RESUMEN
In 2007, several international studies brought useful information for the daily work of internists in hospital settings. This summary is of course subjective but reflects the interests and questions of the chief residents of the Department of internal medicine who wrote this article like an original trip in medical literature. This trip will allow you to review some aspects of important fields such as heart failure, diabetes, endocarditis, COPD, and quality of care. Besides the growing diversity of the fields covered by internal medicine, these various topics underline also the uncertainty internists have to face in a practice directed towards evidence.
Asunto(s)
Medicina Interna , Cuerpo Médico de Hospitales , Accidentes por Caídas/prevención & control , Anciano , Albuterol/análogos & derivados , Albuterol/uso terapéutico , Anemia/tratamiento farmacológico , Anticoagulantes/uso terapéutico , Antagonistas de los Receptores de Hormonas Antidiuréticas , Fibrilación Atrial/etiología , Actitud del Personal de Salud , Benzazepinas/uso terapéutico , Bronquitis Crónica/tratamiento farmacológico , Broncodilatadores/uso terapéutico , Estimulación Cardíaca Artificial/métodos , Diabetes Mellitus/etiología , Endocarditis Bacteriana/prevención & control , Eritropoyetina/uso terapéutico , Insuficiencia Cardíaca/tratamiento farmacológico , Heparina/uso terapéutico , Humanos , Relaciones Interprofesionales , Infarto del Miocardio/complicaciones , Infarto del Miocardio/tratamiento farmacológico , Proteínas Recombinantes , Gestión de Riesgos , Rosiglitazona , Xinafoato de Salmeterol , Tiazolidinedionas/uso terapéutico , Tromboembolia/prevención & control , Tolvaptán , Vasodilatadores/uso terapéutico , Disfunción Ventricular Izquierda/terapia , Carga de TrabajoRESUMEN
Clinical practice in internal medicine has fundamentely changed over the last decade. Our knowledge has dramatically improved and we are facing new types of patients. Their number is increasing, they are older and suffer from increasingly complex medical conditions. The society has evolved as well therefore transforming our daily practice. This implies important modifications of our role and new challenges. We must also develop new aspects of our practice such as recognizing our errors, quality of care, quality of education, ethics, new strategies for taking care of the patient all this in parallel with continuous education. Our role as (general practitioner) is of utmost importance since it enables us to keep the "big pictures" in a more and more specialized environment.
Asunto(s)
Medicina Interna/educación , Medicina Interna/normas , Internado y ResidenciaRESUMEN
Systemic amyloidosis with cardiac involvement may clinically be suspected in the presence of heart failure or arrhythmia of unknown origin. Herein two cases of cardiac amyloidosis are described with a clinical presentation of heart failure refractory to usual treatment. The key role of echocardiography in the diagnosis and prognosis evaluation of cardiac amyloidosis is discussed. A treatment targeted against the generation of amyloid fibril should ideally be initiated before apparition of heart failure.
Asunto(s)
Amiloidosis/diagnóstico por imagen , Cardiomiopatías/diagnóstico por imagen , Ecocardiografía , Anciano , Amiloidosis/patología , Amiloidosis/terapia , Biopsia , Cardiomiopatías/patología , Cardiomiopatías/terapia , Diagnóstico Diferencial , Electrocardiografía , Resultado Fatal , Insuficiencia Cardíaca/diagnóstico por imagen , Insuficiencia Cardíaca/patología , Insuficiencia Cardíaca/terapia , Humanos , Persona de Mediana Edad , Pronóstico , Tejido Subcutáneo/patologíaRESUMEN
OBJECTIVE: Lipid disorders associated with the use of protease inhibitors may contribute to the premature development of atherosclerosis. The purpose of the present study was to determine whether the administration of a protease inhibitor-containing regimen to middle-aged (30-50 years) HIV-infected individuals for 6 months or longer is associated with an increased prevalence of atherosclerosis. METHODS: High-resolution B-mode ultrasound imaging was used to visualize the femoral and carotid arteries of 68 HIV-negative and 168 HIV-infected individuals, including 136 patients who had received protease inhibitors for 26.8 +/- 8.9 months (mean +/- SD). Atherogenic plaques were defined as a thickening of the intima-media > or = 1200 mm. RESULTS: The proportion of participants with one or more plaques was higher in the HIV-infected group in comparison with the HIV-negative group (55 versus 38%; P = 0.02), and so was the prevalence of cigarette smoking (61 versus 46%; P = 0.03) and hyperlipidaemia (56 versus 24%; P < 0.001). The presence of plaque was independently associated with age, male gender, plasma low-density lipoprotein cholesterol levels and smoking. In univariate logistic regression analysis, an association was also found with HIV infection. Among HIV-infected subjects protease inhibitor therapy was not associated with the presence of plaque. CONCLUSIONS: A large proportion of the middle-aged HIV-infected individuals examined during this study had one or more atherosclerotic plaques within the femoral or carotid arteries. The presence of peripheral atherosclerosis within this population is not associated with the use of protease inhibitors, but rather with 'classic' cardiovascular risk factors such as smoking and hyperlipidaemia, which are amenable to interventions.