Update on Extended Treatment for Venous Thromboembolism

The importance of assessing the probability of venous thromboembolism recurrence, a condition that includes deep vein thrombosis and pulmonary embolism, lies in the fact that it is the most important factor in deciding the duration of anticoagulant treatment. Risk of recurrence depends mostly on the presence of a risk factor for developing venous thromboembolism, with patients with unprovoked events being at the higher risk of recurrence. The risk of recurrence needs to be balanced with the risk of bleeding and the potential severity of these thrombotic and hemorrhagic events. In patients with an unprovoked venous thromboembolism who complete treatment for the acute (first 10 days) and post-acute phase of the disease (from day 10 to 3-6 months), decision has to be made regarding prolonged antithrombotic therapy to prevent recurrences. The main goal of extended treatment is preventing recurrences with a safe profile in terms of bleeding risk. Many therapeutic options are now available for these patients, including antiplatelet therapy with aspirin or direct oral anticoagulants. Moreover, apixaban and rivaroxaban at prophylactic doses have demonstrated efficacy in preventing recurrences with a low risk of bleeding

Disforia de Género - Um Olhar para um Novo Diagnóstico

Objectivos: 1. Rever a entidade disforia de género, no que concerne ao diagnóstico, prevalência, comorbilidades e tratamento. 2. Alertar os profissionais que trabalham com crianças e adolescentes para a existência desta entidade com o objectivo de a identificarem, diagnosticarem e orientarem precocemente estes doentes. Métodos: Foi realizada uma pesquisa em motores de busca em inglês e português na Pubmed, B-on, Elsevier, com as palavras chave “gender dysforia”; “gender identity disorder”; “transsexual”; “early diagnosis”; “hormone therapy”; “transsexual parenthood”, com data de publicação entre os anos de 1998 e 2014. Resultados e Conclusões: O diagnóstico de disforia de género do DSM 5 permite chegar mais facilmente ao sofrimento da criança, adolescente ou adulto. É por isso muito importante que este diagnóstico seja feito o mais precocemente possível, para se agir em conformidade. Sabe-se que a disforia de género nas crianças, não culmina sempre em transexualismo, é por isso fundamental fazer uma avaliação cuidada e reduzir o stress existente quer nas crianças, quer nas suas famílias. É importante orientá-los, logo que possível, para uma equipa multidisciplinar experiente na área, com o objectivo de iniciar os tratamentos no período crítico (nomeadamente a supressão hormonal). A Terapia de Substituição Hormonal (TSH) e as cirurgias de reatribuição sexual são tratamentos disponíveis, sempre que sejam indicados. A avaliação do contexto psicossocial e as intervenções psicoterapêuticas são abordagens fundamentais nestes doentes.info:eu-repo/semantics/publishedVersio

Suplemento especial reflexiones en una pandemia

En este suplemento especial se presenta una compilación de los artículos, en forma reseñada, y las imágenes que los acompañaron, publicados en el semanario CRUCE, del ITESO, como parte de la serie “Reflexiones éticas en una pandemia”, que se desarrolló como respuesta y aporte de la comunidad universitaria para impulsar la reflexión y comprensión, desde la ética, de la nueva realidad y los desafíos que vinieron aparejados con la llegada de la covid–19 a México.ITESO, A.C

Using clinical research networks to assess severity of an emerging influenza pandemic

BACKGROUND: Early clinical severity assessments during the 2009 influenza A H1N1 pandemic (pH1N1) overestimated clinical severity due to selection bias and other factors. We retrospectively investigated how to use data from the International Network for Strategic Initiatives in Global HIV Trials, a global clinical influenza research network, to make more accurate case fatality ratio (CFR) estimates early in a future pandemic, an essential part of pandemic response. METHODS: We estimated the CFR of medically attended influenza (CFRMA) as the product of probability of hospitalization given confirmed outpatient influenza and the probability of death given hospitalization with confirmed influenza for the pandemic (2009-2011) and post-pandemic (2012-2015) periods. We used literature survey results on health-seeking behavior to convert that estimate to CFR among all infected persons (CFRAR). RESULTS: During the pandemic period, 5.0% (3.1%-6.9%) of 561 pH1N1-positive outpatients were hospitalized. Of 282 pH1N1-positive inpatients, 8.5% (5.7%-12.6%) died. CFRMA for pH1N1 was 0.4% (0.2%-0.6%) in the pandemic period 2009-2011 but declined 5-fold in young adults during the post-pandemic period compared to the level of seasonal influenza in the post-pandemic period 2012-2015. CFR for influenza-negative patients did not change over time. We estimated the 2009 pandemic CFRAR to be 0.025%, 16-fold lower than CFRMA. CONCLUSIONS: Data from a clinical research network yielded accurate pandemic severity estimates, including increased severity among younger people. Going forward, clinical research networks with a global presence and standardized protocols would substantially aid rapid assessment of clinical severity

WTO must ban harmful fisheries subsidies

Sustainably managed wild fisheries support food and nutritional security, livelihoods, and cultures (1). Harmful fisheries subsidies—government payments that incentivize overcapacity and lead to overfishing—undermine these benefits yet are increasing globally (2). World Trade Organization (WTO) members have a unique opportunity at their ministerial meeting in November to reach an agreement that eliminates harmful subsidies (3). We—a group of scientists spanning 46 countries and 6 continents—urge the WTO to make this commitment..