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Postuar nga NS-6 datė 19 Mars 2007 - 23:21:

FDA Clears Rapid Test for Meningitis

Cod. A19032007

(March 16, 2007)
The U.S. Food and Drug Administration (FDA) today cleared for marketing a test that uses molecular biology to quickly detect the presence of viral meningitis.

The Xpert EV test, when used in combination with other laboratory tests, will help physicians distinguish between viral meningitis and the less-common, but more severe, version of meningitis caused by bacteria.

Meningitis is an infection of the cerebrospinal fluid surrounding a person's spinal cord and brain, causing inflammation of the tissues in these areas. The illness is diagnosed by testing the fluid obtained from a patient during a spinal tap. Typically, diagnostic tests for meningitis can take up to a week to get results. But results from the Xpert EV test are available in two and one-half hours.

"Because this test is significantly faster than existing methods for diagnosing meningitis, it could minimize delays in treating patients. Swift recognition of the cause and appropriate treatment is critical to patient recovery," said Daniel Schultz, M.D., director of the Center for Devices and Radiological Health. "Since bacterial meningitis can be deadly within as little as two days, patients who have viral meningitis are frequently treated with antibiotics as a safeguard against the more dangerous bacterial meningitis. This test should help physicians manage patients appropriately and prevent unnecessary treatment with antibiotics."

Knowing whether the meningitis is viral or bacterial is imperative to early effective treatment. But distinguishing between the two types of infection is difficult because of similar symptoms. Patients with viral meningitis usually recover within two weeks without any medical intervention. Bacterial meningitis, however, can lead to brain damage, hearing loss and even death if not treated properly.

For patients over two years of age, symptoms of meningitis include fever, severe headache, stiff neck, nausea, sleepiness, confusion, and sensitivity to bright lights or seizures. These symptoms may be absent or difficult to detect in newborns and small infants who may only appear slow or inactive, or be irritable, have vomiting or feed poorly.

The Xpert EV test is the first fully-automated medical diagnostic test that isolates and amplifies viral genetic material present in a patient's cerebrospinal fluid by a process called reverse transcription-polymerase chain reaction(RT-PCR). The test identifies infection resulting from a class of viruses known as Enterovirus, which are responsible for approximately 90 percent of all viral meningitis cases.

The Xpert EV test is performed by adding the sample directly to a disposable, single-use cartridge. The cartridge is loaded into the GeneXpert DX instrument which then conducts all the necessary laboratory procedures in a one-step, easy-to-use format that helps minimize errors.

The accuracy of the Xpert EV test was confirmed in a multi-site study at six institutions. A total of 255 patient samples were tested and demonstrated that 96 percent of patients who tested positive did have viral meningitis, and that 97 percent of patients who tested negative did not have viral meningitis.

The Xpert EV test was developed by Cepheid, a company located in Sunnyvale, Calif.


Postuar nga NS-6 datė 17 Prill 2007 - 11:12:

Changes in Lung Function with Inhaled Insulin

Cod. A17042007

Inhaled insulin is the new method of somministration of insulin that should avoid the problems of injections and make its somministration easier. Studies are trying to find out whether this method is more reliable or not and whether this method has any collateral effect or not in order to pay attention in the future.
I'm bringing here an article concerning a study with inhaled insulin and its side effects on the respiratory functions!
-------------------
Changes in Lung Function with Inhaled Insulin

A small initial decline in function did not appear to progress beyond 3 months.

In previous short-term studies, inhaled insulin caused small declines in lung function. In this industry-sponsored trial, researchers assessed longer-term respiratory effects of inhaled insulin.

Nearly 600 adults with type 1 diabetes were randomized to receive premeal inhaled insulin (Exubera) or premeal subcutaneous short-acting insulin; both groups also received long-acting basal insulin. At 3 months, mean FEV1 had declined by 0.05 liters in the inhaled insulin group and 0.03 liters in the subcutaneous insulin group, a small but statistically significant difference. However, after 3 months (and through 24 months), FEV1 declined at the same rate in both groups. For diffusing capacity, the same pattern was noted — a small initial decline, but no further separation between groups during months 3 to 24. Inhaled-insulin recipients reported cough more frequently than subcutaneous-insulin recipients (38% vs. 13%). Glycemic control was similar in the two groups.

Comment: This study demonstrates that inhaled insulin induces small changes in pulmonary function shortly after the start of treatment. On average, however, the changes do not appear to progress after 3 months. Patients are advised to have spirometry before starting inhaled insulin, after 6 months of treatment, and annually thereafter. Inhaled insulin is not recommended for patients with underlying lung disease and is contraindicated in smokers.

— Allan S. Brett, MD

Published in Journal Watch General Medicine March 29, 2007

Citation(s):

Skyler JS et al. Two-year safety and efficacy of inhaled human insulin (Exubera) in adult patients with type 1 diabetes. Diabetes Care 2007 Mar; 30:579-85.


Postuar nga NS-6 datė 18 Prill 2007 - 14:43:

FDA Approves First U.S. Vaccine for Humans Against the Avian Influenza Virus H5N1

Cod. A18042007
The Avian Influenza scared the world all over,remembering to the people that the influence viruses may become virulent in every moment and in order to prevent this,new defensive weapons should be discovered.Today i got an email and inside that email,an article,announcing the discovery of a vaccine against the Avarian Influenza virus H5N1. It seems that all the effort made to discover any way to protect ourselves,are giving the first results...and most probably they won't stop at this point
-----------------
FDA Approves First U.S. Vaccine for Humans Against the Avian Influenza Virus H5N1

April 17,2007

The U.S. Food and Drug Administration (FDA) today announced the first approval in the United States of a vaccine for humans against the H5N1 influenza virus, commonly known as avian or bird flu.

The vaccine could be used in the event the current H5N1 avian virus were to develop the capability to efficiently spread from human to human, resulting in the rapid spread of the disease across the globe. Should such an influenza pandemic emerge, the vaccine may provide early limited protection in the months before a vaccine tailored to the pandemic strain of the virus could be developed and produced.

"The threat of an influenza pandemic is, at present, one of the most significant public health issues our nation and world faces," said Andrew C. von Eschenbach, M.D., Commissioner of Food and Drugs. "The approval of this vaccine is an important step forward in our protection against a pandemic."

The H5N1 virus is one version of the influenza A virus commonly found in birds. Unlike seasonal influenza, where infection ranges from mild to serious symptoms in most people, the disease caused by H5N1 is far more severe and happens quickly, with pneumonia and multi-organ failure commonly seen.

While there have been no reported human cases of H5N1 infection in the United States, almost 300 people worldwide have been infected with this virus since 2003 and more than half of them have died. To date, H5N1 influenza has remained primarily an animal disease but should the virus acquire the ability for sustained transmission among humans, people will have little immunity to this virus and the potential for an influenza pandemic would have grave consequences for global public health.

"The timing and severity of an influenza pandemic is uncertain, but the danger remains very real," said Jesse L. Goodman, M.D., M.P.H., Director of FDA's Center for Biologics Evaluation and Research. "We are working closely with other government agencies, global partners and the vaccine industry to facilitate the development, licensure and availability of needed supplies of safe and effective vaccines to protect against the pandemic threat."

The vaccine was obtained from a human strain and is intended for immunizing people 18 through 64 years of age who could be at increased risk of exposure to the H5N1 influenza virus contained in the vaccine. H5N1 influenza vaccine immunization consists of two intramuscular injections, given approximately one month apart. The manufacturer, sanofi pasteur Inc., will not sell the vaccine commercially. Instead, the vaccine has been purchased by the federal government for inclusion within the U.S. Strategic National Stockpile for distribution by public health officials if needed. The vaccine will be manufactured at sanofi pasteur's Swiftwater, Pa., facility.

A clinical study was conducted to collect safety information and information on recipient's immune responses and to determine the appropriate vaccine dose. A total of 103 healthy adults received a 90 microgram dose of the vaccine by injection followed by another 90 microgram dose 28 days later. In addition, there were approximately 300 healthy adults who received the vaccine at doses lower than 90 micrograms and a total of 48 who received a placebo injection.

The vaccine was generally well tolerated, with the most common side effects reported as pain at the injection site, headache, general ill feeling and muscle pain. The study showed that 45 percent of individuals who received the 90 microgram, two-dose regimen developed antibodies at a level that is expected to reduce the risk of getting influenza. Although the level of antibodies seen in the remaining individuals did not reach that level, current scientific information on other influenza vaccines suggests that less than optimal antibody levels may still have the potential to help reduce disease severity and influenza-related hospitalizations and deaths. Additional information on this H5N1 influenza vaccine is being collected on safety and effectiveness in other age groups and will be available to FDA in the near future.

With the support of FDA, the U.S. National Institutes of Health and other government agencies, sanofi pasteur and other manufacturers are working to develop a next generation of influenza vaccines for enhanced immune responses at lower doses, using technologies intended to boost the immune response. Meanwhile, the approval and availability of this vaccine will enhance national readiness and the nation's ability to protect those at increased risk of exposure.

The U.S. Strategic National Stockpile is maintained by the U.S. Centers for Disease Control and Prevention. It contains large quantities of medicine and medical supplies to protect the American public if there is a public health emergency, which can be delivered to any state in the United States within 12 hours. For more information on the government's preparedness efforts, visit: www.pandemicflu.gov.


Postuar nga NS-6 datė 27 Prill 2007 - 00:23:

The Helium Donald Duck Effect

Cod. A27042007

The human voice originates when the stream of air flowing up the trachea undergoes pressure modulations as it passes between the vibrating vocal chords in the larynx. The sound produced consists of a fundamental frequency, which determines the voice's pitch, and harmonics (integral multiples) of this frequency. For adult males and females the average frequencies of the fundamentals are 130 hertz and 205 hertz, respectively. The amplitudes of the harmonics for vowel sounds vary approximately as the inverse of the 1.5 power of the order of the harmonic.

The sound that exits the mouth is the result of selective transmission by the configuration of the vocal tract (throat, mouth, and nasal cavities) produced by the tongue and lip constrictions. For any cavity, sound waves bouncing back and forth within it will interfere constructively for certain frequencies (the resonance frequencies) to produce a loud sound. The cavities in the vocal tract have such resonances, and the maxima in the sound transmission curve correspond to the resonance frequencies. Those harmonics near a resonance frequency of the vocal tract will be strongly transmitted, while the other harmonics will be damped. The lowest-frequency peak in the transmission curve is referred to as the fundamental, while the regions at the other peaks are called formants.

The fundamental frequency of a resonating cavity is directly proportional to the speed of sound in the gas occupying the cavity. But from the kinetic theory of gases, as well as direct measurements, we know that the speed of sound in an ideal gas (such as dry air) is proportional to the square root of the ratio T/M, where T is the absolute temperature of the gas and M is its molecular weight. For a fixed temperature and cavity volume, it is clear, therefore, that the speed of sound will be greatest for gases with the smallest molecular weights. For example, the speed of sound in dry air (M=28.964) at 0 degrees Celsius is 331.3 m/s. At this temperature in helium (M=4.003) the speed is 891.2 m/s. The resonance frequencies of the vocal tract, and hence the formants, are therefore almost 2.7 times higher for helium than for air. At a pressure of one atmosphere, with pure helium in your vocal tract instead of air, the pitch of your voice will be about two and a half octaves higher than usual (like Donald Duck's). For a helium-oxygen mixture containing 68% helium by volume, the pitch increase is only one and a half octaves.

REFERENCES:

E. G. Richardson, "Technical Aspects of Sound" (Elsevier, New York, 1953), Chapter 10.

F. Reif, "Fundamentals of statistical and thermal physics" (McGraw-Hill, New York), Chapter 5.


Postuar nga amor alucius datė 17 Maj 2007 - 09:26:

Penn and Russian doctors explore a cool surgical procedure

Cod. A17052007

Penn and Russian doctors explore a cool surgical procedure(artikull i 1998 mgjth vazhdon te jete aktual)

--------------------------------------------------------------------------------

A team of Russian physicians visited the Medical Center this month with news about an open-heart surgical procedure that leaves patients cold. The news and the team were warmly received by their Penn anesthesia department hosts, who have received a University grant to begin a collaborative research project with the Russian doctors.
A Siberian patient is iced prior to open-heart surgery as Russian doctors Dmitri Guvanov and Vladimir Lomivorotov and Assistant Anesthesia Professor Stuart Weiss observe. Guvanov is currently a research fellow in Penn's anesthesia department.


The physicians hailed from the Novosibirsk Institute of Circulatory Pathology, where for years doctors have been conducting open-heart surgery without heart-lung bypass machines. Vladimir Lomivorotov, M.D., the institute's chief cardiothoracic anesthesiologist, explained through a translator, "The procedure is quite different from the conventional approach to providing cardiothoracic surgery" in the rest of the world.

In order to operate on the heart, doctors must stop it so they can make the precise incisions needed to repair heart defects. Doing so, however, cuts off the blood flow and oxygen supply to other organs, which can cause permanent damage and even death. "The brain will only survive for three to five minutes at most without blood flow," said Assistant Professor of Anesthesia Albert Cheung.

To prevent this, one of two things must happen: either blood must keep flowing or the body's need for oxygen must be reduced.

Heart surgeons in the West have traditionally opted for the former by using a heart-lung machine, which may cause blood clotting or inflamation. The Novosibirsk method takes the latter approach: it cools the patient's body temperature until it enters suspended animation, a condition known as hypothermia.

By encasing the brain in an ice-filled helmet and covering the patient with ice prior to surgery, the Novosibirsk doctors lower body temperature from 98.6° to about 75°, and brain temperature to 60 to 65°. The doctors then clear the ice from around the body, stop the heart and operate.

"The temperature of the patient's brain is so low that it actually allows you to stop the heart for a sufficient time -- up to an hour and 30 minutes -- to restore the heart defect, restore the circulation afterwards, and restore the full functioning of the brain," Lomivorotov said.

Lomivorotov first described the procedure to Penn anesthesiologists in a talk last October. "The results of the procedure are comparable to what we routinely do here using heart-lung machines," but at a lower cost, Cheung said.

The procedure was actually first used in Japan and England more than 40 years ago, but was largely abandoned after the introduction of bypass machines. Novosibirsk Institute Executive Director Alexandr Karaskov explained that his institute was the only center in the world that continued to actively use and refine the procedure.

"We have refined [it] to the point where it can be safely done without damaging the patient," he said.

The Russians also hope to learn from their American counterparts. The Novosibirsk Institute plans to refashion itself as an academic medical center similar to Penn's Health System, and the delegation included an economist, Larissa Shkhrko, Ph.D., who is studying aspects of the American health system that could be adapted to Russia's changing health-care environment


Postuar nga ~Enigme~ datė 17 Maj 2007 - 15:31:

Shume interesant artikulli qe permenden kryerjen e operacionit te zemres.
Per nje gje nuk isha e qarte. Kerkimi eksperimental midis repartit te anestize dhe doktoreve ruse ka nisur tani apo ne '98?


Postuar nga NS-6 datė 17 Maj 2007 - 18:10:

perderisa artikulli daton vitin 1998 do te thote qe kerkimet kane filluar me perpara dhe me sa shoh per here te pare qenka kryer rreth 40 vjet me para por vetem ruset paskan qene qe paskan vazhduar me ngulm ta permirsojne si teknike. rreth kesaj teme me kujtohet qe ka qene nje shkrim edhe tek revista "Le Scienze" (i ketyre 2 viteve te fundit eshte) dhe trajtonte pikerisht kete lloj operacioni. materiali qe kerkonin te perdornin per te ftohur trupin ishte nje xhel qe ishte prodhuar nga nje firme japoneze per qellime te tjera por pastaj u pa qe mund te kishte dobi ne keto lloj operacionesh. eksperimentet e kryera tek kafshet treguan qe teknika e ftohjes ishte mjaft e mire edhe per ecurine pas operacionit te pacientit. per momentin nuk kam te reja te tjera per kete ceshtje


Postuar nga ~Enigme~ datė 17 Maj 2007 - 19:20:

NS-6 faleminderit per shtimin.
Nuk e di pse nuk me ka dale modifikimi i mesazhit. Por ajo qe doja te percillja me mesazhin tim eshte se nqs keto kerkime eksperimentale kane nisur qe ne 98 atehere do te isha e interesuar te dija me shume burimet e ketyre materialeve per te shtrire pak horizontin ne kete ceshtje, duhen shfletuar journals se nga interneti asnjehere nuk i gjej me tekstet e plota.


Postuar nga NS-6 datė 17 Maj 2007 - 21:22:

Neuroprotective Effect of Mild Hypothermia in Coronary Artery Surgery

Cod. C17042007

ketu po sjell nje abstract mbi nje artikull te publikuar tani ne Maj ne Journal of Thoracic and Cardiovascular Surgery (artikulli i plote ishte me leke).gjithsesi ky shkrim vlereson me shume efektet ne distance 5 vjetesh te nje operacioni te kryer ne hipotermi mbi trurin.

Neuroprotective Effect of Mild Hypothermia in Patients Undergoing Coronary Artery Surgery With Cardiopulmonary Bypass: Five-Year Follow-up of a Randomized Trial
(J Thorac Cardiovasc Surg. 2007 May;133(5):1206-11)

Objective: In a randomized trial of 223 patients undergoing coronary artery surgery with cardiopulmonary bypass, we have reported a neuroprotective effect of mild hypothermia. To determine whether the beneficial effect of mild hypothermia was long-lasting, we repeated the psychometric tests in 131 patients after 5 years.

Methods: Patients were cooled to 32 degrees C during aortic crossclamping and then randomized to rewarming to either 34 degrees C or 37 degrees C, with no further rewarming until arrival in intensive care unit. Cognitive function was measured preoperatively and 1 week and 5 years postoperatively with a battery of 11 psychometric tests interrogating verbal memory, attention, and psychomotor speed and dexterity.

Results: Patients who had greater cognitive decline 1 week after surgery showed poorer performance 5 years later. The magnitude of cognitive decline over 5 years was modest. The incidence of deficits defined as a 1 standard deviation [SD] decline in at least 1 of 3 factors was not different between temperature groups. Fewer patients in the hypothermic group had deficits that persisted over the 5 years, but this difference did not attain statistical significance (RR = 0.64, P = .16).

Conclusions: The effect of surgery on cognitive function observed early after surgery is an important predictor of cognitive performance 5 years later. Although there was evidence of a neuroprotective effect of mild hypothermia early after surgery in the original cohort, the results after 5 years were inconclusive. In general, the magnitude of cognitive changes over 5 years was modest. We believe that further trials investigating the efficacy of mild hypothermia in patients having cardiac surgery are warranted.

do kishte qene interesante te gjehej artikulli i plote per faktin se mund te kontrolloheshin edhe referencat sepse me shume mundesi ka edhe shkrime te tjera qe do kene te bejne me temen...gjithsesi...
ndonje gje tjeter?


Postuar nga NS-6 datė 19 Maj 2007 - 12:23:

Focused Readings: Acute Stroke

Cod. A19052007

there was an article in Journal Watch website concerning the advancement on stroke. here is the main article and 2 other articles cited inside.
-----------------

Focused Readings: Acute Stroke

Recent studies address advances in acute stroke care.

Few areas in emergency medicine have changed as rapidly, or with as much controversy, as the care of acute stroke. Systemic fibrinolysis, once vilified as dangerous and unproven, has emerged as the standard of care for a highly select patient population, with proven outcome benefit. Imaging modalities have evolved, but the clear superiority of magnetic resonance imaging is often negated by lack of access to this imaging study. Here, we present several recent studies of acute stroke. They address the incidence of acute stroke, validation of a score (ABCD2) to help identify patients at high risk, the role of imaging in the decision to administer systemic lytic therapy, functional outcomes at stroke centers, and performance of systemic lytic therapy in "real life."

The bottom line? Emergency departments should have a tightly organized system of care for acute stroke patients, with access to prompt imaging and protocols for administration of acute lytic therapy.

--------------
ARTICLE 1
Declining Risk and Incidence of Clinical Stroke

Age-adjusted incidence of first stroke has decreased during the past 50 years.

Stroke is the third leading cause of death and the number-one etiology of long-term neurologic disability in the U.S. Researchers prospectively examined the Framingham Study cohorts during three intervals (1950–1977, 1978–1989, and 1990–2004) to ascertain trends in stroke incidence, severity, 30-day mortality, and risk. The authors defined clinical stroke as "rapidly developing signs of focal neurologic disturbance of presumed vascular etiology, lasting more than 24 hours."

The age-adjusted incidence of first stroke per 1000 person-years decreased in each of the three intervals both in men (7.6, 6.2, and 5.3, respectively) and in women (6.2, 5.8, and 5.1). The 10-year risk at age 65 decreased significantly in men (from 19.5% to 14.5%) but not in women (from 18.0% to 16.1%). Similarly, 30-day mortality decreased significantly in men (from 23% to 14%) but not in women (from 21% to 20%). Assessment of risk factors at age 65 demonstrated significant reductions in mean systolic blood pressure, total cholesterol, prevalence of hypertension, and prevalence of current smoking as well as an increase in the proportion of persons receiving antihypertensive treatment. However, the prevalence of atrial fibrillation in men and the mean body-mass index in both sexes increased. Overall, the Framingham Stroke Risk Profile, a validated instrument, improved significantly for both men and women. The proportion of strokes that were moderate or severe did not change significantly in men or women.

Comment: The good news is that the annual incidence of clinical stroke has declined during the past 50-plus years for men and women, as has the 10-year risk for stroke for people aged 65. The bad news is that stroke severity has not declined and that 30-day mortality has dropped only in men. The latter finding could be due to older age at stroke onset and greater stroke severity in women. The need for primary prevention continues.

— John A. Marx, MD, FAAEM, FACEP

Published in Journal Watch Emergency Medicine February 2, 2007

Citation(s):

Carandang R et al. Trends in incidence, lifetime risk, severity, and 30-day mortality of stroke over the past 50 years. JAMA 2006 Dec 27; 296:2939-46.
----------------------
ARTICLE 2
Who’s at Risk for Stroke After TIA?

A risk-stratification system is effective for determining a patient's risk for stroke within 2 days.

From 4% to 20% of patients with transient ischemic attacks (TIAs) progress to stroke within 90 days, half within the first 48 hours. How do we identify patients at greatest risk? Researchers first validated two recently developed prognostic scores — the California score (designed to predict stroke within 90 days) and the ABCD score (designed to predict stroke within 7 days; see Journal Watch Emergency Medicine Aug 23 2005) — and then combined the two systems and validated the resulting new score, termed ABCD2 (designed to predict stroke within 2 days).

The scores were derived in two groups of patients (totaling 1916) and validated in four groups of patients (totaling 2893) from emergency departments, clinics, and population-based cohorts in California and Oxford, England.

The ABCD2 score assigns 0 to 7 points based on Age (≥60 years, 1 point), Blood pressure at presentation (≥140/90 mm Hg, 1 point), Clinical features (unilateral weakness, 2 points; speech disturbance without weakness, 1 point), Duration of symptoms (≥60 minutes, 2 points; 10–59 minutes, 1 point), and Diabetes (1 point).

Strokes occurred in 3.9% of patients within 2 days, 5.5% within 7 days, 7.5% within 30 days, and 9.2% within 90 days. When applied to the validation groups, the ABCD2 score stratified 21% of patients as high risk (score, 6–7), 45% as moderate risk (score, 4–5), and 34% as low risk (score, 0–3). The 2-day risks for stroke in the high-, moderate-, and low-risk groups were 8.1%, 4.1%, and 1.0%, respectively.

An editorialist suggests that the ABCD2 system is the best available method for determining which patients are at short-term risk for stroke after TIA but notes that the score should be used as an adjunct to, rather than a replacement for, clinical judgment and data from other sources, such as imaging.

Comment: TIAs are like angina of the brain, and symptoms lasting longer than 1 hour are highly likely to represent stroke (see Journal Watch Emergency Medicine Mar 12 2003). The ABCD2 prediction score helps us to risk-stratify patients. Patients with a score of less than 4 might be suitable for discharge on aspirin therapy with close follow-up, but most patients with new-onset TIA should be admitted to a hospital.

— Kristi L. Koenig, MD, FACEP

Published in Journal Watch Emergency Medicine February 23, 2007

Citation(s):

Johnston SC et al. Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack. Lancet 2007 Jan 27; 369:283-92.
Medline abstract (Free)

Kernan WN. Stroke after transient ischaemic attack: Dealing in futures. Lancet 2007 Jan 27; 369:251-2.
Medline abstract (Free)


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