Wednesday, February 08, 2006

never trust a test-tube only result

The hype that surrounded this article was extreme, but read carefully..... there is space for hope but little more.

Has BYU prof found AIDS cure?
Compound could be long-sought breakthrough
Researchers, including a BYU scientist, believe they have found a new compound that could finally kill the HIV/AIDS virus, not just slow it down as current treatments do. 
   And, unlike the expensive, drug cocktails 25 years of research have produced for those with the deadly virus, the compound invented by Paul D. Savage of Brigham Young University appears to hunt down and kill HIV. 
    Although so far limited to early test tube studies, CSA-54, one of a family of compounds called Ceragenins (or CSAs), mimics the disease-fighting characteristics of anti-microbial and anti-viral agents produced naturally by a healthy human immune system. 
    Under a study sponsored by Ceragenix Pharmaceuticals, Savage and his colleagues developed and synthesized the compound for Vanderbilt University's School of Medicine. In his Nashville, Tenn., laboratories, Derya Unutmaz, an associate professor of Microbiology and Immunology, tested several CSAs for their ability to kill HIV. 
    While issuing a cautious caveat about his early results, Unutmaz acknowledged Monday that CSAs could be the breakthrough HIV/AIDS researchers have sought for so long. 
    "We received these agents [from BYU] in early October and our initial results began to culminate by November 2005. We have since reproduced all our results many times," he said. "We have some preliminary but very exciting results [but] we would like to formally show this before making any claims that would cause unwanted hype." 
    What studies to date show is a compound that attacks HIV at its molecular membrane level, disrupting the virus from interacting with their primary targets, the "T-helper" class white blood cells that comprise and direct the human immune system. Further, CSAs appear to be deadly to all known strains of HIV. 
    That would be a welcome development for the estimated 40.3 million people now living with HIV/AIDS globally, including nearly 5 million newly infected in the past year alone. 
    "We have devoted considerable resources to understand the mechanism of these compounds. We think this knowledge will enable us in collaboration with Dr. Savage to design even better compounds," Unutmaz said. 
    In addition to being a potential checkmate to HIV, the compounds show indications of being just as effective against other diseases plaguing humankind - among them influenza, possibly even the dread bird flu, along with smallpox and herpes. 
    Savage said he and his BYU research team had been studying CSAs for eight years, noting the compounds' value against microbial and bacteria infections. It was only a year ago they saw that CSAs killed viruses, too. 
    "They kill viruses very effectively and in a way paralleling our own, natural defenses," Savage said, noting that beyond the obvious use as a weapon against the AIDS pandemic, CSAs could help many others with non-HIV immune deficiencies. 
    Further, the compounds appear to have few limits on how they are delivered to patients. Although early indications are for application
 of CSAs with an ointment or cream, pills or injections may also be developed - if the compound gets to market. 
    BYU and Vanderbilt have jointly filed a patent on CSA technology, which has been licensed exclusively to Ceragenix. 
    Ceragenix CEO and Chairman Steven Porter said only further research will tell, but he was optimistic about the application of CSAs in the war on HIV/AIDS. There are indications that it could help battle antibiotic- and antiviral-resistance strains of disease as they manifest themselves. 
    "We are encouraged . . . that CSAs may provide a completely unique family of anti-infectives, potentially active against a wide range of viral, fungal and bacterial targets, including those resistant to current therapies," he said. 
    Assuming continued positive test results in animal and eventual human trials, Porter estimates it could be three to seven years before the compound is available by prescription. That transition could be accelerated, however, if the Food and Drug Administration should decide to fast-track the drug. 
    That day is still a long way off, though. First, researchers plan to publish their results in scientific journals, seeking peer review and independent confirmation of their findings. Assuming no flaws are found, several rounds of testing would follow. 
    Most of the nation's leading AIDS experts were attending the Conference on Retroviruses and Opportunistic Infections in Denver on Monday. The event's policies prohibits on-site news conferences or releases during the conference, and efforts to reach scientists there were not successful. 
    Of the few AIDS research luminaries reached, all said they preferred not to comment on the Vanderbilt tests until full results are published.

Friday, January 20, 2006

oh great, more to worry about at work

Heart disease and diabetes linked to stress in the office 

· Researchers study 10,000 civil servants for 14 years
· Women five times more likely to have risk factors 

Sarah Boseley, health editor
Friday January 20, 2006

People who suffer from chronic stress caused by their job are more likely to develop heart disease and diabetes, according to research. It has long been suggested that stress can damage your health, but scientific evidence has been hard to come by. However, researchers writing in this week's British Medical Journal say they have evidence "for the biological plausibility of the link".
Their study looked at the stress levels reported by more than 10,000 civil servants, aged 35 to 55, in 20 government departments in London. The participants in the 14-year study also answered questions on their health and had two physical examinations. The researchers found that those who most often reported stress were most likely to have a set of risk factors for heart disease and diabetes, which include abdominal obesity, raised cholesterol and high blood pressure, known as metabolic syndrome.

CAFFEINE - my favorite subject


this is a Caffeine FAQ, it seems (cursory glance so far) to be mostly accurate, though the 'increases blood pressure/dehydrates you myth tests has not yet been preformed. (on closer examination it is complete in some areas and woefully incomplete in others.)

excerpt:

This FAQ is dedicated to all beverages and products that contain caffeine; including tea, coffee, chocolate, mate, caffeinated soft drinks, caffeinated pills, coffee beans, etc.



  1. The Chemistry of Caffeine and related products
    1. How much caffeine is there in [drink/food/pill]?
    2. How much caffeine there is in X coffee?
    3. Chemically speaking, what is caffeine?
    4. Is it true that tea has no caffeine/What is theine, theobromine, etc?
    5. Where can I find a gif of the caffeine molecule?
    6. Is it true that espresso has less caffeine than regular coffee?
    7. How does caffeine taste?
    8. How much theobromine/theophylline there is in ...?
    9. Does dark roast coffee have less caffeine than light roast?
    10. How do I measure caffeine content at home?
    11. Is there a legal limit for caffeine content?
  2. Caffeine and your Health
    1. Caffeine Withdrawal
    2. What happens when you overdose?
    3. Effects of caffeine on pregnant women.
    4. Caffeine and Osteoporosis (Calcium loss)
    5. Studies on the side-effects of caffeine...
    6. Caffeine and your metabolism.
  3. Miscellaneous
    1. How do you pronounce mate?
  4. Recipes
    1. Chocolate covered espresso beans
    2. How to make your own chocolate
    3. NOTE: for Coffee Recipes check the Coffee FAQ
  5. Electronic Resources
  6. Administrivia
    1. How do I get the newest copy of this FAQ?
    2. List of Contributors
    3. Copyright


Thursday, January 19, 2006

health news


Half of active children pursue non-traditional physical activities

January 17, 2006

A transportation engineer at The University of Texas at Austin has performed one of the most comprehensive surveys of physical activity in children and found that about as many kids stay active by pedaling their bikes to a friend's house or walking around a neighborhood as do others by participating in organized athletics.

"This is a compelling reminder that parents really don't need to think of staying fit as a huge and scheduled time sink," said Dr. Chandra Bhat. "You can, in simple, flexible ways, change a child's lifestyle to incorporate physical activity."

The professor and a graduate student will describe the study results on Monday, Jan. 23, at the 85th annual meeting of the Transportation Research Board in Washington D.C. The talk is based on an analysis Bhat and graduate student Rachel Copperman performed on a 2001 survey about travel choices made by 15,000 households in the San Francisco Bay area.

Recent studies have found that children are exercising less, and becoming more obese. About one in eight American children bike or walk to school, for instance, as compared to one in two children 30 years ago. The percentage of children who are overweight has more than doubled in the same time frame.

http://tinyurl.com/d9w5g





Gene therapy 'turns off' mutation linked to Parkinson's disease

A group of Northwestern University researchers is developing a novel gene therapy aimed at selectively turning off one of the genes involved in the development of Parkinson's disease.
The gene therapy, described in the January online issue of the journal Experimental Neurology, was designed by Martha Bohn and her laboratory group at Northwestern University Feinberg School of Medicine.
Bohn is Medical Research Council Professor and director of the neurobiology program at Children's Memorial Research Center and professor of pediatrics and of molecular pharmacology and biological chemistry at the Feinberg School. The gene technique the Bohn lab developed removes a protein known as alpha-synuclein from the diseased dopamine-producing neurons that die in Parkinson's disease. Alpha-synuclein is abundant in structures known as Lewy bodies – a diagnostic hallmark of Parkinson's disease.
Research has shown that mutant forms of the alpha-synuclein gene, as well as too much alpha- synuclein protein, are involved in the development Parkinson's disease in some families.
For this research, the Bohn lab combined a recently developed technology called "RNA interference" with gene therapy to turn off alpha-synuclein in dopamine neurons. RNA interference is a sophisticated method to selectively turn off one gene in a cell, leaving others unaffected.
By placing the RNA interference into a crippled, non-disease-causing virus, scientists in the Bohn lab have been able to deliver the RNA interference tool to the brain of rats and turn off the alpha-synuclein protein in neurons. "This is the first step in developing a new therapy for Parkinson's disease based on molecular knowledge of the disease," said Mohan K. Sapru, research assistant professor of pediatrics, who is first author on the study and co-inventor of the gene therapy technology.
"It may also be useful for other diseases of the brain, such as dementia with Lewy bodies, a disease also characterized by Lewy bodies in the brain," Sapru said.
The Bohn lab will subsequently test this gene therapy in mouse models of the disease. If the RNA interference approach works in the mouse, a gene therapy based on silencing the _alpha-synuclein gene will be developed for clinical trials for Parkinson's patients.

Wednesday, January 18, 2006

health news

Household insecticides associated with increased risk of childhood leukaemia

Household exposure to pesticides and risk of childhood acute leukaemia; Occupational and Environmental Medicine 2006, 63: 131-4

Household insecticides may increase the risk of childhood leukaemia, suggests French research in Occupational and Environmental Medicine .
Leukaemia is the most common childhood cancer in France, affecting 43 in every million children every year.
The findings are based on 280 children newly diagnosed with acute leukaemia and a further 288 children matched for sex and age, but free of the disease.
Detailed face to face interviews were carried out with each of their mothers. These included questions about the employment history of both parents, the use of insecticides in the home and garden, and the use of insecticidal shampoos to eradicate head lice.
The risk of developing acute leukaemia was almost twice as likely in children whose mothers said that they had used insecticides in the home while pregnant and long after the birth.
Exposure to garden insecticides and fungicides as a child was associated with a more than doubling of the risk of acute childhood leukaemia. And the use of insecticidal shampoos to eradicate head lice, based on what the mothers had said, was associated with almost double the risk.
The authors say that no one agent can be singled out and a causal relation between insecticides and the development of acute childhood leukaemia "remains questionable,"
They add: "However, the consistency of our results and the results from previous studies suggests that it may be opportune to consider preventive action."



Comedy films boost blood flow to the heart

Impact of cinematic viewing on endothelial function; Heart 2006, 92: 261-2

Watching comedy films boosts blood flow to the heart, finds a small study in the journal Heart.
Researchers asked 20 healthy young adults to watch 15 to 30 minute segments of sad and humorous films, a minimum of 48 hours apart.
Examples of sad films included the opening scene of Saving Private Ryan and examples of comedy films included There's Something About Mary.
Participants were asked to abstain from drinking alcohol, using vitamins or herbs, or taking aerobic exercise the evening before the experiment, as all these can affect blood flow.
In all, 160 measurements of brachial artery blood flow were taken before and one minute after phases of laughter or sadness. The brachial artery runs from the shoulder to the elbow, and is a good indicator of blood flow around the body.
Brachial artery blood flow was reduced in 14 of the 20 participants after watching movie clips that caused distress. But it was increased in 19 of the 20 participants after watching movie clips that elicited laughter. The difference in flow between sad and happy responses exceeded 50 per cent.
The extent of the impact of watching a sad film was of the same magnitude as remembering episodes of anger and doing mental arithmetic, say the authors, while the impact of watching a funny film was equivalent to a bout of aerobic exercise or starting on statin treatment.



Mayo collaboration identifies gene in childhood kidney disease

New insight into related disorders

An international research collaboration led by Mayo Clinic has identified a new gene involved in causing the inherited kidney disorder, Meckel-Gruber syndrome (MKS). Children with MKS have central nervous system deformities as well as abnormal cysts in their kidneys, and usually die shortly after birth. The findings appear in the current edition of Nature Genetics (http://www.nature.com/ng/index.html). In addition to Mayo Clinic, the collaboration involved researchers from the Indiana University School of Medicine in Indianapolis, and the University of Birmingham, England.

Significance of the Finding

This news is of immediate importance to MKS families who may now have their blood screened for the defect and seek genetic counseling. The finding also is important for advancing understanding of what goes wrong in common birth defects, such as neural tube defects, as well as for related disorders such as more common forms of polycystic kidney disease (PKD). PKD accounts for more than 5 percent of end-stage kidney disease in the United States and Europe.

"This gene has immediate relevance for a small number of families, but the broader implications are important for the understanding they bring of how cysts develop in the kidney," explains Peter Harris, Ph.D., the Mayo Clinic nephrology researcher who led the research team. "There is a kind of common linkage among these diseases. Our hope is that this new finding will aid us to devise new treatments for a broad category of disabling disease."

Meckel-Gruber kidney disease is separate from, though related to, PKD in that some of the same things go wrong to cause the abnormal formation of cysts that disrupt kidney function. Knowing the identity of one key gene involved in MKS is a first step to understanding the disorder and eventually devising therapies to blunt its effects. Treatments are being developed for the more common forms of polycystic kidney disease.

The current work is an extension of Mayo researchers' groundbreaking work for more than a decade that has helped to reveal the genetic basis of PKD and to develop therapies. In that time, Mayo researchers have identified key genes driving the most common form of the disease in adults and in infants.

Method: From Rat to Humans

The research collaboration brought together Mayo's expertise in polycystic disease genetics with an animal model characterized in Indiana: a rat that mimicked PKD but that also showed symptoms of abnormal brain development. These clinical characteristics linked to a gene made this a useful model for an atypical form of PKD. The researchers identified the neighborhood in the model's genome where the error likely occurred, ultimately finding one gene that was defective. They then looked at the same neighborhood in the human genome for evidence of a disease with symptoms similar to the model (the bottom of chromosome 8) and found Meckel-Gruber syndrome type 3 (MKS3). Screening the corresponding gene, they identified similar changes in the MKS3 patients (characterized by the Birmingham group) and identified the disease gene.

http://tinyurl.com/77a4f




Antidepressant therapy for major depression in children and adolescents


Dr. Graham Emslie, a world leader in research into the use of antidepressants in children and adolescents, along with colleagues Amy Cheung and Taryn Mayes review the evidence from published and unpublished randomized controlled trials on the benefits and harms (including suicide and suicide ideation) of antidepressant therapy for major depressive disorder in pediatric patients. They also make clinical recommendations based on their findings.
p. 193 The use of antidepressants to treat depression in children and adolescents -- A.H. Cheung et al



Absence of critical protein linked to infertility


The absence of a key protein may lead to infertility.
Researchers at the University of Illinois at Urbana-Champaign report that experiments involving mice -- to be detailed in the Proceedings of the National Academy of Sciences -- indicate that the transcription factor protein C/EBPb must be present in the uterus for pregnancy to occur. The study appears online this week at the PNAS Web site.
Without it, they say, an embryo cannot survive in uterine tissue or attach to a mother's blood supply. Other genes also play roles, but C/EBPb is critical for implantation of an embryo, said Milan K. Bagchi, a professor of molecular and integrative physiology.
C/EBPb is scientifically known as CCAAT/Enhancer Binding Protein beta. It is regulated by the hormones estrogen and progesterone. In normal conditions, the protein, driven mostly by progesterone, is expressed rapidly and in large quantities during the critical four-day implantation period in mice, Bagchi said.
During this period, an embryo attaches to the wall of the uterus, advances into it and eventually attaches to the blood supply and forms the placenta. For a successful pregnancy to occur, stromal cells of the uterus must be transformed into decidual cells, which secrete nutrients that allow the embryo to survive until it plugs into the blood supply. C/EBPb is necessary for decidualization, the researchers discovered.
"This protein in the mouse is also in humans," Bagchi said. "We believe it plays a critical role in human pregnancy. It is expressed in the human endometrium at a time that coincides with the time of implantation. We have demonstrated very clearly in the mouse that in the absence of C/EBPb there is no decidualization. We transferred viable mouse embryos from healthy mice into mice lacking the gene, and pregnancy failed."
The project began more than four years ago. First, researchers used DNA microarrays to identify gene expression under normal and abnormal conditions during implantation. After messenger RNA profiling zeroed in on C/EBPb's activity, the researchers collaborated with Peter F. Johnson of the National Cancer Institute's Laboratory of Protein Dynamics and Signaling, who created mice that lacked the protein.
The experimental mice were then used to observe the relationships of the hormones and their receptors with the protein under varying conditions during the critical implantation period. In doing so, researchers determined that C/EBPb is a critical mediator of steroid hormone responsiveness in the uterus.
"This gene is expressed when the uterus is ready for embryo attachment," said co-author Indrani C. Bagchi, a professor of veterinary biosciences in the College of Veterinary Medicine at Illinois. "Its presence indicates a window for success."
If the findings are replicated in human tissue, as expected, she said, the protein's presence could become a vital gene marker for predicting uterine readiness for pregnancy.
"The success rate for the practice of in vitro fertilization currently is, on average, about 25 percent," she said. "The major problem is that the conditions occurring when the embryo is transferred often are not the best in the uterus. It's not known if the uterus is ready to accept an embryo, so often multiple embryos are transferred in hopes that one will attach. In future studies, confirmation of C/EBPb as a marker that correctly indicates uterine readiness for implantation in the human is likely to alleviate these shortcomings."
Other co-authors of the paper were doctoral student Srinivasa Raju Mantena, postdoctoral researchers Athilakshmi Kannan and Yong-Pil Cheon, and research scientist Quanxi Li, all in Indrani Bagchi's veterinary biosciences laboratory.




yogurt to battle aids

Doctors modify yoghurt bacteria to combat HIV infection 
PM - Wednesday, 18 January , 2006  18:26:00
Reporter: Toni Hassan
HAMISH FITZSIMMONS: Doctors in the United States have modified a friendly bacteria found in humans and yoghurt, and discovered, that at least under laboratory conditions, the bacteria can neutralise the deadly HIV virus.

The results published today in the international journal Nature, pave the way for clinical trials this year using monkeys.

Scientists envisage the modified bacteria may one day be incorporated into yoghurts or be taken in tablet form to deliver an HIV blocking drug straight to a woman's vagina. 

A single dose could potentially provide a week's worth of protection from HIV infection, as Toni Hassan reports.

TONI HASSAN: What makes this development exciting is how it differs from the approach of existing Human Immuno-deficiency virus drugs.

Existing drugs inhibit proteins in human cells that HIV requires in order to make copies of itself. The existing drugs limit the damage once the HIV is already in human cells. But there are no drugs to prevent the entry of the AIDS virus entering cells after sexual intercourse.

BHARAT RAMRATNAM: Once HIV enters, the game is pretty much over. The person becomes infected. So this is very much a strategy to prevent infection. 

TONI HASSAN: Dr Bharat Ramratnam is an HIV specialist at Brown Medical School on Rhode Island. He's one of a team in the US that has genetically modified a good bug found in yoghurt and human stomachs - lactococcus lactic - to release a protein that stops HIV infection.

BHARAT RAMRATNAM: Yoghurt has been used for a bazillion years as a therapeutic. We're just sort of changing the mould a little and saying that let's make the yoghurt better and let's make it a drug machine. 

And the thing that's probably not obvious to most people is that this "bug" already resides in us. Lactobacilli… our gastro-intestinal tract is full of bacteria and these bacteria live happily. They don't attack us. They in most cases don't cause disease. They actually probably have some health effects. 

So we chose one of these bugs called Lactobacillus and we changed its genetic composition so that in addition to all the things that the Lactobacillus does, it also secretes a protein and that protein happens to be anti-viral or anti-HIV in activity.

TONI HASSAN: The lab results published today are of course just that and will now be tested on macaque monkeys.

The modified bacteria will be placed in what's called mucosal surfaces in vaginas and rectums of monkeys to test if the protein can in fact target and block HIV in infected semen.

Dr Ramaratnam again.

BHARAT RAMRATNAM: The principle is there. I think the concept is fairly scientifically sound, but the entire question which can only be answered through the animal studies is how much drug is produced by these bacteria and how long they last? 

TONI HASSAN: How much of the bug would you initially need? I mean, you know, are we're talking about the equivalent of truckloads of yoghurt?

BHARAT RAMRATNAM: No, that's the wonderful things about this. The bacteria obviously multiply and so what we're going to do in our macaque studies is to dose the animals differently. 

We're able to then figure out how many of these bacteria are say, still present at six hours, 12 hours, 24 hours, a week. And those data will tell us whether or not this is indeed a strategy that's worth pursuing. 

TONI HASSAN: The modified bacteria could be also given in capsule form, with the active bacteria lining a woman's vagina to protect her from infection. Another application is a gel that would need to be smeared on the mucosal surface before sex. Given that HIV AIDS is its mostly deadly in the developing world, the new therapeutic approach could be a profound answer for people at risk.

HAMISH FITZSIMMONS: Toni Hassan reporting.

Thursday, January 12, 2006

health news 1-12-06

New Way to Stimulate Brain to Release Antioxidants
Posted by samzenpus on Thursday January 12, @12:17AM from the wired-reflexes-2 dept. Neopallium writes "A joint research effort between researchers at the Burnham Institute for Medical Research in La Jolla, CA, and a team from Japan (Iwate University, Osaka City University, Gifu University, Iwate Medical University) has discovered a novel way to treat stroke and neurodegenerative disorders. This approach works by inducing nerve cells in the brain and the spine to release natural antioxidants that protect nerve cells from stress and free radicals that lead to neurodegenerative diseases."


Researchers Discover New Way to Stimulate Brain to Release Antioxidants; Potential Drug Approach for Stroke, Alzheimer's and Other Neurodegenerative Disorders; Research Published as Cover Story in Proceedings of National Academy of Sciences Jan 9, 2006 5:05:00 PM Copyright Business Wire 2006 LA JOLLA, Calif.--(BUSINESS WIRE)--Jan. 9, 2006-- A joint research effort between researchers at the Burnham Institute for Medical Research in La Jolla, CA, and a team from Japan (Iwate University, Osaka City University, Gifu University, Iwate Medical University) has discovered a novel way to treat stroke and neurodegenerative disorders. This approach works by inducing nerve cells in the brain and the spine to release natural antioxidants that protect nerve cells from stress and free radicals that lead to neurodegenerative diseases. Until this discovery, researchers were unable to induce release of these specific antioxidants directly in nerve cells, at the site where damage and degeneration occurs.

http://tinyurl.com/dxdm3




St. Jude projects 90 percent cure rate for ALL

The cure rate for the once almost universally fatal childhood cancer acute lymphoblastic leukemia (ALL) could reach 90 percent in the near future, thanks to improvements in diagnosis and treatment over the past four decades, according to investigators at St. Jude Children's Research Hospital. Almost 4,000 cases of ALL are diagnosed in the United States each year, about two-thirds of which are in children and adolescents, making this disease the most common cancer in this age group.
A report on the progress in the treatment of ALL authored by two St. Jude investigators appears in the January 12 issue of the New England Journal of Medicine.
The progressive improvement in the cure rate since 1962, when only 4 percent of children with ALL survived, reflects in large part the more effective use of existing drugs and the incorporation of sophisticated genetic technologies to personalize treatments, the authors said. Research findings at St. Jude have enabled clinicians to identify patients for whom standard treatment is most likely to fail, and who should therefore be treated more aggressively; these findings have also allowed clinicians to choose the optimal drugs and drug dosages for individual patients.
The improvements in ALL treatment are also helping to reduce the long-term toxic side effects of therapy by enabling clinicians to reduce or avoid the use of certain drugs or radiation that can damage major organs or cause secondary cancers.
"Our success reflects many years of dedication and research by an experienced team that have paid off substantially," said Ching-Hon Pui, M.D., director of the Leukemia/Lymphoma Division at St. Jude and American Cancer Society F.M. Kirby Clinical Research Professor. "A 90 percent cure rate for ALL is quite possible in the near future if we continue to incorporate the breakthroughs of past decades and successfully overcome the remaining challenges."
The dramatic increase in cure rates for children is especially significant in the case of African-American children, Pui noted. They still have poor outcomes in national studies, but studies at St. Jude have shown African-American children have the same high cure rates as white children when given access to the same effective treatments.

http://tinyurl.com/93ebe




One in five patients on commonly prescribed diuretics have abnormal sodium and potassium levels


One in five patients taking diuretics commonly prescribed for high blood pressure or heart conditions end up with reduced sodium and potassium levels, according to a study published in the January issue of the British Journal of Clinical Pharmacology.
Yet recent evidence suggests that perhaps as few as a third of patients on the drugs – used by one in eight adults – have their electrolyte levels tested, despite the fact that reduced levels can lead to a wide range of health problems.
A team from Queen's Medical Centre and the University of Nottingham in the UK reviewed the records of more than 32,000 adults from six general practices in the East Midlands.
They found that just under 12 per cent had received at least one prescription for thiazide diuretics between 1990 and 2002, but only 32 per cent had had their sodium and potassium levels recorded electronically. The drug most commonly prescribed was bendroflumethiazide (bendrofluazide).
21 per cent of those who had been tested had levels that fell below the normal range.
"In a small number of patients reduced sodium and potassium levels – often referred to as electrolyte levels - can be severe enough to require hospital admission, especially if they are elderly" says lead author Dr Jennifer Clayton.
"In milder cases they can make people feel below par, cause general weakness and tiredness and sometimes interfere with the normal rhythm of the heart.
"Severe loss of sodium can make it difficult for people to maintain their blood pressure at a normal level, causing dizziness, confusion and an increased risk of falls in older people.
"And loss of potassium can make people more susceptible to the side effects of other drugs they are taking for heart conditions."
Other findings included:

  • Low sodium levels were much more common than low potassium levels. Of the 196 patients who had low electrolyte levels, 66 per cent had low sodium levels and 40 per cent had low potassium levels. A small number of patients had both.
  • Nine per cent of the 196 patients who showed low levels had severe electrolyte disturbances – with ages ranging from 47 to 93. Ten of these were taken off the medication, but seven – including a 90 year-old male – were not.
  • Patients who had severe electrolyte disturbances had taken the medication for three to 90 months before their levels were checked.
  • 72 per cent of the 130 patients with low sodium levels were mild cases, 21 per cent were moderate and seven per cent were severe. Just over 80 per cent continued taking the drug, including a third of the severe cases.
  • Patients taking thiazide diuretics ranged from 19 to 99 years-old and nearly half were between 60 and 79.
  • 90 per cent were receiving the currently recommended dose of 2.5mg a day, but 10 per cent were receiving a higher dose.
  • The average age of patients tested for electrolyte levels was 69, while the average age of untested patients was slightly lower at 67.
  • Only 30 per cent of females had their electrolytes tested, compared with 36 per cent of males.

"Patients taking higher doses of thiazide diuretics are at particular risk of low potassium levels and elderly patients are at a particular risk of low sodium levels" concludes co-author Professor Ian Hall.

"This points to the need for prescribing low doses of thiazide diuretics and monitoring sodium and potassium levels to reduce the risk and increase the detection and treatment of these electrolyte abnormalities.

"Despite the fact that more than a fifth of the patients we looked at suffered from reduced electrolyte levels, less than a third of the people given this commonly used type of drug appear to have had tests to check their levels."

The authors stress that people should never stop taking prescribed medicine without first seeking advice from their GP.

"In our view, if people are on thiazide diuretics, it would be sensible for them to ask their doctor about routine testing for sodium and potassium levels next time they have an appointment or go to the surgery for a medication review" adds Professor Hall.

"This is particularly important if people have been feeling unwell, are elderly, taking other heart medication or are on higher doses of the drug."

http://tinyurl.com/878fd







one important item

Cold hands warn of fatal illness


LEG pain and cold hands and feet are better warning signs of early meningococcal disease in children than a rash or sensitivity to light, British doctors say.

They want health campaigns revised to focus on these clues.

The Oxford University team came to its conclusion after interviewing parents and examining the medical notes of 448 infected children — a quarter of whom died. They said these common early signs could prompt doctors to give life-saving antibiotic treatment.

The symptoms appeared up to seven hours before a rash and up to 10 hours before children developed an aversion to light, the most recognised signs of the bacterial infection that can cause meningitis and blood poisoning.

The study, by Matthew Thompson from the university's department of primary health care, is the first to map symptoms experienced before admission to hospital, their duration and the order in which they appeared.

The results, published yesterday in The Lancet medical journal, were strong enough to warrant immediate change to information campaigns, Dr Thompson said.

"There would be little risk of harm and considerable potential benefit if these symptoms were to be promoted to both parents and doctors," he wrote.

He said the symptoms were unusual in young children and could help differentiate meningococcal disease from trivial illnesses that started similarly with fever, vomiting and drowsiness.

David Isaacs, professor of infectious diseases at the Children's Hospital at Westmead in Sydney, said experienced doctors could pick up subtle signs of meningococcal infection, and knew that not all children developed the purple rash.

But there was a danger in warning the public to treat leg pains as an emergency, he said, because they also occurred with less serious illnesses.

Chris Hogan, a Victorian GP and spokesman for the Royal Australian College of General Practitioners, said the study showed meningococcal symptoms typically did not begin until at least six hours after the child got sick.

This meant doctors who saw children early in the illness should review them in six hours if they deteriorated, not the next day, which might be too late.

He said parents should seek medical advice if they had a child who got sick quickly.

UNFOLDING SYMPTOMS


Typical period after first becoming unwell that various symptoms appear.

■ Early leg pain (7 hours)

■ Diarrhoea (9 hours)

■ Abnormal skin colour (10 hours)

■ Cold hands and feet (12 hours)

■ Classic rash (13 hours)

■ Neck pain or stiffness (13 hours)

■ Light sensitivity (15 hours)

■ Late confusion or delirium (16 hours)

■ Unconsciousness (22 hours)

NOTE: NOT ALL SYMPTOMS ARE EXPERIENCED BY

ALL CHILDREN, ESPECIALLY IN THE EARLY STAGES.

Tuesday, January 03, 2006

Health news 1-3-06

Guidelines Needed to Help Care for Children During Emergencies

Children Under Age 5 Most at Risk

Evidence-based guidelines for the care of children in emergency situations should be developed and distributed to international relief organizations, according to researchers from the Johns Hopkins Bloomberg School of Public Health and the World Health Organization (WHO). In a review of published literature, the researchers found that the highest mortality rates following armed conflicts, natural disasters, population displacements or famines are often in children younger than five years. The most common causes of death are diarrhea, acute respiratory infections, measles, malaria and malnutrition; these are also the major causes of death in countries with high child mortality rates. The study is published in the January 2006 issue of the Bulletin of the World Health Organization.

“The major causes of child mortality in complex emergencies are well known and we have learned how to manage these conditions in stable situations. However, conflict or disaster often exacerbates the magnitude and severity of these illnesses, requiring rapid assessment and treatment of large numbers of severely ill children. This was seen with the tsunami disaster and the recent earthquake in Pakistan. What we need are simple, easy-to-use guidelines that are brought together in a single package for the different levels of health workers caring for children in complex emergencies,” said William J. Moss, MD, MPH, senior author of the study and an assistant professor in the Bloomberg School of Public Health’s Department of Epidemiology.

http://tinyurl.com/aft49




Oral contraceptive pill may prevent more than pregnancy

New research indicates birth control pill could cause long-term problems with testosterone

In the January issue of The Journal of Sexual Medicine, researchers have published a new investigation measuring sex hormone binding globulin (SHBG) before and after discontinuation of the oral contraceptive pill. The research concluded that women who used the oral contraceptive pill may be exposed to long-term problems from low values of "unbound" testosterone potentially leading to continuing sexual, metabolic, and mental health consequences.
Sex hormone binding globulin (SHBG) is the protein that binds testosterone, rendering it unavailable for a woman's physiologic needs. The study showed that in women with sexual dysfunction, elevated SHBG in "Oral Contraceptive Discontinued-Users" did not decrease to values consistent with those of "Never-Users of Oral Contraceptive". Thus, as a consequence of the chronic elevation in sex hormone binding globulin levels, pill users may be at risk for long-standing health problems, including sexual dysfunction.
Oral contraceptives have been the preferred method of birth control because of their ease of use and high rate of effectiveness. However, in some women oral contraceptives have ironically been associated with women's sexual health problems and testosterone hormonal problems. Now there are data that oral contraceptive pills may have lasting adverse effects on the hormone testosterone.
The research, in an article entitled: "Impact of Oral Contraceptives on Sex Hormone Binding Globulin and Androgen Levels: A Retrospective Study in Women with Sexual Dysfunction" published in The Journal of Sexual Medicine, involved 124 premenopausal women with sexual health complaints for more than 6 months. Three groups of women were defined: i) 62 "Oral Contraceptive Continued-Users" had been on oral contraceptives for more than 6 months and continued taking them, ii) 39 "Oral Contraceptive Discontinued-Users" had been on oral contraceptives for more than 6 months and discontinued them, and iii) 23 "Never-Users of Oral Contraceptives" had never taken oral contraceptives. SHBG values were compared at baseline (groups i, ii and iii), while on the oral contraceptive (groups i and ii), and well beyond the 7 day half-life of sex hormone binding globulin at 49-120 (mean 80) days and more than 120 (mean 196) days after discontinuation of oral contraceptives (group ii).
The researchers concluded that SHBG values in the "Oral Contraceptive Continued-Users" were 4 times higher than those in the "Never-Users of Oral Contraceptives". Despite a decrease in SHBG values after discontinuation of oral contraceptive pill use, SHBG levels in "Oral Contraceptive Discontinued-Users" remained elevated when compared to "Never-Users of Oral Contraceptives". This led to the question of whether prolonged exposure to the synthetic estrogens of oral contraceptives induces gene imprinting and increased gene expression of SHBG in the liver in some women who have used the oral contraceptives.