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viernes, 28 de octubre de 2011

Usa bloqueador solar.... Parafrasea a Borges....

http://www.youtube.com/watch?v=YDRId6QmNTA&feature=youtube_gdata_player

Instantes

(autor: Don Herold, adaptación: Borges)

Si pudiera vivir nuevamente mi vida,
en la próxima trataría de cometer más errores.
No intentaría ser tan perfecto, me relajaría más.
Sería más tonto de lo que he sido,
de hecho tomaría muy pocas cosas con seriedad.
Sería menos higiénico.
Correría más riesgos,
haría más viajes,
contemplaría más atardeceres,
subiría más montañas, nadaría más ríos.
Iría a más lugares adonde nunca he ido,
comería más helados y menos habas,
tendría más problemas reales y menos imaginarios.

Yo fui una de esas personas que vivió sensata
y prolíficamente cada minuto de su vida;
claro que tuve momentos de alegría.
Pero si pudiera volver atrás trataría
de tener solamente buenos momentos.

Por si no lo saben, de eso está hecha la vida,
sólo de momentos; no te pierdas el ahora.

Yo era uno de esos que nunca
iban a ninguna parte sin un termómetro,
una bolsa de agua caliente,
un paraguas y un paracaídas;
si pudiera volver a vivir, viajaría más liviano.

Si pudiera volver a vivir
comenzaría a andar descalzo a principios
de la primavera
y seguiría descalzo hasta concluir el otoño.
Daría más vueltas en calesita,
contemplaría más amaneceres,
y jugaría con más niños,
si tuviera otra vez vida por delante.

Pero ya ven, tengo 85 años…
y sé que me estoy muriendo.

Acantosis nigricans


Paciente de 38 años de edad con un índice de masa corporal de 34.1 kg/m2

Acantosis nigricans

Manifestación dérmica frecuente en personas con síndrome metabólico

jueves, 27 de octubre de 2011

Mas empoderamiento del paciente hipertenso


Averaging clinic and home measures associated with reductions in within-patient variability and may give a better indication of blood pressure control
  1. Kei Asayama,
  2. Lutgarde Thijs,
  3. Jan A Staessen

+ Author Affiliations

  1. Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium
  1. Correspondence to Jan A Staessen
    Department of Cardiovascular Diseases, University of Leuven, Kapucijnenvoer 35, Block D, Box 7001, Leuven, BE-3000, Belgium; jan.staessen@med.kuleuven.be

Commentary on: [Abstract/FREE Full text]

Context

In 2003,1 European guidelines addressed the variability in blood pressure (BP) measurements. They proposed that two or more readings at 1-min intervals be taken at each visit,1 with further readings in case of uncertainty. They also stated that the alarm reaction to BP measurement may persist after several visits, so for patients with sustained elevation of BP, more measurements should be obtained on different occasions over a number of weeks or months before diagnostic or management decisions are made. Alternatively, ambulatory BP measurement or self-measurement of BP away from the medical environment should be performed.1 In a secondary analysis of the Hypertension Intervention Nurse Telemedicine Study (HINTS),2 Powers et al attempted to determine the optimal setting and number of BP measurements that should be used for clinical decision making.

Methods

The HINTS2 was a randomised trial that enrolled patients with poor BP control. Patients were randomised to four arms: (1) a control group receiving usual care; (2) nurse-administered tailored behavioural intervention; (3) nurse-administered medication management; and (4) the combination of the interventions. The major achievement of HINTS was to prove the feasibility of BP telemonitoring in patients with uncontrolled hypertension and low average educational attainment.3 4 In this secondary analysis, patients assigned to the three intervention arms who electronically transmitted home BP readings were eligible. They measured BP repeatedly over 18 months by using three methods: research BPs were measured at the clinic at 6-month intervals, using a ‘BpTRU’ device; clinic BPs were obtained during outpatient visits, using Alaris 4200s and 4410s/4415s automated devices; and home BPs were obtained using an ‘A&D UA767PC’ monitor interfaced with a (Carematix) telemonitoring platform. Using complex mathematical modelling, Powers et al calculated the probability that a patient's true systolic BP was in the hypertensive range given the observed mean systolic BP and using the recommended systolic BP treatment thresholds of 140 mm Hg for clinic BP and 135 mm Hg for home BP.

Findings

Powers et al showed that the effects of within-subject variability could be greatly reduced by averaging several measurements. For clinic systolic BPs between 136 and 144 mm Hg, at least 10 measurements had to be averaged to correctly classify a patient as normotensive or hypertensive with 80% probability. By contrast, for home BP only five measurements were needed to correctly classify subjects with the same probability. The authors conclude that physicians who want to have 80% or more certainty that they correctly classify patients' BP should use the average of several measurements.

Commentary

Recommendations by expert panels5 6 published since 2003 have reinforced similar standards for the frequency and conditions of BP measurement. This secondary analysis of HINTS supports the recommendation that treatment decisions should be based on the average of several measurements, perhaps fewer when they are done at home.

However, we should not overlook the limitations of the present study. First, because in the intervention groups, all treatment decisions were based on the self-measured BP at home;4 the HINTS investigators cannot really determine the optimal setting for BP measurement. Second, the authors dichotomised systolic BP into normotensive and hypertensive values, disregarding that BP is continuously distributed and the potential contribution of diastolic hypertension. Third, the analyses involving 18-month data might not be applicable to clinical practice, because in most patients a shorter time period is required to confirm the diagnosis of hypertension and institute treatment. Fourth, the analyses rely on the discrepancy between the mean of several observed BPs and the true BP. However, the true BP used in analyses was not measured but estimated from the mean, variance and covariance of the observed BP distribution. This method might introduce bias. Fifth, patients randomised to intervention were asked to provide at least three BP measurements per week. The timing of these measurements was not standardised and therefore, a potential source of bias. Patients anxious about their well-being might have measured their BP more frequently, and non-adherent patients were contacted by the care providers.7 Sixth, to our knowledge, the Alaris devices used for the BP measurements at the outpatient clinics have not been validated and may be unsuitable for use in clinical research or patient management. Finally, the study population (92% men, 48% African–Americans, 40% participants with low-literacy level, and 41% patients with uncontrolled hypertension) may not yield broadly generalisable findings.

In conclusion, the secondary analysis of HINTS by Powers et al is consistent with earlier evidence, and suggests that repeated and home BP measurements improve reliability, leading to a more accurate diagnosis and management of hypertension.

jueves, 20 de octubre de 2011

Sigue el debate sobre el cáncer de seno y la mamografía.

http://www.nejm.org/doi/full/10.1056/NEJMe1008369

¿Y, en países mas pobres?

http://askmedline.nlm.nih.gov/pmhhgs/abstract.php?id=21782120&from=pico

El perrito.... Imaginación sobre todo


Un señor va de cacería al África y lleva a su perrito. Un día, el Perrito Se aleja del grupo, se extravía y comienza a vagar solo por la selva.

En eso ve a lo lejos que viene una pantera enorme a toda carrera.

Al ver que la pantera lo va a devorar, piensa rápido qué hacer.

En eso ve un montón de huesos de un animal muerto y empieza a mordisquearlos.

Cuando la pantera está a punto de atacarlo, el perrito dice:

¡¡¡Ah, qué rica pantera me acabo de comer!!!

La pantera lo alcanza a escuchar y frenando en seco, gira y sale despavorida pensando:

¡¡¡¿Quién sabe qué animal será ese. A ver si me come a mí También???!!!

Un mono que andaba trepado en un árbol cercano, oyó y vio la escena.

Sin más salió corriendo tras la pantera para contarle cómo la había engañado el perrito:

¡Pantera tonta. Esos huesos ya estaban ahí, además, es sólo un simple perrito!

La pantera, enojadísima, sale corriendo a buscar al perrito con el mono montado en el lomo. El perrito ve a lo lejos que viene nuevamente la Pantera con el mono y se da cuenta de que este último había ido con el chisme.

¿Y ahora qué hago? piensa todo asustado. Entonces, en vez de
salir corriendo, se queda sentado dándoles la espalda, como si no los hubiera visto, y cuando la pantera estaba cerca de atacarlo de nuevo, el perrito exclama:

¡¡¡ Este mono desgraciado, hace como media hora que lo mandé a traerme otra pantera y todavía no aparece!!!

De nuevo la pantera frena en seco, gira y sale despavorida, claro, no sin antes desquitar su ira y su hambre con el mono!!!!!!

MORALEJA

EN MOMENTOS DE CRISIS, SÓLO LA IMAGINACIÓN ES MÁS IMPORTANTE QUE EL CONOCIMIENTO.

1. Procura ser imaginativo como el PERRITO.
2. Evita ser pendejo como la PANTERA.
3. Y nunca, pero nunca! seas un hijue%&#%&%$... chismoso como el MONO

martes, 11 de octubre de 2011

Como un mal título pueda desinformar

El artículo reza que los suplementos de calcio en el embarazo han mostrado "poco beneficio para la Madre y el BB" al leerlo indica que "Calcium supplementation offers a protective benefit against pre-eclampsia and hypertension in pregnant women, but does not offer any other maternal or fetal advantages, according to a Cochrane Collaboration review".
"Extra Calcium of Little Benefit for Mom or Baby http://www.medpagetoday.com/OBGYN/Pregnancy/28985

Entonces es bueno que ofrezca protección para preeclampsia….

martes, 4 de octubre de 2011

Nimesulida y la Agencia Europea de Medicamentos

La EMA (agencia europea de medicamentos) sacó esta aclaratoria sobre la nimesulida,
http://www.medicalnewstoday.com/releases/229481.php