Medicina clinica
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Letter Case Reports
Atypical presentation of infective endocarditis due to Granulicatella adiacens.
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Pulmonary arterial hypertension (PAH) is a severe, high mortality and progressive disease. Early diagnosis and treatment improves the prognosis. Patients with scleroderma disease presents high risk of developing PAH. Established screening strategies - echocardiogram and DETECT algorithm - recognize the disease when it is already advanced. Cardiopulmonary exercise testing (CPET) detects pulmonary vascular injury in earlier stages. ⋯ CPET and exercise RHC could detect PAH earlier than established screening in patients with scleroderma disease, allowing early diagnosis.
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Opioid dependence is causing an epidemic in the US, but unlike the 1970s it seems more related to prescription opioids than heroin. ⋯ There has been no worrying increase in heroin or prescription opioid abuse in our setting.