Läkartidningen
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Comment Review
[Septic shock--a condition with great potential for improvement. Management and therapy].
There is a recent focus upon treatment of septic shock, related to the publication of a number of interesting studies during the last two years. These studies indicate that patient outcome can be improved, provided care is organized so as to optimize and expedite initial treatment of the patient in septic shock. ⋯ These "new" therapies are presented in a total context with a temporal perspective. It is suggested that emergency sepsis teams be instituted at hospitals.
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Human recombinant activated protein C (Xigris) represents a new concept in adjuvant therapy for patients with severe sepsis. In the large randomized controlled trial on which the registration is based, 28 day mortality was significantly reduced by 6.1% from 30.8% in the placebo group to 24.7% in the treatment group. ⋯ Until further data becomes available from ongoing studies, we recommend that treatment be restricted to those patients for whom benefit has been shown in the clinical trial, i.e. adult patients with septic shock and at least one additional sign of organ dysfunction as defined in the study. Patients with septic organ dysfunctions with a longer duration than 24 h were not evaluated in the study.
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Review Comparative Study
[Use of snuff entails lower risk of cardiovascular diseases than does smoking].
Oral snuff, a form of smokeless tobacco, causes an immediate rise in heart rate and blood pressure, but snuff users do not show permanent changes in heart rate or blood pressure when not exposed to tobacco. Cardiac output during workload and maximal work capacity are unaffected. Snuff users usually do not show the biochemical stigmata that regular smokers do with the exception of a possible excess risk of type 2 diabetes. ⋯ Results on the risk of myocardial infarction have provided conflicting evidence, two case-control studies showing the same risk as in non-tobacco users and one cohort study showing an increased risk of cardiovascular death. A nested case-control study failed to show an excess risk of stroke in snuff users. It is concluded that the use of smokeless tobacco (with snuff being the most studied variant) entails a lower risk of adverse cardiovascular effects than does smoking.