American journal of therapeutics
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In recent years, significant progress has been made in our understanding of the pathophysiology behind obstructive airway diseases in general and asthma in particular; this knowledge, however, has not translated to major breakthroughs in the treatment of these disorders. Current therapeutic options are less than optimal and frequently are associated with systemic adverse effects. Recent studies indicate that endogenous purine nucleotides, adenosine 5'-triphosphate (ATP) in particular, could play a mechanistic role in obstructive airway diseases through their actions on multiple cell types relevant to these disorders, including mast cells, eosinophils, dendritic cells, and neurons. The pharmacologic modulation of ATP signal transduction in these cells represents an attractive new therapeutic target.
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This paper provides a brief history of the evolution of the Jehovah's Witness faith with a short discussion on the biblical justification for followers' refusal of blood transfusions. It also briefly considers the ethical principles leading to potential conflicts between health care workers and Jehovah's Witnesses patients and examines several significant legal rulings in the United States and Canada that caregivers should be aware of. A discussion of what blood products are and are not currently acceptable is also presented. Finally, the impact of the Jehovah's Witness reform movement aimed at allowing blood transfusions and the nature of recent doctrinal shifts in the Jehovah's Witness faith on the matter of blood transfusions are discussed.
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A number of pharmacologic and nonpharmacologic technologies are in current use to minimize perioperative homologous blood use. Clinical trials, many of them randomized controlled trials, have been done evaluating these approaches and have demonstrated their efficacy. However, data on safety has relied mostly on case reports, uncontrolled studies, and, for the pharmacologic agents, extrapolation from the nonsurgical setting. ⋯ DDAVP is low-risk, provided it is not overused, which can induce hyponatremia. Autologous predonation probably has similar risks as homologous blood with respect to transfusion errors and bacterial infection. As with most medical interventions, we must be vigilant to prevent human error.
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In general, transfusion guidelines for non-neonatal pediatric patients are similar to those for adults. However, some differences do exist and certain precautions may be necessary particularly in the setting of massive transfusions. ⋯ We include a discussion of the indications for transfusion and practical considerations such as dosing and administration. Finally, we briefly review the use of directed donations and specialized (irradiated, CMV seronegative) blood components.
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The aim of this study was to investigate the changes in circulating blood volume (CBV) after infusions of Hemoglobin glutamer-200 (bovine; Hb-200) in combination with 6% hetastarch in an animal model of acute posthemorrhagic anemia. Fifteen rabbits with a mean body weight of 2.2 +/- 0.2 kg were studied. After determination of the circulating plasma volume (CPV) and CBV, one third of the CBV was withdrawn via an arterial catheter. ⋯ Study group 2 demonstrated the highest CPV and CBV. The two study groups demonstrated a statistically significant increase in circulating volumes compared with the control group. The magnitude of this difference was lower than expected based on in vitro colloid osmotic pressure measurements.