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Quest Diagnostics : Pharmacogenomics

Posted: April 18, 2019 at 7:50 pm

Quest Diagnostics offers one of the most comprehensive pharmacogenomics test panels available to help you gain insight into a patients potential response to medications and optimize their treatment considerations and outcomes. This includes information for over 280 drugs across 44 genes*. This full panel is particularly advantageous for patients on multiple medications who may otherwise require multiple panelsall at a low cost and coming from a company you trust to meet all of your lab needs.

The Pharmacogenomics Panel from Quest provides pharmacogenetic information for 44 genes, and reports information across multiple classes of medications:

Physicians receive test results in a comprehensive and easy to understand report that may include dosing guidelines from CPIC, FDA-approved labeling, and other pharmacogenomic consortia. Results can be utilized as a reference for your patients throughout their lifetime.

Order Pharmacogenomics PGx panel today.

The Quest Diagnostics Pharmacogenomics Panel is based on pertinent literature sources that may provide clinical insights to help inform treating physicians about a patients genetic attributes to help optimize patient treatment considerations and outcomes.**

Pharmacogenetics/pharmacogenomics is the study of how inherited genetic differences impact the way drugs or medications affect a person. These genetic differences can impact the way a drug is absorbed or metabolized and thereby influence drug response. Pharmacogenomic tests may provide information about a persons genetic makeup to help doctors decide which medications and doses might work best for him or her. Pharmacogenomic testing can also help reduce the time and costs associated with a trial-and-error approach to treatment.1

Avoiding adverse drug reactions can make a difference

The Quest Diagnostics comprehensive pharmacogenomics test panel (PGx) offers insights into patient potential responses to different medications and over 280 drugs.*

The panel may determine:

A Pharmacogenomics Panel may provide additional insights to:

*Pharmacogenomic information is not assessed for potential alternative medications. These data are provided as alternatives to consider based on information reported in the literature due to pharmacogenomic contraindications in other medications.

**Sources available upon request.

DNA will be extracted from the sample and tested for changes in multiple genes.

***The CPT codes provided are based on AMA guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payer being billed.

Download PGx brochure.

Download PGx medication and gene list.

Download PGx Report guide.

Download Patient informed consent form.

Ordering steps

****Get copies of the paper Pharmacogenomics requisition from your Quest Diagnostics account manager.

The information provided herein and in the pharmacogenetics report is for physician consideration and each physician has to determine what is the best treatment for their patient based upon the physicians education, experience, and clinical assessment of the patient.

References

Link:
Quest Diagnostics : Pharmacogenomics

Recommendation and review posted by G. Smith

Pharmacogenomics | Cleveland Clinic

Posted: April 18, 2019 at 7:50 pm

Overview Overview

The Center for Personalized Genetic Healthcare (CPGH) offers comprehensive pharmacogenomics services to individuals who are not responding to medication regimens or who are experiencing adverse side effects.

CPGH offers pharmacogenomics counseling, which can be incorporated into your medical care.

Prior to requesting an appointment, you will need to obtain a referral from your physician. If you are a patient outside the Cleveland Clinic health system, please have your physician complete a referral form and fax to 216.445.6935. To learn more about how to prepare for your appointment, review the "Before Your Visit" tab.

The Center for Personalized Genetic Healthcare (CPGH) is committed to providing comprehensive clinical genetic services, education and support to patients and family members. Our team of genetic experts will work with other Cleveland Clinic primary care providers and specialists to personalize your care by incorporating your genetic information into your overall health care plan.

You should consider having a pharmacogenomic evaluation if you have a personal history or have concerns about the following:

Contact your primary care provider or the Center for Personalized Genetic Healthcare (CPGH) to discuss whether a pharmacogenomics consultation is appropriate for you.

Prior to requesting an appointment, you will need to obtain a physician referral. If you are a patient outside the Cleveland Clinic health system, please have your physician complete a referral form and fax to 216.445.6935.

If you are a patient outside the Cleveland Clinic health system, you should send an authorization for the release of medical records form to each external facility. You may arrange to have medical records faxed (30 pages or less) to our department at 216.445.6935 or sent postal mail.

Cleveland Clinic Center for Personalized Genetic Healthcare Attn: Pharmacogenomics Clinic 9500 Euclid Ave. NE50 Cleveland, OH 44195

To make the most out of your visit, you should gather medication and health history information prior to your appointment. It may be helpful for you to prepare a list of current and past medications. Specifically, you will want to consider the following:

We will provide personalized expert counseling and education to you and your family. During your visit, you will see a genetics expert (clinical geneticist) and a pharmacogenomics clinical specialist for a genetics evaluation. You may also be scheduled with other Cleveland Clinic providers during your visit depending on your medical needs and physician availability.

After your visit, it may take anywhere from a few days up to two weeks for your clinical appointment notes to reach the healthcare providers that you requested to receive a copy. We are also glad to communicate with your healthcare providers about your case as needed. You are always welcome to follow up with us with questions regarding your visit.

Genetics consult and testing are billed as two separate services.

If genetic testing is indicated, your genetics provider will discuss costs and insurance coverage during your appointment.

Some patients are concerned that their genetic information may be used against them. To learn about your patient rights and protections in place to prevent genetic discrimination, read this article on GINA.

To learn more about billing options and financial assistance, review our billing and insurance information.

Prior to requesting an appointment, you will need to obtain a referral from your physician. If you are a patient outside the Cleveland Clinic health system, please have your physician complete a referral form and fax to 216.445.6935. To learn more about how to prepare for your appointment, review the "Before Your Visit" tab.

To schedule an appointment, please call 216.636.1768 or 800.998.4785.

T Building - Center for Personalized Genetic Healthcare9204 Euclid Ave.Cleveland , OH 44195

Link:
Pharmacogenomics | Cleveland Clinic

Recommendation and review posted by G. Smith

Lipid levels and the risk of hemorrhagic … – n.neurology.org

Posted: April 17, 2019 at 11:49 pm

Pamela M. Rist

From the Division of Preventive Medicine, Department of Medicine (P.M. Rist, J.E.B., P.M Ridker), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Neurology (C.S.K.), Emory University, Atlanta, GA; Institute of Public Health (T.K.), CharitUniversittsmedizin, Berlin, Germany; and Division of Women's Health, Department of Medicine (K.M.R.), Brigham and Women's Hospital, Boston, MA.

Julie E. Buring

From the Division of Preventive Medicine, Department of Medicine (P.M. Rist, J.E.B., P.M Ridker), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Neurology (C.S.K.), Emory University, Atlanta, GA; Institute of Public Health (T.K.), CharitUniversittsmedizin, Berlin, Germany; and Division of Women's Health, Department of Medicine (K.M.R.), Brigham and Women's Hospital, Boston, MA.

Paul M Ridker

From the Division of Preventive Medicine, Department of Medicine (P.M. Rist, J.E.B., P.M Ridker), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Neurology (C.S.K.), Emory University, Atlanta, GA; Institute of Public Health (T.K.), CharitUniversittsmedizin, Berlin, Germany; and Division of Women's Health, Department of Medicine (K.M.R.), Brigham and Women's Hospital, Boston, MA.

Carlos S. Kase

From the Division of Preventive Medicine, Department of Medicine (P.M. Rist, J.E.B., P.M Ridker), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Neurology (C.S.K.), Emory University, Atlanta, GA; Institute of Public Health (T.K.), CharitUniversittsmedizin, Berlin, Germany; and Division of Women's Health, Department of Medicine (K.M.R.), Brigham and Women's Hospital, Boston, MA.

Tobias Kurth

From the Division of Preventive Medicine, Department of Medicine (P.M. Rist, J.E.B., P.M Ridker), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Neurology (C.S.K.), Emory University, Atlanta, GA; Institute of Public Health (T.K.), CharitUniversittsmedizin, Berlin, Germany; and Division of Women's Health, Department of Medicine (K.M.R.), Brigham and Women's Hospital, Boston, MA.

Kathryn M. Rexrode

From the Division of Preventive Medicine, Department of Medicine (P.M. Rist, J.E.B., P.M Ridker), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Neurology (C.S.K.), Emory University, Atlanta, GA; Institute of Public Health (T.K.), CharitUniversittsmedizin, Berlin, Germany; and Division of Women's Health, Department of Medicine (K.M.R.), Brigham and Women's Hospital, Boston, MA.

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Lipid levels and the risk of hemorrhagic ... - n.neurology.org

Recommendation and review posted by G. Smith

Second patient free of HIV after stem-cell therapy

Posted: April 17, 2019 at 12:49 am

A person with HIV seems to be free of the virus after receiving a stem-cell transplant that replaced their white blood cells with HIV-resistant versions. The patient is only the second person ever reported to have been cleared of the virus using this method. But researchers warn that it is too early to say that they have been cured.

The patient whose identity hasnt been disclosed was able to stop taking antiretroviral drugs, with no sign of the virus returning 18 months later. The stem-cell technique was first used a decade ago for Timothy Ray Brown, known as the Berlin patient, who is still free of the virus.

So far, the latest patient to receive the treatment is showing a response similar to Browns, says Andrew Freedman, a clinical infectious-disease physician at Cardiff University in the UK who was not involved in the study. Theres good reason to hope that it will have the same result, he says.

Like Brown, the latest patient also had a form of blood cancer that wasnt responding to chemotherapy. They required a bone-marrow transplant, in which their blood cells would be destroyed and replenished with stem cells transplanted from a healthy donor.

But rather than choosing just any suitable donor, the team led by Ravindra Gupta, an infectious-disease physician at the University of Cambridge, UK picked a donor who had two copies of a mutation in the CCR5 gene that gives people resistance to HIV infection. This gene codes for a receptor which sits on the surface of white blood cells involved in the bodys immune response. Normally, the HIV binds to these receptors and attacks the cells, but a deletion in the CCR5 gene stops the receptors from functioning properly. About 1% of people of European descent have two copies of this mutation and are resistant to HIV infection.

Guptas team describes the results in a paper due to be published in Nature on 5 March. The researchers report that the transplant successfully replaced the patients white blood cells with the HIV-resistant variant. Cells circulating in the patients blood stopped expressing the CCR5 receptor, and in the lab, the researchers were unable to re-infect these cells with the patients version of HIV.

The team found that the virus completely disappeared from the patients blood after the transplant. After 16 months, the patient stopped taking antiretroviral drugs, the standard treatment for HIV. In the latest follow-up, 18 months after stopping medication, there was still no sign of the virus.

Gupta says that its not yet possible to say whether the patient has been cured. This can only be demonstrated if the patients blood remains HIV free for longer, he says.

But the study does suggest that Browns successful treatment ten years ago wasnt just a one-off. Gupta says that the latest patient received a less aggressive treatment than Brown to prepare for the transplant. The new patient was given a regimen consisting of chemotherapy alongside a drug that targets cancerous cells, while Brown received radiotherapy across his entire body in addition to a chemotherapy drug.

This suggests that, to be successful, stem-cell transplants in HIV patients would not necessarily need to be accompanied by aggressive treatments that might have particularly severe side effects, says Gupta. The radiation really does knock the bone marrow and make you very sick.

Graham Cooke, a clinical researcher at Imperial College London, points out that this kind of treatment wouldnt be suitable for most people with HIV who dont have cancer and so dont need a bone-marrow transplant, which is a serious procedure that can sometimes have fatal complications. If youre well, the risk of having a bone-marrow transplant is far greater than the risk of staying on tablets every day, he says. Most people with HIV respond well to daily antiretroviral treatment.

But Cooke adds that for those who need a transplant to treat leukaemia or other diseases, it seems reasonable to try and find a donor with the CCR5 mutation, which wouldnt add any risk to the procedure.

Gero Htter, who led Browns treatment and is now medical director of the stem-cell company Cellex in Dresden, Germany, agrees that this kind of treatment could only ever be used for a small group of patients. But he hopes that the paper will stimulate a renewed interest in gene therapies that target CCR5, which could be applied to a much broader group. The real breakthrough, we are still waiting for, he says.

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Originally posted here:
Second patient free of HIV after stem-cell therapy

Recommendation and review posted by G. Smith

Stem Cell Therapy | Ohio Stem Cell

Posted: April 17, 2019 at 12:49 am

Amniotic regenerative cell therapy is one of the newest and most cutting-edge therapies for chronic joint pain. Amniotic derived regenerative cell therapy offers patients 3 essential properties for healing and restoring joint health:

Since amniotic derived regenerative cell therapy is not derived from embryonic stem cells or fetal tissue, there are no ethical issues with the treatment. The amniotic regenerative cell therapy consists of an injection directly into the painful area. The therapy has the potential to actually alter the course of the condition and not simply mask the pain. This therapy has significant potential for those in pain, and could actually repair structural problems while treating pain and inflammation simultaneously. When the amniotic cell material is obtained, it comes from consenting donors who have undergone elective c-sections. The fluid is processed at an FDA regulated lab, and is checked for a full slate of diseases per FDA guidelines. The amniotic material has been used over 60,000 times in the US with no adverse events reported. It acts as an immunologically privileged material, meaning it has NOT been shown to cause any rejection reaction in the body. This means there is no graft versus host problem.

Our services are provided by Dr. John Biery D.O. F.A.O.S.M. F.A.C.S.M. F.A.C.O.F.P

Lauren Sherer P.A.-C

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Stem Cell Therapy | Ohio Stem Cell

Recommendation and review posted by G. Smith

Mayo Clinic Q and A: Stem cell therapy for arthritis Mayo …

Posted: April 17, 2019 at 12:49 am

DEAR MAYO CLINIC: Whats the latest information on using stem cell therapy to treat an arthritic shoulder that causes excessive pain?

ANSWER: New efforts in regenerative medicine, including stem cell therapy, could dramatically affect orthopedic surgery over the coming years. Much of this hope is pinned on using stem cells to treat degenerative conditions such as shoulder arthritis. Although it shows promise, stem cell treatment for arthritis isnt widely available at this time, as its still being researched.

Stem cells are the basic building blocks of all human tissue. Stem cells hold potential as treatment, in part, because they can communicate valuable information about tissue growth and healing to other cells in the body. Arthritis involves joint degeneration due to loss of the cartilage that cushions bones. Recently researchers have begun to look to stem cells for orthopedic conditions such as shoulder arthritis. Progress using stem cells to treat arthritis already has been reported, with the ultimate goal of using stem cells to regrow cartilage.

When discussing stem cell therapy, its important to understand that pure stem cells are not currently available to U.S. patients outside of a clinical research study. A handful of clinical research trials, monitored by the U.S. Food and Drug Administration (FDA), are ongoing at this time to study stem cell treatment for arthritis. The early findings from these trials are encouraging.

Unfortunately, the excitement surrounding emerging stem cell therapy has led some patients and health care providers to overlook the lack of scientific evidence to support its use at this time. Stem cell therapies currently used outside clinical studies do not contain pure stem cells. Instead, they are a mix of a variety of cells, of which only a very small percentage are stem cells. It is possible that many of these treatments do not contain enough stem cells to help.

It is also important to recognize that many stem cell therapies now marketed directly to patients are conducted without the required biologics license from the FDA. Also, some forms of mislabeled stem cell therapies do not contain any living stem cells. Such practices are cause for concern, as these treatments can mislead patients and the public, and delay the scientific progress needed to turn stem cell therapies into cures.

What the research into stem cells and arthritis shows is that there are opportunities for stem cell treatment to be used as injection therapy alone and in addition to orthopedic surgical procedures. Successful stem cell therapies thus far have resulted mostly in pain relief and improvement in function or quality of life. Only a few limited early studies have demonstrated improvement in new cartilage or bone formation needed to cure arthritis. Exactly how that cartilage regrowth occurs, or even how pain relief is achieved, is still unknown. That means if you have a stem cell procedure, it will be used to treat the symptoms of arthritis only. The ability to cure the disease entirely is not yet available.

No major research studies have specifically investigated stem cell treatment for shoulder arthritis. Much of what is known about stem cells in arthritis comes from research into knee degeneration. Its not known if the successes treating knee arthritis will prove to be similarly beneficial when used for the shoulder. Therefore, current recommendations to treat shoulder arthritis remain the judicious use of gentle pain relievers, exercise and occasional steroid injections. In severe cases, shoulder replacement can provide long-lasting pain relief.

With demonstrable safety and mounting evidence of the effectiveness of stem cell therapy for some orthopedic conditions, potentially all orthopedic disease could be treated with stem cell therapy in the future. But, first, doctors and patients will have to wait until the scientific evidence catches up to the excitement around this promising option. Dr. Shane Shapiro, Orthopedic Surgery and Center for Regenerative Medicine, Mayo Clinic, Jacksonville, Florida

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Mayo Clinic Q and A: Stem cell therapy for arthritis Mayo ...

Recommendation and review posted by G. Smith


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