Icu research points 2015 1
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This document contains summaries of several research points related to critical care. It discusses findings that propofol may limit recovery after brain injury in adults, that cardiac dysfunction is associated with mortality after traumatic brain injury, that vitamin D deficiency predicts sepsis in critically ill patients, and that neuromuscular blocking agents are associated with lower mortality in mechanically ventilated sepsis patients. It also summarizes research showing that a bundle of measures was effective at reducing ventriculitis associated with external cerebral ventricular drainage. Finally, it finds that critical illness is characterized by reduced intestinal absorption of glucose and lower expression of glucose transporters and taste receptors.
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3. Awake craniotomy provides benefits over surgery under general anesthesia such as higher rates of total tumor resection, fewer permanent neurological deficits, and shorter hospital stays. However, it requires careful patient selection and management of anesthesia to balance pain and cooperation.
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Cerebrospinalfluid(CSF) sampling
Cerebrospinal liquid (CSF) assortment is a test to check out at the liquid that encompasses the cerebrum and spinal string. CSF goes about as a pad, safeguarding the mind and spine from injury. The liquid is typically clear. It has a similar consistency as water. The test is likewise used to quantify strain in the spinal liquid.
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This document discusses the evolution of surgical management of brain tumors at Abbott Northwestern Hospital over the past two decades. It describes how the integration of neuronavigation, functional MRI, and intraoperative MRI has allowed surgeons to remove more of tumors while avoiding injury to eloquent brain areas. Over 1700 patients with various brain tumors have undergone surgery using these techniques. The document also presents four case examples and discusses how awake brain mapping during surgery helps identify language areas of the brain to further aid in maximal tumor resection.
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This document discusses normal and increased intracranial pressure. It begins by stating normal ICP ranges in adults and babies. ICP is influenced by several factors and shows pressure fluctuations with cardiac systole and respiration. Increased ICP can be caused by obstruction of venous outflow, increasing blood and CSF volume in the cranium. Clinical signs of increased ICP include Cushing's response of hypertension and bradycardia. The document then discusses methods of monitoring ICP, both invasive and non-invasive.
Cerebrospinal fluid
The document discusses cerebrospinal fluid (CSF), including its location in the brain and spinal cord, how it is produced and circulated, its composition and functions. CSF acts as a cushion and protects the brain, removes waste, and transports nutrients and chemicals. It is produced in the brain's ventricles and circulates through the ventricles and spinal cord before being reabsorbed or drained into veins. Abnormalities in CSF production or circulation can cause hydrocephalus. A lumbar puncture is described as a way to collect and analyze CSF samples for diagnostic purposes.
Rheumatic fever
An 11-year-old boy presented with fever, knee pain and swelling, shortness of breath, and an enlarged and erythematous tonsil with exudate. Examination revealed tachycardia, murmur, and a swollen and tender left knee with limited range of motion. Differentials included rheumatic fever. Investigations supported a diagnosis of acute rheumatic fever based on the Jones criteria. Management involved post-streptococcal antibiotics, anti-inflammatory therapy, monitoring for cardiac complications, and long-term secondary prophylaxis.
Cerebrospinal Fluid
The document discusses cerebrospinal fluid (CSF), including its production and pathways in the central nervous system. CSF acts as a cushion or buffer for the brain, is produced by the choroid plexus at a rate of around 500 ml per day, and circulates through the ventricular system and subarachnoid space. Analysis of CSF provides valuable information for diagnosing neurological conditions through examination of cells, proteins, glucose, and other analytes. Abnormal levels can indicate infections, inflammatory conditions, and other disorders.
Increased Intracranial Pressure
The document discusses increased intracranial pressure (ICP), including its causes, signs and symptoms, and treatment approaches. ICP is normally 7-15 mmHg but can increase due to mass effects from tumors or swelling, increased venous pressure, or obstruction of CSF flow. Goals of treatment are to maintain cerebral perfusion pressure and prevent ischemia. Management includes positioning, monitoring vitals, controlling seizures, administering diuretics like mannitol, and in severe cases, surgical intervention.
Traumatic brain injury
This document provides guidelines for the assessment and management of head injuries. It outlines the steps for initial assessment including the ABCs (airway, breathing, circulation), indications for intubation and ventilation, and neurological assessment using the GCS. It also discusses indications for CT scanning, referral to hospital or neurosurgery. Key principles of management include maintaining cerebral perfusion pressure, avoiding hypoxia and reducing intracranial pressure through various means. Surgical intervention may be indicated for certain types or sizes of brain injuries or deterioration in condition.
Csf analysis presentation
Ceribrospinal Fluid Analysis is a very important investigations in all laboratories. You can asses this ppt for your routine laboratory work.
Hydrocephalus
Hydrocephalus is a condition where there is excessive accumulation of cerebrospinal fluid (CSF) in the brain, resulting in increased pressure on brain tissues. It occurs when there is an imbalance between the production and absorption of CSF, blocking its flow. Symptoms vary depending on age but can include headache, nausea, vision issues. It is diagnosed using brain imaging and treated primarily by surgically inserting a shunt to drain CSF out of the brain. Prognosis depends on cause and treatment success, though many children with hydrocephalus can lead normal lives with treatment.
Traumatic brain injury
There are several types of traumatic brain injuries that can result from head trauma:
1. Epidural hematoma occurs when a skull fracture ruptures a meningeal artery, resulting in blood accumulating between the dura and skull. It appears as a biconvex mass on CT scan.
2. Subdural hematoma occurs when bridging veins are damaged, resulting in blood accumulating between the dura and arachnoid. It appears as a crescent-shaped mass on CT scan.
3. Contusions and lacerations are bruises and tears of brain tissue that appear as low-density regions on CT scan.
Hydrocephalus
This document provides information about hydrocephalus. It begins with definitions, noting that hydrocephalus is an excessive accumulation of cerebrospinal fluid in the brain resulting in abnormal widening of brain spaces. It describes the anatomy of the ventricles and circulation of cerebrospinal fluid. It discusses the causes of hydrocephalus, including conditions that block normal fluid flow or absorption. It outlines the main types - congenital, acquired, communicating, and non-communicating hydrocephalus - and their causes. Images are included showing examples of hydrocephalus, obstructions, treatments like VP shunts, and various conditions that can cause hydrocephalus like aqueduct stenosis and tumors.
Approach to traumatic brain injury
This document provides an overview of traumatic brain injury (TBI), including:
1) It defines TBI and outlines primary and secondary brain injury mechanisms. Common causes include motor vehicle accidents, falls, and assaults.
2) It discusses evaluation and treatment, including importance of preventing hypotension and hypoxia. Neuroimaging with CT is important for diagnosis and prognosis.
3) Management of elevated intracranial pressure is also covered, including osmotherapy, sedation, cerebral perfusion pressure maintenance, temperature control, and avoiding hypocapnia or steroids.
head injury
1. The document discusses classification and management of traumatic head injuries, including grading severity based on Glasgow Coma Scale and anatomical findings on CT scans.
2. Management involves stabilizing patients through the pre-hospital and hospital phases, monitoring intracranial pressure, and treating to prevent secondary brain injuries using medical and surgical methods like intubation, sedation, osmotherapy, and surgical evacuation of hematomas if needed.
3. The goal of management is to control factors that raise intracranial pressure like hypoxia, hypotension, and cerebral edema in order to maintain adequate cerebral perfusion pressure and optimize outcomes.
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Anaesthesia for elective neurosurgery journal (zuhura)
This document summarizes key aspects of anaesthesia for elective neurosurgery. It discusses the importance of maintaining optimal cerebral perfusion pressure and oxygenation. While volatile agents remain popular, studies have found propofol and sevoflurane to be suitable options. Propofol may help reduce intracranial pressure and cerebral blood volume compared to other agents. Awake craniotomy techniques are gaining popularity for removal of brain lesions near eloquent areas to allow for neurological monitoring during the procedure. Advances in minimally invasive techniques continue to offer benefits like reduced trauma and faster recovery times.
protocol laptop presentation copy.pptx
This document describes a study aiming to compare the effects of intravenous and intratracheal lignocaine on airway and hemodynamic responses during emergence from general anesthesia and endotracheal extubation. The study will involve 80 patients randomized into two groups, with one group receiving intratracheal lignocaine and intravenous saline, and the other receiving intravenous lignocaine and intratracheal saline. Outcomes such as cough response, smoothness of extubation, and hemodynamic parameters will be observed and recorded before, during, and after extubation to compare the efficacy of the two lignocaine administration methods in attenuating the airway and circulatory responses to extubation.
C0621115
IOSR Journal of Mathematics(IOSR-JM) is an open access international journal that provides rapid publication (within a month) of articles in all areas of mathemetics and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications in mathematics. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Assessment of the Implementation of Ventilator-associated Pneumonia Preventiv...
Background: Pneumonia associated with mechanical ventilation (VAP) is one of the important
causes of nosocomial infections in pediatric intensive care units (PICU). VAP is the leading cause of morbidity
and mortality in PICUs. Aim: To assess the compliance to ventilator bundle components: elevation of the head
of bed >30, sedation interruption, spontaneous breathing trial, peptic ulcer prophylaxis and its effect on the
prevention of VAP. Subjects and Methods: A case control study at PICU of Abo EL Reish El Moneira Hospital,
including all mechanically ventilated patients admitted over a period of one year. The study tested the effect of
implementation of this bundle as regard the rate of VAP in both group, compliance to bundle and most affecting
component of it. Results: There was decrease incidence of VAP after implementation of the bundle, from (50%)
to (14%). Development of VAP was mostly affected by being in supine position, long duration of mechanical
ventilation and presence of pump failure. (p<0.05) The compliance to bundle components was statistically
significant, p= 0.001. Conclusion: VAP rate decreased after implementation of this bundle. Elevation of the
head of bed was the most compliant component of bundle in the PICU.
Synopsis
This document outlines a proposed study on the efficacy of intravenous lidocaine in preventing fentanyl-induced cough before induction of anesthesia. The study aims to determine if lidocaine reduces the incidence of cough caused by fentanyl injection before anesthesia by 30% compared to placebo. It will involve 96 patients randomized to receive either lidocaine or saline before fentanyl injection. The primary outcome is reduction in cough incidence and secondary outcomes include hemodynamic stability and adverse effects. The proposed methodology describes patient selection criteria, interventions, data collection and analysis in detail.
Bohomolets anaesthesiology clinical
This document provides guidance for a practical class on anesthesia for trauma patients. It begins with an overview of the importance of trauma anesthesia and discusses the initial assessment of trauma patients through a primary survey examining airway, breathing, circulation, disability and exposure. It provides details on establishing the airway for trauma patients while protecting the cervical spine, and assessing breathing and circulation. The document outlines the contents to be covered in the practical class, including anesthesia considerations for different types of trauma injuries.
1 s2.0-s0034709413702332-main
1) A 35-year-old pregnant woman at 29 weeks presented with severe preeclampsia, HELLP syndrome, placental abruption, and multiple organ dysfunction. She also had spinal deformity and tracheal displacement from a prior accident.
2) Due to her conditions, she required urgent cesarean section under general anesthesia with nasal intubation. The surgery was successful and she recovered well, being discharged on post-op day 7.
3) This case highlights the importance of balancing benefits and risks when determining anesthesia and treatment for severely preeclamptic patients. Neuraxial blockade is typically preferred but general anesthesia may be necessary in complex cases like this one.
The effects of Sevoflurane and Propofol on IFN-γ And IL-12 Study On Patients ...
Background: This research aimed to analyze the effects of sevoflurane and propofol on IFN-γ and IL-12, the study on patients with craniotomy surgery. The treatment is the anesthesia with sevoflurane or propofol for more than 2 hours. The levels of IFN-γ and IL-12 are measured just before induction of anesthesia and just after anesthesia with sevoflurane or propofol is stopped. Methods: The study design is an observational study by using pre-and-post design. The subjects are patients aged 30-55 years old who were undergoing craniotomy surgery for tumor removal at Dr. Kariadi Hospital. The differences in the means before and after the same anesthesia agent were analyzed with paired T-test if the data distribution is normal, or with the Wilcoxon rank-sum test if the data distribution is not normal. The difference in the means between the two different anesthesia agents was analyzed using an independent T-test if the data distribution is normal, or with the Mann-Whitney test if the data distribution is not normal. Results: It was observed that sevoflurane and propofol increased the level of IFN-γ and IL-12 but not significant. There were differences between IFN-γ and IL-12 before and after anesthesia with sevoflurane compared with propofol. Therefore, the hypothesis was accepted. This shows that the originality of this research has been statistically and empirically proved. Conclusion: The increase of both IFN-γ and IL-12 levels after anesthesia with propofol is significantly higher than those with sevoflurane. Propofol exerts a bigger pro-inflammatory response than sevoflurane in patients undergoing craniotomy surgery.
Annals of Clinical and Medical Case Reports - Acmcasereport
Annals of Clinical and Medical Case Reports :Explore captivating medical cases & treatments that have garnered public interest.
Cefaleas
This study retrospectively analyzed 2399 pregnant patients who underwent neuraxial blockade (spinal, epidural, or combined spinal-epidural anesthesia) for cesarean section, vaginal delivery, or forceps delivery. The study aimed to describe the incidence of neurological complications, specifically post-dural puncture headache and nerve damage, and identify risk factors. The results found that 3% of patients developed post-dural puncture headache, 0.3% developed lower limb paresthesias, and 0.1% developed transient radicular irritation. Patients who remained in the gynecological position for over 60 minutes had an odds ratio of 1.75 for developing lower limb paresthesias, and
Intracranial surgery
There are numerous types of brain surgery. The type used is based on the area of the brain and the condition being treated.
Brain surgery is a critical and complicated process. The type of brain surgery done depends highly on the condition being treated.
Intracranial surgery refers to various medical procedures that involve repairing structural problems in the brain.
Craniotomy
A craniotomy involves making an incision in the scalp and creating a hole known as a bone flap in the skull. The hole and incision are made near the area of the brain being treated.
During open brain surgery, it is done to remove tumors, clip off an aneurysm, drain blood or fluid from an infection & remove abnormal brain tissue
Decompressive craniectomy
It is a neurosurgical procedure in which part of the skull is removed to allow a swelling brain room to expand without being squeezed. It is performed on victims of traumatic brain injury, stroke and other conditions associated with raised intracranial pressure.
Evaluation of Effect of Low Dose Fentanyl, Dexmedetomidine and Clonidine in S...
In the present study effect of intrathecal hyperbaric Bupivacaine 0.5% with low doses of Clonidine
or Fentanyl or Dexmedetomidine were compared in elective lower abdominal surgeries. This was a prospective
randomized control trial. 90 patients belonging to ASA 1 &II, aged between 20-50 years were allocated into
three groups. Group-C: Clonidine 30µg, Group-D: Dexmedetomidine 5 µg, Group-F: Fentanyl 25 µg. The
onset of sensory blockade was comparable in all the three groups. The onset of motor blockade was earlier by
about 1.3 mins in Dexmedetomidine group when compared to Clonidine and Fentanyl group. Duration of
sensory blockade was prolonged in Dexmedetomidine group (346mins) when compared to Clonidine (300mins)
and Fentanyl (302mins) group. Time duration of motor blockade was prolonged in Dexmedetomidine group
(269mins) when compared to Clonidine (223mins) and Fentanyl (220mins) group. The haemodynamic
parameters were clinically and statistically insignificant The time of first request for analgesics by the patients
was more in Dexmedetomidine group (250mins) when compared to Clonidine (194mins) and Fentanyl
(189mins) group. The use of intrathecal Dexmedetomidine as an adjuvant to Bupivacaine is an attractive
alternative to Fentanyl or Clonidine for long duration surgical procedures due to its profound intrathecal
anesthetic and analgesic properties combined with minimal side effects.
Relajantes en quemados
1. Muscle relaxants are commonly used to facilitate intubation in burn, trauma, and critically ill patients by paralyzing the muscles and preventing complications during the intubation process like laryngospasm.
2. However, muscle relaxants can also cause problems in some patients, like hyperkalemia in patients with specific pathologies, and hemodynamic instability.
3. The response of muscles to depolarizing and nondepolarizing muscle relaxants can be altered in burn, trauma, and critically ill patients due to changes in the expression of acetylcholine receptors on muscle membranes.
Manuscript editing service | Primary and secondary data | Neurogenic Shock
Pubrica writers have worked with numerous journals in medical and scientific subjects. We work with scientists and researchers across the globe to write novel manuscripts that explain finding in a clear and cohesive structure. We provide prepublication services, including editing, proofreading, rewriting, and translation services for your manuscript.
Read more @ https://pubrica.com/insights/sample-work/management-of-neurogenic-shock-outside-of-the-hospital/
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This document reviews techniques for predicting epileptic seizures. It discusses how seizure prediction could improve quality of life for epilepsy patients by allowing them to avoid dangerous situations. The document outlines different types of seizures and classification systems. It reviews literature on using sensors and video analysis to detect seizures. Effective prediction is important for clinical management to increase treatment effectiveness and prevent injuries from unexpected seizures.
Relative Efficacies of Nitroglycerine Infusion, Sublingual Nifedipine, and In...
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
ERAS 3.pptx
This document provides an overview of enhanced recovery after surgery (ERAS) protocols. It discusses the history and phases of ERAS, including preoperative, intraoperative, and postoperative considerations. Specifically, it outlines strategies to optimize patient nutrition and exercise preoperatively, prevent hypothermia and infections intraoperatively, and promote early mobilization postoperatively. The overall goal of ERAS is to implement a multimodal, evidence-based approach to accelerate patient recovery through the perioperative period.
Comparison of Ondansetron and Granisetron for Prevention of Nausea and Vomiti...
The most common and distressing symptoms, which follow anaesthesia and surgery, are pain and emesis. The consequences of PONV are physical, surgical and anesthetic complications for patients as well as financial implications for the hospitals or institutions. Sometimes nausea and vomiting may be more distressing especially after minor and ambulatory surgery, delaying the hospital discharge. Laparoscopic surgery is one condition, where risk of PONV is particularly pronounced due to pneumo-peritoneum causing stimulation of mechanoreceptors in the gut. In spite of plenty of anti-emetic drugs available no single drug is 100% effective in prevention of PNV and combination therapy has got a lot of side effects.
Neuro
This document discusses neurologic complications that can occur during pregnancy, including preeclampsia-eclampsia, hemolytic elevated liver enzyme levels and low platelet levels syndrome, and myasthenia gravis. Preeclampsia-eclampsia is a leading cause of maternal mortality and morbidity. Seizures are a hallmark of eclampsia. Magnesium sulfate is the primary treatment for preventing and treating seizures. Hemolytic elevated liver enzyme levels and low platelet levels syndrome is a severe form of preeclampsia associated with high mortality rates. Myasthenia gravis can worsen during pregnancy, especially in the first trimester and postpartum period. Careful monitoring and management is important for these
Case scenario postoperative delirium in elderly
This document discusses a case study of an 81-year-old woman who developed postoperative delirium 4 days after undergoing laparoscopic colon surgery. Key points discussed include:
1) Delirium was diagnosed using validated clinical scales like the Confusion Assessment Method.
2) The pathophysiology of postoperative delirium in the elderly is multifactorial, involving factors like reduced cholinergic transmission, inflammation, and stress.
3) The probable cause of delirium in this case was postoperative peritonitis, as evidenced by a fever the day before surgery and fluid collection found on CT scan.
4) A second episode of delirium was likely caused by benzodiazepine withdrawal, as
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Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
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8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
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13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
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Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
How STIs Influence the Development of Pelvic Inflammatory Disease.pptx
STIs may cause PID. For the both disease, herbal medicine Fuyan Pill can be a solution.
Basavarajeeyam - Ayurvedic heritage book of Andhra pradesh
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Best Ayurvedic medicine for Gas and Indigestion
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Histololgy of Female Reproductive System.pptx
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
The Best Ayurvedic Antacid Tablets in India
Treat the symptoms of indigestion, heartburn and stomach reflux with the 10 Best Ayurvedic Antacid Tablets in India.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptx
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Phone Us ❤8107221448❤ #ℂall #gIRLS In Dehradun By Dehradun @ℂall @Girls Hotel...
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8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.Adhd Medication Shortage Uk - trinexpharmacy.com
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
Top 10 Best Ayurvedic Kidney Stone Syrups in India
we have mentioned the best 10 ayurvedic Kidney Stone Syrups. You can check all these products and choose the best one for yourself.
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Novas diretrizes da OMS para os cuidados perinatais de mais qualidadeProf. Marcus Renato de Carvalho
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Cell Therapy Expansion and Challenges in Autoimmune Disease
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
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Icu research points 2015 1
- 1. ICU RESEARCH POINTS 2014-2015 1 SAMIR EL ANSARY
- 2. Global Critical Care https://www.facebook.com/groups/1451610115129555/#!/groups/145161011512 9555/ Wellcome in our new group ..... Dr.SAMIR EL ANSARY
- 3. Propofolmay prevent or limit reparative processes in the early-phase postinjury. The results therefore indicate that anesthetics may be potentially harmful not only in very young mammalians but also in adult animals following acute cerebral injuries. The results provide first evidence for an altered sensitivity for anesthesia-related negative effects on neurogenesis, functional outcome, and survival in adult rats with brain lesions.
- 4. Preliminary Report on Cardiac Dysfunction After Isolated Traumatic Brain Injury cardiac dysfunction during the first 2 weeks after isolated traumatic brain injury and its association with in-hospital mortality. Cardiac dysfunction was defined as left ventricular ejection fraction less than 50% or presence of regional wall motion abnormality.
- 5. Preliminary Report on Cardiac Dysfunction After Isolated Traumatic Brain Injury Cardiac dysfunction in the setting of isolated traumatic brain injury occurs and is associated with increased in-hospital mortality. This finding raises the question as to whether there are uncharted opportunities for a more timely recognition of cardiac dysfunction and subsequent optimization of the hemodynamic management of these patients.
- 6. Association of Low Serum 25-Hydroxyvitamin D Levels and Sepsis in the Critically Ill 25-hydroxyvitamin D deficiency prior to hospital admission is a significant predictor of sepsis in the critically ill. Additionally, patients with sepsis who are not vitamin D sufficient have an increased risk of mortality following critical care initiation.
- 7. Treatment With Neuromuscular Blocking Agents and the Risk of In-Hospital Mortality Among Mechanically Ventilated Patients With Severe Sepsis* Recent trials suggest that treatment with neuromuscular blocking agents may improve survival in patients requiring mechanical ventilation for acute respiratory distress syndrome. We examined the association between receipt of a neuromuscular blocking agent and in-hospital mortality among mechanically ventilated patients with severe sepsis.
- 8. Treatment With Neuromuscular Blocking Agents and the Risk of In-Hospital Mortality Among Mechanically Ventilated Patients With Severe Sepsis* Among mechanically ventilated patients with severe sepsis and respiratory infection, early treatment with a neuromuscular blocking agent is associated with lower in-hospital mortality.
- 9. Effects of Propofol on Patient-Ventilator Synchrony and Interaction During Pressure Support Ventilation and Neurally Adjusted Ventilatory Assist With neurally adjusted ventilatory assist, ineffective triggering index fell to 0%, regardless of the depth of sedation. With both modes, deep sedation caused a significant increase in PaCO2, which resulted, however, from different breathing patterns and patient-ventilator interactions.
- 10. Effects of Propofol on Patient-Ventilator Synchrony and Interaction During Pressure Support Ventilation and Neurally Adjusted Ventilatory Assist In pressure support ventilation, deep propofol sedation increased asynchronies, while light sedation did not. Propofol reduced the respiratory drive, while breathing timing was not significantly affected. Gas exchange and breathing pattern were also influenced by propofol infusion to an extent that varied with the depth of sedation and the mode of ventilation.
- 11. Bundle of Measures for External Cerebral Ventricular Drainage-Associated Ventriculitis the prevalence and outcome of external cerebral ventricular drainage-associated ventriculitis in neurocritical patients before and after the implementation of a bundle of external cerebral ventricular drainage-associated ventriculitis control measures.
- 12. Bundle of Measures for External Cerebral Ventricular Drainage-Associated Ventriculitis The bundle of external cerebral ventricular drainage- associated ventriculitis control measures included 1) reeducation of ICU personnel on issues of infection control related to external cerebral ventricular drainage, 2) meticulous intraventricular catheter handling, 3) cerebrospinal fluid sampling only when clinically necessary, and 4) routine replacement of the drainage catheter on the seventh drainage day if the catheter was still necessary.
- 13. Bundle of Measures for External Cerebral Ventricular Drainage-Associated Ventriculitis Measurements: External cerebral ventricular drainage-associated ventriculitis prevalence, external cerebral ventricular drainage-associated ventriculitis events per 1,000 drainage days (drain-associated infection rate), length of ICU stay, Glasgow Outcome Scale at 6 months, and risk factors for external cerebral ventricular drainage-associated ventriculitis.
- 14. Bundle of Measures for External Cerebral Ventricular Drainage-Associated Ventriculitis The implementation of a bundle of measures for external cerebral ventricular drainage-associated ventriculitis control was associated with significantly decreased postintervention prevalence of the infection.
- 15. Providing effective enteral nutrition is important during critical illness. In health, glucose is absorbed from the small intestine via sodium-dependent glucose transporter-1 and glucose transporter-2, which may both be regulated by intestinal sweet taste receptors. The effect of critical illness on glucose absorption and expression of intestinal sodium-dependent glucose transporter-1, glucose transporter-2, and sweet taste receptors in humans The Effects of Critical Illness on Intestinal Glucose Sensing, Transporters, and Absorption
- 16. The Effects of Critical Illness on Intestinal Glucose Sensing, Transporters, and Absorption Critical illness is characterized by markedly diminished glucose absorption, associated with reduced intestinal expression of glucose transporters (sodium-dependent glucose transporter-1 and glucose transporter-2) and sweet taste receptor transcripts.
- 17. Global Critical Care https://www.facebook.com/groups/1451610115129555/#!/groups/145161011512 9555/ Wellcome in our new group ..... Dr.SAMIR EL ANSARY
- 18. GOOD LUCK SAMIR EL ANSARY ICU PROFESSOR AIN SHAMS CAIRO elansarysamir@yahoo.com