Neuromuscular blockade in patients with ARDS: a rapid practice guideline.

The aim of this Intensive Care Medicine Rapid Practice Guideline (ICM-RPG) is to formulate an evidence-based guidance for the use of neuromuscular blocking agents (NMBA) in adults with acute respiratory distress syndrome (ARDS). The panel comprised 20 international clinical experts from 12 countries, and 2 patient representatives. We adhered to the methodology for trustworthy clinical practice guidelines and followed a strict conflict of interest policy. We convened panelists through teleconferences and web-based discussions. Guideline experts from the guidelines in intensive care, development, and evaluation Group provided methodological support. Two content experts provided input and shared their expertise with the panel but did not participate in drafting the final recommendations. We followed the Grading of Recommendations Assessment, Development, and Evaluation approach to assess the certainty of evidence and grade recommendations and suggestions. We used the evidence to decision framework to generate recommendations. The panel provided input on guideline implementation and monitoring, and suggested future research priorities. The overall certainty in the evidence was low. The ICM-RPG panel issued one recommendation and two suggestions regarding the use of NMBAs in adults with ARDS. Current evidence does not support the early routine use of an NMBA infusion in adults with ARDS of any severity. It favours avoiding a continuous infusion of NMBA for patients who are ventilated using a lighter sedation strategy. However, for patients who require deep sedation to facilitate lung protective ventilation or prone positioning, and require neuromuscular blockade, an infusion of an NMBA for 48 h is a reasonable option.

Sex hormones in women on hemodialysis.

The pituitary-ovarian axis was studied in 12 women with a creatinine clearance of less than 5 ml/min per 17 m2, established on regular hemodialysis for at least 12 months. Follicle stimulating hormone (FSH) serum levels were found to be slightly lower than normal, luteinizing hormone (LH) plasma concentration generally elevated, while progesterone and estradiol values were extremely low. The major reproductive consequence of chronic renal failure in women on hemodialysis is a severe impairment in ovulatory function.

Correlation between histopathologic features and estrogen receptor status in primary breast cancer.

Relationships between certain histopathologic features of tumor specimens and estrogen receptor (ER) status were investigated. Lobular and ductal carcinomas were found to be richer in ER than other histologic types. Well differentiated carcinomas were more often hormone receptor positive than poorly differentiated tumors. Lymphocytic and plasmatocytic infiltration in and around the tumor as well as elastosis also appeared to be related positively to ER status.

[The copper IUD and gonococcus]. / D.I.U. au cuivre et gonocoques.

PIP: The sensitivity of 66 gonococcus strains isolated from 35 men and 31 women suffering purulent secretion from the urethra was tested in vitro by determination of the inhibition zone to 3 antibiotics and to pure copper. Inhibition of gonococcus growth by copper were also studied in vivo in 15 women with positive cultures following the insertion of an IUD with pure copper. Observations following IUD insertion were very promising and gave completely negative results of the culture and the direct specimen in all but 1 case in which the disease had been localized in the cervical mucus. (author's)^ieng

Germicidal effect of pure electrolytic copper on the gonococcus.

PIP: Asymptomatic gonorrhea is now considered to be the main cause of the high current incidence of gonorrhea, especially among women. Both in vivo and in vitro studies were carried out to assess the germicidal effect of copper on gonococcus strains. Of cultures taken from 32 men who exhibited suspicious symptomatology of gonorrhea and 27 women known to have had intercourse with them, 32 of the male and 20 of the female cultures were positive. 28 of the male and 16 of the female cultures exhibited a sensitivity to copper, i.e., the development of the gonococcus cultures was restrained by the introduction of copper to the culture medium. Of the 27 gonorrhea-exposed women who were tested, 2 had multiple locations of the disease and 20 had infections which were localized in the cervical mucus. For the last 20, culture and sensitivity tests of the gonococcus strains showed 14 to be sensitive to copper. These 14 women were fitted with a copper IUD in the endometrium; no other treatment was followed. The results were promising, giving completely negative culture results in every case where the disease had been localized in the cervical mucus. Therefore, although the bactericidal activity of copper and its salts is known to be of low degree, copper and its ions do seem to suppress or limit the spread of gonorrhea. Only large amounts would be effective in actually killing the gonococci in relatively short time periods.^ieng