RESUMEN
BACKGROUND: Over the last decade, there has been an increasing awareness for the potential harm of the administration of too much oxygen. We aimed to describe self-reported attitudes towards oxygen therapy by clinicians from a large representative sample of intensive care units (ICUs) in the Netherlands. METHODS: In April 2019, 36 ICUs in the Netherlands were approached and asked to send out a questionnaire (59 questions) to their nursing and medical staff (ICU clinicians) eliciting self-reported behaviour and attitudes towards oxygen therapy in general and in specific ICU case scenarios. RESULTS: In total, 1361 ICU clinicians (71% nurses, 24% physicians) from 28 ICUs returned the questionnaire. Of responding ICU clinicians, 64% considered oxygen-induced lung injury to be a major concern. The majority of respondents considered a partial pressure of oxygen (PaO2) of 6-10 kPa (45-75 mmHg) and an arterial saturation (SaO2) of 85-90% as acceptable for 15 minutes, and a PaO2 7-10 kPa (53-75 mmHg) and SaO2 90-95% as acceptable for 24-48 hours in an acute respiratory distress syndrome (ARDS) patient. In most case scenarios, respondents reported not to change the fraction of inspired oxygen (FiO2) if SaO2 was 90-95% or PaO2 was 12 kPa (90 mmHg). CONCLUSION: A representative sample of ICU clinicians from the Netherlands were concerned about oxygen-induced lung injury, and reported that they preferred PaO2 and SaO2 targets in the lower physiological range and would adjust ventilation settings accordingly.
Asunto(s)
Actitud del Personal de Salud , Cuidados Críticos/psicología , Personal de Enfermería en Hospital/psicología , Terapia por Inhalación de Oxígeno/psicología , Médicos/psicología , Adulto , Femenino , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Países Bajos , Pautas de la Práctica en Medicina , Encuestas y CuestionariosRESUMEN
Circulating tumor cells (CTCs) are viable tumor cells that are released into the circulatory system. CTCs have shown a prognostic value in numerous solid tumors. CTC research in epithelial ovarian carcinoma (EOC) has attracted only little attention. Since the primary route of metastasis in EOC is considered to be direct peritoneal spread in the abdominal cavity and distant metastases only occur in one third of the patients, it was thought that there is not enough shedding of tumor cells in the circulation. Nevertheless recent studies revealed an important role of hematogenous spread in EOC and showed that CTC status is associated with advanced tumor stage, CA-125 levels and residual disease after surgery. Furthermore the presence of CTCs correlates with shorter overall and disease free survival. However this prognostic value of CTCs in EOC seems to depend on the used isolation and detection methods. In EOC function- or density based enrichment methods seem to offer more promising results then epithelial cell adhesion molecule (EpCAM)-based approaches. This can be explained by a low number of EpCAM positive CTCs in EOC and the downregulation of EpCAM during epithelial-to-mesenchymal transition (EMT). The presence of CTCs might also have predictive value as CTC status was associated with treatment response in two studies and CTCs showed to be a better monitoring tool then CA-125 in a small population. The (genotypic) characterization of CTCs might become even more important in the future paving the way for CTCs to a true predictive "liquid tumor biopsy".
Asunto(s)
Biomarcadores de Tumor/metabolismo , Neoplasias Glandulares y Epiteliales/metabolismo , Células Neoplásicas Circulantes/metabolismo , Neoplasias Ováricas/metabolismo , Antígenos de Neoplasias/metabolismo , Antígeno Ca-125/metabolismo , Carcinoma Epitelial de Ovario , Molécula de Adhesión Celular Epitelial/metabolismo , Transición Epitelial-Mesenquimal , Femenino , Humanos , Separación Inmunomagnética , Proteínas de la Membrana/metabolismo , Metástasis de la Neoplasia , Estadificación de Neoplasias , Neoplasia Residual , Neoplasias Glandulares y Epiteliales/genética , Neoplasias Glandulares y Epiteliales/patología , Neoplasias Ováricas/genética , Neoplasias Ováricas/patología , Reacción en Cadena de la Polimerasa de Transcriptasa InversaRESUMEN
A 41-year-old woman, who presented with (apparent) essential hypertension, was treated with atenolol and candesartan. This treatment, however, was unsuccessful. After the addition of hydrochlorothiazide (HCT) to the combination, she developed hypokalaemia with muscle cramps and weakness. This hypokalaemia persisted for more than 4 weeks after discontinuation of HCT and starting potassium suppletion. As a result of polyuria (> 4000 ml/day) found in a 24-hour urine collection, it was discovered that the patient drank at least 3 litres of liquorice tea a day. She had denied eating liquorice sweets, a well-known cause of hypertension in the Netherlands, but no one had thought of asking her if she drank liquorice tea. Blood pressure and serum potassium normalized about 2 months after she stopped drinking liquorice tea, and medication was withdrawn. In a patient presenting with hypertension and hypokalaemia, who denies eating liquorice sweets, one should consider the consumption of other products containing liquorice such as liquorice tea. In the Netherlands liquorice tea is increasingly popular and has recently become available on a large scale. Therefore more cases such as the one described may be expected in coming years.