Articles: function.
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A large proportion of patients undergoing surgery have coexisting chronic kidney disease, placing them at greater risk of postoperative morbidity and mortality. The purpose of this review is to review the recent developments in how renal function is estimated, how this relates to surgical outcomes, and how this has been applied clinically. ⋯ Improved accuracy in defining kidney disease will aid clinicians in identifying higher risk patients, and aid earlier diagnosis of acute kidney injury. Further research is required, specifically on the implications of kidney disease in noncardiac surgical patients, and how defining renal function before and after surgery can aid in preventive strategies.
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Despite many unanswered questions regarding the pathogenesis of interstitial lung disease in systemic sclerosis (SSc-ILD) and the lack of accurate epidemiological risk factors, there have been major advances in the identification and prognostic evaluation of SSc-ILD. The evaluation of disease severity is a multidisciplinary exercise, requiring the integration of pulmonary function tests, high-resolution computed tomography data, and symptomatic severity and these factors all need to be considered in the detection of disease progression. Except in a minority of patients with reversible inflammatory disease, the primary goal of treatment is the prevention of disease progression. ⋯ There is a need to broaden therapeutic approaches with the exploration of rituximab (based on recent pilot data) and antifibrotic agents, shown to have treatment effects in other fibrotic interstitial lung diseases. However, it is also important to avoid the overtreatment of SSc-ILD patients with limited nonprogressive lung involvement. In that setting, an initial policy of nonintervention but meticulous observation ("masterful inactivity with cat-like observation") is often warranted.
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Anesthesia and analgesia · Apr 2014
The Effect of Age on the Median Effective Dose (ED50) of Intrathecally Administered Plain Bupivacaine for Motor Block.
In this study, we sought to determine the median effective dose (ED50) for motor block of intrathecally administered plain bupivacaine in adults (20-80 years) and to assess the effect of age on ED50 required for motor block. ⋯ The ED50 for motor block of intrathecally administered plain bupivacaine decreased steeply with advancing age.
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Advances in medical care have led to an increasing elderly population. Elderly individuals should be able to participate in society as long as possible. However, with an increasing age their adaptive capacity gradually decreases, specially before and after major life events (like hospitalization and surgery) making them vulnerable to reduced functioning and societal participation. Therapeutic exercise before and after surgery might augment the postoperative outcomes by improving functional status and reducing the complication and mortality rate. ⋯ The perioperative exercise training protocol known under the name 'Better in, Better out' could be implemented in clinical care for the vulnerable group of patients scheduled for major elective surgery who are at risk for prolonged hospitalization, complications and/or death. Future research should aim to include this at-risk group, evaluate perioperative high-intensity exercise interventions and conduct adequately powered trials.
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Critical care medicine · Apr 2014
Multicenter StudyPolymorphisms in Tumor Necrosis Factor-α Increase Susceptibility to Intra-Abdominal Candida Infection in High-Risk Surgical ICU Patients*
To evaluate the influence of genetic polymorphisms on the susceptibility to Candida colonization and intra-abdominal candidiasis, a blood culture-negative life-threatening infection in high-risk surgical ICU patients. ⋯ We report a strong association between the promoter rs1800629 single-nucleotide polymorphism in tumor necrosis factor-α and an increased susceptibility to intra-abdominal candidiasis in a homogenous prospective cohort of high-risk surgical ICU patients. This finding highlights the relevance of the tumor necrosis factor-α functional polymorphism in immune response to fungal pathogens. Immunogenetic profiling in patients at clinical high risk followed by targeted antifungal interventions may improve the prevention or preemptive management of this life-threatening infection.