Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2014
[The embarrassing lessons of Ebola: scientific knowledge comes too late].
The current Ebola epidemic in Western Africa painfully illustrates both the devastating power of a deadly virus once introduced into a severely compromised health care system, and the unpreparedness of Western countries to respond appropriately. After at least 3857 casualties there has still been hardly any scientific evaluation of therapeutic or preventive treatments. The first uncontrolled observations of a new cocktail of monoclonal antibodies look promising, but given the size of the epidemic, only large-scale vaccination might be sufficient for effective control.
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The response to the Ebola outbreak in West Africa of the governments of Guinea, Sierra Leone and Liberia, local WHO representatives, international organisations with WHO at the helm, and the international community has been much too slow. The help that is now at last being given has come much too late, and, with a few notable exceptions, it is far too little. The European Union, including the Netherlands, is distinguishing itself by its absence. It does not appear to have got through to Europe that, even if it is only in its own interest, it must offer far more help to Guinea, Sierra Leone and Liberia - and quickly.
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The treatment of chronic systolic heart failure has shown important improvements, but there are no evidence-based medical treatment options for patients with diastolic heart failure. A recent elaborate study, the TOPCAT trial, failed to show a beneficial effect of spironolactone on the primary composite endpoint of cardiovascular death or hospital admission for heart failure in patients with heart failure and preserved ejection fraction (HFpEF). ⋯ The difficulties in the study design and in interpreting the results of the TOPCAT study may contribute to this negative conclusion. However, a better understanding of the pathophysiology of HFpEF is needed to find strategies that improve the clinical outcome in patients with diastolic heart failure.
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It has become the rule rather than the exception that junior doctors in training spend 3-4 years on a research project, culminating in a thesis. Without a PhD, clinical career prospects within and outside academia look rather bleak. Here I argue that PhD degrees should be pursued only by the most talented and motivated young clinicians.
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In a reasonably large proportion of patients who take antihypertensive drugs (10-30%), hypertension appears to be therapy resistant; even the use of three antihypertensives does not lower the blood pressure sufficiently. The average nocturnal blood pressure is a better predictor of cardiovascular events than blood pressure measured during the day. ⋯ The exact mechanism of this has not yet been unravelled, but randomised, non-blinded studies suggest that this so-called chronotherapy does indeed lower cardiovascular risk in certain groups. The authors regard this as a promising strategy for patients with therapy-resistant hypertension in whom a nocturnal blood pressure dip does not occur.