Medicina paliativa en pacientes con insuficiencia cardiaca avanzada: nuevas evidencias / Palliative medicine for patients with advanced heart failure: new evidence

A pesar de que la insuficiencia cardiaca es uno de los síndromes clínicos más frecuentes en medicina y de su elevada mortalidad, pocos son los pacientes que se benefician del acceso a unos cuidados paliativos adecuados a su situación clínica. Recientemente se han publicado varios ensayos para comprobar la utilidad de iniciar tratamiento paliativo junto con el tratamiento cardiológico en pacientes con insuficiencia cardiaca avanzada. En la presente revisión se analizan aspectos sobre el diagnóstico y el control de síntomas de pacientes con insuficiencia cardiaca avanzada, y se ofrece una recopilación de ensayos clínicos que analizan la eficacia de una intervención paliativa en este grupo de pacientes. Es preciso dotar al médico de estrategias para reconocer la necesidad de este tipo de intervenciones sin que ello implique descuidar el tratamiento activo de su insuficiencia cardiaca

Although heart failure is one of the most common clinical syndromes in medicine and has a high mortality rate, few patients have access to adequate palliative care for their clinical situation. Several trials have recently been published on the usefulness of starting palliative treatment along with cardiac treatment for patients with advanced heart failure. In this review, we analyse the aspects of diagnosing and controlling the symptoms of patients with advanced heart failure and provide a collection of clinical trials that have analysed the efficacy of a palliative intervention in this patient group. Physicians need to be equipped with strategies for recognizing the need for this type of intervention without it resulting in neglecting the active treatment of the patient's heart failure

Palliative medicine for patients with advanced heart failure: New evidence. / Medicina paliativa en pacientes con insuficiencia cardiaca avanzada: Nuevas evidencias.

Although heart failure is one of the most common clinical syndromes in medicine and has a high mortality rate, few patients have access to adequate palliative care for their clinical situation. Several trials have recently been published on the usefulness of starting palliative treatment along with cardiac treatment for patients with advanced heart failure. In this review, we analyse the aspects of diagnosing and controlling the symptoms of patients with advanced heart failure and provide a collection of clinical trials that have analysed the efficacy of a palliative intervention in this patient group. Physicians need to be equipped with strategies for recognizing the need for this type of intervention without it resulting in neglecting the active treatment of the patient's heart failure.

Mutagenesis of 16S rRNA C1409-G1491 base-pair differentiates between 6'OH and 6'NH3+ aminoglycosides.

Using a single rRNA allelic Gram-positive model system, we systematically mutagenized 16S rRNA positions 1409 and 1491 to probe the functional relevance of structural interactions between aminoglycoside antibiotics and the A-site rRNA that were suggested by X-ray crystallography. At the structural level, the interaction of the 2-deoxystreptamine aminoglycosides with the rRNA base-pair C1409-G1491 has been suggested to involve the following features: (i) ring I of the disubstituted 2-deoxystreptamines stacks upon G1491 and H-bonds to the Watson-Crick edge of A1408; (ii) ring III of the 4,5-disubstituted aminoglycosides shows hydrogen bonding to G1491. However, we found that mutants with altered 16S rRNA bases 1409 and 1491 discriminated poorly between 4,5-disubstituted and 4,6-disubstituted 2-deoxystreptamines, but differentially affected aminoglycosides with a hydroxyl group versus an ammonium group at position 6' of ring I, e.g. G1491U conferred high-level drug resistance to paromomycin and geneticin, but not to neomycin, tobramycin or gentamicin.