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The Lancet - recientes

[Editorial] Examining humanitarian principles in changing warfare
17/2/2018
The Lancet
ver resumen
Violence in war must have a limit. Those who are not participating in the hostilities should be protected to prevent war from sinking into barbarity. Today, this is safeguarded by international humanitarian law (IHL), of which the cornerstones are the four Geneva Conventions of 1949 and its Additional Protocols. IHL provides for the wounded and sick to be collected and cared for by the warring faction that has them in their power, and for them to receive timely medical care. Traditionally, those entering into conflict could be expected to uphold these laws.

[Editorial] What's next for Indigenous health in Australia?
17/2/2018
The Lancet
ver resumen
Last week, the independent Close the Gap Campaign Steering Committee released a 10 year review of the government's Closing the Gap Strategy, ahead of the annual report. The 2008 Council of Australian Governments' Closing the Gap Strategy was developed following their signing of the Close the Gap Statement of Intent. This statement was meant to holistically tackle the social determinants of health inequality with targets in health, education, and employment, and represented a watershed moment, aspiring to secure health equity for Aboriginal and Torres Strait Islanders by 2030.

[Editorial] Asthma in US children
17/2/2018
The Lancet
ver resumen
Around 6 million children in the USA are affected by asthma, making it the most common chronic lung disease in childhood. Last week, the US Centres for Disease Control and Prevention (CDC) published their monthly Vital Signs report, which analyses asthma data from the 2001–16 National Health Interview Survey for children aged 0–17 years. Asthma diagnosis was limited to adult proxy responses to two questions: “Has a doctor or health professional ever told you that [your child] had asthma?”, and “Does [your child] still have asthma?”

[Comment] Acalabrutinib in mantle cell lymphoma
11/12/2017
Prashant Kapoor, Stephen M Ansell
ver resumen
Mantle cell lymphoma is a rare, distinct subtype of non-Hodgkin lymphoma, with a disparate clinical course that varies from indolent at times to frequently aggressive. No standard of care exists; most patients relapse and ultimately die as a result of their disease. Notable strides in the past few years, however, have ushered an era of unprecedented progress, with swift approval of new therapies from a variety of drug classes. One such drug that has catapulted to prominence is ibrutinib, the first-in-class, irreversible inhibitor of Bruton tyrosine kinase (BTK), a crucial component of the B-cell-receptor signalling pathway that is implicated in the pathogenesis of mantle cell lymphoma.

[Comment] Rifampicin for Staphylococcus aureus bacteraemia: give it ARREST
14/12/2017
Thomas L Holland, Vance G Fowler
ver resumen
Although Staphylococcus aureus bacteraemia is both common and potentially lethal, clinical decisions involving its treatment remain largely unencumbered by high-quality data.1 With the ARREST multicentre, randomised, double-blind, placebo-controlled trial, Guy Thwaites and colleagues2 have contributed high-quality evidence and addressed an unresolved question involving the role of adjunctive rifampicin in treatment regimens for patients with S aureus bacteraemia.

[Comment] Improving access to psychological therapies in England
7/12/2017
Graham Thornicroft
ver resumen
Most people with mental illness worldwide receive no treatment at all.1 The number benefiting from effective treatment is even fewer—eg, as low as one in six people with major depression receive effective care in high-income countries, and one in 27 people in low-income or middle-income countries.2 For mild-to-moderate depression, the treatments of choice are psychological therapies.3,4 Are there any examples of a health-care system successfully scaling up evidence-based practice for such common mental disorders? Yes: evidence is emerging that the Improving Access to Psychological Therapies (IAPT) programme in England fits this bill as reported by David M Clark and colleagues in The Lancet.

[Comment] Amending the EU Withdrawal Bill: a safeguard for health
17/2/2018
Martin McKee, Tamara Hervey
ver resumen
Detailed analyses of the health consequences of Brexit have focused on its negative effects on the UK's National Health Service, food security, international cooperation to combat threats to health, medicines regulation, and medical research.1 Faced with this depressing picture, it is natural to seek any glimmer of hope. Could there be any opportunities to improve health? The answer, invariably, is that leaving the European Union (EU) could allow the UK to go beyond existing European policies to strengthen protection in public health—eg, by introducing traffic light labelling on food or implementing stricter environmental standards.

[Comment] Making sense of the latest evidence on electronic cigarettes
6/2/2018
John N Newton, Martin Dockrell, Tim Marczylo
ver resumen
In the UK, 2·85 million people (5·7% of adults) regularly use electronic cigarettes (ECs), almost all of whom are smokers or ex-smokers.1 Prevalence of EC use is similar in the USA2 but is lower in other European Union (EU) countries (average 2%).1 ECs produce an estimated 18 000 additional long-term ex-smokers in England each year;3 a recent update suggests that figure might be as high as 57 000.1

[Comment] Primary care research: a call for papers
17/2/2018
Astrid James, William Summerskill, Richard Horton
ver resumen
To mark the 40th anniversary of the Alma-Ata Declaration, The Lancet will dedicate the issue of Oct 20, 2018, to primary care and related themes. While we welcome submissions on all aspects of primary care at all times, and across all Lancet titles, this call for papers is particularly aimed at researchers in primary care settings.

[Comment] Offline: Apostasy against the public health elites
17/2/2018
Richard Horton
ver resumen
“Epidemiology is built on a history of convincing experiments…We need to get better at using randomised controlled trials as knowledge translation in the public health field”, wrote Anne Cockcroft last year. Who could disagree? The centrality of randomised evidence is firmly established for evaluating interventions and their application in clinical medicine. The same is true in public health. But any clinician or public health practitioner knows that there is more to evidence than the results of a precious randomised trial.

[World Report] CDC faces leadership changes, potential spending cuts
17/2/2018
Susan Jaffe
ver resumen
The CDC has indicated it will reduce its foreign presence, and proposed budget cuts make some fear its core functions are threatened. Susan Jaffe, The Lancet's Washington correspondent, reports.

[World Report] Yemeni health under relentless pressure
17/2/2018
Sharmila Devi
ver resumen
Renewed calls for funding, reports of increasing conflict, and the ongoing blockade of the Red Sea ports draw the picture of a worsening humanitarian situation in Yemen. Sharmila Devi reports.

[World Report] End of a cholera epidemic in South Sudan declared
17/2/2018
Talha Burki
ver resumen
An announcement on Feb 7 declared the end of a cholera epidemic in South Sudan. Talha Burki reports on controlling an epidemic in a country in the midst of civil war.

[Perspectives] Schizophrenia
17/2/2018
Richard Barnett
ver resumen
Dementia praecox, dementia paranoides, catatonia, hebephrenia, stupefaction—just the terms historically associated with schizophrenia could fill up a short essay on the subject. The contentious and surprisingly short history of this diagnosis draws out some of the most difficult questions in psychiatry. Is schizophrenia a natural entity, awaiting objective description, or does it emerge from a shifting intersection of contexts? Is good practice a matter of grouping disorders into broad categories based on underlying resemblances, or does accurate diagnosis depend on breaking these generalisations down into lists of specific symptoms?

[Perspectives] Life behind bars
17/2/2018
Sarah Wise
ver resumen
There's something of a shock in store for anyone who researches the infamous Newgate Prison in London, UK. In place of its reputation for cruelty and Gothic gloom, eyewitness reports and statistics suggest that life inside could be more wholesome than outside, for an ordinary, poor Londoner, with three meals a day, ale, clean bedding, the chance to exercise, and unlimited visits from friends and relations.

[Perspectives] Gabriel Leung: working for a healthier Hong Kong
17/2/2018
Geoff Watts
ver resumen
In 2008, when he was a professor in the School of Public Health at the University of Hong Kong (HKU), Gabriel Leung was invited to join government service as Hong Kong's Under Secretary for Food and Health. As an academic, he was accustomed to offering policy advice: to being, as he puts it, an armchair critic. “If you're given the opportunity to practise what you preach and you turn it down”, he points out, “you have very little credibility in remaining an armchair critic”. He took the job. “As a public health physician”, he adds, “your form of clinical practice is doing public health in the real world”.

[Perspectives] Medical 3D printing and the physician-artist
17/2/2018
Frank J Rybicki
ver resumen
It was psychologically impossible to prepare for the first patient I met who had catastrophic facial deformity. Medical training helped me respond to his sensory defects: sight, sound, smell, and taste. However, when one person meets another, we connect via, and then later recognise, one another's face. When I met that first patient—one of many wounded soldiers with severe facial injuries—I was challenged to help artfully repair the damage. Had the injury occurred in the mid-20th century, surgery would have been greatly limited by the paucity of options in plastic surgery.

[Obituary] Anna Mae Hays
17/2/2018
Geoff Watts
ver resumen
US Army nurse and first female general in US Armed Forces. She was born in Buffalo, NY, USA, on Feb 16, 1920, and died following a heart attack in Washington, DC, USA, on Jan 7, 2018, aged 97 years.

[Correspondence] Dengue vaccination: a more balanced approach is needed
17/2/2018
Tikki Pang, Duane Gubler, Daniel Yam Thiam Goh, Zulkifli Ismail, Asia Dengue Vaccine Advocacy Group
ver resumen
Media reports have cast doubt on the safety of dengue vaccination, resulting in the suspension of school-based immunisation programmes in the Philippines.1 The main concern about the vaccine is the risk of severe disease in children naive to dengue virus. Although these concerns are justified, it is important to consider this risk in the context of the wider population and to consider the public health value of dengue vaccination for the prevention of a disease that affects 400 million people annually, mostly in developing countries.

[Correspondence] Germany's contribution to global health
17/2/2018
Mathias B Bonk, Ole Döring, Timo Ulrichs
ver resumen
4 years after the adoption of Germany's first global health strategy,1 an expansion of Germany's role in global health is being observed and praised.2 Despite being a “latecomer” in this field,2 a lot of achievements have been made over the past few years. The German Government's multilateral approach and its efforts to strengthen the global health architecture in general are highly appreciated, as are the efforts of WHO in particular. Germany's official development assistance for health has increased substantially between 2013 and 2015, but this increase was mainly due to the inclusion of costs for asylum seekers within Germany.



The Lancet - cardiopatía isquémica

[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.

[Articles] Antisense therapy targeting apolipoprotein(a): a randomised, double-blind, placebo-controlled phase 1 study
22/7/2015
ver resumen
ISIS-APO(a)Rx results in potent, dose-dependent, selective reductions of plasma Lp(a). The safety and tolerability support continued clinical development of ISIS-APO(a)Rx as a potential therapeutic drug to reduce the risk of cardiovascular disease and calcific aortic valve stenosis in patients with elevated Lp(a) concentration.

[Articles] An assessment of community health workers' ability to screen for cardiovascular disease risk with a simple, non-invasive risk assessment instrument in Bangladesh, Guatemala, Mexico, and South Africa: an observational study
14/7/2015
ver resumen
Health workers without formal professional training can be adequately trained to effectively screen for, and identify, people at high risk of cardiovascular disease. Using community health workers for this screening would free up trained health professionals in low-resource settings to do tasks that need high levels of formal, professional training.



The Lancet - hipertensión

[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.

[Comment] Blood pressure control after stroke: too little, too late, or too soon to tell?
24/10/2014
ver resumen
Cognitive decline is among the most feared and common changes in late life, and prevention of cognitive decline in any population is a worthy goal. In The Lancet Neurology, Lesly Pearce and colleagues1 report results of a prespecified secondary outcome analysis of cognitive function from the Secondary Prevention of Small Subcortical Strokes (SPS3) trial, which compared aspirin plus clopidogrel with aspirin plus placebo, and high goal (130–149 mm Hg) with low goal (<130 mm Hg) blood pressure targets, in a factorial design.

[Comment] Low vitamin D and hypertension: a causal association?
25/6/2014
ver resumen
In The Lancet Diabetes & Endocrinology, Karani Vimaleswaran and colleagues1 report the results of a mendelian randomisation study with data from up to 146 581 individuals, which suggest that low vitamin D concentrations might be causally associated with an increased risk of hypertension. The investigators used variants of genes that affect 25-hydroxyvitamin D (25[OH]D) synthesis or substrate availability (CYP2R1 and DHCR7) and report that each 10% increase in genetically instrumented plasma 25(OH)D concentration was associated with a decrease in diastolic blood pressure (−0·29 mm Hg, 95%CI −0·52 to −0·07; p=0·01) and systolic blood pressure (−0·37 mm Hg, −0·73 to 0·003; p=0·052), and an 8·1% reduced odds of hypertension (odds ratio [OR] 0·92, 95% CI 0·87–0·97; p=0·002).







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