Autoinjectors offer way to treat prolonged seizures

ScienceDaily (Feb. 15, 2012) ? Drug delivery into muscle using an autoinjector, akin to the EpiPen used to treat serious allergic reactions, is faster and may be a more effective way to stop status epilepticus, a prolonged seizure lasting longer than five minutes, according to a study sponsored by the National Institutes of Health. Status epilepticus is a potentially life-threatening emergency that causes 55,000 deaths each year. Anticonvulsant drugs are typically delivered intravenously (IV) as a first-line treatment.

Starting an IV in a patient experiencing seizures can pose a challenge for paramedics and waste precious time. Giving an intramuscular shot is easier, faster, and more reliable, especially in patients having convulsions. The researchers sought to determine whether an intramuscular injection, which quickly delivers anticonvulsant medicine into a patient's thigh muscle, is as safe and effective as giving medicine directly into a vein. The study, which was carried out by paramedics, compared how well delivery by each method stopped patients' seizures by the time the ambulance arrived at the emergency department.

The investigators compared two medicines known to be effective in controlling seizures, midazolam and lorazepam. Both are benzodiazepines, a class of sedating anticonvulsant drugs. Midazolam was a candidate for injection because it is rapidly absorbed from muscle. But lorazepam must be given by IV. The study found that 73 percent of patients in the group receiving midazolam were seizure-free upon arrival at the hospital, compared to 63 percent of patients who received IV treatment with lorazepam. Patients treated with midazolam were also less likely to require hospitalization than those receiving IV lorazepam. Among those admitted, both groups had similarly low rates of recurrent seizures. The study appears in the Feb. 16, 2012 issue of The New England Journal of Medicine.

"Patients with status epilepticus can suffer severe consequences if seizures are not stopped quickly. This study establishes that rapid intramuscular injection of an anticonvulsant drug is safe and effective," said Walter Koroshetz, M.D., deputy director of the National Institute of Neurological Disorders and Stroke (NINDS), part of the NIH, which funded the study.

The investigators said that while autoinjectors might someday be available for use by epilepsy patients and their family members, more research is required. Because of the strong sedative effect of midazolam, on-site medical supervision is now required for the safety of the patient.

The Rapid Anticonvulsant Medication Prior to Arrival Trial (RAMPART) study was conducted through the NINDS' Neurological Emergencies Treatment Trials (NETT) network. Additional funding was provided by the NIH Countermeasures Against Chemical Threats (NIH CounterACT) program and the Biomedical Advanced Research and Development Authority (BARDA). The Department of Defense's Chemical Biological Medical Systems (CBMS) Joint Project Management Office provided the autoinjectors for the trial under a Memorandum of Agreement with NINDS.

NIH CounterACT, BARDA and CBMS are responsible for enhancing the U.S. government's development of medical countermeasures to natural and intentional public health threats (please see full statement below on CBMS). The chemical defense community has a longstanding interest in research on the rapid treatment of nerve agent-induced seizures. As the RAMPART study was being planned, investigators learned that the departments of Defense and Health and Human Services were already working with a midazolam autoinjector and the study was an opportunity to confirm its effectiveness in patients with seizures.

"There was great synergy when we realized that RAMPART was studying a similar problem that was of concern to the chemical defense community. This led to a perfect collaboration between HHS and DoD," said David Jett, Ph.D., program director for NIH CounterACT and NINDS. "The broader implication of RAMPART is that we now have critical information from studies in humans that a safe and effective tool may one day be available to enhance our public health preparedness. Autoinjectors provide a highly practical way to treat hundreds of people quickly during an emergency."

RAMPART is the first randomized clinical trial to investigate whether intramuscular delivery of midazolam is as effective as IV lorazepam, the current standard of care therapy. The trial started in 2009 and completed enrollment in June, 2011. RAMPART involved more than 79 hospitals, 33 emergency medical services agencies, more than 4,000 paramedics and 893 patients ranging in age from several months old to 103. The network of investigators that designed and carried out the trial was established by NINDS to conduct clinical trials on a variety of acute conditions affecting the brain such as stroke and traumatic brain injury. NETT investigators are organized into a system of 17 major research hospitals each of which is linked to several community hospitals and other medical centers.

Another special aspect of the study was that it was conducted under exception from informed consent for emergency research. This is a federal regulation to protect patients who are involved in research when consent is not possible because of their medical condition. Community consultation is held in advance of the study to raise awareness, ensure transparency, and get input from local residents.

Paramedics in RAMPART used study boxes with a time-stamped voice recorder, designed by the NETT team. This tool allowed paramedics to make quick decisions, indicate the time treatment began and the time the patient's convulsions stopped, all without having to interrupt patient care to record data. The goal of the study was to control the seizures within 10 minutes without having to deliver a second dose of medicine. Prolonged status epilepticus can last for hours and sometimes is controlled only with general anesthesia.

"Few other areas of medicine are as time-dependent as injury to the brain. In epilepsy, even a few minutes can be important. With every minute the seizure continues, it becomes harder to stop. RAMPART offers first responders an important treatment tool that will have a meaningful impact on the lives of many people with epilepsy," said Robert Silbergleit, M.D., of the University of Michigan in Ann Arbor, first author of the NEJM paper.

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The above story is reprinted from materials provided by University of Michigan Health System, via Newswise.

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Journal Reference:

1. Robert Silbergleit, Valerie Durkalski, Daniel Lowenstein, Robin Conwit, Arthur Pancioli, Yuko Palesch, William Barsan. Intramuscular versus Intravenous Therapy for Prehospital Status Epilepticus. New England Journal of Medicine, 2012; 366 (7): 591 DOI: 10.1056/NEJMoa1107494

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

Source: http://feeds.sciencedaily.com/~r/sciencedaily/~3/4mLa0nOxxeo/120215185844.htm

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Health and Fitness Articles ? Blog Archive ? Obesity Causes and ...

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This entry was posted on Wednesday, February 15th, 2012 at 9:15 am and is filed under Exercise. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

Source: http://www.healthandfitnessarticlesblog.com/obesity-causes-and-solutions/

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• As part of the agreement, Facebook and Zynga both sought to "increase the number of Zynga MUUs to [*] over [*] at a linear weekly growth rate," according to the filing. (The [*] appears to represent a redacted number.)

Source: http://www.businessinsider.com/facebook-forced-to-update-its-ipo-filing-to-confirm-its-special-relationship-with-zynga-2012-2

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West reluctantly weighs military aid for Syria rebels

After diplomatic efforts at the UN failed Saturday, there is a growing consensus that supporting the rebel Free Syrian Army may be the only way to break the stalemate between Assad and his opponents.

With Syria's violence escalating and diplomatic efforts deadlocked at the United Nations, international attention is turning toward a possible military solution to hasten the downfall of President Bashar al-Assad.

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A direct Western-led military intervention is being discounted for now. But diplomats and analysts say Western and Arab officials are mulling an option of military support for the rebel Free Syrian Army in the hope that a campaign of attrition will wear down the regular Syrian forces and eventually undermine the Assad regime.

The notion is already winning public support in Washington. Sen. Joe Lieberman (I) of Connecticut has said the FSA deserves a ?range of support? including weapons. And Republican presidential candidate Newt Gingrich also has recommended ?supplying weapons? and providing the necessary backing to the Syrian opposition to help them topple the Assad regime. It is rumored, but not proven, that Qatar ? the tiny Gulf state that armed Libyan rebels last year ? may already be supplying funds and weapons to the FSA.

Still, any Western or Arab military support for the ill-equipped FSA almost guarantees a prolonging and intensification of a conflict that already has killed more than 5,400 people and brought the country to the brink of a sectarian civil war.

?I understand the moral outrage that has led some to demand military intervention," says Andrew Exum, a military analyst at the Center for a New American Security in Washington and author of the Abu Muqawama counterinsurgency blog. "But few simple military solutions present themselves.?

Interest in a military option has grown since Saturday, when Russia and China vetoed a United Nations Security Council resolution condemning the violence in Syria. The deadlock at the UN appears to have exhausted diplomatic options for now. Washington announced yesterday that it had closed the US Embassy in Damascus and recalled all American staff. Several European countries have also recalled their ambassadors to Syria for consultations. And on Tuesday, the six Gulf Arab states said that they were withdrawing their own representatives from Damascus and expelling Syrian ambassadors in their capitals.

Source: http://rss.csmonitor.com/~r/feeds/csm/~3/g6AL2PG3E8E/West-reluctantly-weighs-military-aid-for-Syria-rebels

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Lytro Teardown Shows Potential Wireless Capability, Smallish Sensor

It's been a while since we've heard anything about Lytro (other than nearly grabbing a Crunchie (I voted for them)), the camera where you shoot now and focus later. And the latest news comes not from the company itself, but from the FCC, which just today published the internal photos from its investigation of the device. Like reading about chips and sensors? Click on.

Source: http://feedproxy.google.com/~r/Techcrunch/~3/yYqNIChMH0A/

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Source: http://austinopen4business.com/dwelling-treadmill-reviews-shopping-for-information-plus-treadmill-benefits/

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Victims weep, ridicule Norway killer's court speech (Reuters)

OSLO (Reuters) ? Survivors and relatives of those killed in a Norwegian mass-murder rampage wept and ridiculed the smiling attacker in court Monday as he defended his acts by issuing a tirade against immigration.

Anders Behring Breivik, who killed 77 people, provoked tears and laughter in the packed court as he gave a far-right salute and said he had carried out the massacre to prevent his country's cultural destruction.

"The way he talked, the way he smiled ... everything made me realize that no one has the same picture of the world as he does," said Helene Georgsen, 17, who survived Breivik's shooting spree.

She said the court appearance helped her realize that the anti-Islam fanatic "can't hurt me any more."

Breivik, clad in a black suit with silvery tie, told the court: "The attacks on the government headquarters were preventive attacks on traitors to the nation, people committing or planning to commit cultural destruction, including destruction of Norwegian culture and Norwegian ethnicity."

He has admitted detonating a fertilizer bomb that killed eight people at a government building in Oslo in July and hours later gunning down participants at an island summer camp for Labor Party youths, killing 69.

As the small Scandinavian country steels itself for a wrenching trial set to begin on April 16, Breivik used Monday's routine custody hearing to demand his release on the grounds that "people subjected to genocide" may legally defend themselves.

"We in the Norwegian movement will not sit and see that we are made a minority in our own country," he said.

District Judge Wenche Gjelsten extended his detention until the start of the trial.

"What a clown," said courtroom spectator Freddy Lie, 52, who had one daughter killed and another injured at the summer camp.

"The only thing he lacked was a red nose. To sit and look at us like he did, you can see that he is sick."

Breivik made his statements after the judge let him explain why he had pleaded not guilty despite acknowledging responsibility for the worst outbreak of violence in Norway since World War Two.

As he entered the courtroom the blond-haired killer raised his handcuffed arms after putting his fist on his heart in what his lawyer said was a salute to right-wing extremists. He had agreed in advance to be photographed.

Breivik looked repeatedly toward the audience of about 60 survivors and family members and 64 journalists. When he spoke from a sheaf of notes, his voice was calm.

Some in the courtroom wept at first, among them 18-year-old Anette Davidsen, a survivor of the island shootings.

"It was difficult to see him and to see him smile," she said. "I could see that he does not regret what he has done, and I have lost so many friends."

As Breivik delivered his message, she joined several others in laughing derisively.

"He was ridiculous," she told Reuters. "The way he spoke, the way he smiled. It was good to laugh at him."

In a manifesto posted online before the attacks, Breivik wrote that he was targeting "traitors" whose leftist views and softness on immigration had brought the country low.

Monday he said: "The ethnic Norwegians will be a minority in Oslo in the next 10 years. It is a fact. I represent Norwegian resistance."

Two court-appointed psychiatrists have declared Breivik psychotic, which ordinarily would mean he cannot be sentenced to prison. After a public outcry the judges in the case have asked for another evaluation by different experts.

Breivik called the initial report declaring him psychotic to be "ridiculous," but he was cut off by the judge.

Breivik will stand trial, regardless of the psychiatrists' assessment.

If his judges agree at the end that he is psychotic he is likely to be to placed in a locked psychiatric institution. If deemed fit to serve in prison, he would face up to 21 years upon conviction.

(Writing by Walter Gibbs; Reporting by Gwladys Fouche; Editing by Andrew Heavens)

Source: http://us.rd.yahoo.com/dailynews/rss/europe/*http%3A//news.yahoo.com/s/nm/20120206/wl_nm/us_norway_attacks

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