Sunday, July 30, 2006

Meta-Analysis: Cardiovascular Events Associated with NSAI drugs

(refered by Marcelo Gustavo Colominas [])
Meta-Analysis: Cardiovascular Events Associated with
Nonsteroidal Anti-inflammatory Drugs
Shelley R. Salpeter, MD,a,b Peter Gregor, MD,b Thomas M. Ormiston, MD,b Richard Whitlock, MD,c
Parminder Raina, PhD,c,d Lehana Thabane, PhD,d,e Eric J. Topol, MDf
aStanford University School of Medicine, Stanford, Calif; bSanta Clara Valley Medical Center, San Jose, Calif; cMcMaster Evidencebased
Practice Centre, McMaster University, Hamilton, Ont, Canada; dDepartment of Clinical Epidemiology and Biostatistics,
McMaster University, Hamilton, Ont, Canada; eCentre for Evaluation of Medicines, Saint Joseph’s Healthcare, Hamilton, Ont,
Canada; fDepartment of Genetics, Case Western Reserve University, Cleveland, Ohio.
PURPOSE: We performed a meta-analysis of randomized controlled trials to assess the effect of
nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) on cardiovascular events in trials of joint disease and Alzheimer’s disease.
METHODS: We performed comprehensive searches of MEDLINE, EMBASE, CINAHL and Cochrane databases from 1966 to July 2005, and references of identified articles and reviews. We included randomized placebo-controlled trials of at least 6 weeks duration that evaluated nonselective NSAIDs in trials of joint disease or Alzheimer’s disease, and reported at least one cardiovascular event or death. The outcome measured was the composite of death, myocardial infarction or cerebrovascular accident, with the pooled results reported as odds ratios (OR). Subgroup analyses evaluated the difference between trials of joint disease and Alzheimer’s disease, and for naproxen and non-naproxen NSAIDs.
RESULTS: Pooled data from 13 trials with 7718 participants showed that nonselective NSAIDs had no significant effect on cardiovascular events (OR 1.3; 95% confidence interval [CI], 0.8 to 2.1). No significant effect was seen for joint disease trials (OR 0.6; 95% CI, 0.2 to 1.7) or Alzheimer disease trials (OR 1.6; 95% CI, 0.9 to 2.7). There was no significant difference in results for naproxen and non-naproxen NSAIDs.
CONCLUSION: Nonselective NSAIDs have no significant effect on cardiovascular events or death in trials of joint disease and Alzheimer disease, but a small adverse effect could not be excluded. An indication for risk was present in trials of Alzheimer’s disease but not in joint disease trials. There was no significant adverse or cardioprotective effect of naproxen. © 2006 Elsevier Inc. All rights reserved.

Wednesday, July 26, 2006

The price of growth in the Medical-Device Industry

NEJM -- The Price of Growth in the Medical-Device Industry: "In one of the most dramatic corporate acquisitions in recent memory, Boston Scientific, a large manufacturer of medical devices, outbid industry giant Johnson & Johnson to purchase Guidant Corporation earlier this year. Joining Boston Scientific in this effort was Abbott Laboratories, which paid $5 billion for Guidant's endovascular-device business. The outcome could hardly have been anticipated when Johnson & Johnson agreed to purchase Guidant for $25 billion in December 2004. In the wake of disclosures of lawsuits over allegedly defective Guidant devices, Guidant agreed to reduce the purchase price to $21.5 billion. Then Boston Scientific stepped in with a higher . . ."

Multidetector CT

Multidetector CT Not Yet Ready for Prime Coronary Time - CME Teaching Brief® - MedPage Today: "CLEVELAND, July 25 -- After a real-world multicenter evaluation with varying levels of expertise, the multidetector computed tomography (MDCT) got a thumb's down as a noninvasive competitor for coronary angiography.

Nearly 30% of the time, 16-row MDCT images of coronary artery segments were of too low quality to be evaluated, said Mario J. Garcia, M.D., of the Cleveland Clinic here. But 38% of patients with non-evaluable MDCT images turned out to have significant obstructive disease.

In addition, MDCT resulted in a high rate of false positives, Dr. Garcia and colleagues reported in the July 26 issue of the Journal of the American Medical Association.

Although single-center studies have reported promising results for MDCT in detecting obstructive coronary disease, few multiple-center studies have been done, the investigators said."

Cardiologists urge arterial screening of asymptomatic older people

Cardiologists urge screening of asymptomatic older people -- Charatan 333 (7560): 168 Data Supplement - Longer version -- BMJ: "An international group of prominent cardiologists has called for non-invasive screening for heart disease of all US asymptomatic men aged 45-75 and women aged 55-75.
The Screening For Heart Attack Prevention And Education (SHAPE) task force says that screening should be carried out to measure coronary artery calcium, with computed tomography scan, and carotid intima media thickness and plaque, with carotid ultrasonography.
The group's recommendations were published as a supplement to the American Journal of Cardiology in July, with Pfizer as the major sponsor.
The proposal hinges on the basic principle that traditional risk factor screening -the Framingham risk score and the SCORE criteria in Europe - does a good job of identifying people at very low and high risk of myocardial infarction or stroke over a decade but fails to single out 'at risk' men and women who represent everything in between. The Framingham risk factors include hypertension, hypercholesterolaemia, history of smoking, age, diabetes, and a family history of stroke or heart disease.
Prediman Shah, the head of cardiology at Cedars-Sinai Medical Center, professor of medicine at the University of California in Los Angeles, and a member of the task force, predicted that the new proposed guidelines will change health care./.../ "

Archimedes writings recovered

(From Science)
Sometimes it takes a magnifying glass to decipher an ancient text, and sometimes it takes a linear accelerator. During a live Webcast* from the Exploratorium in San Francisco, California, scholars will fire up an atom smasher to expose concealed writings by the Greek mathematician Archimedes (287-212 B.C.E.).
Known as the Archimedes Palimpsest, the manuscript in question contains the only known copy of one of the great thinker's treatises. But it has taken a beating. Medieval monks reused the pages, and a collector further defaced the work by adding paintings. Applying techniques such as multispectral imaging, researchers have uncovered much of the original text, but some remains unreadable. For the Webcast, experts will train a powerful x-ray beam from the Stanford Linear Accelerator Center on a previously hidden section of the manuscript, causing the underlying ink to fluoresce. A Greek scholar and other Archimedeans will decipher the glowing writing and discuss its significance. The event begins at 7 p.m. U.S. Eastern Time on 4 August. To learn more about the palimpsest, hop over to this site from the Walters Art Museum in Baltimore, Maryland.

Thursday, July 06, 2006

The SuRF Report 2: Surveillance of chronic disease Risk Factors:

This report is the second in the Surveillance of Risk Factors Report Series. SuRF2 updates the Country Profiles provided by SuRF1 in 2003. SuRF2 also presents, for the first time, comparable country-level estimates for raised blood pressure, obesity, and overweight.
The focus of the Country Profiles is recent, nationally representative risk factor data. The risk factors included in this report are those that make the greatest contribution to mortality and morbidity from cardiovascular disease, can be changed through primary intervention, and are easily measured in populations. These risk factors are:

  • tobacco and alcohol use
  • patterns of physical inactivity
  • low fruit/vegetable intake
  • overweight/obesity
  • blood pressure
  • cholesterol
  • diabetes

    The text of SuRF2 (which includes everything but the Country Profiles) can be viewed in its entirety by clicking here, view complete SuRF2.

Tuesday, July 04, 2006

Vacina para Febre Reumática e Jorge Kalil

CNPq - Conselho Nacional de Desenvolvimento Científico e Tecnológico:
"Uma vacina contra a febre reumática, que afeta milhares de crianças e adolescentes todos os anos, é a prioridade do pesquisador Jorge Kalil. Mais comum entre 7 e 14 anos de idade, quando leva ao envolvimento do músculo cardíaco a doença implica em tratamento para o resto da vida. As pesquisas de seu grupo já resultaram na produção de proteínas recombinantes, humanização de anticorpos, novos testes diagnósticos e ensaios clínicos baseados em vacinas de DNA. “O grande desafio atual está em uma aproximação mais forte com a indústria farmacêutica, o que incrementaria a transferência para a sociedade dos diversos medicamentos gerados no programa”, afirma Kalil.
Os trabalhos são desenvolvidos no âmbito do Instituto de Investigação em Imunologia (iii), fundado em 2001 como parte dos Institutos do Milênio, programa do Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq). O iii é formado por um grupo de 31 pesquisadores localizados em seis estados brasileiros, que interagem de modo colaborativo. Juntos, formam uma rede multidisciplinar de grupos de pesquisa com novas abordagens clínicas para doenças de origem imunológica.
Os conhecimentos gerados resultam de estudos em seres humanos, modelos animais e sistemas “in vitro”, utilizando técnicas que incluem a proteômica e a genômica funcional. São objetivos do iii o aperfeiçoamento do tratamento e diagnóstico de alergias, o aumento da tolerância a enxertos, a identificação de moléculas relevantes que possam servir de alvo no tratamento de imunodeficiências e o desenvolvimento de vacinas para febre reumática, esquistossomose, leishmaniose e HIV, além de câncer e doença de Chagas.
O Programa dos Institutos do Milênio permite que cientistas de alta produtividade e de competências complementares atuem sinergicamente na busca de objetivos comuns. Indo do mais fundamental à aplicação clínica, este Instituto do Milênio incorporou o princípio de agilidade técnico-científica que está na essência da proposição do programa.
Gaúcho de Porto Alegre, o professor Jorge Elias Kalil Filho já é um dos mais produtivos cientistas da história do país. Apresentou 913 trabalhos em congressos, tem 31

Sunday, July 02, 2006


Code of Conduct Department HONcode:
Health On the Net (HON) HON:
Geneva University Hospital -
DIM My electronic mail isCH-1211 Geneva 14, Switzerland
Phone/Fax:(41 22)372 6250/8885
Health On the Net Foundation's initiative to improve the quality of the medical Internet. AMICOR has been visited and reviewed by the HONcode team for compliance.

The following lines are inspired on recommendations received from the HONCode team:
I am the author responsible for AMICOR: Aloyzio Cechella Achutti, physician, specialist in Internal Medicine and Cardiology. Graduation in 1958, in the School of Medicine from the Federal University of Rio Grande do Sul (RGS) State, Porto Alegre, Brazil; and Professor, from the same school, until retirement in 1996.Member of the Brazilian Society of Cardiology, the Medical Association of RGS; and member of the Scientific Advisory Board of the International Society and Federation of Cardiology (after World Heart Federation) from 1989 until 2001; also member of the Academy of Medicine from the RGS, and its President 2001 and 2002; Member of the Smoking or Health Expert Panel from the World Health Organization (WHO) from 1982 until 1999.Several times I was temporary advisor for the Brazil Ministry of Health, WHO, Pan American Health Organization and World Bank; also member of the International Advisory Board of ProCOR (initiative of Professor Bernard Lown. Boston, USA)Now, the author is advisor for the Institute of Education and Research of the Hospital Moinhos de Vento and member of its Medical Orientation Panel.AMICOR was created in 1997 May, 17, following the first National Ten Days Seminar on Epidemiology and Prevention. AMICOR started as an e-mail list to discuss the “Gramado Declaration’ with the participants that had access to this communication resource (23). Soon I discovered that was easy to share with my friends and colleagues the material I found as relevant as to keep to myself surfing in INTERNET. Now the open list is composed of more than 300 members, mostly cardiologists from Brazil. Some of the delivered material is referred by other members of the list.AMICOR have had several styles since its starting point, according to the evolution of the media. Now it is a set of Blogs aiming to facilitate pre-selection to the main interest of the specialists’ members of the list. Although destined primarily to medical professionals, the site is open to visit and "The information provided on this web site is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her physician."The information I receive from the members of the list, to send periodically an alert message, are strictly confidential and not shared with any other person or institution.AMICOR is free and do not have any economic or institutional support. It is a personal, autonomic, self-supported activity, and does not accept advertising.The name AMICOR was borrowed to ProCOR, to similar activities from other countries.Collaboration and suggestions to improvements or corrections are welcome.