Medicina
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Review Comparative Study
QT dispersion and heart rate variability in sudden death risk stratification in patients with ischemic heart disease.
The aim of the article is to review the literature data about the significance and problems of the QT dispersion and heart rate variability in sudden death risk stratification in patients with coronary heart disease. QT dispersion is defined as the difference between the longest and the shortest QT intervals as measured in the 12-lead electrocardiogram. A direct relationship between the prolongation of QT dispersion and myocardial ischemia has been reported by several authors. ⋯ Heart rate variability representing a relationship between the autonomic nervous system and cardiovascular mortality, including sudden cardiac death, is one of the most promising markers. The predictive value of heart rate variability is independent of other factors established for postinfarction risk stratification, such as depressed left ventricular ejection fraction, increased ventricular ectopic activity, and presence of late potentials. For prediction of all-cause mortality, the value of heart rate variability is similar to that of left ventricular ejection fraction, but heart rate variability is superior to left ventricular ejection fraction in predicting arrhythmic events (sudden cardiac death and ventricular tachycardia).
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Pneumonia is the most frequently reported nosocomial infection in intensive care unit patients, predominantly in mechanically ventilated individuals. Most of the studies performed in intensive care unit settings reported the estimated 15-65% of ventilator-associated pneumonia, with high mortality rates. Ventilator-associated pneumonia results in prolonged hospitalization and increase in medical care costs. ⋯ Prevention of the ventilator-associated pneumonia by local multidisciplinary strategies may reduce mortality rates and is beneficiary both for the patients and the hospital system. The education of the nursing staff helps to decrease the occurrence of ventilator-associated pneumonia in intensive care unit setting. However, ventilator-associated pneumonia still remains a serious controversy-generating problem in intensive care unit.
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Comparative Study
[Bleeding after cardiac surgery: risk factors, frequency, and outcomes].
According to the data from different cardiac surgery centers, the incidence of urgent repetitive resternotomy for bleeding after cardiac on-pump operations varies from 2 to 5%. The aim of the study was to determinate the risk factors influencing resternotomy after cardiac surgery, features of early postoperative period, and outcomes. ⋯ The use of antiaggregants and anticoagulants before surgery increases the incidence of resternotomies in the early postoperative period. Postoperative infections that require more expensive treatment with antibiotics are detected much more frequently in patients after resternotomies comparing to the remaining postoperative cardiac patients (15/37 and 69/819, respectively). However, longer hospitalization length (15.8 and 58.0 days, respectively) and higher mortality rate (4.5 and 10.8%, respectively) were observed in patients after resternotomy.
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Comparative Study
The evaluation of bone mineral density based on nutritional status, age, and anthropometric parameters in elderly women.
To examine the relationship between bone mineral density and nutritional status, age, and anthropometrical data in elderly women. ⋯ It was determined that the nutritional status of elderly women, assessed by the Mini Nutritional Assessment questionnaire, reflects bone mineral density. It was found that women's age and anthropometric data, reflecting fat reserves in the body (body mass index, skinfold thickness), are significantly related to low bone mineral density.
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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.