An Association of Prior Statin Use with Decreased Perihematomal Edema

Objective  To investigate the impact of statins on perihematomal edema following spontaneous supratentorial intracerebral hemorrhage (ICH). Background  Hematoma expansion and evolution of perihematomal edema are most commonly responsible for neurological deterioration following ICH. A possible role of statins in reducing perihematomal edema has been suggested based on studies in animal models. Methods  Records of consecutive ICH patients admitted to The Johns Hopkins Hospital from 1999 to 2006 were reviewed. Patients with ICH related to trauma or underlying lesions (e.g., brain tumors, aneurysms, and arterio-venous malformations) and of infratentorial location were excluded. Absolute and relative perihematomal edema were assessed on initial head CT. Using regression analysis, the impact of prior statin use on absolute and relative edema at presentation was assessed correcting for other factors possibly impacting perihematomal edema, such as age, coagulopathy, aspirin use, admission mean arterial pressure (MAP), and blood glucose. Results  A total of 125 consecutive ICH patients were studied. Patients with prior statin exposure had a mean edema volume of 13.2 ± 9.2 cc compared to 22.3 ± 18.3 cc in patients who were not using statins at the time of ICH. Following multiple linear regression analysis, we have identified a statistically significant association between prior statin use with reduced early absolute perihematomal edema (P = 0.035). Mean relative perihematomal edema was significantly lower in patients on statins at presentation (0.44) as opposed to 0.81 in patients with no prior statin use. This difference remained statistically significant (P = 0.021) after correcting for other variables. Conclusions  We report the association between statin use prior to ICH and decreased absolute and relative perihematomal edema. A prospective study analyzing the role of statins in perihematomal edema reduction and the resultant effect on mortality and functional outcomes following ICH is warranted.     

Glucocorticoides en la artritis reumatoide

Over the last few decades, one of the most widely debated issues in rheumatology has been definition of the utility of glucocorticoids in rheumatoid arthritis. The high antiinflammatory power of glucocorticoids has been known since the 1950s and these drugs are widely used as symptomatic treatment for clinical exacerbations. Nevertheless, the potential adverse effects of these drugs limit and jeopardize their use. One of the unresolved questions is their potential efficiency beyond clinical improvement, that is, whether these agents act as true disease-modifying antirheumatic drugs.This review focuses on the use of glucocorticoids in rheumatoid arthritis, from the introduction of these drugs until the most recent evidence, which allows us to recommend glucocorticoid use to achieve more rapid clinical response, greater functional capacity and reduced radiological progression.     

Risk of hypospadias in newborn infants exposed to valproic acid during the first trimester of pregnancy: a case-control study in Spain.

BACKGROUND: Hypospadias is one of the most frequently occurring genital anomalies described in infants prenatally exposed to valproic acid (VA). However, to our knowledge, only one publication has studied a potential causal relationship between VA and hypospadias, only estimating the unadjusted global risk. Here we present the results of a multivariate case-control study aimed at analysing and quantifying the specific risk of hypospadias in newborn infants exposed to VA during the first trimester of pregnancy. METHODS: The data analysed here were derived from the Spanish Collaborative Study of Congenital Malformations (ECEMC), an ongoing, hospital-based, case-control study and surveillance system in which collaborating paediatricians identify case and control infants. The paediatricians collect the same data for both case and control infants, blinded to information on any prenatal exposure. The information includes 312 items related to many prenatal exposures, including drug exposure, reproductive and family history, and other characteristics. The sample analysed included 2,393 infants with hypospadias and 12,465 male controls. RESULTS: The results showed that the unadjusted risk of hypospadias in infants prenatally exposed to VA was 5.23 (95% CI 2.31, 11.86; p < 0.00001). Once adjusted for 13 potential confounding factors using conditional logistic regression analyses, the value of the risk was of a similar magnitude (odds ratio = 5.71; 95% CI 1.78, 18.36; p = 0.003). In addition, the frequency of hypospadias in the study population was approximately 1.8/1000 births. This allowed us to calculate the specific risk for an infant with hypospadias to be born to an exposed mother, which was 1 child in 97 births to mothers using VA during the first trimester of pregnancy. We consider this information much more useful for risk assessment than the risk value itself. CONCLUSIONS: An alteration of placental gonadotrophic stimulation caused by changes in gonadotropin-releasing hormone release produced by the effects of VA on GABA is a possible pathogenic mechanism. Our results support the relationship between prenatal exposure to VA and hypospadias.     

Intervention with adolescents and youngsters in prevention and health promotion

BACKGROUND: Over at least the past ten years, measures aimed at health promotion and prevention among young adults and teenagers have been being implemented from different public institutions and, in a certain sense, on a sectorial basis. The overall objective is to assess how the different measures carried out by different Public Institutions with regard to Health Promotion and Prevention have an impact on the actual conduct and practices of teenagers and young adults within the 14-25 age range in the Autonomous Community of Madrid. METHODS: A study based on a structural or qualitative methodology was conducted using the discussion group method, eight groups having been formed and their comments analyzed. RESULTS: The young adults do not feel any health-related prevention "system" as such exists on not considering themselves to be the object thereof. In the opinion of the young adults, disease, confined to the physical body, is conceived as being a short-lived, temporary and readily remedied based on the technological advances current medicine has to offer. On the contrary, the diseases related to the psychological perspective (mental disease dissociated with the area of the medical and connected to the individual/personal area) arouse interest in so much as young people are highly vulnerable to these diseases. CONCLUSIONS: Any measure aimed at generating identification and, therefore, the active response of young people must entail creating a connection between young people and health, which, not based exclusively in providing information, is capable of putting a space of control of the youths with regard to their harmful practices into play whilst at the same time highlighting their taking responsibility for their own actions. Considering we believe it best to "redefine" the term "prevention" in terms nearer to those of maintaining, improving or regaining (in short-lived cases) health, to thus connote the idea of physical and mental well-being.     

The implications of thromboembolism in chronic heart failure

The goal of investigation was to determine whether long-term anticoagulant therapy influences the mortality rate in CHF. The method consisted in the calculation of the annual death rate of the patients with CHF class III-IV NYHA: group A (controls)--who did not receive anticoagulant or antiplatelet therapy; group B--treated with Acenocumarol or Aspirin. The results show in group A, which included 150 patients, during the 5-year interval under study 30 deaths, representing an annual death rate of 4%. In group B, which included 325 patients of which 75 treated with Acenocumarol and 250 patients with aspirin, 20 deaths were recorded during the same 5-year interval, representing an annual death rate of 1.2%. Thus, the mortality risk proved to be 70% lower in group B than in the control group. It came out that the main mechanism of death in CHF is thrombembolism and in this circumstance anticoagulant or antiplatelet therapy would be essential.     

Role of RT-PCR tyrosinase detection in the monitoring of patients with advanced metastatic melanoma

In recent studies a new method has been proposed to detect circulating melanoma cells in the peripheral blood of patients, based on the amplification of the mRNA for tyrosinase, an enzyme involved in melanin biosynthesis that is expressed only by melanocytic cells. The sensitivity and clinical relevance of this method are still controversial. In the present study, 596 blood samples from 186 melanoma patients at various clinical tumour stages, together with samples from 25 healthy volunteers, were analysed with the aim of investigating the value of tyrosinase detection in predicting melanoma recurrence. We suggest a possible role for this marker in the monitoring of melanoma patients after the excision of regional lymph node metastases, and provide evidence that tyrosinase is related to the status of disease in advanced metastatic patients. Moreover, chemotherapy administration appeared to influence tyrosinase determination and may explain the discrepancies in the reported percentages of positive samples.