Researchers quantify muscle soreness

Quantifying how sore a person is after a long workout is a challenge for doctors and researchers, but scientists from Loma Linda and Asuza Pacific Universities think they may have figured it out. Their research article describing a new technique to measure muscle soreness will be published in the Journal of Visualized Experiments (JoVE). Delayed onset muscle soreness (DOMS) or exercise-induced muscle damage (EIMD) is one of the most common sports injuries, but without a reliable method of quantifying muscle soreness, assessing treatments is difficult.
Traditionally, muscle soreness has been measured using the visual analogue scale (VAS). Participants mark their level of agreement to a statement along a continuous line. Rather than measuring soreness subjectively, the researchers used thermal imaging to detect subtle changes in the temperature of the skin above exercised muscles.
"The main advantage of this technique," said paper author Dr. Jerrold Petrofsky, "is that unlike visual scales, which are kind of a subjective measure of whether someone is sore or not, this technique gives you quantifiable, absolute data."
"There is no gold standard for measuring DOMS and other techniques, such as needle biopsies, are invasive and painful for patients," said JoVE Editor, Leiam Colbert. "The technique presented here allows for earlier diagnosis and quicker treatment of soreness."
The very visual technique was published recently in JoVE, the world's only peer reviewed, PubMed indexed science video journal.

*Picture:(c) Journal of Visualized Experiments
**Source: The Journal of Visualized Experiments

Una campaña viral para alertar de las dificultades de los discapacitados para obtener un empleo logra 100.000 visitas

Lifelong brain-stimulating habits linked to lower Alzheimer's protein levels

A new study led by researchers at the University of California, Berkeley, provides even more reason for people to read a book or do a puzzle, and to make such activities a lifetime habit. Brain scans revealed that people with no symptoms of Alzheimer's who engaged in cognitively stimulating activities throughout their lives had fewer deposits of beta-amyloid, a destructive protein that is the hallmark of the disease.
While previous research has suggested that engaging in mentally stimulating activities -- such as reading, writing and playing games -- may help stave off Alzheimer's later in life, this new study identifies the biological target at play. This discovery could guide future research into effective prevention strategies.
"These findings point to a new way of thinking about how cognitive engagement throughout life affects the brain," said study principal investigator Dr. William Jagust, a professor with joint appointments at UC Berkeley's Helen Wills Neuroscience Institute, the School of Public Health and Lawrence Berkeley National Laboratory. "Rather than simply providing resistance to Alzheimer's, brain-stimulating activities may affect a primary pathological process in the disease. This suggests that cognitive therapies could have significant disease-modifying treatment benefits if applied early enough, before symptoms appear."
An estimated 5.4 million Americans live with Alzheimer's disease, but the numbers are growing as baby boomers age. Between 2000 and 2008, deaths from Alzheimer's increased 66 percent, making it the sixth-leading killer in the country. There is currently no cure, but a draft of the first-ever National Alzheimer's Plan, released this week, revealed that the U.S. government is aiming for effective Alzheimer's treatments by 2025.
The new study, published Jan. 23 in the Archives of Neurology, puts the spotlight on amyloid -- protein fibers folded into tangled plaques that accumulate in the brain. Beta-amyloid is considered the top suspect in the pathology of Alzheimer's disease, so finding a way to reduce its development has become a major new direction of research.
The researchers note that the buildup of amyloid can also be influenced by genes and aging -- one-third of people age 60 and over have some amyloid deposits in their brain -- but how much reading and writing one does is under each individual's control.
"This is the first time cognitive activity level has been related to amyloid buildup in the brain," said study lead author Susan Landau, research scientist at the Helen Wills Neuroscience Institute and the Berkeley Lab. "Amyloid probably starts accumulating many years before symptoms appear. So it's possible that by the time you have symptoms of Alzheimer's, like memory problems, there is little that can be done to stop disease progression. The time for intervention may be much sooner, which is why we're trying to identify whether lifestyle factors might be related to the earliest possible changes."
The researchers asked 65 healthy, cognitively normal adults aged 60 and over (average age was 76) to rate how frequently they participated in such mentally engaging activities as going to the library, reading books or newspapers, and writing letters or email. The questions focused on various points in life from age 6 to the present.
The participants took part in extensive neuropsychological testing to assess memory and other cognitive functions, and received positron emission tomography (PET) scans at the Berkeley Lab using a new tracer called Pittsburgh Compound B that was developed to visualize amyloid. The results of the brain scans of healthy older individuals with various levels of lifetime cognitive activity were compared with those of 10 patients diagnosed with Alzheimer's disease and 11 healthy people in their 20s.
The researchers found a significant association between higher levels of cognitive activity over a lifetime and lower levels of beta-amyloid in the PET scans. They analyzed the impact of other factors such as memory function, physical activity, self-rated memory ability, level of education and gender, and found that lifelong cognitive engagement was independently linked to amyloid deposition.
Notably, the researchers did not find a strong connection between amyloid deposition and levels of current cognitive activity alone.
"What our data suggests is that a whole lifetime of engaging in these activities has a bigger effect than being cognitively active just in older age," said Landau.
The researchers are careful to point out that the study does not negate the benefits of kicking up brain activity in later years.
"There is no downside to cognitive activity. It can only be beneficial, even if for reasons other than reducing amyloid in the brain, including social stimulation and empowerment," said Jagust. "And actually, cognitive activity late in life may well turn out to be beneficial for reducing amyloid. We just haven't found that connection yet."

**Source: University of California - Berkeley

El pico máximo de la gripe se espera en España para finales de este mes

El virus de la gripe necesita un ambiente frío y seco, como un buen Martini, y cuenta ahora con las condiciones perfectas para expandirse. Los últimos datos de la Red Nacional de Vigilancia Epidemiológica muestran cómo la infección invernal se ha intensificado este mes y alcanza ya una situación epidémica en el centro del país y algunos puntos del Norte. En la segunda semana de febrero, Madrid, Castilla-La Mancha, sur de Extremadura y algunos puntos del norte de España tenían los niveles más altos de intensidad gripal. Cantabria, según datos regionales —no publicados aún por la red nacional— tiene ya una situación epidémica. En Andalucía, Aragón, Cataluña y Navarra y La Rioja, la intensidad de la gripe aún es media. Aunque está en aumento en toda la Península. Solo se libran de la gripe Canarias y Melilla.
El pico máximo de la gripe se alcanzará previsiblemente a finales de este mes.
Tres muertes
Esta temporada la infección no distingue edades. Aumenta en todos los grupos, aunque es significativo en los menores de 65 años. La edad sí que cuenta en la gravedad de los casos. Desde que comenzó la temporada de gripe el otoño pasado se han registrado 28 casos graves en seis comunidades autónomas que han necesitado hospitalización y tres muertes debidas a la infección, todos mayores de 44 años. Dos de los fallecidos tenían factores de riesgo, susceptibles de sufrir una complicación severa por la gripe. En general, los problemas más graves se han registrado en niños muy pequeños, entre 1 y 4 años, y entre los más mayores, a partir de los 64. En casi todos los casos, los pacientes presentaban factores de riesgo, como son las enfermedades cardiovasculares y respiratorias. El 96,4% correspondieron a infecciones por el virus de la gripe A , que llegó a España para quedarse.
En el resto de Europa la intensidad de la actividad gripal era aún baja, durante la primera semana de febrero. Se ha detectado en Italia, Suecia, Holanda, Noruega y Reino Unido, aunque está en claro aumento, como en España. La buena noticia es que hasta el momento, los virus gripales que circulan por el continente europeo no muestran resistencias a los antivirales específicos para su tratamiento, oseltamivir (tamiflu) y zanamivir.

**Publicado en "ABC"

Women report feeling pain more intensely than men, says Stanford study of electronic medical records

Women report more intense pain than men in virtually every disease category, according to Stanford University School of Medicine investigators who mined a huge collection of electronic medical records to establish the broad gender difference to a high level of statistical significance. Their study, published online in the Journal of Pain, suggests that stronger efforts should be made to recruit women subjects in population and clinical studies in order to find out why this gender difference exists.
The study also shows the value of EMR data mining for research purposes. Using a novel database designed especially for research, the Stanford scientists examined more than 160,000 pain scores reported for more than 72,000 adult patients. From these, they extracted cases where disease-associated pain was first reported, and then stratified these findings by disease and gender.
"None of these data were initially collected for research, but this study shows that we can use it in that capacity," said Atul Butte, MD, PhD, the study's senior author.
The medical literature contains numerous reports indicating that women report more pain than men for one or another particular disease, noted Butte, a professor of systems medicine in pediatrics. "We're certainly not the first to find differences in pain among men and women. But we focused on pain intensity, whereas most previous studies have looked at prevalence: the percentage of men vs. women with a particular clinical problem who are in pain. To the best of our knowledge, this is the first-ever systematic use of data from electronic medical records to examine pain on this large a scale, or across such a broad range of diseases."
The study's first authors were Butte's graduate student Linda Liu and postdoctoral scholar David Ruau, PhD, who splits his time between Butte's group and that of co-author Martin Angst, MD, professor of anesthesia. David Clark, MD, PhD, a professor of anesthesia, was another co-author.
Electronic medical records are deployed in about 1-2 percent of hospitals now, but that should approach 100 percent within the next few years as the United States continues to move toward EMRs, Butte said. Thus, large-scale research using clinically collected data will become increasingly feasible.
In this case, the scientists tapped an existing data archive that has been designed specifically for ease of research: the Stanford Translational Research Integrated Database Environment, or STRIDE. Pioneered by the medical school's chief information officer, Henry Lowe, MD (who is also an associate professor of systems medicine in pediatrics and director of Stanford's Center for Clinical Informatics), STRIDE aggregates clinical data on patients cared for at Stanford Hospital & Clinics and Lucile Packard Children's Hospital, making this data searchable for approved research projects.
Butte's team selected only adult records and looked for gender-related differences in pain intensity as reported on 1-to-10 scales, in which a zero stands for "no pain" and 10 for "worst imaginable." Their search algorithm combed through de-identified EMR data for more than 72,000 patients, and came up with more than 160,000 instances, ranging across some 250 different disease categories, in which a pain score had been reported.
"If someone's reporting that they're in pain, they're probably going to be given medication, which might reduce any subsequently measured pain score," said Butte. To get pain estimates that weren't as confounded by subsequent pain-relief medications or procedures, his group analyzed only the first pain-intensity score reported by a patient per encounter with a hospital-associated health professional.
The search identified 47 separate diagnostic categories for which there were more than 40 pain reports for each gender. The sample included more than 11,000 individual adult patients, of which 56 percent were women and 51 percent of them white. The researchers were able to further analyze these 47 categories by condensing them into 16 disease clusters: "musculoskeletal and connective tissue" (in which the biggest gender differences in reported pain intensity were observed), "circulatory" and so forth.
"We saw higher pain scores for female patients practically across the board," said Butte. Those reported differences were not only statistically significant, but also clinically significant. "In many cases, the reported difference approached a full point on the 1-to-10 scale. How big is that? A pain-score improvement of one point is what clinical researchers view as indicating that a pain medication is working."
While the overall results tended to confirm previous clinical findings -- for example, that female fibromyalgia or migraine patients report more pain than their male counterparts -- the search also unearthed previously unreported gender differences in pain intensity for particular diseases, for example acute sinusitis and "cervical spine disorders," more commonly known as neck pain.
The study's results come with a few caveats. First, the investigators made the assumption that patients' pain hadn't already been treated -- for example, that they hadn't already self-medicated with over-the-counter painkillers -- by the time they showed up in the emergency room, doctor's office or neighborhood health clinic (or, equivalently, that the men and women were equally likely to have done so).
Other possible confounders include the setting in which pain was reported, Butte said. "Will an 18-year-old male report the same pain intensity with or without his mom present, or in the presence of a male vs. a female nurse? We can't be sure." But the sheer size of the study probably washes these concerns out at least to some extent, he said.
The third caveat is perhaps the most controversial. "It's still not clear if women actually feel more pain than men do," said Butte. "But they're certainly reporting more pain than men do. We don't know why. But it's not just a few diseases here and there, it's a bunch of them -- in fact, it may well turn out to be all of them. No matter what the disease, women appear to report more-intense levels of pain than men do."
To get to the bottom of this, Butte's team plans to search EMRs to see if they can find some objective measurement -- an already commonly measured blood-test variable, for instance -- that correlates highly with reported pain. "We want to find a biomarker for pain," he said.

**Source: Stanford University Medical Center

Los problemas derivados del funcionamiento del sistema sanitario son uno de los desencadenantes de la violencia contra los médicos,según la OMC

El coordinador nacional del Observatorio de Agresiones de la Organización Médica Colegial, el doctor José Alberto Becerra, explica en una entrevista concedida al Diario “El Imparcial”, la importancia que está adquiriendo este Observatorio como herramienta tanto para cuantificar como para calificar la problemática de las agresiones a médicos, puesto como dice “con datos es más fácil buscar soluciones”.
Destaca como uno de los principales logros del Observatorio, “haber conseguido involucrar a los Colegios de Médicos”, así, “cuando los médicos tienen el respaldo de la asesoría jurídica de su Colegio, ya no tienen miedo a denunciar a alguien que lo ha intimidado y/o amenazado”.
El doctor Becerra también hace hincapié en la complejidad del problema, partiendo de la dificultad para evitarlo, “los médicos no pueden atender desde detrás de una vitrina blindada, puesto que la cercanía con el paciente es fundamental”.
Desde su punto de vista, la solución pasa por “mejorar la relación entre médico y paciente”, una relación que, a su juicio, “se está deteriorando”. Aunque subraya, por otra parte, que las agresiones suelen producirse por ‘discrepancias’ en la atención médica, es decir, "por problemas derivados del funcionamiento del sistema sanitario, no del médico”.
Respecto al plan de actuación que el Observatorio tiene establecido para 2012´(ver "MedicosyPacientes" del 18-1-12), el doctor Becerra destaca entre las acciones que se van a llevar a cabo: la unificación de datos con el fin de conocer más de fondo la situación; la elaboración de un macroestudio a partir de distintas bases de datos de departamentos de salud laboral, sindicatos, de otros países, etc.; la revisión de los diferentes convenios establecidos con CC.AA. para homogeneizar las penas a los agresores; y la consolidación del 22 de marzo como Día Nacional contra las Agresiones en el ámbito sanitario.

*La entrevista íntegra se puede consultar en la web: www.elimparcial.es/sociedad/la-mesa-del-medico-es-la-oficina-de-reclamaciones-del-sistema-98172.html

**Publicado en "MEDICOS Y PACIENTES"

El 85% de los pacientes diagnosticados con melanoma maligno supera este cáncer si hay diagnóstico precoz

Los pacientes con melanoma maligno (MM), tienen un porcentaje de supervivencia cercano al 100%, si se diagnostica precozmente. Si este tipo de cáncer de piel no se trata a tiempo puede llegar a comprometer la vida del paciente en un 15% de los casos, según un informe de la Unidad Multidisciplinaria del Melanoma del Hospital Universitario Nuestra Señora de Candelaria (Hunsc).
La unidad interdepartamental del Hunsc, adscrito a la Consejería de Sanidad del Gobierno de Canarias, es una de las más completas de España, y en ella colaboran activamente especialistas de servicios como Dermatología, Anatomía Patológica, Cirugía General y Digestiva, Cirugía Plástica, Medicina Nuclear, Oncología Médica y Oncología Radioterápica, así como Oftalmología y Otorrinolaringología. Esta línea de trabajo permite ofrecer una asistencia homogénea a todos los pacientes, siguiendo los estándares médicos para cada fase y estadio de cada lesión.
Estos especialistas han debatido en unas jornadas celebradas en el hospital de La Candelaria las estrategias de futuro, los avances terapéuticos y las líneas de investigación en torno a esta patología.
"La edad media de los pacientes atendidos en la Unidad Multidisciplinaria del Melanoma del Hospital de La Candelaria es de 56 años y por sexos, las mujeres suponen el 60% de las personas diagnosticadas con este tipo de cáncer, y se puede afirmar que sus melanomas son más finos, menos profundos que los que presentan los hombres", explica el dermatólogo Ricardo Fernández de Misa.
El pronóstico del MM se relaciona de forma muy importante con la profundidad que alcanza el tumor siendo la mortalidad prácticamente inexistente en aquellos casos muy precoces o 'in situ', y aumentando en casos de lesiones que invaden zonas más profundas de la piel. En estos casos, la enfermedad puede diseminarse por ganglios linfáticos y otros órganos poniendo en peligro la vida del paciente.
Sin embargo, a pesar de que los tratamientos son cada vez más personalizados y consiguen resultados óptimos, el diagnóstico precoz y las medidas de prevención son las herramientas más eficaces para luchar contra el melanoma maligno, cuya incidencia ha ido aumentando en todo el mundo y en ambos sexos. "Los factores genéticos no pueden modificarse pero sí otros, como evitar una excesiva exposición solar", asevera Fernández de Misa.