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Invasive Candidiasis

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).

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Elucidating COPD pathogenesis by large-scale genetic analyses

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).

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Enviar y recibir mensajes de texto a la hora de acostarse podría ser peligroso para la salud de los adolescentes

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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Redefining Blood-Pressure Targets — SPRINT Starts the Marathon

Blood pressure is a potent determinant of cardiovascular risk, but the most appropriate targets for blood-pressure lowering have long been debated. Observational studies with a low risk of confounding have shown a linear relationship between blood pressure and cardiovascular risk down to 115/75 mm Hg, but some observational studies with a greater potential for confounding, involving persons at increased risk, have suggested a J-shaped curve — that is, below a given blood pressure, risk would increase. When trials of blood-pressure–lowering drugs have shown benefits in patients without hypertension, these effects have often been ascribed to alternative mechanisms. The widespread uncertainty about blood-pressure targets was increased when the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial showed no significant overall difference in cardiovascular events between patients with type 2 diabetes assigned to a systolic blood-pressure target of less than 120 mm Hg and those assigned to a target of less than 140 mm Hg.

Citado: Perkovic V, Rodgers A. Redefining Blood-Pressure Targets–SPRINT Starts the Marathon. N Engl J Med [Internet]. 2015 [citado 7 Nov 2017];373(22).

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A Randomized Trial of Intensive versus Standard Blood-Pressure Control

Abstract: The most appropriate targets for systolic blood pressure to reduce cardiovascular morbidity and mortality among persons without diabetes remain uncertain.We randomly assigned 9361 persons with a systolic blood pressure of 130 mm Hg or higher and an increased cardiovascular risk, but without diabetes, to a systolic blood-pressure target of less than 120 mm Hg (intensive treatment) or a target of less than 140 mm Hg (standard treatment). The primary composite outcome was myocardial infarction, other acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes. Leer más…

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Treatment of Tuberculosis

Tuberculosis, a scourge since prehistoric times, affects more than 9 million people and causes the death of 1.5 million people each year. Effective treatment has been available for 60 years, but such treatment takes at least 6 months, and resistance to the drugs, which is increasing throughout the world, threatens the effectiveness of treatment. This review summarizes the theoretical principles of tuberculosis treatment, current therapeutic approaches, areas of uncertainty, and persistent challenges.

Citado: Horsburgh CR Jr, Barry CE 3rd, Lange C. Treatment of Tuberculosis. N Engl J Med. 2015 Nov 26;373(22)

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Isosorbide Mononitrate in Heart Failure with Preserved Ejection Fraction

Abstract: Nitrates are commonly prescribed to enhance activity tolerance in patients with heart failure and a preserved ejection fraction. We compared the effect of isosorbide mononitrate or placebo on daily activity in such patients. METHODS: In this multicenter, double-blind, crossover study, 110 patients with heart failure and a preserved ejection fraction were randomly assigned to a 6-week dose-escalation regimen of isosorbide mononitrate (from 30 mg to 60 mg to 120 mg once daily) or placebo, with subsequent crossover to the other group for 6 weeks. The primary end point was the daily activity level, quantified as the average daily accelerometer units during the 120-mg phase, as assessed by patient-worn accelerometers. Secondary end points included hours of activity per day during the 120-mg phase, daily accelerometer units during all three dose regimens, quality-of-life scores, 6-minute walk distance, and levels of N-terminal pro–brain natriuretic peptide (NT-proBNP). Leer más…

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