scholarly journals Applications of Steroid in Clinical Practice: A Review

2012 ◽  
Vol 2012 ◽  
pp. 1-11 ◽  
Author(s):  
Safiya Shaikh ◽  
Himanshu Verma ◽  
Nirmal Yadav ◽  
Mirinda Jauhari ◽  
Jyothi Bullangowda

Steroids are perhaps one of the most widely used group of drugs in present day anaesthetic practice, sometimes with indication and sometimes without indications. Because of their diverse effects on various systems of the body, there has been renewed interest in the use of steroids in modern day anaesthetic practice. This paper focuses on the synthesis and functions of steroids and risks associated with their supplementation. This paper also highlights the recent trends, relevance, and consensus issues on the use of steroids as adjunct pharmacological agents in relation to anaesthetic practice and intensive care, along with emphasis on important clinical aspects of perioperative usefulness and supplementation.

2020 ◽  
Author(s):  
Nnenna Ugwu

Pain is a subjective expression of neural impulses induced by a stimulus with a capacity to potentially damage tissues of the body. Simply put, pain is the reaction of the body to a potentially noxious or noxious stimulus, which threatens the normal homeostasis if unrelieved. Pain can be managed via pharmacological and non-pharmacological means, and pharmacological agents are the most widely accepted means, which have been shown to have variable effectiveness against pain. The barriers to effective pharmacological pain management in clinical practice are discussed in this chapter.


Author(s):  
Mayur B. Patel ◽  
Pratik P. Pandharipande

Analgesia is a critical component of intensive care unit (ICU) care. Accordingly, understanding the mechanism, physiological consequences, and assessment of pain is important when caring for the ICU patient. Non-pharmacological approaches should be attempted before supplementing analgesia with pharmacological agents. Pharmacologically-based therapies are divided into regional and systemic therapies. Regional analgesic therapies target specific areas of the body while limiting the systemic effects of intravenous analgesics, but at the risk of invasiveness, local anaesthetic toxicity, and infection of in-dwelling catheters. Systemic analgesic therapy is comprised of two main categories—non-opioids and opioids. Typically, non-opioid analgesics are used as adjunctive therapies and consist of agents such as non-steroidal anti-inflammatory drugs, gabapentinoids, ketamine, or α‎2 agonists. Opioid analgesia in the ICU is commonly infusion-based using fentanyl, hydromorphone, morphine, or recently, remifentanil.


2021 ◽  
Vol 16 (7-8) ◽  
pp. 136-145
Author(s):  
L.V. Usenko ◽  
A.V. Tsarev

The article deals with the life path and research activities of the founder of resuscitation science (intensive care) Vladimir A. Negovsky. He was born in 1909 in the city of Kozelets, Ukraine. After graduating from university in 1933, Negovsky worked as a researcher in the pathophysiological laboratory of the Central Institute of Hematology and Blood Transfusion in Moscow, where he worked for about a year with Professor S.S. Bryuchonenko, the creator of one of the world’s first heart-lung apparatus and where, apparently, his scientific interests were finally formed. In 1936, Negovsky wrote a letter to the Prime Minister of the USSR V.M. Molotov, in which he substantiated the prospects and importance of research in the field of cardiopulmonary resuscitation and asked for help in creating a research laboratory on this problem. Surprisingly, his request was granted — in the same year an order was issued on the organization of a special-purpose laboratory on the problem: ‘Restoration of life processes in phenomena similar to death”. Such a scientific research laboratory was created for the first time in the world. V.A. Negovsky and his collaborators modified the resuscitation method proposed by F.A. Andreev (1879–1952) and included the injection of Ringer-Locke’s solution with adrenaline into the carotid artery towards the heart (centripetally, i.e. against the blood flow). This method was improved by Negovsky and the Laboratory staff by using the radial and brachial arteries as an access for centripetal blood injection, which made it possible to simplify the technique for use in clinical practice and was supplemented by artificial lung ventilation by forced air injection into the lungs with bellows, as they have shown that intra-arterial pumping alone without mechanical ventilation is often ineffective. In the years before the attack of Nazi Germany on the USSR (1938–1941), V.A. Negovsky and his colleagues carried out a series of experimental studies devoted to the resuscitation of animals with lethal blood loss, as well as to the problem of extinction and restoration of brain functions, the results of which were published in several articles. In 1942, V.A. Negovsky defended his PhD on the topic “The relationship of respiration and blood circulation in the process of dying of animals from blood loss and in the subsequent period of restoration of vital functions”. During World War II, Negovsky organized a front-line medical teams, with which he went to the front line and where, in 1943, the developed complex of resuscitation measures was first used for wounded soldiers. In his dissertation on medicine “Restoration of vital functions of an organism in a state of agony or a period of clinical death” defended in 1943, he outlined the main provisions of the pathophysiology of terminal states and the principles of a complex method of resuscitation; the dissertation was published in a book in the same year. In 1945–1946, V.A. Negovsky publishes reports in the journals “JAMA” and “Nature” about the clinical experience of using the developed method of cardiopulmonary resuscitation and the importance of developing this problem of medicine, thus providing a priority in creating a new scientific direction. In 1946, using the experience gained in the war, the Laboratory staff continued their clinical work, starting to provide medical care to dying patients at the Institute of Thoracic Surgery of the USSR of the Academy of Medical Sciences, thus creating their own clinical resuscitation unit. In 1947, V.A. Negovsky was awarded the title of professor. Despite the successes achieved, Negovsky and his colleagues had to overcome stubborn misunderstanding and expressed resistance from many representatives of the medical community. An interesting fact in the biography of V.A. Negovsky was his participation in 1953 in the CPR (chest compression and administration of pharmacological drugs) of Joseph Stalin. In 1952, the Laboratory team created the first instruction, which was published by the USSR Ministry of Health for use in clinical practice “On the introduction into medical practice of methods for restoring the vital functions of an organism in a state of agony or clinical death”, which was republished in 1955, 1959 and 1963 with the introduction of changes to the CPR algorithm. In 1959, on the initiative of V. \A. Negovsky, the first prototype of the intensive care unit in the USSR was organized, which was named “Center for the Treatment of Shock and Terminal States”. In 1961, he reported about creating a new medical science — resuscitation science, the subject of which is nonspecific general pathological reactions of the body, pathogenesis, therapy, and prevention of terminal states, life support in critical states. In 1972, in the first issue of the newly created journal “Resuscitation”, V.A. Negovsky published an article “The second step in resuscitation — the treatment of the ‘post-resuscitation’ disease”, in which he outlines the pathophysiological mechanisms of the development of post-resuscitation changes in the body. A special topic is overcoming the “iron curtain” and acquaintance of V.A. Negovsky with the American founder of the first Intensive Care Units (ICU) P. Safar, who laid the foundation for many years of scientific interaction and personal friendship. In 1985, on the basis of the Laboratory, Negovsky organized the Research Institute of General Reanimatology of the USSR of the Academy of Medical Sciences, which now bears his name. Vladimir Negovsky loved classical music, especially I.S. Bach, painting — Sandro Botticelli, Francisco Goya, always found time and energy for skiing. He died on August 2, 2003, and is buried in Moscow.


2015 ◽  
Vol 4 (1) ◽  
pp. 4-18
Author(s):  
Lauren Rebecca Sklaroff

This state of the field essay examines recent trends in American Cultural History, focusing on music, race and ethnicity, material culture, and the body. Expanding on key themes in articles featured in the special issue of Cultural History, the essay draws linkages to other important literatures. The essay argues for more a more serious consideration of the products within popular culture, less as a reflection of social or economic trends, rather for their own historical significance. While the essay examines some classic texts, more emphasis is on work published within the last decade. Here, interdisciplinary methods are stressed, as are new research perspectives developing by non-western historians.


Author(s):  
Titilayo Dorothy Odetola ◽  
Olusola Oluwasola ◽  
Christoph Pimmer ◽  
Oluwafemi Dipeolu ◽  
Samson Oluwayemi Akande ◽  
...  

The “disconnect” between the body of knowledge acquired in classroom settings and the application of this knowledge in clinical practice is one of the main reasons for professional fear, anxiety and feelings of incompetence among freshly graduated nurses. While the phenomenon of the theory-to-practice gap has been researched quite extensively in high-income country settings much less is known about nursing students’ experiences in a developing country context. To rectify this shortcoming, the qualitative study investigated the experiences of nursing students in their attempt to apply what they learn in classrooms in clinical learning contexts in seven sites in Nigeria. Thematic content analysis was used to analyse data gained from eight focus group discussions (n = 80) with the students. The findings reveal a multifaceted theory-practice gap which plays out along four tensions: (1) procedural, i.e. the difference between practices from education institutions and the ones enacted in clinical wards – and contradictions that emerge even within one clinical setting; (2) political, i.e. conflicts that arise between students and clinical staff, especially personnel with a lower qualification profile than the degree that students pursue; (3) material, i.e. the disconnect between contemporary instruments and equipment available in schools and the lack thereof in clinical settings; and (4) temporal, i.e. restricted opportunities for supervised practice owing to time constraints in clinical settings in which education tends to be undervalued. Many of these aspects are linked to and aggravated by infrastructural limitations, which are typical for the setting of a developing country. Nursing students need to be prepared regarding how to deal with the identified procedural, political, material and temporal tensions before and while being immersed in clinical practice, and, in so doing, they need to be supported by educationally better qualified clinical staff.


2020 ◽  
Vol 5 (5) ◽  
pp. 386-393
Author(s):  
L. M. Gunina ◽  
◽  
Kazys Mylashyus ◽  
Voitenko V. L. ◽  
◽  
...  

Under high-intensity loads, the athlete's bodies take place a number of biochemical reactions and physiological processes that can lead to hyperbilirubinemia. The factors that can initiate the onset of this phenomenon include the syndrome of micro-damage muscle, violation of the integrity of erythrocyte membranes, decreased blood pH, malnutrition and increase oxygen demand of the body. Degree of expression of manifestations of physiological bilirubinemia depends on the level of adaptation of the athlete to the physical activities offered. Hyperbilirubinemia in athletes can be one of the components of the deterioration of the functional state, forming the symptoms of endogenous intoxication. The relevance of this problem in sport lies in the relatively low detection rate of hyperbilirubinemia due to the lack of regular screening studies. However, in drawing up a plan of nutritional- metabolic support for training and competitive activity and recovery measures, must not only the individual reaction of the athlete body to physical activity, but also the severity of shifts in the indicators of bilirubin metabolism and their ratio. The article describes the reasons for the increase in bilirubin levels, which can be caused by both the effect of physical activity and by the presence of pathological processes in athletes. The factors influencing the blood serum’s bilirubin content are also highlighted, which include the state of erythrocyte cell membranes and the rate of hemoglobin destruction, the functional state of the liver, the specifics of physical loads and the use of ergogenic pharmacological agents by athletes. Particular accent has been placed on the illumination of hereditary hyperbilirubinemias, which may have been detected at the stage of selection of athletes. The most common phenomenon is Gilbert's syndrome, which occurs in 2-5% of cases in the general population, is characterized in the clinic by a benign flow and is manifested by episodes of jaundice and an increase in total bilirubin content to moderate values due to indirect. The frequency of detection of hyperbilirubinemias in the population of athletes is 4.68%, among which Gilbert's disease accounts for almost half (48.7%). Conclusion. The work highlighted the pathogenesis and diagnostic algorithm of Gilbert's disease, and also emphasized that its drug prevention and correction in athletes to maintain functional and physical fitness should be carried out taking into account anti-doping rules, which requires upon diagnosis timely receipt of a therapeutic exclusion


2019 ◽  
Vol 31 (3) ◽  
pp. 251-256

Cirrhosis of liver is one of the common medical problem in daily clinical practice and one of the leading causes of morbidity and mortality. Zinc is an essential trace elements for human and plays in many biological roles in the body. Among them, zinc deficiency is thought to be involved in metabolism of ammonia and causes hyperammonia that worsen hepatic encephalopathy. This study aimed to find out the severity of cirrhosis of liver was by Child Turcotte Pugh score and to investigate the associations between serum zinc level and severity of cirrhosis. A hospital-based cross-sectional descriptive study was performed on 78 patients with different underlying causes of cirrhosis of liver at the Medical Units of Yangon General Hospital and Yangon Specialty Hospital. Among the study population, Child grade A was found to be 28.21%, Child grade B was 30.77% and Child grade C was 41.03%. Regarding result of serum zinc level, 62.8% were low level, 28.2% were within normal level and 8.9% were high level. Mean value of serum zinc level in grade A was 0.68 mg/l, grade B was 0.54 mg/l and grade C was 0.48 mg/l (p=0.00). It was found out that there was a high prevalence of zinc deficiency in severe cirrhotic patients. The zinc level was significantly lowest among patients with Child-Pugh C as compare to those with Child-Pugh B and C. Severity of zinc deficiency should be requested for supplementation therapy in cirrhotic patients as to prevent complications such as hepatic encephalopathy, hepatocellular carcinoma and liver failure. Screening for zinc deficiency may need in these patients with more advanced cirrhosis because it seems to be a marker of advanced liver disease and it can be deducted that awareness of serum zinc level among cirrhotic patients is very important in clinical practice.


2018 ◽  
Author(s):  
Azizeh Khaled Sowan ◽  
Meghan Leibas ◽  
Albert Tarriela ◽  
Charles Reed

BACKGROUND The integration of clinical practice guidelines (CPGs) into the nursing care plan and documentation systems aims to translate evidence into practice, improve safety and quality of care, and standardize care processes. OBJECTIVE This study aimed to evaluate nurses’ perceptions of the usability of a nursing care plan solution that includes 234 CPGs. METHODS A total of 100 nurses from 4 adult intensive care units (ICUs) responded to a survey measuring nurses’ perceptions of system usability. The survey included 37 rated items and 3 open-ended questions. RESULTS Nurses’ perceptions were favorable with more than 60.0% (60/100) in agreement on 12 features of the system and negative to moderate with 20.0% (20/100), to 59.0% (59/100) in agreement on 19 features. The majority of the nurses (80/100, 80.0% to 90/100, 90.0%) agreed on 4 missing safety features within the system. More than half of the nurses believed they would benefit from refresher classes on system use. Overall satisfaction with the system was just above average (54/100, 54.0%). Common positive themes from the narrative data were related to the system serving as a reminder for complete documentation and individualizing patient care. Common negative aspects were related to duplicate charting, difficulty locating CPGs, missing unit-specific CPGs, irrelevancy of information, and lack of perceived system value on patient outcomes. No relationship was found between years of system use or ICU experience and satisfaction with the system (P=.10 to P=.25). CONCLUSIONS Care plan systems in ICUs should be easy to navigate; support efficient documentation; present relevant, unit-specific, and easy-to-find information; endorse interdisciplinary communication; and improve safety and quality of care.


2021 ◽  
Vol 10 (2) ◽  
pp. 228
Author(s):  
Tomonari Kinoshita ◽  
Taichiro Goto

Despite complete resection, cancer recurrence frequently occurs in clinical practice. This indicates that cancer cells had already metastasized from their organ of origin at the time of resection or had circulated throughout the body via the lymphatic and vascular systems. To obtain this potential for metastasis, cancer cells must undergo essential and intrinsic processes that are supported by the tumor microenvironment. Cancer-associated inflammation may be engaged in cancer development, progression, and metastasis. Despite numerous reports detailing the interplays between cancer and its microenvironment via the inflammatory network, the status of cancer-associated inflammation remains difficult to recognize in clinical settings. In the current paper, we reviewed clinical reports on the relevance between inflammation and cancer recurrence after surgical resection, focusing on inflammatory indicators and cancer recurrence predictors according to cancer type and clinical indicators.


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