A todos amigos ,um ótimo Natal , um final de ano com muita alegria , saúde , e paz no coração .Em 2010 , novo ciclo , com muita paz , saúde , e apostar na FORÇA DA VIDA.

Lembrando Drumond :

CORTAR O TEMPO

"Quem teve a idéia de cortar o tempo em fatias,
a que se deu o nome de ano,foi um indivíduo genial.
Industrializou a esperança, fazendo-a funcionar no limite da exaustão.
Doze meses dão para qualquer ser humano se cansar e entregar os pontos.
Aí entra o milagre da renovação e tudo começa outra vez, com outro número e outra vontade de acreditar que daqui pra diante vai ser diferente.."

MUSICAS - ALGUMAS DAS MELHORES DO ANO E OUTRAS PRA RECORDAR

Whizzkids ft. Inusa Dawuda - Rumours Digi Digi (Bob Sinclair )
Welcome To My Head - THUNDERPUSS & BARNES
Tom Boxer feat Jay - A Beautiful Day
Submission Dj's, Dj Nano - Polar 2009 (Alex Guerrero Remix)
Rudenko - Everybody (Extended Mix)
Richard Grey,Erick Morillo - Say The Word ft.Maboo & Nicole Silva)
Remady P&R - No Superstar (Mr. Pink Remix)
R.I.O. - After The Love (Original Radio Edit)
Pitbull - I Know You Want Me
Outsiders feat. amanda wilson - keep this fire burning
Medina- You and I
Loose Change ft Donna - I Need Your Love (Rivaz Sax Mix)
Leonid Rudenko - everybody
R.I.O. - After The Love (Original Radio Edit)
Knob - make u love me ( extended)
JUAN MAGAN & JOSEPO - FRIDAY NIGHT
Ian Carey - SOS (Vocal Mix)
Housequake & Anita Kelsey Shed My Skin (Club Mix)
Grooves feat. Reki D - Relax (Chris Decay Remix)
First State feat._Anita Kelsey - Shed My Skin Set Rip
Electro pumpin - welcome to my world
Electrique - You Could Be Mine (Industrial Mix Extended)
DJ Nano & T. Tommy - Closer(OriginalMix)
D'azoo At Night - I'm Not A Superstar (Radio Edit)
David Guetta,Sebastian Ingrosso Dirty South starring Julie McKnight - How Soon Is Now (Extended Version)
David Guetta ft Novel - Missing You (Original Mix)
David Guetta ft Dirty South & Julie Mcknight - How soon is now
David Guetta ft Akon - sexy chick
David Guetta Feat.Kelly Rowland - When Loves Takes Over
David Guetta feat. Chris Willis - Gettin' Over [Tagged]
David Guetta & Kid Cudi - Memories ( Album Version DRM )
Ian Carey - SOS (Vocal Mix)
David Guetta & Kelly Rowland - Its The Way You Love Me
David Guetta - Memories Ft. Kid Cudi
Darren Bailie - Protect Your Mind 2009 (Ph Electro Remix)
Dario Nuñez feat. Josephine Sweett - Milshake Cover (Original Mix)
BK Duke - Anyway (Ruben Alvarez Remix)
BEP - I Gotta Feeling
Benny Royal - Pada Papaya (Robbie Taylor & Marc Rowlands's Booty Mix)
Antoine Clamaran - When The Sun Goes Down
Alex Gaudino and Steve Edwards - Take me down(To the water)
Agnes - Love Love Love (Extended Mix)

1995 - Snap Feat. Summer - Welcome To Tomorrow
2007 - Beirut -elephant gun

EXCELENTE GRUPO DE Hip-Hop - 2008 - People under the stairs - the fun

Outro - KRS - ONE HIP HOP

musica - para o feriadão

começando : pra ficar coladinho

Taylor Swift - Love Story
Natalie & Nat King Cole(Celine Dion & Julio Iglesias - When I Fall In Love (
Riccardo cocciante - Stiamo Insieme
Claudia Leite e Harmonia do Samba - Eu te prometo

e as baladas :

Agnes - Release Me
Kate Ryan - I Surrender
Late Night Alumni - Empty Streets
Basic Element feat. D-Flex - Touch You Right Now
DUFFY - “MERCY” (Gareth Wyn Mix Radio Edit)
chicane ft jewel - spirit
Kim Sozzi - Feel Your Love
Airscape feat. Jes - My Love
Dj Antoine Vs Mad Mark - Neverending Search
Dash Berlin With Cerf, Mitiska & Jaren - Man On The Run
Aurora Ft. Amanda Wilson - Love Resurrection
Delerium feat. Sarah McLachlan - Silence
Dannii Minogue vs Flower Power - You Won't Forget About Me
Mariah Carey - Touch My Body
Natasha Bedingfield Vs Chicane - Bruised Water (Arcdsa Radio Edit)
Polarkreis_18-allein_allein_(radio_edit)


vai acelerando...........

Lady GaGa - Paparazzi
Solange - I Decided
Sia - Sunday
Keri Hilson feat. Kanye West & Ne-Yo - Knock You Down
Eminem - We Made You
Soulja Boy Tell 'Em ft. Sammie - Kiss Me Thru The Phone

e pra terminar...

Deadmau5 - Arguru

medicina - para quem pratica esportes

Several online weight-loss supplements may have hidden heart risks

13 May 2009

MedWire News: Several non-prescription weight-loss supplements available through

the internet contain ingredients with potentially life-threatening cardiac adverse events, US researchers say.They found that eight of the 12 weight-loss supplements studied contained one or more ingredients associated with cardiac arrhythmias or other life-threatening cardiac events.The team searched for weight-loss supplements and diet pills using three popular internet search engines, and bought the top four non-overlapping hits returned from each search. All supplements had ingredients listed on the label, adding up to a total of 60 different substances. Eleven ingredients - representing eight different substances as more than one name was used for some - were each associated with two or more reports of either cardiac arrhythmias, ventricular tachycardia, ventricular fibrillation, myocardial infarction,cardiac arrest, or death. Eight of the 12 supplements contained one or more of these ingredients, but none of these products had warnings of life-threatening cardiac adverse events on the web pages, labels, or package inserts. One product listed ma huang, or Chinese ephedra, even though the marketing of ephedra-containing products is banned in the USA, report Mehdi Razavi and co-workers at the Texas Heart Institute in Houston.
The other potentially hazardous ingredients were bitter orange (also listed as Citrus aurantium and synephrine HCl), green tea (also listed as Camellia sinensis),
buckwheat, guarana, ginseng (listed as Korean ginseng), licorice root, caffeine anhydrous, and ha huang root. “The use of multiple names for the same substance can cause a great deal of confusion, even for physicians,” said Razavi, whose team reports the findings in the journal Heart Rhythm.

The researchers suggest the general public, health care professionals, and especially

weight-loss consultants need to be educated about these weight-loss supplements.
“We recommend more strict regulation of the sale and marketing of weight-loss
supplements on the Internet,’ they say.
MedWire is an independent clinical news service provided by Current Medicine
Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd;
2009
Heart Rhythm 2009; 6: 658-662
© Copyright

voltando

depois de uma folga....logo colocarei novos artigos medicos e nova listagem de musicas

medicina -consumo de energeticos

NEW YORK (Reuters Health) Apr 03 -
Consumption of energy drinks increases blood pressure and heart rate, and should therefore be avoided by people with ypertension or heart disease, according to results of a small prospective study.
The beverages, marketed to enhance cognitive function and stamina, usually contain caffeine, taurine, sugars, vitamins, and other nutritional supplements, Dr. James S. Kalus, at Henry Ford Hospital in Detroit, and co-authors note in The Annals of Pharmacotherapy for April. The potential hemodynamic or electrocardiographic effects of energy drinks have not been studied.
To look into this, the researchers studied 15 healthy volunteers, 20-39 years of age, who abstained from other dietary sources of caffeine, beginning 48 hours prior to baseline.
The subjects drank 500 mL (2 cans, each containing 100 mg taurine and 100 mg caffeine) of an energy drink over 30 minutes daily for 7 days. On days 1 and 7, blood pressure, heart rate, and electrocardiograms were obtained prior to consuming the drinks and 5 times during the 4 hours afterward.
Mean heart rate increased significantly from baseline by 7.8% on day 1 and by 11.0% on day 7; corresponding increases for systolic blood pressure were 7.9% and 9.6%, and for diastolic blood pressure, 7.0% and 7.8%. EKG parameters did not change significantly.
"Increases in blood pressure and heart rate of the magnitude observed in our study could be significant in persons with known cardiovascular disease," Dr. Kalus and his associates maintain, especially in patients who exhibit impaired baroreflex buffering in response to vasoactive substances. Young individuals with undiagnosed, premature
cardiovascular disease could also be at risk.
They advise clinicians that "consumption of these drinks could, theoretically, be a frequently overlooked cause of altered medication effectiveness or even hospital admissions or emergency department visits."
Ann Pharmacother 2009;43.

musica - sabadão de aleluia

Yves Larock & Steve Edwards - Listen To The Voice Inside
The Saturdays - issues
Shark & Sylvain feat. Lara Love - Call me
RIO - Wen the sun comes down
platnum - trippin ( thomas gold remix)
Milow - Ayo Technology (Veron Remix)
Kurd Maverick - Blue Monday (Vandalism Remix)
Kelly Clarkson - my life would suck without you - x-mix (mptubo)
ian rogers feat kris layne - what to do with you (bunker maxi dub mix)
house rockerz - guardian angel (original mix)
Girls Aloud - the promise - jason nevins ext mix (mptubo)
Girls Aloud - the loving kind - wideboys club mix (mptubo)
Armin van Buuren feat. Jaren & Cathy Burton - Unforgiveable Rain (Mufflerash Mashup)
Antoine Clamaran - Gold Original Extended_mix
shontelle - irt (bimbo jones remix)
Ferry Corsten Featuring Betsie Larkin - made of love
Carol Hahn - i can' t stop the rain
Dianne Wesley - ectasy
edson pride - dreams
2 Tyme Featuring Jenny Jones - missing you
Leah Renee - imaginary boyfriend
The House Keepers - hangin on
Aurora feat Amanda Wilson - love resurrection
brian kent - watcha doin' to me
Pussycat Dolls feat Missy Elliot - watcha think about that ( stonebridge )
Enrique Iglesias Featuring Ciara - takin' back my love

musica - DOMINGO - vale a pena recordar

Collective Soul - Shine
Aly & AJ - Potential Breakup Song
Amy McDonald - Mr Rock and Roll.mp3
Arctic Monkeys - Fluorescent Adolescent
Athlete - Hurricane
augustana - boston
bob_evans - nowhere_without_you
Boys Like Girls - The Great Escape
Fall Out Boy - Thnks Fr Th Mmrs
Garbage - Tell Me Where It Hurts
Goo Goo Dolls - Before Its Too Late (Sam And Mikaelas Theme)
Good Charlotte - Dance Floor Anthem (I Don'T Want To Be In Love)
pink - long way to happy
jon mclaughlin - beautiful disaster
incubus-dig.
Lifehouse - First Time
LifeHouse - Love Of A Life Time
Lifehouse - You And Me
Lifehouse - Everything
The Fray - How To Save A Life
The John Butler Trio - Peaches & Cream
the_pipettes_-_pull_shapes
Travis - Selfish Jean
Thriving Ivory - Angels On The Moon
The Prodigy - Omen
O.A.R. - Shattered (Turn The Car Around)
Justin Townes Earle - Hard Livin
keane-perfect_symmetry
KINGS OF LEON - Revelry
Fall Out Boy - America's Suitehearts
the_airborne_toxic _event - sometime_around_midnight
the_offspring-kristy_are_you_doing_okay
Bravery - Believe
hanson - go

musica - esquentando a próxima Lista

Ian rogers feat kris layne - what to do with you

medicina - ECOCARDIOGRAMA - gordura epicardica e DAC

Epicardial adipose tissue thickness by echocardiography is a marker for the presence and severity of coronary artery disease

Eroglu S et al. – Epicardial adipose tissue (EAT) thickness, easily and non-invasively evaluated by transthoracic echocardiography, can be an adjunc marker to classic risk factors for prediction of coronary artery disease (CAD). Methods

• Study of whether echocardiographic EAT thickness can serve as a marker for presence and severity of CAD
• Review of 150 pts: 100 CAD pts; 50 with normal coronary arteries by diagnostic coronary angiography
• Subjects: 65 women, 85 men; mean age 55.7±7.4 yrs
• Measurement of EAT thickness by 2-D echocardiographic parasternal long- and short-axis views
• Comparison of EAT thickness measurements with angiographic findings

Results

• EAT thickness significantly higher in CAD pts vs pts with normal coronary arteries (6.9±1.5 mm vs 4.4±0.8 mm)
• EAT thickness increased with severity of CAD: multivessel disease 7.4±1.2 mm vs single vessel disease 5.7±1.7 mm
• Gensini's score significantly correlated with EAT thicknes
• EAT thickness of ≥5.2mm had 85% sensitivity and 81% specificity for predicting CAD

musicas - abalando

ladyhawke - my delirium

Natalie Bassingthwaighte - Someday Soon

Evermore - Hey Boys and Girls (Truth of the World Part 2)

Lesley Roy - Unbeautiful

The Script - Breakeven

medicina - aspirina

Aspirin to Prevent Cardiovascular Disease: The Association of Aspirin Dose and Clopidogrel With Thrombosis and Bleeding

Steven R. Steinhubl, MD; Deepak L. Bhatt, MD, MPH; Danielle M. Brennan, MS; Gilles Montalescot, MD; Graeme J. Hankey, MD; John W. Eikelboom, MB, BS, MSc; Peter B. Berger, MD; and Eric J. Topol, MD, on behalf of the CHARISMA Investigators

Results: Daily aspirin doses were categorized as less than 100 mg (75 or 81 mg) (n = 7180), 100 mg (n = 4961), and greater than 100 mg (150 or 162 mg) (n = 3454). The hazard of the primary efficacy end point was the same regardless of dose (adjusted hazard ratio, 0.95 [95% CI, 0.80 to 1.13] for 100 mg vs. less than 100 mg, and 1.0 [CI, 0.85 to 1.18] for greater than 100 mg vs. less than 100 mg). The hazard of the primary safety end point also did not depend on dose (adjusted hazard ratio, 0.85 [CI, 0.57 to 1.26] for 100 mg vs. less than 100 mg and 1.05 [CI, 0.74 to 1.48] for greater than 100 mg vs. less than 100 mg). In patients also receiving clopidogrel, daily aspirin doses greater than 100 mg seemed to be non–statistically significantly associated with reduced efficacy (adjusted hazard ratio, 1.16 [CI, 0.93 to 1.44]) and increased harm (adjusted hazard ratio, 1.30 [CI, 0.83 to 2.04]).

Limitation: The analysis was post hoc, and aspirin use was not randomized or blinded.

Conclusion: Daily aspirin doses of 100 mg or greater were associated with no clear benefit in patients taking aspirin only and possibly with harm in patients taking clopidogrel. Daily doses of 75 to 81 mg may optimize efficacy and safety for patients requiring aspirin for long-term prevention, especially for those receiving dual antiplatelet therapy.

Context

• The optimal aspirin dose for prevention of cardiovascular events is unknown.
  

Contribution

• This post hoc analysis of CHARISMA trial data suggests no overall differences in efficacy or safety by aspirin dose. However, in the subgroup of patients randomly assigned to clopidogrel, there was a hint of reduced efficacy and increased harm with higher doses.
  

Caution

• Patients were not randomly assigned to aspirin dose.
  

Implication

• Lower aspirin doses (75 to 81 mg/d) may optimize efficacy and safety for patients requiring aspirin for long-term prevention, especially those taking clopidogrel.
  

—The Editors

MUSICA - ba DA lando

Milow - Ayo Technology (P&A Remix)

Mando diao- dance with somebody

MadCon - beggin

David Craig - Insomnia

Deborah Cox - Beautiful U R (Gabi Newman Club Remix)www.clubkings.eu

MUSICA - embalando o domingo

Calvin Harris - I'm Not Alone ( link youtube )

Tinchy Stryder ft. Taio Cruz - Take Me Back

MUSICAS - boas lembranças nesse sábado

Pink - "Sober"
The Fray - "You Found Me"
Kanye West - "Heartless"
Carolina Liar - "Show Me What I'm Looking For"
Lady Gaga - "Poker Face"
Jason Mraz - "Lucky (With Colbie Caillat)"
Plain White T's - "1, 2, 3, 4"
Britney Spears - "Circus"
Lily Allen - "The Fear"
Natasha Bedingfield - "Soulmate"
Gabriella Cilmi - "Sweet About Me"
Missy Higgins - "Where I Stood"
Nickelback - "Gotta Be Somebody"
The Script - "The Man Who Can't Be Moved"
Bruce Springsteen - "The Wrestler"
Sara Bareilles - "Gravity"
Buckcherry - "Don't Go Away"
Erin McCarley - "Love, Save The Empty"
James Morrison - "Broken Strings"
Joshua Radin - "I'd Rather Be With You"
The Ting Tings - "That's Not My Name"
John Legend - "Green Light"
David Cook - "Light On"
The Airborne Toxic Event - "Sometime Around Midnight"
Brett Dennen - "Make You Crazy"
Death Cab For Cutie - "Grapevine Fires"
Oren Lavie - "Her Morning Elegance"

MUSICA - ANIMANDO A SEXTA 13

Flo Rida Feat Katy Perry - Right Round

musica - sugestão ( samba, rock , pagode e criatividade )

Grupo Sambô

É um grupo de Ribeirão Preto , muito bom , criativo , versátil .Tem feito shows em São Paulo
Estou recebendo o CD , e logo passarei para os parceiros divulgarem e postarem.
Sem duvida tem tudo pra estourar......

medicina - teste ergometrico / ST em assimtomaticos

Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men: a population-based follow-up study

Jari A. Laukkanen^1,2,*, Timo H. Mäkikallio^2,3, Rainer Rauramaa^4,5 and Sudhir Kurl¹

¹ Research Institute of Public Health, University of Kuopio, PO Box 1627, 70211 Kuopio, Finland
² Lapland Central Hospital, Rovaniemi, Finland
³ Division of Cardiology, Department of Internal Medicine, University of Oulu, Oulu, Finland
⁴ Kuopio Research Institute of Exercise Medicine, Kuopio, Finland
⁵ Department of Clinical Physiology and Nuclear Medicine, University Hospital of Kuopio, Kuopio, Finland

Received 12 August 2008; revised 24 November 2008; accepted 11 December 2008; online publish-ahead-of-print 23 January 2009.

^* Corresponding author. Tel: +358 17 162 910, Fax: +358 17 162 936, Email: jariantero.laukkanen@uku.fi

Aims: Silent electrocardiographic ST change predicts future coronary events in patients with coronary heart disease (CHD), but the prognostic significance of asymptomatic ST-segment depression with respect to sudden cardiac death in subjects without apparent CHD is not well known.

Methods and results: We investigated the association between silent ST-segment depression during and after maximal symptom-limited exercise test and the risk of sudden cardiac death in a population-based sample of 1769 men without evident CHD. A total of 72 sudden cardiac death occurred during the median follow-up of 18 years. The risk of sudden cardiac death was increased among men with asymptomatic ST-segment depression during exercise [hazard ratio (HR) 2.1, 95% confidence interval (CI) 1.2–3.9] as well as among those with asymptomatic ST-segment depression during recovery period (HR 3.2, 95% CI 1.7–6.0). Asymptomatic ST-depression during exercise testing was a stronger predictor for the risk of sudden cardiac death especially among smokers as well as in hypercholesterolaemic and hypertensive men than in men without these risk factors.

Conclusion: Asymptomatic ST-segment depression was a very strong predictor of sudden cardiac death in men with any conventional risk factor but no previously diagnosed CHD, emphasizing the value of exercise testing to identify asymptomatic high-risk men who could benefit from preventive measures.

Key Words: Exercise electrocardiography • Sudden death • Risk factors

medicina -consumo de café e mortalidade pós infarto

Coffee consumption and mortality after acute myocardial infarction: The Stockholm Heart Epidemiology Program

Kenneth J. Mukamal, MD, MPHa, Johan Hallqvist, MD, PhDbc, Niklas Hammar, PhDd, Rickard Ljung, MD, MPH, PhDbe, Katalin Gémes, MScbf, Anders Ahlbom, PhDcd, Staffan Ahnve, MD, PhDbc, Imre Janszky, MD, PhDbf

Received 24 September 2008; accepted 17 November 2008. published online 09 January 2009.

Background

Cohort studies have suggested little effect of coffee consumption on risk of acute myocardial infarction. The effect of coffee consumption on prognosis after myocardial infarction is uncertain.

Methods

In a population-based inception cohort study, we followed 1,369 patients hospitalized with a confirmed first acute myocardial infarction between 1992 and 1994 in Stockholm County, Sweden, as part of the Stockholm Heart Epidemiology Program. Participants reported usual coffee consumption over the preceding year with a standardized questionnaire distributed during hospitalization and underwent a health examination 3 months after discharge. Participants were followed for hospitalizations and mortality with national registers through November 2001.

Results

A total of 289 patients died during follow-up. Compared with intake of <1>P trend .06). Coffee intake was not associated with hospitalization for congestive heart failure or stroke. Candidate lipid and inflammatory biomarkers did not appear to account for the observed inverse association with mortality.

Conclusions

Self-reported coffee consumption at the time of hospitalization for myocardial infarction was inversely associated with subsequent postinfarction mortality in this population with broad coffee intake. If confirmed in other settings, identification of relevant mechanisms could lead to an improved prognosis for survivors of acute myocardial infarction.

Musicas - sugestões do dia

No Can Do - Sugababes
Omen - The Prodigy
Love Etc. - Pet Shop Boys ...........................essa tem tudo pra bombar
Sometime Around Midnight - Airborne Toxic Event
Kristy, Are You Doing Okay - The Offspring
No line on the horizon - U2

Medicina - é bom saber ( guia para usuários de anti-coagulantes orais )

Publicado on line na circulation ( 03/03 / 09 ) , acho que sua distribuição livre , é muito importante , devido ao grande numero de usuários dessas substancias

Medicina adiponectina ( 2 )

: J Cardiometab Syndr. 2009 Dec;4(1):44-49.

The Role of Adiponectin in Obesity, Diabetes, and Cardiovascular Disease.

Kawano J, Arora R.

Department of Medicine, Chicago Medical School, North Chicago, IL.

Nearly 1 in 4 adults in the United States is obese. The connection between obesity and insulin resistance, type 2 diabetes, and cardiovascular disease is a well researched one. The increasing prevalence of each of these diseases has become a growing concern for the medical community. Adiponectin is a collagen-like plasma protein secreted by adipocytes that has been suggested to play a causal role in the development of insulin resistance and cardiovascular disease. The protein has been found to be decreased in cases of insulin resistance, diabetes, atherosclerosis, and coronary artery disease. Up-regulation of adiponectin and its receptor, through the use of thiazolidinediones, has been found to be partially related to insulin sensitization and thus antidiabetic effects. In this review, we discuss adiponectin's antiatherogenic effects, its association with insulin resistance and obesity, and the possibility of using adiponectin and its receptor as a therapeutic target.

Medicina - adiponectina

Diabetes Care. 2009 Feb 24. Effect of drinking on adiponectin in healthy men and women: A randomised intervention study of water, ethanol, red wine and beer with or without alcohol.

Imhof A, Plamper I, Maier S, Trischler G, Koenig W.

Dept. of Internal Medicine II, Cardiology, University of Ulm, Ulm, Germany.

Objective: Moderate alcohol consumption is associated with reduced incidence of type 2 diabetes and cardiovascular mortality and increases adiponectin concentrations but effects might be differ according to gender and beverage consumed. Research design and methods: Seventy-two healthy individuals (22-56 years) were enrolled in this randomised controlled cross-over trial. After wash-out, two interventions for 3 weeks followed: ethanol (concentration 12.5 %), beer (5.6 %), or red wine (12.5 %) equivalent to 30 grams of ethanol per day for men and 20 g/d for women or the same de-alcoholised beverages, or water. Adiponectin was measured by sandwich ELISA. Results: Among females adiponectin significantly increased after with red wine (29,8% p<0.05),>

MUSICA - sugestão - Twilight ( soundtrack )

O livro está sendo muito lido , o filme tambem tem muita procura , a trilha interessante
quem quiser , é só baixar.

Para baixar : http://mptubo.blogspot.com

Impact of stress testing before percutaneous coronary intervention or medical management on outcomes of patients with persistent total occlusion after

O paradoxo de nosso tempo

Hoje temos edifícios mais altos, mas pavios mais curtos.
Auto-estradas mais largas, mas pontos de vista mais estreitos.
Gastamos mais, mas temos menos.
Nós compramos mais, mas desfrutamos menos.
Temos casas maiores e famílias menores.
Mais conhecimento e menos poder de julgamento.
Mais medicina, mas menos saúde.
Bebemos demais, fumamos demais, gastamos de forma perdulária, rimos de menos, dirigimos rápido demais, nos irritamos facilmente.
Ficamos acordados até tarde, acordamos cansados demais...
Multiplicamos nossas posses, mas reduzimos nossos valores.
Falamos demais, amamos raramente e odiamos com muita freqüência.
Aprendemos como ganhar a vida, mas não vivemos essa vida.
Fizemos coisas maiores, mas não coisas melhores.
Limpamos o ar, mas poluímos a alma.
Escrevemos mais, mas aprendemos menos.
Planejamos mais, mas realizamos menos.
Aprendemos a correr contra o tempo, mas não a esperar com paciência.
Temos maiores rendimentos, mas menor padrão moral.
Tivemos avanços na quantidade, mas não em qualidade.
Esses são tempos de refeições rápidas e digestão lenta, de homens altos e caráter baixo, lucros expressivos, mas relacionamentos rasos. Mais lazer, mas menos diversão. Maior variedade de tipos de comida, mas menos nutrição.
São dias de viagens rápidas, fraldas descartáveis e moralidade também descartável e pílulas que fazem de tudo: alegrar, aquietar, matar.

Postado por CLEBER ROSA - praticando humor.blogspot.com

musica - sucesso italiana

giusy ferreri

Percutaneous Coronary Intervention versus Coronary-Artery Bypass Grafting for Severe Coronary Artery Disease

CABG remains the standard of care for patients with three-vessel or left main coronary
artery disease, since the use of CABG, as compared with PCI, resulted in lower rates of
the combined end point of major adverse cardiac or cerebrovascular events at 1 year.


n engl j med 360;10 nejm.org march 5, 2009

Mediterranean diet reduces risk of heart attack, stroke

oston, MA - A new analysis of data from the Nurses' Health Study has shown that women whose diets most closely resemble a traditional Mediterranean diet are significantly less likely to develop heart disease and stroke [1].

Lead researcher Dr Teresa T Fung (Harvard School of Public Health, Boston, MA) told heartwire that many other studies have looked at the effects of this diet on cardiovascular mortality, but this is one of few with enough participants to look at nonfatal events and also is the first to examine stroke as a separate outcome. Fung and colleagues report their findings online February 16, 2009 in Circulation.

"What this adds to the existing literature is that it shows a reduced risk of nonfatal events as well," she notes. "My take on this is that all the data from different studies with different types of dietary patterns are pointing in the same kind of direction: a minimally processed, mostly plant-based diet, with an abundance—not just in terms of quantity but in terms of variety—of different plant foods and fish. I will single out fish because we included fish in our score. Oily fish seem to have a very strong relation in terms of being beneficial."

29% reduced risk of MI, 13% reduction in stroke risk

MUSICA - AXÉ ( O CARNA TÁ AÍ )

Veja abaixo a lista com as 37 músicas da pesquisa do maior portal de axé do Brasil:
Acende a Luz - Negra Cor e Chiclete com Banana
Balançaê Papa - Tomate
Bater Panela - Vixe Mainha
Beijar na Boca - Claudia Leitte
Boca de 09 - Guig Guetho
Cadê Dalila? - Ivete Sangalo
Cadê Xoxó? - Marcelo Quintanilha
Chuva de Flores - Timbalada
Dia do Asa - Asa de Águia
É Amor - Ara Ketu
Eu Fico - André Léllis
Eu Sou Mais Você - Alexandre Peixe
Favela - Parangolé
Flutuar - hiclete com Banana
Good Vibration - A Zorra
Kuduro - Fantasmão
Me Diz Qual É - Via Circular
Meu Farol - VoaDois
Meu Tambor - Motumbá
Moicano - Leva Noiz
Muito Bom - Netinho
Nanã na Aldeia - Carlinhos Brown
Ô Papá - Ricardo Chaves
O Tempo é Bom - Rapazolla
Oyá Por Nós - Daniela Mercury
Pisa na Barata - Bonde do Maluco
Pó pará com pó - Jake
Punhado de Areia - Chica Fé
Raga Maga - Margareth Menezes
Se Ela Entendesse o Meu Amor - Batom na Cueca
Seu Encanto - Mina
Só Eu e Você - Eva
Som Que Vem da Rua - Bué da Fixe
Tchau - Jammil e Uma Noites
Tem Que Ser Você - Victor & Léo
Uma Chance - Harmonia do Samba
Xequerê - Cheiro de Amor

fonte:Redação Carnasite

musica pra abalar o sabado - 3 - Saintpaul Dj

musica pra abalar o sabado - 2 dj antoine

musica pra abalar o sabado - 1 - Dj antoine

cd cardiomusic vol 1

Baixe agora : http://mptubo.blogspot.com/

MUSICA - sugestão de hits

Pussycat Dolls - I Hate This Part
Lily Allen - The Fear
Kelly Clarkson - My Life Would Suck Without You
Jason Mraz - Im Yours
Girls Aloud - The Promise
Kings Of Leon - Sex On Fire
White Lies - To Lose My Life
Ne-Yo - Mad
Beyonce - Halo
T.I. f/ Rihanna - Live Your Life
Rihanna - Rehab
Paramore - Decode
Kevin Rudolf f/ Lil Wayne - Let It Rock
Katy Perry - Thinking Of You
Taylor Swift - Love Story
The Saturdays - Issues
Kings Of Leon - Use Somebody
Franz Ferdinand - Ulysses
Kanye West - Heartless
Leona Lewis - Run
All-American Rejects - Gives You Hell
The Killers - Spaceman,
The Fray - You Found Me

James Morrison f/ Nelly Furtado - Broken Strings

Girls Aloud - The Loving Kind

MEDICINA - PARADA CARDIO-RESPIRATORIA

Vale a pena ler, mesmo quem não é da área , voce pode ler apenas as manobras básicas de ressuscitação , e com isso ajudar alguem.
Em breve postarei tópico com este mesmo assunto , em linguagem popular, afinal , ninguém sabe quando lhe poderá ser útil.
Agradeço as Dras Amanda e Marcela , as quais não conheço , por terem divulgado este e outros tópicos , assim disponibilizando para todos na Net.

fonte : Scribd - ACLS -2005 - AMANDA E MARCELA

MUSICA - Conheça - andy stochansky

Andy Stochansky - Shine

fonte : radiola ( faz parte do megamix 477 )

MEDICINA -Majority of patients hospitalized with CAD at guideline-recommended LDL targets

blog com as melhores musicas para ouvir e baixar

http://mptubo-radiola.blogspot.com/

lady gaga - love game

fonte :dj robson michel

36 sucessos com 4 acordes

fonte : revista pix

pra balada >The Wiseguis - Ooh la la

pra balada > soulwax -NY lipps

redefinindo INFARTO AGUDO DO MIOCARDIO

Recent clinical trials results combined with registry data demonstrate the safety and efficacy of the use of drug-eluting stents (DES) in patients with acute myocardial infarction (AMI) at least at one year. But beyond one year, will ongoing evaluation confirm these findings? What are the barriers to managing patients with DES? When should bare metal stents be utilized? How can we reduce stent thrombosis without increasing bleeding? Join our panel of experts, Drs Stone, White, and Harrington as they discuss major new clinical trial evidence on the optimal management of patients with AMI

erick morillo - where are you now

Cytochrome P450 2C19 polymorphism in young patients treated with clopidogrel after myocardial infarction: a cohort study

Original Text

Jean-Philippe Collet MD a, Jean-Sébastien Hulot MD b, Anna Pena PhD a, Eric Villard PhD b, Jean-Baptiste Esteve MD a, Johanne Silvain MD a, Laurent Payot MD c, Delphine Brugier PhD a, Guillaume Cayla MD a, Farzin Beygui MD a, Gilbert Bensimon MD b, Prof Christian Funck-Brentano MD b, Prof Gilles Montalescot MD a

Summary

Background

Clopidogrel and low-dose aspirin have become the mainstay oral antiplatelet regimen to prevent recurrent ischaemic events after acute coronary syndromes or stent placement. The frequent genetic functional variant 681 G>A (*2) of cytochrome P450 2C19 (CYP2C19) is an important contributor to the wide variability between individuals of the antiplatelet effect of clopidogrel. We assessed whether the CYP2C19*2 polymorphism affected long-term prognosis of patients who were chronically treated with clopidogrel.

Methods

Between April 1, 1996, and April 1, 2008, 259 young patients (aged <45>CYP2C19*2 determination. The primary endpoint was a composite of death, myocardial infarction, and urgent coronary revascularisation occurring during exposure to clopidogrel. Follow-up was every 6 months. The key secondary endpoint was stent thrombosis proven by angiography.

Findings

Median clopidogrel exposure time was 1·07 years (IQR 0·28—3·0). Baseline characteristics were balanced between carriers (heterozygous *1/*2, n=64; homozygous *2/*2, n=9) and non-carriers (n=186) of CYP2C19*2 variant. The primary endpoint occurred more frequently in carriers than in non-carriers (15 vs 11 events; hazard ratio [HR] 3·69 [95% CI 1·69—8·05], p=0·0005), as did stent thrombosis (eight vs four events; HR 6·02 [1·81—20·04], p=0·0009). The detrimental effect of the CYP2C19*2 genetic variant persisted from 6 months after clopidogrel initiation up to the end of follow-up (HR 3·00 [1·27—7·10], p=0·009). After multivariable analysis, the CYP2C19*2 genetic variant was the only independent predictor of cardiovascular events (HR 4·04 [1·81—9·02], p=0·0006).

Interpretation

The CYP2C19*2 genetic variant is a major determinant of prognosis in young patients who are receiving clopidogrel treatment after myocardial infarction.

Funding

Délégation à la Recherche Clinique, Assistance Publique-Hôpitaux de Paris.

Como é feita a gravação de uma música?

Como é feita a gravação de uma música?

De forma bem diferente da que rolaria na garagem onde você ou algum de seus amigos barbarizam a vida dos vizinhos. Um estúdio profissional dispõe de salas, instrumentos, equipamentos e técnicos para transformar o som de uma banda em arquivos digitais que, mais tarde, podem virar um álbum ou ser disponibilizados na internet. Há desde estúdios mais bombados - com vários ambientes, alguns capazes de comportar até uma orquestra - até os mais compactos, que seguram bem a onda de uma banda de rock enxuta. }:o]

“GARAGEM” DE RESPEITO
O produtor e o técnico de som monitoram o processo para garantir a sonoridade perfeita para o álbum

Antes de gravar pra valer, a banda “passa o som” - é uma espécie de ensaio para que o técnico ajuste o nível dos sons (graves, médios e agudos) que serão captados das vozes e dos instrumentos. Esse processo é conhecido como equalização.

A bateria é a primeira a entrar em cena - ela compõe, junto com o contrabaixo, a base da gravação. Para ajudar o artista a marcar o ritmo da música, um clique fica pulsando constantemente no retorno (fone de ouvido pelo qual os músicos ouvem o que todos estão tocando).

O resto da banda pode gravar junto ou após a base. Depois de captado, o som passa por um pré-amplificador e chega à interface, aparelho que faz a digitalização da sonzeira antes de mandá-la ao computador. Em geral, o grupo toca várias sessões de uma mesma canção antes de passar para a seguinte.

No processo de edição, produtor e técnico podem manipular o som graficamente por meio de softwares, fazendo ajustes de afinação, além de “recortar” e juntar os melhores trechos de cada sessão para, assim, montar uma versão ideal da música.

O som chega separadamente em cada um dos mais de 90 canais da mesa de som. Na mixagem, são programados, canal por canal, efeitos e variações de volume que dão mais dinâmica à música – isso é feito com a ajuda de equalizadores e outros aparelhos.

A sonzeira toda é condensada em dois canais - direito e esquerdo - para obter o efeito estéreo que se ouve em qualquer fone de ouvido. Daí, vai para a masterização. É hora de, entre outras coisas, uniformizar o volume entre as faixas e escolher a sequência delas no álbum.

Ao final da masterização, temos dois produtos: o CD master - matriz que será enviada à fábrica para gerar milhares de cópias - e os arquivos compactados (mp3, wma etc.), que podem ser disponibilizados na internet.

ANTIVAZAMENTO
Quando o som é captado por microfones - como no caso da bateria e da voz -, a coisa rola numa sala isolada (chamada de aquário), para que o som de um músico não vaze para o microfone de outro. Para o vocal, uma telinha ainda filtra os sons de “p”, que podem “estourar” na gravação.

TURMA DO ABAFA
A acústica ideal é garantida por meio de painéis e revestimentos de madeira e lã mineral, posicionados nas paredes e no teto. Eles diminuem a reflexão das ondas sonoras (o eco), ajudando a captar um som mais puro. Outras peças móveis, como biombos, também fazem esse papel.

VIDRO À PROVA DE FALA
Para isolar os ambientes e evitar zumbidos penetras, as janelas são feitas com dois vidros laminados bem grossos - de até 2 cm de espessura - separados por um vão de ar. Já as portas, reforçadas, pesam até 150 kg.

O SOM DO SILÊNCIO
Essencial, o isolamento acústico evita que ruídos entrem e saiam do estúdio. Em nosso modelo, isso se dá por meio de três camadas: uma parede externa, feita de blocos de concreto, com 20 cm de espessura, preenchidos de areia; um intervalo de ar, de 5 cm; e uma segunda parede, de pelo menos 20 cm.

SONZEIRA ELETRIZANTE
Na sala principal, capta-se o som dos instrumentos elétricos - como isso é feito por cabos, ele não se propaga pelo ar. Dá até pra gravar uma voz-guia nesta sala, já que a zoeira da banda não vaza para o microfone do cantor. Mesmo assim, o vocal definitivo é gravado no aquário, isolado de qualquer ruído, como o de pessoas andando.

Via MundoEstranho

Para maiores de 30 anos

fonte ( blog 21 centigrados )

A melhor maneira de identificar as pessoas que pertencem à mesma geração é comparar as lembranças e os hábitos. Aqui vai um teste.
Se você tem 30 anos ou mais, com certeza vai se identificar.
Você lembra?…

1. Quando Tancredo morreu e ficavam tocando “Coração de Estudante” o dia todo na TV?
2. Daquelas chupetinha doces, balas Banda, Boneco ou de Banana na saída da escola?
3. Já ouviu falar em contaminação por radiação em Goiânia?
4. Relógios Gran Prix para homens e Champions para mulheres (aqueles que trocavam de pulseira) faziam parte do seu dia-a-dia?
5. Leu “Memórias de um Cabo de Vassoura” ,”O Mistério do Cinco Estrelas” ou “O Escaravelho do Diabo” para a prova de português da 4a serie?
6. Você assistiu filmes de ficção científica como Guerra nas Estrelas, Blade Runner, e outros?
7. Comprou a fita do Plunct-Plact-Zum (não vai a lugar nenhum) e assistiu ao programa com o Raul Seixas?
8. Assistia na seção comedia Super Vicky e Caras e Caretas?
9. Chips, antes de virarem batatas, eram 2 policiais?
10. Assistia Armação Ilimitada e Globo de Ouro?
11. Tinha medo das reportagens do Helio Costa no Fantástico?
12. O Jô, antes de ser tão inteligente, fazia o Capitão Gay na Globo, Acompanhado do Carlos Sueli (o mesmo do “cala boca Batista”).
13. Você jogava Genius e Merlin?
14. Colecionava Mad?
15. Se agonizava, quando no Domingo no Parque trocavam uma bicicleta por uma caixa de fósforos? E o Qual e a Musica?
16. E quando o Silvio Santos dava um milho verde enorme para quem pedia de presente um milhão. O premio do Bau era sempre um Fusca Branco da Vimave? E os jurados do Chacrinha?
17. Se lembra que o tênis Montreal (”porque você e jovem”) era anti-microbiotico?
18. Brincava de Acquaplay ?
19. Sabe o que era Trovao Azul, Super Maquina e curtia pra caramba a Ferrari do Magnum ?
20. Se lembra da briga entre VHS e Betamax ? E entre Odissey e Atari? Jogava paredão no TeleJogo.
21. Usou tênis Rainha sem cadarço, ate o dedão furar na ponta?
22. Se lembra do comercial - “Não esqueça da minha Caloi”?
23. Babava pelos Relógios Casio com joguinhos (Batalha espacial, batalha naval e pirâmide)?
24. Tentava imitar o saque Jornada nas Estrelas do Bernard?
25. Ficou alegre no final da A Incrível Fabrica de Chocolates?
26. Tentava imitar o andar para tras’ do Michael Jackson? Se lembra do ritmo “break”?
27. Andava de Caloi-Cross Extra Light, com canote torto, banco concorde e adesivos Kuwahara?
28. Ou então de Ceci com cestinha ou dobravelzinha?
29. Assistiu todos os filmes do Jerry Lewis na Sessão da Tarde?
30. Comia, ainda, AAS infantil como se fosse bala?
31. Pulava ao ver o programa do palhaço Carequinha?
32. Adorava ver o Bozo pendurado no nariz, vermelho e enorme, do cenário?
33. Se lembra que você tinha medo da Cuca, do Sitio do Pica-Pau Amarelo e que ficava triste depois do desenho do Pinóquio na Record?

E mais:
1. Jogava Boliche, River Raid, Enduro, PacMan, Frogger, Pitfall, Tênis e Decatlon no Atari
2. Os Saltimbancos
3. Achar que o Telê Santana e o Cerezo eram pé frio.
4. Assistir A Feiticeira e Jeanie é Um Gênio antes do Agente 86
5. Sitio do Pica-pau Amarelo
6. Desenhos do Homem de Ferro, Incrivel Hulk e do Capitao América (aqueles em que o personagem só mexia a boca)
7. Seriado do Batman (Bif, Pow, Sock, Smack. - mesma bat-hora, mesmo bat-canal)

Quem não:
1. Cantou Ursinho Blau Blau e “Mama-Maria”?
2. Ouviu (Odiou) Menudo (Não se reprima…), Tremendo (todos batendo palmas, isso e tremendo…) e Domino (Companheiro vem, vem no balanço do mar…)?
3. Torceu contra a Lucinha Lins (Purpurina) no Festival dos Festivais (Lembra dos Abelhudos - “Diz qual e o nome, do dono da terra,…)?
4. Achou que o Gurgel ia ser, finalmente, o carro nacional?
5. Jogou Super Trunfo de carro, moto, tanque e avião?
6. Teve revolver de espoleta ( Fox - 6 tiros ou Fúria - 12 tiros)?
7. Viu a estréia do Balão Mágico com Mike (o filho do ladrão), Tob e Simony?
8. Pediu para o pai comprar ou trocar o carro por um Chevette Jeans,
ou pelo novíssimo Del Rey, que tinha vidros elétricos e era a álcool?
9. Morria de medo de ser ovado na escola e na quadra no dia do aniversário?

E você também:
1. Brincou de Vai-Vem;
2. Teve Tonka ou Velotroll;
3. Teve Geleka e Massa Lunar, e quase quebrou o braco com aquelas
bolotas que ficavam presas a um fio e ficavam batendo em cima e embaixo, enchendo o saco de todo mundo com aquele ectectectectectectectectectectetec…;
4. Ficava, com os amigos, assistindo Warriors na casa de um felizardo que tinha videocassete; (PHILIPS prateado)
5. Colecionou io-io da Coca-Cola e nunca conseguiu fazer a “Teia da Aranha” como aqueles gringos que faziam a demonstração no shopping center;
6. Colecionava garrafinhas de MiniCoke e Fanta;
7. Ficava tentando pegar interferência de telefone sem fio (Cobra);
8. Sonhava com aquele Walkman da Sony que pesava 1 tonelada, chiava pra burro e gastava 4 pilhas pequenas por dia;
9. Gostava de ver a Xuxa batendo nos baixinhos no programa da Manchete e cantando “O Alfabeto da Xuxa - A de Amor, B de Baixinho, C de Coração…”;

Para mulheres:
1. Usava caneta de 10 cores com cheiro?
2. Você tinha Melissinha sabor Coca Cola?
3. Colecionava as figurinhas de bichinhos que vinham no chocolate surpresa?
4. Brincava de Fofolete?
5. Colecionava papel de carta da Hello Kitty, Bonnie e Clyde e Moranguinho?
6. Usou saia balone? E calca semi-bag, delave?
7. E sandália de plástico com meia soquete prateada?
8. Usou aquelas pulseirinhas de linha, que tinham o nome da pessoa?
9. Assistiu ao show do A-Ha e achava o Morten liiiiiiiindo?
10. Brincava de bambole - antes de se chamar bambotchan?
11. Morria de pena da Polyanna, que pregava o “jogo do contente”?
12. Comprava aqueles discos tipo “Hits 82″, que sempre tinham na capa uma moca andando de bicicleta, de costas, com close no bumbum?

Para os homens:
1. Você teve o forte apache Guliver, o Falcon e seu magnífico helicóptero e equipamento de mergulho, o circo do Playmobil?
2. Brincava de Autorama com o TCR ou de Ferrorama?
3. Você gostava mais de Ultraman, Spectroman ou Ultra Seven? Lembra do Robo Gigante com cara de Esfinge Egipcia? E do Speed Racer com o seu Mach-5?
4. Queria um Kichute, pois era uma chuteira confortável?
5. Usou calca OP verde limão com a camiseta Hang Loose laranja, achando que estava combinando? E as roupas das Lojas Twin ( em Moema)
6. Para arrematar, o tênis quadriculado, pintado a mão?
7. E o gel New Wave no cabelo?
8. Dançou como Travolta os “Embalos de Sabado a Noite” e Achou a Sandy de “Nos Tempos da Brilhantina ” uma chata de galocha?
9. Comprou o disco dos Bee Gees ?
10. Acha Roger Moore o 007 ( ” O Espião que me Amava”) o mais charmoso?
11. Sabia cantar quase todas as musicas da Blitz (Você não soube me amar..”)?
12. Colecionou figurinhas Ping Pong com os jogadores do campeonato nacional.
13. Comprava “Transfer” na banca e colava as figuras em todo lugar, riscando com caneta BIC.
14. Colecionava Futebol Cards (aquele com chiclete gigante) e ficava jogando bafo na escola para aumentar seu monte.

Se você respondeu afirmativamente a maioria dos itens acima ou teve um ataque de risos durante este teste, você é um privilegiado pois viveu intensamente suas épocas de juventude total!

stroke - recomendações para prevenir as recorrencias

Recommendations for Prevention of Recurrent Stroke Reviewed Laurie Barclay, MD January 27, 2009 — Recommendations for prevention of recurrent stroke are reviewed in the January issue of Mayo Clinic Proceedings. In addition to control of modifiable risk factors, virtually all patients who have had ischemic stroke should be prescribed antiplatelet agents. "Stroke is the leading cause of death and disability in the United States," writes Harold Adams Jr, MD, from the University of Iowa in Iowa City. "The economic consequences of stroke, including health care costs and lost economic productivity, are substantial. These are the reasons that stroke prevention, including treatment of underlying causes, are clearly of critical importance." The leading cause of ischemic stroke is atherosclerotic vascular disease, which gives rise to occlusion or severe stenosis of major intracranial or extracranial arteries, as well as narrowing of small penetrating arteries of the brain. Coronary artery disease, or atherosclerosis of the coronary arteries, may result in myocardial infarction, which in turn is an indirect cause of cardioembolic stroke. Atrial fibrillation and cardioembolic stroke may also complicate ischemic heart disease. "Some risk factors associated with increased likelihood of advanced atherosclerosis and ischemic disease are not modifiable," Dr. Adams writes. "These risk factors include age, sex, ethnicity, family history and premature vascular disease. However, several conditions that augment the course of atherosclerosis can be effectively addressed across the continuum of care." For patients with symptomatic ischemic cerebrovascular disease, a crucial aspect of treatment is prevention of recurrent stroke, myocardial infarction, and other ischemic events. This requires optimal control of modifiable risk factors that accelerate development of atherosclerosis, such as hypertension, hyperlipidemia, diabetes mellitus, and smoking. Management of hypertension should aim to achieve a normal blood pressure for the patient, realizing that no single, specific antihypertensive regimen is ideal for all patients. When prescribing a blood pressure–lowering treatment plan, clinicians should consider a patient's history, while awaiting the results of ongoing and future studies. Some evidence suggests that aggressive lowering of cholesterol levels may modestly increase the risk for hemorrhagic stroke. However, the benefits of statins to decrease the risk for recurrent ischemic stroke and other ischemic vascular events are thought to outweigh the risk of bleeding. In patients with diabetes mellitus, management should include aggressive control of blood pressure and lipid levels as well as of blood glucose levels. More aggressive interventions may be required, such as carotid endarterectomy and endovascular treatment. In selected patients, carotid endarterectomy should be considered as complementary to use of antiplatelet agents and other medications. For other patients with atherosclerotic cerebrovascular disease, extracranial-intracranial bypass surgery and carotid artery stenting may be considered, pending the results of ongoing clinical trials. The keystone of management to prevent recurrent stroke and other cardiovascular events in patients at risk continues to be administration of antiplatelet agents, which should be prescribed for virtually all patients who have had ischemic stroke. Therapeutic options include aspirin, aspirin plus extended-release dipyridamole, or clopidogrel. Specific choice among these should be guided by the patient's previous treatment and history of ischemic events as well as allergies or other potential contraindications. Specific recommendations of the American Heart Association/American Stroke Association for antithrombotic therapy in patients with ischemic stroke of noncardioembolic origin (secondary prevention), and their accompanying levels of evidence, are as follows: Antiplatelet agents are recommended vs oral anticoagulants (level of evidence, I, A). Preferred options for initial treatment are aspirin (50 - 325 mg/day), a combination of aspirin and extended-release dipyridamole, or clopidogrel (level of evidence, I, A). The combination of aspirin and extended-release dipyridamole may be preferred vs aspirin alone (level of evidence, I, B). Instead of aspirin alone, clopidogrel may be considered (level of evidence, IIb, B). Clopidogrel is a reasonable option for patients who are hypersensitive to aspirin (level of evidence, IIa, B). Addition of aspirin to clopidogrel increases the risk for hemorrhage (level of evidence, III, A). "Use of an integrated treatment approach involving risk-factor management, antiplatelet therapy and surgical procedure when indicated presents the opportunity to lower the risk of recurrent stroke and other ischemic events in patients with recent ischemic stroke," Dr. Adams concludes. "Future research may provide support for using new medications, clarify the role of currently available medications, and better define the appropriate role of surgery, particularly endovascular treatments." In an accompanying editorial, James F. Meschia, MD, from the Mayo Clinic in Jacksonville, Florida, confirms that "after the immediate post-thrombolytic period, care needs to focus on secondary prevention." "Patients with acute ischemic stroke are at high risk of recurrent stroke," Dr. Meschia writes. "If successful reperfusion therapy is like dodging a bullet, successful secondary prevention is like being caught in the line of fire again. [Dr. Adams'] review will be welcomed by clinicians seeking guidance beyond evidence-based guidelines." The Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership funded editorial support for Dr. Adams' review. Dr. Adams has disclosed no relevant financial relationships. Dr. Meschia has received support from the Siblings with Ischemic Stroke Study and the Carotid Revascularization Endarterectomy vs Stenting Trial. Mayo Clin Proc. 2009;84:3-4, 43-51. Related Links Resource Centers Stroke/Cerebrovascular Disease

clopidogrel e inibidores ( ppi )

Increased risk of reinfarction with clopidogrel and proton-pump inhibitors

January 29, 2009 | Michael O'Riordan

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Toronto, ON - The addition of a proton-pump inhibitor (PPI) to clopidogrel (Plavix, Bristol-Myers Squibb/Sanofi-Aventis) in acute-MI patients significantly increases the risk of recurrent infarction, a new study has shown [1]. The findings support suspicions that the drug combination diminishes the beneficial effect of the antiplatelet therapy and increases the risk of future events, say researchers.

"Effectively, we're taking a patient who should be getting a benefit from clopidogrel, they have the genetic makeup that allows them to get the benefit, but we're turning them into the equivalent of someone who cannot activate clopidogrel by prescribing selected PPIs," lead investigator Dr David Juurlink (Institute for Clinical Evaluative Science, Toronto, ON) told heartwire. "We're doing this unintentionally, and we're doing it on a massive scale, and we're doing it, quite frankly, without any appreciation of what we're doing."

The study, published online January 28, 2009 in the Canadian Medical Association Journal, showed that while selected PPIs seem to "turn off" the body's natural process of converting clopidogrel into its active form, pantoprazole (Protonix, Wyeth Pharmaceuticals), which does not interfere with clopidogrel's conversion, was not associated with an increased risk of reinfarction.

FDA now has eye on possible interaction

Earlier this week, the Food and Administration (FDA) announced that it was working with Bristol-Myers Squibb and Sanofi-Aventis, the makers of clopidogrel, to further study the effectiveness of the drug in patients taking other medications, particularly PPIs, and in those with genetic variants linked with clopidogrel resistance.

Clopidogrel is a prodrug converted in the liver to its active form by cytochrome P450 isoenzymes, with P450 2C19 playing a particularly important role. Speaking with heartwire, Juurlink said there is evidence suggesting that various PPIs can inhibit P450 2C19, which would alter the effectiveness of clopidogrel and potentially lead to an increased risk of adverse cardiovascular outcomes.

To assess the potential effects of the drug interaction, researchers identified more than 13 000 patients prescribed clopidogrel following an acute MI. Of these, 734 patients were readmitted with MI and 2057 served as event-free controls matched based on age, PCI, and risk score.

Among patients currently prescribed a PPI along with clopidogrel, the risk of reinfarction within 90 days was 27% greater than among those taking clopidogrel only. The risk is limited to those currently taking a PPI and did not extend to pantoprazole, a drug that does not interfere with the conversion of clopidogrel to its active form.

Association between acid-reducing therapy and recurrent MI

End point	Odds ratio (95% CI)
Recurrent MI within 90 d
Current exposure to PPI (within 30 d)	1.27 (1.03-1.57)
Previous exposure to PPI (31-90 d)	0.86 (0.63-1.19)
Remote exposure to PPI (91-180 d)	0.81 (0.57-1.18)
End point based on PPI type
Pantoprazole	1.02 (0.70-1.47)
Other	1.40 (1.10-1.77)

To download table as a slide, click on slide logo above

Juurlink noted that recent guidelines issued by the American Heart Association, American College of Cardiology, and American College of Gastroenterology call for PPI therapy for a majority of patients taking aspirin after MI, including all patients 60 years and older.

"This is important, because patients taking clopidogrel are almost always taking aspirin," he said. "As a result, we're going to end up with millions of people who are taking the combination of clopidogrel and a proton pump inhibitor, and our results suggest that if this is not done with some caution, thousands, perhaps tens of thousands, of recurrent heart attacks could result."

Still, the news is not all bad for patients who need to turn off gastric acid, as they can take an older drug, such as an H2 blocker like Zantac or Pepcid, or pantoprazole, he added.

Speaking with heartwire, Dr Dan Roden (Vanderbilt University School of Medicine, Nashville, TN), who was not part of the Canadian analysis, said that the interaction between clopidogrel and PPIs was addressed by several abstracts presented at the most recent AHA meeting.

"I think it's evident there are people out there in which this is a big deal," he said. "The basic science is there, and the fact that CYP 2C19 affects cardiovascular outcomes is also there, so it's not rocket science to think there are patients being treated with clopidogrel with the expectation they're going to be better, but they're not because they're also getting a drug that inhibits its bioactivation."

Despite the results from this and other studies, Roden said a randomized trial would still be the best way to prove a clinically significant interaction and to estimate its severity, although he doubts one will be ever done.

"I believe the results, but this isn't a very strong paper to prove it," he added. "The problem here is whether the increased MI rates observed are a result of the drug interaction or because sicker patients tend to end up on proton-pump inhibitors. The finding that the most potent CYP 2C19 inhibitor has the greatest effect makes one think this is a real result."

Last week it was announced that Cogentus Pharmaceuticals (Palo Alto, CA) halted its COGENT 1 trial, a 4000-patient study testing a single-pill combination of clopidogrel and omeprazole to reduce the incidence of GI side effects. The company has filed for bankruptcy.

Source

piada ( sem graça )

A mulher está na cama com um ‘amigo’ e de repente ouve o barulho da chave na fechadura. Fica nervosa, principalmente, porque nos apartamentos modernos não há espaço debaixo da cama, estão a 20 andares de altura, não há armários… e, de repente, ela diz ao amante:

- Querido, fica tranquilo e faz tudo o que eu disser. Fica ali de pé, como se fosses um robô, sem pestanejar.

O marido entra:

- Olá amorzinho! Olha, anteciparam o vôo e eu cheguei um dia antes… mas…. quem é esse tipo e que merda está aqui a fazer nu, aí plantado?

A mulher sorri e responde:

- Como me tens abandonado com essas viagens e reuniões, resolvi comprar este ‘robô escravo sexual modelo RTSEX-2007′.
Vem,aproxima-te… toca-o… Tem pele de verdade; é arrefecido a água; gasta pouco, processador de 256 bites, ligação GPRS à Internet, atualizações automáticas, etc, etc…

- Mas, amor..Havia necessidade disso?

- E o que querias? Que me enrolasse com algum vizinho ou com o porteiro do prédio?

- Está bem, deixa-te de parvoíces e vamos para a cama - disse ele.
A mulher, que já estava cansada, responde:

- Ai, fofinho, é que… me dói a cabeça e além do mais eu estou naqueles dias…

- Que má sorte a minha. Então, porque não vais arranjar qualquer coisa para eu comer?

A mulher sai do quarto e vai para a cozinha. O marido, que ficou a sós com o suposto ‘robô’, olhando-o diz:

- Se este invento é bom para a minha mulher, também vai servir para mim.

E então, puxa-o pelo braço, atira-o para cima da cama, põe-o de quatro e… quando está a ponto de partir para os finalmente, o robô diz nervosamente e com a voz mais metálica e robótica que consegue:

- ‘ERRO! ERRO DE SISTEMA, ENTRADA INCORRETA! ERRO! ERRO DE SISTEMA, ENTRADA INCORRETA’.

O marido mira-o de alto a baixo, sobe as calças e diz:

- Que se lixe a merda do robô moderno. Vou atirá-lo agora mesmo pela janela fora…

O amante, assustado ao lembrar-se dos 20 andares do prédio, grita com a mesma voz metálica:

- SISTEMA ATUALIZADO! DOWNLOAD DE SOFTWARE COMPLETO! POR FAVOR, TENTE NOVAMENTE!!!

fonte o astro

piada

Não é seu filho

Maria estava em seu leito de morte, e temendo 'bater as botas' e ir ao céu com um grande pecado, resolveu confidenciar ao marido Manoel:

- Manoel, sabes o nosso filho mais velho, não és teu Manoel!!

Manoel muito tranquilamente, responde:

- Oh! Meria, não tem problema.

Maria, muito intrigada com toda a posição de Manoel, indaga-lhe:

- Mas, como Manoel?! Eu estoi a lhe dizer que nosso filho não és teu, ó homem!?!!

E Manoel novamente responde:

- E eu entendi, ó Meria.

- Ai, Jisus! Por que raios tu não estás azoado e ficas assim, com esta cara?!?

Manoel lhe responde:

- Ora pois... Sabes o nosso filho mais novo? Ele também não és teu!

Maria rebate:

- Como não é meu, ó homem de Deus? Se eu mesma carreguei o gajo na minha barriga por nove meses?

- Meria, lembra-te quando tu estavas ainda na meternidade e me pediste para trocar o menino por que ele estava todo cagado? Pois eu troquei... Por um limpinho que estava ao lado

sindrome metabolica e aspirina

From American Heart Journal

Platelet Reactivity and Response to Aspirin in Subjects With the Metabolic Syndrome

Abstract

Background: Metabolic syndrome (MS) is associated with a prothrombotic state and predicts the subsequent development of type 2 diabetes mellitus. We hypothesized that similar to diabetes, subjects with MS may have increased platelet reactivity, and reduced response to aspirin. We, therefore, compared platelet reactivity and response to aspirin among subjects with MS and healthy volunteers.
Methods: Fifty subjects with MS, defined by Adult Treatment Panel III criteria (age 44 ± 9 years, 80% women, body mass index 35 ± 8 kg/m²) were compared to 50 healthy controls who met none of the MS criteria (age 40 ± 7 years, 80% women, body mass index: 24 ± 3 kg/m²). Blood samples were taken before and 24 hours after 325 mg aspirin (single dose). Platelet function was evaluated by aggregation in response to 1.5 mmol/L arachidonic acid, 1 μg/mL collagen, and 5 and 20 μmol/L adenosine diphosphate; the VerifyNow Aspirin assay (Accumetrics Inc, San Diego, CA); Impact-R Cone and Plate(let) Analyzer (shear-dependent test) (DiaMed, Cresier, Switzerland) and flow cytometric determination of P-selectin expression and activated glycoprotein IIb/IIIa expression; and reticulated platelets (reflecting platelet turnover).
Results: Subjects with MS had higher baseline P-selectin levels (14.5 ± 5 vs 11.3 ± 4 mean fluorescence intensity, P = .002), reticulated platelets (2.8% ± 3% vs 1.2% ± 1%, P = .04) and platelet deposition under flow (Impact-R 7.5% ± 2% vs 5.9% ± 2%, P = .003). Subjects with MS also had lower response to aspirin, as evaluated by the change in all platelet aggregation assays and the VerifyNow score.
Conclusions: Subjects with MS appear to have increased baseline platelet reactivity and turnover and a lower antiplatelet response to aspirin. Further research is required to elucidate platelet properties in subjects with MS and find ways to modify them

Atorvastatin-induced drug reaction with eosinophilia and systemic symptoms (DRESS)

Atorvastatin-induced drug reaction with eosinophilia and systemic symptoms (DRESS); Gressier L, Pruvost-Balland C, Dubertret L, Viguier M; Annales de Dermatologie et de V 136 (1), 50-3 (Jan 2009)

BACKGROUND: Atorvastatin is a widely-used therapeutic statin given for hypercholesterolaemia and for prevention of cardiovascular events. We report herein the occurrence of a drug reaction with eosinophilia and systemic symptoms (DRESS) secondary to intake of this drug. CASE REPORT: A 58-year-old woman presented with a febrile skin rash and facial oedema, appearing 6weeks after the start of atorvastatin for dyslipidaemia. The clinical features associated disseminated polymorphic lesions, oral mucosa involvement and systemic symptoms (fever, abdominal pain, diarrhoea, polyarthralgia and adenomegaly). Blood tests showed hypereosinophilia up to 11,540/mm(3), inflammatory syndrome and anicteric cholestasis without cytolysis. Serological tests for hepatitis B and C, HIV, EBV, HHV-6, HHV-8, CMV and human Parvovirus B-19 were negative. Cutaneous histology was unspecific. A diagnosis of DRESS secondary to atorvastatin was suspected. The clinical outcome was favourable after atorvastatin discontinuation. DISCUSSION: To our knowledge, this is the first description of atorvastatin inducing DRESS, a severe life-threatening drug eruption. Atorvastatin has previously been implicated in various cutaneous adverse events. Because of their potentially serious side effects, prescription of statins must be carefully evaluated.

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