In subjects with essential hypertension, increased cardiac and radial artery mass are positively associated. The mechanical factor that contributes in the larger extent to their enhancement is pulse ...pressure, not mean arterial pressure.
In the nineteenth century, épidémies of peurperal fever ravaged maternity homes and childbirth wards in hospitals. By mid-century, the search for the causes of these epidemies had become a major ...subject of debate at the Academy of Medicine, but the the mechanisms were not clearly revealed until the 1880's. In this article we propose to underscore the relationship between the progression of invasive médical procédures and the occurrence of the épidémies. Technical progress (instruments, surgical procédures and anesthesia) brought about a growing recourse to invasive techniques , but this progress coincided with an increase in the fever épidémies , which were particularly lethal between 1 850 and 1870. We have attempted to show the reactions of the médical corps confronting this scourge as well as the repercussions on the understanding of the phenomenon of contagion prior to the antiseptic révolution.
Au XIXe siècle, les épidémies de fièvre puerpérale ont exercé des ravages dans les maternités et les services d'accouchement hospitalier. Dès le milieu du siècle, la question de la recherche des causes de ces épidémies a occupé les débats à l'Académie de Médecine mais les mécanismes n'ont pu être clairement mis en évidence que dans les années 1880. Nous nous sommes proposés dans cet article de mettre en évidence les relations entre la progression des gestes médicaux invasifs et la survenue des épidémies. En effet, le progrès des techniques (instruments, procédés opératoires et anesthésie) a entraîné un recours croissant aux gestes invasifs. Or, ce progrès coïncide avec une augmentation des épidémies de fièvre, lesquelles ont été particulièrement meurtrières entre 1850 et 1870. Nous avons tenté de montrer les réactions du corps médical face à ce fléau ainsi que les répercussions sur la compréhension du phénomène contagieux jusqu'à la révolution antiseptique.
Diagnosis and treatment of high blood pressure: internationals standards and divergences. High blood pressure affects more than 1.4 billion people worldwide and this number is increasing. Three ...international recommendations were published between 2017 and 2018. Essential hypertension is defined differently from one recommendation to another; AHA/ACC recommendations retain 130/80 mmHg, compared to 140/90 mmHg for Canada and Europe, resulting in a higher prevalence of hypertension. The management of hypertensive patients is based on 2 axes: a non-pharmacological axis that must be recalled at each consultation, and a pharmacological axis; for which the American and European guidelines recommend the introduction of a dual therapy, pharmacologically complementary, when initiating treatment in hypertensive patients. Blood pressure targets are lower in the United States than in Canada and Europe.
PRESCRIPTION OF FIXED DOSE COMBINATIONS OF ANTIHYPERTENSIVE DRUGS. Many fixed-dose antihypertensive combinations are available for treating hypertension. Compared to free associations, fixed-dose ...combinations have major advantages including a well-defined dose-ratio and a better adherence. The later leads to higher antihypertensive efficacy and faster blood pressure lowering effect, particularly interesting in patients at high cardiovascular risk, and to a lower cost of global medical care. However, fixed-dose combinations have some theorical limitations that need to be evaluated in clinical practice: a reduced detection of the possible inefficacy of one of the medications, a reduced possibility of combining different dosages, an increased risk of misuse, and a higher risk of complications in case of non-adherence. Fixed-dose combination therapies are insufficiently prescribed for first-line antihypertensive treatment despite an increasing level of evidence and their recommendations by learned societies. Triple fixed-dose combinations, prescribed as second-line antihypertensive treatment, are not yet reimbursed by health care systems. Drug companies should be encouraged to perform large randomized controlled clinical trials, in order to demonstrate that fixeddose combination therapies, prescribed first-line, increase short and long-term adherence compared to free associations, and thus lower blood pressure to a higher extent, ultimately leading to a lower incidence of cardiovascular complications.
De quoi les enfants souffrent-ils ? Où les soigner et les accueillir ? Comment et quand les vacciner ? Dans la théorie et la pratique médicales, le souci de l’enfance a une histoire, non linéaire et ...aux multiples facettes, que ce livre veut explorer. Il montre, à travers une série d’éclairages variés et détaillés, la manière dont la conscience d’une spécificité de l’enfant a contribué à modeler la médecine depuis l’époque moderne. Les enfants sont tour à tour, de la part des parents, des médecins ou de l’État, objets de curiosité scientifique, de sollicitude ou encore d’inquiétude. Des études savantes, que viennent enrichir les témoignages de deux médecins, font se croiser l’histoire de la pensée médicale, des pratiques vaccinales, de l’architecture hospitalière et des institutions de la santé publique. Les textes de cet ouvrage sont issus d’un colloque tenu en septembre 2018 à l’Université de Picardie Jules Verne et à l’Académie nationale de médecine.
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