Diabetic maternal and fetal complications
Nadia Barghouthi, Jessica Perini in Endocrine Diseases in Pregnancy and the Postpartum Period, 2021
Gestational diabetes mellitus (GDM) is defined as glucose intolerance that is first detected during pregnancy. GDM has been associated with both maternal and fetal complications. Patients with GDM are more likely to develop preeclampsia and exhibit a higher risk of development of type II DM. Early fetal complications include macrosomia, congenital defects, neonatal respiratory distress syndrome, and metabolic derangements. Infants born to women with GDM also have a higher risk of hypoglycemia after birth. Late fetal complications include a higher incidence of childhood obesity and the development of type II DM later in life. Screening and treatment of GDM has been associated with a lower incidence of some of these complications.
Thorax
Dave Maudgil, Anthony Watkinson in The Essential Guide to the New FRCR Part 2A and Radiology Boards, 2017
Are the following statements regarding severe acute respiratory distress syndrome (SARS) true or false? SARS can be confidently diagnosed with a single test. It is caused by SARS-associated coronavirus. The chest radiograph (CXR) findings are easily distinguishable from those of other causes of atypical pneumonia. The right lung is more commonly affected than the left. Calcification, cavitation, pleural effusions and lymph-adenopathy are common findings, particularly in the paediatric population.
Chest
A. Sahib El-Radhi in Paediatric Symptom and Sign Sorter, 2019
Children presenting with dyspnoea usually have other symptoms and signs of respiratory distress syndrome, including tachypnoea, subcostal recession, tachycardia and chest tightness. Asthma can have some shadows in the chest X-ray; these do not indicate pneumonia and will disappear with anti-asthmatic treatment, and antibiotics are not indicated. Chest pain is a common complaint in children. Chest pain in adults is considered a medical emergency because of possible associated heart attack, the overwhelming majority of children have a non-cardiac aetiology. The most common causes of chest pain include idiopathic, injury, musculoskeletal myalgia, pulmonary diseases, cardiac, gastrointestinal disorders and psychogenic causes. Many teenagers present with psychogenic chest pain, often with hyperventilation, reflecting anxiety generated by some events. Chest pain in infancy is difficult to diagnose. Patients with marfanoid appearance and chest pain require close attention because they are at risk of dilatation of the ascending aorta and dissecting aneurysm.
Biomarkers in acute respiratory distress syndrome: from pathobiology to improving patient care
Published in Expert Review of Respiratory Medicine, 2014
James M Walter, Jennifer Wilson, Lorraine B Ware
Acute respiratory distress syndrome (ARDS) is a clinical syndrome characterized by alveolar flooding with protein-rich pulmonary edema fluid. Despite an improved understanding of ARDS pathogenesis, our ability to predict the development of ARDS and risk-stratify patients with the disease remains limited. Biomarkers may help identify patients at highest risk of developing ARDS, assess response to therapy, predict outcome, and optimize enrollment in clinical trials. This review begins with a general description of biomarker use in clinical medicine. We then review evidence that supports the value of various ARDS biomarkers organized by the cellular injury processes central to ARDS development: endothelial injury, epithelial injury, disordered inflammation and coagulation, fibrosis, and apoptosis. Finally, we summarize the growing contributions of genomic and proteomic research and suggest ways in which the field may evolve in the coming years.
Use of neuromuscular blocking agents in acute respiratory distress syndrome
Published in Baylor University Medical Center Proceedings, 2018
G. Tsai-Nguyen, Ariel M. Modrykamien
Acute respiratory distress syndrome is the result of an acute inflammatory response of the lungs, causing severe hypoxemia. A variety of therapeutic modalities have been extensively studied, with only a few demonstrating improvement in survival. Specifically, mechanical ventilation with use of low tidal volumes, prone positioning, and treatment with neuromuscular blocking agents have proven beneficial. This article focuses on the utilization of neuromuscular blocking agents in this entity. In particular, we briefly review the mechanism of action of neuromuscular blockades, the latest published evidence supporting their use in acute respiratory distress syndrome, and current recommendations for their utilization in clinical practice.
The acute respiratory distress syndrome
Published in Baylor University Medical Center Proceedings, 2020
Christopher Wood, Vivek Kataria, Ariel M. Modrykamien
Acute respiratory distress syndrome (ARDS) is a prevalent cause of acute respiratory failure with high rates of mortality, as well as short- and long-term complications, such as physical and cognitive impairment. Therefore, early recognition of this syndrome and application of well-demonstrated therapeutic interventions are essential to change the natural course of this entity and bring about positive clinical outcomes. In this article, we review updated concepts in ARDS. Specifically, we discuss the current definition of ARDS, its risk factors, and the evidence supporting ventilation management, adjunctive therapies, and interventions required in refractory hypoxemia.
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