Medicina clinica
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Hyponatremia is the most frequent electrolytic disorder in hospitalized patients, and the syndrome of inappropriate secretion of antidiuretic hormone (SIADH), the most frequent cause of hiponatremia with clinically normal extracellular volume. It consists of a disorder of the regulation of body water that obeys to different causes, mainly cancer, pulmonary illnesses, disorders of the central nervous system and diverse drugs. ⋯ The available data until the moment show that the clinical diagnosis of SIADH made by professionals is mainly not supported on the established criteria drawn by experts and this lack of accuracy probably hits in the therapeutic result. The basis of the treatment of the SIADH is to correct its cause, water restriction, solutes (sodium chloride) and the use of vaptans in case of failure of the previous measures.
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Efficacy of sodium-glucose cotransporter 2 (SGLT2) inhibitors in combination with renin-angiotensin-system (RAS) blockers for CKD remains controversial. We conducted this meta-analysis to explore the effect of SGLT2 inhibitors combining with RAS blockers on cardiovascular outcomes in chronic kidney disease (CKD) patients. ⋯ These data provide a well-document testimonial of the benefits of the combined use of SGLT2 inhibitors and RAS blockers for cardiovascular and renal outcomes in CKD patients.
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The main clinical relevance of Barrett's esophagus (BE), a result of chronic exposure to gastroesophageal reflux, is its potential progression to esophageal adenocarcinoma (EAC). Although screening for BE is not recommended in the general population, after diagnosis of BE, a surveillance strategy for early detection of dysplasia or neoplasia is needed. ⋯ In addition, any visible lesion should be completely resected, which will be considered curative in the presence of low grade dysplasia (LGD), high-grade dysplasia (HGD) or EAC confined to the mucosa (T1a), followed by eradication of residual BE by endoscopic ablation. In the absence of a visible lesion, radiofrequency ablation should be performed to eradicate BE with LGD, HGD or intramucosal EAC.
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Chronic obstructive pulmonary disease (COPD) has been traditionally understood as a self-inflicted disease cause by tobacco smoking occurring in individuals older than 50-60 years. This traditional paradigm has changed over the last decade because new scientific evidence showed that there are many genetic (G) and environmental (E) factors associated with reduced lung function, that vary, accumulate, and interact over time (T), even before birth (G×E×T). This new perspective opens novel windows of opportunity for the prevention, early diagnosis, and personalized treatment of COPD. This review presents the evidence that supports this proposal, as well as its practical implications, with particular emphasis on the need that clinical histories in patients with suspected COPD should investigate early life events and that spirometry should be used much more widely as a global health marker.
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Psoriatic arthritis (PsA) is a type of inflammatory arthritis that is included within the spondyloarthritis, a group of rheumatological diseases characterized by different clinical manifestations and associated comorbidities, that can compromise the quality of life of patients. The diagnosis of PsA is sometimes difficult due to an enormous clinical and radiological variability, including six different domains of involvement: peripheral joint, axial skeleton, skin psoriasis, nail psoriasis, enthesitis and dactylitis. Currently, there are no biomarkers that allow the detection of PsA in patients with psoriasis, so a high level of suspicion is important, mainly by dermatologists, but also by other specialists, such as family doctors. Advances in the knowledge of new immunological mechanisms and joint management by rheumatologists and dermatologists have made it possible to improve the therapeutic approach in patients with PsA.