The Lancet recientes

The Lancet recientes 2017-01-13T02:37:25+00:00

Project Description

The Lancet - recientes

[Editorial] UK life science research: time to burst the biomedical bubble
21/7/2018
The Lancet
ver resumen
In November, 2017, as part of her long-awaited industrial strategy, UK Prime Minister Theresa May committed to raise investment in research and development (R&D) to 2·4% of gross domestic product by 2027. Life sciences featured prominently in the industrial strategy, described as one of the dominant economic sectors in the UK. A new strategic funding agency—UK Research and Innovation (UKRI)—was created to oversee the allocation of these funds, bringing seven research councils together in a major shake-up of the UK's funding structure.

[Editorial] Gender and health are also about boys and men
21/7/2018
The Lancet
ver resumen
Attention to the gendered dimensions of health has tended to focus on improving the disadvantages and vulnerability of girls and women. But to fully understand the ways that gender shapes how people live, work, and optimise health, more awareness is needed about the circumstances of men's lives that adversely affect their health. Men consistently experience shorter lifespans, greater threats to health and safety, and less access to health care than women.

[Editorial] Cannabinoids: just like any other medication?
21/7/2018
The Lancet
ver resumen
More than 17 countries permit the medicinal use of cannabis, but the UK is not one of them. Cases of children with severe epilepsy who have seen benefit with cannabinoid derivatives from the cannabis plant but cannot access the medication have reignited the debate over medicinal cannabis. The UK's legislative polices and intense bureaucracy over individual licensing are a source of inertia for clinicians and distress for patients. Part of the problem is the confusion between medicinal cannabis using the whole cannabis plant and cannabinoid derivatives, of which there are over 100.

[Comment] Ebola virus disease: 11 323 deaths later, how far have we come?
29/6/2018
Joseph A Lewnard
ver resumen
An ongoing outbreak of Ebola virus disease in Équateur Province, Democratic Republic of the Congo, has caused 57 suspected, probable, and confirmed cases as of June 16, 2018.1 The spread of cases across remote communities and into Mbandaka, a city with land and river connections to Kinshasa and Congo (Brazzaville), has made this the most challenging Ebola virus disease outbreak in the Democratic Republic of the Congo to respond to. As the first major Ebola virus disease outbreak since 2014, the current outbreak holds additional meaning as a test of recent progress by the international community toward global health security objectives.

[Comment] Baricitinib for systemic lupus erythematosus
21/7/2018
Johanna Mucke, Matthias Schneider
ver resumen
Despite improvements in diagnostics and therapy over the past few decades, diagnosis of systemic lupus erythematosus is still associated with significant mortality and severe burden. Belimumab is the only new drug licensed during the past 50 years for systemic lupus erythematosus; therefore, any success of a drug in the pipeline raises new hope for patients and the scientific community.

[Comment] A new step towards an HIV/AIDS vaccine
6/7/2018
George N Pavlakis, Barbara K Felber
ver resumen
A preventive vaccine is an essential part of the strategy to eradicate the HIV pandemic.1 Although the search for an AIDS vaccine has led to many scientific advances, a vaccine remains out of reach. Major impediments include the protean ability of HIV to mutate rapidly and the lack of definitive correlates of vaccine protection. Over the years, a multitude of vaccine methodologies have been tested, but few have progressed to efficacy trials2–7 and only one provided evidence for protection.7 Current HIV vaccine efficacy trials aim to improve on the success of the RV144 trial7 in Thailand, which showed a modest 31·2% protection.

[Comment] Three global health-care quality reports in 2018
21/7/2018
Donald M Berwick, Edward Kelley, Margaret E Kruk, Sania Nishtar, Muhammad Ali Pate
ver resumen
Universal health coverage (UHC) is the central thread of Sustainable Development Goal (SDG) 3. However, without improvements in the quality of the health system, UHC will prove an empty vessel and billions of people will not gain from benefits that could arrive from UHC. Instead, they will be victims of patient safety hazards, underuse of evidence-based care, overuse of inappropriate care, lack of patient-centred care, delays, inefficiency, inequity, financial insecurity, collusion, and corruption.

[Comment] Homeless reduction act in England: impact on health services
21/7/2018
Vibhu Paudyal, Karen Saunders
ver resumen
The Homeless Reduction Act,1 an act of the UK Parliament that legally mandates city authorities and health service providers to provide anticipatory and corrective measures for the reduction of homelessness, came into force in England in April, 2018. It places new legal duties on English city councils (legislative bodies that govern a city) and the National Health Service (NHS) to enable strengthened homeless prevention and management work across partners.

[Comment] Global child and adolescent health: a call for papers
17/7/2018
Jane Godsland, Udani Samarasekera, Esther Lau, Richard Horton
ver resumen
The Lancet and The Lancet Child & Adolescent Health invite submission of high-quality research papers on any area of global child or adolescent health for consideration for our special issues timed to coincide with the 29th International Pediatric Association Congress in Panama City, Panama, on March 17–21, 2019.

[Comment] Offline: What is science for?
21/7/2018
Richard Horton
ver resumen
Georges Braque, the French Cubist painter, wrote that, “Art is meant to disturb, science reassures.” Bertrand Russell, one the great philosophers of the 20th century, disagreed. In his book, The Impact of Science on Society (1952), Russell argued that science is disruptive. Science dispels unfounded traditional beliefs. It can also be put to myriad social uses: changes to the organisation of society, political transformations, and, of course, war. Science enabled the “victory of humanity and common sense”.

[World Report] Changes to dolutegravir policy in several African countries
21/7/2018
Esther Nakkazi
ver resumen
Policy changes would mainly affect women, as safety recommendations have been issued about the use of the drug in women of childbearing age living with HIV. Esther Nakkazi reports from Kampala.

[World Report] PEPFAR at 15 years
21/7/2018
Paul Webster
ver resumen
The US President's Emergency Plan for AIDS Relief celebrates its 15th anniversary this year, prompting calls for continued support for the initiative. Paul Webster reports.

[World Report] Setbacks in the fight to eradicate polio
21/7/2018
Sharmila Devi
ver resumen
Outbreaks of vaccine-derived poliovirus are concerning in the last push towards the eradication of the virus. Sharmila Devi reports.

[Perspectives] The beginning of the end of fingersticks?
21/7/2018
Michael Y Song, Steven R Steinhubl, Eric J Topol
ver resumen
Over 10 years, a person with insulin-dependent diabetes will cut their fingers roughly 20 000 times to obtain blood glucose concentrations. As indispensable as the fingerstick has been in the management of this disease, it presents a barrier to optimal individualised management of diabetes, prediabetes, and even general wellness.

[Perspectives] Charles Dickens' scientific network
21/7/2018
Wendy Moore
ver resumen
Writer and critic George Henry Lewes has a lot to answer for. In 1839, Lewes visited the up-and-coming author Charles Dickens at his home in Doughty Street, London, UK, and, after a swift glance at his bookcases, declared that Dickens was “completely outside philosophy, science, and the higher literature”.

[Perspectives] Death
21/7/2018
Sam Guglani
ver resumen
Walking might conjure it, from an arrhythmic lub-dub of footsteps perhaps: the realisation, as poet Jane Draycott has it, “that you are here until you are suddenly not”. Afterwards, the world can seem different, seem as it is: teeming with death. “So many”, wrote T S Eliot, “I had not thought death had undone so many”. And their bodies, the bodies of the many—fraying slowly, acutely breaking, newly dead—are so often met by medicine. As John Berger tells us, doctors are “the familiar of death…the living intermediary between us and the multitudinous dead”.

[Perspectives] Taking to tobacco
21/7/2018
Phil Withington
ver resumen
We live in an era of national No Smoking Days. With reminders to give up tobacco as regular events, it is worth thinking back 400 years, to when Europeans were starting to smoke for the first time. No other intoxicant has done more to shape and define the modern world than “the holy herb”, as its early proponents tended to call it. Without Europeans taking to tobacco, it is difficult to see how the English colonies in Virginia would have first survived and then flourished; whether African slavery would have become the bulwark of trans-Atlantic economies; how western governments would have garnered the revenues they have; and whether people around the globe would socialise, relax, pose—and of course die—the way that they do.

[Obituary] Jonathan E Fine
21/7/2018
Adam Marcus, Ivan Oransky
ver resumen
Founding member and first Executive Director of Physicians for Human Rights. Born on Oct 21, 1931, in Boston, MA, USA, he died in Cambridge, MA, USA, on Jan 17, 2018, aged 86 years.

[Correspondence] Regional population structures at a glance
21/7/2018
Ilya Kashnitsky, Jonas Schöley
ver resumen
Population ageing is a major demographic challenge for humanity. Since population structures evolve slowly and predictably, the demographic, economic, environmental, and social problems of ageing have been anticipated and discussed for many decades.1 Yet the focus of these discussions has always been the elderly population, with elderly people often defined as those older than a threshold—eg, 65 years or age at retirement—or with a certain number of estimated remaining years of life.2 Such a focus is quite reasonable and understandable but not entirely correct.

[Correspondence] Transparency and accountability in AstraZeneca's access to health-care programmes
15/6/2018
Katarina Ageborg
ver resumen
I wish to clarify the points regarding AstraZeneca contained within Richard Horton's Offline on global health and the private sector (June 2, p 2196).1



The Lancet - cardiopatía isquémica

[Articles] Work stress and risk of death in men and women with and without cardiometabolic disease: a multicohort study
5/6/2018
ver resumen
In men with cardiometabolic disease, the contribution of job strain to risk of death was clinically significant and independent of conventional risk factors and their treatment, and measured lifestyle factors. Standard care targeting conventional risk factors is therefore unlikely to mitigate the mortality risk associated with job strain in this population.

[Articles] 6-month versus 12-month or longer dual antiplatelet therapy after percutaneous coronary intervention in patients with acute coronary syndrome (SMART-DATE): a randomised, open-label, non-inferiority trial
12/3/2018
ver resumen
The increased risk of myocardial infarction with 6-month DAPT and the wide non-inferiority margin prevent us from concluding that short-term DAPT is safe in patients with acute coronary syndrome undergoing percutaneous coronary intervention with current-generation DES. Prolonged DAPT in patients with acute coronary syndrome without excessive risk of bleeding should remain the standard of care.

[Articles] Clinical efficacy and safety of achieving very low LDL-cholesterol concentrations with the PCSK9 inhibitor evolocumab: a prespecified secondary analysis of the FOURIER trial
28/8/2017
ver resumen
There was a monotonic relationship between achieved LDL cholesterol and major cardiovascular outcomes down to LDL-cholesterol concentrations of less than 0·2 mmol/L. Conversely, there were no safety concerns with very low LDL-cholesterol concentrations over a median of 2·2 years. These data support further LDL-cholesterol lowering in patients with cardiovascular disease to well below current recommendations.

[Articles] Adverse events associated with unblinded, but not with blinded, statin therapy in the Anglo-Scandinavian Cardiac Outcomes Trial—Lipid-Lowering Arm (ASCOT-LLA): a randomised double-blind placebo-controlled trial and its non-randomised non-blind extension phase
2/5/2017
ver resumen
These analyses illustrate the so-called nocebo effect, with an excess rate of muscle-related AE reports only when patients and their doctors were aware that statin therapy was being used and not when its use was blinded. These results will help assure both physicians and patients that most AEs associated with statins are not causally related to use of the drug and should help counter the adverse effect on public health of exaggerated claims about statin-related side-effects.

[Articles] Percutaneous coronary angioplasty versus coronary artery bypass grafting in treatment of unprotected left main stenosis (NOBLE): a prospective, randomised, open-label, non-inferiority trial
31/10/2016
ver resumen
The findings of this study suggest that CABG might be better than PCI for treatment of left main stem coronary artery disease.

[Articles] Comparison of an everolimus-eluting bioresorbable scaffold with an everolimus-eluting metallic stent for the treatment of coronary artery stenosis (ABSORB II): a 3 year, randomised, controlled, single-blind, multicentre clinical trial
30/10/2016
ver resumen
The trial did not meet its co-primary endpoints of superior vasomotor reactivity and non-inferior late luminal loss for the Absorb bioresorbable scaffold with respect to the metallic stent, which was found to have significantly lower late luminal loss than the Absorb scaffold. A higher rate of device-oriented composite endpoint due to target vessel myocardial infarction, including peri-procedural myocardial infarction, was observed in the Absorb group. The patient-oriented composite endpoint, anginal status, and exercise testing, were not statistically different between both devices at 3 years.

[Articles] Optical coherence tomography compared with intravascular ultrasound and with angiography to guide coronary stent implantation (ILUMIEN III: OPTIMIZE PCI): a randomised controlled trial
30/10/2016
ver resumen
OCT-guided PCI using a specific reference segment external elastic lamina-based stent optimisation strategy was safe and resulted in similar minimum stent area to that of IVUS-guided PCI. These data warrant a large-scale randomised trial to establish whether or not OCT guidance results in superior clinical outcomes to angiography guidance.

[Articles] Very thin strut biodegradable polymer everolimus-eluting and sirolimus-eluting stents versus durable polymer zotarolimus-eluting stents in allcomers with coronary artery disease (BIO-RESORT): a three-arm, randomised, non-inferiority trial
30/10/2016
ver resumen
At 12 month follow-up, both very thin strut drug-eluting stents with dissimilar biodegradable polymer coatings (eluting either everolimus or sirolimus) were non-inferior to the durable polymer stent (eluting zotarolimus) in treating allcomers with a high proportion of patients with acute coronary syndromes. The absence of a loss of 1 year safety and efficacy with the use of these two biodegradable polymer-coated stents is a prerequisite before assessing their potential longer-term benefits.

[Review] Interpretation of the evidence for the efficacy and safety of statin therapy
8/9/2016
ver resumen
This Review is intended to help clinicians, patients, and the public make informed decisions about statin therapy for the prevention of heart attacks and strokes. It explains how the evidence that is available from randomised controlled trials yields reliable information about both the efficacy and safety of statin therapy. In addition, it discusses how claims that statins commonly cause adverse effects reflect a failure to recognise the limitations of other sources of evidence about the effects of treatment.

[Articles] Early invasive versus non-invasive treatment in patients with non-ST-elevation acute coronary syndrome (FRISC-II): 15 year follow-up of a prospective, randomised, multicentre study
29/8/2016
ver resumen
During 15 years of follow-up, an early invasive treatment strategy postponed the occurrence of death or next myocardial infarction by an average of 18 months, and the next readmission to hospital for ischaemic heart disease by 37 months, compared with a non-invasive strategy in patients with non-ST-elevation acute coronary syndrome. This remaining lifetime perspective supports that an early invasive treatment strategy should be the preferred option in most patients with non-ST-elevation acute coronary syndrome.

[Articles] Platelet function monitoring to adjust antiplatelet therapy in elderly patients stented for an acute coronary syndrome (ANTARCTIC): an open-label, blinded-endpoint, randomised controlled superiority trial
28/8/2016
ver resumen
Platelet function monitoring with treatment adjustment did not improve the clinical outcome of elderly patients treated with coronary stenting for an acute coronary syndrome. Platelet function testing is still being used in many centres and international guidelines still recommend platelet function testing in high-risk situations. Our study does not support this practice or these recommendations.

[Seminar] Acute myocardial infarction
5/8/2016
ver resumen
Acute myocardial infarction has traditionally been divided into ST elevation or non-ST elevation myocardial infarction; however, therapies are similar between the two, and the overall management of acute myocardial infarction can be reviewed for simplicity. Acute myocardial infarction remains a leading cause of morbidity and mortality worldwide, despite substantial improvements in prognosis over the past decade. The progress is a result of several major trends, including improvements in risk stratification, more widespread use of an invasive strategy, implementation of care delivery systems prioritising immediate revascularisation through percutaneous coronary intervention (or fibrinolysis), advances in antiplatelet agents and anticoagulants, and greater use of secondary prevention strategies such as statins.

[Review] Pathophysiology and management of cardiovascular disease in patients with HIV
9/2/2016
ver resumen
Results from several studies have suggested that people with HIV have an increased risk of cardiovascular disease, especially coronary heart disease, compared with people not infected with HIV. People living with HIV have an increased prevalence of traditional cardiovascular disease risk factors, and HIV-specific mechanisms such as immune activation. Although older, more metabolically harmful antiretroviral regimens probably contributed to the risk of cardiovascular disease, new data suggest that early and continuous use of modern regimens, which might have fewer metabolic effects, minimises the risk of myocardial infarction by maintaining viral suppression and decreasing immune activation.

[Articles] Plasma urate concentration and risk of coronary heart disease: a Mendelian randomisation analysis
15/1/2016
ver resumen
Conventional and multivariate Mendelian randomisation analysis implicates a causal role for urate in the development of coronary heart disease, but these estimates might be inflated by hidden pleiotropy. Egger Mendelian randomisation analysis, which accounts for pleiotropy but has less statistical power, suggests there might be no causal effect. These results might help investigators to determine the priority of trials of urate lowering for the prevention of coronary heart disease compared with other potential interventions.

[Articles] Risk of non-fatal cardiovascular diseases in early-onset versus late-onset type 2 diabetes in China: a cross-sectional study
15/12/2015
ver resumen
Chinese patients with early-onset type 2 diabetes are at increased risk of non-fatal cardiovascular disease, mostly attributable to longer duration of diabetes.

[Articles] Regional contributions of six preventable risk factors to achieving the 25 × 25 non-communicable disease mortality reduction target: a modelling study
20/10/2015
ver resumen
No WHO region will meet the 25 × 25 premature mortality target if current mortality trends continue. Achieving the agreed targets for the six risk factors will allow some regions to meet the 25 × 25 target and others to approach it. Meeting the 25 × 25 target in Africa needs other interventions, including those addressing infection-related cancers and cardiovascular disease.

[Comment] Prevention of malaria in pregnancy: a fork in the road?
28/9/2015
ver resumen
In efforts to improve protection against the adverse consequences of malaria in pregnancy, several trials1–3 have investigated alternative drug regimens and strategies to replace sulfadoxine–pyrimethamine for intermittent preventive treatment of malaria in pregnancy. Even before WHO first recommended inclusion of intermittent preventive treatment with sulfadoxine–pyrimethamine in the focused antenatal care package in 2004,4 malaria parasites expressed mutations in the dihydrofolate reductase (Pfdhfr) and dihydropteroate synthetase (Pfdhps) genes,5 compromising the protective effect of the intervention.

[Articles] Intermittent screening and treatment or intermittent preventive treatment with dihydroartemisinin–piperaquine versus intermittent preventive treatment with sulfadoxine–pyrimethamine for the control of malaria during pregnancy in western Kenya: an open-label, three-group, randomised controlled superiority trial
28/9/2015
ver resumen
At current levels of rapid diagnostic test sensitivity, intermittent screening and treatment is not a suitable alternative to intermittent preventive treatment with sulfadoxine–pyrimethamine in the context of high sulfadoxine–pyrimethamine resistance and malaria transmission. However, dihydroartemisinin–piperaquine is a promising alternative drug to replace sulfadoxine–pyrimethamine for intermittent preventive treatment. Future studies should investigate the efficacy, safety, operational feasibility, and cost-effectiveness of intermittent preventive treatment with dihydroartemisinin–piperaquine.

[Articles] Long working hours and risk of coronary heart disease and stroke: a systematic review and meta-analysis of published and unpublished data for 603 838 individuals
19/8/2015
ver resumen
Employees who work long hours have a higher risk of stroke than those working standard hours; the association with coronary heart disease is weaker. These findings suggest that more attention should be paid to the management of vascular risk factors in individuals who work long hours.

[Articles] Cardiovascular safety of albiglutide in the Harmony programme: a meta-analysis
11/8/2015
ver resumen
Cardiovascular events were not significantly more likely to occur with albiglutide than with all comparators. Because the upper bound of the 95% CI for major adverse cardiovascular event plus hospital admission for unstable angina was greater than 1·3, a dedicated study with a cardiovascular endpoint is underway to confirm the safety of albiglutide.



The Lancet - hipertensión

[Articles] May Measurement Month 2017: an analysis of blood pressure screening results worldwide
16/5/2018
ver resumen
Inexpensive global screening of blood pressure is achievable using volunteers and convenience sampling. Pending the set-up of systematic surveillance systems worldwide, MMM will be repeated annually to raise awareness of blood pressure.

[Articles] Intensive systolic blood pressure control and incident chronic kidney disease in people with and without diabetes mellitus: secondary analyses of two randomised controlled trials
20/4/2018
ver resumen
Intensive lowering of systolic blood pressure increased the risk of incident chronic kidney disease in people with and without type 2 diabetes. However, the absolute risk of incident chronic kidney disease was higher in people with type 2 diabetes. Our findings suggest the need for vigilance in monitoring kidney function during intensive antihypertensive drug treatment, particularly in adults with diabetes. Long-term studies are needed to understand the clinical implications of antihypertensive treatment-related reductions in eGFR.

[Articles] Prevalence of obesity, hypertension, and diabetes, and cascade of care in sub-Saharan Africa: a cross-sectional, population-based study in rural and urban Malawi
19/1/2018
ver resumen
Overweight and obesity, hypertension, and diabetes are highly prevalent in urban and rural Malawi, yet many patients are undiagnosed and management is limited. Local-evidence-informed multisectoral, innovative, and targeted interventions are needed urgently to manage the already high burden.

[Articles] Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial
5/12/2017
ver resumen
Our findings show that, at 12 months, almost half of participants achieved remission to a non-diabetic state and off antidiabetic drugs. Remission of type 2 diabetes is a practical target for primary care.

[Articles] Achieved blood pressure and cardiovascular outcomes in high-risk patients: results from ONTARGET and TRANSCEND trials
5/4/2017
ver resumen
Mean achieved SBP less than 120 mm Hg during treatment was associated with increased risk of cardiovascular outcomes except for myocardial infarction and stroke. Similar patterns were observed for DBP less than 70 mm Hg, plus increased risk for myocardial infarction and hospital admission for heart failure. Very low blood pressure achieved on treatment was associated with increased risks of several cardiovascular disease events. These data suggest that the lowest blood pressure possible is not necessarily the optimal target for high-risk patients, although it is not possible to rule out some effect of reverse causality.

[Articles] Quarter-dose quadruple combination therapy for initial treatment of hypertension: placebo-controlled, crossover, randomised trial and systematic review
9/2/2017
ver resumen
The findings of our small trial in the context of previous randomised evidence suggest that the benefits of quarter-dose therapy could be additive across classes and might confer a clinically important reduction in blood pressure. Further examination of the quadpill concept is needed to investigate effectiveness against usual treatment options and longer term tolerability.

[Articles] Cardiovascular event rates and mortality according to achieved systolic and diastolic blood pressure in patients with stable coronary artery disease: an international cohort study
30/8/2016
ver resumen
In patients with hypertension and coronary artery disease from routine clinical practice, systolic blood pressure of less than 120 mm Hg and diastolic blood pressure of less than 70 mm Hg were each associated with adverse cardiovascular outcomes, including mortality, supporting the existence of a J-curve phenomenon. This finding suggests that caution should be taken in the use of blood pressure-lowering treatment in patients with coronary artery disease.

[Articles] Ramipril versus placebo in kidney transplant patients with proteinuria: a multicentre, double-blind, randomised controlled trial
22/10/2015
ver resumen
Treatment with ramipril compared with placebo did not lead to a significant reduction in doubling of serum creatinine, end-stage renal disease, or death in kidney transplant recipients with proteinuria. These results do not support the use of angiotensin-converting enzyme inhibitors with the goal of improving clinical outcomes in this population.

[Articles] Regional contributions of six preventable risk factors to achieving the 25 × 25 non-communicable disease mortality reduction target: a modelling study
20/10/2015
ver resumen
No WHO region will meet the 25 × 25 premature mortality target if current mortality trends continue. Achieving the agreed targets for the six risk factors will allow some regions to meet the 25 × 25 target and others to approach it. Meeting the 25 × 25 target in Africa needs other interventions, including those addressing infection-related cancers and cardiovascular disease.

[Comment] Prevention of malaria in pregnancy: a fork in the road?
28/9/2015
ver resumen
In efforts to improve protection against the adverse consequences of malaria in pregnancy, several trials1–3 have investigated alternative drug regimens and strategies to replace sulfadoxine–pyrimethamine for intermittent preventive treatment of malaria in pregnancy. Even before WHO first recommended inclusion of intermittent preventive treatment with sulfadoxine–pyrimethamine in the focused antenatal care package in 2004,4 malaria parasites expressed mutations in the dihydrofolate reductase (Pfdhfr) and dihydropteroate synthetase (Pfdhps) genes,5 compromising the protective effect of the intervention.

[Articles] Intermittent screening and treatment or intermittent preventive treatment with dihydroartemisinin–piperaquine versus intermittent preventive treatment with sulfadoxine–pyrimethamine for the control of malaria during pregnancy in western Kenya: an open-label, three-group, randomised controlled superiority trial
28/9/2015
ver resumen
At current levels of rapid diagnostic test sensitivity, intermittent screening and treatment is not a suitable alternative to intermittent preventive treatment with sulfadoxine–pyrimethamine in the context of high sulfadoxine–pyrimethamine resistance and malaria transmission. However, dihydroartemisinin–piperaquine is a promising alternative drug to replace sulfadoxine–pyrimethamine for intermittent preventive treatment. Future studies should investigate the efficacy, safety, operational feasibility, and cost-effectiveness of intermittent preventive treatment with dihydroartemisinin–piperaquine.

[Articles] Cardiovascular safety of albiglutide in the Harmony programme: a meta-analysis
11/8/2015
ver resumen
Cardiovascular events were not significantly more likely to occur with albiglutide than with all comparators. Because the upper bound of the 95% CI for major adverse cardiovascular event plus hospital admission for unstable angina was greater than 1·3, a dedicated study with a cardiovascular endpoint is underway to confirm the safety of albiglutide.

[Review] Posterior reversible encephalopathy syndrome: clinical and radiological manifestations, pathophysiology, and outstanding questions
13/7/2015
ver resumen
Almost two decades have elapsed since posterior reversible encephalopathy syndrome (PRES) was described in an influential case series. This usually reversible clinical syndrome is becoming increasingly recognised, in large part because of improved and more readily available brain imaging. Although the pathophysiological changes underlying PRES are not fully understood, endothelial dysfunction is a key factor. A diagnosis of PRES should be considered in the setting of acute neurological symptoms in patients with renal failure, blood pressure fluctuations, use of cytotoxic drugs, autoimmune disorders, or eclampsia.

[Articles] Estimated glomerular filtration rate and albuminuria for prediction of cardiovascular outcomes: a collaborative meta-analysis of individual participant data
28/5/2015
ver resumen
Creatinine-based eGFR and albuminuria should be taken into account for cardiovascular prediction, especially when these measures are already assessed for clinical purpose or if cardiovascular mortality and heart failure are outcomes of interest. ACR could have particularly broad implications for cardiovascular prediction. In populations with chronic kidney disease, the simultaneous assessment of eGFR and ACR could facilitate improved classification of cardiovascular risk, supporting current guidelines for chronic kidney disease.

[Articles] Association between maternal age at childbirth and child and adult outcomes in the offspring: a prospective study in five low-income and middle-income countries (COHORTS collaboration)
18/5/2015
ver resumen
Children of young mothers in LMICs are disadvantaged at birth and in childhood nutrition and schooling. Efforts to prevent early childbearing should be strengthened. After adjustment for confounders, children of older mothers have advantages in nutritional status and schooling. Extremes of maternal age could be associated with disturbed offspring glucose metabolism.

[Articles] Digoxin use in patients with atrial fibrillation and adverse cardiovascular outcomes: a retrospective analysis of the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF)
6/3/2015
ver resumen
Digoxin treatment was associated with a significant increase in all-cause mortality, vascular death, and sudden death in patients with AF. This association was independent of other measured prognostic factors, and although residual confounding could account for these results, these data show the possibility of digoxin having these effects. A randomised trial of digoxin in treatment of AF patients with and without heart failure is needed.

[Articles] Effects of statin therapy on coronary artery plaque volume and high-risk plaque morphology in HIV-infected patients with subclinical atherosclerosis: a randomised, double-blind, placebo-controlled trial
9/1/2015
ver resumen
No significant effects of statin therapy on arterial inflammation of the aorta were seen as measured by FDG-PET. However, statin therapy reduced non-calcified plaque volume and high-risk coronary plaque features in HIV-infected patients. Further studies should assess whether reduction in high-risk coronary artery disease translates into effective prevention of cardiovascular events in this at-risk population.

[Comment] Optimum antihypertensive therapy: does adiposity matter?
4/11/2014
ver resumen
Given that at least 75% of patients with hypertension are obese, it is no coincidence that the continuing obesity epidemic is driving the increasing incidence of hypertension.1 Physicians have questioned whether the benefits of blood pressure lowering for cardiovascular disease might depend, in part, on choice of antihypertensive drugs (as shown in ACCOMPLISH2) and that the choice of drugs should vary with the state of adiposity.3

[Articles] Effects of blood pressure lowering on cardiovascular risk according to baseline body-mass index: a meta-analysis of randomised trials
4/11/2014
ver resumen
We found little evidence that selection of a particular class of blood pressure-lowering drug will lead to substantially different outcomes for individuals who are obese compared with those who are lean.

[Articles] Effects of long-term blood pressure lowering and dual antiplatelet treatment on cognitive function in patients with recent lacunar stroke: a secondary analysis from the SPS3 randomised trial
24/10/2014
ver resumen
Cognitive function is not affected by short-term dual antiplatelet treatment or blood pressure reduction in fairly young patients with recent lacunar stroke. Future studies of cognitive function after stroke should be of longer duration or focus on patients with higher rates of cognitive decline.







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