Presse Med
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High blood pressure in black subjects has been recognized as a clinical entity because of high prevalence, frequent severe complications and pathophysiological and therapeutic specificities. Results from 52 centers in 32 countries show wide variability. In the black population in United States, mean systolic and diastolic blood pressure levels are high, 128/81 mmHg, with a prevalence of hypertension reaching 33.5%, while an ethnic population in Kenya has low mean levels, 110/68 mmHg, with a hypertension prevalence of only 5%. ⋯ However, risk factors including over-weight, alcohol consumption, sodium intake and the socioeconomic environment have been shown to explain most of the differences between the white and the black populations. Differences in diagnosis and management may also play a role. Indeed, while genetic selection may have had an effect, there is no current scientific data which would justify using the colour of the skin as a genetic marker for high blood pressure.
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Review Historical Article
[Intensive care. Birth and development of a concept].
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Moraxella (Branhamella) catarrhalis, a commensal organism of the oropharyngeal flora, has been considered a potential pathogen since the early 1970s, mainly causing otitis in infants and exacerbations of chronic bronchitis in the elderly or in immunosuppressed adults. This view was initially based on the isolation of M. catarrhalis during infections: a density of at least 10(7)/ml of sputum, particularly when it exceeds that of other organisms by at least 100-fold, is considered to indicate the responsibility of M. catarrhalis. The pathogenic potential of M. catarrhalis was proven by the increase in specific serum antibodies (total, IgG, IgA) in patients infected by this organism. Given the large proportion (60 percent) of strains that produce beta-lactamase, antibiotic therapy is based on a combination of amoxycillin and clavulanic acid (or another penicillin/beta-lactamase inhibitor combination) or a third-generation cephalosporin; tetracyclines or macrolides can also be used.
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Editorial Review
[Non steroidal anti-inflammatory agents marketed as analgesics].
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Bacterial meningitis mortality largely results from the intense host inflammation response to infection. Lysis of bacteria releases bacterial components that stimulate production of cytokines. Cerebrospinal fluid concentrations of these cytokines have been shown to correlate with the severity of the meningitis in both experimental and clinical situations. ⋯ It is prudent to administer dexamethasone before the first parenteral dose of antibiotic to prevent the release of bacterial components induced by bacterial lysis. The search for agents that down modulate inflammation more strongly continues. Some monoclonal antibodies are superior to dexamethasone in experimental meningitis without modification of antibiotic pharmacokinetics.