jueves, 13 de enero de 2011

This Bowl of Cherries Offers Food for Thought

MUSIC REVIEW

This Bowl of Cherries Offers Food for Thought

Michelle V. Agins/The New York Times
Christine Ebersole is performing a show of standards and newer songs at the Café Carlyle.
A sneak attack: that’s what you might call the moment in Christine Ebersole’s brilliant new show at the Café Carlyle when the merriment pauses, and she delivers a riveting dramatic performance of “Another Winter in a Summer Town.” With music by Scott Frankel and lyrics by Michael Korie, the song is a crushing moment of self-awareness and an acknowledgment of personal defeat by Little Edie Beale, whom Ms. Ebersole portrayed in the Broadway musical “Grey Gardens.”

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Recalling the glamour of long-ago debutante days that still seem more real than the present, Edie, now middle aged, acknowledges, “My season ended a long time ago/But no one took the party tent down.” At Ms. Ebersole’s opening-night performance on Tuesday the song was attached to “Drift Away,” a lesser-known number from “Grey Gardens” that further deepened what might be described as an aching Proustian reverie of happier times gone by. The audience response was thunderous.
Although Ms. Ebersole’s emotional raid seemed to come out of nowhere, it was actually a carefully prepared moment of truth in a show whose songs and witty patter are about youth and age and Hollywood illusions. “Another Winter in a Summer Town” was immediately preceded by a truncated, lighthearted rendition of “When the World Was Young” that omitted the grown-up side of this summing-up reflection by a world-weary celebrity.
With her gifted director Scott Wittman, Ms. Ebersole seems to share a telepathic kinship in which multiple personalities reveal themselves as one number segues into another. Her musical director and pianist, John Oddo, leading a quartet that included Charles Pillow on reeds, David Finck on bass, and Jim Saporito on drums, contrived light, sophisticated pop-jazz arrangements that underlined her screwball charm without straining to be cute.
In her frisky mode Ms. Ebersole suggests a blond, rosy-cheeked child, the ideal playmate of your youth when you rummaged through a trunk on a rainy afternoon and dressed up as pirates and princesses. Ms. Ebersole’s zany childlike side was epitomized by a version of “Ding-Dong! The Witch Is Dead,” from “The Wizard of Oz,” its adult counterpart by a hilarious Sophie Tucker number, “You Can’t Deep Freeze a Red Hot Mama.” (And why can’t you? “You can’t get her temperature down.”)
With several distinct voices in her arsenal of characters, there is something of the ventriloquist about Ms. Ebersole. One of them that pops in every show is a fluttery, trilling Jeanette MacDonald-like ingénue whom Ms. Ebersole simultaneously adores and spoofs. Behind that persona is a dramatic soprano who is not playing charades.
Just when you were recovering from the first sneak attack came a second, in which Ms. Ebersole belted the deceptively chirpy DeSylva-Brown-Henderson tune “Life Is Just a Bowl of Cherries” as a credo, emphasizing its observation:
The sweet things in life
To you were just loaned,
So how can you lose
What you’ve never owned?
By the time the show ended with “Young at Heart,” Proustian melancholy had morphed into the euphoria encapsulated by the wise DeSylva-Brown-Henderson catchphrase that is hard to live by, as easy as it sounds: “Live and laugh at it all.”
Christine Ebersole continues through Jan. 29 at the Café Carlyle, 35 East 76th Street, Manhattan: (212) 744-1600.

Autism Fraud

EDITORIAL

Autism Fraud

The report that first triggered scares that a vaccine to preventmeaslesmumps and rubella might cause autism in children has received another devastating blow to its credibility. The British Medical Journal has declared that the research was not simply bad science, as has been known for years, but a deliberate fraud.
The study, led by Dr. Andrew Wakefield, was published in The Lancet in 1998. It was based on just 12 children with supposedly autismlike disorders and purported to find a link between the vaccine, the gastrointestinal problems found in many autistic children, and autism.
While parents around the world were understandably alarmed, many scientists rejected the claims, including, eventually, 10 of Dr. Wakefield’s co-authors. A high-level British medical group, after an exhaustive fitness-to-practice hearing, found Dr. Wakefield guilty of dishonesty and misconduct. The Lancet retracted the article in part, it said, because the authors had made false claims about how the study was conducted.
Now the British Medical Journal has taken the extraordinary step of publishing a lengthy report by Brian Deer, the British investigative journalist who first brought the paper’s flaws to light — and has put its own reputation on the line by endorsing his findings.
After seven years of studying medical records and interviewing parents and doctors, Mr. Deer concluded that the medical histories of all 12 children had been misrepresented to make the vaccine look culpable. Time lines, for example, were fudged to make it seem as though autismlike symptoms developed shortly after vaccination, while in some cases problems developed before vaccination and in others months after vaccination.
Dr. Wakefield has accused Mr. Deer of being a hit man. But the medical journal compared the claims with evidence compiled in the voluminous transcript of official hearings and declared that flaws in the paper were not honest mistakes but rather an “elaborate fraud.”
Some parents still consider Dr. Wakefield a hero, and others have moved on to other theories, equally unsupported by scientific evidence, as to how vaccines might cause autism.
They need to recognize that failure to vaccinate their children leaves them truly vulnerable to diseases that can cause enormous harm.

En este día...

On This Day in HistoryThursday, January 13th
The 013th day of 2011.
There are 352 days left in the year.
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Today's Highlights in History
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NYT Front PageSee a larger version of this front page.
On Jan. 13, 1990, Douglas Wilder of Virginia became the nation's first elected black governor as he took the oath of office in Richmond. (Go to article.)On Jan. 13 , 1870Ross GranvilleHarrison , the American zoologist and pioneer in embryonic transplantation , was born. Following his death onSept. 30 , 1959, his obituary appeared in The Times. (Go to obit. |Other Birthdays)
Editorial Cartoon of the Day

On January 13, 1877Harper's Weekly featured a cartoon about the Electoral College controversy. (See the cartoon and read an explanation.)

On this date in:
1794President George Washington approved a measure adding two stars and two stripes to the American flag, following the admission of Vermont and Kentucky to the union.
1808Salmon P. Chase, U.S. senator, secretary of the treasury and chief justice of the Supreme Court, was born in Cornish, N.H.
1893Britain's Independent Labor Party, a precursor to the Labor Party, first met.
1898Novelist Emile Zola's "J'accuse" - a defense of Captain Alfred Dreyfus, a French Jew falsely convicted of treason - was published in a Paris newspaper.
1964Karol Wojtyla, the future Pope John Paul II, was appointed archbishop of Krakow, Poland, by Pope Paul VI.
1966Robert C. Weaver became the first black Cabinet member as he was appointed Secretary of Housing and Urban Development by President Lyndon B. Johnson.
1968Country musician Johnny Cash recorded a live concert at Folsom Prison in California.
1978Former Vice President Hubert H. Humphrey died in Waverly, Minn., at age 66.
1982An Air Florida 737 crashed into the 14th Street Bridge in Washington, D.C., after takeoff and fell into the Potomac River, killing 78 people.
1989New York City subway gunman Bernhard H. Goetz was sentenced to one year in prison for possessing an unlicensed gun that he used to shoot four youths he said were about to rob him.
2000Microsoft chairman Bill Gates stepped aside as chief executive.
2002The off-Broadway musical "The Fantasticks" ended a run of nearly 42 years and 17,162 shows.

Current Birthdays
Patrick Dempsey turns 45years old today.

AP Photo/Peter Kramer Actor Patrick Dempsey ("Grey's Anatomy") turns 45 years old today.

81Frances Sternhagen
Actress
77Rip Taylor
Comedian
73Billy Gray
Actor ("Father Knows Best")
68Richard Moll
Actor ("Night Court")
57Trevor Rabin
Rock musician (Yes)
50Julia Louis-Dreyfus
Actress ("Seinfeld," "The New Adventures of Old Christine")
49Trace Adkins
Country singer
47Penelope Ann Miller
Actress
39Nicole Eggert
Actress
34Orlando Bloom
Actor ("Pirates of the Caribbean" and "The Lord of the Rings" movies)
Historic Birthdays
Ross Granville Harrison
 
1/13/1870 - 9/30/1959
American zoologist 

(Go to obit.)

60Jan van Goyen
1/13/1596 - 4/27/1656
Dutch artist

77Christoph Graupner
1/13/1683 - 5/10/1760
German composer

81Sir Isaac Goldsmid
1/13/1778 - 4/27/1859
English financier

65Salmon Chase
1/13/1808 - 5/7/1873
American politician/lawyer

67Horatio Alger
1/13/1832 - 7/18/1899
American author

51Felix Tisserand
1/13/1845 - 10/20/1896
French astronomer

82Sophie Tucker
1/13/1884 - 2/9/1966
American entertainer

68Elmer Davis
1/13/1890 - 5/18/1958
American broadcaster/writer

90A.B. Jr. Guthrie
1/13/1901 - 4/26/1991
American novelist

Go to a previous date.
SOURCE: The Associated Press
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Mortalidad, pérdida de peso y calidad de vida en pacientes con obesidad mórbida: evaluación del manejo médico y quirúrgicvo después de 2 años

Mortalidad, pérdida de peso y calidad de vida en pacientes con obesidad mórbida: evaluación del manejo médico y quirúrgicvo después de 2 años 
Mortality, weight loss and quality of life of patients with morbid obesity: evaluation of the surgical and medical treatment after 2 years.
Pimenta GP, Saruwatari RT, Corrêa MR, Genaro PL, Aguilar-Nascimento JE.
Federal University of Mato Grosso, Cuiabá, MT, Brazil.
Arq Gastroenterol. 2010 Sep;47(3):263-9.
 
Abstract
CONTEXT: The surgical treatment for morbid obesity is becoming common in this country. Only a few papers reported the long-term results of the surgical approach for morbid obesity, mainly in terms of quality of life. OBJECTIVE: To compare mortality rate, weight loss, improvement of both diabetes and hypertension, and quality of life of patients from the public healthcare in Cuiabá, MT, Brazil, who underwent either medical or surgical interventions after a minimum of 2 years. METHODS: The population of this study was constituted by morbidly obese patients who initiated treatment between June 2002 and December 2006. The casuistic consisted of 89 patients submitted to medical therapy and 76 patients who underwent surgical procedures. The main variables were weight loss, improvement of hypertension and diabetes, quality of life, and mortality. RESULTS: The overall results showed that weight loss was significant in the two groups (P<0.001); however surgical patients showed a greater loss than the medical group (P = 0.05). The improvement of diabetes and hypertension was significantly greater in the surgical group (P<0.001), in which no cases of diabetes persisted. There was an increase in cases of hypertension among patients receiving medical attention. Mortality occurred in six cases (6.7%) of the medical group and in five cases (6.6%) of the surgical group (P = 0.97). The median grade of the quality of life score obtained by surgical patients (2.37 [range: -2.50 to 3.00]) was significantly greater (P<0.001) when compared to the medical group (1.25 [range: -1.50 to 3.00]). CONCLUSION: The surgical group presented better results regarding the weight loss, quality of life and improvement of hypertension and diabetes. There was no significant difference in mortality rate between the two groups after a minimum of 2 years.

 
Tendencias en cirugía bariátrica para la obesidad mórbida en Wisconsin: seguimiento a 6 años.
Trends in bariatric surgery for morbid obesity in Wisconsin: a 6-year follow-up.
Henkel DS, Remington PL, Athens JK, Gould JC.
University of Wisconsin School of Medicine and Public Health, Madison, Wis, USA.
WMJ. 2010 Feb;109(1):21-7.
 

Abstract
BACKGROUND: The prevalence of morbid obesity is increasing throughout Wisconsin and the United States. In 2004, we published a study, "Trends in Bariatric Surgery for Morbid Obesity in Wisconsin." We determined that surgery rates were increasing but felt the demand exceeded the capacity of the surgeons. This is a 6-year follow-up. METHODS: Data was gathered from 3 sources: the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System, the Wisconsin Hospital Association, and a survey administered to Wisconsin bariatric surgeons. RESULTS: From 2003-2008, an average of 2.8% of Wisconsin adults were morbidly obese. Although the number of bariatric surgeries performed in Wisconsin remained steady (1311 surgeries in 2003 and 1343 in 2008), the types of procedures shifted from open gastric bypass (73% in 2003) to laparoscopic gastric bypass (80% in 2008). The rate of surgery was 1 for every 100 morbidly obese adults. The majority of surgeons surveyed (70%) report that a lack of insurance benefits is the biggest barrier to performing bariatric surgery. CONCLUSION: The prevalence of morbid obesity continues to increase in Wisconsin compared to our previously published data. Bariatric surgery volumes have remained stable but the type of procedure has changed. Approximately 1% of bariatric surgery candidates have surgery each year.

 
Manejo quirúrgico de la obesidad
 Surgical treatment of obesity.
Bult MJ, van Dalen T, Muller AF.
Department of Internal Medicine, Diakonessenhuis Utrecht, Bosboomstraat 1, 3582 KE Utrecht, The Netherlands.
Eur J Endocrinol. 2008 Feb;158(2):135-45.
 
Abstract
More than half of the European population are overweight (body mass index (BMI) > 25 and < 30 kg/m2) and up to 30% are obese (BMI > or = 30 kg/m2). Being overweight and obesity are becoming endemic, particularly because of increasing nourishment and a decrease in physical exercise. Insulin resistance, type 2 diabetes, dyslipidemia, hypertension, cholelithiasis, certain forms of cancer, steatosis hepatis, gastroesophageal reflux, obstructive sleep apnea, degenerative joint disease, gout, lower back pain, and polycystic ovary syndrome are all associated with overweight and obesity. The endemic extent of overweight and obesity with its associated comorbidities has led to the development of therapies aimed at weight loss. The long-term effects of diet, exercise, and medical therapy on weight are relatively poor. With respect to durable weight reduction, bariatric surgery is the most effective long-term treatment for obesity with the greatest chances for amelioration and even resolution of obesity-associated complications. Recent evidence shows that bariatric surgery for severe obesity is associated with decreased overall mortality. However, serious complications can occur and therefore a careful selection of patients is of utmost importance. Bariatric surgery should at least be considered for all patients with a BMI of more than 40 kg/m2 and for those with a BMI of more than 35 kg/m2 with concomitant obesity-related conditions after failure of conventional treatment. The importance of weight loss and results of conventional treatment will be discussed first. Currently used operative treatments for obesity and their effectiveness and complications are described. Proposed criteria for bariatric surgery are given. Also, some attention is devoted to more basic insights that bariatric surgery has provided. Finally we deal with unsolved questions and future directions for research.
 
Enlace para leer el artículo completo:
Cirugía bariátrica: riesgos y recompensas
Bariatric Surgery: Risks and Rewards
Walter J. Porie
J Clin Endocrinol Metab. 2008 November; 93(11 Suppl 1): S89-S9

 Context: Over 23 million Americans are afflicted with severe obesity, i.e. their body mass index (in kilograms per square meter) values exceed 35. Of even greater concern is the association of the adiposity with comorbidities such as diabetes, hypertension, cardiopulmonary failure, asthma, pseudotumor cerebri, infertility, and crippling arthritis. Objective: Diets, exercise, behavioral modification, and drugs are not effective in these individuals. This article examines the effect of surgery on the control of the weight and the comorbidities, as well as the safety of these operations. Interventions: Although the article focuses on the outcomes of the three most commonly performed operations, i.e. adjustable gastric banding, the gastric bypass, and the biliopancreatic bypass with duodenal switch, it aims for perspective with the inclusion of abandoned and current investigational procedures, a review of the complications, and an emphasis on the appropriate selection of patients. Positions: Ample evidence, including controlled randomized studies, now document that bariatric surgery produces durable weight loss exceeding 100 lb (46 kg), full and long-term remission of type 2 diabetes in over 80% with salutary effects on the other comorbidities as well with significant reductions in all-cause mortality. Although the severely obese present with serious surgical risks, bariatric surgery is performed safely with a 0.35% 90-d mortality in Centers of Excellence throughout the United States-similar to the complication rates after cholecystectomy. Conclusions: Until better approaches become available, bariatric surgery is the therapy of choice for patients with severe obesity

Enlace para leer el artículo completo 
Atentamente
Dr. Juan Carlos Flores-Carrillo
Anestesiología y Medicina del Dolor

GPC - American Thoracic Society

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Scientific statements and practice guidelines


Links to other critical care practice guidelines

HTA

Situaciones urgentes en hipertensión arterial
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Papel actual de los diuréticos en el tratamiento de la hipertensión arterial
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Manejo de las alteraciones de la presión arterial en la fase aguda del ictus. Actualización 2008 del Documento de Consenso de las Sociedades Catalanas de Hipertensión y de Neurología
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Especialidades farmacéuticas frente a genéricos

Hipertensión y riesgo vascular

Especialidades farmacéuticas frente a genéricos

Por R Córdoba García a
a Unidad Docente de Medicina Familiar y Comunitaria. Centro de Salud Universitario Delicias Sur. Zaragoza. España
El interés por los fármacos genéricos procede de las dificultades de financiación de los sistemas sanitarios y de la necesidad de reducir la factura sanitaria sin merma de los objetivos de salud. Su expansión y uso requiere la aceptación de la población y de los médicos, y que se despejen algunas dudas sobre su verdadera equivalencia respecto a los fármacos originales. La identidad química cuantitativa o cualitativa de un antihipertensivo en dos formas farmacéuticas similares no asegura la misma eficacia terapéutica de ambas. Dos formas sólo pueden considerarse equivalentes cuando lo son también las características químicas, galénicas, biológicas y clínicas. La aparición de la normativa de la especialidad farmaceútica genérica (EFG) supone que estas especialidades deben presentar estudios de bioequivalencia. Esta exigencia se limita a presentar estudios en voluntarios sanos demostrando los niveles plasmáticos. En estos parámetros la legislación permite variaciones del ± 20 % del área bajo la curva y para concentración máxima y del ± 30 % para el tiempo en alcanzarla. La legislación debe ser exigente con la calidad de estos productos y regular cuidadosamente el principio de sustitución. Las compañías farmacéuticas alegan que sólo los beneficios de las especialidades no genéricas generan inversiones para la investigación de nuevos productos que pueden resolver problemas de salud pendientes. Sin embargo, los EFG no han revelado fracasos terapéuticos significativos y pueden contribuir a la contención del gasto farmacéutico. Sería necesario un plan de formación orientado a desarrollar un adecuado espíritu crítico en cuestiones de eficacia, efectividad y coste-efectividad de la prescripción de antihipertensivos.
Hipertensión. 2008;25:169-74.
Palabras clave: especialidades farmacéuticas genéricas, hipertensión, prescripción de medicamentos.
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