Dtsch Arztebl Int
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Review Meta Analysis
The diagnosis and treatment of hypertensive disorders of pregnancy: new findings for antenatal and inpatient care.
Hypertensive disorders of pregnancy (HDP) are among the leading causes of maternal and fetal morbidity and mortality. New guidelines and findings from clinical trials must be taken into account so that the diagnosis and treatment of HDP can be optimized. ⋯ Aside from hypertension and proteinuria, the definition of preeclampsia (PE) should also take organ dysfunction into account. Important aspects of antenatal care include the following: the early recognition of risk factors, measurement of the uterine arteries in the 1st and 2nd trimesters with Doppler ultrasonography (A diagnostic tool which is now well established), prophylactic oral administration of 100 mg of acetylsalicylic acid daily from the beginning of pregnancy, particularly in high-risk patients (EL I++), and appropriate measurement of blood pressure and urinary protein. Patients should be hospitalized whenever indicated. Therapeutic goals are adequate treatment of hypertension, as well as seizure prophylaxis with magnesium sulphate in severe preeclampsia to prevent maternal cerebrovascular complications (EL I++). If delivery is indicated, it should be performed, regardless of the gestational age (EL IV). Careful monitoring during the puerperium and a general medical review six weeks after delivery are essential. Women with preeclampsia have a significantly elevated long-term risk of developing cardiovascular diseases in later life (EL I++).
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The role of placebos is often misunderstood, leading both to overvaluation and to inappropriate disdain. The effect of a placebo that contains no pharmacologically active substance is often confused with the effect of administration by a physician. The aim of this article is to review the current data on placebos, evaluate these data critically, and provide a well-founded and understandable explanation of the effects that placebos do and do not possess. ⋯ The mechanisms of action of placebo administration, with which positive therapeutic effects can be achieved with little effort, should be consciously exploited by physicians when giving their patients pharmacologically active medications as well.
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Even though the performance of coronary diagnostic and therapeutic procedures through the distal forearm arteries has become a well-established practice, only a small minority of procedures employ transcarpal approach. The aim of this review is to describe the state of art in cardiac catheterization through distal forearm arteries, to point out the advantages and disadvantages of this approach, and to discuss the specific aspects in which it differs from the transfemoral approach. ⋯ The current data give a favorable view of this procedure as long as its specific requirements in terms of pretreatment, choice of materials, technique, post-procedural care, and expertise of the physician are taken into account.
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Review Meta Analysis
The morbidity and mortality associated with overweight and obesity in adulthood: a systematic review.
Overweight and obesity are generally thought to elevate morbidity and mortality. New data call this supposed association into question. ⋯ The prevailing notion that overweight increases morbidity and mortality, as compared to so-called normal weight, is in need of further specification. Obesity, however, is indeed associated with an elevated risk for most of the diseases studied.