Anales de la Real Academia Nacional de Medicina
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An R Acad Nac Med (Madr) · Jan 2012
[Multidrug-resistant organisms (MDROs) in healthcare associated infections (H.A.Is): one threat above].
The use of antimicrobials has meant for humanity one of the biggest progresses in our recent History and has enhanced an improvement in living conditions (with different nuances depending on the levels of development). Handling of infectious diseases by curing the patient and limiting the transmissions source has been a very remarkable achievement from Public Health, since the second half of the 20th Century. The antibiotic resistance has been recognized with different levels of attention, but it has been acknowledged from the beginning of the Antibiotics era, with different levels of attention. ⋯ Without forgetting, the possibility of exchange of strains, between areas of different care specialties, hospitals, or long-stay Centers in the community/area. There is an evident risk of therapeutical failure and of transmission and clonal spread, to the extent of producing institutional outbreaks, with varied impacts, that are very difficult to control and eliminate. Certainly, a threat that requires an energetic and an urgent call to action.
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Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic cause of end stage renal disease. In addition, end-stage renal disease is complicated by acquired polycystic kidney disease. Recent advances in our understanding of the pathogenesis of ADPKD have identified the primary cilium as key to cystogenesis, and have defined the molecular, cellular and tissue pathogenesis of the disease, leading to the design of clinical trials that may ultimately lead to effective therapy of the disease. In 2012 a key trial has shown that blockade of vasopressin receptors with tolvaptan slows the rate of cyst growth and may slow the loss of renal function.
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An R Acad Nac Med (Madr) · Jan 2009
[Vaccination against herpes-zoster: a new strategy for post-herpetic neuralgia].
Herpes zoster results from reactivation of latent varicella-zoster virus within the sensory ganglia after primary infection. Its presence in adult age is commonly complicated with post-herpetic neuralgia. ⋯ Herpes zoster is an important contributor to morbidity in adults, increased in immunocompromised patients. Recent approval of a safe and effective herpes-zoster vaccine allows the optimization of population immunization strategies and the improvement of the impact of vaccination in herpes-zoster and varicella epidemiology.
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An R Acad Nac Med (Madr) · Jan 2008
Review Comparative Study[Peculiarities of the surgery in the elderly. I. General considerations].
Geriatric surgery has experienced a great development over the past decades, not only because of the aging of the population, but also because of the better understanding of the aging process and technical progress. All these circumstances have expanded surgical supply to the elderly, as well as similar results to those earned in younger patients. ⋯ After considering the concept of surgical risk, we discuss preoperative evaluation of the old patient, plus aspects related to the surgery itself and postoperative recommendations. Finally, we conclude with some ethical considerations about surgery in the elderly.
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Atrial fibrillation (AF) is the most common sustained arrhythmia in clinical practice. It consists in the triggering of 300 to 600 atrial waves per minute. The ventricular rate depends of the AV node refractory period that without treatment it is very high. ⋯ The useful of statins, ARBII and ACEI for the primary and secondary prevention of AF. For symptomatic patients the electrical managing of the AF is the alternative. Cardioversion is performed as part of a rhythm-control treatment strategy but ablation of the perivenosos pulmonary circuits, ablation of the AV node and implantation of a pacemaker are another alternatives.