Even low-dose aspirin may increase risk of GI bleeding

The risk of gastrointestinal (GI) bleeding needs to be considered when determining the potential preventive benefits associated with low-dose aspirin for cardiovascular disease and cancer. According to a new study in Clinical Gastroenterology and Hepatology, the use of low-dose aspirin increases the risk for GI bleeding, with the risk being increased further with accompanying use of cardiovascular disease-preventing therapies, such as clopidogrel and anticoagulants. In patients who took proton pump inhibitors (PPIs), bleeding risk decreased. "The use of aspirin has been proven beneficial in reducing cardiac events and deaths in patients who have cardiovascular disease, and has even been shown to reduce cancer risk," said Angel Lanas, MD, PhD, of University Hospital Lozano Blesa and lead author of this study. "However, clinicians need to be more proactive in their efforts to reduce potential risk factors associated with all doses of aspirin, especially gastrointestinal bleeding. New low-dose aspirin studies should report more precisely on the incidence of bleedings, especially gastrointestinal bleedings, to better determine the balance between risks and benefits ."
Low-dose aspirin -- commonly defined as 75 to 325 mg daily -- is a mainstay of therapy for cardiovascular disease. In fact, patients with prior cardiovascular disease have fewer cardiovascular events and deaths with the use of low-dose aspirin compared with patients who do not use it. It is now likely to also be used for cancer prevention, especially GI and colon cancer.
A major factor limiting the widespread use of aspirin is concern about the development of GI adverse events, especially GI bleeding. However, damage may vary depending on the dose taken, other medication being consumed along with aspirin and patients' risk profiles. For example, certain patients have an increased likelihood of experiencing bleeding: those with long-term pharmacotherapy use, patients using combinations of low-dose aspirin with clopidogrel and anticoagulants, and patients with previous GI ulcers or bleedings.
In this study, doctors searched 10 electronic databases and collected data on adverse events in studies that evaluated low doses of aspirin alone or in combination with anticoagulants, clopidogrel or PPIs. They found that low doses of aspirin alone decreased the risk of death. However, the risk of major GI bleeding increased with low doses of aspirin alone compared with placebo. The risk also increased when aspirin was combined with clopidogrel (compared with aspirin alone), anticoagulants versus low doses of aspirin alone, or in studies that included patients with a history of GI bleeding or of longer duration. Importantly, PPI use reduced the risk for major GI bleeding in patients given low doses of aspirin.

**Source: American Gastroenterological Association

Fish oil reduces effectiveness of chemotherapy

Researchers at University Medical Center Utrecht, the Netherlands, have discovered a substance that has an adverse effect on nearly all types of chemotherapy -- making cancer cells insensitive to the treatment. Chemotherapy often loses effectiveness over time. It is often unclear how or why this happens. It now appears that chemotherapy is made ineffective by two types of fatty acid that are made by stem cells in the blood. Under the influence of cisplatin chemotherapy, the stem cells secrete these fatty acids that induce resistance to a broad spectrum of chemotherapies. These substances are referred to by researchers as 'PIFAs' which stands for platinum-induced fatty acids. Cisplatin is a type of chemotherapy that is widely used for the treatment of cancer, including cancer of the lungs and ovaries.
Tumors under the skin
The researchers studied the effect of PIFA's in mice and human cells. The mice studied had tumors under the skin. Under normal conditions, the tumors would decrease in size following the administration of chemotherapy. In the study, after administering the fatty acids to the mice, the tumors were found to be insensitive to chemotherapy. The fatty acids were isolated from the medium in which chemotherapy exposed stem cells were grown. But also stem cells in the blood of patients produce the fatty acids that desensitize tumors to chemotherapy.
The fatty acids are also found in commercially-produced fish oil supplements containing omega-3 and omega-6 fatty acids as well as in some algae extracts. In the experiments conducted in mice, the tumors became insensitive to chemotherapy after administration of normal amounts of fish oil. Natural products that include fish oil are frequently used by cancer patients in addition to their regular treatment.
"Don't use these products"
Professor Emile Voest, a medical oncologist at UMC Utrecht, supervised the research. "Where resistance to chemotherapy is concerned, we usually believe that changes in the cancer cells themselves have occurred. Now we show that the body itself secretes protective substances into the blood that are powerful enough to block the effect of chemotherapy. These substances can be found in some types of fish oil. Whilst waiting for the results of further research, we currently recommend that these products should not be used whilst people are undergoing chemotherapy."
Researchers at the University Medical Center Utrecht, the Netherlands, describe these findings, that will appear online on September 12, in the journal Cancer Cell.

*Source: University Medical Center Utrecht

First proof in patients of an improved 'magic bullet' for cancer detection and radio-therapy

Oncologists have long sought a powerful "magic bullet" that can find tumors wherever they hide in the body so that they can be imaged and then destroyed. Until recently scientists accepted the notion that such an agent, an agonist, needed to enter and accumulate in the cancerous cells to act. An international research team has now shown in cancer patients that an investigational agent that sticks onto the surface of tumor cells without triggering internalization, an antagonist, may be safer and even more effective than agonists. One of the Salk Institute's leading researchers, Dr. Jean Rivier, professor in The Clayton Foundation Laboratories for Peptide Biology and holder of the Frederik Paulsen Chair in Neurosciences and his Swiss collaborator, Dr. Jean Claude Reubi, University of Berne and Adjunct Professor at Salk, co-authored a pilot study, published in the September issue of the Journal of Nuclear Medicine, of five patients and demonstrated that their "antagonist," 111In-DOTA-BASS, outperformed the "agonist" agent, OctreoScan, that is widely used in the clinic to image neuroendocrine tumors bearing somatostatin receptors.
"This is the first proof of principle in humans that labeled peptide antagonists can effectively image tumors. Additional research suggests that we could one day use a different radioactive metal to effectively kill the tumors," said Dr. Rivier.
Dr. Reubi, a molecular pathologist, and Dr. Rivier, a chemist, collaborated in the design and selection of natIn-DOTA-BASS for human testing, and Dr. Helmut R. Maecke, a radio chemist, loaded DOTA-BASS with its radioactive marker and tested the compound before use in human. Afterward, the "first in man" study with the radioactive loaded DOTA-BASS was performed at the University Hospital in Freiburgby Drs. Damian Wild, Melpomeni Fani, Martin Behe, Ingo Brink, Helmut R. Maecke, and Wolfgang A. Weber.
The genesis of this study goes back to 1973, when a team of Salk researchers, which included Drs. Brazeau, Vale, Burgus, Rivier, and Roger Guillemin, a 1977 Nobel laureate, isolated and characterized somatostatin, a peptide produced by neuroendocrine glands. The scientists found that the normal function of somatostatin is to block the release of growth hormone throughout the body, which includes inhibiting the release of thyroid-stimulating hormone (TSH) from the thyroid.
Drs. Rivier, Reubi and their colleagues from Germany showed that 111In-DOTA-BASS bound to a greater number of somatostatin receptors on cancer cells than the agonist OctreoScan, and that it did accumulate in normal tissue (liver and kidney) to a lesser extent.
The prototype antagonist therapy has been revamped, and the version studied in the Journal of Nuclear Medicine publication, 111In-DOTA-BASS, detected 25 of 28 metastatic neuroendocrine tumors in the patients, whereas OctreoScan detected only 17.
In-DOTA-BASS has been licensed to a pharmaceutical company for clinical trial development, according to Rivier, who adds that other researchers are exploring an antagonist approach for other G-protein coupled receptors that are abundantly expressed on cancer cells.
The study was funded in part by the Swiss National Science Foundation (JCR).

**Source: Salk Institute

Ophthalmic antibiotics associated with antimicrobial resistance after intraocular injection therapy

Repeated exposure of the eye to ophthalmic antibiotics appears to be associated with the emergence of resistant strains of microbes among patients undergoing intraocular injection therapy for neovascular retinal disease, according to a report in the September issue of Archives of Ophthalmology, one of the JAMA/Archives journals. According to background information in the article, more than 8 million people in the United States are affected by age-related macular degeneration, the leading cause of blindness among individuals older than 65 years in this country. Treating the neovascular or "wet" form of the disease involves monthly injections of medication into the eye; this treatment is also being studied for eye problems related to diabetes and retina vein occlusions (obstructions of veins carrying blood from the retina). To prevent the most severe complication from intraocular injection, endophthalmitis (inflammation inside the eye), ophthalmologists routinely prescribe ophthalmic antibiotics after every injection. "Repeated exposure of ocular flora [microbes living on or inside the body], however, may select for resistant bacterial strains and cultivate 'superbugs' with multiple-drug resistance that may considerably affect the treatment of ocular infections," write the authors.
Stephen J. Kim, M.D., and Hassanain S. Toma, M.D., from the Vanderbilt University School of Medicine, Nashville, Tenn., conducted a randomized, controlled, longitudinal study of 48 eyes of 24 patients who, in one eye each, received intraocular injection. At baseline and after every injection, researchers obtained cultures of the conjunctiva (the membrane of the eye's surface and the inner eyelid) for both treated and untreated (control) eyes. Patients were randomized to one of four antibiotics and after each injection used only the antibiotic they were assigned. The researchers tested the bacterial samples for susceptibility to 16 antibiotics and analyzed the bacterial DNA. Injections were administered every four weeks for at least four consecutive months, and patients were followed for one year.
Repeated exposure to fluoroquinolone antibiotics was associated with coagulase-negative staphylococci (CNS) that demonstrated significantly increased rates of resistance to both older- and newer-generation fluoroquinolones. Repeated exposure to azithromycin was associated with CNS that demonstrated significantly increased resistance to macrolides and decreased resistance to both older- and newer-generation fluoroquinolones. Specimens of CNS from treated eyes demonstrated significant increases in multiple-drug resistance; for example, 81.8 percent of CNS specimens appeared resistant to at least three antibiotics, and 67.5 percent appeared resistant to at least five antibiotics.
The researchers suggest that their results demonstrate rapid development of resistance from CNS to certain antibiotics, and that this resistance is maintained when the antibiotic is periodically readministered. "This finding has considerable implications because conjunctival flora are presumed to be the predominant source of postinjection endophthalmitis," they write, adding that research suggests one strain of CNS is associated with greater intraocular inflammation than are strains more susceptible to antibiotics. "Our findings," the authors conclude, "indicate the need for more judicious use of ophthalmic antibiotics after intraocular injection to reduce the potential emergence and spread of antimicrobial resistance."

*Source: JAMA and Archives Journals

La electrosensiblidad afecta, según estudios independientes, a una de cada mil personas

No es todavía, o al menos según establece la Organización Mundial de Salud, una enfermedad con carácter oficial. La ausencia de estudios impide conocer datos relativos al nivel de incidencia y los efectos sobre la salud de eso que algunos ya conocen y denominan «electrosensibilidad» y que, según estiman los expertos, va camino de convertirse en uno de los grandes males de la llamada «sociedad de la información».
Se sabe más bien poco sobre esta dolencia que aunque parece depender del desarrollo tecnológico lleva varios años sumando afectados. Conocida también por el sobrenombre de «alergia al wifi» -aunque su impacto sobre la salud no depende exclusivamente de redes inalámbricas-, lo que sí se sabe es que se trata de una enfermedad generada por la exposición continuada a campos electromagnéticos y que puede dar lugar a síntomas como la pérdida de la memoria a corto plazo, vómitos, dolores de cabeza, mareos o irritación, que se intensifican cuando el afectado permanece próximo a aparatos eléctricos. Estudios realizados por científicos independientes indican que, a día de hoy, la electrosensibilidad podría afectar a una de cada mil personas, y el Consejo Europeo ya ha advertido sobre los efectos nocivos de este tipo de ondas. [Resolución del Consejo Europeo]
Al margen de nombres que la definan lo cierto es que esta enfermedad invisible, en la que se siente el dolor pero no se ve qué lo provoca, ha comenzado a dar pequeños pasos en su lucha por el reconocimiento. Solo hace algunos meses que Minerva Palomar, electrosensible desde hace 15 años, consiguió que un juez le concediera la incapacidad permanente debido a este problema. Cierto es que hizo falta un extenuante paseíllo por abogados y tribunales para conseguirlo, pero también ha puesto la primera piedra en el camino de una incontable lista de afectados.

--Un medidor de ondas
Resulta cuando menos curioso que un «alérgico al wifi» se vea obligado a recurrir a Internet como método para conocer las causas de su problema. La desesperación ante un trastorno cuyos síntomas se camuflan con los de enfermedades comunes han forzado a los afectados a tirar la toalla ante una cura que intuyen compleja y a centrarse en la búsqueda de sistemas de prevención. Hay, sin embargo, quienes comparan el mal causado por las radiaciones de aparatos como el router wifi o el teléfono inalámbrico con el generado por sustancias como el tabaco o el amianto. Y no les resulta un paralelismo alarmante.

-La generación que viene
Ha empezado, en palabras de enfermos y expertos, la era de una «generación de electrosensibles». «En etapas anteriores no ha habido un contacto tan fuerte con las nuevas tecnologías como ahora. Los niños ya juegan con móviles y tienen wifi en el colegio», alerta José Miguel Rodríguez, director de la empresa de estudios geoambientales Geosanix.
En términos reales, la alergia al wifi es solo una pequeña porción de la tarta de ondas que generan malestar a personas electrosensibles. Yolanda Barbazán es una de las muchas afectadas por la enfermedad invisible que ha querido relatar a ABC cómo el wifi, entre el resto de radiaciones que rodean su vida, ha cambiado para siempre su rutina. «En la oficina me molesta mucho el router, pero no puedo hacer nada porque, según la empresa "es lo que tiene el progreso".
«Cuando mis compañeros descargan datos me duele mucho la cabeza»Cuando mis compañeros descargan datos me duele mucho la cabeza», explica. Similar es el caso de María Jesús, a quien la radiación desprendida por aparatos eléctricos de cualquier clase le afecta de tal manera que no recuerda un día en que haya estado ajena al dolor: «Mi día a día tiene picos, lo paso mal a mediodía cuando los vecinos ponen la televisión para ver el telediario; también por la tarde, cuando la gente enciende los ordenadores y pone el wifi».
Los efectos de las ondas en quien padece electrosensibilidad se multiplican a medida que permanece expuesto a ellas. «Aunque te empiece afectando el wifi cuando llevas mucho tiempo recibiendo radiaciones te acabará afectando todo: el cableado eléctrico, el teléfono...Llegas a un estado en que tu cuerpo se vuelve extremadamente sensible y notas las ondas que desprende cualquier cosa que lleve un enchufe», cuenta Yolanda, que empezó a encontrarse mal por una antena instalada frente a su casa y ahora siente incluso el inalámbrico del vecino.

-Sin medicamentos ni asistencia
Los síntomas generados por la electrosensibilidad son el primer capítulo de la lucha que los afectados libran cada día. Que la enfermedad no se haya reconocido aún por la OMS supone, entre otras consecuencias, la inexistencia de protocolos sanitarios al respecto y una «ignorancia médica» que les lleva a pasar meses e incluso años en un desesperado peregrinaje por consultas y hospitales.
Hay casos, como el de Yolanda, en que los médicos acaban asumiendo que «algo habrán influido esas ondas». En otros, los más comunes, los facultativos se limitan a prescribir paliativos que «no sirven para nada», y en los peores ejemplos se acaba por asociar la electrosensibilidad a un estado de depresión.
«Cuando te convences de que la medicina no resuelve nada, buscas otra solución»Esto se debe, para Alberto Cela, también electrosensible, a que las ondas reducen la producción de serotonina en el cerebro, un antidepresivo natural que si deja de generarse «genera tristeza, cansancio y depresión». Tras 12 años de enfermedad Alberto decidió investigar por su cuenta para reducir los síntomas empleando sus propios medios. No solo lo consiguió, sino que además de haber minimizado sus dolencias ha hecho de su enfermedad su medio de vida, dedicándose a mejorar la habitabilidad de viviendas e intentar liberarlas de radiaciones. «Cuando te convences de que la medicina convencional no sirve de nada buscas otras soluciones, como proteger tu casa con materiales especializados, modificar algunas costumbrees o desprenderte de varios aparatos». Él utiliza solo el teléfono fijo y casi no enciende el ordenador.
Joaquim Fernández Solá es el único médico que diagnostica la enfermedad en España. Lo hace en el Hospital Clínic de Barcelona, al que acuden pacientes cansados del tour por especialistas y de unos síntomas generados quién sabe por qué. «La tendencia en medicina cuando hay una nueva enfermedad es no aceptarla y pensar que es cosa del paciente, que se la ha inventado». Solá no ve «estrictamente» necesario que la OMS decida que la electrosensibilidad es una enfermedad para tratarla como tal: «Tendemos a pensar que es culpa de la OMS, pero la realidad es que ni los médicos, ni el Gobierno, ni muchísimo menos la Industria tienen interés en investigar este problema».

-David contra Goliat
A día de hoy, enfermos y especialistas coinciden en que si en algo puede avanzarse es en la creación de mecanismos de prevención. A María Jesús, como a otros muchos, solo le ha quedado la opción de proteger su cuerpo como una tortuga, con un caparazón de malla metálica que bloquea «más o menos» los efectos de las ondas.
«Los enfermos están librando una guerra parcialmente perdida», considera Francisco Canals, director de la Agencia para la Picaresca en Internet. «Se lograrán cosas importantes como que la enfermedad sea reconocida, de ahí surgirán protocolos médicos y los pacientes optarán a bajas laborales y a un tratamiento más efectivo, pero nada más allá de eso. Es una guerra imposible en la que hay mucho miedo en diversos frentes».
La sentencia que ha otorgado la incapacidad laboral permanente a Minerva Palomar ha sido para muchos un clavo ardiendo al que agarrarse tras años de permanente lucha. Otros afectados, como Alberto, prefieren mantenerse escépticos ante el logro: «No es lo ideal alegrarse porque un juez te dé la razón en los tribunales, estamos pidiendo que un médico nos diagnostique, como a un enfermo cualquiera y nada más».

**Publicado en "ABC"

Association found between long-term use of nonaspirin anti-inflammatory drugs and renal cell cancer

Long-term use of nonaspirin anti-inflammatory drugs (NSAIDs) is associated with an increased risk of renal cell cancer (RCC), according to a report in the September issue of Archives of Internal Medicine, one of the JAMA/Archives journals. According to background information in the article, in the United States, kidney cancer is the seventh leading type of cancer among men and the ninth leading type of cancer among women. The most common type of kidney cancer, renal cell cancer, accounts for 85 percent of all cases. Analgesics (pain-relieving medications) are among the most commonly used groups of drugs in the United States, and some appear to have protective effects against cancer. "However," the authors write, "some epidemiologic data, mainly from case-control studies, suggest an association between analgesic use and an increased risk of RCC."
Eunyoung Cho, Sc.D., from Harvard Medical School and Brigham and Women's Hospital, Boston, and colleagues examined the relationship between analgesic use and RCC risk. They used data from the Nurses' Health Study and the Health Professionals Follow-up Study, both prospective cohort studies. Beginning in 1990 in the Nurses' Health Study and 1986 in the Health Professionals Follow-up Study, and every two years thereafter, use of aspirin, other NSAIDs and acetaminophen was determined. Follow-up was 16 years and 20 years, respectively. The researchers evaluated the baseline and duration of use of analgesics. They also assessed other risk factors for RCC, such as body weight, smoking, recreational physical activity and history of hypertension.
Among the 77,525 women and 49,403 men included in the study, the researchers documented 333 RCC cases. No association was found between aspirin and acetaminophen use and RCC risk. An association was found between regular use of nonaspirin NSAIDs and an increased risk of RCC, with a 51 percent increase in the relative risk. The researchers noticed a dose-response relationship between duration of nonaspirin NSAID use and RCC risk; there was a 19 percent decrease in relative risk for use less than four years, a 36 percent increase in relative risk for use of analgesics for four years to less than 10 years and nearly three times the relative risk for use for 10 or more years.
"In these large prospective studies of women and men, we found that use of nonaspirin NSAIDs was associated with an elevated risk of RCC, especially among those who took them for a long duration," write the authors, who add that aspirin and acetaminophen were not associated with RCC risk. "Risks and benefits should be considered in deciding whether to use analgesics; if our findings are confirmed, an increased risk of RCC should also be considered."

**Source: JAMA and Archives Journals

Según un estudio, la melatonina incrementa la producción de insulina

La diabetes mellitus es una enfermedad metabólica crónica que aparece por deficiencias en la cantidad de insulina, lo que, a su vez, provoca un exceso de glucosa en la sangre. Los afectados por este trastorno tienen que controlar de por vida estos niveles, inyectarse insulina y cuidar su dieta.
Ahora, científicos de la Universidad de Granada (UGR) han demostado que la melatonina, una hormona que segrega de forma natural el cuerpo humano, ayuda a controlar la diabetes ya que incrementa la secreción de insulina, reduce la hiperglucemia y la hemoglobina glicada, disminuye los ácidos grasos libres y mejora la ratio leptina/adiponectina.
La oscuridad de la noche favorece la secreción de esta hormona, razón por la que los investigadores creen que dormir completamente a oscuras puede ayudar a controlar la diabetes asociada a la obesidad y los factores de riesgo asociados a la misma. Los mismos efectos se han demostrado con la ingesta de alimentos que la contienen, como la leche, cerezas y aceitunas o algunas especias como la mostaza, cúrcuma, cardamomo, hinojo o cilantro.
La melatonina se produce en el cerebro de todos los seres vivos en cantidades variables a lo largo del día, pero es inhibida por la luz y estimulada por la oscuridad. Alcanza su pico en la mitad de la noche, y gradualmente desciende, por lo que dormir a oscuras podría ayudar a controlar el sobrepeso, la diabetes, y a prevenir las enfermedades cardiovasculares asociadas, según la investigación de la UGR.

-Experimento con ratas Zucker
Para llegar a esta conclusión, los científicos de la UGR, en colaboración con el Servicio de Análisis Clínicos del Hospital San Cecilio de Granada y el Servicio de Endocrinología del Hospital Carlos III de Madrid, realizaron su experimento en ratas Zucker jóvenes obesas diabéticas, un modelo experimental que simula el desarrollo de la diabetes humana.
Los beneficios derivados de la administración de la melatonina se produjeron en ratas jóvenes, antes de desarrollar complicaciones metabólicas y vasculares, por lo que los científicos creen que la melatonina podría ayudar a mejorar las enfermedades cardiovasculares asociadas a la obesidad y la dislipidemia.
Los autores del estudio, cuyos resultados acaban de publicarse en revista «Journal of Pineal Research», destacan que, si estos hallazgos se confirman en humanos, la administración de melatonina y la ingesta de alimentos que la contienen podrían ser una herramienta para combatir la diabetes asociada a la obesidad y sus complicaciones vasculares.

**Agencias