1,721,048 research outputs found
Ocular, Nasal and Aural Myiasis in an Intoxicated Patient: A Case Report
Full text linkThe authors describe a case of myiasis occurred in a self-intoxicated patient lying outdoor in a reduced state of consciousness for more than two days. The causes and the favoring circumstances of the infestation are described and
discussed
Hematologic problems in the Critically III
No full textThis book covers a wide array of hematologic problems commonly encountered in the daily practice of critical care and Emergency medicine. Unfortunately, the symptoms and sign associated with underlyng hematologic disorders are frequently rather unspecific and confounding; furthemore, the clinical course of patients admitted to intensive care units with such disorders can be fulminant, warrating pompt diagnosis
Management of tricyclic antidepressant poisoning
No full textAlthough a number of more recent substances with fewer side effects have become available for the treatment of depression, tricyclic antidepressants (TCA) are still commonly used. In addition, they are used for the treatment of neuropathic pain. The common basic mechanism of action is inhibition of reuptake of different neuromediators at the presynaptic terminal in both the central nervous system (CNS) and peripheral tissues, with the subsequent prolongation of their effect on the post-synaptic membrane. The earliest drug of this class was imipramine. Despite a phenothiazine-like structure it was not effective for the treatment of schizophrenia; quite unexpectedly, it improved depressive symptoms. Consequently, these substances and the derived TCAs became the first line of treatment for depression until the development of the selective serotonin reuptake inhibitors (SSRI). Although all TCAs share the same mechanisms of action, there are some differences in terms of the mediator involved. Whereas imipramine and some of its derivates, including amitriptyline and doxepin, block the reuptake of noradrenaline and serotonin at the presynaptic terminals, clomipramine has a more selective action on serotonin. After oral administration, TCAs are promptly absorbed and achieve peak blood concentrations in 2–6 hours; their absorption is reduced by antacids and drugs with anticholinergic effects. Being highly lipophilic, TCAs are rapidly taken up by the CNS. They are metabolized in the liver through oxidation and glucoronization. Although they undergo a relevant enterohepatic circulation, they are primarily eliminated through the kidney, with a half-life of 12–24 hours depending on the specific drug
Immunoparalysis in Septic Shock Patients
No full textIn the recent years, it has become clear that septic shock is characterized by the simultaneous production of inflammatory and anti-inflammatory mediators; the primary role of the latter is to counterbalance the former, thus limiting the severity of their systemic effects. However, in a number of patients, the anti-inflammatory substances can cause a downregulation in both the innate and adaptive immune capabilities, leading a second phase characterized to secondary infections caused by opportunist germs and the reactivation of latent viruses, muscle wasting; altogether, these abnormalities set the stage for a chronic critical condition. This condition, whose identification is relatively recent, is called immunoparalysis. Unfortunately, the current approach to septic shock is focused much more on the inflammatory phase than in the ensuing immunoparalysis, whose diagnosis can be challenging. In this chapter, the role played by both classes of mediators, the monitoring of the immune system, and the possible current and not yet available therapeutic strategies of immunoparalysis are reviewed and discussed
VAP incidence in cardiac arrest survivors treated with TH and SDD: our experience
No full textRecently Davies et al.1observed an increased survival in patientstreated with therapeutic hypothermia (TH) after out-of-hospitalcardiac arrest (OHCA) when given early systemic antibiotics ascompared with patients who received antibiotics later on
Anticipating events of in-hospital cardiac arrest
No full textStudy objectives: To determine whether in-hospital cardiac arrests occurring in regular wards are preceded by some event(s), and the diagnostic and therapeutic measures adopted. Methods: From 1 May 1999 to 31 December 2001, events occurring in the 6 h preceding cardiac arrest were reviewed by checking the medical and nurse records and interviewing the attending staff. Exclusion criteria were (a) location in the Coronary Care Unit, the Intensive Care Unit, the Emergency Department and the operating rooms; (b) the presence of rapidly fatal disease; (c) the lack of adequate documentation. Results: Overall, 263 cardiac arrests occurred in the period under consideration. A total of 148 patients (61 women, 87 men, aged 74.3± 1.2 years) fulfilled the entry criteria. Anticipating events were reported in 128 patients (86.4%). These included alterations in consciousness, cardiac arrhythmias, dyspnoea and chest pain. The restoration of cardiac rhythm was obtained in 23 patients (15.5%). Eight (5
Massive cerebral venous thrombosis associated with the bilateral catherization of the internal jugular veins: a case report
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