Oxygen therapy for sepsis and prevention of complications

Patients with sepsis have a wide range of respiratory disorders that can be treated with oxygen therapy. Experimental data in animal sepsis models show that oxygen therapy significantly increases survival, while clinical data on the use of different oxygen therapy protocols are ambiguous. Oxygen therapy, especially hyperbaric oxygenation, in patients with sepsis can aggravate existing oxidative stress and contribute to the development of disseminated intravascular coagulation. The purpose of this article is to compare experimental and clinical data on oxygen therapy in animals and humans, to discuss factors that can influence the results of oxygen therapy for sepsis treatment in humans, and to provide some recommendations for reducing oxidative stress and preventing disseminated intravascular coagulation during oxygen therapy

Screening for Alzheimer’s Disease in Vermont Primary Care Practice

Introduction: • Alzheimer’s Disease (AD) is a form of progressive dementia that affects 5.3 million Americans and is the sixth leading cause of death in the US. • Age is a major risk factor for disease , and 1 in 8 Americans over 65 can expect to develop AD. • The U.S. healthcare system spends $172 billion/year on patients with AD and dementia, more than half of the Medicare budget. This cost is estimated to increase to over$1 trillion by 2050. • In 2003, the US Preventative Services Task Force (USPSTF) concluded that screening older adults for dementia is ineffective due to insufficient means of preventing or slowing its progression. • In 2011, the National Institute on Aging published new diagnostic criteria for AD. • In accordance with these guidelines the Centers for Medicare and Medicaid Services released rules for the new Annual Wellness Visit that include the detection of cognitive impairment. • Our goal was to identify the attitudes and practices of primary care physicians (PCPs) in Vermont (VT) related to screening for AD and dementia.https://scholarworks.uvm.edu/comphp_gallery/1063/thumbnail.jp

Sepsis: mechanisms of bacterial injury to the patient

Abstract In bacteremia the majority of bacterial species are killed by oxidation on the surface of erythrocytes and digested by local phagocytes in the liver and the spleen. Sepsis-causing bacteria overcome this mechanism of human innate immunity by versatile respiration, production of antioxidant enzymes, hemolysins, exo- and endotoxins, exopolymers and other factors that suppress host defense and provide bacterial survival. Entering the bloodstream in different forms (planktonic, encapsulated, L-form, biofilm fragments), they cause different types of sepsis (fulminant, acute, subacute, chronic, etc.). Sepsis treatment includes antibacterial therapy, support of host vital functions and restore of homeostasis. A bacterium killing is only one of numerous aspects of antibacterial therapy. The latter should inhibit the production of bacterial antioxidant enzymes and hemolysins, neutralize bacterial toxins, modulate bacterial respiration, increase host tolerance to bacterial products, facilitate host bactericidal mechanism and disperse bacterial capsule and biofilm

Detection and development of a quantitation method for undeclared compounds in antidiabetic biologically active additives and its validation by high performance liquid chromatography

An isocratic, high-performance liquid chromatography (HPLC) quantitation method was developed for the quantitative determination of metformin, glibenclamide, gliclazide, glimepiride in some antidiabetic biologically active additives. A Nucleosil C18, 5 μm, 4.6 mm × 150 mm, column with mobile phase containing buffer (10 mm Na2HPO4, 10 mm sodium dodecyl sulfate): acetonitrile = 68 : 32 (V/V), pH = 7.5 was used. The flow rate was 1.0 mL/min, and effluents were monitored at 226 nm. The retention times of gliclazide glibenclamide, glimepiride and metformin, were 2.203, 4.587, 5.667 and 10.182 min, respectively. Linearity was studied by preparing standard solutions of gliclazide, glibenclamide, glimepiride and metformin at the concentration range of 50% to 150% of working concentration from a stock solution. The method was successfully applied to the estimation of gliclazide, glibenclamide, glimepiride and metformin in some antidiabetic biologically active additives. This method was validated to confirm its system suitability, selectivity, linearity, precision and accuracy according to international conference on harmonization (ICH) guidelines

Six-Coordinate Nitrato Complexes of Iron Porphyrins with Trans S-Donor Ligands.

The reaction of dimethyl sulfide (DMS) and tetrahydrothiophene (THT) with thin, amorphous layers of the nitrato complexes Fe(Por)(η2-O2NO) (Por = meso-tetraphenylporphyrinato dianion or meso-tetra- p-tolylporphyrinato dianion) at low temperature leads to formation of the corresponding six-coordinate complexes Fe(Por)(L)(η1-ONO2) (L = DMS, THT) as characterized by Fourier transform infrared and optical spectroscopy measurements. Adduct formation was accompanied by bidentate-to-monodentate linkage isomerization of the nitrato ligand, with the FeIII center remaining in a high-spin electronic state. These adducts are thermally unstable; warming to room temperature restores the initial Fe(Por)(η2-O2NO) species

Venous pressure during intravenous regional anesthesia: Implications for setting tourniquet pressure

Background and Aims: Intravenous regional anesthesia (IVRA) is utilized for upper extremity surgery, but higher tourniquet pressure and longer inflation time increase the risk of soft tissue and nerve injury. We investigated the duration and magnitude of elevated venous pressure during IVRA to assess the possibility of safely lowering the tourniquet pressure during surgery. Material and Methods: Twenty adult patients scheduled for distal upper extremity surgery were enrolled. An additional intravenous catheter was placed in the surgical arm connected to a digital pressure transducer for monitoring venous pressure. Venous pressure was recorded prior to IVRA and every 30 s after injection of local anesthetic (LA) until the completion of surgery. Results: All 20 subjects completed the study without complication. Peak venous pressure was 340 mmHg in one patient which lasted for less than 30 s. Mean venous pressures fell below systolic blood pressure after 4.5 min in all cases except one. This patient had elevated venous pressures for 24 of 25 min of tourniquet time exceeding systolic blood pressure. The only statistically significant intraoperative factor associated with elevated venous pressure was elevated peak systolic pressure (P = 0.001). Conclusions: We found that the mean peak venous pressure was below systolic blood pressure in only 14 of the 20 subjects, and the peak injection pressure exceeded 300 mmHg in one patient. Another patient's venous pressure remained above systolic blood pressure for 24 of 25 min of tourniquet time. Current precautions to prevent LA toxicity may be insufficient in some patients and attempts to lower tourniquet pressures to just above systolic blood pressures soon after IVRA injection may result in toxicity, specifically if systolic pressure is elevated