[Importance of NOD2/CARD15 mutations in Crohn's disease].
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Biomedical subjects
Publications and source records attributed to M Díaz-Rubio García.
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The last few years have witnessed radical changes in medical practices due to scientific and technological developments, the population's demands, the evolution of the economy, the optimisation of resources, the Media, not forgetting the major ethical, legal and political aspects, which have changed considerably in just a few years. Basic training, specialised training and ongoing training must allow doctors to assume many of these changes, although in general in should be they who are willing to put such changes into practice. Education and training should be modified to make it easier and faster to assume these changes. Medicine is no longer what it used to be: instead of being limited, knowledge is now boundless, instead of working alone, doctors now work in teams, instead of only the doctor having the information, patients now have it too. There has been a move from the ethics of welfare to the ethics Of autonomy, from problem-free spending to cost containment, from the demand for relief to the demand for treatment and healing, from a call for health to a call for quality of health, from non-judicialisation, and so on and so forth. All these factors have clearly affected the structure of medicine, and it is not surprising that nowadays there is more talk about the prestige of medicine that the prestige of the doctor, as occurred not so many years ago. There is really no substitute for individual attitudes to this situation. The article contains certain considerations about how current changes are affecting doctor's attitudes and the need not only to accept the change but also to lead it. The competitive doctor of today must meet a broad spectrum of requirements, ranging from initiative and flexibility to technological know-how-and capacity. Nowadays society is moving towards a situation in which it not only demands and expects these conditions from its leaders but also from all doctors. Patients have an increasingly higher level of education and, as such, are becoming more demanding because they have tools with which to compare and demand more from doctors.
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The use of vasodilators to prevent the rupture of esophagic varices (EV) due to portal hypertension (PH) would reduce the portal pressure (PP) as the result of increased portocolateral flow. Rinsaterine, a 5-HT2 receptor blocker, reduces PP in experimental models of PH. This pilot study was designed to verify if ritanserine has a sustained and additive effect to propranolol on PP in cirrhotic patients with PH. Ten chronic patients with EV, under prophylactic therapy with propranolol and with a suprahepatic venous pressure gradient (SVPG) > 12 mm Hg, received ritanserine (0.11-0.14 mg/kg/day). One patients completed one month of treatment due to drug intolerance. Nine patients completed one month of treatment; SVPG did not show any significant variation in four patients and decreased 3 mm Hg in five patients, which were treated during 70 days more. After then, HVPG returned to its previous values except in one patient. The long-term association between ritanserine and propranolol does not improve the results of propranolol. However, the initial response observed in all of these patients supports the role of the serotoninergic system in the PH and states the need for further studies on 5-HT2 blocking for the prophylaxis of EV rupture.
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