Descripción del proyecto

The Lancet - recientes

[Editorial] Family planning: accelerating the way ahead
9/12/2017
The Lancet
ver resumen
The latest figures and progress of the Family Planning 2020 (FP2020) global partnership were released in its annual report on Dec 5. FP2020 The Way Ahead, together with a related research paper by Niamh Cahill and colleagues published online in The Lancet, paint a mixed picture. By July, 2017, more than 309 million women and girls of reproductive age in the 69 FP2020 focus (the world's poorest) countries are using modern methods of contraception. That figure is 38·8 million more than at the start of the FP2020 initiative in 2012.

[Editorial] Putting research evidence at the heart of policy making
25/10/2017
The Lancet
ver resumen
To improve patient outcomes, research must inform and shape policy. As history sadly teaches, this ideal is not always realised. But in today's Lancet, two Articles display how research addressing knowledge gaps can inform policy for hypertension control in China.

[Editorial] When a hospital becomes a prison
9/12/2017
The Lancet
ver resumen
Imprisonment for debt has a long history. In England during the 18th and 19th centuries, for instance, thousands of people were detained in debtors' prisons for failure to pay debts. Although such institutions no longer exist, in many parts of the world detention for unpaid debts is still a well known occurrence. Less recognised, however, is hospital detention—the practice of holding people in hospital against their will, not because their condition requires it, but because they have outstanding health-care bills.

[Comment] Hypertension in China: the gap between policy and practice
25/10/2017
Therese Hesketh, Xudong Zhou
ver resumen
The high prevalence of hypertension in China is well known, with stroke being the most common cause of death and disability.1 Two large nationwide studies reported in The Lancet2,3 highlight that although the prevalence of hypertension in China is similar to that suggested in previous studies, it is simple deficiencies in the country's health system that make a large contribution to the disease burden. Both studies used data from the PEACE (Patient-Centred Evaluative Assessment of Cardiac Events) Million Persons Project (MPP), which enrolled 1·7 million adults aged 35–75 years from across China.

[Comment] Childhood cancer: the long-term costs of cure
7/9/2017
Miranda M Fidler, Michael M Hawkins
ver resumen
Survival after childhood cancer has substantially improved over the past several decades, and more than 80% of children diagnosed with cancer in the USA now survive at least 5 years.1 This improvement comes at a cost, however, because the curative therapies used to achieve such successful survival proportions are associated with adverse late effects, with previous research finding increased risks of morbidity,2 poor health status,3 and premature mortality4 compared with sibling and population comparison groups.

[Comment] The global fight against malaria is at crossroads
29/11/2017
Pedro Alonso, Abdisalan M Noor
ver resumen
Since 2000, millions of malaria deaths, especially among young children, have been averted in malaria-endemic countries with the unprecedented global investment in the fight against the disease.1 The malaria targets of the Millennium Development Goals for 2015 were achieved. Remarkably, this progress was reached by the imperfect application of imperfect tools. However, these gains may also have led to complacency about the worrying developments in recent years.

[Comment] The mental health of refugees and asylum seekers on Manus Island
27/11/2017
Suresh Sundram, Peter Ventevogel
ver resumen
On Oct 31, 2017, the Governments of Australia and Papua New Guinea ended support for the Manus Island Regional Processing Centre, an Australian immigration detention facility on Manus Island, Papua New Guinea. Instead, currently incomplete and substandard facilities without adequate service provision have been hastily constructed to accommodate people.1 379 refugees and asylum seekers refused to leave the centre stating fears for their security.2,3 They managed to survive for several weeks with no provision of food and water or electricity and in poor hygienic circumstances.

[Comment] A new vision for global health leadership
30/11/2017
Michele Barry, Zohray Talib, Ashley Jowell, Kelly Thompson, Cheryl Moyer, Heidi Larson, Katherine Burke, Steering Committee of the Women Leaders in Global Health Conference
ver resumen
The complexity of global health problems demands leadership that represents the pluralism in society. The absence of gender parity in the leadership of key global health institutions in academic, governmental, and non-governmental organisations is evidence that this aspiration for diverse and inclusive leadership is not yet a reality.1,2 Women continue to represent most of the health workforce worldwide yet remain the minority in global health leadership.3 For example, only 31% of the world's ministers of health are women, and among the chief executives of the 27 health-care companies in the 2017 global Fortune 500, only one is female.

[Comment] Offline: The tasks facing Dr Tedros
9/12/2017
Richard Horton
ver resumen
Uncertainty is good. The fluidity that doubt brings can stimulate fresh thinking. Old assumptions discarded, orthodoxies dissolved, shibboleths erased. Unpredictability can be provocatively energising. WHO is currently undergoing such a period of creative instability. The draft 13th General Programme of Work (GPW) for 2019–23, presented to a Special Session of the Executive Board last month, was welcomed by member states as an ambitious new vision for the agency. But it also opened up a disruptive conversation about WHO's role and purpose.

[World Report] Phage therapy: revival of the bygone antimicrobial
9/12/2017
Geoff Watts
ver resumen
The idea of using bacteriophages as vectors for antimicrobial therapy has existed for decades, but development towards clinical application still lags behind. Geoff Watts reports.

[World Report] Millions in need of humanitarian assistance in Yemen
9/12/2017
Sharmila Devi
ver resumen
The situation in Yemen—one of the world's worse humanitarian crises—risks deteriorating further. The death of Ali Abdullah Saleh might accelerate conflict. Sharmila Devi reports.

[Perspectives] Qimin Zhan: driving medical research for better health in China
9/12/2017
Rachael Davies
ver resumen
“Clinical medicine + X”—the idea of integrating medicine with other disciplines—is at the heart of Qimin Zhan's vision for better health in China. As President of Peking University Health Science Centre (PUHSC) and Vice Chancellor of Peking University, he oversees five medical colleges, ten affiliated hospitals, and 14 teaching hospitals, and is committed to making this health system one of the world's leading medical centres. “We want to integrate medicine with disciplines like engineering, bioinformatics, nanotechnology, and big data to speed up the development of medical science”, says Qimin.

[Perspectives] Hospital histories
9/12/2017
Margaret McCartney
ver resumen
We never quite know what goes on behind closed doors. Hospitals are incubators for the most vital and vivid of human interactions. Much of these are secret and enclosed, sealed against the outside world. We are stripped down, as patients, wheeled on a trolley for surgery, our flawed and faulty bodies all we are left with. We become reliant on others to fulfil our basic bodily functions. Often dependant and frightened, patients are ministered to by staff, who also come with their own needs, anxieties, and dysfunctions.

[Perspectives] Icarus
9/12/2017
Athar Yawar
ver resumen
When did the Middle Ages end? A traditional date is 1453, the fall of Byzantium. Another candidate is 1610, when Galileo reported that Jupiter had moons. But if a defining feature of the Middle Ages was transcendence—the belief that human beings are ultimately spiritual and that life on earth is a shadow of the heavenly life—then for some people, the Middle Ages ended with the collapse of great theocratic empires (Russia, China, the Ottoman Empire) and the advancement of secular politics.

[Correspondence] Health-care delivery for long-term survivors of childhood cancer
9/12/2017
Gregory J Aune
ver resumen
In their Article in The Lancet (Dec 9, p 2569),1 Bhakta and colleagues provide compelling data and novel statistical analysis to quantify the overwhelming lifetime cumulative burden of chronic health conditions caused by curative paediatric cancer therapies. As a 27-year survivor of Hodgkin's lymphoma, I applaud the authors' suggestion that it might be time to rethink the methods by which we provide care for long-term childhood cancer survivors. As a patient, I have had numerous encounters over the past three decades that have left me frustrated by the scarcity of easy access to coordinated comprehensive care for survivors.

[Correspondence] Political determinants of Sustainable Development Goals
9/12/2017
Camila Gianella, Marta Rodriguez de Assis Machado, Siri Gloppen
ver resumen
We read with interest the article by the GBD 2016 SDG Collaborators1 (Sept 16, p 1423), which presents a comprehensive analysis of the potential gaps and gains in the health-related Sustainable Development Goals by 2030.

[Correspondence] Anonymity in HIV testing: implications for public health
9/12/2017
Edson Luis Bernardo, Laura Fuente-Soro, Elisa Lopez-Varela, Denise Naniche
ver resumen
To end the HIV epidemic, UNAIDS has set an ambitious target: by 2020, 90% of the people living with HIV will be diagnosed, 90% of those diagnosed will receive antiretroviral therapy (ART), and 90% of those receiving ART will be virally suppressed.1 The test and treat strategy will ensure care and treatment for almost 36·7 million people living with HIV, potentially saving millions of lives; however, the implementation of the strategy comes with multiple programmatic challenges.

[Correspondence] Overestimation of cardiovascular outcome incidence
9/12/2017
Yuanzi Ye, Ricardo Fonseca
ver resumen
We read with interest the study by Michael Böhm and colleagues (June 3, p 2226),1 in which they investigated the associations between blood pressure and cardiovascular outcomes and suggested that the lowest blood pressure possible is not the best goal for high-risk patients. Böhm and colleagues1 used Kaplan-Meier curves and Cox regression for the outcomes, stratified by different values of systolic blood pressure and diastolic blood pressure. However, because this study1 regards prediction of cardiovascular outcomes for patients, we caution about overestimation of the cumulative incidence of each outcome in the presence of competing events.

[Correspondence] Overestimation of cardiovascular outcome incidence – Authors' reply
9/12/2017
Helmut Schumacher, Felix Mahfoud, Michael Böhm
ver resumen
We thank Yuanzi Ye and Ricardo Fonseca for their interest in our Article.1 We agree that the cumulative incidence of each outcome is slightly overestimated when the simple technique for calculating Kaplan-Meier curves is used instead of a more sophisticated method accounting for competing risks. However, the effect of overestimation is modest and, because it affects all strata simultaneously, the hazard ratios (HRs) between strata are nearly unchanged.

[Correspondence] Antiplatelet cessation to manage bleeding events in elderly people
9/12/2017
Cody Magnusson
ver resumen
In their Article in The Lancet, Linxin Li and colleagues (June 13, p 490)1 postulated that the increased risk of bleeding events with antiplatelet therapy in patients older than 75 years is sufficient to routinely prescribe proton-pump inhibitors (PPIs) in this group. This assumption is based on extrapolation from data showing the efficacy of PPIs in prevention of upper gastrointestinal bleeding in a younger population (mean age 68·4 years).2 What the authors do not consider is the opposite solution: cessation of antiplatelet therapy.



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] 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).

[Articles] Association of vitamin D status with arterial blood pressure and hypertension risk: a mendelian randomisation study
25/6/2014
ver resumen
Increased plasma concentrations of 25(OH)D might reduce the risk of hypertension. This finding warrants further investigation in an independent, similarly powered study.







Feed aggregation powered by Syndicate Press.
Processed request in 0.62173 seconds.