For example, in their current April/May 2012 issue, I found information about neuropathy and Neuropathy Awareness Week that was relevant to me. One of their feature articles this month, Too Rare for Research? , highlighted the problems that most of us with neuromuscular disease experience in receiving an accurate diagnosis and effective treatment. A companion article provided links useful links regarding rare disease.

The Neurology Now website (see Resources below for web address) offers the ability to search for articles of interest from past issues. A search of their archives found articles on many other neuromuscular diseases, including muscular dystrophy, amyotrophic lateral sclerosis, motor neuron disease, myasthenia gravis, and Freidreichs ataxia. I also found useful articles on other topics of interest to those with neuromuscular disease such as coping with pain, living well with neurological disease, alternative and complementary medicine, and caregiver burnout.

Subscription to Neurology Now can be obtained on their website (see Resources below for address). This magazine offers free print subscriptions to individuals in the U.S. coping with neurological disease, including patients and their families, friends, and caregivers. The Neurology Now website also offers other services, including subscriptions to podcasts and the ability to view the website on internet-enabled mobile devices.

Give Neurology Now a try for reliable, accurate, and easy to understand articles about a variety of neurological disorders including neuromuscular disease. Both the print magazine and the resources available on line provide valuable information from a trustworthy source at no cost to the neuromuscular disease community.

Resources:

Neurology Now website, (2012). Home Page. http://journals.lww.com/neurologynow/pages/default.aspx . Retrieved 4/20/12.

Neurology Now website, (2012). Subscription Services. http://journals.lww.com/neurologynow/Pages/subscriptionservices.aspx . Retrieved 4/20/12.

FTC Disclosure Statement: The magazine reviewed in this article was received by the author as a free subscription. Free subscriptions are available to any individual with a neurological disease residing in the U.S.

Read the original:
Neurology Now Magazine

Early use of the multiple sclerosis drug interferon beta-1a might slow and even stop progression of the disease, according to new research from the American Academy of Neurology.

Patients who received interferon soon after their first disease symptoms were less likely to see the disease progress into "clinically definite" multiple sclerosis, which is categorized as having had two separate attacks along with two separate lesions.

Multiple sclerosis is an autoimmune disease that affects the brain and spinal cord. The disease attacks the myelin sheath, a protective covering that surrounds nerve cells.

The disease is degenerative, and symptoms can vary. Patients suffer attacks that can last days, weeks or months. Symptoms affect the muscles, bowel function, vision, numbness, sexual function and personality.

"While we've known it's beneficial to start MS drugs as soon as possible, this is the first trial to show a benefit of early injections of interferon beta-1a treatment at three years," Dr. Mark Freedman of the University of Ottawa in Ontario and a fellow of the American Academy of Neurology said in a statement.

The three-year trial involved 517 people who had experienced their first MS symptoms, which includes tingling, numbness, muscle weakness or balance problems. The participants also showed at least two lesions on their brain that were detected through MRI scans.

One-third of the patients received injections of the drug three times each week, one-third received the injections once a week, and one-third received a placebo. After two years, the patients who received the placebo were then given a three-times-per-week dose of the drug for another year.

Researchers found that those who received the once-a-week dosage or three-times-per-week dosage were less likely to experience a second demyelinating attack three years after the study's start.

Experts said the preliminary study results reinforce the benefits of diagnosing and beginning treatment early for patients with MS.

"Early on, there are few MS lesions, little brain damage, and much better ability of the brain to repair the damage remyelination," said Dr. Anthony Reder, a neurologist and multiple sclerosis expert at the University of Chicago. "The repair process is helped by MS therapies."

Read more:
Early Use of High Drug Dosage Might Slow MS

From Mayo Clinic YouTube channel: "Being in the hospital after major surgery is no fun. On top of dealing with pain, patients have uncertainty. They also have to worry about getting all the information they need to support their recovery. That's not always easy in the hospital; things happen quickly and doctors and hospital staff are often really busy. Doctors at Mayo Clinic may have a solution to this issue. They're giving iPads to heart surgery patients to see if a new iPad app can make hospital stays easier and more satisfying."

Our research presented during the 2011 ACAAI meeting showed that 95% patients thought the iPad was helpful for coming to understanding of their condition:

PATIENT PERCEPTION OF A POINT-OF-CARE TABLET COMPUTER (IPAD™) BEING USED FOR PATIENT EDUCATION - P318

A. Nickels*, V. Dimov, V. Press, R.Wolf, Chicago, IL.

Background:

During the fall of 2010, the Internal Medicine/Pediatrics program at University of Chicago introduced Point-of-Care Tablet Computers (iPad™) for clinical use. iPads™ are intended to improve access to EMR, work flow, resident and patient education, and access to electronic clinical tools. The graphic display and ease of interface makes the iPad™ a potentially powerful tool to achieve these goals. This pilot study is designed to gauge the initial patient perception of the iPad™ when used for patient education.

Methods:

8 questions, physician administered, patient survey of Allergy Immunology patients or their parents. Preloaded iPads™ with education materials (“mind map” diagrams, clinical pictures) into the photo software were used to clinically education the patients. Simple percentages and Fisher’s exact non-parametric test were used for statistical analysis. Results: 20 patients surveyed (11 resident/9 attending). For those survey items without 100% agreement, there was no statistically significant difference in responses based on level of training (p?0.45). 100% [0.861, 1] of participants liked the iPad™ being used to help explain their children’s condition, 95% [0.783, 0.997] of participants did not find it distracting. 100% [0.8601, 1] found it helpful. 100% [0.861, 1] would like it to be used again to help explain medical information. 95% [0.784, 0.9974386] thought the iPad™ was helpful for coming to understanding of their condition. Limitations of this study include a convenient sample, physician-administered survey, and observer bias.

Conclusion:

Patient perception was very positive toward the use of a Point-of-Care Tablet Computer (iPad™) in a clinical setting. While limited to only two operators, level of training did not have an effect on patient perception. Confirmation of the results may be required before wider implementation.

Source:  Patient Perception of a Point-of-Care Tablet Computer (iPad) Being Used for Patient Education. A. Nickels, V. Dimov, V. Press, R. Wolf. American College of Allergy, Asthma & Immunology (ACAAI) 2011 Annual Meeting.

http://www.annallergy.org/supplements

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Public release date: 15-Apr-2012 [ | E-mail | Share ]

Contact: Rachel Seroka rseroka@aan.com 651-695-2738 American Academy of Neurology

NEW ORLEANS Use of a new drug to detect the beta-amyloid plaques in the brain that are hallmark signs of Alzheimer's disease may help doctors diagnose the disease earlier, according to research that will be presented as part of the Emerging Science program (formerly known as Late-Breaking Science) at the American Academy of Neurology's 64th Annual Meeting in New Orleans April 21 to April 28, 2012.

Currently, Alzheimer's disease can only be definitively confirmed through the detection of amyloid plaques and/or tangles in the brain during autopsy after death or with a brain tissue biopsy. The new method uses the drug florbetaben as a tracer during a PET scan of the brain to visualize amyloid plaques during life.

In order to prove that the florbetaben PET scan detects beta-amyloid in the brain, the global phase III study directly compared brain regions in the PET scan to respective brain regions after death during autopsy.

For the study, more than 200 participants nearing death (including both participants with suspected Alzheimer's disease and those without known dementia) and who were willing to donate their brain underwent MRI and florbetaben PET scan. The amount of plaque found in the 31 participants who reached autopsy was then compared to the results of the scans. A total of 186 brain regions from these donors were analyzed along with 60 brain regions from healthy volunteers. Based on these 246 brain regions the study found florbetaben to detect beta-amyloid with a sensitivity of 77 percent and a specificity of 94 percent.

Comparison of the visual assessment method proposed for florbetaben for clinical practice with the post mortem diagnosis revealed a sensitivity of 100 percent and a specificity of 92 percent. Sensitivity is the percentage of actual positives that are correctly identified as positive, and specificity is the percentage of negatives that are correctly identified.

"These results confirm that florbetaben is able to detect beta-amyloid plaques in the brain during life with great accuracy and is a suitable biomarker," said study author Marwan Sabbagh, MD, director of Banner Sun Health Research Institute in Sun City, Ariz., and a Fellow of the American Academy of Neurology. "This is an easy, non-invasive way to assist an Alzheimer's diagnosis at an early stage. Also exciting is the possibility of using florbetaben as tool in future therapeutic clinical research studies where therapy goals focus on reducing levels of beta-amyloid in the brain."

###

The study was supported by Bayer Healthcare Berlin.

Original post:
New method may help detect marker for Alzheimer's disease earlier

A postal survey included a random sample of 4,500 Australians aged ? 50 years between in 2009-2010 and the response rate was 37%.

Medications use was very common, 87% of participants took one or more drug (called medicines in Australia) and 43% took five or more in the previous 24 hours.

Complementary medicines were used by 46% of participants.

The most commonly used medications were:

- antihypertensive agents, 43% of participants
- natural marine and animal products including fish oil and glucosamine, 32%
- lipid-lowering agents, 30%

Doctors recommended 79% of all medications and 93% of conventional medications.

Much medicines use was to prevent future disease by influencing risk factors.

In a 2011 study, 4 medication classes were linked to 67% of drug-related hospitalizations:

- warfarin, 33%
- insulins, 14%
- oral antiplatelet agents, 13%
- oral hypoglycemic agents, 11%

High-risk medications were implicated in only 1.2% of hospitalizations.

50% of these hospitalizations were among adults 80 years of age or older. 65% of hospitalizations were due to unintentional overdoses.

Classification of adverse reactions to drugs: "SOAP III" mnemonic (click to enlarge the image):

Adverse drug reactions (ADRs) affect 10–20% of hospitalized patients and 25% of outpatients.

Rule of 10s in ADR:

10% of patients develop ADR
10% of these are due to allergy
10% of these lead to anaphylaxis
10% of these lead to death

References:

A national census of medicines use: a 24-hour snapshot of Australians aged 50 years and older. Tessa K Morgan, Margaret Williamson, Marie Pirotta, Kay Stewart, Stephen P Myers and Joanne Barnes. MJA 2012; 196 (1): 50-53, doi: 10.5694/mja11.10698

4 medication classes linked to 67% of drug-related hospitalizations

Image source: Wikipedia, public domain.

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Richard Smith is a former editor of the BMJ and chief executive of the BMJ Publishing Group. He is well-known for provocative editorials. Here is an excerpt from one, published recently in The Scientist:

"Elsevier, the world’s largest publisher of scientific journals, has seen broadly stable revenues (€2,236 million in 2006, €2,370 million in 2010) but growing profits (€683 million in 2006, €847 million in 2010).

Scientific journals remain very profitable. Few industries manage a profit margin of 35.7% (that for Elsevier in 2010), but then few industries are given their raw material—in this case, scientific studies—not only for free, but also in a form that needs minimal processing."

It is nice to see that the current and a former editor of the two most famous British medical journals, The Lancet and BMJ, are now on Twitter:

Why has the Cochrane Collaboration never quite taken off in the US?

— richard horton (@richardhorton1) April 5, 2012

Any symptom in an elderly person should be considered to be a drug side effect until proved otherwise. Jerry Avern

— Richard Smith (@Richard56) April 2, 2012

References:

Reading Into the Future | The Scientist, 2012.

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Please note: The information in the following videos has not been verified by me. The purpose of this post is just to present the idea of this approach to medical education, not to recommend the content of the videos.

Here is the third video tutorial on electrocardiogram (ECG): ECG 3 - Segments, Intervals & Diseases:

Here is what the completed PDF looks like at the end of the drawing:

http://www.handwrittentutorials.com/pdf/pdf_69.pdf

Topics of the videos

Anatomy
Endocrinology
Immunology
Mathematics
Neuroscience
Pharmacology
Physiology

References

Handwritten Video Tutorials in Medicine http://goo.gl/ZxFhb and http://goo.gl/R8xse

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People who have dogs as pets are much less likely to have a heart attack. If they do have a heart attack, they are 2-3 times more likely to survive it.

Mitochondrial genetics studies have shown conclusively that dogs have descended from wolves. Dogs' genes are 99.8% the same as the wolf genes, yet dogs behave in a fundamentally different way.

Over more than 100,000 years dogs have evolved to recognize human emotions. It has been a collaborative process all along. Humans are able to recognize 6 types of dog barks expressing emotions and "intentions" such as fear, excitement, aggression and so on. Dogs are the only animals that specifically look at the right side of the human face where emotions are expressed (see the NOVA video and website below).

Dogs follow directions while chimpanzees, the apes evolutionary closest to humans, do not. The smartest dog can learn 300 different words which is the vocabulary size of a 2-year-old child.

The "400 mnemonic":

400 million dogs worldwide
400 breeds of dogs have been developed by humans

According to a Cleveland Clinic psychologist, "dogs could be called wonder drugs":

"Dogs can provide people with many things. Protection, friendship, and unconditional love top the list, but they may also provide health benefits, too."

How smart are dogs, and what makes them such ideal companions? Dogs Decoded: Nova. Netflix.

Comments from Twitter:

Heidi Allen @dreamingspires: I want one!

References:

Dogs Decoded transcript and more. NOVA.

Image source: Yellow Labrador Retriever, Wikipedia, GNU Free Documentation License.

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Onstage at TED2012, Jack Choi demonstrates a powerful tool for training medical students: a stretcher-sized multi-touch screen of the human body that lets you explore, dissect and understand the body's parts and systems.

Jack is the CEO of Anatomage, a company specializing in 3D medical technology. See the TED video embedded below:

Comments from Twitter:

Mike Cadogan @sandnsurf: NEED! ...Virtual dissection table, stretcher-sized multi-touch screen bit.ly/IIeko3

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This is a presentation by Dr. Ronan Kavanagh, Rheumatologist, Blogger, and Social Media in Healthcare advocate at Western Rheumatology, Galway, Ireland. His website is at ronankavanagh.wordpress.com

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Mosquitoes appear to prefer blonde people with smelly feet. Did you see the moon last night? Got mosquito spray? Mosquito biting activity increases 500 times during a full moon phase! There are more striking facts in this video excerpt from National Geographic.

The video is part of the Amazing Animals YouTube playlist by National Geographic:

Medical Geek Humor on Twitter

The tweets below are part of the series Medical Geek Humor on Twitter - they recall a TED moment from 2009:

@loic Bill Gates released mosquitoes at #TED we're all leaving the room and getting sick about 4 hours ago from web


@stevewhitaker Don't worry about the buggy mosquitos Gates released at #ted. Microsoft's working on a patch that's due out next year. about 14 hours ago from twitterrific
AllergyNotes Releasing mosquitoes by Bill Gates into a startled crowd at TED described as "an amazing TED moment" http://is.gd/iu0o about 12 hours ago from web

AllergyNotes Gates spreads malaria message with mosquitoes http://tinyurl.com/cxwo2e 12 minutes ago from TweetDeck

pyknosis Nice to hear Bill Gates picked up a hobby during his retirement: entomology. http://is.gd/izJn (Not surprised he likes the blood-suckers.) 14 minutes ago from web

pyknosis Don't get me wrong. Not saying B Gates is a bad person. He's not. He just created and championed software that can suck the life out of you. 12 minutes ago from web
pyknosis BTW, now that I understand the context, I think this is a winner of a tweet: http://is.gd/izK5 11 minutes ago from web: "If Steve Jobs had released mosquitoes, everyone would be wanting one."

If you are included in this post but would like to have your tweet removed for any reason, please email me and will comply with your request the same day.

Comments from Twitter:

Vijay @scanman: Mosquitoes are mini-vampires

Tariq @ucisee: Mosquito biting activity increases 500 times during a full moon phase - "appear to pref blonde with smelly feet."

Kathy Mackey @mkmackey: Ha! No one likes full moon!

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Blueberries and Strawberries May Protect Against Parkinson's Disease

By Denise Mann WebMD Health News

Reviewed by Louise Chang, MD

April 5, 2012 -- Can two or more servings of blueberries or strawberries a week help lower risk of Parkinson's disease?

Maybe, according to a new study published in Neurology.

Men and women who ate berries two or more times a week were nearly 25% less likely to develop Parkinson's disease than their counterparts who had less than one serving per month.

Exactly how these fruits may help lower risk is not known, but berries are rich in powerful antioxidants -- known as flavonoids -- which may protect brain cells from damage. Flavonoids are found in fruits and vegetables.

When the researchers looked at the data for men and women separately, the real benefit seemed to go to the men, not the women.

Overall, men who had the most flavonoids in their diet -- including sources such as berries, tea, apples, and red wine -- were 40% less likely to develop Parkinson's than those who ate the least.

Women who ate a high amount of flavonoids were no less likely to develop Parkinson's disease than those who ate the least amount, the study showed.

Read the original post:
Berries May Contain Potent Weapon vs. Parkinson's

Announcement: Blood Management Summit - Transfuse 2012 will be held on April 19-20, 2012 at the JW Marriott in Scottsdale, Arizona.

This conference has been developed with collaboration between Mayo Clinic and Hartford Hospital, building upon the success of three previous national conferences. "Transfuse 2012" is a unique multi-disciplinary conference focused on exploring the current state-of-the-art techniques and programs to reduce allogeneic blood utilization in hospitals. This international conference will feature national and international blood management experts from China, New Zealand and Australia along with a unique iPad app launch and one-of-a-kind hands-on animal lab.

Mayo Clinic's Mark H. Ereth, M.D. introduces the conference and the iPad app in this 3-minute video:

This conference is designed for all physicians, including surgeons and anesthesiologists, perfusionists, nurses and leaders in quality and patient safety. The conference is a CME accredited activity for physicians, nurses and perfusionists.

The Conference Website is: http://www.mayo.edu/cme/anesthesiology-2012r780

One of the course directors is Dr. Ajay Kumar, Chief of Division of Hospital Medicine at Hartford Hospital, and a good friend of mine. Another friend from the time I worked at Cleveland Clinic is also on faculty, Dr. Moises Auron.

It should be a great conference. Go check it out.

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CHICO, CA--(Marketwire -04/05/12)- Masula Chiropractic Neurology and Family Wellness announced that the practice has had significant success helping patients lose weight through a combination of nutritional testing and detoxification diets. The center's detox diet is designed to remove chemicals and environmental toxins that can build up in the body over time. The practice also supports weight management and long-term weight loss through its nutritional lab testing program. In addition to weight loss support, the Chico chiropractor provides spinal decompression therapy, neuropathology and physiotherapy for natural back pain management and injury recovery.

Chico chiropractor Dr. Larry Masula stated that at his practice, Masula Chiropractic Neurology and Family Wellness, they provide nutritional detox and testing services because they aid in weight loss plans.

According to the wellness doctor, these services help remove toxins from the body while identifying missing nutrients. Together with chiropractic care, Dr. Masula says the wellness care can help bring balance back to the body.

"Every day, from the air we breathe to the food we eat, our bodies are bombarded with environmental toxins," said Dr. Masula. "It's no surprise then that many patients are struggling with weight management, fatigue, stress and illness. The liver and kidneys naturally flush out toxins, but when our bodies become overloaded, these organs begin to suffer. Toxins then build up in our bloodstreams, affecting other organs and our metabolism."

Dr. Masula identifies food packed with preservatives and artificial ingredients, as well as indoor and outdoor air pollutants, as primary causes for toxin build up. According to Dr. Masula, symptoms of toxin overload include fatigue, joint pain, mood swings, insomnia and low-grade illness.

"Many of our patients complain of exhaustion and pain, saying that they just don't feel like themselves anymore," said Dr. Masula. "When the body is overloaded, the internal organs can no longer function properly. Detoxification diets are a safe and effective process for removing toxins from the body. This also helps the body's metabolism 'reset' itself."

In conjunction with a detox program, Dr. Masula says that nutritional lab testing can help identify vitamins, minerals and nutrients that are missing from a patient's diet.

"How can we eat right when we don't know what our body needs?" said Dr. Masula. "This is why nutritional testing is so important. Every individual has unique needs, and nutritional testing helps to identify these needs. We will then use this information to recommend specific dietary adjustments. For patients struggling with weight gain, obesity, Type 2 Diabetes or heart disease, these recommendations can make a tremendous difference for overall health."

Dr. Masula stressed that detox diets and nutritional testing are part of an overall approach to whole body wellness. Neither method is designed as a 'quick-fix' or 'fad-diet,' but instead promote long-term well being.

"Our patients consistently tell us that our wellness program makes a tremendous difference in their lives," said Dr. Masula. "Patients have more energy, feel healthier, sleep better and experience less chronic pain."

Continued here:
Chico Chiropractor Finds Nutritional Lab Testing & Detox Vital to Successful Weight Loss

Newswise ST. PAUL, Minn. (April 5, 2012) Former NASA astronaut Michael Rich Clifford is calling on fellow patients with Parkinsons disease not to let the disease drive what they do. Cliffords inspiring story and advice for patients is featured as the cover story in the latest issue of Neurology Now, the American Academy of Neurologys award-winning magazine for patients and caregivers.

Clifford was diagnosed with Parkinsons in 1994 during the early stages of the disease, but he didnt allow it to keep him from climbing aboard the shuttle Atlantis and rocketing off into space for the third time. My NASA medical community knew about my Parkinsons and assumed I wouldnt want to fly again, said Clifford. But I said no, no, no.

Until recently, no one other than NASA medical staff and senior management knew how extraordinary his third flight to space had been because Clifford had kept his newly diagnosed medical condition private.

I didnt want to be identified as the man with Parkinsons flying in space. Plus, I felt the focus should be on the mission, not someone on the mission, said Clifford.

Clifford says he feels the same optimism today as he did when he was first diagnosed with the disease 18 years ago and hopes other Parkinsons patients do too. Dont let Parkinsons drive what you want to do. Remember that youre in charge of your future.

Learn more about Cliffords story, including the Public Leadership in Neurology Award he is receiving this year from the American Academy of Neurology Foundation, in the latest issue of Neurology Now in print, online at http://www.neurologynow.com, and new for the iPad. Plus, find us on Facebook, Twitter, and Google+.

Neurology Now is published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health.

###

About the American Academy of Neurology The American Academy of Neurology, an association of more than 25,000 neurologists and neuroscience professionals, is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimers disease, stroke, migraine, multiple sclerosis, brain injury, Parkinsons disease and epilepsy. For more information about the American Academy of Neurology, visit http://www.aan.com or find us on Facebook, Twitter, Google+ and YouTube.

About Lippincott Williams & Wilkins Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes.

See the original post:
Astronaut with Parkinson's Calls on Patients to Take Charge of Their Future

Crohn's disease is a chronic inflammatory condition affecting the GI tract at any point from the mouth to the rectum.

Symptoms and signs may consist of:

- diarrhea
- abdominal pain
- fever
- weight loss
- abdominal masses
- anemia

Extraintestinal manifestations of Crohn's disease include:

- osteoporosis
- inflammatory arthropathies
- scleritis
- nephrolithiasis
- cholelithiasis
- erythema nodosum

Laboratory findings

Acute phase reactants, such as CRP and ESR, are often increased with inflammation and may correlate with disease activity.

Levels of vitamin B12, folate, albumin, prealbumin, and vitamin D can help assess nutritional status.

Procedures often used to diagnose Crohn's disease:

- colonoscopy with ileoscopy
- capsule endoscopy
- computed tomography (CT) enterography
- small bowel follow-through

Diagnostic tools for extraintestinal manifestations or complications (e.g., abscess, perforation):

- ultrasonography
- computed axial tomography (CT)
- scintigraphy
- MRI

Medical management

Mesalamine products are used for mild to moderate colonic disease. Antibiotics (e.g., metronidazole, fluoroquinolones) are often used for treatment.

Patients with moderate to severe Crohn's disease are treated with:

- corticosteroids
- azathioprine
- 6-mercaptopurine
- anti-tumor necrosis factor agents (e.g., infliximab, adalimumab)

References

Diagnosis and management of Crohn's disease. Wilkins T, Jarvis K, Patel J. Am Fam Physician. 2011 Dec 15;84(12):1365-75.

Image source: Colon (anatomy), Wikipedia, public domain.

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How a genius feels: "I'm a nonentity, an eccentric, an unpleasant person"

March 30th is the birthday of Vincent van Gogh, born in Holland in 1853, a famous painter and also great letter-writer. His letters were lively, engaging, and passionate; they also frequently reflect his struggles with bipolar disorder.

He wrote: "What am I in the eyes of most people — a nonentity, an eccentric, or an unpleasant person — somebody who has no position in society and will never have; in short, the lowest of the low. All right, then — even if that were absolutely true, then I should one day like to show by my work what such an eccentric, such a nobody, has in his heart."

He wrote thousands of letters to his brother Theo over the course of his life. Theo's widow published the van Gogh's letters to her husband in 1913.

Doctors' Day in a high-risk profession: suicide rate of U.S. doctors is one per day

This quote serves as a good reminder how people with depression may have an altered perception of themselves. March 30 is also National Doctors' Day in the U.S. Other countries celebrate Doctors' Day on different dates.

More than a quarter of primary care doctors reported being "burnt out." The United States loses the equivalent of at least one entire medical school class (approximately 400 physicians) each year to suicide.

In other words, 300-400 doctors in the United States kill themselves every year, or roughly 1 per day. Male doctors have suicide rates 1.4 times that of the general population, while female doctors have twice the rate of depression and 2.3 times the suicide rate when compared with women who are not physicians.

A conversation could save a life: "Are you OK?" Day

Hugh Jackman shows his support for R U OK?Day, a national day of action in Australia that aims to prevent suicide by encouraging people to connect with colleagues, friends and loved ones and ask simply: "Are you OK?".

References

Writer's Almanac. NPR, 2012.
High-risk profession: Suicide rate of U.S. doctors is one per day
Help for Today's Tense, Frustrated Doctors. Medscape, 2009.
http://www.medscape.com/viewarticle/710904
Doctors have higher rates of suicide than the general population: 40% higher for male doctors, 130% for female doctors http://goo.gl/ckTm
R U OK? Day
Image source: Vincent van Gogh's 1890 painting At Eternity's Gate. Wikipedia, public domain.

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LOS ANGELES, April 2, 2012 /PRNewswire/ --NeuroSigma, Inc., a Los Angeles-based medical device company, today announced its appointment of Christopher M. DeGiorgio, M.D., as Vice-President, Neurology. In this new role Dr. DeGiorgio, who was previously a Senior Medical Advisor to the Company, will lead NeuroSigma's development of Trigeminal Nerve Stimulation (TNS) for the treatment of neurological indications.

"I am very excited to join NeuroSigma to help move TNS therapy forward as a treatment option for neurological disorders, such as drug-resistant epilepsy, which is estimated to affect over 10 million people worldwide," said Dr. DeGiorgio.

NeuroSigma has completed development of its external TNS (eTNS) system and is developing its implantable subcutaneous TNS (sTNS) system. Near term milestones include filing a CE Mark application in mid-2012 for approval to commence marketing the eTNS system for the treatment of epilepsy in Europe. NeuroSigma is also planning to file, in the second-half of 2012, an IDE with the FDA for a multi-center epilepsy Phase III pivotal trial in the United States.

"We are very fortunate to have Dr. DeGiorgio, who had the vision of conceiving TNS as a therapy for epilepsy, join NeuroSigma as a member of our management team. His appointment represents an important step forward for our company as we move closer to bringing our promising TNS therapies to market," said Lodwrick Cook, Chairman of NeuroSigma. "We are delighted that we will be working closely with Dr. DeGiorgio during this extremely important phase in the regulatory approval process and in planning for post-approval strategy in Europe, US and other key regions in the world," added Leon Ekchian, Ph.D., President and CEO of NeuroSigma.

Dr. DeGiorgio has taken a partial leave of absence as a Professor of Neurology at the David Geffen School of Medicine at UCLA where he previously served as Executive Vice-Chairman in the Department of Neurology. A distinguished physician scientist, Dr. DeGiorgio has also been recognized as one of the Best Doctors in America, and is the recipient of the Excellence in Teaching Award while at UCLA. He was first to study TNS in patients with epilepsy, and collaborated with Ian Cook, M.D., Professor of Psychiatry at UCLA, in developing TNS as a potential treatment for depression, PTSD and ADHD. Among his notable research work, Dr. DeGiorgio has served as Principal Investigator of several interventional clinical trials for drug resistant epilepsy, including Vagus Nerve Stimulation (VNS) for epilepsy and n-3 fatty acids to reduce seizures and the risk of sudden death in epilepsy (SUDEP). Dr. DeGiorgio has also published multiple peer-reviewed research papers in the field of epilepsy, and is the Principal Investigator of a National Institute of Health (NIH) grant recently awarded to NeuroSigma to further develop eTNS for Epilepsy.

About NeuroSigma, Inc. NeuroSigma is a Los Angeles-based medical technology company established to develop early stage technologies with the potential to transform medical practice. Currently, NeuroSigma is focused on a number of neuromodulation therapies and through our majority-owned subsidiary, NSVascular, on Thin-Film Nitinol covered stents for endovascular applications. NeuroSigma employs two neuromodulation therapy platforms: Trigeminal Nerve Stimulation (TNS) and Deep Brain Stimulation (DBS). NeuroSigma has amassed significant intellectual property that is based on technology licensed on an exclusive basis from the University of California, Los Angeles (UCLA), including potential therapies for epilepsy, depression and post-traumatic stress disorder (PTSD) and attention-deficit hyperactivity disorder (ADHD) via TNS and for PTSD, obesity and cachexia via DBS. For more information about NeuroSigma, please visit our website at http://www.neurosigma.com.

CAUTION: The eTNS and sTNS systems are investigational devices and are limited by Federal (or United States) law to investigational use.

NeuroSigma Contacts:

Dr. Leon Ekchian, President & CEO Tel: 310-479-3100 Email: lekchian@neurosigma.com NeuroSigma, Inc. Website: http://www.neurosigma.com

Mr. Mark Collinson, PartnerTel: +1-310-954-1343 Email: mark.collinson@ccgir.com CCG Investor Relations Website: http://www.ccgir.com

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UCLA Neurologist and Innovator of Trigeminal Nerve Stimulation Joins NeuroSigma

Cirrhosis is the 12th leading cause of death in the United States. The mortality rate is 9.7 per 100,000 persons.

The most common causes of cirrhosis are:

- alcohol abuse
- viral hepatitis
- nonalcoholic fatty liver disease is emerging as an increasingly important cause

Patients with cirrhosis should be screened for hepatocellular carcinoma with imaging studies every 6-12 months.

Causes of hepatic encephalopathy include:

- constipation
- infection
- gastrointestinal bleeding
- some medications
- electrolyte imbalances
- noncompliance with medical therapy

Treatment

Lactulose and rifaximin are aimed at reducing serum ammonia levels.

Ascites should be treated initially with salt restriction and diuresis. Physicians should be vigilant for spontaneous bacterial peritonitis.

Patients with acute GI bleeding should be monitored in an intensive care unit, and should have endoscopy performed within 24 hours.

Prevention

Mechanisms to reduce the incidence of cirrhosis:

- treat alcohol abuse
- screen for viral hepatitis
- control risk factors for nonalcoholic fatty liver disease

Cirrhosis: Phil's story (video):

From NHSChoices: Many people enjoy a drink in the pub after work without realising how social drinking can damage health. Phil didn't realise the harm his alcohol intake was doing until he was diagnosed with cirrhosis of the liver. He talks about his experience and the shock he felt at being diagnosed.

References

Cirrhosis: diagnosis, management, and prevention. Starr SP, Raines D. Am Fam Physician. 2011 Dec 15;84(12):1353-9.

Cirrhosis - JAMA Patient Page, 2012.

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During the past 5 years, the Cleveland Clinic has moved aggressively to expand from illness management to wellness management. They even have a Wellness Institute. One example of its programs is Lifestyle 180 (R) which is "designed to reverse" the effects of chronic disease through lifestyle modification.

Here is a 5-minute video about the program from the Clinic YouTube channel:

The program focuses on nutrition, exercise, and stress management. The yearlong program is available at the Cleveland Clinic Wellness Institute campus located in Lyndhurst, Ohio.

References:

Lifestyle medicine

Interactive wellness guide by Cleveland Clinic

Lifestyle 180 (PDF)

Disclaimer: I was on faculty at Cleveland Clinic and Case Western Reserve University as Assistant Professor of Medicine until 2008.

Comments from Twitter:

Meenakshi Budhraja @gastromom: Like>>

Linda Pourmassina,MD @LindaP_MD: "the $3,000 fee for this program represents a fraction of the increasingly high co-pays for doctor visits and medications."

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