Medicina Clinica Practica最新文献

Introduction and objectives

Dizziness, including vertigo, imbalance, and presyncope, affects 15–20% of adults, increasing the risk of falls, especially in the elderly. The interaction between signals from the peripheral vestibular system, vestibular nuclei, and the central nervous system, modulated by neurotransmitters such as glutamate, acetylcholine, and glycine, along with histamine, adrenaline, and noradrenaline, is crucial for balance. Dizziness arises when vestibular information does not match other sources and can be associated with various neurological, psychiatric, respiratory, or infectious conditions. Current treatment is based on rest, particle replacement maneuvers and medications such as betahistine and sedatives, but the fixed combination of cinnarizine and dimenhydrinate has proven effective in clinical trials, effectively treating vertigo of various origins by acting on peripheral and central vestibular systems.

Patients

We present 7 clinical cases, in which we have used the same treatment with cinnarizine and dimenhydrate at fixed doses of 20/40 mg.

Results

The combination of cinnarizine and dimenhydrinate proved effective in managing a variety of vestibular disorders, including recurrent benign paroxysmal positional vertigo, vestibular migraine, Meniere's syndrome, and presbivestibulopathy. Patients experienced improvement in vestibular symptoms, such as dizziness, vertigo, and imbalance, proving to be a safe and effective drug, demonstrating in some cases the resolution of symptoms in patients previously treated with other therapies.

Conclusion

The versatility of the combination allows its use in the treatment of vertigo of various origins, making it a comprehensive and valuable option for situations where the precise diagnosis of the causes of vertigo is not clear.

Objectives

This article aims to discuss the transformative impact of artificial intelligence (AI) on the identification and management of breast diseases, with a specific focus on breast cancer.

Materials and methods

Healthcare providers have integrated AI technologies such as surgical robots and remote monitoring systems to improve the accuracy and efficiency of breast disease diagnosis and treatment.

Results

Surgical robots equipped with AI algorithms provide real-time guidance to surgeons, analyze imaging data, and ensure precise procedures for better outcomes in breast cancer surgeries. AI-driven remote monitoring systems allow for close monitoring of patient health data, disease progression prediction, and personalized treatment recommendations.

Conclusions

The incorporation of AI technology into healthcare practices for breast diseases has revolutionized patient care delivery, enhancing outcomes, promoting patient engagement, and improving overall quality of care. These advancements offer personalized and tailored healthcare strategies that meet the unique needs of each patient, reshaping the healthcare industry.

Salmonellosis is a disease that can become systemic, especially in immunosuppressed patients. However, the case of a 28-year-old male patient with no comorbidities is presented, who was admitted with a history of fever, hepatosplenomegaly, acute kidney injury with proteinuria, and lymphopenia, following ingestion of food at an unsanitary site. Salmonella typhi was identified in 3 blood cultures, and the patient responded favorably to antibiotic treatment.

Objectives

The aim is to determine hidden chronic kidney disease (CKD) and its relationship with the appearance of cardiovascular events (CVD) and mortality. Furthermore, the aim is to identify cardiovascular risk factors (CVRF) and calculate the degree of control of diabetes mellitus (DM) type 2 and dyslipidemia (DLP) prior to CVD.

Material and methods

It consists of a retrospective cohort study carried out in the Basic Health Zones (BHZ) of San Agustín, (population of 33,321 users) which consists of the health centers San Agustín, Illes Columbretes, and the auxiliary clinics of Borriol and Raval; and on the other hand, the BHZ of Almassora (25,831 users), calculated in analysis between January 2015 and December 2018. The main variables were CKD, CVD, mortality and CVRFs.

Results

Final sample of 243 patients from two cohorts of 135 without CKD and 99 with CKD (36.4% occult CKD). The HR of developing CVD was 4.28 and mortality was 12.3 in the group with CKD compared to the group without CKD. Regarding the relationship of CVRFs prior to the appearance of CVD, in the cohort with CKD, hypertension (HTA), DLP, and type 2 DM had significant results, compared to the cohort without CKD. Likewise, in the CKD cohort the percentage of DLP control was less than 50.0%, and greater than 66.66% in DM type 2.

Conclusions

It is observed that a third of patients are not diagnosed with CKD, which has a high probability of developing CVD or death. Given the lack of diagnosis, interventions in the control of DLP and DM type 2 are lower.

Innovation and discovery are the drivers of progress in medicine, which is an ever-changing science. Core concepts in current medical practice include patient-centered and high-value care, evidence-based and personalized medicine, and digital health, that is gaining momentum. Rampant progress is seen in technology development, artificial intelligence, machine learning, large language models such as ChatGPT. Their use in medicine has promising perspectives, conditioned by adequate regulations, based on ethical principles and human-rights, to ensure safety of patient data, fact accuracy, and general applicability.

The future of medicine should aim for universal health coverage, facilitated by digital medicine and guided by empathy and compassion. Human interaction will remain a mainstay in medical practice, and ideally technology will provide the much-needed time for doctor–patient bonding. Climate change, cyber security, and access to basic care are some of the challenges to be resolved in the years to come.

Future medical care should find the balance between high tech and high touch and aim to for global availability.

Technology has become an essential element for the progress of medicine as it applies the scientific knowledge to professional practice. In recent years, it has grown significantly and has occupied important places in medical practice. As a result, it has been raised whether it could aggravate the current process of medical dehumanization experienced that has been repeatedly denounced. In fact, the traditional dilemma arises as to whether medicine is only an applied science that solves strictly biological problems and that the elements of medical humanism could be ignored. This situation is complicated by the widespread access to medical information that patients use to better understand their illnesses. This article analyzes the relationship between new technologies applied to medicine and their influence on medical humanism. It concludes that technology offers a possibility of defining an improved model of doctor-patient relationship if it is implemented considering the principles of traditional medical humanism.

Background

The present study was carried out to evaluate the effect of melatonin and placebo in the patients with atypical facial pain (AFP).

Method

This double blind randomized controlled study was carried out on 30 patients who were suffering from AFP. During this period, patients were divided in 2 study and control groups. Then, they were treated with melatonin. Melatonin group used four 3-mg daily and placebo group received 4 placebo which were similar in size, shape, color with melatonin until the end of treatment, and then the severity of burning sensation was measured by physician. Sleep quality was measured using the visual analog scale using the Petersburg questionnaire.

Result

The results of the present study show that the use of melatonin and placebo in patients with AFP reduces sensation and improves their sleep quality, although it may not reduce it completely. In this study, severity of burning was 5.71 ± 1.42 after treatment in the study group and 5.93 ± 2.65 in the control group, which was not statistically significant (p = .46). The mean score of sleep before treatment was not significantly different between the study (9 ± 1.23) and the control (8 ± 1.56) groups. The mean score of sleep after treatment between the study group (8 ± 1.45) and the control group (7 ± 1.23) was not significantly different (p = .43).

Conclusion

According to the result of the study, melatonin was not superior placebo in treatment of AFP.