octubre 2015 Archivos

In their review on invasive candidiasis, Kullberg and Arendrup (Oct. 8 issue) raise the question of what is the most appropriate initial antifungal therapy for patients who have previously been exposed to echinocandins for prolonged periods. The authors state that triazoles may be the preferred agent in such cases. Recent epidemiologic data show a shift in the distribution of candida species, with a significant increase in Candida glabrata, a species that is more likely to be resistant to azoles and the most common species resistant to fluconazole. Furthermore, prior exposure to echinocandins has also been shown to promote not only resistance to these agents but also multidrug resistance, defined as candida resistant to fluconazole and one or more echinocandins. Thus, for patients with previous antifungal selection pressure, triazoles may not be the most appropriate first-line treatment. Liposomal amphotericin B, which has a broad spectrum of activity, may be a better choice as an empirical therapy in this clinical setting.

Frederic M. Jacobs, M.D.
Hôpital Antoine-Béclère, Clamart, France

Citado: Kullberg BJ, Arendrup MC. Invasive Candidiasis. N Engl J Med [Internet]. 2016 [citado 7 Nov 2017];374(8).

Chronic obstructive pulmonary disease (COPD) is a heterogeneous syndrome defined by the presence of chronic airflow limitation and associated with other clinical and pathological hallmarks, such as chronic bronchitis, emphysema, exacerbations, and comorbidities. COPD is a complex disease, suggesting that both genetic susceptibility and environmental exposures (eg, cigarette smoking and smoke from biomass fuels) contribute to its pathogenesis (figure). In The Lancet Respiratory Medicine, Louise Wain and colleagues report intriguing novel insights into the genetics of smoking behaviour and the airflow obstruction component of COPD.

Citado: Brusselle GG, Bracke KR. Elucidating COPD pathogenesis by large-scale genetic analyses. Lancet Respir Med [Internet]. 2015 [citado 7 Nov 2017];3(10).

647562152Miércoles, 7 de octubre de 2015 (HealthDay News) — Muchos adolescentes estadounidenses envían y reciben mensajes de texto en la cama, lo que lleva a perder horas de sueño, a la somnolencia diurna y un peor rendimiento escolar, según un nuevo estudio.

Unos investigadores de Nueva Jersey observaron a casi 3,200 estudiantes de escuela intermedia y secundaria del estado. Hallaron que casi el 62 por ciento de los niños usaron sus smartphones de alguna forma después de la hora de acostarse; casi el 57 por ciento enviaron o recibieron mensajes de texto, tweets e intercambiaron mensajes cuando estaban en la cama, y casi el 21 por ciento se despertaron por los mensajes de texto.

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