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REVISTA DERMATOLÓGICA MAYO 2003-2024
En este bloque de noticias de Mayo del 2003, no voy a hablar del tema, hoy 2024. Simplemente te podras dar cuenta si lees bien, lo que está ocurriendo hoy día después de la pandemia del Sars-Cov-2.
Mira el número de vacunas RECOMENDADAS para el año 2002, y averigua cuántas más han sido añadidas para el año 2024.
También encontraras, articulos interesantes sobre el NIMESULIDE, VARDENAFIL (LEVITRA), DUTASTERIDE, el SAW PALMETTO o SERENOA REPENS, TATUAJES y HEPATITIS C.
DERMAGIC EXPRESS REVISTA MEDICINA Y DERMATOLOGÍA AÑOS 2003-2004 ACTUALIZADO 2024.
Dr. José Lapenta.
ENGLISH
In this news block from May 2003, I am not going to talk about the topic today, 2024. You can simply see if you read carefully what is happening today after the Sars-Cov-2 pandemic.
Look at the number of RECOMMENDED vaccines for the year 2002, and find out how many more have been added for the year 2024.
You will also find interesting articles about NIMESULIDE, VARDENAFIL (LEVITRA), DUTASTERIDE, SAW PALMETTO or SERENOA REPENS, TATTOOS and HEPATITIS C.
DERMAGIC EXPRESS JOURNAL MEDICINA AND DERMATOLOGY YEARS 2003-2004 UPDATED 2024.
Greetings...
Dr. José Lapenta R.
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REFERENCIAS BIBLIOGRÁFICAS / BIBLIOGRAPHICAL REFERENCES
=====================================================================
1.) Recomendaciones sobre la aplicación de vacunas en niños.
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Traducción y Resumen por Aldo J. Barbero. Marzo 2002 (revisado Junio de 2002). Fundación Nuevo D.I.A. Caracas, Venezuela.
Source: http://www.automedusa.tripod.com/ Introducción. Actualmente se posee información, basada en estudios iniciales, de probables asociaciones entre las inmunizaciones aplicadas a los niños y el desarrollo de trastornos del neurodesarrollo como el autismo, déficit de atención y retardo en el lenguaje. Estas investigaciones han mostrado que los factores causales incluidos en las inmunizaciones pueden ser dos: 1.- El contenido de Timerosal, conservante de la mayoría de las vacunas, por su contenido de mercurio y, 2.- La inmunización en sí (es decir los virus contenidos en ellas), produciendo reacciones autoinmunes, específicamente reacciones a ciertas proteínas del tejido nervioso. Existe en la actualidad una fuerte controversia en torno a estos dos hallazgos, y si bien hay evidencias a favor, también existen evidencias en contra. Sin embargo, ciertas agencias de salud y particulares, han derivado una serie de recomendaciones sobre el esquema de inmunizaciones recomendable a la luz de los hallazgos positivos. Es importante hacer notar que la decisión sobre adoptar o no un patrón determinado de inmunizaciones deber ser el producto de una DECISION INFORMADA, es decir que conoce los basamentos producidos por la investigación a favor y en contra de las hipótesis antes mencionadas. Además de dar las recomendaciones, este pequeño artículo incluirá en su bibliografía, aquellas investigaciones que consideramos como importantes para hacer una decisión informada. I.- Recomendaciones del Comité de Seguridad de la Academia Nacional de Ciencias del Instituto de Medicina de los Estados Unidos de América. El comité concluye que aunque la hipótesis de la asociación de la exposición a vacunas con contenido de Timerosal y la producción de desórdenes del neurodesarrollo no está establecida, y se apoya en información indirecta e incompleta, sobre las analogías con el metilmercurio y los niveles máximos de exposición al mercurio en la vacunas dadas a los niños, es una hipótesis biológicamente posible. Recomendaciones: a.-El comité recomienda el uso de vacunas DtaP, Hib y Hepatitis B libres de timerosal. b.-El comité recomienda estudios de control de casos para examinar la asociación potencial entre los desórdenes del neurodesarrollo y las vacunas con contenido de timerosal. II. Recomendaciones en cuanto a los esquemas de vacunación de Trivalente (Sarampión, Papera y Rubéola (MMR )) y DPT (Difteria, Tos ferina y Tétanos). Vacunas descritas como de alto riesgo: · Trivalente de Paperas, Sarampión y Rubéola (MMR). · DTP (Difteria, Tos Ferina y Tétanos). Recomendaciones: 1.- Aplicar vacunas MONOVALENTES, o de dosis sencillas, dejando por lo menos 6 MESES de intervalo entre una y otra, p.ej. no aplicar DtaP, sino Difteria (D), seis meses después T (Tos Ferina), seis meses después P, siendo la última la vacuna Pertussis, ya que hay cierta evidencia de asociación con problemas neurológicos. No aplicar MMR (Sarampión, Paperas, Rubéola), sino primero Paperas, seis meses después aplicar Rubéola y seis meses después aplicar Sarampión. Asegúrese de separar por lo menos un año, la vacuna de la Papera de la del Sarampión, debido a que se ha descrito que niños que contraen el sarampión y las Paperas en el mismo año muestran un incremento en el riesgo de desarrollar un autismo o dificultades neurológicas. Así mismo, el virus del Sarampión se ha encontrado en el intestino de niños con autismo. 2.- Aplique vacunas de virus muertos no de virus vivos. Tome en cuenta que la vacuna pertussis de células completas o la vacuna oral de la polio, son de virus vivos. 3.- Utilice vacunas libres de TIMEROSAL, considere no colocar vacunas con contenido de mercurio. La siguiente tabla muestra las vacunas libres de timerosal, según el Institute for Vaccine Safety de la Universidad John Hopkins (www.vaccinesafety.edu/IOM-thimerosal-10-01-01.htm) para Abril de 2002.
4.- Considere no vacunar contra "enfermedades leves" como la varicela. 5.-Espere a que el niño sea mayor que lo recomendado en el esquema de vacunación estándar, para dar a su sistema inmune la oportunidad de desarrollarse un poco más. Si el niño tiene más de un año, considere no dar refuerzos de la DTP, debido a que usualmente la difteria y la Tos Ferina no son severas cuando son contraídas por un bebé mayor, y considere dar el refuerzo del Tétano sólo si se presentan heridas que lo amerite. 6.- Si tiene un pediatra comprensivo, pídale vacunar contra aquellas enfermedades que son "médicamente necesarias" según el contexto epidemiológico de su región particular. 7.- No permita NINGUNA vacunación si el niño no se ha recuperado completamente de una enfermedad reciente. El sistema inmune podría estar aún débil por efectos de la enfermedad y no necesita el "peso extra" de la vacuna. 8.-Antes de colocar los refuerzos haga exámenes para medir anticuerpos. No permita ningún refuerzo para la cual los exámenes demuestren que el niño ha desarrollado inmunidad. 9.-Administre vitamina C y A posterior a las vacunaciones. Mantenga al niño en una dieta rica en nutrientes. 10.- No administre vacunas si el niño es alérgico a uno de sus componentes p ej.: levaduras: Hepatitis B, huevo: MMR, Neomicina: MMR o Varicela. 11.- Limite la exposición ambiental. 12.- Si Ud. es Rh- y requiere RhoGam durante el embarazo, considere utilizar BayRho en los próximos embarazos, debido a que no contiene timerosal. Esquema de Vacunación Propuesto (Cave, 2001) Nacimiento: Hepatitis B si la madre es positiva a la Hepatitis B. 4 meses: Hib e IPV 5 meses: DTaP 6 meses: Hib, IPV 7 meses: DTaP 8 meses: Hib 9 meses: DTaP 15 meses: Sarampión. 17 meses: Hib, IPV 18 meses: DTaP 24-36 meses: Prevenar (neumococo) (1er dosis). 27 Meses: Rubéola 39 Meses: Paperas 4-5 años: Varicela 4-5 años: Serie de Hepatitis B 4-5 años: DTaP, Refuerzos de IPV 4-5 años: Realiza pruebas de anticuerpos para Sarampión, Rubéola, Paperas (MMR) y no la incluya a menos que el niño no muestre inmunidad. Coloque sólo aquellas vacunas con resultados negativos. 12 años: Realice de nuevo pruebas de anticuerpos. Bibliografía. Cave, S. Immunization: The Practical Issue. Presentada en la Conferencia DAN! 2001. Disponible en www.up-to-date.com/dan/powerpoint/cave.html Eggers C, Klin Pediatr 1976 Mar;188(2):172-80 "Autistic Syndrome and vaccination Against Smallpox". Gillberg et al The Int Jnl of Res. and Pract. 1998;2(4):423-4 "MMR and autism. Autism" Kaye J, Melero-Montes M, Jick H. Measles, Mumps, and rubella vaccine and the incidence of autism recorded by general practitioners: a time trend analysis. BJM. Vol 322. Feb. 2001. Singh et al 1998; Univ of Michigan, College of Pharmacy, Ann Arbor MI 48109, "Positive Titers of Measles and MMR antibody are related to myelin basic protein autoantibody in autism". Singh et al, Clin Immunol and Immunopath Oct 1998;89(1): 105-108 "Serological association of measles virus & HHV-6 with brain autoantibodies in autism" Singh VK, Lin SX, Yang VC. Serological association of measles virus and human herpesvirus-6 with brain autoantibodies in autism. Clinical Immunology and Immunopathology. 89 (1), : 105:8. 1998. Singh VK, Warren RP, Odell JD, Warren WL, Cole P. Antibodies to myelin basic protein in children with autistic behavior. Brain and Behavior Immunology. 7 (1): 97-103. 1993. Singh, V.K. Plasma incease of interleukin-12 and interferon-gamma. Pathological significance in autism. Journal of Neuroimmunology. May; 66(1-2), 143-145. 1996. Taylor et al BMJ 2002 24 Jan;324 "MMR vaccination and bowel problems or developmental regression in children with autism: population study" Uhlmann V.,Martin CM., Sheils O., Pilkington L., Silva I., Killalea A., Murch S B., Wakefield AJ., O´Leary JJ. Potential viral pathogenic mechanism for new variant inflammatory bowel disease. J. Clin. Pathol.: Mol. Pathol. 2002, 55: 0-6. Wakefield et al Lancet 1998;351:637-41 "Illeal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children" .
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2.) Drug linked to child deaths is still available in India
Source: http://www.archive.mail-list.com/
Sanjay Kumar New Delhi
A drug known to have serious side effects and which has been banned in
parts
of Europe is still available in India, despite reports in the press
of
several deaths in the subcontinent among children who had been taking
it.
There has been a media furore in India over reports of adverse reactions
to
nimesulide, a non-steroidal anti-inflammatory drug, which has been
reported
as causing liver toxicity. Although it was approved for use in India in
1994
for painful inflammatory musculoskeletal disorders, it is often used
for
pain relief and fever.
Dr Chandra Mohan Gulhati, editor of India's drug information bulletin,
the
Monthly Index of Medical Specialities, said that the drug had not
been
approved in the United States, parts of Europe, Canada, or Australia
and
that last year it was banned in Finland, Spain, and Turkey. "But it
continues to be marketed with impunity in India," he said.
After the media outcry, the drugs controller general of India,
Ashwini
Kumar, said on television that the government was appointing a committee
to
look into the issue of adverse reactions to the drug.
The deputy drugs controller, Ram Teke, however, told the BMJ that the
drug
continues to be available and there was no move to reconsider its use
or
approval.
The monthly index puts the national drug turnover to be some 1900
million
rupees (24.5m; $39.5m; ?37.6m). Besides being available as a single
ingredient, nimesulide is also available in more than 30 other drugs and
as
drops for children aged under 1 year. All are unapproved by the drugs
controller and therefore illegal.
"There is no system of monitoring adverse drug reactions in India worth
the
name," says Dr Gulhati. The monthly index lists 12 drugs that are
banned
globally or whose use is severely restricted or not approved owing to
serious side effects but which are freely available in India. These
include
anagen, cerivastatin, droperidol, furazolidone, lynestrenol,
nitrofurazone,
phenformin, phenolphthalein, phenylbutazone, piperazine,
quiniodochlor.
But even though it has banned the drugs, India's record of implementing
any
such ban is phenomenally poor, says Dr Gulhati. He cites the case of
anti
allergy drugs astemizole and terfenadine, which hit the headlines
last
year. A decision to ban them was announced in June, but the notification
was
issued only in October-and the notification said the ban would come
into
effect only in August 2003.
'This is the most absurd thing I have ever come across in my life," said
Dr
Gulhati. "If the drug is bad and harms people's health, you ban it
with
immediate effect." Such decisions are taken only to help the
manufacturers,
he added. He lists commercial interests of the pharmaceutical lobby,
corruption, and total lack of accountability and transparency as the
key
ailments affecting the drug regulatory mechanism in India.
Adverse media reaction has resulted in two companies reportedly
announcing
cuts in the manufacture of nimesulide.
Ajay Kumar Handa, president of marketing for the Bombay based Centaur
Pharmaceutical, said: "We are no longer supplying nimesulide
suspension." He
said that Mr Handa says their decision follows reports of paediatric
hepatotoxicity and added: "As far as I understand there is no problem
with
adult doses of nimesulide." Some other manufacturers too have withdrawn
the
product, Mr Handa confirmed.
A public interest petition filed in December 2002 in Delhi High Court by
the
Social Jurist legal group has challenged the availability of nimesulide
and
other banned drugs in India.
3.) The ban on Nimesulide abroad causes panic in India
Source: http://www.the-week.com/
K. Sunil Thomas with Quaied Najmi and Ambica P. Prabhan
Anger and amazement laced the voice of Dr Vasant Khatau. "Should our
children be treated as guinea pigs for earning money?" asked the Mumbai
pediatrician. The question would have upped the panic of parents who
learnt last week that Nimesulide, a drug often prescribed to bring down
high fever in children, was found to cause serious liver complications
in some patients during tests in Europe. "Our customers, especially
parents buying Nimesulide for their kids, are confused and frightened,"
said Dinesh Sukhija, a chemist near Delhi's Ram Manohar Lohia Hospital.
Is it safe? A chemist in New Delhi displays the various Nimesulide
products
Drug-related controversies are not new in a country which has for long
been considered the dumping ground for sub-standard medicines.
Nimesulide is the new entrant in this arena with 13 deaths reported from
all over the world. A non-steroid anti-inflammatory drug, its popularity
stems from its effectiveness in bringing down high fever. Now, however,
several European countries have withdrawn it after it was found to cause
serious liver complications, especially in children. Even its innovator,
Boehringer, withdrew it earlier this year from Spain and Finland.
Interestingly, the drug was never licensed in the US, Canada, Australia
and Britain.
Panic was triggered in Indian homes after the local media reported the
warnings issued in Europe over the dangerous instances of liver toxicity
caused by the drug. The drug first appeared in the country in the late
eighties as the brand 'Rimulide' from a Bangalore-based pharma company.
There are at least 20 major pharma companies in India manufacturing the
drug under different brand names and it accounts for a turnover of Rs
200 crore.
As the controversy broke, the medical fraternity remained divided on the
issue of side effects. According to Dr S. Malhotra, who runs a
polyclinic in south Delhi, "The side effects of acidity and heartburn
are minor and it is considered safe for asthma patients, unlike other
pain killers." However, Dr Khatau wanted Nimesulide in the syrup and
dispersible tablet forms, widely prescribed for children and infants, to
be immediately banned. Some of the doctors believed that a quantity of
five milligrams and above had the potential to cause serious liver and
kidney problems; overdose can even result in total kidney failure. What
is coming out, said Dr P.K. Rajiv, head of newborn services at the
Amrita Institute of Medical Sciences and Research Centre in Kochi, is
"just the tip of the iceberg". He was sure that Nimesulide-related
deaths were taking place in the country though no one was ready to come
out with the figures yet. "We wouldn't have had to wait for the US to
ban it if proper surveillance had been done in the country," he added.
Doctors have for long been baffled by an increase in liver-related
problems, especially in the elderly. In most cases it was found that the
patients had been prescribed a high dosage of Nimesulide for a long
period. Sadly, there is no proper monitoring in India to track the
possible side effects of a new drug. As Dr Philip Augustine of Kochi put
it, "If we were to go by available information alone, we would not be
able to use most of the drugs which come out."
Pharma companies sponsor clinical research into the safety and efficacy
of their drugs-and it is common knowledge that the results, if negative,
are either not published, or glossed over. "We call them anecdotal
reports," said Dr H.P.S. Sachdev, president-elect of the Indian Academy
of Pediatrics. "A lot of factors have to be taken into account while
evaluating a drug," said T.R. Gopalakrishnan, assistant
secretary-general of the Indian Drug Manufacturers Association.
What is needed now are detailed clinical trials to determine whether it
was a combination of factors that led to liver toxicity in users of
Nimesulide or whether the drug itself is at fault. But even as the Drug
Controller of India decided to review the case and experts suggested
that the panic was probably exaggerated, parents could do little but
worry endlessly.
4.) Use of nimesulide in Indian children must be stopped.
EDITOR
The continuing use of nimesulide for Indian children is shocking.1
Numerous studies have established the life threatening hepatotoxic
effects of nimesulide. 2 3 Nimesulide is not used in the United States,
and many European countries have also banned the drug because of its
unacceptable rate of serious adverse reactions.
Although some studies have indicated that nimesulide may be chosen for
osteoarthritis in selected patients with associated gastric problems,
other non-steroidal anti-inflammatory drugs such as acetaminophen
(paracetamol) are far better choices as antipyretics or analgesics,
especially for children.4 No rationale exists for selecting nimesulide
as the first drug of choice for fever or pain. Published studies from
India indicate rampant abuse of nimesulide.5 At least 12 paediatric
preparations of nimesulide are available in India, which affirms the
widespread use of the drug in children.5
Hardly any dependable post-marketing surveillance for adverse drug
reactions is undertaken in India. Moreover, unlike in the West, Indian
doctors are not under any real supervision and therefore do not
necessarily keep up with the rapidly changing information about adverse
effects.5 Patients receiving nimesulide should be closely monitored for
evolving hepatic failure. Indian patients may not follow necessary
guidelines, for simple economic reasons. Even if the Indian drug control
agencies are reluctant to impose a total ban on nimesulide, they should
immediately forbid its use for treatment of fever or pain.
A plethora of scientific data show that nimesulide should not be
used as the primary mode of treatment as an antipyretic or analgesic,
especially in children, for whom much better and safer choices are
available. It will be unfortunate if the Indian government waits for
another "committee" report before stopping the use of nimesulide, even
for the treatment of pain or fever, and lets more innocent patients
suffer needlessly.
Kunal Saha, assistant professor.
Department of Pediatrics and Molecular Virology, Immunology and Medical
Genetics, Children's Hospital and Ohio State University Medical Center,
700 Children's Drive, Columbus, OH 43205, USA
sahak@pediatrics.ohio-state.edu
1. Kumar S. Drug linked to child death is still available in India. BMJ
2003; 326: 70[Free Full Text]. (11 January.)
2. Ferreio S, Vivas F, Jorquera AB, Dom'uez J, Herrera A, Fern'ez MJ, et
al. Nimesulide-induced hepatotoxicity. Case report and bibliography
review. Gastroenterol Hepatol 2000; 23: 428-430[Medline].
3. Merlani G, Fox M, Oehen HP, Cathomas G, Renner EL, Fattinger K, et
al. Fatal hepatotoxicity secondary to nimesulide. Eur J Clin Pharmacol
2001; 57: 321-326[CrossRef][ISI][Medline].
4. Litalien C, Jacqz-Aigrain E. Risks and benefits of nonsteroidal
anti-inflammatory drugs in children: a comparison with paracetamol.
Paediatr Drugs 2001; 3: 817-858[Medline].
5. Malhotra S, Pandhi P. Analgesics for pediatric use. Indian J Pediatr
2000; 67: 589-590[Medline
5.) Safety and tolerability of the dual 5alpha-reductase inhibitor
dutasteride in the treatment of benign prostatic hyperplasia.
Eur Urol. 2003 Jul;44(1):82-8. Related Articles, Links
Andriole GL, Kirby R.
Division of Urologic Surgery, Washington University School of
Medicine, 4960 Children's Place, Campus Box 8242, 63110, St. Louis,
MO, USA
OBJECTIVE: The objective of this paper is to examine safety and
tolerability data from a number of recently completed clinical trials
with the novel, dual 5alpha-reductase inhibitor, dutasteride.METHODS:
Intent-to-treat analyses were conducted on data for dutasteride
0.5mg/day for drug-related adverse events, clinical laboratory test
results, and prostate-specific antigen (PSA) levels derived from four
large, randomised, double-blind clinical trials (n=5655). Further data
were derived from a randomised, double-blind combination study of
dutasteride 0.5mg/day and tamsulosin 0.4mg/day (n=327), and several
safety studies conducted in healthy volunteers.RESULTS: Data from
two-year blinded clinical studies demonstrate that dutasteride is well
tolerated, with a profile comparable with that of placebo. The
exception is a modestly elevated incidence of impotence, decreased
libido, ejaculation disorders, and gynaecomastia. Clinical laboratory
test abnormalities were reported by <1% of patients treated with
dutasteride, and abnormal values occurred with similar frequency
versus placebo-treated patients. In a healthy volunteer study, when
dutasteride was administered daily for 1 year, it did not
significantly affect bone metabolism markers, bone mineral density or
lipid profiles. Dutasteride reduced total serum PSA concentrations by
approximately 50% following 6, 12, and 24 months of treatment but had
no effect on free-to-total PSA levels. The safety profile of
dutasteride did not differ from that of finasteride in a large,
parallel-group, comparator trial. Additionally, when dutasteride was
used in combination with an alpha(1)-blocker, the drug-related adverse
event profiles were as would be expected for the individual
agents.CONCLUSIONS: Considered together, these data demonstrate
dutasteride to be well-tolerated.
Urology. 2002 Sep;60(3):434-41. Related Articles, Links
Roehrborn CG, Boyle P, Nickel JC, Hoefner K, Andriole G; ARIA3001
ARIA3002 and ARIA3003 Study Investigators.
Department of Urology, University of Texas Southwestern Medical Center
at Dallas, Dallas, Texas 75390-9110, USA.
OBJECTIVES: To study the efficacy and safety of dutasteride, a dual
inhibitor of the 5-alpha-reductase isoenzymes types I and II. METHODS:
A total of 4325 men (2951 completed) with clinical benign prostatic
hyperplasia, moderate to severe symptoms (American Urological
Association-Symptom Index score of 12 points or greater), a peak flow
rate of 15 mL/s or less, a prostate volume of 30 cm3 or greater (as
measured by transrectal ultrasonography), and a serum
prostate-specific antigen level of 1.5 to 10.0 ng/mL (inclusive) were
enrolled into three identical clinical trials and randomized to 0.5 mg
dutasteride daily or placebo. After a 1-month, single-blind, placebo
lead-in, patients were followed up for 24 months in a double-blind
trial with multiple interval assessments. RESULTS: At 24 months, serum
dihydrotestosterone was reduced from baseline by a mean of 90.2%
(median -93.7%; P <0.001), and the total prostate and transition
zone volumes were reduced by a mean of 25.7% and 20.4%, respectively
(P <0.001). The symptom score was improved by as early as 3 months,
with pooled significance from 6 months onward (P <0.001) and a
reduction of 4.5 points (21.4%) at 24 months (P <0.001). The
maximal flow rate improved significantly from 1 month (P <0.01),
with an increase of 2.2 mL/s reported at 24 months (P <0.001).
Hence, the risk reduction of acute urinary retention was 57% and the
risk reduction of benign prostatic hyperplasia-related surgical
intervention was 48% compared with placebo. The drug was well
tolerated. CONCLUSIONS: Dutasteride is a potent inhibitor of
dihydrotestosterone production that is safe and effective in terms of
the reduction of prostate volume and symptoms, flow rate improvement,
and the reduction of the risk of acute urinary retention and surgery
during a 24-month study period.
What is Levitra?
Levitra is a new oral treatment for erectile dysfunction (impotence)
available in the UK. This factsheet provides basic information on
Levitra.
Levitra (vardenafil) belongs to a group of medicines called PDE5
inhibitors. It is a round shaped orange tablet with strengths of 5mg,
10mg or 20mg. It is an oral tablet, which is swallowed. It is not an
aphrodisiac and does not increase sexual desire. For Levitra to be
effective, sexual stimulation is required.
You can obtain treatment for impotence using Levitra at
www.healthexpress.co.uk
How does Levitra work?
Levitra works by helping to relax
the blood vessels in the penis, allowing blood to flow into the penis
causing an erection. Levitra will not give a man an erection
spontaneously, it will only help a man to get an erection if he is
sexually stimulated.
How do you take Levitra?
Levitra is available in three
strengths 5mg, 10mg and 20mg. The initial dose is selected by the doctor
who will assess the most appropriate dose for each patient based on a
consultation.
Levitra normally works within 25-60 minutes, although some men will
achieve an erection within 15 minutes. Within a 5 hour period after
taking the tablet an erection should occur in response to sexual
stimulation.
The action of Levitra is not generally affected by eating before taking
the treatment (except where the meal has a fat content of 57% or
greater) or by drinking alcohol, so men can eat or drink as they would
normally before taking Levitra.
It is recommended that only one dose of Levitra is taken in a 24 hour
period.
What side effects may be associated with Levitra?
The
manufacturers have tested the drug in over 3,750 men in worldwide
clinical trials. When taken at the recommended dose, side effects are
mild and transient. The most common side effects are headache and facial
flushing.
Who cannot take Levitra?
Patients who are taking any
medicines containing nitrates. These are commonly prescribed for the
relief of angina (chest pain). Levitra, in combination with nitrates,
can lower blood pressure significantly leading to untoward effects.
Patients should inform their doctor if they are taking any of these
medicines or should ask if they are uncertain.
Patients with the following:
Known hypersensitivity to any component of the drug Levitra;
Men with cardiac disease of a severity where sex is inadvisable;
Recent stroke, heart attack or low blood pressure;
Unstable angina or angina occurring during sexual intercourse;
Aged over 75 years and taking ritonavir, indinavir, ketoconazole or
itraconazole (oral form)
Levitra should not be taken with other erectile dysfunction
treatments.
You can obtain treatment for impotence using Levitra at
www.healthexpress.co.uk
What conditions may prevent a man using Levitra?
Levitra
should be used with caution in patients with:
An abnormally formed penis.
Diseases that might result in prolonged erections e.g. Sickle cell
anaemia, multiple myeloma, or leukaemia.
A history of postural hypotension.
Severe kidney or liver disease
Can women take Levitra?
Levitra should not be taken by women as it is not licensed and its
safety in women has not been tested.
What happens if I increase the dose?
An increase in dose
should always occur under close medical supervision. Clinical trials
have shown that increasing the dose beyond the maximum recommended dose
of 20mg simply increases the side effects and not the efficacy.
You can obtain treatment for impotence using Levitra at
www.healthexpress.co.uk
Can I drive while taking Levitra?
As dizziness has been
reported in clinical trials of Levitra, patients should be aware of how
they react to the drug before they drive.
Will it work for everyone?
If Levitra does not help you to
get an erection, or your erection does not last long enough for you to
complete your chosen sexual activity you should tell your doctor, who
will be able to advise you as to whether a dose increase is necessary to
reach the desired effect.
Your doctor can also advise you on other possible treatment
options.
You can obtain treatment for impotence using Levitra at
www.healthexpress.co.uk
8.) Saw palmetto for prostate disorders.
Am Fam Physician. 2003 Mar 15;67(6):1281-3.
Gordon AE, Shaughnessy AF.
Harrisburg Family Practice Residency Harrisburg, Pennsylvania
17110-2098, USA. agordon@pinnacle.health.org
Saw palmetto is an herbal product used in the treatment of symptoms
related to benign prostatic hyperplasia. The active component is found
in the fruit of the American dwarf palm tree. Studies have demonstrated
the effectiveness of saw palmetto in reducing symptoms associated with
benign prostatic hyperplasia. Saw palmetto appears to have efficacy
similar to that of medications like finasteride, but it is better
tolerated and less expensive. There are no known drug interactions with
saw palmetto, and reported side effects are minor and rare. No data on
its long-term usage are available. The herbal product also has been used
to treat chronic prostatitis, but currently there is no evidence of its
efficacy.
8.)Long-term clinical and biologic effects of the lipidosterolic
extract of Serenoa repens in patients with symptomatic benign
prostatic hyperplasia.
Adv Ther. 2002 Nov-Dec;19(6):297-306.
Pytel YA, Vinarov A, Lopatkin N, Sivkov A, Gorilovsky L, Raynaud
JP.
Scientific Research Institute of Urology, Moscow, Russia.
Permixon, the lipidosterolic extract of Serenoa repens, is widely used
for the treatment of symptoms associated with benign prostatic
hyperplasia (BPH). This open study assessed the efficacy and
tolerability of Permixon 160 mg twice daily administered for 2 years.
One hundred fifty-five men with clinically diagnosed BPH and
complaints of prostatic symptoms were enrolled in the study. At 6, 12,
18, and 24 months, the International Prostate Symptom Score (I-PSS),
quality of life, and sexual function score were recorded, and
urodynamics and biologic values were measured. Adverse events were
recorded every 3 months. I-PSS and quality of life improved
significantly from baseline at each evaluation time point. At the end
of the study and at each evaluation, maximum urinary flow also
improved significantly. Prostate size decreased. Sexual function
remained stable during the first year of treatment and significantly
improved (P = .001) during the second year. Prostate-specific antigen
was not affected, and no changes in plasma hormone levels were
observed. Nine patients reported 10 adverse events, none related to
treatment. Improvements in efficacy parameters began at 6 months and
were maintained up to 24 months. These data demonstrate the long-term
efficacy and tolerability of Permixon and support its use as a
first-line medical therapy for uncomplicated symptomatic BPH.
Source: http://www.floss.com/
by Nanette Feuling
I was finally asked to research the inevitable. I knew at some point I
would get an assignment that shows my age. This is the one, people, this
is the one! For the life of me, I can’t imagine wanting your tongue
pierced, but then I also did not want my ears done. I have only had them
pierced for about 20 years, now, but it took my teenage daughter’s power
of persuasion at least six months before she could drag me into her
world back before tongues were even “in.”
I think I have been able to get the “scoop” on the tongue thing. All
sources, except testimonials and advertisements, concur that it’s thumbs
down. Now you already knew that, so let’s cut to the chase and lay out
the facts. Then you can go ahead and do what you knew you really
shouldn’t do even before you read this, even when you ultimately become
more aware than ever of the dangers – you can go right ahead even though
you may be literally scared to death!
The Procedure
Tongue piercing is a process whereby the
tongue is penetrated with a medical needle encased in a plastic cannula
or sheath. When the needle is removed, the cannula is left in place. A
stainless steel barbell (jewelry) is then placed through the cannula
lumen or hole; subsequently, the cannula is removed leaving the barbell
pierced through the tongue.
The Risks
Infection
Two infection risks exist: (1) Systemic and (2) Localized
Systemic Infection
HIV virus and Hepatitis are two
examples of systemic infection risks if a sterile environment is not
maintained during a piercing procedure. Autoclave sterilization of
instruments and equipment must be used for the procedure to avoid these
systemic risks and remains perhaps the number one requirement for any
“Piercer.” Toxic shock is a third serious systemic problem that has
resulted from piercing gone awry.
Localized Infection
Slight swelling of the tongue and a
pale yellowish discharge consisting of lymph and plasma around the wound
site are common localized occurrences with piercing. While the tongue is
notorious for its ability to swell when injured, even to the point of
airway obstruction and resultant breathing difficulties, no less
dangerous is localized infection of the wound that can spread despite
efforts with antibacterial care. Although these severe consequences are
not usual or normal occurrences, they are formidable risks. It is
absolutely necessary to call your dentist immediately if any persistent
or unusual swelling occurs or if any unexpected infection becomes
apparent. However, when the procedure heals routinely, the patient
maintains cleanliness at the site by means of careful brushing with a
soft brush, saltwater rinses, and topical antibacterial mouthwash. Tech
2000 and Biotene are products that contain no alcohol and, therefore, do
not irritate or sting. Gly-Oxide, an antiseptic oral cleanser, may be
used to promote healing, as well.
Allergic reactions to inferior-grade metals used as jewelry objects are
also a common source of infection. Stainless steel, titanium, and gold
are appropriate metal choices.
Oral Consequences, Accidents, and Abrasions
Stories of
“barbells” being swallowed during the night that lodge in the trachea,
swollen tongues to the point of tracheostomy, stories of broken teeth,
as well as excessive bleeding during piercing from veins in the tongue -
horror stories, literally, abound. More likely, therefore ultimately
more threatening, are the tiny tooth fractures that can begin to show on
x-rays after extended intermittent biting on those metal objects used
for jewelry. One young aficionado reports, “And they say tongue rings
chip your teeth. Well I have bit mine a lot. I mean I bite it everyday,
and I haven't chipped a tooth.” That young man hasn’t had his yearly
dental x-rays since the procedure, either. Small fractures can
completely undermine a tooth and are a common result and a realistic
consequence of tongue piercing.
Post-procedure, patients routinely experience temporary excessive
salivation, pain, speech impediment, and irritation from foods,
especially salty foods. They are advised to use ice to reduce symptoms
and to maintain a liquid diet for a short duration. Because the tongue
is a muscle, unlike the earlobe, additional more serious consequences
are a reality, although they occur infrequently. These risks include
scarring, permanent damage to veins and nerves, deep cyst formation, as
well as development of neuromas that are defined as overgrowth of nerve
tissue. These complications can produce permanent loss of taste,
sensation, and tongue mobility. The tongue is infused with a vascular
network; therefore, piercing causes considerable bleeding. When a blood
clot forms at the wound site, there is also the remote but distinct
possibility that a small piece could break away and flow through the
bloodstream to lodge in the brain causing a stroke.
Bad Breath
Any body orifice that can harbor bacteria is
also a potential cause of bad breath, elevating oral hygiene to a
position of even more than normal importance after piercing. Dental
offices routinely see plaque-coated barbells from inconsistent and
careless hygiene. If this piercing fashion statement is truly meant to
be appealing, it comes with the responsibility to be
ultra-conscientious. Frankly, when I see “science” as a part of the word
“conscience” – literally, con (with) science - and “conscientious,” I
know why I said, “Oh, NO! Not tongue piercing!” But then, I also know
what peer pressure is all about. It took my teenage daughter six months,
remember, to get me to pierce my ears. And then, in the grand finale, as
a final result, I ended up betraying my conscience!* It was not a move
my better judgment dictated, but ear piercing also carried minor risks
compared with tongue piercing.
I am glad that when I chose to betray my conscience - that I had
all the facts about what I was going to do. It made the “odds” better to
assure that I would get the best possible results with the least
probable chance for casualty. There is a math course that is the study
of “odds,” called “Permutations and Combinations.” Playing the odds in
one’s favor is using math as a backup when you choose to go against your
conscience and to assume a risk. As with science, it requires proper
compilation of reliable data under the circumstances to give you your
best bet.
10.) Hepatitis C
Source:
http://www.sdpt.net/hepatitisc.htm
Prevalencia e incidencia:
El esclarecimiento del genoma del virus de la hepatitis C en 1989 implicó que se adquiriera conciencia de que este virus es un grave problema de salud en todo el mundo, además de saberse que la infección por el virus de la hepatitis C (VHC) es una de las causa más frecuentes de hepatopatía crónica. El 40% de las personas ignoran su estado y se calcula que en la Argentina hay alrededor de 600.000 casos. En cuanto a los dadores de sangre voluntarios sanos, por cada 100 hay uno que padece la enfermedad y no lo sabe.
Si bien no hay datos precisos el mal se desarrolla con más frecuencia en Capital Federal y el Conurbano Bonaerense.
En los Estados Unidos el 1 % de la población es portadora del VHC un estimado de 2,7 millones de personas, mientras que en todo el mundo hay cerca de 170 millones de personas portadoras del VHC, según la OMS.
De no abaratarse la medicación, para el año 2008 la tasa de incidencia de la enfermedad aumentará en un 500%. El tratamiento hoy cuesta entre $ 2.000 a $ 4.000, por mes.
El virus de la hepatitis C (un RNA virus) posee muy poco en común con los virus de las hepatitis A y B, mejor conocidos. Es un miembro de la familia Flaviviridae, que comprende virus como los de la fiebre amarilla y el dengue. La partícula viral consta de una cubierta derivada de las membranas del huésped, en la cual se insertan las glicoproteínas E1 y E2 codificadas por el virus, que rodea a la nucleocápside, y un genoma ARN monocatenario de sentido positivo y una longitud aproximada de 9.500 nucleótidos.
El virus de la hepatitis C se ha clasificado en 6 genotipos importantes basados en los análisis filogenéticos. Los 6 genotipos principales se designan por números:
1,2,3,4,5 y 6. Todavía no se pudo cultivar en el laboratorio.
Formas de transmisión:
El 40% de las causas de contagio se desconoce. La hepatitis C se transmite por vía parenteral. Antes de 1992 cuando aún no se usaban las pruebas de detección en donantes de sangre y otros exámenes la transfusión de sangre o productos derivados del plasma se acompañaba de un Importante riesgo de transmisión de la hepatitis C. Otros factores de riesgo de potenciales contagios son: El uso de cocaína intranasal, los tatuajes, los piercing corporales, los pinchazos accidentales con agujas, y el compartir utensilios del hogar como corta uñas, hojas de afeitar y cepillos de dientes.
También ha habido descripciones de casos de transmisión de hepatitis C entre pacientes sometidos a colonoscopia con un colonoscopio inadecuadamente desinfectado; entre dos miembros de una familia que emprendieron una pelea a puñetazos en la que corrió sangre; luego de usar filtros hemodializadores en varios pacientes y durante cirugías cardiotorácicas.
Los pinchazos accidentales con agujas que sufren los trabajadores sanitarios pueden transmitir el virus. La frecuencia de esta vía de contagio es inferior a la observada con la hepatitis B, pero superior a la del VIH. Después de un pinchazo, la gammaglobulina o la globulina inmune contra hepatitis B carecen de valor en la prevención de la infección por hepatitis C. La expectación vigilante es una estrategia importante para determinar si se va a desarrollar o no la enfermedad. Si es posible, resulta adecuado revisar la carga viral de hepatitis C en el paciente, con el fin de evaluar el riesgo de transmisión. El peligro de contagio de hepatitis C es despreciable cuando el paciente carece de ARN de hepatitis C detectable. Sin embargo, si no se dispone del paciente de origen para realizarle las pruebas o la prueba de ARN de VHC es positiva en él, el receptor del pinchazo debe ser sometido periódicamente a pruebas de VHC, además de recibir tratamiento si resulta positivo para ARN de VHC.
La transmisión sexual de la hepatitis C sigue siendo objeto de controversia y probablemente supone menos del 5% de los casos. Los factores dé riesgo son la promiscuidad sexual, las relaciones con prostitutas, el intercambio sexual rectal y las relaciones sexuales traumáticas. Estudios en parejas casadas indicaron un riesgo mayor de transmisión al cónyuge a medida que se prolonga la duración del matrimonio. Se ignora si este riesgo es secundario a transmisión sexual y falta determinar el papel potencial de compartir los enseres del hogar, las hojas de afeitar y los cepillos de dientes.
La transmisión perinatal de la hepatitis C se produce aproximadamente en el 3% al 5% de los lactantes nacidos de madres infectadas por VHC. Esta vía de contagio se asocia a dos factores de riesgo independientes: elevada carga viral en el momento del parto y tener una madre VIH positiva.
Investigadores italianos describieron recientemente una disminución del riesgo de transmisión perinatal de hepatitis C en el parto por cesárea comparado con el vaginal. El riesgo de transmisión perinatal de la hepatitis C en una mujer VIH positiva se estima en el 15% al 35%. Los niños nacidos de madres infectadas por hepatitis C pueden tener inicialmente anticuerpos positivos contra hepatitis por transferencia pasiva a través de la placenta. Este anticuerpo puede estar presente durante todo el primer año de vida, para luego desaparecer. Por lo tanto, para determinar si existe infección por hepatitis C en el recién nacido, es necesario demostrar la Positividad del ARN de VHC en el suero. La lactancia natural por madres con hepatitis C parece segura, y no se han descrito casos de transmisión del virus a los recién nacidos.
Otros Factores:
Otros grupos de alto riesgo de infección por hepatitis C comprenden las personas que recibieron concentrados de factores de coagulación antes de 1987, personas sometidas a hemodiálisis, hemofílicos y pacientes receptores de trasplante de órgano sólido o de médula ósea antes de 1992. La contaminación de las membranas de ultrafiltración puede explicar la elevada tasa de infección por hepatitis C observada en las unidades de diálisis.
Evolución Natural de la Hepatitis C:
La historia natural precisa de la hepatitis C sigue siendo desconocida debido a la falta de datos prospectivos, la imposibilidad de determinar el momento de inicio de la enfermedad y a las influencias variables de los numerosos cofactores que conducen a su progresión. Lo que sí se determinó es que un subgrupo de pacientes con hepatitis C progresará a la cirrosis y a las complicaciones que la acompañan.
El sello de la infección por hepatitis C es la cronicidad: entre el 15% y el 30% de los pacientes expuestos a VHC se recuperan espontáneamente, mientras que del 70% a 85% restante desarrollan infección crónica. La mayoría de los pacientes con infección crónica por hepatitis C parecen tener una enfermedad histológicamente leve a moderada. Aunque en la hepatitis C es rara la infección fulminante, se han descrito casos.
Varios estudios trataron de determinar la velocidad de progresión histológica en la enfermedad adquirida por transfusión. Tong y colaboradores encontraron un intervalo medio de 20 años desde el momento de la infección hasta el desarrollo de la cirrosis, y un intervalo medio de 28,3 años desde el momento del diagnóstico y el desarrollo del carcinoma hepatocelular. (CHC).
Varios factores parecen influir sobre la velocidad de progresión de la hepatitis C a cirrosis. Estos factores comprenden el consumo de alcohol, la edad en el momento de la exposición, el sexo, y la coinfección con hepatitis B o con VIH.
La ingestión de alcohol y la infección crónica por hepatitis C actúan de forma sinérgica, acelerando la progresión de la hepatopatía. Si el consumo mantenido de alcohol es superior a 40 gramos día existe un aumento del riesgo de cirrosis y de hepatopatía descompensada. Otros efectos del empleo concomitante de alcohol en el contexto de la hepatitis C son los niveles más elevados de transaminasas, cargas de virus de hepatitis C mayores de número de cuasiespecies de hepatitis C. Los valores negativos se reducen si se abandona el hábito de consumir alcohol. A partir de los cuarenta años de edad, la progresión se acelera tal vez por fallas del sistema inmunológico.
Por otra parte, la coinfección de hepatitis C y VIH parece llevar a una progresión rápida de la hepatopatía. La evolución hacia la cirrosis o la falla hepática puede ocurrir entre 10 y 15 años más tarde del momento de infección con el VHC. La velocidad de esta progresión duplica aproximadamente a la que ocurre con la infección por hepatitis C aislada. En la actualidad, la hepatitis C y la hepatopatía relacionada con ella son la primera causa de muerte no asociada a Sida en pacientes con VIH.
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DATA-MEDICOS/ DERMAGIC JOURNAL / MAY 2003-2024/ DR. JOSE LAPENTA
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Produced by Dr. José Lapenta R. Dermatologist
Venezuela
1.998-2.024
Producido por Dr. José Lapenta R. Dermatólogo Venezuela 1.998-2.0024
Tlf: 0414-2976087 - 04127766810
