Doctors using computers the size of cell phones to help diagnose and prescribe; smartphones that act like computers. What would Hippocrates have to say?
For the medical industry, the explosion on to the market of smartphones, applications and related technologies that take physicians onto the information superhighway and links them to on-demand knowledge is nothing short of revolutionary.
And yet while there are still some late adopters, such as hospitals with electronic health record security concerns, it seems that the industry has embraced smartphones and all their potentiality. According to some industry experts, the wireless health market is expected to rise to $9.6 billion within two years, up from $2.7 billion from 2007.
At point-of-care, the numbers are just as impressive: By 2012, physicians with smartphone usage is expected to top 80 percent, while of those who already have them, 95 percent are using downloaded apps like Epocrates, Medscape and Skyscape, according to research. What’s more, smartphone apps are actually changing the way physicians use technology, with 52 percent seeking out medical information several times daily compared to 37 percent of computer users.
As technology evolves and transforms smartphones into medical devices, it begs the question: Which are the leading apps and how are they affecting medical practice?
In Trends in Mobile Medicine: Smartphone Apps for Physicians, FirstWord takes on the constantly evolving world of smartphone apps to discover how they’re affecting healthcare providers and their prescribing habits, who amongst physician groups and hospitals are early adopters and how mobile apps are impacting emerging markets. In the tightly-written and compelling 60-page dossier, FirstWord expertly propels the reader through the key developments, the ten most popular apps, their attractions and their drawbacks.
lunes, 31 de mayo de 2010
Israel ataca flotilla humanitaria propalestina y mata a nueve
No puede ser !!! Eso no puede pasar !!!
jueves, 27 de mayo de 2010
Tragedia en mi país, erupción terrible en el volcán Pacaya
Por lo menos 8 personas desaparecidas, un reportero fallecido...Suspensión de clases en varios departamentos de la república, aeropuerto cerrado, etc...
Mi casa esta llena de arena volcánica, en pocas horas amanecerá y veremos como siguen las cosas...
martes, 25 de mayo de 2010
lunes, 24 de mayo de 2010
More evidence against concept of "metabolic syndrome"
More evidence against concept of "metabolic syndrome"
May 20, 2010 Sue Hughes
Hamilton, ON - Patients with metabolic syndrome are no more at risk of future MI than those with diabetes or hypertension alone, a new study suggests [1].
The study, published in the May 25, 2010 issue of the Journal of the American College of Cardiology, was conducted by a group led by Dr Andrew Mente (McMaster University, Hamilton, ON).
Mente commented to heartwire: "Our study examined whether we need to look at metabolic syndrome as a distinct entity or whether we should instead be focusing on the individual risk factors, and we found that the individual risk-factor approach is probably best. The results strongly suggest that we should be treating the individual risk factors rather than metabolic syndrome."
The results strongly suggest that we should be treating the individual risk factors rather than metabolic syndrome. In the paper, the researchers explain that the common clustering of metabolic abnormalities, including abdominal obesity, elevated glucose, abnormal lipids, and elevated blood pressure is often referred to as the metabolic syndrome. While metabolic syndrome is associated with an increased risk of coronary heart disease, it is not known whether this risk is greater than that conferred by its constituent components, and the value of classifying subjects with metabolic syndrome has recently been called into question.
To investigate this issue, Mente et al analyzed data from the INTERHEART study, a case-control study of incident acute MI that involved 12 297 cases and 14 606 controls from 52 countries. They classified the study participants using the World Health Organization (WHO) and International Diabetes Federation (IDF) criteria for metabolic syndrome, and their risks for MI were compared with the individual metabolic-syndrome component factors. Results showed that metabolic syndrome was associated with a two- to three-times increased risk of MI, but the same risk was conferred by having either hypertension or diabetes alone.
Adjusted odds ratio for MI associated with metabolic syndrome or its component factors
Risk factor
OR (95% CI)
Metabolic syndrome (WHO definition)
2.69 (2.45-2.95)
Metabolic syndrome (IDF definition)
2.20 (2.03-2.38)
Diabetes
2.72 (2.53-2.92)
Hypertension
2.60 (2.46-2.76)
Abdominal obesity (WHO definition)
1.64 (1.55-1.74)
Abdominal obesity (IDF definition)
1.32 (1.25-1.39)
Low HDL
1.30 (1.22-1.37)
To download table as a slide, click on slide logo above
Mente noted: "People who advocate for the metabolic syndrome concept believe that when the component risk factors occur together this would have an additive or greater effect on risk, and therefore it is important to identify these individuals. But we didn't find that. So our study adds to the evidence that a diagnosis of metabolic syndrome is not useful. It is better just to treat the actual risk factors."
The researchers also looked at subthreshold values for the risk factors making up the metabolic syndrome—ie, levels higher than normal but below the levels that define diabetes, hypertension, low HDL or abdominal obesity. They found that there appeared to be a dose-response relationship between MI and risk-factor measures, and an aggregation of risk factors with values below their threshold was associated with a significantly greater risk of MI, compared with having component factors with normal values (OR 1.5), but lower than the risk conferred by an aggregation of risk factors with values above the threshold points.
They write: "These findings of a dose-response relationship between risk-factor severity and MI risk suggest that a standard definition of metabolic syndrome loses information when continuous variables are converted to categorical variables and provide support for calls to replace the categorical definition of metabolic syndrome with a scoring system that may involve each risk factor being assigned a weight based on its level and a regression formula developed to estimate risk."
Yes, in my opinion this should be the end of the metabolic syndrome. To heartwire, Mente added: "This is another knock against the diagnosis of metabolic syndrome. It is not a case of 'Yes, you are at increased risk' or "No, you are not at increased risk.' Risk increases incrementally, and if we use the definition of metabolic syndrome, we would not catch any of the patients with these subthreshold increases in risk factors."
Asked whether there is now enough evidence to do away with the concept of metabolic syndrome, Mente replied: "We are seeing a little more evidence with each study. It gets to a point where the evidence becomes overwhelming. It is hard to say if we are there yet. Our findings are consistent with at least a couple of other studies, and, yes, in my opinion this should be the end of the metabolic syndrome. But there might be some who disagree."
This study was supported by the Canadian Institutes of Health Research, the Heart and Stroke Foundation of Ontario, the International Clinical Epidemiology Network, and unrestricted grants from several pharmaceutical companies (with major contributions from AstraZeneca, Novartis, Hoechst Marion Roussel [now Sanofi-Aventis], Knoll Pharmaceuticals [now Abbott], Bristol-Myers Squibb, and Sanofi-Synthélabo). The authors do not report any other disclosures.
« Previous heartwire article
DES and ICDs have raised total costs
May 20, 2010 15:45 EDT Next heartwire article »
New observational study: No risk of cancer with statins
May 20, 2010 19:01 EDT
Source
1.Mente A, Yusuf S, Islam S, et al. Metabolic syndrome and risk of acute myocardial infarction. A case-control study of 26 903 subjects from 52 countries. J Am Coll Cardiol 2010; 55:2390-2398.
Artículo completo: http://www.theheart.org/article/1080363.do
May 20, 2010 Sue Hughes
Hamilton, ON - Patients with metabolic syndrome are no more at risk of future MI than those with diabetes or hypertension alone, a new study suggests [1].
The study, published in the May 25, 2010 issue of the Journal of the American College of Cardiology, was conducted by a group led by Dr Andrew Mente (McMaster University, Hamilton, ON).
Mente commented to heartwire: "Our study examined whether we need to look at metabolic syndrome as a distinct entity or whether we should instead be focusing on the individual risk factors, and we found that the individual risk-factor approach is probably best. The results strongly suggest that we should be treating the individual risk factors rather than metabolic syndrome."
The results strongly suggest that we should be treating the individual risk factors rather than metabolic syndrome. In the paper, the researchers explain that the common clustering of metabolic abnormalities, including abdominal obesity, elevated glucose, abnormal lipids, and elevated blood pressure is often referred to as the metabolic syndrome. While metabolic syndrome is associated with an increased risk of coronary heart disease, it is not known whether this risk is greater than that conferred by its constituent components, and the value of classifying subjects with metabolic syndrome has recently been called into question.
To investigate this issue, Mente et al analyzed data from the INTERHEART study, a case-control study of incident acute MI that involved 12 297 cases and 14 606 controls from 52 countries. They classified the study participants using the World Health Organization (WHO) and International Diabetes Federation (IDF) criteria for metabolic syndrome, and their risks for MI were compared with the individual metabolic-syndrome component factors. Results showed that metabolic syndrome was associated with a two- to three-times increased risk of MI, but the same risk was conferred by having either hypertension or diabetes alone.
Adjusted odds ratio for MI associated with metabolic syndrome or its component factors
Risk factor
OR (95% CI)
Metabolic syndrome (WHO definition)
2.69 (2.45-2.95)
Metabolic syndrome (IDF definition)
2.20 (2.03-2.38)
Diabetes
2.72 (2.53-2.92)
Hypertension
2.60 (2.46-2.76)
Abdominal obesity (WHO definition)
1.64 (1.55-1.74)
Abdominal obesity (IDF definition)
1.32 (1.25-1.39)
Low HDL
1.30 (1.22-1.37)
To download table as a slide, click on slide logo above
Mente noted: "People who advocate for the metabolic syndrome concept believe that when the component risk factors occur together this would have an additive or greater effect on risk, and therefore it is important to identify these individuals. But we didn't find that. So our study adds to the evidence that a diagnosis of metabolic syndrome is not useful. It is better just to treat the actual risk factors."
The researchers also looked at subthreshold values for the risk factors making up the metabolic syndrome—ie, levels higher than normal but below the levels that define diabetes, hypertension, low HDL or abdominal obesity. They found that there appeared to be a dose-response relationship between MI and risk-factor measures, and an aggregation of risk factors with values below their threshold was associated with a significantly greater risk of MI, compared with having component factors with normal values (OR 1.5), but lower than the risk conferred by an aggregation of risk factors with values above the threshold points.
They write: "These findings of a dose-response relationship between risk-factor severity and MI risk suggest that a standard definition of metabolic syndrome loses information when continuous variables are converted to categorical variables and provide support for calls to replace the categorical definition of metabolic syndrome with a scoring system that may involve each risk factor being assigned a weight based on its level and a regression formula developed to estimate risk."
Yes, in my opinion this should be the end of the metabolic syndrome. To heartwire, Mente added: "This is another knock against the diagnosis of metabolic syndrome. It is not a case of 'Yes, you are at increased risk' or "No, you are not at increased risk.' Risk increases incrementally, and if we use the definition of metabolic syndrome, we would not catch any of the patients with these subthreshold increases in risk factors."
Asked whether there is now enough evidence to do away with the concept of metabolic syndrome, Mente replied: "We are seeing a little more evidence with each study. It gets to a point where the evidence becomes overwhelming. It is hard to say if we are there yet. Our findings are consistent with at least a couple of other studies, and, yes, in my opinion this should be the end of the metabolic syndrome. But there might be some who disagree."
This study was supported by the Canadian Institutes of Health Research, the Heart and Stroke Foundation of Ontario, the International Clinical Epidemiology Network, and unrestricted grants from several pharmaceutical companies (with major contributions from AstraZeneca, Novartis, Hoechst Marion Roussel [now Sanofi-Aventis], Knoll Pharmaceuticals [now Abbott], Bristol-Myers Squibb, and Sanofi-Synthélabo). The authors do not report any other disclosures.
« Previous heartwire article
DES and ICDs have raised total costs
May 20, 2010 15:45 EDT Next heartwire article »
New observational study: No risk of cancer with statins
May 20, 2010 19:01 EDT
Source
1.Mente A, Yusuf S, Islam S, et al. Metabolic syndrome and risk of acute myocardial infarction. A case-control study of 26 903 subjects from 52 countries. J Am Coll Cardiol 2010; 55:2390-2398.
Artículo completo: http://www.theheart.org/article/1080363.do
viernes, 21 de mayo de 2010
Ocean's Depth and Volume Revealed
The Earth's oceans are among the most mysterious places on the planet, but scientists now have at least figured out how deep the oceans are and just how much water they hold.
A group of scientists used satellite measurements to get new estimates of these values, which turned out to be 0.3 billion cubic miles (1.332 billion cubic kilometers) for the volume of the oceans and 12,080.7 feet (3,682.2 meters) for the average ocean depth.
Artículo completo: http://news.yahoo.com/s/livescience/20100519/sc_livescience/oceansdepthandvolumerevealed
A group of scientists used satellite measurements to get new estimates of these values, which turned out to be 0.3 billion cubic miles (1.332 billion cubic kilometers) for the volume of the oceans and 12,080.7 feet (3,682.2 meters) for the average ocean depth.
Artículo completo: http://news.yahoo.com/s/livescience/20100519/sc_livescience/oceansdepthandvolumerevealed
Nintendo Wii gets the AHA thumbs-up
May 19, 2010Michael O'Riordan
Dallas, TX - Parents are no longer able to play the exercise card when it comes to video games, not with the latest endorsement from the American Heart Association (AHA). The video-game maker Nintendo is now allowed to put the AHA "heart check" logo on all Wii virtual exercise and active game systems, making a more difficult case for parents asking kids to put away the console and hop on their bikes for exercise [1].
The partnership between Nintendo and the AHA, which might appear strange given the obesity epidemic in the US, was announced Monday. More than 70% of Americans are completely sedentary, according to the AHA, so this latest move is designed to make exercise more accessible and fun.
The AHA heart logo, which will appear on the Nintendo Wii system, as well as video games Wii Fit and Wii Sports Resort, is part of a nationwide program to let consumers know that the organization considers the system and games healthy choices. Normally, however, the heart-check seal of approval is seen on food packaging, such as Cheerios, where it shows consumers that it meets criteria for saturated fat and cholesterol.
As part of the partnership, Nintendo is donating $1.5 million to the AHA.
Fuente: theheart.org
Dallas, TX - Parents are no longer able to play the exercise card when it comes to video games, not with the latest endorsement from the American Heart Association (AHA). The video-game maker Nintendo is now allowed to put the AHA "heart check" logo on all Wii virtual exercise and active game systems, making a more difficult case for parents asking kids to put away the console and hop on their bikes for exercise [1].
The partnership between Nintendo and the AHA, which might appear strange given the obesity epidemic in the US, was announced Monday. More than 70% of Americans are completely sedentary, according to the AHA, so this latest move is designed to make exercise more accessible and fun.
The AHA heart logo, which will appear on the Nintendo Wii system, as well as video games Wii Fit and Wii Sports Resort, is part of a nationwide program to let consumers know that the organization considers the system and games healthy choices. Normally, however, the heart-check seal of approval is seen on food packaging, such as Cheerios, where it shows consumers that it meets criteria for saturated fat and cholesterol.
As part of the partnership, Nintendo is donating $1.5 million to the AHA.
Fuente: theheart.org
Rotarix Vaccine: Update to Clinicians and Public Health Professionals
03/22/2010
FDA is recommending that healthcare professionals temporarily suspend the use of Rotarix, a vaccine used to prevent rotavirus disease. FDA’s recommendation is a precaution taken while the agency learns more about the situation.
FDA has learned that DNA from porcine circovirus type 1 (PCV1) is present in Rotarix. PCV1 is not known to cause disease in humans. There is no evidence at this time that this finding poses a safety risk. Because available evidence supports the safety of Rotarix, no medical follow-up is needed for patients who have been vaccinated with Rotarix.
There are two licensed vaccines for rotavirus in the United States: RotaTeq and Rotarix. For children who have received one dose of Rotarix, CDC advises that clinicians can complete the series with RotaTeq for the next two doses.
Readers can view this complete Rotarix Vaccine Safety Alert online, along with a link to additional information for healthcare professionals and parents provided in the Update on Rotarix Vaccine - FDA.
FDA is recommending that healthcare professionals temporarily suspend the use of Rotarix, a vaccine used to prevent rotavirus disease. FDA’s recommendation is a precaution taken while the agency learns more about the situation.
FDA has learned that DNA from porcine circovirus type 1 (PCV1) is present in Rotarix. PCV1 is not known to cause disease in humans. There is no evidence at this time that this finding poses a safety risk. Because available evidence supports the safety of Rotarix, no medical follow-up is needed for patients who have been vaccinated with Rotarix.
There are two licensed vaccines for rotavirus in the United States: RotaTeq and Rotarix. For children who have received one dose of Rotarix, CDC advises that clinicians can complete the series with RotaTeq for the next two doses.
Readers can view this complete Rotarix Vaccine Safety Alert online, along with a link to additional information for healthcare professionals and parents provided in the Update on Rotarix Vaccine - FDA.
Does the Choice of Antihypertensive Agent Affect Risk for AFib?
In a case-control study, ACE inhibitors, ARBs, and beta-blockers were associated with a reduction in incident AF compared with calcium-channel blockers.
Hypertension is a known risk factor for atrial fibrillation. To assess and compare the relative risk for incident AF among patients taking different classes of antihypertensive drugs, investigators used a British general practice database to conduct a nested case-control analysis. All participants had hypertension diagnoses and had received one or more prescriptions for an ACE inhibitor, angiotensin-receptor blocker, beta-blocker, calcium-channel blocker, diuretic, or any combination of these drugs.
Of a total of 682,993 antihypertensive drug recipients, 4661 were diagnosed with AF and met inclusion criteria for the analysis. Almost two thirds of the case patients were 70 or older at first AF diagnosis. The investigators randomly identified 18,642 age- and sex-matched participants without AF from the study population as a control group. Obese patients had a higher risk for AF than nonobese patients, whereas current smokers had a lower risk for AF than nonsmokers.
The reference group consisted of patients receiving calcium-channel blockers. Compared with the reference group, long-term (≥12 prescriptions) ACE inhibitor recipients had a significant 25% reduction — and long-term ARB recipients had a significant 29% reduction — in risk for incident AF. Patients who had received beta-blockers for at least 1 year had a significant 22% reduction in risk for AF.
Comment: In patients with hypertension, different classes of drugs can have different effects on risk for future AF. Clinicians should consider this possibility when prescribing drugs for hypertension. In particular, avoiding calcium-channel blockers as front-line therapy in elders might reduce their risk for AF.
— Joel M. Gore, MD
Published in Journal Watch Cardiology February 3, 2010
Copyright © 2009. Massachusetts Medical Society. All rights reserved.
Citation:
Schaer BA et al. Risk for incident atrial fibrillation in patients who receive antihypertensive drugs: A nested case–control study. Ann Intern Med 2010 Jan 19; 152:78. [Medline® Abstract]
Copyright © 2009. Massachusetts Medical Society. All rights reserved.
Hypertension is a known risk factor for atrial fibrillation. To assess and compare the relative risk for incident AF among patients taking different classes of antihypertensive drugs, investigators used a British general practice database to conduct a nested case-control analysis. All participants had hypertension diagnoses and had received one or more prescriptions for an ACE inhibitor, angiotensin-receptor blocker, beta-blocker, calcium-channel blocker, diuretic, or any combination of these drugs.
Of a total of 682,993 antihypertensive drug recipients, 4661 were diagnosed with AF and met inclusion criteria for the analysis. Almost two thirds of the case patients were 70 or older at first AF diagnosis. The investigators randomly identified 18,642 age- and sex-matched participants without AF from the study population as a control group. Obese patients had a higher risk for AF than nonobese patients, whereas current smokers had a lower risk for AF than nonsmokers.
The reference group consisted of patients receiving calcium-channel blockers. Compared with the reference group, long-term (≥12 prescriptions) ACE inhibitor recipients had a significant 25% reduction — and long-term ARB recipients had a significant 29% reduction — in risk for incident AF. Patients who had received beta-blockers for at least 1 year had a significant 22% reduction in risk for AF.
Comment: In patients with hypertension, different classes of drugs can have different effects on risk for future AF. Clinicians should consider this possibility when prescribing drugs for hypertension. In particular, avoiding calcium-channel blockers as front-line therapy in elders might reduce their risk for AF.
— Joel M. Gore, MD
Published in Journal Watch Cardiology February 3, 2010
Copyright © 2009. Massachusetts Medical Society. All rights reserved.
Citation:
Schaer BA et al. Risk for incident atrial fibrillation in patients who receive antihypertensive drugs: A nested case–control study. Ann Intern Med 2010 Jan 19; 152:78. [Medline® Abstract]
Copyright © 2009. Massachusetts Medical Society. All rights reserved.
martes, 18 de mayo de 2010
Advierte la OMS a hinchas que irán Mundial fútbol por brote de fiebre
GINEBRA (Reuters) - Los turistas que irán a Sudáfrica, especialmente los hinchas que acudirán al Mundial de fútbol, deben cuidarse de las picaduras de mosquitos y evitar el contacto con carne cruda debido a un brote de fiebre del Valle del Rift, dijo el martes la Organización Mundial de la Salud (OMS).Las autoridades de Sudáfrica, sede del Mundial que se jugará del 11 de junio al 11 de julio, han reportado 172 casos humanos de la enfermedad viral durante el año, incluyendo 15 muertes.
Muchos turistas recorren los parques del país africano y la OMS advirtió a los visitantes evitar el contacto con animales muertos, otra forma de contraer la enfermedad.
"La gente debería ser consciente de que hay fiebre del Valle del Rift en varias provincias y debería tomar precauciones cuando visiten lugares donde podrían estar expuestos a los animales que pueden estar infectados", dijo a Reuters la portavoz de la OMS, Aphaluck Bhatiasevi.
Se confirmó que una turista alemana que visitó un lugar reservado para la caza se había contagiado la enfermedad tras regresar de Sudáfrica el mes pasado, dijo la OMS en un comunicado. Otros tres viajeros también presentan síntomas, pero todos se han recuperado y no corren peligro.
Según la OMS, el virus suele causar síntomas parecidos a una gripe relativamente leve, pero provoca también rigidez en el cuello, a veces alucinaciones, mareos e incluso un coma.
Un pequeño porcentaje de las víctimas desarrollan una hemorragia que causa el vomito de sangre. La mitad de estos pacientes mueren.
Se han confirmado casos humanos en varias provincias de Sudáfrica, la mayoría después de tener contacto con animales infectados.
Artículo completo: http://www.intramed.net/contenidover.asp?contenidoID=65514&uid=465290
lunes, 17 de mayo de 2010
Expertos hallan explicación de casos graves de dengue
Científicos en Gran Bretaña y Tailandia podrían haber descubierto por qué las personas que se infectan una y otra vez con el virus del dengue sufren síntomas más severos, como fiebre hemorrágica y conmoción, y a veces mueren.
Existen cuatro tipos diferentes de dengue, una enfermedad transmitida por mosquitos. Las personas que son víctimas de infecciones recurrentes de distintos tipos tienden a enfermarse gravemente, pero los expertos aún no han podido explicar por qué.
En un estudio publicado en Science, los investigadores dijeron que, al analizar muestras de sangre donadas por voluntarios infectados, hallaron que el sistema inmune humano produce un tipo de anticuerpo llamado prM para combatir al virus del dengue.
Pero estos estaban lejos de ser perfectos.
"Cuando una persona que ya ha sido infectada con una cepa del virus del dengue se encuentra con una cepa diferente, los anticuerpos prM que emergieron durante la primera infección vuelven a entrar en acción", escribieron los investigadores en un comunicado.
"En vez de proteger al cuerpo de la segunda infección, estos anticuerpos ayudan al virus a establecerse", agregó.
Liderados por Wanwisa Dejnirattisai y Gavin Screaton, del departamento de medicina de la Imperial College London, los científicos dijeron que los fabricantes de las vacunas deben evitar usar los anticuerpos prM.
El diseño de una vacuna o un tratamiento para el dengue es vital debido a que los casos globales se han disparado a raíz de la urbanización, el aumento de las temperaturas y el constante movimiento de las personas, todas condiciones que favorecen el nacimiento del mosquito Aedes aegypti, que transmite el virus.
La Organización Mundial de la Salud (OMS) estimó que 2.500 millones de personas viven en más de 100 países y áreas endémicos donde se transmiten los virus del dengue.
Anualmente ocurren entre 50 y 100 millones de infecciones, con 500.000 casos de fiebre hemorrágica de dengue (FHD) y 22.000 muertes, sobre todo entre los niños.
El dengue es una enfermedad cara, con un costo promedio de 1.394 dólares por cada paciente hospitalizado. En cada caso se pierden al menos 10 días de trabajo, según la OMS.
"Nuestra nueva investigación nos da información clave acerca de qué es lo que probablemente funcione y lo que no al intentar combatir el virus del dengue. Esperamos que nuestros resultados permitan a los científicos acercarse a la creación de una vacuna efectiva", dijeron los investigadores.
Existen cuatro tipos diferentes de dengue, una enfermedad transmitida por mosquitos. Las personas que son víctimas de infecciones recurrentes de distintos tipos tienden a enfermarse gravemente, pero los expertos aún no han podido explicar por qué.
En un estudio publicado en Science, los investigadores dijeron que, al analizar muestras de sangre donadas por voluntarios infectados, hallaron que el sistema inmune humano produce un tipo de anticuerpo llamado prM para combatir al virus del dengue.
Pero estos estaban lejos de ser perfectos.
"Cuando una persona que ya ha sido infectada con una cepa del virus del dengue se encuentra con una cepa diferente, los anticuerpos prM que emergieron durante la primera infección vuelven a entrar en acción", escribieron los investigadores en un comunicado.
"En vez de proteger al cuerpo de la segunda infección, estos anticuerpos ayudan al virus a establecerse", agregó.
Liderados por Wanwisa Dejnirattisai y Gavin Screaton, del departamento de medicina de la Imperial College London, los científicos dijeron que los fabricantes de las vacunas deben evitar usar los anticuerpos prM.
El diseño de una vacuna o un tratamiento para el dengue es vital debido a que los casos globales se han disparado a raíz de la urbanización, el aumento de las temperaturas y el constante movimiento de las personas, todas condiciones que favorecen el nacimiento del mosquito Aedes aegypti, que transmite el virus.
La Organización Mundial de la Salud (OMS) estimó que 2.500 millones de personas viven en más de 100 países y áreas endémicos donde se transmiten los virus del dengue.
Anualmente ocurren entre 50 y 100 millones de infecciones, con 500.000 casos de fiebre hemorrágica de dengue (FHD) y 22.000 muertes, sobre todo entre los niños.
El dengue es una enfermedad cara, con un costo promedio de 1.394 dólares por cada paciente hospitalizado. En cada caso se pierden al menos 10 días de trabajo, según la OMS.
"Nuestra nueva investigación nos da información clave acerca de qué es lo que probablemente funcione y lo que no al intentar combatir el virus del dengue. Esperamos que nuestros resultados permitan a los científicos acercarse a la creación de una vacuna efectiva", dijeron los investigadores.
Fuente: Intramed.com
Armonizando el síndrome metabólico
Las personas con SM duplican el riesgo de complicaciones cardiovasculares en un período de 5-10 años comparadas con individuos sanos.
Artículo completo: http://www.intramed.net/contenidover.asp?contenidoID=63583&uid=465290
Artículo completo: http://www.intramed.net/contenidover.asp?contenidoID=63583&uid=465290
sábado, 15 de mayo de 2010
Médicas Guatemaltecas
Actualmente en Guatemala somos arriba de 15300 médicos según el colegio de médicos, un dato interesante es que a partir de la colegiatura 13,000 las mujeres superan numéricamente a los hombres graduados y por ende colegiados.Supongo que esto indica que los tiempos en que el gremio médico era dominado por los hombres ya pasó a la historia !!!
Fuente: Revista del Colegio de Médicos de Guatemala
Las lágrimas del Juez Garzón son mis lágrimas
Ésto es lo que José Saramago expresa ante la suspensión del juez Garzón por desición del Consejo Gral. del Poder Judicial español por re-abrir invesigaciones de crímenes de la dictadura franquista !!!
Vergûenza para España !!!
Vergûenza para España !!!
Loukanikos EL PERRO REVELDE
Ha sido muy grato ver que la TV internacional le ha dedicado notas especiales a este curioso fenómeno, que ya tiene más de 14000 seguidores en Facebook)
En estos tiempos de crisis, difíciles para todos, pero especialmente para Grecia, ha saltado a la fama un personaje muy peculiar.
¡Loukanikos! Con un nombre difícil de pronunciar y que he visto escrito de diferentes formas, (Loukanikos, Lukanikos, Lucanicos, etc.), es perseguido por los reporteros gráficos de todo el mundo y se ha convertido en la estrella de cuantos actos participa. Ya que Lukanikos, luchador incansable, natural de Exarquia, (centro de la lucha obrera en Atenas -Grecia-), no se pierde ningún acto reivindicativo de la clase obrera.
Loukanikos es....Pacífico y valiente, conoce de que bando es, pero sobre todo es noble y leal.
Espero que cuando estos tiempos pasen, haya un lugar en la historia para alguien que luchó por una sociedad mejor.
De momento Loukanikos tiene incluso página propia, Rebel dog.
martes, 11 de mayo de 2010
sábado, 8 de mayo de 2010
Científica colombiana crea regenerador celular
Colombiana crea regenerador celularLa regeneración natural de los tejidos a partir de la sangre es una realidad gracias a la científica colombiana Elda Restrepo, quien ha logrado la reconstrucción de tejidos periféricos mediante células madre adultas de los propios pacientes.
Tras 15 años de trabajo e investigaciones, Restrepo ha conseguido crear el Cytogel, material que al estar compuesto enteramente a partir del organismo de los pacientes no tiene posibilidad alguna de rechazo.
El Cytogel “regenera, cicatriza, pega, controla pequeños sangrados y se comporta como antiinflamatorio, de manera que disminuye el dolor del paciente” , manifestó Restrepo.
Mediante la aplicación del Cytogel ya se ha demostrado clínicamente que se puede recuperar piel, mucosas, hueso, cartílago, tendones, ligamentos, tejido adiposo, tejido muscular, tejido neural periférico y pelo.
“Con el uso del Cytogel ya hemos demostrado que la regeneración de los tejidos óseos de los niños es mucho más rápida y deja muchas menos secuelas que la medicina tradicional”, refirió la científica.
Aunque ha sido aplicado, sobre todo, en casos de odontología en pacientes que han perdido el hueso en las zonas maxilares, Restrepo ha tratado también a víctimas de accidentes viales e incluso a personas que sufrieron un balazo en el cráneo.
Fuente: prensalibre.com
Tras 15 años de trabajo e investigaciones, Restrepo ha conseguido crear el Cytogel, material que al estar compuesto enteramente a partir del organismo de los pacientes no tiene posibilidad alguna de rechazo.
El Cytogel “regenera, cicatriza, pega, controla pequeños sangrados y se comporta como antiinflamatorio, de manera que disminuye el dolor del paciente” , manifestó Restrepo.
Mediante la aplicación del Cytogel ya se ha demostrado clínicamente que se puede recuperar piel, mucosas, hueso, cartílago, tendones, ligamentos, tejido adiposo, tejido muscular, tejido neural periférico y pelo.
“Con el uso del Cytogel ya hemos demostrado que la regeneración de los tejidos óseos de los niños es mucho más rápida y deja muchas menos secuelas que la medicina tradicional”, refirió la científica.
Aunque ha sido aplicado, sobre todo, en casos de odontología en pacientes que han perdido el hueso en las zonas maxilares, Restrepo ha tratado también a víctimas de accidentes viales e incluso a personas que sufrieron un balazo en el cráneo.
Fuente: prensalibre.com
sábado, 1 de mayo de 2010
Management of Venous Ulcers Reviewed
April 29, 2010 — Diagnosis and treatment of venous ulcers in the family practice setting are reviewed in the April 15 issue of American Family Physician.
"Venous ulcers, or stasis ulcers, account for 80 percent of lower extremity ulcerations," write Lauren Collins, MD, and Samina Seraj, MD, from Thomas Jefferson University Hospital in Philadelphia, Pennsylvania. "Although the overall prevalence is relatively low, the refractory nature of these ulcers increase the risk of morbidity and mortality, and have a significant impact on patient quality of life. The financial burden of venous ulcers is estimated to be $2 billion per year in the United States."
In the United States, the prevalence of venous ulcers is approximately 1%, with possible underlying mechanisms including inflammation causing leukocyte activation, endothelial damage, platelet aggregation, and intracellular edema. Clinical characteristics predisposing to development of venous ulcers include older age, obesity, a history of leg trauma, deep venous thrombosis, and phlebitis.
On physical examination, venous ulcers are typically irregular and shallow, with granulation tissue and fibrin present in the ulcer base. They are usually located over bony prominences and may be accompanied by lower extremity varicosities, edema, venous dermatitis, and lipodermatosclerosis.
An open ulcer may persist for weeks to many years, and it tends to recur. Larger ulcer size and longer duration of the ulcer usually signify a worse prognosis. Severe complications of venous ulcers include cellulitis, osteomyelitis, and malignant change.
Conservative Management Options
Leg elevation, compression therapy, dressings, pentoxifylline, and aspirin are conservative management options for venous ulcers supported by research evidence. Leg elevation reduces edema and should be used for 30-minute sessions, 3 or 4 times a day. No single type of dressing has been shown to be superior.
Compression therapy (inelastic, elastic, intermittent pneumatic) is the standard of care and is associated with a decreased rate of ulcer recurrence. Although compression therapy is of proven benefit, the effect of intermittent pneumatic therapy is less evident. The use of topical negative pressure, or vacuum-assisted closure, for venous ulcers lacks robust-supporting evidence.
Either pentoxifylline (400 mg 3 times daily) or aspirin (300 mg daily) is effective when used with compression therapy, and pentoxifylline may be useful as monotherapy.
Intravenously administered iloprost may be beneficial, but supporting data are limited; it is expensive; and it is not available in the United States.
Oral zinc has not been shown to be effective. Although routine use of systemic antibiotics is not recommended, oral antibiotics should be prescribed to patients with suspected cellulitis. Adding the topical antiseptic cadexomer iodine is of unclear benefit, and this drug is not available in the United States.
Hyperbaric oxygen therapy is of no proven benefit.
Surgical Management
For ulcers that are large, of prolonged duration, or not responsive to conservative measures including pharmacotherapy, surgical management may be considered. Although more research is needed regarding the comparative efficacy of various surgical approaches, options include debridement; human skin grafting; and surgery for venous insufficiency, which is associated with a reduced rate of ulcer recurrence and may be helpful for severe or refractory cases. Artificial skin grafting with human skin equivalent may be effective when used with compression therapy, but there are concerns regarding infection transmission.
Key Recommendations
Key clinical recommendations for practice, and their accompanying level of evidence rating, are as follows:
•Compression therapy is the standard of care for treatment of venous ulcers and has been proven beneficial (level of evidence, A).
•In patients with venous insufficiency, leg elevation reduces edema. A regimen of 30 minutes, 3 or 4 times per day, is recommended as adjunctive therapy for venous ulcers (level of evidence, C).
•For venous ulcer healing, dressings are beneficial, but no specific dressing has been demonstrated to be superior (level of evidence, A).
•Pentoxifylline (400 mg 3 times daily) may be useful as monotherapy for venous ulcers, and it has been shown to be effective when used with compression therapy (level of evidence, A).
•Aspirin, 300 mg per day, is effective for venous ulcers when used with compression therapy (level of evidence, B).
"The role of surgery is to reduce venous reflux, hasten healing, and prevent ulcer recurrence," the review authors conclude. "Surgical options for treatment of venous insufficiency include ablation of the saphenous vein; interruption of the perforating veins with subfascial endoscopic surgery; treatment of iliac vein obstruction with stenting; and removal of incompetent superficial veins with phlebectomy, stripping, sclerotherapy, or laser therapy....There is no evidence demonstrating the superiority of surgery over medical management; however, evaluation for possible surgical intervention should occur early."
The review authors have disclosed no relevant financial relationships.
Am Family Physician. 2010;81:989-996. Abstract
"Venous ulcers, or stasis ulcers, account for 80 percent of lower extremity ulcerations," write Lauren Collins, MD, and Samina Seraj, MD, from Thomas Jefferson University Hospital in Philadelphia, Pennsylvania. "Although the overall prevalence is relatively low, the refractory nature of these ulcers increase the risk of morbidity and mortality, and have a significant impact on patient quality of life. The financial burden of venous ulcers is estimated to be $2 billion per year in the United States."
In the United States, the prevalence of venous ulcers is approximately 1%, with possible underlying mechanisms including inflammation causing leukocyte activation, endothelial damage, platelet aggregation, and intracellular edema. Clinical characteristics predisposing to development of venous ulcers include older age, obesity, a history of leg trauma, deep venous thrombosis, and phlebitis.
On physical examination, venous ulcers are typically irregular and shallow, with granulation tissue and fibrin present in the ulcer base. They are usually located over bony prominences and may be accompanied by lower extremity varicosities, edema, venous dermatitis, and lipodermatosclerosis.
An open ulcer may persist for weeks to many years, and it tends to recur. Larger ulcer size and longer duration of the ulcer usually signify a worse prognosis. Severe complications of venous ulcers include cellulitis, osteomyelitis, and malignant change.
Conservative Management Options
Leg elevation, compression therapy, dressings, pentoxifylline, and aspirin are conservative management options for venous ulcers supported by research evidence. Leg elevation reduces edema and should be used for 30-minute sessions, 3 or 4 times a day. No single type of dressing has been shown to be superior.
Compression therapy (inelastic, elastic, intermittent pneumatic) is the standard of care and is associated with a decreased rate of ulcer recurrence. Although compression therapy is of proven benefit, the effect of intermittent pneumatic therapy is less evident. The use of topical negative pressure, or vacuum-assisted closure, for venous ulcers lacks robust-supporting evidence.
Either pentoxifylline (400 mg 3 times daily) or aspirin (300 mg daily) is effective when used with compression therapy, and pentoxifylline may be useful as monotherapy.
Intravenously administered iloprost may be beneficial, but supporting data are limited; it is expensive; and it is not available in the United States.
Oral zinc has not been shown to be effective. Although routine use of systemic antibiotics is not recommended, oral antibiotics should be prescribed to patients with suspected cellulitis. Adding the topical antiseptic cadexomer iodine is of unclear benefit, and this drug is not available in the United States.
Hyperbaric oxygen therapy is of no proven benefit.
Surgical Management
For ulcers that are large, of prolonged duration, or not responsive to conservative measures including pharmacotherapy, surgical management may be considered. Although more research is needed regarding the comparative efficacy of various surgical approaches, options include debridement; human skin grafting; and surgery for venous insufficiency, which is associated with a reduced rate of ulcer recurrence and may be helpful for severe or refractory cases. Artificial skin grafting with human skin equivalent may be effective when used with compression therapy, but there are concerns regarding infection transmission.
Key Recommendations
Key clinical recommendations for practice, and their accompanying level of evidence rating, are as follows:
•Compression therapy is the standard of care for treatment of venous ulcers and has been proven beneficial (level of evidence, A).
•In patients with venous insufficiency, leg elevation reduces edema. A regimen of 30 minutes, 3 or 4 times per day, is recommended as adjunctive therapy for venous ulcers (level of evidence, C).
•For venous ulcer healing, dressings are beneficial, but no specific dressing has been demonstrated to be superior (level of evidence, A).
•Pentoxifylline (400 mg 3 times daily) may be useful as monotherapy for venous ulcers, and it has been shown to be effective when used with compression therapy (level of evidence, A).
•Aspirin, 300 mg per day, is effective for venous ulcers when used with compression therapy (level of evidence, B).
"The role of surgery is to reduce venous reflux, hasten healing, and prevent ulcer recurrence," the review authors conclude. "Surgical options for treatment of venous insufficiency include ablation of the saphenous vein; interruption of the perforating veins with subfascial endoscopic surgery; treatment of iliac vein obstruction with stenting; and removal of incompetent superficial veins with phlebectomy, stripping, sclerotherapy, or laser therapy....There is no evidence demonstrating the superiority of surgery over medical management; however, evaluation for possible surgical intervention should occur early."
The review authors have disclosed no relevant financial relationships.
Am Family Physician. 2010;81:989-996. Abstract
Vitamin D Deficiency Linked to Cognitive Impairment in Older Women
Más sobre la maravillosa Vit. D
April 29, 2010 (Toronto, Ontario) — Vitamin D deficiency appears to increase the risk for cognitive impairment, a large, population-based study of older women shows.
Presented here at the American Academy of Neurology 62nd Annual Meeting, the cross-sectional study shows older women with serum 25-hydroxyvitamin D (25OHD) levels of less than 10 ng/mL had a 2-fold increased risk of global cognitive impairment compared with their counterparts who were not vitamin D deficient.
"After accounting for all potential confounders, our findings showed an association between vitamin D deficiency and global cognitive impairment. These results are congruent with fundamental research and add to the growing body of evidence in favor of the neurological action of vitamin D," principal investigator, Cédric Annweiler, MD, Angers University Hospital in France, told Medscape Psychiatry.
Dr. Annweiler said he became interested in looking at the potential impact of vitamin D on cognitive function when studying risk factors associated with falling in older women in the Epidemiologie de l'Osteoporose (EPIDOS) study. This large, prospective, observational, multicenter cohort study was designed to evaluate risk factors for hip fracture among more than 7500 healthy, community-dwelling older women.
Typically associated with skeletal disorders, vitamin D deficiency is also associated with neuromuscular disorders in humans and severe coordination disorders in animal research, said Dr. Annweiler.
Specific CNS Effects
A neurosteroid hormone, research shows it has specific effects on the central nervous system (CNS), including regulation of neurotransmission, neuroimmunomodulation, and neuroprotection.
According to Dr. Annweiler, few studies have investigated the association between low serum 25OHD and cognitive impairment. A recent systematic review of the literature conducted by his team produced mixed results (Eur J Neurol. 2009;16:1083-1089).
However, the investigators speculated that these inconclusive findings may be explained by the lack of control for potential confounders.
To determine whether there was an association between vitamin D deficiency and global cognitive impairment, the investigators studied 752 women from the EPIDOS cohort. Participants were 75 years and older and were divided into 2 groups according to serum 25OHD concentration — deficient (<10 ng/mL) or nondeficient (≥10 ng/mL).
Cognitive impairment was determined using the Pfeiffer Short Portable Mental State Questionnaire (SPMSQ), a validated, 10-item, composite questionnaire used to screen for organic brain diseases. Cognitive impairment was defined as an SPMSQ score of less than 8.
Investigators controlled for a variety of potential confounders, including age, body mass index, number of chronic diseases, current hypertension, current depression, use of psychoactive drugs, education level, regular physical activity, and serum intact parathyroid hormone and calcium.
Rampant Problem in the Elderly
The results showed that compared with women who were not vitamin D deficient (n = 623) their vitamin D deficient counterparts had a lower mean SPMSQ score (P < .001) and were also more likely to have an SPMSQ score of less than 8 (P = .006).
Adjusted analysis revealed that vitamin D was significantly associated with cognitive impairment (odds ratio, 2.03; P = .001).
The clinical implications, said Dr. Annweiler, appear clear — clinicians need to assess and treat vitamin D deficiency in their older patients for a variety of health reasons that may include preservation of cognitive function.
Vitamin D deficiency is common in the general population but is rampant among the elderly. According to Dr. Annweiler, it is estimated that 70% to 80% of individuals older than 75 years are vitamin D deficient.
Currently, adequate intakes of vitamin D for 51- to 70-year-olds are 400 IU per day and 600 IU for those older than 70 years to maintain a 25OHD level of 30 ng/mL or more. However, Dr. Annweiler noted that these recommendations are based primarily on preservation of bone health alone.
The reason the elderly are more vulnerable to vitamin D deficiency than younger individuals are several-fold and include decreased exposure to sunlight and inadequate dietary intake. In addition, said Dr. Annweiler, the skin of older people is not as efficient at synthesizing UV-B rays into vitamin D.
"This study provides more evidence to support [vitamin D] supplementation in our elderly patients to normalize serum concentrations and help sustain good health. Although we are not certain yet, it may be that this will also be a viable way to prevent or treat cognitive impairment and possibly turn out to be a new management strategy for dementia," said Dr. Annweiler.
The study was initially published earlier this year in the January 5 issue of Neurology. At that time, in an accompanying editorial, Joshua W. Mill, PhD, UC Davis Medical Center, Sacramento, California, echoed Dr. Annweiler's clinical recommendation (Neurology. 2010;74:13-15).
What are needed now are placebo-controlled intervention studies to determine whether vitamin D supplements will protect against age-related cognitive decline. In the meantime, neurologists and geriatricians should be aware of the high prevalence of vitamin D deficiency in their patient populations and the possibility that supplementation could be beneficial," Dr. Mill writes.
Dr. Annweiler said his team plans to prospectively follow up the cohort and examine the potential relationship between vitamin D status and incident dementia. In addition, his team is exploring the possibility of conducting a clinical trial to look at the impact of supplementation on cognitive outcomes.
The study was funded by the French Ministry of Health. Dr. Annweiler and Dr. Miller have disclosed no relevant financial relationships.
American Academy of Neurology (AAN) 62nd Annual Meeting: Abstract S34.003. Presented April 14, 2010
April 29, 2010 (Toronto, Ontario) — Vitamin D deficiency appears to increase the risk for cognitive impairment, a large, population-based study of older women shows.
Presented here at the American Academy of Neurology 62nd Annual Meeting, the cross-sectional study shows older women with serum 25-hydroxyvitamin D (25OHD) levels of less than 10 ng/mL had a 2-fold increased risk of global cognitive impairment compared with their counterparts who were not vitamin D deficient.
"After accounting for all potential confounders, our findings showed an association between vitamin D deficiency and global cognitive impairment. These results are congruent with fundamental research and add to the growing body of evidence in favor of the neurological action of vitamin D," principal investigator, Cédric Annweiler, MD, Angers University Hospital in France, told Medscape Psychiatry.
Dr. Annweiler said he became interested in looking at the potential impact of vitamin D on cognitive function when studying risk factors associated with falling in older women in the Epidemiologie de l'Osteoporose (EPIDOS) study. This large, prospective, observational, multicenter cohort study was designed to evaluate risk factors for hip fracture among more than 7500 healthy, community-dwelling older women.
Typically associated with skeletal disorders, vitamin D deficiency is also associated with neuromuscular disorders in humans and severe coordination disorders in animal research, said Dr. Annweiler.
Specific CNS Effects
A neurosteroid hormone, research shows it has specific effects on the central nervous system (CNS), including regulation of neurotransmission, neuroimmunomodulation, and neuroprotection.
According to Dr. Annweiler, few studies have investigated the association between low serum 25OHD and cognitive impairment. A recent systematic review of the literature conducted by his team produced mixed results (Eur J Neurol. 2009;16:1083-1089).
However, the investigators speculated that these inconclusive findings may be explained by the lack of control for potential confounders.
To determine whether there was an association between vitamin D deficiency and global cognitive impairment, the investigators studied 752 women from the EPIDOS cohort. Participants were 75 years and older and were divided into 2 groups according to serum 25OHD concentration — deficient (<10 ng/mL) or nondeficient (≥10 ng/mL).
Cognitive impairment was determined using the Pfeiffer Short Portable Mental State Questionnaire (SPMSQ), a validated, 10-item, composite questionnaire used to screen for organic brain diseases. Cognitive impairment was defined as an SPMSQ score of less than 8.
Investigators controlled for a variety of potential confounders, including age, body mass index, number of chronic diseases, current hypertension, current depression, use of psychoactive drugs, education level, regular physical activity, and serum intact parathyroid hormone and calcium.
Rampant Problem in the Elderly
The results showed that compared with women who were not vitamin D deficient (n = 623) their vitamin D deficient counterparts had a lower mean SPMSQ score (P < .001) and were also more likely to have an SPMSQ score of less than 8 (P = .006).
Adjusted analysis revealed that vitamin D was significantly associated with cognitive impairment (odds ratio, 2.03; P = .001).
The clinical implications, said Dr. Annweiler, appear clear — clinicians need to assess and treat vitamin D deficiency in their older patients for a variety of health reasons that may include preservation of cognitive function.
Vitamin D deficiency is common in the general population but is rampant among the elderly. According to Dr. Annweiler, it is estimated that 70% to 80% of individuals older than 75 years are vitamin D deficient.
Currently, adequate intakes of vitamin D for 51- to 70-year-olds are 400 IU per day and 600 IU for those older than 70 years to maintain a 25OHD level of 30 ng/mL or more. However, Dr. Annweiler noted that these recommendations are based primarily on preservation of bone health alone.
The reason the elderly are more vulnerable to vitamin D deficiency than younger individuals are several-fold and include decreased exposure to sunlight and inadequate dietary intake. In addition, said Dr. Annweiler, the skin of older people is not as efficient at synthesizing UV-B rays into vitamin D.
"This study provides more evidence to support [vitamin D] supplementation in our elderly patients to normalize serum concentrations and help sustain good health. Although we are not certain yet, it may be that this will also be a viable way to prevent or treat cognitive impairment and possibly turn out to be a new management strategy for dementia," said Dr. Annweiler.
The study was initially published earlier this year in the January 5 issue of Neurology. At that time, in an accompanying editorial, Joshua W. Mill, PhD, UC Davis Medical Center, Sacramento, California, echoed Dr. Annweiler's clinical recommendation (Neurology. 2010;74:13-15).
What are needed now are placebo-controlled intervention studies to determine whether vitamin D supplements will protect against age-related cognitive decline. In the meantime, neurologists and geriatricians should be aware of the high prevalence of vitamin D deficiency in their patient populations and the possibility that supplementation could be beneficial," Dr. Mill writes.
Dr. Annweiler said his team plans to prospectively follow up the cohort and examine the potential relationship between vitamin D status and incident dementia. In addition, his team is exploring the possibility of conducting a clinical trial to look at the impact of supplementation on cognitive outcomes.
The study was funded by the French Ministry of Health. Dr. Annweiler and Dr. Miller have disclosed no relevant financial relationships.
American Academy of Neurology (AAN) 62nd Annual Meeting: Abstract S34.003. Presented April 14, 2010