Minerva medica
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The electrocardiogram shows a sequence of cardiac electrical events generated by individual electrical currents generated mainly by sodium (Na+), potassium (K+) and calcium (Ca++) ions transiting via specialized transport pathways, such as ion channels, inserted in the membranes of excitable cardiac cells. Na+ and Ca++, entering the cells, are messengers of activating, inward, depolarizing currents (INa, ICa), generating the QRS wave of the electrocardiogram, whereas K+, leaving the cells, carries outward repolarizing currents (e.g. Ito, IKr, IKs and IK1), generating the T wave of the electrocardiogram, which drives the cell to a rest condition. ⋯ Presently, drug candidates are routinely subjected to preclinical and clinical examination for cardiac safety, a property required by health authorities for any new medicine before allowing marketing authorization. Finally, before prescribing a medicinal product prolonging QT interval, a physician should carefully evaluate not only the disease he wants to treat but also the availability of equally effective, alternative drugs. The golden rule, to which such a prescription has always to abide, requires that the beneficial effects expected from a therapy should for each treated patient outweigh any possible adverse consequence, particularly when the latter one could be of lethal nature.
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Postoperative adjuvant radiotherapy is used to reduce local recurrences following breast-conserving surgery for early breast cancer. This review examines factors that may be used to select patients at low risk of local failure following breast-conserving surgery alone.
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Older individuals (subjects aged >65 years) largely contribute to the percentage deaths due to myocardial infarction (MI) and stroke. The incidence of venous thromboembolism (VTE) is also higher >65 years old patients. However, the risk of bleeding complications in patients on antithrombotic drugs increases with age and with clinical conditions, as cognitive/psychiatric diseases, traumas, hypertension, poor compliance with medications, common in the elderly. ⋯ As to prophylaxis of VTE in surgery, in subjects at low-moderate risk, or in medical patients, low-dose heparin or low-dose LMWHs are effective. As to prophylaxis of VTE in surgery in subjects at high risk, adjusted-dose heparin or high-dose LMWHs are recommended. Finally, as to prevention of stroke in patients older than 75 with atrial fibrillation (AF), warfarin is of choice.
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Systemic vasculitides are multisystem diseases characterised pathologically by necrotising inflammation of blood vessels. The clinical presentation of vasculitis depends on the vessels involved. ⋯ It will examine the clinical characteristics of these diseases, the use of ANCA in diagnosis and monitoring of disease along with current and novel treatment strategies. The immunopathology of the ANCA-associated vasculitides will also be explored reviewing the roles of ANCA, neutrophils, T cells and apoptosis in the production of disease.
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Glaucoma is the leading cause of irreversible blindness worldwide. The World Health Organization reported in 1995 that 5.1 million persons were bilaterally blind from glaucoma. Its morbidity and prevalence make it a significant public health problem. ⋯ Treatment of glaucoma consists of topical or systemic intraocular pressure lowering agents, laser treatment or surgery. Primary Open Angle Glaucoma is an often-unrecognized disease due to its slow course and lack of symptoms. Because the decline in vision may be slowed but not restored by treatment, it is important that this condition be diagnosed early in its course.