Revue médicale suisse
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Fibromyalgia is nowadays an object of controversy. It is the most significant painful and chronic pathology, with a prevalence of 2 to 4% in the general population and a ratio of 3.5% of women for 0.5% of men. ⋯ The use of these criteria in practice has proved to be controversial and a wide range of studies has shown that an important percentage of patients with fibromyalgia are diagnosed without the criteria of the ACR. This article describes an alternative method for the diagnosis of fibromyalgia.
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Loop diuretics are commonly prescribed within different clinical settings to prevent and or to treat acute renal failure. In most cases they facilitate fluid management following an increased urine output. ⋯ Glomerular filtration rate did not improve with the administration of loop diuretics after continuous renal replacement therapy. The administration of loop diuretics in the management of acute renal failure should be mainly restricted to patients with hypervolemia.
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Acute kidney injury is associated with higher risk of chronic kidney disease or death. Diagnosis is based on increased serum creatinin, most often several days after the initial renal injury. Several novel biomarkers are being studied and validated in clinical settings. ⋯ They seem also to predict mortality and the need of dialysis. In the near future, these biomarkers could affect the way we treat patients with acute kidney injury, as well as their evolution. However, the real challenge will be in using the best combination of biomarkers and in the correct interpretation of their results.
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Revue médicale suisse · Mar 2011
[Sodium bicarbonate to slow the progression of chronic kidney disease].
Metabolic acidosis is a prevalent complication in moderate and late stages of chronic kidney disease (CKD). It is established that the correction of metabolic acidosis may improve metabolic bone disorders and protein degradation in the skeletal muscle, two characteristic complications of patients with advanced CKD. In the last 18 months, three randomized controlled trials have drawn the attention on a novel indication to correct metabolic acidosis in these patients, i.e., halting CKD progression. These data show that sodium bicarbonate, a cheap and easily manageable treatment, may delay the progression of CKD and the need of a renal replacement therapy such as dialysis or kidney transplantation.
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Revue médicale suisse · Feb 2011
[Group B meningococcal invasive infections: an unresolved public health problem].
Group B meningococcal infections represent 64% of the invasive meningococcal infections in Switzerland. While conjugate vaccine against group C meningococcus is part of the additional vaccinations of the Swiss vaccinal calendar and quadrivalent vaccines protect against serogroups A, C, Y, and W135, there is presently no available vaccine against group B meningococcus in Switzerland. The use of the capsular polysaccharide from the group B meningococcus is ineffective and possibly dangerous because of its similarity with an adhesion molecule of the human neuronal cells. Development of new vaccines with other antigenic targets gives hope for an optimal protection not only against group B meningococcus, but also against other serogroups that share same antigenic determinants.