Substituting With Smokeless Tobacco Saves Lives, Research Suggests

Substituting smokeless tobacco products can save smokers' lives, and there is a scientific foundation that proves it.

That is the message Brad Rodu, D.D.S., professor of medicine at the University of Louisville (UofL) School of Medicine and the Endowed Chair in Tobacco Harm Reduction at UofL's James Graham Brown Cancer Center, delivered at the Annual Meeting of the American Association for the Advancement of Science Feb. 18. Rodu spoke at the session, "Harm Reduction: Policy Change to Reduce the Global Toll of Smoking-Related Disease."

"Quit or die: That's been the brutal message delivered to 45 million American smokers, and it has helped contribute to 443,000 deaths per year, according to statistics from the Centers for Disease Control and Prevention," Rodu said. "The truth, however, is that total nicotine and tobacco abstinence is unattainable and unnecessary for many smokers."

Rodu's presentation, "Transforming Tobacco Use: The Potential of Tobacco Harm Reduction," was based on his almost 20 years of research. His work shows that smokers can greatly reduce their risk of disease and death by replacing smoking products with e-cigarettes or modern, spit-free smokeless tobacco. These products provide a much safer alternative for those smokers who are unable or unwilling to quit smoking because they continue to deliver nicotine without the harmful effect of smoking.

"Nicotine is addictive, but it is not the cause of any smoking-related disease. Like caffeine, nicotine can be used safely by consumers," Rodu said.

Decades of epidemiologic research bear out Rodu's findings. While no tobacco product is completely safe, smokeless products have been shown to be 98 percent safer than cigarettes. In the United Kingdom, the Royal College of Physicians reported in 2002 that smokeless tobacco is up to 1,000 times less hazardous than smoking, and in 2007, further urged world governments to seriously consider instituting tobacco harm reduction strategies as a means to save lives.

To see the proof of what tobacco harm reduction can do, look to Sweden, Rodu said. "Over the past 50 years, Swedish men have had Europe's highest per capita consumption of smokeless tobacco as well as Europe's lowest cigarette use. During the same time, they also have the lowest rate of lung cancer than men in any other European country."

In the United States., steps have been made to document the value of tobacco harm reduction. In 2006, a National Cancer Institute-funded study estimated that if tobacco harm reduction was "responsibly communicated" to smokers, 4 million would switch to smokeless tobacco. The American Council on Science and Health -- which organized Rodu's session at the AAAS Annual Meeting -- concluded in the same year that tobacco harm reduction "shows great potential as a public health strategy to help millions of smokers."

Rodu is well aware of the controversy his research findings generate. Opponents of any use of nicotine delivery products maintain that smokeless tobacco puts the user at great risk for oral cancer, a position not supported by research.

"The risk of mouth cancer among smokeless tobacco users is extremely low -- certainly lower than the risk of smoking-related diseases among smokers," he said. "The annual mortality rate among long-term dry snuff users is 12 deaths per 100,000 and the rate among users of more popular snus, moist snuff and chewing tobacco is much lower. For perspective, the death rate among automobile users is 11 per 100,000 according to a 2009 report from the National Highway Traffic Safety Administration. Compare those to the rate among smokers: more than 600 deaths per 100,000 every year."

"The data clearly show that smokeless tobacco users have, at most, about the same risk of dying from mouth cancer as automobile users have of dying in a car wreck."

University of Louisville. "Substituting with smokeless tobacco saves lives, research suggests." ScienceDaily, 19 Feb. 2012. Web. 28 Feb. 201

HPV Vaccine Recommended for Boys in New AAP Guidelines

The American Academy of Pediatrics (AAP) has published new guidelines for the use of the human papillomavirus vaccine and, for the first time, has specifically recommended use of the vaccine in adolescent boys as well as girls.

The recommendations were published online February 27 and in the March print issue of Pediatrics.

The vaccine was recommended for girls in 2006, but even though at that time the AAP said the vaccine could be used in boys, it was not specifically recommended for that population.

The new recommendations were spurred in part by mounting evidence that the HPV vaccine is effective as prophylaxis against genital warts in both males and females. HPV infection has been associated with increased risk for cervical cancer, anal cancer, and oropharyngeal cancer.

The AAP recommends that the vaccine be administered at 11 to 12 years of age in both boys and girls. Their rationale is 2-fold: First, the vaccine is most effective if it is administered before the individual begins engaging in sexual activity, mainly because the vaccine is inactive against HPV strains acquired before vaccination. Second, children mount the most robust antibody responses to the vaccine when they are between the ages of 9 and 15 years, the AAP says.

Two HPV vaccines are currently available in the United States, but there are differences in their approved indications. Quadrivalent HPV vaccine (HPV4, Gardasil, Merck) is the only vaccine approved for use in boys. Bivalent HPV vaccine (HPV2, Cervarix, GlaxoSmithKline) is only approved for use in girls; HPV4 is also approved for girls.

Among the AAP's updated recommendations are that:

• Girls aged 11 to 12 years should be routinely immunized using 3 doses of the HPV4 or HPV2 vaccine, administered intramuscularly at 0, 1 to 2, and 6 months.
• Girls and women aged from 13 to 26 years who have not been previously immunized or who have not completed their vaccinations should finish the series.
• Boys aged 11 to 12 years should be routinely immunized with HPV4, using the same schedule as for girls.
• Boys and men aged from 13 to 21 years who have not already been immunized or who have not completed their vaccines should finish the series.
• Men aged from 22 to 26 years who have not already been immunized or who have not finished the full series may be administered the recommended vaccine. (The AAP guidelines note that "cost-efficacy models do not justify a stronger recommendation in this age group.")
• Special efforts should be made to target use of the vaccine in gay or bisexual men up to 26 years of age who have not previously received the vaccine.
• People infected with HIV should be vaccinated or complete their series of vaccinations.
• The vaccine is not recommended during pregnancy, nor should it be administered to individuals with a known immediate hypersensitivity to yeast. However, it may be administered during lactation, as well as to those who are immunocompromised from either illness or medication

The AAP recommends that because the HPV vaccine will not prevent infection from all types of HPV types, cervical screening should continue after HPV vaccination.

The organization also says that administration of the vaccine should not alter physicians' recommendations regarding use of barrier methods for preventing HPV and other sexually transmitted diseases.

The AAP urges that use of the vaccine be covered by all public and private health insurance.

More information on implementing the guidelines, including guidance on supply, payment, coding, and liability issues, is available on the AAP's

Pediatrics. 2012;129:602-605.

Tomado de Medscape Medical News © 2012 WebMD, LLC

Un método no invasivo detecta con precisión el riesgo de Síndrome de Down

La técnica, basada en un nuevo algoritmo estadístico conocido como (FORTE), toma en cuenta los riesgos relacionados con la edad y el porcentaje de ADN fetal.

Un test no invasivo que se practica sobre una muestra de sangre materna es capaz de detectar, con un alto grado de precisión, el riesgo de que un feto presente las anormalidades cromosómicas que causan el Síndrome de Down y otro desorden genético conocido como Síndrome de Edwards. Los resultados de la investigación se publicarán en American Journal of Obstetrics & Gynecology (AJOG).

El diagnóstico de anormalidades en cromosomas del feto, o aneuploides, se realiza con test no invasivos realizados con muestra del villus coriónico (CVS, en inglés) o amniocentesis en embarazadas identificadas como de alto riesgo. Aunque son precisos, se trata de tests caros y que conllevan un cierto riesgo de aborto.

Una técnica conocida como secuenciación masivamente paralela (MPSS), que analiza las células libres de ADN (cfDNA) del plasma materno para condiciones fetales, detecta embarazos con trisomía del cromosoma 21 (T21), que lleva al síndrome de Down, y trisomía 18 (T18), el defecto cromosómico relacionado con el Síndrome de Edwards. No obstante, esta prueba requiere una gran cantidad de secuenciación de ADN, lo que limita su utilidad clínica.

Ahora, un equipo de científicos de Aria Diagnostics, en San Jose (California), ha desarrollado un nuevo estudio, denominado Análisis Digital de Regiones Seleccionadas (DANSR, en inglés), que requiere una décima parte de secuenciación de ADN.

Este estudio se basa en un nuevo algoritmo estadístico conocido como Evaluación del Riesgo de Trisomía fetal-fracción optimizado (FORTE), que tiene en cuenta los riesgos relacionados con la edad y el porcentaje de ADN fetal en la muestra para proporcionar una puntuación individualizada de riesgo de trisomía.

Para probar el funcionamiento de DANSR/FORTE, los investigadores evaluaron a un grupo de 123 embarazadas normales, 36 con el T21 y ocho con el T18. La combinación de DANSR y FORTE identificó correctamente los 36 casos de T21 y los ocho de T18.

American Journal of Obstetrics & Gynecology (2012); doi:10.1016/j.ajog.2012.01.030

Tomado de Jano.es

Two New Blood Types Identified

 You probably know your blood type: A, B, AB or O. You may even know if you're Rhesus positive or negative. But how about the Langereis blood type? Or the Junior blood type? Positive or negative? Most people have never even heard of these.

Yet this knowledge could be "a matter of life and death," says University of Vermont biologist Bryan Ballif.

While blood transfusion problems due to Langereis and Junior blood types are rare worldwide, several ethnic populations are at risk, Ballif notes. "More than 50,000 Japanese are thought to be Junior negative and may encounter blood transfusion problems or mother-fetus incompatibility," he writes.

But the molecular basis of these two blood types has remained a mystery -- until now.

In the February issue of Nature Genetics, Ballif and his colleagues report on their discovery of two proteins on red blood cells responsible for these lesser-known blood types.

Ballif identified the two molecules as specialized transport proteins named ABCB6 and ABCG2.

"Only 30 proteins have previously been identified as responsible for a basic blood type," Ballif notes, "but the count now reaches 32."

The last new blood group proteins to be discovered were nearly a decade ago, Ballif says, "so it's pretty remarkable to have two identified this year."

Both of the newly identified proteins are also associated with anticancer drug resistance, so the findings may also have implications for improved treatment of breast and other cancers.

As part of the international effort, Ballif, assistant professor in the biology department, used a mass spectrometer at UVM funded by the Vermont Genetics Network. With this machine, he analyzed proteins purified by his longtime collaborator, Lionel Arnaud at the French National Institute for Blood Transfusion in Paris, France.

Ballif and Arnaud, in turn, relied on antibodies to Langereis and Junior blood antigens developed by Yoshihiko Tani at the Japanese Red Cross Osaka Blood Center and Toru Miyasaki at the Japanese Red Cross Hokkaido Blood Center.

After the protein identification in Vermont, the work returned to France. There Arnaud and his team conducted cellular and genetic tests confirming that these proteins were responsible for the Langereis and Junior blood types. "He was able to test the gene sequence," Ballif says, "and, sure enough, we found mutations in this particular gene for all the people in our sample who have these problems."

Transfusion troubles

Beyond the ABO blood type and the Rhesus (Rh) blood type, the International Blood Transfusion Society recognizes twenty-eight additional blood types with names like Duffy, Kidd, Diego and Lutheran. But Langereis and Junior have not been on this list. Although the antigens for the Junior and Langereis (or Lan) blood types were identified decades ago in pregnant women having difficulties carrying babies with incompatible blood types, the genetic basis of these antigens has been unknown until now.

Therefore, "very few people learn if they are Langereis or Junior positive or negative," Ballif says.

"Transfusion support of individuals with an anti-Lan antibody is highly challenging," the research team wrote in Nature Genetics, "partly because of the scarcity of compatible blood donors but mainly because of the lack of reliable reagents for blood screening." And Junior-negative blood donors are extremely rare too. That may soon change.

With the findings from this new research, health care professionals will now be able to more rapidly and confidently screen for these novel blood group proteins, Ballif wrote in a recent news article. "This will leave them better prepared to have blood ready when blood transfusions or other tissue donations are required," he notes.

"Now that we know these proteins, it will become a routine test," he says.

A better match

This science may be especially important to organ transplant patients. "As we get better and better at transplants, we do everything we can to make a good match," Ballif says. But sometimes a tissue or organ transplant, that looked like a good match, doesn't work -- and the donated tissue is rejected, which can lead to many problems or death.

"We don't always know why there is rejection," Ballif says, "but it may have to do with these proteins."

The rejection of donated tissue or blood is caused by the way the immune system distinguishes self from not-self. "If our own blood cells don't have these proteins, they're not familiar to our immune system," Ballif says, so the new blood doesn't "look like self" to the complex cellular defenses of the immune system. "They'll develop antibodies against it," Ballif says, and try to kill off the perceived invaders. In short, the body starts to attack itself.

"Then you may be out of luck," says Ballif, who notes that in addition to certain Japanese populations, European Gypsies are also at higher risk for not carrying the Langereis and Junior blood type proteins.

"There are people in the United States who have these challenges too," he says, "but it's more rare."

Other proteins

Ballif and his international colleagues are not done with their search. "We're following up on more unknown blood types," he says. "There are probably on the order of 10 to 15 more of these unknown blood type systems -- where we know there is a problem but we don't know what the protein is that is causing the problem."

Although these other blood systems are very rare, "if you're that one individual, and you need a transfusion," Ballif says, "there's nothing more important for you to know."

University of Vermont. "Blood mystery solved: Two new blood types identified." ScienceDaily, 23 Feb. 2012. Web. 24 Feb. 2012

Logran descifrar las palabras que escucha un ser humano a partir de su actividad cerebral

Neurocientíficos de la Universidad de California reconstruyen los mensajes que registra el cerebro de un individuo mediante el análisis del patrón de actividad de una zona del lóbulo temporal.

Neurocientíficos de la Universidad de California, en Estados Unidos, han conseguido descifrar la actividad eléctrica que se produce en el cerebro cuando una persona escucha una conversación, lo que abre la puerta a la comprensión del pensamiento de pacientes afectados por parálisis cerebral. Las conclusiones de la investigación han sido publicadas en la revista PLoS Biology.
Los científicos consiguieron reconstruir las palabras que escucha un individuo a partir del análisis del patrón de actividad de una región del sistema auditivo llamada circunvolución temporal superior (STG, por sus siglas en inglés).
"Este estudio es muy importante para los pacientes que sufren daños en los mecanismos del habla a causa de un accidente cerebrovascular o enfermedad de Lou Gehrig", afirma Robert Knight, profesor de psicología y neurociencia de la Universidad de California en Berkeley.

El primer autor de la investigación, Brian N. Pasley, compara el cerebro con un piano en el que las teclas fueran las zonas encargadas de registrar los sonidos: “Un pianista experto conoce las notas musicales que produce cada tecla, y viendo cuáles se pulsan, sin necesidad de oír la melodía, se forma una idea precisa de la pieza que se está tocando. Igual que Ludwig van Beethoven era capaz de 'oír' sus composiciones a pesar de ser sordo”.
'Un discurso imaginario'
En cierto modo, las 'grabaciones' del cerebro funcionan de forma similar, de modo que se puede establecer una entre la actividad cerebral y las diferentes frecuencias acústicas del sonido. "Si vemos qué sitios del cerebro se activan podemos adivinar qué sonido era el que el paciente ha escuchado”, explica Pasley, quien, no obstante, aclara que el hallazgo no consiste exactamente en 'leer la mente'. "Sólo se han decodificado los sonidos que una persona escucha, no lo que alguien piensa para sí".

Evidencias científicas apuntan que tanto escuchar un sonido como imaginarlo (tararear mentalmente una canción, por ejemplo) pueden activar áreas similares del cerebro. De confirmarse el descubrimiento, y si el cerebro procesa las imágenes auditivas y del habla de forma similar a como se perciben, “se podría aplicar este enfoque a la lectura de un discurso imaginario, que podría ser útil en el desarrollo de prótesis de comunicación para discapacitados grave”, concluye el autor principal.

PLoS Biology (2012); doi:10.1371/journal.pbio.1001251

Tomado de Jano.es

APRENDIZAJE BASADO EN PROBLEMAS

A 50-year-old white woman presents to the emergency department (ED) because of recurrent syncopal episodes over the past 2 days. She reports "passing out" 3 times during the last 48 hours. The patient reports minimal exertion and adequate fluid intake during this time. After the first few episodes, she has remained homebound for fear of falling and injuring herself while in public. The episodes do not coincide with any positional movements or with any specific actions. Upon questioning, the patient reports increased weakness and an unintentional weight loss over the past 3 months. She denies having any fever, chills, dyspnea, nausea, vomiting, diarrhea, abdominal pain, or urinary symptoms during this time. Her medical history is significant for a nonspecific chronic pain disorder involving multiple joints and her back, with associated headaches. She is regularly followed by a primary care provider, in consultation with a neurologist, which she last visited 6 months ago. She is being treated with long-term risedronate, nortriptyline, carisoprodol, buspirone, and omeprazole, which reduces but does not entirely eliminate her symptoms. The patient reports no known allergies to medications. Her family history is notable for a mother with osteoporosis and a father with high blood pressure and elevated cholesterol. She has no siblings. She admits to having a glass of wine on holidays and denies any illicit drug use. The patient has a stable home life with a supportive husband and 2 children in college. She retired 2 years ago after working for 25 years as a school teacher, at which time her chronic pain began to interfere with her ability to concentrate at work. She denies any domestic violence or abuse at home or at her previous job.

On initial presentation, the patient appears sleepy and fatigued, with her eyes downcast and her arms lying loosely at her sides in the bed. She makes minimal effort to get up when the clinician enters her room. On physical examination, her blood pressure is 125/80 mm Hg, temperature is 99.5°F (37.5°C), and her heart rate is about 90 bpm, regular, and without any abnormal heart sounds. She weighed 94 lb (35 kg) 6 months ago but, despite a normal diet, she has lost 15 lb (6.8 kg). The head, neck, pulmonary, and abdominal examinations are all unremarkable. She has normal sensation over her body, with symmetric deep tendon reflexes and normal cranial-nerve responses; however, she does have diffuse weakness in all major muscle groups. Her mental status is normal. A brief survey of her skin reveals no apparent lesions, abrasions, or discolorations.

Routine blood work is sent for a complete blood cell (CBC) count and electrolytes. A bedside electrocardiogram (ECG) is obtained (see Figure).

What is the diagnosis?

Tomado de  Medscape.com

La vergüenza, ¿donde se localiza en el cerebro?

Bases neurológicas descritas gracias a un experimento realizado por científicos de la Universidad de California en San Francisco y en Berkerle

En un experimento llevado a cabo por estos científicos se pidió a un grupo de personas que cantaran la antigua canción Motown, se les grabó, y a continuación se les pidió que se escucharan su voz sin música de acompañamiento.

Podría parecer algo así como un castigo escuchar a la gente desafinando al cantar una canción, pero gracias a este experimento los científicos han encontrado que parte del cerebro es esencial para la vergüenza.

Un detalle significativo era que la mayoría de las personas participantes en este experimento tenían enfermedades neurodegenerativas, lo que ayudó a los científicos a identificar una zona del tamaño del dedo pulgar en el hemisferio derecho en la parte delantera del cerebro. Es la llamada corteza cingulada anterior pregenual, aquí se localizan las base neurológicas de la vergüenza.

Virginia Sturm becaria de la UCSF comenta:

El grado en que los participantes se avergonzaban al escucharse cantar My Girl de 1964, depende del funcionamiento de esa región en particular

En las personas sanas observarse a si mismos cantar provoca una considerablereacción de vergüenza.

• La presión arterial sube
• Aumenta el ritmo cardíaco
• Se altera el ritmo de la respiración.

Las personas que han sufrido daño neurológico en la corteza frontal media responden de forma más indiferente. Esta región cerebral predice esa conducta, cuanto más pequeña es esta región menos vergüenza siente la persona.

A los participantes se les hicieron resonancias magnéticas de gran precisión para analizar los volúmenes de las diferentes regiones del cerebro y examinar si los tamaños de estar regiones podrían predecir la vergüenza.

Los investigadores encontraron que en las personas que tenían enfermedad neurodegenerativa que afectaba a la corteza cingulada anterior pregenual la capacidad de sentir vergüenza era menor, donde existía un mayor deterioro de esa zona del cerebro la persona tenía menos vergüenza de su propio canto.

Al mismo grupo de personas se les dio un susto, como prueba de sus reacciones emocionales. Estaban todos sentados en silencio y de repente un sonido fuerte como un disparo se escuchó en la sala.

Las personas se sobresaltaron y tenían miedo, por tanto no es que no tengan reacciones emocionales, sino que algunos pacientes especialmente los que tienen lesiones en una determinada zona cerebral parecen perder emociones sociales más complejas, tal como la vergüenza. Emociones como la vergüenza parecen ser especialmente afectadas en enfermedades neurodegenerativas que afectan a los lóbulos frontales.

El enamoramiento provoca alteraciones neuronales en áreas del cerebro relacionadas con la percepción

Los últimos hallazgos en neurología apuntan a que este sentimiento, al igual que sucede con la fidelidad, se halla íntimamente vinculado a neurotransmisores como la adrenalina, la dopamina o la serotonina.

En la última década, numerosos estudios han puesto al descubierto el papel de algunas partes de nuestro cerebro (el hipotálamo, la corteza prefrontal, la amígdala, el núcleo accumbens, el área tegmental frontal, etc.) en el amor. Estas investigaciones también apuntan a que tanto el amor como la fidelidad poseen una clara base neurológica, en la que resultan fundamentales neurotransmisores como la adrenalina, la dopamina, la serotonina, la oxitocina o la vasopresina.

Según explica el Dr. Jesús Porta-Etessam, director del Área de Cultura de la Sociedad Española de Neurología (SEN), “algunos de los trabajos más recientes han sido realizados por la Dra. Stephanie Ortigue, quien estimó que hasta 12 áreas del cerebro están involucradas en el sentimiento del amor”.

La Dra. Stephanie Ortigue fue incluso un poco más allá al considerar que sólo tardamos medio segundo en enamorarnos -puesto que es el tiempo que tarda nuestro cerebro en liberar las moléculas neurotrasmisoras que generan las distintas respuestas emocionales- o que el sentimiento amoroso provoca alteraciones neuronales en áreas del cerebro relacionadas con la percepción, lo que puede explicar el hecho de que las personas enamoradas encuentren a su pareja mucho más especial que el resto.

Por su parte, la Dra. Helen Fisher determinó, gracias a técnicas de neuroimagen, que la actividad neuronal es distinta según se trate de amor, apego a la pareja o deseo sexual, por lo que nuestro cerebro no se activa de igual manera en las relaciones duraderas que en las etapas iniciales de enamoramiento. Y, también, que el cerebro de los hombres y el de las mujeres experimentan el amor de forma distinta. “Mientras que los hombres, cuando se enamoran, parecen tener una mayor actividad en la región cerebral asociada a los estímulos visuales, en las mujeres se activan más las áreas asociadas a la memoria”, señala el Dr. Jesús Porta-Etessam.

Pero el pionero en el estudio neurológico del amor es probablemente el Dr. Semir Zeki. “Una de sus múltiples investigaciones al respecto, muestra que tanto el amor como el odio estimulan algunas de las mismas regiones cerebrales. Pero mientras el amor parece inhibir parte de las zonas donde se procesan las ideas racionales, el odio las hiperactiva”, comenta el Dr. Jesús Porta-Etessam.

“Las técnicas de neuroimagen han permitido acercarnos al conocimiento de muchas de las conductas que caracterizan a los seres vivos. Estas investigaciones y otras muchas han sido posibles gracias al estudio de la actividad de las distintas zonas cerebrales, lo que ha permitido comprobar que el funcionamiento de la mente no sólo se limita a los procesos cognitivos. Además, gracias a la neuroimagen, hemos podido avanzar en el estudio de los múltiples problemas generados por las patologías neurológicas como ictus, demencias o parkisionismos”, concluye el Dr. Jesús Porta-Etessam.

Tomado de jano.es

Periodontal blood samples can help diabetes screening

A study from the United States has shown that oral blood samples taken from patients with periodontal disease could be useful for checking haemoglobin A1c (HbA1c), a common measure for diabetes.

Scientists at New York University funded by the Clinical and Translational Science Institute found that blood taken from pockets of periodontal inflammation can be used to measureHbA1c levels more effectively than blood from taken by the finger-stick method.

The study, published in the Journal of Periodontology, involved comparing haemoglobin A1c levels in samples of both oral and finger-stick blood from 75 patients suffering from periodontal disease. It was revealed that a reading of 6.3 or more in the oral sample was associated with a finger-stick reading of 6.5 in the diabetes range. The American Diabetes Association advises that an HbA1c reading of over 6.5 is in the diabetes range.

Lead author Shiela Strauss commented "In light of these findings, the dental visit could be a useful opportunity to conduct an initial diabetes screening – an important first step in identifying those patients who need further testing to determine their diabetes status."

She added "The issue of undiagnosed diabetes is especially critical because early treatment and secondary prevention efforts may help to prevent or delay the long-termcomplications of diabetes that are responsible for reduced quality of life and increased levels of mortality risk."

It was also thought that patients might prefer the oral blood sampling at their dentist's office than the more invasive finger-stick method.

Tomado de :Diabetes News at Diabetes.co.uk

INSUFICIENCIA RENAL CRONICA

PRESENTACION DE LA CLASE DADA POR LA DRA. ELIZABETH PARRA

ALUMNA DE LA ROTACION DE PATOLOGIA CLINICA

DEPARTAMENTO DE MEDICINA Y NUTRICION

UNIVERSIDAD DE GUANAJUATO

Insuficiencia renal crónica (rotación patología clínica)

View more presentations from Hector Marrufo.

Triglyceride Levels Predict Stroke Risk in Postmenopausal Women

Postmenopausal women may be at higher risk of having a stroke than they think. A new study by researchers at NYU Langone Medical Center and colleagues found that traditional risk factors for stroke -- such as high cholesterol -- are not as accurate at predicting risk in postmenopausal women as previously thought. Instead, researchers say doctors should refocus their attention on triglyceride levels to determine which women are at highest risk of suffering a devastating and potentially fatal cardiovascular event.

The study appears online February 3 in the journal Stroke.

"Every year, hundreds of thousands of people are affected by stroke and there is a tremendous emphasis on identifying people at increased risk," said lead author Jeffrey S. Berger, MD, assistant professor of medicine and director of Cardiovascular Thrombosis at NYU School of Medicine, part of NYU Langone Medical Center. "This study revealed that what we've been using to evaluate risk all these years actually has little to no predictive value in older women. Triglyceride levels, however, take on a new significance. "

According to the U.S. Centers for Disease Control and Prevention, nearly 800,000 Americans suffer a stroke each year. Ischemic strokes, the type assessed in this study, account for more than eight out of every ten strokes. They occur when blood clots, developing from high levels of a waxy substance in the blood called cholesterol, obstruct blood vessels to the brain. Cholesterol is made up of several lipids, or lipoproteins. Triglycerides are one type of such a lipoprotein, while others include low-density lipoproteins (LDL) and high-density lipoproteins (HDL)."

"We've always believed that total cholesterol and LDL cholesterol levels were the most important biomarkers for identifying stroke risk, but this study gives us strong evidence to question that approach," Dr. Berger said.

The researchers analyzed data from the Hormones and Biomarkers Predicting Stroke (HaBPS) study, consisting of women enrolled in the Women's Health Initiative (WHI), a landmark National Institutes of Health-sponsored study that has monitored the health of more than 90,000 postmenopausal women nationwide for more than 15 years. HaBPS is composed of the first 972 women who experienced an ischemic stroke while participating in the WHI. These women were matched with a control group of 972 participants who had not had strokes. All the women had donated blood samples when they first enrolled in the WHI, and these samples were then analyzed for differences in lipid biomarkers.

The most compelling finding, according to Dr. Berger, was that high triglyceride levels were significantly associated with the development of stroke. In fact, women in the highest quarter of baseline triglyceride levels were nearly twice as likely to have suffered an ischemic stroke as women in the lowest quarter of triglyceride levels during the course of the study. Surprisingly, LDL cholesterol and total cholesterol, however, were not associated with stroke risk in this population, despite their perceived value in the medical community.

Whether the strong association between triglycerides and stroke would also be seen in other populations is still unknown. "This is only the first step. It's a really important step, but it's not the end of the story," Dr. Berger said. "While this study identifies subjects at increased risk of ischemic stroke, the long term goal is to reduce that risk. Future studies aimed at lowering triglyceride levels for reducing the risk of stroke are warranted."

New York University Langone Medical Center. "Triglyceride levels predict stroke risk in postmenopausal women." ScienceDaily, 2 Feb. 2012. Web. 13 Feb. 2012

APRENDIZAJE BASADO EN UN CASO CLINICO

A previously healthy 10-month-old female infant presented to a hospital emergency room (ER) with two brief (5 min) and consecutive episodes of generalised tonic clonic convulsions after a 2-day bout of vomiting, diarrhoea and low-grade fever. Upon arrival to ER, her blood pressure was 102/54 mm Hg, heart rate was 150 beats/min, respiratory rate was 34 breaths/min, body temperature was 37.8°C and oxygen saturation was 94% on room air. She was lethargic and had dry mucous membranes. The anterior fontanelle was depressed and the capillary refill was delayed (3 s).The pupils were equal and reactive to light with normal fundoscopic examination and there was no neck stiffness. Random blood sugar was 121 mg/dl. After initial stabilisation (hydration, correction of electrolyte imbalances and seizure control), CT of the brain was done and reported as normal. The blood tests revealed hyponatraemia (Na 126 mEq/l), hypoproteinaemia (total protein 4.2 g/dl, albumin 1.9 g/dl), and leukocytosis (white blood cell (WBC) 19.4 × 10³/l (46% lymphocytes)), thrombocytosis (637 × 10³/l) and elevated C reactive protein (CRP, 96 mg/l). Urine was positive for blood (red blood cell (RBC) 30/10⁶). Blood, urine and cerebrospinal fluid (CSF) were sent for culture and broad spectrum antibiotics – ceftriaxone and vancomycin – were administered intravenously empirically for sepsis.7 Intravenous albumin infusions were also started at this time followed by a loop diuretic as needed.

Over the next 24 h, the patient developed generalised oedema with ascites and pleural effusion. Due to the laboured breathing, dyspnoea, hyperpnoea and continued acidosis, the patient was transferred to the intensive care unit where parecentesis and thoracocentesis were performed and a chest tube was left in place to drain. Endotracheal intubation was not needed. Cultures of urine, stool, blood and cerebrospinal fluid (unremarkable chemistry-protein, glucose and cell count within normal limits) were reported negative for bacterial and fungal growth.

On day 4 post admission, low-dose intravenous methylprednisolone was started due to persistent hypoalbuminaemia, increased oxygen requirements and risk of septic shock.8 On day 6, the patient became tachycardiac and hypotensive and the blood results showed neutropaenia (WBC 3.25 × 10³), thrombocytopaenia (82 × 10³), anaemia (haemoglobin 8 g/dl) and coagulopathy (D-dimer elevated to 2055 ug/l, prothrombin time rose to 16 s and partial prothrombin time went up to 53 s). Intravenous ceftazidime was substituted for ceftriaxone to broaden the coverage to include Pseudomonas aeruginosa. The patient received fresh frozen plasma (FFP) and packed red blood cells (PRBC) transfusions.

The cultures from the pleural and peritoneal effusions (transudate) were negative for bacterial and fungal growth. Endoscopy and colonoscopy were visually normal. The patient showed complete clinical and biochemical recovery 12 days after the hospital admission

What is the most likely diagnosis?

De BMJ clinical case.com