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In severe symptomatic aortic stenosis (AS), surgical AVR improves mortality, but there is no medical therapy proven to slow progression of the valvular stenosis. Because AS is accompanied by left ventricular (LV) hypertrophy and fibrosis, and because the risk factors for AS are similar to those for coronary artery disease (CAD), it makes sense that blockade of the renin-angiotensin system may benefit patients with AS.
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In this study from a single medical ICU, prompting physicians to discuss all six items on a daily rounding checklist, as compared with the use of the same checklist without prompting, significantly improved several processes of care and appeared to decrease length of stay and mortality as well.
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Patients who have had percutaneous coronary intervention (PCI) with either bare metal stents (BMS) or drug-eluting stents (DES) require dual antiplatelet therapy until the stent struts are endothelialized. However, patients who have had prior PCI often need to undergo surgery.
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Admission to an ICU increased risk for unintentional medication discontinuation in four of five medication groups commonly used to manage a chronic illness.
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Vaccination has dramatically reduced the number of cases of chickenpox, measles, polio, mumps, and pertussis treated in primary care settings. Antibiotic treatment of streptococcal pharyngitis has reduced the number of cases of rheumatic fever. As a result, there are generations of physicians who have never encountered patients with these diseases. These diseases are often relegated to the historical section of general medical textbooks. However, recent isolated outbreaks in adults as well as children have brought these diseases back into the forefront for primary care providers.
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Trauma continues to be a significant cause of morbidity and mortality. Accidental death remained the fifth most common cause of death for all ages in 2009. Thoracic injuries reportedly have been involved in up to 75% of all deaths related to trauma and may be directly responsible in up to 25% of these deaths.
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The authors conclude that this large observational study suggests ACEI or ARB therapy is associated with an improved survival and a lower risk of cardiovascular events in patients with aortic stenosis.
