Drug-resistant staph infections spread

Drug-resistant staph infections have spread to the urban poor, rising almost seven-fold in recent years in some Chicago neighborhoods, a new study finds.

Researchers said the crowded living conditions of public housing and jails may speed up the person-to-person spread of infection.

The superbugs, first seen mainly in hospitals and nursing homes, have turned up recently among athletes, prisoners and people who get illegal tattoos.

Called methicillin-resistant staphylococcus aureus, or MRSA, these staph germs can cause skin infections that in rare cases have led to pneumonia, bloodstream infections and a painful, flesh-destroying condition. MRSA is hard to treat because the bacteria have developed resistance to the penicillin drug family.

From 2000 to 2005, the infection rate seen in patients seeking care at Chicago's main public hospital and its affiliated clinics climbed from 24 cases per 100,000 to 164 cases per 100,000, the study found.

Dr. Bala Hota of Chicago's Stroger Hospital, a lead author of the study, said the increase is similar to that seen in other cities.

Public housing could be a bridge between high-risk people, the researchers wrote in their study, which appears in Monday's Archives of Internal Medicine.

Dr. Susan Gerber of Chicago's Department of Public Health said it would be a mistake to assume the infection isn't also in affluent neighborhoods. The study looked only at people using the public hospital system. The infection rate in the general population is unknown.
"This is an equal opportunity bacteria," Gerber said.

To prevent staph's spread, the U.S. Centers for Disease Control and Infection recommends washing hands with soap and water or an alcohol-based sanitizer, keeping cuts cleans and covered with a clean bandage until healed, avoiding contact with other people's wounds and bandages and avoiding shared personal items such as towels and razors.

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Fingerprint instead of blood sample to detect drugs and diseases

To this day, fingerprints are just the thing when a perpetrator needs to be arrested or a person needs to be identified. British scientists working with David A. Russell also want to make it possible to use fingerprints to reveal drug and doping transgressions and to diagnose diseases. As the team from the University of East Anglia in Norwich and King's College in London report in the journal Angewandte Chemie, they have now been able to use specific antibodies to differentiate between the fingerprints of smokers and nonsmokers.

A fingerprint is of no use to an investigator unless it can be matched to one in a database or can be directly compared with that of a suspect. Russell and his team expect that we will soon be able to gain information about the lifestyle of the person who made the fingerprints, which could shrink the pool of suspects. In this way, it should be possible to use fingerprints to detect drugs, medications, or food that have been consumed, and also to diagnose some diseases.

Researchers want to coax all of these secrets out of the tiny traces of perspiration that a fingerprint leaves on a surface. The research team demonstrated the ease with which this should be possible by differentiating between fingerprints made by smokers and nonsmokers. To avoid false results from chance contact with tobacco products, they designed their system to detect cotinine, a metabolite formed by the body after consumption of nicotine. The researchers wet the fingerprints with a solution containing gold nanoparticles to which cotinine-specific antibodies were attached.

These bind to the cotinine. Subsequently, a second antibody, which was tagged with a fluorescent dye and binds specifically to cotinine antibodies, was applied to the fingerprint. Because there are many cotinine antibodies attached to each nanosphere, there is a significant amplification effect.

Indeed, the ridge patterns of smokers' fingerprints fluoresce, while those of nonsmokers do not. The fingerprints are very highly resolved and can be lifted for comparison with known prints, just as in conventional procedures. When magnified, even the tiny sweat pores along the ridges of the fingertip become visible, which can also be used to make an unambiguous assignment.

In addition to forensic applications, this method would be ideal for detecting doping. Sample manipulations by the test subjects would hardly be possible since each sample is uniquely assignable to a specific athlete by virtue of the ridge pattern. Medical diagnostics could also benefit in the form of simple and quick mass screening with no danger of sample mix-ups. Another application could be drug screening without taking blood samples - from suspicious drivers, for example.

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Fiber may fight diabetes

Eating fiber-rich, whole-grain cereal may not only keep you regular, but it may also reduce the risk of developing type 2 diabetes.

A new study shows that people who had the most fiber from whole-grain cereals in their diet had a 27% lower risk of developing type 2 diabetes than those who ate the least. Fiber from other sources, such as fruits and vegetables, didn’t show a similar protective effect against diabetes.

Fiber Fights Diabetes
In the study, published in the Archives of Internal Medicine, researchers followed a group of more than 15,000 men and women aged 35 to 65 for an average of seven years. The participants filled out a questionnaire with information on what they ate at the start of the study and were monitored for signs of diabetes.

During the study, 844 people developed type 2 diabetes. The results show that those who consumed more fiber from cereal, bread, and other grain products were less likely to develop diabetes than those who ate less cereal fiber.

For example, those who ate the most cereal fiber (an average of 16.6 grams per day) had a 27% lower risk of type 2 diabetes than those who ate the least (about 6.6 grams per day). No relationship was found between total fiber intake or consumption of other types of fiber, such as from fruits and vegetables, and diabetes risk. There also was no relationship found between magnesium intake and development of diabetes among the study participants.

The researchers note that consuming fiber may help with the body's ability to handle blood sugar. They also note that low magnesium has been linked to patients with type 2 diabetes.

To put their results into perspective, researchers at the German Institute of Human Nutrition Potsdam-Rehbruecke also looked at 17 other studies on fiber and magnesium intake and diabetes risk. The pooled results of those studies showed that people who ate the most cereal fiber had a 33% lower risk of developing type 2 diabetes than those who ate the least.

In addition, those who ate the most magnesium had a 23% lower risk of type 2 diabetes than those who ate the least.

Source: www.medical-health-care-information.com

Antidepressants: Are they safe during pregnancy?

Antidepressants are the first line of treatment for most types of depression. Antidepressants can help relieve your symptoms — and keep you feeling your best. But there's more to the story when you're pregnant or thinking about conceiving. Here's what you need to know about antidepressants and pregnancy.

How does pregnancy affect depression?
Pregnancy hormones were once thought to protect women from depression, but researchers now say this isn't true. In fact, up to 10 percent of women experience depression during pregnancy. Although pregnancy doesn't make depression worse, pregnancy often triggers a range of emotions that can make it more difficult to cope with depression.

Are antidepressants an option during pregnancy?
Few medications have been proved unequivocally safe during pregnancy. Although certain antidepressants have not been linked with an increased risk of birth defects or impaired development — including fluoxetine (Prozac, Sarafem, others), sertraline (Zoloft) and bupropion (Wellbutrin) — the latest studies aren't necessarily reassuring. As researchers continue to learn more about antidepressants, the risks and benefits of taking the drugs during pregnancy must be weighed carefully on a case-by-case basis.

Are some types of antidepressants safer than others?
So far, bupropion (Wellbutrin) has not been associated with risks to a developing baby. But researchers have identified various risks with other types of antidepressants. For example:
Paxil. Paroxetine (Paxil) — a type of antidepressant known as a selective serotonin reuptake inhibitor (SSRI) — has been linked to fetal heart defects when it's taken during the first three months of pregnancy. The American College of Obstetricians and Gynecologists recommends avoiding Paxil during pregnancy, if possible.

Other selective serotonin reuptake inhibitors. Taking other SSRIs — including citalopram (Celexa), fluoxetine (Prozac) and sertraline (Zoloft) — in the last half of pregnancy increases the risk of a rare but serious lung problem known as persistent pulmonary hypertension of the newborn. This condition occurs when a newborn's circulation system doesn't adapt to breathing outside the womb. For some women, however, the benefits of continuing these drugs may outweigh the risks.

Tricyclic antidepressants
These older antidepressants — including amitriptyline and nortriptyline (Aventyl, Pamelor) — are generally discouraged during pregnancy in favor of newer, more effective medications. Potential risks of tricyclic antidepressants to a baby may include damage to the central nervous system, physical deformities or developmental delays.

Are there any other risks for the baby?
If you take an SSRI antidepressant throughout pregnancy or during the last trimester, your baby may experience temporary withdrawal symptoms at birth — including tremors, gastrointestinal problems, sleep disturbances and high-pitched cries.

What happens if a woman stops taking antidepressants during pregnancy?
If you stop taking antidepressants during pregnancy, you risk a depression relapse. In fact, pregnant women who stop taking antidepressants are five times more likely to experience a depression relapse than are pregnant women who continue taking the drugs. Stopping an SSRI abruptly may cause various signs and symptoms, including:
Headache
Nausea and vomiting
Chills
Dizziness
Fatigue
Insomnia
Irritability
Vivid dreams

What's the bottom line?
If you have depression and are trying to conceive or are pregnant, consult your doctor. Sometimes mild depression can be managed with support groups, counseling or other therapies. If your depression is severe or you have a recent history of depression, the risk of relapse may be greater than the risks associated with antidepressants.

It's not an easy decision. Work with your doctor to make an informed choice that gives you — and your baby — the best chance for long-term health.

Dementia risk may be reduced by some hypertension drugs

Some high blood pressure medicines may help protect older adults from declines in memory and other cognitive function, according to new research from Wake Forest University School of Medicine, reported at the annual meeting of the American Geriatrics Society in Seattle.

The drugs that researchers believe are protective are part of a class known as ACE inhibitors - specifically those types that reach the brain and may help reduce the inflammation that might contribute to Alzheimer's disease.

"For older adults who are going to take an ACE inhibitor drug for blood pressure control, it makes sense for their doctors to prescribe one that goes into the brain," said Kaycee Sink, M.D., M.A.S., lead researcher and an assistant professor of internal medicine - gerontology.

Some ACE (angiotensin-converting enzyme) inhibitors are known as centrally acting because they can cross the blood brain barrier, a specialized system of tiny blood vessels that protects the brain from harmful substances in the blood stream. Centrally acting drugs include captropril (Capoten®), fosinopril (Monopril®), lisinopril (Prinivil® or Zestri®), perindopril (Aceon®), ramipril (Altace®) and trandolapril (Mavik®).

The study found a link between taking centrally active ACE inhibitors and lower rates of mental decline as measured by the Modified Mini-Mental State Exam, a test that evaluates memory, language, abstract reasoning and other cognitive functions. For each year that participants were exposed to ACE inhibitors that cross the blood brain barrier, the decline in test results was 50 percent lower than the decline in people taking other kinds of high blood pressure pills.

The researchers also found that non-centrally active ACE inhibitors were associated with a trend towards an increased risk of dementia. However, the results were not statistically significant, which means that they could have occurred by chance. Dementia was diagnosed by a panel of physicians after reviewing results of magnetic resonance imaging and other tests.

"These results suggest that there is more to treating blood pressure than achieving a goal of 140/80," said Sink.

"Which drug you choose for blood pressure control can have broader implications. We know that ACE inhibitors protect against heart failure and kidney failure, and now there is evidence that some of them may also protect against dementia." Sink said the effects may be related to reducing inflammation in the brain.

"The hypothesis for how they may slow cognitive decline is that they are decreasing inflammation in the brain, and we know that inflammation is important in the development of Alzheimer's disease," she said.

The researchers analyzed data from the Cardiovascular Health Study, a long-term study of cardiovascular risk factors that involved 5,888 people over 65 years old from Forsyth County in North Carolina, Sacramento County, Calif., Pittsburgh, Pa., and Washington County, Md. The mean age of participants was 75 years old and most participants (64 percent) were women.

They specifically looked at 1,074 study participants who were free of dementia when they entered the study and who were being treated for high blood pressure. They evaluated whether exposure to ACE inhibitors in general - and to the centrally active versus non-centrally active drugs - was related to dementia and cognitive decline.

Compared to other anti-hypertensive drugs, there was no association between exposure to ACE inhibitors as a class and the risk of dementia. The benefits clearly came from taking the centrally active drugs.

"We need to confirm the results in a study in which people are randomly selected to receive either ACE inhibitors that are centrally active or those that aren't," said Sink. "Hypertension is a risk factor for dementia, so it's important to know if the type of drug pressure medication a person takes can cut that risk."

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Diabetes drug boosts chemo's effectiveness

The diabetes drug rosiglitazone (brand name Avandia) dramatically increases the potency of platinum-based cancer drugs, U.S. researchers report.

In research with mice, scientists at the Dana-Farber Cancer Institute in Boston found that combining a platinum chemotherapy agent with rosiglitazone was as much as three times more effective at halting or shrinking tumors than using either of the drugs alone.

The findings are published in the May issue of the journal Cancer Cell.

If the same results can be achieved in humans, this combination therapy may help improve control of ovarian, lung and other cancers routinely treated with platinum-based chemotherapy, said the researchers, who noted that tumors eventually become resistant to platinum-based chemotherapy.

The results suggest that this combination treatment may extend the use of platinum-based chemotherapy to other cancers which have previously not responded to this kind of chemotherapy, the scientists added.

"There's still a huge gulf between these experiments and human cancers. But it's worked in every animal model of cancer we've looked at, and I think there's a fair chance it will help people," senior author Bruce Spiegelman said in a prepared statement.

The Dana-Farber team is developing plans for initial human clinical trials, which may begin this year.

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Exposure to epilepsy drug depakote during pregnancy

Women with epilepsy who took the seizure drug valporate, which is marketed by Abbott Laboratories under the brand name Depakote, while pregnant increased their risk of having an infant with mental defects, according to a study presented Thursday at the annual meeting of the American Academy of Neurology in Boston, the New York Times reports.

Kimford Meador, professor of neurology at the University of Florida, and colleagues examined 185 infants at age two using standard IQ measures. The mothers of the children had taken either Depakote, GlaxoSmithKline's Lamictal, Novartis' Tegretorl or Parke-Davis' Dilanten (Carey, New York Times, 5/4). The average IQ of the children whose mothers had taken Depakote was 81, compared with an average of 96 for children in the Tegretol group, 94 for the Lamictal group and 95 for the Dilantin group (Gellene, Los Angeles Times, 5/4). After adjusting for the mothers' IQ scores, the researchers found that the two-year-old children who had been exposed to Depakote scored seven to eight points lower on IQ tests than children of mothers who had taken other seizure medications (New York Times, 5/4).

A score of 100 on the IQ test is average and below 70 is considered mentally retarded, according to researchers. Twenty-four percent of children whose mothers took Depakote had IQs below 70, compared with 13% for Tegretol, 11% for Lamictal and 12% for Dilantin. According to researchers, about 2% of all children have IQs below 70. According to the Los Angeles Times, Depakote also is used to treat migraines and some psychiatric conditions, such as bipolar disorder.

Reaction Meador said that the NIH-funded study did not support a conclusion that all four drugs might cause mental retardation (Los Angeles Times, 5/4). However, he said, "In all, it is compelling evidence that [Depakote] should not be used as a first-line choice for treatment in pregnant women" (New York Times, 5/4). Meador said that women who must take Depakote because they do not respond to other drugs should take the lowest possible dose if they become pregnant. He also urged pregnant women to remain on their epilepsy medication because a seizure could be harmful to them and their fetuses (Los Angeles Times, 5/4).

Other researchers said the findings should be considered preliminary because IQ measures are less reliable in two-year-olds than in older children, the Times reports. Laureen Cassidy, a spokesperson for Abbott, said that for many women, "Depakote may be the only effective seizure control medication, and that decision should be made thoughtfully between physician and patient to fully evaluate the risk verses benefit of treatment." Depakote's label now states that the drug "has been associated with birth defects in children of women who have taken it while pregnant," the Times reports. Researchers plan to continue tracking children through age six .

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Rituximab reduced disease activity in MS patients

The drug rituximab reduces disease activity in people with the relapsing-remitting form of multiple sclerosis (MS), according to two new studies.

Rituximab selectively targets and depletes a subset of immune cells called B-cells by targeting a specific protein on the cell surface. It's the first drug designed to target B-cells and may offer a new treatment for relapsing-remitting MS.

In one study, University of California, San Francisco, researchers gave two infusions of rituximab, delivered two weeks apart, to 69 patients, while 35 other patients received a placebo.
During the following six months, the patients who received rituximab had 90 percent fewer brain lesions and 58 percent fewer drug relapses than the patients who received the placebo (14.5 percent vs. 34.3 percent).

In the second study, researchers at McGill University in Montreal gave 26 patients two infusions of rituximab two weeks apart (one course of treatment) and then gave them another course of treatment six months later. The patients were followed for at least a year.

The patients showed a 90 percent reduction in brain lesions, and the relapse rate went from an average of at least one per patient per year to only a few for the entire group of patients during the year of treatment.

Both studies were supported by Genentech Inc., and Biogen Idec., the companies marketing the drug in the United States, where it is currently approved for treating certain types of lymphoma and for a moderate to severe form of rheumatoid arthritis. Rituximab is not approved for treatment of MS.

"While these are early stage clinical trials, these results are exciting, because the current drugs available for MS are only partially effective in reducing disease activity and preventing exacerbations," Dr. Stephen Hauser, author of the California study, said in a prepared statement.

"New and more effective treatments for MS are sorely needed, especially for people who do not adequately respond to current available medications. These data are also important, because they demonstrate that B-cells, which are the precursors of antibody-producing cells, play an essential role in mediating relapses of MS," Hauser said.

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Clot-preventing drug improves heart blood flow after angioplasty

Infusing the clot-preventing drug streptokinase improved blood flow in the tiniest heart blood vessels of people who had artery-opening procedures such as angioplasty, a small Turkish study found.

It's an intriguing study, cardiologists in other countries said, but there's a real question about whether that improvement does any good over the long run.

"We've done this kind of work in the past," said Dr. Kirk Garratt, clinical director of interventional cardiovascular research at Lenox Hill Hospital in New York City. "Giving this drug and drugs like this to improve outcome, it never worked."

But, Garratt added, there are some important differences in what the cardiologists at Istanbul University reported in the May 3 issue of the New England Journal of Medicine. One is that general treatment of people undergoing artery-opening procedures has improved in recent years. The patients in the Turkish trial who were given streptokinase were also given other clot-preventing drugs such as Plavix, for example.

Most significant, the Turkish doctors did extensive measurements of microvascular function -- blood flow through the smallest heart vessels. They found that it was much better than in trial participants who did not get streptokinase.

That was a different result from previous research, Garratt said. "Then, we were looking at how the heart pumped blood," he said. "We didn't find a difference."

That was ultimately true in the Turkish study. After six months, "there was no evidence of a difference between the two study groups in left ventricular size or function," the researchers wrote, referring to the blood-pumping chamber of the heart.

"If you're interested in microvascular flow as an endpoint, this is an approach worth pursuing," Garratt said. "There is some evidence that improving microvascular flow improves outcome."
But even then, streptokinase may not be the best clot-preventing drug to use, Garratt said. "It has probably the worst bleeding rate out there," he said. "When we did this before, we saw lots of bleeding, and that is a significant limitation. Even if you show that improved microvascular
flow is beneficial in the long term, bleeding is a problem."

The Turkish study also was a very small study, noted Dr. Jan J. Piek, professor of cardiology at the Academic Medical Center in Amsterdam, the Netherlands, who wrote an accompanying editorial in the journal. "We have to be a little bit careful, because they studied only 41 patients," he said. "I would consider it a hypothesis-generating study that has to be tested in a larger randomized trial."

Participants in such a trial would have to be chosen carefully, Piek said. "I would focus more on the uniform selection of patients," he said.

"Those who would benefit most would be patients with large myocardial infarctions [heart attacks]. They would be the most appropriate on whom to test this technique," Piek suggested. "The trial would have to be done in a sensitive setting, including only patients with larger infarcts, rather than the non-uniform selection of patients for this trial," he added.

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Miracle Drug For MS Sufferers

200 new cases of multiple sclerosis are diagnosed each week in the U.S. it’s a debilitating disease but now there’s new hope for patients.

In this Healthy Living report, a brand new drug that some are calling a miracle.

It was a diagnosis that hit the Rydalch family out of the blue. The day before Thanksgiving 2006, Clint Rydalch was diagnosed with multiple sclerosis.

Just a few months ago, he was so ill, he couldn’t move.

“I was in bed, couldn’t move, talk to anything. I couldn’t even eat,” says Clint.

“He had to get a feeding tube, he had no memory and couldn’t remember me, the kids, the family,” says Clint’s wife Cindy.

But thanks to a brand new drug for MS called Tysabri Clint is making his way back.

In patients with MS, the protective shield surrounding nerves is attacked by cells and damaged, causing a short circuit in the nervous system. That leads to problems with vision, movement and energy among other things.

Tysabri works by blocking these damaging cells. Doctor John Foley specializes in MS and says results of this drug are very promising.

“In a fairly large number we’re seeing a reversal or improvement of symptoms, in some cases to a fairly dramatic degree,” says Dr Foley.

The drug is given once a month by IV, clint says he noticed immediate results.

Clint says, “my first day after Tysabri I could talk again, move and even sit up in bed with a little help.”

And after four treatments, he’s even back to work part time. This drug is only for certain patients with MS and it can’t be taken with other treatments because a severe brain virus can occur. But for the Rydalch family, it’s been nothing short of a miracle.

Cindy says, “From day one we started noticing miracles, really.”Tysabri is usually given after patients don’t respond to other drug treatments.

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