Medicina clinica
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Numerous prospective studies establish that elevated asleep blood pressure (BP) constitutes a significant cardiovascular disease (CVD) risk factor, irrespective of daytime office BP measurements or awake and 24h BP measurements. Moreover, except for a small number of studies with flawed methodology, multiple clinical trials of high consistency document significantly better BP-lowering efficacy of hypertension medication and their combinations when ingested at bedtime compared to upon awakening as is customary. Additionally, recent trials conclude bedtime hypertension chronotherapy markedly reduces CVD risk not only in the general population, but also in more vulnerable patients of advanced age, with kidney disease, diabetes, or resistant hypertension. Collectively, these results call for a new definition of true arterial hypertension and its proper diagnosis and management.
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Review
New frontiers and clinical implications in the pathophysiology of age-related macular degeneration.
Age-related macular degeneration (AMD) involves progressive degeneration of the central retina, termed the macula, which provides high-acuity vision needed to recognize faces, drive, etc. AMD is the leading cause of blindness in the aging population. A plethora of paradigm-shifting perspectives regarding AMD's multifaceted pathophysiology is emerging. ⋯ Retinal angiogenesis, at the forefront of the neovascular complications of AMD (nAMD), is now being understood as an imbalance between trophic factors released by retinal cells secretome. Additionally, mechanisms involving oxidative stress and inflammatory complement pathways have also been identified, along with genetic and other risk factors that play a key role in AMD's onset and progression. Associations have been drawn with AMD and other degenerative deposit diseases such as Alzheimer's disease, atherosclerosis, and glomerulonephritis, which are providing further insight into this maculopathy.
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The importance of listeriosis is not sufficiently recognised. The general incidence of infection has been stable in recent years, but with an upward trend in people over 65, also in mortality. ⋯ Bacteraemia and neurolisteriosis are the predominant clinical forms, although at present, the main interest is focused on the management of focal infections and those associated with prosthetic devices. Listeriosis is a significant problem for the food industry, and many countries have introduced legislation to control the incidence of the disease.
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Fitz-Hugh-Curtis syndrome (FHCS), also known as perihepatitis, is a rare complication of pelvic inflammatory disease. It has a different incidence depending on which diagnostic criteria are used. ⋯ In recent years, Multidetector Computed Tomography has proven to be a very useful and non-invasive tool, which offers diagnostic confidence within the appropriate clinical setting. Radiological diagnosis of FHCS can avoid unnecessary surgical procedures.