The first wave of GINA now goes into effect. This part goes directly to affect Heath Insurers. To review the law signed in May 21 2008 will directly affect Health Insurance and Employers.
Thursday, May 28, 2009
Posted by Steve Murphy MD at 8:47 AM
Wednesday, May 27, 2009
Step right on up, come one come all....to the greatest show on earth!
Tuesday, May 26, 2009
First, I want to thank reporter Devon Lash at the Stamford Advocate, who wrote a very nice piece about the CT State Dept. of Health asking seniors to speak up about diseases in their family. So many people didn't speak of these things just a few decades ago, but they need to. The article misstates what I said, which is nearly over 40% of women were reclassified when using the Reynolds Risk score in comparison with the Framingham.
Thursday, May 21, 2009
Yes, Swine Flu again. It turns out that Swine Flu is now in our town of Greenwich CT. So I will put up a checklist here......Not that any Genome Readers would be interested, but when you google Steven Murphy......this is what shows up. So I figure that I should place a checklist here.
Temperature > 101° over last 48 hours yes____________no__________
Chills (physical shivering at room temperature) yes______ no _______
Headache yes _______ no _____
Myalgias yes ______ no _____
Arthralgias yes _______ no ______
Sore throat yes _____no ______
Dry cough yes _______ no _____
Productive cough yes _____no ___
Nausea yes_______ no _____
Diarrhea yes ____ no____
CXR with infiltrate yes _____ _ no ____
Family members with similar sickness yes ___ no ___
Contact with patient with novel H1N1 (swine) influenza _____________
Travel to Mexico 3/09 or later _____________________________
Other travel ____________________________
There you have it. If you have 2 or more of these symptoms, you should be seen and evaluated.
203-863-4195 or 888-584-8999
Posted by Steve Murphy MD at 11:51 AM
Wednesday, May 20, 2009
Tuesday, May 19, 2009
I just received an email from Annals of Internal Medicine and I see a letter to the Authors from Dr Gulcher and Dr Stefansson. I chuckled to myself because I just finished writing a letter to the editor and had another published in Nature Biotechnology entitled "In Need of a Reality Check"
Friday, May 15, 2009
Thursday, May 14, 2009
Wednesday, May 13, 2009
Monday, May 11, 2009
Echocardiography should be performed at frequent intervals to monitor the status of the ascending aorta.
Yearly examinations are sufficient with relatively small aortic dimensions and slow rates of aortic dilatation.
More frequent examinations are indicated in any of the following situations:
The aortic root exceeds about 4.5 centimeters in adults.
The rate of aortic growth exceeds about 0.5 cm per year.
Significant aortic regurgitation occurs.
The entire aorta should be imaged every few years, as the incidence of aneurysms in other portions of the aorta may be as high as 20%.
After repair of the ascending aorta, the remaining portion of the aorta needs to be routinely imaged for enlargement of the distal aorta, whether the individual had a type A dissection initially or underwent prophylactic repair of the ascending aorta.
Periodic imaging of the cerebral circulation in individuals with a TGFBR2 to evaluate for cerebral aneurysms is recommended as these aneurysms may occur later in life.
Hemodynamic stress. Medications that reduce hemodynamic stress, such as beta adrenergic blocking agents, are routinely prescribed for individuals with the Marfan syndrome, and similar treatment is recommended for individuals with TAAD [Shores et al 1994]. Aortic dissection is exceedingly rare in early childhood, but aortic dilatation may be present in childhood. Medical therapy should be considered in children and adults with aortic dilatation.
Hypertension should be aggressively treated and controlled in individuals with TAAD.
Prophylactic surgical repair of the aorta to prevent subsequent dissection or rupture is indicated in any of the following situations
When the rate of dilation approaches 1.0 cm per year
When aortic regurgitation progresses
For individuals with TAAD caused by TGFBR2 mutations before the diameter of the ascending aorta reaches 5.0 cm
For those with bicuspid aortic valve (BAV) when the diameter of the ascending aorta is 5.0 cm
For all others with TAAD, when the diameter of the ascending aorta is between 5.0 cm and 5.5 cm
More recently, a valve-sparing procedure has been developed that precludes the need for chronic anticoagulation [David et al 1999].
More aggressive surgical repair may be indicated for individuals with a of aortic dissection without significant aortic root enlargement and in individuals with TGFBR2 mutations.
You can see that this watchful waiting and action when indicated pathway is very similar to other things we do, including BRCA positive surveillance options. This is why genomic medicine will win in the end. We will catch those who have these horrible time bombs and help prevent them. In my mind that is a home run every time. Will testing take place before a good family history? Only if we don't have the skilled manpower to take good histories and physicals.......
The Sherpa Says: I just discovered another one of these families last week. I will say it again and again. You miss 100% of putts you leave short. I.E. if you don't look, you never find.