Dopamine and noradrenaline effects in the blood flux regional on therapeutic in the septic shock

JUSTIFICATIVA E OBJETIVOS: A noradrenalina e a dopamina são utilizadas, no estado de choque, com o intuito de oferecer suporte hemodinâmico e restabelecer a perfusão tecidual. As ações farmacológicas desses vasopressores podem ser variadas, deste modo, o uso necessita, por parte do clinico, interpretação dos efeitos hemodinâmicos, com observação das variáveis sistêmica e regional. O objetivo deste estudo foi analisar as publicações acerca dos efeitos da noradrenalina e dopamina em baixas doses na perfusão hepatoesplâncnica e renal no tratamento do choque séptico. MÉTODO: Foram selecionados artigos (n = 27) sobre o uso de noradrenalina e dopamina em choque séptico, publicados no período de 1997 a setembro de 2007 revisados na PubMed, base de dados da National Library of Medicine (NLM). Utilizou-se o recurso MESH com os descritores noradrenaline, dopamine e sepsis. RESULTADOS: Os efeitos de dopamina e noradrenalina na perfusão renal demonstraram ser semelhantes em relação ao aumento da diurese e não alteração na depuração de creatinina. A noradrenalina não afetou a perfusão tissular renal, apesar de elevar o tônus vascular. Quanto aos efeitos esplâncnicos, os dois fármacos demonstraram aumentar o fluxo sangüíneo, porém redistribuem o sangue nesse compartimento. CONCLUSÕES: Os estudos analisados foram controversos não demonstrando consenso acerca do fármaco mais oportuno para o restabelecimento hemodinâmico e manutenção de perfusão regional adequada.BACKGROUND AND OBJECTIVES: Norepinephrine and dopamine are used, in the state of shock, with the intention of offering hemodynamic support and to reestablish tissue perfusion. The pharmacological effects of these vasopressors can be diverse, for this reason, their use requires, through the clinician, an interpretation of the hemodynamic effects with observation of the systemic variations and region. With this in mind, the objective of this study was to analyze the publications regarding the effects of norepinephrine and low-dose dopamine in hepatosplenic perfusion and renal in treatment of septic shock. METHODS: Articles were selected (n = 27) concerning the use of norepinephrine and dopamine in septic shock, published during the period of 1997 to September 2007, revised in PubMed, data base of the National Library of Medicine (NLM). The MESH method was utilized with the descriptors norepinephrine, dopamine and sepsis. RESULTS: The effects of dopamine and norepinephrine in kidney perfusion are similar; there is an increase in diuresis and no change in creatinine clearance. Norepinephrine did not affect kidney tissue perfusion in spite of the increase of vascular tone. Regarding the splancnic effects, these drugs showed an increase in blood flow, though redistributing the blood in this compartment. CONCLUSIONS: The best agent for the hemodynamic reestablishment that keeps the adequate regional perfusion remains inconclusive

No Difference in Health Related Quality of Life Between Therapeutic Options for Type 1 Gaucher Disease

Type 1 Gaucher disease (GD) is the most common lysosomal storage disorder. Previously, treatment for GD was limited to intravenous enzyme replacement therapy (ERT). ERT reduces symptoms and increases health­related quality of life (HRQoL) in people with this condition. In 2014, oral substrate reduction therapy (SRT) was approved for type 1 GD treatment. Although both therapies alleviate disease symptoms, effects of SRT on HRQoL and preferences for therapy are not well established. Electronic surveys were administered to adults with type 1 GD. HRQoL was scored with the Short Form­36 Version 2 ® Health Survey and descriptive statistics were used to evaluate additional survey items. No differences in physical HRQoL (p = 0.756) or mental HRQoL (p = 0.650) were observed between SRT and ERT users. SRT users most often perceived their health to be similar to when they used ERT. Additionally, SRT users expressed convenience and non­invasiveness as reasons for choosing SRT, while many ERT users cited potential side effects and satisfaction with ERT as reasons for declining SRT. There appears to be no difference in HRQoL between ERT and SRT users and no perceived change in HRQoL for SRT users that previously used ERT. Participant responses illustrate that one particular treatment may not be ideal for all patients with type 1 GD depending on perceived convenience, invasiveness, or side effects. This evidence suggests that individuals with type 1 GD be adequately counseled about the risks and benefits of both therapy options now that SRT is clinically available

Comparativo de personajes de la historia de la enfermería brasileña

Este artículo es una reflexión sobre la historia de los profesionales que se destacaron en la enfermería. Para ello, la búsqueda se llevó a cabo en algunos personajes que hicieron mucho para la enfermería y la salud en el país. El análisis de las historias de estas enfermeras puesto de manifiesto en hechos común como: la ruptura de paradigmas relacionado con el matrimonio, la formación en instituciones de renombre, la ocupación en puestos de gran importancia, la participación en asociaciones profesionales expresiva, a si como una relación con la formación de calidad. A través de sus biografías, se puede ver que a pesar del contexto político de la época han favorecido la formación de esas enfermeras, mucho esfuerzo y dedicación fueron necesarios para esas trayectorias de éxito, que cooperaron en la consolidación de la enfermería brasileña.This article presents a reflection about the story of outstanding nursing professionals. For this purpose, a survey was conducted among some people who contributed a lot to nursing and health in Brazil. The analysis of these nurses' stories unveiled facts in common: breaking of paradigms relating to marriage, education at renowned institutions, holding of very important jobs, significant membership in professional associations, and quality education. The bios of these nurses reveal that, while the political scenario then existing contributed to their education, unswerving dedication and diligence, were the key for their successful careers and helped consolidate nursing in Brazil.Este artigo trata de uma reflexão sobre a história de profissionais que se destacaram na Enfermagem. Para isso, foi realizada uma pesquisa sobre algumas personagens que muito realizaram pela Enfermagem e pela saúde no país. A análise das histórias dessas enfermeiras revelou fatos em comum, como: o rompimento de paradigmas relacionados ao casamento; a formação em instituições renomadas; a ocupação em cargos de grande importância; a participação expressiva em entidades de classe, assim como uma relação com a formação de qualidade. Através de suas biografias, percebe-se que, apesar de o contexto político da época ter favorecido na formação dessas enfermeiras, muito esforço e dedicação foram necessários para essas trajetórias de sucesso, que colaboraram para a consolidação da Enfermagem brasileira.UNIFESPUNIFESPSciEL

Does the Use of Home-Based Continuous Glucose Monitoring Devices in Adults with Diabetes Mellitus Improve Hemoglobin A1c Levels? An Integrative Review

The prevalence of diabetes continues to rise, but patients’ ability to obtain and maintain glycemic control remains a challenge. In 2017, complications from diabetes resulted in over $300 billion expenditures in lost productivity and medical costs. The nation’s approach to addressing this problem starts with acknowledging the benefits that continuous glucose monitoring (CGM) as an adjunct intervention could change the trajectory of both diabetic care outcomes and the national expenditures associated with poor glycemic control, which leads to the destruction of other cells such as those found in the heart, eyes, and kidneys. Moreover, CGM use has been associated with reductions in glycated hemoglobin A1c (HbA1c) levels. Lower HbA1c levels in diabetes patients translate to better glycemic control. If diabetes patients can improve glycemic levels, they could prevent the severe complications associated with poor glycemic control. This integrative review involved a detailed search, review, and analysis of the literature to further evaluate the relationship between CGM use and HbA1c levels, reliability of CGM data, and patients’ acceptance of CGM use for glycemic management

1990 Team Guide, Baseball

This publication includes information on schedules, coaches, player profiles, records, and team photographs.https://digitalcommons.cortland.edu/baseball_documents/1009/thumbnail.jp

\u3cem\u3eProvocateur\u3c/em\u3e (November 7, 1969)

Contains local and school-related news articles written by the students of Assumption College.https://digitalcommons.assumption.edu/provocateur/1045/thumbnail.jp

Measuring Providers’ Adherence to the American Diabetes Association Screening Recommendation for Prevention of Diabetic Nephropathy

Purpose: The purpose of this study was to evaluate provider adherence to the ADA’s recommendation for an annual screening urinary albumin excretion level to check for the presence of microalbuminuria. A secondary objective was to assess for adequate treatment (i.e. ACE inhibitor or ARB prescription) in those patients with microalbuminuria present. Methods: A retrospective chart review was conducted on 60 randomly selected patients seen within a primary care practice in an urban university setting between January 1st, 2014 and December 31st, 2014. Inclusion criteria included age ≥ 18 years and an active diagnosis of type 2 DM as evidenced by ICD codes 250.00-250.93. Data collected included age, gender, ethnicity, marital status, insurance type, BMI, tobacco use status, presence or absence of a urinary albumin excretion level collected within the specified timeframe, and presence or absence of an active ACE inhibitor/ARB prescription. A database of 972 qualifying patients was provided by the university’s Division of Biomedical Informatics and 60 patients were randomly sampled from this database utilizing a random number generator. Results: The retrospective chart review demonstrated that only 1 out of the 60 charts reviewed had received screening for microalbuminuria within the previous calendar year, as recommended by the national guidelines. Conclusion: Increasing urinary albumin excretion rate screening is essential in early recognition and management of renal complications in patients with type 2 DM. Current rates in many practice settings appear to be suboptimal and there exists an opportunity for quality improvement and identifying strategies for improving screening rates

The Role of Traditional Birth Attendants in Family Planning Programs in Southeast Asia

The training and utilization of traditional birth attendants (TBAs) in maternal and child health and family planning programs in Indonesia, the Philippines, Thailand and Malaysia are discussed. Special efforts to organize and train TBAs for family planning in Malaysia are examined in detail. Import factors for successful utilization of TBAs include: (a) definite assignment of functions and tasks, (b) organization of good operational steps and (c) implementation of good supervisory activities.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135477/1/ijgo00128.pd