Appendicitis Could Be Detected with Urine Test

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By John Gever, Senior Editor, MedPage Today Published: June 23, 2009 Reviewed by Zalman S. Agus, MD; Emeritus Professor University of Pennsylvania School of Medicine and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

WHEELING, W.Va., June 23 -- Biomarkers in urine may reliably identify children with appendicitis, researchers said.

Action Points

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• Explain to interested patients that symptoms of appendicitis, especially in its early stages, resemble those of many other conditions.



• Note that up to 30% of appendectomies prove to be unnecessary and that 30% to 45% of appendicitis cases involve rupture before surgery is performed.



• Explain that the results of this study were obtained in a relatively small number of patients and need to be confirmed prospectively in a larger sample.



• Explain that the biomarkers identified in this study are investigational; no FDA approved test based on them is available.

In particular, leucine-rich alpha-2-glycoprotein (LRG) was both specific and sensitive as a marker of appendicitis in 67 children with suspected appendicitis, reported Richard Bachur, MD, of Children's Hospital in Boston, and colleagues online in Annals of Emergency Medicine.

The area under the receiver-operator characteristic curve for LRG was 0.97 (95% CI 0.93 to 1.0), indicating low proportions of both false negatives and false positives, the researchers found.

For example, at a sensitivity of 90%, the specificity was about 97%. With a different cutoff value for LRG concentration such that the specificity was 100%, the sensitivity was about 70%.

LRG was also highly concentrated in diseased appendices, the researchers found.

Wrote Dr. Bachur and colleagues, "LRG appears to be enriched in the urine of patients with appendicitis in the absence of macroscopic inflammatory changes."

They noted that the protein was markedly elevated in two patients with histologically confirmed acute appendicitis whose imaging findings were normal. /.../

Fatal CVD Risk Increases with Inflammation

By Charles Bankhead, Staff Writer, MedPage Today Published: June 23, 2009 Reviewed by Zalman S. Agus, MD; Emeritus Professor University of Pennsylvania School of Medicine and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

HOUSTON, June 23 -- In older patients at risk of vascular disease, biomarkers of inflammation can warn of an increased risk of fatal versus nonfatal clinical events, according to a multicenter European study.

Action Points

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• Explain to patients that levels of proteins associated with inflammation are associated with an increased risk of fatal versus nonfatal cardiovascular events.



• The findings were based on a retrospective review of data in an older population, not a prospective study.

In particular, elevated interleukin-6 (IL-6) and C-reactive protein (CRP) had strong associations with fatal events, Naveed Sattar, MD, PhD, of the University of Glasgow, Scotland, and colleagues reported online in PLoS Medicine.

The findings have implications for clinical management and for understanding the etiology of fatal cardiovascular disease, the authors concluded.

"Our key observation of a stronger link of inflammatory markers with fatal CVD compared with nonfatal CVD significantly extends suggestive (but inconclusive) observations from previous reports . . . of potentially stronger associations between inflammatory markers with CVD death," they said.

I have a dream...

Martin Luther King Speech.

Worth while to hear every again...

Text and video.

Optimal Therapy for Patients with H5N1 Influenza

What Is the Optimal Therapy for Patients with H5N1 Influenza?

• Article
• Related Content

Nicholas J. White^1*, Robert G. Webster^2*, Elena A. Govorkova², Timothy M. Uyeki^3*

1 Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand, 2Department of Infectious Diseases, Division of Virology, St. Jude Children's Research Hospital, Memphis, Tennessee, United States of America, 3Epidemiology and Prevention Branch, Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America

Background to the debate Top

In a 2007 article in PLoS Medicine [10], Holger J. Schünemann and colleagues described a new process used by the World Health Organization for rapidly developing clinical management guidelines in emergency situations. These situations include outbreaks of emerging infectious diseases. The authors discussed how they developed such a “rapid advice” guideline for the pharmacological management of avian influenza A (H5N1) virus infection. The guideline recommends giving the antiviral drug oseltamivir at a dose of 75 mg twice daily for five days. In this Debate, Nicholas White argues that such dosing is inadequate, Robert Webster and Elena Govorkova say that combination antiviral therapy should be used, and Tim Uyeki reminds us that clinical care of patients with H5N1 entails much more than antiviral treatment. These issues may also apply to therapy of patients hospitalized with severe disease due to novel swine-origin influenza A (H1N1) virus infection./.../

PovertyNet Newsletter : WB

PovertyNet Newsletter

In this issue:

1) Moving Out of Poverty Still Possible

2) Regional Focus: The Middle East and North Africa

3) Poverty's “Female Face” in Africa

4) Green jobs for the poor: a public employment approach

5) Help Us!

6) To Receive this Newsletter

Welcome to the one hundred and twenty sixth issue of the PovertyNet electronic newsletter from the World Bank. This newsletter provides an update of new resources about understanding and alleviating poverty available from PovertyNet, http://www.worldbank.org/poverty, and other websites.

Please continue to send suggestions on items to highlight in forthcoming newsletters to povertynet@worldbank.org./.../

Urban Poverty and Health in Developing Countries

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by Mark R. Montgomery

(May 2009) The era in which developing countries could be depicted mainly in terms of rural villages is now in the past. A panoramic view of today's demographic landscape reveals a myriad of cities and towns.

By 2030, according to the projections of the United Nations Population Division, more people in the developing world will live in urban than rural areas; by 2050, two-thirds of its population is likely to be urban.¹ The world's population as a whole is expected to grow by 2.5 billion from 2007 to 2050, with the cities and towns of developing countries absorbing almost all of these additional people./.../

Combater a poluição luminosa ― um malefício para a economia, o ambiente e a astrofísica― é mais simples do que se pensa

O direito à escuridão noturna

Augusto Damineli Edição Impressa 160 - Junho 2009 Pesquisa FAPESP -

© C. Mayhew & R. Simmon (NASA/GSFC), NOAA/ NGDC, DMSP Digital Archive

Composição de images de satélites: manchas luminosas definem as zonas urbanas

A poluição luminosa tem sido negligenciada pelo poder público e pelos ambientalistas. Os astrônomos têm lutado contra ela há mais de um século, sem muito sucesso. Ela traz 3 malefícios: desperdício econômico, impacto negativo sobre a fauna noturna e apagamento dos astros. Seu combate é mais simples do que para os outros tipos de poluição.

As fotos de satélites (ao lado) mostram manchas luminosas que definem perfeitamente as zonas urbanas, indicando que parte significativa da luz noturna é lançada acima do horizonte. As avaliações feitas nos Estados Unidos contabilizam que 30% da iluminação pública é desperdiçada dessa forma, num montante de US$ 2 bilhões anuais. Esse padrão se repete em todo o resto do globo terrestre, resultando em dezenas de bilhões de dólares literalmente jogados ao espaço. Só esse fato mereceria uma racionalização da iluminação pública. Mas existem outras razões importantes: ninguém ganha nada com esse desperdício, o contribuinte paga a conta em dinheiro, o meio ambiente perde muitas vidas e nós perdemos o acesso a incríveis laboratórios de física disponíveis no Universo./.../

Self administered cognitive screening test (TYM) for detection of Alzheimer’s disease:

Jeremy Brown, consultant neurologist, George Pengas, clinical research fellow, Kate Dawson, research nurse, Lucy A Brown, honorary research assistant, Philip Clatworthy, clinical research fellow

¹ Department of Neurology, Addenbrooke’s Hospital, Cambridge CB2 2QQ

Correspondence to: J Brown jmb75@medschl.cam.ac.uk

Abstract

Objective To evaluate a cognitive test, the TYM ("test your memory"), in the detection of Alzheimer’s disease.

Design Cross sectional study.

Setting Outpatient departments in three hospitals, including a memory clinic.

Participants 540 control participants aged 18-95 and 139 patients attending a memory clinic with dementia/amnestic mild cognitive impairment.

Intervention Cognitive test designed to use minimal operator time and to be suitable for non-specialist use.

Main outcome measures Performance of normal controls on the TYM. Performance of patients with Alzheimer’s disease on the TYM compared with age matched controls. Validation of the TYM with two standard tests (the mini-mental state examination (MMSE) and the Addenbrooke’s cognitive examination-revised (ACE-R)). Sensitivity and specificity of the TYM in the detection of Alzheimer’s disease.

Results Control participants completed the TYM with an average score of 47/50. Patients with Alzheimer’s disease scored an average of 33/50. The TYM score shows excellent correlation with the two standard tests. A score of 42/50 had a sensitivity of 93% and specificity of 86% in the diagnosis of Alzheimer’s disease. The TYM was more sensitive in detection of Alzheimer’sdisease than the mini-mental examination, detecting 93% of patientscompared with 52% for the mini-mental state exxamination. The negative and positive predictive values of the TYM with the cut off of 42 were 99% and 42% with a prevalence of Alzheimer’s disease of 10%. Thirty one patients with non-Alzheimer dementias scored an average of 39/50.

Conclusions The TYM can be completed quickly and accurately by normal controls. It is a powerful and valid screening test for the detection of Alzheimer’s disease.

BMJ Video.

Latest video

A video is going online soon about Sir Richard Doll. He was a luminary of clinical research whose case control study, published in the BMJ in 1950, first identified smoking as an important cause of cancer and other diseases. The paper's findings were received with apathy, anger, and disbelief. This 10 minute film to promote the BMJ archive now being fully searchable back to 1840 charts Doll's remarkable life and the impact of both of this paper, and his follow-up British Doctors' Study.

Find out more at BMJ Video.

HCTZ a "paltry" antihypertensive ??!

HCTZ a "paltry" antihypertensive, with no effect on outcomes, new analysis suggests

June 15, 2009 | Lisa Nainggolan

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Milan, Italy - Hydrochlorothiazide (HCTZ), the most commonly employed blood-pressure-lowering drug in the US, used at the usual doses prescribed—12.5 mg to 25 mg/per day—is a "paltry" antihypertensive, inferior to all other drug classes, and there is no published evidence that it reduces heart attack or stroke [1]. These are the controversial conclusions of a new pooled analysis of trials reported by Dr Franz Messerli (St Luke's-Roosevelt Hospital, New York, NY) during a late-breaking clinical-trial session here at the European Meeting on Hypertension 2009 this weekend.

Messerli stressed that his conclusions relate to 24-hour ambulatory BP monitoring and that, "when it comes to office BP, HCTZ isn't that bad. In the clinic, BP [with HCTZ] looks fairly decent, it's almost as good as other antihypertensive drugs, which means very simply that HCTZ lowers the BP fairly well during the day, when the patient sees the doctor in the office, but at night and early-morning hours, it loses its antihypertensive efficacy, so it creates a false sense of security for the patient and the doctor alike. /.../

Atrial Fibrillation Through the Patient’s Eyes

Atrial Fibrillation Through the Patient’s Eyes

Edward P. Havranek, MDFrom the Denver Health Medical Center, University of Colorado Denver School of Medicine, Denver, Colo.
Correspondence to Edward P. Havranek, MD, 777 Bannock St, No. 0960, Denver, CO 80204-4507. E-mail ehavrane@dhha.org

The Canadian Cardiovascular Society Severity in Atrial Fibrillation (CCS-SAF) scale described in the report by Dorian et al¹ in this issue of Circulation: Arrhythmia and Electrophysiology is worthy of our attention because it offers us something we can use. It also serves a deeper purpose and offers us somethingwe should use.
It is of use because it gives us a simple and reliable tool to use at the bedside to understand patients’ experiences with atrial fibrillation. We have scales that assess patient’s overall health status (so-called generic questionnaires), the most widely used of which is the SF-36 questionnaire. The SF-36 has been used previously to assess health status in a number of studies of atrial fibrillation.² Its length, however, limits its use in everyday clinical practice. A shorter version (the SF-12) is available, but it is not clear if this questionnaire is able to separate the impact of atrial fibrillation from the burden of comorbidity that is the lot of the typical patient.We also have questionnaires specific for atrial fibrillation.^3–5 Although they might be able to dissect the impact of atrial fibrillation from that of comorbidity, they have not been widely used and are too long for bedside use.

Scales useful at the bedside have characteristics in common. They combine data from a large enough number of variables to provide adequate discrimination yet from a small enough number of variables to allow commitment to memory—usually 3 to 5./.../

Hygeia’s Constellation

Imagining how to create a city in which life would be good is Hygeia’s art, which is far more complex [than swallowing a pill]. For a city in which life would be good implies that there is none of that noise to which we adapt by losing our hearing, none of those fumes to which we adapt by developing chronic bronchitis, and none of those constructions that prevent the eye from venturing to the horizon. Yes, that’s Hygeia’sart, but it can also become a science, a science that tries to understand the basic requirements permitting human nature to express itself totally.

Dubos and Escande, 1979:87

Medical Liability Reform

The Role of Medical Liability Reform in Federal Health Care Reform

Michelle M. Mello, J.D., Ph.D., M.Phil., and Troyen A. Brennan, M.D., J.D., M.P.H.

Although enthusiasm for health care reform is resounding in Washington these days, the specific shape reform will take and the compromises that will have to be made along the way are opaque. Currently, much of the discussion centers on possibilities for insurance mandates, a public insurance plan modeled after Medicare, and the methods that will be used to control costs.¹ Many other issues will have to be addressed, including physician payment reform, the future of Medicare Advantage, providers' participation in public programs, the role of expansions of Medicaid, and of course, the funding mechanism for any increase in government expenditures. A further question is whether the reform package should include reforms to the medical liability system, which is often blamed for contributing to rising health care costs./.../

Less paperwork, more time with patients keep doctors in medicine

A literature review finds that physicians value autonomy more than money in deciding whether to keep practicing.

By Victoria Stagg Elliott, AMNews staff. Posted June 10, 2009.

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Increasing compensation without addressing factors that can make the practice of medicine so arduous will not be enough to retain physicians in the profession, according to a special article in the April Jackson & Coker Industry Report (www.jacksoncoker.com/newsletter/articles/motivating.aspx).

"Physicians have a higher calling. It's not just about money," said Edward McEachern, vice president of marketing at Jackson & Coker, an Atlanta-based physician staffing agency.

Non-communicable diseases in Millennium Development Goals

Pressure builds to include non-communicable diseases in Millennium Development Goals

Left to right: Rifat Atun, The Global Fund; George Alleyne, Caribbean Commission on Health and Development, Dr Ala Alwan, WHO; Marie-Pierre Lloyd, Seychelles; Leslie Ramsammy, Guyana (click on image to view larger)

Geneva, Switzerland (GenevaLunch) - Swine flu may be in the headlines, but non-communicable diseases (NCDs), especially in developing countries, were in the corridors and meeting rooms as the World Health Assembly, the global body of the World Health Organization (WHO), held its annual meeting in Geneva 17-22 May. NCDs are estimated to reduce gross domestic product by up to five percent in many low- and middle-income countries, where four out of five of the 35 million deaths a year from NCDs occur. A growing chorus of voices is arguing that these diseases should become part of the health package of the UN Millennium Development Goals which countries have signed a compact to meet by 2015.

The figures were put forward this week by three key international health groups who represent 730 member health care organizations which are calling for an “immediate and substantial increase in financing” for these diseases: the International Diabetes Federation, International Union Against Cancer and World Heart Federation./.../

Running the Numbers

Running the Numbers
An American Self-Portrait

Running the Numbers looks at contemporary American culture through the austere lens of statistics. Each image portrays a specific quantity of something: fifteen million sheets of office paper (five minutes of paper use); 106,000 aluminum cans (thirty seconds of can consumption) and so on. My hope is that images representing these quantities might have a different effect than the raw numbers alone, such as we find daily in articles and books. Statistics can feel abstract and anesthetizing, making it difficult to connect with and make meaning of 3.6 million SUV sales in one year, for example, or 2.3 million Americans in prison, or 32,000 breast augmentation surgeries in the U.S. every month.

This project visually examines these vast and bizarre measures of our society, in large intricately detailed prints assembled from thousands of smaller photographs. Employing themes such as the near versus the far, and the one versus the many, I hope to raise some questions about the roles and responsibilities we each play as individuals in a society that is increasingly enormous, incomprehensible, and overwhelming.

~chris jordan, Seattle, 2008

Predicting the 30-Year Risk of Cardiovascular Disease.

Predicting the 30-Year Risk of Cardiovascular Disease. The Framingham Heart Study

Michael J. Pencina PhD^*, Ralph B. D'Agostino Sr PhD, Martin G. Larson ScD, Joseph M. Massaro PhD, and Ramachandran S. Vasan MD

From the Department of Mathematics and Statistics (M.J.P., R.B.D., M.G.L., J.M.M.), School of Medicine (R.S.V.), and Department of Biostatistics (M.J.P., R.B.D., J.M.M.), Boston University, Boston Mass; and Framingham Heart Study, Framingham, Mass (M.J.P., R.B.D., M.G.L., J.M.M., R.S.V.).

^* To whom correspondence should be addressed. E-mail: mpencina@bu.edu.

Background—Present cardiovascular disease (CVD) risk prediction algorithms were developed for a 10-year follow upperiod. Clustering of risk factors at younger ages and increasing life expectancy suggest the need for longer-term risk prediction tools.

Methods and Results—We prospectively followed 4506 participants (2333 women) of the Framingham Offspring cohortaged 20 to 59 years and free of CVD and cancer at baseline examination in 1971–1974 for the development of "hard" CVD events (coronary death, myocardial infarction, stroke). We used a modified Cox model that allows adjustment for competing risk of noncardiovascular death to construct a prediction algorithm for 30-year risk of hard CVD. Cross-validated survival C statistic and calibration ² were used to assess model performance. The 30-year hard CVD event rates adjusted for the competing risk of death were 7.6% for women and 18.3% for men. Standard risk factors (male sex,systolic blood pressure, antihypertensive treatment, total and high-density lipoprotein cholesterol, smoking, and diabetes mellitus), measured at baseline, were significantly related to the incidence of hard CVD and remained significant when updated regularly on follow-up. Body mass index was associated positively with 30-year risk of hard CVD only in models that did not update risk factors. Model performance was excellent as indicated by cross-validated discrimination C=0.803 and calibration ²=4.25 (P=0.894). In contrast, 30-year risk predictions based on different applications of 10-year functions proved inadequate.

Conclusions—Standard risk factors remain strong predictors of hard CVD over extended follow-up. Thirty-year risk prediction functions offer additional risk burden information that complements that of 10-year functions.

The Lancet, Volume 373, Issue 9679, Pages 1993 - 1995, 6 June 2009

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doi:10.1016/S0140-6736(09)60332-9Cite or Link Using DOI

Towards a common definition of global health

Original Text

Prof Jeffrey P Koplan MD a , T Christopher Bond PhD b, Prof Michael H Merson MD c, Prof K Srinath Reddy MD d, Prof Mario Henry Rodriguez MD e, Prof Nelson K Sewankambo FRCP f, Prof Judith N Wasserheit MD g, for the Consortium of Universities for Global Health Executive Board‡

Global health is fashionable. It provokes a great deal of media, student, and faculty interest, has driven the establishment or restructuring of several academic programmes, is supported by governments as a crucial component of foreign policy,1 and has become a major philanthropic target. Global health is derived from public health and international health, which, in turn, evolved from hygiene and tropical medicine. However, although frequently referenced, global health is rarely defined. When it is, the definition varies greatly and is often little more than a rephrasing of a common definition of public health or a politically correct updating of international health. Therefore, how should global health be defined?/.../

History of Biology (from Wikipedia)

History of science

The history of biology traces the study of the living world from ancient to modern times. Although the concept of biology as a single coherent field arose in the 19th century, the biological sciences emerged from traditions of medicine and natural history reaching back to ancient Egyptian medicine and the works of Aristotle and Galen in the ancient Greco-Roman world./.../

Doenças novas

Publicado na ZH de hoje 06 de junho de 2009 | N° 15992

ARTIGOS

Doenças novas, por Aloyzio Achutti *

Enquanto o Exmo. Sr. ministro da Saúde falava sobre a dita gripe suína, ele, com justo orgulho, dizia que tudo estava preparado para enfrentar as doenças novas.

Sem desmerecer todo o esforço de mobilização para rastrear e controlar este problema de saúde pública, é de se perguntar sobre o que está sendo feito com as “doenças velhas”... As doenças crônicas não incomodam mais, já são de costume e, quem sabe, alguém esteja até “se lixando” para elas (como disse o deputado sobre a opinião pública).

As velhas e crônicas: cardiovasculares, câncer, respiratórias, nutricionais e metabólicas, doença mental e violência causam muito mais morbidade e mortalidade, dano social e econômico, do que qualquer “doença nova”, incluindo-se a aids (nem tão nova assim). Também não se fala quase que os primeiros a morrerem das “novas” são os portadores já fragilizados pelas “velhas”.

Parte da atitude paradoxal pode estar na presumida origem das doenças. As novas têm sido relacionadas com os porcos, bugios, macacos, galinhas, aves migratórias e mosquitos. Têm origem no México, na África ou na Ásia. As crônicas têm-se consciência de que são fabricadas pelo próprio homem em busca do desenvolvimento, com seu comportamento individual e coletivo. É mais fácil se mobilizar contra um inimigo aparentemente externo do que arrumar a própria casa.

Sobre as “doenças novas”, o olhar tem sido ingênuo e de curto alcance, satisfazendo-se com o vetor e o hospedeiro, sem uma preocupação maior com toda a rede causal que está por trás. Pouco se fala sobre a responsabilidade humana na utilização da tecnologia para acelerar a produção e aumentar a lucratividade, ao se criarem porcos e galinhas em massa, industrialmente, com rações artificiais, cheias de agrotóxicos e hormônios e manipulação genética. Também não se tem feito grande progresso no controle do clima, do desmatamento, da invasão e destruição dos ecótopos naturais onde o equilíbrio se estabelece.

Da mesma forma, satisfaz a conformidade fatalista de que aconteceu um infarto, um derrame, ou que alguém foi acometido de câncer, ou enlouqueceu. Não se questiona por que e como se chegou a esse ponto e o que é possível fazer para reduzir ou evitar as verdadeiras causas determinantes do mal.

Já foi demonstrado, inclusive em nossa cidade, que todos os males de saúde, os velhos e os novos, ocorrem muito mais (três a quatro vezes) na população marginalizada, em permanente contato com os mais privilegiados e com os quais se entrecruza para servir. Entretanto, enclaves de grande desigualdade social são aceitos como naturais e crescem nas cidades, com gente sem a educação necessária e sem perspectiva de vida. Não basta dispor de profissionais, tecnologia e remédios. Cidadania e solidariedade são essenciais na construção de uma rede de defesa eficaz contra “doenças novas e velhas”.

*MÉDICO