Assuntos
Doença Pulmonar Obstrutiva Crônica , Silicose , Humanos , Espirometria , Tomografia , OxigênioRESUMO
An overview of ethics and clinical ethics is presented in this review. The 4 main ethical principles, that is beneficence, nonmaleficence, autonomy, and justice, are defined and explained. Informed consent, truth-telling, and confidentiality spring from the principle of autonomy, and each of them is discussed. In patient care situations, not infrequently, there are conflicts between ethical principles (especially between beneficence and autonomy). A four-pronged systematic approach to ethical problem-solving and several illustrative cases of conflicts are presented. Comments following the cases highlight the ethical principles involved and clarify the resolution of these conflicts. A model for patient care, with caring as its central element, that integrates ethical aspects (intertwined with professionalism) with clinical and technical expertise desired of a physician is illustrated.
Assuntos
Beneficência , Ética Clínica , Assistência Centrada no Paciente/ética , Autonomia Pessoal , Justiça Social , Confidencialidade/ética , Humanos , Consentimento Livre e Esclarecido/ética , Princípios Morais , Negociação , Resolução de Problemas , Revelação da Verdade/éticaRESUMO
Atherosclerosis, a systemic disease, is the predominant cause of cardiovascular disease (CVD) that far exceeds other causes (egs: congenital, hypertension, arrhythmia). CVD is the leading cause of mortality globally (18 million lives, including 9 million from coronary artery disease (CAD) annually).1 The Global Burden of Disease study reported that in the year 2017, India had one of the highest mortality, most of them premature, from CVD (2.64 million, women 1.18, men 1.45) and CAD (1.54 million, women 0.62, men 0.92) in the world.2 A systemic disease of this magnitude and impact warrants a proactive preventive strategy and not a reactive, invasive and focal approach. In this editorial, we call for a wider use of statins in Indians, explain our rationale based on risk factors and risk-enhancing factors, and present a simplified and cost effective approach to combat CVD.
Assuntos
Aterosclerose/prevenção & controle , Doença da Artéria Coronariana/prevenção & controle , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Prevenção Primária/métodos , Adulto , Aterosclerose/epidemiologia , Doença da Artéria Coronariana/epidemiologia , Feminino , Humanos , Incidência , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Fatores de RiscoAssuntos
Sistemas Eletrônicos de Liberação de Nicotina , Lesão Pulmonar , Vaping , Centers for Disease Control and Prevention, U.S./legislação & jurisprudência , Centers for Disease Control and Prevention, U.S./tendências , Aprovação de Equipamentos/legislação & jurisprudência , Humanos , Lesão Pulmonar/induzido quimicamente , Lesão Pulmonar/diagnóstico , Lesão Pulmonar/epidemiologia , Lesão Pulmonar/prevenção & controle , Medição de Risco , Abandono do Hábito de Fumar/métodos , Abandono do Hábito de Fumar/estatística & dados numéricos , Estados Unidos/epidemiologia , Vaping/efeitos adversos , Vaping/epidemiologia , Vaping/legislação & jurisprudênciaAssuntos
Pneumopatias , Administração dos Cuidados ao Paciente/métodos , Saúde Pública , Poluição do Ar em Ambientes Fechados/prevenção & controle , Mudança Climática , Humanos , Pneumopatias/epidemiologia , Pneumopatias/etiologia , Pneumopatias/terapia , Saúde Ocupacional , Saúde Pública/métodos , Saúde Pública/normas , Saúde Pública/tendências , Fatores de RiscoRESUMO
Malignant coronary artery disease (CAD) refers to a severe and extensive atherosclerotic process involving multiple coronary arteries in young individuals (aged <45 years in men and <50 years in women) with a low or no burden of established risk factors. Indians, in general, develop acute myocardial infarction (AMI) about 10 years earlier; AMI rates are threefold to fivefold higher in young Indians than in other populations. Although established CAD risk factors have a predictive value, they do not fully account for the excessive burden of CAD in young Indians. Lipoprotein(a) (Lp(a)) is increasingly recognized as the strongest known genetic risk factor for premature CAD, with high levels observed in Indians with malignant CAD. High Lp(a) levels confer a twofold to threefold risk of CAD-a risk similar to that of established risk factors, including diabetes. South Asians have the second highest Lp(a) levels and the highest risk of AMI from the elevated levels, more than double the risk observed in people of European descent. Approximately 25% of Indians and other South Asians have elevated Lp(a) levels (≥50 mg/dl), rendering Lp(a) a risk factor of great importance, similar to or surpassing diabetes. Lp(a) measurement is ready for clinical use and should be an essential part of all CAD research in Indians.
Assuntos
Doença da Artéria Coronariana/sangue , Hiperlipoproteinemias/complicações , Lipoproteína(a)/sangue , Adulto , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/mortalidade , Etnicidade , Feminino , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
Lipoprotein(a) [Lp(a)] is a circulating lipoprotein, and its level is largely determined by variation in the Lp(a) gene (LPA) locus encoding apo(a). Genetic variation in the LPA gene that increases Lp(a) level also increases coronary artery disease (CAD) risk, suggesting that Lp(a) is a causal factor for CAD risk. Lp(a) is the preferential lipoprotein carrier for oxidized phospholipids (OxPL), a proatherogenic and proinflammatory biomarker. Lp(a) adversely affects endothelial function, inflammation, oxidative stress, fibrinolysis, and plaque stability, leading to accelerated atherothrombosis and premature CAD. The INTER-HEART Study has established the usefulness of Lp(a) in assessing the risk of acute myocardial infarction in ethnically diverse populations with South Asians having the highest risk and population attributable risk. The 2018 Cholesterol Clinical Practice Guideline have recognized elevated Lp(a) as an atherosclerotic cardiovascular disease risk enhancer for initiating or intensifying statin therapy.