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Severe constipation may be marker for CVD in postmenopausal women
Am J Med 2011; 124: 714–723

Pulse oximetry ‘feasible’ for detecting congenital heart defects in newborns
Lancet 2011; Advance online publication

Clinical characteristics can identify untreated hypertensive patients

Một số xét nghiệm mới được thực hiện tại MEDIC (cập nhật ngày 13-8-2011)


Anti Nucleosome - IgG

Test phát hiện đồng thời:  Chlamydia trachomatis  PCR TAQMAN +  Neisseria gonorrhoeae PCR TAQMAN

CMV DNA Realtime + EBV DNA Realtime


HBV Genotype Taq man + kháng Lamivudine, Adefovir



Melatonin nước bọt

P1NP/ máu

PFA TEST (Đánh giá chức năng tiểu cầu)

PFA P2Y test

PRISCA TEST (Xét nghiệm sàng lọc trước sanh)

ROMA TEST (Risk of Ovarian Malignancy Algorithm Test)

Sirolimus Test

VZV DNA REALTIME (Varicella- Zoster virus)


Internal Medicine

Combination therapy for dyslipidemia; Sharma M; Current Opinion in Cardiology 26 (5), 420-3 (Sep 2011)
PURPOSE OF REVIEW Residual cardiovascular risk remains in individuals treated with statins and combination therapies may reduce this risk further. RECENT FINDINGS Most previous trials of combination therapies have shown a favorable effect on lipid profiles without clinical superiority over statin monotherapy. Trial design has been hampered by short duration and comparison with a low dose statin. The Study of Heart and Renal Protection trial has recently reported findings and shows a benefit of ezetimibe/simvastatin over simvastatin alone. AIM-HIGH (Atherothrombosis Intervention in Metabolic syndrome with Low HDL/High Triglycerides and Impact on Global Health Outcomes), a trial of statin/niacin, has been prematurely halted for futility. Finally, combining a statin with both niacin and ezetimibe shows significant enhancement of the therapeutic effect on lipid profiles. SUMMARYCurrent evidence continues to support initiation of a potent statin with titration to achieve targets. Combinations may be useful in individuals unable to reach desired lipid levels on maximal tolerated doses of statins.


Angiotensin II receptor blocker combinations: From guidelines to clinical practice; Narkiewicz K; Blood Pressure (Aug 2011)
Abstract: European guidelines recommend a combination of at least two antihypertensive drugs to achieve blood pressure (BP) goals in the majority of patients. In addition, they encourage simplification of treatment regimens using single-pill, fixed-dose combinations (FDCs) to aid compliance. Of the preferred combinations, those based on angiotensin II receptor blockers (ARBs) may be more desirable than those based on angiotensin-converting enzyme inhibitors, because of equivalent efficacy and superior tolerability. Significantly better BP reductions and control rates have been observed with the dual combinations of ARBs with amlodipine or hydrochlorothiazide (HCZT) compared with component monotherapies. Furthermore, in the 15-20% of patients who require triple combination therapy to achieve BP goals, fixed-dose triple combinations with an ARB, calcium-channel blocker and diuretic, which have recently become available, provide significantly better BP reductions and control compared with dual combinations. Within the ARB class, olmesartan stands out as being one that has been recently investigated in a considerable number of studies that are relevant to the modern concept of FDC therapy in terms of both dual and triple combination therapy. The availability of such single-pill FDCs has the potential to deliver strong antihypertensive efficacy with good tolerability and improved compliance.


Impact of aliskiren treatment on urinary aldosterone levels in patients with type 2 diabetes and nephropathy: an AVOID substudy; Persson F, Lewis JB, Lewis EJ, Rossing P, Hollenberg NK, Parving HH; Journal of the Renin-Angiotensin-Aldosterone System (JRAAS) (Aug 2011)

INTRODUCTION: Aldosterone blockade reduces albuminuria in diabetic patients with chronic kidney disease (CKD), and improves prognosis in chronic heart failure. This study assessed the effects of direct renin inhibition with aliskiren in combination with losartan and optimal antihypertensive therapy on urinary aldosterone, plasma renin activity (PRA) and plasma renin concentration (PRC). MATERIALS AND METHODS: : In the AVOID study, 599 patients with type 2 diabetes, hypertension and nephropathy received 6 months aliskiren (150 mg force titrated to 300 mg once daily after 3 months) or placebo added to losartan 100 mg and optimal antihypertensive therapy. Urinary aldosterone excretion, PRA and PRC were measured at baseline and after24 weeks in a prespecified subset of 133 patients. RESULTS: : Aliskiren added to losartan provided reductions from baseline in urinary aldosterone compared with adding placebo (-24% vs. -4%, p = 0.017) at week 24. There was no significant difference between the aliskiren and placebo groups in the proportion of patients with aldosterone breakthrough (aliskiren 35%, placebo 46%, p = 0.199). Aliskiren treatment reduced PRA by 93% at 24 weeks and increased PRC by 328%. CONCLUSIONS: : Adding aliskiren to recommended renoprotective treatment with losartan and optimal antihypertensive therapy provided significant reductions in urinary aldosterone excretion which may attenuate decline in kidney function.

Predictors of systolic BP<140 mmHg and systolic BP level by randomly assigned treatment group (benazepril plus amlodipine or hydrochlorothiazide) in the ACCOMPLISH Study; Kjeldsen SE, Jamerson KA, Bakris GL, Pitt B, Dahlöf B, Velazquez EJ, Hua TA, Kelly RY, Zappe D, Hester A, Tuomilehto J, Ostergren J, Ibsen H, Weber M; Blood Pressure (Aug 2011)
Abstract Background. The ACCOMPLISH Trial investigated intensive antihypertensive combination treatment with benazepril + amlodipine (B+A) or benazepril + hydrochlorothiazide (B+H) on cardiovascular outcomes in patients with systolic hypertension. We analyzed the baseline predictors of achieving a systolic blood pressure (SBP)<140 mmHg and achieved SBP level by the end of 12 months in both treatment groups. Methods. Baseline and 12-month SBP was available in 10,506 patients, of whom 6250 had diabetes. Univariate and multivariate logistic regression models were used for SBP control at 12 months and multivariable regression models were used for the prediction of SBP at 12 months. A stepwise procedure was used to select significant (p<0.001) predictors in multivariate analyses. Results. Mean (± SD) BP fell from 145.4/80.1 (± 18.3/10.7) mmHg at randomization to 132.8/74.7 (± 16.0/9.6) mmHg at 12 months. The main baseline predictors of SBP control<140 mmHg were region (USA>Nordic region) and Caucasian ethnicity in both randomization arms. A higher diastolic BP and the use of lipid lowering agents indicated favorable effects in the B+H arm only. The predictors of uncontrolled SBP were: (i) higher baseline SBP values, (ii) higher number of previous antihypertensive medications in both arms, (iii) the previous use of insulin in the B+A arm, and (iv) pre-trial calcium channel blocker (CCB) use in the B+H arm. Additionally, pre-trial use of thiazides and electrocardiogram (ECG)-left ventricular hypertrophy (LVH) at baseline predicted higher, and smoking lower absolute SBP in the B+A arm and the use of thiazides and proteinuria a higher SBP in the B+H arm. Conclusion. Irrespective of treatment, patients in the USA and Caucasians achieved better SBP control, whereas higher baseline SBP and more previous antihypertensive medications indicated less control. Concomitant use of lipid lowering treatment indicated a better SBP control in the benazepril + hydrochlorothiazide arm. Lastly, insulin use and ECG-LVH in the benazepril + amlodipine arm and proteinuria in the benazepril + hydrochlorothiazide arm indicated poor control.

Long-term effects of candesartan and amlodipine on cardiovascular morbidity and mortality in Japanese high-risk hypertensive patients: the Candesartan Antihypertensive Survival Evaluation in Japan Extension Study (CASE-J Ex); Ogihara T, Ueshima K, Nakao K, Fukiyama K, Oba K, Yasuno S, Fujimoto A, Sato T, Matsuoka H, Saruta T; Hypertension Research (Aug 2011)
In the Candesartan Antihypertensive Survival Evaluation in Japan (CASE-J) trial, comparable efficacy was noted between candesartan and amlodipine in the incidence of cardiovascular (CV) morbidity and mortality during 3.2 years of follow up. Candesartan suppressed new-onset diabetes more effectively than amlodipine. In this observational study, we investigated whether or not the efficacy of the two drugs is sustainable for another 3 years beyond the experimental period of the CASE-J trial. Of the 4728 high-risk hypertensive patients initially enrolled in the CASE-J trial, 2232 agreed to further follow up. The primary endpoint was a composite of CV morbidity and mortality. The distribution of demographic characteristics for the 2232 patients in the CASE-J extension was similar to that in the initial 4703 patients in the CASE-J trial. Both drugs controlled blood pressure well over the relatively long period of time. The incidence of CV events was 15.5/1000 patient years in the candesartan group and 16.3/1000 patient years in the amlodipine group (Hazard ratio (HR)=0.95, 95% confidence interval (CI)=0.77-1.18; P=0.650). The incidence of new-onset diabetes was significantly lower in the candesartan group (9.5/1000 patient years) than in the amlodipine group (13.3/1000 patient years), representing a 29% risk reduction for new-onset diabetes (HR=0.71, 95% CI=0.51-1.00, P=0.0495). In conclusion, candesartan and amlodipine showed comparable efficacy against CV events beyond the experimental period of the CASE-J trial in high-risk hypertensive patients. In addition, the effects of candesartan on new-onset diabetes observed during the CASE-J trial were sustained in the CASE-J extension. The CASE-J extension, which covered a 3-year extension of follow-up from the original trial, corroborated the results of the CASE-J trial.Hypertension Research advance online publication, 11 August 2011; doi:10.1038/hr.2011.120.

Treatment of medication overuse headache - guideline of the EFNS headache panel; Evers S, Jensen R; European Journal of Neurology 18 (9), 1115-21 (Sep 2011)
Background:  Medication overuse headache is a common condition with a population-based prevalence of more than 1-2%. Treatment is based on education, withdrawal treatment (detoxification), and prophylactic treatment. It also includes management of withdrawal headache. Aims:  This guideline aims to give treatment recommendations for this headache. Materials and methods:  Evaluation of the scientific literature. Results:  Abrupt withdrawal or tapering down of overused medication is recommended, the type of withdrawal therapy is probably not relevant for the outcome of the patient. However, inpatient withdrawal therapy is recommended for patients overusing opioids, benzodiazepine, or barbiturates. It is further recommended to start individualized prophylactic drug treatment at the first day of withdrawal therapy or even before. The only drug with moderate evidence for the prophylactic treatment in patients with chronic migraine and medication overuse is topiramate up to 200 mg. Corticosteroids (at least 60 mg prednisone or prednisolone) and amitriptyline (up to 50 mg) are possibly effective in the treatment of withdrawal symptoms. Patients after withdrawal therapy should be followed up regularly to prevent relapse of medication overuse. Discussion and conclusion:  Medication overuse headache can be treated according to evidence-based recommendations.

Vitamin D, cognitive dysfunction and dementia in older adults ; Dickens AP, Lang IA et al.; CNS Drugs 25 (8), 629-39 (Aug 2011)

A randomized, double-blind, placebo-controlled trial of simvastatin to treat Alzheimer disease ; Sano M, Bell KL et al.; Neurology (Jul 2011)

Evaluation of C-reactive protein prior to and on-treatment as a predictor of benefit from atorvastatin: observations from the Anglo-Scandinavian Cardiac Outcomes Trial ; Sever PS, Poulter NR et al.; European Heart Journal (Jul 2011)

Influence of Low-Dose Aspirin (81 mg) on the Incidence of Definite Stent Thrombosis in Patients Receiving Bare-Metal and Drug-Eluting Stents ; Lotfi A, Cui J et al.; Clinical Cardiology (Jul 2011)

Eye Disease? There’s an App for That

Rotigotine transdermal patch: a review of its use in the treatment of Parkinson's disease ; Sanford M, Scott LJ; CNS Drugs 25 (8), 699-719 (Aug 2011)

Primary prevention of coronary heart disease: integration of new data, evolving views, revised goals, and role of rosuvastatin in management. A comprehensive survey ; Kones R; Drug Design, Development and Therapy 5 325-80 (2011)

Lipid lowering therapy in type 2 diabetes ; Föger B; Wiener Medizinische Wochenschrift 161 (11-12), 289-296 (Jun 2011)

Antidepressants and the risk of sudden cardiac death and ventricular arrhythmia ; Leonard CE, Bilker WB et al.; Pharmacoepidemiology and Drug Safety (Jul 2011)

Fentanyl for breakthrough pain: a systematic review ; Davis MP; Expert Review of Neurotherapeutics 11 (8), 1197-216 (Aug 2011)



Efficacy of antipsychotic augmentation therapy in treatment-resistant obsessive-compulsive disorder - a meta-analysis of double-blind, randomised, placebo-controlled trials] ; Dold M, Aigner M et al.; Fortschritte der Neurologie-Psychiatrie 79 (8), 453-66 (Aug 2011)

Spotlight on denosumab in postmenopausal osteoporosis† ; Moen MD, Keam SJ; BioDrugs 25 (4), 261-4 (Aug 2011)

Cancer mortality reduction and metformin. A retrospective cohort study in type 2 diabetic patients ; Bo S, Ciccone G et al.; Diabetes, Obesity & Metabolism (Aug 2011)

Comparative long-term efficacy and tolerability of pitavastatin 4 mg and atorvastatin 20-40 mg in patients with type 2 diabetes mellitus and combined (mixed) dyslipidaemia ; Gumprecht J, Gosho M et al.; Diabetes, Obesity & Metabolism (Aug 2011)

What is the role of direct renin inhibitors in the treatment of the hypertensive diabetic patient? ; de la Sierra A, Salazar J; Advances in Therapy (Jul 2011)

Antimicrobial resistance in uncomplicated urinary tract infections in 3 California EDs ; Moffett SE, Frazee BW et al.; American Journal of Emergency Medicine (Jul 2011)

A systematic literature review of drug therapies for the treatment of psoriatic arthritis: current evidence and meta-analysis informing the EULAR recommendations for the management of psoriatic arthritis ; Ash Z, Gaujoux-Viala C et al.; Annals of the Rheumatic Diseases (ARD Online) (Jul 2011)

What Would We Do Without Metronidazole? ; Stover KR, Riche DM et al.; American Journal of the Medical Sciences (Aug 2011)

Pitavastatin Calcium: Clinical Review of a New Antihyperlipidemic Medication ; Yee LL, Wright EA; Clinical Therapeutics (Aug 2011)

Influence of preprandial versus postprandial insulin glulisine on weight and glycemic control in patients initiating basal-bolus regimen for type 2 diabetes: a multicenter, randomized, parallel, open-label study (NCT00135096) ; Ratner R, Wynne A et al.; Diabetes, Obesity & Metabolism (Aug 2011)

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UM Study Shows Soy Does Not Help Women During Menopause


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