Casopís lékar̆ů c̆eských
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Casopís lékar̆ů c̆eských · Jan 2009
Review[Molecular biology and immunopathogenetic mechanisms of sepsis].
Sepsis, the systemic inflammatory response to infection, causes high mortality in patients in non-coronary units of intensive care. The most important characteristic of sepsis is the interaction between two subjects, the macro and the microorganism, associated with the dysfunction of innate and adaptive immunity. ⋯ The inflammation, characterizing sepsis, does not act as a primary physiological compensatory mechanism and rather oscillates between the phase of hyperinflammatory response and anergy or immunoparalysis. The elucidation of the pathogenesis of sepsis is linked to the understanding of immunopathogenetic mechanisms, which characterize the interaction between the macro and microorganisms.
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Casopís lékar̆ů c̆eských · Jan 2007
Review[Obesity based on mutation of genes involved in energy balance].
Within the last decade an intensive research led to an identification of several genes which are involved in a regulation of energy balance. In most cases, carriers of these gene mutations do not exhibit further characteristic phenotypic features except for a severe obesity. Obesity based on mutation of one gene product is called monogenic obesity. ⋯ Mutations of the other genes involved in energy homeostasis are very rare. Although these mutations are sporadic we assume that further research of monogenic forms of obesity might lead to our understanding of physiology and pathophysiology of regulation of the energy homeostasis and eating behaviour. Additionally, they may open new approach to the management of eating behaviour and to the treatment of obesity.
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Sepsis represents an important infectious process with systemic manifestation. The incidence of sepsis is continuously increasing. This epidemiologic trend reflects the aging population, increasing number of chronically ill patients and invasiveness of the modern medicine. ⋯ As an example is a failure of clinical study with monoclonal antibody against TNF-a. Thus, the search for new clinically effective therapeutic agents is aimed at pathogenetic mechanisms activated in longer time frame after the primary insult. Currently, out of drugs modulating the already known immunopathophysiological mechanisms of sepsis corticosteroids and activated protein C are used.
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Casopís lékar̆ů c̆eských · Jan 2007
Review[Thrombotic complications of sepsis and their pharmacological prophylaxis].
Patients with severe sepsis are at increased risk for developing thrombembolic phenomena. This article aims to clarify the association between systemic inflammation activation and coagulation, pathogenesis of coagulation abnormalities during severe sepsis. The article reviews incidence and deep venous thrombosis risk factors among these patients and summarizes recent evidence-based guidelines for deep venous thrombosis prophylaxis.
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Adverse cardiac outcomes continue to be an important cause of perioperative morbidity and mortality in the non-cardiac surgery. This is related to the high prevalence of coronary artery disease in the aging surgical population. Beta-blockers were proved useful and efficacious in the treatment of perioperative myocardial ischaemia and arrhythmia. ⋯ However, one recent meta-analysis and several new studies have not confirmed the postulated beneficial effects of perioperative betablockade and gave rise to an animated controversy. Until the finalization of ongoing large trials in the next two years, the decision to start prophylactic perioperative beta-blockade remains at the discretion of the responsible physicians. This decision should be based on the patient's risk, the type of surgery and on the consideration of potential interactions and side-effects of the selected beta-blocker.