ITP Research and Treatments
- New ITP Treatment Guidelines Submitted to the Journal Blood
- Eleven-Year Study Reveals 57 Patients Who Received Rituximab Developed Fatal Disease
- FTC Rules Against CSL Behring Purchase of Talecris
- Thrombocytopenia May Result From Bacteria Often Found In Exotic Small Pets
- A Machine-Determined Low Platelet Count Isn't Always What it Seems
Hospitals, Insurance, and Medical Care
- NIH Launches New Research and Development Program for Rare and Neglected Diseases
- Study Shows Continuity of Physician Care Between Outpatient and Inpatient Settings is Declining
- Revising Dosing and Labels for Acetaminophen Recommended by FDA
General Health and Medicine
- NIH Launches New ‘Rethinking Drinking’ Initiative
- Sleep Helps Maintain a Healthy Weight, a Healthy Heart, and a Healthy Immune System
- When It Comes to Veggies, Kale is a Superstar
- Injecting Platelets Can Help Heal Wounds
- Vegetarian Diets May Protect Against Developing Type 2 Diabetes and Obesity
General Health and Medicine
NEW ITP TREATMENT GUIDELINES SUBMITTED TO THE JOURNAL BLOOD
New ITP treatment guidelines, the culmination of many months of work by a committee of 23 clinicians, researchers, and patient support group leaders, have been completed and submitted to the journal Blood. The group is hopeful that the new guidelines, both the paper and the on-line version, will be published in the fall.
Source: Dr. Drew Provan e-mail
See also: Young, J, “New ITP Guidelines Coming Soon”. The Platelet News. 2009 Winter vol. 10, no. 4
ELEVEN-YEAR STUDY REVEALS 57 PATIENTS WHO RECEIVED RITUXIMAB DEVELOPED FATAL DISEASE
A group of researchers reviewed adverse event reports from 1997 to 2008 and found 57 patients who developed progressive multifocal leukoencephalopathy (PML), a rare disease of the central nervous system with a 90% fatality rate, following treatment with rituximab (Rituxan) and other agents. PML results from reactivation of latent JC polyoma virus (JCV). One patient with PML was diagnosed with ITP. The other patients had been treated for rheumatoid arthritis (1), pancytopenia (1), lymphoproliferative disorders (52), and lupus (2). Patients with PML presented with confusion/disorientation, motor weakness, dizziness, difficulty walking or speaking, or vision problems. Most cases were identified with MRI and JC virus detection in cerebrospinal fluid.
Carson, K et al, “Progressive multifocal leukoencephalopathy after rituximab therapy in HIV-negative patients: a report of 57 cases from the Research on Adverse Drug Events and Reports project.” Blood. 2009 May 14;113 (20):4834-40
FTC RULES AGAINST CSL BEHRING PURCHASE OF TALECRIS
The U.S. Federal Trade Commission (FTC) reviewed the proposed purchase of Talecris Biotherapeutics by CSL Behring and decided that the purchase would violate the Clayton Act and restrict competition in the production and sale of plasma products, including IVIg and anti-D. CSL Behring (parent company CSL headquartered in Melbourne, Australia) has accepted the ruling and will no longer pursue the purchase. Talecris is headquartered in Research Triangle Park, North Carolina.
THROMBOCYTOPENIA MAY RESULT FROM BACTERIA OFTEN FOUND IN SMALL EXOTIC PETS
Twenty-five percent of exotic small mammals (28 species) imported into Japan carried various types of Bartonella bacteria according to a recent Japanese research study. Some strains of Bartonella bacteria can be transmitted to humans by blood-sucking insects such as ticks, fleas and sand flies, causing severe flu-like symptoms, including a fever and headaches, along with thrombocytopenia. According to the Centers for Disease Control (CDC), Bartonella bacteria transmitted from rodents such as mice, rats and other mammals have been associated with illness in the Southwestern United States.
Inoue, K et al, “Exotic small mammals as potential reservoirs of zoonotic Bartonella spp.”. Emerg Infect Dis. 2009 Apr;15(4):526-32
Iralu, J “Rodent-associated Bartonella febrile illness, Southwestern United States” Emerg Infect Dis. 2006 Jul;12 (7):1081-6
A MACHINE-DETERMINED LOW PLATELET COUNT ISN'T ALWAYS WHAT IT SEEMS
According to a recent letter to the American Journal of Hematology, when a patient showed a surprisingly low platelet count, physicians viewed the blood on a slide and noted that the phagocytosis (platelet destruction by white blood cells) looked like a new phenomenon because of the way platelets were clustered around a white blood cell. They confirmed that EDTA, the anticoagulant placed in blood collection test tubes, caused the problem and that the patient had a normal platelet count.
Bain BJ “Platelet Phagocytosis as a Cause of Pseudothrombocytopenia” Am J Hematol. 2009 Jun; 84 (6):362
(Note: PDSA has information on many causes of thrombocytopenia at http://www.pdsa.org/low-platelet-disorders/index.html)
Hospitals, Insurance, and Medical Care
NIH LAUNCHES NEW RESEARCH AND DEVELOPMENT PROGRAM FOR RARE AND NEGLECTED DISEASES
Hoping to bridge the gap between promising research and clinical trials, the NIH announced a new initiative, “Therapeutics for Rare and Neglected Diseases (TRND),” that helps fund pre-clinical research and product development, known to be barriers for the development of treatments for rare diseases. Since the early-stage development of treatments has a low success rate and is very costly, the program will reduce the risk for interested companies. Unlike other drug development programs TRND will publish failures as well as successes.
STUDY SHOWS CONTINUITY OF PHYSICIAN CARE BETWEEN OUTPATIENT AND INPATIENT SETTINGS IS DECLINING
The chances of having the same doctor manage your care if you go into or out of the hospital are declining according to researchers who reviewed the Medicare claims database for 3 million adults. Inpatient to outpatient continuity dropped from 44% of cases in 1996 to 32% of cases in 2006; outpatient to inpatient continuity dropped from 50% in 1996 to 40% in 2006. Weekend admissions, large metropolitan areas, doctors who specialize in hospital care, and major teaching hospitals prompted greater declines in continuity.
Sharma G et al, “Continuity of outpatient and inpatient care by primary physicians for hospitalized older adults” JAMA 2009 Apr 22/29;301:1671.
REVISING DOSING AND LABELS FOR ACETAMINOPHEN IS RECOMMENDED BY FDA
Acetaminophen (ex. Tylenol), frequently used to quell pain and reduce fever, has long been known to cause liver damage at high doses. A working group of the FDA has recommended changes to acetaminophen’s labeling in order to reduce the number of cases of acute liver failure due to the drug. Alcohol use and the combination of several drugs containing the compound exacerbate the problem. The FDA advisory committee will convene in late June to consider the working group report.
General Health and Medicine
NIH LAUNCHES NEW ‘RETHINKING DRINKING’ INITIATIVE
A “Rethinking Drinking” Web site, clinician’s guide, and patient booklet are part of a recent NIH initiative to help patients reduce their risk for alcohol-related problems. The interactive Web site, http://rethinkingdrinking.niaaa.nih.gov/, includes quizzes, a calorie counter, and suggestions for curbing habits that are harmful to your health. A patient booklet is also provided.
SLEEP HELPS MAINTAIN A HEALTHY WEIGHT, A HEALTHY HEART, AND A HEALTHY IMMUNE SYSTEM.
Sleep can help you reduce weight and fight infections according to recent studies. When we sleep our stomach secretes hormones that moderate our desire for food; sleep less and the stomach secretes more of the hormone that stimulates appetite and less of the hormone that curbs it. University of Montreal researchers found that 26% percent of children who slept less than the normal 10 to 11 hours per night at age two were overweight by age six. Similar studies found a comparable link between sleep and weight for adults.
Sleep less than seven hours a night and you have a three times greater risk of getting a cold scientists at Carnegie Mellon University concluded after dosing volunteers with rhinovirus, one of the viruses associated with a common cold. Lack of sleep has also been implicated in the development of arterial plaque, perhaps related to increased inflammation and higher levels of the stress hormone, cortisol, report researchers at the University of Chicago.
Touchette E, et al “Risk factors and consequences of early childhood dyssomnias: New perspectives” Sleep Med Rev. 2009 Jan 29
Cohen S “Sleep habits and susceptibility to the common cold.” Arch Intern Med. 2009 Jan 12;169 (1):62-7.
King, CR “Short sleep duration and incident coronary artery calcification”JAMA. 2008 Dec 24;300 (24):2859-66.
WHEN IT COMES TO VEGGIES, KALE IS A SUPERSTAR
Kale scored 1,389 points, more than 450 points over cooked spinach, the next highest ranked vegetable, in a Nutrition Action Newsletter analysis of the calories, vitamin K, lutein, vitamin C, potassium, and fiber in 84 vegetables. Leafy greens, rich in vitamin K, important in blood clotting, are designated vegetable “Superstars.”
“Rating Rutabagas: Not all vegetables are created equal”, Nutrition Action Newsletter, January/February 2009
INJECTING PLATELETS CAN HELP HEAL INJURIES
Soft-tissue injuries, such as tendonitis and torn ligaments, are being treated in some clinics by harvesting the patients own platelets and injecting a small amount of platelet-rich plasma into the injured tissue. Two procedures, “platelet-rich plasma” (PRP) and “autologous-conditioned plasma” (ACP) are increasingly used by sports teams to speed their players’ recovery. While PRP has a failure rate of 20 to 40 percent, it costs much less than surgery and according Dr. Allan Mishra of Stanford Medical Center, [PRP] has the power to revolutionize not just sports medicine but all of orthopedics. It still needs a lot more study.”
VEGETARIAN DIETS MAY PROTECT AGAINST DEVELOPING TYPE 2 DIABETES AND OBESITY
Body mass index is highest in meat eaters and lowest in people who follow a vegan diet, a type of vegetarian diet where no animal products such as eggs or cheese are consumed, report researchers at Loma Linda University in a study of Seventh-Day Adventist Church members across the U.S. Meat-eaters also had a higher prevalence of type 2 diabetes. Semi-vegetarians and fish eaters had intermediate results.