Pathophysiology of critical ill patients: focus on critical oxygen delivery.

Critical ill patients experience acute physiological changes because the body cannot fulfill the oxygen demand to perform normal aerobic metabolism. Factors determining oxygen delivery include cardiac output, hemoglobin, and oxygen saturation. Incapability to fulfill adequate oxygen of the body to produce adenosine triphosphate (ATP) may occur due to decreased oxygen delivery and/or increased oxygen consumption. A condition in which oxygen consumption becomes very dependent on oxygen delivery is called critical oxygen delivery. Parameters to evaluate the adequate oxygen delivery to meet the oxygen consumption are central vein oxygen saturation (SvO2), serum lactate, oxygen extraction ratio (O2ER). A comprehension about oxygen delivery and consumption is very important to overcome tissue hypoxia and various factors in critical ill patients.

Correlation between free thyroxin levels and left ventricular ejection fraction in Graves' disease (preliminary study).

AIM: to determine the correlation between free thyroid hormone level and left ventricular ejection fraction in newly diagnosed Graves' patients. METHODS: this is a preliminary study with an initial cross-sectional design using free thyroxine level as a parameter of thyroid hormone state and left ventricular ejection fraction (LVEF) as a parameter of left ventricular systolic function. Free thyroxine level was measured in the laboratory and the LVEF was assessed by Simpson's methods of echocardiography study. RESULTS: ten patients (7 men and 3 women; age 18-52 years old) were studied. Their average of fT4 was 5.75 (SD 0.96) ng/dL and their average of LVEF was 70.57 (SD 4.50)%. There was positive correlation coefficient between free thyroxine level and left ventricular ejection fraction (r=0.711, p=0.021) in newly diagnosed Graves' patients. CONCLUSION: in this study strong positive correlation was found between free thyroxine (fT4) and left ventricular ejection fraction (LVEF) in newly diagnosed Graves' patients.

Internet searching on internal medicine literature.

Internet technology for distributing information enormously supports the development of medical knowledge. Various medical resources on the internet are very helpful for the doctors' self-improvement; either on education, research, or health care application. Famous medical journals have made their online version, which can be accessed at any time and anywhere. However, there are extremely enourmous information that could be retrieved, so that the doctors should have appropriate strategy or measure to obtain the literature effectively and efficiently.