Day: 09/05/2012

What’s the Best Route for Subacromial Injections?

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In a randomized trial, lateral and anterior routes were better than posterior.

The subacromial bursa can be injected using anterior, lateral, or posterior approaches. To determine which approach is best, U.S. researchers performed a study in which each of 75 patients with rotator cuff syndrome was randomized to one of these three approaches. A single orthopedist (who traditionally had used the posterior approach) performed all injections, which contained corticosteroid, local anesthetic, and radiopaque contrast medium. After the injections, shoulders were x-rayed to determine whether the contrast was within the bursa.

The proportion of patients whose injections were intrabursal was significantly greater with the lateral and anterior approaches (92% and 84%, respectively) than with the posterior approach (56%). The lower accuracy of the posterior approach was especially striking in women. Pain relief at 1 hour was significantly greater in patients whose injections were intrabursal than in those whose injections were extrabursal.

Comment: A limitation of this study is that a single physician did the injections; nevertheless, the authors discuss anatomic reasons why the posterior route might be the least accurate. I’ve always done subacromial injections via the lateral approach; this study vindicates that practice.

Source: Journal Watch General Medicine

 

 

Brits Warned Over Deadly Rodent Virus.

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Recent UK visitors to Yosemite park in the US are being contacted after an outbreak of a lethal disease spread by rodents.

UK health officials are contacting around 100 Britons they believe could have been exposed to a deadly rodent virus while on holiday in the US this summer.

Six visitors to California’s Yosemite National Park have so far been infected with Hantavirus Pulmonary Syndrome (HPS), a disease caused by breathing in infected rodent dropping or urine particles.

Hantavirus kills around 38% of people it infects. Of the six confirmed cases, two men have died.

It is not certain that any of those affected have been British citizens.

In a statement, the UK’s Health Protection Authority (HPA) said: “Hantavirus Pulmonary Syndrome is a rare but severe respiratory disease, which is sometimes fatal.

“It is spread by contact with infected rodents, primarily deer mice.

“The virus causing HPS in the US cannot be passed from person to person.

“There is no specific treatment for Hantavirus, but early recognition and supportive care can improve the outcome of this severe disease.”

The recent cases have all been associated with people staying in Yosemite National Park’s Signature Tent Cabins in the Boystown area of Curry Village.

Five of the six reported cases are known to have stayed in these cabins.

The HPA is only contacting British citizens known to have done the same, between the identified risk period from June 10 to August 24, 2012.

America’s Centre for Disease Control estimates that around 10,000 travellers from all over the world stayed in the cabins during that time.

Park officials, who last week shut down the popular camping ground, said a design flaw in the cabins allowed mice to get inside the insulated walls.

It is believed the rodents’ faeces, saliva and urine dried out and mixed with dust that was inhaled by visitors staying in the confined spaces.

Eating contaminated food or being bitten by infected rodents can also cause infection.

Tracking the outbreak has been made more difficult by the long incubation period of hantavirus, which can be up to six weeks.

According to the HPA, victims display flu-like symptoms, including fever, chills, headache, muscle aches, fatigue and a cough.

Other symptoms can include nausea, vomiting and abdominal pain.

The disease can then progress very rapidly, resulting in severe difficulty in breathing as the lungs fill with fluid.

Since the virus was first identified in the USA in 1993 there have been 556 confirmed cases.

 

Source: http://news.sky.com

 

New data for Novartis drug Lucentis® confirms long-term efficacy and safety profile and benefits of individualized treatment .

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  • REPAIR study shows an average of three Lucentis® injections improve visual acuity in patients with myopic choroidal neovascularization
  • RESTORE extension study demonstrates DME patients fully maintained initial vision gains with an average of 13.9 Lucentis injections over three years
  • Retrospective analysis reinforces Lucentis well-characterized safety profile in wet AMD; ongoing LUMINOUSTM program now involves over 10,000 patients

 

New data for Lucentis® (ranibizumab), the only anti-VEGF therapy licensed across three ocular indications, show that individualized treatment with Lucentis provides sustained improvement in vision with a low number of injections. It is estimated that over 80% of visual impairment is preventable when due to conditions such as wet age-related macular degeneration (wet AMD), diabetic macular edema (DME), and visual impairment due to macular edema secondary to retinal vein occlusion (RVO)[1]. These conditions can eventually lead to blindness if left untreated.

 

“Lucentis has become the standard of care in wet AMD and has helped to significantly improve vision in a majority of patients with this disease.” said Tim Wright, Global Head of Development, Novartis Pharma. “These new data confirm that an individualized treatment approach can lead to optimal improvements in vision with a low average number of treatments, thus ensuring that patients with retinal diseases are not over- or under-treated. In addition, these data add to the well-characterized safety profile of Lucentis”.

 

Lucentis also demonstrated benefits in visual acuity outcomes in patients with visual impairment due to choroidal neovascularization (CNV) secondary to pathological myopia (PM). Lucentis is currently not approved to treat this condition. Novartis will submit for regulatory approval in this indication in the European Union in the third quarter of this year and in Japan by the end of 2012.

 

Novartis is dedicated to the research, development and manufacturing of ophthalmic pharmaceuticals. The mission of Novartis in the field of ophthalmology is to discover, develop and manufacture innovative products to improve eye health and enhance people’s lives.

 

Lucentis study highlights at the 12th European Society of Retina Specialists (EURETINA) Congress in Milan, Italy include[2]-[4]:

 

REPAIR

This one year study performed in twelve centers in the United Kingdom explored the efficacy and safety profile of 0.5 mg Lucentis administered on an individualized basis in 65 patients with myopic CNV. After six months of treatment, mean visual acuity improved by twelve letters. Patients received an average of three Lucentis injections with 29 % requiring no further treatment beyond the first injection. This analysis shows that Lucentis therapy leads to improvement in visual acuity in patients with this condition. The six month interim results and the full one year data will be presented at Euretina. Currently, photodynamic therapy with Visudyne® (verteporfin) is the only approved medical treatment for this condition.

 

RESTORE

In the RESTORE extension study, 240 patients with DME received individualized treatment with Lucentis according to a regimen consistent with the European Union label. Results showed that patients who were originally treated with Lucentis received an average of 13.9 injections over three years. 19-25% of patients across all study arms did not require any Lucentis injections during years two and three. An average of 3.7 injections in the second year and 2.7 in the third year were sufficient to fully maintain the mean of seven letters of visual acuity gained in the RESTORE core study. The safety profile was consistent with previous studies conducted in other indications. There were no cases of endophthalmitis reported within the RESTORE core and extension studies.

 

“The results of this study show that individualized treatment with Lucentis can lead to a significant improvement in vision and that these improvements are sustained in the long term” said Professor Francesco Bandello, Department of Ophthalmology, Hospital San Raffaele, University Vita Salute San Raffaele, Milan, Italy and president elect of EURETINA. “It is important that we explore how these insights apply to real-world clinical practice to ensure that we are providing the best possible care for our patients”.

 

LUMINOUS

The Luminous program is one of the largest observational studies in ophthalmology and consists of two parts launched in 2011. The retrospective part comprises pooled data from four European registries of nearly 4,500 patients with wet AMD treated with Lucentis. These data showed no new safety signals for Lucentis and reinforces its well-characterized safety profile. The registries revealed low incidences of key adverse events at 12-months. Additionally, a low number of Lucentis injections were observed during the first year. The mean number of Lucentis injections over twelve months ranged from 4.3 to 5.0 (based on all patients) and 4.7 to 5.5 (based on patients completing one year).

 

The prospective part of Luminous is expected to provide important long-term evidence on the real-world effectiveness and safety profile of Lucentis in its licensed indications. This 5-year study is ongoing and currently has more than 5,500 patients enrolled. It is expected to recruit more than 30,000 patients from clinics across Asia, Australia, Europe, North and South America.

 

About Lucentis® (ranibizumab)

Lucentis is a humanized therapeutic antibody fragment designed to block all biologically active forms of vascular endothelial cell growth factor-A (VEGF-A). Increased levels of VEGF-A are seen in wet AMD and other ocular diseases such as diabetic macular edema (DME) and retinal vein occlusion (RVO). Lucentis has been designed, developed and formulated specifically for use in ocular disease with the aim of stabilizing and improving visual acuity in these patients, while minimizing the risk of systemic side effects.

 

Lucentis is licensed for the treatment of wet AMD in more than 100 countries, in more than 80 countries for the treatment of visual impairment due to DME and in 80 countries for visual impairment due to macular edema secondary to RVO, including both branch- and central-RVO. In many countries, including those in Europe, Lucentis has an individualized treatment regimen with the goal of maximizing visual outcomes while minimizing under- or over-treating patients.

 

Novartis and Alcon sponsor the eXcellence in Ophthalmology Vision Award (XOVA). XOVA is an annual award launched in 2010 that provides funding to non-profit initiatives and projects that will have a positive impact on improving the quality of eye care and make a significant impact in addressing unmet needs in the fields of ophthalmology and optometry.

 

Lucentis has a well-characterized safety profile and Novartis systematically monitors the safety and tolerability of Lucentis for licensed indications on an ongoing basis. Its safety profile has been well established in a clinical development program that enrolled more than 10,000 patients across indications. Since its launch in the United States in 2006, there are more than one million patient-treatment years of exposure for Lucentis.

 

Serious adverse events related to the injection procedure include endophthalmitis, retinal detachment, retinal tear and traumatic cataract. Other serious ocular events observed among Lucentis-treated patients included intraocular inflammation and increased intraocular pressure. Non-eye related serious side effects, although not common, include heart attacks, strokes and death.

 

Lucentis was developed by Genentech and Novartis. Genentech has the commercial rights to Lucentis in the United States. Novartis has exclusive rights in the rest of the world. Lucentis is a registered trademark of Genentech Inc.

 

References

[1] Pascolini D and Mariotti SP. Global estimates of visual impairment: 2010. Br J Ophthalmol 2012;96:614-618.

[2] Tufail A on behalf of the REPAIR study group. The REPAIR study: 12 Month, prospective, multi-center trial of ranibizumab in choroidal neovascularization (CNV) due to pathological myopia (PM). EURETINA 2012.

[3] Lanzetta P on behalf of the RESTORE study group. Long-term safety and efficacy outcome of ranibizumab 0.5 mg in patients with visual impairment due to diabetic macular edema: the RESTORE extension study. EURETINA 2012.

[4] Bandello F on behalf of the LUMINOUS group. Outcomes of the retrospective pooled safety analysis of ranibizumab therapy for neovascular age-related macular degeneration from four european registries and update on the ongoing prospective analysis for the LUMINOUS study. EURETINA 2012.

 

 

Source: Novartis newsletter

 

Add fragrance to your home using simmering waters infused with spices, herbs, & fruit.

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Here’s the thing. I’m married to a man who hates artificial scents of any kind. That goes for air fresheners, candles, perfume, soaps and anything else that is scented. We buy unscented everything. I could probably buy a car with the money I’ve saved on perfume throughout the years of our marriage.

Turns out that King-Man may just be ahead of his time. I’ve recently been reading about air fresheners and their harmful ingredients. Many of them are especially hard on people with allergies and asthma. One more thing to stay away from.

But, the air in my house gets stale sometimes. Or, the day after I’ve cooked with garlic, that aroma that was so appealing when I was cooking becomes very unpleasant. I want to walk into my house and have it smell pleasant. Nothing overpowering or even that noticeable. Just pleasant.

There is a simple, all natural, truly lovely solution. That is to fill the air in my home with subtle scents of spices, herbs, and fruit. All I have to do is simmer some sweet smelling ingredients in water. The steam fills the air with a pleasant scent. Truth is, I did this many years ago on the advice of our realtor when we were selling our house. Realtors often advise sellers to bake cookies or boil cinnamon water right before a potential buyer drops by. That inviting aroma goes a long way to leave a good first impression. Why I didn’t continue scenting the air in a similar way for our own enjoyment, I don’t know.  I’ve now got a simple routine going that keeps our house smelling pleasant without staleness or day-after garlic odor.

Keeping the supply list simple. I only used items available at the grocery store or in my yard for these scent recipes. I want this to be easy and inexpensive so that I can set up a sustainable routine of pleasantly scenting our home. These recipes are simply guidelines and don’t have to be followed exactly. In fact, I change them up all the time based on what I have on hand in my kitchen or yard.

 

Fragrant items for naturally scenting your home:

  • citrus — I’ve tried other fruits. Some of them smell good initially, but they don’t hold up for more than one use. Citrus is sturdier, longer-lasting, and gives these scent recipes freshness. Lemons and oranges are particularly fragrant and have the best staying power in these scented waters.
  • herbs — Any herb can be used for making a room scent, but the ones that are sturdier and on woody twigs hold up the best. My favorites for room scents are rosemary and thyme.
  • pine or cedar twigs/needles — There may be other fragrant trees that will work, too; pine and cedar are the two I’ve tried for their appealing, fresh fragrance.
  • extracts — A touch of vanilla or almond extract improves most room fragrance mixtures. Mint extract has a nice fresh scent.
  • spices — You can use ground or whole sweet spices. The whole spices look prettier, if your scented water will be in a location where it will be seen. I have found that cinnamon sticks and whole cloves have the most scent staying power. Cinnamon sticks can be rinsed off and reused several times. They keep on giving.

Natural Room Scents

By Monica

Ingredients

  • Citrus, sliced — lemons, oranges, limes (may use peel only, if preferred)
  • Herbs — rosemary, thyme, & bay leaves
  • Spices– whole cinnamon, cloves, nutmeg, allspice (optional), anise (optional); may substitute ground/powdered spices
  • Ginger (fresh or powdered)
  • Extracts–vanilla, almond, mint
  • Pine twigs (or other fragrant twigs)

Directions

Use a pint (2 cup) jar, container, or pot to combine scent waters. Add ingredients to container, cover with water, and choose from these options:
–simmer on stove top, topping off with more water as it evaporates
–add heated mixture to a slow cooker, fondue pot, or something similar that will keep mixture heated. Preheat waters to a boil (in microwave or on stove top). As water evaporates, always top it off with HOT water to keep the temperature as high as possible. Higher heat = more fragrance.

FRAGRANT COMBINATIONS:

1. Orange, Cinnamon & Spice. 1 orange, 2 cinnamon sticks (or 2 teaspoons ground cinnamon), 1/2 tablespoon whole cloves (or 1/8 teaspoon ground cloves), 1/2 tablespoon whole allspice (or 1/4 teaspoon ground allspice), 1 anise star (optional)

2. Lemon, Rosemary & Vanilla. 3 sprigs of fresh rosemary, 2 lemons, 1 teaspoon vanilla extract.

3. Lime, Thyme, Mint & Vanilla. 3 limes, 3-4 sprigs fresh thyme, 1/2 teaspoon mint extract, 1 teaspoon vanilla.

4. Orange, Ginger, & Almond. 1 orange (or peel from 2 oranges), 1 4″ finger of ginger, sliced (or 1 tsp ground ginger), 1/2 teaspoon almond extract.

5. Pine, Bay Leaves, & Nutmeg. Handful of pine twigs or needles, 4 bay leaves, 1 whole nutmeg, outer layer grated into mixture.

Scented waters may be refrigerated between uses. Reuse for 2-3 days, or as long as they still have a pleasant fragrance.

 

Source: http://www.theyummylife.com