Las nuevas guías de la AHA reafirman sus anteriores recomendaciones sobre el uso de dosis bajas de ácido acetilsalicílico en mujeres de 65 años o más

La Sociedad Americana del Corazón (AHA por sus siglas en inglés) ha publicado recientemente en la revista Circulation sus nuevas guías para la prevención cardiovascular en la mujer. Estas nuevas guías constituyen una actualización de las ya publicadas en 2007 y continúan incluyendo recomendaciones específicas sobre el uso apropiado de dosis bajas de ácido acetilsalicílico para la prevención del infarto de miocardio y otros accidentes cardiovasculares en mujeres. Las recomendaciones incluidas son las siguientes: En mujeres con riesgo cardiovascular elevado y enfermedad coronaria se recomienda el uso de dosis bajas de ácido acetilsalicílico (75-325 mg) diarios, a menos que esté contraindicado. En mujeres con riesgo cardiovascular elevado y diabetes, se considera razonable el uso de dosis bajas de ácido acetilsalicílico (75-325 mg) a menos que esté contraindicado. En mujeres con riesgo cardiovascular o mujeres sanas de 65 años o más se recomienda valorar el uso de 81 mg diarios ó 100 mg cada dos días de ácido acetilsalicílico, siempre y cuando la presión sanguínea esté controlada y el beneficio en la prevención del ictus isquémico y el infarto de miocardio supere el riesgo de hemorragia gastrointestinal o ictus hemorrágico. En mujeres con fibrilación auricular crónica o paroxística que no pueden tomar warfarina o presentan un riesgo bajo de ictus también se recomienda valorar la terapia con dosis bajas de ácido acetilsalicílico. Además, las nuevas guías indican que el tratamiento con dosis bajas de ácido acetilsalicílico parece coste-efectivo en mujeres de 65 años o más que presentan riesgo moderado o severo de evento cardiovascular. Dicha información está basada en recientes investigaciones farmacoeconómicas relacionadas con intervenciones farmacológicas para la prevención de eventos cardiovasculares primarios o recurrentes. Las guías basadas en la evidencia de las principales sociedades europeas y otras instituciones científicas siguen recomendando el tratamiento con dosis bajas de ácido acetilsalicílico en aquellos pacientes candidatos para la prevención primaria y secundaria de eventos cardiovasculares. Además, las recomendaciones recientes del United States Preventive Services Task Force coinciden con las recomendaciones de las nuevas guías de la AHA en cuanto al uso del ácido acetilsalicílico para la prevención cardiovascular.

Novartis sells Meda rights to atopic dermatitis drug Elidel for $420 million

Novartis said Thursday that it agreed to sell global rights to manufacture, market and commercialise the atopic dermatitis treatment Elidel (pimecrolimus) to Meda for an upfront payment of $420 million. The Swiss drugmaker noted that the deal "reflects [its] strategy to focus commercialisation on new launch portfolio and core brands." Upon closing of the transaction, which is expected in the second quarter of the year, Meda will assume the global manufacturing of Elidel within three years. **Published in "First Word"

Antibiotic-resistant bacteria in Indian public water supply

Disease-causing bacteria carrying the new genetic resistance to antibiotics, NDM-1, have been discovered in New Delhi's drinking water supply. A Cardiff University-led team found new strains of resistant bacteria in the Indian capital, including species which cause cholera and dysentery. The findings are the first evidence of the environmental spread of NDM-1, which had previously only been found in hospitals. The scientists are calling for urgent action by health authorities worldwide to tackle the new strains and prevent their global spread. The Cardiff scientists also highlight the all-round benefits of preventative measures such as better sanitation and appropriate drinking water. Cardiff scientists were the first to identify the NDM-1 gene which makes bacteria resistant to a large range of antibiotics. Moreover, the NDM-1 gene is carried on mobile DNA called plasmids which can carry up to 13 other antibiotic resistance genes. While most patients with the bacteria have recently been hospitalised in India, some cases have occurred there without recent hospital treatment, prompting the team to test the wider environment. Samples were taken in New Delhi from public water taps and from waste seepage, such as water pools in the street. Resistant bacteria were found in 4 per cent of the water supplies and 30 per cent of the seepage sites. The researchers identified 11 new species of bacteria carrying the NDM-1 gene, including strains which cause cholera and dysentry. Antibiotics are used to reduce excretion of bacteria in cholera patients, and to reduce the duration and severity of dysentery. Worryingly, the identified Shigella isolate, which can carry dysentery, is resistant to all appropriate antibiotics. Study leader Professor Tim Walsh, of Cardiff University's School of Medicine, said: "These are extremely worrying results. We found resistant bacteria in public water used for drinking, washing and food preparation and also in pools and rivulets in heavily-populated areas where children play. The spread of resistance to cholera and to a potentially-untreatable strain of dysentery is also a cause for extreme concern." A recent UN report showed that 650 million Indian citizens do not have access to a flush toilet and even more probably have no clean water. The New Delhi sewage system itself is reported to be unable to cater for the city's population. The research team also believes that temperatures and monsoon flooding make New Delhi ideal for the spread of NDM-1. Professor Walsh said: "This is an urgent matter of public health. We need similar environmental studies in cities throughout India, Pakistan and Bangaldesh to establish how widespread resistant bacteria are. If we are to maintain our ability to treat severe infection in vulnerable patients, this action is vital." "The environmental spread of bacteria is also an international issue. We have discovered patients in the UK and Europe carrying NDM-1 who did not visit hospitals while in India. Our research team at Cardiff would be happy to advise the World Health Organisation and the Asian health authorities on the action that needs to be taken." The team's findings are published today in The Lancet Infectious Diseases **Source: Cardiff University

Descubiertos cinco nuevos genes responsables del Alzheimer

Un consorcio internacional sobre genética del alzhéimer en el que participan investigadores españoles ha descubierto cinco nuevos genes responsables de la enfermedad. El estudio, realizado sobre una población de 20.000 pacientes con alzhéimer y 40.000 sujetos, ha permitido añadir los genes ABCA7, MS4A, CD33, CD2AP y EPHA1 a los otros cinco que ya se conocían como responsables de esta enfermedad (APOE, CLU, CR1, PICALM y BIN1). La revista estadounidense Nature Genetics ha publicado estos resultados en su último avance de la edición on line, según ha informado este miércoles la Universidad de Cantabria, que participa en la investigación. El proyecto se presentó en febrero y su objetivo es conocer el papel de la herencia en el desarrollo de esta enfermedad, la causa más frecuente de pérdida de memoria y demencia. Los investigadores se plantean como reto descubrir los genes y las proteínas correspondientes que intervienen en el alzhéimer para poder desarrollar fármacos, así como poner en marcha métodos genéticos de detección precoz de aquellas personas que pudieran estar en riesgo de padecer la enfermedad, una vez que los tratamientos farmacológicos estuvieran a punto. Equipos franceses, italianos, finlandeses y españoles En el proyecto están implicado cuatro consorcios de investigadores: el grupo europeo (EADI), liderado por el Instituto Pasteur de Lille y en el que participan equipos franceses, italianos, finlandeses y españoles; el grupo británico (GERARD), dirigido por la Universidad de Cardiff, y dos grupos estadounidenses, ADGC y CHARGE, que lideran las universidades de Pensilvania y Boston. La participación española está integrada por el Servicio de Neurología del Hospital Valdecilla y la Universidad de Cantabria, que han aportado muestras de ADN de 500 pacientes con alzhéimer y de 500 individuos sanos; el Centro de Biología Molecular Severo Ochoa-Hospital La Paz de Madrid y el Servicio de Genética del Hospital Central de Asturias. **AGENCIAS

Body mass index in adolescence associated with early occurrence of diabetes and heart disease

A new 17 year follow-up study of 37,000 Israeli teenagers found that diabetes risk is mainly associated with increased body mass index (BMI) close to the time of diagnosis at early adulthood, while coronary heart disease risk is associated with elevated BMI both at adolescence and adulthood. The findings are published in the April 7 issue of the New England Journal of Medicine. Lead study author, Amir Tirosh, MD PhD, of the Endocrine Division at Brigham and Women's Hospital said, "The study suggests that the obesity problem in children and teens is likely just the tip of an iceberg for increased risk for type 2 diabetes and heart disease in adulthood." The research team, also including Ben-Gurion Univeristy's Profesors Iris Shai and Assaf Rudich, in Beer-Sheva, Israel, along with researchers from the Israeli Defense Force (IDF) Medical Corps and Tel Hashomer, has followed 37,000 Israeli army career personnel, starting at age 17 years. Their BMI was recorded at baseline and again every several years. During a mean follow-up period of 17 years, the average BMI of the participants rose at a rate of 0.2-0.3 units per year, mounting to an average weight gain of approximately 30 lbs between ages 17 and 30. During the study period, 1,173 new cases of diabetes and 327 new cases of heart disease were diagnosed. When controlling for multiple risk factors for both diseases, including age, fasting blood sugar, blood lipids, blood pressure, smoking and family history, the researchers found that at age 17, BMI, even in the currently considered normal range, could predict the occurrence of both diseases. Every rise in 1 unit of BMI was associated with an approximately 10 percent increased risk for type 2 diabetes in early adulthood, and 12 percent increase in the risk for heart disease. "Previous studies did not unequivocally confirm the association between pre-adulthood BMI and diseases in early adulthood. This study is significant because it demonstrates that the association exists within the currently-considered normal values for BMI, having distinct effect on two diseases occurring in early adulthood and in an age group that is frequently neglected," said Professor Assaf Rudich. Remarkably, elevated risk at age 17 was significant at a BMI of 23.4 Kg/m2 or higher for diabetes and 20.9 Kg/m2 or higher for heart disease (These values correspond to a weight of 163 lbs or 146 lbs in a 5'10" male teenager, respectively). For diabetes, BMI at age 17 predicted the risk mainly since it is associated with BMI later in life. However, for heart disease, both BMI at adolescence as well as BMI at adulthood independently predicted the risk of the disease. "It would seem that heart disease has a longer "memory" for BMI than diabetes, and history of a person's BMI should be part of risk assessment," said Profesor Iris Shai. "We do have options, not necessarily pharmacological, to offer patients to decrease their risk for heart disease. Recent intervention trials showed that nutritional habits modification can not only halt the progression of atheorsclerosis, the underlying process of heart disease, but could also reverse it." Dr. Amir Tirosh adds, "For prevention of early occurrence of heart disease in adulthood it would seem that very early intervention to promote healthy life-style habits is warranted, even during childhood." *Source: Brigham and Women's Hospital

Healthy welders may be at increased risk for early brain damage

New research suggests that workers exposed to welding fumes may be at risk for developing brain damage in an area of the brain also affected in Parkinson's disease. The study is published in the April 6, 2011, online issue of Neurology®, the medical journal of the American Academy of Neurology. Fumes produced by welding contain manganese. Manganese is a chemical element that, even at low levels, has been linked to neurologic problems, including Parkinson's disease-like symptoms. "There are over one million workers who perform welding as part of their job functions in the United States," said Brad A. Racette, MD, with Washington University School of Medicine in St. Louis and a Fellow with the American Academy of Neurology. "If a link between neurotoxic effects and these fumes were proven, it would have a substantial public health impact for the U.S. workforce and economy." The study involved 20 welders with no symptoms of Parkinson's disease, 20 people with Parkinson's disease who were not welders and 20 people who were not welders and did not have Parkinson's. The welders were recruited from two Midwest shipyards and one metal fabrication company. All participants were given brain PET and MRI scans, motor skills tests and examined by a neurologist who specializes in movement disorders. The welders had an average of 30,000 hours of lifetime welding exposure. Their average manganese levels were found to be two times the upper limits of normal. Scientists found that welders had an average 11.7 percent reduction in a marker of dopamine in one area of the brain on PET scans as compared to people who did not weld. Dopamine is a chemical messenger that helps nerve cells communicate and is decreased in specific brain regions in people with Parkinson's disease. The welders' motor skills test scores also showed mild movement difficulties that were about half of that found in the early Parkinson's disease patients. "While these changes in the brain and dopamine dysfunction may be an early marker of neuron death related to welding exposure, the damage appeared to be different from those of people with full-fledged Parkinson's disease," said Racette. "MRI scans also revealed brain changes in welders that were consistent with manganese deposits in the brain." "Although this study shows that these workers had dopamine dysfunction in the brain, the study authors could not determine whether this was specifically related to manganese," said W. R. Wayne Martin, MD, who wrote an accompanying editorial on the topic. Martin is with the University of Alberta in Edmonton, Alberta, Canada and a member of the American Academy of Neurology. "Will these individuals develop full-fledged Parkinson's disease? We can't answer that question based on the study but more research should be done to explore this possibility." **Source: American Academy of Neurology

Sanidad advierte del fraude de la magnetoterapia

La Agencia Española de Medicamentos y Productos Sanitarios (AEMPS) de ha detectado prácticas de venta "engañosas" en distintas comunidades relacionadas con la venta de aparatos dirigidos a la magnetoterapia de distintas marcas y modelos por toda la geografía española. "La primera en avisar fue Navarra a finales de enero, aunque también hay particulares que han advertido este fraude", ha explicado un portavoz del Ministerio de Sanidad.

En concreto, estas prácticas consisten en llamadas de teléfono, vía operador, que ofertan técnicas de magnetoterapia para patologías específicas como lesiones y enfermedades agudas o crónicas, mejorar el rendimiento intelectual y físico e incluso combatir las arrugas. La única finalidad es concretar una cita en el domicilio de la "víctima". El sitio acordado se realiza una demostración de la técnica objeto de la venta. Las personas que suelen realizar estas muestras carecen de cualificación sanitaria como informa la AEMPS. "Estamos en contacto con las distintas comunidades y estamos realizando, también, la oportuna investigación para verificar que las indicaciones que ofrecen los productos se atienen a la reglamentación y están certificados", señala el portavoz de Ministerio. Estos productos también se ofertan a través de Internet, prensa o radio. "Es importante señalar que en muchos casos no se trata necesariamente de un problema de los aparatos (al estilo de un fallo o una reacción adversa en un medicamento), sino de que este tipo de productos no pueden comercializarse de así, sin supervisión", añade. En algunos casos incluso incluyen una recomendación falsa del Ministerio de Sanidad ya que muchos carecen normas de uso y de efectos secundarios perjudiciales. Cuando los aparatos de magnetoterapia se indican a través de un médico especialista (quién supervisará el proceso en todo momento) para el tratamiento de enfermedades o lesiones tienen la consideración de productos sanitarios y están sometidos a lo dispuesto por el Real Decreto 1591/2009 del 16 de octubre. Tienen que tener marcado CE en su etiquetado e instrucciones de uso, acompañado de un número de cuatro dígitos que verifica la evaluación del producto. La terapia magnética o magnetoterapia es una práctica de la medicina alternativa que implica el uso de campos magnéticos -imanes- estáticos o permanentes sobre el cuerpo. Se pueden encontrar todo tipo de productos, desde fajas de neopreno, antifaces, almohadillas, pulseras o jarras que convierten el agua en magnética. Prometen curar la hipertensión, el sida o el cáncer. AEMPS aclara que estos productos no están exentos de la aparición de reacciones adversas en "poblaciones más sensibles o con patología en las que su uso está contraindicado como son las mujeres en gestación, en niños, sufrir hemofilia o padecer graves tumores.

**Publicado en "EL PAIS"