Use of Demonstrably Effective Therapies in the Treatment of Acute Coronary Syndromes: Comparison between Different Brazilian Regions. Analysis of the Brazilian Registry on Acute Coronary Syndromes (BRACE)

Background: Little is known in our country about regional differences in the treatment of acute coronary disease. Objective: To analyze the behavior regarding the use of demonstrably effective regional therapies in acute coronary disease. Methods: A total of 71 hospitals were randomly selected, respecting the proportionality of the country in relation to geographic location, among other criteria. In the overall population was regionally analyzed the use of aspirin, clopidogrel, ACE inhibitors / AT1 blocker, beta-blockers and statins, separately and grouped by individual score ranging from 0 (no drug used) to 100 (all drugs used). In myocardial infarction with ST elevation (STEMI) regional differences were analyzed regarding the use of therapeutic recanalization (fibrinolytics and primary angioplasty). Results: In the overall population, within the first 24 hours of hospitalization, the mean score in the North-Northeast (70.5 +/- 22.1) was lower (p < 0.05) than in the Southeast (77.7 +/- 29.5), Midwest (82 +/- 22.1) and South (82.4 +/- 21) regions. At hospital discharge, the score of the North-Northeast region (61.4 +/- 32.9) was lower (p < 0.05) than in the Southeast (69.2 +/- 31.6), Midwest (65.3 +/- 33.6) and South (73.7 +/- 28.1) regions; additionally, the score of the Midwest was lower (p < 0.05) than the South region. In STEMI, the use of recanalization therapies was highest in the Southeast (75.4%, p = 0.001 compared to the rest of the country), and lowest in the North-Northeast (52.5%, p < 0.001 compared to the rest of the country). Conclusion: The use of demonstrably effective therapies in the treatment of acute coronary disease is much to be desired in the country, with important regional differences.

Diagnosis of endocrine disease: High-yield thyroid fine-needle aspiration cytology: an update focused on ancillary techniques improving its accuracy.

Thyroid fine-needle aspiration (FNA) cytology is a fast growing field. One of the most developing areas is represented by molecular tests applied to cytological material. Patients that could benefit the most from these tests are those that have been diagnosed as 'indeterminate' on FNA. They could be better stratified in terms of malignancy risk and thus oriented with more confidence to the appropriate management. Taking in to consideration the need to improve and keep high the yield of thyroid FNA, professionals from various fields (i.e. molecular biologists, endocrinologists, nuclear medicine physicians and radiologists) are refining and fine-tuning their diagnostic instruments. In particular, all these developments aim at increasing the negative predictive value of FNA to improve the selection of patients for diagnostic surgery. These advances involve terminology, the application of next-generation sequencing to thyroid FNA, the use of immunocyto- and histo-chemistry, the development of new sampling techniques and the increasing use of nuclear medicine as well as molecular imaging in the management of patients with a thyroid nodule. Herein, we review the recent advances in thyroid FNA cytology that could be of interest to the 'thyroid-care' community, with particular focus on the indeterminate diagnostic category.

Galictis cuja (Mammalia): an update of current knowledge and geographic distribution

The lesser grison (Galictis cuja) is one of the least-known mustelids in the Neotropics, despite its broad range across South America. This study aimed to explore current knowledge of the distribution of the species to identify gaps in knowledge and anticipate its full geographic distribution. Eighty-nine articles have mentioned G. cuja since 1969, but only 13 focused on the species. We generated a detailed model of the species' potential distribution that validated previous maps, but with improved detail, supporting previous southernmost records, and providing a means of identifying priority sites for conservation and management of the species.

Health And Social Care Inequalities Monitoring System: First Update Bulletin 2004 (PDF 273 KB)

The Inequalities Monitoring System comprises a basket of indicators which are monitored over time to assess area differences in morbidity, utilisation of and access to health and social care services in Northern Ireland. Inequalities between the 20% most deprived electoral wards and Northern Ireland as a whole are measured with deprived areas identified from an update of the Noble Income domain for current ward boundaries. Results for 20% most rural areas were also compared against Northern Ireland overall using population density from the 2001 Census of Population as a measure of rurality. This report is the first annual update of the baseline results presented in Chapter 8 of Equality and Inequalities in Health and Social care in Northern Ireland – A Statistical Overview (DHSSPS 2004) which focused on 2001/2002. The morbidity and utilisation data in this report are the latest available while the locations of services for the accessibility analysis will be updated in subsequent years åÊ

Consumer Focused Review of Fruit and Vegetables

This review provides an update on the fruit and vegetable review conducted in 2007. It collates and considers the information available – academic, regulatory, public health – on the health and food safety implications of fruit and vegetables. It focuses on ready-to-eat (RTE) fresh fruit and vegetables which are consumed raw, whether whole or prepared, and includes products packaged under vacuum or in a modified atmosphere that have not undergone any treatment (chemical, physical or biological) to ensure preservation, other than chilling. The key finding was that 75% of Irish consumers are now able to identify that they should eat five portions of fruit and vegetables a day, but only a third (36%) of consumers say they are doing so. The average intake of fruit and vegetables is currently less than half that recommended, at 2.4 portions per day. Issues to do with cost, shelf life, preparation time and habit were seen by consumers as barriers to buying and consuming more fruit and vegetables. his review provides an update on the fruit and vegetable review conducted in 2007. It collates and considers the information available – academic, regulatory, public health – on the health and food safety implications of fruit and vegetables. - See more at: http://www.safefood.eu/Publications/Research-reports/Consumer-Focused-Review-of-Fruit-and-Vegetables.aspx#sthash.T98zN2UU.dpuf This review provides an update on the fruit and vegetable review conducted in 2007. It collates and considers the information available – academic, regulatory, public health – on the health and food safety implications of fruit and vegetables. It focuses on ready-to-eat (RTE) fresh fruit and vegetables which are consumed raw, whether whole or prepared, and includes products packaged under vacuum or in a modified atmosphere that have not undergone any treatment (chemical, physical or biological) to ensure preservation, other than chilling. The key finding was that 75% of Irish consumers are now able to identify that they should eat five portions of fruit and vegetables a day, but only a third (36%) of consumers say they are doing so. The average intake of fruit and vegetables is currently less than half that recommended, at 2.4 portions per day. Issues to do with cost, shelf life, preparation time and habit were seen by consumers as barriers to buying and consuming more fruit and vegetables. This review provides an update on the fruit and vegetable review conducted in 2007. It collates and considers the information available – academic, regulatory, public health – on the health and food safety implications of fruit and vegetables. It focuses on ready-to-eat (RTE) fresh fruit and vegetables which are consumed raw, whether whole or prepared, and includes products packaged under vacuum or in a modified atmosphere that have not undergone any treatment (chemical, physical or biological) to ensure preservation, other than chilling. The key finding was that 75% of Irish consumers are now able to identify that they should eat five portions of fruit and vegetables a day, but only a third (36%) of consumers say they are doing so. The average intake of fruit and vegetables is currently less than half that recommended, at 2.4 portions per day. Issues to do with cost, shelf life, preparation time and habit were seen by consumers as barriers to buying and consuming more fruit and vegetables. - See more at: http://www.safefood.eu/Publications/Research-reports/Consumer-Focused-Review-of-Fruit-and-Vegetables.aspx#sthash.T98zN2UU.dpuf This review provides an update on the fruit and vegetable review conducted in 2007. It collates and considers the information available – academic, regulatory, public health – on the health and food safety implications of fruit and vegetables. It focuses on ready-to-eat (RTE) fresh fruit and vegetables which are consumed raw, whether whole or prepared, and includes products packaged under vacuum or in a modified atmosphere that have not undergone any treatment (chemical, physical or biological) to ensure preservation, other than chilling. The key finding was that 75% of Irish consumers are now able to identify that they should eat five portions of fruit and vegetables a day, but only a third (36%) of consumers say they are doing so. The average intake of fruit and vegetables is currently less than half that recommended, at 2.4 portions per day. Issues to do with cost, shelf life, preparation time and habit were seen by consumers as barriers to buying and consuming more fruit and vegetables. - See more at: http://www.safefood.eu/Publications/Research-reports/Consumer-Focused-Review-of-Fruit-and-Vegetables.aspx#sthash.T98zN2UU.dpuf This review provides an update on the fruit and vegetable review conducted in 2007. It collates and considers the information available – academic, regulatory, public health – on the health and food safety implications of fruit and vegetables. It focuses on ready-to-eat (RTE) fresh fruit and vegetables which are consumed raw, whether whole or prepared, and includes products packaged under vacuum or in a modified atmosphere that have not undergone any treatment (chemical, physical or biological) to ensure preservation, other than chilling. The key finding was that 75% of Irish consumers are now able to identify that they should eat five portions of fruit and vegetables a day, but only a third (36%) of consumers say they are doing so. The average intake of fruit and vegetables is currently less than half that recommended, at 2.4 portions per day. Issues to do with cost, shelf life, preparation time and habit were seen by consumers as barriers to buying and consuming more fruit and vegetables. - See more at: http://www.safefood.eu/Publications/Research-reports/Consumer-Focused-Review-of-Fruit-and-Vegetables.aspx#sthash.T98zN2UU.dpuf This review provides an update on the fruit and vegetable review conducted in 2007. It collates and considers the information available – academic, regulatory, public health – on the health and food safety implications of fruit and vegetables. - See more at: http://www.safefood.eu/Publications/Research-reports/Consumer-Focused-Review-of-Fruit-and-Vegetables.aspx#sthash.T98zN2UU.dpuf

Postmortem chemistry update part I.

Postmortem chemistry is becoming increasingly essential in the forensic pathology routine and considerable progress has been made over the past years. Biochemical analyses of vitreous humor, cerebrospinal fluid, blood and urine may provide significant information in determining the cause of death or in elucidating forensic cases. Postmortem chemistry may essentially contribute in the determination of the cause of death when the pathophysiological changes involved in the death process cannot be detected by morphological methods (e.g. diabetes mellitus, alcoholic ketoacidosis and electrolytic disorders). It can also provide significant information and useful support in other forensic situations, including anaphylaxis, hypothermia, sepsis and hormonal disturbances. In this article, we present a review of the literature that covers this vast topic and we report the results of our observations. We have focused our attention on glucose metabolism, renal function and electrolytic disorders.

Focused time-lapse inversion of radio and audio magnetotelluric data

Geoelectrical techniques are widely used to monitor groundwater processes, while surprisingly few studies have considered audio (AMT) and radio (RMT) magnetotellurics for such purposes. In this numerical investigation, we analyze to what extent inversion results based on AMT and RMT monitoring data can be improved by (1) time-lapse difference inversion; (2) incorporation of statistical information about the expected model update (i.e., the model regularization is based on a geostatistical model); (3) using alternative model norms to quantify temporal changes (i.e., approximations of l(1) and Cauchy norms using iteratively reweighted least-squares), (4) constraining model updates to predefined ranges (i.e., using Lagrange Multipliers to only allow either increases or decreases of electrical resistivity with respect to background conditions). To do so, we consider a simple illustrative model and a more realistic test case related to seawater intrusion. The results are encouraging and show significant improvements when using time-lapse difference inversion with non l(2) model norms. Artifacts that may arise when imposing compactness of regions with temporal changes can be suppressed through inequality constraints to yield models without oscillations outside the true region of temporal changes. Based on these results, we recommend approximate l(1)-norm solutions as they can resolve both sharp and smooth interfaces within the same model. (C) 2012 Elsevier B.V. All rights reserved.

Chirurgie viscérale. Chirurgie thyroïdienne et parathyroïdienne: place de la chirurgie minimale invasive [Update in thyroid and parathyroid surgery: the role for minimally invasive surgery].

Thyroid and parathyroid surgery takes an important place in general surgery. Preservation of essential cervical structures and cosmetic of outcomes of cervical incisions are major concern. Several minimally invasive strategies have been developed recently but their acceptance in the surgical community is low. Their main advantages are focused tissue dissection and improved cosmetics. In this review, management and surgical indications of thyroid nodules and parathyroid adenomas are discussed. The various minimally invasive techniques are described and their current indications are reviewed.

Invasive mould infections: a multi-disciplinary update.

Systemic fungal infections remain a significant cause of mortality in neutropenic and immunocompromised patients, despite advances in their diagnosis and treatment. The incidence of such infections is rising due to the use of intensive chemotherapy regimens in patients with solid tumours or haematological cancers, the increasing numbers of allogeneic haematopoietic stem cell and solid organ transplants, and the use of potent immunosuppressive therapy in patients with autoimmune disorders. In addition, the epidemiology of systemic fungal infections is changing, with atypical species such as Aspergillus terreus and zygomycetes becoming more common. Treatment has traditionally focused on empirical therapy, but targeted pre-emptive therapy in high-risk patients and prophylactic antifungal treatment are increasingly being adopted. New treatments, including lipid formulations of amphotericin B, second-generation broad-spectrum azoles, and echinocandins, offer effective antifungal activity with improved tolerability compared with older agents; the potential impact of these treatments is reflected in their inclusion in current treatment and prophylaxis guidelines. New treatment strategies, such as aerosolized lipid formulations of amphotericin B, may also reduce the burden of mortality associated with systemic fungal infections. The challenge is to identify ways of coupling potentially effective treatments with early and reliable identification of patients at highest risk of infection.

Gambling in Spain: update on experience, research and policy

AIMS: To describe the current situation of gambling in Spain, sketching its history and discussing the regulations and legislation currently in force within the framework of the European Union (EU), and to review the epidemiology of gambling in Spain, the self-help groups and professional treatments available, and their potential effectiveness. METHODS: A systematic computerized search was performed in three databases (EMBASE, PubMed and PsychINFO, including articles and chapters) and the reference lists from previous reviews to obtain some of the most relevant studies published up to now on the topic of pathologic gambling in Spain. RESULTS: Similar to other EU countries, Spain has a high prevalence of pathologic gambling, focused on specific culturally bounded types of gambling. Expenditure in online gaming has risen significantly in the last few years, prompting the Spanish government to draft new legislation to regulate gaming. CONCLUSIONS: The gaming industry is expected to be one of the fastest growing sectors in Spain in the coming years owing to the rise of new technologies and the development of online gaming

2010 update of EORTC guidelines for the use of granulocyte-colony stimulating factor to reduce the incidence of chemotherapy-induced febrile neutropenia in adult patients with lymphoproliferative disorders and solid tumours

Chemotherapy-induced neutropenia is a major risk factor for infection-related morbidity and mortality and also a significant dose-limiting toxicity in cancer treatment. Patients developing severe (grade 3/4) or febrile neutropenia (FN) during chemotherapy frequently receive dose reductions and/or delays to their chemotherapy. This may impact the success of treatment, particularly when treatment intent is either curative or to prolong survival. In Europe, prophylactic treatment with granulocyte-colony stimulating factors (G-CSFs), such as filgrastim (including approved biosimilars), lenograstim or pegfilgrastim is available to reduce the risk of chemotherapy-induced neutropenia. However, the use of G-CSF prophylactic treatment varies widely in clinical practice, both in the timing of therapy and in the patients to whom it is offered. The need for generally applicable, European-focused guidelines led to the formation of a European Guidelines Working Party by the European Organisation for Research and Treatment of Cancer (EORTC) and the publication in 2006 of guidelines for the use of G-CSF in adult cancer patients at risk of chemotherapy-induced FN. A new systematic literature review has been undertaken to ensure that recommendations are current and provide guidance on clinical practice in Europe. We recommend that patient-related adverse risk factors, such as elderly age (≥65 years) and neutrophil count be evaluated in the overall assessment of FN risk before administering each cycle of chemotherapy. It is important that after a previous episode of FN, patients receive prophylactic administration of G-CSF in subsequent cycles. We provide an expanded list of common chemotherapy regimens considered to have a high (≥20%) or intermediate (10-20%) risk of FN. Prophylactic G-CSF continues to be recommended in patients receiving a chemotherapy regimen with high risk of FN. When using a chemotherapy regimen associated with FN in 10-20% of patients, particular attention should be given to patient-related risk factors that may increase the overall risk of FN. In situations where dose-dense or dose-intense chemotherapy strategies have survival benefits, prophylactic G-CSF support is recommended. Similarly, if reductions in chemotherapy dose intensity or density are known to be associated with a poor prognosis, primary G-CSF prophylaxis may be used to maintain chemotherapy. Clinical evidence shows that filgrastim, lenograstim and pegfilgrastim have clinical efficacy and we recommend the use of any of these agents to prevent FN and FN-related complications where indicated. Filgrastim biosimilars are also approved for use in Europe. While other forms of G-CSF, including biosimilars, are administered by a course of daily injections, pegfilgrastim allows once-per-cycle administration. Choice of formulation remains a matter for individual clinical judgement. Evidence from multiple low level studies derived from audit data and clinical practice suggests that some patients receive suboptimal daily G-CSFs; the use of pegfilgrastim may avoid this problem.

Exploring oxidative modifications of tyrosine:an update on mechanisms of formation, advances in analysis and biological consequences

Protein oxidation is increasingly recognised as an important modulator of biochemical pathways controlling both physiological and pathological processes. While much attention has focused on cysteine modifications in reversible redox signalling, there is increasing evidence that other protein residues are oxidised in vivo with impact on cellular homeostasis and redox signalling pathways. A notable example is tyrosine, which can undergo a number of oxidative post-translational modifications to form 3-hydroxy-tyrosine, tyrosine crosslinks, 3-nitrotyrosine and halogenated tyrosine, with different effects on cellular functions. Tyrosine oxidation has been studied extensively in vitro, and this has generated detailed information about the molecular mechanisms that may occur in vivo. An important aspect of studying tyrosine oxidation both in vitro and in biological systems is the ability to monitor the formation of oxidised derivatives, which depends on a variety of analytical techniques. While antibody-dependent techniques such as ELISAs are commonly used, these have limitations, and more specific assays based on spectroscopic or spectrometric techniques are required to provide information on the exact residues modified and the nature of the modification. These approaches have helped understanding of the consequences of tyrosine oxidation in biological systems, especially its effects on cell signalling and cell dysfunction, linking to roles in disease. There is mounting evidence that tyrosine oxidation processes are important in vivo and can contribute to cellular pathology.

An Update On The Pharmacogenetics Of Treating Hypertension.

Hypertension is a leading cause of cardiovascular mortality, but only one third of patients achieve blood pressure goals despite antihypertensive therapy. Genetic polymorphisms may partially account for the interindividual variability and abnormal response to antihypertensive drugs. Candidate gene and genome-wide approaches have identified common genetic variants associated with response to antihypertensive drugs. However, there is no currently available pharmacogenetic test to guide hypertension treatment in clinical practice. In this review, we aimed to summarize the recent findings on pharmacogenetics of the most commonly used antihypertensive drugs in clinical practice, including diuretics, angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers, beta-blockers and calcium channel blockers. Notably, only a small percentage of the genetic variability on response to antihypertensive drugs has been explained, and the vast majority of the genetic variants associated with antihypertensives efficacy and toxicity remains to be identified. Despite some genetic variants with evidence of association with the variable response related to these most commonly used antihypertensive drug classes, further replication is needed to confirm these associations in different populations. Further studies on epigenetics and regulatory pathways involved in the responsiveness to antihypertensive drugs might provide a deeper understanding of the physiology of hypertension, which may favor the identification of new targets for hypertension treatment and genetic predictors of antihypertensive response.Journal of Human Hypertension advance online publication, 28 August 2014; doi:10.1038/jhh.2014.76.

An Update On The Role Of Adipokines In Arterial Stiffness And Hypertension.

Adipokines are hormones produced by adipocytes and have been involved in multiple pathologic pathways, including inflammatory and cardiovascular complications in essential hypertension. Arterial stiffness is a frequent vascular complication that represents increased cardiovascular risk in hypertensive patients. Adipokines, such as adiponectin, leptin and resistin, might be implicated in hypertension, as well as in vascular alterations associated with this condition. Arterial stiffness has proven to be a predictor of cardiovascular events. Obesity and target-organ damage such as arterial stiffness are features associated with hypertension. This review aims to update the association between adipokines and arterial stiffness in essential and resistant hypertension (RHTN).