Postgraduate medicine
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Postgraduate medicine · Jun 1996
Review Comparative StudyNoninvasive positive pressure ventilation: what is its role in treating acute respiratory failure?
Noninvasive positive pressure ventilation (NIPPV) is a viable option in treating appropriately selected patients with acute respiratory failure. It is often well tolerated, and it avoids endotracheal intubation with its potential complications. Moreover, gas exchange is reportedly improved. ⋯ Also, studies are needed to compare the efficacy, safety, and cost-effectiveness of NIPPV and standard endotracheal ventilation. Despite these unresolved issues, NIPPV clearly represents an important addition to the techniques available in managing acute respiratory failure. Except in situations in which immediate endotracheal intubation is required, it may become first-line therapy in elderly patients in whom resuscitation status is unsettled.
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Postgraduate medicine · Jun 1996
ReviewDiabetic ketoacidosis and hyperosmolar nonketotic state: gaining control over extreme hyperglycemic complications.
Decompensated hyperglycemia is a frequent, severe complication of diabetes mellitus. Ketoacidosis usually occurs in patients with insulin-dependent (type I) diabetes, and insulin therapy is required to correct their hyperglycemic derangement. ⋯ Some patients exhibit a mixture of ketoacidosis and hyperosmolarity, which suggests that the two conditions may represent variants of decompensated hyperglycemia that differ only by the magnitude of dehydration and the severity of acidosis. All diabetic patients with hyperglycemic decompensation should return to their usual hypoglycemic programs as soon as possible and receive close follow-up after hospitalization.
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Postgraduate medicine · May 1996
ReviewBrain failure in older patients. Uncovering treatable causes of a diminished ability to think.
The term "brain failure" implies only dysfunction of a major organ system, not that an exact diagnosis has been made. Assessment and treatment of older patients with diminished cognitive ability can be challenging; however, the experience can also be extremely rewarding when a reversible condition is alleviated and the patient is given added years of productive life. The first step in patient evaluation is to rule out delirium. ⋯ Finally, extreme care must be taken in making the diagnosis of true dementia. Diagnosis of such a condition (eg, Alzheimer's disease, multi-infarct dementia, dementia of Parkinson's disease) has a profound effect on the patient and the family. These conditions are largely nontreatable, but physicians still have an important role in helping caregivers find appropriate assistance and support.
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Postgraduate medicine · May 1996
Hepatotoxic effects of tuberculosis therapy. A practical approach to a tricky management problem.
Side effects of the most commonly used first-line antituberculosis drugs range from minor gastrointestinal symptoms to severe hepatotoxicity. If unrecognized, they can lead to increased morbidity and mortality as well as to higher healthcare costs. ⋯ Recognition of this problem, mandatory directly observed therapy, judicious standardized follow-up planning, and implementation of modified treatment protocols when needed may play a dominant role in treating and controlling tuberculosis and may also prevent the morbidity and mortality sometimes associated with tuberculosis treatment. In view of the changing epidemiology of tuberculosis and its global impact, the American Thoracic Society and the Centers for Disease Control and Prevention may need to look closely into the issues outlined here to develop a consensus and establish more specific guidelines.