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High Heels Today, Foot Pain Tomorrow

Wearing high heels today may hurt just a little, but even bigger foot pain may be in store later on.

A new study shows that people who make poor shoe choices early in life by wearing unsupportive footwear like high heels, sandals, and slippers are much more likely to suffer from foot pain in later years.

The study showed that men don’t experience the same type of foot pain as women, largely because of the type of shoes men wear. Researchers say the findings may help explain why women are much more likely than men to have foot pain.

Foot and toe pain are among the top 20 reasons adults aged 65-74 visit their physician, but researchers say relatively little is known about the causes of foot pain in older adults. Previous studies on footwear and foot pain have been small or based on people with a particular disease.

Causes of Foot Pain

In this study, published in Arthritis Care & Research, researchers examined the effects of footwear choices early in life on foot pain later in life in a group of 3,378 adults who participated in the Framingham Foot Study.

The participants were asked if they had pain, aching, or stiffness in one or both feet. They also provided information on the types of shoes they wore during the following age groups: 20-29, 30-44, 45-64, 65-74, and 75+.

Shoes were classified into three groups:

  • Good: low-risk shoes, such as athletic and casual sneakers
  • Average: mid-risk shoes, like hard- or rubber-soled shoes, special shoes, and work boots
  • Poor: high-risk footwear that don’t have support or structure, such as high heels, sandals, and slippers

The results showed that 19% of men and 29% of women had generalized foot pain on most days.

Women who wore good shoes in the past were 67% less likely to report hindfoot pain than those who wore average shoes.

“While more research is needed, young women should make careful choices regarding their shoe type to avoid hindfoot pain later in life, or perform stretching exercises to alleviate the effect of high heels on foot pain,” write researcher Alyssa B. Dufour, of the Boston University School of Public Health, and colleagues. 

Researchers found no link between foot pain and shoe choice among men, largely because less than 2% wore bad shoes.

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October 30, 2009 Posted by | 1 | 1 Comment

Shingles May Raise Risk of Stroke

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Study Shows Shingles Patients 30% More Likely to Suffer a Stroke

Adults with shingles are at increased risk for stroke, especially if they have shingles that affects the eyes, a study shows.

The study is not the first to show an elevated stroke risk associated with shingles, but it is the first to quantify the risk, researchers say.

Compared to adults without shingles, those with the painful skin rash were about 30% more likely to suffer a stroke within a year of the attack. Patients who had shingles in and around an eye had four times the risk for stroke in the year following the episode.

“If a person is already at risk for stroke, they should be aware that their risk may be higher if they have had shingles,” study researcher Jiunn-Horng Kang, MD, MSc, tells WebMD.

Also known as herpes zoster, shingles is caused by the varicella-zoster virus (VZV) — the same virus that causes chickenpox.

Anyone who has had chickenpox in childhood can develop shingles at some point in their lives.

In many people, the virus remains dormant in nerves. But in some, especially older people and those with compromised immune systems, it can reactivate as shingles.

The reawakened virus initially causes numbness, itching, severe pain, and even fever, headaches, and chills, followed by the blistering rash characteristic of shingles. The skin rash usually occurs within three to five days after symptoms begin.

Shingles can result in persistent pain lasting for months and even years after the rash has gone away.

The newly published study included nearly 8,000 adults treated for shingles between 1997 and 2001 and about 23,000 people matched for age and sex who had no history of shingles or stroke before 2001.

During the year following the shingles episode, 133 shingles patients (1.7%) and 306 people in the comparison group (1.3%) had strokes.

The shingles patients had a 31% increased risk for strokes of any kind and a nearly threefold increased risk for hemorrhagic strokes.

Hemorrhagic strokes, caused by bleeding in the brain, are much less common than ischemic strokes, which are caused by blocked arteries. Only about 10% to 15% of strokes involve brain bleeds.

Patients with shingles involving the skin around the eye and the eye itself were 4.28 times more likely to have a stroke than were people without shingles.

The study was published online today and will appear in the November issue of the American Heart Association journal Stroke.

Stress, Inflammation May Play Role

Varicella zoster virus-related blood vessel damage has been linked to stroke after shingles attacks, but this did not fully explain the high stroke risk seen in the study, Kang and colleagues wrote.

They added that the stress associated with shingles and the intense pain that can occur with outbreaks and following them could play a role, as could the inflammation that occurs with shingles outbreaks.

ss, Inflammation May Play Role continued…

American Stroke Association spokesman Daniel Lackland, MD, says shingles patients and their doctors need to be aware of the new research.

Lackland is a professor of epidemiology and medicine at the Medical University of South Carolina in Charleston.

“This research needs to be confirmed, but it may be that shingles patients with risk factors for stroke need more aggressive monitoring and treatment than the average patient,” he tells WebMD.

But he adds that the shingles-related stroke risk identified in the study is nowhere near as great as the risk associated with better-established stroke risk factors, like high blood pressure.

“The message doesn’t change based on this study,” he says. “Getting high blood pressure under control and treating other modifiable risk factors is what we have to focus on.”

Early, aggressive treatment with antiviral drugs can lessen the length and severity of shingles attacks.

Kang says it remains to be seen if aggressive antiviral treatment can also lower stroke risk.

“This is a question we need to study,” he says.

 

October 30, 2009 Posted by | 1 | Leave a comment

Postmarketing Safety Evaluation of New Molecular Entities: Final Report

FDA/CDER/Division of Drug Information (DDI)

The Division of Drug Information (DDI) is CDER’s focal point for public inquiries. We serve the public by providing information on human drug products and drug product regulation by FDA.

The Office of Surveillance and Epidemiology and the Office of New Drugs in the Center for Drug Evaluation and Research (CDER) have completed the “NME Postmarketing Safety Evaluation Pilot Program” that began in January, 2007, and the final report is available.

In this pilot program, CDER undertook the systematic and collaborative review of the safety profiles of selected approved new molecular entities that have been marketed for varying lengths of time.  New molecular entities (NMEs) are drugs that include an active ingredient that has not previously been approved for marketing in the United States in any form.  The pilot program determined the value of such a systematic review.  As described in the final report, the pilot program also provided valuable information about the required resources and appropriate methods for conducting such a systematic evaluation.

For more information, please visit: New Molecular Entities

 

October 30, 2009 Posted by | 1 | Leave a comment

‘Michael Jackson’s This Is It’ Trailer and Video Clips

Michael Jackson’s This Is It will offer Jackson fans and music lovers worldwide a rare, behind-the-scenes look at the performer as he developed, created and rehearsed for his sold-out concerts that would have taken place beginning this summer in London’s O2 Arena. Chronicling the months from April through June, 2009, the film is produced with the full support of the Estate of Michael Jackson and drawn from more than one hundred hours of behind-the-scenes footage, featuring Jackson rehearsing a number of his songs for the show. Audiences will be given a privileged and private look at Jackson as he has never been seen before. In raw and candid detail, Michael Jackson’s This Is It captures the singer, dancer, filmmaker, architect, creative genius and great artist at work as he creates and perfects his final show.

 

Michael Jackson’s This Is It Videos

Trailer
Play the Trailer

Video Clip – “Why, why”
Play the Clip

Video Clip – “Drill”
Play the Clip

Video Clip – “Cue that”
Play the Clip

Video Clip – “Featurette’
Play the Clip

Michael Jackson’s This Is It synopsis and videos provided by Sony Pictures.

 

 

 

 

 

 

 

October 30, 2009 Posted by | 1 | Leave a comment

Top 10 Punk Rock Albums With A Touch of Horror

Whether you’re putting together a soundtrack for a Halloween party or simply listening to music on your way to a horror flick, here are some great recommendations for those of us who like our punk rock with a dash of the horrific.

The following albums cover a span of genres of punk, but they all have one thing in common: a dark side. Whether you’re looking for a hint of eeriness or a full-blown gorefest, there’s surely an album on this list that will help you make every day Halloween.

1. Various Artists – ‘Halloween Hootenanny’

This album features a collection of horror-themed songs personally selected by Rob Zombie. But if you’re expecting something hard and heavy like White Zombie, you’re picking the wrong album.

Halloween Hootenanny is an album that predominantly consists of well-known rockabilly, surf and garage bands, including such big names as Reverend Horton Heat, Deadbolt and Rocket From The Crypt. There’s even a cover of “The Munster’s Theme” by Los Straitjackets and a surf song from Zombie himself.

2. Misfits – ‘Legacy Of Brutality’

When you have a scary band playing scary songs and a singer who sounds like cross between Elvis and Jim Morrison, you can’t go wrong.

While any of the Danzig-era Misfits albums could have made this list, and should be checked out, I felt that 1985’s Legacy Of Brutality was the best choice for this list simply because it includes the classic Misfits track, “Halloween.”

3. Various Artists – ‘Nightmare Revisited’

Disney

OK, sure, it’s a collection of covers from a children’s film, but even the original soundtrack to 1993’s The Nightmare Before Christmas was an essential Halloween album. Its eerie sound mixed with childish whimsy makes it nice and dark, combined with punk cred from composer/voice of Jack Skellington, Danny Elfman. Elfman was the frontman for Oingo Boingo and the man behind 1985’s Dead Man’s Party, another dark classic. (See how I snuck another item on to the list?)

Nightmare Revisited is a one up on the original soundtrack, featuring covers of the songs from the original by bands like Rise Against, DeVotchKa, Marilyn Manson, The All-American Rejects and Plain White T’s.

4. Th’ Legendary Shack*Shakers – ‘Pandelirium’

Cover art courtesy of Yep Roc Records

Calling themselves “New American Gothic,” Th’ Legendary Shack*Shakers draw their influence from the dark underbelly of America’s musical heritage. No list of horror punk would be complete without their 2006 album, Pandelirium. The album is a blend of dark Dixieland jazz, Texas polkas, southern blues, old-school honky tonk and some serious punk rock. The result is a bit creepy, vaguely evil, and highly addictive.

5. Gwar – ‘Scumdogs of the Universe’

If you’ve seen Gwar live, you’re aware that music is only part of their package. Their live set is like being in a b-grade horror flick, as beasts are battled and people beheaded, and the crowd is bathed in copious amounts of blood and other fluids. It’s an experience everyone should take in at least once.

While any of their albums could have made this list, 1990’s Scumdogs of the Universe was my introduction to Gwar, and features classics like “Maggots” and “Slaughterama.”

6. Bauhaus – ‘Crackle: The Best Of Bauhaus’

Whether or not they agree, this band will never be able to shake their designation as one of the founders of goth music. There’s good reason for that, as much of their innovative music centered on a dark sound, and frontman Peter Murphy’s voice underlined it all in black.

While I believe you should own everything Bauhaus ever released, if you only get one album go with Crackle, simply because it has both “Bela Lugosi’s Dead” and their cover of “Ziggy Stardust” on one album.

7. Alien Sex Fiend – ‘The Singles: 1983-1995’

Since the early ’80s, Nik and Ms. Fiend have been responsible for releasing a large collection of death rock and dark industrial music. Their recent forays have been more ambient and experimental, but their dark classics will always be their best work.

The Singles: 1983-1995 is a great introduction to Alien Sex Fiend, and features their two greatest (and most evil) songs, “I Walk The Line” and “Now I’m Feeling Zombiefied.”

8. Nick Cave and The Bad Seeds – ‘Murder Ballads’

Whether it’s his early work with the Australian punk band The Birthday Party or his current career with the Bad Seeds, Nick Cave has been amazing fans for decades with his trademark voice and musical talent.

1996’s Murder Ballads stands out in his career, both for its musical depth and its macabre subject matter. On songs such as “O’Malley’s Bar” and “Stagger Lee,” he explores songs about murder from all aspects. It’s a deliciously dark and addictive journey.

9. Mad Sin – ‘Dead Moon’s Calling’

Album cover courtesy of Sailor’s Grave Records

When you hear Dead Moon’s Calling by Mad Sin, it’s hard to believe these guys are from Germany. These guys tear through psychobilly tunes and cowpunk like they were raised in the south. It’s a nice mix of punk, rockabilly and classic horror. The album opens with an audio collage of horror movie samples and eerie music, and then tears into rockabilly tunes with titles like “To Walk The Night” and “Cannibal Superstar.”

10. Plan 9 – ‘Manmade Monsters’

Hearing Manmade Mosters is like hearing the Danzig-era Misfits reborn. In fact, vocalist Aaron Fuller’s voice achieves such dead-on reproduction of Danzig’s vocals that ManMade Monster comes across as a previously unheard collection of new Misfits material, albeit one recorded with conspicuously better quality than the original Misfits releases.

Aside from three covers — “Archangel,” “Teenagers From Mars/We Bite” and “Samhain” — the album consists of original material, but those songs blend seamlessly with the cover versions, making it impossible for a novice to Misfits songs to tell which is the original.

October 29, 2009 Posted by | 1 | Leave a comment

Expert Answers to Top Questions About Rheumatoid Arthritis

WebMD the Magazine – Feature     By Denise Mann Reviewed by Michael W. Smith, MD

Whether you have just been diagnosed with rheumatoid arthritis (RA) or have been living with this autoimmune disease for years, you no doubt have many questions and concerns. To help you get up to speed on the best ways to manage your RA today and for years to come, we took your top questions to rheumatologist Linda A. Russell, MD, an assistant professor of medicine at Weill Medical College of Cornell University and an assistant attending physician at the Hospital for Special Surgery in New York City.

What causes RA?

The precise cause of RA is not yet known. Some research suggests that genes play a role. Other potential culprits include environmental factors such as smoking, and also hormones, since women are two to three times more likely to develop RA than men. Scientists have long suspected infectious agents such as viruses and bacteria may play a role. Either a single factor or a combination prompts the immune system to misfire, attacking its own joints and resulting in pain and inflammation.

How is RA diagnosed today?

We take a thorough history, perform a physical exam, and then evaluate blood work and X-rays. Currently two acceptable blood tests help us make an RA diagnosis. We test for the presence of rheumatoid factor [RF] and anti-CCP [anti-cyclic citrullinated peptide antibody]. [But] these blood tests are not definitive. Anywhere from 10% to 30% of people with RA can be RF-negative or anti-CCP-negative.

When should I start seeing the effects of my new medication?

If you don’t start feeling better within three months, there is probably reason to change or tweak your medication regimen. Feeling better means having more energy, less morning stiffness, less joint pain, and less swelling.

When should I get a second opinion about my treatment?

Get one if you feel that your RA is active and your current doctor doesn’t have anything else to offer or if you are concerned about the side effects of your current medication regimen.

Is there a cure for RA?

Not yet—but many effective medications can control inflammation and help prevent lasting joint damage. In the last 10 years, we have seen a whole new class of drugs called biologics, which exert a greater control over inflammation and have changed the course of RA. These drugs mimic the effects of substances naturally made by the body’s own immune system. The biologics target very specific inflammatory proteins called cytokines such as tumor necrosis factor-alpha. Even with no cure, 10% of people with RA will go into complete remission and be able to stop all of their medications indefinitely.

Will RA affect my chances of getting pregnant and having a healthy baby?

Women with RA do not appear to have decreased fertility, and they often go into remission during pregnancy. Women may have a flare within six to eight weeks of giving birth. Breastfeeding might be problematic because if a woman has a flare, she will need to resume taking her medications, and RA medications can’t be taken while breastfeeding because the drugs can get into the milk supply.

Are my children at risk for developing RA if I have it?

They are at a slightly increased risk of developing RA or another autoimmune disease. [But] we don’t recommend that people with no symptoms have any type of screening test at this point.

Can I live a long life with RA?

Yes. If you have active RA, it’s important to treat the underlying inflammation. This will have positive effects on your quality of life and your life expectancy. People with RA seem to have a greater chance of having heart disease … but treating the inflammation can help reduce that risk. Managing the traditional risk factors for heart disease helps, too — maintaining an appropriate weight and controlling blood pressure and cholesterol levels if they are elevated.

October 29, 2009 Posted by | 1 | 1 Comment

Scary Classical Music for Halloween

Classical Music for Halloween, Vol. 1:

For as long as I can remember, I’ve always advocated using classical music for Halloween. I know it sounds a bit odd, but if you remember all the scary movies you’ve seen, the majority of the films used instrumental music of some kind to help convey the frightening atmosphere. Often times, playing severely inharmonic tones or heart-pounding rhythms. Classical Music for Halloween, Vol. 1 was the first list I compiled. On it you’ll find the Orff’s blood curdling Carmina Burana, O Fortuna as well as Bartok’s suspenseful Music for Strings, Percussion, and Celesta (mvmt. 3).

Classical Music for Halloween, Vol. 2:

With the success of my first compilation, and the fact that there are seemingly endless amounts of scary classical music, I put together a second list. With this list comes some rather interesting selections, like the bizarre and hauntingly eerie Vod Balaenae – a work by George Crumb where the flutist sings into flute while playing it. Also on the list is Bartok’s intense Out of Doors – Musettes, and Penerecki’s anxiety inducing Concerto for Cello and Orchestra No. 1.

Scary Music from the Movies:

As I mentioned before, some of the most frightening movies had soundtracks that you wouldn’t want to listen to while you were at home and alone in the dark. With music from Friday the 13th, Dracula, as well as Texas Chainsaw Massacre that was purposefully composed to be scary, you will find easy to incorporate into your Halloween party or haunted house.

October 29, 2009 Posted by | 1 | Leave a comment

Benefits of Rhodiola

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Also known as golden root or Arctic root, rhodiola (Rhodiola rosea) is an herb long used in traditional medicine in Russia and some European countries. Rhodiola is considered an adaptogen, a class of herbs said to help the body build resistance to stress.

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Uses for Rhodiola

In herbal medicine, rhodiola is typically used in treatment of these health problems:

  • stress
  • fatigue
  • depression
  • sleep problems
  • poor attention span
  • poor memory
  • cardiovascular disease
  • cancer
  • Benefits of Rhodiola

    Although the health effects of rhodiola have yet to be extensively studied, research suggests that the herb may be useful in treatment of the following:

    1) Stress-related fatigue

    Regular intake of rhodiola may help fight fatigue and, in turn, boost mental performance in people struggling with stress-induced burnout, according to a study published in 2009. Study results also showed that the 30 participants taking rhodiola supplements for 28 days had a greater improvement in concentration than those who took a placebo pill for the same amount of time.

    2) Depression

    In a 2007 study, researchers had 89 adults with mild to moderate depression take 340 mg of rhodiola extract, 680 mg of rhodiola extract, or two placebo tablets every day for six weeks. Among those taking either dose of rhodiola, significant improvements in overall depression, insomnia, and emotional instability (but not self-esteem) were gained over the course of the treatment period. Study members taking the placebo tablets showed no such improvements. What’s more, no serious side effects were reported by any participants.

    3) Arrhythmia

    Preliminary research suggests that rhodiola extract daily may help prevent arrhythmias (disorders of the regular rhythmic beating of the heart). However, rhodiola’s heart-protecting properties need to be further studied before the herb can be recommended as a treatment for arrhythmia (a potentially serious problem that can lead to heart disease, stroke, or sudden cardiac death in some cases).

    How to Use Rhodiola

    Available in capsule, liquid, and tea form, rhodiola can be found in many health food stores. The extract is often sold in formulas that contain other adaptogenic herbs.

    Is Rhodiola Safe?

    Although rhodiola is generally considered safe, it may trigger adverse effects like irritability and insomnia. If you’re considering using rhodiola in treatment of a medical condition, make sure to consult a physician before you begin taking the herb.

    For more information on rhodiola, visit About.com: Natural Medicine A-Z.

    Sources:

    Darbinyan V, Aslanyan G, Amroyan E, Gabrielyan E, Malmström C, Panossian A. “Clinical trial of Rhodiola rosea L. extract SHR-5 in the treatment of mild to moderate depression.” Nord J Psychiatry. 2007;61(5):343-8.

    Maslov LN, Lishmanov IuB. “Cardioprotective and antiarrhythmic properties of Rhodiolae roseae preparations.” Eksp Klin Farmakol. 2007 70(5):59-67.

    Olsson EM, von Schéele B, Panossian AG. “A randomised, double-blind, placebo-controlled, parallel-group study of the standardised extract shr-5 of the roots of Rhodiola rosea in the treatment of subjects with stress-related fatigue.” Planta Med. 2009 75(2):105-12.

  • October 29, 2009 Posted by | 1 | 2 Comments

    New Medical Findings In Realation To Neurology

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    Lupus Anticoagulant Increases Risk of Stroke, MI In Young Women

    NEW YORK — September 29, 2009 — A study published online first and in the November edition of The Lancet Neurology shows that women with a particular subtype of antibody called lupus anticoagulant (LA) have a more than 40-fold increased risk of stroke and 5-fold increased risk of myocardial infarction (MI) compared with the general population. In addition, smoking and oral contraceptive use increase the risk of these events even more.

    Although it is known that antiphospholipid syndrome causes thrombosis, bleeding, and repeat miscarriage in women, the extent of the increased risk for stroke and MI was unknown before this study.

    Rolf Urbanus, MD, and Philip de Groot, MD, of the University Medical Centre Utrecht, Utrecht, the Netherlands, together with colleagues from the Leiden University Medical Centre, and colleagues used data from the Risk of Arterial Thrombosis In Relation to Oral Contraceptives (RATIO) study for their analysis.

    A total of 1,006 women aged under 50 years were enrolled between 1990 and 2001. Questionnaires were used to assess the prevalence of various risk factors, with blood samples taken to measure various phospholipid antibodies, including LA. The patient pool included women who had had a stroke (175) or MI (203), and healthy controls (628).

    LA was found in 30 (17%) patients with stroke, 6 (3%) patients with MI, and in 4 (0.7%) healthy controls. Based on the observation that 4 of 628 healthy controls had LA, the prevalence in women in the general population is estimated by the authors to be 7 in 1000, or 0.7%; previous studies have made higher estimates.

    LA increased the risk of stroke 43-fold compared with healthy controls; in women with LA who smoked, the risk was raised 87-fold; and in women with LA who used oral contraceptives, the risk was increased more than 200-fold.

    LA also increased with risk of MI 5-fold compared with healthy controls; LA plus smoking increased the risk 34-fold, and LA plus oral contraceptives increased the risk 22-fold. Smoking and oral contraceptive use enhance the action of LA, explaining these increased risks.

    “Our results suggest that lupus anticoagulant is a major risk factor for arterial thrombotic events in young women, and the presence of other cardiovascular risk factors increases this risk even further…Screening for lupus anticoagulant in young women with ischaemic stroke seems to be warranted,” the authors wrote.

    SOURCE: The Lancet Neurology

    Secondary abscess arising in a craniopharyngioma;

    An abscess arising in a craniopharyngioma is rare, but has potentially high mortality and morbidity. Diagnosis is difficult because clinical and neuroradiological characteristics are not clearly defined. We report a patient with a pituitary abscess concomitant with a craniopharyngioma and discuss the pathophysiological mechanism. We discuss the previous five reports and suggest that abscesses with craniopharyngioma remain challenging clinical entities. We speculate that inflammation is a response to components of the ruptured epithelium of the cyst, thereby providing an explanation of the mechanism of abscess formation.

    Hyperhomocysteinemia in epileptic patients on new antiepileptic drugs;

    Summary Purpose: Older enzyme-inducing antiepileptic drugs (AEDs) may induce supraphysiologic plasma concentrations of total (t) homocysteine (Hcy). The aim of the present study was to investigate the effect of new AEDs on plasma tHcy levels. Methods: Patients 18-50 years of age, on AEDs monotherapy, with no other known cause of hyper-tHcy were enrolled. Plasma tHcy, folate, vitamin B(12), and AEDs levels were determined by standard high-performance liquid chromatography (HPLC) methods. Methylenetetrahydrofolate-reductase (MTHFR) polymorphisms were checked using Puregene genomic DNA purification system (Gentra, Celbio, Italy). A group of healthy volunteers matched for age and sex was taken as control. Results: Two hundred fifty-nine patients (151 on newer and 108 on older AEDs) and 231 controls were enrolled. Plasma tHcy levels were significantly higher [mean values, standard error (SE) 16.8, 0.4 vs. 9.1, 0.2 mum; physiologic range 5-13 mum] and folate lower (6.3, 0.1 vs. 9.3, 0.1 nm; normal>6.8 nm) in patients compared to controls. Patients treated with oxcarbazepine, topiramate, carbamazepine, and phenobarbital exhibited mean plasma tHcy levels above the physiologic range [mean values (SE) 16 (0.8), 19.1 (0.8), 20.5 (1.0), and 18.5 (1.5) mum, respectively]. Conversely, normal tHcy concentrations were observed in the lamotrigine and levetiracetam groups [both 11.1 (0.5) mum]. Discussion: Oxcarbazepine and topiramate might cause hyper-tHcy, most likely because of the capacity of these agents to induce the hepatic enzymes. Because literature data suggest that hyper-tHcy may contribute to the development of cerebrovascular diseases and brain atrophy, a supplement of folate can be considered in these patients to normalize plasma tHcy.

    Should anterior pituitary function be tested during follow-up of all patients presenting at the emergency department because of traumatic brain injury

    Context: A wide range (15-56%) of prevalences of anterior pituitary insufficiency is reported in patients after traumatic brain injury (TBI). However, different study populations, study designs, and diagnostic procedures were used. No data is available on emergency-department-based cohorts of TBI patients. Objective: To assess the prevalence of pituitary dysfunction in an emergency-department-based cohort of TBI patients, using strict endocrinological diagnostic criteria. Methods: Of all patients presenting in the emergency department with TBI over a two-year period, 516 matched the inclusion criteria. 107 patients (77 mild TBI, 30 moderate/severe TBI) agreed to participate. They were screened for anterior pituitary insufficiency by GHRH-arginin testing, evaluation of fasting morning hormone levels (cortisol, TSH, free thyroxine, FSH, LH, and 17beta-estradiol or testosterone), and menstrual history 3-30 months after TBI. Abnormal screening results were defined as low peak GH to GHRH-arginin, or low levels of any of the end-organ hormones with low or normal pituitary hormone levels. Patients with abnormal screening results were extensively evaluated, including additional hormone provocation tests (insulin tolerance test, ACTH-stimulation test, repeated GHRH-arginin test) and assessment of free testosterone levels. Results: Screening results were abnormal in 15 of 107 patients. Subsequent extensive endocrine evaluation diagnosed anterior pituitary dysfunction in 1 patient only (partial hypocortisolism). Conclusion: Applying strict diagnostic criteria to an emergency-department-based cohort of TBI patients showed that anterior pituitary dysfunction is rare (<1%). Routine pituitary screening in unselected patients after TBI is unlikely to be cost-effective.

    Palliation of dyspnoea in advanced COPD: revisiting a role for opioids;

    Chronic obstructive pulmonary disease (COPD) will be the third leading cause of death worldwide by 2020. The burdens of this increasingly prevalent illness borne by patients, their family caregivers and the healthcare system are substantial. Dyspnoea as the predominant symptom becomes increasingly difficult to palliate as COPD progresses through advanced stages and, for 50% of patients, can become refractory to conventional treatment. This narrative review focuses on the potential role for carefully initiated and titrated opioids in the management of dyspnoea for patients with advanced COPD who are not yet in a terminal stage, yet struggle with symptoms that reflect underlying mechanisms of dyspnoea that lend themselves to this approach. The many barriers that currently exist to the provision of opioids in this setting are addressed, and recommendations are provided for an approach that should engender confidence among patients, their caregivers and the physicians who treat them.

    October 29, 2009 Posted by | 1 | Leave a comment

    Mariah Carey – Memoirs of an Imperfect Angel

    Once upon a time it was the norm on major pop albums for an artist to work with one producer or team of producers throughout an entire album. However, in recent years it has become more common to create an album as a hodgepodge of sometimes mismatched tracks recorded with various producers. For Memoirs of an Imperfect Angel, Mariah Carey has collaborated primarily with the team of The-Dream and “Tricky” Stewart for songwriting and producing throughout the entire album. The result is a unique, cohesive musical glimpse of the inner life of Mariah Carey.

    Mariah Carey - Memoirs Of an Imperfect Angel

    Mariah Carey – Memoirs Of an Imperfect Angel

    Courtesy Island Records

    Flights of Vocal Fancy

    For fans of Mariah Carey, the quality of her singing and direction of her vocal arrangements are one of the first things looked for in a new album. As has become common since The Emancipation of Mimi, she spends most of her time singing in a midrange that eliminates much of the vocal acrobatics of earlier in her career. However, Memoirs of an Imperfect Angel does insert enough moments of vocal fancy to keep most fans happy.

    In the sad, painfully slow “H.A.T.E.U,” Mariah Carey delivers one of the key refrains in a lower range narcotized vocal haze that serves to emphasize the song’s message of the emotional torment of lovers being torn apart. “It’s a Wrap” kicks off with classic ethereal Mariah Carey vocal runs followed by an impossibly high range note that has a sonic effect of a small comet zipping through the musical sky. Then there is the glorious vocal workout on “I Want To Know What Love Is” that closes the album. Mariah Carey fans will be standing and cheering.

    It’s Not So Much Fun Being Mariah Carey?

    One of the key messages of Memoirs of an Imperfect Angel is that, emotionally at least, it’s not always a lot of fun being Mariah Carey. “Obsessed” details anger and anxiety at being stalked. “H.A.T.E.U.” explores the emotional pain of being trapped in a relationship where the writing is on the wall. “Up Out My Face” presents anger at an incompatible lover. The album reaches its most painful moments in the elegant “Languishing” about being in a relationship with someone you still don’t feel you know after many years. Mariah Carey is left wondering, “Would you reach for me if you saw that I was languishing?” A musical up side of all of this emotional pain is that the gospel catharsis of “I Want To Know What Love Is” is gloriously effective.

    Top Tracks on ‘Memoirs of an Imperfect Angel’

    • “H.A.T.E.U.”
    • “It’s a Wrap”
    • “Up Out My Face”
    • “I Want To Know What Love Is”

    Solid Musical Statement

    Mariah Carey set out on this album to explore her inner self and lay it bare in song. Memoirs of an Imperfect Angel is a solid, cohesive musical statement that works as that very rare thing in today’s pop music world, a genuine concept album. Mariah Carey has clearly suffered her share of emotional pain, but she remains standing, and, in the performance of “I Want To Know What Love Is,” it sounds like she is positively resolute about heading fearlessly into the future. The recording standards here are of a very high quality, and the songs grow in interest with repeated listening. Memoirs of an Imperfect Angel is a worthy addition to the Mariah Carey catalog.

    October 28, 2009 Posted by | 1 | Leave a comment