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Thursday, January 17, 2013

Another Egg-Free Flu Vaccine Approved by FDA

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First there was Flucelvax introduced in 2012 and now there is Flublock, both considered egg-free for those concerned with egg allergy in traditional flu vaccines.

Rather than being cultured in eggs, Flucelvax is cultured in mammalian cells and Flublock is grown in caterpillar cells injected by an insect virus containing the flu gene.

Both vaccines are approved for use in people 18 years and older.

Why the concern of egg-allergic patients with the traditional flu vaccine used to defend against both seasonal and pandemic flu virus?

Traditionally, the flu shot vaccine (both H1N1 and seasonal) are grown inside eggs which is where this concern arises. It also doesn't help that the pre-flu shot questionnaire specifically asks about egg allergy. Though egg-based, during vaccine production the egg protein is filtered out such that there should be no egg contaminants in the final vaccine. However, it is theoretically possible that some egg may still be present in the vaccine.

Although there is an infinitesimal possibility of egg contaminants, studies have shown that even patients with life-threatening egg allergy can still safely have the flu vaccine.

In spite of these reassurances, there are still concerns from patients and healthcare professionals which makes the availability of two different egg-free flu vaccines welcome news.

FDA approves next-generation, bug-based flu vaccine. MSNBC 1/16/13

Saturday, January 12, 2013

Compact EMG System for Targeted Muscle Injections

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An EMG system (ElectroMyoGraphy) is a critical piece of equipment when it comes to targeted muscle injections in and around the neck, especially when you cannot see or feel the muscle.

This scenario is especially true when dealing with spasmodic dysphonia for which targeted botox injections are quite helpful. Given the muscles that need to be injected are contained inside the voicebox and not able to be seen and felt from outside the neck, accurate injection is quite difficult without EMG guidance.

Watch a video of this procedure using a traditional EMG system.

However, such traditional EMG systems are "overkill" in terms of technology and cost when all it is being used for is muscle placement.

It was with great excitement that a compact EMG device has been developed for just such a need when all that is required is needle localization for directed drug delivery.

Check out the MyoGuide made by Intronix Technologies based in Canada. The US supplier is Ambu.

I've been using MyoGuide for a few months now and am quite pleased with its performance. It pretty much does exactly what I want it to do... no more or less. There is both audio and display feedback, though I mainly depend on audio. It runs only on batteries.

For head and neck muscle injections, I find that a volume setting of 8 and vertical sensitivity of 6 works best.

My personal preference is using Ambu Inoject 35mm 27G needle for ADductor spasmodic dysphonia and the Allergan EMG needle for ABductor spasmodic dysphonia.

For those interested in trying out this device, there is a 2 week free trial.

Friday, January 11, 2013

Parkinson's Disease Diagnosed by Salivary Gland Biopsy

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Taken from Wikipedia
Currently, diagnosing Parkinson's Disease (a degenerative neurological disorder) is hard, usually a clinical exam and assessment of symptoms by a neurologist with at best about an 80% accuracy rate. There is no "test" per se that can diagnose Parkinson's Disease... until possibly now.

According to a study released in advance of its presentation at the annual meeting of the American Academy of Neurology, which will be held from March 16 to 23 in San Diego, Mayo Clinic researchers have determined a submandibular gland biopsy can offer 82% certainty whether a living patient has Parkinson's Disease or not. What is so special about this particular gland located under the jawline?

In patients with Parkinson's Disease, an uniquely abnormal protein called alpha-synuclein protein can be found.

In order to "biopsy" the submandibular gland which produces saliva, it does require a head and neck surgeon given the gland's location under the jawline. Beyond the usual risks of bleeding and infection present with any type of surgery, additional risks with this biopsy include:

• Permanent lip paralysis as the nerve that goes to the lower lip is located right over this gland.
• Permanent tongue paralysis as the nerve that moves the tongue is located right under this gland.
• Permanent numbness of the mouth floor as the nerve that provides sensation in this location is also located right under the gland.

Also, there are questions that need to be answered before this test is available more widely including:

How early in the Parkinson's Disease will this protein accumulate in the submandibular gland? If there is an "accumulation" time period, when is the best time to do the biopsy than?

Does the biopsy require a bloc of tissue or can a needle biopsy be sufficient (thereby reducing some of the surgical risks)?

Will insurance pay for this procedure?

Also, when is the paper going to be published regarding these results and can others replicate these findings? Here's the presentation abstract...

New saliva gland test may better diagnose patients with Parkinson's. FoxNews 1/11/13

Salivary Gland Biopsy as a Diagnostic Test for Parkinson's Disease. AAN 65th Annual Meeting Abstract
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