Acta medica Croatica : c̆asopis Hravatske akademije medicinskih znanosti
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Cardiorenal syndrome, a complex pathophysiological disorder of both the heart and kidneys, is a condition in which acute or chronic damage to one organ can lead to acute or chronic dysfunction of the other organ. Depending on primary organ dysfunction and disease duration, there are five different types of cardiorenal syndrome. Type 1 cardiorenal syndrome (acute cardiorenal syndrome) is defined as acute kidney injury caused by sudden decrease in heart function. ⋯ Despite numerous publications, perplexed physiological, biochemical and hormonal disturbances as parts of the main pathogenic mechanisms of cardiorenal syndrome remain obscure. Even though there are guidelines for the treatment of patients with heart failure and chronic kidney disease, similar guidelines for the treatment of cardiorenal syndrome are lacking. In everyday practice, it is crucial to diagnose cardiorenal syndrome and use all diagnostic and therapeutic procedures available to prevent or alleviate kidney and heart failure.
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Statins, inhibitors of hydroxymethylglutaryl coenzyme A reductase, are the mainstay of the treatment of hypercholesterolemia in patients with cardiovascular disease. Besides the effects on cholesterol synthesis, they also have other effects. Pleiotropic effects of statins have been noted as anti-inflammatory, immunomodulatory, antioxidant, anti-thrombotic and endothelium stabilizing. All the mentioned effects could have beneficial role in the systemic response to infection, i.e. sepsis, but also in other systemic inflammatory conditions. We give a review of pharmacological effects of statins and of trials investigating the effects of statins in acute inflammatory response and sepsis.
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Acute respiratory distress syndrome (ARDS) develops in patients with predisposing conditions that induce systemic inflammatory response such as sepsis, pneumonia, acute pancreatitis, major trauma, or multiple transfusions. Sepsis is the most common cause of ARDS. Sepsis-related ARDS patients have significantly lower PaO2 /FiO2 ratios than patients with non-sepsis-related ARDS. Furthermore, their recovery from lung injury is prolonged, weaning from mechanical ventilation less successful, and extubation rate slower. ⋯ The pool of data on treatment possibilities for patients with ARDS grows every year, with specifically designed mechanical ventilation strategies. Ventilator modes and adequate positive end-expiratory pressure (PEEP) settings play a major role in these strategies. However, how can we best apply these experimental and clinical data to everyday clinical practice? This article emphasizes protective ventilation as a measure that is proven to reduce mortality in this group of patients, when systematically and consistently applied.
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Septic cardiomyopathy is a reversible myocardial dysfunction in patients with sepsis. Depression in myocardial contractility is detected in more than 40% of patients with severe sepsis or septic shock. Sepsis-induced myocardial dysfunction (SIMD) is one of the main predictors of poor outcome in patients with sepsis. ⋯ There are several therapeutic interventions such as infection control, optimization of hemodynamic parameters, adequate volume resuscitation, inotropic drugs, transfusion of blood derivatives, and statins. However, for now, there is no efficient therapy for septic cardiomyopathy. The management of SIMD includes cardio-protective therapy, etiologic treatment of sepsis and septic shock, and supportive measures.
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Stabilization splint is the treatment of choice for pain control in temporomandibular disorder (TMD) patients, even though its mechanism of action is still unknown. The aim of this systematic review is to provide a critical overview of the effectiveness of stabilization splint therapy on the basis of currently available literature data. The available Medline database was searched and 24 studies published since the 1995s have been consequently included in this review. ⋯ This review has shown evidence that most TMD patients are helped by incorporation of a stabilization splint. There is not enough data on the long-term efficacy and effectiveness of this widely used therapeutic tool. In the future, there is a need for well-conducted randomized controlled trials paying attention to adequate sample size, blind outcome assessment, duration of follow up, and using standardized methods for measuring treatment outcomes.