Dr LEE Jong-wook, Director-General of the World Health Organization, has died

Dr LEE Jong-wook, Director-General, WHO
22 May 2006 -- Dr LEE Jong-wook, Director-General of the World Health Organization, has died. He had been in hospital since Saturday afternoon, where he underwent surgery to remove a blood clot on his brain (a subdural hematoma). He remained in intensive care. At 0743 this morning, he was declared dead.

All of the staff of the World Health Organization extend their most sincere condolences to Dr Lee's family. The sudden loss of our leader, colleague and friend, is devastating.

Dr Lee led WHO to continue its mission to help people attain the highest possible level of health.

He was 61 years old. He is survived by his wife and son, two brothers and a sister and their families.
Statement | Official photograph | Statement regarding the Acting Director-General

AMICOR - 9 anos e Sindrome do Estado Fragilizado

Prezados amigos AMICOR,
Grato por me acompanharem até os 9 anos.
Neste ano, até completar uma década pretendo re-estudar nossos métodos de comunicação, bem como o processo em uso. Estarei aberto para sugestões e devo lhes apresentar até a próxima mensagem alguns detalhes e novas idéias.
Abaixo vai um artigo meu publicado na Zero Hora do dia 16.
Um abraço a todos.
AA
Dear friends AMICOR,
Thanks to follow me until the 9th anniversary.
From now to the 10th I wish to evaluate our communication methods, as well aour process in use. I will be open to suggestions and I will present to you until the next message some details and new ideas.
Below is an article published today in the local newspaper Zero Hora
Sincerely
AA


Síndrome do Estado fragilizado
ALOYZIO ACHUTTI/ Membro da Academia Sul-Rio-Grandense de Medicina

Recentemente tem-se nomeado com freqüência duas novas síndromes: a síndrome do status e a síndrome do Estado fraco ou fragilizado. Paralelamente à semelhança verbal das duas, podem-se encontrar também aproximações conceituais e implicações práticas cruzadas.

Síndrome refere-se a um conjunto de sintomas e sinais característicos de um estado anormal ou indesejável e se utiliza muito em medicina para designar condições mórbidas conseqüentes a causas diversas ou desconhecidas. Ambas estão relacionadas com perturbações da saúde e perda de qualidade de vida. Ambas provocam estresse, doenças crônicas e mal-estar, muito além do imaginado.

Circunstâncias responsáveis pela primeira (mais utilizada na perspectiva individual) são muito freqüentes, particularmente em sociedades com grande desigualdade social como a nossa, mas também pelo mundo afora, onde - como diz Sir Michael Marmot, em livro recente sobre o tema referindo-se a sociedades mesmo ditas igualitárias - "alguns são mais iguais do que outros...".

Com a falta ou perda da identidade, falta de alternativas e de apoio social, abandono, desinteresse e atropelo de valores humanos, a vida pode se tornar ainda mais difícil, surgem desespero e falta de motivação, só avaliáveis por quem se encontrar em situação semelhante.

A Síndrome do Estado fragilizado tem sido discutida particularmente com relação a fenômenos observados em países da antiga União das Repúblicas Socialistas Soviéticas após a queda do comunismo, mas o conceito deve ser aplicável mais extensamente, inclusive em nosso caso.

O Estado como organização política da sociedade se destina a facilitar, proteger e disciplinar a vida de seus cidadãos. O status de cidadão é sua identidade, e sua segurança radica na idoneidade e na confiabilidade de seus dirigentes. Seu projeto humano se realiza e se expressa no élan da construção social e, quando se sente ameaçado, encontra guarida em suas instituições.

A contaminação dos objetivos do bem comum pelos interesses individuais ou de grupos voltados para a sustentação artificial no poder dilacera o tecido social, corrompe os valores básicos, aumenta as cisões e se torna terreno fértil para a anarquia.

A governabilidade fica comprometida, gera enorme entropia e compromete o desenvolvimento, piorando ainda mais a desigualdade social e a sensação de desespero dos que se encontram marginalizados. Entretanto, todos sofrem, pioram até os índices de mortalidade e proliferam as doenças crônicas.

Não somente a preservação da natureza, evitando a poluição ambiental, é importante para a proteção da vida. O ambiente social e político também influi na saúde da população e deve ser arrolado entre os itens a serem considerados na prevenção de doenças e considerado pelos nossos representantes no poder.

Mais um motivo para nossa participação e escolha cuidadosa na hora da eleição.

Hypertension Day 2006

The World Hypertension League is devoted to the advancement of hypertension prevention and control through joint efforts of all national leagues and societies. With more than 15 years of achievements, the WHL seeks to promote the exchange of information among its member organizations and offers internationally applicable methods and programs for hypertension control.

Cardiovascular toolkit

Cardiovascular disease is the number one killer in the United States, for both men and women, and claims more lives each year than the next five leading causes of death combined. The Cardiovascular Dynamics effort, led by Charles A. Taylor, Ph.D. and Christopher K. Zarins, M.D., uses biosimulation to understand and help diagnose and treat this prevalent condition.

Our Physics-Based Approach

Our open source Cardiovascular ToolKit (CVTK) provides tools for constructing a virtual aorta, a cardiovascular simulation based on 3D noninvasive imaging and tailored to each individual's anatomy. The process is outlined in the diagram below: (a) acquire a contrast-enhanced magnetic resonance angiogram of the abdominal aorta; (b) determine the centerline of the vessels of interest; (c) segment vessel lumens in each 2D slice using level set methods; (d) combine the 2D segmentations into a complete 3D solid model of the aorta and its branches; (e) use the generated finite element mesh to solve equations governing blood flow in the deformable vessels.

Heart Sounds

"Research demonstrates that practice makes perfect when trying to master cardiac auscultation. Listening to these "Heart Songs" at the computer or iPod can help clinicians at every level refine their auscultation skills." - Michael J. Barrett, M.D., F.A.C.C.

programação científica do congresso Norte-Nordeste de Cardiologia

De: pfalbuquerque [mailto:pfalbuquerque@uol.com.br]
Enviada em: domingo, 30 de abril de 2006 09:53
Para: aloyzio.achutti
Assunto: Programação científica Congresso Norte-Nordeste

Caro Prof. Achutti,

Gentileza comunicar à rede que a programação científica do congresso Norte-Nordeste de Cardiologia, encontra-se no site www.cardiol.br calendário de eventos.

Muito obrigado

Pedro Albuquerque-presidente do evento.

ACC: Combination Therapy Useful In Dyslipidemia

ACC: Combination Therapy Useful In Dyslipidemia - CME Teaching Brief - MedPage Today: "ATLANTA, March 12 - Combination therapies in dyslipidemia have two roles -- to lower LDL cholesterol and to achieve non-HDL goals, according to a symposium here.

'In the absence of a lot of data on outcomes, there are some things that are absolute indications for combination therapies,' said Alan Brown, M.D., medical director of the Midwest Heart Disease Prevention Center in Napierville, Ill.

Specifically, he said, some patients won't achieve LDL goals on monotherapy, at least without going to very high doses, which increases the risk of complications, including rhabdomyalysis.

Others, whose LDL cholesterol is controlled, will need combination treatments to control other aspects of their dyslipidemia, he told a satellite symposium held in conjunction with the annual meeting of the American College of Cardiology."

Enbrel Decreases Inflammatory Markers in Metabolic Syndrome -

Enbrel Decreases Inflammatory Markers in Metabolic Syndrome - CME Teaching Brief - MedPage Today: "BOSTON, April 25 — Blocking a key protein with Enbrel (etanercept) improves several inflammatory markers in patients with metabolic syndrome, according to researchers here.

In a small randomized trial, patients treated with the agent had lower levels of C-reactive protein and higher levels of adiponectin—indications of a decrease in the inflammation thought to be a key link between the syndrome and cardiovascular risk, said Steven Grinspoon, M.D., of Massachusetts General Hospital here.

Results of the study, published in the April 25 issue of Archives of Internal Medicine, amount to 'proof of principle,' Dr. Grinspoon said in a statement, and 'sheds light on the physiology of inflammation and its relation to cardiac risk in obese patients.'"

Coffee Consumption and Coronary Heart Disease in Men and Women. A Prospective Cohort Study -- Lopez-Garcia et al., 10.1161/CIRCULATIONAHA.105.598664 -

Coffee Consumption and Coronary Heart Disease in Men and Women. A Prospective Cohort Study -- Lopez-Garcia et al., 10.1161/CIRCULATIONAHA.105.598664 -- Circulation
Esther Lopez-Garcia DrPH, Rob M. van Dam PhD, Walter C. Willett MD, DrPH, Eric B. Rimm ScD, JoAnn E. Manson MD, DrPH, Meir J. Stampfer MD, DrPH, Kathryn M. Rexrode MD, MPH, and Frank B. Hu MD, PhD^*

From the Departments of Nutrition (E.L.-G., R.M.v.D., W.C.W., E.B.R., M.J.S., F.B.H.) and Epidemiology (W.C.W., E.B.R., J.E.M., M.J.S., F.B.H.), Harvard School of Public Health; the Channing Laboratory (W.C.W., E.B.R., J.E.M., M.J.S., F.B.H.) and Division of Preventive Medicine (J.E.M., M.J.S., K.M.R.), Harvard Medical School, Boston, Mass.
^* To whom correspondence should be addressed. E-mail: nhbfh@channing.harvard.edu.

Background--We examined the association between long-term habitual coffee consumption and risk of coronary heart disease (CHD).

Methods and Results--We performed a prospective cohort study with 44 005 men and 84 488 women without history of cardiovascular disease or cancer. Coffee consumption was first assessed in 1986 for men and in 1980 for women and then repeatedly every 2 to 4 years; the follow-up continued through 2000. We documented 2173 incident cases of coronary heart disease (1449 nonfatal myocardial infarctions and 724 fatal cases of CHD) among men and 2254 cases (1561 nonfatal myocardial infarctions and 693 fatal cases of CHD) among women. Among men, after adjustment for age, smoking, and other CHD risk factors, the relative risks (RRs) of CHD across categories of cumulative coffee consumption (<1> 4 cups/wk, 5 to 7 cups/wk, 2 to 3 cups/d, 4 to 5 cups/d, and 6 cups/d) were 1.0, 1.04 (95% confidence interval 0.91 to 1.17), 1.02 (0.91 to 1.15), 0.97 (0.86 to 1.11), 1.07 (0.88 to 1.31), and 0.72 (0.49 to 1.07; P for trend=0.41); among women, the RRs were 1.0, 0.97 (0.83 to 1.14), 1.02 (0.90 to 1.17), 0.84 (0.74 to 0.97), 0.99 (0.83 to 1.17), and 0.87 (0.68 to 1.11; P for trend=0.08). Stratification by smoking status, alcohol consumption, history of type 2 diabetes mellitus, and body mass index gave similar results. Similarly, we found no effect when the most recent coffee consumption was examined. RRs for quintiles of caffeine intake varied from 0.97 (0.84 to 1.10) in the second quintile to 0.97 (0.84 to 1.11) in the highest quintile (P for trend=0.82) in men and from 1.02 (0.90 to 1.16) to 0.97 (0.85 to 1.11; P for trend=0.37) in women.

Conclusions--These data do not provide any evidence that coffee consumption increases the risk of CHD.

Clinical Stress Testing in the Pediatric Age Group: A Statement From the American Heart Association Council on Cardiovascular Disease in the Young, Co

Clinical Stress Testing in the Pediatric Age Group: A Statement From the American Heart Association Council on Cardiovascular Disease in the Young, Committee on Atherosclerosis, Hypertension, and Obesity in Youth -- Paridon et al. 113 (15): 1905 -- Circulation: "This statement is an updated report of the American Heart Association’s previous publications on exercise in children. In this statement, exercise laboratory requirements for environment, equipment, staffing, and procedures are presented. Indications and contraindications to stress testing are discussed, as are types of testing protocols and the use of pharmacological stress protocols. Current stress laboratory practices are reviewed on the basis of a survey of pediatric cardiology training programs."

Reciprocal Relationships Between Insulin Resistance and Endothelial Dysfunction: Molecular and Pathophysiological Mechanisms -- Kim et al. 113 (15): 1

Reciprocal Relationships Between Insulin Resistance and Endothelial Dysfunction: Molecular and Pathophysiological Mechanisms -- Kim et al. 113 (15): 1888 -- Circulation: "Endothelial dysfunction contributes to cardiovascular diseases, including hypertension, atherosclerosis, and coronary artery disease, which are also characterized by insulin resistance. Insulin resistance is a hallmark of metabolic disorders, including type 2 diabetes mellitus and obesity, which are also characterized by endothelial dysfunction. Metabolic actions of insulin to promote glucose disposal are augmented by vascular actions of insulin in endothelium to stimulate production of the vasodilator nitric oxide (NO). Indeed, NO-dependent increases in blood flow to skeletal muscle account for 25% to 40% of the increase in glucose uptake in response to insulin stimulation. Phosphatidylinositol 3-kinase–dependent insulin-signaling pathways in endothelium related to production of NO share striking similarities with metabolic pathways in skeletal muscle that promote glucose uptake. Other distinct nonmetabolic branches of insulin-signaling pathways regulate secretion of the vasoconstrictor endothelin-1 in endothelium. Metabolic insulin resistance is characterized by pathway-specific impairment in phosphatidylinositol 3-kinase–dependent signaling, which in endothelium may cause imbalance between production of NO and secretion of endothelin-1, leading to decreased blood flow, which worsens insu"

XXVI Congresso Norte/Nordeste de Cardiologia

XXVI Congresso Norte/Nordeste de Cardiologia
De: pfalbuquerque [mailto:pfalbuquerque@uol.com.br] Enviada em: quarta-feira, 19 de abril de 2006 13:
Gentileza divulgar o XXVICongresso Norte-Nordeste de Cardiologia, o qual estamos presidindo será em Maceió nos dias 8,9 e 10 de junho de 2006.
Site http://congresso.cardiol.br/norte-nordeste.
Muito obrigado.
Pedro Albuquerque

Heart Diseases and Stroke Statistics 2006

(Recomendado por Maria Inês Reinert Azambuja)
The American Heart Association works with the Centers for Disease Control and Prevention’s National Center for Health Statistics (CDC/NCHS), the National Heart, Lung, and Blood Institute (NHLBI), the National Institute of Neurological Disorders and Stroke (NINDS), and other government agencies to derive the annual statistics in this update. This section describes the most important sources we use. For more details and an alphabetical list of abbreviations, see the Glossary and Abbreviation Guide.

All statistics are for the most recent year available. Prevalence, mortality and hospitalizations are computed for 2003 unless otherwise noted. Mortality as an underlying or contributing cause of death is for 2002. Economic cost estimates are for 2006. Due to late release of data, some disease mortality are not updated to 2003. Mortality for 2003 are underlying preliminary data, obtained from the NCHS publication National Vital Statistics Report: Deaths: Preliminary Data for 2003 (NVSR, 2005;53:15) and from unpublished tabulations furnished by Robert Anderson of NCHS. US and state death rates and prevalence rates are age-adjusted per 100 000 population (unless otherwise specified) using the 2000 US standard for age standardization.

Morbidity (illness) and mortality (death) data in the United States use a standard classification system—the International Classification of Diseases (ICD). About every 10–20 years, the ICD codes are revised to reflect changes over time in medical technology, diagnosis or terminology. Effective with mortality data for 1999, we’re using the tenth revision (ICD/10). It will be a few more years before the tenth revision is used for hospital discharge data.

Heart Diseases and Stroke Statistics 2006

(Recomendado por Maria Inês Reinert Azambuja)
The American Heart Association works with the Centers for Disease Control and Prevention’s National Center for Health Statistics (CDC/NCHS), the National Heart, Lung, and Blood Institute (NHLBI), the National Institute of Neurological Disorders and Stroke (NINDS), and other government agencies to derive the annual statistics in this update. This section describes the most important sources we use. For more details and an alphabetical list of abbreviations, see the Glossary and Abbreviation Guide.

All statistics are for the most recent year available. Prevalence, mortality and hospitalizations are computed for 2003 unless otherwise noted. Mortality as an underlying or contributing cause of death is for 2002. Economic cost estimates are for 2006. Due to late release of data, some disease mortality are not updated to 2003. Mortality for 2003 are underlying preliminary data, obtained from the NCHS publication National Vital Statistics Report: Deaths: Preliminary Data for 2003 (NVSR, 2005;53:15) and from unpublished tabulations furnished by Robert Anderson of NCHS. US and state death rates and prevalence rates are age-adjusted per 100 000 population (unless otherwise specified) using the 2000 US standard for age standardization.

Morbidity (illness) and mortality (death) data in the United States use a standard classification system—the International Classification of Diseases (ICD). About every 10–20 years, the ICD codes are revised to reflect changes over time in medical technology, diagnosis or terminology. Effective with mortality data for 1999, we’re using the tenth revision (ICD/10). It will be a few more years before the tenth revision is used for hospital discharge data.

The White Man's Burden

http://download.thelancet.com/pdfs/journals/0140-6736/PIIS0140673606685619.pdf
The White Man’s Burden has one basic motif: that large-scale plans to help the poor through increased foreign aid are bound to go awry.
According to William Easterly, there is too much corruption in recipient countries, unaccountability in delivery mechanisms, and sheer uncertainty about what to do. Rather than aiming big, with comprehensive and well funded strategies, Easterly thinks it is better to aim small and piecemeal, making progress one gradual step at a time—“the right plan is to have no plan”, he asserts. Aid should be as he imagines markets to be: without plans but fi lled with “searchers” looking for piecemeal progress.
Searching is, of course, needed to identify best practices for foreign aid. But so too are plans, at local, national, and international levels, to take those best practices to scale.
Easterly seems to misunderstand the historical record on aid, and, far more unfortunately, to misjudge what’s possible in the future. His main methodological error is a failure to make careful distinctions across countries and types of aid programme.
By neglecting to hone in on what has worked and failed in the past, Easterly conveys a misplaced sense of helplessness in the face of massive but solvable problems.
The critical fact is that much is known about how to help the poor. As The Lancet helped to show in its 2003 series on child mortality, the know-how and technologies exist to save lives each year by the millions, and to improve livelihoods by the tens or hundreds of millions, but only by expanding beyond piecemeal approaches and applying knowledge at scale. The same conclusions were reached in two reports that I helped to direct for WHO and the United Nations in
2001 and 2005, respectively, both of which are roundly criticised by Easterly.

WCC September - Call for papers

The Lancet:
"Coronary heart disease has the dubious distinction of being the leading cause of death worldwide, and rapid containment of this global pandemic seems unlikely. New factors, such as sociodemographic change in lower-income countries, are providing fresh challenges for prevention and treatment. The Lancet will publish a special issue to coincide with the World Congress of Cardiology in September, in Barcelona. We therefore welcome papers on any aspect of cardiology, to be submitted by May 22. We are especially interested in research that will be presented at the Congress but will also consider other articles. Submissions from the developing world are particularly welcome. Papers should be submitted online and the covering letters should state that the submission is in response to this call for papers."

Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women -- Mosca et al. 109 (5): 672 -- Circulation

Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women -- Mosca et al. 109 (5): 672 -- Circulation:
"Significant advances in our knowledge about interventions to prevent cardiovascular disease (CVD) have occurred since publication of the first female-specific recommendations for preventive cardiology in 1999.1 Despite research-based gains in the treatment of CVD, it remains the leading killer of women in the United States and in most developed areas of the world.2�3 In the United States alone, more than one half million women die of CVD each year, exceeding the number of deaths in men and the next 7 causes of death in women combined. This translates into approximately 1 death every minute.2 Coronary heart disease (CHD) accounts for the majority of CVD deaths in women, disproportionately afflicts racial and ethnic minorities, and is a prime target for prevention.1�2 Because CHD is often fatal, and because nearly two thirds of women who die suddenly have no previously recognized symptoms, it is essential to prevent CHD.2 Other forms of atherosclerotic/thrombotic CVD, such as cerebrovascular disease and peripheral arterial disease, are critically important in women. Strategies known to reduce the burden of CHD may have substantial benefits for the prevention of noncoronary atherosclerosis, although they have been studied less extensively in some of these settings.
In the wake of the reports of the Women�s Health Initiative and the Heart and Estrogen/Progestin Replacement Study (HERS), which unexpectedly showed that combination hormone therapy was associated with adverse CVD effects, there is a heightened need to critically review and document strategies to prevent CVD in women.4�7 These studies underscore the importance of evidence-based practice for chronic disease prevention. /.../"

New Cardiac Resuscitation Protocol Improves Survival - CME Teaching Brief - MedPage Today

New Cardiac Resuscitation Protocol Improves Survival - CME Teaching Brief - MedPage Today: "Review
TUSCON, Ariz., April 13 - When performed by EMS personnel, a new approach to cardiopulmonary resuscitation (CPR) substantially improves the survival rate for most patients with out-of-hospital cardiac arrest, according to researchers.
The new approach, dubbed cardiocerebral resuscitation (CCR), emphasizes fast, forceful chest compressions to get blood moving through the body over airway management, said Michael J. Kellum, M.D., of the University of Arizona College of Medicine here.
Compared with standard CPR, the new approach nearly tripled survival rates during a one-year study, Dr. Kellum and colleagues reported online in the American Journal of Medicine.
The Wisconsin Emergency Medical Services Bureau teamed with the University of Arizona researchers to test the new protocol in two Wisconsin counties during 2004 and 2005.
During the previous three-year control period, when standard CPR was used, there were 92 adult patients with witnessed cardiac arrests and an initially 'shockable' rhythm. Eighteen of these patients (20%) survived, and 14 (15%) survived neurologically intact.
After the CCR protocol was initiated, there were 33 such patients. Nineteen (57%) survived, and 16 (48%) survived neurologically intact. The differences in both total survival and neurologically normal survival were statistically significant (P=0.001).
With CCR, first responders skip the first steps of the standard protocol: intubating the patient for ventilation and delivering a shock using a defibrillator. While still attaching the victim to a defibrillator, they do not wait for the device to analyze the patient's heart rhythm, but start fast, forceful chest compressions. /.../"

Trans Fats Judged Major Villain in Cardiovascular Disease - CME Teaching Brief - MedPage Today

Trans Fats Judged Major Villain in Cardiovascular Disease - CME Teaching Brief - MedPage Today:
"When talking with patients about food choices, remind them to read labels looking for trans fatty acids amounts but also to heed the serving amounts stated on the label.
Remind patients that the unhealthy trans fats are found in deep-fried foods, bakery products, packaged snack food, margarines, and crackers, and to try to avoid these foods.

Review
BOSTON, April 13 - Consumption of trans fatty acids raised lipid levels and increases the risk of coronary heart disease, sudden death from cardiac causes, and possibly diabetes, according to a review article.
The risk of coronary heart disease increased 23%, said the review in the April 13 issue of New England Journal of Medicine. Sudden death from a cardiac event was up 47% and tripled when evaluated for certain trans-fat isomers. "/.../

ACP: Garlic, Ginseng, Ginkgo Biloba, and Ginger All Bad Actors with Warfarin - CME Teaching Brief - MedPage Today

ACP: Garlic, Ginseng, Ginkgo Biloba, and Ginger All Bad Actors with Warfarin - CME Teaching Brief - MedPage Today: "

Explain to patients who ask that vitamins as well as so-called natural substances can react with prescription drugs.
Explain to patients, who ask, that periodic review of all prescription and non-prescription drugs that they are using can reduce the risk of adverse events.
Review
PHILADELPHIA, April 9 - When it comes to adverse events associated with Coumadin (warfarin) therapy, beware of herbs and many supplements beginning with the letter G, according to a University of Washington investigator. "/.../