First diagnostic indicator for Amytrophic Lateral Sclerosis (ALS) identified
Mount Sinai School of Medicine researchers have identified three proteins that may be first tools for confirming diagnosis of ALS
Published in this month's issue of Neurology.
Researchers from Mount Sinai School of Medicine identified three proteins that are found in significantly lower concentration in the cerebral spinal fluid of patients with ALS than in healthy individuals. These are the first biomarkers for this disease .
"ALS is a very difficult disease to diagnose. To date, there is no one test or procedure to ultimately establish the diagnosis of ALS. It is through a clinical examination and series of diagnostic tests, often ruling out other diseases," website of the ALS Association.
Giulio Pasinetti, MD, PhD, Professor of Psychiatry, Neuroscience, and Geriatrics and Adult Development, Mount Sinai School of Medicine and colleagues compared cerebral spinal fluid from patients diagnosed with ALS, patients with other neurological disorders, and healthy individuals. They found that fluid from patients with ALS had significantly lower concentrations of three proteins than either of the other groups. Evaluating the levels of these three proteins proved 95% accurate for diagnosing ALS.
The researchers found that the changes in concentration of these proteins were evident within 1.5 years of onset of symptoms. With current methods, the average time from onset of symptoms to diagnosis is two years . Testing for these protein concentrations may provide a means of early diagnosis, allowing patients to receive relief from symptoms years earlier...
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Aspirin to Prevent Heart Attack and Stroke: What's the Right Dose?
James E. Dalen MD, MPH
Professor Emeritus, University of Arizona, Tucson
Available online 20 February 2006
Abstract
Despite hundreds of clinical trials, the appropriate dose of aspirin to prevent myocardial infarction (MI) and stroke is uncertain. In the US, the doses most frequently recommended are 80, 160, or 325 mg per day. Because aspirin can cause major bleeding, the appropriate dose is the lowest dose that is effective in preventing both MI and stroke because these two diseases frequently co-exist. Five randomized clinical trials have compared aspirin with placebo or no therapy for the prevention of stroke and MI. These trials varied with regard to the dose of aspirin, the duration of treatment, and, most important, the populations selected for study varied in their baseline risk of stroke and MI. In men, 160 mg/day consistently lowered the risk of MI. In women, doses of 50 mg, 75, and 100 mg/day did not significantly decrease the risk of MI; therefore, the appropriate dose in women must exceed 100 mg/day. The appropriate dose for the primary prevention of stroke in men and women has not been established. Doses of 75 and 100 mg/day have been ineffective in men and women. The appropriate dose must be at least 160 mg/day. The lowest dose to prevent recurrent MI or death in patients with stable coronary artery disease (CAD) is 75 mg/day. In acute MI the lowest dose is 160 mg/day. In patients with a history of stroke or transient ischemic attack (TIA), 50 mg/day has been shown to be effective in men and women. In acute stroke, 160 mg/day is effective in preventing recurrent stroke or death. The risk of major bleeding with 160 mg/day is the same as with 80 mg/day: 1 to 2 cases per 1000 patient years of treatment, and the risk of fatal bleeding is the same with 80 and 160 mg/day. These studies indicate that the most appropriate dose for the primary and secondary prevention of stroke and MI is 160 mg/day.
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---------- Forwarded message ----------
From: Dr. Maulik Baxi
Date: Feb 19, 2006 12:12 AM
Subject: Calcium doens't prevent postmenopausal fractures contrary to popular opinion
To: SBA
Hi!
Please go through this excellent clinical data, study lasting over 7 years in about 36000 patients gives significant and sufficient data to prove that there is
no role of calcium in preventing post-menopausal fractures. On the contrary, it significantly increases incidence of renal calculi.I think this is sufficient evidence to stop prescribing calcium tablets haphazardly to each and every patient that comes across. Active weight bearing still holds the key and such exercises need to be advised more frequently than calcium
as preventive measure.The article doesn't touch area of fracture healing and more evidence is needed to support or refute if calcium supplements help in expediting fracture healing. Therefore in cases of traumatic fractures calcium supplementation might be needed.
In case of pathological fractures, each and every case merits individualized attention according to underlying pathology.
I seek comments and guidance of my seniors on this issue. Apparently not an issue of life and death but still important in day-to-day clinical practice. I'd be grateful if you could throw some light.
Thank you.
Maulik
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Read the abstract here. For complete article go to
http://content.nejm.org/cgi/content/full/354/7/669 ABSTRACT Background The efficacy of calcium with vitamin D supplementation for preventing hip and other fractures in healthy postmenopausal women remains equivocal.
Methods We recruited 36,282 postmenopausal women, 50 to 79 years of age, who were already enrolled in a Women's Health Initiative (WHI) clinical trial. We randomly assigned participants to receive 1000 mg of elemental calcium as calcium carbonate with 400 IU of vitamin D3 daily or placebo. Fractures were ascertained for an average follow-up period of 7.0 years. Bone density was measured at three WHI centers.
Results Hip bone density was 1.06 percent higher in the calcium plus vitamin D group than in the placebo group (P<0.01). Intention-to-treat analysis indicated that participants receiving calcium plus vitamin D supplementation had a hazard ratio of 0.88 for hip fracture (95 percent confidence interval, 0.72 to 1.08), 0.90 for clinical spine fracture (0.74 to 1.10), and 0.96 for total fractures (0.91 to 1.02). The risk of renal calculi increased with calcium plus vitamin D (hazard ratio, 1.17; 95 percent confidence interval, 1.02 to 1.34). Censoring data from women when they ceased to adhere to the study medication reduced the hazard ratio for hip fracture to 0.71 (95 percent confidence interval, 0.52 to 0.97). Effects did not vary significantly according to prerandomization serum vitamin D levels.Conclusions Among healthy postmenopausal women, calcium with vitamin D supplementation resulted in a small but significant improvement in hip bone density, did not significantly reduce hip fracture, and increased the risk of kidney stones. ( ClinicalTrials.gov number, NCT00000611 [ClinicalTrials.gov] .)--
Maulik Baxi, MBBS
Baroda, India
+91-982-541-6408
maulik_baxi@rediffmail.com --
"Nanavaptam avaptavyam varta eva ca karmani" : The God says to Arjuna : Nor I am in want of anything, nor have I need to obtain anything--and yet I am engaged in work. [The Bhagavad Gita - 3.22 @
http://www.asitis.com]
Parents should not pressurise their child to speak in a slow and clear manner as it will make child feel that he/she may have a problem of stuttering and may affect his/her further developmental progress.
Read article of Professor Goetz Schade, who is the head of the Phoniatrics and Paedaudology Section of Bonn's University Clinic. (EurekAlert!)
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