Avastin can stabilize tumors in ovarian cancer, studies find

Two independent groups working with advanced-stage cases say the drug extended the period before the disease worsened by more than 3.5 months.Avastin can stabilize tumors in women suffering from advanced-stage ovarian cancer, extending the period before the disease worsens by more than 3.5 months, according to the results of two large, international clinical trials conducted by separate research teams.

**Read the whole article on LA Times - Science

Los médicos del Hospital Brigham and Women's cuentan los tres casos de trasplantes de cara

Un hombre sin rostro, la mujer deformada por un chimpancé y el que no salía a la calle por miedo a los comentarios. Podrían ser frases de circo para presentar a personajes cómicos o teatrales, sin embargo corresponden a pacientes que, por un motivo u otro, perdieron su rostro y con él su identidad. Estas tres personas han recuperado su normalidad gracias a los trasplantes de cara realizados en el Hospital Brigham and Women's (BWH), en Boston (EEUU). Los médicos que participaron en estas tres operaciones cuentan ahora en la revista médica 'The New England Journal of Medicine' cuáles son las claves de estos trasplantes y cómo ha sido la evolución de los pacientes.

Dallas Wiens, de 25 años, perdió por completo su rostro tras un aparatoso accidente eléctrico en el año 2008. No podía respirar por la nariz, no tenía ninguna expresión facial... No tenía rostro, en definitiva. Pero tras 17 horas en quirófano, recibir 24 unidades de hematíes y 13 de plasma, es decir, entre tres y cuatro litros de sangre, salió con una nueva cara que le permitió, meses después, aparecer públicamente para dar las gracias a la familia del donante. Detalles de esta operación, y de las otras tres realizadas en el BWH, son ahora publicados para compartir esta experiencia con el resto de médicos que están, o quieren estar, implicados en un trasplante de cara.
"A diferencia que la reconstrucción convencional, el trasplante de cara busca transformar los rostros deformados en otros con una apariencia y funcionamiento casi normal, algo que las convencionales técnicas quirúrgicas de cirugía plástica reconstructiva no pueden lograr", explica el doctor Bohdan Pomahac, principal autor del estudio, director del Programa de Cirugía Plástica de Trasplantes en el BWH y cirujano jefe en las tres intervenciones que ahora publican.
Este cirujano, junto con el resto de su equipo, cuenta cómo utilizaron determinados nervios de los donantes, como los de los brazos, para unirlos a los colgajos de la cara de los receptores. "Nuestra estrategia quirúrgica utiliza todos los grades nervios motores y sensitivos para ofrecer un feedback propioceptivo [señales del injerto al organismo] a medida que el injerto se recupera, facilitando la integración cortical de la nueva cara", señalan los médicos del BWH.
En cuanto a la circulación facial, los cirujanos explican que planificaron la recuperación de los tejidos implantados mediante un suplemento vascular simplificado "guiado por un preciso mapa de los vasos en el receptor", ya que, según explican, implantar vaso por vaso hubiera complicado y prolongado la recuperación del injerto. Con esta técnica consiguieron la recuperación facial de los tres pacientes en menos de cuatro horas.


Charla Nash. Amplíe si quiere ver su cara antes de la operación. BWH
A pesar del espectacular resultado que se pudo ver en cada uno de estos tres pacientes, el postoperatorio no fue un camino de rosas. Charla Nash, la mujer que fue atacada por un chimpancé y que se quedó sin nariz, ojos, labios y maxilar, sufrió un rechazo agudo al mes y medio de ser intervenida, sufrió una trombosis venosa profunda en la pierna izquierda en el tercer mes, y tuvo varias infecciones. No obstante, ha tenido avances en su recuperación. Antes de ser intervenida no podía respirar, hablaba con dificultad, no tenía expresión facial y era incapaz de cerrar la boca. Gracias al trasplante, a los dos meses podía respirar por la nariz y por la boca. También ha ido adquiriendo sensibilidad en diferentes zonas de su cara, aunque por el momento no ha recuperado la función motora.

Por su parte, James Maki, que perdió su nariz, el labio superior, las mejillas, el paladar así como varios músculos y nervios de su cara tras caer sobre un raíl electrificado en el metro de Boston en 2005, sufrió una neumonía al segundo día de ser intervenido. A pesar de este contratiempo, al ser dado de alta de la UCI, cuatro días después de su operación, ya podía comer, beber y ver con su nueva cara. Sin embargo, dos semanas después presentó un rechazo del que se recuperó y fue dado de alta dos meses más tarde. En el momento de la recopilación de datos para este artículo, el paciente ya tenía sensación en su frente y barbilla y movía sus labios burdamente.
"Nuestro objetivo sigue siendo documentar el progreso de los pacientes que han recibido un trasplante de cara, y perfeccionar el uso de los inmunosupresores", afirma Pomahac. De hecho, en el artículo que publican ahora estos cirujanos señalan que esperan inminentes y graduales cambios en la apariencia facial de estos pacientes. "Anticipamos que el esqueleto y el volumen facial podrían moldear la apariencia final, haciendo improbable el parecido con los donantes. Es nuestra opinión subjetiva, al igual que la de las familias de dos donantes, que opinan que los pacientes no se parecen a sus familiares (la otra familia ha elegido permanecer en el anonimato)", explican los médicos.

**Publicado en "EL MUNDO"

Los Angeles Vote to Decide on Condoms in Sex Films

Come June, voters here will have a chance to cast their ballots in the presidential primary. Along with their presidential preferences, they will be asked to decide whether actors in pornographic films should be required to wear condoms.
For several years, the AIDS Healthcare Foundation has been lobbying state, county and city lawmakers to enact legislation that would force adult film performers and makers to use condoms and charge a fee to pay for inspections to make sure that they comply.
Growing frustrated in its efforts, the group moved this summer to get the issue placed on the city ballot.
“All politicians have treated this as a hot potato issue,” said Michael Weinstein, president of the AIDS Healthcare Foundation. “The city punts to the county, the county punts to the state, and the State Legislature has punted. We’ve taken it to the voters as a last resort, and that is testimony to the lack of leadership on the issue.”
Los Angeles County officials have said that it would be too difficult to monitor the pornography industry through the health department and that it is a matter for the State Legislature. But Mr. Weinstein said that the group had not been able to find any state lawmaker willing to introduce the bill.
The group collected more than 70,000 signatures, nearly double the 41,000 needed to get the measure on the ballot. The city clerk certified the signatures this week, but the measure still faces legal challenges. The city attorney, Carmen Trutanich, filed papers in court saying that it appeared that voters in the city did not have the legal authority to adopt the measure and that only the state could mandate such regulations.
Under current regulations issued by the California Division of Occupational Safety and Health, actors are required to use condoms. But the agency can act only after it receives a complaint, and it has issued few fines on the matter.
Officials have said that they believe the city could legally require its own inspections, as the proposal seeks.
“We believe that cities and counties can regulate under their police power unless specifically restricted by something else,” Ellen Widess, the director of the state division, wrote to city attorneys last week.
Mr. Weinstein said that with its limited resources, there was little the agency could do to force filmmakers to comply with the current regulations.
Steven Hirsch, a pornography industry veteran and the founder of Vivid Entertainment, said that even if the measure was passed, it would be nearly impossible to enforce.
“It’s unrealistic to think that a city can regulate how movies are being shot,” Mr. Hirsch said. “People will just film elsewhere and take the jobs with them. And what are they going to do, have condom police out and about patrolling the set?”

**Follow @NYTNational

Tests for biomarker may help determine diagnosis of heart attack within hours

For patients admitted to an emergency department with chest pain, use of a contemporary or highly sensitive test for levels of troponin I (a protein in muscle tissue) may help rule-out a diagnosis of heart attack, while changes in the measured levels of this biomarker at 3 hours after admission may be useful to confirm a diagnosis of heart attack, according to a study in the December 28 issue of JAMA. One of the most common reasons patients seek care in an emergency department is for acute chest pain. "Early identification of individuals at high and intermediate risk for myocardial ischemia [insufficient blood flow to the heart muscle] is crucial because they benefit the most from early and aggressive treatment. According to international consensus and task force definitions of myocardial infarction [(MI; heart attack], the diagnosis of MI is based mainly on an elevated cardiac troponin level exceeding the 99th percentile and demonstrating an increase or decrease over time," the authors write. Highly sensitive troponin assays have been developed recently that reliably assess troponin levels in more than 50 percent of the general population. "The reliable detection of very low troponin concentrations using these new highly sensitive assays in the acute setting might pose a challenge in everyday clinical practice."
Till Keller, M.D., of the University Heart Center Hamburg, Germany, and colleagues evaluated the diagnostic performance of the newly developed highly sensitive troponin I (hsTnI) assay compared with a contemporary troponin I (cTnI) assay and their serial changes in the diagnosis of heart attack. The study included a total of 1,818 patients with suspected acute coronary syndrome (condition such as heart attack or angina) who were enrolled at chest pain units in Germany from 2007 to 2008. Twelve biomarkers including hsTnI and cTnI were measured on admission and after 3 and 6 hours.
Of the patients in the study, 413 (22.7 percent) had a final discharge diagnosis of acute MI. For discrimination of acute MI, both hsTnI and cTnI were superior to the other evaluated diagnostic biomarkers. Using the 99th percentile cutoff, hsTnI on admission had a sensitivity of 82.3 percent and negative predictive value (NPV) of 94.7 percent; hsTnI determined after 3 hours had a sensitivity of 98.2 percent with NPV of 99.4 percent. Compared with hsTnI, the cTnI assay (using the 99th percentile as cutoff) had comparable sensitivity and NPV: 79.4 percent sensitivity and 94.0 percent NPV on admission, and 98.2 percent sensitivity and 99.4 percent NPV after 3 hours.
"Combining the 99th percentile cutoff at admission with the serial change in troponin concentration within 3 hours, the positive predictive value (for ruling in AMI) for hsTnI increased from 75.1 percent at admission to 95.8 percent after 3 hours, and for cTnl increased from 80.9 percent at admission to 96.1 percent after 3 hours," the authors write.
"The shortcoming of conventional troponin assays with low sensitivity within the first hours after chest pain onset led to the evaluation of various so-called early biomarkers in the diagnosis of MI. In our study, the diagnostic information of hsTnI was superior to all other evaluated biomarkers alone."
"Use of hsTnI and cTnI assays in patients with suspected MI provides useful diagnostic information," the researchers write. "Determination of hsTnI and cTnI values 3 hours after admission to the emergency department with use of the 99th percentile cutoff provides an NPV greater than 99 percent, potentially allowing a safe rule-out of MI. Application of the relative change in hsTnI or cTnI concentration within 3 hours after admission in combination with the 99th percentile diagnostic cutoff value on admission improves specificity and may facilitate an accurate early rule-in of MI."

**Source: JAMA and Archives Journals

UT Southwestern research suggests new way to ensure effectiveness of TB treatment

A UT Southwestern Medical Center study using a sophisticated "glass mouse" research model has found that multidrug-resistant tuberculosis (TB) is more likely caused in patients by speedy drug metabolism rather than inconsistent doses, as is widely believed. If the study published in The Journal of Infectious Diseases is borne out in future investigations, it may lead to better ways to treat one of the world's major infectious diseases. Health workers worldwide currently are required to witness each administration of the combination of drugs during months of therapy.
"Tuberculosis is a common ailment, accounting for up to 3 percent of all deaths in many countries. Although effective therapy exists, there are still cases of treatment failure and drug resistance remains a threat," said Dr. Tawanda Gumbo, associate professor of internal medicine and senior author of the study.
The results seem to challenge the current approach endorsed by the World Health Organization.
Under that method, directly observed therapy-short-course strategy (DOTS), TB that responds to medication is treated with a cocktail of drugs under the supervision of health care workers, who in many countries must travel to isolated villages -- a costly and time-consuming process.
"Every TB patient is supposed to be watched as they swallow their pills in order to increase adherence and decrease emergence of drug resistance. This is the most expensive part of the program, but has been felt to be cost-effective since it improves compliance," said Dr. Gumbo, administrative director of research programs for the Office of Global Health at UT Southwestern.
In this study, UT Southwestern researchers created a sophisticated system of high-tech test tubes, which they called a "glass mouse," that mimicked standard therapy being given daily for 28 to 56 days, with dosing adherence varying between 0 percent and 100 percent. The threshold for defined non-adherence (failure to take a required dose of medication) was reached at 60 percent of the time or more.
"The first main finding in our laboratory model was that in fact non-adherence did not lead to multidrug resistance or emergence of any drug resistance in repeated studies, even when therapy failed. In fact, even when we started with a bacterial population that had been spiked with drug-resistant bacteria, non-adherence still did not lead to drug resistance," he said.
In fact, using computer simulations based on 10,000 TB patients in Cape Town, South Africa, the researchers discovered that approximately 1 percent of all TB patients with perfect adherence still developed drug resistance because they cleared the drugs from their bodies more quickly.
The body sees drugs as foreign chemicals and tries to rid itself of them, Dr. Gumbo said. A population of individuals with a genetic trait that speeds the process has been found in one area of South Africa that has a high rate of multidrug-resistant TB. In that population, patients who receive standard doses of drugs end up with concentrations in their bodies that are too low to kill the TB bacillus and drug resistance develops, he said.
A Journal of Infectious Diseases editorial that accompanies the study suggests that monitoring the levels of TB drugs in a patient's blood could be as important as monitoring compliance with therapy -- in contrast to current WHO guidelines.
"These data, based on our preclinical model, show that non-adherence alone is insufficient for the emergence of multidrug-resistant TB," Dr. Gumbo said. "It might be more cost-effective to measure patients' drug concentrations during treatment and intervene with dosage increases in those who quickly clear the drugs from their systems."

**Source: UT Southwestern Medical Center

El número de altas con internamiento en los hospitales españoles descendió un 1,3% en 2010, según la última encuesta de Morbilidad del INE

En 2010 se produjeron 4.720.545 altas hospitalarias con internamiento en España, lo que supone un 1,3% menos que en 2009 y se consolida como la segunda bajada anual consecutiva de este tipo de altas, según la última encuesta de movilidad del Instituto Nacional de Estadística
Las enfermedades del aparato circulatorio y los episodios de embarazo y parto originaron el mayor número de altas. La tasa de altas por 100.000 habitantes se situó en 10.246, un 1,6% menos. Esto se debió, fundamentalmente, a la disminución de los episodios de embarazo y parto, por segundo año consecutivo, y al aumento de la cirugía ambulatoria sin pernoctación en los centros hospitalarios.
El 53,6% del total de altas correspondió a mujeres. Sin embargo, si se excluyeran las altas producidas por los episodios de embarazo, parto y puerperio, el mayor porcentaje de participación correspondería a los hombres (52,9%). A continuación se adjunta el informe íntegro.

informemorbilidad.pdf

**Publicado en "MEDICOS Y PACIENTES"

Jaime del Barrio( director general del Instituto Roche): "La Medicina Individualizada no es ciencia-ficción sino una auténtica realidad"

-El Instituto Roche cumple ya ocho años de vida y fue un pionero en la Medicina individualizada
--En este tiempo hemos sido espectadores de un avance imparable y positivo para la sociedad. Muchos de los hitos que se habían cifrado para el año 2020 ya son una realidad. En diez años de la secuenciación del genoma humano se ha avanzado de forma insospechada y esto ha venido acompañado de una tecnología avanzada para estos casos. La Medicina individualizada no es ciencia-ficción sino una auténtica realidad. En tres años el cambio ha sido notable

-¿Se constata que desde la sociedad se puede pensar que la Medicina individualizada es cara?
--No. Esta es una teoría falsa porque con el paso del tiempo se está demostrando un coste efectividad. Es simplemente dar el mejor tratamiento posible con menos gastos sociales. Antes se atendía a un grupo de pacientes en general y ahora se busca a un enfermo concreto para hacerlo más efectivo y seguro. A la larga, por ejemplo, se reducen los costes en fármacos, se evitan largas hospitalizaciones y menos efectos secundarios. Sólo lo que realmente necesitan. Y la tecnología es accesible a todas las personas

-Hay datos concretos al respecto
--Un test de diagnóstico puede resultar muy barato ya que significaría el ahorro de tratamiento de veinte pacientes. Hace cinco años no sabíamos cómo responderían las cosas, pero los avances son notables y sirven para todo
el mundo. No estamos en una Medicina para ricos.

-¿Cómo están respondiendo las Administraciones?.
--Positivamente. Apuestan por este futuro y el caso de la Junta de Andalucía es evidente desde hace tiempo.

-Los proyectos del Instituto Roche para 2012
--Convencer a la gente que la prioridad es el día a día, pero preparando el futuro. Para ello estamos ultimando acuerdos con más grupos de investigación y centros interesados en esta línea. También apostamos por las nuevas
tecnologías con las redes sociales y queremos tejer una red de alianzas estratégicas con Centros de Excelencia dentro de la Red del Sistema Nacional de Salud. Nuestro objetivo es optimizar recursos y utilizar herramientas útiles para los profesionales. También seguiremos con Jornadas y Seminarios por toda España.