RESUMO
Light signal-transduction pathways are a central component of the mechanisms that regulate plant development. These pathways provide the means by which information from specific wavelengths of light may be amplified and coordinated, resulting in complex physiological and developmental responses. This review focuses upon recent approaches towards establishing the intermediates that transmit signals from photoreceptors, phytochromes in particular, to target elements in the promoters of light-regulated genes.
RESUMO
Thrombolysis has become a well-established alternative in the management of acute myocardial infarction. The timing of the initiation of thrombolytic agents is important in determining outcomes. There has been great interest in understanding the delays from onset of symptoms to the initiation of thrombolysis. The experience at Wishard Memorial Hospital in Indianapolis was monitored and reviewed for comparison to other metropolitan area experiences.
Assuntos
Infarto do Miocárdio/tratamento farmacológico , Terapia Trombolítica , Adulto , Idoso , Relação Dose-Resposta a Droga , Serviço Hospitalar de Emergência , Feminino , Fibrinolíticos/administração & dosagem , Fibrinolíticos/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Equipe de Assistência ao PacienteAssuntos
Fenômenos Fisiológicos Vegetais , Transdução de Sinais/fisiologia , Clonagem Molecular , Meio Ambiente , Proteínas de Ligação ao GTP/fisiologia , Mutação/genética , Mutação/fisiologia , Desenvolvimento Vegetal , Reguladores de Crescimento de Plantas/metabolismo , Proteínas de Plantas , Plantas/genética , Plantas Geneticamente Modificadas , Proteínas Quinases/fisiologiaAssuntos
Asparagina/genética , Glutamina/genética , Plantas/genética , Asparagina/biossíntese , Aspartato Aminotransferases/genética , Aspartato-Amônia Ligase/genética , Regulação da Expressão Gênica , Genes de Plantas , Glutamato-Amônia Ligase/genética , Glutamina/biossíntese , Isoenzimas/genética , Família Multigênica , Plantas/metabolismoRESUMO
The use of bronch odilators in the prehospital EMS setting is common. This study examined the safety of the administration of 2.5 mg albuterol using a hand-held nebulizer for the treatment of such patients. A total of 55 patients were included. Following treatment, peak expiratory flow rates (PEFR) increased a mean of 27 L/min, ventilatory rate decreased four breaths/min, heart rate decreased slightly, and systolic blood pressure increased 10 mmHg. Five of the 53 patients in whom cardiac rhythm was monitored, had premature ventricular complexes prior to treatment; only one did following therapy. Breath sounds improved in 61% and were unchanged in 39%. Breathing was reported by the patient as improved in 51 of the 53 (93%) and only one felt worse. Adverse reactions were reported in 15%, but none were severe. This study shows that albuterol (2.5 mg) administration by hand-held nebulizer is both safe and efficacious in the prehospital setting.
Assuntos
Albuterol/uso terapêutico , Nebulizadores e Vaporizadores , Administração por Inalação , Albuterol/efeitos adversos , Pressão Sanguínea , Serviços Médicos de Emergência , Frequência Cardíaca , Humanos , Pico do Fluxo ExpiratórioRESUMO
Students and physicians sometimes struggle with the bedside decision-making process. The following text details a problem-solving algorithm that has evolved and has been tailored to and by clinical practice.
Assuntos
Algoritmos , Resolução de Problemas , Adulto , Gasometria , Diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Planejamento de Assistência ao PacienteRESUMO
This decision-making process is inherently uncomfortable. The recognition and open discussions of the issues are relatively new. There is legal and practice precedent for withholding and withdrawing therapies and support. Institutions must now abide by Joint Commission guidelines while individual physicians are permitted to practice within their own conscience. Patients' best interests must be served, but it should be accepted that permitting the dying process to evolve while attending to comfort is not only an acceptable but desirable strategy. Finally, physicians must play an active and pivotal role as the facilitators of proper care. The details of proper medical care should be physician prescribed.
Assuntos
Tomada de Decisões , Alocação de Recursos para a Atenção à Saúde/legislação & jurisprudência , Cuidados para Prolongar a Vida/legislação & jurisprudência , Eutanásia Passiva , Humanos , Consentimento Livre e Esclarecido , Cooperação do Paciente , Estados UnidosRESUMO
I have reviewed the identifiable hemodynamic effects of selected inotropic and vasoactive agents in the context of several clinical patient subsets. Knowledge of relative hemodynamic effects of various agents permits the selection of those that are best in specific clinical circumstances. Combining drugs may only occasionally be advisable to supplement a desired effect or to attenuate an unwanted one.
Assuntos
Cardiotônicos/farmacologia , Cuidados Críticos , Hemodinâmica/efeitos dos fármacos , Choque/tratamento farmacológico , Vasodilatadores/farmacologia , Cardiotônicos/administração & dosagem , Cardiotônicos/uso terapêutico , Humanos , Consumo de Oxigênio/efeitos dos fármacos , Choque/metabolismo , Choque/fisiopatologia , Vasodilatadores/administração & dosagem , Vasodilatadores/uso terapêuticoRESUMO
Several variables could have influenced the results of resuscitation after two and one-half decades--selection of resuscitation candidates, resuscitation mechanics, pharmacologic interventions, and post-resuscitation management. However, the outcome of CPR remains consistently poor. It appears that only dramatic changes in candidacy or technique will change the likelihood of survival following in-house CPR.
Assuntos
Hospitalização , Ressuscitação , Cardioversão Elétrica , Estudos de Avaliação como Assunto , Humanos , Respiração com Pressão Positiva , Pressão , Ressuscitação/métodos , TóraxRESUMO
Nasotracheal tube aspiration should be recognized as one of the complications of tracheal intubation. We describe a patient identifying such an event and provide an alternative technique for tube retrieval.
Assuntos
Falha de Equipamento , Inalação , Intubação Intratraqueal/efeitos adversos , Respiração , Estado Epiléptico/terapia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Balloon tamponade of esophageal variceal hemorrhage is palliative therapy which is associated with a certain incidence of morbidity, perhaps mortality. Three cases of intrathoracic inflation of the gastric balloon of such tubes are described. The precise mechanism of thoracic placement remains uncertain. Fluoroscopy or chest x-ray should be used to confirm appropriate tube tip placement.
Assuntos
Varizes Esofágicas e Gástricas/terapia , Hemorragia Gastrointestinal/terapia , Intubação Gastrointestinal/efeitos adversos , Tórax , Perfuração Esofágica/etiologia , Humanos , Intubação Gastrointestinal/mortalidade , Masculino , Pessoa de Meia-IdadeAssuntos
Cateterismo Cardíaco/efeitos adversos , Derrame Pericárdico/cirurgia , Veia Cava Superior/fisiopatologia , Adenocarcinoma/fisiopatologia , Ecocardiografia , Eletrocardiografia , Feminino , Humanos , Pessoa de Meia-Idade , Monitorização Fisiológica , Complicações Pós-Operatórias , Artéria Pulmonar , SíndromeRESUMO
This study identifies a subgroup of critically ill patients most likely to develop at least creatine kinase-myocardial isoenzyme (CK-MB) evidence of acute myocardial injury. This group is composed of patients with shock syndromes associated with some combination of anemia, hypoxemia, hypercarbia, acidemia, lactic acidosis, and hypotension. The mechanism of this secondary myocardial injury in shock is not clear but may be multifactorial. Certainly subgroups of patients admitted with critical illnesses may have CK-MB abnormalities usually associated with acute myocardial injury.
Assuntos
Cardiomiopatias/enzimologia , Creatina Quinase/análise , Adulto , Idoso , Cardiomiopatias/diagnóstico , Cardiomiopatias/etiologia , Humanos , Isoenzimas , Pessoa de Meia-Idade , Choque/complicaçõesRESUMO
A case of fatal gastrointestinal hemorrhage from gastric mucosal lacerations related to the closed chest cardiac compression of cardiopulmonary resuscitation is reported. Previous autopsy series suggest that gastroesophageal lacerations may occur in 12 percent of cases not surviving cardiopulmonary resuscitation (CPR). In the presence of increasing out-of-hospital and lay-initiated resuscitation, recognition of this complication of closed chest compression seems to be of particular importance. Attention to the technique of chest compression and ventilation, including early intubation and gastric decompression, may help to minimize the incidence of gastric mucosal laceration occurring during CPR.