SADJ : journal of the South African Dental Association = tydskrif van die Suid-Afrikaanse Tandheelkundige Vereniging
-
As a drug, alcohol has grave bio-psychosocial effects on patients, their families and society in general. It is very important that clinicians be able to recognise, admit and thoroughly treat alcoholism. ⋯ The multidisciplinary team should be involved, and doctors should not hesitate to seek help and advice. Alcoholism is potentially quite treatable.
-
Critically ill patients still commonly die of the effects of sepsis, despite numerous interventions. Earlier trials investigated mostly anti-inflammatory strategies, based on the prevailing theory that sepsis represents an uncontrolled inflammatory response. We now know that sepsis represents a biphasic response to infection, and the initial pro-inflammatory response that we have targeted thus far is invariably followed by a prolonged period of immune suppression. ⋯ The coagulation cascade has a powerful effect on inflammation, and manipulation by means of Activated Protein C has been beneficial. It appears tremendously advantageous to resuscitate the critically ill patient early and aggressively to maintain normal oxidative metabolism. This, coupled with the rigorous maintenance of a physiologically neutral milieu (particularly blood glucose levels) seems to be the most powerful weapon we have to manage the critically ill patient with sepsis.
-
Mortality among critically ill patients has been attributed to the development of sepsis. About 28% of patients with sepsis still die, despite numerous interventions. Trials on sepsis investigated mostly anti-inflammatory strategies, based on the prevailing theory that sepsis represents an uncontrolled inflammatory response. ⋯ A single magic bullet therapy is thus unlikely to work. The mediators of this process are the cytokines, and a lot of research is focussed on modulating these to achieve a better outcome. In addition, the central role of the coagulation cascade in mediating inflammation and sepsis is becoming clear, and therapies addressing this mechanism are promising.
-
Choking on aspirated food or a foreign body (i.e. meat, mushroom, coin, chewing gum and a balloon) is a common cause of laryngeal obstruction, particularly in those persons who are intoxicated by alcohol or who have bulbar palsy (degeneration of motor neurons in the brain stem nuclei of the glossopharyngeal and vagal nerve). The rima glottis in the larynx is an important site where aspirated food or material becomes lodged, thereby causing laryngeal obstruction (choking). ⋯ The manoeuvre can also be used to expel aspirated water from the airways in cases of near drowning. The manoeuvre has been found to be successful as an emergency adjunct measure in removing food blocking the airway.