A medication commonly used to help people stop smoking may have an unanticipated positive side effect for an entirely different vice: drinking alcohol. A new study by University of Chicago researchers finds that varenicline, sold as Chantix, increases the negative effects of alcohol and therefore could hold promise as a treatment for alcoholism. A group of heavy-to-moderate social drinkers given a single dose varenicline three hours before an alcoholic beverage reported increased dysphoria and reduced "liking," even when researchers controlled for the effects of nausea from the drug. Those effects upon the subjective response to alcohol could reduce drinking in people prone to bingeing and other forms of abuse.
"We found that varenicline increased the unpleasant effects of alcohol and decreased drug liking," said Emma Childs, PhD, research associate at the University of Chicago Medicine and first author of the study published in Alcoholism: Clinical and Experimental Research. "Thus, we think that varenicline may reduce drinking by altering the effects of alcohol."
Some patients prescribed Chantix to quit smoking have anecdotally reported a reduction in consumption of alcohol as well, and controlled studies in animals and humans have supported the effect. Researchers are now looking for neurobiological mechanisms that connect varenicline, a partial agonist of the brain's nicotinic receptors, with reduced alcohol craving or consumption.
"Smokers who use varenicline are approximately two to three times more likely to remain abstinent six months or more after their quit date," said Childs. "After it was approved, several patients treated with varenicline also reported reductions in their drinking, so investigators began to assess if this was an actual effect and how it might be produced."
The new experiment is the first to look at the acute effects of a single dose of varenicline on the subjective response to a subsequent alcoholic drink. Subjects were recruited based on heavy drinking behavior, not smoking behavior -- though the recruits did smoke 4 cigarettes a day on average.
15 subjects (8 men and 7 women) were brought to the laboratory for six different sessions. On each day, the subject received either a varenicline or placebo capsule, and then three hours later was given a drink containing 0, 0.4, or 0.8 mg/kg alcohol. Researchers monitored the effects of the drink on cardiovascular and eye movement measures, and subjects filled out questionnaires to report the subjective effects of the drink.
Compared to sessions where the subjects received a placebo pill, varenicline increased nausea, heart rate, blood pressure. After an alcoholic drink, self-reported dysphoria was increased while alcohol effects on subconscious eye movements (a measure of the drugs' objective effects) were reduced. Even after controlling for the effect of nausea upon the subsequent response to a drink, the increased dysphoria and reduced "drug liking" after drinking alcohol remained significant.
By increasing the negative effects of alcohol, varenicline might be most effective in people who are unable to stop consuming alcohol after only one drink, Childs said.
"Our findings shed light on the mechanism underlying why people consume less alcohol when they have taken varenicline," said Childs. "The pleasurable effects of alcohol, for example feeling 'buzzed' and talkative, are associated with greater consumption and binge drinking. Some people lose control of their alcohol consumption during a drinking episode, for example they may aim to only have one or two drinks but end up drinking say four or five. If varenicline counteracts these positive effects by producing unpleasant effects, then as a result people may consume less alcohol during a drinking episode."
The authors cautioned that their study only examined the acute effect of a single dose of varenicline, rather than the sustained exposure experienced with regular use of the drug. But because the effectiveness of varenicline has already been proven as a smoking cessation drug, the unanticipated effects on drinking may make people struggling with both behaviors a logical first target.
"Varenicline may find a nice niche in those individuals who are both nicotine and alcohol dependent, who we know represent a large portion of alcohol-dependent individuals," added Hugh Myrick, associate professor of psychiatry at the Medical University of South Carolina, who was not involved in the study. "Since there is a high comorbidity between nicotine and alcohol dependence, a single medication that could decrease the use of both substances would be ideal."
*Source: University of Chicago Medical Center
16 February 2012
Tener mascota ayuda a cumplir las recomendaciones de ejercicio diario en las embarazadas
Las embarazadas que tienen perro hacen más ejercicio. Según un estudio publicado en la revista 'PLoS One', cumplen con los 30 minutos diarios recomendados en un 50% más que las mujeres que no tienen mascota. Dados los beneficios de esta práctica sobre la salud, los investigadores proponen incluir esta forma de paseo en compañía como estrategia para mejorar los hábitos de las gestantes.
Como argumentan los autores del artículo, de la Universidad de Liverpool (Reino Unido), numerosos estudios demuestran que "la obesidad o una subida importante de peso durante el embarazo puede afectar tanto a la madre como al bebé. Por ejemplo, podría ocasionar dificultades en el nacimiento o tener implicaciones en el desarrollo de una futura obesidad del niño".
Según Jackie Calleja, ginecólogo del Hospital Universitario Quirón Madrid, se sabe que "la actividad sedentaria junto a una dieta poco equilibrada y sobrepeso son factores de riesgo para desarrollar enfermedades que aparecen en el segundo y tercer trimestre de la gestación, como la preeclampsia, la diabetes gestacional, fatiga...".
Por estas razones, recalcan los expertos del estudio británico, los médicos hacen un seguimiento constante del peso y aconsejan realizar ejercicio diario. El ginecólogo español da algunas pistas: "Conviene hacer ejercicio, no deporte, aeróbico entre 30 y 40 minutos tres o cuatro días a la semana. Yoga, pilates, jogging, natación para embarazadas, pasear en bicicleta, caminar. Lo importante es que la embarazada esté activa y se mueva a un ritmo normal, a una intensidad media. Por ejemplo, en media hora pasear unos dos kilómetros".
Normalmente, las gestantes optan por caminar, señala Carri Westgarth, uno de los autores de la investigación. "Aunque ya se había demostrado que tener perro aumenta la actividad física en los adultos en general, este es el primer estudio que valora esta relación en las embarazadas", agrega.
Y la respuesta es afirmativa. Después de analizar a más de 11.000 gestantes, "observamos que tener uno o más perros les ayuda a alcanzar los 150 minutos de ejercicio recomendado a la semana". Los resultados muestran que tener mascota es una motivación y "obliga a mantener actividad física diaria", ya que supone un compromiso con el cuidado del animal. Sin embargo, aclaran los investigadores, no se puede decir que la compañía de un perro esté relacionada con menor peso durante la gestación. Lo que sí se puede decir es que ayuda a promover el ejercicio durante esta etapa, por lo que convendría "estudiar cómo puede incluirse como estrategia de salud y analizar qué tipo son las más adecuadas", entre otros factores.
**publicado en "EL MUNDO"
Como argumentan los autores del artículo, de la Universidad de Liverpool (Reino Unido), numerosos estudios demuestran que "la obesidad o una subida importante de peso durante el embarazo puede afectar tanto a la madre como al bebé. Por ejemplo, podría ocasionar dificultades en el nacimiento o tener implicaciones en el desarrollo de una futura obesidad del niño".
Según Jackie Calleja, ginecólogo del Hospital Universitario Quirón Madrid, se sabe que "la actividad sedentaria junto a una dieta poco equilibrada y sobrepeso son factores de riesgo para desarrollar enfermedades que aparecen en el segundo y tercer trimestre de la gestación, como la preeclampsia, la diabetes gestacional, fatiga...".
Por estas razones, recalcan los expertos del estudio británico, los médicos hacen un seguimiento constante del peso y aconsejan realizar ejercicio diario. El ginecólogo español da algunas pistas: "Conviene hacer ejercicio, no deporte, aeróbico entre 30 y 40 minutos tres o cuatro días a la semana. Yoga, pilates, jogging, natación para embarazadas, pasear en bicicleta, caminar. Lo importante es que la embarazada esté activa y se mueva a un ritmo normal, a una intensidad media. Por ejemplo, en media hora pasear unos dos kilómetros".
Normalmente, las gestantes optan por caminar, señala Carri Westgarth, uno de los autores de la investigación. "Aunque ya se había demostrado que tener perro aumenta la actividad física en los adultos en general, este es el primer estudio que valora esta relación en las embarazadas", agrega.
Y la respuesta es afirmativa. Después de analizar a más de 11.000 gestantes, "observamos que tener uno o más perros les ayuda a alcanzar los 150 minutos de ejercicio recomendado a la semana". Los resultados muestran que tener mascota es una motivación y "obliga a mantener actividad física diaria", ya que supone un compromiso con el cuidado del animal. Sin embargo, aclaran los investigadores, no se puede decir que la compañía de un perro esté relacionada con menor peso durante la gestación. Lo que sí se puede decir es que ayuda a promover el ejercicio durante esta etapa, por lo que convendría "estudiar cómo puede incluirse como estrategia de salud y analizar qué tipo son las más adecuadas", entre otros factores.
**publicado en "EL MUNDO"
Genetic mutation implicated in 'broken' heart
For decades, researchers have sought a genetic explanation for idiopathic dilated cardiomyopathy (DCM), a weakening and enlargement of the heart that puts an estimated 1.6 million Americans at risk of heart failure each year. Because idiopathic DCM occurs as a familial disorder, researchers have long searched for genetic causes, but for most patients the etiology for their heart disease remained unknown. Now, new work from the lab of Christine Seidman, a Howard Hughes Investigator and the Thomas W. Smith Professor of Medicine and Genetics at Harvard Medical School and Brigham and Women's Hospital, and Jonathan Seidman, the Henrietta B. and Frederick H. Bugher Foundation Professor of Genetics at Harvard Medical School, has found that mutations in the gene TTN account for 18 percent of sporadic and 25 percent of familial DCM.
"Until the development of modern DNA sequencing platforms, the enourmous size of the TTN gene prevented a comprehensive analyses -- but now we know TTN is a major cause of DCM," said Christine Seidman, who reported the findings February 16 in the New England Journal of Medicine.
Idiopathic DCM is one of three different types of cardiomyopathy (the term "idiopathic" indicates that acquired causes for DCM such as atherosclerosis, excess drinking or viral infections have been excluded). It affects only about 4 in 10,000 Americans, but may be under-diagnosed because symptoms often appear late in the course of disease. DCM may cause shortness of breath, chest pain, and limited exercise capacity. DCM increases the risk of developing heart failure, for which no cure is available, and the risk of stroke and sudden cardiac death.
These findings will not only help patients understand the cause of their DCM symptoms, but also help to screen family members who might be at risk of developing the condition. Early identification of those at risk allows early intervention with medications that reduce workload on the heart and help prevent the changes in heart muscle, called remodeling, that lead to heart failure.
As DCM progresses, remodeling of the heart tissue makes the heart more prone to disturbances in the normal heart rhythm that can lead to stroke, heart attack and sudden death. "One of the added values to knowing that you are at risk for developing DCM is that we can do prophylactic screening so that silent arrhythmias are picked up before they become harmful," said Christine Seidman. "The discovery is immediately translatable into clinical practice to provide patients with gene-based diagnosis." The Partner's Laboratory for Molecular Medicine, an HMS affiliate, has incorporated TTN analyses.
The Seidmans and others had previously linked other gene mutations to about 20 to 30 percent of idiopathic DCM cases -- and, with more success, to a related disease, hypertrophic cardiomyopathy. They had examined almost all of the genes linked to muscle units known as sarcomeres, but saved the biggest for last: TTN, which encodes the protein titin. At approximately 33,000 amino acids, titin is the largest human protein.
"Titin was a missing link," said Christine Seidman. "A very large missing link."
The Seidmans' collaborated with researchers from the Imperial College (London) and the University of Washington. Traditional sequencing methods had previously found only a few TTN variants in patients with DCM because complete, accurate sequencing was too expensive.
Using next generation sequencing tools that substantially reduce the cost per base (the TTN sequence contains 100,000 bases) by orders of magnitude over earlier standards, the Seidmans were able to perform comprehensive screening for TTN mutations for the first time. They analyzed TTN in 312 DCM patients, 231 HCM patients, and 249 individuals with no disease.
Of the many mutations identified, 72 make the titin protein shorter.
Called TTN truncating variants, these specific mutations appeared almost exclusively in patients with DCM. "Our hypothesis is that any variant that shortens titin is going to cause DCM, which will lead to heart failure by the same mechanism," said Jonathan Seidman.
To identify the pathological mechanism, the Seidmans plan to model a handful of TTN truncating mutations in mice.
One concern in the search for disease causing genes is that, while there will be many gene variants discovered, only a few will cause disease. This is particularly true for missense mutations that cause single nucleotide changes -- changes that substitute a single amino acid within the protein.
"We often don't know if a missense mutation significantly impacts a protein's function, until we model it and study its effects," said Jonathan Seidman.
However, in the case of truncating mutations, "it's the converse," he continued. "We don't have to model all of those different mutations that truncate titin, becuase they all foreshorten the protein. We can pick a few representative ones and expect that they will reveal a common mechanism."
*Source: Harvard Medical School
"Until the development of modern DNA sequencing platforms, the enourmous size of the TTN gene prevented a comprehensive analyses -- but now we know TTN is a major cause of DCM," said Christine Seidman, who reported the findings February 16 in the New England Journal of Medicine.
Idiopathic DCM is one of three different types of cardiomyopathy (the term "idiopathic" indicates that acquired causes for DCM such as atherosclerosis, excess drinking or viral infections have been excluded). It affects only about 4 in 10,000 Americans, but may be under-diagnosed because symptoms often appear late in the course of disease. DCM may cause shortness of breath, chest pain, and limited exercise capacity. DCM increases the risk of developing heart failure, for which no cure is available, and the risk of stroke and sudden cardiac death.
These findings will not only help patients understand the cause of their DCM symptoms, but also help to screen family members who might be at risk of developing the condition. Early identification of those at risk allows early intervention with medications that reduce workload on the heart and help prevent the changes in heart muscle, called remodeling, that lead to heart failure.
As DCM progresses, remodeling of the heart tissue makes the heart more prone to disturbances in the normal heart rhythm that can lead to stroke, heart attack and sudden death. "One of the added values to knowing that you are at risk for developing DCM is that we can do prophylactic screening so that silent arrhythmias are picked up before they become harmful," said Christine Seidman. "The discovery is immediately translatable into clinical practice to provide patients with gene-based diagnosis." The Partner's Laboratory for Molecular Medicine, an HMS affiliate, has incorporated TTN analyses.
The Seidmans and others had previously linked other gene mutations to about 20 to 30 percent of idiopathic DCM cases -- and, with more success, to a related disease, hypertrophic cardiomyopathy. They had examined almost all of the genes linked to muscle units known as sarcomeres, but saved the biggest for last: TTN, which encodes the protein titin. At approximately 33,000 amino acids, titin is the largest human protein.
"Titin was a missing link," said Christine Seidman. "A very large missing link."
The Seidmans' collaborated with researchers from the Imperial College (London) and the University of Washington. Traditional sequencing methods had previously found only a few TTN variants in patients with DCM because complete, accurate sequencing was too expensive.
Using next generation sequencing tools that substantially reduce the cost per base (the TTN sequence contains 100,000 bases) by orders of magnitude over earlier standards, the Seidmans were able to perform comprehensive screening for TTN mutations for the first time. They analyzed TTN in 312 DCM patients, 231 HCM patients, and 249 individuals with no disease.
Of the many mutations identified, 72 make the titin protein shorter.
Called TTN truncating variants, these specific mutations appeared almost exclusively in patients with DCM. "Our hypothesis is that any variant that shortens titin is going to cause DCM, which will lead to heart failure by the same mechanism," said Jonathan Seidman.
To identify the pathological mechanism, the Seidmans plan to model a handful of TTN truncating mutations in mice.
One concern in the search for disease causing genes is that, while there will be many gene variants discovered, only a few will cause disease. This is particularly true for missense mutations that cause single nucleotide changes -- changes that substitute a single amino acid within the protein.
"We often don't know if a missense mutation significantly impacts a protein's function, until we model it and study its effects," said Jonathan Seidman.
However, in the case of truncating mutations, "it's the converse," he continued. "We don't have to model all of those different mutations that truncate titin, becuase they all foreshorten the protein. We can pick a few representative ones and expect that they will reveal a common mechanism."
*Source: Harvard Medical School
Medidas contra el suicidio que sí funcionan en el Reino Unido
La prevención del suicidio debería ser una prioridad internacional. En España, 10 personas se quitan la vida cada día. En el mundo, y según datos de la OMS, cada 40 segundos se suicida una persona, lo que convierte al suicidio en la primera causa de muerte violenta, superando a los fallecimientos por guerras y homicidios juntos.
Un paso importante en el campo de la prevención, y un ejemplo a seguir, es el que ha dado Reino Unido. Tal y como demuestra un estudio dirigido por Navneet Kapur, del Centro de Prevención del Suicidio de la Universidad de Manchester, los servicios de salud mental que han implementado una serie de recomendaciones elaboradas -equipos de crisis disponibles las 24 horas al día- hace una década han logrado disminuir las cifras de personas que se quitan la vida.
José Giner Ubago, del departamento de la Universidad de Sevilla reconoce a ELMUNDO.es la "elevada importancia de este artículo. El suicidio es una de las principales causas de muerte en población joven, pero no se están adoptando las medidas necesarias para su prevención. Sin embargo, trabajos como éste demuestran que se pueden hacer cosas que realmente son eficaces para evitarlos".
La mayoría de los que se quitan la vida tienen un trastorno psiquiátrico. "Los servicios mentales podrían desempeñar una papel importante en la reducción de casos... Nuestro objetivo era examinar la relación entre los servicios de salud mental y las tasas de suicidio. Nos centramos en las recomendaciones realizadas por el Instituto Nacional de Investigación Confidencial para el Suicidio y las Personas con Enfermedad Mental, un proyecto que tiene como objetivo monitorizar el suicidio y, en última instancia, mejorar la calidad de atención de salud mental en el Reino Unido", reconocen los investigadores en 'The Lancet'.
Los científicos recogieron y estudiaron los datos de suicidios de personas en contacto con los servicios de salud mental en Reino Unido desde 1997. Para ello se centraron en las cifras de aquellos que se quitaron la vida entre 1997 y 2006 pertenecientes a 91 centros de salud mental. Asimismo se indagó si dichos centros habían adoptado o no todas o algunas de las nueve medidas preventivas dadas.
Algunas de ellas son: eliminar cualquier objeto del centro de salud mental (ventanas sin rejas, cortinas plegables) que puedan ayudar a cometer un suicidio; establecer servicios comunitarios que incluyan equipos que ofrecen apoyo intensivo para los enfermos mentales que son difíciles de tratar en los centros tradicionales; introducir equipos de crisis disponibles las 24 horas al día que deben responder rápidamente ante una crisis de un paciente con enfermedad mental y así evitar la hospitalización.
Otras recomendaciones importantes son las que hacen referencia al seguimiento de siete días de los pacientes dados de alta psiquiátrica, a las políticas para los pacientes que no cumplen el tratamiento y al entrenamiento de personal sanitario, por lo menos cada tres años, en el manejo del riesgo de suicidio.
-Resultados
El estudio muestra que los centros que aplicaban entre siete y nueve de las recomendaciones tenían menores tasas de suicidio (nueve por cada 10.000 pacientes) que aquéllos que adoptaron seis o menos (11).
"La recomendación que produjo la mayor caída en las tasas de suicidio fue la introducción de equipos de crisis de 24 horas", destacan los investigadores. Otro dato aportado es la gran eficacia del seguimiento de los enfermos dados de alta psiquiátrica.
"Estos hallazgos son muy importantes para la investigación sobre el suicidio y los servicios de salud mental a nivel internacional. Ningún otro estudio ha sido capaz de mostrar el impacto que las mejoras específicas de los servicios de salud mental pueden tener sobre las tasas de suicidio", reconocen los autores de la investigación que no dudan en afirmar que "nuestros datos tienen importantes implicaciones para los servicios de salud mental internacionales".
-Esfuerzo en España
Para el experto español, "el mismo esfuerzo que las autoridades han dedicado a disminuir los accidentes de tráfico se debería realizar para el suicidio". Sin embargo, "y pese a que se trata de un problema de salud pública de gran envergadura, hasta ahora no se ha hecho nada".
El doctor Giner admite que "algunas de las medidas adoptadas en Reino Unido son bien conocidas y desde luego se conoce su valor a la hora de evitar que una persona se suicide. En España, por ejemplo, ningún hospital psiquiátrico tiene ventanas sin rejas, pero no hacemos seguimiento de siete días a los pacientes que reciben el alta".
Insiste en que esta última medida es de suma importancia "dado que hay estudios que demuestran que un mayor riesgo de suicidio en las dos semanas posteriores al alta. El enfermo está mejor y si tiene el impulso del suicidio es más fácil llevarlo a cabo porque cuenta con más fuerza mental, más autodeterminación".
Admite además que "en nuestro país los equipos de crisis de 24 horas como los expuestos en el trabajo no existen y serían de gran ayuda".
Finalmente reconoce la necesidad de que "se hable de este tema, para que la sociedad sea consciente de su existencia y para que los médicos estén alertas a cualquier signo que muestre un paciente o comunique la familia".
**Publicado en "EL MUNDO"
Un paso importante en el campo de la prevención, y un ejemplo a seguir, es el que ha dado Reino Unido. Tal y como demuestra un estudio dirigido por Navneet Kapur, del Centro de Prevención del Suicidio de la Universidad de Manchester, los servicios de salud mental que han implementado una serie de recomendaciones elaboradas -equipos de crisis disponibles las 24 horas al día- hace una década han logrado disminuir las cifras de personas que se quitan la vida.
José Giner Ubago, del departamento de la Universidad de Sevilla reconoce a ELMUNDO.es la "elevada importancia de este artículo. El suicidio es una de las principales causas de muerte en población joven, pero no se están adoptando las medidas necesarias para su prevención. Sin embargo, trabajos como éste demuestran que se pueden hacer cosas que realmente son eficaces para evitarlos".
La mayoría de los que se quitan la vida tienen un trastorno psiquiátrico. "Los servicios mentales podrían desempeñar una papel importante en la reducción de casos... Nuestro objetivo era examinar la relación entre los servicios de salud mental y las tasas de suicidio. Nos centramos en las recomendaciones realizadas por el Instituto Nacional de Investigación Confidencial para el Suicidio y las Personas con Enfermedad Mental, un proyecto que tiene como objetivo monitorizar el suicidio y, en última instancia, mejorar la calidad de atención de salud mental en el Reino Unido", reconocen los investigadores en 'The Lancet'.
Los científicos recogieron y estudiaron los datos de suicidios de personas en contacto con los servicios de salud mental en Reino Unido desde 1997. Para ello se centraron en las cifras de aquellos que se quitaron la vida entre 1997 y 2006 pertenecientes a 91 centros de salud mental. Asimismo se indagó si dichos centros habían adoptado o no todas o algunas de las nueve medidas preventivas dadas.
Algunas de ellas son: eliminar cualquier objeto del centro de salud mental (ventanas sin rejas, cortinas plegables) que puedan ayudar a cometer un suicidio; establecer servicios comunitarios que incluyan equipos que ofrecen apoyo intensivo para los enfermos mentales que son difíciles de tratar en los centros tradicionales; introducir equipos de crisis disponibles las 24 horas al día que deben responder rápidamente ante una crisis de un paciente con enfermedad mental y así evitar la hospitalización.
Otras recomendaciones importantes son las que hacen referencia al seguimiento de siete días de los pacientes dados de alta psiquiátrica, a las políticas para los pacientes que no cumplen el tratamiento y al entrenamiento de personal sanitario, por lo menos cada tres años, en el manejo del riesgo de suicidio.
-Resultados
El estudio muestra que los centros que aplicaban entre siete y nueve de las recomendaciones tenían menores tasas de suicidio (nueve por cada 10.000 pacientes) que aquéllos que adoptaron seis o menos (11).
"La recomendación que produjo la mayor caída en las tasas de suicidio fue la introducción de equipos de crisis de 24 horas", destacan los investigadores. Otro dato aportado es la gran eficacia del seguimiento de los enfermos dados de alta psiquiátrica.
"Estos hallazgos son muy importantes para la investigación sobre el suicidio y los servicios de salud mental a nivel internacional. Ningún otro estudio ha sido capaz de mostrar el impacto que las mejoras específicas de los servicios de salud mental pueden tener sobre las tasas de suicidio", reconocen los autores de la investigación que no dudan en afirmar que "nuestros datos tienen importantes implicaciones para los servicios de salud mental internacionales".
-Esfuerzo en España
Para el experto español, "el mismo esfuerzo que las autoridades han dedicado a disminuir los accidentes de tráfico se debería realizar para el suicidio". Sin embargo, "y pese a que se trata de un problema de salud pública de gran envergadura, hasta ahora no se ha hecho nada".
El doctor Giner admite que "algunas de las medidas adoptadas en Reino Unido son bien conocidas y desde luego se conoce su valor a la hora de evitar que una persona se suicide. En España, por ejemplo, ningún hospital psiquiátrico tiene ventanas sin rejas, pero no hacemos seguimiento de siete días a los pacientes que reciben el alta".
Insiste en que esta última medida es de suma importancia "dado que hay estudios que demuestran que un mayor riesgo de suicidio en las dos semanas posteriores al alta. El enfermo está mejor y si tiene el impulso del suicidio es más fácil llevarlo a cabo porque cuenta con más fuerza mental, más autodeterminación".
Admite además que "en nuestro país los equipos de crisis de 24 horas como los expuestos en el trabajo no existen y serían de gran ayuda".
Finalmente reconoce la necesidad de que "se hable de este tema, para que la sociedad sea consciente de su existencia y para que los médicos estén alertas a cualquier signo que muestre un paciente o comunique la familia".
**Publicado en "EL MUNDO"
Autoinjectors offer way to treat prolonged seizures
Drug delivery into muscle using an autoinjector, akin to the EpiPen used to treat serious allergic reactions, is faster and may be a more effective way to stop status epilepticus, a prolonged seizure lasting longer than five minutes, according to a study sponsored by the National Institutes of Health. Status epilepticus is a potentially life-threatening emergency that causes 55,000 deaths each year. Anticonvulsant drugs are typically delivered intravenously (IV) as a first-line treatment. Starting an IV in a patient experiencing seizures can pose a challenge for paramedics and waste precious time. Giving an intramuscular shot is easier, faster, and more reliable, especially in patients having convulsions. The researchers sought to determine whether an intramuscular injection, which quickly delivers anticonvulsant medicine into a patient's thigh muscle, is as safe and effective as giving medicine directly into a vein. The study, which was carried out by paramedics, compared how well delivery by each method stopped patients' seizures by the time the ambulance arrived at the emergency department.
The investigators compared two medicines known to be effective in controlling seizures, midazolam and lorazepam. Both are benzodiazepines, a class of sedating anticonvulsant drugs. Midazolam was a candidate for injection because it is rapidly absorbed from muscle. But lorazepam must be given by IV. The study found that 73 percent of patients in the group receiving midazolam were seizure-free upon arrival at the hospital, compared to 63 percent of patients who received IV treatment with lorazepam. Patients treated with midazolam were also less likely to require hospitalization than those receiving IV lorazepam. Among those admitted, both groups had similarly low rates of recurrent seizures. The study appears in the Feb. 16, 2012 issue of The New England Journal of Medicine.
"Patients with status epilepticus can suffer severe consequences if seizures are not stopped quickly. This study establishes that rapid intramuscular injection of an anticonvulsant drug is safe and effective," said Walter Koroshetz, M.D., deputy director of the National Institute of Neurological Disorders and Stroke (NINDS), part of the NIH, which funded the study.
The investigators said that while autoinjectors might someday be available for use by epilepsy patients and their family members, more research is required. Because of the strong sedative effect of midazolam, on-site medical supervision is now required for the safety of the patient.
The Rapid Anticonvulsant Medication Prior to Arrival Trial (RAMPART) study was conducted through the NINDS' Neurological Emergencies Treatment Trials (NETT) network. Additional funding was provided by the NIH Countermeasures Against Chemical Threats (NIH CounterACT) program and the Biomedical Advanced Research and Development Authority (BARDA). The Department of Defense's Chemical Biological Medical Systems (CBMS) Joint Project Management Office provided the autoinjectors for the trial under a Memorandum of Agreement with NINDS.
NIH CounterACT, BARDA and CBMS are responsible for enhancing the U.S. government's development of medical countermeasures to natural and intentional public health threats (please see full statement below on CBMS). The chemical defense community has a longstanding interest in research on the rapid treatment of nerve agent-induced seizures. As the RAMPART study was being planned, investigators learned that the departments of Defense and Health and Human Services were already working with a midazolam autoinjector and the study was an opportunity to confirm its effectiveness in patients with seizures.
"There was great synergy when we realized that RAMPART was studying a similar problem that was of concern to the chemical defense community. This led to a perfect collaboration between HHS and DoD," said David Jett, Ph.D., program director for NIH CounterACT and NINDS. "The broader implication of RAMPART is that we now have critical information from studies in humans that a safe and effective tool may one day be available to enhance our public health preparedness. Autoinjectors provide a highly practical way to treat hundreds of people quickly during an emergency."
RAMPART is the first randomized clinical trial to investigate whether intramuscular delivery of midazolam is as effective as IV lorazepam, the current standard of care therapy. The trial started in 2009 and completed enrollment in June, 2011. RAMPART involved more than 79 hospitals, 33 emergency medical services agencies, more than 4,000 paramedics and 893 patients ranging in age from several months old to 103. The network of investigators that designed and carried out the trial was established by NINDS to conduct clinical trials on a variety of acute conditions affecting the brain such as stroke and traumatic brain injury. NETT investigators are organized into a system of 17 major research hospitals each of which is linked to several community hospitals and other medical centers.
The investigators compared two medicines known to be effective in controlling seizures, midazolam and lorazepam. Both are benzodiazepines, a class of sedating anticonvulsant drugs. Midazolam was a candidate for injection because it is rapidly absorbed from muscle. But lorazepam must be given by IV. The study found that 73 percent of patients in the group receiving midazolam were seizure-free upon arrival at the hospital, compared to 63 percent of patients who received IV treatment with lorazepam. Patients treated with midazolam were also less likely to require hospitalization than those receiving IV lorazepam. Among those admitted, both groups had similarly low rates of recurrent seizures. The study appears in the Feb. 16, 2012 issue of The New England Journal of Medicine.
"Patients with status epilepticus can suffer severe consequences if seizures are not stopped quickly. This study establishes that rapid intramuscular injection of an anticonvulsant drug is safe and effective," said Walter Koroshetz, M.D., deputy director of the National Institute of Neurological Disorders and Stroke (NINDS), part of the NIH, which funded the study.
The investigators said that while autoinjectors might someday be available for use by epilepsy patients and their family members, more research is required. Because of the strong sedative effect of midazolam, on-site medical supervision is now required for the safety of the patient.
The Rapid Anticonvulsant Medication Prior to Arrival Trial (RAMPART) study was conducted through the NINDS' Neurological Emergencies Treatment Trials (NETT) network. Additional funding was provided by the NIH Countermeasures Against Chemical Threats (NIH CounterACT) program and the Biomedical Advanced Research and Development Authority (BARDA). The Department of Defense's Chemical Biological Medical Systems (CBMS) Joint Project Management Office provided the autoinjectors for the trial under a Memorandum of Agreement with NINDS.
NIH CounterACT, BARDA and CBMS are responsible for enhancing the U.S. government's development of medical countermeasures to natural and intentional public health threats (please see full statement below on CBMS). The chemical defense community has a longstanding interest in research on the rapid treatment of nerve agent-induced seizures. As the RAMPART study was being planned, investigators learned that the departments of Defense and Health and Human Services were already working with a midazolam autoinjector and the study was an opportunity to confirm its effectiveness in patients with seizures.
"There was great synergy when we realized that RAMPART was studying a similar problem that was of concern to the chemical defense community. This led to a perfect collaboration between HHS and DoD," said David Jett, Ph.D., program director for NIH CounterACT and NINDS. "The broader implication of RAMPART is that we now have critical information from studies in humans that a safe and effective tool may one day be available to enhance our public health preparedness. Autoinjectors provide a highly practical way to treat hundreds of people quickly during an emergency."
RAMPART is the first randomized clinical trial to investigate whether intramuscular delivery of midazolam is as effective as IV lorazepam, the current standard of care therapy. The trial started in 2009 and completed enrollment in June, 2011. RAMPART involved more than 79 hospitals, 33 emergency medical services agencies, more than 4,000 paramedics and 893 patients ranging in age from several months old to 103. The network of investigators that designed and carried out the trial was established by NINDS to conduct clinical trials on a variety of acute conditions affecting the brain such as stroke and traumatic brain injury. NETT investigators are organized into a system of 17 major research hospitals each of which is linked to several community hospitals and other medical centers.
**Source: University of Michigan Health System
Terapia conductual para sudores y sofocos en cáncer de mama
Casi un 85% de las mujeres que han recibido un tratamiento contra el cáncer de mama sufren efectos secundarios como sudores y sofocos nocturnos. Su tratamiento, según un estudio que se The Lancet Oncology, podría hacerse con una terapia cognitivo-conductual, que ha resultado ser segura y efectiva y que, además, ha proporcionado beneficios adicionales en cuanto al humor, sueño y la calidad de vida.
Los investigadores del King's College de Londres (Gran Bretaña) propone que esta terapia se incorpore a los programas para las personas que han superado este cáncer. La investigación, coordinada por Myra Hunter, ha contado con 96 mujeres que sufrían sofocos y sudores nocturnos problemáticos -un mínimo de 10 episodios a la semana- tras recibir un tratamiento de cáncer de mama.
Las participantes fueron divididas en dos grupos para recibir o el tratamiento habitual sólo (49) o este tratamiento más la terapia cognitivo-conductual (47). El grupo de la nueva terapia recibió una sesión de 90 minutos a la semana durante seis semanas, que incluyó educación psicológica, clases para aprender a respirar y estrategias cognitivas y conductuales para manejar los sofocos y estos sudores.
-Beneficio a largo plazo
Las evaluaciones se realizaron a las nueve semanas y a las 26 semanas tras la división de los participantes en grupos. En la primera, a las 9 semanas, los autores vieron que el grupo con la nueva terapia redujo significativamente sus problemas de sofocos y sudores nocturnos, en comparación con el resto. Estas mejoras se mantuvieron a las 26 semanas. Así, con la nueva terapia las pacientes lograron una reducción de estos síntomas de un 46 por ciento a las nueve semanas y de un 52 por ciento a las 26 semanas, mientras que el grupo que seguía el tratamiento clásico alcanzó una reducción del 19 por ciento a las nueve semanas y del 25 por ciento en la semana número 26.
«Nuestros descubrimientos muestran que el grupo que siguió la terapia cognitivo-conductual pudo reducir el efecto de los sofocos y los sudores nocturnos en mujeres que habían recibido un tratamiento para el cáncer de mama», señalan. En su opinión, esta terapia parece una opción de tratamiento «segura, aceptable y efectiva», que puede ser incorporada a los programas de atención a las supervivientes del cáncer de mama.
**Publicado en "ABC SALUD"
Los investigadores del King's College de Londres (Gran Bretaña) propone que esta terapia se incorpore a los programas para las personas que han superado este cáncer. La investigación, coordinada por Myra Hunter, ha contado con 96 mujeres que sufrían sofocos y sudores nocturnos problemáticos -un mínimo de 10 episodios a la semana- tras recibir un tratamiento de cáncer de mama.
Las participantes fueron divididas en dos grupos para recibir o el tratamiento habitual sólo (49) o este tratamiento más la terapia cognitivo-conductual (47). El grupo de la nueva terapia recibió una sesión de 90 minutos a la semana durante seis semanas, que incluyó educación psicológica, clases para aprender a respirar y estrategias cognitivas y conductuales para manejar los sofocos y estos sudores.
-Beneficio a largo plazo
Las evaluaciones se realizaron a las nueve semanas y a las 26 semanas tras la división de los participantes en grupos. En la primera, a las 9 semanas, los autores vieron que el grupo con la nueva terapia redujo significativamente sus problemas de sofocos y sudores nocturnos, en comparación con el resto. Estas mejoras se mantuvieron a las 26 semanas. Así, con la nueva terapia las pacientes lograron una reducción de estos síntomas de un 46 por ciento a las nueve semanas y de un 52 por ciento a las 26 semanas, mientras que el grupo que seguía el tratamiento clásico alcanzó una reducción del 19 por ciento a las nueve semanas y del 25 por ciento en la semana número 26.
«Nuestros descubrimientos muestran que el grupo que siguió la terapia cognitivo-conductual pudo reducir el efecto de los sofocos y los sudores nocturnos en mujeres que habían recibido un tratamiento para el cáncer de mama», señalan. En su opinión, esta terapia parece una opción de tratamiento «segura, aceptable y efectiva», que puede ser incorporada a los programas de atención a las supervivientes del cáncer de mama.
**Publicado en "ABC SALUD"
Diabetes may start in the intestines, research suggests
Scientists at Washington University School of Medicine in St. Louis have made a surprising discovery about the origin of diabetes. Their research suggests that problems controlling blood sugar -- the hallmark of diabetes -- may begin in the intestines. The new study, in mice, may upend long-held theories about the causes of the disease. Because insulin is produced in the pancreas and sugar is stored in the liver, many scientists have looked to those organs for the underlying causes of diabetes.
The findings are reported Feb. 16 in the journal Cell Host & Microbe.
In the new research, scientists studied mice that are unable to make fatty acid synthase (FAS) in the intestine. FAS, an enzyme crucial for the production of lipids, is regulated by insulin, and people with diabetes have defects in FAS. Mice without the enzyme in the intestines develop chronic inflammation in the gut, a powerful predictor of diabetes.
"Diabetes may indeed start in your gut," says principal investigator Clay F. Semenkovich, MD. "When people become resistant to insulin, as happens when they gain weight, FAS doesn't work properly, which causes inflammation that, in turn, can lead to diabetes."
First author Xiaochao Wei, PhD, and Semenkovich, the Herbert S. Gasser Professor of Medicine, professor of cell biology and physiology and director of the Division of Endocrinology, Metabolism and Lipid Research, collaborated with specialists in gastroenterology and genome sciences to determine what happens in mice that can't make FAS in their intestines.
"The first striking thing we saw was that the mice began losing weight," says Wei, a research instructor in medicine. "They had diarrhea and other gastrointestinal symptoms, and when we looked closely at the tissue in the gut, we found a lot of inflammation."
Initially, the researchers thought that the mice became sick because of changes to the mix of microbes that naturally live in the gut, where they help digest food and synthesize vitamins.
In collaboration with Jeffrey I. Gordon, MD, director of the Center for Genome Sciences and Systems Biology at the School of Medicine, they looked more closely at gut microbes in the mice.
"The mice had substantial changes in their gut microbiome," Semenkovich says. "But it wasn't the composition of microbes in the gut that caused the problems."
Instead, Wei says, the mice got sick because of a defect in fatty acid synthase. The mice without fatty acid synthase had lost the protective lining of mucus in the intestines that separates the microbes from direct exposure to cells. This allowed bacteria to penetrate otherwise healthy cells in the gut, making the mice sick.
In a further collaboration with Nicholas O. Davidson, MD, director of the Division of Gastroenterology, the researchers found gastrointestinal effects resembling some features of inflammatory bowel disease. Other investigators studying humans with ulcerative colitis had previously made the unexplained observation that colon biopsies from these patients have low amounts of fatty acid synthase.
"Fatty acid synthase is required to keep that mucosal layer intact," Wei says. "Without it, bad bacteria invade cells in the colon and the small intestine, creating inflammation, and that, in turn, contributes to insulin resistance and diabetes."
Inflammation and insulin resistance reinforce each other. Inflammatory substances can cause insulin resistance and inhibit the production of insulin, both of which interfere with the regulation of blood sugar. In turn, insulin resistance is known to promote inflammation.
Further study showed that the ability to build the thin, but important, layer of mucosal cells was hindered by faulty FAS.
That the gut is so important to the development of diabetes makes sense because many people with the condition not only have faulty FAS, but they also frequently develop gastrointestinal difficulties, Semenkovich says.
"Abdominal pain and diarrhea are some of the most common problems we see in people with diabetes," he says. "We could only connect these 'dots' because other experts at the university could help us link what we observed in these mice to what occurs in patients with diabetes and inflammatory bowel disease," Semenkovich says.
Semenkovich and Wei say much more study is needed, but they say that FAS and a key component of the intestinal mucosa called Muc2 may be potential targets for diabetes therapy. They now plan to study people with diabetes to see whether FAS is altered in a similar way, producing damage to the mucosal layer in the intestines.
The findings are reported Feb. 16 in the journal Cell Host & Microbe.
In the new research, scientists studied mice that are unable to make fatty acid synthase (FAS) in the intestine. FAS, an enzyme crucial for the production of lipids, is regulated by insulin, and people with diabetes have defects in FAS. Mice without the enzyme in the intestines develop chronic inflammation in the gut, a powerful predictor of diabetes.
"Diabetes may indeed start in your gut," says principal investigator Clay F. Semenkovich, MD. "When people become resistant to insulin, as happens when they gain weight, FAS doesn't work properly, which causes inflammation that, in turn, can lead to diabetes."
First author Xiaochao Wei, PhD, and Semenkovich, the Herbert S. Gasser Professor of Medicine, professor of cell biology and physiology and director of the Division of Endocrinology, Metabolism and Lipid Research, collaborated with specialists in gastroenterology and genome sciences to determine what happens in mice that can't make FAS in their intestines.
"The first striking thing we saw was that the mice began losing weight," says Wei, a research instructor in medicine. "They had diarrhea and other gastrointestinal symptoms, and when we looked closely at the tissue in the gut, we found a lot of inflammation."
Initially, the researchers thought that the mice became sick because of changes to the mix of microbes that naturally live in the gut, where they help digest food and synthesize vitamins.
In collaboration with Jeffrey I. Gordon, MD, director of the Center for Genome Sciences and Systems Biology at the School of Medicine, they looked more closely at gut microbes in the mice.
"The mice had substantial changes in their gut microbiome," Semenkovich says. "But it wasn't the composition of microbes in the gut that caused the problems."
Instead, Wei says, the mice got sick because of a defect in fatty acid synthase. The mice without fatty acid synthase had lost the protective lining of mucus in the intestines that separates the microbes from direct exposure to cells. This allowed bacteria to penetrate otherwise healthy cells in the gut, making the mice sick.
In a further collaboration with Nicholas O. Davidson, MD, director of the Division of Gastroenterology, the researchers found gastrointestinal effects resembling some features of inflammatory bowel disease. Other investigators studying humans with ulcerative colitis had previously made the unexplained observation that colon biopsies from these patients have low amounts of fatty acid synthase.
"Fatty acid synthase is required to keep that mucosal layer intact," Wei says. "Without it, bad bacteria invade cells in the colon and the small intestine, creating inflammation, and that, in turn, contributes to insulin resistance and diabetes."
Inflammation and insulin resistance reinforce each other. Inflammatory substances can cause insulin resistance and inhibit the production of insulin, both of which interfere with the regulation of blood sugar. In turn, insulin resistance is known to promote inflammation.
Further study showed that the ability to build the thin, but important, layer of mucosal cells was hindered by faulty FAS.
That the gut is so important to the development of diabetes makes sense because many people with the condition not only have faulty FAS, but they also frequently develop gastrointestinal difficulties, Semenkovich says.
"Abdominal pain and diarrhea are some of the most common problems we see in people with diabetes," he says. "We could only connect these 'dots' because other experts at the university could help us link what we observed in these mice to what occurs in patients with diabetes and inflammatory bowel disease," Semenkovich says.
Semenkovich and Wei say much more study is needed, but they say that FAS and a key component of the intestinal mucosa called Muc2 may be potential targets for diabetes therapy. They now plan to study people with diabetes to see whether FAS is altered in a similar way, producing damage to the mucosal layer in the intestines.
**Source: Washington University in St. Louis
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