AAN: New Guideline on How to Best Treat Involuntary Movements in Huntington's Disease

Newswise MINNEAPOLIS A new guideline released by the American Academy of Neurology recommends several treatments for people with Huntingtons disease who experience choreajerky, random, uncontrollable movements that can make everyday activities challenging. The guideline is published in the July 18, 2012, online issue of Neurology, the medical journal of the American Academy of Neurology.

Chorea can be disabling, worsen weight loss and increase the risk of falling, said guideline lead author Melissa Armstrong, MD, MSc, with the University of Maryland School of Medicine Department of Neurology and a member of the American Academy of Neurology.

Huntingtons disease is a complex disease with physical, cognitive and behavioral symptoms. The new guideline addresses only one aspect of the disease that may require treatment.

The guideline found that the drugs tetrabenazine (TBZ), riluzole and amantadine can be helpful and the drug nabilone may also be considered to treat chorea. The medications riluzole, amantadine and nabilone are not often prescribed for Huntingtons disease.

People with Huntingtons disease who have chorea should discuss with their doctors whether treating chorea is a priority. Huntingtons disease is complex with a wide range of sometimes severe symptoms and treating other symptoms may be a higher priority than treating chorea, said Armstrong.

Armstrong adds that it is important for patients to understand that their doctors may try drugs not recommended in this guideline to treat chorea. More research is needed to know if drugs such as those used for psychosis are effective; however, doctors may prescribe them on the basis of past clinical experience.

Learn more about the guideline at http://www.aan.com/guidelines or Huntingtons disease at http://www.aan.com/patients.

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.

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AAN: New Guideline on How to Best Treat Involuntary Movements in Huntington's Disease

New biomarker in the blood may help predict Alzheimer's disease

Public release date: 18-Jul-2012 [ | E-mail | Share ]

Contact: Rachel Seroka rseroka@aan.com 612-928-6129 American Academy of Neurology

MINNEAPOLIS Higher levels of a certain fat in the blood called ceramides may increase a person's risk of developing Alzheimer's disease, according to a study published in the July 18, 2012, online issue of Neurology, the medical journal of the American Academy of Neurology.

"Our study identifies this biomarker as a potential new target for treating or preventing Alzheimer's disease," said study author Michelle M. Mielke, PhD, an epidemiologist with the Mayo Clinic in Rochester, Minn. Mielke was with Johns Hopkins University at the time of the research.

For the study, 99 women between the ages of 70 and 79 and free of dementia in the Women's Health and Aging Study II had their blood tested for levels of serum ceramides, a fatty compound found throughout the body that is associated with inflammation and cell death. The participants were placed into three groups: high, middle and low levels of ceramides. They were then followed for up to nine years. Of the 99 participants, 27 developed dementia and 18 of those were diagnosed with probable Alzheimer's disease.

The study found that women who had the highest levels of the biomarker were 10 times more likely to develop Alzheimer's disease than women with the lowest levels. Those with middle levels of the biomarker were nearly eight times more likely to develop the disease than those with the lowest levels.

"These findings are important because identifying an accurate biomarker for early Alzheimer's that requires little cost and inconvenience to a patient could help change our focus from treating the disease to preventing or delaying it," said Valory Pavlik, PhD, with the Alzheimer's Disease and Memory Disorders Center of Baylor College of Medicine in Houston and a member of the American Academy of Neurology, in an accompanying editorial.

According to Pavlik, "While a larger, more diverse study is needed to confirm these findings, projections that the global prevalence of Alzheimer's disease will double every 20 years for the foreseeable future have certainly increased the sense of urgency among researchers and health care agencies to identify more effective screening, prevention and treatment strategies."

###

The study was supported by the National Institute on Aging, the National Institute of Neurological Disorders and Stroke and the Johns Hopkins Older Americans Independence Center.

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New biomarker in the blood may help predict Alzheimer's disease

Hirsutism in women – literature review

Here some excerpts from the 2012 review of hirsutism in women in the journal American Family Physician:

Hirsutism is excess terminal hair that commonly appears in a male pattern in women.

Although hirsutism is generally associated with hyperandrogenemia, 50% of women with mild symptoms have normal androgen levels.

Causes of hirsutism

The most common cause of hirsutism is polycystic ovary syndrome (PCOS), which accounts for 3 out of every 4 cases.

Many medications can also cause hirsutism.

In patients whose hirsutism is not related to medication use, evaluation is focused on testing for endocrinopathies and neoplasms, such:

- polycystic ovary syndrome (PCOS)
- adrenal hyperplasia
- thyroid dysfunction
- Cushing syndrome
- androgen-secreting tumors

Symptoms of hirsutism

Symptoms and findings suggestive of neoplasm include rapid onset of symptoms, signs of virilization, and a palpable abdominal or pelvic mass.

Patients without these findings who have mild symptoms and normal menses can be treated empirically.

For patients with moderate or severe symptoms, an early morning total testosterone level should be obtained, and if elevated, it should be followed by a plasma free testosterone level.

A total testosterone level greater than 200 ng per dL (6.94 nmol per L) should prompt evaluation for an androgen-secreting tumor.

Diagnosis of hirsutism

Laboratory workup may include:

- early morning total testosterone level
- plasma free testosterone level
- thyroid function tests
- prolactin level
- 17-hydroxyprogesterone level
- corticotropin stimulation test

Treatment of hirsutism

Treatment includes hair removal and pharmacologic measures.

Shaving is effective but needs to be repeated often. Evidence for the effectiveness of electrolysis and laser therapy is limited.

Laser treatment does not result in complete, permanent hair reduction, but it is more effective than other methods such as shaving, waxing, and electrolysis. It produces hair reduction for up to 6 months. The effect is enhanced with multiple treatments.

In patients who are not planning a pregnancy, first-line pharmacologic treatment should include oral contraceptives. Topical agents, such as eflornithine, may also be used.

Treatment response should be monitored for at least six months before making adjustments.

References:

Hirsutism in women. Bode D, Seehusen DA, Baird D. Am Fam Physician. 2012 Feb 15;85(4):373-80.

Management of Hirsutism (Excess Hair)

Image source: Skin layers. Wikipedia, public domain.

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An App for Medical Emergencies – EmergencyLink – WSJ video

EmergencyLink is a free service that provides medical information and personal contacts to emergency responders - Mossberg for WSJ:

Here is the URL: http://www.emergencylink.com

The company explains how it can help if:

- You Are In An Accident. A first responder locates the EmergencyLink ID and calls EmergencyLink as instructed. EmergencyLink provides the first responder with your emergency medical information and contacts your “Emergency Contacts” as you have instructed.

- Your Child Is Missing. You can quickly create a a Missing Person report and forward it to the police. The police can immediately act on the information maximizing their chances of locating your child quickly and safely.

- Sharing Information with a Caregiver. You are able to electronically share all of the information the caregiver will need in case of an emergency. Whenever your child's profile is updated, everyone with whom you are sharing the information will be updated, no need to constantly update everyone.

- A Friend is in an Accident. If your friend is an EmergencyLink Member and is "sharing" their info with you, you can access their emergency medical information (allergies, medications, medical insurance) and forward them to the first responder.

- Co-Workers Are On A Project Away From Home. Each Member in the group agrees to share their emergency contact information with each other. If there is an emergency situation, the group has the information needed to reach each others emergency contacts.

EmergencyLink is a free 24-Hour Emergency Response Service that helps you store your important information in one location, share emergency information with family and friends and has a 24-Hour Emergency Response center to aid you in an emergency:

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Mayo Clinic latest computer toy: "YES" Board patient tracking system

From Mayo Clinic YouTube channel:

Vernon Smith, M.D., an emergency room physician at Mayo Clinic in Arizona, discusses the benefits of the computerized YES Board patient tracking system which he developed over the course of several years and input from hundreds of doctors, nurses and emergency room staff while he worked at Mayo Clinic in Rochester, Minn.

According to Mayo Clinic, "the YES board reduces the time required to translate data, allowing physicians to forecast the needs of their patients and track progress. It has the capacity to walk physicians through current and past information for each patient — in addition to all patients collectively. Additionally, the YES Board helps to secure usable space and resources and detect the most at-risk patients and also helps forecast the needs of the patients in the emergency department. Plus, the YES Board can be viewed through any approved computer with an internet connection."

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Research and Markets: Mexico Neurology Devices Market Outlook to 2018 – Interventional Neurology, Neurological …

DUBLIN--(BUSINESS WIRE)--

Research and Markets (http://www.researchandmarkets.com/research/75qphh/mexico_neurology_d) has announced the addition of GlobalData's new report "Mexico Neurology Devices Market Outlook to 2018 - Interventional Neurology, Neurological Diagnostic Equipment, Neurostimulation Devices and Others" to their offering.

GlobalData's new report, Mexico Neurology Devices Market Outlook to 2018 - Interventional Neurology, Neurological Diagnostic Equipment, Neurostimulation Devices and Others provides key market data on the Mexico Neurology Devices market. The report provides value (USD million), volume (units) and average price (USD) data for each segment and sub-segment within six market categories - CSF Management, Interventional Neurology, Neurological Diagnostic Equipment, Neurostimulation Devices, Neurosurgical Products and Radiosurgery. The report also provides company shares and distribution shares data for each of the aforementioned market categories. The report is supplemented with global corporate-level profiles of the key market participants with information on company financials and pipeline products, wherever available.

Scope:

- Market size and company share data for Neurology Devices market categories - CSF Management, Interventional Neurology, Neurological Diagnostic Equipment, Neurostimulation Devices, Neurosurgical Products and Radiosurgery.

- Annualized market revenues (USD million), volume (units) and average price (USD) data for each of the segments and sub-segments within six market categories. Data from 2004 to 2011, forecast forward for 7 years to 2018.

- 2011 company shares and distribution shares data for each of the six market categories.

- Global corporate-level profiles of key companies operating within the Mexico Neurology Devices market.

Companies Mentioned:

- Medtronic, Inc.

See more here:
Research and Markets: Mexico Neurology Devices Market Outlook to 2018 - Interventional Neurology, Neurological ...

Research and Markets: Israel Neurology Devices Market Outlook to 2018 – Interventional Neurology, Neurological …

DUBLIN--(BUSINESS WIRE)--

Research and Markets (http://www.researchandmarkets.com/research/59gjfg/israel_neurology_d) has announced the addition of GlobalData's new report "Israel Neurology Devices Market Outlook to 2018 - Interventional Neurology, Neurological Diagnostic Equipment, Neurostimulation Devices and Others" to their offering.

This new report provides key market data on the Israel Neurology Devices market. The report provides value (USD million), volume (units) and average price (USD) data for each segment and sub-segment within five market categories - CSF Management, Interventional Neurology, Neurological Diagnostic Equipment, Neurostimulation Devices and Neurosurgical Products. The report also provides company shares and distribution shares data for each of the aforementioned market categories. The report is supplemented with global corporate-level profiles of the key market participants with information on company financials and pipeline products, wherever available.

This report is built using data and information sourced from proprietary databases, primary and secondary research and in-house analysis by GlobalData's team of industry experts.

Scope

- Market size and company share data for Neurology Devices market categories - CSF Management, Interventional Neurology, Neurological Diagnostic Equipment, Neurostimulation Devices and Neurosurgical Products.

- Annualized market revenues (USD million), volume (units) and average price (USD) data for each of the segments and sub-segments within six market categories. Data from 2004 to 2011, forecast forward for 7 years to 2018.

- 2011 company shares and distribution shares data for each of the five market categories.

- Global corporate-level profiles of key companies operating within the Israel Neurology Devices market.

- Key players covered include Medtronic, Inc., St. Jude Medical, Inc., Stryker Corporation, Nihon Kohden Corporation, DePuy, Inc., Covidien plc and others.

Read more:
Research and Markets: Israel Neurology Devices Market Outlook to 2018 - Interventional Neurology, Neurological ...

Research and Markets: Sweden Neurology Devices Market Outlook to 2018 – Interventional Neurology, Neurological …

DUBLIN--(BUSINESS WIRE)--

Research and Markets (http://www.researchandmarkets.com/research/zgk4p5/sweden_neurology_d) has announced the addition of GlobalData's new report "Sweden Neurology Devices Market Outlook to 2018 - Interventional Neurology, Neurological Diagnostic Equipment, Neurostimulation Devices and Others" to their offering.

This report provides key market data on the Sweden Neurology Devices market. The report provides value (USD million), volume (units) and average price (USD) data for each segment and sub-segment within six market categories - CSF Management, Interventional Neurology, Neurological Diagnostic Equipment, Neurostimulation Devices, Neurosurgical Products and Radiosurgery. The report also provides company shares and distribution shares data for each of the aforementioned market categories. The report is supplemented with global corporate-level profiles of the key market participants with information on company financials and pipeline products, wherever available.

This report is built using data and information sourced from proprietary databases, primary and secondary research and in-house analysis by GlobalData's team of industry experts.

Scope:

- Market size and company share data for Neurology Devices market categories - CSF Management, Interventional Neurology, Neurological Diagnostic Equipment, Neurostimulation Devices, Neurosurgical Products and Radiosurgery.

- Annualized market revenues (USD million), volume (units) and average price (USD) data for each of the segments and sub-segments within six market categories. Data from 2004 to 2011, forecast forward for 7 years to 2018.

- 2011 company shares and distribution shares data for each of the six market categories.

- Global corporate-level profiles of key companies operating within the Sweden Neurology Devices market.

- Key players covered include Medtronic, Inc., Stryker Corporation, DePuy, Inc., St. Jude Medical, Inc., Covidien plc, B. Braun Melsungen AG and others.

More:
Research and Markets: Sweden Neurology Devices Market Outlook to 2018 - Interventional Neurology, Neurological ...

More than 50% of injuries on Fourth of July are related to fireworks

The eyes are the most frequently injured body parts, followed by the fingers and hands. Here is a video from the Cleveland Clinic with some advice how to prevent these injuries:

This video discusses ways to prevent and identify heat-related illness in senior citizens:

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Top medicine articles for June-July 2012

Here are my suggestions for some of the top articles in medicine for June-July 2012:

Should You Put Sunscreen on Infants? It’s best not to use sunscreen on infants under age 6 months - FDA http://buff.ly/LxmJ0u

Guillain-Barre Syndrome - NEJM review http://buff.ly/LxmC55

Long-term use of low-dose azithromycin as an attractive adjunct treatment option for COPD http://buff.ly/LAoNVi

71% of doctors believe quality of healthcare will deteriorate over the next 5 years (19-page survey summary, PDF) http://goo.gl/Sl0wd

Americans' confidence in the U.S. medical system is around the historical average of 39% http://goo.gl/KoTqI

FDA Approves Diet Pill Belviq http://bit.ly/LCvE0o

What is So Good About Growing Old: mind gets sharper at a number of vitally important abilities http://goo.gl/6xI8M

A Lithium Battery in a Hotdog: the picture burns itself into mind - keep out of reach of small children http://buff.ly/LSmPBS

People who remember being pushed or slapped as children more likely to have depression or anxiety later in life http://goo.gl/oTt7p

Physical Punishment Has Long-Lasting Consequences on Children's Mental Health (study) http://buff.ly/LKGrl6

GSK once-daily lung drug LAMA/LABA (umeclidinium/vilanterol) showed positive results in COPD http://goo.gl/s1o0P

1 in 5 Nurses is Depressed - 18% of hospital-employed nurses have depression; twice the rate of the general public http://goo.gl/aioSn

The Medication Generation: Many young people today have now spent most of their lives on antidepressants - WSJ http://on.wsj.com/LLDuVE

Publishing a medical journal is a very profitable activity, says former BMJ Editor-in-Chief and provides examples http://goo.gl/QeaKS

Health Care Mandate Puts a "Cranky Uncle" in Every Exam Room - NYTimes http://goo.gl/v0PpH

The articles were selected from my Twitter and Google Reader streams. Please feel free to send suggestions for articles to clinicalcases@gmail.com and you will receive acknowledgement in the next edition of this publication.

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Research and Markets: United States Neurology Devices Market Outlook to 2018 – Interventional Neurology, Neurological …

DUBLIN--(BUSINESS WIRE)--

Research and Markets (http://www.researchandmarkets.com/research/r4856w/united_states_neur) has announced the addition of GlobalData's new report "United States Neurology Devices Market Outlook to 2018 - Interventional Neurology, Neurological Diagnostic Equipment, Neurostimulation Devices and Others" to their offering.

This new report provides key market data on the United States Neurology Devices market. The report provides value (USD million), volume (units) and average price (USD) data for each segment and sub-segment within six market categories - CSF Management, Interventional Neurology, Neurological Diagnostic Equipment, Neurostimulation Devices, Neurosurgical Products and Radiosurgery. The report also provides company shares and distribution shares data for each of the aforementioned market categories. The report is supplemented with global corporate-level profiles of the key market participants with information on company financials and pipeline products, wherever available.

This report is built using data and information sourced from proprietary databases, primary and secondary research and in-house analysis by GlobalData's team of industry experts.

Scope

- Market size and company share data for Neurology Devices market categories - CSF Management, Interventional Neurology, Neurological Diagnostic Equipment, Neurostimulation Devices, Neurosurgical Products and Radiosurgery.

- Annualized market revenues (USD million), volume (units) and average price (USD) data for each of the segments and sub-segments within six market categories. Data from 2004 to 2011, forecast forward for 7 years to 2018.

- 2011 company shares and distribution shares data for each of the six market categories.

- Global corporate-level profiles of key companies operating within the United States Neurology Devices market.

- Key players covered include Medtronic, Inc., Boston Scientific Corporation, St. Jude Medical, Inc., Cyberonics, Inc., DePuy, Inc., Stryker Corporation and others.

Read the original here:
Research and Markets: United States Neurology Devices Market Outlook to 2018 - Interventional Neurology, Neurological ...

Research and Markets: South Africa Neurology Devices Market Outlook to 2018 – Interventional Neurology, Neurological …

DUBLIN--(BUSINESS WIRE)--

Research and Markets (http://www.researchandmarkets.com/research/8bvx75/south_africa_neuro) has announced the addition of GlobalData's new report "South Africa Neurology Devices Market Outlook to 2018 - Interventional Neurology, Neurological Diagnostic Equipment, Neurostimulation Devices and Others" to their offering.

GlobalData's new report, South Africa Neurology Devices Market Outlook to 2018 - Interventional Neurology, Neurological Diagnostic Equipment, Neurostimulation Devices and Others provides key market data on the South Africa Neurology Devices market. The report provides value (USD million), volume (units) and average price (USD) data for each segment and sub-segment within five market categories - CSF Management, Interventional Neurology, Neurological Diagnostic Equipment, Neurostimulation Devices and Neurosurgical Products. The report also provides company shares and distribution shares data for each of the aforementioned market categories. The report is supplemented with global corporate-level profiles of the key market participants with information on company financials and pipeline products, wherever available.

Scope:

- Market size and company share data for Neurology Devices market categories - CSF Management, Interventional Neurology, Neurological Diagnostic Equipment, Neurostimulation Devices and Neurosurgical Products.

- Annualized market revenues (USD million), volume (units) and average price (USD) data for each of the segments and sub-segments within six market categories. Data from 2004 to 2011, forecast forward for 7 years to 2018.

- 2011 company shares and distribution shares data for each of the five market categories.

- Global corporate-level profiles of key companies operating within the South Africa Neurology Devices market.

Reasons to Buy:

- Develop business strategies by identifying the key market categories and segments poised for strong growth.

See the rest here:
Research and Markets: South Africa Neurology Devices Market Outlook to 2018 - Interventional Neurology, Neurological ...

Drowning Prevention Guidelines

Here is a video from the Cleveland Clinic:

Key risk factors for drowning are:

- male sex
- age of less than 14 years
- alcohol use
- low income
- poor education
- rural residency
- aquatic exposure
- risky behavior
- lack of supervision

For people with epilepsy, the risk of drowning is 15 to 19 times as high as the risk for those who do not have epilepsy.

For every person who dies from drowning, another four persons receive care in the emergency department for nonfatal drowning.

Drowning Doesn’t Look Like Drowning

- Except in rare circumstances, drowning people are physiologically unable to call out for help. The respiratory system was designed for breathing. Speech is the secondary or overlaid function. Breathing must be fulfilled, before speech occurs.

- Drowning people’s mouths alternately sink below and reappear above the surface of the water.

- The mouths of drowning people are not above the surface of the water long enough for them to exhale, inhale, and call out for help. When the drowning people’s mouths are above the surface, they exhale and inhale quickly as their mouths start to sink below the surface of the water.

- Drowning people cannot wave for help. Nature instinctively forces them to extend their arms laterally and press down on the water’s surface. Pressing down on the surface of the water, permits drowning people to leverage their bodies so they can lift their mouths out of the water to breathe.

- Throughout the Instinctive Drowning Response, drowning people cannot voluntarily control their arm movements. Physiologically, drowning people who are struggling on the surface of the water cannot stop drowning and perform voluntary movements such as waving for help, moving toward a rescuer, or reaching out for a piece of rescue equipment.

- From beginning to end of the Instinctive Drowning Response people’s bodies remain upright in the water, with no evidence of a supporting kick. Unless rescued by a trained lifeguard, these drowning people can only struggle on the surface of the water from 20 to 60 seconds before submersion occurs.

References:

Drowning Doesn’t Look Like Drowning. Mario Vittone.On Scene Magazine: Fall 2006 (page 14)
Drowning - free NEJM review, 2012 http://goo.gl/xSqLu

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Top medicine articles for June 2012

Here are my suggestions for some of the top articles in medicine for June 2012:

Open access to research is inevitable, says Nature editor-in-chief http://goo.gl/N3OEU

Diagnosis, treatment, and management of echinococcosis | 2012 BMJ review http://goo.gl/r65Nd

How to be a cool headed clinician. Imperturbability is an essential characteristic for doctors, but how compatible is it with empathy? BMJ http://goo.gl/X7l5y

A doctor's guide to E/M coding - How to minimize lost revenue and likelihood of an audit - ModernMedicine http://goo.gl/RT6OC

Forgotten notebooks shed light on controversial discovery of streptomycin, the first antibiotic to cure TB http://goo.gl/1au0m

Apps for the Traveler With Medical Issues - NYTimes http://goo.gl/vFJzE

Statin Use Linked to Fatigue in Randomized Trial http://goo.gl/4xv0I and http://goo.gl/U2cMh

Thiazolidinedione use is associated with increased risk for diabetic macular edema http://goo.gl/1O0Tz

"Superbug" gonorrhea, becoming untreatable, accounts for 10% of STDs in Europe - doubling since last year http://goo.gl/y5aWr

Rapid Saliva Test for Laryngopharyngeal Reflux (LPR) http://goo.gl/LEsMO and http://goo.gl/GCean

Journal offers flat fee for ‘all you can publish’ Whereas PLoS ONE charges $1,350 per paper, PeerJ users pay $299 http://goo.gl/0kArd

Ipratropium linked to increased risk of stroke in COPD, especially with concomitant use of SABAs or theophylline http://goo.gl/CEr25

Chagas Disease is “The New HIV/AIDS of the Americas” claims the journal PLoS Neglected Tropical Diseases http://goo.gl/1P1qu

Cleveland Clinic summit on Patient Experience shares presentation slides - a must-read for those interested in #HCSM http://goo.gl/EnMbK

Doctors are using electronic records more - but liking them less - Washington Post http://buff.ly/Lpb8SY

Only 6.7% of office-based physicians routinely email with patients http://buff.ly/PPdusu

5 Key Benchmarks That Could Make or Break a Physician Practice http://buff.ly/LpbskH

90% of patients prefer web-based access to health information and education. 88% want to receive email reminders when it is time for preventive or follow-up care. 72% would like to use online services to book, change or cancel physician appointments. http://buff.ly/L0jjQS

The articles were selected from my Twitter and Google Reader streams. Please feel free to send suggestions for articles to clinicalcases@gmail.com and you will receive acknowledgement in the next edition of this publication.

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Acute low back pain: What to do? What works and what doesn’t?

Here is an excerpt from a recent review article in the official AFP journal American Family Physician:

Acute low back pain is one of the most common reasons for adults to see a physician. Most patients recover quickly with minimal treatment.

"Red flags"

Serious "red flags" include:

- significant trauma related to age (i.e., injury related to a fall from a height or motor vehicle crash in a young patient, or from a minor fall or heavy lifting in a patient with osteoporosis or possible osteoporosis)
- major or progressive motor or sensory deficit
- new-onset bowel or bladder incontinence or urinary retention
- loss of anal sphincter tone
- saddle anesthesia
- history of cancer metastatic to bone
- suspected spinal infection

Diagnosis

Without signs of serious pathology, imaging and laboratory testing often are not required.

Treatment

Patient education, nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and muscle relaxants are beneficial.

Bed rest should be avoided, if possible.

Exercises directed by a physical therapist, such as the McKenzie method and spine stabilization exercises, may decrease recurrent pain.

Spinal manipulation and chiropractic techniques are no more effective than established medical treatments.

No substantial benefit has been shown with:

- oral steroids
- acupuncture
- massage
- traction
- lumbar supports
- regular exercise programs

References:

Diagnosis and treatment of acute low back pain. Casazza BA. Am Fam Physician. 2012 Feb 15;85(4):343-50.

Image source: Different regions (curvatures) of the vertebral column, Wikipedia, public domain.

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Genital ulcers – 2012 review from Am Fam Physician

Here is an excerpt from a review article in the official AAFP journal American Family Physician:

Causes of genital ulcers

Herpes simplex virus (HSV) infection and syphilis are the most common causes of genital ulcers in the U.S.

Other infectious causes include:

- chancroid
- lymphogranuloma venereum (LGV)
- granuloma inguinale (donovanosis)
- secondary bacterial infections
- fungi

Noninfectious etiologies of genital ulcers include:

- sexual trauma
- psoriasis
- Behçet syndrome
- fixed drug eruptions

CDC Streaming Health | This video, produced by Be Smart. Be Well., raises awareness of Sexually Transmitted Diseases (STDs): 1) What are they? 2) Why they matter? and, 3) What can I do about them? Footage courtesy of Be Smart. Be Well. http://www.besmartbewell.com, featuring CDC's Dr. John Douglas, Division of Sexually Transmitted Disease Prevention.

Diagnosis

The following tests should be considered in all patients:

- serologic tests for syphilis and darkfield microscopy or direct fluorescent antibody testing for Treponema pallidum
- culture or polymerase chain reaction test for herpes simplex virus (HSV)
- culture for Haemophilus ducreyi in settings with a high prevalence of chancroid

No pathogen is identified in up to 25% of patients with genital ulcers.

Treatment

The first episode of herpes simplex virus infection is usually treated with 7-10 days of oral acyclovir (5 days for recurrent episodes). Famciclovir and valacyclovir are alternative therapies.

One dose of intramuscular penicillin G benzathine is recommended to treat genital ulcers caused by primary syphilis.

Treatment options for chancroid include a single dose of intramuscular ceftriaxone or oral azithromycin, ciprofloxacin, or erythromycin.

Lymphogranuloma venereum and donovanosis are treated with 21 days of oral doxycycline.

Treatment of noninfectious causes of genital ulcers varies by etiology, of course. Topical wound care for ulcers caused by sexual trauma. Subcutaneous pegylated interferon alfa-2a is considered for ulcers caused by Behçet syndrome.

References:

Diagnosis and management of genital ulcers. Roett MA, Mayor MT, Uduhiri KA. Am Fam Physician. 2012 Feb 1;85(3):254-62.

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Research and Markets: Republic of Korea Neurology Devices Market Outlook to 2018 – Interventional Neurology …

DUBLIN--(BUSINESS WIRE)--

Research and Markets (http://www.researchandmarkets.com/research/bwd77m/republic_of_korea) has announced the addition of GlobalData's new report "Republic of Korea Neurology Devices Market Outlook to 2018 - Interventional Neurology, Neurological Diagnostic Equipment, Neurostimulation Devices and Others" to their offering.

GlobalData's new report, Republic of Korea Neurology Devices Market Outlook to 2018 - Interventional Neurology, Neurological Diagnostic Equipment, Neurostimulation Devices and Others provides key market data on the Republic of Korea Neurology Devices market.

The report provides value (USD million), volume (units) and average price (USD) data for each segment and sub-segment within six market categories - CSF Management, Interventional Neurology, Neurological Diagnostic Equipment, Neurostimulation Devices, Neurosurgical Products and Radiosurgery.

The report also provides company shares and distribution shares data for each of the aforementioned market categories. The report is supplemented with global corporate-level profiles of the key market participants with information on company financials and pipeline products, wherever available.

This report is built using data and information sourced from proprietary databases, primary and secondary research and in-house analysis by GlobalData's team of industry experts.

Scope:

- Market size and company share data for Neurology Devices market categories.

- Annualized market revenues (USD million), volume (units) and average price (USD) data for each of the segments and sub-segments within six market categories. Data from 2004 to 2011, forecast forward for 7 years to 2018.

- 2011 company shares and distribution shares data for each of the six market categories.

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Research and Markets: Republic of Korea Neurology Devices Market Outlook to 2018 - Interventional Neurology ...

Research and Markets: Netherlands Neurology Devices Market Outlook to 2018 – Interventional Neurology, Neurological …

DUBLIN--(BUSINESS WIRE)--

Research and Markets (http://www.researchandmarkets.com/research/bz7thk/netherlands_neurol) has announced the addition of GlobalData's new report "Netherlands Neurology Devices Market Outlook to 2018 - Interventional Neurology, Neurological Diagnostic Equipment, Neurostimulation Devices and Others" to their offering.

GlobalData's new report, Netherlands Neurology Devices Market Outlook to 2018 - Interventional Neurology, Neurological Diagnostic Equipment, Neurostimulation Devices and Others provides key market data on the Netherlands Neurology Devices market. The report provides value (USD million), volume (units) and average price (USD) data for each segment and sub-segment within six market categories - CSF Management, Interventional Neurology, Neurological Diagnostic Equipment, Neurostimulation Devices, Neurosurgical Products and Radiosurgery. The report also provides company shares and distribution shares data for each of the aforementioned market categories. The report is supplemented with global corporate-level profiles of the key market participants with information on company financials and pipeline products, wherever available.

Scope:

- Market size and company share data for Neurology Devices market categories - CSF Management, Interventional Neurology, Neurological Diagnostic Equipment, Neurostimulation Devices, Neurosurgical Products and Radiosurgery.

- Annualized market revenues (USD million), volume (units) and average price (USD) data for each of the segments and sub-segments within six market categories. Data from 2004 to 2011, forecast forward for 7 years to 2018.

- 2011 company shares and distribution shares data for each of the six market categories.

- Global corporate-level profiles of key companies operating within the Netherlands Neurology Devices market.

Reasons to Buy:

- Develop business strategies by identifying the key market categories and segments poised for strong growth.

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Research and Markets: Netherlands Neurology Devices Market Outlook to 2018 - Interventional Neurology, Neurological ...

Neurology residency program to meet stroke treatment needs

A new neurology residency program has been approved for Palmetto Health and the USC School of Medicine, a move designed to meet a severe need in the state.

South Carolina has one of the highest stroke rates of any state, ranking in the top 10 for stroke deaths per capita. Every hospital, large and small, has to deal with stroke patients. But many small hospitals dont have stroke neurologists, according to Dr. Souvik Sen, who will direct the new residency program.

We do have a shortage of neurologists, Sen said. Stroke neurologists are very specialized, and every hospital needs at least one.

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The new program, recently approved by the national Accreditation Council for Graduate Medical Education, should help reduce the shortage, though it will take a few years. The program will accept a class of three residents per year, and the training takes four years, Sen said.

The costs of the program are being shared by Palmetto Health, the Veterans Administration and the USC School of Medicine. Residents will do clinical work at both Palmetto Health and the Dorn VA Hospital under a team of 12 physician instructors. The first class will begin in July 2013, Sen said.

The state already has one neurology residency program at the Medical University of South Carolina in Charleston. MUSCs program traditionally has a class of four or five new residents each year.

The number of medical school students in the state has increased slightly in recent years and will see a big jump this year with the addition of a four-year program starting at the University of South Carolina School of Medicine in Greenville. The Greenville schools first class will have 50 students, and school leaders hope to grow to 100 new students each year. The USC School of Medicine in Columbia enrolls about 100 each year, and MUSC takes in a class of about 170.

But the number of residency programs, which provide clinical training after med school, hasnt increased in the state much in the past few years. That means more medical students from state schools have to go outside the state for training, and those doctors are less likely to return to the state, health experts say.

Palmetto Health and USC School of Medicine already have residency programs in dentistry, emergency medicine, family medicine, internal medicine, pediatrics, obstetrics and gynecology, orthopedic surgery, general psychiatry, child and adolescent psychiatry and surgery.

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Neurology residency program to meet stroke treatment needs