Medicina
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Review Comparative Study
[The new aspects of treatment of severe sepsis and septic shock].
The mortality rate of infection-induced organ dysfunction or hypoperfusion abnormalities due to severe sepsis and septic shock remains unacceptably high. The adequacy and speed of treatment administered in the first hours after syndrome develops influence outcome. Initial resuscitation, appropriate antimicrobial treatment, selection of optimal control methods, properties of fluid therapy, use of vasopressors and inotropic therapy, proper corticosteroid administration, value of the use of recombinant human activated protein C, and glucose control are the most important points newly evaluated for severe and septic shock management.
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Review Comparative Study Historical Article
[Physiological aspects of cardiopulmonary resuscitation in adults].
This article reviews the physiology of cardiopulmonary resuscitation (CPR), monitoring and new devices for generating blood flow during CPR. Two controversial mechanisms of blood flow during chest compressions are described: the thoracic pump mechanism and cardiac pump mechanism. Also, new physiological aspects of blood flow, physiology of ventilation and gas transport during CPR are overviewed. ⋯ Electrocardiogram remains the most essential tool for diagnosis and monitoring of cardiac arrest. Monitoring of diastolic blood pressure, myocardial perfusion pressure and end-tidal CO2 are also useful. Other types of monitoring during cardiac arrests can provide information about effectiveness of CPR.
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The aim of the study was to investigate the causative agents of bacteremia in burned patients during 1999-2003. ⋯ Bacteremia was diagnosed at the beginning of the third week of hospital stay. More than half of bacteremic patients (67%) survived. The most common causative agents of bacteriemia were methicillin-resistant Staphylococcus aureus and gentamicin-sensitive strains of Pseudomonas aeruginosa.
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Randomized Controlled Trial Comparative Study
Effects of ketamine on precipitated opiate withdrawal.
N-methyl-D-aspartate antagonists were shown to be effective in suppressing the symptoms of opiate withdrawal. Intravenous anesthetic, ketamine, is the most potent N-methyl-D-aspartate antagonist available in clinical practice. The present study was designed to evaluate the effects of subanesthetic ketamine infusion, as little human data are available on ketamine in precipitated opiate withdrawal. ⋯ In this study, subanesthetic ketamine infusion was an effective adjuvant in the correction of acute precipitated opiate withdrawal although it had no long-term effects on treatment of opiate dependence.
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Photosensitive skin reactions occur when human skin reacts to ultraviolet radiation or visible light abnormally. The forms of photosensitivity are phototoxicity and photoallergy. ⋯ In order to avoid photosensitive reactions it is essential to determine the photosensitizing properties of such substances before drugs are introduced in therapy or products made available on the market. The article reviews the mechanisms of photosensitization, explains the most important differences between phototoxic and photoallergic reactions, summarizes the most common photosensitizers, and presents the clinical features and diagnostic procedures of phototoxic and photoallergic reactions.