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La enfermedad del hígado graso es la enfermedad hepática más común en el mundo. Alrededor del 25% de los adultos en los Estados Unidos tienen hígado graso en ausencia de un consumo excesivo de alcohol, una afección llamada enfermedad del hígado graso no alcohólico. Se presume que más de una cuarta parte de los adultos con hepatopatía grasa no alcohólica tienen esteatohepatitis no alcohólica debido a niveles elevados de aminotransferasa sérica y ausencia de otras causas identificables de daño hepático.

Diehl AM, Day C. Cause, Pathogenesis, and Treatment of Nonalcoholic Steatohepatitis. N Engl J Med [Internet]. 2017 [citado 15 Ene 2018];377(21).

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En esta revisión, discutimos los principios farmacológicos actuales de la terapia diurética, integramos datos de investigaciones recientes y sugerimos enfoques basados en la evidencia para el tratamiento diurético de la insuficiencia cardíaca. La mayoría de los tratamientos farmacológicos aceptados para la insuficiencia cardíaca están respaldados por la evidencia de grandes ensayos clínicos. Por el contrario, faltan generalmente pruebas de ensayos clínicos grandes y bien controlados para guiar el uso de diuréticos, entre los fármacos utilizados con más frecuencia en la insuficiencia cardíaca. La retención de líquidos y la congestión son características de la insuficiencia cardíaca y se asocian con síntomas graves y resultados deficientes. Dada la importancia de la congestión para los síntomas y los resultados, los diuréticos siguen siendo los pilares del tratamiento de la insuficiencia cardíaca.

Ellison DH, Felker GM. Diuretic Treatment in Heart Failure. N Engl J Med [Internet]. 2017 [citado 15 Ene 2018];377(20).

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Irritable bowel syndrome (IBS) is a common condition characterised by abdominal pain, bloating, and poor quality of life. IBS might be caused by a gut dysbiosis. We aimed to compare faecal microbiota transplantation (FMT) with placebo in patients with IBS. Methods: In this double-blind, randomised, placebo-controlled, parallel-group, single-centre study, we enrolled patients with IBS with diarrhoea or with diarrhoea and constipation (excluding dominating constipation) defined by the ROME III criteria, scored as moderate to severe according to the IBS severity scoring system (IBS-SSS; a score of ≥175). Eligible participants were aged 18–75 years and were recruited locally by general practitioners in northern Norway. We randomly assigned participants (2:1) in blocks of six to active or placebo FMT. Personnel not involved in the clinical performance of the trial generated the randomisation sequence using a randomisation website. Non-study personnel performed the final allocation and standardised the active and placebo transplants to make them identical in appearance and temperature. The faeces were freshly processed, and were used the same day (fresh transplant) or were stored in a freezer for later use (frozen transplant); participants’ own faeces served as placebo. A dose of 8 mg loperamide was administered orally 2 h before endoscopy to retain the transplant. The transplant (50–80 g of faeces mixed with 200 mL of isotonic saline and 50 mL of 85% glycerol) was administered by a colonoscope to the caecum. The primary endpoint was symptom relief of more than 75 points assessed by IBS-SSS, 3 months after FMT. The primary analysis was done in the modified intention-to-treat population, excluding participants who did not undergo treatment or who were diagnosed with any other disease by pinch biopsies obtained during the treatment procedure. For the safety analysis, only participants who did not undergo treatment were excluded. The study is registered with ClinicalTrials.gov, number NCT02154867. The trial has been extended with an open-labelled study treating the placebo group with frozen FMT for further exploratory studies.

Johnsen PH, Hilpüsch F, Cavanagh JP, Leikanger IS, Kolstad C, Valle PC, et al. Faecal microbiota transplantation versus placebo for moderate-to-severe irritable bowel syndrome: a double-blind, randomised, placebo-controlled, parallel-group, single-centre trial. Lancet Gastroenterol Hepatol [Internet]. 2018 [citado 13 Ene 2018];3(1).

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During the past 20 years, tremendous advances in methods involving polymerase-chain-reaction (PCR) assays and DNA sequencing have transformed clinical virology and microbiology laboratories. These new methods allow accurate and rapid diagnosis of a wide array of infectious diseases and facilitate the monitoring of responses to the treatment of infections, such as those caused by human immunodeficiency virus and cytomegalovirus. However, there remains an important gap in our diagnostic armamentarium: rapid, reliable, easy-to-use, inexpensive diagnostic tests that can be conducted at the point of care. For years there have been calls for these types of tests in areas with limited resources, but such tests may have importance across a wide range of settings, providing results that can affect clinical decisions in real time.

Citado: Caliendo AM, Hodinka RL. A CRISPR Way to Diagnose Infectious Diseases. N Engl J Med [Internet]. 2017 [citado 7 Nov 2017];377(17).

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Resumen: La hipertensión arterial es uno de los problemas de salud en nuestro país y de la medicina contemporánea, causante de infartos de miocardio, accidentes cerebrovasculares y alteraciones de la retina. Objetivo: describir los cambios del sistema vascular de la retina en pacientes con hipertensión arterial esencial leve y moderada a través de las alteraciones en el fondo del ojo, la respuesta de los tests electrofisiológicos y el comportamiento de la dinámica circulatoria por angiografía. Leer más…

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Resumen: Se examina si los polimorfismos rs180070 y rs2070011 del gen del fibrinógeno podrían afectar al riesgo de enfermedad coronaria de los pacientes hipertensos al modificar el proceso inflamatorio y la coagulación. Métodos. Se practicó una angiografía coronaria a causa de síntomas de angina estable a 744 participantes, de los que 332 tenían hipertensión. Leer más…

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