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farmácia

#Review supports #botox as #treatment for#chronic migraine

Postado em

  •  Noticias Médicas Univadis

A new analysis, which investigated the effect of botulinum toxin type A in reducing the frequency of migraine headaches, has found that not only is it superior to placebo for reducing migraine, but also for the first time, has shown that it may also lead to improvements in quality of life.

Researchers analysed data from 17 studies including a total of 3,646 patients that compared patients receiving botulinum toxin versus placebo injections into head and neck muscles as a preventive treatment for migraine.

They identified a significant reduction in the frequency of chronic migraines with botulinum toxin at three months, with a mean difference in change in migraine frequency per month of -1.56 (95% CI -3.05 to -0.07; P=.04).  There was also a tendency toward a reduction in the frequency of episodic migraine.

Secondary analysis also identified a significant reduction in the frequency of chronic migraines with botulinum toxin type A at two months. There was also a significant improvement in patients’ quality of life at month three in the botulinum toxin type A group (P<.00001).

Presenting the findings in Plastic and Reconstructive Surgery, the authors concluded: “Botulinum toxin type A is a safe and well-tolerated treatment that should be offered to patients with migraine.”

Anúncios

#Una sustancia llamada#EHT podría ayudar a explicar por qué el #café parece proteger frente el #Parkinson (PNAS)

Postado em

  • Noticias Médicas

Algunos estudios han sugerido que el café protege el cerebro frente la enfermedad de Parkinson. Un estudio reciente investiga qué compuestos podrían otorgar al café estos efectos neuroprotectores.

Aunque la cafeína parece desempeñar un papel en dicha neuroprotección, otras moléculas también podrían estar involucradas. En algunos estudios, por ejemplo, se ha visto el café descafeinado también ofrecía protección contra la neurodegeneración en un modelo de enfermedad de Parkinson.

En la búsqueda de componentes del café que podrían ayudar a retrasar la progresión de la enfermedad, investigadores del Rutgers Robert Wood Johnson Medical School Institute for Neurological Therapeutics(Estados Unidos) se centraron recientemente en un compuesto llamado eicosanoil-5-hidroxitriptamida (EHT). En Proceedings of the National Academy of Sciences Explican que se trata de un derivado de los ácidos grasos de la serotonina que se encuentra en la capa cerosa de los granos de café. No está relacionado con la cafeína, y estudios previos han demostrado que tiene propiedades neuroprotectoras y antiinflamatorias.

En particular, los investigadores querían entender si la cafeína y el EHT podrían trabajar juntos para defenderse del Parkinson.

Para investigarlo, administraron a ratones dosis de cafeína o EHT. Algunos los recibieron por separado, otros los recibieron juntos. Luego evaluaron la capacidad de cada combinación para reducir la acumulación de alfa-sinucleína en el cerebro.

Encontraron que ninguno de los dos compuestos tuvo un efecto beneficioso cuando se administró solo. Sin embargo, cuando los ratones consumieron EHT y cafeína, hubo una reducción significativa en la acumulación de proteínas.

Los investigadores también demostraron que los ratones tratados con una combinación de las dos sustancias mostraron una mejor función en las pruebas de comportamiento.

“El EHT es un compuesto que se encuentra en varios tipos de café –explica M. Maral Mouradian, uno de los autores-, pero la cantidad varía. Es importante que se determine la cantidad y proporción apropiadas para que la gente no se sobrecafeine, ya que eso puede tener consecuencias negativas para la salud”.

Los autores también entienden que es probable que la búsqueda de compuestos activos en el café lleve algún tiempo. Debido a que el café es un cóctel tan complejo, los autores creen que “no es improbable que otros componentes del café también tengan un papel beneficioso”.

#Alerta hipertensão. Coma esta fruta e liberte-se da pressão alta

Postado em

Fonte de imagem: Wikipedia

Os casos de pressão alta estão a aumentar exponencialmente em todo o mundo. De forma a prevenir o aparecimento de sintomas e a reduzir o risco de hipertensão naturalmente, coma diariamente esta fruta tropical.

 

A hipertensão provoca inúmeros sintomas, incluindo visão turva e dores de cabeça, afetando um em cada quatro portugueses.

O fenómeno é extremamente preocupante, sobretudo porque aumenta a probabilidade dos pacientes experienciarem ataques cardíacos ou enfartes.

De modo a diminuir o risco, é aconselhável que siga um regime alimentar saudável e equilibrado.

O que deve comer para reduzir a pressão alta?

O Sistema Nacional de Saúde britânico (NHS) recomenda o consumo de uma dieta saudável.

Referindo: “Reduza substancialmente a quantidade de sal que coloca nos cozinhados e coma muita fruta e vegetais”.

Apesar de seguir essas recomendações ser por vezes suficiente para diminuir a tensão arterial naturalmente, existem certos alimentos que são considerados mais benéficos do que outros.

Em declarações ao The Guardian, o médico David Williams revelou recentemente que recomenda aos seus pacientes o consumo específico de uma fruta.

O clínico acredita que comer goiaba diariamente pode reduzir a pressão alta até cerca de 8mmHg.

“Se sofre de hipertensão, a dieta é um das principais maneiras de reduzir esses índices sem o recurso à toma de medicação”.

“Em combinação com certas alterações no estilo de vida e na nutrição, alterar a dieta pode não só reduzir os níveis da tensão, mas contribuir ainda para melhorar a saúde cardiovascular no geral”.

Goiaba

A dita fruta apresenta um baixo teor de sódio e alto teor de potássio, ajudando a controlar a pressão arterial.

#Metformin use in #overweight or #obese pregnant women failed to improve birth outcomes

Postado em

  • The Lancet Diabetology

Background

Maternal overweight and obesity are associated with well recognised pregnancy complications. Antenatal dietary and lifestyle interventions have a modest effect on gestational weight gain without affecting pregnancy outcomes. We aimed to assess the effects on maternal and infant outcomes of antenatal metformin given in addition to dietary and lifestyle advice among overweight and obese pregnant women.

Methods

GRoW was a multicentre, randomised, double-blind, placebo-controlled trial in which pregnant women at 10–20 weeks’ gestation with a BMI of 25 kg/m² or higher were recruited from three public maternity units in Adelaide, SA, Australia. Women were randomly assigned (1:1) via a computer-generated schedule to receive either metformin (to a maximum dose of 2000 mg per day) or matching placebo. Participants, their antenatal care providers, and research staff (including outcome assessors) were masked to treatment allocation. All women received an antenatal dietary and lifestyle intervention. The primary outcome was the proportion of infants with birthweight greater than 4000 g. Secondary outcomes included measures of maternal weight gain, maternal diet and physical activity, maternal pregnancy and birth outcomes, maternal quality of life and emotional wellbeing, and infant birth outcomes. Outcomes were analysed on an intention-to-treat basis (including all randomly assigned women who did not withdraw consent to use their data, and who did not have a miscarriage or termination of pregnancy before 20 weeks’ gestation, or a stillbirth). The trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12612001277831.

Findings

Of 524 women who were randomly assigned between May, 28 2013 and April 26, 2016, 514 were included in outcome analyses (256 in the metformin group and 258 in the placebo group). Median gestational age at trial entry was 16.29 weeks (IQR 14.43–18.00) and median BMI was 32.32 kg/m² (28.90–37.10); 167 (32%) participants were overweight and 347 (68%) were obese. There was no significant difference in the proportion of infants with birthweight greater than 4000 g (40 [16%] with metformin vs 37 [14%] with placebo; adjusted risk ratio [aRR] 0.97, 95% CI 0.65 to 1.47; p=0.899). Women receiving metformin had lower average weekly gestational weight gain (adjusted mean difference –0.08 kg, 95% CI –0.14 to –0.02; p=0.007) and were more likely to have gestational weight gain below recommendations (aRR 1.46, 95% CI 1.10 to 1.94; p=0.008). Total gestational weight gain, pregnancy and birth outcomes, maternal diet and physical activity, and maternal quality of life and emotional wellbeing did not differ significantly between groups. Similar numbers of women in both treatment groups (76% [159/208] in the metformin group and 73% [144/196] in the placebo group) reported side-effects including nausea, diarrhoea, and vomiting. Two stillbirths (placebo group) and one neonatal death (metformin group) occurred; none of the perinatal deaths were determined to be attributable to participation in the trial.

Interpretation

For pregnant women who are overweight or obese, metformin given in addition to dietary and lifestyle advice initiated at 10–20 weeks’ gestation does not improve pregnancy and birth outcomes.

Funding

Australian National Health and Medical Research Council.

How often are #e-prescribing drug warnings inaccurate?

Postado em

  • Noticias Médicas Univadis

New research suggests that prescribers may be receiving incorrect prescribing warnings on electronic prescribing systems.

The survey of members of the American Society of Clinical Psychopharmacology (ASCP) found that a substantial proportion of prescribing clinicians reported receiving inaccurate warnings. Warnings that did not reflect product labelling information for example, regarding maximum dose or contraindications, were particularly problematic.

Among those who electronically prescribed, 83.1 per cent received automated warnings at the time of prescribing. Among these individuals, one-third believed the system provided incorrect information, and one-third of this group believed warnings were inaccurate at least half of the time.

Types of information that clinicians considered inaccurate were dosing range (54.2% of respondents), drug interactions (50.0%), contraindications (41.7%), dosing frequency (37.5%), dosing time (12.5%), indications (12.5%) and other (8.5%).

Among respondents who perceived some warnings to be inaccurate, 95.8 per cent stated that their system allows them to explain their rationale for prescribing or to override the warning. However, a majority reported being unable to alert the system that the prescribing warning was incorrect.

It should be noted that only 118 ASCP members from 33 US States completed the survey (9.6% response rate) and the accuracy or inaccuracy of the alerts was not assessed.

#Contracepção e #gravidez em adolescentes

Postado em

Por Sharon Levy, MD, MPH, Assistant Professor of Pediatrics, Harvard Medical School; Director, Adolescent Substance Abuse Program, Boston Children’s Hospital

Muitos adolescentes participam de atividades sexuais, mas podem não ter sido plenamente informados sobre contracepção, gravidez e doenças sexualmente transmissíveis, incluindo a infecção pelo vírus da imunodeficiência humana (HIV). Impulsividade, falta de planejamento e uso concomitante de drogas e álcool diminuem a probabilidade de que os adolescentes usem métodos contraceptivos e métodos de proteção de barreira (como preservativos).

Contracepção

Qualquer um dos métodos contraceptivos adultos pode ser usado por adolescentes, mas o problema mais comum diz respeito ao cumprimento. Muitas meninas adolescentes, por exemplo, se esquecem de tomar o contraceptivo oral diariamente ou param completamente de tomá-lo, frequentemente sem substituí-lo por outra forma de método contraceptivo. Ainda que preservativos masculinos sejam a forma mais frequentemente usada de contracepção, ainda há percepções que podem inibir o uso consistente (ideias, por exemplo, de que o preservativo diminui o prazer o interfere no “amor romântico”). Algumas meninas também se sentem envergonhadas em pedir ao parceiro para usar preservativos durante o sexo. Recentemente, a utilização de métodos contraceptivos de longo prazo, como injeções mensais, se tornou mais comum entre meninas adolescentes.

Gravidez

A gravidez também pode ser uma fonte significativa de estresse para os adolescentes.

Adolescentes grávidas e seus parceiros tendem a abandonar a escola ou o estágio, piorando assim sua situação econômica, baixando sua autoestima e sobrecarregando os relacionamentos pessoais. Adolescentes grávidas (que somam 13% de todos os casos de gravidez nos Estados Unidos) têm menor propensão do que as adultas a obter cuidados pré-natais, o que resulta em gravidez com resultados desfavoráveis, como elevadas taxas de nascimento prematuro. Adolescentes grávidas, particularmente as que são bastante jovens e aquelas que não estão recebendo acompanhamento pré-natal, têm mais probabilidade de ter problemas médicos, como anemia (quando o organismo não tem uma quantidade suficiente de glóbulos vermelhos saudáveis) e pré-eclâmpsia (hipertensão arterial e proteína na urina que pode causar prejudicar o feto) que as mulheres na faixa dos vinte anos.

Bebês de mães jovens (especialmente mães com menos de 15 anos de idade) são mais propensos a nascer prematuramente e ter baixo peso no nascimento. Contudo, com cuidados pré-natais adequados, adolescentes com mais idade não correm risco mais elevado de problemas de gravidez do que adultas com antecedentes semelhantes.

A adolescente pode decidir dar fim à gravidez. Fazer um aborto não elimina os problemas psicológicos de uma gravidez indesejada – nem para a adolescente, nem para o seu parceiro. Crises emocionais podem ocorrer:

  • Quando a gravidez é diagnosticada

  • Quando a decisão de fazer o aborto é tomada

  • Imediatamente depois que o aborto é realizado

  • Na época em que o bebê deveria ter nascido

  • Nos aniversários daquela data

Uma adolescente grávida pode optar por desistir da criança voluntariamente (adoção) ou criar a criança por si própria ou com o pai da criança, geralmente com o apoio de membros da família.

Todas as opções causam estresse emocional. Aconselhamento familiar e informações sobre métodos contraceptivos, tanto para a menina quanto para o seu parceiro, podem ser muito úteis.

Os pais podem ter reações diferentes quando sua filha diz que está grávida ou seu filho diz que engravidou alguém. As emoções podem variar, indo desde apatia a decepção até raiva. É importante que os pais expressem seu apoio e disposição para ajudar a adolescente a ponderar suas escolhas. Os pais e adolescentes precisam se comunicar abertamente sobre aborto, adoção e paternidade — todas elas opções difíceis demais para o a adolescente encarar sozinho.

#Dietary Supplements Don’t Prevent #Chronic Disease

Postado em

Diana Swift

As the US nutritional and dietary supplements market remains robust — an estimated $41.1 billion in sales in 2016 — the Academy of Nutrition and Dietetics is cautioning against the routine and indiscriminate use of these dietary add-ons.

In an updated position paper, published online November 20 in the Journal of the Academy of Nutrition and Dietetics, the academy states that while single- and multiple-vitamin and mineral supplements may benefit the many Americans whose diets are lacking in micronutrients, there is no scientific evidence to warrant their regular use for preventing chronic disease in healthy individuals.

This conclusion is based on evidence reviews by a number of bodies, including the National Institutes of Health, the Agency for Healthcare Research and Quality (AHRQ), and the US Preventive Services Task Force (USPSTF).

“Those with increased requirements secondary to growth, chronic disease, medication use, malabsorption, pregnancy and lactation, and aging may be at particular risk for inadequate dietary intakes,” write Melissa Ventura Marra, PhD, an assistant professor of human nutrition and foods at West Virginia University in Morgantown, West Virginia, and Regan Bailey, PhD, MPH, an associate professor of nutrition science at Purdue University in West Lafayette, Indiana.

About a third of US adults use a multivitamin-mineral supplement, the authors note. Prudently used, supplements may help close gaps in deficient diets; a previous analysis of data from the National Health and Nutrition Examination Survey show 25% to 70% Americans have low dietary intake of calcium, magnesium, and vitamins A, C, D, and E.

Micronutrient supplements may specifically benefit women intending to conceive or already pregnant, babies primarily breast-fed, alcohol-dependent individuals, and those with age-related macular degeneration, according to the AHRQ statement.

Haphazard use of supplements, however, may raise consumption of certain micronutrients above the tolerable upper intake levels (ULs), thereby posing health risks such as adverse interactions with medications and inhibition of other essential micronutrients. Although most adult users do not exceed ULs, the authors warn some may unwittingly consume excessive amounts of iron (9%), zinc (9%), folic acid (7%), calcium (6%), magnesium (6%), vitamin B6 (3.5%), vitamin A (3%), and vitamin C (1.6%).

“Consumers may not be well informed about the safety and use of these products, and some may have difficulty interpreting product labels,” the authors write.

They stress that care providers offering nutritional advice should keep up to date on the efficacy and safety of these products, as well as on regulatory issues about their use. The paper gives a comprehensive list of authoritative resources for potential contraindications and drug and food interactions, including the AHRQ, the Cochrane Collaboration, the US Food and Drug Administration, the Office of Dietary Supplements, and the National Academy of Medicine.

The position paper supports the following recommendations on specific micronutrient supplements:

  • 400 IU/day vitamin D for mainly breast-fed infants
  • 400 to 800 µg/day folic acid (if not consumed in fortified foods) for women planning pregnancy
  • antioxidant supplements for those with intermediate or advanced age-related macular degeneration
  • 2.4 mg/day vitamin B12 from supplements or fortified foods for those age 50 and older

The authors also provide specific caveats on the use of supplements:

  • Iron supplements should be avoided by postmenopausal women and men and individuals homozygous for hemochromatosis.
  • Postmenopausal women should avoid retinol supplements, which have been linked to reduced bone mineral density and increased hip fracture risk.
  • High supplemental intakes of vitamin B6 have been tied to sensory neuropathy.
  • High-dose iron pills can decrease zinc absorption, while zinc can impede copper absorption. Calcium supplements inhibit both heme and nonheme iron absorption.
  • High-doses can adversely affect medications; for instance, vitamins E and K can interfere with anticoagulants such as Coumadin.
  • High-dose beta-carotene may raise lung cancer risk in smokers.
  • The USPSTF found insufficient evidence to support commonly prescribed calcium and vitamin D supplements for reducing fracture risk in postmenopausal women and suggested these may boost kidney stone risk.

Earlier this year, Medscape Medical News reported on a meta-analysis that found no scientific evidence that multivitamin and mineral supplements reduce the risk of cardiovascular events.

For patients who want to take supplements, Ventura Marra said that a one-a-day multivitamin and mineral supplement that provides close to 100% of the recommended daily value for most nutrients can help prevent inadequacies and is generally safe for healthy individuals. “Ironically, most patients taking a multivitamin supplement aren’t the ones who generally need them most,” she told Medscape Medical News.

By contrast, consuming single vitamins and minerals is generally not advisable unless a specific nutrient deficiency is being treated, Ventura Marra continued.

“When making recommendations to patients, we need to consider individual factors like the overall quality of the diet, health conditions, and medication use,” she said. “Patients following low-calorie diets, who limit certain foods, or have health conditions that interfere with nutrient absorption or use may especially benefit from micronutrient supplementation.”

She stresses that supplementation should not be viewed as a replacement for a healthy diet. “There are many nutrients like dietary fiber or phytochemicals that benefit health that they don’t provide,” she said. Instead, she recommends prescribing the addition of more nutrient-rich foods to patients’ diets to help meet shortfalls.

This position paper received no funding support. Bailey has been a scientific consultant to the National Institutes of Health, Office of Dietary Supplements, and has reported travel support from the Council of Responsible Nutrition. Ventura Marra has disclosed no relevant financial relationships.

J Acad Nutr Diet. 2018;118:2162-2173.

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