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Critical Pathways in Cardiology Dec 2009Natriuretic peptides (B-type natriuretic peptide [BNP] and N-terminal pro-B-type natriuretic peptide [NT]-proBNP) have been proven to be strong diagnostic and prognostic... (Review)
Review
Natriuretic peptides (B-type natriuretic peptide [BNP] and N-terminal pro-B-type natriuretic peptide [NT]-proBNP) have been proven to be strong diagnostic and prognostic tools in the assessment of acutely decompensated heart failure. The emergence of BNP/NT-proBNP testing as a standard of care in this setting has helped to reduce healthcare costs, and may decrease adverse clinical outcomes. The use of BNP and NT-proBNP to "guide" treatment of acutely destabilized heart failure has recently grown. We present an overview of the value of BNP/NT-proBNP in the context of acute heart failure management and therapy optimization, and present an algorithm for natriuretic peptide-guided treatment of acutely destabilized heart failure.
Topics: Acute Disease; Algorithms; Critical Pathways; Heart Failure; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Prognosis
PubMed: 19952548
DOI: 10.1097/HPC.0b013e3181c4a0c6 -
Annals of the New York Academy of... Oct 1996There are many other transcription factors that are regulated by cocaine, and there are several nontranscriptional mechanisms of regulating protein levels as well.... (Review)
Review
There are many other transcription factors that are regulated by cocaine, and there are several nontranscriptional mechanisms of regulating protein levels as well. However, the induction of the chronic AP-1 complex and the chronic Fras provides a mechanism capable of underlying long-lasting alterations in gene expression following chronic cocaine treatment. We hypothesize that while the well-known acute effects of cocaine are occurring, the acutely induced cAMP pathway, possibly in conjunction with other second messenger pathways, is also inducing two general types of alterations in gene expression. 1. Acutely induced significant alterations in gene expression are rapidly induced and relatively short-lived. These alterations in gene expression would allow the cell to rapidly adapt to cocaine in its environment without committing to long-term changes. 2. Additional alterations in gene expression are induced by each acute administration during chronic cocaine exposure. These latter alterations are gradually induced and long-lasting. With each acute activation, the level of induction of these latter longer-lasting alterations in gene expression would be relatively small and insignificant compared to the rapidly induced acute alterations in gene expression. Therefore, with each acute administration, the cell does not commit itself to long-term alterations. However, these small but longer lasting changes in gene expression would accumulate with each acute administration during chronic cocaine treatment, similar to the accumulation of the chronic AP-I complex (FIG. 4). The cumulative alterations which occur during repeated administrations eventually reach a level where they produce significant and long-lasting alterations in gene expression different from those induced acutely. This incremental induction of long-lasting alterations in gene expression would allow the cell to gradually commit to long-term alterations for the purpose of adapting to repeated long-term exposure to cocaine in its environment. These long-lasting alterations in gene expression may underlie the gradual induction of persistent changes in protein levels, neuronal signaling, and related behaviors. This hypothesis allows for the different adaptations observed following acute versus chronic cocaine administration at the biochemical, physiological, and behavioral levels. We hope these investigations provide ideas for specific pharmacological blockade or reversal of the long-term, versus short-term, alterations in gene expression that lead to addiction, without interfering with the animal's or human's ability to experience reward. This would be important for ensuring both efficacy and compliance.
Topics: Cocaine; Gene Expression Regulation; Humans; Transcription Factors
PubMed: 8959019
DOI: 10.1111/j.1749-6632.1996.tb17427.x -
Frontiers in Physiology 2021This review focuses on the advances in the understanding of the pathophysiology of ventilator-induced and acute lung injury that have been afforded by technological... (Review)
Review
This review focuses on the advances in the understanding of the pathophysiology of ventilator-induced and acute lung injury that have been afforded by technological development of imaging methods over the last decades. Examples of such advances include the establishment of regional lung mechanical strain as a determinant of ventilator-induced lung injury, the relationship between alveolar recruitment and overdistension, the regional vs. diffuse nature of pulmonary involvement in acute respiratory distress syndrome (ARDS), the identification of the physiological determinants of the response to recruitment interventions, and the pathophysiological significance of metabolic alterations in the acutely injured lung. Taken together, these advances portray multimodality imaging as the next frontier to both advance knowledge of the pathophysiology of these conditions and to tailor treatment to the individual patient's condition.
PubMed: 34955883
DOI: 10.3389/fphys.2021.762688 -
Swiss Medical Weekly 2015There is no doubt about the strong association of malnutrition and adverse medical outcomes including mortality, morbidity and quality of life. Particularly in the... (Review)
Review
There is no doubt about the strong association of malnutrition and adverse medical outcomes including mortality, morbidity and quality of life. Particularly in the elderly and frail medical inpatient population, loss of appetite due to the acute illness further aggravates nutritional status. In fact, this relationship between acute disease and eating behaviour / nutritional status may well be bidirectional, with not only illness affecting nutritional status, but also dietary factors influencing the course of illness. Whether loss of appetite associated with acute illness is indeed a protective physiological response or a therapeutic target needing early corrective nutritional therapy is a matter of current debate and can only be resolved within a large and well-designed randomised controlled trial comparing early nutritional therapy with "appetite-guided" nutrition in this patient population. Apart from in critical care, where various large trials have recently been published, there is an important lack of high quality data from large randomised trials in unselected acutely ill medical inpatients to support the early use of nutritional therapy, to shed light on the optimal type, caloric amount and timing of nutritional therapy and to answer ultimately the question as to which patient population will in fact benefit from nutritional interventions. Currently, the EFFORT trial is enrolling patients and aims to fill these literature gaps. The aim of this review is to discuss the current evidence regarding nutritional therapy in acutely ill medical inpatients, and to recommend whether or not, based on today's available evidence, physician should indeed encourage their malnourished patients to "…finish their lunch".
Topics: Acute Disease; Feeding Behavior; Hospitalization; Humans; Malnutrition; Nutritional Status; Randomized Controlled Trials as Topic
PubMed: 25906253
DOI: 10.4414/smw.2015.14132 -
Journal of Neurology, Neurosurgery, and... Jun 2002To review the outcome of acute ventilatory support in patients presenting acutely with respiratory failure, either with an established diagnosis of motor neurone disease...
OBJECTIVES
To review the outcome of acute ventilatory support in patients presenting acutely with respiratory failure, either with an established diagnosis of motor neurone disease (MND) or with a clinical event where the diagnosis of MND has not yet been established.
METHODS
Outcome was reviewed in 24 patients with respiratory failure due to MND who received endotracheal intubation and intermittent positive pressure ventilation either at presentation or as a result of the unexpected development of respiratory failure. Patients presenting to local hospitals with acute respiratory insufficiency and requiring tracheal intubation, ventilatory support, and admission to an intensive therapy unit (ITU) before transfer to a regional respiratory care unit were selected. Clinical features of presentation, management, and outcome were studied.
RESULTS
24 patients with MND were identified, all being intubated and ventilated acutely within hours of presentation. 17 patients (71%) were admitted in respiratory failure before the diagnosis of MND had been made; the remaining seven patients (29%) were already known to have MND but deteriorated rapidly such that intubation and ventilation were initiated acutely. Seven patients (29%) died on ITU (between seven and 54 days after admission). 17 patients (71%) were discharged from ITU. 16 patients (67%) received long term respiratory support and one patient required no respiratory support following tracheal extubation. The daily duration of support that was required increased gradually with time.
CONCLUSION
When a patient with MND is ventilated acutely, with or without an established diagnosis, independence from the ventilator is rarely achieved. Almost all of these patients need long term ventilatory support and the degree of respiratory support increases with time as the disease progresses. The aim of management should be weaning the patient to the minimum support compatible with symptomatic relief and comfort. Respiratory failure should be anticipated in patients with MND when the diagnosis has been established.
Topics: Acute Disease; Aged; Diagnosis, Differential; Disease Progression; Female; Humans; Intermittent Positive-Pressure Ventilation; Intubation, Intratracheal; Male; Middle Aged; Motor Neuron Disease; Quality of Life; Respiratory Insufficiency; Retrospective Studies; Treatment Outcome; Ventilator Weaning
PubMed: 12023419
DOI: 10.1136/jnnp.72.6.752 -
Age and Ageing Feb 2022Old or frail acutely hospitalised patients can benefit from geriatric rehabilitation but criteria concerning referral decisions are unclear. This review presents an... (Review)
Review
OBJECTIVE
Old or frail acutely hospitalised patients can benefit from geriatric rehabilitation but criteria concerning referral decisions are unclear. This review presents an overview of clinical factors associated with referral to geriatric rehabilitation that may further consensus between hospital and rehabilitation professionals on triage.
DESIGN
Scoping review.
METHODS
A review was conducted following Arksey and O'Malley's framework. The search included literature concerning a broad spectrum of acutely hospitalised patients and factors associated with their referral to geriatric rehabilitation.
RESULTS
Selected abstracts were categorised into distinct geriatric rehabilitation care pathways such as stroke, hip fracture, amputation of lower limb, cardiac and oncologic rehabilitation. Abstracts on internal medical patients were further reviewed and 29 studies were included. A total of 13 studies focused on factors identifying rehabilitation needs and 16 on factors associated with outcome of geriatric rehabilitation. Triage factors were diverse and included frailty status, functional decline, cognitive symptoms and multimorbidity. Mood symptoms and living situation further specified post-acute care needs. In overview, triage factors could be characterised as demographic (n = 4), diagnosis-related (n = 8), mental (n = 6), functional (n = 10) or multi-domain (n = 12) and mapped in a transitional care pathway.
CONCLUSIONS AND IMPLICATIONS
Frailty and functional decline are characteristics frequently associated with referral to geriatric rehabilitation of acutely hospitalised internal medical patients. A comprehensive geriatric assessment or a simpler multi-domain set of tests reveals rehabilitation needs and approximates a functional prognosis. Professional consensus on factors and timing of triage in hospital is within reach.
Topics: Aged; Frailty; Geriatric Assessment; Hip Fractures; Humans; Referral and Consultation; Triage
PubMed: 35150588
DOI: 10.1093/ageing/afac015 -
Current Opinion in Gastroenterology Mar 2020The current review discusses current practices regarding appropriate indications for parenteral nutrition in acutely ill hospitalized patients. We address-specific... (Review)
Review
PURPOSE OF REVIEW
The current review discusses current practices regarding appropriate indications for parenteral nutrition in acutely ill hospitalized patients. We address-specific indications for parenteral nutrition in the perioperative period, and in inflammatory bowel disease, oncology, hepatobiliary, critical care and end-stage renal disease patients.
RECENT FINDINGS
Acutely ill hospitalized patients can develop intestinal failure requiring parenteral nutrition. Recent studies have provided insight into the main indications. The most common indications for inpatient parenteral nutrition include postsurgical complications, including prolonged ileus, sepsis, fistula and leaks, and bowel obstruction, predominantly malignant. Severe or complicated inflammatory bowel disease and cancer treatment-related mucosal enteropathies (mucositis, enterocolitis, gut graft-versus-host disease) are the next commonest indications. Less frequent indications are primary motility disorders and inability to secure enteral access for enteral nutrition. Gastrointestinal failure of the intensive care patient is a separate entity resulting from multiple mechanisms, including an enteropathy and dysmotility.
SUMMARY
Despite the wider availability of nutrition support teams, use of parenteral nutrition is not without risk. The risks and benefits of parenteral nutrition in the acute setting need to be carefully considered even when it is indicated.
Topics: Acute Disease; Hospitalization; Humans; Nutritional Support; Parenteral Nutrition; Time Factors
PubMed: 31895227
DOI: 10.1097/MOG.0000000000000615 -
Psychotherapie, Psychosomatik,... 2012
Topics: Acute Disease; Caregivers; Chronic Disease; Cost of Illness; Germany; Humans; Meta-Analysis as Topic; Psychotherapy; Social Support
PubMed: 23027387
DOI: 10.1055/s-0032-1327194 -
Irish Journal of Medical Science Feb 1983
Review
Topics: Acute Disease; Acute Kidney Injury; Aged; Folic Acid; Folic Acid Deficiency; Humans; Male; Pancytopenia; Sepsis
PubMed: 6341304
DOI: 10.1007/BF02961035 -
Life Sciences 1990Phosphate-dependent glutaminase (PDG) was measured in kidney cortex homogenates and mitochondria from control and acutely acidotic rats. The effect of plasma from...
Phosphate-dependent glutaminase (PDG) was measured in kidney cortex homogenates and mitochondria from control and acutely acidotic rats. The effect of plasma from acutely acidotic rats on PDG activity in homogenates from normal rats was also studied. Acidosis or incubation in acidotic plasma enhanced enzyme activity when measured at 1.0 mM but not at 20.0 mM glutamine. This effect was not due to increased mitochondrial permeability since similar results were obtained after solubilization of the enzyme with Triton X-100. Increased enzyme activity was observed with either the Tris (monomer) form or the borate (polymer) form of the enzyme, indicating that enhanced activity is not due to polymerization but probably to a conformational change in the enzyme such that the Km for glutamine is lowered.
Topics: Acidosis; Acute Disease; Animals; Enzyme Activation; Glutaminase; Glutamine; Kidney Cortex; Kinetics; Male; Mitochondria; Polymers; Rats; Rats, Inbred Strains
PubMed: 2362547
DOI: 10.1016/0024-3205(90)90505-l