<?xml version="1.0" encoding="utf-8"?>
<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_449"
                     title="FDA Approves Statin for Use in Healthy Adults"
                     score="0.01"
                     href="http://www.medpagetoday.com/InfectiousDisease/PublicHealth/tb/18380?impressionId=1265674928081"
                     
      &lt;br&gt;WASHINGTON -- The FDA has approved rosuvastatin (Crestor) for use in primary prevention of cardiovascular disease. The label change will add elevated highly-sensitive C-reactive protein as an indication for rosuvastatin in adults who have no other cardiovascular risk. &lt;br&gt;&lt;b&gt;Developing story.&lt;/b&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_448"
                     title="Inflammatory Bowel Disease Linked to Dangerous VT (CME/CE)"
                     score="0.01"
                     href="http://www.medpagetoday.com/Gastroenterology/InflammatoryBowelDisease/tb/18362?impressionId=1265674928081"
                     
      &lt;p&gt;Patients with active inflammatory bowel disease (IBD) could be at far greater risk for potentially deadly blood clots than doctors previously thought, a new British study found.&lt;/p&gt;
&lt;p&gt;Nonhospitalized patients with active IBD are 16 times more likely to suffer venous thromboembolism than the general population, with an occurrence rate of 6.4 per 1,000 person-years (HR 15.8, 95% CI 9.8 to 25.5, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.0001), according to an online report in the Feb. 9 issue of &lt;em&gt;The Lancet&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;The authors concluded that such patients could benefit from preventative treatment to prevent blood clotting.&lt;/p&gt;
&lt;p&gt;&quot;Despite the low absolute risks during nonhospitalised periods, these results suggest that active inflammatory bowel disease in ambulatory patients might be a far greater risk factor for venous thromboembolism than previously recognised,&quot; Matthew J. Grainge, MD, of the University of Nottingham, and colleagues wrote.&lt;/p&gt;
&lt;p&gt;Patients with venous thromboembolism in the leg have a short term-mortality rate of about 6%, increasing as high as 20% when the clot has circulated to the lung.&lt;/p&gt;
&lt;p&gt;Researchers believe that infection and inflammation, such as occur in IBD, predispose patients to this life-threatening condition, and those with inflammatory bowel disease seem to be at particular risk.&lt;/p&gt;
&lt;p&gt;Grainge and colleagues used records from the U.K. General Practice Research Database from November 1987 through July 2001, to match 13,756 patients with IBD against 71,672 controls without the disease.&lt;/p&gt;
&lt;p&gt;Of the subjects, 139 patients and 165 controls developed a blood clot during the study period.&lt;/p&gt;
&lt;p&gt;Their results agreed with previous studies indicating that patients hospitalized for IBD are at high risk for venous thromboembolism. However, the new study also found the danger extends to nonhospitalized IBD patients, particularly during a flare-up.&lt;/p&gt;
&lt;p&gt;Overall, the researchers reported, patients with IBD had three times as much risk of an embolism as controls (HR 3.4, 95% CI 2.7 to 4.3; &lt;em&gt;P&lt;/em&gt;&amp;lt;0.0001) with an occurrence rate of 2.6 per 1,000 per person-years.&lt;/p&gt;
&lt;p&gt;During a flare-up, IBD patients were at dramatically greater risk.&lt;/p&gt;
&lt;p&gt;The researchers cautioned that the study excluded patients likely to have received corticosteroids for chronic respiratory disease and rheumatoid arthritis, so the results may not reflect blood clotting rates in these populations.&lt;/p&gt;
&lt;p&gt;They also noted that they relied on anonymous patient records and were dependent on family doctors&apos; diagnoses of inflammatory bowel disease, flare-ups and venous thromboembolism.&lt;/p&gt;
&lt;p&gt;Despite the limitations of the study, they argued that research into ways to prevent embolism in IBD outpatients is warranted.&lt;/p&gt;
&lt;p&gt;&quot;We believe that the medical profession needs to recognise the increased risk in people with inflammatory bowel disease when assessing the likelihood of venous thromboembolism and to address the difficulty of reducing this risk in patients with a flare who are not admitted to hospital,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;They suggested that strategies used to prevent blood clots in hospitalized patients  --  courses of low molecular weight heparin or other newly available anticoagulants  --  might be also be used to prevent clots in nonhospitalized IBD patients experiencing a flare-up.&lt;/p&gt;
&lt;p&gt;In an accompanying editorial, Geoffrey C. Nguyen, MD, and Erik L. Yeo, MD, of the University of Toronto, noted that &quot;the use of steroid prescriptions as a surrogate indicator of acute disease flare restricts the applicability of Grainge and colleagues&apos; findings to flares that are moderate to severe. Whether patients with mild flares are also at increased risk is not clear.&quot;&lt;/p&gt;
&lt;p&gt;&quot;Recognition of venous thromboembolism might be increased during periods of frequent contact with doctors, such as during flares compared with during remission of inflammatory bowel disease, thus potentially introducing a bias in ascertainment of venous thromboembolism,&quot; they added.&lt;/p&gt;
&lt;p&gt;Nguyen and Yeo also argued that the clinical efficacy and cost-effectiveness of pharmacological prevention in patients with inflammatory bowel disease should be proven before it is routinely recommended during acute flares.&lt;/p&gt;
&lt;p&gt;However, they acknowledged that such evidence could be difficult to acquire, given the low numbers of nonhospitalized IBD patients who suffer venous thromboembolism.&lt;/p&gt;
&lt;p&gt;&quot;A pragmatic initial approach to reduction of the rates of morbidity and mortality resulting from venous thromboembolism in ambulatory patients with inflammatory bowel disease would be nonpharmacological thromboprophylaxis, including patients&apos; education and awareness of risk and signs and symptoms of venous thromboembolism, and use of support stockings,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;&quot;Physicians should clinically assess for signs and symptoms of this embolism during visits for acute flare of inflammatory bowel disease.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was funded by the National Association for Colitis and Crohn&apos;s Disease.&lt;/p&gt;&lt;p&gt;The authors reported no financial conflicts of interest.&lt;/p&gt;&lt;p&gt;Nguyen reported serving on advisory boards for Schering-Plough, Canada, and Abbott Pharmaceuticals.&lt;/p&gt;&lt;p&gt;Yeo reported receiving an honorarium from sanofi-aventis.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_447"
                     title="BLOG: Wearing Many Hats"
                     score="0.01"
                     href="http://www.medpagetoday.com/Blogs/18369?impressionId=1265674928081"
                     
      I was surprised by the outcome of a &lt;a target=&quot;_blank&quot; href=&quot;http://www.medpagetoday.com/Neurology/HeadTrauma/18227&quot;&gt;study&lt;/a&gt; of the benefits of wearing helmets while skiing and snowboarding. A pooled analysis of nine earlier studies found that helmet wearers were 35% less likely to suffer a head injury than those without helmets.&lt;br&gt;
&lt;br&gt;
Only 35%!? From personal experience I would have guessed it to be at least 65% -- or more. In all the wipeouts I&apos;ve had on the slopes, the only time I blacked out and suffered a concussion was when I wasn&apos;t wearing a helmet.&lt;br&gt;
&lt;br&gt;
I&apos;m a wearer of many hats, because I engage in several outdoor activities -- and the 
&lt;b&gt;&lt;a target=&quot;_blank&quot; href=&quot;http://www.theenglishmall.com/images/product/1312/3829f4f43e0d014a8ef3d06a6dd8321f.jpg&quot;&gt;snowboard helmet&lt;/a&gt;&lt;/b&gt; ranks at the top of my protective headgear list. It keeps my head warm, and although I&apos;ve been riding for 15+ years, I still add new scratches to its shell.&lt;br&gt;
&lt;br&gt;
This is a helmet I truly believe in.&lt;br&gt;
&lt;br&gt;
Same goes for my old &lt;b&gt;&lt;a target=&quot;_blank&quot; href=&quot;http://www.hockeydogs.com/ProductImages/helmets/CCM%20H892.jpg&quot;&gt;ice hockey helmet&lt;/a&gt;&lt;/b&gt;, which by league regulation must be worn and surely saved my life on many occasions.&lt;br&gt;
&lt;br&gt;
Next: my &lt;b&gt;&lt;a target=&quot;_blank&quot; href=&quot;http://www.westernsafety.com/msaproducts/msapg48traditionalhelmet.jpg&quot;&gt;firefighting helmet&lt;/a&gt;&lt;/b&gt;. In addition to being required by all sorts of governmental agencies, this one is a must. It&apos;s made of thermoplastic or composite material and shields me from heat, falling and flying debris, and water spray. A fireproof lining adds additional protection to the neck and ears, and it dual-functions as a carrier for door-wedges and flash lights.&lt;br&gt;
&lt;br&gt;
I would expect all of these helmets to decrease my risk of head injury far beyond a mere 35%. I feel this statistic may apply more to helmets for less risky activities.&lt;br&gt;
&lt;br&gt;
My &lt;b&gt;&lt;a target=&quot;_blank&quot; href=&quot;http://www.bigaussiehats.com/images/bell_triton_helmet.jpg&quot;&gt;bike helmet&lt;/a&gt;&lt;/b&gt;, for example. I consider it more of a social hat. Personally I don&apos;t think it&apos;ll really do that much for me if I take a bad spill, but since I have one, I usually do wear it -- if nothing else, it sets a good example for kids. There are times when its use is required to participate in events such as &lt;a target=&quot;_blank&quot; href=&quot;http://www.bikenewyork.org/&quot;&gt;Bike NYC&lt;/a&gt; or to ride trails in state parks such as the &lt;a target=&quot;_blank&quot; href=&quot;http://www.lakeminnewaska.org/state.html&quot;&gt;Minnewaska State Park&lt;/a&gt; in the Catskill Mountains.&lt;br&gt;
&lt;br&gt;
Then there&apos;s the &lt;b&gt;&lt;a target=&quot;_blank&quot; href=&quot;http://www.nevisport.com/images/prod-img/373002_ecrinred_zoom.jpg&quot;&gt;rock climbing helmet&lt;/a&gt;&lt;/b&gt;. I highly doubt it&apos;ll offer much protection in case of a major vertical drop. However I can attest to its &lt;a target=&quot;_blank&quot; href=&quot;http://content.backcountry.com/images/items/medium/PTZ/PTZ0203/EHORG.jpg&quot;&gt;shielding powers&lt;/a&gt; against small rocks or even a stray carabiner that may drop from above, and it does offer protection during contact with the wall during short uncontrolled drops. Chances are you&apos;re climbing in an isolated area that&apos;s hard for rescue crews to reach, so why not throw this one in your backpack before you head out?&lt;br&gt;
&lt;br&gt;
On occasion I also use a &lt;b&gt;&lt;a target=&quot;_blank&quot; href=&quot;http://www.powerkiteshop.com/images/productimages/safety/gathstdhelmet.jpg&quot;&gt;water sport helmet&lt;/a&gt;&lt;/b&gt;. There is some discussion in the windsurf and kitesurf community regarding their usefulness since crashing into water does not produce that hard of an impact. There is however the potential of your board smacking you in the head during a wipe out, or hitting a piece of floating debris, ending up like &lt;a href=&quot;http://www.fksa.org/showpost.php?s=95217d805383fc659a0e1d68f3d5ffc0&amp;p=2264&amp;postcount=2&quot; target=&quot;_blank&quot;&gt;this guy&lt;/a&gt;. When you&apos;re out on the ocean and away from immediate help, wearing one might make the difference between hurting and drowning.&lt;b&gt;&lt;b&gt;&lt;b&gt;&lt;b&gt;&lt;br&gt;
&lt;br&gt;
&lt;br&gt;
&lt;img align=&quot;middle&quot; src=&quot;/images/blogMedia/bjoernkils/Blog_8_GX_web.jpg&quot;&gt;&lt;br&gt;
&lt;/b&gt;&lt;/b&gt;&lt;/b&gt;&lt;/b&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_446"
                     title="Proteins Linked to Stress-Induced ACS (CME/CE)"
                     score="0.01"
                     href="http://www.medpagetoday.com/Cardiology/AcuteCoronarySyndrome/tb/18373?impressionId=1265674928081"
                     
      The heart-pounding excitement of Sunday&apos;s Super Bowl football game might have sent some fans to hospital with acute coronary syndrome.&lt;br&gt;
&lt;br&gt;But researchers in Germany say it may be possible to distinguish these cases from people whose coronary syndrome wasn&apos;t stress-related.&lt;br&gt;
&lt;br&gt;Two proteins known as endothelin-1 (ET-1) and &lt;span&gt;monocyte&lt;/span&gt; chemoattractant protein-1 (MCP-1) appear to be highly sensitive and specific markers of excitement-induced acute coronary syndromes, according to Ute Wilbert-Lampen, MD, and colleagues at Ludwig-Maximilians-Universit&amp;#228;t in Munich.&lt;/p&gt;
&lt;p&gt;In a cohort study, the two compounds were markedly elevated in people whose coronary syndromes were associated with excitement and stress over World Cup soccer games, the researchers reported in the Feb. 16 issue of the &lt;em&gt;Journal of the American College of Cardiology&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;And the protein levels were significantly higher than in either healthy controls or a group of matched patients whose coronary syndrome was not associated with the soccer matches, the researchers said.&lt;/p&gt;
&lt;p&gt;Wilbert-Lampen and colleagues reported in 2008 that they had found 2.7-fold spike in the incidence of acute cardiovascular events in association with the 2006 World Cup soccer matches. (See &lt;a href=&quot;http://www.medpagetoday.com/Cardiology/Atherosclerosis/8171&quot; mce_href=&quot;http://www.medpagetoday.com/Cardiology/Atherosclerosis/8171&quot; target=&quot;_blank&quot;&gt;Cardiovascular Events Spike During Critical World Cup Soccer Matches&lt;/a&gt;)&lt;/p&gt;
&lt;p&gt;Although excitement and stress caused the events, exactly how remained unclear, they reported in the journal.&lt;/p&gt;
&lt;p&gt;To help clarify the issue, they looked at 58 representative patients from the earlier analysis for whom blood samples were available. They were compared with the same number of healthy controls and 58 reference patients with acute coronary syndromes&lt;strong&gt; &lt;/strong&gt;who reported no emotional involvement with the World Cup.&lt;/p&gt;
&lt;p&gt;In addition to ET-1 and MCP-1, blood samples were tested for a range of substances, including soluble CD40L (sCD40L), soluble vascular cell adhesion molecule-1 (sVCAM-1), tumor necrosis factor-&amp;#945; (TNF-&amp;#945;), high-sensitivity C-reactive protein (hsCRP), and regulated on activation, normal T-cell expressed and secreted (RANTES).&lt;/p&gt;
&lt;p&gt;The researchers found: &lt;ul&gt; &lt;li&gt;The study group had average ET-1 levels of 4.0 picograms per milliliter, compared with 2.0 for the reference patients and 1.1 for the health controls. Both between-group differences were significant at &lt;em&gt;P&lt;/em&gt;&amp;lt;0.001.&lt;/li&gt; &lt;li&gt;A similar pattern was seen for MCP1 and TNF-&amp;#945;.&lt;/li&gt; &lt;li&gt;The other markers  --  sVCAM-1, hsCRP, and RANTES -- yielded less clear results.&lt;/li&gt; &lt;li&gt;In both groups of patients, ET-1 was significantly correlated (at &lt;em&gt;P&lt;/em&gt;&amp;lt;0.001) with sCD40L and with MCP-1, but other markers were correlated with one or the other or neither.&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;In a receiver operating curve analysis, ET-1 and MCP-1 were found to have diagnostic potential, the researchers said, with the areas under the curve being 0.99 and 0.98, respectively.&lt;/p&gt;
&lt;p&gt;In such an analysis, an area under the curve of 1.0 would mean the proposed diagnostic tool would be completely accurate, without either false positives or false negatives.&lt;/p&gt;
&lt;p&gt;Using a cutoff of 3.1 picograms per milliliter, ET-1 had a sensitivity of 100% and a specificity of 96.6%, the researchers said, while a cutoff of 396 picograms per milliliter for MCP-1 resulted in 93.1% sensitivity and 93.1% specificity.&lt;/p&gt;
&lt;p&gt;One implication of the findings, the researchers said, is that it may be valuable to begin developing prophylactic and therapeutic drugs targeting ET-1.&lt;/p&gt;
&lt;p&gt;They noted that because of the design of the original study, a range of information was not available, including data on troponin or stress-hormone levels, cardiovascular risk factors, infarct size, or clinical outcome.&lt;/p&gt;
&lt;p&gt;Despite those gaps, the study has &quot;some exciting features,&quot; according to Karina Davidson, PhD, of Columbia University College of Physicians and Surgeons in New York City.&lt;/p&gt;
&lt;p&gt;Among other things, she wrote in an accompanying editorial, the study provides &quot;evidence for the importance&quot; of ET-1 in stress-induced ischemic syndromes.&lt;/p&gt;
&lt;p&gt;It may now be possible, she argued, to identify what other factors come into play and eventually to determine who is at risk for such events.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by Else Kr&amp;#246;ner-Fresenius Stiftung. The researchers did not report potential conflicts.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_445"
                     title="Physician Charged in Michael Jackson Death"
                     score="0.01"
                     href="http://www.medpagetoday.com/EmergencyMedicine/EmergencyMedicine/tb/18368?impressionId=1265674928081"
                     
      &lt;p&gt;Conrad Robert Murray, MD, the physician attending Michael Jackson when the pop singer died of cardiac arrest last June, has been charged with involuntary manslaughter in Los Angeles.&lt;/p&gt;
&lt;p&gt;Murray was to be arraigned this afternoon. If convicted, he could receive a maximum prison term of four years.&lt;/p&gt;
&lt;p&gt;According to the L.A. County District Attorney&apos;s office, Murray &quot;did unlawfully, and without malice, kill Michael Joseph Jackson . . . in the commission of an unlawful act, not amounting to a felony; and in the commission of a lawful act which might have produced death, in an unlawful manner, and without due caution and circumspection.&quot;&lt;/p&gt;
&lt;p&gt;Witnesses said Murray was with Jackson when the 50-year-old singer collapsed at his rented home in Beverly Hills. Murray tried to revive Jackson there with CPR, then accompanied him to a hospital. Jackson was pronounced dead at the hospital without regaining consciousness.&lt;/p&gt;
&lt;p&gt;Subsequent statements from investigators indicated that Murry had injected Jackson with the anesthetic agent propofol earlier that day, apparently to help Jackson sleep.&lt;/p&gt;
&lt;p&gt;The singer had long complained of insomnia, according to news reports.&lt;/p&gt;
&lt;p&gt;After an autopsy, the Los Angeles county coroner&apos;s office &lt;a href=&quot;http://www.medpagetoday.com/ProductAlert/Prescriptions/15736&quot; mce_href=&quot;http://www.medpagetoday.com/ProductAlert/Prescriptions/15736&quot; target=&quot;_blank&quot;&gt;ruled in August&lt;/a&gt; that Jackson died of an overdose involving multiple drugs, including propofol and lorazepam (Ativan). Other drugs found in his system included midazolam, diazepam, lidocaine, and ephedrine.&lt;/p&gt;
&lt;p&gt;News reports indicated that other physicians besides Murray had prescribed drugs for Jackson. In addition to insomnia, the singer was believed to suffer from chronic pain related to burns suffered during the filming of a television commercial years earlier.&lt;/p&gt;
&lt;p&gt;The Reuters news service reported that Murray had told investigators he was not the first physician to give propofol to Jackson.&lt;/p&gt;
&lt;p&gt;In numerous public statements, Murray has maintained his innocence of wrongdoing.&lt;/p&gt;
&lt;p&gt;When Jackson died, he was about two weeks from beginning a series of 50 concerts in London, his first major performance effort in a decade. The posthumous concert film &quot;This Is It&quot; was filmed during rehearsals for the series.&lt;/p&gt;
&lt;p&gt;Although paparazzi photographs released in the months prior to his death portrayed the singer looking frail and gaunt  --  one showed him in a wheelchair  --  he appeared healthy in the film.&lt;/p&gt;

    </recommendedItem>
</recommendedContent>
