We report trends in manifestations, treatment, and outcomes of 355 children with culture-confirmed melioidosis over 10 years at a pediatric hospital in northern Cambodia. Bacteremia and presentation ...with pneumonia were risk factors for death. A total of 39 children recovered after being given only oral antimicrobial drug treatment.
There are fundamental biological processes that are important for brain function, but these are significantly influenced by psychological and social factors that mediate both brain development and ...subsequent brain function.7 There are associations between genetic endowment and risk of psychosis but also factors that are linked to the development of the brain, such as childhood trauma or early separation from a parent. The impact of biological factors, such as cannabis or genes, are significantly influenced by psychological and social factors.7 A person's risk of developing schizophrenia relies on an interplay between biological, psychological, and social risk factors at individual and ecological levels that interact over time.8 It may be that not only the causation of the disorder but also the progress and prognosis have a similarly wide-ranging etiology.
Treatment-resistant depression (TRD) presents many challenges for both patients and physicians. This review aims to evaluate the current status of the field of TRD and reflects the main findings of a ...consensus meeting held in September 2009. Literature searches were also conducted using PubMed and EMBASE. Abstracts of the retrieved articles were reviewed independently by the authors for inclusion. Evaluation of the clinical evidence in TRD is complicated by the absence of a validated definition, and there is a need to move away from traditional definitions of remission based on severity of symptoms to one that includes normalisation of functioning. One potential way of improving treatment of TRD is through the use of predictive biomarkers and clinical variables. The advent of new treatments may also help by focusing on neurotransmitters other than serotonin. Strategies such as the switching of antidepressants, use of combination therapy with lithium, atypical antipsychotics and other pharmacological agents can improve outcomes, and techniques such as deep brain stimulation and vagus nerve stimulation have shown promising early results. Despite consistent advances in the pharmacotherapy of mood disorders in the last decade, high rates of TRD are still a challenging aspect of overall management.
Povećanje udjela bolesnika s kontroliranom arterijskom hipertenzijom uključuje bolje razumijevanje i sustavan pristup bolesnicima s rezistentnom arterijskom hipertenzijom (RAH). Proteklih desetljeća ...primijećeno je povećanje prevalencije RAH te je učestalost ovog problema veća i u praksi liječnika obiteljske medicine. Pacijenti s RAH imaju povećanu prevalenciju oštećenja ciljnih organa u odnosu na pacijente koji postižu ciljne vrijednosti arterijskog tlaka te im je rizik od neželjenog kardiovaskularnog događaja (KV) trostruko veći. RAH se defi nira kao hipertenzija kod koje se unatoč promjenama životnog stila, uzimanju najmanje tri antihipertenzivna lijeka u punim dozama, od kojih jedan mora biti diuretik, ne postiže zadovoljavajuća kontrola arterijskog tlaka. Prije postavljanja dijagnoze RAH bitno je isključiti prividne uzroke (nepridržavanje liječenja, neadekvatno doziranje, nepravilnosti u mjerenju krvnog tlaka) te pseudorezistenciju (hipertenziju bijelog ogrtača). Najznačajniji rizični čimbenici za rezistenciju na liječenje su starija životna dob, debljina, pušenje, pretjerani unos soli i alkohola, postojanje hipertrofije lijeve klijetke, kronično bubrežno zatajivanje, dijabetes, neadekvatan barorefleksni luk, kronični stres i pridružena psihička stanja, upotreba nekih lijekova i svi oblici sekundarne hipertenzije. Petina bolesnika s RAH ima primarni aldosteronizam. Opstruktivna apneja u snu (OAS) čest je uzrok RAH, a u literaturi se navodi sve veća učestalost. Optimalno liječenje uključuje kombinaciju tri lijeka od kojih je jedan diuretik. Upotreba mineralokortikoidnog antagonista kao četvrtog lijeka pokazala je značajnu učinkovitost čak i u bolesnika koji nemaju povišenu razinu aldosterona. Nove invazivne metode liječenja obuhvaćaju renalnu denervaciju i trajnu električnu stimulaciju karotidnog sinusa. Cilj ovog rada je naglasiti važnost RAH kao čimbenika KV rizika te značenja ranog prepoznavanja i liječenja na razini obiteljske medicine kao i pravodobnog upućivanja na daljnje postupke radi liječenja specifičnih oblika RAH.
This chapter contains sections titled:
Introduction
The importance of follow‐up
Suboptimal treatment compliance
Approaches for improving treatment compliance
Organisation and delivery of care
...Conclusions
References
Further reading
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