PRECISESADS: systemic autoimmune diseases

27 02 2014

Born PRECISESADS, a European project in search of new treatments against the systemic autoimmune diseases

The project has more of 22 million euros of funding for the next 5 years

 

PRECISESADS It is a European collaborative project framed in the innovative medicines initiative (IMI) participated by 23 research centers and five companies of 12 European countries. The ultimate goal is to find innovative diagnostic technologies to relate the systemic autoimmune diseases (SAD) with changes in their individual molecular signatures.

The next 20 and 21 February will take place at the first meeting of the participants of PRECISESADS at the headquarters of the UCB Pharma company, in Brussels.

 

Systemic autoimmune diseases (SAD)

Connective tissue diseases (CTD) or systemic autoimmune diseases (SAD) they are a group of chronic inflammatory diseases with autoimmune etiology of difficult diagnosis and few treatment options. Its main feature is the presence of non-specific antibodies in the serum of the blood.

Lupus Erythematosus (LES), Rheumatoid arthritis (AR) and systemic sclerosis (CDC) they are the three most representative of this group, but there are other syndromes with a broad clinical overlap with these three. Mixed connective tissue disease (MCTD), Sjogren's syndrome (SSJ) and the primary Antiphospholipid Antibody Syndrome (SAFP) they are very relevant examples. These diseases separately are infrequent but together affect close of the 1 % of the population.

 

El grupo de investigación en Cromatina y Enfermedad participa en PRECISESADS

The chromatin and disease research group participates in PRECISESADS

PRECISESADS

The doctors and scientists who are part of the European project PRECISESADS will study at least 2.000 patients of these diseases and 600 healthy controls, in order to identify groups of individuals through the superimposition of these diseases share molecular characteristics and which therefore could benefit from specific treatments to deal with these common elements of Pathology.

As a prototype, the researchers will work with the new and promising biological treatments being developed for Lupus Erythematosus (LES) but that because of the classification of diseases separately, they may not be used to treat other diseases that are suspected of having a shared molecular physiopathology.

As explained by Esteban Ballestar, participant of the project and head of the Group of chromatin and disease of the Institute of biomedical research of Bellvitge (IDIBELL) “currently patients have little chance of benefiting from already approved treatments because of the heterogeneity of the molecular mechanisms that are of the same class”. “On the other hand, pharmaceutical companies are facing enormous problems when it comes to identifying the endpoints to determine the usefulness of drugs in clinical trials and have biological markers that will help to evaluate the response to treatment".

 

Molecular map

The ultimate goal of PRECISESADS is to, precisely, get a molecular map of systemic autoimmune diseases that could serve as therapy for this group of diseases Guide.

This project involves 23 academic and 5 industrial partners of 12 countries scattered across Europe who worked during 5 years with a budget of 22,7 million euros, of those who 9,9 they come from the seventh framework programme of the European Commission for research and 9,8 pharmaceutical companies participating.

PRECISESADS results will be widely shared to provide a new molecular taxonomy of systemic autoimmune diseases (SAD) It will be accessible directly by physicians, patients, regulators and developers of drugs to help define, refine and discover better treatments for the SAD.

The IMI is the innovative medicines initiative, an Alliance of companies between the European Union and the Association of the pharmaceutical industry EFPIA, There is to accelerate the development of better, safer drugs.

 

 

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

 



Study SYMPLICITY HTN-3: Renal denervation questioned

24 02 2014

The clinical study phase 3 about renal denervation SYMPLICITY HTN-3, for the treatment of resistant hypertension, It failed to reach its primary endpoint of efficacy, According to a statement released by Medtronic that echoed several media.

Despite the safety of the procedure, the study, randomly assigned to 535 patients with treatment-resistant hypertension, It has not demonstrated that treatment with the investigation procedure would result in a sustained reduction of systolic blood pressure.

The results are amazing, given the positive results from the SYMPLICITY study 2 (armless sham control), with the same catheter and the carried out by other commercial houses. The third part of the Group of studies SYMPLICITY looks like it was designed more rigorously to assess the effectiveness of the procedure, Since all patients randomized to the control group underwent a sham procedure (Sham procedure). The primary objective of the study was the change in the ambulatory systolic blood pressure at six months, While the change six months measured by blood pressure holter (MAP) was a secondary objective. The primary objective of security was the incidence of adverse events that occurred a month after treatment to six months.

It is therefore, carefully analyze the results and possible real indications of this recent, and until recently very promising technique (an effective blood pressure lowering effect data has been published, antiarrhythmic, etc.).

At the moment, and the official presentation of these data (and its explanation), have been provisionally suspended several studies on real denervation (SYMPLICITY 4 and EnligHTN IV, the phase 3 St. Jude).

In Europe, the Symplicity of Medtronic system has received the CE mark. Other denervativos systems include employees in the EnligHTN trials (EnligHTN catheter, St. Jude Medical); Vessix V2 (Boston Scientific), used in the study reduced-HTN; the OneShot (Covidien), used in the RHAS study, and the PARADISE (Medical ReCor) study REALISE.

 

Links:

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

Written by Dr. Iván Núñez Gil

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

 



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 atAlvin 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.

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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 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] Available on 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) vaccinvaccine 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 A QUIÉN

 

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



Binge eating disorder: a very prevalent disease but not treated

13 02 2014

The World Health Organization has just published the results of a study about the disorder binge eating, a high-prevalence disorder but that goes widely unnoticed and is not treated while it involves alterations comparable to the bulimia nervosa. The study was conducted from epidemiological studies on 12 countries around the world, with a total of 22.635 adults surveyed and shows that binge eating disorder is approximately two times more common than bulimia among the countries studied (EE.UU., Brazil, Colombia, Mexico, Belgium, Italy, Netherlands, Northern Ireland, Portugal, Romania, Spain and New Zealand ). The study in Spain has been led by Jordi Alonso, Director of the epidemiology and public health program of the IMIM (Hospital del Mar's Medical Research Institute).

The binge eating disorder (adaptation of the English term Binge Eating Disorder) It is a disorder of eating behavior that in most cases an increase of weight and, even, Obesity, but also other important physical and psychological implications. The typical case is that of a person who feels daily desires of eating in an uncontrolled manner (sometimes, surpassing the intake of 6000 calories per day), but, Unlike bulimia, It does not seek to counteract the surfeit causing vomiting.

The binge eating disorder has been widely ignored by health care providers, but it has a huge cost for physical health and psychological well-being of people with the disease“, explains Ronald Kessler, Professor of health policy at the medical school of Harvard and senior author of the article. “When all cases of the disease are taken together, elevated levels of depression, suicide and days lost at work represent major costs for society.”

This is a disorder recently recognized as a separate eating disorder by the American Psychiatric Association and it is believed that there may be genetic factors that predispose to its development than, In addition, It has a high incidence of psychiatric comorbidity associated. The study confirms that both the binge eating disorder and bulimia nervosa emerge during adolescence and are associated with a series of late-onset mental disorders (including depression and anxiety disorders) and physical disorders (for example, Musculoskeletal disorders and diabetes).

“This study has allowed to meet for the first time the prevalence of the disorder binge eating at international level and better understanding of the magnitude of the problem. In addition, the results show that you there is to know and better detect the eating disorders during the school years, Since this will help to prevent the occurrence of further mental and physical disorders and deficiencies associated with these disorders” explains Jordi Alonso, Director of the epidemiology and public health at the IMIM program.

The analysis of this work was conducted jointly with the survey of the health of the Organization world the Health Mental (WMH), and it was supported by the National Institute of Mental Health United States, the study of the burden of Mental Health and by a number of government agencies in the other participating countries, and for foundations and industry sponsors.

 

Reference article

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). Supine , P.A. Berglund , W.T. Chiu , M. Gruber , S. Aguilar- Gaxiola , J. Alonso, L.H. Andrade, (C). Benjet , R. Bruffaerts , G. of Girolamo , R. de Graaf , H.E. Florescu , I.. Haro, S.D. Murphy,JJ. 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 October of 2013] Available on Internet: http://noticias/360/trastorno-por-atracon-una-enfermedad-muy-prevalente-pero-no-tratada www.imim.es/



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.

 

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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.

 

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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 November of 2009] Available on 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] Available on Internet: http://www.hopkinsmedicine.org/news/media/releases/hiv_infected_teens_delaying_treatment_until_advanced_disease_johns_hopkins_study_shows____



Dr MONGUET. Collective intelligence to identify the future.

3 02 2014

Josep M. Monguet Fierro

Professor at the UPC.

 

Now it is vowing to promises of recent information technologies will meet "ya". I read a few days ago that if the potential of the so-called Big Data applies to the health sector, the savings would be spectacular. Does it sound like you lyrics?

 

Often a simple concept is forgotten, fundamental technology, that is the diffusion curve. A curve, "in the form of"S”, It draws as the social use of technology spread, soft at the beginning, at some point take tilt, After a turning point, and at the end, after another inflection, again horizontal up to saturation. The hard part is placed in the temporary axis mentioned tipping points. As there is not a single technology, but many competing among them, each with its own diffusion curve, It is difficult to predict success on real dissemination .

 

It is useful to divide the "S" curve between 3 stadiums: scientific development, the availability of technology and commercial product. As more towards the side of development is technology more cost to use and less "outcomes" provides, but when it is commercial product opportunities of obtaining competitive advantages have begun to blur. These phases overlap between them, and the noise of the market – of all those who try to sell as soon possible – they make it very difficult to know what "time" is exactly each technology.

 

Is it possible to look to the future with some kind of logic? one possible answer is the implementation of strategies of collective intelligence. It's cost-effective way to combine knowledge with the right people, looking for practicality and anticipation about where and when of a technology. The important thing is not the claim of divining the future, on the other hand “inadivinable”, but invite you to think in a systematic and orderly way, exercising the dialogue and consensus.

 

Can we guess the future together?It has some sense to think that the future know it all, Since the future scenarios, basically, them build people. Grace is obviously to see how we can manage this collective intuition, and squeeze it in such a way that it generates meaning. This is what has become for example this year through the application "healthconsensus" prior to the annual meeting of the Health Plan in Sitges, to assess what you think an extensive collective of health professionals, about what will happen in 2015.

 

The future scenarios that we are able to build collective and collaborative have, by themselves, much interest, but we must insist that what matters is not so much the result obtained, as two things this exercise provides:

1. Learning that obtain “key people”, on the systematic reflection to modelling and stage the future.

2. The hybridization of knowledge, its junction with method and intent, between sectors and professional sensitivities.

 

The exercise of thinking systematically about the future it is clear that it is important and it is also evident that this little worked, and that is not being exploited in terms of leverage intelligence and/or collective intuition. Sometimes the future is written and we just don't want to read and much less discuss collectively. A very simple example. If the evolution of the European Innovation Scoreboard, manages a 30 variables, from the year 2000 It is easy to guess how to evolve the summary innovation index. If in 2008, with this data, and a few more, as for example the productivity, the Spanish situation is analyzed coldly, Discover the brutal loss of competitiveness, in a scenario of recession, also announced, allowed no doubt sense the disaster. This is however a critical key analysis, to give one example, but future projects should be in positive, and be driven to discover opportunities to our entrepreneurs.

 

Previous publications of the Dr JM Monguet iron in innovacionensalud.com: