Contents:
- Thrombocytopenia
- Drug-Induced Thrombocytopenia: Heparin and Quinine
- ITP: No Race Disparity in Prevalence Among Males
- Treatments and Treatment Related News
- IVIG Access Problems
- Restoring Bone Density in Patients Taking Glucocorticoids: Fosamax vs.Vitamin D
- Gender and Genetics: Illness, Treatment, and the Gender Divide
- Diet News
- Eat Your Veggies, You Won’t be Sorry
- Alzheimer’s Onset: Impact of Fruit and Vegetable Juices
Diabetes and a Vegan Diet
Thrombocytopenia
Drug-Induced Thrombocytopenia: Heparin and Quinine
Drug-induced thrombocytopenia is common but well documented only for a small number of specific compounds. Two drugs known to induce thrombocytopenia are heparin and quinine. A recent article in the New England Journal of Medicine presents a case vignette of heparin induced thrombocytopenia, examines evidence supporting various treatment strategies, and reviews the formal guidelines http://www.chestjournal.org/cgi/content/full/126/3_suppl/311
In studying quinine-induced thrombocytopenia, researchers unexpectedly found quinine-dependant antibodies in addition to the platelet-reactive antibodies they expected. This may help them design a simpler test to confirm the diagnosis of drug-induced thrombocytopenia.
Note: Quinine is used to treat the common symptom of nocturnal leg cramps. It is an ingredient in tonic water and is present in bitter melons.
Arepally, G.M., et al, “Heparin Induced Thrombocytopenia”, The New England Journal of Medicine, 355:809-817, August 24, 2006.
George, J.N., “Quinine: Common Remedy, Serious Reactions, New Insights”, Blood, vol. 108, no. 3, pp. 782-783, August 1, 2006.
Bougie, D.W., et al, “Patients with Quinine-Induced Immune Thrombocytopenia Have Both ‘Drug-Dependent’ and ‘Drug-Specific’ Antibodies”, Blood, vol. 108, no. 3, pp. 922-927, August 1, 2006. http://www.bloodjournal.or
ITP: No Race Disparities in Prevalence Among Males
The authors of a recent letter to the editor of Blood point out that “ethnic, racial, and geographic differences influence virtually all human disease, and certain conditions exhibit well-established differences between Africans and Europeans.” Awareness and careful study of these differences can have important consequences for health care delivery. The authors in their letter report the results of their study of veteran’s health records. This review did not reveal a significant disparity in the prevalence of ITP among Whites and African Americans. An acknowledged limitation of the study is that the database was all male. Also these results are not consistent with the findings of six other studies that addressed the same question and which were summarized in Blood in 2005 (reference below).
Landgren, O., et al, “Immune Thrombocytopenia Purpura Does Not Exhibit a Disparity in Prevalence between African American and White Veterans” (To the Editor), Blood, vol. 108, no. 3, pp. 1111-1112.
Terrell, D.R., et al, “Is Immune Thrombocytopenia Less Common Among Black Americans?”, Blood, vol. 105, no. 3, February 1, 2005 pp. 1368-1369.
Treatments and Treatment Related News
IVIG Supply Problems
Some patients are experiencing problems obtaining IVIg. The FDA is investigating the situation and is requesting input from patients and physicians. If your physician feels IVIg is a good treatment for you but it is not available, please call 800-835-4709 or email CBERProductShortages@cber.fda.gov. These are provided to report availability issues only. They are not for reimbursement problems, issues or complaints. For Medicare reimbursement issues call 800-633-4227 (800-MEDICARE)
The HHS is also seeking information on the IVIg access. The are hosting a public meeting on September 28, 2006 from 10 a.m. to 5 p.m at the Sheraton Crystal City Hotel in Arlington, VA
To register go to https://www2.ergweb.com/projects/conferences/hhs/ or call the ERG conference registration line, 781-674-7374
Restoring Bone Density in Patients Taking Glucocorticoids: Fosamax vs. Vitamin D
A randomized, double-placebo, double-blind clinical trial lasting 18 months involved 201 patients who were starting glucocorticoids (ex. Prednisone) as treatment for a rheumatic disease. The patients were given either Fosamax and a vitamin-D placebo or vitamin-D and a Fosamax placebo. The primary outcome was the change in bone mineral density of the lumbar spine in 18 months. The researchers report that bone mineral density of the lumbar spine increased by 2.1 percent (1.1% to 3.1%) in the Fosamax group and decreased 1.9 percent (-3.1% to -0.7%) in the vitamin-D group. www.clinicaltrials.gov (ClinicalTrials.gov number, NCT00138983)
De Nijs, et al, “Alendronate [Fosamax] or Alfacalcidol [Vitamin-D] in Glucocorticoid-Induced Osteoporosis”, New England Journal of Medicine, vol. 355, no. 7, August 17, 2006, pp.675-684.
Gender and Genetics: Illness, Treatment and the Gender Divide
Most autoimmune diseases affect women in far greater numbers than they affect men. ITP for instance affects about three times (3:1) as many women as men. The ratio for other autoimmune disease is as high as 10:1. Researchers are looking at genetics to understand this disease disparity. A recent study by a group at the University of California at Los Angeles found that in “liver, fat, and muscle tissue males and females differently expressed 55 to 72 percent” of the 23,000 genes studied. Follow-up studies hint that “sex hormones such as estrogen and testosterone control the expression of many of the genes.” This work with mice (mice and people share about 99% of their genes) “could guide researchers in figuring out why men and women have different risks for different diseases. Further studies might also pinpoint the optimal doses of prescription drugs for men or women or assist researchers in crafting new, gender-specific medicines.”
Brownlee, C., “Gender Divide”, Science News, vol. 170, July 22, 2006, p. 52.
Yang, X., et al, “Tissue Specific Expression and Regulation of Sexually Dimorphic Genes in Mice”, Genome Research, vol. 16, July 6, 2006, pp. 995-1004.
Diet News
Eat Your Veggies, You Won’t be Sorry
The benefits of vegetables in our diet are becoming much better understood. In response the government has revamped the effort to boost their consumption. New recommendations were published jointly by the Department of Health and Human Services and the Department of Agriculture. They consist of specific amounts of produce, measured in cups rather that the vague “servings” and they vary by age and sex, and level of activity. We have a long way to go. According to the Centers for Disease Control, about 90% of the U.S. population does not meet the government’s recommendations. The USDA recommendations can be found at: https://health.gov/dietaryguidelines/
For fruits and vegetables they read;
- Consume a sufficient amount of fruits and vegetables while staying within energy needs. Two cups of fruit and 2½ cups of vegetables per day are recommended for a reference 2,000-calorie intake, with higher or lower amounts depending on the calorie level.
- Choose a variety of fruits and vegetables each day. In particular, select from all five vegetable subgroups (dark green, orange, legumes, starchy vegetables, and other vegetables) several times a week. The 5 top-rated nutritious vegetables are: spinach, romaine lettuce, broccoli, tomatoes, and bell peppers. The 5 top-rated nutritious fruits are: cantaloupe, tangerines, blueberries, apricots, and raspberries
Wang, S., McKay, B., “More Reasons to Eat Your Veggies”, Wall Street Journal, July 25, 2006, p. D1.
Alzheimer’s Onset: Impact of Fruit and Vegetable Juices
A new study links the delayed onset of Alzheimer’s to a diet generous with fruit and vegetable juices. See http://www.medscape.com/viewarticle/544012
Diabetes and a Vegan Diet
A recent study compared the vegan diet to the ADA diet for diabetes in 99 patients. Forty-three percent of those on the vegan diet reduced their need to take drugs to manage their diabetes compared to 26 percent of the ADA diet group.
http://www.cbsnews.com/stories/2006/07/26/health/webmd/printable1837927.shtml