martes, 29 de junio de 2010

Diabetes Mellitus



Joslin's Diabetes Mellitus
Publisher: Lippincott Williams and Wilkins | ISBN: 0781727960 | edition 2004 | CHM |1224 pages | 31,8 mb

We are pleased to present this 14th edition of Joslin's Diabetes Mellitus. This textbook continues to evolve and address the newest and most important insights into this very old but very challenging disease. Indeed, as this book goes to press, despite multiple medical and scientific advances, we are facing a worldwide epidemic of diabetes. This involves a steady increase in type 1 diabetes and almost an exponential increase in type 2 diabetes. The latter is accompanied by a parallel increase in obesity, the metabolic syndrome, and other closely related disorders. Thus we are at a fascinating point in the evolution of diabetes and a fascinating point in the evolution of a book devoted to this disease.
The first edition of the Joslin textbook was published in 1916, a single-handed contribution by a man of extraordinary dedication, vision, and energy, Dr. Elliott P. Joslin. Dr. Joslin began his practice in 1898 in the pre-insulin era, and in this setting, developed a unique understanding of the natural history of diabetes. This perspective was clearly evident in the first edition, which was published some five years before the discovery of insulin by Banting, Best, Macleod, and Collip.

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1 article




Management of the Menopausal Disturbances and Oxidative Stress


Source: Current Pharmaceutical Design, Volume 11, Number 16, June
2005 , pp. 2063-2073(11)

http://www.ingentaconnect.com/content/ben/cpd/2005/00000011/00000016/art00006?crawler=true

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Menopausia



Científicos hallan cómo predecir momento de la menopausia

Martes 29 de Junio del 2010

LONDRES [REUTERS]. Científicos iraníes desarrollaron una nueva forma de usar una prueba simple de sangre para predecir el momento en que una mujer llegará a la menopausia, un hallazgo que le ofrece una oportunidad de planificar su familia y su carrera.

El estudio, hecho a 266 mujeres de entre 20 y 49 años, midió las concentraciones de una hormona llamada antimulleriana, que es producida por células en los ovarios y que controla a los folículos en donde se desarrollan los óvulos. Los científicos creen que este indicador puede ser útil para evaluar el funcionamiento de los ovarios.

La diferencia promedio entre la edad pronosticada y la edad real de la llegada de la menopausia fue un tercio de un año y el máximo margen de error fue de tres a cuatro años.

Los resultados del análisis fueron presentados en un seminario que se desarrolla esta semana en Roma.

Los expertos que comentaron el trabajo coincidieron en que era prometedor, pero dijeron que los resultados deben ser confirmados en ensayos más grandes.

Aji y sueno


¿La comida picante afecta nuestro sueño?

Nishta Saxena, dietista clínica de la University Health Network en Toronto, nos da la respuesta

Martes 29 de junio de 2010 - 12:31 pm
Imagen
(Foto: Christopher / Flickr)

Además de ser utilizados para darles sabor a la comida, los condimentos son utilizados, desde hace siglos, para aliviar problemas digestivos, disminuir la azúcar en la sangre, la inflamación y para bajar de peso. Y, actualmente, muchas de ellas están siendo estudiadas científicamente para entender mejor cuáles son los beneficios que aportan a la salud.

"Las especias secas contienen niveles bastantes altos de antioxidantes, lo que se suma a su poder nutricional. Parecer ser que las especias tienen efectos directos e indirectos en el sueño, y que comer ciertas comidas bastante condimentadas puede tener efectos negativos en los patrones de sueño", dice la dietista clínica Nishta Saxena, en un artículo publicado en theglobeandmail.com.

¿CÓMO AFECTA?
Sucede que hay condimentos altos en proteínas o grasas, lo que los hace más difíciles de digerir, especialmente cuando se consume en grandes porciones. "Ir a la cama después de comer un guiso picante de cordero puede ser una receta para el insomnio. Nuestros cuerpos necesitas dos horas y media para terminar de digerir la mayoría de comidas. Si uno se va acuesta antes, nuestro cuerpo gasta energía digiriendo y no le permite al cerebro iniciar los ciclos de sueño vitales", explica la experta.

Otra razón, agrega Saxena, es que algunas especias son conocidas por empeorar los síntomas del reflujo gastroesofágico, conocido como acidez. "Si bien los condimentos no causan la enfermedad, algunas personas sienten que los efectos de comer comida picante (o muy condimentada) les irrita el tracto digestivo superior. Esto puede causar dolor y reflujo, lo que puede interrumpir el sueño".

    lunes, 21 de junio de 2010

    ACC Atlas of Pathophysiology

    ACC Atlas of Pathophysiology



    ACC Atlas of Pathophysiology
    Publisher:Lippincott Williams Wilkins Pages:448 2005-05-01 ISBN:1582553645 File type: CHM 127 mb


    http://hotfile.com/dl/49657838/d08d22b/ACC_Pathophysiology.rar.html 
     

         gorjussFairiesrochywte.gif picture by rochymauricio    

     

    "There comes a point in your life when you realize who matters, who never did, who won't anymore, and who always will. So don't worry about people from your past, there's a reason they didn't make it to your future

    "Amor no es encontrar a alguien con quien vivir, amor es encontrar a alguien que tu sientas no puedes vivir sin el..."

    __._,_.___

    Calorie restriction, Aging and Longevity




    Arthur V. Everitt, Suresh I. S. Rattan, David G. le Couteur, Rafael de Cabo, "Calorie Restriction, Aging and Longevity"
    Springer | 2010 | ISBN: 9048185556 | 500 pages | PDF | 5,8 MB

    Food or calorie restriction has been shown in many short-lived animals and the rhesus monkey to prolong life-span. Life-long nutrition studies are not possible in humans because of their long survival. Studies over two to six years in healthy adult humans have, however, shown that a 20% reduction in food or calorie intake slows many indices of normal and disease-related aging. Thus, it is widely believed that long-term reduction in calorie or food intake will delay the onset of age-related diseases such as heart disease, diabetes and cancer, and so prolong life.

    Over the last 20 or more years there has been a progressive rise in food intake in many countries of the world, accompanied by a rising incidence of obesity. Thus our increasing food and calorie intake has been linked to the rising incidence of cardiovascular disease and diabetes in early adult life. It is accepted that overeating, accompanied by reduced physical exercise, will lead to more age-related diseases and shortening of life-span. The answer is to reduce our calorie intake, improve our diet, and exercise more. But calorie restriction is extremely difficult to maintain for long periods. How then can we solve this problem?

    Edited by a team of highly distinguished academics, this book provides the latest information on the beneficial effects of calorie restriction on health and life-span. This book brings us closer to an understanding at the molecular, cellular and whole organism level of the way forward.

    http://uploading.com/files/22efmm6m/9048185556Calorie.rar/


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    Uso de Carvedilol en paciente HTA, diabeticos



    ---------- Mensaje reenviado ----------
    De: willy lopez <glopezpv@yahoo.com>
    Fecha: 21 de junio de 2010 20:28
    Asunto: Uso de Carvedilol en paciente HTA, diabeticos
    Para: Jessica Vargas <jpvargas@bagoperu.com.pe>, Victoria Armas Rodriguez <vikyarmas@hotmail.com>, Luis Canchaya Osorio <luis_canchaya@hotmail.com>, Miguel Chipana Osiro <aqua90@gmail.com>, Rodrigo De Pomar <rodrigodepomar@hotmail.com>, Victor Fontinier higa <fontivictor@hotmail.com>, Rolando Fritas Urbizagastegui <rofriu@yahoo.com>, Tomas Gargurevich <tomas_gargurevich@hotmail.com>, Mirian Guevara Paz <myrianguevara@hotmail.com>, Dario Hernandez <sonccodha@yahoo.com>, Victor Herrera Tanaka <viheta@hotmail.com>, Raul Lama Diaz <vrlama@gmail.com>, Marco Lazo Soldevilla <marcolazo77@hotmail.com>, Juan Lema <jjlo49@gmail.com>, Cesar Leon Silva <cleonsilva@hotmail.com>, Cesar Montes <camp318@hotmail.com>, Zoila Moreau <zoila_moreau@yahoo.com>, Claudio Mori <clagui57@gmail.com>, Orlando Nieto Piscolish <jorwet@hotmail.com>, Pedro Nuñez <pedronuneztorres@yahoo.es>, Plinio Obregon <plinioobregon@hotmail.com>, Paola Oliver Rengifo <oliver_pao23@hotmail.com>, Boris Orihuela <boris_orihuela2@hotmail.com>, miguel Ortiz <ortizsamanamudm@yahoo.com>, Walter Paredes <hermanocorazon@hotmail.com>, Andres Paredes <pain10@hotmail.com>, Ursula Peña <ursulajpc@yahoo.com>, Cecilia Peña <cecipena20@yahoo.com>, Carolina Pimentel <caromex@yahoo.com>, Zozimo Pineda <zpinedam@yahoo.es>, Javier Pinto <japico51@gmail.com>, Jesus Poma <jesuspomaclaros@hotmail.com>, Trinidad Quinteros <trinidadquinteros@hotmail.com>, Teodoro Quiñones <cardiouci@hotmail.com>, Carlos Quiroz <carlosquiroz25@yahoo.com>, Alfonso Ramirez <alfonsoarcadio@yahoo.es>, Marco Ramirez <mry852002@yahoo.com>, Noelia Reyes <nolireye@hotmail.com>, Carlos Rios <carlos_rios@yahoo.com>, Fernando Rios <friosca1@hotmail.com>, Yudy Roldan <ymrc@hotmail.com>, Jorge Romero <jromero89@hotmail.es>, Maritza Rosales <malurovi0602@yahoo.com.ar>, Maria Isabel Saldarriaga <dramasain@hotmail.com>, Saul Sanabria <enriquesaulsp@yahoo.es>, Aurelio Sanchez <cardiologiaurelio@yahoo.com>, Wilder Sandoval <wildersandoval@yahoo.es>, Ricardo Santos <ricardosantos@gmail.com>, Gustavo Saravia <cardiolight@hotmail.com>, Cesar Segura <csserveleon@hotmail.com>, Luis Segura <seguis@terra.com.pe>, Cristian Soplopuco Palacios <cisop_1@yahoo.es>, Jose Luis Tapia <jltl55@hotmail.com>, David Telles <datel35@yahoo.com>, Enrique Tordoya <enriquetordoya@speedy.com.pe>, Hugo Torrejon <cardioplastic@hotmail.com>, Ernesto Torres <etr74@hotmail.com>, Fernando Torres <fern.torres@terra.com.pe>, Claudio Euler Torres <cleutorres@intramed.net>, Juan Urquiaga <jurquiaga@hotmail.com>, Gustavo Valderrama Valle <valderramavalle@yahoo.es>, Mario Vargas <mariovar@hotmail.com>, Oscar Vargas <movargase@yahoo.es>, Leonel Vasquez <leovm1@hotmail.com>, Angel Vasquez <angelvasquezvillar@yahoo.es>, Cesar Vecco <cvecco@yahoo.com>, Carlos Velasquez <kalinjvi@hotmail.com>, Marco Ventura <marcoventurag@hotmail.com>, Omar Villanueva <omarvillanueva_dr@msn.com>, Alberto Villegas <albertovc5@hotmail.com>, Wilmer Villegas <wilmervillegas@hotmail.com>, Pablo Vivas <vapean2002@hotmail.com>, Luis Watanabe <lwatanabe@clinicasanfelipe.com>, Hector Zapata <hzapatav@hotmail.com>, James Zepilli <ozeppilli@hotmail.com>, Jhon Zevallos <jazt31077@hotmail.com>, Mario Zubiate <zubiatetalledom@hotmail.com>, Jorge Alania <joralania@hotmail.com>, Martin Correa Flores <mcf1122@hotmail.com>, Julio Durand Velasquez <jrdurandv@hotmail.com>, Pedro Huamani <pedrohp1170@hotmail.com>, Marco La Torre <mlatorreortiz@yahoo.es>, Gisella Mendoza Sanchez <giselamendoza@yahoo.com>, Jorge Martin Mispireta Robles <martinmispireta@hotmail.com>, Marco Pastrana <mpastranac@yahoo.com.ar>, Cesar Valdivieso Roman <calexvr@hotmail.com>


    Dr.(a),
    Un aporte sobre el uso de Carvedilol
     
    Guillermo Lopez Paz-Vergara
    Representante Línea Cardiovascular
    Laboratorios Bago del Perú S.A.
    Nextel: (99)834*4047
    https://mail.google.com/mail/?ui=2&ik=14d8f0f8db&view=att&th=1295d44f03c1bfe2&attid=0.1&disp=attd&zw
     


    Nicotine



    2010/6/20 Vicente Rey <vicente.rey@gmail.com>

    Nicotine (Junior Drug Awareness)
    Chelsea House Publications | 2008-05 | ISBN: 0791096963 | 120 pages | PDF | 5 MB

    Tobacco products are deeply ingrained in our culture, customs, and habits. "Nicotine" provides the facts about tobacco use among teenagers and offers young readers the facts about one of the most prevalent and addictive drugs in the United States. Learn how nicotine addiction has become so widespread and why it is now viewed as a public health crisis.

    http://sharingmatrix.com/file/8629533/9780791096963.rar



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    lunes, 14 de junio de 2010

    Hypertension in Childhood

     



    Edwin Villacorta V.
    MEDICO PEDIATRA
     
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    --- El lun, 6/14/10, William Arellano Santillan <williamarellanos@gmail.com> escribió:
    Hypertension in Childhood

    Description

    There is no current standard UK definition of hypertension in children. However, the issue has been researched in some detail in America were a working group in 2004 defined the condition as an average systolic and/or diastolic blood pressure ≥95th percentile for gender, age and height on 3 or more separate occasions.1 The working group also introduced the concept of 'pre-hypertension' which it defines as a blood pressure level ≥90th percentile but <95th percentile.

    As with adults, blood pressure is a variable parameter in children. It varies between individuals and within individuals from day to day and at various times of the day. Attention must be paid to correct technique in measuring blood pressure and with small patients this includes the use of a small cuff. The traditional method of auscultation of 1st and 5th Korotkoff sounds, using a mercury sphygmomanometer, gives an accuracy that is second only to direct cannulation of the artery. Nowadays mercury and aneroid instruments are being replaced by electronic or Doppler devices.

    White coat hypertension and masked hypertension may be particularly relevant in this patient group. One study found that ambulatory blood pressure measurement correlated quite well with home monitoring2and the latter is becoming a validated method.3 Whatever method is used, the instrument must be regularly checked for accuracy and serviced and used correctly.

    Epidemiology

    A Department of Health Survey for England in 1996 showed that the mean systolic blood pressure for both boys and girls aged 5 to 15 was 111 mmHg.4 Mean diastolic pressure was 57 mmHg in boys and 58 mmHg in girls. Mean pulse pressure was 58 mmHg in both boys and girls aged 5 to 15. 

    An approximate rule of thumb is 80 + (2 x age) for 50th centile, and 100 + (2 x age) for 95th centile.

    Blood pressure increases with age in childhood and children who are either heavier or taller or both have higher blood pressure than smaller children of the same age.5 The relationship between body mass and blood pressure in children is stronger than in adults and children who have high blood pressure and are taller and heavier than their peers are more likely to become hypertensive as adults.6

    Hypertension is on the increase due to the rise in obesity in children. One study found that organ damage, such as left ventricular hypertrophy, thickening of the carotid vessel wall, retinal vascular changes and even subtle cognitive changes, were detectable in children and adolescents with high blood pressure and the authors of this study considered that hypertension was a common long-term health problem in this age group.7

    Risk factors

    In the absence of overt disease that will cause hypertension, there are a number of factors known to affect blood pressure in children and young adults. These are:

    • Salt intake - this is very important and targets to reduce our intake may not go far enough.8Processed and convenience foods tend to be very high in salt.
    • Obesity - childhood obesity increases the risk of childhood hypertension. The Bogalusa Heart Study derived figures from several national studies and found that the odds ratios in obese children were 2.4 for raised diastolic blood pressure and 4.5 for raised systolic blood pressure.9
    • Low birth weight - this seems to be a particular risk factor in patients who subsequently have a high BMI.10,11
    Presentation12

    History

    The condition is usually asymptomatic but may be revealed fortuitously during examination in patients with suspected underlying conditions such as kidney disease or coarctation of the aorta.

    There are a few presenting features that should raise the possibility of hypertension:

    In neonates:

    In older children

    If the condition is found, enquiry should be made for certain features in the child's history:

    Examination

    • Examination of the child starts with looking at the general state of nutrition and apparent state of health. Check height and weight against centile charts.
    • Examination of the pulse precedes measurement of blood pressure. The child should be seated and relaxed or supine if a baby. The cuff is on the right arm at the level of the heart. The rubber blade inside the cloth cover should be long enough to encircle the arm and wide enough to cover approximately ¾ of the distance from shoulder to elbow. Examine the rest of the cardiovascular system. Check for displacement of the apex beat and signs of left ventricular hypertrophy. Heart murmurs in children may be very relevant. Also feel the pulses in the lower limbs. If the amplitude of the pulse is poor this suggests coarctation of the aorta.
    • Look for stigmata of specific diseases:
      • Café au lait spots may suggest pheochromocytoma.
      • Examination of the abdomen will reveal a mass in Wilms' tumour and abdominal bruit may suggest coarctation or other vascular abnormalities including in the renal system.
      • Virilisation will point to congenital adrenal hyperplasia.
    Causes

    In general, the younger the child and the higher the blood pressure the greater the chance of identifying the cause. 80% are due to renal parenchymal abnormality. The table gives the order of frequency of the various causes of hypertension in 4 age groups:12

    Causes of Childhood Hypertension According to Age Group

    Age

    Causes

    1 to 6 years Renal parenchymal disease; renal vascular disease; endocrine causes; coarctation of the aorta; essential hypertension
    6 to 12 years Renal parenchymal disease; essential hypertension; renal vascular disease; endocrine causes; coarctation of the aorta; iatrogenic illness
    12 to 18 years Essential hypertension; iatrogenic illness; renal parenchymal disease; renal vascular disease; endocrine causes; coarctation of the aorta
    Investigations12

    Most adults are deemed to have essential hypertension and little or no further investigation is undertaken but in children a cause for the hypertension should be sought. Basic screening tests to detect underlying pathology should be carried out together with investigations to assess co-morbidity and end organ damage. Further testing may be required, depending on individual and family histories, the presence of risk factors and the results of the screening tests.

    To identify the cause

    • Urine - check for albumin and blood
    • Urea, electrolytes and creatinine - to assess renal function; low potassium may suggest elevated aldosterone
    • Full blood count - may reveal anaemia consistent with renal disease
    • Renal ultrasound - to exclude abnormalities of renal morphology

    To identify co-morbidities

    • Drug screen - this may be relevant in adolescents to exclude ingestion of recreational drugs
    • Fasting lipids and glucose - to rule out hyperlipidaemia, metabolic syndrome, diabetes
    • Polysomnography - to establish the existence of a sleep disorder, which may be linked to hypertension

    To identify end-organ damage

    • ECG - may show left ventricular hypertrophy or strain
    • Echocardiography - can show hypertrophy and abnormal function
    • Retinal examination - may identify retinal vascular changes

    Additional tests as clinically indicated

    • 24-hour urine for protein and creatinine, creatinine clearance - to exclude chronic renal disease
    • Advanced imaging - magnetic resonance angiogram, duplex Doppler flow studies; 3-dimensional computed tomography; arteriography (classic or digital subtraction) , may be required to exclude renovascular abnormalities
    • Ambulatory blood pressure monitoring - may be needed to exclude white coat hypertension
    • Thyroid function tests - to rule out thyrotoxicosis
    • Plasma aldosterone - a high concentration is diagnostic of hyperaldosteronism
    • Plasma catecholamines or urine catecholamines and catecholamine metabolites - high levels are diagnostic of pheochromocytoma or neuroblastoma
    • Plasma renin levels
      • High plasma renin activity indicates renal vascular hypertension, including coarctation of the aorta.
      • Very low plasma renin activity suggests glucocorticoid remediable aldosteronism or apparent mineralocorticoid excess.
    Management1

    There are no consensus UK guidelines on the management of hypertension in children. American guidelines suggest that lifestyle modifications should be applied to all hypertensive paediatric patients and that drugs are indicated in patients who fail to respond to lifestyle measures or have secondary hypertension, symptomatic hypertension, co-morbidity or end-organ damage.

    Lifestyle modification1,12

    This includes weight control, encouragement of exercise, reduction in dietary sodium and fat and, where appropriate, cessation of smoking and alcohol.

    Drugs

    American guidelines suggest starting with one drug and increasing the dose until a therapeutic effect is achieved or side-effects develop, at which point a second drug should be added. There is little experience in using combination drugs in children. There is little comparative evidence so the choice of drug depends on the physician's preference plus any secondary causes or comorbidities.

    • Thiazides and beta blockers - these have the best track record in terms of safety and efficacy.
    • ACE inhibitors and calcium channel blockers - these are gradually gaining preference as first-line drugs in view of their low side-effect profile. Caution may need to be exerted when using ACE inhibitors in patients with renal disease but they can be helpful in some cases.
    • Angiotensin receptor antagonists - their role is currently being evaluated.14 One study found that the blood pressure reduction of angiotensin- converting enzyme inhibitors, angiotensin II receptor antagonists and calcium-channel blockers was almost identical. In children with pathological proteinuria, angiotensin- converting enzyme inhibitors or angiotensin II antagonists were superior to calcium-channel blockers.15

    Management of a hypertensive crisis

    An acute hypertensive crisis may be the result of an acute illness, such as glomerulonephritis oracute renal failure, drugs or psychogenic substances, or exacerbation of moderate hypertension. A hypertensive crisis can present with features of cerebral oedema, seizures, heart failure, pulmonary oedema, or renal failure. The accurate assessment of blood pressure is essential when a patient has a seizure, particularly when no epileptic disorder is known. Anticonvulsant drugs are ineffective to treatconvulsions in a hypertensive crisis. Suitable drugs include nifedipine, labetalol and sodiumnitroprusside. Newer rapid-acting drugs such as clevidipine have been developed.16 The aim is to decrease blood pressure to normal within several hours. Close supervision is required to avoid an excessively rapid decrease in blood pressure that may result in underperfusion.17 A Cochrane review concluded that further research was needed to determine which drugs were best for the treatment of hypertensive crisis and their effect on morbidity and mortality.18

    Prognosis

    This is dependent upon the underlying cause. Experience from adults shows that poorly controlled blood pressure is a risk factor for CHD and is the major risk factor for stroke. There is no definitive data to link childhood blood pressure with cardiovascular risk but extrapolation of other data would suggest that, if hypertension is poorly controlled from an early age, morbidity or mortality will also strike early.12,19


          WILLIAM ARELLANO
                   Pediatra
    facebook.com/ William.Virgo.
              RPM: #893353
             Cel: 964 713855