Muy pero muy útil...
http://professional.diabetes.org/GlucoseCalculator.aspx
martes, 25 de enero de 2011
domingo, 23 de enero de 2011
Woody Allen...
El mago hizo un gesto y desapareció el hambre, hizo otro gesto y desapareció la injusticia, hizo otro gesto y desapareció la guerra. El político hizo un gesto y desapareció el mago.
domingo, 16 de enero de 2011
El increíble OSO DE AGUA
Los tardígrados (Tardigrada) llamados comúnmente osos de agua, constituyen un filo de invertebrados protóstomos segmentados microscópicos (de 0,1 a 1,2 mm) que habitan en el agua y poseen ocho patas con pezuñas, también tienen ojos, músculos y piel. Lo increíble de éstos es que pueden sobrevivir al contacto con nitrógeno líquido, agua hirviente, ácidos minerales, radiación, al vacío del espacio extraterrestre, pero falta aún más, pueden entrar en un estado de hibernación-deshidratación, al menos 120 años, al entrar en contactor con el agua REVIVEN...
sábado, 15 de enero de 2011
El H1N1 puede abrir el camino para una vacuna universal contra la gripe
La protección que han demostrado los anticuerpos generados contra el virus de la gripe A, rara vez se había visto en quienes pasaban la gripe estacional.
Investigadores de la Facultad de Medicina y el Centro de Vacunas de la Universidad de Emory (Estados Unidos) aseguran que el virus A/H1N1 que se expandió por todo el mundo en 2009 puede ser el punto de partida para desarrollar una vacuna universal contra la gripe, ya que algunos afectados por esta cepa han sido capaces de desarrollar anticuerpos que les protegen del resto.
Artìculo completo: http://www.elmedicointeractivo.com/noticias_ext.php?idreg=27870
jueves, 13 de enero de 2011
Tricíclicos para la profilaxis de migrañas y cefaleas tensionales
Estos investigadores de los EE.UU. sometieron a prueba la eficacia y los efectos adversos de los antidepresivos tricíclicos en la prevención de la migraña, el tipo tensional y dolores de cabeza mixta. Se realizó una revisión sistemática con meta-análisis, la búsqueda en Medline, Embase, Registro Cochrane de Ensayos y PsycLIT. Se incluyeron treinta y siete ensayos aleatorios de adultos que reciben tricíclicos. Se extrajo el número de ataques de migraña y el número de días con dolor de cabeza de tipo tensional, junto con la intensidad del dolor de cabeza y el índice de dolor de cabeza.
Los investigadores encontraron: "Los tricíclicos redujeron significativamente el número de días con dolor de cabeza de tipo tensional y el número de ataques de dolor de cabeza de migraña más que el placebo (promedio de diferencia de medias estandarizadas -1,29 y -0,70), pero no en comparación con los inhibidores selectivos de la recaptación de serotonina (-0,80 y 0,20). El efecto de los tricíclicos se incrementó con la duración del tratamiento. Los tricíclicos también tenían más probabilidades de reducir la intensidad de los dolores de cabeza al menos un 50% más que el placebo (riesgo relativo: de tipo tensional: 1,41 migraña: 1,80) o inhibidores selectivos de la recaptación de serotonina (1,73 y 1,72). Los tricíclicos tenían más probabilidades de causar efectos adversos que el placebo (1,53) y los inhibidores selectivos de la recaptación de serotonina (2,22), como sequedad de boca, somnolencia y aumento de peso, pero no aumentaron las tasas de deserción escolar (placebo: 1,22, los inhibidores selectivos de la recaptación de serotonina: 1,16) ".
Los investigadores concluyeron: "Los antidepresivos tricíclicos son eficaces en la prevención de la migraña y dolores de cabeza de tipo tensional y son más eficaces que los inhibidores selectivos de la recaptación de serotonina, aunque con mayores efectos adversos La eficacia de los antidepresivos tricíclicos parece aumentar con el tiempo."
Fuente: BMJ 341:c5222, 20 October 2010 © 2010 Jackson et al Antidepresivos Tricíclicos y cefaleas: Revisión sistemática y meta-análisis. Jeffrey L Jackson, William Shimeall, Laura Sessums, et al. Correspondencia a J L Jackson: Jeffrey.jackson6@va.gov
Safety, efficacy of statin treatment with non-alcoholic fatty liver disease
Long-term statin treatment reduces the frequency of cardiovascular events, but safety and efficacy in patients with abnormal liver tests is unclear. The researchers from Greece and the UK assessed whether statin therapy is safe and effective for these patients through post-hoc analysis of the Greek Atorvastatin and Coronary Heart Disease Evaluation (GREACE) study population. GREACE was a prospective, intention-to-treat study that randomly assigned by a computer-generated randomisation list 1600 patients with coronary heart disease (aged less than 75 years, with serum concentrations of LDL cholesterol greater than 2.6 mmol/L and triglycerides less than 4.5 mmol/L) at the Hippokration University Hospital, Thessaloniki, Greece to receive statin or usual care, which could include statins.
Of 437 patients with moderately abnormal liver tests at baseline, which were possibly associated with non-alcoholic fatty liver disease, 227 who were treated with a statin (mainly atorvastatin 24 mg per day) had substantial improvement in liver tests whereas 210 not treated with a statin had further increases of liver enzyme concentrations. Cardiovascular events occurred in 10% of 227 patients with abnormal liver tests who received statin (3.2 events per 100 patient-years) and 30% of 210 patients with abnormal liver tests who did not receive statin (10.0 events per 100 patient-years; 68% relative risk reduction, significant). This cardiovascular disease benefit was greater than it was in patients with normal liver tests 14% events in 653 patients receiving a statin (4.6 per 100 patient-years) vs 23% in 510 patients not receiving a statin (7.6 per 100 patient- years); 39% relative risk reduction, significant). Fewer than 1% of 880 participants who received a statin discontinued statin treatment because of liver-related adverse effects (transaminase concentrations more than three-times the upper limit of normal).
The researchers concluded: "Statin treatment is safe and can improve liver tests and reduce cardiovascular morbidity in patients with mild-to-moderately abnormal liver tests that are potentially attributable to non-alcoholic fatty liver disease."
Fuente: Safety and efficacy of long-term statin treatment for cardiovascular events in patients with coronary heart disease and abnormal liver tests in the Greek Atorvastatin and Coronary Heart Disease Evaluation (GREACE) Study: a post-hoc analysis. Vasilios G Athyros, Konstantinos Tziomalos, Thomas Gossios et al for the GREACE Study Collaborative Group. Correspondence to Dimitri Mikhailidis: mikhailidis@aol.com
No evidence for benefit of oxygen in acute myocardial infarction
Clinical Question: How effective is routine inhaled oxygen therapy for patients with acute myocardial infarction (AMI)?
Bottom line: There is no conclusive evidence from randomised controlled trials to support the routine use of inhaled oxygen in patients with AMI. There was no difference in analgesic use between the oxygen group and the air groups (room air breathed naturally or via a face mask). Of those who died, nearly 3 times as many people known to have been given oxygen died compared with those known to have been given air.
Caveat:The evidence in this area is sparse, of poor quality and predates advances in reperfusion techniques and trial methods. The evidence available suggests harm but lacks power, so these results could be due to chance.
Context: Oxygen is widely recommended for patients with AMI yet a narrative review has suggested it may do more harm than good. Other systematic reviews have also concluded there is insufficient evidence to know whether oxygen reduced, increased or had no effect on the heart, ischaemia or infarct size.
Cochrane Systematic Review:Cabelo JB et al. Oxygen therapy for acute myocardial infarction. Cochrane Reviews, 2010, Issue 6. Article No. CD007160. DOI: 10.1002/14651858.CD007160.pub2 This review contains 3 studies involving 387 participants
Bottom line: There is no conclusive evidence from randomised controlled trials to support the routine use of inhaled oxygen in patients with AMI. There was no difference in analgesic use between the oxygen group and the air groups (room air breathed naturally or via a face mask). Of those who died, nearly 3 times as many people known to have been given oxygen died compared with those known to have been given air.
Caveat:The evidence in this area is sparse, of poor quality and predates advances in reperfusion techniques and trial methods. The evidence available suggests harm but lacks power, so these results could be due to chance.
Context: Oxygen is widely recommended for patients with AMI yet a narrative review has suggested it may do more harm than good. Other systematic reviews have also concluded there is insufficient evidence to know whether oxygen reduced, increased or had no effect on the heart, ischaemia or infarct size.
Cochrane Systematic Review:Cabelo JB et al. Oxygen therapy for acute myocardial infarction. Cochrane Reviews, 2010, Issue 6. Article No. CD007160. DOI: 10.1002/14651858.CD007160.pub2 This review contains 3 studies involving 387 participants
Rapid vs. Gradual Discontinuation of Antidepressants
Patients' risks for relapse increase when lithium or antipsychotic medications are discontinued rapidly rather than gradually. To compare rapid (1–7 days) versus slow (≥14 days) discontinuation of antidepressants, researchers in Sardinia followed 398 patients with recurrent major depressive disorder (n=224), panic disorder (n=75), bipolar II disorder (n=62), or bipolar I disorder (n=37). Follow-up lasted at least 1 year (mean, 2.8 years; mean length of antidepressant treatment, 8.5 months).
In this observational study, the treating clinicians or the patients had chosen to discontinue medications when patients were clinically well; antidepressants were withdrawn rapidly in 188 patients and gradually in 210. Rapid discontinuation was associated with a significantly shorter time to relapse than gradual discontinuation (median, 3.6 vs. 8.4 months). The authors estimated that time to relapse after rapid discontinuation was only 25% of the average time to earlier relapses in the same patients. The findings were most evident for bipolar I and panic disorders. After rapid discontinuation, the intervals preceding relapse were similar among different drug types, but after gradual discontinuation, time to relapse was substantially longer with tricyclics than with modern antidepressants. Relapse risk was the least pronounced for medications with prolonged half-lives and was not associated with antidepressant dose, duration of illness or treatment, or concurrent treatment.
Comment: Several uncertainties remain, and the study needs replication. Still, these findings align with study results on other psychotropics. Rapid discontinuation substantially increases relapse risks and shortens relapse latencies. Clinicians opting to discontinue antidepressants, particularly short-acting serotonin reuptake inhibitors, should plan to taper over weeks to months. As an editorialist notes, clinicians should forewarn patients who decide to abruptly discontinue their medications, especially pregnant women, of these risks.
Fuente: Published in Journal Watch Psychiatry September 3, 2010
Citations:Baldessarini RJ et al. Illness risk following rapid versus gradual discontinuation of antidepressants. Am J Psychiatry 2010 Aug; 167:934. [Medline® Abstract]
Freedman R. Abrupt withdrawal of antidepressant treatment. Am J Psychiatry 2010 Aug; 167:886. [Medline® Abstract] [Free full-text article pdf]
In this observational study, the treating clinicians or the patients had chosen to discontinue medications when patients were clinically well; antidepressants were withdrawn rapidly in 188 patients and gradually in 210. Rapid discontinuation was associated with a significantly shorter time to relapse than gradual discontinuation (median, 3.6 vs. 8.4 months). The authors estimated that time to relapse after rapid discontinuation was only 25% of the average time to earlier relapses in the same patients. The findings were most evident for bipolar I and panic disorders. After rapid discontinuation, the intervals preceding relapse were similar among different drug types, but after gradual discontinuation, time to relapse was substantially longer with tricyclics than with modern antidepressants. Relapse risk was the least pronounced for medications with prolonged half-lives and was not associated with antidepressant dose, duration of illness or treatment, or concurrent treatment.
Comment: Several uncertainties remain, and the study needs replication. Still, these findings align with study results on other psychotropics. Rapid discontinuation substantially increases relapse risks and shortens relapse latencies. Clinicians opting to discontinue antidepressants, particularly short-acting serotonin reuptake inhibitors, should plan to taper over weeks to months. As an editorialist notes, clinicians should forewarn patients who decide to abruptly discontinue their medications, especially pregnant women, of these risks.
Fuente: Published in Journal Watch Psychiatry September 3, 2010
Citations:Baldessarini RJ et al. Illness risk following rapid versus gradual discontinuation of antidepressants. Am J Psychiatry 2010 Aug; 167:934. [Medline® Abstract]
Freedman R. Abrupt withdrawal of antidepressant treatment. Am J Psychiatry 2010 Aug; 167:886. [Medline® Abstract] [Free full-text article pdf]
Even Low-Dose Aspirin Protects Against Colorectal Cancer
Farhat V N Din, Evropi Theodoratou, Susan M Farrington, et al.
Correspondence to Professor Malcolm G Dunlop, Colon Cancer Genetics Group and Academic Coloproctology, Institute of Genetics and Molecular Medicine, University of Edinburgh and MRC Human Genetics Unit, Western General Hospital, Edinburgh EH4 2XU, UK; malcolm.dunlop@hgu.mrc.ac.uk
Abstract
Background Previous studies have shown that aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) lower colorectal cancer (CRC) risk.
However, the lowest effective NSAID dose, treatment duration, and effects on survival are not defined. In a large population-based case–control study, we have explored the relationship between NSAID dose and duration, CRC risk and overall CRC-specific survival.
Methods The relationship between NSAID use and CRC risk was examined in 2279 cases and 2907 controls. Subjects completed food-frequency and lifestyle questionnaires. NSAID categories were low-dose aspirin (75 mg), non-aspirin NSAIDs (NA-NSAIDs) and any NSAID. Users were defined as taking >4 tablets/week for >1 month. ORs were calculated by logistic regression models and adjusted for potential confounding factors. Effect of NSAID use on all-cause and CRC-specific mortality was estimated using Logrank tests and Cox's hazard models.
Results In all, 354 cases (15.5%) were taking low-dose aspirin compared to 526 controls (18.1%). Low-dose aspirin use was associated with decreased CRC risk (OR 0.78 95% CI 0.65 to 0.92, p=0.004), evident after 1 year and increasing with duration of use (ptrend=0.004). NA-NSAID and any NSAID use were also inversely associated with CRC. There was no demonstrable effect of NSAIDS on all-cause (HR 1.11, p=0.22, 0.94–1.33) or CRC-specific survival (HR 1.01, p=0.93, 0.83–1.23).
Conclusion This is the first study to demonstrate a protective effect against CRC associated with the lowest dose of aspirin (75 mg per day) after only 5 years use in the general population. NSAID use prior to CRC diagnosis does not influence survival from the disease
Fuente: [Link to free full-text Gut article PDF] [PubMed abstract]
Correspondence to Professor Malcolm G Dunlop, Colon Cancer Genetics Group and Academic Coloproctology, Institute of Genetics and Molecular Medicine, University of Edinburgh and MRC Human Genetics Unit, Western General Hospital, Edinburgh EH4 2XU, UK; malcolm.dunlop@hgu.mrc.ac.uk
Abstract
Background Previous studies have shown that aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) lower colorectal cancer (CRC) risk.
However, the lowest effective NSAID dose, treatment duration, and effects on survival are not defined. In a large population-based case–control study, we have explored the relationship between NSAID dose and duration, CRC risk and overall CRC-specific survival.
Methods The relationship between NSAID use and CRC risk was examined in 2279 cases and 2907 controls. Subjects completed food-frequency and lifestyle questionnaires. NSAID categories were low-dose aspirin (75 mg), non-aspirin NSAIDs (NA-NSAIDs) and any NSAID. Users were defined as taking >4 tablets/week for >1 month. ORs were calculated by logistic regression models and adjusted for potential confounding factors. Effect of NSAID use on all-cause and CRC-specific mortality was estimated using Logrank tests and Cox's hazard models.
Results In all, 354 cases (15.5%) were taking low-dose aspirin compared to 526 controls (18.1%). Low-dose aspirin use was associated with decreased CRC risk (OR 0.78 95% CI 0.65 to 0.92, p=0.004), evident after 1 year and increasing with duration of use (ptrend=0.004). NA-NSAID and any NSAID use were also inversely associated with CRC. There was no demonstrable effect of NSAIDS on all-cause (HR 1.11, p=0.22, 0.94–1.33) or CRC-specific survival (HR 1.01, p=0.93, 0.83–1.23).
Conclusion This is the first study to demonstrate a protective effect against CRC associated with the lowest dose of aspirin (75 mg per day) after only 5 years use in the general population. NSAID use prior to CRC diagnosis does not influence survival from the disease
Fuente: [Link to free full-text Gut article PDF] [PubMed abstract]