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HericabMedicine

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22 papers 0 to 25 followers Artículos de Medicina interna
https://www.readbyqxmd.com/read/28672393/management-of-newly-diagnosed-hiv-infection
#1
REVIEW
Judith Feinberg, Susana Keeshin
No field in medicine has moved as swiftly as HIV/AIDS over the past 35 years. Because of the rapid turnover of key information, this In the Clinic focuses on essential principles of care for newly diagnosed adults with HIV-1 infection and how to prevent infection in persons at risk. To ensure continued usefulness, future directions in therapy and how to access updated information on a continuous basis are emphasized.
July 4, 2017: Annals of Internal Medicine
https://www.readbyqxmd.com/read/28791529/effects-of-raas-inhibitors-in-patients-with-kidney-disease
#2
REVIEW
Fan Zhang, Hong Liu, Di Liu, Yexin Liu, Huiqiong Li, Xia Tan, Fuyou Liu, Youming Peng, Hongqing Zhang
Proteinuria and decline of renal function are associated with progression of kidney disease. The Renin Angiotensin Aldosterone System (RAAS) plays an important role in blood pressure regulation, fluid volume, and sodium balance. Overactivity of RAAS contributes to the pathogenesis of a variety of clinical conditions including progress of chronic kidney disease (CKD). This review summarizes the use of RAAS inhibitors as dual therapy or monotherapy in different stages of kidney disease. Experimental and clinical studies have demonstrated RAAS inhibitors prevent proteinuria, kidney fibrosis and slow decline of renal function and thus play a protective role in both early and end stages of kidney disease...
August 8, 2017: Current Hypertension Reports
https://www.readbyqxmd.com/read/28787716/two-liters-a-day-keep-the-doctor-away-considerations-on-the-pathophysiology-of-suboptimal-fluid-intake-in-the-common-population
#3
Florian Lang, Isabelle Guelinckx, Guillaume Lemetais, Olle Melander
Suboptimal fluid intake may require enhanced release of antidiuretic hormone (ADH) or vasopressin for the maintenance of adequate hydration. Enhanced copeptin levels (reflecting enhanced vasopressin levels) in 25% of the common population are associated with enhanced risk of metabolic syndrome with abdominal obesity, type 2 diabetes, hypertension, coronary artery disease, heart failure, vascular dementia, cognitive impairment, microalbuminuria, chronic kidney disease, inflammatory bowel disease, cancer, and premature mortality...
August 9, 2017: Kidney & Blood Pressure Research
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
#4
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/28610806/heart-failure-in-patients-with-kidney-disease-and-iron-deficiency-the-role-of-iron-therapy
#5
Aleix Cases Amenós, Raquel Ojeda López, José María Portolés Pérez
Chronic kidney disease and anaemia are common in heart failure (HF) and are associated with a worse prognosis in these patients. Iron deficiency is also common in patients with HF and increases the risk of morbidity and mortality, regardless of the presence or absence of anaemia. While the treatment of anaemia with erythropoiesis-stimulating agents in patients with HF have failed to show a benefit in terms of morbidity and mortality, treatment with IV iron in patients with HF and reduced ejection fraction and iron deficiency is associated with clinical improvement...
June 10, 2017: Nefrología: Publicación Oficial de la Sociedad Española Nefrologia
https://www.readbyqxmd.com/read/28666993/digoxin-use-and-subsequent-clinical-outcomes-in-patients-with-atrial-fibrillation-with-or-without-heart-failure-in-the-engage-af-timi-48-trial
#6
Alon Eisen, Christian T Ruff, Eugene Braunwald, Rose A Hamershock, Basil S Lewis, Christian Hassager, Tze-Fan Chao, Jean Yves Le Heuzey, Michele Mercuri, Howard Rutman, Elliott M Antman, Robert P Giugliano
BACKGROUND: Digoxin is widely used in patients with atrial fibrillation despite the lack of randomized controlled trials. Observational studies report conflicting results regarding its association with mortality, perhaps because of residual confounding by the presence of heart failure (HF). METHODS AND RESULTS: In the ENGAGE AF-TIMI 48 (Effective Anticoagulation With Factor Xa Next Generation in Atrial Fibrillation-Thrombolysis in Myocardial Infarction 48) trial, clinical outcomes of patients with atrial fibrillation with and without HF were examined by baseline digoxin use during a median follow-up of 2...
June 30, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28605608/canagliflozin-and-cardiovascular-and-renal-events-in-type-2-diabetes
#7
RANDOMIZED CONTROLLED TRIAL
Bruce Neal, Vlado Perkovic, Kenneth W Mahaffey, Dick de Zeeuw, Greg Fulcher, Ngozi Erondu, Wayne Shaw, Gordon Law, Mehul Desai, David R Matthews
Background Canagliflozin is a sodium-glucose cotransporter 2 inhibitor that reduces glycemia as well as blood pressure, body weight, and albuminuria in people with diabetes. We report the effects of treatment with canagliflozin on cardiovascular, renal, and safety outcomes. Methods The CANVAS Program integrated data from two trials involving a total of 10,142 participants with type 2 diabetes and high cardiovascular risk. Participants in each trial were randomly assigned to receive canagliflozin or placebo and were followed for a mean of 188...
August 17, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28612425/iron-deficiency-across-chronic-inflammatory-conditions-international-expert-opinion-on-definition-diagnosis-and-management
#8
REVIEW
Maria Domenica Cappellini, Josep Comin-Colet, Angel de Francisco, Axel Dignass, Wolfram Doehner, Carolyn S P Lam, Iain C Macdougall, Gerhard Rogler, Clara Camaschella, Rezan Kadir, Nicholas J Kassebaum, Donat R Spahn, Ali T Taher, Khaled M Musallam
Iron deficiency, even in the absence of anemia, can be debilitating, and exacerbate any underlying chronic disease, leading to increased morbidity and mortality. Iron deficiency is frequently concomitant with chronic inflammatory disease; however, iron deficiency treatment is often overlooked, partially due to the heterogeneity among clinical practice guidelines. In the absence of consistent guidance across chronic heart failure, chronic kidney disease and inflammatory bowel disease, we provide practical recommendations for iron deficiency to treating physicians: definition, diagnosis, and disease-specific diagnostic algorithms...
October 2017: American Journal of Hematology
https://www.readbyqxmd.com/read/28712645/comparison-of-qsofa-score-and-sirs-criteria-as-screening-mechanisms-for-emergency-department-sepsis
#9
Samir Haydar, Matthew Spanier, Patricia Weems, Samantha Wood, Tania Strout
OBJECTIVES: The Quick Sequential [Sepsis-related] Organ Failure Assessment (qSOFA) score has been shown to accurately predict mortality in septic patients and is part of recently proposed diagnostic criteria for sepsis. We sought to ascertain the sensitive of the score in diagnosing sepsis, as well as the diagnostic timeliness of the score when compared to traditional systemic inflammatory response syndrome (SIRS) criteria in a population of emergency department (ED) patients treated in the ED, admitted, and subsequently discharged with a diagnosis of sepsis...
July 6, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28598792/croi-2017-complications-and-comorbidities-of-hiv-disease-and-its-treatment
#10
Judith S Currier, Diane V Havlir
Complications of HIV disease remained a major focus at the 2017 Conference on Retroviruses and Opportunistic Infections (CROI), and included studies focused on noncommunicable chronic diseases (eg, cardiovascular disease, obesity, bone disease, and malignancies) and opportunistic infections (Mycobacterium tuberculosis and cryptococcosis). Progress in identifying predictors of specific complications as well as interventions for the prevention and treatment of these comorbidities are summarized below.
May 2017: Topics in Antiviral Medicine
https://www.readbyqxmd.com/read/28700476/peripheral-monocytosis-as-a-predictive-factor-for-adverse-outcome-in-the-emergency-department-survey-based-on-a-register-study
#11
Mathias Hensel, Lena Grädel, Alexander Kutz, Sebastian Haubitz, Andreas Huber, Beat Mueller, Philipp Schuetz, Thomas Hügle
Monocytosis is associated with chronic infections such as tuberculosis or endocarditis as well as rheumatic and myeloproliferative disorders. Monocytes are also involved in the pathogenesis of atherosclerosis, coronary artery disease, and stroke. The value of monocytosis as a prognostic marker in different diagnostic groups in the emergency setting, however, has not been investigated so far.The aim of the article is to study monocytosis as an outcome factor in the emergency setting.In a Swiss register study, we analyzed monocyte counts in 4238 patients aged >18 years who were admitted to the emergency department of a regional tertiary care hospital...
July 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28633665/optimizing-bronchodilation-in-the-prevention-of-copd-exacerbations
#12
REVIEW
Marc Miravitlles, Antonio Anzueto, José R Jardim
The natural disease course of chronic obstructive pulmonary disease (COPD) is often punctuated by exacerbations: acute events of symptom worsening associated with significant morbidity and healthcare resource utilization; reduced quality of life; and increased risk of hospitalization and death. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommend that patients at risk of exacerbations (GOLD Groups C and D) receive a long-acting muscarinic antagonist (LAMA) or a long-acting β2-agonist (LABA)/LAMA combination, respectively, as preferred initial treatments...
June 20, 2017: Respiratory Research
https://www.readbyqxmd.com/read/28284301/perioperative-acute-kidney-injury-risk-factors-and-predictive-strategies
#13
REVIEW
Charles Hobson, Rupam Ruchi, Azra Bihorac
Acute kidney injury (AKI) is a common complication in surgical patients and is associated with increases in mortality, an increased risk for chronic kidney disease and hemodialysis after discharge, and increased cost. Better understanding of the risk factors that contribute to perioperative AKI has led to improved AKI prediction and will eventually lead to improved prevention of AKI, mitigation of injury when AKI occurs, and enhanced recovery in patients who sustain AKI. The development of advanced clinical prediction scores for AKI, new imaging techniques, and novel biomarkers for early detection of AKI provides new tools toward these ends...
April 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28561005/management-of-patients-at-risk-of-acute-kidney-injury
#14
REVIEW
Jill Vanmassenhove, Jan Kielstein, Achim Jörres, Wim Van Biesen
Acute kidney injury (AKI) is a multifaceted syndrome that occurs in different settings. The course of AKI can be variable, from single hit and complete recovery, to multiple hits resulting in end-stage renal disease. No interventions to improve outcomes of established AKI have yet been developed, so prevention and early diagnosis are key. Awareness campaigns and education for health-care professionals on diagnosis and management of AKI-with attention to avoidance of volume depletion, hypotension, and nephrotoxic interventions-coupled with electronic early warning systems where available can improve outcomes...
May 27, 2017: Lancet
https://www.readbyqxmd.com/read/28606345/empa-reg-outcome-the-cardiologist-s-point-of%C3%A2-view
#15
REVIEW
Son V Pham, Robert J Chilton
Cardiologists could view empagliflozin as a cardiovascular drug that also has a beneficial effect on reducing hyperglycemia in patients with type 2 diabetes mellitus (T2DM). The effects of empagliflozin in lowering the risk of cardiovascular death and hospitalization for heart failure in T2DM patients with high cardiovascular risk during the recent Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients-Removing Excess Glucose (EMPA-REG OUTCOME) trial may be explained principally in terms of changes to cardiovascular physiology; namely, by the potential ability of empagliflozin to reduce cardiac workload and myocardial oxygen consumption by lowering blood pressure, improving aortic compliance, and improving ventricular arterial coupling...
July 1, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28084624/first-line-combination-therapy-versus-first-line-monotherapy-for-primary-hypertension
#16
REVIEW
Javier Garjón, Luis Carlos Saiz, Ana Azparren, José J Elizondo, Idoia Gaminde, Mª José Ariz, Juan Erviti
BACKGROUND: Starting with one drug and starting with a combination of two drugs are strategies suggested in clinical guidelines as initial treatment of hypertension. The recommendations are not based on evidence about clinically relevant outcomes. Some antihypertensive combinations have been shown to be harmful. The actual harm-to-benefit balance of each strategy is unknown. OBJECTIVES: To determine if there are differences in clinical outcomes between monotherapy and combination therapy as initial treatment for primary hypertension...
January 13, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28529721/the-impact-of-antihypertensives-on-kidney-disease
#17
REVIEW
Diego F Marquez, Gema Ruiz-Hurtado, Luis Ruilope
Arterial hypertension and chronic kidney disease (CKD) are intimately related. The control of blood pressure (BP) levels is strongly recommended in patients with CKD in order to protect the kidney against the accompanying elevation in global cardiovascular (CV) risk. Actually, the goal BP in patients with CKD involves attaining values <140/90 mmHg except if albuminuria is present. In this case, it is often recommended to attain values <130/80 mmHg, although some guidelines still recommend <140/90 mmHg...
2017: F1000Research
https://www.readbyqxmd.com/read/27706464/effect-of-postextubation-high-flow-nasal-cannula-vs-noninvasive-ventilation-on-reintubation-and-postextubation-respiratory-failure-in-high-risk-patients-a-randomized-clinical-trial
#18
RANDOMIZED CONTROLLED TRIAL
Gonzalo Hernández, Concepción Vaquero, Laura Colinas, Rafael Cuena, Paloma González, Alfonso Canabal, Susana Sanchez, Maria Luisa Rodriguez, Ana Villasclaras, Rafael Fernández
Importance: High-flow conditioned oxygen therapy delivered through nasal cannulae and noninvasive mechanical ventilation (NIV) may reduce the need for reintubation. Among the advantages of high-flow oxygen therapy are comfort, availability, lower costs, and additional physiopathological mechanisms. Objective: To test if high-flow conditioned oxygen therapy is noninferior to NIV for preventing postextubation respiratory failure and reintubation in patients at high risk of reintubation...
October 18, 2016: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/27695824/effect-of-hydrocortisone-on-development-of-shock-among-patients-with-severe-sepsis-the-hypress-randomized-clinical-trial
#19
RANDOMIZED CONTROLLED TRIAL
Didier Keh, Evelyn Trips, Gernot Marx, Stefan P Wirtz, Emad Abduljawwad, Sven Bercker, Holger Bogatsch, Josef Briegel, Christoph Engel, Herwig Gerlach, Anton Goldmann, Sven-Olaf Kuhn, Lars Hüter, Andreas Meier-Hellmann, Axel Nierhaus, Stefan Kluge, Josefa Lehmke, Markus Loeffler, Michael Oppert, Kerstin Resener, Dirk Schädler, Tobias Schuerholz, Philipp Simon, Norbert Weiler, Andreas Weyland, Konrad Reinhart, Frank M Brunkhorst
Importance: Adjunctive hydrocortisone therapy is suggested by the Surviving Sepsis Campaign in refractory septic shock only. The efficacy of hydrocortisone in patients with severe sepsis without shock remains controversial. Objective: To determine whether hydrocortisone therapy in patients with severe sepsis prevents the development of septic shock. Design, Setting, and Participants: Double-blind, randomized clinical trial conducted from January 13, 2009, to August 27, 2013, with a follow-up of 180 days until February 23, 2014...
November 1, 2016: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28652799/direct-oral-anticoagulants-in-patients-with-chronic-kidney-disease-patient-selection-and-special-considerations
#20
REVIEW
Jens Lutz, Kerstin Jurk, Helmut Schinzel
Many patients with chronic kidney disease (CKD) receive anticoagulation or antiplatelet therapy due to atrial fibrillation, coronary artery disease, thromboembolic disease, or peripheral artery disease. The treatment usually includes vitamin K antagonists (VKAs) and/or platelet aggregation inhibitors. The direct oral anticoagulants (DOAC) inhibiting factor Xa or thrombin represent an alternative for VKAs. In patients with acute and chronic kidney disease, caution is warranted, as DOACs can accumulate as they are partly eliminated by the kidneys...
2017: International Journal of Nephrology and Renovascular Disease
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