RESUMO
BACKGROUND: The relative efficacy of antihypertensive drugs/combinations is not well known. Identifying the most effective ones and the patients' characteristics associated with best performance of the drugs will improve management of hypertensive patients. OBJECTIVE: To assess the blood pressure (BP) reduction attributed to antihypertensive drugs and identify characteristics associated with BP decrease. DATA SOURCES: MEDLINE, Cochrane Central Register of Controlled Trials from inception through July 2012 and selected papers. STUDY ELIGIBILITY CRITERIA: Double-blind, randomized clinical trials whose main result was the reduction in BP by antihypertensive treatment, with study population ≥50 or ≥25 if the study was a crossover, follow-up of at least 8 weeks, and available required data. STUDY APPRAISAL AND SYNTHESIS METHODS: Study data were independently extracted by multiple observers and introduced in an electronic database. Inconsistencies were resolved by discussion and referral back to the original articles. Meta-analysis was performed according to PRISMA statement and using a Bayesian framework. MAIN OUTCOME(S) AND MEASURE(S): Mean decrease in systolic (SBP) and diastolic blood pressure (DBP) achieved by each drug or combination. RESULTS: Two hundred eight trials including 94,305 patients were identified. In monotherapy, most drugs achieved 10 to 15âmm Hg SBP and 8 to 10âmm Hg DBP decreases.Olmesartan/amlodipine, olmesartan/hydrochlorothiazide, felodipine/metoprolol, and valsartan/hydrochlorothiazide were the combinations leading to the greatest mean SBP reductions (>20âmm Hg). Female sex and body mass index >25âkg/m were associated with more pronounced SBP and DBP reductions, whereas Afro-American ethnicity was associated with BP reductions smaller than the median. Results were adjusted by study duration, cardiovascular disease, and diabetes mellitus. Still, the estimation was performed using the mean administered doses, which do not exactly match those of the available drug formats. LIMITATIONS: Data corresponded to those obtained in each of the included trials; the analysis of the combinations was limited to the most recent ones; estimations were performed using the mean administered doses. CONCLUSIONS AND IMPLICATIONS: Certain drug combinations achieve BP reductions ranging from 20 to 25/10 to 15âmm Hg. Sex, ethnicity, and obesity are associated with antihypertensive response. This information can contribute to better selection of the antihypertensive drug, depending on the magnitude of pretreatment BP elevation. Guidelines should be revised.
Assuntos
Anti-Hipertensivos/uso terapêutico , Hipertensão/tratamento farmacológico , População Negra , Quimioterapia Combinada , Humanos , Obesidade/complicações , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores SexuaisRESUMO
Morbid obesity and its complications are an increasingly prevalent problem. Very low calorie diets (VLCD), providing between 450 and 800 kcal per day, are an option increasingly used. After proper patient selection, VLCD can result in significant weight loss in 8-16 weeks, contributing to improve control of chronic complications such as diabetes, hypertension, dyslipidemia (except for initial elevation of HDL cholesterol) and apnea-hypopnea syndrome. VLDC are increasingly used prior to bariatric surgery, showing a decrease in hepatic steatosis and visceral abdominal fat. Although the results of the different studies are controversial, preoperative use of VLDC may decrease the rate of perioperative complications, operative time and hospital length of stay. a drastic decrease in intake occurs after bariatric surgery, with risk of protein deficiency, which should be frequently corrected with supplementation by protein modules. Side effects such as cholelithiasis, hyperuricemia and bone loss among others should be monitored in patients undergoing this type of diet.
La obesidad mórbida y sus complicaciones suponen un problema cada vez más prevalente. Para su abordaje terapéutico existen diferentes modalidades dietéticas, siendo las dietas de muy bajo valor calórico (DMBVC), que aportan entre 450 y 800 kcal diarias, una opción cada vez más utilizada. Tras una adecuada selección del paciente, pueden conseguir una importante pérdida ponderal en 8-16 semanas, contribuyendo a la mejora del control de las complicaciones crónicas como la diabetes, la hipertensión arterial, la dislipemia (salvo por elevación inicial de HDL colesterol) y el síndrome de apnea-hipopnea del sueño. Las dietas muy bajas en calorías son cada vez más utilizadas en el preoperatorio de la cirugía bariátrica, habiéndose demostrado una disminución en la esteatosis hepática y la grasa visceral abdominal. Aunque los resultados de los diferentes estudios son controvertidos, la utilización preoperatoria de estas dietas podrían disminuir la tasa de complicaciones perioperatorias, el tiempo quirúrgico de la intervención y la estancia hospitalaria. Tras la cirugía bariátrica se produce una disminución drástica en la ingesta, con riesgo de déficit proteico en la dieta, que deben ser corregidos con frecuencia con la suplementación mediante módulos de proteínas. Se debe monitorizar a los pacientes sometidos a este tipo de dietas, ante el riesgo de desarrollar efectos secundarios como colelitiasis, hiperuricemia y pérdida de masa ósea entre otros.
Assuntos
Restrição Calórica , Obesidade Mórbida/dietoterapia , Cirurgia Bariátrica , Restrição Calórica/efeitos adversos , Contraindicações , Diabetes Mellitus Tipo 2/prevenção & controle , Dieta Redutora , Humanos , Obesidade Mórbida/cirurgia , Cuidados Pré-OperatóriosAssuntos
Hemoperitônio/etiologia , Doenças Renais Císticas/complicações , Falência Renal Crônica/terapia , Diálise Peritoneal , Adulto , Biópsia , Diagnóstico Diferencial , Hemoperitônio/diagnóstico por imagem , Hemoperitônio/cirurgia , Humanos , Doenças Renais Císticas/diagnóstico , Doenças Renais Císticas/cirurgia , Falência Renal Crônica/diagnóstico , Masculino , Nefrectomia , Ruptura Espontânea/complicações , Ruptura Espontânea/diagnóstico por imagem , Ruptura Espontânea/cirurgia , Tomografia Computadorizada por Raios XRESUMO
Las quemaduras son el traumatismo más grave que el ser humano puede tener, como resultado de la energía térmica sobre la piel y otros tejidos. Más del 50 por ciento de quemaduras en niños ocurre en el hogar, y la causa más frecuente es por la escaldadura con líquidos calientes en la cocina, vaporizaciones o en el baño, seguido por el fogonazo o explosión de líquidos inflamables (gasolina, diesel, solventes, etc.), y en tercer lugar las quemaduras eléctricas, con poca incidencia en nuestro medio. Las quemaduras provocan alteraciones hemodinámicas, cardiopulmonares, renales y metabólicas que hacen necesario, de acuerdo a la profundidad, extensión y localización de la quemadura el sitio donde derivaremos al paciente...