Search

ArabicCatalanChinese (Simplified)EnglishFrenchGermanHebrewHindiItalianJapaneseKoreanPortugueseRussianSpanishYiddish

04 February, 2015

Medicalización de sexualidad y la sed

Los médicos nos pasamos hablando de las "cosas médicas", y la prevención cuaternaria y tantas otras cosas....lo normal, lo cotidiano, se deja de lado.......y una monja ( por cierto médica y con una maestria en salud pública), nos cuenta algo sobre sexualidad ( que no era monja? ) , y también de la sed. Un poco largo, para cuando tengan tiempo, pero vale la pena, y la alegria, el escucharla. Cómo siempre Teresa Forcades i Vilatrayendo algo de luz, hasta la ignorancia de nos, los médicos, y nosotros difundiendoló a nuestros pacientes....

03 February, 2015

Comparative Effectiveness of Immunosuppressants and Biologics for Inducing and Maintaining Remission in Crohn`s Disease: A Network Meta-analysis

BACKGROUND & AIMS: There is controversy regarding the best treatment for patients with Crohn`s disease because of the lack of direct comparative trials. We compared therapies for induction and maintenance of remission in patients with Crohn`s disease, based on direct and indirect evidence.
METHODS: We performed systematic reviews of MEDLINE, EMBASE, and Cochrane Central databases, through June 2014. We identified randomized controlled trials (N = 39) comparing methotrexate, azathioprine/6-mercaptopurine, infliximab, adalimumab, certolizumab, vedolizumab, or combined therapies with placebo or an active agent for induction and maintenance of remission in adult patients with Crohn`s disease. Pairwise treatment effects were estimated through a Bayesian random-effects network meta-analysis and reported as odds ratios (OR) with a 95% credible interval (CrI).
RESULTS: Infliximab, the combination of infliximab and azathioprine (infliximab + azathioprine), adalimumab, and vedolizumab were superior to placebo for induction of remission. In pair-wise comparisons of anti-tumor necrosis factor agents, infliximab + azathioprine (OR, 3.1; 95% CrI, 1.4-7.7) and adalimumab (OR, 2.1; 95% CrI, 1.0-4.6) were superior to certolizumab for induction of remission. All treatments were superior to placebo for maintaining remission, except for the combination of infliximab and methotrexate. Adalimumab, infliximab, and infliximab + azathioprine were superior to azathioprine/6-mercaptopurine: adalimumab (OR, 2.9; 95% CrI, 1.6-5.1), infliximab (OR, 1.6; 95% CrI, 1.0-2.5), infliximab + azathioprine (OR, 3.0; 95% CrI, 1.7-5.5) for maintenance of remission. Adalimumab and infliximab + azathioprine were superior to certolizumab: adalimumab (OR, 2.5; 95% CrI, 1.4-4.6) and infliximab + azathioprine (OR, 2.6; 95% CrI, 1.3-6.0). Adalimumab was superior to vedolizumab (OR, 2.4; 95% CrI, 1.2-4.6).
CONCLUSIONS: Based on a network meta-analysis, adalimumab and infliximab + azathioprine are the most effective therapies for induction and maintenance of remission of Crohn`s disease.
Hazlewood GS, Rezaie A, Borman M, et al. Comparative Effectiveness of Immunosuppressants and Biologics for Inducing and Maintaining Remission in Crohn`s Disease: A Network Meta-analysis. Gastroenterology. 2015 Feb;148(2):344-354.e5. doi: 10.1053/j.gastro.2014.10.011. Epub 2014 Oct 16. (Review) PMID: 25448924

02 February, 2015

Oseltamivir: ni la MBE, ni la FDA ni el CDC se ponen de acuerdo

El Medical Letter y los CDC contra la Medicina Basada en Pruebas, siguen recomendando Tamiflú (oseltamivir).
The Medical Letter on Drugs and Therapeutics (MLDT). Antiviral Drugs for Seasonal Influenza 2014-2015.
MLDT and the CDC against Evidence Base Medicine. 

http://jama.jamanetwork.com/article.aspx?articleid=2091983
www.cdc.gov/flu
See:
Tamiflu campaign  http://www.bmj.com/tamiflu
El engaño del Tamiflú, con la eficacia de la aspirina http://equipocesca.org/el-asunto-tamiflurelenza-la-salud-publica-y-algunas-lecciones-para-la-decision-y-la-etica/ …
La FDA deja claro (contra el CDC) que ni el Tamiflú ni el Rapivab reducen ni complicaciones ni muertes por gripe. http://fivethirtyeight.com/features/why-the-cdc-and-fda-are-telling-you-two-different-things-about-the-flu/ …

Resective Epilepsy Surgery for Drug-Resistant Focal Epilepsy: A Review.

Importance: Epilepsy surgery is indicated for patients with focal seizures who do not respond to appropriate antiepileptic drug therapy consisting of 2 or more medications.
OBJECTIVES: To review resective surgery outcomes for focal epilepsy, to identify which patients benefit the most, and to discuss why epilepsy surgery may not be universally accepted. Evidence Review: Medline and Cochrane databases were searched between January 1993 and June 2014 for randomized clinical trials, meta-analyses, systematic reviews, and large retrospective case series (>300 patients) using Medical Subject Headings and indexed text terms. Fifty-five articles were included. Subpopulations and prognostic factors were identified. Systematic reviews for cognitive, psychiatric, quality-of-life, and psychosocial outcomes were included.
FINDINGS: Two randomized clinical trials enrolling 118 patients with temporal lobe epilepsy found greater freedom from seizures with surgery when compared with continued medical treatment (58% vs 8% [n = 80] and 73% vs 0% [n = 38], P < .001). Nine systematic reviews and 2 large case series of medically refractory patients treated with surgery reported seizure-free outcomes in 34% to 74% of patients (median, 62.4%). The remainder of systematic reviews and meta-analyses examined subpopulations. Epilepsy surgery was less effective when there were extratemporal lesions, the epilepsy was not associated with a structural lesion, or both. Seizure-free outcomes were similar between children and adults. Hippocampal sclerosis and benign tumors were associated with better outcomes relative to other pathologies. Similar procedures such as selective amygdalohippocampectomy and temporal lobectomy for temporal lobe epilepsy were associated with subtle differences in seizure and neuropsychological outcome. There is low perioperative mortality (0.1%-0.5%) from epilepsy surgery. The most frequent neurologic complication is visual field defect occurring from temporal lobe resection. Quality of life improved after surgery but improved the most in patients who were seizure-free after surgery. Conclusions and Relevance: Epilepsy surgery reduced seizure activity in randomized clinical trials when compared with continued medical therapy. Long-term cognitive, psychiatric, psychosocial, and quality-of-life outcomes were less well defined. Despite good outcomes from high-quality clinical trials, referrals of patients with seizures refractory to medical treatment remain infrequent.

Source: Jobst BC, Cascino GD. Resective Epilepsy Surgery for Drug-Resistant Focal Epilepsy: A Review. JAMA. 2015 Jan 20;313(3):285-293. doi: 10.1001/jama.2014.17426. (Review) PMID: 25602999

LinkWithin

Related Posts Plugin for WordPress, Blogger...