Variants of the elastin (ELN) gene and susceptibility to intracranial aneurysm: a synthesis of genetic association studies using a genetic model-free approach.

Background: The presence of an intracranial aneurysm (IA) is thought to have a genetic origin. The genetic association studies (GAS) that investigated the association between IA and elastin gene (ELN) variants have produced contradictory or inconclusive results.

Materials And Methods: In order to decrease the uncertainty of estimated genetic risk effects, a meta-analysis of published GAS-related variants in the ELN gene (ELN INT20 1315T > C, EX20 1264G > A, INT23 1501 + 24T > C and INT4 196 + 71G > A) with susceptibility to IA was conducted using a genetic model-free approach.

Measured immunoglobulin E in allergic bronchopulmonary aspergillosis treated with omalizumab.

Background: The ability to assess adequate reductions in immunoglobulin E (IgE) in allergic bronchopulmonary aspergillosis (ABPA) has been a concern with regards to omalizumab treatment.

Objective: To describe the clinical course and serial measured IgE levels in two adult patients with elevated IgE levels, hypersensitivity to Aspergillus fumigatus, and bilateral bronchiectasis who were treated with omalizumab. CLINICAL DESCRIPTIONS: Patient 1 met commonly used criteria for ABPA and had a more than 3-fold increase (from 702 to 2462 IU/ml) in measured IgE 4 months after starting omalizumab.

Clinical associations of delirium in hospitalized adult patients and the role of on admission presentation.

Objective: To describe clinical associations of delirium in hospitalized patients and relationships to on admission presentation.

Design: Retrospective analysis of an administrative hospitalization database 1998-2007.

Setting: Acute care hospitalizations in the New York State (NYS).

A colorimetric method for detection of K-ras codon 12 point mutations in DNA extracted from tissue and peripheral blood in pancreatic disorders.

Molecular-based methods to monitor point mutations require special and expensive equipment unavailable in most hospitals. Colorimetric-based analysis is an ideal platform for K-ras codon 12 gene point mutations because it uses commonly found hospital equipment. The colorimetric assay is sensitive and specific, detecting mutated DNA levels as low as 1% in a wild-type background.

Drug-induced, dementia-associated and non-dementia, non-drug delirium hospitalizations in the United States, 1998-2005: an analysis of the national inpatient sample.

Background: The incidence and pattern of delirium recorded in a broad spectrum of American hospitalizations has not been well described. The National Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project is an administrative database of hospitalizations in the US that affords an opportunity to examine for International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9) codes relating to delirium.

Objective: To examine the prevalence of delirium diagnoses and associated clinical factors, including adverse drug effects, in a broad spectrum of hospitalizations in the US.

Omalizumab-associated anaphylactic reactions reported between January 2007 and June 2008.

Background: Anaphylaxis associated with omalizumab treatment is a growing concern. The broader context in which omalizumab-associated allergic reactions occur has not been well described.

Objective: To identify and characterize recently reported anaphylactic reactions associated with omalizumab administration.

N-Acetylcysteine added to volume expansion with sodium bicarbonate does not further prevent contrast-induced nephropathy: results from the cardiac angiography in renally impaired patients study.

We reviewed data from the multicenter CARE (Cardiac Angiography in Renally Impaired Patients) study to see if benefit could be shown for N-acetylcysteine (NAC) in patients undergoing cardiac angiography who all received intravenous bicarbonate fluid expansion. Four hundred fourteen patients with moderate-to-severe chronic kidney disease were randomized to receive intra-arterial administration of iopamidol-370 or iodixanol-320. All patients were prehydrated with isotonic sodium bicarbonate solution.

Deliberative Democracy and stem cell research in New York State: the good, the bad, and the ugly.

Many states in the U.S. have adopted policies regarding human embryonic stem cell (hESC) research in the last few years.

Incidence and impact of adverse effects to antibiotics in hospitalized adults with pneumonia.

Background: This study sought to define the incidence, economic impact, and nature of adverse drug effects (ADEs) related to antibiotics in pneumonia hospitalizations in the US.

Methods: Adult pneumonia hospitalizations were tabulated in statewide (New York) and national databases, respectively, from 2000 through 2005. The incidences of antibiotic related ADEs were determined by identifying antibiotic specific e-codes (external cause of injury codes).

Hearing health care: information for the health professional.

In summary, the field ofaudiology and the role of the audiologist are vast and encompass a wide range of diagnostic testing and rehabilitative treatment plans. It is not through the sole care of the audiologist that a patient would receive treatment for the conditions mentioned above. In order to provide optimal patient care, the support and intervention of various health care providers and family members are necessary for the best possible outcome for the patient.

The gender disparity in adult asthma hospitalizations dynamically relates to age.

Although it is known that women have a higher prevalence of asthma than men, it is not known whether and/or how gender differences in asthma severity are affected by age. Asthma hospitalization rates were compared for men and women in New York State from 1990 through 2006 between the ages of 20 and 84. Female and male hospitalization rates were calculated and characterized for the different age intervals.

Increasing anaphylaxis hospitalizations in the first 2 decades of life: New York State, 1990 -2006.

Background: Although an increase in the occurrence of anaphylaxis has been reported in several parts of the world, this phenomenon has not been described in the United States.

Objective: To characterize anaphylaxis hospitalizations in New York State in patients younger than 20 years.

Methods: Using a statewide administrative database, hospital admissions of patients with an allergic disease (anaphylaxis, angioedema, urticaria, and allergy unspecified) as the primary diagnosis were analyzed from 1990 through 2006 in New York State.

What is conscience and why is respect for it so important?

The literature on conscience in medicine has paid little attention to what is meant by the word 'conscience.' This article distinguishes between retrospective and prospective conscience, distinguishes synderesis from conscience, and argues against intuitionist views of conscience. Conscience is defined as having two interrelated parts: (1) a commitment to morality itself; to acting and choosing morally according to the best of one's ability, and (2) the activity of judging that an act one has done or about which one is deliberating would violate that commitment.

Increasing hospitalizations due to angioedema in the United States.

Background: Angioedema may occur in patients taking angiotensin-converting enzyme inhibitors. With the more prevalent use of this class of medications in the United States, it is not known whether angioedema hospitalizations have increased nationally in recent years.

Objectives: To profile the trends in angioedema hospitalizations and to examine associated demographic factors and comorbid diseases in the United States.

Acquired Chiari malformation secondary to hyperostosis of the skull: a case report and literature review.

Background: Most cases of generalized hyperostosis of the skull are associated with Camurati-Engelmann disease, craniodiaphyseal dysplasia, Worth-type endosteal hyperostosis, or sclerosteosis. Infrequently, a Chiari malformation may also be described. We present the case of a patient with acquired Chiari malformation secondary to hyperostotic skull formation whose findings did not fit into any of the 4 usual conditions.

Beliefs and attitudes of nurses and physicians about do not resuscitate orders and who should speak to patients and families about them.

Objective: Both physicians and nurses play important roles in discussing do not resuscitate (DNR) orders with patients and surrogates. However, the beliefs and attitudes of health professionals about the role nurses should play in this process have received little systematic study.

Design And Setting: An anonymous survey was conducted of 217 attending internists, 132 medical house officers, and 219 staff nurses working on the medical floors and units at two teaching hospitals about their beliefs, attitudes, and confidence regarding DNR discussions.

Maintaining financial independence in advanced age.

In an attempt to personalize Nobel Prize-winning financial literature, this article seeks to show how individuals can take responsibility for their own finances. For instance, before Markowitz's work, pension funds shied away from risky investments. Then, Markowitz proved that the safest portfolios are those that are diversified over many asset classes, including risky investments.

Within you/without you: biotechnology, ontology, and ethics.

As Implantable Cardioverter Defibrillators (ICDs) have become more common, ethical issues have arisen regarding the deactivation of these devices. Goldstein et al., have shown that both patients and cardiologists consider ICD deactivation to be different from the discontinuation of other life-sustaining treatments.

Emergency contraception for women who have been raped: must catholics test for ovulation, or is testing for pregnancy morally sufficient?

On the grounds that tape is an act of violence, not a natural act of intercourse, Roman Catholic teaching traditionally has permitted women who have been raped to take steps to prevent pregnancy, while consistently prohibiting abortion even in the case of rape. Recent scientific evidence that emergency contraception (EC) works primarily by preventing ovulation, not by preventing implantation or by aborting implanted embryos, has led Church authorities to permit the use of EC drugs in the setting of rape. Doubts about whether an abortifacient effect of EC drugs has been completely disproven have led to controversy within the Church about whether it is sufficient to determine that a woman is not pregnant before using EC drugs or whether one must establish that she has not recently ovulated.

Immune cross-reactivity in celiac disease: anti-gliadin antibodies bind to neuronal synapsin I.

Celiac disease is an immune-mediated disorder triggered by ingestion of wheat gliadin and related proteins in genetically susceptible individuals. In addition to the characteristic enteropathy, celiac disease is associated with various extraintestinal manifestations, including neurologic complications such as neuropathy, ataxia, seizures, and neurobehavioral changes. The cause of the neurologic manifestations is unknown, but autoimmunity resulting from molecular mimicry between gliadin and nervous system proteins has been proposed to play a role.

Asthma hospitalization patterns in young children relating to admission age, infection presence, sex, and race.

Background: Although childhood hospitalizations for asthma are common, there are few detailed temporal and demographic descriptions of these hospitalizations.

Objective: To relate temporal patterns of asthma hospitalization in young children to admission age, sex, comorbid infection, and race.

Methods: Retrospective analysis of 151,391 New York State hospitalizations with a principal diagnosis of asthma between January 1, 1990, and December 31, 2004, in children younger than 5 years.

Tube feeding in advanced dementia: an exploratory survey of physician knowledge.

The administration of artificial nutrition by means of a percutaneous endoscopic gastrostomy (PEG) tube in older persons in the advanced stages of dementia is commonplace, yet the treatment is associated with significant treatment burdens and unclear benefits in this population. In addition, there is wide and unexplained geographic variability in the use of PEG in advanced dementia, which may stem partly from physicians' lack of understanding about its indications, risks, benefits, and effect on quality of life in advanced dementia. This study was a mail survey undertaken to assess physician knowledge regarding tube feeding in advanced dementia and explore whether certification in geriatrics or other physician characteristics are associated with physician knowledge.

Cancer care, money, and the value of life: whose justice? Which rationality?

Cost-containment in oncology is a moral issue. While economists use the word "rationing" to describe all limitations on resource utilization that result from human choice, the ordinary language distinction between allocation and rationing is morally meaningful and can help oncologists to determine their proper moral role in cost-containment. It is argued that oncologists should not be required to ration at the bedside, nor should they be given financial incentives to practice frugally, nor should they be subjected to a variety of bureaucratic mechanisms to control costs indirectly.

Comparison of polyetheretherketone cages with femoral cortical bone allograft as a single-piece interbody spacer in transforaminal lumbar interbody fusion.

Object: Transforaminal lumbar interbody fusion (TLIF) is an accepted alternative to circumferential fusion of the lumbar spine in the treatment of degenerative disc disease, spondylolisthesis, and recurrent disc herniation. To maintain disc height while arthrodesis takes place, the technique requires the use of an interbody spacer. Although titanium cages are used in this capacity, the two most common spacers are polyetheretherketone (PEEK) cages and femoral cortical allografts (FCAs).