Articles: chronic.
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Acta Anaesthesiol Scand · Feb 2017
Randomized Controlled Trial Multicenter Study Comparative StudyHigher vs. lower haemoglobin threshold for transfusion in septic shock: subgroup analyses of the TRISS trial.
Using a restrictive transfusion strategy appears to be safe in sepsis, but there may be subgroups of patients who benefit from transfusion at a higher haemoglobin level. We explored if subgroups of patients with septic shock and anaemia had better outcome when transfused at a higher vs. a lower haemoglobin threshold. ⋯ In exploratory analyses of a randomized trial in patients with septic shock and anaemia, we observed no survival benefit in any subgroups of transfusion at a haemoglobin threshold of 90 g/l vs. 70 g/l.
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Opioids are often used for pain treatment, but the response is often insufficient and dependent on e.g. the pain condition, genetic factors and drug class. Thus, there is an urgent need to identify biomarkers to enable selection of the appropriate drug for the individual patient, a concept known as personalized medicine. Quantitative sensory testing (QST) and clinical parameters can provide some guidance for response, but better and more objective biomarkers are urgently warranted. Electroencephalography (EEG) may be suitable since it assesses the central nervous system where opioids mediate their effects. ⋯ The current clinical study demonstrates the viability of EEG as a biomarker and with results consistent with previous experimental results. The combined method of machine learning and electroencephalography offers promising results for future developments of personalized pain treatment.
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The association of paroxysmal hemicrania with trigeminal neuralgia (TN) has been described and called paroxysmal hemicrania-tic syndrome (PH-tic). We report the case of a patient diagnosed as having chronic PH-tic (CPH-tic) syndrome as a clinically isolated syndrome of the central nervous system (CNS) (CIS). A forty year old woman was admitted to our hospital suffering from right facial pain for the last 2 years. ⋯ When dealing with symptomatic cases, like the one described here, when causal therapy is not possible due to the nature of the primary pathological process, a therapeutic approach, although symptomatic, can be fully effective in controlling this painful syndrome. The case report could be a contribution to the pathophysiological and clinical understanding of the association of CPH and TN. Key words: Paroxysmal hemicrania, trigeminal neuralgia, clinically isolated syndrome.
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The question of hormonal dysregulation in patients with CRPS I in whole was investigated very scantily. There are only a few studies concerning catecholamines, oestrogens and endorphins independently. Other hormones were studied in patients with different other chronic pain conditions. Considering the accumulation of sufficient knowledge about the role of disadaptation processes in CRPS I pathogenesis and the role of the hypothalamic-pituitary-adrenal and hypothalamic-pituitary-ovarian systems in the process of adaptation it was logical and consistent to define the role of hormonal dysregulation of these systems in patients with CRPS I. ⋯ This study determined the role of hypothalamic-pituitary-adrenal and hypothalamic-pituitary-ovarian systems in pathogenesis of CRPS I.
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Two-stage exchange arthroplasty remains the preferred method for treating a chronic periprosthetic joint infection (PJI) in North America. However, infection recurrence may occur. Previously, recurrent infections have been classified as persistent (same isolated pathogen) or new (different pathogen identified). We sought to determine (1) recurrence rates among patients with chronic hip and knee PJI, treated with 2-stage exchange arthroplasty; (2) risk factors for infection recurrence; and (3) risk factors for developing persistent vs new infection. ⋯ Female gender, heart disease, and psychiatric disorders increase the risk of hip and knee PJI recurrence. Patients with PJI of the hip and with heart disease are at higher risk of infection persistence.