RESUMO
When faced with a hemorrhage, there are many ways to achieve hemostasis. War medicine and terrorist attacks have taught us the wide use of the tactical tourniquet since hemorrhagic injury is the leading cause of death, mainly in pre-hospital care. The existence of hemorrhagic areas not accessible to tourniquets and the possibility of conversion of a tourniquet by other non-ischemic local hemostasis means have demonstrated the relevance of compression by internal or external packing. Procoagulant hemostatic dressings have progressed in their efficacy over four generations. History and development.
Assuntos
Hemostáticos , Bandagens , Hemorragia/prevenção & controle , Hemostasia , Humanos , TorniquetesRESUMO
Levodopa (L-dopa) remains the basis of pharmacological treatment of Parkinson's disease (PD). However, L-dopa therapy is associated with the development of complications and presents major challenges in the long-term treatment. Thus, other medications may be suggested to delay and/or reduce the doses of L-dopa in order to prevent complications. The interpretation of treatment evolution reported in clinical trials on PD may be tricky, especially due to some variability in medications and dose regimens. Some authors have suggested a conversion factor to generate a total L-dopa equivalent daily dose (LEDD), calculated as a sum of each parkinsonian medication. Therefore, LEDD provides an artificial summary of the total daily medication a patient is receiving, and to date, there is no report focusing on the clinical interpretation of this parameter. Thus, based on a 3-year, multi-center retrospective study assessing the impact of second-line therapy initiation on LEDD in PD patients, the aim of our article was to discuss LEDD as a quantitative outcome to estimate the impact of second-line therapies on medication regimens; and in the second part of the discussion, to provide a narrative review of the clinical outcomes associated with LEDD in the literature.