Potential possibility of phosphocreatine usage in internal medicine.

Adenosintriphosphate is basic unit of cellular energetics, although during situations of high energy demand, cell had developed metabolic inert molecules - phosphagens - including phosphocreatine. Nowadays there are not so many recent publications describing positive effect of phosphocreatine supplementation., its potential benefit in supplementation is mainly in cardiology - acute myocardial infarction, acute or chronic heart failure. Another field of medicine with potential use of phosphocreatine is nephrology - in dialysis patients, or in psotemnopausal women in prevention of osteoporosis. In following article, we present review of studies describing positive effect of using phosphocreatine in specific group of patients in internal medicine. Key words: ATP - ischemia - phosphagens - phosphocreatine.

[2018 scientific breakthroughs in ambulatory general internal medicine]. / Avancées scientifiques de 2018 en médecine interne générale ambulatoire.

Mindfulness meditation and cognitive-behavioral therapy are more cost-effective than conventional management of chronic low back pain. Women with iron deficiency can be treated with oral iron substitution every other day to improve tolerance. Smokers who smoke four or less cigarettes per day have a disproportionately high risk of cardiovascular and cerebrovascular events. All antidepressants are effective in cases of severe depression. Cannabis derivatives have no analgesic effect and do not improve the quality of life of people with neuropathic pain. Cognitive training is effective in cases of mild cognitive impairment. Delegated medical protocols can aid with blood pressure control in hypertensive patients. Nitrofurantoin is the antibiotic of choice for uncomplicated cystitis.

La méditation de pleine conscience et la thérapie cognitivo-comportementale présentent un profil coût-efficacité plus avantageux qu'une prise en charge classique des lombalgies chroniques. Les femmes avec un déficit en fer peuvent être traitées par une substitution orale en fer prise un jour sur deux afin d'améliorer la tolérance. Les fumeurs de 4 ou moins cigarettes par jour ont un risque d'événement cardiovasculaire et cérébrovasculaire élevé. Les antidépresseurs sont tous efficaces en cas d'état dépressif sévère. Les dérivés du cannabis n'ont pas d'effet antalgique significatif et n'améliorent pas la qualité de vie des personnes avec douleurs neuropathiques. L'entraînement cognitif est efficace en cas de déficit cognitif léger. L'hypertension artérielle peut être contrôlée par des protocoles médico-délégués. La nitrofurantoïne est l'antibiotique de choix en cas de cystite non compliquée.

[What's new in Ambulatory General Internal Medicine ?] / Quoi de neuf en médecine interne générale ambulatoire ?

Many treatments are used every day in general medicine without any evidence of their efficacy. This last year, three randomised studies tried to prove the clinical utility of chondroitin/glucosamine in arthritis, cranberry in urinary infections, and acupuncture in migraine. Screening and management of prostate cancer are still controversial. Two recent studies help us advising our patients on this difficult topic. Muscle side effects from statins are well known and have been widely relayed by the press these last years, although myopathies are rare in clinical trials. A new study try to determine if negative expectations could favor such adverse events.

De nombreuses thérapies sont utilisées quotidiennement en médecine générale sans que leur efficacité n'ait jamais été démontrée. L'année dernière, trois études randomisées ont tenté de prouver l'utilité de la chondroïtine/glucosamine dans l'arthrose, de la canneberge dans l'infection urinaire et de l'acupuncture dans la migraine. Le dépistage et la prise en charge du cancer de la prostate restent à ce jour sujets à controverse. Deux études récentes nous aident à mieux conseiller nos patients sur ce sujet épineux. Les effets secondaires musculaires des statines sont connus de beaucoup et ont été largement relayés par la presse ces dernières années bien que les cas de myopathie soient rarement observés dans les études. Une nouvelle étude tente de déterminer si un phénomène d'anticipation négative pourrait avoir un rôle dans la survenue de tels effets indésirables.

La Medicina Interna del siglo xxi: estándares de organización y funcionamiento / The Internal Medicine of the 21st century: organizational and operational standards

La Sociedad Española de Medicina Interna ha elaborado un documento de consenso sobre los estándares y recomendaciones que considera fundamentales en la organización de las unidades de Medicina Interna para desarrollar sus actividades con eficiencia y calidad. Se definieron 3 grupos de procesos clave: la atención al paciente adulto agudamente enfermo, el estudio del paciente con un diagnóstico difícil sin enfermedad específica de órgano y la asistencia integral del paciente crónico complejo. Como procesos de soporte se identificaron la estructura y el funcionamiento de las unidades de Medicina Interna, y como procesos estratégicos, la formación y la investigación. A continuación, se estructuraron los principales subprocesos y se establecieron los estándares y recomendaciones para cada uno de ellos. Por último, se proponen las cargas de trabajo derivadas. Los estándares elaborados deben ser revisados en el plazo máximo de 4 años (AU)

The Spanish Society of Internal Medicine has developed a consensus document on the standards and recommendations that they consider essential to the organisation of internal medicine units for conducting their activities efficiently and with high quality. We defined 3 groups of key processes: the care of acutely ill adult patients, the comprehensive care of complex chronic patients and the examination of a patient with a difficult diagnosis and no organ-specific disease. As support processes, we identified the structure and operation of the Internal Medicine units. As strategic processes, we identified training and research. The main subprocesses are structured below, and we established the standards and recommendations for each of them. Lastly, we proposed resulting workloads. The prepared standards must be reviewed within a maximum of 4 years (AU)

[2016 literature findings in internal general medicine]. / Acquisitions thérapeutiques en médecine ambulatoire en 2016.

Treatment with diclofenac appears to be more effective compared to other NSAIDs in the treatment of osteoarthritis of the large joints. Opioids do not diminish significantly the pain in chronic lower back pain. Degenerative tears of the meniscus, without signs of osteoarthritis, should be treated conservatively. Acute appendicitis without perforation signs should be treated conservatively if possible. Mindfulness meditation could prevent the recurrence of episodes in major depression. Oropharyngeal exercises could reduce the frequency and intensity of snoring. The choice of treatment in Helicobacter pylori infection must consider its effectiveness and tolerance. Concomitant use of statins and vitamin D could be an interesting alternative treatment in migraines.

Le traitement par diclofénac semble être le plus efficace comparé aux autres AINS dans le traitement de la gonarthrose et de la coxarthrose. Les opioïdes ne diminuent pas la douleur de manière significative lors de lombalgies chroniques. Les ruptures dégénératives du ménisque, sans signe d'arthrose, devraient être traitées conservativement. L'appendicite aiguë sans signe de perforation devrait l'être également. La méditation en pleine conscience permettrait de prévenir les récidives lors de dépression majeure. Les exercices oropharyngés pourraient réduire la fréquence et l'intensité des ronflements. Le choix du traitement éradicateur de l'Helicobacter pylori doit tenir compte de son effectivité et de sa tolérance. La prise de statines et de vitamine D constituerait une alternative lors de migraines.

[Geriatrics - an interdisciplinary challenge]. / Geriatrie - eine interdisziplinäre Herausforderung.

The care of elderly patients will continue to challenge the healthcare system over the next decades. As a rule geriatric patients suffer from multimorbidities with complex disease patterns, and the ability to cope with everyday life is severely reduced. Treatment is provided by a multiprofessional geriatric team, and the primary goal is improvement of functional status, quality of life in the social environment and autonomy by employing a holistic approach. In Germany geriatric care is provided by physicians from various medical specialties (e.g. general practitioners, internists, neurologists and psychiatrists). In the training for the subspecialty clinical geriatrics, these specialties enjoy equal rights. Recent efforts to establish a qualification as physician for internal medicine and geriatrics have initiated a discussion to make the suitability for qualification as a geriatrician dependent on the medical specialty. Geriatric patients benefit from multidisciplinary cooperation. Neurologists possess great expertise in the treatment of patients with dementia, depression, delirium, consequences of degenerative spinal cord diseases and vertebral bone fractures, stroke, Parkinson's syndrome, epileptic seizures, vertigo and dizziness, neuropathies, lesions of peripheral nerves and in the multimodal therapy of pain. To function in a position of responsibility in a geriatric department, neurologists need skills in general internal medicine. These are acquired either on a geriatric ward or during specialization as a neurologist by full time secondment to large neurological or interdisciplinary intensive care units.

Internal medicine, art and science in the third millennium.

Internal medicine, art and science in the third millennium is a statement that Medicine is not only science. It acts on the sick individual to reestablish a natural state as a curative art. Medical art, commissioned by an individual or a society, is service. It requires vocation to obtain satisfaction. However due to the incidence of value changes, market globalization, technological and industrial development, the patient/physician relationship is becoming a user/provider relationship. Physician-related factors such as a higher health care demand, resource shortage and a progressive specialization have also influenced this change of paradigm. This is causing dissatisfaction, loss of self-esteem and a lower ethical commitment among professionals. We need to recover a professional repertoire of ideas in the context of a global ethics. Responsibility and co-responsibility are ethical principles addressed to technological civilizations and their collateral effects on people and environment that lead to a "responsible globalization". We also need a scientific futurology to define risks and avoid errors. In this era of progressive specialization, Internal Medicine, with its holistic vision of mankind, may play a fundamental role in the field of bioethics.

Internal medicine, art and science in the third millennium / Medicina interna, arte y ciencia en el tercer milenio

Internal medicine, art and science in the third millennium is a statement that Medicine is not only science. It acts on the sick individual to reestablish a natural state as a curative art. Medical art, commissioned by an individual or a society, is service. It requires vocation to obtain satisfaction. However due to the incidence of value changes, market globalization, technological and industrial development, the patient/physician relationship is becoming a user/provider relationship. Physician-related factors such as a higher health care demand, resource shortage and a progressive specialization have also influenced this change of paradigm. This is causing dissatisfaction, loss of self-esteem and a lower ethical commitment among professionals. We need to recover a professional repertoire of ideas in the context of a global ethics. Responsibility and co-responsibility are ethical principles addressed to technological civilizations and their collateral effects on people and environment that lead to a "responsible globalization". We also need a scientific futurology to define risks and avoid errors. In this era of progressive specialization, Internal Medicine, with its holistic vision of mankind, may play a fundamental role in the field of bioethics.

Medicina Interna, Arte y Ciencia en el Tercer Milenio", expresa que la medicina no es exclusivamente ciencia. Tiene de sí actuar hábilmente sobre el hombre enfermo, (arte curativo), buscando restablecer un estado natural. El arte médico, comisionado por el enfermo o por la sociedad, es servicio. Requiere vocación, obteniendo su propia satisfacción. Sin embargo, la relación "paciente / médico", se ha visto transformada actualmente en "usuario /prestador", Incidiendo factores generales, tales como cambios valóricos, preeminencia del mercado (globalización), desarrollo de la tecnología e industria, y además factores propiamente médicos: mayor demanda asistencial, escasez de recursos, progresiva especialización, presencia de gestores no médicos, y otros. Ello ha provocado en los médicos insatisfacción, pérdida de autoestima y menor compromiso ético. Necesitamos recuperar un ideario profesional, en el contexto de una "ética global". El "principio de la responsabilidad" (Jonas) o la "corresponsabilidad" (Apel), son éticas destinadas a la civilización tecnológica y a sus efectos colaterales sobre las personas y el medio ambiente, conducentes a una "globalización responsable". Necesitamos, además, estimular el desarrollo de una "futurología científica" que permita definir los riesgos a evitar o los errores a corregir. En esta era de creciente especialización, la Medicina Interna, beneficiaria de la mejor tradición médica por su visión holística del hombre, puede y debe jugar un rol fundamental en el campo de la Bioética.

[Plea for internal medicine. Views of a sociologist and an internal medicine physician on the future of internal medicine]. / Plaidoyer pour la médecine interne. Regards croisés d'un sociologue et d'un interniste sur l'avenir de la médecine interne.

In France the internal medicine was born at the end of the 1950s and developed as a speciality like others in the 1960s. Nevertheless, it could now be considered as facing a specific crossroad. The evolution of a broad and holistic understanding of medicine has been weakened for years by the parallel outcome of growing and multi-specialisation. In the same time, the way to consider our welfare state changed into an overwhelming necessity of cost-efficiency, of evidence based knowledge and costs, regarded as new and compulsory rules. The process of specialisation has been reinforced by these recent trends. Could we and should we carry on like that without asking the sense and the attempted light at the end of the way? Are the internist and general practitioner definitely over? Specialists everywhere and nothing else? Which and who could make sense and priorities facing the growing complexity? The authors wanted to assess the new role of internal medicine as the most relevant way to manage both progress and sense in medical care and development.

Medicine of complexity: the modern internal medicine.

Complexity bears its methodological and doctrinal contribution to the general health and medical assistance management, as well as to the clinical context and medical training. Internal Medicine possesses the cultural and methodological tools to confront the challenge of complexity which modern medicine. The science of complexity has suggested an alternative model in which the disease as well as the patients general well-being are the results of a complex interaction between various elements of the entire system, dynamic and unique, in the individual.

SEMI, en la sociedad científica del siglo XXI: lo que hemos hecho en el año 2009 y lo que vamos a hacer en el 2010 / SEMI, in the Scientific Society of the XXI Century: what we did during 2009 and what we are going to do in 2010

En el presente trabajo se revisan las principales acciones que la Sociedad Española de Medicina Interna (SEMI) ha realizado a lo largo del último año. También se anuncian los proyectos de inmediato desarrollo durante el año 2010. En 2009 se persiguió mejorar la política de comunicación, consolidar y agilizar la estructura de la Sociedad con la creación de una comisión permanente, estimular las actividades de los Grupos de Trabajo estratégicos, así como la promoción de nuevos modelos organizativos. Se constituyó un nuevo Grupo de Trabajo sobre Medicina Interna en la práctica privada. Se han diseñado también nuevos proyectos e iniciativas como el proyecto de Informe de Alta Hospitalaria, Estudio MIR y Medicina Interna en la Universidad. Estos proyectos se concretarán en los próximos meses y nos van a fortalecer como especialistas de prestigio. La SEMI continúa un camino positivo en su proyección, modernización y búsqueda de la participación activa de sus miembros. Revista Clínica Española, órgano de expresión de la SEMI, ha experimentado un gran impulso con el nuevo equipo directivo constituido en el año 2009. Nuestra revista debe ser una pieza clave en el futuro de la Sociedad(AU)

The principal actions carried out by the Spanish Society of Internal Medicine (SEMI) during the last year are reviewed in this work. The projects that are going to be developed immediately in 2010 are also announced. In 2009, it was aimed to improve the communication policy, consolidate and strengthen the structure of the Society with the creation of a permanent committee, stimulate the activities of the strategic Work Groups and the promotion of new organizational models. A new Work Group was established on Internal Medicine in private practice. New projects and initiatives were also designed, such as the project of Hospital Discharge Report, Study of Residents and Internal Medicine in the University. These projects will be established within the next months and they will strengthen us as specialists of prestige. The SEMI is continuing along a positive pathway in its projection, modernization and search for the active participation of its members. The Journal, Revista Clínica Española, official publication of the SEMI, has experienced an important impulse with the new administrative team formed in the year 2009. Our journal should be a key piece in the future of the Society(AU)

Cancer survivorship care: exploring the role of the general internist.

According to the National Cancer Institute (NCI), cancer survivorship encompasses the "physical, psychosocial, and economic issues of cancer from diagnosis until the end of life." Today, one in 30 Americans are cancer survivors. Almost two-thirds have at least one chronic health condition. As the numbers of cancer survivors increase, cancer itself can be viewed as a chronic medical condition. This paper illustrates some of the challenges faced by cancer survivors. We discuss the limitations of current models of survivorship care, including shared care. In addition, we explore how the American Board of Internal Medicine's previously proposed credential of Comprehensive Care Internist could serve to define and integrate the complex needs of adult cancer survivors with the skills and talents of general internists.

Chronic disease in the elderly: a vital rationale for the revival of internal medicine.

The phenomenon of population aging has led to a significant rise in the chronic disease rate compared to other human pathologies. Elderly people are usually affected by > or =2 chronic diseases concomitantly, mainly cardiovascular, pulmonary, and central nervous system diseases, metabolic disturbances and cancer. Chronic comorbidities in elderly patients may worsen their clinical status, making both the diagnosis and treatment more difficult. Meanwhile, contemporary medicine is focused on its subspecialties, thus turning away from the tradition of great, academic-based, general internal medicine. Clinical practice is dominated by a specific approach to a single disease rather than a patient with comorbidities. Therefore, an accurate diagnosis, ensuring effective treatment in the case of a complex and ambiguous clinical picture, is based on an attempt to combine multiple expert consultations rather than make a holistic evaluation, so characteristic of traditional internal medicine. For that reason, pathophysiology and clinical picture of a chronic disease in the elderly requires the revival of internal medicine, which is also essential to the development of geriatrics.

[What's new in internal medicine?]. / Quoi de neuf en médecine interne.

Brief virologic news included the discovery of the virophage, a unique parasite of the giant mimivirus and the association of HHV-8 infection with a peculiar form of African diabetes. Secondly, this news focused on risk factors for arterial or venous thrombosis and therapy for auto-immune disorders. Only oral estrogen therapy increases the risk of venous thromboembolism in postmenopausal women. Despite significant homocysteine lowering, vitamin supplementation with folic acid, vitamins B6 and B12 did not reduce total cardiovascular events among high-risk patients. Patients with venous thromboembolism have a substantially increased long-term risk of subsequent cardiovascular events while obesity, systemic arterial hypertension, and diabetes are common risk factors for arterial and venous thrombosis. The non fasting ApoB/ApoA1 ratio was superior to any of the cholesterol ratios for estimation of the risk of acute myocardial infection in all ethnic groups. Preventive anticoagulation of in-patients with risk of venous thromboembolism was inadequately prescribed in many hospitals of the world. Subcutaneous administration of methotrexate was more effective than the oral administration at the same dosage in patients suffering from active rheumatoid arthritis. Hydroxychloroquine directly reduces the binding of antiphospholipid antibody-beta2-glycoprotein I complexes to phospholipid bilayers. Anti-IL-5 and anti-IL-6 antibodies were effective for the treatment of respectively hypereosinophilic syndrome and rheumatoid arthritis. The efficacy of proteasome inhibitors and mesenchymal stems cells have been demonstrated in respectively two mouse strains with lupus-like disease and steroid-resistant severe acute graft-versus-host disease. These treatments may be useful for auto-immune disorders if their long term toxicity is acceptable. In conclusion, subcutaneous injections of physiological saline, used as placebo in two different trials, enhanced in vitro activation of immunocompetent cells in healthy individuals.