Cree ud. que clorando el agua se salva de los parásitos ?

Does the Sodium Hypochlorite inactivate giardia and cryptosporidium?

Giardia and cryptosporidium are both protozoa and are resistant to chlorination because they exist in water in a cyst form. The hard coat of the cysts protects giardia and cryptosporidium from being inactivated by chlorine. Cryptosporidium is more resistant to chlorine than giardia. See this inactivation table for more details. Both protozoa, however, are fairly large. Cryptosporidium is approximately 3-5 times the size of the bacteria E. coli, and giardia is approximately 5-10 times the size of E. coli. Cryptosporidium and giardia can thus be removed by filtration. If giardia or cryptosporidium are a significant health problem in the project area, a filtration step (through ceramic, sand, or other filters) can be added before adding the sodium hypochlorite. The Safe Water System intervention has been proven to reduce diarrhea in children, and this intervention does inactivate many of the ones that cause the most severe disease, like cholera, dysentery, and typhoid fever.

Fuente: http://www.cdc.gov/safewater/publications_pages/pubs_disinfectant.htm#8

El ACIDO URICO es antioxidante pero...

Asymptomatic hyperuricemia that occurs independently of gout might not be benign. Substantial, growing epidemiologic and experimental biologic evidence (reviewed in detail elsewhere) indicates that asymptomatic hyperuricemia is capable of directly promoting hypertension and vascular disease. For example, soluble urate is an antioxidant, but urate also can be converted to pro-oxidants that can affect the disposition of the vasodilator, nitric oxide, and thereby potentially regulate vascular endothelial cell function.

Fuente: http://cme.medscape.com/viewarticle/713753

Que maravilla de imágenes diagnósticas !!!

Dual-energy CT imaging of tophi in patients with gout. a This volume-rendered, color-coded, three-dimensional, dual-energy CT image of the right foot and ankle of a 71 year old man with a known diagnosis of gout reveals multiple urate deposits (red), indicative of a severe disease burden and subclinical tophaceous disease. b This 74 year old man underwent dual-energy CT to assess erosions associated with an established inflammatory arthritis. This multiplanar reformat sagittal color-coded two-material decomposition (urate and calcium) image of the right foot and ankle reveals urate crystal tophi (red) along the Achilles tendon, sinus tarsi and at the first metatarsophalangeal joint, consistent with gout. These images and descriptions were generously provided (with permission) by Dr Hyon Choi, Boston University Medical School, Boston, MA, USA.

Fuente: http://cme.medscape.com/viewarticle/713753

Stone Age flour found across Europe

Starch residues on stone tools suggest early humans ate a balanced diet.

Once thought of as near total carnivores, early humans ate ground flour 20,000 years before the dawn of agriculture. Flour residues recovered from 30,000-year-old grinding stones found in Italy, Russia and the Czech Republic point to widespread processing and consumption of plant grain, according to a paper published online this week in Proceedings of the National Academy of Sciences1

Fuente: Nature magazine. http://www.nature.com/news/2010/101018/full/news.2010.549.html

Reflexión

De toda América, somos el país que más hijos por mujer tiene, pero somos el que más desnutridos los tiene, hay presupuesto para las armas, pero no para la refacción escolar, no hay para el sistema de salud curativa, mucho menos para programas preventivos, no hay tampoco para educación, como si NO hubieran sabido los de facto o los “desgobiernos” electos popularmente que con esos dos pilares estuviéramos “menos peor”. Nuestro índice de analfabetismo supera a la mayoría, no hay trabajo y si te vas “pal” Norte, no hay garantías. La clase política está corrupta hasta la médula, es más ya lo traen en su código genético, el sistema judicial es inoperante, prácticamente todos los crímenes quedan impunes, y éstos criminales nos tiene de rodillas, por eso la capital es la ciudad más violenta de todas. Los grandes empresarios y las grandes compañías evaden impuestos y perpetúan el sistema que nos tiene con éstos índices de calamidad, pero aún así, increíblemente, veo gente sonreír, veo gente responsable y digna todos los días. Me doy cuenta que tener trabajo y familia motiva a cualquiera, es más, nos hace sentirnos ricos, perdón, riquísimos, no en dinero, sino en felicidad, y eso hace que todo lo malo no supere lo bueno, por eso sigo aquí, y seguramente usted también. No claudiquemos, sigamos adelante por Guatemala.

Dr. Víctor Castañeda

El por qué del cabezazo de Zidane

El momento que dio la vuelta al mundo en 2006 parece tener un motivo detrás El ataque del francés estaba justificado, ¿o tal vez no?

Han pasado más de cuatro años, pero nadie ha olvidado los últimos minutos de Zinedine Zidane como futbolista profesional. Su genialidad hacía que, en ocasiones, perdiese loa papeles y aquello fue lo que le pasó en su último partido, nada más y nada menos que un cabezazo a Marco Materazzi en plena final de la Copa del Mundo. El colegiado no dudó: cartulina roja.
Ahora, un periodista francés ha indagado en los motivos que pudieron llevar al que fuese jugador del Real Madrid a cometer aquel error, aunque el resultado es más propio de un programa del corazón. Besma Lahouri, que así se llama el periodista, ha reconocido que el mismo día del partido, el astro galo tuvo una discusión con su mujer. De hecho, "ni siquiera llevaba la alianza durante el partido, como solía hacer".
Lahouri, autor del best-seller 'Zidane, una vida secreta', reconoció en un programa de la televisión italiana que el cabezazo que propinó a Materazzi estuvo provocado por su mal momento personal. "El día antes del partido, Zidane había discutido con su esposa y tenía motivos personales. El mismo día de la final, no llevaba la alianza, estaba muy tenso y nervioso", reconoció el periodista.

La decepción de Zidane

Otro de los secretos del jugador francés que desveló el escritor fue el de los momentos posteriores a su expulsión. Mientras miles de fotógrafos inmortalizaban su imagen yendo hacia los vestuarios y dejando de lado la Copa de campeón del Mundo, Zidane pasaba unos terribles momentos. "Había preparado una camiseta con todos los agradecimientos a la Juve, a Italia, a sus padres y entrenadores... Quería dar la vuelta al mundo con esa camiseta y en su lugar salió con la cabeza gacha".

http://es.eurosport.yahoo.com/16102010/47/curiosport-cabezazo-zidane.html

JURAMENTO MÉDICO DE MAIMÓNIDES (1135-1204)

Me encanta, y se aplica de maravilla a la medicina moderna después de tantos siglos:

Que yo sea moderado en todo, excepto en el conocimiento del arte; que con respecto a él sólo sea yo insaciable; que siempre quede alejada de mí la idea de saberlo todo y de conocerlo todo; concédeme fuerzas, tiempo, oportunidad y ocasión para rectificar siempre los conocimientos adquiridos, para extender su dominio; porque el arte es grandioso, y el espíritu del hombre puede igualmente extenderse indefinidamente, enriquecerse cada día con nuevos conocimientos; puede descubrir hoy muchos errores, y su saber de ayer y la jornada de mañana pueden traerle luces que no ha sospechado hoy.
¡Dios de la bondad! Me has elegido para velar sobre la vida y la muerte de las criaturas; héme aquí que me dispongo a mi vocación".

Dos nuevos países cambian el mapamundi...

Los mapamundis quedaron obsoletos en la medianoche de anteayer con el nacimiento de dos nuevos países en el Caribe, después de que las islas de Curaçao y San Martín, con 190.000 y 50.000 habitantes respectivamente, dejaran de pertenecer a las ahora disueltas Antillas Holandesas, para constituirse en Estados semiautónomos del Reino de Holanda.

Por otro lado, las tres islas menores que también formaban parte del extinto país y que en su conjunto suman menos de 20.000 habitantes, Bonaire, Saba y San Eustaquio, pasarán a ser municipios holandeses, y por tanto pertenecientes a la Unión Europea (UE).

Curaçao y San Martín consiguen así el estatus de país que ya había ganado la isla de Aruba en 1986, manteniendo lazos directos con Holanda.
Las Antillas Holandesas fueron colonizadas en el siglo XVII por los Países Bajos y habían existido como un país dentro del Reino de Holanda desde 1954. Recientemente se incrementaron las tensiones entre sus miembros a causa del reparto de ingresos y deudas.

Are glucosamine and chondroitin sulfate effective for osteoarthritis?

De nuevo, no sirve, datos muy recientes: BMJ 2010; 341:c4675 doi: 10.1136/bmj.c4675 (Published 16 September 2010) Cite this as: BMJ 2010; 341:c4675

Glucosamine and chondroitin sulfate have been used to treat osteoarthritis, but recent studies question their usefulness. These European researchers performed a meta-analysis of existing trial to determine the efficacy of glucosamine and chondroitin sulfate, both alone and together, for pain and radiologic evidence of disease. Data from trials were combined with indirect evidence from other trials by using a Bayesian model that allowed the synthesis of multiple time points. They included randomised controlled trials involving more than 200 patients with osteoarthritis of the knee or hip.

The researchers report: "10 trials in 3803 patients were included. On a 10 cm visual analogue scale the overall difference in pain intensity compared with placebo was -0.4 cm for glucosamine, -0.3 cm for chondroitin, and -0.5 cm for the combination. For none of the estimates did the 95% credible intervals cross the boundary of the minimal clinically important difference. Industry independent trials showed smaller effects than commercially funded trials. The differences in changes in minimal width of joint space were all minute, with 95% credible intervals overlapping zero."

The researchers concluded: "Compared with placebo, glucosamine, chondroitin, and their combination do not reduce joint pain or have an impact on narrowing of joint space. Health authorities and health insurers should not cover the costs of these preparations, and new prescriptions to patients who have not received treatment should be discouraged."

Ya casi hermanos Chilenos !!!

Ya casi...

Global Gastrointestinal Events with Celecoxib vs. Diclofenac and Omeprazole

Risks for clinical events throughout the GI tract were lower with a cyclooxygenase-2 inhibitor than with a nonselective nonsteroidal anti-inflammatory drug plus a proton-pump inhibitor.

The association between nonsteroidal anti-inflammatory drugs (NSAIDs) and upper gastrointestinal (GI) bleeding and ulceration is well documented. Such adverse events can be reduced by use of a cyclooxygenase (COX)-2 selective NSAID or a proton-pump inhibitor (PPI) with a nonselective NSAID.
However, prospective trials that evaluate these strategies to prevent NSAID-related events throughout the GI tract are lacking.

To address this issue, investigators conducted an industry-sponsored trial (CONDOR), involving 4484 patients with osteoarthritis or rheumatoid arthritis from 196 centers in 32 countries. Patients were randomized to receive celecoxib (Celebrex; 200 mg twice daily) or diclofenac (75 mg twice daily) plus omeprazole (20 mg once daily).
All patients had elevated risk for GI complications (age ≥60 or history of gastroduodenal ulcers). Patients with Helicobacter pylori infection and those taking anticoagulant or antiplatelet agents were excluded.

The study endpoints included overt upper or lower GI bleeding, perforation, gastric outlet obstruction, and anemia (decrease in hemoglobin level of ≥20 g/L) from a GI source or from presumed occult GI blood loss.

During 6-month follow-up, fewer patients receiving celecoxib experienced a primary endpoint event than did those receiving diclofenac plus omeprazole (0.9% vs. 3.8%; hazard ratio favoring celecoxib, 4.3; P<0.0001). p="0.03)" p="0.0006).">The authors concluded that the risk for an adverse event anywhere in the GI tract is lower for patients taking a COX-2 selective NSAID than for those taking a nonselective NSAID plus a PPI.

Comment: This paper provides important information about the prevention of lower GI complications from NSAID use. Of note, no between-group differences were seen in upper GI complications (3 in each group) or in overt lower GI bleeding (1 in each group). The difference in outcomes was explained by the large disparity in the number of patients with new-onset anemia (15 in the celecoxib group vs. 77 in the diclofenac plus omeprazole group).
Occult blood loss in the absence of overt bleeding is well documented in patients taking NSAIDs and is independent of gastric acid. In this study, the great majority of patients with anemia were assumed to have experienced occult blood loss in the absence of a documented source.
The number of patients with GI blood loss might be overstated, but it should not differ between groups.
These data suggest that a PPI reduces upper GI events in patients taking nonselective NSAIDs but does not reduce anemia from lower GI blood loss as much as the use of a selective NSAID.

Fuente:
David J. Bjorkman, MD, MSPH (HSA), SM (Epid.)
Published in Journal Watch Gastroenterology June 25, 2010

Metformin: Safety in Cardiac Patients

Citation: Heart 2010;96:99-102. [Free Full-text (pdf)] [PubMed Abstract]


Study Question: What is the safety of metformin in cardiac patients? Perspective: Metformin is a biguanide, insulin sensitizer that reduces blood sugar levels. There are concerns about the risk of lactic acidosis (LA) in patients receiving metformin who have procedures requiring iodinated contrast, and in those with renal impairment or heart failure.
In patients with heart failure, existing evidence suggests that metformin use is associated with improved outcome rather than increased risk.
The risk of metformin-associated LA in patients undergoing cardiac catheterization has not been determined, with no published trial or registry data.
Available data suggest that a generic policy of stopping metformin 48 hours before and 48 hours after the procedure in all patients may be counterintuitive and may not conform to the principles of best practice.

The authors suggest an evidence-based approach to stopping metformin in cardiac patients, as detailed below:
For use of contrast:
If the serum creatinine is normal, no need to withdraw If the serum creatinine is raised >150 μmol/L (or 1.5 mg/dl): Contrast <100>100 ml—withdraw for 48 hours before and 48 hours after the contrast is given and reassess the renal function before restarting metformin.

When contrast is not used: Withdraw if creatinine is >150 μmol/L (or 1.5 mg/dl) No need to withdraw in patients with heart failure and normal creatinine.

Debabrata Mukherjee, M.D., F.A.C.C. Chief, Cardiovascular Medicine, Professor of Internal Medicine, Vice Chairman, Department of Internal Medicine, Texas Tech University , Health Sciences Center General Statement of Disclosure: Data Safety Monitoring Board : Cleveland Clinic Foundation

CDC Recommendations for Combined Seasonal and H1N1 Flu Vaccine for Everyone Older Than 6 Months

Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010

SummaryHighlights of the 2010 recommendations include

1) a recommendation that annual vaccination be administered to all persons aged ≥6 months for the 2010--11 influenza season; 2) a recommendation that children aged 6 months--8 years whose vaccination status is unknown or who have never received seasonal influenza vaccine before (or who received seasonal vaccine for the first time in 2009--10 but received only 1 dose in their first year of vaccination) as well as children who did not receive at least 1 dose of an influenza A (H1N1) 2009 monovalent vaccine regardless of previous influenza vaccine history should receive 2 doses of a 2010--11 seasonal influenza vaccine (minimum interval: 4 weeks) during the 2010--11 season; 3) a recommendation that vaccines containing the 2010--11 trivalent vaccine virus strains A/California/7/2009 (H1N1)-like (the same strain as was used for 2009 H1N1 monovalent vaccines), A/Perth/16/2009 (H3N2)-like, and B/Brisbane/60/2008-like antigens be used; 4) information about Fluzone High-Dose, a newly approved vaccine for persons aged ≥65 years; and 5) information about other standard-dose newly approved influenza vaccines and previously approved vaccines with expanded age indications.Vaccination efforts should begin as soon as the 2010--11 seasonal influenza vaccine is available and continue through the influenza season. These recommendations also include a summary of safety data for U.S.-licensed influenza vaccines.These recommendations and other information are available at CDC's influenza website (http://www.cdc.gov/flu); any updates or supplements that might be required during the 2010--11 influenza season also will be available at this website. Recommendations for influenza diagnosis and antiviral use will be published before the start of the 2010--11 influenza season. Vaccination and health-care providers should be alert to announcements of recommendation updates and should check the CDC influenza website periodically for additional information.BOX. Summary of influenza vaccination recommendations, 2010
All persons aged ≥6 months should be vaccinated annually.
Protection of persons at higher risk for influenza-related complications should continue to be a focus of vaccination efforts as providers and programs transition to routine vaccination of all persons aged ≥6 months.
When vaccine supply is limited, vaccination efforts should focus on delivering vaccination to persons who:
are aged 6 months--4 years (59 months);
are aged ≥50 years;
have chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, neurologic, hematologic, or metabolic disorders (including diabetes mellitus);
are immunosuppressed (including immunosuppression caused by medications or by human immunodeficiency virus);
are or will be pregnant during the influenza season;
are aged 6 months--18 years and receiving long-term aspirin therapy and who therefore might be at risk for experiencing Reye syndrome after influenza virus infection;
are residents of nursing homes and other chronic-care facilities;
are American Indians/Alaska Natives;
are morbidly obese (body-mass index ≥40);
are health-care personnel;
are household contacts and caregivers of children aged <5 years and adults aged ≥50 years, with particular emphasis on vaccinating contacts of children aged <6 months; and
are household contacts and caregivers of persons with medical conditions that put them at higher risk for severe complications from influenza.

July 29, 2010 / 59(Early Release);1-62 [Free full-text online]

EEUU experimentó con sífilis, gonorrea y chancroide con Guatemaltecos

EE. UU. ofreció ayer disculpas a Guatemala por los experimentos que "científicos" de aquel país practicaron en guatemaltecos en la década de 1940

El Departamento de Salud y Recursos Humanos de EE. UU. reconoció que los experimentos con sífilis efectuados con guatemaltecos, durante los cuales murieron 71 de los inoculados, violentaron normas éticas y fueron inseguros.

Fuente:
http://www.prensalibre.com/noticias/Enojo-rechazo-experimentos-Guatemala_0_346165409.html

A comparison of intermediate and long-acting insulins in people with type 2 diabetes starting insulin: an observational database study

Estudio muy importante, es de la vida real, NO es un estudio de laboratorio con esquemas y algoritmos controlados.

Summary
Aims: Insulin is normally added to oral glucose-lowering drugs in people with type 2 diabetes when glycaemic control becomes suboptimal. We evaluated outcomes in people starting insulin therapy with neutral protamine Hagedorn (NPH), detemir, glargine or premixed insulins.
Methods: Insulin-naïve people with type 2 diabetes (n = 8009), ≥ 35 years old, HbA1c≥ 6.5% and begun on NPH (n = 1463), detemir (n = 357), glargine (n = 2197) or premix (n = 3992), were identified from a UK database of primary care records (The Health Improvement Network). Unadjusted and multivariate-adjusted analyses were conducted, with persistence of insulin therapy assessed by survival analysis.
Results: In the study population (n = 4337), baseline HbA1c was 9.5 ± 1.6%, falling to 8.4 ± 1.5% over 12 months (change −1.1 ± 1.8%, p < 0.001). Compared with NPH, people taking detemir, glargine and premix had an adjusted reduction in HbA1c from baseline, of 0.00% (p = 0.99), 0.19% (p < 0.001) and 0.03% (p = 0.51). Body weight increased by 2.8 kg overall (p < 0.001), and by 2.3, 1.7, 1.9, and 3.3 kg on NPH, detemir, glargine and premix (p < 0.001 for all groups); insulin dose at 12 months was 0.70 (overall), 0.64, 0.61, 0.56 and 0.76 U/kg/day. After 36 months, 57% of people on NPH, 67% on glargine and 83% on premix remained on their initially prescribed insulin.
Discussion and Conclusion: In routine clinical practice, people with type 2 diabetes commenced on NPH experienced a modest disadvantage in glycaemic control after 12 months compared with other insulins. When comparing the insulins, glargine achieved best HbA1c reduction, while premix showed greatest weight gain and the highest dose requirement, but had the best persistence of therapy.

Ésta es la conclusión final: In summary, in real clinical practice in the UK, in people with suboptimal glycaemic control with OGLDs and lifestyle therapy, insulin is an effective strategy in reducing HbA1c levels. People commenced on NPH have a modest overall disadvantage in outcomes when compared with other insulins. Between group comparisons showed that HbA1c reductions were greater with insulin glargine, while persistence with therapy was best on premix at a cost of modestly greater weight gain and higher insulin dosage.

Fuente:
A comparison of intermediate and long-acting insulins in people with type 2 diabetes starting insulin: an observational database study

J. Gordon, R. D. Pockett, A. P. Tetlow, P. McEwan and P. D. HomeArticle first published online: 4 OCT 2010 DOI: 10.1111/j.1742-1241.2010.02520.x
http://onlinelibrary.wiley.com/doi/10.1111/j.1742-1241.2010.02520.x/abstract

B Vitamin Treatment Does Not Prevent Recurrent Stroke or TIA

Andrew JosephsonM.D., Department of Neurology, University of California San Francisco, San Francisco, USAElevated levels of plasma total homocysteine are an important risk factor for vascular events.

Treatment of elevated homocysteine with B vitamins is effective in reducing plasma levels, but trials examining the role of B vitamins in primary prevention of actual vascular events have been largely disappointing. Patients who experience a stroke or transient ischemic attack (TIA) are at high risk for recurrence, and a recent trial (VITATOPS Trial Study Group, 2010) examined whether B vitamin supplementation in these patients would mitigate this risk.The authors report the results of a large, randomized, double-blind, placebo-controlled trial of patients with recent (in the last 7 months) stroke or TIA that took place at 123 medical centers in 20 countries. Both hemorrhagic and ischemic stroke subtypes were included. Patients were randomized to treatment with either placebo or a single daily pill of B vitamins containing 2 mg folic acid, 25 mg B6, and 0.5 mg B12. The primary outcome examined was the composite endpoint of nonfatal stroke, nonfatal myocardial infarction (MI), or vascular death.Over a 10-year period, a total of 4089 patients were assigned to treatment with B vitamins and 4075 assigned to placebo. Baseline characteristics were similar between the two ethnically diverse groups, which consisted of 42% of patients who were white, 24% east or southeast Asian, and 26% south Asian. The median follow-up was 3.4 years, although 702 patients (9%) were lost to follow-up. After the first year, 10-11% of each group had discontinued their study medication; this number rose to 27-28% by the end of the trial.The composite primary endpoint was reached by 616 patients (15%) in the treatment group and 678 patients (17%) in the placebo group [relative risk (RR), 0.91; 95% confidence interval (CI), 0.82–1.00; p = .05]. Adjustments for follow-up duration and baseline variables yielded no substantial differences in this result. Despite this nonsignificant difference in events, treatment with B vitamins did indeed lower total homocysteine by a mean of 1.09 (standard deviation, 5.5) μmol/L. There were no significant differences in adverse events in the two groups.The authors added their data to other previously published randomized trials of homocysteine lowering and concluded that a meta-analysis does not suggest that B vitamins reduce the composite risk of stroke, MI, or vascular death (RR, 0.99; 95% CI, 0.94–1.03; p = .49). When examining stroke or MI individually, no significant reductions with B vitamins could be found.This trial failed to show a significant benefit of B vitamin supplementation after stroke.

This result follows a long list of trials that all seem to show effective lowering of homocysteine without any significant improvement in outcomes. One of the advantages of this particular trial is that many of the patients were enrolled in countries with little folic acid fortification of the food supply, thereby increasing the chances that supplementation would be of benefit. While there are an additional three ongoing randomized trials to be published in the coming years, for now there is simply no evidence that B vitamin supplementation should be used by clinicians for secondary prevention of vascular events.-

Josephson SA. B Vitamin Treatment Does Not Prevent Recurrent Stroke or TIA. Harrison’s Online, September 9, 2010. http://www.accessmedicine.com

Related to Chapter 364 Cerebrovascular Diseases, in Harrison’s Principles of Internal Medicine, 17th edition, Anthony S. Fauci, Eugene Braunwald, Dennis L. Kasper, Stephen L. Hauser, Dan L. Longo, J. Larry Jameson, and Joseph Loscalzo, Eds. McGraw-Hill, New York, 2008.

ReferenceVITATOPS Trial Study Group. B vitamins in patients with recent transient ischaemic attack or stroke in the VITAmins TO Prevent Stroke (VITATOPS) trial: A randomised, double-blind, parallel, placebo-controlled trial. Lancet Neurol 2010;9:855. [PubMed Abstract]

Irresponsables !!!

Candidatos a padres del año !!!