miércoles, 28 de julio de 2010


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TEACHING TOPICS from the New England Journal of Medicine

Teaching Topics | July 29, 2010

Resuscitation: Was there any survival advantage between chest compressions alone and chest compressions with rescue breathing?

Acupuncture: According to traditional Chinese medicine, how is acupuncture thought to work?

Teaching Topic


Original Article

CPR with Chest Compression Alone or with Rescue Breathing

T.D. Rea and Others

CME Exam  

Out-of-hospital cardiac arrest claims hundreds of thousands of lives each year worldwide. Successful resuscitation is challenging but achievable, requiring an interdependent set of actions that consist of early arrest recognition, early cardiopulmonary resuscitation (CPR), early defibrillation, expert advanced life support, and timely postresuscitation care.

Clinical Pearls

Clinical Pearl  What is the potential advantage of chest compression alone for CPR?

Chest compression alone may be more acceptable to some laypersons and has the potential physiological advantage of fewer compression interruptions, so that circulation is increased, as compared with traditional CPR, although at a possible cost to oxygenation.

Clinical Pearl  Was there any survival advantage between chest compressions alone and chest compressions with rescue breathing?

No. In this multicenter, randomized trial, CPR instructions consisting of chest compression alone did not increase the rate of survival to hospital discharge overall, as compared with instructions consisting of chest compression plus rescue breathing.

Morning Report Questions

Q. What was the overall rate of survival to hospital discharge among patients with cardiac arrest?

A. The authors observed no significant difference in the rate of survival to hospital discharge (12.5% for instructions to perform chest compression alone and 11.0% for instructions to perform chest compression plus rescue breathing, P=0.31) or the rate of survival to discharge with a favorable neurologic status (14.4% for chest compression alone and 11.5% for chest compression plus rescue breathing, P=0.13).

Q. Which group of patients appeared to have a better outcome when treated with chest compressions alone as compared to chest compressions with rescue breathing?

A. According to subgroup analysis, among patients whose arrest had a cardiac cause, there was a trend toward an increased rate of survival to hospital discharge (15.5%, vs. 12.3% for patients with other causes of arrest; P=0.09) and an increased rate of survival with a favorable neurologic status at discharge (18.9% vs. 13.5%, P=0.03) with chest compression alone.

Table 3. Outcomes.

Teaching Topic


Clinical Therapeutics

Acupuncture for Chronic Low Back Pain

B.M. Berman and Others

CME Exam  

Traditional Chinese medicine espouses an ancient physiological system (not based on Western scientific empiricism) in which health is seen as the result of harmony among bodily functions and between body and nature. Internal disharmony is believed to cause blockage of the body's vital energy, known as qi, which flows along 12 primary and 8 secondary meridians.

Clinical Pearls

Clinical Pearl  According to traditional Chinese medicine, how is acupuncture thought to work?

The insertion of acupuncture needles at specific points along the meridians is supposed to restore the proper flow of qi.

Clinical Pearl  What pathophysiological phenomena have been identified in association with acupuncture?

Local anesthesia at needle-insertion sites completely blocks the immediate analgesic effects of acupuncture, indicating that these effects are dependent on neural innervation. Acupuncture has been shown to induce the release of endogenous opioids in brain stem, subcortical, and limbic structures. Acupuncture also causes effects on local tissues, including mechanical stimulation of connective tissue, release of adenosine at the site of needle stimulation, and increases in local blood flow.

Morning Report Questions

Q. What do the data from the most recent well-powered clinical trials of acupuncture conclude?

A. The most recent well-powered clinical trials of acupuncture for chronic low back pain showed that sham acupuncture was as effective as real acupuncture. The simplest explanation of such findings is that the specific therapeutic effects of acupuncture, if present, are small, whereas its clinically relevant benefits are mostly attributable to contextual and psychosocial factors, such as patients' beliefs and expectations, attention from the acupuncturist, and highly focused, spatially directed attention on the part of the patient.

Q. What guidance do the American College of Physicians and the American Pain Society provide for the use of acupuncture for chronic low back pain?

A. The American College of Physicians and the American Pain Society have issued joint clinical practice guidelines recommending that clinicians consider acupuncture as one possible treatment option for patients with chronic low back pain who do not have a response to self-care. The level of supporting evidence for this recommendation was characterized as fair.

Figure 1. Acupuncture Meridians.

quote of the week

Quote of the Week

"Dispatcher instruction consisting of chest compression alone did not increase the survival rate overall, although there was a trend toward better outcomes in key clinical subgroups. The results support a strategy for CPR performed by laypersons that emphasizes chest compression and minimizes the role of rescue breathing."

T.D. Rea and Others, Original Article,
"CPR with Chest Compression Alone or with Rescue Breathing"

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Causas de muerte y predicción de mortalidad en la EPOC
Ingrid Solanes Garcia.  Pere Casan Clarà.
Arch Bronconeumol. 2010;46:343-6.

La prevalencia de la EPOC en España se ha estimado en el 9,1% en sujetos entre 40-69 años, con una alta morbimortalidad. En los últimos años se están buscando índices de gravedad y pronóstico en los pacientes con EPOC, que permitan adecuar los esfuerzos terapéuticos. En este editorial se comentan los principales índices de mortalidad y su aplicabilidad en la asistencia diaria de estos pacientes
pulse sobre visualizar documento


martes, 27 de julio de 2010



----- Mensaje reenviado ----
De: PABLO ALBAN SILVA <albansilvamedico@hotmail.com>
Para: ASOCIACIÓN PSIQUIATRICA PERUANA <listaapp@yahoogrupos.com.mx>
Enviado: mar,27 julio, 2010 23:52



El biochip y las nuevas tecnologías de la biomedicina sustituirán en un futuro a los diagnósticos basados en pruebas descriptivas, como los recuentos sanguíneos, la comprobación de temperatura corporal y el examen de los síntomas. Con el biochip es posible conseguir en poco tiempo abundante información genética -tanto del individuo como del agente patógeno-,  que permitirá elaborar vacunas, medir las resistencias de las cepas de la tuberculosis a los antibióticos o identificar las mutaciones que experimentan algunos genes y que desempeñan un papel destacado en ciertas enfermedades tumorales, como el gen p53 en los cánceres de colon y de mama. En la actualidad, en Estados Unidos existen portadores del VIH, causante del SIDA, que reciben una combinación de fármacos basada en un análisis previo del genotipo del virus. Durante el VII Encuentro Internacional sobre el Proyecto Genoma Humano, que se celebra Valencia, se puso de manifiesto que el objetivo que  se pretende con estos pequeños artilugios es desarrollar técnicas que permitan detectar cualquier enfermedad a partir de una simple gota de sangre.


  1. ¿Qué es bioinformática?
  2. El Proyecto Genoma Humano
  3. Genómica funcional - La Era Post-Genómica 
  4. Conceptos Generales
  5. Antecedentes
  6. Definiciones
  7. Desarrollo del BIOCHIP.
  8. Sistema integrado de laboratorio.
  9. La biotecnología es la esperanza para una vacuna contra el cáncer

26 Jul 2010 ... EL FACTOR HUMANO de Javier Pérez de Cuéllar (Perú) Quinto Secretario
Preparándome para esta entrevista, me sorprende lo difícil que es encontrar datos sobre su vida personal.
Usted ha sido muy reservado: ¿eso ha sido por necesidad profesional o por inclinación propia?
Es una cuestión personal. A lo largo de mis estudios, por ejemplo, yo siempre tuve 4 o 5 amigos, nunca más.

Yo no soy una persona que intime, como decimos los peruanos. No intimo, puedo tener un buen amigo, pero
ese amigo nunca va a ser mi confidente, ni yo quisiera ser el suyo.
Y no lo ha echado de menos…
Nunca, jamás. Mi consejera es la máquina de afeitar.
Sueña tremendamente racionalista, ¿no?
Pero no hay momento de duda, de angustia, de sufrimiento, incluso en los que…
de sufrimiento, desde luego. No… no he tenido penas cercanas. En mi familia

todos están vivitos, tengo penas lejanas, pero cercanas, no.
¿De modo que la timidez no ha sido un factor poderoso en su vida?
No. Sin duda, alguna veces he podido ser más audaz, pero no está en mi naturaleza, serlo.

Seguramente –dice sonriendo de pronto- porque inconscientemente yo sé que tengo suerte.
Entonces si tú en el fondo sabes que tienes suerte, ya no necesariamente la audacia. Comprendes ¿no?
Sí: usted confía en lo que le va a pasar.
Dígame, esta naturaleza reservada de la que hablamos, ¿lo ha ayudado mucho en su

trabajo diplomático?
Sí, me ha ayudado mucho. ¿Y sabe por qué? Porque no incomoda a los demás.

Esa cualidad te hace no atractivo, pero, por lo menos, muy soportable para los demás.
Entre a Relaciones Exteriores a los 20 años, sin proponérmelo realmente. Se presentó

la oportunidad de hacerlo en Relaciones Exteriores por medio de amistades y contactos
 familiares, esa cosa tan peruana.
Su amigo
Dr. Pablo Albán

jueves, 22 de julio de 2010

Evaluacion clnica de la rodilla


Brote de Peste Neumónica.Cuidado!!!

Brote de Peste en Trujillo. Cuidado con las trasnferencias a los medicos de triaje y Trauma Shock. Tomar medidas preventivas de proteccion para personal. Puede ser mortal.

---------- Mensaje reenviado ----------
De: Enrique Swayne <eritema@gmail.com>
Fecha: 20 de julio de 2010 20:49
Asunto: Re: [SANFERNANDOPERU] Re: Brote de Peste Neumónica
Para: SANFERNANDOPERU@yahoogroups.com


Me ha impresionado la noticia que han fallecido la interna de medicina y el medico residente, si esto es verdad es una verdadera negligencia del sistema. El no usar el perfil epidemiologico e incluir el diagnostico de peste en su fase septicemica ( neumonica) habiendo sido notificados que hace 4 semanas atras ya habia un brote de peste en la zona.

Para recordarles solamente comento que un nicho epidemiologico de peste no se activa en forma individual, cuando un nicho esta activo ya deben estar tamabien las otras zonas infestadas con roedores infectados, pero resistentes a la enfermedad. Como me decia mi maestro el Dr. Nicho en los anos 90 , "...si la peste nos sigue significa que no hemos podido investigar apropiadamente los brotes..."

El 20 de julio de 2010 20:16, Máximo Cuadros <maximocuadros@yahoo.es> escribió:


La Peste Bubónica

Principal Salud a tu alcance

¿Qué es la peste bubónica?

Es una enfermedad infecciosa aguda, causada por la bacteria Yersinia Pestis. Estas bacterias se encuentran en los roedores salvajes pequeños y en sus pulgas.

¿Cómo se transmite?

La enfermedad puede transmitirse a los seres humanos mediante la mordedura de las pulgas infectadas, la mordedura directa de los roedores o a través del contacto directo con los tejidos de los animales infectados.

También puede ser transmitida mediante aerosoles, inhalación de la bacteria (bioterrorismo). Es posible la transmisión de persona a persona.

¿Cúales son los síntomas?

  • Escalofríos.
  • Fiebre.
  • Inflamaciones en los ganglios - bubones (adenopatías).

Si la enfermedad fue transmitida por inhalación, se denomina peste neumónica, ya que se infecta a los pulmones; en este caso, los primeros signos de la enfermedad son fiebre, dolor de cabeza, debilidad, tos productiva.

¿Qué tan pronto aparecen los síntomas?

Si la enfermedad fue transmitida por las pulgas, los síntomas aparecen dos a ocho días después.

Si la enfermedad fue transmitida por inhalación, los síntomas aparecen uno a tres días después.


De: Máximo Cuadros <maximocuadros@yahoo.es>
Para: interno_residente_medico_PERU@yahoogroups.com
Enviado: mar,20 julio, 2010 19:42
Asunto: Brote de Peste Neumónica

Alerta para los que nos exponemos en EMG
ya que hay peligro de muerte

----- Mensaje reenviado ----
De: CLODOALDO NESTOR BARREDA DOMINGUEZ <clodobarreda@hotmail.com>
Para: maximocuadros@yahoo.es
Enviado: mar,20 julio, 2010 16:23
Asunto: Brote de Peste Neumónica

Estimados Colegas:


Cumplimos en remitir adjunto la ALERTA EPIDEMIOLÓGICA Nº 07 - enviado por el MINSA sobre el  Brote de peste en la Provincia Ascope , Departamento La Libertad , año 2010, emitida el 16 de Julio, con las recomendaciones a los servicios de salud respecto a la necesidad de fortalecimiento de las acciones de vigilancia epidemiológica frente a los casos de peste presentados en Ascope – La Libertad , para su conocimiento y difusión. Asimismo se adjunta el Protocolo de Vigilancia de Peste.


Favor recomendar a los médicos a su cargo el tener en cuenta entre su diagnostico diferencial la posibilidad de peste,  para tomar todas las precauciones de tratamiento y protección del personal, con respiradores N95 y aislamiento respiratorio. Así mismo deben notificar todo caso sospechoso.


El medico y la interna de medicina que atendieron el primer caso fallecieron.



Dr. Clodoaldo Barreda D.

Medico Jefe del DECC


Critical Care Medicine August 2010 - Volume 38 - Issue 8


Critical Care Medicine August 2010 - Volume 38 - Issue 8

Critical Care Medicine August 2010 - Volume 38 - Issue 8

Feature Articles

A history of resolving conflicts over end-of-life care in intensive care units in the United States *
Luce, John M.
Critical Care Medicine. 38(8):1623-1629, August 2010.

Phase II trial on the use of Dextran 70 or starch for supportive therapy in Kenyan children with severe malaria *
Akech, Samuel O.; Jemutai, Julie; Timbwa, Molline; Kivaya, Esther; Boga, Mwanamvua; Fegan, Greg; Maitland, Kathryn
Critical Care Medicine. 38(8):1630-1636, August 2010.

Cold aortic flush and chest compressions enable good neurologic outcome after 15 mins of ventricular fibrillation in cardiac arrest in pigs *
Janata, Andreas; Weihs, Wolfgang; Schratter, Alexandra; Bayegan, Keywan; Holzer, Michael; Frossard, Martin; Sipos, Wolfgang; Springler, Gregor; Schmidt, Peter; Sterz, Fritz; Losert, Udo M.; Laggner, Anton N.; Kochanek, Patrick M.; Behringer, Wilhelm
Critical Care Medicine. 38(8):1637-1643, August 2010.

Continuing Medical Education Articles

Therapeutic strategies for severe acute lung injury
Diaz, Janet V.; Brower, Roy; Calfee, Carolyn S.; Matthay, Michael A.
Critical Care Medicine. 38(8):1644-1650, August 2010.

A survival benefit of combination antibiotic therapy for serious infections associated with sepsis and septic shock is contingent only on the risk of death: A meta-analytic/meta-regression study
Kumar, Anand; Safdar, Nasia; Kethireddy, Shravan; Chateau, Dan
Critical Care Medicine. 38(8):1651-1664, August 2010.

Continuing Medical Education Questions
Critical Care Medicine. 38(8):1665, August 2010.

Clinical Investigations

Is heart period variability associated with the administration of lifesaving interventions in individual prehospital trauma patients with normal standard vital signs? *
Rickards, Caroline A.; Ryan, Kathy L.; Ludwig, David A.; Convertino, Victor A.
Critical Care Medicine. 38(8):1666-1673, August 2010.

Validity and reliability of an intuitive conscious sedation scoring tool: The nursing instrument for the communication of sedation *
Mirski, Marek A.; LeDroux, Shannon N.; Lewin, John J. III; Thompson, Carol B.; Mirski, Kara T.; Griswold, Michael
Critical Care Medicine. 38(8):1674-1684, August 2010.

A randomized, double-blind, placebo-controlled trial of TAK-242 for the treatment of severe sepsis *
Rice, Todd W.; Wheeler, Arthur P.; Bernard, Gordon R.; Vincent, Jean-Louis; Angus, Derek C.; Aikawa, Naoki; Demeyer, Ignace; Sainati, Stephen; Amlot, Nicholas; Cao, Charlie; Ii, Masayuki; Matsuda, Hideyasu; Mouri, Kouji; Cohen, Jon
Critical Care Medicine. 38(8):1685-1694, August 2010.

Acute renal failure is NOT an "acute renal success"-a clinical study on the renal oxygen supply/demand relationship in acute kidney injury
Redfors, Bengt; Bragadottir, Gudrun; Sellgren, Johan; Swärd, Kristina; Ricksten, Sven-Erik
Critical Care Medicine. 38(8):1695-1701, August 2010.

Laboratory Investigations

Patients with acute pancreatitis complicated by organ failure show highly aberrant monocyte signaling profiles assessed by phospho-specific flow cytometry *
Oiva, Jani; Mustonen, Harri; Kylänpää, Marja-Leena; Kyhälä, Lea; Alanärä, Tiina; Aittomäki, Saara; Siitonen, Sanna; Kemppainen, Esko; Puolakkainen, Pauli; Repo, Heikki
Critical Care Medicine. 38(8):1702-1708, August 2010.

Quantitative assessment of somatosensory-evoked potentials after cardiac arrest in rats: Prognostication of functional outcomes *
Madhok, Jai; Maybhate, Anil; Xiong, Wei; Koenig, Matthew A.; Geocadin, Romergryko G.; Jia, Xiaofeng; Thakor, Nitish V.
Critical Care Medicine. 38(8):1709-1717, August 2010.

Role of regulatory T cells in long-term immune dysfunction associated with severe sepsis
Nascimento, Daniele C.; Alves-Filho, José C.; Sônego, Fabiane; Fukada, Sandra Y.; Pereira, Marcelo S.; Benjamim, Claudia; Zamboni, Dario S.; Silva, João S.; Cunha, Fernando Q.
Critical Care Medicine. 38(8):1718-1725, August 2010.

Cerebral effects of hyperglycemia in experimental cardiac arrest
Lennmyr, Fredrik; Molnar, Maria; Basu, Samar; Wiklund, Lars
Critical Care Medicine. 38(8):1726-1732, August 2010.

Bone marrow-derived mononuclear cell therapy in experimental pulmonary and extrapulmonary acute lung injury
Araújo, Indianara M.; Abreu, Soraia C.; Maron-Gutierrez, Tatiana; Cruz, Fernanda; Fujisaki, Livia; Carreira, Humberto Jr; Ornellas, Felipe; Ornellas, Debora; Vieira-de-Abreu, Adriana; Castro-Faria-Neto, Hugo C.; Muxfeldt Ab'Saber, Alexandre; Teodoro, Walcy R.; Diaz, Bruno L.; Peres DaCosta, Carlos; Capelozzi, Vera L.; Pelosi, Paolo; Morales, Marcelo M.; Rocco, Patricia R. M.
Critical Care Medicine. 38(8):1733-1741, August 2010.


Futility in the intensive care unit: Hard cases make bad law *
Curtis, J. Randall; Burt, Robert A.
Critical Care Medicine. 38(8):1742-1743, August 2010.

Severe malaria and sepsis: Will one fluid strategy suit both? *
Molyneux, Elizabeth
Critical Care Medicine. 38(8):1744-1745, August 2010.

This is cool! Hypothermia, chest compressions, and ventilation can be accomplished in a large animal cardiac arrest model: Paving the way to human clinical trials *
Helfaer, Mark A.; Topjian, Alexis
Critical Care Medicine. 38(8):1745-1746, August 2010.

Half empty or half full? *
Batchinsky, Andriy I.; Cancio, Leopoldo C.; Buchman, Timothy G.
Critical Care Medicine. 38(8):1747-1748, August 2010.

Communication of sedation in the intensive care unit: Is it the real issue? *
Ramelet, Anne-Sylvie
Critical Care Medicine. 38(8):1748-1749, August 2010.

Biomarkers as end points in clinical trials of severe sepsis: A garden of forking paths *
Salluh, Jorge I. F.; Póvoa, Pedro
Critical Care Medicine. 38(8):1749-1751, August 2010.

Once bitten, twice shy: Defective monocyte signaling in acute pancreatitis *
McGregor, Richard J.; Mole, Damian J.
Critical Care Medicine. 38(8):1751-1752, August 2010.

Promising prognostic potentials: Perhaps *
Young, G. Bryan
Critical Care Medicine. 38(8):1753, August 2010.

Letters to the Editor

Vancomycin plus rifampicin for methicillin-resistant Staphylococcus aureus pneumonia benefits only those who have no development of rifampicin resistance during treatment
Tan, Che-Kim; Lai, Chih-Cheng; Lin, Sheng-Hsiang; Hsueh, Po-Ren
Critical Care Medicine. 38(8):1754, August 2010.

Vancomycin plus rifampicin for methicillin-resistant Staphylococcus aureus pneumonia benefits only those who have no development of rifampicin resistance during treatment
Lim, Chae-Man; Jung, Young Ju
Critical Care Medicine. 38(8):1754-1755, August 2010.

Financial disclosures in clinical practice guidelines
Kahn, Jeremy M.; Rubenfeld, Gordon D.
Critical Care Medicine. 38(8):1755-1756, August 2010.

Response from the Editor-in-Chief of Critical Care Medicine
Parrillo, Joseph E.
Critical Care Medicine. 38(8):1756-1757, August 2010.

Predicting dead space ventilation in critically ill patients using clinically available data
Sue, Darryl Y.
Critical Care Medicine. 38(8):1757, August 2010.

Lazarus phenomenon, autoresuscitation, and nonheart-beating organ donation
Rady, Mohamed Y.; Verheijde, Joseph L.
Critical Care Medicine. 38(8):1757-1758, August 2010.
doi: 10.1097/CCM.0b013e3181defd10
+ Favorites
PDF (365 KB)

Lazarus phenomenon, autoresuscitation, and nonheart-beating organ donation
Shemie, Sam D.; Hornby, Karen; Hornby, Laura
Critical Care Medicine. 38(8):1758-1759, August 2010.

Is passive leg raising safe in mechanically ventilated patients receiving enteral nutrition?
Nseir, Saad; Lubret, Rémy
Critical Care Medicine. 38(8):1759, August 2010.

Mechanical ventilation can cause changes in pulmonary circulation
Ñamendys-Silva, Silvio A.; Domínguez-Cherit, Guillermo
Critical Care Medicine. 38(8):1759-1760, August 2010.

Breathing requirement and metabolic rate during cardiopulmonary resuscitation: Cardiac arrest during exercise
Tiangco, Dexter; Haouzi, Philippe
Critical Care Medicine. 38(8):1760-1761, August 2010.

Defining death in donation after circulatory determination of death protocols: A bluish shade of violet
Zamperetti, Nereo
Critical Care Medicine. 38(8):1761, August 2010.

Defining death in donation after circulatory determination of death protocols: A bluish shade of violet
Bernat, James L.; Capron, Alexander M.
Critical Care Medicine. 38(8):1761-1762, August 2010.
doi: 10.1097/CCM.0b013e3181e285cb


martes, 13 de julio de 2010

Pancreatic Cancer 2008 Edition


Since the previous M.D. Anderson Solid Tumor Oncology Series publication on pancreatic cancer, there have been major advances in our understanding of molecular events which underlie pancreatic cancer development, both in the sporadic and inherited forms. We have seen the development of the first mouse models that accurately recapitulate features of the human disease. Several landmark clinical trials in both resectable and metastatic pancreatic cancer have been completed, raising new questions about the standard of care in this disease. Finally, the era of targeted biologic therapies has engendered new excitement about the prospects of more rapid progress in understanding and successfully treating this dreadful disease. Therefore, it is an appropriate time to review these important advances and outline areas of controversy and question in pancreatic cancer biology and treatment.




lunes, 12 de julio de 2010



Publicado por Claudio Mori Gonzales para Casimiro Ulloa el 7/12/2010 11:24:00 PM

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