ABSTRACT
La enfermedad renal crónica constituye una patología de prevalencia e impacto creciente en la población mundial por sus múltiples complicaciones, incluyendo un riesgo cardiovascular aumentado, que representa la principal causa de morbimortalidad en pacientes nefrópatas crónicos. Sin embargo, la relevancia de las dislipidemias, especialmente, la hipercolesterolemia LDL, en el deterioro de la función renal y desarrollo de ateroesclerosis en sujetos con daño renal crónico no ha sido claramente establecida. Esta situación ha generado controversia sobre el beneficio real del uso de hipolipemiantes en estos pacientes. En base a la evidencia disponible, incluyendo estudios clínicos recientes, la recomendación más apropiada sugiere que el uso de terapia hipolipemiante basada en estatinas (con o sin ezetimiba) es beneficioso desde un punto de vista cardiovascular en nefrópatas crónicos con insuficiencia renal leve a moderada antes de la diálisis. Por otro lado, no existe evidencia definitiva para apoyar el uso rutinario de este tipo de hipolipemiantes en el manejo del deterioro de la filtración glomerular y/o la proteinuria. Basándose en la evidencia analizada en esta revisión, las futuras guías clínicas para el manejo del daño renal crónico deberán incorporar el uso de estatinas y/o ezetimiba como un elemento más dentro del armamento terapéutico de este tipo de pacientes.(AU)
Chronic kidney disease is a condition of increasing prevalence and impact on the world population by its many complications, including increased cardiovascular risk that represents the leading cause of morbidity and mortality in chronic nephropathy patients. However, the relevance of dyslipidemia, especially high LDL cholesterol, in the impairment of renal function and development of atherosclerosis in subjects with chronic kidney disease has not been clearly established. This situation has generated controversy regarding the real benefit of use of lipid-lowering therapy in these patients. Based on available evidence, including recent clinical studies, the most appropriate recommendation suggests that the use of lipid-lowering therapy based on statins (with or without ezetimibe) is beneficial from a cardiovascular standpoint in chronic nephropathy with mild to moderate renal failure before dialysis. On the other hand, there is no definitive evidence to support the routine use of lipid lowering drugs in the management of impaired glomerular filtration and/or proteinuria. Based on the evidence discussed in this review, future clinical guidelines for management of chronic renal damage should incorporate the use of statins and/or ezetimibe as a key element in the therapeutic armamentarium to be applied in these patients.(AU)
Subject(s)
Humans , Male , Female , Hydroxymethylglutaryl-CoA Reductase Inhibitors , Renal Insufficiency, Chronic , Dialysis , Hypolipidemic AgentsABSTRACT
Las bibliotecas biomédicas han mostrado una evolución acelerada en las últimas décadas, aparejadas al desarrollo tecnológico por una parte y a la velocidad acelerada del desarrollo del conocimiento, por otra. Los niveles de organización de la información han superado los textos en formato de libro y artículo y se han generado bases de datos, que han permitido una organización y presentación del conocimiento en forma distinta. Por otra parte, la portabilidad de la información ha transformado a las bibliotecas en estructuras más parecidas a redes neurales que a extensiones del aula de clases. Estos avances determinan, y lo harán más aun en el futuro, cambios sustantivos en los procesos de enseñanza-aprendizaje en medicina, con alumnos que se encuentran en la práctica rodeados de un aura informática que les acompaña en su quehacer cotidiano, haciendo más eficientes las tomas de decisiones e idealmente, disminuyendo los errores.(AU)
Medical libraries have quickly evolved in the last decades associated with technological progress on one side and the continuing rapid advance in knowledge on the other. The levels of information management have moved beyond simple textbooks and papers into databases, which have allowed us to organize and communicate knowledge in different ways. On the other hand, data mobility have made libraries evolve into structures comparable to neural networks more than extensions of our old classrooms. All this improvements have produced and they will accomplish much more in the future- important changes within teaching-learning processes in Medicine. Medical students are now surrounded by digital fields that are constantly available during their daily tasks, improving their clinical decisions and hopefully reducing errors (AU)
Subject(s)
Education, Medical , Libraries , Organizations , KnowledgeABSTRACT
Myelodysplasia, characterized by varied reductions of peripheral blood elements with normal or hypercellular bone marrow, is reltively frequent among older patients and may evolve to acute leukemia. We reviewed findings in 35 patients whon, according to the FAB classification were distributed as follows: simple refractory anemia (RA) 34%, sideroblastic refractory anemia (SRA) 14%, refractory anemia with excess blast forms (RAEB) 31%, chromic myelomonocytic leukemia (CMML) 12% and refractory anemia eith excess blast forms in transformation (RAEBT 9%). Cytogenetic studies performed in 16 patients were abnormal in 5(31%), al among patients with poor prognosis forms of the disorder. All patients had anemia; thrombopenia and neutropenia were more frequent in subtypes RAEB, CMML and RAEBT). Mean survival rate was 30 months, significantly greater in RA and SRA comapred to the other groups. Infections and development of acute leukemia were the causes of death