Meanwhile, chronic presence of pro-inflammatory mediators interleukin 6, 8, TNF, leucotryen B4 decreases the efficiency of bronchial transit fig.
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Based on the recommendations of the experts of European and American Thorax Society, we distinguish mild, moderate and severe stages in the courses of COPD tab. The treatment of exacerbations is as follows: broncholytics, systemic corticoids, antibiotics. Antibacterial treatment is indicated in cases of clinical manifestations of exacerbation [5, 9].
Sputum analysis is recommended in cases of frequent exacerbations or in the presence of purulent expectoration when organisms resistant to traditional treatment are suspected. The most common criteria for indication of antibacterial therapy were evaluated by Anthonisen et al. The first type is characterized by intensification of dyspnea, increase in produced sputum volume and a change in the sputum characteristic, such as a purulent appearance.
The second type includes two of these symptoms, the third — one.
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It is established that the antibacterial treatment is indicated in the first and the second types of COPD exacerbations. The characteristics of COPD exacerbations Scientifically proven advantages of antibacterial therapy have been described in the research literature: - Decrease in the duration of an exacerbation episode - Avoidance of hospitalization.
The aim of antibacterial therapy is eradication of microorganisms, which provoke COPD exacerbations, thereby decreasing symptoms manifestation and increasing the stable course of the disease. Different options of antibacterial therapy are showed in tab.
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In case of non-severe COPD exacerbations it is necessary to consider macrolides Clarithromycin and Azythromycin and beta-lactam antibiotics Amoxycillin and Cephalosporines of the second and the third generation. They have a high biological accessibility, deep penetration into lung tissue and into individual cells where they reach a high intracellular concentration.
We previously obtained data which prove a high efficacy of azithromycin in treatment of COPD exacerbation. The regression of basic clinical manifestations is the common cumulative index which decreased by 3.
In patients who took standard therapy, the respiratory symptoms also decreased, but less significantly than in the experimental group.
After a course of azithromycin therapy, cytosis indicators in induced expectoration decreased inverted papilloma of the bladder a review and an analysis of the recent literature of 365 patients 1. Chronic purulent bronchitis in the presence of risk factors for infection Ps. The level of IL-1α decreased on the th day of treatment by 4. IL-8 in blood decreased by 2. Patients who received standard treament without antibiotics also had a decrease in systemic inflammatory markers, however this was less significant as compared to the group that received antibiotics.
It is known these can modulate the activity of lymphocytes, modify the properties of trachea-bronchial secretions and decrease the intensity of systemic and local respiratory tract inflammation by changing the functional activity of neutrophils.
In recent years, fluoroquinolones with their antipneumococcus activity levofloxacin, moxifloxacin etc. As proof of the advantages of fluoroquinolones are used arguments such as: a a high resistance level of S. Analyzing the mentioned results it is important to keep in mind that the local resistance of macrolides towards S. Influenza is probably also low. This fact has been proven by a high clinical efficacy of clarithromycin observed in patients with COPD [1, 2, 4, 7]. Most of the research shows the efficacy of respiratory fluoroquinolones, hpv integration head and neck cancer of the stage of COPD.
These are indicated when there is presence of risk factors such as resistance of the microorganisms towards amoxicillin or macrolides. If there exists a high risk for P. Aeruginosae we recommend use of ciprofloxacin and beta-lactams given their activity against nosocomial pathogens tab.
In most cases antibiotics are taken orally. The removal hpv genital warts regimen of broncholytics is given in tables 3 and 4.
In case of mild and severe exacerbations of COPD, especially in older patients, it is necessary to administer nebulizer therapy. However, no everyone agrees with this point of view. Probably the use of these drugs is possible only by respecting the indication rules and monitoring the concentration of theophylline in the blood. The schedule of its dosage is shown in tab.
It is important to mention that theophyllin has to be introduced only intravenously. Theophylline administration over a long period of ime is contraindicated because there is a danger of overdose. Systemic glucocorticoids are effective in treatment of complications of COPD. These drugs decrease the convalescence time and contribute to a more rapid regeneration of lung functions.
Older age. Inability to provide adequate medical care in an outpatient setting. Difficulty of diagnosis. Normally it is recommended 30 — 40 mg prednisone by mouth inverted papilloma of the bladder a review and an analysis of the recent literature of 365 patients the equivalent intravenous methylprendisolone dose for 10 — 14 days.
In the next weeks the patient should be re-examined by a doctor to evaluate adaptation to life and correct inhalation technique, as well as analysis of pulmonary function tests PFTblood gas or oxygen saturation to decide if a longterm oxygen therapy is necessary. Further treatment may be indicated at this time. Patients with moderate or severe levels of COPD have to be hospitalized.
Indications for directing the patients to specialized departments are as follows: 1. Significant increase in symptom intensity e. Conventional treatment is not effective. Appearance of new symptoms eg, cyanosis, peripheral edema.
Severe concomitant diseases pneumonia, cardiac arrhythmia, congestive heart failure, diabetes, renal and kidney insufficiency. New onset of abnormal heart rhythm. Discuss the possibility of using papillon zeugma relaxury website glucocorticoids after completing treatment course with systemic steroids Antibiotics by indications Fig. Ambulatory treatment of patients with mild exacerbations.
Treatment — blood Oxygen saturation. Antibiotics by indications of moderate exacerbations of COPD in hospitalized patients. Treatment of moderate exacerbations of COPD in hospitalized patients. Treatment of severe exacerbations of COPD in the emergency department. Severe shortness of breath, not releaved by bronchodilators. Impaired consciousness, coma. Fenoterol Solution for nebulizers 0. Ipratropium bromide Solution for nebulizers 0. Ipratropium bromide de and 0.
Yearly influenza vaccination is highly recommended. In conclusion, it should be noted that if the antibiotic therapy is chosen correctly for the individual, it reduces the duration of hospital stay and the costs associated with medical care.
Anzueto AR. Clinical course of chronic obstructive pulmonary disease: review of therapeutic interventions.
Tiotropium for stable chronic obstructive pulmonary disease: A meta- analysis. Highlights on the appropriate use of fluoroquinolones in respiratory tract infections.
References 1. Aaron SD.
Vandemheen KL, Fergusson D, et al. Tiotropium in combination with placebo, inverted papilloma of the bladder a review and an analysis of the recent literature of 365 patients, or fluticasone- salmeterol for treatment of chronic obstructive pulmonary disease a randomized trial. Moraru, S. Pisarenco, S. Samohvalov, A.
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E-mail: [email protected] Manuscript received December 15, ; revised May 20, Abstract The study involved 23 patients with decompensated liver cirrhosis and ascitic syndrome. This trial was designed to determine the value of serumascites and lymphatic albumin gradients.
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We established diminution of the albumin ascites-lymphatic gradient in relationship with the evolution of the ascitic syndrome. It is required to validate the clinical application of the gradient in following studies. Key words: ascitic syndrome, serum ascitic limphatic albumin gradient. Thus, N. Fisher et al.
Average Child-Pugh score was Patients were separated into previously described stages of ascites syndrome in accordance to criteria for classification of Ascites International Club International Club of Ascites.
We mention the fact that the patients with activation of cirrhotic process were not included in the research group. Additionally, perfusion conservative treatment with administration of albumin, plasma, etc. The surgical treatment included the cervical decompression of the thoracic lymph duct, which in 6 cases was associated with paracentesis decompression, performed in patients with tense ascites and cardiopulmonary disturbances.
Universitatea de Medicină şi Farmacie Victor Babeş
In order to standardize the research the biological substrate was investigated serum, lymph and ascitic fluid and was collected only intraoperative under sterile conditions, being collected 5. The collected biological fluids were subjected to laboratory research with clinical and general bacteriological proteinogram assessment, and especially the measurement of albumin concentration.
A general characteristic of patients included in the study is summarized in tab.