Miguel Camafort, Josep Redón, Wook Bum Pyun, Antonio Coca
According to the last Hypertension guideline recommendations, it may be concluded that intensive BP lowering is only advisable in a subgroup of patients where there is a clear net benefit of targeting to lower BP goals. However, taking into account the relevance of correct BP measurement, estimates of the benefits versus the harm should be based on reliable office BP measurements and home BP measurements.There is still debate about which BP goals are optimal in reducing morbidity and mortality in uncomplicated hypertensives and in those with associated comorbidities...
November 1, 2020: Clinical Hypertension
Brit Long, William J Brady, Rachel E Bridwell, Mark Ramzy, Tim Montrief, Manpreet Singh, Michael Gottlieb
INTRODUCTION: Coronavirus disease of 2019 (COVID-19) is a lower respiratory tract infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This disease can impact the cardiovascular system and lead to abnormal electrocardiographic (ECG) findings. Emergency clinicians must be aware of the ECG manifestations of COVID-19. OBJECTIVE: This narrative review outlines the pathophysiology and electrocardiographic findings associated with COVID-19...
December 29, 2020: American Journal of Emergency Medicine
Benjamin Maïer, Jean Philippe Desilles, Mikael Mazighi
Reperfusion therapies are the mainstay of acute ischemic stroke (AIS) treatments and overall improve functional outcome. Among the established complications of intravenous (IV) tissue-type plasminogen activator (tPA), intracranial hemorrhage (ICH) is by far the most feared and has been extensively described by seminal works over the last two decades. Indeed, IV tPA is associated with increased odds of any ICH and symptomatic ICH responsible for increased mortality rate during the first week after an AIS. Despite these results, IV tPA has been found beneficial in several pioneering randomized trials and improves functional outcome at 3 months...
2020: Frontiers in Neurology
Michal Prokopič, Ulrich Beuers
Primary sclerosing cholangitis (PSC) is a rare cholestatic liver disease, characterized by multiple strictures and dilatations of the intra- and extrahepatic bile ducts, leading to progressive liver fibrosis, in 10-15% cholangiocarcinoma, and ultimately end-stage liver disease. The pathogenesis is poorly understood, but (epi-)genetic factors, mechanisms of innate and adaptive immunity, toxic effects of hydrophobic bile acids, and possibly intestinal dysbiosis appear to be involved. The strong link with inflammatory bowel disease (IBD) is associated with a markedly enhanced risk of colorectal cancer which next to cholangiocarcinoma represents the most serious diagnostic challenge in long-term PSC management...
December 30, 2020: Hepatology International
Jong Geun Seo, Yong Won Cho, Keun Tae Kim, Dong Wook Kim, Kwang Ik Yang, Soon Tae Lee, Jung Ick Byun, Young Joo No, Kyung Wook Kang, Daeyoung Kim
The incidence and prevalence of epilepsy are highest in elderly people, and the etiologies of epilepsy in the elderly differ from those in other age groups. Moreover, diagnosing and treating epilepsy in elderly people may be challenging due to differences in clinical characteristics and physiological changes associated with aging. This review focuses on the pharmacological treatment of epilepsy in elderly patients.
October 2020: Journal of Clinical Neurology
Mehdi C Shelhamer, Paul D Wesson, Ian L Solari, Deanna L Jensen, William Alex Steele, Vihren G Dimitrov, John Daniel Kelly, Shazia Aziz, Victor Perez Gutierrez, Eric Vittinghoff, Kevin K Chung, Vidya P Menon, Herman A Ambris, Sanjiv M Baxi
BACKGROUND: Coronavirus disease 2019 (COVID-19) can lead to acute respiratory distress syndrome (ARDS) but it is unknown whether prone positioning improves outcomes in mechanically ventilated patients with moderate to severe ARDS due to COVID-19. METHODS: A cohort study at a New York City hospital at the peak of the early pandemic in the United States, under crisis conditions. The aim was to determine the benefit of prone positioning in mechanically ventilated patients with ARDS due to COVID-19...
February 2021: Journal of Intensive Care Medicine
Gregory Dobson, Lorraine Chow, Lucie Filteau, Heather Hurdle, Ian McIntyre, Andrew Milne, Robert Milkovich, Michel-Antoine Perrault, Kathryn Sparrow, Petrus A Swart, Yongjun Wang
The Guidelines to the Practice of Anesthesia Revised Edition 2021 (the Guidelines) were prepared by the Canadian Anesthesiologists' Society (CAS), which reserves the right to determine their publication and distribution. The Guidelines are subject to revision and updated versions are published annually. The Guidelines to the Practice of Anesthesia Revised Edition 2021 supersedes all previously published versions of this document. Although the CAS encourages Canadian anesthesiologists to adhere to its practice guidelines to ensure high-quality patient care, the CAS cannot guarantee any specific patient outcome...
January 4, 2021: Canadian Journal of Anaesthesia
Kelly Cushing, Peter D R Higgins
Importance: Crohn disease, a chronic gastrointestinal inflammatory disease, is increasing in incidence and prevalence in many parts of the world. Uncontrolled inflammation leads to long-term complications, including fibrotic strictures, enteric fistulae, and intestinal neoplasia. Therefore, early and effective control of inflammation is of critical importance. Observations: The optimal management approach for Crohn disease incorporates patient risk stratification, patient preference, and clinical factors in therapeutic decision-making...
January 5, 2021: JAMA
Rosario Pivonello, Rosario Ferrigno, Maria Cristina De Martino, Chiara Simeoli, Nicola Di Paola, Claudia Pivonello, Livia Barba, Mariarosaria Negri, Cristina De Angelis, Annamaria Colao
Cushing's disease (CD) is a serious endocrine disorder characterized by chronic hypercortisolism, or Cushing's syndrome (CS), caused by a corticotroph pituitary tumor, which induces an excessive adrenocorticotropic hormone (ACTH) and consequently cortisol secretion. CD presents a severe clinical burden, with impairment of the quality of life and increase in mortality. Pituitary surgery represents the first-line therapy, but it is non-curative in one third of patients, requiring additional treatments. Among second-line treatments, medical therapy is gradually gaining importance, although the current medical treatments are unable to reach optimal efficacy and safety profile...
2020: Frontiers in Endocrinology
Héctor Bueno, Brenda Moura, Patrizio Lancellotti, Johann Bauersachs
No abstract text is available yet for this article.
January 3, 2021: European Heart Journal
Roberta de Pádua Borges, Nathália Abi Habib Degobi, Marcello Casaccia Bertoluci
Statins are among the most widely prescribed medicines in the world and have proved their value in reducing cardiovascular events and mortality. Many patients report adverse effects that lead to interruption of treatment. This review aims to individualize statin treatment, considering efficacy for reducing cardiovascular risk and safety, in the setting of specific diseases, to minimize the side effects and improve compliance. We gathered evidence that may help clinicians to choose specific statins in different clinical situations, such as the risk of new diabetes, chronic kidney disease, liver disease, human immunodeficiency virus infection, organ transplant, heart failure and elderly people...
November 9, 2020: Archives of Endocrinology and Metabolism
Garrick Mok, Ariel Hendin, Peter Reardon, Michael Hickey, Sara Gray, Krishan Yadav
Sepsis is a common disease process encountered by physicians. Sepsis can lead to septic shock, which carries a hospital mortality rate in excess of 40%. Although the Surviving Sepsis Guidelines recommend targeting a mean arterial pressure (MAP) of 65 mmHg and normalization of lactate, these endpoints do not necessarily result in tissue perfusion in states of shock. While MAP and lactate are commonly used markers in resuscitation, clinicians may be able to improve their resuscitation by broadening their assessment of the microcirculation, which more adequately reflects tissue perfusion...
December 30, 2020: Journal of Intensive Care Medicine
Jan F Scheitz, Helena Stengl, Christian H Nolte, Ulf Landmesser, Matthias Endres
Cardiac troponin is a specific and sensitive biomarker to identify and quantify myocardial injury. Myocardial injury is frequently detected after acute ischemic stroke and strongly associated with unfavorable outcomes. Concomitant acute coronary syndrome is only one of several possible differential diagnoses that may cause elevation of cardiac troponin after stroke. As a result, there are uncertainties regarding the correct interpretation and optimal management of stroke patients with myocardial injury in clinical practice...
December 29, 2020: Journal of Neurology
Ken Kuljit S Parhar, Danny J Zuege, Karen Shariff, Gwen Knight, Sean M Bagshaw
Many patients with coronavirus disease (COVID-19) will develop acute respiratory distress syndrome (ARDS). Prone positioning is an important non-pharmacologic strategy that should be considered for all invasively ventilated patients with moderate to severe ARDS (including those with COVID-19). Prone positioning offers several physiologic and clinical benefits, including improving hypoxemia, matching ventilation with perfusion, reducing regional hyperinflation, and improving survival. To safely offer prone positioning, appropriate training, simulation, and health system planning should be undertaken...
December 24, 2020: Canadian Journal of Anaesthesia
Marion Delcroix, Adam Torbicki, Deepa Gopalan, Olivier Sitbon, Frederikus A Klok, Irene Lang, David Jenkins, Nick H Kim, Marc Humbert, Xavier Jais, Anton Vonk Noordegraaf, Joanna Pepke-Zaba, Philippe Brénot, Peter Dorfmuller, Elie Fadel, Hossein-Ardeschir Ghofrani, Marius M Hoeper, Pavel Jansa, Michael Madani, Hiromi Matsubara, Takeshi Ogo, Ekkehard Grünig, Andrea D'Armini, Nazzareno Galie, Bernhard Meyer, Patrick Corkery, Gergely Meszaros, Eckhard Mayer, Gérald Simonneau
Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare complication of acute pulmonary embolism, either symptomatic or not. The occlusion of proximal pulmonary arteries by fibrotic intravascular material, in combination with a secondary microvasculopathy of vessels less than 500 µm, leads to increased pulmonary vascular resistance and progressive right heart failure. The mechanism responsible for the transformation of red clots into fibrotic material remnants has not yet been elucidated. In patients with pulmonary hypertension, the diagnosis is suspected when a ventilation/perfusion lung scan shows mismatched perfusion defects and confirmed by right heart catheterisation and vascular imaging...
December 17, 2020: European Respiratory Journal
Sanjeev Sethi
Membranous nephropathy (MN) occurs due to deposition of immune complexes along the subepithelial region of glomerular basement membrane. Two previously identified target antigens for the immune complexes, PLA2R (identified in 2009) and THSD7A (in 2014), account for approximately 60% of all MN, both primary and secondary. In the remaining MN, target antigens were unknown. Use of laser microdissection and mass spectrometry enabled identification of new "antigens." This approach led to the identification of four novel types of MN: exotosin 1 (EXT1)- and exotosin 2 (EXT2)-associated MN, NELL1-associated MN, Sema3B-associated MN, and PCDH7-associated MN...
December 30, 2020: Journal of the American Society of Nephrology: JASN
E Roofthooft, G P Joshi, N Rawal, M Van de Velde
Caesarean section is associated with moderate-to-severe postoperative pain, which can influence postoperative recovery and patient satisfaction as well as breastfeeding success and mother-child bonding. The aim of this systematic review was to update the available literature and develop recommendations for optimal pain management after elective caesarean section under neuraxial anaesthesia. A systematic review utilising procedure-specific postoperative pain management (PROSPECT) methodology was undertaken. Randomised controlled trials published in the English language between 1 May 2014 and 22 October 2020 evaluating the effects of analgesic, anaesthetic and surgical interventions were retrieved from MEDLINE, Embase and Cochrane databases...
December 28, 2020: Anaesthesia
Guillermo Ruiz-Irastorza, George Bertsias
Besides treating acute flares, the management of SLE should aim at preventing organ damage accrual and drug-associated harms, improving health-related quality of life and prolonging survival. At present, therapy is based on combinations of antimalarials (mainly HCQ), considered the backbone of SLE treatment, glucocorticoids and immunosuppressive drugs. However, these regimens are not universally effective and a substantial degree of damage can be caused by exposure to glucocorticoids. In this review we provide a critical appraisal of the efficacy and safety of available treatments as well as a brief discussion of potentially novel compounds in patients with SLE...
December 5, 2020: Rheumatology
Cheng Peng, Alastair G Stewart, Owen L Woodman, Rebecca H Ritchie, Cheng Xue Qin
Non-alcoholic steatohepatitis (NASH) develops from non-alcoholic fatty liver disease (NAFLD). Currently, around 25% of the population is estimated to have NAFLD, and 25% of NAFLD patients are estimated to have NASH. NASH is typically characterized by liver steatosis inflammation, and fibrosis driven by metabolic disruptions such as obesity, diabetes, and dyslipidemia. NASH patients with significant fibrosis have increased risk of developing cirrhosis and liver failure. Currently, NASH is the second leading cause for liver transplant in the United States...
2020: Frontiers in Pharmacology
Steven Falowski, Dawood Sayed, Jason Pope, Denis Patterson, Michael Fishman, Mayank Gupta, Pankaj Mehta
Introduction: The sacroiliac joint (SIJ) has been estimated to contribute to pain in as much as 38% of cases of lower back pain. There are no clear diagnostic or treatment pathways. This article seeks to establish a clearer pathway and algorithm for treating patients. Methods: The literature was reviewed in order to review the biomechanics, as well as establish the various diagnostic and treatment options. Diagnostic factors addressed include etiology, history, physical exam, and imaging studies...
2020: Journal of Pain Research
2021-01-12 00:24:58
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