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    Friday, September 14, 2012

    Exercise training increases size of hippocampus and improves memory Aerobic exercise may help improve memory in older people

     
    A year of modest aerobic exercise reversed normal brain shrinkage by one to two years in older adults and improved their memory function, according to a study published in the Proceedings of the National Academy of Sciences. As people age, the hippocampus, the brain's memory center, loses 1% to 2% of its volume annually, affecting memory and possibly increasing the risk for dementia. A growing body of evidence has pointed to aerobic exercise as a low-cost hedge against neurocognitive decline. In this study, magnetic resonance imaging was used to measure the effects of aerobic exercise on the hippocampus in 120 Americans in their late 50s to early 80s. Half the group walked three times a week for 40 minutes, aiming for their target heart rate, while the other half did yoga and toning exercises. The hippocampus in walkers increased by 2% after a year and shrank by 1.4% in controls. Both groups showed significant improvements on spatial memory tests conducted before and after the study. This could be due to taking the test repeated times, the researchers said. In the walking group, however, changes in hippocampus volume were directly related to improved memory performance, they said.

    Caveat: The study found that exercise had a selective effect on the brain, influencing the volume of the anterior hippocampus but not the posterior. Researchers suspect aerobic exercise might have the most effect on regions of the brain that show the largest decline in late adulthood, such as the anterior hippocampus.

    Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.Please remember, as
    with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Monday, August 13, 2012

    Enterovirus infection and type I diabetes mellitus: systematic review and meta-analysis of observational molecular studies

     
    Type I diabetes: A virus that causes a host of ailments ranging from mild respiratory illnesses to meningitis and polio was found to be associated with the development of type I diabetes, especially in children under 5, according to a meta-analysis in the British Medical Journal. The global incidence of type I diabetes has been steadily increasing, particularly the juvenile form of the disease. Previous studies have associated enterovirus infections with type I diabetes and pre-diabetes autoimmunity but the findings weren't conclusive. In this study, Australian researchers analyzed 24 studies and two abstracts published from 1965 to 2010 that involved a combined total of 4,448 subjects who had undergone molecular testing for enteroviruses. They found type I diabetics were almost 10 times as likely to have had a recent enterovirus infection as non-diabetics and to experience persistent enterovirus infections. Children with recent enterovirus infections had three times higher risk for pre-diabetes. Researchers recommended further studies of the environmental, geographical and genetic factors believed to play a role in the development of type 1 diabetes.
    Caveat: Other factors that weren't measured may have influenced the risk of developing diabetes, such as cow's milk, vitamin D and weight gain in infancy, researchers said. Also, there was uneven reporting among the various studies of the methodology used to detect enteroviruses.

    Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.Please remember, as
    with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Tuesday, July 31, 2012

    Jewish Ethnicity and Pancreatic Cancer Mortality in a Large United States Cohort Pancreatic Cancer:




    American Jews may be genetically predisposed to developing pancreatic cancer, according to a study in Cancer Epidemiology, Biomarkers and Prevention. Jewish ethnicity and pancreatic cancer have been examined in four previous studies dating to the 1950s, three of which reported higher mortality among Jews than non-Jews. This study is the first to consider the known risk factors for pancreatic cancer—smoking, obesity and diabetes—and the birthplace of Jews and their parents. Data were analyzed from an American Cancer Society study that followed 1,014,625 men and women from 1982 to 2006. Of the 6,727 deaths from pancreatic cancer during this period, 480 were among Jewish participants. Deaths were 43% higher among Jews than non-Jews and didn't vary significantly by age, family history or immigration background. Genetic factors and non-O blood type may contribute to the higher mortality, the study suggests. About 65% of U.S. Jews have non-O blood compared with 55% of white non-Jews. Understanding the reasons why Jews are at greater risk for pancreatic cancer may provide clues to its cause and lead to screening techniques, researchers said.

    Caveat: The study lacked information on Ashkenazi or Sephardic Jewish origin. As the U.S. Jewish population is predominantly Ashkenazi, the results may not generalize to Sephardic Jews, researchers said. Information on the number of Jewish converts involved in the study wasn't available.
    Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.Please remember, as
    with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Monday, July 16, 2012

    Drug Deals with Medical Insurance Carriers Tie Prices to How Well Patients Do.

    So What’s in it for us?

    Pressed by insurance companies, some drug makers are beginning to adjust what they charge for their drugs, based on how well the medicines improve patients’ health, reports A. Pollack. “Think of it as product guarantees by the drug industry.”


    Traditionally, discounts and rebates that drug companies offer insurers have been based on how much drug is used, not how well patients do. But the emerging, outcomes-based contracts would — in theory — better align the incentives of insurers, drug companies and the employers that provide health coverage toward improving people’s health. Johnson & Johnson set what is considered the prototype deal in 2007 with Britain’s national health system, which had tentatively decided not to pay for the cancer drug Velcade. To avert that decision, the company offered essentially a money-back guarantee. If Velcade did not shrink a patient’s tumors after a trial treatment, the company would reimburse the health system for the cost of that patient’s drug.


    In a current deal Merck will agree to peg what the insurer Cigna pays for the diabetes drugs Januvia and Janumet to how well Type 2 diabetes patients are able to control their blood sugar. Also the two companies that jointly sell the osteoporosis drug Actonel agreed to reimburse the insurer Health Alliance for the costs of treating fractures suffered by patients taking that medicine. “We’re standing behind our product,” said Dan Hecht, general manager of the North American pharmaceutical business of Procter & Gamble, which sells Actonel with Sanofi-Aventis. “We’re willing to put our money where our mouth is.” Under the Actonel deal, if a patient insured by Health Alliance suffers a nonspinal fracture despite faithfully taking Actonel, the drug makers will help pay for the medical care — spending $30,000 for a hip fracture, for instance, and $6,000 for a wrist fracture.


    This clearly lowers the cost of the drug to Health Alliance, a small insurer in Illinois and Iowa. But Procter & Gamble and Sanofi-Aventis might benefit as well. The deal could reduce the pressure on the insurance company to move patients off Actonel, which costs about $100 a month, to less-expensive generic versions of Fosamax. And the insurer has kept Actonel in a tier of its drug list that requires a smaller co-payment than for a competing brand-name drug, Boniva.


    Some experts hail such arrangements as a welcome step toward health care that rewards good outcomes for patients. “We’re going to see a growth in outcomes guarantees for pharmaceuticals, and it’s very healthy,” said Robert Seidman, a consultant who was formerly the chief pharmacy officer for WellPoint, an insurance company.


    Such contracts started to take hold a few years ago in countries with national health systems, in which the government could effectively block a drug from being used if it was too costly. In the United States, where insurance companies do not have national monopolies — and where Medicare, by law, is precluded from negotiating drug prices — insurers have less leverage with drug makers. Even so, they can give favorable treatment to certain drugs, by reducing the required co-payments, for example.

    The deal between Cigna and Merck is more complex.


    Rather than getting paid more for good results, Merck will actually give Cigna bigger discounts on Januvia and Janumet. Some discounts will be granted if more people diligently take the drugs as prescribed. This helps both Cigna, because people who take their pills are likely to have fewer complications from the disease, and Merck, because it sells more pills. The assumption is that Cigna will push for patient-compliance programs that urge people to take their medicine at the right times and in the proper doses.


    Moreover, in an unusual move, Merck will offer even greater discounts to Cigna on Januvia and Janumet if patients’ blood sugar is better controlled — regardless of whether the improvement comes through Merck’s drugs or other medications. In effect, though, Merck is betting not only that its drugs prove superior but that Cigna’s incentives to reap the benefits of the deeper Januvia and Janumet discounts will prompt the insurer to try to keep patients on those drugs. Januvia, approved in 2006, costs about $150 a month. Janumet, approved a year later, is a combination of Januvia and metformin, a widely used generic drug.


    As part of the agreement, too, Merck will get better placement for Januvia and Janumet on Cigna’s formulary, meaning a lower co-payment for patients than for some other branded drugs. The deal was made with the pharmacy benefit management division of Cigna, which manages prescriptions for 7.1 million people.


    So what’s in it for us patients?

    If this does not translate to our pocketbooks there will be problems.

    We’ll wait and see if and how much this will save we patients.

     Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.Please remember, as
    with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Friday, June 29, 2012

    TOO MANY X-RAYS ARE HARMFUL

    CT scans is associated with significant radiation exposure in some patients; the risks should be considered carefully when imaging for chronic disease and when screening asymptomatic individuals .It is estimated that 1.5-2.0% of US population cancers may be caused by CT radiation exposure. A retrospective, cohort study at a tertiary academic medical center identified 31,462 patients undergoing diagnostic CT during 2007; and 190,712 CTs over 22 years. Estimated lifetime attributable risk (LAR) for cancer was calculated. In this cohort, baseline cancer rates predicted 13,214 cancers and 6,292 fatal cancers; 98 additional cancers (62 fatal) were predicted from CT.

    REFERENCE:
    “Recurrent CT, Cumulative Radiation Exposure and Associated Radiation-Induced Cancer Risks from CT of Adults” by Sodickson A et al. Radiology 2009;251:175-184 Colonoscopy Prevents 15,000 Cancer Cases


     Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.Please remember, as
    with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Wednesday, June 13, 2012

    Use Genetic Tests To Help Make Prescription Decisions


    Medco Health Solutions Inc. "is encouraging doctors to use genetic tests to determine whether drugs will work for particular patients -- saving money and reducing harm caused when prescriptions are wrong." Medco and CVS Caremark Corp. also have increased their investments in providers of genetic testing services. Bloomberg notes that the FDA requires genetic testing for six drugs, "recommends testing before prescribing for more than two dozen medicines, and mentions diagnostic tests in the labels...of more than 150 others."

    Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.Please remember, as
    with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Monday, May 28, 2012

    Whole-genome sequencing may soon become clinically useful.


    Two newly published papers may reignite the once-"disappointing" search for the "genetic roots of major killers like heart disease, diabetes, and Alzheimer's." In the seven or so years "since first full genetic code of a human was sequenced for some $500 million, less than a dozen genomes had been decoded, all of healthy people." Now, researchers at Baylor College and the Institute for Systems Biology were able to demonstrate that it is "possible to sequence the entire genome of a patient at reasonable cost and with sufficient accuracy to be of practical use to medical researchers."
            
    What makes the technology even more impressive, she said, is that these were whole genomes of people that provided 'very interesting stories about rare diseases.'" 

            University of Utah researchers, "used gene sequencing technology to take a closer look at a "four-member family. After completing and comparing the genomes, investigators were able to tell that the "two parents passed recessive genes to their two children, each of whom had a condition called Miller Syndrome that may cause cleft palates, misshapen ears, and short stature." According to the paper in Science, the children also had "a lung disorder called primary ciliary dyskinesia that can lead to pneumonia, bronchitis and other respiratory infections." 

            Indeed, "experts have long known that Miller syndrome is genetic."But they had never been able to pinpoint the gene." Having the entire family's genomes in their hands, however, "helped shrink the genetic haystack from thousands of genes to four likely targets," and investigators were also able to calculate the odds of inheriting the variants.

    Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com
    For more health info and links visit the author's web site www.hookman.com

    Tuesday, May 15, 2012

    GARLIC CAN CAUSE INCREASED BLEEDING. RISKS OF “NATURAL” MEDICINES


    Herbal medicines are not always the harmless nostrums that many patients and even some physicians think, but may actually contribute to cardiovascular morbidity and mortality, researchers warned in a review published in the Journal of the American College of Cardiology[JACC].
    Many such products, including aloe vera, ginkgo biloba, ginseng, and green tea, can interact with conventional cardiovascular drugs and lead to serious adverse reactions, according to the Mayo Clinic.

    The
    JACC article also listed 15 common herbal medicines known to interact adversely with conventional cardiovascular drugs.In many cases, the herbal products compete with the regular medicines for the same drug-metabolizing cytochrome P450 enzymes, potentiating the latter's effects. In other cases, the herbal products have their own cardiovascular effects.
    Many physicians already know that even “natural” grapefruit juice occupies the CYP3A4 enzyme, leading to slower-than-expected metabolism and, therefore, higher blood levels of a host of pharmaceuticals.These include the statins, calcium channel antagonists, several common anti-arrhythmic drugs, and the angiotensin receptor blocker irbesartan (Avapro), Jahangir and colleagues noted.
    Garlic is one of several common herbal remedies with specific cardiovascular effects in its own right (others include ginkgo biloba, ginseng, and saw palmetto). Garlic inhibits platelet aggregation and thus can lead to increased bleeding risks when combined with aspirin, clopidogrel (Plavix), or warfarin (Coumadin), the researchers noted.
    The Mayo group identified 10 herbal products that increase bleeding risks with anticoagulant and antiplatelet drugs, and listed 27 herbal products that patients with cardiovascular diseases would do well to avoid. These include such common and harmless-seeming products as green tea, capsicum pepper, licorice, and kelp, as well as grapefruit juice and garlic.

    Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com
    For more health info and links visit the author's web site www.hookman.com

    Monday, April 30, 2012

    Boxed Warning Added to Clopidogrel [PLAVIX] Label

    Prescribing information for clopidogrel (Plavix) will now include a boxed warning that the drug can be less effective in poor metabolizers, the FDA indicated. The new warning suggests that many if not all patients on clopidogrel should undergo genetic testing to determine whether they have variants of the CYP2C19 gene associated with poor metabolism of the antiplatelet drug. Clopidogrel is actually a prodrug that requires metabolic activation by the CYP2C19 enzyme to become effective. Poor metabolizers get little or no benefit from the drug at standard doses, and therefore are at increased risk for thrombotic events and death, the FDA said. The drug's label has carried a similar warning since May 2009, but the FDA said today that "it was important to highlight this risk in a boxed warning" in light of a subsequent review of data. Seven different variants of the CYP2C19 gene are associated with poor metabolism of clopidogrel. According to the FDA, patients with two loss-of-function alleles, which do not have to be identical, will be poor metabolizers. The agency estimated that 2% to 14% of patients are poor metabolizers, with some racial-ethnic groups more likely to be affected than others. Whites have the lowest prevalence of poor metabolism and Asians have the highest. The boxed warning also includes this advice to healthcare providers: "Tests are available to identify a patient's CYP2C19 genotype and can be used as an aid in determining therapeutic strategy." A Cardiologist at Brigham and Women's Hospital and Harvard Medical School in Boston, claims the warning effectively means every patient on clopidogrel needs to be tested, although the new label does not say so directly. Some 25 million prescriptions for clopidogrel were written in 2008, according to Drugs.com. The FDA also recommended that physicians "consider alternative dosing" if patients are found to be poor metabolizers. The FDA urged patients currently taking clopidogrel not to stop the drug unless told to do so by their physician. Concerned patients should discuss the new information with their doctors before making any change. Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice. Deepen your understanding of "medical malpractice"... www.MedMalBook.com For more health info and links visit the author's web site www.hookman.com

    Friday, April 13, 2012

    40,000 Former Clinic Patients Notified About Possible Exposure To Blood-Borne Diseases Because Of Unsafe Injection Practices.

    Nurse anesthetists reusing single-dose medicine vials among different patients led to as many as 115 people who contracted hepatitis C because of these unsafe injection practices at two Endoscopy centers. Officials notified 40,000 former clinic patients about possible exposure to blood-borne diseases because of unsafe injection practices. The Clinic’s staff told health investigators they were ordered by administrators, principally the physician owner, to reuse supplies and medications to save money, according to a Las Vegas letter suspending the center’s business license The police investigation ended late last year. Hundreds of former patients have sued the physician, his clinics and the manufacturers of the anesthetic, propofol, that was used during their colonoscopies. Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice. Deepen your understanding of "medical malpractice"... www.MedMalBook.com For more health info and links visit the author's web site www.hookman.com

    Friday, March 30, 2012

    HOW ACCURATE ARE NUTRITION PACKAGE LABELS?

    According to a study published in the Journal of the American Dietetic Association, "prepared foods may contain an average of 8% more calories than their package labels own up to, and restaurant meals may contain a whopping 18% more." The misleading labels are also said to be "perfectly o.k." with the Food and Drug Administration, which "plays no role in checking the calorie claims in restaurants." Without federal regulation, "it's up to the states to handle the job - with the predictable patchwork results." Susan Roberts, who conducted the study, described the unregulated menu counts as "the Wild West when it comes to this."

    Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com
    For more health info and links visit the author's web site www.hookman.com

    Thursday, March 15, 2012

    Sharing hospital room may increase infection risk during stay

    Sharing a hospital room increases your risk of picking up an infection during your stay, a new study shows." The work, by researchers from Queen's University in Kingston, Ont., "found that each new roommate raised a patient's risk of picking up an infection in hospital by about 10 percent." The study's senior author, Dr. Dick Zoutman, said in a statement, "That's a substantial risk, particularly for longer hospital stays when you can expect to have many different roommates."

    Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com
    For more health info and links visit the author's web site www.hookman.com

    Monday, February 27, 2012

    Autism increases in the US

    Almost one percent of American children had an autism spectrum disorder (ASD) in a large CDC surveillance study whose lead author called the condition a "significant public health issue."

    Across 11 sites in the U.S., ASD prevalence in 2006 ranged from about one out of 80 children to one out of every 240 children, with an overall prevalence of one in 111 youngsters, according to a report by investigators from the CDC's Autism and Developmental Disorders Monitoring (ADDM) Network.

    Among 10 ADDM sites that reported data in both 2002 and 2006, there was an average 57% increase in ASD prevalence. No single factor could explain the rise, researchers said. Overall ASD prevalence was 4.5 times higher in boys than in girls: about one in every 70 boys and one in every 315 girls.

    From 2002 to 2006, prevalence increased 60% in boys and 48% in girls (P<0.001 for both).

    The American Academy of Pediatrics has recommended that all children be screened for autism when they are 18 and 24 months old which is especially important, as early recognition and treatment improves outcomes.

    ASD diagnosis was made at a slightly younger age in 2006 than in 2002, but it was still delayed to an average age of 53 months. That was so despite the fact that anywhere from 70% to 95% of children had developmental concerns noted in their records before age 3. Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Tuesday, February 7, 2012

    Abdominal surgeries riskier for older adults than previously thought

    About 2 million older adults undergo abdominal surgeries in the U.S. every year, a number that's expected to grow as the proportion of older adults increases rapidly: by 2020, one in six adults is expected to be older than 65, and 15% will be over 85.

    The patient records came from the Comprehensive Hospital Abstract Reporting System, a state-wide database that contains information on the age, sex, zip code, and billed charges of patients, as well as the codes for their diagnosis and procedures.

    The study focused on complications that occurred within 90 days of discharge and deaths within 90 days of hospital admission.

    After adjusting for various factors, including hospital volume and patient characteristics, the study found that the odds of early death after abdominal surgery increased considerably for each five-year increase in age beyond 65. These associations held for patients with cancer and other diagnoses, and for both elective and nonelective procedures (P<0.001).

    The likelihood of complications increased as patients aged beyond 65 years, with the researchers finding the following associations between age and complication frequency (trend test, P<0.001):

    65 to 69 years, 14.6%
    70 to 74 years, 16.1%
    75 to 79 years, 18.8%
    80 to 84 years, 19.9%
    85 to 89 years, 22.6%
    90 and older, 22.7%

    Similarly, older patients were at higher risk of mortality. Death rates by age group were (trend test, P<0.001):

    65 to 69 years, 2.5%
    70 to 74 years, 3.8%
    75 to 79 years, 6.0%
    80 to 84 years, 8.1%
    85 to 89 years, 12.6%
    90 and older, 16.7%
    http://www.blogger.com/img/blank.gif
    Massarweh N, et al "Impact of advancing age on abdominal surgical outcomes" Archttp://www.blogger.com/img/blank.gifh Surg 2009; 144: 1108-14.

    Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com
    For more health info and links visit the author's web site www.hookman.com

    Tuesday, January 31, 2012

    RECURRENT CLOSTRIDIUM DIFFICILE INFECTION (CDI) ARE DIFFICULT TO TREAT

    Episodes of recurrent Clostridium difficile infection (CDI) are difficult to treat for several reasons. Foremost, data are lacking to support any particular treatment strategy. In addition, treatment of recurrent episodes is not always successful, and repeated, prolonged treatment is often necessary. Identification of subgroups at risk for recurrent CDI may aid in diagnosing and treating these patients. Two likely mechanistic factors increasing the risk of recurrent CDI are an inadequate immune response to C. difficile toxins and persistent disruption of the normal colonic flora. Important epidemiologic risk factors include advanced age, continuation of other antibiotics, and prolonged hospital stays. Current guidelines recommend that the first recurrent episode be treated with the same agent (i.e., metronidazole or vancomycin) used for the index episode. However, if the first recurrence is characterized as severe, vancomycin should be used. A reasonable strategy for managing a subsequent episode involves tapering followed by pulsed doses of vancomycin. Other potentially effective strategies for recurrent CDI include vancomycin with adjunctive treatments, such as Saccharomyces boulardii, rifaximin “chaser” therapy after vancomycin, nitazoxanide, fecal transplantation, and intravenous immunoglobulin. New treatment agents that are active against C. difficile, but spare critical components of the normal flora, may decrease the incidence of recurrent CDI.

    Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com
    For more health info and links visit the author's web site www.hookman.com

    Sunday, January 15, 2012

    Best Treatment for Patients with Both Heart Disease and Diabetes? No Clear Answer

    For patients with both coronary artery disease and type 2 diabetes, outcomes are similar regardless of whether revascularization or medical therapy is used — and whether insulin sensitization or insulin provision is used — reports an industry-supported study published online in the New England Journal of Medicine.

    Researchers randomized some 2400 patients to either prompt revascularization or medical treatment, and to either insulin-sensitization or insulin-provision therapy. At 5 years, all-cause mortality did not differ between the revascularization and medical-therapy groups or between the insulin-sensitization and insulin-provision groups. Similarly, major cardiovascular events did not differ between groups.
    Patients were stratified before randomization according to type of revascularization, and patients in the CABG (but not PCI) group had fewer major cardiovascular events with revascularization but a similar mortality rate.

    Asked to comment, Journal Watch Cardiology Editor-in-Chief Dr. Harlan Krumholz said that the failure of the study to show clear superiority of revascularization and insulin sensitization "reinforces the need to incorporate the patient's preferences, values, and goals — and costs — into decisions about which strategy to pursue."

    Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com
    For more health info and links visit the author's web site www.hookman.com