Frontiers in medicine
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Frontiers in medicine · Jan 2019
Is the Osmolal Concentration of Ethanol Greater Than Its Molar Concentration?
Background: Recent data suggested that the osmolal gap attributed to ethanol as determined by the difference between measured serum osmolality and calculated serum osmolarity is greater than its molar concentration. The increased osmotic activity of ethanol is thought to be due to its binding to water molecules. This study is conducted to determine the true osmotic contribution of ethanol to serum osmolality. ⋯ Linear regression analysis relating the osmolal gap due to ethanol and ethanol concentration yielded the following equation: Osmolal Gap (mOsm/kg H2O) = 0.23 (Ethanol [mg/dL]) - 1.43. Conclusion: The osmolal concentration of ethanol can be calculated based on its molar concentration. We found no evidence for ethanol binding to water molecules over the range of ethanol concentration in this study.
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Frontiers in medicine · Jan 2019
From Opioid Pain Management to Opioid Crisis in the USA: How Can Public-Private Partnerships Help?
The current opioid crisis in the USA arose from (at first) successful opioid pain management in three waves, starting in the'90s. Today, USA patients consume opioid drugs on a massive scale. Considering their potential for tolerance, as well as their potential for lethality in relatively small overdose, the overuse of opioids form an urgent threat to public health in the USA. ⋯ Those collaborations should focus on different aspects related to the opioid crisis such as medical and societal (e.g., pain management process, including addressing opioid use disorders), as well as economical and regulatory issues (e.g., incentivizing the search for alternative non-addictive pain medication and banning aggressive marketing tactics used by the pharmaceutical industry). Additionally, collaborations should cover interdisciplinary education and training of various healthcare actors involved. In conclusion, interdisciplinary collaboration on the various opioid abuse-related aspects is urgently needed to tackle the opioid crisis in the USA.
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Frontiers in medicine · Jan 2019
Case ReportsExtracorporeal Membrane Oxygenation in Severe Acute Eosinophilic Pneumonia.
Acute Eosinophilic Pneumonia (AEP) is a potentially fatal cause of hypoxemic respiratory failure characterized by fever, diffuse bilateral pulmonary infiltrates, and pulmonary eosinophilia. Shown to be associated with a number of environmental exposures and lifestyle choices, AEP has a good prognosis when diagnosed early and treated with corticosteroids. In this clinical case report, we detail the presentation, evaluation, diagnosis, and management of a 40-year old male who presented to the emergency department with dyspnea, chills, and diaphoresis. ⋯ Initial chest CT scan revealed widespread mixed groundglass and solid airspace opacities; over the next 12 hours, he rapidly decompensated and after not responding to other invasive mechanical ventilation, was emergently cannulated for veno-venous extracorporeal membrane oxygenation (V-V ECMO). Bronchoalveolar lavage later revealed pulmonary eosinophilia, and after an infectious workup was negative, a diagnosis of AEP was reached and the patient was started on corticosteroids. To our knowledge, this is one of few published cases of AEP requiring V-V ECMO for clinical stabilization, highlighting the utility of this treatment modality in severe disease.
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The main goal of enhanced recovery program after thoracic surgery is to minimize stress response, reduce postoperative pulmonary complications, and improve patient outcome, which will in addition decrease hospital stay and reduce hospital costs. As minimally invasive technique, video-assisted thoracoscopic surgery represents an important element of enhanced recovery program in thoracic surgery. ⋯ This article focuses on the key elements of the enhanced recovery program in thoracic surgery. Having reviewed recent literature, the authors highlight potential procedures and techniques that might be incorporated into the program.
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Frontiers in medicine · Jan 2018
ReviewThe Role of Plasma Transfusion in Massive Bleeding: Protecting the Endothelial Glycocalyx?
Massive hemorrhage is a leading cause of death worldwide. During the last decade several retrospective and some prospective clinical studies have suggested a beneficial effect of early plasma-based resuscitation on survival in trauma patients. The underlying mechanisms are unknown but appear to involve the ability of plasma to preserve the endothelial glycocalyx. ⋯ In addition, we briefly present data on the possible plasma components responsible for these effects. The endothelial glycocalyx is increasingly recognized as a critical component for the physiological vasculo-endothelial function, which is destroyed in hemorrhagic shock. Interventions for preserving an intact glycocalyx shall improve survival of trauma patients.