Platelet E-News – February 13, 2009

This e-newsletter is a monthly publication of the Platelet Disorder Support Association. The information in this newsletter is for educational purposes only. For advice on your unique medical condition, please consult a health care professional.

Contents:

ITP Research and Treatments

Hospitals, Insurance, and Medical Care

General Health and Medicine

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General Health and Medicine

SEVERE BLEEDING IS RARE IN CHILDREN WITH ITP

Severe bleeding is uncommon at diagnosis in children with ITP, and is rare in the next 4 weeks, regardless of the type of treatment received, according to a review of 863 patients in the Intercontinental Childhood ITP Study Group. The authors suggest examination of other outcomes in future therapeutic trials, such as adverse effects of drug treatment, health-related quality of life, and treatment cost. An accompanying editorial suggests that although most clinicians use a platelet count of less than or equal to 20,000 to institute treatment, regardless of severity of bleeding, the platelet count is not a good surrogate for treatment. He suggests clinicians treat based on clinical bleeding severity, rather than platelet counts, to avoid costly and sometimes toxic treatment for patients who have only mild to moderate bleeding.

Neunert CE, Buchanan GR, Imbach P, et. al. Severe hemorrhage in children with newly diagnosed immune thrombocytopenic purpura. Blood. November 15, 2008, 112(10): 4003-4008.

Abshire T. Childhood ITP: can we venture below 20,000? Blood. November 15, 2008, 112(10): 3918-3919.

PLATELETS IS EXCELLENT RESOURCE

Platelets (Academic Press, 2002, 1000 pages) is “an attractive and essentially comprehensive compendium that is one of the first to appear on this important subject in more than a decade,” according to a 2003 review of the book. The award-winning book contains 61 chapters by 108 experts, and contains descriptions on platelet disorders, including ITP.

Nichols WL. Platelets. Journal of Thrombosis and Haemostasis,1:1860-1861.

STEROIDS INEFFECTIVE FOR WHEEZING PRESCHOOLERS

A short course of oral prednisolone is widely used for preschool children taken to the hospital with wheezing. But a randomized, double-blind trial comparing a 5-day course of oral prednisolone to placebo in 700 children (ages 10 months to 5 years) in 3 U.K. hospitals showed no difference in duration of hospital stay—or in any secondary outcomes—between the two groups.

Panickar J, Lakhanpaul M, Lambert PC, Kenia P, Stephenson T, Smyth A, Grigg J. Oral prednisolone for preschool children with acute virus-induced wheezing. The New England Journal of Medicine. 360(4):329-338.

NEW FINDINGS EXPLAIN HOW IVIG SUPPRESSES IMMUNE SYSTEM

One mechanism for the immunosuppressive activity of IgG, including IVIG, may be through the activity of regulatory T cells. The authors found that regulatory T-cell epitopes (Tregitopes) on IgG activate a subset of natural T regs that tip the resulting immune response toward tolerance rather than immunogenicity (property that enables a substance to provoke an immune response). An editorial in the same journal notes that these findings, that Tregitopes on IgG activate and expand Tregs, helps explain how IVIg promotes tolerance in autoimmune and inflammatory diseases.

DeGroot AS, Moise L, McMurry JA, et. al. Activation of natural regulatory T cells by IgG Fc-derived peptide “Tregitopes.” Blood. October 15, 2008, 112(8):3303-3311. Caspi RR. Tregitopes switch on Tregs. Blood. October 15, 2008, 112(8): 3003-3004.

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Hospitals, Insurance, and Medical Care

UNFAVORABLE DRUG TRIALS OFTEN GO UNPUBLISHED

Information on new drugs is often incomplete and biased, according to a study by UC San Francisco researchers, who found that nearly a quarter of drug trials submitted to the FDA are never published in a medical journal. They reviewed reports of 164 trials of 33 new drugs approved by the FDA from 2001 to 2002. By June 2007, 22 percent of the trials were published only in partial form or were not published at all. The unpublished trials were mainly those with unfavorable results.

Ehrenberg R. Many drug trials never published. Science News. December 20, 2008, pg. 14.

WEB SITE DISCLOSES INDUSTRY TIES TO PHYSICIANS

On its Web site, Cleveland Clinic has begun disclosing industry ties of its physicians and researchers and their immediate families. Duke Clinical Research Institute has made a similar move, and others have made promises to do the same. The online disclosures are a response to concerns about financial conflicts of interest. A NEJM Perspective suggests that the disclosures could go further.

Steinbrook R. Online disclosure of physician-industry relationships. The New England Journal of Medicine. January 22, 2009; 360(4): 325-327.

ANTIBIOTIC-RESISTANT BUGS ARE MAJOR CHALLENGE OF 21ST CENTURY

Several bacteria have adapted and evolved resistance to existing antibiotics so that they pose serious clinical challenges to humans. In a Perspective article, researchers from University of Texas Medical School in Houston describe the challenges in treating infections from methicillin-resistant Staphylococcus aureus (MRSA), Enterococcus faecium and nosocomial gram-negative bacteria. Their emergence outside of hospitals and weak pipeline of new antibiotics is worrisome.

Arias CA, Murray BE. Antibiotic-resistant bugs in the 21st century – a clinical super-challenge. The New England Journal of Medicine. January 29, 2009; 360(5): 439-443.

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General Health and Medicine

PROTECT YOUR HEALTH IN TIMES OF FINANCIAL STRESS

Noting recent survey results that 80% of respondents say the economy is a significant cause of stress, Dr. Andrew Weil’s newsletter offers 4 steps to protect against anxiety and stress. Practice daily relaxation, make a plan to manage your budget, care for your body (eat well, exercise and get enough sleep), and try a “news fast”. In particular, don’t watch the news right before bed.

Health & The Economy. Dr. Andrew Weil’s Self Healing. January 2009. Pg. 1.

4 in 10 AMERICANS USE COMPLEMENTARY AND ALTERNATIVE MEDICINE

Close to 40% of U.S. adults and 12% of children use some form of Complementary and Alternative Medicine (CAM) therapy, according to a survey of 23,000 adults by NIH’s National Center for Complementary and Alternative Medicine. CAM includes therapies not considered part of conventional medicine, such as natural therapies, acupuncture, deep breathing, relaxation, and energy healing therapy. The most commonly used CAM methods were natural therapies, mainly fish oil/omega 3, glucosamine, Echinacea, and flaxseed. Adults were most likely to use CAM methods for back, neck, or joint pain.

http://nccam.nih.gov/news/camstats/2007/camsurvey_fs1.htm

WARNING TO COOKS: COMMON BAKING INGREDIENT MAY CONTAIN TOXIC BLOOD THINNER

Pure vanilla is made with the extract of beans from the vanilla plant. Mexican vanilla is often made with the extract of beans from the tonka tree, which can contain coumarin, a compound related to warfarin, a blood thinner. Eating food with coumarin is risky for people taking blood-thinning drugs. Although the FDA has long banned coumarin from food products, the agency has found Mexican vanilla in ethnic food stores and Mexican restaurants in the U.S. The FDA says beware of lower-priced vanilla extracts, avoid buying vanilla in Latin American countries, and look for vanilla bean on the ingredients list. Avoid products including ‘tonka bean or with vague ingredient lists, and those not written in English.

www.fda.gov/consumer/updates/mexicanvilla102908.html

BRAIN SCANS SHOW FIBROMYALGIA IS REAL

Fibromyalgia sufferers, who are often told the ailment is a figment of their imagination, got a boost from French researchers who evaluated 20 women with fibromyalgia and 10 healthy women. In brain scans using SPECT imaging, fibromyalgia patients had functional abnormalities, and the brain changes correlated with severity of the disease. 10 million Americans are thought to have fibromyalgia, a complex chronic condition affecting mostly women that includes fatigue, problems with cognitive functioning, memory and concentration, difficulty sleeping, and stiffness.

Guedj E, Cammilleri S, Niboyet J, Dupont P, Vidal E, Dropinski J-P, Mundler O. Clinical Correlate of Brain SPECT Perfusion Abnormalities in Fibromyalgia. Journal of Nuclear Medicine. October 16, 2008, 49(11):1798-1803.

ENHANCED MUSHROOMS PACKED WITH VITAMIN D

By exposing ordinary mushrooms to ultraviolet-B light while they grow, the USDA Agricultural Research Service found it can boost the mushrooms’ vitamin D content so that a 3-ounce serving provides 100% of the recommended amount of the hard-to-get vitamin. The enhanced mushrooms, grown by Monterey Mushrooms Inc., will be marketed under the label “Sun Bella.”

http://www.ars.usda.gov/IS/pr/2008/081112.htm?pf=1

http://www.montereymushrooms.com/VitaD.htm

EXERCISE REVERSES MENTAL DECLINE AND REDUCES FALLS

Evidence for the benefit of exercise continues to grow, as noted in the new Physical Activity Guidelines for Americans, released by the Department of Health and Human Services. Two and a half hours of moderate exercise each week is the goal, or 75 minutes of vigorous activity. A new study in people age 70+ found that twice-weekly walks plus strength training and balance exercises can boost performance on cognitive tests and reduces falls by 36%. The new guidelines are available: www.health/gov/paguidelines

Fitness for your brain: exercise reverses mental decline. Tufts University Health & Nutrition Letter. January 2009, pg. 1-2,8.

RESEARCHERS FIND LINK BETWEEN MELATONIN AND DIABETES

Diabetes rates rise as sleep declines. But how? New studies indicate that the link is a protein that senses the sleep-inducing hormone melatonin. Melatonin, which regulates the body’s sleep clock, is closely linked to increased blood sugar levels and diabetes. People with a single change in a gene that encodes the receptor for melatonin were more likely to have high blood sugar levels, low insulin levels, and type 2 diabetes. It turns out that melatonin receptors, which are known to exist in the brain—home to the body’s master clock—are also found on the cells in the pancreas that produce insulin.

Sanders L. Gene connects lack of shut-eye with diabetes. Science News. January 3, 2009, pg. 5.

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This e-newsletter is published by the Platelet Disorder Support Association, 133 Rollins Avenue, Suite 5, Rockville, MD 20852, phone 1-87-Platelet, fax: 301-770-6638, web: http://www.pdsa.org, e-mail: pdsa@pdsa.org

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