Hipertensión arterial

Marzo 14, 2016. No. 2265

Una revisión sistemática de las intervenciones del estilo de vida para reducir la presión arterial. A systemic review on lifestyle interventions to reduce blood pressure. Vooradi S, Mateti UV. J Health Res Rev 2016;3:1-5 Abstract Hypertension (HTN) is considered a major predominant disease with different comorbidities such as diabetes and cardiovascular and renal disorders. Pharmacological methods in addition to nonpharmacological methods play a major role in reducing high blood pressure (BP) that might also offer safe and effective alternatives to drug therapy. Dietary and behavioral techniques are mainly centered so far by the researchers. The purpose of this article is to achieve positive therapeutic outcomes by reviewing evidence-based nonpharmacological treatments and evaluation of patients with HTN. MEDLINE, PUBMED databases were used to review relevant information. HTN with different comorbidities is not only raising the mortality rates but also health-care costs. The monetary burden for nonpharmacological treatment was considered less cost-effective than drug therapy. It is emphasized that providing patient information leaflet with lifestyle modifications can positively influence patients to marque the lifestyle changes. Keywords: Hypertension, intervention, lifestyle, nonpharmacological PDF

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015

Efecto de Drogas y Contaminantes en el desarrollo cerebral del niño y adolescente

Estimado Pediatra te invito al Seminario de Pediatría, Cirugía Pediátrica y Lactancia Materna. El día 16 Marzo 2016 las 21hrs (Centro, México DF, Guadalajara y Lima Perú) a la Conferencia: “Efecto de Drogas y Contaminantes en el desarrollo cerebral del niño y adolescente” por el “Dr. Juan Márquez Jimenez”, Pediatra de la Cd. De Atlacomulco Edo México. La sesión inicia puntualmente las 21 hrs.
Para entrar a la Sala de Conferencia:

1.- hacer click en la siguiente liga, o cópiala y escríbela en tu buscador
http://connectpro60196372.adobeconnect.com/contaminantes_y_desarrollo/
2.- “Entra como Invitado” Escribes tu nombre y apellido en el espacio en blanco
3.- Hacer click en el espacio que dice “Entrar en la Sala”
5.- A disfrutar la conferencia
6.- Recomendamos que dejes tu Nombre Completo, Correo electrónico y que participes.

Henrys
Dr. Enrique Mendoza López Webmaster: CONAPEME Coordinador Nacional: Seminario Ciberpeds-Conapeme Av La clinica 2520-310 Colonia Sertoma ,Mty N.L. México CP 64710 Tel-Fax 52 81 83482940 y 52 81 81146053 Celular 8183094806 www.conapeme.org www.pediatramendoza.com enrique@pediatramendoza.com emendozal@yahoo.com.mx

Bibliotecas. Noticias

bibliotecas
Notificaciones diarias ⋅ 8 de febrero de 2016
NOTICIAS


ElTiempo.com
Dotan a bibliotecas de Meta Casanare y Arauca
ElTiempo.com
Luego de dotar 424 bibliotecas públicas con tecnología complementaria y formar a 366 bibliotecarios públicos en apropiación de TIC, el Ministerio de ...




Faro de Vigo
Una biblioteca de bata blanca
Faro de Vigo
Casi 9.000 volúmenes con revistas catalogadas desde el año 1975. Éste es el generoso fondo bibliográfico de las dos grandes bibliotecas de "bata ...
A falta de camas... buena es una biblioteca - La Voz de Galicia
Cobertura total de la noticia




Diario Atlántico
9.000 libros y 7.000 consultas en las bibliotecas del hospital
Diario Atlántico
En el hospital Álvaro Cunqueiro se gestiona una biblioteca con 4.365 ejemplares y en el Meixoeiro se albergan los fondos propios, un millar de libros ...



Ampliarán programa de bibliotecas virtuales
Plano informativo
Debido a ello, se analiza la posibilidad de abrir más módulos de bibliotecas virtuales en Centros Comunitarios, así como en las delegaciones, entre ...




eldiadigital.es
Crece el número de socios en las Bibliotecas Municipales
eldiadigital.es
La concejal de educación del ayuntamiento de Albacete Mª Ángeles Martinez ha realizado un balance del año 2015 de las 15 bibliotecas públicas ...




Newsweek en Español (Comunicado de prensa)
Las 10 bibliotecas más bellas del mundo
Newsweek en Español (Comunicado de prensa)
De todos los recintos que el ser humano ha construido alrededor del mundo, las bibliotecas son de los más importantes. Guardianas del ...



Bibliotecas y filatelia
La Vanguardia
Como palabra, la filatelia es una invención francesa de la segunda mitad del siglo XIX. Como afición, en cualquier casa burguesa de cierta tradición ...




Plano informativo
Proyectan ampliación de bibliotecas virtuales en San Luis Potosí
HOYSanLuis
San Luis Potosí, SLP.- La Dirección de Educación del Ayuntamiento de San Luis Potosí analiza la posibilidad de abrir más módulos de bibliotecas ...




Lainformacion.com
El primer museo bajo el agua de Europa está en Lanzarote
Lainformacion.com
Todo esto forma parte de lo que será el futuro Museo Atlántico en Lanzarote. Un total de 300 esculturas son obra del autor británico, Jason deCaires y ...



Gracias a Gobernador ya se cuenta con biblioteca digital
La Prensa De Monclova
M. Múzquiz, Coah.- Alfonso Vázquez Sotelo, Coordinador General de Bibliotecas en el Estado, destaco el hecho de que gracias al Gobernador ...


WEB

Biblioteca 2.0
Ayuntamiento de A Coruña
Biblioteca 2.0. Podrás encontrar nuestros canales sociales llenos de actividad en todas estas plataformas. Porque nos parece importante y queremos ...



Crece el número de socios en las Bibliotecas Municipales y aumenta el presupuesto para el año ...
Ayuntamiento de Albacete
08 de Febrero de 2016- La concejal de educación del ayuntamiento de Albacete Mª Ángeles Martinez ha realizado un balance del año 2015 de las ...

Trombosis venosa y embolia pulmonar / DVT and PE

Febrero 9, 2016. No. 2231

Coagulación y la pared vascular en el embolismo pulmonar Coagulation and the vessel wall in pulmonary embolism. Alias S, Lang IM. Pulm Circ. 2013 Dec;3(4):728-38. doi: 10.1086/674768. Abstract Venous thromboembolism comprises deep-vein thrombosis, thrombus in transit, acute pulmonary embolism, and chronic thromboembolic pulmonaryhypertension (CTEPH). Pulmonary thromboemboli commonly resolve, with restoration of normal pulmonary hemodynamics. When they fail to resorb, permanent occlusion of the deep veins and/or CTEPH are the consequences. Apart from endogenous fibrinolysis, venous thrombi resolve by a process of mechanical fragmentation, through organization of the thromboembolus by invasion of endothelial cells, leukocytes, and fibroblasts leading to recanalization. Recent data utilizing various models have contributed to a better understanding of venous thrombosis and the resolution process that is directed at maintaining vascular patency. This review summarizes the plasmatic and cellular components of venous thrombus formation and resolution. KEYWORDS: CTEPH; pulmonary embolism; thrombosis; thrombus resolution  PDF El impacto de trombosis venosa profunda en los pacientes graves: meta-análisis y resultados clínicos importantes The impact of deep vein thrombosis in critically ill patients: a meta-analysis of major clinical outcomes. Malato A, Dentali F, Siragusa S, Fabbiano F, Kagoma Y, Boddi M, Gensini GF, Peris A, Crowther M, Napolitano M. Blood Transfus. 2015 Oct;13(4):559-68. doi: 10.2450/2015.0277-14. Abstract BACKGROUND: Critically ill patients appear to be at high risk of developing deep vein thrombosis (DVT) and pulmonary embolism during their stay in the intensive care unit (ICU). However, little is known about the clinical course of venous thromboembolism in the ICU setting. We therefore evaluated, through a systematic review of the literature, the available data on the impact of a diagnosis of DVT on hospital and ICU stay, duration of mechanical ventilation and mortality in critically ill patients. We also tried to determine whether currently adopted prophylactic measures need to be revised and improved in the ICU setting. MATERIALS AND METHODS: MEDLINE and EMBASE databases were searched up to week 4 of June 2012. Two reviewers selected studies and extracted data. Pooled results are reported as relative risks and weighted mean differences and are presented with 95% confidence intervals (CI). RESULTS: Seven studies for a total of 1,783 patients were included. A diagnosis of DVT was frequent in these patients with a mean rate of 12.7% (95% CI: 8.7-17.5%). DVT patients had longer ICU and hospital stays compared to those without DVT (7.28 days; 95% CI: 1.4-13.15; and 11.2 days; 95% CI: 3.82-18.63 days, respectively). The duration of mechanical ventilation was significantly increased in DVT patients (weighted mean difference: 4.85 days; 95% CI: 2.07-7.63). DVT patients had a marginally significant increase in the risk of hospital mortality (relative risk 1.31; 95% CI: 0.99-1.74; p=0.06), and a not statistically significant increase in the risk of ICU mortality (RR 1.64; 95% CI: 0.91-2.93; p=0.10). CONCLUSIONS: A diagnosis of DVT upon ICU admission appears to affect clinically important outcomes including duration of ICU and hospital stay and hospital mortality. Larger, prospective studies are warranted. PDF  Modelos de predicción de diagnóstico para la sospecha de embolia pulmonar: revisión sistemática y validación externa independiente en la atención primaria. Diagnostic prediction models for suspected pulmonary embolism: systematic review and independent external validation in primary care. Hendriksen JM, Geersing GJ, Lucassen WA, Erkens PM, Stoffers HE, van Weert HC, Büller HR, Hoes AW, Moons KG. BMJ. 2015 Sep 8;351:h4438. doi: 10.1136/bmj.h4438. Abstract OBJECTIVE: To validate all diagnostic prediction models for ruling out pulmonary embolism that are easily applicable in primary care. DESIGN: Systematic review followed by independent external validation study to assess transportability of retrieved models to primary care medicine. SETTING: 300 general practices in the Netherlands. PARTICIPANTS: Individual patient dataset of 598 patients with suspected acute pulmonary embolism in primary care. MAIN OUTCOME MEASURES: Discriminative ability of all models retrieved by systematic literature search, assessed by calculation and comparison of C statistics. After stratification into groups with high and low probability of pulmonary embolism according to pre-specified model cut-offs combined with qualitative D-dimer test, sensitivity, specificity, efficiency (overall proportion of patients with low probability of pulmonary embolism), and failure rate (proportion of pulmonary embolism cases in group of patients with low probability) were calculated for all models. RESULTS: Ten published prediction models for the diagnosis of pulmonary embolism were found. Five of these models could be validated in the primary care dataset: the original Wells, modified Wells, simplified Wells, revised Geneva, and simplified revised Geneva models. Discriminative ability was comparable for all models (range of C statistic 0.75-0.80). Sensitivity ranged from 88% (simplified revised Geneva) to 96% (simplified Wells) and specificity from 48% (revised Geneva) to 53% (simplified revised Geneva). Efficiency of all models was between 43% and 48%. Differences were observed between failure rates, especially between the simplified Wells and the simplified revised Geneva models (failure rates 1.2% (95% confidence interval 0.2% to 3.3%) and 3.1% (1.4% to 5.9%), respectively; absolute difference -1.98% (-3.33% to -0.74%)). Irrespective of the diagnostic prediction model used, three patients were incorrectly classified as having low probability of pulmonary embolism; pulmonary embolism was diagnosed only after referral to secondary care. CONCLUSIONS: Five diagnostic pulmonary embolism prediction models that are easily applicable in primary care were validated in this setting. Whereas efficiency was comparable for all rules, the Wells rules gave the best performance in terms of lower failure rates. PDF

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015

Tratamiento de TVP y TEP / DVT and PE management

Febrero 10, 2016. No. 2232

Tratamiento anticoagulante de la TVP y TEP: Elestado actualdel manejo. Anticoagulant Treatment of Deep Vein Thrombosis and Pulmonary Embolism: The Present State of the Art. Thaler J, Pabinger I, Ay C. Front Cardiovasc Med. 2015 Jul 14;2:30. doi: 10.3389/fcvm.2015.00030. eCollection 2015. Abstract Venous thromboembolism (VTE), a disease entity comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), is a frequent and potentially life-threatening event. To date different agents are available for the effective treatment of acute VTE and the prevention of recurrence. For several years, the standard of care was the subcutaneous application of a low molecular weight heparin (LMWH) or fondaparinux, followed by a vitamin K antagonist (VKA). The so-called direct oral anticoagulants (DOAC) were introduced rather recently in clinical practice for the treatment of VTE. DOAC seem to have a favorable risk-benefit profile compared to VKA. Moreover, DOAC significantly simplify VTE treatment because they are administered in fixed doses and no routine monitoring is needed. Patients with objectively diagnosed DVT or PE should receive therapeutic anticoagulation for a minimum of 3 months. Whether a patient ought to receive extended treatment needs to be evaluated on an individual basis, depending mainly on risk factors determined by characteristics of the thrombotic event and patient related factors. In specific patient groups (e.g., pregnant women, cancer patients, and elderly patients), treatment of VTE is more challenging than that in the general population and additional issues need to be considered in those patients. The aim of this review is to give an overview of the currently available treatment modalities of acute VTE and secondary prophylaxis. In particular, specific aspects regarding the initiation of VTE treatment, duration of anticoagulation, and specific patient groups will be discussed. KEYWORDS: anticoagulation; deep vein thrombosis; pulmonary embolism; secondary prevention; venous thromboembolism PDF  Anticoagulantes orales directos en el tratamiento del tromboembolismo venoso, con un enfoque en los pacientes con embolia pulmonar: una revisión basada en la evidencia. Direct oral anticoagulants in the treatment of venous thromboembolism, with a focus on patients with pulmonary embolism: an evidence-based review. Gómez-Outes A, Suárez-Gea ML, Lecumberri R, Terleira-Fernández AI, Vargas-Castrillón E. Vasc Health Risk Manag. 2014 Nov 7;10:627-39. doi: 10.2147/VHRM.S50543. eCollection 2014. Abstract Pulmonary embolism (PE) is a relatively common cardiovascular emergency. PE and deep vein thrombosis (DVT) are considered expressions of the same disease, termed as venous thromboembolism (VTE). In the present review, we describe and meta-analyze the efficacy and safety data available with the direct oral anticoagulants (DOAC; dabigatran, rivaroxaban, apixaban, edoxaban) in clinical trials testing these new compounds in the acute/long-term and extended therapy of VTE, providing subgroup analyses in patients with index PE. We analyzed ten studies in 35,019 randomized patients. A total of 14,364 patients (41%) had index PE. In the acute/long-term treatment of VTE, the DOAC showed comparable efficacy in preventing recurrent VTE to standard treatment in patients with index PE (risk ratio [RR]: 0.88; 95% confidence interval [CI]: 0.70-1.11) and index DVT (RR: 0.93; 95% CI: 0.75-1.16) (P for subgroup differences =0.76). VTE recurrence depending on PE anatomical extension and presence/absence of right ventricular dysfunction was only reported in two trials, with results being consistent with those obtained in the overall study populations. In the single trial comparing extended therapy of VTE with DOAC versus warfarin, the point estimate for recurrent VTE tended to disfavor the DOAC in patients with index PE (RR: 2.05; 95% CI: 0.83-5.03) and in patients with index DVT (RR: 1.11; 95% CI: 0.49-2.50) (P for subgroup differences =0.32). In trials that compared DOAC versus placebo for extended therapy, the reduction in recurrent VTE was consistent in patients with PE (RR: 0.15; 95% CI: 0.01-1.82) and in patients with DVT (RR: 0.25; 95% CI: 0.10-0.61) (P for subgroup differences =0.71). The DOAC were associated with a consistently lower risk of clinically relevant bleeding (CRB) than standard treatment of acute VTE and higher risk of CRB than placebo for extended therapy of VTE regardless of index event. In summary, the DOAC were as effective as, and safer than, standard treatment of (hemodynamically stable) PE. Their efficacy in preventing recurrent VTE seemed consistent regardless of anatomical extension of PE (extensive, intermediate, or limit) or presence/absence of right ventricular dysfunction although the data are limited. For extended therapy, the DOAC were more effective than placebo in preventing recurrent VTE but were associated with an increase in CRB regardless of index event. KEYWORDS: anticoagulant; apixaban; dabigatran; edoxaban; pulmonary embolism; rivaroxaban PDF  Los avances en el manejo y tratamiento de la embolia pulmonar. Developments in the management and treatment of pulmonary embolism. Limbrey R, Howard L. Eur Respir Rev. 2015 Sep;24(137):484-97. doi: 10.1183/16000617.00006614. Abstract Pulmonary embolism (PE) is a serious and costly disease for patients and healthcare systems. Guidelines emphasise the importance of differentiating between patients who are at high risk of mortality (those with shock and/or hypotension), who may be candidates for thrombolytic therapy or surgery, and those with less severe presentations. Recent clinical studies and guidelines have focused particularly on risk stratification of intermediate-risk patients. Although the use of thrombolysis has been investigated in these patients, anticoagulation remains the standard treatment approach. Individual risk stratification directs initial treatment. Rates of recurrence differ between subgroups of patients with PE; therefore, a reviewof provoking factors, along with the risks of morbidity and bleeding, guides the duration of ongoing anticoagulation. The direct oral anticoagulants have shown similar efficacy and, in some cases, reduced major bleeding compared with standard approaches for acute treatment. They also offer the potential to reduce the burden on patients and outpatient services in the post-hospital phase. Rivaroxaban, dabigatran and apixaban have been shown to reduce the risk of recurrent venous thromboembolism versus placebo, when given for >12 months. Patients receiving direct oral anticoagulants do not require regular coagulation monitoring, but follow-up, ideally in a specialist PE clinic in consultation with primary care providers, is recommended. PDF

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015