Refractive Errors and Strabismus in Children With Down Syndrome: A Controlled Study

...Ocular findings were discovered in 97.4% of children with Down syndrome and 42.4% of control subjects (P < .0001). The point prevalence of nystagmus, strabismus, hypermetropia, astigmatism, and congenital cataract was significantly higher in children with Down syndrome (P < .0001 for the first four categories, and P < .01 for congenital cataract)....

Comments: All children and adult with any kind of genetic anomaly, syndrome, acquired brain injury, etc. should have a comprehensive eye and vision examination. DM

Early Brain Activity Sheds New Light On The Neural Basis Of Reading

A study ...showed very early interactions between the vision and language domains during reading, with the speech motor areas of the brain (inferior frontal gyrus) being active at the same time (after a seventh of a second) as the orthographic word-form is being resolved within a brain region called the fusiform gyrus. This finding challenges the conventional view of a temporally serial processing sequence for reading in which letter forms are initially decoded, interact with their phonological and semantic representations, and only then gain access to a speech code.This finding has a potentially important clinical application in relation to developmental dyslexia (affecting between 15-30 million people in the US alone) and those with acquired reading disabilities through injury or disease. A better understanding of normal reading processes could potentially help these individuals....

Brain Training Improves Memory And Attention And The Effects Last

...The study found that participants who trained on the software, The Brain Fitness Program(tm) from Posit Science(r), more than doubled their processing speed, with an average increase of 131%. They also saw gains on standard measures of memory and attention of 10 years, on average. These changes were big enough that participants reported significant improvements in every day activities (such as remembering names or understanding conversations in noisy restaurants). The gains of the brain exercise group were clinically significant; the gains of the lecture group were significantly smaller and not clinically significant....

Autism Linked To Being Firstborn, Breech Or Moms 35 And Older Giving Birth

...In the April 27, 2009, online issue of the journal Pediatrics, the researchers showed that women who give birth at 35 or older are 1.7 times more likely to have a child with an autism spectrum disorder (ASD), compared with women between the ages of 20-34. Children diagnosed with ASD also were nearly 1.8 times more likely to be the firstborn child, the researchers found. Although they didn't identify a causal relationship between breech births and autism, children diagnosed with the disorder were more than twice as likely to have been a breech presentation, meaning they were not born head first. ...

Common Genetic Factors That Affect Autism Risk Have Been Identified

..."Until now, no common genetic variant has been identified with such overwhelming evidence to support its role in autism spectrum disorders," said Pericak-Vance, "The identification of a common variant for autism is a monumental achievement. Researchers have been looking for clues about the genetic architecture of autism for decades. Many thought that this day would never come, but we persisted." ....

No Data Supporting Antipsychotic Drug For Low-IQ Kids With ADHD

...A new Cochrane review finds no evidence to support the use of risperidone to treat attention- deficit/hyperactivity disorder (ADHD) in people with intellectual disabilities, even though the review authors say this is a common prescribing pattern. Risperidone, or Risperdal, is a second-generation antipsychotic drug. Long-term use of these drugs is associated with serious side effects, including weight gain and increased risk for type 2 diabetes....

Change in ocular alignment after topical anesthetic cataract surgery

....The overall incidence of topical anesthesia-related change in ocular alignment after uneventful cataract surgery was 5%. However, no patients had symptomatic diplopia. Topical anesthetic cataract surgery could abolish the risk of postoperative diplopia and improve the heterophoric status of preexisting misalignment. ...

Comments: FIVE PERCENT! As my daughter would say, OMG!! Wasn't it nice that the patients didn't notice seeing double. Wait a minute...why was that...adults aren't supposed to be able to suppress double images generated by misaligned eyes...so why no diplopia? DM

The Safety Gap: Money, Medicine and You

...Half of all Americans take at least one prescription drug. One in six take three medications or more. While all of these drugs go through an approval process, studies don't catch all of the kinks. Adverse drug reactions cause 100,000 deaths a year, and it's all because of a struggle between money, medicine and safety....

Comments: If you work with special populations (individuals with any number of disabilities), you know that the polypharmacy involved is overwhelming. Who monitors all these drugs? Who has assessed how these drugs interact? I mentioned that Dr. Donati and I did a study looking at the polypharmacy of individuals with intellectual disabilities and mental illness and we found that many of these individuals are taking mulitple drugs that could effect them adversely both systemtically and visually. Please review all drugs that your patients take....ask if they are actually taking them the way they are supposed to...and get a program like "Epocrates" to help sort it all out! Look for.... RJ Donati RJ, Maino DM, Bartell H, Kieffer M. Polypharmacy and the Lack of Oculo-Visual Complaints from those with Mental Illness and Dual Diagnosis.Optometry 2009;80:249-254.... in this months issue of Optometry. DM

Writing Disorder May Be Common Among Kids

...Though dyslexia and attention-deficit disorder are better known, another learning disability -- the inability to write properly -- strikes a significant number of children, a new study suggests....So-called written-language disorder is a "forgotten learning disability...

Comments: Dysgraphia (a deficiency in the ability to write, regardless of the ability to read, not due to intellectual impairment) is very commonly seen with many of the patients Optometrists diagnose and treat. I find that if "true" dysgraphia" is present, we can typically improve writing....but seldom make it "teacher perfect"! DM

First Neuroimaging Study Examining Motor Execution In Children With Autism Reveals New Insights

...The study, published online in the journal Brain’s April 23 Brain Advanced Access, compared the brain activity of children with high functioning autism and their typically developing peers while performing a simple motor task—tapping their fingers in sequence. The researchers found that children with autism relied more heavily on a region of the brain responsible for conscious, effortful movement, while their typically developing peers utilized a region of the brain important for automating motor tasks. Children with autism also showed less connectivity between different regions of the brain involved in coordinating and executing movement, supporting the theory that a decreased ability of distant regions of the brain to communicate with each other forms the neurological basis of autism....

Comments: So if we teach children with autism to habituate a motor response, will that improve function? Something to think about. DM

Vision Screening vs Comprehensive Eye Examination

This is a video put out by IOA on the difference between screenings and eye exams.

http://www.youtube.com/watch?v=zRyNLiFFKEs&eurl=http%3A%2F%2Fwww%2Evisionfirstfoundation%2Eorg%2F&feature=player_embedded

Estrogen controls how the brain processes sound

...The findings, published in today's issue of The Journal of Neuroscience, show for the first time that a sex hormone can directly affect auditory function, and point toward the possibility that estrogen controls other types of sensory processing as well. Understanding how estrogen changes the brain's response to sound, say the authors, might open the door to new ways of treating hearing deficiencies....

Corneal Reshaping and Myopia Progression

...Results confirm previous reports of slowed eye growth following corneal reshaping contact lens wear....

ADHD Takes Toll on Sleep

...When Taiwanese researchers compared 281 kids age 10 to 17 who had been diagnosed with ADHD at a mean age of about 7 with 185 healthy children, they found the ADHD kids were more likely to suffer from sleep problems, regardless of whether they were still suffering from ADHD or not....

Feature Article-Financial Assistance for Eye Care

More than 11 million Americans have common vision problems such as nearsightedness, farsightedness, astigmatism, and/or presbyopia.1 The good news is that these problems can be detected through a comprehensive dilated eye exam and are easily corrected. Please join the National Eye Institute (NEI) this May during Healthy Vision Month to help raise awareness about the importance of eye exams in detecting common vision problems.
Read More...

Organizational Profile-Women's Eye Health.org Women's Eye Health.org (WEH.org) was formed in response to the troubling reality that two-thirds of the world's population of blind and visually impaired persons are women. In 2001, an analysis of over 70 epidemiologic studies on blindness revealed this previously unknown and still largely unpublicized fact. A group of researchers at the Schepens Eye Research Institute in Boston joined forces with colleagues from around the U.S. and the world to form WEH.org. It has been estimated that three-quarters of blindness and visual impairment is preventable or treatable; thus, education of the public is paramount.
Read More...

10 Eye-Catching Tips for Women Use these tips in any of your publications or newsletters to educate women in your community about eye health and the importance of taking care of their eyes.
Never wear contacts without a prescription.
Remember: insert contact lenses first, then apply eye makeup.
Read More...

Tools and Resources Join the National Eye Institute this May in observing Healthy Vision Month. Visit www.healthyvision2010.nei. nih.gov/hvm for more information and to download free educational materials.
Read More...

For more information, visit:
http://healthyvision2010.nei.nih.gov/hvm/

American Academy of optometry

The American Academy of Optometry meeting is coming up in November. It's not to early to start planning on coming for the very best of everything.

I will be giving a course and want to invite all to come! Check it out.

BV-05 Neuroplasticity - A Paradigm Sea Change

Dominick M. Maino, OD, MEd, FAAO
A sea change is a change of such magnitude that it alters the very nature of the subject. Our understanding of neuroplasticity has undergone such a sea change paradigm. This course reviews the current research on neuroplasticity and specifically how it affects the diagnosis, prognosis and management of our patients.
1 hour November 12, 8:00 AM

Yeah....I know it's at 8AM....but hey, come early...get your CE in and spend the rest of the day playing in beautiful Florida!

Protect Yourself Against Swine Flu

Dozens of cases of swine influenza have been confirmed across the United States over the past few days, making many people wonder if they're next in line. What can you do to protect yourself?

Comments: Wash your hands. Wash your hands. Wash your hands. Wash your hands. Cover your mouth when you sneeze. Cover your mouth when you sneeze. Cover your mouth when you sneeze. Wash your hands. Wash your hands. Wash your hands. Wash your hands. Cover your mouth when you sneeze. Cover your mouth when you sneeze. Cover your mouth when you sneeze. DM

Visual function and ocular status of children with hearing impairment in Oman: A case series

...Visual functions of children with hearing disability were evaluated in a school of Muscat, Oman in 2006. Two hundred and twenty-three children were tested for near vision, distant vision, contrast sensitivity, color vision, field of vision, motion perception and crowding. Profound and severe hearing loss was noted in 161 and 63 students respectively. Thirty-five (81%) students with refractive error were using spectacles. Color vision and field of vision was defective in one student each. In 286 (64.1%) eyes, contrast sensitivity was defective. Abnormal contrast sensitivity was not associated with the severity of hearing loss [RR = 1.04 (95% CI 0.91 to 1.29)]. Children with hearing impairment should be assessed for visual functions. Refractive error and defect in contrast sensitivity were unusually high among these children. In addition to visual aids, we recommend environmental changes to improve illumination and contrast to improve the quality of life of such children with double disability....

Comments: Click on title above for full text of the article. DM

Botox Gets Black Box Warning - Dangerous Side Effects May Occur

...Prompted by reports of serious adverse events, the U.S. Food and Drug Administration today announced that safety label changes, including a boxed warning, and a Risk Evaluation and Mitigation Strategy (REMS), are necessary for all botulinum toxin products....

Comments: Botox is used for many reasons, one of which is for the treatment of strabismus....as with all drugs...you should know the potential adverse side effects. DM

Autism findings may pave way for new treatments

...Studies of autistic twins have suggested that genes play a major role in the disorder. This discovery may give scientists targets to begin developing treatments...

Age of Autism Web Newspaper

Doctors try to bar online reviews

Do physicians have a right to privacy that overrules patients' rights to speak freely about their health care experiences? This question is at the center of the debate about so-called medical "gag orders" some doctors are using to prohibit patients from commenting on their care. Read more in this month's feature story, "Medical Muzzle."

Comments: Why would you want to "gag" a patient? I would want to know that all comments are reviewed....Angie's List has a reputation for doing just that....DM

Increased Central Corneal Thickness in Children With Cerebral Palsy

...Children with CP had an increased central corneal thickness compared with healthy control subjects. There was however no significant difference in CCT values between the children with and without intellectual disabilityin our CP group....

Research shows wide age gap between possible and actual autism diagnosis

..."Timely identification and diagnosis of an autism spectrum disorder (ASD) can impact a child's development and is the key to opening the door to the services and therapies available to children with autism," says Paul Shattuck, Ph.D., assistant professor at the George Warren Brown School of Social Work at Washington University in St. Louis. "Unfortunately, our research shows that the average age of autism diagnosis is nearly six years old, which is three to four years after diagnosis is possible."...

http://www.cdc.gov/media/pressrel/2009/r090430.htm

...The number of U.S. adults reporting a disability increased by 3.4 million between 1999 and 2005, according to a recent report released by the Centers for Disease Control and Prevention....

Scientists learn why the flu may turn deadly

...New research published in the Journal of Leukocyte Biology suggests that the influenza virus 'paralyzes' the immune system...

Human Brain Can Recognize Objects Much Faster Than Some Have Thought

...Human beings far outpace computers in their ability to recognize faces and other objects, handling with ease variations in size, color, orientation, lighting conditions and other factors. But how our brains handle this visual processing isn't known in much detail....

Parameters predicting outcomes of strabismus surgery in the management of Graves' ophthalmopathy

...Relative symmetry of orbitopathy at onset and a shorter time interval between onset of orbitopathy and surgery, while allowing for disease stability, are predictive of a good outcome following strabismus surgery for Graves' ophthalmopathy...

Genetics and Autism

The whole December 2008 issue of American Journal of Medical Genetics Part B was devoted to autism. If you are interested in autism, this single topic volume abstracts are now available at http://www3.interscience.wiley.com/journal/121520270/issue .

Medline Plus: Everything you always wanted to know about Down Syndrome

Comments: I've forgotten about this wonderful resource. Click on the title above for lots of great information. Sadly, they have little information about all the eye and vision problems associated with this syndrome. Call (312-949-7282) or email me (dmaino@ico.edu) if you'd like to discuss the eye problems associated with Down syndrome. DM

Security Requirements for a Lifelong Electronic Health Record System: An Opinion

...This article discusses the authors' views on the security requirements of a central, unique electronic health record. The requirements are based on the well-known principles of confidentiality and integrity and the less discussed principles of control and legal value. The article does not discuss any technical or legal solutions to the requirements proposed herein....

Comments: It's not if, but rather, when...all docs go to an EHR. They must be secure, confidential, and the pt should have control over who sees the info in the EHR. Here's a discussion that both docs and patients should read. Very soon we will all be using EHRs. DM

Syndrome Diagnosis: Human Intuition or Machine Intelligence?

...The aim of this study was to investigate whether artificial intelligence methods can represent objective methods that are essential in syndrome diagnosis. Most syndromes have no external criterion standard of diagnosis. The predictive value of a clinical sign used in diagnosis is dependent on the prior probability of the syndrome diagnosis. Clinicians often misjudge the probabilities involved. Syndromology needs objective methods to ensure diagnostic consistency, and take prior probabilities into account. We applied two basic artificial intelligence methods to a database of machine-generated patients - a ‘vector method’ and a set method. As reference methods we ran an ID3 algorithm, a cluster analysis and a naive Bayes’ calculation on the same patient series. The overall diagnostic error rate for the the vector algorithm was 0.93%, and for the ID3 0.97%. For the clinical signs found by the set method, the predictive values varied between 0.71 and 1.0. The artificial intelligence methods that we used, proved simple, robust and powerful, and represent objective diagnostic methods....

Comments: Will docs be replaced by AI? DM

FTC Will Grant Three-Month Delay of Enforcement of ‘Red Flags’ Rule Requiring Creditors and Financial Institutions to Adopt Identity Theft Prevention

...The Federal Trade Commission will delay enforcement of the new “Red Flags Rule” until August 1, 2009, to give creditors and financial institutions more time to develop and implement written identity theft prevention programs. For entities that have a low risk of identity theft, such as businesses that know their customers personally, the Commission will soon release a template to help them comply with the law. Today’s announcement does not affect other federal agencies’ enforcement of the original November 1, 2008 compliance deadline for institutions subject to their oversight....

Comments: We are all trying to figure out where optometrists fit into this. Thank goodness for our state an national associations who over see what our government does. DM

E-Healthcare at an Experimental Welfare Techno House in Japan

...An automated monitoring system for home health care has been designed for an experimental house in Japan called the Welfare Techno House (WTH). Automated electrocardiogram (ECG) measurements can be taken while in bed, in the bathtub, and on the toilet, without the subject’s awareness, and without using body surface electrodes. In order to evaluate this automated health monitoring system, overnight measurements were performed to monitor health status during the daily lives of both young and elderly subjects....

Comments: Now you don't even have to leave home to assess your health. For the full article, click on the title above. I wonder if we can do something like this in optometry? DM

Polypharmacy and the lack of oculo-visual complaints from

Hot off the presses!

...It has been established that MI and DD populations exhibit a higher incidence of oculovisual anomalies (uncorrected refractive error, binocular vision anomalies, ocular pathology) than noted in the general population. They are also typically taking 1 or more neuropsychotropic medications that are frequently associated with undesirable visual side effects. Individuals with MI and DD should report numerous complaints associated with the medications they take and the oculo-visual anomalies they exhibit during the initial case history and the review of systems. The data from this study suggest that this is not the case and that only about 50% of those who should have complaints actually report them....

RJ Donati RJ, Maino DM, Bartell H, Kieffer M. Polypharmacy and the Lack of Oculo-Visual Complaints from those with Mental Illness and Dual Diagnosis.Optometry 2009;80:249-254.

Comments: A couple of summers ago I hosted an OD-PhD student (from China via Australia) who wanted to work with me in the area of vision and developmental disabilities. He was evaluating methodologies on how to assess pain/discomfort in those with developmental disabilities (Cui Y, Stapleton F, Suttle C. Developing an instrument to assess vision-related and subjective quality of life in children with intellectual disability: data collection and preliminary analysis in a Chinese population. Ophthalmic Physiol Opt. 2008 May;28(3):238-46.).

Dr. Cui's paper was the 1st paper in the ophthalmic literature taking a serious look at how we can determine if our patients are in pain or other discomfort. Dr. Donati and I looked at those who had a dual dx of Mental Illness and Intellectual Disability, and if they complained about any vision/systemic problems during our case history and review of systems. Even though plenty of oculo-visual problems were noted and the drugs they were taking should have elicited numersous unwanted side effects....they complained infrequently.

When you work with patients who have a disability, be aware that they may not tell you that they are in discomfort.... Depending upon your findings, you may need to treat the presenting disorders even if the patient does not acknowledge a problem being present.

The bottomline is, if you think your patient should have symptoms associated with the clinical data you've found...treat 'em. Schedule a followup evaluation in a timely manner to see if your pt's quality of life has become better....

I tend to be fairly aggressive in treating those patients who have DD, MI, ID, and MR . All too often I find others do not treat these patients just because they have a disability....treat these individuals as you would anyone else....watch them react to your treatment plans....make changes....improve your patients' lives. DM

Illinois College of Optometry July 19-20-2009 Continuing Education

Illinois College of Optometry July 19-20-2009
Continuing Education

This program is presented by Luxottica as part of its "Excellence in Eye Care" series. This event is sponsored by Alcon.

Sunday, July 19, 2009 7:00-8:00 A.M. – Continental Breakfast
8:00-10:00 A.M. Common Pediatric Ocular Diseases and Their Treatment Christine Allison, O.D.
10:00 A.M.-12:00 P.M. The Non-Glaucomatous Optic Neuropathies: Anterior Ischemic Optic Neuropathy and Optic Neuritis Leonard Messner, O.D. and Wendy Stone, O.D.
12:00-12:30 P.M. -- Lunch
12:30-2:30 P.M. Diagnosing and Managing the Glaucoma Suspect Michael Chaglasian, O.D.
2:30-3:30 P.M. Glaucoma Case Presentations Eric Conley, O.D. and Michael Chaglasian, O.D.
3:30-4:30 P.M. An Update on Multifocal and Accommodating Intraocular Lens Technology Dominick Opitz, O.D.

Monday, July 20, 2009 7:00-8:00 A.M. – Continental Breakfast
8:00-10:00 A.M. Age-Related Macular Degeneration: New Thoughts About an Old Disease Leonard Messner, O.D., Elizabeth Wyles, O.D., and Timothy Tsang, O.D.
10:00 A.M.-12:00 P.M. Contact Lens Update: Discussion on Latest Availabilities to Enhance Vision, Comfort, and Corneal Health Jennifer Harthan, O.D.
12:00-12:30 P.M. -- Lunch
12:30-2:30 P.M. Current Trends in Treating Amblyopic and Convergence Insufficiency in a Primary Care Practice Yi Pang, O.D.
2:30-4:30 P.M. Ocular Surface Disease Diagnosis and Management Renee Reeder, O.D.


Course includes parking, continental breakfast, lunch, course materials, and certificate of attendance. Tests will be in multiple-choice format and are optional. The tests will be mailed to registrants after the event. One re-take will be permitted. All courses are COPE qualification pending.

To find out more about this event, please email continuinged@ico.edu. Continuing Education Coordinator
Illinois College of Optometry 3241 S. Michigan Ave Chicago, IL 60626
Phone: 312-949-7426 Fax: 312-949-7383

Positive and negative gaze perception in autism spectrum conditions

...Results showed that the ASC group was worse at judging gaze direction with positive stimuli, and showed less of a decrement in performance when eye stimuli changed from positive to negative polarity. The differences in gaze perception for the ASC group were most evident when information from the eyes was more difficult and ambiguous. Typical females performed better at gaze direction detection with positive polarity than typical males, who in turn performed better than males with ASC. This latter finding is consistent with the extreme male brain theory of autism, and with the idea that people with ASC have less gaze expertise.

Affective response to eye contact and face recognition ability in children with ASD

ROBERT M. JOSEPH, KELLY EHRMAN, REBECCA MCNALLY and BRANDON KEEHN (2008). Affective response to eye contact and face recognition ability in children with ASD. Journal of the International Neuropsychological Society, 14 , pp 947-955

...Children with ASD exhibited significantly larger SCRs than TD children to faces with direct and averted gaze. There were no differences between SCRs to direct gaze and averted gaze in either group. Children with ASD exhibited a marginally significant decrease in face recognition accuracy relative to TD children, particularly when face recognition depended on the eye region of the face. Face recognition accuracy among children with ASD was negatively correlated with the amplitude of SCRs to direct gaze but not to averted gaze. There was no association between face recognition accuracy and SCRs to gaze in the TD group. These findings suggest that autonomic reactivity to eye contact may interfere with face identity processing in some children with ASD....

Functional brain organization for visual search in ASD

...While the ASD group did not evidence accelerated response time (RT) compared with the TD group, they did demonstrate increased search efficiency, as measured by RT by set size slopes. Activation patterns also showed differences between ASD group, which recruited a network including frontal, parietal, and occipital cortices, and the TD group, which showed less extensive activation mostly limited to occipito-temporal regions. Direct comparisons (for both homogeneous and heterogeneous search conditions) revealed greater activation in occipital and frontoparietal regions in ASD than in TD participants. These results suggest that search efficiency in ASD may be related to enhanced discrimination (reflected in occipital activation) and increased top-down modulation of visual attention (associated with frontoparietal activation)....

BRANDON KEEHN, LAURIE BRENNER, ERICA PALMER, ALAN J. LINCOLN and RALPH-AXEL MÜLLER (2008). Functional brain organization for visual search in ASD. Journal of the International Neuropsychological Society, 14 , pp 990-1003

Face and gaze processing in Prader-Willi syndrome.

...while the behavioural tests did not discriminate between the UPD and deletion forms of the syndrome, electrophysiological measures of face processing did differentiate the groups....

Comments: You might also want to look at:

Libov AJ, Maino DM. Prader-Willi syndrome. J Am Optom Assoc. 1994 May;65(5):355-9.

Schneider BB, Maino DM. Angelman syndrome. J Am Optom Assoc. 1993 Jul;64(7):502-6.

Brain function and gaze fixation during facial-emotion processing in fragile X and autism.

...The FXS group displayed significantly greater activation than both the TD control and ASD groups in the left hippocampus (HIPP), left superior temporal gyrus (STG), right insula (INS), and left postcentral gyrus (PCG). These group differences in brain activation are important as they suggest unique underlying face-processing neural circuitry in FXS versus idiopathic ASD, largely supporting the hypothesis that ASD characteristics in FXS and idiopathic ASD reflect partially divergent impairments at the neural level, at least in FXS individuals without a co-morbid diagnosis of ASD....

Brief Report: Visual Processing of Faces in Individuals with Fragile X Syndrome: An Eye Tracking Study.

..Results provide quantitative evidence for significant differences in gaze patterns and increased pupillary reactivity when individuals with FXS passively view static faces. Such abnormalities have significant implications in terms of understanding causes of gaze avoidance observed in individuals with FXS....

Topiramate Generic Available

From Epocrates

First-Time Generic Topiramate Now Available
The generic drug topiramate (brand Topamax) is now available for the treatment of primary generalized tonic-clonic, partial, and Lennox-Gastaut seizures in adults and children over two years old, as well as migraine prophylaxis in adult patients.
View Drug monograph for Topiramate »

Comments: Topomax seems to be Rx'd for everything these days....and now that there is a generic...well, watch out! This drug has many unwanted side effects. Check them out at Epocrates. DM

Swine Flu H1N1

From Epocrates

Swine Influenza (H1N1)

Latest Updates

Disease transmission is similar to seasonal influenza, through person-person spread via cough/ sneeze at close distance or contact with droplet-contaminated surfaces. All respiratory secretions and bodily fluids of cases are considered potentially infectious. The infectious period is 1 day before to 7 days after symptom onset. Clinical findings include fever, headache, upper respiratory symptoms, myalgia, fatigue, chills, vomiting, diarrhea; disease severity and course are variable. Suspected case definition: acute febrile respiratory illness (100.4 F and nasal congestion, rhinorrhea, sore throat, or cough) and onset within 7 days of close contact with or travel to areas with a confirmed case. Suspected and confirmed cases warrant treatment with oseltamivir (Tamiflu) or zanamivir (Relenza). Prophylaxis is appropriate for certain household contacts and some healthcare workers. The seasonal influenza vaccine is unlikely to provide protection against swine H1N1 viruses.

Epocrates offers continually updated swine flu recommendations based on CDC guidance:

• Antiviral treatment and prophylaxis: Epocrates Rx oseltamivir (Tamiflu), zanamivir (Relenza) monographs
• CDC case definitions and key facts: Epocrates Tables - Swine Influenza Guidance
• Diagnosis, treatment, infection control: Swine Influenza overview on Epocrates Online Diseases and Dx for iPhone.

*Please note, Disease content available for Epocrates Online, Epocrates® Online Premium or Epocrates Essentials® for the iPhone™.

Anti-Viral Drug Dosing for Swine Flu
Based on CDC recommendations, dosing for the prophylaxis and treatment of swine influenza A (H1N1) has been added to the Tamiflu (oseltamivir) monograph.
View Drug Monograph for Tamiflu»

Corneal Power and Astigmatism in Down Syndrome

Little JA, Woodhouse JM, Saunders KJ.Corneal Power and Astigmatism in Down Syndrome.Optom Vis Sci. 2009 Apr 22.

The study is the first to explicitly investigate the association between corneal power and refractive error in children with DS. The majority of the DS group have significant refractive errors including an increased prevalence of oblique astigmatism. Corneal curvature in DS is not related to spherical or astigmatic refractive error. Further research is required to better understand the association between the ocular structures of the DS eye and their impact on functional vision.

New molecular virus tests changing treatment practices

...New molecular techniques are facilitating the rapid detection of viruses - including the 2009 influenza A H1N1 – but what pediatricians do with the information gained from these diagnostics depends upon the type of virus and the type of symptoms that virus is causing....