Presse Med
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Review Comparative Study
[Objectives for antibiotic therapy in acute exacerbations of chronic bronchitis].
ANTIBIOTIC EFFICACY: According to early studies, antibiotics have moderate efficacy in acute exacerbation of chronic bronchitis. The lack of efficacy is particularly clear for patent exacerbation with marked alteration of respiratory function. Recent studies have shown that newer compounds exhibit an efficacy similar (no proven superiority) to comparison compounds (75 to 95% favorable outcome with treatment). The recommendations of the IVth Consensus Conference on Anti-infectious Therapy thus propose first line antibiotic therapy for patients with a forced expiratory volume in 1 second (FEV1) between 80 and 35% and broader spectrum and new antibiotics in case of failure of the first line treatment for patients with severe obstruction or frequently recurrent exacerbation.
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UNDERESTIMATED SIDE EFFECTS: Skin reactions to interferon (INF) treatment are uncommon in the larger series in the literature and are usually considered to be minor. They account for 5 to 12% of adverse effects to IFN and are encountered increasingly in patients with active chronic hepatitis C. Reactions may be local, occurring exclusively at the site of injection, or general.
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Cough and expectorations present for at least 3 months every year for at least 2 consecutive years are the characteristic feature of chronic bronchitis. Pulmonary emphysema is a permanent distension of the air spaces beyond the bronchioles with destruction of the alveolar walls. Chronic obstructive pulmonary disease (COPD), which often develops after chronic bronchitis, is defined as an obstructive ventilatory syndrome demonstrated by a forced expiratory volume in 1 second/vital capacity (FEV1/VC) ratio below 70%. Acute exacerbation of chronic bronchitis is characterized by worsening cough, expectoration and/or dyspnea. ⋯ In patients without co-morbidity, only about 30% of all cases of chronic bronchitis are diagnosed. Medical care is given to about 15%. The impact of acute exacerbations (average 3 episodes per year according to the survey), both in number and in terms of quality of life, would be underestimated.
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A POTENTIALLY FATAL CONDITION: Pulmonary embolism (PE) is a potentially fatal disorder for which heparin therapy improves the outcome. In spite of anticoagulation, mortality of PE remains high, especially when associated with shock or right ventricular dysfunction. THROMBOLYSIS: Indications of thrombolytic therapy in the treatment of PE remain relatively undefined. ⋯ However, there is an increasing risk of major bleeding when using thrombolytic agents. In summary, thrombolytic therapy use should be restricted to patients who have hemodynamic instability in absence of absolute contraindications. A large-scale prospective randomized controlled trial, comparing heparin alone and thrombolysis therapy is needed to clarify the indications of these treatments.
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Comparative Study
[Off-label prescriptions in an adult surgical intensive care unit].
The aim of the study was to document off label prescribing in an adult surgical intensive care unit setting and to determine explanatory factors. ⋯ Off label prescription is frequent in the setting of adult surgical intensive care unit. Seldom medical situations and the gap between official labeling and medical knowledge are explanatory factors of these off label prescriptions.