Internal medicine journal
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Internal medicine journal · May 2016
ReviewRole of long-term mechanical circulatory support in patients with advanced heart failure.
Advanced heart failure represents a small proportion of patients with heart failure that possess high-risk features associated with high hospital readmission rates, significant functional impairment and mortality. Identification of those who have progressed to, or are near a state of advanced heart failure should prompt referral to a service that offers therapies in mechanical circulatory support (MCS) and cardiac transplantation. ⋯ The technology has evolved to such an extent that Destination Therapy is now being utilised as a strategy in management of advanced heart failure in appropriately selected patients. Complication rates have decreased with VAD implantation, but remain a significant consideration in the decision to implant a device, and in the follow up of these patients.
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Internal medicine journal · May 2016
Multicenter Study Observational StudyClopidogrel, prasugrel or ticagrelor in patients with acute coronary syndromes undergoing percutaneous coronary intervention.
Guidelines recommend prasugrel or ticagrelor instead of clopidogrel in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary interventions (PCI). ⋯ Prasugrel and ticagrelor are increasingly used in ACS patients treated with PCI, predominantly in a younger cohort with less comorbidity. Although antiplatelet therapy should still be individualised based on the thrombotic and bleeding risk, our study highlights the safety of the new P2Y12 inhibitors in contemporary Australian practice.
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Concerns have been expressed 'that the physician-researcher is a dying breed'. As yet there are few Australian data. ⋯ Since 1989, more medical graduates are completing SMS PhDs, although more often prior to completing clinical Fellowships, and many have ongoing, albeit low, research activity. Nationally NHMRC project grant success rates have declined significantly, as has the proportion of funded physician-led projects. Medical practitioner salaries from NHMRC and from Universities are less than in public hospitals. The Australian physician-researcher is at-risk. Knowledge and actions are needed to protect our medical research capacity.
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Internal medicine journal · May 2016
Association of the Glu504Lys polymorphism in the aldehyde dehydrogenase 2 gene with endothelium-dependent dilation disorder in Chinese Han patients with essential hypertension.
In essential hypertension (EH), 30-50% of the variability in blood pressure is determined by genetic factors. The aldehyde dehydrogenase 2 (ALDH2) gene Glu504Lys polymorphism is associated with 'alcohol flush' and might be associated with EH. ⋯ The ALDH2 Glu504Lys polymorphism was associated with EDD disorders in Chinese Han patients with EH, providing further evidence that this mutation and 'alcohol flush' are not harmless in this Asian population.