Aspectos prácticos de medicina basada en evidencias

Si se considera a la historia como algo más queun depósito de anécdotas o cronología, puedeproducir una transformación decisiva de laimagen que tenemos actualmente de la ciencia.Ya desde 1962 Thomas S. Kuhn remarcaba laimportancia del cambio y transformación de losparadigmas en el campo científico considerandocomo paradigma a un modelo o patrón aceptado.En esta aplicación común, el paradigma funcionapermitiendo la renovación de ejemplos cada unode los cuales podría servir para reemplazarlo. Enciencia un paradigma es raramente un objetopara renovación, en lugar de ello, tal y como unadecisión judicial aceptada en el derecho común,es un objeto para una mayor articulación yespecificación, en condiciones nuevas o másrigurosas1. El desarrollo de la Medicina Basada enEvidencias (MBE) surge como un nuevoparadigma que busca responder a las nuevas necesidades, sociales, económicas y culturalescontemporáneas

Comparison of Rifaximin and Lactulose for the Treatment of Hepatic Encephalopathy: A Prospective Randomized Study

Rifaximin has been reported to be effective for the treatment of hepatic encephalopathy (HE) in Europe. However, it is unknown whether Rifaximin is effective for the treatment of HE in Koreans, therefore we conducted a open-label prospective randomized study to evaluate the efficacy of rifaximin versus lactulose in Korean patients. Fifty-four patients with liver cirrhosis and hepatic encephalopathy were enrolled. Thirty-two patients were randomized to receive rifaximin and 22 to receive lactulose both over a 7-day periods. Before and at the end of treatment, gradation of blood ammonia, flapping tremor, mental status, number connection test (NCT) were performed and estimation of HE indexes determined. Both rifaximin and lactulose were effective in the majority of patients (84.4% and 95.4%, respectively, p=0.315). Blood NH3, flapping tremor, mental status, and NCT was significantly improved by rifaximin and lactulose, and the posttreatment levels of these measures were similar for the rifaximin and lactulose-treated groups, as was the HE index (rifaximin group (10.0→4.2, p=0.000); lactulose group (11.3→5.0, p=0.000)). One patient treated with rifaximin complained of abdominal pain, which was easily controlled. There was no episode of renal function impairment in either treatment group. Rifaximin proved to be as safe and as effective as lactulose for the treatment of Korean patients with hepatic encephalopathy

Ethanol and Cognition: Indirect Effects, Neurotoxicity and Neuroprotection: A Review

Ethanol affects cognition in a number of ways. Indirect effects include intoxication, withdrawal, brain trauma, central nervous system infection, hypoglycemia, hepatic failure, and Marchiafava-Bignami disease. Nutritional deficiency can cause pellagra and Wernicke-Korsakoff disorder. Additionally, ethanol is a direct neurotoxin and in sufficient dosage can cause lasting dementia. However, ethanol also has neuroprotectant properties and in low-to-moderate dosage reduces the risk of dementia, including Alzheimer type. In fetuses ethanol is teratogenic, and whether there exists a safe dose during pregnancy is uncertain and controversial

Nonalcoholic fatty liver disease and its association with cardiovascular disease

An association between non-alcoholic fatty liver disease (NAFLD) and cardiovascular disease (CVD) has been recently suggested. Indeed, different studies have demonstrated that NAFLD patients present increased subclinical atherosclerosis compared to non-steatosic individuals, and are supported by the few follow-up studies revealing that CVD is the second most common cause of death in NAFLD patients. However, the nature of the relationship NAFLD/CVD is still under debate