Wiener klinische Wochenschrift
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Wien. Klin. Wochenschr. · May 2002
Review Comparative Study[Determination of glycated hemoglobins (Hb A1c)].
Glycated hemoglobin is measured as HbA1c and is the result of an irreversible non-enzymatic glycation of the beta chain of hemoglobin A. HbA1c is used routinely to assess long term glycemic control in patients with diabetes mellitus. ⋯ This manuscript reviews the current information on glycation of hemoglobin, HbA1c determination methods, interferences and attempts for standardization. We aim at pointing out to the reader the current problems of glycated hemoglobin determination and to describe the necessary measures which need to be taken for proper measurement of HbA1c.
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Wien. Klin. Wochenschr. · Jan 2002
Review[Cortisol in critically ill patients with sepsis--physiological functions and therapeutic implications].
Modern immunology reveals that cortisol interacts with the immune response at virtually all levels exerting suppressive and permissive effects. A prerequisite for the defense of severe infections is the functional integrity of the hypothalamic-pituitary-adrenal axis (HPAA) resulting in adequate cortisol production. There is increasing evidence that cortisol physiology and regulation substantially change in the course of septic shock. ⋯ The earlier weaning from vasopressor therapy was associated with a trend towards improvements in organ dysfunction and mortality, respectively. Large-scale trials are on the way to investigate the benefit of stress doses of hydrocortisone on mortality of septic shock. This paper will focus on changes in glucocorticoid physiology and regulation during septic shock and will discuss the effects of stress doses of hydrocortisone on immune response and vascular tone in the course of septic shock.
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Wien. Klin. Wochenschr. · Jan 2002
Review[Acute phase reaction and immunocompetence in sepsis and SIRS].
The incidence of sepsis and SIRS, respectively is still rising. Mortality is 40 to 70% and, thus, remains very high in spite of major advances in intensive care medicine. Numerous experimental data have helped to explain isolated aspects of the pathophysiology of these disease states but the complex patho-mechanism remains to be elucidated. ⋯ Additionally, several gene polymorphisms have been detected for example within the toll-like receptor genes and TNF genes. These polymorphisms document the existence of pre-disposing factors, which influence acute phase reaction as well as immuno-competence in sepsis. Both genes and gender will play an important role in the future to identify patients at risk and potentially, to design a specific and individualized immuno-therapies.
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In the year 2000, new international guidelines for cardiopulmonary resuscitation (CPR) were published by the American Heart Association, and the European Resuscitation Council. These guidelines are evidence-based, indicating that these recommendations are based primarily on interpretation of data from clinical studies. Levels of recommendation range from class I (proven safe and useful), class IIa (intervention of choice), IIb (alternative intervention), indeterminate (research stage), and class III (unacceptable, no benefit). ⋯ If 1 mg epinephrine fails to be effective in adult patients with pulseless electrical activity or asystole, 1 mg atropine can be administered (class indeterminate). Regarding antiarrhythmic drugs, 300 mg amiodarone (class IIb) showed the best results in shock-refractory ventricular fibrillation. The postresuscitation phase has the goal to achieve the best possible neurological performance after return of spontaneous circulation, which requires careful optimization of organ functions.
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Poliomyelitis, an infectious disease with acute and persistent flaccid paralysis is caused by poliovirus (types 1, 2 or 3), an enterovirus. The infection is asymptomatic in 95% of infected subjects. Most of the paralytic cases occur in adolescents or adults in the course of polio type 1 infection. ⋯ A high vaccination rate, preferably with 3 doses of OPV in infancy or early childhood, and exact worldwide monitoring of cases is indispensable for the eradication. For the complete eradication of poliovirus the live vaccine OPV would have to be changed to an inactivated vaccine IPV worldwide. However, this is presently unachieveable, because of logistic problems and high costs.