viernes, 31 de diciembre de 2010

El control de la obesidad y de la diabetes reduce el riesgo de ciertos tipos de cáncer

ENDOCRINOLOGÍA

El control de la obesidad y de la diabetes reduce el riesgo de ciertos tipos de cáncer

JANO.es y agencias · 29 Diciembre 2010 12:52

Los pacientes con diabetes tipo 2 u obesidad tienen un riesgo mayor de desarrollar cáncer, así como un peor pronóstico cuando la enfermedad ya se ha manifestado y confluyen ambas patologías, según ha señalado el Dr. Enrique Palacio, jefe del Servicio de Endocrinología del Hospital Nuestra Señora de la Candelaria (Tenerife), en el marco del simposio “Seguridad de análogos de insulina”.
Se estima que la mitad de los diabéticos tipo 2 presenta obesidad y un 60% no alcanza un control óptimo de la enfermedad.

 
En España se estima que la diabetes tipo 2 afecta a 4,6 millones de personas, que aproximadamente la tercera parte de ellas no están diagnosticadas, y que prácticamente la mitad de los pacientes presentan obesidad.
 
Por este motivo, este especialista señala que estos pacientes deben controlar el peso para conseguir un mejor control metabólico, “ya que resulta mucho más fácil si tiene un peso adecuado que si padece sobrepeso”. Asimismo, ha explicado que “la obesidad y el sobrepeso aumentan la probabilidad de presentar hipertensión, colesterol o patología cardiovascular”.
 
Los datos disponibles hasta la actualidad indican que el 60% de los pacientes no alcanza un control óptimo de la enfermedad, es decir, de los 246 millones de personas que padecen diabetes tipo 2 en el mundo, en torno a 150 millones tienen un nivel de glucosa en sangre superior al objetivo.
 
Al respecto, el Dr. Palacio ha recordado que “el control de los niveles de glucosa en el paciente con diabetes es fundamental, dado que no alcanzar un control metabólico puede suponer lesiones en múltiples tejidos, entre ellos, la retina, los riñones y el sistema cardiovascular. Las personas con diabetes, por ejemplo, tienen entre 15 y 40 veces más riesgo de sufrir una amputación de extremidades inferiores, y aumentan la posibilidad de padecer una enfermedad cardiovascular”.
 
Durante el encuentro, celebrado en Santa Cruz de Tenerife con la colaboración de Novo Nordis, el Dr. Arturo Rolla, profesor de Medicina Clínica en la Universidad de Harvard, aseguró que “el hecho de que la obesidad y la diabetes aumenten el riesgo de cáncer podría ser debido a la actividad trófica de la insulina, en general”.
 
Por este motivo, recuerda la importancia de controlar las glucemias y de la hemoglobina glicosilada que, como señala, además “disminuye las complicaciones crónicas de la diabetes”.
 
Para un control terapéutico óptimo han recordado que los análogos de insulina han mejorado el tratamiento de la diabetes en los últimos años, hasta tal punto que se han convertido en la opción terapéutica más eficaz.
 
Según el Dr. Rolla, “los análogos de acción rápida permiten un mejor control de la glucemia posprandial con la conveniencia de que los pacientes se pueden inyectar antes de las comidas, mientras que por su parte, los análogos de larga duración mejoran la calidad de vida de los pacientes, dada su menor variabilidad ya que duran 24 horas y no tienen un pico de actividad muy acusado”.

Investigadores de Barcelona redefinen el síndrome mielodisplásico

Investigadores de Barcelona redefinen el síndrome mielodisplásico

JANO.es · 30 Diciembre 2010 11:41

Investigadores del Hospital del Mar de Barcelona han liderado un estudio multicéntrico internacional que ha logrado redefinir el síndrome mielodisplásico (SMD), enfermedad hematológica también conocida como preleucemia, así como su tratamiento.
Su investigación, publicada en “Leukemia”, también confirman los buenos resultados de un tratamiento del que se había desaconsejado el uso a causa de efectos indeseados que ahora se han desestimado.

 
La investigación, publicada en la revista Leukemia, arroja datos de referencia sobre los parámetros que determinan la evolución del síndrome y describe cambios citogenéticos en el cromosoma 5 (5q-), que tienen valor pronóstico.
 
Hematólogos citogenetistas de Austria, Alemania, Japón, Estados Unidos y España, todos ellos miembros del grupo Cytogenetics MDS Working Group (MDS Foundation), han participado en el estudio y análisis de una serie de 541 pacientes, la muestra más grande en un estudio con pacientes con esta anomalía.
 
Los hallazgos podrían suponer un antes y un después para los pacientes afectados por esta enfermedad, ya que no sólo redefinen la enfermedad, sino que confirman los buenos resultados de un tratamiento del que se había desaconsejado el uso a causa de efectos indeseados que ahora se han desestimado.
 
“Poder disponer de un tratamiento que ayude a normalizar la vida de estos pacientes y que mejore su calidad de vida es una buena noticia”, ha celebrado el coordinador del estudio, Francesc Solé, del grupo de expertos MDS Foundation. “Hace unos años –añade- se desaconsejó el uso de este fármaco a causa de la sospecha de que producía una mayor tasa de evolución a leucemia aguda”.
 
Desde entonces, los pacientes afectados por SMD se quedaron huérfanos de tratamiento. “Con los resultados de este estudio, hemos confirmado que los pacientes con SMD y tratados con lenalidomida no padecen más leucemias que los afectados por SMD sin tratamiento, ya que estas leucemias forman parte de la historia natural de la evolución de la enfermedad y algunos pacientes la sufrirán, tomen o no el fármaco”, ha argumentado el citado especialista.
 
Por el contrario, los pacientes con SMD mejoran mucho las alteraciones sanguíneas que padecen hasta el punto de que el 70% de ellos en dos meses dejan de tener que hacerse transfusiones continuadas.
 
Los síndromes mielodisplásicos son un grupo de enfermedades de la sangre y la médula ósea y presentan un bajo número de células sanguíneas sanas. El origen de la dolencia es una anomalía en las células madre de la medula ósea, las responsables de fabricar las células de la sangre, que imposibilitan que éstas se conviertan en glóbulos blancos, rojos y plaquetas.

Families Bear Brunt of Deployment Strains

A YEAR AT WAR

Families Bear Brunt of Deployment Strains

Marcus Yam/The New York Times
Sgt. First Class Brian Eisch embraced his sons, Joey, 8, left; and Isaac, 12, before returning to his deployment in Afghanistan after a two week midtour leave.



WAUTOMA, Wis. — Life changed for Shawn Eisch with a phone call last January. His youngest brother, Brian, a soldier and single father, had just received orders to deploy from Fort Drum, N.Y., to Afghanistan and was mulling who might take his two boys for a year. Shawn volunteered.

A Year at War

The Home Front
Articles in this series are chronicling the yearlong deployment of the First Battalion, 87th Infantry Regiment, based in Kunduz Province, Afghanistan. The series follows the battalion’s part in the surge in northern Afghanistan and the impact of war on individual soldiers and their families back home.
Marcus Yam/The New York Times
Joey, left, and Isaac Eisch with their father, Sgt. First Class Brian Eisch, before his return to Afghanistan from leave.

Readers' Comments

Readers shared their thoughts on this article.
So began a season of adjustments as the boys came to live in their uncle’s home here. Joey, the 8-year-old, got into fistfights at his new school. His 12-year-old brother, Isaac, rebelled against their uncle’s rules. And Shawn’s three children quietly resented sharing a bedroom, the family computer and, most of all, their parents’ attention with their younger cousins.
The once comfortable Eisch farmhouse suddenly felt crowded.
“It was a lot more traumatic than I ever pictured it, for them,” Shawn, 44, said. “And it was for me, too.”
The work of war is very much a family affair. Nearly 6 in 10 of the troops deployed today are married, and nearly half have children. Those families — more than a million of them since 2001 — have borne the brunt of the psychological and emotional strain of deployments.
Siblings and grandparents have become surrogate parents. Spouses have struggled with loneliness and stress. Children have felt confused and abandoned during the long separations. All have felt anxieties about the distant dangers of war.
Christina Narewski, 26, thought her husband’s second deployment might be easier for her than his first. But she awoke one night this summer feeling so anxious about his absence that she thought she was having a heart attack and called an ambulance. And she still jumps when the doorbell rings, worried it will be officers bearing unwanted news.
“You’re afraid to answer your door,” she said.
Social scientists are just beginning to document the rippling effects of multiple combat deployments on families — effects that those families themselves have intimately understood for years. A study published in The New England Journal of Medicine in January found that wives of deployed soldiers sought mental health services more often than other Army wives.
They were also more likely to report mental health problems, including depression, anxiety and sleep disorder, the longer the deployments lasted.
And a paper published in the journal Pediatrics in late 2009 found that children in military families were more likely to report anxiety than children in civilian families. The longer a parent had been deployed in the previous three years, the researchers found, the more likely the children were to have had difficulties in school and at home.
But those studies do not describe the myriad ways, often imperceptible to outsiders, in which families cope with deployments every day.
For Ms. Narewski, a mother of three, it has meant taking a grocery store job to distract her from thinking about her husband, a staff sergeant with the First Battalion, 87th Infantry, now in northern Afghanistan.
For Tim Sullivan, it has meant learning how to potty train, braid hair and fix dinner for his two young children while his wife, a sergeant in a support battalion to the 1-87, is deployed.
For young Joey Eisch, it meant crying himself to sleep for days after his father, a platoon sergeant with the battalion, left last spring. His older brother, Isaac, calm on the outside, was nervous on the inside.
“It’s pretty hard worrying if he’ll come back safe,” Isaac said. “I think about it like 10 or more times a day.”
Joining the Army Life
Soon after Christina and Francisco Narewski married in 2004, he applied for a job with the local sheriff’s office in Salinas, Calif. But he got tired of waiting and, after talking things over with Christina, enlisted in the Army instead.
“We both signed up for it,” Ms. Narewski said. “We knew deployments were going to come.”
That day arrived in the fall of 2007, when their third child was just 5 months old. Ms. Narewski missed Francisco dearly and sometimes cried just hearing his voice when he called from Iraq. But when he returned home in October 2008, it took them weeks to feel comfortable together again, she recalled.

Families Bear Brunt of Deployment Strains


(Page 2 of 3)
“It’s almost like you’ve forgotten how to be with each other,” she said. “He’s been living in his spot for 15 months. Me and the kids have our own routine. It’s hard to get back to, ‘Oh, you’re home.’ ”
Marcus Yam/The New York Times
TWO WEEKS ON LEAVE, TOO SHORT A TIME Sgt. First Class Brian Eisch as his son Joey, 8, gets the “high and tight” look like his father’s.

A Year at War

The Home Front
Articles in this series are chronicling the yearlong deployment of the First Battalion, 87th Infantry Regiment, based in Kunduz Province, Afghanistan. The series follows the battalion’s part in the surge in northern Afghanistan and the impact of war on individual soldiers and their families back home.
Marcus Yam/The New York Times
Isaac Eisch, 12, in the back seat of his uncle’s car after saying goodbye to his father, who was returning to Afghanistan.

Readers' Comments

Readers shared their thoughts on this article.
Last April, he left again, this time to Afghanistan. Ms. Narewski, who lives in Watertown, N.Y., thought she was prepared. Her mother came to live with them. She signed up for exercise classes to fill the hours. She and Francisco bought BlackBerrys with instant messaging service so they could communicate daily. And yet.
“I’ve never missed him as much as I do right now,” she said recently. “It doesn’t feel like we’re moving. It’s like you’re in a dream and you’re trying to get something and you can’t get it.”
Not all the spouses back home are women. Tim Sullivan’s days have revolved almost entirely around his two children, Austin, 4, and Leah, 2, since his wife, Sgt. Tamara Sullivan, deployed to Afghanistan in March.
He rises each weekday at 5:30 a.m. to dress and feed them before shuttling them to day care. Evenings are the reverse, usually ending with him dozing off in front of the television at their rented ranch-style house in Fayetteville, N.C.
He has moved twice and changed jobs three times in recent years to accommodate his wife’s military career. But he does not mind being home with the children, he says, because his father was not, having left the family when Mr. Sullivan was young.
“I’m not going to put my kids through that,” said Mr. Sullivan, 35, who handles child support cases for the county. “I’m going to be there.”
He worries about lost intimacy with his wife, saying that they have had a number of arguments by phone, usually about bill paying or child rearing. “She tells me: ‘Tim, you can’t just be Daddy, the hard person. You have to be Mommy, too,’” he said. “I tell her it’s not that easy.”
Yet he says that if she stays in the Army — as she has said she wants to do — he is prepared to move again or even endure another deployment. “I love her,” he said. “I’m already signed up. I made a decision to join the life that goes with that.”
Doing What Uncle Sam Asks
Isaac and Joey Eisch have also had to adjust to their father’s nomadic life. “I don’t try to get too attached to my friends because I move around a lot,” said Isaac, who has lived in five states and Germany with his father. (Joey has lived in three states.) “When I leave, it’s like, hard.”
When Sergeant Eisch got divorced in 2004, he took Isaac to an Army post in Germany while Joey stayed with his mother in Wisconsin. Soon after returning to the States in 2007, the sergeant became worried that his ex-wife was neglecting Joey. He petitioned family court for full custody of both boys and won.
In 2009, he transferred to Fort Drum and took the boys with him. Within months, he received orders for Afghanistan.
After nearly 17 years in the Army with no combat deployments, Sergeant Eisch, 36, was determined to go to war. The boys, he felt, were old enough to handle his leaving. Little did he know how hard it would be.
When Shawn put the boys in his truck at Fort Drum to take them to Wautoma, a two-stoplight town in central Wisconsin, Isaac clawed at the rear window “like a caged animal,” Sergeant Eisch said. He still tears up at the recollection.
“I question myself every day if I’m doing the right thing for my kids,” he said. “I’m trying to do my duty to my country and deploy, and do what Uncle Sam asks me to do. But what’s everybody asking my boys to do?”
Within a few weeks of arriving at his uncle’s home, Joey beat up a boy so badly that the school summoned the police. It was not the last time Shawn and his wife, Lisa, would be summoned to the principal’s office.
The boys were in pain, Shawn realized. “There was a lot more emotion,” he said, “than Lisa and I ever expected.”

Shawn, a state water conservation officer, decided he needed to set strict rules for homework and behavior. Violations led to chores, typically stacking wood. But there were carrots, too: for Joey, promises of going to Build-a-Bear if he obeyed his teachers; for Isaac, going hunting with his uncle was the prize. Gradually, the calls from the principal declined, though they have not ended.
Marcus Yam/The New York Times
Sergeant Eisch and the boys at the boys’ grandparents’ home on his last night before returning.

A Year at War

The Home Front
Articles in this series are chronicling the yearlong deployment of the First Battalion, 87th Infantry Regiment, based in Kunduz Province, Afghanistan. The series follows the battalion’s part in the surge in northern Afghanistan and the impact of war on individual soldiers and their families back home.
Marcus Yam for The New York Times
WOUNDED, BUT STILL IN ONE PIECEIsaac, with Joey, helping his father at Walter Reed Army Medical Center in Washington. Sitting with them was Sergeant Eisch’s brother, Shawn, who has been keeping the boys.

In September, Sergeant Eisch returned for midtour leave and the homecoming was as joyful as his departure had been wrenching. Father and sons spent the first nights in hotels, visited an amusement park, went fishing and traveled to New York City, where they saw Times Square and the Intrepid Sea, Air and Space Museum.
But the two weeks were over in what seemed like hours. In his final days, Sergeant Eisch had prepped the boys for his departure, but that did not make it any easier.
“Why can’t we just, like, end the war?” Isaac asked at one point.
As they waited at the airport, father and sons clung to each other. “I’m going to have to drink like a gallon of water to replenish these tears,” the sergeant said. “Be safe,” Isaac implored him over and over.
Sergeant Eisch said he would, and then was gone.
Despite his worries, Isaac tried to reassure himself. “He’s halfway through, and he’s going to make it,” he said. “With all that training he’s probably not going to get shot. He knows if there’s a red dot on his chest, run. Not toward the enemy. Run, and shoot.”
But his father did not run.
Dad Comes Home
Just weeks after returning to Afghanistan, Sergeant Eisch, the senior noncommissioned officer for a reconnaissance and sniper platoon, was involved with Afghan police officers in a major offensive into a Taliban stronghold south of Kunduz city.
While directing fire from his armored truck, Sergeant Eisch saw a rocket-propelled grenade explode among a group of police officers standing in a field. The Afghans scattered, leaving behind a man writhing in pain. Sergeant Eisch ordered his medic to move their truck alongside the officer to shield him from gunfire. Then Sergeant Eisch got out.
“I just reacted,” he recalled. “I seen a guy hurt and nobody was helping him, so I went out there.”
The police officer was bleeding from several gaping wounds and seemed to have lost an eye. Sergeant Eisch started applying tourniquets when he heard the snap of bullets and felt “a chainsaw ripping through my legs.” He had been hit by machine gun fire, twice in the left leg, once in the right.
He crawled back into his truck and helped tighten tourniquets on his own legs. He was evacuated by helicopter and taken to a military hospital where, in a morphine daze, he called Shawn.
“Are you sitting down?” Brian asked woozily. “I’ve been shot.”
Shawn hung up and went into a quiet panic. He could not tell how badly Brian had been wounded. Would he lose his leg? He called the school and asked them to shield the boys from the news until he could get there.
Outside school, Shawn told Isaac, Joey and his 12-year-old daughter, Anna, about Brian’s injury. Only Isaac stayed relatively calm.
But later, Shawn found Isaac in his bedroom weeping quietly while looking at a photograph showing his father outside his tent, holding a rifle. Shawn helped him turn the photograph into a PowerPoint presentation titled, “I Love You Dad!”
For Shawn, a gentle and reserved man, his brother’s injury brought six months of family turmoil to a new level. Sensing his distress, Lisa urged him to go hunting, a favorite pastime. So he grabbed his bow and went to a wooded ridge on his 40 acres of property.
To his amazement, an eight-point buck wandered by. Shawn hit the deer, the largest he had ever killed with a bow. It seemed a good omen.
A few days later, Shawn flew with the boys, his father and Brian’s twin sister, Brenda, to Washington to visit Sergeant Eisch at Walter Reed Army Medical Center. At the entrance, they saw men in wheelchairs with no arms and no legs. Others were burned or missing eyes. Shawn feared what the boys would see inside Brian’s room.
But Brian, giddy from painkillers, was his cheerful self. His right leg seemed almost normal. His left leg, swollen and stapled together, looked terrible. But it was a real leg, and it was still attached. The boys felt relieved.
Within days, Brian was wheeling himself around the hospital and cracking jokes with nurses, a green-and-yellow Green Bay Packers cap on his head. While Joey lost himself in coloring books and television, Isaac attended to his father’s every need.
“I feel a little more grown up,” Isaac said. “I feel a lot more attached to him than I was when he left.”
One doctor told Brian that he would never be able to carry a rucksack or run again because of nerve damage in his left leg. Someone even asked him if he wanted the leg amputated, since he would certainly be able to run with a prosthetic. Brian refused, and vowed to prove the doctor wrong. By December, he was walking with a cane and driving.
For Shawn, too, the future had become murkier. It might be many weeks before Brian could reclaim his sons. But he also knew how glad the boys were to have their father back in one piece.
“Brian came home,” Shawn said one evening after visiting his brother in the hospital. “He didn’t come home like we hoped he would come home, but he came home.”
“Every single day I think about all those families and all those kids that are not going to have a dad come home from Afghanistan,” he said. “That hurts more than watching my brother try to take a step because I know my brother will take a step and I know he’s going to walk down the dock and get in his bass boat someday.”
It was late, and he had to get the boys up the next morning to visit their father at the hospital again. The holidays were fast approaching and the snow would soon be arriving in Wisconsin. Shawn wondered whether he could get Isaac out hunting before the season ended.
Yeah, he thought. He probably could.

This article has been revised to reflect the following correction:
Correction: December 31, 2010
Picture captions with an earlier version of this article misstated the rank of Sgt. First Class Brian Eisch
.