Biomedicine & pharmacotherapy = Biomédecine & pharmacothérapie
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Biomed. Pharmacother. · Jun 2008
Neutrophil elastase and systemic inflammatory response syndrome in the initiation and development of acute lung injury among critically ill patients.
Critically ill patients are commonly associated with systemic inflammatory response syndrome (SIRS) and are at a greater risk of developing acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). Under these conditions, large amounts of various cytokines are produced, which either directly or indirectly induce tissue injury and finally organ dysfunctions, through the activation of neutrophils and as a result of release of cytotoxic molecules, especially neutrophil elastase (NE). In the present study, we determined plasma neutrophil elastase-alpha-1 antitrypsin complex (NE-AT) and elastase digests of cross-linked fibrin (e-XDP) in critically ill patients to elucidate the significance of NE in the initiation and progression of ALI and ARDS in the presence or absence of SIRS. ⋯ Furthermore, NE-AT, but not e-XDP, significantly increased in subgroups whose PaO(2)/FIO(2) ratio decreased by more than 20%. Such correlations and differences between the subgroups were not observed in the non-ALI patients. From these results, we speculate that NE-AT, but not e-XDP, may be predictive of progressive lung injury in the early stage of ALI and ARDS.
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This review details the specific needs of women for omega-3 fatty acids, including alpha linoleic acid (ALA) and the very long chain fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Omega-3 fatty acid (dietary or in capsules) ensures that a woman's adipose tissue contains a reserve of these fatty acids for the developing fetus and the breast-fed newborn infant. This ensures the optimal cerebral and cognitive development of the infant. ⋯ The only adequate sources are rapeseed oil (canola), walnuts and so-called "omega-3" eggs (similar to wild-type or Cretan eggs). The amounts of EPA and DHA in the diet vary greatly from person to person. The only good sources are fish and seafood, together with "omega-3" eggs.
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At present, the opioids, anti-epileptic, membrane stabilising and anti-depressant drugs are the mainstay of treatment for alleviating neuropathic pain. This article summarises data on some new medications of these classes and also other groups of medications in development. Recent data on the use of combination medications and its implications will also be discussed.
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Ketamine is a dissociative anaesthetic; its mechanism of action is primarily an antagonism of the N-methyl-D-aspartate (NMDA) receptor. The role of ketamine, in particular in lower sub-anaesthetic doses, has recently gained increasing interest in pain management. It has been studied in a considerable number of trials and analysed in meta-analyses and systematic reviews. ⋯ Low dose ketamine also has 'preventive analgesia' properties. Furthermore, in higher doses it provides effective and safe sedation and analgesia for painful procedures. The place of ketamine in the treatment of chronic pain and the effects of long-term medicinal use remain unclear.
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For more than 100 years, the use of opioid analgesic agents has been linked with modulation of the immune system in man. More recently, it has become apparent that both exogenous and endogenous opioids exert some effect upon the immune system but that this can be beneficial or deleterious depending on numerous variables. ⋯ However, it still remains unclear whether this is clinically important in man although it would appear to be good practice to avoid such agents in patients already immunosuppressed by disease or pharmacotherapy. Powerful opioid analgesics without immunosuppressive properties can be selected and should be used in such situations and as these agents can offer additional benefits in addition to their non-immunosuppresive analgesia, it should be considered whether to use them at all times in preference to immunosuppressive opioids.