Britanijos mokslininkai teigia, kad Helicobacter pylori sunaikinimas jokių simptomų nejaučiantiems asmenims mažina skrandžio vėžio riziką, rašoma internetiniame žurnale The Cochrane Library. Duomenys apibendrinti atlikus šešių tyrimų, kuriuose dalyvavo 6497 asmenys, metaanalizę. Plačiau...
(HealthDay News) -- Eradication of Helicobacter pylori in asymptomatic adults is associated with a reduction in the incidence of gastric cancer, according to a review published online July 22 in The Cochrane Library.
Alexander C. Ford, M.B., Ch.B., M.D., from St. James's University Hospital in Leeds, U.K., and colleagues examined the effectiveness of H. pylori eradication in healthy asymptomatic individuals in the general population in reducing the incidence of gastric cancer. Data were included from six trials (five in Asian populations) which compared at least one week of H. pylori therapy with placebo or no treatment in otherwise healthy and asymptomatic H. pylori-positive adults.
The researchers found that H. pylorieradication therapy was superior to placebo or no treatment for preventing development of subsequent gastric cancer (six trials, 6,497 participants; risk ratio, 0.66; 95 percent confidence interval, 0.46 to 0.95). Wide confidence intervals were seen on analysis of the effect of H. pylori eradication on preventing death from gastric cancer compared with placebo or no treatment (three trials, 4,475 participants; risk ratio, 0.67; 95 percent confidence interval, 0.40 to 1.11). No effect was seen on all-cause mortality (four trials; 5,253 participants; risk ratio, 1.09; 95 percent confidence interval, 0.86 to 1.38).
"We found limited, moderate-quality evidence that searching for and eradicating H. pylori reduces the incidence of gastric cancer in healthy asymptomatic infected Asian individuals, but we cannot necessarily extrapolate this data to other populations," the authors write.
Skiriant didelias dozes amoksicilino/klavulaninės rūgšties kartu su varfarinu padidėja kraujavimo rizika. Nustatyta, kad didelės dozės minėto vaistų derinio 87,5 proc. atvejų padidina INR ≥4, o normalios dozės - tik 28,9 proc., rašoma žurnale Journal of Clinical Pharmacology. Plačiau...
(HealthDay News) -- Among hospitalized patients, high-dose amoxicillin/clavulanate correlates with increased risk of over-anticoagulation when combined with warfarin, according to a study published online July 2 in the Journal of Clinical Pharmacology.
Mahmoud I. Abdel-Aziz, from Assiut University in Egypt, and colleagues conducted a cross-sectional observational study involving 120 hospitalized patients to examine the impact of polypharmacy and high doses of amoxicillin/clavulanate on warfarin response.
The researchers found that during hospital stay, international normalized ratio (INR) values ≥4 were seen for 87.5 percent of patients prescribed high-dose amoxicillin/clavulanate and 28.9 percent of those prescribed normal dose (P < 0.001). An elevated number of potentially interacting drugs known to increase INR significantly predicted having INR values ≥4 (odds ratio, 2.5). An elevated number of potentially interacting drugs known to increase bleeding risk was identified as a significant predictor of bleeding episodes (odds ratio, 3.1).
"High doses of amoxicillin/clavulanate were associated with a higher risk of over anticoagulation when combined with warfarin than normal doses," the authors write. "Frequent monitoring of warfarin therapy along with patient's medications is necessary to avoid complications."
Atnaujintose rekomendacijose didžiausias griežtai pasisakoma prieš antikoaguliantų, imatinibo, endotelinių receptorių antagonistų vartojimą idiopatinės plaučių fibrozės gydyme. Rekomendacijos paskelbtos žurnale American Journal of Respiratory and Critical Care Medicine. Plačiau...
Recommendations for idiopathic pulmonary fibrosis (IPF) treatment have been updated by an international group of respiratory societies. The updated clinical practice guideline was published in the July 15 issue of the American Journal of Respiratory and Critical Care Medicine.
Ganesh Raghu, M.D., from the University of Washington in Seattle, and colleagues conducted systematic reviews and meta-analyses to update guidelines on IPF treatment. All relevant available evidence was assessed and discussed by a multidisciplinary panel. Conflict-of-interest management strategies were applied and non-conflicted panelists formulated, wrote, and graded recommendations.
The authors developed recommendations for or against specific treatment interventions. Updated guidelines included strong treatment recommendations against the use of anticoagulation (warfarin); imatinib; combination prednisone, azathioprine, and N-acetylcysteine; and selective endothelin receptor antagonist (ambrisentan). Conditional recommendations were for the use of nintedanib and pirfenidone, and against the use of phosphodiesterase-5 inhibitor and dual endothelin receptor antagonists. Recommendations remaining unchanged from 2011 included conditional recommendations against the use of N-acetylcysteine monotherapy and for the use of anti-acid therapy.
"Our systematic review of the available evidence on IPF treatments points to the need for additional research and long-term studies of their safety and efficacy," Raghu said in a statement. "The guidelines empower the clinician to make the most appropriate treatment choices for the patient confronted with IPF and encourage shared decision-making with the well-informed patient to choose the most appropriate treatment options tailored to the individual patient's needs."
Several authors disclosed financial ties to the biopharmaceutical industry.
Atlikus palyginamąją analizę nustatyta, kad po penkiarių metų po operacinio opinio kolito gydymo, mirties rizika sumažėja 33 proc., palyginus su asmenims, kuriems buvo taikytas medikamentinis gydymas. Tyrime dalyvavo 830 asmenų, kuriems buvo atlikta kolektomija ir 7541asmuo, kuriems taikytas gydymas vaistais. Plačiau...
(HealthDay News) -- Colectomy may extend the lives of older adults with ulcerative colitis, new research suggests. The study was published online July 14 in the Annals of Internal Medicine.
Meenakshi Bewtra, M.D., M.P.H., Ph.D., assistant professor of medicine and epidemiology at the University of Pennsylvania Perelman School of Medicine, and colleagues used data from Medicare and Medicaid for the study. The team followed 830 patients who had elective colectomy and 7,541 who took medication to manage the condition.
Over five years, colectomy was linked with a 33 percent reduced risk of death compared to medication, Bewtra's team found. The operations were performed between 2000 and 2011. Survival benefit was greatest for those 50 and older who had advanced disease. The study suggests that colectomy should be considered earlier in the course of the disease, Bewtra told HealthDay, not viewed as a last resort.
"Too often we, as gastroenterologists, think that the yardstick, the touchstone, the criterion of success in treating patients is keeping them away from the surgeon," David B. Sachar, M.D., author of an editorial accompanying the study, toldHealthDay. Sachar is a gastroenterologist and professor of medicine at the Icahn School of Medicine at Mount Sinai in New York City. If medicines are doing the job, that's great, Sachar said. "But often the swiftest, safest, surest treatment for ulcerative colitis is an operation. The name of the game is not saving colons, but saving lives, and that includes quality of life," he said.
Žurnale Annals of Internal Medicine apibendrinti geriausi 2014 metų straipsniai, kurie pateikia naujausią mokslinę informaciją apie difuzinių plaučių ligų, astmos, lėtinės obstrukcinės ligos, plaučių vėžio, respiracinių infekcijų diagnostiką ir gydymą. Plačiau...
(HealthDay News) -- Articles relating to diffuse parenchymal lung disease, asthma, chronic obstructive pulmonary disease (COPD), lung cancer, pulmonary diagnostics, and respiratory infections are included in a special update summary published online April 30 in the Annals of Internal Medicine.
Jess Mandel, M.D., from the University of California in San Diego, identified key studies published in 2014 that are highly relevant to the practice of pulmonary medicine.
Mandel included articles discussing beneficial therapies for idiopathic pulmonary fibrosis, which had previously eluded effective treatment. Another study described a select group of patients with severe asthma refractory to traditional therapies who may benefit from a monoclonal antibody-based therapy. For COPD, one trial demonstrated that inhaled corticosteroids may be withdrawn from treatment of some patients with stable disease, while a second trial demonstrated that azithromycin most effectively decreases acute exacerbations that necessitate antibiotics and glucocorticoids in certain subsets of patients. Low-dose computed tomography screening was reported to be cost-effective for lung cancer screening in appropriate patient groups. High sensitivity and specificity were reported in a meta-analysis of point-of-care ultrasonography for the diagnosis of acute cardiogenic pulmonary edema, when experienced operators perform the test. Finally, oseltamivir was found to be modestly effective for influenza treatment in adults, although adverse events were reported.
"This article summarizes important studies published in 2014 that have the potential to substantially influence the practice of pulmonary and internal medicine," Mandel writes.
Mandel disclosed financial ties to the medical publishing industry.
Žurnale Annals of Internal Medicine apibendrintos 2014 metų hematologijos naujienos nuo piktybinių kraujo ligų gydymo iki kraujavimo ir krešėjimo korekcijos naujų rekomendacijų. Transfuziologijoje naujai apibrėžta, jog kraujo perpylimas septiniams ligoniams indikuotinas esant Hb žemiau 90 g/l, o ne žemiau 70 g/l. Plačiau...
(HealthDay News) -- Articles relating to malignant hematology, transfusion medicine, and bleeding and clotting disorders are included in a special update summary published online April 30 in the Annals of Internal Medicine.
Alice D. Ma, M.D., from the University of North Carolina at Chapel Hill, summarized studies relating to benign and malignant hematologic conditions published in 2014 that are relevant to practicing internists.
Ma highlighted the use of a new agent, idelalisib, which was added to rituximab to treat frail, elderly, pretreated patients with chronic lymphocytic leukemia. A study that reported updated findings with personalized cellular therapeutics was also included for the treatment of relapsed acute lymphoblastic leukemia in children and adults. Studies in the field of transfusion medicine included one describing the superiority of a hemoglobin trigger of 70 g/L to a trigger of 90 g/L for determining when to transfuse blood to septic patients. An additional study examined the risk of hospital-acquired infections with red blood cell transfusions. Meta-analyses examined genomic-based strategies for warfarin dosing, and compared the best anticoagulant regimens for acute venous thromboembolism. A randomized trial found compression stockings to be ineffective for preventing post-thrombotic syndrome compared with sham compression hose.
"In addition to [these articles], it's also worth noting that in 2014, the American Society of Hematology published its second 'Choosing Wisely' list," Ma writes. "The Society has added five commonly used tests, treatments, and procedures in hematology that might not always be necessary."
Ma disclosed financial ties to the pharmaceutical and medical device industries.
Keturiasdešimtmetės moterys turi pasikonsultuot su savo gydytoju ir pačios nuspręsti, ar tikslinga atlikti mamogramą. Reguliarios mamogramos turi būti atliekamos nuo 50 metų amžiaus. Nustatyta, jog mamogramos apsaugo nuo krūties vėžio mirčių keturias iš 10000, kai jos atliekamos nuo 40 iki 49 metų, 8 - nuo 50 iki 59 metų ir 21 iš 10000 virš 60 metų amžiaus moterų. Plačiau...
Mammograms a Personal Decision for Women in Their 40s, Panel Says
Išanalizavus 876 pažengusiu kiaušidžių vėžiu sergančių pacienčių gydymo taktiką nustatyta, jog po intraperitoninės chemoterapijos pacientės vidutiniškai išgyveno 61,8 mėnesio, o po intraveninės -51,4 mėnesio. Kiekvienas intraperitoninės chemoterapijos ciklas mirties riziką sumažina 12 proc. Plačiau...
(HealthDay News) -- Intraperitoneal (IP) chemotherapy offers lasting benefit for patients with advanced ovarian cancer, according to a study published online March 23 in the Journal of Clinical Oncology.
Devansu Tewari, M.D., from the Kaiser Permanente Irvine Medical Center in California, and colleagues examined long-term survival after IP chemotherapy in patients with advanced ovarian cancer. Data were analyzed for 876 patients from Gynecologic Oncology Group protocols 114 and 172, followed for a median of 10.7 years.
The researchers found that median survival was 61.8 months with IP therapy, compared with 51.4 months for intravenous therapy. IP therapy correlated with a reduced risk of death (adjusted hazard ratio [aHR], 0.77; P = 0.002). Among those with gross residual (≤1 cm) disease, IP therapy improved survival (aHR, 0.75 P = 0.006). For each IP chemotherapy cycle completed, the risk of death decreased by 12 percent (aHR, 0.88; P < 0.001). Clear/mucinous versus serous histology (aHR, 2.79), gross residual versus no visible disease (aHR, 1.89), and fewer versus more cycles of IP chemotherapy (aHR, 0.88) were factors associated with poorer survival (all P < 0.001). The IP regimen was more likely to be completed by younger patients; with each year of age there was a 5 percent decrease in probability of completion (odds ratio, 0.95; P < 0.001).
"The advantage of IP over intravenous chemotherapy extends beyond 10 years," the authors write. "Survival improved with increasing number of IP cycles."
One author disclosed financial ties to the pharmaceutical industry.
Individualių patalogų krūties biopsijos tyrimų interpretacijos didžiąja dalimi (75,3 proc.) sutampa su ekspertų grupės bendru sutarimu nustatytomis diagnozėmis, rašoma žurnale Journal of the American Medical Association. Tyrime dalyvavo 115 patalogų, kurie nustatė 6900 individualių diagnozių. Atskirai pagal patologiją tyrimų rezultatų sutapimo nuošimtis buvo skirtingas - 87 proc. - tiriant gerybinius auglius be atipijos; 48 proc. su atipija; 84 proc. tiriant duktalinę karcinomą in situ; 96 proc. invazyvinės karcinomos tyrime. Plačiau...
(HealthDay News) -- Individual pathologists' interpretations of a single breast biopsy slide generally concur with expert consensus-derived reference diagnoses, according to a study published in the March 17 issue of the Journal of the American Medical Association.
Joann G. Elmore, M.D., M.P.H., from the University of Washington in Seattle, and colleagues quantified the magnitude of diagnostic disagreement among pathologists compared with a consensus panel reference diagnosis in interpretation of breast biopsies. Participants interpreted slides from test sets of 60 breast biopsies; they were blinded to interpretations of other study pathologists and consensus panel members. Unanimous agreement of independent diagnoses was 75 percent among the three consensus panel members; there was 90.3 percent concordance with consensus-derived reference diagnosis. Data were included from 115 pathologists, providing 6,900 individual case diagnoses.
The researchers found that the overall concordance rate of diagnostic interpretations of participating pathologists was 75.3 percent compared with the consensus-derived reference diagnosis. The overall concordance rate was 87 percent for diagnosis of benign without atypia; 48 percent for atypia; 84 percent for ductal carcinoma in situ; and 96 percent for invasive carcinoma. Among biopsies from women with higher versus lower breast density on prior mammograms, there was significantly higher disagreement with the reference diagnosis (overall concordance rate, 73 and 77 percent, respectively; P < 0.001). Pathologists who interpreted lower weekly case volumes, or worked in smaller practices or nonacademic settings also had higher disagreement with reference diagnosis.
"This study confirms that the majority of diagnoses, especially at either end of the spectrum from benign to invasive cancer, are readily and accurately made by practicing pathologists," write the authors of an accompanying editorial. "It also identifies areas of uncertainty that must be addressed, providing a framework for process improvement in the pathology and scientific communities, especially in the diagnosis of atypia."
One author disclosed financial ties to Genentech; assistance for the digital scanning equipment and digital viewer were provided by Ventana Medical Systems and HD View SL.