São Paulo medical journal = Revista paulista de medicina
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Controlled Clinical Trial
Effects of prone position on the oxygenation of patients with acute respiratory distress syndrome.
Acute respiratory distress syndrome (ARDS) is characterized by arterial hypoxemia, and prone position (PP) is one possible management strategy. The objective here was to evaluate the effects of PP on oxygenation. ⋯ For a significant number of ARDS patients, PP may rapidly enhance arterial oxygenation and its inclusion for management of severe ARDS is justified. However, it is not a cost-free maneuver and caution is needed in deciding on using PP.
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Review
Practical ways to deal with the high burden of cardiovascular disease in hemodialysis patients.
Cardiovascular disease is the main cause of death among hemodialysis patients. Although uremia by itself may be considered to be a cardiovascular risk factor, a significant proportion of dialysis patients die because of cardiovascular disease not directly attributable to uremia. ⋯ Lack of proper medical care during the early stages of renal insufficiency and present-day dialysis routines, by failing to correct hypertension, hypervolemia and left ventricular hypertrophy in many patients, may also add to the cardiovascular burden. The author suggests that, in addition to early treatment and referral to a specialist, chronic renal failure patients should undergo intensive cardiovascular screening and treatment, and correction of cardiovascular risk factors based on guidelines established for the general population.
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Noncompaction of the left ventricular myocardium is a morphogenetic abnormality involving loss of compaction of the myocardial fiber meshwork during intrauterine life. It is an extremely rare condition, accounting for only 0.05% of the cases evaluated in databanks. ⋯ Many cases have so far been misdiagnosed due to poor knowledge of the findings relating to this syndrome. There needs to be an attempt at early and accurate diagnosis, because of the need to investigate the patients family upon such diagnosis, and today this can be achieved using echocardiographic criteria.
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Lack of consensus about which screening tests to use for gestational diabetes mellitus (GDM) and difficulties in performing the gold-standard diagnostic test, the 100-g glucose tolerance test (100-g GTT), justify comparison with alternatives. The aim was to compare this with two other screening tests: combined fasting glucose with risk factors (FG + RF) and 50-g GTT. ⋯ Diagnostic efficiency with simplicity, practicality and low cost make FG + RF more appropriate for screening for GDM. The equivalence of 1hPG allows a new, cheaper and less uncomfortable protocol to be proposed for screening and diagnosing GDM.