Minerva medica
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Meningococcal disease continue to have a major public health impact in many countries. Five major groups of Neisseria meningitidis (A, B, C, Y and W135) are responsible for most meningococcal diseases. Plain polysaccharides vaccines for Neisseria meningitidis groups A, C, Y and W-135 have been in use for approximately 20 years, both to prevent invasive disease in high-risk population and to control disease outbreaks. ⋯ Tetravalent serogroup A, C, Y and W135 meningococcal vaccines are under development and one has already been licensed. There is still no universal vaccine available against the serogroup B, which is a major cause of invasive disease. This report summarises the different approaches to the development of vaccines against the pathogenic meningococci.
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Burn trauma is a frequent cause of morbidity and mortality all over the world. Advancements in resuscitation, surgical tecniques, infection control and nutritional/metaolic support decreased mortality and morbidity. This article intends to review current outlines for initial treatment and resuscitation nutritional/metabolic support and wound management peculiar to burn patients.
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Up to 15% of people that are visited in the Emergency Department of a Hospital have a mental disorder and/or a psychiatric symptom: often this is not recognized or not properly treated. The reasons for this are more than one and involve: the emergency physicians that are not always prepared and sensible to face this kind of disorders; the psychiatrists that are not always well tuned with the language and the clinic of the emergency; and the patients, that can ignore or deny the psychiatric nature of their problems. After an initial definitions of the most important terms and concepts (Psychiatric Emergency and Urgency, Behavioral Emergency, Acute Presentations of Mental Disorders, and Crisis) the Medical and Psychiatric Assessment are discussed with different Clinical Presentations and Classifications, Psychosocial Evaluation and Risk Assessment. Finally the Clinical Management and the Pharmacological Treatment are presented with special attention to the underlying medical causes and to the use of new drugs, especially second generation antipsychotics, alone or combined with benzodiazepines.
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Electrical storm is the clustering of hemodynamically destabilizing ventricular tachycardia or ventricular fibrillation that typically requires multiple electrical cardioversions or defibrillations within a 24-hour period. Electrical storm is frequently seen in the acute phase of myocardial infarction, in patients with the genetic arrhythmia syndromes, and in patients with implanted cardioverters-defibrillators. ⋯ In this review we present the most common conditions associated with electrical storm, therapeutic options for suppression of electrical storm, and new investigational techniques emerging for the treatment of electrical storm in refractory cases. The management of this life threatening arrhythmia typically requires the coordinated efforts of emergency medicine, critical care, cardiology, cardiac electrophysiology, and pacemaker experts.
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Natural history of patients with acute myocardial infarction has significantly improved in the last 20 years. The main reason for this progress was the introduction of effective reperfusion strategies. It has been clearly documented that the speed, extension, and duration of reperfusion are key prognostic factors. Mechanical reperfusion during primary percutaneous coronary interventions has been shown to be superior to fibrinolysis in order to achieve these ⋯ All the techniques able to positively interact with the ischemia-reperfusion process and that have been evaluated so far (stent, adjunctive pharmacological therapy, anti-embolic devices, etc.) will be discussed.