Asfiksija je kombinacija hipoksije in hipoperfuzije, ki ovira izmenjavo plinov in dovajanje energetskih substratov in s tem povzroči tkivno acidozo. Obporodna asfiksija je kljub napredku perinatalne ...medicine še vedno pogosto stanje, ki ima lahko pomembne dolgotrajne posledice. Najpogostejša je okvara možganov oz. hipoksično-ishemična encefalopatija. Lahko pa so pomembno prizadeti tudi drugi organski sistemi. Zato novorojenček po obporodni asfiksiji potrebuje celostno obravnavo.
Slovenska priporočila za obravnavo bolnikov z kronično odpovedjo prebavil so povzeta so po smernicah Evropskega združenja za klinično prehrano in metabolizem (angl. ESPEN; European Society for ...Clinical Nutrition and Metabolism) in prilagojena slovenskim izkušnjah zdravljenja odpovedi prebavil. Pretežni del bolnikov z odpovedjo prebavil predstavljajo bolniki s sindromom kratkega črevesa (SKČ), zato je poudarek priporočil na diagnostiki, obravnavi in zdravljenju bolnikov s SKČ. Namen priporočil je vzpostavitev bolj učinkovite prepoznave in obravnave bolnikov z odpovedjo ter vzpostavitvi temeljnih strokovnih izhodišč za zdravljenje teh bolnikov v Sloveniji. Dejavnost zdravljenja kronične odpovedi prebavil z parenteralno prehrano na domu pri odrasli pacientih je bila v Sloveniji formalno vzpostavljena leta 2008, v 13 letih smo zdravili več kot 230 pacientov, v začetku leta 2021 je v 2 centrih (OI Ljubljana, UKC Ljubljana) v zdravljenje vključeno 95 odraslih bolnikov. Pred 6 leti Smo paciente v programu zdravljenja odpovedi prebavil v okviru OI LjubljanA vključili v evropski register premljanja bolnikov na Parenteralni prehrani na domu (PPD), v okviru ESPEN.
Background. The prevalence of premature ovarian failure (POF) of 1 % has important psychosocial consequences and impact on general health. Besides known etiology (genetic, chromosomal, infections, ...iatrogenic) autoimmunity can be the pathologic mechanism for POF. Material and methods. Eleven women with POF, with excluded other reasons for the disease except autoimmunity were included in this study. The control group consisted of 13 healthy normo-ovulatory women. In both groups targeted family and personal history was taken and determinations of: FSH, LH, TSH, prolactin, antimüllerian hormone (AMH), inhibin B, thyroid antibodies TG and TPO. At the cellular level periferal blood T-lymphocytes were analyzed by flow cytometry, on humoral level ovarian antibodies were detected with indirect immunofluorescence on human ovary sections. Quick ACTH test was performed in study group only. Results. In 9 patients POF was associated with another autoimmune disease. Six patients of the study group (55 %) presented very elevated thyroid autoantibodies TG and TPO, in the control group the levels of both autoantibodies were within normal range. Hormonal analyses in the study group exhibited the values of hypergonadotropic hypogonadism and consequently low levels of inhibin B and AMH. Lymphocyte subset in study group namely CD4+, CD19+ and CD8+ was significantly higher, while natural killer cells and regulatory T cells were significantly lower then in the control. group. In 4 patients (36 %) antiovarian autoantibodies were detected. Results of the quick ACTH test in the study group were normal. Conslusions. POF is frequently associated with autoimmune disorders. The presence of antithyroid and antiovarian antibodies together with abnormalities of the cellular immunity can potentionally represent an autoimmune mechanism of POF. The question of immunomodulatory therapy in selected patients with POF is open.
To help general practitioners (GPs) in early identification of patients with palliative care (PC) needs, this pilot study aimed to determine the potential of the combined original surprise question ...(SQ1) ('Would I be surprised if this patient died within the next 12 months?') and the second surprise question (SQ2) ('Would I be surprised if this patient was still alive after 12 months?'). We hypothesized that answering these SQs would trigger them to make a multidimensional care plan.
26 Slovenian GPs, randomized into 4 groups, were invited to write a care plan for each of the four patients described in case vignettes (2 oncologic, 1 organ failure and 1 frailty case). GPs in group 1 were only asked to write a care plan for each patient. GPs in group 2 answered SQ1 and GPs in groups 3 and 4 answered SQ1 and SQ2 before writing the care plan. The type and number of PC aspects mentioned in the respective care plans were quantified into a numeric RADboud ANTicipatory (RADIANT) score.
Mean RADIANT scores in groups 1-4 were 2.2, 3.6, 2.5 and 3.1, respectively. When comparing the different vignettes, vignette B (terminal oncologic patient) scored best (3.6). Mean RADIANT scores in groups 3 and 4 were slightly higher for GPs who would be surprised compared to GPs who would not be surprised if the patient was still alive in 12 months.
The combined SQs were considered helpful in the early identification of patients in need of PC in Slovenian general practice.
Hud akutni pankreatitis (HAP) je akutna vnetna bolezen trebušne slinavke, ki je še vedno povezana z visoko obolevnostjo in smrtnostjo. Glavna značilnost bolezni je hud sistemski vnetni odgovor ...organizma, ki velikokrat vodi v odpoved več organskih sistemov. Za oceno optimalnega načina zdravljenja je potreben individualni pristop, ki temelji na pozornem spremljanju kliničnih znakov, intenzivnem monitoriranju ter krvnih in slikovnih preiskavah. Infekcijski zapleti dodatno otežijo potek bolezni in pomembno vplivajo na večjo smrtnost pri bolnikih, ki so preživeli prvo vnetno fazo bolezni. Diagnosticiranje okužene nekroze trebušne slinavke je pogosto težavna naloga. Edina jasna indikacija za protimikrobno zdravljenje HAP je dokazana okužena nekroza trebušne slinavke. Če stanje bolnika omogoča, se ta hrani enteralno, v nasprotnem primeru pa parenteralno oziroma kombinirano. Sodobno kirurško zdravljenje HAP temelji na odloženih kirurških posegih, ki naj vključujejo različne minimalno invazivne tehnike. Intenzivno zdravljenje bolnikov s HAP obsega podporno zdravljenje ter preprečevanje zapletov.
Pri bolnikih, ki so se zdravili zaradi raka v otroštvu, so okvare kardiovaskularnega sistema med poglavitnimi vzroki pozne umrljivosti, ki je sedem-krat večja kot pri splošni populaciji. ...Najpogostejši vzrok komplikacij na srcu pri bolnikih z rakom so antraciklini ki sodijo med najučinkovitejša zdravila neoplastičnih bolezni. Pri opisu primera našega bolnika želimo opozoriti na napredujočo okvaro srčne mišice po zdravljenju ne-Hodgkinovega limfoma s kemoterapijo, ki je vsebovala antracikline in alkilirajoče agense, in je 28 let po končanem zdravljenju privedla do odpovedi srca, zaradi katere je bila potrebna transplantacija srca. Pri bolnikih, zdravljenih z antracikini, je zelo pomembno doživljenjsko sledenje funkcije srca, da vsako motnjo (tudi klinično nemo) na srcu čim prej odkrijemo in ustrezno zdravimo. Ehokardiografija je najpogosteje uporabljena diagnostična metoda za ocenjevanje delovanja srca v okviru sledenja poznih posledic zdravljenja s citostatiki in/ali obsevanjem. Zelo pomembno je morebitne okvare najti v fazi, ko je bolnik še asimptomatski, saj lahko z ustreznim zdravljenjem (predvsem ACE inhibitorji in beta-blokatorji) in ustreznim načinom življenja in zmanjševanjem drugih dejavnikov tveganja za razvoj kardiovaskularnih obolenj preprečimo oz. upočasnimo razvoj življenje ogrožujoče okvare srca.
As copper sulphate pentahydrate (CSP) is a common compound used in agriculture and industry, chronic occupational exposures to CSP are well known, but acute poisoning is rare in the Western world. ...This case report describes acute poisoning of a 33-year-old woman who attempted suicide by ingesting an unknown amount of CSP. On admission to the hospital, she had symptoms and signs of severe hemorrhagic gastroenteritis, dehydration, renal dysfunction and methaemoglobinaemia with normal serum copper level. Therapy included early gastric lavage, fluid replacement, vasoactive drugs, furosemide, antiemetic drugs, ranitidine, and antidotes methylene blue and 2,3-dimercaptopropane-1-sulphonate (DMPS). However, the patient developed severe intravascular haemolysis, acute severe hepatic and renal failure, as well as adrenal insufficiency. After prolonged, but successful hospital treatment, including haemodialysis and IV hydrocortisone, the patient was discharged with signs of mild renal and liver impairment. Our conclusion is that in severe cases of copper poisoning early supportive measures are essential. In addition, antidotes such as methylene blue for methaemoglobinaemia and chelating agent such as DMPS improve morbidity and survival of severely poisoned victims.
Bakrov sulfat pentahidrat (BSP) se pogosto uporablja v kmetijstvu in industriji, zato so kronične poklicne zastrupitve dobro poznane, akutne zastrupitve pa so v razvitem svetu redke. Opisujemo primer akutne zastrupitve zaradi poskusa samomora pri 33-letni ženski zaradi zaužitja neznane količine BSP. Ob sprejemu so bili prisotni simptomi in znaki težkega hemoragičnega gastroenteritisa, izsušitve, razvijajoče se ledvične odpovedi in methemoglobinemije z normalno vrednostjo bakra v serumu. Takoj smo sprali želodec in začeli iv. dajati tekočine, kateholamine, furosemid, antiemetik, ranitidin in antidota metilensko modrilo in 2,3-dimerkaptopropan-1-sulfonat (DMPS). Kljub zgodnjim ukrepom se je razvila težka znotrajžilna hemoliza, težka akutna jetrna in ledvična odpoved ter odpoved nadledvičnice. Po dolgem, vendar uspešnem zdravljenju, vključno z zdravljenjem s hemodializo in iv. steroidi, je bila bolnica odpuščena z znaki blage ledvične in jetrne okvare. Zaključujemo, da je pri težkih zastrupitvah z bakrom zgodnje simptomatsko zdravljenje prvi najpomembnejši ukrep. Uporaba antidotov, kot je metilensko modrilo pri methemoglobinemiji, in ionskih izmenjevalcev, kot je DMPS, pa dodatno zmanjša obolevnost in izboljša preživetje težko zastrupljenih.
At War Within Clark, William R
1995, 19951130
eBook, Book
In the seventeenth century, smallpox reigned as the world’s worst killer. Luck, more than anything else, decided who would live and who would die. That is, until Lady Mary Wortley Montagu, an English ...aristocrat, moved to Constantinople and noticed the Turkish practice of “ingrafting” or inoculation, which, she wrote, made “the small-pox … entirely harmless.” Convinced by what she witnessed, she allowed her six-year-old son to be ingrafted, and the treatment was a complete success--the young Montagu enjoyed lifelong immunity from smallpox. Lady Montagu’s discovery would, however, remain a quiet one; it would be almost 150 years before inoculation (in the more modern form of vaccination) would become widely accepted while the medical community struggled to understand the way our bodies defend themselves against disease. William Clark’s At War Within takes us on a fascinating tour through the immune system, examining the history of its discovery, the ways in which it protects us, and how it may bring its full force to bear at the wrong time or in the wrong place. Scientists have only gradually come to realize that this elegant defence system not only has the potential to help, as in the case of smallpox, but also the potential to do profound harm in health problems ranging from allergies to AIDS, and from organ transplants to cancer. Dr. Clark discusses the myriad of medical problems involving the immune system, and he systematically explains each one. For example, in both tuberculosis and AIDS, the underlying pathogens take up residence within the immune system itself, something Clark compares to having a prowler take up residence in your house, crawling around through the walls and ceilings while waiting to do you in. He discusses organ transplants, showing how the immune system can work far too well, and touching on the heated ethical debate over the use of both primate and human organs. He explores the mind’s powerful ability to influence the performance of the immune system; and the speculation that women, because they have developed more powerful immune systems in connection with childbearing, are more prone than men to contract certain diseases such as lupus. In a fascinating chapter on AIDS, arguably the most deadly epidemic seen on Earth since the smallpox, Clark explains how the disease originated and the ways in which it operates. And, in each section, we learn about the most recent medical breakthroughs. At first glance, it may appear that our immune system faces daunting odds; it must learn to successfully fend off, not thousands, but millions of different types of microbes. Fortunately, according to Clark, it would be almost impossible to imagine a more elegant strategy for our protection than the one chosen by our immune system, and his At War Within provides a thorough and engaging explanation of this most complex and delicately balanced mechanism.
Provider: Czech digital library/Česká digitální knihovna - Institution: National Medical Library/Národní lékařská knihovna - Data provided by Europeana Collections- Carnosine is a dipeptide formed of ...the amino acids β-alanine and histidine. Only a limited number of studies have examined the effects of carnosine on sympathetic nerve activation and anxiety. The present study was undertaken to determine the dose-related effects of carnosine on anxiety in the elevated T-maze test (ETM) with electrodermal activity (EDA). Carnosine was injected in three groups of rats with doses of 10 (low dose), 100 (medium dose) and 1000 (high dose) mg/kg i.p. Physiological saline was injected in the sham group. The anxiety scores of the rats were measured with ETM 20 minutes after injection. Then, SCL was measured. The decreased number of entries into the open arm (NEOA), the percentage of time spent in the open arm (% TSOA) and higher EDA shown by skin conductance level (SCL) indicate higher anxiety. The NEOA and % TSOA were lower in the high-dose group than in the other groups. SCL was lower in the medium-dose carnosine group than in the high-dose carnosine and sham groups. SCL was higher in the high-dose group than in the medium-dose and sham groups. Our results suggest that high-dose carnosine produced anxiety-like effects as assessed in the SCL and ETM. Medium-dose carnosine acted as an anxiolytic. The anxiety-related responses of carnosine depend on its dose-related effect.- N. Dolu, H. Acer, A. Y. Kara- All metadata published by Europeana are available free of restriction under the Creative Commons CC0 1.0 Universal Public Domain Dedication. However, Europeana requests that you actively acknowledge and give attribution to all metadata sources including Europeana
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