關鍵報告

Archives' Studies Call into Question Statins for Primary Prevention Two papers in the Archives of Internal Medicine cast doubt on the benefits of statins for primary prevention. In a meta-analysis, researchers combined data from 11 placebo-controlled trials of statin use in some 65,000 high-risk patients without cardiovascular disease at baseline. During nearly 4 years of treatment, LDL levels were lower in statin than in placebo users (mean, 94 vs. 134 mg/dL) — but there was no difference in all-cause mortality. Editorialists say the analysis "makes it clear that in the short-term, for true primary prevention, the benefit, if any, is very small." In another paper, investigators took a closer look at the JUPITER trial, in which rosuvastatin reportedly lowered cardiovascular risk by 50% among patients without heart disease or hypercholesterolemia but with high C-reactive protein. The investigators say the trial was "flawed" — it was stopped too early, data on car...

Actos都比較安全，但是兩者都有CHF risk More Evidence Against Rosiglitazone Rosiglitazone continues to compare unfavorably with other diabetes therapies in two studies released online Monday. Updating their 2007 meta-analysis, researchers again found that rosiglitazone significantly increased the risk for myocardial infarction, while there was no increase in risk for cardiovascular or all-cause mortality. The update appears in the Archives of Internal Medicine. Writing in JAMA, researchers present their analysis of cardiovascular and mortality risks in a retrospective cohort of over 200,000 Medicare patients. The subjects had started treatment with either rosiglitazone or pioglitazone and were followed for up to 3 years (median, 105 days). Compared with patients taking pioglitazone, those on rosiglitazone had higher risks for stroke, heart failure, and death. Risk for MI did not differ between the groups. The authors calculate a number needed to harm of 60 patients treated for 1 year. JAMA's edi...

加拿大的健保資料…科科 The Importance of Being Timely In a population-based cohort with ST-segment-elevation myocardial infarction, time to reperfusion had a stronger effect than method of reperfusion on outcomes. Clinical trial and registry data show that rapid coronary reperfusion improves outcomes in patients with ST-segment-elevation myocardial infarction (STEMI). To assess the importance of timely treatment in a broader population, investigators evaluated STEMI care from October 2006 through March 2007 at 80 hospitals where >95% of patients with acute MI in Quebec, Canada, are treated. Of 2356 STEMI patients, 61.1% received primary percutaneous coronary intervention (PPCI), 16.6% received fibrinolysis, and 22.2% received neither intervention. At 30 days, mortality was 6.1% in fibrinolytic recipients and 5.2% in PPCI recipients. At 1 year, mortality was 7.4% in fibrinolytic recipients and 7.9% in PPCI recipients, and the rates of combined death or readmission for acute MI or heart failure ...

非常了不起 大部份抗生素都是趁細菌在replication的時候下手殺菌 但對TB這種難得分裂的細菌就無法下手 所以才要高劑量長時間的給予，讓病人受苦 但冬眠的細菌仍要大便 把大便筒塞住他就完了 所以這個藥如果ok 可以大幅度縮短TB療程 New Approach to Treating Tuberculosis Targeting nonreplicative bacteria might avert long courses of therapy for TB patients. In contrast to most bacterial pathogens, Mycobacterium tuberculosis is a slow-growing organism with a propensity for latency, which means that patients with this infection require treatment with multiple drugs for many months. To remain healthy, every cell, including single-cell organisms, requires proper levels of each protein that it produces. This fact means that a balance must exist between synthesis and degradation of proteins. Many antibacterials target synthesis of bacterial proteins, but none inhibit degradation of proteins. Unlike other bacteria, mycobacteria have proteasomes — a key site of protein degradation — and might be susceptible to inhibitory agents. A multi-institutional team has identified a class of compounds that inhibit pr...

Rice Intake and Risk for Developing Type 2 Diabetes Substituting brown rice for white rice might lower relative risk for diabetes. Brown rice retains the outer bran and germ that are stripped off to make white rice; the glycemic index (a measure of blood glucose response) of brown rice is lower than that of white rice. Rice intake in the U.S. is almost 21 pounds per person annually, and 70% of that amount is white rice. Harvard investigators pooled data from three U.S. prospective cohort studies to assess the difference in risk for developing type 2 diabetes with brown or white rice intake. Nearly 200,000 adults without known diabetes, cardiovascular disease, or cancer were assessed at baseline and every 2 to 4 years thereafter (follow-up, 14–22 years). About 10,500 incident cases of diabetes were identified. In adjusted analyses, relative risk for developing diabetes was 17% greater in the group with the highest intake of white rice (≥5 servings weekly) than in the lowest-intake group...

http://www.medscape.com/viewarticle/723217?src=mp&spon=13&uac=62514FX

This study shows that although acceptance of LTBI treatment is relatively high (83%), the proportion completing is low (47%). When the product of these two proportions is calculated, we see that completion was achieved by only 39% of persons who were offered LTBI treatment. The major risk factor for noncompletion was being prescribed the 9-month INH regimen. As shown in Figure 1, when the proportions completing the three most commonly prescribed regimens are compared, it can be seen that there is an inverse relationship between length of the regimen prescribed and the proportion completing treatment. The increased completion that we observed with the 4-month rifampin regimen is consistent with previous reports.[18–20] It is of interest to note that if completion of the 9-month regimen were defined as completion of at least 6 months of INH, the noncompletion rate of the 9-month regimen, 42.9%, would have been almost identical to that of the 6-month regimen, 44.8%. Thus, prescribing the...