Kommentaar artiklile "Hüperventilatsiooni ilmingud rituaalsetes tantsudes"

In applied medicine, respiration is viewed as the chemical process of gas exchange of oxygen and carbon dioxide. Corresponding experimental studies have enabled to observe the condition of all systems involved in respiration. In relaxation state, the cycles of inhalation and exhalation generally follow the temporal ratio 1:3 (1:1 for infants). The acceleration of breathing rate usually occurs on account of the shortening of exhalation cycle. The situation in which the exhalation phase is longer than the inhalation phase cannot be seen in normal circumstances. In the treatment of acute respiratory failure, this pattern of breathing is in rare cases used together with artificial pulmonary respiration. Hyperventilation always leads to hypocapnia of a healthy lung, since the exchange of carbon dioxide in alveolus occurs very rapidly by means of diffusion on the principle of redistribution of concentrations. From the viewpoint of medical practices, hypocapnia resulting from hyperventilation has a negative regulatory effect on humans. Scientists have explored the role of hyperventilation in various physiological psychoemotional conditions and activities. Various scientific theories and empirical studies link pathological anxiety and panic with hyperventilation. A patient may deliberately use hyperventilation to bring on clinical symptoms and in this case it is used as a diagnostic tool. At the same time, respiration training (including deliberate hyperventilation) is used for the same psychiatric disorders. In this study, the author's approach to hyperventilation is somewhat overgeneralised but is accurate in principle. The hypothesis posed by the author of the article, arguing that dancing (a motor activity), the technique of singing and/or breathing, the psychological disposition of participants of the ritual and the cultural context may evoke the state of trance, is a theory generally recognised also by other scholars

N-glükosüülimise kaasasündinud defektid: kirjanduse ülevaade ja haigusjuhu kirjeldus

Glükosüülimise kaasasündinud defektid on kiiresti kasvav, erinevaid elundisüsteeme haarav ainevahetushaiguste rühm. Glükosüülimine on valkude modifitseerimise protsess, mille tulemusel sünteesitakse glükoproteiin. Kõige sagedamini esineb valkude N-glükosüülimise defekte. Erinevate glükoproteiinide hüpoglükosüülimisest põhjustatud haiguste kliiniline pilt ja raskusaste on väga varieeruvad, haarates erinevaid elundisüsteeme või piirdudes vaid kindlate elunditega. On oluline, et kõiki nii ainevahetushaiguse kahtluse kui ka ebaselge kliinilise pildiga patsiente uuritakse glükosüülimise kaasasündinud defektide suhtes.Eesti Arst 2014; 93(1):41–4

Clinical parameters predicting failure of empirical antibacterial therapy in early onset neonatal sepsis, identified by classification and regression tree analysis

<p>Abstract</p> <p>Background</p> <p>About 10-20% of neonates with suspected or proven early onset sepsis (EOS) fail on the empiric antibiotic regimen of ampicillin or penicillin and gentamicin. We aimed to identify clinical and laboratory markers associated with empiric antibiotic treatment failure in neonates with suspected EOS.</p> <p>Methods</p> <p>Maternal and early neonatal characteristics predicting failure of empiric antibiotic treatment were identified by univariate logistic regression analysis from a prospective database of 283 neonates admitted to neonatal intensive care unit within 72 hours of life and requiring antibiotic therapy with penicillin or ampicillin and gentamicin. Variables, identified as significant by univariate analysis, were entered into stepwise multiple logistic regression (MLR) analysis and classification and regression tree (CRT) analysis to develop a decision algorithm for clinical application. In order to ensure the earliest possible timing separate analysis for 24 and 72 hours of age was performed.</p> <p>Results</p> <p>At 24 hours of age neonates with hypoglycaemia ≤ 2.55 mmol/L together with CRP values > 1.35 mg/L or those with BW ≤ 678 g had more than 30% likelihood of treatment failure. In normoglycaemic neonates with higher BW the best predictors of treatment failure at 24 hours were GA ≤ 27 weeks and among those, with higher GA, WBC ≤ 8.25 × 10⁹L^-1together with platelet count ≤ 143 × 10⁹L^-1. The algorithm allowed capture of 75% of treatment failure cases with a specificity of 89%. By 72 hours of age minimum platelet count ≤ 94.5 × 10⁹L^-1with need for vasoactive treatment or leukopaenia ≤ 3.5 × 10⁹L^-1or leukocytosis > 39.8 × 10⁹L^-1or blood glucose ≤ 1.65 mmol/L allowed capture of 81% of treatment failure cases with the specificity of 88%. The performance of MLR and CRT models was similar, except for higher specificity of the CRT at 72 h, compared to MLR analysis.</p> <p>Conclusion</p> <p>There is an identifiable group of neonates with high risk of EOS, likely to fail on conventional antibiotic therapy.</p

Väga enneaegsete vastsündinute ravitulem Eestis

Artiklis on esitatud ülevaade väga enneaegsete vastsündinute ravitrendidest maailmas ja Eesti Perinatoloogia Seltsi algatusel korraldatud uuringust, millest selgusid selle patsiendirühma ravitulemused Eestis. Aastatel 2007–2008 hinnati internetipõhise “Vastsündinute tervise andmekogu” baasil enneaegseid vastsündinuid ravitakse Eestis aktiivselt. Laste elulemus on kõrge ja varane haigestumine suur. Eesti Arst 2009; 88(Lisa4):12−2

Angiotensiini konverteeriva ensüümi inhibiitori ja angiotensiin II retseptori blokaatori kasutamise ohud raseduse ajal: haigusjuhu kirjeldus ja kirjanduse ülevaade

Artiklis on kirjeldatud raseduse kulgu ja vastsündinu seisundit kogu raseduse vältel angiotensiini konverteeriva ensüümi inhibiitorit (AKEI) ja angiotensiin II retseptori blokaatorit (ARB) kasutanud naisel. Reniin-angiotensiinsüsteemi (RAS) mõjutavad ravimid määrati 2. tüüpi diabeeti põdevale kõrgvererõhktõvega naisele 3 aastat enne rasedust. Raseduse ajal jäi raviskeem muutmata. Raseduse 37. nädalal diagnoositi oligohüdramnion, loote düstress ning loote kasvu mahajäämus ja rasedus lõpetati erakorralise keisrilõikega. Vastsündinu suri kopsude hüpoplaasia ning neerupuudulikkuse tõttu 38 tunni vanusena. Kirjanduse andmetel seostatakse selliseid vastsündinu kahjustusi AKEI ja ARB rasedusaegse kasutamisega, mistõttu neid ravimeid raseduse ajal tarvitada ei tohi. Haigusjuhtu on arutatud TÜ Kliinikumi patoanatoomilisel konverentsil 12. mail 2010. Eesti Arst 2010; 89(7−8):502−50

Muutused aju ja siseelundite verevoolu kiiruses asfüksias sündinud vastsündinutel

Raskes asfüksias sündinud lastel teki&shy;vad pärast sündi lisaks neuroloogiliste&shy;le probleemidele mitmete elundite ve&shy;revarustuse häired. Elundikahjustuse ulatust aitab hinnata verevoolukiiruste uurimine aju ja vistseraalsete organite arterites. Raske hüpoksilis-isheemilise entsefalopaatia (HIE) korral kujuneb esimesel elunädalal vasoparalüüsi tõttu oluline aju verevoolu kiiruse suurene&shy;mine. Ülemises mesenteriaalarteris ja truncus coeliacus’es esineb kerge ning mõõduka HIE korral esimestel tundidel asfüksia järel verevoolukiiruse kompen&shy;satoorne suurenemine, raske HIE korral verevoolukiiruse vähenemine neeruar&shy;teris ja mesenteriaalarteris. Ühe kuu va&shy;nuses verevoolukiirused vistseraalsetes arterites normaliseeruvad, raske HIEga lastel kujuneb väike pea ümbermõõt ja väike verevoolukiirus ajuarterites. Eesti Arst 2 008; 87(10):755−76

Ampitsilliini-gentamütsiini ja penitsilliini-gentamütsiini kombinatsioonide võrdlus vastsündinu varase sepsise ravis

Töö eesmärgiks oli võrrelda ampitsilliini-gentamütsiini vs penitsilliinigentamütsiini kombinatsioonide kliinilist efektiivsust vastsündinute varase sepsise (VVS) ravis. Kahekeskuseline prospektiivne klastriga juhuslikustatud uuring hõlmas kõik VVS-kahtlusega alla 72 tunni vanused vastsündinud. Esimesel uuringuperioodil kasutati ühes keskuses ampitsilliini ja teises penitsilliini kombinatsioonis gentamütsiiniga. Beetalaktaamantibiootikumid vahetati, kui pooled haiged olid uuringusse lülitatud. Primaarne tulem oli ravi ebaõnnestumine (vajadus antibakteriaalse ravi muutmiseks 72 tunni jooksul) ja/või surm 7 päeva jooksul. Soole kolonisatsiooni hinnati perineumi kaape alusel. Tõestatud VVSi sagedus oli 4,9%. Ampitsilliini ja penitsilliini skeemide vahel ei olnud erinevust 72 tunni jooksul antibakteriaalse ravi vahetuse, 7 päeva suremuse ega ravi ebaõnnestumise osas. Ampitsilliin ja penitsilliin kombinatsioonis gentamütsiiniga on võrdselt tõhusad vastsündinu varase sepsise empiirilises ravis. Eesti Arst 2009; 88(Lisa4):21−2

Baa, Baa, Black Sheep Have You Any Wool? Developing the RBV Through a Study of the New Zealand Merino Clothing Industry

This thesis explores how the traditional approaches to researching the Resource-Based View (RBV) do not fully address the heterogeneity within the participants of the research. Traditional approaches assume similar levels of knowledge, prioritisation, and value (awareness) are held across the participants. This thesis proposes that this similarity may not exist for every industry. Focused on the New Zealand merino clothing industry, this research employed two studies to determine the key characteristics and perceptions of the main players in the industry. Initially an industry profile is formed from secondary data sources, which covers the 30 years since the inception of the New Zealand merino clothing industry. This profile forms the basis for the interview sample and provides comparison for interview findings. Through the use of open-ended questions and a semi-structured interview process this thesis carried out interviews with the CEOs of thirteen New Zealand based merino clothing firms from throughout New Zealand. These interviews offered the participants the opportunity to express their perspectives on the resources they deem to be most important. The outcomes of these interviews are surprising; with the results questioning more assumptions of RBV research than just the similarity of awareness. Drawing together the analysis of the industry profile and the findings of the interviews, these two studies highlight a number of key findings. Most significantly, it is apparent that the majority of the interviewees do not perceive themselves as competing, though the industry profile indicates that the industry has a high level of competitive rivalry. Additionally, the firms do not appear to be differentiating themselves from one another, with few unique approaches utilised by the interviewees in regards to product, design, and business practice. Lastly, this thesis illustrates that these differences in perception between the industry profile analysis and the interview findings could be due to the ambition and future perspectives of the CEOs