PRECISESADS: enfermedades autoinmunes sistémicas

27 02 2014

Nace PRECISESADS, un proyecto europeo a la búsqueda de nuevos tratamientos contra las enfermedades autoinmunes sistémicas

El proyecto cuenta con más de 22 millones de euros de financiación para los próximos 5 años

 

PRECISESADS es un proyecto de colaboración europeo enmarcado en la Iniciativa sobre Medicamentos Innovadores (IMI) participado por 23 centros de investigación y cinco compañías de 12 países europeos. El objetivo final es encontrar tecnologías de diagnóstico innovadoras para relacionar las enfermedades autoinmunes sistémicas (SAD) con cambios en sus firmas moleculares individuales.

Los próximos 20 y 21 de Febrero tendrá lugar en la primera reunión de los participantes de PRECISESADS en la sede de la compañía UCB Pharma, en Bruselas.

 

Enfermedades autoinmunes sistémicas (SAD)

Las enfermedades del tejido conectivo (CTD) o enfermedades autoinmunes sistémicas (SAD) son un grupo de enfermedades inflamatorias crónicas con etiología autoinmune de diagnóstico difícil y con pocas opciones terapéuticas. Su característica principal es la presencia de anticuerpos no específicos en el suero de la sangre.

El Lupus Eritematoso Sistémico (LES), la artritis reumatoide (AR) y la esclerosis sistémica (CDC) son las tres enfermedades más representativas de este grupo pero existen otros síndromes con un amplio solapamiento clínico con estas tres. La enfermedad mixta del tejido conectivo (EMTC), el síndrome de Sjögren (SSJ) y el síndrome de anticuerpos antifosfolípido primario (SAFP) son ejemplos muy relevantes. Estas enfermedades por separado son poco frecuentes pero juntas afectan a cerca del 1 % de la población.

 

El grupo de investigación en Cromatina y Enfermedad participa en PRECISESADS

El grupo de investigación en Cromatina y Enfermedad participa en PRECISESADS

 PRECISESADS

Los médicos y los científicos que forman parte del proyecto europeo PRECISESADS estudiarán al menos 2.000 pacientes de estas enfermedades y 600 controles sanos, con el objetivo de identificar grupos de individuos a través de la superposición de estas enfermedades que comparten características moleculares y que por lo tanto podrían beneficiarse de tratamientos específicos para hacer frente a estos elementos comunes de la patología.

Como prototipo, los investigadores trabajarán con los nuevos y prometedores tratamientos biológicos que se están desarrollando para el Lupus eritematoso sistémico (LES) pero que debido a la clasificación de enfermedades por separado, no se pueden usar para tratar otras enfermedades de las que se sospecha que tienen una fisiopatología molecular compartida.

Según explicó Esteban Ballestar, participante del proyecto y jefe del grupo de cromatina y enfermedad del Instituto de Investigación Biomédica de Bellvitge (IDIBELL) “actualmente los pacientes tienen pocas posibilidades de beneficiarse de tratamientos ya aprobados debido a la heterogeneidad de los mecanismos moleculares que resultan de la misma clase de enfermedad”. “Por otro lado, las compañías farmacéuticas se enfrentan a enormes problemas cuando se trata de identificar los puntos finales para determinar la utilidad de los fármacos en los ensayos clínicos y no tienen marcadores biológicos que ayuden a evaluar la respuesta al tratamiento”.

 

Mapa molecular

El objetivo final de PRECISESADS es, precisamente, conseguir un mapa molecular de las enfermedades autoinmunes sistémicas que funcione como guía terapéutica de este grupo de enfermedades.

En este proyecto participan 23 académicos y 5 socios industriales de 12 países repartidos por toda Europa que trabajaron durante 5 años con un presupuesto de 22,7 millones de euros, de los que 9,9 provienen del Séptimo Programa Marco de la Comisión Europea para la Investigación y 9,8 de las compañías farmacéuticas que participan.

Los resultados de PRECISESADS serán ampliamente compartidos para ofrecer una nueva taxonomía molecular de las enfermedades autoinmunes sistémicas (SAD) que será accesible directamente por médicos, pacientes, reguladores y desarrolladores de medicamentos para ayudar a definir, refinar y descubrir mejores tratamientos para las SAD.

La IMI es la Iniciativa sobre Medicamentos Innovadores, una alianza de empresas entre la Unión Europea y la asociación de la industria farmacéutica EFPIA, que existe para acelerar el desarrollo de medicamentos mejores y más seguros.

 

 

Idibell.cat [en línea] Barcelona (ESP): idibell.cat, 27 de febrero de 2014 [ref. 18 de febrero de 2014] Disponible en Internet: http://www.idibell.cat/modul/noticies/es/657/nace-precisesads-un-proyecto-europeo-a-la-busqueda-de-nuevos-tratamientos-contra-las-enfermedades-autoinmunes-sistemicas

 



Estudio SYMPLICITY HTN-3: Denervación renal cuestionada

24 02 2014

El estudio clínico fase 3 sobre denervación renal SYMPLICITY HTN-3, para el tratamiento de la hipertensión resistente, no logró alcanzar su punto final primario de eficacia, según un comunicado difundido por Medtronic del que se han hecho eco varios medios de comunicación.

A pesar de la seguridad del procedimiento, el estudio, que asignó al azar a 535 pacientes con hipertensión resistente al tratamiento, no ha demostrado que el tratamiento con el procedimiento de investigación diera lugar a una reducción sostenida de la presión arterial sistólica.

Los resultados son sorprendentes, dados los resultados positivos del estudio SYMPLICITY 2 (sin brazo control sham), con el mismo catéter y los llevados a cabo por otras casas comerciales. La tercera parte del grupo de estudios SYMPLICITY parece que fue diseñada más rigurosamente para evaluar la eficacia del procedimiento, ya que todos los pacientes asignados al azar al grupo de control se sometieron a un procedimiento simulado (sham procedure). El objetivo final primario del estudio fue el cambio en la presión arterial sistólica ambulatoria a los seis meses, mientras que el cambio a los seis meses medidos por el holter de presión arterial (MAPA) fue un objetivo final secundario. El objetivo final primario de seguridad fue la incidencia de eventos adversos que ocurrieron un mes después del tratamiento hasta los seis meses.

Queda por tanto, analizar cuidadosamente los resultados y las posibles indicaciones reales de esta reciente, y hasta hace poco muy prometedora técnica (se ha publicado datos de un eficaz efecto hipotensor, antiarrítmico, etc.).

De momento, y pendientes de la presentación oficial de estos datos (y de su explicación), se han suspendido cautelarmente varios estudios sobre denervación real (SYMPLICITY 4 y EnligHTN IV, el fase 3 de St. Jude).

En Europa, el sistema Symplicity de Medtronic ha recibido la Marca CE. Otros sistemas denervativos incluyen los empleados en los ensayos EnligHTN (catéter EnligHTN, de St. Jude Medical); el Vessix V2 (Boston Scientific), utilizado en el estudio REDUCE-HTN; el OneShot (Covidien), empleado en el estudio RHAS, y el PARADISE (ReCor Médica) del estudio REALISE.

 

Enlaces:

Medscape.com – Renal Denervation Fails in SYMPLICITY HTN-3 »

Escrito por Dr. Iván Núñez Gil

Cardioteca.com [en línea] Madrid (ESP): cardioteca.com, 24 de febrero de 2014 [ref. 22 de enero de 2014] Disponible en Internet: http://www.cardioteca.com/noticias/noticia-hipertension-arterial-pulmonar/noticia-intervencionismo-estructural-2/910-estudio-symplicity-htn-3-denervacion-renal-cuestionada.html

 



Special glasses help surgeons ‘see’ cancer

20 02 2014

High-tech glasses developed at Washington University School of Medicine in St. Louis may help surgeons visualize cancer cells, which glow blue when viewed through the eyewear.

 

The wearable technology, so new it’s yet unnamed, was used during surgery for the first time Feb. 10 at Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine.

 

High-tech glasses help breast surgeon Julie Margenthaler, MD, visualize cancer cells in a patient

High-tech glasses help breast surgeon Julie Margenthaler, MD, visualize cancer cells in a patient

Cancer cells are notoriously difficult to see, even under high-powered magnification. The glasses are designed to make it easier for surgeons to distinguish cancer cells from healthy cells, helping to ensure that no stray tumor cells are left behind during surgery.

 

“We’re in the early stages of this technology, and more development and testing will be done, but we’re certainly encouraged by the potential benefits to patients,” said breast surgeon Julie Margenthaler, MD, an associate professor of surgery at Washington University, who performed the operation. “Imagine what it would mean if these glasses eliminated the need for follow-up surgery and the associated pain, inconvenience and anxiety.”

 

The current standard of care requires surgeons to remove the tumor and some neighboring tissue that may or may not include cancer cells. The samples are sent to a pathology lab and viewed under a microscope. If cancer cells are found in neighboring tissue, a second surgery often is recommended to remove additional tissue that also is checked for the presence of cancer.

 

The glasses could reduce the need for additional surgical procedures and subsequent stress on patients, as well as time and expense.

 

Margenthaler said about 20-25 percent of breast cancer patients who have lumps removed require a second surgery because current technology doesn’t adequately show the extent of the disease during the first operation.

 

“Our hope is that this new technology will reduce or ideally eliminate the need for a second surgery,” she said.

 

The technology, developed by a team led by Samuel Achilefu, PhD, professor of radiology and of biomedical engineering at Washington University, incorporates custom video technology, a head-mounted display and a targeted molecular agent that attaches to cancer cells, making them glow when viewed with the glasses.

 

In a study published in the Journal of Biomedical Optics, researchers noted that tumors as small as 1 mm in diameter (the thickness of about 10 sheets of paper) could be detected.

 

Ryan Fields, MD, a Washington University assistant professor of surgery and Siteman surgeon, plans to wear the glasses later this month when he operates to remove a melanoma from a patient. He said he welcomes the new technology, which theoretically could be used to visualize any type of cancer.

 

“A limitation of surgery is that it’s not always clear to the naked eye the distinction between normal tissue and cancerous tissue,” Fields said. “With the glasses developed by Dr. Achilefu, we can better identify the tissue that must be removed.”

 

In pilot studies conducted on lab mice, the researchers utilized indocyanine green, a commonly used contrast agent approved by the U.S. Food and Drug Administration. When the agent is injected into the tumor, the cancerous cells glow when viewed with the glasses and a special light.

 

Achilefu, who also is co-leader of the Oncologic Imaging Program at Siteman Cancer Center and a professor of biochemistry and molecular biophysics, is seeking FDA approval for a different molecular agent he’s helping to develop for use with the glasses. This agent specifically targets and stays longer in cancer cells.

 

“This technology has great potential for patients and health-care professionals,” Achilefu said. “Our goal is to make sure no cancer is left behind.”

 

Viktor Gruev, PhD, assistant professor of engineering at WUSTL, and Ron Liang, PhD, of the University of Arizona, assisted with development of the glasses. WUSTL graduate students Suman Mondal, Shengkui Gao and Yang Liu and postdoctoral fellow Nan Zhu also played key roles.

Imagen de previsualización de YouTube

Achilefu has worked with Washington University’s Office of Technology Management and has a patent pending for the technology.

 

The research is funded by the National Cancer Institute (R01CA171651) at the National Institutes of Health.

 

Washington University School of Medicine’s 2,100 employed and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children’s hospitals. The School of Medicine is one of the leading medical research, teaching and patient-care institutions in the nation, currently ranked sixth in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children’s hospitals, the School of Medicine is linked to BJC HealthCare .

 

Alvin J. Siteman Cancer Center, the only National Cancer Institute-designated Comprehensive Cancer Center in Missouri, is ranked among the top cancer facilities in the nation by U.S. News & World Report. Comprising the cancer research, prevention and treatment programs of Barnes-Jewish Hospital and Washington University School of Medicine, Siteman also is Missouri’s only member of the National Comprehensive Cancer Network.

 

 

News.wustl.edu [en línea] St Louis, MO (USA): news.wustl.edu, 20 de febrero de 2014 [ref. 10 de febrero de 2014] Disponible en Internet: https://news.wustl.edu/news/Pages/26496.aspx

 



Germs, Microbes Compete With Athletes in Sochi Olympics

17 02 2014

By Judy Stone

The Olympics are not just a chance for countries to bring home the gold. They also provide a perfect chance to spread infections all over the world. The Olympics are likely surpassed only by the annual Hajj Islamic pilgrimage to Mecca in the opportunity to rapidly disseminate infections. Let’s look at how.

 

 

Mass Gatherings

The Olympics pales in comparison to the largest gatherings, which are religious. The Hindu pilgrimage along the Ganges River, the Kumbh Mela, attracted 120 million in 2013; visitors may number 5 million on one day alone, but it lacks the global breadth of visitors. Kumbh Mela is thought to have contributed to the 1817-24 cholera pandemic, which spread from the Ganges to Kolkata and Mumbai, across India, and then was further disseminated by British soldiers and sailors to Europe and Asia.

The World Expo in Shanghai in 2010 attracted 73 million for a brief period. Other religious gatherings pale in comparison: Lourdes attracts 5 million/year, Manila’s Feast of the Black Nazarene 7-8 million in 2011. Other sports and political gatherings have generally been far less.

The annual Hajj pilgrimage has been a great place to study mass gatherings. The Hajj ritual attracts 2-3 million people from more than 183 countries to Saudi Arabia each year. Because the location of the gathering is always the same, it is an ideal place to study infectious disease mixing. The Islamic calendar is based on a lunar cycle, so the date and season of the Hajj shift every year, presenting additional challenges, like heat-related illnesses, some years. For example, in August, 1985, more than 18,000 needed treatment for heat exhaustion, there were 2000 cases of heat stroke and more than 1000 deaths at Hajj.
Previous infectious outbreaks at Hajj have included meningococcal infections, TB, pertussis, and influenza. Hajj has provided the opportunity to develop systems for real-time detection of diseases at mass gathering, as well as refinement of “global health diplomacy.”

Non-communicable diseases have had a larger impact than infectious diseases on deaths at mass gatherings. In particular, human stampedes and crush injuries have resulted in more than 7000 deaths and 14000 injured people over the past 27 years.

 

Infectious diseases at religious and sport events

While not likely quite as good as massive religious gatherings at disseminating infection, sports venues like the Olympics contribute their share to public health problems. For example, there have been these outbreaks of infections at mass gatherings:

2000-2001 – meningococcal outbreak at Hajj, led to global spread.

2002 – influenza in Salt Lake Winter Olympics

2006 – norovirus outbreak during the Football World Cup in Germany

2006 – chicken pox outbreak among members of the Maldives volleyball squad during the Asian Games in Doha, Qatar

2006 – leptospirosis in Germany among triathlon athletes

2008 – influenza World Youth Day, Sydney

2009 – Hajj, which took place during the influenza A H1N1 epidemic

2010 – measles at the Winter Olympics in Vancouver, Canada. The outbreak spread to remote areas of British Columbia, causing significant morbidity, especially among indigenous people.

 

What are the likely infections at mass gatherings?

Some of the likely infectious candidates are predictable, like norovirus, the highly contagious vomiting-and-diarrhea causing virus, which is notorious for outbreaks on cruise ships. Cholera has been a big problem in India, as noted above. Food and water-borne outbreaks can spread efficiently. For example, more than 50% of the ~12,700 attendees at the Rainbow Family meeting in North Carolina in 1987 became ill with an unusual strain of Shigella sonnei, due to contaminated drinking water and poor sanitation.

Outbreaks of meningococcal infections, which cause meningitis outbreaks, are less common at Hajj now, because of a mandatory vaccination requirement since 2002. Other respiratory transmitted pathogens include Legionella, tuberculosis, pertussis (whooping cough) and influenza. Flu is worrisome because of the potential for different strains to combine, as mentioned in my recent overview of flu, H1N-what?

Measles has the potential to be a huge problem, because it is highly communicable. Many countries in Europe, including Russia, have active, ongoing measles outbreaks.

Some less common bugs have surfaced, as well. For example, there was an outbreak of African tick-bite fever, caused by Rickettsia africae, among a group of participants in the “Raid Gauloises” in Lesotho and Natal, South Africa. This competition included multiple sports—rafting, horseback riding, trekking, and mountain biking. The attack rate ranged from 3.9-7.6% of participants, with those affected becoming ill with symptoms like headache, lymphadenopathy (swollen glands), fever, myalgias (muscle aches) and a typical rash called “tache noir.” There is a risk of acquiring the parasitic infection schistosomiasis from contact with contaminated water during swimming or water sports in South Africa.

Skin infections like MRSA (methicillin resistant Staph aureus) are frequently transmitted in gyms and locker rooms, or during close contact sports. Other odd outbreaks occur among wrestlers. There have been occasional outbreaks of molluscum, Herpes simplex (Herpes gladiotorum) and Hepatitis B among them. Unexpectedly, 1500 cases of Hepatitis B also occurred among those orienteering in Sweden.
Interestingly, intense exercise may increase an athlete’s susceptibility to infection, especially respiratory tract infections. Close quarters further facilitates spread of droplet and airborne infections.

Some infections likely are acquired not just directly at such sports venues, but through tourism around the event. Zoonotic illnesses from rabies, leptospirosis and tularemia are higher in Sochi than the average rate in Russia and, were it not for the Olympics being held in winter there, would pose an increased risk from people being active outdoors and being exposed to animals.

In 2016, the Olympics will be held in Rio de Janeiro—the first time South America has hosted the event. Dengue cases are common there. While malaria is not transmitted in Rio, ecotourism outside the city might expose visitors to that and to Leishmaniasis, a nasty parasitic infection transmitted by sandflies, as well as to Hepatitis A.

Exotic travel locales tend to lead to “loosening of sexual inhibitions.” Sexually transmitted diseases, including HIV are noted as a possibly high-risk public health problem associated with the Olympics. Presumably, excessive alcohol and drug use associated with sports events also increases this risk.

 

Besides these direct person-to-person forms of transmission, vector-borne diseases can potentially cause big problems. We’ve just seen that with the recent emergence of a viral infection, Chikungunya, in the Carribbean, where it has just become established for the first time. Previously, this virus was limited to Asia and Africa, then spread to Italy in 2007, before arriving in St. Maarten’s. Just in the past month, there has been an explosion in cases, now spreading throughout the Carribbean. This virus, like dengue, is transmitted by Aedes aegypti and Aedes albopictus mosquitoes. Asian tiger mosquitoes  (A. albopictus) were introduced to the Americas in the mid-1980s, probably in old scrap tires with pools of standing water. Initial spread then followed the interstate highway routes. These specific mosquitoes can transmit these tropical diseases, allowing them to become established now in the western hemisphere. No doubt Chikungunya will soon follow dengue and move to the Florida coast and Tex-Mex border as well.  All it takes is an infected traveler to be bitten by a mosquito, who then transmits it to another person. Or it could set up housekeeping in New York City, by the combination of travelers and global warming allowing the mosquito to propagate. Some worry that Yellow Fever could similarly become reestablished in the USA in this way, just as dengue did in the 1980s.

 

Planning considerations

At the Olympics, as for Hajj, planning for infectious disease has to take a number of factors into consideration. These include what diseases might be endemic in the region of the gathering, and what diseases might be circulating seasonally, like the current influenza. A particular problem is that air travel enables dissemination of an infection like the flu or measles, both of which are highly transmissible, before the incubation period is complete. Seasonal flu will not be readily detected by surveillance systems, unless a new strain emerges. Such surveillance systems, like GeoSentinel, are more likely to pick up a spike or cluster of unusual infections. For example, in 2000, 304 athletes from 26 countries participated in an endurance race in Borneo, Malaysia. After they returned home, a London GeoSentinal clinic identified a patient with suspected leptospirosis, an infection associated with exposure to water which has been contaminated by rodent waste during sports (think kayaking, swimming, for example). Within hours, other suspected cases were identified in Canada and the US. An alert enabled others who were exposed to receive prompt antibiotic treatment.
Projects like HealthMap and ProMed are invaluable resources, gathering data from search engine queries and case reports, serving as an early warning system. Besides, they are just fun sites to browse, as there is often something weird and new being reported.

The scope of the logistical planning involved is also intriguing. Modeling helps in evaluating different scenarios and predicting problem spots. But think of the magnitude of concerns—from transportation and moving people without provoking riots, stampedes, and crushing deaths, to housing. Think of providing food and water for 3 million in 1 week at Hajj. How do you handle sanitation and waste disposal? It seems miraculous that there are not more infectious outbreaks linked to mass gatherings. Add to this the number of countries sending visitors, the various languages, and the need for cooperation between so many countries, and the success becomes even more impressive. Imagine if such cooperation occurred in other situations.

From the infectious disease perspective, surveillance is essential, as are strict regulations to try and prevent the spread of communicable disease. Mass gatherings are not the place to try raw goat milk for all, or undercooked meat. Sanitation needs to be efficient. And it is imperative to insist on vaccinations, as Saudi Arabia did for reducing meningococcal infections during Hajj.

 

What to watch for in Sochi

So the big things to watch for, bug wise, are influenza and measles rapidly spreading. Colds, strep throat, and similar common infections are readily spread in close quarters and by athletes pushing themselves to compete, even when ill. Twenty years ago, there was a memorable outbreak of diptheria in Russia; fortunately, that has been well-controlled.

Drug-resistant tuberculosis (MDR-TB) is rising in Eastern Europe. The Russian Federation ranks third globally in total cases of multi drug-resistant TB (MDR-TB), beaten only by China and India. A scary recent genetic study of 1000 TB isolates from Russia found not only widespread drug resistance, but mutations that enabled the TB to spread more readily.

If the flu strains commingle, we could see new pandemic strains emerge, with athletes bringing home far more than the gold.

 

What can we do to reduce risk of infections?

Several diseases are highly contagious before a person develops symptoms, including influenza, measles, and chickenpox. This obviously makes them of great concern wherever large numbers of people gather. Just as Saudi Arabia now requires meningococcal vaccine to attend Hajj, thought should be given to requiring some vaccinations to attend sports and other mass gatherings—particularly measles and influenza.
To protect yourself—at home and abroad—be sure to have your vaccinations:
Hepatitis A & B
measles-mumps-rubella (MMR) vaccine,
diphtheria-tetanus-pertussis vaccine,
varicella (chickenpox) vaccine,
polio vaccine, and your yearly flu shot.

Without those precautions, Olympic visitors and participants in other mass gatherings may get far more than than they bargained for when they purchased their tickets. Additionally, I always get a baseline TB test before I leave and after I return from higher-risk travel overseas.
I also keep my Kwikpoint translator card handy (most recently, it was handy on an international flight where attendants couldn’t communicate with a passenger seated near me). I love those cards.

So enjoy your travels. I’m going to sit back and watch for any new diseases that might emerge, and marvel at how epidemiologists do their sleuthing. Disease detection is a great spectator sport!

 

 

 

About the Author: Judy Stone, MD is an infectious disease specialist, experienced in conducting clinical research. She is the author of Conducting Clinical Research, the essential guide to the topic. She survived 25 years in solo practice in rural Cumberland, Maryland, and is now broadening her horizons. She particularly loves writing about ethical issues, and tilting at windmills in her advocacy for social justice. As part of her overall desire to save the world when she grows up, she has become especially interested in neglected tropical diseases. When not slaving over hot patients, she can be found playing with photography, friends’ dogs, or in her garden. Follow on Twitter @drjudystone or on her website.

 

Credits:

Measles and tuberculosis maps, courtesy WHO

 

Blogs.scientificamerican.com [en línea] Cumberland, MD (USA): blogs.scientificamerican.com, 17 de febrero de 2014 [ref. 05 de febrero de 2014] Disponible en Internet: http://blogs.scientificamerican.com/molecules-to-medicine/2014/02/05/germs-microbes-compete-with-athletes-in-sochi-olympics/



Trastorno por atracón: una enfermedad muy prevalente pero no tratada

13 02 2014

La Organización Mundial de la Salud acaba de publicar los resultados de un estudio realizado sobre el trastorno por atracón, un trastorno de alta prevalencia pero que pasa ampliamente desapercibido y que no está tratado a pesar de que conlleva alteraciones comparables a las de la bulimia nerviosa. El estudio se ha realizado a partir de estudios epidemiológicos realizados en 12 países de todo el mundo, con un total de 22.635 adultos encuestados y muestra que el trastorno por atracón es aproximadamente dos veces más común que la bulimia entre los países estudiados (EE.UU., Brasil, Colombia, México, Bélgica, Italia, Países Bajos, Irlanda del Norte, Portugal, Rumania, España y Nueva Zelanda ). El estudio en España ha sido liderado por Jordi Alonso, director del Programa de Epidemiología y Salud Pública del IMIM (Instituto Hospital del Mar de Investigaciones Médicas).

 El trastorno por atracón (adaptación del término inglés Binge Eating Disorder) es un trastorno de la conducta alimentaria que supone en la mayoría de los casos un aumento de peso y, incluso, obesidad, pero también otras importantes implicaciones físicas y psicológicas. El caso típico es el de una persona que siente deseos diarios de ingerir alimentos de forma descontrolada (en ocasiones, sobrepasando la ingesta de 6000 calorías diarias), pero, a diferencia de la bulimia, no busca contrarrestar el empacho provocándose el vómito.

El Trastorno por atracón ha sido ampliamente ignorado por los proveedores de atención de la salud, pero tiene un enorme coste para la salud física y el bienestar psicológico de las personas con la enfermedad“, explica Ronald Kessler, profesor de Políticas de Salud en la Escuela de Medicina de Harvard y autor principal del artículo. “Cuando todos los casos de la enfermedad se toman en conjunto, los niveles elevados de depresión, el suicidio y los días perdidos en el trabajo representan costes importantes para la sociedad.”

Este es un trastorno recientemente reconocido como trastorno independiente de la conducta alimentaria por la Asociación Psiquiátrica Americana y se cree que pueden existir factores genéticos que predispongan a su desarrollo que, además, tiene asociada una alta incidencia de comorbilidad psiquiátrica. El estudio confirma que tanto el trastorno por atracón como la bulimia nerviosa surgen durante la adolescencia y van asociados con una serie de trastornos mentales de inicio tardío (incluyendo trastornos de depresión y ansiedad) y de trastornos físicos (por ejemplo, los trastornos musculoesqueléticos y la diabetes).

“Este estudio ha permitido conocer por primera vez la prevalencia del trastorno por atracón a nivel internacional y comprender mejor la magnitud del problema. Además, los resultados evidencian que hay que conocer y detectar mejor los trastornos de la alimentación durante los años escolares, ya que esto será de gran ayuda para prevenir la aparición de trastornos mentales y físicos posteriores y las deficiencias asociadas a estos trastornos” explica Jordi Alonso, director del Programa de Epidemiología y Salud Pública del IMIM.

El análisis de este trabajo se llevó a cabo conjuntamente con la Encuesta Mundial de la Salud de la Organización Mundial de la Salud Mental (WMH), y estuvo apoyada por el Instituto Nacional de Estados Unidos para la Salud Mental, el Estudio de la carga de la Salud Mental y por una serie de organismos gubernamentales en los demás países participantes, así como por fundaciones y patrocinadores de la industria.

 

Artículo de referencia

A comparative analysis of role attainment and impairment in binge – eating disorder and bulimia nervosa : results from the WHO World Mental Health Surveys” RC Kessler , V. Shahly , J.I. Hudson, D. Supina , P.A. Berglund , W.T. Chiu , M. Gruber , S. Aguilar- Gaxiola , J. Alonso, L.H. Andrade, C. Benjet , R. Bruffaerts , G. de Girolamo , R. de Graaf , S.E. Florescu , J.M. Haro, S.D. Murphy, J. Posada-Villa, K. Scott and M. Xavier. Epidemiology and Psychiatric Sciences doi : 10.1017/S2045796013000516

 

 

 

Imim.es [en línea] Barcelona (ESP): imim.es, 13 de febrero de 2014 [ref. 17 de octubre de 2013] Disponible en Internet: http://www.imim.es/noticias/360/trastorno-por-atracon-una-enfermedad-muy-prevalente-pero-no-tratada



Smart Hand – robotic hand gives amputees a sense of touch

10 02 2014

 Developed by EU researchers, the Smart Hand is a complex prosthesis with four motors and forty sensors designed to provide realistic motion and sense to the user. Te sensors enabled it to become the first device of its kind to send signals back to the wearer, allowing them to feel what they touch. Phantom limb syndrome is the sensation amputees have that their missing body part is still there. The brain has remained open to receiving input from those nerves although they were cut off long ago. Likewise, impulses from the brain to control the missing limb still travel down the neurons towards the sight of amputation.

Scientists can use electronic sensors to pick up the control signals and relay them to a mechanical device. We’ve seen this technology used in the HAL exoskeleton from Cyberdyne, and in the i-Limb prostheses. Smart Hand is unique because it also takes advantage of those phantom limb pathways still being open. Doctors connect the sensors in the hand to the nerves in the stump of the arm, hence the patients can feel as well as in control of an artificial limb.

 

Imagen de previsualización de YouTube

 

The goal of the Smart Hand project is to create a replacement limb that is almost identical to the lost one. In both objectives, the Smart Hand is far from ultimate success. Four motors, although providing an impressive range of motion, do not have the full degrees of freedom, nor the variation in applied strength that a human hand has. It is amazing that the forty sensors can communicate with the human brain at all, but they do not provide nearly as much sensation as the millions of nerves in your biological hand. Yet, as mentioned in the video, the current Smart Hand prototype represents more than ten years of dedicated work.

 

Imagen de previsualización de YouTube

 

Robin af Ekenstam, the first amputee who tried their robotic hand, said it was just like using his real hand. He lost his hand after it was amputated in order to prevent a tumor spreading. He said: “It’s a feeling I have not had in a long time. When I grab something tightly I can feel it in the fingertips. It’s strange since I don’t have them any more! It’s amazing.”

He is able to use it in order to pick up objects, with a feedback manifested as a sense of touch on the fingertips of the prosthesis even at this stage of development. It is clear from his involvement in this project that this level of capability is well worth the time and effort involved. In other words, an imperfect Smart Hand is still a very desirable hand, and can perform remarkable tasks.

Beside limb replacement, it is thought the hand could also help eliminate ‘phantom pains’ that amputees and as a result improve their quality of life. Beyond that, if artificial limbs will one day match the human ones, there’s no reason they couldn’t be further improved. We would then see bionic limbs, or perhaps entirely bionic bodies, which exceed human limitations. Could these mechanical bodies be accepted as authentically human? The Olympic Committee already decided that some athletes with prostheses have an unfair advantage and are ineligible to compete. In the years to come we will see how society reacts when “good enough” becomes “good as new” and finally “better than ever”.

 

 

Robaid.com [en línea] Novi Sad (SRB): robaid.com, 10 de febrero de 2014 [ref. 11 de noviembre de 2009] Disponible en Internet: http://www.robaid.com/bionics/smart-hand-robotic-hand-gives-amputees-a-sense-of-touch.htm



HIV-INFECTED TEENS DELAYING TREATMENT UNTIL ADVANCED DISEASE

6 02 2014

Nearly half of HIV-infected teenagers and young adults forgo timely treatment, delaying care until their disease has advanced, which puts them at risk for dangerous infections and long-term complications, according to a study led by the Johns Hopkins Children’s Center.

The researchers say their findings, published Feb. 3 in ‪JAMA Pediatrics, are particularly troubling in light of mounting evidence that starting treatment as early as possible can go long way toward keeping the virus in check and prevent the cardiovascular, renal and neurological damage characteristic of poorly controlled HIV infection over time. Those most likely to show up in clinic with advanced infections were male and members of a minority group, the study found.

While the researchers did not study specifically why patients were showing up in clinic with advanced infections, they believe some youth were simply unaware of their HIV status, while others had been diagnosed earlier but, for a variety of reasons, did not seek care.

“These are decidedly disappointing findings that underscore the need to develop better ways to diagnose teens sooner and, just as importantly, to get them into care and on therapy sooner,” says lead investigator Allison Agwu, M.D., an infectious disease specialist and HIV expert at the Johns Hopkins Children’s Center.

The researchers analyzed records of nearly 1,500 teens and young adults, ages 12 to 24, infected with HIV and seen between 2002 and 2010 in 13 clinics across the country. Between 30 percent and 45 percent of study participants sought treatment when their disease had reached an advanced stage, defined as having fewer than 350 CD4 cells per cubic millimeter of blood. CD4 cells are HIV’s favorite target and the immune system’s best trained sentinels against infection. Depletion or destruction of CD4 cells makes people vulnerable to a wide range of bacterial, viral and fungal organisms that generally cause no disease in healthy people, but lead to severe life-threatening infections in those with compromised immune systems. In a healthy person, the number of CD4 cells can range between 500 and 1,500 per cubic millimeter. HIV-infected people with CD4 counts below 500 require treatment with highly active anti-retroviral therapy that keeps the virus in check and prevents it from multiplying. Those with CD4 cell counts below 200 have full-blown AIDS.

Even though the U.S. Centers for Disease Control and Prevention recommend HIV testing for everyone between the ages of 13 and 64, many infected people continue to slip through the cracks, the investigators say, due to unwillingness to get tested, fear, stigma and clinicians’ biases.

“Clinicians need to get away from their own preconceived notions about who gets infected, stop risk-profiling patients and test across the board,” Agwu says.
In addition, Agwu says, pediatricians should help teens view HIV testing as part of their regular physical — just as essential as checking their weight or blood sugar levels.

One finding of particularly grave concern, the investigators note, was that patients with lower CD4 cell counts tended to have more active virus circulating in their blood and bodily fluids, which makes them more likely to spread the infection to others.

Those diagnosed with HIV should start therapy early and be followed vigilantly, the researchers say, to ensure that the virus is under control, to prevent complications and to reduce the risk of spreading the infection to others.

“We have to become more creative in linking those already diagnosed with services so they are not deteriorating out there and infecting others,” Agwu says.

Males and members of racial and ethnic minorities were more likely than others to seek care at more advanced disease stages, the study showed. Black youth were more than twice as likely as their white counterparts to show up in clinic at more advanced stages, while Hispanic youth were 1.7 times more likely to do so. Boys and young men were more likely than girls to show up in clinic with lower CD4 cell counts. Males, as a whole, may be at higher risk for delaying treatment, the researchers say, because they tend to receive less regular care than teen girls and young women, whose annual OB/GYN exams make them more likely to get tested and treated sooner.

Males infected through heterosexual intercourse also tended to get to clinic for treatment at more advanced disease stages than homosexual males, a finding that suggests this population may underestimate its own HIV risk. This perception of low risk, the researchers say, may have been fueled inadvertently by public health campaigns that focus on men who have sex with men — the group at highest risk for HIV infection.

“In our study, heterosexual males emerged as this fall-through-the-cracks group,” Agwu says. “We’ve put a lot of emphasis on men who have sex with men in our screening and outreach, but one side effect of this may be that straight males perceive themselves as low risk.”

Cindy Voss, M.A., of Johns Hopkins was co-investigator in the research.

Other institutions involved in the study included the University of Pennsylvania and the Children’s Hospital of Philadelphia.

The research was funded by the Agency for Healthcare Research and Quality under grant number 290-01-0012 and the Health Resources and Services Administration under contract HHSH250020100008C.

 

 

 

Hopkinsmedicine.org [en línea] Baltimore, MD (USA): hopkinsmedicine.org, 06 de febrero de 2014 [ref. 03 de febrero de 2014] Disponible en Internet: http://www.hopkinsmedicine.org/news/media/releases/hiv_infected_teens_delaying_treatment_until_advanced_disease_johns_hopkins_study_shows____



Dr MONGUET. Inteligencia colectiva para identificar el futuro.

3 02 2014

Josep M. Monguet Fierro

Profesor de la UPC. 

 

Ahora se está jurando que las promesas de las tecnologías de la información de los últimos años se van a cumplir “ya”.  Leía hace pocos días que si se aplicara el potencial del denominado Big Data al sector de la salud, los ahorros serian espectaculares. ¿Les suena la letra?

 

A menudo se olvida un concepto sencillo, fundamental en tecnología, que es el de la curva de difusión. Una curva, en forma de “S”, dibuja como se propaga el uso social de una tecnología, suave al principio, en algún momento coge inclinación, tras un punto de inflexión, y al final, tras otra inflexión, de nuevo horizontal hasta la saturación. Lo difícil es situar en el eje temporal los mencionados puntos de inflexión. Como no hay una única tecnología, sino muchas que compiten entre ellas, cada una con su propia curva de difusión, resulta difícil pronosticar con éxito sobre su difusión real .

 

Es útil dividir la curva “S” entre 3 estadios: el de desarrollo científico, el de disponibilidad de la tecnología y el de producto comercial. Como más hacia el lado del desarrollo se encuentra la tecnología más cuesta de usar y menos “outcomes” proporciona, pero cuando ya es producto comercial las oportunidades de obtener ventajas competitivas se han empezado a diluir. Esas fases se solapan entre ellas, y el ruido del mercado – de todos los que intentan vender lo antes posibles – hacen muy difícil saber en qué “tempo” se encuentra exactamente cada tecnología.

 

¿Es posible mirar hacia el futuro con algún tipo de lógica?  Una posible respuesta se encuentra en la aplicación de estrategias de Inteligencia Colectiva. Se trata de combinar de forma coste-efectiva el conocimiento de las personas adecuadas, buscando sentido práctico y anticipación sobre el qué y cuándo de una tecnología. Lo importante no es la pretensión de adivinar el futuro, por otra parte “inadivinable”, sino invitar a pensar de forma sistemática y ordenada, ejercitando el diálogo y el consenso.

 

¿Podemos intuir el futuro entre todos?  Tiene cierto sentido pensar que el futuro lo conocemos entre todos, ya que los escenarios del futuro, básicamente, los construimos las personas. La gracia está obviamente en ver de qué manera podemos gestionar esta intuición colectiva, y exprimirla de forma que genere significado. Esto es lo que se ha hecho por ejemplo este año mediante la aplicación “healthconsensus” previamente al encuentro anual del Plan de Salud en Sitges, para valorar que piensa un extenso colectivo de profesionales de la salud, sobre lo que sucederá en 2015.

 

Los escenarios de futuro que seamos capaces de construir colectiva y colaborativamente tienen, por sí mismos, mucho interés, pero hay que insistir en que lo que importa no es tanto el resultado obtenido, como dos cosas que tal ejercicio proporciona:

1. El aprendizaje que obtienen “personas clave”, sobre la reflexión sistemática para modelar y escenificar el futuro.

2. La hibridación de conocimientos, su cruce con método e intención, entre sectores  y sensibilidades profesionales.

 

El ejercicio de pensar en el futuro de forma sistemática está claro que es importante y también es evidente que está poco trabajado, y que no está siendo explotado en términos de aprovechar la inteligencia y/o la intuición colectiva.  A veces el futuro está escrito y simplemente no lo queremos leer y mucho menos discutir colectivamente. Un ejemplo bien sencillo. Si se analiza la evolución del European Innovation Scoreboard, que maneja unas 30 variables, a partir del año 2000 es fácil adivinar cómo evolucionará el índice de innovación. Si en 2008, con este dato, y unos pocos más, como por ejemplo el de la productividad, se analiza fríamente la situación española, se descubre la brutal pérdida de competitividad, que en un escenario de recesión, también anunciado, permitía sin duda intuir el desastre. Este es sin embargo un análisis en clave crítica, para poner un ejemplo, pero los proyectos de futuro deberían ser en clave positiva, y estar orientados a descubrir oportunidades para nuestros emprendedores.

 

Publicaciones anteriores del Dr JM Monguet Fierro en innovacionensalud.com: