Check Up: So far, very little flu

CDC Director Gerberding Gives Green Light to G...
CDC Director Gerberding Gives Green Light to Gardasil then Goes to Work for Merck (g1a2d0049c1) (Photo credit: watchingfrogsboil)

Check Up: So far, very little flu

The U.S. Centers for Disease Control and Prevention has confirmed what you already guessed: This has been a remarkably mild flu season.
The influenza virus likes cold weather, so infections normally occur from October through March. But technically, the flu season doesn’t start until labs that test respiratory swabs from sick people find the virus in more than 10 percent of the samples.
This season, that threshold wasn’t reached until the week ended Feb. 11, making this the kindest flu spell in 29 years.
Pennsylvania, for example, had only 80 confirmed cases in all of January – barely more than one achy, feverish, nauseated citizen per county.
What’s going on?
No one really knows.
“With flu, everything is unpredictable,” said immunologist Scott Hensley, a flu expert at the Wistar Institute in Philadelphia. “I don’t think we’re out of the woods; it could just be a delayed season.”
Then again, maybe the flu has been as scarce as snow because snow has been scarce.
“Flu is more easily transmitted in colder temperatures. This has been a mild winter,” Hensley said.
Another theory is that the population has high levels of immunity to the influenza strains now circulating, which include the one that caused the 2009 “swine flu” pandemic. Because the strains have been so stable, people have had time to develop antibodies against them. Vaccination has also boosted immunity.
Although Hensley subscribes to this theory, he adds a caveat: “If that’s true . . . the virus will start mutating” to evade human defenses. “A novel strain might emerge in the next couple of months.”
While there’s no room for complacency, let us celebrate the signs, monitored by the CDC, that the flu has given the nation a respite:
One person per 100,000 has been hospitalized with the flu since October. That’s a 95 percent drop from last season’s rate of 22 people per 100,000.
Only 1 percent to 2 percent of visits to doctors since October have been for flulike illness. The usual rate is 3 percent to 8 percent.
This flu season, there have been three flu-related deaths among children, compared with 122 pediatric deaths last season – and 348 during the 2009 pandemic.
– Marie McCullough

Read more: Watch sports videos you won’t find anywhere else

La enfermedad arterial periférica es una manifestación común de la aterosclerosis cuya prevalencia aumenta con la edad (12% en la población general, alcanzando el 20% en mayores de 70 años) y la presencia de factores de riesgo cardiovascular. El tabaco (más del 80% de los pacientes son o han sido fumadores) y la diabetes mellitus son los principales factores de riesgo1,2.
La mayoría de las personas con esta enfermedad se encuentran asintomáticas y su diagnóstico requiere del cálculo del índice tobillo/brazo junto con una anamnesis y exploración física completa1,3,4.
Alrededor de un tercio de los pacientes con enfermedad arterial de las extremidades inferiores presentan sintomatología5. Dentro de estos síntomas, la claudicación intermitente es el más característico, y se define como un dolor intenso y atenazante en grupos musculares de la extremidad afectada, que aparece al caminar y se alivia con el reposo6.
La enfermedad cardiovascular es la principal causa de muerte en pacientes con claudicación intermitente, por lo que el abordaje de esta patología debe centrarse no solo en mejorar la movilidad y la calidad de vida, sino también en disminuir el riesgo cardiovascular. Para ello han de llevarse a cabo varios tipos de intervenciones1-7:
– Control de los factores de riesgo cardiovascular con especial énfasis en el ejercicio físico y el abandono del tabaco.
– Tratamiento antiagregante.
– Tratamiento farmacológico para el alivio de los síntomas.
– Angioplastia o revascularización cuando la sintomatología es incapacitante a pesar del tratamiento conservador1,3,4.

Las alertas de seguridad y los cambios producidos en la disponibilidad de varios fármacos utilizados en el alivio de los síntomas de la claudicación intermitente hacen necesario actualizar la información disponible y en este aspecto se va a centrar este boletín INFAC
Te recomendamos su lectura haciendo clic aquí 
Equipo de GAPURMED y Excellencis
El boletín INFAC es parte de la Sociedad Internacional de Boletines de Medicamentos, independientes de la industria farmacéutica (ISDB)

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Who defends lilly and novonordisk diabetes meds

Source: Pharmalot

conflictsofinterest212The scene at the European Association for the Study of Diabetes being held in Lisbon this week has included a heated debate over the extent to which a particular type of diabetes medicine called GLP-1 therapies can increase the risk of pancreatic and thyroid cancer. These include Byetta, which is sold by Eli Lilly and its partner, Amylin Pharmaceuticals, and Victoza, which is marketed by Novo Nordisk.
The issue has actually been percolating for more than a year (read here), although a review published two months ago in Gastroenterology that reviewed the FDA database of side effects showed patients taking Byetta had a much larger chance of developing pancreatitis, which can increase the risk of tumors (read the abstract). The drugmakers maintain their meds are safe.
And so there was a debate among researchers in attendance, including Peter Butler of the University of California at Los Angeles, who was one of the authors of the Gasterenterology study. One of his opponents was Michael Nauck, head of the Diabeteszentrum Bad Lauterberg in Germany, who told Bloomberg News that “the bulk of findings tends to speak against such an association. There is no general agreement.”
In fact, he believes the FDA database not only fails to establish a link to thyroid and pancreatic cancer, but may instead show the drugs could protect against other forms of cancer, such as prostate tumors. “Looking at same database and using very, very similar methods, I find evidence that some forms of cancer are reduced.”
Similarly, Matteo Monami, a physician at the University of Florence and Carreggi Teaching Hospital in Italy, told Bloomberg that the Gasteroenterology study is “erroneous analysis” and its results “are really not reliable at all.” He presented a study showing no increase in cancer or pancreatitis for so-called dipeptidyl peptidase-4 inhibitors such as Januvia.
However, what was not made clear is that both Nauck and Monami have ties to the drugmakers that sell the GLP-1 treatments. For instance, Nauck has worked as a consultant to both Lilly and Novo Nordisk, and also received clinical research grants from both drugmakers (look here). And Monami has received speaking fees from Lilly (see this).
Of course, it does not automatically follow that one or both researchers is biased due to their relationships with either drugmaker. Just the same, such ties would have been helpful to know, given that they were rather outspoken in defending the medications at an important meeting where the scientific community gathers to absorb and ponder research that is used to influence medical practice.

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Effect of early intensive multifactorial therapy on 5-year cardiovascular outcomes in individuals with type 2 diabetes detected by screening (ADDITION-Europe): a cluster-randomised trial

Age-standardised disability-adjusted life year...                          Image via WikipediaGriffin SJ, Borch-Johnsen K, Davies MJ, et al. Effect of early intensive multifactorial therapy on 5-year cardiovascular outcomes in individuals with type 2 diabetes detected by screening (ADDITION-Europe): a cluster-randomised trialLancet. 2011 Jun 24. (Original) PMID: 21705063

BACKGROUND: Intensive treatment of multiple cardiovascular risk factors can halve mortality among people with established type 2 diabetes. We investigated the effect of early multifactorial treatment after diagnosis by screening.
METHODS: In a pragmatic, cluster-randomised, parallel-group trial done in Denmark, the Netherlands, and the UK, 343 general practices were randomly assigned screening of registered patients aged 40-69 years without known diabetes followed by routine care of diabetes or screening followed by intensive treatment of multiple risk factors. The primary endpoint was first cardiovascular event, including cardiovascular mortality and morbidity, revascularisation, and non-traumatic amputation within 5 years. Patients and staff assessing outcomes were unaware of the practice`s study group assignment. Analysis was done by intention to treat. This study is registered with, number NCT00237549.
FINDINGS: Primary endpoint data were available for 3055 (99.9%) of 3057 screen-detected patients. The mean age was 60.3 (SD 6.9) years and the mean duration of follow-up was 5.3 (SD 1.6) years. Improvements in cardiovascular risk factors (HbA(1c) and cholesterol concentrations and blood pressure) were slightly but significantly better in the intensive treatment group. The incidence of first cardiovascular event was 7.2% (13.5 per 1000 person-years) in the intensive treatment group and 8.5% (15.9 per 1000 person-years) in the routine care group (hazard ratio 0.83, 95% CI 0.65-1.05), and of all-cause mortality 6.2% (11.6 per 1000 person-years) and 6.7% (12.5 per 1000 person-years; 0.91, 0.69-1.21), respectively.
INTERPRETATION: An intervention to promote early intensive management of patients with type 2 diabetes was associated with a small, non-significant reduction in the incidence of cardiovascular events and death.
FUNDING: National Health Service Denmark, Danish Council for Strategic Research, Danish Research Foundation for General Practice, Danish Centre for Evaluation and Health Technology Assessment, Danish National Board of Health, Danish Medical Research Council, Aarhus University Research Foundation, Wellcome Trust, UK Medical Research Council, UK NIHR Health Technology Assessment Programme, UK National Health Service R&D, UK National Institute for Health Research, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, Novo Nordisk, Astra, Pfizer, GlaxoSmithKline, Servier, HemoCue, Merck.