artigo04.pdf (application/pdf Object)
Nadine Clausell, Angela M. V. Tavares
(MEMBROS DA LISTA AMICOR)
O Receptor Ativado por Proliferadores de Peroxissoma (PPAR) é um fator de transcrição, pertencente à super família de receptores nucleares que se ligam a agonistas específicos, também conhecidos como ligantes ou ativadores de PPARs. Evidências crescentes têm demonstrado a importância dos PPARs no controle de diversos processos biológicos relacionados principalmente ao metabolismo lipídico e ao processo inflamatório, desempenhando
papeis-chave em várias doenças cardiovasculares. Neste sentido, um elo que tem sido explorado, envolvendo a ação dos PPARs nessas doenças, é o efeito anti-inflamatório exercido por alguns ativadores de PPARs, como as glitazonas e os fibratos em modelos experimentais de ateroscleroese e insuficiência cardíaca, com potenciais implicações no tratamento dessas doenças em seres humanos. Neste artigo, estaremos revisando, em maior profundidade, o papel dos PPARs, tanto na aterosclerose como na insuficiência cardíaca, enfatizando conceitos mecanísticos e suas potenciais aplicações clínicas.
Sunday, July 31, 2005
BNP: do Laboratório à Beira do Leito
artigo03.pdf (application/pdf Object)
Luís Beck da Silva Neto, Nadine Clausell
(MEMBROS DA LISTA AMICOR)
Até meados de 1950, acreditava-se que a diurese era controlada por dois mecanismos neuro-hormonais: o sistema vasopressina (ADH) e o sistema renina-angiotensina-aldosterona (SRAA). No entanto, ainda em relatos daquela década, acreditavase existir um “terceiro fator”, o qual era pouco elucidado. Com adescrição de aumento de diurese associado a episódios paroxísticos de taquicardia supraventricular, passou-se a suspeitar que o terceiro fator estivesse ligado ao coração. Seguiu-se a clássica descrição do reflexo de Henry & Gauer, em que a dilatação atrial era capaz de
aumentar a diurese.1,2 Posteriormente, com o advento da microscopia eletrônica, foi possível visualizar a presença de grânulos intracelulares
nos miócitos atriais, em grande semelhança aos encontrados nas células endócrinas. A noção de que o coração possuía funções endócrinas ganhava fundamentação.3 A confirmação definitiva da ligação endócrina entre o coração e os rins foi definitivamente confirmada pelo clássico experimento de Bold e colaboradores, publicado em 1981.4 Neste experimento, extrato de músculo atrial foi injetado em ratos e observou-se rápido e potente efeito diurético e vasodilatador. Estava descoberto o fator natriurético atrial (ANF), um peptídeo circulante com propriedades natriuréticas, diuréticas e
vasodilatadoras, posteriormente chamado peptídeo natriurético atrial (ANP). Desde então, um imenso número de investigações multidisciplinares foi conduzido para esclarecer o real papel deste peptídeo na patogênese das doenças cardiovasculares, na regulação da pressão arterial e na excreção de sal e água. Em 1988, um grupo de pesquisadores japoneses demonstrou a existência de um peptídeo natriurético tipo-ANF em cérebro de porcos e o nomeou brain natriuretic peptide (BNP).5 Inúmeros experimentos subseqüentes demonstraram que o BNP era, de fato, produzido em miócitos cardíacos e que compartilhava receptores periféricos com o ANP. Hoje, o BNP (renomeado peptídeo natriurético tipo-B) tem alcançado importante papel na prática clínica cardiológica e seu uso clínico é brevemente revisado neste trabalho. Essas investigações se tornaram um excelente exemplo de pesquisa que evoluiu da bancada do laboratório à beira do leito do paciente.
Luís Beck da Silva Neto, Nadine Clausell
(MEMBROS DA LISTA AMICOR)
Até meados de 1950, acreditava-se que a diurese era controlada por dois mecanismos neuro-hormonais: o sistema vasopressina (ADH) e o sistema renina-angiotensina-aldosterona (SRAA). No entanto, ainda em relatos daquela década, acreditavase existir um “terceiro fator”, o qual era pouco elucidado. Com adescrição de aumento de diurese associado a episódios paroxísticos de taquicardia supraventricular, passou-se a suspeitar que o terceiro fator estivesse ligado ao coração. Seguiu-se a clássica descrição do reflexo de Henry & Gauer, em que a dilatação atrial era capaz de
aumentar a diurese.1,2 Posteriormente, com o advento da microscopia eletrônica, foi possível visualizar a presença de grânulos intracelulares
nos miócitos atriais, em grande semelhança aos encontrados nas células endócrinas. A noção de que o coração possuía funções endócrinas ganhava fundamentação.3 A confirmação definitiva da ligação endócrina entre o coração e os rins foi definitivamente confirmada pelo clássico experimento de Bold e colaboradores, publicado em 1981.4 Neste experimento, extrato de músculo atrial foi injetado em ratos e observou-se rápido e potente efeito diurético e vasodilatador. Estava descoberto o fator natriurético atrial (ANF), um peptídeo circulante com propriedades natriuréticas, diuréticas e
vasodilatadoras, posteriormente chamado peptídeo natriurético atrial (ANP). Desde então, um imenso número de investigações multidisciplinares foi conduzido para esclarecer o real papel deste peptídeo na patogênese das doenças cardiovasculares, na regulação da pressão arterial e na excreção de sal e água. Em 1988, um grupo de pesquisadores japoneses demonstrou a existência de um peptídeo natriurético tipo-ANF em cérebro de porcos e o nomeou brain natriuretic peptide (BNP).5 Inúmeros experimentos subseqüentes demonstraram que o BNP era, de fato, produzido em miócitos cardíacos e que compartilhava receptores periféricos com o ANP. Hoje, o BNP (renomeado peptídeo natriurético tipo-B) tem alcançado importante papel na prática clínica cardiológica e seu uso clínico é brevemente revisado neste trabalho. Essas investigações se tornaram um excelente exemplo de pesquisa que evoluiu da bancada do laboratório à beira do leito do paciente.
Therapeutics in Clinical Cardiovascular Practice. Experiences and Evidence
8501015.pdf (application/pdf Object)
Flávio Danni Fuchs
(AUTORMEMBRO DA LISTA AMIVOR)
A qualidade da evidência em Cardiologia acentuou-se nos últimos anos. Excedendo a fundamentação farmacológica e biológica clássica, os métodos da medicina baseada em evidências, particularmente o ensaio clínico randomizado, aplicaram-se ao cenário clínico, permitindo discernir entre terapias eficazes, inertes e deletérias.
Estudos clássicos, como o que demonstrou a ineficácia de cirurgia de ligadura da artéria mamária no tratamento da angina de peito refratária, foram predominantemente realizados em afecções cardiovasculares. A apropriação da linguagem e métodos da medicina baseada em evidências por parte das corporações, com o correspondente investimento em pesquisas e promoção, expandiu em muito o armamentário terapêutico e diagnóstico. Vive-se, no
entanto, época de distorções no relacionamento entre as corporações, academia e profissionais, decorrente de forte viés corporativo, que influencia prioridades de pesquisa, divulgação e prescrição. Limitações de custeio público requerem que cardiologistas se habilitem fortemente no domínio dos paradigmas da medicina baseada em evidências, para explorar a precisão de terapêutica cardiovascular a um custo socialmente tolerável.
Flávio Danni Fuchs
(AUTORMEMBRO DA LISTA AMIVOR)
A qualidade da evidência em Cardiologia acentuou-se nos últimos anos. Excedendo a fundamentação farmacológica e biológica clássica, os métodos da medicina baseada em evidências, particularmente o ensaio clínico randomizado, aplicaram-se ao cenário clínico, permitindo discernir entre terapias eficazes, inertes e deletérias.
Estudos clássicos, como o que demonstrou a ineficácia de cirurgia de ligadura da artéria mamária no tratamento da angina de peito refratária, foram predominantemente realizados em afecções cardiovasculares. A apropriação da linguagem e métodos da medicina baseada em evidências por parte das corporações, com o correspondente investimento em pesquisas e promoção, expandiu em muito o armamentário terapêutico e diagnóstico. Vive-se, no
entanto, época de distorções no relacionamento entre as corporações, academia e profissionais, decorrente de forte viés corporativo, que influencia prioridades de pesquisa, divulgação e prescrição. Limitações de custeio público requerem que cardiologistas se habilitem fortemente no domínio dos paradigmas da medicina baseada em evidências, para explorar a precisão de terapêutica cardiovascular a um custo socialmente tolerável.
Lipid Profile and Risk Factors for Cardiovascular Diseases in Medicine Students
8501011.pdf (application/pdf Object)
Vanessa Gregorin Coelho, Loeni Fátima Caetano, Raphael Del Roio Liberatore Júnior, José Antônio Cordeiro, Dorotéia Rossi Silva Souza
Analisar o perfil lipídico e sua correlação com fatores de risco
para doenças cardiovasculares (DCV) em estudantes de medicina.
Métodos
Foram avaliados 153 estudantes, independente do sexo, com idade entre 18 e 31 anos, submetidos à análise do perfil lipídico, incluindo níveis séricos de colesterol total (CT), fração de colesterol das lipoproteínas de baixa (LDLc), alta (HDLc) e muito baixa densidade (VLDLc) e triglicérides (TG), além de hábitos de vida e dados antropométricos. Aplicou-se análise estatística, incluindo teste de Mann Whitney, qui-quadrado, correlação de Pearson e análise multivariada, admitindo-se nível de significância para valor p<0,05.
Resultados
Destacaram-se sedentarismo (43,1%) e antecedentes familiais para DCV, particularmente hipertensão arterial (74,5%). O perfil lipídico mostrou-se desejável, embora níveis alterados de CT, LDLc e TG foram detectados em 11,8%, 9,8% e 8,5% dos estudantes, respectivamente, e níveis reduzidos de HDLc em 12,4% deles.
As mulheres apresentaram valores significativamente reduzidos para LDLc e elevados para HDLc comparado aos homens (p=0,031 e p<0,0001, respectivamente). Houve associação significante entre perfil lipídico e, preferencialmente, índice de massa corpórea (IMC), sedentarismo, ingesta de álcool, uso de anticoncepcional, antecedentes familiais de acidente vascular cerebral e dislipidemia.
Conclusão
Antecedentes familiais para DCV, sedentarismo e uso de anticoncepcional entre os estudantes de medicina mostram-se freqüentes e associados ao perfil lipídico, assim como ingesta de álcool e IMC. Embora com perfil lipídico desejável, independente do sexo, níveis mais elevados de LDLc e reduzidos de HDLc no sexo masculino conferem aos homens desvantagem comparado às mulheres.
Vanessa Gregorin Coelho, Loeni Fátima Caetano, Raphael Del Roio Liberatore Júnior, José Antônio Cordeiro, Dorotéia Rossi Silva Souza
Analisar o perfil lipídico e sua correlação com fatores de risco
para doenças cardiovasculares (DCV) em estudantes de medicina.
Métodos
Foram avaliados 153 estudantes, independente do sexo, com idade entre 18 e 31 anos, submetidos à análise do perfil lipídico, incluindo níveis séricos de colesterol total (CT), fração de colesterol das lipoproteínas de baixa (LDLc), alta (HDLc) e muito baixa densidade (VLDLc) e triglicérides (TG), além de hábitos de vida e dados antropométricos. Aplicou-se análise estatística, incluindo teste de Mann Whitney, qui-quadrado, correlação de Pearson e análise multivariada, admitindo-se nível de significância para valor p<0,05.
Resultados
Destacaram-se sedentarismo (43,1%) e antecedentes familiais para DCV, particularmente hipertensão arterial (74,5%). O perfil lipídico mostrou-se desejável, embora níveis alterados de CT, LDLc e TG foram detectados em 11,8%, 9,8% e 8,5% dos estudantes, respectivamente, e níveis reduzidos de HDLc em 12,4% deles.
As mulheres apresentaram valores significativamente reduzidos para LDLc e elevados para HDLc comparado aos homens (p=0,031 e p<0,0001, respectivamente). Houve associação significante entre perfil lipídico e, preferencialmente, índice de massa corpórea (IMC), sedentarismo, ingesta de álcool, uso de anticoncepcional, antecedentes familiais de acidente vascular cerebral e dislipidemia.
Conclusão
Antecedentes familiais para DCV, sedentarismo e uso de anticoncepcional entre os estudantes de medicina mostram-se freqüentes e associados ao perfil lipídico, assim como ingesta de álcool e IMC. Embora com perfil lipídico desejável, independente do sexo, níveis mais elevados de LDLc e reduzidos de HDLc no sexo masculino conferem aos homens desvantagem comparado às mulheres.
Anthropometric Indexes of Obesity as an Instrument of Screening for High
8501006.pdf (application/pdf Object)
Francisco José Gondim Pitanga e Ines Lessa
(AUTOR MEMBRO DA LISTA AMICOR)
Comparar vários indicadores antropométricos de obesidade e identificar dentre eles qual melhor discrimina o risco coronariano elevado (RCE).
Métodos
Estudo de corte transversal, com amostra composta por 968 adultos de 30 a 74 anos de idade, sendo 391 (40,4%) do sexo masculino. Foram construídas diversas curvas Receiver Operating Characteristic (ROC) e comparadas às áreas sob as mesmas entre o índice de conicidade (índice C), índice de massa corporal (IMC), razão circunferência cintura-quadril (RCCQ), circunferência de cintura (CC) e RCE. Verificou-se também a sensibilidade e especificidade para identificar e comparar o melhor ponto de corte entre os diversos indicadores de obesidade para discriminar o RCE. Foi utilizado intervalo de confiança a 95%.
Resultados
A maior área sob a curva ROC foi encontrada entre o índice C e RCE, em indivíduos do sexo masculino, 0,80 (0,74-0,85), diferindo significativamente dos demais indicadores de obesidade. Em mulheres, a maior área sob a curva ROC encontrada foi de 0,76 (0,71-0,81), sendo iguais entre índice C, RCCQ e RCE.
Conclusão
Esses resultados demonstram que o índice C e RCCQ são os melhores indicadores de obesidade para discriminar RCE. A CC tem intermediário poder discriminatório e o IMC foi o indicador antropométrico de obesidade menos adequado para discriminar RCE. Estes dados sugerem que os indicadores de obesidade abdominal são melhores para discriminar RCE que os indicadores de obesidade generalizada.
Francisco José Gondim Pitanga e Ines Lessa
(AUTOR MEMBRO DA LISTA AMICOR)
Comparar vários indicadores antropométricos de obesidade e identificar dentre eles qual melhor discrimina o risco coronariano elevado (RCE).
Métodos
Estudo de corte transversal, com amostra composta por 968 adultos de 30 a 74 anos de idade, sendo 391 (40,4%) do sexo masculino. Foram construídas diversas curvas Receiver Operating Characteristic (ROC) e comparadas às áreas sob as mesmas entre o índice de conicidade (índice C), índice de massa corporal (IMC), razão circunferência cintura-quadril (RCCQ), circunferência de cintura (CC) e RCE. Verificou-se também a sensibilidade e especificidade para identificar e comparar o melhor ponto de corte entre os diversos indicadores de obesidade para discriminar o RCE. Foi utilizado intervalo de confiança a 95%.
Resultados
A maior área sob a curva ROC foi encontrada entre o índice C e RCE, em indivíduos do sexo masculino, 0,80 (0,74-0,85), diferindo significativamente dos demais indicadores de obesidade. Em mulheres, a maior área sob a curva ROC encontrada foi de 0,76 (0,71-0,81), sendo iguais entre índice C, RCCQ e RCE.
Conclusão
Esses resultados demonstram que o índice C e RCCQ são os melhores indicadores de obesidade para discriminar RCE. A CC tem intermediário poder discriminatório e o IMC foi o indicador antropométrico de obesidade menos adequado para discriminar RCE. Estes dados sugerem que os indicadores de obesidade abdominal são melhores para discriminar RCE que os indicadores de obesidade generalizada.
Thursday, July 28, 2005
Lipid-Q&A-CARDS.pdf (application/pdf Object)
Lipid-Q&A-CARDS.pdf (application/pdf Object)
Foro AmiCOR-FECC - ProCOR-FAC wrote:
Foro AmiCOR-FECC - ProCOR-FAC wrote:
Federación Argentina de Cardiología - ProCOR
Foro AmiCOR-FECC - www.fac.org.ar/amicor
______________________________________________
Hace no mucho tiempo, me fueron presentados, en apretada síntesis - como lo hace la “industria”- los resultados del CARDS (Collaborative AtoRvastatin Diabetes Study, Lancet 2004;364:685-96) sobre las bondades de ésta estatina en la prevención primaria de diabéticos normolipidémicos o fronterizos con 1 o más factores de riesgo agrregado/s. Y la sospecha me asaltó inmediatamente. Eran resultados que se me hacían difíciles de creer. No por la estatina en sí, la cuál me parece excelente herremienta terapéutica, sinó por lo llamativo de los RRR (35% para eventos coronarios agudos y 47% para stroke).
Mi curiosidad me llevó a buscar “algo más” en Google y la primera opción que encontré es la siguiente, que recomiendo:
http://www.rxfiles.ca/acrobat/Lipid-Q&A-CARDS.pdf
Algunas cosas interesantes y para tener en cuenta:
-Como es la regla el porcentaje de varones de varones (68%) es muy superior; y el 94% de raza blanca (RU e Irlanda). La edad promedio 62 años (rango 40-75), algo tarde para prevención primaria...
-El NNT (sigla e información que esconden casi sistemáticamente los Trials financiados por la industria) es de:
32 pacientes durante 4 años para evitar un primer evento de cualquier tipo.
53 pacientes para evitar un síndrome coronario agudo (p = 0.02)
77 pacientes para evitar un stroke (p = 0.02)
-Magnitud del beneficio: 1 paciente menos desarrollará un evento cualquiera (Muerte coronaria, IAM, hospitalización por AI, paro cardíaco resuscitado, revascularización coronaria, stroke) si tratamos 32 pacientes con 10 mg de atorvastatin durante 4 años. Para semejante punto final combinado, el beneficio me parece casi impresentable.
-El LDL inicial global fue de 3.00 mmol/L. Rama placebo = 3.11 mmol/L; rama atorvastatin = 2.11 mmol/L. Un poco distintos, no?
-La diferencia en el número de pacientes revascularizados no fue significativa: placebo = 2.4 %, atorvastatin = 1.7 % (p=NS)
¿Qué opinarán de éstos datos los cardiodiabetólogos y los fundamentalistas de la MBE?
¿Se ajusta éste costo-beneficio a nuestra Medicina?
____________________________
Marcelo G. Colominas
SCChaco
Foro AmiCOR-FECC - ProCOR-FAC wrote:
Foro AmiCOR-FECC - ProCOR-FAC wrote:
Federación Argentina de Cardiología - ProCOR
Foro AmiCOR-FECC - www.fac.org.ar/amicor
______________________________________________
Hace no mucho tiempo, me fueron presentados, en apretada síntesis - como lo hace la “industria”- los resultados del CARDS (Collaborative AtoRvastatin Diabetes Study, Lancet 2004;364:685-96) sobre las bondades de ésta estatina en la prevención primaria de diabéticos normolipidémicos o fronterizos con 1 o más factores de riesgo agrregado/s. Y la sospecha me asaltó inmediatamente. Eran resultados que se me hacían difíciles de creer. No por la estatina en sí, la cuál me parece excelente herremienta terapéutica, sinó por lo llamativo de los RRR (35% para eventos coronarios agudos y 47% para stroke).
Mi curiosidad me llevó a buscar “algo más” en Google y la primera opción que encontré es la siguiente, que recomiendo:
http://www.rxfiles.ca/acrobat/Lipid-Q&A-CARDS.pdf
Algunas cosas interesantes y para tener en cuenta:
-Como es la regla el porcentaje de varones de varones (68%) es muy superior; y el 94% de raza blanca (RU e Irlanda). La edad promedio 62 años (rango 40-75), algo tarde para prevención primaria...
-El NNT (sigla e información que esconden casi sistemáticamente los Trials financiados por la industria) es de:
32 pacientes durante 4 años para evitar un primer evento de cualquier tipo.
53 pacientes para evitar un síndrome coronario agudo (p = 0.02)
77 pacientes para evitar un stroke (p = 0.02)
-Magnitud del beneficio: 1 paciente menos desarrollará un evento cualquiera (Muerte coronaria, IAM, hospitalización por AI, paro cardíaco resuscitado, revascularización coronaria, stroke) si tratamos 32 pacientes con 10 mg de atorvastatin durante 4 años. Para semejante punto final combinado, el beneficio me parece casi impresentable.
-El LDL inicial global fue de 3.00 mmol/L. Rama placebo = 3.11 mmol/L; rama atorvastatin = 2.11 mmol/L. Un poco distintos, no?
-La diferencia en el número de pacientes revascularizados no fue significativa: placebo = 2.4 %, atorvastatin = 1.7 % (p=NS)
¿Qué opinarán de éstos datos los cardiodiabetólogos y los fundamentalistas de la MBE?
¿Se ajusta éste costo-beneficio a nuestra Medicina?
____________________________
Marcelo G. Colominas
SCChaco
Thursday, July 21, 2005
Simpler Cardiovascular Risk Prediction in Women Suggested -
Simpler Cardiovascular Risk Prediction in Women Suggested - CME Teaching Brief - MedPage Today
* Evaluate primary cardiovascular risk in middle-aged, healthy women by calculating non-HDL-C or by using a ratio of LDL-C to total cholesterol.
* Apolipoprotein and high-sensitivity CRP evaluation may be useful adjunctively to monitor patients on statin therapy.
Review
BOSTON, July 20-Predicting cardiovascular risk in women is best done using simple measures such as non-HDL-cholesterol or LDL-C to total cholesterol ratios, rather than complex apolipoprotein evaluations or high sensitivity C-reactive protein (CRP), say researchers here.
When evaluating healthy, middle-age women those simple tests are as good as more expensive assays for apolipoproteins B100 and A-1, and superior to use of total cholesterol or LDL-cholesterol alone, said Paul M. Ridker, M.D., of the Center for Cardiovascular Disease Management.
* Evaluate primary cardiovascular risk in middle-aged, healthy women by calculating non-HDL-C or by using a ratio of LDL-C to total cholesterol.
* Apolipoprotein and high-sensitivity CRP evaluation may be useful adjunctively to monitor patients on statin therapy.
Review
BOSTON, July 20-Predicting cardiovascular risk in women is best done using simple measures such as non-HDL-cholesterol or LDL-C to total cholesterol ratios, rather than complex apolipoprotein evaluations or high sensitivity C-reactive protein (CRP), say researchers here.
When evaluating healthy, middle-age women those simple tests are as good as more expensive assays for apolipoproteins B100 and A-1, and superior to use of total cholesterol or LDL-cholesterol alone, said Paul M. Ridker, M.D., of the Center for Cardiovascular Disease Management.
Monday, July 18, 2005
The Art of Scenario Thinking for Nonprofits
GBN: What If?
The Art of Scenario Thinking for Nonprofits
Diana Scearce, Katherine Fulton
July 2004
Scenario thinking is a tool for motivating people to challenge the status quo, or get better at doing so, by asking "What if?" Asking "What if?" in a disciplined way allows you to rehearse the possibilities of tomorrow, and then to take action today empowered by those provocations and insights. What if we are about to experience a revolutionary change that will bring new challenges for nonprofits? Or enter a risk-averse world of few gains, yet few losses? What if we experience a renaissance of social innovation? And, importantly, what if the future brings new and unforeseen opportunities or challenges for your organization? Will you be ready to act?
What If? The Art of Scenario Thinking for Nonprofits (July 2004) aims to better prepare nonprofit leaders for the future by familiarizing them with scenario thinking. The material presented here derives from the institutional knowledge of Global Business Network and from GBN's multi-year partnership with the David and Lucille Packard Foundation's Organizational Effectiveness and Philanthropy Program, launched in early 2001 with the goal of raising awareness of scenario thinking among nonprofits. This guide is but one result of that collaboration.
The Art of Scenario Thinking for Nonprofits
Diana Scearce, Katherine Fulton
July 2004
Scenario thinking is a tool for motivating people to challenge the status quo, or get better at doing so, by asking "What if?" Asking "What if?" in a disciplined way allows you to rehearse the possibilities of tomorrow, and then to take action today empowered by those provocations and insights. What if we are about to experience a revolutionary change that will bring new challenges for nonprofits? Or enter a risk-averse world of few gains, yet few losses? What if we experience a renaissance of social innovation? And, importantly, what if the future brings new and unforeseen opportunities or challenges for your organization? Will you be ready to act?
What If? The Art of Scenario Thinking for Nonprofits (July 2004) aims to better prepare nonprofit leaders for the future by familiarizing them with scenario thinking. The material presented here derives from the institutional knowledge of Global Business Network and from GBN's multi-year partnership with the David and Lucille Packard Foundation's Organizational Effectiveness and Philanthropy Program, launched in early 2001 with the goal of raising awareness of scenario thinking among nonprofits. This guide is but one result of that collaboration.
Están aumentando los casos de mal de Chagas | LA NACION LINE
Están aumentando los casos de mal de Chagas | LA NACION LINE: "Están aumentando los casos de mal de Chagas
(recomendado por Marcelo Gustavo Colominas [mgcolominas@hotmail.com])
Un trabajo científico lo atribuye a la falta de desinsectación
* En la década del noventa habían descendido las notificaciones a dos o tres al año
* El último registro reconoce 24 casos agudos en cinco provincias
* Sólo se notifica el 5%"
(recomendado por Marcelo Gustavo Colominas [mgcolominas@hotmail.com])
Un trabajo científico lo atribuye a la falta de desinsectación
* En la década del noventa habían descendido las notificaciones a dos o tres al año
* El último registro reconoce 24 casos agudos en cinco provincias
* Sólo se notifica el 5%"
Saturday, July 16, 2005
The Euro Cardio-QoL Project. health-related quality of life
The Euro Cardio-QoL Project. An international study to develop a core heart disease health-related quality of life questionnaire, the HeartQoL
Neil Oldridgea, Hugo Sanerb and Hannah M. McGeec
(Recommended by: Marcelo Gustavo Colominas [mgcolominas@gigared.com]. Full text available on request)
Cardiovascular diseases, which include coronary heart disease, account for 48% of deaths in Europe and many developed countries have specifically targeted significant reductions in coronary heart disease deaths as major health care objectives.
Reduction in the death rate and morbidity from coronary heart disease can be accomplished through three primary interventions: (1) modification of lifestyle behaviors; (2) use of medications; and (3) surgical procedures. In order to prescribe a specific intervention, patients with heart disease are typically iagnosed by physicians with one or more of three inter-related (but clinically distinct) conditions: myocardial infarction, angina pectoris, or heart failure. This diagnostic conceptualization of coronary heart disease has led to important improvements in specific treatments and researchers have increasingly focused their attention on comparing the efficacy of one intervention versus another. Patients, providers, and researchers have increasingly become interested in identifying those interventions that not only improve mortality but also improve symptoms, function, and health-related quality of life. Thus, researchers have developed specific symptom
scales and health-related quality of life instruments for each of these three coronary heart disease conditions for use in clinical trials. As part of the Euro Cardio-QoL Project, the HeartQoL study is designed to develop a single reliable and valid core coronary heart disease-specific, health-related quality of life questionnaire, to be called the HeartQoL, in order to compare outcomes with the same or across different treatments among pure or mixed populations of patients with
myocardial infarction, angina pectoris, and/or heart failure. To be of value in international studies, health-related quality of life instruments must be available in a range of languages as many important clinical studies require multi-national and
multi-language site collaboration. The project will recruit a total of 4200 patients with myocardial infarction (n =1400), angina (n= 1400), and heart failure (n = 1400) in 40 sites located in 15 countries where 13 different languages are spoken.
Data will be collected using a battery of three valid self-administered, health-related quality of life instruments at baseline and again within 2 to 4 weeks to develop the core HeartQoL questionnaire and to establish its reliability. Anxiety, depression, mood, personality, and generic health-related quality of life will also be assessed at baseline to provide preliminary evidence of validity. Eur J Cardiovasc Prev Rehabil 12:87–94 2005 The European Society of Cardiology
European Journal of Cardiovascular Prevention and Rehabilitation 2005, 12:87–94
Keywords: coronary heart disease, health status, health-related quality of life, questionnaires, outcome assessment, clinical trials, HeartQoL Introduction
Cardiovascular disease is the main cause of death in Europe. Coronary heart disease (CHD) is the main form of cardiovascular disease and accounted for 48% of the
cardiovascular disease deaths in Europe and other developed areas of the world [1]. Significant reductions in coronary mortality and morbidity have been targeted as
major health care objectives and decreased endpoints, including mortality, have been observed as a result
Neil Oldridgea, Hugo Sanerb and Hannah M. McGeec
(Recommended by: Marcelo Gustavo Colominas [mgcolominas@gigared.com]. Full text available on request)
Cardiovascular diseases, which include coronary heart disease, account for 48% of deaths in Europe and many developed countries have specifically targeted significant reductions in coronary heart disease deaths as major health care objectives.
Reduction in the death rate and morbidity from coronary heart disease can be accomplished through three primary interventions: (1) modification of lifestyle behaviors; (2) use of medications; and (3) surgical procedures. In order to prescribe a specific intervention, patients with heart disease are typically iagnosed by physicians with one or more of three inter-related (but clinically distinct) conditions: myocardial infarction, angina pectoris, or heart failure. This diagnostic conceptualization of coronary heart disease has led to important improvements in specific treatments and researchers have increasingly focused their attention on comparing the efficacy of one intervention versus another. Patients, providers, and researchers have increasingly become interested in identifying those interventions that not only improve mortality but also improve symptoms, function, and health-related quality of life. Thus, researchers have developed specific symptom
scales and health-related quality of life instruments for each of these three coronary heart disease conditions for use in clinical trials. As part of the Euro Cardio-QoL Project, the HeartQoL study is designed to develop a single reliable and valid core coronary heart disease-specific, health-related quality of life questionnaire, to be called the HeartQoL, in order to compare outcomes with the same or across different treatments among pure or mixed populations of patients with
myocardial infarction, angina pectoris, and/or heart failure. To be of value in international studies, health-related quality of life instruments must be available in a range of languages as many important clinical studies require multi-national and
multi-language site collaboration. The project will recruit a total of 4200 patients with myocardial infarction (n =1400), angina (n= 1400), and heart failure (n = 1400) in 40 sites located in 15 countries where 13 different languages are spoken.
Data will be collected using a battery of three valid self-administered, health-related quality of life instruments at baseline and again within 2 to 4 weeks to develop the core HeartQoL questionnaire and to establish its reliability. Anxiety, depression, mood, personality, and generic health-related quality of life will also be assessed at baseline to provide preliminary evidence of validity. Eur J Cardiovasc Prev Rehabil 12:87–94 2005 The European Society of Cardiology
European Journal of Cardiovascular Prevention and Rehabilitation 2005, 12:87–94
Keywords: coronary heart disease, health status, health-related quality of life, questionnaires, outcome assessment, clinical trials, HeartQoL Introduction
Cardiovascular disease is the main cause of death in Europe. Coronary heart disease (CHD) is the main form of cardiovascular disease and accounted for 48% of the
cardiovascular disease deaths in Europe and other developed areas of the world [1]. Significant reductions in coronary mortality and morbidity have been targeted as
major health care objectives and decreased endpoints, including mortality, have been observed as a result
Wednesday, July 13, 2005
no hay "alimentos prohibidos" para comer de forma saludable
12/07/2005 09:38
(recomendado por Marcelo Gustavo Colominas [mgcolominas@gigared.com])
El catedrático de Medicina Interna de la Universidad Complutense de Madrid y miembro de la Sociedad Española Arteriosclerosis, Jesús Millán, aseguró que no hay "alimentos prohibidos" para comer de forma saludable, subrayando que "la salud es compatible con la buena cocina y la creatividad".
El Dr. Millán, que presentó las I Jornadas de Gastronomía para prevenir la arteriosclerosis, que cuenta con la colaboración de prestigiosos cocineros como Sergi Arola, Paco Roncero, Andrés Madrigal o Joaquín de Felipe, explicó que esta iniciativa de la Sociedad Española de Arteriosclerosis pretende llegar hasta la población haciéndola partícipe de que la dieta saludable forma parte de la prevención del riesgo cardiovascular.
Según recordó, el 40% de las muertes que se producen en España se debe a enfermedades cardiovasculares, en las cuales tiene una influencia determinante el estilo de vida, apoyado en la dieta, el ejercicio físico y la cesación del hábito tabáquico.
En este sentido, el Dr. Millán señaló que en España hay excelentes alimentos y componentes de la dieta, como frutas, verduras, féculas o hidratos de carbono, así como excelentes profesionales para combinarlos.
Por ello, el objetivo de esta iniciativa, que pretende llegar a más de 1.000 restaurantes de toda España, es diseñar unos menús que fomenten la salud a través de los líderes de la nueva cocina, sensibilizando a la agente de que "es posible comer bien y sano" y de que "no hay que pensar que hay alimentos prohibidos, sino formas de comer más saludables que otras".
Así, considera que a la hora de alimentarse hay que tener en consideración las calorías que se ingieren, de manera que se tomen las calorías necesarias para mantener el peso, o menos en los casos de obesidad o sobrepeso.
Como norma general, el Dr. Millán recomienda cocinar con poca sal y abundante fibra, con predominio y abundancia de verduras y frutas que aportan minerales, vitaminas y otros elementos imprescindibles como antioxidantes.
Además, la cantidad total de grasas no debe superar el 30% aproximadamente del total de las calorías, aprovechando una de las mejores grasas como es la monoinsaturada, representada por el aceite de oliva.
"Siempre se debe fomentar una parte importante de aceite de oliva, más del 10% del aporte calórico -añadió-, restringiendo las grasas saturadas procedentes principalmente de las grasas de origen animal". A su juicio, los alimentos más perjudiciales son los que tienen más grasas saturadas aunque, dijo, también se puede cocinar quitando a la carne el tocino, la grasa y la piel al pollo.
Por último, el citado especialista indicó que la Sociedad Española de Arteriosclerosis pondrá a disposición de los clientes de estos restaurantes una publicación, titulada "Vida Sana" para fomentar estilos de vida, con la opinión de expertos, reportajes y recetas de algunos chefs de prestigio.
Noticias Relacionadas
El Dr. William Roberts considera que la arteriosclerosis no es una enfermedad multifactorial, sino causada básicamente por la hipercolesterolemia 23/05/2005
Los participantes en el Congreso de la Sociedad Europea de Arteriosclerosis redefinen el concepto de la enfermedad 19/04/2004
Sanidad lanza una campaña educativa para recomendar dieta sana, ejercicio y evitar el tabaco y el alcohol 03/09/2003
La dieta sana es clave para mantener un corazón sano 19/06/2001
Webs Relacionadas
Sociedad Española de Arteriosclerosis
(recomendado por Marcelo Gustavo Colominas [mgcolominas@gigared.com])
El catedrático de Medicina Interna de la Universidad Complutense de Madrid y miembro de la Sociedad Española Arteriosclerosis, Jesús Millán, aseguró que no hay "alimentos prohibidos" para comer de forma saludable, subrayando que "la salud es compatible con la buena cocina y la creatividad".
El Dr. Millán, que presentó las I Jornadas de Gastronomía para prevenir la arteriosclerosis, que cuenta con la colaboración de prestigiosos cocineros como Sergi Arola, Paco Roncero, Andrés Madrigal o Joaquín de Felipe, explicó que esta iniciativa de la Sociedad Española de Arteriosclerosis pretende llegar hasta la población haciéndola partícipe de que la dieta saludable forma parte de la prevención del riesgo cardiovascular.
Según recordó, el 40% de las muertes que se producen en España se debe a enfermedades cardiovasculares, en las cuales tiene una influencia determinante el estilo de vida, apoyado en la dieta, el ejercicio físico y la cesación del hábito tabáquico.
En este sentido, el Dr. Millán señaló que en España hay excelentes alimentos y componentes de la dieta, como frutas, verduras, féculas o hidratos de carbono, así como excelentes profesionales para combinarlos.
Por ello, el objetivo de esta iniciativa, que pretende llegar a más de 1.000 restaurantes de toda España, es diseñar unos menús que fomenten la salud a través de los líderes de la nueva cocina, sensibilizando a la agente de que "es posible comer bien y sano" y de que "no hay que pensar que hay alimentos prohibidos, sino formas de comer más saludables que otras".
Así, considera que a la hora de alimentarse hay que tener en consideración las calorías que se ingieren, de manera que se tomen las calorías necesarias para mantener el peso, o menos en los casos de obesidad o sobrepeso.
Como norma general, el Dr. Millán recomienda cocinar con poca sal y abundante fibra, con predominio y abundancia de verduras y frutas que aportan minerales, vitaminas y otros elementos imprescindibles como antioxidantes.
Además, la cantidad total de grasas no debe superar el 30% aproximadamente del total de las calorías, aprovechando una de las mejores grasas como es la monoinsaturada, representada por el aceite de oliva.
"Siempre se debe fomentar una parte importante de aceite de oliva, más del 10% del aporte calórico -añadió-, restringiendo las grasas saturadas procedentes principalmente de las grasas de origen animal". A su juicio, los alimentos más perjudiciales son los que tienen más grasas saturadas aunque, dijo, también se puede cocinar quitando a la carne el tocino, la grasa y la piel al pollo.
Por último, el citado especialista indicó que la Sociedad Española de Arteriosclerosis pondrá a disposición de los clientes de estos restaurantes una publicación, titulada "Vida Sana" para fomentar estilos de vida, con la opinión de expertos, reportajes y recetas de algunos chefs de prestigio.
Noticias Relacionadas
El Dr. William Roberts considera que la arteriosclerosis no es una enfermedad multifactorial, sino causada básicamente por la hipercolesterolemia 23/05/2005
Los participantes en el Congreso de la Sociedad Europea de Arteriosclerosis redefinen el concepto de la enfermedad 19/04/2004
Sanidad lanza una campaña educativa para recomendar dieta sana, ejercicio y evitar el tabaco y el alcohol 03/09/2003
La dieta sana es clave para mantener un corazón sano 19/06/2001
Webs Relacionadas
Sociedad Española de Arteriosclerosis
Friday, July 08, 2005
Acute Rheumatic Fever
The Lancet:
"Jonathan R Carapetis, Malcolm McDonald, and Nigel J Wilson
Summary
Acute rheumatic fever (ARF) and its chronic sequela, rheumatic heart disease (RHD), have become rare in most affluent populations, but remain unchecked in developing countries and in some poor, mainly indigenous populations in wealthy countries. More than a century of research, mainly in North America and Europe, has improved our understanding of ARF and RHD. However, whether traditional views need to be updated in view of the epidemiological shift of the past 50 years is still to be established, and improved data from developing countries are needed. Doctors who work in populations with a high incidence of ARF are adapting existing diagnostic guidelines to increase their sensitivity. Group A streptococcal vaccines are still years away from being available and, even if the obstacles of serotype coverage and safety can be overcome, their cost could make them inaccessible to the populations that need them most. New approaches to primary prevention are needed given the limitations of primary prophylaxis as a population-based strategy. The most effective approach for control of ARF and RHD is secondary prophylaxis, which is best delivered as part of a coordinated control programme."
"Jonathan R Carapetis, Malcolm McDonald, and Nigel J Wilson
Summary
Acute rheumatic fever (ARF) and its chronic sequela, rheumatic heart disease (RHD), have become rare in most affluent populations, but remain unchecked in developing countries and in some poor, mainly indigenous populations in wealthy countries. More than a century of research, mainly in North America and Europe, has improved our understanding of ARF and RHD. However, whether traditional views need to be updated in view of the epidemiological shift of the past 50 years is still to be established, and improved data from developing countries are needed. Doctors who work in populations with a high incidence of ARF are adapting existing diagnostic guidelines to increase their sensitivity. Group A streptococcal vaccines are still years away from being available and, even if the obstacles of serotype coverage and safety can be overcome, their cost could make them inaccessible to the populations that need them most. New approaches to primary prevention are needed given the limitations of primary prophylaxis as a population-based strategy. The most effective approach for control of ARF and RHD is secondary prophylaxis, which is best delivered as part of a coordinated control programme."
Thursday, July 07, 2005
Oxidized Phospholipids, Lp(a) Lipoprotein, and Coronary Artery Disease
NEJM -- Oxidized Phospholipids, Lp(a) Lipoprotein, and Coronary Artery Disease:
Sotirios Tsimikas, M.D. et al.
"Background Lp(a) lipoprotein binds proinflammatory oxidized phospholipids. We investigated whether levels of oxidized low-density lipoprotein (LDL) measured with use of monoclonal antibody E06 reflect the presence and extent of obstructive coronary artery disease, defined as a stenosis of more than 50 percent of the luminal diameter"
(From Daily Headlines)
SAN DIEGO, July 6-The connection between levels of oxidized low-density lipoprotein (LDL) and the risk of coronary artery disease has been strengthened, a finding that may one day lead to the era of oxidized phospholipids as a diagnostic marker or even a therapeutic target.
Oxidized LDL levels showed a "strong and graded association (P <0.001) with the presence and extent of coronary artery disease," reported Sotirios Tsimikas, M.D., of the University of San Diego and colleagues in the July 7 issue of the New England Journal of Medicine.
Although phospholipids such as LDL are important to the structural integrity of cells, when oxidized they can promote inflammation, which in turn can lead to coronary artery disease, the researchers said.
To evaluate the relationship between circulating oxidized LDL and coronary artery disease, Dr. Tsimikas measured oxidized LDL levels in 504 patients 18 to 75 years old before they underwent clinically indicated coronary angiography.
The researchers also measured the levels of another molecule, Lp(a) lipoprotein, which many believe binds to oxidized LDL and helps degrade it. But this molecule can also contribute to coronary artery disease when its levels are chronically high.
Statistical analysis showed that, in the entire study group, the predictive value of oxidized LDL for coronary artery disease was similar to that of traditional risk factors such as age, hypertension, and LDL cholesterol levels.
However, the association between oxidized LDL and coronary artery disease was much stronger for patients less than 60 years old compared with older patients.
Among patients 60 or younger, those in the highest quartile for oxidized LDL had more than three times the risk for coronary artery disease compared with those in the lowest quartile (P <0.001).
Also among patients 60 or younger, those in the highest quartile for Lp(a) had more than 3.5 times the disease risk compared to those in the lowest quartile (P <0.001).
The researchers speculated that the strength of the association between oxidized LDL and coronary artery disease decreased for those older than 60 because of the cumulative contributions of additional risk factors as people grow older.
In an Perspectives article, Judith A. Berliner, Ph.D., and Andrew D. Watson, Ph.D., of UCLA welcomed the new findings, going as far as to state they established a causal connection -- a claim the researchers themselves did not make.
"This study is the first to establish a causal connection between the levels of oxidized phospholipids and the risk of coronary artery disease," they wrote. "Thus, oxidized phospholipids may be a diagnostic marker of coronary artery disease or may represent a potential target for therapeutic intervention."
Related article:
* Rheumatoid Arthritis Increases Risk of Multi-vessel CAD
Primary source: New England Journal of Medicine
Source reference:
Tsimikas S et al. Oxidized phospholipids, Lp(a) lipoprotein, and coronary artery disease. NEJM. 2005; 353(1): 46-57.
Additional source: New England Journal of Medicine
Source reference:
Berliner JA et al. A role for oxidized phospholipids in atherosclerosis. NEJM. 2005; 353(1): 9-11.
Sotirios Tsimikas, M.D. et al.
"Background Lp(a) lipoprotein binds proinflammatory oxidized phospholipids. We investigated whether levels of oxidized low-density lipoprotein (LDL) measured with use of monoclonal antibody E06 reflect the presence and extent of obstructive coronary artery disease, defined as a stenosis of more than 50 percent of the luminal diameter"
(From Daily Headlines)
SAN DIEGO, July 6-The connection between levels of oxidized low-density lipoprotein (LDL) and the risk of coronary artery disease has been strengthened, a finding that may one day lead to the era of oxidized phospholipids as a diagnostic marker or even a therapeutic target.
Oxidized LDL levels showed a "strong and graded association (P <0.001) with the presence and extent of coronary artery disease," reported Sotirios Tsimikas, M.D., of the University of San Diego and colleagues in the July 7 issue of the New England Journal of Medicine.
Although phospholipids such as LDL are important to the structural integrity of cells, when oxidized they can promote inflammation, which in turn can lead to coronary artery disease, the researchers said.
To evaluate the relationship between circulating oxidized LDL and coronary artery disease, Dr. Tsimikas measured oxidized LDL levels in 504 patients 18 to 75 years old before they underwent clinically indicated coronary angiography.
The researchers also measured the levels of another molecule, Lp(a) lipoprotein, which many believe binds to oxidized LDL and helps degrade it. But this molecule can also contribute to coronary artery disease when its levels are chronically high.
Statistical analysis showed that, in the entire study group, the predictive value of oxidized LDL for coronary artery disease was similar to that of traditional risk factors such as age, hypertension, and LDL cholesterol levels.
However, the association between oxidized LDL and coronary artery disease was much stronger for patients less than 60 years old compared with older patients.
Among patients 60 or younger, those in the highest quartile for oxidized LDL had more than three times the risk for coronary artery disease compared with those in the lowest quartile (P <0.001).
Also among patients 60 or younger, those in the highest quartile for Lp(a) had more than 3.5 times the disease risk compared to those in the lowest quartile (P <0.001).
The researchers speculated that the strength of the association between oxidized LDL and coronary artery disease decreased for those older than 60 because of the cumulative contributions of additional risk factors as people grow older.
In an Perspectives article, Judith A. Berliner, Ph.D., and Andrew D. Watson, Ph.D., of UCLA welcomed the new findings, going as far as to state they established a causal connection -- a claim the researchers themselves did not make.
"This study is the first to establish a causal connection between the levels of oxidized phospholipids and the risk of coronary artery disease," they wrote. "Thus, oxidized phospholipids may be a diagnostic marker of coronary artery disease or may represent a potential target for therapeutic intervention."
Related article:
* Rheumatoid Arthritis Increases Risk of Multi-vessel CAD
Primary source: New England Journal of Medicine
Source reference:
Tsimikas S et al. Oxidized phospholipids, Lp(a) lipoprotein, and coronary artery disease. NEJM. 2005; 353(1): 46-57.
Additional source: New England Journal of Medicine
Source reference:
Berliner JA et al. A role for oxidized phospholipids in atherosclerosis. NEJM. 2005; 353(1): 9-11.
Tuesday, July 05, 2005
Obesity, Insulin Resistance, and the Metabolic Syndrome: Determinants of Endothelial Dysfunction in Whites and Blacks -- Lteif et al. 112 (1): 32 -- C
Obesity, Insulin Resistance, and the Metabolic Syndrome: Determinants of Endothelial Dysfunction in Whites and Blacks -- Lteif et al. 112 (1): 32 -- Circulation
Conclusions— These findings suggest that insulin resistance and systolic blood pressure are the principal determinants of endothelial dysfunction in the MS and that there are ethnic differences in the relative importance of these factors. These differences may imply different benefits from treatments targeting blood pressure or insulin resistance in different ethnic groups.
Conclusions— These findings suggest that insulin resistance and systolic blood pressure are the principal determinants of endothelial dysfunction in the MS and that there are ethnic differences in the relative importance of these factors. These differences may imply different benefits from treatments targeting blood pressure or insulin resistance in different ethnic groups.
Sunday, July 03, 2005
125th Anniversary Issue: Science Online Special Feature
125th Anniversary Issue: Science Online Special Feature:
"THE QUESTIONS
The Top 25
Essays by our news staff on 25 big questions facing science over the next quarter-century.
>What Is the Universe Made Of?
>What is the Biological Basis of Consciousness?
>Why Do Humans Have So Few Genes?
>To What Extent Are Genetic Variation and Personal Health Linked?
>Can the Laws of Physics Be Unified?
>How Much Can Human Life Span Be Extended?
>What Controls Organ Regeneration?
>How Can a Skin Cell Become a Nerve Cell?
>How Does a Single Somatic Cell Become a Whole Plant?
>How Does Earth's Interior Work?
>Are We Alone in the Universe?
>How and Where Did Life on Earth Arise?
>What Determines Species Diversity?
>What Genetic Changes Made Us Uniquely Human?
>How Are Memories Stored and Retrieved?
>How Did Cooperative Behavior Evolve?
>How Will Big Pictures Emerge from a Sea of Biological Data?
>How Far Can We Push Chemical Self-Assembly?
>What Are the Limits of Conventional Computing?
>Can We Selectively Shut Off Immune Responses?
>Do Deeper Principles Underlie Quantum Uncertainty and Nonlocality?
>Is an Effective HIV Vaccine Feasible?
>How Hot Will the Greenhouse World Be?
>What Can Replace Cheap Oil -- and When?
>Will Malthus Continue to Be Wrong?
So Much More to Know . . .
A roundup of 100 additional problems that should keep researchers busy for years to come."
"THE QUESTIONS
The Top 25
Essays by our news staff on 25 big questions facing science over the next quarter-century.
>What Is the Universe Made Of?
>What is the Biological Basis of Consciousness?
>Why Do Humans Have So Few Genes?
>To What Extent Are Genetic Variation and Personal Health Linked?
>Can the Laws of Physics Be Unified?
>How Much Can Human Life Span Be Extended?
>What Controls Organ Regeneration?
>How Can a Skin Cell Become a Nerve Cell?
>How Does a Single Somatic Cell Become a Whole Plant?
>How Does Earth's Interior Work?
>Are We Alone in the Universe?
>How and Where Did Life on Earth Arise?
>What Determines Species Diversity?
>What Genetic Changes Made Us Uniquely Human?
>How Are Memories Stored and Retrieved?
>How Did Cooperative Behavior Evolve?
>How Will Big Pictures Emerge from a Sea of Biological Data?
>How Far Can We Push Chemical Self-Assembly?
>What Are the Limits of Conventional Computing?
>Can We Selectively Shut Off Immune Responses?
>Do Deeper Principles Underlie Quantum Uncertainty and Nonlocality?
>Is an Effective HIV Vaccine Feasible?
>How Hot Will the Greenhouse World Be?
>What Can Replace Cheap Oil -- and When?
>Will Malthus Continue to Be Wrong?
So Much More to Know . . .
A roundup of 100 additional problems that should keep researchers busy for years to come."
World Hypertension League Newsletter
World Hypertension League
The WHL Newsletter is a free bimonthly WHL periodical published at the Max Delbruck Center for Molecular Medicine in Berlin, Germany. Dr. Anja Kroke is the Editor. Each issue includes:
Advances in high blood pressure treatment,
A description of the activities of the member organizations, and
A calendar that lists major upcoming meetings on cardiovascular-related topics throughout the world.
The WHL Newsletter is distributed six times/year to more than 14,000 colleagues in 133 countries. In addition, Chinese, Portuguese, and Italian translations are produced and distributed locally, bringing the overall circulation to approximately 50,000 copies/issue. Presently, there are 81 national hypertension organizations and 10 Supporting Members, for a total of 91 WHL member organizations. The local societies distribute the WHL Newsletter to additional professionals in their area.
The WHL Newsletter is a free bimonthly WHL periodical published at the Max Delbruck Center for Molecular Medicine in Berlin, Germany. Dr. Anja Kroke is the Editor. Each issue includes:
Advances in high blood pressure treatment,
A description of the activities of the member organizations, and
A calendar that lists major upcoming meetings on cardiovascular-related topics throughout the world.
The WHL Newsletter is distributed six times/year to more than 14,000 colleagues in 133 countries. In addition, Chinese, Portuguese, and Italian translations are produced and distributed locally, bringing the overall circulation to approximately 50,000 copies/issue. Presently, there are 81 national hypertension organizations and 10 Supporting Members, for a total of 91 WHL member organizations. The local societies distribute the WHL Newsletter to additional professionals in their area.
New score predicts risk of stroke in patients with transient ischaemic attack
New score predicts risk of stroke in patients with transient ischaemic attack
Researchers from Oxford in the United Kingdom have developed a simple scoring system to help predict which patients with transient ischaemic attack are most likely to have a stroke soon afterwards. The system, called ABCD, scores patients up to a maximum of 6 points according to their age ( 60 years = 1), blood pressure (systolic > 140 mm Hg or diastolic 90, or both = 1), clinical picture (unilateral weakness = 2, speech disturbance without weakness = 1, other = 0) and duration of symptoms ( 60 minutes = 2, 10-59 = 1, < 10 = 0). When tested in a population based cohort of nearly 400 patients with suspected transient ischaemic attack, the ABCD score was highly predictive of early stroke (P < 0.0001); 19 out of the 20 strokes occurred in the 27% of patients with a score of 5 or more. Overall, the seven day risk of stroke was 0.4% for patients who scored less than 5, 12.1% for patients who scored 5, and 31.4% for patients who scored 6.
This preliminary validation looks promising but there's always room for more. In the meantime the authors hope their simple system will help primary care doctors assess patients for referral more rapidly and reliably, and help hospital specialists triage referrals for emergency investigations and treatment. A score of 6, say the authors, should be treated as a medical emergency.
Lancet 2005 June 21; doi 10.1061/S0140-6736(05)66702-5[CrossRef]
Researchers from Oxford in the United Kingdom have developed a simple scoring system to help predict which patients with transient ischaemic attack are most likely to have a stroke soon afterwards. The system, called ABCD, scores patients up to a maximum of 6 points according to their age ( 60 years = 1), blood pressure (systolic > 140 mm Hg or diastolic 90, or both = 1), clinical picture (unilateral weakness = 2, speech disturbance without weakness = 1, other = 0) and duration of symptoms ( 60 minutes = 2, 10-59 = 1, < 10 = 0). When tested in a population based cohort of nearly 400 patients with suspected transient ischaemic attack, the ABCD score was highly predictive of early stroke (P < 0.0001); 19 out of the 20 strokes occurred in the 27% of patients with a score of 5 or more. Overall, the seven day risk of stroke was 0.4% for patients who scored less than 5, 12.1% for patients who scored 5, and 31.4% for patients who scored 6.
This preliminary validation looks promising but there's always room for more. In the meantime the authors hope their simple system will help primary care doctors assess patients for referral more rapidly and reliably, and help hospital specialists triage referrals for emergency investigations and treatment. A score of 6, say the authors, should be treated as a medical emergency.
Lancet 2005 June 21; doi 10.1061/S0140-6736(05)66702-5[CrossRef]
Friday, July 01, 2005
Adiposopathy
Cardiosource: "Adiposopathy is defined as pathological adipose tissue function that may be promoted and exacerbated by fat accumulation (adiposity) and sedentary lifestyle in genetically susceptible patients. Adiposopathy is associated with metabolic diseases such as type 2 diabetes mellitus, hypertension, and dyslipidemia more than is adiposity alone, as illustrated by patient populations such as “metabolically healthy, but obese” and “metabolically obese, but normal weight” as well as patients with lipodystrophy, familial combined hyperlipidemia, and some Asian Indians."
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