Subject prognosis

There are two common systems for categorizing patients with HF. The New York Heart Association (NYHA) Functional Classification (FC) system is based on the patient s activity level and exercise tolerance. It divides patients into one of four classes, with functional class I patients exhibiting no symptoms or limitations of daily activities, and functional class IV patients who are symptomatic at rest (Table 3-5). The NYHA FC system reflects a subjective assessment by a health care provider and can change frequently over short periods of time. Functional class correlates poorly with EF however, EF is one of the strongest predictors of prognosis. In general, anticipated survival declines in conjunction with a decline in functional ability. 

Vulnerability of the liver to injury necessitates routine evaluation of hepatic function in patients and asymptomatic individuals to avert or control adverse clinical conditions. Thus, a plethora of methods has been developed for the diagnosis of liver diseases and dysfunctions. One such method uses physical palpation to determine alterations or changes in the orientation of the liver, which provides valuable information about the organ status but the quality of information is subjective and imprecise [3]. Another common method for the diagnosis of more serious hepatic injuries involves liver biopsies coupled with biochemical tests to determine the extent of liver injury and prognosis [4-7]. However, in acute and some chronic hepatic disorders, dynamic and continuous hepatic function monitoring would be advantageous. 

Schmidt-Lucke et al. [46] followed 120 patients (43 control subjects, 44 patients with stable CAD, and 33 patients with acute coronary syndromes) for 10 months and recorded MACE events (Fig. 7.2). Patients with reduced EPCs had significantly higher rates of MACE. When the results were analyzed by multivariate analysis, reduced EPC levels were found to be an independent predictor of worse prognosis, even after adjustment for traditional cardiovascular risk factors and disease activity (hazard ratio, 3.9 P< 0.05). 

It is well established that increased sympathetic nerve activity is associated with chronic heart failure (CHF) (Porter et al. 1990 Singh 2000 Olshansky 2005 Brodde et al. 2006 Watson et al. 2006). The increase in sympathetic activity is a compensatory mechanism that provides inotropic support to the heart and peripheral vasoconstriction. However, it promotes disease progression and worsens prognosis (Watson et al. 2006). The autonomic nervous system (ANS) is a very complex, balanced system that influences the initiation, termination, and perpetuation of atrial fibrillation (AF), and the AF affects the ANS (Olshansky, 2005). At rest, sympathetic and parasympathetic outflows are related reciprocally heart failure patients had high sympathetic and low parasympathetic outflows, and healthy subjects had low sympathetic and high parasympathetic outflows (Porter et al. 1990). 

Drug addiction should be seen as a chronic condition, subject to relapses. If clients comply with the services offered to them by healthcare professionals, the prognosis may be favourable. However, it must be emphasised that clients will have to maintain a long-life condition of abstention from illicit drugs. Sometimes, this will require long-term attendance of self-help groups (e.g. Narcotics Anonymous). 

The rate of reversibility of tardive dyskinesia after drug withdrawal is 0-90% (269). Since patients with tardive dyskinesia rarely have subjective complaints (304), periodic assessment of dyskinetic movements is essential in making an early diagnosis and can increase the chance of reversing the disorder. Some reports are relatively encouraging regarding reversibility (305,306) the characteristics of reversible and irreversible forms have been reviewed, but no firm conclusion can be drawn (307). However, the prognosis of tardive dyskinesia was better in patients treated for a shorter duration and in those treated with lower doses (308). 

Likewise, the hemodynamic effects of DCLHb (an intramolecularly cross-linked human Hb Baxter) in 14 critically ill patients were evaluated in a prospective, observational study. All of the subjects required vasopressor therapy to maintain adequate MAP and had secondary organ dysfunction prior to DCLHb treatment. Following a decision by the investigator to infuse, boluses (100 ml) of DCLHb were given up to a maximum of 500 ml. Each infusion was separated by 60-90 min. Hemodynamic parameters, norepinephrine and inotropic requirements, arterial and mixed venous blood gases, and urine output were monitored, and biochemical and hematological analyses were made before DCLHb administration and at multiple times up to 72 h postadministration. The main end-point employed to assess the efficacy of DCLHb as a vasopressor was maintenance of the MAP at approximately pre-infusion values concomitant with a reduction in norepinephrine requirements. This objective was met, and reductions in norepinephrine requirements were maintained at 24, 48, and 72h p < 0.01 at all time points). Thus, even in these critically ill patients, whose prognosis of survival was very poor, DCLHb seemed to have a beneficial effect. 

More trials during and after myocardial infarction have been pubhshed and subjected to meta-analysis (12). This very large database provides valuable information on the rate of the most common adverse effects. Of all trials of the effects of ACE inhibitors on mortality in acute myocardial infarction, only the CONSENSUS II trial did not show a positive effect. In this trial, enalaprUat was infused within 24 hours after the onset of symptoms, followed by oral enalapril. The reasons for the negative result of CONSENSUS II remain unresolved, but hypotension and a proischemic effect linked to a poorer prognosis have been suggested. 

In conclusion, these results suggest that the prognosis of subjects with Cd-induced renal dysfunction is unfavourable. The mortality rate tended to become higher as the severity of renal dysfunction progressed. Moreover, an isolated increase in urinary p2-microglobulin is an important factor in assessing the prognosis of a person s mild proximal tubular dysfunction. 

The editors concept of clinical chemistry, as stated in previous volumes of this serial publication, encompasses a wide field of subjects— from the mechanism of blood coagulation to the microbiological assay of vitamins, and from the significance of trace metals in health and disease to the therapeutic application of increased gas pressure. The natural history of clinical conditions and their comparison with normal controls share one common feature, namely, the central position of some species of molecules, be they small or large, all of them the natural subject of chemical research. Hence, practical methods develop, either manual or mechanized, the results of which become increasingly more useful for the clinician in diagnosis, therapy, and prognosis. 

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