd, 2019 - NEW YORK (Reuters Health) - Holding infants intubated in an intensive care unit (ICU) to increase early mobility was well tolerated by the infants and well received by nurses and parents, researchers say. "The risks of holding infants on life support for respiratory failure are low, and there may be benefits for both infants and families," Dr. Laura Ortmann of Children's Hospital and Medical Ce...

Out-of-Hospital Hypothermia Clinical Practice Guidelines (2019)
https://www.medscape.com/viewarticle/922078

Dec 3rd, 2019 - Guidelines on the out-of-hospital evaluation and treatment of accidental hypothermia were released in November 2019 by the Wilderness Medical Society.[1] Key factors that should guide hypothermia treatment are as follows: Level of consciousness Alertness Shivering intensity Physical performance Cardiovascular stability (assessed based on blood pressure and cardiac rhythm) Core Temperature While...

One Bout of Childhood Pancreatitis Tied to Higher T2DM Risk
https://www.medscape.com/viewarticle/921979

Dec 2nd, 2019 - NEW YORK (Reuters Health) - A single episode of pancreatitis in childhood is associated with a higher risk of developing type 2 diabetes in adulthood, according to new findings. "Children and adolescents with pancreatitis may require a tighter follow-up for their glucose levels and a careful control of modifiable diabetes risk factors following an event of acute pancreatitis that has been resol...

Former U.S. President Carter Home for the Holidays After Surgery
https://www.medscape.com/viewarticle/921891

Dec 2nd, 2019 - WASHINGTON (Reuters) - Former U.S. President Jimmy Carter was discharged from a hospital in Georgia on Wednesday after a successful surgery to relieve pressure on his brain, heading home one day before the Thanksgiving holiday. Carter, 95, had been hospitalized at Emory University in Atlanta in the latest episode in a string of recent health scares for the nation's oldest living former presiden...

Drowning Risk? Unexpected Effect of Deep Brain Stimulation Surfaces
https://www.medscape.com/viewarticle/921956

Nov 28th, 2019 - An unexpected, and potentially life-threatening, side effect of deep brain stimulation for Parkinson disease (PD) has surfaced. A case series of nine PD patients who had been surgically implanted with subthalamic nucleus deep brain stimulators (STN-DBSs) shows that although the device improved other movement symptoms, patients' swimming skills deteriorated. "Awareness is the most important goal...

Awake Tracheal Intubation Clinical Practice Guidelines (2019)
https://www.medscape.com/viewarticle/921825

Nov 26th, 2019 - The guidelines on awake tracheal intubation were released on November 14, 2019, by the Difficult Airway Society (DAS).[1] Awake tracheal intubation must be considered in the presence of predictors of difficult airway management. A cognitive aid (eg, a checklist) is recommended before and during performance of awake tracheal intubation. Supplemental oxygen should always be administered during aw...

Climate-Related Wheezing, Allergy, Trauma Affecting Practice
https://www.medscape.com/viewarticle/921875

Nov 26th, 2019 - At her pediatric practice in Reno, Nevada, Debra Hendrickson, MD, sees the effects of climate change first-hand: a little girl wheezing from wildfire smoke inhalation; a young boy suffering heatstroke on yet another record-high temperature day; a child with sustained stress after fleeing a hurricane. Reno is about a 3-hour drive, through the Tahoe National Forest, from Paradise, California wher...

Impella-Pump Bleeding, Mortality 'Signals' in MI-Shock and High-Risk PCI
https://www.medscape.com/viewarticle/921847

Nov 25th, 2019 - PHILADELPHIA — Interventional cardiology has taken quite a shine to Impella ventricular assist pumps (Abiomed) for cardiogenic shock (CS) and to support high-risk procedures, but two new observational studies have independently called into question whether all of that luster is deserved. Together, the analyses show a steady climb in Impella use in the United States since its 2008 regulatory app...

Regular use of disinfectants at work associated with increased risk of COPD
https://www.mdedge.com/familymedicine/article/213045/copd/regular-use-disinfectants-work-associated-increased-risk-copd?channel=39313
CHEST Physician; Steve Cimino

Nov 25th, 2019 - A study has found that consistent occupational exposure to disinfectants is associated with an increased risk of chronic obstructive pulmonary disease (COPD). “Clinicians should be aware of this new risk factor and systematically look for sources of exposure to cleaning products and disinfectants in addition to other occupational exposures in patients with COPD,” wrote Orianne Dumas, PhD, of th.

Fast Five Quiz: Key Aspects of Influenza
https://www.medscape.com/viewarticle/921711

Nov 24th, 2019 - Influenza viruses are highly contagious and can cause seasonal epidemics. Illness manifests as an acute febrile illness with variable degrees of severity, ranging from mild fatigue to respiratory failure and death. Influenza is one of the most significant causes of acute upper respiratory tract infections worldwide. Each year, seasonal influenza usually occurs during the late autumn and winter ...

FDA approves Givlaari for treatment of acute hepatic porphyria
https://www.mdedge.com/clinicalneurologynews/article/212845/anemia/fda-approves-givlaari-treatment-acute-hepatic-porphyria?channel=37225
Lucas Franki, Clinical Neurology News

Nov 21st, 2019 - The Food and Drug Administration has approved givosiran (Givlaari) for the treatment of adult patients with acute hepatic porphyria, a genetic disorder that causes buildup of porphyrin molecules. Wikimedia Commons/FitzColinGerald/ Creative Commons License “This buildup can cause acute attacks, known as porphyria attacks, which can lead to severe pain and paralysis, respiratory failure, seizures.