AMNews: March 7, 2005. Minding the gender gap: The divergence between men's and women's health research ... American Medical NewsBy Susan J. Landers, AMNews staff. March 7, 2005.
Vive la difference!
Science is pointing out new ways to celebrate differences -- specifically those between the sexes -- and recognize that these differences go far beyond the reproductive system to permeate every part of the body. Researchers think that understanding those variations could result in changes in the way all sorts of diseases are diagnosed and treated
Monday, February 28, 2005
Wednesday, February 23, 2005
Sunday, February 20, 2005
Tuesday, February 15, 2005
COX-2 Inhibitors — Lessons in Drug Safety
Bruce M. Psaty, M.D., Ph.D., and Curt D. Furberg, M.D., Ph.D.
After millions of Americans have used COX-2inhibitors, which were intended to avert the gastrointestinal complications common to other nonsteroidal
antiinflammatory drugs (NSAIDs), serious adverse cardiovascular events have now been reported for three members of the class. Physicians are dismayed, pharmaceutical companies are embarrassed and financially threatened, and patients are injured. Indeed, the integrity of the American drug-safety system has been questioned. How did such problems arise, and how can they be prevented in the future?
Monday, February 14, 2005
Association of weight change with ethnicity and life course socioeconomic position among Brazilian civil servants
IJE vol.33 no.1 © International Epidemiological Association 2004; all rights reserved. International Journal of Epidemiology 2004;33:100–106
Dóra Chor, Eduardo Faerstein, George A Kaplan, John W Lynch4 and Claudia S Lopes
Background Adult weight gain is generally associated with ethnicity of African descent, in addition to low socioeconomic position (SEP), but little information is available from the African diaspora in less-developed countries. We evaluated ethnic differences in adult weight change and the role of life course SEP in those differences.
Methods We conducted a cross-sectional analysis of baseline data (1999–2001) from 2594 non-faculty civil servants working at university campuses in Rio de Janeiro (Brazil) and participating in the longitudinal Pró-Saúde Study. Weight and height were measured at study entry whereas ethnicity, markers of SEP, and weight at age 20 were assessed through self-administered questionnaire.
Results Black and mulatto women gained, respectively, an excess of 1.6 kg and 1.2 kg per 10 years of adult life, compared with whites. After adjustment for markers of participants’ early and later-life SEP, the estimates of excess weight gain for black and mulatto women decreased by about one-third, but a statistically significant estimate was still observed for black women. Among men, neither unadjusted nor adjusted ethnic gradients in weight gain were relevant.
Conclusions Only among women, black and mulatto ethnicity was associated with increased weight gain, which was partially explained through the association with their lower SEP.
Dóra Chor, Eduardo Faerstein, George A Kaplan, John W Lynch4 and Claudia S Lopes
Background Adult weight gain is generally associated with ethnicity of African descent, in addition to low socioeconomic position (SEP), but little information is available from the African diaspora in less-developed countries. We evaluated ethnic differences in adult weight change and the role of life course SEP in those differences.
Methods We conducted a cross-sectional analysis of baseline data (1999–2001) from 2594 non-faculty civil servants working at university campuses in Rio de Janeiro (Brazil) and participating in the longitudinal Pró-Saúde Study. Weight and height were measured at study entry whereas ethnicity, markers of SEP, and weight at age 20 were assessed through self-administered questionnaire.
Results Black and mulatto women gained, respectively, an excess of 1.6 kg and 1.2 kg per 10 years of adult life, compared with whites. After adjustment for markers of participants’ early and later-life SEP, the estimates of excess weight gain for black and mulatto women decreased by about one-third, but a statistically significant estimate was still observed for black women. Among men, neither unadjusted nor adjusted ethnic gradients in weight gain were relevant.
Conclusions Only among women, black and mulatto ethnicity was associated with increased weight gain, which was partially explained through the association with their lower SEP.
[2234 - AMICOR - 14/FEV/2004] AMICOR; SMOKE; PRESERVE
Caros AMICOR,
Conforme anunciado, estou enviando mensagem cumulativa (com menor frequência) com os títulos publicados em cada um dos Blog AMICOR, tentando respeitar um pouco de especificidade no material selecionado. Novas referências estarão sendo acrescentadas na medida em que forem sendo encontradas. Assim quando tiverem oportunidade podem visitar os endereços de seu interesse, independentemente de mensagem de alerta.
Dear AMICOR,
As previous announced, this message is cumulative (less frequent)with the titles published in each Blog AMICOR, trying to follow a little bit the specificity of the selected material. New references will be added as they will be found. So, when you have an opportunity you are invited to visit the addresses of you address, independently of the alert message.
http://amicor.blogspot.com
http://amicorsmoke.blogspot.com
http://amicor_preserve.blogspot.com
Conforme anunciado, estou enviando mensagem cumulativa (com menor frequência) com os títulos publicados em cada um dos Blog AMICOR, tentando respeitar um pouco de especificidade no material selecionado. Novas referências estarão sendo acrescentadas na medida em que forem sendo encontradas. Assim quando tiverem oportunidade podem visitar os endereços de seu interesse, independentemente de mensagem de alerta.
Dear AMICOR,
As previous announced, this message is cumulative (less frequent)with the titles published in each Blog AMICOR, trying to follow a little bit the specificity of the selected material. New references will be added as they will be found. So, when you have an opportunity you are invited to visit the addresses of you address, independently of the alert message.
http://amicor.blogspot.com
2/13/2005 Nefazodona ( SERZONE, Bristol Meyers Squibb)
Retirado do mercado Americano
02/12/2005 Introduction to Evidence-Based Medicine
02/10/2005 El Corazón de las Mujeres
02/07/2005 Recommendations for Blood Pressure Measurement in
Humans and Experimental Animals: Part 1: Blood Pressure
Measurement in Humans
02/07/2005 Role of Noninvasive Testing in the Clinical Evaluation of
Women With Suspected Coronary Artery Disease
02/07/2005 Periodontal Microbiota and Carotid Intima-Media Thickness:
The Oral Infections and Vascular Disease Epidemiology Study (INVEST)
02/07/2005 ICML 9 - Commitment to Equity
02/06/2005 Global Chronic Diseases
02/06/2005 CMPR - Collège de Médecine de Premier Recours
02/05/2005 ELEIÇÕES: PRESIDÊNCIA DA SBC
http://amicorsmoke.blogspot.com
2/14/2005 Never too old to quit: You can help the elderly stop smoking
02/04/2005 Mortality associated with passive smoking in Hong Kong
02/04/2005 Environmental tobacco smoke and risk of respiratory cancer
and chronic obstructive pulmonary disease in former smokers
and never smokers.
02/04/2005 Smoke: A Global History of Smoking
http://amicor_preserve.blogspot.com
02/08/2005 Forum Social - Democracia Brasileira
02/08/2005 Welcome to IHSUMMIT.com
02/06/2005 Global Chronic Diseases
02/05/2005 CataList, the official catalog of LISTSERV lists
02/04/2005 Alcohol and public health
02/04/2005 GEO Data Portal - The Online Environmental Database:
UNEP.Net, the Environment Network
02/04/2005 Mechanisms of Hair Graying
Sunday, February 13, 2005
Nefazodona ( SERZONE, Bristol Meyers Squibb) Retirado do mercado Americano
Nefazodona ( SERZONE, Bristol Meyers Squibb)
No dia 19 de maio de 2004 o laboratório BRISTOL MEYERS SQUIBB dos Estados Unidos anunciou que iria interromper as vendas do antidepressivo nefazodona, comercializado com o nome de fantasia SERZONE. O medicamento foi removido do mercado de todos os demais países exceto os Estados Unidos. Em 8 de janeiro de 2003 o medicamento foi retirado do mercado Europeu (todos os países) pois seu uso foi associado a 26 mortes devido lesão hepática. Isto seguiu-se a uma advertência (Black Box Warning) da FDA EM 2001.
Em dezembro de 2001 a FDA notificou o Laboratório Bristol-Meyers Squibb que deveria incluir uma ADVERTÊNCIA EM DESTAQUE COM TARJA PRETA na bula do produto antidepressivo SERZONE alertando os pacientes que embora raramente havia a possibilidade ocorrer uma insuficiência hepática com risco de vida no uso do medicamento. Este tipo de advertência é a forma mais séria e grave utilizada pela FDA NOS Estados Unidos.
A designação usada pela FDA ( Black-Box ) refere-se a um linha preta em destaque no topo do rótulo e no livro “Physicians' Desk Reference!, uma indicação recomendada apenas para os mais graves efeitos indesejáveis de medicamentos. A FDA mandou uma notícia para a Bristol-Meyers alertar a classe médica através de correspondência sobre o risco dos pacientes apresentarem grave insuficiência hepática ou necessitar de um transplante hepático.
O SERZONE é um antidepressivo comercializado pelo Laboratório Bristol-Meyers Squibb; o nome genérico para o SERZONE é nefazodona, cloridrato. O medicamento foi aprovado pela FDA nos Estados Unidos para uso no tratamento da depressão em 1994. O SERZONE é um antidepressivo heterocíclico em uma classe única em termos de estrutura e composição (triazolona substituída) e apresenta algumas características comuns com outros inibidores seletivos da recaptação da serotonina (ISRS) como fluoxetina (PROZAC), paroxetina (aropax) e sertralina (ZOLOFT). A nefazodona tornou-se popular entre médicos e pacientes por ser um dos únicos antidepressores que é desprovido de capacidade inibitória sobre a libido e a função sexual.
ATENÇÃO :
No Brasil o produto ainda é comercializado com registro renovado através da RESOLUÇÃO - RDC N° 280, DE 22 DE NOVEMBRO DE 2004.
Caro DR. AAchutti e colegas do AMICOR,
Remédios que são desenvolvidos pela indústria farmacêutica são sempre aceitos como seguros e eficazes. Mas isto nem sempre é verdade. Estima-se que anualmente em torno de 200.000 americanos morrem devido reações alérgicas e efeitos tóxicos de medicamentos prescritos pela classe médica (FDA, USA – www.fda.gov). Na realidade, acredita-se que morrem mais americanos devido prescrições médicas (alergia, interações, intoxicações) do que devido o uso de drogas ilícitas. Adicionalmente milhares de americanos apresentam problemas graves de saúde ou mesmo morrem devido a automedicação através do abuso de remédios vendidos sem prescrição médica.
Darcy Roberto Lima
No dia 19 de maio de 2004 o laboratório BRISTOL MEYERS SQUIBB dos Estados Unidos anunciou que iria interromper as vendas do antidepressivo nefazodona, comercializado com o nome de fantasia SERZONE. O medicamento foi removido do mercado de todos os demais países exceto os Estados Unidos. Em 8 de janeiro de 2003 o medicamento foi retirado do mercado Europeu (todos os países) pois seu uso foi associado a 26 mortes devido lesão hepática. Isto seguiu-se a uma advertência (Black Box Warning) da FDA EM 2001.
Em dezembro de 2001 a FDA notificou o Laboratório Bristol-Meyers Squibb que deveria incluir uma ADVERTÊNCIA EM DESTAQUE COM TARJA PRETA na bula do produto antidepressivo SERZONE alertando os pacientes que embora raramente havia a possibilidade ocorrer uma insuficiência hepática com risco de vida no uso do medicamento. Este tipo de advertência é a forma mais séria e grave utilizada pela FDA NOS Estados Unidos.
A designação usada pela FDA ( Black-Box ) refere-se a um linha preta em destaque no topo do rótulo e no livro “Physicians' Desk Reference!, uma indicação recomendada apenas para os mais graves efeitos indesejáveis de medicamentos. A FDA mandou uma notícia para a Bristol-Meyers alertar a classe médica através de correspondência sobre o risco dos pacientes apresentarem grave insuficiência hepática ou necessitar de um transplante hepático.
O SERZONE é um antidepressivo comercializado pelo Laboratório Bristol-Meyers Squibb; o nome genérico para o SERZONE é nefazodona, cloridrato. O medicamento foi aprovado pela FDA nos Estados Unidos para uso no tratamento da depressão em 1994. O SERZONE é um antidepressivo heterocíclico em uma classe única em termos de estrutura e composição (triazolona substituída) e apresenta algumas características comuns com outros inibidores seletivos da recaptação da serotonina (ISRS) como fluoxetina (PROZAC), paroxetina (aropax) e sertralina (ZOLOFT). A nefazodona tornou-se popular entre médicos e pacientes por ser um dos únicos antidepressores que é desprovido de capacidade inibitória sobre a libido e a função sexual.
ATENÇÃO :
No Brasil o produto ainda é comercializado com registro renovado através da RESOLUÇÃO - RDC N° 280, DE 22 DE NOVEMBRO DE 2004.
Saturday, February 12, 2005
Introduction to Evidence-Based Medicine
Introduction to Evidence-Based Medicine
This tutorial is intended for any health care practitioner or student who needs a basic introduction to the principles of Evidence-Based Medicine.
Upon completion of this self-paced tutorial, you will be able to:
*define Evidence-Based Medicine (EBM)
*identify the parts of a well-built clinical question
*identify EBM searching strategies that could improve MEDLINE retrieval
*identify key issues that help determine the validity of the results of a study
This tutorial is intended for any health care practitioner or student who needs a basic introduction to the principles of Evidence-Based Medicine.
Upon completion of this self-paced tutorial, you will be able to:
*define Evidence-Based Medicine (EBM)
*identify the parts of a well-built clinical question
*identify EBM searching strategies that could improve MEDLINE retrieval
*identify key issues that help determine the validity of the results of a study
Thursday, February 10, 2005
El Corazón de las Mujeres
(Contribucion del AMICOR Alejando Wajner)reina630ahw@yahoo.com.ar
El numero de febrero de Circulation está dedicado a trabajos sobre el Corazón de las mujeres.
Hay un estudio muy interesante sobre Fallo Ventricular Izquierdo transitorio y reversible en situaciones de stress o angustia y desesperación.
Creo que es uno de los pocos que trata con recursos positivistas de mostrar que ciertas mujeres sufren y lastiman su corazón y que esto es un proceso dinámico y reversible.
Les dejo algunas ideas sobre el tema:
El problema no es el rompecabezas biológico sino el pensamiento científico atrapado por la simplificación, el reduccionismo y la soberbia.
Debemos utilizar otra epistemología( conocimiento) para una hermeneutica (interpretación) clínica antropológica.
Incorporar la complejidad de la vida: la sociedad, la historia y su organización.
"Los genes son pequeñas sociedades con historia y dinamismo".
Las mujeres sufren de otra manera que los hombres.
Suelen ser sensibles y estructuradas por las condiciones económico-
políticas y culturales históricas.
Han sido oprimidas durante siglos por el poder masculino: desempeñado el trabajo en la casa con la crianza de los niños y usados sus cuerpos para procurar placer a su dominador.
Hace poco que intentan emanciparse de la explotación masculina.
Y el capitalismo avanzado las utiliza como fuerza productiva barata y accesible.
Las japonesas hacen miocardiopatías reversibles.
Culturalmente sufren años de poder fálico y explotación por los hombres.
Vasoespasmo y procesos inflamatorios dinámicos va descubriendo la biología molecular y la tecnología de imágenes, pero no es interpretado complejamente por la actual Medicina asociada al capitalismo avanzado y al primer Mundo.
¿Que hombre conoce bien a una mujer?
Pocos en la historia y en la literatura y en el arte.
Imaginen en la ciencia: manejada por hombres con rigidez de pensamiento.
Juan Carlos Kasky hace años que trabaja con Sindrome X y recibe en su mayoría mujeres...que ningún colega sabe manejar ni aconsejar.
Para incrementar nuestro conocimiento debemos ampliarlo con elementos de la
antropología, la sociología, el psicoanalisis y las escuelas de filosofía críticas.
Tener un pensamiento complejo para encontrar en la Medicina la vida que desconocemos, ocultamos y tememos.
Un abrazo y espero una jugosa discusión
Dr.Ale Wajner
Buenos Aires, Argentina
------------
Resumen del trabajo
Acute and Reversible Cardiomyopathy Provoked by Stress in Women From the United States
Scott W. Sharkey, MD; John R. Lesser, MD; Andrey G. Zenovich, MSc; Martin S.
Maron, MD; Jana Lindberg, RT; Terrence F. Longe, MD; Barry J. Maron, MD
Background-A clinical entity characterized by acute but rapidly reversible left ventricular (LV) systolic dysfunction and triggered by psychological stress is emerging, with reports largely confined to Japan.
Methods and Results-Over a 32-month period, 22 consecutive patients with this novel cardiomyopathy were prospectively identified within a community-based practice in the Minneapolis-St. Paul, Minn, area. All patients were women aged 32 to 89 years old (mean 6513 years); 21 (96%) were 50 years of age. The syndrome is haracterized by (1) acute substernal chest pain with ST-segment elevation and/or T-wave inversion; (2) absence of significant coronary arterial narrowing by angiography; 3) systolic dysfunction (ejection fraction 299%), with abnormal wall motion of the mid and distal LV, ie, "apical ballooning"; and (4) profound psychological stress (eg, death of relatives, domestic buse, arguments, catastrophic medical diagnoses, devastating financial or gambling losses) immediately preceding and triggering the cardiac events. A significant proportion of patients (37%) had hemodynamic compromise and required vasopressor agents and intra-aortic balloon counterpulsation.
Each patient survived with normalized ejection fraction (636%; P0.001) and rapid restoration to previous functional cardiovascular status within 63 days.
In 95%, MRI identified diffusely distributed segmental wall-motion abnormalities that encompassed LV myocardium in multiple coronary arterial vascular territories.
Conclusions-A reversible cardiomyopathy triggered by psychologically stressful events occurs in older women and may mimic evolving acute myocardial infarction or coronary syndrome. This condition is characterized by a distinctive form of systolic dysfunction that predominantly affects the distal LV chamber and a favorable outcome with appropriate medical therapy. (Circulation. 2005;111:472-479.)
Acute and rapidly reversible left ventricular (LV) dysfunction triggered by profound psychological stress is a recently recognized clinical scenario. Prior reports have
largely been confined to Japanese patients, which raises the possibility of a geographically restricted cardiovascular syndrome.
1-6 This clinical entity is of substantial general medical interest owing to its presentation, which mimics myocardial infarction and acute coronary syndrome, potentially unfavorable consequences, and a high likelihood of survival with
appropriate medical therapy. Therefore, it is timely to report the present sizable and prospectively assembled patient cohort from the United States that demonstrates the clinical profile of this cardiomyopathy.
El numero de febrero de Circulation está dedicado a trabajos sobre el Corazón de las mujeres.
Hay un estudio muy interesante sobre Fallo Ventricular Izquierdo transitorio y reversible en situaciones de stress o angustia y desesperación.
Creo que es uno de los pocos que trata con recursos positivistas de mostrar que ciertas mujeres sufren y lastiman su corazón y que esto es un proceso dinámico y reversible.
Les dejo algunas ideas sobre el tema:
El problema no es el rompecabezas biológico sino el pensamiento científico atrapado por la simplificación, el reduccionismo y la soberbia.
Debemos utilizar otra epistemología( conocimiento) para una hermeneutica (interpretación) clínica antropológica.
Incorporar la complejidad de la vida: la sociedad, la historia y su organización.
"Los genes son pequeñas sociedades con historia y dinamismo".
Las mujeres sufren de otra manera que los hombres.
Suelen ser sensibles y estructuradas por las condiciones económico-
políticas y culturales históricas.
Han sido oprimidas durante siglos por el poder masculino: desempeñado el trabajo en la casa con la crianza de los niños y usados sus cuerpos para procurar placer a su dominador.
Hace poco que intentan emanciparse de la explotación masculina.
Y el capitalismo avanzado las utiliza como fuerza productiva barata y accesible.
Las japonesas hacen miocardiopatías reversibles.
Culturalmente sufren años de poder fálico y explotación por los hombres.
Vasoespasmo y procesos inflamatorios dinámicos va descubriendo la biología molecular y la tecnología de imágenes, pero no es interpretado complejamente por la actual Medicina asociada al capitalismo avanzado y al primer Mundo.
¿Que hombre conoce bien a una mujer?
Pocos en la historia y en la literatura y en el arte.
Imaginen en la ciencia: manejada por hombres con rigidez de pensamiento.
Juan Carlos Kasky hace años que trabaja con Sindrome X y recibe en su mayoría mujeres...que ningún colega sabe manejar ni aconsejar.
Para incrementar nuestro conocimiento debemos ampliarlo con elementos de la
antropología, la sociología, el psicoanalisis y las escuelas de filosofía críticas.
Tener un pensamiento complejo para encontrar en la Medicina la vida que desconocemos, ocultamos y tememos.
Un abrazo y espero una jugosa discusión
Dr.Ale Wajner
Buenos Aires, Argentina
------------
Resumen del trabajo
Acute and Reversible Cardiomyopathy Provoked by Stress in Women From the United States
Scott W. Sharkey, MD; John R. Lesser, MD; Andrey G. Zenovich, MSc; Martin S.
Maron, MD; Jana Lindberg, RT; Terrence F. Longe, MD; Barry J. Maron, MD
Background-A clinical entity characterized by acute but rapidly reversible left ventricular (LV) systolic dysfunction and triggered by psychological stress is emerging, with reports largely confined to Japan.
Methods and Results-Over a 32-month period, 22 consecutive patients with this novel cardiomyopathy were prospectively identified within a community-based practice in the Minneapolis-St. Paul, Minn, area. All patients were women aged 32 to 89 years old (mean 6513 years); 21 (96%) were 50 years of age. The syndrome is haracterized by (1) acute substernal chest pain with ST-segment elevation and/or T-wave inversion; (2) absence of significant coronary arterial narrowing by angiography; 3) systolic dysfunction (ejection fraction 299%), with abnormal wall motion of the mid and distal LV, ie, "apical ballooning"; and (4) profound psychological stress (eg, death of relatives, domestic buse, arguments, catastrophic medical diagnoses, devastating financial or gambling losses) immediately preceding and triggering the cardiac events. A significant proportion of patients (37%) had hemodynamic compromise and required vasopressor agents and intra-aortic balloon counterpulsation.
Each patient survived with normalized ejection fraction (636%; P0.001) and rapid restoration to previous functional cardiovascular status within 63 days.
In 95%, MRI identified diffusely distributed segmental wall-motion abnormalities that encompassed LV myocardium in multiple coronary arterial vascular territories.
Conclusions-A reversible cardiomyopathy triggered by psychologically stressful events occurs in older women and may mimic evolving acute myocardial infarction or coronary syndrome. This condition is characterized by a distinctive form of systolic dysfunction that predominantly affects the distal LV chamber and a favorable outcome with appropriate medical therapy. (Circulation. 2005;111:472-479.)
Acute and rapidly reversible left ventricular (LV) dysfunction triggered by profound psychological stress is a recently recognized clinical scenario. Prior reports have
largely been confined to Japanese patients, which raises the possibility of a geographically restricted cardiovascular syndrome.
1-6 This clinical entity is of substantial general medical interest owing to its presentation, which mimics myocardial infarction and acute coronary syndrome, potentially unfavorable consequences, and a high likelihood of survival with
appropriate medical therapy. Therefore, it is timely to report the present sizable and prospectively assembled patient cohort from the United States that demonstrates the clinical profile of this cardiomyopathy.
Monday, February 07, 2005
ICML 9 - Commitment to Equity
Contributed Paper & Poster session - ICML 9 - Commitment to Equity
Salvador Welcomes ICML9 in Salvador in 2005
The Latin American and Caribbean Center on Health Sciences Information – BIREME/PAHO/WHO and IFLA Section of Biological and Medical Sciences Libraries invite you to participate in the 9th International Congress on Medical Librarianship, to be held in September 2005 in the city of Salvador, state of Bahia, Brazil.
Celebrating the presence of the ICML in the country for the first time it will incorporate a number of regional and national meetings, including the 7th Latin American and Caribbean Congress on Health Sciences Information, CRICS VII. The ICML9 will promote the opportunity to discuss the Commitment to Equity, the Congress theme, focusing on the understanding that knowledge should permeate all action in human health. The scientific program is being distributed in plenary sessions, contributed papers and poster sections.
Salvador Welcomes ICML9 in Salvador in 2005
The Latin American and Caribbean Center on Health Sciences Information – BIREME/PAHO/WHO and IFLA Section of Biological and Medical Sciences Libraries invite you to participate in the 9th International Congress on Medical Librarianship, to be held in September 2005 in the city of Salvador, state of Bahia, Brazil.
Celebrating the presence of the ICML in the country for the first time it will incorporate a number of regional and national meetings, including the 7th Latin American and Caribbean Congress on Health Sciences Information, CRICS VII. The ICML9 will promote the opportunity to discuss the Commitment to Equity, the Congress theme, focusing on the understanding that knowledge should permeate all action in human health. The scientific program is being distributed in plenary sessions, contributed papers and poster sections.
Sunday, February 06, 2005
Global Chronic Diseases
Derek Yach, Stephen R. Leeder, John Bell, Barry Kistnasamy
Chronic diseases, particularly cardiovascular disease (CVD), type 2 diabetes, cancer, and respiratory disease, account for more than 50% of all deaths worldwide. Tobacco use, poor diet, and physical inactivity are among the major risk factors contributing to this disease burden. Yet even as the harmful impact of these diseases on health and economies strengthens and spreads globally, there is still only limited public health, financial, and political support for programs aimed at their prevention.
One reason for this neglect has been the belief by governments and philanthropists that chronic diseases are afflictions of affluent populations who have led a life of sloth. In reality, these diseases are now global problems that have been driven by profound changes in consumption patterns.
Ubiquitous marketing of tobacco and unhealthy food introduces children to (and in the case of tobacco, addicts them to) lifestyles that greatly elevate their disease risk. Rapid changes in transport, work, and leisure activities have led to a global collapse in physical activity levels. Overall, unhealthy choices have become the easy choices.....
One of the authors (Stephen Leeder) coordinates an international research on Economic Impact of CVD in Developing Countries, where Mario Maranhao, Maria Ines Reinert Azambuja and AA, are working on the segment of Brazil.
CMPR - Collège de Médecine de Premier Recours
CMPR - Collège de Médecine de Premier Recours:
(apud Ueli Grueninger)
"Dès 2005, les deux groupes de travail 'Recherche' de la SSMG et du CMPR vont réunir leurs forces, leurs idées et leurs moyens pour constituer un nouveau groupe 'Recherche en médecine de premier recours'. On attend de cette fusion une efficacité et une continuité améliorée quant aux études portant sur la médecine de premier recours et, par là même, une valorisation du travail du médecin de famille. "
...............
(apud Ueli Grueninger)
"Dès 2005, les deux groupes de travail 'Recherche' de la SSMG et du CMPR vont réunir leurs forces, leurs idées et leurs moyens pour constituer un nouveau groupe 'Recherche en médecine de premier recours'. On attend de cette fusion une efficacité et une continuité améliorée quant aux études portant sur la médecine de premier recours et, par là même, une valorisation du travail du médecin de famille. "
...............
Saturday, February 05, 2005
ELEIÇÕES: PRESIDÊNCIA DA SBC
Candidadura Celso Amodeo
Mensagem recebida do AMICOR Celso Amodeo que é candidato à presidência de nossa Sociedade:
Estou lhe escrevendo para saber da possibilidade de ser divulgado no site AMICOR a inauguração do meu site www.celsoamodeo.med.br. Lá eu apresento a programação de aulas da minha seção de hipertensão arterial do Dante Pazzanese para o primeiro semestre em todo o Brasil e também falo das minhas propostas como candidato às eleições da SBC para 2008/09.
Se houver essa possibilidade eu lhe agradeço muito e espero contar com o apoio dos colegas do Rio Grande do Sul nesta nossa empreitada.
A primeira fase das eleições começa em 15de fevereiro de 2005
Atenciosamente
Celso Amodeo
camodeo@terra.com.br
www.celsoamodeo.med.br
Em tempo: Como eleições para a direção de nossa sociedade é um assunto de interesse de nosso desenvolvimento associativo, este espaço fica a disposição para alertar também para outras candidaturas, se solicitado.
Mensagem recebida do AMICOR Celso Amodeo que é candidato à presidência de nossa Sociedade:
Estou lhe escrevendo para saber da possibilidade de ser divulgado no site AMICOR a inauguração do meu site www.celsoamodeo.med.br. Lá eu apresento a programação de aulas da minha seção de hipertensão arterial do Dante Pazzanese para o primeiro semestre em todo o Brasil e também falo das minhas propostas como candidato às eleições da SBC para 2008/09.
Se houver essa possibilidade eu lhe agradeço muito e espero contar com o apoio dos colegas do Rio Grande do Sul nesta nossa empreitada.
A primeira fase das eleições começa em 15de fevereiro de 2005
Atenciosamente
Celso Amodeo
camodeo@terra.com.br
www.celsoamodeo.med.br
Em tempo: Como eleições para a direção de nossa sociedade é um assunto de interesse de nosso desenvolvimento associativo, este espaço fica a disposição para alertar também para outras candidaturas, se solicitado.
[2233 - AMICOR - 05/02/2005]
We will follow using the Blog style and the alert messages just one or two times a week.
This Blog as well as the other AMICOR blogs (AMICOR Preserve, AMICOR Smoke, AMICOR Club, AMICOR CVD or AMICOR Medicine) may be visited at anytime while they will be receiving permanently new inputs from material found in the web or sent by friends.
Selections since the last AMICOR alert message:
*Illness And Injury As Contributors To Bankruptcy
*Hair loss and cardiovascular health
*Trial Scorecards in Today in Cardiology
*PREMISE: Secondary prevention of myocardial infarction and health-related quality of life
*Blacks in South at Greater Risk of Stroke Death
*Percutaneous Coronary Intervention and Adjunctive Pharmacotherapy in Women.
*Role of Noninvasive Testing in the Clinical Evaluation of Women With Suspected Coronary Artery Disease.
*Institute for Coffee Studies Home Page
*Women Missing Out on Heart Disease Diagnoses, Treatments
*First International Symposium on Arrhythmogenic Right Ventricular Dysplasia
*Cardiovascular Disease And Global Health: Threat And Opportunity
*Nonphysicians eager to pick up prescription pad
*Bush Offers High-Tech Health Care Prescription
Illness And Injury As Contributors To Bankruptcy
MarketWatch: Illness And Injury As Contributors To Bankruptcy -- Himmelstein et al., 10.1377/hlthaff.w5.63 -- Health Affairs
In 2001, 1.458 million American families filed for bankruptcy. To investigate medical contributors to bankruptcy, we surveyed 1,771 personal bankruptcy filers in five federal courts and subsequently completed in-depth interviews with 931 of them. About half cited medical causes, which indicates that 1.9–2.2 million Americans (filers plus dependents) experienced medical bankruptcy. Among those whose illnesses led to bankruptcy, out-of-pocket costs averaged $11,854 since the start of illness; 75.7 percent had insurance at the onset of illness. Medical debtors were 42 percent more likely than other debtors to experience lapses in coverage. Even middle-class insured families often fall prey to financial catastrophe when sick.
If the debtor be insolvent to serve creditors, let his body be cut in pieces on the third market day. It may be cut into more or fewer pieces with impunity. Or, if his creditors consent to it, let him be sold to foreigners beyond the Tiber.
—Twelve Tables, Table III, 6 (ca. 450 B.C.)
In 2001, 1.458 million American families filed for bankruptcy. To investigate medical contributors to bankruptcy, we surveyed 1,771 personal bankruptcy filers in five federal courts and subsequently completed in-depth interviews with 931 of them. About half cited medical causes, which indicates that 1.9–2.2 million Americans (filers plus dependents) experienced medical bankruptcy. Among those whose illnesses led to bankruptcy, out-of-pocket costs averaged $11,854 since the start of illness; 75.7 percent had insurance at the onset of illness. Medical debtors were 42 percent more likely than other debtors to experience lapses in coverage. Even middle-class insured families often fall prey to financial catastrophe when sick.
If the debtor be insolvent to serve creditors, let his body be cut in pieces on the third market day. It may be cut into more or fewer pieces with impunity. Or, if his creditors consent to it, let him be sold to foreigners beyond the Tiber.
—Twelve Tables, Table III, 6 (ca. 450 B.C.)
Hair loss and cardiovascular health
The Lancet
Yvo Smulders, Cees-Jan Oostwouder, Frank Stam
In August, 2003, a 39-year-old anesthestist went for a routine physical examination. He had minor non-specific abdominal complaints, which subsided spontaneously and he decided it would be a good idea to have a check-up. His medical history was unremarkable, apart from a congenital single kidney. He had noticed increased hair loss during the previous year. His family history was positive for hypercholesterolaemia (his mother had a total cholesterol of >8·0 mmol/L). Physical examination showed alopecia (figure 1, A) and hypertension (160/ 105 mm Hg), but no other abnormalities. Further tests were done which showed renal insufficiency (serum creatinine 160 mmol/L; urinary creatinine clearance 66 mL/min), and hypercholesterolaemia (total cholesterol 9·6 mmol/L; LDL cholesterol 7·2 mmol/L). Urine analysis showed no proteinuria and a normal urinary sediment. An electrocardiogram showed ST-segment elevation in the anteroseptal leads and negative T waves in the anterolateral leads (figure 2, A). The same day, he was seen by a cardiologist, who ordered tests for cardiac enzymes. Although total serum creatine phosphokinase was elevated (744 U/L), the creatine phosphokinase-MB isoenzyme fraction and troponin-T concentrations were within normal limits. He was then given the diagnoses of hypertension, familial hypercholesterolaemia, hypertensive renal disease of his single kidney, and chronic symptomless ischaemic heart disease. He was referred to our outpatient clinic for treatment, where he arrived in quite a bad mood.
Yvo Smulders, Cees-Jan Oostwouder, Frank Stam
In August, 2003, a 39-year-old anesthestist went for a routine physical examination. He had minor non-specific abdominal complaints, which subsided spontaneously and he decided it would be a good idea to have a check-up. His medical history was unremarkable, apart from a congenital single kidney. He had noticed increased hair loss during the previous year. His family history was positive for hypercholesterolaemia (his mother had a total cholesterol of >8·0 mmol/L). Physical examination showed alopecia (figure 1, A) and hypertension (160/ 105 mm Hg), but no other abnormalities. Further tests were done which showed renal insufficiency (serum creatinine 160 mmol/L; urinary creatinine clearance 66 mL/min), and hypercholesterolaemia (total cholesterol 9·6 mmol/L; LDL cholesterol 7·2 mmol/L). Urine analysis showed no proteinuria and a normal urinary sediment. An electrocardiogram showed ST-segment elevation in the anteroseptal leads and negative T waves in the anterolateral leads (figure 2, A). The same day, he was seen by a cardiologist, who ordered tests for cardiac enzymes. Although total serum creatine phosphokinase was elevated (744 U/L), the creatine phosphokinase-MB isoenzyme fraction and troponin-T concentrations were within normal limits. He was then given the diagnoses of hypertension, familial hypercholesterolaemia, hypertensive renal disease of his single kidney, and chronic symptomless ischaemic heart disease. He was referred to our outpatient clinic for treatment, where he arrived in quite a bad mood.
Friday, February 04, 2005
Trial Scorecards in Today in Cardiology
Today in Cardiology - Current News in Cardiovascular Disease: "Trial Scorecards
Many of the clinical trial results reported in Today in Cardiology are summarized in scorecards, with the most important information presented in easy-to-read format.
All of the scorecards that have appeared in our print edition can be accessed here.
Hyperlinks for the scorecards are provided."
Many of the clinical trial results reported in Today in Cardiology are summarized in scorecards, with the most important information presented in easy-to-read format.
All of the scorecards that have appeared in our print edition can be accessed here.
Hyperlinks for the scorecards are provided."
PREMISE: Secondary prevention of myocardial infarction and health-related quality of life
Entrez PubMed
Substantial evidence from randomized controlled trials reveals that pharmacological interventions in people with established ischemic coronary events notably reduces the risk of cardiovascular mortality and morbidity. The objective of this study was to assess potential control level of modifiable risk factors as well as of prophylactic treatment and quality of life in patients with a first myocardial infarction. METHOD: Prospective, 2-years follow-up study, carried out in 4 public hospitals and in their corresponding primary care centers in Catalonia. RESULTS: We included 618 patients (76% males) with a mean age of 64 years. Patients were mostly followed up by both general practitioners and cardiologists. Prevalence of risk factors was as follows: 54% patients had hypercholesterolemia, 41% were hypertensive, 11% smokers, 76% had overweight and 19% were obese. With regard to the prophylactic treatment, lipid lowering drugs were prescribed in 52% of patients, beta-blockers in 50%, antiplatelet drugs in 87%, ACE inhibitors in 32%, nitrates in 52%, calcium antagonists in 31% and oral anticoagulants in 8% of patients. Mean scores of the quality of life questionnaire were 5.34, 5.42 and 5.63 for emotional role, physical role and social role, respectively; the subgroup of patients who were hospitalized during the follow up had worse scores. CONCLUSIONS: There is still a considerable potential to gain in the secondary prevention of myocardial infarction with regard to the prophylactic treatment and the control of risk factors. Health-related quality of life in patients, two years after the first myocardial infarction, is fairly good, although differences between subgroups are observed.
Substantial evidence from randomized controlled trials reveals that pharmacological interventions in people with established ischemic coronary events notably reduces the risk of cardiovascular mortality and morbidity. The objective of this study was to assess potential control level of modifiable risk factors as well as of prophylactic treatment and quality of life in patients with a first myocardial infarction. METHOD: Prospective, 2-years follow-up study, carried out in 4 public hospitals and in their corresponding primary care centers in Catalonia. RESULTS: We included 618 patients (76% males) with a mean age of 64 years. Patients were mostly followed up by both general practitioners and cardiologists. Prevalence of risk factors was as follows: 54% patients had hypercholesterolemia, 41% were hypertensive, 11% smokers, 76% had overweight and 19% were obese. With regard to the prophylactic treatment, lipid lowering drugs were prescribed in 52% of patients, beta-blockers in 50%, antiplatelet drugs in 87%, ACE inhibitors in 32%, nitrates in 52%, calcium antagonists in 31% and oral anticoagulants in 8% of patients. Mean scores of the quality of life questionnaire were 5.34, 5.42 and 5.63 for emotional role, physical role and social role, respectively; the subgroup of patients who were hospitalized during the follow up had worse scores. CONCLUSIONS: There is still a considerable potential to gain in the secondary prevention of myocardial infarction with regard to the prophylactic treatment and the control of risk factors. Health-related quality of life in patients, two years after the first myocardial infarction, is fairly good, although differences between subgroups are observed.
Blacks in South at Greater Risk of Stroke Death
ABC News: Blacks in South at Greater Risk of Stroke Death: "Blacks in South at Greater Risk of Stroke Death
Reuters
Feb. 2, 2005 - By Martha Kerr (reference from Mario Maranhão)NEW ORLEANS (Reuters Health) - Compared with African Americans living in other regions of the United States, those in the south have a higher risk of death from stroke -- compounding their overall increased risk of stroke death compared with other ethnic groups.
Dr. George Howard of the University of Alabama at Birmingham presented his findings Wednesday at the American Stroke Association's International Stroke Conference 2005 that is underway here.
Howard and his colleagues at Birmingham and at the Centers for Disease Control and Prevention in Atlanta collected information on stroke deaths from state databases from 1997 through 2001.
They found the greatest differences in death according to race occurred in those 45 to 64 years old. Differences diminished with age until 85 years, when there was no racial difference."
Reuters
Feb. 2, 2005 - By Martha Kerr (reference from Mario Maranhão)NEW ORLEANS (Reuters Health) - Compared with African Americans living in other regions of the United States, those in the south have a higher risk of death from stroke -- compounding their overall increased risk of stroke death compared with other ethnic groups.
Dr. George Howard of the University of Alabama at Birmingham presented his findings Wednesday at the American Stroke Association's International Stroke Conference 2005 that is underway here.
Howard and his colleagues at Birmingham and at the Centers for Disease Control and Prevention in Atlanta collected information on stroke deaths from state databases from 1997 through 2001.
They found the greatest differences in death according to race occurred in those 45 to 64 years old. Differences diminished with age until 85 years, when there was no racial difference."
Thursday, February 03, 2005
Percutaneous Coronary Intervention and Adjunctive Pharmacotherapy in Women.
Percutaneous Coronary Intervention and Adjunctive Pharmacotherapy in Women. A Statement for Healthcare Professionals From the American Heart Association -- Lansky et al., 10.1161/01.CIR.0000155337.50423.C9 -- Circulation: "Percutaneous Coronary Intervention and Adjunctive Pharmacotherapy in Women. A Statement for Healthcare Professionals From the American Heart Association
Alexandra J. Lansky MD, Chair, Judith S. Hochman MD, Patricia A. Ward MA, Gary S. Mintz MD, Rosalind Fabunmi PhD, Peter B. Berger MD, Gishel New MD, Cindy L. Grines MD, Cody G. Pietras , Morton J. Kern MD, Margaret Ferrell MD, Martin B. Leon MD, Roxana Mehran MD, Christopher White MD, Jennifer H. Mieres MD, Jeffrey W. Moses MD, Gregg W. Stone MD, and Alice K. Jacobs MD Abstract--More than 1.2 million percutaneous coronary interventions are performed annually in the United States, with only an estimated 33% performed in women, despite the established benefits of percutaneous coronary intervention and adjunctive pharmacotherapy in reducing fatal and nonfatal ischemic complications in acute myocardial infarction and high-risk acute coronary syndromes. This statement reviews sex-specific data on the safety and efficacy of contemporary interventional therapies in women."
Alexandra J. Lansky MD, Chair, Judith S. Hochman MD, Patricia A. Ward MA, Gary S. Mintz MD, Rosalind Fabunmi PhD, Peter B. Berger MD, Gishel New MD, Cindy L. Grines MD, Cody G. Pietras , Morton J. Kern MD, Margaret Ferrell MD, Martin B. Leon MD, Roxana Mehran MD, Christopher White MD, Jennifer H. Mieres MD, Jeffrey W. Moses MD, Gregg W. Stone MD, and Alice K. Jacobs MD Abstract--More than 1.2 million percutaneous coronary interventions are performed annually in the United States, with only an estimated 33% performed in women, despite the established benefits of percutaneous coronary intervention and adjunctive pharmacotherapy in reducing fatal and nonfatal ischemic complications in acute myocardial infarction and high-risk acute coronary syndromes. This statement reviews sex-specific data on the safety and efficacy of contemporary interventional therapies in women."
Role of Noninvasive Testing in the Clinical Evaluation of Women With Suspected Coronary Artery Disease.
Role of Noninvasive Testing in the Clinical Evaluation of Women With Suspected Coronary Artery Disease. Consensus Statement From the Cardiac Imaging Committee, Council on Clinical Cardiology, and the Cardiovascular Imaging and Intervention Committee: "Role of Noninvasive Testing in the Clinical Evaluation of Women With Suspected Coronary Artery Disease. Consensus Statement From the Cardiac Imaging Committee, Council on Clinical Cardiology, and the Cardiovascular Imaging and Intervention Committee, Council on Cardiovascular Radiology and Intervention, American Heart Association
Jennifer H. Mieres MD, Chair, Leslee J. Shaw PhD, Andrew Arai MD, Matthew J. Budoff MD, Scott D. Flamm MD, W. Gregory Hundley MD, Thomas H. Marwick MD, PhD, Lori Mosca MD, PhD, Ayan R. Patel MD, Miguel A. Quinones MD, Rita F. Redberg MD, MSc, Kathryn A. Taubert PhD, Allen J. Taylor MD, Gregory S. Thomas MD, MPH, and Nanette K. Wenger MD
Abstract--Cardiovascular disease is the leading cause of mortality for women in the United States. Coronary heart disease, which includes coronary atherosclerotic disease, myocardial infarction, acute coronary syndromes, and angina, is the largest subset of this mortality, with >240 000 women dying annually from the disease. Atherosclerotic coronary artery disease (CAD) is the focus of this consensus statement. Research continues to report underrecognition and underdiagnosis of CAD as contributory to high mortality rates in women. Timely and accurate diagnosis can significantly reduce CAD mortality for women; indeed, once the diagnosis is made, it does appear that current treatments are equally effective at reducing risk in both women and men. As such, noninvasive diagnostic and prognostic testing offers the potential to identify women at increased CAD risk as the basis for institu"
Jennifer H. Mieres MD, Chair, Leslee J. Shaw PhD, Andrew Arai MD, Matthew J. Budoff MD, Scott D. Flamm MD, W. Gregory Hundley MD, Thomas H. Marwick MD, PhD, Lori Mosca MD, PhD, Ayan R. Patel MD, Miguel A. Quinones MD, Rita F. Redberg MD, MSc, Kathryn A. Taubert PhD, Allen J. Taylor MD, Gregory S. Thomas MD, MPH, and Nanette K. Wenger MD
Abstract--Cardiovascular disease is the leading cause of mortality for women in the United States. Coronary heart disease, which includes coronary atherosclerotic disease, myocardial infarction, acute coronary syndromes, and angina, is the largest subset of this mortality, with >240 000 women dying annually from the disease. Atherosclerotic coronary artery disease (CAD) is the focus of this consensus statement. Research continues to report underrecognition and underdiagnosis of CAD as contributory to high mortality rates in women. Timely and accurate diagnosis can significantly reduce CAD mortality for women; indeed, once the diagnosis is made, it does appear that current treatments are equally effective at reducing risk in both women and men. As such, noninvasive diagnostic and prognostic testing offers the potential to identify women at increased CAD risk as the basis for institu"
Institute for Coffee Studies Home Page
Institute for Coffee Studies Home Page
(Reference from Darci Roberto Lima)
Caro Dr. AAchutti e colegas do AMICOR, envio em anexo arquivo pdf o primeiro exemplar da Carta Medica 1 da Unidade de Pesquisas Medicas do Cafe e Coração do INCOR e Fundação Zerbini ( Ver Expediente na pág 8) . Esperamos opinioes, sugestoes, contribuicoes e participacao dos colegas neste projeto de pesquisa inicialmente a nivel nacional . A proxima etapa sera a nivel mundial, com aprovação do Comite Cientifico da World Heart Federation, visando detectar o possivel papel preventivo do consumo de cafe em relação as grandes ameaças de 2020 segundo a OMS, 1) doença isquemica do coracao e 2 ) a depressão.
No futuro palestras e seminarios serao realizados em todo o Brasil , demais paises produtores e ricos paises consumidores, para apresentar o projeto aos colegas medicos.
Caso confirmada a hipotese do valor profilatico do cafe ( e sub-produtos como fitoterapicos, cafes medicinais, medicamentos de sintese ) contra estas patologias, mais o alcoolismo, o beneficio economico, social, politico e medico para o nosso Brasil sera inestimavel. Assim o que é bom para o Brasil será bom para todo mundo....
cordialmente
Darcy Lima ( em nome do Conselho Editorial)
www.cafeesaude.com.br
www.mc.vanderbilt.edu/coffee
www.incor.usp.br
www.worldheart.org
(Reference from Darci Roberto Lima)
Caro Dr. AAchutti e colegas do AMICOR, envio em anexo arquivo pdf o primeiro exemplar da Carta Medica 1 da Unidade de Pesquisas Medicas do Cafe e Coração do INCOR e Fundação Zerbini ( Ver Expediente na pág 8) . Esperamos opinioes, sugestoes, contribuicoes e participacao dos colegas neste projeto de pesquisa inicialmente a nivel nacional . A proxima etapa sera a nivel mundial, com aprovação do Comite Cientifico da World Heart Federation, visando detectar o possivel papel preventivo do consumo de cafe em relação as grandes ameaças de 2020 segundo a OMS, 1) doença isquemica do coracao e 2 ) a depressão.
No futuro palestras e seminarios serao realizados em todo o Brasil , demais paises produtores e ricos paises consumidores, para apresentar o projeto aos colegas medicos.
Caso confirmada a hipotese do valor profilatico do cafe ( e sub-produtos como fitoterapicos, cafes medicinais, medicamentos de sintese ) contra estas patologias, mais o alcoolismo, o beneficio economico, social, politico e medico para o nosso Brasil sera inestimavel. Assim o que é bom para o Brasil será bom para todo mundo....
cordialmente
Darcy Lima ( em nome do Conselho Editorial)
www.cafeesaude.com.br
www.mc.vanderbilt.edu/coffee
www.incor.usp.br
www.worldheart.org
Women Missing Out on Heart Disease Diagnoses, Treatments
ABC News: Women Missing Out on Heart Disease Diagnoses, Treatments: "TUESDAY, Feb. 1 (HealthDayNews) � Women often miss out on lifesaving diagnoses and treatments for heart disease, even though it kills them more often than any other illness.
That's the unequivocal message of several studies appearing in a themed issue of the journal Circulation, which is being released at a news conference Tuesday to coincide with the beginning of American Heart Month. Friday is National Wear Red Day, when the National Institutes of Health, the American Heart Association and others ask Americans to wear something red to show support for the fight against women's heart disease."
(Reference from Mário Maranhão)
That's the unequivocal message of several studies appearing in a themed issue of the journal Circulation, which is being released at a news conference Tuesday to coincide with the beginning of American Heart Month. Friday is National Wear Red Day, when the National Institutes of Health, the American Heart Association and others ask Americans to wear something red to show support for the fight against women's heart disease."
(Reference from Mário Maranhão)
First International Symposium on Arrhythmogenic Right Ventricular Dysplasia
First International Symposium on Arrhythmogenic Right Ventricular Dysplasia: "Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia
Julia H. Indik, MD PhD and Frank I. Marcus, MD
Sarver Heart Center, University of Arizona, Tucson AZ"
Julia H. Indik, MD PhD and Frank I. Marcus, MD
Sarver Heart Center, University of Arizona, Tucson AZ"
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