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Recurrent Wheezing
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Understanding Red Blood Cell Rheology in Sepsis and its Role in Clinical Practice. From Biomolecular Aspects to Possible Therapeutic Interventions

Abstract

Erythrocyte rheology is of interest in understanding microcirculation and oxygen delivery and consumption alterations induced by sepsis and septic shock. Several mechanisms are proposed: (i) direct or indirect RBC membrane alterations, (ii) abnormal intraerythrocytic homeostasis, (iii) RBCs interaction with other cells and extracellular molecules, (iiii) increased reactive species production and altered redox homeostasis. In this review, we describe in part these mechanisms and what’s the impact of these hemorheological disturbances on the outcome and mortality rate. Also, we outline the possible therapeutic interventions and further perspectives regarding sepsis and septic shock management.

Open access
Vitamin D in Critically Ill Patients - From Molecular Damage Interactions to Clinical Outcomes Benefits. When, Why, How?

Abstract

Vitamin D - „the sunshine vitamin” is essential for the good functioning of the human body. The most important forms of the vitamin D are the vitamin D2 and the vitamin D3, both biologically inactived. Vitamin D can come from: diet or nutritiv suplimentts and skin. The activation of vitamin D is effect in two steps to the physiologically active 1,25-dihydroxyvitamin D [1,25(OH)2D]. The biological actions of Vitamin D involve regulation of gene expression at the transcriptional level and are mediated through binding to a Vitamin D Receptor (VDR). Vitamin D has multiple roles: hormonale/ nonhormonale, skeletale/nonscheletale, genomice/nongenomice. Interesting is inversely corelation between Vitamin D and total body fat (BMI) and correlation between Vitamin D and cognitive impairment, especially Alzheimer Disease or delirium during hospitalisation. The curent recomandations regarding the supplying with Vitamin D are different for regions of the globe, also differ depending on the baseline serum Vitamin D and on the desired effect. So, potential nonskeletal effects occur at levels >30ng/ml, above 50-75ng/ml, serum level who should become the target of the supplementation. The loading dose should be considered perioperatively for rapid effects. In conclusion, Vitamin D is more than just a vitamin. It is a substance with multiple roles in body’s economy, and in recent years there has been an interest in the relation be tween vitamin D deficiency and obesity or cognitive impairment. The majority of the data supports association, not causation, of low vitamin D levels. In other words, much of data does not clearly support the idea that vitamin D supplementation in a patient with low vitamin D levels reduces the risk of these diseases. But, the supplimentation is very easy and no harm might be done.

Open access