PLEURODESIS CON IODOPOVIDONA

Efficacy of Iodopovidone Pleurodesis and Comparison of Small-Bore Catheter Versus Large-Bore Chest Tube
Annals of Surgical Oncology 15:2594-2599 (2008)

Background: To evaluate the efficacy of iodopovidone as an agent for pleurodesis in malignant pleural effusion (MPE) and to compare the efficacy of small-bore catheter (Pleuracan, Braun, Melsungen, Germany) and conventional large-bore chest tube in pleural fluid drainage and sclerotherapy.
Methods: Patients with MPE were prospectively consecutively randomized into two groups between August 2004 and February 2007: pleurodesis via conventional (32F) chest tube (group 1) and small-bore catheter (group 2), both using iodopovidone. After 3 months’ follow-up, response rates (complete or partial), complication rates, and duration of procedures within whole group, group 1, and group 2 were compared. Statistical analyses were performed by Mann-Whitney U, 2, and Fisher’s exact test.
Results: Forty-three pleurodeses were performed in 41 patients. The response was complete in 26 (60.5%) and partial in 12 (27.9%), and the overall success rate was 88.4%. The response rate was not associated with the type of inserted tube (P = .750), pleural fluid pH (P = .290), or pleural fluid lactate dehydrogenase (P = .727). In group 1 (n = 20), 12 demonstrated complete and 6 demonstrated partial response, with a 90% success rate; success was 86.9% in group 2, with complete response in 14 and partial response in 6 patients. Success rates were similar in the two groups (P = 1.000). Of 43 procedures, complications were observed in 14 (32.5%), and complication rates were 35% and 30.4% in groups 1 and 2, respectively (P = .750). The most frequent complication was pain (16.2%), followed by fever, subcutaneous emphysema, dyspnea, and hypotension.
Conclusion: Iodopovidone is an effective, inexpensive, safe, and easily available alternative in chemical pleurodesis in MPE. The success rates of pleurodesis were found to be similar regardless of the type of the tube inserted.

EL NUMERO NECESARIO A TRATAR

The "number needed to treat" turns 20 — and continues to be used and misused

CMAJ • September 9, 2008; 179 (6). doi:10.1503/cmaj.080484.© 2008 Canadian Medical Association or its licensors

In the 20 years since the initial description of the number needed to treat,1 this method of expressing the efficacy of an intervention has become widely used. Indeed, the Consolidated Standards of Reporting Trials statement recommends that the number needed to treat be reported in randomized trial publications,2 and journals of secondary publication (e.g., American College of Physicians Journal Club) routinely calculate and report the number needed to treat for studies of therapy. As well, there have been increasing calls for health care policy makers to use numbers needed to treat to inform their recommendations;3 and league tables comparing numbers needed to treat have appeared in the literature4–7 and on the internet (See www.cebm.utoronto.ca/glossary/nnts.htm#table and www.jr2.ox.ac.uk/bandolier/band50/b50-8.html for examples from different branches of medicine).
Having attended hundreds of journal clubs as well as departmental and divisional rounds over the past 2 decades, I am consistently impressed by the frequency with which audience members display skepticism about a therapy if its efficacy is presented only in relative terms such as odds ratios or relative risk reductions. Not infrequently, this skepticism is healthy — the dangers of misinterpreting the importance of a therapy when relying solely on relative effect estimates are well known.1 However, I have also been struck by the extent to which discussions of a therapy's number needed to treat, and even comparisons between therapies on this basis, are accepted at face value. A review of the literature and their experiences in journal club and critical appraisal settings led Chong and colleagues to also express concern that many clinicians appear to hold "the impression that NNT [number needed to treat] values in and of themselves are broadly comparable" and display "an implicit belief that an unadjusted NNT value adequately captures the overall worth of a treatment."8
In this article, I explore the factors (beyond the efficacy of a therapy) that influence the number needed to treat and that must be taken into account when comparing these values between therapies.
What is the number needed to treat?
The number needed to treat is an aggregate measure of clinical benefit that represents the number of patients who would need to be treated to prevent 1 additional adverse event. It is calculated by taking the reciprocal of the absolute risk reduction between 2 treatment options. This number is a useful way to summarize the potential impact of a therapy when discussing treatment options with patients. A detailed discussion of how to personalize this number to each patient's situation, including means to incorporate potential harms as well as patient values and preferences, has been published.9..................

http://www.cmaj.ca/cgi/content/full/179/6/549

CONCEPTO DE PREVENCION

The concept of prevention: a good idea gone astray?
Journal of Epidemiology and Community Health 2008;62:580-583; doi:10.1136/jech.2007.071027Copyright © 2008 by the BMJ Publishing Group Ltd.

Over time, the definition of prevention has expanded so that its meaning in the context of health services is now unclear. As risk factors are increasingly considered to be the equivalent of “diseases” for purposes of intervention, the concept of prevention has lost all practical meaning. This paper reviews the inconsistencies in its utility, and suggests principles that it should follow in the future: a population orientation with explicit consideration of attributable risk, the setting of priorities based on reduction in illness and avoidance of adverse effects, and the imperative to reduce inequities in health.

ira a http://jech.bmj.com/cgi/reprint/62/7/580

HARRISON

HARRISON EN ESPAÑOL ----:)
http://www.harrisonmedicina.com/ uvalencia medicine

NEONATOLOGIA

Consecuencia de la introducción de nuevos tratamientos en neonatología
Bol. Med. Hosp. Infant. Mex. v.64 n.1 México ene./feb. 2007
http://scielo.unam.mx/scielo.php?script=sci_arttext&pid=S1665-11462007000100010&lng=es&nrm=iso

Se describen, en orden cronológico, 16 ejemplos de las consecuencias que en la historia de la neonatología ha tenido la introducción de nuevas medidas terapéuticas sin un suficiente análisis experimental en cuanto a sus riesgos. En ellos podrá identificarse la no realización de protocolos prospectivos de investigación específicos en neonatos, así como estudios de seguridad de varios de los medicamentos que se reíatan. Lo anterior con la finalidad de que el lector reflexione sobre estos hechos, así como el considerar algunas recomendaciones que se mencionan al final

LIBRO DE ESTADISTICA

INTRODUCCION A LA ESTADISTICA SPSS

http://rs33. rapidshare. com/files/ 4354478/SPSS_ for_Introductory _Statistics. pdf.

Tratado de Fisiologia Medica (spanish)
Arthur C. Guyton John Hall McGraw-Hill Interamericana


Tratado de FisiologÍa Médica (Guyton),
Texto clásico en la fisiología médica, que mantiene la línea de ediciones anteriores en cuanto al nivel de exposición y presentación de la materia.
- Todos los temas han sido revisados y actualizados, y se han introducido cambios significativos: a) Ofrece las técnicas de estudio de la fisiología molecular y celular que han aparecido en los últimos años b) Incluye los últimos avances de la fisiología gastrointestinal, metabolismo, endocrinologí a, reproducción y soportes fisiológicos
- En esta edición, el Dr. Hall adquiere mayor peso e importancia, al redactar y revisar el doble de capítulos que en la edición anterior
- Asimismo, se utilizan dos tamaños de letra en el texto: a) La letra más pequeña, aporta información sobre anatomía, química y otras materias que el estudiante aprenderá con más detalle en otros cursos, así como información fisiológica especialmente importante en ciertos campos de medicina clínica. b) La letra de tamaño normal corresponde a los principios fundamentales de la fisiología
UNIDAD I. INTRODUCCIÓN A LA FISIOLOGÍA: LA CÉLULA Y FISIOLOGÍA GENERAL.UNIDAD II. FISIOLOGÍA DE LA MEMBRANA, EL NERVIO Y EL MÚSCULO.UNIDAD III. EL CORAZÓN.UNIDAD IV. LA CIRCULACIÓN.UNIDAD V. EL RIÑÓN Y LOS LÍQUIDOS CORPORALES.UNIDAD VI. GLÓBULOS SANGUÍNEOS. INMUNIDAD Y COAGULACION DE LA SANGRE.UNIDAD VII. RESPIRACIÓN.UNIDAD VIII. FISIOLOGÍA DE LA AVIACIÓN, EL ESPACIO Y BUCEO A GRAN PROFUNDIDAD.UNIDAD IX. EL SISTEMA NERVIOSO: A. PRINCIPIOS GENERALES Y FISIOLOGÍA DE LOS SENTIDOS.UNIDAD X. EL SISTEMA NERVIOSO.UNIDAD XI. EL SISTEMA NERVIOSO: C. NEUROFISIOLOGÍ A MOTORA E INTEGRADORA.UNIDAD XII. FISIOLOGÍA GASTROINTESTINAL.UNIDAD XIII. METABOLISMO Y REGULACIÓN DE LA TEMPERATURA.UNIDAD XIV. ENDOCRINOLOGÍ A Y REPRODUCCIÓN.UNIDAD XV. FISIOLOGÍA DEL DEPORTE.Idioma: Español
Sitio de descarga:
http://rapidshare. com/files/ 108759126/ Indice.pdfhttp://rapidshare. com/files/ 108759056/ Unidad_I. pdfhttp://rapidshare. com/files/ 108759137/ Unidad_II. pdfhttp://rapidshare. com/files/ 108761215/ Unidad_III. pdfhttp://rapidshare. com/files/ 108759817/ Unidad_IV. pdfhttp://rapidshare. com/files/ 108761910/ Unidad_V. pdfhttp://rapidshare. com/files/ 108762998/ Unidad_VI. pdfhttp://rapidshare. com/files/ 108764943/ Unidad_VII. pdfhttp://rapidshare. com/files/ 108770136/ Unidad_VIII. pdfhttp://rapidshare. com/files/ 108760144/ Unidad_IX. pdfhttp://rapidshare. com/files/ 108770545/ Unidad_X. pdfhttp://rapidshare. com/files/ 108771023/ Unidad_XI. pdfhttp://rapidshare. com/files/ 108770858/ Unidad_XII. pdfhttp://rapidshare. com/files/ 108771173/ Unidad_XIII. pdfhttp://rapidshare. com/files/ 109609561/ Unidad_XIV. pdfhttp://rapidshare. com/files/ 108770849/ Unidad_XV. pdf

pdf unico
http://mihd. net/g89n7ahttp://mihd. net/7l9vi4http://mihd. net/rnchf7http://mihd. net/2nskvxhttp://mihd. net/ib4tsmhttp://mihd. net/fpi2gc

CARDIOLOGIA PREVENTIVA

Comparison Effect of Atorvastatin (10 versus 80 mg) on Biomarkers of Inflammation and Oxidative Stress in Subjects With Metabolic Syndrome
The American Journal of CardiologyVolume 102, Issue 3, 1 August 2008, Pages 321-325
Uma Singh PhDa, Sridevi Devaraj PhDa, Ishwarlal Jialal MD, PhDa, b, , and David Siegel MD
The Laboratory for Atherosclerosis and Metabolic Research, Department of Pathology and Laboratory Medicine, UC Davis Medical Center, Sacramento, California
bVA Medical Center at Mather, California.

Metabolic syndrome (MS), characterized by low-grade inflammation, confers an increased risk for cardiovascular disease. Statins, in addition to having lipid-lowering effects, have pleiotropic effects and decrease biomarkers of inflammation and oxidative stress. The Treating to New Target Study showed a greater decrease in low-density lipoprotein (LDL) cholesterol and cardiovascular events with atorvastatin 80 mg versus 10 mg in patients with MS with coronary heart disease. However, part of this benefit could be caused by the greater pleiotropic effects of the higher dose of atorvastatin. The dose–response effect of atorvastatin on biomarkers of inflammation and oxidative stress has not been investigated in subjects with MS. Thus, the dose–response effect of atorvastatin on biomarkers of inflammation (high-sensitivity C-reactive protein [hs-CRP], matrix metalloproteinase-9, and nuclear factor-κB [NF-kB] activity) and oxidative stress (oxidized LDL, urinary nitrotyrosine, F2-isoprostanes, and monocyte superoxide release) was tested in a randomized double-blind clinical trial in subjects with MS. Seventy subjects were randomly assigned to receive placebo or atorvastatin 10 or 80 mg/day for 12 weeks. A strong dose–response (atorvastatin 10 compared with 80 mg, p <0.05) was observed for changes in total, LDL (32% and 44% reduction), non–high-density lipoprotein (28% and 40% reduction), and oxidized LDL cholesterol (24% and 39% reduction) at atorvastatin 10 and 80 mg, respectively. Hs-CRP, matrix metalloproteinase-9, and NF-kB significantly decreased in the 80-mg atorvastatin group compared with baseline. In conclusion, this randomized trial of subjects with MS showed the superiority of atorvastatin 80 mg compared with its 10-mg dose in decreasing oxidized LDL, hs-CRP, matrix metalloproteinase-9, and NF-kB activity

CUIDADO PREVENTIVO

Geriatric Screening and Preventive Care
Mary C. Spalding, MD, and Sean C. Sebesta, MD Texas Tech University Health Sciences Center at El Paso, El Paso, Texas
Preventive health care decisions and recommendations become more complex as the population ages. The leading causes of death (i.e., heart disease, malignant neoplasms, cerebrovascular disease, and chronic lower respiratory disease) among older adults mirror the actual causes of death (i.e., tobacco use, poor diet, and physical inactivity) among persons of all ages. Many aspects of mortality in older adults are modifiable through behavior change. Patients 65 years and older should be counseled on smoking cessation, diets rich in healthy fats, aerobic exercise, and strength training. Other types of preventive care include aspirin therapy; lipid management; and administration of tetanus and diphtheria, pneumococcal, and influenza vaccines.
Although cancer is the second leading cause of death in patients 65 years and older, a survival benefit from cancer screening is not seen unless the patient’s life expectancy exceeds five years. Therefore, it isbest to review life expectancy, functionality, and comorbidities with older patients when making cancer screening recommendations. Other recommended screenings include abdominal aortic aneurysm for men 65 to 75 years of age, breast cancer for women 40 years and older with a life expectancy greater than five years, and colorectal cancer for men
and women 50 years and older with a life expectancy greater than five years. (Am Fam Physician. 2008;78(2):206-215. Copyright © 2008
American Academy of Family Physicians.)


pproximately 8 percent of the world’s population was 60 years and older in 1950. B y 2000,
this number had increased to 10 percent; it is expected to reach 21 percent by 2050.1 D elivering comprehensive clinical preventive services to this population is important; however, persons older than 65 are rarely included in preventive care research. T his article reviews the leading and actual causes of death and discusses how behaviors, functional status, comorbidities,
and life expectancy can predict who will benefit most from geriatric screening and preventive care.
Leading vs. Actual Causes of Death
The leading causes of death among persons 65 years and older in the United States in 2002 are listed in Table 1.2 T he actual causes of death among persons of all ages are determined by analyzing modifiable risk factors with U.S. mortality data (Table 23).
The actual causes of death (i.e., tobacco use, poor diet, and physical inactivity) mirror the
leading causes of death (i.e., heart disease, malignant neoplasm, cerebrovascular disease,
and chronic lower respiratory disease) in older adults. T herefore, many aspects of
mortality among older adults may be preventable through a change in lifestyle behaviors.
Behavioral Counseling and Other Preventive Therapies Tobaco c essat ion co unseling
Smoking cessation at 65 years of age leads to an increase in life expectancy of 1.4 to 2.0
years for men and 2.7 to 3.7 years for women.4
Additionally, smoking cessation at any age benefits those exposed to secondhand smoke,
which causes 80 to 90 percent of the negative cardiovascular health effects related to personal
smoking.5 T he U.S. P reventive Services Task Force (USPSTF) and the U.S. Surgeon
General recommend three-minute counseling sessions with patients, with or without
the use of pharmacologic aids6,7 (i.e., varenicline [Chantix],8 bupropion [Wellbutrin], or
nicotine products). T elephone support can be a successful adjunct to counseling

Nutrition co unseling
Elimination of industrially produced transfatty acids would avert 6 to 19 percent of all coronary heart disease (CHD) events in the United States each year.9 A diet rich in healthy fats (e.g., the Mediterranean diet;online Table A) is associated with decreased overall mortality.10 Healthy A geing: a Longitudinal study in E urope (HALE ) followed E uropeans 70 to 90 years of age for
10 years and found that use of the Mediterranean diet, moderate to high levels of physical
activity, moderate alcohol consumption,and nonsmoking were associated with a 50 percent reduction in all-cause mortality. 10 N o more than two alcoholic drinks per day for men and one per day for women are recommended.11 T he A merican A cademy of Family P hysicians (AA FP) and the USPSTF recommend nutrition counseling for patients with diet-related illness such
as diabetes or hypertension and those with other risk factors for CHD.12,13 Exercise co unseling
Physical activity is beneficial to all adults. I t reduces the rate of all-cause mortality and
helps to prevent osteoporosis and obesity.14 A regular exercise program is an integral part of any weight-reduction or weightmaintenance program. A lthough the USPSTF recognizes the importance of exercise and the potential benefits of counseling, it is unable to recommend physician counseling because of insufficient evidence of effectiveness.15 T he U.S. Surgeon G eneral recommends that all adults perform aerobic exercise three times per week for a minimum of one half hour, as well as strength training at least twice per week.