domingo, 29 de enero de 2012

ESPERANZA PARA LA HEPATITIS C

Imagine, for a moment, that you recently received a brand new Time-O-Matic Time Machine as a gift. How far back would you have to set the dial to see that meaningful progress has been made in the treatment of hepatitis C?

First, let’s say you set the dial to January 2011 and –- Puff-kachunk! — you’re there. Standard treatment for chronic hepatitis C genotype 1 infection consisted of 48 weeks of pegylated interferon-alpha and ribavirin, an approach more likely to produce adverse effects than clearance of the virus.

Your next trip (Zing-kersplat!) takes you to May 2011. The oral serine protease inhibitors boceprevir and telaprevir have just become available for treatment of chronic HCV genotype 1 infection. When added to pegylated interferon and ribavirin, these direct-acting antivirals dramatically improve the rate of sustained virologic response (SVR). But many patients still do not respond to treatment, and medication intolerance remains an issue. You step into your Time-O-Matic and return to January 2012 feeling somewhat discouraged.

Fortunately, this week’s NEJM might raise your spirits. In it, Dr. Anna S. Lok (University of Michigan, Ann Arbor, MI) and colleagues report on an open-label, phase 2a study that used a combination of two direct-acting antivirals to treat chronic HCV genotype 1 infection. Twenty-one ‘null responders’ (patients who failed to achieve ≥2log10 decline in HCV RNA after ≥12 weeks of peginterferon and ribavirin) were randomized to 24 weeks of treatment in one of two treatment arms:

• Group A received BMS-790052 (an oral, first-in-class, NS5A replication complex inhibitor) and BMS-650032 (an oral NS3 protease inhibitor);
• Group B received BMS-790052 and BMS-650032 plus peginterferon alfa-2a and ribavirin.

Four of eleven (36%) patients in Group A and ten of ten (100%) of patients in Group B achieved an undetectable HCV RNA twelve weeks after completion of study treatment (SVR12, the primary end point). There were no deaths, serious adverse events, or discontinuations. The most common mild-to-moderate adverse effects were diarrhea, fatigue, headache, and nausea.

These results are exciting. The high rate of SVR12 achieved in Group B suggests that more effective treatment regimens may soon be available for null responders. But for editorialist Dr Raymond T. Chung (Massachusetts General Hospital, Boston, MA), it’s the Group A proof-of-concept results that really put HCV therapy “on the threshold of a treatment revolution.” The 36% of Group A patients achieving SVR12 demonstrate that combination direct-acting antivirals with non-overlapping resistance profiles can achieve HCV clearance without the use of interferon. If interferon and its adverse effects can be avoided, there is hope that treatment might be offered and accepted by a much greater number of patients.

“Current HCV treatment regimens are far from perfect,“ says primary care physician and NEJM deputy editor Dr. Mary Beth Hamel, “so it’s satisfying to see encouraging results from this kind of early-phase trial. It will be exciting to see what the future brings.”

Curious? Go ahead. Step into the Time-O-Matic and set the dial to see how far HCV therapy has progressed by January 2017. The rest of us, however, will just have to wait

Tomado: Blog NEJM

viernes, 27 de enero de 2012

Fit doctors more likely to talk to patients about weight loss

Overweight physicians don't always address patient weight issues

If you're overweight and trying to lose pounds you may not get help from your doctor if he is overweight too, according to new research.
According to a new study by researchers at the Johns Hopkins Bloomberg School of Public Health, physicians with a normal body mass index were more likely than overweight doctors to engage their obese patients in weight loss discussions.
Normal weight doctors were also more likely to diagnose a patient as obese if they perceived the patient's BMI was equal too or larger than their own.
 The results are featured in the January issue of Obesity.
"Physicians with normal BMI also have greater confidence in their ability to provide diet and exercise counseling and perceive their weight loss advice as trustworthy when compared to overweight or obese physicians," Sara Bleich, lead author of the study and an assistant professor with the Bloomberg School's Department of Health Policy and Management, said in a statement. "In addition, obese physicians had greater confidence in prescribing weight loss medications and were more likely to report success in helping patients lose weight."
The study looked at 500 physicians and how they diagnosed patients. Those with a self-reported BMI below 25 kg/m2 were considered to be of normal weight and physicians reporting a BMI at or above 25 kg/m2 were considered overweight or obese.
The research was supported by in part by the National Heart, Lung and Blood Institute and the Health Resources and Services Administration.
12:22 p.m. ESTJanuary 26, 2012
Copyright © 2012, The Baltimore Sun

jueves, 26 de enero de 2012

APRENDIZAJE BASADO EN UN CASO


38 year-old woman. Admitted for hysterectomy
Normal preoperative laboratory studies. Surgery uneventful
Day 3 - RLE pain and swelling, IV heparin started
Day 8 - RiUpExtr.  pain, cool and dusky, decreased pulses
Right radial artery thrombosis found and Platelet  count 40,000/ul

What is the most likely etiology of the thrombosis ?
What immediate action should be undertaken ?
What additional laboratory assays should be requested

Tomado de
Department of Pathology
Medical College of Virginia

sábado, 21 de enero de 2012

El consumo continuo de alcohol provoca obesidad abdominal

La ingesta de bebidas alcohólicas, y especialmente de cerveza, tiende a producir un aumento del perímetro de la cintura, lo que, a su vez, implica un mayor riesgo de mortalidad en adultos.



La ingesta continua de alcohol está relacionada con la obesidad abdominal, que, a su vez, implica un mayor riesgo de mortalidad en adultos, según las conclusiones de un estudio publicado en European Journal of Clinical Nutrition y recogido por la plataforma SINC.
Los autores del trabajo sugieren que el consumo de alcohol a lo largo de la vida produce adiposidad abdominal con aumento del perímetro de la cintura, y, en los hombres, obesidad general con aumento del Índice de Masa Corporal (IMC).
La investigación, desarrollada durante nueve años, recogió una muestra de 258.177 individuos de entre 25 y 70 años procedentes de Francia, Italia, Grecia, Holanda, Alemania, Suecia, Noruega, Reino Unido y España.
"Es el único estudio realizado hasta la fecha que analiza el consumo de alcohol en una amplia muestra de personas adultas de diferentes regiones europeas y examina el papel de la exposición durante mucho tiempo al alcohol en la obesidad abdominal y general", señala una de sus autoras, María Dolores Chirlaque, investigadora de la Consejería de Sanidad de la Región de Murcia.
El estudio señala que los mayores incrementos del perímetro de la cintura se observan en consumos altos de alcohol, por lo que no desaconseja un consumo moderado.
"Queda ahora por analizar si el abandono del alcohol, o un consumo bajo de éste, revierte la obesidad abdominal y en cuánto tiempo", explica Chirlaque, que también pertenece al Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP).
Más adiposidades con la cerveza
En el estudio se analizaron asimismo los efectos que tenían la cerveza y el vino en la formación de adiposidad, lo que reveló que la primera fomenta en mayor medida la obesidad abdominal.
Así, en los hombres que consumen más de tres vasos de cerveza, el riesgo de desarrollar obesidad abdominal aumenta en un 50%. Por su parte, las mujeres que beben uno o dos vasos diarios a lo largo de la vida contraen un riesgo ligeramente mayor de desarrollar obesidad abdominal que las que no llegan a consumir medio vaso.
Con respecto al vino, las mujeres que toman tres o más vasos tienen más posibilidades (60%) de padecer sobrepeso abdominal que las que no llegan a beber medio vaso. Mientras que, en hombres, este riesgo se sitúa en el 28%.


European Journal of Clinical Nutrition (2011); doi:10.1038/ejcn.2011.70
Tomado de jano.es

lunes, 16 de enero de 2012

Why Coffee Drinking Reduces the Risk of Type 2 Diabetes

 ScienceDaily (Jan. 11, 2012) — Why do heavy coffee drinkers have a lower risk of developing Type 2 diabetes, a disease on the increase around the world that can lead to serious health problems? Scientists are offering a new solution to that long-standing mystery in a report in ACS' Journal of Agricultural & Food Chemistry.

Ling Zheng, Kun Huang and colleagues explain that previous studies show that coffee drinkers are at a lower risk for developing Type 2 diabetes, which accounts for 90-95 percent of diabetes cases in the world. Those studies show that people who drink four or more cups of coffee daily have a 50 percent lower risk of Type 2 diabetes. And every additional cup of coffee brings another decrease in risk of almost 7 percent. Scientists have implicated the misfolding of a substance called human islet amyloid polypeptide (hIAPP) in causing Type 2 diabetes, and some are seeking ways to block that process. Zheng and Huang decided to see if coffee's beneficial effects might be due to substances that block hIAPP.
Indeed, they identified two categories of compounds in coffee that significantly inhibited hIAPP. They suggest that this effect explains why coffee drinkers show a lower risk for developing diabetes. "A beneficial effect may thus be expected for a regular coffee drinker," the researchers conclude.
The authors acknowledge funding from the National Natural Science Foundation of China, the National Basic Research Program of China and the Chinese Ministry of Education.

Biao Cheng, Xinran Liu, Hao Gong, Lianqi Huang, Hong Chen, Xin Zhang, Chuanzhou Li, Muyang Yang, Bingjun Ma, Lihua Jiao, Ling Zheng, Kun Huang. Coffee Components Inhibit Amyloid Formation of Human Islet Amyloid Polypeptide in Vitro: Possible Link between Coffee Consumption and Diabetes MellitusJournal of Agricultural and Food Chemistry, 2011; 59 (24): 13147 DOI:10.1021/jf201702h
American Chemical Society. "Why coffee drinking reduces the risk of Type 2 diabetes."ScienceDaily, 11 Jan. 2012. Web. 16 Jan. 2012.

viernes, 13 de enero de 2012

CRITERIOS DIAGNOTICOS DE LAS ENFERMEDADES REUMATICAS

CRITERIOS DIAGNOSTICO DE LAS ENFERMEDADES REUMATICAS MAS COMUNES
FUENTE:SOCIEDAD ESPAÑOLA DE REUMATOLOGIA

HYPERTENSION- CLINICAL MANAGEMENT OF PRIMARY HYPERTENSION IN ADULTS



Guia Tomada de: National institute for health and clinical Excellence
NICE clinical guideline 127
Developed by the Newcastle Guideline Development and Research Unit and updated by the National Clinical Guideline Centre (formerly the National Collaborating Centre for Chronic Conditions) and the British Hypertension Society



jueves, 12 de enero de 2012

El entrenamiento cerebral con videojuegos mejora algunas funciones cognitivas


Un estudio muestra que juegos como el Tetris o Brain Age contribuyen a mejorar las funciones ejecutivas del cerebro humano.

El videojuego 'Brain Age' puede mejorar algunas funciones cognitivas relativamente rápido, aunque no afecta a la atención ni al estado cognitivo global, según un artículo publicado en PLoS ONE.
El estudio comparó las funciones cognitivas de 32 participantes de edad avanzada, antes y después de cuatro semanas de practicar con el 'Brain Age' o el Tetris durante 15 minutos al día, por lo menos cinco días a la semana.
Al final de las cuatro semanas, los investigadores observaron que los jugadores que practicaron con 'Brain Age' presentaban una pequeña mejoría en sus funciones ejecutivas y su velocidad de procesamiento, aunque otras funciones cognitivas se mantuvieron sin cambios.
Según los investigadores, dirigidos por Rui Nouchi, de la Universidad de Tohoku, en Japón, el tiempo de entrenamiento relativamente corto que se utilizó en el estudio, sugiere que los videojuegos podría mejorar algunas funciones cognitivas con mucha rapidez.
Tomado de: Jano.es