Endocarditis: oral antibiotics

Oral Antibiotics Safe Stable Endocarditis

Switching after a period of IV antibiotics didn't raise event rates in POET trial

• SAVESAVED

• by Crystal Phend, Senior Associate Editor, MedPage TodayAugust 28, 2018
• This article is a collaboration between MedPage Today® and:
   

MUNICH -- Switching to oral antibiotics once an endocarditis patient is stable appears safe and could allow them to head home from the hospital sooner, the randomized Partial Oral Treatment of Endocarditis (POET) trial showed.

The group getting oral tablets after at least 10 days IV antibiotics had a 9.0% rate of all-cause mortality, unplanned cardiac surgery, embolic events, or relapse of bacteremia with the primary pathogen by 6 months after completion of treatment.

That rate was noninferior to the 12.1% in the IV-only antibiotic group (HR 0.72, P=0.40), Henning Bundgaard, MD, of Rigshospitalet in Copenhagen, reported here at the European Society of Cardiology meeting and simultaneously online in the New England Journal of Medicine.

IceCube Observatory

Astrônomos descobrem origem de neutrino espacial pela primeira vez na história

Posted: 28 Aug 2018 08:39 AM PDT

Uma estrutura montada no fundo do gelo da Antártida sul está nos trazendo respostas sobre mistérios do espaço. Usando o observatório de neutrinos do pólo sul, batizado de IceCube, telescópios e satélites, cientistas conseguiram traçar pela primeira vez a origem de um neutrino espacial. Neutrinos são partículas subatômicas bastante comuns no espaço, mas são muito […]

Chrm1 and Chrm3

Genes that Regulate How Much We Dream by Neuroscience News Acetylcholine receptors Chrm1 and Chrm3 (illustrated as Sandman gnomes 1 and 3) are essential for REM (dream) sleep. In this visual description of the study, the receptors help a mouse dream about a sleeping cat and Michel Jouvet (1925-2017), a pioneer of REM sleep studies. NeuroscienceNews.com image is credited to Hiroko Uchida.

A new study identifies two genes which regulate how much we dream. The genes, Chrm1 and Chrm3, play a key role in regulating REM sleep and function in different ways.

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Drugs to Curb Smoking

Researchers Develop Drugs with Potential to Curb Smoking

Nicotine triggers the release of dopamine and serotonin, two pleasure causing chemicals produced by the body. But as it gets metabolized, users can experience withdrawal symptoms like tingling in the hands and feet, sweating, anxiety and irritability. NeuroscienceNews.com image is in the public domain.by Neuroscience News
Researchers have developed more than a dozen new potential drug candidates they believe have the potential to curb smoking addiction by slowing how nicotine is broken down in the body.

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Time Dilation

Dammnn

I don't write, I talk

Aug 11

Time Dilation — Einstein’s Theory Of Relativity

One evening in the spring of 1905 Albert Einstein than a mere patent clerk in Bern after trudging through his day’s work, decided to board a tram car on his way back home.

Einstein would often wrap up his work as soon as possible to contemplate the truths of the universe in his free time.

It was one of these thoughts experiments he devised on that tram car that revolutionised modern physics forever.

Social Determinants

Social Determinants of HealthNew

View HP2020 Data for:

 Social Determinants of Health

Midcourse Review Data
Are In!

Check out our interactive infographic to see progress toward the Social Determinants of Health objectives and other Healthy People topic areas.

Goal

Create social and physical environments that promote good health for all.

Overview

Health starts in our homes, schools, workplaces, neighborhoods, and communities. We know that taking care of ourselves by eating well and staying active, not smoking, getting the recommended immunizations and screening tests, and seeing a doctor when we are sick all influence our health. Our health is also determined in part by access to social and economic opportunities; the resources and supports available in our homes, neighborhoods, and communities; the quality of our schooling; the safety of our workplaces; the cleanliness of our water, food, and air; and the nature of our social interactions and relationships. The conditions in which we live explain in part why some Americans are healthier than others and why Americans more generally are not as healthy as they could be./.../

John McCain's Farewell

Do Not Despair of Our Present Difficulties.' Read John McCain's Powerful Farewell Letter

In a final letter written before his death, the late Arizona Sen. John McCainsaid he had enjoyed “experiences, adventures and friendships enough for 10 satisfying lives” and urged Americans not to “despair of our present difficulties.”

“Fellow Americans, that association has meant more to me than any other,” McCain wrote. “I lived and died a proud American. We are citizens of the world’s greatest republic — a nation of ideals, not blood and soil. We are blessed and are a blessing to humanity when we uphold and advance those ideals at home and in the world.”/.../

Skull and Brain

Unearthing Secret Tunnels Between the Skull and Brain by Neuroscience News Newly discovered channels in the skull may provide a shortcut for immune cells going to damaged tissue. NeuroscienceNews.com image is credited to Nahrendorf Lab.

A new study sheds light on how immune cells may rush through channels to quickly get to injured brain tissue. Researchers say bone marrow in the skull is more likely to help supply neutrophils to the brain following a stroke.

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Neuroscience News | August 27, 2018 at 11:19 am | Tags: bine marrow, hematopoietic system, murine skull, SDF-1, tibia | URL: https://wp.me/p4sXNK-dgL

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World Population

WP Data Sheet 2018

The world population will reach 9.9 billion by 2050, up 2.3 billion or 29 percent from an estimated 7.6 billion people now, according to projections by Population Reference Bureau (PRB) included in the 2018 World Population Data Sheet.

PRB has produced the World Population Data Sheet (www.worldpopdata.org) package annually since 1962. The digital and print editions are widely used and cited by educators, policymakers, journalists, program implementers, and others who value the Data Sheet as a trusted reference and source of timely demographic analysis.

Sobrenomes BR

10 sobrenomes mais populares Brasil

• Por Karen · 
• Agosto 14, 2018
•  · Família

Hoje vamos falar de nomes e sobrenomes.

No Brasil, nome é uma coisa levada muito a sério. A maioria dos pais escolhe com muito cuidado o nome que dará ao seu rebento. Assim sendo, existem desde pais muito empenhados em dar aos seus filhos os nomes mais raros do mundo (e não se importam se os nomes acabem ficando muito extravagantes).

Já outros pais que acham que a grafia é fundamental (e capricham em colocar muitos “H”s, “L”s, mesmo quando isso não faz sentido algum). Finalmente, há pais que se preocupam em dar nomes mais tradicionais e que tenham um som mais brasileiro (por isso vemos agora uma nova geração com nomes considerados mais antigos como Maria, Ana, João e Joaquim).

No caso dos sobrenomes, a autonomia não é tanta. Afinal estes contam a história de uma família e carregá-los na nossa identidade é motivo de orgulho e de tradição. Os sobrenomes vão sendo passados de pai para filho e alguns deles são mais conhecidos do que outros.

Leonardo da Vinci

The Nature of the Human Body

Before dressing them, we first draw them nude

Walter Isaacson

Oct 30, 2017

Asa young painter in Florence, Leonardo studied human anatomy primarily to improve his art. His forerunner as an artist-engineer, Leon Battista Alberti, had written that anatomical study was essential for an artist because properly depicting people and animals requires beginning with an understanding of their insides. “Isolate each bone of the animal, on this add its muscles, then clothe all of it with its flesh,” he wrote in On Painting, which became a bible for Leonardo. “Before dressing a man we first draw him nude, then we enfold him in draperies. So in painting the nude, we place first his bones and muscles which we then cover with flesh so that it is not difficult to understand where each muscle is beneath.”

The Inspiration Behind Leonardo da Vinci’s Vitruvian Man

A look at the classic drawing stripped down to its essence

Walter Isaacson

Myocardial infarction Difinition

Fourth Universal Definition Separates MI From Myocardial Injury

Marlene Busko

August 26, 2018

The document defines the five subtypes of myocardial infarction as:

• Type 1: Due to an atherosclerotic plaque rupture with subsequent coronary arterial thrombosis; patients can have an ST-elevation or a non-ST elevation myocardial infarction and are usually treated with antiplatelet medication and stenting of the culprit lesion in the coronary artery;
• Type 2: Due to ischemia (oxygen deprivation) without any plaque disruption; for example, a patient may have hypotension (decreased myocardial oxygen supply) or a tachyarrhythmia (increased myocardial oxygen demand);
• Type 3: Classic (such as typical ST elevation; electrocardiogram) but no troponin blood test result;
• Type 4: In the setting of a percutaneous coronary intervention in the catheterization laboratory; and
• Type 5: At the time of coronary bypass surgery.

"You can have myocardial injury and the release of troponin" that can be detected by high-sensitivity troponin assays if you have kidney disease or even if you are an athlete (eg, a runner), which is "certainly not myocardial infarction," Thygesen stressed. Other situations that can cause myocardial injury and a rise in troponin include Infection, sepsis, and heart surgery.

Faillure of Aspirin at long term

Daily Aspirin Fails to Lower CV Risk in Long-term, Primary Prevention ARRIVE Trial

MUNICH — Aspirin at a daily dose of 100 mg was not seen to reduce the long-term risk for cardiovascular (CV) or cerebrovascular events in a trial that randomly assigned more than 12,000 nondiabetic adults with multiple CV risk factors but no history of CV events. Nor was the risk for stroke reduced.

In the study's primary intention-to-treat (ITT) analysis, 4.29% of persons assigned to aspirin and 4.48% of those in the placebo group experienced the primary endpoint of CV death, myocardial infarction (MI), unstable angina, stroke, or transient ischemic attack (TIA) over a mean of 5 years. The adjusted hazard ratio (HR) for aspirin vs placebo was 0.96 (95% confidence interval [CI], 0.81 - 1.13; P = .604).

Aspirin also did not show a significant effect on any of the individual components of the primary endpoint.

++++++++++++++++++++++

Cleland doesn't seem to buy into the alleged value of a per protocol analysis and sees it as emblematic of a more widespread problem. "The presentation of aspirin data is always biased," he said.

"I think it's fine for them to show the per protocol analysis, but ultimately, their conclusions are correct, that there isn't a benefit of aspirin." Or, Cleland added, "that such benefits, if they exist, are so small that, why don't we move on to something more useful."/.../

Overprescribing in the Elderly

Overprescribing in the Elderly: We Have a Problem

Melissa Walton-Shirley, MD

DISCLOSURES 

August 26, 2018

At the European Society of Cardiology (ESC) 2018 Congress, the presenters for the session titled "Drug Prescription in the Elderly" threw around words like "sarcopenia" and "frailty." The initials "GFR" (glomerular filtration rate) got some focus by Christian Funck-Brentano of Paris. "Kidney function is key to drug accumulation and side effects," he said. Muscle wasting and the tendency to fall are almost never mentioned in late-breaking clinical trial presentations, but for patients over age 65, sarcopenia, frailty, and GFR are everything. They predict whether our patients will  break a hip, become confused, or even die.

The panelists meant for us to leave convinced that these terms should never be an afterthought but rather a first consideration when sending an e-script. It worked for me.

Claudio Cenconi from Italy made the  point that the prevalence of heart failure soared between 1988 and 2008, in his presentation "Pharmacotherapy in the Elderly." And the proportion of these patients over 80 years of age increased from 13.3% to 22.4%.^[1] The mean number of daily meds per patient has increased from 4.1 to 6.4 over this time, coinciding with an increase in patients with five or more chronic comorbidities (from 42% to 58%).^[1] Both systolic and diastolic impairment are common, so understanding this basic milieu of our geriatric patients is salient to nearly all prescriptions./.../

Blood-Brain Barrier in Alzheimer’s Patients

Safe and Non-Invasive Way to Open the Blood-Brain Barrier in Alzheimer’s Patients by Neuroscience News

Researchers use focused ultrasound to safely and non-invasively open the blood-brain barrier in Alzheimer's patients.

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Neuroscience News | August 26, 2018 at 10:36 am | Tags: amyloid-beta, focused ultrasound, University of Ontario | URL: https://wp.me/p4sXNK-dgh

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Reward and Behavior

Key Brain Circuits for Reward Seeking and Avoidance Behavior Identified by Neuroscience News

Researchers have identified two subpopulations of neurons in the BNST that connect to separate populations of neurons in the lateral hypothalamus which appear to drive two opposing emotional states; avoidance and reward seeking

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Neuroscience News | August 26, 2018 at 8:47 am | Tags: bed nucleus of stria terminalis, HCRT | URL: https://wp.me/p4sXNK-dg8

Researchers mapped new connections in the extended amygdala related to reward-seeking and aversion. Here neurons in that pathway are labeled in fluorescent green in a cross-section of a rodent brain. NeuroscienceNews.com image is credited to Stanford University – de Lecea lab.

Aging

Neuroscience News

Neuroscience

24 de ago de 2018



The Molecular Link Between Aging and Neurodegeneration

Researchers discovery of a molecular link between aging and a major genetic cause of both ALS and FTD, two related neurodegenerative diseases with shared genetic risk factors.

The research is in Cell. (full access paywall)

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The Molecular Link Between Aging and Neurodegeneration

neurosciencenews.com