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Treatments for Excessive Sweating of Underarms, Feet or Hands

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A sweaty handshake can be an uncomfortable situation for many, particularly in business settings. Called focal hyperhidrosis, the condition is characterized by excessive sweating of the palms, underarms and the soles of the feet. Focal hyperhidrosis usually starts by the end of the teenage years, and is often hereditary.

Treatment options for focal hyperhidrosis include:

  • Non-prescription antipirspirants: Includes products such as Certain Dri, Secret Clinical Strength, Degree Clinical Protection and 5 Day. These products often work well to inhibit mild to moderate sweating.
  • Prescription antipirspirants: These containing aluminum chloride (Drysol, Xerac) and may be more effective than non-prescription antipirspirants.
  • Lontophoresis: This treatment can be done at home and involves placing hands or feet in a pan of water while a battery-powered device delivers a low-voltage current through the water. Treatments last 15 to 30 minutes and are typically done daily for a couple of weeks and then less frequently for maintenance. Iontophoresis is believed to temporarily block the sweat glands, but results may not be any better than using an antiperspirant.
  • Oral medications: Drugs in the anticholinergic class can help. This approach isn’t used often because of side effects that include dry eyes and mouth and difficulty urinating. Anti-anxiety medications may be helpful if stress-induced anxiety contributes to excessive sweating.
  • Botulinum (Botox) injections: Injections of Botox into the palms, soles or underarms can block the nerves that trigger sweat glands. This approach is effective for even severe hyperhidrosis, but the injections are painful. The effect from the Botox wears off after four to 12 months, and the treatment needs to be repeated.
  • Surgery: Two surgical approaches are options when other treatments haven’t worked. They entail surgically removing sweat glands from the underarms or severing the nerve in the chest that carries messages to the sweat glands. Surgery is seldom used because it is a major procedure. If needed, it’s effective.

As with any health concerns, it is essential to consult your healthcare provider before following any course of action.

Alzheimer’s Disease Risk Different for Men and Women

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Recent research suggests that the chances of developing Alzheimer’s Disease are different for men and women, with stroke in men and depression in women being key elements.

The research was conducted in France, among 7,000 people aged 65 and over, drawn from the general population. While none of the participants had dementia, some 40% had mild cognitive impairment. Four years later 6.5% of those displaying mild cognitive impairment had developed dementia, while no change was noted in just over half. About one third returned to normal cognitive ability.

The move from cognitive impairment to dementia however, was marked among subjects taking anticholinergic drugs for depression. A variation in the ApoE gene, a known risk factor for dementia, was also more common among those whose mild cognitive impairment progressed.

The results demonstrated that men with mild cognitive impairment were probably overweight and diabetic, and to have suffered a stroke. In fact, male stroke victims were three times as likely to progress from cognitive impairment to dementia.

Women with mild cognitive impairment had poorer general health, were disabled, and suffered from insomnia, besides having an inadequate support group. They were also unable to perform the daily tasks that would enable them to live alone without assistance. It was judged they were 3.5 times as likely to develop dementia, while those suffering from depression were twice as likely to do so. Stroke was not a risk factor for women, although there was similar rate of occurrence in men and women.

Source: Journal of Neurology, Neurosurgery, and Psychology, 2008; doi 10.1136/jnnp.2007.136903

Gene Linked to Severe Diabetic Retinopathy and Renal Disease

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Researchers have identified a gene called erythropoietin (EPO) that is linked to higher risk of severe retinopathy and nephropathy, eye and kidney diseases that often affect diabetic patients.

Diabetic retinopathy (PDR) is the most common cause of legal blindness in working-aged adults in the United States, accounting for 10% of new cases of blindness. Diabetes is also the leading cause of kidney disease, called end-stage renal disease (ESRD), in the U.S. and the Western world.

While researchers have known that these conditions in diabetic patients can be hereditary, the actual genese involved have been relatively unknown until now.

Researchers discovered the involvement of the EPO gene in a study of 1,618 people with diabetic retinopathy and end-stage renal disease, and 954 diabetes patients without any eye or kidney disease in three separate populations. Their studies demonstrate that if a person has a copy of the mutant EPO gene, they have an increased risk of developing PDR and ESRD during their lifetime.

According to Dr. Dean Li from the Program in Human Molecular Biology and Genetics at the University of Utah, while there is no proven pharmacologic treatment for diabetic vascular eye diseases, "inhibiting the growth of unwanted blood vessel growth using antibodies directed against vascular endothelial growth factor (anti-VEGF therapy) has been advocated. This genetic study suggests that future therapeutic strategies need to consider blunting the effects of erythropoietin in addition or as an alternative to an anti-VEGF strategy."

The study was led by Kang Zhang M.D., Ph.D., Director of the Division of Ophthalmic Genetics at the Moran Eye Center and Associate Professor of Ophthalmology and Visual Sciences at the University of Utah, and was published in the journal Proceedings of National Academy of Sciences.

New Crohn’s Disease Treatment Approved by FDA

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The U.S. Food and Drug Administration (FDA) has approved a new medicine called Cimzia for the treatment of Chron’s disease. The drug is manufactured by UCB, Inc., and is known as a tumor necrosis factor (TNF) blocker. It is used to reduce the signs and symptoms of moderately to severely active Crohn’s disease in adult patients who have not been helped enough by usual treatments.

Crohn’s disease is a condition that causes inflammation of the gastrointestinal tract, and most commonly occurs at the lower end of the small intestine. Typical symptoms include diarrhea, fever, rectal bleeding, malnutrition, narrowing of the intestinal tract, obstructions, abscesses, cramping, and abdominal pain. It also can lead to abnormal connections (fistulas) leading from the intestine to the skin or internal organs. The disease affects more than 1 million men and women worldwide. It has no cure and its cause is unknown.

"Crohn’s is a debilitating disease that disrupts the quality of life for its sufferers," said Julie Beitz, M.D., director of the Office of Drug Evaluation III for the FDA’s Center for Drug Evaluation and Research. "This drug works to reduce the signs and symptoms of Crohn’s, but it also carries risks that will require patients on it to be closely monitored by their physicians or other health care professionals."

Patients treated with Cimzia will receive an injection every two weeks for the first three injections. Once benefit has been established, Cimzia should be given once every four weeks.

The most common side effects of Cimzia are headache, upper respiratory infections, abdominal pain, injection site reactions and nausea.

Patients taking Cimzia are at increased risk for serious adverse effects, including serious infections that can lead to hospitalization or death. Because Cimzia affects the immune system, it can lower the body’s ability to fight infections, such as tuberculosis and other opportunistic infections. Cimzia is a blocker of TNF (tumor necrosis factor) and may cause lymphomas (a form of cancer) and other malignancies. Although an increased risk of tumors was not seen in studies of Cimzia, the modest size and relatively short duration of the controlled studies prevents any firm conclusion. Post-marketing studies and clinical trials will be required to obtain long-term safety data.

Patients taking Cimzia should be educated about how to identify an infection and be instructed to contact their health care professional at the first sign of infection while on Cimzia. In cases of serious infections, the drug should be discontinued immediately.

New Study Begins for Kids with High Risk Cancer, Neuroblastoma

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Molecular Insight Pharmaceuticals has announced the initiation of a clinical trial of Azedra in pediatric neuroblastoma patients. Neuroblastoma is a type of neuroendocrine cancer that primarily affects children and is the most common solid tumor in children outside of the brain.

The drug Azedra is a small, targeted radiotherapeutic molecule that binds to the norepinephrine transporter, a protein highly expressed on neuroendocrine tumors such as neuroblastoma. Because of this preferential binding, Azedra can deliver a greater amount of radiation to the tumor cell, thus increase tumor killing while reducing side effects.

“Neuroblastoma is an aggressive and difficult to treat form of neuroendocrine cancer that usually affects children under five years of age,” said Katherine Matthay, M.D., Chief of Pediatric Hematology and Oncology at the University of California San Francisco Children’s Medical Center. “Unfortunately, the prognosis for many of these children is quite poor. There currently are no FDA-approved treatments available for patients who have progressive, recurrent or refractory disease, and our current treatment options are extremely limited.”

Usage of Testicular Cancer Markers Too Limited, Say Researchers

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A standard part of testicular cancer care isn’t used in more than half of all patients who have the condition, researchers have found.

Doctors generally rely on a series of three serum-based tumor markers for testicular cancer, since these are helpful with diagnosis, prognostication and surveillance for disease recurrence following treatment.

Reviewing 4,700 testicular cancer cases however, the researchers found that a combination of two of these tumor markers were used less than half of the time, while all three tumor markers were measured in just 16 percent of the cases.

The study authors also discovered that only 45% of cases used the tumor markers AFP (alpha fetoprotein) and HCG (human chiorionic gonadotrophin), with a third tumor marker, LDH or lactate dehydrogenates, used in combination with the other two, just 16% of the time. These results are reported in Urologic Oncology, Seminars and Original Investigations.

"Tumor markers play a central role in showing physicians how a patient is responding to treatment and whether the disease has recurred," says lead author Scott M. Gilbert, M.D., clinical lecturer in the University of Michigan Department of Urology. "We were extremely surprised by the low rates of usage."

Dr. Gilbert conduct regular checks on all three markers in their patients, because if the markers stay elevated after therapy, it shows the cancer remains; or if the markers begin to rise during the observation period following successful treatment, this too shows the cancer has returned.

One explanation for the low rates of marker usage could be poor documentation in medical records, since incidents of tumor marker use were not always recorded, says senior author Brent K. Hollenbeck, M.D., M.S., assistant professor in the U-M Department of Urology. "Even if it isn’t a problem related to the care of the patients, it is a quality problem at the medical centers that are not recording the data properly. Either way, major improvements need to occur," he says.

But other data in the study suggest that the reporting of tumor marker use may not be the problem. Using the data from the Surveillance, Epidemiology, and End Results (SEER) program, the researchers found substantially more documentation of PSA use in prostate cancer patients compared to the testicular cancer tumor markers. That information supports the notion that recording may not be the problem, but that the use of testicular cancer markers is in fact very low.

Source: University of Michigan

Are Optimists Healthier than Pessimists?

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According to a series of studies, optimists enjoy better health than pessimists. The May issue of Harvard Men’s Health Watch explores possible reasons for this connection.

Many studies have reported that optimism influences health. Among the findings:

  • Optimistic coronary bypass patients were only half as likely as pessimists to require re-hospitalization.
  • Highly pessimistic men were three times more likely to develop hypertension.
  • People with positive emotions had lower blood pressures.
  • In one study, the most pessimistic men were more than twice as likely to develop heart disease compared with the most optimistic.

These results argue persuasively that optimism is good for health. But people who are healthy are likely to have a brighter outlook than people who are ill, so perhaps optimism is actually the result of good health instead of the other way around.

To counter this argument, scientists have adjusted their analyses to account for pre-existing medical conditions. The studies that made these adjustments found that existing illnesses did not tarnish the benefits of optimism.

One explanation is behavioral. It is possible that optimists enjoy better health and longer lives because they lead healthier lifestyles, build stronger social support networks, and get better medical care. In addition, optimism itself may have biological benefits, such as lower levels of stress hormones and less inflammation.

Finally, heredity may explain some of the link. It is possible that genes predispose some people to optimism, and that the same genes affect health and longevity.

Source: Harvard Health Publications

Researchers Find that a Small Molecule Can Block Cancer Cell Division

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By activating a cancer suppressor gene, a small molecule called nutlin-3a can block cancer cell division, according to researchers at the National Cancer Institute (NCI), part of the National Institutes of Health.

This activation of the p53 gene leads to cellular senescence, a process by which cells lose their ability to grow and divide. An opportunity for new genetic mutations occurs each time a cell divides, so limiting the number of cell divisions in a cancer cell inhibits tumor progression.

Activation of p53 can suppress tumor growth through more than one mechanism. It can interfere with the cell cycle, prompting a cell with unrepaired DNA damage to commit suicide through a complex signaling pathway called apoptosis. Alternatively, p53 may trigger cellular senescence in response to DNA damage or cellular stress.

The expression of p53 is regulated by Mdm2, a protein that is overexpressed in several human cancers. ,are small-molecule inhibitors that prevent the p53 protein from forming a complex with Mdm2, resulting in activation of p53. Previous studies have shown that nutlin can induce apoptosis in human cancer cells.

"Although p53 is mutated or deleted in about half of all cancers, it is still potentially functional in the other 50 percent," said Curtis C. Harris, M.D., chief of the Laboratory of Human Carcinogenesis at NCI’s Center for Cancer Research and an author of the study. "A better understanding of molecules, such as nutlin-3a, that can activate p53 may lead to the development of new treatment options for certain cancers."

To examine the effects of nutlin-3a on cellular senescence, the Harris team exposed human skin cells and cancer cells to two different forms of nutlin-3: forms a and b. (Nutlin-3a has a 150-fold greater affinity for Mdm2 than nutlin-3b.) After a seven-day exposure period, the scientists found that almost 100 percent of the cells treated with nutlin-3a had stopped proliferating. These cells did not regain the ability to proliferate even after being removed from nutlin-3a, indicating that they had undergone permanent senescence. By contrast, nutlin-3b had little effect on the cells.

Next, the researchers investigated whether the senescence induced by nutlin-3a is dependent on the presence of p53 protein. After exposure to nutlin-3a for seven or 14 days, more than 80 percent of the human cells containing a functional p53 gene exhibited signs of senescence. The researchers also found that nutlin-3 treatment increased the expression of p53. However, the researchers did not observe any changes in p53-deficient cells.

Previous research by this team showed that the genes affected by p53 activation differed depending on the type of activator. To gain a better understanding of nutlin-3a-induced senescence, the researchers used microarray analysis to determine the effect of p53 activation on gene expression after cancer cells were treated with nutlin-3a. Microarray analysis is a technique that allows researchers to examine the expression of thousand of genes simultaneously. Almost 3,000 genes were differentially expressed when cells with normal p53, cells with mutant p53, and p53-deficient cells were compared. Among the genes with increased expression after nutlin-3a-activation of p53 were several genes that play a role in cellular senescence and cell death.

The researchers also found that the inhibitor of growth 2 gene (ING2) was among those with decreased expression in response to nutlin-3a treatment. ING2 regulates gene activation or expression, and it may play a role in tumor development, cell proliferation, and senescence. The researchers found that p53 seemed to suppress ING2 expression by binding directly to two sites on the ING2 promoter.

"This study further characterizes the actions of nutlin-3a on genes that can play a role in the development of cancer," said Harris. "Our study reinforces the idea that using Mdm2 inhibitors, such as nutlin-3a, to promote the growth suppressive and cell-killing activity of p53 is a potentially valuable strategy to pursue in cancer treatment."

Source: Cancer Research, May 1, 2008 and National Institutes of Health (NIH)

FDA Approves Amitiza to Treat Irritable Bowel Syndrome (IBS-C)

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The U.S. Food and Drug Administration has approved Amitiza (lubiprostone) for the treatment of Irritable Bowel Syndrome with Constipation (IBS-C) in adult women aged 18 and over. There is currently no prescription drug therapy for IBS-C. With this approval, Amitiza becomes the only FDA-approved medical treatment for IBS-C available in the United States.

Irritable bowel syndrome is a disorder characterized by cramping, abdominal pain, bloating, constipation, and diarrhea. IBS causes a great deal of discomfort and distress to its sufferers. It affects at least twice as many women as men.

"For some people IBS can be quite disabling, making it difficult for them to fully participate in everyday activities," said Julie Beitz, M.D., director of the Office of Drug Evaluation III, Center for Drug Evaluation and Research, FDA. "This drug represents an important step in helping to provide medical relief from their symptoms."

The safety and efficacy of Amitiza was established in two major studies involving 1,154 patients diagnosed with IBS-C. The majority of the patients studied were women (approximately 8 percent were men). Patients enrolled in the studies were experiencing at least mild abdominal discomfort or pain that was associated with at least two of the following additional symptoms: 1) fewer than 3 spontaneous bowel movements per week (that did not result from laxative use); 2) hard stools; or 3) moderate or severe straining with bowel movements. In the studies some patients received Amitiza and others were given a placebo. More patients treated with Amitiza reported that their IBS symptoms were moderately or significantly relieved over a 12 week treatment period than patients who received placebo. The safety of long term treatment was assessed in a study in which all patients were treated with Amitiza for a duration that ranged 9 to 13 months.

The efficacy of Amitiza in men was not conclusively demonstrated for IBS-C.
Amitiza, like most prescription medications, is accompanied by some side effects. Common side effects of Amitiza include nausea, diarrhea, and abdominal pain. Other rare side effects include urinary tract infections, dry mouth, syncope (fainting), peripheral edema (swelling of the extremities), dyspnea (difficulty breathing), and heart palpitations.

Amitiza should be taken twice-a-day in 8 microgram doses with food and water. Patients and their health care professionals should periodically assess the need for continued therapy.

Amitiza is not approved for use in children and men. It is not to be administered to patients suffering from severe diarrhea or patients with known or suspected bowel obstructions. Its safety and efficacy has not been established in patients with renal or hepatic impairment, pregnant, or nursing mothers.

Amitiza is also approved for the treatment of chronic idiopathic constipation (CIC), but the dose for that indication is higher, 24 micrograms twice a day.

Amitiza is manufactured by Sucampo Pharmaceuticals, Bethesda, MD, and will be jointly marketed by Sucampo and Takeda Pharmaceuticals America, Inc., Deerfield, IL. As with all FDA-approved products, the agency will monitor Amitiza throughout its life cycle. Consumers and health care professionals are encouraged to report adverse events to the FDA.

Source: FDA, April 29, 2008

Exercise Habits Strongly Influenced by Neighborhood

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The quality of a neighborhood can encourage—or discourage—people to stay physically active and exercise regularly, says a Chicago study led by Christopher Browning, associate professor of sociology at Ohio State University. Such factors as levels of poverty, lower education, and more families headed up by women can actively discourage exercise habits. The study found that individual income was less important in determining exercise levels as the type of neighborhood involved.

"We can’t encourage people to exercise more without looking at the neighborhood environment in which they live," said says Christopher Browning, co-author of the study and associate professor of sociology at Ohio State University.. "Some people may have the personal resources and desire to exercise, but don’t live in a neighborhood in which they feel comfortable to go outside for activities."

The study found that neighborhood context was more important for women than for men in determining how much they exercised. Additional factors brought out by the study were that levels of trust among neighbors, perceived violence in the community, and beliefs that neighbors help each other, all contributed to how much people exercised in a specific community.

Ming Wen, assistant professor of sociology at the University of Utah, and Kathleen Cagney, associate professor of health studies at the University of Chicago, collaborated with Browning on the study, the results of which appeared in a recent issue of Urban Studies.

The study examined levels of exercise among 8,782 residents of 373 neighborhoods in Chicago, and combined statistics from three data sources from the 1990s: the Metropolitan Chicago Information Center Metro Survey, the 1990 U.S. Census, and the Project on Human Development in Chicago Neighborhoods Survey. Social and economic factors, and the level of poverty were found to be the most important factors affecting levels of physical activity, although neighborhood characteristics were judged to be more important in determining a person’s exercise level than income.

"The result is surprising enough that it needs to be confirmed by other studies," said Browning. "But if the finding is substantiated, it would show just how important neighborhoods are, and would have important implications for any new initiatives aimed at enhancing health and well-being." Women’s exercise habits were affected more by the neighborhood than men, which could also explain why African-American women have much higher obesity rates than other groups, said Browning.

Contrary to other research, this study found that once neighborhood factors were taken into account, African Americans in general exercised as much as white residents did. Browning said this finding suggests African Americans will exercise more if they live in neighborhoods where they feel comfortable doing so.

Source: Ohio State University