NCTR Research Highlights: “FAQ: Microbes and Oil Spills.”

Current Highlight from February 25, 2011


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Microbes and Oil Spills

The Director of NCTR's Division of Microbiology was a colloquium participant with other experts from the American Academy of Microbiology that published a report titled “FAQ: Microbes and Oil Spills.” The publication addresses questions raised following the Gulf oil spill, which sparked concern over the Gulf seafood supply, and provides science-based answers concerning the natural processes of oil degradation by microorganisms. The publication is posted on the American Academy of Microbiology website under Colloquia-Reports23.

NCTR Strategic Planning

On February 23-24, 2011, NCTR administrators and Division Directors met to discuss and develop NCTR’s Strategic Plan for 2011-2015. The discussion focused on identification of Center goals and outcomes in support of the FDA mission.

Colloquia Reports


NCTR Publications > NCTR Research Highlights

Eculizumab un anticuerpo monoclonal para la hemoglobinuria paroxística nocturna - JANO.es - ELSEVIER

HEMATOLOGÍA
Eculizumab, un anticuerpo monoclonal para la hemoglobinuria paroxística nocturna
JANO.es · 28 Febrero 2011 13:05

.Un estudio demuestra que los pacientes afectados tratados con dicho fármaco tienen los mismos índices de supervivencia que la población general.


La hemoglobinuria paroxística nocturna (HPN) se ha convertido en una de las pocas enfermedades raras con un tratamiento que demuestra los mismos índices de supervivencia que la población general. Así lo indica el estudio que el departamento de Hematología del Hospital Universitario St. James de Leeds (Inglaterra), liderado por el Prof. Peter Hillmen, llevado a cabo durante ocho años (2002-2010) con la participación de 79 pacientes.

El estudio, que se presentó en la pasada edición del congreso anual de la Sociedad Americana de Hematología, demuestra que el fármaco es capaz de reducir significativamente el riesgo de trombosis, la causa de muerte más común entre los pacientes HPN. De hecho, se habían producido 34 episodios trombóticos en 21 de los 79 pacientes (el 27%) antes de ser tratados con eculizumab. Sin embargo, en los pacientes tratados con el fármaco sólo se produjeron 2 casos de trombosis.

Asimismo, el tratamiento redujo drásticamente la necesidad de transfusiones de sangre que estos pacientes requieren a causa de la anemia. De esta manera, el estudio de la supervivencia de los pacientes con HPN tratados con eculizumab concluye que se trata de un fármaco tolerado a largo plazo (más de 8 años de tratamiento), que es capaz de frenar el desarrollo de trombosis y que supone una mejora continua de los síntomas asociados a la HPN.

Por otra parte, la semana pasada se celebró en Barcleona la IV Reunión HPN, donde, entre otras novedades, se presentaron los registros nacional e internacional de HPN. El Registro Nacional, tal como expuso la Dra. Montserrat López, del Hospital Príncipe de Asturias de Alcalá de Henares, “surge a partir de la aprobación europea de eculizumab para recoger datos anuales de la enfermedad”. Este registro, iniciado el pasado mes de abril de 2010, cuenta con la participación de 21 centros.

El Dr. Álvaro Urbano, del Hospital Clínic de Barcelona, expuso el trabajo que se está realizando en el Registro Internacional de HPN, que cuenta con el análisis de 766 casos a día de hoy y tiene 200 centros activados en todo el mundo que introducen datos de pacientes. Gracias a estos registros se conoce, por ejemplo, que la edad media de los pacientes diagnosticados de HPN es de 32 años y el 52% son mujeres.

En el encuentro también se expusieron los puntos básicos de la Guía Clínica de HPN, que ha sido confeccionada por el grupo de trabajo de la Sociedad Española de Hematología.

Por último, la IV Reunión HPN contó con la participación de la Dra. Anita Hill, del Hospital St. James’s de Leeds y miembro del equipo del Dr. Hillmen, que presentó, por primera vez en

España, los resultados del estudio de pacientes de HPN tratados con eculizumab.

Soliris (eculizumab)
Soliris - FDA-Approved Treatment for PNH Disease | Soliris.net.

Actualidad Ultimas noticias - JANOes - Eculizumab un anticuerpo monoclonal para la hemoglobinuria paroxistica nocturna - JANO.es - ELSEVIER

NIAID Clinical Trials Update - Rare Diseases - ClinicalTrials.gov - ClinicalTrials.gov

NIAID Clinical Trials Update – Rare Diseases

NIAID recognizes Rare Disease Day, February 28, 2011, which was established to raise awareness of the impact these diseases have on patients’ lives and the importance of biomedical research to develop diagnostics and treatments. NIAID is seeking volunteers to participate in clinical trials on rare conditions. The following are selected trials with links to full study titles, descriptions, and locations:


► Investigational Treatment for Idiopathic CD4 Lymphocytopenia (NCT00839436) evaluates the safety and immune-boosting ability of interleukin 7 in patients with idiopathic CD4 lymphocytopenia (ICL).
· Who may be eligible? Individuals 18 years of age and older diagnosed with ICL.
full-text
Interleukin-7 (CYT107) Treatment of Idiopathic CD4 Lymphocytopenia: Expansion of CD4 T Cells
(ICICLE) - Full Text View - ClinicalTrials.gov



► Reducing the Side Effects of Standard Treatment of Loa Loa Infection (NCT01111305) evaluates the experimental drug reslizumab in the treatment of Loa loa infection.
· Who may be eligible? Individuals 18 to 65 years of age who have lived in or traveled to Loa-endemic regions in central and western Africa for at least 1 month.

full-text:
A Randomized, Placebo-controlled, Double-blind Pilot Study of Single-dose Humanized Anti-IL5 Antibody (Reslizumab) for the Reduction of Eosinophilia Following Diethylcarbamazine Treatment of Loa Loa Infection - Full Text View - ClinicalTrials.gov



► Rituximab for Treatment of Systemic Sclerosis-Associated Pulmonary Arterial Hypertension (NCT01086540) aims to determine if the drug rituximab has a beneficial effect on disease progression, with minimal toxicity, when compared to placebo in patients with systemic sclerosis-associated pulmonary arterial hypertension (SSc-PAH).
· Who may be eligible? Individuals 18 to 70 years of age with SSc-PAH.

full-text:
Rituximab for Treatment of Systemic Sclerosis-Associated Pulmonary Arterial Hypertension (SSc-PAH) - Full Text View - ClinicalTrials.gov




► Safety Trial of Fludase in Adults with Bronchiectasis (NCT01113034) evaluates whether the medication DAS181 is safe in people with well-controlled asthma or bronchiectasis.
· Who may be eligible? Individuals 18 to 65 years of age with a diagnosis of bronchiectasis based on CT scan findings within 12 months of study enrollment, less than 2 acute exacerbations in the last 12 months and none in the last 4 weeks, and who have had no change in treatment for chronic lung infection within the last 3 months.

full-text:
A Safety Trial of DAS181 (Fludase®) in Adult Subjects With Well-Controlled Asthma or Bronchiectasis - Full Text View - ClinicalTrials.gov



► Scleroderma: Cyclophosphamide or Transplantation (SCOT – NCT00114530) compares two ways of treating scleroderma. Find out more on the SCOT study Web site.
· Who may be eligible? Individuals 18 to 69 years of age with severe forms of scleroderma.

full-text:
Scleroderma: Cyclophosphamide or Transplantation (SCOT) - Full Text View - ClinicalTrials.gov

How UV Radiation Triggers Melanoma

February 7-28, 2010


How UV Radiation Triggers Melanoma
A protein that immune cells use to communicate with each other is involved in the development of melanoma, a new study shows. The findings offer fresh insight into how melanoma may develop in some patients and suggest a new potential target for treatment.

A human melanoma cell grown in culture. Image by Anne Weston, LRI, CRUK, all rights reserved by Wellcome Images. Melanoma is an aggressive skin cancer that often resists drug treatment. It arises when pigment-producing skin cells, called melanocytes, become cancerous. Unfortunately, melanoma is becoming more common every year.

Studies have shown that exposure to ultraviolet (UV) radiation from the sun increases your risk of getting melanoma, especially if you had sunburns during childhood. Over the last several years, a team of scientists has used genetically engineered mice to confirm the link between UV and melanoma. The team, including Dr. Glenn Merlino and Dr. M. Raza Zaidi of NIH’s National Cancer Institute (NCI), has recently been working to decipher the nature of that link.

In the current study, published online in Nature on January 19, 2011, the researchers set out to determine what changes take place when melanocytes are exposed to UV radiation. The scientists developed mice whose melanocytes expressed a green fluorescent protein. The cells could then be easily tracked in the mouse and purified from the skin.

The team exposed the mice to levels of UV radiation that would normally cause sunburn in people. They saw greater numbers of melanocytes in the skin afterward, and the cells migrated toward the outer skin layer. Analysis of the cells showed that they expressed a set of genes known to respond to a protein called interferon-gamma (IFN-g). These changes did not occur when the researchers blocked IFN-g in the mice, suggesting that this protein is involved in activating melanocytes upon exposure to UV radiation. The finding is surprising because IFN-g had previously been thought to contribute to the body’s defenses against cancer.

The scientists figured out that the IFN-g came from immune cells called macrophages, which entered the skin upon UV exposure. When the team mixed these UV-elicited macrophages with melanoma cells and transplanted them into mouse skin, they saw increased growth of tumors. However, macrophages taken from mice that hadn’t been exposed to UV didn’t promote tumor growth. The increased tumor growth also disappeared when the researchers blocked IFN-g.

Finally, the team looked at human melanoma tumors. They found that 70% of them contained macrophages producing IFN-g. Taken together, these findings strongly suggest that IFN-g-producing macrophages play a substantial role in promoting UV-induced melanoma. Therefore, treatments that block IFN-g after sunburn might prevent melanocytes from becoming cancerous.

"We anticipate that this discovery may change how interferons are used in the clinic as anticancer agents," says Merlino. "If applicable to humans, our findings raise the possibility that targeting the IFN-g pathway may represent a novel, less toxic therapeutic alternative for effective treatment of a subset of malignant melanoma patients, who currently have poor cure rates."

Related Links:
Melanoma:
http://www.cancer.gov/cancertopics/types/melanoma

Pigment Gene Affects Risk for Melanoma:
http://www.nih.gov/researchmatters/july2006/07072006pigment.htm


full-text:
How UV Radiation Triggers Melanoma

Recently Updated Advisory Committee Materials

Recently Updated Advisory Committee Materials
- - Posted on February 28, 2011
Pharmaceutical Science and Clinical Pharmacology Advisory Committee

.FDA Briefing Information for the March 2, 2011 Meeting of the Advisory Committee for Pharmaceutical Science and Clinical Pharmacology (PDF – 1.82MB)1 (PDF - 3292KB)

.Briefing Information for the March 2, 2011 Meeting of the Pharmaceutical Science and Clinical Pharmacology Advisory Committee2

.Committee Roster for the March 2, 2011 Meeting of the Pharmaceutical Science and Clinical Pharmacology Advisory Committee3 (PDF - 29KB)

.Draft Meeting Roster for the March 2, 2011 Meeting of the Pharmaceutical Science and Clinical Pharmacology Advisory Committee4 (PDF - 31KB)

.Draft Questions for the March 2, 2011 Meeting of the Pharmaceutical Science and Clinical Pharmacology Advisory Committee5 (PDF - 28KB)

.Draft Agenda for the March 2, 2011 Meeting of the Pharmaceutical Science and Clinical Pharmacology Advisory Committee6 (PDF - 21KB)

.2011 Meeting Materials, Pharmaceutical Science and Clinical Pharmacology Advisory Committee7


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Recently Updated Advisory Committee Materials

Motor Oil For Your Joints -- Research Summary | Medical News and Health Information

Motor Oil For Your Joints -- Research Summary

BACKGROUND:
According to the Arthritis Foundation, arthritis is the most common cause of disability in the United States, limiting the activities of nearly 21 million adults. Arthritis is a group of conditions involving damage to the joints of the body. There are over 100 different forms of arthritis. The most common form, osteoarthritis, is a result of trauma to the joint, infection of the joint, or age. Other arthritis forms are rheumatoid arthritis, psoriatic arthritis, and autoimmune disease, in which the body attacks itself. Each year, arthritis results in nearly 1,000,000 hospitalizations and close to 45,000,000 outpatient visits to health care centers.

The causes of arthritis depend on the form. Causes include injury metabolic abnormalities, hereditary factors, the direct and indirect effect of infections, and a misdirected immune system with autoimmunity. Symptoms of arthritis include pain; limited function of joints; and inflammation of the joints, which is characterized by joint stiffness, swelling, redness, and warmth. (SOURCE: The Arthritis Foundation)

TREATMENT:
The treatment of arthritis is very dependent on the precise type of arthritis present. An accurate diagnosis increases the chances for successful treatment. Some treatments available include physical therapy, splinting, cold-pack application, paraffin wax dips, anti-inflammatory medications immune-altering medications, and surgical operations.

A NEW SHOT AT LIFE:
Viscosupplementation is a way to treat osteoarthritis of the knee. In recent years, it's also been used to treat arthritis in the hip. Viscosupplementation involves an injection, made from a natural substance, which lubricates and cushions joints. These injections can typically provide up to six months of pain relief. It's about 15-minute procedure for patients, and they’ll be able to go home immediately after the treatment. Doctors may take X-rays of the patient, infusing a dye to show them that the needle is in the arthritic joint. Then, they inject the gel directly in that spot. It cushions and lubricates the area -- just like real cartilage. MORE


FOR MORE INFORMATION, PLEASE CONTACT:

Sandra Tansman, Director of Marketing
Cedars-Sinai Imaging Medical Group
Los Angeles, CA
tansmans@cshs.org

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Motor Oil For Your Joints -- Research Summary | Medical News and Health Information


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Motor Oil For Your Joints | Medical News and Health Information

Shocking The Shakes From Parkinson's -- Research Summary | Medical News and Health Information

Shocking The Shakes From Parkinson's -- Research Summary

BACKGROUND:
Parkinson's disease (PD) is a disorder of the brain that causes individuals to experience tremors and difficulty with walking, movement, and coordination. The disorder may affect one or both sides of the body. According to the National Institute of Neurological Disorders and Stroke, there is no cure for PD, but a variety of medications and therapies can provide dramatic relief from the symptoms. One such treatment is deep brain stimulation (DBS). DBS is a surgical procedure used to treat a variety of disabling neurological symptoms, but it's commonly used to treat PD patients. In 2002, DBS was FDA-approved to treat Parkinson's.

TREATMENT:
During DBS, a thin lead containing electrode contacts is implanted into a specific target area in the brain. The lead extends through a small opening in the skull below the skin and is connected to an extension wire with a connection behind the ear. The wire is connected to an impulse generator that is implanted under the skin just below the collarbone. Once the system is in place, electrical impulses are sent from the neurostimulator up along the extension wire and the lead and into the brain. These impulses block the electrical signals that cause PD symptoms. Programming of the stimulation is easy and painless using an external magnetic control box. The patient is left awake during the surgery (which typically lasts two to three hours). On average, the hospital stay is 24 hours. The stimulators are turned on for the first time three weeks after implantation. (SOURCE: University of Miami)

PROGNOSIS:
At present, DBS is used only for patients whose PD symptoms cannot be adequately controlled with medications. DBS specifically helps treat tremors, rigidity, stiffness, slowed movement, and walking problems. Although most patients still need to take medication after undergoing DBS, many experience a significant reduction of their PD symptoms and are able to reduce their medications. The amount of reduction varies from patient to patient. The reduction in dose of medication leads to a significant improvement in side effects such as dyskinesias (involuntary movements caused by long-term use of levodopa). In some cases, the stimulation itself can suppress dyskinesias without a reduction in medication. (SOURCE: Mayo Clinic) MORE

FOR MORE INFORMATION, PLEASE CONTACT:

Stanford Hospitals & Clinics
Movement Disorders Center
(650) 723-6469

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Shocking The Shakes From Parkinson's -- Research Summary | Medical News and Health Information

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Shocking The Shakes From Parkinson's | Medical News and Health Information

Rescuing a Cop: Saving Christine From A Brain Tumor -- Research Summary | Medical News and Health Information

Rescuing a Cop: Saving Christine From A Brain Tumor -- Research Summary

BACKGROUND:
According to the National Institutes of Health, a primary brain tumor is a group of abnormal cells that start in the brain. These tumors can directly destroy brain cells. They can also damage cells by producing inflammation, putting pressure on other parts of the brain, and increasing pressure within in the skull. Brain tumors can be noncancerous (benign) or cancerous (malignant). The cause of primary brain tumors is unknown; however, there are some possible risk factors that may play a role. These can include radiation therapy to the brain and some inherited conditions. The risk of using cell phones has been debated in recent years. However, most studies have shown cell phones, cordless phones and wireless devices are safe and do not increase the risk.

SYMPTOMS:
There are many symptoms of a brain tumor. Some tumors may not cause symptoms until they have grown very large. These symptoms depend on the tumor's size, location, how far it has spread and related swelling. Some of the most common symptoms include headaches, seizures, weakness in one part of the body, and changes in a person's mental functions.

TREATMENT:
Treatment for brain tumors depends on each individual case but can involve surgery, radiation and chemotherapy. These types of tumors are typically best treated by a team involving a neurosurgeon, a radiation oncologist, an oncologist or neuro-oncologist, and other health care providers. Some tumors may be completely removed surgically. However, those that are deep inside the brain or those that enter the brain tissue may be debulked instead of entirely removed. Debulking is a procedure to reduce the tumor's size. Other medications may be used to treat primary brain tumors in children. Physical and occupational therapy may also be needed to improve quality of life in some patients.

LIFE-SAVING SURGERY:
Dr. Bob Shafa from UCLA had a patient with a brain tumor that threatened her sight. It was twisted around her optic nerve. The patient was losing vision rapidly and would become blind if the tumor became larger. The tumor was also strangling the major arteries that supply the brain with blood and oxygen. Dr. Shafa removed the upper portion of the patient's eye socket to gain a window into the tumor at the base of her skull. This was then placed back after the tumor was removed. Dr. Shafa performed the surgery under a microscope. Once the tumor was isolated, the microscope had to be used to meticulously separate it from the optic nerve and the major arteries of the brain. This process took many hours. Today, that patient is clear of any tumor. MORE


FOR MORE INFORMATION, PLEASE CONTACT:

Mark Wheeler, Senior Media Relations Representative
UCLA Health Sciences
Los Angeles, CAmwheeler@mednet.ucla.edu

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Rescuing a Cop: Saving Christine From A Brain Tumor -- Research Summary | Medical News and Health Information

When Words Get Stuck - NIH News in Health, February 2011

When Words Get Stuck
An Update on Stuttering



In “The King’s Speech,” a recent movie set in pre-World War II England, soon-to-be King George VI has to conquer a stammer (Americans call it a stutter) that has hindered him since childhood and makes public speaking an agony. With the help of a speech therapist, the king learns how to control his stutter enough to get through a speech. But King George never completely defeated his stutter. Although he managed to overcome the characteristic repetition of sounds at the beginnings of words, in old films you can still see him pausing, grimacing, gathering his courage and moving on as best he can.

More than 50 years later, therapies for those who stutter aren’t that different from the king’s. Many, like King George's, focus on learning ways to minimize the impact of the disorder. They involve learning to speak more slowly, regulating breathing, and gradually progressing from single-syllable responses to longer words and more complex sentences.

Stuttering affects more than 3 million people in America and another 60 million worldwide. Approximately 75% to 85% of those who stutter in childhood will outgrow it when they become adults. However, there is currently no way to know who will stop and who will continue. Boys are more than twice as likely as girls to stutter, a difference that increases even more in adulthood, when men are 3 to 4 times more likely to stutter than women.

People have recognized stuttering as a speech disorder for thousands of years. They’ve speculated about what causes it for just as long. In King George’s time, it was thought to stem from childhood emotional trauma or an unhealthy attachment to a parent, usually the mother. Today, some people still mistakenly think that stuttering is caused by psychological or social problems, or nervousness and anxiety.

That’s beginning to change because of a recent discovery by a team of researchers led by NIH scientists. They identified changes in 3 different genes that appear to play a role in stuttering. The researchers propose that part of the brain dedicated to fluency of speech may be uniquely sensitive to problems caused by defects in these genes. Further research could provide new insights into what causes stuttering. Eventually, this work may suggest ways to correct the problem.

Researchers hope that one day stuttering can be treated as a biological disorder with a medical cure, not a character weakness. In the meantime, if you or your child stutters, a variety of treatments are available. Talk to a speech-language pathologist—a health professional trained to test and treat children with voice, speech and language problems—about the options.
When Words Get Stuck - NIH News in Health, February 2011

Vitamin D

Dietary Supplement Fact Sheet: Vitamin D


What is vitamin D and what does it do?

Vitamin D is a nutrient found in some foods that is needed for health and to maintain strong bones. It does so by helping the body absorb calcium (one of bone's main building blocks) from food and supplements. People who get too little vitamin D may develop soft, thin, and brittle bones, a condition known as rickets in children and osteomalacia in adults.

Vitamin D is important to the body in many other ways as well. Muscles need it to move, for example, nerves need it to carry messages between the brain and every body part, and the immune system needs vitamin D to fight off invading bacteria and viruses. Together with calcium, vitamin D also helps protect older adults from osteoporosis. Vitamin D is found in cells throughout the body.

full-text:
Vitamin D


Where can I find out more about vitamin D?

•For general information on vitamin D:
◦Office of Dietary Supplements Health Professional Fact Sheet on Vitamin D.
◦Office of Dietary Supplements Vitamin D QuickFacts.
◦Vitamins, MedLinePlus®


•For more information on food sources of vitamin D:
◦U.S. Department of Agriculture (USDA) National Nutrient Database Web site
◦Vitamin D Content of Selected Foods, USDA.


•For more advice on buying dietary supplements:
◦Office of Dietary Supplements Frequently Asked Questions: Which brand(s) of dietary supplements should I purchase?


•For information on the government's food guidance system:
◦MyPyramid
◦Dietary Guidelines for Americans

Safety Alerts for Human Medical Products > Negative Pressure Wound Therapy (NPWT) systems - Preliminary Public Health Notification

Negative Pressure Wound Therapy (NPWT) systems

FDA notified healthcare professionals of an update of activities to date involving NPWT, including a summary of additional adverse event reports received by the FDA since November 2009, as well as new recommendations for health care providers and patients/caregivers, and information about pediatric use. The safety and effectiveness of NPWT systems in newborns, infants and children has not been established at this time and currently, there are no NPWT systems cleared for use in these populations.

Read the MedWatch safety alert, including links to the FDA safety communication, at:
http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm190704.htm

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Safety Alerts for Human Medical Products > Negative Pressure Wound Therapy (NPWT) systems - Preliminary Public Health Notification

IntraMed - Artículos - ¿Cuándo solicitar una tomografía en casos de cefalea?

28 FEB 11 | Atención médica y evolución de los pacientes
¿Cuándo solicitar una tomografía en casos de cefalea?
El abuso de la tomografía computarizada por cefalea en pacientes ambulatorios es preocupante. Debido a que la exposición a la radiación conlleva el riesgo de cáncer se debe evitar cuando las probabilidades de enfermedad grave son escasas.

Dres. You J, Gladstone J, Symons S
The American Journal of Medicine
english version (abstract):
Patterns of Care and Outcomes After Computed Tomography Scans for Headache
Patterns of Care and Outcomes After Computed Tomography Scans for Headache


Introducción

La cefalea es uno de los motivos más frecuentes de consulta al médico de atención primaria, al servicio de urgencias o al neurólogo. Si bien en la amplia mayoría de los pacientes la cefalea no es causada por ninguna enfermedad grave, sí lo es en una pequeña minoría, por lo que la evaluación clínica del paciente con cefalea es esencial. Los médicos a menudo se sienten obligados a indicar estudios por imágenes para investigar la cefalea porque:

1) el error diagnóstico o el retraso en el diagnóstico puede causar mortalidad o discapacidad de por vida.

2) con frecuencia el paciente está muy ansioso y teme que la cefalea sea la manifestación inicial de una enfermedad grave, como un tumor cerebral.

Hay muy pocas recomendaciones para asistir a los profesionales en el empleo de los estudios por imágenes a fin de evaluar a los pacientes con cefalea. Estudios transversales mostraron que la tomografía computarizada (TC) para evaluar la cefalea en pacientes ambulatorios no es muy útil para el diagnóstico, ya que sólo se descubren datos que pueden ser importantes en el 0,2-2% de los pacientes estudiados. Estos datos hacen pensar que los estudios por imágenes se emplean en exceso para evaluar a los pacientes con cefalea y causan demasiados gastos y exposición innecesaria a la radiación.

Los autores efectuaron un estudio de cohortes retrospectivo en el que los datos de un estudio transversal de auditoría de TC en pacientes ambulatorios se cruzaron con datos sanitarios administrativos para evaluar el empleo de los servicios sanitarios y la evolución de los pacientes tras la TC por cefalea.

Material y Método:

Se analizaron el empleo de los servicios sanitarios, el diagnóstico de tumor cerebral y las muertes durante el año siguiente a la TC. A estos fines se cruzaron los registros de la auditoría de 3930 TC cerebrales efectuadas en pacientes ambulatorios en 2005 en Ontario, Canadá, con 4 bases de datos administrativas. Las TC se realizaron en 20 hospitales elegidos al azar.

Enfermeras entrenadas extrajeron y resumieron datos de las indicaciones para las TC y los resultados de las mismas mediante un formulario electrónico estandarizado. Clasificaron las imágenes halladas en cada TC como incidentales (clínicamente insignificantes), indeterminadas (no se pudo identificar la presencia de un hallazgo o describir su naturaleza en la TC) o anormales. Las bases de datos permitieron rastrear los servicios de salud y la evolución de los pacientes.

El estudio incluyó sólo TC que fueron indicadas específicamente para evaluar la cefalea, con lo que la muestra quedó reducida a 623 TC cerebrales. Dos tercios de los participantes fueron mujeres y dos tercios fueron menores de 50 años.

Se identificaron las TC y las resonancias magnéticas (RM) cerebrales efectuadas durante los 10 años previos a la TC índice y durante el año posterior a ella. También se identificaron los procedimientos neuroquirúrgicos, los diagnósticos nuevos de cáncer y las muertes ocurridas durante el año posterior a la TC índice. Para las TC indicadas por médicos de atención primaria, se identificaron las interconsultas con neurólogos, médicos clínicos y neurocirujanos durante el seguimiento, así como todas las visitas de control a los especialistas durante el año posterior a la consulta inicial.

La cefalea fue el motivo más frecuente para solicitar la TC en pacientes ambulatorios.

La mayoría de las TC (578/623, 92%) fueron normales o revelaron hallazgos incidentales, clínicamente insignificantes. Una pequeña cantidad reveló hallazgos indeterminados (16/ 623, 2,6%) o anormales (29/623, 4,7%). Trece de las TC (13/623, 2,1%) tuvieron hallazgos indeterminados o anormales que podrían haber sido la causa de la cefalea del paciente.

Empleo previo y ulterior de TC y RM cerebral

A más de un cuarto de los pacientes (28,4%) se les había efectuado por lo menos una TC cerebral durante la década anterior y la más reciente se había realizado una mediana de 2,7 años antes de la TC índice. Sólo el 5,5% de los pacientes habían sido sometidos a una RM durante la década anterior. Durante el año de seguimiento, se efectuó TC a 42 pacientes (6,7%) y RM a 41 pacientes (6,6%). Fue más probable que se indicara una TC o RM ulterior si el estudio índice mostró resultados anormales o indeterminados que si éste fue normal o reveló sólo hallazgos incidentales (28,9% vs 5,1% para la TC ulterior; 33,3% vs 4,5% para la RM ulterior).

De las 42 TC realizadas durante el año posterior a la TC índice, 32 (76,2%) fueron indicadas por un médico distinto al que indicó la TC índice. De las 41 RM realizadas durante el año posterior a la TC índice MRI, 25 (61,0%) fueron indicadas por un médico distinto al que indicó el estudio índice.

Empleo de los servicios de salud y evolución tras la tc cerebral por cefalea en pacientes ambulatorios

El 75,9% (473/623) de los estudios índice fueron indicados por médicos de atención primaria. La mayor parte de los pacientes (80.3%) no vieron a un especialista durante el seguimiento. Cuando fueron consultados, los especialistas fueron neurólogos, médicos clínicos o neurocirujanos. La interconsulta fue más probable cuando el resultado del estudio índice fue anormal o indeterminado (se solicitó interconsulta para el 42,5% de estos pacientes) que cuando fue normal o incidental (se solicitó interconsulta para el 17,6% de estos pacientes) Aproximadamente la mitad de los pacientes derivados al especialista volvieron para al menos una visita de seguimiento con éste durante el año posterior a la consulta inicial.

De la cohorte total del estudio, pocos pacientes (12/623, 1,9%) fueron hospitalizados por causas neuropsiquiátricas durante el año siguiente a la TC índice por cefalea. La depresión fue el motivo de ingreso más frecuente. Sólo un paciente (0,2%), que tuvo un hallazgo indeterminado de un posible glioma en la TC índice, sufrió un tumor cerebral maligno durante el seguimiento. Seis pacientes (1,0%) murieron durante el seguimiento. Ninguno de los cuatro pacientes en quienes se pudo determinar la causa de muerte, murió por causas del sistema nervioso central.

Conclusiones

Este estudio halló que la mayor parte de las TC fueron indicadas por médicos de atención primaria, pocas TC revelaron anomalías que podrían ser causa de la cefalea y la mayoría de los pacientes no fueron derivados a un especialista.

El dato de que sólo el 2% de las TC de pacientes ambulatorios indicadas por cefalea reveló anomalías que podrían ser la causa de la cefalea concuerda con estudios previos que comprobaron la escasa utilidad de la TC en estas circunstancias.

Durante el seguimiento de un año los autores comprobaron que el diagnóstico de un tumor maligno y los procedimientos neuroquirúrgicos fueron muy raros. Fue preocupante que, para algunos pacientes del estudio la TC índice por cefalea no fue única, sino que fue una de varias TC del cerebro que recibieron, a menudo indicada por otro médico que no era quien ordenó la primera y con una mediana de tiempo desde la primera de sólo 106 días. Hay creciente inquietud de que la exposición a la radiación durante una TC pueda ser un riesgo sanitario. Una sola TC cerebral se asocia con una dosis de radiación promedio de 1-2 millisieverts (equivalente a 100-200 radiografías de tórax). El riesgo estimado de cáncer atribuible a una sola TC cerebral es del 0,005% (1/20.000) para una persona de 45 años.

El riesgo es mayor entre los pacientes más jóvenes y entre los que reciben mayores dosis acumuladas de radiación como resultado de múltiples pruebas radiodiagnósticas.

Desafortunadamente, hasta la fecha no se han identificado características clínicas útiles para descartar causas graves de cefalea.

Un estudio clínico aleatorio halló que la ansiedad disminuía a los 3 meses entre pacientes a quienes se les había efectuado TC.

Entrevistas con especialistas en Ontario sugieren que algunos especialistas no reciben a los pacientes para interconsulta a menos que traigan el informe de una TC o una RM.

Es probable que las TC repetidas, con poco valor diagnóstico y el curso clínico favorable de la mayoría de los pacientes en quienes se efectúa una TC por cefalea continúen causando preocupación por el abuso de las TC para esta indicación. Dado que se conoce el riesgo de cáncer por exposición a la radiación durante la TC, es necesario que los médicos se aseguren de que no se indican TC para aquellos pacientes que es improbable que se beneficien con ella. La creación de reglas de pronóstico clínico de gran sensibilidad que puedan eliminar la necesidad de estudios por imágenes para los pacientes con cefalea sería muy útil para los médicos de atención primaria que son quienes reciben la mayor parte de los pacientes con este síntoma tan frecuente.

♦ Comentarios y resumen objetivo: Dr. Ricardo Ferreira

IntraMed - Artículos - ¿Cuándo solicitar una tomografía en casos de cefalea?

IntraMed - Artículos - Infecciones relacionadas con los catéteres intravasculares

28 FEB 11 | ¿Cuál es el origen predominante?
Infecciones relacionadas con los catéteres intravasculares
Existen programas de prevención de máxima eficacia para abordar las diferentes fuentes de la infección relacionada con los catéteres

Dr. Leonard A. Mermel
Clinical Infectious Diseases 2011;52(2):211–212
english version (full-text): http://cid.oxfordjournals.org/content/52/2/211.full.pdf



La fuente principal de las infecciones del torrente sanguíneo relacionadas con los catéteres intravasculares ha sido un interrogante clínico y de investigación durante más de 30 años. Durante ese tiempo, se ha pasado de considerar la existencia de una sola fuente que predomina en todos los cuadros clínicos hasta un concepto más realista que acepta que la piel del sitio de inserción del catéter y el centro del catéter y el conector (es decir, una fuente intraluminal y otra extraluminal) son importantes y que hay programas de prevención de máxima eficacia para abordar las diferentes fuentes de infección.

Siempre se ha debatido acerca de la vía que siguen los microbios hasta infectar los catéteres intravasculares; la vía extraluminal deriva del sitio de inserción del catéter en la piel o la vía intraluminal, a partir de la punta del catéter, de la conexión del tubo del catéter o, con menos frecuencia, la contaminación intravenosa por líquidos.

La mayoría de las pruebas sugieren que, en general, la fuente de la infección extraluminal predomina en los catéteres colocados por un período más corto de tiempo, mientras que el origen intraluminal predomina en los catéteres que permanecen durante tiempos prolongados. En un estudio de 25 infecciones del torrente sanguíneo por catéteres a corto plazo (ITSCCP), que utilizó la huella dactilar molecular para confirmar la fuente de la infección, 15 tuvieron un origen extraluminal; 3 de fuente intraluminal y 7 podrían haber tenido su origen en cualquiera de la fuente.

En un marcado contraste, un estudio de 24 ITSCCP a largo plazo se comprobó que 5 eran de origen extraluminal, 16 intraluminal, 2 podría haber surgido a partir de cualquier fuente y, en 1 caso, la siembra hematógena provino del catéter. En otro estudio que utilizó las huellas dactilares moleculares, la duración media de la cateterización fue de 14 días para las ITSCCP, con un descenso confirmado de la fuente extraluminal; 24 días cuando la fuente fue extraluminal o intraluminal y, 64 días cuando la fuente fue confirmada como intraluminal.

La colonización intraluminal con microbios productores de biofilm fue más extendida después de la cateterización prolongada en un estudio que halló que más del 40% de la superficie intraluminal en el sitio de entrada del catéter estaba cubierta de biofilm a los 30 días, en comparación con solo el 15% en la superficie intraluminal de los catéteres en su lugar, <10 días. En un estudio de pacientes con catéteres de hemodiálisis, se hicieron hemocultivos semanales por tracción del catéter. Si un cultivo de sangre por extracción del catéter revelaba el crecimiento microbiano, luego los hemocultivos se hacían semanalmente por extracción percutánea. De los 31 pacientes, 21 desarrollaron hemocultivo positivo en un tiempo de permanencia media de 27 días. De estos 21 pacientes, 12 mostraron posteriormente un crecimiento microbiano concordante con los hemocultivos obtenidos por vía percutánea, en un tiempo medio de 32 días después del primer cultivo positivo. Estos hallazgos sugieren que la colonización concordante del catéter, medida por los hemocultivos positivos extraídos del catéter se produce en los catéteres de larga duración, y si no se controla, puede conducir a una verdadera ITSCCP. Las ITSCCP derivadas del sitio de inserción son extraluminales, por lo que la adecuada antisepsia de la zona de inserción reduce el riesgo de estas infecciones. Las ITSCCP derivadas de una fuente intraluminal reflejan una brecha en la técnica aséptica en el momento de la manipulación de los catéteres, tapas, conectores o llaves de paso o, la contaminación de la misma infusión. En un estudio, el 31% de las enfermeras no desinfectaron los conectores del catéter sin aguja antes de acceder a ellos y el 17%. De las muestras de sangre “descartada” a partir de la sangre extraída a través de estos conectores sin aguja tenían crecimiento microbiano. Esto puede reflejar la falta de tiempo para limpiar adecuadamente los conectores antes de acceder a ellos, una formación profesional inadecuada o ambos. Del mismo modo, independientemente, una relación enfermera-paciente baja, aumenta el riesgo de infección del catéter, probablemente reflejando fallas en la técnica aséptica. Del mismo modo, hay enfermeras insuficientemente capacitadas que trabajan en una unidad de cuidados intensivos, lo cual aumenta en forma independiente el riesgo de estas infecciones. Algunos conectores sin aguja se asocian con una mayor incidencia de infección del catéter, probablemente de origen intraluminal. Esto puede deberse a la dificultad de limpiar la superficie de algunos conectores que se comercializan en la actualidad, la incapacidad para desinfectar los componentes del conector interno o problemas de comportamiento, como se señaló anteriormente, lo que hace que la desinfección de los conectores antes de ser utilizados sea subóptima, o incluso, que no se desinfecten. Por otra parte, algunos estudios han comprobado que con el uso de de conectores con aguja el riesgo de colonización es menor, lo que sugiere que con los dispositivos de uso clínico actual probablemente haya diferencias en el riesgo de contaminación del torrente sanguíneo. Conclusiones

Tanto la vía de infección extraluminal como intraluminal es importante en la patogénesis de las infecciones relacionadas con los catéteres venosos centrales. Inmediatamente después de la inserción, la vía de infección predominante es la extraluminal, mientras que la vía intraluminal predomina después de un tiempo de permanencia más prolongado del catéter.

Por lo tanto, el cuidado en la inserción del catéter ayudará a prevenir las ITSCCP que se producen a los pocos días del cateterismo y el cuidado en el mantenimiento del catéter ayudará a prevenir las infecciones posteriores. Los cambios de comportamiento derivados de la educación, basada en la evidencia sobre la inserción del catéter y la utilización de un paquete de mantenimiento, como así la promesa de catéteres nuevos y de novedades en los conectores, apósitos antimicrobianos y soluciones para el lavado del catéter reducirán aún más el riesgo de infecciones relacionadas con el catéter.

♦ Traducción y resumen objetivo: Dra. Marta Papponetti. Esp. Medicina Interna.

Referencias
1. Safdar N, Maki DG. The pathogenesis of catheter-related bloodstream infection with noncuffed short-term central venous catheters. Intensive Care Med 2004;30:62–7.
2. Segura M, Llado´ L, Guirao X, et al. A prospective study of a new protocol for ‘in situ’ diagnosis of central venous catheter related bacteraemia. Clin Nutr 1993; 12:103–7.
3. Douard MC, Clementi E, Arlet G, et al. Negative catheter-tip culture and diagnosis of catheter-related bacteremia. Nutrition 1994; 10:397–404.
4. Raad I, Costerton W, Sabharwal U, Sacilowski M, Anaissie E, Bodey GP. Ultrastructural analysis of indwelling vascular catheters: A quantitative relationship between luminal colonization and duration of placement. J Infect Dis 1993; 168:400–7.
5. Dittmer ID, Sharp D, McNulty CA, Williams AJ, Banks RA. A prospective study of central venous hemodialysis catheter colonization and peripheral bacteremia. Clin Nephrol 1999; 51:34–9.
6. Chaiyakunapruk N, Veenstra DL, Lipsky BA, Saint S. Chlorhexidine compared with povidone- iodine solution for vascular cathetersite care: A meta-analysis. Ann Intern Med 2002; 136:792–801.
7. Karchmer TB, Cook EM, Palavecino E, et al. Needleless valve ports may be associated with a high rate of catheter-related bloodstream infection [abstract]. In: Program of the 15thAnnual Meeting of the Society for Healthcare Epidemiology of America (Los Angeles, CA). Washington, DC: Society for Healthcare Epidemiology of America, 2005. 307.
8. Fridkin SK, Pear SM, Williamson TH, Galgiani JN, Jarvis WR. The role of understaffing in central venous catheterassociated bloodstream infections. Infect Control Hosp Epidemiol 1996; 17:150–8.
9. Alonso-Echanove J, Edwards JR, Richards MJ, et al. Effect of nurse staffing antimicrobialimpregnated central venous catheters on the risk for bloodstream infections in intensive care units. Infect Control Hosp Epidemiol 2003; 24:916–25.
10. Jarvis WR, Murphy C, Hall KK, et al. Health care-associated bloodstream infections associated with negative- or positive- pressure or displacement mechanical valve needleless connectors. Clin Infect Dis 2009; 49:1821–7.
11. Bouza E, Mun˜oz P, López-Rodrı´guez J, et al. A needleless closed system device (CLAVE) protects from intravascular catheter tip and hub colonization: A prospective randomized study. J Hosp Infect 2003; 54:279–87.
12. Casey AL, Worthington T, Lambert PA, Quinn D, Faroqui MH, Elliott TS. A randomized, prospective clinical trial to assess the potential infection risk associated with the PosiFlow needleless connector. J Hosp Infect 2003; 54:288–93.
13. Sawyer M, Weeks K, Goeschel CA, et al. Using evidence, rigorous measurement, and collaboration to eliminate central catheterassociated bloodstream infections. Crit Care Med 2010; 38:S292–8.
14. Miller MR, Griswold M, HarrisII JM, et al. Decreasing PICU catheter-associated bloodstream infections: NACHRI’s quality transformation efforts. Pediatrics 2010; 125:206–13.
15. Sannoh S, Clones B, Munoz J, Montecalvo M, Parvez B. A multimodal approach to central venous catheter hub care can decrease catheter-related bloodstream infection. Am J Infect Control 2010; 38:424–9.
16. Maki DG. In vitro studies of a novel antimicrobial luer-activated needleless connector for prevention of catheter-related bloodstream infection. Clin Infect Dis 2010; 50:1580–7.
17. Casey AL, Mermel LA, Nightingale P, Elliott TSJ. Antimicrobial central venous catheters in adults: A systematic review and metaanalysis. Lancet Infect Dis 2008; 8:763–76.
18. Timsit JF, Schwebel C, Bouadma L, et al. Chlorhexidine-impregnated sponges and less frequent dressing changes for prevention of catheter-related infections in critically ill adults: A randomized controlled trial. JAMA 2009; 301:1231–41.
19. Venkatesh M, Rong L, Raad I, Versalovic J. Novel synergistic antibiofilm combinations for salvage of infected catheters. J Med Microbiol 2009; 58:936–44.


IntraMed - Artículos - Infecciones relacionadas con los catéteres intravasculares

RARE DISEASE - IntraMed - Noticias médicas - Día Mundial de las Enfermedades Raras

28 FEB 11 | Enfermedades que nadie debe olvidar
Día Mundial de las Enfermedades Raras
Un grupo de patologías que reclaman una actitud proactiva de todos los miembros del equipo de salud.

El 28 de febrero es un día especial dentro en el calendario griego, por eso de que siempre es el último día de cada mes, salvo cuando es bisiesto. Sin embargo, desde hace unos años es especial por otra cosa más: es el Día Mundial de las Enfermedades Raras, una fecha dedicada a un colectivo especial y tocado por el azar, compuesto actualmente por más de 3 millones de personas, y que suponen un 7% de la población mundial.

IntraMed ha realizado la primera Guía de Recursos en Enfermedades Raras de Argentina que se encuentra disponible para su descarga libre y gratuita.

Una guía de recursos sobre algunas de las enfermedades raras en nuestro país: las definiciones, los contactos con expertos, asociaciones de pacientes y familiares. Información concisa de utilidad para el médico asistencial para reducir las demoras en el diagnóstico y el acceso al tratamiento.




Guía IntraMed de Recursos en Enfermedades Raras
Para bajar el documento completo haga click debajo:
http://www.intramed.net/userfiles/2010/file/Maria/guia_03_2010web.pdf

Una investigación realizada por el equipo de IntraMed

Las publicaciones sobre el tema “Enfermedades raras” en nuestro portal han estado desde el inicio sacudidas por el estremecimiento que el contacto humano impone a la biología, a la investigación científica o a la mera difusión.

Por eso, entre otras cosas, esta guía es el resultado de un trabajo colectivo. Apenas un fragmento visible de lo que muchas personas ofrecieron con generosidad, pasión y solidaridad. Esta guía es de ellos. IntraMed sólo ha sido el espacio de confluencia de informaciones dispersas que ahora organizamos.

Este trabajo es un primer intento por paliar en alguna medida el interminable peregrinaje de tantas familias en la búsqueda de la persona indicada o del centro capacitado para la asistencia de patologías infrecuentes. En éstas, mucho más que en otras áreas de la medicina, los propios enfermos y sus familias son quienes tienen un rol determinante sobre los resultados obtenidos. Esa transferencia del poder hacia quienes padecen una enfermedad ha sido producto de una necesidad y la única vía a través de la cual se han obtenido algunas respuestas aún insuficientes.

IntraMed ofrece un recurso concreto. Una serie de datos recopilados, verificados y organizados que se proponen facilitar el contacto entre quienes tienen una necesidad y quienes tienen una respuesta. Una herramienta inmadura, incompleta y viva que se irá enriqueciendo en el futuro con los aportes que esta primera edición logre estimular.

Nuestro propósito es que el médico de atención primaria encuentre un recurso donde localizar a expertos en cada área de las enfermedades poco frecuentes. La guía aporta una muy breve definición médica del cuadro, su codificación internacional y los datos de asociaciones de familiares y centros especializados públicos y privados que hemos logrado reunir.

Aliviar el dolor es el primer objetivo del conocimiento. El resto es sana curiosidad o absurda pedantería. Entre todos somos capaces de transformar el impiadoso destino que hoy enfrentan miles de personas y de estar a la altura del coraje con que tantas madres y padres -que ahora hemos conocido bien- demuestran en silencio cada día de sus vidas.

IntraMed - Noticias médicas - Día Mundial de las Enfermedades Raras

Blog.AIDS.gov: Using Pre-Exposure Prophylaxis (PrEP) as a Prevention Tool for MSM: The Promise Comes with Challenges

ResearchFebruary 27, 2011
0Using Pre-Exposure Prophylaxis (PrEP) as a Prevention Tool for MSM: The Promise Comes with Challenges
By Ronald Valdiserri, M.D., M.P.H, Deputy Assistant Secretary for Health, Infectious Diseases, U.S. Department of Health and Human Services

Dr. Ronald Valdiserri

On Saturday, February 26th, I attended a day-long meeting organized by the Centers for Disease Control and Prevention (CDC) and hosted by the Fenway Community Health Center in Boston. The theme of the meeting was “Moving forward with PrEP Implementation.” Meeting participants included researchers involved in the original iPrEX study and other ongoing HIV prevention studies, health care providers caring for men-who-have-sex-with-men (MSM), state and local health department program directors, MSM community advocates, policy experts, and federal officials.

The meeting began with a detailed review of the iPrEx study, which included nearly 2,500 participants from Peru, Ecuador, Brazil, Thailand, South Africa, and the United States. Participants were MSM engaging in high-risk sex with other men—including a small number of transgender women who reported high-risk sex with men. The study findings, released in November 2010, showed that sexually active MSM who took a once-daily pill containing 2 anti-HIV drugs were 44% less likely to become infected with HIV, compared with participants who took a placebo.

Because iPrEx was a “blinded” study, participants did not know if they were receiving active drugs or placebos (inactive drugs). As such, all study participants received intensive risk-reduction counseling. Along with this counseling, all study participants also received monthly HIV testing, condom provision, and treatment for other acquired sexually transmitted diseases.

When these results were summarized at the Saturday meeting in Boston, the audience was reminded that the level of protection experienced by study participants who received the active drug varied widely, depending upon how consistently they took their daily pills. For those who took the daily drug at least 90% of the time, HIV risk was reduced by 73%. Others, who took the drug less frequently, had only a 21% reduction in HIV risk. Given this finding, a significant theme of our discussion in Boston was the critical role that adherence counseling must play in any future efforts to develop and implement PrEP programs for MSM.

The U.S. Public Health Service is currently at work on guidelines for PrEP use among MSM. In the meantime, CDC has released interim guidance, as well as a fact sheet on Pre-Exposure Prophylaxis for HIV Prevention (PDF). But, as our meeting in Boston highlighted, there are many critical questions that must be answered before we can move this important prevention research finding from the pages of a scientific journal and into the day-to-day lives of MSM who are at high, ongoing risk for HIV infection. Several of the major questions raised by participants were:

•Among the diverse communities of MSM in the U.S., what subset of men would be the most appropriate candidates for this new prevention tool?
•Given the disproportionate burden of HIV infection among MSM of color—many of whom also live at or near the poverty level—how will daily drug treatments be financed?
•In the real world of competing needs and resource constraints, how should PrEP programs for MSM be combined with other prevention approaches for MSM to result in the greatest pay-off in terms of decreasing new HIV infections?
•How do we build the needed capacity among medical providers, health departments, and community-based organizations so that PrEP can be implemented as part of a comprehensive package of HIV prevention services for MSM at risk for HIV?
•Could PrEP serve as a “gateway” into other equally effective—and perhaps less costly—prevention approaches for MSM?
While everyone at the Boston meeting recognized the promise of this new tool, there was a general consensus that PrEP is not a “magic bullet” and that it should not be viewed as the sole approach to reducing new HIV infections among MSM.

Moving forward with discussions about how to implement PrEP as a new prevention strategy for MSM, let’s keep in mind the necessity of supporting combined biomedical, behavioral, and structural approaches—all of which are called for in the National HIV/AIDS Strategy. Given the ongoing burden of new HIV infections among MSM communities in the United States, we are obliged to carefully examine our current approaches and, when called for, make changes in where and how we deliver our HIV prevention services.

If you enjoyed this post, please consider leaving a comment or subscribing to the feed to have future articles delivered to your feed reader or email.

Posted at 07:11 PM in HIV Vaccine, HIV/AIDS Research, PrEP, Research | Permalink |Share This Post

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EL BIRUNI: DIRECTORIO DE DOCUMENTOS EDITADOS EN FEBRERO 2011 [*]

lunes 28 de febrero de 2011
CIENCIAS MÉDICAS NEWS
CIENCIAS MÉDICAS APLICADAS
RESEARCH & CLINICAL DEVELOPMENT

EL BIRUNI: DIRECTORIO DE DOCUMENTOS EDITADOS EN FEBRERO 2011 [*]
DIRECTORIO DE DOCUMENTOS EDITADOS EN FEBRERO 2011 [*]


GRUPO DE BLOGS SALUD EQUITATIVA
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▲ CIENCIAS MÉDICAS NEWS

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▲ GESTIÓN EN SALUD PÚBLICA

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Consultas acumuladas desde enero 2009 a la fecha: 309.071
Consultas totales conjuntas (todos los blogs): 1.354.747
Páginas consultadas desde el inicio de los blogs (3): >4,5 millones

Discriminadas como sigue:
1. ARGENTINA: 44.807 [14,5%]
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3. ESPAÑA: 43.031 [13,9%]
4. MÉXICO: 40.020 [12,9%]
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3.- NCI Cancer Bulletin for February 22, 2011 - Nation...
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11.- CDC - Blogs - Safe Healthcare – NHSN Trainings Fil...
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14.- Spinal Fluid May Hold Clues to Lyme Disease, Chron...
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66.- Use of a Registry to Improve Acute Stroke Care ---...
67.- Fatal Laboratory-Acquired Infection with an Attenu...
68.- Recapitulation of premature ageing with iPSCs from...
69.- Drug Approvals and Databases > Additions/Deletions...
70.- Drug Approvals and Databases > Electronic Orange B...
71.- Orange Book: Approved Drug Products with Therapeut...
72.- Guidances (Drugs) > Individual Product Bioequivale...
73.- Development Resources > Medical, Statistical, and ...
74.- Concepts: Potential Opportunities -- NIAID Researc...
75.- February 2011 DMID Council-Approved Concepts -- NI...
76.- February 2011 DAIT Council-Approved Concepts -- NI...
77.- February 2011 DAIDS Council-Approved Concepts -- N...
78.- 6q24-related transient neonatal diabetes mellitus ...
79.- Idiopathic inflammatory myopathy - Genetics Home R...
80.- familial TAAD - Genetics Home Reference
81.- Safety Information > January 2011
82.- Largest oil spill health study to launch along Gul...
83.- Rare gene glitch may hold clues for schizophrenia ...
84.- COPD May Make Shingles More Likely: MedlinePlus
85.- More unusual, fewer usual breaks with bone drugs: ...
86.- Mammograms May Not Be Fool-Proof at Catching Secon...
87.- Cell Phones Affect Areas of the Brain, Study Shows...
88.- New Cell Phone Warning: MedlinePlus Health News Vi...
89.- NIAID International Awards -- NIAID Research Fundi...
90.- Vaccines: Recs/Schedules/Child Schedule main page
91.- Disruption of the SapM locus in Mycobacterium bovi...
92.- DNA Methylation Array Analysis Identifies Profiles...
93.- Antimicrobial resistance: no action today, no cure...
94.- NCI Cancer Bulletin for February 22, 2011 - Nation...
95.- NCI Cancer Bulletin for February 22, 2011 - Nation...
96.- NCI Cancer Bulletin for February 22, 2011 - Nation...
97.- NCI Cancer Bulletin for February 22, 2011 - Nation...
98.- NCI Cancer Bulletin for February 22, 2011 - Nation...
99.- NCI Cancer Bulletin for February 22, 2011 - Nation...
100.- NCI Cancer Bulletin for February 22, 2011 - Nation...
101.- NCI Cancer Bulletin for February 22, 2011 - Nation...
102.- NCI Cancer Bulletin for February 22, 2011 - Nation...
103.- NCI Cancer Bulletin for February 22, 2011 - Nation...
104.- NCI Cancer Bulletin for February 22, 2011 - Nation...
105.- National Guideline Clearinghouse | Routine prenata...
106.- National Guideline Clearinghouse | Diagnosis and m...
107.- RFA-AI-11-016: Combined Multipurpose Strategies fo...
108.- CDC - NIOSH Docket: 194 - Ten-Year Review of the N...
109.- Education Might Help Kidney Recipients Spot Skin C...
110.- Clots in Coronary Stents More Likely in Early Morn...
111.- Large-Scale Study Identifies Factors for Sleep Dis...
112.- Menkes Syndrome
113.- Drug Safety and Availability > FDA Drug Safety Com...
114.- Safety Alerts for Human Medical Products > Antipsy...
115.- New U.S. Dietary Guidelines Focus on Salt Reductio...
116.- U.S. Preventive Services Task Force: Opportunity f...
117.- National Guideline Clearinghouse | Evidence-based ...
118.- National Guideline Clearinghouse | Best evidence s...
119.- National Guideline Clearinghouse | Best evidence s...
120.- National Guideline Clearinghouse | Best evidence s...
121.- National Guideline Clearinghouse | Best evidence s...
122.- National Guideline Clearinghouse | ACR Appropriate...
123.- National Guideline Clearinghouse | ACR Appropriate...
124.- National Guideline Clearinghouse | ACR Appropriate...
125.- National Guideline Clearinghouse | ACR Appropriate...
126.- National Guideline Clearinghouse | ACR Appropriate...
127.- National Guideline Clearinghouse | Use of combinat...
128.- National Guideline Clearinghouse | Guidance for co...
129.- The Nutrition & Metabolism Collection
130.- HealthyChildren.org - Sweeteners and Sugar Substit...
131.- Stunting tall girls' growth may impact fertility: ...
132.- National Guideline Clearinghouse | Diagnosis and t...
133.- National Guideline Clearinghouse | British Associa...
134.- National Guideline Clearinghouse | Guideline Synth...
135.- National Guideline Clearinghouse | Guideline Synth...
136.- National Guideline Clearinghouse | Expert Commenta...
137.- Weight Loss Surgery May Cut Knee Osteoarthritis Pa...
138.- VIRUS MAYARO, PROBABLE TRANSMISIÓN URBANA - BRASIL...
139.- IntraMed - Artículos - Pruebas no invasivas para e...
140.- proteína c-reactiva y riesgo cardiovascular - Intr...
141.- fiebre hemorrágica Argentina Candid-1 | IntraMed -...
142.- Airway microbiota and bronchial hyperresponsivenes...
143.- p53 regulates biosynthesis through direct inactiva...
144.- Serotonin reverts age-related capillarization and ...
145.- Cyclin E amplification/overexpression is a mechani...
146.- Breast-Feeding May Counter Some Effects of Childho...
147.- CDC Grand Rounds: Prescription Drug Overdoses
148.- Diabetes Data and Trends
149.- Integrating pharmacogenetics into gemcitabine dosi...
150.- The Pharmacogenetic Rescue of Side-Lined Anticance...
151.- Genetics and Alcohol: A Lethal Combination in Panc...
152.- The Cardiology & Vascular Medicine Collection
153.- Status of OTC Rulemakings > Rulemaking History of ...
154.- Clinical Pharmacogenomics: Premarketing Evaluation...
155.- Assessing Suicide Risk: Initial Tips for Counselor...
156.- SAMHSA News: Veterans & Their Families: A SAMHSA P...
157.- New Suicide Prevention Training Video for Substanc...
158.- RFA-AI-11-004: Chemical Approaches to Target Valid...
159.- Genetic polymorphisms in sepsis. [Crit Care Nurs C...
160.- Polymorphisms in genes involved in folate metaboli...
161.- Genetic susceptibility to autoimmune liver disease...
162.- Genome-wide association studies in multiple sclero...
163.- Utility of genetic determinants of lipids and card...
164.- Nutrigenetics of the Postprandial Lipoprotein Meta...
165.- Genetic modifiers of cancer risk for BRCA1 and BRC...
166.- Genetic counseling for patients and families with ...
167.- New Eye Treatment May Save Preemies' Sight: Medlin...
168.- Press Announcements > FDA approves product to prev...
169.- Crib Injuries Land Thousands of Toddlers in ER Eac...
170.- Research Sheds Light on Gene Linked to Preeclampsi...
171.- Hay fever guidelines don't reflect real life: Medl...
172.- Corifact Approved for Genetic Bleeding Disorder: M...
173.- Study Says 2 Therapies Help Fight Chronic Fatigue ...
174.- Researchers identify protein essential for embryo ...
175.- Doubt cast on salt guidelines for diabetics: Medli...
176.- Age-Specific Spatio-Temporal Patterns of Female Br...
177.- Efficacy of Intravitreal Bevacizumab for Stage 3+ ...
178.- Africa, Asia and the Pacific > President's Emergen...
179.- síndrome de Laron - IntraMed - Noticias médicas - ...
180.- Autoimmune Genes Linked To Preeclampsia
181.- Noninvasive test for trisomy 21 closer at hand
182.- Decades Of Dwarf Research May Unveil New CVD Stati...
183.- Researchers link gene mutations to Ebstein's anoma...
184.- Researchers Link Gene Mutations To High Blood Pres...
185.- Presence Of 'Jumping Genes,' Amplified Oncogenes M...
186.- Whole genome sequencing used to help inform cancer...
187.- PHG Foundation | New insight for prostate cancer t...
188.- FDA Drug Safety Communication: New warnings agains...
189.- Cancer survival in Australia, Canada, Denmark, Nor...
190.- Rare Disease Day at NIH presents latest research f...
191.- Rates of Pneumonia Dramatically Reduced in Patient...
192.- Acute anemia linked to silent strokes in children
193.- Landes Bioscience Journals: Cancer Biology & Thera...
194.- Growth Hormone Receptor Deficiency Is Associated w...
195.- Press Announcements > FDA warns against certain us...
196.- Notes from the Field: Deaths from Acute Hepatitis ...
197.- Update: Influenza Activity --- United States, Octo...
198.- Potential Transmission of Viral Hepatitis Through ...
199.- Prevalence of Doctor-Diagnosed Arthritis and Arthr...
200.- Dwarfism Mutation May Protect From Cancer, Diabete...
201.- NIAID Leadership Group for a Clinical Research Net...
202.- The Future of the NIAID Clinical Trials Networks
203.- In-Hospital Blood Sugar Levels Should Be Higher: R...
204.- Recently Updated Advisory Committee Materials
205.- Vaccines and Related Biological Products Advisory ...
206.- Recent clonal origin of cholera in Haiti
207.- Differential Notch Signaling in the Epicardium Is ...
208.- U.S. hepatitis C cases down sharply since 1980s: M...
209.- Experts Issue New Heart Disease Guidelines for Wom...
210.- Higher Levels of Blood Protein Linked to Lower Res...
211.- Fluctuating Hormones Linked to More Severe Bipolar...
212.- A phase II study of sunitinib in patients with rec...
213.- Histotype predicts the curative potential of radio...
214.- Plasma TIMP-1 levels and treatment outcome in pati...
215.- Efficacy of high-dose methotrexate, ifosfamide, et...
216.- Posterior reversible encephalopathy syndrome in ch...
217.- New Guidelines OK Pradaxa Blood Thinner as Option ...
218.- Final Guidance for Industry: Potency Tests for Cel...
219.- Alcohol Disrupts Women's Sleep More Than Men's: St...
220.- Angioplasty associated with triple costs and uncle...
221.- Walking training which includes body-weight suppor...
222.- Intravenous drug did not significantly reduce stro...
223.- Hibernation stress response decreases stroke brain...
224.- Zinc May Help Ease Common Cold: Analysis: MedlineP...
225.- New anti-clotting drug added to recommendations fo...
226.- The impact of radiation therapy in patients with d...
227.- Immunoglobulin D multiple myeloma: response to the...
228.- Comparison of four prognostic scores in peripheral...
229.- Unfavorable prognosis of elderly patients with ear...
230.- Time trend in treatment-related deaths of patients...
231.- Clinical validation of an autoantibody test for lu...
232.- Long-term follow-up of HER2-overexpressing stage I...
233.- Breast cancer incidence and time trend in France f...
234.- Weekly combination of non-pegylated liposomal doxo...
235.- Positron emission tomography/computed tomography i...
236.- Integrating bevacizumab, everolimus, and lapatinib...
237.- Prognostic factors for progression-free and overal...
238.- Randomized phase III trial of 2nd line gemcitabine...
239.- Updating progress in sarcoma therapy with mTOR inh...
240.- A review of PARP inhibitors: from bench to bedside...
241.- Anthracycline cardiotoxicity in the elderly cancer...
242.- Merkel cell carcinoma, chronic lymphocytic leukemi...
243.- Chronic non-communicable diseases, the European Ch...
244.- Randomized phase III trials of second-line chemoth...
245.- Male pattern baldness and the risk of prostate can...
246.- Las increíbles imágenes de una niña con 26 dedos -...
247.- No hay evidencias de la utilidad de las plataforma...
248.- NIH-funded study finds new possible risk factor of...
249.- Advanced Imaging Reveals Secrets of Increased Frac...
250.- Perry syndrome - Genetics Home Reference
251.- Energy Drinks May Hurt Kids: Study: MedlinePlus
252.- Obesity Alone Raises Risk of Fatal Heart Attack, S...
253.- WHO | Diabetes: the sweet irony of modern technolo...
254.- Familial History of Stroke Is Associated with Acut...
255.- 'Immunogenetics of Aging': report on the activitie...
256.- Genetic predisposition to autoimmunity - What have...
257.- Recent progress in the genetics of cardiomyopathy ...
258.- Genetic analysis in cardiovascular disease: a clin...
259.- Genetically informed lung cancer medicine. [J Path...
260.- A new era: melanoma genetics and therapeutics. [J ...
261.- Perceived Impact of Diabetes Genetic Risk Testing ...
262.- New IBD genetics: common pathways with other disea...
263.- Genome-wide association studies of sleep disorders...
264.- Genetics of Liver Injury and Fibrosis. [Alcohol Cl...
265.- European Human Genetics Conference, May 28-31, 201...
266.- National Guideline Clearinghouse | Screening and o...
267.- National Guideline Clearinghouse | Prevention of s...
268.- National Guideline Clearinghouse | New antiretrovi...
269.- National Guideline Clearinghouse | Hepatitis C vir...
270.- National Guideline Clearinghouse | Diagnostic, mon...
271.- National Guideline Clearinghouse | ACR Appropriate...
272.- National Guideline Clearinghouse | ACR Appropriate...
273.- National Guideline Clearinghouse | ACR Appropriate...
274.- National Guideline Clearinghouse | ACR Appropriate...
275.- National Guideline Clearinghouse | ACR Appropriate...
276.- AMA - PCPI Performance Measures
277.- USAID Administrator Shah to deliver major global h...
278.- New NIH cookbook encourages families to eat health...
279.- Updated NDEP guide helps keep children with diabet...
280.- Surgery Before Birth Improves Spina Bifida Outcome...
281.- Rare Artery Disease Linked to Gene Variant
282.- Press Announcements > FDA finalizes regulation for...
283.- National Guideline Clearinghouse | Guideline Synth...
284.- AUA - Clinical Guidelines: management of benign pr...
285.- National Guideline Clearinghouse | Bacterial menin...
286.- National Guideline Clearinghouse | Chronic kidney ...
287.- National Guideline Clearinghouse | Guidelines of c...
288.- National Guideline Clearinghouse | Guidelines of c...
289.- Berries May Offer Sweet Protection Against Parkins...
290.- Weight Guidelines May Be High for Severely Obese M...
291.- Women at High Risk for Diabetes: Access and Qualit...
292.- Greater Caution Urged for X-Rays in Pregnancy, Inf...
293.- Few Stroke Patients Given Clot-Buster Quickly Enou...
294.- No Benefit to Lowering Blood Pressure in Acute Str...
295.- RFA-AI-11-009: Targeting Resistance in Select Gram...
296.- Vaccines: Recs/Vac-Admin/Misperceived Contraindica...
297.- Vaccines: Recs/Vac-Admin/Contraindications to Vacc...
298.- Development Resources > Medical, Statistical, and ...
299.- IntraMed - Noticias médicas - Subsidios para inves...
300.- ALERTA SARAMPIÓN - IntraMed - Noticias médicas - A...
301.- CDC - Blogs - Safe Healthcare – Implementation Sci...
302.- Food Allergy: An Overview
303.- 2nd member in Alzheimer's toxic duo identified
304.- PHG Foundation | Parkinson's influenced by more ge...
305.- PHG Foundation | International collaboration on ge...
306.- PHG Foundation | Genetic link to sleepwalking
307.- Early Risk Of Alzheimer's May Be Identified By Com...
308.- Immune System Genes Associated With Increased Risk...
309.- Gene Linked To Major Depression
310.- Genome Regions Are Signposts To The Biology Of Inf...
311.- Searching for the soul of the genome
312.- The Genotype Of Disorders Causing Cardiac Sudden D...
313.- Gene Test Could Solve Prostate Cancer Riddle And S...
314.- Sweeping View Of Prostate Cancer Genome Yields Dee...
315.- Large NIH-funded rehabilitation study looks at get...
316.- NIH study finds two pesticides associated with Par...
317.- FDA approves first 3-D mammography imaging system
318.- Press Announcements > FDA clears test to help pati...
319.- Garden Encounters Often Lead to Rashes, Hives, Itc...
320.- Testicular cancer deaths double with after 40 diag...
321.- When Given Control, Women Use Less Epidural Anesth...
322.- Fruits and veggies may not lower kids' allergy ris...
323.- Folate May Not Protect Against Premature Birth: Me...
324.- Nearly 25% of Women With Early Ovarian Cancer Not ...
325.- Drug may improve outcomes in mild stroke patients,...
326.- Ischemic stroke hospitalizations decline in middle...
327.- Advanced macular degeneration is associated with a...
328.- Stroke in Mexican-Americans expected to rise 350 p...
329.- MRI can help decide therapy in patients with uncle...
330.- Young, uninsured or Medicare Part D survivors ofte...
331.- Final data shows experimental agent better than as...
332.- Robot therapy can improve arm, shoulder mobility a...
333.- Few Stroke Patients Given Clot-Buster Quickly Enou...
334.- Fruit salad and blood sugar meters don't mix: Medl...
335.- Prescription Drug Overdoses: An American Epidemic:...
336.- Recommended Immunization Schedules for Persons Age...
337.- Genetic Discovery Improves Understanding of FSH Mu...
338.- Discordant Results from Reverse Sequence Syphilis ...
339.- Scientists Identify New Genetic Region Associated ...
340.- Genetic Findings in Alopecia Areata Have Implicati...
341.- Mouse Study Suggests New Clues to Celiac Disease: ...
342.- 'Pathway' Leading to Health Declines of Aging Iden...
343.- First Look at Prostate Cancer Genome Yields Insigh...
344.- Hallucinogens Legally Sold as 'Bath Salts' a New T...
345.- Males' Drug-Related Suicide Attempts Vary by Month...
346.- Genetic Discovery Improves Understanding of FSH Mu...
347.- Surgery on fetus reduces complications of spina bi...
348.- FDA Webinar on Safety of the Blood Supply
349.- SCIENCE REPORT en ESPAÑOL - Edición Febrero 2011 -...
350.- PAR-11-108: Centers for AIDS Research and Developm...
351.- NIAID Leadership Group for a Clinical Research Net...
352.- National Guideline Clearinghouse | Guidelines by T...
353.- National Guideline Clearinghouse | Guidelines by T...
354.- National Guideline Clearinghouse | ACR Appropriate...
355.- National Guideline Clearinghouse | ACR Appropriate...
356.- National Guideline Clearinghouse | ACR Appropriate...
357.- National Guideline Clearinghouse | ACR Appropriate...
358.- National Guideline Clearinghouse | ACR Appropriate...
359.- Shingles Returns More Often Than Thought: MedlineP...
360.- Study Links Brain Molecule to Risk of Major Depres...
361.- Birth Defect Risk Slightly Higher for Kids of Male...
362.- Rare form of stroke during pregnancies, post-partu...
363.- Warming Injections May Take Out the Sting: Medline...
364.- Lead Exposure May Raise Blood Pressure in Pregnanc...
365.- Heart Enzymes May Predict Outcome After Bypass Sur...
366.- Press Announcements > FDA approves 1st pacemaker d...
367.- Removing Many Lymph Nodes in Early Breast Cancer N...
368.- NHGRI charts course for the next phase of genomics...
369.- Drug-Resistant Pandemic (H1N1) 2009, South Korea1
370.- Genomic Analysis of Highly Virulent Isolate of Afr...
371.- Use of Intravenous Gamma Globulin and Corticostero...
372.- Structured Self-Monitoring of Blood Glucose Signif...
373.- National Guideline Clearinghouse | Zoledronic acid...
374.- National Guideline Clearinghouse | The prophylacti...
375.- National Guideline Clearinghouse | The prophylacti...
376.- National Guideline Clearinghouse | Rituximab in ch...
377.- National Guideline Clearinghouse | Primary excisio...
378.- National Guideline Clearinghouse | Imatinib mesyla...
379.- Consumer Updates > FDA Advises Women with Breast I...
380.- NCI Cancer Bulletin for February 8, 2011 - Nationa...
381.- NCI Cancer Bulletin for February 8, 2011 - Nationa...
382.- NCI Cancer Bulletin for February 8, 2011 - Nationa...
383.- NCI Cancer Bulletin for February 8, 2011 - Nationa...
384.- NCI Cancer Bulletin for February 8, 2011 - Nationa...
385.- Nosocomial Pandemic (H1N1) 2009, United Kingdom, 2...
386.- NCI Cancer Bulletin for February 8, 2011 - Nationa...
387.- NCI Cancer Bulletin for February 8, 2011 - Nationa...
388.- NCI Cancer Bulletin for February 8, 2011 - Nationa...
389.- NCI Cancer Bulletin for February 8, 2011 - Nationa...
390.- NCI Cancer Bulletin for February 8, 2011 - Nationa...
391.- NCI Cancer Bulletin for February 8, 2011 - Nationa...
392.- NCI Cancer Bulletin for February 8, 2011 - Nationa...
393.- Bartter syndrome - Genetics Home Reference
394.- Gitelman syndrome - Genetics Home Reference
395.- Dense deposit disease - Genetics Home Reference
396.- IMPORTANT SAFETY INFORMATION REGARDING ALCOHOL PRE...
397.- Pot Use Might Speed Onset of Psychosis: Study: Med...
398.- Schizophrenia Drugs May Spur Subtle Brain Tissue L...
399.- National Guideline Clearinghouse | Endometriosis: ...
400.- National Guideline Clearinghouse | Alcohol use and...
401.- National Guideline Clearinghouse | Management of c...
402.- National Guideline Clearinghouse | Guideline Synth...
403.- Clinical Practice Guidelines by the Infectious Dis...
404.- Vaccines: VFC/ACIP-VFC Resolutions
405.- Vaccines: IIS/home page
406.- Orangutan Genome Sequenced
407.- How UV Radiation Triggers Melanoma
408.- Study Reveals Parkinson’s Disease Risk Genes
409.- Dermatologists Caution That Atopic Dermatitis is a...
410.- Data Show Incidence of Skin Cancer Rising at Alarm...
411.- Going to Great Lengths for Beautiful Hair? Dermato...
412.- Red, White and Brown: Defining Characteristics of ...
413.- Small Changes in Skin Care Routine Can Significant...
414.- Dermatologists Warn That Plants Can Cause A Garden...
415.- Seniors Vulnerable to Hypothermia: MedlinePlus
416.- Just how bad is cocaine use during pregnancy?: Med...
417.- Breast Cancer Treatment May Lead to Hip Fracture: ...
418.- Rare Form of Stroke Strikes More Often Than Though...
419.- Flu breakthrough promises a vaccine to kill all st...
420.- Pharmacogenomics of antipsychotics efficacy for sc...
421.- Genome-wide Association Studies for Discovery of G...
422.- Clinical Pharmacogenetics Implementation Consortiu...
423.- [Pharmacogenetics and pharmacogenomics of methotre...
424.- Epilepsy genetics-past, present, and future. [Curr...
425.- Where are the missing pieces of the schizophrenia ...
426.- The genetics of Tourette disorder. [Curr Opin Gene...
427.- Developments in schizophrenia genetics: From linka...
428.- SLC11A1 (NRAMP1) Polymorphisms and Tuberculosis Su...
429.- Genetic epidemiology of tuberculosis susceptibilit...
430.- Review: A high capacity of the human placenta for ...
431.- Epigenetic changes of DNA repair genes in cancer. ...
432.- Effect of maternal diet on the epigenome: implicat...
433.- Genetic risk profiling for prediction of type 2 di...
434.- The American College of Gastroenterology Emily Cou...
435.- Nasopharyngeal carcinoma as a paradigm of cancer g...
436.- Genomics and the Continuum of Cancer Care — NEJM
437.- Cancer risk management strategies and perceptions ...
438.- Preventing the aortic complications of Marfan synd...
439.- The epigenetics of autoimmunity. [Cell Mol Immunol...
440.- Abstract | Synopsis and meta-analysis of genetic a...
441.- HIV/AIDS, NIAID, NIH (2)
442.- NOT-CA-11-003: Notice of Availability of Administr...
443.- HIV/AIDS, NIAID, NIH
444.- Research on Cardiovascular Disease in Women: Progr...
445.- Genomics|Translation|2009 Translation Research and...
446.- Genomics|Translation|2008 Translation Research and...
447.- The Newborn Screening Clearinghouse
448.- Review: A high capacity of the human placenta for ...
449.- PHG Foundation | China joins Human Variome Project...
450.- Rock 'N Rollin' DNA
451.- A Study From The 1000 Genomes Project Yields Data ...
452.- Genetic Alliance Funds Innovation in Newborn Scree...
453.- Researchers Uncover Genetic Clues To Compulsive, S...
454.- Researchers Identify 5 New Genetic Variations In T...
455.- BUSM Researchers Involved In First International C...
456.- Celiac Disease And Crohn's Disease Share Part Of T...
457.- NIH researchers identify genetic cause of new vasc...
458.- Altered Gene Protects Some African-Americans From ...
459.- Link Between A Women's Heart Attack Risk And Mater...
460.- Improved Prediction Of Breast Cancer Outcomes: New...
461.- Researchers Solve Decades-Old Medical Mysteries Wi...
462.- A Diagnostic Marker In Hepatocellular Carcinoma
463.- Researchers Pinpoint How One Cancer Gene Functions...
464.- Press Announcements > FDA clears first diagnostic ...
465.- Vaccines: Recs/Schedules/Child Schedule main page
466.- Vaccines: Recs/Schedules/Adult Schedule main page
467.- HIV/AIDS Update - Reyataz (atazanavi​r) label revi...
468.- Safety Alerts for Human Medical Products > America...
469.- European Subtype Tick-borne Encephalitis Virus in ...
470.- Dengue Virus Serotype 3 Subtype III, Zhejiang Prov...
471.- Surface Layer Protein A Variant of Clostridium dif...
472.- Clonal Spread of Streptococcus pyogenes emm44 amon...
473.- No Xenotropic Murine Leukemia Virus–related Virus ...
474.- Orbiviruses in Rusa Deer, Mauritius, 2007 | CDC EI...
475.- Segniliparus rugosus–associated Bronchiolitis in C...
476.- A226V Strains of Chikungunya Virus, Réunion Island...
477.- Genetic Detection of Dobrava/Belgrade Virus, Bulga...
478.- New Delhi Metallo-β-Lactamase, Ontario, Canada | C...
479.- Maternal–Fetal Transmission of Cryptococcus gattii...
480.- Hantavirus Infection in Istanbul, Turkey | CDC EID...
481.- Press Announcements > FDA review indicates possibl...
482.- New HRSA Training Module
483.- SAFE-PCI for Women Protocol Launch
484.- OWH Science Day - Gender and the Genome: A complic...
485.- NIH encourages women to take charge of their heart...
486.- Introduction of Japanese Encephalitis Virus Genoty...
487.- Monitoring and Characterization of Oseltamivir-Res...
488.- Kids' Rising Obesity Rates Due to Bad Habits, Not ...
489.- New mosquito type seen making malaria fight harder...
490.- Rare Form of Stroke Strikes More Often Than Though...
491.- Narrowed Leg Arteries Disable Women Faster Than Me...
492.- Just how bad is cocaine use during pregnancy?: Med...
493.- Study calls antibiotic-asthma link into question: ...
494.- Restrictive Diet May Reduce ADHD Symptoms: Medline...
495.- Healthier Lifestyles May Prevent 340,000 U.S. Canc...
496.- Cold Viruses Appear Linked to Type 1 Diabetes: Med...
497.- Readily Available Tissue-Engineered Vascular Graft...
498.- A Cryptic Subgroup of Anopheles gambiae Is Highly ...
499.- Vall d' Hebron Research Institute (VHIR): A study ...
500.- FDA approves drug to reduce risk of preterm birth ...
501.- Oseltamivir-Resistant Pandemic (H1N1) 2009 | CDC E...
502.- Recommended Adult Immunization Schedule --- United...
503.- Announcement: Congenital Heart Defect Awareness We...
504.- Pandemic and Seasonal Influenza Viral Loads | CDC ...
505.- Pandemic (H1N1) 2009, Abu Dhabi | CDC EID
506.- PCR Primers and Detecting Rhinovirus | CDC EID
507.- Surveillance for WNV in Dead Wild Birds | CDC EID
508.- Workshops, Meetings & Conferences (Biologics) The...
509.- Drug Safety and Availability FDA Drug Safety Comm...
510.- El Hospital: Hospital-acquired pressure ulcers at ...
511.- Pandemic (H1N1) 2009–associated Pneumonia | CDC EI...
512.- Eschar-associated Spotted Fever Rickettsiosis, Bah...
513.- Novel HIV-1 Recombinants | CDC EID
514.- Blastomycosis in Man after Kinkajou Bite | CDC EID...
515.- New Avian Influenza Virus (H5N1), China | CDC EID
516.- Alert System for School-based Outbreaks | CDC EID
517.- Primary Amebic Meningoencephalitis, Pakistan | CDC...
518.- Oseltamivir-Resistant Pandemic (H1N1) 2009 | CDC E...
519.- Transmission of A. armillatus Ova, The Gambia | CD...
520.- Unusual Transmission of Plasmodium falciparum | CD...
521.- School Closures and Student Contact Patterns | CDC...
522.- NDM-1 in Traveler, Canada | CDC EID
523.- Full bladder wakes one in five men at night: Medli...
524.- CDC Features - High Blood Pressure & Cholesterol: ...
525.- Gene test may help spot lethal prostate tumors: Me...
526.- Scientists Discover Rare Vascular Disease: Medline...
527.- Joubert syndrome - Genetics Home Reference
528.- Isoniazid-Resistant Tuberculous Meningitis, United...
529.- NIH researchers identify genetic cause of new vasc...
530.- About the Center for Drug Evaluation and Research:...
531.- Evaluation of a screening tool for bleeding disord...
532.- Mapping copy number variation by population-scale ...
533.- Endocrine Disruptor Knowledge Base (EDKB) EDKB Re...
534.- CDC - DHDSP - Vital Signs: High Blood Pressure and...
535.- Harmful Algal Blooms: Pfiesteria: About | CDC HSB
536.- Pediatricians Issue New Vaccination Recommendation...
537.- Too Few Get Needed Rheumatoid Arthritis Drugs: Stu...
538.- More Evidence Cancer Drug Avastin May Cause Harm: ...
539.- HIV Linked to Higher Pregnancy Rate in Young Women...
540.- Test for blocked neck arteries only necessary for ...
541.- Maternal stroke history tied to women’s heart atta...
542.- Routine Osteoporosis Screening Recommended for All...
543.- Call for Public Review: Effectiveness of Cochlear ...
544.- Guidance for Clinical Investigators, Sponsors, and...
545.- GENETICS DISEASES - Genetics Home Reference
546.- Collaboration Fuels Promising New Approach to a TB...
547.- Adverse Events Reporting System (AERS) Potential ...
548.- NIH summit to focus on management of radiation dos...
549.- Level of tumor protein indicates chances cancer wi...
550.- Antioxidants halt axonal degeneration in a mouse m...
551.- Arbovirus Prevalence in Mosquitoes, Kenya | CDC EI...
552.- Next-Generation Sequencing of C. immitis | CDC EID...
553.- Leptospirosis in Hawaii | CDC EID
554.- Phocine Distemper Virus in Seals | CDC EID
555.- Penicillium marneffei in Humans and Rodents | CDC ...
556.- Pandemic (H1N1) 2009 Virus Reassortment | CDC EID
557.- Risk Factors for Cryptococcus gattii Infection | C...
558.- Severe Cases of Pandemic (H1N1) 2009 in Children |...
559.- Human Infections with Non-O157 STEC, Switzerland |...
560.- Hepatitis E Virus and Neurologic Disorders | CDC E...
561.- Vol. 17, No. 2 Cover: The Icy Realm of the Rime | ...
562.- New U.S. Dietary Guidelines Focus on Salt Reductio...
563.- Drowsiness May Decline After Apnea Surgery: Medlin...
564.- Sex During Pregnancy Deemed Safe: MedlinePlus
565.- Why a Woman May Avoid a Mammogram: MedlinePlus
566.- New 'mini' surgeries offer little over original: M...
567.- Too many narcotics prescribed after surgery: study...
568.- Odds of Quitting Smoking May Be Clear on Scans: Me...
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570.- Survival After Stroke Better for Blacks: MedlinePl...
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