The American journal of medicine
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The continuing high mortality of septic shock has prompted a major effort by the research community to identify novel therapeutic targets. These targets can be conveniently grouped into (1) those derived from microbial components or products; (2) inflammatory mediators; and (3) effector molecules. ⋯ In this article, we discuss the possible reasons for these failures: (1) the targets are wrong; (2) the agents are inappropriate; or (3) the trial design is flawed. It would be premature to conclude that adjunctive agents have no future in the therapy of sepsis, but identifying the correct agent, and perhaps more importantly, the correct target population, is going to be more difficult than was at first believed.
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Viral respiratory infections are a leading cause of acute morbidity in the community. The annual frequency of respiratory illness rises during the second year of life, falls during subsequent years, increases again during child-bearing years, then decreases with advancing age (although some increase may be seen in the elderly). In terms of restriction on activity and prompting of visits to physicians, the greatest number of illnesses are associated with rhinoviruses followed by influenza viruses. ⋯ However, the potential for side effects is more marked with amantadine. Some studies have shown that the rate of treatment withdrawal is no greater with rimantadine than with placebo. As we enter the next century, we may well see improvements in influenza vaccines, as well as the advent of antiviral agents that are effective against both type A and type B influenza.
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Iron overload unexplained by dietary or medicinal iron excess, transfusion, or sideroblastic anemia has been described infrequently in Americans of African descent. The purpose of this study was to characterize iron overload attributable to excessive iron absorption in African Americans. ⋯ In comparison with Caucasians with hemochromatosis, our patients have slightly lower mean values of serum iron concentration and transferrin saturation, more Kupffer cell iron deposits, a higher incidence of thalassemia and hemoglobinopathy, and infrequent positivity for HLA-A3. Iron overload in African Americans appears to be more similar to that in certain sub-Saharan African natives than to hemochromatosis.
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Randomized Controlled Trial Clinical Trial
Alpha sympathomimetic treatment of autonomic insufficiency with orthostatic hypotension.
In this double-blind study, the authors compared the safety and efficacy of the investigational oral agent midodrine, a specific alpha 1-sympathomimetic agent, with ephedrine, a nonspecific alpha- and beta-adrenergic receptor agonist. Eight patients (4 men and 4 women) with refractory orthostatic hypotension resulting from autonomic failure were studied. This study was based on the notion that neurogenic orthostatic hypotension results from attenuation of adrenergic nerve traffic and not from alpha-adrenergic receptor dysfunction. Although arteriolar vasoconstrictors seem to be appropriate therapeutic agents, their success has been limited, and the search for an ideal drug is ongoing. ⋯ Midodrine safely and effectively improved orthostatic hypotension caused by autonomic failure. Our data suggest that the ability to stand is improved better by midodrine than by ephedrine.