Medicina
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Review Comparative Study
Systematic review on the incidence and prevalence of severe maternal morbidity.
To summarize the prevalence and the incidence of serious morbidity from studies reporting data on severe maternal morbidity and to compare study designs and definitions. ⋯ The prevalence of severe maternal morbidity ranged from 0.07-8.23% and the case-fatality ratio from 0.02-37%. Studies estimating the incidence of severe maternal morbidity have used different definitions and ways of identification. Severe hemorrhage, sepsis and hypertensive disorders of pregnancy are the commonly used "near-miss" conditions. Further work will be able to create clear definition and method of identification.
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Review Comparative Study
[Etiology and pathogenesis of acute respiratory failure].
The aim of this study was to determine factors influencing acute respiratory failure and pathogenesis according to literature and clinical findings in critically ill patients. The term "respiratory failure" implies the inability to maintain either the normal delivery of oxygen to tissues and release or the normal removal of carbon dioxide from the tissues. There are many patients suffering from acute respiratory failure caused by nosocomial pneumonia, septic syndrome, aspiration, interstitial or alveolar lung edema, thromboembolism of a. pulmonalis, polytrauma and lung contusion, acute respiratory distress syndrome, long-term mechanical ventilation of the lungs, acute lung injury, status asthmaticus, rather massive transfusions of blood products, and lipid embolism in the intensive care unit. ⋯ Failure of any step in this process can lead to respiratory failure. Long-term hypoxia causes ischemic changes and dysfunction of brain, heart, kidney, lungs and can worsen the course of disease or cause higher mortality. It is important to determine the pathogenetic mechanisms of acute respiratory failure, estimate the main parameters and their interrelations and prescribe proper treatment.
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Postoperative lung injury is one of the most frequent complications in cardiac surgery that has a significant impact on health care expenditures and largely has been believed to result from the use of cardiopulmonary bypass. Cardiopulmonary bypass induces the whole body inflammatory response leading to postoperative lung dysfunction. Pulmonary complications after these operations take the first place in morbidity and mortality rates. ⋯ Therefore, the prevention of such alterations is an urgent problem worldwide. Still it is not known what is the cause of pulmonary alterations, as well as there are no means to prevent them. In our paper we review the international studies in order to present worldwide practice of prevention of pulmonary alterations using various methods of mechanical lung ventilation.
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Comparative Study
[Influence of patient's social and demographic characteristics on patient's expectations for medical consultation].
Most of the patients, coming to see their primary care physician, have explicit expectations and priorities for the medical consultation. Recognition of these expectations is an important step in organizing patient-oriented health care services. Patient expectations depend on a number of factors: health problem and its severity, as well as social and demographic characteristics of patient and physician. Objective of this survey was to evaluate influence of patient's socio-demographic characteristics and some health status indicators on expectations for primary care consultation. ⋯ Patient's need for emotional support from physician depends on his age, marital status, frequency of his visits to physician during the year, self-perception of the health status and course of disease. Analysis of relationship between patient's expectations and his sex, education, physician's sex or type of practice did not show statistically significant differences between groups. No influence of analyzed social and demographic characteristics or perceived health status on biomedical expectations (laboratory tests, specialist consultations, and hospital treatment) was found during our study.
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Objective of the paper was to review the latest scientific reference data on chemoprevention possibilities of lung cancer. Lung cancer is the leading cause of cancer death in Lithuania. The current lung cancer therapy includes surgery, radiation and chemotherapy. ⋯ Whether primary, secondary or tertiary prevention has the potential to improve the dismal statistics associated with this cancer? Several randomized clinical or translational chemoprevention trials have been conducted. All have so far produced either neutral (using retinal, retinyl palmitate, N-acetyl cysteine or isotretinoin) or harmful (using beta-carotene) primary endpoint results showing that lung cancer was not prevented in smokers. Secondary results supporting treatment with isotretinoin in "never" and former smokers and data from prevention trials involving selenium and vitamin E, however, are encouraging and offer a promising direction for future clinical study.