MelCap Electronic Pill to Help Treat Obesity, Eating Disorders

melcapMelCap Systems is an Israeli firm that may offer a new way of treating obesity and other eating conditions using a swallowable electronic pill. The technology is still in development, but the company already received a patent for its pill that supposedly stimulates the stomach to make it believe it’s full.

To begin the therapy, the pill is swallowed and an external magnet is used to position it in a specific spot within the stomach, be it near the lower esophagus sphincter or in proximity to the vagus nerve. The pill unfurls a mesh filled with inflated particles and a wireless device is then used to activate the pill. When it receives the signal, the pill delivers a series of electrical pulses to the lining of the stomach, stimulating the organ. Depending on the pill’s location, different effects can be achieved to tailor the therapy to the individual patients’ needs.

This is still a technology waiting for further development and requires confirmation using clinical trials, but MelCap is forging ahead and hopes to have a product ready to market hopefully sometime next year.

Here’s a company video describing the new technology:

 

Link: MelCap Systems homepage…

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REMI 2047. ¿Cómo definir y detectar la sepsis?





Artículo originalSystemic Inflammatory Response Syndrome Criteria in Defining Severe Sepsis. Kaukonen KM, Bailey M, Pilcher D, Cooper DJ, Bellomo R. N Engl J Med 2015. [Resumen] [Artículos relacionados]
   
Introducción: Desde hace más de 20 años la sepsis se define como la respuesta inflamatoria a la infección, y se manifiesta por la presencia de dos o más criterios de respuesta inflamatoria sistémica (SRIS), con o sin disfunción de órganos [1, 2]; sin embargo, se reconoce que sus manifestaciones clínicas son variadas y heterogéneas [3], y la validez de la definición de sepsis no se ha evaluado de forma sistemática en una base amplia de pacientes.
      
Resumen: A fin de conocer la sensibilidad y validez de los criterios de definición de sepsis se evaluaron 109.663 pacientes con infección y fallo de órganos atendidos en 172 UCI de Australia y Nueva Zelanda entre 2000 y 2013. De ellos, el 12,1% no cumplían criterios de sepsis (menos de 2 criterios de SRIS). La mortalidad fue menor entre los pacientes sin criterios de SRIS, y a lo largo de los 14 años evaluados, la mortalidad disminuyó sustancialmente tanto en pacientes con como sin SRIS (con SRIS: de 36,1% a 18,3%; P < 0,001; sin SRIS: de 27,7% a 9,3%; P < 0,001). La mortalidad aumentó de forma lineal con cada criterio SRIS adicional (OR ajustada 1,13; IC 95% 1,11-1,15; P < 0,001), sin que se apreciara un punto de corte entre < 2 y 2 o más criterios (punto de corte empleado en la definición de sepsis).
      
Comentario: El estudio demuestra que la actualidad definición de sepsis no detecta una octava parte de los pacientes con infección y fallo de órganos, y que el punto de corte en 2 criterios de SRIS para etiquetar al paciente como "séptico" es arbitrario. En la actualidad se están validando herramientas informáticas como alertasepsis®, que pueden ser capaces de detectar una mayor proporción de pacientes con infecciones graves y valorar de forma individualizada el riesgo de muerte.
   
Eduardo Palencia Herrejón
Hospital Universitario Infanta Leonor, Madrid.
© REMI, http://medicina-intensiva.com. Abril 2015.
      
Enlaces:
  1. Palencia Herrejón E. La sepsis: definiciones y estadios. [REMI 2004; 4(6): C1]
  2. The natural history of the systemic inflammatory response syndrome (SIRS). A prospective study. Rangel-Frausto MS, Pittet D, Costigan M, Hwang T, Davis CS, Wenzel RP. JAMA 1995; 273: 117-123. [PubMed]
  3. Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G; International Sepsis Definitions Conference. 2001 SCCM/ ESICM/ ACCP/ ATS/ SIS International Sepsis Definitions Conference. Intensive Care Med 2003; 29: 530-538. [PubMed
  4. Palencia Herrejón E. Alertasepsis®, herramienta informática para la detección de la sepsis. [REMI 2014; 14(4): A192]
Búsqueda en PubMed:
  • Enunciado: Criterios de definición de sepsis
  • Sintaxis: sepsis[mh] definition criteria 
  • [Resultados]
       

KT Evidence Bite: Colchicine for Pericarditis

Editor’s note: This is a series based on work done by three physicians (Patrick ArchambaultTim Chaplin, and our BoringEM Managing editor Teresa Chan)  for the Canadian National Review Course (NRC). You can read a description of this course here.

The NRC brings EM residents from across the Canada together in their final year for a crash course on everything emergency medicine. Since we are a specialty with heavy allegiance to the tenets of Evidence-Based Medicine, we thought we would serially release the biggest, baddest papers in EM to help the PGY5s in their studying via a spaced-repetition technique. And, since we’re giving this to them, we figured we might as well share those appraisals with the #FOAMed community! We have kept much of the material as drop downs so that you can quiz yourself on the studies.

Paper: A Randomized Trial of Colchicine for Acute Pericarditis

Citation: 

Imazio, Massimo, et al. “A randomized trial of colchicine for acute pericarditis.”New England Journal of Medicine 369.16 (2013): 1522-1528. PMID: 23992557

Summarized by: Patrick Archambault
Reviewed by: Teresa Chan & Tim Chaplin

Clinical Question

Is colchicine effective in treating a first attack of acute pericarditis and in the prevention of recurrent symptoms?

Population18 years of age or older with a first episode of acute pericarditis* (idiopathic, viral, after cardiac injury, or associated with connective-tissue disease).

Exclusion criteria: tuberculous, neoplastic, or purulent pericarditis; severe liver disease or current aminotransferase levels of more than 1.5 times the upper limit of the normal range; a serum creatinine level of more than 2.5 mg per deciliter (221 μmol per liter); skeletal myopathy or a serum creatine kinase level above the upper limit of the normal range; blood dyscrasia; inflammatory bowel disease; hypersensitivity to colchicine or other contraindication to its use
InterventionColchicine was administered at a dose of 0.5 to 1.0 mg daily for 3 months. Dose was based on weight: 0.5mg BID if >70kg, 0.5mg ID if < 70kg

All patients also received: (1) NSAIDS (ASA 800 mg TID or ibuprofen 600mg TID) for 7-10 days tapered over 3-4 weeks OR (2) prednisone (0.2-0.5 mg/kg daily if NSAIDS were contraindicated) for 2 weeks with gradual tapering AND a PPI for gastrointestinal prophylaxis.
Controlplacebo AND NSAIDS (or prednisone) AND PPI
Outcome1) Incessant (recurrence < 6 weeks after first attack) or recurrent pericarditis (after a 6-week symptom free period)

2) Symptom persistence at 72 hours, remission within 1 week, number of recurrences, the time to the first recurrence, disease-related hospitalization, cardiac tamponade, and constrictive pericarditis

Methods

This was a randomized, double-blind trial, with intention-to-treat analysis

Results

n=240

Primary outcome (rate of incessant/recurrent pericarditis)

  • Colchicine: 20 patients (16.7%) vs. Placebo: 45 patients (37.5%)
  • RRR in the colchicine group, 0.56; 95%CI, 0.30 to 0.72  (P<0.001)
  • NNT=4

Secondary outcomes

  • Lower rate of symptom persistence at 72 hours in the colchicine group (19.2% vs. 40.0%, P = 0.001)
  • Lower number of recurrences per patient in the colchicine group (0.21 vs. 0.52, P = 0.001)
  • Reduced hospitalization rate in the colchicine group (5.0% vs. 14.2%, P = 0.02)
  • Higher remission rate at 1 week in the colchicine group (85.0% vs. 58.3%, P<0.001)
  • No serious adverse events were observed

Conclusions

Colchicine in addition to conventional antiinflammatory therapy significantly reduced the rate of incessant or recurrent pericarditis, reduced the number of recurrences of pericarditis, and prolonged the time to recurrence, as compared with placebo.

Take Home Point

Colchicine is safe and effective to use in acute pericarditis (of idiopathic, viral and autoimmune etiologies).

EBM Considerations

  • Sample size: Small study with 240 patients (120 in each arm), that was however adequately powered to detect a large reduction in incessant and recurrent pericarditis
  • Side effects: Although there were no differences in rates of adverse events, diarrhea was the major limiting side effect associated with colchicine and was reported in less than 10% of patients, and no serious adverse events were recorded.
  • Generalizability: Colchicine was not used in bacterial or neoplastic pericarditis so use cannot be easily extrapolated to use in these disease conditions.

For a pdf version of this summary click NRC – BoringEM – Colchicine for Pericarditis

Author information

Eve Purdy
Medical Student Editor at BoringEM
Fourth year medical student at Queen's University-happily consuming, sharing, creating and researching #FOAMed

The post KT Evidence Bite: Colchicine for Pericarditis appeared first on BoringEM and was written by Eve Purdy.

Eyenuk EyeArt Software Automatically Screens Fundus Images for Signs of Diabetic Retinopathy

eyeart-lesion-detection

Eyenuk, a Woodland Hills, California company, won the European CE mark for its EyeArt software that analyzes images of the retina taken using fundus cameras to help detect diabetic retinopathy (DR). The software requires nothing more than a well produced color retinal image and has shown a sensitivity of detecting DR often better than human professionals.

EyeArt is able to process entire batches of images, going through thousands in a matter of hours. This may allow entire populations to be screened for DR, hopefully saving many eyes and improving lives.

More about the technology according to Eyenuk:

EyeArt’s image analysis algorithms represent cutting-edge of research in image processing, computer vision, and machine learning. Technological innovations like morphology-inspired filter bank descriptors can automatically analyze fundus images to detect and localize lesions resulting from diabetic retinopathy.

Product page: EyeArt…

Press release: Eyenuk, Inc. granted CE marking for EyeArt…

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