Presse Med
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Treatment of pulmonary arterial hypertension (PAH) attempts to counteract the deleterious effects of pulmonary vasoconstriction, pulmonary vascular remodeling, thrombosis and right heart dysfunction. The development of therapies targeting the endothelial dysfunction (endothelin-receptor antagonists, prostacyclin derivatives, phosphodiesterase type 5 inhibitors) has markedly improved patients' prognosis. Intravenous epoprostenol remains the first line treatment for the most severe patients (NYHA [New York Heart Association] functional class IV). ⋯ Recommendations in pediatric PAH are equivalent to those proposed in adults. Randomised studies are rare and pharmacokinetics data for available drugs are scarce. The impact of these new therapeutic approaches on long-term survival of patients with PAH is a major challenge in the near future.
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Infective endocarditis (IE) is a severe form of valve disease still associated with a high mortality (10-26 % in-hospital mortality). IE is a rare disease, with reported incidences ranging from 3 to 10 episodes/100,000 people per year. The epidemiological profile of IE has changed over the last few years, with newer predisposing factors - valve prostheses, degenerative valve sclerosis, intravenous drug abuse (IVDA), associated with the increased use of invasive procedures at risk for bacteremia. ⋯ HF is the most frequent and severe complication of IE. Unless severe comorbidity exists, the presence of HF indicates early surgery. The new guidelines give for the first time informations not only on the indications of surgery, but also on the timing of surgery.
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Randomized Controlled Trial Multicenter Study Comparative Study
[Treating pain after dental surgery: a randomised, controlled, double-blind trial to assess a new formulation of paracetamol, opium powder and caffeine versus tramadol or placebo].
The aim of this study was to evaluate the analgesic efficacy and the safety of the association, paracetamol, opium prepared and caffeine, in two different dosages as compared to the conventional analgesic tramadol hydrochloride, on acute postoperative dental pain. ⋯ This study evidenced the non-inferiority of the paracetamol, caffeine, and opium 25mg or 50mg vs. tramadol 100, and even though the strengths of the tested formulations were higher than that of the 2009, commercialised formulation of paracetamol, caffeine, and opium, efficacy was not offset by an alteration of the well recognised safety profile of the less strengthened formulation of the product being in use for decades.
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The restless legs syndrome (RLS) is a chronic sensori-motor disorder characterized by a complaint of an irresistible urge to move the legs. This urge can often be accompanied by pain or other unpleasant sensations, it either occurs or worsens with rest, particularly at night, and temporarily improves with activity. Prevalence estimates vary between 7.2% and 11.5% of the Caucasian adult population. ⋯ Although RLS is mainly idiopathic, several clinical conditions have been associated with it, mainly pregnancy, iron deficiency with or without anemia, end-stage renal disease and peripheral neuropathy. RLS is often underdiagnosed and there is a clear need for complementary education to improve the accurate diagnosis of RLS. Indeed, a better knowledge of this syndrome is a prerequisite to prompt an appropriate therapeutic management.