challenging and advanced questions

El calentamiento global es real, de eso no cabe duda. Diferentes medios de comunicacin a nivel mundial transmiten noticias sobre el asunto, algo que est sirviendo para despertar el inters pblico necesario y llevar a cabo medidas al respecto. Aunque an existen personas que prefieren dejar de lado este problema, la concientizacin sobre l ya se est realizando desde los centros educativos, de este modo, las nuevas generaciones estn creciendo con una mentalidad ms acorde. Entonces, solo queda establecer formas y acciones que ayuden a mitigar los efectos que est causando.

Es necesario entender la gravedad que involucra el calentamiento global para la humanidad, para conseguirlo se debe tener en claro de qu se trata. Consiste en el aumento progresivo de la temperatura promedio en el planeta Tierra, tanto en la atmsfera como en los mares. Esto produce variaciones en los patrones climticos, que se ven reflejadas en el retroceso de los glaciares, sequas, alteraciones de hbitats, lluvias, extincin de especies, entre otros.

Q1

Is the use of amlodipine or furosemide recommended to normalize blood

pressure in a case of hypertensive heart failure? If so, which is most

effective?

Q2

How can diabetes cause endothelial dysfunction? What are the roles of

ACE inhibitors in the kinin-kallikrein system? What are the mechanisms

by which a decrease in the level of nitric oxide causes endothelial

dysfunction?

Q3

Can sublingual nifedipine be given to a patient with malignant

hypertension/accelerated hypertension? It seems to be a controversial

issue with some favouring it and some against it.

Q4

Is the diagnosis of malignant hypertension based only on the basis of the

retinopathy (even in the presence of a normotensive state)? Labetalol,

parenterally, is suggested as a treatment for malignant hypertension.

What other more readily available preparations (besides sodium

nitroprusside) are recommended in addition to this drug? Parental

labetalol is not available in Pakistan!

Q5

Patients at medium risk of DVT and pulmonary embolism are usually

given specific prophylaxis with low-dose heparin at a dose of 5000 units

subcutaneously every 8-12 hours until the patient is ambulatory. Is the

Q6

'Anticoagulants are not necessary, as embolism does not occur from

superficial thrombophlebitis' (K&C 7e, p. 809). Why?

Q7

Can we use enoxaparin for deep vein thrombosis (DVT) prophylaxis

in the immediate postoperative period and in a case of cerebral

haemorrhage? Wouldn't it increase the risk of haemorrhage in

either case?

Q8

Can external jugular vein thrombosis cause tingling numbness over

the earlobe and adjoining part of the lower face?

Q9

For how long does a patient have to stay in bed to be labelled as

bedridden and to merit low-molecular-weight heparin (LMWH) as

prophylaxis for deep vein thrombosis?

Q10

Is an inferior vena cava filter an alternative treatment for a patient with

a history of recurrent deep vein thrombosis on lifelong anticoagulation1101120