MEPREP: Medication Exposure in Pregnancy Risk Evaluation Program - FDA, Health Organizations to Study Safety of Medications Taken During Pregnancy

Media Inquiries: Shelly Burgess, 301-796-4651; shelly.burgess@fda.hhs.gov
Consumer Inquiries: 888-INFO-FDA

FDA, Health Organizations to Study Safety of Medications Taken During Pregnancy
New collaborative research program to study effects on mothers and their babies

A new research program called the Medication Exposure in Pregnancy Risk Evaluation Program (MEPREP) will fund research to study the effects of prescription medications used during pregnancy. The program is a collaboration among the U.S. Food and Drug Administration and researchers at the HMO Research Network Center for Education and Research in Therapeutics (CERT), Kaiser Permanente’s multiple research centers and Vanderbilt University.

About two-thirds of women who deliver a baby have taken at least one prescription medication during pregnancy according to a journal article published in the American Journal of Obstetrics and Gynecology. There are very few clinical trials that test the safety of medications in pregnancy due to concerns about the health of the mother and child.

“This program is a great example of FDA and the private sector working together to improve the health of pregnant women and their children,” said Margaret Hamburg, MD, Commissioner of Food and Drugs. "These data will guide regulatory policy and influence medical practice."

To overcome the challenges presented by the lack of clinical trial data about the use of medications during pregnancy, the research program will link health care information for mothers and their babies in each of the participating research sites. Collectively, the 11 participating sites have health care information for about 1 million births over the past seven years (2001-2007). Many of the mothers associated with these births likely used medication during their pregnancies and now, with the program in place, the FDA and participating researchers have a systematic and timely way of retrieving information from this network.

“This collaborative effort creates a unique resource to study the effects of medication in pregnant women and their children,” said Gerald Dal Pan, M.D., director of the Office of Surveillance and Epidemiology at the FDA’s Center for Drug Evaluation and Research. “Results of these studies will provide valuable information for patients and physicians when making decisions about medication during pregnancy.”

The program blends clinical and research expertise and population-based databases from 11 health plan-affiliated research sites including Kaiser Permanente (Northern California, Southern California, Georgia,, Pacific Northwest, and Colorado regions); Harvard Pilgrim Health Care Institute, Group Health Research Institute, HealthPartners, Lovelace Clinic Foundation, the Meyers Primary Care Institute, and Tennessee State Medicaid, and the FDA. The HMO Research Network CERT Data Center at the Department of Population Medicine of Harvard Medical School and Harvard Pilgrim Health Care Institute, led by Richard Platt, M.D., M.S., is the coordinating center for the program.

Lead researchers include Susan Andrade, Sc.D. HMO Research Network William Cooper, M.D., M.P.H. (Vanderbilt); Robert Davis, M.D., M.P.H. (Kaiser Permanente Georgia); Craig Cheetham, Pharm.D.; (Kaiser Permanente Southern California); and De-Kun Li, M.D., Ph.D. (Kaiser Permanente Northern California). The investigators have collaborated on numerous studies related to medication use during pregnancy and birth outcomes, as well as studies on the effects of anti-depressant medications, antibiotics, and cardiovascular medications on birth defects and perinatal outcomes.

A Steering Committee composed of representatives from each participating site and the FDA will oversee MEPREP activities and provide overall scientific leadership. FDA epidemiologist, Pamela E. Scott, Ph.D., is the FDA project lead and chair of the Steering Committee.
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm195934.htm

WHO | Pandemic (H1N1) 2009 - update 81

Pandemic (H1N1) 2009 - update 81
Weekly update
30 December 2009 -- As of 27 December 2009, worldwide more than 208 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including at least 12220 deaths.

WHO is actively monitoring the progress of the pandemic through frequent consultations with the WHO Regional Offices and member states and through monitoring of multiple sources of data.

Situation update:
The most active areas of pandemic influenza transmission currently are in central and eastern Europe. Focal increases in rates of ILI/ARI during recent weeks were reported in at least three eastern European countries, Georgia, Montenegro, and Ukraine. A high intensity of respiratory diseases activity with concurrent circulation of pandemic influenza persists in parts of southern and eastern Europe, particularly in Greece, Poland, Bulgaria, Serbia, Ukraine, and the Urals Region of the Russian Federation. In Western Europe, influenza transmission remains active and widespread, but overall disease activity has peaked. At least 13 of 21 countries (testing more than 20 sentinel samples) reported that 30% or more of sentinel specimens were positive for influenza, down from a peak of over 70%. All were influenza viruses detected in Western Europe were pandemic H1N1 2009, however, very small numbers of seasonal influenza viruses, making up less than 1% of all influenza viruses detected, were reported in Russia. In addition, limited available data indicates that active, high intensity transmission is occurring in Northern African countries along the Mediterranean coast (Algeria, Tunisia, and Egypt).

In Central Asia, limited data suggest that influenza virus circulation remains active, but transmission may have recently peaked in some places. In West Asia, Israel, Iran, Iraq, Oman, and Afghanistan also appear to have passed their peak period of transmission within the past month, though both areas continue to have some active transmission and levels of respiratory disease activity have not yet returned to baseline levels.

In East Asia, influenza transmission remains active but appears to be declining overall. Influenza/ILI activity continued to decline in Japan, in northern and southern China, Chinese Taipei, and Hong Kong SAR (China). Slight increases in ILI were reported in Mongolia after weeks of declining activity following a large peak of activity over one month ago. In southern Asia, influenza activity continues to be intense, particularly in northern India, Nepal, and, Sri Lanka. Seasonal influenza A (H3N2) viruses are still being detected in very small numbers in China making up about 2.5% of the influenza A viruses detected there.

In North America, influenza transmission remains widespread but has declined substantially in all countries. In the US, sentinel outpatient ILI activity has returned to the seasonal baseline, and indicators of severity, including hospitalizations, paediatric mortality, and P&I mortality have declined substantially since peaking during late October. Rates of hospitalization among cases aged 5-17 years and 18-49 year far exceeded rates observed during recent influenza seasons, while rates of hospitalizations among cases aged >65 years were far lower than those observed during recent influenza seasons.

In the tropical regions of Central and South America and the Caribbean, influenza transmission remains geographically widespread but overall disease activity has been declining or remains unchanged in most parts, except for focal increases in respiratory disease activity in a few countries.

In the temperate regions of the southern hemisphere, sporadic cases of pandemic influenza continued to be reported without evidence of sustained community transmission.

The Global Influenza Surveillance Network (GISN) continues monitoring the global circulation of influenza viruses, including pandemic, seasonal and other influenza viruses infecting, or with the potential to infect, humans including seasonal influenza. For more information on virological surveillance and antiviral resistance please see the weekly virology update (Virological surveillance data, below).

Weekly update (Virological surveillance data)
*Countries in temperate regions are defined as those north of the Tropic of Cancer or south of the Tropic of Capricorn, while countries in tropical regions are defined as those between these two latitudes.

**Abbreviations: influenza-like-illness (ILI), acute respiratory infection (ARI), and severe acute respiratory infection (SARI)

abrir aquí para acceder al documento WHO completo:
WHO | Pandemic (H1N1) 2009 - update 81

La ÉTICA por sobre TODAS las COSAS

Diariomedico.com
ESPAÑA
DECLARACIÓN DE LA UNIVERSIDAD DE NAVARRA
"El embarazo no deseado no se debe solucionar abortando"

La Universidad de Navarra ha mostrado su oposición a la nueva ley del aborto propuesta por el Gobierno de Rodríguez Zapatero en una declaración en la que dice que "la tragedia de un embarazo indeseado no puede ser solucionado con la tragedia superior del aborto".

Europa Press. Pamplona - Jueves, 17 de Diciembre de 2009 - Actualizado a las 00:00h.

José Andrés Gómez, director general de la Clínica Universidad de Navarra; María Pilar Civeira, decana de la Facultad de Medicina; Ignacio López, decano de Ciencias; Iciar Astiasarán, decana de Farmacia, y Mercedes Pérez, directora de la Escuela de Enfermería, han presentado una declaración conjunta en la que muestran su oposición a la ley.

El texto recoge la oposición de la Universidad a "incorporar las técnicas abortivas a los contenidos de la educación". Los firmantes muestran su compromiso con "formar profesionales para curar, investigar y ayudar", ya que "nuestra ilusión es que la educación y la información lleguen a todas las mujeres".

Según recoge la declaración, la Universidad de Navarra quiere que una mujer embarazada "nunca se encuentre sola, sino que el padre y el hijo también cuenten, pues la vida que comienza es asunto de tres".

El texto defiende que los políticos y la legislación apuesten por "la defensa de los más débiles, el hijo y la madre", porque "una sociedad que protege al débil es fuerte". Además, en la declaración se advierte de que "la historia juzgará nuestra pasividad cómplice o nuestro compromiso solidario con el débil".

BLOG: adhiere a la declaración de la Universidad de Navarra.

CIENCIAS MÉDICAS NEWS: DIRECTORIO DE DOCUMENTOS de DICIEMBRE 2009

JUEVES 31 DE DICIEMBRE DE 2009
DIRECTORIO DE DOCUMENTOS de DICIEMBRE 2009

CIENCIAS MÉDICAS NEWS©: Directorio de Documentos editados en DICIEMBRE 2009
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Consultas acumuladas por el grupo de blogs de salud equitativa®:324.811
CIENCIAS MÉDICAS NEWS©: Directorio de documentos editados en diciembre de 2009

Desde su creación el 10 de enero de 2009, el blog ha recibido aproximadamente 118.000 consultas (31/12/2009 a las 14.00 horas de Argentina). Una vez más, cabe agradecer a todos los anónimos que buscan en estas páginas contenidos científicos fehacientes, lo cual se transfiere a la calidad de las fuentes que los proveen.
Este blog es usualmente consultado desde todo el mundo (quién lo hubiera dicho). Acceden a él, instituciones académicas, centros de investigación, instituciones de salud tanto públicas como privadas, entes oficiales de distintos gobiernos, así como también profesionales médicos, bioquímicos, farmacéuticos, enfermeros, psicólogos y muchos otros de aquellos que integran el “equipo de salud”.
Si bien la intención original era publicar todo en idioma español únicamente, las circunstancias me fueron impulsando a incluir documentos en idioma inglés, los que hoy ocupan mayoritariamente las ediciones diarias. Pedimos disculpas por ello, pero bajo la evidencia del interés que los mismos documentos en idioma inglés despiertan, sustentamos la conducta prometiendo acrecentar las ediciones en español para aquellos que no son bilingües o no se sienten cómodos leyendo en inglés.
Agradezco profundamente a todas y cada una de las fuentes: Agencia Europea de Medicamentos, Food and Drug Administration-USA, National Institute of Health-USA; CDC-USA; AHRQ-USA; NGC-USA; NQMC-USA; Sociedad Internacional de Enfermedades Infecciosas [ISID], IntraMed, El Hospital (usa), El Médico Interactivo (España), Jano.es/Elsevier (España), Diario Médico (España), y a todas las demás instituciones del gobierno de los estados unidos de norteamérica y Europa, que nos aportan diariamente con información altamente calificada.
Este blog se nutre de información en red que se distribuye gratuitamente y no monetiza los contenidos por respeto a las necesidades de los profesionales del equipo de la salud. Por dicho motivo, tenemos la libertad de administrar la información que recibimos sin emitir opinión (salvo excepciones de ética y/o bioética explícitas) y sin calificar como así tampoco descalificar a las fuentes. En lo personal entiendo que la información científico-médica debe ser de acceso universal ya que ello habilita a la discusión y al crecimiento del conocimiento. Cerasale©. Diciembre 31, 2009.-

ranking de consultas hasta el 30 de Noviembre de 2009:
1. Argentina: 22.132 - 18,7 %
2. España: 18.797 - 15,9%
3. México: 17.219 – 14,6 %
4. Estados Unidos: 9.784 - 8,3 %
5. Perú: 7.640 - 6,5 %
6. Venezuela: 7.344 - 6,2 %
7. Colombia: 6.944 - 5,9 %
8. Chile: 4.634 - 3,9 %
9. Ecuador: 2.875 - 2,4 %
10. Bolivia: 2.301 - 1,9%
el resto: 18.571 - 15,7 %
total: 118.241 - 100,0 %


Archivo del blog
• ▼ 2009 (4500)
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 4487. HER2-like And Basal-Like Genotype Breast Cancer Ar...
 4486. Columbia scientists discover 2 genes that drive ag...
 4485. Understanding the Genetics of Colon Cancer
 4484. Enfermos graves por gripe A (H1N1) en México / Int...
 4483.Ensayo de Selección Espermática
 4482. ▲ Pain, Chronic; Assessment and Management of (Guide...
 4481. ▲ Pain, Acute, Assessment and Management of (Guideli...
 4480. ▲ Low Back Pain, Adult (Guideline) [ICSI-NQMC-AHRQ]...
 4479. RARE DISEASES: 5th European Conference on Rare Dis...
 FELIZ AÑO 2010 a todos los lectores
 4477. ► Cardiovascular Guidelines: 10 clinical guidelines ...
 4476. ▲ Displacement of Dengue Virus Type 1 by Type 4 | CD...
 4475. Human Herpesvirus 8 in Healthy Blood Donors, Argen...
 4474. Influenza Virus Vaccine for the 2009-2010 Season
 4473. Influenza A (H1N1) 2009 Monovalent Vaccines Compos...
 4472. Necesitamos una medicina mínimamente agresiva - In...
 4471. El uso de la telemedicina en UCI no mejora la supe...
 4470. La FDA aprueba dispositivos cardiovasculares sin l...
 4469. Otomastoiditis caused by Mycobacterium abscessus, ...
 4468. Increase in Serotype 6C Pneumococcal Carriage, Uni...
 4467. Real-Time PCR for Diagnosis of Oculoglandular Tula...
 4466. Enterotoxigenic Escherichia coli in Guatemala and ...
 4465. A Guide for Clinical Supervision
 4464. Guidelines for Responding to Mental Health Crisis ...
 4463. Screening, Brief Intervention, and Referral to Tre...
 4462. Vaccines: CoCASA/Installation
 4461. White-nose syndrome fungus (Geomyces destructans) ...
 4460. Employment and compliance with pandemic influenza ...
 4459. Household responses to pandemic (H1N1) 2009–relate...
 4458. DIARREA - ISID / BARCOS CRUCEROS
 4457. H1N1 - gripe porcina - ISID / ARGENTINA: elevada l...
 4456. RESISTENCIA A ANTIBIÓTICOS - INDUCCIÓN - ISID /
 4455. CHAGAS: Nacen unos 4000 chicos con el parásito del...
 4454. Los casos de muerte súbita podrían evitarse mucho ...
 4453. NOT-HS-10-010: Clarification and Update Notice for...
 4452. ► GLOBAL HEALTH RISKS [WHO-OMS 2009]
 4451. La epidemiología impulsa el avance científico - Di...
 4450. Hacen falta evidencias sobre la mejoría de los ant...
 4449. Tylenol Arthritis Pain Caplet 100 count: MedWatch
 4448. CDC - Seasonal Influenza (Flu) - Weekly Report: In...
 4447. WHO | Pandemic (H1N1) 2009 - update 80
 4446. Thermoflect Blankets and product line - Recall
 4445. Vertebral fracture assessment: the 2007 ISCD offic...
 4444. Quantitative ultrasound in the management of osteo...
 4443. Peripheral quantitative computed tomography in chi...
 4442. Peripheral dual-energy x-ray absorptiometry in the...
 4441. Fracture prediction and the definition of osteopor...
 4440. Dual-energy x-ray absorptiometry technical issues:...
 4439. Dual-energy x-ray absorptiometry interpretation an...
 4438. Dual-energy x-ray absorptiometry assessment in chi...
 4437. Clinical use of quantitative computed tomography a...
 4436. Human GAS Virulence Genes in Bovine GCS | CDC EID
 4435. Serogroup W135 Meningococci, Southeastern Florida ...
 4433. Syphilis in Martinique | CDC EID
 4432. Actinobaculum schaalii, a Common Uropathogen | CDC...
 4431. Meningitis Caused by Echovirus Type 4 | CDC EID
 4430. Leptospirosis - ISID / Argentina
 4429. TUBERCULOSIS XXDR - ISID / USA
 4428. LEISHMANIASIS VISCERAL, HUMANA, CASOS ATÍPICOS / I...
 4427. EFECTOS BIOLÓGICOS DE LAS RADIACIONES IONIZANTES
 4426. ICSI - Depression, Major, in Adults in Primary Car...
 4425. ICSI - ADHD, Attention Deficit Hyperactivity Disor...
 4424. * IntraMed - Artículos - Profilaxis de las adherenci...
 4423. H1N1 - gripe porcina - ISID / USA: severidad en pa...
 4422. Primer volumen de la enciclopedia microbiana - Dia...
 4421. Pandemic (H1N1) 2009 Virus in Pigs | CDC EID
 4420. Hospitalizations for Pandemic (H1N1) 2009 | CDC EI...
 4419. Pandemic and Seasonal Influenza, Singapore | CDC E...
 4418. Encephalopathy and Influenza A Infection in Adults...
 4417. Pandemic (H1N1) 2009 Reinfection, Chile | CDC EID
 4416. Age-based Human Influenza A Virus (H5N1) Infection...
 4415. Ceftiofur Resistance in Salmonella Heidelberg | CD...
 4414. STAPHYLOCOCCUS AUREUS / ISID - transmisión de huma...
 4413. ACINETOBACTER SP. RESISTENTE / ISID - USA
 4412. NEUMONÍA - ISID/ contaminación del aire
 4411. PAROTIDITIS - ISID / USA: brote en inmunizados
 4410. Fluoroquinolone-Resistant Escherichia coli | CDC E...
 4409. Oseltamivir- and Amantadine-Resistant Influenza Vi...
 4408. Induction of labour.
 4407. Antenatal care. Routine care for the healthy pregn...
 4406. Approved Drug Products with Therapeutic Equivalenc...
 4405. Individual Product Bioequivalence Recommendations
 4404. Drugs to be Discontinued by FDA
 4403. Adverse Event Reporting for Emergency Use of Peram...
 4402. Case Studies in Infectious Disease | CDC EID
 4401. Imported Chikungunya Virus Infection | CDC EID
 4400. Carbapenemase Gene of A. baumannii | CDC EID
 4399. S. aureus Infections in Dogs | CDC EID
 4398. Skin Lesion Caused by ST398 and ST1 MRSA, Spain | ...
 4397. CA-MRSA in Outpatients, United States, 1999–2006, ...
 4396. Antihemophilic Factor (Recombinant), Plasma/Albumi...
 4395. Recall: T.R.U.E. Test Box Lot 94009
 4394. FDA Approves A High Dose Seasonal Influenza Vaccin...
 4393. CDC H1N1 Flu | In The News - 2009 H1N1 Hospitaliza...
 4392. CDC H1N1 Flu | Non-Safety-Related Voluntary Recall...
 4391. Influenza virus vaccine: Approval History, Letter...
 4390. WHO | Pandemic (H1N1) 2009 - update 80
 4389. La gripe A, más virulenta en los chicos
 4388. Coal Workers' Pneumoconiosis-Related Years of Pote...
 4387. DENGUE: CDC - Clinical and Laboratory Guidance - D...
 4386. Prevención de la exposición ocupacional a los anti...
 4385. Laboratory Surge Response to Pandemic (H1N1) Outbr...
 4384. Norovirus Gastroenteritis Outbreak | CDC EID
 4383. Seagulls as Reservoirs for E. coli | CDC EID
 4382. Novel Human Parechovirus, Sri Lanka | CDC EID
 4381. Detection of Newly Described Astrovirus MLB1 in St...
 4380. Fatal Case of Pneumonia Associated with Pandemic (...
 4379. → Pandemic influenza vaccine (H1N1) (split virion, i...
 4378. → Pegfilgrastim - EPARs for authorised medicinal pro...
 4377. → rosiglitazone - EPARs for authorised medicinal pro...
 4376. → European Medicines Agency - Human Medicines - Medi...
 4375. H1N1 - gripe porcina - ISID / INMUNIZACIÓN: riesgo...
 4374. Influenza Virus Vaccine: Fluzone High-Dose
 4373. FDA-Issued rRT-PCR Swine Flu Panel
 4372. CDC H1N1 Flu | Vaccine Info for Healthcare Profess...
 4371. H1N1 - gripe porcina - ISID / U.S.A.: infección ca...
 4370. SARM - CEPA USA600 - ISID / U.S.A.
 4369. MENINGITIS - ISID / VENEZUELA
 4368. Global Occurrence of C. gattii | CDC EID
 4367. Intent to Receive Influenza A (H1N1) 2009 Monovale...
 4366. Impact of Seasonal Influenza-Related School Closur...
 4365. Hantavirus Pulmonary Syndrome in Five Pediatric Pa...
 4364. Otomastoiditis caused by Mycobacterium abscessus, ...
 4363. Use of Human Blood and Blood Components
 4362. Vaccines: VPD-VAC/HPV/Vaccine FAQ
 4361. Distinct Molecular Signature of Bovine Spongiform ...
 4360. Clinical practice guidelines for quality palliativ...
 4359. Increase in Serotype 6C Pneumococcal Carriage, Uni...
 4358. Perceptions and Reactions, Pneumonic Plague | CDC ...
 4357. Severe Pneumonia and Pandemic (H1N1) 2009, Mexico ...
 4356. RFA-HS-10-001: Recovery Act 2009 Limited Competiti...
 4355. CDC H1N1 Flu | What You Should Know and Do this Fl...
 4354. WHO | Comparing deaths from pandemic and seasonal ...
 4353. leishmaniasis canina: alerta por una nueva enferme...
 4352. ESHG Conference 2010 - June 12 - 15 - Gothenburg, ...
 4351. Follow-Up to the August 2008 Early Communication A...
 4350. Food Reservoir for Escherichia coli Causing Urinar...
 4349. ▲ Specific management of IgA nephropathy: role of st...
 4348. ▲ Specific management of IgA nephropathy: role of fi...
 4347. ▲ Renal artery stenosis.
 4346. ▲ DYALISIS 3: Other criteria for starting dialysis.
 4345. ▲ DIALYSIS 2: Mode of dialysis at initiation.
 4344. ▲ DIALYSIS 1: Level of renal function at which to in...
 4343. Global Occurrence of C. gattii | CDC EID
 4342. Laboratory Surge Response to Pandemic (H1N1) Outbr...
 4341. ► CA-MRSA in Outpatients, United States, 1999–2006, ...
 4340. → vitespen - European Medicines Agency - Withdrawals...
 4339. → Prepandemic influenza vaccine (H5N1) - EPARs for a...
 4338. → orlistat - EPARs for authorised medicinal products...
 4337. → paliperidone - EPARs for authorised medicinal prod...
 4336. → varenicline tartrate - EPARs for authorised medici...
 4335. → sorafenib - EPARs for authorised medicinal product...
 4334. → Rotigotine - EPARs for authorised medicinal produc...
 4333. → Drotrecogin alfa (activated) - EPARs for authorise...
 4332. → Rasagiline (as mesilate) - EPARs for authorised me...
 4331. → Aripiprazole - EPARs for authorised medicinal prod...
 NAVIDAD 2009
 4329. → Human Medicines - Herbal Medicinal Products - Call...
 4328. → Human Medicines - Herbal Medicinal Products - Adop...
 4327. → Human Medicines - Herbal Medicinal Products - Publ...
 4326. → European Medicines Agency - Human Medicines - Medi...
 4325. → European Medicines Agency - Human Medicines - CHMP...
 4324. → European Medicines Agency - Withdrawals of Applica...
 4323. CDC H1N1 Flu | Updated Interim Recommendations: Sp...
 4322. Soy Infant Formula Information
 4321. Comparative Effectiveness of Hematopoietic Stem-Ce...
 4320. Comparative Effectiveness of Typical and Atypical ...
 4319. Schizophrenia, Schizophrenia-related psychoses - C...
 4318. Síndrome del túnel carpiano [El Hospital]
 4317. Trompa de Falopio humana: una nueva fuente de célu...
 4316. Narrowing the Boundaries of the Genetic Architectu...
 4315. Your Own Personal Genome | Cover Story | Chemical ...
 4314. PHG Foundation | Rare copy number variant causes c...
 4313. Amount Of Gene Surplus Determines Severity Of Ment...
 4312. Gene Identified As Cause Of Some Forms Of Intellec...
 4311. Leprosy susceptibility genes identified; largest g...
 4310. Crean una molécula efectiva contra una enfermedad ...
 4309. Investigadores argentinos demuestran un gran avanc...
 4308. ISID: vacuna H1N1
 4307. DIARREAS - ISID / GLOBAL: mortalidad creciente
 4306. DENGUE - ISID / SUD AMÉRICA: tendencias epidemioló...
 4305. DENGUE - ISID / VENEZUELA: epidemia
 4304. Drug Safety Oversight Board Meeting, November 19, ...
 4303. FDA > Guidance for Industry
 4302. → European Medicines Agency - Human Medicines - Refe...
 4301. → European Medicines Agency - Human Medicines - Refe...
 4300. → European Medicines Agency - Human Medicines - Refe...
 4299. National Survey on Drug Use and Health, 2008
 4298. → European Medicines Agency - Human Medicines - Refu...
 4297. → sitimagene ceradenovec // European Medicines Agenc...
 4296. ▲ AUTISM: Appendix
 4295. ▲ AUTISM: Prevalence of Autism Spectrum Disorders --...
 4294. ISMP's List of High-Alert Medications - AHRQ Patie...
 4293. Neuromuscular blocking agents: reducing associated...
 4292. ♣ FDA Medication Guides 2009
 4291. European Medicines Agency - Human Medicines - CHMP...
 4290. Questions and Answers on AHRQ ARRA Recovery Act 20...
 4289. Use of genetics in the clinical evaluation of card...
 4288. Fatty acid interactions with genetic polymorphisms...
 4287. TGen analysis identifies biomarkers for diabetic k...
 4286. Genetic Link To Heart Failure
 4285. Germany Starts Its Part In The International Cance...
 4284. 454 Sequencing Systems And NimbleGen Sequence Capt...
 4283. NIH-Funded Study Unveils Potential Genetic Links t...
 4282. New genes for lung disease discovered
 4281. Study examines the association of BRCA1 gene, infe...
 4280. New Suppressor Of Common Liver Cancer
 4279. First Comprehensive Genetic Analysis Of Lung Cance...
 4278. Public Health Genomics at the 2009 APHA Conference...
 4277. NOT-HS-10-007: Special Emphasis Notice (SEN): AHRQ...
 4276. WHO: Pandemic (H1N1) 2009 Vaccine Deployment Updat...
 4275. RFA-HS-10-009: Recovery Act 2009 Limited Competiti...
 4274. * IntraMed - Artículos - Nuevo Libro Virtual: Introd...
 4273. → dronedarone - EPARs for human use - Multaq
 4272. Recovery Month 2009 - New Publication on Clinical ...
 4271. FDA MedWatch - November 2009 Drug Safety Labeling ...
 4270. → Insulin aspart - EPARs for human use - NovoRapid
 4269. → Tipranavir - EPARs for human use - Aptivus
 4268. → Fosamprenavir calcium - EPARs for human use - Te...
 4267. → Amprenavir - EPARs human use - Agenerase
 4266. → Human Medicines - Herbal Medicinal Products - HMPC...
 4265. The Role of Public Health in Addressing Racial and...
 4264. Evolving definitions of mental illness and wellnes...
 4263. Agranulocytosis Associated with Cocaine Use --- Fo...
 4262. Imported Case of Marburg Hemorrhagic Fever --- Col...
 4261. Assessment of Epidemiology Capacity in State Healt...
 4260. Prevalence of Pandemic (H1N1) 2009, United States ...
 4259. clevidipine butyrate
 4258. Infection Prevention and Control Measures for Occu...
 4257. Developing and Implementing the Massachusetts Comp...
 4256. Choropleth Map Design for Cancer Incidence, Part 2...
 4255. Choropleth Map Design for Cancer Incidence, Part 1...
 4254. AHRQ ARRA Recovery Act 2009 Limited Competition
 4253. Call for Public Review
 4252. Lay Representations of Cancer Prevention and Early...
 4251. Ethnic and Regional Differences in Prevalence and ...
 4250. The Prevalence of Multiple Sclerosis in 3 US Commu...
 4249. Optimized Probability Sampling of Study Sites to I...
 4248. Health Behaviors and Quality of Life of Cancer Sur...
 4247. Factors Predicting Glycemic Control in Middle-Aged...
 4246. Familial Risk for Chronic Disease... - Preventing ...
 4245. Bridging Mental Health and Public Health - Prevent...
 4244. A Shared Worldview: Mental Health and Public Healt...
 4243. Preventing Chronic Disease: January 2010: 09_0171
 4242. H1N1 - gripe porcina - ISID / Inmunosupresiones
 4241. Cardiac signaling genes exhibit unexpected sequenc...
 4240. Comparative Effectiveness of Core-Needle and Open ...
 4239. Non-surgical Method for Diagnosing Breast Cancer S...
 4238. Non-Safety-Related Voluntary Recall of Certain Lot...
 4237. Undeclared drug, sulfoaildenafil, may result in lo...
 4236. ▲ Science Report - Revista Digital de CEDEPAP TV / ...
 4235. inédito trasplante “dominó”, una mujer recibió el ...
 4234. LEGIONELLA - ISID / U.S.A.
 4233. H1N1 - gripe porcina - ISID / U.S.A.: vacuna con a...
 4232. FDA Expands Presence Outside U.S. with Opening of ...
 4231. FDA Approves First Generic Aricept to Treat Dement...
 4230. Ventricular septal defect. In: ACC/AHA 2008 guidel...
 4229. Tricuspid atresia/single ventricle. In: ACC/AHA 20...
 4228. Diagnosis and Treatment of Low Back Pain: A Joint ...
 4227. The Many Facets of Evidence: Commentary on the Ame...
 4226. Tetralogy of Fallot. In: ACC/AHA 2008 guidelines f...
 4225. Right ventricular outflow tract obstruction. In: A...
 4224. Recommendations for delivery of care and ensuring ...
 4223. Patent ductus arteriosus. In: ACC/AHA 2008 guideli...
 4222. Pulmonary hypertension/Eisenmenger physiology. In:...
 4221. Left-sided heart obstructive lesions: aortic valve...
 4220. Ebstein's anomaly. In: ACC/AHA 2008 guidelines for...
 4219. Non-surgical Method for Diagnosing Breast Cancer S...
 4218. CDC 2009 H1N1 Flu | 2009 H1N1 U.S. Situation Updat...
 4217. CDC H1N1 Flu | In The News - Deaths related to 200...
 4216. NIAID Web Bulletin: NIAID Testing Candidate DNA Va...
 4215. WHO | Pandemic (H1N1) 2009 - update 78
 4214. → European Medicines Agency - Withdrawals of Applica...
 4213. → European Medicines Agency - Human Medicines - Refe...
 4212. Dextro-transposition of the great arteries. In: AC...
 4211. Coronary artery abnormalities. In: ACC/AHA 2008 gu...
 4210. Congenitally corrected transposition of the great ...
 4209. Atrioventricular septal defect. In: ACC/AHA 2008 g...
 4208. Atrial septal defect. In: ACC/AHA 2008 guidelines ...
 4207. Las muertes por gripe A en el mundo se acercan a 1...
 4206. mieloma múltiple: Lenalidomida retrasa un 50% la p...
 4205. RFA-HS-10-011: AHRQ ARRA Recovery Act 2009 Limited...
 4204. RFA-HS-10-007: AHRQ ARRA Recovery Act 2009 Limited...
 4203. Hepatitis A Inactivated & Hepatitis B (Recombinant...
 4202. H1N1 - gripe porcina - ISID / URUGUAY
 4201. Genomic microarrays in mental retardation: from CN...
 4200. Prevention and control of meningococcal disease. R...
 4199. Adalimumab, etanercept and infliximab for ankylosi...
 4198. MALARIA - ISID - Guayana Francesa
 4197. A pooling-based genome-wide analysis identifies ne...
 4196. Epistatic interactions between genetic disorders o...
 4195. Salmonella en ranas - U.S.A. [ISID]
 4194. VIRUS del NILO OCCIDENTAL - Sur de Europa - ISID
 4193. DENGUE HEMORRÁGICO en México [ISID]
 4192. Scientific Presentations by NCTR Researchers — Ima...
 4191. Tamiflu for Oral Suspension
 4190. ♣ Serologic cross-reactivity with pandemic (H1N1) 20...
 4189. ♣ Hospitalizations for Pandemic (H1N1) 2009 among Ma...
 4188. ♣ Pandemic (H1N1) 2009 Surveillance and Prevalence o...
 4187. AHRQ Innovations Exchange | Guide to Clinical Prev...
 4186. Epigenetics and the environmental regulation of th...
 4185. Role of host genetics in fibrosis. [Fibrogenesis T...
 4184. Postgraduate Symposium The MTHFR C677T polymorphis...
 4183. Genetics of coronary artery disease: focus on geno...
 4182. Genetic Variants Identified in a European Genome-W...
 4181. Tumor protein 53 mutations and inherited cancer: b...
 4180. Molecular epidemiology of genetic susceptibility t...
 4179. Female BRCA mutation carriers with a preference fo...
 4178. Copy number variations and cancer susceptibility. ...
 4177. Quest Diagnostics Reveals New Genetic Discoveries ...
 4176. Type 2 Diabetes Gene Predisposes Children To Obesi...
 4175. Study identifies genetic predeterminants for diabe...
 4174. Gene module underlying atherosclerosis development...
 4173. UC Davis News & Information :: Understanding DNA R...
 4172. Master gene plays a key role in development of a c...
 4171. New Gene Findings Will Help Guide Treatment In Inf...
 4170. Gene’s Position in the Nucleus Can be Used to Dist...
 4169. Genetic Variations Indicate Risk Of Recurrence, Se...
 4168. Identification Of Possible Ovarian Cancer Treatmen...
 4167. Polycythemia Vera // ATSDR - Press Release - 12/8...
 4166. Marrow transplant cures adult sickle cell disease ...
 4165. European Medicines Agency - Human Medicines - Refe...
 4164. European Medicines Agency - Human Medicines - Refe...
 4163. CDC H1N1 Flu | African Americans and H1N1
 4162. CDC H1N1 Flu | In The News - People living with HI...
 4161. ╠ Trial Complements Current Studies in HIV-Infected ...
 4160. H1N1 - gripe porcina - ISID / PERÚ - REPÚBLICA DOM...
 4159. H1N1 - gripe porcina - ISID / OSELTAMIVIR CUESTION...
 4158. Negative Pressure Wound Devices Draw FDA Notice, A...
 4157. Safety of Influenza A (H1N1) 2009 Monovalent Vacci...
 4156. ╠ Outbreak of Erythema Nodosum of Unknown Cause --- ...
 4155. Fatal Poisoning Among Young Children from Diethyle...
 4154. ╠ Deaths Related to 2009 Pandemic Influenza A (H1N1)...
 4153. → European Medicines Agency - Human Medicines - Orph...
 4152. Positron Emission Tomography (PET)
 4151. CHAGAS - ISID / ravuconazol
 4150. HPV Vaccine by CDC ACIP
 4149. Yellow Fever Vaccine by CDC ACIP
 4148. Recomendaciones provisionales actualizadas para el...
 4147. → Updated Interim Recommendations for the Use of Ant...
 4146. → European Medicines Agency - Human Medicines - Orph...
 4145. Public Workshop: Emerging Arboviruses: Evaluating ...
 4144. Procleix Ultrio Assay: Human Immunodeficiency Viru...
 4143. AHRQ Technology Assessments Update: Horizon Scan: ...
 4142. → abacavir sulfate // EPARs for authorised medicina...
 4141. → abacavir / lamivudine / zidovudine - EPARs for a...
 4140. → COMMITTEE FOR MEDICINAL PRODUCTS FOR HUMAN USE PUR...
 4139. OPINION OF THE COMMITTEE FOR MEDICINAL PRODUCTS FO...
 4138. COMMITTEE FOR MEDICINAL PRODUCTS FOR HUMAN USE PUR...
 4137. nsaids appendix1
 4136. ADEQUACY OF GUIDANCE ON THE ELDERLY REGARDING MEDI...
 4135. bisphosphonates opinion by CHMP
 4134. Presence of the antibiotic resistance marker gene ...
 4133. MEDICINAL PRODUCTS CONTAINING NON-SELECTIVE NON ST...
 4132. ► Eficacy of Antidepressants, CHMP opinions
 4131. QUESTIONS AND ANSWERS ON THE REVIEW OF NON-SELECTI...
 4130. Questions and answers on the review of the use of ...
 4129. ► OPINION ON THE POTENTIAL RISKS OF CARCINOGENS, MUT...
 4128. ◊ BISPHOSPHONATES AND OSTEONECROSIS OF THE JAW: CHMP...
 4127. ◊ CONVENTIONAL ANTIPSYCHOTICS: CHMP ASSESSMENT REPOR...
 4126. ◊ OPINION OF THE COMMITTEE FOR MEDICINAL PRODUCTS FO...
 4125. User Fee Billable Biologic Products and Potencies ...
 4124. H1N1 - gripe porcina - ISID / Patología respirator...
 4123. H1N1 - gripe porcina - ISID / SUIZA: decesos post ...
 4122. → European Medicines Agency - Withdrawals of Applica...
 4121. HHS modifies approach to supporting second generat...
 4120. New York Autopsies Show 2009 H1N1 Influenza Virus ...
 4119. PLoS Medicine: The Severity of Pandemic H1N1 Influ...
 4118. Critical Issues in the Management of Adult Patient...
 4117. Clinical Guideline for the Evaluation, Management ...
 4116. ▲ SCREENING FOR COLORECTAL CANCER // NGC - Compare -...
 4115. NGC - Expert Resources - Expert Commentary
 4114. Work-related carpal tunnel syndrome diagnosis and ...
 4113. ◄ Evidence-based practice guideline. Acute confusion...
 4112. ▼ Screening of infants for hyperbilirubinemia to pre...
 4111. ▼ Screening for impaired visual acuity in older adul...
 4110. ▼Screening for hepatitis B virus infection in pregn...
 4109. ► Type 2 diabetes. In: Prevention, detection and tre...
 4108. ► Type 1 diabetes. In: Prevention, detection and tre...
 4107. ► Diabetes in pregnancy. In: Prevention, detection a...
 4106. ▲ Chronic kidney disease. Early identification and m...
 4105. ▲ Colorectal cancer screening clinical practice guid...
 4104. ▲ Gliomas.
 4103. ▲ Rectal cancer.
 4102. ▲ Colon cancer.
 4101. ▲ Prostate-specific antigen best practice statement:...
 4100. ▲ Screening and surveillance for the early detection...
 4099. ▲ Guidelines of care for the management of psoriasis...
 4098. → European Medicines Agency - Withdrawals of Marketi...
 4097. NIAID Web Bulletin: NIAID to Compare Responses of ...
 4096. WHO | Pandemic (H1N1) 2009 - update 77
 4095. FDA, CDC, and States Investigating Norovirus Illne...
 4094. FDA Makes Interim Recommendations to Address Conce...
 4093. ∞ Advancing Patient Safety: A Decade of Evidence, De...
 4092. → Alendronic acid as alendronate sodium trihydrate a...
 4091. → Strontium ranelate // EPARs for authorised medici...
 4090. → Strontium ranelate - EPARs for human use - Protelo...
 4089. → shingles (herpes zoster) vaccine (live) - EPARs fo...
 4088. → Palivizumab - EPARs for human use - Synagis
 4087. → rotavirus vaccine, live, oral - EPARs for human u...
 4086. → Alendronate sodium trihydrate and colecalciferol -...
 4085. → interferon beta-1b // EPARs for human use - Extavi...
 4084. → EPARs for human use - Prepandemic influenza vaccin...
 4083. von Willebrand Factor/Coagulation Factor VIII Comp...
 4082. → European Medicines Agency - Human Medicines - Medi...
 4081. → European Medicines Agency - Withdrawals of Applica...
 4080. → Sodium oxybate - EPARs for authorised medicinal pr...
 4079. H1N1 - gripe porcina - ISID / resistencia a Oselta...
 4078. Research Activities, December 2009: Research Brief...
 4077. Research Activities, December 2009: HIV/AIDS Resea...
 4076. Research Activities, December 2009: HIV/AIDS Resea...
 4075. Research Activities, December 2009: Primary Care: ...
 4074. Research Activities, December 2009: Primary Care: ...
 4073. Research Activities, December 2009: Emergency Medi...
 4072. Research Activities, December 2009: Emergency Medi...
 4071. Research Activities, December 2009: Child/Adolesce...
 4070. Research Activities, December 2009: Women's Health...
 4069. Research Activities, December 2009: Men's Health: ...
 4068. Research Activities, December 2009: Men's Health: ...
 4067. Research Activities, December 2009: Outcomes/Effec...
 4066. Research Activities, December 2009: Outcomes/Effec...
 4065. Research Activities, December 2009: Outcomes/Effec...
 4064. Research Activities, December 2009: Disparities/Mi...
 4063. Research Activities, December 2009: Pharmaceutical...
 4062. Research Activities, December 2009: Pharmaceutical...
 4061. Racial and ethnic disparities in awareness of gene...
 4060. Treatment-focused DNA testing for newly diagnosed ...
 4059. Imaging genetics of anxiety disorders. [Neuroimage...
 4058. Molecular mechanisms underlying anorexia nervosa: ...
 4057. Worldwide frequency of G2019S LRRK2 mutation in Pa...
 4056. From genes to proteins in mendelian Parkinson's di...
 4055. Genomic and personalized medicine: foundations and...
 4054. Personalized medicine: individualized care of canc...
 4053. Using Lifetime Risk Estimates in Personal Genomic ...
 4052. Pharmacogenetic profiling in the treatment of hear...
 4051. Pharmacogenomics of beta1-adrenergic receptor poly...
 4050. Effect of beta2-adrenergic receptor polymorphism o...
 4049. Genomics of pulmonary arterial hypertension: impli...
 4048. The COPD genetic association compendium: a compreh...
 4047. "Personalizing" academic medicine: opportunities a...
 4046. Evaluation of the discriminative accuracy of genom...
 4045. Leptospirosis - ISID / República Dominicana
 4044. Bacillus cereus - ISID / MÉXICO
 4043. VIH - SIDA / ISID - fosamprenavir (ver otros alert...
 4042. Sífilis congénita - ISID / alta incidencia en Amér...
 4041. VIH - SIDA / ISID - transmisión en expansión
 4040. FDA Drug Safety Newsletter
 4039. Steris System 1 Processor: FDA Notice and Recommen...
 4038. ♦ Case & Commentary (5/5) - AHRQ WebM&M
 4037. ♦ Case & Commentary (4/5) - AHRQ WebM&M
 4036. ♦ Case & Commentary (3/5) - AHRQ WebM&M
 4035. ♦ Perspectives on Safety (2/5) - AHRQ WebM&M
 4034. ♦ Perspectives on Safety (1/5) - AHRQ WebM&M
 4033. ☼ Oseltamivir- and Amantadine-Resistant Influenza Vi...
 4032. Fatal Case of Pneumonia Associated with Pandemic (...
 4031. Severe Pneumonia Associated with Pandemic (H1N1) 2...
 4030. HIV/AIDS Update: fosamprenavir calcium [2]
 4029. ◙ diclofenac sodium topical gel: Hepatic Effects Lab...
 4028. Safety of Influenza A (H1N1) 2009 Monovalent Vacci...
 4027. H1N1 Flu (Swine Flu): Preparedness Tools for Profe...
 4026. Parental Knowledge and Attitudes Toward Hypertroph...
 4025. Implementation of ironXS: a study of the acceptabi...
 4024. Heterogeneous prevalence of recurrent BRCA1 and BR...
 4023. Evaluation of genetic tests for susceptibility to ...
 4022. Efficiency of BRCAPRO and Myriad II mutation proba...
 4021. A Nationwide Genetic Testing Survey in Italy, Year...
 4020. The impact of genetic counseling on knowledge and ...
 4019. Population-based family-history-specific risks for...
 4018. Family History of Diabetes and Prevalence of the M...
 4017. A Pilot Study of Hereditary Breast and Ovarian Kno...
 4016. Genome-wide SNP genotyping study using pooled DNA ...
 4015. Factor V Leiden and hemophilia. [Thromb Res. 2009]...
 4014. Vascular tone and the genomics of hypertension. [H...
 4013. The genetics of cardiomyopathy: genotyping and gen...
 4012. Targeting device therapy: genomics of sudden death...
 4011. Genomics of heart failure. [Heart Fail Clin. 2010]...
 4010. The validation of a simulation model incorporating...
 4009. RD Lawrence Lecture 2009. Old genes, new tricks: l...
 4008. Influenza virus surface antigens, inactivated: A/C...
 4007. Split influenza virus, inactivated, containing ant...
 4006. Adolescent Mental Health: Service Settings and Rea...
 4005. Employment and Major Depressive Episode
 4004. Mental Health Support and Self-Help Groups
 4003. * IntraMed - Artículos - El Síndrome Burnout en médi...
 4002. El yeyuno que se convierte en esófago - DiarioMedi...
 4001. WHO | Oseltamivir resistance in immunocompromised ...
 4000. HLA-DPB1 and DPB2 are genetic loci for systemic sc...
 3999. Study on the genetics of osteoarthritis
 3998. Gene Increases Effectiveness Of Drugs Used To Figh...
 3997. Genetic pattern indicates early-stage lung cancer
 3996. Shedding light on celiac disease // NorthJersey.co...
 3995. ◘ Valproate Sodium and related products (valproic ac...
 3994. ◘ Risk of Neural Tube Birth Defects following prenat...
 3993. ◘ Fosamprenavir calcium (Lexiva) - MEDWATCH by FDA
 3992. National Survey on Drug Use and Health: National F...
 3991. Recent Mental Health Research Findings
 3990. Announcement: 13th Annual Conference on Vaccine Re...
 3989. ▲ Global Measles Mortality, 2000--2008
 3988. ▲ Adult Blood Lead Epidemiology and Surveillance ---...
 3987. ▲ Appendix: Trichinae Certification Program Final Ru...
 3986. ► Trichinellosis Surveillance --- United States, 200...
 3985. ▲ Idiopathic Granulomatous Mastitis in Hispanic Wome...
 3984. Annual Drive-Through Clinic Enhances Access to Inf...
 3983. Medication Errors: Significance of Accurate Patien...
 3982. → European Medicines Agency - Withdrawals of Applica...
 3981. → European Medicines Agency - Withdrawals of Applica...
 3980. TUBERCULOSIS creciente en REINO UNIDO
 3979. ECALLANTIDE for Treating Potentially Life-Threaten...
 3978. Influenza A (H1N1) 2009 Monovalent Vaccines Compos...
 3977. Influenza Virus Vaccine for the 2009-2010 Season
 3976. Norpramin (desipramine hydrochloride)
 3975. ♥ National Heart, Lung, and Blood Institute Initiate...
 3974. ♥ 2009 Guidelines on Human Stem Cell Research [Stem ...
 3973. ♥ First Human Embryonic Stem Cell Lines Approved for...
 3972. Opening and Mixing Tamiflu® Capsules with Liquids ...
 3972. * IntraMed - Entrevistas - ¿Por qué ser médico hoy?
 3971. * IntraMed - Artículos - Encuesta Exclusiva IntraMed...
 3970. * IntraMed - Artículos - ¿Qué piensan los médicos so...
 3969. * IntraMed - Artículos - ¿Cómo percibieron los médic...
 3968. * IntraMed - Artículos - La enfermedad de los médico...
 3967. * IntraMed - Artículos - Estudio DOCTOR
 3965. → sunitinib malate - EPARs for authorised medicina...
 3964. → thalidomide - EPARs for authorised medicinal pro...
 3963. → lapatinib ditosylate monohydrate // EPARs for auth...
 3962. → Perflutren - EPARs for authorised medicinal produc...
 3961. → SORAFENIB - EPARs for authorised medicinal product...
 3960. → Mangafodipir trisodium (anhydrous) - EPARs for aut...
 3959. → European Medicines Agency - Human Medicines - Medi...
 3958. → clopidogrel besilate - EPARs for authorised medi...
 3957. → European Medicines Agency - Withdrawals of Applica...
 3956. → Eptifibatide - EPARs for authorised medicinal pr...
 3955. → doripenem monohydrate - EPARs for authorised medic...
 3954. → prasugrel - EPARs for authorised medicinal produc...
 3953. → Posaconazole - EPARs for authorised medicinal pro...
 3952. → Human Papillomavirus vaccine [Types 16, 18] (Recom...
 3951. → Perflutren - EPARs for authorised medicinal produc...
 3950. FDA's MedWatch Safety Alerts: November 2009
 3949. → Bortezomib - EPARs for human use - Velcade
 3948. → Oseltamivir phosphate - EPARs for human use - Tami...
 3947. → Lamivudine - EPARs for human use - Epivir
 3946. → LAMIVUDINE - Opinions on medicines for use outside...
 3945. CDC - Seasonal Influenza (Flu) - Weekly Report: In...
 3944. Center For Drug Evaluation and Research List of Gu...
 3943. Presentación de investigaciones pioneras que marca...
 3942. Availability of pharmacist: does the hospital have...
 3941. Screening for Depression in Adults
 3940. HEPATITIS B en PERÚ [ISID]
 3939. ♣ Provisional Recommendations for HPV Vaccine
 3938. December 2009 MedSun Newsletter
 3937. December 2009 FDA Patient Safety News
 3936. ► ACR Appropriateness Criteria® Hodgkin's lymphoma-s...
 3935. ► ACR Appropriateness Criteria® Hodgkin's lymphoma-f...
 3934. ► ACR Appropriateness Criteria® definitive external ...
 3933. ► ACR Appropriateness Criteria® nonsurgical treatmen...
 3932. Commonwealth leaders issue groundbreaking action s...
 3931. ♣ Guidelines for the Use of Antiretroviral Agents in...
 3930. ♣ NGC - Resources - Hospital Acquired Conditions
 3929. ▲ Guidelines for Glucose Monitoring and Treatment of...
 3928. ▲ Schizophrenia. Core interventions in the treatment...
 3927. ▲ Prostate cancer. Diagnosis and treatment.
 3926. ▲ ACPM has submitted guidelines on screening for ost...
 3925. Bortezomib in multiple myeloma and lymphoma.
 3924. ▲ Gastroscopy following a positive fecal occult bloo...
 3923. ▲ Guideline for optimization of surgical pathologica...
 3922. ▲ Optimization of surgical and pathological quality ...
 3921. ▲ Treatment of acute myeloid leukemia in older patie...
 3920. ► DIAGNOSIS AND MANAGEMENT OF STABLE CHRONIC OBSTRUC...
 3919. ▲ Surgical management of otitis media with effusion ...
 3918. H1N1 - gripe porcina - ISID / Infecciones bacteria...
 3917. → azacitidine - EPARs for human use - Vidaza
 3916. → olanzapine - EPARs for human use - Zalasta
 3915. → rivaroxaban - EPARs for human use - Xarelto
 3914. → Human Medicines - Herbal Medicinal Products - Inte...
 3913. 3ª Reunión Anual de la RECAVA (Red de Investigació...
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ARCHIVO DEL BLOG
• ▼ 2009 (3926)
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 3912. WHO | Arsenic in drinking water
 3911. El componente acetabular tiene tanta importancia c...
 3910. La técnica Notes permite extirpar un cáncer de rec...
 3909. Los niños precisan ensayos de anti-VIH con arreglo...
 3908. La evolución del sida pide nuevos esfuerzos - Diar...
 3907. WHO | Rapid advice: use of antiretroviral drugs fo...
 3906. WHO | Pandemic (H1N1) 2009 - update 76

HER2-like And Basal-Like Genotype Breast Cancer Are More Likely To Respond To Chemotherapy

HER2-like And Basal-Like Genotype Breast Cancer Are More Likely To Respond To Chemotherapy
Editor's Choice
Main Category: Breast Cancer
Also Included In: Cancer / Oncology; Clinical Trials / Drug Trials
Article Date: 26 Dec 2009 - 3:00 PST

New data suggest that breast cancer patients with HER2- and basal-molecular subtypes are more likely to respond to neoadjuvant chemotherapy than patients with luminal-type molecular subtype characteristics.

The findings were released at the 32nd Annual San Antonio Breast Cancer Symposium (SABCS).

George Somlo, MD, Co-Director of the Breast Cancer Program at the City of Hope Comprehensive Cancer Center in Duarte, California, and colleagues are assessing the predictive value of Mammaprint scores as well as basal-, luminal-, and HER2- molecular subtype profiling in women with stages II to III and inflammatory breast cancer in order to determine the response to treatment for three different neoadjuvant chemotherapy regimens.

These regimens include docetaxel, doxorubicin, cyclophosphamide (TAC); doxurubicin, cyclophosphamide, and nab--paclitaxel; and carboplatin with or without trastuzumab.

Prior research has shown that pathologic complete response and minimal residual cancer burden after neoadjuvant chemotherapy may predict improved survival, Dr. Somlo and his group wrote in their poster presentation. Thus, improved neoadjuvant chemotherapy regimens in conjunction with molecular markers that predict for both response and/or resistance are needed.

For the ongoing trial, women with stages II-III breast cancer are randomized to receive 6 cycles of docetaxel 75 mg/m2, doxorubicin 50 mg/m2, cyclophosphamide 500 mg/m2 with filgrastim support (TAC, arm A) versus a novel regimen of A 60 mg/m2 and C 600 mg/m2 given every 2 weeks x 4, followed by 3 weekly doses of carboplatin (AUC 2) and nab-paclitaxel 100 mg/m2 repeated as 28 day cycles x 3 (arm B). Patients with HER2 + BC receive neoadjuvant chemotherapy similar to arm B, but with the addition of 12 weekly doses of trastuzumab given together with carboplatin and nab-paclitaxel (arm C).

Sufficient amounts of breast cancer tissue and good quality RNA for gene array assessment were procured in 64% of the first 90 patients who have undergone pre-treatment core biopsies followed by neoadjuvant chemotherapy and then definitive surgery.

Complete data available in 50 women thusfar reveal that by gene profiling, 28% of the tumors were HER2-type (versus 38% by IHC 3+, or FISH, representing all patients treated on arm C), 26% basal-type, 42% luminal-type, and 4% borderline luminal-type. Poor-prognosis signature by the 70-gene assay was observed in 74% of patients: 92% of HER2-type, 100% of basal-type, and 52% of luminal-type tumors were characterized as poor-risk by the 70-gene assay.

Following neoadjuvant chemotherapy, Symmans RCB scores of 0-1 were documented in 71% of patients with HER2-like, 38% with basal-type, and 28% of patients with luminal-type molecular subtype characteristics.

Overall, the results to date suggest that breast cancer with HER2- and basal-molecular subtypes are more likely to respond to neoadjuvant chemotherapy and are frequently associated with poor-risk characteristics as determined by the 70-gene assay, Dr. Somlo said.

He added that the trial plans to recruit a total of 115 women.

Written by Jill Stein
Jill Stein is a Paris-based freelance medical writer.
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

abrir aquí: [reproduced because genomics update edited it]
HER2-like And Basal-Like Genotype Breast Cancer Are More Likely To Respond To Chemotherapy
file4500dec2009/filemonth574

Columbia scientists discover 2 genes that drive aggressive brain cancers

Columbia scientists discover 2 genes that drive aggressive brain cancers
Discovery made using new systems biology method, which enabled the scientists to pinpoint the genes from a mass of data

Contact: Elizabeth Streich
cumcnews@columbia.edu
212-305-3900
Columbia University Medical Center

NEW YORK – A team of Columbia scientists have discovered two genes that, when simultaneously activated, are responsible for the most aggressive forms of human brain cancer.

This finding was made possible by the assembly of the first comprehensive network of molecular interactions that determine the behavior of these cancer cells, a map so complex and elusive that, until now, it could not be constructed. The discovery may lead to completely novel strategies to diagnose and treat these incurable tumors.

The findings will be published in an advanced online edition of Nature on Dec. 23, 2009, by a team of Columbia scientists led by Antonio Iavarone, M.D., associate professor of neurology in the Herbert Irving Comprehensive Cancer Center, and Andrea Califano, Ph.D., director of the Columbia Initiative in Systems Biology.

The researchers studied a type of human malignancy, called glioblastoma multiforme, which is among the most lethal because it rapidly invades the normal brain producing inoperable brain tumors. Recently, glioblastoma claimed the life of Senator Edward Kennedy only sixteen months after diagnosis.

Before this study, cancer researchers had little idea why glioblastoma is so aggressive. "We now know that two genes – C/EPB and Stat3 – are the disease's master 'control knobs'," said Dr. Iavarone. "When simultaneously activated, they work together to turn on hundreds of other genes that transform brain cells into highly aggressive, migratory cells."

The two genes are active in about 60 percent of all glioblastoma patients and help identify poor-prognosis patients. All patients in the study whose tumors showed activation of both factors died within 140 weeks after diagnosis, while one half of the patients without these factors were still alive.

"The finding means that suppressing both genes simultaneously, using a combination of drugs, may be a powerful therapeutic approach for these patients, for whom no satisfactory treatment exists," said Dr. Califano.

This approach, called combination therapy, is supported by this study since silencing both genes in human glioblastoma cells completely blocked their ability to form tumors when injected in a mouse. Based on these results, the Columbia scientists received a grant from the American Recovery and Reinvestment Act to develop drugs specifically aimed at these genes.

Two Genes Uncovered with a Systems Biology Approach

Biomedical researchers today are like city engineers trying to reduce traffic jams without a street map. Armed only with a list of congested roads, engineers would not be able to locate the traffic jams or find the best way to unclog them. But with a city map in hand, clusters of congestion would immediately become apparent along with possible solutions.

"We are fighting very much the same problem in the post-genomic era," said Dr. Califano. "The human genome project has given biologists a wonderfully comprehensive list of street names – the genes inside every human cell. Unfortunately, it provided virtually no understanding of how all those genes may work together, within highly complex control networks, to operate the cell. In short, biologists need a map of the cell."

Thirty years of laboratory experimentation have revealed glimpses of the complete network. Yet, with trillions of potential interactions among our genes and different network structures in different cells, experimentation alone is unlikely to succeed. Best estimates indicate that only 10 percent of all the molecular interactions in a cell are understood and only a very small fraction of them in any specific cell type.

The Columbia team, which includes physicists and biologists, has for the first time assembled and experimentally validated such a cellular network for a glioblastoma cell, a hugely complex challenge that required several novel approaches drawn from the fields of information theory and computational biology.

"Armed with such a blueprint of the cell machinery, we can now ask pointed questions, such as which genes are responsible for the most deadly features of these tumors," said Dr. Iavarone.

From this blueprint, produced in Dr. Califano's lab, the scientists pinpointed the tumor's two master regulator genes. Experiments conducted by Dr. Iavarone in brain cancer cells and mice then confirmed the accuracy of the network and the importance of the two genes.

Discovery Accelerates Search for Better Treatments, Changes How Scientists Investigate Disease

"The identification of C/EPB and Stat3 came as a complete surprise to us, since these genes had never been implicated before in brain cancer," said Dr. Iavarone. Based on traditional approaches, their critical role may have eluded researchers for a long time.

"From a therapeutic perspective, it means we are no longer wasting time developing drugs against minor actors in brain cancer," added Dr. Iavarone. "We can now attack the major players."

Given its generality, the new approach has the potential to change the way researchers think not just about cancer but also about many other diseases.

In the last decade, reams of data have been generated by the human genome project and new high-throughput technologies that measure the activity of each gene inside a cell. Yet, the way cancer biologists evaluate this data seemed very biased to the Columbia scientists. Typically, researchers compare data from cancer cells and normal cells and focus on the genes with the greatest change in activity.

It's like investigating a plane crash and blaming the wing because it has the most damage. The actual alterations that caused the crash – like the causes of cancer – may be far more subtle, like a tiny defective control circuit that shows almost no damage.

Instead of focusing on the "damaged wings" of cancer, the new network approach allows biologists to pinpoint causal genes by tracing their downstream effects back to the source.

Indeed, in the case of glioblastoma, the activity of the two master genes was virtually identical in cancer cells compared to normal cells. Yet, like a tiny control switch causing a plane crash, their combined effect turned out to be massive.


###

The Herbert Irving Comprehensive Cancer Center at Columbia University Medical Center and NewYork-Presbyterian Hospital encompasses pre-clinical and clinical research, treatment, prevention and education efforts in cancer. The Cancer Center was initially funded by the NCI in 1972 and became a National Cancer Institute (NCI)–designated comprehensive cancer center in 1979. The designation recognizes the Center's collaborative environment and expertise in harnessing translational research to bridge scientific discovery to clinical delivery, with the ultimate goal of successfully introducing novel diagnostic, therapeutic and preventive approaches to cancer. For more information, visit www.hiccc.columbia.edu.

Columbia University Medical Center provides international leadership in basic, pre-clinical and clinical research, in medical and health sciences education, and in patient care. The medical center trains future leaders and includes the dedicated work of many physicians, scientists, public health professionals, dentists, and nurses at the College of Physicians and Surgeons, the Mailman School of Public Health, the College of Dental Medicine, the School of Nursing, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions. Established in 1767, Columbia's College of Physicians and Surgeons was the first institution in the country to grant the M.D. degree and is now among the most selective medical schools in the country. Columbia University Medical Center is home to the most comprehensive medical research enterprise in New York City and state and one of the largest in the United States. Columbia University Medical Center is affiliated with NewYork-Presbyterian Hospital, the nation's largest not-for-profit hospital provider. For more information, please visit www.cumc.columbia.edu.

Understanding the Genetics of Colon Cancer

Reported December 30, 2009
Understanding the Genetics of Colon Cancer
(Ivanhoe Newswire) -- As researchers and clinicians search for causes and cures for colorectal cancer, 160,000 cases are diagnosed and 57,000 patients die of the disease each year. It is the second leading cause of death from cancer among adults, after lung cancer.

In a recent study, Dr. Sanford Markowitz, professor at Case Western Reserve University School of Medicine and oncologist at Case Medical Center, and co-author, Dr. Monica Bertagnolli, from the Brigham and Women's Hospital, Harvard Medical School, were quoted as saying, "Today's challenges are to understand the molecular basis of individual susceptibility to colorectal cancer and to determine factors that initiate the development of the tumor, drive its progression, and determine its responsiveness or resistance to antitumor agents."

Studies that aid in understanding colorectal cancer on a molecular level have provided genetic testing for high-risk familial forms of the disease, predictive markers for selecting patients for certain classes of drug therapies and molecular diagnostics for the noninvasive detection of early cancers.

For example, patients with inherited mutations in tumor-suppressor genes, such as APC, MLH1, and MSH2, have a very high risk of colorectal cancer and require early and frequent surveillance for colon cancer and often prophylactic surgery.

Patients whose colon cancers have mutations in either RAS or BRAF genes are known not to benefit from treatment with the anti-colon cancer agent Cetuximab.

The development of molecular diagnostics for the early detection of colorectal cancer is emerging as an important tool in clinical practice. One example is the development of stool DNA tests for early detection of colorectal cancer or advanced adenomas. Stool DNA testing for colorectal cancer has now been added to the cancer-screening guidelines of the American Cancer Society.
SOURCE: New England Journal of Medicine, December 17, 2009
http://www.ivanhoe.com/channels/p_channelstory.cfm?storyid=23248

Enfermos graves por gripe A (H1N1) en México / IntraMed - Artículos -

30 DIC 09 | Publicado en "JAMA"
Enfermos graves por gripe A (H1N1) en México
Un enfoque con resultados interesantes para la mejor detección precoz y tratamiento de los pacientes con gripe A (H1N1) en países en vías de desarrollo

Dres. Domínguez-Cherit G; Lapinsky SE; Macias AE, et al
JAMA. 2009;302(17)

Introducción

El 21 de abril de 2009, los Centros para la prevención y el control de enfermedades (CDC) de los EE.UU. notificaron la detección de dos casos de infección humana por virus influenza A (H1N1) en California. La mayor carga de enfermedad grave y muerte fue en México, entre mayo y junio de 2009, con 5029 casos y 97 muertes. Para el 30 de agosto ya había más de 116.046 casos con 2234 muertes en los países americanos y 277.607 casos y por lo menos 3205 muertes en todo el mundo.

Los autores informan sobre 58 pacientes en México que sufrieron enfermedad grave por gripe A (H1N1) confirmada, probable o presunta. Esta información puede ser valiosa para:

- identificar precozmente a personas en riesgo de sufrir enfermedad grave, para quienes ciertas intervenciones específicas, como la vacunación y el tratamiento antiviral, pueden ser útiles
- planificar recursos para la atención de la salud durante una pandemia
- proporcionar datos sobre la morbimortalidad asociada a la gripe A (H1N1) 2009, comparando experiencias en diferentes lugares e identificar cambios en la virulencia de la enfermedad con el tiempo.

Métodos

Diseño del estudio

Se efectuó un estudio retrospectivo de todos los pacientes graves con gripe A (H1N1) confirmada, probable o presunta en México, hospitalizados entre el 24 de marzo y el 1 de junio de 2009, en 6 hospitales que fueron centros de referencia para la atención de estos pacientes.

Se definió a los pacientes graves como aquellos que fueron hospitalizados en una unidad de cuidados intensivos (UCI), necesitaron ventilación mecánica, tuvieron una fracción de oxígeno inspirado (FIO2) mayor o igual al 60% o recibieron una infusión intravenosa de inotrópicos o vasopresores durante la hospitalización.

Se efectuó la detección sistemática de virus A (H1N1) en todos los pacientes que ingresaron a esos 6 hospitales con síntomas respiratorios o fiebre durante el período del brote.

Recolección de datos

Se empleó un formulario creado por investigadores de Canadá, con datos proporcionados por el personal de la UCI, infectólogos e investigadores clínicos.

Los datos obtenidos fueron los criterios de elegibilidad para influenza A (H1N1) y enfermedad grave, datos demográficos y detalles de los contactos, síntomas, enfermedades asociadas, características clínicas, curso temporal de la enfermedad aguda, muestras microbiológicas y tratamientos.

La gravedad de la enfermedad se evaluó mediante la Acute Physiology and Chronic Health Evaluation II (APACHE II) para adultos o la puntuación del Pediatric Risk of Mortality III para niños.

Los parámetros de resultados fueron la duración de la ventilación mecánica, la duración de la estadía en la UCI y en el hospital y la mortalidad en la UCI y en el hospital.

Resultados

Pacientes y hospitales

Durante el período estudiado, 899 pacientes con gripe A (H1N1) confirmada, probable o presunta, ingresaron a los hospitales del estudio. De ellos, 58 (6,5%) sufrieron enfermedad grave (29 confirmada, 14 probable, 15 presunta). No hubo diferencias significativas en la demografía, la gravedad de la enfermedad, las enfermedades asociadas o la mortalidad entre aquéllos con enfermedad confirmada, probable o presunta y se los menciona como un grupo único.

Durante el período de recolección de datos, se produjeron 5029 casos de influenza A (H1N1) y 97 muertes en todo México. Esta cohorte de 6 hospitales representa aproximadamente un cuarto de todas las muertes en México durante el período del estudio.

Los pacientes del estudio tuvieron una mediana de edad de 44 años (rango, 10-83), el 53% fueron mujeres y dos fueron trabajadores sanitarios. Sólo se hospitalizaron 2 niños (de 10 y 14 años) con enfermedad grave en los centros del estudio y tuvieron una media de Pediatric Risk of Mortality III de 6,5 (DE, 2,1) al ingreso. En todos los pacientes, los síntomas fueron fiebre en 58 (100%); síntomas respiratorios (tos, disnea o sibilancias) en 57 (98%); debilidad generalizada en 41 (71%); mialgias en 35 (60%); cefalea en 33 (57%) y síntomas gastrointestinales, como náuseas, vómitos o diarrea en 18 (30%).

Sólo 2 pacientes tuvieron antecedentes de enfermedad pulmonar obstructiva crónica. La obesidad fue la entidad asociada más frecuente. Veintiún pacientes (36%) tenían índice de masa corporal (IMC) mayor de 30 y 8 (14%) padecían obesidad mórbida (IMC >40).

Evolución y tratamientos recibidos

Tratamientos médicos. Los síntomas aparecieron 4-8 días antes de la hospitalización. El tiempo transcurrido entre la hospitalización y el ingreso a la UCI fue de un día. Entre los 55 pacientes que recibieron tratamiento médico, 52 (95%) fueron tratados con antibióticos, 45 (78%) recibieron inhibidores de la neuraminidasa (oseltamivir [44], zanamivir [6]), 8 recibieron amantidina (14%), 1 rimantidina (2%) y 40 (69%) corticosteroides. Dos pacientes recibieron proteína C. activada recombinante.

Dos habían recibido vacunación antigripal en 2008 o 2009.

Apoyo ventilatorio. Cincuenta y cuatro pacientes, entre ellos 1 de los 2 niños, necesitaron ventilación mecánica durante su hospitalización. En el primer día de la enfermedad grave, la FIO2 media fue del 72%, la presión positiva de fin de espiración (PEEP) programada fue de 13 cm H2O y la presión de meseta fue 27 cm H2O. La mediana del índice PaO2/FIO2 fue de 83 mmHg, con saturación de oxígeno del 88%.

Las radiografías de tòrax del día 1 mostraron enfermedad bilateral grave en el 95,6% de los pacientes.

Se produjo barotrauma en 6 pacientes (10.3%) durante el estudio.

Disfunción orgánica no respiratoria. El 58,6% de los pacientes necesitó medicamentos inotrópicos o vasoactivos en el día 1. La concentración de creatina cinasa fue alta (285 UI/l). Durante el seguimiento, siguió siendo frecuente la necesidad de medicamentos vasoactivos debido a hipotensión. El Staphylococcus aureus fue la causa más frecuente de neumonía bacteriana secundaria (4 pacientes).

Evolución. Sesenta días después del comienzo de la enfermedad grave, 24 de 58 pacientes (41,4%) habían muerto. Fallecieron 19 pacientes en las dos primeras semanas de enfermar gravemente. Otros 4 pacientes habían muerto al llegar al día 28 y se produjo sólo otra muerte dentro de los 60 días.

Cuatro pacientes murieron en el servicio de urgencias, 3 dentro de las 8 horas y 1 dentro de las 24 horas de su ingreso. Todas las muertes de los primeros 28 días estuvieron relacionadas con insuficiencia respiratoria. Los 2 niños sobrevivieron. La duración de la internación en la UCI entre los supervivientes fue 13,5 (6-24) días, mientras que los no supervivientes murieron a los 7 días (2-13) de su ingreso a la UCI.

Comparación entre los pacientes que sobrevivieron y los que murieron. Los pacientes que murieron fueron más proclives a tener mayor puntuación APACHE II y SOFA, menor presión arterial al ingreso, evidencia de lesión renal y hepática, menor índice PaO2/FIO2 y mayor PEEP programada al ingreso a la UCI.

La muerte a los 28 días fue más probable para los pacientes con creatina cinasa más alta.

Riesgo para los trabajadores sanitarios.

Entre los 3 centros más grandes que atendieron al 65,6% de los pacientes en esta serie, 40 de 6755 trabajadores sanitarios (0,6%) sufrieron gripe A (H1N1).

Comentario

Este análisis de pacientes graves con gripe A (H1N1) revela que la enfermedad afectó a un grupo etario joven.

En la mayoría de los casos los primeros síntomas fueron fiebre y síntomas respiratorios. Hubo un período relativamente prolongado de enfermedad antes de la consulta hospitalaria, seguido por un período breve de deterioro respiratorio agudo y grave. Estos pacientes sufrieron hipoxia grave y dificultad respiratoria aguda.

En 60 días, el 41% de los pacientes con enfermedad grave había muerto. La tasa de mortalidad del 41% para la enfermedad grave por gripe A (H1N1) es semejante a la del síndrome de dificultad respiratoria aguda producido por otras gripes, pero es mayor que la del síndrome respiratorio agudo severo (SARS). La mediana de edad baja y la salud previa relativamente buena de este grupo de enfermos graves son diferentes de las de la gripe estacional y el SARS, donde los pacientes más ancianos son más susceptibles a sufrir enfermedad grave.

Los mayores de 60 años parecen tener cierta inmunidad frente a este virus novedoso.

La peor evolución de los pacientes con aumento de creatina cinasa es un dato novedoso.

La obesidad fue la enfermedad asociada más frecuente. No obstante, la mortalidad no fue significativamente mayor entre los pacientes obesos que entre los no obesos.

Tanto la puntuación SOFA como la APACHE II pueden contribuir a identificar a pacientes con gran riesgo de muerte.

La tasa de contagio de los trabajadores sanitarios fue muy baja.

Es posible que la experiencia con la gripe A (H1N1) en 2009 sea distintiva de México y se relacione con diversos factores, como el clima, la calidad del aire y la altura (2240 m sobre el nivel del mar) en la ciudad de México o con posibles diferencias en el momento en que la población consulta en relación con otros ámbitos. Estos pacientes gravemente enfermos acudieron al hospital cuando la enfermedad estaba muy avanzada.

El reconocimiento precoz de la gripe A (H1N1) por los síntomas constantes de fiebre y enfermedad respiratoria durante los brotes, con rápida atención médica y administración de inhibidores de la neuraminidasa y apoyo intensivo de la insuficiencia de la oxigenación y la ulterior disfunción orgánica, puede proporcionar oportunidades para mitigar la progresión de la enfermedad y la mortalidad observadas en México.
♦ Comentario y resumen objetivo: Dr. Ricardo Ferreira

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IntraMed - Artículos - Enfermos graves por gripe A (H1N1) en México

Ensayo de Selección Espermática

Santiago del Estero

INVESTIGACIÓN - La doctora María Eugenia Tévez trabaja en un Ensayo de Selección Espermática
Santiagueña desarrolla innovador método para mejorar la fertilización
Avances. La joven investigadora santiagueña trabaja en Córdoba, y ha colaborado en la creación de un sistema que permite seleccionar espermatozoides aptos para la fecundación exitosa.

Por Ernesto Picco - epicco@elliberal.com.ar

La científica santiagueña María Eugenia Tévez es investigadora del Centro de Biología Celular y Molecular de la Facultad de Ciencias Exactas de la Universidad Nacional de Córdoba. Sus exploraciones permitieron importantes avances en los estudios sobre fecundación, y los resultados de su tesis doctoral, en la que reveló detalles desconocidos del comportamiento de los espermatozoides, permitieron desarrollar un dispositivo, aún en estudio, para mejorar la fertilización.

La doctora Tévez realizó su doctorado en el Centro de Biología Celular y Molecular, siguiendo los estudios previos de la doctora Laura Giojalas, quien logró determinar que existe un sistema de indicación del trayecto para los espermatozoides una vez que están en el útero. Los estudios de Tévez permitieron determinar que la hormona que facilita este proceso es la progesterona, pero que sólo responden a ella los espermatozoides morfológica y genéticamente aptos.

“La pregunta que nos guiaba era cómo los espermatozoides buscaban el óvulo para poder fecundarlo”, planteó la doctora Tévez. La doctora Giojalas descubrió que no cualquiera podía llegar sino que había un modelo de selección. Empezó estudiando el fenómeno en conejos y en ratones, y lo describió como quimiotaxis, que es la liberación de una hormona que genera un gradiente y el espermatozoide lo va detectando, para seguir su camino. “Es como un rastro que va dejando para que los espermatozoides lo sigan – explicó Tévez – ahí ve de qué trompa salió el óvulo y no se va para el otro lado, y va haciendo el trayecto, que es muy largo”.

Al descubrir que se trataba de la progesterona, se hicieron varias publicaciones en revistas internacionales, y se difundieron los secretos del comportamiento de los espermatozoides.

Sin embargo, esta fue sólo la puerta de entrada para lo que vendría. “Lo que pudimos hacer es reproducir el gradiente que ocurre en el cuerpo de la mujer, y aplicar esto en terapia de infertilidad, o fertilización in vitro”. A partir de estos hallazgos, se logró crear un sistema de ensayo de selección espermática (ver pag. 11) a través del cual se pueden elegir los espermatozoides para optimizar las posibilidades de éxito de una fertilización asistida.

RECONOCIMIENTO
Importante Premio en Innovar

El Ensayo de Selección Espermática (ESE) obtuvo uno de los primeros premios en el Concurso Innovar 2009 en la categoría Investigación Aplicada, en octubre pasado.
“Este reconocimiento no hace más que aumentar nuestro compromiso para con la sociedad de seguir realizando investigación de calidad y desarrollando tecnologías útiles a la misma”, explicaron desde el Instituto.

“Agradecemos profundamente a todas las personas e instituciones que han apoyado este desarrollo y que nos alientan a seguir adelante”, agregaron.
Innovar es una plataforma de lanzamiento de productos y/o procesos que se destacan por su diseño, tecnología o por su grado de originalidad, impulsado por el Ministerio de Ciencia y Tecnología de la Nación.

El ESE, como todos los proyectos que llegan a Innovar, pasó por un proceso de evaluación de distintos grados de profundidad de gran importancia para aquellos que se proponen lanzar un nuevo producto.

El Programa Innovar se ha convertido en un espacio de contacto con los emprendedores innovadores de distintos campos de todo el país: grupos de investigación más o menos institucionalizados, diseñadores, micro y pequeñas empresas (muchas vinculadas a lo agropecuario), especialistas en tecnología, técnicos, diseñadores y escuelas técnicas y agrotécnicas.


PROPIEDADES - El dispositivo está a prueba, y podría producirse en serie
Ayudó a crear el sistema para elegir los espermatozoides más aptos
Características. Se trata de una cámara en la que se somete a los espermatozoides a estímulos que permiten determinar cuáles son los más aptos para la fecundación, y utilizarlos.

En el proceso de fecundación, sólo el 10% de los espermatozoides responde a la señal química que les permite hacer contacto con el óvulo. Es por esto que muchos procesos de fertilización asistida no terminan exitosamente, ya sea porque no se logra la fecundación, o porque los óvulos ya fecundados terminan en un aborto espontáneo. Ahora, con el dispositivo creado por el equipo donde trabaja la doctora Tévez, se podrían detectar y aprovechar precisamente los espermatozoides aptos.

“Creamos un ensayo de selección espermática que nos permite hacer esto – explicó Tévez a EL LIBERAL – tenemos una cámara de acrílico con dos compartimentos, en los que ponemos de un lado los espermatozoides y del otro la progesterona sintética que debe atraerlos. Así, se genera un gradiente y podemos observar las células que reaccionan a la señal química de la progesterona, y pasan del otro lado. Así las seleccionamos, y esas son las que vamos a usar para la fertilización in vitro, con una gran posibilidad de éxito”.

“Nos concentramos sobre esas células, las que realmente sirven, las concentramos”, dijo Tévez, quien hizo hincapié en que “hay mucha gente que va a tratamientos de inseminación, y no fertilizan, o después hacen un aborto espontáneo. Esta técnica mejoraría la calidad espermática, y todos los buenos que puedan llegar se concentran”.

Este dispositivo que se inventó en Córdoba, con talento santiagueño, será probado a partir de 2010 en clínicas de Chile y España. El objetivo es testear los resultados, y comparar si hay un aumento de embriones viables que no mueran.
Ahora, el Conicet, que es otra de las instituciones involucradas en la investigación, gestionó la patente del dispositivo a nivel nacional, y ya han iniciado las tratativas para que se haga una patente internacional.

La doctora Tévez explicó: “Si se corroboran los resultados que nosotros tenemos, y se publica, se podrá dar la venta masiva al público, e implementar en otras clínicas y centros de salud”.

DESARROLLO
Futuro en Estados Unidos

Tras colaborar con los exitosos desarrollos en el Centro de Biología Celular y Molecular, la doctora María Eugenia Tévez continuará, a partir del 2010, realizando sus investigaciones en Estados Unidos.

La destacada científica se prepara para instalarse en el país del norte por cuestiones familiares, y ya entabló contactos en la Commonwelth University, en Richmond, donde existe un centro de investigación en reproducción.

“El objetivo es llevar adelante un proyecto de colaboración con la Universidad Nacional de Córdoba, y continuar trabajando en esta línea, en la que aún hay mucho por avanzar”, señaló la especialista.
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Santiago del Estero / República Argentina

Pain, Chronic; Assessment and Management of (Guideline) [ICSI-NQMC-AHRQ]

Pain, Chronic; Assessment and Management of (Guideline)

abrir aquí: [pdf - 92 páginas - 2MB]NEW GUIDELINE
http://www.icsi.org/pain__chronic__assessment_and_management_of_14399/pain__chronic__assessment_and_management_of__guideline_.html

Scope and Target Population:
The guideline will address the management of chronic pain for physiologically mature adolescents (between 16-18 years) and adults. It can be applied to pediatric populations where noted. It is not intended for the treatment of migraine headaches, cancer pain, advanced cancer pain, or in the context of palliative care or end-of-life management.

Definitions

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage (International Association for the Study of Pain).

Acute pain states can be brief, lasting moments or hours, or they can be persistent, lasting weeks or several months until the disease or injury heals. The condition has a predictable beginning, middle and end.

Chronic pain is defined as persistent pain, which can be either continuous or recurrent and of sufficient duration and intensity to adversely affect a patient's well-being, level of function, and quality of life. If the patient has not been previously evaluated, attempt to differentiate between untreated acute pain and ongoing chronic pain. If a patient's pain has persisted for six weeks (or longer than the anticipated healing time), a thorough evaluation for the course of the chronic pain is warranted.
-Chronic Pain Syndrome – is at the end of the spectrum of chronic pain. The work group defines this as a constellation of behaviors related to persistent pain that represents significant life role disruption.

Clinical Highlights and Recommendations:
-Chronic pain assessment should include determining the mechanisms of pain through documentation of pain location, intensity, quality and onset/duration; functional ability and goals; and psychological/social factors such as depression or substance abuse.

-The goal of treatment is an emphasis on improving function through the development of long-term, self-management skills including fitness and a healthy lifestyle in the face of pain that may persist.

-A patient-centered, multifactorial, comprehensive care plan is necessary, one that includes addressing biopsychosocial factors. Addressing spiritual and cultural issues is also important. It is important to have a multidisciplinary team approach coordinated by the primary care physician to lead a team including specialty areas of psychology and physical rehabilitation.

-Level I treatment approaches should be implemented as first steps toward rehabilitation before Level II treatments are considered.

-Medications are not the sole focus of treatment in managing pain and should be used when needed to meet overall goals of therapy in conjunction with other treatment modalities.

-Careful patient selection and close monitoring of all non-malignant pain patients on chronic opioids is necessary to assess the effectiveness and watch for signs of misuse or aberrant behavior.


Priority Aims:
Improve the function of adult patients with chronic pain.

Improve the assessment and reassessment of adult patients with chronic pain utilizing the biopsychosocial model.

Improve the appropriate use of Level I and Level II treatment approaches for adult patients with chronic pain.

Improve the effective use of non-opioid medications in the treatment of adult patients with chronic pain.

Improve the effective use of opioid medications in the treatment of adult patients with chronic pain.