nový liek na osteoporózu - denosumab

denosumab (Prolia - Amgen)


nový liek na osteoporózu. monoklonálna protilátka proti ligandu RANK (výsledkom znížená aktivácia osteoklastov).
biologikum - monoklonálna protilátka, subkutánne 1x za 6mesiacov

EMEA (SPC)
wikipedia

nové antiarytmiká - dronedaron

dronedaron (Multaq)

nové antiarytmikum III. triedy, podobné amiodaronu, s porovnateľnou účinnosťou ale nižším výskytom nežiadúcich účinkov.

EMEA (SPC)
Současné trendy v antiarytmické medikamentózní léčbě fibrilace síní (CZ 2009)
 Současný pohled na antiarytmika (CZ 2009)
Remedia (rok 2005)

mimotelové eliminačné metódy, hepatológia, toxikológia (nefrológia)

MARS - Molekulový absorpčný recirkulačný systém


Je to extrakorporálna eliminačná metóda (Molecular Adsorbents Recirculating System, MARS), pri ktorej sa robí dialýza albumínov a ich následné oèistenie od toxí-nov, odstránenie lipofilných toxínov viazaných na plazmatické bielkoviny z cirkulácie intoxikovaného pacienta. Jej prínos je najmä u pacientov s hepatálnym zlyhaním.  
INDIKáCIE: akútne a chronické zlyhanie pečene pri chorobách pečene i pri toxickom poškodení heparu, chronická cholestáza (pruritus), príprava pacienta na transplantáciu pečene, primárna dysfunkcia transplantovanej peèene a zlyhanie pečene po chirurgických výkonoch  
IN Kresánek:
Indikácie MARS

VYUŽITIE MIMOTELOVEJ ELIMINÁCIE V TOXIKOLÓGII

podrobnejšie o MARS -word dokument zo stránky impax (dialýza, a dovozca MARS systému), dr Topoľský
- obsahuje schématický obrázok
- zoznam indikácií


Standardní doporučený postup diagnostiky a léčby intoxikace houbou "Amanita phalloides"



mimotelové eliminačné metódy - atestačná práca dr Polasčina,
- uvádza aj metódy pri hepatálnom zlyhaní: MARS - albumínová dialýza, SPAD - jednorazový prechod albumínu, systém Prometheus

tlačová správa z BB - Štyri mesiace na albumínovej dialýze 

Celiakia - etiopatogenéza

etiopatogenéza celiakie (glutén senzitívnej enteropatie) nie je známa, predpokladá sa genetická susceptibilita + environmentálne vplyvy.
štúdia CLUE:
USA autori vyšetrili autoprotilátky charakteristické pre gluténsenzitívnu enteropatiu (GSE) v dvoch kohortách s rozdielom 15 rokov. (vzorky z roku 1974 a z roku 1985).

prevalencia celiakie na základe pozitivity autoprotilátok zistili
1974: 1 z 501
1985: 1 z 219

Compared to controls, untreated CD subjects showed increased incidence of osteoporosis and associated autoimmune disorders, but they did not reach statistical significance. Conclusions. During a 15-year period CD prevalence increased 2-fold in the CLUE cohort and 5-fold overall in the US since 1974. The CLUE study demonstrated that this increase was due to an increasing number of subjects that lost the immunological tolerance to gluten in their adulthood.

diskusia: 
dôležitosť environmentálnych faktorov v patogenéze celiakie

clinical:
kedy myslieť na celiakiu .... 
rezistentné anémie
osteoporóza
poruchy fertility
...
u pacientov s inými autoimunitnými ochoreniami

škorica a diabetes - príklad príspevku

škorica a diabetes 
- meta-analýza z roku 2003 uvádza priaznivý vplyv škorice na glykemickú kompenzáciu 

- meta-analýza z roku 2008 uvádza prehľad klinických štúdií s negatívnym výsledkom  odkaz:

- bezpečnosť škorice u diabetikov - POZOR na interakcie škorice s inými liekmi  odkaz: 

Statíny a riziko diabetu

prevzaté z medscape. 

Do Statins Raise the Risk for Diabetes?

Gregory A. Nichols, PhD

Posted: 05/04/2010

Statins and Risk of Incident Diabetes: A Collaborative Meta-analysis of Randomised Statin Trials

Sattar N, Preiss D, Murray HM, et al
Lancet. 2010;375:735-742. Epub 2010 Feb 16.

Study Summary

Using data from 13 clinical trials with 91,140 participants, the investigators conducted a meta-analysis to determine whether a relationship exists between statin use and the development of diabetes. Six of the trials had previously published data for incident diabetes. The other 7 studies had not analyzed or published data on incident diabetes.
For each trial in the meta-analysis, odds ratios and 95% confidence intervals were calculated on the basis of the number of patients who did not have diabetes at baseline and the number who developed incident diabetes. An overall odds ratio was then calculated with a random-effects model meta-analysis. Meta-regression analysis was also used to investigate potential differences (heterogeneity) between trials. Specifically, baseline age, body mass index (BMI), and percentage of change in low-density lipoprotein (LDL) cholesterol were tested.
Of the 91,140 participants without diabetes, 4278 developed incident diabetes over a mean study follow-up of about 4 years. The rate of diabetes in individual trials varied substantially. Of the 13 trials, 2 independently showed positive associations between statin therapy and incident diabetes. In the combined data, 174 more cases of incident diabetes occurred in the groups assigned to statin treatment than in the placebo or standard-care groups, representing a 9% increase in the likelihood of development of diabetes during follow-up. The investigators estimated that this amounted to 1 additional case of diabetes per 255 patients treated with statins over 4 years. The results were nearly identical when the analyses were restricted to placebo-controlled trials. Heterogeneity between trials was low. Although the association between statin therapy and risk for incident diabetes was stronger in trials with older participants, baseline BMI and percent change in LDL cholesterol did not seem to be important factors.

Viewpoint

Although most statin trials to date had not found a relationship between statin use and diabetes incidence, the recent JUPITER (Crestor 20mg Versus Placebo in Prevention of Cardiovascular (CV) Events)^[1] trial that reported an increased risk for diabetes in patients assigned to the rosuvastatin arm seconded concerns raised several years ago when the PROSPER (PROspective Study of Pravastatin in the Elderly at Risk)^[2] trial reported similar findings with pravastatin. However, most trials had not looked at diabetes as a secondary outcome. The investigators of the current study are to be commended for obtaining access to previously unpublished results, thus eliminating a common flaw in meta-analyses.
With these data, they were able to identify a small but significantly increased risk for incident diabetes associated with statin use. Like observational studies, however, a meta-analysis cannot establish causation; therefore, it is possible that unmeasured factors explain the results. For example, the analysis did not account for baseline glycemic level. This is unlikely to be different between groups in randomized trials, but it is possible or even likely that patients who developed diabetes were more dysglycemic, and that a small "nudge" from statins was enough for them to convert to diabetes. If so, these patients were already at increased cardiovascular risk,^[3] in which case treatment with statins would be far more important than the few milligrams per deciliter of fasting glucose that took these patients over the diagnostic threshold for diabetes. It is also important to note that these results do not address whether statins raise blood sugar in people already diagnosed with diabetes, most of whom should already be taking statins.^[4]

References