DIRECTORIO DE DOCUMENTOS EDITADOS EN JUNIO 2010

DIRECTORIO DE DOCUMENTOS EDITADOS EN JUNIO 2010

CIENCIAS MÉDICAS NEWS
CIENCIAS MÉDICAS APLICADAS
RESEARCH & CLINICAL DEVELOPMENT

►http://elbiruniblogspotcom.blogspot.com

►http://saludequitativa.blogspot.com

►http://herenciageneticayenfermedad.blogspot.com

Consultas acumuladas desde enero 2009 a la fecha: 198.018
Consultas totales conjuntas (todos los blogs): 714.193
Discriminadas como sigue:
1. ARGENTINA: 31.468 [15,9%]
2. ESPAÑA: 31.428 [15,9%]
3. MÉXICO: 27.830 [14,1%]
4. U.S.A.: 20.213 [10,2%]
5. COLOMBIA: 11.660 [5.9%]
6. VENEZUELA: 11.464 [5,8%]
7. PERÚ: 11.6343 [5,7%]
8. CHILE: 7.045 [3,6%]
9. ECUADOR: 4.947 [2,5%]
10. BOLIVIA: 3.642 [1,8%]
11. LOS DEMÁS: 36.978 [18.7%]
Total de consultas: 198.018


Documentos del mes de JUNIO: 462
Documentos acumulados en 2010: 2.946
Documentos editados desde el inicio del blog: 7.452

ARCHIVO DEL BLOG
• ▼ 2010 (2946)
o ▼ junio (462)
 Estudio pone en duda el amplio uso de estatinas - ...
 Statins May Lower Rates of Prostate Cancer Recurre...
 Combo Vaccine Raises Risk of Fever-Related Seizure...
 Public Reporting of Healthcare Associated Infectio...
 ACR Appropriateness Criteria® suspected small-bowe...
 ACR Appropriateness Criteria® routine admission an...
 ACR Appropriateness Criteria® routine chest radiog...
 ACR Appropriateness Criteria® routine chest radiog...
 ACR Appropriateness Criteria® screening for pulmon...
 ACR Appropriateness Criteria® Crohn's disease - Am...
 ACR Appropriateness Criteria® chronic dyspnea — su...
 ACR Appropriateness Criteria® blunt abdominal trau...
 ACR Appropriateness Criteria® acute abdominal pain...
 NIH-Supported ACCORD Eye Study Finds Two Therapies...
 Aiming for Near-Normal Blood Sugar Did Not Delay C...
 Mercury's Threat Greater in Ocean Fish Than Freshw...
 Diabetes Drug Avandia Ups Heart Risk, Reviews Conc...
 DIAGNOSIS AND MANAGEMENT OF STABLE CHRONIC OBSTRUC...
 CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD): PULM...
 Secondary prevention of coronary artery disease. :...
 Chronic kidney disease - identification, evaluatio...
 Diagnosis and management of complicated intra-abdo...
 guidelines for the investigation of newly detected...
 Guidelines on the diagnosis and management of soli...
 Guidelines for the diagnosis and management of dis...
 Guidelines for the diagnosis and management of apl...
 Intervention Lowered Obesity Rate in Youth at High...
 Tracing Flu Infections in Mice
 Type of Rice Linked to Diabetes Risk
 Progress Toward an Artificial Liver Transplant
 Regulatory Research Perspectives Journal
 Metabolic fingerprints of proliferative diabetic r...
 Mesenchymal Stem Cells Provide Better Results Than...
 Guidance for Industry and FDA Staff: In Vitro Diag...
 Rapid Diagnostic Tests and Severity of Illness in ...
 Oseltamivir-Resistant Pandemic (H1N1) 2009 in Pati...
 Long-term Shedding of Influenza A Virus | CDC EID
 Swine Influenza Virus Reassortants in Pigs | CDC E...
 Oseltamivir Resistance and Pandemic (H1N1) 2009 | ...
 Persistence of HPAI Viruses in Natural Ecosystems ...
 Human Parechovirus Infections in Monkeys | CDC EID...
 L-type Bovine Prions in Peripheral Nerve Tissues |...
 HANTAVIRUS, MUERTE, CONSCRIPTO - CHILE (AYSÉN)
 ENFERMEDADES DE TRANSMISIÓN SEXUAL, INTERCAMBIO DE...
 DENGUE, AUMENTO: EMERGENCIA SANITARIA - HONDURAS
 PALOMAS, RESERVORIO DE PATÓGENOS BACTERIANOS - ESP...
 MALARIA, CASOS, NIVELES EPIDÉMICOS - VENEZUELA
 ENCEFALITIS EQUINA DEL ESTE, BROTE, CASOS HUMANOS ...
 Unlocking genetic disease with next-generation seq...
 Progress Made Against Genetic Killer Of Infants An...
 Researchers identify promising gene therapy for DM...
 Sequencing a single genome yields cause of inherit...
 New Genetic Analysis Reveals Principles Of Phenoty...
 Peer Drug Use May Increase An Individual's Genetic...
 Findings Indicate Digestive Disorder In Infants Ma...
 PHG Foundation | Rapid genome sequencing to shed l...
 Genetic Septet In Control Of Blood Platelet Clotti...
 Y Chromosome Linked To Fatal Aneurysm, Increasing ...
 Common Predisposition Alleles For Moderately Commo...
 Researchers Find Structural Basis For Incidence Of...
 Decoding The Language Of RNA: Study Reveals New Fu...
 darunavir - EPARs for authorised medicinal product...
 hydroxocobalamin - EPARs for authorised medicinal ...
 Docetaxel - EPARs for authorised medicinal product...
 Memantine hydrochloride - EPARs for authorised med...
 pantoprazole (as sodium sesquihydrate) - EPARs for...
 AHRQ Update: Guides Offer Hospitals Advice on Emer...
 Human Brucella canis Infections Diagnosed by Blood...
 15th International Workshop on Campylobacter, Heli...
 Roseomonas sp. Isolated from Ticks, China | CDC EI...
 Endocarditis Caused by Actinobaculum schaalii, Aus...
 ACC-1 β-Lactamase–producing Salmonella enterica Se...
 Evolution of Seventh Cholera Pandemic | CDC EID
 Septicemia and Candidatus Neoehrlichia mikurensis ...
 East African Relapsing Fever Borrelia spp. | CDC E...
 C. gattii infection in Man, Japan, 2007 | CDC EID
 NIBIB and the Indian Department of Biotechnology C...
 European Medicines Agency - Human Medicines - Refe...
 European Medicines Agency - Human Medicines - Medi...
 European Medicines Agency - Human Medicines - Refu...
 indacaterol maleate - EPARs for authorised medicin...
 Bisphenol-A Exposure during Pregnancy Disrupts Glu...
 Notice to Readers: Limitations Inherent to a Cross...
 Detection of Enterobacteriaceae Isolates Carrying ...
 Sodium Intake Among Adults --- United States, 2005...
 Routine Jail-Based HIV Testing --- Rhode Island, 2...
 Expanded HIV Testing and Trends in Diagnoses of HI...
 Researchers Discover How Folate Promotes Healing I...
 Updated Guidelines for Using Interferon Gamma Rele...
 Malaria Surveillance --- United States, 2008
 Summary of Notifiable Diseases --- United States, ...
 Oil Spills: MedlinePlus (in spanish too) Derrame d...
 European Medicines Agency - Human Medicines - Orph...
 CDC Newsroom Press Release: June 22, 2010
 Mycobacterium chelonae Wound Infection after Lipos...
 Misindentification of Mycobacterium kumamotonense ...
 Mycobacterium conceptionense Infection after Breas...
 Genetic linkages in B. burgdorferi | CDC EID
 R. felis–associated Uneruptive Fever | CDC EID
 Dogs as Sentinels for Human Infection with JEV | C...
 Fatal Babesiosis in Man, Finland, 2004 | CDC EID
 Human Infection with R. felis, Kenya | CDC EID
 East African Relapsing Fever Borrelia spp. | CDC E...
 Logran detectar vibraciones en moléculas individua...
 Deforestation and Malaria, Brazil | CDC EID
 Extensive Drug Resistance in Malaria and TB | CDC ...
 Oseltamivir-Resistant Pandemic (H1N1) 2009 in Pati...
 Rapid Diagnostic Tests and Severity of Illness in ...
 Saffold Cardioviruses in Children, China | CDC EID...
 Zoonotic Transmission of Avian Influenza Virus | C...
 Influenza A Pandemic (H1N1) 2009 Virus and HIV | C...
 Drotrecogin alfa (activated) - EPARs for authorise...
 EPARs for authorised medicinal products for human ...
 European Medicines Agency - Human Medicines - Orph...
 Longer Therapy, Iatrogenic Amenorrhea, and Surviva...
 Gene—environment interactions in 7610 women with b...
 Desvelan como las bacterias controlan su desplazam...
 lamivudine / zidovudine - EPARs for authorised med...
 abacavir / lamivudine / zidovudine - EPARs for aut...
 Gemtuzumab Ozogamicin
 Flame Retardant May Up Risk of Thyroid Problems in...
 PCBs May Weaken Kids' Vaccination Response: Medlin...
 ORLive, Inc. and U.S. National Library of Medicine...
 Transplantation techniques. In: Guidelines on rena...
 Matching of donors and recipients. In: Guidelines ...
 Malignancy. In: Guidelines on renal transplantatio...
 Kidney recipient. In: Guidelines on renal transpla...
 Kidney donation. In: Guidelines on renal transplan...
 Immunosuppression after kidney transplantation. In...
 Immunological complications. In: Guidelines on ren...
 Graft and patient survival. In: Guidelines on rena...
 Annual screening. In: Guidelines on renal transpla...
 Management of antithrombotic agents for endoscopic...
 Fall prevention guidelines. In: Promoting active l...
 American Osteopathic Association guidelines for os...
 Miglustat - EPARs for authorised medicinal produc...
 ENCEFALITIS EQUINA DEL ESTE, BROTE, CASOS HUMANOS ...
 DENGUE, EPIDEMIA EN PROGRESO - VENEZUELA
 Webinar on the Development of Articles for Rare Di...
 Management of attention deficit and hyperkinetic d...
 Head injury. Triage, assessment, investigation and...
 Evaluation of prenatally diagnosed structural cong...
 Antibiotic therapy in preterm premature rupture of...
 testosterone therapy in adult men with androgen de...
 DIAGNOSIS AND MANAGEMENT OF OTITIS MEDIA IN CHILDR...
 FDA: Pfizer Voluntarily Withdraws Cancer Treatment...
 Mylotarg (gemtuzumab ozogamicin): Market Withdrawa...
 Drug Substitutes for Training to Blunt Fears in Ra...
 Brain Scans Support Genes’ Role in Alzheimer's Dis...
 Stem Cells Used to Create Cells to Study Heart Con...
 golimumab - EPARs for authorised medicinal produc...
 aliskiren - EPARs for authorised medicinal product...
 Teriparatide - EPARs for authorised medicinal prod...
 European Medicines Agency - Withdrawals of Marketi...
 Blog.AIDS.gov: Future Priorities for NIAID’s HIV P...
 NIH and Wellcome Trust Announce Partnership To Sup...
 National Heart, Lung, and Blood Institute Funds Re...
 H1N1 Flu Undergoing Genetic Changes in Pigs: Medli...
 FDA Approves First Diagnostic Assay to detect both...
 HuGENavigator|HuGE Literature Finder|Search
 Epigenetics as a unifying principle in the aetiolo...
 Nutrigenomics and IBD: The Intestinal Microbiota a...
 Recently Updated Advisory Committee Materials
 Should the ApoE genotype be a covariate for clinic...
 Hereditary Hemochromatosis: Pathogenesis, Diagnosi...
 [Progress in diabetes genetics] [Tidsskr Nor Laege...
 Candidate genes for non-diabetic ESRD in African A...
 Genome-wide searching of rare genetic variants in ...
 The importance of genetic counseling, DNA diagnost...
 The primary care physician role in cancer genetics...
 Effect of genome-wide association studies, direct-...
 USO INADECUADO DE ANTIBIÓTICOS, RESISTENCIA, EFECT...
 Sharp Increase in Emergency Department Visits for ...
 Health Care-Associated Infections: New Study Finds...
 Some people do not taste salt like others
 Turner Syndrome Society Of The United States (TSSU...
 Genetic Modifier In Usher Syndrome Will Lead To Be...
 New Therapeutic Route For Rare Kidney Disease
 An introduction to pharmacogenomics - UB Reporter
 PHG Foundation | Rare copy number variants highlig...
 Role Of Gene That Causes Early Onset Alzheimer's R...
 Genome Canada Funded Research Uncovers Key Changes...
 What Is Childhood Schizophrenia? What Causes Child...
 Study Evaluates Association Between Genetic Factor...
 Digestive disorder in infants may be genetic, find...
 Pregabalin - EPARs for authorised medicinal produ...
 Levodopa/ Carbidopa/ Entacapone - EPARs for autho...
 Duloxetine hydrochloride - EPARs for authorised m...
 paliperidone - EPARs for authorised medicinal pro...
 sugammadex - EPARs for authorised medicinal produc...
 WHO | Pandemic (H1N1) 2009 - update 105
 CDC - Blogs - Safe Healthcare - HICPAC’s Impact – ...
 New study to use genetic 'chips' for examining DNA...
 How Genetic 'chips' Could Help Identify New Genes ...
 Scientists Identify Three New Genetic Variants Tha...
 A Mechanism Behind Negative Tumor Suppressor Gene ...
 Control of cancer cell pathways key to halting dis...
 Researchers discover microRNA biomarkers to treat ...
 Mechanism behind three cancer-causing genes in acu...
 Gene linked to autoimmune diseases : Nature News
 May 2010
 Vitamin D Status Is Not Associated With Risk for L...
 Cancer Clinical Trials — A Chronic but Curable Cri...
 Dasatinib versus Imatinib in Newly Diagnosed Chron...
 Nilotinib versus Imatinib for Newly Diagnosed Chro...
 Maternal or Infant Antiretroviral Drugs to Reduce ...
 Comparison of Zotarolimus-Eluting and Everolimus-E...
 Identification of Late-Onset Hypogonadism in Middl...
 Fungal Cell Gigantism during Mammalian Infection
 SÍFILIS, AUMENTO PERSISTENTE - EEUU (ILLINOIS)
 DENGUE, MALARIA, NIVELES EPIDÉMICOS - VENEZUELA
 ENCEFALITIS EQUINA DEL ESTE, BROTE, ALTA LETALIDA...
 cabazitaxel - FDA Approves New Treatment for Advan...
 NILOTINIB - FDA Approves New Indication for Tasign...
 Tamiflu: Counterfeit Product Sold on Internet
 U S. Medical Eligibility Criteria for Contraceptiv...
 New CDC Study Finds Many Doctors Screen for Cervic...
 Congreso Nacional de Pacientes con Alergia Aliment...
 La vacuna de la gripe H1N1 es eficaz frente a la c...
 Postmarketing Drug Safety Evaluations
 New Videos Reveal How NIH Identifies the Most Prom...
 NIH-Supported Experimental Marburg Vaccine Prevent...
 NIAID Media Avaiability: NIH-Funded Scientists Fin...
 HICPAC – Taking the Lead on Safe Healthcare Practi...
 Developmental Cell - Flower Forms an Extracellular...
 Standards of medical care in diabetes. VIII. Diabe...
 Standards of medical care in diabetes. VII. Diabet...
 Standards of medical care in diabetes. VI. Prevent...
 Standards of medical care in diabetes. V. Diabetes...
 Standards of medical care in diabetes. IV. Prevent...
 Standards of medical care in diabetes. III. Detect...
 Standards of medical care in diabetes. II. Testing...
 Standards of medical care in diabetes. I. Classifi...
 Diabetes management in correctional institutions.
 Diabetes care in the school and day care setting.
 Diabetes and employment.
 FDA to Communicate Safety Monitoring Activities to...
 Infant Overdose Risk With Liquid Vitamin D
 ACR Appropriateness Criteria® urinary tract infect...
 ACR Appropriateness Criteria® sinusitis — child.
 ACR Appropriateness Criteria® seizures — child.
 ACR Appropriateness Criteria® hematuria — child.
 What's New from the Office of Oncology Drug Produc...
 Hexaminolevulinate Hydrochloride
 National Vaccine Advisory Committee
 MANAGEMENT OF MICROVASCULAR COMPLICATIONS OF TYPE ...
 Management of Bipolar Disorder in Adults - VA/DoD ...
 Management of Opioid Therapy (OT) for Chronic Pain...
 Gene Pattern Marks Transplant Patients Who Can Avo...
 New Mechanism for Clearing Blocked Microvessels
 Infants Can Learn When They’re Asleep
 European Medicines Agency - Human Medicines - Orph...
 European Medicines Agency - Human Medicines - Medi...
 European Medicines Agency - Human Medicines - Medi...
 ENFERMEDAD DE CHAGAS, ORAL, BROTE - COLOMBIA (CESA...
 AHRQ WebM&M: Perspectives on Safety
 Fatal Error in Neonate: Does "Just Culture" Provid...
 Tacit Handover, Overt Mishap - AHRQ WebM&M: Case &...
 Acute Respiratory Arrest in Pregnancy - AHRQ WebM&...
 ENCEFALITIS EQUINA VENEZOLANA, CASOS HUMANOS, MEDI...
 HANTAVIRUS, NUEVOS CASOS - CHILE (MAULEE)
 LEISHMANIASIS VISCERAL, HUMANA: ACTUALIZACIÓN - ES...
 Haptoglobin polymorphism and infection. [Adv Clin ...
 Meta-analysis of genome-wide association studies. ...
 Implementing routine testing for severe combined i...
 Cystic fibrosis newborn screening: using experienc...
 Common genetic variation and susceptibility to par...
 Genome-Wide Association Study of Major Recurrent D...
 Genome-wide association study identifies genes tha...
 The influence of common polymorphisms on breast ca...
 Glutathione S-transferase P1 Ile105Val polymorphis...
 Genetics and genomics of neuroblastoma. [Cancer Tr...
 Evidence on the association between NQO1 Pro187Ser...
 Evaluation of association of HNF1B variants with d...
 PHG Foundation | Recommendations for expanded newb...
 Benicar (olmesartan): Ongoing Safety Review
 Recently Updated Advisory Committee Materials
 Sanidad recomienda no iniciar la vacunación con Ro...
 Detailed analysis of epigenetics of Wilms tumor re...
 SERCA2a gene therapy proves effective in people wi...
 Two variants of LPA gene associated with increased...
 Potential Genetic Factor In Eating Disorders Disco...
 Identification Of Gene Linked To Hereditary Incont...
 Future Continues To Brighten For Children With Vel...
 Gene Mutation That Causes Heart Failure Carried By...
 Genetic Markers Could Predict Prostate Cancer In Y...
 PHG Foundation | Tumour profiling and stratified m...
 PHG Foundation | Genetic and environmental factors...
 Gene loss can cause leukemia, researchers find
 World's largest DNA scan reveals rare variants tha...
 Blog.AIDS.gov: Restructuring NIAID's HIV/AIDS Clin...
 National Eye Institute Hosts Translational Researc...
 Gene Linked to Alzheimer's Disease Plays Key Role ...
 NIH Researchers Identify New Steps in Spread of Ma...
 FIEBRE DE OROPOUCHE, BROTE EXTENSO - PERÚ (JUANJUI...
 VACUNA DE ROTAVIRUS, CIRCOVIRUS: PRECAUCIÓN - ESPA...
 Hallan genes en el cromosoma 21 con un efecto anti...
 MAMA - Extirpar más ganglios que el centinela no m...
 Giardiasis Surveillance --- United States, 2006--2...
 Cryptosporidiosis Surveillance --- United States, ...
 ROTAVIRUS - Addition of Severe Combined Immunodefi...
 H1N1 - Deaths and Hospitalizations Related to 2009...
 Ecstasy Overdoses at a New Year's Eve Rave --- Los...
 Functional impact of global rare copy number varia...
 melatonin - EPARs for authorised medicinal produ...
 Dibotermin alfa - EPARs for authorised medicinal p...
 Human Medicines - Herbal Medicinal Products - Adop...
 Tumores gigantes pero benignos - DiarioMedico.com
 Los expertos revisan las directrices para la deter...
 Rivastigmine hydrogen tartrate - EPARs for author...
 Rivastigmine hydrogen tartrate - EPARs for authori...
 panitumumab - EPARs for authorised medicinal prod...
 sapropterin dihydrochloride - EPARs for authorised...
 lapatinib - EPARs for authorised medicinal product...
 JAMA
 Inspecting Outpatient Surgery Centers – Lapses in ...
 PET imaging in testicular cancer: recommendations....
 PET imaging in small cell lung cancer: recommendat...
 PET imaging in ovarian cancer: recommendations.
 PET imaging in brain cancer: recommendations.
 Zoledronic acid - EPARs for authorised medicinal...
 West-Ward Pharmaceuticals Recalls Ondansetron in 5...
 Pfizer Initiates a Nationwide Voluntary Recall of ...
 Sun Safety: Save Your Skin (video)
 CDC - Blogs - Safe Healthcare - Dr. Fishman’s Top ...
 zonisamide - EPARs for authorised medicinal produ...
 European Medicines Agency - Human Medicines - Orph...
 NIH Researchers Explore How Healthy, Young Adults ...
 ACR Appropriateness Criteria® suspected spine trau...
 ACR Appropriateness Criteria® suspected ankle frac...
 ACR Appropriateness Criteria® soft-tissue masses.
 ACR Appropriateness Criteria® primary bone tumors....
 ACR Appropriateness Criteria® metastatic bone dise...
 Immunization programs for infants, children, adole...
 Primary care guidelines for the management of pers...
 AIDSinfo - HIV Guidelines - Perinatal
 SCREENING AND RISK ASSESSMENT FOR OSTEOPOROSIS IN ...
 Neck pain: clinical practice guidelines linked to ...
 Hip pain and mobility deficits - hip osteoarthriti...
 Heel pain - plantar fasciitis: clinical practice g...
 Recommendations for Initiating Antiretroviral Ther...
 Management of osteoporosis in postmenopausal women...
 e- Boletín DROGAS Y MEDICAMENTOS
 Utilizan CA-125 más eco transvaginal para detectar...
 Targeted intraoperative radiotherapy versus whole ...
 Meiotic Recombination Provokes Functional Activati...
 Dietary Supplement Fact Sheets
 Landmark Genetic Analysis Probes Nature vs. Nurtur...
 Nanotechnology-Related Information
 Reference Genomes Advance Human Microbiome Studies...
 Surgeries Equally Effective for Women’s Bladder Co...
 Assessing the Risks, Benefits of Oxygen Therapies ...
 FIEBRE MAYARO, NUEVOS CASOS -VENEZUELA (APURE)
 Sienta las bases para una prueba que determine la ...
 NEJM -- Ten Years On -- The Human Genome and Medic...
 NEJM -- Genomic Medicine -- An Updated Primer
 Pharmacogenetic Approach for a Better Drug Treatme...
 Personalized therapy in pain management: where do ...
 Genetic etiology of Parkinson disease associated w...
 Uptake of carrier testing in families after cystic...
 Symposium on Research Methods for Clinical and Com...
 Rabies: Haiti Pre-decision Brief for Public Health...
 Diphtheria: Haiti Pre-decision Brief for Public He...
 Preventing Clostridium difficile Infection (CDI)—A...
 INFECCIONES POSTQUIRÚRGICAS, CLORHEXIDINA, REDUCCI...
 MALARIA, TUBERCULOSIS, RETOS, NUEVAS ESTRATEGIAS D...
 INFLUENZA, H1N1, BROTE ESCOLAR - COSTA RICA (HERED...
 BACTERIEMIAS, UCI, REDUCCIÓN DE CASOS - ESPAÑA
 MALARIA, AUMENTO MARCADO - VENEZUELA (BOLÍVAR)
 FIEBRE MAYARO, BROTE MASIVO - VENEZUELA (PORTUGUES...
 INFLUENZA, H1N1, PANDEMIA, OMS: INFORME CRÍTICO
 TUBERCULOSIS, EMPEORAMIENTO DE SITUACIÓN EPIDEMIOL...
 HuGENavigator|HuGE Literature Finder|Search
 WHO | Director-General statement following the eig...
 GammaGard Liquid, Immune Globulin Intravenous (Hum...
 FDA Drug Safety Podcasts by Date
 Stroke Prevention Study in Children with Sickle Ce...
 Roche interrumpe inscripción de pacientes para ens...
 Predicting BRCA1 and BRCA2 gene mutation carriers:...
 dbCPCO: A database of genetic markers tested for t...
 Candidate gene association studies and risk of chi...
 A genome-wide association study of nasopharyngeal ...
 Leveraging human genetics to develop future therap...
 Copy number variants highlight candidate genes for...
 Study Finds Jumping Genes Provide Extensive 'Raw M...
 Study papers shows how nutrients affect gene expre...
 Research team confirms gene mutation associated wi...
 Genes' Link to Certain Cancers Questioned
 Discovery Of Gene Mutation Linked To Lymphatic Dys...
 Large-Scale Variation In Human DNA Revealed By Pow...
 Medical Researcher's Discovery May Explain How Cer...
 3 New Susceptibility Genes Identified In Genome-Wi...
 Genetic Mutation Shown To Trigger Melanoma
 Breast Cancer Genetic Risks Not Affected By Lifest...
 Pitt researchers discover gene mutation linked to ...
 Sun-induced skin cancer: new discovery permits doc...
 Scientists move closer to pinpointing gene involve...
 Mutations in TMEM216 perturb ciliogenesis and caus...
 Dr. Cliff on Tackling C. difficile – Part 1 of 3
 Study of MicroRNA Helps NIH Scientists Unlock Secr...
 Drug Substitutes for Training in Rats, Inducing a ...
 Aviso sobre el turismo de las células madre / Warn...
 stiripentol - EPARs for authorised medicinal produ...
 tolcapone - EPARs for authorised medicinal product...
 Deep Brain Stimulation at Two Different Targets Pr...
 Preliminary Results: Surveillance for Guillain-Bar...
 Dengue Fever Among U.S. Travelers Returning from t...
 La cocaína contaminada puede causar putrefacción e...
 Varicose Veins and Spider Veins
 FDA Licensure of Quadrivalent Human Papillomavirus...
 FDA Licensure of Bivalent Human Papillomavirus Vac...
 Use of Combination Measles, Mumps, Rubella, and Va...
 FDA Drug Safety Communication: Drug labels now con...
 NHLBI to Hold Workshop on Health Consequences of S...
 NIH-Supported Study Looks for Earliest Changes in ...
 pandemic influenza vaccine (whole virion, vero cel...
 zonisamide - EPARs for authorised medicinal produ...
 Oseltamivir - EPARs for authorised medicinal produ...
 Etanercept - EPARs for authorised medicinal produc...
 Human medicines highlights // HMH May 2010
 pemetrexed - EPARs for authorised medicinal produ...
 filgrastim - EPARs for authorised medicinal produ...
 Using the Guidelines for Adolescent Preventive Ser...
 The mucosal immune system and its integration with...
 Breastfeeding and Maternal and Infant Health Outco...
 Second trimester insulin resistance, early pregnan...
 Outcomes of Maternal Weight Gain -- AHRQ Evidence ...
 Neonatal mortality risk for repeat cesarean compar...
 Vaginal Birth After Cesarean: New Insights: Struct...
 Necrotizing enterocolitis in 20,822 infants: analy...
 Male gender is associated with intraventricular he...
 Burden of influenza-related hospitalizations among...
 Incidence and trends of pediatric ovarian torsion ...
 Bronchiolitis: recent evidence on diagnosis and ma...
 Management of Bronchiolitis in Infants and Childre...
 Screening for Lipid Disorders in Children: U.S. Pr...
 Incidence of fractures among children with burns w...
 Agitation during procedural sedation and analgesia...
 FDA Approves New Injectable Osteoporosis Treatment...
 Preliminary Results: Surveillance for Guillain-Bar...
 Thyrotropin alfa // Authorised Medicines for Huma...
 From Estonia to Eye Genetics Research, Eye on NEI,...
 ACR Appropriateness Criteria® chronic wrist pain.
 ACR Appropriateness Criteria® chronic foot pain.
 ACR Appropriateness Criteria® chronic ankle pain.
 ACR Appropriateness Criteria® avascular necrosis (...
 ACR Appropriateness Criteria® acute trauma to the ...
 DIAGNOSIS AND ASSESSMENT OF ALZHEIMER'S DISEASE AN...
 Urethral trauma. In: Guidelines on urological trau...
 Ureteral trauma. In: Guidelines on urological trau...
 Renal trauma. In: Guidelines on urological trauma....
 Mass casualty events, triage and damage control. I...
 Genital trauma. In: Guidelines on urological traum...
 Bladder trauma. In: Guidelines on urological traum...
 Free Webinar on Language, Culture, and Genetics
 Clinical Trial Finds Azithromycin Pills Equal to P...
 Immune Cell's Role in Lupus Nephritis Demonstrated...
 La droga recreativa "Special K" podría causar inco...
 MALARIA, NUEVA ESPECIE TRANSMISORA: COMENTARIO - C...
 ESÓFAGO DE BARRETT - IntraMed - Artículos
 EFECTO PLACEBO / IntraMed / Artículos
 El juicio moral, las emociones y el cerebro utilit...
o ► mayo (615)
o ► abril (504)
o ► marzo (510)
o ► febrero (345)
o ► enero (510)
• ► 2009 (4504)
o ► diciembre (578)
o ► noviembre (558)
o ► octubre (566)
o ► septiembre (505)
o ► agosto (472)
o ► julio (388)
o ► junio (374)
o ► mayo (326)
o ► abril (272)
o ► marzo (214)
o ► febrero (182)
o ► enero (69)

Estudio pone en duda el amplio uso de estatinas - MedlinePlus

Estudio pone en duda el amplio uso de estatinas
Traducido del inglés: martes, 29 de junio, 2010
Por Kate Kelland

LONDRES (Reuters) - No existen evidencias de que los fármacos para reducir el colesterol recetados a pacientes en riesgo de enfermedad cardíaca, conocidos como estatinas, reduzcan sus probabilidades de muerte prematura en el corto plazo, dijeron científicos.

Los resultados de un estudio británico pusieron en duda el uso generalizado de estatinas, como Lipitor, de Pfizer, y Crestor, de AstraZeneca, en pacientes que no tienen enfermedad cardíaca pero podrían desarrollarla.

Las estatinas son unos de los fármacos más usados para el tratamiento y la prevención de la enfermedad cardíaca, tanto entre las personas que ya tienen la condición como entre las que están en alto riesgo pero son sanas. Son medicamentos muy exitosos que han prevenido millones de infartos y accidentes cerebrovasculares (ACV).

Pero en un metaanálisis -un estudio que revisa toda la evidencia científica previamente publicada sobre determinado tema-, el profesor Kausik Ray y su equipo de la Universidad de Cambridge y el Addenbrooke's Hospital hallaron pocas pruebas de que las estatinas salven vidas en el corto plazo en los grupos sin problemas del corazón.

"Hay poca evidencia de que las estatinas reduzcan el riesgo de morir de cualquier causa en las personas sin enfermedad cardíaca", escribieron en el estudio, que apareció en Archives of Internal Medicine journal.

"Esto, junto a otros daños causados por las estatinas en algunos subgrupos, puso en duda sus beneficios en la prevención primaria (para evitar el desarrollo de la enfermedad cardíaca)", agregó el equipo.

Esta condición es la principal causa de muerte en hombres y mujeres en los países industrializados y también es un creciente problema en las naciones en desarrollo.

Si bien las estatinas son consideradas seguras y efectivas, un estudio publicado el mes pasado halló que los usuarios de estos fármacos podrían tener más riesgo de disfunción del hígado, falla renal, debilidad muscular y cataratas.

Los científicos advirtieron que estos efectos secundarios deben ser controlados de cerca.

En su análisis, el equipo de Cambridge combinó datos de 11 estudios que involucraron a 65.229 personas. Un total de 32.623 individuos tomaron las estatinas y 32.606 un placebo.

En un seguimiento promedio de 3,7 años, 2.793 participantes murieron, incluyendo 1.447 usuarios de placebo y 1.346 pacientes que tomaron estatinas. Los científicos dijeron que la pequeña reducción en este segundo grupo no fue estadísticamente significativa.

Los científicos dijeron que sus resultados muestran "la necesidad de ser cautelosos cuando se extienden los potenciales beneficios de las estatinas a un mayor grupo de individuos".

El profesor Peter Weissberg, de la Fundación Británica del Corazón, tomó nota de los resultados, pero dijo que eran sólo de corto plazo.

"Las personas en estos estudios fueron seguidas menos de cuatro años en promedio. Dado que la enfermedad cardíaca y circulatoria se desarrolla durante varias décadas, es razonable asumir que podríamos ver una significativa mejora en la mortalidad luego de un período más largo de seguimiento", dijo en un comunicado.


Reuters Health

© 2010 Thomson Reuters. Reservados todos los derechos. Los contenidos Reuters son propiedad intelectual de Thomson Reuters y/o de sus proveedores de contenido. El contenido de estas páginas no puede copiarse, publicarse ni redistribuirse parcial o totalmente, sin el previo consentimiento por escrito de Thomson Reuters. Thomson Reuters no sera responsable por errores o demoras en el contenido. "Reuters" y su logotipo son marcas registradas o marcas comerciales del grupo de empresas de Thomson Reuters en todo el mundo. Para mayor información sobre otros productos para Medios de Reuters favor visitar http://about.reuters.com/media/. © Thomson Reuters 2010
http://www.nlm.nih.gov/medlineplus/spanish/news/fullstory_100546.html

Statins May Lower Rates of Prostate Cancer Recurrence - MedlinePlus [english-spanish]

Statins May Lower Rates of Prostate Cancer Recurrence
But connection needs to be confirmed by future study, researcher says

HealthDay

Monday, June 28, 2010


MONDAY, June 28 (HealthDay News) -- A new study suggests that men who take the cholesterol-lowering drugs known as statins are a third less likely to suffer from recurrences of prostate cancer.

But don't demand that your doctor prescribe a statin -- drugs such as Crestor, Lipitor and Zocor -- for you just yet.

The findings aren't firm enough for doctors to make a blanket recommendation about statin therapy for men who have had prostate cancer, said study senior author Dr. Stephen Freedland, an associate professor of urology and pathology at Duke University.

Another physician went further, saying the findings simply aren't convincing.

Some prior research has suggested that men who took the cholesterol-lowering drugs were less likely than other men to develop advanced prostate cancer and have it come back. But other studies haven't found such positive effects, so the jury is still out, said Dr. Nelson Neal Stone, a professor of urology and radiation oncology at Mount Sinai School of Medicine.

The goal of the new study was to see if statins might be helping those who had already had the disease.

The researchers examined the medical records of more than 1,300 men who'd had their prostates removed after being diagnosed with prostate cancer. Of those, 18 percent were taking a statin when they had the procedures.

The study results appear in the June 28 online issue of the journal Cancer.

After adjusting their statistics so they wouldn't be thrown off by factors such as high or low numbers or who were, say, obese or older, researchers found that those on statins were 30 percent less likely to suffer a recurrence of prostate cancer. More specifically, tumors recurred in 25 percent of those who didn't use statins and 16 percent of those who did.

The study doesn't prove a cause-and-effect relationship: The statins did not necessarily directly lower the risk of prostate cancer recurrence, the experts note. To confirm whether a drug actually reduces risk, researchers rely on studies -- unlike this one -- that randomly assign patients to certain treatments.

Stone added that the study has statistical problems that make its results questionable.

Still, men did better if they took higher doses of statins, Freedland said, suggesting that the drugs may have an effect. They may work by reducing inflammation that spurs tumor growth, he theorized.

Statins are among the most widely prescribed drugs in America, but they do come with risks. Patients may develop liver problems and muscle damage, although the likelihood of that is low, Freeland said.

And the drugs aren't as inexpensive as, say, aspirin. Statins can cost $5 a day or more, depending on dose, although some are much cheaper.

However, not every prostate cancer patient may need to take them, Freedland said. Tests at the time of surgery can estimate a man's risk of prostate cancer recurrence, and statins would be most appropriate for those at highest risk, he explained.

For now, Freedland doesn't recommend that prostate cancer patients start taking statins to prevent recurrence. However, "if you're already on a statin, I'd keep you on that statin," he said. "If you have a clear-cut indication, the benefits outweigh the risks."

SOURCES: Stephen Freedland, M.D., associate professor, urology and pathology, Duke University, Durham, N.C.; Nelson Neal Stone, M.D., professor, urology and radiation oncology, Mount Sinai School of Medicine, New York City; June 28, 2010, Cancer, online

HealthDay

Copyright (c) 2010 HealthDay. All rights reserved.
http://www.nlm.nih.gov/medlineplus/news/fullstory_100471.html





Las estatinas podrían reducir los índices de reincidencia de cáncer de próstata
Sin embargo, según un investigador, es necesario confirmar la conexión en un estudio futuro

Traducido del inglés: martes, 29 de junio, 2010


LUNES, 28 de junio (HealthDay News/DrTango) -- Un estudio reciente sugiere que los hombres que toman estatinas, medicamentos para reducir el colesterol, son un tercio menos propensos a sufrir de recurrencia de cáncer de próstata.

Sin embargo, no le exija todavía a su médico que le recete una estatina, como Crestor, Lipitor o Zocor.

Los hallazgos no son suficientemente sólidos para que los médicos puedan hacer una recomendación generalizada acerca de la terapia con estatinas para los hombres que han tenido cáncer de próstata, señaló el Dr. Stephen Freedland, autor principal del estudio y profesor asociado de urología y patología de la Universidad de Duke.

Otro médico fue aún más allá y dijo que los hallazgos simplemente no son convincentes.

Algunas investigaciones anteriores han sugerido que los hombres que tomaron las estatinas tuvieron menos probabilidades que otros de desarrollar cáncer de próstata o su reincidencia. Sin embargo, otros estudios no han hallado efectos positivos de este tipo, así que no hay consenso, señaló el Dr. Nelson Neal Stone, profesor de urología y oncología de radiación de la Escuela de medicina Mount Sinai.

La meta del nuevo estudio era determinar si las estatinas podrían estar ayudando a los que ya tenían la enfermedad.

Los investigadores examinaron los registros médicos de más de 1,300 hombres a los que se había extirpado la próstata luego del diagnóstico de cáncer. De esos, el 18 por ciento estaba tomando una estatina cuando se sometió al procedimiento.

Los resultados del estudio aparecen en la edición en línea del 28 de julio de la revista Cancer.

Luego de ajustar sus estadísticas para no resultar confundidos por factores como cifras elevadas o reducidas o por la obesidad o la edad, por ejemplo, los investigadores hallaron que los que tomaban estatinas tenían treinta por ciento menos probabilidades de recurrencia de cáncer de próstata. Más específicamente, los tumores reincidieron en el 25 por ciento de los que no usaban estatinas y en el 16 por ciento de los que sí.

El estudio no prueba una relación de causa y efecto. Las estatinas no reducen necesaria y directamente el riesgo de reincidencia de cáncer de próstata, anotan los expertos. Para confirmar si un medicamento en realidad reduce un riesgo, los investigadores se basan en estudios, distintos a éste, que asignan al azar pacientes a ciertos tratamientos.

Stone agregó que el estudio tiene problemas estadísticos que cuestionan los resultados.

Aún así, a los hombres les fue mejor si tomaron dosis más elevadas de estatinas, aseguró Freedland, lo que sugiere que los medicamentos podrían tener que ver. Quizá funcionen por reducir la inflamación que suscita el desarrollo de tumores, especuló.

Las estatinas se encuentran entre los medicamentos más recetados de los EE. UU., pero tienen sus riesgos. Los pacientes podrían desarrollar problemas hepáticos y daño muscular, aunque la probabilidad es bastante baja, advirtió Freedland.

Además, los medicamentos no son de costo bajo, como, digamos, la aspirina. Las estatinas cuestan $5 al día o más, según la dosis, aunque algunas valen bastante menos.

Sin embargo, es posible que no todos los pacientes de cáncer tengan que tomarlas, señaló Freedland. Los exámenes en el momento de la cirugía pueden calcular el riesgo de reincidencia del cáncer. Las estatinas serían más apropiadas para los que están en mayor riesgo, explicó.

Por ahora, Freedland no recomienda que los pacientes de cáncer de próstata comiencen a tomar estatinas para prevenir reincidencia. Sin embargo, "si ya las está tomando, yo no se las quitaría", dijo. "Si hay una indicación bien definida es que los beneficios superan los riesgos".

Artículo por HealthDay, traducido por Hispanicare

FUENTES: Stephen Freedland, M.D., associate professor, urology and pathology, Duke University, Durham, N.C.; Nelson Neal Stone, M.D., professor, urology and radiation oncology, Mount Sinai School of Medicine, New York City; June 28, 2010, Cancer, online

HealthDay

(c) Derechos de autor 2010, HealthDay
http://www.nlm.nih.gov/medlineplus/spanish/news/fullstory_100530.html

Combo Vaccine Raises Risk of Fever-Related Seizures in Kids - MedlinePlus [english-spanish]

Combo Vaccine Raises Risk of Fever-Related Seizures in Kids
MMR, varicella vaccines given separately seem safer, though real risk still rare, study finds

HealthDay
Monday, June 28, 2010


MONDAY, June 28 (HealthDay News) -- Toddlers who receive the combination MMRV (measles, mumps, rubella and varicella) vaccine are at higher risk of having a febrile seizure a week to 10 days after receiving the shot than children who get the MMR and varicella (chicken pox) vaccines separately at the same visit, a new study confirms.

Although the combination shot doubles the risk of febrile seizure, the odds are still quite small, experts noted.

"What's important for parents to understand is that even though there's a doubling of the risk for the combination vaccine, the overall risk of seizure to any one child with any measles-containing vaccine is still less than one in 1,000 doses," said Dr. Nicola Klein, co-director of the Kaiser Permanente Vaccine Study Center in Oakland, Calif., and lead investigator of the study, published online June 28 and in the July print issue of Pediatrics.

The study, funded by the U.S. Centers for Disease Control and Prevention, involved the health records of more than 459,000 children who received their first dose of measles-containing vaccine between 2000 and 2008. The data came the Vaccine Safety Datalink (VSD), a vaccine safety surveillance system sponsored by the CDC and comprised of health records from eight managed care organizations across the country.

Researchers found that among 12- to 23-months olds who received their first dose of measles-containing vaccine, the MMRV shot resulted in one additional febrile seizure for every 2,300 doses given when compared with separate MMRV and varicella vaccines.

Febrile seizures are brief convulsions brought on by fever that occur in about 5 percent of children between 6 months and 5 years of age, said Klein. Although the seizures are distressing, especially to parents, they don't lead to epilepsy or seizure disorders.

The findings are a follow-up to preliminary findings on the twofold increased risk of febrile seizures, which Klein and her colleagues reported to the CDC's Advisory Committee on Immunization Practices (ACIP) in February 2008. Soon afterward, the ACIP changed its recommendations from a stated preference for the MMRV vaccine to no preference for either MMRV or separate MMR and varicella vaccines.

"The reason we did the larger study was to confirm the finding of the twofold increased risk, and to evaluate seizures that occurred at other times, and we found no increased risk outside the seven-to-10-day window," said Klein.

The MMRV vaccine, made by Merck & Co., was licensed by the U.S. Food and Drug Administration in 2005, for use in children aged 12 months to 12 years. The first dose was recommended at 12 to 15 months, and the second at 4 to 6 years. Since 2007, the vaccine has been unavailable because of manufacturing problems, but the company recently began taking orders for it again. Many clinics and doctors offices still had the vaccine in stock for much of 2008.

Dr. Wendy Sue Swanson, a pediatrician in Mill Creek, Wash., who is also on staff at Seattle Children's Hospital, said she was initially a big proponent of the MMRV vaccine but began counseling parents about the increased risk of febrile seizures as soon as the preliminary findings were made public and the ACIP changed its recommendation.

"I would say, 'There's a new report out that says seizures are twice as likely with this combination vaccine, but they're still really rare,' and every person chose to separate the vaccines," said Swanson. "Parents thought it was worth an extra 20 seconds of discomfort if they could protect their kids from these diseases equally well with two shots and reduce the risk of seizures."

"My job as a pediatrician is to help families decrease side effects and risks," added Swanson, herself a parent of two young children. "One in 2,300 is nearly nil, but it's not entirely nil. And nobody wants their child to be that one."

Partly because of the findings of this larger study, the CDC last month released new recommendations for the MMRV vaccine, stating that all children with a personal or family history of seizures should get the separate MMR and varicella vaccines. The CDC also said that, although either the MMRV or the separate MMR and varicella vaccines may be used as the first dose for children aged 12 to 47 months, health care providers should give separate vaccines for the first dose "unless the parent or caregiver expresses a preference for MMRV vaccine."



SOURCES: Nicola P. Klein, M.D., Ph.D., co-director, Kaiser Permanente Vaccine Study Center, Oakland, Calif.; Wendy Sue Swanson, M.D., The Everett Clinic, Mill Creek, Wash., staff pediatrician, Seattle Children's Hospital; June 28, 2010, Pediatrics, online, July 2010 Pediatrics

HealthDay

Copyright (c) 2010 HealthDay. All rights reserved.
http://www.nlm.nih.gov/medlineplus/news/fullstory_100466.html





Vacuna combinada aumenta el riesgo de convulsiones por fiebre en los niños
Un estudio halla que las vacunas triple vírica y contra la varicela que se aplican por separado parecen más seguras, aunque el riesgo real sigue siendo raro

Traducido del inglés: martes, 29 de junio, 2010


LUNES, 28 de junio (HealthDay News/DrTango) -- Un estudio confirma que los bebés que están aprendiendo a caminar que reciben la vacuna SPRV (sarampión paperas, rubéola y varicela, en inglés MMRV) están en mayor riesgo de tener convulsiones febriles entre una semana y diez días después de recibir la inyección que los niños que reciben la vacuna triple (SPR o MMR en inglés) y la de varicela por separado en la misma consulta.

Aunque la vacuna combinada duplica el riesgo de convulsiones febriles, los expertos advirtieron que las probabilidades siguen siendo bastante reducidas.

"Lo que es importante que entiendan los padres es que, aunque existe una duplicación del riesgo con la vacuna combinada, el riesgo general de convulsiones para cualquier niño con la vacuna que contiene sarampión es inferior a uno entre mil", recalcó la Dra. Nicola Klein, codirectora el Centro de Estudio sobre Vacunación Kaiser Permanente en Oakland, California, e investigadora líder del estudio, publicado en línea el 28 de junio y en la edición impresa de julio de Pediatrics.

El estudio, financiado por los Centros para el Control y la Prevención de Enfermedades, incluyó los registros médicos de más de 459,000 niños que recibieron la primera dosis de vacuna que contenía sarampión entre 2000 y 2008. Los datos provinieron de Vaccine Safety Datalink (VSD), un sistema de vigilancia de seguridad de las vacunas financiado por los CDC y compuesto por los registros médicos de ocho organizaciones de medicina administrada por todo el país.

Los investigadores hallaron que entre los que tenían entre 12 y 23 meses que recibieron la primera dosis de vacuna que contenía sarampión, la SPRV causó un episodio de convulsiones febriles adicional por cada 2,300 dosis, comparado con vacunas separadas de SPR y varicela.

Las convulsiones febriles son causadas por la fiebre y ocurren en cerca del cinco por ciento de los niños entre los seis meses y los cinco años de edad, explicó Klein. Aunque las convulsiones son perturbadoras, sobre todo para los padres, no conducen ni a epilepsia ni a trastornos convulsivos.

Los hallazgos son un seguimiento de los resultados primarios sobre el riesgo duplicado de convulsiones febriles, sobre de los que Klein y sus colegas informaron al Comité Asesor de Prácticas de Vacunación (Advisory Committee on Immunization Practices, ACIP) de los CDC en febrero de 2008. Poco después, el ACIP cambió sus recomendaciones de una preferencia establecida por la vacuna SPRV a ninguna preferencia por SPRV, o vacunas separadas de SPR y varicela.

"La razón por la que hicimos el estudio más grande fue para confirmar el hallazgo de la duplicación del riesgo y para evaluar convulsiones que ocurrieron en otros momentos. No hallamos mayor riesgo fuera de la ventana de siete a diez", aseguró Klein.

La vacuna SPRV, fabricada por Merck & Co., fue autorizada por la Administración de Alimentos y Medicamentos de los EE.UU. en 2005 para su uso en niños entre los doce meses y los doce años. La primera dosis se recomendó entre los doce y los quince meses, y la segunda entre los cuatro y los seis años. Desde 2007, la vacuna no ha estado disponible por problemas de fabricación, pero la empresa ha comenzado a tomar pedidos recientemente. Muchas clínicas y consultorios tuvieron existencias de la vacuna incluso por buena parte de 2008.

La Dra. Wendy Sue Swanson, pediatra de Mill Creek, Washington, que también trabaja en el Hospital Infantil de Seattle, aseguró que inicialmente era una defensora acérrima de la vacuna SPRV, aunque comenzó a informar a los padres acerca del riesgo de convulsiones febriles en cuanto se dieron a conocer los hallazgos preliminares y el ACIP cambió su recomendación.

"Les decía que había salido un informe que decía que es el doble de probable que haya convulsiones con esta vacuna combinada, aunque siguen siendo muy poco probables, y todos prefirieron las vacunas separadas", relató Swanson. "Los padres pensaron que valían la pena los veinte segundos adicionales de incomodidad si podían proteger a sus hijos de estas enfermedades igual de bien con dos inyecciones y reducir el riesgo de convulsiones".

"Como pediatra, mi labor es ayudar a las familias a reducir los efectos secundarios y los riesgos", agregó Swanson, madre de dos. "Uno de cada 2,300 es prácticamente nada, aunque no del todo. Nadie quiere que su hijo sea ese uno".

En parte, porque los CDC, por los hallazgos de este estudio de mayor tamaño, publicaron el mes pasado nuevas recomendaciones para la vacuna SPRV que dicen que los niños que tienen antecedentes personales o familiares de convulsiones deben ponerse vacunas de SPR y varicela de manera separada. Los CDC también dijeron que, aunque las vacunas SPRV o SPR y varicela separadas pueden ser usadas como primera dosis para niños entre 12 y 47 meses, los proveedores de atención de la salud deben aplicar vacunas separadas para la primera dosis "a menos que el padre o cuidador indique específicamente que prefiere la vacuna SPRV".


Artículo por HealthDay, traducido por Hispanicare


FUENTES: Nicola P. Klein, M.D., Ph.D., co-director, Kaiser Permanente Vaccine Study Center, Oakland, Calif.; Wendy Sue Swanson, M.D., The Everett Clinic, Mill Creek, Wash., staff pediatrician, Seattle Children's Hospital; June 28, 2010, Pediatrics, online, July 2010 Pediatrics

HealthDay

(c) Derechos de autor 2010, HealthDay
http://www.nlm.nih.gov/medlineplus/spanish/news/fullstory_100529.html

Public Reporting of Healthcare Associated Infections – Part 1 of 2

Public Reporting of Healthcare Associated Infections – Part 1 of 2
June 29th, 2010 2:30 pm ET -


Dr. Daniel Pollock
— Dr. Daniel Pollock
Head of CDC’s National Healthcare Safety Network

A colleague began a recent presentation by asking the audience, “How many of you have had a colonoscopy?”

The majority of participants raised their hands.

Then he asked, “How many of you assumed that the instruments used during your procedure were truly clean?”

All raised their hands again.

Then, he asked, “How would you feel if you found out two weeks, or even a year later, that you may have contracted a severe illness because the tools used were contaminated?”

Silence…

No one expects that receiving healthcare will make them sicker instead of well. ‪

Healthcare-associated infections (HAIs) are a significant concern that affects all types of patients in all kinds of settings including hospitals, surgery centers, dialysis clinics, community clinics, long-term care facilities and more. While we know that the financial cost and, more importantly, the emotional and physical toll of these infections is huge, HAIs were historically accepted as part of routine care. Certainly, not many people outside of the medical and public health communities knew much about what we now know are largely preventable infections.


‪In recent years, however, there has been a momentum building to incorporate more accountability, transparency, and patient empowerment into our healthcare system. With that movement came interest in having HAIs reported publicly, a stance that CDC supports. In fact, we published a statement on the topic in February 2010. Several states have laws that mandate public disclosure of infection rates and certain healthcare facilities, and we expect that trend to expand quickly. In addition, CDC began this year publishing state specific HAI information, and we will report again this fall and include more infection types and all states.
‪
Public reporting of HAIs has had many intended and unintended consequences. In addition to providing increased transparency, infection prevention professionals are telling us that they are getting more support for their prevention efforts. Intense focus on HAI prevention has patients asking about infection rates and other safe healthcare issues. We’ve also heard that some healthcare professionals are not in favor of this type of reporting.

‪What is your take on public reporting? How has it been handled in your organization? What impact has it had?

open here please:
http://blogs.cdc.gov/safehealthcare/?p=467

or here please:
http://blogs.cdc.gov/safehealthcare/

ACR Appropriateness Criteria® suspected small-bowel obstruction - American College of Radiology

GUIDELINE TITLE
American College of Radiology
ACR Appropriateness Criteria® suspected small-bowel obstruction.

BIBLIOGRAPHIC SOURCE(S)
Huprich JE, Rosen MP, Fidler JL, Gay SB, Grant TH, Greene FL, Lalani T, Miller FH, Rockey DC, Sudakoff GS, Expert Panel on Gastrointestinal Imaging. ACR Appropriateness Criteria® suspected small-bowel obstruction. [online publication]. Reston (VA): American College of Radiology (ACR); 2008. 5 p. [46 references]

GUIDELINE STATUS
This is the current release of the guideline.

This guideline updates a previous version: Ros PR, Huprich JE, Bree RL, Foley WD, Gay SB, Glick SN, Heiken JP, Levine MS, Rosen MP, Shuman WP, Greene FL, Expert Panel on Gastrointestinal Imaging. Suspected small bowel obstruction. [online publication]. Reston (VA): American College of Radiology (ACR); 2005. 5 p. [43 references]

The appropriateness criteria are reviewed annually and updated by the panels as needed, depending on introduction of new and highly significant scientific evidence.

open here to see the full-text:
http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=15728&nbr=&string=

ACR Appropriateness Criteria® routine admission and preoperative chest radiography - American College of Radiology

GUIDELINE TITLE
American College of Radiology
ACR Appropriateness Criteria® routine admission and preoperative chest radiography.

BIBLIOGRAPHIC SOURCE(S)
MacMahon H, Khan AR, Mohammed TL, Amorosa JK, Batra PV, Dyer DS, Gurney JW, Jeudy J, Kaiser L, Raoof S, Vydareny KH, Expert Panel on Thoracic Imaging. ACR Appropriateness Criteria® routine admission and preoperative chest radiography. [online publication]. Reston (VA): American College of Radiology (ACR); 2008. 5 p. [41 references]

GUIDELINE STATUS
This is the current release of the guideline.

This guideline updates a previous version: McLoud TC, Davis SD, Aquino SD, Batra PV, Goodman PC, Haramati LB, Khan A, Leung AN, Rosado de Christenson ML, Rozenshtein A, White CS, Kaiser LR, Raoof S, Expert Panel on Thoracic Imaging. Routine admission and preoperative chest radiography. [online publication]. Reston (VA): American College of Radiology (ACR); 2006. 5 p. [39 references]

The appropriateness criteria are reviewed annually and updated by the panels as needed, depending on introduction of new and highly significant scientific evidence.

open here to see the full-text:
http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=15755&nbr=&string=

ACR Appropriateness Criteria® routine chest radiograph - American College of Radiology

GUIDELINE TITLE
American College of Radiology
ACR Appropriateness Criteria® routine chest radiograph.

BIBLIOGRAPHIC SOURCE(S)
Amorosa JK, Bramwit MP, Khan AR, Mohammed TL, Batra PV, Dyer DS, Gurney JW, Jeudy J, Kaiser L, MacMahon H, Raoof S, Vydareny KH, Expert Panel on Thoracic Imaging. ACR Appropriateness Criteria® routine chest radiograph. [online publication]. Reston (VA): American College of Radiology (ACR); 2008. 5 p. [22 references]

GUIDELINE STATUS
This is the current release of the guideline.

This guideline updates a previous version: Aquino SL, Khan A, Batra PV, Gurney JW, Haramati LB, MacMahon H, Mohammed TL, Rozenshtein A, Vydareny KH, Washington L, Winer-Muram HT, Woodard PK, Kaiser L, Raoof S, Expert Panel on Thoracic Imaging. Routine chest radiograph. [online publication]. Reston (VA): American College of Radiology (ACR); 2006. 6 p. [21 references]

The appropriateness criteria are reviewed annually and updated by the panels as needed, depending on introduction of new and highly significant scientific evidence.

open here to see the full-text:
http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=15756&nbr=&string=

ACR Appropriateness Criteria® routine chest radiographs in uncomplicated hypertension - American College of Radiology

GUIDELINE TITLE
American College of Radiology

ACR Appropriateness Criteria® routine chest radiographs in uncomplicated hypertension.

BIBLIOGRAPHIC SOURCE(S)
Khan AR, Mohammed TL, Amorosa JK, Batra PV, Dyer DS, Gurney JW, Jeudy J, Kaiser L, MacMahon H, Raoof S, Vydareny KH, Expert Panel on Thoracic Imaging. ACR Appropriateness Criteria® routine chest radiographs in uncomplicated hypertension. [online publication]. Reston (VA): American College of Radiology (ACR); 2008. 4 p. [15 references]

GUIDELINE STATUS
This is the current release of the guideline.

This guideline updates a previous version: Khan A, Davis SD, Aquino SL, Batra PV, Goodman PC, Haramati LB, Leung AN, McLoud TC, Rosado de Christenson ML, Rozenshtein A, White CS, Kaiser LR, Raoof S, Expert Panel on Thoracic Imaging. Routine chest radiographs in uncomplicated hypertension. [online publication]. Reston (VA): American College of Radiology (ACR); 2006. 3 p. [13 references]

The appropriateness criteria are reviewed annually and updated by the panels as needed, depending on introduction of new and highly significant scientific evidence.

open here to see the full-text:
http://www.guideline.gov/summary/summary.aspx?view_id=1&doc_id=15757

ACR Appropriateness Criteria® screening for pulmonary metastases - American College of Radiology

GUIDELINE TITLE
American College of Radiology
ACR Appropriateness Criteria® screening for pulmonary metastases.

BIBLIOGRAPHIC SOURCE(S)
Mohammed TL, Chowdhry AA, Khan AR, Amorosa JK, Batra PV, Dyer DS, Gurney JW, Jeudy J, Kaiser L, MacMahon H, Raoof S, Vydareny KH, Expert Panel on Thoracic Imaging. ACR Appropriateness Criteria® screening for pulmonary metastases. [online publication]. Reston (VA): American College of Radiology (ACR); 2008. 7 p. [41 references]

GUIDELINE STATUS
This is the current release of the guideline.

This guideline updates a previous version: Mohammed TL, Chowdhry AA, Khan A, Aquino SL, Batra PV, Gurney JW, Haramati LB, MacMahon H, Rozenshtein A, Vydareny KH, Washington L, Winer-Muram HT, Woodard PK, Kaiser L, Raoof S, Expert Panel on Thoracic Imaging. Screening for pulmonary metastases. [online publication]. Reston (VA): American College of Radiology (ACR); 2006. 7 p. [33 references]

The appropriateness criteria are reviewed annually and updated by the panels as needed, depending on introduction of new and highly significant scientific evidence.

open here to see the full-text:
http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=15758&nbr=&string=

ACR Appropriateness Criteria® Crohn's disease - American College of Radiology

GUIDELINE TITLE
American College of Radiology
ACR Appropriateness Criteria® Crohn's disease.

BIBLIOGRAPHIC SOURCE(S)
Huprich JE, Rosen MP, Fidler JL, Gay SB, Grant TH, Greene FL, Lalani T, Miller FH, Rockey DC, Sudakoff GS, Gunderman R, Coley BD, Expert Panel on Gastrointestinal Imaging. ACR Appropriateness Criteria® Crohn's disease. [online publication]. Reston (VA): American College of Radiology (ACR); 2008. 10 p. [60 references]

GUIDELINE STATUS
This is the current release of the guideline.

This guideline updates a previous version: Huprich JE, Bree RL, Foley WD, Gay SB, Glick SN, Heiken JP, Levine MS, Ros PR, Rosen MP, Shuman WP, Greene FL, Rockey DC, Expert Panel on Gastrointestinal Imaging. Crohn's disease. [online publication]. Reston (VA): American College of Radiology (ACR); 2005. 11 p. [46 references]

The appropriateness criteria are reviewed annually and updated by the panels as needed, depending on introduction of new and highly significant scientific evidence.

open here to see the full-text:
http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=15727&nbr=&string=

ACR Appropriateness Criteria® chronic dyspnea — suspected pulmonary origin. - American College of Radiology

GUIDELINE TITLE
American College of Radiology
ACR Appropriateness Criteria® chronic dyspnea — suspected pulmonary origin.

BIBLIOGRAPHIC SOURCE(S)
Dyer DS, Khan AR, Mohammed TL, Amorosa JK, Batra PV, Gurney JW, Jeudy J, Kaiser L, MacMahon H, Raoof S, Vydareny KH, Expert Panel on Thoracic Imaging. ACR Appropriateness Criteria® chronic dyspnea - suspected pulmonary origin. [online publication]. Reston (VA): American College of Radiology (ACR); 2009. 4 p. [29 references]

GUIDELINE STATUS
This is the current release of the guideline.

This guideline updates a previous version: Batra PV, Davis SD, Aquino SL, Goodman PC, Haramati LB, Khan A, Leung AN, McLoud TC, Rosado de Christenson ML, Rozenshtein A, White CS, Kaiser LR, Raoof S, Expert Panel on Thoracic Imaging. Dyspnea. [online publication]. Reston (VA): American College of Radiology (ACR); 2006. 4 p. [14 references]

The appropriateness criteria are reviewed annually and updated by the panels as needed, depending on introduction of new and highly significant scientific evidence

open here to see the full-text:
http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=15754&nbr=&string=

ACR Appropriateness Criteria® blunt abdominal trauma. - American College of Radiology

GUIDELINE TITLE
American College of Radiology
ACR Appropriateness Criteria® blunt abdominal trauma.

BIBLIOGRAPHIC SOURCE(S)
Sudakoff GS, Yucel EK, Rosen MP, Francis IR, Baum RA, Foley WD, Gay SB, Greene FL, Mansour MA, Rybicki FJ, Expert Panels on Vascular Imaging, Gastrointestinal Imaging, and Urologic Imaging. ACR Appropriateness Criteria® blunt abdominal trauma. [online publication]. Reston (VA): American College of Radiology (ACR); 2008. 6 p. [70 references]

GUIDELINE STATUS
This is the current release of the guideline.

This guideline updates a previous version: Shuman WP, Holtzman SR, Bree RL, Bettmann MA, Casciani T, Foley WD, Gay SB, Gomes AS, Rosen MP, Sacks D, Greene FL, Expert Panel on Gastrointestinal Imaging. Blunt abdominal trauma. [online publication]. Reston (VA): American College of Radiology (ACR); 2005. 8 p. [98 references]

The appropriateness criteria are reviewed annually and updated by the panels as needed, depending on introduction of new and highly significant scientific evidence.

open here to see the full-text:
http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=15726&nbr=&string=

ACR Appropriateness Criteria® acute abdominal pain and fever or suspected abdominal abscess - American College of Radiology

GUIDELINE TITLE
American College of Radiology
ACR Appropriateness Criteria® acute abdominal pain and fever or suspected abdominal abscess.

BIBLIOGRAPHIC SOURCE(S)
Grant TH, Rosen MP, Fidler JL, Gay SB, Greene FL, Huprich JE, Lalani T, Miller FH, Rockey DC, Sudakoff GS, Expert Panel on Gastrointestinal Imaging. ACR Appropriateness Criteria® acute abdominal pain and fever or suspected abdominal abscess. [online publication]. Reston (VA): American College of Radiology (ACR); 2008. 7 p. [67 references]

GUIDELINE STATUS
This is the current release of the guideline.

This guideline updates a previous version: Rosen MP, Bree RL, Foley WD, Gay SB, Glick SN, Heiken JP, Huprich JE, Levine MS, Ros PR, Shuman WP, Greene FL, Rockey DC, Expert Panel on Gastrointestinal Imaging. Acute abdominal pain and fever or suspected abdominal abscess. [online publication]. Reston (VA): American College of Radiology (ACR); 2006. 7 p. [56 references]

The appropriateness criteria are reviewed annually and updated by the panels as needed, depending on introduction of new and highly significant scientific evidence.

open here to see the full-text:
http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=15725&nbr=&string=

NIH-Supported ACCORD Eye Study Finds Two Therapies Slow Diabetic Eye Disease Progression

NIH-Supported ACCORD Eye Study Finds Two Therapies Slow Diabetic Eye Disease Progression
Tuesday, June 29, 2010
11:15 a.m. EDT Contact:
National Eye Institute
301-496-5248

NHLBI Communications Office
301-496-4236

NIDDK Communications Office
301-496-3583
NIH-Supported ACCORD Eye Study Finds Two Therapies Slow Diabetic Eye Disease Progression
In high-risk adults with type 2 diabetes, researchers have found that two therapies may slow the progression of diabetic retinopathy, an eye disease that is the leading cause of vision loss in working-age Americans.

Intensive blood sugar control reduced the progression of diabetic retinopathy compared with standard blood sugar control, and combination lipid therapy with a fibrate and statin also reduced disease progression compared with statin therapy alone. However, intensive blood pressure control provided no additional benefit to patients compared with standard blood pressure control.

Results of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Eye Study, supported by the National Institutes of Health, are published online June 29 in the New England Journal of Medicine (NEJM) and will be presented June 29 at the 70th Scientific Sessions of the American Diabetes Association.

"The ACCORD Eye Study clearly indicates that intensive glycemic control and fibrate treatment added to statin therapy separately reduce the progression of diabetic retinopathy," said Emily Chew, M.D., chair of the Eye Study and chief of the Clinical Trials Branch of the Division of Epidemiology and Clinical Applications at the National Eye Institute (NEI). "The main ACCORD findings showed that fibrate treatment added to statin therapy is safe for patients like those involved in the study. However, intensive blood sugar control to near normal glucose levels increased the risk of death and severe low blood sugar, so patients and their doctors must take these potential risks into account when implementing a diabetes treatment plan."

The ACCORD study was a landmark clinical trial that included 10,251 adults with type 2 diabetes who were at especially high risk for heart attack, stroke or cardiovascular death. The study evaluated three intensive strategies compared with standard treatments for lowering cardiovascular risks associated with diabetes.

Intensive treatments included control of blood sugar to near normal levels, control of blood pressure to normal levels, and combination treatment of multiple blood lipids with fenofibrate and simvastatin compared to standard treatment with simvastatin alone. Fenofibrate treatment lowers triglycerides and raises the "good" high density lipoprotein (HDL) cholesterol levels, while simvastatin lowers the "bad" low density lipoprotein (LDL) cholesterol levels. All participants were enrolled in the blood sugar trial and in either the blood pressure or lipid trial.

The ACCORD Eye Study involved a subset of 2,856 participants. Researchers analyzed the effects of the treatment strategies on blood vessels in the eye by identifying diabetic retinopathy progression over four years. Diabetic retinopathy is a disease in which blood vessels in the eye’s light-sensitive retinal tissue are damaged by diabetes. Blood vessels can begin to leak, causing swelling in the retina, and abnormal new blood vessels can develop, both causing vision loss. In the study, disease progression was identified through retinal photographs that indicated blood vessel changes or by the need for laser or eye surgery to treat abnormal blood vessels.

Compared with standard blood sugar control, intensive control decreased the progression of diabetic retinopathy by about one-third, from 10.4 percent to 7.3 percent, over four years. Participants in the intensive control group had a median blood sugar level of 6.4 percent hemoglobin A1c—a level close to values in people without diabetes. The standard blood sugar control group maintained a median level of 7.5 percent.

"Previous clinical trials have shown the beneficial effects of intensive blood sugar control on slowing the progression of diabetic retinopathy in people with type 1 diabetes or newly diagnosed type 2 diabetes," said NEI director Paul A. Sieving, M.D., Ph.D. "The ACCORD Eye Study expands these findings to a larger population of adults who had type 2 diabetes for an average of 10 years, and demonstrates that the eye benefits from the reduction of glucose below previously established levels."

In addition, compared with simvastatin treatment alone, combination lipid therapy with fenofibrate plus simvastatin also reduced disease progression by about one-third, from 10.2 percent to 6.5 percent, over four years. No prior clinical trial has shown that the combination of fenofibrate and simvastatin reduces diabetic eye disease progression.

There were no differences in diabetic retinopathy progression among participants treated to an intensive systolic blood pressure (top number in a reading) target of less than 120 mm Hg compared with those treated to a standard target of less than 140 mm Hg.

In the main ACCORD study, none of the three treatment strategies resulted in a significant decrease in the combined rates of heart attack, stroke or cardiovascular death compared with standard treatments. However, over about three-and-a-half years of follow up, participants in the intensive blood sugar group had a 22 percent higher risk of death (5.0 percent versus 4.0 percent) and a three times higher risk of seriously low blood sugar (10.5 percent versus 3.5 percent) compared with participants in the standard blood sugar control group.

The ACCORD study began in 2001, and participants were treated and monitored for an average of five years. Results of the blood sugar clinical trial were reported in 2008, when the intensive blood sugar therapy was stopped 18 months early due to an increased risk of death in that treatment group compared with the standard blood sugar control group. Findings from the blood pressure and lipid clinical trials appeared in the April 29, 2010 edition of NEJM.

"A key question in the main ACCORD study was whether intensive glucose control, previously demonstrated to reduce risk of microvascular disease — including eye problems — in diabetes, would reduce large vessel disease that causes problems like heart attacks. Investigators are continuing to evaluate the risks and benefits of the treatment strategies in these high-risk patients with type 2 diabetes," said Susan B. Shurin, M.D., acting director of the National Heart, Lung, and Blood Institute, the primary sponsor of the ACCORD study. "Clinicians should individualize treatment for each patient to prevent complications, also incorporating information about conditions such as cardiovascular or visual problems. Lifestyle interventions, including physical activity, weight loss and healthy diets, can improve diabetes control and reduce onset of diabetes."

Find more information about this trial (NCT00542178) at www.clinicaltrials.gov. Visit www.nei.nih.gov/health/diabetic for more information about diabetic retinopathy.

The National Heart, Lung, and Blood Institute is the primary sponsor of ACCORD, with additional funding and scientific expertise contributed by the National Institute of Diabetes and Digestive and Kidney Diseases. The ACCORD Eye Study was supported by the National Eye Institute. Another component of the National Institutes of Health — the National Institute on Aging — and the Centers for Disease Control and Prevention support additional substudies. The following companies provided study medications, equipment, or supplies: Abbott Laboratories, Amylin Pharmaceuticals, AstraZeneca Pharmaceuticals LP, Bayer HealthCare LLC, Closer Healthcare Inc., GlaxoSmithKline Pharmaceuticals, King Pharmaceuticals Inc., Merck & Co. Inc., Novartis Pharmaceuticals Inc., Novo Nordisk Inc., Omron Healthcare Inc., Sanofi-Aventis U.S., and Takeda Pharmaceuticals Inc.

The National Eye Institute, part of the National Institutes of Health, leads the federal government’s research on the visual system and eye diseases. NEI supports basic and clinical science programs that result in the development of sight-saving treatments. For more information, visit www.nei.nih.gov.

Part of the NIH, the National Heart, Lung, and Blood Institute (NHLBI) plans, conducts, and supports research related to the causes, prevention, diagnosis, and treatment of heart, blood vessel, lung, and blood diseases; and sleep disorders. The Institute also administers national health education campaigns on women and heart disease, healthy weight for children, and other topics. NHLBI press releases and other materials are available online at www.nhlbi.nih.gov.

The National Institute of Diabetes and Digestive and Kidney Diseases, part of NIH, conducts and supports basic and clinical research and research training on some of the most common, severe and disabling conditions affecting Americans. The Institute's research interests include: diabetes and other endocrine and metabolic diseases; digestive diseases, nutrition, and obesity; and kidney, urologic and hematologic diseases. For more information, visit www.niddk.nih.gov.
The National Institutes of Health (NIH) — The Nation's Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.


----------
RESOURCES:
National Eye Health Education Program: www.nei.nih.gov/NEHEP

National Diabetes Education Program: http://ndep.nih.gov

ACCORD clinical trial website: www.accordtrial.org/public/index.cfm

Questions and answers about the ACCORD trial: www.nhlbi.nih.gov/health/prof/heart/other/accord/q_a.htm

Previous ACCORD news releases and publications: www.nhlbi.nih.gov/health/prof/heart/other/accord/index.htm

Aiming for Near-Normal Blood Sugar Did Not Delay Combined Risk of Diabetic Damage for People With Long-standing Diabetes, NIH-Sponsored Trial Finds

Aiming for Near-Normal Blood Sugar Did Not Delay Combined Risk of Diabetic Damage for People With Long-standing Diabetes, NIH-Sponsored Trial Finds
Tuesday, June 29, 2010
11:15 a.m. EDT Contact:
NHLBI Communications Office
301-496-4236

NIDDK Communications Office
301-496-3583


Aiming for Near-Normal Blood Sugar Did Not Delay Combined Risk of Diabetic Damage for People With Long-standing Diabetes, NIH-Sponsored Trial Finds
Some Signs of Damage to Kidneys, Eyes, Nerves Delayed

In people with longstanding type 2 diabetes who are at high risk for heart attack and stroke, lowering blood sugar to near-normal levels did not delay the combined risk of diabetic damage to kidneys, eyes, or nerves, but did delay several other signs of diabetic damage, a study has found. The intensive glucose treatment was compared with standard glucose control.

These findings are from the NIH-funded Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. Although intensive treatment produced some beneficial changes, this approach was reported in 2008 to increase death rates.

The new ACCORD findings appear June 29, 2010 in The Lancet's special online diabetes issue, coinciding with a presentation of the study results at the American Diabetes Association's 70th annual scientific sessions in Orlando.

Over time, diabetes damages the small blood vessels of the eyes, nerves, kidneys and other organs, leading to pain and disability. Heart disease due to damaged large blood vessels is a major cause of death in persons with type 2 diabetes. The longer a person has diabetes, the greater the chances of serious complications, including vision loss and blindness, foot ulcers and amputations, kidney disease and kidney failure, and heart disease and stroke.

"In these ACCORD participants with established type 2 diabetes and additional risk factors for cardiovascular disease, intensive lowering of blood glucose reduced some markers of eye, nerve and kidney disease compared with standard glucose control, but the groups did not differ in the rate of progression to kidney failure, nerve disease, and major vision loss," said lead author Faramarz Ismail-Beigi, M.D., Ph.D., of Case Western Reserve University, Cleveland.

The ACCORD clinical study compared the effect of intensive control of blood sugar, blood pressure, and blood lipids to standard, less-intensive treatments on the risk of major cardiovascular events in more than 10,000 adults with established type 2 diabetes. The study's intensive glycemia arm was halted in February 2008 due to excess deaths in that group. At that time, participants in the intensively treated group were moved to standard glucose control.

At enrollment, ACCORD participants averaged 62 years of age and were obese. In addition to having type 2 diabetes for an average of 10 years, about one-third had pre-existing heart disease, and the remainder had at least two additional cardiovascular disease risk factors. They also had high blood sugar, as measured by the hemoglobin A1C test, which shows average blood sugar in the preceding two to three months. Half of participants had an A1C over 8.1 percent — above the currently recommended target for good control. A1C values in people without diabetes are less than 6 percent.

Previously reported results showed that over about three-and-a-half years of follow up, participants in the intensive blood sugar group had a 22 percent higher risk of death (5 percent versus 4 percent) and a three times higher risk of seriously low blood sugar (10.5 percent versus 3.5 percent) compared with participants in the standard blood sugar control group.

A secondary goal of the ACCORD blood sugar trial was to determine the effects of near-normal glucose control compared with standard control on microvascular, or small blood vessel, damage to organs and tissues. Earlier, well conducted clinical trials in patients with newly diagnosed type 1 and type 2 diabetes had proven lowering blood sugar levels reduced eye, nerve and kidney disease. ACCORD builds on this earlier data by studying benefits of further reduction of glucose to targets near normal, and by studying participants with long-standing rather than newly diagnosed diabetes.

In ACCORD, the A1C target for the intensively treated group was less than 6 percent, a level seen in adults without diabetes and significantly lower than the levels tested in earlier trials. The goal for standard control was an A1C of 7 to 7.9 percent, an average range achieved by individuals treated for type 2 diabetes in the United States. Both groups were treated with Food and Drug Administration-approved diabetes medications, as prescribed by their study clinician.

Eye, nerve, and kidney complications in the two groups were compared after 3.7 years, when intensive control was halted, and again at the study’s end after 5 years. When intensive glucose treatment was halted in the group receiving such treatment, half those participants had an A1C of 6.4 percent or lower, which rose to 7.2 percent at study end. In the standard treatment group, that A1C measure was 7.5 percent, rising to 7.6 percent by the end of the study.

The treatment groups did not differ in the rate of progression to kidney failure, major vision loss, or advanced peripheral neuropathy, a common nerve problem in diabetes that usually begins as tingling or numbness in the feet. However, people in intensive control had less deterioration in a vision test, and 20 percent fewer cataract surgeries compared with those in standard control. They also had a 30 percent lower rate of protein leakage in the urine, a sign of kidney disease and increased risk of heart disease. Testing for vibratory sensation, an indicator of nerve health, showed no difference between the groups, but the intensively controlled group scored better on other nerve tests.

ACCORD is continuing follow-up to assess whether the early changes seen in this study will result in differences in blindness, nephropathy and neuropathy. “The study had a relatively short time period – 3.7 years – to see significant differences in serious complications. Diabetes is a chronic disease, and prevention of complications should be measured over many years,” said Ismail-Beigi.

The effects of intensive blood sugar control on vision are consistent with findings from the ACCORD Eye Study, which explored the effects of intensive treatments on progression of diabetic retinopathy in a subset of about 3,000 ACCORD participants. The most common cause of vision loss in working-age Americans, diabetic retinopathy is a disease in which blood vessels in the eye’s light-sensitive retinal tissue are damaged by diabetes. Intensive blood sugar control was found to be beneficial in retarding the progression of diabetic retinopathy.

"ACCORD provides important data on the risks and benefits of intensive glucose control in people with established type 2 diabetes," said Susan B. Shurin, M.D., acting director of the NIH's National Heart, Lung, and Blood Institute (NHLBI). "Although increasing treatment to try to achieve near-normal blood sugar provides some benefit, clinicians and patients should note that this treatment strategy also potentially increases the risk of adverse effects in patients with additional risk factors for heart disease, such as those studied in ACCORD."

"Earlier landmark trials have proven that intensive glucose control early in the course of diabetes provides long-term benefits in reducing microvascular complications. ACCORD fills an important gap by studying adults with diabetes later in the disease and examining even more stringent glucose control than that previously proven beneficial," said Judith Fradkin, M.D., director of the Division of Diabetes, Endocrinology, and Metabolic Diseases of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). "This new information will help tailor therapy for individuals with long established diabetes who are at high risk of cardiovascular events or already have cardiovascular disease."

About 24 million people in the United States have diabetes. It is the main cause of kidney failure, limb amputations, and new onset blindness in adults and a major cause of heart disease and stroke. Type 2 diabetes, which accounts for up to 95 percent of all diabetes cases, becomes more common with increasing age. It is strongly associated with obesity, physical inactivity, family history of diabetes, history of gestational diabetes (diabetes that occurs during pregnancy), and impaired glucose metabolism, and it is more common in minority groups. The prevalence of diagnosed diabetes has more than doubled in the last 30 years, due in large part to the upsurge in obesity and aging of the population.

The NHLBI is the primary sponsor of ACCORD, with additional funding and scientific expertise contributed by the NIDDK. Other components of the NIH — the National Institute on Aging and National Eye Institute — as well as the Centers for Disease Control and Prevention, supported sub-studies. The following companies provided study medications, equipment, or supplies: Abbott Laboratories, Amylin Pharmaceutical, AstraZeneca Pharmaceuticals LP, Bayer HealthCare LLC, Closer Healthcare Inc., GlaxoSmithKline Pharmaceuticals, King Pharmaceuticals, Inc., Merck & Co., Inc., Novartis Pharmaceuticals, Inc., Novo Nordisk, Inc., Omron Healthcare, Inc., Sanofi-Aventis U.S., and Takeda Pharmaceuticals Inc.

To interview an NHLBI spokesperson, please call the NHLBI Communications Office at (301) 496-4236 or email nhlbi_news@nhlbi.nih.gov. To interview an NIDDK spokesperson, call (301) 496-3583 or e-mail NIDDKMedia@mail.nih.gov. To interview Dr. Ismail-Beigi, call (216) 368-6129 or e-mail fxi2@case.edu.

Part of the NIH, the National Heart, Lung, and Blood Institute (NHLBI) plans, conducts, and supports research related to the causes, prevention, diagnosis, and treatment of heart, blood vessel, lung, and blood diseases; and sleep disorders. The Institute also administers national health education campaigns on women and heart disease, healthy weight for children, and other topics. NHLBI press releases and other materials are available online at www.nhlbi.nih.gov.

The National Institute of Diabetes and Digestive and Kidney Diseases, part of NIH, conducts and supports basic and clinical research and research training on some of the most common, severe and disabling conditions affecting Americans. The Institute's research interests include: diabetes and other endocrine and metabolic diseases; digestive diseases, nutrition, and obesity; and kidney, urologic and hematologic diseases. For more information, visit www.niddk.nih.gov.

The National Institutes of Health (NIH) — The Nation's Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.


-----------
Resources:

For further information about this trial (NCT00000620), visit www.clinicaltrials.gov or the ACCORD clinical trial website : www.accordtrial.org

June 29, 2010 news release— ACCORD Eye Study Finds Intensive Blood Sugar Control or Combination Lipid Therapy Decrease Diabetic Eye Disease Progression: Release will be available on June 29, 2010 at 11:15 AM EDT at http://www.nei.nih.gov/news/

March 15, 2010 news release—Landmark ACCORD Trial Finds Intensive Blood Pressure and Combination Lipid Therapies do not Reduce Combined Cardiovascular Events in Adults with Diabetes http://www.nih.gov/news/health/mar2010/nhlbi-15.htm

June 6, 2008 news release — ACCORD Clinical Trial Publishes Results — Targeting Blood Sugar to Near-Normal Levels Does Not Reduce Cardiovascular Events But is Associated with Increased Mortality in Persons with Diabetes at High Risk, http://public.nhlbi.nih.gov/newsroom/home/GetPressRelease.aspx?id=2573

Questions and Answers about the ACCORD Clinical Trial, http://www.nhlbi.nih.gov/health/prof/heart/other/accord/q_a.htm

National Diabetes Information Clearinghouse, http://diabetes.niddk.nih.gov/

National Diabetes Education Program, http://ndep.nih.gov/