Please join Guest Moderator, Joel Zonszein, M.D., C.D.E., Professor of Clinical Medicine, Albert Einstein College of Medicine, and his colleagues, Sheryl Merkin, M.S., F.N.P., C.D.E., and Sharon Movsas, M.S., R.D., C.D.E., from The Clinical Diabetes Center of Montefiore Medical Center, New York, as they present the most comprehensive review of T1DM you have ever read anywhere. This activity has been approved for AMA PRA Category 1 Credit^TM.

Gastroenterology

Going off the gold standard? No, we're not talking about the recent fluctuations in currency markets that should bring lots of tourists here to the USA soon. We're talking about liver biopsy (this is Cyberounds, after all).

In the United States alone, there are an estimated 400,000 people with cirrhosis and liver fibrosis, an incidence likely to rise because of the epidemics of hepatitis C and non alcoholic fatty liver disease. And though fibrosis can improve significantly if the underlying insult is removed, there is still no magic bullet for its treatment.

Liver biopsy is the gold standard for diagnosis for liver disease, but study after study has shown it to be a poor standard. Now there may be some alternatives, as well as promising new treatments.

Please join Rebecca Wells, M.D., Assistant Professor of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, as she presents "Liver Fibrosis: New Mechanisms, New Treatments, and Why They Matter." FREE CME: this activity has been approved for 1.0 AMA PRA Category 1 Credit^TM.

Geriatrics

According to a recent study, more than 52% of men over the age of 40 experience, at one time or another, erectile dysfunction (ED). Defined as the inability to achieve or maintain an erection sufficient for satisfactory sexual performance, ED not surprisingly increases with age.

Please join John Morley, M.D, Dammert Professor of Gerontology, and Guest Moderator, Devraj Munikrishnappa, M.D., Adjunct Clinical Instructor, Department of Geriatrics, Saint Louis University School of Medicine, St. Louis, Missouri, as they lead you through the emerging (no pun intended) therapeutics of elderly erectile dysfunction. One hour toward the AMA PRA Category 1 Credit^TM.

Health Law

Can you love GINA?

Sorry, it's not quite as sexy as it sounds. We are talking about GINA, the new act of Congress.

The Genetic Information Non-Discrimination Act (GINA) was passed unanimously by the U.S. Senate in April and then by the House by a vote of 414-1 and on May 21, 2008 signed into law by President Bush, so it sure sounds as if everyone loves it.

But the truth, as we all know, is a little more complicated. Indeed, there are some unintended policy implications of the Act. For example, "It is likely that some employers who now provide health benefits will no longer be able to do so."

And what are the implications for health professionals who recommend genetic testing for their patients?

Please join Maxwell Mehlman, J.D., Arthur E. Petersilge Professor of Law and Director of the Law-Medicine Center, Case Western Reserve University School of Law, as he negotiates GINA in The Genetic Information Nondiscrimination Act (GINA): What It Does and Does Not Do and What It Means for Health Care Professionals. This activity has been approved for 1.0 AMA PRA Category 1Credit^TM.

Hematology/Oncology

We recently received a welcome letter from the AARP. Yeah, right. Thanks a lot for tracking us all these years.

They mean well because with aging, of course, come additional challenges. One medical hurdle is AML, acute myeloid leukemia. Primarily a disease of the elderly with a median age of 65, AML represents a distinct biological and clinical entity which is difficult to treat because elderly patients demonstrate increased treatment-associated morbidity and mortality from the currently available chemo. But new investigational therapies offer the promise of better outcomes.

Please welcome David Avigan, M.D., Assistant Professor, Harvard Medical School, and Director Hematological Malignancies/Bone Marrow Transplantation, Beth Israel Deaconess Medical Center, Boston, Massachusetts, as he reviews the progress being made in the treatment of Acute Myeloid Leukemia (AML) in the Elderly. One hour toward the AMA PRA Category I credit^TM.

Medical Genetics

The ability to smell is essential for animals to detect food sources, predators, mating partners and toxic compounds in the environment. In humans, the sense of smell is part of a variety of daily activities such as enjoying meals, detecting gas leakage, and even appreciating the body odor of others.

The mammalian olfactory system can detect and discriminate thousands of volatile odorants. Evolution has shaped this percept to exquisitely distinguish minute differences in the structure of odorant chemicals. Now, thanks to new research, we are beginning to understand the genetic basis for the variation in human olfactory perception.

Please join Hanyi Zhuang, Ph.D., Department of Pathophysiology, Shanghai Jiaotong University School of Medicine, and Hiroaki Matsunami, Ph.D., assistant professor, Department of Molecular Genetics and Microbiology, Duke University School of Medicine, as they review the Molecular Mechanisms Underlying Mammalian Olfaction. This activity has been approved for 1.0 AMA PRA Category 1 Credit^TM.

Nephrology

Failing kidneys are associated with decreased response to vaccination and impaired cell-mediated immunity. Immunosuppression and its corollary, immunocompromise, are what we do to help people with failing kidneys when we offer them our most successful form of treatment for uremia: kidney transplantation.

In other words, we take an immunocompromised individual and compromise them further. So, it's not really a surpise when these doubly-compromised patients become infected with opportunistic bacteria, some never before seen, and viruses.

Please join Frieda Wolf, M.D., Assistant Professor of Medicine, SUNY Downstate School of Medicine, as she considers the clinical challenges faced by patients who receive kidney transplant. One hour toward the AMA PRA Category 1 Credit^TM.

Nutrition

Humans can't live without it!

Email? Sex? Cell phones? Nope.

We are talking about something key to biological survival that is uniquely needed by human beings and by no other mammal. Without it we tire easily, our wounds won't heal, our tissues will degenerate and ultimately, we will die.

Luckily, the nutrient, vitamin C, is plentiful and widely available. And, moreover, its potential role in advanced therapy of multifactorial diseases (e.g., cancer and heart disease) is still evolving.

Please join Yi Li, B.Sc., and Herb E. Schellhorn, Ph.D., Professor, Department of Biology, McMaster University, Hamilton, Ontario, Canada, as they present a comprehensive portrait of Vitamin C and Human Nutrition. One hour toward the AMA PRA Category 1 Credit^TM.

Ophthalmology

The fascination with quantification, AKA demographics, continues.

If we told you that:

• More than 9 million Americans have it.
• It primarily affects whites, especially cigarette smokers.
• And mostly those over 55.

What would you think we're talking about?

Not politics, we can assure you.

Age-related macular degeneration (AMD), also known as age-related maculopathy, is a potentially progressive macular disease that is the leading cause of adult visual impairment and blindness in industrialized nations.

Please join Joshua L. Dunaief, M.D., Ph.D, Assistant Professor of Ophthalmology, and Leon Charkoudian, M.D., Resident, F.M. Kirby Center for Molecular Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, as they present Age-related Macular Degeneration (AMD). This activity has been approved for 1.0 hour toward the AMA PRA Category 1 Credit^TM.

Psychiatry/Neuroscience

Ten to twenty percent of the general population and 50% of patients seen in primary care suffer from clinically significant insomnia.

Despite the prevalence of this disorder, there is evidence that many affected individuals do not receive treatment and that much of the treatment administered is not empirically based.

Please join Andrew D. Krystal, M.D., M.S., Director, Insomnia and Sleep Research Program, and Associate Professor with Tenure in Psychiatry and Behavioral Sciences, Duke University School of Medicine, as he keeps you awake with The Treatment of Insomnia. One hour toward the AMA PRA Category I credit^TM.

Public Health

Multi-drug resistant organsisms (MDROs) have become an increasingly vexing problem in American hospitals. MDROs include MRSA, VRE, C. diff and multi-drug resistant gram-negative rods (MDR-GNR). Reports from the Federal Centers for Disease Control (CDC) indicate that in ICUs MRSA now makes up 60% of S. aureus isolates.

Invasive devices are a mainstay of modern medical care. While lifesaving, they also significantly increase the risk of infection. In the U.S. somewhere between 5 and 15% of patients who spend a significant amount of time in the hospital acquire some type of infection there.

Is there anything we can do about the rising threat of resistant infectious agents in hospitals?

Please join Keith F. Woeltje, M.D., Ph.D., Associate Professor of Medicine, Infectious Diseases, Washington University School of Medicine, St. Louis, MO, as he presents this week's Cyberounds Public Health -- Infection Control. One hour toward the AMA PRA Category 1 Credit^TM.

Pulmonary Medicine

A few months ago U.S. Vice President Dick Cheney was hospitalized with a case of deep vein thrombosis (DVT) and, given his history of problems with his heart (clinically speaking, of course), his medical team worried about the possibility of a pulmonary embolus (PE).

So Cheney's doctors looked for Hampton's hump and Westermark's sign, two classic findings. Do you remember what they are? One clue: they're confirmative but RARE.

In case you've forgotten Hampton and Westermark, there are many other diagnostic techniques available for DVT and PE, plus new therapeutic strategies, which you really should know about.

Please join Dr. Victor Tapson, Professor of Medicine, Duke University School of Medicine, Durham, North Carolina, as he illuminates The Diagnosis and Management of Venous Thromboembolism. One FREE hour toward the AMA PRA Category 1 Credit^TM.

Rheumatology

A 28-year-old woman who works in a day care center arrives in your office with all the signs and symptoms of, but no medical reason for, arthritis. What is going on?

Hint: The kids are the key.

Please join Peter Barland, M.D, Professor Emeritus of Medicine and Pathology at the Albert Einstein College of Medicine, Cendrella Hojeily, M.D, medical resident in internal medicine at Staten Island University Hospital and Bernard Hojaili, M.D., staff rheumatologist at Iberia Medical Center, Bronx NY, as they present our current Cyberounds Rheumatology. This activity has been approved for 1.0 AMA PRA Category 1Credit^TM.

Women's Health

Ovarian cancer is the most lethal of all the gynecologic malignancies. It's often symptom-free until it reaches dangerously advanced stages. And screening methods, such as the use of transvaginal ultrasonography and serum CA-125, are not effective.

So what should you do?

Please join Jonathan S. Berek, M.D., M.S.S., Professor and Chair, and Renata Urban, M.D., Resident, Department of Obstetrics and Gynecology, Stanford University Medical Center, Stanford, CA., as they present the Diagnosis and Treatment of Epithelial Ovarian Cancer. One hour toward the AMA PRA Category 1 Credit^TM.

Special Features

You probably don't think about it as a health issue, but actually, it's more important than you think. Oxygen is essential to survival. Every cell in every body needs it. On good days, 21% of the air we breathe is oxygen. And, the body's oxygen balance may, according to new research, be the key to various diseases such as cancer and heart disease.

But what controls oxygen levels? Is hemoglobin the big enchilada or is the system more complex?

According to our guest author, Gregg L. Semenza, M.D., Ph.D., from Johns Hopkins, there's a master regulator that's pulling the strings and controlling whether you're healthy or sick.

Please welcome Dr. Semenza, Professor in the Deparments of Pediatrics, Medicine, Oncology, Radiation Oncology and McKusick-Nathans Institute of Genetic Medicine at the Johns Hopkins University School of Medicine and Director of the Vascular Program in the Johns Hopkins Institute for Cell Engineering, as he presents the brave new oxygen world in "Oxygen Homeostasis in Health and Disease." One hour toward the AMA PRA Category 1 Credit^TM.

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