Daily Health and Medicine News

Venous Thromboembolism and Australia Pharmacy

Proven, symptomatic VTE or fatal PE occurring between discharge from hospital, when thromboprophylaxis was stopped, and 3 months later. Values in parentheses are %.

Sudden death occurred in three patients with known heart disease. No autopsies were performed, so PE was not excluded.

Thus, while extended prophylaxis appears to reduce the relative risk of symptomatic VTE by about 60%, the absolute risk reduction is low, especially for PE.

Six randomized, placebo-controlled clinical tri-als have evaluated extended LMWH prophylaxis for up to 35 days among THR patients who completed in-hospital prophylaxis with either LMWH (ie, enoxaparin or dalteparin) or warfarin. Each study observed lower rates of venographically screened DVT with extended prophylaxis. A systematic review of these six trials demonstrated a significant decrease in both total and proximal DVT with extended LMWH use, as well as reduced risk of symptomatic VTE arising during the treatment period generic viagra new zealand. The rates of out-of-hospital symptomatic VTE were 4.2% with in-hospital prophylaxis and 1.4% with extended prophylaxis (relative risk, 0.36; p < 0.001; NNT, 36). In another randomized clinical trial that compared in-hospital use of LMWH and LMWH therapy that was continued after hospital discharge, extended prophylaxis did not further prevent symptomatic VTE.

One clinical trial also confirmed the benefit of posthospital discharge pophylaxis with VKAs. More than 350 consecutive patients undergoing THR were randomized to receive warfarin prophylaxis (target INR, 2 to 3) until hospital discharge (mean duration, 9 days) or for another 4 weeks after hospital discharge. DUS was performed 1, 2, and 4 weeks post-hospital discharge. The study was prematurely terminated because of the demonstrated superiority of extended prophylaxis. VTE occurred in 5.1% of in-hospital prophylaxis patients, and in 0.5% of those who continued warfarin, a relative risk of 9.4 (95% CI, 1.2 to 73.5). The NNT to prevent one VTE using extended warfarin prophylaxis was 22.

Only one patient experienced major bleeding. In another trial of 1,279 patients undergoing THR, the LMWH reviparin (4,200 U SC once daily) was compared with a VKA (target INR, 2 to 3), both administered for 6 weeks. Objectively confirmed, symptomatic VTE occurred in 2.3% of patients receiving LMWH, and in 3.3% of those receiving the VKA (p = 0.3). However, the rates of major bleeding were 1.3% and 5.5%, respectively (p = 0.001). Thus, these studies indicate that VKAs also may provide effective extended prophylaxis after THR, although major bleeding is more frequent with the use of these anticoagulants.

Extending LMWH prophylaxis to postoperative day 28 in one clinical trial of patients undergoing TKA did not significantly reduce the rate of objectively screened DVT (17.5%) compared to 7 to 10 days of prophylaxis (20.8%). Hospital readmission rates for VTE also did not differ significantly (3.2% and 5.4%, respectively).

Arthritis Treatment News: Why It’s Hard to Stick With Rheumatoid Arthritis Treatment

Why It’s Hard to Stick With Rheumatoid Arthritis Treatment

If dealing with rheumatoid arthritis is a full-time job, the treatment for RA is a task that requires painstaking attention to detail and a whole-hearted commitment to a long-term goal.

While the payoff can be huge — —preventing or at least slowing down potentially disabling joint destruction — —it’s still hard for patients to stick with the treatment, whether it’s pills, self-administered injections, or three-hour-long infusions given in a doctor’s office.

Consider also that RA medications can be pricey and have side effects and that there’s the psychological impact of having to undergo lifelong treatment, and you have a recipe for noncompliance — —the medical term for people who don’t take their medicine as directed.

“Compliance is a huge issue,” confirms Christopher Ritchlin, MD, MPH, a rheumatologist and professor of medicine at the University of Rochester Medical Center in New York. According to a 2007 study, some people with RA missed their meds between 10 percent and 36 percent of the time, depending on the drug taken. Other studies have reported noncompliance rates as high as 70 percent.

“I can deal with bouts of pain, but the fact that it’s chronic and never going away, that’s the hardest thing to deal with,” says Angela Lundberg, 32, who was diagnosed at 18.

It’s especially tempting to skip medication when the beneficial effects aren’t obvious unless you’re looking at an X-ray showing the condition’s progression (or even if they are obvious). Still, research suggests that without treatment joints will deteriorate more rapidly and the journey to disability will be quicker. Hence, it’s important to find ways to stay motivated.

How treatment helps

Even though there are many different kinds of RA medication, the mainstay of treatment is the disease-modifying antirheumatic drug, or DMARD. (Other important classes of drugs for RA are inflammation-fighting corticosteroids, like prednisone, and nonsteroidal anti-inflammatory meds, or NSAIDs.)

DMARDs are the only RA drugs—whether they are newer biologics, such as Enbrel, Humira, Orencia, Remicade, and Rituxan, or older drugs, such as methotrexate and Plaquenil — —that have been shown to slow down joint destruction. After years of research, experts think a “hit it early, hit it hard” approach is best, meaning it’s better to take strong medication that delays joint destruction as soon as a diagnosis of RA is confirmed, rather than wait until the disease progresses.

Many of the DMARDs work by suppressing the hyperactive immune system to keep it from attacking the joints. These drugs are typically very helpful so the benefits outweigh the risk of side effects—and side effects are one of the main reasons people may skip meds.

“Each one of the drugs used to treat rheumatoid arthritis has its own unique set of side effects, some of them mild. But most of the drugs that are the most effective have potentially serious side effects,” says Bruce Baethge, MD, a professor of internal medicine at Texas A&M Health Science Center College of Medicine in College Station and a rheumatologist with Scott & White in Temple. “Fortunately, they only occur in a small percentage of people, but that doesn’t mean it can’t happen.”

The more serious adverse effects can include a heightened risk for infection, including upper-respiratory infections and even tuberculosis. Methotrexate, a drug that is the “anchor therapy” for the condition, can cause nausea and mouth sores, says Eric Matteson, MD, a rheumatologist with the Mayo Clinic in Rochester, Minn.

The fear of side effects can be as big a problem as the side effects themselves.

Dr. Ritchlin tells the story of one patient who had severe psoriatic arthritis, a cousin of rheumatoid arthritis. “His arthritis was flaring like crazy. He could barely walk,” he recalls. But when asked how often he was taking Enbrel, the man told Dr. Ritchlin that it was only once every four months, rather than twice a week as recommended, because he was afraid of getting lymphoma.

RA in general can increase lymphoma risk, and although the Food and Drug Administration has investigated a link between some biologics and lymphoma, there isn’t evidence to support the link.

Some people can be hesitant to take methotrexate, Dr. Ritchlin adds, due to the fact that it is also given to cancer patients in chemotherapy regimens—even though the dosage for RA is only a fraction of that used in cancer treatment.

Dr. Matteson says education is key. “The more the patients understand about the drugs, the more likely they are to be compliant, even if they see they are problematic. We point out that they also have a very difficult and often devastating disease, so we try to put that in perspective.”

Another way to keep things in perspective is to stay on top of monitoring the disease. Dr. Matteson says that his patients receive regular tests, such as X-rays, to assess their joint health. If patients see that joint destruction has halted since they started a DMARD, for example, they may feel more compelled to stick to their drug regime.

However, if the medicines do turn out to be too difficult to take, Dr. Matteson recommends that patients bring up these issues with their doctor and ask about alternatives. “If the problems are prohibitive, we have effective alternatives available. We try to individualize the therapies,” he says.

For example, if methotrexate makes a patient nauseated, Dr. Matteson would seek another option or another way of taking methotrexate, or recommend an antinausea medication to counter this side effect.

Cost and other issues

DMARDs and other RA medications aren’t necessarily easy to take, cheap, or fast acting. Some have to be taken two or three times a day (Plaquenil is one example); others are taken once a day; and some other drugs, like Enbrel, require a self-injection once a week.

Lundberg, who lives in the Minneapolis area, had been visiting a clinic every two months for a Remicade infusion. But when she moved to Ireland for a short time, she had to switch to Enbrel, which is self-injected, because it was difficult to get to the doctor’s office for regular appointments. “It’s not hard to learn the injection, but I never got comfortable doing it,” she says. “I always got really nervous and hated it.”

Dr. Matteson advises patients to speak with their doctor about switching to a different delivery method. “I seek to offer these where available,” he says. “This is a common point of discussion.”

Cost is also a factor. The cheapest DMARD is probably methotrexate, which can run from $500 to $1,000 a year, depending on factors like dosing, how it is delivered, and insurance coverage, says Dr. Matteson. Biologics “are easily up to $20,000 or $30,000 a year and insurance is extremely variable,” he adds.

If cost is a factor, contact the drug manufacturer. Almost all will provide reduced-cost medication if you meet their income requirement. The Chronic Disease Fund, Patient Advocate Foundation Co-Pay Relief, and The HealthWell Foundation are nonprofit organizations that help people with RA cover their co-payments and other medical expenses.

When you start a new medication, it can also help to have realistic expectations. It can take months for some of the DMARDs, such as Remicade, Enbrel and Humira, to work, says Dr. Baethge.

Overall, one of the best ways to stick with treatment or cope with side effects is to talk to other people with RA. Social support is invaluable for any chronic condition, and about 1.3 million people in the U.S. have RA. “RA affects 1 percent of the population so it’s not hard to find someone,” Dr. Baethge says.

Lundberg has volunteered with the Arthritis Foundation, where she has met other young people with RA, and even started a blog.

“It makes me feel like I’m not totally alone,” she says.

Cornerstone Physical Therapy on arthritis treatment

Arthritis is a word that many of us have heard of, and might even experience, but what does it really mean? According to the Arthritis Foundation, 46 million adults in the U.S. have some form of arthritis. Common symptoms of osteoarthirits include joint pain, swelling, stiffness and tenderness, resulting in pain with functional activities such as standing, walking, or even holding a coffee mug. Osteoarthritis, the most common form of arthritis, typically affects the weight-bearing joints, such as the knees, hips, and ankles, due to the compressive forces placed on these joints. These compressive forces break down cartilage, which is at the ends of joints, causing the ends of bone to rub together. More specifically, arthritis is an acute or chronic inflammation of the joints of the body, which is a wearing away of the smooth cartilaginous surfaces on the ends of bone. As a result of the wearing away of the cartilage, one might experience popping or grinding of a joint, known as crepetous, which can be painful, resulting in decreased function.

When pain develops, the inflammatory response takes over, shutting down certain muscles in order to protect the body, resulting in a further decrease in function and greater levels of pain. Osteoarthritis can be diagnosed by your physician through physical examination and diagnostic imaging, such as x-rays. In osteoarthritis, improving joint mobility, flexibility, range of motions and strength will decrease pain and loss of function.

Proper education is extremely important when treating this patient population to prevent further wearing away of these joint surfaces. Arthritis is a term heard very often, and sometimes overused in the medical field, and frequently overlooked. With the advancements in medicine and with physical therapy intervention, there is no reason one should not live in pain, nor discomfort because of arthritis.

Come and see your local physical therapist, at Cornerstone Physical Therapy Health and Wellness Center, conveniently located on 77 Brant Ave. in Clark. If you have any questions in regards to choosing the proper course of treatment and specific exercises you might benefit from, or any other orthopedic condition, give us a call at 732-499-4540. We specialize in many facets of physical therapy, focusing on complete patient satisfaction and patient results. We also guarantee that each individual will be seen within 48 hours, and we are now accepting all insurances. Let us help you enjoy your life, without worrying about uneasy pain.

Anxiety Treatment News: Genes behind anxiety in patients with too much protein identified

Genes behind anxiety in patients with too much protein identified

London, Jan 9 (ANI): Overexpression of two genes is responsible for the anxiety and behavioural issues associated with excess MeCP2 protein, say scientists.

The genes (Crh [corticotropin-releasing hormone] and Oprm 1 [mu-opioid receptor MOR 1]) may point the way to treating these problems in patients with too much of the protein, said scientists at the Baylor College of Medicine.

MeCP2 is a “Goldilocks” in the protein world. When the protein is lacking or defective, girls develop the neurological disorder Rett syndrome early in life.

Too much protein results in the more recently identified MeCP2 duplication syndrome, which usually affects boys, who may inherit the gene duplications either from their mothers or, in rare cases, develop it sporadically.

In both cases, anxiety and social behavioural deficits are typical of those with the disease, along with other motor problems and cognitive defects.

“This is a nice example of a translational story,” said Dr. Rodney Samaco, assistant professor of molecular and human genetics at BCM and first author of the study.

“We first identified the mouse model for MeCP2 duplication syndrome and then found people with the disorder in the clinic. We went back to the lab and found out that MeCP2 was indeed the major contributor to this phenotype in patients.

“We have now identified two genes involved in two major symptoms of the syndrome. Eventually, we may take the information back to the clinic to develop a treatment for patients,” Samaco stated.

Patients with MeCP2 duplication disorder have a duplication in chromosomes that span both the MECP2 gene and another called IRAK1. But with this new study, it is now clear that excess MeCP2 accounts for the neuropsychiatric symptoms.

This finding is important because it shows that tweaking the expression of genes that the protein affects, rather than trying to adjust the levels of the finicky MeCP2 protein itself, can modify symptoms of MeCP2 disorders.

The finding appeared online in the journal Nature Genetics. (ANI)

Supplement Can Bolster Pets’ Anxiety Treatment

When it comes to pets, fears, anxieties and phobias are more common than most people realize. In people—at least some of them—logic and reasoning can be used to help that person understand that an object, noise or event is not as scary as it may seem. But for pets, their perception is their reality. No amount of discussion or psychotherapy can change their minds about a situation that seems threatening or dangerous to them.

In a national online survey about anxiety in pets, nearly 40 percent of pet owners who responded say they have at least one pet that experiences anxiety.1 Possible contributing factors to anxious behavior may be a lack of proper socialization, some traumatic event, genetic predisposition, and even cognitive decline.

As an animal ages, hearing and sight may be compromised, and with confusion or even discomfort from arthritis, that can result in a more stressed or anxious pet.

Nearly a third of the owners who responded to the online survey say their pets’ fears and anxieties are “extremely or very” problematic, while 44 percent say it is “somewhat” problematic. And 70 percent say the anxiety their pet experiences occurs “fairly often” or “frequently.”

It has been reported that a major reason owners relinquish pets or have them euthanized is for behavior-related issues,2,3 some of which can be related to anxiety and fear.

Occasional fear is normal as a response to unknown or threatening people, sounds or events, and to avoid risky situations. But if the anxiety is chronic and worsening, or exaggerated during episodic instances, the pet can be suffering.

Changes in the pet’s life, from a move to a new pet or baby, can contribute to insecurity and anxiety about the animal’s everyday existence. A dog may show excessive attention-seeking behavior, be constantly vigilant and show repetitive behavior (licking), and cats may start urine marking or spraying.

Chronic stress and anxiety can potentially increase the risk of illness, including skin and digestive problems or heart disease, and can lead to behavior problems or aggression.

Episodic anxiety can result in intense reactions to things such as thunderstorms, fireworks, houseguests and traveling.

Sometimes owners hesitate to bring the issue to their veterinarian’s attention, but ignoring the problem seldom helps it go away.

Early Detection
Veterinarians should rule out any physical problems and take a complete and detailed history (medical, nutritional and behavioral) to help define the issue better. While the possibility of preventing anxious behavior is debatable, early detection of tell-tale signs can stimulate measures to try to keep it from getting worse.

Veterinarians and veterinary staff can discuss appropriate early socialization, teach pet owners to avoid punishment and use positive reinforcement, and try to avoid stressful stimuli, if reasonable. Proper behavior modification can go a long way to helping a pet cope with exposure to fearful situations, and the veterinary team can be a great resource in providing guidance.

Methods such as counter-conditioning and desensitization can be very effective in certain cases. Some pets, however, may benefit from the addition of medications or supplements, particularly during the period of behavior modification, to reduce the perceived level of anxiety and allow the training to be more effective.

While certain prescription medications can help (SSRIs, tricyclic antidepressants and benzodiazapines), some owners are reluctant to go straight to the pharmaceutical solution as a first line of treatment. Concerns about sedative effects and having a change in their family interaction lead some pet owners to look for alternatives.

In fact, a combined 51 percent of pet owners in the previously mentioned survey “try to avoid pharmaceuticals for my pet” and “prefer natural products.” Only 31 percent say they have no issues with pharmaceuticals.

A Supplemental Option
The amino acid L-theanine is found naturally in green tea and is known for its calming properties. At therapeutic levels, L-theanine is shown to increase concentrations of GABA, an inhibitory neurotransmitter, and increase brain serotonin and dopamine levels.4 Suntheanine is a patented, pure active form of L-theanine, free of D-theanine, which can exhibit a competitive effect with respect to intestinal absorption.

In humans, L-theanine has been shown to generate alpha brain waves, indicative of relaxed, effortless alertness, or in other words, calming effects without drowsiness.

Anxitane (L-Theanine) Chewable Tablets, available through Virbac Animal Health, contain Suntheanine in a chewable form proven to reduce clinical signs related to fear and anxiety.

In an open-field trial designed and performed by veterinary behaviorists Drs. Valerie Dramard and Laurent Kern,5 two of three dogs showed significant improvement when treated with Anxitane Tablets. In clinical signs associated with fear, such as trembling, mydriasis, hypervigilance, inhibition, flight and avoidance, there was a significant reduction (P < 0.0001), with similar data in cats resulting in owner satisfaction.5

While some pets may show a rapid response, for chronic conditions, progressive improvement in behavior is expected over three to six weeks. For the best evaluation in a pet, regular administration for a period of two months may be needed to assess its full potential, and it can be used long-term.

For episodic stressful situations such as car rides, fireworks or visitors, doses should be administered 12 hours and two hours before the event. For a prolonged situation, the administration can be repeated every six hours.

While thunderstorms may be considered episodic events, they are often difficult to predict, so regular administration during thunderstorm season with supplementation during the storm could be the best regimen for the pet, paired with behavior modification.

In summary, while anxiety and stress may be common in pets and each one’s experience is individualized, veterinarians can play an important role in helping the owner recognize the early signs, and to be proactive in recommending behavior modification and potential supplements or medication to help decrease the impact these behavior problems can have on pets.

Dental Care Today: Tooth Decay Higher in Rural Alaska

Tooth Decay Higher in Rural Alaska

According to a report released by the U.S. Centers for Disease Control and Prevention and the Alaska Department of Health and Social Services children in rural Alaska are 4.5 times more likely to have severe cavities compared to the national average.

Officials say the two leading factors associated with tooth decay in both kids baby and adult teeth are the lack of water fluoridation and drinking sugary drinks, like soda.

This finding is based on an investigation conducted in 2008 by the CDC and the Alaska Department of Health and Social Services on childhood dental health in rural Alaska.

The findings also found that children age’s 4 to 5 year olds on villages without fluoridation have a tooth decay rate 2.6 times higher than in villages with fluoridation.

Doctor Tom Hennessy of CDC recommends that villages with water systems set up for fluoridation to have it added to their water. For those villages without running water he says, parents can be sure their kids use toothpaste with fluoride or to have health care providers apply fluoride directly onto their teeth.

Improving dental care

The provincial government hopes to put the bite on dental decay.
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Beginning this fall, preschool children and schoolage children as well as preand post-natal moms in a number of health regions will have increased access to preventive dental care.

Initially, the program will be implemented in schools in those health regions with the greatest need. These include Athabasca, Keewatin Yatthe, Mamawetan Churchill River, Prince Albert/Parkland, Prairie North, Regina Qu’Appelle and Saskatoon Health Regions.

The program will expand to the province’s remaining health regions early in 2012.

“Oral disease is preventable, yet each year approximately 1,800 children under the age of five undergo dental surgery in hospital under general anaesthetic,” Health Minister Don McMorris noted in a news release. “We have committed funding of $1.4 million, through the Saskatchewan Surgical Initiative, to improve children’s oral health and reduce the need for surgery by increasing access to dental care, prevention and education.”

The initiative will focus on disease prevention and health promotion and target early childhood tooth decay in at-risk populations. Services will include oral health assessments, referral and followup, fluoride varnish and dental sealants. Oral health assessments will be provided to all preschool children in the province.

Children from six months of age to five years, who are at risk of early childhood tooth decay, will be given two fluoride varnish applications a year. Dental sealants will be offered in a phased-in approach to students attending schools with populations at risk.

Dr. Moira McKinnon, the province’s chief medical health officer, said studies show good oral health can prevent chronic heart disease, diabetes and obesity and reduce infections that can cause severe illness or be life-threatening.

She said evidence shows that poor oral health results in a poor diet and is more conducive to chronic disease.

Cancers of various parts of the mouth, such as the tongue or lip, can also occur when teeth aren’t healthy.

“Healthy teeth are important for the overall health and well-being of an individual for their lifetime and it starts in childhood,” she said.

The enhanced services will include consultations with pre and post-natal mothers to promote good oral health and ensure a healthy pregnancy and healthy development of their baby’s teeth. “It ends up being a good social environment to discuss health issues, but also to create peer support,” McKinnon said.

Dental care should begin right from infancy

Whether you’re a parent, guardian or grandparent, having children means you stay busy and dental health can be easily overlooked due to daily chores. Caring for children’s oral hygiene from birth before the visible growth of teeth is vital.

“Start your child on the way to healthy oral regime even before the appearance of the first baby tooth”, says Dr Ashutosh Sharma BDS, MDS, Specialist Dentist (Paedodontist), Aster Medical Centre, Dubai.

According to Dr Sharma, dental care begins right from infancy, where parents should ensure that the baby’s gums are gently cleaned with soft wet cloth after every feed to prevent any possible bacterial infection. Once the child develops teeth, it is recommended that the teeth are cleaned with a soft toothbrush after every meal.

The oral cavity is a fertile ground for bacteria which thrives mostly on sugar. The bacterial interactions in the oral cavity also generate acidic components that could be harmful to the teeth. “In my practice, I have often seen good dental hygiene is neglected by parents as we often do not understand the damage the acidic formations can do to a child’s teeth. If a regular habit of brushing the teeth is not nurtured among kids, these acidic formations can create cavities across the dental rows which can lead to tooth decay and dental erosion, which would require treatment at a later stage,” the doctor says.

Children’s teeth have thinner enamel than adult teeth and are more susceptible to the bacteria that cause decay. Decay in a baby’s tooth is swift and destructive; it quickly penetrates the enamel, then the dentin, and then infects the nerve.

Dr Sharma says that eatables which contain a high content of sugar, like chocolates, play a large role in dental decay and cavities. “Chocolates will remain ever popular among kids. However, it is very important for the health of their teeth that kids are not given sweets in excess. While we do not believe in denying the child of their favourite treats, we always recommend parents to introduce their children to a balanced diet.” Dr Sharma says.

Feeding infants in bottles can also trigger dental problems, particularly if the kid is allowed to sleep with the feeding bottle in his mouth. Babies should also be discouraged from sucking their thumbs, which is a habit they often pick up in infancy, but must be cut out by the time the child turns one.

“Forming a good routine of brushing teeth twice daily and cleaning them after every meal, regular check-ups with the dentist and a good diet helps in good dental hygiene. With simple care from an early stage, parents can easily ensure a lifetime of happy teeth for their children,” the doctor says.

Metro Dentists Offer Free Dental Care to Those in Need

Foster said with the tough economy, more people are being forced to do without preventive dental care because they can’t afford it.

“¿There is a tremendous need in the community for dental service – people who are out of jobs, people who don’t have insurance,” said the dentist. “It’s just another way to help out and provide some care to people that desperately need it.”

That’s why, for the second year, the Blue Springs dentist is participating in Dentistry from the Heart. He, along with six other community dentists, a slew of dental hygienists and a handful of volunteers will offer free dental work to anyone who needs it during an all-day event Saturday.

“We had a lot of people last year who just wanted a front tooth fixed so they could feel good about applying for a job,” said Dr. Foster.

Over the last ten years, dentistry from the heart has provides $6 million in free dental services to more than 60,000 patients all over the country.

“We’re doing this because we want to help people out,” said the dentist. “We really enjoy being able to do this event to take a day out of our life every year give it away to other people.”

Last year his Blue Springs office spread healthy smiles to 100 people. This year he hopes to do that for at least 101.

Dr. Foster will offer free dental care this Sat., Sept. 24 from 8 a.m. to 4 p.m. at his Blue Springs office at 2150 Northwest South Outer Road. Services are for adults only on a first come, first serve basis. Because the line get long early, his staff recommend that you line up before 8 a.m. For complete details, call: 816-463-9529.

In you can’t make it to Saturday’s event, there are other metro dentists who participate in the Dentistry from the Heart program. Just visit the ‘Events’ page of the site from a list of upcoming free dental days.

Additionally, some health departments and dental universities offer free or reduced cost dental care. Contact your local health department for more information.

Pain Management News: New treatment offers relief without medicine

New LUMEDX Chest Pain Management Solution Bridges Cardiology and Emergency Medicine

LUMEDX Corporation, a leading provider of fully integrated, cloud-powered cardiovascular imaging and information systems (CVIS), announced the release of the HealthView Chest Pain Management solution. HealthView Chest Pain Management makes pre-hospital electrocardiographs (ECGs/EKGs) instantaneously available to cardiologists for interpretation–and simultaneous comparison with prior ECGs, laboratory information and other patient data. By integrating current and historical information into a single view, the HealthView Chest Pain Management system bridges cardiac and emergency medicine, and transforms emergency cardiac care.

“Chest pain is the cause of about 12 million ED visits a year in the United States,” said LUMEDX Vice President of Strategic Products Praveen Lobo. “The stakes in chest pain management are very high–high for the hospital and high for the patient. For example, it’s very costly to activate a cath lab when a patient presenting symptoms does not, in fact, need a percutaneous coronary intervention (PCI). Resources are wasted. And of course it’s far more costly–and dangerous–to discharge a patient who needs a PCI. So getting the ECG and other clinical information in front of a cardiologist as soon as possible is crucial for successful outcomes and a successful hospital.”

Designed using American College of Cardiology and American Heart Association acute coronary syndrome (ACS) management guidelines, HealthView Chest Pain enables systematic, organized clinical pathways for STEMI, NSTEMI and low-risk chest pain patients. The institution of systematic clinical pathways resolves key problems in the coordination and delivery of care in this high-risk area of medicine.

The HealthView Chest Pain Management solution:

– Integrates pre-hospital ECGs, lab results and other clinical information into a single dashboard view–accessible anytime, anywhere via Web PC, Mac or iPhone.

– Seamlessly connects the ED with the cardiovascular service line for improved patient care.

– Facilitates timely and fully informed decision-making; helps reduce door-to-balloon times and length of stay.

– Enables systematic, best-practice clinical pathways for STEMI, NSTEMI and low-risk chest pain patients.

– Supports registry participation and QI efforts; allows easy monitoring of AMI Core Measures.

– Minimizes malpractice, RAC audit and other risks; maximizes revenue opportunity.

Newark Chiropractic Center Announces Acupuncture Treatment for Pain Management

Newark Pain and Rehab Center has announced that the chiropractor offers acupuncture for pain management. Acupuncture is a non-invasive, natural treatment used to relieve chronic pain following sports injuries, auto injuries and work injuries. Based on an ancient Chinese healing art, acupuncture uses thin needles to stimulate the nerves, muscles and connective tissues in the body. Scientific studies suggest that this stimulation increase blood flow and prompts the body to release natural painkillers, which may relieve arm pain, neck pain and back pain. Newark Pain and Rehab Center serves the Newark, East Orange, Ironbound and Irvington communities.

Dr. Vincent Saraceno, a chiropractor in Newark, has announced that his practice, Newark Pain and Rehab Center, offers acupuncture as a treatment for arm pain, back pain and other chronic pain conditions.

Medical acupuncture for pain management is based on the traditional Chinese healing art of using thin needles to stimulate pressure points in the body. Western science has adapted this treatment for pain relief and now uses therapy to naturally manage pain, boost immune function and improve wellness.

“Acupuncture is an important complement to chiropractic treatments,” said Dr. Saraceno. “I frequently recommend this care to patients who are struggling with back pain and arm pain following an accident. By targeting pressure points on the body, this treatment naturally relieves pain while promoting internal healing.”

Scientific research suggests that the act of inserting a thin needle into a pressure point stimulates nerves, muscles and connective tissue. This stimulation may increase blood flow and prompt your body to release natural painkillers, including neurotransmitters and hormones. These chemicals are known to dull pain, boost the immune system and regulate the body’s functions.

Dr. Saraceno typically combines treatments with other non-invasive techniques, including adjustment and spinal decompression. This combination of care is part of his ‘whole body’ approach to wellness and the natural management of pain.

“Traditional medical treatments rely on prescription painkillers to cover up pain. While medication can temporarily relieve back pain and arm pain, it cannot correct the underlying problem,” said Dr. Saraceno. “Non-invasive treatments like spinal decompression and physical therapy, in conjunction with acupuncture, can restore alignment to the musculoskeletal system and even prevent future occurrences of sciatica in patients without relying on painkillers or invasive surgery.”

Dr. Saraceno and the Newark Pain and Rehab Center provides care for the Newark, East Orange, Ironbound and Irvington communities. In addition to acupuncture, services include chiropractic adjustment, spinal decompression, physical therapy and safe manipulation under anesthesia. Dr. Saraceno also provides general wellness counseling and lifestyle advice to his patients.

“My goal is to help every patient live a full, active and healthy life,” said Dr. Saraceno. “I strive to help every patient find meaningful pain relief through natural wellness treatments.”

New treatment offers relief without medicine

The latest in pain management doesn’t come in a pill. And while it uses a needle, that needle is not full of medicine.

Dry needling is a new procedure offered at Redmond Regional Medical Center’s Rehab Center.

Michael Shin, a doctor of physical therapy, first learned of dry needling while he was a student at North Georgia College & State University. In the past two months, he has seen about 100 patients who look to the procedure for pain relief.

Earlier this year, the Georgia Legislature approved the use of dry needling as part of the Georgia Physical Therapy Practice Act under House Bill 145.

Even though it may seem similar to Chinese acupuncture, Shin is quick to point out that it is not related in any way.

“Dry needling is an integrative therapeutic modality for soft tissue dysfunction,” Shin said.

“This treatment technique is used to address painful conditions that are related to small contractures in muscles, called trigger points. Dry needling is a minimally invasive procedure in which a monofilament needle is inserted into the skin and muscle directly at a trigger point,” Shin said.

The procedure works because inserting a needle into a trigger point can cause favorable biomechanical, neurological and mechanical changes.

“These changes help to eliminate the trigger point and any associated pain by decreasing inflammation and modulating response of sensory nerve fibers to pain,” Shin said.

A variety of conditions can be treated with dry needling, Shin said, including lower back and neck pain, shoulder and arm pain (tendonitis, carpal tunnel syndrome and impingement), hip and leg pain (sciatica, muscle strain and calf tightness/spasm), foot (ankle sprain, Achilles tendonitis and plantar fascitis), headache and jaw pain.

Some of the patients referred to him “have chronic pain, and they have tried everything,” Shin said.

After the treatments, most patients feel soreness that can last from a few hours to a few days, and as with all treatments involving a needle, there is a risk for infection.

Shin uses a single-packed disposable and sterile needle during treatment to prevent infection.

DJO Global Launches the Empi Active Knee System to Manage Knee Pain

DJO Global, Inc., (“DJO” or the “Company”) a leading provider of medical device solutions for musculoskeletal health, vascular health and pain management, today announced the launch of the Empi Active(TM) Knee TENS System to treat knee pain, a condition which may affect more than 19 million Americans. Transcutaneous Electrical Nerve Stimulation (TENS) uses comfortable electrical stimulation to inhibit pain signals from reaching the brain thus effectively blocking the pain sensation.

The Empi Active Knee, with predetermined electrode placement built into a specialized wrap, delivers a proprietary TENS waveform to the knee to manage acute, chronic and arthritic pain while minimizing interruption of daily activities. The technology delivers a similar physiologic response as pain medication, but without the possible negative side effects from chronic use of medication. Approximately 250 million drug prescriptions for pain medications are written every year in the U.S.

Dr. Melisa Estes, a physiatrist and board certified pain medicine physician, reported, “I find that the Empi Active device can be helpful in decreasing the amount of pain medications that a patient may take. I also find it very useful for patients who have difficulty tolerating usual medications such as muscle relaxants or non steroidal anti-inflammatories.”

“Chronic knee pain from osteoarthritis, tendonitis and other conditions is an obstacle to maintaining healthy and active lifestyles and often leads to prolonged inactivity that can create other, more serious health consequences,” said Mike Mogul, president and chief executive officer of DJO Global. “With our broad portfolio of orthopedic preventative and rehabilitative products, DJO is uniquely positioned to help these patients.”

The Empi Active Knee System follows DJO Global’s success with its 2010 release of Empi Active Back, which uses the same proprietary TENS waveform technology to target back pain. Back pain affects approximately 65 million Americans and is the second most common reason people visit a doctor. Similar to the Empi Active Back, primary care physicians, orthopedic surgeons, pain specialists, rheumatologists and physical therapists can better manage their patients’ knee pain without disrupting their daily activities.

Hypertension Treatment News: Device Promising for Resistant Hypertension

Device Promising for Resistant Hypertension

Although a baroreflex activation therapy device designed to treat resistant hypertension lowered blood pressure, it failed to meet two of five coprimary endpoints in a pivotal trial, researchers found.

The trial did not meet endpoints regarding short-term systolic blood pressure response and safety of the procedure to implant the device, according to John Bisognano, MD, PhD, of the University of Rochester in New York, and colleagues.

It did, however, show a benefit on sustained response, safety of baroreflex activation therapy, and safety of the device, the researchers reported online in the Journal of the American College of Cardiology.

The findings were originally reported at the American College of Cardiology meeting in April.

The authors noted that all five of the coprimary endpoints needed to be met to establish the overall efficacy and safety of the Rheos device.

However, they wrote, “the weight of the overall evidence suggests that over the long-term, baroreflex activation therapy can safely reduce systolic blood pressure in patients with resistant hypertension. Future clinical trials will address the limitations of this study and further define the therapeutic benefit of [the therapy].”

They added that “new technology for delivering baroreflex activation therapy that involves a less invasive implant procedure has been developed by [Rheos manufacturer] CVRx and is currently undergoing confirmatory study in Europe.”

The Rheos system is targeted to the 20% to 30% of patients with hypertension who are resistant to treatment, defined as a failure to achieve a blood pressure less than 140/90 mm Hg with maximally tolerated doses of at least three antihypertensives, including a diuretic.

The system involves leads strung from a pulse generator implanted in a patient’s chest to each carotid sinus. The electrical impulses stimulate the baroreceptors there, reducing sympathetic activity and increasing parasympathetic activity, which causes the blood vessels to open and heart rate and blood pressure to drop.

In the current phase III trial, 265 patients with resistant hypertension — who were taking an average of 5.2 antihypertensives at baseline — were implanted with the device, which was turned off.

After one month, they were randomized 2:1 to have the device turned on for 12 months (181 patients) or to have the device turned off for the first six months and then turned on for the last six months (84 patients).

At six months, the mean decrease in systolic blood pressure was greater in the group with the device turned on, although the difference did not reach statistical significance (16 versus 9 mm Hg, P=0.08).

By 12 months, when both groups had had the device turned on for at least six months, the mean reduction in systolic blood pressure from baseline was 25 mm Hg in both groups.

The trial failed to meet two of the five coprimary endpoints:
The percentage of patients who achieved at least a 10 mm Hg drop in systolic pressure from baseline at six months was not significantly greater in the group with the device on (54% versus 46%, P=0.97).
The percentage of patients in both groups who remained free of serious procedure- or system-related adverse events 30 days after implantation (74.8%) did not exceed the goal of 82%. Most events were related to lead placement and involved transient or permanent nerve injury in 4.4 to 4.8% of patients.

The trial did meet the other three endpoints:
The percentage of patients who had the device turned on for the entire 12-month study who had a significant blood pressure response at six months and who maintained that response at one year (88%) exceeded the goal of 65%.
The percentage of patients who remained free of adverse events related to baroreflex activation therapy from 30 days to six months post implantation did not differ between the groups by more than 15% (91.7% with the device on for 12 months versus 89.3% in the other group). That met criteria for noninferiority (P<0.001).
The percentage of patients in both groups who remained free of hypertension-related and serious device-related adverse events from 30 days to 12 months post implantation (87.2%) exceeded the goal of 72%.

A prespecified ancillary analysis showed that a greater percentage of patients who had the device turned on achieved a systolic blood pressure of 140 mm Hg or less at six months (42% versus 24%, P=0.005), although the proportion was about 50% in both groups by one year.

Researchers admitted that certain assumptions had to be made that could not be verified beforehand because of the novelty of the device.

Also, variability in blood pressure measurements could have been reduced if the trial design had allowed for several qualifying measurements.

Pluristem stem-cell out-license comes into effect

The license that Pluristem Therapeutics Ltd. (Nasdaq:PSTI; DAX: PJT: PLTR) awarded to United Therapeutics Corporation (Nasdaq: UTHR) to use of its PLacental eXpanded (PLX) cells to develop and commercialize a cell-based product for the treatment of pulmonary hypertension came into effect yesterday. Pluristem awarded the license on June 19, after obtaining permission from the Office of the Chief Scientist.

United Therapeutics paid Pluristem a down payment of $4 million when the agreement was signed, and it will make up to $55 million in milestone payments, and cover the costs of development and clinical trials for this indication. If the product is commercialized, United Therapeutics will also pay royalties.

Pluristem’s share price fell 5.7% on Nasdaq yesterday to $3.15, giving a market cap of $131 million, but rose 1.3% premarket trading today, but fell 2.8% by mid-afternoon on the TASE today to NIS 10.89.

JIPMER to test genes for personalised treatment

PUDUCHERRY: At a time when the world is looking towards personalised medicine, the Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) has taken the lead among government hospitals in the country by introducing pharmacogenomics testing of genes to provide personalised treatment.

Initially, the testing would be done for CYP2C9, CYP2C19 and VKORC1 genes which would promote personalised treatment of patients with epilepsy, peptic ulcer, diabetes, hypertension, stroke, cardiac diseases, deep vein thrombosis and patients undergoing valve therapy, said Dr C Adithan, professor and head , department of pharmacology, JIPMER. He added that it was the first step towards personalised medicine.

The idea behind the pharmogenomic testing is to understand the genetic make up of an individual associated with drug metabolism and treatment response to drugs. Pharmocogenomics stems from the concept that one drug doesn’t fit all. Instead of the patient undergoing a ‘trial and error’ of various drugs, all it takes is one DNA test to analyse one’s genes which are the code for drug metabolising enzymes.

Knowing the patient’s genetic constitution would enable the physician to prescribe more confidently the appropriate drug. One could do away with the adverse drug reaction (ADR) or non-response. He added that there was no accounting for the cost effectiveness in the long run.

The testing would be done in the PCR laboratory of JIPMER. After the logistics are put in place, the testing would begin in the next three to six months and thereafter testing of other genes would be introduced in a phased manner, he said.

The department of pharmacology, JIPMER, also has a drug information centre, where on an average 70 area reports are received on ADR.

Symposium on Hepatitis B

A symposium on ‘hepatitis B-resolving the dilemma’ was held at JIPMER on Saturday.

Dr Sankaranarayanan from Chennai KK trust hospital who spoke on hepatitis in children emphasised on the importance of hepatitis B vaccination in high risk groups. The methods of testing used to diagnose acute and chronic hepatitis B were elaborated by Dr George Kurien.

Dr Piramanayagam from Apollo hospital, Chennai, spoke on hepatitis B and pregnancy and Dr Thomas Alexander from Pondicherry Institute of Medical Sciences on hepatitis B in adults.

Dr Biju Pottakkat from JIPMER who spoke on liver cancer detailed the various therapeutic options in liver cancer associated with Hepatitis B. Dr Lakshmi and Dr Amit Goel, gastroenterologists from JIPMER, outlined several aspects to prevent hepatitis B in adults and children.

The symposium urged the delegates to increase the awareness among health workers and public about hepatitis B and its complications.

Dangers of hypertension

Hypertension sharply increases the risk of heart attack, stroke, heart failure, and kidney failure

Hypertension is one of the most common medical problems in the US; at present, one of every American adults has high blood pressure. It’s a shame since many, if not most, cases could be prevented by simple lifestyle measures such as dietary salt restriction, weight control, and moderate exercise.

Hypertension is also one of the most important medical problems in America; it sharply increases the risk of heart attack, stroke, heart failure, and kidney failure. That’s also a shame, since excellent drugs are available to lower blood pressure and prevent these deadly complications.

You don’t have to bring your pressure down to normal (below 120/80 millimetres of mercury) to get the benefit of treatment. Simply lowering an elevated blood pressure to modest treatment targets (below 140/90 for people without certain complicating conditions; below 130/80 for those with diabetes, kidney disease, heart failure, or atherosclerosis) can cut the risk of heart attack and stroke by about 34 per cent and 21 per cent, respectively.

But the biggest shame of all is that only about 44 per cent of hypertensive patients reach these goals.

There are many explanations for these sorry results. A study highlights one of the most important reasons: poor adherence to medication regimes.

The study

Researchers in Italy obtained information from 400 primary care physicians to identify 18,806 patients ages 35 and older who were first diagnosed with hypertension during 2000 and 2001. None of the patients had been diagnosed with coronary artery disease, heart failure, or cerebrovascular disease when they entered the study; the scientists followed the patients for an average of 4.6 years to track the onset of these complications.

All patients in the study received prescriptions for one or more effective antihypertensive medications. Based on how often they filled their prescriptions, the patients were classified into three adherence levels: high (pills on at least 80 per cent of days), medium (40 per cent to 79 per cent), or low (below 40 per cent).

At the start of the study, only 8 per cent were in the high-adherence group; by the end of the study, 19 per cent achieved this level. Intermediate adherence fell from 41 per cent to 32 per cent, and low adherence was stubbornly high, declining only minimally from 51 per cent to 49 per cent.

Did adherence matter? It sure did. As compared with their low-adherence counterparts, the high-adherence patients enjoyed a 38 per cent lower risk of acute cardiovascular events during the study period.

Perspectives

Although previous research has demonstrated that good adherence to medication results in lower blood pressure readings, fewer hospitalisations, and lower medical costs, the study is one of the first to document reduced cardiovascular events. Curiously, though, the study did not provide information on blood pressure readings, nor did it rate the patients according to their adherence to the lifestyle changes that can also lower blood pressure. Despite these limitations, the research serves to emphasize the importance of compliance with medication.
In randomised clinical trials of anti-hypertensive therapy, only 5 per cent to 10 per cent of motivated, supervised volunteers discontinue their medications over the course of a year, but in real world clinical practice, discontinuation rates can be 50 percent or higher within just six months. But why?

Doctors often blame their patients, but physicians who fail to explain the importance of continually taking medication, long-term lifestyle changes, and careful blood pressure monitoring and follow-up surely deserve some of the blame. And patients are often discouraged by complex medication schedules, expensive drugs, or both.

Stop Smoking News: Anti-smoking supporter’s new proposal

Anti-smoking supporter’s new proposal

A campaigner whose plan to ban smoking outside public buildings and transport stops was rejected has taken a new tact – banning smoking in key city spots.

George Wood, chairman of Auckland Council’s community safety forum, put forward a proposal that would stop smokers congregating outside city buildings and near public transport areas.

The idea failed to gain majority support at the forum’s meeting on Thursday night because councillors said smoke-free areas in the city cannot be enforced unless money is spent on creating a new bylaw.

Wood refuses to let that decision extinguish his idea and now plans to push for smoking bans in downtown Auckland in plazas like Britomart, Aotea Square and Albert and Myers parks.

“The issue is not dead. Ok, we didn’t get it backed, but we’ll continue working on it and refining it,” he says.

He’s pushing for the support of Sandra Coney, chairman of the council’s parks, recreation and heritage forum as most Auckland parks have become smoke-free.

Wood also believes creating a stigma around smoking in public will be enough to prevent people from lighting up.

“Public pressure is strong enough for people to stop smoking in open areas. The stigma alone is enough to stop them from doing it,” he says.

Wood ruled out fining smokers as a means of enforcement, saying it would be “taking it a step too far”.

He wants smoking in public banned because it causes mess and it is “harmful to other people”.

“People step outside for a cigarette and they don’t seem to care about others and what harm they’re doing by passive smoking.”

Expectant mothers who quit smoking help baby

Stockholm – Expectant mothers who stop smoking around the time of getting pregnant can eliminate the heightened risk of low birthweight, premature birth and associated brain damage from tobacco, according to British research.

A team led by Professor Nick Macklon, from the Department of Obstetrics and Gynaecology, University of Southampton, UK, studied data from some 50,000 pregnancies registered at the Southampton University Medical Centre between 2002 to 2010.

It found that babies from women who stopped smoking either immediately before or shortly after conceiving had a significantly higher birthweight than those from mothers who had continued to smoke.

Macklon said that babies in this group had also reached the same gestational age and head circumference as those born to mothers who had never smoked. The study, he said, gave mothers-to-be hard evidence that stopping smoking no later than in the early phase of pregnancy was beneficial for their baby.

Macklon said that low birthweight was ‘the most common negative outcome’ of smoking during pregnancy. Pointing to long-term effects, too, he warned expectant mothers who continued to smoke because they believed that a smaller baby meant an easier birth.

‘Smoking during pregnancy is not just bad for the mother and baby,’ Macklon said, ‘but for the adult it will grow into.’

The findings were reported at the annual meeting of the European Society of Human Reproduction and Embryology (ESHRE) in Stockholm.

Stop smoking and drinking

The RF Ministry of transport has developed a draft bill aiming to forbid drinking and smoking at stations, on trains, airplanes and ships.

The bill suggests forbidding selling beer and any other alcohol at railway stations and stops. Smoking is to be forbidden in city public transport, on commuter and long-distance trains, in airplanes in case the flight lasts less than three hours, at railway stations and stops.

Smoking on commuter trains, in places not designated for smoking at railway stations, stops and on local and long-distance trains, on board sea-going and inland vessels and airplanes in case the flight lasts less than three hours will be punished by either a warning or a fine of 2,000 rubles.

In Europe, it will cost you 2,000 euro to smoke at a railway station. But then, they have sockets for e-cigarettes everywhere.

Acne Treatment News: Acne Treatment Basics

Acne Treatment Basics

Acne is a common skin condition that causes pimples or zits on the face, chest, back, and other areas. An estimated 60 million people in the United States have acne at some time during their lives. Acne is most common in teenagers, but can be a problem for people of all ages.

The first rule of acne treatment is never to pop or pick at pimples or zits. No matter how clean the skin seems to be, popping a pimple allows bacteria and other germs to get inside the protective surface layer of the skin which in most cases will cause a red spot or bump that will last much longer than the original pimple would have. In general, acne treatments try to deal with one of three basic causes of acne: clogged pores, bacteria on the skin, and excess oil production by glands in the skin.

Open clogged pores
There are many products available that claim to open pores. It’s important to remember that if you have acne, your skin is sensitive and needs to be treated gently. Choose mild a mild cleanser that won’t dry out your skin. Some products contain fine granules that act as a mild scrub or a low concentration of salicylic acid that acts as a mild peeling agent to help open pores. Be sure to wash skin once or twice a day, especially after exercising and after wearing makeup to remove sweat and other substances that can clog the pores.

Control bacteria
Some cleansers that are available over-the-counter (OTC) contain antibacterial agents including benzoyl peroxide. Topical products that are applied to the skin include gels, creams, and lotions that may contain benzoyl peroxide, sulfur, resorcinol, salicylic acid, lactic acid, or other antibacterial agents. You may develop dry, flaky, or irritated skin after using these products. For some people, side effects go away after about a month of use. Others need to stop using the product to cancel the side effect. Also be aware that benzoyl peroxide is a bleach which can cause blotches on colored clothing, towels, carpeting, and other textiles.

Isotretinoin’s Link to IBD: Examining the Evidence

Although no link between isotretinoin therapy and inflammatory bowel disease has been proven, the absolute risk for these disorders in conjunction with treatment appears small.

“We would need to treat 2,977 patients with isotretinoin to observe 1 excess case of ulcerative colitis,” Dr. Catalin Mihai Popescu and her colleagues wrote in a research review (Arch. Dermatol. 2011;147:724-9).

Dr. Popescu, of Colentina Hospital, Bucharest, Romania, and her colleagues reviewed three case-controlled studies that examined the relationship between isotretinoin treatment for acne and the development of irritable bowel disease (IBD) or ulcerative colitis.

“Because the incidence of IBD is very low, randomized controlled trials or prospective cohort studies cannot be performed owing to issues of cost and sample size,” the authors wrote. “The most feasible, quickest, and cheapest approach that can provide the best evidence is a population-based case-control study.”

The studies examined included two led by Dr. S.D. Crockett of the University of North Carolina, Chapel Hill: a review of 12 case reports and 1 case series (Am. J. Gastroenterol. 2009;104:2387-93) and a population-based case-control study (Am. J. Gastroenterol. 2010;105:1986-93). The third study, led by Dr. C.N. Bernstein of the University of Manitoba IBD Clinical and Research Centre, Winnipeg, was also a population-based case-control study (Am. J. Gastroenterol. 2009;104:2274-78).

In their review of case reports, Dr. Crockett and colleagues found 15 cases of IBD among isotretinoin users in seven countries over a 23-year period. Based on this finding, the authors suggested that 59 cases of IBD could occur each year in conjunction with isotretinoin treatment.

In the population-based case control study, Dr. Crockett and colleagues used data from a large insurance claims database of 87 U.S. health plans. The authors found no significant isotretinoin association among patients with diagnostic claims for IBD, Crohn’s disease, or ulcerative colitis. When the researchers considered any exposure to the drug, they found that only the risk for ulcerative colitis was significant (odds ratio, 4.36). Higher doses, dose escalation, and longer duration of isotretinoin treatment increased the risk for ulcerative colitis significantly (up to OR 5.63).

Dr. Bernstein and colleagues’ case-control study found 1,960 cases of IBD diagnosed in a Manitoba health database during the period from 1995 to 2007. IBD and ulcerative colitis cases were matched with more than 19,419 controls. Patients with IBD were no more likely than matched controls to have used isotretinoin before diagnosis.

Dr. Popescu and her colleagues noted the quality of the studies was high, but their disparate findings make logical conclusions difficult. Dr. Popescu also suggested that antibiotics could be a possible link between acne treatment and IBD. Before taking isotretinoin, most patients with acne undergo protracted antibiotic treatment.

“A recent population-based case-control study showed that the hazard ratio for developing IBD for any exposure to a tetracycline antibiotic was 1.39,” they wrote. Other antibiotics used for acne treatment were associated with higher risks for Crohn’s disease: HR 2.25 for doxycycline and Crohn’s disease, and 1.61 for tetracycline/oxytetracycline.

“The risk of ulcerative colitis, but not Crohn’s disease, seems to be increased in patients taking isotretinoin,” the authors noted, “but further studies are needed to confirm or refute this finding. Although the absolute risk is very small … dermatologists and their patients should be aware of it, and, if persistent bowel symptoms develop, isotretinoin administration should be discontinued and patients should be referred to a gastroenterologist.”

However, they concluded, “this low absolute risk has to be weighed against the high risk of disfiguring scarring that may result from withholding isotretinoin treatment in patients with severe acne.”

Dr. Popescu reported receiving travel grants and honoraria from numerous pharmaceutical companies that manufacture acne and other dermatologic medications.

From acne treatment to menopause masks, Dr. Ava Shamban’s new book, Heal Your Skin, focuses on beautiful skin throughout life with ingredients that can already be found in your home!

The largest organ in the body, skin plays a huge role in self confidence and it is what most use to gauge the aging process. While genetics play a big part in determining the quality of your skin, there is no reason why you can’t make the effort to attain the most beautiful skin possible, especially with so many of the ingredients to do so already at home!

Recently, dermatologist and author Dr. Ava Shamban visited the set of The Doctors to discuss her new book, Heal Your Skin in which she talks about the importance of holistically treating the skin. Including fitness and nutrition tips, one of the things that Dr. Shamban stresses in her book is that beautiful and healthy skin does not have to cost a lot of money. Focusing on skin care that can be made at home from normal everyday kitchen items, Dr. Shamban shared 3 recipes to make at home for beautiful skin, regardless of life stage.

Acne Spot Treatment
Dr. Shamban calls adult acne “the perfect hormonal storm” and while there are expensive acne treatments available, she recommends making this spot treatment at home. Mixing together a teaspoon of nutmeg and a teaspoon of milk to create a paste, the nutmeg acts as an anti-inflammatory and the milk as an alpha hydroxy to spot treat acne. She recommends leaving the paste on the pimple for at least an hour or sleeping with it on overnight.

Pregnancy Scrub
During pregnancy, many skin issues may arise: more acne breakouts than usual and some women may experience melasma, also known as the pregnancy mask. This hyper-pigmentation occurs across the center of the face and while fractional laser resurfacing procedures may help, Dr. Shamban recommends this all-natural brown sugar scrub. Combine 2-3 tablespoons of brown sugar, half a cup of yogurt and whisk it together with egg whites for an all natural scrub for the face.

Menopause Mask
In menopause, hormonal changes can be vast and this also affects the skin. Normal skin could one day feel oily and dry the next as hormones fluctuate. Bioidentical Hormone Replacement may help but Dr. Shamban suggests an at-home remedy, the Menopause Mask that might help with some of those skin issues. Combining 1 teaspoon of honey, a liquid form of acai berry, yogurt and corn starch to create a mask, Dr. Shamban says honey acts as an antiseptic and an anti-inflammatory agent while acai berry has powerful antioxidant qualities to help calm menopausal skin.

Dr. Shamban’s book Heal Your Skin covers skin care through several stages of life while looking at the importance of nutrition and fitness. She firmly believes that your skin is an accurate barometer of what you’re eating and how stressed out you are as well as how you treat your skin. Heal Your Skin not only provides at home tips on how to treat your skin issues, it is also full of tips on how to improve skin from the inside out.

Sleep Disorders News: Getting A Good Night’s Sleep

Getting A Good Night’s Sleep

A good night’s sleep is something we all value. Scientists tell us, and we know from experience, that it refreshes us, helps us perform better, and contributes significantly to health and happiness, especially in children. And yet, there are millions of us suffering from ongoing shortage of sleep.

According to the World Association of Sleep Medicine (WASM), sleep problems add up to a global epidemic that affects 45% of the world’s population.

“Insomnia, obstructive sleep apnea (OSA), restless legs syndrome (RLS), and sleep deprivation significantly impact physical, mental and emotional health, in addition to affecting work performance and personal relationships,” they said, on the fourth annual World Sleep Day on Friday 18th March 2011, when health professionals from WASM and other organizations worldwide came together to deliver the message that sleep is a “human privilege that is often compromised by the habits of modern life”.
The 24/7 Technological Society
When we think about it, these figures are hardly surprising. Over the last two or three decades, the choice of round the clock activity available to the average Westerner today has become overwhelming. We can shop at 2 am, either at the supermarket or online, we can do our banking online 24/7, we can watch any number of films and TV channels or catch up on programs around the clock, we can download games, books and software and start enjoying them without having to wait until the morning.

And then there’s the communications technology through which we make ourselves accessible to others, via mobile or cell phones, internet chats and and social networks like Facebook and Twitter. Over less than a generation our social “interfaces” have multiplied enormously, leading to an ever increasing volume of transactions with a growing number of people.
Viagra Australia
And all this impacts not only our daytime activity, but damages our sleep environment: it’s much harder to wind down and prepare for sleep when the bedroom is more like a NASA control center than a haven of peace and tranquility.

This is especially evident in the younger generation. Research suggests that as a group, teenagers are experiencing sleep deprivation on an unprecedented scale. A contributing factor is the tide of technology flooding into the bedroom of the average teenager.

Home insurance surveys show that most British children have a games console, a TV, a CD player and a DVD player in their bedroom, which one in five parents now ranks as containing more expensive items than the kitchen or living room. The bedroom is also the room teenagers spend most of their time in, and where they tend to hang out with their friends when they call round.

Calling and texting on cell phones is an especially big stealer of sleep time among teenagers. Doctors in the US are becoming very concerned about the effect this has on their health and development.

Dr R Michael Seyffert of the New Jersey Neuroscience Institute at JFK Medical Center in Edison, sees two or three teenagers a month with severe night-time cell phone problems, which he defines as spending two or more hours of texting and phoning each night. He says he has seen more of this in the last five years than ever before, and predicts it is only going to get worse.

Few would disagree with him: as we drift on this tide of technology toward a total 24/7, globally connected society, with an increasing number of gadgets to inform, stimulate and entertain us, the traditional boundaries between activity and sleep are being eroded, and we are likely to see a rise in the number of people experiencing health problems from lack of sleep.
How Much Sleep Do We Need?
Expert opinion varies as to the exact number of hours of sleep we need for optimum health, and some suggest it also depends on individual needs and age. The American Academy of Sleep Medicine says most adults need about seven to eight hours of sleep a night to feel alert and well rested. The National Sleep Foundation also recommends between 7 and 9 hours.

One recent study suggests it could be as little as 6 hours, but more than 9 hours could be just as bad as not enough. Dr Charles Bae, a neurologist at the Cleveland Clinic Sleep Disorders Center in Ohio, and colleagues examined data on 10,654 patients who had competed questionnaires about quality of life, depression and average hours sleep per night.

They were surprised to find that sleeping more than 9 hours a night was linked to a similar reduction in quality of life and increase in symptoms of depression as sleeping less than 6, they said at the SLEEP 2011 conference in Minneapolis.

Children and teenagers need more sleep than adults. Teenagers need at least 9 hours, says the National Sleep Foundation in the US.

Many people do not realize that sleep is far from being a “passive” process where the brain just switches off at night. It is an “active” process involving the whole body and the brain.

Neurotransmitters, chemicals that brain cells use to signal to each other, control whether we are asleep or awake by action on different parts of the brain. In the brainstem, which joins the brain to the spinal cord, brain cells produce serotonin and norepinephrine that keep some parts of the brain active while we are awake, while other brain cells at the base of the brain control signals that lead to sleepiness and falling asleep by “switching off” the ones that keep us awake.

When we sleep we go through several stages of sleep from light to deep sleep, and then the cycle starts over. One of the stages is REM (rapid eye movement), which stimulates the brain regions used in learning. Infants spend much more time in REM sleep than adults. REM is also linked to increased production of proteins and learning of mental skills.

Research also suggests that a chemical called adenosine, which causes drowsiness, gradually accumulates in the bloodstream while we are awake and gradually breaks down during sleep.

Study: Sleep boosts athletic performance

Young basketball players wanting to improve their game should put in long hours — not only of practice time, but also of sleep, U.S. researchers say.

A researcher in the Stanford University Sleep Disorders Clinic and Research Laboratory said her study has shown that basketball players at the college level improved on-court performance by increasing their amount of total sleep time.

“Athletes may be able to optimize training and competition outcomes by identifying strategies to maximize the benefits of sleep,” the researchers wrote in the journal SLEEP.

While it’s long been known lack of sleep can have negative consequences, very few studies have looked at the effect that sleep extension can have on performance, particularly of athletes, a Stanford release said Friday.

Most athletes focus on nutrition and physical training as part of their regimen, Mah said, but competitive athletes at all levels typically do not consider optimizing their sleep and recovery.

“Intuitively many players and coaches know that rest and sleep are important, but it is often the first to be sacrificed,” she said.

Over the course of two basketball seasons, Mah and colleagues worked with 11 healthy players to measure the effects of sleep extension on specific measures of athletic performance. At the end of the study period, the players ran faster 282-foot sprints (16.2 seconds vs. 15.5 seconds) and their shooting accuracy during practice improved, with free throw percentages increasing by 9 percent and 3-point field goal percentage increasing by 9.2 percent.

Sleep is an “unrecognized, but likely critical factor in reaching peak performance,” Mah said.

Home Sleep Testing (HST) Surpasses User Expectations

Sleep Group Solutions (SGS) is pleased to announce the widespread launch of InterpStudies.com, a home sleep study interpretation portal. Home sleep testing has been among the fastest growing segments of the sleep and medical market as it is a viable and cost effective study, similar to the overnight PSG tests done in sleep labs.

Home sleep tests (HST), such as the Embletta is the same HST device used today in many hospitals, Sleep Disorders Centers, VA and Kaiser Systems. These home sleep tests are user friendly, and frequently administered by primary care physicians, internal medicine physicians, dentists and other specialties. Since Embletta supplies many sleep labs with sleep study technology-sleep doctors are familiar with the data and diagnosing is seamless when studies are uploaded to InterpStudies.com. “Interpstudies.com was built with a scalable infrastructure so that companies interested in getting started with home sleep testing do not need to invest in the technology and expensive servers or programs, nor networking with physicians to make a system like this work. With Sleep Group Solutions and the InterpStudies.com network distributors, DME companies, multi-state medical groups and others can work with home sleep testing and offer physician interpretation nationwide with no additional investment.” explains John Nadeau, Sleep Group Solutions, VP.

Being a part of Sleep Group Solutions ‘Complete Home Sleep Testing Solution’ includes:

*Embletta Units: The “gold standard” in home sleep testing, and most other HST devises
*Customized web portal access for you and your customers: Seamless and easy access
*Interpretations by InterpStudies.com

Create your business’s own ‘Complete Home Sleep Testing Solution’ today, with the most cost effective model, and comprehensive company around. Dr. Gregory Carnevale, a sleep doctor in New York, and part creator of InterpStudies.com says “InterpStudies, LLC was born out of this idea to provide home sleep study interpretations efficiently and accurately using the most modern technology, and competitive price.” Dr. Carnevale mentions in a recent interview with the Sleep Magazine, and that’s exactly what InterpStudies delivers.

About Interpstudies.com
InterpStudies is a completely web-based company that transfers (“uploads”) home sleep study data that you provide to our team of “Analyzers” who are board certified sleep physicians. Our Analyzers will send you a report within 5 business days providing you with the most current American Academy of Sleep Medicine guidelines regarding diagnosis and treatment options, including CPAP, oral appliances and other treatments. Interpstudies.com work most often with Remlogic software and Embletta home sleep study equipment. Additional devices can be used including: MediByte Jr, Easy Ambulatory PSG, Somte, Watch-PAT (Prices and acceptance of new clients will change from time to time). The InterpStudy team with help you with all phases of the process including set-up and uploading. Most of this assistance can be done remotely.

About Sleep Group Solution

Sleep Group Solutions is an airway diagnostic technology company serving the needs of physicians and dentists interested in screening, diagnosing and treating sleep apnea and other upper airway disorders. Sleep Group Solutions offers the latest screening and diagnostic equipment solutions for patients with allergy, sinus congestion, rhinitis, deviated septum, nasal polyps, snoring and sleep apnea. SGS offers the most comprehensive dental sleep medicine CE seminars in the industry focused on teaching dentists the protocols needed to make the treatment of snoring and sleep apnea part of their practice. SGS offers sleep study interpretation, oral appliances (Norad Boil & Bite, Respire), online directory 1800SleepLab.com and online marketing at Sleeptest.com. SGS is the manufacturer of the Eccovision Systems Rhinometer and Pharyngometer.

Arthritis Treatment News: Abbott, Biotest To Team Up On Treatment For Arthritis, Psoriasis

Abbott, Biotest To Team Up On Treatment For Arthritis, Psoriasis

Abbott Laboratories (ABT) reached an agreement with Biotest AG (BBTAY, BIO.XE) to develop and commercialize the Germany-based company’s treatment for rheumatoid arthritis and psoriasis.

Under the agreement, Abbott will pay an upfront fee of $85 million to Biotest, which specializes in haematology and immunology products. The agreement also includes potential milestone payments of up to $395 million.

The companies will co-promote the treatment in Germany, France, the U.K., Italy and Spain. Abbott will have exclusive rights outside those five markets.

Abbott’s diversified business lineup has cushioned it from some problems facing other large drug makers, such as patent expirations and generic competition. It has made a series of acquisitions in recent years to help reduce its dependence for sales growth on the anti-inflammatory drug Humira, which may face heightened competition in coming years.

Biotest’s treatment, which aims to improve the body’s immune system response to the diseases, is in phase II clinical trials. Preclinical studies are under way to assess potential use in other immune-system related diseases.

“This novel compound will strengthen Abbott’s immunology pipeline and we look forward to continuing to build on our expertise in exploring multiple mechanisms and approaches to treat inflammatory diseases,” said John Leonard, senior vice president of global research and development at Abbott.
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Abbott in April reported a 14% decline in first-quarter earnings on costs associated with acquisitions and employee layoffs, while newly acquired drugs in foreign markets contributed to a 17% increase in revenue.

Abbott shares were up 8 cents at $52.10 in early trading. Biotest’s American depositary shares rose 8 cents to $30.56.

FDA Committee Votes Against Green-Lighting Novartis’ Gouty Arthritis sBLA

An FDA advisory committee has voted against recommending the sBLA for Novartis’ ACZ885 (canakinumab) in the treatment of gouty arthritis in patients who don’t obtain adequate relief using NSAID drugs or colchicine. Although the advisory committee was happy with the efficacy of the drug, its concerns lay with overall safety. The committee has, as a result, suggested ACZ885 may be more suitable for a narrower population of patients. Novartis says it now aims to work with FDA to identify the right patient population.

The recommendation, which FDA is not bound by in terms of making a final regulatory decision, was based on the committee’s review of data from two pivotal Phase III studies in over 450 gouty arthritis patients. Reported by Novartis last month, the study results showed that in comparison with steroid therapy, treatment with ACZ885 led to better pain relief at 72 hours, and a 56% reduction in the risk of new attacks over six months. 28% of patients receiving ACZ885 experienced new attacks over 24 weeks, compared with 49% of patients treated using the injectable steroid triamcinolone acetonide.

ACZ885 is a fully human monoclonal antibody designed to selectively inhibit interleukin-1 beta. The drug is already approved under the brand name Ilaris® in over 45 countries, including the EU and U.S., for the treatment of adults and children with cryopyrin-associated periodic syndromes. Approval applications for canakinumab as a treatment for gouty arthritis in patients for whom other treatment are inadequate were submitted in the EU in 2010 and in the U.S., Canada, and Switzerland in the first quarter of 2011. A final FDA decision is expected during Q3 2011.

Arthritis treatment undergoes Rapidfact testing

Quotient Clinical has announced an agreement with Medigene to undertake a Rapidfact formulation development and clinical testing programme on Rhudex.

This is subject to ethical and Medicines and Healthcare Products Regulatory Agency approval.

Rhudex is a potential first-in-class treatment for rheumatoid arthritis and other inflammatory disorders.

Quotient Clinical’s Rapidfact service makes use of its tightly integrated GMP manufacturing and clinical testing processes and facilities to enable the rapid clinical evaluation of new drug formulations.

Rapidfact is said to enable shortening of project timelines and a reduction of ~90 per cent in API consumption.