http://biblioteca.universia.net/verColeccion.do?id=4007 Mostrando recursos 1 - 20 de 3,189 es http://biblioteca.universia.net/img/logotipo.jpg http://biblioteca.universia.net/ http://biblioteca.universia.net/ficha.do?id=7960629 Statins have a variety of properties that are independent of their lipid lowering ability. These anti-inflammatory, antioxidant, immunomodulatory, and antiapoptotic features have been collectively referred to as pleiotropic effects. Severe sepsis is an intense infection-induced inflammatory syndrome that ultimately results in organ dysfunction. Because so many cascades are triggered during sepsis, merely blocking a single component may be insufficient to arrest the inflammatory process. A gro... Novack, Victor; Terblanche, Marius; Almog, Yaniv http://biblioteca.universia.net/ficha.do?id=7960632 Hurricanes Katrina and Rita destroyed an entire beloved city and shattered a large part of the US Gulf Coast. Unlike the destruction of 9/11, it is difficult to say at the time of this writing whether or not this region will ever be fully restored. In light of these and other man-made and natural disasters, the world needs to revisit its approach to disaster planning and preparedness to insure that we can best meet the needs of those likely to be affected by future calamities. Chalfin, Donald B http://biblioteca.universia.net/ficha.do?id=7960633 The PROWESS (Recombinant Human Activated Protein C Worldwide Evaluation in Severe Sepsis) trial demonstrated a 6.1% absolute decrease in mortality with a p value of 0.005. Despite the impressive results of this trial, criticism of the study has targeted various aspects of design, analysis and interpretation. Additional studies of recombinant activated protein C (rhAPC) have added to our understanding about this drug and to controversy as well. So how do we deal with rhAPC use in our clinical ... Dellinger, R Phillip http://biblioteca.universia.net/ficha.do?id=7960635 Hurricane Katrina came ashore in Louisiana at approximately 07:00 hours on Monday, 29 August 2005. The storm washed away a swathe of the Louisiana coastline, destroyed large portions of the city of New Orleans, and forever changed the state of Louisiana. Our Lady of the Lake Regional Medical Center in Baton Rouge, Louisiana was one of the receiving hospitals for evacuees from the New Orleans area. This commentary briefly describes the hospital's preparation before the storm and the activities... Aucoin, Robert G http://biblioteca.universia.net/ficha.do?id=7960639 Although many pharmaceutical and technological advances are heavily touted, they have had relatively little impact on overall outcome improvements in the critically ill. Acting on the increasing recognition that 'less may be best' has, in my opinion, been the greatest single advance in patient management in the intensive care unit in the past 10 years. Although certainly not qualifying as a 'brave new world' in terms of daring and exciting innovation, the importance of (often covert) iatrogen... Singer, Mervyn http://biblioteca.universia.net/ficha.do?id=7960641 Well developed disaster plans are essential in today's atmosphere of natural and man-made disasters. We describe the problems faced by a community hospital on the Mississippi Gulf Coast during and in the wake of Hurricane Katrina. Because of significant damage to surrounding health care facilities, this hospital was called upon to provide care to a large section of the affected population. In spite of a previously successful disaster plan, a number of unforeseen difficulties were encountered.... Babar, Ijlal; Rinker, Ronald http://biblioteca.universia.net/ficha.do?id=7960642 Recent studies have suggested that combination antibiotic therapy is preferable to monotherapy for severe community-acquired pneumonia (CAP). In this issue Mortensen and colleagues present retrospective data suggesting that combination therapy with a cephalosporin and a fluoroquinolone is inferior to combination therapy with a cephalosporin and a macrolide. Several mechanisms exist by which quinolones could be inferior to macrolides in combination therapy, so if these findings are confirmed b... Waterer, Grant W; Rello, Jordi http://biblioteca.universia.net/ficha.do?id=7960643 We report a multiresistant Enterobacter cloacae outbreak in an intensive care unit, associated with mattresses and with antibacterial-treated and vapour-permeable polyurethane synthetic mattress covers of therapeutic beds. van der Mee-Marquet, Nathalie; Girard, Sophie; Lagarrigue, François; Leroux, Isabelle; Voyer, Isabelle; Bloc, Daniel; Besnier, Jean-Marc; Quentin, Roland http://biblioteca.universia.net/ficha.do?id=7960646 Even more than in previous disasters, Katrina has proven itself to be a testing ground for a plethora of new technologies. Although not all of these technologies did immediately save lives, in this regard a number of them exhibited considerable potential for the future, and hence there is a need to include them in future contingency plans. However, a need for change in the modes and patterns of technology deployment to maximize their leverage has also become very clear. Leitl, Eugen http://biblioteca.universia.net/ficha.do?id=7960648 Emlet, Lillian L; Crippen, David http://biblioteca.universia.net/ficha.do?id=7960649 Pancreatic necrosis complicating severe acute pancreatitis is a challenging scenario in contemporary critical care practice; it requires multidisciplinary care in a setting where there is a relatively limited evidence base to support decision making. This commentary provides a concise overview of current management of patients with infected necrosis, focusing on detection, the role of pharmacologic intervention, and the timing and nature of surgical interventions. Fine-needle aspiration of ne... Jamdar, Saurabh; Siriwardena, Ajith K http://biblioteca.universia.net/ficha.do?id=7960653 Changes in hemodynamic monitoring over the past 10 years have followed two paths. First, there has been a progressive decrease in invasive monitoring, most notably a reduction in the use of the pulmonary artery catheter because of a presumed lack of efficacy in its use in the management of critically ill patients, with an increased use of less invasive monitoring requiring only central venous and arterial catheterization to derive the same data. Second, numerous clinical trials have documente... Pinsky, Michael R http://biblioteca.universia.net/ficha.do?id=7960658 As the number of critically ill patients requiring tracheotomy for prolonged ventilation has increased, the demand for a procedural alternative to the surgical tracheostomy (ST) has also emerged. Since its introduction, percutaneous dilatational tracheostomies (PDT) have gained increasing popularity. The most commonly cited advantages are the ease of the familiar technique and the ability to perform the procedure at the bedside. It is now considered a viable alternative to (ST) in the intensi... Al-Ansari, Mariam A; Hijazi, Mohammed H http://biblioteca.universia.net/ficha.do?id=7960659 Plötz, Frans B http://biblioteca.universia.net/ficha.do?id=7960662 The preferred analysis for studies of mortality among patients treated in an intensive care unit should compare the proportions of patients who died during hospitalization. Studies that look for prognostic covariates should use logistic regression. Survival methods, such as the proportional hazards model, or methods based on competing risk analysis are not appropriate because prolonged survival among patients that die during their hospitalization does not benefit the patient and, therefore, s... Schoenfeld, David http://biblioteca.universia.net/ficha.do?id=7960663 Treatment in the intensive care unit of patients with end-stage liver disease has been limited. Liver transplantation has been a major improvement in this and has become standard in the management of these patients. However, many patients die awaiting liver transplantation, mainly due to the scarcity of organ donors. Conventional hemodialysis techniques have little or no effect on liver detoxification and do not improve the prognosis of these patients. In patients with acute hepatic failure, ... Saliba, Faouzi http://biblioteca.universia.net/ficha.do?id=7960666 Hubbard, Charlotte; Vincent, Jean-Louis http://biblioteca.universia.net/ficha.do?id=7960670 Vespa, Paul http://biblioteca.universia.net/ficha.do?id=7960671 Traditional teaching suggests that corticosteroids should be avoided during acute infectious episodes for fear of compromising the immune response. However, the outcome benefit shown through steroid administration in early septic shock implies this paranoia may be misplaced. We therefore performed a systematic review of the literature to identify the current strength of evidence for the use of corticosteroids in specified infections, and to make appropriate graded recommendations. Aberdein, Jody; Singer, Mervyn http://biblioteca.universia.net/ficha.do?id=7960673 Unique among animals, humans survive not by superb physical adaptation to our environment, but rather by intelligent, large-scale adaptation of the environment to our needs. We build houses with climate control systems that mimic the environment of sub-Saharan Africa. We safely live in environments where the temperature never rises above freezing and where the level of the sea is higher than the land we farm and build vast cities upon. We live in tropical rainforests teeming with hostile orga... Darwin, Mike