Hydroxychloroquine May Help Delay Skin Damage In SLE Patients.
By jeremyc | March 3, 2010
MedPage Today (3/2, Walsh) reported that, according to a study published in March issue of Arthritis Care & Research, “treatment with hydroxychloroquine (Plaquenil) may help delay the occurrence of skin damage in patients with systemic lupus erythematosus (SLE).” In a study of “580 patients who had not yet developed skin damage at baseline,” researchers found that use of hydroxychloroquine “was associated with a longer time until integument damage — defined as scarring alopecia, extensive skin scarring, and skin ulcers — was present.” Moreover, “the cumulative probability of damage at five years was 5% for those taking hydroxychloroquine, compared with 24% for those who were not on the drug.”
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Osteoporosis drugs may reduce breast cancer risk
By jeremyc | March 3, 2010
Source: MedWire News
Women who use biphosphonate drugs to prevent and treat osteoporosis may have a lower risk for breast cancer than non-users, according to a study by US researchers.
“Because we were able to account for important confounders, these findings may reflect real benefits due to the anti-tumor mechanisms of these medications,” remark Polly Newcomb (Fred Hutchinson Cancer Research Center) and colleagues in the British Journal of Cancer.
Bisphosphonates are primarily used for the prevention and treatment of osteoporosis, but have also been shown to directly induce tumor apoptosis, inhibit angiogenesis, and prevent tumor cell adhesion, explain the researchers.
To evaluate whether the use of these drugs may be associated breast cancer, Newcomb and team conducted a case-control study in Wisconsin from 2003 to 2006. They interviewed 2936 women with breast cancer and 2975 population-based controls about their history of fractures, whether they had been diagnosed with osteoporosis, and their history of bisphosphonate use.
After adjusting for potential confounders such as family history of breast cancer, age at first birth, postmenopausal hormone use and body mass index, the researchers found that current bisphosphonate users had a 33% reduced risk for breast cancer compared with non-users. Moreover, increasing duration of use was significantly associated with a greater reduction in risk.
Of note, the protective effect seemed limited to women who were not obese. “Obese women may have elevated estrogen levels, so underlying hormones may influence the ability of bisphosphonates to reduce breast cancer risk,” Newcomb said.
The researchers note that the molecular targets of biphosphonates are unknown. However, “in a recent clinical trial of early-stage breast cancer, nitrogen-containing bisphosphonates seemed to improve long-term outcomes, and several large clinical trials are currently underway to clarify this issue,” they report.
Newcomb and co-authors conclude that their results “are suggestive of an additional benefit of the common use of bisphosphonates, in this instance, the reduction in breast cancer risk.”
Topics: Breast cancer, Osteoporosis | No Comments »
Thyroid drug in short supply
By jeremyc | March 3, 2010
A shortage of thyroid medicines that contain powdered pig thyroid has frustrated patients, physicians and pharmacists.
Patients for decades have used the medicines, distributed under names such as Armour Thyroid and Nature-throid.
Over the past few months, Armour Thyroid has been “available to us for a while, and then it goes away,” said Kris Shubert, a pharmacist at Kohll’s in Omaha. “So it’s kind of on again, off again.”
He said he encounters about 10 patients a day who want the pig thyroid product.
Dr. Patricia Ryan, an Omaha family physician, said that at one point she had to order Nature-throid from an Arizona pharmacy. Most of the time, she said, she can get it from Kohll’s or Kubat Pharmacy.
It is unclear what has caused the shortage.
A spokesman for New York-based Forest Laboratories said in an e-mail this week that a supplier shortage of the Armour powder “has been resolved.” The spokesman, Frank Murdolo, suggested that the supply “is improving so that patients may have their prescriptions filled without delay.”
Shubert said he received a fairly large shipment of Nature-throid early this week. Nature-throid is similar to Armour Thyroid but is made by a different manufacturer.
Although Armour Thyroid and Nature-throid have only a small share of the market — estimated at from less than 5 percent to 15 percent — that still would be hundreds of thousands of patients.
The medications are among several drugs used for hypothyroidism, a condition in which the thyroid produces low levels of hormones. That can lead to weight gain, lethargy, depression, constipation, dry skin and other symptoms.
Among the most widely used hypothyroid drugs are Synthroid and Levoxyl, which are synthetic hormones as opposed to pig thyroid medicines.
The latter drugs have fallen from favor with some endocrinologists, or physicians who specialize in thyroid and other conditions, because it’s harder to control their potency than synthetic medicines.
“It’s just subject to more variability in potency,” said Mary Ross, assistant director of the department of pharmaceutical care at the University of Iowa Hospitals and Clinics. Her institution, in fact, doesn’t stock the medicines that use pig thyroid.
But the shortage has caused concern among others.
“It’s been quite a headache, actually,” said Jessica Karas, a pharmacist for Kubat.
Ryan said she has patients who feel better on Armour Thyroid or Nature-throid and show no problems tolerating the medicine when their blood is tested.
“I like it because, overall, my patients feel good on it,” Ryan said.
Grace Ford of Bellevue said she tried Synthroid and felt less tired. But when she started taking Armour Thyroid about a year ago, she said, she felt much better.
“It was just amazing,” Ford, 60, said. “I felt like I was normal again.”
There have been several days during which she had to take half a dose while waiting for her Armour prescription, she said. Otherwise, she has been able to obtain it.
The American Association of Clinical Endocrinologists estimates that 27 million Americans have thyroid diseases, the majority of whom suffer with hypothyroidism.
Topics: Thyroid | No Comments »
Suppressive antiretroviral therapy slows progression of atherosclerosis
By jeremyc | March 2, 2010
Antiretroviral therapy that reduces viral load to an undetectable level was linked to slower progression of sub-clinical atherosclerosis, as indicated by carotid intima-media thickness, researchers reported last week at the 17thConference on Retroviruses and Opportunistic Infections (CROI) in San Francisco.
Atherosclerosis (’hardening of the arteries’) is an inflammatory condition in which plaques (accumulations of lipids, immune cells, scar tissue and cell debris) build up in artery walls. This leads to narrowing of the arteries, and ruptured plaques and the resulting clots can block blood vessels, causing a heart attack or stroke. Several studies have shown that people with HIV have more rapid atherosclerosis progression than HIV-negative people, but data have not always been consistent.
Jason Baker and fellow investigators evaluated artery changes amongst participants in the SUN study, an observational cohort of HIV-positive people in four US cities enrolled during the modern antiretroviral therapy era (2004-2006). Most (78%) were men, about 60% were white and the median age was 42 years.
The researchers measured sub-clinical or pre-symptomatic atherosclerosis using ultrasound to assess the thickness of artery walls – known as intima-media thickness or IMT – in the carotid arteries that supply blood to the brain.
IMT was assessed in the common carotid, the main part of the artery before it splits into two branches. Another study presented at CROI showed that carotid IMT can vary considerably depending on where in the artery it is measured.
The SUN researchers measured IMT at entry to the study and then two years later. The researchers undertook analyses to determine factors associated with carotid artery thickening among this group at low risk for progression to AIDS.
Many of the participants had traditional risk factors for cardiovascular disease when they entered the study. The median body mass index was about 26 (considered overweight), about 40% were smokers and about 30% had high blood pressure or metabolic syndrome. However, total cholesterol and LDL (bad) cholesterol levels were generally low and within recommended ranges. The median Framingham Risk Score (a frequently used indicator of cardiovascular risk) was low, at 2, but 30% had a score of 5 or higher.
At baseline, 78% of participants were taking antiretroviral therapy, about evenly divided between non-nucleoside reverse transcriptase inhibitors (NNRTIs) and protease inhibitors. The median CD4 cell count was near normal at 481 cells/mm3 – though the nadir or lowest-ever count was about 200 cells/mm3 – and 71% had a viral load below 400 copies/ml.
Over two years of follow-up, the overall median common carotid IMT increased from 0.710 mm at baseline to 0.720 mm (a median increase of +0.013 mm); the largest proportion of patients, however, showed no change.
Presenter Jason Baker noted that whilst general population studies have also shown carotid IMT increases in the range of +0.01 to +0.02 mm, those patients were typically around ten years older than the SUN cohort.
SUN participants whose viral load was consistently suppressed below 400 copies/ml at all study visits experienced a significantly smaller increase in common carotid IMT (+0.011 mm) than those with one or more higher viral load measurements (+0.019 mm).
But the researchers saw some difference between antiretroviral drug classes. NNRTI use was associated with a significantly smaller common carotid IMT increase (+0.009 mm) compared with protease inhibitor use (+0.016 mm), a difference of -0.007 mm.
They did not find a significant difference, however, between patients who took tenofovir (Viread, also in the Truvada andAtripla combination pills) and those who took abacavir (Ziagen, also in the Kivexa and Trizivir coformulations) (+0.013 vs +0.015, respectively).
After adjusting for traditional cardiovascular risk factors, negative predictors of carotid IMT progression – that is, those associated with smaller increases – were baseline viral suppression (difference of -0.010 mm), persistent viral suppression during follow-up (difference of -0.014 mm) and baseline antiretroviral therapy use (difference of 0.009 mm). Though small, these differences were statistically significant.
The SUN investigators also found that older age and being overweight were associated with larger IMT increases. Each additional ten years of age increased carotid IMT by a further 0.005 mm, whilst having a body mass index above 25 was linked to an additional 0.013 mm increase. However, high sensitivity C-reactive protein (CRP), a biomarker of inflammation, was not a significant predictor of increased IMT.
“Maintaining a suppressed HIV viral load decreased progression of sub-clinical atherosclerosis (carotid IMT),” the investigators concluded. “Factors related to both HIV infection and the type of antiretroviral therapy independently associate with the rate of carotid IMT progression.”
Dr Baker said that the study found changes in atherosclerosis “at the level of the arterial wall” that are consistent with the elevated risk of cardiovascular events like heart attacks seen in the D:A:D observational cohort and other studies.
Topics: HIV/AIDS | No Comments »
Awareness: Report Calls for Spotlight on Hypertension
By jeremyc | March 2, 2010
Source: New York Times
High blood pressure is the underlying cause of one in six deaths in the United States, but many Americans do not know they have it and doctors are lax about treating it, according to a new Institute of Medicine report that calls hypertension a “neglected disease.”
The report, issued last week, calls for population-based public health measures to prevent hypertension by expanding access to potassium-rich fruits and vegetables that help keep blood pressure in check, lowering the salt content in processed foods and making it easier for people to incorporate physical activity into their daily lives.
“People want to exercise, but they don’t have walking and biking paths available,” said Dr. David Fleming, chairman of the committee that wrote the report and the health commissioner of Seattle and King County. “They want to eat better foods, but the corner grocery store doesn’t stock fresh produce.”
He said doctors also needed to be more aggressive about treating hypertension, which is relatively simple to diagnose and to treat. They are often lax about treating mild hypertension, especially in elderly people who have many other medical problems, Dr. Fleming said. As a result, even people who go to the doctor regularly often do not know that they are hypertensive and are not being treated.
Topics: Blood Pressure | No Comments »
Pericardial fat linked to carotid stiffness
By jeremyc | February 28, 2010
Source: MedWire News
Pericardial fat is associated with carotid artery stiffness independently of traditional risk factors for cardiovascular disease (CVD) and obesity, US researchers report.
Arterial stiffness is a hallmark of aging that is characterized by elastin degeneration and increases in collagen, wall thickening, and progressive dilation, say Tina Brinkley and co-workers from Wake Forest University School of Medicine in Winston-Salem, North Carolina.
They investigated whether fat around the heart and blood vessels – known as pericardial fat – might contribute to arterial stiffness in 5770 participants, with a mean age of 62 years, from the Multi-Ethnic Study of Atherosclerosis.
Pericardial fat was measured using computed tomography, while common carotid artery stiffness was assessed using ultrasonography and the measurements used to calculate a distensibility coefficient (DC) and Young’s modulus (YM).
Lower DC and higher YM values indicate stiffer arteries.
Increasing quartiles of pericardial fat were highly associated with demographic, behavioral, anthropometric, hemodynamic, metabolic, and disease variables in men and women.
Each 41.91 cm3 increase in pericardial fat – equivalent to one standard deviation – was associated with a 0.00007 1/mmHg lower DC in men after adjusting for height, clinical site, CVD risk factors, and medications. The YM value lost significance after adjustment.
In women, each 41.91 cm3 increase was associated with a 48.1 mmHg/mm higher YM after adjustment, with the DC not statistically significant.
Further adjusting for C-reactive protein, coronary artery calcification, and carotid intima-media thickness had only modest effects.
“More importantly, adjusting for body mass index and waist circumference did not significantly change the overall results,” the authors note in the Journal of Nutrition.
They conclude: “Although more studies are needed to address whether fat around the heart and blood vessels is a distinct risk factor or simply a marker of visceral fat, this fat depot may prove to be a therapeutic target in reducing CVD morbidity and mortality.”
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Thyroid Hormone Boosts In Vitro Success, Researchers Find
By jeremyc | February 24, 2010
Adding thyroid hormone to the in vitro fertilization process produces more viable embryos and has the potential to increase the success rates of pregnancy, according to a groundbreaking study by University of Guelphresearchers.
A team of biomedical scientists discovered that adding the synthetic hormone to bovine eggs after fertilization boosted the number of viable embryos by 30 per cent.
They also found that the hormone-treated embryos were more advanced in morphology and cell number and had fewer damaged cells than the embryos developed without the hormone.
“These embryos were of higher quality, so there’s a greater chance they will survive and create a pregnancy,” said Prof. Allan King, who worked on the study with PhD student Fazl Ashkar. “Despite the widespread use of in vitro fertilization, only 25 to 30 per cent of the procedures result in a successful pregnancy, so any increase is beneficial.”
The thyroid hormone-treated embryos also showed a 25-per-cent increase in survival after freezing and thawing. Embryos are frozen for storage before they are transferred to recipients.
This research was highlighted in Tuesday’s Globe and Mail.
Published recently in the journal Human Reproduction, the study involved bovine embryos because cows are one of the closest species to humans when it comes to reproduction.
“The cow is a good model for humans because both release one or two eggs per cycle and both have similar reproductive systems and thyroid hormone levels,” said Ashkar. “Embryo development for humans and cows is also the same, with the gestation period being about nine months.”
The researchers turned their attention to thyroid hormone because women who have disturbances in fertility due to polycystic ovarian syndrome have levels of the hormone that are often lower than normal ranges.
“Thyroid hormone is involved in the regulation of gene expression, metabolism and growth, which are all areas important for early embryo development,” said Ashkar.
For the first part of their research, they had to determine to what extent the hormone exists naturally in the female reproductive system.
This initial study, which was recently published in Experimental Biology and Medicine, revealed the hormone was present in all areas of the reproductive tract, including the oviduct, which is the primary site of fertilization.
“This told us that thyroid hormone should have a function in fertility,” said Ashkar.
The next step was to investigate what impact adding the synthetic hormone to the in vitro process would have on early embryo development. The researchers added the hormone to the in vitro embryo production media at different stages of the process and found it had the most impact after the eggs were fertilized.
The scientists are currently working with other research partners to explore the potential impact their findings can have on human in vitro fertilization.
“Based on this research, it makes sense that thyroid hormone is important in embryo development regardless of the species,” said King. “Since human and bovine reproduction is so similar, we predict thyroid hormonewill have an effect on pre-implantation and consequently post-implantation human embryo development. Thus we are hoping this research can help improve the efficiency of in vitro fertilization in humans.”
Topics: Thyroid | No Comments »
Menopause linked to increased risk for gout
By jeremyc | February 23, 2010
Source: MedWire News
Study findings suggest that menopause is linked to an increased risk for gout, which is reduced through postmenopausal hormone therapy.
The researchers used data from the Nurses’ Health Study to examine the association between menopause, age at menopause, postmenopausal hormone use, and risk for self-reported physician diagnosed incident gout among 92,535 women without gout at baseline, over a 16-year period.
In total, 1,703 cases of incident gout were documented. The incidence of gout significantly increased from 0.6 cases per 1,000 person-years in women aged younger than 45 years to 2.5 cases per 1,000 person-years in women aged 75 years or older.
After adjusting for age, body mass index, diuretic use, hypertension, alcohol intake, and dietary factors, postmenopausal women had a significantly increased risk for gout compared with premenopausal women (relative risk [RR] = 1.26), which was higher among women with surgical than with natural menopause (RR = 1.37 vs 1.17).
Women who experienced menopause aged younger than 45 years were also significantly more likely to have incident gout compared with those who reached menopause aged 50-54 years (RR = 1.62).
Furthermore, postmenopausal hormone users had a significant 18% reduced risk for gout compared with women who never used hormone therapy.
“The current study provides the first prospective evidence for the long-suspected hypothesis that menopause and postmenopausal hormone use affect the risk for gout among women,” say Hyon Choi (Boston University School of Medicine, Massachusetts, USA) and co-authors.
Topics: Women's Health | No Comments »
Statins May Significantly Reduce Prostate Tumor Inflammation.
By jeremyc | February 23, 2010
HealthDay (2/22, Preidt) reported that “cholesterol-lowering statins significantly reduce prostate tumor inflammation, which may help lower the risk of disease progression,” according to a study published online in the journal Cancer Epidemiology, Biomarkers & Prevention. Investigators “examined tissue samples of prostate tumors from 236 men undergoing prostate cancer surgery.” The researchers “concluded that statin use was associated with reduced inflammation within tumors.”
Dietary Supplement May Help Interrupt Growth-Promoting Pathways In Prostate Cancer. MedWire (2/22, Guy) reported, “Australian researchers have developed a dietary supplement which interrupts growth-promoting signaling pathways in prostate cancer cells.” Specifically, there was “a dose-dependent reduction in in vitro LNCaP and PC3 growth of 83 and 93%, respectively, after 72 hours of treatment with 0.64% concentration of supplement.” According to the paper in the Journal of Nutrition, the “supplement is designed for men on active surveillance programs for low-risk prostate cancer and contains ingredients commonly consumed in Mediterranean and East-Asian countries where prostate cancer incidence is lower than in Western societies.”
Skin Patch Containing Minute Doses Of Nitroglycerine May Effectively Treat Prostate Cancer. The UK’s Daily Mail (2/22, Hagan) reported, “A chemical once used as a deadly explosive could be a powerful new treatment for prostate cancer,” UK researchers found after studying 24 patients. Participants wore a “skin patch containing minute doses of nitroglycerine” 24 hours a day for two years, and were also “checked…every few months for their PSA doubling time.” According to the paper in Urology, “within six months, PSA levels had stabilized in all but five of the 24 volunteers. After a year, most were either still stable or even declining.”
Topics: Prostate, Statins | No Comments »
Phisohex Still Available in Canada
By jeremyc | February 20, 2010
With Phisohex taken off the market in the United States, many Americans are trying to find Phisohex soap. Phisohex is still available in Canada. Universal Drugstore is at the forefront of providing Phisohex cleanser. Phisohex uses are many. Go here to find Phisohex prices.
Topics: Uncategorized | No Comments »
