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Medicina interna

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143 papers 100 to 500 followers
https://www.readbyqxmd.com/read/28958334/antiplatelet-agents-for-the-treatment-and-prevention-of-coronary-atherothrombosis
#1
REVIEW
Carlo Patrono, Joao Morais, Colin Baigent, Jean-Philippe Collet, Desmond Fitzgerald, Sigrun Halvorsen, Bianca Rocca, Agneta Siegbahn, Robert F Storey, Gemma Vilahur
Antiplatelet drugs provide first-line antithrombotic therapy for the management of acute ischemic syndromes (both coronary and cerebrovascular) and for the prevention of their recurrence. Their role in the primary prevention of atherothrombosis remains controversial because of the uncertain balance of the potential benefits and risks when combined with other preventive strategies. The aim of this consensus document is to review the evidence for the efficacy and safety of antiplatelet drugs, and to provide practicing cardiologists with an updated instrument to guide their choice of the most appropriate antiplatelet strategy for the individual patient presenting with different clinical manifestations of coronary atherothrombosis, in light of comorbidities and/or interventional procedures...
October 3, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/28733178/clinical-usefulness-of-serum-antibodies-as-biomarkers-of-gastrointestinal-and-liver-diseases
#2
REVIEW
Antonio Di Sabatino, Federico Biagi, Marco Lenzi, Luca Frulloni, Marco Vincenzo Lenti, Paolo Giuffrida, Gino Roberto Corazza
The progressively growing knowledge of the pathophysiology of a number of immune-mediated gastrointestinal and liver disorders, including autoimmune atrophic gastritis, coeliac disease, autoimmune enteropathy, inflammatory bowel disease, autoimmune hepatitis, primary sclerosing cholangitis, primary biliary cholangitis and autoimmune pancreatitis, together with the improvement of their detection methods have increased the diagnostic power of serum antibodies. In some cases - coeliac disease and autoimmune atrophic gastritis - they have radically changed gastroenterologists' diagnostic ability, while in others - autoimmune hepatitis, inflammatory bowel disease and autoimmune pancreatitis - their diagnostic performance is still inadequate...
September 2017: Digestive and Liver Disease
https://www.readbyqxmd.com/read/28924481/euglycemic-diabetic-ketoacidosis-a-diagnostic-and-therapeutic-dilemma
#3
Prashanth Rawla, Anantha R Vellipuram, Sathyajit S Bandaru, Jeffrey Pradeep Raj
Euglycemic diabetic ketoacidosis (EDKA) is a clinical triad comprising increased anion gap metabolic acidosis, ketonemia or ketonuria and normal blood glucose levels <200 mg/dL. This condition is a diagnostic challenge as euglycemia masquerades the underlying diabetic ketoacidosis. Thus, a high clinical suspicion is warranted, and other diagnosis ruled out. Here, we present two patients on regular insulin treatment who were admitted with a diagnosis of EDKA. The first patient had insulin pump failure and the second patient had urinary tract infection and nausea, thereby resulting in starvation...
2017: Endocrinology, Diabetes & Metabolism Case Reports
https://www.readbyqxmd.com/read/28940011/guidelines-for-the-diagnosis-and-management-of-critical-illness-related-corticosteroid-insufficiency-circi-in-critically-ill-patients-part-i-society-of-critical-care-medicine-sccm-and-european-society-of-intensive-care-medicine-esicm-2017
#4
Djillali Annane, Stephen M Pastores, Bram Rochwerg, Wiebke Arlt, Robert A Balk, Albertus Beishuizen, Josef Briegel, Joseph Carcillo, Mirjam Christ-Crain, Mark S Cooper, Paul E Marik, Gianfranco Umberto Meduri, Keith M Olsen, Sophia Rodgers, James A Russell, Greet Van den Berghe
OBJECTIVE: To update the 2008 consensus statements for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in adult and pediatric patients. PARTICIPANTS: A multispecialty task force of 16 international experts in Critical Care Medicine, endocrinology, and guideline methods, all of them members of the Society of Critical Care Medicine and/or the European Society of Intensive Care Medicine. DESIGN/METHODS: The recommendations were based on the summarized evidence from the 2008 document in addition to more recent findings from an updated systematic review of relevant studies from 2008 to 2017 and were formulated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology...
September 21, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28870355/mechanical-ventilation-state-of-the-art
#5
REVIEW
Tài Pham, Laurent J Brochard, Arthur S Slutsky
Mechanical ventilation is the most used short-term life support technique worldwide and is applied daily for a diverse spectrum of indications, from scheduled surgical procedures to acute organ failure. This state-of-the-art review provides an update on the basic physiology of respiratory mechanics, the working principles, and the main ventilatory settings, as well as the potential complications of mechanical ventilation. Specific ventilatory approaches in particular situations such as acute respiratory distress syndrome and chronic obstructive pulmonary disease are detailed along with protective ventilation in patients with normal lungs...
September 2017: Mayo Clinic Proceedings
https://www.readbyqxmd.com/read/28802875/primary-sclerosing-cholangitis-a-comprehensive-review
#6
REVIEW
Tom H Karlsen, Trine Folseraas, Douglas Thorburn, Mette Vesterhus
Primary sclerosing cholangitis (PSC) is a rare disorder characterised by multi-focal bile duct strictures and progressive liver disease. Inflammatory bowel disease is usually present and there is a high risk of cholangiocarcinoma and colorectal cancer. Most patients ultimately require liver transplantation, after which disease recurrence may occur. With limited therapeutic options and a lack of proven surveillance strategies, patients currently have significant unmet needs. In the present seminar, we provide a comprehensive review of the status of the field...
December 2017: Journal of Hepatology
https://www.readbyqxmd.com/read/28842060/after-4-decades-of-lupus-nephritis-trials-is-there-a-best-therapy
#7
EDITORIAL
Andrew S Bomback
No abstract text is available yet for this article.
September 2017: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/28685511/clinical-guidelines-for-the-management-of-adrenal-incidentaloma
#8
REVIEW
Jung Min Lee, Mee Kyoung Kim, Seung Hyun Ko, Jung Min Koh, Bo Yeon Kim, Sang Wan Kim, Soo Kyung Kim, Hae Jin Kim, Ohk Hyun Ryu, Juri Park, Jung Soo Lim, Seong Yeon Kim, Young Kee Shong, Soon Jib Yoo
An adrenal incidentaloma is an adrenal mass found in an imaging study performed for other reasons unrelated to adrenal disease and often accompanied by obesity, diabetes, or hypertension. The prevalence and incidence of adrenal incidentaloma increase with age and are also expected to rise due to the rapid development of imaging technology and frequent imaging studies. The Korean Endocrine Society is promoting an appropriate practice guideline to meet the rising incidence of adrenal incidentaloma, in cooperation with the Korean Adrenal Gland and Endocrine Hypertension Study Group...
June 2017: Endocrinology and Metabolism
https://www.readbyqxmd.com/read/28838972/acute-pancreatitis-recent-advances-through-randomised-trials
#9
REVIEW
Sven M van Dijk, Nora D L Hallensleben, Hjalmar C van Santvoort, Paul Fockens, Harry van Goor, Marco J Bruno, Marc G Besselink
Acute pancreatitis is one of the most common GI conditions requiring acute hospitalisation and has a rising incidence. In recent years, important insights on the management of acute pancreatitis have been obtained through numerous randomised controlled trials. Based on this evidence, the treatment of acute pancreatitis has gradually developed towards a tailored, multidisciplinary effort, with distinctive roles for gastroenterologists, radiologists and surgeons. This review summarises how to diagnose, classify and manage patients with acute pancreatitis, emphasising the evidence obtained through randomised controlled trials...
November 2017: Gut
https://www.readbyqxmd.com/read/28757818/procalcitonin-assisted-antibiotic-strategy-in-sepsis
#10
Domonkos Trásy, Zsolt Molnár
Sepsis is one of the biggest challenges in critical care nowadays. Defining sepsis is a difficult task on its own and its diagnosis and treatment requires well trained, devoted personnel with interdisciplinary collaboration in order to provide the patients the best chance for survival. Immediate resuscitation, early adequate antimicrobial therapy, source control and highly sophisticated organ support on the intensive care units are all inevitable necessities for successful recovery. To help fast and accurate diagnosis biomarkers have been measured for decades...
May 2017: EJIFCC
https://www.readbyqxmd.com/read/28785442/biomarkers-in-acute-heart-failure-cardiac-and-kidney
#11
A Mark Richards
Natriuretic peptides (NP) are well-validated aids in the diagnosis of acute decompensated heart failure (ADHF). In acute presentations, both brain natriuretic peptide (BNP) and N-terminal of the prohormone brain natriuretic peptide (NT-proBNP) offer high sensitivity (>90 %) and negative predictive values (>95 %) for ruling out ADHF at thresholds of 100 and 300 pg/ml, respectively. Plasma NP rise with age. For added rule-in performance age-adjusted thresholds (450 pg/ml for under 50 years, 900 pg/ml for 50-75 years and 1,800 pg/ml for those >75 years) can be applied to NT-proBNP results...
October 2015: Card Fail Rev
https://www.readbyqxmd.com/read/28598791/croi-2017-neurologic-complications-of-hiv-infection
#12
Serena S Spudich, Beau M Ances
The brain is a major target for HIV infection and is a potential viral reservoir even in virologically well-controlled HIV-infected individuals. Data presented at the 2017 Conference on Retroviruses and Opportunistic Infections (CROI) suggested that during early HIV infection, CD4+ T cells in the meninges and choroid plexus serve as an important early site of HIV infection in the central nervous system (CNS), with brain macrophages and microglial cells becoming an important source of viral replication with advancing disease...
May 2017: Topics in Antiviral Medicine
https://www.readbyqxmd.com/read/28646995/executive-summary-of-the-2017-kdigo-chronic-kidney%C3%A2-disease-mineral-and-bone-disorder-ckd-mbd-guideline-update-what-s-changed-and-why-it-matters
#13
Markus Ketteler, Geoffrey A Block, Pieter Evenepoel, Masafumi Fukagawa, Charles A Herzog, Linda McCann, Sharon M Moe, Rukshana Shroff, Marcello A Tonelli, Nigel D Toussaint, Marc G Vervloet, Mary B Leonard
The KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of CKD-MBD represents a selective update of the prior CKD-MBD Guideline published in 2009. This update, along with the 2009 publication, is intended to assist the practitioner caring for adults and children with chronic kidney disease (CKD), those on chronic dialysis therapy, or individuals with a kidney transplant. This review highlights key aspects of the 2017 CKD-MBD Guideline Update, with an emphasis on the rationale for the changes made to the original guideline document...
July 2017: Kidney International
https://www.readbyqxmd.com/read/28798095/the-art-of-breathing-saturation
#14
Gary P Anderson, Tom Kotsimbos
No abstract text is available yet for this article.
August 2017: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
https://www.readbyqxmd.com/read/28140454/geriatric-infectious-diseases-current-concepts-on-diagnosis-and-management
#15
REVIEW
Thomas T Yoshikawa, Dean C Norman
New information on infectious diseases in older adults has become available in the past 20 years. In this review, in-depth discussions on the general problem of geriatric infectious diseases (epidemiology, pathogenesis, age-related host defenses, clinical manifestations, diagnostic approach); diagnosis and management of bacterial pneumonia, urinary tract infection, and Clostridium difficile infection; and the unique challenges of diagnosing and managing infections in a long-term care setting are presented.
March 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28784609/understanding-cardiac-troponin-part-1-avoiding-troponinitis
#16
REVIEW
Richard Body, Edward Carlton
Cardiac troponin (cTn) is a highly specific biomarker of myocardial injury and is central to the diagnosis of acute myocardial infarction (AMI). By itself, however, cTn cannot identify the cause of myocardial injury. 'Troponinitis' is the condition that leads clinicians to falsely assign a diagnosis of AMI based only on the fact that a patient has an elevated cTn concentration. There are many causes of myocardial injury other than AMI. Clinicians are required to differentiate myocardial injury caused by AMI from other causes...
August 7, 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/28609703/etiologic-classification-of-ischemic-stroke-where-do-we-stand
#17
REVIEW
Răzvan Alexandru Radu, Elena Oana Terecoasă, Ovidiu Alexandru Băjenaru, Cristina Tiu
Despite major technological advances in ischemic stroke diagnostic techniques, our current understanding of stroke mechanisms and etiology continues to remain unclear in a significant percent of patients. As a result, several etiological ischemic stroke classifications have emerged during the last two decades but their reliability and validity is far from perfect and further world-wide research is needed in order to achieve the so much needed "standard reference language". An ideal ischemic stroke classification should both comprise all underlying pathologies that could potentially concur to an index event and emphasize the most likely etiological and pathophysiological mechanism...
August 2017: Clinical Neurology and Neurosurgery
https://www.readbyqxmd.com/read/28594069/glucose-targets-for-preventing-diabetic-kidney-disease-and-its-progression
#18
REVIEW
Marinella Ruospo, Valeria M Saglimbene, Suetonia C Palmer, Salvatore De Cosmo, Antonio Pacilli, Olga Lamacchia, Mauro Cignarelli, Paola Fioretto, Mariacristina Vecchio, Jonathan C Craig, Giovanni Fm Strippoli
BACKGROUND: Diabetes is the leading cause of end-stage kidney disease (ESKD) around the world. Blood pressure lowering and glucose control are used to reduce diabetes-associated disability including kidney failure. However there is a lack of an overall evidence summary of the optimal target range for blood glucose control to prevent kidney failure. OBJECTIVES: To evaluate the benefits and harms of intensive (HbA1c < 7% or fasting glucose levels < 120 mg/dL versus standard glycaemic control (HbA1c ≥ 7% or fasting glucose levels ≥ 120 mg/dL for preventing the onset and progression of kidney disease among adults with diabetes...
June 8, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28602369/heart-failure-complicating-acute-mtyocardial-infarction
#19
REVIEW
Wilbert S Aronow
Factors predisposing the older person with acute myocardial infarction (MI) to develop heart failure (HF) include an increased prevalence of MI, multivessel coronary artery disease, decreased left ventricular (LV) contractile reserve, impairment of LV diastolic relaxation, increased hypertension, LV hypertrophy, diabetes mellitus, valvular heart disease, and renal insufficiency. HF associated with acute MI should be treated with a loop diuretic. The use of nitrates, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, aldosterone antagonists, beta-blockers, digoxin, and positive inotropic drugs; treatment of arrhythmias and mechanical complications; and indications for use of implantable cardioverter-defibrillators and cardiac resynchronization is discussed...
July 2017: Heart Failure Clinics
https://www.readbyqxmd.com/read/28402929/kidney-disease-and-hiv-infection
#20
REVIEW
Christina M Wyatt
The risk of acute and chronic kidney disease remains higher in HIV-infected persons than in the general population, and kidney disease in HIV-infected persons is associated with poor outcomes, including increased mortality. HIV-associated nephropathy occurs less frequently in the era of antiretroviral therapy. HIV immune complex kidney disease is being diagnosed more frequently, but the term is currently used to refer to a heterogeneous group of kidney diseases. Comorbid chronic kidney disease poses a growing burden in HIV-infected persons due to an overrepresentation of risk factors such as black race, diabetes, hypertension, and coinfection with hepatitis C virus...
February 2017: Topics in Antiviral Medicine
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