February 08, 2010
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| Evodia rutaecarpa and Three Major Alkaloids Abrogate Influenza A Virus (H1N1)-induced Chemokines Production and Cell Migration - Evidence-based Complementary and Alternative Medicine |
| Chiou WF et al. – Three major alkaloids displayed different potentials for inhibiting chemokines secretion and subsequently cell migration, which could partially explain the activity of ER. As an effective agent to suppress H1N1–induced chemokines production and block chemokine–attracted leukocytes recruitment, E. rutaecarpa and its active components may be useful in influenza virus infection–related inflammatory disorders.... |
| Update on Obstetric Emergencies - The Female Patient |
| Mirza FG et al. – Although the 20th century witnessed a remarkable decline in maternal mortality in the United States, little progress has been made during the past 2 decades. Obstetric hemorrhage, which accounts for approximately 17% of all maternal deaths, represents the second most common cause of pregnancy–related mortality. Although obstetric hemorrhage most often occurs in association with abnormal placentation, several other clinical scenarios can result in excessive blood loss. The purpose of this article is to review a number of obstetric emergencies that can lead to life–threatening hemorrhage.... |
| Managing Postpartum Hypertension - The Female Patient |
| Clark SL – While preeclampsia is ultimately “cured” by delivery, it may worsen in the immediate postpartum period. Blood pressures must be followed carefully until the patient has completely stabilized and BPs have returned to normal or near–normal values, in order to prevent stroke. A measurement of 160/110 mm Hg has traditionally been viewed as the level at which acute lowering of BP is essential. Had this been done in this case, the intracerebral hemorrhage would likely have been avoided. But what if only one of these values is exceeded? One approach is to use the mean arterial pressure: MAP = ([systolic] + 2[diastolic])/3. When this value exceeds the MAP represented by 160/110 mm Hg (MAP = 127 mm Hg), it is generally a good idea to administer an antihypertensive drug. There are several good drugs available; the most commonly used are hydralazine and labetalol. Remember, magnesium sulfate is given to prevent eclamptic seizures, but it is not an antihypertensive agent.... |
| Posttraumatic Stress Disorder After Injury: Does Admission to Intensive Care Unit Increase Risk - Journal of Trauma |
| O'Donnell ML et al. – Injury patients are three times more likely to develop later PTSD if they have an ICU admission. Given authors controlled for many risk variables, it seems that an ICU admission itself may contribute to the development of PTSD. Mental health services such as screening and early intervention may be particularly useful for this population.... |
| Nutrition in Trauma and Critically Ill Patients - European Journal of Trauma and Emergency Surgery |
| Latifi R et al. – Despite significant improvements in the practice of metabolic support of critically ill patients in recent years, malnutrition continues to be common among surgical patients, adding significantly to complications, infections, length of stay, costs, and increased mortality. Furthermore, hypercatabolism is the major metabolic response after major trauma and emergency surgery, making this patient population a unique subgroup of critically ill patients vulnerable to further decline in nutritional status.... |
| Controversies in non-ST-elevation acute coronary syndromes and percutaneous coronary interventions - Cleveland Clinic Journal of Medicine |
| Bhatt DL – The data favor an aggressive strategy of routine catheterization, rather than a conservative strategy of catheterization only if a patient develops recurrent, spontaneous, or stress–induced ischemia. Early percutaneous intervention (within 24 hours) may be beneficial in patients at higher risk, but not necessarily in those at lower risk. Drug–eluting stents appear safe, assuming dual antiplatelet therapy is used. It is unclear how long this therapy needs to be continued. The choice of revascularization strategy – bypass surgery, bare–metal stent, or drug–eluting stent – should be individualized based on the risk of restenosis, thrombosis, and other factors.... |
| Acute painful joints - Paediatrics and Child Health |
| Rogers MJ et al. – Musculoskeletal pain affects up to 20% of children at any one time, by far the majority of whom have minor or benign disorders. Deciding which patients have significant pathology is key. The authors consider the presentation of joint pain in four clinical settings: a child who is unwell with fever; a child who is well with mechanical joint symptoms or following trauma; a child with acute joint pain as part of a chronic condition; and a child with hip specific pathologies. This approach can help to formulate a differential diagnosis, guide appropriate investigations and institute effective treatment.... |
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