Platelet E-News – August 15, 2005

Contents:

  • Single Dose Rituximab For Children With ITP
  • Clinical Significance of Antiphospholipid Antibodies in ITP
  • Less Is More: Puzzle of Industrial Chemicals
  • Health Information Technology Moves Forward
  • NY Offers Prescription Price Comparison Website
  • Healthy Lifestyle: Only 3% of Americans Make It
  • Some Not-So-Ready-To-Eat Food
  • Alcohol Increases Virulence of Bacteria (A. baumannii)
  • Contact Information From Cell Phones In Case of Emergency (ICE)

 

SINGLE DOSE RITUXIMAB FOR CHILDREN WITH ITP

German researchers report that a single dose of rituximab, a treatment that eliminates B cells that produce anti-platelet antibodies, is enough to effectively treat chronic ITP in childhood and should be considered in order to reduce costs and patients' strain, especially for children. Rituximab, as therapy for chronic ITP, is traditionally given in four doses (375 mg/m2 each) – following the more aggressive treatment outlined for cancer patients since B cells are often malignant in these cases. However, these researchers have found that a single dose of the same amount is effective in treating ITP, which involves non-malignant B cells, because it does deplete CD20+ cells in peripheral blood that would otherwise later attack platelets. In fact, the response rate after a single dose was very similar to that after four doses, and likewise, the relapse rate wasn't very different. Researchers tested 22 children who all had previously been treated either with intravenous immunoglobulins (IVIG) and/or steroids, and gave them each a single intravenous dose of rituximab. They found that children who were diagnosed with ITP at an older age were more likely to experience a complete response to the treatment (they defined a complete response as a platelet count greater than 100 x 109 /L).

Tillmann Taube, et al, The Hematology Journal, February 2005, pg. 90.

CLINICAL SIGNIFICANCE OF ANTIPHOSPHOLIPID ANTIBODIES IN ITP

The British Journal of Hematology is reporting on research of antiphospholipid antibodies (APLA) and their unclear connection to ITP. APLA are non-specific, meaning they don't target any kind of specific antigen, which is unlike autoantibodies that specifically target platelet cells in ITP. Nonetheless, an inverse relationship has been found between platelet count in ITP patients and the concentration of APLA. Antiphospholipid antibodies also occur with other autoimmune conditions such as multiple sclerosis. Scientists monitored ITP patients who were not suffering from any other concurrent disorder or disease. They found that APLA tended to emerge and increase with the onset or exacerbation of ITP, concurrently with new episodes of bleeding. APLA leveled off when ITP became stable, and it became virtually undetectable during remission. The present study was not conclusive, but researchers believe these findings raise the possibility that APLA either plays a role in exacerbating the development of ITP (and bringing about remission), or is simply an aftereffect of the platelet destruction that occurs with ITP.

Carlos J. Bidot, et al, British Journal of Hematology, February 2005, pg. 366.

LESS IS MORE: PUZZLE OF INDUSTRIAL CHEMICALS

The prevalence of certain industrial chemicals in the environment has long been linked to a steady rise of various diseases, from breast and prostate cancer to childhood learning disabilities. Traditionally, scientists sought through research to define – for each type of substance – a “maximum exposure” level at which humans can still be in close proximity to these chemicals without experiencing any health effects. However, research now suggests that diseases and other maladies are developing at much lower levels of exposure than the ones government scientists had previously designated as “safe.” If anything, the effects of certain chemicals are less apparent in higher doses than at lower ones. Additionally, the research shows that while low levels of individual chemicals proved to be safe, in a realistic urban environment where many compounds make their way into the air and water regularly, a combination of chemicals can be detrimental. Japan and the European Union are beginning to regulate the use of such chemicals in mass production, but in the U.S., industry experts and the Bush Administration insist that the research is inconclusive. However, the state legislatures in California and New York are looking into bills that would ban the use of certain phthalates in toys and cosmetics and restrict the use of bisphenol A in polycarbonate plastic bottles and food-can linings.

Peter Waldman, The Wall Street Journal, July 25, 2005, pg. A1.

HEALTH INFORMATION TECHNOLOGY MOVES FORWARD

Two developments during June promise to further advance the process of providing standardized health information available to all parties who will likely need to make important personal and professional decisions based on it. The Secretary of the U.S. Department of Health and Human Services announced a national private-public collaboration called the American Health Information Community (AHIC) to provide all Americans with electronic health records within 10 years. The AHIC was formed under the Federal Advisory Committee Act and is tasked with making recommendations to the Department of Health and Human Services about a number of issues, including protecting patient privacy and security and setting up a network of information-sharing that uses the Internet. The Institute of Medicine estimates that medical errors kill 45,000 to 98,000 Americans a year in hospitals. Improved technology is believed to be able to save lives, time, reduce duplication and waste, and improve efficiency with the potential to reduce costs by as much as 10 percent. Also during June, a Senate bill was introduced that would provide $625 million to fund regional and local health care information technology projects. The bill would establish “legal safe harbors allowing hospitals and other organizations to extend their IT systems to doctors and medical groups.”

Guy Bates, Hematology & Oncology News & Issues, July 2005, pg. 9

NY OFFERS PRESCRIPTION PRICE COMPARISON WEBSITE

The New York legislature has approved a bill that sanctions the creation of the nation's first Internet price-comparison Web site for prescription drugs. The bill requires all pharmacies to submit prices for the 150 most commonly prescribed drugs to the state's Department of Health, which will then post that data online. The AARP is among those who support the bill, insisting it will allow patients – especially the elderly – to save hundreds of dollars a month on prescription drugs. Pharmacists oppose the bill, saying many of those needing the drugs don't have Internet access; the measure will cost them a lot of money, and they claim some elderly patients risk taking the wrong drugs if they buy different drugs from different companies, since no one pharmacy can verify that there would not be drug interaction conflicts. New York currently requires pharmacies to produce weekly updated price lists for customers. According to the National Conference of State Legislatures, Maine and Maryland post Medicaid drug prices on state-sponsored Web sites as well.

Guy Bates, Hematology & Oncology News & Issues, July 2005, pg. 10.

HEALTHY LIFESTYLE: ONLY 3% OF AMERICANS MAKE IT

A study led by a researcher at Michigan State University has found that only 3% of Americans lead a healthy lifestyle, as defined after considering four factors: not smoking, maintaining a healthy weight, exercising regularly (at least 30 minutes, five times a week), and eating at least five daily servings of fruits and vegetables. Experts had thought the number was higher – somewhere closer to 15%. When each of those factors were considered individually, 76% of Americans don't smoke, 40.1% maintain a healthy weight, 23.3% eat the minimum, daily recommended amounts of fruits and vegetables, and only 22.2% exercise as outlined by health experts. The results were compiled from survey data of more than 150,000 Americans by the Centers for Disease Control and Prevention. Alcohol consumption was not considered in this study because of the ongoing debate over its health risks and benefits. The study also found that those with higher incomes and a college education faired better in maintaining healthy lifestyles. Likewise, women faired slightly better than men. Experts believe leading a healthy lifestyle sharply cuts the risk for developing cardiovascular disease, diabetes, and cancer.

Jennifer Corbett Dooren, Wall Street Journal, April 26, 2005, pg. D6.

SOME NOT-SO-READY-TO-EAT FOOD

Researchers in Michigan have found that some pre-packaged, ready-to-eat spinach that claims to have been pre-washed actually contains a significant number of bacteria that can infect humans. What's worse: The bacteria look to be resistant to several types of antibiotics. The scientists tested several bags of Ready-To-Eat Baby Spinach by pureeing the leaves in a sterile mixer and then spreading the extracts on petri dishes lined with nutrients that encourage bacteria to grow. Bacterial varieties of Staphylococcus, Enterobacter, and Escherichia developed within days, and 95% of them proved to be resistant to two or more common antibiotics such as ampicillin and ciprofloxacin. While researchers will continue testing a number of different types and brands of ready-to-eat salads, they recommend that consumers can still purchase these products and avoid bacterial infection by washing the vegetables – even if the bags says it's already washed – and cooking them.

C.B., Science News, June 25, 2005, pg. 414.

ALCOHOL INCREASES VIRULENCE OF BACTERIA (A. BAUMANNII)

While some people might believe that drinking alcohol, where the dominant intoxicating ingredient is ethanol, can kill off a budding infection, new research is suggesting booze might actually make certain bacteria more virulent. The bacteria Acinetobacter baumanii is responsible for pneumonia, meningitis, and urinary tract infections in humans, and more recently, it has been implicated in blood infections of U.S. soldiers in Iraq. The scientists first looked into interactions between this bacteria and yeast – noting that the bacteria grew better with the yeast around – and traced this effect to the ethanol byproduct the yeast secreted while fermenting sugar. Further research found that alcohol increased the virulence of the bacterium. The researchers note that while some think that drinking alcohol can kill off a budding infection, “drinking may actually make some bacteria more powerful and speed along a nascent infection.”

C.B., Science News, June 25, 2005, pg. 414.

CONTACT INFORMATION FROM CELL PHONES IN CASE OF EMERGENCY (ICE)

The recent bombing attacks in London have spurred emergency workers and law enforcement worldwide to support the ICE-ing of cell phones. ICE, for “In Case of Emergency,” lets each cell phone owner program ICE phone numbers into his/her unit so that in the event that they are involved in an accident and can no longer communicate, emergency workers need only push a keypad to find a family member of friend who can provide helpful medical or other background information. ICE would also help identify unfortunate victims in case other distinguishing physical features were no longer intact. Due to the popularity of the program, anyone with an ICE number in their phone is likely to be assisted in many places nationwide. And advocates are pressing phone companies to make the ICE feature available for their customers. More information about the ICE program is available on the Internet at www.ICEcontact.com, including wallet cards that carry emergency information.

http://firechief.com/ar/ICE-for-responders080105/.

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