Biomedical subjects

Dagmara Reingardiene

Publications and source records attributed to Dagmara Reingardiene.

At least 19 recordsLinked to original sources

PubMed2006

[Acute salicylate poisoning].

Although aspirin (acetylsalicylic acid) has become widely available without prescription, cases of self-poisoning due to overdose of salicylates are quite uncommon, with a low reported mortality. However, severe poisoning with these preparations is life threatening. Besides the aspirin, there are other sources of salicylate poisoning, such as an excessive application of topical agents, ingestion of salicylate containing ointments, use of keratolytic agents or agents containing methyl salicylate (e.g. oil of wintergreen). Most of these preparations are liquid, highly concentrated and lipid soluble, and, therefore, they are able to provoke a severe, rapid salicylate poisoning. On the basis of clinical and metabolic features or salicylate concentration in plasma it is very important to diagnose severe poisoning with salicylates in time and prescribe an adequate treatment. In the present review article various aspects of salicylate poisoning and its treatment are discussed: epidemiology, pharmacokinetics and pharmacodynamics of salicylates, clinical manifestations of their toxicity, management, enhanced elimination and prognosis.

Acute Disease↗

PubMed2006

[Ecstasy toxicity].

The substance, 3,4-methylenedioxymethamphetamine (MDMA) or ecstasy, is an amphetamine derivate. A mistaken belief that it is a safe drug of low toxicity and a long duration of action has led to its widespread popularity among teenagers and young adults in recent years. Unfortunately, ecstasy use has increased to epidemic proportions. In this review article pharmacokinetics and pathophysiology of MDMA, general medical adverse effects, cardiovascular effects, serotonin syndrome, hyponatremia, neurologic effects, hepatotoxicity, and long-term neuropsychiatric effects, clinical features of toxicity, prehospital and emergency department care problems, and mortality/morbidity, prophylactic advices are discussed.

Adolescent↗

PubMed2006

[The consequence of epinephrine (adrenaline) overdose].

Epinephrine is an adrenergic agonist used to treat bronchospasm, anaphylactic reactions, bradycardia, cardiac arrest, and hypotension. Its toxicity is usually caused by iatrogenic errors. In overdose there is a typical rapid onset of agitation, hypertension, tachycardia, and dysrhythmias. This review article focuses on the causes of overdose, signs and symptoms, treatment and expected course, and prognosis of this iatrogenic pathology.

Adrenergic Agonists↗

PubMed2005

[Hydroxyethyl starch solutions].

Hypovolemia is common among surgical, trauma, and intensive care unit patients. It can occur in the absence of obvious fluid loss secondary to vasodilatation or during generalized alterations of the endothelial barrier resulting in increased capillary permeability. Hydroxyethyl starch solutions are increasingly used for the volume replacement therapy. Hydroxyethyl starch solutions are synthetic colloids with the pharmacological properties that are the closest to natural colloids. Important characteristics for these products are molecular weight, their concentration, the degree of molar substitution, and the substitution pattern. In this review article a large variety of hydroxyethyl starch solutions, their physical and chemical characteristics, pharmacokinetics and metabolism, the main route of elimination, mechanism of action, effect on blood plasma volume, safety, tolerability and side effects (the risk of adverse effects on hemostasis, platelet function, frequency of pruritus, anaphylactoid reaction, incidence of rise in serum amylase) are presented.

Colloids↗

PubMed2005

[Hypertensive emergencies and urgencies].

Hypertension is one of the most common medical problems affecting approximately 1 billion individuals worldwide. Severe hypertension that is a potentially life-threatening condition refers to a hypertensive crisis. Severe hypertension is further classified into hypertensive emergencies or hypertensive urgencies. Hypertensive emergency refers to a severe hypertension that is associated with new or progressive end-organ damage. In these clinical situations, blood pressure should be reduced immediately to prevent or minimize organ dysfunction. Hypertensive urgency refers to severe hypertension without evidence of new or worsening end-organ injury. Blood pressure can be lowered less rapidly in this condition. In this review article it is discussed about clinical assessment of patients under these conditions, evaluating neurological, cardiovascular, renal end-organ damage; how much blood pressure should be lowered, which medication should be used to lower blood pressure, treating hypertensive emergencies and urgencies; and management of specific conditions (acute intracranial events, acute left ventricular dysfunction etc).

Acute Disease↗

PubMed2005

[The novelty in the treatment of heart failure].

Heart failure is a very common clinical pathology. The treatment of heart failure is expensive; therefore, it is a large burden on the health care system in the world. Despite many recent advances in heart failure therapy, the prognosis remains poor. Levosimendan is a novel inotropic vasodilator agent. This drug induces enhanced contractility mainly via its calcium sensitizing actions. Levosimendan does not increase myocardial oxygen demand and also reduces significantly systemic vascular resistance, pulmonary artery pressure, and pulmonary vascular resistance. It causes venous, arterial, and coronary vasodilation. The drug is not proarrhythmic, has anti-ischemic and anti-stunning effects. It is well-tolerated drug for the treatment of cardiac failure. This review article discusses mechanism of action of levosimendan, its pharmacokinetics and metabolism, hemodynamic studies with this drug, effects on morbidity and mortality, therapeutic indication for its use, contraindications, special warnings and precautions for use, interactions with others medical products, undesirable effects of levosimendan.

Adolescent↗

PubMed2005

[Hallucinogenic mushrooms].

The group of hallucinogenic mushrooms (species of the genera Conocybe, Gymnopilus, Panaeolus, Pluteus, Psilocybe, and Stropharia) is psilocybin-containing mushrooms. These "magic", psychoactive fungi have the serotonergic hallucinogen psilocybin. Toxicity of these mushrooms is substantial because of the popularity of hallucinogens. Psilocybin and its active metabolite psilocin are similar to lysergic acid diethylamide. These hallucinogens affect the central nervous system rapidly (within 0.5-1 hour after ingestion), producing ataxia, hyperkinesis, and hallucinations. In this review article there are discussed about history of use of hallucinogenic mushrooms and epidemiology; pharmacology, pharmacodynamics, somatic effects and pharmacokinetics of psilocybin, the clinical effects of psilocybin and psilocin, signs and symptoms of ingestion of hallucinogenic mushrooms, treatment and prognosis.

Adolescent↗

PubMed2004

[Intravenous catheters and nosocomial infection].

Peripheral, especially central venous catheters, are used with increasing frequency in the intensive care unit and in general medical wards to administer intravenous fluids and blood products, drugs, parenteral nutrition, and to monitor hemodynamic status. Catheter infection is associated with increased morbidity, mortality, and duration of hospital stay. Risk factors in the development of catheter colonization and bloodstream infections include patient factors (increased risk associated with malignancy, neutropenia, and shock) and treatment-related factors (increased risk associated with total parenteral nutrition, intensive care unit admission for any reason, and endotracheal intubation). In this review article terms and definitions of catheter-related infections, pathophysiology and epidemiology of "catheter sepsis", factors determining risk of infection, catheter types and materials, insertion procedure, choice of insertion site, indwelling time, dressing and care of the insertion site, various preventive strategies and future developments, special situations and procedures, and treatment are discussed. Reducing catheter infections rates requires a multiple-strategy approach. Therefore, intensive care units and other locations where catheters are used should implement strict guidelines and protocols for catheter insertion, care, and maintenance.

Antibiotic Prophylaxis↗

PubMed2004

[Procalcitonin as a marker of the systemic inflammatory response to infection].

Despite advances in the diagnosis and treatment of infections diseases, sepsis and ensuing multiorgan failure are the major causes of morbidity and mortality in the intensive care units. Such manifestations of systemic inflammation as fever, leukocytosis, tachycardia, etc. may be noninfectious in origin and are neither specific nor sensitive for sepsis. Procalcitonin is a new potential marker for detection of bacterial, fungal and protozoal infections. Procalcitonin, a propeptide of calcitonin, is normally produced in the C-cells of the thyroid gland. Procalcitonin is a polypeptide consisting of 116 amino acids and with a molecular weight of about 13 kDa. During severe systemic infections it is produced by extrathyroidal tissues. Procalcitonin can be put to immediate use in both diagnostic and therapeutic decision-making. This review article discusses biology of procalcitonin, its laboratory determination, usage as an indicator for severe infection and sepsis, and comparison with circulating cytokines in severe infection. It also reviews value of procalcitonin in differentiation of infectious vs non-infectious inflammatory host response, possible elevation of procalcitonin in the absence of infection, its use for differentiation of viral and non-viral infections and as marker for prognosis and evaluation of therapy. Specific indications for determination of procalcitonin are also discussed.

Biomarkers↗

PubMed2004

[Diagnosis of acute respiratory failure and nosocomial pneumonia].

The aim of this study was to determine diagnosis and factors influencing acute respiratory failure and nosocomial pneumonia according to literature and clinical findings in critically ill patients. The term "respiratory failure" implies the inability to maintain either normal delivery of oxygen to tissues or normal removal of carbon dioxide from the tissues. There are many patients suffering from acute respiratory failure caused by nosocomial pneumonia, septic syndrome, aspiration, interstitial or alveolar lung edema, thromboembolism of a. pulmonalis, polytrauma and contusion of the lungs, acute respiratory distress syndrome, acute lung injury, status asthmaticus, rather massive transfusions of blood products, and lipid embolism in the intensive care unit. There are actually three processes involved: transfer of oxygen across the alveolus, transport to the tissues (by cardiac output), and removal of carbon dioxide from the blood into the alveolus with subsequent exhalation into the environment. Failure of any step in this process can lead to respiratory failure. Long-term hypoxia causes ischemic changes and dysfunction of brain, heart, kidney, lungs and can worsen the outcome of disease or can cause higher mortality.

Acute Disease↗

PubMed2003

[Hypothermia].

Hypothermia is defined as a core body temperature less than 35 degrees C (95 degrees F) and results from prolonged exposure to cold environment, drugs, and underlying pathologic conditions. Hypothermia is associated with marked depression of cerebral blood flow and oxygen requirement, reduced cardiac output, and decreased arterial pressure. Victims can appear to be clinically dead because of marked depression of brain and cardiovascular function, bet full resuscitation with intact neurological recovery is possible. Alcohol or drug intoxication are the dominant precipitating factors. There are about 20,000 hypothermia--related deaths a year in Britain, about 25,000--in the USA, 8,000 deaths a year in Canada. There are suggestions that the unofficial number of hypothermia--related deaths is substantially higher, particularity in the elderly. This article reviews the cause, pathogenesis, pathophysiology, clinical features, electrocardiographic manifestations of hypothermia, diagnosis, pre-hospital stabilization, hospital passive, active external, active core rewarming methods, other questions of treatment, and mortality of hypothermia. It is very important to remember, thar if a hypothermic victim is alive when rescued but dies during recovery treatment, and there is no other significant trauma or disease, this suggests that death may have resulted from either inappropriate or ineffective treatment, or no treatment at all.

Adult↗

PubMed2003

[Venous air embolism].

Venous air embolism is the entry of air into the venous system as a consequence of trauma or iatrogenic complications (especially central venous cannulation or pressurized intravenous infusion systems). It also can occur following the surgical procedures. Venous air embolism results in right ventricular dysfunction and pulmonary injury. In this review article various causes, frequency, pathophysiology, clinical features, diagnosis, treatment, outcome and prevention of venous air embolism are discussed.

Adult↗

PubMed2003

[Hyperglycemic hyperosmolar nonketotic syndrome].

Hyperglycemic hyperosmolar nonketotic syndrome and diabetic ketoacidosis are two of the most serious acute complications of diabetes. Hyperglycemic hyperosmolar nonketotic syndrome is found mostly in type 2 diabetic patients. It is characterized by extreme dehydration and neurologic symptoms, which are related directly to the degree of hyperosmolarity. Hyperglycemic hyperosmolar nonketotic syndrome continues to be important cause of morbidity and mortality among patients with diabetes in spite of major advances in the understanding of its pathogenesis and more uniform agreement about its diagnosis and treatment. This article reviews data about precipitating factors, pathogenesis, carbohydrate, water and electrolyte metabolism in this hyperosmolar hyperglycemic state. The review discusses diagnostic procedures, laboratory evaluation, differential diagnosis and treatment: replacement of fluid and electrolytes, low-dose insulin therapy. A discussion of complications management of hyperosmolar hyperglycemia, mortality rate and prevention are included in this review.

Adult↗

PubMed2003

[Sudden cardiac death by commotio cordis].

Commotio cordis due to blunt trauma to the precordium is a rare cause of death in young athletes, occurring less frequently than all of the other athletics-related deaths. Commotio cordis is a term used to describe cases of blunt thoracic impact causing fatality without structural damage of the heart and internal organs. Death is attributed to ventricular fibrillation, which is often resistant to resuscitative therapy. In this article we discussed this catastrophic event, its historical development, epidemiology and clinical presentation, mechanisms for sudden death in commotio cordis, limitations of evidence using animal models, autopsy findings, resuscitation and preventive measures.

Adolescent↗

PubMed2003

[Preeclampsia and eclampsia].

Preeclampsia is a multisystem disorder after the 20(th) week of gestation, that is usually associated with raised blood pressure, proteinuria, and pathologic edema. Eclampsia is defined as the occurrence of conculsions in association with the syndrome of preeclampsia. In Europe and other developed countries eclampsia complicates approximately 1 in 2,000 deliveries, while in developing countries estimates vary between 1 in 100 to 1 in 1,700. 44% of seizures occur postnatally, the remainder being antepartum (38%) or intrapartum (18%). Although rare, eclampsia probably accounts for 50,000 maternal deaths a year world-wide. In this review article we discussed conditions, which are associated with a higher incidence of preeclampsia, pathophysiology, findings at physical examination, principles of treatment (blood pressure control, anticonvulsant therapy, and fluid management), post-partum management, complications, maternal morbidity and mortality, as well as prevention.

Adolescent↗

PubMed2002

[Acute adrenocortical insufficiency].

Severe acute adrenocortical insufficiency or adrenal crisis are often elusive diagnoses that may result in severe morbidity and mortality when undiagnosed or ineffectively treated. Although more than 50 steroids are produced within the adrenal cortex, cortisol and aldosterone are far the most abundant and physiologically active. In primary adrenocortical insufficiency, glucocorticoid and mineral-corticoid properties are lost; however, in secondary adrenocortical insufficiency (i.e., secondary to disease or suppression of the hypothalamic-pituitary axis), mineralocorticoid function is preserved. Every emergency physician should be familiar with adrenocortical insufficiency--a potentially life-threatening entity. The initial diagnosis and decision to treat are presumptive and are based on history, physical examination, and, occasionally, laboratory findings. Delay in treatment while attempting to confirm this diagnosis can result in poor patient outcomes. This article review data about physiology, pathophysiology of the adrenal cortex, physiologic effects of glucocorticoids, aldosterone, causes of primary and secondary adrenal insufficiency, frequency, clinical picture, laboratory and imaging studies of adrenal crisis, laboratory evaluation of adrenal function and emergency therapy, replacement therapy, mortality/morbidity of this pathology.

Acute Disease↗

PubMed2002

[Diabetic ketoacidosis].

Diabetic ketoacidosis is an emergency medical condition that can be life-threatening if not treated properly. Diabetic ketoacidosis occurs most often in patients with type 1 diabetes (formerly called insulin-dependent diabetes mellitus); however, its occurrence in patients with type 2 diabetes (formerly called noninsulin-dependent diabetes mellitus) is not as rare as was once thought. This article reviews data about precipitating events, pathogenesis, carbohydrate, lipid and ketone, water and electrolyte metabolism in this hyperglycemic crisis. The review discusses diagnostic procedures, laboratory evaluation, differential diagnosis and treatment: replacement of fluid and electrolytes, low-dose insulin therapy and recommendations for use of bicarbonate. A discussion of complications management of diabetic ketoacidosis (hypoglycemia, hypokalemia, cerebral edema, hyperchloremic metabolic acidosis, pulmonary edema, adult respiratory distress syndrome), mortality rate and prevention are included in this review.

Adult↗

PubMed2002

[Diagnosis and therapy of systemic Candida infection].

Over the past three decades, the significant morbidity and mortality associated with candidemia and invasive candidiasis have been well established. Technological and scientific advancement had led to an increase in the incidence of serious Candida infections. With the introduction of the azoles and other antifungal agents, our ability to treat these infections has improved; however, our ability to diagnose these infections in a timely fashion remains limited, and patient outcomes remain poor. This review article discusses these problems, the role of antifungal prophylaxis, risk factors for invasive Candida infection and treatment of systemic Candida infection.

Antifungal Agents↗