Internal and emergency medicine
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Review Meta Analysis
Serum albumin and risk of cardiovascular events in primary and secondary prevention: a systematic review of observational studies and Bayesian meta-regression analysis.
The predictive role of serum albumin (SA) has been evaluated in primary prevention studies. We want to assess the association of SA with the subsequent risk of cardiovascular events (CVE) in primary and secondary prevention studies. We performed a systematic review and Bayesian meta-regression analysis. ⋯ Females and males had a similar risk for CVE (HR 2.46, 95% CI 1.92-3.16, and HR 1.46, 95% CI 1.27-1.69, respectively). We found a similar risk of CVE between primary and secondary prevention studies (HR 1.79, 95% CI 1.5-2.17, and HR 2.47, 95% CI 2.24-2.75, respectively). Low SA levels are associated with an increased risk of CVE, not only in subjects free from CVE, but also in patients who already experienced a CVE.
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Headache is a significant reason for access to Emergency Departments (ED) worldwide. Though primary forms represent the vast majority, the life-threatening potential of secondary forms, such as subarachnoid hemorrage or meningitis, makes it imperative for the ED physician to rule out secondary headaches as first step, based on clinical history, careful physical (especially neurological) examination and, if appropriate, hematochemical analyses, neuroimaging or lumbar puncture. Once secondary forms are excluded, distinction among primary forms should be performed, based on the international headache classification criteria. ⋯ Opioids should be avoided, for their scarce effectiveness in the acute phase, while IV hydration should be limited in cases of ascertained dehydration. Referral of the patient to a Headache Center should subsequently be an integral part of the ED approach to the headache patients, being ascertained that lack of this referral involves a high rate of relapse and new accesses to the ED. More controlled studies are needed to establish specific protocols of management for the headache patient in the ED.
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Transjugular intrahepatic portosystemic shunt (TIPS) represents a very effective treatment of complications of portal hypertension. Established indications to TIPS in cirrhotic patients include portal hypertensive bleeding and refractory ascites. Over the years additional indications have been proposed, such as the treatment of vascular disease of the liver, hepatic hydrothorax, hepatorenal syndrome and bleeding from ectopic varices. ⋯ These issues are particularly relevant considering aging in TIPS candidates in Western countries. Correct selection of patients is mandatory to prevent complications which may eventually frustrate the good hemodynamic results and worsen the patient's quality of life or even life expectancy. The possible role of small diameter TIPS to prevent post-procedural complications is discussed.