domingo, 26 de septiembre de 2010

: Neurology Emergencies

Jonathan Edlow, Magdy Selim - Neurology Emergencies
Oxford University Press | ISBN: 0195388585 | 2010-09-30 | PDF | 256 pages | 1.20 Mb

This compact handbook provides all the essential specific steps for assessment and management of emergencies in neurology. Edited by an emergency medicine physician and a neurologist, these chapters are easy to review during or after a busy shift. Focus is placed on the acute patient with both common and complex neurological presentations. Also covered are specific, diagnosis-based problems, including traumatic brain injury, stroke, and seizures. Each chapter is filled with relevant computed tomography, magnetic resonance, and vascular studies, as well as many other images, algorithms, and tables. Neurology Emergencies will prove invaluable not only to busy residents in emergency and internal medicine, family practice and neurology, but also medical students who want to excel. This reference guide will also benefit hospitalists and attendings who care for patients with acute neurological problems.

Best regards

welcome to a good password forum, and medcine forum, we provider special resoucres (some passwords) for donators who donate >100 usd, open

you can use paypal to donate, click the orange donate of index, or you can donate will western union (for member's group higher than Sophomores ),
For more options, visit this group at

miércoles, 8 de septiembre de 2010

Increased risk of death with Tygacil (tigecycline)


Ver en:

FDA Drug Safety Communication: Increased risk of death with Tygacil (tigecycline) compared to other antibiotics used to treat similar infections

Safety Announcement
Additional Information for Healthcare Professionals
Data Summary


Safety Announcement

[09-01-2010] The U.S. Food and Drug Administration (FDA) is reminding healthcare professionals of an increased mortality risk associated with the use of the intravenous antibacterial Tygacil (tigecycline) compared to that of other drugs used to treat a variety of serious infections. The increased risk was determined using a pooled analysis of clinical trials. The cause of the excess death in these trials is often uncertain, but it is likely that most deaths in patients with these severe infections were related to progression of the infection.

The increased risk was seen most clearly in patients treated for hospital-acquired pneumonia, especially ventilator-associated pneumonia, but was also seen in patients with complicated skin and skin structure infections, complicated intra-abdominal infections and diabetic foot infections. Tygacil is not approved for the treatment of hospital-acquired pneumonia (including ventilator-associated pneumonia) or diabetic foot infection. Tygacil is approved by FDA for the treatment of complicated skin and skin structure infections, complicated intra-abdominal infections, and community acquired pneumonia.

FDA has updated the Warnings and Precautions and Adverse Reactions sections of the Tygacil drug label to include information regarding increased mortality risk of Tygacil. Healthcare professionals have also been informed of this increased risk via a Dear Health Care Professional letter.

See the Data Summary Section for details.


Additional Information for Healthcare Professionals

  • The greatest increase in risk of death with Tygacil was seen in patients with ventilator-associated pneumonia, an unapproved use.
  • Alternatives to Tygacil should be considered in patients with severe infections.
  • Report adverse events involving Tygacil to the FDA MedWatch program using the information in the "Contact Us" box at the bottom of this page.


Data Summary

The pooled analysis grouped 13 trials with patients given Tygacil for both approved and unapproved indications by type of infection (see Table below), comparing the overall mortality for Tygacil vs. pooled control agents. Overall, in the trials, death occurred in 4.0% (150/3788) of patients receiving Tygacil and 3.0% (110/3646) of patients receiving comparator antibiotics. An adjusted risk difference for all-cause mortality based on a random effects model stratified by trial weight was 0.6% (95% CI 0.1, 1.2) between Tygacil and comparator treated patients. Results are shown in the following table:


Patients with outcome of death by infection type
Infection Type Tygacil deaths/total patients (%) Comparator Antibiotics deaths/total patients (%) Risk Difference* (95% Confidence Interval)
cSSSI 12/834 (1.4%) 6/813 (0.7%) 0.7 (-0.3, 1.7)
cIAI 42/1382 (3.0%) 31/1393 (2.2%) 0.8 (-0.4, 2.0)
CAP 12/424 (2.8%) 11/422 (2.6%) 0.2 (-2.0, 2.4)
HAP 66/467 (14.1%) 57/467 (12.2%) 1.9 (-2.4, 6.3)
Non-VAP† 41/336 (12.2%) 42/345 (12.2%) 0.0 (-4.9, 4.9)
VAP† 25/131 (19.1%) 15/122 (12.3%) 6.8 (-2.1, 15.7)
RP 11/128 (8.6%) 2/43 (4.7%) 3.9 (-4.0, 11.9)
DFI 7/553 (1.3%) 3/508 (0.6%) 0.7 (-0.5, 1.8)
Overall Adjusted 150/3788 (4.0%) 110/3646 (3.0%) 0.6 (0.1, 1.2) **

cSSSI = Complicated skin and skin structure infection; cIAI = Complicated intra-abdominal infections; CAP = Community-acquired pneumonia; HAP = Hospital-acquired pneumonia; VAP = Ventilator-associated pneumonia; RP = Resistant pathogens; DFI = Diabetic foot infection.

*Risk Difference = the difference between the percentage of patients who died in the Tygacil and comparator antibiotic groups. The 95% CI for each infection type was calculated using the normal approximation method without continuity correction.

† Subgroups of the HAP population

** Overall adjusted (random effects model by trial weight) risk difference estimate

Although for each indication, the mortality difference was not statistically significant, mortality in Tygacil treated patients was numerically greater in every infection, sometimes considerably greater, particularly in ventilator-associated pneumonia. Tygacil is not approved for ventilator associated pneumonia because of an unacceptably low cure rate, as well as excess mortality.

As stated in the package insert, in general, Tygacil is considered bacteriostatic; however, it has demonstrated bactericidal activity against isolates of S. pneumoniae and L. pneumophila. One possible reason for the mortality difference is that in certain severe infections, Tygacil's bacteriostatic mechanism may put it at some disadvantage, although for approved indications, cure rates with Tygacil were generally similar to that seen with the bactericidal active control agents. 

Eddie A. Angles Y.
Medico Infectologo / Tropicalista 
Hospital Nacional Arzobispo Loayza (HNAL)
Grupo de Investigacion Peruano de Enfermedades Infecciosas y Tropicales (GIPEIT)
Cel. 511-996470205


jueves, 2 de septiembre de 2010

Electrocardiografía y arritmias Arango Duque

Electrocardiografía y arritmias

 William Uribe Arango , Mauricio Duque R. Eduardo Medina D.

Edición: P.L.A. Export editores Ltda. 
rústica, 142 páginas, 2005. No  ISBN

Dentro de la misma tónica del manual reseñado arriba este es un libro concebido para médicos generales; es práctico, con ilustraciones muy didácticas y claras y textos que, por sencillos, no dejan de ser completos y adecuados para el nivel al que pretende llegar. Merecen comentario aparte la diagramación y la calidad editorial. En este libro se destaca el colorido de las imágenes y su disposición en relación con el texto que está editado sin economías exageradas en el tamaño de la letra o de los párrafos, lo que hace más fácil la lectura de esta obra.

descargar pdf  
92728 KB 
un solo archivo optimizado, se agregaron marcadores