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Current Concepts in Fluid Resuscitation and Vasopressor Use in Cirrhosis.
Semin Liver Dis
January 2025
Hepatology, University of Pennsylvania, Philadelphia, United States.
Critically ill patients with cirrhosis and liver failure not uncommonly have hypotension due to multifactorial reasons, that include hyperdynamic state with increased cardiac index, low systemic vascular resistance due to portal hypertension, following the use of beta blocker or diuretic therapy, and severe sepsis. These changes are mediated by microvascular alterations in the liver, systemic inflammation, activation of renin angiotensin aldosterone system, and vasodilatation due to endothelial dysfunction. Hemodynamic assessment includes measuring inferior vena cava indices, cardiac output and systemic vascular resistance using point-of-care ultrasound (POCUS), in addition to arterial waveform analysis, or pulmonary artery pressures, and lactate clearance to guide fluid resuscitation.
View Article and Find Full Text PDFComplex equilibrium involving aldosterone underlies the pathophysiology of renovascular hypertension.
Clin Pediatr Endocrinol
January 2025
Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan.
The mechanisms underlying the maintenance of hypertension in renovascular hypertension (RVH) are not well understood. To test the current concept of RVH pathophysiology, circulating aldosterone levels in clinical cases were investigated through a literature survey of pediatric cases. Fifty-four patients with documented aldosterone levels were identified.
View Article and Find Full Text PDFMicroRNA and Heart Failure: A Novel Promising Diagnostic and Therapeutic Tool.
J Clin Med
December 2024
Cardio Thoracic and Vascular Department, 'S. Maria alle Scotte Hospital', University of Siena, 53100 Siena, Italy.
Heart failure (HF) has a multifaceted and complex pathophysiology. Beyond neurohormonal, renin-angiotensin-aldosterone system, and adrenergic hyperactivation, a role for other pathophysiological determinants is emerging. Genetic and epigenetic factors are involved in this syndrome.
View Article and Find Full Text PDFMuscle mass, muscle strength and the renin-angiotensin system.
Clin Sci (Lond)
December 2024
Osaka Rosai Hospital, Sakai, Osaka, Japan.
The renin-angiotensin system (RAS) is a classically known circulatory regulatory system. In addition to the previously known multi-organ circulatory form of the RAS, the existence of tissue RASs in individual organs has been well established. Skeletal muscle has also been identified as an organ with a distinct RAS.
View Article and Find Full Text PDFCognitive Frailty and Aging: Clinical Characteristics, Pathophysiological Mechanisms, and Potential Prevention Strategies.
Arch Med Res
January 2025
Instituto de Envejecimiento, Pontificia Universidad Javeriana, Bogotá, Colombia.
Frailty has been conceptualized not only as a physical disease, but also as a multidomain entity that encompasses a multimorbid status, disability, cognitive impairment, psychosocial risk factors, and even geriatric syndromes. In addition to physical ailments and depending on the diagnostic model. Standardized neuropsychological tests can identify cognitive deficiencies along with mild cognitive impairment, a pre-dementia stage characterized by memory and/or other cognitive domain impairments with relatively preserved instrumental activities of daily living.
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