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Spotting The Difference Between Heartburn & Heart Attack Can Be A Lifesaver

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How many people regret over-indulging on Thanksgiving Day? Some can sleep off the tumult in their stomachs, others experience alarming symptoms. Is that pain in their chest heartburn or a heat attack? The symptoms are similar, but the health consequences differ dramatically.

“We see people in the Emergency Room who think they are only having severe heartburn or experiencing the flu when they are actually having a heart attack,” said Nick Zenarosa, M.D., emergency medicine physician on the medical staff at Baylor University Medical Center at Dallas.

If you think you are experiencing heartburn, Dr. Zenarosa recommends watching for the following symptoms which are not typical of heartburn and could indicate a heart attack:

  • Breaking into a cold sweat
  • Pain moving from the chest into the jaw, shoulder or arms
  • Increased pain when you exert yourself, rapid onset of fatigue
  • shortness of breath
  • turning pale
  • slow or no response of symptoms to antacids
  • nausea and possible vomiting

Keep in mind that the signs of a heart attack can be subtle, particularly in women. If you are experiencing any of these signs, coupled with chest pain and/or pain that radiates through your jaw or down your arm, be sure to go to an Emergency Room.

Time is of the essence when a person is having a heart attack. According to the National Heart, Lung and Blood Institute, the sooner clot-busting drugs and other artery-opening treatments are started, the more good they will do, and the greater the chances are for survival and a full recovery.

Source: Baylor Health Care System

Scientists Finding Anti-Obesity Drugs With Fewer Side Effects

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Fen-phen was once regarded as a miracle weight-loss drug, but when it induced heart valve lesions and mother life-threatening side effects, it was taken off the market. UT Southwestern Medical Center scientists are exploring Fen-phen’s behavior in the brain so that safer anti-obesity drugs with less side effects can be developed.

In a recent study, the researchers define a circuit in the brain that explains the ways fenfluramine, a component of Fen-phen, suppresses appetite.

“Our findings provide evidence that the neural circuit we’ve proposed is sufficient for the neurotransmitter serotonin to regulate food intake and body weight, ” said Dr. Joel Elmquist, professor of internal medicine and pharmacology at UT Southwestern and senior author of the study. “Fen-phen works directly on this pathway. Unfortunately, that drug also adversely affects peripheral tissue such as the heart.”

Mice were engineered for the current study, in which the expression of a serotonin receptor called 5-hydroxytryptamine 2C was blocked throughout the entire body. Previously, this produced obese mice resistant to the anorexic actions of fenfluramine. When activated by serotonin, however, this receptor is also known to suppress appetite. Using this mouse model, the authors engineered another set of mice in which the same serotonin receptor was blocked everywhere in the body except within a group of brain cells called pro-opiomelanocortin, or POMC, neurons. The POMC neurons, which are found in the hypothalamus, are also known to play an important role in suppressing appetite and inducing weight loss.

The scientists noted that the animals with no serotonin 2c receptors expectedly developed obesity as well as other metabolism disorders such as increased food intake, hyperactivity and leptin insensitivity. They also were prone to spontaneous seizures, said Dr. Elmquist. The mice in which the serotonin receptor was fre-expressed and functioning only in the POMC neurons stayed slim and responded to fenfluramine.

“The POMC-specific reactivation of the receptor only in POMC neurons normalizes the abnormal metabolism in these mice,” Dr. Elmquist said. “The animals don’t eat excessively. Their hyperactivity is also gone.”

Previous work from the UT Southwestern group led to the hypothesis that Fen-phen worked by activating the serotonin 2c receptor in the POMC neurons in the hypothalamus. The current work provides genetic proof supporting this model.

“Conventional wisdom is that fenfluramine increases serotonin release that then activates serotonin receptors in the brain to regulate food intake and body weight, but unfortunately, this drug also causes lesions in heart valves,” he said. “If you could develop a drug that would travel to both the brain and the peripheral tissues, and then give a blocker to protect the heart, it’s possible that you could prevent the harmful side effects and still aid weight loss. Admittedly, that’s a bit farfetched, but this mouse model could be used to test that theory.”

The team’s next step is to determine whether they’ve identified the sole circuit required to suppress appetite and induce weight loss.

Source: Neuron,

Chronic Kidney Disease Up 30% Over Past Decade

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A 30 percent increase in chronic kidney disease over the past decade has prompted the U.S. Renal Data System (USRDS) to issue for the first time a separate report documenting the magnitude of the disease, which affects an estimated 27 million Americans and accounts for more than 24 percent of Medicare costs.

“NIDDK’s annual analysis and publication of data on kidney disease in the United States is essential in quantifying public health trends, guiding funding priorities, and designing targeted kidney research programs,” said NIH Director Elias A. Zerhouni, M.D. “The major focus on chronic kidney disease in this year’s report acknowledges that this disorder is a growing public health issue deserving of wider public awareness and intensified scientific investigation.”

Using data from multiple sources, the USRDS has created a new handbook of information that can be used by researchers, government officials, health program planners, and others to develop research goals, assess public health needs, set program priorities, and inform policymakers and the public. USRDS research depends on collaborations with other agencies of the U.S. Department of Health and Human Services, especially the Centers for Medicare and Medicaid Services, the Health Resources and Services Administration, and the Centers for Disease Control and Prevention. Patient registries for other countries also contribute data for analyses.

Volume One of the report defines the disease burden of chronic kidney disease and examines cardiovascular and other related health problems, rates of adverse health events, preventive care, prescription medication therapies, delivery of care in the transition to end-stage renal disease, and the cost to Medicare and employer group health plans.

One of the major findings central to public health is that those with chronic kidney disease are more likely to die from cardiovascular disease than to reach end-stage kidney disease. However, cardiovascular risk factors can be detected and treated. This suggests that those transitioning from chronic to end-stage kidney disease merit more attention. Expenditures during the transition from chronic to end-stage kidney disease are considerable, ranging from $14,500 for Medicare patients to $29,000 for those covered by employer group health plans in the month of dialysis initiation.

“These latest data on kidney disease underscore the importance of the research we fund,” said NIDDK Director Griffin P. Rodgers, M.D. “With rising rates of chronic and end-stage kidney disease, we need to stimulate research that will help us discover new, effective therapies for these devastating disorders.”

Volume Two reports that the number of people with end-stage kidney disease is increasing in size and cost. The incidence of chronic kidney disease in 2006 was more than 100,000, or 360 per one million people, an increase of 3.4 percent over the 2005 incidence rate. There were more than half a million patients with end-stage kidney disease in 2006. Of these, 70 percent were on dialysis. An important step before a patient begins dialysis is the preparation of a vascular access, which is the site on the patient’s body where blood is removed and returned during dialysis.

The three types of vascular access for dialysis are arteriovenous (AV) fistula, an AV graft, and a venous catheter. Both the fistula and the graft involve connecting an artery to a vein, usually beneath the skin in a patient’s arm.

The fistula is considered the best long-term vascular access for dialysis. The catheter is a tube inserted into a vein in the patient’s neck, chest, or leg near the groin. It is usually only used as a temporary access until a permanent fistula or graft can be developed. This volume reports that more than 80 percent of new dialysis patients started with a catheter, more than 50 percent of current dialysis patients had a fistula, and 30 percent had a graft.

Volume Two also reports that Medicare paid about $70,000 per dialysis patient. Patients with end-stage kidney disease accounted for a little more than 1 percent of the Medicare population and more than 7 percent of Medicare costs. Total cost for end-stage kidney disease was $33.6 billion. This number includes Medicare spending and all expenditures by other payers, such as employer group health plans.

In addition, more than 18,000 kidney transplants were performed in 2006, an increase of 3.5 percent over 2005. Use of deceased donor kidneys increased between 2003 and 2006 at a rate of about 6 percent to 7 percent. Use of living donors fell 3 percent during that period, but the use of living unrelated donors continues to increase relative to the total number of living donations, and now accounts for 45 percent of all living donor transplantations.

NIDDK conducts and supports research in diabetes and other endocrine and metabolic diseases; digestive diseases, nutrition, and obesity; and kidney, urologic, and hematologic diseases. Spanning the full spectrum of medicine and afflicting people of all ages and ethnic groups, these diseases encompass some of the most common, severe, and disabling conditions affecting Americans.

The USRDS is funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health (NIH). The USRDS 2008 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease, is online at www.usrds.org.

The National Institutes of Health (NIH) — The Nation’s Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

Source: National Institutes of Health (NIH)

FDA Approves Use of Temporary Pump to Assist Heart’s Right Side

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The U.S. Food and Drug Administration(FDA) today approved a Humanitarian Device Exemption (HDE) for the first heart pump that provides certain critically ill patients with temporary support for the right side of the heart. The approval is a first for certain critically ill patients.

Heart assist devices are mechanical pumps that aid in the pumping action of a weakened heart. Most heart assist devices support the heart’s left ventricle, which pumps oxygen-rich blood to the rest of the body. The pump, manufactured by Levitronix LLC, is called the CentriMag Right Ventricular Assist System, is intended for patients requiring support for the heart’s right ventricle, which passes oxygen-depleted blood to the lungs to be refreshed with oxygen.

HDEs facilitate the development of medical devices intended to treat or diagnose a disease or condition affecting fewer than 4,000 people in the United States every year. To receive approval of an HDE application, a company must demonstrate the product’s safety and probable benefit. Such products are generally used under the supervision of an Institutional Review Board, a committee that approves, monitors, and reviews biomedical research within a locality.

“This device will provide patients with much needed time until a more permanent treatment option is available,” said Daniel Schultz, M.D., director of the FDA’s Center for Devices and Radiological Health. “The approval reaffirms the FDA’s commitment to even the smallest patient populations.”

The CentriMag system is for critically ill patients with a failing right ventricle when other therapies have failed. It is intended to be used for up to 14 days to keep the patients alive until their heart recovers or until a heart transplant or long-term heart assist device can be implanted.

While severe right-side heart failure is uncommon, it can lead to death. It is often caused by left-side heart failure or, in unusual cases, by heart surgery.

Safety data from two multi-center clinical trials showed that the CentriMag system does not expose patients to an unreasonable risk, and the probable health benefit from use of the device outweighs the risk, taking into account the probable risks and benefits of alternative forms of treatment.

Because shortness of breath is common in patients with right-sided heart failure, it is unclear whether the device caused any of the breathing difficulties reported in the study group.

Patients who are unable or unwilling to take anti-clotting medicine should not use the CentriMag system, because bleeding and blood clots are two of the most common adverse events associated with heart assist devices.

The CentriMag Right Ventricular Assist System is manufactured by Levitronix LLC, Waltham, Mass.

Source: FDA

Women More Vulnerable to Alcohol’s Long-term Effects Than Men

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Women are more vulnerable to alcohol’s longterm effects than men, according to the Harvard Heart Letter. The difference is in women’s ability to break down alcohol, which is slower than men’s.

The result is that a woman drinking the same amount as a man will have a higher blood level of alcohol, and for a longer time. Her tissues are exposed to more alcohol per drink than a man’s, and a Japanese study indicates that too much alcohol is bad for a woman’s heart and arteries, as well as being a danger to breast tissue.

Current thinking, according to the Harvard Heart Letter, suggests that “healthy drinkng” is no more than two drinks daily for men and one drink daily for women, a recommendation for the average person. The effects of alcohol intake will depend on your genes, diet and medications taken. Since alcohol prevents the absorption of folic acid, drinkers need to take extra folic acid, which can be accomplished by taking a daily multivitamin/multimineral supplement.

Source: Harvard Heart Letter

Americans Consume Twice Daily Recommendations of Salt

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Most Americans consume more than double the amount of their daily recommended level of sodium. A new study by the Centers for Disease Control and Prevention shows that more than 2 out of 3 adults are in population groups that should consume no more than 1,500 milligrams (mg) per day of sodium. During 2005-2006 the estimated average intake of sodium for persons in the United States age 2 years and older was 3,436 mg per day.

A diet high in sodium increases the risk of having higher blood pressure, a major cause for heart disease and stroke. These diseases are the first and third leading causes of death in the United States.

“It’s important for people to eat less salt. People who adopt a heart healthy eating pattern that includes a diet low in sodium and rich in potassium and calcium can improve their blood pressure,” said Darwin R. Labarthe, M.D., Ph.D., director of the CDC’s Division for Heart Disease and Stroke Prevention. “Reducing sodium intake can prevent or delay increases in blood pressure for everyone.’’

“People need to know their recommended daily sodium limit and take action to reduce sodium intake,” Labarthe said. Most of the sodium we eat comes from packaged, processed and restaurant foods. CDC along with other HHS agencies, including the Food and Drug Administration, will be working with major food manufacturers and chain restaurants to reduce sodium levels in the food supply.

The study in CDC’s Morbidity and Mortality Weekly Report used data from the National Health and Nutrition Examination Survey, a survey designed to assess the health and nutritional status of adults and children in the United States.

This study is the first to use national data to show that 69.2 percent of the adult population belongs to a specific group that should aim to consume no more than 1,500 mg of sodium per day. This group includes persons with high blood pressure, blacks, or middle-aged and older adults (more than 40 years old). The 2005 Dietary Guidelines for Americans recommend that adults in general should consume less than 2,300 mg (approximately one teaspoon of salt) of sodium per day.

The dietary guidelines, by the U.S. Department of Health and Human Services and the U.S. Department of Agriculture, provide advice for people 2 years and older about how good dietary habits can promote health and reduce risk for major chronic diseases.

Nationwide, 16 million men and women have heart disease and 5.8 million are estimated to have had a stroke. People who reduce their sodium consumption benefit from improved blood pressure and reduce their risk for developing other serious health problems. Choosing foods like fresh fruits and vegetables, when eating out, asking that foods be prepared without added salt, and reading the nutrition label of foods before purchasing can improve health for all adults.

Source: CDC, March 26, 2009

Malaria Parasite Showing Signs of Resistance to Top-Line Drugs (Artemisinins)

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The parasite that causes malaria is showing signs of resistance to the most potent drugs currently used against it. Scientists report that top-line drugs called artemisinins take nearly twice as long to knock out the parasite in people who contract malaria in western Cambodia as the drugs take in other areas—suggesting the parasite is finding ways to thwart the drugs’ effects.

Source: Science News

Experimental Malaria Vaccines to be Tested in FDA and PATH-MVI Collaboration

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The U.S. Food and Drug Administration has announced a collaboration with the PATH Malaria Vaccine Initiative (PATH-MVI) to develop laboratory tests to better predict the level of safety and effectiveness of experimental malaria vaccines before they are used in human clinical trials.

“This collaboration with the PATH-MVI supports the overall mission of the FDA and specifically the Agency’s work under our Critical Path Initiative,” said Jesse L. Goodman, M.D., M.P.H., director of the FDA’s Center for Biologics Evaluation and Research. “We are actively seeking ways to help organizations such as PATH develop safe and effective products that can benefit the public health both in the United States and globally.”

PATH is an international, nonprofit organization that creates sustainable, culturally relevant solutions to improve global health and well-being. PATH-MVI supports the development of malaria vaccines and is expected to spearhead the efforts to ensure their availability and accessibility in the developing world once a safe and effective vaccine becomes available.

The PATH-MVI collaborative project is expected to span about three years and is being conducted under the Cooperative Research and Development Agreement (CRADA) program, which allows federal laboratories and businesses to form partnerships that help expedite research activities. Recent scientific advances suggest that vaccines based on live, weakened (attenuated) malaria parasites may be possible in the future but assessing safety and effectiveness in the early stages of product development is challenging. Under this CRADA, PATH-MVI provides the FDA with about $1.5 million to develop tests for evaluating malaria vaccines early in their development.

To date, there are no approved vaccines to prevent malaria but several vaccines are in development. This CRADA will help develop laboratory tests to assess whether a vaccine candidate is safe enough to begin Phase I clinical trials.

Each year 350-500 million cases of malaria occur worldwide, killing an estimated one million people, most of them young children in sub-Saharan Africa. Travel between the United States and the affected areas, as well as men and women in the U.S. military who are stationed in regions at high risk for malaria, can bring the disease into the United States.

The Center’s Global Vaccine Initiative fosters the development, evaluation and availability of vaccines needed to protect against major global infectious diseases and is part of the Center’s commitment to work with others, including the World Health Organization, in advancing global public health.

The Critical Path Initiative is the FDA’s effort to stimulate and facilitate a national effort to modernize the sciences through which FDA-regulated products are developed, evaluated and manufactured.

Landmark Research Into Child And Maternal Health Expanded

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A landmark research study into childrens’ health, the National Childrens’ Study, will now add the St Louis area. Researchers will monitor children from Jefferson County in Missouri and Johnson, Union and Williamson counties in southern Illinois from before birth to age 21 to learn more about environmental and genetic influences on diseases.

Saint Louis University School of Public Health was awarded a $26.3 million contract from the National Institutes of Health, the Centers for Disease Control and Prevention (CDC) and the U.S. Environmental Protection Agency.

“Families in Jefferson County and southern Illinois will have an opportunity to be on the forefront of landmark research into child and maternal health,” says Terry Leet, Ph.D., lead investigator of the Jefferson, Johnson, Union and Williamson counties study sites and chairman of the department of community health at Saint Louis University School of Public Health. “Ultimately, what we find will benefit all Americans because we will gain information to help develop strategies to prevent disease, design health and safety guidelines and possibly find new treatments and cures for diseases.”

Saint Louis University School of Public Health was awarded a $26.8 million contract last year to monitor the health of children from St. Louis City and Macoupin County in Illinois, and the research team will enroll participants from those areas in 2010.

Dr. Leet, who was recently appointed to serve on the executive steering committee of the National Children’s Study, is lead investigator of both sets of study sites. This appointment acknowledges his national expertise in maternal and child health.

The four Missouri and Illinois sites form the region’s Gateway Study Center. Partnering institutions are Saint Louis University School of Medicine; Southern Illinois University Edwardsville School of Nursing; Southern Illinois University School of Medicine; Washington University School of Medicine; Southern Illinois University Carbondale’s Center for Rural Health and Social Service Development; and Battelle Memorial Institute.

Factors affecting a child’s health before it is born will be followed, and information about diet and exposure to chemicals and other substances in the environment and emotional stress.will be obtained from pregnant women or women likely to become pregnant.

“Recruiting mothers before conception, or in very early pregnancy, means we can measure environmental influences when the fetus is first forming. We have limited knowledge currently but we know that early exposures can have lifelong effects on metabolism and risk of chronic disease in adulthood,” said Louise Flick, DrPH, co-principal investigator and professor of nursing from Southern Illinois University Edwardsville School of Nursing.

Once the child is born, researchers will collect air, water and environmental samples from where children spend most of their time. They will analyze fingernail, hair, blood and urine samples and screen for birth defects, injury susceptibility, physical and mental disorders, asthma, diabetes and obesity, among other conditions.

“Our research will give scientists access to a vault of information that could ensure a healthier future for generations to come,” Leet says. “What we find could have huge implications for the health of our children and their children’s children.” “Large population-based studies are best suited by institutions with overlapping, yet distinct skills,” said Allison King, M.D., assistant professor of pediatrics and of occupational therapy at Washington University School of Medicine in St. Louis and co-principal investigator of the study. “We are lucky enough to have several strong institutions in the area that complement each other.”

The National Children’s Study will be conducted in 105 locations across the country. During the last two years, Congress has appropriated a total of $179.9 million to support the project.

New Technique May Restore Functions to Stroke Patients Long After Attack

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A revolutionary new technique, which involves jump-starting the growth of nerve fibers to compensate for brain cells destroyed by the stroke, may be capable of restoring functions to a stroke patient weeks, and even months after the attack, according to a recent report.

“In the best-case scenario, this would open up the window of time that people could recover and go back to normal functional status,” said Gwendolyn Kartje, MD, Ph.D., a professor in the department of cell biology, neurobiology and anatomy and department of neurology at Loyola University Chicago Stritch School of Medicine.

The experimental approach is described by Kartje and colleagues in the journal Topics in Stroke Rehabilitation. Called anti-nogo-A immunotherapy, anti-nogo has dramatically improved functions in lab animals that have experienced strokes. Anti-nogo is also the subject of an ongoing clinical trial in Europe and Canada to test the technique in patients with spinal chord injuries.

Most strokes are caused by clots that block blood flow to one part of the brain, killing brain cells within hours. The drug TPA can minimize damage by dissolving the clot. But TPA is safe and effective only when given within about three hours of the onset of symptoms. Most patients don’t receive treatment within that brief window. Patients typically arrive at the hospital too late, or hospitals do not begin administering TPA soon enough.

Nogo-A is a protein that inhibits the growth of nerve fibers called axons, and checks uncontrolled nerve growth causing excessive sensitivity to pain, or involuntary movements.In anti nogo immunotherapy, an antibody disables the nogo protein.

The left side of the brain controls movements on the right side of the body, and vice versa. Thus, a stroke on the left side of the brain can cause paralysis on the right side of the body. In such a patient, anti-nogo would, it’s hoped, spur the growth of axons from the healthy right side of the brain. These axons would then grow into the right side of the body and restore functions lost by the stroke.

Rats that have undergone strokes in old age have been tested with anti nogo. After anti nogo function in the front paw of the affected side was almost completely restored in some rats. The Novartis company is sponsoring a phase 1 clinical trial of anti-nogo for patients paralyzed by spinal cord injuries, and a clinical trial for stroke [patients could begin by 2012, according to Kartje, who believes anti-nogo has great potential for stroke patients.

Anti nogo “offers the potential for stroke patients to recover, return to nearly normal functional status, and stay out of nursing homes,” Kartje said. “Theoretically, there’s no reason why this should not happen.”

Source: Loyola University Health System